CNAP Update "How it will affect APN practice"

CNAP Interim Update #1 – Propositions & SB 532 FAQs

Lynda Woolbert, Executive Director

Coalition for Nurses in Advanced Practice

October 26, 2009

November 3rd Ballot Propositions Made Easy

Each of us probably knows the sensation of civic failure as we stand in the voting booth contemplating the meaning of a proposition on the ballot. No need to experience that unpleasant feeling this year. Keep reading to research the propositions in record time and download a perfectly legal cheat sheet.

Early voting for the statewide election on November 3rd continues through Saturday, October 30th. The ballot includes 11 propositions to amend the Texas Constitution.

Access any of these nonpartisan sources of information by clicking on the hyperlinks. The most succinct explanation is on the Secretary of State’s website, with a brief explanatory statement of each proposed constitutional amendment and the wording that appears on the ballot. Reports produced by the House Research Organization (HRO) and the Texas Legislative Council include more background information.

An email is circulating that urges voting against Propositions 2 and 3, claiming they would allow the state to tax residential homeowners and increase property taxes. In fact, this email totally misinterprets the effect of these propositions.

• Proposition 2 and its enabling legislation, HB 3613, would prohibit a primary homestead from being appraised based on commercial property values. This would protect property owners from having the appraised value of their primary home increased dramatically because the “highest and best use” would be as commercial property. Proponents say this would protect property owners. Opponents say this will reduce future tax revenue.

• Proposition 3 would give the state more oversight of appraisal district practices and procedures. Proponents say this will improve consistency of appraisals among districts by requiring local appraisal districts to follow best practices and standard procedures. Opponents say it is unnecessary and can lead to a loss of local control.

In order to make voting as easy as possible, I prepared a one-page abbreviated version of the Secretary of State’s explanations of the proposed constitutional amendments. You can mark FOR or AGAINST beside each proposition and take it into the polling place with you. To access this plain English list of the propositions, CLICK HERE.

The Secretary of State Website has a copy of the sample ballot for the propositions you will encounter in the voting booth and much more information for voters. The sample ballot on your county clerk’s website will also include any local elections that will appear on your ballot.

SB 532: The Facts

Questions I receive indicate that a lot of APNs and delegating physicians are confused about SB 532. They want to know how the new law affects their practices and what they need to do as a result. Here are answers to the five most frequent questions being asked.

1. Where can I find information on SB 532 and how it changes prescriptive authority? Answer: The Texas Medical Board (TMB) has an excellent 2-page summary of the changes resulting from SB 532. You can access that document on TMB’s website. There is also an article on CNAP’s website that summarizes SB 532 and explains the political background. The prescriptive authority information on CNAP’s website is also updated. The TMB proposed amendments to its rules on delegating prescriptive authority to APNs and PAs on October 2, 2009. To read the proposed Medical Board Rules implementing SB 532, Click Here. It is expected that those rules will be adopted in November. The Board of Nursing rule revisions on prescriptive authority will be proposed in November and probably adopted by January. Unfortunately the changes in the Medical Practice Act created by SB 532 have not yet been incorporated into the Medical Practice Act posted on the Internet, so, for now, it is best to refer physicians who want more information to the resources listed above.

2. Physicians who delegate prescriptive authority are being required to register the APNs to whom they delegate. When does that registration start and where and how do they complete the registration? Answer: Physicians will be required to register the name and license number of the APNs and PAs to whom he or she delegates prescriptive authority with the Texas Medical Board (TMB) by February 1, 2010. While the law allows the Texas Medical Board to adopt an online registration system, no money was appropriated for that purpose. Therefore, the TMB will post a registration form on its website. Physicians must download and return the completed registration form to the TMB by fax or mail. It is possible that the form could also be scanned and sent to the medical board electronically, but the TMB has not yet decided if that option will be available.

3. Are physicians who delegate prescriptive authority in a hospital facility-based practice now limited to only delegating to four APNs or PAs? Answer: No, physicians who delegate prescriptive authority in hospital facility-based practices are not, and never have been, limited in the number of APNs to whom they may delegate prescriptive authority in that hospital. Physicians are also not limited in the number of APNs to whom they may delegate prescriptive authority in sites that are designated as medically underserved.

4. Is it true that ANPs in primary practice sites can only see established patients now? Answer: No it is not true. This misinformation is probably based on that fact that SB 532 adds three settings to the primary practice site designation. When a delegating physician spends 50% of the time with the APN in other settings, that physician may also delegate prescriptive authority to that APN in 3 additional settings without fulfilling any additional supervisory requirements. One of those new settings is where the APN sees established patients. If the APN is only seeing established patients, then the physician does not have to be on-site with the APN, review charts or meet any additional supervision requirements in that new setting. While the APN would not be able to see new patients in that new setting, the APN can continue to see new patients in any other primary practice settings or alternate practice sites where that physician delegates prescriptive authority to the APN.

5. What steps do I need to take to implement changes that are permitted by SB 532? Answer: Discuss the changes with your delegating physician. Once you have the physician’s approval, revise your practice agreement protocol to reflect those changes. The delegating physician, any alternate physicians, and you must sign and date the revised protocol. Then adjust your practice accordingly.