The Facts

* According to the U.S. Department of Health and Human Services (HHS), 126 of Texas’ 254 counties do not have enough primary care physicians and are designated Health Professional Shortage Areas (HPSA), roughly defined as areas with a doctor-patient ratio of about one per 3,000 residents.

* Texas has 295 Medically Underserved Areas (MUA), more than any other state in the country.

* The U.S. Department of Health and Human Services (HHS) estimates that without expanding Medicaid, as many as 2.8 million Texans could gain coverage in 2014.

* SB 406, designed to expand scope of practice, kept in place numerous state regulations, including a prohibition on NPs collecting reimbursement by Medicaid managed care organizations (MCOs) if the supervising physician does not accept Medicaid or have a contract with the patient’s MCO.

* The utilization of nurses as primary care providers is an emerging trend nationwide. The number of Medicare patients who received primary care from NPs rose 15-fold between 1998 and 2010.

* A survey of 37 articles published between 1990 and 2009 on the quality, safety, and effectiveness of primary care provided by NPs compared to physicians found that outcomes were comparable across all categories.

* Basic health care services provided by NPs in retail clinics have been shown to be associated with lower costs per visit, and eliminating scope of practice restrictions could have a large effect on cost savings that NP-operated clinics are able to achieve.


* To remain competitive with other states and fill persistent gaps in health care delivery, Texas lawmakers should expand scope of practice laws for APRNs—including NPs, certified registered nurse anesthetists, certified nurse midwives, and clinical nurse specialists.

* Texas law should mirror the most liberal scope of practice laws in the country, similar to those in New Mexico, such that APRNs are given prescriptive and diagnostic authority, the ability to operate independent on-site clinics, and serve as primary care providers.

* SB 406 should be revisited and legislation passed to enable NPs to be reimbursed by MCOs regardless of whether the supervising physician is contracted with the MCO.