2017 Special Session (July 18 – August 16)
The Texas Governor may call as many special sessions as necessary to pass essential legislation that did not pass during the regular session. Each special session lasts only 30 days, and the subject matter of legislation is limited to topics the Governor specifies in The Call. Governor Abbott’s Call for the 85th Legislature, 1st Special Session, was a lengthy list of 20 items. Unfortunately, none of them allowed APRNs to make any further progress.
The essential unfinished business remaining after the regular session was extending the life of several health occupation licensing boards by passing each occupation’s Sunset legislation. Among these board was the Texas Medical Board. The legislature passed all the Sunset bills, and extended the Maternal Mortality and Morbidity Task Force. The Legislature also passed SB 11 and it directly impacts APRNs and other nurses in health care facilities.
DNR Orders in Hospitals & Other Health Care Facilities
SB 11 (Author: Sen. Charles Perry, SD #28, Lubbock; Sponsor: Rep. Greg Bonnen, HD #24, Friendswood) continues to prohibit APRNs and physician assistants from signing Do Not Resuscitate (DNR) orders. Only the attending physician may issue a DNR order in a health care facility, including a hospital, nursing facility, assisted living facility, or hospice, (including hospice services delivered by a home and community support agency). This bill requires that a nurse, or other health care practitioner in the facility, notifies the patient, or patient’s agent, that the DNR order was issued. The health care facility must also notify the patient, or the patient’s agent, if the patient is transferred to a health care facility with a DNR order in place. A patient, or the patient’s agent, may revoke a DNR order at any time. It is a Class A misdemeanor to intentionally conceal, cancel, effectuate, or falsify another person’s DNR order or to intentionally conceal or withhold personal knowledge of revocation of a DNR order. Such action is subject to discipline by the health care practitioner’s licensing board. The bill goes into effect on April 1, 2018.
2017 Regular Session
SB 654 and SB 919 signed by the Governor ♥
SB 919 went into immediate effect on June 1 and SB 654 is effective on September 1, 2017.
♥ SB 654 by Sen. Kel Seliger (R-SD#31-Amarillo) was signed by the Governor on May 29th and went into effect on 9/1/17. The bill specifies that APRNs may be primary care providers in Medicaid managed care networks, whether or not the delegating physician is in-network. (As introduced, this bill would have applied to all HMOs & PPOs rather than only applying to Medicaid & CHIP managed care plans.)
♥SB 919 by Sen. José Rodriquez (D- SD#29-El Paso) was signed by the Governor on June 1 and went into immediate effect. It allows APRNs and PAs to sign medical certifications on death certificates for their hospice and pallative care patients. (As introduced, the bill would have allowed APRNs and PAs to sign out-of-hospital DNR orders and medical certifications on all death certificates.)
Other Bills Directly Impacting APRNs that Passed
BON Sunset Bill
HB 2950 by Rep. Cindy Burkett (A: R-HD#113-Garland; S: Chuy Hinojosa D-SD#20-McAllen) includes some important protections for all nurses, and enacts the new Interstate Nursing (RN & LVN) Licensure Compact language. The final version of the bill stripped the provisions in the introduced version requiring APRNs to check the Prescription Monitoring Program (PMP) before prescribing a controlled substance. However, APRNs need to be aware that similar provisions requiring all prescribers to check the PMP are in the Texas State Board of Pharmacy (TSBP) Sunset Bill, HB 2561. Some of the significant protections added for nurses in the BON Sunset bill include the following:
→The BON will no longer be able to overturn the findings of an administrative law judge; and
→is required to remove disciplinary actions from its website by March 1, 2019, if the violation was not related to the practice of nursing, or, if the violation did not involve a suspension or revocation of the license, after the nurse completes the terms of a disciplinary order.
The bill was sent to the Governor on May 30th and he signed the bill on June 9th. The bill went into effect on September 1, 2017.
Texas State Board of Pharmacy Sunset Bill
HB 2561 passed to enrollment on May 29th, and contains requirements for BON and other agencies that license prescribers to monitor prescribing practices of licensees (new §481.0762 H&S Code). Requires APRNs and other practitioners who prescribe controlled substances to check the Prescription Monitoring Program prior to writing a prescription for a controlled substance (new §481.0764 H&S Code). The bill went into effect on September 1, 2017.
Telemedicine & Telehealth
SB 1107 (Author: Sen. Charles Schwertner, SD #5, Georgetown; Sponsor: Rep. Four Price, HD #87, Amarillo) modifies the definitions of telemedicine and telehealth, and allows a telemedicine visit to be provided without a face-to-face visit. The bill also requires insurers to display reimbursement policies on their website. SB 1107 was signed by the Governor’s on May 27th. The primary portions of the bill took effect immediately. The portion requiring insurers to post telemedicine & telehealth reimbursement policies takes effect January 1, 2018. Click Here to read an interesting article about this bill published May 22, 2017, in The National Law Review.
Liability Exemption (Eye Ointment Bill)
HB 2886 (Author: Rep. Stephanie Klick, HD #91, Fort Worth; Sponsor: Sen. Konni Burton, SD #10, Colleyville) exempts health care providers that attend births from civil or criminal prosecution for not administering prophylactic eye drops or ointment if the parents object and the objection is documented. The bill passed on May 27 and the Governor signed the bill on June 9th. The Governor signed the bill and it went into effect on September 1, 2017.
Other Bills of Interest to Nurses that Passed
HB 62 (Author: Rep. Tom Craddick, HD #82, Midland; Sponsor: Sen. Judith Zaffirini, SD #21, Laredo) passed to Enrollment on May 23rd. This bill applies penalties for texting while driving and using wireless communication devices unless they are hands-free. The Governor signed the bill and it took effect on September 1, 2017.
HB 280 (Author: Rep. Donna Howard, HD # 48, Austin; Sponsor: Sen. Dawn Buckingham, SD #24, Lakeway) passed to Enrollment on May 24th and was signed by the Governor on June 1. The bill establishes a grant program to fund innovative approaches to reduce verbal and physical violence against nurses in hospitals, freestanding emergency medical care facilities, nursing facilities, and home health agencies. It took effect September 1, 2017.
HB 1076 (Author: Rep. Oliverson, HD #: Sponsor: Sen. Don Huffines, SD #16, Dallas) changes required scoliosis screening in grades 6 and 9 to ages that will be determined by the Commissioner of Health, in cooperation with the Commissioner of Education, based on “the most recent nationally accepted and peer-reviewed scientific research….” The Governor signed the bill on June 1, and the bill takes effect at the beginning of the 2018-2019 school year.
HB 3296 (Author: Rep. Stephanie Klick, HD #91, Fort Worth; Sponsor: Sen. Charles Perry, SD #28, Lubbock) reduces the number of nurses from 10 to 8 that triggers the requirement for an employer to have a peer review committee.
SB 196 (Author: Sen. Sylvia Garcia, HD #6, Houston; Sponsor: Rep. Garnett Coleman HD #147, Houston) would require school districts to report if they have no full-time school counselor, librarian or nurse on campus. The House amended and passed the bill on May 24th. The Senate concurred with House amendments on May 27th, and the bill passed. Unfortunately, the Governor vetoed the bill on June 15th. Click Here to read the Governor’s veto statement.
SB 489 (Author: Sen. Eddie Lucio, Jr., SD #27, Brownsville; Sponsor: Rep. Carol Alvarado, HD #145, Houston) requires local health advisory councils to make recommendations to public schools on preventing the use of e-cigarettes. The bill went into immediate effect when the Governor signed it on May 28th.
SB 579 (Author: Sen. Van Taylor, SD #8, Plano; Sponsor: Rep. Philip Cortez, HD #117, San Antonio) applies public school EpiPen regulations to private schools. The Governor signed the bill on May 22nd, and was effective immediately.
SB 2118 (Author: Sen. Kel Seliger, SD #31, Amarillo: Sponsor: Rep. Sarah Davis, HD #134, West University Place) allows community colleges to offer B.S. degrees in nursing and/or applied technology. The House and Senate adopted the conference committee report on May 28th. The bill went into immediate effect when the Governor signed the bill on June 12th.
Overview of the 2017 Texas Legislative Regular and Special Session
The 85th Texas Legislative Session began on January 10, 2017, and ended on May 29th. The Governor may sign or veto bills until midnight, June 18th. All bills not signed or vetoed, are automatically enacted on June 19th.
The session was one of the most contentious in memory. The Legislature passed the 2018-2019 Budget (SB 1, the only bill the Legislature is required to pass), but many of the Sunset bills did not, including the Texas Medical Board Sunset Bill. Therefore the Governor called a Special Session to begin July 18th. In addition to Sunset legislation, the Governor listed 19 other issues that legislators may address. For a full list of those issues, Click Here. With a list this long, it is possible that there will be more than one special session.
Legislators are not permitted to file bills outside the bounds of the 20 topics listed in the Call unless the Governor expands the list. Therefore, APRNs cannot look forward to another chance to pass full practice authority until January 2019.
The following list includes bills filed during the Regular Session that directly related to APRNs but did not pass. Preferred bills supported by NLAC are noted in bold print.
- Full Practice Authority Bills (no change in controlled substances)
SB 681 by Sen. Kelly Hancock (R-SD#9-North Richland Hills) and Co-Authored by Sen. José Rodriquez (D-SD#29-El Paso)
HB 1415 by Reps. Stephanie Klick (R-HD#91-North Richland Hills), Donna Howard (D-HD#48-Austin), Drew Darby (R-HD#72-San Angelo), and Garnet Coleman (D-HD#147-Houston) (The House Public Health Committee heard the bill on April 25th, but was left pending in committee.)
- Signature Authority Bills expand the health care documents or orders that APRNs may sign.
SB 431 by Sen. José Rodriquez (D- SD#29-El Paso)
SB 919 passed
HB 3857 by Rep. Coleman (D-HD#147-Houston) – SB 919 Companion.
- Pharmacists in Class A pharmacies may fill Schedule 2 Controlled Substance prescriptions signed by APRNs and PAs (This is a clean-up bill from SB 406 [Acts of 83rd Texas Legislature, 2013]).
SB 433 by Sen. José Rodriquez (D- SD#29-El Paso)
HB 1846 by Rep. Garnet Coleman (D-HD#147-Houston)(This bill was sent to the House Calendars Committee on May 8th, but was never set on the House Floor Calendar. The companion bill did not receive a committee hearing.)
- Managed care bills – As introduced, these bills would have recognized APRNs could be primary care providers and/or in-network in all HMOs and PPOs, whether or not the delegating physician is in the network.
HB 654 passed.
HB 1225 by Reps. John Smithee (R-HD#86-Amarillo) and Donna Howard (D-HD#48-Austin)
HB 2807 by Rep. Four Price (R-HD#87-Amarillo). Same as above, except only applies to APRNs in counties with no physician.
- Expands Practice Authority (FPA) for specific groups of APRNs
SB 831 by Sen. José Rodriquez (D- SD#29-El Paso) allows APRNs who are military active duty, or veterans who were APRNs while on active duty, to prescribe without physician delegation.
HB 1804 by Reps. César Blanco (D-HD# 76-El Paso) & Diego Bernal (D-HD#123-San Antonio) – Companion to SB 831.
HB 3395 by Rep. Four Price (R-HD#87-Amarillo) permits APRNs in counties with no physicians to have full practice authority.
- Other Bills Impacting Prescriptive Authority
HB 2141 would have simplified monthly QA meeting requirements for any APRN, PA, and physician signing a Prescriptive Authority Agreement, allowing the delegating physician and APRN or PA to determine the type of monthly meeting. This would have ended the face-to-face meeting requirement, permitting them to be held through real time, HIPAA compliant electronic means. Unfortunately for APRNs, Representatives Cortez and Oliverson were able to attach this bill as an amendment to the PA Sunset bill, SB 1625, but including APRNs was not germane to the bill. Therefore, PAs now have the advantage of not being required to have face-to-face meetings while APRNs and delegating physicians must still meet the complex face-to-face meeting requirements.
HB 3406 by Oliverson (R-HD#130-Cypress [NW Harris County]) would not have permitted physicians to charge for delegating prescriptive authority to an APRN or PA. (This bill would have made it almost impossible for APRNs to find a physician willing to delegate prescriptive unless employed by a physician, physician group, long-term care facility or hospital. It did not pass but APRNs need to be alert for similar legislation filed next session)
CNAP is a member of the Nursing Legislative Agenda Coalition (NLAC). Through NLAC, CNAP receives Texas Nurses Association (TNA) Nursewatch. Nursewatch updates Texas nurses on activities at the Capitol that occurred the previous week, and includes bills that will be heard in upcoming health care committees. CNAP thanks TNA for granting permission to post these updates. Each issue is posted by date of publication. Select the link to access the update. As the session proceeds, check this post often for other important events as they occur.
May 30, 2017 – Click Here to read about the wild end to an unusual legislative session, and to read a summary of most bills that passed that interest nurses.
May 15, 2017 – Over 5,000 bills filed by Texas Legislators are officially dead, but there is still hope for a few nursing bills. Click Here to get details.
May 1, 2017 – Click Here for highlights of the APRN bill hearings on April 25th, and important nursing bills for this week, including the BON Sunset Bill.
April 17, 2017 – Bills are starting to move rapidly now so Click Here to see what is happening to some of the bills important to nursing.
April 3, 2017 – The anesthesiologist licensing bill that nursing opposes, HB 2525 by Chairman John Zerwas, is being heard in the House Licensing & Administrative Procedures Committee. Two bills nursing supports, the BON Sunset Bill and HB 1076 on spinal screening are on Tuesday’s House Public Health agenda. To read more, Click Here.
March 20, 2017 – Click Here for bills to be heard by Senate Health & Human Services Committee on Monday & Wednesday, and House Public Health Committee on Tuesday. Two bills
March 13, 2017 – The bill filing deadline was March 10th and 6,485 bills have been filed. To read more, Click Here.
March 6, 2017 – Lists bills that will be heard in House Public Health committee this Tuesday, and Senate Health & Human Services on Wednesday.
February 21, 2017 – SB 681 was referred to Senate Health & Human Services Committee on 2/15/17.
February 14, 2017 – Last Thursday’s press conference about APRN full practice authority bills, H.B. 1415/S.B. 681, generated a press coverage throughout the state. This Nursewatch includes links to those news items.
February 9, 2017 – Check out the press conference on APRN full practice authority bills on TNA’s Facebook page.
February 6, 2017 – The APRN full practice authority bills filed in House & Senate. Press conference scheduled Thursday, February 9th at 9:30 A.M.
January 23, 2017 – The hot topic in the first weeks of the legislative session was the Budget. Find the opening House and Senate proposals for appropriations important to nursing. Senate committees were appointed.