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A deal with medicine has been reached and SB 406 was filed by Senator Jane Nelson! SB 406 continues a delegated model; however, passage of this bill will eliminate the site-based restrictions that have created so many barriers to practice and replace it with a signed prescriptive authority agreement that describes how prescriptive authority quality assurance and improvement activities will be handled by the practice (Nelson, 2019). Some highlights of the bill include:· FTEs. The number of full-time equivalent APRNs or PAs that a physician can delegate prescriptive authority to increases from 4 to 7. In practice sites serving medically underserved populations (MUPs) and in hospitals there is no limit on the number of APRNs to whom a physician can delegate, just as in current law.· Frequency of meetings. The frequency of required face-to-face meetings between the physician and the APRN or PA is being reduced to monthly for 3 years and then quarterly thereafter with monthly contact in between by means of a remote electronic communications system, including videoconferencing technology or the Internet. All current APRNs and PAs will get credit for the time you have been prescribing under protocols, so many of you will immediately start with quarterly meetings.· Location of meetings. The physician and APRN or PA will decide where the face-to-face meetings will occur and indicate this in the prescriptive authority agreement.· Quality assurance and improvement plan. The prescriptive authority agreement will describe a prescriptive authority QA plan that includes chart review, but the number of charts reviewed will be determined by the physician and APRN or PA.· Schedule II, Controlled Substances. Physicians will be allowed to delegate the ordering or prescribing of Schedule IIs to APRNs or PAs in hospitals and for the treatment of a person in hospice care.· Prescriptive authority agreement. The agreement signed by the APRNs or PAs and physicians will identify the types or categories of drugs or devices that can or cannot be prescribed, which maintains current law. Full practice authority means that a nurse practitioner can practice without physician involvement. The nurse practitioner is the sole authority of the state board of nursing. This full practice authority guarantees that nurse practitioners can practice to their full educational preparation and provide an avenue for patients to access a qualified healthcare provider (Brom et al., 2019). Defining the scope of practice for any healthcare provider is the state’s responsibility. Laws for healthcare practice were created to be expensive and to pertain to licensed physicians. Scope of practice laws for other healthcare providers for written so non-physician providers could carve out a portion of physician practices and be able to perform to the level of their education (Brom et al., 2019). Defining the scope of practice for health care providers is a state responsibility. Laws for the practice of health care were originally created to be expansive and to pertain to licensed physicians. The scope of practice laws for other health care providers were based on services nonphysicians could “carve out” of physician practice and perform Some states mandate a monthly face-to-face visit with a supervising physician, restricting an APRN’s authority to prescribe medication and medical equipment, further there are restrictions on APRN’s authority to provide care in a skilled nursing facility. These are just a few restrictions listed state to state. They reduce both APRNs and physicians time for patient care, add additional undue costs, and create a gap in care for patients especially in rural areas (Fauteux et al., 2019). A collaborative practice agreement may give policymakers the false impression that these CPAs mandate collaboration in the care of a digital patients but they do not. Instead purchase agreement spell out the restrictions that will govern and APRN’s practice (Brom et al., 2019). Presumably it’s the states purpose when requiring a CPA to protect the public, but there is no evidence that shows that a CPA in place serves this function. Meanwhile these legal agreements and pose a significant cost on providers and patients (Brom et al., 2019). When will we stop just discussing this and actually move forward to freaking nurse practitioners and patients to have high quality accessible healthcare?Brom, H., Salsberry, P., & Clark Graham, M. (2019). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners. https://pubmed.ncbi.nlm.nih.gov/29757880/. Fauteux, N., Brand, R., Fink, J. L., Frelick, M., & Werrlein, D. (2019, January 24). The Case for Removing Barriers to APRN Practice. RWJF. https://www.rwjf.org/en/library/research/2017/03/the-case-for-removing-barriers-to-aprn-practice.html. Nelson, J. (2019). SB – 406. https://capitol.texas.gov/tlodocs/83R/billtext/pdf/SB00406I.pdf#navpanes=0. https://capitol.texas.gov/tlodocs/83R/billtext/pdf/SB00406I.pdf#navpanes=0.