Important Info for NPs: Waivers, Regulatory, and Policies Related to COVID-19

Out-of-State RN/APRN Licensure

In accordance with Section 418.171 of the Texas Government Code, any out-of-state nurse, including APRNs, may practice in Texas for the purpose of rendering aid, provided the nurse holds a current license in good standing in their home state. Therefore, any out-of-state nurse with a license in good standing* is not required to hold a Texas license in order to practice nursing in a disaster relief effort operation setting. Additionally, Texas is a member state of the Nurse Licensure Compact. As such, any LVN or RN holding an active compact license already holds a privilege to practice in Texas. See BON's announcement here.

Waiving Written Delegation Requirements

Pursuant to Texas Medical Board Rule 172.21, APRNs practicing in the context of a disaster declaration are not required to have a written prescriptive authority agreement (e.g. Prescriptive Authority Agreement or Facility-based protocol) for practice in a disaster relief effort operation setting. Although the written delegation agreement is waived, APRNs are still required by the rule to have some form of delegating physician, and specifically, a delegating physician who: 1) is licensed in Texas; and 2) practiced prior to the date of the emergency. However, the arrangement with this delegating physician is informal and can be made with any physician who meets the two criteria above. See BON's announcement here.

Continuing Competency Requirements for Licensure Renewal during COVID-19 Disaster Declaration Period

The Board of Nursing will consider extenuating circumstances on a case-by-case basis regarding the completion of continuing competency requirements for licensure renewal during the COVID-19 Disaster Declaration Period. For more information about continuing competency requirements, please visit the Board’s Frequently Asked Questions for Continuing Education & Competency here. If a licensee needs to request a waiver of continuing competency requirements, please email a request to the following address: Mark.Majek@bon.texas.gov

In the request, include your name, dated of birth and license number. Once received, the BON will allow an online renewal.

Telehealth/Telemedicine Exceptions and Waivers

• Allowing Phone Consults. Telemedicine, including the use of telephone only, may be used to establish a physician-patient relationship (see Texas Medical Board announcement here). This expanded use of telemedicine may be used for diagnosis, treatment, ordering of tests, and prescribing for all conditions. The standard of care must be met in all instances. 
• Reimbursement for State-Regulated Health Insurance Plans: The Texas Department of Insurance filed an emergency rule requiring insurers to pay the same amount for telemedicine services, including covered mental health services, as they do for in-person services. Please see an FAQ on the emergency rule here. The rule applies to in-network services for state-regulated health plans. State-regulated plans cover about 15% of the Texas market, including plans purchased through Healthcare.gov. The insurance cards for state-regulated plans have either “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them.

The Centers for Medicare and Medicaid Services, Telehealth Changes

The Centers for Medicare and Medicaid Services (CMS) have announced significant short term changes to Medicare telehealth policy. They will reimburse for telehealth visits to Medicare patients starting March 6, regardless of location, to patients in facilities or in homes. Please see an FAQ on the Medicare telehealth changes here.

Controlled Substances/Ryan Haight and Telemedicine
The Drug Enforcement Administration (DEA) has announced that telemedicine can now be used under the conditions outlined in the Controlled Substances Act under the public health emergency telemedicine exception to Ryan Haight. DEA-registered prescribers may issue prescriptions for controlled substances via telemedicine without a prior in-person evaluation if the prescription is for a legitimate medical purpose, real-time two-way audio-video is used, and the practitioner is acting in accordance with state law. See more information on their coronavirus page under "telemedicine."

HIPAA Changes
The Department of Health and Human Services Office for Civil Rights (HHS OCR) has issued a notification of Enforcement Discretion indicating that OCR will not enforce certain HIPAA regulations during this emergency in order to ease access to telehealth services. Please review their release here.