Texas 2009 - 81st Regular

Texas Senate Bill SB532 Compare Versions

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1	1	S.B. No. 532
2	2
3	3
4	4	AN ACT
5	5	relating to a physician's delegation of prescriptive authority to
6	6	physician assistants or advanced practice nurses.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Subsections (b) and (b-1), Section 157.0511,
9	9	Occupations Code, are amended to read as follows:
10	10	(b) A physician may delegate the carrying out or signing of
11	11	a prescription drug order for a controlled substance only if:
12	12	(1) the prescription is for a controlled substance
13	13	listed in Schedule [Schedules] III, IV, or V as established by the
14	14	commissioner of public health under Chapter 481, Health and Safety
15	15	Code;
16	16	(2) the prescription, including a refill of the
17	17	prescription, is for a period not to exceed 90 [30] days;
18	18	(3) with regard to the refill of a prescription, the
19	19	refill is authorized after consultation with the delegating
20	20	physician and the consultation is noted in the patient's chart; and
21	21	(4) with regard to a prescription for a child less than
22	22	two years of age, the prescription is made after consultation with
23	23	the delegating physician and the consultation is noted in the
24	24	patient's chart.
25	25	(b-1) The board shall adopt rules that require a physician
26	26	who delegates the carrying out or signing of a prescription drug
27	27	order under this subchapter to register with the board the name and
28	28	license number of the physician assistant or advanced practice
29	29	nurse [maintain records that show when and] to whom a delegation is
30	30	made. The board may develop and use an electronic online delegation
31	31	registration process for registration under this subsection
32	32	[access the physician's records under this subsection as necessary
33	33	for an investigation].
34	34	SECTION 2. Subsections (a) and (e), Section 157.053,
35	35	Occupations Code, are amended to read as follows:
36	36	(a) In this section, "primary practice site" means:
37	37	(1) the practice location of a physician at which the
38	38	physician spends the majority of the physician's time;
39	39	(2) a licensed hospital, a licensed long-term care
40	40	facility, or a licensed adult care center where both the physician
41	41	and the physician assistant or advanced practice nurse are
42	42	authorized to practice;
43	43	(3) a clinic operated by or for the benefit of a public
44	44	school district to provide care to the students of that district and
45	45	the siblings of those students, if consent to treatment at that
46	46	clinic is obtained in a manner that complies with Chapter 32, Family
47	47	Code;
48	48	(4) the residence of an established patient; [or]
49	49	(5) another location at which the physician is
50	50	physically present with the physician assistant or advanced
51	51	practice nurse; or
52	52	(6) a location where a physician assistant or advanced
53	53	practice nurse who practices on-site with the physician more than
54	54	50 percent of the time and in accordance with board rules provides:
55	55	(A) health care services for established
56	56	patients;
57	57	(B) without remuneration, voluntary charity
58	58	health care services at a clinic run or sponsored by a nonprofit
59	59	organization; or
60	60	(C) without remuneration, voluntary health care
61	61	services during a declared emergency or disaster at a temporary
62	62	facility operated or sponsored by a governmental entity or
63	63	nonprofit organization and established to serve persons in this
64	64	state.
65	65	(e) A physician's authority to delegate the carrying out or
66	66	signing of a prescription drug order is limited to:
67	67	(1) four [three] physician assistants or advanced
68	68	practice nurses or their full-time equivalents practicing at the
69	69	physician's primary practice site or at an alternate practice site
70	70	under Section 157.0541 unless a waiver is granted under Section
71	71	157.0542(b-1); and
72	72	(2) the patients with whom the physician has
73	73	established or will establish a physician-patient relationship.
74	74	SECTION 3. Subsection (b), Section 157.054, Occupations
75	75	Code, is amended to read as follows:
76	76	(b) A physician's authority to delegate under Subsection
77	77	(a) is limited as follows:
78	78	(1) the delegation must be made under a physician's
79	79	order, standing medical order, standing delegation order, or
80	80	another order or protocol developed in accordance with policies
81	81	approved by the facility's medical staff or a committee of the
82	82	facility's medical staff as provided by the facility bylaws;
83	83	(2) the delegation must occur in the facility in which
84	84	the physician is the medical director, the chief of medical staff,
85	85	the chair of the credentialing committee, or a department chair;
86	86	(3) the delegation may not permit the carrying out or
87	87	signing of prescription drug orders for the care or treatment of the
88	88	patients of any other physician without the prior consent of that
89	89	physician;
90	90	(4) delegation in a long-term care facility must be by
91	91	the medical director and is limited to the carrying out and signing
92	92	of prescription drug orders to not more than four [three] advanced
93	93	practice nurses or physician assistants or their full-time
94	94	equivalents; and
95	95	(5) a physician may not delegate at more than one
96	96	licensed hospital or more than two long-term care facilities unless
97	97	approved by the board.
98	98	SECTION 4. Subsections (a), (c), and (e), Section 157.0541,
99	99	Occupations Code, are amended to read as follows:
100	100	(a) In this section, "alternate site" means a practice site:
101	101	(1) where services similar to the services provided at
102	102	the delegating physician's primary practice site are provided; and
103	103	(2) located within 75 [60] miles of the delegating
104	104	physician's residence or primary practice site.
105	105	(c) Physician supervision is adequate for the purposes of
106	106	this section if [the delegating physician]:
107	107	(1) the delegating physician:
108	108	(A) is on-site with the advanced practice nurse
109	109	or physician assistant at least 10 [20] percent of the hours of
110	110	operation of the site each month that the physician assistant or
111	111	advanced practice nurse is acting with delegated prescriptive
112	112	authority and is available while on-site to see, diagnose, treat,
113	113	and provide care to those patients for services provided or to be
114	114	provided by the physician assistant or advanced practice nurse to
115	115	whom the physician has delegated prescriptive authority; and
116	116	(B) is not prohibited by contract from seeing,
117	117	diagnosing, or treating a patient for services provided or to be
118	118	provided by the physician assistant or advanced practice nurse
119	119	under delegated prescriptive authority [time];
120	120	(2) the delegating physician reviews at least 10
121	121	percent of the medical charts, including through electronic review
122	122	of the charts from a remote location, for each advanced practice
123	123	nurse or physician assistant at the site; and
124	124	(3) the delegating physician is available through
125	125	direct telecommunication for consultation, patient referral, or
126	126	assistance with a medical emergency.
127	127	(e) Unless a waiver is granted under Section 157.0542(b-1),
128	128	the [The] combined number of advanced practice nurses and physician
129	129	assistants to whom a physician may delegate under this section and
130	130	at a primary practice site under Section 157.053 may not exceed four
131	131	[three] physician assistants or advanced practice nurses or the
132	132	full-time equivalent of four [three] physician assistants or
133	133	advanced practice nurses.
134	134	SECTION 5. Section 157.0542, Occupations Code, is amended
135	135	by amending Subsection (a) and adding Subsections (b-1), (b-2), and
136	136	(b-3) to read as follows:
137	137	(a) On determining that the conditions of Subsection (b)
138	138	have been met, the board may waive or modify any of the site or
139	139	supervision requirements for a physician to delegate the carrying
140	140	out or signing of prescription drug orders to an advanced practice
141	141	nurse or physician assistant under Sections 157.052, 157.053,
142	142	157.054, and 157.0541, or under board rules. The board may not
143	143	waive the limitation on the number of primary or alternate practice
144	144	sites at which a physician may delegate the carrying out or signing
145	145	of prescription drug orders or the number of advanced practice
146	146	nurses or physician assistants to whom a physician may delegate the
147	147	carrying out or signing of prescription drug orders, except as
148	148	provided by Subsection (b-1)(1).
149	149	(b-1) If the board determines that the types of health care
150	150	services provided by a physician assistant or advanced practice
151	151	nurse under Section 157.0541 are limited in nature and duration and
152	152	are within the scope of delegated authority under this subchapter,
153	153	as defined by board rule, and that patient health care will not be
154	154	adversely affected, the board may modify or waive:
155	155	(1) the limitation on the number of physician
156	156	assistants or advanced practice nurses, or their full-time
157	157	equivalents, if the board does not authorize more than six
158	158	physician assistants or advanced practice nurses or their full-time
159	159	equivalents;
160	160	(2) the mileage limitation; or
161	161	(3) the on-site supervision requirements, except that
162	162	the physician must be available on-site at regular intervals and
163	163	when on-site the physician must be available to treat patients.
164	164	(b-2) A modification or waiver granted under this section
165	165	may not validate or authorize a contract provision that prohibits a
166	166	physician from seeing, diagnosing, or treating any patient.
167	167	(b-3) In granting a modification or waiver under Subsection
168	168	(b-1), the board may not limit the authority of the physician to
169	169	delegate to less than the requirements established under Section
170	170	157.0541(a)(2) or Section 157.0541(e) or greater than the
171	171	requirements established under Section 157.0541(c)(1)(A).
172	172	SECTION 6. Subsection (f), Section 157.059, Occupations
173	173	Code, is amended to read as follows:
174	174	(f) The authority of a physician to delegate under this
175	175	section is limited to:
176	176	(1) four [three] nurse midwives or physician
177	177	assistants or their full-time equivalents; and
178	178	(2) the designated facility at which the nurse midwife
179	179	or physician assistant provides care.
180	180	SECTION 7. Not later than January 31, 2010, the Texas
181	181	Medical Board shall adopt the rules necessary to implement Chapter
182	182	157, Occupations Code, as amended by this Act.
183	183	SECTION 8. This Act takes effect September 1, 2009.
184	184	______________________________ ______________________________
185	185	President of the Senate Speaker of the House
186	186	I hereby certify that S.B. No. 532 passed the Senate on
187	187	March 26, 2009, by the following vote: Yeas 31, Nays 0; and that
188	188	the Senate concurred in House amendments on May 28, 2009, by the
189	189	following vote: Yeas 31, Nays 0.
190	190	______________________________
191	191	Secretary of the Senate
192	192	I hereby certify that S.B. No. 532 passed the House, with
193	193	amendments, on May 20, 2009, by the following vote: Yeas 145,
194	194	Nays 0, two present not voting.
195	195	______________________________
196	196	Chief Clerk of the House
197	197	Approved:
198	198	______________________________
199	199	Date
200	200	______________________________
201	201	Governor