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 TAO Advocacy Update - Final Report on the 89th Legislative Session

The 89th Texas Legislature featured several critical debates on health policy that have a wide-ranging impact on the practice of medicine, patient care, and collaboration within the broader healthcare system. Discussions included physician oversight in hearing aid evaluations for minors, scope-of-practice expansions, and newborn screening protocols. 

While not exhaustive, this report outlines several of the most significant issues the Texas Association of Otolaryngology engaged in during the session and highlights our ongoing efforts to advocate for the practice of otolaryngology while supporting sound public policy that serves the best interests of patients. 

Universal CMV Screening Bill 

Introduced by Rep. Joanne Shofner (R-Nacogdoches), HB 4882 proposed significant changes to the state's approach to screening newborns for congenital cytomegalovirus (CMV). Specifically the bill would require that all newborns and infants be tested for CMV prior to discharge from the hospital, regardless of their hearing screening results. 

This universal screening approach marked a significant shift from the existing protocol that TAO helped negotiate last session, which required CMV testing only for infants who did not pass their initial hearing screening. Under HB 2478 (2023), if a newborn fails their hearing test, a hospital or birthing center is required to conduct a CMV test, unless the parents decline it. The legislation also mandates that parents be informed of the test results, the potential effects of CMV, and available treatment options, including referrals to appropriate healthcare providers. 

While HB 2478 focused on infants at higher risk (those who failed hearing screenings), HB 4882's broader approach raised concerns regarding resource allocation, cost-effectiveness, and the management of false positives. Implementing universal CMV screening, as envisioned in HB 4882, would require additional resources, including laboratory capacity and follow-up services, which could strain existing healthcare infrastructure. 

While HB 4882 passed the Texas House of Representatives with substantial bipartisan support (117-0), the bill ultimately did not advance in the Senate. Concerns were raised regarding the cost of universal screening, the risk of false positives, laboratory capacity, and the potential strain on pediatric infectious disease specialists. We anticipate continued discussions related to CMV screening in future legislative sessions and will continue to advocate for policies that are evidence-based, sustainable, and focused on patient outcomes. 

Hearing Aid Evaluation for Minors 

This session, Sen. Judith Zaffirini (D-Laredo) introduced several pieces of legislation regarding the evaluation and sale of hearing aids to minors: SB 904, which focused on the licensing and regulation of hearing instrument fitters and dispensers, and SB 905, which addressed the licensing and regulation of speech-language pathologists and audiologists. 

Among less substantive statutory changes suggested by the Texas Department of Licensing and Regulation (the state agency responsible for regulating hearing aid fitters and dispensers, speech-language pathologists, and audiologists), the introduced versions of both SB 904 and SB 905 loosened a key provision that required physicians "specializing in diseases of the ear" to authorize the purchase of hearing aids for minors. The revised language in SB 904 and SB 905 would allow any licensed physician to provide this authorization, with the goal of expanding access to hearing aids for children who need them, particularly in areas of the state where ear, nose, and throat (ENT) specialists are scarce. 

Working with Sen. Zaffirini and her staff, TAO was successful in amending both bills to include compromise language to clarify that while any licensed physician is authorized to order hearing aids to a minor, these evaluations "should be conducted by a licensed otolaryngologists whenever practicable." 

This compromise strikes a balance between valid concerns regarding the lack of access to appropriate specialty care in rural and underserved areas of the state, while also formally acknowledging a preference for these evaluations to be conducted by an otolaryngologist, who has specialized training and equipment capable of detecting rare and/or serious conditions like cholesteatoma, temporal bone tumors, or congenital malformations of the ear that might be overlooked during a standard hearing evaluation. 

Both SB 904 and SB 905 were ultimately passed with broad bipartisan support and now await the signature of Governor Greg Abbott. Overall, we believe this legislation will help improve access to hearing healthcare for minors in Texas, particularly in underserved areas, while still recognizing the critical role of otolaryngologists in providing specialized care. 

Audiologist/Speech Language Pathologist Interstate Licensure Compact

As in previous sessions, the 89th Legislature saw a renewed effort by lawmakers to have Texas join the Audiology and Speech-Language Pathology Interstate Licensure Compact (ASLP-IC). This session, Sen. Angela Paxton (R-McKinney) filed SB 1843, and Rep. Tom Oliverson, MD (R-Tomball) introduced its companion, HB 4409, to allow Texas audiologists and speech-language pathologists to practice in other states participating in the compact without the need to obtain a new license in each state. 

While the ASLP-IC is often promoted to improve access to care in rural and underserved areas and streamline the process for licensed professionals to offer services across state lines, it also raises serious concerns about the oversight and regulation of audiologists and speech-language pathologists practicing in Texas and beyond. By authorizing Texas to join this multistate licensure agreement, SB 1843 and HB 4409 would enable out-of-state providers to treat Texas patients without being licensed under out state's current regulatory standards or held to the same degree of accountability. If an out-of-state audiologist practicing under the provisions of the compact commits a professional error, the Texas Department of Licensing and Regulation would have limited authority to intervene, leading to a fragmented regulatory structure that complicates both enforcement and patient safety. 

By ceding the state's authority to safeguard patient care to a multistate commission that may not reflect the same priorities as our own licensing authorities, this legislation continues to raise more problems than it solves. Ultimately, these concerns doomed the ASLP-IC, as both SB 1843 and HB 4409 died without receiving a hearing in either the Senate Health and Human Services Committee or the House Committee on Public Health. 

While increasing access to care is a laudable goal, these kind of "privilege to practice" licensure compacts must not come at the expense of quality of care or patient safety. Future consideration of the ASLP-IC in Texas should include stronger safeguards that preserve state control over licensure and disciplinary actions and require clear minimum standards to ensure that compact participants are held to the same clinical standards as audiologists and speech-language pathologists licensed to practice in Texas. 

Graduate Medical Education 

In the final version of the 2026-2027 state budget (SB 1) significantly increased funding for Graduate Medical Education (GME) in Texas. The budget allocated a total of $304.4 million for GME expansion, which includes $282.4 million from General Revenue Funds ($71.3 million more than in the previous biennium) and $22.0 million from the Permanent Fund Supporting Graduate Medical Education. 

These investments aim to maintain a 1.1-to-1 ratio of residency position to medical school graduates in Texas, with the goal of retaining a greater number of the state's medical graduates to treat patients within the state. The Family Medicine Resident Program also received increased funding, raising a per-resident support to $15,000 annually to enhance primary care training and encourage entry into family medicine, especially in underserved areas. These investments reflect Texas's commitment to expanding its healthcare workforce and providing essential training opportunities for medical graduates. 

APRN Independent Practice

In what became one of the most challenging fights of the legislative session, Rep. Drew Darby (R-San Angelo) filed HB 3794, a sweeping scope of practice expansion bill that would grant nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists full independent practice authority without the supervision or delegation of a licensed physician. 

Under the provisions of the bill, APRNs would have full authority to evaluate patients, diagnose conditions, order tests, prescribe treatments (including controlled substances), and serve as a patient's primary care provider - all without physician involvement. The bill even redefines "nursing" to include medical diagnosis and prescribing, effectively authorizing APRNs to practice medicine without a license. 

To state the obvious - HB 3794 represents a direct threat to Texas' physician-led care model and, more importantly, to patient safety. Otolaryngologists and other specialists recognize that complex medical conditions require a team approach, and while nurses and advanced practitioners are vital members of this team, physician oversight is critical for complex decision-making, diagnosing nuanced conditions, and managing complications. 

On April 14, HB 3794 was called before the House Committee on Public Health in a contentious hearing marked by hours of intense debate. TAO joined a broad coalition of physician groups and medical societies in opposing HB 3794, asserting that patient access can be improved without compromising quality of care. The bill was initially left pending, and for a time, it seemed that our opposition might have successfully forestalled the bill entirely. 

Two weeks later, we learned different. Chairman Gary VanDeaver (R-Texarkana) announced that the House Public Health Committee would hold a vote on HB 3794 the following day. The physician lobby team and I scrambled ahead of the vote in a pitched battle with the nursing lobbyists, hoping to solidify opposition to the bill and prevent the nurses from swaying any votes in their favor. As we navigated the Capitol, counting and recounting votes, both the nurses and physicians were convinced that the votes were in their favor. 

At the appointed time, Chairman VanDeaver called the House Public Health Committee to order in a packed meeting room behind the House chamber. After addressing several dozen unrelated bills, they reached HB 3794. At the moment of truth, Chairman VanDeaver seemed to acknowledge that the bill lacked sufficient support and chose to leave HB 3784 pending rather than risk a vote he felt was sure to fail. 

That very day, on the other side of the Capitol rotunda, the Senate Committee on State Affairs was busy hearing its own version of the APRN scope expansion bill, SB 3055 by Sen. Mayes Middleton (R-Galveston). In a hearing that lasted from morning until night, dozens of physicians from across the state took their turn testifying in opposition to the unsupervised practice of nurses in Texas. They highlighted the potential harm to patient safety and outlined the substantial differences in educational and clinical experience between nurses and physicians. After many hours of testimony, the bill was also left pending without a vote. 

In the end, despite a forceful showing from the nursing lobby, our efforts to stop HB 3794 and SB 3055 were successful, as neither was ultimately called for a vote or advanced out of their respective committees. Our message to lawmakers remains clear: Texas should expand access by building on physician-led teams, not dismantling them. We support measures to provide care to rural and underserved areas but handing over unsupervised medical practice to nonphysicians is not a responsible action. 

Health Impact, Cost, & Coverage Analysis Program (HICCAP)

This session, House Insurance Committee Chairman Jay Dean (R-Longview) filed HB 138 to establish the Health Impact, Cost, and Coverage Analysis Program (HICCAP) at the UT Health Science Center in Houston to evaluate new insurance benefit mandates proposed by the Texas Legislature. Before voting on legislation that would mandate additional coverage benefits in state law, the members of the legislature would receive an HICCAP report estimating costs, coverage impacts, and utilization. 

In response to concerns raised by the Texas Medical Association (TMA), the Texas Hospital Association (THA), TAO, and other physician groups, the House Insurance Committee ultimately adopted a substitute bill that requires a more balanced evaluations of legislative proposals, including the potential for improved patient outcomes and public health impacts. It mandates the use of Texas's all-payer claims database and peer-reviewed literature and allows both chairs and vice-chairs to request analyses. Conflict-of-interest policies were also added. 

The revised version of HB 138 was eventually passed in the Texas House (141-3) and then the Texas Senate (31-0). It now awaits Governor Abbott's signature. 

Employer Choice of Benefits Plan

The 89th Legislature also saw concerted efforts by the health insurance lobby to allow health plans to offer limited "Employer Choice of Benefits" health plans that would be exempt from most state insurance mandates and consumer protections. 

Authored by House Insurance Committee Chairman Jay Dean (R-Longview), HB 139 would allow health plans to legally exclude essential state-mandated benefits and safeguards, including coverage mandates, surprise billing protections, prompt-pay requirements, and network adequacy standards. Other critical patient protections - such as continuity of care provisions, appeal rights, and prior authorization reforms - would also not apply. 

While HB 139's stated goal was to reduce the high cost of premiums by easing regulations, the bill was more likely to expose Texas patients to unexpected medical costs, narrow networks, and insurance denials for necessary care, such as cancer screenings and, importantly, specialist care. The widespread adoption of these "barebones" health insurance plans could erode broader health insurance standards and significantly undermine patient confidence in the healthcare system's ability to provide adequate medical care without financially crushing denials and exclusions. Lower premiums mean little if health plans leave patients on the hook for massive out-of-pocket expenses. 

On April 4, despite vocal opposition from physician group and patient advocates, HB 139 was voted out of the House Insurance Committee on the 6-3 vote. While TMA, THA, and other physician groups were successful in delaying a floor vote on HB 139 for nearly a month, the bill was ultimately scheduled for a vote on May 15, the final day for House bills to be heard. 

Our physician lobby team and allies spent days engaged in a full-court press, expressing opposition to all 150 members of the Texas House of Representatives. In the end, our efforts proved successful, as Rep. Dean was finally forced to acknowledge that the bill lacked the necessary support to pass and chose to withdraw HB 139 before it could be voted down.