Texas Bill seeks to Restrict Supervision and Delegation

Posted By Mike Meyer, Tuesday, March 14, 2023

Bill Name: House Bill 3567 (HB 3567)

Primary Sponsor: Representative Steve Allison

Status: 3/16/2022 Referred to Public Health

AmSpa’s Take: The national trend has been to relax supervision requirements for advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs). This bill seeks to re-impose supervision restrictions and does not match current practice standards present in the majority of states.

Outlook: This bill is in the first steps of the process and, based on the sponsor’s past record, it has a lower likelihood of passing.

Analysis: Currently, Texas medical spas are regulated in the same way as other medical offices and follow clearly defined supervision rules adopted by the Texas Medical Board. Advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) work under the supervision and collaboration of physicians. The current supervision rules allow a high degree of flexibility and allow the use of modern technologies to ensure appropriate supervision. The newly introduced House Bill 3567 (HB 3567), if passed, would limit the supervision of PAs and NPs and place restrictions on the supervision of medical spas.

In Texas, as in many states, a physician may delegate a medical act to a qualified and trained individual, provided it can be safely performed and doesn’t violate any other statute. HB 3567 would require that the physician only delegate medical acts that are within their primary specialty for at least the prior five years. This would seem to mean that physicians could only delegate to others once they have been practicing for at least five years and stayed in the same specialty.

HB 3567 goes on to require that these delegated acts must be supervised on site by the physician, a PA or an NP, and that they cannot take place more than 75 miles from the physician’s primary practice location. Currently, supervision can be on or off site, based on what is prudent for the tasks delegated and the safety of the patient. But HB 3567 would require the physician or advanced practitioner’s onsite presence, even for mundane and routine tasks. Also, the bill would require that drug orders must include the dosage as determined by a physician, PA or NP. This is a somewhat confusing change, as this is already the law.

HB 3567 then goes on to make changes to PA and NP practice. It adds “laser and intense-pulsed light devices, and injectable implant devices” to the definition of “devices” that a PA or NP can prescribe. Again, this is confusing, as these items are already included in the definition—they just aren’t expressly stated. HB 3567 also reduces the total number of PAs and NPs that a physician may supervise from seven full-time equivalent persons to five and requires that an alternate supervising physician be utilized if the PA or NP is practicing more than 75 miles from the physician’s primary practice location. Currently in Texas, there is no mile limit, as consultation and collaboration can take place through phone and video conferencing means.

Additionally, HB 3567 re-adds a requirement that at least 10% of the NP or PA’s charts are reviewed. Current law allows for the specific amount to be determined based on the nature of the practice. Finally, and perhaps most confusingly, HB 3567 removes “advanced practice registered nurse” and replaces it with “clinical nurse specialist” from a section that governs orders and protocols of other advanced practitioners. Clinical nurse specialist are also advanced practice registered nurses, however—so are NPs, midwives, and certified registered nurse anesthetists, all of whom are currently included in that section. It is unclear what that portion of HB 3567 is attempting to accomplish.

HB 3567 is an extremely unusual bill. Many of the changes it would make were made law 10 to 15 years ago; the Texas supervision laws have changed since then to reflect more modern practices. The national trend has seen many states making larger changes, including independent practice for PAs and NPs. HB 3567 would be counter to this trend and would take Texas supervision laws back in time. It is unclear what the motivation for this regression is.

We will be monitoring this bill as it works its way through the legislature. If you would like additional information, to read the bill or to contact the sponsors, you can find this information through this link.