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Texas Medical Association

TEXPAC

American Academy of Otolaryngology

Audiology and Speech-Language Path.Instrst.com

 TAO Spring 2026 Advocacy Update

Scope of Practice: Quiet for Now (But Not for Long)

In the last legislative session, TAO's main scope-of-practice battles - including the audiology and speech language pathology interstate licensure compact (ALSP-ISC) and APRN independent practice - both ended favorably, and the interim has remained quiet. 

The quiet, however, is almost certainly temporary. Lt. Gov. Patrick has identified scope as a Senate priority ahead of the 90th Legislative Session, and the House Public Health Committee's interim charge on workforce shortages and service delivery in rural Texas is the standard framing under which independent practice and direct bills return. Even though the audiology and speech-language pathologist interstate licensure compact (ASLP-ISC) failed for the third consecutive session in 2025 (SB 1843 / HB 4409), similar mid-level licensure compacts have returned each cycle with a broader coalition of legislative sponsors. 

As we continue to meet with lawmakers ahead of next session, the message from TAO remains consistent: efforts to undermine the physician-lead care team model fundamentally undermine patient safety. The practice of otolaryngology involves diagnostic complexities that many mid-level practitioners are simply not trained or equipped to readily identify, and the cost of failure can have dire consequences for Texas patients. 

Prior Authorization: Federal Rule Live, State Rule Coming

On January 1, the CMS Interoperability and Prior Authorization Final Rule took effect, requiring Medicare Advantage, Medicaid managed care, and CHIP plans to issue standard prior authorization decisions within seven days and urgent decisions within 72 hours, and to publicly report denial rates this year. ENT practices should monitor their Medicare Advantage payers' turnaround times on all PA-heavy services, imaging, sleep apnea diagnostics, CPAP, balloon sinuplasty, etc.) and cite the rule in any appeals of late determination. 

On the state level, the revision to Texas' "gold card" statute (HB 3812) becomes fully effective September 1, 2026. The Texas Department of Insurance is expected to propose rulemaking this summer to provide clinical guidance for how CPT codes will be grouped for the 90% threshold calculation. TAO will provide the membership with additional guidance for practices when the final rules are published by TDI. 

New AI & EHR Compliance Rules Now in Effect

Last session, the Texas Legislature passed two new laws governing the use of AI in health care and both carry the potential for significant exposure for ENTs. SB 1188 requires physicians using AI in diagnosis or treatment planning (imaging, ambient scribes, clinical decision support) to disclose that use to patients and review all AI-generated records consistent with TMB standards. The same statute requires that, after January 1, 2026, all EHRs containing Texas patient data must be physically stored in the United States, catching practices using offshore transcription, coding, or cloud backup. Civil penalties range from $5,000 to $250,000 per violation. 

HB 149, the Texas Responsible AI Governance Act, also took effect January 1, and requires clear written disclosure whenever a patient interacts with an AI system in care, enforced by the Attorney General with a 60-day cure period. ENT practices currently using an AI scribe, audiology algorithm, or AI-assisted imaging tool should audit their intake forms and patient consent documents. 

Other Interim Activity Worth Watching

This fall, the new House Select Committee on Health Care Affordability will meet to examine issues of health care coverage and cost containment - including a likely revisit of the limited-mandate Employer Choice of Benefits proposals (HB 139) that failed last session under intense opposition from TAO, the Texas Medical Association (TMA), Texas Hospital Association (THA), and other medical specialty groups. 

The Texas Association of Health Plans (TAHP) and allied business interests are pushing these "lower-cost, limited-benefit" health plans with lawmakers concerned over the rising cost of insurance for small employers. In reality, these proposals promise cheaper insurance rates by exempting employee-sponsored health plans from effectively all state laws and mandates on insurance, including covered services, network adequacy, prompt-pay, and the very prior authorization "gold carding" reforms we just secured.