Texas 2009 - 81st Regular

Texas House Bill HB800 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R5723 YDB-F
2	2	By: Orr H.B. No. 800
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a physician's delegation of prescriptive authority to
8	8	physician assistants or advanced practice nurses.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 157.0511(b) and (b-1), Occupations
11	11	Code, are amended to read as follows:
12	12	(b) A physician may delegate the carrying out or signing of
13	13	a prescription drug order for a controlled substance only if:
14	14	(1) the prescription is for a controlled substance
15	15	listed in Schedule [Schedules] III, IV, or V as established by the
16	16	commissioner of public health under Chapter 481, Health and Safety
17	17	Code;
18	18	(2) the prescription, including a refill of the
19	19	prescription, is for a period not to exceed 90 [30] days;
20	20	(3) with regard to the refill of a prescription, the
21	21	refill is authorized after consultation with the delegating
22	22	physician and the consultation is noted in the patient's chart; and
23	23	(4) with regard to a prescription for a child less than
24	24	two years of age, the prescription is made after consultation with
25	25	the delegating physician and the consultation is noted in the
26	26	patient's chart.
27	27	(b-1) The board shall adopt rules that require a physician
28	28	who delegates the carrying out or signing of a prescription drug
29	29	order under this subchapter to register with the board the name and
30	30	license number of the physician assistant or advanced practice
31	31	nurse [maintain records that show when and] to whom a delegation is
32	32	made. The board may develop and use an electronic online delegation
33	33	registration process for registration under this subsection
34	34	[access the physician's records under this subsection as necessary
35	35	for an investigation].
36	36	SECTION 2. Sections 157.053(a) and (e), Occupations Code,
37	37	are amended to read as follows:
38	38	(a) In this section, "primary practice site" means:
39	39	(1) the practice location of a physician at which the
40	40	physician spends the majority of the physician's time;
41	41	(2) a licensed hospital, a licensed long-term care
42	42	facility, or a licensed adult care center where both the physician
43	43	and the physician assistant or advanced practice nurse are
44	44	authorized to practice;
45	45	(3) a clinic operated by or for the benefit of a public
46	46	school district to provide care to the students of that district and
47	47	the siblings of those students, if consent to treatment at that
48	48	clinic is obtained in a manner that complies with Chapter 32, Family
49	49	Code;
50	50	(4) the residence of an established patient; [or]
51	51	(5) another location at which the physician is
52	52	physically present with the physician assistant or advanced
53	53	practice nurse; or
54	54	(6) a practice location providing care for established
55	55	patients for a physician assistant or advanced practice nurse who
56	56	practices on-site with the physician more than 50 percent of the
57	57	time.
58	58	(e) A physician's authority to delegate the carrying out or
59	59	signing of a prescription drug order is limited to:
60	60	(1) three physician assistants or advanced practice
61	61	nurses or their full-time equivalents practicing at the physician's
62	62	primary practice site or at an alternate practice site under
63	63	Section 157.0541 unless a waiver is granted under Section
64	64	157.0542(b-1); and
65	65	(2) the patients with whom the physician has
66	66	established or will establish a physician-patient relationship.
67	67	SECTION 3. Sections 157.0541(a), (c), and (e), Occupations
68	68	Code, are amended to read as follows:
69	69	(a) In this section, "alternate site" means a practice site:
70	70	(1) where services similar to the services provided at
71	71	the delegating physician's primary practice site are provided; and
72	72	(2) located within 75 [60] miles of the delegating
73	73	physician's residence or primary practice site.
74	74	(c) Physician supervision is adequate for the purposes of
75	75	this section if the delegating physician:
76	76	(1) is on-site with the advanced practice nurse or
77	77	physician assistant at least 10 [20] percent of the hours of
78	78	operation of the site each month that the physician assistant or
79	79	advanced practice nurse is acting with delegated prescriptive
80	80	authority, is available while on-site to see, diagnose, treat, and
81	81	provide care to those patients for services provided or to be
82	82	provided by the physician assistant or advanced practice nurse to
83	83	whom the physician has delegated prescriptive authority, and is not
84	84	prohibited by contract from seeing, diagnosing, or treating a
85	85	patient for services provided or to be provided by the physician
86	86	assistant or advanced practice nurse under delegated prescriptive
87	87	authority [time];
88	88	(2) reviews at least 10 percent of the medical charts,
89	89	including through electronic review of the charts from a remote
90	90	location, for each advanced practice nurse or physician assistant
91	91	at the site; and
92	92	(3) is available through direct telecommunication for
93	93	consultation, patient referral, or assistance with a medical
94	94	emergency.
95	95	(e) Unless a waiver is granted under Section 157.0542(b-1),
96	96	the [The] combined number of advanced practice nurses and physician
97	97	assistants to whom a physician may delegate under this section and
98	98	at a primary practice site under Section 157.053 may not exceed
99	99	three physician assistants or advanced practice nurses or the
100	100	full-time equivalent of three physician assistants or advanced
101	101	practice nurses.
102	102	SECTION 4. Section 157.0542, Occupations Code, is amended
103	103	by adding Subsections (b-1), (b-2), and (b-3) to read as follows:
104	104	(b-1) If the board determines that the types of health care
105	105	services provided by a physician assistant or advanced practice
106	106	nurse under Section 157.0541 are limited in nature and duration and
107	107	are within the scope of delegated authority under this subchapter,
108	108	as defined by board rule, and that patient health care will not be
109	109	adversely affected, the board may modify or waive:
110	110	(1) the limitation on the number of physician
111	111	assistants or advanced practice nurses, or their full-time
112	112	equivalents, if the board does not authorize more than six
113	113	physician assistants or advanced practice nurses or their full-time
114	114	equivalents;
115	115	(2) the mileage limitation; or
116	116	(3) the on-site supervision requirements, except that
117	117	the physician must be available on-site at regular intervals and
118	118	when on-site the physician must be available to treat patients.
119	119	(b-2) A modification or waiver granted under this section
120	120	may not validate or authorize a contract provision that prohibits a
121	121	physician from seeing, diagnosing, or treating any patient.
122	122	(b-3) In granting a modification or waiver under Subsection
123	123	(b-1), the board may not limit the delegation authority of the
124	124	physician to requirements less stringent than the requirements
125	125	established under Section 157.0541(a)(2) or Section 157.0541(e) or
126	126	more stringent than the requirements established under Section
127	127	157.0541(c)(1).
128	128	SECTION 5. Subchapter B, Chapter 157, Occupations Code, is
129	129	amended by adding Section 157.0543 to read as follows:
130	130	Sec. 157.0543. VOLUNTARY CHARITY CARE AT NONPROFIT CLINIC.
131	131	(a) A physician may delegate the carrying out or signing of a
132	132	prescription drug order to a physician assistant or advanced
133	133	practice nurse who:
134	134	(1) has delegation authority under Section 157.052,
135	135	157.053, 157.054, or 157.0541; and
136	136	(2) provides without remuneration and in accordance
137	137	with board rules voluntary charity health care services at a clinic
138	138	run by or sponsored by a nonprofit organization.
139	139	(b) A delegation under this section does not require
140	140	additional on-site supervision or chart review.
141	141	SECTION 6. Not later than January 31, 2010, the Texas
142	142	Medical Board shall adopt the rules necessary to implement Chapter
143	143	157, Occupations Code, as amended by this Act.
144	144	SECTION 7. The changes in law made by this Act apply only to
145	145	a physician's delegation of prescriptive authority made on or after
146	146	February 1, 2010.
147	147	SECTION 8. This Act takes effect September 1, 2009.