Scope Bills, Budget Gains Mark Start of 2025 Legislative Session

Capping off a robust week of advocacy, the Texas Medical Association has begun its work targeting a pair of scope-of-practice infringement bills before the 2025 Texas Legislature and digging into the Senate’s first take on a proposed state budget.  

TMA also kicked off this year’s debut First Tuesdays at the Capitol event on Feb. 4 as the Texas Legislature begins to appoint key committees that will consider the association’s legislative priorities this session.  

Bills on the move

Among those priorities, medicine has galvanized in opposition to nurses’ routine attempts to expand their scope of practice, this session with Senate Bill 911. The measure would allow nurse practitioners, nurse midwives, and clinical nurse specialists to independently practice and prescribe without physician supervision and delegation after 3,000 hours of clinical experience within a five-year span.  

Similarly, House Bill 1756, while not officially a companion bill to SB 911, offers prescribing powers without a clinical experience requirement to nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists.  

While proponents of the bills claim they’ll help expand health care to rural parts of the state, TMA reified that this is one of several myths the association aims to dispel.   

"Scope of practice is a real problem," Dallas internist Donna Casey, MD, told lawmakers during TMA’s First Tuesdays event. "I have [physician assistants] and nurse practitioners that work under me ...  I look at everything everybody does because I want to catch mistakes when they're made … because they don't have the same depth of knowledge and education [physicians] have."  

TMA Council on Education Chair Robert Emmick, MD, reiterated proven solutions to the state’s workforce woes in his Feb. 5 testimony to the Senate Finance Committee. 

“When you are No. 1 in the nation in population gains, this presents a challenge for keeping up with escalating health care needs,” he said.  

Thanks to the legislature’s ongoing investments in graduate medical education (GME) and other physician pipeline programs, “now we are setting records for new physicians and the rate of physician growth is greater than the rate of population gains,” Dr. Emmick added. “But the work is not done.” 

In order to meet the state’s physician workforce needs, he urged lawmakers to continue to boost funding for Texas Higher Education Coordinating Board programs including the: 

• State Rural Resident Training Program, 

• State Physician Education Loan Repayment Assistance Program, 

• Family Practice Residency Program, and 

• Joint Admission Medical Program. 

Meanwhile, another big set of bills TMA is currently tracking and supporting target prior authorization reform, including:  

• Senate Bill 547, which builds on the landmark 2021 gold carding law by setting up a notification system regarding physicians’ prior authorization exemption status; 

• Senate Bill 177/House Bill 2150, which requires health plans to approve patient care and verify coverage in a timely manner; and  

• House Bill 1818, which requires the Texas Department of Insurance to conduct more frequent health plan reviews for compliance with certain utilization review and preauthorization requirements. 

TMA also aims to get Senate Bill 922/House Bill 1699 across the finish line this session to ensure patients receive serious and sensitive test results from physicians rather than electronic patient portals. Similar measures cleared the legislature last session but fell victim to a last-minute veto of a broader package in which they were included.  

Budget wins, asks

The Senate weighed in first on the budget with Senate Bill 1, garnering early praise from medicine for supporting key areas like women and child health services, including mental health, and women’s preventive health mobile units; tobacco use prevention; and systems to ensure families don’t unnecessarily lose access to Medicaid, nutrition assistance, or other public programs.  

During a Senate Finance Committee Feb. 4 hearing, however, medicine cautioned more work needs to be done to support the state’s public health infrastructure and safety-net programs.         

During testimony on behalf of TMA, the Texas Public Health Coalition, and others, Missouri City pediatrician Janeana White, MD, praised the legislature for funding the Department of State Health Services’ (DSHS’) base budget “to maintain existing core services required to carry out public health activities critical to the state. These essential public health activities protect Texans’ health through effective disease control, prevention, and treatment.” 

Especially given rising costs, however, the member of TMA’s Committee on Infectious Diseases implored, "robust public health infrastructure is an essential component of a strong health care system.” 

Similarly, in testimony on the Health and Human Services Commission 2026-27 budget, Tilden Childs, MD, immediate past chair of TMA’s Council on Legislation, said, “Our organizations are committed to improving the health of all Texans. But to achieve this goal, physicians rely on having robust, effective, and efficient safety-net programs – Medicaid, the Children’s Health Insurance Program (CHIP), women’s health programs, and behavioral health services – all of which join to form the backbone of Texas’ health care delivery system.” 

Also to strengthen that backbone – of which physicians are a major part – Dr. Childs presented to the finance committee TMA’s “urgent” request for a 10% across-the-board Medicaid physician rate increase.  

TMA also urged lawmakers to strengthen funding for:  

• Updated and streamlined Medicaid and CHIP systems, including physician enrollment and revalidation and patient eligibility determinations; 

• Timely and quality maternal and child health data, including those related to congenital syphilis, and the Texas Health and Human Services Commission’s Children’s Mental Health Strategic Plan recommendations;  

• Public health infrastructure items including lab capacity to track infectious, foodborne, and other diseases that plague the state, and regional and local public health entities; and 

• Anti-vaping programs, especially for youth. 

Stay involved

These and other items will continue to be deliberated by Senate and House committees, to which friends of medicine have been or will be appointed. 

As of this writing, House committee leadership had not been announced. On the Senate side, among those committees that typically handle health care items:  

• Sen. Charles Schwertner, MD, chairs the Senate Committee on Business and Commerce, which typically handles insurance matters. Also serving on that committee is Sen. Donna Campbell, MD. 

• Sen. Joan Huffman will chair the Senate Committee on Finance, which handles the budget. Also serving on that committee are Senators Schwertner and Campbell.  

• Sen. Lois Kolkhorst will again chair the Senate Committee on Health and Human Services, which typically handles scope of practice and other major public health and health care-related items.  

For more on TMA’s legislative work at the Texas Capitol, visit the state advocacy page.  

To get involved, sign up for one of the remaining First Tuesdays events March 4, April 1, and May 6, and check out these six ways to get involved in advocacy.