85R2865 EES-F
By: Klick H.B. No. 1415
A BILL TO BE ENTITLED
AN ACT
relating to the licensing and authority of advanced practice
registered nurses.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES
SECTION 1.001. Section 301.002, Occupations Code, is
amended by amending Subdivision (2) and adding Subdivisions (6),
(7), (8), (9), and (10) to read as follows:
(2) "Professional nursing" means the performance of an
act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application
of the principles of biological, physical, and social science as
acquired by a completed course in an approved school of
professional nursing. The term does not include acts of medical
diagnosis or the prescription of therapeutic or corrective
measures, except as authorized for advanced practice registered
nurses. Professional nursing involves:
(A) the observation, assessment, intervention,
evaluation, rehabilitation, care and counsel, or health teachings
of a person who is ill, injured, infirm, or experiencing a change in
normal health processes;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a health care practitioner legally
authorized to prescribe the medication or treatment [physician,
podiatrist, or dentist];
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the performance of an act by an advanced
practice registered nurse in accordance with Section 301.357 [the
requesting, receiving, signing for, and distribution of
prescription drug samples to patients at practices at which an
advanced practice registered nurse is authorized to sign
prescription drug orders as provided by Subchapter B, Chapter 157];
(G) the performance of an act delegated by a
physician under Section [157.0512, 157.054,] 157.058[,] or
157.059; and
(H) the development of the nursing care plan.
(6) "Controlled substance" has the meaning assigned by
Section 157.051.
(7) "Dangerous drug" has the meaning assigned by
Section 157.051.
(8) "Device" has the meaning assigned by Section
157.051.
(9) "Nonprescription drug" has the meaning assigned by
Section 157.051.
(10) "Prescribe or order a drug or device" has the
meaning assigned by Section 157.051.
SECTION 1.002. Section 301.152, Occupations Code, is
transferred to Subchapter H, Chapter 301, Occupations Code,
redesignated as Section 301.357, Occupations Code, and amended to
read as follows:
Sec. 301.357 [301.152]. ADVANCED PRACTICE REGISTERED NURSES
[RULES REGARDING SPECIALIZED TRAINING]. (a) In this section,
"advanced practice registered nurse" means a registered nurse
licensed by the board to practice as an advanced practice
registered nurse on the basis of completion of an advanced
educational program. The term includes a nurse practitioner,
nurse midwife, nurse anesthetist, and clinical nurse
specialist. The term is synonymous with "advanced nurse
practitioner" and "advanced practice nurse."
(a-1) Advanced practice registered nursing includes:
(1) ordering, performing, and interpreting diagnostic
tests;
(2) formulating primary and differential medical
diagnoses and advanced assessments;
(3) treating actual and potential health problems;
(4) prescribing therapeutic and corrective measures,
including nutrition and diagnostic support services, home health
care, hospice care, physical therapy, and occupational therapy, and
delegating and assigning the performance of therapeutic and
corrective measures to assistive personnel;
(5) to the extent authorized by the board under
Section 301.358 or delegated by a physician under Section 157.058
or 157.059, prescribing, ordering, procuring, administering, and
dispensing drugs and devices, including blood and blood products,
controlled substances listed in Schedules II, III, IV, and V,
dangerous drugs, and nonprescription drugs;
(6) providing referrals to health care agencies,
health care providers, and community resources;
(7) serving as the primary care provider of record;
and
(8) performing other acts that require education and
training consistent with professional standards and that are
commensurate with the advanced practice registered nurse's
education, licensure, and demonstrated competencies and
experience.
(b) The board shall adopt rules to:
(1) license a registered nurse as an advanced practice
registered nurse;
(2) establish:
(A) any specialized education or training,
including pharmacology, that an advanced practice registered nurse
must have to prescribe or order a drug or device as authorized
[delegated] by the board [a physician] under Section 301.358
[157.0512 or 157.054];
(B) a system for approving an advanced practice
registered nurse to prescribe or order a drug or device as
authorized [delegated] by the board [a physician] under Section
301.358 [157.0512 or 157.054] on the receipt of evidence of
completing the specialized education and training requirement
under Paragraph (A); and
(C) a system for issuing a prescription
authorization number to an advanced practice registered nurse
approved under Paragraph (B); and
(3) concurrently renew any license or approval granted
to an advanced practice registered nurse under this subsection and
a license renewed by the advanced practice registered nurse under
Section 301.301.
(c) At a minimum, the rules adopted under Subsection (b)(2)
must:
(1) require completion of pharmacology and related
pathophysiology education for initial approval; and
(2) require continuing education in clinical
pharmacology and related pathophysiology in addition to any
continuing education otherwise required under Section 301.303.
(d) The signature of an advanced practice registered nurse
attesting to the provision of a legally authorized service by the
advanced practice registered nurse satisfies any documentation
requirement for that service established by a state agency.
(e) An advanced practice registered nurse shall practice as
a licensed independent practitioner in accordance with standards
established and recognized by the board to protect the public
health and safety.
(f) An advanced practice registered nurse is accountable to
patients, the nursing profession, and the board for:
(1) complying with the requirements of this chapter;
(2) providing quality advanced nursing care;
(3) recognizing the nurse's limits of knowledge;
(4) planning for the management of situations beyond
the nurse's expertise; and
(5) consulting with or referring patients to other
health care providers as appropriate.
(g) This section does not limit or modify the scope of
practice of a registered nurse who is not an advanced practice
registered nurse.
SECTION 1.003. Subchapter H, Chapter 301, Occupations Code,
is amended by adding Section 301.358 to read as follows:
Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
ADVANCED PRACTICE REGISTERED NURSE. (a) The board may authorize an
advanced practice registered nurse, with a prescription
authorization number issued as required under Section 301.357(b),
to prescribe and order drugs and devices, including controlled
substances listed in Schedules III, IV, and V, dangerous drugs, and
nonprescription drugs.
(b) The board may authorize an advanced practice registered
nurse, with a prescription authorization number issued as required
under Section 301.357(b), to prescribe and order controlled
substances listed in Schedule II only:
(1) in a hospital facility-based practice in
accordance with policies approved by the hospital's medical staff
or a committee of the hospital's medical staff as provided by the
hospital bylaws to ensure patient safety, and as part of the care
provided to a patient who:
(A) has been admitted to the hospital and is
expected to remain in the hospital for a period of 24 hours or more;
or
(B) is receiving services in the emergency
department of the hospital; or
(2) as part of the plan of care for the treatment of a
person who has executed a written certification of a terminal
illness, has elected to receive hospice care, and is receiving
hospice treatment from a qualified hospice provider.
ARTICLE 2. CONFORMING AMENDMENTS REGARDING DELEGATION
SECTION 2.001. The heading to Subchapter B, Chapter 157,
Occupations Code, is amended to read as follows:
SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
AND] PHYSICIAN ASSISTANTS AND CERTAIN ADVANCED PRACTICE REGISTERED
NURSES
SECTION 2.002. Sections 157.051(1) and (14), Occupations
Code, are amended to read as follows:
(1) "Advanced practice registered nurse" has the
meaning assigned to that term by Section 301.357 [301.152]. The
term includes an advanced nurse practitioner and advanced practice
nurse.
(14) "Prescriptive authority agreement" means an
agreement entered into by a physician and a [an advanced practice
registered nurse or] physician assistant through which the
physician delegates to the [advanced practice registered nurse or]
physician assistant the act of prescribing or ordering a drug or
device.
SECTION 2.003. Section 157.0511(b-2), Occupations Code, is
amended to read as follows:
(b-2) The board shall adopt rules that require a physician
who delegates the prescribing or ordering of a drug or device to
register with the board the name and license number of the physician
assistant [or advanced practice registered nurse] to whom a
delegation is made. The board may develop and use an electronic
online delegation registration process for registration under this
subsection.
SECTION 2.004. Sections 157.0512(a), (b), (c), (e), (f),
(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
to read as follows:
(a) A physician may delegate to a [an advanced practice
registered nurse or] physician assistant, acting under adequate
physician supervision, the act of prescribing or ordering a drug or
device as authorized through a prescriptive authority agreement
between the physician and the [advanced practice registered nurse
or] physician assistant[, as applicable].
(b) A physician and a [an advanced practice registered nurse
or] physician assistant are eligible to enter into or be parties to
a prescriptive authority agreement only if:
(1) [if applicable, the Texas Board of Nursing has
approved the advanced practice registered nurse's authority to
prescribe or order a drug or device as authorized under this
subchapter;
[(2)] the [advanced practice registered nurse or]
physician assistant:
(A) holds an active license to practice in this
state as a [an advanced practice registered nurse or] physician
assistant[, as applicable,] and is in good standing in this state;
and
(B) is not currently prohibited by the [Texas
Board of Nursing or the] Texas Physician Assistant Board[, as
applicable,] from executing a prescriptive authority agreement;
and
(2) [(3)] before executing the prescriptive authority
agreement, the physician and the [advanced practice registered
nurse or] physician assistant disclose to the other prospective
party to the agreement any prior disciplinary action by the board[,
the Texas Board of Nursing,] or the Texas Physician Assistant
Board[, as applicable].
(c) Except as provided by Subsection (d), the [combined]
number of [advanced practice registered nurses and] physician
assistants with whom a physician may enter into a prescriptive
authority agreement may not exceed seven [advanced practice
registered nurses and] physician assistants or the full-time
equivalent of seven [advanced practice registered nurses and]
physician assistants.
(e) A prescriptive authority agreement must, at a minimum:
(1) be in writing and signed and dated by the parties
to the agreement;
(2) state the name, address, and all professional
license numbers of the parties to the agreement;
(3) state the nature of the practice, practice
locations, or practice settings;
(4) identify the types or categories of drugs or
devices that may be prescribed or the types or categories of drugs
or devices that may not be prescribed;
(5) provide a general plan for addressing consultation
and referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and
the sharing of information between the physician and the [advanced
practice registered nurse or] physician assistant to whom the
physician has delegated prescriptive authority related to the care
and treatment of patients;
(8) if alternate physician supervision is to be
utilized, designate one or more alternate physicians who may:
(A) provide appropriate supervision on a
temporary basis in accordance with the requirements established by
the prescriptive authority agreement and the requirements of this
subchapter; and
(B) participate in the prescriptive authority
quality assurance and improvement plan meetings required under this
section; and
(9) describe a prescriptive authority quality
assurance and improvement plan and specify methods for documenting
the implementation of the plan that includes the following:
(A) chart review, with the number of charts to be
reviewed determined by the physician and [advanced practice
registered nurse or] physician assistant; and
(B) periodic face-to-face meetings between the
[advanced practice registered nurse or] physician assistant and the
physician at a location determined by the physician and the
[advanced practice registered nurse or] physician assistant.
(f) The periodic face-to-face meetings described by
Subsection (e)(9)(B) must:
(1) include:
(A) the sharing of information relating to
patient treatment and care, needed changes in patient care plans,
and issues relating to referrals; and
(B) discussion of patient care improvement; and
(2) be documented and occur:
(A) except as provided by Paragraph (B):
(i) at least monthly until the third
anniversary of the date the agreement is executed; and
(ii) at least quarterly after the third
anniversary of the date the agreement is executed, with monthly
meetings held between the quarterly meetings by means of a remote
electronic communications system, including videoconferencing
technology or the Internet; or
(B) if during the seven years preceding the date
the agreement is executed the [advanced practice registered nurse
or] physician assistant for at least five years was in a practice
that included the exercise of prescriptive authority with required
physician supervision:
(i) at least monthly until the first
anniversary of the date the agreement is executed; and
(ii) at least quarterly after the first
anniversary of the date the agreement is executed, with monthly
meetings held between the quarterly meetings by means of a remote
electronic communications system, including videoconferencing
technology or the Internet.
(g) The prescriptive authority agreement may include other
provisions agreed to by the physician and [advanced practice
registered nurse or] physician assistant.
(i) The prescriptive authority agreement need not describe
the exact steps that a [an advanced practice registered nurse or]
physician assistant must take with respect to each specific
condition, disease, or symptom.
(j) A physician[, advanced practice registered nurse,] or
physician assistant who is a party to a prescriptive authority
agreement must retain a copy of the agreement until the second
anniversary of the date the agreement is terminated.
(l) In the event that a party to a prescriptive authority
agreement is notified that the individual has become the subject of
an investigation by the board[, the Texas Board of Nursing,] or the
Texas Physician Assistant Board, the individual shall immediately
notify the other party to the prescriptive authority agreement.
(m) The prescriptive authority agreement and any amendments
must be reviewed at least annually, dated, and signed by the parties
to the agreement. The prescriptive authority agreement and any
amendments must be made available to the board[, the Texas Board of
Nursing,] or the Texas Physician Assistant Board not later than the
third business day after the date of receipt of request, if any.
(n) The prescriptive authority agreement should promote the
exercise of professional judgment by the [advanced practice
registered nurse or] physician assistant commensurate with the
[advanced practice registered nurse's or] physician assistant's
education and experience and the relationship between the [advanced
practice registered nurse or] physician assistant and the
physician.
(o) This section shall be liberally construed to allow the
use of prescriptive authority agreements to safely and effectively
utilize the skills and services of [advanced practice registered
nurses and] physician assistants.
SECTION 2.005. Section 157.0513, Occupations Code, is
amended to read as follows:
Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
INFORMATION. (a) The board[, the Texas Board of Nursing,] and the
Texas Physician Assistant Board shall jointly develop a process:
(1) to exchange information regarding the names,
locations, and license numbers of each physician[, advanced
practice registered nurse,] and physician assistant who has entered
into a prescriptive authority agreement;
(2) by which each board shall immediately notify the
other board [boards] when a license holder of the board becomes the
subject of an investigation involving the delegation and
supervision of prescriptive authority, as well as the final
disposition of any such investigation; and
(3) by which each board shall maintain and share a list
of the board's license holders who have been subject to a final
adverse disciplinary action for an act involving the delegation and
supervision of prescriptive authority.
(b) If the board[, the Texas Board of Nursing,] or the Texas
Physician Assistant Board receives a notice under Subsection
(a)(2), the board that received notice may open an investigation
against a license holder of the board who is a party to a
prescriptive authority agreement with the license holder who is
under investigation by the board that provided notice under
Subsection (a)(2).
(c) The board shall maintain and make available to the
public a searchable online list of physicians[, advanced practice
registered nurses,] and physician assistants who have entered into
a prescriptive authority agreement authorized under Section
157.0512 and identify the physician[, advanced practice registered
nurse, or physician assistant] with whom each [physician, advanced
practice registered nurse, and] physician assistant has entered
into a prescriptive authority agreement.
(d) The board shall collaborate with the [Texas Board of
Nursing and the] Texas Physician Assistant Board to maintain and
make available to the public a list of physicians[, advanced
practice registered nurses,] and physician assistants who are
prohibited from entering into or practicing under a prescriptive
authority agreement.
SECTION 2.006. Sections 157.054(a), (a-1), (b), and (c),
Occupations Code, are amended to read as follows:
(a) One or more physicians licensed by the board may
delegate, to one or more physician assistants [or advanced practice
registered nurses] acting under adequate physician supervision
whose practice is facility-based at a hospital or licensed
long-term care facility, the administration or provision of a drug
and the prescribing or ordering of a drug or device if each of the
delegating physicians is:
(1) the medical director or chief of medical staff of
the facility in which the physician assistant [or advanced practice
registered nurse] practices;
(2) the chair of the facility's credentialing
committee;
(3) a department chair of a facility department in
which the physician assistant [or advanced practice registered
nurse] practices; or
(4) a physician who consents to the request of the
medical director or chief of medical staff to delegate the
prescribing or ordering of a drug or device at the facility in which
the physician assistant [or advanced practice registered nurse]
practices.
(a-1) The limits on the number of [advanced practice
registered nurses or] physician assistants to whom a physician may
delegate under Section 157.0512 do not apply to a physician under
Subsection (a) whose practice is facility-based under this section,
provided that the physician is not delegating in a freestanding
clinic, center, or practice of the facility.
(b) A physician's authority to delegate under Subsection
(a) is limited as follows:
(1) the delegation must be made under a physician's
order, standing medical order, standing delegation order, or
another order or protocol developed in accordance with policies
approved by the facility's medical staff or a committee of the
facility's medical staff as provided by the facility bylaws;
(2) the delegation must occur in the facility in which
the physician is the medical director, the chief of medical staff,
the chair of the credentialing committee, a department chair, or a
physician who consents to delegate under Subsection (a)(4);
(3) the delegation may not permit the prescribing or
ordering of a drug or device for the care or treatment of the
patients of any other physician without the prior consent of that
physician; and
(4) delegation in a long-term care facility must be by
the medical director and is limited to the prescribing or ordering
of a drug or device to not more than seven [advanced practice
registered nurses or] physician assistants or their full-time
equivalents.
(c) Physician supervision of the prescribing or ordering of
a drug or device must conform to what a reasonable, prudent
physician would find consistent with sound medical judgment but may
vary with the education and experience of the particular [advanced
practice registered nurse or] physician assistant. A physician
shall provide continuous supervision, but the constant physical
presence of the physician is not required.
SECTION 2.007. Section 157.055, Occupations Code, is
amended to read as follows:
Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
order shall be defined in a manner that promotes the exercise of
professional judgment by the [advanced practice registered nurse
and] physician assistant commensurate with the education and
experience of that person. Under this section, an order or
protocol used by a reasonable and prudent physician exercising
sound medical judgment:
(1) is not required to describe the exact steps that
[an advanced practice registered nurse or] a physician assistant
must take with respect to each specific condition, disease, or
symptom; and
(2) may state the types or categories of medications
that may be prescribed or the types or categories of medications
that may not be prescribed.
SECTION 2.008. Section 157.056, Occupations Code, is
amended to read as follows:
Sec. 157.056. PRESCRIPTION INFORMATION. The following
information must be provided on each prescription subject to this
subchapter:
(1) the patient's name and address;
(2) the drug to be dispensed;
(3) directions to the patient regarding the taking of
the drug and the dosage;
(4) the intended use of the drug, if appropriate;
(5) the name, address, and telephone number of the
physician;
(6) the name, address, telephone number, and
identification number of the [registered nurse or] physician
assistant completing or signing the prescription drug order;
(7) the date; and
(8) the number of refills permitted.
SECTION 2.009. Section 157.060, Occupations Code, is
amended to read as follows:
Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED
ACT. Unless the physician has reason to believe the physician
assistant [or advanced practice registered nurse] lacked the
competency to perform the act, a physician is not liable for an act
of a physician assistant [or advanced practice registered nurse]
solely because the physician signed a standing medical order, a
standing delegation order, or another order or protocol, or entered
into a prescriptive authority agreement, authorizing the physician
assistant [or advanced practice registered nurse] to administer,
provide, prescribe, or order a drug or device.
ARTICLE 3. GENERAL CONFORMING AMENDMENTS
SECTION 3.001. Section 38.151(1), Education Code, is
amended to read as follows:
(1) "Advanced practice nurse" has the meaning assigned
to "advanced practice registered nurse" by Section 301.357
[301.152], Occupations Code.
SECTION 3.002. Section 61.601, Education Code, is amended
to read as follows:
Sec. 61.601. DEFINITION. In this subchapter, "mental
health professional" means:
(1) a licensed physician who is:
(A) a graduate of an accredited psychiatric
residency training program; or
(B) certified in psychiatry by:
(i) the American Board of Psychiatry and
Neurology; or
(ii) the American Osteopathic Board of
Neurology and Psychiatry;
(2) a psychologist, as defined by Section 501.002,
Occupations Code;
(3) a licensed professional counselor, as defined by
Section 503.002, Occupations Code;
(4) an advanced practice registered nurse, as defined
by Section 301.357 [301.152], Occupations Code, who holds a
nationally recognized board certification in psychiatric or mental
health nursing; and
(5) a licensed clinical social worker, as defined by
Section 505.002, Occupations Code.
SECTION 3.003. Section 671.001(b), Government Code, is
amended to read as follows:
(b) The pilot program must provide for the following:
(1) a licensed advanced practice registered nurse as
defined by Section 301.357 [301.152], Occupations Code, or a
licensed physician assistant as described by Chapter 204,
Occupations Code, who is employed by the state or whose services are
acquired by contract, who will be located at a state office complex;
(2) if applicable, a licensed physician, who is
employed by a state governmental entity for purposes other than the
pilot program or whose services are acquired by contract, who will
delegate to and supervise the [advanced practice registered nurse
or] physician assistant under a prescriptive authority agreement
under Chapter 157, Occupations Code;
(3) appropriate office space and equipment for the
advanced practice registered nurse or physician assistant to
provide basic medical care to employees at the state office complex
where the nurse or physician assistant is located; and
(4) professional liability insurance covering
services provided by the advanced practice registered nurse or the
physician assistant.
SECTION 3.004. Section 47.011(a), Health and Safety Code,
is amended to read as follows:
(a) In this section, "midwife" has the meaning assigned by
Section 203.002, Occupations Code, and includes a nurse midwife
described by Section 301.357 [301.152], Occupations Code.
SECTION 3.005. Section 481.002(39), Health and Safety Code,
is amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, advanced practice registered
nurse, or other person licensed, registered, or otherwise permitted
to distribute, dispense, analyze, conduct research with respect to,
or administer a controlled substance in the course of professional
practice or research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, advanced
practice registered nurse, or podiatrist, having a current Federal
Drug Enforcement Administration registration number, who may
legally prescribe Schedule II, III, IV, or V controlled substances
in that state; or
(D) a [an advanced practice registered nurse or]
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
SECTION 3.006. Section 481.073(a), Health and Safety Code,
is amended to read as follows:
(a) Only a practitioner defined by Section 481.002(39)(A)
and an agent designated in writing by the practitioner in
accordance with rules adopted by the board may communicate a
prescription by telephone. A pharmacy that receives a
telephonically communicated prescription shall promptly write the
prescription and file and retain the prescription in the manner
required by this subchapter. A practitioner who designates an
agent to communicate prescriptions shall maintain the written
designation of the agent in the practitioner's usual place of
business and shall make the designation available for inspection by
investigators for the Texas Medical Board, the State Board of
Dental Examiners, the State Board of Veterinary Medical Examiners,
the Texas Board of Nursing, the board, and the department. A
practitioner who designates a different agent shall designate that
agent in writing and maintain the designation in the same manner in
which the practitioner initially designated an agent under this
section.
SECTION 3.007. Section 481.074(d), Health and Safety Code,
is amended to read as follows:
(d) Except as specified in Subsections (e) and (f), the
board, by rule and in consultation with the Texas Medical Board and
the Texas Board of Nursing, shall establish the period after the
date on which the prescription is issued that a person may fill a
prescription for a controlled substance listed in Schedule II. A
person may not refill a prescription for a substance listed in
Schedule II.
SECTION 3.008. Section 481.076(c), Health and Safety Code,
is amended to read as follows:
(c) The board by rule shall design and implement a system
for submission of information to the board by electronic or other
means and for retrieval of information submitted to the board under
this section and Sections 481.074 and 481.075. The board shall use
automated information security techniques and devices to preclude
improper access to the information. The board shall submit the
system design to the director, [and] the Texas Medical Board, and
the Texas Board of Nursing for review and comment a reasonable time
before implementation of the system and shall comply with the
comments of those agencies unless it is unreasonable to do so.
SECTION 3.009. Sections 483.001(4), (12), and (13), Health
and Safety Code, are amended to read as follows:
(4) "Designated agent" means:
(A) a licensed nurse, physician assistant,
pharmacist, or other individual designated by a practitioner to
communicate prescription drug orders to a pharmacist;
(B) a licensed nurse, physician assistant, or
pharmacist employed in a health care facility to whom the
practitioner communicates a prescription drug order; or
(C) a [registered nurse or] physician assistant
authorized by a practitioner to carry out a prescription drug order
for dangerous drugs under Subchapter B, Chapter 157, Occupations
Code, or an advanced practice registered nurse authorized by a
practitioner to carry out a prescription drug order for dangerous
drugs.
(12) "Practitioner" means:
(A) a person licensed by the Texas Medical Board,
State Board of Dental Examiners, Texas State Board of Podiatric
Medical Examiners, Texas Optometry Board, Texas Board of Nursing,
or State Board of Veterinary Medical Examiners to prescribe and
administer dangerous drugs;
(B) a person licensed by another state in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs;
(C) a person licensed in Canada or Mexico in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs; or
(D) a [an advanced practice registered nurse or]
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
(13) "Prescription" means an order from a
practitioner, or an agent of the practitioner designated in writing
as authorized to communicate prescriptions, or an order made in
accordance with Subchapter B, Chapter 157, Occupations Code, or
Section 203.353, Occupations Code, to a pharmacist for a dangerous
drug to be dispensed that states:
(A) the date of the order's issue;
(B) the name and address of the patient;
(C) if the drug is prescribed for an animal, the
species of the animal;
(D) the name and quantity of the drug prescribed;
(E) the directions for the use of the drug;
(F) the intended use of the drug unless the
practitioner determines the furnishing of this information is not
in the best interest of the patient;
(G) the name, address, and telephone number of
the practitioner at the practitioner's usual place of business,
legibly printed or stamped; and
(H) the name, address, and telephone number of
the licensed midwife[, registered nurse,] or physician assistant,
legibly printed or stamped, if signed by a licensed midwife[,
registered nurse,] or physician assistant.
SECTION 3.010. Section 483.022(f), Health and Safety Code,
is amended to read as follows:
(f) A practitioner may designate a person who is a licensed
vocational nurse or has an education equivalent to or greater than
that required for a licensed vocational nurse to communicate
prescriptions of a [an advanced practice nurse or] physician
assistant authorized by the practitioner to sign prescription drug
orders under Subchapter B, Chapter 157, Occupations Code, or of an
advanced practice registered nurse.
SECTION 3.011. Section 483.042(a), Health and Safety Code,
is amended to read as follows:
(a) A person commits an offense if the person delivers or
offers to deliver a dangerous drug:
(1) unless:
(A) the dangerous drug is delivered or offered
for delivery by a pharmacist under:
(i) a prescription issued by a practitioner
described by Section 483.001(12)(A) or (B);
(ii) a prescription signed by a [registered
nurse or] physician assistant in accordance with Subchapter B,
Chapter 157, Occupations Code; or
(iii) an original written prescription
issued by a practitioner described by Section 483.001(12)(C); and
(B) a label is attached to the immediate
container in which the drug is delivered or offered to be delivered
and the label contains the following information:
(i) the name and address of the pharmacy
from which the drug is delivered or offered for delivery;
(ii) the date the prescription for the drug
is dispensed;
(iii) the number of the prescription as
filed in the prescription files of the pharmacy from which the
prescription is dispensed;
(iv) the name of the practitioner who
prescribed the drug and, if applicable, the name of the [registered
nurse or] physician assistant who signed the prescription;
(v) the name of the patient and, if the drug
is prescribed for an animal, a statement of the species of the
animal; and
(vi) directions for the use of the drug as
contained in the prescription; or
(2) unless:
(A) the dangerous drug is delivered or offered
for delivery by:
(i) a practitioner in the course of
practice; or
(ii) a [registered nurse or] physician
assistant in the course of practice in accordance with Subchapter
B, Chapter 157, Occupations Code; and
(B) a label is attached to the immediate
container in which the drug is delivered or offered to be delivered
and the label contains the following information:
(i) the name and address of the
practitioner who prescribed the drug, and if applicable, the name
and address of the [registered nurse or] physician assistant;
(ii) the date the drug is delivered;
(iii) the name of the patient and, if the
drug is prescribed for an animal, a statement of the species of the
animal; and
(iv) the name of the drug, the strength of
the drug, and directions for the use of the drug.
SECTION 3.012. Section 32.03141, Human Resources Code, is
amended to read as follows:
Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
addition to other health care practitioners authorized by federal
law, the following persons may order and prescribe durable medical
equipment and supplies under the medical assistance program:
(1) an advanced practice registered nurse; and
(2) a [or] physician assistant acting under adequate
physician supervision and to whom a physician has delegated the
authority to prescribe and order drugs and devices under Chapter
157, Occupations Code[, may order and prescribe durable medical
equipment and supplies under the medical assistance program].
SECTION 3.013. Section 843.312, Insurance Code, is amended
to read as follows:
Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
REGISTERED NURSES. (a) A health maintenance organization may not
refuse a request by a physician participating in the health
maintenance organization delivery network and a physician
assistant [or advanced practice nurse] who is authorized by the
physician to provide care under Subchapter B, Chapter 157,
Occupations Code, or an advanced practice registered nurse who is
authorized to provide care under Section 301.357, Occupations Code,
to identify a physician assistant or advanced practice registered
nurse as a provider in the network.
(b) A health maintenance organization may refuse a request
under Subsection (a) if the physician assistant or advanced
practice registered nurse does not meet the quality of care
standards previously established by the health maintenance
organization for participation in the network by physician
assistants and advanced practice registered nurses.
SECTION 3.014. Section 1301.001(1-a), Insurance Code, is
amended to read as follows:
(1-a) "Health care provider" means a practitioner,
institutional provider, or other person or organization that
furnishes health care services and that is licensed or otherwise
authorized to practice in this state. The term includes a
pharmacist, [and] a pharmacy, and an advanced practice registered
nurse. The term does not include a physician.
SECTION 3.015. Section 1301.052, Insurance Code, is amended
to read as follows:
Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
offering a preferred provider benefit plan may not refuse a request
made by a physician participating as a preferred provider under the
plan and an advanced practice registered nurse or physician
assistant to have the advanced practice registered nurse or
physician assistant included as a preferred provider under the plan
if:
(1) the [advanced practice nurse or] physician
assistant is authorized by the physician to provide care under
Subchapter B, Chapter 157, Occupations Code, or the advanced
practice registered nurse is authorized to provide care under
Section 301.357, Occupations Code; and
(2) the advanced practice registered nurse or
physician assistant meets the quality of care standards previously
established by the insurer for participation in the plan by
advanced practice registered nurses and physician assistants.
SECTION 3.016. Section 1451.001(2), Insurance Code, is
amended to read as follows:
(2) "Advanced practice registered nurse" means an
individual licensed by the Texas Board of Nursing as a registered
nurse and licensed [recognized] by that board as an advanced
practice registered nurse.
SECTION 3.017. Section 1451.104(c), Insurance Code, is
amended to read as follows:
(c) Notwithstanding Subsection (a), a health insurance
policy may provide for a different amount of payment or
reimbursement for scheduled services or procedures performed by an
advanced practice registered nurse, nurse first assistant,
licensed surgical assistant, or physician assistant if the
methodology used to compute the amount is the same as the
methodology used to compute the amount of payment or reimbursement
when the services or procedures are provided by a physician.
SECTION 3.018. Section 1451.106, Insurance Code, is amended
to read as follows:
Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
NURSE. An insured may select an advanced practice registered nurse
to provide the services scheduled in the health insurance policy
that are within the scope of the nurse's license.
SECTION 3.019. Section 1452.051(1), Insurance Code, is
amended to read as follows:
(1) "Advanced practice nurse" has the meaning assigned
to "advanced practice registered nurse" by Section 301.357
[301.152], Occupations Code.
SECTION 3.020. Section 204.1025, Occupations Code, is
amended to read as follows:
Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
AGREEMENTS. The physician assistant board shall in conjunction
with the Texas Medical Board [and the Texas Board of Nursing]
perform the functions and duties relating to prescriptive authority
agreements assigned to the physician assistant board in Sections
157.0512 and 157.0513.
SECTION 3.021. Sections 551.003(14) and (34), Occupations
Code, are amended to read as follows:
(14) "Designated agent" means:
(A) an individual, including a licensed nurse,
physician assistant, or pharmacist:
(i) who is designated by a practitioner and
authorized to communicate a prescription drug order to a
pharmacist; and
(ii) for whom the practitioner assumes
legal responsibility;
(B) a licensed nurse, physician assistant, or
pharmacist employed in a health care facility to whom a
practitioner communicates a prescription drug order; or
(C) a [registered nurse or] physician assistant
authorized by a practitioner to administer a prescription drug
order for a dangerous drug under Subchapter B, Chapter 157, or an
advanced practice registered nurse authorized by a practitioner to
administer a prescription drug order for a dangerous drug.
(34) "Practitioner" means:
(A) a person licensed or registered to prescribe,
distribute, administer, or dispense a prescription drug or device
in the course of professional practice in this state, including a
physician, dentist, podiatrist, advanced practice registered
nurse, or veterinarian but excluding a person licensed under this
subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license holder in this state may legally
prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian,
advanced practice registered nurse, or podiatrist, who has a
current federal Drug Enforcement Administration registration
number and who may legally prescribe a Schedule II, III, IV, or V
controlled substance, as specified under Chapter 481, Health and
Safety Code, in that other state; or
(D) a [an advanced practice registered nurse or]
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054.
SECTION 3.022. Section 563.051(e), Occupations Code, is
amended to read as follows:
(e) A practitioner may designate a licensed vocational
nurse or a person having education equivalent to or greater than
that required for a licensed vocational nurse to communicate the
prescriptions of a [an advanced practice nurse or] physician
assistant authorized by the practitioner to sign prescription drug
orders under Subchapter B, Chapter 157, or of an advanced practice
registered nurse.
SECTION 3.023. Section 563.053, Occupations Code, is
amended to read as follows:
Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
RURAL AREAS. (a) In this section, "reimbursement for cost" means
an additional charge, separate from that imposed for the
physician's or advanced practice registered nurse's professional
services, that includes the cost of the drug product and all other
actual costs to the physician or advanced practice registered nurse
incidental to providing the dispensing service. The term does not
include a separate fee imposed for the act of dispensing the drug
itself.
(b) This section applies to an area located in a county with
a population of 5,000 or less, or in a municipality or an
unincorporated town with a population of less than 2,500, that is
within a 15-mile radius of the physician's or advanced practice
registered nurse's office and in which a pharmacy is not located.
This section does not apply to a municipality or an unincorporated
town that is adjacent to a municipality with a population of 2,500
or more.
(c) A physician who practices medicine or an advanced
practice registered nurse who practices advanced practice
registered nursing in an area described by Subsection (b) may:
(1) maintain a supply of dangerous drugs in the
physician's or advanced practice registered nurse's office to be
dispensed in the course of treating the physician's or advanced
practice registered nurse's patients; and
(2) be reimbursed for the cost of supplying those
drugs without obtaining a license under Chapter 558.
(d) A physician or advanced practice registered nurse who
dispenses dangerous drugs under Subsection (c) shall:
(1) comply with each labeling provision under this
subtitle applicable to that class of drugs; and
(2) oversee compliance with packaging and
recordkeeping provisions applicable to that class of drugs.
(e) A physician who desires to dispense dangerous drugs
under this section shall notify both the board and the Texas Medical
[State] Board [of Medical Examiners] that the physician practices
in an area described by Subsection (b). An advanced practice
registered nurse who desires to dispense dangerous drugs under this
section shall notify both the board and the Texas Board of Nursing
that the advanced practice registered nurse practices in an area
described by Subsection (b). The physician or advanced practice
registered nurse may continue to dispense dangerous drugs in the
area until the board determines, after notice and hearing, that the
physician or advanced practice registered nurse no longer practices
in an area described by Subsection (b).
SECTION 3.024. Section 605.002(14), Occupations Code, is
amended to read as follows:
(14) "Orthotics" means the science and practice of
measuring, designing, fabricating, assembling, fitting, adjusting,
or servicing an orthosis under an order from a licensed physician,
chiropractor, [or] podiatrist, or [an] advanced practice
registered nurse, or from a physician assistant acting under the
delegation and supervision of a licensed physician as provided by
Subchapter B, Chapter 157, and rules adopted by the Texas Medical
Board, for the correction or alleviation of a neuromuscular or
musculoskeletal dysfunction, disease, injury, or deformity.
SECTION 3.025. Section 605.2515, Occupations Code, is
amended to read as follows:
Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
person licensed to practice orthotics or prosthetics who measures,
designs, fabricates, fits, assembles, adjusts, or services an
orthosis or a prosthesis under an order from a licensed physician,
chiropractor, [or] podiatrist, or [an] advanced practice
registered nurse, or from a physician assistant acting under the
delegation and supervision of a licensed physician as provided by
Subchapter B, Chapter 157, and rules adopted by the Texas Medical
Board, for a specific patient is exempt from licensing as a device
manufacturer under Subchapter L, Chapter 431, Health and Safety
Code. A person licensed to practice orthotics or prosthetics who
fabricates or assembles an orthosis or a prosthesis without an
order from a licensed physician, chiropractor, [or] podiatrist, or
[an] advanced practice registered nurse, or from a physician
assistant acting under the delegation and supervision of a licensed
physician as provided by Subchapter B, Chapter 157, and rules
adopted by the Texas Medical Board, for a specific patient is
required to be licensed as a device manufacturer under Subchapter
L, Chapter 431, Health and Safety Code.
ARTICLE 4. REPEALER
SECTION 4.001. Section 301.168, Occupations Code, is
repealed.
ARTICLE 5. TRANSITION AND EFFECTIVE DATE
SECTION 5.001. Not later than February 1, 2018, the Texas
Board of Nursing shall adopt the rules necessary to implement the
changes in law made by this Act.
SECTION 5.002. Notwithstanding any changes in law made by
this Act, an advanced practice registered nurse who has been
delegated the authority to prescribe and order drugs and medical
devices by a physician's protocol or order under Section 157.0511,
157.0512, or 157.054, Occupations Code, may continue to exercise
that authority until February 1, 2018.
SECTION 5.003. This Act takes effect September 1, 2017.