Texas 2019 - 86th Regular

Texas House Bill HB2174 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	H.B. No. 2174
	1	+	By: Zerwas, et al. (Senate Sponsor - Kolkhorst) H.B. No. 2174
	2	+	(In the Senate - Received from the House April 26, 2019;
	3	+	April 29, 2019, read first time and referred to Committee on Health &
	4	+	Human Services; May 19, 2019, reported favorably by the following
	5	+	vote: Yeas 8, Nays 1; May 19, 2019, sent to printer.)
	6	+	Click here to see the committee vote
2	7
3	8
	9	+	A BILL TO BE ENTITLED
4	10		AN ACT
5	11		relating to controlled substance prescriptions and reimbursement
6	12		for treatment for certain substance use disorders; authorizing a
7	13		fee.
8	14		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	15		SECTION 1. Section 552.118, Government Code, is amended to
10	16		read as follows:
11	17		Sec. 552.118. EXCEPTION: CONFIDENTIALITY OF OFFICIAL
12	18		PRESCRIPTION PROGRAM INFORMATION. Information is excepted from the
13	19		requirements of Section 552.021 if it is:
14	20		(1) information on or derived from an official
15	21		prescription form filed with the Texas State Board of Pharmacy
16	22		under Section 481.0755, Health and Safety Code, or an electronic
17	23		prescription record filed with the Texas State Board of Pharmacy
18	24		under Section 481.075, Health and Safety Code; or
19	25		(2) other information collected under Section 481.075
20	26		or 481.0755 of that code.
21	27		SECTION 2. Sections 481.002(10) and (47), Health and Safety
22	28		Code, are amended to read as follows:
23	29		(10) "Designated agent" means an individual
24	30		designated under Section 481.074(b-2) [481.073] to communicate a
25	31		practitioner's instructions to a pharmacist in an emergency.
26	32		(47) "Official prescription form" means a
27	33		prescription form that is used for a Schedule II controlled
28	34		substance under Section 481.0755 and contains the prescription
29	35		information required by Section 481.0755(e) [481.075].
30	36		SECTION 3. Section 481.003(a), Health and Safety Code, is
31	37		amended to read as follows:
32	38		(a) The director may adopt rules to administer and enforce
33	39		this chapter, other than Sections [481.073,] 481.074, 481.075,
34	40		481.0755, 481.0756, 481.076, 481.0761, 481.0762, 481.0763,
35	41		481.07635, 481.07636, 481.0764, 481.0765, and 481.0766. The board
36	42		may adopt rules to administer Sections [481.073,] 481.074, 481.075,
37	43		481.0755, 481.0756, 481.076, 481.0761, 481.0762, 481.0763,
38	44		481.07635, 481.07636, 481.0764, 481.0765, and 481.0766.
39	45		SECTION 4. Section 481.074, Health and Safety Code, is
40	46		amended by amending Subsections (b), (c), (e), (f), (g), (h), (k),
41	47		and (q) and adding Subsections (b-1) and (b-2) to read as follows:
42	48		(b) Except in an emergency as defined by board rule under
43	49		Subsection (b-1) [of the board] or as otherwise provided by
44	50		[Subsection (o) or] Section 481.075(j) or (m) or 481.0755, a person
45	51		may not dispense or administer a controlled substance [listed in
46	52		Schedule II without a written prescription of a practitioner on an
47	53		official prescription form or] without an electronic prescription
48	54		that meets the requirements of and is completed by the practitioner
49	55		in accordance with Section 481.075.
50	56		(b-1) In an emergency as defined by board rule, a person may
51	57		dispense or administer a controlled substance [listed in Schedule
52	58		II] on the oral or telephonically communicated prescription of a
53	59		practitioner. The person who administers or dispenses the
54	60		substance shall:
55	61		(1) if the person is a prescribing practitioner or a
56	62		pharmacist, promptly comply with Subsection (c); or
57	63		(2) if the person is not a prescribing practitioner or
58	64		a pharmacist, promptly write the oral or telephonically
59	65		communicated prescription and include in the written record of the
60	66		prescription the name, address, and Federal Drug Enforcement
61	67		Administration number issued for prescribing a controlled
62	68		substance in this state of the prescribing practitioner, all
63	69		information required to be provided by a practitioner under Section
64	70		481.075(e)(1), and all information required to be provided by a
65	71		dispensing pharmacist under Section 481.075(e)(2).
66	72		(b-2) In an emergency described by Subsection (b-1), an
67	73		agent designated in writing by a practitioner defined by Section
68	74		481.002(39)(A) may communicate a prescription by telephone. A
69	75		practitioner who designates a different agent shall designate that
70	76		agent in writing and maintain the designation in the same manner in
71	77		which the practitioner initially designated an agent under this
72	78		subsection. On the request of a pharmacist, a practitioner shall
73	79		furnish a copy of the written designation. This subsection does not
74	80		relieve a practitioner or the practitioner's designated agent from
75	81		the requirement of Subchapter A, Chapter 562, Occupations Code. A
76	82		practitioner is personally responsible for the actions of the
77	83		designated agent in communicating a prescription to a pharmacist.
78	84		(c) Not later than the seventh day after the date a
79	85		prescribing practitioner authorizes an emergency oral or
80	86		telephonically communicated prescription, the prescribing
81	87		practitioner shall cause an [a written or] electronic prescription,
82	88		completed in the manner required by Section 481.075, to be
83	89		delivered to the dispensing pharmacist at the pharmacy where the
84	90		prescription was dispensed. [A written prescription may be
85	91		delivered in person or by mail. The envelope of a prescription
86	92		delivered by mail must be postmarked not later than the seventh day
87	93		after the date the prescription was authorized. On receipt of a
88	94		written prescription, the dispensing pharmacy shall file the
89	95		transcription of the telephonically communicated prescription and
90	96		the pharmacy copy and shall send information to the board as
91	97		required by Section 481.075.] On receipt of the [an] electronic
92	98		prescription, the pharmacist shall annotate the electronic
93	99		prescription record with the original authorization and date of the
94	100		emergency oral or telephonically communicated prescription.
95	101		(e) The partial filling of a prescription for a controlled
96	102		substance listed in Schedule II is permissible in accordance with
97	103		applicable federal law[, if the pharmacist is unable to supply the
98	104		full quantity called for in a written or electronic prescription or
99	105		emergency oral prescription and the pharmacist makes a notation of
100	106		the quantity supplied on the face of the written prescription, on
101	107		the written record of the emergency oral prescription, or in the
102	108		electronic prescription record. The remaining portion of the
103	109		prescription may be filled within 72 hours of the first partial
104	110		filling; however, if the remaining portion is not or cannot be
105	111		filled within the 72-hour period, the pharmacist shall so notify
106	112		the prescribing individual practitioner. No further quantity may
107	113		be supplied beyond 72 hours without a new prescription].
108	114		(f) A prescription for a Schedule II controlled substance
109	115		for a patient in a long-term care facility (LTCF) or for a hospice
110	116		patient with a medical diagnosis documenting a terminal illness may
111	117		be filled in partial quantities to include individual dosage units.
112	118		If there is any question about whether a hospice patient may be
113	119		classified as having a terminal illness, the pharmacist must
114	120		contact the practitioner before partially filling the
115	121		prescription. Both the pharmacist and the practitioner have a
116	122		corresponding responsibility to assure that the controlled
117	123		substance is for a terminally ill hospice patient. The pharmacist
118	124		must record the prescription [on an official prescription form or]
119	125		in the electronic prescription record and must indicate [on the
120	126		official prescription form or] in the electronic prescription
121	127		record whether the patient is a "terminally ill hospice patient" or
122	128		an "LTCF patient." A prescription that is partially filled and does
123	129		not contain the notation "terminally ill hospice patient" or "LTCF
124	130		patient" is considered to have been filled in violation of this
125	131		chapter. For each partial filling, the dispensing pharmacist shall
126	132		record [on the back of the official prescription form or] in the
127	133		electronic prescription record the date of the partial filling, the
128	134		quantity dispensed, the remaining quantity authorized to be
129	135		dispensed, and the identification of the dispensing pharmacist.
130	136		Before any subsequent partial filling, the pharmacist must
131	137		determine that the additional partial filling is necessary. The
132	138		total quantity of Schedule II controlled substances dispensed in
133	139		all partial fillings may not exceed the total quantity prescribed.
134	140		Schedule II prescriptions for patients in a long-term care facility
135	141		or hospice patients with a medical diagnosis documenting a terminal
136	142		illness are valid for a period not to exceed 60 days following the
137	143		issue date unless sooner terminated by discontinuance of the
138	144		medication.
139	145		(g) A person may not dispense a controlled substance in
140	146		Schedule III or IV that is a prescription drug under the Federal
141	147		Food, Drug, and Cosmetic Act (21 U.S.C. Section 301 et seq.) without
142	148		a [written, electronic, oral, or telephonically communicated]
143	149		prescription of a practitioner defined by Section 481.002(39)(A) or
144	150		(D), except that the practitioner may dispense the substance
145	151		directly to an ultimate user. A prescription for a controlled
146	152		substance listed in Schedule III or IV may not be filled or refilled
147	153		later than six months after the date on which the prescription is
148	154		issued and may not be refilled more than five times, unless the
149	155		prescription is renewed by the practitioner. A prescription under
150	156		this subsection must comply with other applicable state and federal
151	157		laws.
152	158		(h) A pharmacist may dispense a controlled substance listed
153	159		in Schedule III, IV, or V under a [written, electronic, oral, or
154	160		telephonically communicated] prescription issued by a practitioner
155	161		defined by Section 481.002(39)(C) [and] only if the pharmacist
156	162		determines that the prescription was issued for a valid medical
157	163		purpose and in the course of professional practice. A prescription
158	164		described by [issued under] this subsection may not be filled or
159	165		refilled later than six months after the date the prescription is
160	166		issued and may not be refilled more than five times, unless the
161	167		prescription is renewed by the practitioner.
162	168		(k) A prescription for a controlled substance must show:
163	169		(1) the quantity of the substance prescribed:
164	170		(A) [numerically, followed by the number written
165	171		as a word, if the prescription is written;
166	172		[(B)] numerically, if the prescription is
167	173		electronic; or
168	174		(B) [(C)] if the prescription is communicated
169	175		orally or telephonically, as transcribed by the receiving
170	176		pharmacist;
171	177		(2) the date of issue;
172	178		(2-a) if the prescription is issued for a Schedule II
173	179		controlled substance to be filled at a later date under Subsection
174	180		(d-1), the earliest date on which a pharmacy may fill the
175	181		prescription;
176	182		(3) the name, address, and date of birth or age of the
177	183		patient or, if the controlled substance is prescribed for an
178	184		animal, the species of the animal and the name and address of its
179	185		owner;
180	186		(4) the name and strength of the controlled substance
181	187		prescribed;
182	188		(5) the directions for use of the controlled
183	189		substance;
184	190		(6) the intended use of the substance prescribed
185	191		unless the practitioner determines the furnishing of this
186	192		information is not in the best interest of the patient; and
187	193		(7) the name, address, Federal Drug Enforcement
188	194		Administration number, and telephone number of the practitioner at
189	195		the practitioner's usual place of business[, which must be legibly
190	196		printed or stamped on a written prescription; and
191	197		[(8) if the prescription is handwritten, the signature
192	198		of the prescribing practitioner].
193	199		(q) Each dispensing pharmacist shall send all required
194	200		information[, including any information required to complete the
195	201		Schedule III through V prescription forms,] to the board by
196	202		electronic transfer or another form approved by the board not later
197	203		than the next business day after the date the prescription is
198	204		completely filled.
199	205		SECTION 5. The heading to Section 481.075, Health and
200	206		Safety Code, is amended to read as follows:
201	207		Sec. 481.075. SCHEDULE II PRESCRIPTIONS [OFFICIAL
202	208		PRESCRIPTION PROGRAM].
203	209		SECTION 6. Sections 481.075(a), (e), (g), (h), (i), and
204	210		(j), Health and Safety Code, are amended to read as follows:
205	211		(a) A practitioner who prescribes a controlled substance
206	212		listed in Schedule II shall, except as provided by Section
207	213		481.074(b-1) or 481.0755 or a rule adopted under Section 481.0761,
208	214		record the prescription [on an official prescription form or] in an
209	215		electronic prescription that includes the information required by
210	216		this section.
211	217		(e) Each [official prescription form or electronic]
212	218		prescription used to prescribe a Schedule II controlled substance
213	219		must contain:
214	220		(1) information provided by the prescribing
215	221		practitioner, including:
216	222		(A) the date the prescription is issued;
217	223		(B) the controlled substance prescribed;
218	224		(C) the quantity of controlled substance
219	225		prescribed, shown[:
220	226		[(i)] numerically[, followed by the number
221	227		written as a word, if the prescription is written; or
222	228		[(ii) numerically, if the prescription is
223	229		electronic];
224	230		(D) the intended use of the controlled substance,
225	231		or the diagnosis for which the controlled substance [it] is
226	232		prescribed, and the instructions for use of the substance;
227	233		(E) the practitioner's name, address, and
228	234		Federal Drug Enforcement Administration number issued for
229	235		prescribing a controlled substance in this state;
230	236		(F) the name, address, and date of birth or age of
231	237		the person for whom the controlled substance is prescribed; and
232	238		(G) if the prescription is issued to be filled at
233	239		a later date under Section 481.074(d-1), the earliest date on which
234	240		a pharmacy may fill the prescription;
235	241		(2) information provided by the dispensing
236	242		pharmacist, including the date the prescription is filled; and
237	243		(3) [for a written prescription, the signatures of the
238	244		prescribing practitioner and the dispensing pharmacist or for an
239	245		electronic prescription,] the prescribing practitioner's
240	246		electronic signature or other secure method of validation
241	247		authorized by federal law.
242	248		(g) Except for an emergency oral or telephonically
243	249		communicated prescription described by [prescribed under] Section
244	250		481.074(b-1) [481.074(b)], the prescribing practitioner shall:
245	251		(1) record [legibly fill in,] or direct a designated
246	252		agent to record [legibly fill in, on the official prescription form
247	253		or] in the electronic prescription[,] each item of information
248	254		required to be provided by the prescribing practitioner under
249	255		Subsection (e)(1), unless the practitioner determines that:
250	256		(A) under rule adopted by the board for this
251	257		purpose, it is unnecessary for the practitioner or the
252	258		practitioner's agent to provide the patient identification number;
253	259		or
254	260		(B) it is not in the best interest of the patient
255	261		for the practitioner or practitioner's agent to provide information
256	262		regarding the intended use of the controlled substance or the
257	263		diagnosis for which it is prescribed; and
258	264		(2) [sign the official prescription form and give the
259	265		form to the person authorized to receive the prescription or, in the
260	266		case of an electronic prescription,] electronically sign or
261	267		validate the electronic prescription as authorized by federal law
262	268		and transmit the prescription to the dispensing pharmacy.
263	269		(h) In the case of an emergency oral or telephonically
264	270		communicated prescription described by [prescribed under] Section
265	271		481.074(b-1) [481.074(b)], the prescribing practitioner shall give
266	272		the dispensing pharmacy the information needed to complete the
267	273		[official prescription form or] electronic prescription record.
268	274		(i) Each dispensing pharmacist shall:
269	275		(1) [fill in on the official prescription form or]
270	276		note in the electronic prescription record each item of information
271	277		given orally to the dispensing pharmacy under Subsection (h) and
272	278		the date the prescription is filled[,] and[:
273	279		[(A) for a written prescription, fill in the
274	280		dispensing pharmacist's signature; or
275	281		[(B) for an electronic prescription,]
276	282		appropriately record the identity of the dispensing pharmacist in
277	283		the electronic prescription record;
278	284		(2) retain with the records of the pharmacy for at
279	285		least two years:
280	286		(A) [the official prescription form or] the
281	287		electronic prescription record[, as applicable]; and
282	288		(B) the name or other patient identification
283	289		required by Section 481.074(m) or (n); and
284	290		(3) send all required information, including any
285	291		information required to complete an [official prescription form or]
286	292		electronic prescription record, to the board by electronic transfer
287	293		or another form approved by the board not later than the next
288	294		business day after the date the prescription is completely filled.
289	295		(j) A medication order written for a patient who is admitted
290	296		to a hospital at the time the medication order is written and filled
291	297		is not required to be recorded [on an official prescription form or]
292	298		in an electronic prescription record that meets the requirements of
293	299		this section.
294	300		SECTION 7. Subchapter C, Chapter 481, Health and Safety
295	301		Code, is amended by adding Sections 481.0755 and 481.0756 to read as
296	302		follows:
297	303		Sec. 481.0755. WRITTEN, ORAL, AND TELEPHONICALLY
298	304		COMMUNICATED PRESCRIPTIONS. (a) Notwithstanding Sections 481.074
299	305		and 481.075, a prescription for a controlled substance is not
300	306		required to be issued electronically and may be issued in writing if
301	307		the prescription is issued:
302	308		(1) by a veterinarian;
303	309		(2) in circumstances in which electronic prescribing
304	310		is not available due to temporary technological or electronic
305	311		failure, as prescribed by board rule;
306	312		(3) by a practitioner to be dispensed by a pharmacy
307	313		located outside this state, as prescribed by board rule;
308	314		(4) when the prescriber and dispenser are in the same
309	315		location or under the same license;
310	316		(5) in circumstances in which necessary elements are
311	317		not supported by the most recently implemented national data
312	318		standard that facilitates electronic prescribing;
313	319		(6) for a drug for which the United States Food and
314	320		Drug Administration requires additional information in the
315	321		prescription that is not possible with electronic prescribing;
316	322		(7) for a non-patient-specific prescription pursuant
317	323		to a standing order, approved protocol for drug therapy,
318	324		collaborative drug management, or comprehensive medication
319	325		management, in response to a public health emergency or in other
320	326		circumstances in which the practitioner may issue a
321	327		non-patient-specific prescription;
322	328		(8) for a drug under a research protocol;
323	329		(9) by a practitioner who has received a waiver under
324	330		Section 481.0756 from the requirement to use electronic
325	331		prescribing;
326	332		(10) under circumstances in which the practitioner has
327	333		the present ability to submit an electronic prescription but
328	334		reasonably determines that it would be impractical for the patient
329	335		to obtain the drugs prescribed under the electronic prescription in
330	336		a timely manner and that a delay would adversely impact the
331	337		patient's medical condition; or
332	338		(11) before January 1, 2021.
333	339		(b) A dispensing pharmacist who receives a controlled
334	340		substance prescription in a manner other than electronically is not
335	341		required to verify that the prescription is exempt from the
336	342		requirement that it be submitted electronically. The pharmacist
337	343		may dispense a controlled substance pursuant to an otherwise valid
338	344		written, oral, or telephonically communicated prescription
339	345		consistent with the requirements of this subchapter.
340	346		(c) Except in an emergency, a practitioner must use a
341	347		written prescription to submit a prescription described by
342	348		Subsection (a). In an emergency, the practitioner may submit an
343	349		oral or telephonically communicated prescription as authorized
344	350		under Section 481.074(b-1).
345	351		(d) A written prescription for a controlled substance other
346	352		than a Schedule II controlled substance must include the
347	353		information required under Section 481.074(k) and the signature of
348	354		the prescribing practitioner.
349	355		(e) A written prescription for a Schedule II controlled
350	356		substance must be on an official prescription form and include the
351	357		information required for an electronic prescription under Section
352	358		481.075(e), the signature of the practitioner, and the signature of
353	359		the dispensing pharmacist after the prescription is filled.
354	360		(f) The board by rule shall authorize a practitioner to
355	361		determine whether it is necessary to obtain a particular patient
356	362		identification number and to provide that number on the official
357	363		prescription form.
358	364		(g) On request of a practitioner, the board shall issue
359	365		official prescription forms to the practitioner for a fee covering
360	366		the actual cost of printing, processing, and mailing the forms.
361	367		Before mailing or otherwise delivering prescription forms to a
362	368		practitioner, the board shall print on each form the number of the
363	369		form and any other information the board determines is necessary.
364	370		(h) Each official prescription form must be sequentially
365	371		numbered.
366	372		(i) A person may not obtain an official prescription form
367	373		unless the person is a practitioner as defined by Section
368	374		481.002(39)(A) or an institutional practitioner.
369	375		(j) Not more than one Schedule II prescription may be
370	376		recorded on an official prescription form.
371	377		(k) Not later than the 30th day after the date a
372	378		practitioner's Federal Drug Enforcement Administration number or
373	379		license to practice has been denied, suspended, canceled,
374	380		surrendered, or revoked, the practitioner shall return to the board
375	381		all official prescription forms in the practitioner's possession
376	382		that have not been used for prescriptions.
377	383		(l) Each prescribing practitioner:
378	384		(1) may use an official prescription form only to
379	385		submit a prescription described by Subsection (a);
380	386		(2) shall date or sign an official prescription form
381	387		only on the date the prescription is issued; and
382	388		(3) shall take reasonable precautionary measures to
383	389		ensure that an official prescription form issued to the
384	390		practitioner is not used by another person to violate this
385	391		subchapter or a rule adopted under this subchapter.
386	392		(m) In the case of an emergency oral or telephonically
387	393		communicated prescription described by Section 481.074(b-1), the
388	394		prescribing practitioner shall give the dispensing pharmacy the
389	395		information needed to complete the official prescription form if
390	396		the pharmacy is not required to use the electronic prescription
391	397		record.
392	398		(n) Each dispensing pharmacist receiving an oral or
393	399		telephonically communicated prescription under Subsection (m)
394	400		shall:
395	401		(1) fill in on the official prescription form each
396	402		item of information given orally to the dispensing pharmacy under
397	403		Subsection (m) and the date the prescription is filled and fill in
398	404		the dispensing pharmacist's signature;
399	405		(2) retain with the records of the pharmacy for at
400	406		least two years:
401	407		(A) the official prescription form; and
402	408		(B) the name or other patient identification
403	409		required by Section 481.074(m) or (n); and
404	410		(3) send all required information, including any
405	411		information required to complete an official prescription form, to
406	412		the board by electronic transfer or another form approved by the
407	413		board not later than the next business day after the date the
408	414		prescription is completely filled.
409	415		Sec. 481.0756. WAIVERS FROM ELECTRONIC PRESCRIBING. (a)
410	416		The appropriate regulatory agency that issued the license,
411	417		certification, or registration to a prescriber is authorized to
412	418		grant a prescriber a waiver from the electronic prescribing
413	419		requirement under the provisions of this section.
414	420		(b) The board shall convene an interagency workgroup that
415	421		includes representatives of each regulatory agency that issues a
416	422		license, certification, or registration to a prescriber.
417	423		(c) The work group described by Subsection (b) shall
418	424		establish recommendations and standards for circumstances in which
419	425		a waiver from the electronic prescribing requirement is appropriate
420	426		and a process under which a prescriber may request and receive a
421	427		waiver.
422	428		(d) The board shall adopt rules establishing the
423	429		eligibility for a waiver, including:
424	430		(1) economic hardship;
425	431		(2) technological limitations not reasonably within
426	432		the control of the prescriber; or
427	433		(3) other exceptional circumstances demonstrated by
428	434		the prescriber.
429	435		(e) Each regulatory agency that issues a license,
430	436		certification, or registration to a prescriber shall adopt rules
431	437		for the granting of waivers consistent with the board rules adopted
432	438		under Subsection (d).
433	439		(f) A waiver may be issued to a prescriber for a period of
434	440		one year. A prescriber may reapply for a subsequent waiver not
435	441		earlier than the 30th day before the date the waiver expires if the
436	442		circumstances that necessitated the waiver continue.
437	443		SECTION 8. Sections 481.0761(c) and (d), Health and Safety
438	444		Code, are amended to read as follows:
439	445		(c) The board by rule may:
440	446		(1) [permit more than one prescription to be
441	447		administered or dispensed and recorded on one prescription form for
442	448		a Schedule III through V controlled substance;
443	449		[(1-a)] establish a procedure for the issuance of
444	450		multiple prescriptions of a Schedule II controlled substance under
445	451		Section 481.074(d-1);
446	452		(2) remove from or return to the official prescription
447	453		program any aspect of a practitioner's or pharmacist's hospital
448	454		practice, including administering or dispensing;
449	455		(3) waive or delay any requirement relating to the
450	456		time or manner of reporting;
451	457		(4) establish compatibility protocols for electronic
452	458		data transfer hardware, software, or format, including any
453	459		necessary modifications for participation in a database described
454	460		by Section 481.076(j);
455	461		(5) establish a procedure to control the release of
456	462		information under Sections 481.074, 481.075, and 481.076; and
457	463		(6) establish a minimum level of prescription activity
458	464		below which a reporting activity may be modified or deleted.
459	465		(d) The board by rule shall authorize a practitioner to
460	466		determine whether it is necessary to obtain a particular patient
461	467		identification number and to provide that number [on the official
462	468		prescription form or] in the electronic prescription record.
463	469		SECTION 9. Subchapter C, Chapter 481, Health and Safety
464	470		Code, is amended by adding Sections 481.07635 and 481.07636 to read
465	471		as follows:
466	472		Sec. 481.07635. CONTINUING EDUCATION. (a) A person
467	473		authorized to receive information under Section 481.076(a)(5)
468	474		shall, not later than the first anniversary after the person is
469	475		issued a license, certification, or registration to prescribe or
470	476		dispense controlled substances under this chapter, complete two
471	477		hours of professional education related to approved procedures of
472	478		prescribing and monitoring controlled substances.
473	479		(b) A person authorized to receive information may annually
474	480		take the professional education course under this section to fulfil
475	481		hours toward the ethics education requirement of the person's
476	482		license, certification, or registration.
477	483		(c) The regulatory agency that issued the license,
478	484		certification, or registration to a person authorized to receive
479	485		information under Section 481.076(a)(5) shall approve professional
480	486		education to satisfy the requirements of this section.
481	487		Sec. 481.07636. OPIOID PRESCRIPTION LIMITS. (a) In this
482	488		section, "acute pain" means the normal, predicted, physiological
483	489		response to a stimulus such as trauma, disease, and operative
484	490		procedures. Acute pain is time limited. The term does not include:
485	491		(1) chronic pain;
486	492		(2) pain being treated as part of cancer care;
487	493		(3) pain being treated as part of hospice or other
488	494		end-of-life care; or
489	495		(4) pain being treated as part of palliative care.
490	496		(b) For the treatment of acute pain, a practitioner may not:
491	497		(1) issue a prescription for an opioid in an amount
492	498		that exceeds a 10-day supply; or
493	499		(2) provide for a refill of an opioid.
494	500		(c) Subsection (b) does not apply to a prescription for an
495	501		opioid approved by the United States Food and Drug Administration
496	502		for the treatment of substance addiction that is issued by a
497	503		practitioner for the treatment of substance addiction.
498	504		(d) A dispenser is not subject to criminal, civil, or
499	505		administrative penalties for dispensing or refusing to dispense a
500	506		controlled substance under a prescription that exceeds the limits
501	507		provided by Subsection (b).
502	508		SECTION 10. Section 481.128(a), Health and Safety Code, is
503	509		amended to read as follows:
504	510		(a) A registrant or dispenser commits an offense if the
505	511		registrant or dispenser knowingly:
506	512		(1) distributes, delivers, administers, or dispenses
507	513		a controlled substance in violation of Subchapter C [Sections
508	514		481.070-481.075];
509	515		(2) manufactures a controlled substance not
510	516		authorized by the person's Federal Drug Enforcement Administration
511	517		registration or distributes or dispenses a controlled substance not
512	518		authorized by the person's registration to another registrant or
513	519		other person;
514	520		(3) refuses or fails to make, keep, or furnish a
515	521		record, report, notification, order form, statement, invoice, or
516	522		information required by this chapter;
517	523		(4) prints, manufactures, possesses, or produces an
518	524		official prescription form without the approval of the board;
519	525		(5) delivers or possesses a counterfeit official
520	526		prescription form;
521	527		(6) refuses an entry into a premise for an inspection
522	528		authorized by this chapter;
523	529		(7) refuses or fails to return an official
524	530		prescription form as required by Section 481.0755(k) [481.075(k)];
525	531		(8) refuses or fails to make, keep, or furnish a
526	532		record, report, notification, order form, statement, invoice, or
527	533		information required by a rule adopted by the director or the board;
528	534		or
529	535		(9) refuses or fails to maintain security required by
530	536		this chapter or a rule adopted under this chapter.
531	537		SECTION 11. Section 481.129(a), Health and Safety Code, is
532	538		amended to read as follows:
533	539		(a) A person commits an offense if the person knowingly:
534	540		(1) distributes as a registrant or dispenser a
535	541		controlled substance listed in Schedule I or II, unless the person
536	542		distributes the controlled substance as authorized under the
537	543		federal Controlled Substances Act (21 U.S.C. Section 801 et seq.);
538	544		(2) uses in the course of manufacturing, prescribing,
539	545		or distributing a controlled substance a Federal Drug Enforcement
540	546		Administration registration number that is fictitious, revoked,
541	547		suspended, or issued to another person;
542	548		(3) issues a prescription bearing a forged or
543	549		fictitious signature;
544	550		(4) uses a prescription issued to another person to
545	551		prescribe a Schedule II controlled substance;
546	552		(5) possesses, obtains, or attempts to possess or
547	553		obtain a controlled substance or an increased quantity of a
548	554		controlled substance:
549	555		(A) by misrepresentation, fraud, forgery,
550	556		deception, or subterfuge;
551	557		(B) through use of a fraudulent prescription
552	558		form; [or]
553	559		(C) through use of a fraudulent oral or
554	560		telephonically communicated prescription; or
555	561		(D) through the use of a fraudulent electronic
556	562		prescription; or
557	563		(6) furnishes false or fraudulent material
558	564		information in or omits material information from an application,
559	565		report, record, or other document required to be kept or filed under
560	566		this chapter.
561	567		SECTION 12. Section 32.024, Human Resources Code, is
562	568		amended by adding Subsection (z-2) to read as follows:
563	569		(z-2) The limits on prescription drugs and medications
564	570		under the medical assistance program provided by Subsections (z)
565	571		and (z-1) do not apply to a prescription for an opioid for the
566	572		treatment of acute pain under Section 481.07636, Health and Safety
567	573		Code.
568	574		SECTION 13. Subchapter B, Chapter 32, Human Resources Code,
569	575		is amended by adding Section 32.03115 to read as follows:
570	576		Sec. 32.03115. REIMBURSEMENT FOR MEDICATION-ASSISTED
571	577		TREATMENT FOR OPIOID OR SUBSTANCE USE DISORDER. (a) In this
572	578		section, "medication-assisted opioid or substance use disorder
573	579		treatment" means the use of methadone, buprenorphine, oral
574	580		buprenorphine/naloxone, or naltrexone to treat opioid or substance
575	581		use disorder.
576	582		(b) Notwithstanding Sections 531.072 and 531.073,
577	583		Government Code, or any other law and subject to Subsections (c) and
578	584		(d), the commission shall provide medical assistance reimbursement
579	585		for medication-assisted opioid or substance use disorder treatment
580	586		without requiring a recipient of medical assistance or health care
581	587		provider to obtain prior authorization or precertification for the
582	588		treatment, except as needed to minimize the opportunity for fraud,
583	589		waste, or abuse.
584	590		(c) The duty to provide medical assistance reimbursement
585	591		for medication-assisted opioid or substance use disorder treatment
586	592		under Subsection (b) does not apply with respect to:
587	593		(1) a prescription for methadone;
588	594		(2) a recipient for whom medication-assisted opioid or
589	595		substance use disorder treatment is determined to be medically
590	596		contraindicated by the recipient's physician; or
591	597		(3) a recipient who is subject to an age-related
592	598		restriction applicable to medication-assisted opioid or substance
593	599		use disorder treatment.
594	600		(d) The commission may provide medical assistance
595	601		reimbursement for medication-assisted opioid or substance use
596	602		disorder treatment only if the treatment is prescribed to a
597	603		recipient of medical assistance by a licensed health care provider
598	604		who is authorized to prescribe methadone, buprenorphine, oral
599	605		buprenorphine/naloxone, or naltrexone.
600	606		(e) This section expires August 31, 2023.
601	607		SECTION 14. Section 554.051(a-1), Occupations Code, is
602	608		amended to read as follows:
603	609		(a-1) The board may adopt rules to administer Sections
604	610		[481.073,] 481.074, 481.075, 481.0755, 481.0756, 481.076,
605	611		481.0761, 481.0762, 481.0763, 481.07635, 481.07636, 481.0764,
606	612		481.0765, and 481.0766, Health and Safety Code.
607	613		SECTION 15. Section 565.003, Occupations Code, is amended
608	614		to read as follows:
609	615		Sec. 565.003. ADDITIONAL GROUNDS FOR DISCIPLINE REGARDING
610	616		APPLICANT FOR OR HOLDER OF NONRESIDENT PHARMACY LICENSE. Unless
611	617		compliance would violate the pharmacy or drug statutes or rules in
612	618		the state in which the pharmacy is located, the board may discipline
613	619		an applicant for or the holder of a nonresident pharmacy license if
614	620		the board finds that the applicant or license holder has failed to
615	621		comply with:
616	622		(1) Section 481.074, [or] 481.075, 481.0755,
617	623		481.0756, 481.076, 481.0761, 481.0762, 481.0763, 481.07635,
618	624		481.07636, 481.0764, 481.0765, or 481.0766, Health and Safety Code;
619	625		(2) Texas substitution requirements regarding:
620	626		(A) the practitioner's directions concerning
621	627		generic substitution;
622	628		(B) the patient's right to refuse generic
623	629		substitution; or
624	630		(C) notification to the patient of the patient's
625	631		right to refuse substitution;
626	632		(3) any board rule relating to providing drug
627	633		information to the patient or the patient's agent in written form or
628	634		by telephone; or
629	635		(4) any board rule adopted under Section 554.051(a)
630	636		and determined by the board to be applicable under Section
631	637		554.051(b).
632	638		SECTION 16. Sections 481.073, 481.074(o) and (p), and
633	639		481.075(b), (c), (d), (f), (k), and (l), Health and Safety Code, are
634	640		repealed.
635	641		SECTION 17. A person who holds a license, certification, or
636	642		registration to prescribe or dispense a controlled substance issued
637	643		before September 1, 2020, is required to take the continuing
638	644		education course provided by Section 481.07635, Health and Safety
639	645		Code, as added by this Act, not later than September 1, 2021.
640		-	SECTION 18. (a) In this section, "qualifying
641		-	practitioner" has the meaning assigned by 21 U.S.C. Section
642		-	823(g)(2)(G)(iii).
643		-	(
644		-	b) Not later than November 1, 2019, the Health and Human
645		-	Services Commission shall amend the commission's Medicaid
646		-	Substance Use Disorder Services Medical Policy and any other
647		-	provider or claims payment policy or manual necessary to authorize
648		-	Medicaid medical benefits reimbursement for the prescribing of
649		-	buprenorphine for the treatment of an opioid use disorder by an
650		-	advanced practice registered nurse recognized by the Texas Board of
651		-	Nursing as a clinical nurse specialist, nurse anesthetist, or nurse
652		-	midwife, provided that the advanced practice registered nurse:
653		-	(1) is a qualifying practitioner;
654		-	(2) has obtained a waiver from registration
655		-	requirements as provided by 21 U.S.C. Section 823(g); and
656		-	(3) is acting under adequate physician supervision and
657		-	a physician's delegation under Section 157.0512 or 157.054,
658		-	Occupations Code.
659		-	SECTION 19. If before implementing any provision of this
	646	+	SECTION 18. If before implementing any provision of this
660	647		Act a state agency determines that a waiver or authorization from a
661	648		federal agency is necessary for implementation of that provision,
662	649		the agency affected by the provision shall request the waiver or
663	650		authorization and may delay implementing that provision until the
664	651		waiver or authorization is granted.
665		-	SECTION 20. This Act takes effect September 1, 2019.
666		-	______________________________ ______________________________
667		-	President of the Senate Speaker of the House
668		-	I certify that H.B. No. 2174 was passed by the House on April
669		-	25, 2019, by the following vote: Yeas 129, Nays 4, 1 present, not
670		-	voting; and that the House concurred in Senate amendments to H.B.
671		-	No. 2174 on May 24, 2019, by the following vote: Yeas 131, Nays 9,
672		-	3 present, not voting.
673		-	______________________________
674		-	Chief Clerk of the House
675		-	I certify that H.B. No. 2174 was passed by the Senate, with
676		-	amendments, on May 21, 2019, by the following vote: Yeas 28, Nays
677		-	3.
678		-	______________________________
679		-	Secretary of the Senate
680		-	APPROVED: __________________
681		-	Date
682		-	__________________
683		-	Governor
	652	+	SECTION 19. This Act takes effect September 1, 2019.
	653	+	* * * * *