| TO: | Honorable Lois W. Kolkhorst, Chair, House Committee on Public Health |
| FROM: | John S O'Brien, Director, Legislative Budget Board |
| IN RE: | HB915 by Christian (Relating to the authority of advanced practice registered nurses to make medical diagnoses and to prescribe and order prescription drugs and devices.), As Introduced |
| Fiscal Year | Probable Net Positive/(Negative) Impact to General Revenue Related Funds |
|---|---|
| 2012 | $459,187 |
| 2013 | $459,187 |
| 2014 | $459,187 |
| 2015 | $459,187 |
| 2016 | $459,187 |
| Fiscal Year | Probable Revenue Gain from General Revenue Fund 1 |
Probable Savings/(Cost) from General Revenue Fund 1 |
Probable Savings/(Cost) from State Highway Fund 6 |
Probable Savings/(Cost) from Oper & Chauffeurs Lic Ac 99 |
|---|---|---|---|---|
| 2012 | $550,689 | ($91,502) | ($115,941) | ($133,485) |
| 2013 | $548,689 | ($89,502) | ($115,941) | ($117,481) |
| 2014 | $555,082 | ($95,895) | ($18,441) | ($117,481) |
| 2015 | $555,082 | ($95,895) | ($18,441) | ($120,187) |
| 2016 | $562,475 | ($103,288) | ($18,441) | ($117,481) |
| Fiscal Year | Change in Number of State Employees from FY 2011 |
|---|---|
| 2012 | 3.3 |
| 2013 | 3.3 |
| 2014 | 3.3 |
| 2015 | 3.3 |
| 2016 | 3.3 |
This bill would implement recommendations in the report "Increase Access to Primary Care Services by Allowing Advanced Practice Registered Nurses to Prescribe" in the Legislative Budget Board's Government Effectiveness and Efficiency Report, submitted to the Eighty-second Texas Legislature, 2011.
The bill would establish a tiered prescriptive authority for advanced practice nurses. Under the bill, an Advanced Practice Registered Nurse (APRN) would complete 3,600 hours of practice with delegated prescriptive authority and then be able to apply to the Board of Nursing for an prescriptive authority that did not require physician delegation. Thereafter, the APRN would function as an autonomous practitioner licensed by the Board of Nursing to provide care in a defined roles and for specific populations.
Currently, APRNs are authorized to prescribe Schedule III, IV, and V drugs. The changes proposed in the bill would authorize an APRN to prescribe a Schedule II drug (in accordance with their defined scope of practice).
The bill would take effect September 1, 2011.
The Texas Board of Nursing assumes that overseeing the prescriptive authority process would require one new FTE at a cost of $180,000 of General Revenue Funds in the 2012-13 biennium. The bill allows the Board to increase APRN license fees to cover the cost of the FTE, and this revenue would cover the cost of administering the program.
Under current law, APRNs have authority to prescribe drugs in Schedules III, IV, and V. This bill would give some APRNs authority to prescribe Schedule II drugs. The department of Public Safety (DPS) assumes that it would process approximately 2,177 new Controlled Substances Registrations each year of the biennium. Gains to the General Revenue Fund would come from Cntrolled Substances Registration fees and from the sale of Schedule II prescription forms from DPS.
DPS estimates that processing additional Schedule II registrations and handling prescription pad requests would require an increase of 2.3 FTEs. Costs related to regulartory functions are paid out of Fund 99.
None of the health and human services agencies estimate a cost or savings as a result of the bill. However, the department of State Health Services estimates that the bill would free up some psychiatrist time at state hospitals as they would no longer have to supervise APRNs.
| Source Agencies: | 405 Department of Public Safety, 507 Texas Board of Nursing, 529 Health and Human Services Commission, 537 State Health Services, Department of, 539 Aging and Disability Services, Department of
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| LBB Staff: | JOB, CL, JI, BH
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