Office of House Bill AnalysisH.B. 803
By: Junell
Public Health


A registered nurse first assistant (RNFA) is a technically skilled and
highly educated nursing professional who renders direct care to surgical
patients before, during, and after surgery.  RNFAs perform the same first
assisting duties as surgeons, physicians, physician assistants, and some
nurse practitioners, all of whom are authorized to receive Medicaid
reimbursement for their first assisting services.  Nevertheless, prior to
the 77th Legislature, Medicaid and most private insurance companies did not
directly reimburse RNFAs for their services, and the reimbursement rates
that RNFAs did receive were not always commensurate with the reimbursement
rates of other health care professionals who perform the same first
assisting duties. Failure to reimburse or adequately reimburse RNFAs may
result in costs being shifted to patients.  House Bill 803 prohibits an
insurance company from refusing to contract with an RNFA or to cover first
assisting services because they were performed by an RNFA. 


It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the Board of Nurse Examiners in SECTION
5 (Section 301.1525, Occupations Code) of this bill.  


House Bill 803 amends the Occupations Code to authorize the Board of Nurse
Examiners (board) to adopt rules governing nurse first assistants (RNFAs).
The bill prohibits a health maintenance organization or an insurer,
including an insurer offering a preferred provider benefit plan, from
requiring, by contract or any other method, a physician to use the services
of an RNFA (Sec. 301.1525).  

The bill amends the Insurance Code to authorize any person with health
insurance coverage to select an RNFA to provide services scheduled in a
policy that fall within the scope of the RNFA's license and are requested
by the physician whom the nurse is assisting.  The bill prohibits an
insurance company, association, or organization from denying or making any
classification, differentiation, or discrimination in the payment for
scheduled services or procedures because they were performed by an RNFA
(Sec. 3, Art. 21.52).  

The bill amends the Human Resources Code to require the Health and Human
Services Commission to assure that a Medicaid recipient is authorized to
select an RNFA to perform any health care service or procedure covered
under the medical assistance program if the selected RNFA is authorized to
perform the service or procedure and the physician requests that the
service or procedure be performed by the RNFA (Sec. 32.027). 

The bill amends the Insurance Code to prohibit a preferred provider or a
health maintenance organization from refusing to contract with an RNFA to
be included in the network or refuse to reimburse the RNFA or a covered
service that a physician has requested the RNFA to perform (Sec. 3, Art.
3.70-3C, and Sec. 14, Art. 20A.14).  

The bill amends the Labor Code to prohibit an insurance carrier from
refusing to reimburse a health care  practitioner solely because that
practitioner is an RNFA for a covered service that a physician providing
health care services under worker's compensation has requested the RNFA to
perform (Sec. 408.029). 


September 1, 2001.  The Act applies only to a health insurance policy that
is delivered, issued for delivery, or renewed on or after January 1, 2002.