LEGISLATIVE BUDGET BOARD
                              Austin, Texas
                                     
                    FISCAL NOTE, 77th Regular Session
  
                              April 17, 2001
  
  
          TO:  Honorable Patricia Gray, Chair, House Committee on Public
               Health
  
        FROM:  John Keel, Director, Legislative Budget Board
  
       IN RE:  HB803  by Junell (Relating to reimbursement for services
               provided by registered nurse first assistants.),
               Committee Report 1st House, Substituted
  
**************************************************************************
*  Estimated Two-year Net Impact to General Revenue Related Funds for    *
*  HB803, Committee Report 1st House, Substituted:  an impact of $0      *
*  through the biennium ending August 31, 2003.                          *
*                                                                        *
*  The bill would make no appropriation but could provide the legal      *
*  basis for an appropriation of funds to implement the provisions of    *
*  the bill.                                                             *
**************************************************************************
  
General Revenue-Related Funds, Five-Year Impact:
  
          ****************************************************
          *  Fiscal Year  Probable Net Positive/(Negative)   *
          *               Impact to General Revenue Related  *
          *                             Funds                *
          *       2002                                   $0  *
          *       2003                                    0  *
          *       2004                                    0  *
          *       2005                                    0  *
          *       2006                                    0  *
          ****************************************************
  
All Funds, Five-Year Impact:
  
**************************************************************************
*Fiscal        Probable         Probable Revenue    Change in Number of  *
* Year    Savings/(Cost) from   Gain/(Loss) from   State Employees from  *
*        General Revenue Fund General Revenue Fund        FY 2001        *
*                0001                 0001                               *
*  2002              $(83,198)              $83,198                  2.0 *
*  2003               (78,615)               78,615                  2.0 *
*  2004               (81,093)               81,093                  2.0 *
*  2005               (83,664)               83,664                  2.0 *
*  2006               (86,312)               86,312                  2.0 *
**************************************************************************
  
Fiscal Analysis
  
The bill would amend the Occupations Code by adding a new Section that
requires the Board of Nurse Examiners (BNE) to adopt rules for the
approval of Nurse First Assistants.  The provisions of the bill would
allow certification by an outside organization recognized by the BNE,
setting guidelines for the approval process and monitoring continuing
education beyond the existing requirements of a registered nurse.

The bill would take effect September 1, 2001.
  
  
Methodology
  
BNE estimates it will need two additional Full-time Equivalent Positions
(FTEs).  BNE estimates they will need one full time program specialist to
develop rules, interpret the rules, approve applications and answer
practice questions.  It would also requires one full time administrative
technician to support the program specialist and to answer administrative
questions regarding registration, renewal and continuing education
requirements, which mirrors that of the Advanced Nurse Practitioner
program.  BNE currently has over 9,000 registered nurses who have
provided statistical information they are working in an operating room
environment.  BNE assumes they will have to promulgate rules to implement
this program which will require additional travel funds for a
representative of the BNE.  BNE assumes it will have to develop an
approval mechanism by which each Nurse First Assistant will have to
register with the BNE and create and maintain on ongoing program to
re-register and update the registrant's status and monitor their
continuing education requirements.

It is assumed the BNE would adjust fees to cover the cost of implementing
the bill.
  
  
Local Government Impact
  
No significant fiscal implication to units of local government is
anticipated.
  
  
Source Agencies:   454   Texas Department of Insurance, 529   Health and
                   Human Services Commission, 507   Board of Nurse
                   Examiners
LBB Staff:         JK, HD, DE