Passed into law in May, Texas Senate Bill 406 replaces the site-based model with what APRNs describe as a streamlined prescriptive agreement model. Under the new model, the APRN and physician have more flexibility to determine what is the appropriate level of physician involvement based on their particular practice, relationship, and experience, according to Alexia Green, RN, PhD, FAAN, professor and dean emeritus, School of Nursing, Texas Tech University Health Sciences Center, Lubbock. While the agreement must meet certain requirements, they are not nearly as prescriptive as current law, she said.
SB 406 will go into effect on Nov. 1. Sponsored by Sen. Jane Nelson and Rep. Lois Kolkhorst, the bill was introduced Feb. 6 and passed through the Senate and House in March and May. Prior to SB 406, no legislation has made significant changes in APRN prescriptive authority since 2003, said Ellarene Sanders, RN, PhD, NEA-BC, interim executive director, Texas Nurses Association.
The bill calls for increasing the number of APRNs to whom a physician may delegate prescriptive authority from four to seven and replacing frequent on-site visits by a physician with monthly and quarterly meetings at a predetermined location by the APRN and physician, according to Green. It also eliminates a minimum number of chart reviews and permits practitioners to determine the appropriate number.
Additionally, the bill eliminates the requirement for the APRN to be located within a certain number of miles of the physician and allows APRNs to prescribe Schedule II controlled substances to hospitalized patients and qualified hospice patients. SB 406 requires Medicaid and CHIP to treat APRNs in the the same way as physicians when assigning clients to a primary care provider.
Green credits the Texas Nurses Association and the APRN Roundtable for their leadership and hard work to pass this legislation. The APRN Roundtable includes the Coalition for Nurses in Advanced Practice and all Texas APRN specialty groups.
“Now the Board of Nursing and the Board of Medicine are in the process of working out the logistics of the legislation,” said Sanders. “For example, in the bill, there is wording that the APRN or PA must be in ‘good standing,’ so the two groups need to define what that term means.”