84R7918 SCL-D
By: Garcia S.B. No. 1980
A BILL TO BE ENTITLED
AN ACT
relating to the participation of an advanced practice nurse as a
primary care provider for certain governmental and other health
benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 533.005, Government Code, is amended by
adding Subsection (d) to read as follows:
(d) For purposes of Subsection (a)(13), an advanced
practice nurse, including an advanced practice nurse certified as a
psychiatric/mental health advanced practice nurse, may be included
as a primary care provider in a managed care organization's
provider network regardless of whether the physician delegating to
or supervising the advanced practice nurse under Subchapter B,
Chapter 157, Occupations Code, is in the provider network. If a
managed care organization includes an advanced practice nurse as a
primary care provider under this subsection, the physician
delegating to or supervising the advanced practice nurse is part of
the network for purposes of supervision. This subsection may not be
construed as authorizing a managed care organization to supervise
or control the practice of medicine as prohibited by Subtitle B,
Title 3, Occupations Code.
SECTION 2. Section 62.1551, Health and Safety Code, is
amended to read as follows:
Sec. 62.1551. INCLUSION OF CERTAIN HEALTH CARE PROVIDERS IN
PROVIDER NETWORKS. (a) Notwithstanding any other law, including
Sections 843.312 and 1301.052, Insurance Code, the executive
commissioner of the commission shall adopt rules to require a
managed care organization or other entity to ensure that advanced
practice registered nurses and physician assistants are available
as primary care providers in the organization's or entity's
provider network. The rules must require advanced practice
registered nurses and physician assistants to be treated in the
same manner as primary care physicians with regard to:
(1) selection and assignment as primary care
providers;
(2) inclusion as primary care providers in the
provider network; and
(3) inclusion as primary care providers in any
provider network directory maintained by the organization or
entity.
(b) For purposes of Subsection (a), an advanced practice
nurse, including an advanced practice nurse certified as a
psychiatric/mental health advanced practice nurse, may be included
as a primary care provider in a managed care organization's or
entity's provider network regardless of whether the physician
delegating to or supervising the advanced practice nurse under
Subchapter B, Chapter 157, Occupations Code, is in the provider
network. If a managed care organization or other entity includes an
advanced practice nurse as a primary care provider under this
subsection, the physician delegating to or supervising the advanced
practice nurse is part of the provider network for purposes of
supervision.
(c) This section may not be construed as authorizing a
managed care organization or other entity to supervise or control
the practice of medicine as prohibited by Subtitle B, Title 3,
Occupations Code.
SECTION 3. Section 32.024(gg), Human Resources Code, is
amended to read as follows:
(gg) Notwithstanding any other law, including Sections
843.312 and 1301.052, Insurance Code, the department shall ensure
that advanced practice registered nurses, including advanced
practice registered nurses certified as psychiatric/mental health
advanced practice nurses, and physician assistants may be selected
by and assigned to recipients of medical assistance as the primary
care providers of those recipients regardless of whether the
physician delegating to or supervising the advanced practice
registered nurse under Subchapter B, Chapter 157, Occupations Code,
is included in any directory of providers of medical assistance
maintained by the department. If an advanced practice registered
nurse is included as a primary care provider under this subsection,
the physician delegating to or supervising the advanced practice
registered nurse is included in the directory for purposes of
supervision. This subsection may not be construed as authorizing
the department to supervise or control the practice of medicine as
prohibited by Subtitle B, Title 3, Occupations Code. The
department must require that advanced practice registered nurses
and physician assistants be treated in the same manner as primary
care physicians with regard to:
(1) selection and assignment as primary care
providers; and
(2) inclusion as primary care providers in any
directory of providers of medical assistance maintained by the
department.
SECTION 4. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.3125 to read as follows:
Sec. 843.3125. CONTRACTS WITH ADVANCED PRACTICE NURSES.
(a) A health maintenance organization may contract directly with
an advanced practice nurse to provide health care services on
behalf of the health maintenance organization regardless of whether
the physician delegating to or supervising the advanced practice
nurse under Subchapter B, Chapter 157, Occupations Code, provides
health care services for the health maintenance organization.
(b) If a health maintenance organization contracts directly
with an advanced practice nurse under Subsection (a), the physician
delegating to or supervising the advanced practice nurse is part of
an applicable limited provider network for purposes of supervision.
(c) This section may not be construed as authorizing a
health maintenance organization to supervise or control the
practice of medicine as prohibited by Subtitle B, Title 3,
Occupations Code.
SECTION 5. Subchapter B, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0525 to read as follows:
Sec. 1301.0525. DESIGNATION OF ADVANCED PRACTICE NURSES AS
PREFERRED PROVIDERS. (a) An insurer offering a preferred provider
benefit plan may designate an advanced practice nurse as a
preferred provider regardless of whether the physician delegating
to or supervising the advanced practice nurse under Subchapter B,
Chapter 157, Occupations Code, is a preferred provider.
(b) If an insurer designates an advanced practice nurse as a
preferred provider under Subsection (a), the physician delegating
to or supervising the advanced practice nurse is a preferred
provider for purposes of supervision.
(c) This section may not be construed as authorizing an
insurer to supervise or control the practice of medicine as
prohibited by Subtitle B, Title 3, Occupations Code.
SECTION 6. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 7. This Act takes effect September 1, 2015.