Advanced practice nurses and physician assistants under the supervision of a physician may soon have broader authority to prescribe controlled substances, after the House gave preliminary approval on Tuesday to a so-called scope-of-practice bill.
SENATE BILL 406 HEARD ON APRIL 24TH
SB 406 hearing. Senate Bill 406 (Nelson/Kolkhorst), the “agreed-to” bill on delegated prescriptive authority, was heard as the first bill of the day in the House Committee on Public Health (HPH) meeting on Wednesday, April 24. As is typical in the House when a bill is heard for the first time in a committee after all of the public testimony, SB 406 was left pending. Hopefully, it will be voted out of the committee before the end of the month.
Chair Lois Kolkhorst (R-Brenham) laid out the bill and its committee substitute by stating that getting an “agreed-to” bill has been a long time coming and has been worked on for years. She expressed appreciation to Senator Jane Nelson (R-Flower Mound), chair of the Senate Health & Human Services Committee, for working so hard to get the bill to where we are today. Chair Kolkhorst also praised the work of members who have worked in previous sessions on scope-of-practice legislation including Garnet Coleman (D-Houston); Rob Orr (R-Burleson); Elliott Naishtat (D-Austin), Susan King (R-Abilene) and Donna Howard (D-Austin). The Chair also mentioned the interim study issued by Speaker Joe Straus and the work of the Public Health Committee during the interim of the 82nd Texas Legislature in 2011-12, that included:
Interim Charge #1: Examine the adequacy of the primary care workforce in Texas and assess the impact of an aging population, the passage of the Patient Protection and Affordable Care Act, and state and federal funding reductions to graduate medical education and physician loan repayment programs. Make recommendations to increase patient access to primary care and address geographic disparities.
Recommendation: The Legislature should consider replacing and/or revising the current opaque regulatory scheme of physician delegation and supervision with a simpler regulatory framework based upon physician led collaboration with advanced nurse practitioners and physician assistants to allow more flexibility and increase patient access to primary care and address geographic disparities.
Here is a link to the full interim committee report: http://www.house.state.tx.us/_media/pdf/committees/reports/82interim/House-Committee-on-Public-Health-Interim-Report.pdf
Kolkhorst said that past scope-of-practice bills have typically been fraught with much angst and difficulty. She thanked all of the groups for working together this time to craft an agreed-to-bill that increases access to care and maintains patient safety. She outlined the specifics of the bill by saying it:·
- Eliminates the current site-based requirements and replaces them with a standardized prescriptive authority agreement that requires practitioners (physicians, advanced practice registered nurses and/or physician assistants) to develop and sign an agreement that is best for their practice as a professional team. ·
- Establishes minimum standards for prescriptive authority agreements but gives the practitioners flexibility to determine the specifics of the agreement.·
- Allows hospital-based practices and practices serving medically underserved populations to remain unlimited in the number of APRNs and PAs to which a physician may delegate prescriptive authority.·
- Increases from four to seven the number of individuals to whom a physician may delegate prescriptive authority at all other practice sites.·
- Improves coordination between the boards: Texas Medical Board, Texas Board of Nursing and the Texas Physician Assistants Board.·
- Allows physicians to delegate prescriptive authority for Schedule IIs Controlled Substances to APRNs and PAs in hospitals and hospice.
In addition to the above specifics of SB 406 when it was passed by the Senate in February, the committee substitute includes changes agreed to by the professions, Senator Nelson’s office and Chair Kolkhorst. These changes include: ·
- Ensures that APRNs and PAs are treated the same as physicians in Medicaid and CHIP for the purposes of being assigned as primary care providers (PCPs).·
- Clarifies that a physician in a hospital may only delegate the prescribing of Schedule II Controlled Substances to APRNs and PAs for patients in the emergency room (ER) and patients admitted to the hospital for an intended length of stay for at least 24-hours.·
- Clarifies that the prescribing of durable medical equipment is reimbursable under Medicaid when prescribed by an APRN and PA.·
- Clarifies that the limitation the TMB’s rulemaking authority does not limit the Board’s ability to adopt rules for physicians’ authority to delegate prescriptive authority.·
- Sets the effective date of the bill as November 1, 2013.
Kolkhorst said by 2014 an additional 2.4 to 2.6 million Texans will have health insurance, and Texas must meet its healthcare workforce challenges; SB 406 will help. She said there is “no victory with people running around with insurance cards who cannot see a provider.” The cost of Medicaid and meeting the workforce challenges will be work that must continue in the future.
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Start of 83rd Texas Legislature Convened on Tuesday, January 8, 2013
The next regular session of the Texas Legislature convened at noon on Tuesday, January 8, 2013. Under the Advocacy section, CNAP has posted its Legislative Update #1 that gives a brief overview of the financial challenges facing the state and information about interim reports made by Senate and House Committees in the 82nd Legislature to their successors serving in the 83rd session. Check out Legislative Update #1, and check back each week for updates to keep you posted about the happenings during this session.
Also, you may want to bookmark the Texas Legislature On-line website,
www.capitol.state.tx.us, so you can find out who the members are, what bills have been filed and when committees are meeting.
CNAP Speaks to Houston Area Nurse Practioners
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| Left: Pattie Featherson; Right: Melanie Dossey |
CNAP Chair Melanie Dossey, and CNAP Director of Public Policy Pattie Featherston, appeared as presenters for the keynote address at the Houston Area Nurse Practitioners Annual Conference on Saturday, August 11. HANP is a very dynamic local organization whose membership diversity represents the various APRN specialty practice areas. HANP has recently developed a robust membership drive, increasing its numbers significantly in the last year. HANP has also created an impressive Web site, www.hanp.org. CNAP’s presentation at the HANP Conference (included here) updated attendees about the 2013 APRN Legislative initiative, and inspired them to get involved in public policy and support organizations working on their behalf.
2013 APRN Legislative Agenda and Important Economic Impact Study
[For full text of this Interim Report, click here.]
The Coalition for Nurses in Advanced Practice, in conjunction with other nursing organizations and the Texas Team, announced at a press conference on May 14, 2012, a legislative initiative to take forward to the 83rd Legislature when the session begins in January 2013. Simultaneously, the Texas Team unveiled an economic study done by a well-acclaimed economist, Ray Perryman, which examines the impact of greater utilizing advanced practice nurses as recommended by the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health.
The Perryman Report estimates that the medical cost savings resulting from the efficiencies created by greater utilization of APRNs by removing some of the existing legal barriers would yield a broader economic impact that includes over $8 Billion in gross product and over 97,000 new jobs, annually; an estimate that he assures is conservative. The overall economic stimulus is over $16 Billion, plus there is a gain to state and local sales tax revenue of over $480 Million and $230 Million, respectively.
CNAP’s proposed 2013 Legislative Initiative would eliminate delegation and the current overly complex site-based restrictions. Under this collaborative model, an APRN would be credentialed by the Board of Nursing (same as current law) and must secure and maintain a collaborative prescriptive authority agreement with a physician, or physician group, for the purpose of referrals and consultation.
CNAP has worked diligently with its member organizations and related stakeholder groups for many months to develop a legislative initiative that will have consensus among all nursing groups and other important allies.
WHAT ARE NEXT STEPS? [Click here]
Other Resources:
Press Conference (May 14, 2012) video
Texas Team, outline of IOM report,
Press Coverage, In the News: Articles, Audio and Video clips from around the state
Governor Appoints New Health and Human Services Commissioner
July 30, 2012
Former Republican State Sen. Kyle Janek, a practicing anesthesiologist, will head the state's Health and Human Services Commission, replacing outgoing chief Tom Suehs, the governor's office announced on Monday.
And Chris Traylor, commissioner of the state's Department of Aging and Disability Services, will become chief deputy HHSC commissioner, replacing Billy Millwee, the state's Medicaid director who is also leaving the agency this summer.
Janek, of Houston, served in the House for eight years before winning election to the Senate, where he served until 2008. In recent years, he’s been a registered lobbyist, with clients including the Texas Medical Liability Trust, the Texas Society of Anesthesiologists, the American Cancer Society and a New Jersey-based pharmaceutical company. He will take his new job Sept. 1.
Traylor has been commissioner of DADS since 2010. He is past associate commissioner for Medicaid and the Children’s Health Insurance Program.
New CMS Regulations on Conditions of Participation
Two recent regulations released by the Centers for Medicare & Medicaid Services revised existing Conditions of Participation for hospitals and critical access hospitals the agency says will save approximately $5 billion over five years.
A final regulation revises the existing CoP for hospitals and critical access hospitals. CMS also released a final rule that addresses more than two dozen regulatory requirements for a broader range of providers, including hospitals, ambulatory surgical centers, end-stage renal disease facilities and durable medical equipment suppliers. CMS officials say the changes attempt to promote efficiency and transparency while also aiming to reduce health care providers' overall regulatory burden. CMS estimates the rules will save $5 billion over five years.
Every hospital that accepts Medicare and Medicaid patients must comply with the CMS CoP, a 422-page manual with interpretive guidelines that must be followed. Facilities accredited by The Joint Commission, AOA, and DNV Healthcare also must follow these regulations. Implementation of many of these regulatory requirements will require changes in Texas law as well. A number of changes can be made through modifications to the hospital licensing rules, while other changes will require action by the Texas Legislature.
