Bill Text: TX SB1985 | 2019-2020 | 86th Legislature | Introduced

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Bill Title: Relating to the regulation of certain health organizations certified by the Texas Medical Board; providing an administrative penalty.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2019-03-19 - Referred to Health & Human Services [SB1985 Detail]

Download: Texas-2019-SB1985-Introduced.html

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By: Hughes S.B. No. 1985

A BILL TO BE ENTITLED
AN ACT
relating to the regulation of certain health organizations
certified by the Texas Medical Board; providing an administrative
penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 162.003, Occupations Code, is amended to
read as follows:
Sec. 162.003. REFUSAL TO CERTIFY; REVOCATION; PENALTY. On
a determination that a health organization commits a violation of
this subtitle or is established, organized, or operated in
violation of or with the intent to violate this subtitle, the board
may:
(1) refuse to certify the health organization on
application for certification by the organization under Section
162.001;
(2) revoke a certification made under Section 162.001
to that organization; or
(3) impose an administrative penalty against the
health organization under Subchapter A, Chapter 165.
SECTION 2. Subchapter A, Chapter 162, Occupations Code, is
amended by adding Sections 162.004, 162.005, and 162.006 to read as
follows:
Sec. 162.004. PROCEDURES FOR AND DISPOSITION OF COMPLAINTS
AGAINST HEALTH ORGANIZATIONS. (a) The board shall accept and
process complaints against a health organization certified under
Section 162.001(b) for alleged violations of this subchapter or any
other provision of this subtitle applicable to a health
organization in the same manner as provided under Subchapter B,
Chapter 154, and the rules adopted under that subchapter, including
the requirements to:
(1) maintain a system to promptly and efficiently act
on complaints filed with the board;
(2) notify the health organization that is the subject
of a complaint filed with the board, disclose the nature of the
complaint, and provide the health organization with an opportunity
to respond to the complaint;
(3) ensure that a complaint is not dismissed without
appropriate consideration; and
(4) establish methods by which physicians employed by
a health organization are notified of the name, mailing address,
and telephone number of the board for the purpose of directing
complaints under this section to the board.
(b) Each complaint, adverse report, investigation file,
other investigation report, and other investigative information in
the possession of or received or gathered by the board or the
board's employees or agents relating to a health organization
certified under Section 162.001(b) is privileged and confidential
and is not subject to discovery, subpoena, or other means of legal
compulsion for release to anyone other than the board or the board's
employees or agents involved in the investigation or discipline of
a health organization certified under Section 162.001(b).
(c) The board may dispose of a complaint or resolve the
investigation of a complaint under this section in a manner
provided under Subchapter A, Chapter 164, to the extent the board
determines the provisions of that subchapter can be made applicable
to a health organization certified under Section 162.001.
(d) Nothing in this Section shall be construed to either
sanction or prohibit an individual from, separately or
contemporaneously with a complaint to the board, initiating a
complaint directly to the health organization certified under
Section 162.001(b) relating to:
(1) care or services provided by, or policies of, the
health organization;
(2) alleged violations of this subchapter; or
(3) any other provision of this subtitle applicable to
a health organization.
Sec. 162.005. ANTI-RETALIATION POLICY. (a) A health
organization shall develop, implement, and comply with an
anti-retaliation policy extending to physicians that provides the
health organization may not terminate, demote, retaliate against,
discipline, discriminate against, or otherwise penalize a person,
because the person:
(1) files reasonably and in good faith a complaint
under Section 162.004;
(2) cooperates, reasonably and in good faith, in an
investigation or proceeding of the board relating to a complaint
filed under Section 162.004; or
(3) communicates to a patient in good faith regarding
what he or she reasonably believes to be the physician's best,
independent medical judgment.
(b) On a determination that a health organization has failed
to adopt, implement, or comply with a policy as described in
subsection (a), the board may exercise all remedies available
against a health organization allowed under this subchapter or
rules of the board.
Sec. 162.006. REPORTING REQUIREMENTS FOR HEALTH
ORGANIZATIONS. (a) Each health organization certified under
Section 162.001(b) shall file with the board a biennial report in
September of each odd numbered year if certified in an odd numbered
year, and in September of each even numbered year if certified in an
even numbered year, and the biennial report shall include the
following:
(1) a statement signed and verified by the president
or chief executive officer:
(A) indicating the name and mailing address of
the health organization;
(B) indicating the names and mailing addresses
of:
(1) all members or that there are no members;
(2) the chief executive officer, if any,
president, secretary and treasurer;
(3) members of the board of directors; and
(C) disclosing any changes in the composition of
the board of directors since the last biennial report.
(2) a statement signed and verified by the president
or chief executive officer attaching a copy of the current
certificate of incorporation and by-laws of the health organization
if not already on file with the board and indicating:
(A) whether or not the by-laws or articles of
incorporation of the health organization have been revised since
the last biennial report;
(B) whether or not such revisions, if any, were
recommended or approved by the board of directors; and
(C) a concise explanation of such revisions, if
any;
(3) statements signed and verified by each current
member of the board of directors indicating that such director:
(A) is licensed by the board;
(B) is actively engaged in the practice of
medicine and has no restrictions on his or her Texas medical
license;
(C) will, as a director, exercise independent
judgement in all matters and, specifically, matters relating to
credentialing, quality assurance, utilization review, peer review,
and the practice of medicine;
(D) will, as a director, exercise best efforts to
cause the health organization to comply with all relevant
provisions of this subtitle and board rules;
(E) will, as a director, immediately report to
the board any action or event which such director reasonably and in
good faith believes constitutes a violation or attempted violation
of this subtitle or board rules; and
(F) has disclosed the identity of all of such
director's financial relationships, if any, which such director has
with any member of the health organization, any other director, any
supplier of the health organization or any affiliate of any member
of the health organization, other director, or supplier of the
health organization and provided a concise explanation of the
nature of each such financial relationship within such director's
statement;
(4) a statement signed and verified by the president
or chief executive officer indicating that the health organization
is in compliance with the requirements for certification and
continued certification as required by the provisions of this
subtitle and board rules; and
(5) a fee in the amount and form specified by the board
relating to registration and renewal fees.
(b) On January 1 of each year, the board shall
electronically publish all materials described in subsection
(a)(1) for each health organization certified under Section
162.001(b). The information described in subsections (a)(2)-(4) is
public information available to members of the public under Chapter
552, Government Code.
(f) The board may adopt rules as necessary to implement this
section.
SECTION 3. Section 162.003, Occupations Code, as amended by
this Act, and Sections 162.004 and 162.005, Occupations Code, as
added by this Act, apply only to a violation by a health
organization that occurs on or after the effective date of this Act.
A violation that occurs before the effective date of this Act is
governed by the law in effect on the date the violation occurred,
and the former law is continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2019.