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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 practice, patients could literally wait several months for a psychiatric appointment.

Roughly 80% of nurse practitioners like Jessica accept Medicaid and Medicare, while only 41% of Texas physicians accept new Medicaid patients. While nurse practitioners like Jessica are happy to fill the provider gap and serve these patients, the high cost of maintaining a practice like hers can be challenging. APRNs receive lower Medicaid and Medicare reimbursement rates than their physician and psychiatrist colleagues. On top of lower reimbursement rates, PMHNPs in particular often pay hefty amounts for their state-mandated contracts with physicians, or what's called a "delegation agreement." Jessica has paid flat fees or as much as 20% of total gross income for this agreement, which oftentimes amounts to nothing more than a signature on a page.

How can these extra costs and regulations affect the care a patient receives? “If I were to lose a collaborating physician, which has occurred in the past,” says Jessica, “my patients would have absolutely nowhere to receive mental health care. In that case, they are admitted to hospitals, costing millions for inpatient care, if they even seek help.”

Many patients have an established relationship and rapport with Jessica and are not comfortable going to another health care provider or even an emergency room if a mental health crisis strikes. In this case, losing access means compromised safety for the patient and others.

HB 1415/SB 681 will allow APRNs to practice to the full extent of their training and education without incurring additional fees and regulations. PMHNPs are already addressing the psychiatric care gap in Texas. Now it’s time to support their role within the collaborative care model.

As Jessica notes, this bill is important “not only for our communities and our profession, but for every patient in our state who has ever been treated by an advanced practice nurse for health care.”

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