Texas legislature passed SB406, improving PA practice. On to Rick Perry's desk

[treejay]

The following summarizes the changes to current law that are included in this bill that represent MAJOR VICTORIES for PAs in Texas:

• Reduces site-based language from 5 settings to 2 (community and facility-based).

• Delegation of schedule II medications to PAs working in Hospitals or for patients in Hospice.

• Increases the number of PAs that a physician can delegate prescriptive practice from 4 to 7.

• Allows for unlimited delegated prescriptive practice in underserved and rural areas.

• Clarifies language that allows for unlimited delegated prescriptive practice at Hospitals.

• Removes the limitation for physicians to delegate prescriptive practice only at one Hospital.

• Removes distance limitations for physician supervision.

• Removes the percentage of charts that a physician must review and co-sign.

• Improves PA Board collaboration with the Medical Board and Nursing Board.

• Removes requirements for a percentage of hours of operation that a physician must be present at a practice.

The bill has new language regarding quality and patient safety that are NOT new to PAs and are already part of our everyday practice. These include:

• Regular communication between physicians, APNs and PAs.

• Prescriptive Practice Agreements that list the parameters of APN and PA prescriptive authority.

• Quality Assurance processes that allow the physician, APN and PA to determine: if chart review is needed; what processes are used to implement improvement in patient care; how emergencies are handled; the general process for referrals; and, indicating alternate supervising physicians in the event the primary supervising physician is unavailable.

• Regular face-to-face meetings between physicians, APNs and PAs that take place at least monthly to discuss patient care and practice issues.

[rcdavis]

This is good news. Does the unrestricted prescriptive privilege in undeserved/rural areas include controlled Meds?

[whoRyou]

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. http://www.texasnp.org/associations/8899/files/PressID9567_1_020613.pdf

 

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.

 

[h=2]Some Highlights of the Bill Include:[/h]

• 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. http://ntnp.enpnetwork.com/nurse-practitioner-news/13521-tnp-legislative-updates

[SoCal_PA]

Thumbs up from California!

[True Anomaly]

Can't wait to move back to Tejas

[Swarley]

A good step. Work still needs to be done with the prescription limitations.

 

But since I want to work in a rural area I can move Texas to a potential place to practice in post PA school.