By: Goodwin H.B. No. 1462
A BILL TO BE ENTITLED
AN ACT
relating to the prescriptive authority of certain psychologists;
authorizing a fee.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 501.002, Occupations Code, is amended by
adding Subdivision (2-a) to read as follows:
(2-a) "Prescription drug" and "prescription drug
order" have the meanings assigned by Section 551.003.
SECTION 2. Section 501.003(a)(1), Occupations Code, is
amended to read as follows:
(1) "Practice of psychology" means:
(A) the observation, description, diagnosis,
evaluation, assessment, interpretation, or treatment of and
intervention in human behavior by applying education, training,
methods, and procedures for the purpose of:
(i) preventing, predicting, treating,
remediating, or eliminating:
(a) symptomatic, maladaptive, or
undesired behavior;
(b) emotional, interpersonal,
learning, substance use, neuropsychological, cognitive, or
behavioral disorders or disabilities, including those that
accompany medical problems; or
(c) mental illness;
(ii) evaluating, assessing, or
facilitating, by a license holder or a person who represents the
person to the public by a title or description of services that
includes the word "psychological," "psychologist," or
"psychology," the enhancement of individual, group, or
organizational effectiveness, including evaluating, assessing, or
facilitating:
(a) personal effectiveness;
(b) adaptive behavior;
(c) interpersonal relationships;
(d) academic, vocational, and life
adjustment;
(e) health; or
(f) individual, group, or
organizational performance;
(iii) providing psychological,
neuropsychological, and psychoeducational evaluation, therapy, and
remediation as well as counseling, psychoanalysis, psychotherapy,
hypnosis, and biofeedback; or
(iv) consulting with others, including
other mental health professionals, physicians, school personnel,
or organizations within the scope of the provider's competency and
training with respect to services provided for a specific
individual; [or]
(B) action taken under the authority granted by a
prescriptive authority certificate issued under Section 501.353;
or
(C) the supervision of an activity or service
described by Paragraph (A) or (B).
SECTION 3. Section 501.051(b), Occupations Code, is amended
to read as follows:
(b) To ensure adequate representation on the board of the
diverse fields of psychology, the governor in making appointments
under Subsection (a)(1) shall appoint:
(1) at least two members who provide psychological
services, at least one of whom holds a prescriptive authority
certificate issued under Section 501.353;
(2) at least one member who conducts research in the
field of psychology; and
(3) at least one member who teaches as a member of the
faculty of a psychological training institution.
SECTION 4. Subchapter D, Chapter 501, Occupations Code, is
amended by adding Section 501.163 to read as follows:
Sec. 501.163. ADVISORY COMMITTEE ON PRESCRIPTIVE
AUTHORITY. (a) The board shall appoint an advisory committee on
prescriptive authority for psychologists.
(a-1) Effective September 1, 2021, the advisory committee
consists of six members as follows:
(1) three members who each hold a prescriptive
authority certificate issued under Section 501.353;
(2) one member who is a psychiatrist;
(3) one member who is a pediatrician; and
(4) one member who represents the public.
(a-2) This subsection and Subsection (a-1) expire September
1, 2022.
(b) Effective September 1, 2022, the advisory committee
consists of six members as follows:
(1) five members who each hold a prescriptive
authority certificate issued under Section 501.353; and
(2) one member who represents the public.
(c) The advisory committee shall make recommendations to
the board regarding the regulation of psychologists who hold
prescriptive authority certificates issued under Section 501.353,
including recommendations concerning board rules to establish:
(1) eligibility requirements; and
(2) standards of practice for certificate holders.
(d) Chapter 2110, Government Code, does not apply to the
composition or duration of the advisory committee.
SECTION 5. Section 507.157, Occupations Code, is amended by
adding Subsection (b) to read as follows:
(b) The rules adopted under Subsection (a) must require
that, of the minimum number of hours of continuing education
required to renew a license as a psychologist, half of that number
of hours or 10 hours, whichever is less, must be in the areas of
pharmacology and pathophysiology if the psychologist holds a
prescriptive authority certificate.
SECTION 6. Subchapter H, Chapter 501, Occupations Code, is
amended by adding Sections 501.353 and 501.354 to read as follows:
Sec. 501.353. PRESCRIPTIVE AUTHORITY CERTIFICATE. (a) The
board shall issue a prescriptive authority certificate to a
psychologist who:
(1) meets the eligibility requirements of Subsection
(b);
(2) submits an application on a form prescribed by the
board;
(3) has not, in the two-year period preceding the date
of the application, had a prescriptive authority certificate
revoked; and
(4) pays the fee set by the board.
(b) To be eligible for a prescriptive authority certificate
a psychologist must:
(1) have completed a training program in
psychopharmacology from an institution of higher education or a
provider of continuing education approved by the board that
includes instruction in:
(A) basic life sciences;
(B) neuroscience;
(C) clinical and research pharmacology and
psychopharmacology;
(D) clinical pathophysiology;
(E) physical assessments and laboratory
examinations;
(F) clinical pharmacotherapeutics; and
(G) ethical and legal issues relevant to
prescriptive authority and associated research;
(2) pass a nationally recognized examination approved
by the board in the area of prescriptive authority; and
(3) provide evidence of professional liability
coverage.
(c) A psychologist who holds a prescriptive authority
certificate is authorized to:
(1) issue a prescription drug order;
(2) administer or dispense a prescription drug;
(3) order tests commonly associated with monitoring
the use of prescription drugs; and
(4) represent that the psychologist holds a
prescriptive authority certificate.
(d) The authority of a psychologist to issue a prescription
drug order or administer or dispense a prescription drug under a
prescriptive authority certificate is limited to a drug or device
related to the diagnosis, treatment, or management of emotional,
interpersonal, learning, substance use, neuropsychological,
cognitive, or behavioral disorders or disabilities, or mental
illness. A prescriptive authority certificate does not authorize
the prescribing, administering, or dispensing of an opioid.
(e) A psychologist who holds a prescriptive authority
certificate may only practice under the supervision of a physician
or a psychologist who meets the requirements of Section 501.354
until the certificate holder satisfies the supervised experience
requirement of that section.
(f) The board shall adopt rules to protect the health of
patients by requiring a psychologist who holds a prescriptive
authority certificate to notify a patient's primary care physician
or provider, if any, before the psychologist:
(1) issues a prescription drug order for a drug or
otherwise changes the type or dosage of any drug prescribed for the
patient; or
(2) administers or dispenses a prescription drug to
the patient.
(g) A primary care provider is not liable for an act of a
psychologist acting under a prescriptive authority certificate
based solely on the provider receiving a notification under
Subsection (f).
Sec. 501.354. REQUIRED SUPERVISED EXPERIENCE FOR
PRESCRIPTIVE AUTHORITY CERTIFICATE HOLDER. (a) Not later than the
second anniversary of the date of issuance of a prescriptive
authority certificate, the psychologist who holds the certificate
must complete at least 2,000 hours of practice under the authority
of the certificate treating not less than 100 patients under the
supervision of a physician or a psychologist who has maintained a
prescriptive authority certificate for the three years preceding
the date the supervision began. The supervision must be under a
written agreement approved by the board that requires periodic
meetings between the psychologist and supervising provider.
(b) A physician or psychologist may not at any time
supervise under this section more than the full-time equivalent of
seven psychologists.
(c) Unless the supervising provider has reason to believe
the psychologist lacked the competency to perform the act, a
supervising provider is not liable for an act of a psychologist
solely because the provider entered into an agreement to supervise
the psychologist.
(d) The board shall revoke the prescriptive authority
certificate of a psychologist who does not complete the supervised
experience as required by Subsection (a).
SECTION 7. Section 481.002(39), Health and Safety Code, is
amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, psychologist, or other person
licensed, registered, or otherwise permitted to distribute,
dispense, analyze, conduct research with respect to, or administer
a controlled substance in the course of professional practice or
research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, psychologist,
or podiatrist, having a current Federal Drug Enforcement
Administration registration number, who may legally prescribe
Schedule II, III, IV, or V controlled substances in that state; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
SECTION 8. Section 481.073(a), Health and Safety Code, is
amended to read as follows:
(a) Only a practitioner defined by Section 481.002(39)(A)
and an agent designated in writing by the practitioner in
accordance with rules adopted by the board may communicate a
prescription by telephone. A pharmacy that receives a
telephonically communicated prescription shall promptly write the
prescription and file and retain the prescription in the manner
required by this subchapter. A practitioner who designates an
agent to communicate prescriptions shall maintain the written
designation of the agent in the practitioner's usual place of
business and shall make the designation available for inspection by
investigators for the Texas Medical Board, the State Board of
Dental Examiners, the State Board of Veterinary Medical Examiners,
the Texas State Board of Examiners of Psychologists, the board, and
the department. A practitioner who designates a different agent
shall designate that agent in writing and maintain the designation
in the same manner in which the practitioner initially designated
an agent under this section.
SECTION 9. Section 481.074(d), Health and Safety Code, is
amended to read as follows:
(d) Except as specified in Subsections (e) and (f), the
board, by rule and in consultation with the Texas Medical Board and
the Texas State Board of Examiners of Psychologists, shall
establish the period after the date on which the prescription is
issued that a person may fill a prescription for a controlled
substance listed in Schedule II. A person may not refill a
prescription for a substance listed in Schedule II.
SECTION 10. Sections 481.076(a) and (c), Health and Safety
Code, are amended to read as follows:
(a) The board may not permit any person to have access to
information submitted to the board under Section 481.074(q) or
481.075 except:
(1) the board, the Texas Medical Board, the Texas
Department of Licensing and Regulation [State Board of Podiatric
Medical Examiners], the State Board of Dental Examiners, the State
Board of Veterinary Medical Examiners, the Texas Board of Nursing,
[or] the Texas Optometry Board, or the Texas State Board of
Examiners of Psychologists for the purpose of:
(A) investigating a specific license holder; or
(B) monitoring for potentially harmful
prescribing or dispensing patterns or practices under Section
481.0762;
(2) an authorized officer or member of the department
or authorized employee of the board engaged in the administration,
investigation, or enforcement of this chapter or another law
governing illicit drugs in this state or another state;
(3) the department on behalf of a law enforcement or
prosecutorial official engaged in the administration,
investigation, or enforcement of this chapter or another law
governing illicit drugs in this state or another state;
(4) a medical examiner conducting an investigation;
(5) provided that accessing the information is
authorized under the Health Insurance Portability and
Accountability Act of 1996 (Pub. L. No. 104-191) and regulations
adopted under that Act:
(A) a pharmacist or a pharmacy technician, as
defined by Section 551.003, Occupations Code, acting at the
direction of a pharmacist; or
(B) a practitioner who:
(i) is a physician, dentist, veterinarian,
podiatrist, optometrist, psychologist, or advanced practice nurse
or is a physician assistant described by Section 481.002(39)(D) or
an employee or other agent of a practitioner acting at the direction
of a practitioner; and
(ii) is inquiring about a recent Schedule
II, III, IV, or V prescription history of a particular patient of
the practitioner;
(6) a pharmacist or practitioner who is inquiring
about the person's own dispensing or prescribing activity; or
(7) one or more states or an association of states with
which the board has an interoperability agreement, as provided by
Subsection (j).
(c) The board by rule shall design and implement a system
for submission of information to the board by electronic or other
means and for retrieval of information submitted to the board under
this section and Sections 481.074 and 481.075. The board shall use
automated information security techniques and devices to preclude
improper access to the information. The board shall submit the
system design to the director, [and] the Texas Medical Board, and
the Texas State Board of Examiners of Psychologists for review and
comment a reasonable time before implementation of the system and
shall comply with the comments of those agencies unless it is
unreasonable to do so.
SECTION 11. Section 483.001(12), Health and Safety Code, is
amended to read as follows:
(12) "Practitioner" means:
(A) a person:
(i) licensed or certified by the Texas
Medical Board, State Board of Dental Examiners, [Texas State Board
of Podiatric Medical Examiners,] Texas Optometry Board, Texas State
Board of Examiners of Psychologists, or State Board of Veterinary
Medical Examiners to prescribe and administer dangerous drugs; or
(ii) licensed by the Texas Department of
Licensing and Regulation, with respect to podiatry, to prescribe
and administer dangerous drugs;
(B) a person licensed by another state in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs;
(C) a person licensed in Canada or Mexico in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
SECTION 12. Sections 576.025(b), (c), (e), and (f), Health
and Safety Code, are amended to read as follows:
(b) Consent to the administration of psychoactive
medication given by a patient or by a person authorized by law to
consent on behalf of the patient is valid only if:
(1) the consent is given voluntarily and without
coercive or undue influence;
(2) the treating physician, a treating psychologist
who holds a prescriptive authority certificate, or a person
designated by the physician or psychologist, provided the following
information, in a standard format approved by the department, to
the patient and, if applicable, to the patient's representative
authorized by law to consent on behalf of the patient:
(A) the specific condition to be treated;
(B) the beneficial effects on that condition
expected from the medication;
(C) the probable health and mental health
consequences of not consenting to the medication;
(D) the probable clinically significant side
effects and risks associated with the medication;
(E) the generally accepted alternatives to the
medication, if any, and why the physician or psychologist
recommends that they be rejected; and
(F) the proposed course of the medication;
(3) the patient and, if appropriate, the patient's
representative authorized by law to consent on behalf of the
patient is informed in writing that consent may be revoked; and
(4) the consent is evidenced in the patient's clinical
record by a signed form prescribed by the facility or by a statement
of the [treating] physician or psychologist described by
Subdivision (2), or a person designated by the physician or the
psychologist, that documents that consent was given by the
appropriate person and the circumstances under which the consent
was obtained.
(c) If the [treating] physician or psychologist described
by Subsection (b)(2) designates another person to provide the
information under Subsection (b), then, not later than two working
days after that person provides the information, excluding weekends
and legal holidays, the physician or psychologist shall meet with
the patient and, if appropriate, the patient's representative who
provided the consent, to review the information and answer any
questions.
(e) In prescribing psychoactive medication, a [treating]
physician or psychologist described by Subsection (b)(2) shall:
(1) prescribe, consistent with clinically appropriate
medical care, the medication that has the fewest side effects or the
least potential for adverse side effects, unless the class of
medication has been demonstrated or justified not to be effective
clinically; and
(2) administer the smallest therapeutically
acceptable dosages of medication for the patient's condition.
(f) If a physician or psychologist described by Subsection
(b)(2) issues an order to administer psychoactive medication to a
patient without the patient's consent because the patient is having
a medication-related emergency:
(1) the physician or psychologist shall document in
the patient's clinical record in specific medical or behavioral
terms the necessity of the order and that the physician or
psychologist has evaluated but rejected other generally accepted,
less intrusive forms of treatment, if any; and
(2) treatment of the patient with the psychoactive
medication shall be provided in the manner, consistent with
clinically appropriate medical care, least restrictive of the
patient's personal liberty.
SECTION 13. Section 301.002(2), Occupations Code, is
amended to read as follows:
(2) "Professional nursing" means the performance of an
act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application
of the principles of biological, physical, and social science as
acquired by a completed course in an approved school of
professional nursing. The term does not include acts of medical
diagnosis or the prescription of therapeutic or corrective
measures. Professional nursing involves:
(A) the observation, assessment, intervention,
evaluation, rehabilitation, care and counsel, or health teachings
of a person who is ill, injured, infirm, or experiencing a change in
normal health processes;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a health care practitioner legally
authorized to prescribe the medication or treatment [physician,
podiatrist, or dentist];
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the requesting, receiving, signing for, and
distribution of prescription drug samples to patients at practices
at which an advanced practice registered nurse is authorized to
sign prescription drug orders as provided by Subchapter B, Chapter
157;
(G) the performance of an act delegated by a
physician under Section 157.0512, 157.054, 157.058, or 157.059; and
(H) the development of the nursing care plan.
SECTION 14. Section 551.003(34), Occupations Code, is
amended to read as follows:
(34) "Practitioner" means:
(A) a person licensed, certified, or registered
to prescribe, distribute, administer, or dispense a prescription
drug or device in the course of professional practice in this state,
including a physician, dentist, podiatrist, psychologist, or
veterinarian but excluding a person licensed under this subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license or certificate holder in this state may
legally prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian,
psychologist, or podiatrist, who has a current federal Drug
Enforcement Administration registration number and who may legally
prescribe a Schedule II, III, IV, or V controlled substance, as
specified under Chapter 481, Health and Safety Code, in that other
state; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054.
SECTION 15. Section 501.051(b), Occupations Code, as
amended by this Act, does not affect the entitlement of a member
serving on the Texas State Board of Examiners of Psychologists
immediately before the effective date of this Act to continue to
serve for the remainder of the member's term. With the first
appointment of a member described by Section 501.051(a)(1),
Occupations Code, to be made by the governor on or after the
effective date of this Act, the governor shall appoint a member to
the board who has the qualifications required by Section
501.051(b), Occupations Code, as amended by this Act.
SECTION 16. (a) Not later than December 1, 2021, the Texas
State Board of Examiners of Psychologists shall appoint members of
the advisory committee in accordance with Section 501.163(a-1),
Occupations Code, as added by this Act.
(b) Not later than June 1, 2022, the advisory committee
shall make initial recommendations to the Texas State Board of
Examiners of Psychologists as described by Section 501.163(c),
Occupations Code, as added by this Act.
(c) Not later than December 1, 2024, the Texas State Board
of Examiners of Psychologists shall appoint members to the advisory
committee so that the composition of the committee complies with
Section 501.163(b), Occupations Code, as added by this Act.
SECTION 17. Not later than September 1, 2022, the Texas
State Board of Examiners of Psychologists shall adopt rules and
procedures necessary to implement Sections 501.353 and 501.354,
Occupations Code, as added by this Act.
SECTION 18. This Act takes effect September 1, 2021.