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.