Texas 2019 - 86th Regular

Texas Senate Bill SB2438 Compare Versions

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1	1	86R5023 BEE-F
2	2	By: Rodríguez S.B. No. 2438
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the authority of certain advanced practice registered
8	8	nurses.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES
11	11	SECTION 1.001. Section 301.002, Occupations Code, is
12	12	amended by amending Subdivision (2) and adding Subdivisions (6),
13	13	(7), (8), (9), and (10) to read as follows:
14	14	(2) "Professional nursing" means the performance of an
15	15	act that requires substantial specialized judgment and skill, the
16	16	proper performance of which is based on knowledge and application
17	17	of the principles of biological, physical, and social science as
18	18	acquired by a completed course in an approved school of
19	19	professional nursing. The term does not include acts of medical
20	20	diagnosis or the prescription of therapeutic or corrective
21	21	measures, except as performed by an advanced practice registered
22	22	nurse authorized to practice by the board under Section 301.357.
23	23	Professional nursing involves:
24	24	(A) the observation, assessment, intervention,
25	25	evaluation, rehabilitation, care and counsel, or health teachings
26	26	of a person who is ill, injured, infirm, or experiencing a change in
27	27	normal health processes;
28	28	(B) the maintenance of health or prevention of
29	29	illness;
30	30	(C) the administration of a medication or
31	31	treatment as ordered by a health care practitioner legally
32	32	authorized to prescribe the medication or treatment [physician,
33	33	podiatrist, or dentist];
34	34	(D) the supervision or teaching of nursing;
35	35	(E) the administration, supervision, and
36	36	evaluation of nursing practices, policies, and procedures;
37	37	(F) the requesting, receiving, signing for, and
38	38	distribution of prescription drug samples to patients at practices
39	39	at which an advanced practice registered nurse is authorized to
40	40	sign prescription drug orders as provided by Subchapter B, Chapter
41	41	157;
42	42	(G) the performance of an act delegated by a
43	43	physician under Section 157.0512, 157.054, 157.058, or 157.059;
44	44	[and]
45	45	(H) the development of the nursing care plan; and
46	46	(I) the performance of an act by an advanced
47	47	practice registered nurse authorized to practice by the board under
48	48	Section 301.357.
49	49	(6) "Controlled substance" has the meaning assigned by
50	50	Section 481.002, Health and Safety Code.
51	51	(7) "Dangerous drug" has the meaning assigned by
52	52	Section 483.001, Health and Safety Code.
53	53	(8) "Device" has the meaning assigned by Section
54	54	551.003, and includes durable medical equipment.
55	55	(9) "Nonprescription drug" has the meaning assigned by
56	56	Section 551.003.
57	57	(10) "Prescribe or order a drug or device" has the
58	58	meaning assigned by Section 157.051.
59	59	SECTION 1.002. Section 301.152(b), Occupations Code, is
60	60	amended to read as follows:
61	61	(b) The board shall adopt rules to:
62	62	(1) license a registered nurse as an advanced practice
63	63	registered nurse;
64	64	(2) establish:
65	65	(A) any specialized education or training,
66	66	including pharmacology, that an advanced practice registered nurse
67	67	must have to prescribe or order a drug or device as delegated by a
68	68	physician under Section 157.0512 or 157.054 or authorized by the
69	69	board under Section 301.358;
70	70	(B) a system for approving an advanced practice
71	71	registered nurse to prescribe or order a drug or device as delegated
72	72	by a physician under Section 157.0512 or 157.054 or authorized by
73	73	the board under Section 301.358 on the receipt of evidence of
74	74	completing the specialized education and training requirement
75	75	under Paragraph (A); and
76	76	(C) a system for issuing a prescription
77	77	authorization number to an advanced practice registered nurse
78	78	approved under Paragraph (B); and
79	79	(3) concurrently renew any license or approval granted
80	80	to an advanced practice registered nurse under this subsection and
81	81	a license renewed by the advanced practice registered nurse under
82	82	Section 301.301.
83	83	SECTION 1.003. Subchapter H, Chapter 301, Occupations Code,
84	84	is amended by adding Sections 301.357 and 301.358 to read as
85	85	follows:
86	86	Sec. 301.357. INDEPENDENT PRACTICE BY CERTAIN ADVANCED
87	87	PRACTICE REGISTERED NURSES. (a) The board shall authorize the
88	88	practice under this section of an advanced practice registered
89	89	nurse who:
90	90	(1) is a nurse practitioner, nurse midwife, or
91	91	clinical nurse specialist;
92	92	(2) has practiced for at least 1,000 hours under the
93	93	delegation of a physician under Chapter 157; and
94	94	(3) applies for authorization under this section in
95	95	the manner prescribed by the board.
96	96	(b) The scope of practice of an advanced practice registered
97	97	nurse authorized to practice under this section includes:
98	98	(1) ordering, performing, and interpreting diagnostic
99	99	tests;
100	100	(2) formulating primary and differential medical
101	101	diagnoses and advanced assessments;
102	102	(3) treating actual and potential health problems;
103	103	(4) prescribing therapeutic and corrective measures,
104	104	including nutrition and diagnostic support services, home health
105	105	care, hospice care, physical therapy, and occupational therapy, and
106	106	delegating and assigning the performance of therapeutic and
107	107	corrective measures to assistive personnel;
108	108	(5) to the extent authorized by the board under
109	109	Section 301.358, prescribing, ordering, procuring, administering,
110	110	and dispensing drugs and devices, including blood and blood
111	111	products, controlled substances listed in Schedules II, III, IV,
112	112	and V, dangerous drugs, and nonprescription drugs;
113	113	(6) providing referrals to health care agencies,
114	114	health care providers, and community resources;
115	115	(7) serving as the primary care provider of record;
116	116	and
117	117	(8) performing other acts that require education and
118	118	training consistent with professional standards and that are
119	119	commensurate with the advanced practice registered nurse's
120	120	education, licensure, and demonstrated competencies and
121	121	experience.
122	122	(c) An advanced practice registered nurse authorized to
123	123	practice by the board under this section shall practice as a
124	124	licensed independent practitioner in accordance with standards
125	125	established and recognized by the board to protect the public
126	126	health and safety.
127	127	(d) An advanced practice registered nurse authorized to
128	128	practice by the board under this section is accountable to
129	129	patients, the nursing profession, and the board for:
130	130	(1) complying with the requirements of this chapter;
131	131	(2) providing quality advanced nursing care;
132	132	(3) recognizing the nurse's limits of knowledge;
133	133	(4) planning for the management of situations beyond
134	134	the nurse's expertise; and
135	135	(5) consulting with or referring patients to other
136	136	health care providers as appropriate.
137	137	(e) This section does not limit or modify the scope of
138	138	practice of a nurse who is not authorized to practice by the board
139	139	under this section.
140	140	(f) The board by rule shall:
141	141	(1) prescribe the application process for
142	142	authorization to practice under this section; and
143	143	(2) establish guidelines for continuing education for
144	144	advanced practice registered nurses authorized to practice under
145	145	this section, including:
146	146	(A) a requirement that the advanced practice
147	147	registered nurse complete not less than 48 hours of continuing
148	148	education in each two-year period as a condition of license
149	149	renewal; and
150	150	(B) a provision authorizing the advanced
151	151	practice registered nurse to complete up to 24 hours of the
152	152	continuing education required under Paragraph (A) through informal
153	153	self-study or attendance at hospital lectures.
154	154	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
155	155	ADVANCED PRACTICE REGISTERED NURSE. (a) The board may authorize an
156	156	advanced practice registered nurse authorized to practice by the
157	157	board under Section 301.357 to prescribe and order drugs and
158	158	devices, including controlled substances listed in Schedules III,
159	159	IV, and V, dangerous drugs, and nonprescription drugs.
160	160	(b) The board may authorize an advanced practice registered
161	161	nurse authorized to practice by the board under Section 301.357 to
162	162	prescribe and order controlled substances listed in Schedule II
163	163	only:
164	164	(1) in a hospital facility-based practice in
165	165	accordance with policies approved by the hospital's medical staff
166	166	or a committee of the hospital's medical staff as provided by the
167	167	hospital bylaws to ensure patient safety, and as part of the care
168	168	provided to a patient who:
169	169	(A) has been admitted to the hospital and is
170	170	expected to remain in the hospital for a period of 24 hours or more;
171	171	or
172	172	(B) is receiving services in the emergency
173	173	department of the hospital; or
174	174	(2) as part of the plan of care for the treatment of a
175	175	person who has executed a written certification of a terminal
176	176	illness, has elected to receive hospice care, and is receiving
177	177	hospice treatment from a qualified hospice provider.
178	178	ARTICLE 2. CONFORMING AMENDMENTS
179	179	SECTION 2.001. Section 671.001(b), Government Code, is
180	180	amended to read as follows:
181	181	(b) The pilot program must provide for the following:
182	182	(1) a licensed advanced practice registered nurse as
183	183	defined by Section 301.152, Occupations Code, or a licensed
184	184	physician assistant as described by Chapter 204, Occupations Code,
185	185	who is employed by the state or whose services are acquired by
186	186	contract, who will be located at a state office complex;
187	187	(2) if applicable, a licensed physician, who is
188	188	employed by a state governmental entity for purposes other than the
189	189	pilot program or whose services are acquired by contract, who will
190	190	delegate to and supervise the advanced practice registered nurse or
191	191	physician assistant under a prescriptive authority agreement under
192	192	Chapter 157, Occupations Code;
193	193	(3) appropriate office space and equipment for the
194	194	advanced practice registered nurse or physician assistant to
195	195	provide basic medical care to employees at the state office complex
196	196	where the nurse or physician assistant is located; and
197	197	(4) professional liability insurance covering
198	198	services provided by the advanced practice registered nurse or the
199	199	physician assistant.
200	200	SECTION 2.002. Section 481.002(39), Health and Safety Code,
201	201	is amended to read as follows:
202	202	(39) "Practitioner" means:
203	203	(A) a physician, dentist, veterinarian,
204	204	podiatrist, scientific investigator, advanced practice registered
205	205	nurse authorized to prescribe and order drugs and devices under
206	206	Section 301.358, Occupations Code, or other person licensed,
207	207	registered, or otherwise permitted to distribute, dispense,
208	208	analyze, conduct research with respect to, or administer a
209	209	controlled substance in the course of professional practice or
210	210	research in this state;
211	211	(B) a pharmacy, hospital, or other institution
212	212	licensed, registered, or otherwise permitted to distribute,
213	213	dispense, conduct research with respect to, or administer a
214	214	controlled substance in the course of professional practice or
215	215	research in this state;
216	216	(C) a person practicing in and licensed by
217	217	another state as a physician, dentist, veterinarian, advanced
218	218	practice registered nurse, or podiatrist, having a current Federal
219	219	Drug Enforcement Administration registration number, who may
220	220	legally prescribe Schedule II, III, IV, or V controlled substances
221	221	in that state; or
222	222	(D) an advanced practice registered nurse or
223	223	physician assistant to whom a physician has delegated the authority
224	224	to prescribe or order a drug or device under Section 157.0511,
225	225	157.0512, or 157.054, Occupations Code.
226	226	SECTION 2.003. Section 481.073(a), Health and Safety Code,
227	227	is amended to read as follows:
228	228	(a) Only a practitioner defined by Section 481.002(39)(A)
229	229	and an agent designated in writing by the practitioner in
230	230	accordance with rules adopted by the board may communicate a
231	231	prescription by telephone. A pharmacy that receives a
232	232	telephonically communicated prescription shall promptly write the
233	233	prescription and file and retain the prescription in the manner
234	234	required by this subchapter. A practitioner who designates an
235	235	agent to communicate prescriptions shall maintain the written
236	236	designation of the agent in the practitioner's usual place of
237	237	business and shall make the designation available for inspection by
238	238	investigators for the Texas Medical Board, the State Board of
239	239	Dental Examiners, the State Board of Veterinary Medical Examiners,
240	240	the Texas Board of Nursing, the board, and the department. A
241	241	practitioner who designates a different agent shall designate that
242	242	agent in writing and maintain the designation in the same manner in
243	243	which the practitioner initially designated an agent under this
244	244	section.
245	245	SECTION 2.004. Section 481.074(d), Health and Safety Code,
246	246	is amended to read as follows:
247	247	(d) Except as specified in Subsections (e) and (f), the
248	248	board, by rule and in consultation with the Texas Medical Board and
249	249	the Texas Board of Nursing, shall establish the period after the
250	250	date on which the prescription is issued that a person may fill a
251	251	prescription for a controlled substance listed in Schedule II. A
252	252	person may not refill a prescription for a substance listed in
253	253	Schedule II.
254	254	SECTION 2.005. Section 481.076(c), Health and Safety Code,
255	255	is amended to read as follows:
256	256	(c) The board by rule shall design and implement a system
257	257	for submission of information to the board by electronic or other
258	258	means and for retrieval of information submitted to the board under
259	259	this section and Sections 481.074 and 481.075. The board shall use
260	260	automated information security techniques and devices to preclude
261	261	improper access to the information. The board shall submit the
262	262	system design to the director, [and] the Texas Medical Board, and
263	263	the Texas Board of Nursing for review and comment a reasonable time
264	264	before implementation of the system and shall comply with the
265	265	comments of those agencies unless it is unreasonable to do so.
266	266	SECTION 2.006. Sections 483.001(4), (12), and (13), Health
267	267	and Safety Code, are amended to read as follows:
268	268	(4) "Designated agent" means:
269	269	(A) a licensed nurse, physician assistant,
270	270	pharmacist, or other individual designated by a practitioner to
271	271	communicate prescription drug orders to a pharmacist;
272	272	(B) a licensed nurse, physician assistant, or
273	273	pharmacist employed in a health care facility to whom the
274	274	practitioner communicates a prescription drug order; or
275	275	(C) an advanced practice [a] registered nurse or
276	276	physician assistant authorized by a practitioner to carry out a
277	277	prescription drug order for dangerous drugs under Subchapter B,
278	278	Chapter 157, Occupations Code.
279	279	(12) "Practitioner" means:
280	280	(A) a person licensed by:
281	281	(i) the Texas Medical Board, State Board of
282	282	Dental Examiners, [Texas State Board of Podiatric Medical
283	283	Examiners,] Texas Optometry Board, or State Board of Veterinary
284	284	Medical Examiners to prescribe and administer dangerous drugs; or
285	285	(ii) the Texas Department of Licensing and
286	286	Regulation, with respect to podiatry, to prescribe and administer
287	287	dangerous drugs;
288	288	(B) a person licensed by another state in a
289	289	health field in which, under the laws of this state, a licensee may
290	290	legally prescribe dangerous drugs;
291	291	(C) a person licensed in Canada or Mexico in a
292	292	health field in which, under the laws of this state, a licensee may
293	293	legally prescribe dangerous drugs; [or]
294	294	(D) an advanced practice registered nurse or
295	295	physician assistant to whom a physician has delegated the authority
296	296	to prescribe or order a drug or device under Section 157.0511,
297	297	157.0512, or 157.054, Occupations Code; or
298	298	(E) an advanced practice registered nurse
299	299	authorized to prescribe and order drugs and devices under Section
300	300	301.358, Occupations Code.
301	301	(13) "Prescription" means an order from a
302	302	practitioner, or an agent of the practitioner designated in writing
303	303	as authorized to communicate prescriptions, or an order made in
304	304	accordance with Subchapter B, Chapter 157, Occupations Code, or
305	305	Section 203.353, Occupations Code, to a pharmacist for a dangerous
306	306	drug to be dispensed that states:
307	307	(A) the date of the order's issue;
308	308	(B) the name and address of the patient;
309	309	(C) if the drug is prescribed for an animal, the
310	310	species of the animal;
311	311	(D) the name and quantity of the drug prescribed;
312	312	(E) the directions for the use of the drug;
313	313	(F) the intended use of the drug unless the
314	314	practitioner determines the furnishing of this information is not
315	315	in the best interest of the patient;
316	316	(G) the name, address, and telephone number of
317	317	the practitioner at the practitioner's usual place of business,
318	318	legibly printed or stamped; and
319	319	(H) the name, address, and telephone number of
320	320	the licensed midwife, advanced practice registered nurse, or
321	321	physician assistant, legibly printed or stamped, if signed by a
322	322	licensed midwife, advanced practice registered nurse, or physician
323	323	assistant.
324	324	SECTION 2.007. Section 483.042(a), Health and Safety Code,
325	325	is amended to read as follows:
326	326	(a) A person commits an offense if the person delivers or
327	327	offers to deliver a dangerous drug:
328	328	(1) unless:
329	329	(A) the dangerous drug is delivered or offered
330	330	for delivery by a pharmacist under:
331	331	(i) a prescription issued by a practitioner
332	332	described by Section 483.001(12)(A) or (B);
333	333	(ii) a prescription signed by an advanced
334	334	practice [a] registered nurse or physician assistant in accordance
335	335	with Subchapter B, Chapter 157, Occupations Code; or
336	336	(iii) an original written prescription
337	337	issued by a practitioner described by Section 483.001(12)(C); and
338	338	(B) a label is attached to the immediate
339	339	container in which the drug is delivered or offered to be delivered
340	340	and the label contains the following information:
341	341	(i) the name and address of the pharmacy
342	342	from which the drug is delivered or offered for delivery;
343	343	(ii) the date the prescription for the drug
344	344	is dispensed;
345	345	(iii) the number of the prescription as
346	346	filed in the prescription files of the pharmacy from which the
347	347	prescription is dispensed;
348	348	(iv) the name of the practitioner who
349	349	prescribed the drug and, if applicable, the name of the advanced
350	350	practice registered nurse or physician assistant who signed the
351	351	prescription;
352	352	(v) the name of the patient and, if the drug
353	353	is prescribed for an animal, a statement of the species of the
354	354	animal; and
355	355	(vi) directions for the use of the drug as
356	356	contained in the prescription; or
357	357	(2) unless:
358	358	(A) the dangerous drug is delivered or offered
359	359	for delivery by:
360	360	(i) a practitioner in the course of
361	361	practice; or
362	362	(ii) an advanced practice [a] registered
363	363	nurse or physician assistant in the course of practice in
364	364	accordance with Subchapter B, Chapter 157, Occupations Code; and
365	365	(B) a label is attached to the immediate
366	366	container in which the drug is delivered or offered to be delivered
367	367	and the label contains the following information:
368	368	(i) the name and address of the
369	369	practitioner who prescribed the drug, and if applicable, the name
370	370	and address of the advanced practice registered nurse or physician
371	371	assistant;
372	372	(ii) the date the drug is delivered;
373	373	(iii) the name of the patient and, if the
374	374	drug is prescribed for an animal, a statement of the species of the
375	375	animal; and
376	376	(iv) the name of the drug, the strength of
377	377	the drug, and directions for the use of the drug.
378	378	SECTION 2.008. Section 32.03141, Human Resources Code, is
379	379	amended to read as follows:
380	380	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
381	381	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
382	382	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
383	383	addition to other health care practitioners authorized by federal
384	384	law, the following persons may order and prescribe durable medical
385	385	equipment and supplies under the medical assistance program:
386	386	(1) an advanced practice registered nurse authorized
387	387	to prescribe and order drugs and devices under Section 301.358,
388	388	Occupations Code; and
389	389	(2) an advanced practice registered nurse or physician
390	390	assistant acting under adequate physician supervision and to whom a
391	391	physician has delegated the authority to prescribe and order drugs
392	392	and devices under Chapter 157, Occupations Code[, may order and
393	393	prescribe durable medical equipment and supplies under the medical
394	394	assistance program].
395	395	SECTION 2.009. Section 843.312, Insurance Code, is amended
396	396	to read as follows:
397	397	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
398	398	REGISTERED NURSES. (a) A health maintenance organization may not
399	399	refuse a request by a physician participating in the health
400	400	maintenance organization delivery network and a physician
401	401	assistant or advanced practice registered nurse who is authorized
402	402	by the physician to provide care under Subchapter B, Chapter 157,
403	403	Occupations Code, to identify a physician assistant or advanced
404	404	practice registered nurse as a provider in the network.
405	405	(b) A health maintenance organization may refuse a request
406	406	under Subsection (a) if the physician assistant or advanced
407	407	practice registered nurse does not meet the quality of care
408	408	standards previously established by the health maintenance
409	409	organization for participation in the network by physician
410	410	assistants and advanced practice registered nurses.
411	411	SECTION 2.010. Section 1301.001(1-a), Insurance Code, is
412	412	amended to read as follows:
413	413	(1-a) "Health care provider" means a practitioner,
414	414	institutional provider, or other person or organization that
415	415	furnishes health care services and that is licensed or otherwise
416	416	authorized to practice in this state. The term includes a
417	417	pharmacist, [and] a pharmacy, and an advanced practice registered
418	418	nurse authorized to practice under Section 301.357, Occupations
419	419	Code. The term does not include a physician.
420	420	SECTION 2.011. Section 1301.052, Insurance Code, is amended
421	421	to read as follows:
422	422	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
423	423	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
424	424	offering a preferred provider benefit plan may not refuse a request
425	425	made by a physician participating as a preferred provider under the
426	426	plan and an advanced practice registered nurse or physician
427	427	assistant to have the advanced practice registered nurse or
428	428	physician assistant included as a preferred provider under the plan
429	429	if:
430	430	(1) the advanced practice registered nurse or
431	431	physician assistant is authorized by the physician to provide care
432	432	under Subchapter B, Chapter 157, Occupations Code; and
433	433	(2) the advanced practice registered nurse or
434	434	physician assistant meets the quality of care standards previously
435	435	established by the insurer for participation in the plan by
436	436	advanced practice registered nurses and physician assistants.
437	437	SECTION 2.012. Section 1451.001(2), Insurance Code, is
438	438	amended to read as follows:
439	439	(2) "Advanced practice registered nurse" means an
440	440	individual licensed by the Texas Board of Nursing as a registered
441	441	nurse and licensed [recognized] by that board as an advanced
442	442	practice registered nurse.
443	443	SECTION 2.013. Section 1451.104(c), Insurance Code, is
444	444	amended to read as follows:
445	445	(c) Notwithstanding Subsection (a), a health insurance
446	446	policy may provide for a different amount of payment or
447	447	reimbursement for scheduled services or procedures performed by an
448	448	advanced practice registered nurse, nurse first assistant,
449	449	licensed surgical assistant, or physician assistant if the
450	450	methodology used to compute the amount is the same as the
451	451	methodology used to compute the amount of payment or reimbursement
452	452	when the services or procedures are provided by a physician.
453	453	SECTION 2.014. Section 1451.106, Insurance Code, is amended
454	454	to read as follows:
455	455	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
456	456	NURSE. An insured may select an advanced practice registered nurse
457	457	to provide the services scheduled in the health insurance policy
458	458	that are within the scope of the nurse's license.
459	459	SECTION 2.015. Section 1452.051(1), Insurance Code, is
460	460	amended to read as follows:
461	461	(1) "Advanced practice nurse" has the meaning assigned
462	462	to "advanced practice registered nurse" by Section 301.152,
463	463	Occupations Code.
464	464	SECTION 2.016. Section 301.303(b), Occupations Code, is
465	465	amended to read as follows:
466	466	(b) Except as provided by a rule adopted under Section
467	467	301.357(f), the [The] board may not require participation in more
468	468	than a total of 20 hours of continuing education in a two-year
469	469	licensing period.
470	470	SECTION 2.017. Sections 551.003(14) and (34), Occupations
471	471	Code, are amended to read as follows:
472	472	(14) "Designated agent" means:
473	473	(A) an individual, including a licensed nurse,
474	474	physician assistant, or pharmacist:
475	475	(i) who is designated by a practitioner and
476	476	authorized to communicate a prescription drug order to a
477	477	pharmacist; and
478	478	(ii) for whom the practitioner assumes
479	479	legal responsibility;
480	480	(B) a licensed nurse, physician assistant, or
481	481	pharmacist employed in a health care facility to whom a
482	482	practitioner communicates a prescription drug order; or
483	483	(C) an advanced practice [a] registered nurse or
484	484	physician assistant authorized by a practitioner to administer a
485	485	prescription drug order for a dangerous drug under Subchapter B,
486	486	Chapter 157.
487	487	(34) "Practitioner" means:
488	488	(A) a person licensed or registered to prescribe,
489	489	distribute, administer, or dispense a prescription drug or device
490	490	in the course of professional practice in this state, including a
491	491	physician, dentist, podiatrist, advanced practice registered nurse
492	492	authorized to prescribe and order drugs and devices under Section
493	493	301.358, or veterinarian but excluding a person licensed under this
494	494	subtitle;
495	495	(B) a person licensed by another state, Canada,
496	496	or the United Mexican States in a health field in which, under the
497	497	law of this state, a license holder in this state may legally
498	498	prescribe a dangerous drug;
499	499	(C) a person practicing in another state and
500	500	licensed by another state as a physician, dentist, veterinarian,
501	501	advanced practice registered nurse, or podiatrist, who has a
502	502	current federal Drug Enforcement Administration registration
503	503	number and who may legally prescribe a Schedule II, III, IV, or V
504	504	controlled substance, as specified under Chapter 481, Health and
505	505	Safety Code, in that other state; or
506	506	(D) an advanced practice registered nurse or
507	507	physician assistant to whom a physician has delegated the authority
508	508	to prescribe or order a drug or device under Section 157.0511,
509	509	157.0512, or 157.054.
510	510	SECTION 2.018. Section 563.053, Occupations Code, is
511	511	amended to read as follows:
512	512	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
513	513	RURAL AREAS. (a) In this section, "reimbursement for cost" means
514	514	an additional charge, separate from that imposed for the
515	515	physician's or advanced practice registered nurse's professional
516	516	services, that includes the cost of the drug product and all other
517	517	actual costs to the physician or advanced practice registered nurse
518	518	incidental to providing the dispensing service. The term does not
519	519	include a separate fee imposed for the act of dispensing the drug
520	520	itself.
521	521	(a-1) This section applies to an advanced practice
522	522	registered nurse only to the extent that the advanced practice
523	523	registered nurse is authorized to prescribe and order drugs and
524	524	devices under Section 301.358.
525	525	(b) This section applies to an area located in a county with
526	526	a population of 5,000 or less, or in a municipality or an
527	527	unincorporated town with a population of less than 2,500, that is
528	528	within a 15-mile radius of the physician's or advanced practice
529	529	registered nurse's office and in which a pharmacy is not located.
530	530	This section does not apply to a municipality or an unincorporated
531	531	town that is adjacent to a municipality with a population of 2,500
532	532	or more.
533	533	(c) A physician who practices medicine or an advanced
534	534	practice registered nurse who practices advanced practice
535	535	registered nursing in an area described by Subsection (b) may:
536	536	(1) maintain a supply of dangerous drugs in the
537	537	physician's or advanced practice registered nurse's office to be
538	538	dispensed in the course of treating the physician's or advanced
539	539	practice registered nurse's patients; and
540	540	(2) be reimbursed for the cost of supplying those
541	541	drugs without obtaining a license under Chapter 558.
542	542	(d) A physician or advanced practice registered nurse who
543	543	dispenses dangerous drugs under Subsection (c) shall:
544	544	(1) comply with each labeling provision under this
545	545	subtitle applicable to that class of drugs; and
546	546	(2) oversee compliance with packaging and
547	547	recordkeeping provisions applicable to that class of drugs.
548	548	(e) A physician who desires to dispense dangerous drugs
549	549	under this section shall notify both the board and the Texas Medical
550	550	[State] Board [of Medical Examiners] that the physician practices
551	551	in an area described by Subsection (b). An advanced practice
552	552	registered nurse who desires to dispense dangerous drugs under this
553	553	section shall notify both the board and the Texas Board of Nursing
554	554	that the advanced practice registered nurse practices in an area
555	555	described by Subsection (b). The physician or advanced practice
556	556	registered nurse may continue to dispense dangerous drugs in the
557	557	area until the board determines, after notice and hearing, that the
558	558	physician or advanced practice registered nurse no longer practices
559	559	in an area described by Subsection (b).
560	560	SECTION 2.019. Section 605.002(14), Occupations Code, is
561	561	amended to read as follows:
562	562	(14) "Orthotics" means the science and practice of
563	563	measuring, designing, fabricating, assembling, fitting, adjusting,
564	564	or servicing an orthosis under an order from a licensed physician,
565	565	chiropractor, [or] podiatrist, or advanced practice registered
566	566	nurse authorized to prescribe and order drugs and devices under
567	567	Section 301.358, or an advanced practice registered nurse or
568	568	physician assistant acting under the delegation and supervision of
569	569	a licensed physician as provided by Subchapter B, Chapter 157, and
570	570	rules adopted by the Texas Medical Board, for the correction or
571	571	alleviation of a neuromuscular or musculoskeletal dysfunction,
572	572	disease, injury, or deformity.
573	573	SECTION 2.020. Section 605.2515, Occupations Code, is
574	574	amended to read as follows:
575	575	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
576	576	person licensed to practice orthotics or prosthetics who measures,
577	577	designs, fabricates, fits, assembles, adjusts, or services an
578	578	orthosis or a prosthesis under an order from a licensed physician,
579	579	chiropractor, [or] podiatrist, or advanced practice registered
580	580	nurse authorized to prescribe and order drugs and devices under
581	581	Section 301.358, or an advanced practice registered nurse or
582	582	physician assistant acting under the delegation and supervision of
583	583	a licensed physician as provided by Subchapter B, Chapter 157, and
584	584	rules adopted by the Texas Medical Board, for a specific patient is
585	585	exempt from licensing as a device manufacturer under Subchapter L,
586	586	Chapter 431, Health and Safety Code. A person licensed to practice
587	587	orthotics or prosthetics who fabricates or assembles an orthosis or
588	588	a prosthesis without an order from a licensed physician,
589	589	chiropractor, [or] podiatrist, or advanced practice registered
590	590	nurse authorized to prescribe and order drugs and devices under
591	591	Section 301.358, or an advanced practice registered nurse or
592	592	physician assistant acting under the delegation and supervision of
593	593	a licensed physician as provided by Subchapter B, Chapter 157, and
594	594	rules adopted by the Texas Medical Board, for a specific patient is
595	595	required to be licensed as a device manufacturer under Subchapter
596	596	L, Chapter 431, Health and Safety Code.
597	597	ARTICLE 3. TRANSITION; CONFLICT WITH OTHER LEGISLATION; EFFECTIVE
598	598	DATE
599	599	SECTION 3.001. Not later than December 1, 2019, the Texas
600	600	Board of Nursing shall adopt the rules necessary to implement the
601	601	changes in law made by this Act.
602	602	SECTION 3.002. To the extent of any conflict, this Act
603	603	prevails over another Act of the 86th Legislature, Regular Session,
604	604	2019, relating to nonsubstantive additions to and corrections in
605	605	enacted codes.
606	606	SECTION 3.003. This Act takes effect September 1, 2019.