1-1                                   AN ACT
 1-2     relating to the regulation of surgical assistants; granting
 1-3     rulemaking authority; providing an administrative penalty.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1. Subtitle C, Title 3, Occupations Code, is amended
 1-6     by adding Chapter 206 to read as follows:
 1-7                      CHAPTER 206. SURGICAL ASSISTANTS
 1-8                      SUBCHAPTER A. GENERAL PROVISIONS
 1-9           Sec. 206.001. DEFINITIONS. In this chapter:
1-10                 (1)  "Advisory committee" means the advisory committee
1-11     created under this chapter.
1-12                 (2)  "Delegating physician" means a physician who is
1-13     licensed by the medical board either as a doctor of medicine or
1-14     doctor of osteopathic medicine and who delegates, to a licensed
1-15     surgical assistant, surgical assisting and oversees and accepts
1-16     responsibility for that surgical assisting.
1-17                 (3)  "Direct supervision" means supervision by a
1-18     delegating physician who is physically present and who personally
1-19     directs delegated acts and remains immediately available to
1-20     personally respond to any emergency until the patient is released
1-21     from the operating room or care and has been transferred, as
1-22     determined by medical board rule, to another physician.
1-23                 (4)  "Executive director" means the executive director
1-24     of the medical board.
 2-1                 (5)  "Medical board" means the Texas State Board of
 2-2     Medical Examiners.
 2-3                 (6)  "Surgical assisting" means providing aid under
 2-4     direct supervision in exposure, hemostasis, and other
 2-5     intraoperative technical functions that assist a physician in
 2-6     performing a safe operation with optimal results for the patient,
 2-7     including the delegated authority to provide local infiltration or
 2-8     the topical application of a local anesthetic at the operation
 2-9     site.  This term is synonymous with "first assisting."
2-10           Sec. 206.002.  APPLICABILITY. (a)  A person is not required
2-11     to hold a license under this chapter if the person is:
2-12                 (1)  a student enrolled in a surgical assistant
2-13     education program approved by the medical board who is assisting in
2-14     a surgical operation that is an integral part of the program of
2-15     study;
2-16                 (2)  a surgical assistant employed in the service of
2-17     the federal government while performing duties related to that
2-18     employment;
2-19                 (3)  a person acting under the delegated authority of a
2-20     licensed physician;
2-21                 (4)  a licensed health care worker acting within the
2-22     scope of the person's license;
2-23                 (5)  a registered nurse; or
2-24                 (6)  a licensed physician assistant.
2-25           (b)  This chapter does not affect the authority of a licensed
2-26     physician to delegate acts under Subtitle B.
2-27              (Sections 206.003-206.050 reserved for expansion
 3-1                      SUBCHAPTER B.  ADVISORY COMMITTEE
 3-2           Sec. 206.051.  ADVISORY COMMITTEE. (a)  The advisory
 3-3     committee is an informal advisory committee to the medical board
 3-4     and is not subject to Chapter 2110, Government Code.
 3-5           (b)  The advisory committee has no independent rulemaking
 3-6     authority.
 3-7           Sec. 206.052.  APPOINTMENT OF ADVISORY COMMITTEE. (a)  The
 3-8     advisory committee consists of six members appointed by the
 3-9     president of the medical board.  One member must be a registered
3-10     perioperative nurse with at least five years of clinical experience
3-11     as a registered perioperative nurse.  Each of the remaining members
3-12     must be:
3-13                 (1)  a practicing surgical assistant who has at least
3-14     five years of clinical experience as a surgical assistant; or
3-15                 (2)  a physician licensed in this state who supervises
3-16     a surgical assistant.
3-17           (b)  Appointments to the advisory committee shall be made
3-18     without regard to the race, color, disability, sex, religion, age,
3-19     or national origin of the appointees.
3-20           Sec. 206.053.  MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a)  In
3-21     this section, "Texas trade association" means a cooperative and
3-22     voluntarily joined association of business or professional
3-23     competitors in this state designed to assist its members and its
3-24     industry or profession in dealing with mutual business or
3-25     professional problems and in promoting their common interest.
3-26           (b)  A person may not be a member of the advisory committee
3-27     if:
 4-1                 (1)  the person is an officer, employee, or paid
 4-2     consultant of a Texas trade association in the field of surgical
 4-3     assisting; or
 4-4                 (2)  the person's spouse is an officer, manager, or
 4-5     paid consultant of a Texas trade association in the field of
 4-6     surgical assisting.
 4-7           (c)  A person may not be a member of the advisory committee
 4-8     if the person is required to register as a lobbyist under Chapter
 4-9     305, Government Code, because of the person's activities for
4-10     compensation on behalf of a profession related to the field of
4-11     surgical assisting.
4-12           Sec. 206.054.  TERMS; VACANCY. (a)  Members of the advisory
4-13     committee are appointed for two-year terms.  The terms of the
4-14     members expire on February 1 of each odd-numbered year.
4-15           (b)  If a vacancy occurs during a member's term, the
4-16     president of the medical board shall appoint a new member to fill
4-17     the unexpired term.
4-18           (c)  An advisory committee member may not serve more than two
4-19     consecutive full terms.
4-20           Sec. 206.055.  GROUNDS FOR REMOVAL. (a)  It is a ground for
4-21     removal from the advisory committee that a member:
4-22                 (1)  does not have at the time of appointment the
4-23     qualifications required by Section 206.052;
4-24                 (2)  does not maintain during service on the advisory
4-25     committee the qualifications required by Section 206.052;
4-26                 (3)  is ineligible for membership under Section
4-27     206.053; or
 5-1                 (4)  cannot, because of illness or disability,
 5-2     discharge the member's duties for a substantial part of the
 5-3     member's term.
 5-4           (b)  The validity of an action of the committee is not
 5-5     affected by the fact that it is taken when a ground for removal of
 5-6     a committee member exists.
 5-7           Sec. 206.056.  OFFICERS. The president of the medical board
 5-8     shall designate biennially a committee member as the presiding
 5-9     officer of the advisory committee to serve in that capacity at the
5-10     will of the president.
5-11           Sec. 206.057.  PER DIEM. An advisory committee member is not
5-12     entitled to reimbursement for travel expenses or compensation.
5-13           Sec. 206.058.  MEETINGS. (a)  The advisory committee shall
5-14     meet as requested by the medical board.
5-15           (b)  A meeting may be held by telephone conference call.
5-16              (Sections 206.059-206.100 reserved for expansion
5-17              SUBCHAPTER C. POWERS AND DUTIES OF MEDICAL BOARD
5-18           Sec. 206.101.  GENERAL POWERS AND DUTIES. The medical board
5-19     shall:
5-20                 (1)  establish qualifications for a surgical assistant
5-21     to practice in this state;
5-22                 (2)  establish requirements for an examination for a
5-23     license to practice as a surgical assistant;
5-24                 (3)  establish minimum education and training
5-25     requirements necessary for a license to practice as a surgical
5-26     assistant;
5-27                 (4)  prescribe the application form for a license to
 6-1     practice as a surgical assistant; and
 6-2                 (5)  develop an approved program of mandatory
 6-3     continuing education and the manner in which attendance at all
 6-4     approved courses, clinics, forums, lectures, programs, or seminars
 6-5     is monitored and recorded.
 6-6           Sec. 206.102.  ANNUAL REPORT.  (a)  The medical board shall
 6-7     prepare annually a complete and detailed written report accounting
 6-8     for all funds received and disbursed by the medical board under
 6-9     this chapter during the preceding fiscal year.
6-10           (b)  The annual report must meet the reporting requirements
6-11     applicable to financial reporting provided in the General
6-12     Appropriations Act.
6-13           Sec. 206.103.  GIFTS, GRANTS, AND DONATIONS. In addition to
6-14     any fees paid to the medical board or money appropriated to the
6-15     medical board, the medical board may receive and accept under this
6-16     chapter a gift, grant, donation, or other item of value from any
6-17     source, including the United States or a private source.
6-18              (Sections 206.104-206.150 reserved for expansion
6-19          SUBCHAPTER D. PUBLIC INTEREST INFORMATION; COMPLAINT AND
6-20                          INVESTIGATIVE INFORMATION
6-21           Sec. 206.151.  PUBLIC PARTICIPATION. (a)  The medical board
6-22     shall develop and implement policies that provide the public with a
6-23     reasonable opportunity to appear before the medical board and speak
6-24     on any issue relating to surgical assistants.
6-25           (b)  The executive director of the medical board shall
6-26     prepare and maintain a written plan that describes how a person who
6-27     does not speak English may be provided reasonable access to the
 7-1     medical board's programs and services under this chapter.
 7-2           Sec. 206.152.  PUBLIC INTEREST INFORMATION. (a)  The medical
 7-3     board shall prepare information of public interest describing the
 7-4     functions of the medical board and the procedures by which
 7-5     complaints are filed and resolved under this chapter.
 7-6           (b)  The medical board shall make the information available
 7-7     to the public and appropriate state agencies.
 7-8           Sec. 206.153.  COMPLAINTS. (a)  The medical board by rule
 7-9     shall establish methods by which consumers and service recipients
7-10     are notified of the name, mailing address, and telephone number of
7-11     the medical board for the purpose of directing complaints about
7-12     licensed surgical assistants to the medical board.
7-13           (b)  The medical board shall list with its regular telephone
7-14     number any toll-free telephone number established under other state
7-15     law that may be called to present a complaint about a licensed
7-16     surgical assistant.
7-17           Sec. 206.154.  RECORDS OF COMPLAINTS. (a)  The medical board
7-18     shall maintain a file on each written complaint filed with the
7-19     medical board under this chapter.  The file must include:
7-20                 (1)  the name of the person who filed the complaint;
7-21                 (2)  the date the complaint is received by the medical
7-22     board;
7-23                 (3)  the subject matter of the complaint;
7-24                 (4)  the name of each person contacted in relation to
7-25     the complaint;
7-26                 (5)  a summary of the results of the review or
7-27     investigation of the complaint; and
 8-1                 (6)  an explanation of the reason the file was closed,
 8-2     if the medical board closed the file without taking action other
 8-3     than to investigate the complaint.
 8-4           (b)  The medical board shall provide to the person filing the
 8-5     complaint and to each person who is a subject of the complaint a
 8-6     copy of the medical board's policies and procedures relating to
 8-7     complaint investigation and resolution.  A person who reports a
 8-8     complaint by phone shall be given information on how to file a
 8-9     written complaint.
8-10           (c)  The medical board, at least quarterly and until final
8-11     disposition of the complaint, shall notify the person filing the
8-12     complaint and each person who is a subject of the complaint of the
8-13     status of the investigation unless the notice would jeopardize an
8-14     undercover investigation.
8-15           Sec. 206.155.  LICENSE HOLDER ACCESS TO COMPLAINT
8-16     INFORMATION. (a)  The medical board shall provide a license holder
8-17     who is the subject of a formal complaint filed under this chapter
8-18     with access to all information in its possession that the medical
8-19     board intends to offer into evidence in presenting its case in
8-20     chief at the contested hearing on the complaint, subject to any
8-21     other privilege or restriction established by rule, statute, or
8-22     legal precedent.  The medical board shall provide the information
8-23     not later than the 30th day after receipt of a written request from
8-24     the license holder or the license holder's counsel, unless good
8-25     cause is shown for delay.
8-26           (b)  Notwithstanding Subsection (a), the medical board is not
8-27     required to provide:
 9-1                 (1)  medical board investigative reports;
 9-2                 (2)  investigative memoranda;
 9-3                 (3)  the identity of a nontestifying complainant;
 9-4                 (4)  attorney-client communications;
 9-5                 (5)  attorney work product; or
 9-6                 (6)  other material covered by a privilege recognized
 9-7     by the Texas Rules of Civil Procedure or the Texas Rules of
 9-8     Evidence.
 9-9           (c)  The provision of information does not constitute a
9-10     waiver of privilege or confidentiality under this chapter or other
9-11     law.
9-12           Sec. 206.156.  HEALTH CARE ENTITY REQUEST FOR INFORMATION. On
9-13     the written request of a health care entity, the medical board
9-14     shall provide to the entity:
9-15                 (1)  information about a complaint filed against a
9-16     license holder that was resolved after investigation by:
9-17                       (A)  a disciplinary order of the medical board;
9-18     or
9-19                       (B)  an agreed settlement; and
9-20                 (2)  the basis of and current status of any complaint
9-21     under active investigation that has been referred by the executive
9-22     director or the director's designee for legal action.
9-23           Sec. 206.157.  CONFIDENTIALITY OF INVESTIGATIVE INFORMATION.
9-24     A complaint, adverse report, investigation file, or other report,
9-25     the identity of and reports made by a physician or surgical
9-26     assistant performing or supervising compliance monitoring for the
9-27     medical board, or other investigative information in the possession
 10-1    of or received or gathered by the medical board, medical board
 10-2    employee or agent relating to a license holder, a license
 10-3    application, or a criminal investigation or proceeding is
 10-4    privileged and confidential and is not subject to discovery,
 10-5    subpoena, or other means of legal compulsion for release to any
 10-6    person other than the medical board or medical board employee or
 10-7    agent involved in license holder discipline.
 10-8          Sec. 206.158.  PERMITTED DISCLOSURE OF INVESTIGATIVE
 10-9    INFORMATION. (a)  Investigative information in the possession of
10-10    the medical board, medical board employee, or agent that relates to
10-11    the discipline of a license holder may be disclosed to:
10-12                (1)  a licensing authority in another state or a
10-13    territory or country in which the license holder  is licensed or
10-14    has applied for a license; or
10-15                (2)  a peer review committee reviewing:
10-16                      (A)  an application for privileges; or
10-17                      (B)  the qualifications of the license holder
10-18    with respect to retaining privileges.
10-19          (b)  If the investigative information in the possession of
10-20    the medical board or a medical board employee or agent indicates a
10-21    crime may have been committed, the medical board shall report the
10-22    information to the proper law enforcement agency.  The medical
10-23    board shall cooperate with and assist all law enforcement agencies
10-24    conducting criminal investigations of a license holder by providing
10-25    information relevant to the investigation.  Confidential
10-26    information disclosed by the medical board to a law enforcement
10-27    agency remains confidential and may not be disclosed by the law
 11-1    enforcement agency except as necessary to further the
 11-2    investigation.
 11-3          Sec. 206.159.  IMMUNITY AND REPORTING REQUIREMENTS. (a)  A
 11-4    medical peer review committee in this state, a quality assurance
 11-5    committee in this state, a surgical assistant, a surgical assistant
 11-6    student, a physician practicing medicine in this state, or any
 11-7    person usually present in an operating room, including a nurse or
 11-8    surgical technologist, shall report relevant information to the
 11-9    advisory committee related to the acts of a surgical assistant in
11-10    this state if, in that person's opinion, a surgical assistant poses
11-11    a continuing threat to the public welfare through the person's
11-12    practice as a surgical assistant.  The duty to report under this
11-13    section may not be nullified through contract.
11-14          (b)  A person who, without malice, furnishes records,
11-15    information, or assistance to the advisory committee under this
11-16    section is immune from any civil liability arising from that action
11-17    in a suit against the person brought by or on behalf of a surgical
11-18    assistant who is reported under this section.
11-19          (c)  Sections 160.002, 160.003, 160.006, 160.007, 160.009,
11-20    160.013, and 160.014 apply to medical peer review regarding a
11-21    licensed surgical assistant.
11-22             (Sections 206.160-206.200 reserved for expansion
11-23                    SUBCHAPTER E.  LICENSE REQUIREMENTS
11-24          Sec. 206.201.  LICENSE REQUIRED. (a)  Except as provided by
11-25    Section 206.002, a person may not practice as a surgical assistant
11-26    unless the person is licensed under this chapter.
11-27          (b)  Unless the person holds a license under this chapter, a
 12-1    person may not use, in connection with the person's name:
 12-2                (1)  the title "Licensed Surgical Assistant"; or
 12-3                (2)  any other designation that would imply that the
 12-4    person is a licensed surgical assistant.
 12-5          Sec. 206.202.  LICENSE APPLICATION. An applicant for a
 12-6    license must:
 12-7                (1)  file a written application with the medical board
 12-8    on a form prescribed by the medical board; and
 12-9                (2)  pay the application fee set by the medical board.
12-10          Sec. 206.203.  LICENSE ELIGIBILITY. (a)  Except as provided
12-11    by Section 206.206, to be eligible for a license, a person must:
12-12                (1)  be of good moral character;
12-13                (2)  have not been convicted of a felony or a crime
12-14    involving moral turpitude;
12-15                (3)  not use drugs or alcohol to an extent that affects
12-16    the applicant's professional competency;
12-17                (4)  not have had a license or certification revoked by
12-18    a licensing agency or by a certifying professional organization;
12-19    and
12-20                (5)  not have engaged in fraud or deceit in applying
12-21    for a license under this chapter.
12-22          (b)  In addition to meeting the requirements of Subsection
12-23    (a), a person must:
12-24                (1)  pass the examination required by Section 206.204;
12-25                (2)  hold at least an associate's degree based on
12-26    completion of an educational program that is substantially
12-27    equivalent to the education required for a registered nurse or
 13-1    physician assistant who specializes in surgical assisting;
 13-2                (3)  demonstrate to the satisfaction of the medical
 13-3    board the completion of full-time work experience performed in this
 13-4    country under the direct supervision of a physician licensed in
 13-5    this country and consisting of at least 2,000 hours of performance
 13-6    as an assistant in surgical procedures for the three years
 13-7    preceding the date of application; and
 13-8                (4)  possess a current certification by a national
 13-9    certifying body approved by the medical board.
13-10          (c)  A degree program described by Subsection (b)(2) must
13-11    contain a clinical component and must include courses in anatomy,
13-12    physiology, basic pharmacology, aseptic techniques, operative
13-13    procedures, chemistry, microbiology, and pathophysiology.
13-14          Sec. 206.204.  EXAMINATION. An applicant for a surgical
13-15    assistant license must pass a surgical assistant examination
13-16    approved by the medical board.  Any written portion of the
13-17    examination must be validated by an independent testing
13-18    professional.
13-19          Sec. 206.205.  SPECIAL ELIGIBILITY FOR LICENSE. (a)  A person
13-20    who is otherwise eligible for a license under Section 206.203 is
13-21    not required to take the examination required by Section
13-22    206.203(b)(1) if the person:
13-23                (1)  passed a surgical assistant examination required
13-24    for certification under Section 206.203(b)(4) that the medical
13-25    board determines is substantially equivalent to the examination
13-26    required by the medical board under this chapter; and
13-27                (2)  applies for a license under this section before
 14-1    September 1, 2002.
 14-2          (b)  A person who is otherwise eligible for a license under
 14-3    Section 206.203 is not required to meet the educational
 14-4    requirements under Section 206.203(b)(2) if the person applies for
 14-5    a license under this section before September 1, 2002, and:
 14-6                (1)  will complete before the third anniversary of the
 14-7    date the license is issued under this subsection the following
 14-8    academic courses approved by the medical board:
 14-9                      (A)  anatomy;
14-10                      (B)  physiology;
14-11                      (C)  basic pharmacology;
14-12                      (D)  aseptic techniques;
14-13                      (E)  operative procedures;
14-14                      (F)  chemistry; and
14-15                      (G)  microbiology; or
14-16                (2)  has been continuously certified since September
14-17    30, 1995, as a surgical assistant by a national certifying body
14-18    approved by the medical board and has practiced full-time as a
14-19    surgical assistant under the direct supervision of a physician
14-20    licensed in this country.
14-21          (c)  A license issued under Subsection (b)(1) may not be
14-22    renewed after the third anniversary of the date of issuance unless
14-23    the license holder completes the academic courses described by
14-24    Subsection (b)(1).
14-25          Sec. 206.206.  TEMPORARY LICENSE.  (a)  The medical board
14-26    may, through the executive director, issue a temporary license to
14-27    an applicant who:
 15-1                (1)  submits an application on a form prescribed by the
 15-2    medical board;
 15-3                (2)  has passed an examination required by the medical
 15-4    board relating to the practice of surgical assisting;
 15-5                (3)  pays the appropriate fee set by the medical board;
 15-6                (4)  if licensed in another state, is licensed in good
 15-7    standing; and
 15-8                (5)  meets all the qualifications for a license under
 15-9    this chapter and is waiting for the next scheduled meeting of the
15-10    medical board for the license to be issued.
15-11          (b)  A temporary license is valid until the 100th day after
15-12    the date issued and may be extended until the 130th day after the
15-13    date issued.
15-14          Sec. 206.207.  ASSISTANCE BY MEDICAL BOARD.  The medical
15-15    board shall provide administrative and clerical employees as
15-16    necessary to administer this subchapter.
15-17          Sec. 206.208.  FEES. (a)  The medical board shall set and
15-18    collect fees in amounts that are reasonable and necessary to cover
15-19    the costs of administering and enforcing this chapter without the
15-20    use of any other funds generated by the medical board.
15-21          (b)  Fees collected by the medical board under this chapter
15-22    shall be deposited by the medical board in the state treasury to
15-23    the credit of an account in the general revenue fund and may be
15-24    spent to cover the costs of administering and enforcing this
15-25    chapter.  At the end of each fiscal biennium, the comptroller shall
15-26    transfer any surplus money remaining in the account to the general
15-27    revenue fund.
 16-1          (c)  All money paid to the medical board under this chapter
 16-2    is subject to Subchapter F, Chapter 404, Government Code.
 16-3          Sec. 206.209.  ISSUANCE AND RENEWAL OF LICENSE.  The medical
 16-4    board shall issue a surgical assistant license in this state to a
 16-5    person who meets the requirements of this chapter and the rules
 16-6    adopted under this chapter.
 16-7          Sec. 206.210.  LICENSE RENEWAL.  (a)  The medical board by
 16-8    rule shall provide for the annual renewal of a surgical assistant
 16-9    license.
16-10          (b)  The medical board by rule may adopt a system under which
16-11    licenses expire on various dates during the year. For the year in
16-12    which the license expiration date is changed, license fees shall be
16-13    prorated on a monthly basis so that each license holder pays only
16-14    that portion of the license fee that is allocable to the number of
16-15    months during which the license is valid. On renewal of the license
16-16    on the new expiration date, the total license renewal fee is
16-17    payable.
16-18          Sec. 206.211.  NOTICE OF LICENSE RENEWAL.  At least 30 days
16-19    before the expiration of a person's license, the medical board
16-20    shall send written notice of the impending license expiration to
16-21    the person at the license holder's last known address according to
16-22    the records of the medical board.
16-23          Sec. 206.212.  PROCEDURE FOR RENEWAL.  (a)  A person who is
16-24    otherwise eligible to renew a license may renew an unexpired
16-25    license by paying the required renewal fee to the medical board
16-26    before the expiration date of the license. A person whose license
16-27    has expired may not engage in activities that require a license
 17-1    until the license has been renewed under this section.
 17-2          (b)  If the person's license has been expired for 90 days or
 17-3    less, the person may renew the license by paying to the medical
 17-4    board one and one-half times the required renewal fee.
 17-5          (c)  If the person's license has been expired for longer than
 17-6    90 days but less than one year, the person may renew the license by
 17-7    paying to the medical board two times the required renewal fee.
 17-8          (d)  If the person's license has been expired for one year or
 17-9    longer, the person may not renew the license.  The person may
17-10    obtain a new license by complying with the requirements and
17-11    procedures for obtaining an original license.
17-12          Sec. 206.213.  RENEWAL OF EXPIRED LICENSE BY OUT-OF-STATE
17-13    PRACTITIONER.  (a)  If the person was licensed as a surgical
17-14    assistant in this state, moved to another state, and is currently
17-15    licensed as a surgical assistant and has been in practice as a
17-16    surgical assistant in the other state for the two years preceding
17-17    application, the person may renew an expired surgical assistant
17-18    license without reexamination.
17-19          (b)  The person must pay to the medical board a fee that is
17-20    equal to two times the required renewal fee for the license.
17-21          Sec. 206.214.  LICENSE HOLDER INFORMATION.  (a)  Each license
17-22    holder shall file with the medical board:
17-23                (1)  the license holder's mailing address;
17-24                (2)  the address of the license holder's residence;
17-25                (3)  the mailing address of each of the license
17-26    holder's offices; and
17-27                (4)  the address for the location of each of the
 18-1    license holder's offices if that address is different from the
 18-2    office's mailing address.
 18-3          (b)  A license holder shall:
 18-4                (1)  notify the medical board of a change of the
 18-5    license holder's residence or business address; and
 18-6                (2)  provide the medical board with the license
 18-7    holder's new address not later than the 30th day after the date the
 18-8    address change occurs.
 18-9             (Sections 206.215-206.250 reserved for expansion
18-10                      SUBCHAPTER F. SCOPE OF PRACTICE
18-11          Sec. 206.251.  SCOPE OF PRACTICE.  (a)  The practice of a
18-12    surgical assistant is limited to surgical assisting performed under
18-13    the direct supervision of a physician who delegated the acts.
18-14          (b)  The practice of a surgical assistant may be performed in
18-15    any place authorized by a delegating licensed physician, including
18-16    a clinic, hospital, ambulatory surgical center, or other
18-17    institutional setting.
18-18          Sec. 206.252.  SERVICE CONTRACTS.  This chapter does not:
18-19                (1)  limit the employment arrangement of a surgical
18-20    assistant licensed under this chapter;
18-21                (2)  require a surgeon or hospital to contract with a
18-22    surgical assistant;
18-23                (3)  authorize a health maintenance organization,
18-24    preferred provider organization, or health benefit plan to require
18-25    a surgeon to contract with a surgical assistant; or
18-26                (4)  require a hospital to use a licensed surgical
18-27    assistant for surgical assisting.
 19-1          Sec. 206.253.  CERTAIN PROHIBITED PRACTICES. (a)  This
 19-2    chapter does not authorize a person who holds a license issued
 19-3    under this chapter to engage in the practice of:
 19-4                (1)  medicine, as defined by Subtitle B, Title 3,
 19-5    Occupations Code;
 19-6                (2)  professional nursing, as defined by Chapter 301,
 19-7    Occupations Code; or
 19-8                (3)  nursing, as defined by Chapter 302, Occupations
 19-9    Code.
19-10          (b)  A health maintenance organization, preferred provider
19-11    organization, or health benefit plan may not require a registered
19-12    nurse or physician assistant to be licensed as a surgical assistant
19-13    as a condition for reimbursement.
19-14          (c)  A clinic, hospital, ambulatory surgical center, or other
19-15    facility may not require a registered nurse or physician assistant
19-16    to be licensed as a surgical assistant as a condition for assisting
19-17    at surgery at the facility.
19-18          Sec. 206.254.  ESTABLISHMENT OF CERTAIN FUNCTIONS AND
19-19    STANDARDS. A surgical assistant and the surgical assistant's
19-20    delegating physician shall ensure that:
19-21                (1)  the surgical assistant's scope of function is
19-22    identified;
19-23                (2)  the delegation of medical tasks is appropriate to
19-24    the surgical assistant's level of competence;
19-25                (3)  the relationship between the surgical assistant
19-26    and the delegating physician and the access of the surgical
19-27    assistant to the delegating physician are defined; and
 20-1                (4)  a process is established for evaluating the
 20-2    surgical assistant's performance.
 20-3             (Sections 206.255-206.300 reserved for expansion
 20-4                  SUBCHAPTER G.  DISCIPLINARY PROCEEDINGS
 20-5          Sec. 206.301.  DISCIPLINARY ACTIONS BY THE MEDICAL BOARD. (a)
 20-6    Except as provided by Section 206.305, on a determination that an
 20-7    applicant or license holder committed an act described by Section
 20-8    206.302, 206.303, or 206.304, the medical board by order shall take
 20-9    any of the following actions:
20-10                (1)  deny the person's license application or revoke
20-11    the person's license;
20-12                (2)  require the person to submit to the care,
20-13    counseling, or treatment of a health care practitioner designated
20-14    by the medical board;
20-15                (3)  stay enforcement of an order and place the person
20-16    on probation;
20-17                (4)  require the person to complete additional
20-18    training;
20-19                (5)  suspend, limit, or restrict the person's license,
20-20    including:
20-21                      (A)  limiting the practice of the person to, or
20-22    excluding from the person's practice, one or more specified
20-23    activities of surgical assisting; or
20-24                      (B)  stipulating periodic medical board review;
20-25                (6)  assess an administrative penalty against the
20-26    person as provided by Section 206.351;
20-27                (7)  order the person to perform public service; or
 21-1                (8)  administer a public reprimand.
 21-2          (b)  If the medical board stays enforcement of an order and
 21-3    places a person on probation, the medical board retains the right
 21-4    to vacate the probationary stay and enforce the original order for
 21-5    noncompliance with the terms of probation or impose any other
 21-6    remedial measure or sanction authorized by this section.
 21-7          (c)  The medical board may restore or reissue a license or
 21-8    remove any disciplinary or corrective measure that the medical
 21-9    board has imposed.
21-10          Sec. 206.302.  CONDUCT RELATED TO FRAUD OR MISREPRESENTATION.
21-11    The medical board may take action under Section 206.301 against an
21-12    applicant or license holder who:
21-13                (1)  fraudulently or deceptively obtains or attempts to
21-14    obtain a license;
21-15                (2)  fraudulently or deceptively uses a license;
21-16                (3)  falsely represents that the person is a physician;
21-17                (4)  acts in an unprofessional or dishonorable manner
21-18    that is likely to deceive, defraud, or injure the public;
21-19                (5)  fraudulently alters any surgical assistant
21-20    license, certificate, or diploma;
21-21                (6)  uses any surgical assistant license, certificate,
21-22    or diploma that has been fraudulently purchased, issued, or
21-23    counterfeited or that has been materially altered;
21-24                (7)  directly or indirectly  aids or abets the practice
21-25    as a surgical assistant by any person not licensed by the medical
21-26    board to practice as a surgical assistant; or
21-27                (8)  unlawfully advertises in a false, misleading, or
 22-1    deceptive manner as defined by Section 101.201.
 22-2          Sec. 206.303.  CONDUCT RELATED TO VIOLATION OF LAW. (a)  The
 22-3    medical board may take action under Section 206.301 against an
 22-4    applicant or license holder who:
 22-5                (1)  violates this chapter or a rule adopted under this
 22-6    chapter;
 22-7                (2)  is convicted of a felony, placed on deferred
 22-8    adjudication, or placed in a pretrial diversion program; or
 22-9                (3)  violates state law if the violation is connected
22-10    with practice as a surgical assistant.
22-11          (b)  A complaint, indictment, or conviction of a law
22-12    violation is not necessary for the medical board to act under
22-13    Subsection (a)(3).  Proof of the commission of the act while in
22-14    practice as a surgical assistant or under the guise of practice as
22-15    a surgical assistant is sufficient for action by the medical board.
22-16          Sec. 206.304.  CONDUCT INDICATING LACK OF FITNESS. (a)  The
22-17    medical board may take action under Section 206.301 against an
22-18    applicant or license holder who:
22-19                (1)  habitually uses drugs or intoxicating liquors to
22-20    the extent that, in the medical board's opinion, the person cannot
22-21    safely perform as a surgical assistant;
22-22                (2)  has been adjudicated as mentally incompetent;
22-23                (3)  has a mental or physical condition that renders
22-24    the person unable to safely perform as a surgical assistant;
22-25                (4)  has committed an act of moral turpitude;
22-26                (5)  has failed to practice as a surgical assistant in
22-27    an acceptable manner consistent with public health and welfare;
 23-1                (6)  has had the person's license or other
 23-2    authorization to practice as a surgical assistant suspended,
 23-3    revoked, or restricted;
 23-4                (7)  has had other disciplinary action taken by another
 23-5    state or by the uniformed services of the United States regarding
 23-6    practice as a surgical assistant;
 23-7                (8)  is removed or suspended or has disciplinary action
 23-8    taken by the person's peers in any professional association or
 23-9    society or is being disciplined by a licensed hospital or medical
23-10    staff of a hospital, including removal, suspension, limitation of
23-11    privileges, or other disciplinary action, if that action, in the
23-12    opinion of the medical board, was based on unprofessional conduct
23-13    or professional incompetence that was likely to harm the public;
23-14                (9)  has repeated or recurring meritorious health care
23-15    liability claims that, in the medical board's opinion, are evidence
23-16    of professional incompetence likely to harm the public; or
23-17                (10)  sexually abuses or exploits another person during
23-18    the license holder's practice as a surgical assistant.
23-19          (b)  For the purpose of Subsection (a)(7), a certified copy
23-20    of the record of the state or uniformed services of the United
23-21    States taking the action constitutes conclusive evidence of that
23-22    action.
23-23          (c)  An action described by Subsection (a)(8)  does not
23-24    constitute state action on the part of the association, society, or
23-25    hospital medical staff.
23-26          Sec. 206.305.  REHABILITATION ORDER. The medical board,
23-27    through an agreed order or after a contested case proceeding, may
 24-1    impose a rehabilitation order on an applicant, as a prerequisite
 24-2    for issuing a license, or on a license holder based on:
 24-3                (1)  the person's intemperate use of drugs or alcohol
 24-4    directly resulting from habituation or addiction caused by medical
 24-5    care or treatment provided by a physician;
 24-6                (2)  the person's intemperate use of drugs or alcohol
 24-7    during the five years preceding the date of the report that could
 24-8    adversely affect the person's ability to safely practice as a
 24-9    surgical assistant, if the person:
24-10                      (A)  reported the use; and
24-11                      (B)  has not previously been the subject of a
24-12    substance abuse related order of the medical board;
24-13                (3)  a judgment by a court that the person is of
24-14    unsound mind; or
24-15                (4)  the results of a mental or physical examination,
24-16    or an admission by the person, indicating that the person suffers
24-17    from a potentially dangerous limitation or an inability to practice
24-18    as a surgical assistant with reasonable skill and safety because of
24-19    illness or any other physical or mental condition.
24-20          Sec. 206.306.  EFFECT OF REHABILITATION ORDER. (a)  A
24-21    rehabilitation order imposed under Section 206.305 is a
24-22    nondisciplinary private order. If entered into by agreement, the
24-23    order is an agreed disposition or settlement agreement for purposes
24-24    of civil litigation and is exempt from Chapter 552, Government
24-25    Code.
24-26          (b)  The rehabilitation order must contain findings of fact
24-27    and conclusions of law. The order may impose a license revocation
 25-1    or suspension, a period of probation or restriction, or any other
 25-2    sanction authorized by this chapter or agreed to by the medical
 25-3    board and the person subject to the order.
 25-4          (c)  A violation of a rehabilitation order may result in
 25-5    disciplinary action under this chapter or under the terms of the
 25-6    agreed order.
 25-7          (d)  A violation of a rehabilitation order is grounds for
 25-8    disciplinary action based on:
 25-9                (1)  unprofessional or dishonorable conduct; or
25-10                (2)  any provision of this chapter that applies to the
25-11    conduct that resulted in the violation.
25-12          Sec. 206.307.  AUDIT OF REHABILITATION ORDER. (a)  The
25-13    medical board shall maintain a rehabilitation order imposed under
25-14    Section 206.305 in a confidential file. The file is subject to an
25-15    independent audit by the state auditor or a private auditor with
25-16    whom the board contracts to perform the audit to ensure that only
25-17    qualified license holders are subject to rehabilitation orders.
25-18          (b)  An audit may be performed at any time at the direction
25-19    of the medical board. The medical board shall ensure that an audit
25-20    is performed at least once in each three-year period.
25-21          (c)  The audit results are a matter of public record and
25-22    shall be reported in a manner that maintains the confidentiality of
25-23    each license holder who is the subject of a rehabilitation order.
25-24          Sec. 206.308.  SUBPOENA. (a)  The executive director, the
25-25    director's designee, or the secretary-treasurer of the board may
25-26    issue a subpoena or subpoena duces tecum:
25-27                (1)  to conduct an investigation or a contested case
 26-1    proceeding related to:
 26-2                      (A)  alleged misconduct by a surgical assistant;
 26-3                      (B)  an alleged violation of this chapter or
 26-4    another law related to the practice of a surgical assistant; or
 26-5                      (C)  the provision of health care under this
 26-6    chapter;
 26-7                (2)  for purposes of determining whether to issue,
 26-8    suspend, restrict, or revoke a license under this chapter; or
 26-9                (3)  for purposes of determining whether to issue or
26-10    deny a license under this chapter.
26-11          (b)  Failure to timely comply with a subpoena issued under
26-12    this section is a ground for:
26-13                (1)  disciplinary action by the medical board or
26-14    another licensing or regulatory agency with jurisdiction over the
26-15    person subject to the subpoena; and
26-16                (2)  denial of a license application.
26-17          Sec. 206.309.  PROTECTION OF PATIENT IDENTITY. In a
26-18    disciplinary investigation or proceeding conducted under this
26-19    chapter, the medical board shall protect the identity of each
26-20    patient whose medical records are examined and used in a public
26-21    proceeding unless the patient:
26-22                (1)  testifies in the public proceeding; or
26-23                (2)  submits a written release in regard to the
26-24    patient's records or identity.
26-25          Sec. 206.310.  RULES FOR DISCIPLINARY PROCEEDINGS. Rules of
26-26    practice adopted under this chapter by the medical board under
26-27    Section 2001.004, Government Code, applicable to the proceedings
 27-1    for a disciplinary action may not conflict with rules adopted by
 27-2    the State Office of Administrative Hearings.
 27-3          Sec. 206.311.  REQUIRED SUSPENSION OF INCARCERATED SURGICAL
 27-4    ASSISTANT. Regardless of the offense, the medical board shall
 27-5    suspend the license of a surgical assistant serving a prison term
 27-6    in a state or federal penitentiary during the term of the
 27-7    incarceration.
 27-8          Sec. 206.312.  TEMPORARY SUSPENSION. (a)  The president of
 27-9    the medical board, with medical board approval, shall appoint a
27-10    three-member disciplinary panel consisting of medical board members
27-11    to determine whether a surgical assistant's license should be
27-12    temporarily suspended.
27-13          (b)  If the disciplinary panel determines from the evidence
27-14    or information presented to the panel that a person licensed to
27-15    practice as a surgical assistant would, by the person's
27-16    continuation in practice, constitute a continuing threat to the
27-17    public welfare, the disciplinary panel shall temporarily suspend
27-18    the license of that person.
27-19          (c)  A license may be suspended under this section without
27-20    notice or hearing on the complaint if:
27-21                (1)  institution of proceedings for a hearing before
27-22    the medical board is initiated simultaneously with the temporary
27-23    suspension; and
27-24                (2)  a hearing is held under Chapter 2001, Government
27-25    Code, and this chapter as soon as possible.
27-26          (d)  Notwithstanding Chapter 551, Government Code, the
27-27    disciplinary panel may hold a meeting by telephone conference call
 28-1    if immediate action is required and convening the disciplinary
 28-2    panel at one location is inconvenient for any member of the panel.
 28-3             (Sections 206.313-206.350 reserved for expansion
 28-4                   SUBCHAPTER H.  ADMINISTRATIVE PENALTY
 28-5          Sec. 206.351.  ADMINISTRATIVE PENALTY. (a)  The medical board
 28-6    by order may impose an administrative penalty against a person
 28-7    licensed under this chapter who violates this chapter or a rule or
 28-8    order adopted under this chapter.
 28-9          (b)  The penalty may be in an amount not to exceed $5,000.
28-10    Each day a violation continues or occurs is a separate violation
28-11    for purposes of imposing a penalty.
28-12          (c)  The medical board shall base the amount of the penalty
28-13    on:
28-14                (1)  the severity of patient harm;
28-15                (2)  the severity of economic harm to any person;
28-16                (3)  the severity of any environmental harm;
28-17                (4)  the increased potential for harm to the public;
28-18                (5)  any attempted concealment of misconduct;
28-19                (6)  any premeditated or intentional misconduct;
28-20                (7)  the motive for the violation;
28-21                (8)  any prior misconduct of a similar or related
28-22    nature;
28-23                (9)  the license holder's disciplinary history;
28-24                (10)  any prior written warnings or written
28-25    admonishments from any government agency or official regarding
28-26    statutes or rules relating to the misconduct;
28-27                (11)  whether the violation is of a board order;
 29-1                (12)  the person's failure to implement remedial
 29-2    measures to correct or mitigate harm from the misconduct;
 29-3                (13)  the person's lack of rehabilitative potential or
 29-4    likelihood of future misconduct of a similar nature;
 29-5                (14)  any relevant circumstances increasing the
 29-6    seriousness of the misconduct; and
 29-7                (15)  any other matter that justice may require.
 29-8          (d)  The medical board by rule shall prescribe the procedures
 29-9    by which it may impose an administrative penalty. A proceeding
29-10    under this section is subject to Chapter 2001, Government Code.
29-11          (e)  If the medical board by order determines that a
29-12    violation has occurred and imposes an administrative penalty, the
29-13    medical board shall give notice to the person of the order. The
29-14    notice must include a statement of the person's right to judicial
29-15    review of the order.
29-16          SECTION 2. Subsection (B), Section 2, Chapter 397, Acts of
29-17    the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
29-18    Vernon's Texas Insurance Code), is amended to read as follows:
29-19          (B)  No policy of accident and sickness insurance shall make
29-20    benefits contingent upon treatment or examination by a particular
29-21    practitioner or by particular practitioners of the healing arts
29-22    hereinafter designated unless such policy contains a provision
29-23    designating the practitioner or practitioners who will be
29-24    recognized by the insurer and those who will not be recognized by
29-25    the insurer.  Such provision may be located in the "Exceptions" or
29-26    "Exceptions and Reductions" provisions, or elsewhere in the policy,
29-27    or by endorsement attached to the policy, at the insurer's option.
 30-1    In designating the practitioners who will and will not be
 30-2    recognized, such provision shall use the following terms:  Doctor
 30-3    of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
 30-4    Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
 30-5    Audiologist, Licensed Speech-language Pathologist, Doctor in
 30-6    Psychology, Licensed Master Social Worker--Advanced Clinical
 30-7    Practitioner, Licensed Dietitian, Licensed Professional Counselor,
 30-8    Licensed Marriage and Family Therapist, Licensed Chemical
 30-9    Dependency Counselor, Licensed Hearing Instrument Fitter and
30-10    Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed
30-11    Occupational Therapist, Licensed Physical Therapist, Licensed
30-12    Acupuncturist, [and] Licensed Psychological Associate, and Licensed
30-13    Surgical Assistant.
30-14          For purposes of this Act, such designations shall have the
30-15    following meanings:
30-16          Doctor of Medicine:  One licensed by the Texas State Board of
30-17    Medical Examiners on the basis of the degree "Doctor of Medicine";
30-18          Doctor of Osteopathy:  One licensed by the Texas State Board
30-19    of Medical Examiners on the basis of the degree of "Doctor of
30-20    Osteopathy";
30-21          Doctor of Dentistry:  One licensed by the State Board of
30-22    Dental Examiners;
30-23          Doctor of Chiropractic:  One licensed by the Texas Board of
30-24    Chiropractic Examiners;
30-25          Doctor of Optometry:  One licensed by the Texas Optometry
30-26    Board;
30-27          Doctor of Podiatry:  One licensed by the Texas State Board of
 31-1    Podiatric Medical Examiners;
 31-2          Licensed Audiologist:  One with a master's or doctorate
 31-3    degree in audiology from an accredited college or university and
 31-4    who is licensed as an audiologist by the State Board of Examiners
 31-5    for Speech-Language Pathology and Audiology;
 31-6          Licensed Speech-language Pathologist:  One with a master's or
 31-7    doctorate degree in speech pathology or speech-language pathology
 31-8    from an accredited college or university and who is licensed as a
 31-9    speech-language pathologist by the State Board of Examiners for
31-10    Speech-Language Pathology and Audiology;
31-11          Doctor in Psychology:  One licensed by the Texas State Board
31-12    of Examiners of Psychologists and certified as a Health Service
31-13    Provider;
31-14          Licensed Master Social Worker--Advanced Clinical
31-15    Practitioner:  One licensed by the Texas State Board of Social
31-16    Worker Examiners as a Licensed Master Social Worker with the order
31-17    of recognition of Advanced Clinical Practitioner;
31-18          Licensed Dietitian:  One licensed by the Texas State Board of
31-19    Examiners of Dietitians;
31-20          Licensed Professional Counselor:  One licensed by the Texas
31-21    State Board of Examiners of Professional Counselors;
31-22          Licensed Marriage and Family Therapist:  One licensed by the
31-23    Texas State Board of Examiners of Marriage and Family Therapists;
31-24          Licensed Chemical Dependency Counselor:  One licensed by the
31-25    Texas Commission on Alcohol and Drug Abuse;
31-26          Licensed Hearing Instrument Fitter and Dispenser:  One
31-27    licensed by the State Committee of Examiners in the Fitting and
 32-1    Dispensing of Hearing Instruments;
 32-2          Advanced Practice Nurse:  One licensed by the Board of Nurse
 32-3    Examiners as a registered nurse and recognized by that board as an
 32-4    advanced practice nurse;
 32-5          Physician Assistant:  One licensed by the Texas State Board
 32-6    of Physician Assistant Examiners;
 32-7          Licensed Occupational Therapist:  One licensed by the Texas
 32-8    Board of Occupational Therapy Examiners;
 32-9          Licensed Physical Therapist:  One licensed by the Texas Board
32-10    of Physical Therapy Examiners;
32-11          Licensed Acupuncturist:  One licensed by the Texas State
32-12    Board of Medical Examiners as an acupuncturist;  [and]
32-13          Licensed Psychological Associate:  One licensed by the Texas
32-14    State Board of Examiners of Psychologists and practicing under the
32-15    supervision of a licensed psychologist; and
32-16          Licensed Surgical Assistant: One licensed by the Texas State
32-17    Board of Medical Examiners as a surgical assistant.
32-18          SECTION 3. Section 1, Article 21.52, Insurance Code, is
32-19    amended by adding Subsection (u) to read as follows:
32-20          (u)  "Surgical assistant" means a person licensed by the
32-21    Texas State Board of Medical Examiners as a surgical assistant.
32-22          SECTION 4. Section 3(a), Article 21.52, Insurance Code, as
32-23    amended by Chapters 428 and 888,  Acts of the 76th Legislature,
32-24    Regular Session, 1999, is amended to read as follows:
32-25          (a)  Any person who is issued, who is a party to, or who is a
32-26    beneficiary under any health insurance policy delivered, renewed,
32-27    or issued for delivery in this state by any insurance company,
 33-1    association, or organization to which this article applies may
 33-2    select:
 33-3                (1)  a licensed doctor of podiatric medicine, a
 33-4    licensed dentist, or a doctor of chiropractic to perform the
 33-5    medical or surgical services or procedures scheduled in the policy
 33-6    which fall within the scope of the license of that practitioner;
 33-7                (2)  a licensed doctor of optometry to perform the
 33-8    services or procedures scheduled in the policy which fall within
 33-9    the scope of the license of that doctor of optometry;
33-10                (3)  an occupational therapist to provide the services
33-11    scheduled in the policy which fall within the scope of the license
33-12    of that occupational therapist;
33-13                (4)  a physical therapist to provide the services
33-14    scheduled in the policy which fall within the scope of the license
33-15    of that physical therapist;
33-16                (5)  a licensed audiologist to measure hearing for the
33-17    purpose of determining the presence or extent of a hearing loss and
33-18    to provide aural rehabilitation services to a person with a hearing
33-19    loss if those services or procedures are scheduled in the policy;
33-20                (6)  a licensed speech-language pathologist to evaluate
33-21    speech and language and to provide habilitative and rehabilitative
33-22    services to restore speech or language loss or to correct a speech
33-23    or language impairment if those services or procedures are
33-24    scheduled in the policy;
33-25                (7)  a licensed master social worker--advanced clinical
33-26    practitioner to provide the services that fall within the scope of
33-27    the license of such certified practitioner and which are specified
 34-1    as services within the terms of the policy of insurance, including
 34-2    the provision of direct, diagnostic, preventive, or clinical
 34-3    services to individuals, families, and groups whose functioning is
 34-4    threatened or affected by social or psychological stress or health
 34-5    impairment, if those services or procedures are scheduled in the
 34-6    policy;
 34-7                (8)  a licensed dietitian including a provisional
 34-8    licensed dietitian under a licensed dietitian's supervision to
 34-9    provide the services that fall within the scope of the license of
34-10    that dietitian if those services are scheduled in the policy;
34-11                (9)  a licensed professional counselor to provide the
34-12    services that fall within the scope of the license of that
34-13    professional if those services are scheduled in the policy;
34-14                (10)  a licensed marriage and family therapist to
34-15    provide the services that fall within the scope of the license of
34-16    that professional if those services are scheduled in the policy;
34-17                (11)  a psychologist to perform the services or
34-18    procedures scheduled in the policy that fall within the scope of
34-19    the license of that psychologist;
34-20                (12)  a licensed chemical dependency counselor to
34-21    perform the services or procedures scheduled in the policy that
34-22    fall within the scope of the license of that practitioner;
34-23                (13) [(12)]  a licensed acupuncturist to perform the
34-24    services or procedures scheduled in the policy that fall within the
34-25    scope of the license of that practitioner;
34-26                (14) [(13)]  an advanced practice nurse to provide the
34-27    services scheduled in the policy that fall within the scope of the
 35-1    license of that practitioner;
 35-2                (15) [(14)]  a physician assistant to provide the
 35-3    services scheduled in the policy that fall within the scope of the
 35-4    license of that practitioner;
 35-5                (16) [(15)]  a licensed hearing instrument fitter and
 35-6    dispenser to provide the services or procedures scheduled in the
 35-7    policy that fall within the scope of the license of that
 35-8    practitioner;
 35-9                (17)  a licensed surgical assistant to provide the
35-10    services or procedures scheduled in the policy that fall within the
35-11    scope of the license of that practitioner; or
35-12                (18) [(16)]  a licensed psychological associate to
35-13    provide the services that fall within the scope of the license of
35-14    that professional if those services are scheduled in the policy.
35-15          SECTION 5. Section 3(d), Article 21.52,  Insurance Code, is
35-16    amended to read as follows:
35-17          (d)  There shall not be any classification, differentiation,
35-18    or other discrimination in the payment schedule or the payment
35-19    provisions in a health insurance policy, nor in the amount or
35-20    manner of payment or reimbursement thereunder, between scheduled
35-21    services or procedures when performed by a doctor of podiatric
35-22    medicine, a doctor of optometry, a doctor of chiropractic, a
35-23    licensed dentist, an occupational therapist, a physical therapist,
35-24    a licensed audiologist, a licensed speech-language pathologist, a
35-25    licensed master social worker--advanced clinical practitioner, a
35-26    licensed dietitian, a licensed professional counselor, a licensed
35-27    marriage and family therapist, a psychologist, a licensed
 36-1    psychological associate, a licensed chemical dependency counselor,
 36-2    an advanced practice nurse to provide the services scheduled in the
 36-3    policy, a physician assistant to provide the services scheduled in
 36-4    the policy, a licensed acupuncturist, or a licensed hearing
 36-5    instrument fitter and dispenser which fall within the scope of that
 36-6    practitioner's license or certification and the same services or
 36-7    procedures when performed by any other practitioner of the healing
 36-8    arts whose services or procedures are covered by the policy.
 36-9    However, a health insurance policy may provide for a different
36-10    amount of payment or reimbursement for scheduled services or
36-11    procedures when performed by an advanced practice nurse, licensed
36-12    surgical assistant, or physician assistant provided the
36-13    reimbursement methodology used to calculate the payment for the
36-14    service or procedure is the same methodology used to calculate the
36-15    payment when the service or procedure is provided by a physician.
36-16          SECTION 6.  Section 32.027, Human Resources Code, is amended
36-17    by adding Subsection (j) to read as follows:
36-18          (j)  The department shall assure that a recipient of medical
36-19    assistance under this chapter may select a surgical assistant
36-20    licensed under Chapter 206, Occupations Code, to perform any health
36-21    care service or procedure covered under the medical assistance
36-22    program if:
36-23                (1)  the selected surgical assistant is authorized by
36-24    law to perform the service or procedure; and
36-25                (2)  the physician requests that the service or
36-26    procedure be performed by the surgical assistant.
36-27          SECTION 7. (a)  Notwithstanding Section 206.201 and
 37-1    Subchapter H, Chapter 206, Occupations Code, as added by this Act,
 37-2    a person is not required to obtain a license under Chapter 206,
 37-3    Occupations Code, as added by this Act, until September 1, 2002.
 37-4          (b)  The Texas State Board of Medical Examiners shall adopt
 37-5    rules under Chapter 206, Occupations Code, as added by this Act,
 37-6    not later than January 1, 2002.
 37-7          SECTION 8. Section 2, Chapter 397, Acts of the 54th
 37-8    Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
 37-9    Insurance Code), and Article 21.52, Insurance Code, as amended by
37-10    this Act, apply only to an insurance policy, contract, or evidence
37-11    of coverage delivered, issued for delivery, or renewed on or after
37-12    January 1, 2003.  A policy, contract, or evidence of coverage
37-13    delivered, issued for delivery, or renewed before January 1, 2003,
37-14    is governed by the law as it existed immediately before the
37-15    effective date of this Act, and that law is continued in effect for
37-16    that purpose.
37-17          SECTION 9. This Act takes effect September 1, 2001.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I certify that H.B. No. 1183 was passed by the House on May
         4, 2001, by a non-record vote; and that the House concurred in
         Senate amendments to H.B. No. 1183 on May 24, 2001, by a non-record
         vote.
                                             _______________________________
                                                 Chief Clerk of the House
               I certify that H.B. No. 1183 was passed by the Senate, with
         amendments, on May 18, 2001, by a viva-voce vote.
                                             _______________________________
                                                 Secretary of the Senate
         APPROVED:  __________________________
                              Date
                    __________________________
                            Governor