BILL ANALYSIS
C.S.S.B. 673
By: Madla
Health and Human Services
5-1-95
Committee Report (Substituted)
BACKGROUND
The country is rapidly moving towards managed health care plans.
Many rural residents and providers have concerns that if the proper
safeguards are not in place, this movement may jeopardize the
viability of hundreds of rural health clinics, disrupt existing
patient-physician relationships, and cause rural residents to
travel great distances for care. These concerns are especially
critical in light of efforts to convert Medicaid to managed care
because many traditional Medicaid providers are not presently a
part of managed care networks.
PURPOSE
As proposed, C.S.S.B. 673 requires the Department of Human Services
to establish a clearinghouse of information as part of a
comprehensive health professions resource center; requires the
Center for Rural Health Initiatives to perform certain functions
regarding areas that are medically underserved; sets forth
standards for health care facilities and services for the elderly,
disabled, and long-term care individuals; and authorizes a
physician to delegate certain prescription drug orders.
RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is granted
to the Texas Board of Health under SECTION 11 (Section
3.06(d)(5)(D)(vi), Article 4495b, V.T.C.S.) and to the Texas State
Board of Medical Examiners under SECTION 12 (Section 3.06(d)(6)(D),
Article 4495b, V.T.C.S.) and under SECTION 13 (Sections 8(a) and
(b), Article 4514, V.T.C.S.) of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Chapter 105, Health and Safety Code, by adding
Section 105.007, as follows:
Sec. 105.007. CLEARINGHOUSE. (a) Requires the Department of
Human Services (department) to develop and establish a
clearinghouse for health professionals seeking collaborative
practice as part of the comprehensive health professions
resource center.
(b) Authorizes the department to set and collect a fee and
solicit, receive, and spend monies from public and private
sources to comply with this section and contract with public
or private entities in the performance of its
responsibilities.
SECTION 2. Amends Section 106.025(a), Health and Safety Code, to
require the Center for Rural Health Initiatives to encourage the
use of advanced communication technology to ensure that rural areas
receive the maximum benefits of telemedicine and distance learning
by promoting a transmission rate structure and improving
telecommunications infrastructure in rural areas, to develop and
initiate a study of rural health clinics with certain objectives
and a quality assessment program to evaluate the health outcomes of
patients treated in rural clinics, and encourage the active
participation by physicians and other health care providers in the
early periodic diagnosis and treatment program, among other
requirements.
SECTION 3. Amends Chapter 262.034, Health and Safety Code, as
follows:
New heading: FACILITIES AND SERVICES FOR ELDERLY AND DISABLED
(a)-(d) Authorize a hospital authority to construct, acquire,
own, operate, enlarge, improve, furnish, or equip certain
facilities or services, including long-term care, elderly
housing, assisted living, home health, personal care, special
care, continuing care and durable medical equipment for the
elderly or disabled. Make conforming changes.
(e) Applies this section only to an authority that owns or
operates a hospital licensed under Chapter 241 and that is
located in a county with a population of 35,000 or less, those
portions of extended municipalities that the federal Census
Bureau (bureau) has determined to be rural, or an area that is
not delineated as an urbanized area by the bureau (rural
area).
SECTION 4. Amends Chapter 285, Health and Safety Code, by adding
Subchapter H, as follows:
SUBCHAPTER H. LONG-TERM CARE AND RELATED FACILITIES
Sec. 285.101. FACILITIES OR SERVICES FOR ELDERLY OR DISABLED.
(a) Applies this subchapter only to a hospital, hospital
district, or authority created and operated under Article IX,
Texas Constitution, under a special law, or under this title
that is located in a rural area.
(b) Sets forth authorized actions regarding facilities and
services of any hospital, hospital district, or authority
covered by this subchapter.
(c) Provides that a facility service created under
Subsection (a) is considered to be a hospital project under
Chapter 223.
SECTION 5. Amends Section 483.001(13), Health and Safety Code, to
redefine "prescription."
SECTION 6. Amends Section 671.001(d), Health and Safety Code, as
follows:
(d) Authorizes a physician assistant, in addition to a
registered nurse, to pronounce a person dead in certain
situations if permitted by policies of the facility providing
services to that person. Requires those policies to consider
assistants who are credentialed or otherwise permitted to
practice at the facility.
SECTION 7. Amends Section 671.002, Health and Safety Code, to make
conforming changes.
SECTION 8. Amends Section 51.918(c), Education Code, to require the
Center for Rural Health Initiatives to develop relief service
programs for rural physicians and allied health personnel to
facilitate ready access to practice coverage for purposes other
than continuing medical education.
SECTION 9. Amends Section 501.059, Government Code, to require the
Managed Health Care Advisory Committee to the Texas Department of
Criminal Justice to develop a managed health care plan (plan) for
all inmates at the institutional division that includes provisions
concerning the establishment of criteria for hospitals, home
health, or hospice providers, requiring the plan to accept
certification by the Medicare program as an alternative to
accreditation by the Joint Commission on Accreditation of
Healthcare Organizations. Makes conforming changes.
SECTION 10. Amends Section 5(42), Article 4542a-1, V.T.C.S.
(Texas Pharmacy Act), to make a conforming change.
SECTION 11. Amends Section 3.06(d)(5), Article 4495b, V.T.C.S.
(Medical Practice Act) to provide that the authority of a physician
to delegate the carrying out or signing of prescription drug orders
is limited to dangerous drugs. Redefines "carrying out or signing
a petition" and "medically underserved area." Makes conforming
changes.
SECTION 12. Amends Section 3.06, Article 4495b, V.T.C.S., by
adding Subsection (d)(6), as follows:
(6)(A) Authorizes a physician licensed by the Texas State
Board of Medical Examiners (board) to delegate to a physician
assistant or an advanced nurse practitioner acting under
adequate supervision the acts of administering, providing,
carrying out, or signing a prescription drug order for
dangerous drugs as authorized through board protocols.
Requires providing and carrying out or signing a prescription
drug order to be limited to dangerous drugs.
(B) Requires protocols and other orders to be defined to
promote the exercise of professional judgment by the
advanced nurse practitioner and physician assistant
commensurate with their education and experience. Sets
forth requirements for protocols used by a reasonable and
prudent physician exercising sound medical judgment.
(C) Requires supervision of the carrying out and signing of
prescriptions to conform to what a reasonable, prudent
physician would find consistent with sound medical judgment,
but authorizes the judgment to vary with the education and
experience of the individuals. Requires a physician to
provide continuous supervision, but does not require the
physician's constant physical presence.
(D) Authorizes an alternate physician to provide appropriate
supervision on a temporary basis as defined and established
by board rule.
(E) Requires the carrying out or signing of petitions to
comply with other applicable laws.
(F) Sets forth the limits of a physician's responsibility to
delegate.
(G) Defines "advanced nurse practitioner," "physician
assistant," "primary practice site," and "carrying out or
signing a prescription drug order."
(H) Requires a licensed physician to be authorized to
delegate to physician assistant or advanced nurse
practitioners acting under physician supervision whose
facility is based at a licensed hospital or long-term care
facility, the carrying out or signing of prescriptions if
the physician is the director or chief of staff of the
facility in which the assistant or practitioner practices,
the chair of the facility's credentialing committee, or is
a department chair of a facility department in which the
assistant or practitioner who consents to the delegation
practices. Sets forth limits of a physician's authority to
delegate under this provision.
(I) Authorizes a physician to delegate in a licensed
hospital or ambulatory surgical center to a certified
registered nurse anesthetist the ordering of drugs and
devices necessary to administer an anesthetic or anesthesia
related service ordered by the physician. Provides that the
physician's order does not have to be drug, dose, or
administration-technique specific. Authorizes the nurse
anesthetist to select, obtain, and administer those drugs
and apply to appropriate devices necessary to accomplish the
order and maintain the patient within good status pursuant
to the order and in accordance with facility policies or
bylaws.
(J) Prohibits holding a physician liable for the acts of an
assistant or practitioner solely on the basis of having
signed certain orders or protocols authorizing the person to
perform the acts of administering, providing, carrying out,
or signing a prescription unless the physician has reason to
believe that the person lacked the competency to perform the
acts.
(K) Prohibits construing the authority granted to a
physician to delegate as limiting the authority of a
physician to delegate under any other subdivision of this
subsection.
SECTION 13. Amends Article 4514, V.T.C.S., by adding Section 8,
as follows:
(a) Requires the board to adopt rules for approval of a
registered nurse as an advanced nurse practitioner or an
advanced practice nurse. Defines "advanced nurse
practitioner" or "advanced practice nurse."
(b) Requires the board to adopt rules for the initial approval
and biennial renewal of an advanced nurse practitioner to
carry out or sign prescriptions. Sets forth minimum
requirements for the rules to meet.
SECTION 14. Amends Section 5, Article 4518, V.T.C.S., to
redefine "professional nursing."
SECTION 15. Emergency clause.
Effective date: upon passage.