1-1 By: Maxey (Senate Sponsor - Moncrief) H.B. No. 456 1-2 (In the Senate - Received from the House May 7, 2001; 1-3 May 7, 2001, read first time and referred to Committee on Health 1-4 and Human Services; May 11, 2001, reported favorably by the 1-5 following vote: Yeas 7, Nays 0; May 11, 2001, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to exemption from nursing license requirements for certain 1-9 services provided to persons with disabilities. 1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-11 SECTION 1. Section 531.051, Government Code, as added by 1-12 Section 1, Chapter 1288, Acts of the 76th Legislature, Regular 1-13 Session, 1999, is amended by adding Subsections (f), (g), and (h) 1-14 to read as follows: 1-15 (f) Section 301.251(a), Occupations Code, does not apply to 1-16 delivery of a service for which payment is provided under the 1-17 voucher payment program developed under this section if: 1-18 (1) the person who delivers the service: 1-19 (A) has not been denied a license under Chapter 1-20 301 or 302, Occupations Code; 1-21 (B) has not been issued a license under Chapter 1-22 301, Occupations Code, that is revoked or suspended; and 1-23 (C) provides a service listed under Subsection 1-24 (h); and 1-25 (2) the consumer who receives the service: 1-26 (A) has a functional disability and the service 1-27 would have been performed by the consumer, or the parent or 1-28 guardian for the consumer, except for that disability; and 1-29 (B) if: 1-30 (i) the consumer is capable of training 1-31 the person in the proper performance of the service, the consumer 1-32 directs the person to deliver the service; or 1-33 (ii) the consumer is not capable of 1-34 training the person in the proper performance of the service, the 1-35 consumer's parent or guardian is capable of training the person in 1-36 the proper performance of the service and directs the person to 1-37 deliver the service. 1-38 (g) If the person delivers the service under Subsection 1-39 (f)(2)(B)(ii), the parent or guardian must be present when the 1-40 service is performed or immediately accessible to the person who 1-41 delivers the service. If the person will perform the service when 1-42 the parent or guardian is not present, the parent or guardian must 1-43 observe the person performing the service at least once to assure 1-44 the parent or guardian that the person performing the service can 1-45 competently perform that service. 1-46 (h) The types of services that may be delivered under 1-47 Subsection (f) are: 1-48 (1) bathing, including feminine hygiene; 1-49 (2) grooming, including nail care, except for clients 1-50 with medical conditions like diabetes; 1-51 (3) feeding, including feeding through a permanently 1-52 placed feeding tube; 1-53 (4) routine skin care, including decubitus Stage 1; 1-54 (5) transferring, ambulation, or positioning; 1-55 (6) exercising and range of motion; 1-56 (7) the administering of a bowel and bladder program, 1-57 including suppositories, catheterization, enemas, manual 1-58 evacuation, and digital stimulation; and 1-59 (8) administering oral medications that are normally 1-60 self-administered, including administration through a gastrostomy 1-61 tube. 1-62 SECTION 2. (a) Not later than November 30, 2001, the Board 1-63 of Nurse Examiners shall appoint a task force to review and make 1-64 recommendations regarding the provision of health maintenance tasks 2-1 to persons with functional disabilities in independent living 2-2 environments, including analysis of: 2-3 (1) when delegation and assignment of those tasks by 2-4 registered nurses is appropriate and safe; 2-5 (2) the feasibility and desirability of separate 2-6 regulations relating to delegation and assignment of those tasks; 2-7 and 2-8 (3) procedures for resolving disagreements between 2-9 clients and registered nurses or home and community support service 2-10 agencies about the appropriateness and safety of delegating or 2-11 assigning tasks. 2-12 (b) The task force consists of 13 members appointed by the 2-13 Board of Nurse Examiners as follows: 2-14 (1) one member from the Board of Nurse Examiners, who 2-15 shall serve as the presiding officer; 2-16 (2) three members appointed from advocacy groups for 2-17 the disabled, including Advocacy, Inc., the Consortium For Citizens 2-18 With Disabilities, ADAPT of Texas, or similar advocacy groups; 2-19 (3) three members appointed from a list of persons 2-20 recommended by advocacy groups for the disabled, including 2-21 recommendations from Advocacy, Inc., the Consortium For Citizens 2-22 With Disabilities, ADAPT of Texas, or similar advocacy groups; 2-23 (4) one member from the Texas Nurses Association; 2-24 (5) one member from the Texas Association For Home 2-25 Care; and 2-26 (6) four members who are registered nurses in this 2-27 state, including two members who provide professional nursing 2-28 services to persons with disabilities in an "independent living 2-29 environment," as that term is defined in Section 142.001, Health 2-30 and Safety Code. 2-31 (c) The following shall serve as ex officio, nonvoting 2-32 members on the task force, appointed by the applicable state 2-33 agency: 2-34 (1) an individual from the Texas Department of Human 2-35 Services involved in the licensing of home and community support 2-36 services; 2-37 (2) an individual from the Texas Department of Human 2-38 Services involved in the regulation of long-term care services; 2-39 (3) an individual from the Texas Council for 2-40 Developmental Disabilities; 2-41 (4) an individual from the state Medicaid office of 2-42 the Health and Human Services Commission; and 2-43 (5) an individual from the Texas Department of Mental 2-44 Health and Mental Retardation involved in a community program. 2-45 (d) The task force shall hold its first meeting not later 2-46 than January 31, 2002. 2-47 (e) Not later than November 1, 2002, the task force shall 2-48 report its findings and recommendations to the speaker of the house 2-49 of representatives and the lieutenant governor. The report must 2-50 include any minority findings and recommendations on issues 2-51 regarding which the task force did not reach a consensus. 2-52 SECTION 3. This Act takes effect immediately if it receives 2-53 a vote of two-thirds of all the members elected to each house, as 2-54 provided by Section 39, Article III, Texas Constitution. If this 2-55 Act does not receive the vote necessary for immediate effect, this 2-56 Act takes effect September 1, 2001. 2-57 * * * * *