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North Texas Nurse Practitioners

TNP Legislative Updates

Posted almost 6 years ago by Robert Metzger

TNP Legislative Updates

We Have Two Bills - SB406

GREAT NEWS!!! A deal with medicine has been reached and SB 406 was filed by Senator Jane Nelson (R-Flower Mound), Chair of the Senate Health and Human Services Committee, after a joint press conference with Representative Lois Kolkhorst (R-Brenham), Chair of the House Public Health Committee. Click here for the Press Release issued by Senator Nelson.

Although SB 406 continues a delegated model, passage of this bill will eliminate the site-based restrictions that have created so many barriers to practice and replace it with a signed prescriptive authority agreement that describes how prescriptive authority quality assurance and improvement activities will be handled by the practice.

Some Highlights of the Bill Include:

  • FTEs. The number of full-time equivalent APRNs or PAs that a physician can delegate prescriptive authority to increases from 4 to 7. In practice sites serving medically underserved populations (MUPs) and in hospitals there is no limit on the number of APRNs to whom a physician can delegate, just as in current law.
  • Frequency of meetings. The frequency of required face-to-face meetings between the physician and the APRN or PA is being reduced to monthly for 3 years and then quarterly thereafter with monthly contact in between by means of a remote electronic communications system, including videoconferencing technology or the Internet. All current APRNs and PAs will get credit for the time you have been prescribing under protocols, so many of you will immediately start with quarterly meetings.
  • Location of meetings. The physician and APRN or PA will decide where the face-to-face meetings will occur and indicate this in the prescriptive authority agreement.
  • Quality assurance and improvement plan. The prescriptive authority agreement will describe a prescriptive authority QA plan that includes chart review, but the number of charts reviewed will be determined by the physician and APRN or PA.
  • Schedule II, Controlled Substances. Physicians will be allowed to delegate the ordering or prescribing of Schedule IIs to APRNs or PAs in hospitals and for the treatment of a person in hospice care.
  • Prescriptive authority agreement. The agreement signed by the APRNs or PAs and physicians will identify the types or categories of drugs or devices that can or cannot be prescribed, which maintains current law.
  • Rule making. The Texas Medical Board is prohibited from adding requirements to the prescriptive authority agreement/QA process that are not in statute.

More details will be forthcoming, but you can also look at the bill by clicking here and reading SB 406.

All organizations are still working with medicine to improve the bill and address issues identified by APRNs as important to your practice. One of those is the issue of Medicaid recognizing APRNs as PCPs, listed appropriately in provider manuals, etc. We do expect this will be positively addressed either administratively or in statute. In addition to our legislation efforts on this front, TNP is also putting together a working group that includes private practice APRNs and representatives from the various health plans to make sure this is addressed with or without legislative language.

The language included in this draft is not the final version of the bill, but Senator Nelson has assured us that she will take care of all outstanding issues. Every lobbyist representing APRNs is dedicated to making sure that this bill addresses as many issues as possible that affect your practice. This has truly been a team effort with many dedicated people from TNP, CNAP, TNA, and TANA. Our goal is to guarantee that we improve APRN practice and increase access to care in Texas. We will never move away from these two principles.


As previously mentioned, things are moving at breakneck speed this legislative session. Wednesday, February 6th, Senator Jane Nelson filed SB SB 406. The bill has been referred to committee and is scheduled for hearing on February 12, 2013 at 9:00 a.m. Time flies when you’re having fun.

If you want to listen live to the hearing next Tuesday, you can do so by going to the Senate Broadcast page here If you are unable to listen live, all hearings are archived and available and can be found through the link above.

Another piece of news is that Representative Lois Kolkhorst, chair of the House Public Health Committee has filed the companion to SB 406. That bill number is HB 1055. While only one bill will pass, having two protects us in case the first one gets hung up during the legislative process.

Things look to be moving quickly for us this session so watch your email inbox as we will be sending updates and alerts, often asking that you call or email your legislator to ask for support.

You can also check out the story in the Texas Tribune regarding SB 406.