Texas 2013 - 83rd Regular

Texas Senate Bill SB406 Compare Versions

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1	1	83R24733 EES-F
2	2	By: Nelson, et al. S.B. No. 406
3	3	(Kolkhorst, Coleman, Orr, Naishtat, Guerra, et al.)
4	4	Substitute the following for S.B. No. 406: No.
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the practice of advanced practice registered nurses and
10	10	physician assistants and the delegation of prescriptive authority
11	11	by physicians to and the supervision by physicians of certain
12	12	advanced practice registered nurses and physician assistants.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. The heading to Subchapter B, Chapter 157,
15	15	Occupations Code, is amended to read as follows:
16	16	SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE REGISTERED NURSES
17	17	AND PHYSICIAN ASSISTANTS
18	18	SECTION 2. Section 157.051, Occupations Code, is amended to
19	19	read as follows:
20	20	Sec. 157.051. DEFINITIONS. In this subchapter:
21	21	(1) "Advanced practice registered nurse" has the
22	22	meaning assigned to that term by Section 301.152. The term includes
23	23	an advanced nurse practitioner and advanced practice nurse.
24	24	(2) ["Carrying out or signing a prescription drug
25	25	order" means completing a prescription drug order presigned by the
26	26	delegating physician, or the signing of a prescription by a
27	27	registered nurse or physician assistant.
28	28	[(2-a)] "Controlled substance" has the meaning
29	29	assigned to that term by Section 481.002, Health and Safety Code.
30	30	(3) [(2-b)] "Dangerous drug" has the meaning assigned
31	31	to that term by Section 483.001, Health and Safety Code.
32	32	(4) "Device" has the meaning assigned by Section
33	33	551.003, and includes durable medical equipment.
34	34	(5) "Health professional shortage area" means:
35	35	(A) an urban or rural area of this state that:
36	36	(i) is not required to conform to the
37	37	geographic boundaries of a political subdivision but is a rational
38	38	area for the delivery of health services;
39	39	(ii) the secretary of health and human
40	40	services determines has a health professional shortage; and
41	41	(iii) is not reasonably accessible to an
42	42	adequately served area;
43	43	(B) a population group that the secretary of
44	44	health and human services determines has a health professional
45	45	shortage; or
46	46	(C) a public or nonprofit private medical
47	47	facility or other facility that the secretary of health and human
48	48	services determines has a health professional shortage, as
49	49	described by 42 U.S.C. Section 254e(a)(1).
50	50	(6) "Hospital" means a facility that:
51	51	(A) is:
52	52	(i) a general hospital or a special
53	53	hospital, as those terms are defined by Section 241.003, Health and
54	54	Safety Code, including a hospital maintained or operated by the
55	55	state; or
56	56	(ii) a mental hospital licensed under
57	57	Chapter 577, Health and Safety Code; and
58	58	(B) has an organized medical staff.
59	59	(7) "Medication order" has the meanings assigned by
60	60	Section 551.003 of this code and Section 481.002, Health and Safety
61	61	Code.
62	62	(8) "Nonprescription drug" has the meaning assigned by
63	63	Section 551.003.
64	64	(9) [(3)] "Physician assistant" means a person who
65	65	holds a license issued under Chapter 204.
66	66	(10) "Physician group practice" means an entity
67	67	through which two or more physicians deliver health care to the
68	68	public through the practice of medicine on a regular basis and that
69	69	is:
70	70	(A) owned and operated by two or more physicians;
71	71	or
72	72	(B) a freestanding clinic, center, or office of a
73	73	nonprofit health organization certified by the board under Section
74	74	162.001(b) that complies with the requirements of Chapter 162.
75	75	(11) "Practice serving a medically underserved
76	76	population" means:
77	77	(A) a practice in a health professional shortage
78	78	area;
79	79	(B) a clinic designated as a rural health clinic
80	80	under 42 U.S.C. Section 1395x(aa);
81	81	(C) a public health clinic or a family planning
82	82	clinic under contract with the Health and Human Services Commission
83	83	or the Department of State Health Services;
84	84	(D) a clinic designated as a federally qualified
85	85	health center under 42 U.S.C. Section 1396d(l)(2)(B);
86	86	(E) a county, state, or federal correctional
87	87	facility;
88	88	(F) a practice:
89	89	(i) that either:
90	90	(a) is located in an area in which the
91	91	Department of State Health Services determines there is an
92	92	insufficient number of physicians providing services to eligible
93	93	clients of federally, state, or locally funded health care
94	94	programs; or
95	95	(b) is a practice that the Department
96	96	of State Health Services determines serves a disproportionate
97	97	number of clients eligible to participate in federally, state, or
98	98	locally funded health care programs; and
99	99	(ii) for which the Department of State
100	100	Health Services publishes notice of the department's determination
101	101	in the Texas Register and provides an opportunity for public
102	102	comment in the manner provided for a proposed rule under Chapter
103	103	2001, Government Code; or
104	104	(G) a practice at which a physician was
105	105	delegating prescriptive authority to an advanced practice
106	106	registered nurse or physician assistant on or before March 1, 2013,
107	107	based on the practice qualifying as a site serving a medically
108	108	underserved population.
109	109	(12) "Prescribe or order a drug or device" means
110	110	prescribing or ordering a drug or device, including the issuing of a
111	111	prescription drug order or a medication order.
112	112	(13) "Prescription drug" has the meaning assigned by
113	113	Section 551.003.
114	114	(14) "Prescriptive authority agreement" means an
115	115	agreement entered into by a physician and an advanced practice
116	116	registered nurse or physician assistant through which the physician
117	117	delegates to the advanced practice registered nurse or physician
118	118	assistant the act of prescribing or ordering a drug or device.
119	119	SECTION 3. Section 157.0511, Occupations Code, is amended
120	120	to read as follows:
121	121	Sec. 157.0511. DELEGATION OF PRESCRIBING AND ORDERING DRUGS
122	122	AND DEVICES [PRESCRIPTION DRUG ORDERS]. (a) A physician's
123	123	authority to delegate the prescribing or ordering of a drug or
124	124	device [carrying out or signing of a prescription drug order] under
125	125	this subchapter is limited to:
126	126	(1) nonprescription drugs;
127	127	(2) dangerous drugs; and
128	128	(3) [(2)] controlled substances to the extent
129	129	provided by Subsections [Subsection] (b) and (b-1).
130	130	(b) Except as provided by Subsection (b-1), a [A] physician
131	131	may delegate the prescribing or ordering of [carrying out or
132	132	signing of a prescription drug order for] a controlled substance
133	133	only if:
134	134	(1) the prescription is for a controlled substance
135	135	listed in Schedule III, IV, or V as established by the commissioner
136	136	of the Department of State Health Services [public health] under
137	137	Chapter 481, Health and Safety Code;
138	138	(2) the prescription, including a refill of the
139	139	prescription, is for a period not to exceed 90 days;
140	140	(3) with regard to the refill of a prescription, the
141	141	refill is authorized after consultation with the delegating
142	142	physician and the consultation is noted in the patient's chart; and
143	143	(4) with regard to a prescription for a child less than
144	144	two years of age, the prescription is made after consultation with
145	145	the delegating physician and the consultation is noted in the
146	146	patient's chart.
147	147	(b-1) A physician may delegate the prescribing or ordering
148	148	of a controlled substance listed in Schedule II as established by
149	149	the commissioner of the Department of State Health Services under
150	150	Chapter 481, Health and Safety Code, only:
151	151	(1) in a hospital facility-based practice under
152	152	Section 157.054, in accordance with policies approved by the
153	153	hospital's medical staff or a committee of the hospital's medical
154	154	staff as provided by the hospital bylaws to ensure patient safety,
155	155	and as part of the care provided to a patient who:
156	156	(A) has been admitted to the hospital for an
157	157	intended length of stay of 24 hours or greater; or
158	158	(B) is receiving services in the emergency
159	159	department of the hospital; or
160	160	(2) as part of the plan of care for the treatment of a
161	161	person who has executed a written certification of a terminal
162	162	illness, has elected to receive hospice care, and is receiving
163	163	hospice treatment from a qualified hospice provider.
164	164	(b-2) The board shall adopt rules that require a physician
165	165	who delegates the prescribing or ordering of a drug or device
166	166	[carrying out or signing of a prescription drug order under this
167	167	subchapter] to register with the board the name and license number
168	168	of the physician assistant or advanced practice registered nurse to
169	169	whom a delegation is made. The board may develop and use an
170	170	electronic online delegation registration process for registration
171	171	under this subsection.
172	172	(c) This subchapter does not modify the authority granted by
173	173	law for a licensed registered nurse or physician assistant to
174	174	administer or provide a medication, including a controlled
175	175	substance listed in Schedule II as established by the commissioner
176	176	of the Department of State Health Services [public health] under
177	177	Chapter 481, Health and Safety Code, that is authorized by a
178	178	physician under a physician's order, standing medical order,
179	179	standing delegation order, or protocol.
180	180	SECTION 4. Subchapter B, Chapter 157, Occupations Code, is
181	181	amended by adding Sections 157.0512, 157.0513, and 157.0514 to read
182	182	as follows:
183	183	Sec. 157.0512. PRESCRIPTIVE AUTHORITY AGREEMENT. (a) A
184	184	physician may delegate to an advanced practice registered nurse or
185	185	physician assistant, acting under adequate physician supervision,
186	186	the act of prescribing or ordering a drug or device as authorized
187	187	through a prescriptive authority agreement between the physician
188	188	and the advanced practice registered nurse or physician assistant,
189	189	as applicable.
190	190	(b) A physician and an advanced practice registered nurse or
191	191	physician assistant are eligible to enter into or be parties to a
192	192	prescriptive authority agreement only if:
193	193	(1) if applicable, the Texas Board of Nursing has
194	194	approved the advanced practice registered nurse's authority to
195	195	prescribe or order a drug or device as authorized under this
196	196	subchapter;
197	197	(2) the advanced practice registered nurse or
198	198	physician assistant:
199	199	(A) holds an active license to practice in this
200	200	state as an advanced practice registered nurse or physician
201	201	assistant, as applicable, and is in good standing in this state; and
202	202	(B) is not currently prohibited by the Texas
203	203	Board of Nursing or the Texas Physician Assistant Board, as
204	204	applicable, from executing a prescriptive authority agreement; and
205	205	(3) before executing the prescriptive authority
206	206	agreement, the physician and the advanced practice registered nurse
207	207	or physician assistant disclose to the other prospective party to
208	208	the agreement any prior disciplinary action by the board, the Texas
209	209	Board of Nursing, or the Texas Physician Assistant Board, as
210	210	applicable.
211	211	(c) Except as provided by Subsection (d), the combined
212	212	number of advanced practice registered nurses and physician
213	213	assistants with whom a physician may enter into a prescriptive
214	214	authority agreement may not exceed seven advanced practice
215	215	registered nurses and physician assistants or the full-time
216	216	equivalent of seven advanced practice registered nurses and
217	217	physician assistants.
218	218	(d) Subsection (c) does not apply to a prescriptive
219	219	authority agreement if the prescriptive authority is being
220	220	exercised in:
221	221	(1) a practice serving a medically underserved
222	222	population; or
223	223	(2) a facility-based practice in a hospital under
224	224	Section 157.054.
225	225	(e) A prescriptive authority agreement must, at a minimum:
226	226	(1) be in writing and signed and dated by the parties
227	227	to the agreement;
228	228	(2) state the name, address, and all professional
229	229	license numbers of the parties to the agreement;
230	230	(3) state the nature of the practice, practice
231	231	locations, or practice settings;
232	232	(4) identify the types or categories of drugs or
233	233	devices that may be prescribed or the types or categories of drugs
234	234	or devices that may not be prescribed;
235	235	(5) provide a general plan for addressing consultation
236	236	and referral;
237	237	(6) provide a plan for addressing patient emergencies;
238	238	(7) state the general process for communication and
239	239	the sharing of information between the physician and the advanced
240	240	practice registered nurse or physician assistant to whom the
241	241	physician has delegated prescriptive authority related to the care
242	242	and treatment of patients;
243	243	(8) if alternate physician supervision is to be
244	244	utilized, designate one or more alternate physicians who may:
245	245	(A) provide appropriate supervision on a
246	246	temporary basis in accordance with the requirements established by
247	247	the prescriptive authority agreement and the requirements of this
248	248	subchapter; and
249	249	(B) participate in the prescriptive authority
250	250	quality assurance and improvement plan meetings required under this
251	251	section; and
252	252	(9) describe a prescriptive authority quality
253	253	assurance and improvement plan and specify methods for documenting
254	254	the implementation of the plan that includes the following:
255	255	(A) chart review, with the number of charts to be
256	256	reviewed determined by the physician and advanced practice
257	257	registered nurse or physician assistant; and
258	258	(B) periodic face-to-face meetings between the
259	259	advanced practice registered nurse or physician assistant and the
260	260	physician at a location determined by the physician and the
261	261	advanced practice registered nurse or physician assistant.
262	262	(f) The periodic face-to-face meetings described by
263	263	Subsection (e)(9)(B) must:
264	264	(1) include:
265	265	(A) the sharing of information relating to
266	266	patient treatment and care, needed changes in patient care plans,
267	267	and issues relating to referrals; and
268	268	(B) discussion of patient care improvement; and
269	269	(2) be documented and occur:
270	270	(A) except as provided by Paragraph (B):
271	271	(i) at least monthly until the third
272	272	anniversary of the date the agreement is executed; and
273	273	(ii) at least quarterly after the third
274	274	anniversary of the date the agreement is executed, with monthly
275	275	meetings held between the quarterly meetings by means of a remote
276	276	electronic communications system, including videoconferencing
277	277	technology or the Internet; or
278	278	(B) if during the seven years preceding the date
279	279	the agreement is executed the advanced practice registered nurse or
280	280	physician assistant for at least five years was in a practice that
281	281	included the exercise of prescriptive authority with required
282	282	physician supervision:
283	283	(i) at least monthly until the first
284	284	anniversary of the date the agreement is executed; and
285	285	(ii) at least quarterly after the first
286	286	anniversary of the date the agreement is executed, with monthly
287	287	meetings held between the quarterly meetings by means of a remote
288	288	electronic communications system, including videoconferencing
289	289	technology or the Internet.
290	290	(g) The prescriptive authority agreement may include other
291	291	provisions agreed to by the physician and advanced practice
292	292	registered nurse or physician assistant.
293	293	(h) If the parties to the prescriptive authority agreement
294	294	practice in a physician group practice, the physician may appoint
295	295	one or more alternate supervising physicians designated under
296	296	Subsection (e)(8), if any, to conduct and document the quality
297	297	assurance meetings in accordance with the requirements of this
298	298	subchapter.
299	299	(i) The prescriptive authority agreement need not describe
300	300	the exact steps that an advanced practice registered nurse or
301	301	physician assistant must take with respect to each specific
302	302	condition, disease, or symptom.
303	303	(j) A physician, advanced practice registered nurse, or
304	304	physician assistant who is a party to a prescriptive authority
305	305	agreement must retain a copy of the agreement until the second
306	306	anniversary of the date the agreement is terminated.
307	307	(k) A party to a prescriptive authority agreement may not by
308	308	contract waive, void, or nullify any provision of this section or
309	309	Section 157.0513.
310	310	(l) In the event that a party to a prescriptive authority
311	311	agreement is notified that the individual has become the subject of
312	312	an investigation by the board, the Texas Board of Nursing, or the
313	313	Texas Physician Assistant Board, the individual shall immediately
314	314	notify the other party to the prescriptive authority agreement.
315	315	(m) The prescriptive authority agreement and any amendments
316	316	must be reviewed at least annually, dated, and signed by the parties
317	317	to the agreement. The prescriptive authority agreement and any
318	318	amendments must be made available to the board, the Texas Board of
319	319	Nursing, or the Texas Physician Assistant Board not later than the
320	320	third business day after the date of receipt of request, if any.
321	321	(n) The prescriptive authority agreement should promote the
322	322	exercise of professional judgment by the advanced practice
323	323	registered nurse or physician assistant commensurate with the
324	324	advanced practice registered nurse's or physician assistant's
325	325	education and experience and the relationship between the advanced
326	326	practice registered nurse or physician assistant and the physician.
327	327	(o) This section shall be liberally construed to allow the
328	328	use of prescriptive authority agreements to safely and effectively
329	329	utilize the skills and services of advanced practice registered
330	330	nurses and physician assistants.
331	331	(p) The board may not adopt rules pertaining to the elements
332	332	of a prescriptive authority agreement that would impose
333	333	requirements in addition to the requirements under this section.
334	334	The board may adopt other rules relating to physician delegation
335	335	under this chapter.
336	336	(q) The board, the Texas Board of Nursing, and the Texas
337	337	Physician Assistant Board shall jointly develop responses to
338	338	frequently asked questions relating to prescriptive authority
339	339	agreements not later than January 1, 2014. This subsection expires
340	340	January 1, 2015.
341	341	Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
342	342	INFORMATION. (a) The board, the Texas Board of Nursing, and the
343	343	Texas Physician Assistant Board shall jointly develop a process:
344	344	(1) to exchange information regarding the names,
345	345	locations, and license numbers of each physician, advanced practice
346	346	registered nurse, and physician assistant who has entered into a
347	347	prescriptive authority agreement;
348	348	(2) by which each board shall immediately notify the
349	349	other boards when a license holder of the board becomes the subject
350	350	of an investigation involving the delegation and supervision of
351	351	prescriptive authority, as well as the final disposition of any
352	352	such investigation; and
353	353	(3) by which each board shall maintain and share a list
354	354	of the board's license holders who have been subject to a final
355	355	adverse disciplinary action for an act involving the delegation and
356	356	supervision of prescriptive authority.
357	357	(b) If the board, the Texas Board of Nursing, or the Texas
358	358	Physician Assistant Board receives a notice under Subsection
359	359	(a)(2), the board that received notice may open an investigation
360	360	against a license holder of the board who is a party to a
361	361	prescriptive authority agreement with the license holder who is
362	362	under investigation by the board that provided notice under
363	363	Subsection (a)(2).
364	364	(c) The board shall maintain and make available to the
365	365	public a searchable online list of physicians, advanced practice
366	366	registered nurses, and physician assistants who have entered into a
367	367	prescriptive authority agreement authorized under Section 157.0512
368	368	and identify the physician, advanced practice registered nurse, or
369	369	physician assistant with whom each physician, advanced practice
370	370	registered nurse, and physician assistant has entered into a
371	371	prescriptive authority agreement.
372	372	(d) The board shall collaborate with the Texas Board of
373	373	Nursing and the Texas Physician Assistant Board to maintain and
374	374	make available to the public a list of physicians, advanced
375	375	practice registered nurses, and physician assistants who are
376	376	prohibited from entering into or practicing under a prescriptive
377	377	authority agreement.
378	378	Sec. 157.0514. PRESCRIPTIVE AUTHORITY AGREEMENT:
379	379	INSPECTIONS. If the board receives a notice under Section
380	380	157.0513(a)(2), the board or an authorized board representative may
381	381	enter, with reasonable notice and at a reasonable time, unless the
382	382	notice would jeopardize an investigation, a site where a party to a
383	383	prescriptive authority agreement practices to inspect and audit any
384	384	records or activities relating to the implementation and operation
385	385	of the agreement. To the extent reasonably possible, the board and
386	386	the board's authorized representative shall conduct any inspection
387	387	or audit under this section in a manner that minimizes disruption to
388	388	the delivery of patient care.
389	389	SECTION 5. Section 157.054, Occupations Code, is amended by
390	390	amending Subsections (a), (b), and (c) and adding Subsections (a-1)
391	391	and (b-1) to read as follows:
392	392	(a) One or more physicians [A physician] licensed by the
393	393	board may delegate, to one or more physician assistants or advanced
394	394	practice registered nurses acting under adequate physician
395	395	supervision whose practice is facility-based at a [licensed]
396	396	hospital or licensed long-term care facility, the administration or
397	397	provision of a drug and the prescribing or ordering of a drug or
398	398	device [carrying out or signing of a prescription drug order] if
399	399	each of the delegating physicians [physician] is:
400	400	(1) the medical director or chief of medical staff of
401	401	the facility in which the physician assistant or advanced practice
402	402	registered nurse practices;
403	403	(2) the chair of the facility's credentialing
404	404	committee;
405	405	(3) a department chair of a facility department in
406	406	which the physician assistant or advanced practice registered nurse
407	407	practices; or
408	408	(4) a physician who consents to the request of the
409	409	medical director or chief of medical staff to delegate the
410	410	prescribing or ordering of a drug or device [carrying out or signing
411	411	of a prescription drug order] at the facility in which the physician
412	412	assistant or advanced practice registered nurse practices.
413	413	(a-1) The limits on the number of advanced practice
414	414	registered nurses or physician assistants to whom a physician may
415	415	delegate under Section 157.0512 do not apply to a physician under
416	416	Subsection (a) whose practice is facility-based under this section,
417	417	provided that the physician is not delegating in a freestanding
418	418	clinic, center, or practice of the facility.
419	419	(b) A physician's authority to delegate under Subsection
420	420	(a) is limited as follows:
421	421	(1) the delegation must be made under a physician's
422	422	order, standing medical order, standing delegation order, or
423	423	another order or protocol developed in accordance with policies
424	424	approved by the facility's medical staff or a committee of the
425	425	facility's medical staff as provided by the facility bylaws;
426	426	(2) the delegation must occur in the facility in which
427	427	the physician is the medical director, the chief of medical staff,
428	428	the chair of the credentialing committee, [or] a department chair,
429	429	or a physician who consents to delegate under Subsection (a)(4);
430	430	(3) the delegation may not permit the prescribing or
431	431	ordering of a drug or device [carrying out or signing of
432	432	prescription drug orders] for the care or treatment of the patients
433	433	of any other physician without the prior consent of that physician;
434	434	and
435	435	(4) delegation in a long-term care facility must be by
436	436	the medical director and is limited to the prescribing or ordering
437	437	of a drug or device [carrying out and signing of prescription drug
438	438	orders] to not more than seven [four] advanced practice registered
439	439	nurses or physician assistants or their full-time equivalents.[;
440	440	and]
441	441	(b-1) A facility-based [(5) a] physician may not delegate at
442	442	more than one [licensed] hospital or more than two long-term care
443	443	facilities under this section unless approved by the board. The
444	444	facility-based physician may not be prohibited from delegating the
445	445	prescribing or ordering of drugs or devices under Section 157.0512
446	446	at other practice locations, including hospitals or long-term care
447	447	facilities, provided that the delegation at those locations
448	448	complies with all the requirements of Section 157.0512.
449	449	(c) Physician supervision of the prescribing or ordering of
450	450	a drug or device [carrying out and signing of prescription drug
451	451	orders] must conform to what a reasonable, prudent physician would
452	452	find consistent with sound medical judgment but may vary with the
453	453	education and experience of the particular advanced practice
454	454	registered nurse or physician assistant. A physician shall provide
455	455	continuous supervision, but the constant physical presence of the
456	456	physician is not required.
457	457	SECTION 6. Section 157.055, Occupations Code, is amended to
458	458	read as follows:
459	459	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
460	460	order shall be defined in a manner that promotes the exercise of
461	461	professional judgment by the advanced practice registered nurse and
462	462	physician assistant commensurate with the education and experience
463	463	of that person. Under this section, an order or protocol used by a
464	464	reasonable and prudent physician exercising sound medical
465	465	judgment:
466	466	(1) is not required to describe the exact steps that an
467	467	advanced practice registered nurse or a physician assistant must
468	468	take with respect to each specific condition, disease, or symptom;
469	469	and
470	470	(2) may state the types or categories of medications
471	471	that may be prescribed or the types or categories of medications
472	472	that may not be prescribed.
473	473	SECTION 7. Section 157.057, Occupations Code, is amended to
474	474	read as follows:
475	475	Sec. 157.057. ADDITIONAL IMPLEMENTATION METHODS. The board
476	476	may adopt additional methods to implement:
477	477	(1) a physician's prescription; or
478	478	(2) the delegation of prescriptive authority [the
479	479	signing of a prescription under a physician's order, standing
480	480	medical order, standing delegation order, or other order or
481	481	protocol].
482	482	SECTION 8. Sections 157.059(b), (d), (e), (f), and (j),
483	483	Occupations Code, are amended to read as follows:
484	484	(b) A physician may delegate to a physician assistant
485	485	offering obstetrical services and certified by the board as
486	486	specializing in obstetrics or an advanced practice registered nurse
487	487	recognized by the Texas Board of Nursing as a nurse midwife the act
488	488	of administering or providing controlled substances to the
489	489	physician assistant's or nurse midwife's clients during intrapartum
490	490	and immediate postpartum care.
491	491	(d) The delegation of authority to administer or provide
492	492	controlled substances under Subsection (b) must be under a
493	493	physician's order, medical order, standing delegation order,
494	494	prescriptive authority agreement, or protocol that requires
495	495	adequate and documented availability for access to medical care.
496	496	(e) The physician's orders, medical orders, standing
497	497	delegation orders, prescriptive authority agreements, or protocols
498	498	must require the reporting of or monitoring of each client's
499	499	progress, including complications of pregnancy and delivery and the
500	500	administration and provision of controlled substances by the nurse
501	501	midwife or physician assistant to the clients of the nurse midwife
502	502	or physician assistant.
503	503	(f) The authority of a physician to delegate under this
504	504	section is limited to:
505	505	(1) seven [four] nurse midwives or physician
506	506	assistants or their full-time equivalents; and
507	507	(2) the designated facility at which the nurse midwife
508	508	or physician assistant provides care.
509	509	(j) This section does not limit the authority of a physician
510	510	to delegate the prescribing or ordering of [carrying out or signing
511	511	of a prescription drug order involving] a controlled substance
512	512	under this subchapter.
513	513	SECTION 9. Section 157.060, Occupations Code, is amended to
514	514	read as follows:
515	515	Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED ACT.
516	516	Unless the physician has reason to believe the physician assistant
517	517	or advanced practice registered nurse lacked the competency to
518	518	perform the act, a physician is not liable for an act of a physician
519	519	assistant or advanced practice registered nurse solely because the
520	520	physician signed a standing medical order, a standing delegation
521	521	order, or another order or protocol, or entered into a prescriptive
522	522	authority agreement, authorizing the physician assistant or
523	523	advanced practice registered nurse to administer, provide,
524	524	prescribe, or order a drug or device [carry out, or sign a
525	525	prescription drug order].
526	526	SECTION 10. Section 156.056, Occupations Code, is amended
527	527	to read as follows:
528	528	Sec. 156.056. CERTAIN VOLUNTEER SERVICES. (a) In this
529	529	section, "practice [site] serving a medically underserved
530	530	population" has the meaning assigned by Section 157.051 [157.052].
531	531	(b) The board by rule shall permit a license holder to
532	532	complete half of any informal continuing medical education hours
533	533	required under this subchapter by providing volunteer medical
534	534	services at a practice [site] serving a medically underserved
535	535	population other than a site that is a primary practice site of the
536	536	license holder.
537	537	SECTION 11. Subchapter C, Chapter 204, Occupations Code, is
538	538	amended by adding Section 204.1025 to read as follows:
539	539	Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
540	540	AGREEMENTS. The physician assistant board shall in conjunction
541	541	with the Texas Medical Board and the Texas Board of Nursing perform
542	542	the functions and duties relating to prescriptive authority
543	543	agreements assigned to the physician assistant board in Sections
544	544	157.0512 and 157.0513.
545	545	SECTION 12. Section 204.1565, Occupations Code, is amended
546	546	to read as follows:
547	547	Sec. 204.1565. INFORMAL CONTINUING MEDICAL EDUCATION. (a)
548	548	In this section, "practice [site] serving a medically underserved
549	549	population" has the meaning assigned by Section 157.051 [157.052].
550	550	(b) The physician assistant board by rule shall permit a
551	551	license holder to complete half of any informal continuing medical
552	552	education hours required to renew a license under this chapter by
553	553	providing volunteer medical services at a practice [site] serving a
554	554	medically underserved population, other than a site that is a
555	555	primary practice site of the license holder.
556	556	SECTION 13. Section 204.202(b), Occupations Code, is
557	557	amended to read as follows:
558	558	(b) Medical services provided by a physician assistant may
559	559	include:
560	560	(1) obtaining patient histories and performing
561	561	physical examinations;
562	562	(2) ordering or performing diagnostic and therapeutic
563	563	procedures;
564	564	(3) formulating a working diagnosis;
565	565	(4) developing and implementing a treatment plan;
566	566	(5) monitoring the effectiveness of therapeutic
567	567	interventions;
568	568	(6) assisting at surgery;
569	569	(7) offering counseling and education to meet patient
570	570	needs;
571	571	(8) requesting, receiving, and signing for the receipt
572	572	of pharmaceutical sample prescription medications and distributing
573	573	the samples to patients in a specific practice setting in which the
574	574	physician assistant is authorized to prescribe pharmaceutical
575	575	medications and sign prescription drug orders as provided by
576	576	Section 157.0512 or [157.052, 157.053,] 157.054[, 157.0541, or
577	577	157.0542 or as otherwise authorized by physician assistant board
578	578	rule];
579	579	(9) prescribing or ordering a drug or device [signing
580	580	or completing a prescription] as provided by Subchapter B, Chapter
581	581	157; and
582	582	(10) making appropriate referrals.
583	583	SECTION 14. Section 204.204, Occupations Code, is amended
584	584	by adding Subsection (c) to read as follows:
585	585	(c) The number of physician assistants a physician may
586	586	supervise in a practice setting may not be less than the number of
587	587	physician assistants to whom a physician may delegate the authority
588	588	to prescribe or order a drug or device in that practice setting
589	589	under Subchapter B, Chapter 157.
590	590	SECTION 15. Section 301.002(2), Occupations Code, is
591	591	amended to read as follows:
592	592	(2) "Professional nursing" means the performance of an
593	593	act that requires substantial specialized judgment and skill, the
594	594	proper performance of which is based on knowledge and application
595	595	of the principles of biological, physical, and social science as
596	596	acquired by a completed course in an approved school of
597	597	professional nursing. The term does not include acts of medical
598	598	diagnosis or the prescription of therapeutic or corrective
599	599	measures. Professional nursing involves:
600	600	(A) the observation, assessment, intervention,
601	601	evaluation, rehabilitation, care and counsel, or health teachings
602	602	of a person who is ill, injured, infirm, or experiencing a change in
603	603	normal health processes;
604	604	(B) the maintenance of health or prevention of
605	605	illness;
606	606	(C) the administration of a medication or
607	607	treatment as ordered by a physician, podiatrist, or dentist;
608	608	(D) the supervision or teaching of nursing;
609	609	(E) the administration, supervision, and
610	610	evaluation of nursing practices, policies, and procedures;
611	611	(F) the requesting, receiving, signing for, and
612	612	distribution of prescription drug samples to patients at practices
613	613	at [sites in] which an advanced practice [a] registered nurse is
614	614	authorized to sign prescription drug orders as provided by
615	615	Subchapter B, Chapter 157;
616	616	(G) the performance of an act delegated by a
617	617	physician under Section 157.0512 [157.052, 157.053], 157.054,
618	618	[157.0541, 157.0542,] 157.058, or 157.059; and
619	619	(H) the development of the nursing care plan.
620	620	SECTION 16. Section 301.005, Occupations Code, is amended
621	621	to read as follows:
622	622	Sec. 301.005. REFERENCE IN OTHER LAW. (a) A reference in
623	623	any other law to the former Board of Nurse Examiners means the Texas
624	624	Board of Nursing.
625	625	(b) A reference in any other law to an "advanced nurse
626	626	practitioner" or "advanced practice nurse" means an advanced
627	627	practice registered nurse.
628	628	SECTION 17. Section 301.152, Occupations Code, is amended
629	629	to read as follows:
630	630	Sec. 301.152. RULES REGARDING SPECIALIZED TRAINING. (a)
631	631	In this section, "advanced practice registered nurse" means a
632	632	registered nurse licensed [approved] by the board to practice as an
633	633	advanced practice registered nurse on the basis of completion of an
634	634	advanced educational program. The term includes a nurse
635	635	practitioner, nurse midwife, nurse anesthetist, and clinical nurse
636	636	specialist. The term is synonymous with "advanced nurse
637	637	practitioner" and "advanced practice nurse."
638	638	(b) The board shall adopt rules to:
639	639	(1) license a registered nurse as an advanced practice
640	640	registered nurse;
641	641	(2) establish:
642	642	(A) any specialized education or training,
643	643	including pharmacology, that an advanced practice [a] registered
644	644	nurse must have to prescribe or order a drug or device as delegated
645	645	by a physician [carry out a prescription drug order] under Section
646	646	157.0512 or 157.054 [157.052]; [and]
647	647	(B) a system for approving an advanced practice
648	648	registered nurse to prescribe or order a drug or device as delegated
649	649	by a physician under Section 157.0512 or 157.054 on the receipt of
650	650	[assigning an identification number to a registered nurse who
651	651	provides the board with] evidence of completing the specialized
652	652	education and training requirement under Paragraph (A)
653	653	[Subdivision (1)(A)]; and
654	654	(C) a system for issuing a prescription
655	655	authorization number to an advanced practice registered nurse
656	656	approved under Paragraph (B) [(2) approve a registered nurse as an
657	657	advanced practice nurse]; and
658	658	(3) concurrently [initially approve and biennially]
659	659	renew any license or approval granted to an advanced practice
660	660	registered nurse under this subsection and a license renewed by the
661	661	advanced practice registered nurse under Section 301.301 [an
662	662	advanced practice nurse's authority to carry out or sign a
663	663	prescription drug order under Chapter 157].
664	664	(c) At a minimum, the rules adopted under Subsection (b)(2)
665	665	[(b)(3)] must:
666	666	(1) require completion of pharmacology and related
667	667	pathophysiology [pathology] education for initial approval; and
668	668	(2) require continuing education in clinical
669	669	pharmacology and related pathophysiology [pathology] in addition
670	670	to any continuing education otherwise required under Section
671	671	301.303[; and
672	672	[(3) provide for the issuance of a prescription
673	673	authorization number to an advanced practice nurse approved under
674	674	this section].
675	675	(d) The signature of an advanced practice registered nurse
676	676	attesting to the provision of a legally authorized service by the
677	677	advanced practice registered nurse satisfies any documentation
678	678	requirement for that service established by a state agency.
679	679	SECTION 18. Subchapter D, Chapter 301, Occupations Code, is
680	680	amended by adding Section 301.168 to read as follows:
681	681	Sec. 301.168. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
682	682	AGREEMENTS. The board shall in conjunction with the Texas Medical
683	683	Board and the Texas Physician Assistant Board perform the functions
684	684	and duties relating to prescriptive authority agreements assigned
685	685	to the board in Sections 157.0512 and 157.0513.
686	686	SECTION 19. Sections 551.003(34) and (45), Occupations
687	687	Code, are amended to read as follows:
688	688	(34) "Practitioner" means:
689	689	(A) a person licensed or registered to prescribe,
690	690	distribute, administer, or dispense a prescription drug or device
691	691	in the course of professional practice in this state, including a
692	692	physician, dentist, podiatrist, or veterinarian but excluding a
693	693	person licensed under this subtitle;
694	694	(B) a person licensed by another state, Canada,
695	695	or the United Mexican States in a health field in which, under the
696	696	law of this state, a license holder in this state may legally
697	697	prescribe a dangerous drug;
698	698	(C) a person practicing in another state and
699	699	licensed by another state as a physician, dentist, veterinarian, or
700	700	podiatrist, who has a current federal Drug Enforcement
701	701	Administration registration number and who may legally prescribe a
702	702	Schedule II, III, IV, or V controlled substance, as specified under
703	703	Chapter 481, Health and Safety Code, in that other state; or
704	704	(D) an advanced practice registered nurse or
705	705	physician assistant to whom a physician has delegated the authority
706	706	to prescribe or order a drug or device [carry out or sign
707	707	prescription drug orders] under Section 157.0511, 157.0512
708	708	[157.052, 157.053], or 157.054[, 157.0541, or 157.0542].
709	709	(45) "Written protocol" means a physician's order,
710	710	standing medical order, standing delegation order, or other order
711	711	or protocol as defined by rule of the Texas Medical [State] Board
712	712	[of Medical Examiners] under Subtitle B.
713	713	SECTION 20. Section 533.005(a), Government Code, is amended
714	714	to read as follows:
715	715	(a) A contract between a managed care organization and the
716	716	commission for the organization to provide health care services to
717	717	recipients must contain:
718	718	(1) procedures to ensure accountability to the state
719	719	for the provision of health care services, including procedures for
720	720	financial reporting, quality assurance, utilization review, and
721	721	assurance of contract and subcontract compliance;
722	722	(2) capitation rates that ensure the cost-effective
723	723	provision of quality health care;
724	724	(3) a requirement that the managed care organization
725	725	provide ready access to a person who assists recipients in
726	726	resolving issues relating to enrollment, plan administration,
727	727	education and training, access to services, and grievance
728	728	procedures;
729	729	(4) a requirement that the managed care organization
730	730	provide ready access to a person who assists providers in resolving
731	731	issues relating to payment, plan administration, education and
732	732	training, and grievance procedures;
733	733	(5) a requirement that the managed care organization
734	734	provide information and referral about the availability of
735	735	educational, social, and other community services that could
736	736	benefit a recipient;
737	737	(6) procedures for recipient outreach and education;
738	738	(7) a requirement that the managed care organization
739	739	make payment to a physician or provider for health care services
740	740	rendered to a recipient under a managed care plan not later than the
741	741	45th day after the date a claim for payment is received with
742	742	documentation reasonably necessary for the managed care
743	743	organization to process the claim, or within a period, not to exceed
744	744	60 days, specified by a written agreement between the physician or
745	745	provider and the managed care organization;
746	746	(8) a requirement that the commission, on the date of a
747	747	recipient's enrollment in a managed care plan issued by the managed
748	748	care organization, inform the organization of the recipient's
749	749	Medicaid certification date;
750	750	(9) a requirement that the managed care organization
751	751	comply with Section 533.006 as a condition of contract retention
752	752	and renewal;
753	753	(10) a requirement that the managed care organization
754	754	provide the information required by Section 533.012 and otherwise
755	755	comply and cooperate with the commission's office of inspector
756	756	general and the office of the attorney general;
757	757	(11) a requirement that the managed care
758	758	organization's usages of out-of-network providers or groups of
759	759	out-of-network providers may not exceed limits for those usages
760	760	relating to total inpatient admissions, total outpatient services,
761	761	and emergency room admissions determined by the commission;
762	762	(12) if the commission finds that a managed care
763	763	organization has violated Subdivision (11), a requirement that the
764	764	managed care organization reimburse an out-of-network provider for
765	765	health care services at a rate that is equal to the allowable rate
766	766	for those services, as determined under Sections 32.028 and
767	767	32.0281, Human Resources Code;
768	768	(13) a requirement that, notwithstanding any other
769	769	law, including Sections 843.312 and 1301.052, Insurance Code, the
770	770	organization:
771	771	(A) use advanced practice registered nurses and
772	772	physician assistants in addition to physicians as primary care
773	773	providers to increase the availability of primary care providers in
774	774	the organization's provider network; and
775	775	(B) treat advanced practice registered nurses
776	776	and physician assistants in the same manner as primary care
777	777	physicians with regard to:
778	778	(i) selection and assignment as primary
779	779	care providers;
780	780	(ii) inclusion as primary care providers in
781	781	the organization's provider network; and
782	782	(iii) inclusion as primary care providers
783	783	in any provider network directory maintained by the organization;
784	784	(14) a requirement that the managed care organization
785	785	reimburse a federally qualified health center or rural health
786	786	clinic for health care services provided to a recipient outside of
787	787	regular business hours, including on a weekend day or holiday, at a
788	788	rate that is equal to the allowable rate for those services as
789	789	determined under Section 32.028, Human Resources Code, if the
790	790	recipient does not have a referral from the recipient's primary
791	791	care physician;
792	792	(15) a requirement that the managed care organization
793	793	develop, implement, and maintain a system for tracking and
794	794	resolving all provider appeals related to claims payment, including
795	795	a process that will require:
796	796	(A) a tracking mechanism to document the status
797	797	and final disposition of each provider's claims payment appeal;
798	798	(B) the contracting with physicians who are not
799	799	network providers and who are of the same or related specialty as
800	800	the appealing physician to resolve claims disputes related to
801	801	denial on the basis of medical necessity that remain unresolved
802	802	subsequent to a provider appeal; and
803	803	(C) the determination of the physician resolving
804	804	the dispute to be binding on the managed care organization and
805	805	provider;
806	806	(16) a requirement that a medical director who is
807	807	authorized to make medical necessity determinations is available to
808	808	the region where the managed care organization provides health care
809	809	services;
810	810	(17) a requirement that the managed care organization
811	811	ensure that a medical director and patient care coordinators and
812	812	provider and recipient support services personnel are located in
813	813	the South Texas service region, if the managed care organization
814	814	provides a managed care plan in that region;
815	815	(18) a requirement that the managed care organization
816	816	provide special programs and materials for recipients with limited
817	817	English proficiency or low literacy skills;
818	818	(19) a requirement that the managed care organization
819	819	develop and establish a process for responding to provider appeals
820	820	in the region where the organization provides health care services;
821	821	(20) a requirement that the managed care organization
822	822	develop and submit to the commission, before the organization
823	823	begins to provide health care services to recipients, a
824	824	comprehensive plan that describes how the organization's provider
825	825	network will provide recipients sufficient access to:
826	826	(A) preventive care;
827	827	(B) primary care;
828	828	(C) specialty care;
829	829	(D) after-hours urgent care; and
830	830	(E) chronic care;
831	831	(21) a requirement that the managed care organization
832	832	demonstrate to the commission, before the organization begins to
833	833	provide health care services to recipients, that:
834	834	(A) the organization's provider network has the
835	835	capacity to serve the number of recipients expected to enroll in a
836	836	managed care plan offered by the organization;
837	837	(B) the organization's provider network
838	838	includes:
839	839	(i) a sufficient number of primary care
840	840	providers;
841	841	(ii) a sufficient variety of provider
842	842	types; and
843	843	(iii) providers located throughout the
844	844	region where the organization will provide health care services;
845	845	and
846	846	(C) health care services will be accessible to
847	847	recipients through the organization's provider network to a
848	848	comparable extent that health care services would be available to
849	849	recipients under a fee-for-service or primary care case management
850	850	model of Medicaid managed care;
851	851	(22) a requirement that the managed care organization
852	852	develop a monitoring program for measuring the quality of the
853	853	health care services provided by the organization's provider
854	854	network that:
855	855	(A) incorporates the National Committee for
856	856	Quality Assurance's Healthcare Effectiveness Data and Information
857	857	Set (HEDIS) measures;
858	858	(B) focuses on measuring outcomes; and
859	859	(C) includes the collection and analysis of
860	860	clinical data relating to prenatal care, preventive care, mental
861	861	health care, and the treatment of acute and chronic health
862	862	conditions and substance abuse;
863	863	(23) subject to Subsection (a-1), a requirement that
864	864	the managed care organization develop, implement, and maintain an
865	865	outpatient pharmacy benefit plan for its enrolled recipients:
866	866	(A) that exclusively employs the vendor drug
867	867	program formulary and preserves the state's ability to reduce
868	868	waste, fraud, and abuse under the Medicaid program;
869	869	(B) that adheres to the applicable preferred drug
870	870	list adopted by the commission under Section 531.072;
871	871	(C) that includes the prior authorization
872	872	procedures and requirements prescribed by or implemented under
873	873	Sections 531.073(b), (c), and (g) for the vendor drug program;
874	874	(D) for purposes of which the managed care
875	875	organization:
876	876	(i) may not negotiate or collect rebates
877	877	associated with pharmacy products on the vendor drug program
878	878	formulary; and
879	879	(ii) may not receive drug rebate or pricing
880	880	information that is confidential under Section 531.071;
881	881	(E) that complies with the prohibition under
882	882	Section 531.089;
883	883	(F) under which the managed care organization may
884	884	not prohibit, limit, or interfere with a recipient's selection of a
885	885	pharmacy or pharmacist of the recipient's choice for the provision
886	886	of pharmaceutical services under the plan through the imposition of
887	887	different copayments;
888	888	(G) that allows the managed care organization or
889	889	any subcontracted pharmacy benefit manager to contract with a
890	890	pharmacist or pharmacy providers separately for specialty pharmacy
891	891	services, except that:
892	892	(i) the managed care organization and
893	893	pharmacy benefit manager are prohibited from allowing exclusive
894	894	contracts with a specialty pharmacy owned wholly or partly by the
895	895	pharmacy benefit manager responsible for the administration of the
896	896	pharmacy benefit program; and
897	897	(ii) the managed care organization and
898	898	pharmacy benefit manager must adopt policies and procedures for
899	899	reclassifying prescription drugs from retail to specialty drugs,
900	900	and those policies and procedures must be consistent with rules
901	901	adopted by the executive commissioner and include notice to network
902	902	pharmacy providers from the managed care organization;
903	903	(H) under which the managed care organization may
904	904	not prevent a pharmacy or pharmacist from participating as a
905	905	provider if the pharmacy or pharmacist agrees to comply with the
906	906	financial terms and conditions of the contract as well as other
907	907	reasonable administrative and professional terms and conditions of
908	908	the contract;
909	909	(I) under which the managed care organization may
910	910	include mail-order pharmacies in its networks, but may not require
911	911	enrolled recipients to use those pharmacies, and may not charge an
912	912	enrolled recipient who opts to use this service a fee, including
913	913	postage and handling fees; and
914	914	(J) under which the managed care organization or
915	915	pharmacy benefit manager, as applicable, must pay claims in
916	916	accordance with Section 843.339, Insurance Code; and
917	917	(24) a requirement that the managed care organization
918	918	and any entity with which the managed care organization contracts
919	919	for the performance of services under a managed care plan disclose,
920	920	at no cost, to the commission and, on request, the office of the
921	921	attorney general all discounts, incentives, rebates, fees, free
922	922	goods, bundling arrangements, and other agreements affecting the
923	923	net cost of goods or services provided under the plan.
924	924	SECTION 21. Section 671.001(b), Government Code, is amended
925	925	to read as follows:
926	926	(b) The pilot program must provide for the following:
927	927	(1) a licensed advanced practice registered nurse as
928	928	defined by Section 301.152, Occupations Code, or a licensed
929	929	physician assistant as described by Chapter 204, Occupations Code,
930	930	who is employed by the state or whose services are acquired by
931	931	contract, who will be located at a state office complex;
932	932	(2) a licensed physician, who is employed by a state
933	933	governmental entity for purposes other than the pilot program or
934	934	whose services are acquired by contract, who will delegate to and
935	935	supervise the advanced practice registered nurse or physician
936	936	assistant under a prescriptive authority agreement under Chapter
937	937	157 [perform all supervisory functions described by Section
938	938	157.052(e)], Occupations Code;
939	939	(3) appropriate office space and equipment for the
940	940	advanced practice registered nurse or physician assistant to
941	941	provide basic medical care to employees at the state office complex
942	942	where the nurse or physician assistant is located; and
943	943	(4) professional liability insurance covering
944	944	services provided by the advanced practice registered nurse or the
945	945	physician assistant.
946	946	SECTION 22. Subchapter D, Chapter 62, Health and Safety
947	947	Code, is amended by adding Section 62.1551 to read as follows:
948	948	Sec. 62.1551. INCLUSION OF CERTAIN HEALTH CARE PROVIDERS IN
949	949	PROVIDER NETWORKS. Notwithstanding any other law, including
950	950	Sections 843.312 and 1301.052, Insurance Code, the executive
951	951	commissioner of the commission shall adopt rules to require a
952	952	managed care organization or other entity to ensure that advanced
953	953	practice registered nurses and physician assistants are available
954	954	as primary care providers in the organization's or entity's
955	955	provider network. The rules must require advanced practice
956	956	registered nurses and physician assistants to be treated in the
957	957	same manner as primary care physicians with regard to:
958	958	(1) selection and assignment as primary care
959	959	providers;
960	960	(2) inclusion as primary care providers in the
961	961	provider network; and
962	962	(3) inclusion as primary care providers in any
963	963	provider network directory maintained by the organization or
964	964	entity.
965	965	SECTION 23. Section 481.002(39), Health and Safety Code, is
966	966	amended to read as follows:
967	967	(39) "Practitioner" means:
968	968	(A) a physician, dentist, veterinarian,
969	969	podiatrist, scientific investigator, or other person licensed,
970	970	registered, or otherwise permitted to distribute, dispense,
971	971	analyze, conduct research with respect to, or administer a
972	972	controlled substance in the course of professional practice or
973	973	research in this state;
974	974	(B) a pharmacy, hospital, or other institution
975	975	licensed, registered, or otherwise permitted to distribute,
976	976	dispense, conduct research with respect to, or administer a
977	977	controlled substance in the course of professional practice or
978	978	research in this state;
979	979	(C) a person practicing in and licensed by
980	980	another state as a physician, dentist, veterinarian, or podiatrist,
981	981	having a current Federal Drug Enforcement Administration
982	982	registration number, who may legally prescribe Schedule II, III,
983	983	IV, or V controlled substances in that state; or
984	984	(D) an advanced practice registered nurse or
985	985	physician assistant to whom a physician has delegated the authority
986	986	to prescribe or order a drug or device [carry out or sign
987	987	prescription drug orders] under Section 157.0511, 157.0512
988	988	[157.052, 157.053], or 157.054, [157.0541, or 157.0542,]
989	989	Occupations Code.
990	990	SECTION 24. Section 483.001(12), Health and Safety Code, is
991	991	amended to read as follows:
992	992	(12) "Practitioner" means [a person licensed]:
993	993	(A) a person licensed by the Texas [State Board
994	994	of] Medical Board [Examiners], State Board of Dental Examiners,
995	995	Texas State Board of Podiatric Medical Examiners, Texas Optometry
996	996	Board, or State Board of Veterinary Medical Examiners to prescribe
997	997	and administer dangerous drugs;
998	998	(B) a person licensed by another state in a
999	999	health field in which, under the laws of this state, a licensee may
1000	1000	legally prescribe dangerous drugs;
1001	1001	(C) a person licensed in Canada or Mexico in a
1002	1002	health field in which, under the laws of this state, a licensee may
1003	1003	legally prescribe dangerous drugs; or
1004	1004	(D) an advanced practice registered nurse or
1005	1005	physician assistant to whom a physician has delegated the authority
1006	1006	to prescribe or order a drug or device [carry out or sign
1007	1007	prescription drug orders] under Section 157.0511, 157.0512
1008	1008	[157.052, 157.053], or 157.054, [157.0541, or 157.0542,]
1009	1009	Occupations Code.
1010	1010	SECTION 25. Section 32.024, Human Resources Code, is
1011	1011	amended by adding Subsection (gg) to read as follows:
1012	1012	(gg) Notwithstanding any other law, including Sections
1013	1013	843.312 and 1301.052, Insurance Code, the department shall ensure
1014	1014	that advanced practice registered nurses and physician assistants
1015	1015	may be selected by and assigned to recipients of medical assistance
1016	1016	as the primary care providers of those recipients. The department
1017	1017	must require that advanced practice registered nurses and physician
1018	1018	assistants be treated in the same manner as primary care physicians
1019	1019	with regard to:
1020	1020	(1) selection and assignment as primary care
1021	1021	providers; and
1022	1022	(2) inclusion as primary care providers in any
1023	1023	directory of providers of medical assistance maintained by the
1024	1024	department.
1025	1025	SECTION 26. Subchapter B, Chapter 32, Human Resources Code,
1026	1026	is amended by adding Section 32.03141 to read as follows:
1027	1027	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
1028	1028	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
1029	1029	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, an
1030	1030	advanced practice registered nurse or physician assistant acting
1031	1031	under adequate physician supervision and to whom a physician has
1032	1032	delegated the authority to prescribe and order drugs and devices
1033	1033	under Chapter 157, Occupations Code, may order and prescribe
1034	1034	durable medical equipment and supplies under the medical assistance
1035	1035	program.
1036	1036	SECTION 27. Sections 157.052, 157.053, 157.0541, and
1037	1037	157.0542, Occupations Code, are repealed.
1038	1038	SECTION 28. The calculation under Chapter 157, Occupations
1039	1039	Code, as amended by this Act, of the amount of time an advanced
1040	1040	practice registered nurse or physician assistant has practiced
1041	1041	under the delegated prescriptive authority of a physician under a
1042	1042	prescriptive authority agreement shall include the amount of time
1043	1043	the advanced practice registered nurse or physician assistant
1044	1044	practiced under the delegated prescriptive authority of that
1045	1045	physician before the effective date of this Act.
1046	1046	SECTION 29. Not later than November 1, 2013, the Texas
1047	1047	Medical Board, the Texas Board of Nursing, and the Texas Physician
1048	1048	Assistant Board shall adopt the rules necessary to implement the
1049	1049	changes in law made by this Act.
1050	1050	SECTION 30. This Act takes effect November 1, 2013.