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.