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.
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