Texas 2015 - 84th Regular

Texas House Bill HB1885 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R6565 EES-D
2	2	By: Bell H.B. No. 1885
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the scope of practice of and the prescribing and
8	8	ordering authority of advanced practice registered nurses.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES
11	11	SECTION 1.001. Section 301.002, Occupations Code, is
12	12	amended by amending Subdivision (2) and adding Subdivisions (6),
13	13	(7), (8), (9), and (10) to read as follows:
14	14	(2) "Professional nursing" means the performance of an
15	15	act that requires substantial specialized judgment and skill, the
16	16	proper performance of which is based on knowledge and application
17	17	of the principles of biological, physical, and social science as
18	18	acquired by a completed course in an approved school of
19	19	professional nursing. The term does not include acts of medical
20	20	diagnosis or the prescription of therapeutic or corrective
21	21	measures, except as authorized for advanced practice registered
22	22	nurses. Professional nursing involves:
23	23	(A) the observation, assessment, intervention,
24	24	evaluation, rehabilitation, care and counsel, or health teachings
25	25	of a person who is ill, injured, infirm, or experiencing a change in
26	26	normal health processes;
27	27	(B) the maintenance of health or prevention of
28	28	illness;
29	29	(C) the administration of a medication or
30	30	treatment as ordered by a health care practitioner legally
31	31	authorized to prescribe the medication or treatment [physician,
32	32	podiatrist, or dentist];
33	33	(D) the supervision or teaching of nursing;
34	34	(E) the administration, supervision, and
35	35	evaluation of nursing practices, policies, and procedures;
36	36	(F) the requesting, receiving, signing for, and
37	37	distribution of prescription drug samples to patients by [at
38	38	practices at which] an advanced practice registered nurse [is
39	39	authorized to sign prescription drug orders as provided by
40	40	Subchapter B, Chapter 157];
41	41	(G) the prescribing and ordering of drugs and
42	42	devices by an advanced practice registered nurse [performance of an
43	43	act delegated by a physician under Section 157.0512, 157.054,
44	44	157.058, or 157.059]; and
45	45	(H) the development of the nursing care plan.
46	46	(6) "Controlled substance" has the meaning assigned by
47	47	Section 157.051.
48	48	(7) "Dangerous drug" has the meaning assigned by
49	49	Section 157.051.
50	50	(8) "Device" has the meaning assigned by Section
51	51	157.051.
52	52	(9) "Nonprescription drug" has the meaning assigned by
53	53	Section 157.051.
54	54	(10) "Prescribe or order a drug or device" has the
55	55	meaning assigned by Section 157.051.
56	56	SECTION 1.002. Section 301.152(b), Occupations Code, is
57	57	amended to read as follows:
58	58	(b) The board shall adopt rules to:
59	59	(1) license a registered nurse as an advanced practice
60	60	registered nurse;
61	61	(2) establish:
62	62	(A) any specialized education or training,
63	63	including pharmacology, that an advanced practice registered nurse
64	64	must have to prescribe or order a drug or device [as delegated by a
65	65	physician under Section 157.0512 or 157.054];
66	66	(B) a system for approving an advanced practice
67	67	registered nurse to prescribe or order a drug or device [as
68	68	delegated by a physician under Section 157.0512 or 157.054] on the
69	69	receipt of evidence of completing the specialized education and
70	70	training requirement under Paragraph (A); and
71	71	(C) a system for issuing a prescription
72	72	authorization number to an advanced practice registered nurse
73	73	approved under Paragraph (B); and
74	74	(3) concurrently renew any license or approval granted
75	75	to an advanced practice registered nurse under this subsection and
76	76	a license renewed by the advanced practice registered nurse under
77	77	Section 301.301.
78	78	SECTION 1.003. Subchapter H, Chapter 301, Occupations Code,
79	79	is amended by adding Sections 301.357 and 301.358 to read as
80	80	follows:
81	81	Sec. 301.357. SCOPE OF PRACTICE OF ADVANCED PRACTICE
82	82	REGISTERED NURSE. (a) The scope of practice of an advanced
83	83	practice registered nurse includes formulating medical diagnoses,
84	84	prescribing therapeutic and corrective measures, and prescribing
85	85	and ordering drugs and devices.
86	86	(b) This section does not limit or modify the scope of
87	87	practice of a registered nurse who is not an advanced practice
88	88	registered nurse.
89	89	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
90	90	ADVANCED PRACTICE REGISTERED NURSE. An advanced practice
91	91	registered nurse, with a prescription authorization number issued
92	92	as required under Section 301.152(b), may prescribe and order drugs
93	93	and devices, including controlled substances, dangerous drugs, and
94	94	nonprescription drugs.
95	95	ARTICLE 2. CONFORMING AMENDMENTS REGARDING DELEGATION
96	96	SECTION 2.001. The heading to Subchapter B, Chapter 157,
97	97	Occupations Code, is amended to read as follows:
98	98	SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
99	99	AND] PHYSICIAN ASSISTANTS
100	100	SECTION 2.002. Section 157.051(14), Occupations Code, is
101	101	amended to read as follows:
102	102	(14) "Prescriptive authority agreement" means an
103	103	agreement entered into by a physician and a [an advanced practice
104	104	registered nurse or] physician assistant through which the
105	105	physician delegates to the [advanced practice registered nurse or]
106	106	physician assistant the act of prescribing or ordering a drug or
107	107	device.
108	108	SECTION 2.003. Section 157.0511(b-2), Occupations Code, is
109	109	amended to read as follows:
110	110	(b-2) The board shall adopt rules that require a physician
111	111	who delegates the prescribing or ordering of a drug or device to
112	112	register with the board the name and license number of the physician
113	113	assistant [or advanced practice registered nurse] to whom a
114	114	delegation is made. The board may develop and use an electronic
115	115	online delegation registration process for registration under this
116	116	subsection.
117	117	SECTION 2.004. Sections 157.0512(a), (b), (c), (e), (f),
118	118	(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
119	119	to read as follows:
120	120	(a) A physician may delegate to a [an advanced practice
121	121	registered nurse or] physician assistant, acting under adequate
122	122	physician supervision, the act of prescribing or ordering a drug or
123	123	device as authorized through a prescriptive authority agreement
124	124	between the physician and the [advanced practice registered nurse
125	125	or] physician assistant[, as applicable].
126	126	(b) A physician and a [an advanced practice registered nurse
127	127	or] physician assistant are eligible to enter into or be parties to
128	128	a prescriptive authority agreement only if:
129	129	(1) [if applicable, the Texas Board of Nursing has
130	130	approved the advanced practice registered nurse's authority to
131	131	prescribe or order a drug or device as authorized under this
132	132	subchapter;
133	133	[(2)] the [advanced practice registered nurse or]
134	134	physician assistant:
135	135	(A) holds an active license to practice in this
136	136	state as a [an advanced practice registered nurse or] physician
137	137	assistant[, as applicable,] and is in good standing in this state;
138	138	and
139	139	(B) is not currently prohibited by the [Texas
140	140	Board of Nursing or the] Texas Physician Assistant Board[, as
141	141	applicable,] from executing a prescriptive authority agreement;
142	142	and
143	143	(2) [(3)] before executing the prescriptive authority
144	144	agreement, the physician and the [advanced practice registered
145	145	nurse or] physician assistant disclose to the other prospective
146	146	party to the agreement any prior disciplinary action by the board[,
147	147	the Texas Board of Nursing,] or the Texas Physician Assistant
148	148	Board[, as applicable].
149	149	(c) Except as provided by Subsection (d), the [combined]
150	150	number of [advanced practice registered nurses and] physician
151	151	assistants with whom a physician may enter into a prescriptive
152	152	authority agreement may not exceed seven [advanced practice
153	153	registered nurses and] physician assistants or the full-time
154	154	equivalent of seven [advanced practice registered nurses and]
155	155	physician assistants.
156	156	(e) A prescriptive authority agreement must, at a minimum:
157	157	(1) be in writing and signed and dated by the parties
158	158	to the agreement;
159	159	(2) state the name, address, and all professional
160	160	license numbers of the parties to the agreement;
161	161	(3) state the nature of the practice, practice
162	162	locations, or practice settings;
163	163	(4) identify the types or categories of drugs or
164	164	devices that may be prescribed or the types or categories of drugs
165	165	or devices that may not be prescribed;
166	166	(5) provide a general plan for addressing consultation
167	167	and referral;
168	168	(6) provide a plan for addressing patient emergencies;
169	169	(7) state the general process for communication and
170	170	the sharing of information between the physician and the [advanced
171	171	practice registered nurse or] physician assistant to whom the
172	172	physician has delegated prescriptive authority related to the care
173	173	and treatment of patients;
174	174	(8) if alternate physician supervision is to be
175	175	utilized, designate one or more alternate physicians who may:
176	176	(A) provide appropriate supervision on a
177	177	temporary basis in accordance with the requirements established by
178	178	the prescriptive authority agreement and the requirements of this
179	179	subchapter; and
180	180	(B) participate in the prescriptive authority
181	181	quality assurance and improvement plan meetings required under this
182	182	section; and
183	183	(9) describe a prescriptive authority quality
184	184	assurance and improvement plan and specify methods for documenting
185	185	the implementation of the plan that includes the following:
186	186	(A) chart review, with the number of charts to be
187	187	reviewed determined by the physician and [advanced practice
188	188	registered nurse or] physician assistant; and
189	189	(B) periodic face-to-face meetings between the
190	190	[advanced practice registered nurse or] physician assistant and the
191	191	physician at a location determined by the physician and the
192	192	[advanced practice registered nurse or] physician assistant.
193	193	(f) The periodic face-to-face meetings described by
194	194	Subsection (e)(9)(B) must:
195	195	(1) include:
196	196	(A) the sharing of information relating to
197	197	patient treatment and care, needed changes in patient care plans,
198	198	and issues relating to referrals; and
199	199	(B) discussion of patient care improvement; and
200	200	(2) be documented and occur:
201	201	(A) except as provided by Paragraph (B):
202	202	(i) at least monthly until the third
203	203	anniversary of the date the agreement is executed; and
204	204	(ii) at least quarterly after the third
205	205	anniversary of the date the agreement is executed, with monthly
206	206	meetings held between the quarterly meetings by means of a remote
207	207	electronic communications system, including videoconferencing
208	208	technology or the Internet; or
209	209	(B) if during the seven years preceding the date
210	210	the agreement is executed the [advanced practice registered nurse
211	211	or] physician assistant for at least five years was in a practice
212	212	that included the exercise of prescriptive authority with required
213	213	physician supervision:
214	214	(i) at least monthly until the first
215	215	anniversary of the date the agreement is executed; and
216	216	(ii) at least quarterly after the first
217	217	anniversary of the date the agreement is executed, with monthly
218	218	meetings held between the quarterly meetings by means of a remote
219	219	electronic communications system, including videoconferencing
220	220	technology or the Internet.
221	221	(g) The prescriptive authority agreement may include other
222	222	provisions agreed to by the physician and [advanced practice
223	223	registered nurse or] physician assistant.
224	224	(i) The prescriptive authority agreement need not describe
225	225	the exact steps that a [an advanced practice registered nurse or]
226	226	physician assistant must take with respect to each specific
227	227	condition, disease, or symptom.
228	228	(j) A physician[, advanced practice registered nurse,] or
229	229	physician assistant who is a party to a prescriptive authority
230	230	agreement must retain a copy of the agreement until the second
231	231	anniversary of the date the agreement is terminated.
232	232	(l) In the event that a party to a prescriptive authority
233	233	agreement is notified that the individual has become the subject of
234	234	an investigation by the board[, the Texas Board of Nursing,] or the
235	235	Texas Physician Assistant Board, the individual shall immediately
236	236	notify the other party to the prescriptive authority agreement.
237	237	(m) The prescriptive authority agreement and any amendments
238	238	must be reviewed at least annually, dated, and signed by the parties
239	239	to the agreement. The prescriptive authority agreement and any
240	240	amendments must be made available to the board[, the Texas Board of
241	241	Nursing,] or the Texas Physician Assistant Board not later than the
242	242	third business day after the date of receipt of request, if any.
243	243	(n) The prescriptive authority agreement should promote the
244	244	exercise of professional judgment by the [advanced practice
245	245	registered nurse or] physician assistant commensurate with the
246	246	[advanced practice registered nurse's or] physician assistant's
247	247	education and experience and the relationship between the [advanced
248	248	practice registered nurse or] physician assistant and the
249	249	physician.
250	250	(o) This section shall be liberally construed to allow the
251	251	use of prescriptive authority agreements to safely and effectively
252	252	utilize the skills and services of [advanced practice registered
253	253	nurses and] physician assistants.
254	254	SECTION 2.005. Section 157.0513, Occupations Code, is
255	255	amended to read as follows:
256	256	Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
257	257	INFORMATION. (a) The board[, the Texas Board of Nursing,] and the
258	258	Texas Physician Assistant Board shall jointly develop a process:
259	259	(1) to exchange information regarding the names,
260	260	locations, and license numbers of each physician[, advanced
261	261	practice registered nurse,] and physician assistant who has entered
262	262	into a prescriptive authority agreement;
263	263	(2) by which each board shall immediately notify the
264	264	other board [boards] when a license holder of the board becomes the
265	265	subject of an investigation involving the delegation and
266	266	supervision of prescriptive authority, as well as the final
267	267	disposition of any such investigation; and
268	268	(3) by which each board shall maintain and share a list
269	269	of the board's license holders who have been subject to a final
270	270	adverse disciplinary action for an act involving the delegation and
271	271	supervision of prescriptive authority.
272	272	(b) If the board[, the Texas Board of Nursing,] or the Texas
273	273	Physician Assistant Board receives a notice under Subsection
274	274	(a)(2), the board that received notice may open an investigation
275	275	against a license holder of the board who is a party to a
276	276	prescriptive authority agreement with the license holder who is
277	277	under investigation by the board that provided notice under
278	278	Subsection (a)(2).
279	279	(c) The board shall maintain and make available to the
280	280	public a searchable online list of physicians[, advanced practice
281	281	registered nurses,] and physician assistants who have entered into
282	282	a prescriptive authority agreement authorized under Section
283	283	157.0512 and identify the physician[, advanced practice registered
284	284	nurse, or physician assistant] with whom each [physician, advanced
285	285	practice registered nurse, and] physician assistant has entered
286	286	into a prescriptive authority agreement.
287	287	(d) The board shall collaborate with the [Texas Board of
288	288	Nursing and the] Texas Physician Assistant Board to maintain and
289	289	make available to the public a list of physicians[, advanced
290	290	practice registered nurses,] and physician assistants who are
291	291	prohibited from entering into or practicing under a prescriptive
292	292	authority agreement.
293	293	SECTION 2.006. Sections 157.054(a), (a-1), (b), and (c),
294	294	Occupations Code, are amended to read as follows:
295	295	(a) One or more physicians licensed by the board may
296	296	delegate, to one or more physician assistants [or advanced practice
297	297	registered nurses] acting under adequate physician supervision
298	298	whose practice is facility-based at a hospital or licensed
299	299	long-term care facility, the administration or provision of a drug
300	300	and the prescribing or ordering of a drug or device if each of the
301	301	delegating physicians is:
302	302	(1) the medical director or chief of medical staff of
303	303	the facility in which the physician assistant [or advanced practice
304	304	registered nurse] practices;
305	305	(2) the chair of the facility's credentialing
306	306	committee;
307	307	(3) a department chair of a facility department in
308	308	which the physician assistant [or advanced practice registered
309	309	nurse] practices; or
310	310	(4) a physician who consents to the request of the
311	311	medical director or chief of medical staff to delegate the
312	312	prescribing or ordering of a drug or device at the facility in which
313	313	the physician assistant [or advanced practice registered nurse]
314	314	practices.
315	315	(a-1) The limits on the number of [advanced practice
316	316	registered nurses or] physician assistants to whom a physician may
317	317	delegate under Section 157.0512 do not apply to a physician under
318	318	Subsection (a) whose practice is facility-based under this section,
319	319	provided that the physician is not delegating in a freestanding
320	320	clinic, center, or practice of the facility.
321	321	(b) A physician's authority to delegate under Subsection
322	322	(a) is limited as follows:
323	323	(1) the delegation must be made under a physician's
324	324	order, standing medical order, standing delegation order, or
325	325	another order or protocol developed in accordance with policies
326	326	approved by the facility's medical staff or a committee of the
327	327	facility's medical staff as provided by the facility bylaws;
328	328	(2) the delegation must occur in the facility in which
329	329	the physician is the medical director, the chief of medical staff,
330	330	the chair of the credentialing committee, a department chair, or a
331	331	physician who consents to delegate under Subsection (a)(4);
332	332	(3) the delegation may not permit the prescribing or
333	333	ordering of a drug or device for the care or treatment of the
334	334	patients of any other physician without the prior consent of that
335	335	physician; and
336	336	(4) delegation in a long-term care facility must be by
337	337	the medical director and is limited to the prescribing or ordering
338	338	of a drug or device to not more than seven [advanced practice
339	339	registered nurses or] physician assistants or their full-time
340	340	equivalents.
341	341	(c) Physician supervision of the prescribing or ordering of
342	342	a drug or device must conform to what a reasonable, prudent
343	343	physician would find consistent with sound medical judgment but may
344	344	vary with the education and experience of the particular [advanced
345	345	practice registered nurse or] physician assistant. A physician
346	346	shall provide continuous supervision, but the constant physical
347	347	presence of the physician is not required.
348	348	SECTION 2.007. Section 157.055, Occupations Code, is
349	349	amended to read as follows:
350	350	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
351	351	order shall be defined in a manner that promotes the exercise of
352	352	professional judgment by the [advanced practice registered nurse
353	353	and] physician assistant commensurate with the education and
354	354	experience of that person. Under this section, an order or
355	355	protocol used by a reasonable and prudent physician exercising
356	356	sound medical judgment:
357	357	(1) is not required to describe the exact steps that
358	358	[an advanced practice registered nurse or] a physician assistant
359	359	must take with respect to each specific condition, disease, or
360	360	symptom; and
361	361	(2) may state the types or categories of medications
362	362	that may be prescribed or the types or categories of medications
363	363	that may not be prescribed.
364	364	SECTION 2.008. Section 157.056, Occupations Code, is
365	365	amended to read as follows:
366	366	Sec. 157.056. PRESCRIPTION INFORMATION. The following
367	367	information must be provided on each prescription subject to this
368	368	subchapter:
369	369	(1) the patient's name and address;
370	370	(2) the drug to be dispensed;
371	371	(3) directions to the patient regarding the taking of
372	372	the drug and the dosage;
373	373	(4) the intended use of the drug, if appropriate;
374	374	(5) the name, address, and telephone number of the
375	375	physician;
376	376	(6) the name, address, telephone number, and
377	377	identification number of the [registered nurse or] physician
378	378	assistant completing or signing the prescription drug order;
379	379	(7) the date; and
380	380	(8) the number of refills permitted.
381	381	SECTION 2.009. Sections 157.059(b), (e), (f), (g), (h), and
382	382	(i), Occupations Code, are amended to read as follows:
383	383	(b) A physician may delegate to a physician assistant
384	384	offering obstetrical services and certified by the board as
385	385	specializing in obstetrics [or an advanced practice registered
386	386	nurse recognized by the Texas Board of Nursing as a nurse midwife]
387	387	the act of administering or providing controlled substances to the
388	388	physician assistant's [or nurse midwife's] clients during
389	389	intrapartum and immediate postpartum care.
390	390	(e) The physician's orders, medical orders, standing
391	391	delegation orders, prescriptive authority agreements, or protocols
392	392	must require the reporting of or monitoring of each client's
393	393	progress, including complications of pregnancy and delivery and the
394	394	administration and provision of controlled substances by the [nurse
395	395	midwife or] physician assistant to the clients of the [nurse
396	396	midwife or] physician assistant.
397	397	(f) The authority of a physician to delegate under this
398	398	section is limited to:
399	399	(1) seven [nurse midwives or] physician assistants or
400	400	their full-time equivalents; and
401	401	(2) the designated facility at which the [nurse
402	402	midwife or] physician assistant provides care.
403	403	(g) The controlled substance must be supplied in a suitable
404	404	container that is labeled in compliance with the applicable drug
405	405	laws and must include:
406	406	(1) the patient's name and address;
407	407	(2) the drug to be provided;
408	408	(3) the name, address, and telephone number of the
409	409	physician;
410	410	(4) the name, address, and telephone number of the
411	411	[nurse midwife or] physician assistant; and
412	412	(5) the date.
413	413	(h) This section does not authorize a physician or [,]
414	414	physician assistant[, or nurse midwife] to operate a retail
415	415	pharmacy as defined under Subtitle J.
416	416	(i) This section authorizes a physician to delegate the act
417	417	of administering or providing a controlled substance to a [nurse
418	418	midwife or] physician assistant but does not require physician
419	419	delegation of[:
420	420	[(1) further acts to a nurse midwife; or
421	421	[(2)] the administration of medications by a physician
422	422	assistant [or registered nurse] other than as provided by this
423	423	section.
424	424	SECTION 2.010. Section 157.060, Occupations Code, is
425	425	amended to read as follows:
426	426	Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED
427	427	ACT. Unless the physician has reason to believe the physician
428	428	assistant [or advanced practice registered nurse] lacked the
429	429	competency to perform the act, a physician is not liable for an act
430	430	of a physician assistant [or advanced practice registered nurse]
431	431	solely because the physician signed a standing medical order, a
432	432	standing delegation order, or another order or protocol, or entered
433	433	into a prescriptive authority agreement, authorizing the physician
434	434	assistant [or advanced practice registered nurse] to administer,
435	435	provide, prescribe, or order a drug or device.
436	436	ARTICLE 3. GENERAL CONFORMING AMENDMENTS
437	437	SECTION 3.001. Section 671.001(b), Government Code, is
438	438	amended to read as follows:
439	439	(b) The pilot program must provide for the following:
440	440	(1) a licensed advanced practice registered nurse as
441	441	defined by Section 301.152, Occupations Code, or a licensed
442	442	physician assistant as described by Chapter 204, Occupations Code,
443	443	who is employed by the state or whose services are acquired by
444	444	contract, who will be located at a state office complex;
445	445	(2) if applicable, a licensed physician, who is
446	446	employed by a state governmental entity for purposes other than the
447	447	pilot program or whose services are acquired by contract, who will
448	448	delegate to and supervise a [the advanced practice registered nurse
449	449	or] physician assistant under a prescriptive authority agreement
450	450	under Chapter 157, Occupations Code;
451	451	(3) appropriate office space and equipment for the
452	452	advanced practice registered nurse or physician assistant to
453	453	provide basic medical care to employees at the state office complex
454	454	where the nurse or physician assistant is located; and
455	455	(4) professional liability insurance covering
456	456	services provided by the advanced practice registered nurse or the
457	457	physician assistant.
458	458	SECTION 3.002. Section 481.002(39), Health and Safety Code,
459	459	is amended to read as follows:
460	460	(39) "Practitioner" means:
461	461	(A) a physician, dentist, veterinarian,
462	462	podiatrist, scientific investigator, advanced practice registered
463	463	nurse, or other person licensed, registered, or otherwise permitted
464	464	to distribute, dispense, analyze, conduct research with respect to,
465	465	or administer a controlled substance in the course of professional
466	466	practice or research in this state;
467	467	(B) a pharmacy, hospital, or other institution
468	468	licensed, registered, or otherwise permitted to distribute,
469	469	dispense, conduct research with respect to, or administer a
470	470	controlled substance in the course of professional practice or
471	471	research in this state;
472	472	(C) a person practicing in and licensed by
473	473	another state as a physician, dentist, veterinarian, advanced
474	474	practice registered nurse, or podiatrist, having a current Federal
475	475	Drug Enforcement Administration registration number, who may
476	476	legally prescribe Schedule II, III, IV, or V controlled substances
477	477	in that state; or
478	478	(D) a [an advanced practice registered nurse or]
479	479	physician assistant to whom a physician has delegated the authority
480	480	to prescribe or order a drug or device under Section 157.0511,
481	481	157.0512, or 157.054, Occupations Code.
482	482	SECTION 3.003. Section 481.073(a), Health and Safety Code,
483	483	is amended to read as follows:
484	484	(a) Only a practitioner defined by Section 481.002(39)(A)
485	485	and an agent designated in writing by the practitioner in
486	486	accordance with rules adopted by the department may communicate a
487	487	prescription by telephone. A pharmacy that receives a
488	488	telephonically communicated prescription shall promptly write the
489	489	prescription and file and retain the prescription in the manner
490	490	required by this subchapter. A practitioner who designates an
491	491	agent to communicate prescriptions shall maintain the written
492	492	designation of the agent in the practitioner's usual place of
493	493	business and shall make the designation available for inspection by
494	494	investigators for the Texas [State Board of] Medical Board
495	495	[Examiners], the State Board of Dental Examiners, the State Board
496	496	of Veterinary Medical Examiners, the Texas Board of Nursing, and
497	497	the department. A practitioner who designates a different agent
498	498	shall designate that agent in writing and maintain the designation
499	499	in the same manner in which the practitioner initially designated
500	500	an agent under this section.
501	501	SECTION 3.004. Section 481.074(d), Health and Safety Code,
502	502	is amended to read as follows:
503	503	(d) Except as specified in Subsections (e) and (f), the
504	504	director, by rule and in consultation with the Texas Medical Board,
505	505	[and] the Texas State Board of Pharmacy, and the Texas Board of
506	506	Nursing, shall establish the period after the date on which the
507	507	prescription is issued that a person may fill a prescription for a
508	508	controlled substance listed in Schedule II. A person may not
509	509	refill a prescription for a substance listed in Schedule II.
510	510	SECTION 3.005. Section 481.076(c), Health and Safety Code,
511	511	is amended to read as follows:
512	512	(c) The director by rule shall design and implement a system
513	513	for submission of information to the director by electronic or
514	514	other means and for retrieval of information submitted to the
515	515	director under this section and Sections 481.074 and 481.075. The
516	516	director shall use automated information security techniques and
517	517	devices to preclude improper access to the information. The
518	518	director shall submit the system design to the Texas State Board of
519	519	Pharmacy, [and] the Texas Medical Board, and the Texas Board of
520	520	Nursing for review and approval or comment a reasonable time before
521	521	implementation of the system and shall comply with the comments of
522	522	those agencies unless it is unreasonable to do so.
523	523	SECTION 3.006. Sections 483.001(4), (12), and (13), Health
524	524	and Safety Code, are amended to read as follows:
525	525	(4) "Designated agent" means:
526	526	(A) a licensed nurse, physician assistant,
527	527	pharmacist, or other individual designated by a practitioner to
528	528	communicate prescription drug orders to a pharmacist;
529	529	(B) a licensed nurse, physician assistant, or
530	530	pharmacist employed in a health care facility to whom the
531	531	practitioner communicates a prescription drug order; or
532	532	(C) a [registered nurse or] physician assistant
533	533	authorized by a practitioner to carry out a prescription drug order
534	534	for dangerous drugs under Subchapter B, Chapter 157, Occupations
535	535	Code, or an advanced practice registered nurse authorized by a
536	536	practitioner to carry out a prescription drug order for dangerous
537	537	drugs.
538	538	(12) "Practitioner" means:
539	539	(A) a person licensed by the Texas Medical Board,
540	540	State Board of Dental Examiners, Texas State Board of Podiatric
541	541	Medical Examiners, Texas Optometry Board, Texas Board of Nursing,
542	542	or State Board of Veterinary Medical Examiners to prescribe and
543	543	administer dangerous drugs;
544	544	(B) a person licensed by another state in a
545	545	health field in which, under the laws of this state, a licensee may
546	546	legally prescribe dangerous drugs;
547	547	(C) a person licensed in Canada or Mexico in a
548	548	health field in which, under the laws of this state, a licensee may
549	549	legally prescribe dangerous drugs; or
550	550	(D) a [an advanced practice registered nurse or]
551	551	physician assistant to whom a physician has delegated the authority
552	552	to prescribe or order a drug or device under Section 157.0511,
553	553	157.0512, or 157.054, Occupations Code.
554	554	(13) "Prescription" means an order from a
555	555	practitioner, or an agent of the practitioner designated in writing
556	556	as authorized to communicate prescriptions, or an order made in
557	557	accordance with Subchapter B, Chapter 157, Occupations Code, or
558	558	Section 203.353, Occupations Code, to a pharmacist for a dangerous
559	559	drug to be dispensed that states:
560	560	(A) the date of the order's issue;
561	561	(B) the name and address of the patient;
562	562	(C) if the drug is prescribed for an animal, the
563	563	species of the animal;
564	564	(D) the name and quantity of the drug prescribed;
565	565	(E) the directions for the use of the drug;
566	566	(F) the intended use of the drug unless the
567	567	practitioner determines the furnishing of this information is not
568	568	in the best interest of the patient;
569	569	(G) the name, address, and telephone number of
570	570	the practitioner at the practitioner's usual place of business,
571	571	legibly printed or stamped; and
572	572	(H) the name, address, and telephone number of
573	573	the licensed midwife[, registered nurse,] or physician assistant,
574	574	legibly printed or stamped, if signed by a licensed midwife[,
575	575	registered nurse,] or physician assistant.
576	576	SECTION 3.007. Section 483.022(f), Health and Safety Code,
577	577	is amended to read as follows:
578	578	(f) A practitioner may designate a person who is a licensed
579	579	vocational nurse or has an education equivalent to or greater than
580	580	that required for a licensed vocational nurse to communicate
581	581	prescriptions of a [an advanced practice nurse or] physician
582	582	assistant authorized by the practitioner to sign prescription drug
583	583	orders under Subchapter B, Chapter 157, Occupations Code.
584	584	SECTION 3.008. Section 483.042(a), Health and Safety Code,
585	585	is amended to read as follows:
586	586	(a) A person commits an offense if the person delivers or
587	587	offers to deliver a dangerous drug:
588	588	(1) unless:
589	589	(A) the dangerous drug is delivered or offered
590	590	for delivery by a pharmacist under:
591	591	(i) a prescription issued by a practitioner
592	592	described by Section 483.001(12)(A) or (B);
593	593	(ii) a prescription signed by a [registered
594	594	nurse or] physician assistant in accordance with Subchapter B,
595	595	Chapter 157, Occupations Code; or
596	596	(iii) an original written prescription
597	597	issued by a practitioner described by Section 483.001(12)(C); and
598	598	(B) a label is attached to the immediate
599	599	container in which the drug is delivered or offered to be delivered
600	600	and the label contains the following information:
601	601	(i) the name and address of the pharmacy
602	602	from which the drug is delivered or offered for delivery;
603	603	(ii) the date the prescription for the drug
604	604	is dispensed;
605	605	(iii) the number of the prescription as
606	606	filed in the prescription files of the pharmacy from which the
607	607	prescription is dispensed;
608	608	(iv) the name of the practitioner who
609	609	prescribed the drug and, if applicable, the name of the [registered
610	610	nurse or] physician assistant who signed the prescription;
611	611	(v) the name of the patient and, if the drug
612	612	is prescribed for an animal, a statement of the species of the
613	613	animal; and
614	614	(vi) directions for the use of the drug as
615	615	contained in the prescription; or
616	616	(2) unless:
617	617	(A) the dangerous drug is delivered or offered
618	618	for delivery by:
619	619	(i) a practitioner in the course of
620	620	practice; or
621	621	(ii) a [registered nurse or] physician
622	622	assistant in the course of practice in accordance with Subchapter
623	623	B, Chapter 157, Occupations Code; and
624	624	(B) a label is attached to the immediate
625	625	container in which the drug is delivered or offered to be delivered
626	626	and the label contains the following information:
627	627	(i) the name and address of the
628	628	practitioner who prescribed the drug, and if applicable, the name
629	629	and address of the [registered nurse or] physician assistant;
630	630	(ii) the date the drug is delivered;
631	631	(iii) the name of the patient and, if the
632	632	drug is prescribed for an animal, a statement of the species of the
633	633	animal; and
634	634	(iv) the name of the drug, the strength of
635	635	the drug, and directions for the use of the drug.
636	636	SECTION 3.009. Section 32.03141, Human Resources Code, is
637	637	amended to read as follows:
638	638	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
639	639	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
640	640	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
641	641	addition to other health care practitioners authorized by federal
642	642	law, the following persons may order and prescribe durable medical
643	643	equipment and supplies under the medical assistance program:
644	644	(1) an advanced practice registered nurse; and
645	645	(2) a [or] physician assistant acting under adequate
646	646	physician supervision and to whom a physician has delegated the
647	647	authority to prescribe and order drugs and devices under Chapter
648	648	157, Occupations Code[, may order and prescribe durable medical
649	649	equipment and supplies under the medical assistance program].
650	650	SECTION 3.010. Section 843.312, Insurance Code, is amended
651	651	to read as follows:
652	652	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
653	653	REGISTERED NURSES. (a) A health maintenance organization may not
654	654	refuse a request by a physician participating in the health
655	655	maintenance organization delivery network and a physician
656	656	assistant [or advanced practice nurse] who is authorized by the
657	657	physician to provide care under Subchapter B, Chapter 157,
658	658	Occupations Code, or an advanced practice registered nurse who is
659	659	authorized to provide care by the physician to identify a physician
660	660	assistant or advanced practice registered nurse as a provider in
661	661	the network.
662	662	(b) A health maintenance organization may refuse a request
663	663	under Subsection (a) if the physician assistant or advanced
664	664	practice registered nurse does not meet the quality of care
665	665	standards previously established by the health maintenance
666	666	organization for participation in the network by physician
667	667	assistants and advanced practice registered nurses.
668	668	SECTION 3.011. Section 1301.001(1-a), Insurance Code, is
669	669	amended to read as follows:
670	670	(1-a) "Health care provider" means a practitioner,
671	671	institutional provider, or other person or organization that
672	672	furnishes health care services and that is licensed or otherwise
673	673	authorized to practice in this state. The term includes a
674	674	pharmacist, [and] a pharmacy, and an advanced practice registered
675	675	nurse. The term does not include a physician.
676	676	SECTION 3.012. Section 1301.052, Insurance Code, is amended
677	677	to read as follows:
678	678	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
679	679	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
680	680	offering a preferred provider benefit plan may not refuse a request
681	681	made by a physician participating as a preferred provider under the
682	682	plan and an advanced practice registered nurse or physician
683	683	assistant to have the advanced practice registered nurse or
684	684	physician assistant included as a preferred provider under the plan
685	685	if:
686	686	(1) the [advanced practice nurse or] physician
687	687	assistant is authorized by the physician to provide care under
688	688	Subchapter B, Chapter 157, Occupations Code, or the advanced
689	689	practice registered nurse is authorized to provide care by the
690	690	physician; and
691	691	(2) the advanced practice registered nurse or
692	692	physician assistant meets the quality of care standards previously
693	693	established by the insurer for participation in the plan by
694	694	advanced practice registered nurses and physician assistants.
695	695	SECTION 3.013. Section 1451.001(2), Insurance Code, is
696	696	amended to read as follows:
697	697	(2) "Advanced practice registered nurse" means an
698	698	individual licensed by the Texas Board of Nursing as a registered
699	699	nurse and licensed [recognized] by that board as an advanced
700	700	practice registered nurse.
701	701	SECTION 3.014. Section 1451.104(c), Insurance Code, is
702	702	amended to read as follows:
703	703	(c) Notwithstanding Subsection (a), a health insurance
704	704	policy may provide for a different amount of payment or
705	705	reimbursement for scheduled services or procedures performed by an
706	706	advanced practice registered nurse, nurse first assistant,
707	707	licensed surgical assistant, or physician assistant if the
708	708	methodology used to compute the amount is the same as the
709	709	methodology used to compute the amount of payment or reimbursement
710	710	when the services or procedures are provided by a physician.
711	711	SECTION 3.015. Section 1451.106, Insurance Code, is amended
712	712	to read as follows:
713	713	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
714	714	NURSE. An insured may select an advanced practice registered nurse
715	715	to provide the services scheduled in the health insurance policy
716	716	that are within the scope of the nurse's license.
717	717	SECTION 3.016. Section 204.1025, Occupations Code, is
718	718	amended to read as follows:
719	719	Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
720	720	AGREEMENTS. The physician assistant board shall in conjunction
721	721	with the Texas Medical Board [and the Texas Board of Nursing]
722	722	perform the functions and duties relating to prescriptive authority
723	723	agreements assigned to the physician assistant board in Sections
724	724	157.0512 and 157.0513.
725	725	SECTION 3.017. Sections 551.003(14) and (34), Occupations
726	726	Code, are amended to read as follows:
727	727	(14) "Designated agent" means:
728	728	(A) an individual, including a licensed nurse,
729	729	physician assistant, or pharmacist:
730	730	(i) who is designated by a practitioner and
731	731	authorized to communicate a prescription drug order to a
732	732	pharmacist; and
733	733	(ii) for whom the practitioner assumes
734	734	legal responsibility;
735	735	(B) a licensed nurse, physician assistant, or
736	736	pharmacist employed in a health care facility to whom a
737	737	practitioner communicates a prescription drug order; or
738	738	(C) a [registered nurse or] physician assistant
739	739	authorized by a practitioner to administer a prescription drug
740	740	order for a dangerous drug under Subchapter B, Chapter 157, or an
741	741	advanced practice registered nurse authorized by a practitioner to
742	742	administer a prescription drug order for a dangerous drug.
743	743	(34) "Practitioner" means:
744	744	(A) a person licensed or registered to prescribe,
745	745	distribute, administer, or dispense a prescription drug or device
746	746	in the course of professional practice in this state, including a
747	747	physician, dentist, podiatrist, advanced practice registered
748	748	nurse, or veterinarian but excluding a person licensed under this
749	749	subtitle;
750	750	(B) a person licensed by another state, Canada,
751	751	or the United Mexican States in a health field in which, under the
752	752	law of this state, a license holder in this state may legally
753	753	prescribe a dangerous drug;
754	754	(C) a person practicing in another state and
755	755	licensed by another state as a physician, dentist, veterinarian,
756	756	advanced practice registered nurse, or podiatrist, who has a
757	757	current federal Drug Enforcement Administration registration
758	758	number and who may legally prescribe a Schedule II, III, IV, or V
759	759	controlled substance, as specified under Chapter 481, Health and
760	760	Safety Code, in that other state; or
761	761	(D) a [an advanced practice registered nurse or]
762	762	physician assistant to whom a physician has delegated the authority
763	763	to prescribe or order a drug or device under Section 157.0511,
764	764	157.0512, or 157.054.
765	765	SECTION 3.018. Section 563.051(e), Occupations Code, is
766	766	amended to read as follows:
767	767	(e) A practitioner may designate a licensed vocational
768	768	nurse or a person having education equivalent to or greater than
769	769	that required for a licensed vocational nurse to communicate the
770	770	prescriptions of a [an advanced practice nurse or] physician
771	771	assistant authorized by the practitioner to sign prescription drug
772	772	orders under Subchapter B, Chapter 157, or an advanced practice
773	773	registered nurse.
774	774	SECTION 3.019. Section 563.053, Occupations Code, is
775	775	amended to read as follows:
776	776	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
777	777	RURAL AREAS. (a) In this section, "reimbursement for cost" means
778	778	an additional charge, separate from that imposed for the
779	779	physician's or advanced practice registered nurse's professional
780	780	services, that includes the cost of the drug product and all other
781	781	actual costs to the physician or advanced practice registered nurse
782	782	incidental to providing the dispensing service. The term does not
783	783	include a separate fee imposed for the act of dispensing the drug
784	784	itself.
785	785	(b) This section applies to an area located in a county with
786	786	a population of 5,000 or less, or in a municipality or an
787	787	unincorporated town with a population of less than 2,500, that is
788	788	within a 15-mile radius of the physician's or advanced practice
789	789	registered nurse's office and in which a pharmacy is not located.
790	790	This section does not apply to a municipality or an unincorporated
791	791	town that is adjacent to a municipality with a population of 2,500
792	792	or more.
793	793	(c) A physician who practices medicine or an advanced
794	794	practice registered nurse who practices professional nursing in an
795	795	area described by Subsection (b) may:
796	796	(1) maintain a supply of dangerous drugs in the
797	797	physician's or advanced practice registered nurse's office to be
798	798	dispensed in the course of treating the physician's or advanced
799	799	practice registered nurse's patients; and
800	800	(2) be reimbursed for the cost of supplying those
801	801	drugs without obtaining a license under Chapter 558.
802	802	(d) A physician or advanced practice registered nurse who
803	803	dispenses dangerous drugs under Subsection (c) shall:
804	804	(1) comply with each labeling provision under this
805	805	subtitle applicable to that class of drugs; and
806	806	(2) oversee compliance with packaging and
807	807	recordkeeping provisions applicable to that class of drugs.
808	808	(e) A physician who desires to dispense dangerous drugs
809	809	under this section shall notify both the board and the Texas Medical
810	810	[State] Board [of Medical Examiners] that the physician practices
811	811	in an area described by Subsection (b). An advanced practice
812	812	registered nurse who desires to dispense dangerous drugs under this
813	813	section shall notify both the board and the Texas Board of Nursing
814	814	that the advanced practice registered nurse practices in an area
815	815	described by Subsection (b). The physician or advanced practice
816	816	registered nurse may continue to dispense dangerous drugs in the
817	817	area until the board determines, after notice and hearing, that the
818	818	physician or advanced practice registered nurse no longer practices
819	819	in an area described by Subsection (b).
820	820	SECTION 3.020. Section 605.002(14), Occupations Code, is
821	821	amended to read as follows:
822	822	(14) "Orthotics" means the science and practice of
823	823	measuring, designing, fabricating, assembling, fitting, adjusting,
824	824	or servicing an orthosis under an order from a licensed physician,
825	825	chiropractor, or podiatrist, or [an] advanced practice registered
826	826	nurse, or from a physician assistant acting under the delegation
827	827	and supervision of a licensed physician as provided by Subchapter
828	828	B, Chapter 157, and rules adopted by the Texas Medical Board, for
829	829	the correction or alleviation of a neuromuscular or musculoskeletal
830	830	dysfunction, disease, injury, or deformity.
831	831	SECTION 3.021. Section 605.2515, Occupations Code, is
832	832	amended to read as follows:
833	833	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
834	834	person licensed to practice orthotics or prosthetics who measures,
835	835	designs, fabricates, fits, assembles, adjusts, or services an
836	836	orthosis or a prosthesis under an order from a licensed physician,
837	837	chiropractor, or podiatrist, or [an] advanced practice registered
838	838	nurse, or from a physician assistant acting under the delegation
839	839	and supervision of a licensed physician as provided by Subchapter
840	840	B, Chapter 157, and rules adopted by the Texas Medical Board, for a
841	841	specific patient is exempt from licensing as a device manufacturer
842	842	under Subchapter L, Chapter 431, Health and Safety Code. A person
843	843	licensed to practice orthotics or prosthetics who fabricates or
844	844	assembles an orthosis or a prosthesis without an order from a
845	845	licensed physician, chiropractor, or podiatrist, or [an] advanced
846	846	practice registered nurse, or from a physician assistant acting
847	847	under the delegation and supervision of a licensed physician as
848	848	provided by Subchapter B, Chapter 157, and rules adopted by the
849	849	Texas Medical Board, for a specific patient is required to be
850	850	licensed as a device manufacturer under Subchapter L, Chapter 431,
851	851	Health and Safety Code.
852	852	ARTICLE 4. REPEALER
853	853	SECTION 4.001. The following sections of the Occupations
854	854	Code are repealed:
855	855	(1) Section 157.051(1);
856	856	(2) Section 157.058; and
857	857	(3) Section 301.168.
858	858	ARTICLE 5. TRANSITION AND EFFECTIVE DATE
859	859	SECTION 5.001. Not later than February 1, 2016, the Texas
860	860	Board of Nursing shall adopt the rules necessary to implement the
861	861	changes in law made by this Act.
862	862	SECTION 5.002. Notwithstanding any changes in law made by
863	863	this Act, an advanced practice registered nurse who has been
864	864	delegated the authority to prescribe and order drugs and medical
865	865	devices by a physician's protocol or order under Subchapter B,
866	866	Chapter 157, Occupations Code, may continue to exercise that
867	867	authority until February 1, 2016.
868	868	SECTION 5.003. This Act takes effect September 1, 2015.