HCS HB 354 -- REGISTERED NURSE FIRST ASSISTANTS

SPONSOR:  Auer (Barry)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Insurance
by a vote of 14 to 3.

This substitute requires a health insurance plan to provide
coverage for services rendered or ordered by a registered nurse
first assistant practicing as an independent contractor.  The
requirement takes effect January 1, 2000.

FISCAL NOTE:  Estimated Net Cost to General Revenue is Unknown
in FY 2000, FY 2001, and FY 2002.  Costs expected to exceed
$100,000.  Estimated Net Income to Insurance Dedicated Fund of
$14,450 to $28,900 in FY 2000, $0 in FY 2001, and $0 in FY 2002.

PROPONENTS:  Supporters say that registered nurse first
assistants (RNFAs) have duties similar to physician assistants.
However, reimbursements by insurance companies for their
services are sporadic.  Some companies will reimburse RNFAs and
some will not.  Requiring insurance companies to reimburse RNFAs
for their services will make it equitable for all RNFAs as they
deal with various health plans.

Testifying for the bill were Representative Barry; David Keune,
RNFA; Juanita Duling, RNFA; JoAnn Workman, RNFA; Carol Stinsin,
RNFA; Sheila Dirch, RNFA; and Missouri Nurses Association.

OPPONENTS:  Those who oppose the bill say that insurance
companies try to contract with hospitals for surgical services
as a package.  If laws pass that unbundle this package by
allowing more third party billing, then health insurance costs
will rise.  Both insurance company and employer interests oppose
mandates that lead to higher health insurance costs and limit
the management of benefits.  In contrast to insurance company
and employer interests, certified surgical technicians who
testified do not oppose third party billing and want to be added
to the bill.

Testifying against the bill were Missouri Association of
Osteopathic Physicians and Surgeons; United HealthCare; Missouri
Association of Health Plans; Associated Industries of Missouri;
Alliance Blue Cross and Blue Shield; Health Insurance
Association of America; Beverly Oster, Certified Surgical
Technician (CST)/Certified First Assistant (CFA); Tammy
Luihardt, CST/CFA; and Dawn Smithee, CST.

Marty Romitti, Legislative Analyst

HB 354 -- Registered Nurse First Assistants

Sponsor:  Barry

This bill requires a health insurance plan to provide coverage
for services rendered or ordered by a registered nurse first
assistant.  The requirement takes effect January 1, 2000.