TMA Legislative Hotline

Hotline is a daily electronic newsletter exclusively for TMA members that reports the legislature's latest actions on bills affecting Texas medicine.

Legislative Hotline: Reining in Scope Expansion

(Budget, Health Insurance, Public Health, Scope of Practice) Permanent link


Each session, nonphysician practitioners ask lawmakers to expand their legal scope of practice beyond what their education, training, and skills safely allow. This session, that day was today.

In the House Public Health Subcommittee on the Health Professions, more than a dozen scope-expansion bills were on the agenda, covering almost every nonphysician practitioner from physical therapists to psychologists.

The Texas Medical Association showed strong opposition to the most egregious of the bills, House Bill 1792 by Rep. Stephanie Klick (R-Fort Worth), which would grant advanced practice registered nurses (APRNs) “full practice authority” – their term for independent prescribing without delegation, supervision, or limitation.

TMA supports team-based collaborative care capitalizing on having the right professional provide the right service to the right patient at the right time, with overall direction and coordination by physicians.

TMA Council on Legislation member Dara Grieger, MD, who previously worked as an APRN, testified against the bill.

Dr. Grieger’s testimony focused on the difference in education and training received by physicians and APRNs, the latter of which now is conducted almost entirely online.

“Online schools often require students to find their own preceptors. Often, the clinical experiences are merely shadowing at best,” Dr. Grieger said. “It is not unusual for a student not to show up for clinical hours and merely have the paperwork signed.

“There is little clinical training. The former nurse practitioner in me is appalled and embarrassed by the poor quality of education in these online schools. I believe patients deserve better.”

TMA submitted written testimony in opposition to House Bill 2733 by Rep. Phil Stephenson (R-Wharton), which would expand the statutory definition of chiropractic to include “neuromusculoskeletal,” which is well beyond chiropractors’ education and training.

“Adding the term ‘neuro’ is not merely the addition of the nerves that may connect muscle tissue or bones,” TMA’s testimony states. “It is the addition of the entire neurological system that includes the brain, the spinal cord, and the regulation of many bodily functions – all well beyond chiropractors’ education and training.”

In the House County Affairs Committee, TMA submitted written suggestions to improve House Bill 1722 by Rep. Garnet Coleman (D-Houston.) HB 1722 would allow counties and municipalities to address the spread of blood-borne pathogens that occur with intravenous drug use by instituting sterile syringe service programs.

“Almost every state allows for comprehensive syringe exchange because of the widely recognized evidence that such a program offers intravenous drug users a path to treatment in their community,” TMA's statement says. “For people not ready to go into treatment, the information physicians, public health personnel, and others share on the value of clean needles and syringes – and information about needle exchange – will enable them to better protect themselves and others from infectious diseases.”

Late yesterday, in the House Public Health Committee, New Braunfels family physician Emily Briggs, MD – who also chairs TMA’s Committee on Reproductive, Women’s, and Perinatal Health – testified in strong support of House Bill 1111 by Rep. Sarah Davis (R-West University Place).

HB 1111 would direct the Health and Human Services Commission (HHSC) to establish new pregnancy medical home (PMH) pilots in Texas. PMHs would provide pregnant women with comprehensive, team-based care, including behavioral health care.

“As a family physician, I care for patients from cradle to the end of life and every age and condition in between, including pregnancy and postpartum care,” Dr. Briggs said. Having coordinated care through a PMH helps both physicians and patients because “knowing the risk factors for each woman helps her obstetrical team establish a care plan specific to her,” she said.

Other states have extensive experience and positive outcomes with this model. TMA will keep you posted on the bill’s progress.


So far this session, lawmakers have filed 7,665 bills. TMA is monitoring 1,938 of them. Bills must be referred to committee before they can be heard on the floor and voted on by the full body. Then the process repeats in the other chamber. Fifty-three days remain until sine die. 


Here are some bills TMA is watching. Keep an eye on your email inbox for Action Alerts as we work to pass or kill bills. 

  • House Bill 2594 by Rep. Justin Holland (R-Rockwall) would allow hospice providers to adopt written policies regarding the disposal of a patient’s unused prescription drugs, preventing those drugs from falling into unauthorized hands. TMA supports this bill. 
  • Senate Bill 1140 by Sen. Kirk Watson (D-Austin) would establish an independent review organization to review Medicaid appeals and adverse determinations on the basis of medical necessity. House Bill 3478 by Representative Davis is the companion. TMA supports these bills.  


If talk of bills and committees and backroom deals initiate tachycardia, you might want to join TMA Leading Advocates. It’s TMA’s exclusive Facebook group for legislative advocacy. Enjoy special features, news in advance, and a community of TMA members who are excited to talk about the Texas legislature and medicine's advocacy priorities. This closed group is open only to TMA and TMA Alliance members, and TMA and county medical society staff. Join today.


TMA’s 2019 legislative agenda includes priorities to help advance patient care in Texas.

At the top of the list are the state budget, insurance reform, scope of practice, maternal health, the Texas Medical Board and Medical Practice Act, and public health.

TMA member physicians and medical students, and TMA Alliance members play a significant role in advancing medicine’s priorities at the Capitol. Here are some ways you can help:

Make sure you receive TMA’s Legislative News Hotline each day, via Texas Medicine Today. Here’s how: Just log in to the Edit My Interests page on your TMA profile. Ensure you get all the legislative updates by selecting "Health care issues in the Texas Legislature" as one of your Grassroots and Advocacy interests. TMA’s updates on the latest bills affecting medicine will arrive in your inbox as part of Texas Medicine Today at 2 pm each day lawmakers convene at the Capitol throughout Texas’ 86th legislative session. 


Today’s physician of the day is Linda Siy, MD, of Bedford. Dr. Siy graduated from the University of Missouri-Kansas City School of Medicine and is a member of both TMA and the Tarrant County Medical Society.


Patient protection against surprise billing moves forward in Texas Senate – Houston Chronicle

Congress Looks to Tackle Surprise Medical Bills – The Wall Street Journal

Will fixes to Texas’ broken Medicaid system live or die? Patient groups, insurers draw battle lines – The Dallas Morning News

Bills would curb denials of Medicaid services for disabled children – Austin American-Statesman

ENTERPRISE EDITORIAL: Medicaid red tape not good for state, children – Beaumont Enterprise

Sick of property taxes? Then expand Medicaid in Texas to address the health care system [Opinion- Op Ed] – The Dallas Morning News

Vaccine advocates push for policies to strengthen Texas immunization rates – Austin American-Statesman