89R2533 JTZ-D
By: González of El Paso H.B. No. 5537
A BILL TO BE ENTITLED
AN ACT
relating to the prescriptive authority of certain psychologists;
authorizing a fee.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 501.003(a)(1), Occupations Code, is
amended to read as follows:
(1) "Practice of psychology" means:
(A) the observation, description, diagnosis,
evaluation, assessment, interpretation, or treatment of and
intervention in human behavior by applying education, training,
methods, and procedures for the purpose of:
(i) preventing, predicting, treating,
remediating, or eliminating:
(a) symptomatic, maladaptive, or
undesired behavior;
(b) emotional, interpersonal,
learning, substance use, neuropsychological, cognitive, or
behavioral disorders or disabilities, including those that
accompany medical problems; or
(c) mental illness;
(ii) evaluating, assessing, or
facilitating, by a license holder or a person who represents the
person to the public by a title or description of services that
includes the word "psychological," "psychologist," or
"psychology," the enhancement of individual, group, or
organizational effectiveness, including evaluating, assessing, or
facilitating:
(a) personal effectiveness;
(b) adaptive behavior;
(c) interpersonal relationships;
(d) academic, vocational, and life
adjustment;
(e) health; or
(f) individual, group, or
organizational performance;
(iii) providing psychological,
neuropsychological, and psychoeducational evaluation, therapy, and
remediation as well as counseling, psychoanalysis, psychotherapy,
hypnosis, and biofeedback; or
(iv) consulting with others, including
other mental health professionals, physicians, school personnel,
or organizations within the scope of the provider's competency and
training with respect to services provided for a specific
individual; [or]
(B) action taken under the authority granted by a
certificate issued under Subchapter H-1; or
(C) the supervision of an activity or service
described by Paragraph (A) or (B).
SECTION 2. Section 501.051, Occupations Code, is amended by
amending Subsection (b) and adding Subsection (b-1) to read as
follows:
(b) To ensure adequate representation on the board of the
diverse fields of psychology, the governor in making appointments
under Subsection (a)(1) shall appoint:
(1) at least two members who provide psychological
services;
(2) at least two members who hold certificates issued
under Subchapter H-1;
(3) at least one member who conducts research in the
field of psychology; and
(4) [(3)] at least one member who teaches as a member
of the faculty of a psychological training institution.
(b-1) Notwithstanding Subsection (b)(2), a person satisfies
the requirement of that subdivision if the person has completed the
requirements of Sections 501.372(b)(1) and (2), regardless of
whether the person has been issued a certificate under Subchapter
H-1. This subsection expires October 31, 2029.
SECTION 3. Subchapter D, Chapter 501, Occupations Code, is
amended by adding Section 501.152 to read as follows:
Sec. 501.152. ADVISORY COMMITTEE ON PRESCRIPTIVE
AUTHORITY. (a) The executive council shall appoint an advisory
committee on prescriptive authority for psychologists.
(a-1) Effective September 1, 2025, the advisory committee
consists of six members as follows:
(1) three members who are psychologists, each of whom
has completed the requirements of Sections 501.372(b)(1) and (2);
(2) one member who is a psychiatrist;
(3) one member who is a pediatrician or primary care
physician with experience in child and adolescent medicine; and
(4) one member who represents the public.
(a-2) In appointing members under Subsection (a-1)(1), the
executive council shall give preference to psychologists who have
previously been licensed or certified to prescribe drugs in another
jurisdiction. This subsection and Subsection (a-1) expire
September 1, 2028.
(b) Effective September 1, 2028, the advisory committee
consists of six members as follows:
(1) five members who each hold a certificate issued
under Subchapter H-1; and
(2) one member who represents the public.
(c) A member appointed to represent the public may not have
a significant financial interest, as determined by executive
council rule, in the practice of psychology or prescriptive
authority for psychologists.
(d) The advisory committee shall make recommendations to
the executive council and board regarding the regulation of
psychologists who hold certificates issued under Subchapter H-1,
including recommendations concerning rules to establish:
(1) eligibility requirements;
(2) standards of practice for certificate holders;
(3) continuing education requirements;
(4) requirements regarding the use of appropriate
prescription drug monitoring programs by a psychologist with a
certificate issued under Subchapter H-1;
(5) requirements for training programs described by
Section 501.372(b)(1)(B);
(6) guidelines and procedures for peer review of a
psychologist with a conditional prescription certificate issued
under Section 501.372;
(7) procedures for the review of an applicant under
Section 501.379; and
(8) procedures for the review of a complaint involving
a psychologist with a certificate issued under Subchapter H-1.
(e) Chapter 2110, Government Code, does not apply to the
composition or duration of the advisory committee.
SECTION 4. Chapter 501, Occupations Code, is amended by
adding Subchapter H-1 to read as follows:
SUBCHAPTER H-1. PRESCRIPTION CERTIFICATE
Sec. 501.371. DEFINITIONS. In this subchapter:
(1) "Prescribing psychologist" means a psychologist
to whom a prescription certificate or conditional prescription
certificate has been issued under this subchapter.
(2) "Prescription drug" and "prescription drug order"
have the meanings assigned by Section 551.003.
(3) "Psychotropic medication" means a controlled
substance, as defined by Section 481.002, Health and Safety Code,
or dangerous drug, as defined by Section 483.001, Health and Safety
Code, that is used for the diagnosis, treatment, or management of
mental, nervous, emotional, behavioral, substance use, or
cognitive disorders.
(4) "Supervising clinician" means a physician or
psychologist who meets the requirements of Section 501.382 to
supervise a psychologist with a conditional prescription
certificate.
Sec. 501.372. CONDITIONAL PRESCRIPTION CERTIFICATE. (a)
The executive council shall issue a conditional prescription
certificate to a psychologist who:
(1) meets the eligibility requirements of Subsection
(b);
(2) submits an application on a form prescribed by the
executive council;
(3) has not, in the two-year period preceding the date
of the application, had a certificate under this subchapter
revoked; and
(4) pays the fee set by the executive council.
(b) To be eligible for a conditional prescription
certificate a psychologist must:
(1) have completed a training program in
psychopharmacology from:
(A) a postdoctoral education and training
program that has received designation in psychopharmacology from
the American Psychological Association; or
(B) a psychopharmacology training program
approved by the executive council that includes instruction in:
(i) basic life sciences;
(ii) neuroscience;
(iii) clinical and research pharmacology
and psychopharmacology;
(iv) clinical pathophysiology;
(v) physical assessments and laboratory
examinations;
(vi) clinical pharmacotherapeutics; and
(vii) ethical and legal issues relevant to
prescriptive authority and associated research;
(2) pass a nationally recognized examination approved
by the executive council in the area of prescriptive authority;
(3) provide evidence of professional liability
coverage in amounts required by executive council rule;
(4) have completed a practicum in clinical assessment
and pathophysiology under the supervision of a physician that
included not less than 80 hours of supervised practice;
(5) have completed, under the supervision of a
physician or psychologist with a prescription certificate issued
under Section 501.373, a practicum consisting of not less than 400
hours observing, participating in, or assisting in the treatment of
mental disorders with psychotropic medication in not less than 100
patients;
(6) have completed training approved by the executive
council on the administration of psychotropic medications by
injection; and
(7) satisfy any other requirement of executive council
rule.
(c) A psychologist who holds a conditional prescription
certificate is authorized to:
(1) issue a prescription drug order;
(2) administer or dispense a prescription drug;
(3) order tests commonly associated with monitoring
the use of prescription drugs;
(4) represent that the psychologist holds a
conditional prescription certificate; and
(5) under the supervision of a supervising clinician,
administer a psychotropic medication by injection.
(d) A psychologist who holds a conditional prescription
certification shall notify the executive council of the name of the
psychologist's supervising clinician in accordance with executive
council rule.
Sec. 501.373. PRESCRIPTION CERTIFICATE. (a) The executive
council shall issue a prescription certificate to a psychologist
who:
(1) meets the eligibility requirements of Subsection
(b);
(2) submits an application on a form prescribed by the
executive council;
(3) has not, in the two-year period preceding the date
of the application, had a certificate under this subchapter
revoked; and
(4) pays the fee set by the executive council.
(b) To be eligible for a prescription certificate a
psychologist must:
(1) have a conditional prescription certificate
issued under Section 501.372;
(2) have not less than two years of experience
prescribing psychotropic medication under a supervising clinician;
(3) have completed an independent peer review of the
applicant's experience described by Subdivision (2) as provided by
executive council rule;
(4) have completed training approved by the executive
council on the administration of psychotropic medications by
injection;
(5) provide evidence of professional liability
coverage in amounts required by executive council rule; and
(6) satisfy any other requirement of executive council
rule.
(c) A psychologist who holds a prescription certificate is
authorized to:
(1) issue a prescription drug order;
(2) administer or dispense a prescription drug;
(3) order tests commonly associated with monitoring
the use of prescription drugs;
(4) represent that the psychologist holds a
prescription certificate; and
(5) administer a psychotropic medication by
injection.
Sec. 501.374. REQUIREMENTS FOR PRESCRIPTION DRUG ORDER. A
prescription drug order issued by a prescribing psychologist must:
(1) comply with applicable state and federal law; and
(2) include:
(A) a statement that the order is issued by a
"psychologist certified to prescribe"; and
(B) the psychologist's certificate number.
Sec. 501.375. NOTICE TO PRIMARY CARE PRACTITIONER. (a) A
prescribing psychologist shall notify a patient's primary care
practitioner not later than:
(1) 72 hours after the time the psychologist issues
for the patient a prescription drug order for a psychotropic
medication or changes the type or dosage of a psychotropic
medication for the patient; and
(2) the 20th day after the date the psychologist
issues for the patient a prescription drug order for a drug to
manage or protect from a side effect of a psychotropic medication.
(b) A primary care practitioner is not liable for an act of a
prescribing psychologist based solely on the practitioner
receiving a notice under Subsection (a).
(c) This section does not require a prescribing
psychologist to give notice to or obtain approval from the
patient's primary care practitioner before prescribing a drug to a
patient with whom the psychologist has established a
psychologist-patient relationship.
Sec. 501.376. DRUG ENFORCEMENT ADMINISTRATION REGISTRATION
NUMBER. A prescribing psychologist who has a current federal Drug
Enforcement Administration registration number shall submit
information regarding that registration to the executive council in
accordance with executive council rule.
Sec. 501.377. RECORDS. A prescribing psychologist shall
maintain a record of all prescription drug orders issued by the
psychologist with the applicable patient record.
Sec. 501.378. DELEGATION PROHIBITED. A prescribing
psychologist may not delegate to any other person the authority to
perform any act for which a certificate issued under this
subchapter is required.
Sec. 501.379. ISSUANCE OF CERTIFICATE TO PRESCRIBING
PSYCHOLOGIST FROM ANOTHER JURISDICTION. The executive council
shall issue a prescription certificate under Section 501.373 to a
psychologist who:
(1) has previously been authorized to prescribe
psychotropic medication for not less than three years in another
jurisdiction if the other jurisdiction's requirements for the
authorization are substantially equal to the requirements of
Section 501.373;
(2) provides evidence of professional liability
coverage in amounts required by executive council rule; and
(3) satisfies any other requirement adopted by
executive council rule.
Sec. 501.380. EXPIRATION AND RENEWAL. The executive
council shall adopt rules providing for the expiration and renewal
of a certificate under this subchapter. The rules must provide that
a license holder's certificate expires on the same date as the
license under this chapter.
Sec. 501.381. CONTINUING EDUCATION. The executive council
shall adopt rules requiring a psychologist with a prescription
certificate issued under Section 501.373 to complete continuing
education on the prescribing of psychotropic medications as a
requirement to renew the certificate.
Sec. 501.382. REQUIREMENT OF SUPERVISING CLINICIAN. (a) A
person may not act as a supervising clinician for a psychologist
with a conditional prescription certificate unless the person:
(1) is a physician or psychologist with a prescription
certificate issued under Section 501.373; and
(2) has not less than three years of experience
prescribing psychotropic medications.
(b) A physician or psychologist acting as a supervising
clinician shall notify the Texas Medical Board or the executive
council, as applicable, of that fact and of the name of each
psychologist being supervised in accordance with rules of the Texas
Medical Board or executive council.
(c) A supervising clinician may not supervise more than the
full-time equivalent of seven psychologists, as determined by
executive council rule.
(d) A supervising clinician may supervise a psychologist
with a conditional prescription certificate through in-person
meetings or by use of telecommunications technology.
Sec. 501.383. LIMITATION ON LIABILITY OF SUPERVISING
CLINICIAN. A supervising clinician is not liable for any injury or
loss resulting from the acts of a psychologist under the
clinician's supervision unless the injury or loss arose from an act
under the direction or control of the clinician.
Sec. 501.384. DISCIPLINARY ACTION. The executive council
may deny, revoke, suspend, or refuse to renew a certificate issued
under this subchapter if the certificate holder violates this
chapter or a rule adopted under this chapter.
Sec. 501.385. RULES. The executive council shall adopt
rules to implement this subchapter.
SECTION 5. Section 481.002(39), Health and Safety Code, is
amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, psychologist, or other person
licensed, registered, or otherwise permitted to distribute,
dispense, analyze, conduct research with respect to, or administer
a controlled substance in the course of professional practice or
research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, psychologist,
or podiatrist, having a current Federal Drug Enforcement
Administration registration number, who may legally prescribe
Schedule II, III, IV, or V controlled substances in that state; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
SECTION 6. Section 481.074(d), Health and Safety Code, is
amended to read as follows:
(d) Except as specified in Subsections (e) and (f), the
board, by rule and in consultation with the Texas Medical Board and
the Texas Behavioral Health Executive Council, shall establish the
period after the date on which the prescription is issued that a
person may fill a prescription for a controlled substance listed in
Schedule II. A person may not refill a prescription for a substance
listed in Schedule II.
SECTION 7. Sections 481.076(a) and (c), Health and Safety
Code, are amended to read as follows:
(a) The board may not permit any person to have access to
information submitted to the board under Section 481.074(q) or
481.075 except:
(1) the board, the Texas Medical Board, the Texas
Department of Licensing and Regulation, with respect to the
regulation of podiatrists, the State Board of Dental Examiners, the
State Board of Veterinary Medical Examiners, the Texas Board of
Nursing, [or] the Texas Optometry Board, or the Texas Behavioral
Health Executive Council, with respect to the regulation of
psychologists, for the purpose of:
(A) investigating a specific license holder; or
(B) monitoring for potentially harmful
prescribing or dispensing patterns or practices under Section
481.0762;
(2) an authorized employee of the board engaged in the
administration, investigation, or enforcement of this chapter or
another law governing illicit drugs in this state or another state;
(3) the department or other law enforcement or
prosecutorial official engaged in the administration,
investigation, or enforcement of this chapter or another law
governing illicit drugs in this state or another state, if the board
is provided a warrant, subpoena, or other court order compelling
the disclosure;
(4) a medical examiner conducting an investigation;
(5) provided that accessing the information is
authorized under the Health Insurance Portability and
Accountability Act of 1996 (Pub. L. No. 104-191) and regulations
adopted under that Act:
(A) a pharmacist or a pharmacist-intern,
pharmacy technician, or pharmacy technician trainee, as defined by
Section 551.003, Occupations Code, acting at the direction of a
pharmacist, who is inquiring about a recent Schedule II, III, IV, or
V prescription history of a particular patient of the pharmacist;
or
(B) a practitioner who:
(i) is a physician, dentist, veterinarian,
podiatrist, optometrist, psychologist, or advanced practice nurse
or is a physician assistant described by Section 481.002(39)(D) or
an employee or other agent of a practitioner acting at the direction
of a practitioner; and
(ii) is inquiring about a recent Schedule
II, III, IV, or V prescription history of a particular patient of
the practitioner;
(6) a pharmacist or practitioner who is inquiring
about the person's own dispensing or prescribing activity or a
practitioner who is inquiring about the prescribing activity of an
individual to whom the practitioner has delegated prescribing
authority;
(7) one or more states or an association of states with
which the board has an interoperability agreement, as provided by
Subsection (j);
(8) a health care facility certified by the federal
Centers for Medicare and Medicaid Services; or
(9) the patient, the patient's parent or legal
guardian, if the patient is a minor, or the patient's legal
guardian, if the patient is an incapacitated person, as defined by
Section 1002.017(2), Estates Code, inquiring about the patient's
prescription record, including persons who have accessed that
record.
(c) The board by rule shall design and implement a system
for submission of information to the board by electronic or other
means and for retrieval of information submitted to the board under
this section and Sections 481.074 and 481.075. The board shall use
automated information security techniques and devices to preclude
improper access to the information. The board shall submit the
system design to the director, [and] the Texas Medical Board, and
the Texas Behavioral Health Executive Council for review and
comment a reasonable time before implementation of the system and
shall comply with the comments of those agencies unless it is
unreasonable to do so.
SECTION 8. Section 483.001(12), Health and Safety Code, is
amended to read as follows:
(12) "Practitioner" means:
(A) a person [licensed by]:
(i) licensed by the Texas Medical Board,
State Board of Dental Examiners, Texas Optometry Board, or State
Board of Veterinary Medical Examiners to prescribe and administer
dangerous drugs; [or]
(ii) licensed by the Texas Department of
Licensing and Regulation, with respect to podiatry, to prescribe
and administer dangerous drugs; or
(iii) certified by the Texas Behavioral
Health Executive Council, with respect to psychology, to prescribe
and administer dangerous drugs;
(B) a person licensed by another state in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs;
(C) a person licensed in Canada or Mexico in a
health field in which, under the laws of this state, a licensee may
legally prescribe dangerous drugs; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
SECTION 9. Sections 576.025(b), (c), (e), and (f), Health
and Safety Code, are amended to read as follows:
(b) Consent to the administration of psychoactive
medication given by a patient or by a person authorized by law to
consent on behalf of the patient is valid only if:
(1) the consent is given voluntarily and without
coercive or undue influence;
(2) the treating physician, a treating psychologist
who holds a certificate issued under Subchapter H-1, Chapter 501,
Occupations Code, or a person designated by the physician or
psychologist, provided the following information, in a standard
format approved by the department, to the patient and, if
applicable, to the patient's representative authorized by law to
consent on behalf of the patient:
(A) the specific condition to be treated;
(B) the beneficial effects on that condition
expected from the medication;
(C) the probable health and mental health
consequences of not consenting to the medication;
(D) the probable clinically significant side
effects and risks associated with the medication;
(E) the generally accepted alternatives to the
medication, if any, and why the physician or psychologist
recommends that they be rejected; and
(F) the proposed course of the medication;
(3) the patient and, if appropriate, the patient's
representative authorized by law to consent on behalf of the
patient is informed in writing that consent may be revoked; and
(4) the consent is evidenced in the patient's clinical
record by a signed form prescribed by the facility or by a statement
of the [treating] physician or psychologist described by
Subdivision (2), or a person designated by the physician or the
psychologist, that documents that consent was given by the
appropriate person and the circumstances under which the consent
was obtained.
(c) If the [treating] physician or psychologist described
by Subsection (b)(2) designates another person to provide the
information under Subsection (b), then, not later than two working
days after that person provides the information, excluding weekends
and legal holidays, the physician or psychologist shall meet with
the patient and, if appropriate, the patient's representative who
provided the consent, to review the information and answer any
questions.
(e) In prescribing psychoactive medication, a [treating]
physician or psychologist described by Subsection (b)(2) shall:
(1) prescribe, consistent with clinically appropriate
medical care, the medication that has the fewest side effects or the
least potential for adverse side effects, unless the class of
medication has been demonstrated or justified not to be effective
clinically; and
(2) administer the smallest therapeutically
acceptable dosages of medication for the patient's condition.
(f) If a physician or psychologist described by Subsection
(b)(2) issues an order to administer psychoactive medication to a
patient without the patient's consent because the patient is having
a medication-related emergency:
(1) the physician or psychologist shall document in
the patient's clinical record in specific medical or behavioral
terms the necessity of the order and that the physician or
psychologist has evaluated but rejected other generally accepted,
less intrusive forms of treatment, if any; and
(2) treatment of the patient with the psychoactive
medication shall be provided in the manner, consistent with
clinically appropriate medical care, least restrictive of the
patient's personal liberty.
SECTION 10. Section 301.002(2), Occupations Code, is
amended to read as follows:
(2) "Professional nursing" means the performance of an
act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application
of the principles of biological, physical, and social science as
acquired by a completed course in an approved school of
professional nursing. The term does not include acts of medical
diagnosis or the prescription of therapeutic or corrective
measures. Professional nursing involves:
(A) the observation, assessment, intervention,
evaluation, rehabilitation, care and counsel, or health teachings
of a person who is ill, injured, infirm, or experiencing a change in
normal health processes;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a health care practitioner legally
authorized to prescribe the medication or treatment [physician,
podiatrist, or dentist];
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the requesting, receiving, signing for, and
distribution of prescription drug samples to patients at practices
at which an advanced practice registered nurse is authorized to
sign prescription drug orders as provided by Subchapter B, Chapter
157;
(G) the performance of an act delegated by a
physician under Section 157.0512, 157.054, 157.058, or 157.059; and
(H) the development of the nursing care plan.
SECTION 11. Section 551.003(34), Occupations Code, is
amended to read as follows:
(34) "Practitioner" means:
(A) a person licensed, certified, or registered
to prescribe, distribute, administer, or dispense a prescription
drug or device in the course of professional practice in this state,
including a physician, dentist, podiatrist, psychologist, or
veterinarian but excluding a person licensed under this subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license or certificate holder in this state may
legally prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian,
psychologist, or podiatrist, who has a current federal Drug
Enforcement Administration registration number and who may legally
prescribe a Schedule II, III, IV, or V controlled substance, as
specified under Chapter 481, Health and Safety Code, in that other
state; or
(D) an advanced practice registered nurse or
physician assistant to whom a physician has delegated the authority
to prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054.
SECTION 12. Section 501.051(b), Occupations Code, as
amended by this Act, does not affect the entitlement of a member
serving on the Texas State Board of Examiners of Psychologists
immediately before the effective date of this Act to continue to
serve for the remainder of the member's term. With the first
appointment of a member described by Section 501.051(a)(1),
Occupations Code, to be made by the governor on or after the
effective date of this Act, the governor shall appoint a member to
the board who has the qualifications required by Section
501.051(b), Occupations Code, as amended by this Act.
SECTION 13. (a) Not later than December 1, 2025, the Texas
Behavioral Health Executive Council shall appoint members of the
advisory committee in accordance with Section 501.152(a-1),
Occupations Code, as added by this Act.
(b) Not later than June 1, 2026, the advisory committee
shall make initial recommendations to the Texas Behavioral Health
Executive Council and the Texas State Board of Examiners of
Psychologists as described by Section 501.152(d), Occupations
Code, as added by this Act.
(c) Not later than September 1, 2028, the Texas Behavioral
Health Executive Council shall appoint members to the advisory
committee so that the composition of the committee complies with
Section 501.152(b), Occupations Code, as added by this Act.
SECTION 14. Not later than December 1, 2026, the Texas
Behavioral Health Executive Council shall adopt rules and
procedures necessary to implement Subchapter H-1, Chapter 501,
Occupations Code, as added by this Act.
SECTION 15. This Act takes effect September 1, 2025.