By: Madla S.B. No. 1131
99S0695/1
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 of
2-10 physicians and a podiatrist or a group of podiatrists who by action
2-11 of the governing body of a hospital are privileged to work in and
2-12 use the facilities of a hospital for or in connection with the
2-13 observation, care, diagnosis, or treatment of an individual who is,
2-14 or may be, suffering from a mental or physical disease or disorder
2-15 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 SECTION 3. Section 33, Texas Pharmacy Act (Article 4542a-1,
6-15 Vernon's Texas Civil Statutes), is amended by adding Subsection (f)
6-16 to read as follows:
6-17 (f) A person who qualifies as a practitioner's designated
6-18 agent under Section 5(18)(A) or (B) of this Act may be designated
6-19 by the practitioner to communicate prescriptions of an advanced
6-20 practice nurse or physician assistant authorized by the
6-21 practitioner to sign prescription drug orders under Section
6-22 3.06(d)(5) or (6), Medical Practice Act (Article 4495b, Vernon's
6-23 Texas Civil Statutes).
6-24 SECTION 4. Section 483.022, Health and Safety Code, is
6-25 amended by adding Subsection (f) to read as follows:
6-26 (f) A practitioner may designate a person who qualifies as a
7-1 designated agent of the practitioner under Section 483.001(4)(A) or
7-2 (B) to communicate prescriptions of an advanced practice nurse or
7-3 physician assistant authorized by the practitioner to sign
7-4 prescription drug orders under Section 3.06(d)(5) or (6), Medical
7-5 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
7-6 SECTION 5. Section 31, Chapter 1036, Acts of the 62nd
7-7 Legislature, Regular Session, 1971 (Article 8451a, Vernon's Texas
7-8 Civil Statutes), is amended to read as follows:
7-9 Sec. 31. Health Certificate. (a) Every applicant for an
7-10 original or renewal operator license, instructor license,
7-11 reciprocal license, or specialty certificate must submit a
7-12 certificate of health signed by a licensed physician, licensed
7-13 advanced practice nurse, or licensed physician assistant, showing
7-14 that the applicant is free, as determined by an examination, from
7-15 tuberculosis, hepatitis, or a contagious disease for which the
7-16 applicant is not entitled to protection under the Americans with
7-17 Disabilities Act (42 U.S.C. Section 12101 et seq.).
7-18 (b) Any physician, advanced practice nurse, or physician
7-19 assistant who signs a health certificate required by Subsection (a)
7-20 of this section showing the applicant to be free from a disease
7-21 covered by that subsection without having made the physical
7-22 examination is guilty of a misdemeanor, and on conviction may be
7-23 fined not less than $50 or more than $200.
7-24 SECTION 6. Section 1, Article 21.52, Insurance Code, is
7-25 amended to read as follows:
7-26 Sec. 1. DEFINITIONS. As used in this article:
8-1 (a) "health insurance policy" means any individual, group,
8-2 blanket, or franchise insurance policy, insurance agreement, or
8-3 group hospital service contract, providing benefits for medical or
8-4 surgical expenses incurred as a result of an accident or sickness;
8-5 (b) "doctor of podiatric medicine" includes D.P.M.,
8-6 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
8-7 (c) "doctor of optometry" includes optometrist, doctor of
8-8 optometry, and O.D.;
8-9 (d) "doctor of chiropractic" means a person who is licensed
8-10 by the Texas Board of Chiropractic Examiners to practice
8-11 chiropractic;
8-12 (e) "licensed dentist" means a person who is licensed to
8-13 practice dentistry by the State Board of Dental Examiners;
8-14 (f) "licensed audiologist" means a person who has received a
8-15 master's or doctorate degree in audiology from an accredited
8-16 college or university and is licensed as an audiologist by the
8-17 State Committee of Examiners for Speech-Language Pathology and
8-18 Audiology;
8-19 (g) "licensed speech-language pathologist" means a person
8-20 who has received a master's or doctorate degree in speech-language
8-21 pathology from an accredited college or university and is licensed
8-22 as a speech-language pathologist by the State Committee of
8-23 Examiners for Speech-Language Pathology and Audiology;
8-24 (h) "licensed master social worker--advanced clinical
8-25 practitioner" means a person who is licensed by the Texas State
8-26 Board of Social Worker Examiners as a licensed master social worker
9-1 with the order of recognition of advanced clinical practitioner;
9-2 (i) "licensed dietitian" means a person who is licensed by
9-3 the Texas State Board of Examiners of Dietitians;
9-4 (j) "licensed professional counselor" means a person who is
9-5 licensed by the Texas State Board of Examiners of Professional
9-6 Counselors;
9-7 (k) "psychologist" means a person licensed to practice
9-8 psychology by the Texas State Board of Examiners of Psychologists;
9-9 (l) "licensed marriage and family therapist" means a person
9-10 who is licensed by the Texas State Board of Examiners of Marriage
9-11 and Family Therapists;
9-12 (m) "licensed chemical dependency counselor" means a person
9-13 who is licensed by the Texas Commission on Alcohol and Drug Abuse;
9-14 (n) "licensed hearing aid fitter and dispenser" means a
9-15 person who is licensed by the Texas Board of Examiners in the
9-16 Fitting and Dispensing of Hearing Aids
9-17 (o) "licensed psychological associate" means a person who is
9-18 licensed by the Texas State Board of Examiners of Psychologists and
9-19 who practices under the supervision of a licensed psychologist;
9-20 (p) "occupational therapist" means a person who is licensed
9-21 to practice occupational therapy by the Texas Board of Occupational
9-22 Therapy Examiners; [and]
9-23 (q) "physical therapist" means a person who practices
9-24 physical therapy and is licensed by the Texas Board of Physical
9-25 Therapy Examiners;
9-26 (r) "advanced practice nurse" means a person licensed by the
10-1 Board of Nurse Examiners and recognized by that board as an
10-2 advanced practice nurse; and
10-3 (s) "physician assistant" means a person licensed by the
10-4 Texas State Board of Physician Assistant Examiners.
10-5 SECTION 7. Section 3, Article 21.52, Insurance Code, as
10-6 amended by Chapter 429, Acts of the 74th Legislature, Regular
10-7 Session, 1995, Chapter 541, Acts of the 74th Legislature, Regular
10-8 Session, 1995, and Chapter 946, Acts of the 75th Legislature,
10-9 Regular Session, 1997, is conformed and amended to read as follows:
10-10 Sec. 3. Selection of practitioners. Any person who is
10-11 issued, who is a party to, or who is a beneficiary under any health
10-12 insurance policy delivered, renewed, or issued for delivery in this
10-13 state by any insurance company, association, or organization to
10-14 which this article applies may select a licensed doctor of
10-15 podiatric medicine, a licensed dentist, or a doctor of chiropractic
10-16 to perform the medical or surgical services or procedures scheduled
10-17 in the policy which fall within the scope of the license of that
10-18 practitioner, a licensed doctor of optometry to perform the
10-19 services or procedures scheduled in the policy which fall within
10-20 the scope of the license of that doctor of optometry, an
10-21 occupational therapist to provide the health care services
10-22 scheduled in the policy which fall within the scope of the license
10-23 of that occupational therapist, a physical therapist to provide the
10-24 health care services scheduled in the policy which fall within the
10-25 scope of the license of that physical therapist, a licensed
10-26 audiologist to measure hearing for the purpose of determining the
11-1 presence or extent of a hearing loss and to provide aural
11-2 rehabilitation services to a person with a hearing loss if those
11-3 services or procedures are scheduled in the policy, a licensed
11-4 speech-language pathologist to evaluate speech and language and to
11-5 provide habilitative and rehabilitative services to restore speech
11-6 or language loss or to correct a speech or language impairment if
11-7 those services or procedures are scheduled in the policy, a
11-8 licensed master social worker--advanced clinical practitioner to
11-9 provide the services that fall within the scope of the license of
11-10 such certified practitioner and which are specified as services
11-11 within the terms of the policy of insurance, including the
11-12 provision of direct, diagnostic, preventive, or clinical services
11-13 to individuals, families, and groups whose functioning is
11-14 threatened or affected by social or psychological stress or health
11-15 impairment, if those services or procedures are scheduled in the
11-16 policy, a licensed dietitian including a provisional licensed
11-17 dietitian under a licensed dietitian's supervision to provide the
11-18 services that fall within the scope of the license of that
11-19 dietitian if those services are scheduled in the policy, a licensed
11-20 professional counselor to provide the services that fall within the
11-21 scope of the license of that professional if those services are
11-22 scheduled in the policy, a licensed marriage and family therapist
11-23 to provide the services that fall within the scope of the license
11-24 of that professional if those services are scheduled in the policy,
11-25 a psychologist to perform the services or procedures scheduled in
11-26 the policy that fall within the scope of the license of that
12-1 psychologist, a licensed chemical dependency counselor to perform
12-2 the services or procedures scheduled in the policy that fall within
12-3 the scope of the license of that practitioner, an advanced practice
12-4 nurse to provide the services scheduled in the policy that fall
12-5 within the scope of the license of that practitioner, a physician
12-6 assistant to provide the services scheduled in the policy that fall
12-7 within the scope of the license of that practitioner, a licensed
12-8 hearing aid fitter and dispenser to provide the services or
12-9 procedures scheduled in the policy that fall within the scope of
12-10 the license of that practitioner, or a licensed psychological
12-11 associate to provide the services that fall within the scope of the
12-12 license of that professional if those services are scheduled in the
12-13 policy. The services of a licensed master social worker--advanced
12-14 clinical practitioner, licensed professional counselor, or licensed
12-15 marriage and family therapist that are included in this Act may
12-16 require a professional recommendation by a doctor of medicine or
12-17 doctor of osteopathy unless the health insurance policy terms do
12-18 not require such a recommendation. The payment or reimbursement by
12-19 the insurance company, association, or organization for those
12-20 services or procedures in accordance with the payment schedule or
12-21 the payment provisions in the policy shall not be denied because
12-22 the same were performed by a licensed doctor of podiatric medicine,
12-23 a licensed doctor of optometry, a licensed doctor of chiropractic,
12-24 a licensed dentist, an occupational therapist, a physical
12-25 therapist, a licensed audiologist, a licensed speech-language
12-26 pathologist, a licensed master social worker--advanced clinical
13-1 practitioner, a licensed dietitian, a licensed professional
13-2 counselor, a licensed marriage and family therapist, a
13-3 psychologist, a licensed psychological associate, a licensed
13-4 chemical dependency counselor, an advanced practice nurse, a
13-5 physician assistant, or a licensed hearing aid fitter and
13-6 dispenser. There shall not be any classification, differentiation,
13-7 or other discrimination in the payment schedule or the payment
13-8 provisions in a health insurance policy, nor in the amount or
13-9 manner of payment or reimbursement thereunder, between scheduled
13-10 services or procedures when performed by a doctor of podiatric
13-11 medicine, a doctor of optometry, a doctor of chiropractic, a
13-12 licensed dentist, an occupational therapist, a physical therapist,
13-13 a licensed audiologist, a licensed speech-language pathologist, a
13-14 licensed master social worker--advanced clinical practitioner, a
13-15 licensed dietitian, a licensed professional counselor, a licensed
13-16 marriage and family therapist, a psychologist, a licensed
13-17 psychological associate, a licensed chemical dependency counselor,
13-18 an advanced practice nurse to provide the services scheduled in the
13-19 policy, a physician assistant to provide the services scheduled in
13-20 the policy, or a licensed hearing aid fitter and dispenser which
13-21 fall within the scope of the license or certification and the same
13-22 services or procedures when performed by any other practitioner of
13-23 the healing arts whose services or procedures are covered by the
13-24 policy. However, a health insurance policy may provide for a
13-25 different amount of payment or reimbursement for scheduled services
13-26 or procedures when performed by an advanced practice nurse or
14-1 physician assistant provided the reimbursement methodology used to
14-2 calculate the payment for the service or procedure is the same
14-3 methodology used to calculate the payment when the service or
14-4 procedure is provided by a physician. Any provision in a health
14-5 insurance policy contrary to or in conflict with the provisions of
14-6 this article shall, to the extent of the conflict, be void, but
14-7 such invalidity shall not affect the validity of the other
14-8 provisions of this policy. Any presently approved policy form
14-9 containing any provision in conflict with the requirements of this
14-10 Act shall be brought into compliance with this Act by the use of
14-11 riders and endorsements which have been approved by the State Board
14-12 of Insurance or by the filing of new or revised policy forms for
14-13 approval by the State Board of Insurance.
14-14 SECTION 8. This Act takes effect September 1, 1999.
14-15 SECTION 9. The importance of this legislation and the
14-16 crowded condition of the calendars in both houses create an
14-17 emergency and an imperative public necessity that the
14-18 constitutional rule requiring bills to be read on three several
14-19 days in each house be suspended, and this rule is hereby suspended.