CNAP Legislative Update #17


CNAP Legislative Update #17

Lynda Woolbert, Executive Director

Coalition for Nurses in Advanced Practice

July 2, 2011


Final Sine Die

As regular readers know, the House and Senate of the 82nd Regular Legislative Session adjourned Sine Die on May 30th only to immediately reconvene in the 1st Called Session on May 31st. The Governor originally called the Special Session to address fiscal matters necessary to implement the budget, measures for more efficient operation of school districts and health care cost containment. In separate proclamations, the Governor added two essential issues not resolved during the Regular Session: Congressional redistricting and operation of the Texas Windstorm Insurance Association. Bills related to all these issues passed within the 30-days allowed for each Special Session. The other issues the Governor added to the call were sanctuary cities and security procedures at airports. Those bills did not pass and the Governor has publically stated that he will not call another Special Session to deal with those issues.


The Senate adjourned Sine Die on June 28th and the House adjourned Sine Die at 12:30 p.m. on June 29th. We anticipate that the work of the 82nd Legislature is complete until the Lt. Governor and Speaker issue their Interim Charges to the Senate and House committees late this year or early 2012.


What Happened to the APRN Study?

The last update sent on June 15th included a cliff hanger that never resolved. As you may remember, I announced the language adding a study on APRNs to SB 7 in the House was stripped out of the bill by the Conference Committee. However, the House added very similar language to a corrections bill, HB 26. I promised to keep readers updated as the bill moved through the Senate. Unfortunately for our language, that never happened. Portions of HB 26 were added to another bill in the Senate and HB 26 with our provision for an APRN study went into limbo.


However, we are very confident this will not be the end of an APRN study during the Interim. In the debate on HB 26, Representative Lois Kolkhorst (R-Brenham, HB 13), Chair of the House Public Health Committee, stated that she intends to request that the Speaker issue a charge to her committee to again consider changes in prescriptive authority for APRNs .


Reflections and Next Steps

As we garner our forces to achieve independent prescriptive authority for Texas APRNs in 2013, we need to reflect on what we achieved over the past two sessions.



Two legislators, Representatives Wayne Christian (R-Center, HD 9) and Eddie Rodriguez (D-Austin, HD 51) authored 1 independent prescriptive authority bill.

Seven legislators, Representatives Wayne Christian, Eddie Rodriguez, Kelly Hancock (R-Ft. Worth, HD 91), Garnet Coleman (D-Houston, HD 147), Rob Orr (R-Burleson, HD 58), and Senators Rodney Ellis (D-Houston, SD 13) and Royce West (D-Dallas, SD 23) authored 5 independent prescriptive authority bills.

The Health Care Policy Council had 2 statements in a report on Graduate Medical Education supporting greater use of non-physicians.

The Legislative Budget Board recommended the Legislature allow APRNs to diagnose and prescribe independently. Prior to the session, the Lt. Governor issued an Interim Charge requiring the Senate Health & Human Services Committee to study expanding prescriptive authority for APRNs, and CNAP provided invited testimony at its first Interim hearing. The House County Affairs Committee also heard testimony about APRNs at 6 of its Interim hearings, and issued a strong recommendation that “The Texas Legislature should adopt measures that remove barriers to the full utilization of NPs, PAs and other health providers.”

One business writer for the San Antonio Express, David Hendricks, wrote articles supporting independent prescriptive authority for APRNs.

In addition to articles by David Hendricks, the Editorial Boards of the San Antonio Express and the Dallas Morning News published editorials supporting changes in APRN prescriptive authority. The Austin American Statesman published an article by Timothy Knettler and an editorial by Lynda Woolbert calling for independent prescriptive authority. The Texas Tribune also published an article on the debate about prescriptive authority for APRNs.

One organization in Texas, the Texas Public Policy Foundation, publicly supported independent prescriptive authority for APRNs

Thirteen organizations in Texas supported independent prescriptive authority for APRNs.

- AARP Texas

- Amerigroup

- Greater Houston Partnership

- Methodist Healthcare Ministries of South Texas

- NAMI (National Alliance on Mental Illness) San Antonio

- Private Providers Association of Texas (PPAT)

- Provider Alliance for Community Services of Texas (PACSTX)

-Texas Association of Business (TAB)

-Texas Organization of Rural and Community Hospitals (TORCH)

- Public Policy Foundation

-Texas Silver Haired Legislature

- WellPoint

Economic savings to Texas are theorized but no actual dollar value.

Study supported by TNP found more NPs adding to the primary care workforce could save the state $136 million annually. HHSC would certify savings to the Medicaid Program totaling over $9 million.

In addition to our big Legislative Day when 405 APRNs came to the Texas Capitol, TANA Board members (CRNAs) came to the Capitol weekly and APRNs from CNAP came once a month.

In addition to CNAP’s big Legislative Day when 435 APRNs came to the Texas Capitol, TANA Board members and NPs from TNP came weekly, and APRNs from CNAP came once a month. More APRNs are also educating their legislators in their home districts where it really counts.

APRNs in 13 states have independent prescriptive authority.

APRNs in 18 states have independent prescriptive authority, and national events are offering more research, reports and journal publications that support independent prescriptive authority for APRNS.

The job for CNAP and all APRNs is to continue building on our successes until we reach the inevitable tipping point when the Texas Legislature changes the law to allow APRNs to independently diagnose and prescribe. With our increasing momentum and the crisis in health care access and affordability, we believe 2013 can be the tipping point.


What are the next steps to success?

1. Contribute to CNAP now so we can continue our PR, legislative and regulatory efforts.

2. Contribute to the Texas RN/APN PAC.

3. Within the next 2 months, contact your state representative and senator to visit with them in your home district about the health care you give and the importance of changing the law to allow APRNs to diagnose and prescribe without physician delegation.



The American Psychiatric Nurses Association is accredited with distinction as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.