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A BILL TO BE ENTITLED
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AN ACT
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relating to the participation of an advanced practice nurse as a |
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primary care provider for certain governmental and other health |
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benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.005, Government Code, is amended by |
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adding Subsection (d) to read as follows: |
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(d) For purposes of Subsection (a)(13), an advanced |
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practice nurse, including an advanced practice nurse certified as a |
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psychiatric/mental health advanced practice nurse, may be included |
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as a primary care provider in a managed care organization's |
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provider network regardless of whether the physician delegating to |
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or supervising the advanced practice nurse under Subchapter B, |
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Chapter 157, Occupations Code, is in the provider network. If a |
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managed care organization includes an advanced practice nurse as a |
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primary care provider under this subsection, the physician |
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delegating to or supervising the advanced practice nurse is part of |
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the network for purposes of supervision. This subsection may not be |
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construed as authorizing a managed care organization to supervise |
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or control the practice of medicine as prohibited by Subtitle B, |
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Title 3, Occupations Code. |
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SECTION 2. Section 62.1551, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 62.1551. INCLUSION OF CERTAIN HEALTH CARE PROVIDERS IN |
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PROVIDER NETWORKS. (a) Notwithstanding any other law, including |
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Sections 843.312 and 1301.052, Insurance Code, the executive |
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commissioner of the commission shall adopt rules to require a |
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managed care organization or other entity to ensure that advanced |
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practice registered nurses and physician assistants are available |
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as primary care providers in the organization's or entity's |
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provider network. The rules must require advanced practice |
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registered nurses and physician assistants to be treated in the |
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same manner as primary care physicians with regard to: |
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(1) selection and assignment as primary care |
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providers; |
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(2) inclusion as primary care providers in the |
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provider network; and |
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(3) inclusion as primary care providers in any |
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provider network directory maintained by the organization or |
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entity. |
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(b) For purposes of Subsection (a), an advanced practice |
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nurse, including an advanced practice nurse certified as a |
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psychiatric/mental health advanced practice nurse, may be included |
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as a primary care provider in a managed care organization's or |
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entity's provider network regardless of whether the physician |
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delegating to or supervising the advanced practice nurse under |
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Subchapter B, Chapter 157, Occupations Code, is in the provider |
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network. If a managed care organization or other entity includes an |
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advanced practice nurse as a primary care provider under this |
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subsection, the physician delegating to or supervising the advanced |
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practice nurse is part of the provider network for purposes of |
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supervision. |
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(c) This section may not be construed as authorizing a |
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managed care organization or other entity to supervise or control |
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the practice of medicine as prohibited by Subtitle B, Title 3, |
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Occupations Code. |
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SECTION 3. Section 32.024(gg), Human Resources Code, is |
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amended to read as follows: |
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(gg) Notwithstanding any other law, including Sections |
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843.312 and 1301.052, Insurance Code, the department shall ensure |
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that advanced practice registered nurses, including advanced |
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practice registered nurses certified as psychiatric/mental health |
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advanced practice nurses, and physician assistants may be selected |
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by and assigned to recipients of medical assistance as the primary |
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care providers of those recipients regardless of whether the |
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physician delegating to or supervising the advanced practice |
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registered nurse under Subchapter B, Chapter 157, Occupations Code, |
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is included in any directory of providers of medical assistance |
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maintained by the department. If an advanced practice registered |
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nurse is included as a primary care provider under this subsection, |
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the physician delegating to or supervising the advanced practice |
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registered nurse is included in the directory for purposes of |
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supervision. This subsection may not be construed as authorizing |
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the department to supervise or control the practice of medicine as |
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prohibited by Subtitle B, Title 3, Occupations Code. The |
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department must require that advanced practice registered nurses |
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and physician assistants be treated in the same manner as primary |
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care physicians with regard to: |
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(1) selection and assignment as primary care |
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providers; and |
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(2) inclusion as primary care providers in any |
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directory of providers of medical assistance maintained by the |
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department. |
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SECTION 4. Subchapter I, Chapter 843, Insurance Code, is |
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amended by adding Section 843.3125 to read as follows: |
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Sec. 843.3125. CONTRACTS WITH ADVANCED PRACTICE NURSES. |
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(a) A health maintenance organization may contract directly with |
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an advanced practice nurse to provide health care services on |
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behalf of the health maintenance organization regardless of whether |
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the physician delegating to or supervising the advanced practice |
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nurse under Subchapter B, Chapter 157, Occupations Code, provides |
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health care services for the health maintenance organization. |
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(b) If a health maintenance organization contracts directly |
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with an advanced practice nurse under Subsection (a), the physician |
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delegating to or supervising the advanced practice nurse is part of |
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an applicable limited provider network for purposes of supervision. |
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(c) This section may not be construed as authorizing a |
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health maintenance organization to supervise or control the |
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practice of medicine as prohibited by Subtitle B, Title 3, |
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Occupations Code. |
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SECTION 5. Subchapter B, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0525 to read as follows: |
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Sec. 1301.0525. DESIGNATION OF ADVANCED PRACTICE NURSES AS |
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PREFERRED PROVIDERS. (a) An insurer offering a preferred provider |
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benefit plan may designate an advanced practice nurse as a |
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preferred provider regardless of whether the physician delegating |
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to or supervising the advanced practice nurse under Subchapter B, |
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Chapter 157, Occupations Code, is a preferred provider. |
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(b) If an insurer designates an advanced practice nurse as a |
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preferred provider under Subsection (a), the physician delegating |
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to or supervising the advanced practice nurse is a preferred |
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provider for purposes of supervision. |
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(c) This section may not be construed as authorizing an |
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insurer to supervise or control the practice of medicine as |
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prohibited by Subtitle B, Title 3, Occupations Code. |
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SECTION 6. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 7. This Act takes effect September 1, 2015. |