Addressing the Coalition Letter of March 3 2026
Today we'll be addressing the coalition letter. Let's look at the claims made in the letter issued March 3rd, 2026 by the "coalition" of professional organizations who disagree with the TX AG Office's Opinion (KP-0518).
Addressing The Coalition Letter
They claim the following:
1. "The services in SB14 (88R) that are expressly prohibited to be performed by the health care provider are explicitly associated with the treatment of physical health that are outside the scope of practice for any mental health care professional."
That's actually a true statement. No one is expecting or requiring a mental health counselor to do any surgical procedure. But simply stating that counselors aren't surgeons doesn't mean that licensed mental health counselors aren't "health care providers", which is a covered category in this bill. THAT was the primary question behind the RFO to Paxton's office: are licensed BHEC counselors subject to oversight via SB14 or not? (A request to address "scope of work" was also made and addressed in the Opinion.)
Paxton's office said, "yes". We are health care providers.
2. "There is no mention of any mental health services in SB14.
Not utilizing the term "mental health" there isn't. But "Health Services" IS covered and that's the first domino.
Health Services is made up of two sub-groups, "Physicians" and "Health Care Providers" and both of those groups are specifically listed and covered by SB14. That's domino #2.
Through specific explanation in both code and in the Paxton Opinion, if a member of "Health Services" is NOT classified as a "Physician" they are by default included in the other sub-group, "Health Care Provider". That's domino #3.
Just to put a little extra english on that last point, the inclusion of mental health care providers in the "Health Care Provider" group has been repeatedly established and underscored in both code and case law over the past 50 years. (Ask yourself why we had to clarify this settled law yet again??)
The coalition letter conveniently ignored all of the logic presented above and instead went looking for a legal loophole. Why? Because their logic which they submitted in their Briefs to Paxton's Office didn't carry legal weight. They couldn't fall back on that nor could they recognize the legal logic Paxton's office utilized in the Opinion because it doesn't support their narrative. So here's what they came up with:
3. "Article 37 of the TX Administrative Code, Section 380.9175 explicitly defines "health care professional" and "mental health professional" as two unique provider groups."
The rest of their statement (the letter) only has legs if you buy into their implied reasoning. They want you to believe without doing any research that this somehow excludes them from oversight by SB14. It does not. Let's examine those two definitions.
Definitions Are Part of the Puzzle
The two definitions they reference in the Admin Code are indeed there and here they are:
(3) Health Care Professional--an individual licensed by a professional board to practice in the State of Texas in a health care field including nursing, medicine, psychiatry, or dentistry.
Paxtons Opinion addresses this definition in no uncertain terms. This is an umbrella category and inclusion in it is done by EXCLUSION from the "Physician" category. If you're not a Physician and you're "in a mental or physical healing profession", you fall squarely in this category. It specifically lists the "mental" care professions. No exclusions listed.
But the next definition is the one they're hanging their hat on, hoping you won't think.
(6) Mental Health Professional--a doctoral-level psychologist, masters-level mental health specialist, licensed professional counselor, licensed psychological associate, or licensed clinical social worker.
Three Points to Address
That second definition/sub-category, (6) MHP, likely exists because there is code somewhere that specifically references and targets the mental health professional and, at some point in the past, a lawmaker did not want to include other sub-segments (massage therapists, acupuncturists, etc) that fall under the umbrella term, "Health Care Providers", in their bill/code. It exists to specifically target a segment of licensees who belong to the larger, Health Care Professionals category. Read that again.
The terms, "Health Care Provider" and "Mental Health Professional" are not parallel or equal groupings. The latter is a sub-segment of the former, and one does not exclude the other unless specified in a bill.
Second, that there are sub-segments (massage therapists, acupuncturists, etc) within the Health Care Provider group does not exclude any of those groups, unless specifically and intentionally excluded in the bill, especially if they are "licensed by a professional board to practice in the State of Texas in a healthcare field". That last phrase, included in both the original SB14 Bill and the AG Opinion allows for NO EXCLUSION of any sub-groups within the Health Care Provider group's inclusion in the bill.
Third, the phrasing, "including (list)" is not exhaustive and is not intended to exclude any sub-segment. Exclusion is done by clear and specific text. Also addressed in Paxton's Opinion.
Let's Connect The Dots
This is a classic game of misdirection with words. These organizations are counting on their members to blindly follow their lead without applying any research or critical thinking as to what the bill and the opinion actually say. Both extant code and Paxton's ruling make it clear that:
1. "Health Services", the master category, is covered by SB14.
2. Both Health Services sub-groups, "Physicians" and "Health Care Providers", are specifically listed in, and covered by, SB14.
3. By exclusion from the "Physicians" category, licensed mental health care providers are automatically included in the "Health Care Provider" group, as stated in the Opinion.
4. There is no exclusion made in SB14 for the "Mental Health Professional" sub-segment of the Health Care Provider group. Therefore, since they belong firmly under the "Health Care Provider" group, SB14 and all of its prohibitions, enumerated or implied, apply to the licensed mental health counselor community.
The Larger Impact of This On Licensees
The fact that legacy professional organizations didn't get the legal opinion or outcome they wanted and are choosing to publicly disagree with it is fine, they have that right. Whether it's right (or smart) to buck the AG's Office and your licensing agency publicly is another issue.
What they should be concerned about is gaslighting their professional membership into thinking it's ok to ignore the ruling, break the law, and risk their license, saying nothing about putting the public at risk (minors under 18). Also, that someone thought willfully putting their membership at legal risk of losing their license might be a smart membership development tactic should cost someone their job. All of this is highly unethical and shameful behavior.
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Thank you greatly, Phillip Crum, for this thouroughly written article, and I have printed it out to read again and have it for reference since I too have this built in forgetter at times.