HBA-NRS C.S.H.B. 456 77(R)BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 456
By: Maxey
Public Health
4/9/2001
Committee Report (Substituted)



BACKGROUND AND PURPOSE 

Currently, under the state's voucher payment program, a person with a
disability may use the voucher payment option to pay for certain health
care services. Many of the tasks, such as regularly scheduled oral and
topical medication administration, feeding, and medication administration
through permanently placed gastrostomy tubes are normally performed by the
primary caregiver. The purpose of C.S.H.B. 456 is to allow an unlicensed
personal attendant hired by a consumer participating in the voucher payment
program to perform those responsibilities under the direction of the
consumer or the consumer's parent or guardian without the supervision of a
licensed nurse who delegates or intervenes in those responsibilities.
C.S.H.B. 456 exempts professional nursing services provided to persons with
disabilities under the voucher payment program from nursing licensing
requirements and requires Board of Nurse Examiners to appoint a task force
to review and make recommendations regarding the provision of health
maintenance tasks to persons with functional disabilities in independent
living environments. 

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. 

ANALYSIS

C.S.H.B. 456 amends the Government Code to provide that the provision
prohibiting a person from practicing or offering to practice professional
nursing in this state unless the person is properly licensed does not apply
to the delivery of a service for which payment is provided under the
voucher payment program, if the person who delivers the service has not
been denied a license as a registered nurse or a licensed vocational nurse
and has not been issued a license as a registered nurse that is revoked or
suspended, and the consumer who receives the service has a functional
disability and the service would have been performed by the consumer, or
the parent or guardian for the consumer, except for the disability, and if
the consumer or the consumer's parent or guardian is capable of training
the person in the proper performance of the service. If a service is
provided to a consumer who is not capable of training the person in the
proper performance of the service, the consumer's parent or guardian who is
capable of training the person either must be present during service
delivery or must observe the person performing the service at least once to
assure adequate performance.  

The bill specifies the types of service which may be delivered to a
consumer by an unlicenced registered nurse or a licensed vocational nurse
under the voucher payment program.  

The bill requires the Board of Nurse Examiners not later than November 30,
2001, to appoint a task force to review and make recommendations regarding
the provision of health maintenance tasks to persons with functional
disabilities in independent living environments. The bill sets forth the
composition of the task force. The bill requires the task force to report
its findings and recommendations to the speaker of the house of
representatives and the lieutenant governor not later than November 1,
2002. 


 EFFECTIVE DATE

On passage, or if the Act does not receive the necessary vote, the Act
takes effect September 1, 2001. 

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 456 modifies the original bill by specifying the allowable tasks
performed by individuals without a nursing license to persons with
disabilities participating in the voucher program. The substitute adds that
the individual performing the service will do so if the service would
either be routinely performed by the consumer or a parent or guardian of
the consumer were it not for the disability. The substitute establishes
supervision and training requirements for the person performing the
service. The substitute requires the Board of Nurse Examiners to appoint a
task force to review and make recommendations regarding the provision of
health maintenance tasks to persons with functional disabilities in
independent living environments.