Texas 2021 - 87th Regular

Texas House Bill HB2029 Compare Versions

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1	1	87R3775 BEE-F
2	2	By: Klick H.B. No. 2029
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the licensing and authority of advanced practice
8	8	registered 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 to read as follows:
13	13	Sec. 301.002. DEFINITIONS. In this chapter:
14	14	(1) "Advanced practice registered nurse" means a
15	15	registered nurse licensed by the board to practice as an advanced
16	16	practice registered nurse on the basis of completion of an advanced
17	17	educational program. The term includes a nurse practitioner, nurse
18	18	midwife, nurse anesthetist, and clinical nurse specialist.
19	19	(2) [(1)] "Board" means the Texas Board of Nursing.
20	20	(3) [(1-a)] "Chief nursing officer" means the
21	21	registered nurse who is administratively responsible for the
22	22	nursing services at a facility.
23	23	(4) "Controlled substance" has the meaning assigned by
24	24	Section 481.002, Health and Safety Code.
25	25	(5) "Dangerous drug" has the meaning assigned by
26	26	Section 483.001, Health and Safety Code.
27	27	(6) "Device" has the meaning assigned by Section
28	28	551.003, and includes durable medical equipment.
29	29	(7) "Nonprescription drug" has the meaning assigned by
30	30	Section 551.003.
31	31	(8) "Nurse" means a person required to be licensed
32	32	under this chapter to engage in professional or vocational nursing.
33	33	(9) "Nursing" means professional or vocational
34	34	nursing.
35	35	(10) [(1-b)] "Patient safety committee" has the
36	36	meaning assigned by Section 303.001.
37	37	(11) "Prescribe or order a drug or device" has the
38	38	meaning assigned by Section 157.051.
39	39	(12) [(2)] "Professional nursing" means the
40	40	performance of an act that requires substantial specialized
41	41	judgment and skill, the proper performance of which is based on
42	42	knowledge and application of the principles of biological,
43	43	physical, and social science as acquired by a completed course in an
44	44	approved school of professional nursing. The term does not include
45	45	acts of medical diagnosis or the prescription of therapeutic or
46	46	corrective measures, except as authorized for an advanced practice
47	47	registered nurse. Professional nursing involves:
48	48	(A) the observation, assessment, intervention,
49	49	evaluation, rehabilitation, care and counsel, or health teachings
50	50	of a person who is ill, injured, infirm, or experiencing a change in
51	51	normal health processes;
52	52	(B) the maintenance of health or prevention of
53	53	illness;
54	54	(C) the administration of a medication or
55	55	treatment as ordered by a health care practitioner legally
56	56	authorized to prescribe the medication or treatment [physician,
57	57	podiatrist, or dentist];
58	58	(D) the supervision or teaching of nursing;
59	59	(E) the administration, supervision, and
60	60	evaluation of nursing practices, policies, and procedures;
61	61	(F) [the requesting, receiving, signing for, and
62	62	distribution of prescription drug samples to patients at practices
63	63	at which an advanced practice registered nurse is authorized to
64	64	sign prescription drug orders as provided by Subchapter B, Chapter
65	65	157;
66	66	[(G)] the performance of an act by an advanced
67	67	practice registered nurse [delegated by a physician under Section
68	68	157.0512, 157.054, 157.058, or 157.059]; and
69	69	(G) [(H)] the development of the nursing care
70	70	plan.
71	71	[(3) "Nurse" means a person required to be licensed
72	72	under this chapter to engage in professional or vocational nursing.
73	73	[(4) "Nursing" means professional or vocational
74	74	nursing.]
75	75	(13) [(5)] "Vocational nursing" means a directed
76	76	scope of nursing practice, including the performance of an act that
77	77	requires specialized judgment and skill, the proper performance of
78	78	which is based on knowledge and application of the principles of
79	79	biological, physical, and social science as acquired by a completed
80	80	course in an approved school of vocational nursing. The term does
81	81	not include acts of medical diagnosis or the prescription of
82	82	therapeutic or corrective measures. Vocational nursing involves:
83	83	(A) collecting data and performing focused
84	84	nursing assessments of the health status of an individual;
85	85	(B) participating in the planning of the nursing
86	86	care needs of an individual;
87	87	(C) participating in the development and
88	88	modification of the nursing care plan;
89	89	(D) participating in health teaching and
90	90	counseling to promote, attain, and maintain the optimum health
91	91	level of an individual;
92	92	(E) assisting in the evaluation of an
93	93	individual's response to a nursing intervention and the
94	94	identification of an individual's needs; and
95	95	(F) engaging in other acts that require education
96	96	and training, as prescribed by board rules and policies,
97	97	commensurate with the nurse's experience, continuing education,
98	98	and demonstrated competency.
99	99	SECTION 1.002. Section 301.005(b), Occupations Code, is
100	100	amended to read as follows:
101	101	(b) A reference in any other law to an "advanced nurse
102	102	practitioner," [or] "advanced practice nurse," or "advanced
103	103	practice registered nurse" means an advanced practice registered
104	104	nurse.
105	105	SECTION 1.003. Section 301.152, Occupations Code, is
106	106	transferred to Subchapter H, Chapter 301, Occupations Code,
107	107	redesignated as Section 301.357, Occupations Code, and amended to
108	108	read as follows:
109	109	Sec. 301.357 [301.152]. ADVANCED PRACTICE REGISTERED NURSES
110	110	[RULES REGARDING SPECIALIZED TRAINING]. (a) Advanced practice
111	111	registered nursing includes:
112	112	(1) ordering, performing, and interpreting diagnostic
113	113	tests;
114	114	(2) formulating primary and differential medical
115	115	diagnoses and advanced assessments;
116	116	(3) treating actual and potential health problems;
117	117	(4) prescribing therapeutic and corrective measures,
118	118	including nutrition and diagnostic support services, home health
119	119	care, hospice care, physical therapy, and occupational therapy, and
120	120	delegating and assigning the performance of therapeutic and
121	121	corrective measures to assistive personnel;
122	122	(5) to the extent authorized by the board under
123	123	Section 301.358, prescribing, ordering, procuring, administering,
124	124	and dispensing drugs and devices, including blood and blood
125	125	products, controlled substances listed in Schedules II, III, IV,
126	126	and V, dangerous drugs, and nonprescription drugs;
127	127	(6) providing referrals to health care agencies,
128	128	health care providers, and community resources;
129	129	(7) serving as the primary care provider of record;
130	130	and
131	131	(8) performing other acts that require education and
132	132	training consistent with professional standards and that are
133	133	commensurate with the advanced practice registered nurse's
134	134	education, licensure, and demonstrated competencies and
135	135	experience. [In this section, "advanced practice registered nurse"
136	136	means a registered nurse licensed by the board to practice as an
137	137	advanced practice registered nurse on the basis of completion of an
138	138	advanced educational program. The term includes a nurse
139	139	practitioner, nurse midwife, nurse anesthetist, and clinical nurse
140	140	specialist. The term is synonymous with "advanced nurse
141	141	practitioner" and "advanced practice nurse."]
142	142	(b) The board shall adopt rules to:
143	143	(1) license a registered nurse as an advanced practice
144	144	registered nurse;
145	145	(2) establish:
146	146	(A) any specialized education or training,
147	147	including pharmacology, that an advanced practice registered nurse
148	148	must have to prescribe or order a drug or device as authorized
149	149	[delegated] by the board [a physician] under Section 301.358
150	150	[157.0512 or 157.054];
151	151	(B) a system for approving an advanced practice
152	152	registered nurse to prescribe or order a drug or device as
153	153	authorized [delegated] by the board [a physician] under Section
154	154	301.358 [157.0512 or 157.054] on the receipt of evidence of
155	155	completing the specialized education and training requirement
156	156	under Paragraph (A); and
157	157	(C) a system for issuing a prescription
158	158	authorization number to an advanced practice registered nurse
159	159	approved under Paragraph (B); and
160	160	(3) concurrently renew any license or approval granted
161	161	to an advanced practice registered nurse under this subsection and
162	162	a license renewed by the advanced practice registered nurse under
163	163	Section 301.301.
164	164	(c) At a minimum, the rules adopted under Subsection (b)(2)
165	165	must:
166	166	(1) require completion of pharmacology and related
167	167	pathophysiology education for initial approval; and
168	168	(2) require continuing education in clinical
169	169	pharmacology and related pathophysiology in addition to any
170	170	continuing education otherwise required under Section 301.303.
171	171	(d) The signature of an advanced practice registered nurse
172	172	attesting to the provision of a legally authorized service by the
173	173	advanced practice registered nurse satisfies any documentation
174	174	requirement for that service established by a state agency.
175	175	(e) An advanced practice registered nurse shall practice as
176	176	a licensed independent practitioner in accordance with standards
177	177	established and recognized by the board to protect the public
178	178	health and safety.
179	179	(f) An advanced practice registered nurse is accountable to
180	180	patients, the nursing profession, and the board for:
181	181	(1) complying with the requirements of this chapter;
182	182	(2) providing quality advanced nursing care;
183	183	(3) recognizing the nurse's limits of knowledge;
184	184	(4) planning for the management of situations beyond
185	185	the nurse's expertise; and
186	186	(5) consulting with or referring patients to other
187	187	health care providers as appropriate.
188	188	(g) This section does not limit or modify the scope of
189	189	practice of a registered nurse who is not an advanced practice
190	190	registered nurse.
191	191	(h) Notwithstanding any other law, an advanced practice
192	192	registered nurse performing an act described by Subsection (a) is
193	193	not considered to be practicing medicine without a license.
194	194	SECTION 1.004. Section 301.354(a), Occupations Code, is
195	195	amended to read as follows:
196	196	(a) In this section, "nurse first assistant" means a
197	197	registered nurse who:
198	198	(1) has completed a nurse first assistant educational
199	199	program approved or recognized by an organization recognized by the
200	200	board; and
201	201	(2) [is] either:
202	202	(A) is certified in perioperative nursing by an
203	203	organization recognized by the board; or
204	204	(B) is [recognized by the board as] an advanced
205	205	practice registered nurse [and] qualified by education, training,
206	206	or experience to perform the tasks involved in perioperative
207	207	nursing.
208	208	SECTION 1.005. Subchapter H, Chapter 301, Occupations Code,
209	209	is amended by adding Section 301.358 to read as follows:
210	210	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
211	211	ADVANCED PRACTICE REGISTERED NURSE. (a) The board may authorize an
212	212	advanced practice registered nurse to prescribe and order drugs and
213	213	devices, including controlled substances listed in Schedules III,
214	214	IV, and V, dangerous drugs, and nonprescription drugs.
215	215	(b) Except as provided by Subsection (c), the board may
216	216	authorize an advanced practice registered nurse to prescribe and
217	217	order controlled substances listed in Schedule II only:
218	218	(1) in a hospital facility-based practice in
219	219	accordance with policies approved by the hospital's medical staff
220	220	or a committee of the hospital's medical staff as provided by the
221	221	hospital bylaws to ensure patient safety, and as part of the care
222	222	provided to a patient who:
223	223	(A) has been admitted to the hospital and is
224	224	expected to remain in the hospital for a period of 24 hours or more;
225	225	or
226	226	(B) is receiving services in the emergency
227	227	department of the hospital; or
228	228	(2) as part of the plan of care for the treatment of a
229	229	person who has executed a written certification of a terminal
230	230	illness, has elected to receive hospice care, and is receiving
231	231	hospice treatment from a qualified hospice provider.
232	232	(c) The board may authorize a certified registered nurse
233	233	anesthetist practicing in an ambulatory surgical center to order
234	234	drugs and devices necessary for the nurse anesthetist to administer
235	235	an anesthetic or anesthesia-related service.
236	236	ARTICLE 2. CONFORMING AMENDMENTS REGARDING DELEGATION
237	237	SECTION 2.001. The heading to Subchapter B, Chapter 157,
238	238	Occupations Code, is amended to read as follows:
239	239	SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
240	240	AND] PHYSICIAN ASSISTANTS
241	241	SECTION 2.002. Sections 157.051(11) and (14), Occupations
242	242	Code, are amended to read as follows:
243	243	(11) "Practice serving a medically underserved
244	244	population" means:
245	245	(A) a practice in a health professional shortage
246	246	area;
247	247	(B) a clinic designated as a rural health clinic
248	248	under 42 U.S.C. Section 1395x(aa);
249	249	(C) a public health clinic or a family planning
250	250	clinic under contract with the Health and Human Services Commission
251	251	or the Department of State Health Services;
252	252	(D) a clinic designated as a federally qualified
253	253	health center under 42 U.S.C. Section 1396d(l)(2)(B);
254	254	(E) a county, state, or federal correctional
255	255	facility;
256	256	(F) a practice:
257	257	(i) that either:
258	258	(a) is located in an area in which the
259	259	Department of State Health Services determines there is an
260	260	insufficient number of physicians providing services to eligible
261	261	clients of federally, state, or locally funded health care
262	262	programs; or
263	263	(b) is a practice that the Department
264	264	of State Health Services determines serves a disproportionate
265	265	number of clients eligible to participate in federally, state, or
266	266	locally funded health care programs; and
267	267	(ii) for which the Department of State
268	268	Health Services publishes notice of the department's determination
269	269	in the Texas Register and provides an opportunity for public
270	270	comment in the manner provided for a proposed rule under Chapter
271	271	2001, Government Code; or
272	272	(G) a practice at which a physician was
273	273	delegating prescriptive authority to an advanced practice
274	274	registered nurse, as defined by Section 301.002, or physician
275	275	assistant on or before March 1, 2013, based on the practice
276	276	qualifying as a site serving a medically underserved population.
277	277	(14) "Prescriptive authority agreement" means an
278	278	agreement entered into by a physician and a [an advanced practice
279	279	registered nurse or] physician assistant through which the
280	280	physician delegates to the [advanced practice registered nurse or]
281	281	physician assistant the act of prescribing or ordering a drug or
282	282	device.
283	283	SECTION 2.003. Section 157.0511(b-2), Occupations Code, is
284	284	amended to read as follows:
285	285	(b-2) The board shall adopt rules that require a physician
286	286	who delegates the prescribing or ordering of a drug or device to
287	287	register with the board the name and license number of the physician
288	288	assistant [or advanced practice registered nurse] to whom a
289	289	delegation is made. The board may develop and use an electronic
290	290	online delegation registration process for registration under this
291	291	subsection.
292	292	SECTION 2.004. Sections 157.0512(a), (b), (c), (e), (f),
293	293	(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
294	294	to read as follows:
295	295	(a) A physician may delegate to a [an advanced practice
296	296	registered nurse or] physician assistant, acting under adequate
297	297	physician supervision, the act of prescribing or ordering a drug or
298	298	device as authorized through a prescriptive authority agreement
299	299	between the physician and the [advanced practice registered nurse
300	300	or] physician assistant[, as applicable].
301	301	(b) A physician and a [an advanced practice registered nurse
302	302	or] physician assistant are eligible to enter into or be parties to
303	303	a prescriptive authority agreement only if:
304	304	(1) [if applicable, the Texas Board of Nursing has
305	305	approved the advanced practice registered nurse's authority to
306	306	prescribe or order a drug or device as authorized under this
307	307	subchapter;
308	308	[(2)] the [advanced practice registered nurse or]
309	309	physician assistant:
310	310	(A) holds an active license to practice in this
311	311	state as a [an advanced practice registered nurse or] physician
312	312	assistant[, as applicable,] and is in good standing in this state;
313	313	and
314	314	(B) is not currently prohibited by the [Texas
315	315	Board of Nursing or the] Texas Physician Assistant Board[, as
316	316	applicable,] from executing a prescriptive authority agreement;
317	317	and
318	318	(2) [(3)] before executing the prescriptive authority
319	319	agreement, the physician and the [advanced practice registered
320	320	nurse or] physician assistant disclose to the other prospective
321	321	party to the agreement any prior disciplinary action by the board[,
322	322	the Texas Board of Nursing,] or the Texas Physician Assistant
323	323	Board[, as applicable].
324	324	(c) Except as provided by Subsection (d), the [combined]
325	325	number of [advanced practice registered nurses and] physician
326	326	assistants with whom a physician may enter into a prescriptive
327	327	authority agreement may not exceed seven [advanced practice
328	328	registered nurses and] physician assistants or the full-time
329	329	equivalent of seven [advanced practice registered nurses and]
330	330	physician assistants.
331	331	(e) A prescriptive authority agreement must, at a minimum:
332	332	(1) be in writing and signed and dated by the parties
333	333	to the agreement;
334	334	(2) state the name, address, and all professional
335	335	license numbers of the parties to the agreement;
336	336	(3) state the nature of the practice, practice
337	337	locations, or practice settings;
338	338	(4) identify the types or categories of drugs or
339	339	devices that may be prescribed or the types or categories of drugs
340	340	or devices that may not be prescribed;
341	341	(5) provide a general plan for addressing consultation
342	342	and referral;
343	343	(6) provide a plan for addressing patient emergencies;
344	344	(7) state the general process for communication and
345	345	the sharing of information between the physician and the [advanced
346	346	practice registered nurse or] physician assistant to whom the
347	347	physician has delegated prescriptive authority related to the care
348	348	and treatment of patients;
349	349	(8) if alternate physician supervision is to be
350	350	utilized, designate one or more alternate physicians who may:
351	351	(A) provide appropriate supervision on a
352	352	temporary basis in accordance with the requirements established by
353	353	the prescriptive authority agreement and the requirements of this
354	354	subchapter; and
355	355	(B) participate in the prescriptive authority
356	356	quality assurance and improvement plan meetings required under this
357	357	section; and
358	358	(9) describe a prescriptive authority quality
359	359	assurance and improvement plan and specify methods for documenting
360	360	the implementation of the plan that include the following:
361	361	(A) chart review, with the number of charts to be
362	362	reviewed determined by the physician and [advanced practice
363	363	registered nurse or] physician assistant; and
364	364	(B) periodic meetings between the [advanced
365	365	practice registered nurse or] physician assistant and the
366	366	physician.
367	367	(f) The periodic meetings described by Subsection (e)(9)(B)
368	368	must:
369	369	(1) include:
370	370	(A) the sharing of information relating to
371	371	patient treatment and care, needed changes in patient care plans,
372	372	and issues relating to referrals; and
373	373	(B) discussion of patient care improvement;
374	374	(2) be documented; and
375	375	(3) take place at least once a month in a manner
376	376	determined by the physician and the [advanced practice registered
377	377	nurse or] physician assistant.
378	378	(g) The prescriptive authority agreement may include other
379	379	provisions agreed to by the physician and [advanced practice
380	380	registered nurse or] physician assistant.
381	381	(i) The prescriptive authority agreement need not describe
382	382	the exact steps that a [an advanced practice registered nurse or]
383	383	physician assistant must take with respect to each specific
384	384	condition, disease, or symptom.
385	385	(j) A physician[, advanced practice registered nurse,] or
386	386	physician assistant who is a party to a prescriptive authority
387	387	agreement must retain a copy of the agreement until the second
388	388	anniversary of the date the agreement is terminated.
389	389	(l) In the event that a party to a prescriptive authority
390	390	agreement is notified that the individual has become the subject of
391	391	an investigation by the board[, the Texas Board of Nursing,] or the
392	392	Texas Physician Assistant Board, the individual shall immediately
393	393	notify the other party to the prescriptive authority agreement.
394	394	(m) The prescriptive authority agreement and any amendments
395	395	must be reviewed at least annually, dated, and signed by the parties
396	396	to the agreement. The prescriptive authority agreement and any
397	397	amendments must be made available to the board[, the Texas Board of
398	398	Nursing,] or the Texas Physician Assistant Board not later than the
399	399	third business day after the date of receipt of request, if any.
400	400	(n) The prescriptive authority agreement should promote the
401	401	exercise of professional judgment by the [advanced practice
402	402	registered nurse or] physician assistant commensurate with the
403	403	[advanced practice registered nurse's or] physician assistant's
404	404	education and experience and the relationship between the [advanced
405	405	practice registered nurse or] physician assistant and the
406	406	physician.
407	407	(o) This section shall be liberally construed to allow the
408	408	use of prescriptive authority agreements to safely and effectively
409	409	utilize the skills and services of [advanced practice registered
410	410	nurses and] physician assistants.
411	411	SECTION 2.005. Section 157.0513, Occupations Code, is
412	412	amended to read as follows:
413	413	Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
414	414	INFORMATION. (a) The board[, the Texas Board of Nursing,] and the
415	415	Texas Physician Assistant Board shall jointly develop a process:
416	416	(1) to exchange information regarding the names,
417	417	locations, and license numbers of each physician[, advanced
418	418	practice registered nurse,] and physician assistant who has entered
419	419	into a prescriptive authority agreement;
420	420	(2) by which each board shall immediately notify the
421	421	other board [boards] when a license holder of the board becomes the
422	422	subject of an investigation involving the delegation and
423	423	supervision of prescriptive authority, as well as the final
424	424	disposition of any such investigation;
425	425	(3) by which each board shall maintain and share a list
426	426	of the board's license holders who have been subject to a final
427	427	adverse disciplinary action for an act involving the delegation and
428	428	supervision of prescriptive authority; and
429	429	(4) to ensure that each [advanced practice registered
430	430	nurse or] physician assistant who has entered into a prescriptive
431	431	authority agreement authorizing the prescribing of opioids is
432	432	required to complete not less than two hours of continuing
433	433	education annually regarding safe and effective pain management
434	434	related to the prescription of opioids and other controlled
435	435	substances, including education regarding:
436	436	(A) reasonable standards of care;
437	437	(B) the identification of drug-seeking behavior
438	438	in patients; and
439	439	(C) effectively communicating with patients
440	440	regarding the prescription of an opioid or other controlled
441	441	substance.
442	442	(b) If the board[, the Texas Board of Nursing,] or the Texas
443	443	Physician Assistant Board receives a notice under Subsection
444	444	(a)(2), the board that received notice may open an investigation
445	445	against a license holder of the board who is a party to a
446	446	prescriptive authority agreement with the license holder who is
447	447	under investigation by the board that provided notice under
448	448	Subsection (a)(2).
449	449	(c) The board shall maintain and make available to the
450	450	public a searchable online list of physicians[, advanced practice
451	451	registered nurses,] and physician assistants who have entered into
452	452	a prescriptive authority agreement authorized under Section
453	453	157.0512 and identify the physician[, advanced practice registered
454	454	nurse, or physician assistant] with whom each [physician, advanced
455	455	practice registered nurse, and] physician assistant has entered
456	456	into a prescriptive authority agreement.
457	457	(d) The board shall collaborate with the [Texas Board of
458	458	Nursing and the] Texas Physician Assistant Board to maintain and
459	459	make available to the public a list of physicians[, advanced
460	460	practice registered nurses,] and physician assistants who are
461	461	prohibited from entering into or practicing under a prescriptive
462	462	authority agreement.
463	463	SECTION 2.006. Sections 157.054(a), (a-1), (b), and (c),
464	464	Occupations Code, are amended to read as follows:
465	465	(a) One or more physicians licensed by the board may
466	466	delegate, to one or more physician assistants [or advanced practice
467	467	registered nurses] acting under adequate physician supervision
468	468	whose practice is facility-based at a hospital or licensed
469	469	long-term care facility, the administration or provision of a drug
470	470	and the prescribing or ordering of a drug or device if each of the
471	471	delegating physicians is:
472	472	(1) the medical director or chief of medical staff of
473	473	the facility in which the physician assistant [or advanced practice
474	474	registered nurse] practices;
475	475	(2) the chair of the facility's credentialing
476	476	committee;
477	477	(3) a department chair of a facility department in
478	478	which the physician assistant [or advanced practice registered
479	479	nurse] practices; or
480	480	(4) a physician who consents to the request of the
481	481	medical director or chief of medical staff to delegate the
482	482	prescribing or ordering of a drug or device at the facility in which
483	483	the physician assistant [or advanced practice registered nurse]
484	484	practices.
485	485	(a-1) The limit [limits] on the number of [advanced practice
486	486	registered nurses or] physician assistants to whom a physician may
487	487	delegate under Section 157.0512 does [do] not apply to a physician
488	488	under Subsection (a) whose practice is facility-based under this
489	489	section, provided that the physician is not delegating in a
490	490	freestanding clinic, center, or practice of the facility.
491	491	(b) A physician's authority to delegate under Subsection
492	492	(a) is limited as follows:
493	493	(1) the delegation must be made under a physician's
494	494	order, standing medical order, standing delegation order, or
495	495	another order or protocol developed in accordance with policies
496	496	approved by the facility's medical staff or a committee of the
497	497	facility's medical staff as provided by the facility bylaws;
498	498	(2) the delegation must occur in the facility in which
499	499	the physician is the medical director, the chief of medical staff,
500	500	the chair of the credentialing committee, a department chair, or a
501	501	physician who consents to delegate under Subsection (a)(4);
502	502	(3) the delegation may not permit the prescribing or
503	503	ordering of a drug or device for the care or treatment of the
504	504	patients of any other physician without the prior consent of that
505	505	physician; and
506	506	(4) delegation in a long-term care facility must be by
507	507	the medical director and is limited to the prescribing or ordering
508	508	of a drug or device to not more than seven [advanced practice
509	509	registered nurses or] physician assistants or their full-time
510	510	equivalents.
511	511	(c) Physician supervision of the prescribing or ordering of
512	512	a drug or device must conform to what a reasonable, prudent
513	513	physician would find consistent with sound medical judgment but may
514	514	vary with the education and experience of the particular [advanced
515	515	practice registered nurse or] physician assistant. A physician
516	516	shall provide continuous supervision, but the constant physical
517	517	presence of the physician is not required.
518	518	SECTION 2.007. Section 157.055, Occupations Code, is
519	519	amended to read as follows:
520	520	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
521	521	order shall be defined in a manner that promotes the exercise of
522	522	professional judgment by the [advanced practice registered nurse
523	523	and] physician assistant commensurate with the education and
524	524	experience of that person. Under this section, an order or
525	525	protocol used by a reasonable and prudent physician exercising
526	526	sound medical judgment:
527	527	(1) is not required to describe the exact steps that
528	528	[an advanced practice registered nurse or] a physician assistant
529	529	must take with respect to each specific condition, disease, or
530	530	symptom; and
531	531	(2) may state the types or categories of medications
532	532	that may be prescribed or the types or categories of medications
533	533	that may not be prescribed.
534	534	SECTION 2.008. Section 157.056, Occupations Code, is
535	535	amended to read as follows:
536	536	Sec. 157.056. PRESCRIPTION INFORMATION. The following
537	537	information must be provided on each prescription subject to this
538	538	subchapter:
539	539	(1) the patient's name and address;
540	540	(2) the drug to be dispensed;
541	541	(3) directions to the patient regarding the taking of
542	542	the drug and the dosage;
543	543	(4) the intended use of the drug, if appropriate;
544	544	(5) the name, address, and telephone number of the
545	545	physician;
546	546	(6) the name, address, telephone number, and
547	547	identification number of the [registered nurse or] physician
548	548	assistant completing or signing the prescription drug order;
549	549	(7) the date; and
550	550	(8) the number of refills permitted.
551	551	SECTION 2.009. Sections 157.059(b), (e), (f), (g), (h), and
552	552	(i), Occupations Code, are amended to read as follows:
553	553	(b) A physician may delegate to a physician assistant
554	554	offering obstetrical services and certified by the board as
555	555	specializing in obstetrics [or an advanced practice registered
556	556	nurse recognized by the Texas Board of Nursing as a nurse midwife]
557	557	the act of administering or providing controlled substances to the
558	558	physician assistant's [or nurse midwife's] clients during
559	559	intrapartum and immediate postpartum care.
560	560	(e) The physician's orders, medical orders, standing
561	561	delegation orders, prescriptive authority agreements, or protocols
562	562	must require the reporting of or monitoring of each client's
563	563	progress, including complications of pregnancy and delivery and the
564	564	administration and provision of controlled substances by the [nurse
565	565	midwife or] physician assistant to the clients of the [nurse
566	566	midwife or] physician assistant.
567	567	(f) The authority of a physician to delegate under this
568	568	section is limited to:
569	569	(1) seven [nurse midwives or] physician assistants or
570	570	their full-time equivalents; and
571	571	(2) the designated facility at which the [nurse
572	572	midwife or] physician assistant provides care.
573	573	(g) The controlled substance must be supplied in a suitable
574	574	container that is labeled in compliance with the applicable drug
575	575	laws and must include:
576	576	(1) the patient's name and address;
577	577	(2) the drug to be provided;
578	578	(3) the name, address, and telephone number of the
579	579	physician;
580	580	(4) the name, address, and telephone number of the
581	581	[nurse midwife or] physician assistant; and
582	582	(5) the date.
583	583	(h) This section does not authorize a physician or [,]
584	584	physician assistant[, or nurse midwife] to operate a retail
585	585	pharmacy as defined under Subtitle J.
586	586	(i) This section authorizes a physician to delegate the act
587	587	of administering or providing a controlled substance to a [nurse
588	588	midwife or] physician assistant but does not require physician
589	589	delegation of[:
590	590	[(1) further acts to a nurse midwife; or
591	591	[(2)] the administration of medications by a physician
592	592	assistant [or registered nurse] other than as provided by this
593	593	section.
594	594	SECTION 2.010. Section 157.060, Occupations Code, is
595	595	amended to read as follows:
596	596	Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED
597	597	ACT. Unless the physician has reason to believe the physician
598	598	assistant [or advanced practice registered nurse] lacked the
599	599	competency to perform the act, a physician is not liable for an act
600	600	of a physician assistant [or advanced practice registered nurse]
601	601	solely because the physician signed a standing medical order, a
602	602	standing delegation order, or another order or protocol, or entered
603	603	into a prescriptive authority agreement, authorizing the physician
604	604	assistant [or advanced practice registered nurse] to administer,
605	605	provide, prescribe, or order a drug or device.
606	606	ARTICLE 3. GENERAL CONFORMING AMENDMENTS
607	607	SECTION 3.001. Section 38.151(1), Education Code, is
608	608	amended to read as follows:
609	609	(1) "Advanced practice nurse" has the meaning assigned
610	610	to "advanced practice registered nurse" by Section 301.002
611	611	[301.152], Occupations Code.
612	612	SECTION 3.002. Section 61.601, Education Code, as amended
613	613	by Chapters 891 (H.B. 3083) and 1101 (H.B. 3808), Acts of the 85th
614	614	Legislature, Regular Session, 2017, is reenacted and amended to
615	615	read as follows:
616	616	Sec. 61.601. DEFINITION. In this subchapter, "mental
617	617	health professional" means:
618	618	(1) a licensed physician who is:
619	619	(A) a graduate of an accredited psychiatric
620	620	residency training program; or
621	621	(B) certified in psychiatry by:
622	622	(i) the American Board of Psychiatry and
623	623	Neurology; or
624	624	(ii) the American Osteopathic Board of
625	625	Neurology and Psychiatry;
626	626	(2) a psychologist, as defined by Section 501.002,
627	627	Occupations Code;
628	628	(3) a licensed professional counselor, as defined by
629	629	Section 503.002, Occupations Code;
630	630	(4) an advanced practice registered nurse, as defined
631	631	by Section 301.002 [301.152], Occupations Code, who holds a
632	632	nationally recognized board certification in psychiatric or mental
633	633	health nursing;
634	634	(5) a licensed clinical social worker, as defined by
635	635	Section 505.002, Occupations Code; [and]
636	636	(6) a licensed marriage and family therapist, as
637	637	defined by Section 502.002, Occupations Code; and
638	638	(7) [(6)] a chemical dependency counselor, as defined
639	639	by Section 504.001, Occupations Code.
640	640	SECTION 3.003. Section 263.001(a)(1), Family Code, is
641	641	amended to read as follows:
642	642	(1) "Advanced practice nurse" has the meaning assigned
643	643	to "advanced practice registered nurse" by Section 301.002
644	644	[157.051], Occupations Code.
645	645	SECTION 3.004. Section 266.001(1), Family Code, is amended
646	646	to read as follows:
647	647	(1) "Advanced practice nurse" has the meaning assigned
648	648	to "advanced practice registered nurse" by Section 301.002
649	649	[157.051], Occupations Code.
650	650	SECTION 3.005. Section 531.0217(k), Government Code, is
651	651	amended to read as follows:
652	652	(k) This section does not affect any requirement relating
653	653	to:
654	654	(1) a rural health clinic; or
655	655	(2) physician delegation of the authority to carry out
656	656	or sign prescription drug orders to a [an advanced practice nurse
657	657	or] physician assistant.
658	658	SECTION 3.006. Section 671.001(b), Government Code, is
659	659	amended to read as follows:
660	660	(b) The pilot program must provide for the following:
661	661	(1) a licensed advanced practice registered nurse as
662	662	defined by Section 301.002 [301.152], Occupations Code, or a
663	663	licensed physician assistant as described by Chapter 204,
664	664	Occupations Code, who is employed by the state or whose services are
665	665	acquired by contract, who will be located at a state office complex;
666	666	(2) if applicable, a licensed physician, who is
667	667	employed by a state governmental entity for purposes other than the
668	668	pilot program or whose services are acquired by contract, who will
669	669	delegate to and supervise the [advanced practice registered nurse
670	670	or] physician assistant under a prescriptive authority agreement
671	671	under Chapter 157, Occupations Code;
672	672	(3) appropriate office space and equipment for the
673	673	advanced practice registered nurse or physician assistant to
674	674	provide basic medical care to employees at the state office complex
675	675	where the nurse or physician assistant is located; and
676	676	(4) professional liability insurance covering
677	677	services provided by the advanced practice registered nurse or the
678	678	physician assistant.
679	679	SECTION 3.007. Section 47.001(3), Health and Safety Code,
680	680	is amended to read as follows:
681	681	(3) "Health care provider" means:
682	682	(A) [a registered nurse recognized as] an
683	683	advanced practice registered nurse as defined by Section 301.002,
684	684	Occupations Code; [the Texas Board of Nursing] or
685	685	(B) a physician assistant licensed by the Texas
686	686	Physician Assistant Board.
687	687	SECTION 3.008. Section 47.011(a), Health and Safety Code,
688	688	is amended to read as follows:
689	689	(a) In this section, "midwife" has the meaning assigned by
690	690	Section 203.002, Occupations Code, and includes a nurse midwife
691	691	[described by Section 301.152, Occupations Code].
692	692	SECTION 3.009. Sections 161.0052(b) and (c), Health and
693	693	Safety Code, are amended to read as follows:
694	694	(b) The executive commissioner by rule shall require a
695	695	hospital to inform each elderly person admitted to the hospital for
696	696	a period of 24 hours or more that the pneumococcal and influenza
697	697	vaccines are available. If the elderly person requests a vaccine,
698	698	and if a physician, [or] an advanced nurse practitioner, or a
699	699	physician assistant on behalf of a physician, determines that the
700	700	vaccine is in the person's best interest, the hospital must make the
701	701	vaccination available to the person before the person is discharged
702	702	from the hospital.
703	703	(c) The executive commissioner by rule shall require an end
704	704	stage renal disease facility to offer, to the extent possible as
705	705	determined by the facility, the opportunity to receive the
706	706	pneumococcal and influenza vaccines to each elderly person who
707	707	receives ongoing care at the facility if a physician, [or] an
708	708	advanced nurse practitioner, or a physician assistant on behalf of
709	709	a physician, determines that the vaccine is in the person's best
710	710	interest. If the facility decides it is not feasible to offer the
711	711	vaccine, the facility must provide the person with information on
712	712	other options for obtaining the vaccine.
713	713	SECTION 3.010. Section 241.003(1), Health and Safety Code,
714	714	is amended to read as follows:
715	715	(1) "Advanced practice nurse" has the meaning assigned
716	716	to "advanced practice registered nurse" by Section 301.002,
717	717	Occupations Code [means a registered nurse recognized as an
718	718	advanced practice nurse by the Texas Board of Nursing].
719	719	SECTION 3.011. Section 481.002(39), Health and Safety Code,
720	720	is amended to read as follows:
721	721	(39) "Practitioner" means:
722	722	(A) a physician, dentist, veterinarian,
723	723	podiatrist, scientific investigator, advanced practice registered
724	724	nurse, or other person licensed, registered, or otherwise permitted
725	725	to distribute, dispense, analyze, conduct research with respect to,
726	726	or administer a controlled substance in the course of professional
727	727	practice or research in this state;
728	728	(B) a pharmacy, hospital, or other institution
729	729	licensed, registered, or otherwise permitted to distribute,
730	730	dispense, conduct research with respect to, or administer a
731	731	controlled substance in the course of professional practice or
732	732	research in this state;
733	733	(C) a person practicing in and licensed by
734	734	another state as a physician, dentist, veterinarian, advanced
735	735	practice registered nurse, or podiatrist, having a current Federal
736	736	Drug Enforcement Administration registration number, who may
737	737	legally prescribe Schedule II, III, IV, or V controlled substances
738	738	in that state; or
739	739	(D) a [an advanced practice registered nurse or]
740	740	physician assistant to whom a physician has delegated the authority
741	741	to prescribe or order a drug or device under Section 157.0511,
742	742	157.0512, or 157.054, Occupations Code.
743	743	SECTION 3.012. Section 481.074(d), Health and Safety Code,
744	744	is amended to read as follows:
745	745	(d) Except as specified in Subsections (e) and (f), the
746	746	board, by rule and in consultation with the Texas Medical Board and
747	747	the Texas Board of Nursing, shall establish the period after the
748	748	date on which the prescription is issued that a person may fill a
749	749	prescription for a controlled substance listed in Schedule II. A
750	750	person may not refill a prescription for a substance listed in
751	751	Schedule II.
752	752	SECTION 3.013. Section 481.076(c), Health and Safety Code,
753	753	is amended to read as follows:
754	754	(c) The board by rule shall design and implement a system
755	755	for submission of information to the board by electronic or other
756	756	means and for retrieval of information submitted to the board under
757	757	this section and Sections 481.074 and 481.075. The board shall use
758	758	automated information security techniques and devices to preclude
759	759	improper access to the information. The board shall submit the
760	760	system design to the director, [and] the Texas Medical Board, and
761	761	the Texas Board of Nursing for review and comment a reasonable time
762	762	before implementation of the system and shall comply with the
763	763	comments of those agencies unless it is unreasonable to do so.
764	764	SECTION 3.014. Section 481.0767(b), Health and Safety Code,
765	765	is amended to read as follows:
766	766	(b) The board shall appoint the following members to the
767	767	advisory committee:
768	768	(1) a physician licensed in this state who practices
769	769	in pain management;
770	770	(2) a physician licensed in this state who practices
771	771	in family medicine;
772	772	(3) a physician licensed in this state who performs
773	773	surgery;
774	774	(4) a physician licensed in this state who practices
775	775	in emergency medicine at a hospital;
776	776	(5) a physician licensed in this state who practices
777	777	in psychiatry;
778	778	(6) an oral and maxillofacial surgeon;
779	779	(7) a physician assistant [or advanced practice
780	780	registered nurse] to whom a physician has delegated the authority
781	781	to prescribe or order a drug or an advanced practice registered
782	782	nurse;
783	783	(8) a pharmacist working at a chain pharmacy;
784	784	(9) a pharmacist working at an independent pharmacy;
785	785	(10) an academic pharmacist; and
786	786	(11) two representatives of the health information
787	787	technology industry, at least one of whom is a representative of a
788	788	company whose primary line of business is electronic medical
789	789	records.
790	790	SECTION 3.015. Sections 483.001(4), (12), and (13), Health
791	791	and Safety Code, are amended to read as follows:
792	792	(4) "Designated agent" means:
793	793	(A) a licensed nurse, physician assistant,
794	794	pharmacist, or other individual designated by a practitioner to
795	795	communicate prescription drug orders to a pharmacist;
796	796	(B) a licensed nurse, physician assistant, or
797	797	pharmacist employed in a health care facility to whom the
798	798	practitioner communicates a prescription drug order; or
799	799	(C) a [registered nurse or] physician assistant
800	800	authorized by a practitioner to carry out a prescription drug order
801	801	for dangerous drugs under Subchapter B, Chapter 157, Occupations
802	802	Code.
803	803	(12) "Practitioner" means:
804	804	(A) a person licensed by:
805	805	(i) the Texas Medical Board, State Board of
806	806	Dental Examiners, Texas Optometry Board, or State Board of
807	807	Veterinary Medical Examiners to prescribe and administer dangerous
808	808	drugs; or
809	809	(ii) the Texas Department of Licensing and
810	810	Regulation, with respect to podiatry, to prescribe and administer
811	811	dangerous drugs;
812	812	(B) a person licensed by another state in a
813	813	health field in which, under the laws of this state, a licensee may
814	814	legally prescribe dangerous drugs;
815	815	(C) a person licensed in Canada or Mexico in a
816	816	health field in which, under the laws of this state, a licensee may
817	817	legally prescribe dangerous drugs; [or]
818	818	(D) a [an advanced practice registered nurse or]
819	819	physician assistant to whom a physician has delegated the authority
820	820	to prescribe or order a drug or device under Section 157.0511,
821	821	157.0512, or 157.054, Occupations Code; or
822	822	(E) an advanced practice registered nurse
823	823	authorized to prescribe and order drugs and devices under Section
824	824	301.358, Occupations Code.
825	825	(13) "Prescription" means an order from a
826	826	practitioner, or an agent of the practitioner designated in writing
827	827	as authorized to communicate prescriptions, or an order made in
828	828	accordance with Subchapter B, Chapter 157, Occupations Code, or
829	829	Section 203.353, Occupations Code, to a pharmacist for a dangerous
830	830	drug to be dispensed that states:
831	831	(A) the date of the order's issue;
832	832	(B) the name and address of the patient;
833	833	(C) if the drug is prescribed for an animal, the
834	834	species of the animal;
835	835	(D) the name and quantity of the drug prescribed;
836	836	(E) the directions for the use of the drug;
837	837	(F) the intended use of the drug unless the
838	838	practitioner determines the furnishing of this information is not
839	839	in the best interest of the patient;
840	840	(G) the name, address, and telephone number of
841	841	the practitioner at the practitioner's usual place of business,
842	842	legibly printed or stamped; and
843	843	(H) the name, address, and telephone number of
844	844	the licensed midwife[, registered nurse,] or physician assistant,
845	845	legibly printed or stamped, if signed by a licensed midwife[,
846	846	registered nurse,] or physician assistant.
847	847	SECTION 3.016. Section 483.022(f), Health and Safety Code,
848	848	is amended to read as follows:
849	849	(f) A practitioner may designate a person who is a licensed
850	850	vocational nurse or has an education equivalent to or greater than
851	851	that required for a licensed vocational nurse to communicate
852	852	prescriptions of a [an advanced practice nurse or] physician
853	853	assistant authorized by the practitioner to sign prescription drug
854	854	orders under Subchapter B, Chapter 157, Occupations Code, or of an
855	855	advanced practice registered nurse.
856	856	SECTION 3.017. Section 483.042(a), Health and Safety Code,
857	857	is amended to read as follows:
858	858	(a) A person commits an offense if the person delivers or
859	859	offers to deliver a dangerous drug:
860	860	(1) unless:
861	861	(A) the dangerous drug is delivered or offered
862	862	for delivery by a pharmacist under:
863	863	(i) a prescription issued by a practitioner
864	864	described by Section 483.001(12)(A), [or] (B), or (E);
865	865	(ii) a prescription signed by a [registered
866	866	nurse or] physician assistant in accordance with Subchapter B,
867	867	Chapter 157, Occupations Code; or
868	868	(iii) an original written prescription
869	869	issued by a practitioner described by Section 483.001(12)(C); and
870	870	(B) a label is attached to the immediate
871	871	container in which the drug is delivered or offered to be delivered
872	872	and the label contains the following information:
873	873	(i) the name and address of the pharmacy
874	874	from which the drug is delivered or offered for delivery;
875	875	(ii) the date the prescription for the drug
876	876	is dispensed;
877	877	(iii) the number of the prescription as
878	878	filed in the prescription files of the pharmacy from which the
879	879	prescription is dispensed;
880	880	(iv) the name of the practitioner who
881	881	prescribed the drug and, if applicable, the name of the [registered
882	882	nurse or] physician assistant who signed the prescription;
883	883	(v) the name of the patient and, if the drug
884	884	is prescribed for an animal, a statement of the species of the
885	885	animal; and
886	886	(vi) directions for the use of the drug as
887	887	contained in the prescription; or
888	888	(2) unless:
889	889	(A) the dangerous drug is delivered or offered
890	890	for delivery by:
891	891	(i) a practitioner in the course of
892	892	practice; or
893	893	(ii) a [registered nurse or] physician
894	894	assistant in the course of practice in accordance with Subchapter
895	895	B, Chapter 157, Occupations Code; and
896	896	(B) a label is attached to the immediate
897	897	container in which the drug is delivered or offered to be delivered
898	898	and the label contains the following information:
899	899	(i) the name and address of the
900	900	practitioner who prescribed the drug, and if applicable, the name
901	901	and address of the [registered nurse or] physician assistant;
902	902	(ii) the date the drug is delivered;
903	903	(iii) the name of the patient and, if the
904	904	drug is prescribed for an animal, a statement of the species of the
905	905	animal; and
906	906	(iv) the name of the drug, the strength of
907	907	the drug, and directions for the use of the drug.
908	908	SECTION 3.018. Section 32.024(gg), Human Resources Code, is
909	909	amended to read as follows:
910	910	(gg) Notwithstanding any other law, including Sections
911	911	843.312 and 1301.052, Insurance Code, the commission shall ensure
912	912	that advanced practice registered nurses and physician assistants
913	913	may be selected by and assigned to recipients of medical assistance
914	914	as the primary care providers of those recipients [regardless of
915	915	whether the physician supervising the advanced practice registered
916	916	nurse is included in any directory of providers of medical
917	917	assistance maintained by the commission]. This subsection may not
918	918	be construed as authorizing the commission to supervise or control
919	919	the practice of medicine as prohibited by Subtitle B, Title 3,
920	920	Occupations Code. The commission must require that advanced
921	921	practice registered nurses and physician assistants be treated in
922	922	the same manner as primary care physicians with regard to:
923	923	(1) selection and assignment as primary care
924	924	providers; and
925	925	(2) inclusion as primary care providers in any
926	926	directory of providers of medical assistance maintained by the
927	927	commission.
928	928	SECTION 3.019. Section 32.03141, Human Resources Code, is
929	929	amended to read as follows:
930	930	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
931	931	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
932	932	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
933	933	addition to other health care practitioners authorized by federal
934	934	law, the following persons may order and prescribe durable medical
935	935	equipment and supplies under the medical assistance program:
936	936	(1) an advanced practice registered nurse; and
937	937	(2) a [or] physician assistant acting under adequate
938	938	physician supervision and to whom a physician has delegated the
939	939	authority to prescribe and order drugs and devices under Chapter
940	940	157, Occupations Code[, may order and prescribe durable medical
941	941	equipment and supplies under the medical assistance program].
942	942	SECTION 3.020. Section 843.312, Insurance Code, is amended
943	943	to read as follows:
944	944	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
945	945	REGISTERED NURSES. (a) A health maintenance organization may not
946	946	refuse a request by a physician participating in the health
947	947	maintenance organization delivery network and a physician
948	948	assistant [or advanced practice nurse] who is authorized by the
949	949	physician to provide care under Subchapter B, Chapter 157,
950	950	Occupations Code, or an advanced practice registered nurse, as
951	951	defined by Section 301.002, Occupations Code, to identify a
952	952	physician assistant or advanced practice registered nurse as a
953	953	provider in the network.
954	954	(b) A health maintenance organization may refuse a request
955	955	under Subsection (a) if the physician assistant or advanced
956	956	practice registered nurse does not meet the quality of care
957	957	standards previously established by the health maintenance
958	958	organization for participation in the network by physician
959	959	assistants and advanced practice registered nurses.
960	960	SECTION 3.021. Section 1301.001(1-a), Insurance Code, is
961	961	amended to read as follows:
962	962	(1-a) "Health care provider" means a practitioner,
963	963	institutional provider, or other person or organization that
964	964	furnishes health care services and that is licensed or otherwise
965	965	authorized to practice in this state. The term includes a
966	966	pharmacist, [and] a pharmacy, and an advanced practice registered
967	967	nurse. The term does not include a physician.
968	968	SECTION 3.022. Section 1301.052, Insurance Code, is amended
969	969	to read as follows:
970	970	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
971	971	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
972	972	offering a preferred provider benefit plan may not refuse a request
973	973	made by a physician participating as a preferred provider under the
974	974	plan and an advanced practice registered nurse or physician
975	975	assistant to have the advanced practice registered nurse or
976	976	physician assistant included as a preferred provider under the plan
977	977	if, as applicable:
978	978	(1) the [advanced practice nurse or] physician
979	979	assistant is authorized by the physician to provide care under
980	980	Subchapter B, Chapter 157, Occupations Code; and
981	981	(2) the advanced practice registered nurse or
982	982	physician assistant meets the quality of care standards previously
983	983	established by the insurer for participation in the plan by
984	984	advanced practice registered nurses and physician assistants.
985	985	SECTION 3.023. Section 1451.001(2), Insurance Code, is
986	986	amended to read as follows:
987	987	(2) "Advanced practice registered nurse" has the
988	988	meaning assigned by Section 301.002, Occupations Code [means an
989	989	individual licensed by the Texas Board of Nursing as a registered
990	990	nurse and recognized by that board as an advanced practice nurse].
991	991	SECTION 3.024. Section 1451.104(c), Insurance Code, is
992	992	amended to read as follows:
993	993	(c) Notwithstanding Subsection (a), a health insurance
994	994	policy may provide for a different amount of payment or
995	995	reimbursement for scheduled services or procedures performed by an
996	996	advanced practice registered nurse, nurse first assistant,
997	997	licensed surgical assistant, or physician assistant if the
998	998	methodology used to compute the amount is the same as the
999	999	methodology used to compute the amount of payment or reimbursement
1000	1000	when the services or procedures are provided by a physician.
1001	1001	SECTION 3.025. Section 1451.106, Insurance Code, is amended
1002	1002	to read as follows:
1003	1003	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
1004	1004	NURSE. An insured may select an advanced practice registered nurse
1005	1005	to provide the services scheduled in the health insurance policy
1006	1006	that are within the scope of the nurse's license.
1007	1007	SECTION 3.026. Section 1452.051(1), Insurance Code, is
1008	1008	amended to read as follows:
1009	1009	(1) "Advanced practice nurse" has the meaning assigned
1010	1010	to "advanced practice registered nurse" by Section 301.002
1011	1011	[301.152], Occupations Code.
1012	1012	SECTION 3.027. Section 408.025, Labor Code, is amended by
1013	1013	amending Subsection (a-1) and adding Subsection (a-2) to read as
1014	1014	follows:
1015	1015	(a-1) A [treating doctor may delegate to a physician
1016	1016	assistant who is licensed to practice in this state under Chapter
1017	1017	204, Occupations Code, or an advanced practice registered nurse who
1018	1018	is licensed to practice in this state under Chapter 301,
1019	1019	Occupations Code, the authority to complete and sign a] work status
1020	1020	report regarding an injured employee's ability to return to work
1021	1021	may be completed and signed by:
1022	1022	(1) a physician assistant licensed to practice in this
1023	1023	state under Chapter 204, Occupations Code, who has been delegated
1024	1024	the authority by a treating doctor; or
1025	1025	(2) an advanced practice registered nurse, as defined
1026	1026	by Section 301.002, Occupations Code.
1027	1027	(a-2) The delegating treating doctor is responsible for the
1028	1028	acts of a [the] physician assistant [or advanced practice
1029	1029	registered nurse] under Subsection (a-1) [this subsection].
1030	1030	SECTION 3.028. Section 203.002(2), Occupations Code, is
1031	1031	amended to read as follows:
1032	1032	(2) "Certified nurse-midwife" means an advanced
1033	1033	practice [a person who is:
1034	1034	[(A) a] registered nurse as defined by Section
1035	1035	301.002 who is [under Chapter 301;
1036	1036	[(B) recognized as an advanced nurse
1037	1037	practitioner by the Texas Board of Nursing; and
1038	1038	[(C)] certified by the American College of
1039	1039	Nurse-Midwives.
1040	1040	SECTION 3.029. Section 204.1025, Occupations Code, is
1041	1041	amended to read as follows:
1042	1042	Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
1043	1043	AGREEMENTS. The physician assistant board shall in conjunction
1044	1044	with the Texas Medical Board [and the Texas Board of Nursing]
1045	1045	perform the functions and duties relating to prescriptive authority
1046	1046	agreements assigned to the physician assistant board in Sections
1047	1047	157.0512 and 157.0513.
1048	1048	SECTION 3.030. Sections 551.003(14) and (34), Occupations
1049	1049	Code, are amended to read as follows:
1050	1050	(14) "Designated agent" means:
1051	1051	(A) an individual, including a licensed nurse,
1052	1052	physician assistant, or pharmacist:
1053	1053	(i) who is designated by a practitioner and
1054	1054	authorized to communicate a prescription drug order to a
1055	1055	pharmacist; and
1056	1056	(ii) for whom the practitioner assumes
1057	1057	legal responsibility;
1058	1058	(B) a licensed nurse, physician assistant, or
1059	1059	pharmacist employed in a health care facility to whom a
1060	1060	practitioner communicates a prescription drug order; or
1061	1061	(C) a [registered nurse or] physician assistant
1062	1062	authorized by a practitioner to administer a prescription drug
1063	1063	order for a dangerous drug under Subchapter B, Chapter 157.
1064	1064	(34) "Practitioner" means:
1065	1065	(A) a person licensed or registered to prescribe,
1066	1066	distribute, administer, or dispense a prescription drug or device
1067	1067	in the course of professional practice in this state, including a
1068	1068	physician, dentist, podiatrist, advanced practice registered nurse
1069	1069	authorized to prescribe and order drugs and devices under Section
1070	1070	301.358, or veterinarian but excluding a person licensed under this
1071	1071	subtitle;
1072	1072	(B) a person licensed by another state, Canada,
1073	1073	or the United Mexican States in a health field in which, under the
1074	1074	law of this state, a license holder in this state may legally
1075	1075	prescribe a dangerous drug;
1076	1076	(C) a person practicing in another state and
1077	1077	licensed by another state as a physician, dentist, veterinarian,
1078	1078	advanced practice registered nurse, or podiatrist, who has a
1079	1079	current federal Drug Enforcement Administration registration
1080	1080	number and who may legally prescribe a Schedule II, III, IV, or V
1081	1081	controlled substance, as specified under Chapter 481, Health and
1082	1082	Safety Code, in that other state; or
1083	1083	(D) a [an advanced practice registered nurse or]
1084	1084	physician assistant to whom a physician has delegated the authority
1085	1085	to prescribe or order a drug or device under Section 157.0511,
1086	1086	157.0512, or 157.054.
1087	1087	SECTION 3.031. Section 563.051(e), Occupations Code, is
1088	1088	amended to read as follows:
1089	1089	(e) A practitioner may designate a licensed vocational
1090	1090	nurse or a person having education equivalent to or greater than
1091	1091	that required for a licensed vocational nurse to communicate the
1092	1092	prescriptions of a [an advanced practice nurse or] physician
1093	1093	assistant authorized by the practitioner to sign prescription drug
1094	1094	orders under Subchapter B, Chapter 157, or of an advanced practice
1095	1095	registered nurse.
1096	1096	SECTION 3.032. Sections 605.002(14) and (18), Occupations
1097	1097	Code, are amended to read as follows:
1098	1098	(14) "Orthotics" means the science and practice of
1099	1099	measuring, designing, fabricating, assembling, fitting, adjusting,
1100	1100	or servicing an orthosis under an order from a licensed physician,
1101	1101	chiropractor, [or] podiatrist, or [an] advanced practice
1102	1102	registered nurse, or from a physician assistant acting under the
1103	1103	delegation and supervision of a licensed physician as provided by
1104	1104	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1105	1105	Board, for the correction or alleviation of a neuromuscular or
1106	1106	musculoskeletal dysfunction, disease, injury, or deformity.
1107	1107	(18) "Prosthetics" means the science and practice of
1108	1108	measuring, designing, fabricating, assembling, fitting, adjusting,
1109	1109	or servicing a prosthesis under an order from a licensed physician,
1110	1110	chiropractor, [or] podiatrist, or [an] advanced practice
1111	1111	registered nurse, or from a physician assistant acting under the
1112	1112	delegation and supervision of a licensed physician as provided by
1113	1113	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1114	1114	Board.
1115	1115	SECTION 3.033. Section 605.2515, Occupations Code, is
1116	1116	amended to read as follows:
1117	1117	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
1118	1118	person licensed to practice orthotics or prosthetics who measures,
1119	1119	designs, fabricates, fits, assembles, adjusts, or services an
1120	1120	orthosis or a prosthesis under an order from a licensed physician,
1121	1121	chiropractor, [or] podiatrist, or [an] advanced practice
1122	1122	registered nurse, or from a physician assistant acting under the
1123	1123	delegation and supervision of a licensed physician as provided by
1124	1124	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1125	1125	Board, for a specific patient is exempt from licensing as a device
1126	1126	manufacturer under Subchapter L, Chapter 431, Health and Safety
1127	1127	Code. A person licensed to practice orthotics or prosthetics who
1128	1128	fabricates or assembles an orthosis or a prosthesis without an
1129	1129	order from a licensed physician, chiropractor, [or] podiatrist, or
1130	1130	[an] advanced practice registered nurse, or from a physician
1131	1131	assistant acting under the delegation and supervision of a licensed
1132	1132	physician as provided by Subchapter B, Chapter 157, and rules
1133	1133	adopted by the Texas Medical Board, for a specific patient is
1134	1134	required to be licensed as a device manufacturer under Subchapter
1135	1135	L, Chapter 431, Health and Safety Code.
1136	1136	ARTICLE 4. REPEALER
1137	1137	SECTION 4.001. The following provisions are repealed:
1138	1138	(1) Section 533.005(d), Government Code;
1139	1139	(2) Section 62.1551(b), Health and Safety Code; and
1140	1140	(3) Sections 157.051(1), 157.058, and 301.168,
1141	1141	Occupations Code.
1142	1142	ARTICLE 5. TRANSITION AND EFFECTIVE DATE
1143	1143	SECTION 5.001. Not later than February 1, 2022, the Texas
1144	1144	Board of Nursing shall adopt the rules necessary to implement the
1145	1145	changes in law made by this Act.
1146	1146	SECTION 5.002. Notwithstanding any changes in law made by
1147	1147	this Act, an advanced practice registered nurse who has been
1148	1148	delegated the authority to prescribe and order drugs and medical
1149	1149	devices by a physician's protocol or order under Section 157.0511,
1150	1150	157.0512, or 157.054, Occupations Code, may continue to exercise
1151	1151	that authority until February 1, 2022.
1152	1152	SECTION 5.003. This Act takes effect September 1, 2021.