HBA-MPM H.B. 3223 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 3223 By: Capelo Public Health 3/29/99 Introduced BACKGROUND AND PURPOSE The Coalition for Nurses in Advanced Practice, Texas Academy of Physician Assistants, Texas Medical Association, and the Texas Nurses Association have identified certain practice problems faced by advanced practice nurses (APNs) and physician assistants (PAs). These issues are as follows: _the lack of clarity in clinical privileging granted by a hospital to APNs and PAs; _the lack of insurance coverage for certain services provided by APNs and PAs that would normally be covered by insurance policies; _an APN's or PA's limited authority to write prescriptions. H.B. 3223 does not require a hospital to grant privileges to an APN or PA, however, if the hospital chooses to do so, this bill requires that hospital to implement policies related to the clinical privileges enjoyed by APNs and PAs. This bill also adds APNs and PAs to the list of providers in Article 21.52 (Right to Select Practitioner Under Health and Accident Policies), Insurance Code against whom insurers cannot discriminate. Finally, this bill authorizes physicians to designate an agent who may call in the prescriptions of an APN or PA with whom the physician collaborates. 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 privileges to advanced practice nurses (APN) and physician assistants (PA). Authorizes the policies to include the application process, reasonable qualifications for privileges, and the process for the renewal, modification, or revocation of privileges. (b) Entitles an APN or PA qualifying for privileges under the governing body's policy regarding the granting of certain privileges, if so adopted, 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. Provides that any policy adopted must at least specify a reasonable time for processing and considering the application and provide for written notification of the applicant of any final action by the hospital on the application, including a reason for denying or restricting the requested privileges. (c) Prohibits a hospital that has granted clinical privileges to an APN or PA from modifying or revoking the privileges without providing certain procedural rights to provide fairness of process to the APN or PA, as determined by the hospital's governing body. Provides that the hospital must at least provide the APN or PA with written reasons for the modification or revocation and a means to appeal the decision to an appropriate entity within the hospital, as determined by the governing body. (d) Requires an APN or PA to provide written notification to the hospital if a hospital has granted clinical privileges to the APN or PA with the condition that the person has a sponsoring or collaborative relationship with a physician and that relationship ceases to exist. Provides that on receipt of this notice, the hospital is considered to meet its responsibilities under this section by notifying the APN or PA in writing that the person's clinical privileges are revoked. (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. SECTION 3. Amends Subchapter B, Chapter 483, Health and Safety Code, by adding Section 483.0225, as follows: Sec. 483.0225. COMMUNICATION OF PRESCRIPTIONS OF ADVANCED PRACTICE NURSE AND PHYSICIAN ASSISTANT. Authorizes a designated agent under Section 483.001(4)(A) or (B) (Definitions; "designated agent"), Health and Safety Code, to be designated by a practitioner to communicate the prescriptions of an APN or PA under Section 3.06(d)(5) or (6) (Construction), Article 4495b, V.T.C.S. (Medical Practice Act). SECTION 4. Amends Section 1, Article 21.52, Insurance Code, to redefine "licensed audiologist" as a person who has received a master's or doctorate degree in audiology from an accredited college or university and is licensed as an audiologist by the State Board of Examiners for Speech-Language Pathology and Audiology, rather than the State Committee of Examiners for Speech-Language Pathology and Audiology. Redefines "licensed hearing aid fitter and dispenser" as a person licensed by the State Committee of Examiners in the Fitting and Dispensing of Hearing Instruments, rather than the Texas Board of Examiners in the Fitting and Dispensing of Hearing Aids. Adds "advanced practice nurse" and "physician assistant" to the list of definitions provided for this article. Makes conforming and nonsubstantive changes. SECTION 5. Amends Section 3, Article 21.52, Insurance Code, as amended by Chapter 541, Acts of the 74th Legislature, Regular Session, 1995, and as reenacted and amended by Chapter 946, Acts of the 75th Legislature, Regular Session, 1997, as follows: Sec. 3. SELECTION OF PRACTITIONERS. Adds the following individuals to a list of those individuals who may be selected by a person who is issued, a party to, or a beneficiary under any health care policy delivered, renewed, or issued for delivery in this state by any insurance company, association, or organization: _a licensed chemical dependency counselor to perform the services or procedures scheduled in the policy that fall within the scope of the practitioner's license; _an APN to provide the services scheduled in the policy that fall within the scope of the APN's license; and _a PA to provide the services scheduled in the policy that fall within the scope of the PA's license. Authorizes a health insurance policy to provide for a different amount of payment or reimbursement for scheduled services or procedures provided by an APN or PA if the reimbursement methodology used to compute the payment or reimbursement is the same as that used to compute the payment for performance of the same service or procedure by a physician. Requires any presently approved policy form containing any provision in conflict with the requirements of this Act to be brought into compliance by use of riders and endorsements that are approved by the commissioner of insurance (commissioner), rather than the State Board of Insurance, or by the filing of new or revised policy forms for approval by the commissioner, rather than the State Board of Insurance. Makes conforming and nonsubstantive changes. SECTION 6. Amends Section 33, Article 4542a-1, V.T.C.S. (Texas Pharmacy Act), by adding Subsection (f), as follows: (f) Authorizes a designated agent under Section 5(18)(A) or (B) (Texas Pharmacy Act; definition of "designated agent"), Article 4542a-1, V.T.C.S., to be designated by a practitioner to communicate the prescriptions of an APN or PA under Section 3.06 (5) or (6), Article 4495b, V.T.C.S. (Medical Practice Act). SECTION 7. Amends Section 31, Article 8451a, V.T.C.S. (Chapter 1036, Acts of the 62nd Legislature, Regular Session, 1971), to include an APN among those individuals that are authorized to sign a certificate of health in connection with an application for an original or renewal operator license, instructor license, reciprocal license, or specialty certificate. Makes a conforming change. SECTION 8. Repealer: Section 3, (Selection of Practitioners) Article 21.52, Insurance Code, as amended by Chapter 429, Acts of the 74th Legislature, Regular Session, 1995, and reenacted and amended by Chapter 946, Acts of the 75th Legislature, Regular Session, 1997. SECTION 9. Effective date: September 1, 1999. Makes application of this Act prospective to a health insurance policy delivered, issued for delivery, or renewed before January 1,2000. SECTION 10. Emergency clause.