Texas 2025 - 89th Regular

Texas House Bill HB2532 Compare Versions

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1	1	89R8850 BEE-D
2	2	By: Shofner H.B. No. 2532
3	3
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5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the licensing and regulation of certain advanced
10	10	practice registered nurses; authorizing a fee.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	ARTICLE 1. REGULATION OF ADVANCED PRACTICE REGISTERED NURSES
13	13	SECTION 1.001. Section 301.002, Occupations Code, is
14	14	amended to read as follows:
15	15	Sec. 301.002. DEFINITIONS. In this chapter:
16	16	(1) "Advanced practice registered nurse" means a
17	17	registered nurse licensed by the board to practice as an advanced
18	18	practice registered nurse on the basis of completion of an advanced
19	19	educational program. The term includes a nurse practitioner, nurse
20	20	midwife, nurse anesthetist, and clinical nurse specialist.
21	21	(2) [(1)] "Board" means the Texas Board of Nursing.
22	22	(3) [(1-a)] "Chief nursing officer" means the
23	23	registered nurse who is administratively responsible for the
24	24	nursing services at a facility.
25	25	(4) "Controlled substance" has the meaning assigned by
26	26	Section 481.002, Health and Safety Code.
27	27	(5) "Dangerous drug" has the meaning assigned by
28	28	Section 483.001, Health and Safety Code.
29	29	(6) "Device" has the meaning assigned by Section
30	30	551.003, and includes durable medical equipment.
31	31	(7) "Nonprescription drug" has the meaning assigned by
32	32	Section 551.003.
33	33	(8) "Nurse" means a person required to be licensed
34	34	under this chapter to engage in professional or vocational nursing.
35	35	(9) "Nursing" means professional or vocational
36	36	nursing.
37	37	(10) [(1-b)] "Patient safety committee" has the
38	38	meaning assigned by Section 303.001.
39	39	(11) "Prescribe or order a drug or device" has the
40	40	meaning assigned by Section 157.051.
41	41	(12) [(2)] "Professional nursing" means the
42	42	performance of an act that requires substantial specialized
43	43	judgment and skill, the proper performance of which is based on
44	44	knowledge and application of the principles of biological,
45	45	physical, and social science as acquired by a completed course in an
46	46	approved school of professional nursing. The term does not include
47	47	acts of medical diagnosis or the prescription of therapeutic or
48	48	corrective measures, except as performed by an advanced practice
49	49	registered nurse authorized to practice by the board under Section
50	50	301.357. 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 by an advanced practice
70	70	registered nurse of an act delegated by a physician under Section
71	71	157.0512, 157.054, 157.058, or 157.059; [and]
72	72	(H) the development of the nursing care plan; and
73	73	(I) the performance of an act by an advanced
74	74	practice registered nurse authorized to practice by the board under
75	75	Section 301.357.
76	76	[(3) "Nurse" means a person required to be licensed
77	77	under this chapter to engage in professional or vocational nursing.
78	78	[(4) "Nursing" means professional or vocational
79	79	nursing.]
80	80	(13) [(5)] "Vocational nursing" means a directed
81	81	scope of nursing practice, including the performance of an act that
82	82	requires specialized judgment and skill, the proper performance of
83	83	which is based on knowledge and application of the principles of
84	84	biological, physical, and social science as acquired by a completed
85	85	course in an approved school of vocational nursing. The term does
86	86	not include acts of medical diagnosis or the prescription of
87	87	therapeutic or corrective measures. Vocational nursing involves:
88	88	(A) collecting data and performing focused
89	89	nursing assessments of the health status of an individual;
90	90	(B) participating in the planning of the nursing
91	91	care needs of an individual;
92	92	(C) participating in the development and
93	93	modification of the nursing care plan;
94	94	(D) participating in health teaching and
95	95	counseling to promote, attain, and maintain the optimum health
96	96	level of an individual;
97	97	(E) assisting in the evaluation of an
98	98	individual's response to a nursing intervention and the
99	99	identification of an individual's needs; and
100	100	(F) engaging in other acts that require education
101	101	and training, as prescribed by board rules and policies,
102	102	commensurate with the nurse's experience, continuing education,
103	103	and demonstrated competency.
104	104	SECTION 1.002. Section 301.005(b), Occupations Code, is
105	105	amended to read as follows:
106	106	(b) A reference in any other law to an "advanced nurse
107	107	practitioner," [practitioner" or] "advanced practice nurse," or
108	108	"advanced practice registered nurse" means an advanced practice
109	109	registered nurse.
110	110	SECTION 1.003. Section 301.152(b), Occupations Code, is
111	111	amended to read as follows:
112	112	(b) The board shall adopt rules to:
113	113	(1) license a registered nurse as an advanced practice
114	114	registered nurse;
115	115	(2) establish:
116	116	(A) any specialized education or training,
117	117	including pharmacology, that an advanced practice registered nurse
118	118	must have to prescribe or order a drug or device as delegated by a
119	119	physician under Section 157.0512 or 157.054 or authorized by the
120	120	board under Section 301.358;
121	121	(B) a system for approving an advanced practice
122	122	registered nurse to prescribe or order a drug or device as delegated
123	123	by a physician under Section 157.0512 or 157.054 or authorized by
124	124	the board under Section 301.358 on the receipt of evidence of
125	125	completing the specialized education and training requirement
126	126	under Paragraph (A); and
127	127	(C) a system for issuing a prescription
128	128	authorization number to an advanced practice registered nurse
129	129	approved under Paragraph (B); and
130	130	(3) concurrently renew any license or approval granted
131	131	to an advanced practice registered nurse under this subsection and
132	132	a license renewed by the advanced practice registered nurse under
133	133	Section 301.301.
134	134	SECTION 1.004. Section 301.303(b), Occupations Code, is
135	135	amended to read as follows:
136	136	(b) Except as provided by a rule adopted under Section
137	137	301.357(g) for an advanced practice registered nurse authorized by
138	138	the board to practice under that section, the [The] board may not
139	139	require participation in more than a total of 20 hours of continuing
140	140	education in a two-year licensing period.
141	141	SECTION 1.005. Subchapter H, Chapter 301, Occupations Code,
142	142	is amended by adding Sections 301.357 and 301.358 to read as
143	143	follows:
144	144	Sec. 301.357. INDEPENDENT PRACTICE BY CERTAIN ADVANCED
145	145	PRACTICE REGISTERED NURSES. (a) The board shall authorize the
146	146	practice under this section of an advanced practice registered
147	147	nurse who pays any application fee established by the board and
148	148	applies for authorization under this section in the manner
149	149	prescribed by the board.
150	150	(b) The scope of practice of an advanced practice registered
151	151	nurse authorized to practice under this section includes:
152	152	(1) ordering, performing, and interpreting diagnostic
153	153	tests;
154	154	(2) formulating primary and differential medical
155	155	diagnoses and advanced assessments;
156	156	(3) treating actual and potential health problems;
157	157	(4) prescribing therapeutic and corrective measures,
158	158	including nutrition and diagnostic support services, home health
159	159	care, hospice care, physical therapy, and occupational therapy, and
160	160	delegating and assigning the performance of therapeutic and
161	161	corrective measures to assistive personnel;
162	162	(5) to the extent authorized by the board under
163	163	Section 301.358, prescribing, ordering, procuring, administering,
164	164	and dispensing drugs and devices, including blood and blood
165	165	products, controlled substances listed in Schedules II, III, IV,
166	166	and V, dangerous drugs, and nonprescription drugs;
167	167	(6) providing referrals to health care agencies,
168	168	health care providers, and community resources;
169	169	(7) serving as the primary care provider of record;
170	170	and
171	171	(8) performing other acts that require education and
172	172	training consistent with professional standards and that are
173	173	commensurate with the advanced practice registered nurse's
174	174	education, licensure, and demonstrated competencies and
175	175	experience.
176	176	(c) Subject to Subsection (d), an advanced practice
177	177	registered nurse authorized to practice under this section shall
178	178	practice as a licensed independent practitioner in accordance with
179	179	standards established and recognized by the board to protect the
180	180	public health and safety.
181	181	(d) An advanced practice registered nurse authorized to
182	182	practice under this section may practice as a licensed independent
183	183	practitioner only when practicing in:
184	184	(1) a rural county as defined by Section 487.301,
185	185	Government Code; or
186	186	(2) a practice serving a medically underserved
187	187	population as defined by Section 157.051.
188	188	(e) An advanced practice registered nurse authorized to
189	189	practice under this section is accountable to patients, the nursing
190	190	profession, and the board for:
191	191	(1) complying with the requirements of this chapter;
192	192	(2) providing quality advanced nursing care;
193	193	(3) recognizing the nurse's limits of knowledge;
194	194	(4) planning for the management of situations beyond
195	195	the nurse's expertise; and
196	196	(5) consulting with or referring patients to other
197	197	health care providers as appropriate.
198	198	(f) This section does not limit or modify the scope of
199	199	practice of a nurse who is not authorized to practice under this
200	200	section.
201	201	(g) The board by rule shall establish the application
202	202	process for authorization to practice under this section and
203	203	guidelines for continuing education for advanced practice
204	204	registered nurses authorized to practice under this section.
205	205	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
206	206	ADVANCED PRACTICE REGISTERED NURSE. The board may authorize an
207	207	advanced practice registered nurse authorized to practice by the
208	208	board under Section 301.357 to prescribe and order drugs and
209	209	devices, including controlled substances listed in Schedules II,
210	210	III, IV, and V, dangerous drugs, and nonprescription drugs.
211	211	ARTICLE 2. CONFORMING AMENDMENTS
212	212	SECTION 2.001. Section 38.151(1), Education Code, is
213	213	amended to read as follows:
214	214	(1) "Advanced practice nurse" has the meaning assigned
215	215	to "advanced practice registered nurse" by Section 301.002
216	216	[301.152], Occupations Code.
217	217	SECTION 2.002. Section 38.211(a), Education Code, is
218	218	amended to read as follows:
219	219	(a) A physician, a [or] person who has been delegated
220	220	prescriptive authority under Chapter 157, Occupations Code, or an
221	221	advanced practice registered nurse authorized to prescribe and
222	222	order drugs and devices under Section 301.358, Occupations Code,
223	223	may prescribe epinephrine auto-injectors or medication for
224	224	respiratory distress in the name of a school district,
225	225	open-enrollment charter school, or private school.
226	226	SECTION 2.003. Section 38.225(a), Education Code, is
227	227	amended to read as follows:
228	228	(a) A physician, a [or] person who has been delegated
229	229	prescriptive authority under Chapter 157, Occupations Code, or an
230	230	advanced practice registered nurse authorized to prescribe and
231	231	order drugs and devices under Section 301.358, Occupations Code,
232	232	may prescribe opioid antagonists in the name of a school district,
233	233	open-enrollment charter school, or private school.
234	234	SECTION 2.004. Section 61.601, Education Code, is amended
235	235	to read as follows:
236	236	Sec. 61.601. DEFINITION. In this subchapter, "mental
237	237	health professional" means:
238	238	(1) a licensed physician who is:
239	239	(A) a graduate of an accredited psychiatric
240	240	residency training program; or
241	241	(B) certified in psychiatry by:
242	242	(i) the American Board of Psychiatry and
243	243	Neurology; or
244	244	(ii) the American Osteopathic Board of
245	245	Neurology and Psychiatry;
246	246	(2) a psychologist, as defined by Section 501.002,
247	247	Occupations Code;
248	248	(3) a licensed professional counselor, as defined by
249	249	Section 503.002, Occupations Code;
250	250	(4) an advanced practice registered nurse, as defined
251	251	by Section 301.002 [301.152], Occupations Code, who holds a
252	252	nationally recognized board certification in psychiatric or mental
253	253	health nursing;
254	254	(5) a licensed clinical social worker, as defined by
255	255	Section 505.002, Occupations Code;
256	256	(6) a licensed specialist in school psychology, as
257	257	defined by Section 501.002, Occupations Code;
258	258	(7) a chemical dependency counselor, as defined by
259	259	Section 504.001, Occupations Code; and
260	260	(8) a licensed marriage and family therapist, as
261	261	defined by Section 502.002, Occupations Code.
262	262	SECTION 2.005. Section 1101.100(1), Estates Code, is
263	263	amended to read as follows:
264	264	(1) "Advanced practice registered nurse" has the
265	265	meaning assigned by Section 301.002 [301.152], Occupations Code.
266	266	SECTION 2.006. Section 671.001(b), Government Code, is
267	267	amended to read as follows:
268	268	(b) The pilot program must provide for the following:
269	269	(1) either:
270	270	(A) both:
271	271	(i) a licensed advanced practice registered
272	272	nurse as defined by Section 301.002 [301.152], Occupations Code, or
273	273	a licensed physician assistant as described by Chapter 204,
274	274	Occupations Code, who is employed by the state or whose services are
275	275	acquired by contract, who will be located at a state office complex;
276	276	and
277	277	(ii) [(2)] a licensed physician, who is
278	278	employed by a state governmental entity for purposes other than the
279	279	pilot program or whose services are acquired by contract, who will
280	280	delegate to and supervise the advanced practice registered nurse or
281	281	physician assistant under a prescriptive authority agreement under
282	282	Chapter 157, Occupations Code; or
283	283	(B) an advanced practice registered nurse
284	284	authorized to practice under Section 301.357, Occupations Code;
285	285	(2) [(3)] appropriate office space and equipment for
286	286	the advanced practice registered nurse or physician assistant to
287	287	provide basic medical care to employees at the state office complex
288	288	where the nurse or physician assistant is located; and
289	289	(3) [(4)] professional liability insurance covering
290	290	services provided by the advanced practice registered nurse or the
291	291	physician assistant.
292	292	SECTION 2.007. Sections 161.0052(b) and (c), Health and
293	293	Safety Code, are amended to read as follows:
294	294	(b) The executive commissioner by rule shall require a
295	295	hospital to inform each elderly person admitted to the hospital for
296	296	a period of 24 hours or more that the pneumococcal and influenza
297	297	vaccines are available. If the elderly person requests a vaccine,
298	298	and if a physician, or an advanced nurse practitioner or physician
299	299	assistant on behalf of a physician, or an advanced practice
300	300	registered nurse authorized to prescribe and order drugs and
301	301	devices under Section 301.358, Occupations Code, determines that
302	302	the vaccine is in the person's best interest, the hospital must make
303	303	the vaccination available to the person before the person is
304	304	discharged from the hospital.
305	305	(c) The executive commissioner by rule shall require an end
306	306	stage renal disease facility to offer, to the extent possible as
307	307	determined by the facility, the opportunity to receive the
308	308	pneumococcal and influenza vaccines to each elderly person who
309	309	receives ongoing care at the facility if a physician, or an advanced
310	310	nurse practitioner or physician assistant on behalf of a physician,
311	311	or an advanced practice registered nurse authorized to prescribe
312	312	and order drugs and devices under Section 301.358, Occupations
313	313	Code, determines that the vaccine is in the person's best
314	314	interest. If the facility decides it is not feasible to offer the
315	315	vaccine, the facility must provide the person with information on
316	316	other options for obtaining the vaccine.
317	317	SECTION 2.008. Section 401.504(d), Health and Safety Code,
318	318	is amended to read as follows:
319	319	(d) This subchapter does not apply to a physician, [or to] a
320	320	physician's employee or delegate acting under Chapter 157,
321	321	Occupations Code, or an advanced practice registered nurse
322	322	authorized to prescribe and order drugs and devices under Section
323	323	301.358, Occupations Code.
324	324	SECTION 2.009. Section 481.002(39), Health and Safety Code,
325	325	is amended to read as follows:
326	326	(39) "Practitioner" means:
327	327	(A) a physician, dentist, veterinarian,
328	328	podiatrist, scientific investigator, advanced practice registered
329	329	nurse authorized to prescribe and order drugs and devices under
330	330	Section 301.358, Occupations Code, or other person licensed,
331	331	registered, or otherwise permitted to distribute, dispense,
332	332	analyze, conduct research with respect to, or administer a
333	333	controlled substance in the course of professional practice or
334	334	research in this state;
335	335	(B) a pharmacy, hospital, or other institution
336	336	licensed, registered, or otherwise permitted to distribute,
337	337	dispense, conduct research with respect to, or administer a
338	338	controlled substance in the course of professional practice or
339	339	research in this state;
340	340	(C) a person practicing in and licensed by
341	341	another state as a physician, dentist, veterinarian, advanced
342	342	practice registered nurse, or podiatrist, having a current Federal
343	343	Drug Enforcement Administration registration number, who may
344	344	legally prescribe Schedule II, III, IV, or V controlled substances
345	345	in that state; or
346	346	(D) an advanced practice registered nurse or
347	347	physician assistant to whom a physician has delegated the authority
348	348	to prescribe or order a drug or device under Section 157.0511,
349	349	157.0512, or 157.054, Occupations Code.
350	350	SECTION 2.010. Section 481.074(d), Health and Safety Code,
351	351	is amended to read as follows:
352	352	(d) Except as specified in Subsections (e) and (f), the
353	353	board, by rule and in consultation with the Texas Medical Board and
354	354	the Texas Board of Nursing, shall establish the period after the
355	355	date on which the prescription is issued that a person may fill a
356	356	prescription for a controlled substance listed in Schedule II. A
357	357	person may not refill a prescription for a substance listed in
358	358	Schedule II.
359	359	SECTION 2.011. Section 481.076(c), Health and Safety Code,
360	360	is amended to read as follows:
361	361	(c) The board by rule shall design and implement a system
362	362	for submission of information to the board by electronic or other
363	363	means and for retrieval of information submitted to the board under
364	364	this section and Sections 481.074 and 481.075. The board shall use
365	365	automated information security techniques and devices to preclude
366	366	improper access to the information. The board shall submit the
367	367	system design to the director, [and] the Texas Medical Board, and
368	368	the Texas Board of Nursing for review and comment a reasonable time
369	369	before implementation of the system and shall comply with the
370	370	comments of those agencies unless it is unreasonable to do so.
371	371	SECTION 2.012. Section 481.0767(b), Health and Safety Code,
372	372	is amended to read as follows:
373	373	(b) The board shall appoint the following members to the
374	374	advisory committee:
375	375	(1) a physician licensed in this state who practices
376	376	in pain management;
377	377	(2) a physician licensed in this state who practices
378	378	in family medicine;
379	379	(3) a physician licensed in this state who performs
380	380	surgery;
381	381	(4) a physician licensed in this state who practices
382	382	in emergency medicine at a hospital;
383	383	(5) a physician licensed in this state who practices
384	384	in psychiatry;
385	385	(6) an oral and maxillofacial surgeon;
386	386	(7) a physician assistant or advanced practice
387	387	registered nurse to whom a physician has delegated the authority to
388	388	prescribe or order a drug or an advanced practice registered nurse
389	389	authorized to prescribe and order drugs and devices under Section
390	390	301.358, Occupations Code;
391	391	(8) a pharmacist working at a chain pharmacy;
392	392	(9) a pharmacist working at an independent pharmacy;
393	393	(10) an academic pharmacist; and
394	394	(11) two representatives of the health information
395	395	technology industry, at least one of whom is a representative of a
396	396	company whose primary line of business is electronic medical
397	397	records.
398	398	SECTION 2.013. Sections 483.001(4), (12), and (13), Health
399	399	and Safety Code, are amended to read as follows:
400	400	(4) "Designated agent" means:
401	401	(A) a licensed nurse, physician assistant,
402	402	pharmacist, or other individual designated by a practitioner to
403	403	communicate prescription drug orders to a pharmacist;
404	404	(B) a licensed nurse, physician assistant, or
405	405	pharmacist employed in a health care facility to whom the
406	406	practitioner communicates a prescription drug order; or
407	407	(C) an advanced practice [a] registered nurse or
408	408	physician assistant authorized by a practitioner to carry out a
409	409	prescription drug order for dangerous drugs under Subchapter B,
410	410	Chapter 157, Occupations Code.
411	411	(12) "Practitioner" means:
412	412	(A) a person licensed by:
413	413	(i) the Texas Medical Board, State Board of
414	414	Dental Examiners, Texas Optometry Board, or State Board of
415	415	Veterinary Medical Examiners to prescribe and administer dangerous
416	416	drugs; or
417	417	(ii) the Texas Department of Licensing and
418	418	Regulation, with respect to podiatry, to prescribe and administer
419	419	dangerous drugs;
420	420	(B) a person licensed by another state in a
421	421	health field in which, under the laws of this state, a licensee may
422	422	legally prescribe dangerous drugs;
423	423	(C) a person licensed in Canada or Mexico in a
424	424	health field in which, under the laws of this state, a licensee may
425	425	legally prescribe dangerous drugs; [or]
426	426	(D) an advanced practice registered nurse or
427	427	physician assistant to whom a physician has delegated the authority
428	428	to prescribe or order a drug or device under Section 157.0511,
429	429	157.0512, or 157.054, Occupations Code; or
430	430	(E) an advanced practice registered nurse
431	431	authorized to prescribe and order drugs and devices under Section
432	432	301.358, Occupations Code.
433	433	(13) "Prescription" means an order from a
434	434	practitioner, or an agent of the practitioner designated in writing
435	435	as authorized to communicate prescriptions, or an order made in
436	436	accordance with Subchapter B, Chapter 157, Occupations Code, or
437	437	Section 203.353, Occupations Code, to a pharmacist for a dangerous
438	438	drug to be dispensed that states:
439	439	(A) the date of the order's issue;
440	440	(B) the name and address of the patient;
441	441	(C) if the drug is prescribed for an animal, the
442	442	species of the animal;
443	443	(D) the name and quantity of the drug prescribed;
444	444	(E) the directions for the use of the drug;
445	445	(F) the intended use of the drug unless the
446	446	practitioner determines the furnishing of this information is not
447	447	in the best interest of the patient;
448	448	(G) the name, address, and telephone number of
449	449	the practitioner at the practitioner's usual place of business,
450	450	legibly printed or stamped; and
451	451	(H) the name, address, and telephone number of
452	452	the licensed midwife, advanced practice registered nurse, or
453	453	physician assistant, legibly printed or stamped, if signed by a
454	454	licensed midwife, advanced practice registered nurse, or physician
455	455	assistant.
456	456	SECTION 2.014. Section 483.022(f), Health and Safety Code,
457	457	is amended to read as follows:
458	458	(f) A practitioner may designate a person who is a licensed
459	459	vocational nurse or has an education equivalent to or greater than
460	460	that required for a licensed vocational nurse to communicate
461	461	prescriptions of an advanced practice registered nurse or physician
462	462	assistant authorized by the practitioner to sign prescription drug
463	463	orders under Subchapter B, Chapter 157, Occupations Code, or of an
464	464	advanced practice registered nurse authorized to prescribe and
465	465	order drugs and devices under Section 301.358, Occupations Code.
466	466	SECTION 2.015. Section 483.042(a), Health and Safety Code,
467	467	is amended to read as follows:
468	468	(a) A person commits an offense if the person delivers or
469	469	offers to deliver a dangerous drug:
470	470	(1) unless:
471	471	(A) the dangerous drug is delivered or offered
472	472	for delivery by a pharmacist under:
473	473	(i) a prescription issued by a practitioner
474	474	described by Section 483.001(12)(A), [or] (B), or (E);
475	475	(ii) a prescription signed by an advanced
476	476	practice [a] registered nurse or physician assistant in accordance
477	477	with Subchapter B, Chapter 157, Occupations Code; or
478	478	(iii) an original written prescription
479	479	issued by a practitioner described by Section 483.001(12)(C); and
480	480	(B) a label is attached to the immediate
481	481	container in which the drug is delivered or offered to be delivered
482	482	and the label contains the following information:
483	483	(i) the name and address of the pharmacy
484	484	from which the drug is delivered or offered for delivery;
485	485	(ii) the date the prescription for the drug
486	486	is dispensed;
487	487	(iii) the number of the prescription as
488	488	filed in the prescription files of the pharmacy from which the
489	489	prescription is dispensed;
490	490	(iv) the name of the practitioner who
491	491	prescribed the drug and, if applicable, the name of the advanced
492	492	practice registered nurse or physician assistant who signed the
493	493	prescription;
494	494	(v) the name of the patient and, if the drug
495	495	is prescribed for an animal, a statement of the species of the
496	496	animal; and
497	497	(vi) directions for the use of the drug as
498	498	contained in the prescription; or
499	499	(2) unless:
500	500	(A) the dangerous drug is delivered or offered
501	501	for delivery by:
502	502	(i) a practitioner in the course of
503	503	practice; or
504	504	(ii) an advanced practice [a] registered
505	505	nurse or physician assistant in the course of practice in
506	506	accordance with Subchapter B, Chapter 157, Occupations Code; and
507	507	(B) a label is attached to the immediate
508	508	container in which the drug is delivered or offered to be delivered
509	509	and the label contains the following information:
510	510	(i) the name and address of the
511	511	practitioner who prescribed the drug, and if applicable, the name
512	512	and address of the advanced practice registered nurse or physician
513	513	assistant;
514	514	(ii) the date the drug is delivered;
515	515	(iii) the name of the patient and, if the
516	516	drug is prescribed for an animal, a statement of the species of the
517	517	animal; and
518	518	(iv) the name of the drug, the strength of
519	519	the drug, and directions for the use of the drug.
520	520	SECTION 2.016. Section 773.0145(k), Health and Safety Code,
521	521	is amended to read as follows:
522	522	(k) A physician, a [or] person who has been delegated
523	523	prescriptive authority under Chapter 157, Occupations Code, or an
524	524	advanced practice registered nurse authorized to prescribe and
525	525	order drugs and devices under Section 301.358, Occupations Code,
526	526	may prescribe epinephrine auto-injectors in the name of an entity.
527	527	SECTION 2.017. Section 32.024(gg), Human Resources Code, is
528	528	amended to read as follows:
529	529	(gg) Notwithstanding any other law, including Sections
530	530	843.312 and 1301.052, Insurance Code, the commission shall ensure
531	531	that advanced practice registered nurses and physician assistants
532	532	may be selected by and assigned to recipients of medical assistance
533	533	as the primary care providers of those recipients regardless of
534	534	whether, if applicable, the physician supervising the advanced
535	535	practice registered nurse is included in any directory of providers
536	536	of medical assistance maintained by the commission. This
537	537	subsection may not be construed as authorizing the commission to
538	538	supervise or control the practice of medicine as prohibited by
539	539	Subtitle B, Title 3, Occupations Code. The commission must require
540	540	that advanced practice registered nurses and physician assistants
541	541	be treated in the same manner as primary care physicians with regard
542	542	to:
543	543	(1) selection and assignment as primary care
544	544	providers; and
545	545	(2) inclusion as primary care providers in any
546	546	directory of providers of medical assistance maintained by the
547	547	commission.
548	548	SECTION 2.018. Section 32.03141, Human Resources Code, is
549	549	amended to read as follows:
550	550	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
551	551	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
552	552	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
553	553	addition to other health care practitioners authorized by federal
554	554	law, the following persons may order and prescribe durable medical
555	555	equipment and supplies under the medical assistance program:
556	556	(1) an advanced practice registered nurse authorized
557	557	to prescribe and order drugs and devices under Section 301.358,
558	558	Occupations Code; and
559	559	(2) an advanced practice registered nurse or physician
560	560	assistant acting under adequate physician supervision and to whom a
561	561	physician has delegated the authority to prescribe and order drugs
562	562	and devices under Chapter 157, Occupations Code[, may order and
563	563	prescribe durable medical equipment and supplies under the medical
564	564	assistance program].
565	565	SECTION 2.019. Section 42.067(b), Human Resources Code, is
566	566	amended to read as follows:
567	567	(b) A physician, [or] a person who has been delegated
568	568	prescriptive authority under Chapter 157, Occupations Code, or an
569	569	advanced practice registered nurse authorized to prescribe and
570	570	order drugs and devices under Section 301.358, Occupations Code,
571	571	may prescribe epinephrine auto-injectors in the name of a day-care
572	572	center.
573	573	SECTION 2.020. Section 843.312, Insurance Code, is amended
574	574	to read as follows:
575	575	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
576	576	REGISTERED NURSES. (a) A health maintenance organization may not
577	577	refuse a request by a physician participating in the health
578	578	maintenance organization delivery network and a physician
579	579	assistant or advanced practice registered nurse who is authorized
580	580	by the physician to provide care under Subchapter B, Chapter 157,
581	581	Occupations Code, or an advanced practice registered nurse
582	582	authorized to prescribe and order drugs and devices under Section
583	583	301.358, Occupations Code, to identify a physician assistant or
584	584	advanced practice registered nurse as a provider in the network.
585	585	(b) A health maintenance organization may refuse a request
586	586	under Subsection (a) if the physician assistant or advanced
587	587	practice registered nurse does not meet the quality of care
588	588	standards previously established by the health maintenance
589	589	organization for participation in the network by physician
590	590	assistants and advanced practice registered nurses.
591	591	SECTION 2.021. Section 1301.001(1-a), Insurance Code, is
592	592	amended to read as follows:
593	593	(1-a) "Health care provider" means a practitioner,
594	594	institutional provider, or other person or organization that
595	595	furnishes health care services and that is licensed or otherwise
596	596	authorized to practice in this state. The term includes a
597	597	pharmacist, [and] a pharmacy, and an advanced practice registered
598	598	nurse authorized to practice under Section 301.357, Occupations
599	599	Code. The term does not include a physician.
600	600	SECTION 2.022. Section 1452.051(1), Insurance Code, is
601	601	amended to read as follows:
602	602	(1) "Advanced practice nurse" has the meaning assigned
603	603	to "advanced practice registered nurse" by Section 301.002
604	604	[301.152], Occupations Code.
605	605	SECTION 2.023. Section 408.025, Labor Code, is amended by
606	606	amending Subsection (a-1) and adding Subsection (a-2) to read as
607	607	follows:
608	608	(a-1) A [treating doctor may delegate to a physician
609	609	assistant who is licensed to practice in this state under Chapter
610	610	204, Occupations Code, or an advanced practice registered nurse who
611	611	is licensed to practice in this state under Chapter 301,
612	612	Occupations Code, the authority to complete and sign a] work status
613	613	report regarding an injured employee's ability to return to work
614	614	may be completed and signed by:
615	615	(1) a physician assistant licensed to practice in this
616	616	state under Chapter 204, Occupations Code, who has been delegated
617	617	the authority by a treating doctor;
618	618	(2) an advanced practice registered nurse licensed to
619	619	practice in this state under Chapter 301, Occupations Code, who has
620	620	been delegated the authority by a treating doctor; or
621	621	(3) an advanced practice registered nurse authorized
622	622	to practice under Section 301.357, Occupations Code.
623	623	(a-2) The delegating treating doctor is responsible for the
624	624	acts of a [the] physician assistant [or advanced practice
625	625	registered nurse] under Subsection (a-1)(1) or an advanced practice
626	626	registered nurse under Subsection (a-1)(2) [this subsection].
627	627	SECTION 2.024. Section 157.051(1), Occupations Code, is
628	628	amended to read as follows:
629	629	(1) "Advanced practice registered nurse" has the
630	630	meaning assigned [to that term] by Section 301.002 [301.152]. [The
631	631	term includes an advanced nurse practitioner and advanced practice
632	632	nurse.]
633	633	SECTION 2.025. Section 203.002(2), Occupations Code, is
634	634	amended to read as follows:
635	635	(2) "Certified nurse-midwife" means an advanced
636	636	practice [a person who is:
637	637	[(A) a] registered nurse [under Chapter 301;
638	638	[(B) recognized as an advanced nurse
639	639	practitioner by the Texas Board of Nursing; and
640	640	[(C)] certified by the American College of
641	641	Nurse-Midwives.
642	642	SECTION 2.026. Sections 551.003(14) and (34), Occupations
643	643	Code, are amended to read as follows:
644	644	(14) "Designated agent" means:
645	645	(A) an individual, including a licensed nurse,
646	646	physician assistant, or pharmacist:
647	647	(i) who is designated by a practitioner and
648	648	authorized to communicate a prescription drug order to a
649	649	pharmacist; and
650	650	(ii) for whom the practitioner assumes
651	651	legal responsibility;
652	652	(B) a licensed nurse, physician assistant, or
653	653	pharmacist employed in a health care facility to whom a
654	654	practitioner communicates a prescription drug order; or
655	655	(C) an advanced practice [a] registered nurse or
656	656	physician assistant authorized by a practitioner to administer a
657	657	prescription drug order for a dangerous drug under Subchapter B,
658	658	Chapter 157.
659	659	(34) "Practitioner" means:
660	660	(A) a person licensed or registered to prescribe,
661	661	distribute, administer, or dispense a prescription drug or device
662	662	in the course of professional practice in this state, including a
663	663	physician, dentist, podiatrist, advanced practice registered nurse
664	664	authorized to prescribe and order drugs and devices under Section
665	665	301.358, or veterinarian but excluding a person licensed under this
666	666	subtitle;
667	667	(B) a person licensed by another state, Canada,
668	668	or the United Mexican States in a health field in which, under the
669	669	law of this state, a license holder in this state may legally
670	670	prescribe a dangerous drug;
671	671	(C) a person practicing in another state and
672	672	licensed by another state as a physician, dentist, veterinarian,
673	673	advanced practice registered nurse, or podiatrist, who has a
674	674	current federal Drug Enforcement Administration registration
675	675	number and who may legally prescribe a Schedule II, III, IV, or V
676	676	controlled substance, as specified under Chapter 481, Health and
677	677	Safety Code, in that other state; or
678	678	(D) an advanced practice registered nurse or
679	679	physician assistant to whom a physician has delegated the authority
680	680	to prescribe or order a drug or device under Section 157.0511,
681	681	157.0512, or 157.054.
682	682	SECTION 2.027. Section 563.051(e), Occupations Code, is
683	683	amended to read as follows:
684	684	(e) A practitioner may designate a licensed vocational
685	685	nurse or a person having education equivalent to or greater than
686	686	that required for a licensed vocational nurse to communicate the
687	687	prescriptions of an advanced practice registered nurse or physician
688	688	assistant authorized by the practitioner to sign prescription drug
689	689	orders under Subchapter B, Chapter 157, or of an advanced practice
690	690	registered nurse authorized to prescribe and order drugs and
691	691	devices under Section 301.358.
692	692	SECTION 2.028. Section 563.053, Occupations Code, is
693	693	amended to read as follows:
694	694	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
695	695	RURAL AREAS. (a) In this section:
696	696	(1) "Advanced practice registered nurse" has the
697	697	meaning assigned by Section 301.002.
698	698	(2) "Reimbursement [, "reimbursement] for cost" means
699	699	an additional charge, separate from that imposed for the
700	700	physician's or advanced practice registered nurse's professional
701	701	services, that includes the cost of the drug product and all other
702	702	actual costs to the physician or advanced practice registered nurse
703	703	incidental to providing the dispensing service. The term does not
704	704	include a separate fee imposed for the act of dispensing the drug
705	705	itself.
706	706	(a-1) This section applies to an advanced practice
707	707	registered nurse only to the extent that the advanced practice
708	708	registered nurse is authorized to prescribe and order drugs and
709	709	devices under Section 301.358.
710	710	(b) This section applies to an area located in a county with
711	711	a population of 5,000 or less, or in a municipality or an
712	712	unincorporated town with a population of less than 2,500, that is
713	713	within a 15-mile radius of the physician's or advanced practice
714	714	registered nurse's office and in which a pharmacy is not located.
715	715	This section does not apply to a municipality or an unincorporated
716	716	town that is adjacent to a municipality with a population of 2,500
717	717	or more.
718	718	(c) A physician who practices medicine or advanced practice
719	719	registered nurse who practices advanced practice registered
720	720	nursing in an area described by Subsection (b) may:
721	721	(1) maintain a supply of dangerous drugs in the
722	722	physician's or advanced practice registered nurse's office to be
723	723	dispensed in the course of treating the physician's or advanced
724	724	practice registered nurse's patients; and
725	725	(2) be reimbursed for the cost of supplying those
726	726	drugs without obtaining a license under Chapter 558.
727	727	(d) A physician or advanced practice registered nurse who
728	728	dispenses dangerous drugs under Subsection (c) shall:
729	729	(1) comply with each labeling provision under this
730	730	subtitle applicable to that class of drugs; and
731	731	(2) oversee compliance with packaging and
732	732	recordkeeping provisions applicable to that class of drugs.
733	733	(e) A physician who desires to dispense dangerous drugs
734	734	under this section shall notify both the board and the Texas Medical
735	735	[State] Board [of Medical Examiners] that the physician practices
736	736	in an area described by Subsection (b). An advanced practice
737	737	registered nurse who desires to dispense dangerous drugs under this
738	738	section shall notify both the board and the Texas Board of Nursing
739	739	that the advanced practice registered nurse practices in an area
740	740	described by Subsection (b). The physician or advanced practice
741	741	registered nurse may continue to dispense dangerous drugs in the
742	742	area until the board determines, after notice and hearing, that the
743	743	physician or advanced practice registered nurse no longer practices
744	744	in an area described by Subsection (b).
745	745	SECTION 2.029. Sections 605.002(14) and (18), Occupations
746	746	Code, are amended to read as follows:
747	747	(14) "Orthotics" means the science and practice of
748	748	measuring, designing, fabricating, assembling, fitting, adjusting,
749	749	or servicing an orthosis under an order from a licensed physician,
750	750	chiropractor, [or] podiatrist, or advanced practice registered
751	751	nurse authorized to prescribe and order drugs and devices under
752	752	Section 301.358, or an advanced practice registered nurse or
753	753	physician assistant acting under the delegation and supervision of
754	754	a licensed physician as provided by Subchapter B, Chapter 157, and
755	755	rules adopted by the Texas Medical Board, for the correction or
756	756	alleviation of a neuromuscular or musculoskeletal dysfunction,
757	757	disease, injury, or deformity.
758	758	(18) "Prosthetics" means the science and practice of
759	759	measuring, designing, fabricating, assembling, fitting, adjusting,
760	760	or servicing a prosthesis under an order from a licensed physician,
761	761	chiropractor, [or] podiatrist, or advanced practice registered
762	762	nurse authorized to prescribe and order drugs and devices under
763	763	Section 301.358, or an advanced practice registered nurse or
764	764	physician assistant acting under the delegation and supervision of
765	765	a licensed physician as provided by Subchapter B, Chapter 157, and
766	766	rules adopted by the Texas Medical Board.
767	767	SECTION 2.030. Section 605.2515, Occupations Code, is
768	768	amended to read as follows:
769	769	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
770	770	person licensed to practice orthotics or prosthetics who measures,
771	771	designs, fabricates, fits, assembles, adjusts, or services an
772	772	orthosis or a prosthesis under an order from a licensed physician,
773	773	chiropractor, [or] podiatrist, or advanced practice registered
774	774	nurse authorized to prescribe and order drugs and devices under
775	775	Section 301.358, or an advanced practice registered nurse or
776	776	physician assistant acting under the delegation and supervision of
777	777	a licensed physician as provided by Subchapter B, Chapter 157, and
778	778	rules adopted by the Texas Medical Board, for a specific patient is
779	779	exempt from licensing as a device manufacturer under Subchapter L,
780	780	Chapter 431, Health and Safety Code. A person licensed to practice
781	781	orthotics or prosthetics who fabricates or assembles an orthosis or
782	782	a prosthesis without an order from a licensed physician,
783	783	chiropractor, [or] podiatrist, or advanced practice registered
784	784	nurse authorized to prescribe and order drugs and devices under
785	785	Section 301.358, or an advanced practice registered nurse or
786	786	physician assistant acting under the delegation and supervision of
787	787	a licensed physician as provided by Subchapter B, Chapter 157, and
788	788	rules adopted by the Texas Medical Board, for a specific patient is
789	789	required to be licensed as a device manufacturer under Subchapter
790	790	L, Chapter 431, Health and Safety Code.
791	791	SECTION 2.031. Section 1701.703(a), Occupations Code, is
792	792	amended to read as follows:
793	793	(a) A physician, [or] a person who has been delegated
794	794	prescriptive authority under Chapter 157, or an advanced practice
795	795	registered nurse authorized to prescribe and order drugs and
796	796	devices under Section 301.358 [Occupations Code,] may prescribe
797	797	epinephrine auto-injectors in the name of a law enforcement agency.
798	798	ARTICLE 3. REPEALER
799	799	SECTION 3.001. Section 301.152(a), Occupations Code, is
800	800	repealed.
801	801	ARTICLE 4. TRANSITIONS AND EFFECTIVE DATE
802	802	SECTION 4.001. Not later than February 1, 2026, the Texas
803	803	Board of Nursing shall adopt the rules necessary to implement the
804	804	changes in law made by this Act.
805	805	SECTION 4.002. This Act takes effect September 1, 2025.