Legislative Summary of the 84th Regular Session
TNP helped to introduce eight bills that would have made changes to the regulatory practice environment for NPs. All but one of the bills were stalled in committee and never received a public hearing. HB 2602, however, was voted almost unanimously out of committee and made it to the House Calendar Committee, the final gatekeeper and entity charged with scheduling bills for a vote on the House Floor. A summary of TNP’s bills can be found below.
HB 1885 (Bell)/ SB 751 (Rodriguez): This bill would have authorized APRNs to evaluate and diagnose patients, order and interpret diagnostic tests, and initiate and manage treatments – including the prescribing of medications – under the exclusive licensure authority of the Texas Board of Nursing. APRN’s would no longer need to secure a physician to delegate this authority.
HB 3398 (Paddie)/SB 1980 (Garcia): This bill would have allowed Medicaid managed care plans, HMOs, and PPOs to recognize APRNs as primary care providers and include them in the list of provider directories, regardless of whether or their delegating physician is in an insurers’ network or not.
HB 2602 (Coleman): This bill would have allowed physicians to delegate ordering and prescribing of Schedule II Controlled Substances to APRNs specializing in psychiatric/mental health and palliative care.
HB 1473 (Bell): This bill would have allowed APRN’s to sign paperwork certifying the care or condition of their patients, including certification of disability for patient to receive disabled parking permits or placards, signing physicals for student athletes, and signing workers compensation for employees on the job.
HB 3912 (Phelan): This bill would have allowed APRN’s to sign the medical certification portion of a death certificate for patients under their care.
SB 466 (Rodriguez): This bill would have granted APRNs the authority to complete and sign the required statement for patients seeking exemption from jury service for a physical or mental impairment.
Key Bills that Passed Impacting the APRN Profession
SB 195 (Schwertner): This bill transfers regulation of the state’s prescription drug monitoring program from the Department of Public Safety (DPS) to the Texas State Board of Pharmacy (BOP), and phases out the Controlled Substance Registration process with DPS.
SB 239 (Schwertner): This bill establishes a loan repayment assistance for APRN Mental Health providers in rural or underserved areas.
SB 1753 (Davis): Effective 2020, this bill will requires a health care provider in a hospital to wear a photo id badge with name, department and license type –”nurse practitioner”, “nurse midwife”, “nurse anesthetist“, or “clinical nurse specialist.
SB 1235 (Whitmire): This bill increases criminal penalties for “pill mill activities” and clarifies the persons considered to be an operator of a pain management clinic to include not just clinic or practice owners, but also medical directors and physicians engaged in supervision or delegation activities related to the clinic.
HB 495 (Howard): This bill ensures that the tobacco lawsuit settlement funds continue to be dedicated to the Texas Higher Education Coordinating Board for the Nursing Education Innovative Grant Program.
Health Care Budget
The final budget that passed the state legislature included several appropriations items related to nursing education, the state Board of Nursing, and financing for Medicaid and hospitals.
• $33.75 million for the Professional Nursing Shortage Reduction Program to increase RN graduates.
• $822,000 for the Texas Center for Nursing Workforce Studies.
• $4.5 million for trauma fellowships for emergency physicians and nurses.
• Continuation of the Nursing Faculty Loan Repayment Program.
Board of Nursing
• 2016-2017 funding for the Board of Nursing covers 15 new full time equivalent staff positions, funding for expert witnesses, and litigation costs related to pill mill activities. This funding was approved without a contingency rider, which means the agency does not need to make up for the increased appropriation with higher fees.
• Approximately $220 million in new state funds over the biennium to increase Medicaid rates for rural hospital outpatient services, trauma care, and safety net hospitals.