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A BILL TO BE ENTITLED
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AN ACT
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relating to the participation of an advanced practice nurse as a |
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primary care provider for certain governmental and other health |
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benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.005, Government Code, is amended by |
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adding Subsections (d) and (e) to read as follows: |
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(d) For purposes of Subsection (a)(13) and subject to |
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Subsection (e), an advanced practice nurse, including an advanced |
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practice nurse certified as a psychiatric/mental health advanced |
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practice nurse, may be included as a primary care provider in a |
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managed care organization's provider network regardless of whether |
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the physician delegating to or supervising the advanced practice |
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nurse under Subchapter B, Chapter 157, Occupations Code, is in the |
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provider network. If a managed care organization includes an |
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advanced practice nurse as a primary care provider under this |
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subsection, the physician delegating to or supervising the advanced |
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practice nurse is part of the network for purposes of supervision. |
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This subsection may not be construed as authorizing a managed care |
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organization to supervise or control the practice of medicine as |
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prohibited by Subtitle B, Title 3, Occupations Code. |
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(e) Subsection (d) applies only to an advanced practice |
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nurse practicing in a county: |
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(1) in which there are no practicing physicians; and |
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(2) that: |
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(A) has been designated as a medically |
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underserved area under state or federal law; or |
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(B) contains a medically underserved population. |
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SECTION 2. Section 62.1551, Health and Safety Code, is |
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amended to read as follows: |
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Sec. 62.1551. INCLUSION OF CERTAIN HEALTH CARE PROVIDERS IN |
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PROVIDER NETWORKS. (a) Notwithstanding any other law, including |
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Sections 843.312 and 1301.052, Insurance Code, the executive |
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commissioner shall adopt rules to require a managed care |
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organization or other entity to ensure that advanced practice |
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registered nurses and physician assistants are available as primary |
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care providers in the organization's or entity's provider network. |
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The rules must require advanced practice registered nurses and |
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physician assistants to be treated in the same manner as primary |
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care physicians with regard to: |
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(1) selection and assignment as primary care |
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providers; |
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(2) inclusion as primary care providers in the |
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provider network; and |
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(3) inclusion as primary care providers in any |
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provider network directory maintained by the organization or |
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entity. |
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(b) For purposes of Subsection (a) and subject to Subsection |
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(c), an advanced practice nurse, including an advanced practice |
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nurse certified as a psychiatric/mental health advanced practice |
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nurse, may be included as a primary care provider in a managed care |
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organization's or entity's provider network regardless of whether |
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the physician delegating to or supervising the advanced practice |
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nurse under Subchapter B, Chapter 157, Occupations Code, is in the |
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provider network. If a managed care organization or other entity |
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includes an advanced practice nurse as a primary care provider |
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under this subsection, the physician delegating to or supervising |
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the advanced practice nurse is part of the provider network for |
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purposes of supervision. |
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(c) Subsection (b) applies only to an advanced practice |
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nurse practicing in a county: |
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(1) in which there are no practicing physicians; and |
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(2) that: |
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(A) has been designated as a medically |
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underserved area under state or federal law; or |
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(B) contains a medically underserved population. |
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(d) This section may not be construed as authorizing a |
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managed care organization or other entity to supervise or control |
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the practice of medicine as prohibited by Subtitle B, Title 3, |
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Occupations Code. |
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SECTION 3. Section 32.024, Human Resources Code, is amended |
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by amending Subsection (gg) and adding Subsection (gg-1) to read as |
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follows: |
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(gg) Subject to Subsection (gg-1) and notwithstanding |
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[Notwithstanding] any other law, including Sections 843.312 and |
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1301.052, Insurance Code, the commission shall ensure that advanced |
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practice registered nurses, including advanced practice registered |
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nurses certified as psychiatric/mental health advanced practice |
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nurses, and physician assistants may be selected by and assigned to |
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recipients of medical assistance as the primary care providers of |
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those recipients regardless of whether the physician delegating to |
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or supervising the advanced practice registered nurse under |
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Subchapter B, Chapter 157, Occupations Code, is included in any |
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directory of providers of medical assistance maintained by the |
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commission. If an advanced practice registered nurse is included |
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as a primary care provider under this subsection, the physician |
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delegating to or supervising the advanced practice registered nurse |
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is included in the directory for purposes of supervision. This |
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subsection may not be construed as authorizing the commission to |
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supervise or control the practice of medicine as prohibited by |
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Subtitle B, Title 3, Occupations Code. The commission must require |
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that advanced practice registered nurses and physician assistants |
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be treated in the same manner as primary care physicians with regard |
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to: |
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(1) selection and assignment as primary care |
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providers; and |
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(2) inclusion as primary care providers in any |
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directory of providers of medical assistance maintained by the |
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commission. |
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(gg-1) Subsection (gg) applies only to an advanced practice |
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nurse practicing in a county: |
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(1) in which there are no practicing physicians; and |
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(2) that: |
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(A) has been designated as a medically |
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underserved area under state or federal law; or |
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(B) contains a medically underserved population. |
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SECTION 4. Subchapter I, Chapter 843, Insurance Code, is |
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amended by adding Section 843.3125 to read as follows: |
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Sec. 843.3125. CONTRACTS WITH ADVANCED PRACTICE NURSES. |
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(a) This section applies only to an advanced practice nurse |
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practicing in a county: |
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(1) in which there are no practicing physicians; and |
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(2) that: |
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(A) has been designated as a medically |
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underserved area under state and federal law; or |
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(B) contains a medically underserved population. |
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(b) A health maintenance organization may contract directly |
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with an advanced practice nurse to provide health care services on |
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behalf of the health maintenance organization regardless of whether |
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the physician delegating to or supervising the advanced practice |
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nurse under Subchapter B, Chapter 157, Occupations Code, provides |
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health care services for the health maintenance organization. |
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(c) If a health maintenance organization contracts directly |
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with an advanced practice nurse under Subsection (b), the physician |
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delegating to or supervising the advanced practice nurse is part of |
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an applicable limited provider network for purposes of supervision. |
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(d) This section may not be construed as authorizing a |
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health maintenance organization to supervise or control the |
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practice of medicine as prohibited by Subtitle B, Title 3, |
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Occupations Code. |
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SECTION 5. Subchapter B, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0525 to read as follows: |
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Sec. 1301.0525. DESIGNATION OF ADVANCED PRACTICE NURSES AS |
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PREFERRED PROVIDERS. (a) This section applies only to an advanced |
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practice nurse practicing in a county: |
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(1) in which there are no practicing physicians; and |
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(2) that: |
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(A) has been designated as a medically |
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underserved area under state and federal law; or |
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(B) contains a medically underserved population. |
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(b) An insurer offering a preferred provider benefit plan |
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may designate an advanced practice nurse as a preferred provider |
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regardless of whether the physician delegating to or supervising |
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the advanced practice nurse under Subchapter B, Chapter 157, |
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Occupations Code, is a preferred provider. |
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(c) If an insurer designates an advanced practice nurse as a |
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preferred provider under Subsection (b), the physician delegating |
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to or supervising the advanced practice nurse is a preferred |
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provider for purposes of supervision. |
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(d) This section may not be construed as authorizing an |
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insurer to supervise or control the practice of medicine as |
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prohibited by Subtitle B, Title 3, Occupations Code. |
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SECTION 6. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 7. This Act takes effect September 1, 2017. |