By Junell H.B. No. 803
77R1678 MXM-D
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. Subchapter D, Chapter 301, Occupations Code, is
1-6 amended by adding Section 301.1525 to read as follows:
1-7 Sec. 301.1525. NURSE FIRST ASSISTANTS. (a) In this section,
1-8 "nurse first assistant" means a registered nurse who:
1-9 (1) provides surgical first assisting services;
1-10 (2) is approved by the board to practice as a nurse
1-11 first assistant on the basis of completion of an advanced
1-12 educational program; and
1-13 (3) is certified as a nurse first assistant by an
1-14 organization recognized by the board.
1-15 (b) The board shall adopt rules to approve a registered
1-16 nurse as a nurse first assistant.
1-17 (c) At a minimum, the rules adopted under Subsection (b)
1-18 must require:
1-19 (1) completion of at least 2,000 hours of first
1-20 assisting a physician with surgery and related preoperative,
1-21 intraoperative, and postoperative care; and
1-22 (2) continuing education in providing first assistant
1-23 services in addition to any continuing education otherwise required
1-24 under Section 301.303.
2-1 SECTION 2. Section 1(9), Article 3.70-3C, Insurance Code, as
2-2 added by Chapter 1024, Acts of the 75th Legislature, Regular
2-3 Session, 1997, is amended to read as follows:
2-4 (9) "Practitioner" means a person who practices a
2-5 healing art and is:
2-6 (A) a practitioner described by Section 2(B),
2-7 Chapter 397, Acts of the 54th Legislature, 1955 (Article 3.70-2,
2-8 Vernon's Texas Insurance Code), or Article 21.52 of this code; or
2-9 (B) an occupational therapist, physical
2-10 therapist, nurse first assistant, or advanced practice nurse.
2-11 SECTION 3. Section 1, Article 21.52, Insurance Code, as
2-12 amended by Chapters 428 and 888, Acts of the 76th Legislature,
2-13 Regular Session, 1999, is amended to read as follows:
2-14 Sec. 1. DEFINITIONS. As used in this article:
2-15 (a) "health insurance policy" means any individual, group,
2-16 blanket, or franchise insurance policy, insurance agreement, or
2-17 group hospital service contract, providing benefits for medical or
2-18 surgical expenses incurred as a result of an accident or sickness;
2-19 (b) "doctor of podiatric medicine" includes D.P.M.,
2-20 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
2-21 (c) "doctor of optometry" includes optometrist, doctor of
2-22 optometry, and O.D.;
2-23 (d) "doctor of chiropractic" means a person who is licensed
2-24 by the Texas Board of Chiropractic Examiners to practice
2-25 chiropractic;
2-26 (e) "licensed dentist" means a person who is licensed to
2-27 practice dentistry by the State Board of Dental Examiners;
3-1 (f) "licensed audiologist" means a person who has received a
3-2 master's or doctorate degree in audiology from an accredited
3-3 college or university and is licensed as an audiologist by the
3-4 State Board of Examiners for Speech-Language Pathology and
3-5 Audiology;
3-6 (g) "licensed speech-language pathologist" means a person
3-7 who has received a master's or doctorate degree in speech-language
3-8 pathology from an accredited college or university and is licensed
3-9 as a speech-language pathologist by the State Board of Examiners
3-10 for Speech-Language Pathology and Audiology;
3-11 (h) "licensed master social worker--advanced clinical
3-12 practitioner" means a person who is licensed by the Texas State
3-13 Board of Social Worker Examiners as a licensed master social worker
3-14 with the order of recognition of advanced clinical practitioner;
3-15 (i) "licensed dietitian" means a person who is licensed by
3-16 the Texas State Board of Examiners of Dietitians;
3-17 (j) "licensed professional counselor" means a person who is
3-18 licensed by the Texas State Board of Examiners of Professional
3-19 Counselors;
3-20 (k) "psychologist" means a person licensed to practice
3-21 psychology by the Texas State Board of Examiners of Psychologists;
3-22 (l) "licensed marriage and family therapist" means a person
3-23 who is licensed by the Texas State Board of Examiners of Marriage
3-24 and Family Therapists;
3-25 (m) "licensed chemical dependency counselor" means a person
3-26 who is licensed by the Texas Commission on Alcohol and Drug Abuse;
3-27 (n) "licensed hearing instrument fitter and dispenser" means
4-1 a person who is licensed by the State Committee of Examiners in the
4-2 Fitting and Dispensing of Hearing Instruments;
4-3 (o) "licensed psychological associate" means a person who is
4-4 licensed by the Texas State Board of Examiners of Psychologists and
4-5 who practices under the supervision of a licensed psychologist;
4-6 (p) "occupational therapist" means a person who is licensed
4-7 to practice occupational therapy by the Texas Board of Occupational
4-8 Therapy Examiners;
4-9 (q) "physical therapist" means a person who practices
4-10 physical therapy and is licensed by the Texas Board of Physical
4-11 Therapy Examiners;
4-12 (r) "advanced practice nurse" means a person licensed by the
4-13 Board of Nurse Examiners and recognized by that board as an
4-14 advanced practice nurse; [and]
4-15 (s) [(r)] "licensed acupuncturist" means a person licensed
4-16 to practice acupuncture by the Texas State Board of Medical
4-17 Examiners.
4-18 (t) [(s)] "physician assistant" means a person licensed by
4-19 the Texas State Board of Physician Assistant Examiners; and
4-20 (u) "nurse first assistant" means a person licensed by the
4-21 Board of Nurse Examiners and recognized by that board as a nurse
4-22 first assistant.
4-23 SECTION 4. Section 3(a), Article 21.52, Insurance Code, as
4-24 amended by Chapters 428 and 888, Acts of the 76th Legislature,
4-25 Regular Session, 1999, is amended to read as follows:
4-26 (a) Any person who is issued, who is a party to, or who is a
4-27 beneficiary under any health insurance policy delivered, renewed,
5-1 or issued for delivery in this state by any insurance company,
5-2 association, or organization to which this article applies may
5-3 select:
5-4 (1) a licensed doctor of podiatric medicine, a
5-5 licensed dentist, or a doctor of chiropractic to perform the
5-6 medical or surgical services or procedures scheduled in the policy
5-7 which fall within the scope of the license of that practitioner;
5-8 (2) a licensed doctor of optometry to perform the
5-9 services or procedures scheduled in the policy which fall within
5-10 the scope of the license of that doctor of optometry;
5-11 (3) an occupational therapist to provide the services
5-12 scheduled in the policy which fall within the scope of the license
5-13 of that occupational therapist;
5-14 (4) a physical therapist to provide the services
5-15 scheduled in the policy which fall within the scope of the license
5-16 of that physical therapist;
5-17 (5) a licensed audiologist to measure hearing for the
5-18 purpose of determining the presence or extent of a hearing loss and
5-19 to provide aural rehabilitation services to a person with a hearing
5-20 loss if those services or procedures are scheduled in the policy;
5-21 (6) a licensed speech-language pathologist to evaluate
5-22 speech and language and to provide habilitative and rehabilitative
5-23 services to restore speech or language loss or to correct a speech
5-24 or language impairment if those services or procedures are
5-25 scheduled in the policy;
5-26 (7) a licensed master social worker--advanced clinical
5-27 practitioner to provide the services that fall within the scope of
6-1 the license of such certified practitioner and which are specified
6-2 as services within the terms of the policy of insurance, including
6-3 the provision of direct, diagnostic, preventive, or clinical
6-4 services to individuals, families, and groups whose functioning is
6-5 threatened or affected by social or psychological stress or health
6-6 impairment, if those services or procedures are scheduled in the
6-7 policy;
6-8 (8) a licensed dietitian including a provisional
6-9 licensed dietitian under a licensed dietitian's supervision to
6-10 provide the services that fall within the scope of the license of
6-11 that dietitian if those services are scheduled in the policy;
6-12 (9) a licensed professional counselor to provide the
6-13 services that fall within the scope of the license of that
6-14 professional if those services are scheduled in the policy;
6-15 (10) a licensed marriage and family therapist to
6-16 provide the services that fall within the scope of the license of
6-17 that professional if those services are scheduled in the policy;
6-18 (11) a psychologist to perform the services or
6-19 procedures scheduled in the policy that fall within the scope of
6-20 the license of that psychologist;
6-21 (12) a licensed chemical dependency counselor to
6-22 perform the services or procedures scheduled in the policy that
6-23 fall within the scope of the license of that practitioner;
6-24 (13) [(12)] a licensed acupuncturist to perform the
6-25 services or procedures scheduled in the policy that fall within the
6-26 scope of the license of that practitioner;
6-27 (14) [(13)] an advanced practice nurse to provide the
7-1 services scheduled in the policy that fall within the scope of the
7-2 license of that practitioner;
7-3 (15) [(14)] a physician assistant to provide the
7-4 services scheduled in the policy that fall within the scope of the
7-5 license of that practitioner;
7-6 (16) [(15)] a licensed hearing instrument fitter and
7-7 dispenser to provide the services or procedures scheduled in the
7-8 policy that fall within the scope of the license of that
7-9 practitioner; [or]
7-10 (17) [(16)] a licensed psychological associate to
7-11 provide the services that fall within the scope of the license of
7-12 that professional if those services are scheduled in the policy; or
7-13 (18) a nurse first assistant to provide the services
7-14 scheduled in the policy that fall within the scope of the license
7-15 of that practitioner.
7-16 SECTION 5. Sections 3(c) and (d), Article 21.52, Insurance
7-17 Code, are amended to read as follows:
7-18 (c) The payment or reimbursement by the insurance company,
7-19 association, or organization for services or procedures in
7-20 accordance with the payment schedule or the payment provisions in
7-21 the policy shall not be denied because the same were performed by a
7-22 licensed doctor of podiatric medicine, a licensed doctor of
7-23 optometry, a licensed doctor of chiropractic, a licensed dentist,
7-24 an occupational therapist, a physical therapist, a licensed
7-25 audiologist, a licensed speech-language pathologist, a licensed
7-26 master social worker--advanced clinical practitioner, a licensed
7-27 dietitian, a licensed professional counselor, a licensed marriage
8-1 and family therapist, a psychologist, a licensed psychological
8-2 associate, a licensed chemical dependency counselor, an advanced
8-3 practice nurse, a nurse first assistant, a physician assistant, a
8-4 licensed acupuncturist, or a licensed hearing instrument fitter and
8-5 dispenser.
8-6 (d) There shall not be any classification, differentiation,
8-7 or other discrimination in the payment schedule or the payment
8-8 provisions in a health insurance policy, nor in the amount or
8-9 manner of payment or reimbursement thereunder, between scheduled
8-10 services or procedures when performed by a doctor of podiatric
8-11 medicine, a doctor of optometry, a doctor of chiropractic, a
8-12 licensed dentist, an occupational therapist, a physical therapist,
8-13 a licensed audiologist, a licensed speech-language pathologist, a
8-14 licensed master social worker--advanced clinical practitioner, a
8-15 licensed dietitian, a licensed professional counselor, a licensed
8-16 marriage and family therapist, a psychologist, a licensed
8-17 psychological associate, a licensed chemical dependency counselor,
8-18 an advanced practice nurse to provide the services scheduled in the
8-19 policy, a nurse first assistant to provide the services scheduled
8-20 in the policy, a physician assistant to provide the services
8-21 scheduled in the policy, a licensed acupuncturist, or a licensed
8-22 hearing instrument fitter and dispenser which fall within the scope
8-23 of that practitioner's license or certification and the same
8-24 services or procedures when performed by any other practitioner of
8-25 the healing arts whose services or procedures are covered by the
8-26 policy. However, a health insurance policy may provide for a
8-27 different amount of payment or reimbursement for scheduled services
9-1 or procedures when performed by an advanced practice nurse, a nurse
9-2 first assistant, or physician assistant provided the reimbursement
9-3 methodology used to calculate the payment for the service or
9-4 procedure is the same methodology used to calculate the payment
9-5 when the service or procedure is provided by a physician.
9-6 SECTION 6. Section 32.027, Human Resources Code, is amended
9-7 by adding Subsection (j) to read as follows:
9-8 (j) The department shall assure that a recipient of medical
9-9 assistance under this chapter may select a nurse first assistant,
9-10 as defined by Section 301.1525, Occupations Code, to perform any
9-11 health care service or procedure covered under the medical
9-12 assistance program if the selected nurse first assistant is
9-13 authorized by law to perform the service or procedure.
9-14 SECTION 7. This Act takes effect September 1, 2001, and
9-15 applies only to a health insurance policy that is delivered, issued
9-16 for delivery, or renewed on or after January 1, 2002. A health
9-17 insurance policy that is delivered, issued for delivery, or renewed
9-18 before January 1, 2002, is governed by the law as it existed
9-19 immediately before the effective date of this Act, and that law is
9-20 continued in effect for that purpose.