Update on Radiology Rules
Dear TAPA Colleagues,
The TAPA Board has learned that the radiology rule has been revisited by the Texas Medical Board. There was a stakeholder meeting held in Austin recently and the overwhelming feedback provided was that a rule like this is both unnecessary and would have a negative impact on the practice of any PA who uses radiological imaging in their practice.
In summary, the proposed rule 193.21 states that a physician may delegate performance of radiological procedures to properly trained PAs and APRNs acting under adequate physician supervision. It specifically states we may “do preliminary reading and interpretation of the radiological studies and render a preliminary diagnosis and course of treatment based on the radiological studies.” The rule further specifies that the “delegating physician’s approval or changes must be documented in the medical record within a reasonable time following the action taken by a PA or APRN.” This would require ALL charts to be cosigned by a physician if a radiological study was ordered by a PA or APRN.
The Texas Medical Board will be meeting on October 18th to discuss the rule. This is not a final vote and the rule will not go into effect after the meeting on the 18th. This will be a vote to publish for public comment. The TAPA Board is requesting that any PA who is able to attend this meeting and make a statement regarding this rule will do so. Also, if you will engage the physicians in your group to speak out regarding the impact of this rule it will help the TMB to understand the widespread potential significant and negative impacts this rule would have on medical practices across the state.
We believe that current laws and rules provide for the delegation of what the TMB is trying to restrict. There is no need or basis for restricting our practice in this manner. The meeting details can be found below. Please attend if you are able and encourage your physician colleagues to submit statements that speak to the negative impact of such a rule.
: October 18, 2019
: 333 Guadalupe, Austin, TX 78701
Time and Agenda
: TBD http://www.tmb.state.tx.us/page/medical-board-calendar
TAPA Board of Directors
CMS Releases Proposed Rule that Would Improve PA Practice and Increase Patient Access to Care - TAPA Needs You!
On July 29 the Centers for Medicare and Medicaid Services (CMS) issued the proposed Physician Fee Schedule for 2020. This proposed rule
(pages 65-66) contains important changes to the federal Medicare program which, if finalized, would substantially benefit PAs and the patients they serve beginning January 1, 2020.
The most significant proposed change for PAs is language that would modify Medicare’s existing physician supervision requirement to defer to state law regarding how PAs practice with physicians and other members of the healthcare team.
CMS has the ability to make changes to Medicare policy as it relates to the practice relationship between PAs and physicians, but changes made by CMS will not override individual state law and how those laws define the PA-physician relationship. TAPA is committed to promoting legislation that reduces burdensome regulatory rules so that the Texas PA-Physician teams can determine scope, delegation, collaboration and other operational aspects at the practice level.
TAPA encourages you to send your comments to CMS (see sample letter
) asking the agency to finalize its proposal to modify Medicare’s PA supervision requirements and defer to PA state law to determine how PAs practice.
Comments on the proposed Fee Schedule rule are due to CMS no later than September 27.
A CMS fact sheet on the proposed rule’s changes can be found here
How to submit comments – due on September 27, 2019
: You may submit electronic comments on this regulation to http://www.regulations.gov
. Follow the ‘‘Submit a comment’’ instructions.
Official document click here
Physician Assistants: PArtners in Healthcare, PArt of the Solution
PAs work with
physicians and work for
We are not mid-level providers, we are not APPs, we are not NPPs. By legal definition, we are Physician Assistants (PAs).
To deliver on our professional oath and duty to care for patients, it is essential we collaborate with rather than divide or demean other members of the healthcare team. PAs are committed to teamwork and collaboration; together, with our physician colleagues, we provide the highest quality care.
All PAs are trained in the medical model. The ARC-PA sets the rigorous standards for PA education and has since 1971 when it was tied to the American Medical Association. This close relationship empowers PAs to lead, educate, and collaborate with every member of the healthcare team, especially physicians.
For 50+ years and in every field of medicine, PAs have maintained a prominent role in healthcare systems and provide comprehensive, quality care of patients. The proven success of the PA-Physician relationship depends on our continued collaboration.
The Texas Academy of Physician Assistants (TAPA) always has and always will legislatively support rules and regulations supporting quality and affordable care for the patients of Texas. TAPA remains willing to work with any group with this same patient centered goal. TAPA favors a legislative foundation that reduces regulatory burdens on the physician and PA team by allowing decisions to be made by the physician and PA at the practice site.
PAs play a critical role in the efficiency, accessibility, affordability and quality of medical care. PAs are PArtners with our physician colleagues and PArt of the solution for healthcare in Texas.
Eric P. Martinez, PA-C
President, Texas Academy of Physician Assistants
We have learned that the Texas Medical Board will be postponing the adoption of rule 193.21 until at least the late Spring or early Summer.
This rule would have removed the ability for a physician to delegate the reading, interpretation and diagnosis of medical conditions based on radiologic studies- thereby making a significantly negative impact on the practice of PAs across the state.
There will be a stakeholder meeting later this Spring regarding this rule, and you can be assured that TAPA will be present to make sure PA practice is protected.
Thank you to everyone who has contacted the Texas Medical Board about this rule so far! You can continue to contact them at the address they have provided- firstname.lastname@example.org.
We’ll continue to monitor this situation closely, and will provide more information as it becomes available.
Letter from TAPA to the Texas Medical Board in regards to proposed rules.
The Texas Academy of Physician Assistants (TAPA) is extremely concerned about the proposed rule regarding the reading and interpreting of radiologic studies, as outlined in TAC 193.21(d), on page 403 of the Texas Register published on January 25, 2019.
It is unfortunate that TAPA, an important stakeholder, was not included in this process as we were for the input regarding the proposed rules on the performance of radiologic procedures under TAC 185.32. TAPA collaborated with the Texas PA Board and the Texas Medical Board on language that maintains delegation at the practice site.
TAPA represents close to 10,000 practicing Physician Assistants in the state of Texas. There is zero evidence that the “reading and interpreting of radiological studies” and then “rendering a diagnosis based on the radiological studies” by a physician assistant who is acting in accordance with a practice agreement with a physician is in any way harmful to patients. In fact, thousands of physician assistants in Texas daily order radiologic studies, interpret these studies, render a diagnosis and then a proper treatment for patients, in accordance with the practice agreement with a physician.
Section 204.202 of the Physician Assistant Practice Act clearly outlines the scope of practice of physician assistants in Texas. In this statute, it does not restrict the ordering, reading, interpreting or rendering a diagnosis based upon radiologic studies.
Section 204.204 of the Physician Assistant Practice Act also clearly outlines the supervision requirements for a physician assistant by a physician. This statute states that “the supervision does not require the constant physical presence of the supervising physician where physician assistant services are being performed, but, if a supervising physician is not present, the supervising physician and the physician assistant must be, or must be able to easily be, in contact with one another by radio, telephone, or another telecommunication device”.
In accordance with these statutes, physician assistants frequently work in a clinic or hospital setting autonomously where they must be able to care for patients by ordering and interpreting diagnostic tests and then treat a patient, including radiologic studies. Restricting a physician’s ability to delegate this to the PA will cause a severe disruption in patient care for all Texans who are being cared for by physician assistants. Thus, will lead to decreased utilization of physician assistants by physicians and healthcare entities. This is a step backwards in the physician-PA partnership, especially as physician assistants have safely cared for millions of Texans based upon the ordering, interpreting and rendering diagnoses and treatments purely from radiologic studies for over 50 years.
The language in this proposed rule is unnecessarily stark and restrictive; it will endanger patients. Imposing arbitrary and punitive regulatory restrictions on the physicians who supervise PAs and at the same time restricting the PA role on the health care team will disrupt the lives of thousands of the very patients we all seek to serve.
Finally, the use of the term “mid-level provider” in the proposed rule is not defined in statute and does not have a recognized legal definition in Texas. This term does not differentiate between physician assistants and advanced practice registered nurses. TAPA is concerned why this particular wording was chosen, when in all other areas of law and rule the specific professions are expressly defined.
TAPA asks the Texas Medical Board to reject Rule 193.21(d) of the Texas Administrative Code for the sake of all Texas patients and the physician assistants who care for them every day.
Eva J. Montes, MCG, MPAS, PA-C
President, Texas Academy of Physician Assistants
Template for letter to Texas Medical Board.
TAPA is aware of proposed rules by the Texas Medical Board, as published in the Texas Register on January 25, 2019. Please go to http://www.tmb.state.tx.us/page/proposed-rule-changes
then look under Board Rule Changes Proposed (Physician Assistant Board) - January 25, 2019.
In short, Section 193.21(d) states that there are certain acts that cannot be delegated to a "mid-level provider" (their words): The reading and interpreting of radiological studies, and rendering a diagnosis based upon radiological studies". TAPA is very concerned about the implications of this language and the possible detriment to the practice of all Texas PAs and ultimately the patients they care for. PAs have ordered, read, interpreted and rendered treatment to patients based upon radiologic studies for years, in accordance with practice agreements with physicians.
TAPA is currently crafting a response to the Texas Medical Board and will continue to pursue this issue.
The Texas Medical Board is currently soliciting public comment on these proposed rules and have provided an email address for contact. We encourage our membership to express concerns regarding these rules at the following address, as provided by the Texas Medical Board: email@example.com
. You can also send a formal letter to the following address:
Texas Medical Board
ATTN: Rita Chapin
PO Box 2018
Austin, TX 78768-2018
Thank you to members who have contacted us; please know that we are working diligently on this issue and will provide more information as it becomes available.
You can also reach out to TAPA to express concerns here: firstname.lastname@example.org
Welcome Andrade Van de Putte!
TAPA is excited to announce our new lobbying firm Andrade Van de Putte to represent Texas PAs at the Capitol and promote PA legislation!
AVDP brings years of legislative experience to the table, and TAPA believes they are well-suited to be our voice at the State Capitol.
AVDP has two lobbyists, both of whom enjoyed long careers in the Texas Legislature: Senator Leticia Van de Putte, and Representative Jim Keffer
Leticia Van de Putte
Leticia Van de Putte, a practicing pharmacist since 1980, served in the Texas Legislature for over two decades representing a large portion of San Antonio and Bexar County. She has been recognized and honored with over two hundred awards and citations for her work on behalf of small business, veterans, families, quality education, healthcare and economic development, such as Community Advocate of the Year Award, Fighter for Free Enterprise Award, Fearless Trailblazer Award, MALDEF Lifetime Achievement Award, the Edward R. Roybal Award by the National Association of Latino Elected and Appointed Officials, and the Vietnam Veterans of America Texas State Council’s Legislator of the Year Award.
Senator Van de Putte was named by Texas Monthly Magazine as one of the “Top Ten Legislators” and is the subject of a book, Latina Legislator: Leticia Van de Putte and the Road to Leadership by Dr. Sharon Navarro.
Nationally, Leticia has held numerous important positions on Boards, comprising the Texas Pharmacy Association, Families USA, Milbank Memorial Fund, The National Assessment Governing Board; commissions such as The National Center on Addiction and Substance Abuse Advisory Commission, and Foundations like the National Conference of State Legislatures Foundation, and American Legacy Foundation. She is in demand as a dynamic and inspiring speaker. She is especially recognized for her work battling Human Trafficking.
Chairman Jim Keffer
James “Jim” Keffer, served in the Texas Legislature for 20 years representing House District 60. Throughout his tenure in the Texas House of Representatives, he served as Chairman of various House committees including: Natural Resources, Energy Resources, Ways and Means, Economic Development, and the Select Committee on Property Tax Relief.
Prior to running for the Texas Legislature, Keffer served as Republican County Chairman for Eastland County. In 1997, he became the first Republican to ever represent District 60, which encompasses Brown, Callahan, Coleman, Eastland, Hood, Palo Pinto, Shackelford, and Stephens Counties.
Representative Keffer has been recognized with honored with numerous awards and citations for his workings, and was also named by Texas Monthly Magazine as one of the “Top Ten Legislators.”
He is president of EBAA Iron Sales, Inc., an iron foundry with locations in Eastland and Albany, Texas, and is a graduate of Texas Tech University. He and Leslie, his wife of 40 years, have three grown sons, a daughter-in-law, and two grandchildren.
Senator Van de Putte will be at the TAPA Annual Conference at the Westin Memorial City in Houston on February 9th. She will be our guest speaker at the awards luncheon. Please make plans to join us, and help us welcome Andrade Van de Putte!
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):
- ISC hearings held by the Texas PA Board requires a PA board member to be present at the hearing
- Texas PA Board may go into Executive Session for disciplinary or licensure matters regarding specific licensees to protect the confidentiality of the licensee
- Removing the requirement that PA applicants be of “Good Moral Character”
- 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
- Allows the PA board to deny renewal applications
- Created a training manual for all PA board members involving the scope of, and limitations on, the board’s rule making authority
- 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
- 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
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.
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 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 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 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.
- Volunteerism for PAs
- 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:
- Simplifying QA Meetings for Prescription Delegation
- Whistleblower Protection for PAs
- 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!
- 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.
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.
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.
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.
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
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
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
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 email@example.com with any questions or concerns.
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
- 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
- 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:
-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!
-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.