1-1 By: Junell (Senate Sponsor - Duncan) H.B. No. 803
1-2 (In the Senate - Received from the House May 11, 2001;
1-3 May 11, 2001, read first time and referred to Committee on Business
1-4 and Commerce; May 11, 2001, reported favorably by the following
1-5 vote: Yeas 4, Nays 0; May 11, 2001, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to reimbursement for services provided by registered nurse
1-9 first assistants.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Section 1, Article 21.52, Insurance Code, as
1-12 amended by Chapters 428 and 888, Acts of the 76th Legislature,
1-13 Regular Session, 1999, is amended to read as follows:
1-14 Sec. 1. DEFINITIONS. As used in this article:
1-15 (a) "health insurance policy" means any individual,
1-16 group, blanket, or franchise insurance policy, insurance agreement,
1-17 or group hospital service contract, providing benefits for medical
1-18 or surgical expenses incurred as a result of an accident or
1-19 sickness;
1-20 (b) "doctor of podiatric medicine" includes D.P.M.,
1-21 podiatrist, doctor of surgical chiropody, D.S.C. and chiropodist;
1-22 (c) "doctor of optometry" includes optometrist, doctor
1-23 of optometry, and O.D.;
1-24 (d) "doctor of chiropractic" means a person who is
1-25 licensed by the Texas Board of Chiropractic Examiners to practice
1-26 chiropractic;
1-27 (e) "licensed dentist" means a person who is licensed
1-28 to practice dentistry by the State Board of Dental Examiners;
1-29 (f) "licensed audiologist" means a person who has
1-30 received a master's or doctorate degree in audiology from an
1-31 accredited college or university and is licensed as an audiologist
1-32 by the State Board of Examiners for Speech-Language Pathology and
1-33 Audiology;
1-34 (g) "licensed speech-language pathologist" means a
1-35 person who has received a master's or doctorate degree in
1-36 speech-language pathology from an accredited college or university
1-37 and is licensed as a speech-language pathologist by the State Board
1-38 of Examiners for Speech-Language Pathology and Audiology;
1-39 (h) "licensed master social worker--advanced clinical
1-40 practitioner" means a person who is licensed by the Texas State
1-41 Board of Social Worker Examiners as a licensed master social worker
1-42 with the order of recognition of advanced clinical practitioner;
1-43 (i) "licensed dietitian" means a person who is
1-44 licensed by the Texas State Board of Examiners of Dietitians;
1-45 (j) "licensed professional counselor" means a person
1-46 who is licensed by the Texas State Board of Examiners of
1-47 Professional Counselors;
1-48 (k) "psychologist" means a person licensed to practice
1-49 psychology by the Texas State Board of Examiners of Psychologists;
1-50 (l) "licensed marriage and family therapist" means a
1-51 person who is licensed by the Texas State Board of Examiners of
1-52 Marriage and Family Therapists;
1-53 (m) "licensed chemical dependency counselor" means a
1-54 person who is licensed by the Texas Commission on Alcohol and Drug
1-55 Abuse;
1-56 (n) "licensed hearing instrument fitter and dispenser"
1-57 means a person who is licensed by the State Committee of Examiners
1-58 in the Fitting and Dispensing of Hearing Instruments;
1-59 (o) "licensed psychological associate" means a person
1-60 who is licensed by the Texas State Board of Examiners of
1-61 Psychologists and who practices under the supervision of a licensed
1-62 psychologist;
1-63 (p) "occupational therapist" means a person who is
1-64 licensed to practice occupational therapy by the Texas Board of
2-1 Occupational Therapy Examiners;
2-2 (q) "physical therapist" means a person who practices
2-3 physical therapy and is licensed by the Texas Board of Physical
2-4 Therapy Examiners;
2-5 (r) "advanced practice nurse" means a person licensed
2-6 by the Board of Nurse Examiners and recognized by that board as an
2-7 advanced practice nurse; [and]
2-8 (s) [(r)] "licensed acupuncturist" means a person
2-9 licensed to practice acupuncture by the Texas State Board of
2-10 Medical Examiners;[.]
2-11 (t) [(s)] "physician assistant" means a person
2-12 licensed by the Texas State Board of Physician Assistant Examiners;
2-13 and
2-14 (u) "nurse first assistant" has the meaning assigned
2-15 by Section 301.1525, Occupations Code.
2-16 SECTION 2. Section 3(a), Article 21.52, Insurance Code, as
2-17 amended by Chapters 428 and 888, Acts of the 76th Legislature,
2-18 Regular Session, 1999, is amended to read as follows:
2-19 (a) Any person who is issued, who is a party to, or who is a
2-20 beneficiary under any health insurance policy delivered, renewed,
2-21 or issued for delivery in this state by any insurance company,
2-22 association, or organization to which this article applies may
2-23 select:
2-24 (1) a licensed doctor of podiatric medicine, a
2-25 licensed dentist, or a doctor of chiropractic to perform the
2-26 medical or surgical services or procedures scheduled in the policy
2-27 which fall within the scope of the license of that practitioner;
2-28 (2) a licensed doctor of optometry to perform the
2-29 services or procedures scheduled in the policy which fall within
2-30 the scope of the license of that doctor of optometry;
2-31 (3) an occupational therapist to provide the services
2-32 scheduled in the policy which fall within the scope of the license
2-33 of that occupational therapist;
2-34 (4) a physical therapist to provide the services
2-35 scheduled in the policy which fall within the scope of the license
2-36 of that physical therapist;
2-37 (5) a licensed audiologist to measure hearing for the
2-38 purpose of determining the presence or extent of a hearing loss and
2-39 to provide aural rehabilitation services to a person with a hearing
2-40 loss if those services or procedures are scheduled in the policy;
2-41 (6) a licensed speech-language pathologist to evaluate
2-42 speech and language and to provide habilitative and rehabilitative
2-43 services to restore speech or language loss or to correct a speech
2-44 or language impairment if those services or procedures are
2-45 scheduled in the policy;
2-46 (7) a licensed master social worker--advanced clinical
2-47 practitioner to provide the services that fall within the scope of
2-48 the license of such certified practitioner and which are specified
2-49 as services within the terms of the policy of insurance, including
2-50 the provision of direct, diagnostic, preventive, or clinical
2-51 services to individuals, families, and groups whose functioning is
2-52 threatened or affected by social or psychological stress or health
2-53 impairment, if those services or procedures are scheduled in the
2-54 policy;
2-55 (8) a licensed dietitian including a provisional
2-56 licensed dietitian under a licensed dietitian's supervision to
2-57 provide the services that fall within the scope of the license of
2-58 that dietitian if those services are scheduled in the policy;
2-59 (9) a licensed professional counselor to provide the
2-60 services that fall within the scope of the license of that
2-61 professional if those services are scheduled in the policy;
2-62 (10) a licensed marriage and family therapist to
2-63 provide the services that fall within the scope of the license of
2-64 that professional if those services are scheduled in the policy;
2-65 (11) a psychologist to perform the services or
2-66 procedures scheduled in the policy that fall within the scope of
2-67 the license of that psychologist;
2-68 (12) a licensed chemical dependency counselor to
2-69 perform the services or procedures scheduled in the policy that
3-1 fall within the scope of the license of that practitioner;
3-2 (13) [(12)] a licensed acupuncturist to perform the
3-3 services or procedures scheduled in the policy that fall within the
3-4 scope of the license of that practitioner;
3-5 (14) [(13)] an advanced practice nurse to provide the
3-6 services scheduled in the policy that fall within the scope of the
3-7 license of that practitioner;
3-8 (15) [(14)] a physician assistant to provide the
3-9 services scheduled in the policy that fall within the scope of the
3-10 license of that practitioner;
3-11 (16) [(15)] a licensed hearing instrument fitter and
3-12 dispenser to provide the services or procedures scheduled in the
3-13 policy that fall within the scope of the license of that
3-14 practitioner; [or]
3-15 (17) [(16)] a licensed psychological associate to
3-16 provide the services that fall within the scope of the license of
3-17 that professional if those services are scheduled in the policy; or
3-18 (18) a nurse first assistant to provide the services
3-19 scheduled in the policy that:
3-20 (A) fall within the scope of the license of that
3-21 practitioner; and
3-22 (B) are requested by the physician whom the
3-23 nurse is assisting.
3-24 SECTION 3. Sections 3(c) and (d), Article 21.52, Insurance
3-25 Code, are amended to read as follows:
3-26 (c) The payment or reimbursement by the insurance company,
3-27 association, or organization for services or procedures in
3-28 accordance with the payment schedule or the payment provisions in
3-29 the policy shall not be denied because the same were performed by a
3-30 licensed doctor of podiatric medicine, a licensed doctor of
3-31 optometry, a licensed doctor of chiropractic, a licensed dentist,
3-32 an occupational therapist, a physical therapist, a licensed
3-33 audiologist, a licensed speech-language pathologist, a licensed
3-34 master social worker--advanced clinical practitioner, a licensed
3-35 dietitian, a licensed professional counselor, a licensed marriage
3-36 and family therapist, a psychologist, a licensed psychological
3-37 associate, a licensed chemical dependency counselor, an advanced
3-38 practice nurse, a nurse first assistant, a physician assistant, a
3-39 licensed acupuncturist, or a licensed hearing instrument fitter and
3-40 dispenser.
3-41 (d) There shall not be any classification, differentiation,
3-42 or other discrimination in the payment schedule or the payment
3-43 provisions in a health insurance policy, nor in the amount or
3-44 manner of payment or reimbursement thereunder, between scheduled
3-45 services or procedures when performed by a doctor of podiatric
3-46 medicine, a doctor of optometry, a doctor of chiropractic, a
3-47 licensed dentist, an occupational therapist, a physical therapist,
3-48 a licensed audiologist, a licensed speech-language pathologist, a
3-49 licensed master social worker--advanced clinical practitioner, a
3-50 licensed dietitian, a licensed professional counselor, a licensed
3-51 marriage and family therapist, a psychologist, a licensed
3-52 psychological associate, a licensed chemical dependency counselor,
3-53 an advanced practice nurse to provide the services scheduled in the
3-54 policy, a nurse first assistant to provide the services scheduled
3-55 in the policy and requested by the physician whom the nurse is
3-56 assisting, a physician assistant to provide the services scheduled
3-57 in the policy, a licensed acupuncturist, or a licensed hearing
3-58 instrument fitter and dispenser which fall within the scope of that
3-59 practitioner's license or certification and the same services or
3-60 procedures when performed by any other practitioner of the healing
3-61 arts whose services or procedures are covered by the policy.
3-62 However, a health insurance policy may provide for a different
3-63 amount of payment or reimbursement for scheduled services or
3-64 procedures when performed by an advanced practice nurse, a nurse
3-65 first assistant, or physician assistant provided the reimbursement
3-66 methodology used to calculate the payment for the service or
3-67 procedure is the same methodology used to calculate the payment
3-68 when the service or procedure is provided by a physician.
3-69 SECTION 4. Section 32.027, Human Resources Code, is amended
4-1 by adding Subsection (j) to read as follows:
4-2 (j) The department shall assure that a recipient of medical
4-3 assistance under this chapter may select a nurse first assistant,
4-4 as defined by Section 301.1525, Occupations Code, to perform any
4-5 health care service or procedure covered under the medical
4-6 assistance program if:
4-7 (1) the selected nurse first assistant is authorized
4-8 by law to perform the service or procedure; and
4-9 (2) the physician requests that the service or
4-10 procedure be performed by the nurse first assistant.
4-11 SECTION 5. Subchapter D, Chapter 301, Occupations Code, is
4-12 amended by adding Section 301.1525 to read as follows:
4-13 Sec. 301.1525. NURSE FIRST ASSISTANTS. (a) In this section,
4-14 "nurse first assistant" means a registered nurse who:
4-15 (1) is certified in perioperative nursing by an
4-16 organization recognized by the board; and
4-17 (2) has completed a nurse first assistant educational
4-18 program approved by an organization recognized by the board.
4-19 (b) The board may adopt rules governing nurse first
4-20 assistants.
4-21 (c) A health maintenance organization or an insurer,
4-22 including an insurer offering a preferred provider benefit plan,
4-23 may not, by contract or any other method, require a physician to
4-24 use the services of a nurse first assistant.
4-25 SECTION 6. Section 1(9), Article 3.70-3C, Insurance Code, as
4-26 added by Chapter 1024, Acts of the 75th Legislature, Regular
4-27 Session, 1997, is amended to read as follows:
4-28 (9) "Practitioner" means a person who practices a
4-29 healing art and is[:]
4-30 [(A)] a practitioner described by:
4-31 (A) Section 2(B), Chapter 397, Acts of the 54th
4-32 Legislature, 1955 (Article 3.70-2, Vernon's Texas Insurance
4-33 Code);[,] or
4-34 (B) Article 21.52 of this code[; or]
4-35 [(B) an occupational therapist, physical
4-36 therapist, or advanced practice nurse].
4-37 SECTION 7. Section 3, Article 3.70-3C, Insurance Code, as
4-38 added by Chapter 1024, Acts of the 75th Legislature, Regular
4-39 Session, 1997, is amended by adding Subsection (o) to read as
4-40 follows:
4-41 (o) A preferred provider may not refuse to contract with a
4-42 nurse first assistant, as defined by Section 301.1525, Occupations
4-43 Code, to be included in the provider's network or refuse to
4-44 reimburse the nurse first assistant for a covered service that a
4-45 physician has requested the nurse first assistant to perform.
4-46 SECTION 8. Section 14, Texas Health Maintenance Organization
4-47 Act (Article 20A.14, Vernon's Texas Insurance Code), is amended by
4-48 adding Subsection (o) to read as follows:
4-49 (o) A health maintenance organization may not refuse to
4-50 contract with a nurse first assistant, as defined by Section
4-51 301.1525, Occupations Code, to be included in the organization's
4-52 provider network or refuse to reimburse the nurse first assistant
4-53 for a covered service that a physician has requested the nurse
4-54 first assistant to perform.
4-55 SECTION 9. Subchapter B, Chapter 408, Labor Code, is amended
4-56 by adding Section 408.029 to read as follows:
4-57 Sec. 408.029. NURSE FIRST ASSISTANT SERVICES. An insurance
4-58 carrier may not refuse to reimburse a health care practitioner
4-59 solely because that practitioner is a nurse first assistant, as
4-60 defined by Section 301.1525, Occupations Code, for a covered
4-61 service that a physician providing health care services under this
4-62 subtitle has requested the nurse first assistant to perform.
4-63 SECTION 10. This Act takes effect September 1, 2001, and
4-64 applies only to a health insurance policy that is delivered, issued
4-65 for delivery, or renewed on or after January 1, 2002. A health
4-66 insurance policy that is delivered, issued for delivery, or renewed
4-67 before January 1, 2002, is governed by the law as it existed
4-68 immediately before the effective date of this Act, and that law is
4-69 continued in effect for that purpose.
5-1 * * * * *