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SB 406 (2013 Announcement)
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GREAT NEWS!!! SB 406 Filed

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. Below is a link to 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.
· Rulemaking. 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 going to and reading SB 406.
We 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.
Therefore, this is not the final version of the bill, but Senator Nelson wanted to go ahead and file it so a hearing could be scheduled soon. Know that Trish and I will continue to work with TNP’s, TANA’s and TNA’s staff and lobbyists to craft the best bill possible. This has been a team effort, but a special shout out goes to Jim Willmann, TNA’s General Counsel, and Janis Carter, one of TNP’s external lobbyists, for the MANY hours they have spent by my side negotiating with medicine. I am grateful for the skills they bring to the table and their hard work. Please join me in thanking them the next time you see them.

Link to Sen. Nelson’s Press Release

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