Transcript Highlights:

• This action is necessary to ensure North Dakota can swiftly accept and appropriate the federal funding

Bills: SB2401, SB2402, SB2403, SB2404

Keywords: SB 2401, North Dakota, Century Code, occupational therapy, occupational therapy board, criminal history record check, background check, licensee investigation, physician continuing education, medical license renewal, nutrition education, metabolic health, chronic disease prevention, health occupation boards, medical board, licensure fee, audit response, disciplinary action, Title 43, board of medicine

Summary: The Senate convened in special session with prayer, the Pledge of Allegiance, and roll call establishing a quorum of 45 members present and two absent. The chamber received certification from the Secretary of State and the governor’s executive order calling the special session to address funding for the Rural Health Transformation Program and to act quickly to accept and appropriate federal funds. The main action was adoption of the procedural rules for the extraordinary session. Senator Klein explained the proposed rule changes, which were designed to speed up consideration of bills during the short session, including limits on bill introduction, same-day second reading and final passage, elimination of standing committees for the session, creation of a Joint Policy Committee and Joint Appropriations Committee, and authorization for remote testimony and limited remote participation. The procedural committee’s report on these rules was adopted without opposition. The Senate also adopted reports naming members to the Joint Policy Committee and Joint Appropriations Committee. Announcements noted that the Senate Employment Committee, Joint Policy Committee, and Joint Appropriations Committee would meet later that morning, that the Senate would not reconvene at 4 p.m., and that a Highway Patrol presentation on legislator safety would be held. The Senate then moved through the listed orders of business and recessed, planning to meet in joint session with the House before adjourning until Thursday, January 22, 2026.

Transcript Highlights:

• The chair of the committee substitutes... action to the option of a committee substitute, the chair hears
• The medical board has disciplinary oversight over physicians, however, ambiguity exists regarding the
• As a result, regulatory agencies are unable to pursue disciplinary actions against such who perform.
• action.
• The bill also allows TDLR to take disciplinary action against the PO whose licenses are expired.

Bills: HB2450, SB378, SB764, SB917, SB1254, SB1255

Keywords: elevator inspection, building safety, construction standards, health and safety code, regulatory requirements, SB 378, Texas Occupations Code, barbering, cosmetology, barber, cosmetologist, licensing, professional licensing, unauthorized practice, medical procedures, skin incision, dermis, injections, devices, consumer safety

Transcript Highlights:

• Imagine how much more beneficial that is for people trying to take action to help the students.
• Results so I can see, I as a parent can see the questions and how my kid answered with specific action
• Will have actionable data to personalize just-in-time instruction, which can close learning gaps and
• One that provides educators with actionable growth data throughout the year while preserving a strong
• now seen multiple years of academically unacceptable performance, you need to see a bolder set of actions

Bills: SB8, SB 8

Keywords: education, accountability, public school assessment, state law, transparency, intervention, performance ratings, sex designation, restroom access, civil penalties, private civil right of action, women's privacy, 1185, senate, all

Transcript Highlights:

• under the same prudent investor standard currently followed today, ensuring responsible financial action

Bills: SB 21, SB21, SB72, SB140, SB262, SB370, SB372, SB495, SB627, SB703, SB764, SB842

Keywords: emergency alerts, weather alerts, public safety, local government, municipality, county, website posting, online notice, emergency management, disaster preparedness, evacuation, National Weather Service, NOAA, Texas Division of Emergency Management, TDEM, localized alerts, hazard warnings, severe weather, watch warning advisory, public information

Transcript Highlights:

• the future, with businesses providing real-world value that would make sense in terms of strategic action
• Each action is checked to make sure that nobody is creating Bitcoin outside of the issuance schedule.
• It relates to the procedure of a hearing by TDLR on the denial of an electrician's license or disciplinary
• action against an electrician.
• Within their scope of practice, unless that action constitutes gross negligence, every combative sports

Bills: SB 21, SB21, SB72, SB140, SB262, SB370, SB372, SB495, SB627, SB703, SB764, SB842

Keywords: emergency alerts, weather alerts, public safety, local government, municipality, county, website posting, online notice, emergency management, disaster preparedness, evacuation, National Weather Service, NOAA, Texas Division of Emergency Management, TDEM, localized alerts, hazard warnings, severe weather, watch warning advisory, public information

Transcript Highlights:

• ministry is not providing the right disclosure, then they are putting themselves out there at risk for action
• It does not create any new penalties or causes of action against a public adjuster.
• This bill will also prohibit a money service business from avoiding disciplinary action by clarifying
• This bill will also prohibit a money service business from avoiding disciplinary action by clarifying

Bills: S0266, S0394, S0540, S0632, S0642, S0832, S0834, S1028

Keywords: public adjuster, contract cancellation, state of emergency, vulnerable adults, disciplinary actions, financial regulation, information security, financial exploitation, licensing, transportation, insurance, TNC, ride-sharing, automobile liability, bail bond, insurance regulation, foreign insurers, financial disclosure, premium reporting, residential property insurance

Summary: The Committee on Banking and Insurance met with a quorum and took up several bills, beginning with SB 834 on insurance requirements for nonprofit religious organizations and health care sharing ministries. The bill repeals a recent restriction on licensed insurance agents marketing or selling faith-based health care sharing programs. Supporters argued the change restores free speech and consumer education while preserving existing fraud and disclosure protections; opponents said allowing agents and brokers could create consumer confusion and has been associated with bad actors. A title amendment was adopted, and after debate the committee reported the bill favorably. The committee also heard and passed SB 642, which extends reporting and duty requirements to foreign and alien bail bond insurers, and SB 394, a technical bill updating reinsurance intermediary manager law to match current DFS practice. SB 266, which lets vulnerable adults rescind public adjuster contracts without penalty, was reported favorably after testimony from supporters in the insurance and elder law communities and a public adjuster who said the intent was good but the bill may need refinement. SB 832, a residential property insurance transparency bill requiring rate breakdown reports and a consumer resource center, also passed after discussion about consumer clarity and whether the required cost categories can be compiled as written. Later, the committee approved SB 540, which creates cybersecurity requirements for mortgage and money service businesses, closes a regulatory gap for certain investment advisers, adjusts OFR examination-payment deadlines, changes de novo charter requirements, allows virtual credit union meetings, and makes other financial regulation updates. Several amendments were adopted, including a substitute amendment removing fintech sandbox provisions. Finally, SB 1028 on Citizens Property Insurance Corporation was reported favorably after debate over a commercial lines clearinghouse intended to reduce Citizens’ exposure and shift more business to the private market; members discussed taxpayer risk, market competition, and consumer protections. The meeting ended with adjournment.

Bills: HB40, HB1916, HB1973, HB2524, HB2530, HB3180, HB3421, HB3783, HB4170, HB4213

Keywords: business court, civil procedure, litigation, jurisdiction, arbitration, divorce, property division, family law, court jurisdiction, marital assets, parent-child relationship, birth certificate, identity proof, Family Code, court process, attorney fees, court costs, legal expenses, dispute resolution, child support

Summary: The committee considered several House bills dealing with family law and civil procedure. House Bill 1916, concerning a court’s jurisdiction in suits to divide property not divided on dissolution of marriage, was reported favorably on a 4-0 vote and recommended for the local and uncontested calendar. House Bill 1973, addressing proof of the identity of a child’s parents in a suit affecting the parent-child relationship, was also adopted with a committee substitute, reported favorably 4-0, and sent to the local and uncontested calendar. House Bill 2524, on recovery of fees, court costs, and expenses in family law proceedings, and House Bill 2530, on special appointments in suits affecting the parent-child relationship, each received favorable 4-0 votes and were likewise recommended for the local and uncontested calendar. The committee then took up House Bill 3180, which was reported favorably 4-0 and recommended for the local and uncontested calendar. The most detailed discussion centered on House Bill 40, relating to updates to business courts. Senator Hughes explained a committee amendment that made conforming changes requested by the Finance Committee and removed language creating two new judgeships, replacing it with a different judge allocation. The amendment was adopted, the amended committee substitute was adopted, and the bill was reported favorably on a 4-0 vote and sent to the local and uncontested calendar. At the end of the meeting, members briefly clarified procedural details about the House Bill 40 amendment and then closed out the agenda. The committee also noted a correction to an earlier reference to Bartleby the Scrivener, and the Chair recessed the Committee on Jurisprudence subject to the call of the chair.

Transcript Highlights:

• clarify that the court which issued the final divorce decree retains exclusive jurisdiction over any actions
• The AG, on the other hand, rolls six months forward before taking any action.
• I'm not an attorney either, but I do know that there are negative enforcement actions for non-payment
• order the transportation of a child to a location by force, threat of force, undue coercion, or other action
• order the transportation of a child to a location by force, threat of force, undue coercion or other action

Bills: HB40, HB1916, HB1973, HB2524, HB2530, HB3180, HB3421, HB3783, HB4170, HB4213

Keywords: business court, civil procedure, litigation, jurisdiction, arbitration, divorce, property division, family law, court jurisdiction, marital assets, parent-child relationship, birth certificate, identity proof, Family Code, court process, attorney fees, court costs, legal expenses, dispute resolution, child support

Summary: The committee heard several House bills, most of them relating to family law and court procedure, and left each bill pending after testimony. House Bill 1916 would clarify that the court that issued a final divorce decree retains exclusive jurisdiction over later actions involving undivided property. House Bill 1973 would require a certified birth certificate, if reasonably available, to be filed with a SAPCR petition or allow alternative proof of parentage while keeping the information confidential. House Bill 2530 would add qualifications and procedural safeguards for appointing amicus attorneys in SAPCR cases, including notice and hearing requirements, minimum qualifications, conflict rules, and limits on what amicus attorneys may do. House Bill 2524 would make Family Code references to attorney’s fees consistent by using “reasonable and necessary” language. House Bill 3180 would correct a scrivener’s error in the civil discovery rules by changing “settlement” to “statement.” The committee also heard House Bill 4213, which would change the interest rate on overdue child support from the current 6 percent simple interest to a fixed 5 percent and require the Attorney General to report on the impact of the change. Testimony was sharply divided: supporters argued lower interest could improve collections and help low-income obligors catch up, citing research and the size of child-support arrearages; opponents said lowering the rate would reduce incentives to pay and harm custodial parents and children. The Attorney General’s office raised implementation concerns about a House version that would have created a variable rate, while the committee substitute was described as restoring a simple fixed rate. After testimony, the bill was left pending. The committee also discussed House Bill 40, updating business court provisions and supplemental jurisdiction; House Bill 3421, streamlining probate procedures for original wills and copies; and House Bill 417, clarifying venue for lawsuits involving private transfer fees on real property. Each drew limited testimony and was left pending. Finally, House Bill 3783 drew extensive testimony on court-ordered counseling and reunification therapy in family cases. The sponsor and supporters said the bill would protect children and abuse victims from coercive, unregulated reunification practices, while opponents argued it was too broad, could interfere with legitimate therapy and judicial discretion, and might affect military families and other high-conflict cases. The committee heard testimony from judges, therapists, parents, survivors, and advocates, but took no final action and left the bill pending.

Transcript Highlights:

• It, um, creates a wrongful death cause of action.
• No cause of action.
• Your bill would allow a cause of action. For a legal abortion performed, let me clarify.
• under this bill would, would exist, the wrongful death cause of action.
• The father would have a cause of action against anybody, man. I, I get it. I, I get it.

Bills: HB 229, HB 3990, HB 5082, HB 5510

Keywords: biological sex, government information, definitions, sex-based distinctions, public health, flags, display, state law, municipalities, government buildings, drug enforcement, local control, home rule, municipal charter, county policy, ordinance preemption, state preemption, attorney general enforcement, civil penalties, mandamus

Transcript Highlights:

• If the information is released, without the donor's permission, there's a cause of action.
• If unrecoverable and claiming owner fault, they would now have a direct cause of action under statute
• You have no cause of action.
• And I guess... would be sabotage and man-made actions that disrupt operations, whether they're actual
• It needs to be expedited in conjunction with Senator Kolkhorst's actions. Thank you. César Blanco.

Bills: SB75, SB715, SB776, SB1299, SB1405, SB1968, SB2021, SB2077, SB2148, SB2321, SB2330, SB2411

Keywords: electric generation, reliability, ERCOT, Public Utility Commission, penalties, performance requirements, energy policy, construction contracts, compensatory damages, government delays, contractor, legislation, nonprofit donor privacy, membership lists, supporter confidentiality, volunteer privacy, association rights, public records exemption, Texas Public Information Act, government transparency

Transcript Highlights:

• We agree with Senator Johnson that we would like to see a little more action on those and get those over
• And it's not about restricting the action of unions, public or otherwise.

Bills: SB75, SB715, SB776, SB1299, SB1405, SB1968, SB2021, SB2077, SB2148, SB2321, SB2330, SB2411

Keywords: electric generation, reliability, ERCOT, Public Utility Commission, penalties, performance requirements, energy policy, construction contracts, compensatory damages, government delays, contractor, legislation, nonprofit donor privacy, membership lists, supporter confidentiality, volunteer privacy, association rights, public records exemption, Texas Public Information Act, government transparency

Transcript Highlights:

• We would like to see a little more action on those and get those over the finish line.
• With Senator Johnson, we would like to see a little more action on those and get those over the finish
• Teachers, and Service Employees International Union, SEIU, regularly meet in Austin to discuss political action
• To discuss political action that is not necessarily in the interest of every taxpaying Texan.
• place both for reasons of efficiency as well as transparency, and it's not about restricting the action

Bills: SB75, SB715, SB776, SB1299, SB1405, SB1968, SB2021, SB2077, SB2148, SB2321, SB2330, SB2411

Keywords: electric generation, reliability, ERCOT, Public Utility Commission, penalties, performance requirements, energy policy, construction contracts, compensatory damages, government delays, contractor, legislation, nonprofit donor privacy, membership lists, supporter confidentiality, volunteer privacy, association rights, public records exemption, Texas Public Information Act, government transparency

Summary: The Senate Committee on Business and Commerce heard Senate Bill 2021 by Senator Johnson, as substituted, on distributed energy resources (DERs). Johnson said the bill was intended to create a regulatory framework for DERs and virtual power plants, address interconnection and registration issues, and prevent regulatory capture as the industry grows. Testimony was split: Texas Electric Cooperatives asked for clarification so co-ops would not be unintentionally excluded from owning or operating DERs; AECT supported the bill as providing needed rules and customer protections; TABA, Texas Solar and Storage Association, Sierra Club, Texas Solar Energy Society, and several others opposed it or raised concerns that it was too utility-centric, imposed red tape, and could burden homeowners and small businesses with registration and interconnection requirements. Johnson repeatedly said the bill was not meant to stop rooftop solar or backup systems and that he was open to specific redlines and further changes. SB 2021 was left pending after testimony. The committee then took up Senate Bill 2330 by Senator Parker, which would end government payroll deduction for dues to certain public employee organizations, while exempting first responders under Chapters 143 and 147 and making other conforming changes in a committee substitute. Parker argued the bill was about government neutrality, transparency, and employee freedom from coercion, and said organizations can collect dues directly using modern payment methods. Supporters from Texas Public Policy Foundation, Texas Business Coalition, Freedom Foundation, ABC Texas, and Texans for Fiscal Responsibility said taxpayer-funded payroll systems should not be used to collect dues for private organizations, especially ones involved in political activity. Opponents, including ATPE, Texas Classroom Teachers Association, Texas Public Employees Association, and correctional employees, said payroll deduction is a convenient, secure service that helps professional associations and employee groups, and argued the bill would burden teachers and other public employees. Several witnesses and senators focused on the bill’s exemptions and whether it treated teachers differently from first responders. Senator Menendez questioned why some public employees were excluded while others were not, and a Houston police union representative said he moved from opposing to supporting the bill after being told the substitute would preserve meet-and-confer deductions under Chapters 143 and 147. Senator Parker closed by saying the bill was not meant to eliminate associations or payroll deduction entirely, only to remove the state as a middleman. SB 2330 was left pending, and the committee then recessed subject to call.

Transcript Highlights:

• If the information is released without the donor's permission, there's a cause of action.
• would be likely to pursue delay claims, including specious ones, and could now have a direct cause of action
• contract provision does not exist, the sovereign immunity waiver is unavailable and there is no cause of action
• something were to kick off, you could pretty much guarantee that there's going to be some degree of action

Bills: SB75, SB715, SB776, SB1299, SB1405, SB1968, SB2021, SB2077, SB2148, SB2321, SB2330, SB2411

Keywords: electric generation, reliability, ERCOT, Public Utility Commission, penalties, performance requirements, energy policy, construction contracts, compensatory damages, government delays, contractor, legislation, nonprofit donor privacy, membership lists, supporter confidentiality, volunteer privacy, association rights, public records exemption, Texas Public Information Act, government transparency

Summary: The committee first took up pending business and favorably reported several bills without objection or by recorded vote, including SB 783, SB 1238, SB 1706, SB 1791, SB 458, SB 1644, and SB 1810, with some of them also sent to the local and uncontested calendar. The committee then moved into hearings on additional bills. SB 1968, by Senator Schwertner, would update the Real Estate License Act by repealing subagency, requiring written buyer-agent agreements before showings, and clarifying when a formal buyer representation agreement must be signed. Texas Realtors testified in support, saying the bill modernizes agency rules and increases transparency, while a committee substitute corrected drafting issues. SB 2411, the annual update to the Texas Business Organizations Code, was also laid out and left pending after supportive testimony from the Texas Business Law Foundation and drafting committee representatives. The committee also heard SB 2321, which would codify ERCOT’s current practice of notifying TCEQ when backup generation needs enforcement discretion for grid reliability; Sierra Club and a chamber of commerce witness supported it with suggestions for clearer emissions reporting, and the bill was left pending. SB 2077 would broaden eligibility for the Texas Mutual Insurance Company board by narrowing conflict restrictions tied to insurance-related interests; Texas Mutual supported the change and the bill was left pending. SB 1405, a broadband bill, would align state law with FCC standards and streamline Broadband Development Office processes; it was left pending after supportive testimony. SB 1299, protecting nonprofit donor privacy, drew support from privacy advocates and concerns from one witness about transparency for publicly funded nonprofit operations; it was left pending. The committee then heard SB 776, which would bar government construction contracts from shifting delay damages to contractors when delays are caused solely by the public owner. Contractors, surety representatives, and water infrastructure advocates supported the bill, arguing it would improve fairness and reduce inflated bids, while water utilities and critical infrastructure entities opposed it, warning of more litigation and higher costs; the bill was left pending. Finally, SB 715, which would apply reliability requirements retroactively to all generation resources in ERCOT, drew opposition from renewable and storage groups and support from some critics of renewable subsidies, with witnesses split over whether it would improve reliability or raise costs; testimony was underway when the transcript ended.

Transcript Highlights:

• actions?
• action for that behavior.
• <00:10:47.399> action<00:10:48.279> um<00:10:48.519> for professional disciplinary
• action um for professional disciplinary action um for that<00:10:49.680> behavior<00:10:50.680
• <00:38:38.079> we<00:38:38.200> might take whatever necessary action we might take

Bills: HF1379, HF1596, HF2260, HF1429

Keywords: nonopioid directive, opioid refusal, opioid-free care, pain management, health care directive, advance directive, patient autonomy, informed consent, substance use disorder, opioid epidemic, prescriber immunity, provider liability, emergency medical services, EMS, health record, Minnesota Department of Health, health care agent, medical power of attorney, Metropolitan Council, Minnesota government data practices

Transcript Highlights:

• We believe that there is some language that looks like it could be a private right of action in this
• actions, or administrative sanctions solely for providing or receiving goods or services related to
• These protections do not apply in cases of negligence, criminal activity, or actions that fall outside
• I also serve as the health care action team chair for the Nevada chapter of the National Organization
• I also serve as the health care action team chair for the Nevada chapter of the National Organization

Bills: AB52, AB76, AB163, AB388, AB483

Keywords: health insurance, claims process, insurance regulation, admin penalties, healthcare access, cannabis, cannabis establishment, medical cannabis, adult-use cannabis, advertising regulations, packaging requirements, unlicensed cannabis activities, state prosecution, confidentiality, Cannabis Compliance Board, disciplinary proceedings, mental health, counseling, interstate practice, telehealth

Bills: HB40, HB40, HB1916, HB1973, HB2524, HB2530, HB3180, HB3421, HB3783, HB4170, HB4213

Keywords: law enforcement, sheriffs, constables, contracts, county authority, business court, civil procedure, litigation, jurisdiction, arbitration, divorce, property division, family law, court jurisdiction, marital assets, parent-child relationship, birth certificate, identity proof, Family Code, court process

Transcript Highlights:

• clarify that the court which issued the final divorce decree retains exclusive jurisdiction over any actions
• The AG, on the other hand, rolls six months forward before taking any action.
• I'm not an attorney either, but I do know that there are negative... ...enforcement actions for non-payment
• Action, that seems pretty uncontroversial.

Bills: HB40, HB1916, HB1973, HB2524, HB2530, HB3180, HB3421, HB3783, HB4170, HB4213, HB40

Keywords: business court, civil procedure, litigation, jurisdiction, arbitration, divorce, property division, family law, court jurisdiction, marital assets, parent-child relationship, birth certificate, identity proof, Family Code, court process, attorney fees, court costs, legal expenses, dispute resolution, child support

Transcript Highlights:

• General to investigate alleged violations relating to sex reassignment for minors and commence a civil action
• And your bill creates new criminal penalties as well as a civil cause of action?
• General can commence investigations of alleged violations, but also there is an individual cause of action
• Next, we'll hear from Kurt Michelli, speaking for Do No Harm Action. You're recognized.
• Kurt Michelli with Do No Harm Action.

Bills: S0560, S0590, S0778, S1010

Keywords: child welfare, psychotropic medication, Department of Children and Families, community-based care, liability insurance, forensic services, defendants, mental health, judicial system, defense, legal definitions, minors, healthcare, parental rights, criminal penalties, civil action, sex-reassignment, investigations, economic damages

Summary: The Committee on Children, Families, and Elder Affairs considered four bills. SB 590, by Sen. Bradley, would toll the statute of limitations for failure to report suspected child abuse by mandatory reporters until the offense is known to law enforcement; an amendment clarified retroactive application for offenses not already time-barred by the bill’s effective date. Sen. Bradley said the bill is intended to ensure accountability in institutional abuse cases and not to change the reasonable-suspicion reporting standard. The committee adopted the amendment and reported the bill favorably. The committee also heard SB 778, by Sen. Simon, which would update the definition of forensic client so certain individuals with intellectual disabilities or autism whose charges were dismissed for incompetency can be housed with other Chapter 916 residents, reducing duplicative staffing and space needs at the Agency for Persons with Disabilities. Barney Bishop appeared in support, and the bill was reported favorably without amendment. SB 560, by Sen. Garcia, would streamline procedures for psychotropic medication prescriptions for children in DCF custody, reduce duplicative background checks and reporting, and simplify consent documentation. Amendments removed language allowing licensed clinical social workers and marriage and family therapists to serve as evaluators and narrowed changes to the Road to Independence Program’s postsecondary education services and supports, extending eligibility ages from 18 to 26 while keeping the five-year cap. Senators discussed the fiscal impact and funding blend for the education stipend. The committee adopted the amendments and reported the bill favorably. The committee then took up SB 1010, by Sen. Yarbrough, which adds criminal and civil enforcement for violations involving sex-reassignment prescriptions or procedures for minors and related parental-rights provisions. An amendment clarified that the civil action authority applies to minors and that damages benefit the affected minor. Public testimony was heavily divided, with supporters saying the bill enforces existing protections and opponents warning it would chill care, counseling, and school-based support for transgender youth. Senators Harrell, Sharief, and Rouson raised concerns about vagueness, standing, and impacts on teachers and health professionals; Sharief voted no, while the bill was still reported favorably.

Bills: HB4336, HB1818, HB3194, HB3538, HB3682, HB3762, HB3793, HB3930, HB3931, HB3934, HB4124, HB4200, HB4410, HB4457, HB4473, HB3884, HB1912

Keywords: interventional pain management, pain management clinic, chronic pain, acute pain, spinal injections, epidural steroid injection, peripheral nerve block, nerve ablation, spinal cord stimulator, intrathecal infusion pump, endoscopic diskectomy, fluoroscopy, physician supervision, allopathic physician, osteopathic physician, CRNA, certified registered nurse anesthetist, nurse anesthetist, freestanding pain management facility, medical licensure

Bills: HB4336, HB1818, HB3194, HB3538, HB3682, HB3762, HB3793, HB3930, HB3931, HB3934, HB4124, HB4200, HB4410, HB4457, HB4473, HB3884, HB1912

Keywords: interventional pain management, pain management clinic, chronic pain, acute pain, spinal injections, epidural steroid injection, peripheral nerve block, nerve ablation, spinal cord stimulator, intrathecal infusion pump, endoscopic diskectomy, fluoroscopy, physician supervision, allopathic physician, osteopathic physician, CRNA, certified registered nurse anesthetist, nurse anesthetist, freestanding pain management facility, medical licensure