A new bill has been proposed in Texas that would require in-person supervision of registered nurses. This bill relates to requirements for the renewal of a physician’s registration permit and the delegation by a physician of certain medical acts as reported in the 88th Legislature Regular Session by Steve Allison, Representative – Republican – District 121. The bill was introduced into the Texas House of Representatives in March 2023 and has since gained bi-partisan support from both Republican and Democratic representatives. If this bill passes in Texas, other states may soon follow suit.

Previously, House Bill 278 was passed in 2019 and removed the face-to-face meeting requirement for Advanced Practice Registered Nurses (APRNs). Additionally, it required that meetings between the APRNs and physicians occur at least once a month in a manner determined by the physician and APRN. It only applies to prescriptive authority agreements entered into on/after the bill’s effective date of September 1, 2019.

HB 3567 covers a different topic, addressing the license holder who has entered into a prescriptive authority agreement, submits a registration renewal application, and makes an electronically signed attestation to the board. This bill would also place APRNs, Registered Nurses, and Physician Assistants entirely under the oversight of a physician, who may delegate to a qualified and properly trained person acting under the physician’s supervision. It would pertain to any medical act that a reasonable and prudent physician would find within the scope of sound medical judgment to delegate with certain restrictions.

This bill would further restrict delegated medical acts, prohibiting performance at a location more than 75 miles from the physician’s primary practice location. Additionally, the supervising ratio for APRNs and PAs would be changed from 7 to 5, and chart review would be increased to at least 10 percent of the patients treated under the prescriptive authority agreement. If passed, this Act would take effect on September 1, 2023.

If you have questions regarding this bill, please arrange a consultation to go over the proposed changes to the law,  how they might affect you, and what to do about it.

If this bill passes:

1. All Texas aesthetics businesses, medical spas, IV hydration companies, and wellness clinics will need an NP, PA, or MD on site;
2. Medical directors will be required to be within 75 miles of the business they are overseeing; 
3. The number of NPs and PAs one MD can supervise will be lowered from 7 to 5; and
4. 10% of all charts will need to be reviewed by an MD.

To track the bill’s progress through the Texas House of Representatives and Senate, follow this link: https://fastdemocracy.com/bill-search/tx/88/bills/TXB00063894/. 

You may contact the Representatives sponsoring this bill and let them know how it will affect your business using these email addresses:

Mihaela.Plesa@house.texas.gov

Steve.Allison@house.texas.gov

Here is a sample email you can send to the representatives sponsoring this bill:

Dear Representative Allison and Representative Plesa,

Your proposed bill 3567 would destroy my business and livelihood in Texas. I am a [single mother and the sole breadwinner of my family]. I started this small business to support myself and my family while also bringing joy, health and happiness to my clients.

With the many technological advances in medicine and communications, on-site supervision of registered nurses is unnecessary and allows for better access to care for patients. There is a nationwide shortage of doctors and other medical and nursing professionals. If this bill passes, it will further exacerbate this shortage and reduce patient care access. Texas has 206 locations designated as “medically underserved areas,” ranking it second in the nation. There are 440 “health professional shortage areas” in Texas, affecting nearly 7.5 million Texans.

This bill is terrible for the people of Texas, bad for the Texas healthcare system, and bad for the Texas economy. Small businesses make up a majority of the businesses in Texas and are the backbone of the Texas economy contributing tens of billions of dollars to the economy. This bill is detrimental to small businesses across Texas.