Ad Hoc Committee on Collaborative Practice Agreement
January 30, 2003
A. Prescriptive Authority for Controlled Substances. Texas physicians would be allowed to delegate to APNs and PAs the prescribing of Controlled Substances with the following limitations:
B. Medicaid Reimbursement.
- Increase to 92 percent of physician fees by 2003.
- Contingent on fee increases not compromising funds available for physician fees.
C. Moratorium
1. Anesthesia issues are off the table through the 2003 session and any special sessions that follow.
2. Controlled substances are off the table through the 2007 session at which time discussion of prescriptive authority for controlled substances would resume.
3. APNs agree to a moratorium through the 2007 Legislative Session on any increase in Medicaid reimbursement for APNs, unless initiated by a statewide physician or hospital professional organization in response to a change in Medicaid policy, except as part of an across-the-board Medicaid increase for all providers or to maintain a rate equal to PAs billing under their own provider number.
4. All parties agree to participate in ongoing discussions after the 2003 Legislative Session on what action, if any, is needed on the waiver that expires on 9/1/05.
5. After the 2005 Legislative Session, all parties agree to participate in discussions about adding a physician-based model of prescriptive authority to include in legislation in 2007, if a consensus is reached.
6. All other issues are off the table through the 2007 session. This is a full moratorium on legislative, regulatory and judicial initiatives. APNs/PAs agree the moratorium includes any regulatory changes that would expand the scope of practice for APNs/PAs or change the way in which physicians and APNs/PAs engage in collaborative practice, and the physicians agree to a moratorium during this same time period on any regulatory changes that would restrict the scope of practice for APNs/PAs or change the way in which physicians and APNs/PAs engage in collaborative practice. However, the Ad Hoc committee can take up and consider any issue based on agreement among the committee members and member organizations that such discussion is warranted. In addition, all member organizations are free to seek changes in regulatory and legislative language consistent with current law and any changes in law resulting from this agreement.
7. The moratorium would not include current negotiations with the BME on anesthesia assistants policy (as set forth in the letter from Carla Cox).
8. The moratorium would provide that until after the 2003 Legislative Session and any Special Sessions that follow, all parties would agree to maintain the status quo regarding the provision of anesthesia by not seeking or supporting changes in the provision of anesthesia through legislation, regulation or legal precedent through a court opinion. Specifically the moratorium would include the following:
- No association representing APNs would request or support a request of the Governor to exercise the option for Texas to opt out of the CMS requirement for CRNA supervision by a physician in Texas hospitals;
- No association representing physicians would request or support a request of the Governor to commit to not exercising the option for Texas to opt out of the CMS requirement for CRNA supervision by a physician in Texas hospitals; and
- No party to this agreement would seek or support regulatory changes or legislation changing the current level of physician supervision of CRNAs in Texas hospitals.
D. Other Elements of Agreement
The following are additional elements that would be incorporated into a final agreement.
- All parties agree to support standardized credentialing for APNs and PAs.
- If for any reason the preceding legislative initiatives are not successful in 2003, all parties agree to continue support until passage.
- The parties agree that lobbyists will discuss issues that arise in the legislative session that have not been discussed during the interim by the Ad Hoc Committee on Collaborative Practice or were mentioned, but not a priority issue.
- Some medical specialty organizations (including, but not limited to psychiatrists) that may have an interest in the issues being negotiated have not actively participated in the Ad Hoc Committee process. Consequently, they might not feel bound by any agreement on the basis of not having participated in the negotiations. The same could be true of nursing and PA organizations. All organizations party to this agreement agree that if any other organization opposes or seeks to amend the legislation implementing this agreement that we will clarify for legislators that the legislation has been agreed to by our organizations.
- The parties acknowledge that there are differences in education, training and experience between physicians and PAs/APNs.
The authorized signatures below signify agreement of the associations represented at the meetings of the Ad Hoc Committee on Collaborative Practice to all the terms and conditions of the agreement set forth above.
Texas Academy of Physician Assistants
By: ________________________________
Texas Nurses Association
By: ________________________________
Coalition for Nurses in Advances Practice and
Texas Association of Nurse Anesthetists
By: _________________________________
Texas Nurse Practitioners
By: _________________________________
Consortium of Texas Certified Nurse Midwives
By: __________________________________
Texas Medical Association
By: __________________________________
Texas Academy of Family Physicians
By: ___________________________________
Texas Academy of Internal Medicine Services
By: ____________________________________
Texas Association of Obstetricians and Gynecologists
By: ____________________________________
Texas Society of Anesthesiologists
By: ____________________________________
Texas Pediatric Society
By: ____________________________________ |
