Texas 2017 - 85th Regular

Texas House Bill HB1415 Compare Versions

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

Old	New	Differences
1	1	85R2865 EES-F
2	2	By: Klick H.B. No. 1415
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the licensing and authority of advanced practice
8	8	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 performance of an act by an advanced
37	37	practice registered nurse in accordance with Section 301.357 [the
38	38	requesting, receiving, signing for, and distribution of
39	39	prescription drug samples to patients at practices at which an
40	40	advanced practice registered nurse is authorized to sign
41	41	prescription drug orders as provided by Subchapter B, Chapter 157];
42	42	(G) the performance of an act delegated by a
43	43	physician under Section [157.0512, 157.054,] 157.058[,] or
44	44	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, Occupations Code, is
57	57	transferred to Subchapter H, Chapter 301, Occupations Code,
58	58	redesignated as Section 301.357, Occupations Code, and amended to
59	59	read as follows:
60	60	Sec. 301.357 [301.152]. ADVANCED PRACTICE REGISTERED NURSES
61	61	[RULES REGARDING SPECIALIZED TRAINING]. (a) In this section,
62	62	"advanced practice registered nurse" means a registered nurse
63	63	licensed by the board to practice as an advanced practice
64	64	registered nurse on the basis of completion of an advanced
65	65	educational program. The term includes a nurse practitioner,
66	66	nurse midwife, nurse anesthetist, and clinical nurse
67	67	specialist. The term is synonymous with "advanced nurse
68	68	practitioner" and "advanced practice nurse."
69	69	(a-1) Advanced practice registered nursing includes:
70	70	(1) ordering, performing, and interpreting diagnostic
71	71	tests;
72	72	(2) formulating primary and differential medical
73	73	diagnoses and advanced assessments;
74	74	(3) treating actual and potential health problems;
75	75	(4) prescribing therapeutic and corrective measures,
76	76	including nutrition and diagnostic support services, home health
77	77	care, hospice care, physical therapy, and occupational therapy, and
78	78	delegating and assigning the performance of therapeutic and
79	79	corrective measures to assistive personnel;
80	80	(5) to the extent authorized by the board under
81	81	Section 301.358 or delegated by a physician under Section 157.058
82	82	or 157.059, prescribing, ordering, procuring, administering, and
83	83	dispensing drugs and devices, including blood and blood products,
84	84	controlled substances listed in Schedules II, III, IV, and V,
85	85	dangerous drugs, and nonprescription drugs;
86	86	(6) providing referrals to health care agencies,
87	87	health care providers, and community resources;
88	88	(7) serving as the primary care provider of record;
89	89	and
90	90	(8) performing other acts that require education and
91	91	training consistent with professional standards and that are
92	92	commensurate with the advanced practice registered nurse's
93	93	education, licensure, and demonstrated competencies and
94	94	experience.
95	95	(b) The board shall adopt rules to:
96	96	(1) license a registered nurse as an advanced practice
97	97	registered nurse;
98	98	(2) establish:
99	99	(A) any specialized education or training,
100	100	including pharmacology, that an advanced practice registered nurse
101	101	must have to prescribe or order a drug or device as authorized
102	102	[delegated] by the board [a physician] under Section 301.358
103	103	[157.0512 or 157.054];
104	104	(B) a system for approving an advanced practice
105	105	registered nurse to prescribe or order a drug or device as
106	106	authorized [delegated] by the board [a physician] under Section
107	107	301.358 [157.0512 or 157.054] on the receipt of evidence of
108	108	completing the specialized education and training requirement
109	109	under Paragraph (A); and
110	110	(C) a system for issuing a prescription
111	111	authorization number to an advanced practice registered nurse
112	112	approved under Paragraph (B); and
113	113	(3) concurrently renew any license or approval granted
114	114	to an advanced practice registered nurse under this subsection and
115	115	a license renewed by the advanced practice registered nurse under
116	116	Section 301.301.
117	117	(c) At a minimum, the rules adopted under Subsection (b)(2)
118	118	must:
119	119	(1) require completion of pharmacology and related
120	120	pathophysiology education for initial approval; and
121	121	(2) require continuing education in clinical
122	122	pharmacology and related pathophysiology in addition to any
123	123	continuing education otherwise required under Section 301.303.
124	124	(d) The signature of an advanced practice registered nurse
125	125	attesting to the provision of a legally authorized service by the
126	126	advanced practice registered nurse satisfies any documentation
127	127	requirement for that service established by a state agency.
128	128	(e) An advanced practice registered nurse shall practice as
129	129	a licensed independent practitioner in accordance with standards
130	130	established and recognized by the board to protect the public
131	131	health and safety.
132	132	(f) An advanced practice registered nurse is accountable to
133	133	patients, the nursing profession, and the board for:
134	134	(1) complying with the requirements of this chapter;
135	135	(2) providing quality advanced nursing care;
136	136	(3) recognizing the nurse's limits of knowledge;
137	137	(4) planning for the management of situations beyond
138	138	the nurse's expertise; and
139	139	(5) consulting with or referring patients to other
140	140	health care providers as appropriate.
141	141	(g) This section does not limit or modify the scope of
142	142	practice of a registered nurse who is not an advanced practice
143	143	registered nurse.
144	144	SECTION 1.003. Subchapter H, Chapter 301, Occupations Code,
145	145	is amended by adding Section 301.358 to read as follows:
146	146	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
147	147	ADVANCED PRACTICE REGISTERED NURSE. (a) The board may authorize an
148	148	advanced practice registered nurse, with a prescription
149	149	authorization number issued as required under Section 301.357(b),
150	150	to prescribe and order drugs and devices, including controlled
151	151	substances listed in Schedules III, IV, and V, dangerous drugs, and
152	152	nonprescription drugs.
153	153	(b) The board may authorize an advanced practice registered
154	154	nurse, with a prescription authorization number issued as required
155	155	under Section 301.357(b), to prescribe and order controlled
156	156	substances listed in Schedule II only:
157	157	(1) in a hospital facility-based practice in
158	158	accordance with policies approved by the hospital's medical staff
159	159	or a committee of the hospital's medical staff as provided by the
160	160	hospital bylaws to ensure patient safety, and as part of the care
161	161	provided to a patient who:
162	162	(A) has been admitted to the hospital and is
163	163	expected to remain in the hospital for a period of 24 hours or more;
164	164	or
165	165	(B) is receiving services in the emergency
166	166	department of the hospital; or
167	167	(2) as part of the plan of care for the treatment of a
168	168	person who has executed a written certification of a terminal
169	169	illness, has elected to receive hospice care, and is receiving
170	170	hospice treatment from a qualified hospice provider.
171	171	ARTICLE 2. CONFORMING AMENDMENTS REGARDING DELEGATION
172	172	SECTION 2.001. The heading to Subchapter B, Chapter 157,
173	173	Occupations Code, is amended to read as follows:
174	174	SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
175	175	AND] PHYSICIAN ASSISTANTS AND CERTAIN ADVANCED PRACTICE REGISTERED
176	176	NURSES
177	177	SECTION 2.002. Sections 157.051(1) and (14), Occupations
178	178	Code, are amended to read as follows:
179	179	(1) "Advanced practice registered nurse" has the
180	180	meaning assigned to that term by Section 301.357 [301.152]. The
181	181	term includes an advanced nurse practitioner and advanced practice
182	182	nurse.
183	183	(14) "Prescriptive authority agreement" means an
184	184	agreement entered into by a physician and a [an advanced practice
185	185	registered nurse or] physician assistant through which the
186	186	physician delegates to the [advanced practice registered nurse or]
187	187	physician assistant the act of prescribing or ordering a drug or
188	188	device.
189	189	SECTION 2.003. Section 157.0511(b-2), Occupations Code, is
190	190	amended to read as follows:
191	191	(b-2) The board shall adopt rules that require a physician
192	192	who delegates the prescribing or ordering of a drug or device to
193	193	register with the board the name and license number of the physician
194	194	assistant [or advanced practice registered nurse] to whom a
195	195	delegation is made. The board may develop and use an electronic
196	196	online delegation registration process for registration under this
197	197	subsection.
198	198	SECTION 2.004. Sections 157.0512(a), (b), (c), (e), (f),
199	199	(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
200	200	to read as follows:
201	201	(a) A physician may delegate to a [an advanced practice
202	202	registered nurse or] physician assistant, acting under adequate
203	203	physician supervision, the act of prescribing or ordering a drug or
204	204	device as authorized through a prescriptive authority agreement
205	205	between the physician and the [advanced practice registered nurse
206	206	or] physician assistant[, as applicable].
207	207	(b) A physician and a [an advanced practice registered nurse
208	208	or] physician assistant are eligible to enter into or be parties to
209	209	a prescriptive authority agreement only if:
210	210	(1) [if applicable, the Texas Board of Nursing has
211	211	approved the advanced practice registered nurse's authority to
212	212	prescribe or order a drug or device as authorized under this
213	213	subchapter;
214	214	[(2)] the [advanced practice registered nurse or]
215	215	physician assistant:
216	216	(A) holds an active license to practice in this
217	217	state as a [an advanced practice registered nurse or] physician
218	218	assistant[, as applicable,] and is in good standing in this state;
219	219	and
220	220	(B) is not currently prohibited by the [Texas
221	221	Board of Nursing or the] Texas Physician Assistant Board[, as
222	222	applicable,] from executing a prescriptive authority agreement;
223	223	and
224	224	(2) [(3)] before executing the prescriptive authority
225	225	agreement, the physician and the [advanced practice registered
226	226	nurse or] physician assistant disclose to the other prospective
227	227	party to the agreement any prior disciplinary action by the board[,
228	228	the Texas Board of Nursing,] or the Texas Physician Assistant
229	229	Board[, as applicable].
230	230	(c) Except as provided by Subsection (d), the [combined]
231	231	number of [advanced practice registered nurses and] physician
232	232	assistants with whom a physician may enter into a prescriptive
233	233	authority agreement may not exceed seven [advanced practice
234	234	registered nurses and] physician assistants or the full-time
235	235	equivalent of seven [advanced practice registered nurses and]
236	236	physician assistants.
237	237	(e) A prescriptive authority agreement must, at a minimum:
238	238	(1) be in writing and signed and dated by the parties
239	239	to the agreement;
240	240	(2) state the name, address, and all professional
241	241	license numbers of the parties to the agreement;
242	242	(3) state the nature of the practice, practice
243	243	locations, or practice settings;
244	244	(4) identify the types or categories of drugs or
245	245	devices that may be prescribed or the types or categories of drugs
246	246	or devices that may not be prescribed;
247	247	(5) provide a general plan for addressing consultation
248	248	and referral;
249	249	(6) provide a plan for addressing patient emergencies;
250	250	(7) state the general process for communication and
251	251	the sharing of information between the physician and the [advanced
252	252	practice registered nurse or] physician assistant to whom the
253	253	physician has delegated prescriptive authority related to the care
254	254	and treatment of patients;
255	255	(8) if alternate physician supervision is to be
256	256	utilized, designate one or more alternate physicians who may:
257	257	(A) provide appropriate supervision on a
258	258	temporary basis in accordance with the requirements established by
259	259	the prescriptive authority agreement and the requirements of this
260	260	subchapter; and
261	261	(B) participate in the prescriptive authority
262	262	quality assurance and improvement plan meetings required under this
263	263	section; and
264	264	(9) describe a prescriptive authority quality
265	265	assurance and improvement plan and specify methods for documenting
266	266	the implementation of the plan that includes the following:
267	267	(A) chart review, with the number of charts to be
268	268	reviewed determined by the physician and [advanced practice
269	269	registered nurse or] physician assistant; and
270	270	(B) periodic face-to-face meetings between the
271	271	[advanced practice registered nurse or] physician assistant and the
272	272	physician at a location determined by the physician and the
273	273	[advanced practice registered nurse or] physician assistant.
274	274	(f) The periodic face-to-face meetings described by
275	275	Subsection (e)(9)(B) must:
276	276	(1) include:
277	277	(A) the sharing of information relating to
278	278	patient treatment and care, needed changes in patient care plans,
279	279	and issues relating to referrals; and
280	280	(B) discussion of patient care improvement; and
281	281	(2) be documented and occur:
282	282	(A) except as provided by Paragraph (B):
283	283	(i) at least monthly until the third
284	284	anniversary of the date the agreement is executed; and
285	285	(ii) at least quarterly after the third
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; or
290	290	(B) if during the seven years preceding the date
291	291	the agreement is executed the [advanced practice registered nurse
292	292	or] physician assistant for at least five years was in a practice
293	293	that included the exercise of prescriptive authority with required
294	294	physician supervision:
295	295	(i) at least monthly until the first
296	296	anniversary of the date the agreement is executed; and
297	297	(ii) at least quarterly after the first
298	298	anniversary of the date the agreement is executed, with monthly
299	299	meetings held between the quarterly meetings by means of a remote
300	300	electronic communications system, including videoconferencing
301	301	technology or the Internet.
302	302	(g) The prescriptive authority agreement may include other
303	303	provisions agreed to by the physician and [advanced practice
304	304	registered nurse or] physician assistant.
305	305	(i) The prescriptive authority agreement need not describe
306	306	the exact steps that a [an advanced practice registered nurse or]
307	307	physician assistant must take with respect to each specific
308	308	condition, disease, or symptom.
309	309	(j) A physician[, advanced practice registered nurse,] or
310	310	physician assistant who is a party to a prescriptive authority
311	311	agreement must retain a copy of the agreement until the second
312	312	anniversary of the date the agreement is terminated.
313	313	(l) In the event that a party to a prescriptive authority
314	314	agreement is notified that the individual has become the subject of
315	315	an investigation by the board[, the Texas Board of Nursing,] or the
316	316	Texas Physician Assistant Board, the individual shall immediately
317	317	notify the other party to the prescriptive authority agreement.
318	318	(m) The prescriptive authority agreement and any amendments
319	319	must be reviewed at least annually, dated, and signed by the parties
320	320	to the agreement. The prescriptive authority agreement and any
321	321	amendments must be made available to the board[, the Texas Board of
322	322	Nursing,] or the Texas Physician Assistant Board not later than the
323	323	third business day after the date of receipt of request, if any.
324	324	(n) The prescriptive authority agreement should promote the
325	325	exercise of professional judgment by the [advanced practice
326	326	registered nurse or] physician assistant commensurate with the
327	327	[advanced practice registered nurse's or] physician assistant's
328	328	education and experience and the relationship between the [advanced
329	329	practice registered nurse or] physician assistant and the
330	330	physician.
331	331	(o) This section shall be liberally construed to allow the
332	332	use of prescriptive authority agreements to safely and effectively
333	333	utilize the skills and services of [advanced practice registered
334	334	nurses and] physician assistants.
335	335	SECTION 2.005. Section 157.0513, Occupations Code, is
336	336	amended to read as follows:
337	337	Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
338	338	INFORMATION. (a) The board[, the Texas Board of Nursing,] and the
339	339	Texas Physician Assistant Board shall jointly develop a process:
340	340	(1) to exchange information regarding the names,
341	341	locations, and license numbers of each physician[, advanced
342	342	practice registered nurse,] and physician assistant who has entered
343	343	into a prescriptive authority agreement;
344	344	(2) by which each board shall immediately notify the
345	345	other board [boards] when a license holder of the board becomes the
346	346	subject of an investigation involving the delegation and
347	347	supervision of prescriptive authority, as well as the final
348	348	disposition of any such investigation; and
349	349	(3) by which each board shall maintain and share a list
350	350	of the board's license holders who have been subject to a final
351	351	adverse disciplinary action for an act involving the delegation and
352	352	supervision of prescriptive authority.
353	353	(b) If the board[, the Texas Board of Nursing,] or the Texas
354	354	Physician Assistant Board receives a notice under Subsection
355	355	(a)(2), the board that received notice may open an investigation
356	356	against a license holder of the board who is a party to a
357	357	prescriptive authority agreement with the license holder who is
358	358	under investigation by the board that provided notice under
359	359	Subsection (a)(2).
360	360	(c) The board shall maintain and make available to the
361	361	public a searchable online list of physicians[, advanced practice
362	362	registered nurses,] and physician assistants who have entered into
363	363	a prescriptive authority agreement authorized under Section
364	364	157.0512 and identify the physician[, advanced practice registered
365	365	nurse, or physician assistant] with whom each [physician, advanced
366	366	practice registered nurse, and] physician assistant has entered
367	367	into a prescriptive authority agreement.
368	368	(d) The board shall collaborate with the [Texas Board of
369	369	Nursing and the] Texas Physician Assistant Board to maintain and
370	370	make available to the public a list of physicians[, advanced
371	371	practice registered nurses,] and physician assistants who are
372	372	prohibited from entering into or practicing under a prescriptive
373	373	authority agreement.
374	374	SECTION 2.006. Sections 157.054(a), (a-1), (b), and (c),
375	375	Occupations Code, are amended to read as follows:
376	376	(a) One or more physicians licensed by the board may
377	377	delegate, to one or more physician assistants [or advanced practice
378	378	registered nurses] acting under adequate physician supervision
379	379	whose practice is facility-based at a hospital or licensed
380	380	long-term care facility, the administration or provision of a drug
381	381	and the prescribing or ordering of a drug or device if each of the
382	382	delegating physicians is:
383	383	(1) the medical director or chief of medical staff of
384	384	the facility in which the physician assistant [or advanced practice
385	385	registered nurse] practices;
386	386	(2) the chair of the facility's credentialing
387	387	committee;
388	388	(3) a department chair of a facility department in
389	389	which the physician assistant [or advanced practice registered
390	390	nurse] practices; or
391	391	(4) a physician who consents to the request of the
392	392	medical director or chief of medical staff to delegate the
393	393	prescribing or ordering of a drug or device at the facility in which
394	394	the physician assistant [or advanced practice registered nurse]
395	395	practices.
396	396	(a-1) The limits on the number of [advanced practice
397	397	registered nurses or] physician assistants to whom a physician may
398	398	delegate under Section 157.0512 do not apply to a physician under
399	399	Subsection (a) whose practice is facility-based under this section,
400	400	provided that the physician is not delegating in a freestanding
401	401	clinic, center, or practice of the facility.
402	402	(b) A physician's authority to delegate under Subsection
403	403	(a) is limited as follows:
404	404	(1) the delegation must be made under a physician's
405	405	order, standing medical order, standing delegation order, or
406	406	another order or protocol developed in accordance with policies
407	407	approved by the facility's medical staff or a committee of the
408	408	facility's medical staff as provided by the facility bylaws;
409	409	(2) the delegation must occur in the facility in which
410	410	the physician is the medical director, the chief of medical staff,
411	411	the chair of the credentialing committee, a department chair, or a
412	412	physician who consents to delegate under Subsection (a)(4);
413	413	(3) the delegation may not permit the prescribing or
414	414	ordering of a drug or device for the care or treatment of the
415	415	patients of any other physician without the prior consent of that
416	416	physician; and
417	417	(4) delegation in a long-term care facility must be by
418	418	the medical director and is limited to the prescribing or ordering
419	419	of a drug or device to not more than seven [advanced practice
420	420	registered nurses or] physician assistants or their full-time
421	421	equivalents.
422	422	(c) Physician supervision of the prescribing or ordering of
423	423	a drug or device must conform to what a reasonable, prudent
424	424	physician would find consistent with sound medical judgment but may
425	425	vary with the education and experience of the particular [advanced
426	426	practice registered nurse or] physician assistant. A physician
427	427	shall provide continuous supervision, but the constant physical
428	428	presence of the physician is not required.
429	429	SECTION 2.007. Section 157.055, Occupations Code, is
430	430	amended to read as follows:
431	431	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
432	432	order shall be defined in a manner that promotes the exercise of
433	433	professional judgment by the [advanced practice registered nurse
434	434	and] physician assistant commensurate with the education and
435	435	experience of that person. Under this section, an order or
436	436	protocol used by a reasonable and prudent physician exercising
437	437	sound medical judgment:
438	438	(1) is not required to describe the exact steps that
439	439	[an advanced practice registered nurse or] a physician assistant
440	440	must take with respect to each specific condition, disease, or
441	441	symptom; and
442	442	(2) may state the types or categories of medications
443	443	that may be prescribed or the types or categories of medications
444	444	that may not be prescribed.
445	445	SECTION 2.008. Section 157.056, Occupations Code, is
446	446	amended to read as follows:
447	447	Sec. 157.056. PRESCRIPTION INFORMATION. The following
448	448	information must be provided on each prescription subject to this
449	449	subchapter:
450	450	(1) the patient's name and address;
451	451	(2) the drug to be dispensed;
452	452	(3) directions to the patient regarding the taking of
453	453	the drug and the dosage;
454	454	(4) the intended use of the drug, if appropriate;
455	455	(5) the name, address, and telephone number of the
456	456	physician;
457	457	(6) the name, address, telephone number, and
458	458	identification number of the [registered nurse or] physician
459	459	assistant completing or signing the prescription drug order;
460	460	(7) the date; and
461	461	(8) the number of refills permitted.
462	462	SECTION 2.009. Section 157.060, Occupations Code, is
463	463	amended to read as follows:
464	464	Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED
465	465	ACT. Unless the physician has reason to believe the physician
466	466	assistant [or advanced practice registered nurse] lacked the
467	467	competency to perform the act, a physician is not liable for an act
468	468	of a physician assistant [or advanced practice registered nurse]
469	469	solely because the physician signed a standing medical order, a
470	470	standing delegation order, or another order or protocol, or entered
471	471	into a prescriptive authority agreement, authorizing the physician
472	472	assistant [or advanced practice registered nurse] to administer,
473	473	provide, prescribe, or order a drug or device.
474	474	ARTICLE 3. GENERAL CONFORMING AMENDMENTS
475	475	SECTION 3.001. Section 38.151(1), Education Code, is
476	476	amended to read as follows:
477	477	(1) "Advanced practice nurse" has the meaning assigned
478	478	to "advanced practice registered nurse" by Section 301.357
479	479	[301.152], Occupations Code.
480	480	SECTION 3.002. Section 61.601, Education Code, is amended
481	481	to read as follows:
482	482	Sec. 61.601. DEFINITION. In this subchapter, "mental
483	483	health professional" means:
484	484	(1) a licensed physician who is:
485	485	(A) a graduate of an accredited psychiatric
486	486	residency training program; or
487	487	(B) certified in psychiatry by:
488	488	(i) the American Board of Psychiatry and
489	489	Neurology; or
490	490	(ii) the American Osteopathic Board of
491	491	Neurology and Psychiatry;
492	492	(2) a psychologist, as defined by Section 501.002,
493	493	Occupations Code;
494	494	(3) a licensed professional counselor, as defined by
495	495	Section 503.002, Occupations Code;
496	496	(4) an advanced practice registered nurse, as defined
497	497	by Section 301.357 [301.152], Occupations Code, who holds a
498	498	nationally recognized board certification in psychiatric or mental
499	499	health nursing; and
500	500	(5) a licensed clinical social worker, as defined by
501	501	Section 505.002, Occupations Code.
502	502	SECTION 3.003. Section 671.001(b), Government Code, is
503	503	amended to read as follows:
504	504	(b) The pilot program must provide for the following:
505	505	(1) a licensed advanced practice registered nurse as
506	506	defined by Section 301.357 [301.152], Occupations Code, or a
507	507	licensed physician assistant as described by Chapter 204,
508	508	Occupations Code, who is employed by the state or whose services are
509	509	acquired by contract, who will be located at a state office complex;
510	510	(2) if applicable, a licensed physician, who is
511	511	employed by a state governmental entity for purposes other than the
512	512	pilot program or whose services are acquired by contract, who will
513	513	delegate to and supervise the [advanced practice registered nurse
514	514	or] physician assistant under a prescriptive authority agreement
515	515	under Chapter 157, Occupations Code;
516	516	(3) appropriate office space and equipment for the
517	517	advanced practice registered nurse or physician assistant to
518	518	provide basic medical care to employees at the state office complex
519	519	where the nurse or physician assistant is located; and
520	520	(4) professional liability insurance covering
521	521	services provided by the advanced practice registered nurse or the
522	522	physician assistant.
523	523	SECTION 3.004. Section 47.011(a), Health and Safety Code,
524	524	is amended to read as follows:
525	525	(a) In this section, "midwife" has the meaning assigned by
526	526	Section 203.002, Occupations Code, and includes a nurse midwife
527	527	described by Section 301.357 [301.152], Occupations Code.
528	528	SECTION 3.005. Section 481.002(39), Health and Safety Code,
529	529	is amended to read as follows:
530	530	(39) "Practitioner" means:
531	531	(A) a physician, dentist, veterinarian,
532	532	podiatrist, scientific investigator, advanced practice registered
533	533	nurse, or other person licensed, registered, or otherwise permitted
534	534	to distribute, dispense, analyze, conduct research with respect to,
535	535	or administer a controlled substance in the course of professional
536	536	practice or research in this state;
537	537	(B) a pharmacy, hospital, or other institution
538	538	licensed, registered, or otherwise permitted to distribute,
539	539	dispense, conduct research with respect to, or administer a
540	540	controlled substance in the course of professional practice or
541	541	research in this state;
542	542	(C) a person practicing in and licensed by
543	543	another state as a physician, dentist, veterinarian, advanced
544	544	practice registered nurse, or podiatrist, having a current Federal
545	545	Drug Enforcement Administration registration number, who may
546	546	legally prescribe Schedule II, III, IV, or V controlled substances
547	547	in that state; or
548	548	(D) a [an advanced practice registered nurse or]
549	549	physician assistant to whom a physician has delegated the authority
550	550	to prescribe or order a drug or device under Section 157.0511,
551	551	157.0512, or 157.054, Occupations Code.
552	552	SECTION 3.006. Section 481.073(a), Health and Safety Code,
553	553	is amended to read as follows:
554	554	(a) Only a practitioner defined by Section 481.002(39)(A)
555	555	and an agent designated in writing by the practitioner in
556	556	accordance with rules adopted by the board may communicate a
557	557	prescription by telephone. A pharmacy that receives a
558	558	telephonically communicated prescription shall promptly write the
559	559	prescription and file and retain the prescription in the manner
560	560	required by this subchapter. A practitioner who designates an
561	561	agent to communicate prescriptions shall maintain the written
562	562	designation of the agent in the practitioner's usual place of
563	563	business and shall make the designation available for inspection by
564	564	investigators for the Texas Medical Board, the State Board of
565	565	Dental Examiners, the State Board of Veterinary Medical Examiners,
566	566	the Texas Board of Nursing, the board, and the department. A
567	567	practitioner who designates a different agent shall designate that
568	568	agent in writing and maintain the designation in the same manner in
569	569	which the practitioner initially designated an agent under this
570	570	section.
571	571	SECTION 3.007. Section 481.074(d), Health and Safety Code,
572	572	is amended to read as follows:
573	573	(d) Except as specified in Subsections (e) and (f), the
574	574	board, by rule and in consultation with the Texas Medical Board and
575	575	the Texas Board of Nursing, shall establish the period after the
576	576	date on which the prescription is issued that a person may fill a
577	577	prescription for a controlled substance listed in Schedule II. A
578	578	person may not refill a prescription for a substance listed in
579	579	Schedule II.
580	580	SECTION 3.008. Section 481.076(c), Health and Safety Code,
581	581	is amended to read as follows:
582	582	(c) The board by rule shall design and implement a system
583	583	for submission of information to the board by electronic or other
584	584	means and for retrieval of information submitted to the board under
585	585	this section and Sections 481.074 and 481.075. The board shall use
586	586	automated information security techniques and devices to preclude
587	587	improper access to the information. The board shall submit the
588	588	system design to the director, [and] the Texas Medical Board, and
589	589	the Texas Board of Nursing for review and comment a reasonable time
590	590	before implementation of the system and shall comply with the
591	591	comments of those agencies unless it is unreasonable to do so.
592	592	SECTION 3.009. Sections 483.001(4), (12), and (13), Health
593	593	and Safety Code, are amended to read as follows:
594	594	(4) "Designated agent" means:
595	595	(A) a licensed nurse, physician assistant,
596	596	pharmacist, or other individual designated by a practitioner to
597	597	communicate prescription drug orders to a pharmacist;
598	598	(B) a licensed nurse, physician assistant, or
599	599	pharmacist employed in a health care facility to whom the
600	600	practitioner communicates a prescription drug order; or
601	601	(C) a [registered nurse or] physician assistant
602	602	authorized by a practitioner to carry out a prescription drug order
603	603	for dangerous drugs under Subchapter B, Chapter 157, Occupations
604	604	Code, or an advanced practice registered nurse authorized by a
605	605	practitioner to carry out a prescription drug order for dangerous
606	606	drugs.
607	607	(12) "Practitioner" means:
608	608	(A) a person licensed by the Texas Medical Board,
609	609	State Board of Dental Examiners, Texas State Board of Podiatric
610	610	Medical Examiners, Texas Optometry Board, Texas Board of Nursing,
611	611	or State Board of Veterinary Medical Examiners to prescribe and
612	612	administer dangerous drugs;
613	613	(B) a person licensed by another state in a
614	614	health field in which, under the laws of this state, a licensee may
615	615	legally prescribe dangerous drugs;
616	616	(C) a person licensed in Canada or Mexico in a
617	617	health field in which, under the laws of this state, a licensee may
618	618	legally prescribe dangerous drugs; or
619	619	(D) a [an advanced practice registered nurse or]
620	620	physician assistant to whom a physician has delegated the authority
621	621	to prescribe or order a drug or device under Section 157.0511,
622	622	157.0512, or 157.054, Occupations Code.
623	623	(13) "Prescription" means an order from a
624	624	practitioner, or an agent of the practitioner designated in writing
625	625	as authorized to communicate prescriptions, or an order made in
626	626	accordance with Subchapter B, Chapter 157, Occupations Code, or
627	627	Section 203.353, Occupations Code, to a pharmacist for a dangerous
628	628	drug to be dispensed that states:
629	629	(A) the date of the order's issue;
630	630	(B) the name and address of the patient;
631	631	(C) if the drug is prescribed for an animal, the
632	632	species of the animal;
633	633	(D) the name and quantity of the drug prescribed;
634	634	(E) the directions for the use of the drug;
635	635	(F) the intended use of the drug unless the
636	636	practitioner determines the furnishing of this information is not
637	637	in the best interest of the patient;
638	638	(G) the name, address, and telephone number of
639	639	the practitioner at the practitioner's usual place of business,
640	640	legibly printed or stamped; and
641	641	(H) the name, address, and telephone number of
642	642	the licensed midwife[, registered nurse,] or physician assistant,
643	643	legibly printed or stamped, if signed by a licensed midwife[,
644	644	registered nurse,] or physician assistant.
645	645	SECTION 3.010. Section 483.022(f), Health and Safety Code,
646	646	is amended to read as follows:
647	647	(f) A practitioner may designate a person who is a licensed
648	648	vocational nurse or has an education equivalent to or greater than
649	649	that required for a licensed vocational nurse to communicate
650	650	prescriptions of a [an advanced practice nurse or] physician
651	651	assistant authorized by the practitioner to sign prescription drug
652	652	orders under Subchapter B, Chapter 157, Occupations Code, or of an
653	653	advanced practice registered nurse.
654	654	SECTION 3.011. Section 483.042(a), Health and Safety Code,
655	655	is amended to read as follows:
656	656	(a) A person commits an offense if the person delivers or
657	657	offers to deliver a dangerous drug:
658	658	(1) unless:
659	659	(A) the dangerous drug is delivered or offered
660	660	for delivery by a pharmacist under:
661	661	(i) a prescription issued by a practitioner
662	662	described by Section 483.001(12)(A) or (B);
663	663	(ii) a prescription signed by a [registered
664	664	nurse or] physician assistant in accordance with Subchapter B,
665	665	Chapter 157, Occupations Code; or
666	666	(iii) an original written prescription
667	667	issued by a practitioner described by Section 483.001(12)(C); and
668	668	(B) a label is attached to the immediate
669	669	container in which the drug is delivered or offered to be delivered
670	670	and the label contains the following information:
671	671	(i) the name and address of the pharmacy
672	672	from which the drug is delivered or offered for delivery;
673	673	(ii) the date the prescription for the drug
674	674	is dispensed;
675	675	(iii) the number of the prescription as
676	676	filed in the prescription files of the pharmacy from which the
677	677	prescription is dispensed;
678	678	(iv) the name of the practitioner who
679	679	prescribed the drug and, if applicable, the name of the [registered
680	680	nurse or] physician assistant who signed the prescription;
681	681	(v) the name of the patient and, if the drug
682	682	is prescribed for an animal, a statement of the species of the
683	683	animal; and
684	684	(vi) directions for the use of the drug as
685	685	contained in the prescription; or
686	686	(2) unless:
687	687	(A) the dangerous drug is delivered or offered
688	688	for delivery by:
689	689	(i) a practitioner in the course of
690	690	practice; or
691	691	(ii) a [registered nurse or] physician
692	692	assistant in the course of practice in accordance with Subchapter
693	693	B, Chapter 157, Occupations Code; and
694	694	(B) a label is attached to the immediate
695	695	container in which the drug is delivered or offered to be delivered
696	696	and the label contains the following information:
697	697	(i) the name and address of the
698	698	practitioner who prescribed the drug, and if applicable, the name
699	699	and address of the [registered nurse or] physician assistant;
700	700	(ii) the date the drug is delivered;
701	701	(iii) the name of the patient and, if the
702	702	drug is prescribed for an animal, a statement of the species of the
703	703	animal; and
704	704	(iv) the name of the drug, the strength of
705	705	the drug, and directions for the use of the drug.
706	706	SECTION 3.012. Section 32.03141, Human Resources Code, is
707	707	amended to read as follows:
708	708	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
709	709	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
710	710	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
711	711	addition to other health care practitioners authorized by federal
712	712	law, the following persons may order and prescribe durable medical
713	713	equipment and supplies under the medical assistance program:
714	714	(1) an advanced practice registered nurse; and
715	715	(2) a [or] physician assistant acting under adequate
716	716	physician supervision and to whom a physician has delegated the
717	717	authority to prescribe and order drugs and devices under Chapter
718	718	157, Occupations Code[, may order and prescribe durable medical
719	719	equipment and supplies under the medical assistance program].
720	720	SECTION 3.013. Section 843.312, Insurance Code, is amended
721	721	to read as follows:
722	722	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
723	723	REGISTERED NURSES. (a) A health maintenance organization may not
724	724	refuse a request by a physician participating in the health
725	725	maintenance organization delivery network and a physician
726	726	assistant [or advanced practice nurse] who is authorized by the
727	727	physician to provide care under Subchapter B, Chapter 157,
728	728	Occupations Code, or an advanced practice registered nurse who is
729	729	authorized to provide care under Section 301.357, Occupations Code,
730	730	to identify a physician assistant or advanced practice registered
731	731	nurse as a provider in the network.
732	732	(b) A health maintenance organization may refuse a request
733	733	under Subsection (a) if the physician assistant or advanced
734	734	practice registered nurse does not meet the quality of care
735	735	standards previously established by the health maintenance
736	736	organization for participation in the network by physician
737	737	assistants and advanced practice registered nurses.
738	738	SECTION 3.014. Section 1301.001(1-a), Insurance Code, is
739	739	amended to read as follows:
740	740	(1-a) "Health care provider" means a practitioner,
741	741	institutional provider, or other person or organization that
742	742	furnishes health care services and that is licensed or otherwise
743	743	authorized to practice in this state. The term includes a
744	744	pharmacist, [and] a pharmacy, and an advanced practice registered
745	745	nurse. The term does not include a physician.
746	746	SECTION 3.015. Section 1301.052, Insurance Code, is amended
747	747	to read as follows:
748	748	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
749	749	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
750	750	offering a preferred provider benefit plan may not refuse a request
751	751	made by a physician participating as a preferred provider under the
752	752	plan and an advanced practice registered nurse or physician
753	753	assistant to have the advanced practice registered nurse or
754	754	physician assistant included as a preferred provider under the plan
755	755	if:
756	756	(1) the [advanced practice nurse or] physician
757	757	assistant is authorized by the physician to provide care under
758	758	Subchapter B, Chapter 157, Occupations Code, or the advanced
759	759	practice registered nurse is authorized to provide care under
760	760	Section 301.357, Occupations Code; and
761	761	(2) the advanced practice registered nurse or
762	762	physician assistant meets the quality of care standards previously
763	763	established by the insurer for participation in the plan by
764	764	advanced practice registered nurses and physician assistants.
765	765	SECTION 3.016. Section 1451.001(2), Insurance Code, is
766	766	amended to read as follows:
767	767	(2) "Advanced practice registered nurse" means an
768	768	individual licensed by the Texas Board of Nursing as a registered
769	769	nurse and licensed [recognized] by that board as an advanced
770	770	practice registered nurse.
771	771	SECTION 3.017. Section 1451.104(c), Insurance Code, is
772	772	amended to read as follows:
773	773	(c) Notwithstanding Subsection (a), a health insurance
774	774	policy may provide for a different amount of payment or
775	775	reimbursement for scheduled services or procedures performed by an
776	776	advanced practice registered nurse, nurse first assistant,
777	777	licensed surgical assistant, or physician assistant if the
778	778	methodology used to compute the amount is the same as the
779	779	methodology used to compute the amount of payment or reimbursement
780	780	when the services or procedures are provided by a physician.
781	781	SECTION 3.018. Section 1451.106, Insurance Code, is amended
782	782	to read as follows:
783	783	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
784	784	NURSE. An insured may select an advanced practice registered nurse
785	785	to provide the services scheduled in the health insurance policy
786	786	that are within the scope of the nurse's license.
787	787	SECTION 3.019. Section 1452.051(1), Insurance Code, is
788	788	amended to read as follows:
789	789	(1) "Advanced practice nurse" has the meaning assigned
790	790	to "advanced practice registered nurse" by Section 301.357
791	791	[301.152], Occupations Code.
792	792	SECTION 3.020. Section 204.1025, Occupations Code, is
793	793	amended to read as follows:
794	794	Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
795	795	AGREEMENTS. The physician assistant board shall in conjunction
796	796	with the Texas Medical Board [and the Texas Board of Nursing]
797	797	perform the functions and duties relating to prescriptive authority
798	798	agreements assigned to the physician assistant board in Sections
799	799	157.0512 and 157.0513.
800	800	SECTION 3.021. Sections 551.003(14) and (34), Occupations
801	801	Code, are amended to read as follows:
802	802	(14) "Designated agent" means:
803	803	(A) an individual, including a licensed nurse,
804	804	physician assistant, or pharmacist:
805	805	(i) who is designated by a practitioner and
806	806	authorized to communicate a prescription drug order to a
807	807	pharmacist; and
808	808	(ii) for whom the practitioner assumes
809	809	legal responsibility;
810	810	(B) a licensed nurse, physician assistant, or
811	811	pharmacist employed in a health care facility to whom a
812	812	practitioner communicates a prescription drug order; or
813	813	(C) a [registered nurse or] physician assistant
814	814	authorized by a practitioner to administer a prescription drug
815	815	order for a dangerous drug under Subchapter B, Chapter 157, or an
816	816	advanced practice registered nurse authorized by a practitioner to
817	817	administer a prescription drug order for a dangerous drug.
818	818	(34) "Practitioner" means:
819	819	(A) a person licensed or registered to prescribe,
820	820	distribute, administer, or dispense a prescription drug or device
821	821	in the course of professional practice in this state, including a
822	822	physician, dentist, podiatrist, advanced practice registered
823	823	nurse, or veterinarian but excluding a person licensed under this
824	824	subtitle;
825	825	(B) a person licensed by another state, Canada,
826	826	or the United Mexican States in a health field in which, under the
827	827	law of this state, a license holder in this state may legally
828	828	prescribe a dangerous drug;
829	829	(C) a person practicing in another state and
830	830	licensed by another state as a physician, dentist, veterinarian,
831	831	advanced practice registered nurse, or podiatrist, who has a
832	832	current federal Drug Enforcement Administration registration
833	833	number and who may legally prescribe a Schedule II, III, IV, or V
834	834	controlled substance, as specified under Chapter 481, Health and
835	835	Safety Code, in that other state; or
836	836	(D) a [an advanced practice registered nurse or]
837	837	physician assistant to whom a physician has delegated the authority
838	838	to prescribe or order a drug or device under Section 157.0511,
839	839	157.0512, or 157.054.
840	840	SECTION 3.022. Section 563.051(e), Occupations Code, is
841	841	amended to read as follows:
842	842	(e) A practitioner may designate a licensed vocational
843	843	nurse or a person having education equivalent to or greater than
844	844	that required for a licensed vocational nurse to communicate the
845	845	prescriptions of a [an advanced practice nurse or] physician
846	846	assistant authorized by the practitioner to sign prescription drug
847	847	orders under Subchapter B, Chapter 157, or of an advanced practice
848	848	registered nurse.
849	849	SECTION 3.023. Section 563.053, Occupations Code, is
850	850	amended to read as follows:
851	851	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
852	852	RURAL AREAS. (a) In this section, "reimbursement for cost" means
853	853	an additional charge, separate from that imposed for the
854	854	physician's or advanced practice registered nurse's professional
855	855	services, that includes the cost of the drug product and all other
856	856	actual costs to the physician or advanced practice registered nurse
857	857	incidental to providing the dispensing service. The term does not
858	858	include a separate fee imposed for the act of dispensing the drug
859	859	itself.
860	860	(b) This section applies to an area located in a county with
861	861	a population of 5,000 or less, or in a municipality or an
862	862	unincorporated town with a population of less than 2,500, that is
863	863	within a 15-mile radius of the physician's or advanced practice
864	864	registered nurse's office and in which a pharmacy is not located.
865	865	This section does not apply to a municipality or an unincorporated
866	866	town that is adjacent to a municipality with a population of 2,500
867	867	or more.
868	868	(c) A physician who practices medicine or an advanced
869	869	practice registered nurse who practices advanced practice
870	870	registered nursing in an area described by Subsection (b) may:
871	871	(1) maintain a supply of dangerous drugs in the
872	872	physician's or advanced practice registered nurse's office to be
873	873	dispensed in the course of treating the physician's or advanced
874	874	practice registered nurse's patients; and
875	875	(2) be reimbursed for the cost of supplying those
876	876	drugs without obtaining a license under Chapter 558.
877	877	(d) A physician or advanced practice registered nurse who
878	878	dispenses dangerous drugs under Subsection (c) shall:
879	879	(1) comply with each labeling provision under this
880	880	subtitle applicable to that class of drugs; and
881	881	(2) oversee compliance with packaging and
882	882	recordkeeping provisions applicable to that class of drugs.
883	883	(e) A physician who desires to dispense dangerous drugs
884	884	under this section shall notify both the board and the Texas Medical
885	885	[State] Board [of Medical Examiners] that the physician practices
886	886	in an area described by Subsection (b). An advanced practice
887	887	registered nurse who desires to dispense dangerous drugs under this
888	888	section shall notify both the board and the Texas Board of Nursing
889	889	that the advanced practice registered nurse practices in an area
890	890	described by Subsection (b). The physician or advanced practice
891	891	registered nurse may continue to dispense dangerous drugs in the
892	892	area until the board determines, after notice and hearing, that the
893	893	physician or advanced practice registered nurse no longer practices
894	894	in an area described by Subsection (b).
895	895	SECTION 3.024. Section 605.002(14), Occupations Code, is
896	896	amended to read as follows:
897	897	(14) "Orthotics" means the science and practice of
898	898	measuring, designing, fabricating, assembling, fitting, adjusting,
899	899	or servicing an orthosis under an order from a licensed physician,
900	900	chiropractor, [or] podiatrist, or [an] advanced practice
901	901	registered nurse, or from a physician assistant acting under the
902	902	delegation and supervision of a licensed physician as provided by
903	903	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
904	904	Board, for the correction or alleviation of a neuromuscular or
905	905	musculoskeletal dysfunction, disease, injury, or deformity.
906	906	SECTION 3.025. Section 605.2515, Occupations Code, is
907	907	amended to read as follows:
908	908	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
909	909	person licensed to practice orthotics or prosthetics who measures,
910	910	designs, fabricates, fits, assembles, adjusts, or services an
911	911	orthosis or a prosthesis under an order from a licensed physician,
912	912	chiropractor, [or] podiatrist, or [an] advanced practice
913	913	registered nurse, or from a physician assistant acting under the
914	914	delegation and supervision of a licensed physician as provided by
915	915	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
916	916	Board, for a specific patient is exempt from licensing as a device
917	917	manufacturer under Subchapter L, Chapter 431, Health and Safety
918	918	Code. A person licensed to practice orthotics or prosthetics who
919	919	fabricates or assembles an orthosis or a prosthesis without an
920	920	order from a licensed physician, chiropractor, [or] podiatrist, or
921	921	[an] advanced practice registered nurse, or from a physician
922	922	assistant acting under the delegation and supervision of a licensed
923	923	physician as provided by Subchapter B, Chapter 157, and rules
924	924	adopted by the Texas Medical Board, for a specific patient is
925	925	required to be licensed as a device manufacturer under Subchapter
926	926	L, Chapter 431, Health and Safety Code.
927	927	ARTICLE 4. REPEALER
928	928	SECTION 4.001. Section 301.168, Occupations Code, is
929	929	repealed.
930	930	ARTICLE 5. TRANSITION AND EFFECTIVE DATE
931	931	SECTION 5.001. Not later than February 1, 2018, the Texas
932	932	Board of Nursing shall adopt the rules necessary to implement the
933	933	changes in law made by this Act.
934	934	SECTION 5.002. Notwithstanding any changes in law made by
935	935	this Act, an advanced practice registered nurse who has been
936	936	delegated the authority to prescribe and order drugs and medical
937	937	devices by a physician's protocol or order under Section 157.0511,
938	938	157.0512, or 157.054, Occupations Code, may continue to exercise
939	939	that authority until February 1, 2018.
940	940	SECTION 5.003. This Act takes effect September 1, 2017.