Coalition for Nurses in Advanced Practice


CNAP Specializes in Legislation & Regulation

Coalition for Nurses in Advanced Practice serves to be an advocate for all advance practice registered nurses and actively monitors legislative and regulatory issues within Texas. CNAP also monitors the work of Interim legislative committees and arranges testimony on APRN issues whenever appropriate.

The learn the legislative process for a bill click here.
For a diagram of the legislative process click here.


As the 84th Legislative Session approaches, CNAP continues to work on issues that improve the delivery of health care and practice of advanced practice registered nurses. 
The next legislative session begins Tuesday, January 15, 2015.  Pre-filing of bills began on Monday, November 10, 2014.  As of today, some 661 bills have already been filed!  Based on past sessions, that number represents nearly 12% of the total number of bills that will be filed during the 83rd Legislature.
During the last month, CNAP has continued its advocacy on behalf of APRNs, including:
CNAP and other stakeholders have met with the Texas Health and Human Services Commission (HHSC) staff to negotiate improvements to the rules governing Medicaid reimbursement rates to APRNs.  Currently, HHSC is modifying the rules that govern the Medicaid reimbursement rates for treatment provided by APRNs, but billed under a physician's Medicaid number. While the Legislature has mandated a 92% rate of a physician's reimbursement for APRN services, the rules being proposed by HHSC were unsatisfactory.  CNAP has joined with TMA (and their member organizations) in written comments to HHSC opposing the proposed plans and suggesting revisions to try to ensure that APRNs will be able to continue to bill at 100% in as many situations as possible. 
CNAP is in negotiations with the Texas Association of Health Plans (TAHP) to develop a non-legislative option to allow APRNs to practice as in-network providers, when the delegating physician is in another network.  If legislation is required, we are working to get TAHP's support. 
CNAP representatives attended the Texas Statewide Health Coordinating Council(SHCC) meetings in Austin.  The SHCC is a 17-member council, with 13 members appointed by the governor and four ex-officio members representing specified state agencies. The broad purpose of the SHCC is to ensure health care services and facilities are available to all Texans through health planning activities. Based on these planning activities, the SHCC makes recommendations to the governor and the legislature through the Texas State Health Plan (TSHP). The council also provides overall guidance in the development of the TSHP, submission of the plan to the governor, and promoting the implementation of the plan. The plan is due to the governor for adoption by November 1 of each even-numbered year.
The SHCC also published a report in response to HB 1023 (83rd Legislature, 2013) that recommends: "The State of Texas should more extensively incorporate advanced practice nurses and physician assistants into its mental health workforce.  Specifically, the Legislature should alter Texas Administrative Code Title 25 §411.472 to allow qualified advanced practice nurses and physician assistants to conduct initial and follow-up psychiatric evaluations."  The full report can be found at the SHCC website at:

For further information, please contact the CNAP Policy Directors, Ian Randolph(512.632.4833 or or John Hubbard (512.653.6428  Please consider becoming a sustaining member of CNAP or contributing online at:


BON Announces Temporary Permit for APRNs

The Texas Board of Nursing (BON) recently announced a process has been created whereby APRNs who do not have the required 400-hours of practice may obtain a 6-month temporary permit to complete the required practice hours for a fee of $25.00.

This would apply to APRNs who are on inactive status, delinquent, who need to complete a refresher course/extensive orientation, and even to those APRNs who practiced less than 400-hours during the biennium. BON staff have set this process in motion based on the 6-month temporary permit process that is already in place for LVNs and RNs.

The application for the 6-month temporary permit is available on the BON website at the hyperlink provided below:

BON stated that they are hopeful that this temporary permit process will assist APRNs who need to complete supervised practice hours, particularly when they have to go through the credentialing process to do so. Once the permit has been issued, it can be verified on the BON website.

Texas Department of State Health Services

Cyclospora Illnesses in Texas Prompt Investigation

A recent surge in reports of illnesses due to the parasite Cyclospora has prompted the Texas Department of State Health Services to begin an investigation into the infections in hopes of determining a common source. DSHS has received reports of 77 Cyclosporiasis cases from around Texas this year, including 69 in the last month. The department is collaborating with local health departments to gather information and identify the cause.

Last year, Texas had 351 cases, more than any other state. In most previous years, the number of cases reported was in the single or low double digits.

Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with the Cyclospora parasite. The major symptom is watery diarrhea lasting a few days to a few months. Additional symptoms may include loss of appetite, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting and a low fever. Symptoms may come and go multiple times over a period of weeks.

People who think they may have a Cyclospora infection should contact their health care provider. DSHS encourages health care providers to test patients for Cyclospora if they have diarrheal illness lasting more than a few days or diarrhea accompanied by a severe loss of appetite or fatigue. Cases should be reported promptly.

DSHS recommends thoroughly washing fresh produce, but that may not entirely eliminate the risk because Cyclospora can be difficult to wash off. Cooking will kill the parasite.

Although no common exposure source has been identified yet, past outbreaks in the United States have been associated with imported fresh produce, including pre-packaged salad mix, raspberries, basil, snow peas and mesclun greens. A 2013 outbreak in Texas was linked, at least in part, to fresh cilantro from Puebla, Mexico.



Comparison of Texas Prescriptive Authority Law for APRNs before and after November 1, 2013

Lynda Woolbert, MSN, RN, CPNP-PC, FAANP

SB 406 is the new prescriptive authority law governing delegation of prescriptive authority to Advanced Practice Registered Nurses (APRNs) and Physician Assistants in Texas. The law goes into effect on November 1, 2013. Before November 1, 2013, physicians who delegate prescriptive authority and APRNs who have delegated prescriptive authority must practice under the current site-based restrictions.


For a complete comparison and more details click here.

Click here to get the order form for a "Sample” Prescriptive Authority Agreemen


Community Search

Do you have Practice Questions?


If you have a practice question regarding rules and regulations, CNAP is here to assist you with these complex issues.

Click here to complete the submission form.


CNAP Meeting Dates

Sept 14
Oct 17 - Retreat
Nov 9
Dec 14


Newly Updated 9/1/15!

CNAP'S Sample Prescriptive Authority Agreement

This is the second revision of CNAP’s Sample Prescriptive Authority Agreement (PAA) since the Texas nursing and medical boards adopted rules implementing Texas Senate Bill 406 in November 2013. With a table of contents and new checklists, the sample PAA is simple to use. Purchasers may modify and copy the sample PAA (pp. 13-22), checklists, and compliance forms for their own practices. This 43-page document defines terms and explains essential information all APRNs and delegating physicians must know.
To purchase a copy
click here.




Coalition for Nurses in Advanced Practice

8501 N. Mopac Expessway, Ste. 400 * Austin, TX  78759 * 512.663.6629