Texas Register Texas Medical Board Employment of Physicians

A recent decision overturning a legislative rule was made by the Texas Medical Board that has significant impact for RHC Physician Assistant and Nurse Practitioner owners. Previously the Texas Legislature during its last session had approved a bill that said effective in January 2012, a PA or NP could not own the majority interest in a RHC. Only PA and NP owners of current existing RHCs were grandfathered. This requirement has now been overturned by the Medical Board after a number of non-physician providers obtained legal advice and court support to overrule that requirement. Below is a section from the current Texas Register that overturns the rule.

“The Texas Medical Board (Board) has adopted the amendments to Section 177.17, concerning Exceptions to Corporate Practice of Medicine Doctrine , without changes to the proposed text as published in the July 27, 2012,issue of the Texas Register (37 TexReg 5539) and will not be republished.

The amendments to Section 177.17 to provide exception to doctrine for rural health clinics that meet the requirements of 42 CFR 491.8. The Board sought stakeholder input through Stakeholder Groups which made comments on the suggested changes to the rule in a meeting held on July 20, 2012. The comments were incorporated into the proposed rules.

The Board received comments regarding Section 177.17 from the Texas Medical Association (TMA).

TMA commented that the proposed rule exceeds the Texas Medical Board’s statutory authority that prohibits the corporate practice of medicine under the Medical Practice Act, including Section 164.052(a) (17) that prohibits physicians from aiding and abetting the practice of medicine by unlicensed persons.

The Board disagrees with this comment. Under federal law, specifically, 42 CFR 491.8, it provides that in relation to federally qualified health centers and rural health clinics, “The physician assistant, nurse practitioner, nurse-midwife, clinical social worker, or clinical psychologist member of the staff may be the owner or an employee of the clinic or center, or may furnish services under contract to the center.” < clinic means Rural Health Clinic RHC and center means a Federally Qualified Health Center FQHC> The Board has made the determination that as federal law has granted physician assistants the authority to own rural health clinics, that Board rules may recognize that authority and not penalize physician assistants for exercising their rights. Further, the Board supports the intent of the federal law which is to improve access to primary health care in rural, underserved communities and promote a collaborative model of health care delivery.”

Source: The Secretary of State John Steen

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