Overview
The Healthcare Expanded and Accessed Locally for Texans (HEAL Texans) Act aims to significantly expand the scope of practice for advanced practice registered nurses (APRNs) and physician assistants (PAs) in Texas, particularly in rural and underserved areas. The bill grants APRNs and PAs broader prescriptive authority, including the ability to prescribe controlled substances, and allows them to practice more independently from physicians. It establishes new licensing and regulatory frameworks, modifies existing healthcare delivery systems, and creates pilot programs to evaluate the impact of these changes. The legislation seeks to improve access to primary care, reduce healthcare costs, and address provider shortages in rural Texas communities.
Core Provisions
The bill grants APRNs the authority to prescribe and order drugs and devices, including controlled substances, under certain conditions. It establishes a pathway for independent APRN practice, subject to licensing requirements and oversight by the Texas Board of Nursing. The legislation allows APRNs and PAs to serve as primary care providers for medical assistance recipients and expands their ability to order durable medical equipment and supplies. It modifies prescriptive authority agreements between physicians and APRNs/PAs, increasing the number of such agreements a physician can enter into from 7 to 9. The bill creates a pilot program for APRNs and PAs to dispense dangerous drugs in counties with populations under 68,750. It also mandates that hospitals inform elderly patients about APRNs and PAs as potential primary care providers.
Key Points
- Grants APRNs prescriptive authority, including for controlled substances
- Establishes pathway for independent APRN practice
- Allows APRNs and PAs to serve as primary care providers for medical assistance recipients
- Increases physician-to-APRN/PA ratio from 1:7 to 1:9
- Creates pilot program for APRNs and PAs to dispense dangerous drugs in rural counties
- Requires hospitals to inform elderly patients about APRNs and PAs as primary care options
Legal References
- Section 301.358, Texas Occupations Code
- Section 301.357, Texas Occupations Code
- Section 32.03141, Texas Human Resources Code
- Section 157.0512, Texas Occupations Code
Implementation
The Texas Board of Nursing is primarily responsible for implementing the new APRN licensing and regulatory framework. The Board must adopt rules for licensing APRNs, establish education and training requirements for prescriptive authority, and approve prescriptive authority agreements for Schedule II controlled substances. The Texas Medical Board is tasked with establishing rules for physician delegation and supervision of APRNs and PAs. The Texas Health and Human Services Commission must ensure reimbursement for APRNs and PAs supplying drugs without separate licensing. The bill mandates annual reporting by independently practicing APRNs to the Board of Nursing regarding their practice locations. A study on the effects of the Act is required to be conducted by the Board of Nursing, with results due to the Governor, Lieutenant Governor, and legislature by September 1, 2028.
Impact
The primary beneficiaries of this legislation are residents of rural and underserved areas in Texas who will likely experience improved access to primary care services. APRNs and PAs will benefit from expanded scope of practice and increased professional autonomy. The bill is expected to reduce healthcare costs by allowing APRNs and PAs to provide services previously restricted to physicians. However, it may increase administrative burden on the Texas Board of Nursing and Texas Medical Board due to new licensing, reporting, and oversight requirements. The pilot program for dispensing dangerous drugs in rural counties is set to expire on December 31, 2029, allowing for evaluation of its effectiveness. The full impact on patient outcomes, healthcare costs, and provider distribution will be assessed through mandated reporting and studies.
Legal Framework
The bill primarily amends the Texas Occupations Code, particularly Chapter 301 relating to nurses, and Chapter 157 concerning physician delegation. It also modifies sections of the Texas Health and Safety Code, Texas Human Resources Code, and Texas Insurance Code. The legislation builds upon existing statutory authorities for healthcare professional regulation in Texas. It does not appear to preempt federal law but may supersede some existing state regulations regarding APRN and PA practice. The bill does not explicitly address judicial review provisions, but challenges to the expanded scope of practice could potentially be brought under existing administrative law procedures in Texas.
Critical Issues
The expanded scope of practice for APRNs and PAs may face opposition from physician groups concerned about patient safety and quality of care. Implementation challenges include ensuring adequate oversight of independently practicing APRNs and PAs, particularly in rural areas. The bill's impact on healthcare costs is uncertain and may depend on how insurers and the state Medicaid program adjust reimbursement rates for APRN and PA services. There may be unintended consequences in terms of provider distribution, potentially exacerbating shortages in some areas if APRNs and PAs concentrate in more desirable locations. The pilot program for dispensing dangerous drugs in rural counties raises concerns about drug diversion and misuse. Constitutional challenges are unlikely, but the bill may face legal challenges from professional organizations seeking to maintain the status quo in healthcare delivery.