Bill Text: TX HB2807 | 2017-2018 | 85th Legislature | Introduced

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Bill Title: Relating to the participation of an advanced practice nurse as a primary care provider for certain governmental and other health benefit plans.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2017-04-25 - Left pending in committee [HB2807 Detail]

Download: Texas-2017-HB2807-Introduced.html

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85R12890 SCL-D
By: Price H.B. No. 2807

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 Subsections (d) and (e) to read as follows:
(d) For purposes of Subsection (a)(13) and subject to
Subsection (e), 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.
(e) Subsection (d) applies only to an advanced practice
nurse practicing in a county:
(1) in which there are no practicing physicians; and
(2) that:
(A) has been designated as a medically
underserved area under state or federal law; or
(B) contains a medically underserved population.
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 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) and subject to Subsection
(c), 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) Subsection (b) applies only to an advanced practice
nurse practicing in a county:
(1) in which there are no practicing physicians; and
(2) that:
(A) has been designated as a medically
underserved area under state or federal law; or
(B) contains a medically underserved population.
(d) 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, Human Resources Code, is amended
by amending Subsection (gg) and adding Subsection (gg-1) to read as
follows:
(gg) Subject to Subsection (gg-1) and notwithstanding
[Notwithstanding] any other law, including Sections 843.312 and
1301.052, Insurance Code, the commission 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
commission. 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 commission to
supervise or control the practice of medicine as prohibited by
Subtitle B, Title 3, Occupations Code. The commission 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
commission.
(gg-1) Subsection (gg) applies only to an advanced practice
nurse practicing in a county:
(1) in which there are no practicing physicians; and
(2) that:
(A) has been designated as a medically
underserved area under state or federal law; or
(B) contains a medically underserved population.
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) This section applies only to an advanced practice nurse
practicing in a county:
(1) in which there are no practicing physicians; and
(2) that:
(A) has been designated as a medically
underserved area under state and federal law; or
(B) contains a medically underserved population.
(b) 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.
(c) If a health maintenance organization contracts directly
with an advanced practice nurse under Subsection (b), the physician
delegating to or supervising the advanced practice nurse is part of
an applicable limited provider network for purposes of supervision.
(d) 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) This section applies only to an advanced
practice nurse practicing in a county:
(1) in which there are no practicing physicians; and
(2) that:
(A) has been designated as a medically
underserved area under state and federal law; or
(B) contains a medically underserved population.
(b) 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.
(c) If an insurer designates an advanced practice nurse as a
preferred provider under Subsection (b), the physician delegating
to or supervising the advanced practice nurse is a preferred
provider for purposes of supervision.
(d) 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, 2017.