82R23113 AJZ-D
By: Truitt H.B. No. 3611
Substitute the following for H.B. No. 3611:
By: Kolkhorst C.S.H.B. No. 3611
A BILL TO BE ENTITLED
AN ACT
relating to the administration of medication for persons with
intellectual and developmental disabilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 161, Human Resources Code, is amended by
adding Subchapter D-1 to read as follows:
SUBCHAPTER D-1. ADMINISTRATION OF MEDICATION FOR CLIENTS WITH
INTELLECTUAL AND DEVELOPMENTAL DISABILITIES
Sec. 161.091. DEFINITIONS. In this subchapter:
(1) "Administration of medication" means:
(A) removing a unit or dose of medication from a
previously dispensed, properly labeled container;
(B) verifying the medication with the medication
order;
(C) giving the proper medication in the proper
dosage to the proper client at the proper time by the proper
administration route; and
(D) recording the time of administration and
dosage administered.
(2) "Client" means a person with an intellectual and
developmental disability who is receiving services from a facility
or program listed in Section 161.092.
(3) "Unlicensed person" means an individual not
licensed as a health care provider who provides services at or for a
facility or program listed in Section 161.092, including:
(A) a nurse aide, orderly, assistant, attendant,
technician, home health aide, medication aide with a permit issued
by a state agency, or other individual who provides personal health
care-related services;
(B) a person who is monetarily compensated to
perform certain health-related tasks and functions in a
complementary or assistive role to a licensed nurse who provides
direct client care or performs common nursing functions;
(C) a person who performs those tasks and
functions as a volunteer but does not qualify as a friend providing
gratuitous nursing care of the sick under Section 301.004,
Occupations Code; or
(D) a person who is a professional nursing
student who provides care for monetary compensation and not as part
of a formal educational program.
Sec. 161.092. APPLICABILITY. This subchapter applies only
to administration of medication provided to certain persons with
intellectual and developmental disabilities who are served:
(1) in a small facility with not less than one and not
more than eight beds that is licensed or certified under Chapter
252, Health and Safety Code;
(2) in a medium facility with not less than nine and
not more than 13 beds that is licensed or certified under Chapter
252, Health and Safety Code; or
(3) by one of the following Section 1915(c) waiver
programs administered by the Department of Aging and Disability
Services to serve persons with intellectual and developmental
disabilities:
(A) the Home and Community-Based Services waiver
program; or
(B) the Texas Home Living waiver program.
Sec. 161.093. ADMINISTRATION OF MEDICATION. (a)
Notwithstanding other law, an unlicensed person may provide
administration of medication to a client without the requirement
that a registered nurse delegate or oversee each administration if:
(1) the medication is:
(A) an oral medication;
(B) a topical medication; or
(C) a metered dose inhaler;
(2) the medication is administered to the client for a
stable or predictable condition;
(3) the client has been personally assessed by a
registered nurse initially and in response to significant changes
in the client's health status, and the registered nurse has
determined that the client's health status permits the
administration of medication by an unlicensed person; and
(4) the unlicensed person has been:
(A) trained by a registered nurse or licensed
vocational nurse under the direction of a registered nurse
regarding proper administration of medication; or
(B) determined to be competent by a registered
nurse or licensed vocational nurse under the direction of a
registered nurse regarding proper administration of medication,
including through a demonstration of proper technique by the
unlicensed person.
(b) The administration of medication other than the
medications described by Subsection (a)(1) is subject to the rules
of the Texas Board of Nursing regarding the delegation of nursing
tasks to unlicensed persons in independent living environments such
as the facilities and programs listed in Section 161.092.
Sec. 161.094. DEPARTMENT DUTIES. (a) The department shall
ensure that:
(1) administration of medication by an unlicensed
person under this subchapter is reviewed at least annually and
after any significant change in a client's condition by a
registered nurse or a licensed vocational nurse under the
supervision of a registered nurse; and
(2) a facility or program listed in Section 161.092
has policies to ensure that the determination of whether an
unlicensed person may provide administration of medication to a
client under Section 161.093 may be made only by a registered nurse.
(b) The department shall verify that:
(1) each client is assessed to identify the client's
needs and abilities regarding the client's medications;
(2) the administration of medication by an unlicensed
person to a client is performed only by an unlicensed person who is
authorized to perform that administration under Section 161.093;
and
(3) the administration of medication to each client is
performed in such a manner as to ensure the greatest degree of
independence, including the use of an adaptive or assistive aid,
device, or strategy as allowed under program rules.
(c) The department shall enforce this subchapter.
Sec. 161.095. LIABILITY. (a) A registered nurse
performing a client assessment required under Section 161.093, or a
registered nurse or licensed vocational nurse training an
unlicensed person or determining whether an unlicensed person is
competent to perform administration of medication under Section
161.093, may be held accountable or civilly liable only in relation
to whether the nurse properly:
(1) performed the assessment;
(2) conducted the training; and
(3) determined whether the unlicensed person is
competent to provide administration of medication to clients.
(b) The Texas Board of Nursing may take disciplinary action
against a registered nurse or licensed vocational nurse under this
subchapter only in relation to whether:
(1) the registered nurse properly performed the client
assessment required by Section 161.093;
(2) the registered nurse or licensed vocational nurse
properly trained the unlicensed person in the administration of
medication; and
(3) the registered nurse or licensed vocational nurse
properly determined whether an unlicensed person is competent to
provide administration of medication to clients.
(c) A registered nurse or licensed vocational nurse may not
be held accountable or civilly liable for the acts or omissions of
an unlicensed person performing administration of medication.
Sec. 161.096. CONFLICT WITH OTHER LAW. This subchapter
controls to the extent of a conflict with other law.
SECTION 2. (a) The Texas Board of Nursing and the Texas
Department of Aging and Disability Services shall conduct a pilot
program to evaluate licensed vocational nurses providing on-call
services by telephone to clients, as defined by Section 161.091,
Human Resources Code, as added by this Act, who are under the care
of the licensed vocational nurses. The licensed vocational nurses
shall use standardized and validated protocols or decision trees in
performing telephone on-call services in the pilot program. The
department shall collect data to evaluate the efficacy of licensed
vocational nurses performing telephone on-call services in the
pilot program. The pilot program must begin not later than
September 1, 2011, and must end on August 31, 2012.
(b) The Texas Board of Nursing and the Department of Aging
and Disability Services, in consultation with affected
stakeholders, including public and private providers, registered
and licensed vocational nurses employed by the facilities or
providers of services listed in Section 161.092, Human Resources
Code, as added by this Act, and other persons or entities the
executive director of the board and the commissioner of the
department consider appropriate, shall:
(1) develop the goals and measurable outcomes of the
pilot program;
(2) review the outcomes of the pilot program and make
recommendations regarding potential regulatory or statutory
changes; and
(3) on notice of unsafe or ineffective nursing care
discovered in the pilot program, review the data or the outcomes and
make recommendations for corrective action.
(c) Not later than December 1, 2012, the Texas Board of
Nursing and the Department of Aging and Disability Services shall
submit a report detailing the findings of the pilot program and any
jointly developed recommendations to the Senate Committee on Health
and Human Services and the House Committee on Public Health.
(d) This section expires September 1, 2013.
SECTION 3. In developing any policies, processes, or
training curriculum required by Subchapter D-1, Chapter 161, Human
Resources Code, as added by this Act, the Texas Department of Aging
and Disability Services shall convene an advisory committee of
affected stakeholders, including public and private providers and
registered and licensed vocational nurses employed by the
facilities or providers of services listed in Section 161.092,
Human Resources Code, as added by this Act, and other persons or
entities the department considers appropriate.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2011.