88R12746 DIO-F
By: Allison H.B. No. 3567
A BILL TO BE ENTITLED
AN ACT
relating to requirements for the renewal of a physician's
registration permit and the delegation by a physician of certain
medical acts.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 156.001, Occupations Code, is amended by
adding Subsection (d-1) to read as follows:
(d-1) A license holder who has entered into a prescriptive
authority agreement under Section 157.0512 shall, at the time the
license holder submits a registration renewal application, make an
electronically signed attestation to the board that periodic
meetings required by Section 157.0512(e)(9)(B) have taken place in
accordance with Section 157.0512(f).
SECTION 2. Section 157.001, Occupations Code, is amended by
amending Subsections (a) and (c) and adding Subsections (a-1) and
(a-2) to read as follows:
(a) A physician may delegate to a qualified and properly
trained person acting under the physician's supervision any medical
act that a reasonable and prudent physician would find within the
scope of sound medical judgment to delegate if, in the opinion of
the delegating physician:
(1) the act:
(A) can be properly and safely performed by the
person to whom the medical act is delegated;
(B) is performed in its customary manner; [and]
(C) is not in violation of any other statute; and
(D) is within the scope of practice of the
physician's primary specialty during the five-year period
preceding the delegation; and
(2) the person to whom the delegation is made does not
represent to the public that the person is authorized to practice
medicine.
(a-1) The performance of a delegated medical act by a
qualified person must be supervised:
(1) at the location and for the period the delegated
medical act is performed; and
(2) by:
(A) the delegating physician; or
(B) an advanced practice registered nurse or
physician assistant supervised by the delegating physician and to
whom the delegating physician has delegated the supervision of the
qualified person.
(a-2) A delegated medical act may not be performed at a
location that is more than 75 miles from the physician's primary
practice location.
(c) The board may determine whether:
(1) an act constitutes the practice of medicine, not
inconsistent with this chapter; and
(2) a medical act may be properly or safely delegated
and supervised by a physician with a thorough knowledge of the
delegated medical act [physicians].
SECTION 3. Section 157.002(b), Occupations Code, is amended
to read as follows:
(b) A physician may delegate to any qualified and properly
trained person acting under the physician's supervision the act of
administering or providing dangerous drugs in the physician's
office, as ordered by the physician, that are used or required to
meet the immediate needs of the physician's patients. The
administration or provision of the dangerous drugs must be
performed in compliance with laws relating to the practice of
medicine and state and federal laws relating to those dangerous
drugs, including a requirement that the proper dosage of a
dangerous drug may be determined only by:
(1) the delegating physician; or
(2) an advanced practice registered nurse or physician
assistant acting under the physician's delegation through a
standing order.
SECTION 4. Section 157.051(4), Occupations Code, is amended
to read as follows:
(4) "Device" has the meaning assigned by Section
551.003, and includes durable medical equipment, laser and
intense-pulsed light devices, and injectable implant devices.
SECTION 5. Sections 157.0512(c), (e), and (f), Occupations
Code, are amended to read as follows:
(c) Except as provided by Subsection (d), the combined
number of advanced practice registered nurses and physician
assistants with whom a physician may enter into a prescriptive
authority agreement and whom a physician may supervise may not
exceed five [seven] advanced practice registered nurses and
physician assistants or the full-time equivalent of five [seven]
advanced practice registered nurses and physician assistants.
(e) A prescriptive authority agreement must, at a minimum:
(1) be in writing and signed and dated by the parties
to the agreement;
(2) state the name, address, and all professional
license numbers of the parties to the agreement;
(3) state the nature of the practice, practice
locations, or practice settings;
(4) identify the types or categories of drugs or
devices that may be prescribed or the types or categories of drugs
or devices that may not be prescribed;
(5) provide a general plan for addressing consultation
and referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and
the sharing of information between the physician and the advanced
practice registered nurse or physician assistant to whom the
physician has delegated prescriptive authority related to the care
and treatment of patients;
(8) provide that [if] alternate physician supervision
will [is to] be utilized during any period during which the
supervising physician is more than 75 miles from the advanced
practice registered nurse's or physician assistant's primary
practice location and [,] designate one or more alternate
physicians who may:
(A) provide appropriate supervision on a
temporary basis in accordance with the requirements established by
the prescriptive authority agreement and the requirements of this
subchapter; and
(B) participate in the prescriptive authority
quality assurance and improvement plan meetings required under this
section; and
(9) describe a prescriptive authority quality
assurance and improvement plan and specify methods for documenting
the implementation of the plan that include the following:
(A) chart review, including provisions for the
physician to sign a chart to denote that the physician reviewed the
chart and for [with the number of charts to be reviewed determined
by] the physician to review the charts of at least 10 percent of the
patients treated under the prescriptive authority agreement by the
[and] advanced practice registered nurse or physician assistant, as
applicable; and
(B) periodic meetings between the advanced
practice registered nurse or physician assistant and the physician.
(f) The periodic meetings described by Subsection (e)(9)(B)
must:
(1) include:
(A) the sharing of information relating to
patient treatment and care, needed changes in patient care plans,
and issues relating to referrals; and
(B) discussion of patient care improvement;
(2) be documented in writing; [and]
(3) identify the patients whose treatment and care is
discussed; and
(4) [(3)] take place at least once a month in a manner
determined by the physician and the advanced practice registered
nurse or physician assistant.
SECTION 6. Section 157.055, Occupations Code, is amended to
read as follows:
Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
order shall be defined in a manner that promotes the exercise of
professional judgment by the clinical nurse specialist or [advanced
practice registered nurse and] physician assistant, as applicable,
commensurate with the education and experience of that person.
Under this section, an order or protocol used by a reasonable and
prudent physician exercising sound medical judgment:
(1) is not required to describe the exact steps that a
clinical nurse specialist [an advanced practice registered nurse]
or a physician assistant must take with respect to each specific
condition, disease, or symptom; and
(2) may state the types or categories of medications
that may be prescribed or the types or categories of medications
that may not be prescribed.
SECTION 7. Not later than December 1, 2023, the Texas
Medical Board shall adopt the rules necessary to implement the
changes in law made by this Act, including a rule prescribing the
method by which a physician may make and electronically sign the
attestation required by Section 156.001(d-1), Occupations Code, as
added by this Act.
SECTION 8. Section 156.001(d-1), Occupations Code, as added
by this Act, applies only to an application for renewal of a
registration permit submitted on or after January 1, 2024.
SECTION 9. Section 157.0512, Occupations Code, as amended
by this Act, applies only to a prescriptive authority agreement
entered into on or after the effective date of this Act. An
agreement entered into before the effective date of this Act is
governed by the law in effect on the date the agreement was entered
into, and the former law is continued in effect for that purpose.
SECTION 10. This Act takes effect September 1, 2023.