LEGISLATIVE BUDGET BOARD Austin, Texas FISCAL NOTE, 89TH LEGISLATIVE REGULAR SESSION May 1, 2025 TO: Honorable Bryan Hughes, Chair, Senate Committee on State Affairs FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: SB3055 by Middleton (Relating to the licensing and regulation of advanced practice registered nurses and the number of advanced practice registered nurses and physician assistants with whom a physician may enter into a prescriptive authority agreement.), As Introduced Estimated Two-year Net Impact to General Revenue Related Funds for SB3055, As Introduced: a negative impact of ($932,244) through the biennium ending August 31, 2027. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill. General Revenue-Related Funds, Five- Year Impact: Fiscal Year Probable Net Positive/(Negative) Impact toGeneral Revenue Related Funds2026($466,122)2027($466,122)2028($466,122)2029($466,122)2030($466,122)All Funds, Five-Year Impact: Fiscal Year Probable Savings/(Cost) fromGeneral Revenue Fund1 Change in Number of State Employees from FY 20252026($466,122)5.02027($466,122)5.02028($466,122)5.02029($466,122)5.02030($466,122)5.0 Fiscal AnalysisThe bill would allow certain Advanced Practice Registered Nurses (APRNs) to practice independently in counties with a populations less than 68,750. The bill would require APRNs practicing independently to submit certain information to the Board of Nursing annually, and the Board to annually aggregate, anonymize, and publish on the agency's website the information reported by APRNs. The bill would require the Board of Nursing to engage in rulemaking, as well as to conduct a multi-year study on the legislation's impacts on: changes in access in rural versus urban areas; patient health outcomes in identified counties; APRN practice location trends; and financial impacts on rural hospitals.The bill would take effect on September 1, 2025.
LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 89TH LEGISLATIVE REGULAR SESSION
May 1, 2025
TO: Honorable Bryan Hughes, Chair, Senate Committee on State Affairs FROM: Jerry McGinty, Director, Legislative Budget Board IN RE: SB3055 by Middleton (Relating to the licensing and regulation of advanced practice registered nurses and the number of advanced practice registered nurses and physician assistants with whom a physician may enter into a prescriptive authority agreement.), As Introduced
TO: Honorable Bryan Hughes, Chair, Senate Committee on State Affairs
FROM: Jerry McGinty, Director, Legislative Budget Board
IN RE: SB3055 by Middleton (Relating to the licensing and regulation of advanced practice registered nurses and the number of advanced practice registered nurses and physician assistants with whom a physician may enter into a prescriptive authority agreement.), As Introduced
Honorable Bryan Hughes, Chair, Senate Committee on State Affairs
Honorable Bryan Hughes, Chair, Senate Committee on State Affairs
Jerry McGinty, Director, Legislative Budget Board
Jerry McGinty, Director, Legislative Budget Board
SB3055 by Middleton (Relating to the licensing and regulation of advanced practice registered nurses and the number of advanced practice registered nurses and physician assistants with whom a physician may enter into a prescriptive authority agreement.), As Introduced
SB3055 by Middleton (Relating to the licensing and regulation of advanced practice registered nurses and the number of advanced practice registered nurses and physician assistants with whom a physician may enter into a prescriptive authority agreement.), As Introduced
Estimated Two-year Net Impact to General Revenue Related Funds for SB3055, As Introduced: a negative impact of ($932,244) through the biennium ending August 31, 2027. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
Estimated Two-year Net Impact to General Revenue Related Funds for SB3055, As Introduced: a negative impact of ($932,244) through the biennium ending August 31, 2027. The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.
General Revenue-Related Funds, Five- Year Impact:
2026 ($466,122)
2027 ($466,122)
2028 ($466,122)
2029 ($466,122)
2030 ($466,122)
All Funds, Five-Year Impact:
2026 ($466,122) 5.0
2027 ($466,122) 5.0
2028 ($466,122) 5.0
2029 ($466,122) 5.0
2030 ($466,122) 5.0
Fiscal Analysis
The bill would allow certain Advanced Practice Registered Nurses (APRNs) to practice independently in counties with a populations less than 68,750. The bill would require APRNs practicing independently to submit certain information to the Board of Nursing annually, and the Board to annually aggregate, anonymize, and publish on the agency's website the information reported by APRNs. The bill would require the Board of Nursing to engage in rulemaking, as well as to conduct a multi-year study on the legislation's impacts on: changes in access in rural versus urban areas; patient health outcomes in identified counties; APRN practice location trends; and financial impacts on rural hospitals.The bill would take effect on September 1, 2025.
The bill would take effect on September 1, 2025.
Methodology
Based on analysis by the Board of Nursing, the agency would need an additional 5.0 FTEs to implement the bill's provisions. The agency would require 1.0 additional Web Administrator IV position, with an annual salary of $92,000 and benefits of $27,527, to develop and maintain a web portal for APRNs practicing independently to report the required annual information to the Board. The agency would require 2.0 additional License and Permit Specialist II positions, each with an annual salary of $53,000 and benefits of $15,857, to verify APRN-specific data fields and maintain profile accuracy. The agency would require 1.0 additional Customer Service Representative II position, with an annual salary of $49,000 and benefits of $14,661, to respond to increased call volumes from nurses and the public regarding qualification requirements, application processes, and reporting updates. The agency would require 1.0 additional Advanced Practice Registered Nurse I position, with an annual salary of $101,000 and benefits of $30,220, to review APRN applications for independent practice authorization and to coordinate the required study. Based on analysis by the State Office of Administrative Hearings (SOAH), the bill could result in increased application denials and enforcement actions from the Board of Nursing and thus an increased caseload at SOAH. Due to the extent of the increased caseload being unknown, the fiscal impact the bill would have on SOAH cannot be determined.
Technology
Based on analysis by the Board of Nursing, the agency would require $14,000 in one-time costs in fiscal year 2026 to purchase hardware and software for the additional FTEs.
Local Government Impact
No significant fiscal implication to units of local government is anticipated.
Source Agencies: b > td > 327 Employees Retirement System, 360 State Office of Administrative Hearings, 407 Commission on Law Enforcement, 452 Department of Licensing and Regulation, 454 Department of Insurance, 503 Texas Medical Board, 507 Texas Board of Nursing, 515 Board of Pharmacy, 529 Health and Human Services Commission
327 Employees Retirement System, 360 State Office of Administrative Hearings, 407 Commission on Law Enforcement, 452 Department of Licensing and Regulation, 454 Department of Insurance, 503 Texas Medical Board, 507 Texas Board of Nursing, 515 Board of Pharmacy, 529 Health and Human Services Commission
LBB Staff: b > td > JMc, WP, GDZ, DPE
JMc, WP, GDZ, DPE