By Maxey H.B. No. 456
Substitute the following for H.B. No. 456:
By Maxey C.S.H.B. No. 456
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to exemption from nursing license requirements for certain
1-3 services provided to persons with disabilities.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 531.051, Government Code, as added by
1-6 Section 1, Chapter 1288, Acts of the 76th Legislature, Regular
1-7 Session, 1999, is amended by adding Subsections (f), (g), and (h)
1-8 to read as follows:
1-9 (f) Section 301.251(a), Occupations Code, does not apply to
1-10 delivery of a service for which payment is provided under the
1-11 voucher payment program developed under this section if:
1-12 (1) the person who delivers the service:
1-13 (A) has not been denied a license under Chapter
1-14 301 or 302, Occupations Code;
1-15 (B) has not been issued a license under Chapter
1-16 301, Occupations Code, that is revoked or suspended; and
1-17 (C) provides a service listed under Subsection
1-18 (h); and
1-19 (2) the consumer who receives the service:
1-20 (A) has a functional disability and the service
1-21 would have been performed by the consumer, or the parent or
1-22 guardian for the consumer, except for that disability; and
1-23 (B) if:
1-24 (i) the consumer is capable of training
2-1 the person in the proper performance of the service, the consumer
2-2 directs the person to deliver the service; or
2-3 (ii) the consumer is not capable of
2-4 training the person in the proper performance of the service, the
2-5 consumer's parent or guardian is capable of training the person in
2-6 the proper performance of the service and directs the person to
2-7 deliver the service.
2-8 (g) If the person delivers the service under Subsection
2-9 (f)(2)(B)(ii), the parent or guardian must be present when the
2-10 service is performed or immediately accessible to the person who
2-11 delivers the service. If the person will perform the service when
2-12 the parent or guardian is not present, the parent or guardian must
2-13 observe the person performing the service at least once to assure
2-14 the parent or guardian that the person performing the service can
2-15 competently perform that service.
2-16 (h) The types of services which may be delivered under
2-17 Subsection (f) are:
2-18 (1) bathing, including feminine hygiene;
2-19 (2) grooming, including nail care, except for clients
2-20 with medical conditions like diabetes;
2-21 (3) feeding, including feeding through a permanently
2-22 placed feeding tube;
2-23 (4) routine skin care, including decubitus Stage 1;
2-24 (5) transferring, ambulation, or positioning;
2-25 (6) exercising and range of motion;
2-26 (7) the administering of a bowel and bladder program,
2-27 including suppositories, catheterization, enemas, manual
3-1 evacuation, and digital stimulation; and
3-2 (8) administering oral medications that are normally
3-3 self-administered, including administration through a gastrostomy
3-4 tube.
3-5 SECTION 2. (a) Not later than November 30, 2001, the Board
3-6 of Nurse Examiners shall appoint a task force to review and make
3-7 recommendations regarding the provision of health maintenance tasks
3-8 to persons with functional disabilities in independent living
3-9 environments, including analysis of:
3-10 (1) when delegation and assignment of those tasks by
3-11 registered nurses is appropriate and safe;
3-12 (2) the feasibility and desirability of separate
3-13 regulations relating to delegation and assignment of those tasks;
3-14 and
3-15 (3) procedures for resolving disagreements between
3-16 clients and registered nurses or home and community support service
3-17 agencies about the appropriateness and safety of delegating or
3-18 assigning tasks.
3-19 (b) The task force consists of 13 members appointed by the
3-20 Board of Nurse Examiners as follows:
3-21 (1) one member from the Board of Nurse Examiners, who
3-22 shall serve as the presiding officer;
3-23 (2) three members appointed from advocacy groups for
3-24 the disabled, including Advocacy, Inc., the Consortium For Citizens
3-25 With Disabilities, ADAPT of Texas, or similar advocacy groups;
3-26 (3) three members appointed from a list of persons
3-27 recommended by advocacy groups for the disabled, including
4-1 recommendations from Advocacy, Inc., the Consortium For Citizens
4-2 With Disabilities, ADAPT of Texas, or similar advocacy groups;
4-3 (4) one member from the Texas Nurses Association;
4-4 (5) one member from the Texas Association For Home
4-5 Care; and
4-6 (6) four members who are registered nurses in this
4-7 state, including two members who provide professional nursing
4-8 services to persons with disabilities in an "independent living
4-9 environment", as that term is defined in Section 142.001, Health
4-10 and Safety Code.
4-11 (c) The following shall serve as ex officio, nonvoting
4-12 members on the task force, appointed by the applicable state
4-13 agency:
4-14 (1) an individual from the Texas Department of Human
4-15 Services involved in the licensing of home and community support
4-16 services;
4-17 (2) an individual from the Texas Department of Human
4-18 Services involved in the regulation of long-term care services;
4-19 (3) an individual from the Texas Planning Council for
4-20 Developmental Disabilities;
4-21 (4) an individual from the state Medicaid Office of
4-22 the Health and Human Services Commission; and
4-23 (5) an individual from the Texas Department of Mental
4-24 Health and Mental Retardation involved in a community program.
4-25 (d) The task force shall hold its first meeting not later
4-26 than January 31, 2002.
4-27 (e) Not later than November 1, 2002, the task force shall
5-1 report its findings and recommendations to the speaker of the house
5-2 of representatives and the lieutenant governor. The report must
5-3 include any minority findings and recommendations on issues
5-4 regarding which the task force did not reach a consensus.
5-5 SECTION 3. This Act takes effect immediately if it receives
5-6 a vote of two-thirds of all the members elected to each house, as
5-7 provided by Section 39, Article III, Texas Constitution. If this
5-8 Act does not receive the vote necessary for immediate effect, this
5-9 Act takes effect September 1, 2001.