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

2. Who Am I?

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

5. First, let’s understand the context……

6. Trending Issues: Opioid Epidemic

7. Trending Issues: Veteran Health

8. Trending Issues: Mental Health

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

10. 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.

11. 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

12. 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

13. 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

14. 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

16. 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

17. 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

18. 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.

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

20. 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

21. TNP’s Work: Insurance Issue

22. 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 that will propose 4 percent cuts from levels for many state services.

23. 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.

24. TNP’s Legislative Agenda

25. 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.

26. 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.

27. 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.

28. 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

29. Political Environment: House
House Public Health Committee

30. Who Supports Full Practice?

31. 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.

32. 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.

33. 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.

34. Going forward: What You can do

35. 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

36. So Before you do this…

37. Conclusion