HBA-CCH H.B. 803 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 803 By: Junell Public Health 3/23/2001 Introduced BACKGROUND AND PURPOSE A registered nurse first assistant (RNFA) is a technically skilled and highly educated nursing professional who renders direct care to surgical patients before, during, and after surgery. RNFAs perform the same first assisting duties as surgeons, physicians, physician assistants, and some nurse practitioners, all of whom are authorized to receive Medicare reimbursement for their first assisting services. Nevertheless, Medicare and most private insurance companies do not directly reimburse RNFAs for their services, and reimbursement rates that RNFAs do receive are not always commensurate with the reimbursement rates of other health care professionals who perform the same first assisting duties. Failure to reimburse or adequately reimburse RNFAs may result in costs being shifted to patients. House Bill 803 sets forth criteria for a nurse to be classified as an RNFA and prohibits an insurance company from refusing to cover first assisting services because they were performed by an RNFA. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Board of Nurse Examiners in SECTION 1 (Section 301.1525, Occupations Code) of this bill. ANALYSIS House Bill 803 amends the Occupations Code to require the Board of Nurse Examiners (board) to adopt rules to approve a registered nurse as a nurse first assistant (RNFA). The bill provides that the rules must, at a minimum, require a RNFA to complete at least 2,000 hours of first assisting a physician with surgery and related preoperative, intraoperative, and postoperative care and continuing education in providing first assistant services in addition to any other continuing education required by the board (Sec. 301.1525). H.B. 803 amends the Insurance Code to authorize any person with health insurance coverage to select a RNFA to provide services scheduled in a policy that fall within the scope of the RNFA's license. The bill prohibits an insurance company, association, or organization from denying or making any classification, differentiation, or discrimination in the payment for scheduled services or procedures because they were performed by a RNFA (Sec. 3, Article 21.52). The bill also amends the Human Resources Code to require the Health and Human Services Commission to assure that a recipient of medical assistance is authorized to select a RNFA to perform any health care service or procedure covered under the medical assistance program if the selected RNFA is authorized to perform the service or procedure (Sec. 32.027). EFFECTIVE DATE September 1, 2001. The Act applies only to a health insurance policy that is delivered, issued for delivery, or renewed on or after January 1, 2002.