By Junell                                              H.B. No. 803
         77R13016 E                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to reimbursement for services provided by registered nurse
 1-3     first assistants.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1. Section 1, Article 21.52, Insurance Code, as
 1-6     amended by Chapters 428 and 888, Acts of the 76th Legislature,
 1-7     Regular Session, 1999, is amended to read as follows:
 1-8           Sec. 1.  DEFINITIONS. As used in this article:
 1-9                 (a)  "health insurance policy" means any individual,
1-10     group, blanket, or franchise insurance policy, insurance agreement,
1-11     or group hospital service contract, providing benefits for medical
1-12     or surgical expenses incurred as a result of an accident or
1-13     sickness;
1-14                 (b)  "doctor of podiatric medicine" includes D.P.M.,
1-15     podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
1-16                 (c)  "doctor of optometry" includes optometrist, doctor
1-17     of optometry, and O.D.;
1-18                 (d)  "doctor of chiropractic" means a person who is
1-19     licensed by the Texas Board of Chiropractic Examiners to practice
1-20     chiropractic;
1-21                 (e)  "licensed dentist" means a person who is licensed
1-22     to practice dentistry by the State Board of Dental Examiners;
1-23                 (f)  "licensed audiologist" means a person who has
1-24     received a master's or doctorate degree in audiology from an
 2-1     accredited college or university and is licensed as an audiologist
 2-2     by the State Board of Examiners for Speech-Language Pathology and
 2-3     Audiology;
 2-4                 (g)  "licensed speech-language pathologist" means a
 2-5     person who has received a master's or doctorate degree in
 2-6     speech-language pathology from an accredited college or university
 2-7     and is licensed as a speech-language pathologist by the State Board
 2-8     of Examiners for Speech-Language Pathology and Audiology;
 2-9                 (h)  "licensed master social worker--advanced clinical
2-10     practitioner" means a person who is licensed by the Texas State
2-11     Board of Social Worker Examiners as a licensed master social worker
2-12     with the order of recognition of advanced clinical practitioner;
2-13                 (i)  "licensed dietitian" means a person who is
2-14     licensed by the Texas State Board of Examiners of Dietitians;
2-15                 (j)  "licensed professional counselor" means a person
2-16     who is licensed by the Texas State Board of Examiners of
2-17     Professional Counselors;
2-18                 (k)  "psychologist" means a person licensed to practice
2-19     psychology by the Texas State Board of Examiners of Psychologists;
2-20                 (l)  "licensed marriage and family therapist" means a
2-21     person who is licensed by the Texas State Board of Examiners of
2-22     Marriage and Family Therapists;
2-23                 (m)  "licensed chemical dependency counselor" means a
2-24     person who is licensed by the Texas Commission on Alcohol and Drug
2-25     Abuse;
2-26                 (n)  "licensed hearing instrument fitter and dispenser"
2-27     means a person who is licensed by the State Committee of Examiners
 3-1     in the Fitting and Dispensing of Hearing Instruments;
 3-2                 (o)  "licensed psychological associate" means a person
 3-3     who is licensed by the Texas State Board of Examiners of
 3-4     Psychologists and who practices under the supervision of a licensed
 3-5     psychologist;
 3-6                 (p)  "occupational therapist" means a person who is
 3-7     licensed to practice occupational therapy by the Texas Board of
 3-8     Occupational Therapy Examiners;
 3-9                 (q)  "physical therapist" means a person who practices
3-10     physical therapy and is licensed by the Texas Board of Physical
3-11     Therapy Examiners;
3-12                 (r)  "advanced practice nurse" means a person licensed
3-13     by the Board of Nurse Examiners and recognized by that board as an
3-14     advanced practice nurse; [and]
3-15                 (s) [(r)]  "licensed acupuncturist" means a person
3-16     licensed to practice acupuncture by the Texas State Board of
3-17     Medical Examiners;[.]
3-18                 (t) [(s)]  "physician assistant" means a person
3-19     licensed by the Texas State Board of Physician Assistant Examiners;
3-20     and
3-21                 (u)  "nurse first assistant" has the meaning assigned
3-22     by Section 301.1525, Occupations Code.
3-23           SECTION 2. Section 3(a), Article 21.52, Insurance Code, as
3-24     amended by Chapters 428 and 888, Acts of the 76th Legislature,
3-25     Regular Session, 1999, is amended to read as follows:
3-26           (a)  Any person who is issued, who is a party to, or who is a
3-27     beneficiary under any health insurance policy delivered, renewed,
 4-1     or issued for delivery in this state by any insurance company,
 4-2     association, or organization to which this article applies may
 4-3     select:
 4-4                 (1)  a licensed doctor of podiatric medicine, a
 4-5     licensed dentist, or a doctor of chiropractic to perform the
 4-6     medical or surgical services or procedures scheduled in the policy
 4-7     which fall within the scope of the license of that practitioner;
 4-8                 (2)  a licensed doctor of optometry to perform the
 4-9     services or procedures scheduled in the policy which fall within
4-10     the scope of the license of that doctor of optometry;
4-11                 (3)  an occupational therapist to provide the services
4-12     scheduled in the policy which fall within the scope of the license
4-13     of that occupational therapist;
4-14                 (4)  a physical therapist to provide the services
4-15     scheduled in the policy which fall within the scope of the license
4-16     of that physical therapist;
4-17                 (5)  a licensed audiologist to measure hearing for the
4-18     purpose of determining the presence or extent of a hearing loss and
4-19     to provide aural rehabilitation services to a person with a hearing
4-20     loss if those services or procedures are scheduled in the policy;
4-21                 (6)  a licensed speech-language pathologist to evaluate
4-22     speech and language and to provide habilitative and rehabilitative
4-23     services to restore speech or language loss or to correct a speech
4-24     or language impairment if those services or procedures are
4-25     scheduled in the policy;
4-26                 (7)  a licensed master social worker--advanced clinical
4-27     practitioner to provide the services that fall within the scope of
 5-1     the license of such certified practitioner and which are specified
 5-2     as services within the terms of the policy of insurance, including
 5-3     the provision of direct, diagnostic, preventive, or clinical
 5-4     services to individuals, families, and groups whose functioning is
 5-5     threatened or affected by social or psychological stress or health
 5-6     impairment, if those services or procedures are scheduled in the
 5-7     policy;
 5-8                 (8)  a licensed dietitian including a provisional
 5-9     licensed dietitian under a licensed dietitian's supervision to
5-10     provide the services that fall within the scope of the license of
5-11     that dietitian if those services are scheduled in the policy;
5-12                 (9)  a licensed professional counselor to provide the
5-13     services that fall within the scope of the license of that
5-14     professional if those services are scheduled in the policy;
5-15                 (10)  a licensed marriage and family therapist to
5-16     provide the services that fall within the scope of the license of
5-17     that professional if those services are scheduled in the policy;
5-18                 (11)  a psychologist to perform the services or
5-19     procedures scheduled in the policy that fall within the scope of
5-20     the license of that psychologist;
5-21                 (12)  a licensed chemical dependency counselor to
5-22     perform the services or procedures scheduled in the policy that
5-23     fall within the scope of the license of that practitioner;
5-24                 (13) [(12)]  a licensed acupuncturist to perform the
5-25     services or procedures scheduled in the policy that fall within the
5-26     scope of the license of that practitioner;
5-27                 (14) [(13)]  an advanced practice nurse to provide the
 6-1     services scheduled in the policy that fall within the scope of the
 6-2     license of that practitioner;
 6-3                 (15) [(14)]  a physician assistant to provide the
 6-4     services scheduled in the policy that fall within the scope of the
 6-5     license of that practitioner;
 6-6                 (16) [(15)]  a licensed hearing instrument fitter and
 6-7     dispenser to provide the services or procedures scheduled in the
 6-8     policy that fall within the scope of the license of that
 6-9     practitioner; [or]
6-10                 (17) [(16)]  a licensed psychological associate to
6-11     provide the services that fall within the scope of the license of
6-12     that professional if those services are scheduled in the policy; or
6-13                 (18)  a nurse first assistant to provide the services
6-14     scheduled in the policy that:
6-15                       (A)  fall within the scope of the license of that
6-16     practitioner; and
6-17                       (B)  are requested by the physician whom the
6-18     nurse is assisting.
6-19           SECTION 3.  Sections 3(c) and (d), Article 21.52, Insurance
6-20     Code, are amended to read as follows:
6-21           (c)  The payment or reimbursement by the insurance company,
6-22     association, or organization for services or procedures in
6-23     accordance with the payment schedule or the payment provisions in
6-24     the policy shall not be denied because the same were performed by a
6-25     licensed doctor of podiatric medicine, a licensed doctor of
6-26     optometry, a licensed doctor of chiropractic, a licensed dentist,
6-27     an occupational therapist, a physical therapist, a licensed
 7-1     audiologist, a licensed speech-language pathologist, a licensed
 7-2     master social worker--advanced clinical practitioner, a licensed
 7-3     dietitian, a licensed professional counselor, a licensed marriage
 7-4     and family therapist, a psychologist, a licensed psychological
 7-5     associate, a licensed chemical dependency counselor, an advanced
 7-6     practice nurse, a nurse first assistant, a physician assistant, a
 7-7     licensed acupuncturist, or a licensed hearing instrument fitter and
 7-8     dispenser.
 7-9           (d)  There shall not be any classification, differentiation,
7-10     or other discrimination in the payment schedule or the payment
7-11     provisions in a health insurance policy, nor in the amount or
7-12     manner of payment or reimbursement thereunder, between scheduled
7-13     services or procedures when performed by a doctor of podiatric
7-14     medicine, a doctor of optometry, a doctor of chiropractic, a
7-15     licensed dentist, an occupational therapist, a physical therapist,
7-16     a licensed audiologist, a licensed speech-language pathologist, a
7-17     licensed master social worker--advanced clinical practitioner, a
7-18     licensed dietitian, a licensed professional counselor, a licensed
7-19     marriage and family therapist, a psychologist, a licensed
7-20     psychological associate, a licensed chemical dependency counselor,
7-21     an advanced practice nurse to provide the services scheduled in the
7-22     policy, a nurse first assistant to provide the services scheduled
7-23     in the policy and requested by the physician whom the nurse is
7-24     assisting, a physician assistant to provide the services scheduled
7-25     in the policy, a licensed acupuncturist, or a licensed hearing
7-26     instrument fitter and dispenser which fall within the scope of that
7-27     practitioner's license or certification and the same services or
 8-1     procedures when performed by any other practitioner of the healing
 8-2     arts whose services or procedures are covered by the policy.
 8-3     However, a health insurance policy may provide for a different
 8-4     amount of payment or reimbursement for scheduled services or
 8-5     procedures when performed by an advanced practice nurse, a nurse
 8-6     first assistant, or physician assistant provided the reimbursement
 8-7     methodology used to calculate the payment for the service or
 8-8     procedure is the same methodology used to calculate the payment
 8-9     when the service or procedure is provided by a physician.
8-10           SECTION 4. Section 32.027, Human Resources Code, is amended
8-11     by adding Subsection (j) to read as follows:
8-12           (j)  The department shall assure that a recipient of medical
8-13     assistance under this chapter may select a nurse first assistant,
8-14     as defined by Section 301.1525, Occupations Code, to perform any
8-15     health care service or procedure covered under the medical
8-16     assistance program if:
8-17                 (1)  the selected nurse first assistant is authorized
8-18     by law to perform the service or procedure; and
8-19                 (2)  the physician requests that the service or
8-20     procedure be performed by the nurse first assistant.
8-21           SECTION 5. Subchapter D, Chapter 301, Occupations Code, is
8-22     amended by adding Section 301.1525 to read as follows:
8-23           Sec. 301.1525.  NURSE FIRST ASSISTANTS. (a)  In this section,
8-24     "nurse first assistant" means a registered nurse who:
8-25                 (1)  is certified in perioperative nursing by an
8-26     organization recognized by the board; and
8-27                 (2)  has completed a nurse first assistant educational
 9-1     program approved by an organization recognized by the board.
 9-2           (b)  The board may adopt rules governing nurse first
 9-3     assistants.
 9-4           (c)  A health maintenance organization or an insurer,
 9-5     including an insurer offering a preferred provider benefit plan,
 9-6     may not, by contract or any other method, require a physician to
 9-7     use the services of a nurse first assistant.
 9-8           SECTION 6. Section 1(9), Article 3.70-3C, Insurance Code, as
 9-9     added by Chapter 1024, Acts of the 75th Legislature, Regular
9-10     Session, 1997, is amended to read as follows:
9-11                 (9)  "Practitioner" means a person who practices a
9-12     healing art and is[:]
9-13                       [(A)]  a practitioner described by:
9-14                       (A)  Section 2(B), Chapter 397, Acts of the 54th
9-15     Legislature, 1955 (Article 3.70-2, Vernon's Texas Insurance
9-16     Code);[,] or
9-17                       (B)  Article 21.52 of this code[; or]
9-18                       [(B)  an occupational therapist, physical
9-19     therapist, or advanced practice nurse].
9-20           SECTION 7. Section 3, Article 3.70-3C, Insurance Code, as
9-21     added by Chapter 1024, Acts of the 75th Legislature, Regular
9-22     Session, 1997, is amended by adding Subsection (o) to read as
9-23     follows:
9-24           (o)  A preferred provider may not refuse to contract with a
9-25     nurse first assistant, as defined by Section 301.1525, Occupations
9-26     Code, to be included in the provider's network or refuse to
9-27     reimburse the nurse first assistant for a covered service that a
 10-1    physician has requested the nurse first assistant to perform.
 10-2          SECTION 8. Section 14, Texas Health Maintenance Organization
 10-3    Act (Article 20A.14, Vernon's Texas Insurance Code), is amended by
 10-4    adding Subsection (o) to read as follows:
 10-5          (o)  A health maintenance organization may not refuse to
 10-6    contract with a nurse first assistant, as defined by Section
 10-7    301.1525, Occupations Code, to be included in the organization's
 10-8    provider network or refuse to reimburse the nurse first assistant
 10-9    for a covered service that a physician has requested the nurse
10-10    first assistant to perform.
10-11          SECTION 9. Subchapter B, Chapter 408, Labor Code, is amended
10-12    by adding Section 408.029 to read as follows:
10-13          Sec. 408.029.  NURSE FIRST ASSISTANT SERVICES. An insurance
10-14    carrier may not refuse to reimburse a health care practitioner
10-15    solely because that practitioner is a nurse first assistant, as
10-16    defined by Section 301.1525, Occupations Code, for a covered
10-17    service that a physician providing health care services under this
10-18    subtitle has requested the nurse first assistant to perform.
10-19          SECTION 10. This Act takes effect September 1, 2001, and
10-20    applies only to a health insurance policy that is delivered, issued
10-21    for delivery, or renewed on or after January 1, 2002.  A health
10-22    insurance policy that is delivered, issued for delivery, or renewed
10-23    before January 1, 2002, is governed by the law as it existed
10-24    immediately before the effective date of this Act, and that law is
10-25    continued in effect for that purpose.