By Capelo H.B. No. 3223
76R6052 JMM-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of health services provided by and the
1-3 scope of practice of advanced practice nurses and physician
1-4 assistants.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section 241.003, Health and Safety Code, as
1-7 amended by Chapters 43 and 623, Acts of the 75th Legislature,
1-8 Regular Session, 1997, is amended to read as follows:
1-9 Sec. 241.003. DEFINITIONS. In this chapter:
1-10 (1) "Advanced practice nurse" means a registered nurse
1-11 recognized as an advanced practice nurse by the Board of Nurse
1-12 Examiners.
1-13 (2) "Board" means the Texas Board of Health.
1-14 (3) [(2)] "Comprehensive medical rehabilitation
1-15 hospital" means a general hospital that specializes in providing
1-16 comprehensive medical rehabilitation services, including surgery
1-17 and related ancillary services.
1-18 (4) [(2)] "Department" means the Texas Department of
1-19 Health.
1-20 (5) [(3)] "General hospital" means an establishment
1-21 that:
1-22 (A) offers services, facilities, and beds for
1-23 use for more than 24 hours for two or more unrelated individuals
1-24 requiring diagnosis, treatment, or care for illness, injury,
2-1 deformity, abnormality, or pregnancy; and
2-2 (B) regularly maintains, at a minimum, clinical
2-3 laboratory services, diagnostic X-ray services, treatment
2-4 facilities including surgery or obstetrical care or both, and other
2-5 definitive medical or surgical treatment of similar extent.
2-6 (6) [(4)] "Governmental unit" means a political
2-7 subdivision of the state, including a hospital district, county, or
2-8 municipality, and any department, division, board, or other agency
2-9 of a political subdivision.
2-10 (7) [(5)] "Hospital" includes a general hospital and a
2-11 special hospital.
2-12 (8) [(6)] "Medical staff" means a physician or group
2-13 of physicians and a podiatrist or group of podiatrists who by
2-14 action of the governing body of a hospital are privileged to work
2-15 in and use the facilities of a hospital for or in connection with
2-16 the observation, care, diagnosis, or treatment of an individual who
2-17 is, or may be, suffering from a mental or physical disease or
2-18 disorder or a physical deformity or injury.
2-19 (9) "Pediatric and adolescent hospital" means a
2-20 general hospital that specializes in providing services to children
2-21 and adolescents, including surgery and related ancillary services.
2-22 (10) "Person" means an individual, firm, partnership,
2-23 corporation, association, or joint stock company, and includes a
2-24 receiver, trustee, assignee, or other similar representative of
2-25 those entities.
2-26 (11) "Physician" means a physician licensed by the
2-27 Texas State Board of Medical Examiners.
3-1 (12) "Physician assistant" means a physician assistant
3-2 licensed by the Texas State Board of Physician Assistant Examiners.
3-3 (13) [(12)] "Podiatrist" means a podiatrist licensed
3-4 by the Texas State Board of Podiatric Medical Examiners.
3-5 (14) [(13)] "Premises" means:
3-6 (A) a single building where inpatients receive
3-7 hospital services; or
3-8 (B) multiple buildings where inpatients receive
3-9 hospital services, provided that the following criteria are met:
3-10 (i) all inpatient buildings and inpatient
3-11 services are subject to the control and direction of the governing
3-12 body of the hospital;
3-13 (ii) all inpatient buildings are within a
3-14 30-mile radius of the main address of the licensee;
3-15 (iii) there is integration of the
3-16 organized medical staff of the hospital;
3-17 (iv) there is a single chief executive
3-18 officer who reports directly to the governing body and through whom
3-19 all administrative authority flows and who exercises control and
3-20 surveillance over all administrative activities of the hospital;
3-21 (v) there is a single chief medical
3-22 officer who reports directly to the governing body and who is
3-23 responsible for all medical staff activities of the hospital; and
3-24 (vi) each building that is geographically
3-25 separate from other buildings contains at least one nursing unit
3-26 for inpatients, unless providing only diagnostic or laboratory
3-27 services, or a combination thereof, in the building for hospital
4-1 inpatients.
4-2 (15) [(14)] "Special hospital" means an establishment
4-3 that:
4-4 (A) offers services, facilities, and beds for
4-5 use for more than 24 hours for two or more unrelated individuals
4-6 who are regularly admitted, treated, and discharged and who require
4-7 services more intensive than room, board, personal services, and
4-8 general nursing care;
4-9 (B) has clinical laboratory facilities,
4-10 diagnostic X-ray facilities, treatment facilities, or other
4-11 definitive medical treatment;
4-12 (C) has a medical staff in regular attendance;
4-13 and
4-14 (D) maintains records of the clinical work
4-15 performed for each patient.
4-16 SECTION 2. Subchapter E, Chapter 241, Health and Safety
4-17 Code, is amended by adding Section 241.105 to read as follows:
4-18 Sec. 241.105. HOSPITAL PRIVILEGES FOR ADVANCED PRACTICE
4-19 NURSES AND PHYSICIAN ASSISTANTS. (a) The governing body of a
4-20 hospital may establish policies concerning the granting of
4-21 privileges to advanced practice nurses and physician assistants.
4-22 The policies may include the application process, reasonable
4-23 qualifications for privileges, and the process for the renewal,
4-24 modification, or revocation of privileges.
4-25 (b) If the governing body of a hospital has adopted a policy
4-26 of granting privileges to advanced practice nurses or physician
4-27 assistants, an advanced practice nurse or physician assistant who
5-1 qualifies for privileges under the policy is entitled to certain
5-2 procedural rights to provide fairness of process, as determined by
5-3 the governing body, when an application for privileges is submitted
5-4 to the hospital. Any policy adopted must at least specify a
5-5 reasonable time for processing and considering the application and
5-6 provide for written notification of the applicant of any final
5-7 action by the hospital on the application, including a reason for
5-8 denying or restricting the requested privileges.
5-9 (c) A hospital that has granted clinical privileges to an
5-10 advanced practice nurse or physician assistant may not modify or
5-11 revoke the privileges without providing certain procedural rights
5-12 to provide fairness of process to the advanced practice nurse or
5-13 physician assistant as determined by the hospital governing body.
5-14 The hospital must at least provide the advanced practice nurse or
5-15 physician assistant with written reasons for the modification or
5-16 revocation and a means to appeal the decision to an appropriate
5-17 entity within the hospital as determined by the governing body.
5-18 (d) If a hospital has granted clinical privileges to an
5-19 advanced practice nurse or physician assistant with the condition
5-20 that the advanced practice nurse or physician assistant must have a
5-21 sponsoring or collaborative relationship with a physician and that
5-22 relationship ceases to exist, the advanced practice nurse or
5-23 physician assistant shall provide written notification of that fact
5-24 to the hospital. On receipt of the notice, the hospital is
5-25 considered to meet its responsibilities under this section by
5-26 notifying the advanced practice nurse or physician assistant in
5-27 writing that the person's clinical privileges at the hospital are
6-1 revoked.
6-2 (e) This section may not be construed as modifying:
6-3 (1) the Medical Practice Act (Article 4495b, Vernon's
6-4 Texas Civil Statutes);
6-5 (2) the Nursing Practice Act (Article 4513 et seq.,
6-6 Revised Statutes);
6-7 (3) the Physician Assistant Licensing Act (Article
6-8 4495b-1, Vernon's Texas Civil Statutes); or
6-9 (4) any other law relating to the scope of practice of
6-10 a physician, advanced practice nurse, or physician assistant.
6-11 SECTION 3. Subchapter B, Chapter 483, Health and Safety
6-12 Code, is amended by adding Section 483.0225 to read as follows:
6-13 Sec. 483.0225. COMMUNICATION OF PRESCRIPTIONS OF ADVANCED
6-14 PRACTICE NURSE AND PHYSICIAN ASSISTANT. A designated agent under
6-15 Section 483.001(4)(A) or (B) may be designated by a practitioner to
6-16 communicate the prescriptions of an advanced practice nurse or
6-17 physician assistant under Section 3.06(d)(5) or (6), Medical
6-18 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
6-19 SECTION 4. Section 1, Article 21.52, Insurance Code, is
6-20 amended to read as follows:
6-21 Sec. 1. DEFINITIONS. As used in this article:
6-22 (a) "health insurance policy" means any individual,
6-23 group, blanket, or franchise insurance policy, insurance agreement,
6-24 or group hospital service contract, providing benefits for medical
6-25 or surgical expenses incurred as a result of an accident or
6-26 sickness;
6-27 (b) "doctor of podiatric medicine" includes D.P.M.,
7-1 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
7-2 (c) "doctor of optometry" includes optometrist, doctor
7-3 of optometry, and O.D.;
7-4 (d) "doctor of chiropractic" means a person who is
7-5 licensed by the Texas Board of Chiropractic Examiners to practice
7-6 chiropractic;
7-7 (e) "licensed dentist" means a person who is licensed
7-8 to practice dentistry by the State Board of Dental Examiners;
7-9 (f) "licensed audiologist" means a person who has
7-10 received a master's or doctorate degree in audiology from an
7-11 accredited college or university and is licensed as an audiologist
7-12 by the State Board [Committee] of Examiners for Speech-Language
7-13 Pathology and Audiology;
7-14 (g) "licensed speech-language pathologist" means a
7-15 person who has received a master's or doctorate degree in
7-16 speech-language pathology from an accredited college or university
7-17 and is licensed as a speech-language pathologist by the State Board
7-18 [Committee] of Examiners for Speech-Language Pathology and
7-19 Audiology;
7-20 (h) "licensed master social worker--advanced clinical
7-21 practitioner" means a person who is licensed by the Texas State
7-22 Board of Social Worker Examiners as a licensed master social worker
7-23 with the order of recognition of advanced clinical practitioner;
7-24 (i) "licensed dietitian" means a person who is
7-25 licensed by the Texas State Board of Examiners of Dietitians;
7-26 (j) "licensed professional counselor" means a person
7-27 who is licensed by the Texas State Board of Examiners of
8-1 Professional Counselors;
8-2 (k) "psychologist" means a person licensed to practice
8-3 psychology by the Texas State Board of Examiners of Psychologists;
8-4 (l) "licensed marriage and family therapist" means a
8-5 person who is licensed by the Texas State Board of Examiners of
8-6 Marriage and Family Therapists;
8-7 (m) "licensed chemical dependency counselor" means a
8-8 person who is licensed by the Texas Commission on Alcohol and Drug
8-9 Abuse;
8-10 (n) "licensed hearing aid fitter and dispenser" means
8-11 a person who is licensed by the State Committee [Texas Board] of
8-12 Examiners in the Fitting and Dispensing of Hearing Instruments;
8-13 [Aids]
8-14 (o) "licensed psychological associate" means a person
8-15 who is licensed by the Texas State Board of Examiners of
8-16 Psychologists and who practices under the supervision of a licensed
8-17 psychologist;
8-18 (p) "occupational therapist" means a person who is
8-19 licensed to practice occupational therapy by the Texas Board of
8-20 Occupational Therapy Examiners; [and]
8-21 (q) "physical therapist" means a person who practices
8-22 physical therapy and is licensed by the Texas Board of Physical
8-23 Therapy Examiners;
8-24 (r) "advanced practice nurse" means a person licensed
8-25 by the Board of Nurse Examiners and recognized by that board as an
8-26 advanced practice nurse; and
8-27 (s) "physician assistant" means a person licensed by
9-1 the Texas State Board of Physician Assistant Examiners.
9-2 SECTION 5. Section 3, Article 21.52, Insurance Code, as
9-3 amended by Chapter 541, Acts of the 74th Legislature, Regular
9-4 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
9-5 the 75th Legislature, Regular Session, 1997, is amended to read as
9-6 follows:
9-7 Sec. 3. SELECTION OF PRACTITIONERS. (a) Any person who is
9-8 issued, who is a party to, or who is a beneficiary under any health
9-9 insurance policy delivered, renewed, or issued for delivery in this
9-10 state by any insurance company, association, or organization to
9-11 which this article applies may select:
9-12 (1) a licensed doctor of podiatric medicine, a
9-13 licensed dentist, or a doctor of chiropractic to perform the
9-14 medical or surgical services or procedures scheduled in the policy
9-15 which fall within the scope of the license of that practitioner;
9-16 (2) [,] a licensed doctor of optometry to perform the
9-17 services or procedures scheduled in the policy which fall within
9-18 the scope of the license of that doctor of optometry;
9-19 (3) [,] an occupational therapist to provide the
9-20 services scheduled in the policy which fall within the scope of the
9-21 license of that occupational therapist;
9-22 (4) [,] a physical therapist to provide the services
9-23 scheduled in the policy which fall within the scope of the license
9-24 of that physical therapist;
9-25 (5) [,] a licensed audiologist to measure hearing for
9-26 the purpose of determining the presence or extent of a hearing loss
9-27 and to provide aural rehabilitation services to a person with a
10-1 hearing loss if those services or procedures are scheduled in the
10-2 policy;
10-3 (6) [,] a licensed speech-language pathologist to
10-4 evaluate speech and language and to provide habilitative and
10-5 rehabilitative services to restore speech or language loss or to
10-6 correct a speech or language impairment if those services or
10-7 procedures are scheduled in the policy;
10-8 (7) [,] a licensed master social worker--advanced
10-9 clinical practitioner to provide the services that fall within the
10-10 scope of the license of such certified practitioner and which are
10-11 specified as services within the terms of the policy of insurance,
10-12 including the provision of direct, diagnostic, preventive, or
10-13 clinical services to individuals, families, and groups whose
10-14 functioning is threatened or affected by social or psychological
10-15 stress or health impairment, if those services or procedures are
10-16 scheduled in the policy;
10-17 (8) [,] a licensed dietitian including a provisional
10-18 licensed dietitian under a licensed dietitian's supervision to
10-19 provide the services that fall within the scope of the license of
10-20 that dietitian if those services are scheduled in the policy;
10-21 (9) [,] a licensed professional counselor to provide
10-22 the services that fall within the scope of the license of that
10-23 professional if those services are scheduled in the policy;
10-24 (10) [,] a licensed marriage and family therapist to
10-25 provide the services that fall within the scope of the license of
10-26 that professional if those services are scheduled in the policy;
10-27 (11) [,] a psychologist to perform the services or
11-1 procedures scheduled in the policy that fall within the scope of
11-2 the license of that psychologist;
11-3 (12) a licensed chemical dependency counselor to
11-4 perform the services or procedures scheduled in the policy that
11-5 fall within the scope of the license of that practitioner;
11-6 (13) [,] a licensed hearing aid fitter and dispenser
11-7 to provide the services or procedures scheduled in the policy that
11-8 fall within the scope of the license of that practitioner;
11-9 (14) [, or] a licensed psychological associate to
11-10 provide the services that fall within the scope of the license of
11-11 that professional if those services are scheduled in the policy;
11-12 (15) an advanced practice nurse to provide the
11-13 services scheduled in the policy that fall within the scope of the
11-14 license of that advanced practice nurse; or
11-15 (16) a physician assistant to provide the services
11-16 scheduled in the policy that fall within the scope of the license
11-17 of that physician assistant.
11-18 (b) The services of a licensed master social
11-19 worker--advanced clinical practitioner, licensed professional
11-20 counselor, or licensed marriage and family therapist that are
11-21 included in this Act may require a professional recommendation by a
11-22 doctor of medicine or doctor of osteopathy unless the health
11-23 insurance policy terms do not require such a recommendation.
11-24 (c) The payment or reimbursement by the insurance company,
11-25 association, or organization for [those] services or procedures in
11-26 accordance with the payment schedule or the payment provisions in
11-27 the policy shall not be denied because the same were performed by a
12-1 licensed doctor of podiatric medicine, a licensed doctor of
12-2 optometry, a licensed doctor of chiropractic, a licensed dentist,
12-3 an occupational therapist, a physical therapist, a licensed
12-4 audiologist, a licensed speech-language pathologist, a licensed
12-5 master social worker--advanced clinical practitioner, a licensed
12-6 dietitian, a licensed professional counselor, a licensed marriage
12-7 and family therapist, a psychologist, a licensed psychological
12-8 associate, a licensed chemical dependency counselor, [or] a
12-9 licensed hearing aid fitter and dispenser, an advanced practice
12-10 nurse, or a physician assistant.
12-11 (d) There shall not be any classification, differentiation,
12-12 or other discrimination in the payment schedule or the payment
12-13 provisions in a health insurance policy, nor in the amount or
12-14 manner of payment or reimbursement thereunder, between scheduled
12-15 services or procedures when performed by a doctor of podiatric
12-16 medicine, a doctor of optometry, a doctor of chiropractic, a
12-17 licensed dentist, an occupational therapist, a physical therapist,
12-18 a licensed audiologist, a licensed speech-language pathologist, a
12-19 licensed master social worker--advanced clinical practitioner, a
12-20 licensed dietitian, a licensed professional counselor, a licensed
12-21 marriage and family therapist, a psychologist, a licensed
12-22 psychological associate, a licensed chemical dependency counselor,
12-23 [or] a licensed hearing aid fitter and dispenser, an advanced
12-24 practice nurse, or a physician assistant which fall within the
12-25 scope of that practitioner's [his] license or certification and the
12-26 same services or procedures when performed by any other
12-27 practitioner of the healing arts whose services or procedures are
13-1 covered by the policy. However, a health insurance policy may
13-2 provide for a different amount of payment or reimbursement for
13-3 scheduled services or procedures performed by an advanced practice
13-4 nurse or physician assistant if the reimbursement methodology used
13-5 to compute the payment or reimbursement is the same methodology
13-6 used to compute the payment for performance of the same service or
13-7 procedure by a physician.
13-8 (e) Any provision in a health insurance policy contrary to
13-9 or in conflict with the provisions of this article shall, to the
13-10 extent of the conflict, be void, but such invalidity shall not
13-11 affect the validity of the other provisions of this policy. Any
13-12 presently approved policy form containing any provision in conflict
13-13 with the requirements of this Act shall be brought into compliance
13-14 with this Act by the use of riders and endorsements which have been
13-15 approved by the commissioner [State Board of Insurance] or by the
13-16 filing of new or revised policy forms for approval by the
13-17 commissioner [State Board of Insurance].
13-18 SECTION 6. Section 33, Texas Pharmacy Act (Article 4542a-1,
13-19 Vernon's Texas Civil Statutes), is amended by adding Subsection (f)
13-20 to read as follows:
13-21 (f) A designated agent under Section 5(18)(A) or (B) may be
13-22 designated by a practitioner to communicate the prescriptions of an
13-23 advanced practice nurse or physician assistant under Section
13-24 3.06(d)(5) or (6), Medical Practice Act (Article 4495b, Vernon's
13-25 Texas Civil Statutes).
13-26 SECTION 7. Section 31, Chapter 1036, Acts of the 62nd
13-27 Legislature, Regular Session, 1971 (Article 8451a, Vernon's Texas
14-1 Civil Statutes), is amended to read as follows:
14-2 Sec. 31. HEALTH CERTIFICATE. (a) Every applicant for an
14-3 original or renewal operator license, instructor license,
14-4 reciprocal license, or specialty certificate must submit a
14-5 certificate of health signed by a licensed physician, advanced
14-6 practice nurse, or licensed physician assistant, showing that the
14-7 applicant is free, as determined by an examination, from
14-8 tuberculosis, hepatitis, or a contagious disease for which the
14-9 applicant is not entitled to protection under the Americans with
14-10 Disabilities Act (42 U.S.C. Section 12101 et seq.).
14-11 (b) Any physician, advanced practice nurse, or physician
14-12 assistant who signs a health certificate required by Subsection (a)
14-13 of this section showing the applicant to be free from a disease
14-14 covered by that subsection without having made the physical
14-15 examination is guilty of a misdemeanor, and on conviction may be
14-16 fined not less than $50 or more than $200.
14-17 SECTION 8. Section 3, Article 21.52, Insurance Code, as
14-18 amended by Chapter 429, Acts of the 74th Legislature, Regular
14-19 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
14-20 the 75th Legislature, Regular Session, 1997, is repealed.
14-21 SECTION 9. This Act takes effect September 1, 1999, and
14-22 applies only to a health insurance policy that is delivered, issued
14-23 for delivery, or renewed on or after January 1, 2000. A health
14-24 insurance policy that is delivered, issued for delivery, or renewed
14-25 before January 1, 2000, is governed by the law as it existed
14-26 immediately before the effective date of this Act, and that law is
14-27 continued in effect for that purpose.
15-1 SECTION 10. The importance of this legislation and the
15-2 crowded condition of the calendars in both houses create an
15-3 emergency and an imperative public necessity that the
15-4 constitutional rule requiring bills to be read on three several
15-5 days in each house be suspended, and this rule is hereby suspended.