Texas 2023 - 88th Regular

Texas House Bill HB3567 Compare Versions

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1	1	88R12746 DIO-F
2	2	By: Allison H.B. No. 3567
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to requirements for the renewal of a physician's
8	8	registration permit and the delegation by a physician of certain
9	9	medical acts.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 156.001, Occupations Code, is amended by
12	12	adding Subsection (d-1) to read as follows:
13	13	(d-1) A license holder who has entered into a prescriptive
14	14	authority agreement under Section 157.0512 shall, at the time the
15	15	license holder submits a registration renewal application, make an
16	16	electronically signed attestation to the board that periodic
17	17	meetings required by Section 157.0512(e)(9)(B) have taken place in
18	18	accordance with Section 157.0512(f).
19	19	SECTION 2. Section 157.001, Occupations Code, is amended by
20	20	amending Subsections (a) and (c) and adding Subsections (a-1) and
21	21	(a-2) to read as follows:
22	22	(a) A physician may delegate to a qualified and properly
23	23	trained person acting under the physician's supervision any medical
24	24	act that a reasonable and prudent physician would find within the
25	25	scope of sound medical judgment to delegate if, in the opinion of
26	26	the delegating physician:
27	27	(1) the act:
28	28	(A) can be properly and safely performed by the
29	29	person to whom the medical act is delegated;
30	30	(B) is performed in its customary manner; [and]
31	31	(C) is not in violation of any other statute; and
32	32	(D) is within the scope of practice of the
33	33	physician's primary specialty during the five-year period
34	34	preceding the delegation; and
35	35	(2) the person to whom the delegation is made does not
36	36	represent to the public that the person is authorized to practice
37	37	medicine.
38	38	(a-1) The performance of a delegated medical act by a
39	39	qualified person must be supervised:
40	40	(1) at the location and for the period the delegated
41	41	medical act is performed; and
42	42	(2) by:
43	43	(A) the delegating physician; or
44	44	(B) an advanced practice registered nurse or
45	45	physician assistant supervised by the delegating physician and to
46	46	whom the delegating physician has delegated the supervision of the
47	47	qualified person.
48	48	(a-2) A delegated medical act may not be performed at a
49	49	location that is more than 75 miles from the physician's primary
50	50	practice location.
51	51	(c) The board may determine whether:
52	52	(1) an act constitutes the practice of medicine, not
53	53	inconsistent with this chapter; and
54	54	(2) a medical act may be properly or safely delegated
55	55	and supervised by a physician with a thorough knowledge of the
56	56	delegated medical act [physicians].
57	57	SECTION 3. Section 157.002(b), Occupations Code, is amended
58	58	to read as follows:
59	59	(b) A physician may delegate to any qualified and properly
60	60	trained person acting under the physician's supervision the act of
61	61	administering or providing dangerous drugs in the physician's
62	62	office, as ordered by the physician, that are used or required to
63	63	meet the immediate needs of the physician's patients. The
64	64	administration or provision of the dangerous drugs must be
65	65	performed in compliance with laws relating to the practice of
66	66	medicine and state and federal laws relating to those dangerous
67	67	drugs, including a requirement that the proper dosage of a
68	68	dangerous drug may be determined only by:
69	69	(1) the delegating physician; or
70	70	(2) an advanced practice registered nurse or physician
71	71	assistant acting under the physician's delegation through a
72	72	standing order.
73	73	SECTION 4. Section 157.051(4), Occupations Code, is amended
74	74	to read as follows:
75	75	(4) "Device" has the meaning assigned by Section
76	76	551.003, and includes durable medical equipment, laser and
77	77	intense-pulsed light devices, and injectable implant devices.
78	78	SECTION 5. Sections 157.0512(c), (e), and (f), Occupations
79	79	Code, are amended to read as follows:
80	80	(c) Except as provided by Subsection (d), the combined
81	81	number of advanced practice registered nurses and physician
82	82	assistants with whom a physician may enter into a prescriptive
83	83	authority agreement and whom a physician may supervise may not
84	84	exceed five [seven] advanced practice registered nurses and
85	85	physician assistants or the full-time equivalent of five [seven]
86	86	advanced practice registered nurses and physician assistants.
87	87	(e) A prescriptive authority agreement must, at a minimum:
88	88	(1) be in writing and signed and dated by the parties
89	89	to the agreement;
90	90	(2) state the name, address, and all professional
91	91	license numbers of the parties to the agreement;
92	92	(3) state the nature of the practice, practice
93	93	locations, or practice settings;
94	94	(4) identify the types or categories of drugs or
95	95	devices that may be prescribed or the types or categories of drugs
96	96	or devices that may not be prescribed;
97	97	(5) provide a general plan for addressing consultation
98	98	and referral;
99	99	(6) provide a plan for addressing patient emergencies;
100	100	(7) state the general process for communication and
101	101	the sharing of information between the physician and the advanced
102	102	practice registered nurse or physician assistant to whom the
103	103	physician has delegated prescriptive authority related to the care
104	104	and treatment of patients;
105	105	(8) provide that [if] alternate physician supervision
106	106	will [is to] be utilized during any period during which the
107	107	supervising physician is more than 75 miles from the advanced
108	108	practice registered nurse's or physician assistant's primary
109	109	practice location and [,] designate one or more alternate
110	110	physicians who may:
111	111	(A) provide appropriate supervision on a
112	112	temporary basis in accordance with the requirements established by
113	113	the prescriptive authority agreement and the requirements of this
114	114	subchapter; and
115	115	(B) participate in the prescriptive authority
116	116	quality assurance and improvement plan meetings required under this
117	117	section; and
118	118	(9) describe a prescriptive authority quality
119	119	assurance and improvement plan and specify methods for documenting
120	120	the implementation of the plan that include the following:
121	121	(A) chart review, including provisions for the
122	122	physician to sign a chart to denote that the physician reviewed the
123	123	chart and for [with the number of charts to be reviewed determined
124	124	by] the physician to review the charts of at least 10 percent of the
125	125	patients treated under the prescriptive authority agreement by the
126	126	[and] advanced practice registered nurse or physician assistant, as
127	127	applicable; and
128	128	(B) periodic meetings between the advanced
129	129	practice registered nurse or physician assistant and the physician.
130	130	(f) The periodic meetings described by Subsection (e)(9)(B)
131	131	must:
132	132	(1) include:
133	133	(A) the sharing of information relating to
134	134	patient treatment and care, needed changes in patient care plans,
135	135	and issues relating to referrals; and
136	136	(B) discussion of patient care improvement;
137	137	(2) be documented in writing; [and]
138	138	(3) identify the patients whose treatment and care is
139	139	discussed; and
140	140	(4) [(3)] take place at least once a month in a manner
141	141	determined by the physician and the advanced practice registered
142	142	nurse or physician assistant.
143	143	SECTION 6. Section 157.055, Occupations Code, is amended to
144	144	read as follows:
145	145	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
146	146	order shall be defined in a manner that promotes the exercise of
147	147	professional judgment by the clinical nurse specialist or [advanced
148	148	practice registered nurse and] physician assistant, as applicable,
149	149	commensurate with the education and experience of that person.
150	150	Under this section, an order or protocol used by a reasonable and
151	151	prudent physician exercising sound medical judgment:
152	152	(1) is not required to describe the exact steps that a
153	153	clinical nurse specialist [an advanced practice registered nurse]
154	154	or a physician assistant must take with respect to each specific
155	155	condition, disease, or symptom; and
156	156	(2) may state the types or categories of medications
157	157	that may be prescribed or the types or categories of medications
158	158	that may not be prescribed.
159	159	SECTION 7. Not later than December 1, 2023, the Texas
160	160	Medical Board shall adopt the rules necessary to implement the
161	161	changes in law made by this Act, including a rule prescribing the
162	162	method by which a physician may make and electronically sign the
163	163	attestation required by Section 156.001(d-1), Occupations Code, as
164	164	added by this Act.
165	165	SECTION 8. Section 156.001(d-1), Occupations Code, as added
166	166	by this Act, applies only to an application for renewal of a
167	167	registration permit submitted on or after January 1, 2024.
168	168	SECTION 9. Section 157.0512, Occupations Code, as amended
169	169	by this Act, applies only to a prescriptive authority agreement
170	170	entered into on or after the effective date of this Act. An
171	171	agreement entered into before the effective date of this Act is
172	172	governed by the law in effect on the date the agreement was entered
173	173	into, and the former law is continued in effect for that purpose.
174	174	SECTION 10. This Act takes effect September 1, 2023.