By: Nelson S.B. No. 406
A BILL TO BE ENTITLED
AN ACT
relating to the delegation and supervision of prescriptive
authority by physicians to certain advanced practice registered
nurses and physician assistants.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subchapter B, Chapter 157,
Occupations Code, is amended to read as follows:
SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE REGISTERED NURSES
AND PHYSICIAN ASSISTANTS
SECTION 2. Section 157.051, Occupations Code, is amended to
read as follows:
(1) "Advanced practice registered nurse" has the
meaning assigned to that term by Section 301.152. The term includes
an advanced nurse practitioner and advanced practice nurse.
(2) "Carrying out or signing a prescription drug
order" means completing a prescription drug order presigned by the
delegating physician, or the signing of a prescription by a
registered nurse or physician assistant.
(2-a) "Controlled substance" has the meaning assigned
to that term by Section 481.002, Health and Safety Code.
(2-b3) "Dangerous drug" has the meaning assigned to
that term by Section 483.001, Health and Safety Code.
(2-c4) "Health professional shortage area" means:
(A) an urban or rural area of this state that:
(i) is not required to conform to the
geographic boundaries of a political subdivision but is a rational
area for the delivery of health service;
(ii) the secretary of health and human
services determines has a health professional shortage; and
(iii) is not reasonably accessible to an
adequately served area;
(B) a population group that the secretary of
health and human services determines has a health professional
shortage; or
(C) a public or nonprofit private medical
facility or other facility that the secretary of health and human
services determines has a health professional shortage, as
described by 42 U.S.C. Section 254e(a)(1).
(5) "Hospital" means:
(A) a general hospital or a special hospital, as
those
terms are defined by Section 241.003, including a hospital
maintained or operated by this state; or
(B) a mental hospital licensed under Chapter 577.
(6) "Medication order" has the meaning assigned by
Sections 551.003(24), Occupations Code and 481.002(28), Health and
Safety Code.
(7) "Nonprescription drug" has the meaning assigned by
Section 551.003(25).
(38) "Physician assistant" means a person who holds a
license issued under Chapter 204.
(9) "Physician group practice" means an entity for
which two or more physicians deliver health care to the public
through the practice of medicine on a regular basis and that is:
(A) owned and operated by two or more physicians;
or
(B) a freestanding clinic, center, or office of a
nonprofit health organization certified by the board under Section
162.001(b) that complies with the requirements of Chapter 162.
(10) "Practice serving a medically underserved
population" means:
(A) a practice in a health professional shortage
area;
(B) a clinic designated as a rural health clinic
under 42 U.S.C. Section 1395x(aa);
(C) a public health clinic or a family planning
clinic under contract with the Health and Human Services Commission
or the Texas Department of State Health Services;
(D) a clinic designated as a federally qualified
health clinic under 42 U.S.C. Section 1396d(1)(2)(B); or
(E) a practice:
(i) that is either:
(a) located in an area in which the
Texas Department of State Health Services determines there is an
insufficient number of physicians providing services to eligible
clients of federal, state, or locally funded health care programs;
or
(b) a practice that the Texas
Department of State Health Services determines serves a
disproportionate number of clients eligible to participate in
federal, state, or locally funded health care programs; and
(ii) for which the Texas Department of
State Health Services publishes notice of its determination in the
Texas Register and provides an opportunity for public comment in
the manner provided for a proposed rule under Chapter 2001,
Government Code;
(F) a practice at which a physician was
delegating prescriptive authority to an advanced practice
registered nurse or physician assistant on or before March 1, 2013
based on the practice qualifying as a site serving a medically
underserved population.
(11) "Prescribe or order a drug or device" means
prescribing or ordering a drug or device, including the issuing of a
"prescription drug order" or a "medication order."
(12) "Prescription drug" has the meaning assigned by
Section 551.003(36).
(13) "Prescriptive authority agreement" means an
agreement entered into by a physician and an advanced practice
registered nurse or physician assistant through which the physician
delegates to the advanced practice registered nurse or physician
assistant the act of prescribing or ordering a drug or device.
SECTION 3. Sections 157.0511(a), (b) and (b-1), Occupations
Code, are amended, and a new Section (b-1) is added, to read as
follows:
(a) A physician's authority to delegate the carrying out or
signing of a prescription drug order prescribing and ordering of a
drug or device under this subchapter is limited to:
(1) non prescription drugs;
(2) dangerous drugs; and
(3) controlled substances to the extent provided by
Subsection (b) and (b-1).
(b) Except as provided in (b-1), a A physician may delegate
the carrying out or signing of a prescription drug order
prescribing or ordering of a drug or device for a controlled
substance only if:
(1) the prescription is for a controlled substance
listed in Schedule III, IV, or V as established by the commissioner
of State Health Services under Chapter 481, Health and Safety Code;
(2) the prescription, including a refill of the
prescription, is for a period not to exceed 90 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) A physician may delegate the prescribing or ordering
of a controlled substance listed in Schedule II as established by
the commissioner of state health services under Chapter 481, Health
and Safety Code only:
(1) in a hospital facility-based practice under
Section 157.054 and in accordance with policies approved by the
facility's medical staff or a committee of the facility's medical
staff as provided by the facility bylaws to ensure patient safety;
or
(2) as part of the plan of care, for the treatment of a
person that has executed a written certification of a terminal
illness, has elected to receive hospice care and is receiving
hospice treatment from a qualified hospice provider.
(b-12) The board shall adopt rules that require a physician
who delegates the prescribing or ordering of a drug or device
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 registered nurse to
whom a delegation is made. The board may develop and use an
electronic online delegation registration process for registration
under this subsection.
SECTION 4. Subchapter B, Chapter 157, Occupations Code, is
amended by adding Sections 157.0512, 157.0513, and 157.0514 to read
as follows:
Sec. 157.0512. PRESCRIPTIVE AUTHORITY AGREEMENT.
(a) A physician may delegate to an advanced practice
registered nurse or physician assistant, acting under adequate
physician supervision, the act of prescribing or ordering a drug or
device as authorized through a prescriptive authority agreement
between the physician and the advanced practice registered nurse or
physician assistant, as applicable.
(b) A physician and an advanced practice registered nurse or
physician assistant are eligible to enter into or be a party to a
prescriptive authority agreement only if:
(1) the Texas Board of Nursing has approved the
advanced practice registered nurse's authority to prescribe or
order a drug or device as authorized in this Chapter this
Subchapter;
(2) the advanced practice registered nurse or
physician assistant:
(A) holds an active license to practice in this
state as a registered nurse or physician assistant, as applicable,
and is in good standing in this state; and
(B) is not currently prohibited by the Texas
Board of Nursing or Texas Board of Physician Assistants, as
applicable, from executing a prescriptive authority agreement; and
(3) prior to executing a prescriptive authority
agreement, an advanced practice registered nurse, physician
assistant, and physician must disclose to the other prospective
party any prior disciplinary action by the board, Texas Board of
Nursing, or Texas Board of Physician Assistants, as applicable.
(c) Except as provided in Subsection (d), the combined
number of advanced practice registered nurses and physician
assistants with whom a physician may enter into a prescriptive
authority agreement may not exceed seven advanced practice
registered nurses and physician assistants or the full-time
equivalent of seven advanced practice registered nurses and
physician assistants.
(d) Subsection (c) does not apply to a prescriptive authority
agreement if the prescriptive authority is being exercised in:
(1) a practice serving a medically underserved
population; or
(2) a hospital facility-based practice in a hospital
under Section 157.054.
(e) A prescriptive authority agreement must, at a minimum:
(1) be in writing and signed and dated by the parties
to the agreement;
(2) state the name, address and all professional
license numbers of the parties to the agreement;
(3) state the nature of the practice, practice
locations, or practice settings;
(4) identify the types or categories of drugs or
devices that may be prescribed or the types or categories of drugs
or devices that may not be prescribed;
(5) provide a general plan for addressing consultation
and referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and
sharing of information between the physician and an advanced
practice registered nurse or physician assistant to whom the
physician has delegated prescriptive authority related to the care
and treatment of patients.
(8) if alternate physician supervision is to be
utilized, designate one or more alternate physicians who may
provide appropriate supervision on a temporary basis in accordance
with the requirements established by the prescriptive authority
agreement and the requirements of this Subchapter and who may
participate in the prescriptive authority quality assurance and
improvement plan meetings required under this Section; and
(9) describe a prescriptive authority quality
assurance and improvement plan and specify methods for documenting
the implementation of the plan that includes the following:
(A) chart review with the number of charts
reviewed determined by the physician and advanced practice
registered nurse or physician assistant;
(B) periodic face-to-face meetings of the
advanced practice registered nurse or physician assistant with the
physician at a location determined by the physician and advanced
practice registered nurse or physician assistant. The meetings
shall include:
(i) sharing of information relating to
patients' treatment and care, needed changes in patient care plans,
and issues relating to referrals; and
(ii) discussion of patient care
improvement.
(C) The periodic face-to-face meetings described
in (9)(B) shall be documented and occur:
(i)(a) no less frequently than monthly for
three years beginning on the date of execution of the agreement; and
(b) no less frequently than quarterly
after three years with monthly meetings held between the quarterly
meetings by means of a remote electronic communications system,
including videoconferencing technology or the Internet; or
(ii) if during the seven year period
immediately preceding execution of the prescriptive authority
agreement, the advanced practice registered nurse or physician
assistant was in practice for at least five years that included the
exercise of prescriptive authority with required physician
supervision:
(a) no less frequently than monthly for one
year beginning on the date of execution of the agreement; and (b) no
less frequently than quarterly after one year with monthly meetings
held between the quarterly meetings by means of a remote electronic
communications system, including videoconferencing technology or
the Internet.
(f) The prescriptive authority agreement may include other
provisions agreed to by the physician and advanced practice
registered nurse or physician assistant.
(g) If the parties to the prescriptive authority agreement
practice in a physician group practice, the physician may appoint
one or more alternate supervising physicians designated under
(E)(8) of this Section, if any, to conduct and document the quality
assurance meeting in accordance with the requirements of this
Subchapter.
(h) The prescriptive authority agreement need not describe
the exact steps that an advanced practice registered nurse or
physician assistant must take with respect to each specific
condition, disease, or symptom.
(i) A physician, advanced practice registered nurse, or
physician assistant who is a party to a prescriptive authority
agreement must retain a copy of the agreement until the second
anniversary of the date the agreement is terminated.
(j) A party to a prescriptive authority agreement may not by
contract waive, void, or nullify any provision of this section or
Section 157.0513.
(k) In the event a party to a prescriptive authority
agreement is notified that he or she has become the subject of an
investigation by the board, Texas Board of Nursing, or Texas Board
of Physician Assistants, the individual must immediately notify the
other party to the prescriptive authority agreement.
(l) The prescriptive authority agreement and any amendments
must be reviewed at least annually, dated, and signed by the parties
to the agreement, and made available to the board, Texas Board of
Nursing, or Texas Board of Physician Assistants within three
business days of receipt of request, if any.
(m) The prescriptive authority agreement should promote the
exercise of professional judgment by the advanced practice
registered nurse or physician assistant commensurate with the
advanced practice registered nurse's or physician assistant's
education and experience and the relationship between the advanced
practice registered nurse or physician assistant and physician.
(n) This section shall be liberally construed to allow the
use of prescriptive authority agreements to safely and effectively
utilize the skills and services of advanced practice registered
nurses and physician assistants.
(o) The board may not adopt rules pertaining to the elements
of the prescriptive authority agreement that would impose
requirements in addition to those required under this Section. The
board, Texas Board of Nursing, and Texas Board of Physician
Assistants will jointly develop Frequently Asked Questions (FAQs)
by January 2014.
SECTION 5. Sec. 157.0513. PRESCRIPTIVE AUTHORITY
AGREEMENT: INFORMATION.
(a) The board shall jointly with the Texas Board of Nursing
and the Texas Physician Assistant Board develop a process:
(1) to exchange information regarding the names,
locations, and license numbers of each physician, advanced practice
registered nurse, and physician assistant who has entered into a
prescriptive authority agreement;
(2) by which each board shall immediately notify the
other boards when one of its licensees becomes the subject of an
investigation involving the delegation and supervision of
prescriptive authority, as well as the final disposition of any
such investigation; and
(3) for each board to maintain and share a list of its
licensees who have been subject to a final adverse disciplinary
action for an act involving the delegation and supervision of
prescriptive authority.
(b) The board, Texas Board of Nursing, or Texas Physician
Assistant Board may use a notice received under Section (a)(2) to
open an investigation against a licensee who is a party to a
prescriptive authority agreement with the licensee who is under
investigation by the board which provided notice under Section
(a)(2).
(c) The board shall maintain and make available to the
public an online searchable list of physician, advanced practice
registered nurses, and physician assistants who have entered into a
prescriptive authority agreement authorized under Section 157.0512
and identify the physician with whom each advanced practice
registered nurse and physician assistant has entered into an
agreement.
(d) The board shall collaborate with the Texas Board of
Nursing and Texas Physician Assistant Board to maintain and make
available to the public a list of physicians, advanced practice
registered nurses, and physician assistants who are prohibited from
entering into or practicing under a prescriptive authority
agreement.
SECTION 6. Sec. 157.0514. PRESCRIPTIVE AUTHORITY
AGREEMENT: INSPECTIONS. If the board is notified under Section
157.0513(a)(2), the board or an authorized board representative may
enter, with reasonable notice and at a reasonable time, unless the
notice would jeopardize an investigation, a site where a party to a
prescriptive authority agreement practices to inspect and audit any
records or activities relating to the implementation and operation
of the agreement. To the extent reasonably possible, the board and
the board's authorized representative shall conduct any inspection
or audit under this subsection in a manner that minimizes
disruption to the delivery of patient care.
SECTION 7. Section 157.054, Occupations Code, is amended to
read as follows:
Sec. 157.054. PRESCRIBING AT FACILITY-BASED PRACTICE
SITES. (a) One or more physicians licensed by the board may
delegate, to one or more physician assistants or advanced practice
registered nurses acting under adequate physician supervision
whose practice is facility-based at a licensed hospital as defined
under Section 157.051 or licensed long-term care facility, the
administration or provision of a drug and the carrying out or
signing of a prescription drug order prescribing or ordering of a
drug or device if the physician is:
(1) the medical director or chief of medical staff of
the facility in which the physician assistant or advanced practice
registered nurse practices;
(2) the chair of the facility's credentialing
committee;
(3) a department chair of a facility department in
which the physician assistant or advanced practice nurse practices;
or
(4) one or more physicians who consent to the request
of the medical director or chief of medical staff to delegate the
carrying out or signing of a prescription drug order prescribing or
ordering of a drug or device at the facility in which the physician
assistant or advanced practice nurse practices.
(a-1) The limits on the number of Advanced Practice
Registered Nurses or Physician Assistants to whom a physician may
delegate under Section 157.0512 do not apply to a physician under
(a)(4) whose practice is facility-based under this Section,
provided that the physician is not delegating in a freestanding
clinic, center, or practice of the facility.
(b) A physician's authority to delegate under Subsection
(a) is limited as follows:
(1) the delegation must be made under a physician's
order, standing medical order, standing delegation order, or
another order or protocol developed in accordance with policies
approved by the facility's medical staff or a committee of the
facility's medical staff as provided by the facility bylaws;
(2) the delegation must occur in the facility in which
the physician is the medical director, the chief of medical staff,
the chair of the credentialing committee, or a department chair, or
a physician who consents to delegate under (a)(4);
(3) the delegation may not permit the carrying out or
signing of prescription drug orders prescribing or ordering of a
drug or device for the care or treatment of the patients of any
other physician without the prior consent of that physician; and
(4) delegation in a long-term care facility must be by
the medical director and is limited to the carrying out and signing
of prescription drug orders prescribing or ordering of a drug or
device to not more than four seven advanced practice nurses or
physician assistants or their full-time equivalents.; and
(5) a facility based physician may not delegate at
more than one licensed hospital or more than two long-term care
facilities unless approved by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders prescribing or ordering of a drug or
device must conform to what a reasonable, prudent physician would
find consistent with sound medical judgment but may vary with the
education and experience of the particular advanced practice
registered nurse or physician assistant. A physician shall provide
continuous supervision, but the constant physical presence of the
physician is not required.
(d) An alternate physician may provide appropriate
supervision on a temporary basis as defined and established by
board rule.
SECTION 8. Section 156.056(a) and (b), Occupations Code,
are amended to read as follows:
(a) In this section, "site practice serving a medically
underserved population" has the meaning assigned by Section 157.051
157.052.
(b) The board by rule shall permit a license holder to
complete half of any informal continuing medical education hours
required under this subchapter by providing volunteer medical
services at a site practice serving a medically underserved
population other than a site that is a primary practice site of the
license holder.
SECTION 9. Section 157.057, Occupations Code, is amended to
read as follows:
Sec. 157.057. ADDITIONAL IMPLEMENTATION METHODS. The board
may adopt additional methods to implement:
(1) a physician's prescription; or
(2) the delegation of prescriptive authority the
signing of a prescription under a physician's order, standing
medical order, standing delegation order, or other order or
protocol.
SECTION 10. Sec. 157.059. DELEGATION REGARDING CERTAIN
OBSTETRICAL SERVICES.
(a) In this section, "provide" means to supply, for a term
not to exceed 48 hours, one or more unit doses of a controlled
substance for the immediate needs of a patient.
(b) A physician may delegate to a physician assistant
offering obstetrical services and certified by the board as
specializing in obstetrics or an advanced practice registered
nurse recognized by the Texas Board of Nursing as a nurse midwife
the act of administering or providing controlled substances to the
physician assistant's or nurse midwife's clients during intrapartum
and immediate postpartum care.
(c) The physician may not delegate:
(1) the use of a prescription sticker or the use or
issuance of an official prescription form; or
(2) the authority to issue an electronic prescription
under Section 481.075, Health and Safety Code.
(d) The delegation of authority to administer or provide
controlled substances under Subsection (b) must be under a
physician's order, medical order, standing delegation order,
prescriptive authority agreement, or protocol that requires
adequate and documented availability for access to medical care.
(e) The physician's orders, medical orders, standing
delegation orders, or protocols must require the reporting of or
monitoring of each client's progress, including complications of
pregnancy and delivery and the administration and provision of
controlled substances by the nurse midwife or physician assistant
to the clients of the nurse midwife or physician assistant.
(f) The authority of a physician to delegate under this
section is limited to:
(1) four seven nurse midwives or physician assistants
or their full-time equivalents; and
(2) the designated facility at which the nurse midwife
or physician assistant provides care.
(g) The controlled substance must be supplied in a suitable
container that is labeled in compliance with the applicable drug
laws and must include:
(1) the patient's name and address;
(2) the drug to be provided;
(3) the name, address, and telephone number of the
physician;
(4) the name, address, and telephone number of the
nurse midwife or physician assistant; and
(5) the date.
(h) This section does not authorize a physician, physician
assistant, or nurse midwife to operate a retail pharmacy as defined
under Subtitle J.
(i) This section authorizes a physician to delegate the act
of administering or providing a controlled substance to a nurse
midwife or physician assistant but does not require physician
delegation of:
(1) further acts to a nurse midwife; or
(2) the administration of medications by a physician
assistant or registered nurse other than as provided by this
section.
(j) This section does not limit the authority of a physician
to delegate the carrying out or signing of a prescription drug order
involving the prescribing or ordering a controlled substance under
this subchapter.
SECTION 11. Section 157.060, Occupations Code, is amended
to read as follows:
Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED ACT.
Unless the physician has reason to believe the physician assistant
or advanced practice registered nurse lacked the competency to
perform the act, a physician is not liable for an act of a physician
assistant or advanced registered practice nurse solely because the
physician signed a standing medical order, a standing delegation
order, or another order or protocol or entered into a prescriptive
authority agreement authorizing the physician assistant or
advanced practice registered nurse to administer, provide, carry
out, prescribe or order a drug or device. sign a prescription drug
order.
SECTION 12. Section 204.1565(a) and (b), Occupations Code,
are amended to read as follows:
(a) In this section, "site practice serving a medically
underserved population" has the meaning assigned by Section
157.051. 157.052.
(b) The physician assistant board by rule shall permit a
license holder to complete half of any informal continuing medical
education hours required to renew a license under this chapter by
providing volunteer medical services at a site practice serving a
medically underserved population, other than a site that is a
primary practice site of the license holder.
SECTION 13. Section 204.202(b), Occupations Code, is
amended to read as follows:
(b) Medical services provided by a physician assistant may
include:
(1) obtaining patient histories and performing
physical examinations;
(2) ordering or performing diagnostic and therapeutic
procedures;
(3) formulating a working diagnosis;
(4) developing and implementing a treatment plan;
(5) monitoring the effectiveness of therapeutic
interventions;
(6) assisting at surgery;
(7) offering counseling and education to meet patient
needs;
(8) requesting, receiving, and signing for the receipt
of pharmaceutical sample prescription medications and distributing
the samples to patients in a specific practice setting in which the
physician assistant is authorized to prescribe pharmaceutical
medications and sign prescription drug orders as provided by
Section 157.0512 [157.052, 157.053], or 157.054, [157.0541,] or
157.0542 [or as otherwise authorized by physician assistant board
rule];
(9) signing or completing a prescription prescribing
or ordering a drug or device as provided by Subchapter B, Chapter
157; and
(10) making appropriate referrals.
SECTION 14. Section 301.002(2), Occupations Code, is
amended to read as follows:
(2) "Professional nursing" means the performance of an
act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application
of the principles of biological, physical, and social science as
acquired by a completed course in an approved school of
professional nursing. The term does not include acts of medical
diagnosis or the prescription of therapeutic or corrective
measures. Professional nursing involves:
(A) the observation, assessment, intervention,
evaluation, rehabilitation, care and counsel, or health teachings
of a person who is ill, injured, infirm, or experiencing a change in
normal health processes;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a physician, podiatrist, or dentist;
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the requesting, receiving, signing for, and
distribution of prescription drug samples to patients at sites in
practices at which an advanced practice registered nurse is
authorized to sign prescription drug orders or a medication order
as provided by Subchapter B, Chapter 157;
(G) the performance of an act delegated by a
physician under Section 157.0512 [157.052, 157.053], 157.054,
[157.0541,] 157.0542, 157.058, or 157.059; and
(H) the development of the nursing care plan.
SECTION 15. Section 301.152 (a) and (b), Occupations Code,
are amended to read as follows:
(a) In this section, "advanced practice registered nurse"
means a registered nurse approved licensed by the board to practice
as an advanced practice registered nurse on the basis of completion
of an advanced educational program. The term includes a nurse
practitioner, nurse midwife, nurse anesthetist, and clinical nurse
specialist. The term is synonymous with "advanced nurse
practitioner" and "advanced practice nurse."
(b) The board shall adopt rules to:
(1) license a registered nurse as an advanced practice
registered nurse;
(12) establish:
(A) any specialized education or training,
including pharmacology, that an advanced practice registered nurse
must have to carry out a prescription drug order prescribe or order
a drug or device as delegated by a physician under Section 157.0512,
or 157.054, or 157.0542 [Section 157.052]; and
(B) a system for:
(i) approving an advanced practice
registered nurse to prescribe and order a drug or device as
delegated by a physician under Section 157.0512 or 157.054 upon the
providing of assigning an identification number to a registered
nurse who provides the board with evidence of completing the
specialized education and training requirement under Subdivision
(1)(A); and
(ii) issuing a prescription authorization
number to advanced practice registered nurses approved under (i).
(3) renew the license issued under (1) and the
approval granted under (2)(B) concurrently with renewal of the
advanced practice registered nurse's professional nursing license
under Section 301.301.
(2) approve a registered nurse as an advanced
registered practice nurse; and practice nurse; and
(3) initially approve and biennially renew an advanced
practice registered nurse's authority to carry out or sign a
prescription drug order under Chapter 157.
(c) At a minimum, the rules adopted under Subsection (b)([3]
2) must:
(1) require completion of pharmacology and related
pathology pathophysiology education for initial approval; and
(2) require continuing education in clinical
pharmacology and related pathology pathophysiology in addition to
any continuing education otherwise required under Section
301.303.; and
(3) provide for the issuance of a prescription
authorization number to an advanced practice nurse approved under
this section.
(d) The signature of an advanced practice registered nurse
attesting to the provision of a legally authorized service by the
advanced practice registered nurse satisfies any documentation
requirement for that service established by a state agency.
SECTION 16. Sections 551.003(34) and (45), Occupations
Code, are amended to read as follows:
(34) "Practitioner" means:
(A) a person licensed or registered to prescribe,
distribute, administer, or dispense a prescription drug or device
in the course of professional practice in this state, including a
physician, dentist, podiatrist, or veterinarian but excluding a
person licensed under this subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license holder in this state may legally
prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian, or
podiatrist, who has a current federal Drug Enforcement
Administration registration number and who may legally prescribe a
Schedule II, III, IV, or V controlled substance, as specified under
Chapter 481, Health and Safety Code, in that other state; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to carry out or sign prescription drug orders prescribe or order a
drug or device under Section 157.0511, 157.0512 [157.052, 157.053],
or 157.054, [157.0541,] or 157.0542.
(45) "Written protocol" means a physician's order,
standing medical order, standing delegation order, or other order
or protocol as defined by rule of the Texas Medical [State] Board
[of Medical Examiners] under Subtitle B.
SECTION 17. Section 671.001, Government Code, is amended by
amending Subsection (b) and adding Subsection (b-1) to read as
follows:
(b) The pilot program must provide for the following:
(1) a licensed advanced practice registered nurse as
defined by Section 301.152, Occupations Code, or a licensed
physician assistant as described by Chapter 204, Occupations Code,
who is employed by the state or whose services are acquired by
contract, who will be located at a state office complex;
(2) a licensed physician, who is employed by a state
governmental entity for purposes other than the pilot program or
whose services are acquired by contract, who will delegate to and
supervise the advanced practice registered nurse or physician
assistant pursuant to a prescriptive authority agreement under
Chapter 157, Occupations Code. [perform all supervisory functions
described by Section 157.052(e), Occupations Code];
(3) appropriate office space and equipment for the
advanced practice registered nurse or physician assistant to
provide basic medical care to employees at the state office complex
where the nurse or physician assistant is located; and
(4) professional liability insurance covering
services provided by the advanced practice registered nurse or the
physician assistant.
SECTION 18. Section 481.002(39), Health and Safety Code, is
amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, or other person licensed,
registered, or otherwise permitted to distribute, dispense,
analyze, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, or podiatrist,
having a current Federal Drug Enforcement Administration
registration number, who may legally prescribe Schedule II, III,
IV, or V controlled substances in that state; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to carry out or sign prescription drug orders prescribe or order a
drug or device under Section 157.0511, 157.0512 [157.052, 157.053],
or 157.054, [157.0541,] or 157.0542, Occupations Code.
SECTION 19. Section 483.001(12), Health and Safety Code, is
amended to read as follows:
(12) "Practitioner" means [a person licensed]:
(A) a person licensed by the Texas [State Board
of] Medical Board [Examiners], State Board of Dental Examiners,
Texas State Board of Podiatric Medical Examiners, Texas Optometry
Board, or State Board of Veterinary Medical Examiners to prescribe
and administer dangerous drugs;
(B) a person licensed by another state in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs;
(C) a person licensed in Canada or Mexico in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to carry out or sign prescription drug orders prescribe or order a
drug or device under Section 157.0511, 157.0512 [157.052, 157.053],
or 157.054, [157.0541,] or 157.0542, Occupations Code.
SECTION 20. Sections 157.052, 157.053, 157.0541, and
157.0542, Occupations Code, are repealed.
SECTION 21. (a) The changes in law made by this Act apply
only to a delegation of prescriptive authority by a physician to an
advanced practice registered nurse or physician assistant made or
amended on or after January 31, 2014. A delegation of prescriptive
authority made or amended before January 31, 2014, is governed by
the law in effect on the date the delegation was made or amended,
and the former law is continued in effect for that purpose.
(b) Any calculation under this Act requiring the amount of
time an advanced practice registered nurse or physician assistant
has practiced under the delegated prescriptive authority of a
physician pursuant to a prescriptive authority agreement shall
include the amount of time the advanced practice registered nurse
or physician assistant practiced under the delegated prescriptive
authority of that physician prior to the effective date of this Act.
SECTION 22. Not later than December 31, 2013, the Texas
Medical Board shall adopt the rules necessary to implement the
changes in law made by this Act.
SECTION 23. This Act takes effect September 1, 2013.