HBA-JRA S.B. 1207 76(R)BILL ANALYSIS Office of House Bill AnalysisS.B. 1207 By: Cain Public Health 5/11/1999 Committee Report (Amended) BACKGROUND AND PURPOSE Currently, the Medical Practice Act of Texas is used to license physicians in this state. The Act assures that physicians seeking licensure in Texas by way of endorsement or by way of original license are reviewed, examined, and evaluated according to certain standards. The Texas State Board of Medical Examiners (board) is the state agency that oversees the appropriate regulation of physicians who practice medicine in Texas. S.B. 1207 rewrites the licensure section of the Medical Practice Act for clarification purposes, consolidates relevant subsections, and deletes obsolete wording. This bill also establishes provisions regarding the board and the licensure of physicians, while providing penalties for violations of the Act. 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 3.01, 3.02, 3.03, 3.04, and 3.05, Article 4495b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 2.09, Article 4495b, V.T.C.S. (Medical Practice Act), by amending Subsections (d), (h), (k), and (t) and adding Subsection (bb), as follows: (d) Deletes the requirement that the Texas State Board of Medical Examiners (board) maintain records showing the name, age, place, and duration of residence of each applicant, the time spent in medical study in respective medical schools, and the years and schools from which degrees were granted. Requires a certified copy of permanent records to be admitted in evidence in all courts with the hand and seal of the executive director, rather than the secretary-treasurer. Makes a nonsubstantive change. (h) Authorizes, rather than requires, the board to submit to the Department of Public Safety a complete set of fingerprints of every applicant for a license. Deletes the requirement that any applicant for licensure or any licensee whose license is subject to revocation, cancellation, or suspension because of adverse information contained in the criminal records or reports be afforded the opportunity for a hearing before the board prior to any action on the application for license or revocation, cancellation, or suspension of license. Makes a nonsubstantive change. (k) Requires the board to place all money, rather than all fees, received under the authority of this Act in the state treasury. Deletes text specifying that said fees are required, if not otherwise specified, to be placed into the medical licensing fund in the state treasury. (t) Requires the board, on the request of a licensee, to issue certification of the licensee's state board examination grades to the Federation of State Medical Boards and to charge a reasonable fee for the issuance of that certificate. (bb) Requires the executive director of the Texas State Board of Medical Examiners (executive director) to file a surety bond with the board and the board to pay the premium on the bond. Provides the bond must be in an amount no less than $10,000, in compliance with the insurance laws of this state, and payable to the state for the state's use if the executive director does not faithfully discharge the executive director's duties under this Act. SECTION 2. Amends Sections 3.01-3.05, Article 4495b, V.T.C.S. (Medical Practice Act), as follows: Sec. 3.01. New title: ANNUAL REGISTRATION OF PHYSICIANS. (a) Requires a person qualified to practice medicine in this state or who is licensed to practice medicine by the board to register annually as a practitioner with the board. Requires the initial annual registration permit (permit) to be issued with the license. (b) Requires the permit fee as set by board rule to apply to each physician licensed by the board, whether or not the physician is practicing in this state, other than a retired physician as provided by rules adopted by the board. (c) Exempts a physician whose only practice is voluntary charity care from the annual registration permit fee as provided by rules of the board. (d) Requires the board to mail a permit renewal application to each practitioner at the practitioner's last known address according to the records of the board no later than the 30th day before the expiration date of the permit. (e) Requires the board to allow a 30-day grace period from the date of the expiration of the permit for renewing the permit. (f) Authorizes a licensee to renew the permit by submitting to the board, on or before the expiration date, the required renewal application and renewal fee. Provides that each renewal application must include the name and mailing address of the licensee, the address of each place where the licensee is engaged in the practice of medicine, and other necessary information required by the board. (g) Provides that if the licensee is licensed to practice medicine by another state, the District of Columbia, a territory of the United States, another country, or the uniformed services of the United States, the renewal application must include a description of any investigations the licensee knows are in progress and of any sanctions imposed by or disciplinary matters pending in the respective area of service. (h) Requires the board to issue a permit to a licensee certifying that the licensee has filed the renewal application and has paid the annual permit fee for that year and has completed the requirements for registration on receipt of the application and appropriate fee and after ascertaining from records or from other reliable sources that the applicant is a licensed practitioner of medicine in this state. (i) Authorizes a licensee to renew a permit by submitting to the board the required renewal application, renewal fee, and a $50 penalty fee if the licensee's permit has expired for 90 days or less. (j) Authorizes the licensee to renew a permit by submitting to the board the required renewal application, renewal fee, and a $100 penalty fee if the licensee's permit has been expired for longer than 90 days but less than one year. (k) Provides that if a licensee's permit has been expired for more than one year and an investigation is not pending with regard to the licensee, that license is canceled and the annual registration permit is prohibited from being renewed. Prohibits a licensee from renewing a permit in this instance. (l) Authorizes a physician whose license is canceled to obtain a new license by submitting to reexamination and complying with the requirements, fees, and procedures for obtaining a license. Authorizes the board to issue a new license without examination to a person whose license is canceled for less than two years. (m) Authorizes the board, by rule, to adopt a system under which permits expire on various dates during the year. Requires a permit fee to be prorated for the year in which the expiration date is changed. Provides that on renewal of the registration on the new expiration date, the total fee is payable. (n) Provides that the filing of the renewal application, payment of the appropriate fee, and issuance of the permit do not entitle a registration applicant to practice medicine in this state. Provides that the applicant must also have previously been licensed as a practitioner by the board, as prescribed by law, and that the applicant's license to practice medicine must be in full force and effect. Prohibits the permit required by this Act from being treated as evidence that the permit holder is lawfully entitled to practice medicine in a prosecution for the unlawful practice of medicine. (o) Makes practicing medicine as defined in this Act without a permit for the current year subject to all penalties under this Act for practicing medicine without a license. Deletes existing subsections relating to registration and licensing requirements and procedures. Sec. 3.02. New title: PHYSICIAN IN TRAINING PERMITS. Authorizes a physician not licensed by the board who participates in a graduate training program that is board-approved to be issued a physician-in-training permit as provided by board rule. Provides that this permit does not authorize the performance of medical acts unless performed as part of a graduate medical education training program and under the supervision of a licensed practitioner of medicine. Authorizes the board to discipline a physician whose permit has expired if the violation of the law occurred during the time the permit was valid. Authorizes the board to retain jurisdiction over an investigation if it is pending on the date the permit expires. Deletes existing text relating to renewal of registration. Sec. 3.03. New title: LICENSURE OF PHYSICIANS. (a) Authorizes the board to grant a license to practice medicine to any physician qualifying under this Act. (b) Provides that an application for a license must be in writing and on board-prescribed forms. Authorizes the board to allow or require, by rule, an applicant to use the Federation of State Medical Boards' Credentials Verification System. (c) Provides that the application form must be accompanied by all fees, documents, and photographs required by board rule. (d) Provides that a license applicant must subscribe to an oath in writing before an officer authorized by law to administer oaths. Provides that the written oath is part of the application. (e) Makes an applicant ineligible for licensure under certain circumstances. (f) Requires each applicant to present proof satisfactory to the board that any medical school attended by the applicant outside this state is substantially equivalent to a medical school of this state, as determined by board rule. (g) Requires an applicant who is a graduate of a medical school located outside the United States or Canada to present proof satisfactory to the board that the applicant has certain qualifications. (h) Provides that all medical or osteopathic medical education received by the applicant in the United States must be accredited by an accrediting body officially recognized by the United States Department of Education as the accrediting body for medical education leading to the doctor of medicine degree or the doctor of osteopathy degree in the United States. Makes this subsection inapplicable to postgraduate medical education or training. (i) Provides that an applicant unable to comply with the requirements of Subsection (h) of this section may be eligible for an unrestricted license if the applicant meets certain criteria. (j) Requires the executive director to review each license application and recommend to the board each applicant eligible for licensure. Authorizes the committee to refer any application for determination of eligibility to the full board. Requires the executive director to report to the board each applicant determined to be ineligible for a license, accompanied by the reasons for the recommendation. Authorizes an applicant considered ineligible for a license by the executive director to review the recommendation by a committee of the board no later than the 20th day after receiving the notice. Authorizes the executive director to refer any application to the committee for a recommendation concerning eligibility. Requires that, if the committee finds the applicant ineligible for licensure, that recommendation, along with the reasons for the recommendation, be submitted to the full board unless the applicant requests a hearing no later than the 20th day after receiving notice of the committee's determination. Requires the hearing to be before an administrative law judge of the State Office of Administrative Hearings and to comply with Chapter 2001 (Administrative Procedures), Government Code, the rules of the State Office of Administrative Hearings, and board rules. Requires the board, after receiving the administrative law judge's proposed findings of fact and conclusions of law, to determine the applicant's eligibility. Requires the board to issue a written statement containing the reasons for the board's action to a physician whose application is denied. (k) Provides that examination questions that may be used in the future, examinations other than the one taken by the person requesting the examination, and deliberations and records relating to the professional character and fitness of applicants are confidential and not subject to disclosure under Chapters 551 and 552 (Open Meetings and Public Information, respectively), Government Code. (l) Provides that a report received or information gathered by the board on an applicant is confidential and not subject to disclosure under Chapter 552, Government Code. Authorizes the board to disclose the report to the appropriate licensing authorities in other states and requires the board to report all licensure actions to appropriate licensing authorities in other states and to the Federation of State Medical Boards. (m) Authorizes the board to require applicants to comply with other requirements it considers appropriate in addition to requirements prescribed by this section. Deletes existing text relating to application requirements. Sec. 3.04. New title: QUALIFICATIONS OF LICENSEES. Provides that to be eligible for licensure, each applicant must present proof to the board that the applicant has not violated Section 3.08 of this Act; has completed the entire primary, secondary, and premedical education required in the country of medical school graduation, if the medical school is located outside the United States or Canada or substantially equivalent courses as determined by board rule; is a graduate of a medical school located inside the United States or Canada and approved by the board who has successfully completed one year of graduate medical training approved by the board in the United States or Canada or is a graduate of a medical school outside the United States or Canada who has successfully completed three years of graduate medical training approved by the board in the United States or Canada; has successfully passed within three attempts an examination accepted or administered by the board; and has successfully passed a Texas medical jurisprudence examination as determined by board rule. Deletes existing Subsections (b)-(j) relating to qualifications. Sec. 3.05. New title: EXAMINATIONS ACCEPTED OR ADMINISTERED. (a) Authorizes the board to administer or accept a specified list of examinations for licensure as determined by rule. (b) Requires an applicant wishing to request a reasonable accommodation due to a disability to submit the request upon filing the application. (c) Requires the examination to include subjects generally taught by medical schools, a knowledge of which is commonly and generally required of candidates for the degree of doctor of medicine or doctor of osteopathy conferred by schools in Texas. (d) Requires the board to administer the Texas medical jurisprudence examination to all applicants. (e) Requires the minimum passing grade for each examination used by the board to be determined by board rule. (f) Requires examinations administered to evaluate basic medical knowledge and clinical competency to be prepared by a national testing service or prepared by the board and validated by qualified independent testing professionals. (g) Requires all questions, answers, and grades to be preserved for one year as directed by the board by rule. (h) Requires each applicant to be given notice of the date and place of the examination if it is administered by the board. (i) Requires each examinee to be notified of the results of the examination no later than the 120th day after it is administered by the board. Requires the board to notify each examinee of the results no later than the 30th day after the board receives the results, if the examination is graded or reviewed by a national testing service. (j) Provides that all parts of the National Board of Osteopathic Medical Examiners, National Board of Medical Examiners, Medical Council of Canada, and Federal Licensing examinations after June 1, 1985, and United States Medical Licensing examinations must be passed no later than the seventh anniversary of the initial attempt to pass the licensing examination. Provides that an applicant who is a graduate of a program designed to lead to a doctor of philosophy degree and either a doctor of medicine degree or doctor of osteopathy degree must pass each part of those examinations no later than the second anniversary of the date the applicant is awarded the relevant degree. (k) Provides that all parts of any examination used for licensure must be passed within three attempts. (l) Provides that an applicant is considered to have satisfied the requirements of this section if the applicant passed all but one part of an examination within three attempts and passed the remaining part of the examination within five attempts; is specialty board certified by a board that is a member of the American Board of Medical Specialties; or a specialty board approved by the American Osteopathic Association; enrolled before September 1, 1993, in a board-approved postgraduate medical training program in this state; and completed two years of board-approved postgraduate medical training in this state. (m) Provides that an applicant who is a graduate of a program designed to lead to both a doctor of philosophy degree and a doctor of medicine degree or doctor of osteopathy degree must pass each part of an examination described by Subsection (a) of this section by the second anniversary of the date the applicant was awarded a doctor of medicine degree or doctor of osteopathy degree. Deletes existing examination requirements. SECTION 3. Amends Section 3.10, Article 4495b, V.T.C.S. (Medical Practice Act), as follows: Sec. 3.10. FEES. (a) Requires all receipts collected by the board to be deposited in the state treasury and authorizes such money to be spent only as provided by the General Appropriations Act, this Act, or other applicable law for the enforcement of this Act, the prohibition of the unlawful practice of medicine, the dissemination of information to prevent the violation of laws, and the prosecution of those who violate the laws. Authorizes all distributions to be made only on written approval of the executive director of the board or the executive director's designee. (b) Prohibits the board from setting, charging, collecting, receiving, or depositing certain fees in excess of a certain limit. (c) Authorizes the board to set and collect a charge for making copies of records in the office of the board and for any material it publishes. (d) Provides that the board's financial transactions are subject to audit by the state auditor in accordance with Chapter 321 (State Auditor), Government Code. (e) Requires the board to file annually with the governor and the presiding officer of each house of the legislature a complete and detailed written report accounting for all funds received and disbursed by the board during the preceding fiscal year. Provides that the annual report must be in the form and reported in the time provided by the General Appropriations Act. Deletes existing text relating to registration fees. SECTION 4. Amends Section 3.11A, Article 4495b, V.T.C.S. (Medical Practice Act), as follows: Sec. 3.11A. New title: SURCHARGE; DISPOSITION. (a) Requires an additional $200 surcharge to apply to certain other fees for certain licenses or permits. Deletes existing text relating to fees. Makes a conforming change. SECTION 5. Repealer: Section 2.10, as added by Section 1.04, Chapter 36, Acts of the 73rd Legislature, Regular Session, 1993 (Article 4495b, V.T.C.S.) (Creation of Funds); Sections 3.0305 (Temporary License for Out-of-State Practitioners) and 3.031 (Temporary Reciprocal License for Physicians Employed by Texas Department of Mental Health and Mental Retardation), Article 4495b, V.T.C.S. SECTION 6. Emergency clause. Effective date: upon passage. EXPLANATION OF AMENDMENTS Committee Amendment #1 SECTION 2. In Section 3.04, Article 4495b, V.T.C.S. (Medical Practice Act), provides that Sections 3.05 (k), (l), and (m) provide exceptions to the provision that an applicant must present satisfactory proof to the Texas State Board of Medical Examiners (board) that the applicant has successfully passed within three attempts an examination accepted or administered by the board.