TO:	Honorable Stephanie Klick, Chair, House Committee on Public Health
FROM:	Jerry McGinty, Director, Legislative Budget Board
IN RE:	HB1524 by Lucio III (Relating to the prescribing and ordering of Schedule II controlled substances by certain advanced practice registered nurses and physician assistants.), As Introduced

General Revenue-Related Funds, Five- Year Impact:

All Funds, Five-Year Impact:

Fiscal Analysis

The bill would amend the Occupations Code as it relates to the ability of physicians to delegate to certain advanced practice registered nurses (APRNs) and physician assistants (PAs) the authority to prescribe or order certain drugs. The bill would expand the list of medications that can be delegated to include Schedule II controlled substances.

Methodology

Based upon analysis of historical data collected following the Drug Enforcement Administration's reclassification of certain schedule substances in 2014, the Texas Medical Board (TMB) and the Board of Nursing (BON) both anticipate that there will be increases in complaints received associated with potential Schedule II prescribing violations involving physician assistants (PAs) and advanced practice registered nurses (APRNs). TMB also anticipates an increase in complaints against physicians for potential delegation violations. 

TMB projects that there will be approximately 30 new complaints against PAs and 20 new complaints against physicians related to potential Schedule II violations each fiscal year, amounting to $120,400 in total potential enforcement costs associated with complaints involving PAs and $115,400 for those involving physicians. Of these 50 new complaints, the agency anticipates 30 to progress from expert review to Informal Settlement Conferences (ISCs) and 4 to progress from ISCs to State Office of Administrative Hearings (SOAH) proceedings. 

The agency reports that prescribing and delegation complaints involve standard of care violations which require expert review. Based upon the estimated increase in cases, expert reviewer remuneration expenses could total $85,000 yearly. Current statute requires two TMB board members to participate in the next step, ISC proceedings. Board members are located across the state and travel to execute these duties, generating expenses which the agency is obligated to cover. TMB approximates the average expenses for both board members combined for necessary ISC days to be $7,200 per fiscal year. Further expenses associated with State Office of Administrative Hearings (SOAH) proceedings, including supplemental expert services, the collection of depositions, and the creation of required transcripts, are estimated by TMB to cost $143,600 each fiscal year. 

BON anticipates being able to absorb the costs associated with additional APRN complaints within existing resources given the size of the impacted licensee population. Other agencies affected by provisions of this bill also anticipate being able to absorb associated costs. 

This analysis assumes that the Texas Medical Board would collect sufficient revenue to offset any costs associated with the implementation of the bill.

Local Government Impact

No fiscal implication to units of local government is anticipated.