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Texas is classified as a restricted-practice state for APRNs. Physician-delegated medical authority remains required, but the written mechanism depends on the role and setting. Use this page as a verification map, not a substitute for legal advice.
6/9 roles restricted · Updated 2026-08-24
For education and operational planning only. Verify every citation with counsel, the relevant board, internal privileges, payer rules, and local policy before changing staffing, supervision, or clinical workflows. Keep licenses, DEA information, agreements, verifications, and employee files in the employer's approved systems—not FQHC Talent.
Identify the role, medical and nursing functions, location, setting, and payer.
Confirm the current board rule, statute, privileges, delegator, and written instrument.
State only verified requirements and route documents to the employer's approved system.
Texas requires physician-delegated authority for APRN medical/prescriptive functions and for PA practice, but the written mechanism depends on the role and setting. Most non-facility prescriptive arrangements use a Prescriptive Authority Agreement; qualifying facility-based practices may use protocols or other written authorization. Treat delegation coverage, agreement maintenance, privileges, payer rules, and credential verification as staffing inputs—not as a one-size-fits-all 'career-long PAA' rule.
Texas's 2025 effort to grant APRNs full (independent) practice authority did not advance. SB 911 (Sen. Cesar Blanco) was referred to Senate Business & Commerce on Feb 13, 2025 and did not receive a committee vote; the House companion HB 3794 had an April 14, 2025 hearing but did not become law. No APRN full-practice bill was enacted, so Texas remains a restricted-practice state. With a biennial legislature, the next opportunity is the 2027 session.
SB 911, 89th Texas Legislature (2025); House companion HB 3794Do not treat 'restricted practice' as 'every APRN site has a career-long PAA.' Verify the role's medical and nursing functions, practice setting, current delegating authority, facility status, payer rules, privileges, and actual written instrument before publishing or credentialing the role.
Do not describe every PA arrangement as the same as every APRN arrangement. Verify the named delegating physician, setting, written instrument, scope, payer rules, privileges, and current Texas Medical Board requirements.
RNs are the supervising layer for LVNs/UAPs and anchor care-management / RN co-visit staffing models. 'Reduced' here flags only the absence of medical/prescriptive authority — nursing practice itself is not physician-supervised.
Every LVN needs a named supervisor on duty — a key staffing-ratio and supervision-coverage consideration for Texas FQHC clinic models.
No MA licensing board in Texas. MA duties (rooming, vitals, injections per order) must be covered by a physician's standing delegation orders with documented supervision.
The 180-hour curriculum took effect February 1, 2026. Graduates of an approved 160-hour course completed before that date may apply within three years of graduation. Verify the person's current certificate and the actual paid or volunteer duties; do not collect credential files in FQHC Talent.
Behavioral-health therapists can deliver care independently at full licensure — a relative bright spot for Texas FQHC integrated-BH models — but medication management still needs a prescriber under physician delegation.
Texas FQHC dental programs operate under independent dentist authority; the dentist is the delegating/supervising authority for the dental team.
Because on-site dentist presence is not required for delegated acts (only an exam within 12 months), §262.002 enables FQHC mobile/school-based and 'alternate setting' dental programs under dentist supervision.
TMHP says its August 18 activation message came from noreply@okta.com or Do_Not_Reply_TMHP_IAMOnline@tmhp.partner.hhs.texas.gov and that the link expires after seven days. Release 4 takes effect August 24 for LTCOP, the LTC Dashboard, the EVV Portal, and Care Forms. A sender address alone does not prove that a particular message or destination is safe: affected billing, EVV, or IT staff should start from TMHP's official Account Management page or independently call the published EDI Help Desk at 888-863-3638 before activating, especially if the message is unexpected or the link has expired. Use MFA and the center's approved password manager; never put credentials, recovery codes, activation links, tokens, screenshots, or patient information into FQHC Talent. The notice names no health center and applies only to personnel who use the affected applications or received an activation email.
Texas Medicaid & Healthcare Partnership (TMHP) →TMHP's current notice makes Release 4 effective August 24, 2026 for the Long-term Care Online Portal, LTC Dashboard, Electronic Visit Verification Portal, and Care Forms. Affected users need a separately activated TMHP IAMOnline account even if they already use HHSC IAMOnline for STEPS. Revenue-cycle, EVV, and IT leads should verify that named users can reach only their assigned applications through the official TMHP entry point, that MFA recovery follows the center's policy, and that access is removed when duties change. TMHP says inactive accounts can be deactivated after 90 days; that is an account-maintenance rule, not a reason to share logins or create unnecessary access. FQHC Talent does not test portal access and must not receive usernames, passwords, codes, tokens, screenshots, claims, or patient data.
Texas Medicaid & Healthcare Partnership (TMHP) →Texas DSHS says the nine-competency, 180-hour curriculum took effect February 1, 2026 and training centers were required to align by August 1. People who completed an approved 160-hour course before February 1 may still apply for certification within three years of graduation; existing CHW and instructor certifications were not invalidated. DSHS also distinguishes paid CHW work, which requires certification, from uncompensated volunteer service. Workforce and learning leads should check the candidate's actual graduation date, current DSHS certificate, job duties, and the official application path rather than infer qualification from a course title. Keep certificates, IDs, employment files, background material, and health or client information in approved systems—not FQHC Talent.
Texas DSHS — CHW Program →Texas DSHS's August 12 outcome summary says the July 21–23 preparedness exercise served 2,565 people and delivered 11,838 services at five medical points of dispensing in Cameron, Hidalgo, Willacy, Starr, and Webb counties. DSHS separately reports 1,405 immunizations for 834 people and 1,397 medical exams; it says daily patient counts were lower than in each of the prior five exercise years, with no event in 2025. These are event totals, not unique diagnoses, longitudinal outcomes, referrals completed, or FQHC activity. Border health-center leaders can use the report to ask local partners about referral and follow-up protocols before the next exercise, while keeping any patient handoff inside approved clinical systems—not FQHC Talent.
Texas Department of State Health Services →TMHP's provider notice states that effective September 1, 2026, the Baylor Scott & White and FirstCare health plans no longer participate in Texas Medicaid managed care: FirstCare exits CHIP (Lubbock) and STAR (Lubbock and MRSA West), and Baylor Scott & White exits STAR (MRSA Central). The notice says August 31, 2026 'will be the last date of service (DOS) that the Texas Medicaid & Healthcare Partnership (TMHP) will accept any claims submitted under' the two plans, that providers have 24 months to submit claims with dates of service on or before August 31 (federal deadline August 31, 2028), and that members transition to newly selected plans through HHSC turnover procedures. The notice names no health center and publishes no enrollment counts — but West and Central Texas FQHCs contracted with these MCOs face member reassignment and a hard date-of-service boundary for the exiting plans, which makes eligibility re-verification at check-in the operational task for September.
Texas Medicaid & Healthcare Partnership (TMHP) →Legacy's current Acres Homes page posts July 14, 2026, welcomes new patients, and says appointments are available at 3011 W. Gulf Bank Road. It lists adult medicine, OB/GYN, pediatrics, and pharmacy, accepts Medicaid, CHIP, Medicare, Medicare Advantage, and most HMO/PPO plans, and offers help with sliding-fee options. The site credits a Houston Methodist donation for the expansion, confirming the clinic has moved from a construction announcement to patient access.
Legacy Community Health →Explore all 80 Texas community health centers in the directory.
Legal citations come from the Texas Occupations Code and state boards; confirm currency and local application before relying on them.