Texans for Healthcare Access

Allow Advanced Practice Registered Nurses to care for Texans.

Desk with Stethoscope
 The Issue

Advanced Practice Registered Nurses (APRNs) are masters or doctorate level health care providers who are subject to specific occupational licensing barriers which limit access to care for patients and drive up the cost of health care in Texas.


Texas has a critical shortage of primary care providers, with 432 Primary Care Health Professional Shortage Areas (HPSAs) in urban, suburban, and rural areas across the state.  APRNs are quality, cost-effective providers who can help address this shortage if Texas passes legislation to remove barriers standing in the way of APRNs and their patients.

The Problem

To practice in Texas, APRNs are required to enter into a contract, or what’s called a “delegation agreement,” with a physician. In many cases, the delegation is simply a physician's signature that says the APRN can practice. Some APRNs actually have to pay thousands of dollars a year for this agreement.


More states are opting to cut the red tape, eliminate delegation agreements, and give patients full and direct access to the quality care APRNs provide. Currently 22 states, the District of Columbia, the Department of Defense, and the U.S. Department of Veteran Affairs do not require these agreements. Meanwhile, lawmakers in New Mexico and Arizona are recruiting Texas-trained APRNs to their states, where APRNs face fewer regulatory burdens and lower practice costs.

The Solution

The Coalition for Health Care Access urges all Texas legislators to join us in supporting legislation, which will keep more APRNs in Texas and remove the requirement for unnecessary, expensive, and many times unfair pay-to-play delegation agreements between APRNs and physicians. This is zero-risk, zero-cost solution that will put patients first, and ensure that more Texans can access the vital care they need.

Recent Posts



Advocates Praise Bill to make Primary Health Care Available to More Texans

(AUSTIN) – Advocates representing consumers, business, and a broad range of health care stakeholders are testifying in Austin today in support of expanding access to primary health care for Texans. House Bill 1415 by Representative Stephanie Klick would remove remaining barriers to full practice by registered nurses with advanced degrees. "Updating the state's antiquated practice laws will be a powerful tool to reduce delays in receiving basic health care and lack of access to reliable and affordable care Texans experience today," said Anne Dunkelberg, associate director of the Center for Public Policy Priorities. "Nationwide, 22 states and the District of Columbia allow Advance Practice Re

Psych APRNs: Another Reason Why We Need HB 1415/SB 681

Jessica Wilson is a Psychiatric Mental Health Nurse Practitioner (PMHNP) and the owner of a psychiatric practice in Texas. Jessica supports HB 1415/ SB 681 on behalf of many thousands of patients who are well because of the care PMHNPs provide. In her community, Jessica provides mental health care to over 900 psychiatric patients. Her background includes military, civilian, and forensic psychiatry. Hospitals, psychiatrists, and primary care providers often refer patients who need mental health services to Jessica. Jessica’s practice serves the disabled and severely mentally ill who are often reliant on Medicaid and have few psychiatrists to choose from in Texas. If it weren’t for her practic

Texas Laws Forcing Psych NPs Out of State

Of the 254 counties in Texas, 185 do not have a single practicing psychiatrist. Texas is 47th in the nation in mental health care access and coverage. Much like primary care advanced practice registered nurses (APRNs), psychiatric APRNs are often called upon to meet the gap left in rural and underserved areas throughout Texas. HB 1415/SB 681, introduced by Texas Representative Klick and Senator Hancock, would allow APRNs to practice to the full extent of their training and education—without being held to outdated, costly, and oftentimes unfair delegation agreements with physicians. Kate (who asked to remain anonymous for this interview to protect her privacy) is a board-certified Family Psyc


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