Texas 2021 - 87th Regular

Texas House Bill HB4362 Compare Versions

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

Old	New	Differences
1	1	87R5482 BEE-D
2	2	By: Klick H.B. No. 4362
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the licensing and regulation of certain health
8	8	professions; requiring an occupational certificate to perform
9	9	certain surgical procedures.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES
12	12	SECTION 1.01. Section 38.151(1), Education Code, is amended
13	13	to read as follows:
14	14	(1) "Advanced practice nurse" has the meaning assigned
15	15	to "advanced practice registered nurse" by Section 301.002
16	16	[301.152], Occupations Code.
17	17	SECTION 1.02. Section 61.601, Education Code, as amended by
18	18	Chapters 891 (H.B. 3083) and 1101 (H.B. 3808), Acts of the 85th
19	19	Legislature, Regular Session, 2017, is reenacted and amended to
20	20	read as follows:
21	21	Sec. 61.601. DEFINITION. In this subchapter, "mental
22	22	health professional" means:
23	23	(1) a licensed physician who is:
24	24	(A) a graduate of an accredited psychiatric
25	25	residency training program; or
26	26	(B) certified in psychiatry by:
27	27	(i) the American Board of Psychiatry and
28	28	Neurology; or
29	29	(ii) the American Osteopathic Board of
30	30	Neurology and Psychiatry;
31	31	(2) a psychologist, as defined by Section 501.002,
32	32	Occupations Code;
33	33	(3) a licensed professional counselor, as defined by
34	34	Section 503.002, Occupations Code;
35	35	(4) an advanced practice registered nurse, as defined
36	36	by Section 301.002 [301.152], Occupations Code, who holds a
37	37	nationally recognized board certification in psychiatric or mental
38	38	health nursing;
39	39	(5) a licensed clinical social worker, as defined by
40	40	Section 505.002, Occupations Code; [and]
41	41	(6) a licensed marriage and family therapist, as
42	42	defined by Section 502.002, Occupations Code; and
43	43	(7) [(6)] a chemical dependency counselor, as defined
44	44	by Section 504.001, Occupations Code.
45	45	SECTION 1.03. Section 263.001(a)(1), Family Code, is
46	46	amended to read as follows:
47	47	(1) "Advanced practice nurse" has the meaning assigned
48	48	to "advanced practice registered nurse" by Section 301.002
49	49	[157.051], Occupations Code.
50	50	SECTION 1.04. Section 266.001(1), Family Code, is amended
51	51	to read as follows:
52	52	(1) "Advanced practice nurse" has the meaning assigned
53	53	to "advanced practice registered nurse" by Section 301.002
54	54	[157.051], Occupations Code.
55	55	SECTION 1.05. Section 531.0217(k), Government Code, is
56	56	amended to read as follows:
57	57	(k) This section does not affect any requirement relating
58	58	to:
59	59	(1) a rural health clinic; or
60	60	(2) physician delegation of the authority to carry out
61	61	or sign prescription drug orders to a [an advanced practice nurse
62	62	or] physician assistant.
63	63	SECTION 1.06. Section 671.001(b), Government Code, is
64	64	amended to read as follows:
65	65	(b) The pilot program must provide for the following:
66	66	(1) a licensed advanced practice registered nurse as
67	67	defined by Section 301.002 [301.152], Occupations Code, or a
68	68	licensed physician assistant as described by Chapter 204,
69	69	Occupations Code, who is employed by the state or whose services are
70	70	acquired by contract, who will be located at a state office complex;
71	71	(2) if applicable, a licensed physician, who is
72	72	employed by a state governmental entity for purposes other than the
73	73	pilot program or whose services are acquired by contract, who will
74	74	delegate to and supervise the [advanced practice registered nurse
75	75	or] physician assistant under a prescriptive authority agreement
76	76	under Chapter 157, Occupations Code;
77	77	(3) appropriate office space and equipment for the
78	78	advanced practice registered nurse or physician assistant to
79	79	provide basic medical care to employees at the state office complex
80	80	where the nurse or physician assistant is located; and
81	81	(4) professional liability insurance covering
82	82	services provided by the advanced practice registered nurse or the
83	83	physician assistant.
84	84	SECTION 1.07. Section 47.001(3), Health and Safety Code, is
85	85	amended to read as follows:
86	86	(3) "Health care provider" means:
87	87	(A) [a registered nurse recognized as] an
88	88	advanced practice registered nurse as defined by Section 301.002,
89	89	Occupations Code; [the Texas Board of Nursing] or
90	90	(B) a physician assistant licensed by the Texas
91	91	Physician Assistant Board.
92	92	SECTION 1.08. Section 47.011(a), Health and Safety Code, is
93	93	amended to read as follows:
94	94	(a) In this section, "midwife" has the meaning assigned by
95	95	Section 203.002, Occupations Code, and includes a nurse midwife
96	96	[described by Section 301.152, Occupations Code].
97	97	SECTION 1.09. Sections 161.0052(b) and (c), Health and
98	98	Safety Code, are amended to read as follows:
99	99	(b) The executive commissioner by rule shall require a
100	100	hospital to inform each elderly person admitted to the hospital for
101	101	a period of 24 hours or more that the pneumococcal and influenza
102	102	vaccines are available. If the elderly person requests a vaccine,
103	103	and if a physician, [or] an advanced nurse practitioner, or a
104	104	physician assistant on behalf of a physician, determines that the
105	105	vaccine is in the person's best interest, the hospital must make the
106	106	vaccination available to the person before the person is discharged
107	107	from the hospital.
108	108	(c) The executive commissioner by rule shall require an end
109	109	stage renal disease facility to offer, to the extent possible as
110	110	determined by the facility, the opportunity to receive the
111	111	pneumococcal and influenza vaccines to each elderly person who
112	112	receives ongoing care at the facility if a physician, [or] an
113	113	advanced nurse practitioner, or a physician assistant on behalf of
114	114	a physician, determines that the vaccine is in the person's best
115	115	interest. If the facility decides it is not feasible to offer the
116	116	vaccine, the facility must provide the person with information on
117	117	other options for obtaining the vaccine.
118	118	SECTION 1.10. Section 241.003(1), Health and Safety Code,
119	119	is amended to read as follows:
120	120	(1) "Advanced practice nurse" has the meaning assigned
121	121	to "advanced practice registered nurse" by Section 301.002,
122	122	Occupations Code [means a registered nurse recognized as an
123	123	advanced practice nurse by the Texas Board of Nursing].
124	124	SECTION 1.11. Section 481.002(39), Health and Safety Code,
125	125	is amended to read as follows:
126	126	(39) "Practitioner" means:
127	127	(A) a physician, dentist, veterinarian,
128	128	podiatrist, scientific investigator, advanced practice registered
129	129	nurse, or other person licensed, registered, or otherwise permitted
130	130	to distribute, dispense, analyze, conduct research with respect to,
131	131	or administer a controlled substance in the course of professional
132	132	practice or research in this state;
133	133	(B) a pharmacy, hospital, or other institution
134	134	licensed, registered, or otherwise permitted to distribute,
135	135	dispense, conduct research with respect to, or administer a
136	136	controlled substance in the course of professional practice or
137	137	research in this state;
138	138	(C) a person practicing in and licensed by
139	139	another state as a physician, dentist, veterinarian, advanced
140	140	practice registered nurse, or podiatrist, having a current Federal
141	141	Drug Enforcement Administration registration number, who may
142	142	legally prescribe Schedule II, III, IV, or V controlled substances
143	143	in that state; or
144	144	(D) a [an advanced practice registered nurse or]
145	145	physician assistant to whom a physician has delegated the authority
146	146	to prescribe or order a drug or device under Section 157.0511,
147	147	157.0512, or 157.054, Occupations Code.
148	148	SECTION 1.12. Section 481.074(d), Health and Safety Code,
149	149	is amended to read as follows:
150	150	(d) Except as specified in Subsections (e) and (f), the
151	151	board, by rule and in consultation with the Texas Medical Board and
152	152	the Texas Board of Nursing, shall establish the period after the
153	153	date on which the prescription is issued that a person may fill a
154	154	prescription for a controlled substance listed in Schedule II. A
155	155	person may not refill a prescription for a substance listed in
156	156	Schedule II.
157	157	SECTION 1.13. Section 481.076(c), Health and Safety Code,
158	158	is amended to read as follows:
159	159	(c) The board by rule shall design and implement a system
160	160	for submission of information to the board by electronic or other
161	161	means and for retrieval of information submitted to the board under
162	162	this section and Sections 481.074 and 481.075. The board shall use
163	163	automated information security techniques and devices to preclude
164	164	improper access to the information. The board shall submit the
165	165	system design to the director, [and] the Texas Medical Board, and
166	166	the Texas Board of Nursing for review and comment a reasonable time
167	167	before implementation of the system and shall comply with the
168	168	comments of those agencies unless it is unreasonable to do so.
169	169	SECTION 1.14. Section 481.0767(b), Health and Safety Code,
170	170	is amended to read as follows:
171	171	(b) The board shall appoint the following members to the
172	172	advisory committee:
173	173	(1) a physician licensed in this state who practices
174	174	in pain management;
175	175	(2) a physician licensed in this state who practices
176	176	in family medicine;
177	177	(3) a physician licensed in this state who performs
178	178	surgery;
179	179	(4) a physician licensed in this state who practices
180	180	in emergency medicine at a hospital;
181	181	(5) a physician licensed in this state who practices
182	182	in psychiatry;
183	183	(6) an oral and maxillofacial surgeon;
184	184	(7) a physician assistant [or advanced practice
185	185	registered nurse] to whom a physician has delegated the authority
186	186	to prescribe or order a drug or an advanced practice registered
187	187	nurse;
188	188	(8) a pharmacist working at a chain pharmacy;
189	189	(9) a pharmacist working at an independent pharmacy;
190	190	(10) an academic pharmacist; and
191	191	(11) two representatives of the health information
192	192	technology industry, at least one of whom is a representative of a
193	193	company whose primary line of business is electronic medical
194	194	records.
195	195	SECTION 1.15. Sections 483.001(4), (12), and (13), Health
196	196	and Safety Code, are amended to read as follows:
197	197	(4) "Designated agent" means:
198	198	(A) a licensed nurse, physician assistant,
199	199	pharmacist, or other individual designated by a practitioner to
200	200	communicate prescription drug orders to a pharmacist;
201	201	(B) a licensed nurse, physician assistant, or
202	202	pharmacist employed in a health care facility to whom the
203	203	practitioner communicates a prescription drug order; or
204	204	(C) a [registered nurse or] physician assistant
205	205	authorized by a practitioner to carry out a prescription drug order
206	206	for dangerous drugs under Subchapter B, Chapter 157, Occupations
207	207	Code.
208	208	(12) "Practitioner" means:
209	209	(A) a person licensed by:
210	210	(i) the Texas Medical Board, State Board of
211	211	Dental Examiners, Texas Optometry Board, or State Board of
212	212	Veterinary Medical Examiners to prescribe and administer dangerous
213	213	drugs; or
214	214	(ii) the Texas Department of Licensing and
215	215	Regulation, with respect to podiatry, to prescribe and administer
216	216	dangerous drugs;
217	217	(B) a person licensed by another state in a
218	218	health field in which, under the laws of this state, a licensee may
219	219	legally prescribe dangerous drugs;
220	220	(C) a person licensed in Canada or Mexico in a
221	221	health field in which, under the laws of this state, a licensee may
222	222	legally prescribe dangerous drugs; [or]
223	223	(D) a [an advanced practice registered nurse or]
224	224	physician assistant to whom a physician has delegated the authority
225	225	to prescribe or order a drug or device under Section 157.0511,
226	226	157.0512, or 157.054, Occupations Code; or
227	227	(E) an advanced practice registered nurse
228	228	authorized to prescribe and order drugs and devices under Section
229	229	301.358, Occupations Code.
230	230	(13) "Prescription" means an order from a
231	231	practitioner, or an agent of the practitioner designated in writing
232	232	as authorized to communicate prescriptions, or an order made in
233	233	accordance with Subchapter B, Chapter 157, Occupations Code, or
234	234	Section 203.353, Occupations Code, to a pharmacist for a dangerous
235	235	drug to be dispensed that states:
236	236	(A) the date of the order's issue;
237	237	(B) the name and address of the patient;
238	238	(C) if the drug is prescribed for an animal, the
239	239	species of the animal;
240	240	(D) the name and quantity of the drug prescribed;
241	241	(E) the directions for the use of the drug;
242	242	(F) the intended use of the drug unless the
243	243	practitioner determines the furnishing of this information is not
244	244	in the best interest of the patient;
245	245	(G) the name, address, and telephone number of
246	246	the practitioner at the practitioner's usual place of business,
247	247	legibly printed or stamped; and
248	248	(H) the name, address, and telephone number of
249	249	the licensed midwife[, registered nurse,] or physician assistant,
250	250	legibly printed or stamped, if signed by a licensed midwife[,
251	251	registered nurse,] or physician assistant.
252	252	SECTION 1.16. Section 483.022(f), Health and Safety Code,
253	253	is amended to read as follows:
254	254	(f) A practitioner may designate a person who is a licensed
255	255	vocational nurse or has an education equivalent to or greater than
256	256	that required for a licensed vocational nurse to communicate
257	257	prescriptions of a [an advanced practice nurse or] physician
258	258	assistant authorized by the practitioner to sign prescription drug
259	259	orders under Subchapter B, Chapter 157, Occupations Code, or of an
260	260	advanced practice registered nurse.
261	261	SECTION 1.17. Section 483.042(a), Health and Safety Code,
262	262	is amended to read as follows:
263	263	(a) A person commits an offense if the person delivers or
264	264	offers to deliver a dangerous drug:
265	265	(1) unless:
266	266	(A) the dangerous drug is delivered or offered
267	267	for delivery by a pharmacist under:
268	268	(i) a prescription issued by a practitioner
269	269	described by Section 483.001(12)(A), [or] (B), or (E);
270	270	(ii) a prescription signed by a [registered
271	271	nurse or] physician assistant in accordance with Subchapter B,
272	272	Chapter 157, Occupations Code; or
273	273	(iii) an original written prescription
274	274	issued by a practitioner described by Section 483.001(12)(C); and
275	275	(B) a label is attached to the immediate
276	276	container in which the drug is delivered or offered to be delivered
277	277	and the label contains the following information:
278	278	(i) the name and address of the pharmacy
279	279	from which the drug is delivered or offered for delivery;
280	280	(ii) the date the prescription for the drug
281	281	is dispensed;
282	282	(iii) the number of the prescription as
283	283	filed in the prescription files of the pharmacy from which the
284	284	prescription is dispensed;
285	285	(iv) the name of the practitioner who
286	286	prescribed the drug and, if applicable, the name of the [registered
287	287	nurse or] physician assistant who signed the prescription;
288	288	(v) the name of the patient and, if the drug
289	289	is prescribed for an animal, a statement of the species of the
290	290	animal; and
291	291	(vi) directions for the use of the drug as
292	292	contained in the prescription; or
293	293	(2) unless:
294	294	(A) the dangerous drug is delivered or offered
295	295	for delivery by:
296	296	(i) a practitioner in the course of
297	297	practice; or
298	298	(ii) a [registered nurse or] physician
299	299	assistant in the course of practice in accordance with Subchapter
300	300	B, Chapter 157, Occupations Code; and
301	301	(B) a label is attached to the immediate
302	302	container in which the drug is delivered or offered to be delivered
303	303	and the label contains the following information:
304	304	(i) the name and address of the
305	305	practitioner who prescribed the drug, and if applicable, the name
306	306	and address of the [registered nurse or] physician assistant;
307	307	(ii) the date the drug is delivered;
308	308	(iii) the name of the patient and, if the
309	309	drug is prescribed for an animal, a statement of the species of the
310	310	animal; and
311	311	(iv) the name of the drug, the strength of
312	312	the drug, and directions for the use of the drug.
313	313	SECTION 1.18. Section 32.024(gg), Human Resources Code, is
314	314	amended to read as follows:
315	315	(gg) Notwithstanding any other law, including Sections
316	316	843.312 and 1301.052, Insurance Code, the commission shall ensure
317	317	that advanced practice registered nurses and physician assistants
318	318	may be selected by and assigned to recipients of medical assistance
319	319	as the primary care providers of those recipients [regardless of
320	320	whether the physician supervising the advanced practice registered
321	321	nurse is included in any directory of providers of medical
322	322	assistance maintained by the commission]. This subsection may not
323	323	be construed as authorizing the commission to supervise or control
324	324	the practice of medicine as prohibited by Subtitle B, Title 3,
325	325	Occupations Code. The commission must require that advanced
326	326	practice registered nurses and physician assistants be treated in
327	327	the same manner as primary care physicians with regard to:
328	328	(1) selection and assignment as primary care
329	329	providers; and
330	330	(2) inclusion as primary care providers in any
331	331	directory of providers of medical assistance maintained by the
332	332	commission.
333	333	SECTION 1.19. Section 32.03141, Human Resources Code, is
334	334	amended to read as follows:
335	335	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
336	336	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
337	337	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
338	338	addition to other health care practitioners authorized by federal
339	339	law, the following persons may order and prescribe durable medical
340	340	equipment and supplies under the medical assistance program:
341	341	(1) an advanced practice registered nurse; and
342	342	(2) a [or] physician assistant acting under adequate
343	343	physician supervision and to whom a physician has delegated the
344	344	authority to prescribe and order drugs and devices under Chapter
345	345	157, Occupations Code[, may order and prescribe durable medical
346	346	equipment and supplies under the medical assistance program].
347	347	SECTION 1.20. Section 843.312, Insurance Code, is amended
348	348	to read as follows:
349	349	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
350	350	REGISTERED NURSES. (a) A health maintenance organization may not
351	351	refuse a request by a physician participating in the health
352	352	maintenance organization delivery network and a physician
353	353	assistant [or advanced practice nurse] who is authorized by the
354	354	physician to provide care under Subchapter B, Chapter 157,
355	355	Occupations Code, or an advanced practice registered nurse, as
356	356	defined by Section 301.002, Occupations Code, to identify a
357	357	physician assistant or advanced practice registered nurse as a
358	358	provider in the network.
359	359	(b) A health maintenance organization may refuse a request
360	360	under Subsection (a) if the physician assistant or advanced
361	361	practice registered nurse does not meet the quality of care
362	362	standards previously established by the health maintenance
363	363	organization for participation in the network by physician
364	364	assistants and advanced practice registered nurses.
365	365	SECTION 1.21. Section 1301.001(1-a), Insurance Code, is
366	366	amended to read as follows:
367	367	(1-a) "Health care provider" means a practitioner,
368	368	institutional provider, or other person or organization that
369	369	furnishes health care services and that is licensed or otherwise
370	370	authorized to practice in this state. The term includes a
371	371	pharmacist, [and] a pharmacy, and an advanced practice registered
372	372	nurse. The term does not include a physician.
373	373	SECTION 1.22. Section 1301.052, Insurance Code, is amended
374	374	to read as follows:
375	375	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
376	376	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
377	377	offering a preferred provider benefit plan may not refuse a request
378	378	made by a physician participating as a preferred provider under the
379	379	plan and an advanced practice registered nurse or physician
380	380	assistant to have the advanced practice registered nurse or
381	381	physician assistant included as a preferred provider under the plan
382	382	if, as applicable:
383	383	(1) the [advanced practice nurse or] physician
384	384	assistant is authorized by the physician to provide care under
385	385	Subchapter B, Chapter 157, Occupations Code; and
386	386	(2) the advanced practice registered nurse or
387	387	physician assistant meets the quality of care standards previously
388	388	established by the insurer for participation in the plan by
389	389	advanced practice registered nurses and physician assistants.
390	390	SECTION 1.23. Section 1451.001(2), Insurance Code, is
391	391	amended to read as follows:
392	392	(2) "Advanced practice registered nurse" has the
393	393	meaning assigned by Section 301.002, Occupations Code [means an
394	394	individual licensed by the Texas Board of Nursing as a registered
395	395	nurse and recognized by that board as an advanced practice nurse].
396	396	SECTION 1.24. Section 1451.104(c), Insurance Code, is
397	397	amended to read as follows:
398	398	(c) Notwithstanding Subsection (a), a health insurance
399	399	policy may provide for a different amount of payment or
400	400	reimbursement for scheduled services or procedures performed by an
401	401	advanced practice registered nurse, nurse first assistant,
402	402	licensed surgical assistant, or physician assistant if the
403	403	methodology used to compute the amount is the same as the
404	404	methodology used to compute the amount of payment or reimbursement
405	405	when the services or procedures are provided by a physician.
406	406	SECTION 1.25. Section 1451.106, Insurance Code, is amended
407	407	to read as follows:
408	408	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
409	409	NURSE. An insured may select an advanced practice registered nurse
410	410	to provide the services scheduled in the health insurance policy
411	411	that are within the scope of the nurse's license.
412	412	SECTION 1.26. Section 1452.051(1), Insurance Code, is
413	413	amended to read as follows:
414	414	(1) "Advanced practice nurse" has the meaning assigned
415	415	to "advanced practice registered nurse" by Section 301.002
416	416	[301.152], Occupations Code.
417	417	SECTION 1.27. Section 408.025, Labor Code, is amended by
418	418	amending Subsection (a-1) and adding Subsection (a-2) to read as
419	419	follows:
420	420	(a-1) A [treating doctor may delegate to a physician
421	421	assistant who is licensed to practice in this state under Chapter
422	422	204, Occupations Code, or an advanced practice registered nurse who
423	423	is licensed to practice in this state under Chapter 301,
424	424	Occupations Code, the authority to complete and sign a] work status
425	425	report regarding an injured employee's ability to return to work
426	426	may be completed and signed by:
427	427	(1) a physician assistant licensed to practice in this
428	428	state under Chapter 204, Occupations Code, who has been delegated
429	429	the authority by a treating doctor; or
430	430	(2) an advanced practice registered nurse, as defined
431	431	by Section 301.002, Occupations Code.
432	432	(a-2) The delegating treating doctor is responsible for the
433	433	acts of a [the] physician assistant [or advanced practice
434	434	registered nurse] under Subsection (a-1) [this subsection].
435	435	SECTION 1.28. The heading to Subchapter B, Chapter 157,
436	436	Occupations Code, is amended to read as follows:
437	437	SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
438	438	AND] PHYSICIAN ASSISTANTS
439	439	SECTION 1.29. Sections 157.051(11) and (14), Occupations
440	440	Code, are amended to read as follows:
441	441	(11) "Practice serving a medically underserved
442	442	population" means:
443	443	(A) a practice in a health professional shortage
444	444	area;
445	445	(B) a clinic designated as a rural health clinic
446	446	under 42 U.S.C. Section 1395x(aa);
447	447	(C) a public health clinic or a family planning
448	448	clinic under contract with the Health and Human Services Commission
449	449	or the Department of State Health Services;
450	450	(D) a clinic designated as a federally qualified
451	451	health center under 42 U.S.C. Section 1396d(l)(2)(B);
452	452	(E) a county, state, or federal correctional
453	453	facility;
454	454	(F) a practice:
455	455	(i) that either:
456	456	(a) is located in an area in which the
457	457	Department of State Health Services determines there is an
458	458	insufficient number of physicians providing services to eligible
459	459	clients of federally, state, or locally funded health care
460	460	programs; or
461	461	(b) is a practice that the Department
462	462	of State Health Services determines serves a disproportionate
463	463	number of clients eligible to participate in federally, state, or
464	464	locally funded health care programs; and
465	465	(ii) for which the Department of State
466	466	Health Services publishes notice of the department's determination
467	467	in the Texas Register and provides an opportunity for public
468	468	comment in the manner provided for a proposed rule under Chapter
469	469	2001, Government Code; or
470	470	(G) a practice at which a physician was
471	471	delegating prescriptive authority to an advanced practice
472	472	registered nurse, as defined by Section 301.002, or physician
473	473	assistant on or before March 1, 2013, based on the practice
474	474	qualifying as a site serving a medically underserved population.
475	475	(14) "Prescriptive authority agreement" means an
476	476	agreement entered into by a physician and a [an advanced practice
477	477	registered nurse or] physician assistant through which the
478	478	physician delegates to the [advanced practice registered nurse or]
479	479	physician assistant the act of prescribing or ordering a drug or
480	480	device.
481	481	SECTION 1.30. Section 157.0511(b-2), Occupations Code, is
482	482	amended to read as follows:
483	483	(b-2) The board shall adopt rules that require a physician
484	484	who delegates the prescribing or ordering of a drug or device to
485	485	register with the board the name and license number of the physician
486	486	assistant [or advanced practice registered nurse] to whom a
487	487	delegation is made. The board may develop and use an electronic
488	488	online delegation registration process for registration under this
489	489	subsection.
490	490	SECTION 1.31. Sections 157.0512(a), (b), (c), (e), (f),
491	491	(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
492	492	to read as follows:
493	493	(a) A physician may delegate to a [an advanced practice
494	494	registered nurse or] physician assistant, acting under adequate
495	495	physician supervision, the act of prescribing or ordering a drug or
496	496	device as authorized through a prescriptive authority agreement
497	497	between the physician and the [advanced practice registered nurse
498	498	or] physician assistant[, as applicable].
499	499	(b) A physician and a [an advanced practice registered nurse
500	500	or] physician assistant are eligible to enter into or be parties to
501	501	a prescriptive authority agreement only if:
502	502	(1) [if applicable, the Texas Board of Nursing has
503	503	approved the advanced practice registered nurse's authority to
504	504	prescribe or order a drug or device as authorized under this
505	505	subchapter;
506	506	[(2)] the [advanced practice registered nurse or]
507	507	physician assistant:
508	508	(A) holds an active license to practice in this
509	509	state as a [an advanced practice registered nurse or] physician
510	510	assistant[, as applicable,] and is in good standing in this state;
511	511	and
512	512	(B) is not currently prohibited by the [Texas
513	513	Board of Nursing or the] Texas Physician Assistant Board[, as
514	514	applicable,] from executing a prescriptive authority agreement;
515	515	and
516	516	(2) [(3)] before executing the prescriptive authority
517	517	agreement, the physician and the [advanced practice registered
518	518	nurse or] physician assistant disclose to the other prospective
519	519	party to the agreement any prior disciplinary action by the board[,
520	520	the Texas Board of Nursing,] or the Texas Physician Assistant
521	521	Board[, as applicable].
522	522	(c) Except as provided by Subsection (d), the [combined]
523	523	number of [advanced practice registered nurses and] physician
524	524	assistants with whom a physician may enter into a prescriptive
525	525	authority agreement may not exceed seven [advanced practice
526	526	registered nurses and] physician assistants or the full-time
527	527	equivalent of seven [advanced practice registered nurses and]
528	528	physician assistants.
529	529	(e) A prescriptive authority agreement must, at a minimum:
530	530	(1) be in writing and signed and dated by the parties
531	531	to the agreement;
532	532	(2) state the name, address, and all professional
533	533	license numbers of the parties to the agreement;
534	534	(3) state the nature of the practice, practice
535	535	locations, or practice settings;
536	536	(4) identify the types or categories of drugs or
537	537	devices that may be prescribed or the types or categories of drugs
538	538	or devices that may not be prescribed;
539	539	(5) provide a general plan for addressing consultation
540	540	and referral;
541	541	(6) provide a plan for addressing patient emergencies;
542	542	(7) state the general process for communication and
543	543	the sharing of information between the physician and the [advanced
544	544	practice registered nurse or] physician assistant to whom the
545	545	physician has delegated prescriptive authority related to the care
546	546	and treatment of patients;
547	547	(8) if alternate physician supervision is to be
548	548	utilized, designate one or more alternate physicians who may:
549	549	(A) provide appropriate supervision on a
550	550	temporary basis in accordance with the requirements established by
551	551	the prescriptive authority agreement and the requirements of this
552	552	subchapter; and
553	553	(B) participate in the prescriptive authority
554	554	quality assurance and improvement plan meetings required under this
555	555	section; and
556	556	(9) describe a prescriptive authority quality
557	557	assurance and improvement plan and specify methods for documenting
558	558	the implementation of the plan that include the following:
559	559	(A) chart review, with the number of charts to be
560	560	reviewed determined by the physician and [advanced practice
561	561	registered nurse or] physician assistant; and
562	562	(B) periodic meetings between the [advanced
563	563	practice registered nurse or] physician assistant and the
564	564	physician.
565	565	(f) The periodic meetings described by Subsection (e)(9)(B)
566	566	must:
567	567	(1) include:
568	568	(A) the sharing of information relating to
569	569	patient treatment and care, needed changes in patient care plans,
570	570	and issues relating to referrals; and
571	571	(B) discussion of patient care improvement;
572	572	(2) be documented; and
573	573	(3) take place at least once a month in a manner
574	574	determined by the physician and the [advanced practice registered
575	575	nurse or] physician assistant.
576	576	(g) The prescriptive authority agreement may include other
577	577	provisions agreed to by the physician and [advanced practice
578	578	registered nurse or] physician assistant.
579	579	(i) The prescriptive authority agreement need not describe
580	580	the exact steps that a [an advanced practice registered nurse or]
581	581	physician assistant must take with respect to each specific
582	582	condition, disease, or symptom.
583	583	(j) A physician[, advanced practice registered nurse,] or
584	584	physician assistant who is a party to a prescriptive authority
585	585	agreement must retain a copy of the agreement until the second
586	586	anniversary of the date the agreement is terminated.
587	587	(l) In the event that a party to a prescriptive authority
588	588	agreement is notified that the individual has become the subject of
589	589	an investigation by the board[, the Texas Board of Nursing,] or the
590	590	Texas Physician Assistant Board, the individual shall immediately
591	591	notify the other party to the prescriptive authority agreement.
592	592	(m) The prescriptive authority agreement and any amendments
593	593	must be reviewed at least annually, dated, and signed by the parties
594	594	to the agreement. The prescriptive authority agreement and any
595	595	amendments must be made available to the board[, the Texas Board of
596	596	Nursing,] or the Texas Physician Assistant Board not later than the
597	597	third business day after the date of receipt of request, if any.
598	598	(n) The prescriptive authority agreement should promote the
599	599	exercise of professional judgment by the [advanced practice
600	600	registered nurse or] physician assistant commensurate with the
601	601	[advanced practice registered nurse's or] physician assistant's
602	602	education and experience and the relationship between the [advanced
603	603	practice registered nurse or] physician assistant and the
604	604	physician.
605	605	(o) This section shall be liberally construed to allow the
606	606	use of prescriptive authority agreements to safely and effectively
607	607	utilize the skills and services of [advanced practice registered
608	608	nurses and] physician assistants.
609	609	SECTION 1.32. Section 157.0513, Occupations Code, is
610	610	amended to read as follows:
611	611	Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
612	612	INFORMATION. (a) The board[, the Texas Board of Nursing,] and the
613	613	Texas Physician Assistant Board shall jointly develop a process:
614	614	(1) to exchange information regarding the names,
615	615	locations, and license numbers of each physician[, advanced
616	616	practice registered nurse,] and physician assistant who has entered
617	617	into a prescriptive authority agreement;
618	618	(2) by which each board shall immediately notify the
619	619	other board [boards] when a license holder of the board becomes the
620	620	subject of an investigation involving the delegation and
621	621	supervision of prescriptive authority, as well as the final
622	622	disposition of any such investigation;
623	623	(3) by which each board shall maintain and share a list
624	624	of the board's license holders who have been subject to a final
625	625	adverse disciplinary action for an act involving the delegation and
626	626	supervision of prescriptive authority; and
627	627	(4) to ensure that each [advanced practice registered
628	628	nurse or] physician assistant who has entered into a prescriptive
629	629	authority agreement authorizing the prescribing of opioids is
630	630	required to complete not less than two hours of continuing
631	631	education annually regarding safe and effective pain management
632	632	related to the prescription of opioids and other controlled
633	633	substances, including education regarding:
634	634	(A) reasonable standards of care;
635	635	(B) the identification of drug-seeking behavior
636	636	in patients; and
637	637	(C) effectively communicating with patients
638	638	regarding the prescription of an opioid or other controlled
639	639	substance.
640	640	(b) If the board[, the Texas Board of Nursing,] or the Texas
641	641	Physician Assistant Board receives a notice under Subsection
642	642	(a)(2), the board that received notice may open an investigation
643	643	against a license holder of the board who is a party to a
644	644	prescriptive authority agreement with the license holder who is
645	645	under investigation by the board that provided notice under
646	646	Subsection (a)(2).
647	647	(c) The board shall maintain and make available to the
648	648	public a searchable online list of physicians[, advanced practice
649	649	registered nurses,] and physician assistants who have entered into
650	650	a prescriptive authority agreement authorized under Section
651	651	157.0512 and identify the physician[, advanced practice registered
652	652	nurse, or physician assistant] with whom each [physician, advanced
653	653	practice registered nurse, and] physician assistant has entered
654	654	into a prescriptive authority agreement.
655	655	(d) The board shall collaborate with the [Texas Board of
656	656	Nursing and the] Texas Physician Assistant Board to maintain and
657	657	make available to the public a list of physicians[, advanced
658	658	practice registered nurses,] and physician assistants who are
659	659	prohibited from entering into or practicing under a prescriptive
660	660	authority agreement.
661	661	SECTION 1.33. Sections 157.054(a), (a-1), (b), and (c),
662	662	Occupations Code, are amended to read as follows:
663	663	(a) One or more physicians licensed by the board may
664	664	delegate, to one or more physician assistants [or advanced practice
665	665	registered nurses] acting under adequate physician supervision
666	666	whose practice is facility-based at a hospital or licensed
667	667	long-term care facility, the administration or provision of a drug
668	668	and the prescribing or ordering of a drug or device if each of the
669	669	delegating physicians is:
670	670	(1) the medical director or chief of medical staff of
671	671	the facility in which the physician assistant [or advanced practice
672	672	registered nurse] practices;
673	673	(2) the chair of the facility's credentialing
674	674	committee;
675	675	(3) a department chair of a facility department in
676	676	which the physician assistant [or advanced practice registered
677	677	nurse] practices; or
678	678	(4) a physician who consents to the request of the
679	679	medical director or chief of medical staff to delegate the
680	680	prescribing or ordering of a drug or device at the facility in which
681	681	the physician assistant [or advanced practice registered nurse]
682	682	practices.
683	683	(a-1) The limit [limits] on the number of [advanced practice
684	684	registered nurses or] physician assistants to whom a physician may
685	685	delegate under Section 157.0512 does [do] not apply to a physician
686	686	under Subsection (a) whose practice is facility-based under this
687	687	section, provided that the physician is not delegating in a
688	688	freestanding clinic, center, or practice of the facility.
689	689	(b) A physician's authority to delegate under Subsection
690	690	(a) is limited as follows:
691	691	(1) the delegation must be made under a physician's
692	692	order, standing medical order, standing delegation order, or
693	693	another order or protocol developed in accordance with policies
694	694	approved by the facility's medical staff or a committee of the
695	695	facility's medical staff as provided by the facility bylaws;
696	696	(2) the delegation must occur in the facility in which
697	697	the physician is the medical director, the chief of medical staff,
698	698	the chair of the credentialing committee, a department chair, or a
699	699	physician who consents to delegate under Subsection (a)(4);
700	700	(3) the delegation may not permit the prescribing or
701	701	ordering of a drug or device for the care or treatment of the
702	702	patients of any other physician without the prior consent of that
703	703	physician; and
704	704	(4) delegation in a long-term care facility must be by
705	705	the medical director and is limited to the prescribing or ordering
706	706	of a drug or device to not more than seven [advanced practice
707	707	registered nurses or] physician assistants or their full-time
708	708	equivalents.
709	709	(c) Physician supervision of the prescribing or ordering of
710	710	a drug or device must conform to what a reasonable, prudent
711	711	physician would find consistent with sound medical judgment but may
712	712	vary with the education and experience of the particular [advanced
713	713	practice registered nurse or] physician assistant. A physician
714	714	shall provide continuous supervision, but the constant physical
715	715	presence of the physician is not required.
716	716	SECTION 1.34. Section 157.055, Occupations Code, is amended
717	717	to read as follows:
718	718	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
719	719	order shall be defined in a manner that promotes the exercise of
720	720	professional judgment by the [advanced practice registered nurse
721	721	and] physician assistant commensurate with the education and
722	722	experience of that person. Under this section, an order or
723	723	protocol used by a reasonable and prudent physician exercising
724	724	sound medical judgment:
725	725	(1) is not required to describe the exact steps that
726	726	[an advanced practice registered nurse or] a physician assistant
727	727	must take with respect to each specific condition, disease, or
728	728	symptom; and
729	729	(2) may state the types or categories of medications
730	730	that may be prescribed or the types or categories of medications
731	731	that may not be prescribed.
732	732	SECTION 1.35. Section 157.056, Occupations Code, is amended
733	733	to read as follows:
734	734	Sec. 157.056. PRESCRIPTION INFORMATION. The following
735	735	information must be provided on each prescription subject to this
736	736	subchapter:
737	737	(1) the patient's name and address;
738	738	(2) the drug to be dispensed;
739	739	(3) directions to the patient regarding the taking of
740	740	the drug and the dosage;
741	741	(4) the intended use of the drug, if appropriate;
742	742	(5) the name, address, and telephone number of the
743	743	physician;
744	744	(6) the name, address, telephone number, and
745	745	identification number of the [registered nurse or] physician
746	746	assistant completing or signing the prescription drug order;
747	747	(7) the date; and
748	748	(8) the number of refills permitted.
749	749	SECTION 1.36. Sections 157.059(b), (e), (f), (g), (h), and
750	750	(i), Occupations Code, are amended to read as follows:
751	751	(b) A physician may delegate to a physician assistant
752	752	offering obstetrical services and certified by the board as
753	753	specializing in obstetrics [or an advanced practice registered
754	754	nurse recognized by the Texas Board of Nursing as a nurse midwife]
755	755	the act of administering or providing controlled substances to the
756	756	physician assistant's [or nurse midwife's] clients during
757	757	intrapartum and immediate postpartum care.
758	758	(e) The physician's orders, medical orders, standing
759	759	delegation orders, prescriptive authority agreements, or protocols
760	760	must require the reporting of or monitoring of each client's
761	761	progress, including complications of pregnancy and delivery and the
762	762	administration and provision of controlled substances by the [nurse
763	763	midwife or] physician assistant to the clients of the [nurse
764	764	midwife or] physician assistant.
765	765	(f) The authority of a physician to delegate under this
766	766	section is limited to:
767	767	(1) seven [nurse midwives or] physician assistants or
768	768	their full-time equivalents; and
769	769	(2) the designated facility at which the [nurse
770	770	midwife or] physician assistant provides care.
771	771	(g) The controlled substance must be supplied in a suitable
772	772	container that is labeled in compliance with the applicable drug
773	773	laws and must include:
774	774	(1) the patient's name and address;
775	775	(2) the drug to be provided;
776	776	(3) the name, address, and telephone number of the
777	777	physician;
778	778	(4) the name, address, and telephone number of the
779	779	[nurse midwife or] physician assistant; and
780	780	(5) the date.
781	781	(h) This section does not authorize a physician or [,]
782	782	physician assistant[, or nurse midwife] to operate a retail
783	783	pharmacy as defined under Subtitle J.
784	784	(i) This section authorizes a physician to delegate the act
785	785	of administering or providing a controlled substance to a [nurse
786	786	midwife or] physician assistant but does not require physician
787	787	delegation of[:
788	788	[(1) further acts to a nurse midwife; or
789	789	[(2)] the administration of medications by a physician
790	790	assistant [or registered nurse] other than as provided by this
791	791	section.
792	792	SECTION 1.37. Section 157.060, Occupations Code, is amended
793	793	to read as follows:
794	794	Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED
795	795	ACT. Unless the physician has reason to believe the physician
796	796	assistant [or advanced practice registered nurse] lacked the
797	797	competency to perform the act, a physician is not liable for an act
798	798	of a physician assistant [or advanced practice registered nurse]
799	799	solely because the physician signed a standing medical order, a
800	800	standing delegation order, or another order or protocol, or entered
801	801	into a prescriptive authority agreement, authorizing the physician
802	802	assistant [or advanced practice registered nurse] to administer,
803	803	provide, prescribe, or order a drug or device.
804	804	SECTION 1.38. Section 203.002(2), Occupations Code, is
805	805	amended to read as follows:
806	806	(2) "Certified nurse-midwife" means an advanced
807	807	practice [a person who is:
808	808	[(A) a] registered nurse as defined by Section
809	809	301.002 who is [under Chapter 301;
810	810	[(B) recognized as an advanced nurse
811	811	practitioner by the Texas Board of Nursing; and
812	812	[(C)] certified by the American College of
813	813	Nurse-Midwives.
814	814	SECTION 1.39. Section 204.1025, Occupations Code, is
815	815	amended to read as follows:
816	816	Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
817	817	AGREEMENTS. The physician assistant board shall in conjunction
818	818	with the Texas Medical Board [and the Texas Board of Nursing]
819	819	perform the functions and duties relating to prescriptive authority
820	820	agreements assigned to the physician assistant board in Sections
821	821	157.0512 and 157.0513.
822	822	SECTION 1.40. Section 301.002, Occupations Code, is amended
823	823	to read as follows:
824	824	Sec. 301.002. DEFINITIONS. In this chapter:
825	825	(1) "Advanced practice registered nurse" means a
826	826	registered nurse licensed by the board to practice as an advanced
827	827	practice registered nurse on the basis of completion of an advanced
828	828	educational program. The term includes a nurse practitioner, nurse
829	829	midwife, nurse anesthetist, and clinical nurse specialist.
830	830	(2) [(1)] "Board" means the Texas Board of Nursing.
831	831	(3) [(1-a)] "Chief nursing officer" means the
832	832	registered nurse who is administratively responsible for the
833	833	nursing services at a facility.
834	834	(4) "Controlled substance" has the meaning assigned by
835	835	Section 481.002, Health and Safety Code.
836	836	(5) "Dangerous drug" has the meaning assigned by
837	837	Section 483.001, Health and Safety Code.
838	838	(6) "Device" has the meaning assigned by Section
839	839	551.003, and includes durable medical equipment.
840	840	(7) "Nonprescription drug" has the meaning assigned by
841	841	Section 551.003.
842	842	(8) "Nurse" means a person required to be licensed
843	843	under this chapter to engage in professional or vocational nursing.
844	844	(9) "Nursing" means professional or vocational
845	845	nursing.
846	846	(10) [(1-b)] "Patient safety committee" has the
847	847	meaning assigned by Section 303.001.
848	848	(11) "Prescribe or order a drug or device" has the
849	849	meaning assigned by Section 157.051.
850	850	(12) [(2)] "Professional nursing" means the
851	851	performance of an act that requires substantial specialized
852	852	judgment and skill, the proper performance of which is based on
853	853	knowledge and application of the principles of biological,
854	854	physical, and social science as acquired by a completed course in an
855	855	approved school of professional nursing. The term does not include
856	856	acts of medical diagnosis or the prescription of therapeutic or
857	857	corrective measures, except as authorized for an advanced practice
858	858	registered nurse. Professional nursing involves:
859	859	(A) the observation, assessment, intervention,
860	860	evaluation, rehabilitation, care and counsel, or health teachings
861	861	of a person who is ill, injured, infirm, or experiencing a change in
862	862	normal health processes;
863	863	(B) the maintenance of health or prevention of
864	864	illness;
865	865	(C) the administration of a medication or
866	866	treatment as ordered by a health care practitioner legally
867	867	authorized to prescribe the medication or treatment [physician,
868	868	podiatrist, or dentist];
869	869	(D) the supervision or teaching of nursing;
870	870	(E) the administration, supervision, and
871	871	evaluation of nursing practices, policies, and procedures;
872	872	(F) [the requesting, receiving, signing for, and
873	873	distribution of prescription drug samples to patients at practices
874	874	at which an advanced practice registered nurse is authorized to
875	875	sign prescription drug orders as provided by Subchapter B, Chapter
876	876	157;
877	877	[(G)] the performance of an act by an advanced
878	878	practice registered nurse [delegated by a physician under Section
879	879	157.0512, 157.054, 157.058, or 157.059]; and
880	880	(G) [(H)] the development of the nursing care
881	881	plan.
882	882	[(3) "Nurse" means a person required to be licensed
883	883	under this chapter to engage in professional or vocational nursing.
884	884	[(4) "Nursing" means professional or vocational
885	885	nursing.]
886	886	(13) [(5)] "Vocational nursing" means a directed
887	887	scope of nursing practice, including the performance of an act that
888	888	requires specialized judgment and skill, the proper performance of
889	889	which is based on knowledge and application of the principles of
890	890	biological, physical, and social science as acquired by a completed
891	891	course in an approved school of vocational nursing. The term does
892	892	not include acts of medical diagnosis or the prescription of
893	893	therapeutic or corrective measures. Vocational nursing involves:
894	894	(A) collecting data and performing focused
895	895	nursing assessments of the health status of an individual;
896	896	(B) participating in the planning of the nursing
897	897	care needs of an individual;
898	898	(C) participating in the development and
899	899	modification of the nursing care plan;
900	900	(D) participating in health teaching and
901	901	counseling to promote, attain, and maintain the optimum health
902	902	level of an individual;
903	903	(E) assisting in the evaluation of an
904	904	individual's response to a nursing intervention and the
905	905	identification of an individual's needs; and
906	906	(F) engaging in other acts that require education
907	907	and training, as prescribed by board rules and policies,
908	908	commensurate with the nurse's experience, continuing education,
909	909	and demonstrated competency.
910	910	SECTION 1.41. Section 301.005(b), Occupations Code, is
911	911	amended to read as follows:
912	912	(b) A reference in any other law to an "advanced nurse
913	913	practitioner," [or] "advanced practice nurse," or "advanced
914	914	practice registered nurse" means an advanced practice registered
915	915	nurse.
916	916	SECTION 1.42. Section 301.152, Occupations Code, is
917	917	transferred to Subchapter H, Chapter 301, Occupations Code,
918	918	redesignated as Section 301.357, Occupations Code, and amended to
919	919	read as follows:
920	920	Sec. 301.357 [301.152]. ADVANCED PRACTICE REGISTERED NURSES
921	921	[RULES REGARDING SPECIALIZED TRAINING]. (a) Advanced practice
922	922	registered nursing includes:
923	923	(1) ordering, performing, and interpreting diagnostic
924	924	tests;
925	925	(2) formulating primary and differential medical
926	926	diagnoses and advanced assessments;
927	927	(3) treating actual and potential health problems;
928	928	(4) prescribing therapeutic and corrective measures,
929	929	including nutrition and diagnostic support services, home health
930	930	care, hospice care, physical therapy, and occupational therapy, and
931	931	delegating and assigning the performance of therapeutic and
932	932	corrective measures to assistive personnel;
933	933	(5) to the extent authorized by the board under
934	934	Section 301.358, prescribing, ordering, procuring, administering,
935	935	and dispensing drugs and devices, including blood and blood
936	936	products, controlled substances listed in Schedules II, III, IV,
937	937	and V, dangerous drugs, and nonprescription drugs;
938	938	(6) providing referrals to health care agencies,
939	939	health care providers, and community resources;
940	940	(7) serving as the primary care provider of record;
941	941	and
942	942	(8) performing other acts that require education and
943	943	training consistent with professional standards and that are
944	944	commensurate with the advanced practice registered nurse's
945	945	education, licensure, and demonstrated competencies and
946	946	experience. [In this section, "advanced practice registered nurse"
947	947	means a registered nurse licensed by the board to practice as an
948	948	advanced practice registered nurse on the basis of completion of an
949	949	advanced educational program. The term includes a nurse
950	950	practitioner, nurse midwife, nurse anesthetist, and clinical nurse
951	951	specialist. The term is synonymous with "advanced nurse
952	952	practitioner" and "advanced practice nurse."]
953	953	(b) The board shall adopt rules to:
954	954	(1) license a registered nurse as an advanced practice
955	955	registered nurse;
956	956	(2) establish:
957	957	(A) any specialized education or training,
958	958	including pharmacology, that an advanced practice registered nurse
959	959	must have to prescribe or order a drug or device as authorized
960	960	[delegated] by the board [a physician] under Section 301.358
961	961	[157.0512 or 157.054];
962	962	(B) a system for approving an advanced practice
963	963	registered nurse to prescribe or order a drug or device as
964	964	authorized [delegated] by the board [a physician] under Section
965	965	301.358 [157.0512 or 157.054] on the receipt of evidence of
966	966	completing the specialized education and training requirement
967	967	under Paragraph (A); and
968	968	(C) a system for issuing a prescription
969	969	authorization number to an advanced practice registered nurse
970	970	approved under Paragraph (B); and
971	971	(3) concurrently renew any license or approval granted
972	972	to an advanced practice registered nurse under this subsection and
973	973	a license renewed by the advanced practice registered nurse under
974	974	Section 301.301.
975	975	(c) At a minimum, the rules adopted under Subsection (b)(2)
976	976	must:
977	977	(1) require completion of pharmacology and related
978	978	pathophysiology education for initial approval; and
979	979	(2) require continuing education in clinical
980	980	pharmacology and related pathophysiology in addition to any
981	981	continuing education otherwise required under Section 301.303.
982	982	(d) The signature of an advanced practice registered nurse
983	983	attesting to the provision of a legally authorized service by the
984	984	advanced practice registered nurse satisfies any documentation
985	985	requirement for that service established by a state agency.
986	986	(e) An advanced practice registered nurse shall practice as
987	987	a licensed independent practitioner in accordance with standards
988	988	established and recognized by the board to protect the public
989	989	health and safety.
990	990	(f) An advanced practice registered nurse is accountable to
991	991	patients, the nursing profession, and the board for:
992	992	(1) complying with the requirements of this chapter;
993	993	(2) providing quality advanced nursing care;
994	994	(3) recognizing the nurse's limits of knowledge;
995	995	(4) planning for the management of situations beyond
996	996	the nurse's expertise; and
997	997	(5) consulting with or referring patients to other
998	998	health care providers as appropriate.
999	999	(g) This section does not limit or modify the scope of
1000	1000	practice of a registered nurse who is not an advanced practice
1001	1001	registered nurse.
1002	1002	(h) Notwithstanding any other law, an advanced practice
1003	1003	registered nurse performing an act described by Subsection (a) is
1004	1004	not considered to be practicing medicine without a license.
1005	1005	SECTION 1.43. Section 301.354(a), Occupations Code, is
1006	1006	amended to read as follows:
1007	1007	(a) In this section, "nurse first assistant" means a
1008	1008	registered nurse who:
1009	1009	(1) has completed a nurse first assistant educational
1010	1010	program approved or recognized by an organization recognized by the
1011	1011	board; and
1012	1012	(2) [is] either:
1013	1013	(A) is certified in perioperative nursing by an
1014	1014	organization recognized by the board; or
1015	1015	(B) is [recognized by the board as] an advanced
1016	1016	practice registered nurse [and] qualified by education, training,
1017	1017	or experience to perform the tasks involved in perioperative
1018	1018	nursing.
1019	1019	SECTION 1.44. Subchapter H, Chapter 301, Occupations Code,
1020	1020	is amended by adding Section 301.358 to read as follows:
1021	1021	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
1022	1022	ADVANCED PRACTICE REGISTERED NURSE. (a) The board may authorize an
1023	1023	advanced practice registered nurse to prescribe and order drugs and
1024	1024	devices, including controlled substances listed in Schedules III,
1025	1025	IV, and V, dangerous drugs, and nonprescription drugs.
1026	1026	(b) Except as provided by Subsection (c), the board may
1027	1027	authorize an advanced practice registered nurse to prescribe and
1028	1028	order controlled substances listed in Schedule II only:
1029	1029	(1) in a hospital facility-based practice in
1030	1030	accordance with policies approved by the hospital's medical staff
1031	1031	or a committee of the hospital's medical staff as provided by the
1032	1032	hospital bylaws to ensure patient safety, and as part of the care
1033	1033	provided to a patient who:
1034	1034	(A) has been admitted to the hospital and is
1035	1035	expected to remain in the hospital for a period of 24 hours or more;
1036	1036	or
1037	1037	(B) is receiving services in the emergency
1038	1038	department of the hospital; or
1039	1039	(2) as part of the plan of care for the treatment of a
1040	1040	person who has executed a written certification of a terminal
1041	1041	illness, has elected to receive hospice care, and is receiving
1042	1042	hospice treatment from a qualified hospice provider.
1043	1043	(c) The board may authorize a certified registered nurse
1044	1044	anesthetist practicing in an ambulatory surgical center to order
1045	1045	drugs and devices necessary for the nurse anesthetist to administer
1046	1046	an anesthetic or anesthesia-related service.
1047	1047	SECTION 1.45. Sections 551.003(14) and (34), Occupations
1048	1048	Code, are amended to read as follows:
1049	1049	(14) "Designated agent" means:
1050	1050	(A) an individual, including a licensed nurse,
1051	1051	physician assistant, or pharmacist:
1052	1052	(i) who is designated by a practitioner and
1053	1053	authorized to communicate a prescription drug order to a
1054	1054	pharmacist; and
1055	1055	(ii) for whom the practitioner assumes
1056	1056	legal responsibility;
1057	1057	(B) a licensed nurse, physician assistant, or
1058	1058	pharmacist employed in a health care facility to whom a
1059	1059	practitioner communicates a prescription drug order; or
1060	1060	(C) a [registered nurse or] physician assistant
1061	1061	authorized by a practitioner to administer a prescription drug
1062	1062	order for a dangerous drug under Subchapter B, Chapter 157.
1063	1063	(34) "Practitioner" means:
1064	1064	(A) a person licensed or registered to prescribe,
1065	1065	distribute, administer, or dispense a prescription drug or device
1066	1066	in the course of professional practice in this state, including a
1067	1067	physician, dentist, podiatrist, advanced practice registered nurse
1068	1068	authorized to prescribe and order drugs and devices under Section
1069	1069	301.358, or veterinarian but excluding a person licensed under this
1070	1070	subtitle;
1071	1071	(B) a person licensed by another state, Canada,
1072	1072	or the United Mexican States in a health field in which, under the
1073	1073	law of this state, a license holder in this state may legally
1074	1074	prescribe a dangerous drug;
1075	1075	(C) a person practicing in another state and
1076	1076	licensed by another state as a physician, dentist, veterinarian,
1077	1077	advanced practice registered nurse, or podiatrist, who has a
1078	1078	current federal Drug Enforcement Administration registration
1079	1079	number and who may legally prescribe a Schedule II, III, IV, or V
1080	1080	controlled substance, as specified under Chapter 481, Health and
1081	1081	Safety Code, in that other state; or
1082	1082	(D) a [an advanced practice registered nurse or]
1083	1083	physician assistant to whom a physician has delegated the authority
1084	1084	to prescribe or order a drug or device under Section 157.0511,
1085	1085	157.0512, or 157.054.
1086	1086	SECTION 1.46. Section 563.051(e), Occupations Code, is
1087	1087	amended to read as follows:
1088	1088	(e) A practitioner may designate a licensed vocational
1089	1089	nurse or a person having education equivalent to or greater than
1090	1090	that required for a licensed vocational nurse to communicate the
1091	1091	prescriptions of a [an advanced practice nurse or] physician
1092	1092	assistant authorized by the practitioner to sign prescription drug
1093	1093	orders under Subchapter B, Chapter 157, or of an advanced practice
1094	1094	registered nurse.
1095	1095	SECTION 1.47. Sections 605.002(14) and (18), Occupations
1096	1096	Code, are amended to read as follows:
1097	1097	(14) "Orthotics" means the science and practice of
1098	1098	measuring, designing, fabricating, assembling, fitting, adjusting,
1099	1099	or servicing an orthosis under an order from a licensed physician,
1100	1100	chiropractor, [or] podiatrist, or [an] advanced practice
1101	1101	registered nurse, or from a physician assistant acting under the
1102	1102	delegation and supervision of a licensed physician as provided by
1103	1103	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1104	1104	Board, for the correction or alleviation of a neuromuscular or
1105	1105	musculoskeletal dysfunction, disease, injury, or deformity.
1106	1106	(18) "Prosthetics" means the science and practice of
1107	1107	measuring, designing, fabricating, assembling, fitting, adjusting,
1108	1108	or servicing a prosthesis under an order from a licensed physician,
1109	1109	chiropractor, [or] podiatrist, or [an] advanced practice
1110	1110	registered nurse, or from a physician assistant acting under the
1111	1111	delegation and supervision of a licensed physician as provided by
1112	1112	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1113	1113	Board.
1114	1114	SECTION 1.48. Section 605.2515, Occupations Code, is
1115	1115	amended to read as follows:
1116	1116	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
1117	1117	person licensed to practice orthotics or prosthetics who measures,
1118	1118	designs, fabricates, fits, assembles, adjusts, or services an
1119	1119	orthosis or a prosthesis under an order from a licensed physician,
1120	1120	chiropractor, [or] podiatrist, or [an] advanced practice
1121	1121	registered nurse, or from a physician assistant acting under the
1122	1122	delegation and supervision of a licensed physician as provided by
1123	1123	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1124	1124	Board, for a specific patient is exempt from licensing as a device
1125	1125	manufacturer under Subchapter L, Chapter 431, Health and Safety
1126	1126	Code. A person licensed to practice orthotics or prosthetics who
1127	1127	fabricates or assembles an orthosis or a prosthesis without an
1128	1128	order from a licensed physician, chiropractor, [or] podiatrist, or
1129	1129	[an] advanced practice registered nurse, or from a physician
1130	1130	assistant acting under the delegation and supervision of a licensed
1131	1131	physician as provided by Subchapter B, Chapter 157, and rules
1132	1132	adopted by the Texas Medical Board, for a specific patient is
1133	1133	required to be licensed as a device manufacturer under Subchapter
1134	1134	L, Chapter 431, Health and Safety Code.
1135	1135	SECTION 1.49. The following provisions are repealed:
1136	1136	(1) Section 533.005(d), Government Code;
1137	1137	(2) Section 62.1551(b), Health and Safety Code; and
1138	1138	(3) Sections 157.051(1), 157.058, and 301.168,
1139	1139	Occupations Code.
1140	1140	SECTION 1.50. Not later than February 1, 2022, the Texas
1141	1141	Board of Nursing shall adopt the rules necessary to implement the
1142	1142	changes in law made by this Act.
1143	1143	SECTION 1.51. Notwithstanding any changes in law made by
1144	1144	this Act, an advanced practice registered nurse who has been
1145	1145	delegated the authority to prescribe and order drugs and medical
1146	1146	devices by a physician's protocol or order under Section 157.0511,
1147	1147	157.0512, or 157.054, Occupations Code, may continue to exercise
1148	1148	that authority until February 1, 2022.
1149	1149	ARTICLE 2. DENTAL HYGIENISTS
1150	1150	SECTION 2.01. Section 258.001, Occupations Code, is amended
1151	1151	to read as follows:
1152	1152	Sec. 258.001. [IMPERMISSIBLE] DELEGATIONS. (a) A dentist
1153	1153	may not delegate:
1154	1154	(1) an act to an individual who, by board order, is
1155	1155	prohibited from performing the act;
1156	1156	(2) any of the following acts to a person not licensed
1157	1157	as a dentist or dental hygienist:
1158	1158	(A) the removal of calculus, deposits, or
1159	1159	accretions from the natural and restored surfaces of exposed human
1160	1160	teeth and restorations in the human mouth;
1161	1161	(B) root planing or the smoothing and polishing
1162	1162	of roughened root surfaces or exposed human teeth; or
1163	1163	(C) any other act the delegation of which is
1164	1164	prohibited by board rule; or
1165	1165	(3) any of the following acts to a person not licensed
1166	1166	as a dentist:
1167	1167	(A) comprehensive examination or diagnosis and
1168	1168	treatment planning;
1169	1169	(B) a surgical or cutting procedure on hard or
1170	1170	soft tissue;
1171	1171	(C) the prescription of a drug, medication, or
1172	1172	work authorization;
1173	1173	(D) the taking of an impression for a final
1174	1174	restoration, appliance, or prosthesis;
1175	1175	(E) the making of an intraoral occlusal
1176	1176	adjustment;
1177	1177	(F) direct pulp capping, pulpotomy, or any other
1178	1178	endodontic procedure;
1179	1179	(G) the final placement and intraoral adjustment
1180	1180	of a fixed or removable appliance; or
1181	1181	(H) the placement of any final restoration.
1182	1182	(b) A dentist may delegate[; or
1183	1183	[(4) the authority] to an individual the authority to
1184	1184	administer a local anesthetic agent, inhalation sedative agent,
1185	1185	parenteral sedative agent, or general anesthetic agent if the
1186	1186	individual is [not] licensed as:
1187	1187	(1) [(A)] a dentist, with a permit issued by the board
1188	1188	for the procedure being performed[,] if a permit is required;
1189	1189	(2) [(B)] a certified registered nurse anesthetist
1190	1190	[licensed] by the Texas Board of Nursing, only if the delegating
1191	1191	dentist holds a permit issued by the board for the procedure being
1192	1192	performed[,] if a permit is required; [or]
1193	1193	(3) [(C)] a physician anesthesiologist [licensed] by
1194	1194	the Texas Medical Board; or
1195	1195	(4) a dental hygienist, only if:
1196	1196	(A) the procedure is the administration of a
1197	1197	local anesthetic agent under Section 262.002(a)(6);
1198	1198	(B) the dental hygienist has passed a
1199	1199	certification examination approved by the board; and
1200	1200	(C) the dental hygienist:
1201	1201	(i) has completed a course approved by the
1202	1202	board to train dental hygienists to administer local anesthetic
1203	1203	agents; or
1204	1204	(ii) has been licensed in good standing
1205	1205	within the preceding year to administer local anesthetic agents:
1206	1206	(a) by a branch of the United States
1207	1207	armed forces; or
1208	1208	(b) by another state.
1209	1209	SECTION 2.02. Section 262.002(a), Occupations Code, is
1210	1210	amended to read as follows:
1211	1211	(a) A person practices dental hygiene if the person:
1212	1212	(1) removes accumulated matter, tartar, deposits,
1213	1213	accretions, or stains, other than mottled enamel stains, from the
1214	1214	natural and restored surface of exposed human teeth and
1215	1215	restorations in the human mouth;
1216	1216	(2) smoothes roughened root surfaces;
1217	1217	(3) polishes exposed human teeth, restorations in the
1218	1218	human mouth, or roughened root surfaces;
1219	1219	(4) topically applies drugs to the surface tissues of
1220	1220	the human mouth or the exposed surface of human teeth;
1221	1221	(5) makes dental x-rays; [and]
1222	1222	(6) administers intraoral block or infiltration
1223	1223	anesthesia under the authorization and direct supervision of a
1224	1224	dentist; and
1225	1225	(7) performs any other service, task, or procedure
1226	1226	prescribed by board rule.
1227	1227	SECTION 2.03. (a) Not later than January 1, 2022, the State
1228	1228	Board of Dental Examiners shall:
1229	1229	(1) prescribe by rule the requirements for a course to
1230	1230	train dental hygienists to administer local anesthetic agents; and
1231	1231	(2) develop a procedure for the approval of courses
1232	1232	described by Subdivision (1) of this subsection.
1233	1233	(b) A rule adopted under Subsection (a) of this section must
1234	1234	require that a course be offered in a classroom setting at an
1235	1235	educational institution accredited by the Commission on Dental
1236	1236	Accreditation of the American Dental Association.
1237	1237	ARTICLE 3. OPTOMETRISTS AND THERAPEUTIC OPTOMETRISTS
1238	1238	SECTION 3.01. Section 351.002(7), Occupations Code, is
1239	1239	amended to read as follows:
1240	1240	(7) "Practice of therapeutic optometry" means using
1241	1241	objective or subjective means, [not] including surgery, except as
1242	1242	prohibited by Section 351.4521 [or laser surgery], to:
1243	1243	(A) determine or measure the powers of vision of
1244	1244	the human eye as provided by Section 351.355;
1245	1245	(B) examine or diagnose visual defects, abnormal
1246	1246	conditions, or diseases of the human eye or adnexa;
1247	1247	(C) prescribe or fit lenses or prisms to correct
1248	1248	or remedy a defect or abnormal condition of vision as provided by
1249	1249	Section 351.356;
1250	1250	(D) administer or prescribe a drug or physical
1251	1251	treatment in the manner authorized by this chapter; or
1252	1252	(E) treat the visual system, including the eye or
1253	1253	adnexa as authorized by this chapter.
1254	1254	SECTION 3.02. The heading to Section 351.151, Occupations
1255	1255	Code, is amended to read as follows:
1256	1256	Sec. 351.151. RULES; INTERPRETATION OF CHAPTER AND RULES.
1257	1257	SECTION 3.03. Section 351.151, Occupations Code, is amended
1258	1258	by adding Subsection (c) to read as follows:
1259	1259	(c) The board may provide an interpretation of a provision
1260	1260	of this chapter or a rule adopted under this chapter, including by
1261	1261	issuing an advisory opinion or declaratory ruling.
1262	1262	SECTION 3.04. Subchapter D, Chapter 351, Occupations Code,
1263	1263	is amended by adding Section 351.170 to read as follows:
1264	1264	Sec. 351.170. SOLE AUTHORITY OVER PRACTICE OF OPTOMETRY.
1265	1265	The board has sole authority to regulate optometrists and
1266	1266	therapeutic optometrists and to determine the scope of practice of
1267	1267	an optometrist or therapeutic optometrist.
1268	1268	SECTION 3.05. Section 351.358, Occupations Code, is amended
1269	1269	by amending Subsections (b) and (c) and adding Subsection (f) to
1270	1270	read as follows:
1271	1271	(b) A therapeutic optometrist may[:
1272	1272	[(1)] administer, perform, or prescribe ophthalmic
1273	1273	devices, procedures, and appropriate medications administered by
1274	1274	any [topical or oral] means[, in accordance with this section and
1275	1275	Section 351.3581,] to diagnose or treat visual defects, abnormal
1276	1276	conditions, or diseases of the human vision system, including the
1277	1277	eye and adnexa[; or
1278	1278	[(2) administer medication by parenteral means for a
1279	1279	purpose and in a manner prescribed by Subsection (e)].
1280	1280	(c) A therapeutic optometrist may prescribe not more than
1281	1281	[oral medications only in the following classifications of oral
1282	1282	pharmaceuticals]:
1283	1283	(1) [one 10-day supply of oral antibiotics;
1284	1284	[(2) one 72-hour supply of oral antihistamines;
1285	1285	[(3) one seven-day supply of oral nonsteroidal
1286	1286	anti-inflammatories;
1287	1287	[(4)] one three-day supply of any medication
1288	1288	classified as a controlled substance under Schedule [analgesic
1289	1289	identified in Schedules] III, IV, or [and] V of 21 U.S.C. Section
1290	1290	812; and
1291	1291	(2) one three-day supply of hydrocodone or a
1292	1292	hydrocodone combination medication classified as a controlled
1293	1293	substance under Schedule II of 21 U.S.C. Section 812 [(5) any
1294	1294	other oral pharmaceutical recommended by the Optometric Health Care
1295	1295	Advisory Committee and approved by the board and the Texas State
1296	1296	Board of Medical Examiners].
1297	1297	(f) A therapeutic optometrist may administer, perform,
1298	1298	prescribe, or order diagnostic studies, analyses, tests, imaging
1299	1299	studies, or laboratory tests necessary to diagnose or treat visual
1300	1300	defects, abnormal conditions, or diseases of the human vision
1301	1301	system, including the eye and adnexa.
1302	1302	SECTION 3.06. The heading to Section 351.3581, Occupations
1303	1303	Code, is amended to read as follows:
1304	1304	Sec. 351.3581. [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.
1305	1305	SECTION 3.07. Section 351.3581(a), Occupations Code, is
1306	1306	amended to read as follows:
1307	1307	(a) A therapeutic optometrist may not administer or
1308	1308	prescribe an oral or parenteral medication or treat glaucoma unless
1309	1309	the therapeutic optometrist holds a certificate issued by the
1310	1310	board. A therapeutic optometrist certified under this section
1311	1311	[subsection] shall be known as an optometric glaucoma specialist.
1312	1312	To obtain a certificate, a therapeutic optometrist must [as
1313	1313	required under Section 351.165(c)]:
1314	1314	(1) complete an instructional clinical review course;
1315	1315	and
1316	1316	(2) pass an examination approved by the board.
1317	1317	SECTION 3.08. Subchapter H, Chapter 351, Occupations Code,
1318	1318	is amended by adding Section 351.3582 to read as follows:
1319	1319	Sec. 351.3582. CERTAIN SURGICAL PROCEDURES: CERTIFICATE
1320	1320	REQUIRED. A therapeutic optometrist may not perform a surgical
1321	1321	procedure described by Section 351.4521(b) unless the therapeutic
1322	1322	optometrist holds a certificate issued by the board. To obtain a
1323	1323	certificate, a therapeutic optometrist must:
1324	1324	(1) complete an instructional clinical review course;
1325	1325	and
1326	1326	(2) pass an examination approved by the board.
1327	1327	SECTION 3.09. Section 351.4521, Occupations Code, is
1328	1328	amended to read as follows:
1329	1329	Sec. 351.4521. PERFORMANCE OF CERTAIN SURGICAL PROCEDURES
1330	1330	BY THERAPEUTIC OPTOMETRISTS [SURGERY] PROHIBITED. (a) A
1331	1331	therapeutic optometrist may not perform the following surgical
1332	1332	procedures:
1333	1333	(1) retinal laser procedures;
1334	1334	(2) laser-assisted in situ keratomileusis (LASIK),
1335	1335	photorefractive keratectomy (PRK), or laser epithelial
1336	1336	keratomileusis (LASEK);
1337	1337	(3) penetrating keratoplasty, corneal transplant, or
1338	1338	lamellar keratoplasty;
1339	1339	(4) a surgical procedure that requires the
1340	1340	administration of general anesthesia;
1341	1341	(5) intraocular injection;
1342	1342	(6) a surgical procedure relating to the removal of
1343	1343	the eye from a living person;
1344	1344	(7) surgical intraocular implants;
1345	1345	(8) surgery of the eyelid for a suspected eyelid
1346	1346	malignancy;
1347	1347	(9) tarsorrhaphy;
1348	1348	(10) surgery of the bony orbit, including orbital
1349	1349	implants; and
1350	1350	(11) retrobulbar injection or injection into the
1351	1351	extraocular orbital space.
1352	1352	(b) A therapeutic optometrist may not perform the following
1353	1353	surgical procedures unless the therapeutic optometrist holds a
1354	1354	certificate under Section 351.3582 and the procedure is performed
1355	1355	using laser or any form of ionizing or non-ionizing radiation:
1356	1356	(1) a surgical procedure requiring full-thickness
1357	1357	incision or excision of the cornea or sclera other than
1358	1358	paracentesis in an emergency situation requiring immediate
1359	1359	reduction of the pressure inside of the eye;
1360	1360	(2) a surgical procedure requiring incision or
1361	1361	excision of the iris and ciliary body;
1362	1362	(3) a surgical procedure requiring incision or
1363	1363	excision of the vitreous;
1364	1364	(4) a surgical procedure requiring incision or
1365	1365	excision of the retina;
1366	1366	(5) a surgical procedure requiring incision or
1367	1367	excision of the crystalline lens;
1368	1368	(6) a surgical procedure requiring incision or
1369	1369	excision of the extraocular muscles;
1370	1370	(7) the incisional or excisional repair of
1371	1371	blepharochalasis, dermatochalasis, or ptosis;
1372	1372	(8) a surgical procedure requiring incision or
1373	1373	excision of the lacrimal system other than lacrimal probing and
1374	1374	related procedures;
1375	1375	(9) a surgical procedure requiring conjunctivoplasty
1376	1376	with graft or flap; and
1377	1377	(10) a surgical procedure requiring incision or
1378	1378	excision of pterygium [surgery or laser surgery].
1379	1379	(c) This section does not:
1380	1380	(1) prevent a therapeutic optometrist from providing
1381	1381	preoperative or postoperative care relating to a surgical procedure
1382	1382	listed in Subsection (a) or (b); or
1383	1383	(2) limit the use of a diagnostic or therapeutic
1384	1384	instrument necessary to perform surgical treatments or procedures
1385	1385	to the eye or adnexa except for those treatments or procedures
1386	1386	specifically prohibited by this section.
1387	1387	SECTION 3.10. Section 453.001(9), Occupations Code, is
1388	1388	amended to read as follows:
1389	1389	(9) "Referring practitioner" means a qualified
1390	1390	licensed health care professional who, within the scope of
1391	1391	professional licensure, may refer a person for health care
1392	1392	services. The term includes:
1393	1393	(A) a physician licensed to practice medicine by
1394	1394	a state board of medical examiners;
1395	1395	(B) a dentist licensed by a state board of dental
1396	1396	examiners;
1397	1397	(C) a chiropractor licensed by a state board of
1398	1398	chiropractic examiners; [and]
1399	1399	(D) a podiatrist licensed by a state board of
1400	1400	podiatric medical examiners; and
1401	1401	(E) an optometrist or therapeutic optometrist
1402	1402	licensed by a state board of optometry.
1403	1403	SECTION 3.11. Section 454.213(b), Occupations Code, is
1404	1404	amended to read as follows:
1405	1405	(b) Implementation of direct occupational therapy to a
1406	1406	person for a specific health care condition must be based on a
1407	1407	referral from:
1408	1408	(1) a physician licensed by a state board of medical
1409	1409	examiners;
1410	1410	(2) a dentist licensed by a state board of dental
1411	1411	examiners;
1412	1412	(3) a chiropractor licensed by a state board of
1413	1413	chiropractic examiners;
1414	1414	(4) a podiatrist licensed by a state board of
1415	1415	podiatric medical examiners; [or]
1416	1416	(5) an optometrist or therapeutic optometrist
1417	1417	licensed by a state board of optometry; or
1418	1418	(6) another qualified, licensed health care
1419	1419	professional who is authorized to refer for health care services
1420	1420	within the scope of the professional's license.
1421	1421	SECTION 3.12. Not later than December 1, 2021, the Texas
1422	1422	Optometry Board shall adopt rules necessary to implement the
1423	1423	changes in law made by this Act to Chapter 351, Occupations Code.
1424	1424	SECTION 3.13. The following provisions of the Occupations
1425	1425	Code are repealed:
1426	1426	(1) Section 351.160;
1427	1427	(2) Section 351.358(d); and
1428	1428	(3) Sections 351.3581(b), (c), (d), (e), (f), (g),
1429	1429	(h), (i), and (j).
1430	1430	ARTICLE 4. EFFECTIVE DATE
1431	1431	SECTION 4.01. This Act takes effect September 1, 2021.