Texas 2017 - 85th Regular

Texas House Bill HB1804 Compare Versions

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

Old	New	Differences
1	1	85R5768 EES-D
2	2	By: Blanco H.B. No. 1804
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the prescribing and ordering authority of certain
8	8	advanced practice registered nurses who are military veterans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. PRESCRIPTIVE AUTHORITY FOR CERTAIN ADVANCED PRACTICE
11	11	REGISTERED NURSES WHO ARE MILITARY VETERANS
12	12	SECTION 1.001. Section 301.002, Occupations Code, is
13	13	amended by amending Subdivision (2) and adding Subdivisions (6),
14	14	(7), (8), (9), and (10) to read as follows:
15	15	(2) "Professional nursing" means the performance of an
16	16	act that requires substantial specialized judgment and skill, the
17	17	proper performance of which is based on knowledge and application
18	18	of the principles of biological, physical, and social science as
19	19	acquired by a completed course in an approved school of
20	20	professional nursing. The term does not include acts of medical
21	21	diagnosis or the prescription of therapeutic or corrective
22	22	measures. Professional nursing involves:
23	23	(A) the observation, assessment, intervention,
24	24	evaluation, rehabilitation, care and counsel, or health teachings
25	25	of a person who is ill, injured, infirm, or experiencing a change in
26	26	normal health processes;
27	27	(B) the maintenance of health or prevention of
28	28	illness;
29	29	(C) the administration of a medication or
30	30	treatment as ordered by a health care practitioner legally
31	31	authorized to prescribe the medication or treatment [physician,
32	32	podiatrist, or dentist];
33	33	(D) the supervision or teaching of nursing;
34	34	(E) the administration, supervision, and
35	35	evaluation of nursing practices, policies, and procedures;
36	36	(F) the requesting, receiving, signing for, and
37	37	distribution of prescription drug samples to patients at practices
38	38	at which an advanced practice registered nurse is authorized to
39	39	sign prescription drug orders as provided by Subchapter B, Chapter
40	40	157, or Section 301.357;
41	41	(G) the performance of an act delegated by a
42	42	physician under Section 157.0512, 157.054, 157.058, or 157.059;
43	43	[and]
44	44	(H) the development of the nursing care plan; and
45	45	(I) the prescribing and ordering of drugs and
46	46	devices by an advanced practice registered nurse as authorized by
47	47	the board under Section 301.357.
48	48	(6) "Controlled substance" has the meaning assigned by
49	49	Section 157.051.
50	50	(7) "Dangerous drug" has the meaning assigned by
51	51	Section 157.051.
52	52	(8) "Device" has the meaning assigned by Section
53	53	157.051.
54	54	(9) "Nonprescription drug" has the meaning assigned by
55	55	Section 157.051.
56	56	(10) "Prescribe or order a drug or device" has the
57	57	meaning assigned by Section 157.051.
58	58	SECTION 1.002. Section 301.152(b), Occupations Code, is
59	59	amended to read as follows:
60	60	(b) The board shall adopt rules to:
61	61	(1) license a registered nurse as an advanced practice
62	62	registered nurse;
63	63	(2) establish:
64	64	(A) any specialized education or training,
65	65	including pharmacology, that an advanced practice registered nurse
66	66	must have to prescribe or order a drug or device as delegated by a
67	67	physician under Section 157.0512 or 157.054 or as authorized by the
68	68	board under Section 301.357;
69	69	(B) a system for approving an advanced practice
70	70	registered nurse to prescribe or order a drug or device as delegated
71	71	by a physician under Section 157.0512 or 157.054 or as authorized by
72	72	the board under Section 301.357 on the receipt of evidence of
73	73	completing the specialized education and training requirement
74	74	under Paragraph (A); and
75	75	(C) a system for issuing a prescription
76	76	authorization number to an advanced practice registered nurse
77	77	approved under Paragraph (B); and
78	78	(3) concurrently renew any license or approval granted
79	79	to an advanced practice registered nurse under this subsection and
80	80	a license renewed by the advanced practice registered nurse under
81	81	Section 301.301.
82	82	SECTION 1.003. Subchapter H, Chapter 301, Occupations Code,
83	83	is amended by adding Section 301.357 to read as follows:
84	84	Sec. 301.357. PRESCRIBING AND ORDERING AUTHORITY OF CERTAIN
85	85	ADVANCED PRACTICE REGISTERED NURSES. (a) In this section, "active
86	86	duty" and "military veteran" have the meanings assigned by Section
87	87	55.001.
88	88	(b) The board may authorize an advanced practice registered
89	89	nurse to prescribe and order drugs and devices, including
90	90	controlled substances listed in Schedules III, IV, and V, dangerous
91	91	drugs, and nonprescription drugs, if the advanced practice
92	92	registered nurse:
93	93	(1) is a military veteran;
94	94	(2) practiced as an advanced practice registered nurse
95	95	while on active duty; and
96	96	(3) has been issued a prescription authorization
97	97	number under Section 301.152(b).
98	98	(c) The board may authorize an advanced practice registered
99	99	nurse described by Subsection (b) to prescribe and order controlled
100	100	substances listed in Schedule II only:
101	101	(1) in a hospital facility-based practice in
102	102	accordance with policies approved by the hospital's medical staff
103	103	or a committee of the hospital's medical staff as provided by the
104	104	hospital bylaws to ensure patient safety, and as part of the care
105	105	provided to a patient who:
106	106	(A) has been admitted to the hospital and is
107	107	expected to remain in the hospital for a period of 24 hours or more;
108	108	or
109	109	(B) is receiving services in the emergency
110	110	department of the hospital; or
111	111	(2) as part of the plan of care for the treatment of a
112	112	person who has executed a written certification of a terminal
113	113	illness, has elected to receive hospice care, and is receiving
114	114	hospice treatment from a qualified hospice provider.
115	115	ARTICLE 2. CONFORMING AMENDMENTS
116	116	SECTION 2.001. Section 38.151(1), Education Code, is
117	117	amended to read as follows:
118	118	(1) "Advanced practice nurse" has the meaning assigned
119	119	to "advanced practice registered nurse" by Section 301.152,
120	120	Occupations Code.
121	121	SECTION 2.002. Section 671.001(b), Government Code, is
122	122	amended to read as follows:
123	123	(b) The pilot program must provide for the following:
124	124	(1) a licensed advanced practice registered nurse as
125	125	defined by Section 301.152, Occupations Code, or a licensed
126	126	physician assistant as described by Chapter 204, Occupations Code,
127	127	who is employed by the state or whose services are acquired by
128	128	contract, who will be located at a state office complex;
129	129	(2) if applicable, a licensed physician, who is
130	130	employed by a state governmental entity for purposes other than the
131	131	pilot program or whose services are acquired by contract, who will
132	132	delegate to and supervise the advanced practice registered nurse or
133	133	physician assistant under a prescriptive authority agreement under
134	134	Chapter 157, Occupations Code;
135	135	(3) appropriate office space and equipment for the
136	136	advanced practice registered nurse or physician assistant to
137	137	provide basic medical care to employees at the state office complex
138	138	where the nurse or physician assistant is located; and
139	139	(4) professional liability insurance covering
140	140	services provided by the advanced practice registered nurse or the
141	141	physician assistant.
142	142	SECTION 2.003. Section 481.002(39), Health and Safety Code,
143	143	is amended to read as follows:
144	144	(39) "Practitioner" means:
145	145	(A) a physician, dentist, veterinarian,
146	146	podiatrist, scientific investigator, advanced practice registered
147	147	nurse, or other person licensed, registered, or otherwise permitted
148	148	to distribute, dispense, analyze, conduct research with respect to,
149	149	or administer a controlled substance in the course of professional
150	150	practice or research in this state;
151	151	(B) a pharmacy, hospital, or other institution
152	152	licensed, registered, or otherwise permitted to distribute,
153	153	dispense, conduct research with respect to, or administer a
154	154	controlled substance in the course of professional practice or
155	155	research in this state;
156	156	(C) a person practicing in and licensed by
157	157	another state as a physician, dentist, veterinarian, advanced
158	158	practice registered nurse, or podiatrist, having a current Federal
159	159	Drug Enforcement Administration registration number, who may
160	160	legally prescribe Schedule II, III, IV, or V controlled substances
161	161	in that state; or
162	162	(D) an advanced practice registered nurse or
163	163	physician assistant to whom a physician has delegated the authority
164	164	to prescribe or order a drug or device under Section 157.0511,
165	165	157.0512, or 157.054, Occupations Code.
166	166	SECTION 2.004. Section 481.073(a), Health and Safety Code,
167	167	is amended to read as follows:
168	168	(a) Only a practitioner defined by Section 481.002(39)(A)
169	169	and an agent designated in writing by the practitioner in
170	170	accordance with rules adopted by the board may communicate a
171	171	prescription by telephone. A pharmacy that receives a
172	172	telephonically communicated prescription shall promptly write the
173	173	prescription and file and retain the prescription in the manner
174	174	required by this subchapter. A practitioner who designates an
175	175	agent to communicate prescriptions shall maintain the written
176	176	designation of the agent in the practitioner's usual place of
177	177	business and shall make the designation available for inspection by
178	178	investigators for the Texas Medical Board, the State Board of
179	179	Dental Examiners, the State Board of Veterinary Medical Examiners,
180	180	the Texas Board of Nursing, the board, and the department. A
181	181	practitioner who designates a different agent shall designate that
182	182	agent in writing and maintain the designation in the same manner in
183	183	which the practitioner initially designated an agent under this
184	184	section.
185	185	SECTION 2.005. Section 481.074(d), Health and Safety Code,
186	186	is amended to read as follows:
187	187	(d) Except as specified in Subsections (e) and (f), the
188	188	board, by rule and in consultation with the Texas Medical Board and
189	189	the Texas Board of Nursing, shall establish the period after the
190	190	date on which the prescription is issued that a person may fill a
191	191	prescription for a controlled substance listed in Schedule II. A
192	192	person may not refill a prescription for a substance listed in
193	193	Schedule II.
194	194	SECTION 2.006. Section 481.076(c), Health and Safety Code,
195	195	is amended to read as follows:
196	196	(c) The board by rule shall design and implement a system
197	197	for submission of information to the board by electronic or other
198	198	means and for retrieval of information submitted to the board under
199	199	this section and Sections 481.074 and 481.075. The board shall use
200	200	automated information security techniques and devices to preclude
201	201	improper access to the information. The board shall submit the
202	202	system design to the director, [and] the Texas Medical Board, and
203	203	the Texas Board of Nursing for review and comment a reasonable time
204	204	before implementation of the system and shall comply with the
205	205	comments of those agencies unless it is unreasonable to do so.
206	206	SECTION 2.007. Sections 483.001(4) and (12), Health and
207	207	Safety Code, are amended to read as follows:
208	208	(4) "Designated agent" means:
209	209	(A) a licensed nurse, physician assistant,
210	210	pharmacist, or other individual designated by a practitioner to
211	211	communicate prescription drug orders to a pharmacist;
212	212	(B) a licensed nurse, physician assistant, or
213	213	pharmacist employed in a health care facility to whom the
214	214	practitioner communicates a prescription drug order; or
215	215	(C) [a] an advanced practice registered nurse or
216	216	physician assistant authorized by a practitioner to carry out a
217	217	prescription drug order for dangerous drugs under Subchapter B,
218	218	Chapter 157, Occupations Code, or an advanced practice registered
219	219	nurse authorized by a practitioner to carry out a prescription drug
220	220	order for dangerous drugs under other law.
221	221	(12) "Practitioner" means:
222	222	(A) a person licensed by the Texas Medical Board,
223	223	State Board of Dental Examiners, Texas State Board of Podiatric
224	224	Medical Examiners, Texas Optometry Board, Texas Board of Nursing,
225	225	or State Board of Veterinary Medical Examiners to prescribe and
226	226	administer dangerous drugs;
227	227	(B) a person licensed by another state in a
228	228	health field in which, under the laws of this state, a licensee may
229	229	legally prescribe dangerous drugs;
230	230	(C) a person licensed in Canada or Mexico in a
231	231	health field in which, under the laws of this state, a licensee may
232	232	legally prescribe dangerous drugs; or
233	233	(D) an advanced practice registered nurse or
234	234	physician assistant to whom a physician has delegated the authority
235	235	to prescribe or order a drug or device under Section 157.0511,
236	236	157.0512, or 157.054, Occupations Code.
237	237	SECTION 2.008. Section 32.03141, Human Resources Code, is
238	238	amended to read as follows:
239	239	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
240	240	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
241	241	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
242	242	addition to other health care practitioners authorized by federal
243	243	law, the following persons may order and prescribe durable medical
244	244	equipment and supplies under the medical assistance program:
245	245	(1) an advanced practice registered nurse authorized
246	246	to prescribe and order drugs and devices under Section 301.357,
247	247	Occupations Code; and
248	248	(2) an advanced practice registered nurse or physician
249	249	assistant acting under adequate physician supervision and to whom a
250	250	physician has delegated the authority to prescribe and order drugs
251	251	and devices under Chapter 157, Occupations Code[, may order and
252	252	prescribe durable medical equipment and supplies under the medical
253	253	assistance program].
254	254	SECTION 2.009. Section 843.312, Insurance Code, is amended
255	255	to read as follows:
256	256	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
257	257	REGISTERED NURSES. (a) A health maintenance organization may not
258	258	refuse a request by a physician participating in the health
259	259	maintenance organization delivery network and a physician
260	260	assistant or advanced practice registered nurse who is authorized
261	261	by the physician to provide care under Subchapter B, Chapter 157,
262	262	Occupations Code, or an advanced practice registered nurse who is
263	263	authorized to provide care by the physician under other law, to
264	264	identify a physician assistant or advanced practice registered
265	265	nurse as a provider in the network.
266	266	(b) A health maintenance organization may refuse a request
267	267	under Subsection (a) if the physician assistant or advanced
268	268	practice registered nurse does not meet the quality of care
269	269	standards previously established by the health maintenance
270	270	organization for participation in the network by physician
271	271	assistants and advanced practice registered nurses.
272	272	SECTION 2.010. Section 1301.001(1-a), Insurance Code, is
273	273	amended to read as follows:
274	274	(1-a) "Health care provider" means a practitioner,
275	275	institutional provider, or other person or organization that
276	276	furnishes health care services and that is licensed or otherwise
277	277	authorized to practice in this state. The term includes a
278	278	pharmacist, [and] a pharmacy, and an advanced practice registered
279	279	nurse. The term does not include a physician.
280	280	SECTION 2.011. Section 1301.052, Insurance Code, is amended
281	281	to read as follows:
282	282	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
283	283	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
284	284	offering a preferred provider benefit plan may not refuse a request
285	285	made by a physician participating as a preferred provider under the
286	286	plan and an advanced practice registered nurse or physician
287	287	assistant to have the advanced practice registered nurse or
288	288	physician assistant included as a preferred provider under the plan
289	289	if:
290	290	(1) the advanced practice registered nurse or
291	291	physician assistant is authorized by the physician to provide care
292	292	under Subchapter B, Chapter 157, Occupations Code, or the advanced
293	293	practice registered nurse is authorized to provide care by the
294	294	physician under other law; and
295	295	(2) the advanced practice registered nurse or
296	296	physician assistant meets the quality of care standards previously
297	297	established by the insurer for participation in the plan by
298	298	advanced practice registered nurses and physician assistants.
299	299	SECTION 2.012. Section 1451.001(2), Insurance Code, is
300	300	amended to read as follows:
301	301	(2) "Advanced practice registered nurse" means an
302	302	individual licensed by the Texas Board of Nursing as a registered
303	303	nurse and licensed [recognized] by that board as an advanced
304	304	practice registered nurse.
305	305	SECTION 2.013. Section 1451.104(c), Insurance Code, is
306	306	amended to read as follows:
307	307	(c) Notwithstanding Subsection (a), a health insurance
308	308	policy may provide for a different amount of payment or
309	309	reimbursement for scheduled services or procedures performed by an
310	310	advanced practice registered nurse, nurse first assistant,
311	311	licensed surgical assistant, or physician assistant if the
312	312	methodology used to compute the amount is the same as the
313	313	methodology used to compute the amount of payment or reimbursement
314	314	when the services or procedures are provided by a physician.
315	315	SECTION 2.014. Section 1451.106, Insurance Code, is amended
316	316	to read as follows:
317	317	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
318	318	NURSE. An insured may select an advanced practice registered nurse
319	319	to provide the services scheduled in the health insurance policy
320	320	that are within the scope of the nurse's license.
321	321	SECTION 2.015. Section 1452.051(1), Insurance Code, is
322	322	amended to read as follows:
323	323	(1) "Advanced practice nurse" has the meaning assigned
324	324	to "advanced practice registered nurse" by Section 301.152,
325	325	Occupations Code.
326	326	SECTION 2.016. Sections 551.003(14) and (34), Occupations
327	327	Code, are amended to read as follows:
328	328	(14) "Designated agent" means:
329	329	(A) an individual, including a licensed nurse,
330	330	physician assistant, or pharmacist:
331	331	(i) who is designated by a practitioner and
332	332	authorized to communicate a prescription drug order to a
333	333	pharmacist; and
334	334	(ii) for whom the practitioner assumes
335	335	legal responsibility;
336	336	(B) a licensed nurse, physician assistant, or
337	337	pharmacist employed in a health care facility to whom a
338	338	practitioner communicates a prescription drug order; or
339	339	(C) a registered nurse or physician assistant
340	340	authorized by a practitioner to administer a prescription drug
341	341	order for a dangerous drug under Subchapter B, Chapter 157, or an
342	342	advanced practice registered nurse authorized by a practitioner to
343	343	administer a prescription drug order for a dangerous drug under
344	344	other law.
345	345	(34) "Practitioner" means:
346	346	(A) a person licensed or registered to prescribe,
347	347	distribute, administer, or dispense a prescription drug or device
348	348	in the course of professional practice in this state, including a
349	349	physician, dentist, podiatrist, advanced practice registered
350	350	nurse, or veterinarian but excluding a person licensed under this
351	351	subtitle;
352	352	(B) a person licensed by another state, Canada,
353	353	or the United Mexican States in a health field in which, under the
354	354	law of this state, a license holder in this state may legally
355	355	prescribe a dangerous drug;
356	356	(C) a person practicing in another state and
357	357	licensed by another state as a physician, dentist, veterinarian,
358	358	advanced practice registered nurse, or podiatrist, who has a
359	359	current federal Drug Enforcement Administration registration
360	360	number and who may legally prescribe a Schedule II, III, IV, or V
361	361	controlled substance, as specified under Chapter 481, Health and
362	362	Safety Code, in that other state; or
363	363	(D) an advanced practice registered nurse or
364	364	physician assistant to whom a physician has delegated the authority
365	365	to prescribe or order a drug or device under Section 157.0511,
366	366	157.0512, or 157.054.
367	367	SECTION 2.017. Section 563.053, Occupations Code, is
368	368	amended to read as follows:
369	369	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
370	370	RURAL AREAS. (a) In this section, "reimbursement for cost" means
371	371	an additional charge, separate from that imposed for the
372	372	physician's or advanced practice registered nurse's professional
373	373	services, that includes the cost of the drug product and all other
374	374	actual costs to the physician or advanced practice registered nurse
375	375	incidental to providing the dispensing service. The term does not
376	376	include a separate fee imposed for the act of dispensing the drug
377	377	itself.
378	378	(b) This section applies to an area located in a county with
379	379	a population of 5,000 or less, or in a municipality or an
380	380	unincorporated town with a population of less than 2,500, that is
381	381	within a 15-mile radius of the physician's or advanced practice
382	382	registered nurse's office and in which a pharmacy is not located.
383	383	This section does not apply to a municipality or an unincorporated
384	384	town that is adjacent to a municipality with a population of 2,500
385	385	or more.
386	386	(c) A physician who practices medicine or an advanced
387	387	practice registered nurse who is authorized to prescribe and order
388	388	drugs and devices under Section 301.357 and who practices advanced
389	389	practice registered nursing in an area described by Subsection (b)
390	390	may:
391	391	(1) maintain a supply of dangerous drugs in the
392	392	physician's or advanced practice registered nurse's office to be
393	393	dispensed in the course of treating the physician's or advanced
394	394	practice registered nurse's patients; and
395	395	(2) be reimbursed for the cost of supplying those
396	396	drugs without obtaining a license under Chapter 558.
397	397	(d) A physician or advanced practice registered nurse who
398	398	dispenses dangerous drugs under Subsection (c) shall:
399	399	(1) comply with each labeling provision under this
400	400	subtitle applicable to that class of drugs; and
401	401	(2) oversee compliance with packaging and
402	402	recordkeeping provisions applicable to that class of drugs.
403	403	(e) A physician who desires to dispense dangerous drugs
404	404	under this section shall notify both the board and the Texas Medical
405	405	[State] Board [of Medical Examiners] that the physician practices
406	406	in an area described by Subsection (b). An advanced practice
407	407	registered nurse who desires to dispense dangerous drugs under this
408	408	section shall notify both the board and the Texas Board of Nursing
409	409	that the advanced practice registered nurse practices in an area
410	410	described by Subsection (b). The physician or advanced practice
411	411	registered nurse may continue to dispense dangerous drugs in the
412	412	area until the board determines, after notice and hearing, that the
413	413	physician or advanced practice registered nurse no longer practices
414	414	in an area described by Subsection (b).
415	415	SECTION 2.018. Section 605.002(14), Occupations Code, is
416	416	amended to read as follows:
417	417	(14) "Orthotics" means the science and practice of
418	418	measuring, designing, fabricating, assembling, fitting, adjusting,
419	419	or servicing an orthosis under an order from a licensed physician,
420	420	chiropractor, [or] podiatrist, or [an] advanced practice
421	421	registered nurse, or from an advanced practice registered nurse or
422	422	physician assistant acting under the delegation and supervision of
423	423	a licensed physician as provided by Subchapter B, Chapter 157, and
424	424	rules adopted by the Texas Medical Board, for the correction or
425	425	alleviation of a neuromuscular or musculoskeletal dysfunction,
426	426	disease, injury, or deformity.
427	427	SECTION 2.019. Section 605.2515, Occupations Code, is
428	428	amended to read as follows:
429	429	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
430	430	person licensed to practice orthotics or prosthetics who measures,
431	431	designs, fabricates, fits, assembles, adjusts, or services an
432	432	orthosis or a prosthesis under an order from a licensed physician,
433	433	chiropractor, [or] podiatrist, or [an] advanced practice
434	434	registered nurse, or from an advanced practice registered nurse or
435	435	physician assistant acting under the delegation and supervision of
436	436	a licensed physician as provided by Subchapter B, Chapter 157, and
437	437	rules adopted by the Texas Medical Board, for a specific patient is
438	438	exempt from licensing as a device manufacturer under Subchapter L,
439	439	Chapter 431, Health and Safety Code. A person licensed to practice
440	440	orthotics or prosthetics who fabricates or assembles an orthosis or
441	441	a prosthesis without an order from a licensed physician,
442	442	chiropractor, [or] podiatrist, or [an] advanced practice
443	443	registered nurse, or from an advanced practice registered nurse or
444	444	physician assistant acting under the delegation and supervision of
445	445	a licensed physician as provided by Subchapter B, Chapter 157, and
446	446	rules adopted by the Texas Medical Board, for a specific patient is
447	447	required to be licensed as a device manufacturer under Subchapter
448	448	L, Chapter 431, Health and Safety Code.
449	449	ARTICLE 3. TRANSITION AND EFFECTIVE DATE
450	450	SECTION 3.001. Not later than February 1, 2018, the Texas
451	451	Board of Nursing shall adopt the rules necessary to implement the
452	452	changes in law made by this Act.
453	453	SECTION 3.002. This Act takes effect September 1, 2017.