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 Medicare
reimbursement for their first assisting services.  Nevertheless, Medicare
and most private insurance companies do not directly reimburse RNFAs for
their services, and reimbursement rates that RNFAs do receive are 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 sets forth criteria for a  nurse to be
classified as an RNFA and prohibits an insurance company from refusing 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
1 (Section 301.1525, Occupations Code) of this bill. 


House Bill 803 amends the Occupations Code to require the Board of Nurse
Examiners (board) to adopt rules to approve a registered nurse as a nurse
first assistant (RNFA). The bill provides that the rules must, at a
minimum, require a RNFA to complete at least 2,000 hours of first assisting
a physician with surgery and related preoperative, intraoperative, and
postoperative care and continuing education in providing first assistant
services in addition to any other continuing education required by the
board (Sec. 301.1525). 

H.B. 803 amends the Insurance Code to authorize any person with health
insurance coverage to select a RNFA to provide services scheduled in a
policy that fall within the scope of the RNFA's license.  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 a RNFA (Sec. 3, Article 21.52).  

The bill also amends the Human Resources Code to require the Health and
Human Services Commission to assure that a recipient of medical assistance
is authorized to select a 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 (Sec. 32.027). 


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.