1-1 By: Berlanga, Maxey (Senate Sponsor - Madla) H.B. No. 2846
1-2 (In the Senate - Received from the House May 7, 1997;
1-3 May 8, 1997, read first time and referred to Committee on Health
1-4 and Human Services; May 17, 1997, reported favorably, as amended,
1-5 by the following vote: Yeas 9, Nays 0; May 17, 1997, sent to
1-6 printer.)
1-7 COMMITTEE AMENDMENT NO. 1 By: Madla
1-8 Amend H.B. 2846 as follows:
1-9 In Section 4, Subsection (j) (Engrossed version, Page 3, Line
1-10 5), between "assistant" and "because", insert "solely".
1-11 COMMITTEE AMENDMENT NO. 2 By: Madla
1-12 Amend HB 2846 by adding a new SECTION 4 to read as follows and
1-13 renumbering subsequent sections accordingly:
1-14 SECTION 4. Article 4525d, Revised Statutes, is amended by amending
1-15 Subsections (c) and (d) and by adding Subsection (e) to read as
1-16 follows:
1-17 (c) If a collaborating physician or other person who
1-18 regularly employs, hires, or otherwise contracts for the services
1-19 of at least 10 advanced practice nurses or other registered nurses
1-20 requests one of those nurses to engage in conduct that the nurse
1-21 believes violates a registered nurse's duty to a patient, the nurse
1-22 may request a finding by a nursing peer review committee under
1-23 Article 4525b, Revised Statutes, of whether the conduct violates a
1-24 registered nurse's duty to a patient. A nurse who in good faith
1-25 requests, on a form produced by the board, a peer review
1-26 determination under this subsection may engage in the requested
1-27 conduct pending the peer review, is not subject to the reporting
1-28 requirement under Article 4525a, Revised Statutes, and may not be
1-29 disciplined by the board for engaging in that conduct while the
1-30 peer review is pending. The findings of the peer review committee
1-31 shall be considered in a decision to discipline the nurse, but
1-32 those findings are not binding if a registered nurse administrator
1-33 believes in good faith that the peer review committee has
1-34 incorrectly determined a registered nurse's duty. A nurse who in
1-35 good faith requests a peer review under this subsection may not be
1-36 disciplined or discriminated against for making the request. If
1-37 the conduct for which the peer review is requested under this
1-38 subsection involves the medical reasonableness of a physician's
1-39 order, the medical staff or medical director shall be requested to
1-40 make a determination as to the medical reasonableness of the
1-41 physician's order, which shall be determinative of that issue. A
1-42 registered nurse's rights under this article may not be nullified
1-43 by a contract.
1-44 (d) An appropriate licensing agency may take action against
1-45 a person who violates this article.
1-46 (e) [(d)] In this article:[,]
1-47 (1) "Collaborating physician" means a physician who
1-48 has delegated prescriptive authority to an advanced practice nurse
1-49 pursuant to 3.06(d)(5) or (6), Medical Practice Act (Article 4495b,
1-50 Vernon's Texas Civil Statutes).
1-51 (2) "Duty to a patient" means conduct, including
1-52 administrative decisions directly affecting a registered nurse's
1-53 ability to comply with that duty, required by standards of practice
1-54 or professional conduct adopted by the board.
1-55 (3) "Person" ["person"] includes an individual,
1-56 organization, agency, facility, or other entity.
1-57 COMMITTEE AMENDMENT NO. 3 By: Carona
1-58 Amend HB 2846 page 2 line 48
1-59 Sec. 3.06(b) by adding after students, provided that consent to
1-60 treatment complies with the provisions of Chapter 32, Family Code,
1-61 Vernon's Texas Codes Anotated
1-62 A BILL TO BE ENTITLED
1-63 AN ACT
1-64 relating to the provision of health care services by advanced
2-1 practice nurses and physician assistants in collaborative practice
2-2 with physicians.
2-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
2-4 SECTION 1. Section 3.06(d)(5)(D), Medical Practice Act
2-5 (Article 4495b, Vernon's Texas Civil Statutes), is amended to read
2-6 as follows:
2-7 (D) Physician supervision shall be adequate if a
2-8 delegating physician:
2-9 (i) is responsible for the formulation or
2-10 approval of such physician's orders, standing medical orders,
2-11 standing delegation orders, or other orders or protocols and
2-12 periodically reviews such orders and the services provided patients
2-13 under such orders;
2-14 (ii) is on site to provide medical
2-15 direction and consultation at least once every 10 business days
2-16 during which the advanced practice nurse or physician assistant is
2-17 on site providing care [a week to provide medical direction and
2-18 consultation];
2-19 (iii) receives a daily status report from
2-20 the advanced practice nurse [registered nurse] or physician
2-21 assistant on any problems or complications encountered; and
2-22 (iv) is available through direct
2-23 telecommunication for consultation, assistance with medical
2-24 emergencies, or patient referral.
2-25 SECTION 2. Section 3.06(d)(5)(E), Medical Practice Act
2-26 (Article 4495b, Vernon's Texas Civil Statutes), is amended by
2-27 adding Subparagraph (vii) to read as follows:
2-28 (vii) "Advanced practice nurse" has the
2-29 meaning assigned to that term by Section 8, Article 4514, Revised
2-30 Statutes.
2-31 SECTION 3. Section 3.06(d)(6)(G)(iii), Medical Practice Act
2-32 (Article 4495b, Vernon's Texas Civil Statutes), is amended to read
2-33 as follows:
2-34 (iii) "Primary practice site" means:
2-35 (a) the practice location
2-36 where the physician spends the majority of the physician's time;
2-37 (b) a licensed hospital, a
2-38 licensed long-term care facility, and a licensed adult care center
2-39 where both the physician and the physician assistant or advanced
2-40 nurse practitioner are authorized to practice, a clinic operated by
2-41 or for the benefit of a public school district for the purpose of
2-42 providing care to the students of that district and the siblings of
2-43 those students, or an established patient's residence; or
2-44 (c) where the physician is
2-45 physically present with the physician assistant or advanced nurse
2-46 practitioner.
2-47 SECTION 4. Section 14, Texas Health Maintenance Organization
2-48 Act (Article 20A.14, Vernon's Texas Insurance Code), is amended by
2-49 adding Subsections (i) and (j) to read as follows:
2-50 (i) If an advanced practice nurse or physician assistant is
2-51 authorized to provide care under Section 3.06(d)(5) or (6), Medical
2-52 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), by a
2-53 physician participating in a health maintenance organization's
2-54 provider network, the health maintenance organization may not
2-55 refuse a request made by the physician and physician assistant or
2-56 advanced practice nurse to have the physician assistant or advanced
2-57 practice nurse identified as a provider in the provider network
2-58 unless the physician assistant or advanced practice nurse fails to
2-59 meet the quality of care standards previously established by the
2-60 health maintenance organization for participation in the network by
2-61 advanced practice nurses and physician assistants.
2-62 (j) A health maintenance organization may not refuse to
2-63 contract with an advanced practice nurse or physician assistant to
2-64 be included in the organization's provider network, refuse to
2-65 reimburse the advanced practice nurse or physician assistant for
2-66 covered services, or otherwise discriminate against the advanced
2-67 practice nurse or physician assistant because the advanced practice
2-68 nurse or physician assistant is not identified under Section 3,
2-69 Article 21.52, Insurance Code.
3-1 SECTION 5. Subchapter G, Chapter 3, Insurance Code, is
3-2 amended by adding Article 3.70-3C to read as follows:
3-3 Art. 3.70-3C. USE OF ADVANCED PRACTICE NURSES AND PHYSICIAN
3-4 ASSISTANTS BY PREFERRED PROVIDER PLANS
3-5 Sec. 1. In this article:
3-6 (1) "Preferred provider" means a physician, advanced
3-7 practice nurse, physician assistant, or other health care provider,
3-8 or an organization of physicians or health care providers, who
3-9 contracts with an insurer to provide medical care or health care to
3-10 insureds covered by a health insurance policy, certificate, or
3-11 contract.
3-12 (2) "Preferred provider benefit plan" means a benefit
3-13 plan through which an insurer provides, through its health
3-14 insurance policy, for the payment of a level of coverage that is
3-15 different from the basic level of coverage provided by the health
3-16 insurance policy if the insured uses a preferred provider.
3-17 Sec. 2. If an advanced practice nurse or physician assistant
3-18 is authorized to provide care under Section 3.06(d)(5) or (6),
3-19 Medical Practice Act (Article 4495b, Vernon's Texas Civil
3-20 Statutes), by a physician participating as a preferred provider
3-21 under a preferred provider benefit plan, that plan may not refuse a
3-22 request made by the physician and physician assistant or advanced
3-23 practice nurse to have the physician assistant or advanced practice
3-24 nurse included as a preferred provider by the plan unless the
3-25 physician assistant or advanced practice nurse fails to meet the
3-26 quality of care standards previously established by the preferred
3-27 provider benefit plan for participation in the plan by advanced
3-28 practice nurses and physician assistants.
3-29 Sec. 3. A preferred provider benefit plan may not refuse to
3-30 contract with an advanced practice nurse or physician assistant to
3-31 be included in the plan's provider network, refuse to reimburse the
3-32 advanced practice nurse or physician assistant for covered
3-33 services, or otherwise discriminate against the advanced practice
3-34 nurse or physician assistant because the advanced practice nurse or
3-35 physician assistant is not identified under Section 3, Article
3-36 21.52, Insurance Code.
3-37 SECTION 6. Section 2(B), Chapter 397, Acts of the 54th
3-38 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
3-39 Insurance Code), is amended to read as follows:
3-40 (B) No policy of accident and sickness insurance shall make
3-41 benefits contingent upon treatment or examination by a particular
3-42 practitioner or by particular practitioners of the healing arts
3-43 hereinafter designated unless such policy contains a provision
3-44 designating the practitioner or practitioners who will be
3-45 recognized by the insurer and those who will not be recognized by
3-46 the insurer. Such provision may be located in the "Exceptions" or
3-47 "Exceptions and Reductions" provisions, or elsewhere in the policy,
3-48 or by endorsement attached to the policy, at the insurer's option.
3-49 In designating the practitioners who will and will not be
3-50 recognized, such provision shall use the following terms: Doctor
3-51 of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
3-52 Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
3-53 Audiologist, Licensed Speech-language Pathologist, Doctor in
3-54 Psychology, Licensed Master Social Worker--Advanced Clinical
3-55 Practitioner, Licensed Dietitian, Licensed Professional Counselor,
3-56 Licensed Marriage and Family Therapist, Licensed Chemical
3-57 Dependency Counselor, Licensed Hearing Aid Fitter and Dispenser,
3-58 Advanced Practice Nurse, Physician Assistant, and Licensed
3-59 Psychological Associate.
3-60 For purposes of this Act, such designations shall have the
3-61 following meanings:
3-62 Doctor of Medicine: One licensed by the Texas State Board of
3-63 Medical Examiners on the basis of the degree "Doctor of Medicine";
3-64 Doctor of Osteopathy: One licensed by the Texas State Board
3-65 of Medical Examiners on the basis of the degree of "Doctor of
3-66 Osteopathy";
3-67 Doctor of Dentistry: One licensed by the State Board of
3-68 Dental Examiners;
3-69 Doctor of Chiropractic: One licensed by the Texas Board of
4-1 Chiropractic Examiners;
4-2 Doctor of Optometry: One licensed by the Texas Optometry
4-3 Board;
4-4 Doctor of Podiatry: One licensed by the Texas State Board of
4-5 Podiatric Medical Examiners;
4-6 Licensed Audiologist: One with a master's or doctorate
4-7 degree in audiology from an accredited college or university and
4-8 who is licensed as an audiologist by the State Board [Committee] of
4-9 Examiners for Speech-Language Pathology and Audiology;
4-10 Licensed Speech-language Pathologist: One with a master's or
4-11 doctorate degree in speech pathology or speech-language pathology
4-12 from an accredited college or university and who is licensed as a
4-13 speech-language pathologist by the State Board [Committee] of
4-14 Examiners for Speech-Language Pathology and Audiology;
4-15 Doctor in Psychology: One licensed by the Texas State Board
4-16 of Examiners of Psychologists and certified as a Health Service
4-17 Provider;
4-18 Licensed Master Social Worker--Advanced Clinical
4-19 Practitioner: One licensed by the Texas State Board of Social
4-20 Worker Examiners as a Licensed Master Social Worker with the order
4-21 of recognition of Advanced Clinical Practitioner;
4-22 Licensed Dietitian: One licensed by the Texas State Board of
4-23 Examiners of Dietitians;
4-24 Licensed Professional Counselor: One licensed by the Texas
4-25 State Board of Examiners of Professional Counselors;
4-26 Licensed Marriage and Family Therapist: One licensed by the
4-27 Texas State Board of Examiners of Marriage and Family Therapists;
4-28 Licensed Chemical Dependency Counselor: One licensed by the
4-29 Texas Commission on Alcohol and Drug Abuse;
4-30 Licensed Hearing Aid Fitter and Dispenser: One licensed by
4-31 the Texas Committee [Board] of Examiners in the Fitting and
4-32 Dispensing of Hearing Instruments [Aids];
4-33 Advanced Practice Nurse: One licensed by the Board of Nurse
4-34 Examiners as a registered nurse and recognized by that board as an
4-35 advanced practice nurse;
4-36 Physician Assistant: One licensed by the Texas State Board
4-37 of Physician Assistant Examiners; and
4-38 Licensed Psychological Associate: One licensed by the Texas
4-39 State Board of Examiners of Psychologists and practicing under the
4-40 supervision of a licensed psychologist.
4-41 SECTION 7. Sections 4-6 of this Act apply only to an
4-42 insurance policy or evidence of coverage that is delivered, issued
4-43 for delivery, or renewed on or after January 1, 1998. A policy or
4-44 evidence of coverage that is delivered, issued for delivery, or
4-45 renewed before January 1, 1998, is governed by the law as it
4-46 existed immediately before the effective date of this Act, and that
4-47 law is continued in effect for this purpose.
4-48 SECTION 8. This Act takes effect September 1, 1997.
4-49 SECTION 9. The importance of this legislation and the
4-50 crowded condition of the calendars in both houses create an
4-51 emergency and an imperative public necessity that the
4-52 constitutional rule requiring bills to be read on three several
4-53 days in each house be suspended, and this rule is hereby suspended.
4-54 * * * * *