C.S.H.B. 3000 78(R) BILL ANALYSIS C.S.H.B. 3000 By: Capelo Business & Industry Committee Report (Substituted) BACKGROUND AND PURPOSE This bill addresses the eligibility for reimbursement of certified and licensed surgical first assistants. A surgical first assistant is a healthcare professional who stands across from the surgeon during surgery and assists the surgeon. Surgical first assistants in Texas routinely bill third party payers for their services. Last session, the Texas Legislature created a license for surgical assistants in HB 1183, designated them as eligible providers under the Insurance Code, and made them eligible for state Medicaid reimbursement, but, inadvertently, did not cover workers compensation reimbursement. Surgical assistants had routinely been paid in Texas for workers compensation cases. See modifier 85 under the 1996 Medical Fee Guidelines of the Texas Workers Compensation Commission that provides for reimbursement of certified surgical technologist/certified first assistant (CST/CFA). However, when the TWCC recently adopted new fee guidelines based on Medicare, surgical assistants were left out because they are not currently reimbursed under Federal Medicare. Registered nurse first assistants (RNFAs) perform the identical function of the CST/CFA and licensed surgical assistants during surgery. RNFAs are expressly authorized to be reimbursed in workers compensation cases pursuant to Section 408.029, Labor Code. It is neither consistent nor logical to exclude non-nurse first assistants from reimbursement under the workers compensation system. They are several reasons to reimburse certified surgical first assistants. First, as indicated above, certified first assistants had been part of the workers compensation system for a number of years and provide a valuable service. Second, certified surgical first assistants save money for the system. Customarily, non-physician surgical first assistants are reimbursed at a rate of ten to twenty five percent less than physician surgical assistants. Third, the use of non-physician surgical assistants reflects a trend in health care delivery in recent years that enables competent professionals to fill a void that has grown as more surgeons lack the time or incentive to assist in surgery. In many operations, surgeons prefer to be assisted by a nonphysician assistant who is familiar with their surgery style and has a more flexible schedule than the physician surgical assistant. Fourth, non-physician surgical first assistants provide hospitals with a valuable resource to address acute staffing shortages in the operating room. For these reasons, Texas workers compensation patients, and the system itself, will benefit from the reimbursement of non-physician surgical first assistants in workers compensation cases. The purpose of CSHB 3000 is to make certified first assistants and licensed surgical assistants eligible for compensation under the Texas workers compensation system, and to be reimbursed at rates paid other non-physician surgical first assistants under Medicare. RULEMAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution. ANALYSIS Section 1. Amends Chapter 408, Labor Code, by adding Section 408.030 as follows: Authorizes a licensed surgical assistant or a surgical assistant certified by a national organization approved by the Texas Board of Medical Examiners to be reimbursed in workers compensation cases for first assistant services provided at the request of a physician. Provides that a licensed surgical assistant or a certified surgical assistant be reimbursed on the same basis as a physician assistant, nurse practitioner, or clinical nurse specialist who function as a first assistant in surgery. Section 2. Effective date. Takes effect September 1, 2003 and applies only to a claim for workers' compensation benefits based on a compensable injury that occurs on or after that date. EFFECTIVE DATE September 1, 2003 COMPARISON OF ORIGINAL TO SUBSTITUTE Changed the section of the Labor Code amended by the bill to Section 408.030 to clarify that nonphysician surgical assistants are to be reimbursed at a lower rate than physician surgical assistants. Adds language to provide that only surgical assistants certified by a national organization approved by the Texas Board of Medical Examiners will be eligible for reimbursement. Adds language to link the reimbursement rate to those practitioners who currently are eligible to be reimbursed under Medicare when functioning as a first assistant in surgery.