TEXAS Bills Seek to Restrict PA and NP Practice

Posted By Mike Meyer, Friday, March 31, 2023

Bill Names: House Bill 3230 (HB 3230), House Bill 3229 (HB 3229) and Senate Bill 1959 (SB 1959) (same as HB 3229)

Primary Sponsors: HB 3230—Representatives Steve Allison, Jacey Jetton and Liz Campos; HB 3229—Representatives Steve Allison and Liz Campos; SB 1959—Senator Pete Flores

Status: HB 3230—3/15/23 Referred to House Committee on Public Health; HB 3229—3/15/23 Referred to House Committee on Public Health; SB 1959—3/21/23 Referred to Senate Committee on Health & Human Services

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 impose supervision restrictions and does not match current practice standards present in most states.

Outlook: These bills are in the first steps of the process and, based on the sponsor’s past record, they have a lower likelihood of passing. However, Liz Campos is vice chair on the House Committee on Public Health, where two of the bills have been assigned.

Analysis: Currently in Texas, 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 autonomy, and they allow the use of modern technologies to ensure appropriate supervision. This includes the ability of NPs and PAs to see patients and prescribe medications and treatments pursuant to written prescriptive delegation agreements with a physician. The newly introduced bills HB 3230, HB 3229 and SB 1959, if passed, would substantially limit and restrict the practice of PAs and NPs. These are in addition to a different bill, HB 3567, which is also sponsored by Representative Allison and also seeks to restrict PA and NP practice.

HB 3229 and its twin, SB 1959, would prohibit a physician from delegating prescribing authority to a PA or NP unless they share the same medical specialty. “Medical specialty,” in this case, means that their residency training was in the specialty, it is the specialty of their current primary practice, or it was the physician’s previous specialty, in which they have at least five years of practice. This would drastically limit the options for PAs or NPs to find appropriate physician supervision in high-demand or niche specialties. This would also limit physicians from being able to expand the scope of their practices by bringing on additional personal and restrict the range of services they provide to the public.

HB 3220 similarly seeks to restrict the prescriptive authority of PAs and NPs. The method this bill takes is to instead prohibit a physician from delegating prescriptive authority to a PA or NP, with one exception—the PA or NP could only prescribe to a patient who had already established physician-patient relationship with the physician. This, in essence, would keep PAs or NPs from ever seeing new patients; a physician would be required to see the patient before they could receive any treatment. This would drastically reduce the ability of patients to receive both primary and specialty care. A patient would need to wait for the already busy physician to see them, while all the otherwise qualified PAs and NPs sit idle.

All three of these bills are extremely unusual. The changes they would make are more like the law from 15 to 20 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 and granting more autonomy, including independent practice for PAs and NPs. These bills would be starkly counter to this trend and would take Texas supervision laws back in time. This would make Texas the most restrictive state for a PA or NP to practice in, possibly resulting in many leaving Texas altogether. AmSpa is unsure if the sponsors of these bills have considered how this will harm normal Texans’ access to health care or its population of highly trained and educated health professionals. 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 bills or to contact the sponsors, you can find this information through these links: HB 3230, HB 3229 and SB 1959.