HBA-NMO, MPM H.B. 3216 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 3216 By: McCall Public Health 9/20/1999 Enrolled BACKGROUND AND PURPOSE As a result of certain health care reforms and recent changes in the health care delivery and reimbursement system, the health care industry has put increased emphasis on the credentialing of physicians. Prior to the 76th Legislature, state law required a physician to complete a credentialing application for each health care facility with which the physician sought to hold or renew an affiliation. This process applied not only to hospitals, but to nursing homes, long-term care facilities, large clinics, and managed care facilities. H.B. 3216 requires the Texas State Board of Medical Examiners to develop standardized forms for collecting, verifying, maintaining, and storing core credentials data and for releasing the data to health care entities or to the designated credentials verification organization. Furthermore, the bill allows appropriate entities, such as hospitals and managed care facilities, to access this information with the physician's permission to verify the core credentials the entity requires. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas State Board of Medical Examiners in SECTION 2 (Sections 7.05 and 7.07, Article 4495b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Sets forth the legislative findings and purpose of the mandatory credentials collection program established under Subchapter G, Article 4459b, V.T.C.S., as added by this Act. SECTION 2. Amends Article 4495b, V.T.C.S. (Medical Practice Act), by adding Subchapter G, as follows: SUBCHAPTER G. PHYSICIAN CREDENTIALING Sec. 7.01. DEFINITIONS. Defines "core credentials data," "credentials verification organization," "health care entity," and "physician." Sec. 7.01A. ASSOCIATIONS. Provides that each provision of this article that applies to a health care entity also applies to an association that represents federally qualified health centers. Defines "federally qualified health center." Sec. 7.02. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM. (a) Requires the Texas State Board of Medical Examiners (board) to develop standardized forms and guidelines for and administer the collection, verification, correction, updating, modification, maintenance, and storage of information relating to physician credentials, and the release of that information to health care entities or designated credentials verification organizations authorized by the physician to receive that information. (b) Provides that a physician whose core credentials data is submitted to the board, except as provided by Subsection (c), is not required to resubmit the data when applying for practice privileges with a health care entity. (c) Requires a physician to provide to the board any correction, update, or modification of the physician's core credentials data not later than the 30th day after the date the data on file is no longer accurate, and resubmit the physician's core credentials data annually if the physician did not submit a correction, update, or modification during the preceding year. (d) Provides that a health care entity that employs, contracts with, or credentials physicians must use the board to obtain core credentials data for items the board is designated or accepted as a primary source by a national accreditation organization. Authorizes a health care entity to act through its designated credentials verification organization. (e) Provides that this section does not restrict the authority of the health care entity to approve or deny an original or renewal application for hospital staff membership, clinical privileges, or managed care network participation. Sec. 7.03. FURNISHING OF DATA TO HEALTH CARE ENTITY. Requires the board, not later than the 15th business day after the date the board receives a request for the data, to make available to a health care entity or its designated credentials verification organization all core credentials data it collects on a physician, including any correction, update, or modification of that data, if authorized by the physician. Sec. 7.04. REVIEW OF DATA BY PHYSICIAN. (a) Requires the board, before releasing a physician's core credentials data from its data bank for the first time, to provide to the affected physician 15 business days to review the data and request reconsideration or resolution of errors in or omissions from the data. Requires the board to include with the data any change or clarification made by the physician. (b) Requires the board to notify a physician of any change to the physician's core credentials data when a change is made or initiated by a person other than the physician. (c) Authorizes a physician to request to review the physician's core credentials data collected at any time after the initial release of information, but does not require the board by virtue of a request to hold, release, or modify any information. Sec. 7.05. DATA DUPLICATION PROHIBITED. (a) Prohibits a health care entity from collecting or attempting to collect duplicate core credential data from a physician if the information is already on file with the board. Provides that this section does not restrict the right of a health care entity to request additional information not included in the core credentials data on file with the board that is necessary for the entity to credential the physician. Authorizes a health care entity or its designated credentials verification organization to collect any additional information required by the health care entity's credentialing process from a primary source of that information. (b) Prohibits a state agency from collecting or attempting to collect duplicate core credentials data from a physician if the information is already on file with the board. Provides that this section does not restrict the right of a state agency to request additional information not included in the core credentials data on file with the board that the agency considers necessary for its specific credentialing purposes. (c) Authorizes the board, by rule, to provide exceptions to Subsections (a) and (b) if the request for a type or class of information is necessary in order for a health care entity to provide temporary privileges during the credentialing process. Sec. 7.05. IMMUNITY. Provides that a health care entity or its designated credentials verification organization is immune from liability arising from its reliance on data furnished by the board under this subchapter. Sec. 7.07. RULES. Requires the board to adopt rules necessary to develop and implement the standardized credentials verification program established by this subchapter. Sec. 7.08. CONFIDENTIALITY. Provides that the information collected, maintained, or stored by the board under this subchapter is privileged and confidential and not subject to discovery, subpoena, or other means of legal compulsion for its release or disclosure, except as provided by this subchapter. Sec. 7.09. USE OF INDEPENDENT CONTRACTOR. Authorizes the board to contract with an independent contractor to collect, verify, maintain, store, or release information. Provides that the contract must provide for board oversight and for the confidentiality of the information. Provides that an independent entity that is not a governmental unit is not immune from liability, if the board contracts with such an entity to carry out the provisions of this subchapter. Sec. 7.10. FEES. Requires the board to charge and collect fees in amounts necessary to cover the cost of operating and administering its duties and functions under this subchapter. Authorizes the board to waive a fee for a state agency that is required to obtain core credentials data from the board and that is prohibited by Section 7.05 from collecting duplicate data. Sec. 7.11. GIFTS, GRANTS, AND DONATIONS. Authorizes the board, in addition to any fees paid or funds appropriated to it, to receive and accept a gift, grant, donation, or other thing of value from any source, including the United States government or a private source. SECTION 3. Requires the board to implement this Act only if the legislature appropriates money specifically for that purpose. Authorizes the board to implement this Act using other appropriations, gifts, grants, or donations available for that purpose, if the legislature does not appropriate money specifically for that purpose. SECTION 4. Requires the board, except as provided by SECTION 3 and not later than September 1, 2001, to make available the credentials reports required by this Act. Provides that a health care entity is not required to use the board's core credentials data until September 1, 2001, and not until that data is available from the board for items for which the board is designated or accepted as a primary source by a national accreditation organization. SECTION 5. Effective date: September 1, 1999. SECTION 6. Emergency clause.