Scope of practice updates

During the 2019 legislative session, a number of bills were introduced to expand the scope of practice for non-physician health care professionals. Here is the latest on 2019 scope of practice legislation.

Physical therapists
Physical therapists (PTs) in Texas can now see patients without a referral, under a new state law that went into effect on September 1, 2019.

House Bill 29 amended the scope of practice to allow for treatment by a physical therapist without a physician referral, if the physical therapist: (a)

1. has been licensed to practice physical therapy for at least one year;
2. is covered by professional liability insurance in the minimum amount required by board rule; and
3. either: 

a. possesses a doctoral degree in physical therapy from:

i. a program that is accredited by the Commission on Accreditation in Physical Therapy Education; or

ii. an institution that is accredited by an agency or association recognized by the United States secretary of education; or

iii. has completed at least 30 hours of continuing competence activities in the area of differential diagnosis. 

(a-). Except as provided by subsection (a-2), a physical therapist may treat a patient under subsection (a) for not more than 10 consecutive business days.

(a-2). A physical therapist who possesses a doctoral degree described by subsection (a)(3)(A) and has completed a residency or fellowship may treat a patient under subsection a for not more than 15 consecutive business days. 

b. The physical therapist must obtain a referral from a referring practitioner before the physical therapist may continue treatment that exceeds treatment authorized under subsections (a-1) and (a-2).

c. A physical therapist who treats a patient without a referral shall obtain from the patient a signed disclosure on a form prescribed by the board in which the patient acknowledges that:

1. physical therapy is not a substitute for medical diagnosis by a physician;
2. physical therapy is not based on radiological imaging;
3. a physical therapist cannot diagnose an illness or disease; and
4. the patient’s health insurance may not include coverage for the physical therapist’s services.

These forms are available from the Texas Board of Physical Therapy Examiners in English and Spanish.


Certified Registered Nurse Anesthetists
Texas Attorney General Ken Paxton issued an opinion reaffirming that there is no independent or unsupervised practice of anesthesia by certified registered nurse anesthetists (CRNAs) allowed in Texas.

In the opinion issued on September 5, 2019, Attorney General Paxton states that providing anesthesia is the practice of medicine; the TMB has regulatory authority over physician decisions to delegate anesthesia to CRNAs; and CRNAs cannot independently administer anesthesia unless a physician delegates that task to them.

“The practice of medicine includes the provision of anesthesia by a licensed physician,” Attorney General Paxton wrote. “However . . . when a [CRNA] administers anesthesia pursuant to a physician’s delegation, such act falls within the scope of nursing.”

According to Paxton, the definition of “professional nursing,” specifically “excludes from the scope of nursing the ‘acts of medical diagnosis or the prescription of therapeutic or corrective measures,’ and no other provision within the Nurse Practice Act provides authority otherwise. .  . . Thus, a [CRNA] does not possess independent authority to administer anesthesia without delegation by a physician.”

The Texas Medical Board weighed in on the issue, stating that “Anesthesiologists and CRNAs provide tremendous care to the people of Texas. But they do as a team with the CRNA under the delegation and supervision of a physician as provided by statute and TMB rules,” said Stephen Brint Carlton, JD, executive director of the TMB.  

While not binding law, opinions of the attorney general are considered persuasive authority. Interpretation of state law is ultimately left to the courts.