77R10555 GJH-F                           
         By Capelo                                             H.B. No. 1183
         Substitute the following for H.B. No. 1183:
         By Capelo                                         C.S.H.B. No. 1183
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to the regulation of surgical assistants; granting
 1-3     rulemaking authority; providing penalties.
 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 assumes responsibility and
1-15     legal liability for the services rendered by a surgical assistant.
1-16                 (3)  "Direct supervision" means supervision by a
1-17     delegating physician who is present where the surgical assisting is
1-18     provided and is immediately available.
1-19                 (4)  "Executive director" means the executive director
1-20     of the medical board.
1-21                 (5)  "Medical board" means the Texas State Board of
1-22     Medical Examiners.
1-23                 (6)  "Surgical assisting" means providing aid under
1-24     direct supervision in exposure, hemostasis, and other
 2-1     intraoperative technical functions that assist a physician in
 2-2     performing a safe operation with optimal results for the patient,
 2-3     including the delegated authority to provide local infiltration or
 2-4     the topical application of a local anesthetic at the operation
 2-5     site.  This term is synonymous with "first assisting."
 2-6           Sec. 206.002.  APPLICABILITY. A person is not required to
 2-7     hold a license under this chapter if the person is:
 2-8                 (1)  a student enrolled in a surgical assistant
 2-9     education program approved by the medical board who is assisting in
2-10     a surgical operation that is an integral part of the program of
2-11     study;
2-12                 (2)  a surgical assistant employed in the service of
2-13     the federal government while performing duties related to that
2-14     employment;
2-15                 (3)  a person acting under the delegated authority of a
2-16     licensed physician;
2-17                 (4)  a licensed health care worker acting within the
2-18     scope of the person's license;
2-19                 (5)  a registered nurse; or
2-20                 (6)  a licensed physician assistant.
2-21              (Sections 206.003-206.050 reserved for expansion
2-22                      SUBCHAPTER B.  ADVISORY COMMITTEE
2-23           Sec. 206.051.  ADVISORY COMMITTEE. The advisory committee is
2-24     an informal advisory committee to the medical board and is not
2-25     subject to Chapter 2110, Government Code.
2-26           Sec. 206.052.  APPOINTMENT OF ADVISORY COMMITTEE. (a)  The
2-27     advisory committee consists of five members appointed by the
 3-1     president of the medical board.  Each member of the advisory
 3-2     committee must be:
 3-3                 (1)  a practicing surgical assistant who has at least
 3-4     five years of clinical experience as a surgical assistant; or
 3-5                 (2)  a physician licensed in this state who supervises
 3-6     a surgical assistant.
 3-7           (b)  Appointments to the advisory committee shall be made
 3-8     without regard to the race, color, disability, sex, religion, age,
 3-9     or national origin of the appointees.
3-10           Sec. 206.053.  MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a)  In
3-11     this section, "Texas trade association" means a cooperative and
3-12     voluntarily joined association of business or professional
3-13     competitors in this state designed to assist its members and its
3-14     industry or profession in dealing with mutual business or
3-15     professional problems and in promoting their common interest.
3-16           (b)  A person may not be a member of the advisory committee
3-17     if:
3-18                 (1)  the person is an officer, employee, or paid
3-19     consultant of a Texas trade association in the field of surgical
3-20     assisting; or
3-21                 (2)  the person's spouse is an officer, manager, or
3-22     paid consultant of a Texas trade association in the field of
3-23     surgical assisting.
3-24           (c)  A person may not be a member of the advisory committee
3-25     if the person is required to register as a lobbyist under Chapter
3-26     305, Government Code, because of the person's activities for
3-27     compensation on behalf of a profession related to the field of
 4-1     surgical assisting.
 4-2           Sec. 206.054.  TERMS; VACANCY. (a)  Members of the advisory
 4-3     committee are appointed for two-year terms.  The terms of the
 4-4     members expire on February 1 of each odd-numbered year.
 4-5           (b)  If a vacancy occurs during a member's term, the
 4-6     president of the medical board shall appoint a new member to fill
 4-7     the unexpired term.
 4-8           (c)  An advisory committee member may not serve more than two
 4-9     consecutive full terms.
4-10           Sec. 206.055.  GROUNDS FOR REMOVAL. (a)  It is a ground for
4-11     removal from the advisory committee that a member:
4-12                 (1)  does not have at the time of appointment the
4-13     qualifications required by Section 206.052;
4-14                 (2)  does not maintain during service on the advisory
4-15     committee the qualifications required by Section 206.052;
4-16                 (3)  is ineligible for membership under Section
4-17     206.053; or
4-18                 (4)  cannot, because of illness or disability,
4-19     discharge the member's duties for a substantial part of the
4-20     member's term.
4-21           (b)  The validity of an action of the committee is not
4-22     affected by the fact that it is taken when a ground for removal of
4-23     a committee member exists.
4-24           Sec. 206.056.  OFFICERS. The president of the medical board
4-25     shall designate biennially a committee member as the presiding
4-26     officer of the advisory committee to serve in that capacity at the
4-27     will of the president.
 5-1           Sec. 206.057.  PER DIEM. An advisory committee member is not
 5-2     entitled to reimbursement for travel expenses or compensation.
 5-3           Sec. 206.058.  MEETINGS. (a)  The advisory committee shall
 5-4     meet as requested by the medical board.
 5-5           (b)  A meeting may be held by telephone conference call.
 5-6              (Sections 206.059-206.100 reserved for expansion
 5-7            SUBCHAPTER C. POWERS AND DUTIES OF ADVISORY COMMITTEE
 5-8                              AND MEDICAL BOARD
 5-9           Sec. 206.101.  GENERAL POWERS AND DUTIES. (a)  The medical
5-10     board shall:
5-11                 (1)  establish qualifications for a surgical assistant
5-12     to practice in this state;
5-13                 (2)  establish requirements for an examination for a
5-14     license to practice as a surgical assistant;
5-15                 (3)  establish minimum education and training
5-16     requirements necessary for a license to practice as a surgical
5-17     assistant;
5-18                 (4)  prescribe the application form for a license to
5-19     practice as a surgical assistant;
5-20                 (5)  make recommendations on an application for a
5-21     license to practice as a surgical assistant;
5-22                 (6)  develop an approved program of continuing
5-23     education and the manner in which attendance at all approved
5-24     courses, clinics, forums, lectures, programs, or seminars is
5-25     monitored, recorded, and submitted to the advisory committee; and
5-26                 (7)  recommend additional rules as are necessary for
5-27     the administration and enforcement of this chapter.
 6-1           (b)  The advisory committee has no independent rulemaking
 6-2     authority.
 6-3           Sec. 206.102.  ANNUAL REPORT.  (a)  The medical board shall
 6-4     prepare annually a complete and detailed written report accounting
 6-5     for all funds received and disbursed by the medical board under
 6-6     this chapter during the preceding fiscal year.
 6-7           (b)  The annual report must meet the reporting requirements
 6-8     applicable to financial reporting provided in the General
 6-9     Appropriations Act.
6-10           Sec. 206.103.  IMMUNITY AND REPORTING REQUIREMENTS. (a)  A
6-11     medical peer review committee in this state, a quality assurance
6-12     committee in this state, a surgical assistant, a surgical assistant
6-13     student, a physician practicing medicine in this state, or any
6-14     person usually present in an operating room, including a nurse or
6-15     surgical technologist, shall report relevant information to the
6-16     advisory committee related to the acts of a surgical assistant in
6-17     this state if, in that person's opinion, a surgical assistant poses
6-18     a continuing threat to the public welfare through the person's
6-19     practice as a surgical assistant.  The duty to report under this
6-20     section may not be nullified through contract.
6-21           (b)  A person who, without malice, furnishes records,
6-22     information, or assistance to the advisory committee under this
6-23     section is immune from any civil liability arising from that action
6-24     in a suit against the person brought by or on behalf of a surgical
6-25     assistant who is reported under this section.
6-26           (c)  Sections 160.002, 160.003, 160.006, 160.007(d), 160.009,
6-27     160.013, and 160.014 apply to medical peer review regarding a
 7-1     licensed surgical assistant.
 7-2           Sec. 206.104.  GIFTS, GRANTS, AND DONATIONS. In addition to
 7-3     any fees paid to the medical board or money appropriated to the
 7-4     medical board, the medical board may receive and accept under this
 7-5     chapter a gift, grant, donation, or other item of value from any
 7-6     source, including the United States or a private source.
 7-7              (Sections 206.105-206.150 reserved for expansion
 7-8          SUBCHAPTER D. PUBLIC INTEREST INFORMATION; COMPLAINT AND
 7-9                          INVESTIGATIVE INFORMATION
7-10           Sec. 206.151.  PUBLIC PARTICIPATION. (a)  The medical board
7-11     shall develop and implement policies that provide the public with a
7-12     reasonable opportunity to appear before the medical board and speak
7-13     on any issue relating to surgical assistants.
7-14           (b)  The executive director of the medical board shall
7-15     prepare and maintain a written plan that describes how a person who
7-16     does not speak English may be provided reasonable access to the
7-17     medical board's programs and services under this chapter.
7-18           Sec. 206.152.  PUBLIC INTEREST INFORMATION. (a)  The medical
7-19     board shall prepare information of public interest describing the
7-20     functions of the medical board and the procedures by which
7-21     complaints are filed and resolved under this chapter.
7-22           (b)  The medical board shall make the information available
7-23     to the public and appropriate state agencies.
7-24           Sec. 206.153.  COMPLAINTS. (a)  The medical board by rule
7-25     shall establish methods by which consumers and service recipients
7-26     are notified of the name, mailing address, and telephone number of
7-27     the medical board for the purpose of directing complaints about
 8-1     licensed surgical assistants to the medical board.
 8-2           (b)  The medical board shall list with its regular telephone
 8-3     number any toll-free telephone number established under other state
 8-4     law that may be called to present a complaint about a licensed
 8-5     surgical assistant.
 8-6           Sec. 206.154.  RECORDS OF COMPLAINTS. (a)  The medical board
 8-7     shall maintain a file on each written complaint filed with the
 8-8     medical board under this chapter.  The file must include:
 8-9                 (1)  the name of the person who filed the complaint;
8-10                 (2)  the date the complaint is received by the medical
8-11     board;
8-12                 (3)  the subject matter of the complaint;
8-13                 (4)  the name of each person contacted in relation to
8-14     the complaint;
8-15                 (5)  a summary of the results of the review or
8-16     investigation of the complaint; and
8-17                 (6)  an explanation of the reason the file was closed,
8-18     if the medical board closed the file without taking action other
8-19     than to investigate the complaint.
8-20           (b)  The medical board shall provide to the person filing the
8-21     complaint and to each person who is a subject of the complaint a
8-22     copy of the medical board's policies and procedures relating to
8-23     complaint investigation and resolution.  A person who reports a
8-24     complaint by phone shall be given information on how to file a
8-25     written complaint.
8-26           (c)  The medical board, at least quarterly and until final
8-27     disposition of the complaint, shall notify the person filing the
 9-1     complaint and each person who is a subject of the complaint of the
 9-2     status of the investigation unless the notice would jeopardize an
 9-3     undercover investigation.
 9-4           Sec. 206.155.  LICENSE HOLDER ACCESS TO COMPLAINT
 9-5     INFORMATION. (a)  The medical board shall provide a license holder
 9-6     who is the subject of a formal complaint filed under this chapter
 9-7     with access to all information in its possession that the medical
 9-8     board intends to offer into evidence in presenting its case in
 9-9     chief at the contested hearing on the complaint, subject to any
9-10     other privilege or restriction established by rule, statute, or
9-11     legal precedent.  The medical board shall provide the information
9-12     not later than the 30th day after receipt of a written request from
9-13     the license holder or the license holder's counsel, unless good
9-14     cause is shown for delay.
9-15           (b)  Notwithstanding Subsection (a), the medical board is not
9-16     required to provide:
9-17                 (1)  medical board investigative reports;
9-18                 (2)  investigative memoranda;
9-19                 (3)  the identity of a nontestifying complainant;
9-20                 (4)  attorney-client communications;
9-21                 (5)  attorney work product; or
9-22                 (6)  other material covered by a privilege recognized
9-23     by the Texas Rules of Civil Procedure or the Texas Rules of
9-24     Evidence.
9-25           (c)  The provision of information does not constitute a
9-26     waiver of privilege or confidentiality under this chapter or other
9-27     law.
 10-1          Sec. 206.156.  HEALTH CARE ENTITY REQUEST FOR INFORMATION. On
 10-2    the written request of a health care entity, the medical board
 10-3    shall provide to the entity:
 10-4                (1)  information about a complaint filed against a
 10-5    license holder that was resolved after investigation by:
 10-6                      (A)  a disciplinary order of the medical board;
 10-7    or
 10-8                      (B)  an agreed settlement; and
 10-9                (2)  the basis of and current status of any complaint
10-10    under active investigation that has been referred by the executive
10-11    director or the director's designee for legal action.
10-12          Sec. 206.157.  CONFIDENTIALITY OF INVESTIGATIVE INFORMATION.
10-13    A complaint, adverse report, investigation file, compliance file,
10-14    other report, or other investigative information in the possession
10-15    of or received or gathered by the medical board, medical board
10-16    employee, or agent relating to a license holder, a license
10-17    application, or a criminal investigation or proceeding is
10-18    privileged and confidential and is not subject to discovery,
10-19    subpoena, or other means of legal compulsion for release to any
10-20    person other than the medical board or medical board employee or
10-21    agent involved in license holder discipline.
10-22          Sec. 206.158.  PERMITTED DISCLOSURE OF INVESTIGATIVE
10-23    INFORMATION. (a)  Investigative information in the possession of
10-24    the medical board, medical board employee, or agent that relates to
10-25    the discipline of a license holder may be disclosed to:
10-26                (1)  a licensing authority in another state or a
10-27    territory or country in which the license holder  is licensed or
 11-1    has applied for a license; or
 11-2                (2)  a peer review committee reviewing:
 11-3                      (A)  an application for privileges; or
 11-4                      (B)  the qualifications of the license holder
 11-5    with respect to retaining privileges.
 11-6          (b)  If the investigative information in the possession of
 11-7    the medical board or a medical board employee or agent indicates a
 11-8    crime may have been committed, the medical board shall report the
 11-9    information to the proper law enforcement agency.  The medical
11-10    board shall cooperate with and assist all law enforcement agencies
11-11    conducting criminal investigations of a license holder by providing
11-12    information relevant to the investigation.  Confidential
11-13    information disclosed by the medical board to a law enforcement
11-14    agency remains confidential and may not be disclosed by the law
11-15    enforcement agency except as necessary to further the
11-16    investigation.
11-17             (Sections 206.159-206.200 reserved for expansion
11-18                    SUBCHAPTER E.  LICENSE REQUIREMENTS
11-19          Sec. 206.201.  LICENSE REQUIRED. (a)  Except as provided by
11-20    Section 206.002, a person may not practice as a surgical assistant
11-21    unless the person is licensed under this chapter.
11-22          (b)  Unless the person holds a license under this chapter, a
11-23    person may not use, in connection with the person's name:
11-24                (1)  the title "Licensed Surgical Assistant"; or
11-25                (2)  any other designation that would imply that the
11-26    person is a licensed surgical assistant.
11-27          Sec. 206.202.  LICENSE APPLICATION. An applicant for a
 12-1    license must:
 12-2                (1)  file a written application with the medical board
 12-3    on a form prescribed by the medical board; and
 12-4                (2)  pay the application fee set by the medical board.
 12-5          Sec. 206.203.  LICENSE ELIGIBILITY. (a)  Except as provided
 12-6    by Section 206.206, to be eligible for a license, a person must:
 12-7                (1)  be of good moral character;
 12-8                (2)  have not been convicted of a felony or a crime
 12-9    involving moral turpitude;
12-10                (3)  not use drugs or alcohol to an extent that affects
12-11    the applicant's professional competency;
12-12                (4)  not have had a license or certification revoked by
12-13    a licensing agency or by a certifying professional organization;
12-14    and
12-15                (5)  not have engaged in fraud or deceit in applying
12-16    for a license under this chapter.
12-17          (b)  In addition to meeting the requirements of Subsection
12-18    (a), a person must:
12-19                (1)  pass the examination required by Section 206.204;
12-20                (2)  hold at least an associate's degree based on
12-21    completion of an educational program that is substantially
12-22    equivalent to the education required for a registered nurse or
12-23    physician assistant who specializes in surgical assisting;
12-24                (3)  demonstrate to the satisfaction of the medical
12-25    board the completion of full-time work experience performed in this
12-26    country under the direct supervision of a physician licensed in
12-27    this country and consisting of at least 2,000 hours of performance
 13-1    as an assistant in surgical procedures for the three years
 13-2    preceding the date of application; and
 13-3                (4)  possess a current certification by a national
 13-4    certifying body approved by the medical board.
 13-5          (c)  A degree program described by Subsection (b)(2) must
 13-6    contain a clinical component and must include courses in anatomy,
 13-7    physiology, basic pharmacology, aseptic techniques, operative
 13-8    procedures, chemistry, microbiology, and pathophysiology.
 13-9          Sec. 206.204.  EXAMINATION. An applicant for a surgical
13-10    assistant license must pass a psychometrically validated surgical
13-11    assistant examination approved by the medical board.
13-12          Sec. 206.205.  SPECIAL ELIGIBILITY FOR LICENSE. (a)  A person
13-13    who is otherwise eligible for a license under Section 206.203 is
13-14    not required to take the examination required by Section
13-15    206.203(b)(1) if the person:
13-16                (1)  passed a surgical assistant examination required
13-17    for certification under Section 206.203(b)(4) that the medical
13-18    board determines is substantially equivalent to the examination
13-19    required by the medical board under this chapter; and
13-20                (2)  applies for a license under this section before
13-21    September 1, 2002.
13-22          (b)  A person who is otherwise eligible for a license under
13-23    Section 206.203 is not required to meet the educational
13-24    requirements under Section 206.203(b)(2) if the person:
13-25                (1)  completed an academic course approved by the
13-26    medical board in anatomy, physiology, basic pharmacology, aseptic
13-27    techniques, operative procedures, chemistry, and microbiology, or
 14-1    has been certified after September 30, 1995, as a surgical
 14-2    assistant by a national certifying body approved by the medical
 14-3    board and has practiced full-time as a surgical assistant under the
 14-4    direct supervision of a physician licensed in this country; or
 14-5                (2)  applies for a license under this section before
 14-6    September 1, 2002.
 14-7          (c)  A license issued under Subsection (b) expires on the
 14-8    third anniversary of issuance unless the license holder fulfills
 14-9    both requirements of Subsection (b)(1).
14-10          Sec. 206.206.  TEMPORARY LICENSE.  (a)  The medical board
14-11    may, through the executive director, issue a temporary license to
14-12    an applicant who:
14-13                (1)  submits an application on a form prescribed by the
14-14    medical board;
14-15                (2)  has passed an examination required by the medical
14-16    board relating to the practice of surgical assisting;
14-17                (3)  pays the appropriate fee set by the medical board;
14-18                (4)  if licensed in another state, is licensed in good
14-19    standing; and
14-20                (5)  meets all the qualifications for a license under
14-21    this chapter and is waiting for the next scheduled meeting of the
14-22    medical board for the license to be issued.
14-23          (b)  A temporary license is valid until the 100th day after
14-24    the date issued and may be extended until the 130th day after the
14-25    date issued.
14-26          Sec. 206.207.  ASSISTANCE BY MEDICAL BOARD.  The medical
14-27    board shall provide administrative and clerical employees as
 15-1    necessary to administer this subchapter.
 15-2          Sec. 206.208.  FEES. (a)  The medical board shall set and
 15-3    collect fees in amounts that are reasonable and necessary to cover
 15-4    the costs of administering and enforcing this chapter without the
 15-5    use of any other funds generated by the medical board.
 15-6          (b)  Fees collected by the medical board under this chapter
 15-7    shall be deposited by the medical board in the state treasury to
 15-8    the credit of an account in the general revenue fund and may be
 15-9    spent to cover the costs of administering and enforcing this
15-10    chapter.  At the end of each fiscal biennium, the comptroller shall
15-11    transfer any surplus money remaining in the account to the general
15-12    revenue fund.
15-13          (c)  All money paid to the medical board under this chapter
15-14    is subject to Subchapter F, Chapter 404, Government Code.
15-15          Sec. 206.209.  ISSUANCE AND RENEWAL OF LICENSE.  The medical
15-16    board shall issue a surgical assistant license in this state to a
15-17    person who meets the requirements of this chapter and the rules
15-18    adopted under this chapter.
15-19          Sec. 206.210.  LICENSE RENEWAL.  (a)  The medical board by
15-20    rule shall provide for the annual renewal of a surgical assistant
15-21    license.
15-22          (b)  The medical board by rule may adopt a system under which
15-23    licenses expire on various dates during the year. For the year in
15-24    which the license expiration date is changed, license fees shall be
15-25    prorated on a monthly basis so that each license holder pays only
15-26    that portion of the license fee that is allocable to the number of
15-27    months during which the license is valid. On renewal of the license
 16-1    on the new expiration date, the total license renewal fee is
 16-2    payable.
 16-3          Sec. 206.211.  NOTICE OF LICENSE RENEWAL.  At least 30 days
 16-4    before the expiration of a person's license, the medical board
 16-5    shall send written notice of the impending license expiration to
 16-6    the person at the license holder's last known address according to
 16-7    the records of the medical board.
 16-8          Sec. 206.212.  PROCEDURE FOR RENEWAL.  (a)  A person who is
 16-9    otherwise eligible to renew a license may renew an unexpired
16-10    license by paying the required renewal fee to the medical board
16-11    before the expiration date of the license. A person whose license
16-12    has expired may not engage in activities that require a license
16-13    until the license has been renewed under this section.
16-14          (b)  If the person's license has been expired for 90 days or
16-15    less, the person may renew the license by paying to the medical
16-16    board one and one-half times the required renewal fee.
16-17          (c)  If the person's license has been expired for longer than
16-18    90 days but less than one year, the person may renew the license by
16-19    paying to the medical board two times the required renewal fee.
16-20          (d)  If the person's license has been expired for one year or
16-21    longer, the person may not renew the license.  The person may
16-22    obtain a new license by complying with the requirements and
16-23    procedures for obtaining an original license.
16-24          Sec. 206.213.  RENEWAL OF EXPIRED LICENSE BY OUT-OF-STATE
16-25    PRACTITIONER.  (a)  If the person was licensed as a surgical
16-26    assistant in this state, moved to another state, and is currently
16-27    licensed as a surgical assistant and has been in practice as a
 17-1    surgical assistant in the other state for the two years preceding
 17-2    application, the person may renew an expired surgical assistant
 17-3    license without reexamination.
 17-4          (b)  The person must pay to the medical board a fee that is
 17-5    equal to two times the required renewal fee for the license.
 17-6          Sec. 206.214.  LICENSE HOLDER INFORMATION.  (a)  Each license
 17-7    holder shall file with the medical board:
 17-8                (1)  the license holder's mailing address;
 17-9                (2)  the address of the license holder's residence;
17-10                (3)  the mailing address of each of the license
17-11    holder's offices; and
17-12                (4)  the address for the location of each of the
17-13    license holder's offices if that address is different from the
17-14    office's mailing address.
17-15          (b)  A license holder shall:
17-16                (1)  notify the medical board of a change of the
17-17    license holder's residence or business address; and
17-18                (2)  provide the medical board with the license
17-19    holder's new address not later than the 30th day after the date the
17-20    address change occurs.
17-21             (Sections 206.215-206.250 reserved for expansion
17-22                      SUBCHAPTER F. SCOPE OF PRACTICE
17-23          Sec. 206.251.  SCOPE OF PRACTICE.  (a)  The practice of a
17-24    surgical assistant is limited to surgical assisting performed under
17-25    the direct supervision of a physician who delegated the acts.
17-26          (b)  The practice of a surgical assistant may be performed in
17-27    any place authorized by a delegating licensed physician, including
 18-1    a clinic, hospital, ambulatory surgical center, or other
 18-2    institutional setting.
 18-3          Sec. 206.252.  SERVICE CONTRACTS.  This chapter does not:
 18-4                (1)  limit the employment arrangement of a surgical
 18-5    assistant licensed under this chapter;
 18-6                (2)  require a surgeon or hospital to contract with a
 18-7    surgical assistant;
 18-8                (3)  authorize a health maintenance organization,
 18-9    preferred provider organization, or health benefit plan to require
18-10    a surgeon to contract with a surgical assistant;
18-11                (4)  authorize a health maintenance organization,
18-12    preferred provider organization, or health benefit plan to require
18-13    a registered nurse or physician assistant to be licensed as a
18-14    surgical assistant as a condition of reimbursement;
18-15                (5)  authorize a clinic, hospital, ambulatory surgical
18-16    center, or other facility to require a registered nurse or
18-17    physician assistant to be licensed as a surgical assistant as a
18-18    condition of assisting at surgery at the facility; or
18-19                (6)  require a hospital to use a licensed surgical
18-20    assistant for surgical assisting.
18-21          Sec. 206.253.  CERTAIN PROHIBITED PRACTICES. This chapter
18-22    does not authorize a person who holds a license issued under this
18-23    chapter to engage in the practice of:
18-24                (1)  medicine, as defined by Subtitle B, Title 3,
18-25    Occupations Code;
18-26                (2)  professional nursing, as defined by Chapter 301,
18-27    Occupations Code; or
 19-1                (3)  nursing, as defined by Chapter 302, Occupations
 19-2    Code.
 19-3          Sec. 206.254.  ESTABLISHMENT OF CERTAIN FUNCTIONS AND
 19-4    STANDARDS. A surgical assistant and the surgical assistant's
 19-5    delegating physician shall ensure that:
 19-6                (1)  the surgical assistant's scope of function is
 19-7    identified;
 19-8                (2)  the delegation of medical tasks is appropriate to
 19-9    the surgical assistant's level of competence;
19-10                (3)  the relationship between the surgical assistant
19-11    and the delegating physician and the access of the surgical
19-12    assistant to the delegating physician are defined; and
19-13                (4)  a process is established for evaluating the
19-14    surgical assistant's performance.
19-15             (Sections 206.255-206.300 reserved for expansion
19-16                  SUBCHAPTER G.  DISCIPLINARY PROCEEDINGS
19-17          Sec. 206.301.  DISCIPLINARY ACTIONS BY THE MEDICAL BOARD. (a)
19-18    Except as provided by Section 206.305, on a determination that an
19-19    applicant or license holder committed an act described by Section
19-20    206.302, 206.303, or 206.304, the medical board by order shall take
19-21    any of the following actions:
19-22                (1)  deny the person's license application or revoke
19-23    the person's license;
19-24                (2)  require the person to submit to the care,
19-25    counseling, or treatment of a health care practitioner designated
19-26    by the medical board;
19-27                (3)  stay enforcement of an order and place the person
 20-1    on probation;
 20-2                (4)  require the person to complete additional
 20-3    training;
 20-4                (5)  suspend, limit, or restrict the person's license,
 20-5    including:
 20-6                      (A)  limiting the practice of the person to, or
 20-7    excluding from the person's practice, one or more specified
 20-8    activities of surgical assisting; or
 20-9                      (B)  stipulating periodic medical board review;
20-10                (6)  assess an administrative penalty against the
20-11    person as provided by Section 206.351;
20-12                (7)  order the person to perform public service; or
20-13                (8)  administer a public reprimand.
20-14          (b)  If the medical board stays enforcement of an order and
20-15    places a person on probation, the medical board retains the right
20-16    to vacate the probationary stay and enforce the original order for
20-17    noncompliance with the terms of probation or impose any other
20-18    remedial measure or sanction authorized by this section.
20-19          (c)  The medical board may restore or reissue a license or
20-20    remove any disciplinary or corrective measure that the medical
20-21    board has imposed.
20-22          Sec. 206.302.  CONDUCT RELATED TO FRAUD OR MISREPRESENTATION.
20-23    The medical board may take action under Section 206.301 against an
20-24    applicant or license holder who:
20-25                (1)  fraudulently or deceptively obtains or attempts to
20-26    obtain a license;
20-27                (2)  fraudulently or deceptively uses a license;
 21-1                (3)  falsely represents that the person is a physician;
 21-2                (4)  acts in an unprofessional or dishonorable manner
 21-3    that is likely to deceive, defraud, or injure the public;
 21-4                (5)  fraudulently alters any surgical assistant
 21-5    license, certificate, or diploma;
 21-6                (6)  uses any surgical assistant license, certificate,
 21-7    or diploma that has been fraudulently purchased, issued, or
 21-8    counterfeited or that has been materially altered;
 21-9                (7)  directly or indirectly  aids or abets the practice
21-10    as a surgical assistant by any person not licensed by the medical
21-11    board to practice as a surgical assistant; or
21-12                (8)  unlawfully advertises in a false, misleading, or
21-13    deceptive manner as defined by Section 101.201.
21-14          Sec. 206.303.  CONDUCT RELATED TO VIOLATION OF LAW. (a)  The
21-15    medical board may take action under Section 206.301 against an
21-16    applicant or license holder who:
21-17                (1)  violates this chapter or a rule adopted under this
21-18    chapter;
21-19                (2)  is convicted of a felony, placed on deferred
21-20    adjudication, or placed in a pretrial diversion program; or
21-21                (3)  violates state law if the violation is connected
21-22    with practice as a surgical assistant.
21-23          (b)  A complaint, indictment, or conviction of a law
21-24    violation is not necessary for the medical board to act under
21-25    Subsection (a)(3).  Proof of the commission of the act while in
21-26    practice as a surgical assistant or under the guise of practice as
21-27    a surgical assistant is sufficient for action by the medical board.
 22-1          Sec. 206.304.  CONDUCT INDICATING LACK OF FITNESS. (a)  The
 22-2    medical board may take action under Section 206.301 against an
 22-3    applicant or license holder who:
 22-4                (1)  habitually uses drugs or intoxicating liquors to
 22-5    the extent that, in the medical board's opinion, the person cannot
 22-6    safely perform as a surgical assistant;
 22-7                (2)  has been adjudicated as mentally incompetent;
 22-8                (3)  has a mental or physical condition that renders
 22-9    the person unable to safely perform as a surgical assistant;
22-10                (4)  has committed an act of moral turpitude;
22-11                (5)  has failed to practice as a surgical assistant in
22-12    an acceptable manner consistent with public health and welfare;
22-13                (6)  has had the person's license or other
22-14    authorization to practice as a surgical assistant suspended,
22-15    revoked, or restricted;
22-16                (7)  has had other disciplinary action taken by another
22-17    state or by the uniformed services of the United States regarding
22-18    practice as a surgical assistant;
22-19                (8)  is removed or suspended or has disciplinary action
22-20    taken by the person's peers in any professional association or
22-21    society or is being disciplined by a licensed hospital or medical
22-22    staff of a hospital, including removal, suspension, limitation of
22-23    privileges, or other disciplinary action, if that action, in the
22-24    opinion of the medical board, was based on unprofessional conduct
22-25    or professional incompetence that was likely to harm the public;
22-26                (9)  has repeated or recurring meritorious health care
22-27    liability claims that, in the medical board's opinion, are evidence
 23-1    of professional incompetence likely to harm the public; or
 23-2                (10)  sexually abuses or exploits another person during
 23-3    the license holder's practice as a surgical assistant.
 23-4          (b)  For the purpose of Subsection (a)(7), a certified copy
 23-5    of the record of the state or uniformed services of the United
 23-6    States taking the action constitutes conclusive evidence of that
 23-7    action.
 23-8          (c)  An action described by Subsection (a)(8)  does not
 23-9    constitute state action on the part of the association, society, or
23-10    hospital medical staff.
23-11          Sec. 206.305.  REHABILITATION ORDER. The medical board,
23-12    through an agreed order or after a contested case proceeding, may
23-13    impose a rehabilitation order on an applicant, as a prerequisite
23-14    for issuing a license, or on a license holder based on:
23-15                (1)  the person's intemperate use of drugs or alcohol
23-16    directly resulting from habituation or addiction caused by medical
23-17    care or treatment provided by a physician;
23-18                (2)  the person's intemperate use of drugs or alcohol
23-19    during the five years preceding the date of the report that could
23-20    adversely affect the person's ability to safely practice as a
23-21    surgical assistant, if the person:
23-22                      (A)  reported the use; and
23-23                      (B)  has not previously been the subject of a
23-24    substance abuse related order of the medical board;
23-25                (3)  a judgment by a court that the person is of
23-26    unsound mind; or
23-27                (4)  the results of a mental or physical examination,
 24-1    or an admission by the person, indicating that the person suffers
 24-2    from a potentially dangerous limitation or an inability to practice
 24-3    as a surgical assistant with reasonable skill and safety because of
 24-4    illness or any other physical or mental condition.
 24-5          Sec. 206.306.  EFFECT OF REHABILITATION ORDER. (a)  A
 24-6    rehabilitation order imposed under Section 206.305 is a
 24-7    nondisciplinary private order. If entered into by agreement, the
 24-8    order is an agreed disposition or settlement agreement for purposes
 24-9    of civil litigation and is exempt from Chapter 552, Government
24-10    Code.
24-11          (b)  The rehabilitation order must contain findings of fact
24-12    and conclusions of law. The order may impose a license revocation
24-13    or suspension, a period of probation or restriction, or any other
24-14    sanction authorized by this chapter or agreed to by the medical
24-15    board and the person subject to the order.
24-16          (c)  A violation of a rehabilitation order may result in
24-17    disciplinary action under this chapter or under the terms of the
24-18    agreed order.
24-19          (d)  A violation of a rehabilitation order is grounds for
24-20    disciplinary action based on:
24-21                (1)  unprofessional or dishonorable conduct; or
24-22                (2)  any provision of this chapter that applies to the
24-23    conduct that resulted in the violation.
24-24          Sec. 206.307.  AUDIT OF REHABILITATION ORDER. (a)  The
24-25    medical board shall maintain a rehabilitation order imposed under
24-26    Section 206.305 in a confidential file. The file is subject to an
24-27    independent audit by the state auditor or a private auditor with
 25-1    whom the board contracts to perform the audit to ensure that only
 25-2    qualified license holders are subject to rehabilitation orders.
 25-3          (b)  An audit may be performed at any time at the direction
 25-4    of the medical board. The medical board shall ensure that an audit
 25-5    is performed at least once in each three-year period.
 25-6          (c)  The audit results are a matter of public record and
 25-7    shall be reported in a manner that maintains the confidentiality of
 25-8    each license holder who is the subject of a rehabilitation order.
 25-9          Sec. 206.308.  SUBPOENA. (a)  The executive director, the
25-10    director's designee, or the secretary-treasurer of the board may
25-11    issue a subpoena or subpoena duces tecum:
25-12                (1)  to conduct an investigation or a contested case
25-13    proceeding related to:
25-14                      (A)  alleged misconduct by a surgical assistant;
25-15                      (B)  an alleged violation of this chapter or
25-16    another law related to the practice of a surgical assistant; or
25-17                      (C)  the provision of health care under this
25-18    chapter;
25-19                (2)  for purposes of determining whether to issue,
25-20    suspend, restrict, or revoke a license under this chapter; or
25-21                (3)  for purposes of determining whether to issue or
25-22    deny a license under this chapter.
25-23          (b)  Failure to timely comply with a subpoena issued under
25-24    this section is a ground for:
25-25                (1)  disciplinary action by the medical board or
25-26    another licensing or regulatory agency with jurisdiction over the
25-27    person subject to the subpoena; and
 26-1                (2)  denial of a license application.
 26-2          Sec. 206.309.  PROTECTION OF PATIENT IDENTITY. In a
 26-3    disciplinary investigation or proceeding conducted under this
 26-4    chapter, the medical board shall protect the identity of each
 26-5    patient whose medical records are examined and used in a public
 26-6    proceeding unless the patient:
 26-7                (1)  testifies in the public proceeding; or
 26-8                (2)  submits a written release in regard to the
 26-9    patient's records or identity.
26-10          Sec. 206.310.  RULES FOR DISCIPLINARY PROCEEDINGS. Rules of
26-11    practice adopted under this chapter by the medical board under
26-12    Section 2001.004, Government Code, applicable to the proceedings
26-13    for a disciplinary action may not conflict with rules adopted by
26-14    the State Office of Administrative Hearings.
26-15          Sec. 206.311.  REQUIRED SUSPENSION OF INCARCERATED SURGICAL
26-16    ASSISTANT. Regardless of the offense, the medical board shall
26-17    suspend the license of a surgical assistant serving a prison term
26-18    in a state or federal penitentiary during the term of the
26-19    incarceration.
26-20          Sec. 206.312.  TEMPORARY SUSPENSION. (a)  The president of
26-21    the medical board, with medical board approval, shall appoint a
26-22    three-member disciplinary panel consisting of medical board members
26-23    to determine whether a surgical assistant's license should be
26-24    temporarily suspended.
26-25          (b)  If the disciplinary panel determines from the evidence
26-26    or information presented to the panel that a person licensed to
26-27    practice as a surgical assistant would, by the person's
 27-1    continuation in practice, constitute a continuing threat to the
 27-2    public welfare, the disciplinary panel shall temporarily suspend
 27-3    the license of that person.
 27-4          (c)  A license may be suspended under this section without
 27-5    notice or hearing on the complaint if:
 27-6                (1)  institution of proceedings for a hearing before
 27-7    the medical board is initiated simultaneously with the temporary
 27-8    suspension; and
 27-9                (2)  a hearing is held under Chapter 2001, Government
27-10    Code, and this chapter as soon as possible.
27-11          (d)  Notwithstanding Chapter 551, Government Code, the
27-12    disciplinary panel may hold a meeting by telephone conference call
27-13    if immediate action is required and convening the disciplinary
27-14    panel at one location is inconvenient for any member of the panel.
27-15             (Sections 206.313-206.350 reserved for expansion
27-16         SUBCHAPTER H.  OTHER PENALTIES AND ENFORCEMENT PROVISIONS
27-17          Sec. 206.351.  ADMINISTRATIVE PENALTY. (a)  The medical board
27-18    by order may impose an administrative penalty against a person
27-19    licensed under this chapter who violates this chapter or a rule or
27-20    order adopted under this chapter.
27-21          (b)  The penalty may be in an amount not to exceed $5,000.
27-22    Each day a violation continues or occurs is a separate violation
27-23    for purposes of imposing a penalty.
27-24          (c)  The medical board shall base the amount of the penalty
27-25    on:
27-26                (1)  the severity of patient harm;
27-27                (2)  the severity of economic harm to any person;
 28-1                (3)  the severity of any environmental harm;
 28-2                (4)  the increased potential for harm to the public;
 28-3                (5)  any attempted concealment of misconduct;
 28-4                (6)  any premeditated or intentional misconduct;
 28-5                (7)  the motive for the violation;
 28-6                (8)  any prior misconduct of a similar or related
 28-7    nature;
 28-8                (9)  the license holder's disciplinary history;
 28-9                (10)  any prior written warnings or written
28-10    admonishments from any government agency or official regarding
28-11    statutes or rules relating to the misconduct;
28-12                (11)  whether the violation is of a board order;
28-13                (12)  the person's failure to implement remedial
28-14    measures to correct or mitigate harm from the misconduct;
28-15                (13)  the person's lack of rehabilitative potential or
28-16    likelihood of future misconduct of a similar nature;
28-17                (14)  any relevant circumstances increasing the
28-18    seriousness of the misconduct; and
28-19                (15)  any other matter that justice may require.
28-20          (d)  The medical board by rule shall prescribe the procedures
28-21    by which it may impose an administrative penalty. A proceeding
28-22    under this section is subject to Chapter 2001, Government Code.
28-23          (e)  If the medical board by order determines that a
28-24    violation has occurred and imposes an administrative penalty, the
28-25    medical board shall give notice to the person of the order. The
28-26    notice must include a statement of the person's right to judicial
28-27    review of the order.
 29-1          Sec. 206.352.  CRIMINAL PENALTY. (a)  A person commits an
 29-2    offense if, without holding a license issued under this chapter,
 29-3    the person:
 29-4                (1)  represents that the person is a surgical
 29-5    assistant;
 29-6                (2)  uses any combination or abbreviation of the term
 29-7    "surgical assistant" to indicate or imply that the person is a
 29-8    surgical assistant; or
 29-9                (3)  acts as a surgical assistant.
29-10          (b)  An offense under this section is a felony of the third
29-11    degree.
29-12          SECTION 2. Subsection (B), Section 2, Chapter 397, Acts of
29-13    the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
29-14    Vernon's Texas Insurance Code), is amended to read as follows:
29-15          (B)  No policy of accident and sickness insurance shall make
29-16    benefits contingent upon treatment or examination by a particular
29-17    practitioner or by particular practitioners of the healing arts
29-18    hereinafter designated unless such policy contains a provision
29-19    designating the practitioner or practitioners who will be
29-20    recognized by the insurer and those who will not be recognized by
29-21    the insurer.  Such provision may be located in the "Exceptions" or
29-22    "Exceptions and Reductions" provisions, or elsewhere in the policy,
29-23    or by endorsement attached to the policy, at the insurer's option.
29-24    In designating the practitioners who will and will not be
29-25    recognized, such provision shall use the following terms:  Doctor
29-26    of Medicine, Doctor of Osteopathy, Doctor of Dentistry, Doctor of
29-27    Chiropractic, Doctor of Optometry, Doctor of Podiatry, Licensed
 30-1    Audiologist, Licensed Speech-language Pathologist, Doctor in
 30-2    Psychology, Licensed Master Social Worker--Advanced Clinical
 30-3    Practitioner, Licensed Dietitian, Licensed Professional Counselor,
 30-4    Licensed Marriage and Family Therapist, Licensed Chemical
 30-5    Dependency Counselor, Licensed Hearing Instrument Fitter and
 30-6    Dispenser, Advanced Practice Nurse, Physician Assistant, Licensed
 30-7    Occupational Therapist, Licensed Physical Therapist, Licensed
 30-8    Acupuncturist, [and] Licensed Psychological Associate, and Licensed
 30-9    Surgical Assistant.
30-10          For purposes of this Act, such designations shall have the
30-11    following meanings:
30-12          Doctor of Medicine:  One licensed by the Texas State Board of
30-13    Medical Examiners on the basis of the degree "Doctor of Medicine";
30-14          Doctor of Osteopathy:  One licensed by the Texas State Board
30-15    of Medical Examiners on the basis of the degree of "Doctor of
30-16    Osteopathy";
30-17          Doctor of Dentistry:  One licensed by the State Board of
30-18    Dental Examiners;
30-19          Doctor of Chiropractic:  One licensed by the Texas Board of
30-20    Chiropractic Examiners;
30-21          Doctor of Optometry:  One licensed by the Texas Optometry
30-22    Board;
30-23          Doctor of Podiatry:  One licensed by the Texas State Board of
30-24    Podiatric Medical Examiners;
30-25          Licensed Audiologist:  One with a master's or doctorate
30-26    degree in audiology from an accredited college or university and
30-27    who is licensed as an audiologist by the State Board of Examiners
 31-1    for Speech-Language Pathology and Audiology;
 31-2          Licensed Speech-language Pathologist:  One with a master's or
 31-3    doctorate degree in speech pathology or speech-language pathology
 31-4    from an accredited college or university and who is licensed as a
 31-5    speech-language pathologist by the State Board of Examiners for
 31-6    Speech-Language Pathology and Audiology;
 31-7          Doctor in Psychology:  One licensed by the Texas State Board
 31-8    of Examiners of Psychologists and certified as a Health Service
 31-9    Provider;
31-10          Licensed Master Social Worker--Advanced Clinical
31-11    Practitioner:  One licensed by the Texas State Board of Social
31-12    Worker Examiners as a Licensed Master Social Worker with the order
31-13    of recognition of Advanced Clinical Practitioner;
31-14          Licensed Dietitian:  One licensed by the Texas State Board of
31-15    Examiners of Dietitians;
31-16          Licensed Professional Counselor:  One licensed by the Texas
31-17    State Board of Examiners of Professional Counselors;
31-18          Licensed Marriage and Family Therapist:  One licensed by the
31-19    Texas State Board of Examiners of Marriage and Family Therapists;
31-20          Licensed Chemical Dependency Counselor:  One licensed by the
31-21    Texas Commission on Alcohol and Drug Abuse;
31-22          Licensed Hearing Instrument Fitter and Dispenser:  One
31-23    licensed by the State Committee of Examiners in the Fitting and
31-24    Dispensing of Hearing Instruments;
31-25          Advanced Practice Nurse:  One licensed by the Board of Nurse
31-26    Examiners as a registered nurse and recognized by that board as an
31-27    advanced practice nurse;
 32-1          Physician Assistant:  One licensed by the Texas State Board
 32-2    of Physician Assistant Examiners;
 32-3          Licensed Occupational Therapist:  One licensed by the Texas
 32-4    Board of Occupational Therapy Examiners;
 32-5          Licensed Physical Therapist:  One licensed by the Texas Board
 32-6    of Physical Therapy Examiners;
 32-7          Licensed Acupuncturist:  One licensed by the Texas State
 32-8    Board of Medical Examiners as an acupuncturist;  [and]
 32-9          Licensed Psychological Associate:  One licensed by the Texas
32-10    State Board of Examiners of Psychologists and practicing under the
32-11    supervision of a licensed psychologist; and
32-12          Licensed Surgical Assistant: One licensed by the Texas State
32-13    Board of Medical Examiners as a surgical assistant.
32-14          SECTION 3. Section 1, Article 21.52, Insurance Code, is
32-15    amended by adding Subsection (u) to read as follows:
32-16          (u)  "Surgical assistant" means a person licensed by the
32-17    Texas State Board of Medical Examiners as a surgical assistant.
32-18          SECTION 4. Section 3(a), Article 21.52, Insurance Code, as
32-19    amended by Chapters 428 and 888,  Acts of the 76th Legislature,
32-20    Regular Session, 1999, is amended to read as follows:
32-21          (a)  Any person who is issued, who is a party to, or who is a
32-22    beneficiary under any health insurance policy delivered, renewed,
32-23    or issued for delivery in this state by any insurance company,
32-24    association, or organization to which this article applies may
32-25    select:
32-26                (1)  a licensed doctor of podiatric medicine, a
32-27    licensed dentist, or a doctor of chiropractic to perform the
 33-1    medical or surgical services or procedures scheduled in the policy
 33-2    which fall within the scope of the license of that practitioner;
 33-3                (2)  a licensed doctor of optometry to perform the
 33-4    services or procedures scheduled in the policy which fall within
 33-5    the scope of the license of that doctor of optometry;
 33-6                (3)  an occupational therapist to provide the services
 33-7    scheduled in the policy which fall within the scope of the license
 33-8    of that occupational therapist;
 33-9                (4)  a physical therapist to provide the services
33-10    scheduled in the policy which fall within the scope of the license
33-11    of that physical therapist;
33-12                (5)  a licensed audiologist to measure hearing for the
33-13    purpose of determining the presence or extent of a hearing loss and
33-14    to provide aural rehabilitation services to a person with a hearing
33-15    loss if those services or procedures are scheduled in the policy;
33-16                (6)  a licensed speech-language pathologist to evaluate
33-17    speech and language and to provide habilitative and rehabilitative
33-18    services to restore speech or language loss or to correct a speech
33-19    or language impairment if those services or procedures are
33-20    scheduled in the policy;
33-21                (7)  a licensed master social worker--advanced clinical
33-22    practitioner to provide the services that fall within the scope of
33-23    the license of such certified practitioner and which are specified
33-24    as services within the terms of the policy of insurance, including
33-25    the provision of direct, diagnostic, preventive, or clinical
33-26    services to individuals, families, and groups whose functioning is
33-27    threatened or affected by social or psychological stress or health
 34-1    impairment, if those services or procedures are scheduled in the
 34-2    policy;
 34-3                (8)  a licensed dietitian including a provisional
 34-4    licensed dietitian under a licensed dietitian's supervision to
 34-5    provide the services that fall within the scope of the license of
 34-6    that dietitian if those services are scheduled in the policy;
 34-7                (9)  a licensed professional counselor to provide the
 34-8    services that fall within the scope of the license of that
 34-9    professional if those services are scheduled in the policy;
34-10                (10)  a licensed marriage and family therapist to
34-11    provide the services that fall within the scope of the license of
34-12    that professional if those services are scheduled in the policy;
34-13                (11)  a psychologist to perform the services or
34-14    procedures scheduled in the policy that fall within the scope of
34-15    the license of that psychologist;
34-16                (12)  a licensed chemical dependency counselor to
34-17    perform the services or procedures scheduled in the policy that
34-18    fall within the scope of the license of that practitioner;
34-19                (13) [(12)]  a licensed acupuncturist to perform the
34-20    services or procedures scheduled in the policy that fall within the
34-21    scope of the license of that practitioner;
34-22                (14) [(13)]  an advanced practice nurse to provide the
34-23    services scheduled in the policy that fall within the scope of the
34-24    license of that practitioner;
34-25                (15) [(14)]  a physician assistant to provide the
34-26    services scheduled in the policy that fall within the scope of the
34-27    license of that practitioner;
 35-1                (16) [(15)]  a licensed hearing instrument fitter and
 35-2    dispenser to provide the services or procedures scheduled in the
 35-3    policy that fall within the scope of the license of that
 35-4    practitioner;
 35-5                (17)  a licensed surgical assistant to provide the
 35-6    services or procedures scheduled in the policy that fall within the
 35-7    scope of the license of that practitioner; or
 35-8                (18) [(16)]  a licensed psychological associate to
 35-9    provide the services that fall within the scope of the license of
35-10    that professional if those services are scheduled in the policy.
35-11          SECTION 5. (a)  Notwithstanding Section 206.201 and
35-12    Subchapter H, Chapter 206, Occupations Code, as added by this Act,
35-13    a person is not required to obtain a license under Chapter 206,
35-14    Occupations Code, as added by this Act, until September 1, 2002.
35-15          (b)  The Texas State Board of Medical Examiners shall adopt
35-16    rules under Chapter 206, Occupations Code, as added by this Act,
35-17    not later than January 1, 2002.
35-18          SECTION 6. Section 2, Chapter 397, Acts of the 54th
35-19    Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
35-20    Insurance Code), and Article 21.52, Insurance Code, as amended by
35-21    this Act, apply only to an insurance policy, contract, or evidence
35-22    of coverage delivered, issued for delivery, or renewed on or after
35-23    January 1, 2003.  A policy, contract, or evidence of coverage
35-24    delivered, issued for delivery, or renewed before January 1, 2003,
35-25    is governed by the law as it existed immediately before the
35-26    effective date of this Act, and that law is continued in effect for
35-27    that purpose.
 36-1          SECTION 7. This Act takes effect September 1, 2001.