ADVOCACY

Previous Legislative Sessions

See a full history of TNP bills from 2011-2023 below:

88th Regular Session (2023)

TNP’s 2023 Legislative Agenda

Retiring Delegation Requirements, Expanding Access for Patients (SB 1700): TNP supports legislation that would allow NPs to practice to the full extent of their training and education, remove the mandate for costly and burdensome delegation agreements with physicians, and place NPs under the exclusive regulatory authority of the Texas Board of Nursing (BON). A state regulatory system that allows patients full and direct access to all the services NPs are educated and trained to provide will best position the state to address our current and future health care workforce needs, especially in rural and underserved areas.

Scheduled II Prescriptive Authority (HB 1190): TNP supports legislation that would ensure adequate prescriptive authority for NPs and extend delegated Schedule II prescriptive authority to all NPs, regardless of practice setting or specialty. Texas is only one of a handful of states that does not extend Schedule II prescriptive authority to NPs, and such restrictions harm their ability to treat patients with mental health conditions, cancer, chronic disease, and other illnesses in a variety of practice settings. It also prevents hospital-based NPs from being able to write timely discharge prescriptions for their patients, contributing to delays in care and increased costs for hospitals.

APRN Representation in the Texas Board of Nursing (HB 2635/SB 1343): The number of NPs has tripled over the last decade and is a growing role under the BON’s jurisdiction. In response to this growth, TNP supports legislation that would increase the number of APRNs serving on the Board of the Texas BON. We also support legislation that would ensure peer review for APRNs for any complaints involving standard of care issues, which would help maintain the highest clinical standard for APRN care while also promoting a just culture and fair disciplinary process for APRN licensees.

Board Procedures for Complaints Against Health Care Providers (HB 724/SB 161): This bill would require regulatory agencies to refer any complaints for a licensed individual to the appropriate board of jurisdiction. For example, if a complaint against an APRN were submitted to the Texas Medical Board (TMB), the TMB would be required to refer this complaint to the Texas Board of Nursing.

Nursing Education/Graduate Nursing Education (SB 25): TNP supports legislation to increase current funding for nursing and graduate nursing education funding in Texas, including the Nursing Shortage Reduction Program, the Nursing Faculty Loan Repayment Program, and the Nursing Innovation Grant Program.

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87th Regular Session (2021)

TNP’s 2021 Legislative Agenda

Retiring APRN Delegation Requirements, Expanding Access for Patients (SB 915 / HB 2029): TNP supports legislation that would allow nurse practitioners (NPs) to practice to the full extent of their training and education, remove costly and burdensome regulatory requirements such as signed delegation agreements with physicians, and place NPs under the exclusive regulatory authority of the Texas Board of Nursing. A state regulatory system that allows patients full and direct access to all of the services NPs are educated and trained to provide will best position the state to address our current and future health care needs, especially in rural and underserved areas.

APRN Scheduled II Prescriptive Authority (HB 1524): TNP supports legislation that would ensure adequate prescriptive authority for NPs and extend delegated Schedule II prescriptive authority to all NPs, regardless of practice setting or specialty. Texas is only one of a handful of states that does not extend Schedule II prescriptive authority to NPs, and such restrictions harm the ability to treat patients with mental health conditions, cancer, chronic disease, and other illnesses in a variety of practice settings. It also prevents hospital-based NPs from being able to write timely discharge prescriptions for their patients, contributing to delays in care and increased costs for hospitals.

APRN DNR/Death Certificate Signature Authority (SB 1752): TNP supports legislation recognizing the signature of NPs and PAs for death certificates, as well as in-hospital/out-of-hospital Do Not Resuscitate Orders (DNRs). Making these changes will allow NPs to serve patients in a more timely and cost-effective manner, while also reducing the medical paperwork burden on both patients and physicians.

Death Certificate Signature Authority (HB 4048): TNP supports legislation recognizing the signature of NPs and PAs for death certificates. Making these changes will allow NPs to serve patients in a more timely and cost-effective manner, while also reducing the medical paperwork burden on both patients and physicians.

Disciplinary Issues (SB 2115): TNP supports legislation that would prohibit a Board from taking action against a person who is licensed by a different board. Instead, it would require the complaint to be referred to the issuer of the license. For example, all complaints against APRNs would need to be referred to the Texas Board of Nursing instead of other Boards, such as the Texas Medical Board.

Nursing Education/Graduate Nursing Education: TNP supports legislation to maintain current funding for nursing and graduate nursing education funding in Texas, including the Nursing Shortage Reduction Program and the Nursing Faculty Loan Repayment Program.

86th Regular Session (2019)

TNP’s 2019 Legislative Agenda

Full Practice Authority (HB 1792/ SB 2438 ): TNP firmly supports legislation that would allow nurse practitioners (NPs) to practice to the full extent of their training and education, remove costly and burdensome regulatory requirements such as signed delegation agreements with physicians, and place NPs under the exclusive regulatory authority of the Texas Board of Nursing. A state regulatory system that allows patients full and direct access to all of the services NPs are educated and trained to provide will best position the state to address our current and future health care needs.

Prescriptive Authority for Schedule II Controlled Substances (HB 2250/ SB 1308): TNP supports legislation that would ensure adequate prescriptive authority for NPs and extend delegated Schedule II prescriptive authority to all NPs, regardless of practice setting or specialty. Texas is only one of a handful of states that does not extend Schedule II prescriptive authority to NPs, and such restrictions harm the ability to treat patients with mental health conditions, cancer, chronic disease, and other illnesses in a variety of practice settings.

Virtual Meetings for Prescriptive Authority Agreements (HB 278/ SB 311)TNP supports legislation that would modernize and streamline the existing framework for physician/NP delegation. This includes legislation that would revise the statutory requirements for monthly meetings outlined in NP Prescriptive Authority Agreements (PAAs) such that these meetings would no longer have to take place “face-to-face” and could be conducted virtually or in a manner of the physician and NP’s choosing (e.g. face time, videoconference, etc.).

Signature Recognition for Worker’s Compensation Forms (HB 387/ SB 1022): TNP supports common-sense legislation recognizing the signature of NPs on health-related forms, including Work Status Reports (DWC-73) for the workers’ compensation system. Making these changes will allow NPs to serve patients in a more timely and cost-effective manner, while also reducing the medical paperwork burden on both patients and physicians.

Signature Recognition for Concussion Return-to-Play Forms (HB 3128): TNP supports legislation recognizing the signature of NPs on sports clearance forms that allow a student athlete to return to practice/competition and school following a suspected concussion. Making this change will improve timely access to care for patients in hospital settings, as well as rural and underserved areas.

APRN Out-of-State & Disaster Licensure (HB 912): TNP supports legislation that would create new policies to streamline and fast-track the license application process for out-of-state, active APRNS seeking to hold a license in Texas. In the absence of the APRN Compact in Texas or state reciprocity agreements that recognize APRN licenses across state borders, an expedited licensure process for out-of-state APRNs is critical to helping Texas address its health care provider shortages, recruit and retain workers in other states, and improve the ability for APRN providers to practice telemedicine and telehealth.

Graduate Nursing Education Funding (HB 2980): This is an agenda item TNP is working on collaboratively with our colleagues, the Texas Nurses Association. Our organizations fully support legislation creating a dedicated funding stream for Graduate Nursing Education. This bill would create a new incentive program to provide grants to schools who are pursuing innovative solutions for increasing the number of clinical placements/preceptorships for graduate nursing students.

85th Regular Session (2017)

TNP’s 2017 Legislative Agenda

Full Practice Authority for APRNs (HB 1415/SB 681): legislation that would allow nurse practitioner (NPs) to practice to the full extent of their training and education, remove costly and burdensome regulatory requirements such as signed delegation agreements with physicians, and place NPs under the exclusive regulatory authority of the Texas Board of Nursing. HB 1415/SB 681 is supported by a broad-based coalition of over 20 business, consumer, and health care organizations, and is common-sense legislation that will best position Texas to address our growing and changing health care needs.

APRN Insurance (HB 1225/SB 654): legislation that would remove the requirement that APRNs be in the same health insurance network as their delegating physician. Such insurance reforms are necessary to keep pace with the growing numbers of NPs providing primary care in Texas and to increase network adequacy in areas with health care provider shortages.

APRN Discharge Prescriptive Authority (HB 1846/SB 433): legislation clarifying that physicians may delegate to facility-based and hospice APRNs the ability to write Schedule II prescriptions to be filled in community pharmacies for patients being discharged from the hospital or emergency room. Clarifying this authority will ensure NPs can oversee the discharge process and write prescriptions that will allow their patients to go home and continue their recovery.

APRN Signature Authority (HB 3857/SB 919, SB 431): legislation recognizing the signature of NPs on health-related forms, including: birth and death certificates, orders for handicap placards, jury duty and immunization waivers, and worker’s compensation forms. Making these changes will allow NPs to serve patients in a more timely and cost-effective manner, while also reducing the medical paperwork burden on both patients and physicians.

APRN Veteran Health Care Provider Parity (HB 1804/ SB 831): legislation that would grant full practice authority to U.S. Veterans who are licensed as nurse practitioners in Texas and who practiced in this role while serving in the military. This proposal would free Texas NP Veterans to do the job they were educated and trained to do, in exactly the same way they once did it as active-duty members of the military.

84th Regular Session (2015)

Legislative Summary of the 84th Regular Session

HB 1885/SB 751: 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/SB 1980: 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: 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: 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: This bill would have allowed APRN’s to sign the medical certification portion of a death certificate for patients under their care.

SB 466: 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: 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: This bill establishes a loan repayment assistance for APRN Mental Health providers in rural or underserved areas.

SB 1753: 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: 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: 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.

Nursing

$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.

Medicaid

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.

83rd Regular Session (2013)

APRN Bills of Interest

SB 406: SB 406 was the last major piece of legislation to pass that addressed scope of practice and regulatory issues for APRNs in Texas. This legislation removed the site-based requirements and mileage restrictions for physician delegation, granted Schedule II prescriptive authority to facility-based APRNs, and gave physicians the ability to delegate to limitless numbers of APRNs and Physician Assistants in facility-based settings and medically underserved areas. See the SB406 comparison sheet here for additional information.

SB 1058: SB 1058 amends the Nursing Practice Act and will improve the regulation of professional and vocational nursing. Specifically the bill requires students planning to attend a professional or vocational nursing program have a criminal background check conducted by the Board of Nursing, makes permanent the Board of Nursing’s current pilot authority to take deferred disciplinary action against nurses for less serious violations of the Nursing Practice Act or board rules, and makes BON orders referring nurses to a board-approved peer assistance not subject to disclosure as a public record.

82nd Regular Session (2011)

APRN Bills of Interest

HB 1266: Relating to a study of the practice of advanced practice registered nurses and the authority of those nurses to prescribe and order prescription drugs.

HB 915: Relating to the authority of advanced practice registered nurses to make medical diagnoses and to prescribe and order prescription drugs and devices.

SB 1339: Relating to the authority of advanced practice registered nurses to make medical diagnoses and to prescribe and order prescription drugs and devices.

HB 708: Relating to licensing, regulation, and prescribing and ordering authority of advanced practice registered nurses and the regulation of registered nurses and physician assistants.

SB 1260: Relating to licensing of advanced practice registered nurses and the authority of those nurses to prescribe and order prescription drugs.

HB 3164: Relating to contracts between advanced practice registered nurses and health maintenance organizations, preferred provider benefit plans or other insurers.

SB 1770: Relating to contracts between advanced practice registered nurses and health maintenance organizations, preferred provider benefit plans or other insurers.