1999 Legislative Compendium: Scope of Practice

Optometry  | Advanced Practice Nurses/Physician Assistants  ]


Through TMA's collaborative efforts with other allied health practitioners, turf fights that previously have consumed scarce time and energy were largely avoided. TMA, Texas Ophthalmology Society, Texas Academy of Family Physicians, and many other specialties joined forces to combat efforts by optometrists to expand their scope of practice into dangerous new grounds. However, by mid-session, ophthalmologists and optometrists ended years of bruising battle by agreeing to a consensus bill.

The bill negotiated by the two parties, HB 1051 by Rep. Kim Brimer (R-Arlington) accomplished the following:

  • Defines surgery using an ophthalmology-generated definition;
  • Prohibits optometrists from performing surgery;
  • Allows optometrists to prescribe certain oral medications, but only once and for a limited period of time;
  • Establishes ophthalmology/optometry co-management of glaucoma;
  • Establishes a multi-professional committee to develop additional educational requirements and to review possible expansions of the optemetric formulary (The Optometry Board or Board of Medical Examiners can veto the decisions of the committee.); and
  • Establishes a six-year moratorium on additional legislation.

TMA also worked closely with the Texas Acupuncture Association to come up with legislation that would allow acupuncturists greater independence in setting education requirements and fees for the licensure process while remaining under the authority of the TSBME. A third attempt at legislation that would have allowed for the licensure and right to practice medicine for "naturopathic physicians" went down in flames through efforts of TMA and, surprisingly, the Texas State Naturopathic Medical Association.

Advanced Practice Nurses/Physician Assistants

-SB 1131, sponsored by Senator Madla, addresses several issues involving advanced practice nurses (APNs) and physician assistants (PAs).

Nondiscrimination under Texas Insurance Code--SB 1131 added APNs and PAs to the list of 17 providers covered by the "nondiscrimination" or "choice of provider" provision (Article 21.52) of the Texas Insurance Code. This article provides that if an insurer would reimburse a physician for a service, then it cannot refuse to reimburse any of the listed providers for that service as long as it is one they can legally provide. The legislation does not require the insurer necessarily to reimburse the APN or PA the same dollar amount as a physician as long as the reimbursement methodology used to calculate the actual amount is the same for APNs, PAs, and physicians. For example, if APNs, PAs, and physicians generally charge a different fee for a particular service, and the methodology used by an insurer to calculate reimbursement is based on actual charges, the fee actually paid an APN or PA could differ from the fee paid a physician.

Due Process in Hospital Clinical Privileging--SB 1131 also amends the Hospital Licensing Act to require hospitals to provide "procedural rights to assure fairness of process" to APNs and PAs applying for clinical privileges, or if the hospital wants to modify or revoke privileges once granted. The legislation doesn't mandate that hospitals provide clinical privileges to APNs or PAs. However, if a hospital does elect to clinically privilege APNs and PAs, it will now have to give individual APNs and PAs applying for privileges "due process" type protections such as a timely response and the reasons for any denial. The Hospital Licensing Act also was amended to reflect that physicians were to receive due process for termination from a hospital medical staff and not just on application.

Agents Calling in Prescriptions--SB 1131 further amended the Pharmacy Act to permit agents to call in prescriptions to the pharmacist for APNs and PAs. The agent will have to be "a LVN (licensed vocational nurse) or have an education equivalent to or greater than that required for LVNs". The agent will need to be designated by the collaborating physician (rather than the APN/PA directly).

Documenting Services Provided--SB 1131 amended the Nursing Practice Act and the Physician Assistant Act to provide that an APN's or PA's signature "attesting to the provision of a service…shall satisfy any documentation requirement for that service established by a state agency." This legislation is designed to address the problem of APNs and PAs being able to provide a service but then having to have the physician sign the paperwork documenting it was provided. This legislation may not solve all of the problems because some of the documentation problems result from federal reimbursement laws, and state law cannot change federal law. However, if a state agency responsible for implementing a federal law has discretion in determining how services should be documented, then this legislation should apply.

Scope of Practice Staff Contacts
Matt Thompson, Legislative Affairs: (512) 370-1355
CJ Francisco, Office of the General Counsel: (512) 370-1339
Barbara James, Science and Quality: (512) 370-1412

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