Texans for Healthcare Access

Allow Advanced Practice Registered Nurses to care for Texans.

 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.

May 24, 2019

Texans for Healthcare Access today applauded Texas lawmakers for passing HB 278 by Rep. Tom Oliverson, MD, which allows nurse practitioners and their delegating physician to use technology for required monthly meetings, removing an outdated mandate that they meet in pe...

May 17, 2019

Our ongoing efforts to free nurse practitioners from the delegation agreement mandate has passed a new milestone. For the first time since we have been fighting this antiquated requirement, our cause was heard before the Senate. 

S.B. 2438, by Senator José Rodríguez of...

May 1, 2019

This week, Jessica Boston of the Texas Association of Business, one of the key members of the Coalition for Healthcare Access, was featured in the The Marshall News Messengers in an Oped on how outdated regulations of advanced practice registered nurses (APRNs) are har...

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