By: Patrick S.B. No. 532
A BILL TO BE ENTITLED
AN ACT
relating to a physician's delegation of prescriptive authority to
physician assistants or advanced practice nurses.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsections (b) and (b-1), Section 157.0511,
Occupations Code, are amended to read as follows:
(b) A physician may delegate the carrying out or signing of
a prescription drug order for a controlled substance only if:
(1) the prescription is for a controlled substance
listed in Schedule [Schedules] III, IV, or V as established by the
commissioner of public health under Chapter 481, Health and Safety
Code;
(2) the prescription, including a refill of the
prescription, is for a period not to exceed 90 [30] days;
(3) with regard to the refill of a prescription, the
refill is authorized after consultation with the delegating
physician and the consultation is noted in the patient's chart; and
(4) with regard to a prescription for a child less than
two years of age, the prescription is made after consultation with
the delegating physician and the consultation is noted in the
patient's chart.
(b-1) The board shall adopt rules that require a physician
who delegates the carrying out or signing of a prescription drug
order under this subchapter to register with the board the name and
license number of the physician assistant or advanced practice
nurse [maintain records that show when and] to whom a delegation is
made. The board may develop and use an electronic online delegation
registration process for registration under this subsection
[access the physician's records under this subsection as necessary
for an investigation].
SECTION 2. Subsections (a) and (e), Section 157.053,
Occupations Code, are amended to read as follows:
(a) In this section, "primary practice site" means:
(1) the practice location of a physician at which the
physician spends the majority of the physician's time;
(2) a licensed hospital, a licensed long-term care
facility, or a licensed adult care center where both the physician
and the physician assistant or advanced practice nurse are
authorized to practice;
(3) a clinic operated by or for the benefit of a public
school district to provide care to the students of that district and
the siblings of those students, if consent to treatment at that
clinic is obtained in a manner that complies with Chapter 32, Family
Code;
(4) the residence of an established patient; [or]
(5) another location at which the physician is
physically present with the physician assistant or advanced
practice nurse; or
(6) a practice location providing care for established
patients for a physician assistant or advanced practice nurse who
practices on-site with the physician more than 50 percent of the
time.
(e) A physician's authority to delegate the carrying out or
signing of a prescription drug order is limited to:
(1) three physician assistants or advanced practice
nurses or their full-time equivalents practicing at the physician's
primary practice site or at an alternate practice site under
Section 157.0541 unless a waiver is granted under Section
157.0542(b-1); and
(2) the patients with whom the physician has
established or will establish a physician-patient relationship.
SECTION 3. Subsections (a), (c), and (e), Section 157.0541,
Occupations Code, are amended to read as follows:
(a) In this section, "alternate site" means a practice site:
(1) where services similar to the services provided at
the delegating physician's primary practice site are provided; and
(2) located within 75 [60] miles of the delegating
physician's residence or primary practice site.
(c) Physician supervision is adequate for the purposes of
this section if the delegating physician:
(1) is on-site with the advanced practice nurse or
physician assistant at least 10 [20] percent of the hours of
operation of the site each month that the physician assistant or
advanced practice nurse is acting with delegated prescriptive
authority, is available while on-site to see, diagnose, treat, and
provide care to those patients for services provided or to be
provided by the physician assistant or advanced practice nurse to
whom the physician has delegated prescriptive authority, and is not
prohibited by contract from seeing, diagnosing, or treating a
patient for services provided or to be provided by the physician
assistant or advanced practice nurse under delegated prescriptive
authority [time];
(2) reviews at least 10 percent of the medical charts,
including through electronic review of the charts from a remote
location, for each advanced practice nurse or physician assistant
at the site; and
(3) is available through direct telecommunication for
consultation, patient referral, or assistance with a medical
emergency.
(e) Unless a waiver is granted under Section 157.0542(b-1),
the [The] combined number of advanced practice nurses and physician
assistants to whom a physician may delegate under this section and
at a primary practice site under Section 157.053 may not exceed
three physician assistants or advanced practice nurses or the
full-time equivalent of three physician assistants or advanced
practice nurses.
SECTION 4. Section 157.0542, Occupations Code, is amended
by adding Subsections (b-1), (b-2), and (b-3) to read as follows:
(b-1) If the board determines that the types of health care
services provided by a physician assistant or advanced practice
nurse under Section 157.0541 are limited in nature and duration and
are within the scope of delegated authority under this subchapter,
as defined by board rule, and that patient health care will not be
adversely affected, the board may modify or waive:
(1) the limitation on the number of physician
assistants or advanced practice nurses, or their full-time
equivalents, if the board does not authorize more than six
physician assistants or advanced practice nurses or their full-time
equivalents;
(2) the mileage limitation; or
(3) the on-site supervision requirements, except that
the physician must be available on-site at regular intervals and
when on-site the physician must be available to treat patients.
(b-2) A modification or waiver granted under this section
may not validate or authorize a contract provision that prohibits a
physician from seeing, diagnosing, or treating any patient.
(b-3) In granting a modification or waiver under Subsection
(b-1), the board may not limit the delegation authority of the
physician to requirements less stringent than the requirements
established under Section 157.0541(a)(2) or Section 157.0541(e) or
more stringent than the requirements established under Section
157.0541(c)(1).
SECTION 5. Subchapter B, Chapter 157, Occupations Code, is
amended by adding Section 157.0543 to read as follows:
Sec. 157.0543. VOLUNTARY CHARITY CARE AT NONPROFIT CLINIC.
(a) A physician may delegate the carrying out or signing of a
prescription drug order to a physician assistant or advanced
practice nurse who:
(1) has delegation authority under Section 157.052,
157.053, 157.054, or 157.0541; and
(2) provides without remuneration and in accordance
with board rules voluntary charity health care services at a clinic
run by or sponsored by a nonprofit organization.
(b) A delegation under this section does not require
additional on-site supervision or chart review.
SECTION 6. Not later than January 31, 2010, the Texas
Medical Board shall adopt the rules necessary to implement Chapter
157, Occupations Code, as amended by this Act.
SECTION 7. The changes in law made by this Act apply only to
a physician's delegation of prescriptive authority made on or after
February 1, 2010.
SECTION 8. This Act takes effect September 1, 2009.