HB 1869 establishes provisions for recognizing alternate board certifications for physicians within Texas. It mandates that health care facilities licensed by the state cannot refuse to accept alternate board certifications when making employment, practice, or admitting privilege decisions for physicians. It also requires the Texas Medical Board to adopt rules for issuing alternate board certifications that meet state-specific criteria, excluding requirements related to treatments or procedures deemed unlawful in Texas. Health care facilities violating these provisions face license revocation. The Health and Human Services Commission and the Texas Medical Board are directed to implement necessary rules by the act's effective date, September 1, 2025.