TNP Policy Presentation & Update: HANP Annual Conference Erin Cusack, Director of Public Affairs, TNP

Who Am I?

Our Agenda TODAY TNP’s Work, Legislative Interim TNP’s 2017 Legislative Agenda

First, let’s understand the context……

Trending Issues: Opioid Epidemic

Trending Issues: Veteran Health

Trending Issues: Mental Health

Trending Issues: Telemedicine Teledoc – a telemedicine company, sued TMB over a rule that requires face-to-face visits with new patients.

Trending Issues: Regulatory reform In North Carolina Dental Board v. FTC, the Supreme Court said that state licensing boards made up of active members of the profession, such as practicing doctors, are not immune from antitrust laws unless they are actively supervised by the state.

What other states are doing WEST VIRGINIA’s GOVERNOR SIGNS HB 4334 – Removes Collaborative Agreement for APRNs PENNSYLVANIA SB 717 Near Miss– Grants Full Practice Authority to APRNs LOUISIANA SB 187, Near Miss – Would have granted Full Practice Authority to APRNs in primary care HPSA’s

TNPs Work: Legislative Interim APRN Alliance Interim Charges: Mental Health, Healthy Aging, Veterans Sunset Review of Texas Board of Nursing Medicaid Insurance Issue for Practice Owners Telemedicine Stakeholder Workgroup Budget Advocacy

TNP’s Work: APRN Alliance APRN Legislative Days (next on on 2/10!) Coordinated Grassroots & Legislative Outreach Joint Recommendations for BON Sunset Fiscal Impact Study Building Business Coalition for Full practice Campaign

TNP’s Work: Interim Charges “Our Sailors and Marines are not concerned with independent versus delegated practice rules. They are only concerned with receiving quality, compassionate care.” -Michael Watson, FNP, U.S. Navy Veteran

TNP’s Work: Interim Charges Speaker Joe Straus: House Select Committee on Mental Health Sen. Nelson: Chairing Senate Behavioral Health Coordinating Council Coordinating Council to create a behavioral health statewide strategic plan

TNP’s Work: Sunset Cut the Red Tape TNP issued joint recommendations with APRN Alliance, met with Sunset Commission, and is testifying on Nov. 10. Key message: Eliminate dual regulation of APRNs. Cut the Red Tape

TNP’s Work: Sunset Streamline Regulation and Place APRNs Under the Exclusive Licensure Authority of the Texas Board of Nursing. Fully Adopt all Elements of the APRN Consensus Model, Including Granting Full Practice Authority for APRNs. Support the Enhanced Nurse Licensure & APRN Compact. Ensure Fair and Impartial Disciplinary Proceedings for Texas APRNs. Investigate the Impact of BON Regulations on APRNs Working in the VHA.

BON Staff Report, And I Quote… “Texas Board of Nursing is a shining example of how a health licensing agency should be run.”

What’s Not in Sunset Report NO APRN ISSUES, AND DOES NOT ADDRESS: DUAL regulation of APRNs under BON & TMB Discussion of APRN Compact Need for APRN peer review and investigators in disciplinary process

TNP’s Work: Insurance Issue

TNP’s Work: Budget In a letter released by “The Big Three” last week, Gov. Greg Abbott, Lt. Gov. Dan Patrick and Speaker Joe Straus directed state agencies to craft budgets for 2018-2019 that will propose 4 percent cuts from 2016-2017 levels for many state services.

TNP’s Work: Telemedicine Led by Texas E-health Alliance, Texas Medical Association, and Texas Association of Family Physicians, the goal is to revamp the regulatory framework for telemedicine in Texas.

TNP’s Legislative Agenda

Issue 1: Full Practice Authority Remove the delegation agreement between APRNs and physicians, and place APRNs under the exclusive licensure and regulatory authority of the Texas Board of Nursing.

Legislative Environment for Full Practice Bill Budget: With a tough budget year, FPA could bring cost savings to the state. Regulatory Reform: Spotlight on regulatory issues this year due to Sunset. In September, the FTC sided with Teledoc in its case against TMB. Earlier in the year, the Supreme Court also ruled against the NC Dental Board for antitrust activity. Health Care Access: FPA will allow us to fill the gaps in women's health, primary healthcare, and mental health. These are all items the legislature recognizes are absolutely critical.

Political environment The 2017 Session will likely see at least 25 new members and 3 new Senators. House: The former Chair and Vice Chair of the House Public Health Committee both retired, meaning we will have new leadership. With so many new House members, committee membership will also change significantly. Senate: The Health & Human Services Chairs are the same.

Political environment: Senate Texas Senate HHS Sen. Campbell Sen. Estes Sen. Perry Sen. Schwertner Sen. Kolkhorst Sen. Zaffirini Sen. Rodriguez Sen. Van Taylor Sen. Uresti

Political Environment: House House Public Health Committee

Who Supports Full Practice?

Issue 2: Insurance and Medicaid Parity The bill will achieve two things: Allow APRNs to contract directly with HMOs/PPOs. Remove the requirement that an APRN must be in the same insurance network as his/her delegating physician.

Issue 3: Discharge Prescriptive Authority Clarify statute and close a gap in past legislation, SB 406, so that facility-based APRNs can write for Schedule II prescriptions in community based pharmacies and not just in the hospital.

Issue 4: NP Signature Recognition Give APRNs the authority to sign medical forms, such as birth and death certificates, student physicals, worker’s compensation forms, jury duty exemption, handicap placards, etc.

Going forward: What You can do

Going forward: What You can do Join TNP!!!!! Visit Legislators in HOME Districts Help us raise awareness about NP issues during NP Week, 11/13-19 (e.g. Letters to the Editor) Stay tuned to our Policy & PAC updates Save the Date: APRN Legislative Day 2/10/17

So Before you do this…

Conclusion