Texas 2019 - 86th Regular

Texas Senate Bill SB268 Compare Versions

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

Old	New	Differences
1	1	86R1543 MAW-F
2	2	By: Rodríguez S.B. No. 268
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the prescriptive authority of certain psychologists;
8	8	authorizing a fee.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 501.002, Occupations Code, is amended by
11	11	adding Subdivision (2-a) to read as follows:
12	12	(2-a) "Prescription drug" and "prescription drug
13	13	order" have the meanings assigned by Section 551.003.
14	14	SECTION 2. Section 501.003(a)(1), Occupations Code, is
15	15	amended to read as follows:
16	16	(1) "Practice of psychology" means:
17	17	(A) the observation, description, diagnosis,
18	18	evaluation, assessment, interpretation, or treatment of and
19	19	intervention in human behavior by applying education, training,
20	20	methods, and procedures for the purpose of:
21	21	(i) preventing, predicting, treating,
22	22	remediating, or eliminating:
23	23	(a) symptomatic, maladaptive, or
24	24	undesired behavior;
25	25	(b) emotional, interpersonal,
26	26	learning, substance use, neuropsychological, cognitive, or
27	27	behavioral disorders or disabilities, including those that
28	28	accompany medical problems; or
29	29	(c) mental illness;
30	30	(ii) evaluating, assessing, or
31	31	facilitating, by a license holder or a person who represents the
32	32	person to the public by a title or description of services that
33	33	includes the word "psychological," "psychologist," or
34	34	"psychology," the enhancement of individual, group, or
35	35	organizational effectiveness, including evaluating, assessing, or
36	36	facilitating:
37	37	(a) personal effectiveness;
38	38	(b) adaptive behavior;
39	39	(c) interpersonal relationships;
40	40	(d) academic, vocational, and life
41	41	adjustment;
42	42	(e) health; or
43	43	(f) individual, group, or
44	44	organizational performance;
45	45	(iii) providing psychological,
46	46	neuropsychological, and psychoeducational evaluation, therapy, and
47	47	remediation as well as counseling, psychoanalysis, psychotherapy,
48	48	hypnosis, and biofeedback; or
49	49	(iv) consulting with others, including
50	50	other mental health professionals, physicians, school personnel,
51	51	or organizations within the scope of the provider's competency and
52	52	training with respect to services provided for a specific
53	53	individual; [or]
54	54	(B) action taken under the authority granted by a
55	55	prescriptive authority certificate issued under Section 501.353;
56	56	or
57	57	(C) the supervision of an activity or service
58	58	described by Paragraph (A) or (B).
59	59	SECTION 3. Section 501.051(b), Occupations Code, is amended
60	60	to read as follows:
61	61	(b) To ensure adequate representation on the board of the
62	62	diverse fields of psychology, the governor in making appointments
63	63	under Subsection (a)(1) shall appoint:
64	64	(1) at least two members who provide psychological
65	65	services, at least one of whom holds a prescriptive authority
66	66	certificate issued under Section 501.353;
67	67	(2) at least one member who conducts research in the
68	68	field of psychology; and
69	69	(3) at least one member who teaches as a member of the
70	70	faculty of a psychological training institution.
71	71	SECTION 4. Subchapter D, Chapter 501, Occupations Code, is
72	72	amended by adding Section 501.163 to read as follows:
73	73	Sec. 501.163. ADVISORY COMMITTEE ON PRESCRIPTIVE
74	74	AUTHORITY. (a) The board shall appoint an advisory committee on
75	75	prescriptive authority for psychologists.
76	76	(a-1) Effective September 1, 2019, the advisory committee
77	77	consists of six members as follows:
78	78	(1) three members who each hold a prescriptive
79	79	authority certificate issued under Section 501.353;
80	80	(2) one member who is a psychiatrist;
81	81	(3) one member who is a pediatrician; and
82	82	(4) one member who represents the public.
83	83	(a-2) This subsection and Subsection (a-1) expire September
84	84	1, 2022.
85	85	(b) Effective September 1, 2022, the advisory committee
86	86	consists of six members as follows:
87	87	(1) five members who each hold a prescriptive
88	88	authority certificate issued under Section 501.353; and
89	89	(2) one member who represents the public.
90	90	(c) The advisory committee shall make recommendations to
91	91	the board regarding the regulation of psychologists who hold
92	92	prescriptive authority certificates issued under Section 501.353,
93	93	including recommendations concerning board rules to establish:
94	94	(1) eligibility requirements; and
95	95	(2) standards of practice for certificate holders.
96	96	(d) Chapter 2110, Government Code, does not apply to the
97	97	composition or duration of the advisory committee.
98	98	SECTION 5. Section 501.304, Occupations Code, is amended by
99	99	adding Subsection (a-1) to read as follows:
100	100	(a-1) The rules adopted under Subsection (a) must require
101	101	that, of the minimum number of hours of continuing education
102	102	required to renew a license as a psychologist, half of that number
103	103	of hours or 10 hours, whichever is less, must be in the areas of
104	104	pharmacology and pathophysiology if the psychologist holds a
105	105	prescriptive authority certificate.
106	106	SECTION 6. Subchapter H, Chapter 501, Occupations Code, is
107	107	amended by adding Sections 501.353 and 501.354 to read as follows:
108	108	Sec. 501.353. PRESCRIPTIVE AUTHORITY CERTIFICATE. (a) The
109	109	board shall issue a prescriptive authority certificate to a
110	110	psychologist who:
111	111	(1) meets the eligibility requirements of Subsection
112	112	(b);
113	113	(2) submits an application on a form prescribed by the
114	114	board;
115	115	(3) has not, in the two-year period preceding the date
116	116	of the application, had a prescriptive authority certificate
117	117	revoked; and
118	118	(4) pays the fee set by the board.
119	119	(b) To be eligible for a prescriptive authority certificate
120	120	a psychologist must:
121	121	(1) have completed a training program in
122	122	psychopharmacology from an institution of higher education or a
123	123	provider of continuing education approved by the board that
124	124	includes instruction in:
125	125	(A) basic life sciences;
126	126	(B) neuroscience;
127	127	(C) clinical and research pharmacology and
128	128	psychopharmacology;
129	129	(D) clinical pathophysiology;
130	130	(E) physical assessments and laboratory
131	131	examinations;
132	132	(F) clinical pharmacotherapeutics; and
133	133	(G) ethical and legal issues relevant to
134	134	prescriptive authority and associated research;
135	135	(2) pass a nationally recognized examination approved
136	136	by the board in the area of prescriptive authority; and
137	137	(3) provide evidence of professional liability
138	138	coverage.
139	139	(c) A psychologist who holds a prescriptive authority
140	140	certificate is authorized to:
141	141	(1) issue a prescription drug order;
142	142	(2) administer or dispense a prescription drug;
143	143	(3) order tests commonly associated with monitoring
144	144	the use of prescription drugs; and
145	145	(4) represent that the psychologist holds a
146	146	prescriptive authority certificate.
147	147	(d) The authority of a psychologist to issue a prescription
148	148	drug order or administer or dispense a prescription drug under a
149	149	prescriptive authority certificate is limited to a drug or device
150	150	related to the diagnosis, treatment, or management of emotional,
151	151	interpersonal, learning, substance use, neuropsychological,
152	152	cognitive, or behavioral disorders or disabilities, or mental
153	153	illness. A prescriptive authority certificate does not authorize
154	154	the prescribing, administering, or dispensing of an opioid.
155	155	(e) A psychologist who holds a prescriptive authority
156	156	certificate may only practice under the supervision of a physician
157	157	or a psychologist who meets the requirements of Section 501.354
158	158	until the certificate holder satisfies the supervised experience
159	159	requirement of that section.
160	160	(f) The board shall adopt rules to protect the health of
161	161	patients by requiring a psychologist who holds a prescriptive
162	162	authority certificate to notify a patient's primary care physician
163	163	or provider, if any, before the psychologist:
164	164	(1) issues a prescription drug order for a drug or
165	165	otherwise changes the type or dosage of any drug prescribed for the
166	166	patient; or
167	167	(2) administers or dispenses a prescription drug to
168	168	the patient.
169	169	(g) A primary care provider is not liable for an act of a
170	170	psychologist acting under a prescriptive authority certificate
171	171	based solely on the provider receiving a notification under
172	172	Subsection (f).
173	173	Sec. 501.354. REQUIRED SUPERVISED EXPERIENCE FOR
174	174	PRESCRIPTIVE AUTHORITY CERTIFICATE HOLDER. (a) Not later than the
175	175	second anniversary of the date of issuance of a prescriptive
176	176	authority certificate, the psychologist who holds the certificate
177	177	must complete at least 2,000 hours of practice under the authority
178	178	of the certificate treating not less than 100 patients under the
179	179	supervision of a physician or a psychologist who has maintained a
180	180	prescriptive authority certificate for the three years preceding
181	181	the date the supervision began. The supervision must be under a
182	182	written agreement approved by the board that requires periodic
183	183	meetings between the psychologist and supervising provider.
184	184	(b) A physician or psychologist may not at any time
185	185	supervise under this section more than the full-time equivalent of
186	186	seven psychologists.
187	187	(c) Unless the supervising provider has reason to believe
188	188	the psychologist lacked the competency to perform the act, a
189	189	supervising provider is not liable for an act of a psychologist
190	190	solely because the provider entered into an agreement to supervise
191	191	the psychologist.
192	192	(d) The board shall revoke the prescriptive authority
193	193	certificate of a psychologist who does not complete the supervised
194	194	experience as required by Subsection (a).
195	195	SECTION 7. Section 481.002(39), Health and Safety Code, is
196	196	amended to read as follows:
197	197	(39) "Practitioner" means:
198	198	(A) a physician, dentist, veterinarian,
199	199	podiatrist, scientific investigator, psychologist, or other person
200	200	licensed, registered, or otherwise permitted to distribute,
201	201	dispense, analyze, conduct research with respect to, or administer
202	202	a controlled substance in the course of professional practice or
203	203	research in this state;
204	204	(B) a pharmacy, hospital, or other institution
205	205	licensed, registered, or otherwise permitted to distribute,
206	206	dispense, conduct research with respect to, or administer a
207	207	controlled substance in the course of professional practice or
208	208	research in this state;
209	209	(C) a person practicing in and licensed by
210	210	another state as a physician, dentist, veterinarian, psychologist,
211	211	or podiatrist, having a current Federal Drug Enforcement
212	212	Administration registration number, who may legally prescribe
213	213	Schedule II, III, IV, or V controlled substances in that state; or
214	214	(D) an advanced practice registered nurse or
215	215	physician assistant to whom a physician has delegated the authority
216	216	to prescribe or order a drug or device under Section 157.0511,
217	217	157.0512, or 157.054, Occupations Code.
218	218	SECTION 8. Section 481.073(a), Health and Safety Code, is
219	219	amended to read as follows:
220	220	(a) Only a practitioner defined by Section 481.002(39)(A)
221	221	and an agent designated in writing by the practitioner in
222	222	accordance with rules adopted by the board may communicate a
223	223	prescription by telephone. A pharmacy that receives a
224	224	telephonically communicated prescription shall promptly write the
225	225	prescription and file and retain the prescription in the manner
226	226	required by this subchapter. A practitioner who designates an
227	227	agent to communicate prescriptions shall maintain the written
228	228	designation of the agent in the practitioner's usual place of
229	229	business and shall make the designation available for inspection by
230	230	investigators for the Texas Medical Board, the State Board of
231	231	Dental Examiners, the State Board of Veterinary Medical Examiners,
232	232	the Texas State Board of Examiners of Psychologists, the board, and
233	233	the department. A practitioner who designates a different agent
234	234	shall designate that agent in writing and maintain the designation
235	235	in the same manner in which the practitioner initially designated
236	236	an agent under this section.
237	237	SECTION 9. Section 481.074(d), Health and Safety Code, is
238	238	amended to read as follows:
239	239	(d) Except as specified in Subsections (e) and (f), the
240	240	board, by rule and in consultation with the Texas Medical Board and
241	241	the Texas State Board of Examiners of Psychologists, shall
242	242	establish the period after the date on which the prescription is
243	243	issued that a person may fill a prescription for a controlled
244	244	substance listed in Schedule II. A person may not refill a
245	245	prescription for a substance listed in Schedule II.
246	246	SECTION 10. Sections 481.076(a) and (c), Health and Safety
247	247	Code, are amended to read as follows:
248	248	(a) The board may not permit any person to have access to
249	249	information submitted to the board under Section 481.074(q) or
250	250	481.075 except:
251	251	(1) the board, the Texas Medical Board, the Texas
252	252	Department of Licensing and Regulation [State Board of Podiatric
253	253	Medical Examiners], the State Board of Dental Examiners, the State
254	254	Board of Veterinary Medical Examiners, the Texas Board of Nursing,
255	255	[or] the Texas Optometry Board, or the Texas State Board of
256	256	Examiners of Psychologists for the purpose of:
257	257	(A) investigating a specific license holder; or
258	258	(B) monitoring for potentially harmful
259	259	prescribing or dispensing patterns or practices under Section
260	260	481.0762;
261	261	(2) an authorized officer or member of the department
262	262	or authorized employee of the board engaged in the administration,
263	263	investigation, or enforcement of this chapter or another law
264	264	governing illicit drugs in this state or another state;
265	265	(3) the department on behalf of a law enforcement or
266	266	prosecutorial official engaged in the administration,
267	267	investigation, or enforcement of this chapter or another law
268	268	governing illicit drugs in this state or another state;
269	269	(4) a medical examiner conducting an investigation;
270	270	(5) provided that accessing the information is
271	271	authorized under the Health Insurance Portability and
272	272	Accountability Act of 1996 (Pub. L. No. 104-191) and regulations
273	273	adopted under that Act:
274	274	(A) a pharmacist or a pharmacy technician, as
275	275	defined by Section 551.003, Occupations Code, acting at the
276	276	direction of a pharmacist; or
277	277	(B) a practitioner who:
278	278	(i) is a physician, dentist, veterinarian,
279	279	podiatrist, optometrist, psychologist, or advanced practice nurse
280	280	or is a physician assistant described by Section 481.002(39)(D) or
281	281	an employee or other agent of a practitioner acting at the direction
282	282	of a practitioner; and
283	283	(ii) is inquiring about a recent Schedule
284	284	II, III, IV, or V prescription history of a particular patient of
285	285	the practitioner;
286	286	(6) a pharmacist or practitioner who is inquiring
287	287	about the person's own dispensing or prescribing activity; or
288	288	(7) one or more states or an association of states with
289	289	which the board has an interoperability agreement, as provided by
290	290	Subsection (j).
291	291	(c) The board by rule shall design and implement a system
292	292	for submission of information to the board by electronic or other
293	293	means and for retrieval of information submitted to the board under
294	294	this section and Sections 481.074 and 481.075. The board shall use
295	295	automated information security techniques and devices to preclude
296	296	improper access to the information. The board shall submit the
297	297	system design to the director, [and] the Texas Medical Board, and
298	298	the Texas State Board of Examiners of Psychologists for review and
299	299	comment a reasonable time before implementation of the system and
300	300	shall comply with the comments of those agencies unless it is
301	301	unreasonable to do so.
302	302	SECTION 11. Section 483.001(12), Health and Safety Code, is
303	303	amended to read as follows:
304	304	(12) "Practitioner" means:
305	305	(A) a person:
306	306	(i) licensed or certified by the Texas
307	307	Medical Board, State Board of Dental Examiners, [Texas State Board
308	308	of Podiatric Medical Examiners,] Texas Optometry Board, Texas State
309	309	Board of Examiners of Psychologists, or State Board of Veterinary
310	310	Medical Examiners to prescribe and administer dangerous drugs; or
311	311	(ii) licensed by the Texas Department of
312	312	Licensing and Regulation, with respect to podiatry, to prescribe
313	313	and administer dangerous drugs;
314	314	(B) a person licensed by another state in a
315	315	health field in which, under the laws of this state, a licensee may
316	316	legally prescribe dangerous drugs;
317	317	(C) a person licensed in Canada or Mexico in a
318	318	health field in which, under the laws of this state, a licensee may
319	319	legally prescribe dangerous drugs; or
320	320	(D) an advanced practice registered nurse or
321	321	physician assistant to whom a physician has delegated the authority
322	322	to prescribe or order a drug or device under Section 157.0511,
323	323	157.0512, or 157.054, Occupations Code.
324	324	SECTION 12. Sections 576.025(b), (c), (e), and (f), Health
325	325	and Safety Code, are amended to read as follows:
326	326	(b) Consent to the administration of psychoactive
327	327	medication given by a patient or by a person authorized by law to
328	328	consent on behalf of the patient is valid only if:
329	329	(1) the consent is given voluntarily and without
330	330	coercive or undue influence;
331	331	(2) the treating physician, a treating psychologist
332	332	who holds a prescriptive authority certificate, or a person
333	333	designated by the physician or psychologist, provided the following
334	334	information, in a standard format approved by the department, to
335	335	the patient and, if applicable, to the patient's representative
336	336	authorized by law to consent on behalf of the patient:
337	337	(A) the specific condition to be treated;
338	338	(B) the beneficial effects on that condition
339	339	expected from the medication;
340	340	(C) the probable health and mental health
341	341	consequences of not consenting to the medication;
342	342	(D) the probable clinically significant side
343	343	effects and risks associated with the medication;
344	344	(E) the generally accepted alternatives to the
345	345	medication, if any, and why the physician or psychologist
346	346	recommends that they be rejected; and
347	347	(F) the proposed course of the medication;
348	348	(3) the patient and, if appropriate, the patient's
349	349	representative authorized by law to consent on behalf of the
350	350	patient is informed in writing that consent may be revoked; and
351	351	(4) the consent is evidenced in the patient's clinical
352	352	record by a signed form prescribed by the facility or by a statement
353	353	of the [treating] physician or psychologist described by
354	354	Subdivision (2), or a person designated by the physician or the
355	355	psychologist, that documents that consent was given by the
356	356	appropriate person and the circumstances under which the consent
357	357	was obtained.
358	358	(c) If the [treating] physician or psychologist described
359	359	by Subsection (b)(2) designates another person to provide the
360	360	information under Subsection (b), then, not later than two working
361	361	days after that person provides the information, excluding weekends
362	362	and legal holidays, the physician or psychologist shall meet with
363	363	the patient and, if appropriate, the patient's representative who
364	364	provided the consent, to review the information and answer any
365	365	questions.
366	366	(e) In prescribing psychoactive medication, a [treating]
367	367	physician or psychologist described by Subsection (b)(2) shall:
368	368	(1) prescribe, consistent with clinically appropriate
369	369	medical care, the medication that has the fewest side effects or the
370	370	least potential for adverse side effects, unless the class of
371	371	medication has been demonstrated or justified not to be effective
372	372	clinically; and
373	373	(2) administer the smallest therapeutically
374	374	acceptable dosages of medication for the patient's condition.
375	375	(f) If a physician or psychologist described by Subsection
376	376	(b)(2) issues an order to administer psychoactive medication to a
377	377	patient without the patient's consent because the patient is having
378	378	a medication-related emergency:
379	379	(1) the physician or psychologist shall document in
380	380	the patient's clinical record in specific medical or behavioral
381	381	terms the necessity of the order and that the physician or
382	382	psychologist has evaluated but rejected other generally accepted,
383	383	less intrusive forms of treatment, if any; and
384	384	(2) treatment of the patient with the psychoactive
385	385	medication shall be provided in the manner, consistent with
386	386	clinically appropriate medical care, least restrictive of the
387	387	patient's personal liberty.
388	388	SECTION 13. Section 301.002(2), Occupations Code, is
389	389	amended to read as follows:
390	390	(2) "Professional nursing" means the performance of an
391	391	act that requires substantial specialized judgment and skill, the
392	392	proper performance of which is based on knowledge and application
393	393	of the principles of biological, physical, and social science as
394	394	acquired by a completed course in an approved school of
395	395	professional nursing. The term does not include acts of medical
396	396	diagnosis or the prescription of therapeutic or corrective
397	397	measures. Professional nursing involves:
398	398	(A) the observation, assessment, intervention,
399	399	evaluation, rehabilitation, care and counsel, or health teachings
400	400	of a person who is ill, injured, infirm, or experiencing a change in
401	401	normal health processes;
402	402	(B) the maintenance of health or prevention of
403	403	illness;
404	404	(C) the administration of a medication or
405	405	treatment as ordered by a health care practitioner legally
406	406	authorized to prescribe the medication or treatment [physician,
407	407	podiatrist, or dentist];
408	408	(D) the supervision or teaching of nursing;
409	409	(E) the administration, supervision, and
410	410	evaluation of nursing practices, policies, and procedures;
411	411	(F) the requesting, receiving, signing for, and
412	412	distribution of prescription drug samples to patients at practices
413	413	at which an advanced practice registered nurse is authorized to
414	414	sign prescription drug orders as provided by Subchapter B, Chapter
415	415	157;
416	416	(G) the performance of an act delegated by a
417	417	physician under Section 157.0512, 157.054, 157.058, or 157.059; and
418	418	(H) the development of the nursing care plan.
419	419	SECTION 14. Section 551.003(34), Occupations Code, is
420	420	amended to read as follows:
421	421	(34) "Practitioner" means:
422	422	(A) a person licensed, certified, or registered
423	423	to prescribe, distribute, administer, or dispense a prescription
424	424	drug or device in the course of professional practice in this state,
425	425	including a physician, dentist, podiatrist, psychologist, or
426	426	veterinarian but excluding a person licensed under this subtitle;
427	427	(B) a person licensed by another state, Canada,
428	428	or the United Mexican States in a health field in which, under the
429	429	law of this state, a license or certificate holder in this state may
430	430	legally prescribe a dangerous drug;
431	431	(C) a person practicing in another state and
432	432	licensed by another state as a physician, dentist, veterinarian,
433	433	psychologist, or podiatrist, who has a current federal Drug
434	434	Enforcement Administration registration number and who may legally
435	435	prescribe a Schedule II, III, IV, or V controlled substance, as
436	436	specified under Chapter 481, Health and Safety Code, in that other
437	437	state; or
438	438	(D) an advanced practice registered nurse or
439	439	physician assistant to whom a physician has delegated the authority
440	440	to prescribe or order a drug or device under Section 157.0511,
441	441	157.0512, or 157.054.
442	442	SECTION 15. Section 501.051(b), Occupations Code, as
443	443	amended by this Act, does not affect the entitlement of a member
444	444	serving on the Texas State Board of Examiners of Psychologists
445	445	immediately before the effective date of this Act to continue to
446	446	serve for the remainder of the member's term. With the first
447	447	appointment of a member described by Section 501.051(a)(1),
448	448	Occupations Code, to be made by the governor on or after the
449	449	effective date of this Act, the governor shall appoint a member to
450	450	the board who has the qualifications required by Section
451	451	501.051(b), Occupations Code, as amended by this Act.
452	452	SECTION 16. (a) Not later than December 1, 2019, the Texas
453	453	State Board of Examiners of Psychologists shall appoint members of
454	454	the advisory committee in accordance with Section 501.163(a-1),
455	455	Occupations Code, as added by this Act.
456	456	(b) Not later than June 1, 2020, the advisory committee
457	457	shall make initial recommendations to the Texas State Board of
458	458	Examiners of Psychologists as described by Section 501.163(c),
459	459	Occupations Code, as added by this Act.
460	460	(c) Not later than December 1, 2022, the Texas State Board
461	461	of Examiners of Psychologists shall appoint members to the advisory
462	462	committee so that the composition of the committee complies with
463	463	Section 501.163(b), Occupations Code, as added by this Act.
464	464	SECTION 17. Not later than September 1, 2020, the Texas
465	465	State Board of Examiners of Psychologists shall adopt rules and
466	466	procedures necessary to implement Sections 501.353 and 501.354,
467	467	Occupations Code, as added by this Act.
468	468	SECTION 18. This Act takes effect September 1, 2019.