Texas 2019 - 86th Regular

Texas House Bill HB927 Compare Versions

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

Old	New	Differences
1	1	86R4821 BEE-D
2	2	By: White H.B. No. 927
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the practice of certain advanced practice registered
8	8	nurses in certain rural counties; authorizing a fee.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. PRACTICE OF ADVANCED PRACTICE REGISTERED NURSES IN
11	11	CERTAIN RURAL COUNTIES
12	12	SECTION 1.001. Chapter 487, Government Code, is amended by
13	13	adding Subchapter S to read as follows:
14	14	SUBCHAPTER S. REQUEST TO AUTHORIZE PRACTICE OF ADVANCED PRACTICE
15	15	REGISTERED NURSES IN CERTAIN RURAL COUNTIES
16	16	Sec. 487.851. IDENTIFICATION OF HEALTH PROFESSIONAL
17	17	SHORTAGE AREAS. (a) Not later than October 1 of each year, the
18	18	office shall:
19	19	(1) identify the rural counties of this state that are
20	20	determined to be health professional shortage areas by the United
21	21	States Department of Health and Human Services; and
22	22	(2) provide a list of the counties identified under
23	23	Subdivision (1) to:
24	24	(A) each county judge in this state; and
25	25	(B) the Texas Board of Nursing.
26	26	(b) The department by rule shall establish the criteria for
27	27	a county to be identified as a rural county for the purposes of
28	28	Subsection (a).
29	29	Sec. 487.852. REQUEST FOR AUTHORIZATION OF PRACTICE OF
30	30	ADVANCED PRACTICE REGISTERED NURSES. Not later than December 1 of
31	31	each year, the county commissioners court of a county identified
32	32	under Section 487.851(a)(1) or of an adjacent county may direct the
33	33	county judge to submit to the Texas Board of Nursing a written
34	34	request for the board to authorize the practice in the county of
35	35	advanced practice registered nurses under Section 301.357,
36	36	Occupations Code.
37	37	SECTION 1.002. Section 301.002, Occupations Code, is
38	38	amended by amending Subdivision (2) and adding Subdivisions (6),
39	39	(7), (8), (9), and (10) to read as follows:
40	40	(2) "Professional nursing" means the performance of an
41	41	act that requires substantial specialized judgment and skill, the
42	42	proper performance of which is based on knowledge and application
43	43	of the principles of biological, physical, and social science as
44	44	acquired by a completed course in an approved school of
45	45	professional nursing. The term does not include acts of medical
46	46	diagnosis or the prescription of therapeutic or corrective
47	47	measures, except with respect to an advanced practice registered
48	48	nurse authorized to practice under Section 301.357. Professional
49	49	nursing involves:
50	50	(A) the observation, assessment, intervention,
51	51	evaluation, rehabilitation, care and counsel, or health teachings
52	52	of a person who is ill, injured, infirm, or experiencing a change in
53	53	normal health processes;
54	54	(B) the maintenance of health or prevention of
55	55	illness;
56	56	(C) the administration of a medication or
57	57	treatment as ordered by a health care practitioner legally
58	58	authorized to prescribe the medication or treatment [physician,
59	59	podiatrist, or dentist];
60	60	(D) the supervision or teaching of nursing;
61	61	(E) the administration, supervision, and
62	62	evaluation of nursing practices, policies, and procedures;
63	63	(F) the requesting, receiving, signing for, and
64	64	distribution of prescription drug samples to patients at practices
65	65	at which an advanced practice registered nurse is authorized to
66	66	sign prescription drug orders as provided by Subchapter B, Chapter
67	67	157, or Section 301.357;
68	68	(G) the performance of an act delegated by a
69	69	physician under Section 157.0512, 157.054, 157.058, or 157.059;
70	70	[and]
71	71	(H) the development of the nursing care plan; and
72	72	(I) the performance of an act by an advanced
73	73	practice registered nurse in accordance with Section 301.357.
74	74	(6) "Controlled substance" has the meaning assigned by
75	75	Section 481.002, Health and Safety Code.
76	76	(7) "Dangerous drug" has the meaning assigned by
77	77	Section 483.001, Health and Safety Code.
78	78	(8) "Device" has the meaning assigned by Section
79	79	551.003, and includes durable medical equipment.
80	80	(9) "Nonprescription drug" has the meaning assigned by
81	81	Section 551.003.
82	82	(10) "Prescribe or order a drug or device" has the
83	83	meaning assigned by Section 157.051.
84	84	SECTION 1.003. Section 301.152(b), Occupations Code, is
85	85	amended to read as follows:
86	86	(b) The board shall adopt rules to:
87	87	(1) license a registered nurse as an advanced practice
88	88	registered nurse;
89	89	(2) establish:
90	90	(A) any specialized education or training,
91	91	including pharmacology, that an advanced practice registered nurse
92	92	must have to prescribe or order a drug or device as delegated by a
93	93	physician under Section 157.0512 or 157.054 or as authorized by the
94	94	board under Section 301.357;
95	95	(B) a system for approving an advanced practice
96	96	registered nurse to prescribe or order a drug or device as delegated
97	97	by a physician under Section 157.0512 or 157.054 or as authorized by
98	98	the board under Section 301.357 on the receipt of evidence of
99	99	completing the specialized education and training requirement
100	100	under Paragraph (A); and
101	101	(C) a system for issuing a prescription
102	102	authorization number to an advanced practice registered nurse
103	103	approved under Paragraph (B); and
104	104	(3) concurrently renew any license or approval granted
105	105	to an advanced practice registered nurse under this subsection and
106	106	a license renewed by the advanced practice registered nurse under
107	107	Section 301.301.
108	108	SECTION 1.004. Subchapter H, Chapter 301, Occupations Code,
109	109	is amended by adding Section 301.357 to read as follows:
110	110	Sec. 301.357. PRACTICE OF CERTAIN ADVANCED PRACTICE
111	111	REGISTERED NURSES IN CERTAIN RURAL COUNTIES. (a) The board shall
112	112	authorize the practice under this section of an advanced practice
113	113	registered nurse who:
114	114	(1) practices in a county:
115	115	(A) identified under Section 487.851(a)(1),
116	116	Government Code; and
117	117	(B) the county judge of which has submitted a
118	118	request under Section 486.852, Government Code;
119	119	(2) has been issued a prescription authorization
120	120	number as provided by Section 301.152(b); and
121	121	(3) applies for authorization under this section in
122	122	the manner prescribed by the board.
123	123	(b) The scope of practice of an advanced practice registered
124	124	nurse authorized to practice under this section includes:
125	125	(1) ordering, performing, and interpreting diagnostic
126	126	tests;
127	127	(2) formulating primary and differential medical
128	128	diagnoses and advanced assessments;
129	129	(3) treating actual and potential health problems;
130	130	(4) prescribing therapeutic and corrective measures,
131	131	including nutrition and diagnostic support services, home health
132	132	care, hospice care, physical therapy, and occupational therapy, and
133	133	delegating and assigning the performance of therapeutic and
134	134	corrective measures to assistive personnel;
135	135	(5) subject to Subsection (c), prescribing and
136	136	ordering drugs and devices, including controlled substances listed
137	137	in Schedules II, III, IV, and V, dangerous drugs, and
138	138	nonprescription drugs;
139	139	(6) providing referrals to health care agencies,
140	140	health care providers, and community resources;
141	141	(7) serving as the primary care provider of record;
142	142	and
143	143	(8) performing other acts that require education and
144	144	training consistent with professional standards and that are
145	145	commensurate with the advanced practice registered nurse's
146	146	education, licensure, and demonstrated competencies and
147	147	experience.
148	148	(c) An advanced practice registered nurse authorized to
149	149	practice under this section may prescribe and order controlled
150	150	substances listed in Schedule II only:
151	151	(1) in a hospital facility-based practice in
152	152	accordance with policies approved by the hospital's medical staff
153	153	or a committee of the hospital's medical staff as provided by the
154	154	hospital bylaws to ensure patient safety, and as part of the care
155	155	provided to a patient who:
156	156	(A) has been admitted to the hospital and is
157	157	expected to remain in the hospital for a period of 24 hours or more;
158	158	or
159	159	(B) is receiving services in the emergency
160	160	department of the hospital; or
161	161	(2) as part of the plan of care for the treatment of a
162	162	person who has executed a written certification of a terminal
163	163	illness, has elected to receive hospice care, and is receiving
164	164	hospice treatment from a qualified hospice provider.
165	165	(d) The board by rule:
166	166	(1) shall prescribe the application process for
167	167	authorization to practice under this section;
168	168	(2) shall establish criteria to determine the county
169	169	in which an advanced practice registered nurse practices for
170	170	purposes of Subsection (a)(1); and
171	171	(3) may set a fee for an application for authorization
172	172	under this section in a reasonable amount that is sufficient to
173	173	cover the costs of administering this section.
174	174	(e) An authorization under this section remains in effect as
175	175	long as the advanced practice registered nurse practices in a
176	176	county described by Subsection (a)(1).
177	177	ARTICLE 2. CONFORMING AMENDMENTS
178	178	SECTION 2.001. Section 38.151(1), Education Code, is
179	179	amended to read as follows:
180	180	(1) "Advanced practice nurse" has the meaning assigned
181	181	to "advanced practice registered nurse" by Section 301.152,
182	182	Occupations Code.
183	183	SECTION 2.002. Section 671.001(b), Government Code, is
184	184	amended to read as follows:
185	185	(b) The pilot program must provide for the following:
186	186	(1) a licensed advanced practice registered nurse as
187	187	defined by Section 301.152, Occupations Code, or a licensed
188	188	physician assistant as described by Chapter 204, Occupations Code,
189	189	who is employed by the state or whose services are acquired by
190	190	contract, who will be located at a state office complex;
191	191	(2) if applicable, a licensed physician, who is
192	192	employed by a state governmental entity for purposes other than the
193	193	pilot program or whose services are acquired by contract, who will
194	194	delegate to and supervise the advanced practice registered nurse or
195	195	physician assistant under a prescriptive authority agreement under
196	196	Chapter 157, Occupations Code;
197	197	(3) appropriate office space and equipment for the
198	198	advanced practice registered nurse or physician assistant to
199	199	provide basic medical care to employees at the state office complex
200	200	where the nurse or physician assistant is located; and
201	201	(4) professional liability insurance covering
202	202	services provided by the advanced practice registered nurse or the
203	203	physician assistant.
204	204	SECTION 2.003. Section 481.002(39), Health and Safety Code,
205	205	is amended to read as follows:
206	206	(39) "Practitioner" means:
207	207	(A) a physician, dentist, veterinarian,
208	208	podiatrist, scientific investigator, advanced practice registered
209	209	nurse, or other person licensed, registered, or otherwise permitted
210	210	to distribute, dispense, analyze, conduct research with respect to,
211	211	or administer a controlled substance in the course of professional
212	212	practice or research in this state;
213	213	(B) a pharmacy, hospital, or other institution
214	214	licensed, registered, or otherwise permitted to distribute,
215	215	dispense, conduct research with respect to, or administer a
216	216	controlled substance in the course of professional practice or
217	217	research in this state;
218	218	(C) a person practicing in and licensed by
219	219	another state as a physician, dentist, veterinarian, advanced
220	220	practice registered nurse, or podiatrist, having a current Federal
221	221	Drug Enforcement Administration registration number, who may
222	222	legally prescribe Schedule II, III, IV, or V controlled substances
223	223	in that state; or
224	224	(D) an advanced practice registered nurse or
225	225	physician assistant to whom a physician has delegated the authority
226	226	to prescribe or order a drug or device under Section 157.0511,
227	227	157.0512, or 157.054, Occupations Code.
228	228	SECTION 2.004. Section 481.073(a), Health and Safety Code,
229	229	is amended to read as follows:
230	230	(a) Only a practitioner defined by Section 481.002(39)(A)
231	231	and an agent designated in writing by the practitioner in
232	232	accordance with rules adopted by the board may communicate a
233	233	prescription by telephone. A pharmacy that receives a
234	234	telephonically communicated prescription shall promptly write the
235	235	prescription and file and retain the prescription in the manner
236	236	required by this subchapter. A practitioner who designates an
237	237	agent to communicate prescriptions shall maintain the written
238	238	designation of the agent in the practitioner's usual place of
239	239	business and shall make the designation available for inspection by
240	240	investigators for the Texas Medical Board, the State Board of
241	241	Dental Examiners, the State Board of Veterinary Medical Examiners,
242	242	the Texas Board of Nursing, the board, and the department. A
243	243	practitioner who designates a different agent shall designate that
244	244	agent in writing and maintain the designation in the same manner in
245	245	which the practitioner initially designated an agent under this
246	246	section.
247	247	SECTION 2.005. Section 481.074(d), Health and Safety Code,
248	248	is amended to read as follows:
249	249	(d) Except as specified in Subsections (e) and (f), the
250	250	board, by rule and in consultation with the Texas Medical Board and
251	251	the Texas Board of Nursing, shall establish the period after the
252	252	date on which the prescription is issued that a person may fill a
253	253	prescription for a controlled substance listed in Schedule II. A
254	254	person may not refill a prescription for a substance listed in
255	255	Schedule II.
256	256	SECTION 2.006. Section 481.076(c), Health and Safety Code,
257	257	is amended to read as follows:
258	258	(c) The board by rule shall design and implement a system
259	259	for submission of information to the board by electronic or other
260	260	means and for retrieval of information submitted to the board under
261	261	this section and Sections 481.074 and 481.075. The board shall use
262	262	automated information security techniques and devices to preclude
263	263	improper access to the information. The board shall submit the
264	264	system design to the director, [and] the Texas Medical Board, and
265	265	the Texas Board of Nursing for review and comment a reasonable time
266	266	before implementation of the system and shall comply with the
267	267	comments of those agencies unless it is unreasonable to do so.
268	268	SECTION 2.007. Sections 483.001(4) and (12), Health and
269	269	Safety Code, are amended to read as follows:
270	270	(4) "Designated agent" means:
271	271	(A) a licensed nurse, physician assistant,
272	272	pharmacist, or other individual designated by a practitioner to
273	273	communicate prescription drug orders to a pharmacist;
274	274	(B) a licensed nurse, physician assistant, or
275	275	pharmacist employed in a health care facility to whom the
276	276	practitioner communicates a prescription drug order; or
277	277	(C) an advanced practice [a] registered nurse or
278	278	physician assistant authorized by a practitioner to carry out a
279	279	prescription drug order for dangerous drugs under Subchapter B,
280	280	Chapter 157, Occupations Code, or an advanced practice registered
281	281	nurse authorized to practice under Section 301.357, Occupations
282	282	Code.
283	283	(12) "Practitioner" means:
284	284	(A) a person licensed by:
285	285	(i) the Texas Medical Board, State Board of
286	286	Dental Examiners, [Texas State Board of Podiatric Medical
287	287	Examiners,] Texas Optometry Board, Texas Board of Nursing, or State
288	288	Board of Veterinary Medical Examiners to prescribe and administer
289	289	dangerous drugs; or
290	290	(ii) the Texas Department of Licensing and
291	291	Regulation, with respect to podiatry, to prescribe and administer
292	292	dangerous drugs;
293	293	(B) a person licensed by another state in a
294	294	health field in which, under the laws of this state, a licensee may
295	295	legally prescribe dangerous drugs;
296	296	(C) a person licensed in Canada or Mexico in a
297	297	health field in which, under the laws of this state, a licensee may
298	298	legally prescribe dangerous drugs; or
299	299	(D) an advanced practice registered nurse or
300	300	physician assistant to whom a physician has delegated the authority
301	301	to prescribe or order a drug or device under Section 157.0511,
302	302	157.0512, or 157.054, Occupations Code.
303	303	SECTION 2.008. Section 32.03141, Human Resources Code, is
304	304	amended to read as follows:
305	305	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
306	306	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
307	307	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
308	308	addition to other health care practitioners authorized by federal
309	309	law, the following persons may order and prescribe durable medical
310	310	equipment and supplies under the medical assistance program:
311	311	(1) an advanced practice registered nurse authorized
312	312	to practice under Section 301.357, Occupations Code; and
313	313	(2) an advanced practice registered nurse or physician
314	314	assistant acting under adequate physician supervision and to whom a
315	315	physician has delegated the authority to prescribe and order drugs
316	316	and devices under Chapter 157, Occupations Code[, may order and
317	317	prescribe durable medical equipment and supplies under the medical
318	318	assistance program].
319	319	SECTION 2.009. Section 843.312, Insurance Code, is amended
320	320	to read as follows:
321	321	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
322	322	REGISTERED NURSES. (a) A health maintenance organization may not
323	323	refuse a request by a physician participating in the health
324	324	maintenance organization delivery network and a physician
325	325	assistant or advanced practice registered nurse who is authorized
326	326	by the physician to provide care under Subchapter B, Chapter 157,
327	327	Occupations Code, or an advanced practice registered nurse who is
328	328	authorized to practice under Section 301.357, Occupations Code, to
329	329	identify a physician assistant or advanced practice registered
330	330	nurse as a provider in the network.
331	331	(b) A health maintenance organization may refuse a request
332	332	under Subsection (a) if the physician assistant or advanced
333	333	practice registered nurse does not meet the quality of care
334	334	standards previously established by the health maintenance
335	335	organization for participation in the network by physician
336	336	assistants and advanced practice registered nurses.
337	337	SECTION 2.010. Section 1301.001(1-a), Insurance Code, is
338	338	amended to read as follows:
339	339	(1-a) "Health care provider" means a practitioner,
340	340	institutional provider, or other person or organization that
341	341	furnishes health care services and that is licensed or otherwise
342	342	authorized to practice in this state. The term includes a
343	343	pharmacist, [and] a pharmacy, and an advanced practice registered
344	344	nurse. The term does not include a physician.
345	345	SECTION 2.011. Section 1301.052, Insurance Code, is amended
346	346	to read as follows:
347	347	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
348	348	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
349	349	offering a preferred provider benefit plan may not refuse a request
350	350	made by a physician participating as a preferred provider under the
351	351	plan and an advanced practice registered nurse or physician
352	352	assistant to have the advanced practice registered nurse or
353	353	physician assistant included as a preferred provider under the plan
354	354	if:
355	355	(1) the advanced practice registered nurse or
356	356	physician assistant is authorized by the physician to provide care
357	357	under Subchapter B, Chapter 157, Occupations Code, or the advanced
358	358	practice registered nurse is authorized to practice under Section
359	359	301.357, Occupations Code; and
360	360	(2) the advanced practice registered nurse or
361	361	physician assistant meets the quality of care standards previously
362	362	established by the insurer for participation in the plan by
363	363	advanced practice registered nurses and physician assistants.
364	364	SECTION 2.012. Section 1451.001(2), Insurance Code, is
365	365	amended to read as follows:
366	366	(2) "Advanced practice registered nurse" means an
367	367	individual licensed by the Texas Board of Nursing as a registered
368	368	nurse and licensed [recognized] by that board as an advanced
369	369	practice registered nurse.
370	370	SECTION 2.013. Section 1451.104(c), Insurance Code, is
371	371	amended to read as follows:
372	372	(c) Notwithstanding Subsection (a), a health insurance
373	373	policy may provide for a different amount of payment or
374	374	reimbursement for scheduled services or procedures performed by an
375	375	advanced practice registered nurse, nurse first assistant,
376	376	licensed surgical assistant, or physician assistant if the
377	377	methodology used to compute the amount is the same as the
378	378	methodology used to compute the amount of payment or reimbursement
379	379	when the services or procedures are provided by a physician.
380	380	SECTION 2.014. Section 1451.106, Insurance Code, is amended
381	381	to read as follows:
382	382	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
383	383	NURSE. An insured may select an advanced practice registered nurse
384	384	to provide the services scheduled in the health insurance policy
385	385	that are within the scope of the nurse's license.
386	386	SECTION 2.015. Section 1452.051(1), Insurance Code, is
387	387	amended to read as follows:
388	388	(1) "Advanced practice nurse" has the meaning assigned
389	389	to "advanced practice registered nurse" by Section 301.152,
390	390	Occupations Code.
391	391	SECTION 2.016. Sections 551.003(14) and (34), Occupations
392	392	Code, are amended to read as follows:
393	393	(14) "Designated agent" means:
394	394	(A) an individual, including a licensed nurse,
395	395	physician assistant, or pharmacist:
396	396	(i) who is designated by a practitioner and
397	397	authorized to communicate a prescription drug order to a
398	398	pharmacist; and
399	399	(ii) for whom the practitioner assumes
400	400	legal responsibility;
401	401	(B) a licensed nurse, physician assistant, or
402	402	pharmacist employed in a health care facility to whom a
403	403	practitioner communicates a prescription drug order; or
404	404	(C) a registered nurse or physician assistant
405	405	authorized by a practitioner to administer a prescription drug
406	406	order for a dangerous drug under Subchapter B, Chapter 157, or an
407	407	advanced practice registered nurse authorized to practice under
408	408	Section 301.357.
409	409	(34) "Practitioner" means:
410	410	(A) a person licensed or registered to prescribe,
411	411	distribute, administer, or dispense a prescription drug or device
412	412	in the course of professional practice in this state, including a
413	413	physician, dentist, podiatrist, advanced practice registered
414	414	nurse, or veterinarian but excluding a person licensed under this
415	415	subtitle;
416	416	(B) a person licensed by another state, Canada,
417	417	or the United Mexican States in a health field in which, under the
418	418	law of this state, a license holder in this state may legally
419	419	prescribe a dangerous drug;
420	420	(C) a person practicing in another state and
421	421	licensed by another state as a physician, dentist, veterinarian,
422	422	advanced practice registered nurse, or podiatrist, who has a
423	423	current federal Drug Enforcement Administration registration
424	424	number and who may legally prescribe a Schedule II, III, IV, or V
425	425	controlled substance, as specified under Chapter 481, Health and
426	426	Safety Code, in that other state; or
427	427	(D) an advanced practice registered nurse or
428	428	physician assistant to whom a physician has delegated the authority
429	429	to prescribe or order a drug or device under Section 157.0511,
430	430	157.0512, or 157.054.
431	431	SECTION 2.017. Section 563.053, Occupations Code, is
432	432	amended to read as follows:
433	433	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
434	434	RURAL AREAS. (a) In this section, "reimbursement for cost" means
435	435	an additional charge, separate from that imposed for the
436	436	physician's or advanced practice registered nurse's professional
437	437	services, that includes the cost of the drug product and all other
438	438	actual costs to the physician or advanced practice registered nurse
439	439	incidental to providing the dispensing service. The term does not
440	440	include a separate fee imposed for the act of dispensing the drug
441	441	itself.
442	442	(b) This section applies to an area located in a county with
443	443	a population of 5,000 or less, or in a municipality or an
444	444	unincorporated town with a population of less than 2,500, that is
445	445	within a 15-mile radius of the physician's or advanced practice
446	446	registered nurse's office and in which a pharmacy is not located.
447	447	This section does not apply to a municipality or an unincorporated
448	448	town that is adjacent to a municipality with a population of 2,500
449	449	or more.
450	450	(c) A physician who practices medicine or an advanced
451	451	practice registered nurse who is authorized to practice under
452	452	Section 301.357 and who practices advanced practice registered
453	453	nursing in an area described by Subsection (b) may:
454	454	(1) maintain a supply of dangerous drugs in the
455	455	physician's or advanced practice registered nurse's office to be
456	456	dispensed in the course of treating the physician's or advanced
457	457	practice registered nurse's patients; and
458	458	(2) be reimbursed for the cost of supplying those
459	459	drugs without obtaining a license under Chapter 558.
460	460	(d) A physician or advanced practice registered nurse who
461	461	dispenses dangerous drugs under Subsection (c) shall:
462	462	(1) comply with each labeling provision under this
463	463	subtitle applicable to that class of drugs; and
464	464	(2) oversee compliance with packaging and
465	465	recordkeeping provisions applicable to that class of drugs.
466	466	(e) A physician who desires to dispense dangerous drugs
467	467	under this section shall notify both the board and the Texas Medical
468	468	[State] Board [of Medical Examiners] that the physician practices
469	469	in an area described by Subsection (b). An advanced practice
470	470	registered nurse who desires to dispense dangerous drugs under this
471	471	section shall notify both the board and the Texas Board of Nursing
472	472	that the advanced practice registered nurse practices in an area
473	473	described by Subsection (b). The physician or advanced practice
474	474	registered nurse may continue to dispense dangerous drugs in the
475	475	area until the board determines, after notice and hearing, that the
476	476	physician or advanced practice registered nurse no longer practices
477	477	in an area described by Subsection (b).
478	478	SECTION 2.018. Section 605.002(14), Occupations Code, is
479	479	amended to read as follows:
480	480	(14) "Orthotics" means the science and practice of
481	481	measuring, designing, fabricating, assembling, fitting, adjusting,
482	482	or servicing an orthosis under an order from a licensed physician,
483	483	chiropractor, [or] podiatrist, or [an] advanced practice
484	484	registered nurse, or from an advanced practice registered nurse or
485	485	physician assistant acting under the delegation and supervision of
486	486	a licensed physician as provided by Subchapter B, Chapter 157, and
487	487	rules adopted by the Texas Medical Board, for the correction or
488	488	alleviation of a neuromuscular or musculoskeletal dysfunction,
489	489	disease, injury, or deformity.
490	490	SECTION 2.019. Section 605.2515, Occupations Code, is
491	491	amended to read as follows:
492	492	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
493	493	person licensed to practice orthotics or prosthetics who measures,
494	494	designs, fabricates, fits, assembles, adjusts, or services an
495	495	orthosis or a prosthesis under an order from a licensed physician,
496	496	chiropractor, [or] podiatrist, or [an] advanced practice
497	497	registered nurse, or from an advanced practice registered nurse or
498	498	physician assistant acting under the delegation and supervision of
499	499	a licensed physician as provided by Subchapter B, Chapter 157, and
500	500	rules adopted by the Texas Medical Board, for a specific patient is
501	501	exempt from licensing as a device manufacturer under Subchapter L,
502	502	Chapter 431, Health and Safety Code. A person licensed to practice
503	503	orthotics or prosthetics who fabricates or assembles an orthosis or
504	504	a prosthesis without an order from a licensed physician,
505	505	chiropractor, [or] podiatrist, or [an] advanced practice
506	506	registered nurse, or from an advanced practice registered nurse or
507	507	physician assistant acting under the delegation and supervision of
508	508	a licensed physician as provided by Subchapter B, Chapter 157, and
509	509	rules adopted by the Texas Medical Board, for a specific patient is
510	510	required to be licensed as a device manufacturer under Subchapter
511	511	L, Chapter 431, Health and Safety Code.
512	512	ARTICLE 3. TRANSITION; CONFLICT WITH OTHER LEGISLATION; EFFECTIVE
513	513	DATE
514	514	SECTION 3.001. (a) Notwithstanding the deadline provided
515	515	by Section 487.851, Government Code, as added by this Act, the
516	516	Office of Rural Affairs established in the Department of
517	517	Agriculture shall produce the initial list required under that
518	518	section not later than December 1, 2019. Notwithstanding the
519	519	deadline provided by Section 487.852, Government Code, as added by
520	520	this Act, a county judge may submit an initial request as provided
521	521	by that section not later than February 1, 2020.
522	522	(b) Not later than February 1, 2020, the Texas Board of
523	523	Nursing shall adopt the rules necessary to implement the changes in
524	524	law made by this Act.
525	525	SECTION 3.002. To the extent of any conflict, this Act
526	526	prevails over another Act of the 86th Legislature, Regular Session,
527	527	2019, relating to nonsubstantive additions to and corrections in
528	528	enacted codes.
529	529	SECTION 3.003. This Act takes effect September 1, 2019.