Clinical Practice and Professional Issues Discussion Paper

Practice Restrictions and Reimbursement Rates for PMHNPs in Texas

PMHNP Practice Restrictions in Texas

PMHNPs in Texas face significant practice limitations:

1. Collaborative Agreement Requirement: PMHNPs must maintain a collaborative agreement with a physician (Phoenix & Chapman, 2020). This constrains their autonomy as they practice under physician supervision.
2. Prescriptive Authority:  Phoenix & Chapman (2020) indicate that PMHNPs have prescriptive authority, but restrictions exist. A delegated prescriptive agreement with a collaborating physician is mandatory for Schedule II controlled substances.
3. Scope of Practice: Despite their training, PMHNPs have a more restricted scope of practice than physicians. This impacts access to mental health care in underserved regions. Clinical Practice and Professional Issues Discussion Paper
   

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Clinical Practice and Professional Issues

The requirement for an agreement to collaborate is a problem for Texas PMHNPs.

This can cause logistical issues. Finding a willing collaborator physician can be challenging. This issue also adds an administrative layer burden to their practice. For certain medications, the requirement for a delegated prescriptive authority agreement can cause delays in patient care (Roberts & Knestrick, 2023).

Reimbursement Rates for Treatment Modalities

Phoenix and Chapman (2020) state that PMHNPs in Texas sometimes receive lower reimbursement rates than physicians. This discrepancy can significantly impede increasing access to mental health care. It may discourage PMHNPs from working in underserved areas. PMHNPs receive lower reimbursement rates for specific treatment methods than other healthcare providers. Clinical Practice and Professional Issues Discussion Paper

Comparison to Other Provider Rates

The PMHNPs receive lower reimbursement rates than other medical professionals (Gigli et al., 2023). This rate discrepancy can be attributed to the collaborative agreement requirement. This influences reimbursement agreements with insurance providers. Difference in rates affect the willingness of PMHNPs to practice in the state. The difference may also incentivize them to seek practice in states with more favorable reimbursement conditions.

References

Gigli, K. H., Martsolf, G. R., Vinci, R. J., & Buerhaus, P. I. (2023). A Cross-Sectional Examination of the Nurse Practitioner Workforce Caring for Children in the United States. The Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2023.02.020

Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of psychiatric nursing, 34(5), 370-376. https://doi.org/10.1016%2Fj.apnu.2020.07.001

Roberts, M. E., & Knestrick, J. (2023). The Nurse Practitioner in the USA: Role Exemplars. In Nurse Practitioners and Nurse Anesthetists: The Evolution of the Global Roles (pp.  Clinical Practice and Professional Issues Discussion Paper

American Nurses Credentialing Center (ANCC) is currently the only option for PMHNPs to obtain the national certification as a PMHNP-BC (across the lifespan). Board certification is not a requirement in all the states for the NP license, but malpractice insurance providers and many health care facilities may require NP board certification as a prerequisite to grant privilege to practice.
1 page paper: I’m in the state of TEXAS
Examine and describe the PMHNP practice restrictions/limitations in your state (TEXAS”).
Describe a clinical practice or professional issues with the licensure and certification.
Research reimbursement rates for various treatment modalities.
Compare NP rates to other provider rates. Clinical Practice and Professional Issues Discussion Paper