HBA-MPM H.B. 3216 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 3216 By: McCall Public Health 4/6/1999 Introduced BACKGROUND AND PURPOSE Currently, physicians in this state are required to complete a credentialing application for each health care facility with which they seek to hold or renew an affiliation. This process applies not only to hospitals, but to nursing homes, long-term care facilities, large clinics, and managed care facilities. The credentialing effort has increased significantly as a result of health care reform and recent changes in the health care delivery and reimbursement system. Standards established by the Health Care Quality Improvement Act of 1986 and the National Committee for Quality Assurance have required an increased focus on credentialing of health care practitioners. The resulting duplication of physician credentialing activities may be unnecessary. Currently, much of the information regarding physicians is collected, verified, and stored at the Texas State Board of Medical Examiners as part of the initial licensure process. H.B. 3216 creates the Credentials Verification Council, which is charged with developing and administering a standardized credentials verification program, which provides that once a physician's relevant data is collected, validated, maintained, and stored, this information need not be duplicated. 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 Credentials Verification Council (council) in SECTION 1 (Section 7.07, Article 4495b, V.T.C.S.) and to the Texas State Board of Medical Examiners in SECTION 1 (Section 7.11, Article 4495b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Article 4495b, V.T.C.S. (Medical Practice Act), to add Subchapter G, as follows: SUBCHAPTER G. Sec. 7.01. FINDINGS AND PURPOSE. Sets forth the findings and purpose of the mandatory credentials collection program established under this subchapter. Sec. 7.02. CREDENTIALS VERIFICATION COUNCIL. (a) Creates the Credentials Verification Council (council) to develop standardized forms and guidelines and to administer the collecting, verifying, maintaining and storing of information relating to physician credentials and for releasing that information to health care entities authorized by the physician to receive such information. (b) Requires the council to consist of 10 members. Requires the executive director of the Texas State Board of Medical Examiners, or the executive director's designee, to serve as a board member and council chair. Requires the chair of the council to appoint the remaining members. Requires appointments to be for four-year staggered terms, with one four-year reappointment, as applicable, except for any initial lesser term required to achieve staggering. Sets forth the council composition and representation of the council members. Sec. 7.03. ADMINISTRATION. Provides that the council is administratively attached to the (board). Requires the board to provide administrative and operational duties and functions for the council. Employees of the board are required to serve as staff for the council. Sec. 7.04. DEFINITIONS. Defines, for the purpose of this subchapter, the following terms: "council," "core credentials data.," "credentialing," "credentialing verification organization," "board," "drug enforcement administration certification," "health care entity," "physician," "hospital affiliations," "licensure core credentials data," "national accrediting organization," "primary source verification," "professional training," "recredentialing," "secondary source verification," and "specialty board certification." Sec. 7.05. STANDARDIZED CREDENTIALS VERIFICATION PROGRAM. (a) Requires the council, in accordance with this section, to develop standardized forms and guidelines for collecting, verifying, maintaining, and storing core credentials data and for releasing it to health entities or its designated credentials verification organization authorized by the physician to receive the data. Provides that once the core credentials are submitted to the council, the physician is not required to resubmit this initial data when applying for practice privileges with a health care entity. Provides that each physician is responsible for providing to the council within 60 days any corrections, updates, and modifications to the physician's core credentials data, to ensure that all data remains current. Provides that if no data has been reported, a physician must update the physician's data on an annual basis on a council-prescribed form. (b) Requires the council, in consultation with the board, to develop standard forms for certain purposes. (c) Provides that any health care entity employing, contracting with, or allowing physicians to treat its patients must use the council to obtain core credentials data on a physician applying for privileges with that entity. Authorizes the health care entity to act through its designated credentials verification organization. (d) Provides that nothing in this section is authorized to be construed to restrict access to the National Practitioner Data Bank by the board, council, or any health care entity. (e) Provides that nothing in this section is authorized to be construed to restrict the authority of the health care entity to approve or deny an application for hospital staff membership, clinical privileges, or managed care network participation. Sec. 7.06. AVAILABILITY OF DATA COLLECTED. Requires the council to make available to a health care entity or its designated credentials verification organization, all core credentials data it collects on any physician. Includes among this data corrections, updates, and modifications, if authorized by the physician. Requires the council to charge the health care entity or its designated credentials verification organization a reasonable fee to access all core credentials data maintained on physicians. Requires the fee to be set in consultation with the council. Sec. 7.07. DUPLICATION OF DATA PROHIBITED. Prohibits a health care entity from collecting or attempting to collect duplicate core credentials data from any physician, if the information is available from the council. Provides that nothing in this section is authorized to be construed to restrict the right of any health care entity to request additional information not included in the core credentials data file, which is necessary for it to credential the physician. Provides that additional information required by the health care entity's credentialing process is authorized to be collected from the primary sources of that information, either by the entity or its designated credentials verification organization. Authorizes the council, by rule, to add data elements to the core credential data set. (b) Prohibits a Texas state agency, effective July 1, 2002, from collecting or attempting to collect duplicate core credentials data from any individual physician if the information is already available from the council. Provides that nothing in this section is authorized to be construed to restrict the right of any state agency to request additional information not included in the core credential file, but which is deemed necessary for the agency's credentialing purposes. Sec. 7.08. LIABILITY. Provides that no civil, criminal, or administrative action is authorized to be instituted, and prohibits any liability against any health care entity because of its reliance on any data obtained from the council. Sec. 7.09. REVIEW. Provides that before releasing a physician's core credentials data, the council must provide the practitioner up to 30 days to review the data and request reconsideration or resolution of errors in or omissions of data collected during the credentials verification process. Sec. 7.10. VERIFICATION OF CREDENTIALS DATA. Provides that the primary and secondary source verification procedures used by the council are required to meet national standards outlined by national accrediting organizations. Provides that the council must be appropriately accredited by such organizations. Sec. 7.11. RULES. Requires the board, in consultation with the council, to adopt rules necessary to develop and implement the standardized credentials verification program established by this subsection. Sec. 7.12. CONFIDENTIALITY. Provides that the information received, collected or stored by the council is proprietary information and is privileged and confidential and cannot be released except as provided by this subchapter. Provides that this information is not subject to the Open Records Law in Chapter 552 (Public Information), Government Code. Sec. 7.13. APPROPRIATIONS, GRANTS AND DONATIONS. Authorizes the council to receive and accept gifts, grants, donations, and any other type of funds, or things of value from any source, including the United States Government and any private source, in addition to any fees paid or fund appropriated to the council. Sec. 7.14. FEES. Requires the council, in consultation with the board, to charge and collect fees in amounts necessary to cover the cost of administering its duties and functions under this subchapter. Requires the council to pay and otherwise compensate the board for any and all expenses and services rendered on the council's behalf. SECTION 2. Requires the council to study the feasibility of adding additional health care providers to credentials verification services that it provides. Requires the study to include a cost estimate and phase in requirements that may be necessary. Requires the council to report to the speaker of the house and to the lieutenant governor no later than December 1, 2000. SECTION 3. Requires the council to appoint a task force no later than January 5, 2000, to develop procedures to expand the standardized credentials verification program to include office site visits and medical chart reviews. Provides that the task force will report to the council no later than December 1, 2000. Requires the council to report to the speaker of the house and the lieutenant governor by December 31, 2000. SECTION 4. Effective date: September 1, 1999. SECTION 5. Requires the council to make available the credentials report required by this Act starting no later than July 1, 2000. SECTION 6. Emergency clause.