2011 Montana Legislature
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HOUSE BILL NO. 547
INTRODUCED BY K. PETERSON
AN ACT PROVIDING INSURANCE COVERAGE FOR ADVANCED PRACTICE REGISTERED NURSES AND REGISTERED NURSE FIRST ASSISTANTS IN A MANNER SIMILAR TO PHYSICIAN ASSISTANTS; INCLUDING REGISTERED NURSE FIRST ASSISTANTS AS PROVIDERS IN HEALTH MAINTENANCE ORGANIZATIONS; REQUIRING THE BOARD OF NURSING TO SPECIFY CRITERIA FOR A REGISTERED NURSE FIRST ASSISTANT; AMENDING SECTIONS 33-22-114, 33-31-102, AND 37-8-202, MCA; AND PROVIDING AN EFFECTIVE DATE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Section 33-22-114, MCA, is amended to read:
"33-22-114. Coverage required for services provided by physician assistants, advanced practice registered nurses, and registered nurse first assistants. An insurer, a health service corporation, or any employee health and welfare fund that provides accident or health insurance benefits to residents of this state shall provide, in group and individual insurance contracts, coverage as well as payment or reimbursement for health services provided by:
(1) a physician assistant as normally covered by contracts for services supplied by a physician if health care services that the physician assistant is approved to perform are covered by the contract;
(2) an advanced practice registered nurse, defined in 37-8-102, as normally covered by contracts for services supplied by a physician or a physician assistant if health care services that the advanced practice registered nurse is approved to perform are covered by the contract; and
(3) a registered nurse first assistant, licensed under Title 37, chapter 8, as normally covered by contracts for surgical services supplied by a physician, a physician's assistant, or an advanced practice registered nurse if surgical services that the registered nurse first assistant is approved to perform are covered by the contract."
Section 2. Section 33-31-102, MCA, is amended to read:
"33-31-102. Definitions. As used in this chapter, unless the context requires otherwise, the following definitions apply:
(1) "Affiliation period" means a period that, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective.
(2) "Basic health care services" means:
(a) consultative, diagnostic, therapeutic, and referral services by a provider;
(b) inpatient hospital and provider care;
(c) outpatient medical services;
(d) medical treatment and referral services;
(e) accident and sickness services by a provider to each newborn infant of an enrollee pursuant to 33-31-301(3)(e);
(f) care and treatment of mental illness, alcoholism, and drug addiction;
(g) diagnostic laboratory and diagnostic and therapeutic radiologic services;
(h) preventive health services, including:
(ii) well-child care from birth;
(iii) periodic health evaluations for adults;
(iv) voluntary family planning services;
(v) infertility services; and
(vi) children's eye and ear examinations conducted to determine the need for vision and hearing correction;
(i) minimum mammography examination, as defined in 33-22-132;
(j) outpatient self-management training and education for the treatment of diabetes along with certain diabetic equipment and supplies as provided in 33-22-129; and
(k) treatment and medical foods for inborn errors of metabolism. "Medical foods" and "treatment" have the meanings provided for in 33-22-131.
(3) "Commissioner" means the commissioner of insurance of the state of Montana.
(4) "Dependent" has the meaning provided in 33-22-140.
(5) "Enrollee" means a person:
(a) who enrolls in or contracts with a health maintenance organization;
(b) on whose behalf a contract is made with a health maintenance organization to receive health care services; or
(c) on whose behalf the health maintenance organization contracts to receive health care services.
(6) "Evidence of coverage" means a certificate, agreement, policy, or contract issued to an enrollee setting forth the coverage to which the enrollee is entitled.
(7) "Health care services" means:
(a) the services included in furnishing medical or dental care to a person;
(b) the services included in hospitalizing a person;
(c) the services incident to furnishing medical or dental care or hospitalization; or
(d) the services included in furnishing to a person other services for the purpose of preventing, alleviating, curing, or healing illness, injury, or physical disability.
(8) "Health care services agreement" means an agreement for health care services between a health maintenance organization and an enrollee.
(9) (a) "Health maintenance organization" means a person who provides or arranges for basic health care services to enrollees on a prepaid basis, either directly through provider employees or through contractual or other arrangements with a provider or a group of providers. This subsection does not limit methods of provider payments made by health maintenance organizations.
(b) The term does not apply to a PACE organization that has received a waiver pursuant to 33-31-201.
(10) "Insurance producer" means an individual or business entity appointed or authorized by a health maintenance organization to solicit applications for health care services agreements on its behalf.
(11) "PACE organization" means an organization, as defined in 42 CFR 460.6, that is authorized by the centers for medicare and medicaid services and the department of public health and human services to operate a program of all-inclusive care for the elderly.
(12) "Person" means:
(a) an individual;
(b) a group of individuals;
(c) an insurer, as defined in 33-1-201;
(d) a health service corporation, as defined in 33-30-101;
(e) a corporation, partnership, facility, association, or trust; or
(f) an institution of a governmental unit of any state licensed by that state to provide health care, including but not limited to a physician, hospital, hospital-related facility, or long-term care facility.
(13) "Plan" means a health maintenance organization operated by an insurer or health service corporation as an integral part of the corporation and not as a subsidiary.
(14) "Point-of-service option" means a delivery system that permits an enrollee of a health maintenance organization to receive health care services from a provider who is, under the terms of the enrollee's contract for health care services with the health maintenance organization, not on the provider panel of the health maintenance organization.
(15) "Provider" means a physician, hospital, hospital-related facility, long-term care facility, dentist, osteopath, chiropractor, optometrist, podiatrist, psychologist, licensed social worker, registered pharmacist, or advanced practice registered nurse, as specifically listed in 37-8-202, or registered nurse first assistant as defined by the board of nursing under Title 37, chapter 8, who treats any illness or injury within the scope and limitations of the provider's practice or any other person who is licensed or otherwise authorized in this state to furnish health care services.
(16) "Provider panel" means those providers with whom a health maintenance organization contracts to provide health care services to the health maintenance organization's enrollees.
(17) "Purchaser" means the individual, employer, or other entity, but not the individual certificate holder in the case of group insurance, that enters into a health care services agreement.
(18) "Uncovered expenditures" mean the costs of health care services that are covered by a health maintenance organization and for which an enrollee is liable if the health maintenance organization becomes insolvent."
Section 3. Section 37-8-202, MCA, is amended to read:
"37-8-202. Organization -- meetings -- powers and duties. (1) The board shall:
(a) meet annually and elect from among the members a president and a secretary;
(b) hold other meetings when necessary to transact its business;
(c) prescribe standards for schools preparing persons for registration and licensure under this chapter;
(d) provide for surveys of schools at times the board considers necessary;
(e) approve programs that meet the requirements of this chapter and of the board;
(f) conduct hearings on charges that may call for discipline of a licensee, revocation of a license, or removal of schools of nursing from the approved list;
(g) cause the prosecution of persons violating this chapter. The board may incur necessary expenses for prosecutions.
(h) adopt rules regarding authorization for prescriptive authority of advanced practice registered nurses. If considered appropriate for an advanced practice registered nurse who applies to the board for authorization, prescriptive authority must be granted.
(i) adopt rules to define criteria for the recognition of registered nurses who are certified through a nationally recognized professional nursing organization as registered nurse first assistants; and
(i)(j) establish a program to assist licensed nurses who are found to be impaired by mental illness, habitual intemperance, or the excessive use of narcotic drugs, alcohol, or any other drug or substance. The program must provide for assistance to licensees in seeking treatment for mental illness or substance abuse and monitor their efforts toward rehabilitation. For purposes of funding this program, the board shall adjust the renewal fee to be commensurate with the cost of the program.
(2) The board may:
(a) participate in and pay fees to a national organization of state boards of nursing to ensure interstate endorsement of licenses;
(b) define the educational requirements and other qualifications applicable to recognition of advanced practice registered nurses. Advanced practice registered nurses are nurses who must have additional professional education beyond the basic nursing degree required of a registered nurse. Additional education must be obtained in courses offered in a university setting or the equivalent. The applicant must be certified or in the process of being certified by a certifying body for advanced practice registered nurses. Advanced practice registered nurses include nurse practitioners, nurse-midwives, nurse anesthetists, and clinical nurse specialists.
(c) establish qualifications for licensure of medication aides, including but not limited to educational requirements. The board may define levels of licensure of medication aides consistent with educational qualifications, responsibilities, and the level of acuity of the medication aides' patients. The board may limit the type of drugs that are allowed to be administered and the method of administration.
(d) adopt rules for delegation of nursing tasks by licensed nurses to unlicensed persons;
(e) adopt rules necessary to administer this chapter; and
(f) fund additional staff, hired by the department, to administer the provisions of this chapter."
Section 4. Effective date. [This act] is effective July 1, 2011.
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Version of HB 547 (HB0547.ENR)
Processed for the Web on March 31, 2011 (5:09pm)
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