Monitoring the Session

HB 4099

bill extending physical therapy without referral to 30 days

Became law, effective Sep 1, 2025

Verdict: No flags

No flagsInitial review
Rep. Caroline Harris DavilaRHouse 52

Initial review · graded Oct 20, 2026 · Headline, summary and grade are analysis of the bill text, not a finding about any person · How we grade

Caption

relating to the treatment of a patient by a physical therapist without a referral.

Caption from analyzed text · version I.

Summary

Up from 10 consecutive business days!

The bill lets a physical therapist treat a patient without a doctor's referral for up to 30 consecutive business days, up from 10. It touches physical therapists, their patients, and the doctors who now write referrals, and it repeals a separate subsection that set its own limit. After that window the therapist still needs a referral to keep treating, and the physical therapy board must write rules by December 1, 2025.

Labels

Labels: BACK FROM THE DEAD. Same text as a bill filed before that died: 88R HB 4291 by Rep. Swanson (Died in committee). Filed in 2 sessions, counting this one. Checked against 88R only.TRY NO. 2. Filed in 2 sessions: 88R and 89R. Checked against 88R only.ACROSS THE AISLE. Joint authors: 3 Republicans, 2 Democrats. Party as the Legislative Reference Library lists it for the 89th Legislature.

Receipt

The receipt

89R-HB4099 · 2025-03-07

SOLD BY

Rep. Caroline Harris DavilaRHouse 52 Rep. Cody HarrisRHouse 8 Rep. Cody VasutRHouse 25

+ 2 more authors, 41 coauthors

ITEM

relating to the treatment of a patient by a physical therapist without a referral.

WHAT IT DOES

Up from 10 consecutive business days!

The bill lets a physical therapist treat a patient without a doctor's referral for up to 30 consecutive business days, up from 10. It touches physical therapists, their patients, and the doctors who now write referrals, and it repeals a separate subsection that set its own limit. After that window the therapist still needs a referral to keep treating, and the physical therapy board must write rules by December 1, 2025.

CHARGES

[ ] NONE FOUND

TOTAL

No significant fiscal implication to the State is anticipated.

LBB estimate · fiscal note version E · source

Sources

Fiscal note · version E · May 20, 2025

No first-year general revenue figure available here.

LBB published estimates · flow over the stated periods.

Source snapshot 2026-10-19, Central time.

HISTORY

  1. Filed
  2. Read first time
  3. Referred to Public Health
  4. Scheduled for public hearing on . . .
  5. Considered in public hearing
  6. Committee substitute considered in committee
  7. Testimony taken/registration(s) recorded in committee
  8. Left pending in committee
  9. Considered in formal meeting
  10. Committee substitute considered in committee
  11. Reported favorably as substituted
  12. Comte report filed with Committee Coordinator
  13. Committee report distributed
  14. Committee report sent to Calendars
  15. Considered in Calendars
  16. Placed on General State Calendar
  17. Read 2nd time
  18. Point of order withdrawn Rule 4, Section 32(c)(1)
  19. Passed to engrossment
  20. Record vote RV#2726
  21. Statement(s) of vote recorded in Journal
  22. Read 3rd time
  23. Passed
  24. Record vote RV#2842
  25. Statement(s) of vote recorded in Journal
  26. Reported engrossed
  27. Received from the House
  28. Read first time
  29. Referred to Health & Human Services
  30. Posting rule suspended
  31. Scheduled for public hearing on . . .
  32. Considered in public hearing
  33. Testimony taken in committee
  34. Left pending in committee
  35. Considered in public hearing
  36. Vote taken in committee
  37. Reported favorably w/o amendments
  38. Committee report printed and distributed
  39. Co-sponsor authorized
  40. Placed on intent calendar
  41. Rules suspended-Regular order of business
  42. Read 2nd time & passed to 3rd reading
  43. Vote recorded in Journal
  44. Three day rule suspended
  45. Record vote
  46. Read 3rd time
  47. Passed
  48. Record vote
  49. Senate passage reported
  50. Reported enrolled
  51. Signed in the House
  52. Signed in the Senate
  53. Sent to the Governor
  54. Signed by the Governor
  55. Effective on 9/1/25
FILED UNDER

No verified beat found.

SIGNED FOR BY

House · 99 yea · 15 nay

Senate · 31 yea · 0 nay

Sources

House: Final passage · May 16, 2025. Journal. Published stock for this vote. Snapshot 2026-10-19, Central time.

Senate: Final passage · May 28, 2025. Journal. Published stock for this vote. Snapshot 2026-10-19, Central time.

All floor motions and other positions below.

No flags

THANK YOU FOR CHECKING THE RECEIPT

CAMPAIGN PAID FOR BY

CAMPAIGN PAID FOR BY

Caroline Harris Davila

Donors

Texans for Lawsuit Reform PAC$961KTexas Conservative Majority PAC$739KCourt Reform Action for Familes Texas PAC$75K

Not tied to this bill.

Sources

The author's campaign account only. Own money and internal transfers are separate on the member page.

Derived itemized flow · Oct 27, 2024 to Oct 24, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Texans for Lawsuit Reform PAC$960,552.08

Texans for Lawsuit Reform PAC

$960,552.08

Cash
$85,000.00
Paid by others
$875,552.08
Total
$960,552.08
advertising $595,238.00mail $237,770.40polling $42,460.35fundraiser $83.33

Also funds 124 other sitting lawmakers.

Derived recipient stock · Jul 10, 2024 to Oct 23, 2026. State data as of Nov 4, 2026.

TEC account match.

Team
Sources

Derived itemized flow · Jun 23, 2025 to Oct 23, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Report IDs: 101008087, 101031516, 101035818, 101040655, 101057099, 101067933, 101070037.

Texas Conservative Majority PAC$739,102.00

Texas Conservative Majority PAC

$739,102.00

Cash
$200,000.00
Paid by others
$539,102.00
Total
$739,102.00
canvassing $430,352.00advertising $100,000.00polling $8,750.00

Also funds 42 other sitting lawmakers.

Derived recipient stock · Jan 23, 2026 to Oct 23, 2026. State data as of Nov 4, 2026.

TEC account match.

Team
Sources

Derived itemized flow · Sep 8, 2026 to Oct 23, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Report IDs: 101067933, 101070037.

Court Reform Action for Familes Texas PAC$75,000.00

Court Reform Action for Familes Texas PAC

$75,000.00

Cash
$75,000.00
Paid by others
$0.00
Total
$75,000.00

Also funds 0 other sitting lawmakers.

Derived recipient stock · on Oct 6, 2026. State data as of Nov 4, 2026.

Name match, not a verified identity: normalized filed name and state.

Sources

Derived itemized flow · on Oct 6, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Report IDs: 101070037.

Money

Missing data does not establish zero giving. Display amounts are rounded.

×

Texans for Lawsuit Reform PAC

$960,552.08

Cash
$85,000.00
Paid by others
$875,552.08
Total
$960,552.08
advertising $595,238.00mail $237,770.40polling $42,460.35fundraiser $83.33

Also funds 124 other sitting lawmakers.

Derived recipient stock · Jul 10, 2024 to Oct 23, 2026. State data as of Nov 4, 2026.

TEC account match.

Team
Sources

Derived itemized flow · Jun 23, 2025 to Oct 23, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Report IDs: 101008087, 101031516, 101035818, 101040655, 101057099, 101067933, 101070037.

×

Texas Conservative Majority PAC

$739,102.00

Cash
$200,000.00
Paid by others
$539,102.00
Total
$739,102.00
canvassing $430,352.00advertising $100,000.00polling $8,750.00

Also funds 42 other sitting lawmakers.

Derived recipient stock · Jan 23, 2026 to Oct 23, 2026. State data as of Nov 4, 2026.

TEC account match.

Team
Sources

Derived itemized flow · Sep 8, 2026 to Oct 23, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Report IDs: 101067933, 101070037.

×

Court Reform Action for Familes Texas PAC

$75,000.00

Cash
$75,000.00
Paid by others
$0.00
Total
$75,000.00

Also funds 0 other sitting lawmakers.

Derived recipient stock · on Oct 6, 2026. State data as of Nov 4, 2026.

Name match, not a verified identity: normalized filed name and state.

Sources

Derived itemized flow · on Oct 6, 2026. State data as of Nov 4, 2026.

Derived itemized contributions on live regular reports and uncovered special-session dates. Internal account transfers and daily reports are excluded.

Report IDs: 101070037.

Votes6

Senate May 28, 2025

Yea
31
Nay
0
Present, not voting
Not printed
Absent
Not printed
Excused
Not printed
Names

Senate journal

Names were not printed. No individual positions are inferred.

Sources

Senator Perry moved that Senate Rule 7.18 and the Constitutional Rule requiring bills to be read on three several days be suspended and that HB 4099 be placed on its third reading and final passage. The motion prevailed by the following vote: Yeas 31, Nays 0. The bill was read third time and was passed by the following vote: Yeas 31, Nays 0.

Published stock of positions for this vote, except where marked derived.

  • Yea: 31 (published)
  • Nay: 0 (published)
  • Present, not voting: Not printed
  • Absent: Not printed
  • Excused: Not printed

Senate journal. Source snapshot 2026-10-19, Central time.

Senate May 28, 2025

Yea
31
Nay
0
Present, not voting
Not printed
Absent
Not printed
Excused
Not printed
Names

Senate journal

Names were not printed. No individual positions are inferred.

Sources

Senator Perry moved that Senate Rule 7.18 and the Constitutional Rule requiring bills to be read on three several days be suspended and that HB 4099 be placed on its third reading and final passage. The motion prevailed by the following vote: Yeas 31, Nays 0.

Published stock of positions for this vote, except where marked derived.

  • Yea: 31 (published)
  • Nay: 0 (published)
  • Present, not voting: Not printed
  • Absent: Not printed
  • Excused: Not printed

Senate journal. Source snapshot 2026-10-19, Central time.

Senate May 28, 2025

Yea
Not printed
Nay
Not printed
Present, not voting
Not printed
Absent
Not printed
Excused
Not printed
Names

Senate journal

Names were not printed. No individual positions are inferred.

Voice vote. No numeric tally or individual yeas are inferred.

Sources

The bill was read second time and was passed to third reading by a viva voce vote.

Published stock of positions for this vote, except where marked derived.

  • Yea: Not printed
  • Nay: Not printed
  • Present, not voting: Not printed
  • Absent: Not printed
  • Excused: Not printed

Senate journal. Source snapshot 2026-10-19, Central time.

House May 16, 2025

Yea
99
Nay
15
Present, not voting
2
Absent
9
Excused
25
Names

Named positions matched to lawmakers. See the journal for unmatched names.

House journal

Sources

Record 2842

HB 4099 was passed by (Record 2842): 99 Yeas, 15 Nays, 2 Present, not voting.

Published stock of positions for this vote, except where marked derived.

  • Yea: 99 (published)
  • Nay: 15 (published)
  • Present, not voting: 2 (published)
  • Absent: 9 (derived from named list)
  • Excused: 25 (derived from named list)

House journal. Source snapshot 2026-10-19, Central time.

House May 15, 2025

Yea
117
Nay
14
Present, not voting
2
Absent
8
Excused
9
Names

Named positions matched to lawmakers. See the journal for unmatched names.

House journal

Sources

Record 2726

CSHB 4099 was passed to engrossment by (Record 2726): 117 Yeas, 14 Nays, 2 Present, not voting.

Published stock of positions for this vote, except where marked derived.

  • Yea: 117 (published)
  • Nay: 14 (published)
  • Present, not voting: 2 (published)
  • Absent: 8 (derived from named list)
  • Excused: 9 (derived from named list)

House journal. Source snapshot 2026-10-19, Central time.

House May 15, 2025

Yea
42
Nay
64
Present, not voting
2
Absent
33
Excused
9
Names

Named positions matched to lawmakers. See the journal for unmatched names.

House journal

Sources

Record 2725

The request was not granted by (Record 2725): 42 Yeas, 64 Nays, 2 Present, not voting.

Published stock of positions for this vote, except where marked derived.

  • Yea: 42 (published)
  • Nay: 64 (published)
  • Present, not voting: 2 (published)
  • Absent: 33 (derived from named list)
  • Excused: 9 (derived from named list)

House journal. Source snapshot 2026-10-19, Central time.

Witnesses33
For
17
Against
16
On
0
Names

For

  • Coalition of Texans with Disabilities1 registration
  • Combined Law Enforcement Associations of Texas (CLEAT)2 registrations
  • Concentra1 registration
  • Make Texans Healthy Again1 registration
  • R Street Institute2 registrations
  • Self4 registrations
  • Self; Americans for Prosperity1 registration
  • Self; Americans for prosperity1 registration
  • Self; Texas Physical Therapy Association1 registration
  • Self; The LIBRE Initiative2 registrations
  • Texas physical therapy association1 registration

Against

  • Self3 registrations
  • Self; Texas Academy of Family Physicians1 registration
  • Self; Texas Medical Association2 registrations
  • Self; Texas Medical Association, Texas Chapter of the American College of Physicians Services1 registration
  • Texas Chapter American College of Physicians2 registrations
  • Texas College of Emergency Physicians1 registration
  • Texas Orthopaedic Association2 registrations
  • Texas Osteopathic Medical Association1 registration
  • Texas Pediatric Society1 registration
  • Texas Radiological Society1 registration
  • Texas Society of Eye Physicians and Surgeons1 registration
Sources

33 parsed registrations across the loaded witness lists.

Derived stock of witness registrations. Repeated appearances count separately. Organizations and self-representation appear as printed.

House witness list. Source snapshot 2026-10-20, Central time.

Senate witness list. Source snapshot 2026-10-20, Central time.

Fiscal

No significant fiscal implication to the State is anticipated.

LBB estimate · fiscal note version E · source

Sources

Fiscal note · version E · May 20, 2025

No first-year general revenue figure available here.

LBB published estimates · flow over the stated periods.

Source snapshot 2026-10-19, Central time.

How this was graded

Analysis of text version I by claude-opus-5-5, Oct 20, 2026, against the published rubric.

FILED BEFORE

Filed 2 times: 88R and 89R. Checked against 88R only.

88R HB 4291

by Rep. Swanson, different lead author · Died in committee · same text

Introduced text

Last action, Mar 21, 2023: Referred to Public Health

Relating to the treatment of a patient by a physical therapist without a referral.

Caption, 88R bill history

Sources

Texas House · Filed Mar 7, 2025

06/20/2025 E Effective on 9/1/25

Texas Legislature Online · Introduced · House Committee Report · Engrossed · Senate Committee Report · Enrolled

Data snapshot Oct 26, 2026 at 6:51 AM CDT. Grades, charges, quotes and corrections follow the published record.

Coauthors
Daniel AldersRHouse 6 Keith BellRHouse 4 Benjamin BumgarnerRHouse 63 Briscoe CainRHouse 128 Giovanni CapriglioneRHouse 98 David CookRHouse 96 Tom CraddickRHouse 82 Charles CunninghamRHouse 127 Pat CurryRHouse 56 Harold V. Dutton Jr.DHouse 142 James FrankRHouse 69 Gary GatesRHouse 28 Stan GerdesRHouse 17 Ryan GuillenRHouse 31 Janis HoltRHouse 18 Andy HopperRHouse 64 Carrie IsaacRHouse 73 Helen KerwinRHouse 58 Stan KitzmanRHouse 85 Terri Leo WilsonRHouse 23 Mitch LittleRHouse 65 AJ LouderbackRHouse 30 David LoweRHouse 91 J. M. LozanoRHouse 43 Shelley LutherRHouse 62 Christian ManuelDHouse 22 Terry MezaDHouse 105 Brent MoneyRHouse 2 Candy NobleRHouse 89 Claudia OrdazDHouse 79 Jared PattersonRHouse 106 Katrina PiersonRHouse 33 Richard Peña RaymondDHouse 42 Keresa RichardsonRHouse 61 Ana-María Rodríguez RamosDHouse 102 Joanne ShofnerRHouse 11 Valoree SwansonRHouse 150 Tony TinderholtRHouse 94 Steve TothRHouse 15 Ellen TroxclairRHouse 19 Erin ZwienerDHouse 45
Sponsors
Charles PerryRSenate 28
Cosponsors
César BlancoDSenate 29 José MenéndezDSenate 26

House committee · Public Health · Committee vote 8 aye, 3 nay, 2 absent · Out of committee

Senate committee · Health & Human Services · Committee vote 8 aye, 0 nay, 1 absent · Out of committee

Companion

SB 157 by Menéndez (similar)

SB 671 by Hughes (similar)

Subjects

Occupational Regulation--Health Occupations

PHYSICAL THERAPISTS

BOARD OF PHYSICAL THERAPY EXAMINERS, TEXAS

Text

The text as introduced · 163 words

By: Harris Davila
H.B. No. 4099

A BILL TO BE ENTITLED

AN ACT

relating to the treatment of a patient by a physical therapist

without a referral.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Sections 453.301(a-1) and (b), Occupations Code,

are amended to read as follows:

(a-1) A [ Except as provided by Subsection (a-2), a ] physical

therapist may treat a patient under Subsection (a) for not more than

30 [ 10 ] consecutive calendar business days.

(b) The physical therapist must obtain a referral from a

referring practitioner before the physical therapist may continue

treatment that exceeds treatment authorized under Subsection (a-1)

[ or (a-2), as applicable ].

SECTION 2. Section 453.301(a-2), Occupations Code, is

repealed.

SECTION 3. Not later than December 1, 2025, the Texas Board

of Physical Therapy Examiners shall adopt rules necessary to

implement Section 453.301, Occupations Code, as amended by this

Act.

SECTION 4. This Act takes effect September 1, 2025.