The 83 rd Texas Legislative Session What does it mean for the Nurse Practitioner? Julie K. Kuzin, PNP, AC/PC Legislative Chair HAC-NAPNAP Government Action Committee Texas Nurse Practitioners
Flowchart model of delegated practice prior to SB 406
Proposed model of delegation, after Independent Practice was rejected.
Depiction of Delegated Prescriptive Authority under SB406
Take Note: -Facility based practice now is changed to include ONLY hospitals and long term care facilities. If you work in a clinic that is part of a hospital you are not considered facility based any longer You fall into the category of All Other. -Schedule II s may only be delegated to APPs in hospitals, ERs and hospice.
2013 Legislative Results -SB 406-9.5million towards GME residency spots -New medical schools in Austin & Rio Grande Valley -Family Medicine loan repayment program -All these doctors Physicians & APPs identify yourself - Effective January 1, 2014
SB406 TX Medical Board Board of Nursing TX Physician Assistant Board Must: Develop FAQ document Create a system to share info on registered Prescriptive Authority Agreements (PAG) Publicly share list of PAGs
SB 406 Overview A collaborative, delegated model Delegation 4 7, unlimited in facility or underserved prescriptive authority agreements (PAG) for non-facility, standing order/protocol for facility Delegation of Schedule II's in hospitals & hospice. Midwives intrapartum and immediate postpartum (BON TAC chp 222 3 hrs CEUs) Equal treatment by Medicaid & CHIPselection and assignment as PCP, listed as PCP in provider network... Device defined to include DME Prohibits TMB from imposing new rules on SB 406 Quality assurance plan must be in place Meetings
Prescriptive Authority Agreement (PAG) must: Be in writing, signed and dated by all parties Include the name, address, and all professional license numbers of the parties state the nature of the practice, practice locations, or practice settings identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed provide a general plan for addressing consultation, referral & emergencies. state the general process for communication and the sharing of patient care information between the physician and the delegated APRN or PA if alternate physician supervision is to be utilized, designate one or more alternate physicians who may provide appropriate supervision on a temporary basis in accordance with the requirements established by the PAG participate in the prescriptive authority quality assurance and improvement plan meetings describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that includes - chart review, with the number of charts to be reviewed, periodic face-to-face meetings between the APRN or PA and the physician at a location determined by the physician and the APRN or PA + anything else you want to add...
All prescriptive delegations must be registered online! http://www.tmb.state.tx.us/
Meetings (non facility based practice) discuss patient care, improvement to patient care and issues related to referrals Be documented Monthly face to face for 3 years following initial PAG signing; then quarterly face to face meetings with monthly (video) conference. If in prior 7 years the APRN or PA had 5 years of delegated prescriptive authority, then meetings must be face to face monthly for 1 year, then face to face quarterly, with monthly videoconferencing.
Facility Based Practice Facility based practice has not changed. The facility may determine their own plan for oversight **clinics associated with facilities are NOT facility based practice anymore**
CEU requirements - BON Ruling APRN without Rx authority 20 CEUs APRN with Rx authority 25 (5 pharm) APRN with Rx authority 28 CEUs total, + prescribes controlled substances (5 pharm, 3 contolled sub)
2015 and beyond... Independent Practice -Practice under their own license. -APRNs practice professional accountabilty, and do not need delegated restraints to stay within scope of practice. -Removing barriers to APRN practice improves access to care, provides high quality & cost effective care. -Removing the barrier, doesn't change the where & way APRNs practice...
Support the Legislative Efforts that Protect NP Practice. - Talk to your medical colleagues about the burden of delegated practice - Meet with and educate your state senator and representative - Financially contribute to CNAP and Texas Nurse Practitioners legislative funds
CNAP www.cnaptexas.org CNAP Legislative Day, every February Member organizations (voting rights, contributions) Consortium of Texas Certified Nurse-Midwives Greater Texas Chapter NAPNAP Gulf Coast Gerontological Advanced Practice Nurses Association Houston Area Chapter NAPNAP Psychiatric Advanced Practice Nurses of Texas Texas Association of Neonatal Nurse Practitioners Texas Association of Nurse Anesthetists Texas Clinical Nurse Specialists Texas Nurse Practitioners Executive Director: Jennifer Fontana Public Policy Director: Trish Conradt Board of Directors Kathy Hutto, lobbyist Jackson Walker law firm
TNP www.texasnp.org www.facebook.com/texasnp @TNPAustin Executive Director: Emily Eastin Public Policy Director: David Williams Board of Directors Lobbyists: Thomas Ratliff Janice Carter Kevin Cooper