By: Madla S.B. No. 1131
A BILL TO BE ENTITLED
AN ACT
1-1 relating to advanced practice nurses and physician assistants;
1-2 providing penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 241.003, Health and Safety Code, is
1-5 amended to read as follows:
1-6 Sec. 241.003. Definitions. In this chapter:
1-7 (1) "Advanced practice nurse" means a registered nurse
1-8 recognized as an advanced practice nurse by the Board of Nurse
1-9 Examiners.
1-10 (2) "Board" means the Texas Board of Health.
1-11 (3) [(2)] "Comprehensive medical rehabilitation
1-12 hospital" means a general hospital that specializes in providing
1-13 comprehensive medical rehabilitation services, including surgery
1-14 and related ancillary services.
1-15 (4) [(2)] "Department" means the Texas Department of
1-16 Health.
1-17 (5) [(3)] "General hospital" means an establishment
1-18 that:
1-19 (A) offers services, facilities, and beds for
1-20 use for more than 24 hours for two or more unrelated individuals
1-21 requiring diagnosis, treatment, or care for illness, injury,
1-22 deformity, abnormality, or pregnancy; and
1-23 (B) regularly maintains, at a minimum, clinical
1-24 laboratory services, diagnostic X-ray services, treatment
2-1 facilities including surgery or obstetrical care or both, and other
2-2 definitive medical or surgical treatment of similar extent.
2-3 (6) [(4)] "Governmental unit" means a political
2-4 subdivision of the state, including a hospital district, county, or
2-5 municipality, and any department, division, board, or other agency
2-6 of a political subdivision.
2-7 (7) [(5)] "Hospital" includes a general hospital and a
2-8 special hospital.
2-9 (8) [(6)] "Medical staff" means a physician or group
2-10 of physicians and a podiatrist or a group of podiatrists who by
2-11 action of the governing body of a hospital are privileged to work
2-12 in and use the facilities of a hospital for or in connection with
2-13 the observation, care, diagnosis, or treatment of an individual who
2-14 is, or may be, suffering from a mental or physical disease or
2-15 disorder or a physical deformity or injury.
2-16 (9) "Pediatric and adolescent hospital" means a
2-17 general hospital that specializes in providing services to children
2-18 and adolescents, including surgery and related ancillary services.
2-19 (10) "Person" means an individual, firm, partnership,
2-20 corporation, association, or joint stock company, and includes a
2-21 receiver, trustee, assignee, or other similar representative of
2-22 those entities.
2-23 (11) "Physician" means a physician licensed by the
2-24 Texas State Board of Medical Examiners.
2-25 (12) "Physician assistant" means a physician assistant
2-26 licensed by the Texas State Board of Physician Assistant Examiners.
3-1 (13) [(12)] "Podiatrist" means a podiatrist licensed
3-2 by the Texas State Board of Podiatric Medical Examiners.
3-3 (14) [(13)] "Premises" means:
3-4 (A) a single building where inpatients receive
3-5 hospital services; or
3-6 (B) multiple buildings where inpatients receive
3-7 hospital services, provided that the following criteria are met:
3-8 (i) all inpatient buildings and inpatient
3-9 services are subject to the control and direction of the governing
3-10 body of the hospital;
3-11 (ii) all inpatient buildings are within a
3-12 30-mile radius of the main address of the licensee;
3-13 (iii) there is integration of the
3-14 organized medical staff of the hospital;
3-15 (iv) there is a single chief executive
3-16 officer who reports directly to the governing body and through whom
3-17 all administrative authority flows and who exercises control and
3-18 surveillance over all administrative activities of the hospital;
3-19 (v) there is a single chief medical
3-20 officer who reports directly to the governing body and who is
3-21 responsible for all medical staff activities of the hospital; and
3-22 (vi) each building that is geographically
3-23 separate from other buildings contains at least one nursing unit
3-24 for inpatients, unless providing only diagnostic or laboratory
3-25 services, or a combination thereof, in the building for hospital
3-26 inpatients.
4-1 (15) [(14)] "Special hospital" means an establishment
4-2 that:
4-3 (A) offers services, facilities, and beds for
4-4 use for more than 24 hours for two or more unrelated individuals
4-5 who are regularly admitted, treated, and discharged and who require
4-6 services more intensive than room, board, personal services, and
4-7 general nursing care;
4-8 (B) has clinical laboratory facilities,
4-9 diagnostic X-ray facilities, treatment facilities, or other
4-10 definitive medical treatment;
4-11 (C) has a medical staff in regular attendance;
4-12 and
4-13 (D) maintains records of the clinical work
4-14 performed for each patient.
4-15 SECTION 2. Subchapter E, Chapter 241, Health and Safety
4-16 Code, is amended by adding Section 241.105 to read as follows:
4-17 Sec. 241.105. HOSPITAL PRIVILEGES FOR ADVANCED PRACTICE
4-18 NURSES AND PHYSICIAN ASSISTANTS. (a) The governing body of a
4-19 hospital is authorized to establish policies concerning the
4-20 granting of clinical privileges to advanced practice nurses and
4-21 physician assistants, including policies relating to the
4-22 application process, reasonable qualifications for privileges, and
4-23 the process for renewal, modification, or revocation of privileges.
4-24 (b) If the governing body of a hospital has adopted a policy
4-25 of granting clinical privileges to advanced practice nurses or
4-26 physician assistants, an individual advanced practice nurse or
5-1 physician assistant who qualifies for privileges under that policy
5-2 shall be entitled to certain procedural rights to provide fairness
5-3 of process, as determined by the governing body of the hospital,
5-4 when an application for privileges is submitted to the hospital.
5-5 At a minimum, any policy adopted shall specify a reasonable period
5-6 for the processing and consideration of the application and shall
5-7 provide for written notification to the applicant of any final
5-8 action on the application by the hospital, including any reason for
5-9 denial or restriction of the privileges requested.
5-10 (c) If an advanced practice nurse or physician assistant has
5-11 been granted clinical privileges by a hospital, the hospital may
5-12 not modify or revoke those privileges without providing certain
5-13 procedural rights to provide fairness of process, as determined by
5-14 the governing body of the hospital, to the advanced practice nurse
5-15 or physician assistant. At a minimum, the hospital shall provide
5-16 the advanced practice nurse or physician assistant written reasons
5-17 for the modification or revocation of privileges and a mechanism
5-18 for appeal to the appropriate committee or body within the
5-19 hospital, as determined by the governing body of the hospital.
5-20 (d) If a hospital extends clinical privileges to an advanced
5-21 practice nurse or physician assistant conditioned on the advanced
5-22 practice nurse or physician assistant having a sponsoring or
5-23 collaborating relationship with a physician and that relationship
5-24 ceases to exist, the advanced practice nurse or physician assistant
5-25 and the physician shall provide written notification to the
5-26 hospital that the relationship no longer exists. Once the hospital
6-1 receives such notice from an advanced practice nurse or physician
6-2 assistant and the physician, the hospital shall be deemed to have
6-3 met its obligations under this section by notifying the advanced
6-4 practice nurse or physician assistant in writing that the advanced
6-5 practice nurse's or physician assistant's clinical privileges no
6-6 longer exist at that hospital.
6-7 (e) Nothing in this section shall be construed as modifying
6-8 the Medical Practice Act (Article 4495b, Vernon's Texas Civil
6-9 Statutes), the Nursing Practice Act (Articles 4513-4528, Revised
6-10 Statutes), the Physician Assistant Licensing Act (Article 4495b-1,
6-11 Vernon's Texas Civil Statutes), or any other law relating to the
6-12 scope of practice of physicians, advanced practice nurses, or
6-13 physician assistants.
6-14 (f) This section does not apply to an employer-employee
6-15 relationship between an advanced practice nurse or physician
6-16 assistant and a hospital.
6-17 SECTION 3. Section 33, Texas Pharmacy Act (Article 4542a-1,
6-18 Vernon's Texas Civil Statutes), is amended by adding Subsection (f)
6-19 to read as follows:
6-20 (f) A person who is a licensed vocational nurse or has an
6-21 education equivalent to or greater than that required for a
6-22 licensed vocational nurse may be designated by the practitioner to
6-23 communicate prescriptions of an advanced practice nurse or
6-24 physician assistant authorized by the practitioner to sign
6-25 prescription drug orders under Section 3.06(d)(5) or (6), Medical
6-26 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
7-1 SECTION 4. Section 483.022, Health and Safety Code, is
7-2 amended by adding Subsection (f) to read as follows:
7-3 (f) A practitioner may designate a person who is a licensed
7-4 vocational nurse or has an education equivalent to or greater than
7-5 that required for a licensed vocational nurse to communicate
7-6 prescriptions of an advanced practice nurse or physician assistant
7-7 authorized by the practitioner to sign prescription drug orders
7-8 under Section 3.06(d)(5) or (6), Medical Practice Act (Article
7-9 4495b, Vernon's Texas Civil Statutes).
7-10 SECTION 5. Section 31, Chapter 1036, Acts of the 62nd
7-11 Legislature, Regular Session, 1971 (Article 8451a, Vernon's Texas
7-12 Civil Statutes), is amended to read as follows:
7-13 Sec. 31. Health Certificate. (a) Every applicant for an
7-14 original or renewal operator license, instructor license,
7-15 reciprocal license, or specialty certificate must submit a
7-16 certificate of health signed by a licensed physician, licensed
7-17 advanced practice nurse, or licensed physician assistant, showing
7-18 that the applicant is free, as determined by an examination, from
7-19 tuberculosis, hepatitis, or a contagious disease for which the
7-20 applicant is not entitled to protection under the Americans with
7-21 Disabilities Act (42 U.S.C. Section 12101 et seq.).
7-22 (b) Any physician, advanced practice nurse, or physician
7-23 assistant who signs a health certificate required by Subsection (a)
7-24 of this section showing the applicant to be free from a disease
7-25 covered by that subsection without having made the physical
7-26 examination is guilty of a misdemeanor, and on conviction may be
8-1 fined not less than $50 or more than $200.
8-2 SECTION 6. Section 1, Article 21.52, Insurance Code, is
8-3 amended to read as follows:
8-4 Sec. 1. DEFINITIONS. As used in this article:
8-5 (a) "health insurance policy" means any individual, group,
8-6 blanket, or franchise insurance policy, insurance agreement, or
8-7 group hospital service contract, providing benefits for medical or
8-8 surgical expenses incurred as a result of an accident or sickness;
8-9 (b) "doctor of podiatric medicine" includes D.P.M.,
8-10 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
8-11 (c) "doctor of optometry" includes optometrist, doctor of
8-12 optometry, and O.D.;
8-13 (d) "doctor of chiropractic" means a person who is licensed
8-14 by the Texas Board of Chiropractic Examiners to practice
8-15 chiropractic;
8-16 (e) "licensed dentist" means a person who is licensed to
8-17 practice dentistry by the State Board of Dental Examiners;
8-18 (f) "licensed audiologist" means a person who has received a
8-19 master's or doctorate degree in audiology from an accredited
8-20 college or university and is licensed as an audiologist by the
8-21 State Committee of Examiners for Speech-Language Pathology and
8-22 Audiology;
8-23 (g) "licensed speech-language pathologist" means a person
8-24 who has received a master's or doctorate degree in speech-language
8-25 pathology from an accredited college or university and is licensed
8-26 as a speech-language pathologist by the State Committee of
9-1 Examiners for Speech-Language Pathology and Audiology;
9-2 (h) "licensed master social worker--advanced clinical
9-3 practitioner" means a person who is licensed by the Texas State
9-4 Board of Social Worker Examiners as a licensed master social worker
9-5 with the order of recognition of advanced clinical practitioner;
9-6 (i) "licensed dietitian" means a person who is licensed by
9-7 the Texas State Board of Examiners of Dietitians;
9-8 (j) "licensed professional counselor" means a person who is
9-9 licensed by the Texas State Board of Examiners of Professional
9-10 Counselors;
9-11 (k) "psychologist" means a person licensed to practice
9-12 psychology by the Texas State Board of Examiners of Psychologists;
9-13 (l) "licensed marriage and family therapist" means a person
9-14 who is licensed by the Texas State Board of Examiners of Marriage
9-15 and Family Therapists;
9-16 (m) "licensed chemical dependency counselor" means a person
9-17 who is licensed by the Texas Commission on Alcohol and Drug Abuse;
9-18 (n) "licensed hearing aid fitter and dispenser" means a
9-19 person who is licensed by the Texas Board of Examiners in the
9-20 Fitting and Dispensing of Hearing Aids;
9-21 (o) "licensed psychological associate" means a person who is
9-22 licensed by the Texas State Board of Examiners of Psychologists and
9-23 who practices under the supervision of a licensed psychologist;
9-24 (p) "occupational therapist" means a person who is licensed
9-25 to practice occupational therapy by the Texas Board of Occupational
9-26 Therapy Examiners; [and]
10-1 (q) "physical therapist" means a person who practices
10-2 physical therapy and is licensed by the Texas Board of Physical
10-3 Therapy Examiners;
10-4 (r) "advanced practice nurse" means a person licensed by the
10-5 Board of Nurse Examiners and recognized by that board as an
10-6 advanced practice nurse; and
10-7 (s) "physician assistant" means a person licensed by the
10-8 Texas State Board of Physician Assistant Examiners.
10-9 SECTION 7. Section 3, Article 21.52, Insurance Code, as
10-10 amended by Chapter 541, Acts of the 74th Legislature, Regular
10-11 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
10-12 the 75th Legislature, Regular Session, 1997, is amended to read as
10-13 follows:
10-14 Sec. 3. Selection of practitioners. (a) Any person who is
10-15 issued, who is a party to, or who is a beneficiary under any health
10-16 insurance policy delivered, renewed, or issued for delivery in this
10-17 state by any insurance company, association, or organization to
10-18 which this article applies may select:
10-19 (1) a licensed doctor of podiatric medicine, a
10-20 licensed dentist, or a doctor of chiropractic to perform the
10-21 medical or surgical services or procedures scheduled in the policy
10-22 which fall within the scope of the license of that practitioner;
10-23 (2) [,] a licensed doctor of optometry to perform the
10-24 services or procedures scheduled in the policy which fall within
10-25 the scope of the license of that doctor of optometry;
10-26 (3) [,] an occupational therapist to provide the
11-1 services scheduled in the policy which fall within the scope of the
11-2 license of that occupational therapist;
11-3 (4) [,] a physical therapist to provide the services
11-4 scheduled in the policy which fall within the scope of the license
11-5 of that physical therapist;
11-6 (5) [,] a licensed audiologist to measure hearing for
11-7 the purpose of determining the presence or extent of a hearing loss
11-8 and to provide aural rehabilitation services to a person with a
11-9 hearing loss if those services or procedures are scheduled in the
11-10 policy;
11-11 (6) [,] a licensed speech-language pathologist to
11-12 evaluate speech and language and to provide habilitative and
11-13 rehabilitative services to restore speech or language loss or to
11-14 correct a speech or language impairment if those services or
11-15 procedures are scheduled in the policy;
11-16 (7) [,] a licensed master social worker--advanced
11-17 clinical practitioner to provide the services that fall within the
11-18 scope of the license of such certified practitioner and which are
11-19 specified as services within the terms of the policy of insurance,
11-20 including the provision of direct, diagnostic, preventive, or
11-21 clinical services to individuals, families, and groups whose
11-22 functioning is threatened or affected by social or psychological
11-23 stress or health impairment, if those services or procedures are
11-24 scheduled in the policy;
11-25 (8) [,] a licensed dietitian including a provisional
11-26 licensed dietitian under a licensed dietitian's supervision to
12-1 provide the services that fall within the scope of the license of
12-2 that dietitian if those services are scheduled in the policy;
12-3 (9) [,] a licensed professional counselor to provide
12-4 the services that fall within the scope of the license of that
12-5 professional if those services are scheduled in the policy;
12-6 (10) [,] a licensed marriage and family therapist to
12-7 provide the services that fall within the scope of the license of
12-8 that professional if those services are scheduled in the policy;
12-9 (11) [,] a psychologist to perform the services or
12-10 procedures scheduled in the policy that fall within the scope of
12-11 the license of that psychologist;
12-12 (12) a licensed chemical dependency counselor to
12-13 perform the services or procedures scheduled in the policy that
12-14 fall within the scope of the license of that practitioner;
12-15 (13) an advanced practice nurse to provide the
12-16 services scheduled in the policy that fall within the scope of the
12-17 license of that practitioner;
12-18 (14) a physician assistant to provide the services
12-19 scheduled in the policy that fall within the scope of the license
12-20 of that practitioner;
12-21 (15) [,] a licensed hearing aid fitter and dispenser
12-22 to provide the services or procedures scheduled in the policy that
12-23 fall within the scope of the license of that practitioner;[,] or
12-24 (16) a licensed psychological associate to provide the
12-25 services that fall within the scope of the license of that
12-26 professional if those services are scheduled in the policy.
13-1 (b) The services of a licensed master social
13-2 worker--advanced clinical practitioner, licensed professional
13-3 counselor, or licensed marriage and family therapist that are
13-4 included in this Act may require a professional recommendation by a
13-5 doctor of medicine or doctor of osteopathy unless the health
13-6 insurance policy terms do not require such a recommendation.
13-7 (c) The payment or reimbursement by the insurance company,
13-8 association, or organization for [those] services or procedures in
13-9 accordance with the payment schedule or the payment provisions in
13-10 the policy shall not be denied because the same were performed by a
13-11 licensed doctor of podiatric medicine, a licensed doctor of
13-12 optometry, a licensed doctor of chiropractic, a licensed dentist,
13-13 an occupational therapist, a physical therapist, a licensed
13-14 audiologist, a licensed speech-language pathologist, a licensed
13-15 master social worker--advanced clinical practitioner, a licensed
13-16 dietitian, a licensed professional counselor, a licensed marriage
13-17 and family therapist, a psychologist, a licensed psychological
13-18 associate, a licensed chemical dependency counselor, an advanced
13-19 practice nurse, a physician assistant, or a licensed hearing aid
13-20 fitter and dispenser.
13-21 (d) There shall not be any classification, differentiation,
13-22 or other discrimination in the payment schedule or the payment
13-23 provisions in a health insurance policy, nor in the amount or
13-24 manner of payment or reimbursement thereunder, between scheduled
13-25 services or procedures when performed by a doctor of podiatric
13-26 medicine, a doctor of optometry, a doctor of chiropractic, a
14-1 licensed dentist, an occupational therapist, a physical therapist,
14-2 a licensed audiologist, a licensed speech-language pathologist, a
14-3 licensed master social worker--advanced clinical practitioner, a
14-4 licensed dietitian, a licensed professional counselor, a licensed
14-5 marriage and family therapist, a psychologist, a licensed
14-6 psychological associate, a licensed chemical dependency counselor,
14-7 an advanced practice nurse to provide the services scheduled in the
14-8 policy, a physician assistant to provide the services scheduled in
14-9 the policy, or a licensed hearing aid fitter and dispenser which
14-10 fall within the scope of that practitioner's [his] license or
14-11 certification and the same services or procedures when performed by
14-12 any other practitioner of the healing arts whose services or
14-13 procedures are covered by the policy. However, a health insurance
14-14 policy may provide for a different amount of payment or
14-15 reimbursement for scheduled services or procedures when performed
14-16 by an advanced practice nurse or physician assistant provided the
14-17 reimbursement methodology used to calculate the payment for the
14-18 service or procedure is the same methodology used to calculate the
14-19 payment when the service or procedure is provided by a physician.
14-20 (e) Any provision in a health insurance policy contrary to
14-21 or in conflict with the provisions of this article shall, to the
14-22 extent of the conflict, be void, but such invalidity shall not
14-23 affect the validity of the other provisions of this policy. Any
14-24 presently approved policy form containing any provision in conflict
14-25 with the requirements of this Act shall be brought into compliance
14-26 with this Act by the use of riders and endorsements which have been
15-1 approved by the commissioner [State Board of Insurance] or by the
15-2 filing of new or revised policy forms for approval by the
15-3 commissioner [State Board of Insurance].
15-4 SECTION 8. Section 3, Article 21.52, Insurance Code, as
15-5 amended by Chapter 429, Acts of the 74th Legislature, Regular
15-6 Session, 1995, and as reenacted and amended by Chapter 946, Acts of
15-7 the 75th Legislature, Regular Session, 1997, is repealed.
15-8 SECTION 9. This Act takes effect September 1, 1999.
15-9 SECTION 10. The importance of this legislation and the
15-10 crowded condition of the calendars in both houses create an
15-11 emergency and an imperative public necessity that the
15-12 constitutional rule requiring bills to be read on three several
15-13 days in each house be suspended, and this rule is hereby suspended.