Scope of Practice – 2023 Texas Legislature

Mid-Levels – Regulatory Authority

In an “under-the-radar” scope of practice expansion bill, SB 161 and HB 724 would have prevented state licensing boards from investigating other licensees for scope of practice violations.

The chiropractors previously pushed this legislation to stop the Texas Medical Board from investigating chiropractors for the practice of medicine. The optometrists and a number of mid-level groups jumped on this legislation.

Action: After passing out of the Senate, the bill did not even receive a House committee vote after a committee hearing.

Nurse Practitioners & CRNAs

Independent Practice

After a high level of media attention, the bills that would have granted independent practice to nurse practitioners and CRNAs – HB 4071 and SB 1700 – did not even receive committee hearings in either chamber.

Interstate Compact for APRNs

HB 4404 would have created an interstate compact for APRNs. However, organized medicine expressed concerns that the bill could have allowed APRN licensure to supersede Texas’ APRN independent practice laws.

Action: The bill died in the House committee.


Vaccinations for Younger Children to Age Three

HB 1105 would have allowed pharmacists to order and administer vaccines to younger children to age three.

After finally passing out of the House, the bill stalled in late May after the Senate added amendments related to Covid-19.

Action: The bill did not pass.

Test and Treat

Several bills – HB 2079 and SB 160 – related to pharmacist test and treat for Covid-19, influenza and strep throat experienced almost no movement.

In a twist, the Senate bill would have allowed physician dispensing as a compromise.

Athletic Trainers

The physical therapists turned on the athletic trainers and attempted to stop one of the athletic trainers’ bills in the final days.

Updating Athletic Trainer Definition

HB 2512 was signed into law and modernizes the athletic trainer definition. (2023 vs. 1971, which is when the law was originally set.) “Athletic training” in the context of the new law now means:

[The] form of health care that includes principles and methods for managing and treating athletic injuries for athletic individuals in good general health, rather than the practice of preventing, recognizing, assessing, managing, treating, disposing of, and reconditioning athletic injuries, under the direction of a physician licensed in this state or another qualified, licensed health professional who is authorized to refer for health care services within the scope of the person’s license, and consists of:

(A) managing the risk of an athletic injury or illness;

(B) preventing an athletic injury or illness;

(C) assessing an athletic injury or illness;

(D) providing immediate emergency care;

(E) providing therapeutic intervention for an athletic injury; and

(F) reconditioning an athletic injury or illness.

The Texas Physical Therapy Association testified against the bill, and TPTA’s lobby team attempted to kill the bill in the final days.

Action: Signed into law.

Athletic Trainer Licenses: Language Clean-up

HB 2495 was signed into law and simply cleans up regulatory language to make athletic trainer licensing uniform with processes at the TDLR.

Action: Signed into law.

Physical Therapy

Direct Access

HB 2553 would have pushed the state’s 2019 direct access law from 15 business days to 20 business days for all physical therapists, no matter the level of training.

Action: The bill was defeated on the House floor.


The chiropractors pushed several measures, and more can be found on those bills in other sections of this legislative wrap-up:

  • SB 161, which would prohibit the Texas Medical Board from investigating chiropractors and other mid-level providers for accusations of practicing medicine.
  • The removal of the designated doctor sales tax.
  • An initiative to increased designated doctor payments.
  • An initiative to allow chiropractors to serve as expert witnesses in chiropractic malpractice causation cases.
  • HB 1002, which will add chiropractors to concussion oversight teams.

Any Willing Provider Laws

Mid-level provider are continuing to identify “sneaky” avenues for pushing indirect scope of practice changes.

The optometrists pushed legislation in the form of any willing provider laws, which are defined by ChatGPT as:

Under AWP laws, if a healthcare provider, insurer, or pharmacy meets the requirements set forth by the insurance company or managed care organization, the insurer must include them in their network and allow patients to receive care from those providers. This means that patients can receive covered services from any provider who is willing to accept the insurance company’s terms and conditions, even if they are not part of the insurer’s preferred network.

Some of the optometry bills could have forced health plans to reimburse optometrists and ophthalmologists at the same level, despite the vast differences in training and education. The opthalmologists ultimately cleared up the issues.

Prohibitions Against Certain Managed Care Business Practices for Optometrists

HB 1696 was signed into law and provides protection for optometrists in relation to managed care contracts.

Both the health plans and physician groups opposed the original House version in committee due to “any willing provider” concerns. The original legislation could have been interpreted to mean that health plans must view ophthalmologists and optometrists as equals.

The ophthalmologists were removed from the final product. Vision plans ultimately opposed the final product.