Texas 2023 - 88th Regular

Texas Senate Bill SB1700 Compare Versions

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1	1	2023S0248-T 03/06/23
2	2	By: Blanco S.B. No. 1700
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the licensing and authority of advanced practice
8	8	registered nurses.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	ARTICLE 1. SHORT TITLE
11	11	SECTION 1.001. This Act may be cited as the Healthcare
12	12	Expanded and Accessed Locally for Texans (HEAL Texans) Act.
13	13	ARTICLE 2. ADVANCED PRACTICE REGISTERED NURSES
14	14	SECTION 2.001. Section 301.002, Occupations Code, is
15	15	amended to read as follows:
16	16	Sec. 301.002. DEFINITIONS. In this chapter:
17	17	(1) "Advanced practice registered nurse" means a
18	18	registered nurse licensed by the board to practice as an advanced
19	19	practice registered nurse on the basis of completion of an advanced
20	20	educational program. The term includes a nurse practitioner, nurse
21	21	midwife, nurse anesthetist, and clinical nurse specialist.
22	22	(2) [(1)] "Board" means the Texas Board of Nursing.
23	23	(3) [(1-a)] "Chief nursing officer" means the
24	24	registered nurse who is administratively responsible for the
25	25	nursing services at a facility.
26	26	(4) "Controlled substance" has the meaning assigned by
27	27	Section 481.002, Health and Safety Code.
28	28	(5) "Dangerous drug" has the meaning assigned by
29	29	Section 483.001, Health and Safety Code.
30	30	(6) "Device" has the meaning assigned by Section
31	31	551.003, and includes durable medical equipment.
32	32	(7) "Nonprescription drug" has the meaning assigned by
33	33	Section 551.003.
34	34	(8) "Nurse" means a person required to be licensed
35	35	under this chapter to engage in professional or vocational nursing.
36	36	(9) "Nursing" means professional or vocational
37	37	nursing.
38	38	(10) [(1-b)] "Patient safety committee" has the
39	39	meaning assigned by Section 303.001.
40	40	(11) "Prescribe or order a drug or device" has the
41	41	meaning assigned by Section 157.051.
42	42	(12) [(2)] "Professional nursing" means the
43	43	performance of an act that requires substantial specialized
44	44	judgment and skill, the proper performance of which is based on
45	45	knowledge and application of the principles of biological,
46	46	physical, and social science as acquired by a completed course in an
47	47	approved school of professional nursing. The term does not include
48	48	acts of medical diagnosis or the prescription of therapeutic or
49	49	corrective measures, except as authorized for an advanced practice
50	50	registered nurse. Professional nursing involves:
51	51	(A) the observation, assessment, intervention,
52	52	evaluation, rehabilitation, care and counsel, or health teachings
53	53	of a person who is ill, injured, infirm, or experiencing a change in
54	54	normal health processes;
55	55	(B) the maintenance of health or prevention of
56	56	illness;
57	57	(C) the administration of a medication or
58	58	treatment as ordered by a health care practitioner legally
59	59	authorized to prescribe the medication or treatment [physician,
60	60	podiatrist, or dentist];
61	61	(D) the supervision or teaching of nursing;
62	62	(E) the administration, supervision, and
63	63	evaluation of nursing practices, policies, and procedures;
64	64	(F) [the requesting, receiving, signing for, and
65	65	distribution of prescription drug samples to patients at practices
66	66	at which an advanced practice registered nurse is authorized to
67	67	sign prescription drug orders as provided by Subchapter B, Chapter
68	68	157;
69	69	[(G)] the performance of an act by an advanced
70	70	practice registered nurse [delegated by a physician under Section
71	71	157.0512, 157.054, 157.058, or 157.059]; and
72	72	(G) [(H)] the development of the nursing care
73	73	plan[.
74	74	[(3) "Nurse" means a person required to be licensed
75	75	under this chapter to engage in professional or vocational
76	76	nursing].
77	77	[(4) "Nursing" means professional or vocational
78	78	nursing.]
79	79	(13) [(5)] "Vocational nursing" means a directed
80	80	scope of nursing practice, including the performance of an act that
81	81	requires specialized judgment and skill, the proper performance of
82	82	which is based on knowledge and application of the principles of
83	83	biological, physical, and social science as acquired by a completed
84	84	course in an approved school of vocational nursing. The term does
85	85	not include acts of medical diagnosis or the prescription of
86	86	therapeutic or corrective measures. Vocational nursing involves:
87	87	(A) collecting data and performing focused
88	88	nursing assessments of the health status of an individual;
89	89	(B) participating in the planning of the nursing
90	90	care needs of an individual;
91	91	(C) participating in the development and
92	92	modification of the nursing care plan;
93	93	(D) participating in health teaching and
94	94	counseling to promote, attain, and maintain the optimum health
95	95	level of an individual;
96	96	(E) assisting in the evaluation of an
97	97	individual's response to a nursing intervention and the
98	98	identification of an individual's needs; and
99	99	(F) engaging in other acts that require education
100	100	and training, as prescribed by board rules and policies,
101	101	commensurate with the nurse's experience, continuing education,
102	102	and demonstrated competency.
103	103	SECTION 2.002. Section 301.005(b), Occupations Code, is
104	104	amended to read as follows:
105	105	(b) A reference in any other law to an "advanced nurse
106	106	practitioner," [or] "advanced practice nurse," or "advanced
107	107	practice registered nurse" means an advanced practice registered
108	108	nurse.
109	109	SECTION 2.003. Section 301.152, Occupations Code, is
110	110	transferred to Subchapter H, Chapter 301, Occupations Code,
111	111	redesignated as Section 301.357, Occupations Code, and amended to
112	112	read as follows:
113	113	Sec. 301.357 [301.152]. ADVANCED PRACTICE REGISTERED
114	114	NURSES [RULES REGARDING SPECIALIZED TRAINING]. (a) Advanced
115	115	practice registered nursing includes:
116	116	(1) ordering, performing, and interpreting diagnostic
117	117	tests;
118	118	(2) formulating primary and differential medical
119	119	diagnoses and advanced assessments;
120	120	(3) treating actual and potential health problems;
121	121	(4) prescribing therapeutic and corrective measures,
122	122	including nutrition and diagnostic support services, home health
123	123	care, hospice care, physical therapy, and occupational therapy, and
124	124	delegating and assigning the performance of therapeutic and
125	125	corrective measures to assistive personnel;
126	126	(5) to the extent authorized by the board under
127	127	Section 301.358, prescribing, ordering, procuring, administering,
128	128	and dispensing drugs and devices, including blood and blood
129	129	products, controlled substances listed in Schedules II, III, IV,
130	130	and V, dangerous drugs, and nonprescription drugs;
131	131	(6) providing referrals to health care agencies,
132	132	health care providers, and community resources;
133	133	(7) serving as the primary care provider of record;
134	134	and
135	135	(8) performing other acts that require education and
136	136	training consistent with professional standards and that are
137	137	commensurate with the advanced practice registered nurse's
138	138	education, licensure, and demonstrated competencies and
139	139	experience. [In this section, "advanced practice registered nurse"
140	140	means a registered nurse licensed by the board to practice as an
141	141	advanced practice registered nurse on the basis of completion of an
142	142	advanced educational program. The term includes a nurse
143	143	practitioner, nurse midwife, nurse anesthetist, and clinical nurse
144	144	specialist. The term is synonymous with "advanced nurse
145	145	practitioner" and "advanced practice nurse."]
146	146	(b) The board shall adopt rules to:
147	147	(1) license a registered nurse as an advanced practice
148	148	registered nurse;
149	149	(2) establish:
150	150	(A) any specialized education or training,
151	151	including pharmacology, that an advanced practice registered nurse
152	152	must have to prescribe or order a drug or device as authorized
153	153	[delegated] by the board [a physician] under Section 301.358
154	154	[157.0512 or 157.054];
155	155	(B) a system for approving an advanced practice
156	156	registered nurse to prescribe or order a drug or device as
157	157	authorized [delegated] by the board [a physician] under Section
158	158	301.358 [157.0512 or 157.054] on the receipt of evidence of
159	159	completing the specialized education and training requirement
160	160	under Paragraph (A); and
161	161	(C) a system for issuing a prescription
162	162	authorization number to an advanced practice registered nurse
163	163	approved under Paragraph (B); and
164	164	(3) concurrently renew any license or approval granted
165	165	to an advanced practice registered nurse under this subsection and
166	166	a license renewed by the advanced practice registered nurse under
167	167	Section 301.301.
168	168	(c) At a minimum, the rules adopted under Subsection (b)(2)
169	169	must:
170	170	(1) require completion of pharmacology and related
171	171	pathophysiology education for initial approval; and
172	172	(2) require continuing education in clinical
173	173	pharmacology and related pathophysiology in addition to any
174	174	continuing education otherwise required under Section 301.303.
175	175	(d) The signature of an advanced practice registered nurse
176	176	attesting to the provision of a legally authorized service by the
177	177	advanced practice registered nurse satisfies any documentation
178	178	requirement for that service established by a state agency.
179	179	(e) An advanced practice registered nurse shall practice as
180	180	a licensed independent practitioner in accordance with standards
181	181	established and recognized by the board to protect the public
182	182	health and safety.
183	183	(f) An advanced practice registered nurse is accountable to
184	184	patients, the nursing profession, and the board for:
185	185	(1) complying with the requirements of this chapter;
186	186	(2) providing quality advanced nursing care;
187	187	(3) recognizing the nurse's limits of knowledge;
188	188	(4) planning for the management of situations beyond
189	189	the nurse's expertise; and
190	190	(5) consulting with or referring patients to other
191	191	health care providers as appropriate.
192	192	(g) This section does not limit or modify the scope of
193	193	practice of a registered nurse who is not an advanced practice
194	194	registered nurse.
195	195	(h) Notwithstanding any other law, an advanced practice
196	196	registered nurse performing an act described by Subsection (a) is
197	197	not considered to be practicing medicine without a license.
198	198	SECTION 2.004. Section 301.354(a), Occupations Code, is
199	199	amended to read as follows:
200	200	(a) In this section, "nurse first assistant" means a
201	201	registered nurse who:
202	202	(1) has completed a nurse first assistant educational
203	203	program approved or recognized by an organization recognized by the
204	204	board; and
205	205	(2) [is] either:
206	206	(A) is certified in perioperative nursing by an
207	207	organization recognized by the board; or
208	208	(B) is [recognized by the board as] an advanced
209	209	practice registered nurse [and] qualified by education, training,
210	210	or experience to perform the tasks involved in perioperative
211	211	nursing.
212	212	SECTION 2.005. Subchapter H, Chapter 301, Occupations Code,
213	213	is amended by adding Section 301.358 to read as follows:
214	214	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
215	215	ADVANCED PRACTICE REGISTERED NURSE. The board may authorize an
216	216	advanced practice registered nurse to prescribe and order drugs and
217	217	devices, including controlled substances listed in Schedules II,
218	218	III, IV, and V, dangerous drugs, and nonprescription drugs.
219	219	ARTICLE 3. CONFORMING AMENDMENTS REGARDING DELEGATION
220	220	SECTION 3.001. The heading to Subchapter B, Chapter 157,
221	221	Occupations Code, is amended to read as follows:
222	222	SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
223	223	AND] PHYSICIAN ASSISTANTS
224	224	SECTION 3.002. Sections 157.051(11) and (14), Occupations
225	225	Code, are amended to read as follows:
226	226	(11) "Practice serving a medically underserved
227	227	population" means:
228	228	(A) a practice in a health professional shortage
229	229	area;
230	230	(B) a clinic designated as a rural health clinic
231	231	under 42 U.S.C. Section 1395x(aa);
232	232	(C) a public health clinic or a family planning
233	233	clinic under contract with the Health and Human Services Commission
234	234	or the Department of State Health Services;
235	235	(D) a clinic designated as a federally qualified
236	236	health center under 42 U.S.C. Section 1396d(l)(2)(B);
237	237	(E) a county, state, or federal correctional
238	238	facility;
239	239	(F) a practice:
240	240	(i) that either:
241	241	(a) is located in an area in which the
242	242	Department of State Health Services determines there is an
243	243	insufficient number of physicians providing services to eligible
244	244	clients of federally, state, or locally funded health care
245	245	programs; or
246	246	(b) is a practice that the Department
247	247	of State Health Services determines serves a disproportionate
248	248	number of clients eligible to participate in federally, state, or
249	249	locally funded health care programs; and
250	250	(ii) for which the Department of State
251	251	Health Services publishes notice of the department's determination
252	252	in the Texas Register and provides an opportunity for public
253	253	comment in the manner provided for a proposed rule under Chapter
254	254	2001, Government Code; or
255	255	(G) a practice at which a physician was
256	256	delegating prescriptive authority to an advanced practice
257	257	registered nurse, as defined by Section 301.002, or physician
258	258	assistant on or before March 1, 2013, based on the practice
259	259	qualifying as a site serving a medically underserved population.
260	260	(14) "Prescriptive authority agreement" means an
261	261	agreement entered into by a physician and a [an advanced practice
262	262	registered nurse or] physician assistant through which the
263	263	physician delegates to the [advanced practice registered nurse or]
264	264	physician assistant the act of prescribing or ordering a drug or
265	265	device.
266	266	SECTION 3.003. Section 157.0511(b-2), Occupations Code, is
267	267	amended to read as follows:
268	268	(b-2) The board shall adopt rules that require a physician
269	269	who delegates the prescribing or ordering of a drug or device to
270	270	register with the board the name and license number of the physician
271	271	assistant [or advanced practice registered nurse] to whom a
272	272	delegation is made. The board may develop and use an electronic
273	273	online delegation registration process for registration under this
274	274	subsection.
275	275	SECTION 3.004. Sections 157.0512(a), (b), (c), (e), (f),
276	276	(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
277	277	to read as follows:
278	278	(a) A physician may delegate to a [an advanced practice
279	279	registered nurse or] physician assistant, acting under adequate
280	280	physician supervision, the act of prescribing or ordering a drug or
281	281	device as authorized through a prescriptive authority agreement
282	282	between the physician and the [advanced practice registered nurse
283	283	or] physician assistant[, as applicable].
284	284	(b) A physician and a [an advanced practice registered nurse
285	285	or] physician assistant are eligible to enter into or be parties to
286	286	a prescriptive authority agreement only if:
287	287	(1) [if applicable, the Texas Board of Nursing has
288	288	approved the advanced practice registered nurse's authority to
289	289	prescribe or order a drug or device as authorized under this
290	290	subchapter;
291	291	[(2)] the [advanced practice registered nurse or]
292	292	physician assistant:
293	293	(A) holds an active license to practice in this
294	294	state as a [an advanced practice registered nurse or] physician
295	295	assistant[, as applicable,] and is in good standing in this state;
296	296	and
297	297	(B) is not currently prohibited by the [Texas
298	298	Board of Nursing or the] Texas Physician Assistant Board[, as
299	299	applicable,] from executing a prescriptive authority agreement;
300	300	and
301	301	(2) [(3)] before executing the prescriptive authority
302	302	agreement, the physician and the [advanced practice registered
303	303	nurse or] physician assistant disclose to the other prospective
304	304	party to the agreement any prior disciplinary action by the board[,
305	305	the Texas Board of Nursing,] or the Texas Physician Assistant
306	306	Board[, as applicable].
307	307	(c) Except as provided by Subsection (d), the [combined]
308	308	number of [advanced practice registered nurses and] physician
309	309	assistants with whom a physician may enter into a prescriptive
310	310	authority agreement may not exceed seven [advanced practice
311	311	registered nurses and] physician assistants or the full-time
312	312	equivalent of seven [advanced practice registered nurses and]
313	313	physician assistants.
314	314	(e) A prescriptive authority agreement must, at a minimum:
315	315	(1) be in writing and signed and dated by the parties
316	316	to the agreement;
317	317	(2) state the name, address, and all professional
318	318	license numbers of the parties to the agreement;
319	319	(3) state the nature of the practice, practice
320	320	locations, or practice settings;
321	321	(4) identify the types or categories of drugs or
322	322	devices that may be prescribed or the types or categories of drugs
323	323	or devices that may not be prescribed;
324	324	(5) provide a general plan for addressing consultation
325	325	and referral;
326	326	(6) provide a plan for addressing patient emergencies;
327	327	(7) state the general process for communication and
328	328	the sharing of information between the physician and the [advanced
329	329	practice registered nurse or] physician assistant to whom the
330	330	physician has delegated prescriptive authority related to the care
331	331	and treatment of patients;
332	332	(8) if alternate physician supervision is to be
333	333	utilized, designate one or more alternate physicians who may:
334	334	(A) provide appropriate supervision on a
335	335	temporary basis in accordance with the requirements established by
336	336	the prescriptive authority agreement and the requirements of this
337	337	subchapter; and
338	338	(B) participate in the prescriptive authority
339	339	quality assurance and improvement plan meetings required under this
340	340	section; and
341	341	(9) describe a prescriptive authority quality
342	342	assurance and improvement plan and specify methods for documenting
343	343	the implementation of the plan that include the following:
344	344	(A) chart review, with the number of charts to be
345	345	reviewed determined by the physician and [advanced practice
346	346	registered nurse or] physician assistant; and
347	347	(B) periodic meetings between the [advanced
348	348	practice registered nurse or] physician assistant and the
349	349	physician.
350	350	(f) The periodic meetings described by Subsection (e)(9)(B)
351	351	must:
352	352	(1) include:
353	353	(A) the sharing of information relating to
354	354	patient treatment and care, needed changes in patient care plans,
355	355	and issues relating to referrals; and
356	356	(B) discussion of patient care improvement;
357	357	(2) be documented; and
358	358	(3) take place at least once a month in a manner
359	359	determined by the physician and the [advanced practice registered
360	360	nurse or] physician assistant.
361	361	(g) The prescriptive authority agreement may include other
362	362	provisions agreed to by the physician and [advanced practice
363	363	registered nurse or] physician assistant.
364	364	(i) The prescriptive authority agreement need not describe
365	365	the exact steps that a [an advanced practice registered nurse or]
366	366	physician assistant must take with respect to each specific
367	367	condition, disease, or symptom.
368	368	(j) A physician[, advanced practice registered nurse,] or
369	369	physician assistant who is a party to a prescriptive authority
370	370	agreement must retain a copy of the agreement until the second
371	371	anniversary of the date the agreement is terminated.
372	372	(l) In the event that a party to a prescriptive authority
373	373	agreement is notified that the individual has become the subject of
374	374	an investigation by the board[, the Texas Board of Nursing,] or the
375	375	Texas Physician Assistant Board, the individual shall immediately
376	376	notify the other party to the prescriptive authority agreement.
377	377	(m) The prescriptive authority agreement and any amendments
378	378	must be reviewed at least annually, dated, and signed by the parties
379	379	to the agreement. The prescriptive authority agreement and any
380	380	amendments must be made available to the board[, the Texas Board of
381	381	Nursing,] or the Texas Physician Assistant Board not later than the
382	382	third business day after the date of receipt of request, if any.
383	383	(n) The prescriptive authority agreement should promote the
384	384	exercise of professional judgment by the [advanced practice
385	385	registered nurse or] physician assistant commensurate with the
386	386	[advanced practice registered nurse's or] physician assistant's
387	387	education and experience and the relationship between the [advanced
388	388	practice registered nurse or] physician assistant and the
389	389	physician.
390	390	(o) This section shall be liberally construed to allow the
391	391	use of prescriptive authority agreements to safely and effectively
392	392	utilize the skills and services of [advanced practice registered
393	393	nurses and] physician assistants.
394	394	SECTION 3.005. Section 157.0513, Occupations Code, is
395	395	amended to read as follows:
396	396	Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:
397	397	INFORMATION. (a) The board[, the Texas Board of Nursing,] and the
398	398	Texas Physician Assistant Board shall jointly develop a process:
399	399	(1) to exchange information regarding the names,
400	400	locations, and license numbers of each physician[, advanced
401	401	practice registered nurse,] and physician assistant who has entered
402	402	into a prescriptive authority agreement;
403	403	(2) by which each board shall immediately notify the
404	404	other board [boards] when a license holder of the board becomes the
405	405	subject of an investigation involving the delegation and
406	406	supervision of prescriptive authority, as well as the final
407	407	disposition of any such investigation;
408	408	(3) by which each board shall maintain and share a list
409	409	of the board's license holders who have been subject to a final
410	410	adverse disciplinary action for an act involving the delegation and
411	411	supervision of prescriptive authority; and
412	412	(4) to ensure that each [advanced practice registered
413	413	nurse or] physician assistant who has entered into a prescriptive
414	414	authority agreement authorizing the prescribing of opioids is
415	415	required to complete not less than two hours of continuing
416	416	education annually regarding safe and effective pain management
417	417	related to the prescription of opioids and other controlled
418	418	substances, including education regarding:
419	419	(A) reasonable standards of care;
420	420	(B) the identification of drug-seeking behavior
421	421	in patients; and
422	422	(C) effectively communicating with patients
423	423	regarding the prescription of an opioid or other controlled
424	424	substance.
425	425	(b) If the board[, the Texas Board of Nursing,] or the Texas
426	426	Physician Assistant Board receives a notice under Subsection
427	427	(a)(2), the board that received notice may open an investigation
428	428	against a license holder of the board who is a party to a
429	429	prescriptive authority agreement with the license holder who is
430	430	under investigation by the board that provided notice under
431	431	Subsection (a)(2).
432	432	(c) The board shall maintain and make available to the
433	433	public a searchable online list of physicians[, advanced practice
434	434	registered nurses,] and physician assistants who have entered into
435	435	a prescriptive authority agreement authorized under Section
436	436	157.0512 and identify the physician[, advanced practice registered
437	437	nurse, or physician assistant] with whom each [physician, advanced
438	438	practice registered nurse, and] physician assistant has entered
439	439	into a prescriptive authority agreement.
440	440	(d) The board shall collaborate with the [Texas Board of
441	441	Nursing and the] Texas Physician Assistant Board to maintain and
442	442	make available to the public a list of physicians[, advanced
443	443	practice registered nurses,] and physician assistants who are
444	444	prohibited from entering into or practicing under a prescriptive
445	445	authority agreement.
446	446	SECTION 3.006. Sections 157.054(a), (a-1), (b), and (c),
447	447	Occupations Code, are amended to read as follows:
448	448	(a) One or more physicians licensed by the board may
449	449	delegate, to one or more physician assistants [or advanced practice
450	450	registered nurses] acting under adequate physician supervision
451	451	whose practice is facility-based at a hospital or licensed
452	452	long-term care facility, the administration or provision of a drug
453	453	and the prescribing or ordering of a drug or device if each of the
454	454	delegating physicians is:
455	455	(1) the medical director or chief of medical staff of
456	456	the facility in which the physician assistant [or advanced practice
457	457	registered nurse] practices;
458	458	(2) the chair of the facility's credentialing
459	459	committee;
460	460	(3) a department chair of a facility department in
461	461	which the physician assistant [or advanced practice registered
462	462	nurse] practices; or
463	463	(4) a physician who consents to the request of the
464	464	medical director or chief of medical staff to delegate the
465	465	prescribing or ordering of a drug or device at the facility in which
466	466	the physician assistant [or advanced practice registered nurse]
467	467	practices.
468	468	(a-1) The limit [limits] on the number of [advanced practice
469	469	registered nurses or] physician assistants to whom a physician may
470	470	delegate under Section 157.0512 does [do] not apply to a physician
471	471	under Subsection (a) whose practice is facility-based under this
472	472	section, provided that the physician is not delegating in a
473	473	freestanding clinic, center, or practice of the facility.
474	474	(b) A physician's authority to delegate under Subsection
475	475	(a) is limited as follows:
476	476	(1) the delegation must be made under a physician's
477	477	order, standing medical order, standing delegation order, or
478	478	another order or protocol developed in accordance with policies
479	479	approved by the facility's medical staff or a committee of the
480	480	facility's medical staff as provided by the facility bylaws;
481	481	(2) the delegation must occur in the facility in which
482	482	the physician is the medical director, the chief of medical staff,
483	483	the chair of the credentialing committee, a department chair, or a
484	484	physician who consents to delegate under Subsection (a)(4);
485	485	(3) the delegation may not permit the prescribing or
486	486	ordering of a drug or device for the care or treatment of the
487	487	patients of any other physician without the prior consent of that
488	488	physician; and
489	489	(4) delegation in a long-term care facility must be by
490	490	the medical director and is limited to the prescribing or ordering
491	491	of a drug or device to not more than seven [advanced practice
492	492	registered nurses or] physician assistants or their full-time
493	493	equivalents.
494	494	(c) Physician supervision of the prescribing or ordering of
495	495	a drug or device must conform to what a reasonable, prudent
496	496	physician would find consistent with sound medical judgment but may
497	497	vary with the education and experience of the particular [advanced
498	498	practice registered nurse or] physician assistant. A physician
499	499	shall provide continuous supervision, but the constant physical
500	500	presence of the physician is not required.
501	501	SECTION 3.007. Section 157.055, Occupations Code, is
502	502	amended to read as follows:
503	503	Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other
504	504	order shall be defined in a manner that promotes the exercise of
505	505	professional judgment by the [advanced practice registered nurse
506	506	and] physician assistant commensurate with the education and
507	507	experience of that person. Under this section, an order or
508	508	protocol used by a reasonable and prudent physician exercising
509	509	sound medical judgment:
510	510	(1) is not required to describe the exact steps that
511	511	[an advanced practice registered nurse or] a physician assistant
512	512	must take with respect to each specific condition, disease, or
513	513	symptom; and
514	514	(2) may state the types or categories of medications
515	515	that may be prescribed or the types or categories of medications
516	516	that may not be prescribed.
517	517	SECTION 3.008. Section 157.056, Occupations Code, is
518	518	amended to read as follows:
519	519	Sec. 157.056. PRESCRIPTION INFORMATION. The following
520	520	information must be provided on each prescription subject to this
521	521	subchapter:
522	522	(1) the patient's name and address;
523	523	(2) the drug to be dispensed;
524	524	(3) directions to the patient regarding the taking of
525	525	the drug and the dosage;
526	526	(4) the intended use of the drug, if appropriate;
527	527	(5) the name, address, and telephone number of the
528	528	physician;
529	529	(6) the name, address, telephone number, and
530	530	identification number of the [registered nurse or] physician
531	531	assistant completing or signing the prescription drug order;
532	532	(7) the date; and
533	533	(8) the number of refills permitted.
534	534	SECTION 3.009. Sections 157.059(b), (e), (f), (g), (h), and
535	535	(i), Occupations Code, are amended to read as follows:
536	536	(b) A physician may delegate to a physician assistant
537	537	offering obstetrical services and certified by the board as
538	538	specializing in obstetrics [or an advanced practice registered
539	539	nurse recognized by the Texas Board of Nursing as a nurse midwife]
540	540	the act of administering or providing controlled substances to the
541	541	physician assistant's [or nurse midwife's] clients during
542	542	intrapartum and immediate postpartum care.
543	543	(e) The physician's orders, medical orders, standing
544	544	delegation orders, prescriptive authority agreements, or protocols
545	545	must require the reporting of or monitoring of each client's
546	546	progress, including complications of pregnancy and delivery and the
547	547	administration and provision of controlled substances by the [nurse
548	548	midwife or] physician assistant to the clients of the [nurse
549	549	midwife or] physician assistant.
550	550	(f) The authority of a physician to delegate under this
551	551	section is limited to:
552	552	(1) seven [nurse midwives or] physician assistants or
553	553	their full-time equivalents; and
554	554	(2) the designated facility at which the [nurse
555	555	midwife or] physician assistant provides care.
556	556	(g) The controlled substance must be supplied in a suitable
557	557	container that is labeled in compliance with the applicable drug
558	558	laws and must include:
559	559	(1) the patient's name and address;
560	560	(2) the drug to be provided;
561	561	(3) the name, address, and telephone number of the
562	562	physician;
563	563	(4) the name, address, and telephone number of the
564	564	[nurse midwife or] physician assistant; and
565	565	(5) the date.
566	566	(h) This section does not authorize a physician or[,]
567	567	physician assistant[, or nurse midwife] to operate a retail
568	568	pharmacy as defined under Subtitle J.
569	569	(i) This section authorizes a physician to delegate the act
570	570	of administering or providing a controlled substance to a [nurse
571	571	midwife or] physician assistant but does not require physician
572	572	delegation of[:
573	573	[(1) further acts to a nurse midwife; or
574	574	[(2)] the administration of medications by a physician
575	575	assistant [or registered nurse] other than as provided by this
576	576	section.
577	577	SECTION 3.010. Section 157.060, Occupations Code, is
578	578	amended to read as follows:
579	579	Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED
580	580	ACT. Unless the physician has reason to believe the physician
581	581	assistant [or advanced practice registered nurse] lacked the
582	582	competency to perform the act, a physician is not liable for an act
583	583	of a physician assistant [or advanced practice registered nurse]
584	584	solely because the physician signed a standing medical order, a
585	585	standing delegation order, or another order or protocol, or entered
586	586	into a prescriptive authority agreement, authorizing the physician
587	587	assistant [or advanced practice registered nurse] to administer,
588	588	provide, prescribe, or order a drug or device.
589	589	ARTICLE 4. GENERAL CONFORMING AMENDMENTS
590	590	SECTION 4.001. Section 38.151(1), Education Code, is
591	591	amended to read as follows:
592	592	(1) "Advanced practice nurse" has the meaning assigned
593	593	to "advanced practice registered nurse" by Section 301.002
594	594	[301.152], Occupations Code.
595	595	SECTION 4.002. Section 61.601, Education Code, as amended
596	596	by Chapters 891 (H.B. 3083) and 1101 (H.B. 3808), Acts of the 85th
597	597	Legislature, Regular Session, 2017, is reenacted and amended to
598	598	read as follows:
599	599	Sec. 61.601. DEFINITION. In this subchapter, "mental
600	600	health professional" means:
601	601	(1) a licensed physician who is:
602	602	(A) a graduate of an accredited psychiatric
603	603	residency training program; or
604	604	(B) certified in psychiatry by:
605	605	(i) the American Board of Psychiatry and
606	606	Neurology; or
607	607	(ii) the American Osteopathic Board of
608	608	Neurology and Psychiatry;
609	609	(2) a psychologist, as defined by Section 501.002,
610	610	Occupations Code;
611	611	(3) a licensed professional counselor, as defined by
612	612	Section 503.002, Occupations Code;
613	613	(4) an advanced practice registered nurse, as defined
614	614	by Section 301.002 [301.152], Occupations Code, who holds a
615	615	nationally recognized board certification in psychiatric or mental
616	616	health nursing;
617	617	(5) a licensed clinical social worker, as defined by
618	618	Section 505.002, Occupations Code; [and]
619	619	(6) a licensed marriage and family therapist, as
620	620	defined by Section 502.002, Occupations Code; and
621	621	(7) [(6)] a chemical dependency counselor, as defined
622	622	by Section 504.001, Occupations Code.
623	623	SECTION 4.003. Section 263.001(a)(1), Family Code, is
624	624	amended to read as follows:
625	625	(1) "Advanced practice nurse" has the meaning assigned
626	626	to "advanced practice registered nurse" by Section 301.002
627	627	[157.051], Occupations Code.
628	628	SECTION 4.004. Section 266.001(1), Family Code, is amended
629	629	to read as follows:
630	630	(1) "Advanced practice nurse" has the meaning assigned
631	631	to "advanced practice registered nurse" by Section 301.002
632	632	[157.051], Occupations Code.
633	633	SECTION 4.005. Section 531.0217(k), Government Code, is
634	634	amended to read as follows:
635	635	(k) This section does not affect any requirement relating
636	636	to:
637	637	(1) a rural health clinic; or
638	638	(2) physician delegation of the authority to carry out
639	639	or sign prescription drug orders to a [an advanced practice nurse
640	640	or] physician assistant.
641	641	SECTION 4.006. Section 671.001(b), Government Code, is
642	642	amended to read as follows:
643	643	(b) The pilot program must provide for the following:
644	644	(1) a licensed advanced practice registered nurse as
645	645	defined by Section 301.002 [301.152], Occupations Code, or a
646	646	licensed physician assistant as described by Chapter 204,
647	647	Occupations Code, who is employed by the state or whose services are
648	648	acquired by contract, who will be located at a state office complex;
649	649	(2) if applicable, a licensed physician, who is
650	650	employed by a state governmental entity for purposes other than the
651	651	pilot program or whose services are acquired by contract, who will
652	652	delegate to and supervise the [advanced practice registered nurse
653	653	or] physician assistant under a prescriptive authority agreement
654	654	under Chapter 157, Occupations Code;
655	655	(3) appropriate office space and equipment for the
656	656	advanced practice registered nurse or physician assistant to
657	657	provide basic medical care to employees at the state office complex
658	658	where the nurse or physician assistant is located; and
659	659	(4) professional liability insurance covering
660	660	services provided by the advanced practice registered nurse or the
661	661	physician assistant.
662	662	SECTION 4.007. Section 47.001(3), Health and Safety Code,
663	663	is amended to read as follows:
664	664	(3) "Health care provider" means:
665	665	(A) [a registered nurse recognized as] an
666	666	advanced practice registered nurse as defined by Section 301.002,
667	667	Occupations Code; [the Texas Board of Nursing] or
668	668	(B) a physician assistant licensed by the Texas
669	669	Physician Assistant Board.
670	670	SECTION 4.008. Section 47.011(a), Health and Safety Code,
671	671	is amended to read as follows:
672	672	(a) In this section, "midwife" has the meaning assigned by
673	673	Section 203.002, Occupations Code, and includes a nurse midwife
674	674	[described by Section 301.152, Occupations Code].
675	675	SECTION 4.009. Sections 161.0052(b) and (c), Health and
676	676	Safety Code, are amended to read as follows:
677	677	(b) The executive commissioner by rule shall require a
678	678	hospital to inform each elderly person admitted to the hospital for
679	679	a period of 24 hours or more that the pneumococcal and influenza
680	680	vaccines are available. If the elderly person requests a vaccine,
681	681	and if a physician, [or] an advanced nurse practitioner, or a
682	682	physician assistant on behalf of a physician, determines that the
683	683	vaccine is in the person's best interest, the hospital must make the
684	684	vaccination available to the person before the person is discharged
685	685	from the hospital.
686	686	(c) The executive commissioner by rule shall require an end
687	687	stage renal disease facility to offer, to the extent possible as
688	688	determined by the facility, the opportunity to receive the
689	689	pneumococcal and influenza vaccines to each elderly person who
690	690	receives ongoing care at the facility if a physician, [or] an
691	691	advanced nurse practitioner, or a physician assistant on behalf of
692	692	a physician, determines that the vaccine is in the person's best
693	693	interest. If the facility decides it is not feasible to offer the
694	694	vaccine, the facility must provide the person with information on
695	695	other options for obtaining the vaccine.
696	696	SECTION 4.010. Section 241.003(1), Health and Safety Code,
697	697	is amended to read as follows:
698	698	(1) "Advanced practice nurse" has the meaning assigned
699	699	to "advanced practice registered nurse" by Section 301.002,
700	700	Occupations Code [means a registered nurse recognized as an
701	701	advanced practice nurse by the Texas Board of Nursing].
702	702	SECTION 4.011. Section 481.002(39), Health and Safety Code,
703	703	is amended to read as follows:
704	704	(39) "Practitioner" means:
705	705	(A) a physician, dentist, veterinarian,
706	706	podiatrist, scientific investigator, advanced practice registered
707	707	nurse, or other person licensed, registered, or otherwise permitted
708	708	to distribute, dispense, analyze, conduct research with respect to,
709	709	or administer a controlled substance in the course of professional
710	710	practice or research in this state;
711	711	(B) a pharmacy, hospital, or other institution
712	712	licensed, registered, or otherwise permitted to distribute,
713	713	dispense, conduct research with respect to, or administer a
714	714	controlled substance in the course of professional practice or
715	715	research in this state;
716	716	(C) a person practicing in and licensed by
717	717	another state as a physician, dentist, veterinarian, advanced
718	718	practice registered nurse, or podiatrist, having a current Federal
719	719	Drug Enforcement Administration registration number, who may
720	720	legally prescribe Schedule II, III, IV, or V controlled substances
721	721	in that state; or
722	722	(D) a [an advanced practice registered nurse or]
723	723	physician assistant to whom a physician has delegated the authority
724	724	to prescribe or order a drug or device under Section 157.0511,
725	725	157.0512, or 157.054, Occupations Code.
726	726	SECTION 4.012. Section 481.074(d), Health and Safety Code,
727	727	is amended to read as follows:
728	728	(d) Except as specified in Subsections (e) and (f), the
729	729	board, by rule and in consultation with the Texas Medical Board and
730	730	the Texas Board of Nursing, shall establish the period after the
731	731	date on which the prescription is issued that a person may fill a
732	732	prescription for a controlled substance listed in Schedule II. A
733	733	person may not refill a prescription for a substance listed in
734	734	Schedule II.
735	735	SECTION 4.013. Section 481.076(c), Health and Safety Code,
736	736	is amended to read as follows:
737	737	(c) The board by rule shall design and implement a system
738	738	for submission of information to the board by electronic or other
739	739	means and for retrieval of information submitted to the board under
740	740	this section and Sections 481.074 and 481.075. The board shall use
741	741	automated information security techniques and devices to preclude
742	742	improper access to the information. The board shall submit the
743	743	system design to the director, [and] the Texas Medical Board, and
744	744	the Texas Board of Nursing for review and comment a reasonable time
745	745	before implementation of the system and shall comply with the
746	746	comments of those agencies unless it is unreasonable to do so.
747	747	SECTION 4.014. Section 481.0767(b), Health and Safety Code,
748	748	is amended to read as follows:
749	749	(b) The board shall appoint the following members to the
750	750	advisory committee:
751	751	(1) a physician licensed in this state who practices
752	752	in pain management;
753	753	(2) a physician licensed in this state who practices
754	754	in family medicine;
755	755	(3) a physician licensed in this state who performs
756	756	surgery;
757	757	(4) a physician licensed in this state who practices
758	758	in emergency medicine at a hospital;
759	759	(5) a physician licensed in this state who practices
760	760	in psychiatry;
761	761	(6) an oral and maxillofacial surgeon;
762	762	(7) a physician assistant [or advanced practice
763	763	registered nurse] to whom a physician has delegated the authority
764	764	to prescribe or order a drug or an advanced practice registered
765	765	nurse;
766	766	(8) a pharmacist working at a chain pharmacy;
767	767	(9) a pharmacist working at an independent pharmacy;
768	768	(10) an academic pharmacist; and
769	769	(11) two representatives of the health information
770	770	technology industry, at least one of whom is a representative of a
771	771	company whose primary line of business is electronic medical
772	772	records.
773	773	SECTION 4.015. Sections 483.001(4), (12), and (13), Health
774	774	and Safety Code, are amended to read as follows:
775	775	(4) "Designated agent" means:
776	776	(A) a licensed nurse, physician assistant,
777	777	pharmacist, or other individual designated by a practitioner to
778	778	communicate prescription drug orders to a pharmacist;
779	779	(B) a licensed nurse, physician assistant, or
780	780	pharmacist employed in a health care facility to whom the
781	781	practitioner communicates a prescription drug order; or
782	782	(C) a [registered nurse or] physician assistant
783	783	authorized by a practitioner to carry out a prescription drug order
784	784	for dangerous drugs under Subchapter B, Chapter 157, Occupations
785	785	Code.
786	786	(12) "Practitioner" means:
787	787	(A) a person licensed by:
788	788	(i) the Texas Medical Board, State Board of
789	789	Dental Examiners, Texas Optometry Board, or State Board of
790	790	Veterinary Medical Examiners to prescribe and administer dangerous
791	791	drugs; or
792	792	(ii) the Texas Department of Licensing and
793	793	Regulation, with respect to podiatry, to prescribe and administer
794	794	dangerous drugs;
795	795	(B) a person licensed by another state in a
796	796	health field in which, under the laws of this state, a licensee may
797	797	legally prescribe dangerous drugs;
798	798	(C) a person licensed in Canada or Mexico in a
799	799	health field in which, under the laws of this state, a licensee may
800	800	legally prescribe dangerous drugs; [or]
801	801	(D) a [an advanced practice registered nurse or]
802	802	physician assistant to whom a physician has delegated the authority
803	803	to prescribe or order a drug or device under Section 157.0511,
804	804	157.0512, or 157.054, Occupations Code; or
805	805	(E) an advanced practice registered nurse
806	806	authorized to prescribe and order drugs and devices under Section
807	807	301.358, Occupations Code.
808	808	(13) "Prescription" means an order from a
809	809	practitioner, or an agent of the practitioner designated in writing
810	810	as authorized to communicate prescriptions, or an order made in
811	811	accordance with Subchapter B, Chapter 157, Occupations Code, or
812	812	Section 203.353, Occupations Code, to a pharmacist for a dangerous
813	813	drug to be dispensed that states:
814	814	(A) the date of the order's issue;
815	815	(B) the name and address of the patient;
816	816	(C) if the drug is prescribed for an animal, the
817	817	species of the animal;
818	818	(D) the name and quantity of the drug prescribed;
819	819	(E) the directions for the use of the drug;
820	820	(F) the intended use of the drug unless the
821	821	practitioner determines the furnishing of this information is not
822	822	in the best interest of the patient;
823	823	(G) the name, address, and telephone number of
824	824	the practitioner at the practitioner's usual place of business,
825	825	legibly printed or stamped; and
826	826	(H) the name, address, and telephone number of
827	827	the licensed midwife[, registered nurse,] or physician assistant,
828	828	legibly printed or stamped, if signed by a licensed midwife[,
829	829	registered nurse,] or physician assistant.
830	830	SECTION 4.016. Section 483.022(f), Health and Safety Code,
831	831	is amended to read as follows:
832	832	(f) A practitioner may designate a person who is a licensed
833	833	vocational nurse or has an education equivalent to or greater than
834	834	that required for a licensed vocational nurse to communicate
835	835	prescriptions of a [an advanced practice nurse or] physician
836	836	assistant authorized by the practitioner to sign prescription drug
837	837	orders under Subchapter B, Chapter 157, Occupations Code, or of an
838	838	advanced practice registered nurse.
839	839	SECTION 4.017. Section 483.042(a), Health and Safety Code,
840	840	is amended to read as follows:
841	841	(a) A person commits an offense if the person delivers or
842	842	offers to deliver a dangerous drug:
843	843	(1) unless:
844	844	(A) the dangerous drug is delivered or offered
845	845	for delivery by a pharmacist under:
846	846	(i) a prescription issued by a practitioner
847	847	described by Section 483.001(12)(A), [or] (B), or (E);
848	848	(ii) a prescription signed by a [registered
849	849	nurse or] physician assistant in accordance with Subchapter B,
850	850	Chapter 157, Occupations Code; or
851	851	(iii) an original written prescription
852	852	issued by a practitioner described by Section 483.001(12)(C); and
853	853	(B) a label is attached to the immediate
854	854	container in which the drug is delivered or offered to be delivered
855	855	and the label contains the following information:
856	856	(i) the name and address of the pharmacy
857	857	from which the drug is delivered or offered for delivery;
858	858	(ii) the date the prescription for the drug
859	859	is dispensed;
860	860	(iii) the number of the prescription as
861	861	filed in the prescription files of the pharmacy from which the
862	862	prescription is dispensed;
863	863	(iv) the name of the practitioner who
864	864	prescribed the drug and, if applicable, the name of the [registered
865	865	nurse or] physician assistant who signed the prescription;
866	866	(v) the name of the patient and, if the drug
867	867	is prescribed for an animal, a statement of the species of the
868	868	animal; and
869	869	(vi) directions for the use of the drug as
870	870	contained in the prescription; or
871	871	(2) unless:
872	872	(A) the dangerous drug is delivered or offered
873	873	for delivery by:
874	874	(i) a practitioner in the course of
875	875	practice; or
876	876	(ii) a [registered nurse or] physician
877	877	assistant in the course of practice in accordance with Subchapter
878	878	B, Chapter 157, Occupations Code; and
879	879	(B) a label is attached to the immediate
880	880	container in which the drug is delivered or offered to be delivered
881	881	and the label contains the following information:
882	882	(i) the name and address of the
883	883	practitioner who prescribed the drug, and if applicable, the name
884	884	and address of the [registered nurse or] physician assistant;
885	885	(ii) the date the drug is delivered;
886	886	(iii) the name of the patient and, if the
887	887	drug is prescribed for an animal, a statement of the species of the
888	888	animal; and
889	889	(iv) the name of the drug, the strength of
890	890	the drug, and directions for the use of the drug.
891	891	SECTION 4.018. Section 32.024(gg), Human Resources Code, is
892	892	amended to read as follows:
893	893	(gg) Notwithstanding any other law, including Sections
894	894	843.312 and 1301.052, Insurance Code, the commission shall ensure
895	895	that advanced practice registered nurses and physician assistants
896	896	may be selected by and assigned to recipients of medical assistance
897	897	as the primary care providers of those recipients [regardless of
898	898	whether the physician supervising the advanced practice registered
899	899	nurse is included in any directory of providers of medical
900	900	assistance maintained by the commission]. This subsection may not
901	901	be construed as authorizing the commission to supervise or control
902	902	the practice of medicine as prohibited by Subtitle B, Title 3,
903	903	Occupations Code. The commission must require that advanced
904	904	practice registered nurses and physician assistants be treated in
905	905	the same manner as primary care physicians with regard to:
906	906	(1) selection and assignment as primary care
907	907	providers; and
908	908	(2) inclusion as primary care providers in any
909	909	directory of providers of medical assistance maintained by the
910	910	commission.
911	911	SECTION 4.019. Section 32.03141, Human Resources Code, is
912	912	amended to read as follows:
913	913	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
914	914	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
915	915	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
916	916	addition to other health care practitioners authorized by federal
917	917	law, the following persons may order and prescribe durable medical
918	918	equipment and supplies under the medical assistance program:
919	919	(1) an advanced practice registered nurse; and
920	920	(2) a [or] physician assistant acting under adequate
921	921	physician supervision and to whom a physician has delegated the
922	922	authority to prescribe and order drugs and devices under Chapter
923	923	157, Occupations Code[, may order and prescribe durable medical
924	924	equipment and supplies under the medical assistance program].
925	925	SECTION 4.020. Section 843.312, Insurance Code, is amended
926	926	to read as follows:
927	927	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
928	928	REGISTERED NURSES. (a) A health maintenance organization may not
929	929	refuse a request by a physician participating in the health
930	930	maintenance organization delivery network and a physician
931	931	assistant [or advanced practice nurse] who is authorized by the
932	932	physician to provide care under Subchapter B, Chapter 157,
933	933	Occupations Code, or an advanced practice registered nurse, as
934	934	defined by Section 301.002, Occupations Code, to identify a
935	935	physician assistant or advanced practice registered nurse as a
936	936	provider in the network.
937	937	(b) A health maintenance organization may refuse a request
938	938	under Subsection (a) if the physician assistant or advanced
939	939	practice registered nurse does not meet the quality of care
940	940	standards previously established by the health maintenance
941	941	organization for participation in the network by physician
942	942	assistants and advanced practice registered nurses.
943	943	SECTION 4.021. Section 1301.001(1-a), Insurance Code, is
944	944	amended to read as follows:
945	945	(1-a) "Health care provider" means a practitioner,
946	946	institutional provider, or other person or organization that
947	947	furnishes health care services and that is licensed or otherwise
948	948	authorized to practice in this state. The term includes a
949	949	pharmacist, [and] a pharmacy, and an advanced practice registered
950	950	nurse. The term does not include a physician.
951	951	SECTION 4.022. Section 1301.052, Insurance Code, is amended
952	952	to read as follows:
953	953	Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
954	954	NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
955	955	offering a preferred provider benefit plan may not refuse a request
956	956	made by a physician participating as a preferred provider under the
957	957	plan and an advanced practice registered nurse or physician
958	958	assistant to have the advanced practice registered nurse or
959	959	physician assistant included as a preferred provider under the plan
960	960	if, as applicable:
961	961	(1) the [advanced practice nurse or] physician
962	962	assistant is authorized by the physician to provide care under
963	963	Subchapter B, Chapter 157, Occupations Code; and
964	964	(2) the advanced practice registered nurse or
965	965	physician assistant meets the quality of care standards previously
966	966	established by the insurer for participation in the plan by
967	967	advanced practice registered nurses and physician assistants.
968	968	SECTION 4.023. Section 1451.001(2), Insurance Code, is
969	969	amended to read as follows:
970	970	(2) "Advanced practice registered nurse" has the
971	971	meaning assigned by Section 301.002, Occupations Code [means an
972	972	individual licensed by the Texas Board of Nursing as a registered
973	973	nurse and recognized by that board as an advanced practice nurse].
974	974	SECTION 4.024. Section 1451.104(c), Insurance Code, is
975	975	amended to read as follows:
976	976	(c) Notwithstanding Subsection (a), a health insurance
977	977	policy may provide for a different amount of payment or
978	978	reimbursement for scheduled services or procedures performed by an
979	979	advanced practice registered nurse, nurse first assistant,
980	980	licensed surgical assistant, or physician assistant if the
981	981	methodology used to compute the amount is the same as the
982	982	methodology used to compute the amount of payment or reimbursement
983	983	when the services or procedures are provided by a physician.
984	984	SECTION 4.025. Section 1451.106, Insurance Code, is amended
985	985	to read as follows:
986	986	Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
987	987	NURSE. An insured may select an advanced practice registered nurse
988	988	to provide the services scheduled in the health insurance policy
989	989	that are within the scope of the nurse's license.
990	990	SECTION 4.026. Section 1452.051(1), Insurance Code, is
991	991	amended to read as follows:
992	992	(1) "Advanced practice nurse" has the meaning assigned
993	993	to "advanced practice registered nurse" by Section 301.002
994	994	[301.152], Occupations Code.
995	995	SECTION 4.027. Section 408.025, Labor Code, is amended by
996	996	amending Subsection (a-1) and adding Subsection (a-2) to read as
997	997	follows:
998	998	(a-1) A [treating doctor may delegate to a physician
999	999	assistant who is licensed to practice in this state under Chapter
1000	1000	204, Occupations Code, or an advanced practice registered nurse who
1001	1001	is licensed to practice in this state under Chapter 301,
1002	1002	Occupations Code, the authority to complete and sign a] work status
1003	1003	report regarding an injured employee's ability to return to work
1004	1004	may be completed and signed by:
1005	1005	(1) a physician assistant licensed to practice in this
1006	1006	state under Chapter 204, Occupations Code, who has been delegated
1007	1007	the authority by a treating doctor; or
1008	1008	(2) an advanced practice registered nurse, as defined
1009	1009	by Section 301.002, Occupations Code.
1010	1010	(a-2) The delegating treating doctor is responsible for the
1011	1011	acts of a [the] physician assistant [or advanced practice
1012	1012	registered nurse] under Subsection (a-1) [this subsection].
1013	1013	SECTION 4.028. Section 203.002(2), Occupations Code, is
1014	1014	amended to read as follows:
1015	1015	(2) "Certified nurse-midwife" means an advanced
1016	1016	practice [a person who is:
1017	1017	[(A) a] registered nurse as defined by Section
1018	1018	301.002 who is [under Chapter 301;
1019	1019	[(B) recognized as an advanced nurse
1020	1020	practitioner by the Texas Board of Nursing; and
1021	1021	[(C)] certified by the American College of
1022	1022	Nurse-Midwives.
1023	1023	SECTION 4.029. Section 204.1025, Occupations Code, is
1024	1024	amended to read as follows:
1025	1025	Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY
1026	1026	AGREEMENTS. The physician assistant board shall in conjunction
1027	1027	with the Texas Medical Board [and the Texas Board of Nursing]
1028	1028	perform the functions and duties relating to prescriptive authority
1029	1029	agreements assigned to the physician assistant board in Sections
1030	1030	157.0512 and 157.0513.
1031	1031	SECTION 4.030. Sections 551.003(14) and (34), Occupations
1032	1032	Code, are amended to read as follows:
1033	1033	(14) "Designated agent" means:
1034	1034	(A) an individual, including a licensed nurse,
1035	1035	physician assistant, or pharmacist:
1036	1036	(i) who is designated by a practitioner and
1037	1037	authorized to communicate a prescription drug order to a
1038	1038	pharmacist; and
1039	1039	(ii) for whom the practitioner assumes
1040	1040	legal responsibility;
1041	1041	(B) a licensed nurse, physician assistant, or
1042	1042	pharmacist employed in a health care facility to whom a
1043	1043	practitioner communicates a prescription drug order; or
1044	1044	(C) a [registered nurse or] physician assistant
1045	1045	authorized by a practitioner to administer a prescription drug
1046	1046	order for a dangerous drug under Subchapter B, Chapter 157.
1047	1047	(34) "Practitioner" means:
1048	1048	(A) a person licensed or registered to prescribe,
1049	1049	distribute, administer, or dispense a prescription drug or device
1050	1050	in the course of professional practice in this state, including a
1051	1051	physician, dentist, podiatrist, advanced practice registered nurse
1052	1052	authorized to prescribe and order drugs and devices under Section
1053	1053	301.358, or veterinarian but excluding a person licensed under this
1054	1054	subtitle;
1055	1055	(B) a person licensed by another state, Canada,
1056	1056	or the United Mexican States in a health field in which, under the
1057	1057	law of this state, a license holder in this state may legally
1058	1058	prescribe a dangerous drug;
1059	1059	(C) a person practicing in another state and
1060	1060	licensed by another state as a physician, dentist, veterinarian,
1061	1061	advanced practice registered nurse, or podiatrist, who has a
1062	1062	current federal Drug Enforcement Administration registration
1063	1063	number and who may legally prescribe a Schedule II, III, IV, or V
1064	1064	controlled substance, as specified under Chapter 481, Health and
1065	1065	Safety Code, in that other state; or
1066	1066	(D) a [an advanced practice registered nurse or]
1067	1067	physician assistant to whom a physician has delegated the authority
1068	1068	to prescribe or order a drug or device under Section 157.0511,
1069	1069	157.0512, or 157.054.
1070	1070	SECTION 4.031. Section 563.051(e), Occupations Code, is
1071	1071	amended to read as follows:
1072	1072	(e) A practitioner may designate a licensed vocational
1073	1073	nurse or a person having education equivalent to or greater than
1074	1074	that required for a licensed vocational nurse to communicate the
1075	1075	prescriptions of a [an advanced practice nurse or] physician
1076	1076	assistant authorized by the practitioner to sign prescription drug
1077	1077	orders under Subchapter B, Chapter 157, or of an advanced practice
1078	1078	registered nurse.
1079	1079	SECTION 4.032. Sections 605.002(14) and (18), Occupations
1080	1080	Code, are amended to read as follows:
1081	1081	(14) "Orthotics" means the science and practice of
1082	1082	measuring, designing, fabricating, assembling, fitting, adjusting,
1083	1083	or servicing an orthosis under an order from a licensed physician,
1084	1084	chiropractor, [or] podiatrist, or [an] advanced practice
1085	1085	registered nurse, or from a physician assistant acting under the
1086	1086	delegation and supervision of a licensed physician as provided by
1087	1087	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1088	1088	Board, for the correction or alleviation of a neuromuscular or
1089	1089	musculoskeletal dysfunction, disease, injury, or deformity.
1090	1090	(18) "Prosthetics" means the science and practice of
1091	1091	measuring, designing, fabricating, assembling, fitting, adjusting,
1092	1092	or servicing a prosthesis under an order from a licensed physician,
1093	1093	chiropractor, [or] podiatrist, or [an] advanced practice
1094	1094	registered nurse, or from a physician assistant acting under the
1095	1095	delegation and supervision of a licensed physician as provided by
1096	1096	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1097	1097	Board.
1098	1098	SECTION 4.033. Section 605.2515, Occupations Code, is
1099	1099	amended to read as follows:
1100	1100	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
1101	1101	person licensed to practice orthotics or prosthetics who measures,
1102	1102	designs, fabricates, fits, assembles, adjusts, or services an
1103	1103	orthosis or a prosthesis under an order from a licensed physician,
1104	1104	chiropractor, [or] podiatrist, or [an] advanced practice
1105	1105	registered nurse, or from a physician assistant acting under the
1106	1106	delegation and supervision of a licensed physician as provided by
1107	1107	Subchapter B, Chapter 157, and rules adopted by the Texas Medical
1108	1108	Board, for a specific patient is exempt from licensing as a device
1109	1109	manufacturer under Subchapter L, Chapter 431, Health and Safety
1110	1110	Code. A person licensed to practice orthotics or prosthetics who
1111	1111	fabricates or assembles an orthosis or a prosthesis without an
1112	1112	order from a licensed physician, chiropractor, [or] podiatrist, or
1113	1113	[an] advanced practice registered nurse, or from a physician
1114	1114	assistant acting under the delegation and supervision of a licensed
1115	1115	physician as provided by Subchapter B, Chapter 157, and rules
1116	1116	adopted by the Texas Medical Board, for a specific patient is
1117	1117	required to be licensed as a device manufacturer under Subchapter
1118	1118	L, Chapter 431, Health and Safety Code.
1119	1119	ARTICLE 5. REPEALER
1120	1120	SECTION 5.001. The following provisions are repealed:
1121	1121	(1) Section 533.005(d), Government Code;
1122	1122	(2) Section 62.1551(b), Health and Safety Code; and
1123	1123	(3) Sections 157.051(1), 157.058, and 301.168,
1124	1124	Occupations Code.
1125	1125	ARTICLE 6. TRANSITION AND EFFECTIVE DATE
1126	1126	SECTION 6.001. Not later than February 1, 2024, the Texas
1127	1127	Board of Nursing shall adopt the rules necessary to implement the
1128	1128	changes in law made by this Act.
1129	1129	SECTION 6.002. Notwithstanding any changes in law made by
1130	1130	this Act, an advanced practice registered nurse who has been
1131	1131	delegated the authority to prescribe and order drugs and medical
1132	1132	devices by a physician's protocol or order under Section 157.0511,
1133	1133	157.0512, or 157.054, Occupations Code, may continue to exercise
1134	1134	that authority until February 1, 2024.
1135	1135	SECTION 6.003. This Act takes effect September 1, 2023.