HBA-MPM S.B. 1131 76(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1131 By: Madla Public Health 4/14/1999 Engrossed BACKGROUND AND PURPOSE Over the years, various health care associations have worked together to address practice problems faced by the advanced practice nurses (APNs) and physician assistants (PAs). The following three issues were identified during the last interim as being in need of legislative attention: clinical privileging; reimbursement by insurance companies; and the inability of APNs and PAs to have their patients' prescriptions called into a pharmacy. S.B. 1131 regulates APNs and PAs, and provides penalties. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 241.003, Health and Safety Code, as amended by Chapters 43 and 623, Acts of the 75th Legislature, Regular Session, 1997, as follows: Sec. 241.003. DEFINITIONS. Adds "advanced practice nurse" and "physician assistant" to the list of definitions included in this chapter. Redesignates existing Subdivision (1) to Subdivision (2); existing Subdivision (2) as amended by Acts 1997, 75th Leg., ch. 43, Sec. 1, to Subdivision (3); existing Subdivision (2) as amended by Acts 1997, 75th Leg., ch. 623, Sec. 2, to Subdivision (4); existing Subdivisions (3)-(6) to Subdivisions (5)-(8); and existing Subdivisions (12)-(14) to Subdivisions (13)-(15), respectively. SECTION 2. Amends Subchapter E, Chapter 241, Health and Safety Code, by adding Section 241.105, as follows: Sec. 241.105. HOSPITAL PRIVILEGES FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS. (a) Authorizes the governing body of a hospital to establish policies concerning the granting of clinical privileges to advanced practice nurses (APNs) and physician assistants (PAs), including policies relating to the application process, reasonable qualifications for privileges, and the process for renewal, modification, or revocation of privileges. (b) Entitles an APN or PA qualifying for privileges under the governing body's policy to certain procedural rights to provide fairness of process, as determined by the governing body, when an application for privileges is submitted to the hospital, if the governing body has adopted a policy of granting clinical privileges to APNs or PAs. (c) Prohibits a hospital from modifying or revoking clinical privileges without providing certain procedural rights to provide fairness of process, as determined by the governing body, to the APN or PA, if the APN or PA has been granted privileges by a hospital. Requires the hospital, at a minimum, to provide the APN or PA written reasons for the modification or revocation of privileges and a mechanism for appeal to the appropriate committee or body within the hospital, as determined by its governing body. (d) Requires an APN or PA and physician, if a hospital extends clinical privileges to an APN or PA conditioned on the APN or PA having a sponsoring or collaborating relationship with a physician, to provide written notification to the hospital if the relationship between the APN or PA and physician no longer exists. Requires the hospital, once it receives such a notice, to be deemed to have met its obligation under this section by notifying the APN or PA in writing that the APN's or PA's privileges no longer exist at that hospital. (e) Provides that this section does not modify the following: Article 4495b, V.T.C.S. (Medical Practice Act); Article 4513 et seq., V.T.C.S. (Nursing Practice Act); Article 4495b-1, V.T.C.S. (Physician Assistant Licensing Act); or any other law relating to the scope of practice of a physician, APN, or PA. (f) Provides that this section is inapplicable to an employer-employee relationship between an APN or PA and a hospital. SECTION 3. Amends Section 33, Article 4542a-1, V.T.C.S. (Texas Pharmacy Act), by adding Subsection (f), as follows: (f) Authorizes a person who is a licensed vocational nurse (LVN) or who has an education equivalent to or greater than that required for an LVN to be designated by the practitioner to communicate prescriptions of an APN or PA authorized by the practitioner to sign prescription drug orders under Section 3.06(d)(5) or (6), (Construction), Article 4495b, V.T.C.S. (Medical Practice Act). SECTION 4. Amends Section 483.022, Health and Safety Code, by adding Subsection (f), as follows: (f) Authorizes a practitioner to designate a person who is an LVN or who has an education equivalent to or greater than that required for an LVN to communicate prescriptions of an APN or PA authorized by the practitioner to sign prescription drug orders under Section 3.06(d)(5) or (6), Article 4495b, V.T.C.S. (Medical Practice Act). SECTION 5. Amends Section 31, Article 8451a, V.T.C.S. (Chapter 1036, Acts of the 62nd Legislature, Regular Session, 1971), to make conforming changes. SECTION 6. Amends Section 1, Article 21.52, Insurance Code, to make conforming changes. SECTION 7. Amends Section 3, Article 21.52, Insurance Code, to include a licensed chemical dependency counselor, an APN or PA, to perform or provide the services or procedures scheduled in the policy that fall within the scope of the license of that practitioner among those parties any person who is issued, is party or, or is beneficiary under, any health insurance policy delivered, renewed, or issued for delivery in this state by any insurance company, association, or organization, to which this article applies, is authorized to select. Authorizes a health insurance policy to provide for a different amount of payment or reimbursement for scheduled services or procedures when performed by an APN or PA provided the reimbursement methodology used to calculate the payment for the service or procedure is the same as that used to calculate the payment when the service or procedure is provided by a physician. Makes conforming and nonsubstantive changes. SECTION 8. Repealer: Section 3 (Selection of Practitioners), Article 21.52 (Right to Select Practitioner Under Health and Accident Policies), Insurance Code. SECTION 9. Effective date: September 1, 1999 SECTION 10. Emergency clause.