6-29-18 - New PA Laws – Rules Update

The following is a list of bills TAPA passed during the 85th legislative session. It includes their effective date and if rules needed to be written, it includes information on that as well.  If you have any questions about any of the following please contact the TAPA office.

  • HB 1978- Volunteerism for PAs
    - Allow PAs to volunteer their services at any public or private events
    Effective date September 1, 2017
  • HB 2546- Worker’s Compensation
    - Allows physicians and PAs now to fill out and sign the work status report, DWC – 073
    Effective date September 1, 2017
  • TDI – DWC published proposed rules 28 TAC 129.5 on April 20, 2018, should be adopted by September 1, 2018.
  • SB 1625- Whistleblower Law and More
    Whistleblower law. This makes it illegal to terminate a PA who refuses to commit or omit an action that the PA knows would be reportable to the Texas PA Board and this protection may not be nullified by contract
    Effective date September 1, 2017

    Prescriptive Authority Agreements for PAs. 
    Simplified quality assurance meetings for PAs only by allowing the physician and PA to determine in what manner the QA meetings will be held, face-to-face meetings no longer required for PAs.  The physician and PA must meet once a month in the manner of their choosing.
    January 16, 2018 Rules written and approved 
    22 TAC 193.8

    Sunset Rule Changes (included in SB 1625):  
  1. ISC hearings held by the Texas PA Board requires a PA board member to be present at the hearing
  2. Texas PA Board may go into Executive Session for disciplinary or licensure matters regarding specific licensees to protect the confidentiality of the licensee
  3. Removing the requirement that PA applicants be of “Good Moral Character”
  4. PA license will now be valid for a minimum of two years, this process of converting licenses to 2 years has begun and most PAs should see the change at their next renewal cycle – added to this rule are the changes to CME requirements.  When renewing on the new two year cycle, 40 hours will be required, 20 of which shall be Category I
  5. Allows the PA board to deny renewal applications
  6. Created a training manual for all PA board members involving the scope of, and limitations on, the board’s rule making authority
  7. All PAs will be required to submit a set of fingerprints to the Board for a background check.  The process for doing this will be explained at the next license renewal
  8. For new PA licenses, they now must be processed within 51-days after the PA’s application is complete.
    January 16, 2018 Rules written and adopted
    22 TAC 185 et.seq.
  • SB 919 – Signing of Death Certificates
    Allows a PA to sign the death certificate of a patient who was under hospice care or palliative care
    Effective date September 1, 2017
  • SB 1107 - Telemedicine
    Created new expansive laws for the use of telemedicine and includes PAs as participating providers
    November 26, 2017 Rules written and adopted
    22 TAC 174.1 – 174.9

  • Other – Sunset Bill from the 84th Legislative Session (2015)
    SB 202 - PAs Performing Radiologic Procedures
    185.32 Minimum Training and Registration Requirements for PAs Performing Radiologic Procedures
    In order to perform radiologic procedures a licensed PA must have successfully completed an educational program for PAs accredited by the Commission on Allied Health Education and Accreditations and must be registered by the Texas PA Board.  All past requirements on PAs for this have been rescinded. 
    January 16, 2018 Rules written and approved  
    22 TAC 185.32

Legislation Introduced to Authorize Direct Pay to PAs Under Medicare
HR 5506 Levels the Playing Field

April 16, 2018


Representative Adrian Smith with Nicole Buettner, PA-C (middle) and Jessica Stemper, PA-C (right)

On April 13, Representatives Adrian Smith (R-NE) and Terri Sewell (D-AL) introduced HR 5506, the Physician Assistant Direct Payment Act, to authorize PAs to receive direct payment under Medicare. If enacted, this legislation would advance AAPA’s Optimal Team Practice for those PAs billing under Medicare.

PAs are the only health professionals that cannot receive direct payment from Medicare. As a result, PAs can face administrative burdens and unnecessary red tape when they work in retail clinics, rural health clinics, medical groups that contract with a hospital, or other clinical arrangements.

As emerging healthcare delivery models replace traditional practice models, there is an increased need for PAs to be authorized to receive direct payment. Emerging healthcare models may include models in which PAs, physicians and other healthcare team members work in hospitals and health systems in more innovative, patient-centered arrangements rather than one physician employing one PA.

Medicare statute permits other health professionals (e.g. physicians, advanced practice nurses, physical therapists, psychologists, podiatrists, social workers, and others) that bill the program to receive payment directly under their own name. This legislation will level the playing field so PAs are allowed to compete with other health professionals on the basis of their clinical competence and skillsets without the concern of administrative burdens hindering employment opportunities.

Enactment of this legislation will largely not change how PAs currently practice and it will not change PA scope of practice.

Please visit AAPA’s Advocacy Action Center to urge your legislator to support this important legislation. For more information on the bill, contact Tate Heuer, AAPA vice president, federal advocacy.



September 3, 2017
New laws as of September 1st!

HB 1978- Volunteerism for PAs
HB 1978 by Representative JD Sheffield, DO (R - Gatesville) and Senator Dawn Buckingham, MD (R - Lakeway) will allow PAs to volunteer their services at any public or private gathering, including camps, church events, 5Ks, marathons and other athletic events, and so much more!  Volunteering can be done with or without a supervising physician, and the new law will also provide PAs immunity from liability while volunteering.  HB 1978 passed both the House and Senate unanimously and was signed by the Governor on June 15th.

SB 1625- Whistleblower Law and Much, Much More
SB 1625 by Senator Carlos Uresti (D - San Antonio) and Representative Phil Cortez (D - San Antonio) began as whistleblower protection for PAs, but we amended several additional TAPA bills and Sunset issues onto SB 1625.

The following are all aspects of this bill that will change current laws for PAs.

   *  Whistleblower Protection- It is now illegal to terminate a PA who refuses to commit or omit an action that the PA knows would be reportable to the Texas PA Board.  This law cannot be nullified by any contract whatsoever.
    * QA Meeting Revisions- The law regarding quality assurance meetings between a PA and a physician has been simplified.  These meetings now take place once a month in a manner determined between a physician and a PA- which can be by teleconference.  No more required face-to-face meetings. (originally HB 2141 by Representative Tom Oliverson (R – Cypress)).
    * Licensure Timeframe Extension- A PA license will now be valid for a minimum of two years.
    * ISC Hearings- Informal Settlement Conference hearings held by the Texas PA Board must now require a board member that is a PA to be present at each of these meetings. This will ensure that PAs have a fair hearing with another licensed PA present.
    * Executive Session for the Texas PA Board- During any disciplinary or licensure hearings held by the Texas PA Board regarding a specific issue with a licensee, the deliberations may now be done in a closed-door meeting, to protect the confidentiality of the licensee being discussed.  The physicians already had this requirement in place on the Texas Medical Board during similar meetings.
    * Removing the Requirement that PA Licensure Applicants be of “Good Moral Character.” The standard of “good moral character” is unclear, subjective and difficult to enforce.
    * Allowing the Board to Deny Renewal Applications. The PA board will have the discretion to determine whether noncompliant applicants can safely perform their job or if their renewal should be denied.
    * Creating a Training Manual for all PA Board Members. This board training manual must at a minimum include a discussion of the scope of, and limitations on, the board’s rule making authority.
   *  Fingerprinting for a Licensure Background Check. This will authorize the current practice of requiring fingerprinting for a background check.  This matches an across-the-board implementation among several other healthcare professional boards in the state.

 


August 19, 2017
GREAT NEWS for Texas PAs!

The Texas Legislature has passed and Governor Abbott has signed into law SB 20 which extends the Texas Medical Board and Texas PA Board, as well as the Texas Medical Practice Act and the PA Practice Act for 2 more years.  The TMB and TPAB will go through the Sunset Review process once again, and TAPA will be working hard to protect and advance our PA practice in Texas.  As you are aware TAPA was able to get our Sunset issues amended into SB 1625 by Sen. Carlos Uresti (D-San Antonio) and Rep. Philip Cortez (D-San Antonio), which passed during the regular session.

Congratulations your PA license is good for at least 2 more years!!


June 20, 2017
85th Session

The 85th Legislature’s Regular Session was a rarity from many perspectives, including the number of bills passed.  The 85th met a historic low in bills passed.  Not since 1891 has the legislature passed this low a percentage of filed bills.  Only 18% (1208 of 6631 filed bills) made it to the Governor’s desk.

Despite this record low passage rate, TAPA was very successful and is very proud that we were able to pass a significant portion of our legislative agenda, with the most number of items ever passed in our legislative history!

TAPA began with 6 legislative issues and passed 4, which have all been signed by the Governor – SB 1625, HB 1978, and HB 2546.

TAPA began with 7 Sunset issues and passed 4, plus added 4 additional sunset amendments, contained within SB 1625 and signed by the Governor.

TAPA Legislation:

HB 1978- Volunteerism for PAs
HB 1978 by Representative JD Sheffield, DO (Gatesville – R) and Senate sponsor Senator Dawn Buckingham, MD (Lakeway – R) will allow PAs to volunteer your services at any public or private gathering, including camps, church events, 5Ks, marathons and other athletic events, and so much more!  Volunteering can be done with or without a supervising physician, and the law will now offer liability protection while you are volunteering.  HB 1978 passed both the House and Senate unanimously and was signed by the Governor on June 15th.  This law will go into effect on September 1st, 2017.

HB 2546- Worker’s Compensation Form Completion by a PA
HB 2546 by John Zerwas, MD (Richmond – R) and Senate sponsor Senator Donna Campbell, MD (New Braunfels – R) will now allow a PA to fill out and sign the work status report (DWC – 073) in a worker’s compensation setting. This form has to be filled out at every visit a patient makes to a worker’s compensation provider.  TAPA has been working on this for the last two sessions, and this time it was passed unanimously by both the House and Senate and signed by the Governor on June 9th.  The law goes into effect immediately!

SB 1625- Whistleblower Law and Much More
SB 1625 by Senator Carlos Uresti (San Antonio – D) started its life in the Senate as providing for whistleblower protection for PAs, but as session wound down several other TAPA pieces of legislation were added to this bill, along with additional amendments. The conglomeration of bills had additional sponsors that included Representative Phil Cortez (San Antonio – D), and Representative Tom Oliverson, MD, (Cypress – R). The following are all aspects of this bill that will change current laws for PAs, going into effect on September 1st, 2017
•    Whistleblower Protection- It is now illegal to terminate a PA who refuses to commit or omit an action that the PA knows would be reportable to the Texas PA Board.  This law cannot be nullified by any contract whatsoever.
•    QA Meeting Revisions- The law regarding quality assurance meetings between a PA and a physician has been simplified.  These meetings now take place once a month in a manner determined between a physician and a PA- which includes teleconferencing.  No more required face-to-face meetings.
Items relating specifically to the PA Board Sunset bill - -
•    Licensure Timeframe Extension- A PA license will now be valid for a minimum of two years, could be more depending on rules that the PA Board will decide.  •    ISC Hearings- Informal Settlement Conference hearings held by the Texas PA Board must now require a board member that is a PA to be present at each of these meetings. This will ensure that PAs have a fair hearing with another licensed PA present.
•    Executive Session for the Texas PA Board- During any disciplinary or licensure hearings held by the Texas PA Board regarding a specific issue with a licensee, the deliberations may now be done in a closed-door meeting, to protect the confidentiality of the licensee being discussed.  The physicians already had this requirement in place on the Texas Medical Board during similar meetings.
•    Removing the Requirement that Applicants be of “Good Moral Character.” The standard of “good moral character” is unclear, subjective and difficult to enforce.
•    Allowing the Board to Deny Renewal Applications. The PA board would have the discretion to determine whether noncompliant applicants can safely perform their job or if their renewal should be denied.
•    Creating a Training Manual for all PA Board Members. This board training manual must include a discussion of the scope of, and limitations on, the board’s rule making authority.
•    Fingerprinting for a Licensure Background Check. This will authorize the current practice of requiring fingerprinting for a background check.  This matches an across-the-board implementation among several other healthcare professional boards in the state.

In addition to all the Sunset provisions in this bill the Sunset Commission voted unanimously on a “management action” instructing the PA Board to process PA licenses within 51-days after the PA’s application is complete, just like the Texas Medical Board treats physicians.  The 51-day language does not appear in statute or rule, just like it does not for the TMB, but is part of the Sunset Commission’s Report.


HB 2548
HB 2548 by Representative John Zerwas, MD (Richmond – R) passed out of the House Public Health Committee unanimously, but unfortunately due to end of session deadlines died before it could be scheduled for a House floor vote. This bill would have given complete schedule II delegation to all PAs in Texas.  Dr. Zerwas added this bill on as another amendment to SB 1635 (above), hoping to give it a second chance to get passed.  

A Conference Committee was appointed to iron out some of the differences the House and Senate had in it.  The senate conferees refused to accept Representative Zerwas’ amendment and it was stripped out of the bill.   TAPA had physician support of Schedule II prescribing but other outside forces were unfortunately opposed to PAs getting Schedule II prescribing. This is the closest TAPA has come to getting PAs to be able to prescribe schedule II in all settings.


TAPA also worked on the following successful legislation:

SB 919
SB 919 by Senator Jose Rodriguez (El Paso – D) allows a PA or APRN to sign the death certificate of a patient who was under hospice care or palliative care.  This bill came from the Palliative Care Interdisciplinary Council, created last session by Representative John Zerwas, MD.  TAPA has had a representative, Bruce Christensen, on this Council since its inception. The Governor signed this bill on June 1st and it went into effect immediately.

SB 1107
SB 1107 Senator Charles Schwertner, MD (Georgetown – R) created new laws for the practice of telemedicine, all of which include PAs as participating providers. This was signed by the Governor May 27th and the majority of all provisions of the bill go into effect immediately.

This was a landmark session filled with many successes. TAPA believes this can serve as a basis going forward in future sessions to further shape the practice environment for PAs, making Texas the best place to practice as a PA in the entire country!  

It has been my pleasure to serve as legislative affairs chair for the past two years, and I extend sincere thanks to members of the Legislative Affairs Committee, the TAPA Board, Jaime Capelo and the PAs who took time out of their schedule to come testify on behalf of TAPA legislation.  

– Matt Boutte, PA-C


May 25, 2017

 

We are not finished yet!

Three PA bills have already passed the Texas Legislature, and are in route to Governor Abbott’s desk for his signature!

HB 1978 passed both chambers and will allow for PAs to use their expertise and scope of practice to volunteer their services at any public or private event, with or without a supervising physician.  It also extends liability protection strictly for this volunteer work.  TAPA is grateful to Representative JD Sheffield, DO, for authoring this legislation, and Senator Dawn Buckingham, MD, for sponsoring this legislation in the Senate.

HB 2546 improves the PA practice in the worker’s compensation system.  As you know, only physicians may sign the TDI-DWC-073 forms but HB 2546 will now allow PAs to also sign the form.    TAPA has worked hard to change the law and help PAs who see injured workers.  We extend a huge thanks to Representative John Zerwas, MD, for authoring this legislation in the House.  We are also grateful to Senator Donna Campbell, MD, for sponsoring this legislation in the Senate.  Senator Campbell made sure this important legislation was passed last night before the bill deadline hit!

Finally, SB 919, was also passed in the final hours of May 24th that would allow PAs and APRNs to sign the death certificate for patients who were under hospice or palliative care.  PAs inclusion in this bill is a direct result of TAPA’s membership on the Texas Palliative Care Interdisciplinary Council, formed in 2015. TAPA’s President, Bruce Christensen, has been a member of this Council since its inception. This Council was created by a bill authored by Representative John Zerwas, MD. TAPA extends thanks to Senator José Rodríguez for authoring this important legislation.

Countdown to Sine Die – only 4 days left in the 85th Legislative Session.  In the week following Session a longer, more detailed description of all PA bills will be posted and sent to the membership.


June 20, 2017



May 9, 2017


Happy last month of the 85th Legislature! Below are several updates regarding our Bills

Currently, we have two Bills that have passed out of the Texas House UNANIMOUSLY.

HB 1978 - Volunteerism for PAs
HB 2546 - PAs Signing Department of Workers’ Compensation Forms

Both of these Bills are now in the Senate, and have been referred to committee.  On Wednesday, May 10th, HB 1978 will be heard in the Senate Health and Human Services, and TAPA will be present to testify in support.  If you believe that PAs should be able to volunteer their services like every other healthcare profession in Texas, contact the members of the Senate Health and Human Services committee! (Link to Senate Health and Human Services committee page: http://www.senate.state.tx.us/cmte.php?c=610)

The following TAPA Bills have passed out of their respective House committees and are awaiting placement on the House calendar for full votes:

HB 2141 - Simplifying QA Meetings for Prescription Delegation
HB 2143 - Whistleblower Protection for PAs
HB 2548 - Complete Schedule II Delegation for PAs

The Senate version of the Whistleblower Bill, SB 1625, has been amended to include TAPA’s requests for changes to the function of the Texas PA Board as it continues through the Sunset process.  These include mandating that a board member who is a PA be present at all ISC (Informal Settlement Conference) hearings, as well as allowing the PA Board to go into executive session during licensing and disciplinary hearings.  SB 1625 will be up for a vote in the Senate this week - we do anticipate it to pass out of the Senate.


April 14, 2017

HB 2546, which would allow PAs to be able to complete and sign the TDI-DWC 073 form for Worker's Compensation patients, was heard in the House Business and Industry Committee this past Monday.  There was no opposing testimony offered, and on Wednesday the bill was voted favorably out of committee unanimously, and will be added to the Local and Consent Calendar in the House!  This now marks two of TAPA's bills that have been voted unanimously out of committee for this session!  

HB 1977- adding PAs as mental health providers- is still pending in the House Public Health Committee.  If you are a PA working in mental health, you know how important it is to be recognized by the state of Texas for the work you do every day- please contact the House Public Health Committee members and tell them that Texas PAs deserve to be recognized as mental health providers!  Link to the committee webpage

 



April 5, 2017

On Tuesday April 4th, the House Public Health Committee voted on HB 1978 that would allow PAs to volunteer their services.  I'm happy to report that the bill was voted favorably out of committee with unanimous support!  HB 1978 will now go to Calendars in order to get on the House floor for a vote.

HB 1977, our mental health recognition bill in which we testified on last week in the House Public Health Committee, was not taken up for a vote during the committee's meeting this week.

March 28, 2017

Great news!  In addition to our six bills in the Texas House, TAPA also has 4 bills in the Texas Senate:

•    SB 1624 (Sen. Carlos Uresti- San Antonio): Adding PAs as mental health providers
•    SB 1625 (Uresti): Whistleblower protection for PAs
•    SB 1928 (Sen. Lois Kolkhorst- Brenham): Simplifying prescription delegation meeting requirements
•    SB 2194 (Sen. Dawn Buckingham, MD- Lakeway): Volunteerism for PAs

On Tuesday, March 28th, the House Public Health Committee will hold a public hearing on two of TAPA's bills:

•    HB 1977- Adding PAs as mental health providers
•    HB 1978- Volunteerism for PAs

TAPA will be present to testify in support of both bills.  We are grateful to Representative JD Sheffield, DO, for sponsoring this important legislation!
March 17, 2017

 

TAPA PA Day at the Capitol - April 2-3, 2017

Thank you for your interest in our upcoming PA Day.  If you would like attend please click on the following link and register.
https://www.surveymonkey.com/r/TAPA_Member_PA_Day_Reg
 
We are charging a nominal fee this year ($35) to our attendees to help us cover a fraction of the costs for food, drink and materials.  
 
Also, we have a room block at the Sheraton Hotel and I can make reservations for anyone that needs them.  If you need a room at the Sheraton, please contact Lisa Jackson


March 7, 2017

 

March Legislative Update

We are deep into the 85th Legislative Session, and it has already been a season filled with headlines that grab our attention daily.  While the work that your TAPA Legislative Affairs Committee (LAC) has done this Session may not be as headline-grabbing, we are proud to put forward an agenda that has seen us file a record number of bills for TAPA!  We have discussed before what our agenda is, but now that the Bills are officially filed below gives you more information about each:

     -    HB 1977 (Representative J.D. Sheffield, MD - Gatesville) Mental Health Recognition in State Law for PAs.  This bill will add PAs to the definition of "non-physician mental health professional".
     -    HB 1978 (Representative J.D. Sheffield, MD - Gatesville) Volunteerism for PAs.  This bill would allow PAs to volunteer their services at a charitable organization or at a public or private event, including a sporting event, community event or health fair, without having a supervisory agreement in place.
     -    HB 2141 (Representative Tom Oliverson, MD - Cypress) QA Meeting Revision for Prescription Delegation.  Currently there exists legal language defining a series of convoluted meeting requirements in order for physicians to delegate prescriptive authority to PAs.  This bill simplifies the requirements and eliminates the staggered time frames that currently exist.
     -    HB 2143 (Representative Phil Cortez – San Antonio) Whistleblower Act for PAs. A member brought an issue to us during the legislative off-session which qualified as a whistleblower situation. There currently exists no such protection for PAs.  This bill would equal the protection that currently exists for APRNs in Texas and apply it exclusively to PAs. It also cannot be nullified by any contract.
     -    HB 2546 (Representative John Zerwas, MD - Richmond) Workers’ Compensation Forms.  In the workers’ compensation system, the form used for every patient visit is DWC-073.  It cannot be signed by a PA, only a physician.  This bill would allow PAs to sign this form without any physician co-signature.
     -    HB 2548 (Representative John Zerwas, MD - Richmond) Schedule II Expansion.  This bill would allow for physicians to delegate to PAs the ability to write for any schedule II medication, regardless of practice setting.

Sunset Laws

It is not over yet!  The Sunset Advisory Commission has concluded their hearings and have now introduced the Texas Medical Board Sunset bill, which includes the Texas Physician Assistant Board, HB 3040, sponsored by Cindy Burkett.  The highlights directly involving PAs include:

     -    Disciplinary and licensing hearing deliberations will be conducted in executive session.  However, hearing evidence and testimony will still occur in open session, as well as the vote and announcement of the decision.
     -    Additional training requirements for PA Board members are put into place, as well as issuance of a training manual including the information.  They specifically list “the law governing physician assistant board operations”.  These same additions are going to be placed on the Texas Medical Board for physicians.
     -    Fingerprinting will be required for criminal background check for both initial licensure and renewal of the same license.  This only needs to be done once, once you have done the fingerprinting, it is not required for every renewal.  This requirement also is being added for physicians.
     -    PA licenses can be valid for two years.
     -    PAs will be required to search the Prescription Monitoring Database before issuing any prescription for opioids, benzodiazepines, barbiturates and carisoprodol.  There is a specific carve-out for patients diagnosed with cancer and those under hospice care.  Physicians and all other prescribers will also be subject to this requirement.
     -    The PA Board is directed to check the Prescription Monitoring Program database for potentially harmful prescribing patterns or practices involving controlled substances and can both notify the PA of this and also initiate a complaint against the PA.  This is also being added for physicians and all other prescribers.
     -    ISC hearings must include a licensed PA board member at each.

Other Legislation

HB 1415/SB 681
The APRN Independence bill was introduced last month, identifying APRNs as a “licensed independent practitioner” who “formulate primary and differential medical diagnoses”.  TAPA is very aware of this legislation and will be following closely and will keep the membership updated.

Federal legislation

Recently, the Veterans Affairs PA Association worked with Senator Jon Tester (Montana) on crafting a bill to address the shortage of PAs who work in the VA system.  Last month, S426, the "Grow Our Own Directive: PA Employment and Education Act of 2017" was filed, which has two separate actions to help increase PA staff in the VA system.  Below is a quote from the letter the AAPA wrote to Senator Tester's office regarding this bill and its details:

"The GOOD Pilot Program, designed to create a pathway for veterans to become educated as PAs, is a creative, two-pronged investment for our nation’s veterans. The GOOD Pilot Program supports veterans in becoming part of a well-respected healthcare profession with a longstanding commitment to veterans and veterans’ health; additionally, the program will add to the supply of PAs in VA medical facilities. S. 426 will also require the VA to establish a national strategic plan to recruit and retain PAs, including the adoption of standards leading to competitive pay for PAs employed by the VA."

We applaud VAPAA and their efforts to support our profession nationally


February 10, 2017

 

Legislative Agenda

The 85th Texas Legislature kicked off on January 10th, and below are the items the Legislative Affairs Committee (LAC) has crafted over the past year and a half.

Our agenda for this session will include:
•    Revising schedule II language
•    Recognition of PAs as mental health providers
•    PAs being able to volunteer their services at any community event
•    Protection for PAs in “whistleblower” situations
•    PAs signing workers compensation forms
•    Revision of quality assurance meetings between physicians and PAs for the purpose of prescription delegation

Sunset

The LAC has been working on for the past year and a half the Sunset Advisory Commission’s review of the Texas PA Board.  TAPA testified before the Commission and presented the issues discussed in prior newsletter articles.  On January 11th, the Commission met again and formally approved 3 of our Sunset agenda items:

•    Ensuring a mandatory time frame exists for the issuing of PA licenses (average of 51 days, same as physicians)
•    Texas PA Board being allowed to go into executive session during both licensing and disciplinary hearings
•    Mandate that a licensed PA who is on the Texas PA Board be present at informal settlement conference (ISC) hearings

These items and several others will now go forward as a bill to the Legislature.  Two other items were included that directly affect PAs as well submitted by the Commission:

•    PA licensure renewal will move to every 2 years, not every year
•    PAs (and all other licensed professions under the Texas Medical Board) will be required to check the Prescription Monitoring Program website before prescribing opiates, benzodiazepines, barbiturates and carisoprodol.  There will be an exception made for active oncology patients.

PA Day at the Capitol – April 2nd and 3rd

One of TAPA’s most popular events, “PA Day at the Capitol” will occur on Monday, April 3rd, with a preparatory session occurring the previous afternoon.  Every legislative session we gather PAs, PA students and even pre-PAs to join us in walking the halls of the beautiful Texas Capitol.  On this day we talk to representatives, senators and their staff regarding our legislative issues.  We will be sending out further details soon! 


August 11, 2016

 

Letter from the Texas Physician Assistant Board

To all TAPA members:

The Texas PA Board has asked us to share a letter with our membership. TAPA has been working with the TPAB and the Texas Medical Board to improve the licensure process, especially with record numbers of applicants this year. Thanks to these efforts, we are happy to share the PA Board's plan to address this issue in the short and long term.

We will continue to aid the TPAB and the TMB to explore these issues to ensure safe and efficient licensure. Please be watching your email and social media for ways you can help us improve PA practice during our Sunset review this fall.

The Texas PA Board letter is below:
 

Texas Physician Assistant Board
AUSTIN, TEXAS


 August 10, 2016

A message from the Presiding Officer:

Over the past year I have increasingly heard from many of you about the long wait for licensure. The TMB's regulatory oversight of medical occupations increased last fall, adding approximately 60,000 new licensee types. This, combined with the spring and early summer graduations, resulted in a surge for our processing department. This has also resulted in daily phone calls to the TMB increasing into the thousands with some days reporting upwards of 20,000 phone calls. Despite the extraordinary work by TMB staff, we recognize that not all of the spring graduates were processed in time to make the July Board meeting. Let me assure you that we take your concerns seriously and the Texas PA Board members are working to improve the licensing process.

Here are a few of the expected changes we anticipate will improve this process:

•    The TMB Technology department will begin upgrading the original 1990's database systems, as well as possibly launching a portal allowing electronic submission of your application forms. These changes will allow for more efficient processing and thereby having fewer things done by hand and on paper files.

•    The TMB has begun hiring and training additional licensing staff. Just as your PA training wasn't quick, neither is this process because we want to ensure our analysts continue to provide accurate and friendly service.

•    Our future Board agenda will explore potential ways to allow the agency to issue a full license to qualified applicants faster and independently from our board meetings that currently occur just three times per year.

In addition to delays in processing licensure applications, some of you have expressed concern about hospital systems not accepting a temporary license as approval to begin practice. The TMB considers a temporary license as equally valid to a regular license; however, the TMB can not alter the policies of various health systems regarding their choice of whether or not to accept the temporary license for credentialing. We have issued many letters and statements in the past validating the Board's authority to issue these license types and will continue to advocate for their acceptance. Currently the temporary license is the only legal option for those of you applying between Board meetings but will become an agenda item as mentioned above.

Lastly, I'm happy to announce that our Board plans to hold a called meeting on August 29th 2016. This meeting will help expedite processing of applicants who are pending a permanent license to be issued. I'm optimistic that this will assist many of you who are otherwise qualified and are simply waiting for the next scheduled meeting which is planned for November.

Thank you for your patience and cooperation with the Texas PA Board.

Jason Cooper, MPAS, EMT-P, PA-C Presiding Officer

View Original Letter Here.


Legislative Session 2017

January is fast approaching, and while the Sunset agenda will be voted on during the next session, TAPA must also consider our overall legislative agenda.  We sent a survey to all TAPA members to elicit feedback for potential targets to focus on during the next session, and the TAPA board will use this information to help guide the direction we will take. I will keep this area updated with the latest news regarding our legislative efforts.  As always, you can email me at mbouttepac@gmail.com with any questions or concerns.

Sunset

https://www.sunset.texas.gov/ Another election year is upon us, and I don’t think I need to tell you, but this year is unlike any other. As the political theater plays out  in  the national front, in Texas we are also experiencing a unique legislative off-season this year. The buzzword at the center of it is “SUNSET”. Every state agency has an expiration date, including the Texas Medical Board and the Texas PA Board. In order to continue to exist, each agency is evaluated at least once every 12 years by the Sunset Commission, which is a bipartisan, independent body made up of state representatives, senators and public members. The Sunset Commission asks a basic question, “Should a state agency be continued?” This process allows for examination of an agency to determine what functions, if any, need to be changed before it is allowed to be renewed and continue to operate. As the voice of Texas PAs, TAPA will be making recommendations to the Sunset Commission on the function of the Texas PA Board.   As of this writing, the PA Board has submitted their own self-review of their agency to the Commission, which is also one of the initial steps of the Sunset process.  Later this year, we will be at the public Sunset hearings regarding the PA Board, ready to testify to the changes we have recommended- expect this to occur in September or October.  As these are public hearings, any member of the public may also testify to any changes they believe should occur to each agency.

Bills Passed 2015 Session

SB 622- Thanks to Senator Carlos Uresti from San Antonio District 19, the PA Board added an additional four PA members to the thirteen member board bringing the number of PAs on the board to seven. The bill also stipulates that the chair must be a PA. •    The new chair of the PA Board is Jason Cooper, MPAS, EMT-P, PA-C.  Mr. Cooper was already a member of the PA Board when he was appointed chair by the governor •    The additional PAs on the Board include two prior TAPA presidents:
•    Melinda Ann Moore Gottschalk, PA-C
•    Karrie L. Crosby, PA-C
•    Maribel De Ponce, PA-C
•    Jennifer L. Clarner, PA-C

HB 1874- Establishment of the Palliative Care Interdisciplinary Council- sponsored by Rep. John Zerwas MD, an anesthesiologist who had a strong personal belief in creating such a council for Texas.  This council will include PAs as key participants.
•    TAPA’s President-Elect, Bruce Christensen, DHSc, PA-C, is the PA representative to this new council
•    The website for the council can be found here:
https://www.hhsc.state.tx.us/about_hhsc/AdvisoryCommittees/pciac.shtml

SB 195-Senator Charles Schwertner authored a bill which transfers rulemaking authority over the state’s prescription drug monitoring program from the DPS to the Texas State Board of Pharmacy. Each individual agency (TMB, Texas Physician Assistant Board, etc.) that licenses individuals to access the state prescription monitoring plan or to prescribe and dispense controlled substances would issue the authority to prescribe controlled substances. There will be an increase to the license fee, but no controlled substance fee. What this means: you will have your license and a DEA number only- on September 1st 2016, DPS registration will be a thing of the past!

SB 202 -Senator Jane Nelson sponsored a Sunset bill related to the transfer of certain occupational regulatory programs and the deregulation of certain activities and occupations. Within this bill it inadvertently gave the Radiation Technologist Advisory Board authority over all professions that used radiology. The problem was identified and now the Texas Physician Assistant Board has authority over the education and training of PAs use in radiation.

Archives

5/4/15 - HB2602 Update

Dear TAPA Colleagues,

Great news!  Tuesday night, the House Public Health Committee UNANIMOUSLY passed HB 2602 by Coleman.  This is a bill supported by TAPA that:

    Allows physicians to delegate Schedule II drugs to Psych/MH APRNs and PAs and to those APRNs/PAs providing palliative care;
    Clarifies that physicians can delegate to APRNs and PAs in hospitals and ERs the writing of discharge prescriptions for Schedule II drugs; and,
    Allows physicians to delegate to APRNs and PAs the ability to prescribe Hydrocodone-combination products.

Please write Representative Coleman a thank you note for his leadership and if your Representative serves on the Public Health Committee, please contact them and express your appreciation for their support.

You can find information for Rep. Coleman, the members of the House Public Health Committee, who your legislators are, and get information on bills, at the Legislature Online at: www.capitol.state.tx.us.

The next step is for HB 2602 to go to the House Calendars Committee.  If your Representative serves on that committee, please call or email them and ask that they recommend the bill be set on the House Calendar as soon as possible.

TAPA testified in support of this bill and discussed the bill with the TMA in efforts to ensure that physician-PA teams are empowered to take care of our patients.

Todd Pickard
President
 4/6/15 - Legislative Request

We Need Your Help!

DO YOU WORK IN PSYCHIATRY?   DO YOU WORK WITH PATIENTS WITH MENTAL HEALTH ISSUES?  If so, we need to hear from you.  Where do you work?  How many patients a day do you see?  What do you do every day?

TAPA testified on two bills this week regarding mental health providers.  The first was regarding the definition of a non-physician mental health provider.  We want PAs added to that list.  Please read  HB 1998 by Rep. Coleman.  Please have your physicians support this bill by adding PAs to the list of non-physician health care providers.  Call your Representative.  Call your Senator.  Have your physician call his representative and senator as well as his professional organizations and voice his support for these bills.  Your voice and your physician’s voice matters.

http://www.capitol.state.tx.us/BillLookup/Text.aspx?LegSess=84R&Bill=HB1998

DO YOU WORK WITH WORKERS COMPENSATION PATIENTS?                                                                               

You need a signed DWC73 after you see your workers compensation patients. Does it delay care and return to work because your physician has to sign the DWC73 even though you saw the patient? Are you in a rural or secondary site and it takes up to a week for the physician to receive the form and return it to you thus delaying care and return to work??

If so, then SB1572 by Sen. Uresti and HB 3833 by Rep Coleman are bills that could resolve that problem for Texas patients.  If the bill is heard, TAPA intends to amend the bill to state DWC73 form only.  But we need your help. .  Call your Representative.  Call your Senator.  Have your physician call his representative and senator as well as his professional organizations and voice his support for these bills.  Your voice and your physician’s voice matters.

http://www.capitol.state.tx.us/BillLookup/Text.aspx?LegSess=84R&Bill=SB1572

WE CAN NOT DO THIS WITHOUT YOU!  Respond to melindagpac@gmail.com with your data, but do not forget to call your senator and representative in Austin.  Please encourage your physician to do the same.

Who Represents Me?

http://www.fyi.legis.state.tx.us/Home.aspx
3/1/15 - LAC Update

Progress!

The supervision limit on PAs is now a thing of the past. Now physician can supervise as many PAs as they need for their practice. Remember: This does not change the number of PAs (or NPs) that the physician can delegate prescriptive authority.

This step forward has propelled Texas into the list of states within the AAPA that have all six key elements. Great work by all who were involved in this huge success!


Just released form the Texas Medical Board:
RULE CHANGES ADOPTED

CHAPTER 185. PHYSICIAN ASSISTANTS

§185.16, Employment Guidelines

The Amendments to §185.16, relating to Employment Guidelines, delete language related to limits on the number of physician assistants (PAs) that may be supervised by a physician. The amendments relate to general supervision only. The amendments are not intended to change laws related to limits on the numbers of PAs that may have prescriptive delegation authority.
2/16/15 Schedule II Clarification

PA Colleagues,

This e-blast is to update you on the Schedule ll prescriptions situation. The Texas Medical Board, Texas State Board of Pharmacy and the Texas Board of Nursing are currently interpreting SB 406 to only allow for PAs (and NPs) to prescribe hospice Schedule II prescriptions and hospital in-patient and hospital ER Schedule ll prescriptions that are filled in the hospital’s pharmacy for use by the patient in the hospital. We believe that Schedule ll discharge prescriptions will not be allowed.

The Texas Medical Board, Texas State Board of Pharmacy and the Texas Board of Nursing are working on a joint FAQ to specifically address their interpretation of SB 406 and PAs (and NPs) Schedule ll delegated prescriptive rights regarding discharge.

This current interpretation is different from the interpretation previously provided to TAPA. It is also different from TAPA’s understanding of the statutory language of SB 406. The Texas Medical Board and the Texas Pharmacy Board believe SB406 is ambiguous regarding discharge prescriptions.

For those PAs in hospital settings, please ask your delegating physicians about their understanding of Schedule ll prescriptions in the hospital setting regarding discharge, what impact this will have on their practice and care for the patients, and if they have concerns, if they have expressed their concerns to the hospital administrators and their medical societies.

TAPA will continue to work with the physicians, hospitals, nurses, legislators, the Texas Medical Board, Texas Physician Assistant Board, Texas State Board of Pharmacy, and the Texas Board of Nursing for a solution for this problem. We will update you as soon as we receive new information regarding Schedule ll discharge prescriptions.
9/18/14

For News and Updates from the Texas Department of Public Safety regarding the scheduling of Tramadol and Hydrocodone, please go here - http://www.txdps.state.tx.us/RSD/PrescriptionProgram/News/updates.htm
9/17/14

On August 11, 2014, Tramadol (in all forms) went to Schedule 4 status.  this may effect your ability to e-scribe or fax new prescription or refills of Tramadol
 8/29/14

Announcement regarding the reclassification of hydrocodone and all combination products containing hydrocodone to schedule II

Below you will find the link to the FDA ruling -
https://www.federalregister.gov/articles/2014/08/22/2014-19922/schedules-of-controlled-substances-rescheduling-of-hydrocodone-combination-products-from-schedule

Effective October 6, 2014 hydrocodone and all combination products containing hydrocodone will be classified as schedule II. This will require the following changes in practice:

• Hydrocodone Prescriptions on or after October 6, 2014 will require a physician signature unless appropriate delegated for the inpatient, emergency center or hospice setting.
• Prescriptions for schedule II drugs must be written on Texas DPS approved prescription pads or paper stock for printing
• Prescriptions for hydrocodone and combination products written prior to October 6, 2014 can be signed by a PA and refills may be dispensed from that prescription until April 8, 2015

In the state of Texas PAs cannot be delegated the prescribing of schedule II with the exception of in the hospital inpatient setting, the emergency center and for patients in Hospice.

Please be aware of this change and discuss how your practice plans to address this change that will impact your outpatient clinical practice. You should encourage all professions impacted by this change to engage in conversations with their peers and professional organizations.

TAPA is aware that this will impact practices across the state. We will review and work with all stakeholders in Texas to address this change.

There is a FAQ on the TMB website regarding the delegation of schedule II for inpatient, the EC and hospice settings. http://www.tmb.state.tx.us/page/prescriptive-delegation
10/15/13 New Prescriptive Authority Agreement

Beginning November 1, 2013, physician-PA teams, except in "facility-based” practice settings (hospitals and long term care facilities), will be required to have a Prescriptive Authority Agreement (PAA) for the delegation of the act of prescribing or ordering a drug or device.   

Any Physician-PA team drafting a PAA should begin reviewing our state's laws and rules governing physician delegated prescriptive authority, which are contained within Texas Occupations Code Section 157 and Texas Administrative Code Chapter 193.   

Physician-PA teams will also be required to show documentation of Prescriptive Authority Quality Assurance & Improvement Plan Meetings.  There are specific requirements within the laws and rules that require "periodic face-to-face meetings”.       

TAPA’s Legislative Affairs Committee Special Task Force, Jaime Capelo, and Lisa Jackson have been hard at work drafting and finalizing documents that may be helpful to our membership when entering into a PAA that fits their physician-PA team practice needs.   The TAPA Board of Directors recently decided to make these resources available under the member's only portion of our website.  

TAPA continues to work to bring value to its members.  We believe these resources can be helpful to you and your physician.  As the rule making process continues with SB 406, we will continue to update you on how the new rules will affect your practice.

New Prescriptive Authority Information (you must be a TAPA member to view)
5/15/13 Congratulations SB 406 passed on 2nd reading with NO amendments and UNANIMOUS Support

The Texas Academy of Physician Assistant is proud to announce that SB 406 authored by Senator Jane Nelson and sponsored by Rep. Lois Kolkhorst has passed both houses of the legislature and is now on its way to the Governor’s desk for his signature! SB 406 will enhance the team-based practice between physicians, physician assistants and advanced practice nurses in Texas. This bill developed with the leadership and guidance of Senator Nelson and Representative Kolkhorst will enhance the health care delivered to the citizens of Texas. Now more than ever these kinds of efforts are crucial to improving the lives of our patients and removing barriers that prevent physicians, physician assistants and advanced practice nurses from working together to deliver quality, safe and effective care for Texas.
 
 The LAC formed a task force to lead the negotiations for TAPA with the TMA and the Nurses Coalition. This task force included: Lauren Dobbs, Karrie Crosby, Todd Pickard, Melinda Moore, Jaime Capelo and Lisa Jackson. This group worked tirelessly over several months to ensure that the bill contains victories for the PA profession and moves our practice forward. The following summarizes the changes to current law that are included in this bill that represent MAJOR VICTORIES for PAs in Texas:

• Reduces site-based language from 5 settings to 2 (community and facility-based).
• Delegation of schedule II medications to PAs working in Hospitals or for patients in Hospice.
• Increases the number of PAs that a physician can delegate prescriptive practice from 4 to 7.
• Allows for unlimited delegated prescriptive practice in underserved and rural areas.
• Clarifies language that allows for unlimited delegated prescriptive practice at Hospitals.
• Removes the limitation for physicians to delegate prescriptive practice only at one Hospital.
• Removes distance limitations for physician supervision.
• Removes the percentage of charts that a physician must review and co-sign.
• Improves PA Board collaboration with the Medical Board and Nursing Board.
• Removes requirements for a percentage of hours of operation that a physician must be present at a practice.

 The bill has new language regarding quality and patient safety that are NOT new to PAs and are already part of our everyday practice. These include:

• Regular communication between physicians, APNs and PAs.
• Prescriptive Practice Agreements that list the parameters of APN and PA prescriptive authority.
• Quality Assurance processes that allow the physician, APN and PA to determine: if chart review is needed; what processes are used to implement improvement in patient care; how emergencies are handled; the general process for referrals; and, indicating alternate supervising physicians in the event the primary supervising physician is unavailable.
• Regular face-to-face meetings between physicians, APNs and PAs that take place at least monthly to discuss patient care and practice issues.

The political process is always challenging and filled with obstacles but TAPA has again scored a major victory in the Texas Legislature.  The 83rd Legislature’s Regular Session will end in 12 days and the Texas PAs will celebrate significant improvements in our practice.  Stay tuned for more details.

 
 TAPA is committed to the continuous improvement of PA practice in Texas.  TAPA will always fight for PAs in Texas.
2/6/13 TAPA Member Notice - SB406
 
The Texas Academy of Physician Assistant is proud to support SB 406 sponsored by Senator Nelson that will enhance the team-based practice between physicians, physician assistants and advanced practice nurses in Texas. This bill developed under the leadership and guidance of Senator Nelson will enhance the health care delivered to the citizens of Texas. Now more than ever these kinds of efforts are crucial to improving the lives of our patients and removing barriers that prevent physicians, physician assistants and advanced practice nurses from working together to deliver quality, safe and effective care for Texas.
 
The LAC formed a task force to lead the negotiations for TAPA with the TMA and the Nurses Coalition. This task force included:  Lauren Dobbs, Karrie Crosby, Todd Pickard, Melinda Moore, Jaime Capelo and Lisa Jackson. This group worked tirelessly over several months to ensure that the bill contains victories for the PA profession and moves our practice forward. The following summarizes the changes to current law that are included in this bill that represent MAJOR VICTORIES for PAs in Texas:
 
1.       Reduces site-based language from 5 settings to 2 (community and facility-based).
2.       Delegation of schedule II medications to PAs working in Hospitals or for patients in Hospice.
3.       Increases the number of PAs that a physician can delegate prescriptive practice from 4 to 7.
4.       Allows for unlimited delegated prescriptive practice in underserved and rural areas.
5.       Clarifies language that allows for unlimited delegated prescriptive practice at Hospitals.
6.       Removes the limitation for physicians to delegate prescriptive practice only at one Hospital.
7.       Removes distance limitations for physician supervision.
8.       Removes the percentage of charts that a physician must review and co-sign.
9.       Improves PA Board collaboration with the Medical Board and Nursing Board.
10.   Removes requirements for a percentage of hours of operation that a physician must be present at a practice.
 
The bill has new language regarding quality and patient safety that are NOT new to PAs and are already part of our everyday practice. These include:
 
1.       Regular communication between physicians, APNs and PAs.
2.       Prescriptive Practice Agreements that list the parameters of APN and PA prescriptive authority.
3.       Quality Assurance processes that allow the physician, APN and PA to determine: if chart review is needed; what processes are used to implement improvement in patient care; how emergencies are handled; the general process for referrals; and, indicating alternate supervising physicians in the event the primary supervising physician is unavailable.
4.       Regular face-to-face meetings between physicians, APNs and PAs that take place at least monthly to discuss patient care and practice issues.
 
TAPA is committed to the continuous improvement for PA practice in Texas. The political process can be challenging and require small steps over many years to reach our goal. You will be hearing more information about these and other legislative issues throughout the 83rd Legislative Session.
 
Rest assured that TAPA will never stop fighting for PAs.
 
 
Attached Press Release from Senator Jane Nelson
9/21/12 Letter from TAPA Legislative Affairs Chair.  For full letter please click here.   

May 15, 2012

Honorable Lois Kolkhorst
Chair, House Public Health Committee

Dear Madam Chair,

The following is my testimony for the House Public Health Committee hearing on Tuesday, May 15th on behalf of the Texas Academy of Physician Assistants.

Thank you for the invitation to appear before the House Public Health Committee on Interim Charge #1.

Sincerely,
 
Todd Pickard, MMSc, PA-C
Chair, Legislative Affairs Committee
6/20/12

Legislative Affairs Committee Update
Todd Pickard, PA-C

The LAC has been hard at work for Texas PAs. On May 15, 2012 TAPA provided testimony at a Texas House of Representatives Public Health Committee. At the end of the last legislative session the Speaker of the House charged the Public Health Committee to look at the Texas health care workforce and how the expanded use of non-physicians can provide answers to the problems in access to care. Todd Pickard spoke on a panel with Nurse Practitioners to describe the PA profession, training, PA schools in Texas and to advocate for reduced bureaucratic restrictions from the TMB on Physician-PA teams. The PA testimony was very positively received and has broad support from our physician colleagues. Representative Garnet Coleman was very receptive and thanked TAPA for its testimony stating "I really learned a lot today, great testimony”. You can read the full testimony in the LAC section of the TAPA website.

The LAC-TMA taskforce continues to work with TMA to discuss the Physician-PA team and how it can be improved through legislative efforts to reduce TMB restrictions on supervision, delegation, physician geographic restrictions at alternate sites and chart review. Karrie Crosby, Lauren Dobbs, Melinda Moore and Todd Pickard staffed a TAPA booth at the TexMed Conference in Dallas on May 19-20, 2012. Many physicians stopped by the booth to ask about hiring PAs and even how they can get their children into PA school. The LAC-TMA taskforce also had a very productive meeting with the TMA Legislative Council leadership to review the TAPA legislative agenda. They expressed strong support for all of our agenda items and plan to work with TAPA to begin crafting bills for the next legislative session.

If you have an interest in the legislative process or helping to advocate for real change for the PA profession in Texas, please volunteer to join the LAC. Submit your interest through the TAPA website today!
4/17/12

Jointly Owned Entities:Physicians/Physician Assistants
Texas Medical Board
HB 2098, enacted by the 82nd Legislature, allows entities to be jointly owned by physicians and physician assistants subject to certain limitations, including percent of ownership by physician assistants. There are annual reporting requirements for physician and physician assistant owners. The full text of HB 2098 can be found here:

http://www.capitol.state.tx.us/BillLookup/Text.aspx?LegSess=82R&Bill=HB2098.

The new law applies to jointly owned entities formed on or after June 17, 2011. Highlights include:

    the organizers must be physicians and a physician or physicians must control and manage the entity
    for corporations, the professional services offered by the entity must consist of one or more of the following:
        carrying out research in the public interest in medical science, medical economics, public health, sociology, or a related field;
        supporting medical education in medical schools through grants or scholarships;
        developing the capabilities of individuals or institutions studying, teaching, or practicing medicine or acting as a physician assistant;
        delivering health care to the public; or
        instructing the public regarding medical science, public health, hygiene, or a related matter
    for corporations, professional associations or professional limited liability companies, physician assistants cannot be officers
    for partnerships, physician assistants cannot be a general partner nor can any physician assistants participate in the management of the partnership
    a physician assistant or combination of physician assistants can have no more than a minority ownership interest
    the ownership interest of an individual physician assistant cannot not equal or exceed the ownership interest of any individual physician owner
    a physician assistant or combination of physician assistants cannot interfere with the practice of medicine by a physician owner or the supervision of physician assistants by a physician owner
    a physician cannot contract with, or be employed by, a physician assistant as a supervising physician
    a physician assistant cannot contract with or employ a physician to be his/her supervising physician
    a physician assistant cannot contract with or employ a physician to supervise another physician in the entity who, in turn, supervises the physician assistant
    nothing in statute may be construed to allow the practice of medicine by someone not licensed as a physician, or to allow a person not licensed as a physician to direct the activities of a physician in the practice of medicine

Applicability:

    The restrictions on ownership interests apply to entities formed on or after June 17, 2011.
    Entities formed before June 17, 2011 are governed by the law in effect at the time the interest was acquired.
    Entities formed prior to June 17, 2011 that operate under the former law become subject to the new law (Tex. Occ. Code, Sec. 162.053 and Sec. 204.209) when: 1) the ownership interests of an entity change; or, 2) an entity contracts with a new supervising physician to provide services.

Summary of Legislation and Requirements

Reporting forms:
          For entities formed before June 17, 2011, fill out the Annual Reporting packet — Before June 17, 2011
          For entities formed on or after June 17, 2011, fill out the Annual Reporting packet — On or After June 17, 2011
 
Frequently asked Questions:
 
Who has to report?
All entities in which a physician assistant has an ownership interest, in which the physician assistant performs a professional service that falls within the scope of physician assistant practice, must register annually, regardless of percent of ownership or when they were formed.
 
When is the annual reporting due?
The annual reporting for physician assistant or jointly owned entities is April 30th of each year.
 
Is there a fee for reporting?
For entities formed on or after June 17, 2011 there is a reporting fee of $18.00. There is no reporting fee for entities formed before June 17, 2011.
 
Do I have to report even if my business was formed prior to the implementation of this statute?
Yes. All entities in which a physician assistant has an ownership interest, in which the physician assistant performs a professional service that falls within the scope of physician assistant practice, must register annually, regardless of percent of ownership or when they were formed.

I am a physician assistant. If my business was formed before June 17, 2011, then I am not subject to the restrictions on ownership interests, correct?
Correct. However, a physician assistant owned entity or physician/physician assistant jointly owned entity will become subject to the new law (Tex. Occ. Code, Sec. 162.053 and Sec. 204.209) when:
     1) the ownership interests of the entity change; or,

     2) an entity contracts with a new supervising physician to provide services.

    Ownership interests change when any owner is dropped or owner(s) are added. Changes in ownership in an entity formed prior to June 17, 2011 subject the entity to the new law.
    An entity is defined to include both owners and agents of the entity. Therefore an individual physician assistant owner contracting with a new supervising physician constitutes a change in an entity formed prior to June 17, 2011 that subject the entity to the new law.

How does HB 2098 affect my pain management clinic ownership?
HB 2098 has no effect on the requirement that pain management clinics be owned by physicians. Tex. Occ. Code, Sec. 167.102(a), requires that a pain management clinic be owned and operated by physicians practicing in Texas under an unrestricted license. An ownership interest by anyone other than a physician is not allowed.

Note: The TMB cannot give legal advice. Please consult an attorney if you have questions regarding whether or not your entity is required to report. However, the owners of entities that have not been properly reported can be investigated.
3/28/12

TAPA Legislative Affairs Committee Updates
Todd Pickard, MMSc, PA-C
Chair, LAC
 
The LAC has been working diligently to represent PAs and improve PA practice in Texas. With the efforts of this hardworking group of your colleagues we have been able to move the profession forward in some important ways.
 
A Federal Task force has been established to represent Texas PAs at the AAPA Capitol Connections in March. We will have congressional visits with Texas Representatives and Senators to advocate for Texas PAs. Members include Todd Pickard, Karrie Crosby, Lauren Dobbs, Melinda Moore and Sandra Guerra .
 
A Texas Medical Association Task force has been established to continue our ongoing relationship with the TMA Legislative Council. This relationship has been developed over the past three years and is crucial to ensuring TMA support for TAPA legislative initiatives. Additionally regular meetings with the TMA foster a close working relationship and frequent exchanges of ideas with our physician colleagues. Members include: Todd Pickard, Karrie Crosby and Melinda Moore. The first meeting was held on January 28, 2012 and was very productive. At this meeting we worked with TMA to review a presentation and printed guide: Incorporating Non-physician providers into your practice that was created by the TMA practice management consultant group. There were some minor errors and opportunities to improve the overall tone of the presentation. The feedback was received very positively and the presentation and guideline was revised to incorporate TAPA ideas.
 
A Survey Monkey was sent to TAPA membership for input on the creation of a legislative agenda, membership needs regarding education on legislative issues, feedback from our members regarding issues that impact PA practice in Texas. Some of the key responses include:
 
•           Top 3 things members want to know more about
–        Reimbursement
–        Physician Supervision Rules
–        PA Scope of Practice
•           92% want legislative and regulatory CME topics at conferences
•           Top 3 Issues that impact practice
–        Lack of Schedule II Delegation (23%)
–        Inability to order Home Health (15%)
–        Difficulty with Reimbursement Rules/Limits (14%)
 
The LAC proposed a Legislative Agenda to the TAPA BOD for the 83rd Texas Legislature based on the feedback from the membership survey and conversations with the TMA. Many of these concepts are included in the AAPA elements of the ideal PA Practice Act. These items include: determination of PA supervision limits at the practice site, determination of onsite requirements for physicians to be determined at the practice site, determination of chart review and co-signature by physicians to be determined at the practice site, and the ability of physicians to delegate Schedule II medications. We are committed to improving access to care for our patients by decreasing regulatory burdens on Physician – PA teams that distract us from our mission of providing outstanding health care.
2/28/11 Another successful PA Day at the Texas Capitol!

Monday, February 28, 2011 over 60 PAs converged on the Capitol to meet with Texas lawmakers and educate them on the PA profession and PA issues.  In the majority of the meetings the PAs were able to have face to face meetings with the actual legislator.  It was a very successful day.