Association of periOperative Registered Nurses

Texas  Government Affairs

State Coordinator

Jean Franks
(281) 360-1068

Regional Coordinator

Pat Darnell

RN Circulator Laws and Language

Hospital: TEXAS ADMINISTRATIVE CODE TITLE 25. HEALTH SERVICES PART 1. DEPARTMENT OF STATE HEALTH SERVICES CHAPTER 133. HOSPITAL LICENSING SUBCHAPTER C. OPERATIONAL REQUIREMENTS AMENDED: Subchapter B, Chapter 241, Health and Safety Code, Section 241.0262 AS AMENDED BY HB 1718 (2005): Sec, 241.0262. CIRCULATING DUTIES FOR SURGICAL SERVICES Circulating duties in the operating room must be performed by qualified registered nurses. In accordance with approved medical staff policies and procedures, licensed vocational nurses and surgical technologists may assist in circulatory duties under the direct supervision of a qualified registered nurse circulator. (Eff. September 1, 2005)
ASC: TEXAS ADMINISTRATIVE CODE TITLE 25. HEALTH SERVICES PART 1. DEPARTMENT OF STATE HEALTH SERVICES CHAPTER 135. AMBULATORY SURGICAL CENTERS SUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS 135.15. Nursing Services (a) There shall be an organized nursing service under the direction of a qualified registered nurse (RN) and staffed to assure that the nursing needs of all patients are met. (3) Surgical technicians and licensed vocational nurses may be permitted to serve as the scrub nurse under the direct supervision of an RN; they shall not be permitted to function as circulating nurses in the operating rooms, except in ASCs where no general anesthesia is administered and when there is an adequate number of RNs immediately available for an emergency situation. Licensed vocational nurses and surgical technicians may assist in circulatory duties under the supervision of a qualified RN during general anesthesia cases.

Registered Nurse First Assistants (RNFAs)

Reimbursement:  Texas Statutes and Code, Insurance Code: Title 6, Subtitle C, Chapter 843, Subchapter I, 843.3045 – A health maintenance organization may not refuse to contract with a nurse first assistant, as defined by Section 301.1525, Occupations Code, to be included in the provider’s network or refuse to reimburse the nurse first assistant for a covered service that a physician has requested the nurse first assistant to perform. [Similar provision at 1301.201 for preferred providers] 1451.104. Nondiscriminatory payment or Reimbursement; Exception Texas Statutes and Code, Labor Code Title 5, Subtitle A, Chapter 408, Subchapter B, 408.029 – 1451.104. NONDISCRIMINATORY PAYMENT OR REIMBURSEMENT; EXCEPTION. (a) An insurer may not classify, differentiate, or discriminate between scheduled services or procedures provided by a health care practitioner selected under this subchapter and performed in the scope of that practitioner's license and the same services or procedures provided by another type of health care practitioner whose services or procedures are covered by a health insurance policy, in regard to: (1) the payment schedule or payment provisions of the policy; or (2) the amount or manner of payment or reimbursement under the policy. (b) An insurer may not deny payment or reimbursement for services or procedures in accordance with the policy payment schedule or payment provisions solely because the services or procedures were performed by a health care practitioner selected under this subchapter. (c) Notwithstanding Subsection (a), a health insurance policy may provide for a different amount of payment or reimbursement for scheduled services or procedures performed by an advanced practice nurse, nurse first assistant, licensed surgical assistant, or physician assistant if the methodology used to compute the amount is the same as the methodology used to compute the amount of payment or reimbursement when the services or procedures are provided by a physician. Added by Acts 2003, 78th Leg., ch. 1274, 3, eff. April 1, 2005.
Definition:  Texas Statutes and Codes - OCCUPATIONS CODE. TITLE 3. HEALTH PROFESSIONS. SUBTITLE E. REGULATION OF NURSING. CHAPTER 301. NURSES. SUBCHAPTER D. GENERAL POWERS AND DUTIES OF BOARD. 301.1525. Nurse First Assistants. (a) In this section, "nurse first assistant" means a registered nurse who: (1) is certified in perioperative nursing by an organization recognized by the board; and (2) has completed a nurse first assistant educational program approved by an organization recognized by the board.
Scope:  Texas Administrative Code, Title 22 - Examining Boards, Part 11 - Board of Nurse Examiners, Chapter 217 - Licensure, Peer Assistance and Practice, Rule 217.18 -Registered Nurse First Assistants. (3) The registered nurse whose functions include acting as a first assistant in surgery shall know and conform to the Texas Nursing Practice Act; current Board rules, regulations, and standards of professional nursing; and all federal, state and local laws, rules, and regulations affecting the RNFA specialty area. When collaborating with other health care providers, the RNFA shall be accountable for knowledge of the statutes and rules relating to RNFAs and function within the scope of the registered nurse. (4) A registered nurse functioning as a first assistant in surgery shall comply with the standards set forth by the AORN.

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