HBA-NRS C.S.H.B. 456 77(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 456 By: Maxey Public Health 4/9/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE Currently, under the state's voucher payment program, a person with a disability may use the voucher payment option to pay for certain health care services. Many of the tasks, such as regularly scheduled oral and topical medication administration, feeding, and medication administration through permanently placed gastrostomy tubes are normally performed by the primary caregiver. The purpose of C.S.H.B. 456 is to allow an unlicensed personal attendant hired by a consumer participating in the voucher payment program to perform those responsibilities under the direction of the consumer or the consumer's parent or guardian without the supervision of a licensed nurse who delegates or intervenes in those responsibilities. C.S.H.B. 456 exempts professional nursing services provided to persons with disabilities under the voucher payment program from nursing licensing requirements and requires Board of Nurse Examiners to appoint a task force to review and make recommendations regarding the provision of health maintenance tasks to persons with functional disabilities in independent living environments. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. ANALYSIS C.S.H.B. 456 amends the Government Code to provide that the provision prohibiting a person from practicing or offering to practice professional nursing in this state unless the person is properly licensed does not apply to the delivery of a service for which payment is provided under the voucher payment program, if the person who delivers the service has not been denied a license as a registered nurse or a licensed vocational nurse and has not been issued a license as a registered nurse that is revoked or suspended, and the consumer who receives the service has a functional disability and the service would have been performed by the consumer, or the parent or guardian for the consumer, except for the disability, and if the consumer or the consumer's parent or guardian is capable of training the person in the proper performance of the service. If a service is provided to a consumer who is not capable of training the person in the proper performance of the service, the consumer's parent or guardian who is capable of training the person either must be present during service delivery or must observe the person performing the service at least once to assure adequate performance. The bill specifies the types of service which may be delivered to a consumer by an unlicenced registered nurse or a licensed vocational nurse under the voucher payment program. The bill requires the Board of Nurse Examiners not later than November 30, 2001, to appoint a task force to review and make recommendations regarding the provision of health maintenance tasks to persons with functional disabilities in independent living environments. The bill sets forth the composition of the task force. The bill requires the task force to report its findings and recommendations to the speaker of the house of representatives and the lieutenant governor not later than November 1, 2002. EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 456 modifies the original bill by specifying the allowable tasks performed by individuals without a nursing license to persons with disabilities participating in the voucher program. The substitute adds that the individual performing the service will do so if the service would either be routinely performed by the consumer or a parent or guardian of the consumer were it not for the disability. The substitute establishes supervision and training requirements for the person performing the service. The substitute requires the Board of Nurse Examiners to appoint a task force to review and make recommendations regarding the provision of health maintenance tasks to persons with functional disabilities in independent living environments.