Austin, Texas
                                   FISCAL NOTE
                               75th Regular Session
                                  March 9, 1997
      TO: Honorable Judith Zaffirini, Chair            IN RE:  Senate Bill No. 617
          Committee on Health & Human Services                              By: Moncrief
          Austin, Texas
         FROM:  John Keel, Director    
In response to your request for a Fiscal Note on SB617 ( Relating 
to the licensure and regulation of nurses, including the development 
of certain pilot programs by the Board of Nurse Examiners.) 
this office has detemined the following:
         Biennial Net Impact to General Revenue Funds by SB617-As Introduced
Implementing the provisions of the bill would result in a net 
positive impact of $12,260 to General Revenue Related Funds 
through the biennium ending August 31, 1999.
The bill would make no appropriation but could provide the legal 
basis for an appropriation of funds to implement the provisions 
of the bill.
Fiscal Analysis
The bill would allow the Board of Nurse Examiners to develop 
pilot programs to evaluate the effectiveness of mechanisms for 
assuring: 1) maintenance of clinical competencies by registered 
nurses, including proactive nursing peer review and targeted 
continuing education; and 2) that registered nurses understand 
laws and rules governing the practice of nursing.  Should the 
Board develop pilot programs, the bill would require the Board 
to consult with an advisory committee of at least 16 individuals 
on the development, administration and funding of pilot programs. 
 Beginning November 1, 1998, the Board shall issue an annual 
report on pilot programs developed or approved and the programs' 
effectiveness.  Upon request, the report shall be mailed to 
statewide associations of registered nurses, registered nurse 
educators, and employers of nurses. The final report shall be 
issued by June 1, 2000.

The bill would change the composition 
of the Board of Nurse Examiners by replacing a faculty member 
from a diploma program with a faculty member from a graduate 
nursing program preparing Advanced Practice Nurses. 

bill would allow the Board to require: 1) individuals accepted 
into or enrolled in education programs preparing students for 
initial licensure as registered nurses; or 2) these educational 
programs; to collect and submit information to the Board that 
would allow the Board to determine whether students are aware 
of any conditions that would disqualify the student from licensure 
as a professional nurse upon graduation.  The Board must notify 
the educational institution of individuals whom the Board has 
determined may not be eligible for licensure upon graduation. 
 Education programs shall not enroll students so identified 
beyond the term or semester immediately following the current 
term or semester without the Board's written approval.

bill would exempt from the hearing process, individuals whose 
license was not renewed by the board and who failed to submit 
an application for renewal, or who submitted an incomplete application, 
an application showing "on its face" that the individual does 
not meet the renewal requirements, or an application not accompanied 
by the correct fee. 
It is assumed that fiscal implications would result only from 
the pilot projects.

The Board would hire a nursing consultant 
at $45,420 per year for FY 1998-2000 to facilitate and monitor 
the pilots and programs.

I.  Methodology for Competencies 
The methodology assumes that the Board or its designated 
agent will use a contractor to measure and evaluate the continued 
nursing competencies pilots. The estimated cost of $25,000 is 
spread out over three years.

The Board  would contract with 
a maximum of 10 employers of registered nurses, schools, hospitals, 
nurses in private practice or other entities in practice settings 
to participate in the program.  Grant amounts of $100 per registered 
nurse in the pilot would be given to these entities for costs 
incurred in the evaluation of RN competency.  The total estimated 
cost is $100,000.  Grants would be made in FY 1999.

would last for 12 months with 3 to 6 months of follow-up evaluation 
in FY 2000.

II.  Methodology for Legal and Regulatory Pilots:
Board would contract out for: 
A) a legal review of state and 
federal laws to be included in curriculum; 
B) the development 
of a review curriculum;
C) development and validation of a 
jurisprudence examination.
Estimated cost for review and curriculum 
development is $32,000 over three years.  Estimated costs for 
examination development and validation is $75,000 ($50,000 in 
1999 and $25,000 in 2000).

III. Advisory Committee Costs
committee costs would be limited to $500 per year for committee 
support for postage, mailing and miscellaneous expenses, for 
FY 1998-FY 2000, for a total of $1,500.

To cover costs of 
the pilot programs, the Board would increase fees by $2 for 
FY 1998 and FY 1999.  The Board would adjust fees downward by 
$1 in FY 2000, and by another $1 in 2001.  
The probable fiscal implications of implementing the provisions 
of the bill during each of the first five years following passage 
is estimated as follows:
Five Year Impact:
Fiscal Year Probable           Probable Revenue   Change in Number   
            Savings/(Cost)     Gain/(Loss) from   of State                                                
            from General       General Revenue    Employees from                                          
            Revenue Fund       Fund               FY 1997                                                 
            0001               0001                                                                        
       1998         ($93,370)          $166,000               1.0                                    
       1998         (234,370)           174,000               1.0                                    
       2000          (95,370)            98,000               1.0                                    
         Net Impact on General Revenue Related Funds:
The probable fiscal implication to General Revenue related funds 
during each of the first five years is estimated as follows:
              Fiscal Year      Probable Net Postive/(Negative)
                               General Revenue Related Funds
               1998              $72,630
               1999             (60,370)
               2000                2,630
               2001                    0
               2002                    0
No significant fiscal implication to units of local government 
is anticipated.

The bill would allow the Board of Nurse Examiners 
to require that educational programs collect and submit information 
to the Board that will permit the Board to determine whether 
enrollees or individuals accepted for enrollment are aware of 
conditions that may disqualify individuals from qualifying for 
licensure upon graduation.  This may require additional administrative 
activities for educational programs.  These activities should 
be absorbed by existing resources, and should not have significant 
fiscal impact to local units of government. 
   Source:            Agencies:   507   Board of Nurse Examiners
                      LBB Staff:   JK ,BB ,MM