Texas 2025 - 89th Regular

Texas Senate Bill SB3021 Compare Versions

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1	1	By: Blanco S.B. No. 3021
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6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to the licensing and regulation of certain advanced
9	9	practice registered nurses; authorizing a fee.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	ARTICLE 1. SHORT TITLE
12	12	SECTION 1.001. This Act may be cited as the Healthcare
13	13	Expanded and Accessed Locally for Texans (HEAL Texans) Act.
14	14	ARTICLE 2. REGULATION OF ADVANCED PRACTICE REGISTERED NURSES
15	15	SECTION 2.001. Section 301.002, Occupations Code, is
16	16	amended to read as follows:
17	17	Sec. 301.002. DEFINITIONS. In this chapter:
18	18	(1) "Advanced practice registered nurse" means a
19	19	registered nurse licensed by the board to practice as an advanced
20	20	practice registered nurse on the basis of completion of an advanced
21	21	educational program. The term includes a nurse practitioner, nurse
22	22	midwife, nurse anesthetist, and clinical nurse specialist.
23	23	(2) [(1)] "Board" means the Texas Board of Nursing.
24	24	(3) [(1-a)] "Chief nursing officer" means the
25	25	registered nurse who is administratively responsible for the
26	26	nursing services at a facility.
27	27	(4) "Controlled substance" has the meaning assigned by
28	28	Section 481.002, Health and Safety Code.
29	29	(5) "Dangerous drug" has the meaning assigned by
30	30	Section 483.001, Health and Safety Code.
31	31	(6) "Device" has the meaning assigned by Section
32	32	551.003, and includes durable medical equipment.
33	33	(7) "Nonprescription drug" has the meaning assigned by
34	34	Section 551. 003.
35	35	(8) "Nurse" means a person required to be licensed
36	36	under this chapter to engage in professional or vocational nursing.
37	37	(9) "Nursing" means professional or vocational
38	38	nursing.
39	39	(10) [(1-b)] "Patient safety committee" has the meaning
40	40	assigned by Section 303.001.
41	41	(11) "Prescribe or order a drug or device" has the
42	42	meaning assigned by Section 157.051.
43	43	(12) [(2)] "Professional nursing" means the
44	44	performance of an act that requires substantial specialized
45	45	judgment and skill, the proper performance of which is based on
46	46	knowledge and application of the principles of biological,
47	47	physical, and social science as acquired by a completed course in an
48	48	approved school of professional nursing. The term does not include
49	49	acts of medical diagnosis or the prescription of therapeutic or
50	50	corrective measures, except as performed by an advanced practice
51	51	registered nurse authorized to practice by the board under Section
52	52	301.357. Professional nursing involves:
53	53	(A) the observation, assessment, intervention,
54	54	evaluation, rehabilitation, care and counsel, or health teachings
55	55	of a person who is ill, injured, infirm, or experiencing a change in
56	56	normal health processes;
57	57	(B) the maintenance of health or prevention of
58	58	illness;
59	59	(C) the administration of a medication or
60	60	treatment as ordered by a health care practitioner legally
61	61	authorized to prescribe the medication or treatment [physician,
62	62	podiatrist, or dentist];
63	63	(D) the supervision or teaching of nursing;
64	64	(E) the administration, supervision, and
65	65	evaluation of nursing practices, policies, and procedures;
66	66	(F) the requesting, receiving, signing for, and
67	67	distribution of prescription drug samples to patients at practices
68	68	at which an advanced practice registered nurse is authorized to
69	69	sign prescription drug orders as provided by Subchapter B, Chapter
70	70	157;
71	71	(G) the performance by an advanced practice
72	72	registered nurse of an act delegated by a physician under Section
73	73	157.0512, 157.054, 157.058, or 157.059; [and]
74	74	(H) the development of the nursing care plan; and
75	75	(I) the performance of an act by an advanced
76	76	practice registered nurse authorized to practice by the board under
77	77	Section 301.357.
78	78	[(3) "Nurse" means a person required to be licensed
79	79	under this chapter to engage in professional or vocational nursing.
80	80	[(4) "Nursing" means professional or vocational
81	81	nursing.]
82	82	(13) [(5)] "Vocational nursing" means a directed
83	83	scope of nursing practice, including the performance of an act that
84	84	requires specialized judgment and skill, the proper performance of
85	85	which is based on knowledge and application of the principles of
86	86	biological, physical, and social science as acquired by a completed
87	87	course in an approved school of vocational nursing. The term does
88	88	not include acts of medical diagnosis or the prescription of
89	89	therapeutic or corrective measures. Vocational nursing involves:
90	90	(A) collecting data and performing focused
91	91	nursing assessments of the health status of an individual;
92	92	(B) participating in the planning of the nursing
93	93	care needs of an individual;
94	94	(C) participating in the development and
95	95	modification of the nursing care plan;
96	96	(D) participating in health teaching and
97	97	counseling to promote, attain, and maintain the optimum health
98	98	level of an individual;
99	99	(E) assisting in the evaluation of an
100	100	individual's response to a nursing intervention and the
101	101	identification of an individual's needs; and
102	102	(F) engaging in other acts that require education
103	103	and training, as prescribed by board rules and policies,
104	104	commensurate with the nurse's experience, continuing education,
105	105	and demonstrated competency.
106	106	SECTION 2.002. Section 301.005(b), Occupations Code, is
107	107	amended to read as follows:
108	108	(b) A reference in any other law to an "advanced nurse
109	109	practitioner," [practitioner" or] "advanced practice nurse," or
110	110	"advanced practice registered nurse" means an advanced practice
111	111	registered nurse.
112	112	SECTION 2.003. Section 301.152(b), Occupations Code, is
113	113	amended to read as follows:
114	114	(b) The board shall adopt rules to:
115	115	(1) license a registered nurse as an advanced practice
116	116	registered nurse;
117	117	(2) establish:
118	118	(A) any specialized education or training,
119	119	including pharmacology, that an advanced practice registered nurse
120	120	must have to prescribe or order a drug or device as delegated by a
121	121	physician under Section 157.0512 or 157.054 or authorized by the
122	122	board under Section 301.358;
123	123	(B) a system for approving an advanced practice
124	124	registered nurse to prescribe or order a drug or device as delegated
125	125	by a physician under Section 157.0512 or 157.054 or authorized by
126	126	the board under Section 301.358 on the receipt of evidence of
127	127	completing the specialized education and training requirement
128	128	under Paragraph (A); and
129	129	(C) a system for issuing a prescription
130	130	authorization number to an advanced practice registered nurse
131	131	approved under Paragraph (B); and
132	132	(3) concurrently renew any license or approval granted
133	133	to an advanced practice registered nurse under this subsection and
134	134	a license renewed by the advanced practice registered nurse under
135	135	Section 301. 301.
136	136	SECTION 2.004. Section 301.303(b), Occupations Code, is
137	137	amended to read as follows:
138	138	(b) Except as provided by a rule adopted under Section
139	139	301.357(h) for an advanced practice registered nurse authorized by
140	140	the board to practice under that section, the [The] board may not
141	141	require participation in more than a total of 20 hours of continuing
142	142	education in a two-year licensing period.
143	143	SECTION 2.005. Subchapter H, Chapter 301, Occupations Code,
144	144	is amended by adding Sections 301. 357 and 301. 358 to read as
145	145	follows:
146	146	Sec. 301.357. INDEPENDENT PRACTICE BY CERTAIN ADVANCED
147	147	PRACTICE REGISTERED NURSES. (a) The board shall authorize the
148	148	practice under this section of an advanced practice registered
149	149	nurse who:
150	150	(1) is a nurse practitioner, nurse midwife, or
151	151	clinical nurse specialist;
152	152	(2) subject to Subsection (b), has completed three
153	153	years of full-time clinical practice preceding the authorization
154	154	request; and
155	155	(3) pays the fee established by the board and applies
156	156	for authorization under this section in the manner prescribed by
157	157	the board; and
158	158	(4) successfully completed an accredited nursing
159	159	program at a Texas university or college authorized by the Texas
160	160	Board of Nursing.
161	161	(b) The clinical practice hours requirement of Subsection
162	162	(a) (2) may be satisfied by successful completion if the applicant
163	163	is currently licensed or authorized by the board to practice as a
164	164	registered nurse in this state, clinical practice years received
165	165	while practicing as an advanced practice registered nurse under the
166	166	supervision of a physician who held an active, unencumbered license
167	167	issued by any state during the period of supervision
168	168	(c) To be eligible for authorization to practice under this
169	169	section, an applicant must:
170	170	(1) be licensed or authorized by the board to practice
171	171	as a registered nurse in this state;
172	172	(2) have graduated from an advanced practice
173	173	registered nurse graduate or post-graduate education program that
174	174	is recognized by the board and the United States Secretary of
175	175	Education or the Council for Higher Education Accreditation or its
176	176	successor organization and that includes completion of three
177	177	separate graduate level courses in:
178	178	(A) advanced physiology and pathophysiology;
179	179	(B) advanced health assessment; and
180	180	(C) advanced pharmacology which includes
181	181	pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of
182	182	all broad categories of agents; and
183	183	(3) successfully complete and be currently certified
184	184	on passage of an appropriate board-recognized advanced practice
185	185	registered nurse national certification examination.
186	186	(d) The scope of practice of an advanced practice registered
187	187	nurse authorized to practice under this section includes:
188	188	(1) ordering, performing, and interpreting diagnostic
189	189	tests;
190	190	(2) formulating primary and differential medical
191	191	diagnoses and advanced assessments;
192	192	(3) treating actual and potential health problems;
193	193	(4) prescribing therapeutic and corrective measures,
194	194	including nutrition and diagnostic support services, home health
195	195	care, hospice care, physical therapy, and occupational therapy, and
196	196	delegating and assigning the performance of therapeutic and
197	197	corrective measures to assistive personnel;
198	198	(5) to the extent authorized by the board under
199	199	Section 301.358, prescribing, ordering, procuring, administering,
200	200	and dispensing drugs and devices, including blood and blood
201	201	products, controlled substances listed in Schedules II, III, IV,
202	202	and V, dangerous drugs, and nonprescription drugs;
203	203	(6) providing referrals to health care agencies,
204	204	health care providers, and community resources;
205	205	(7) serving as the primary care provider of record;
206	206	and
207	207	(8) performing other acts that require education and
208	208	training consistent with professional standards and that are
209	209	commensurate with the advanced practice registered nurse's
210	210	education, licensure, and demonstrated competencies and
211	211	experience.
212	212	(e) An advanced practice registered nurse authorized to
213	213	practice under this section shall practice as a licensed
214	214	independent practitioner in accordance with standards established
215	215	and recognized by the board to protect the public health and safety.
216	216	(f) An advanced practice registered nurse authorized to
217	217	practice under this section is accountable to patients, the nursing
218	218	profession, and the board for:
219	219	(1) complying with the requirements of this chapter;
220	220	(2) providing quality advanced nursing care;
221	221	(3) recognizing the nurse's limits of knowledge;
222	222	(4) planning for the management of situations beyond
223	223	the nurse's expertise; and
224	224	(5) consulting with or referring patients to other
225	225	health care providers as appropriate.
226	226	(g) This section does not limit or modify the scope of
227	227	practice of a nurse who is not authorized to practice under this
228	228	section.
229	229	(h) The board by rule shall establish:
230	230	(1) the application process for authorization to
231	231	practice under this section; and
232	232	(2) a requirement that an advanced practice registered
233	233	nurse authorized to practice under this section complete at least
234	234	48 hours of continuing education, including 10 hours of continuing
235	235	education in pharmacology, every two years.
236	236	(i) Notwithstanding any other law, an advanced practice
237	237	registered nurse authorized to practice under this section who is
238	238	performing an act described by Subsection (d) is not considered to
239	239	be practicing medicine without a license.
240	240	(j) An APRN who, as of the effective date of this Act, has
241	241	completed at least 10 years of clinical practice under the
242	242	supervision of a delegating physician in Texas shall be eligible
243	243	for expanded practice authority under this section.
244	244	(k) An advanced practice registered nurse authorized to
245	245	practice under this section may practice as a licensed independent
246	246	practitioner only in a practice serving a medically underserved
247	247	population, as defined by Section 157.051(11).
248	248	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
249	249	ADVANCED PRACTICE REGISTERED NURSE. (a) The board may authorize an
250	250	advanced practice registered nurse authorized to practice by the
251	251	board under Section 301. 357 to prescribe and order drugs and
252	252	devices, including controlled substances listed in Schedules III,
253	253	IV, and V, dangerous drugs, and nonprescription drugs.
254	254	(b) The board may authorize an advanced practice registered
255	255	nurse authorized to practice by the board under Section 301.357 to
256	256	prescribe and order controlled substances listed in Schedule II
257	257	only:
258	258	(1) in a hospital facility-based practice in
259	259	accordance with policies approved by the hospital's medical staff
260	260	or a committee of the hospital's medical staff as provided by the
261	261	hospital bylaws to ensure patient safety and as part of the care
262	262	provided to a patient who:
263	263	(A) has been admitted to the hospital and is
264	264	expected to remain in the hospital for a period of 24 hours or more;
265	265	or
266	266	(B) is receiving services in the emergency
267	267	department of the hospital; or
268	268	(2) as part of the plan of care for the treatment of a
269	269	person who has executed a written certification of a terminal
270	270	illness, has elected to receive hospice care, and is receiving
271	271	hospice treatment from a qualified hospice provider.
272	272	Sec. 301.359. JOINT INDEPENDENT PRACTICE COMMITTEE. The
273	273	Joint Independent Practice Committee ("Committee") is established
274	274	to oversee the credentialing of Advanced Practice Registered Nurses
275	275	(APRNs) who seek full independent practice authority in the State
276	276	of Texas under this chapter.
277	277	(b) The Committee shall consist of eight (8) voting members
278	278	appointed, of which:
279	279	(1) two members are appointed by the Governor,
280	280	consisting of one physician and one APRN;
281	281	(2) two members are appointed by the Lieutenant
282	282	Governor consisting of one physician and one APRN;
283	283	(3) two members are appointed by the Speaker of the
284	284	House of Representatives, consisting of one physician and one APRN;
285	285	(4) one member appointed by the Texas Medical
286	286	Association; and
287	287	(5) one member appointed by the Texas Nurse
288	288	Practitioners.
289	289	(c) The Executive Director of the Texas Medical Board and
290	290	the Executive Director of the Texas Board of Nursing shall serve as
291	291	ex officio, nonvoting members.
292	292	(d) A physician appointed to the Committee shall be either
293	293	a:
294	294	(1) faculty physician from a Texas school of medicine
295	295	or health science center; or
296	296	(2) physician delegating and supervising an APRN or
297	297	nurse practitioner.
298	298	(e) An APRN appointed to the committee shall be either a:
299	299	(1) faculty APRN representing accredited nursing
300	300	education programs in Texas; or
301	301	(2) APRN whom must be a Nurse Practitioner from the
302	302	state at large, who holds full independent practice authority under
303	303	this section.
304	304	(f) The Committee shall:
305	305	(1) Review and decide upon applications submitted by
306	306	APRNs for full independent practice authority;
307	307	(2) Maintain and publish a record of all APRNs who have
308	308	been granted independent practice authority; and
309	309	(3) Provide quarterly reports to the Senate Committee
310	310	on Health and Human Services and the House Committee on Public
311	311	Health regarding applications, approvals, and denials.
312	312	SECTION 2.007. Subchapter H, Chapter 157, Occupations Code, is
313	313	amended by amending Sections 157.0512(c) to read as follows:
314	314	(c) Except as provided by Subsection (d), the combined
315	315	number of advanced practice registered nurses and physician
316	316	assistants with whom a physician may enter into a prescriptive
317	317	authority agreement may not exceed sevennine advanced practice
318	318	registered nurses and physician assistants or the full-time
319	319	equivalent of sevennine advanced practice registered nurses and
320	320	physician assistants.
321	321	SECTION 2.007. Subchapter H, Chapter 157, Occupations Code,
322	322	is amended by adding Sections 157.060 to read as follows:
323	323	Section 157.060. FEES FOR DELEGATION AND SUPERVISION OF
324	324	ADVANCED PRACTICE REGISTERED NURSES. (a) A physician who delegates
325	325	prescriptive authority or supervises an advanced practice
326	326	registered nurse (APRN) under this chapter may charge a reasonable
327	327	fee for such delegation and supervision, provided that:
328	328	(1) The fee is based on fair market value for the
329	329	physician's time and expertise in providing oversight; and
330	330	(2) The fee does not exceed an amount equivalent to the
331	331	average hourly compensation of a board-certified family medicine
332	332	physician in Texas, as determined annually by the Texas Medical
333	333	Board in consultation with the Texas Health and Human Services
334	334	Commission and based on available workforce and salary data.
335	335	(b) The Texas Medical Board shall:
336	336	(1) Establish and publish the maximum allowable fee on
337	337	an annual basis, adjusting as necessary to reflect current fair
338	338	market value; and
339	339	(2) Ensure that any fee arrangement does not create a
340	340	conflict of interest, interfere with patient care, or impose an
341	341	undue financial burden on the APRN.
342	342	(c) Any fee charged under this section shall be disclosed in
343	343	writing to the APRN before delegation or supervision begins and
344	344	shall be subject to review by the Texas Medical Board upon complaint
345	345	or inquiry.
346	346	ARTICLE 3. CONFORMING AMENDMENTS
347	347	SECTION 3.001. Section 38.151(1), Education Code, is
348	348	amended to read as follows:
349	349	(1) "Advanced practice nurse" has the meaning assigned
350	350	to "advanced practice registered nurse" by Section 301.002
351	351	[301.152], Occupations Code.
352	352	SECTION 3.002. Section 38.21l(a), Education Code, is
353	353	amended to read as follows:
354	354	(a) A physician, a [or] person who has been delegated
355	355	prescriptive authority under Chapter 157, Occupations Code, or an
356	356	advanced practice registered nurse authorized to prescribe and
357	357	order drugs and devices under Section 301. 358, Occupations Code,
358	358	may prescribe epinephrine auto-injectors or medication for
359	359	respiratory distress in the name of a school district,
360	360	open-enrollment charter school, or private school.
361	361	SECTION 3.003. Section 38.225(a), Education Code, is
362	362	amended to read as follows:
363	363	(a) A physician, a [or] person who has been delegated
364	364	prescriptive authority under Chapter 157, Occupations Code, or an
365	365	advanced practice registered nurse authorized to prescribe and
366	366	order drugs and devices under Section 301.358, Occupations Code,
367	367	may prescribe opioid antagonists in the name of a school district,
368	368	open-enrollment charter school, or private school.
369	369	SECTION 3.004. Section 61.601, Education Code, is amended
370	370	to read as follows:
371	371	Sec. 61.601. DEFINITION. In this subchapter, "mental
372	372	health professional" means:
373	373	(1) a licensed physician who is:
374	374	(A) a graduate of an accredited psychiatric
375	375	residency training program; or
376	376	(B) certified in psychiatry by:
377	377	(i) the American Board of Psychiatry and
378	378	Neurology; or
379	379	(ii) the American Osteopathic Board of
380	380	Neurology and Psychiatry;
381	381	(2) a psychologist, as defined by Section 501.002,
382	382	Occupations Code;
383	383	(3) a licensed professional counselor, as defined by
384	384	Section 503.002, Occupations Code;
385	385	(4) an advanced practice registered nurse, as defined
386	386	by Section 301.002 [301.152], Occupations Code, who holds a
387	387	nationally recognized board certification in psychiatric or mental
388	388	health nursing;
389	389	(5) a licensed clinical social worker, as defined by
390	390	Section 505.002, Occupations Code;
391	391	(6) a licensed specialist in school psychology, as
392	392	defined by Section 501.002, Occupations Code;
393	393	(7) a chemical dependency counselor, as defined by
394	394	Section 504.001, Occupations Code; and
395	395	(8) a licensed marriage and family therapist, as
396	396	defined by Section 502.002, Occupations Code.
397	397	SECTION 3.005. Section 1101.100(1), Estates Code, is
398	398	amended to read as follows:
399	399	(1) "Advanced practice registered nurse" has the
400	400	meaning assigned by Section 301.002 [381.152], Occupations Code.
401	401	SECTION 3.006. Section 671.00l(b), Government Code, is
402	402	amended to read as follows:
403	403	(b) The pilot program must provide for the following:
404	404	(1) either:
405	405	(A) both:
406	406	(i) a licensed advanced practice
407	407	registered nurse as defined by Section 301.002 [301.152],
408	408	Occupations Code, or a licensed physician assistant as described by
409	409	Chapter 204, Occupations Code, who is employed by the state or whose
410	410	services are acquired by contract, who will be located at a state
411	411	office complex; and
412	412	(ii) [(2)] a licensed physician, who is
413	413	employed by a state governmental entity for purposes other than the
414	414	pilot program or whose services are acquired by contract, who will
415	415	delegate to and supervise the advanced practice registered nurse or
416	416	physician assistant under a prescriptive authority agreement under
417	417	Chapter 157, Occupations Code; or
418	418	(B) an advanced practice registered nurse
419	419	authorized to practice under Section 301.357, Occupations Code;
420	420	(2) [(3)] appropriate office space and equipment for the
421	421	advanced practice registered nurse or physician assistant to
422	422	provide basic medical care to employees at the state office complex
423	423	where the nurse or physician assistant is located; and
424	424	(3) [(4)] professional liability insurance covering
425	425	services provided by the advanced practice registered nurse or the
426	426	physician assistant.
427	427	SECTION 3.007. Sections 161.0052(b) and (c), Health and
428	428	Safety Code, are amended to read as follows:
429	429	(b) The executive commissioner by rule shall require a
430	430	hospital to inform each elderly person admitted to the hospital for
431	431	a period of 24 hours or more that the pneumococcal and influenza
432	432	vaccines are available. If the elderly person requests a vaccine,
433	433	and if a physician, or an advanced nurse practitioner or physician
434	434	assistant on behalf of a physician, or an advanced practice
435	435	registered nurse authorized to prescribe and order drugs and
436	436	devices under Section 301.358, Occupations Code, determines that
437	437	the vaccine is in the person's best interest, the hospital must make
438	438	the vaccination available to the person before the person is
439	439	discharged from the hospital.
440	440	(c) The executive commissioner by rule shall require an end
441	441	stage renal disease facility to offer, to the extent possible as
442	442	determined by the facility, the opportunity to receive the
443	443	pneumococcal and influenza vaccines to each elderly person who
444	444	receives ongoing care at the facility if a physician, or an advanced
445	445	nurse practitioner or physician assistant on behalf of a physician,
446	446	or an advanced practice registered nurse authorized to prescribe
447	447	and order drugs and devices under Section 301. 358, Occupations
448	448	Code, determines that the vaccine is in the person's best interest.
449	449	If the facility decides it is not feasible to offer the vaccine, the
450	450	facility must provide the person with information on other options
451	451	for obtaining the vaccine.
452	452	SECTION 3.008. Section 401.504(d), Health and Safety Code,
453	453	is amended to read as follows:
454	454	(d) This subchapter does not apply to a physician, [or to] a
455	455	physician's employee or delegate acting under Chapter 157,
456	456	Occupations Code, or an advanced practice registered nurse
457	457	authorized to prescribe and order drugs and devices under Section
458	458	301.358, Occupations Code.
459	459	SECTION 3.009. Section 481.002(39), Health and Safety Code,
460	460	is amended to read as follows:
461	461	(39) "Practitioner" means:
462	462	(A) a physician, dentist, veterinarian,
463	463	podiatrist, scientific investigator, advanced practice registered
464	464	nurse authorized to prescribe and order drugs and devices under
465	465	Section 301.358, Occupations Code, or other person licensed,
466	466	registered, or otherwise permitted to distribute, dispense,
467	467	analyze, conduct research with respect to, or administer a
468	468	controlled substance in the course of professional practice or
469	469	research in this state;
470	470	(B) a pharmacy, hospital, or other institution
471	471	licensed, registered, or otherwise permitted to distribute,
472	472	dispense, conduct research with respect to, or administer a
473	473	controlled substance in the course of professional practice or
474	474	research in this state;
475	475	(C) a person practicing in and licensed by
476	476	another state as a physician, dentist, veterinarian, advanced
477	477	practice registered nurse, or podiatrist, having a current Federal
478	478	Drug Enforcement Administration registration number, who may
479	479	legally prescribe Schedule II, III, IV, or V controlled substances
480	480	in that state; or
481	481	(D) an advanced practice registered nurse or
482	482	physician assistant to whom a physician has delegated the authority
483	483	to prescribe or order a drug or device under Section 157. 0511,
484	484	157.0512, or 157.054, Occupations Code.
485	485	SECTION 3.010. Section 481.074(d), Health and Safety Code,
486	486	is amended to read as follows:
487	487	(d) Except as specified in Subsections (e) and (f), the
488	488	board, by rule and in consultation with the Texas Medical Board and
489	489	the Texas Board of Nursing, shall establish the period after the
490	490	date on which the prescription is issued that a person may fill a
491	491	prescription for a controlled substance listed in Schedule II. A
492	492	person may not refill a prescription for a substance listed in
493	493	Schedule II.
494	494	SECTION 3.011. Section 481.076(c), Health and Safety Code,
495	495	is amended to read as follows:
496	496	(c) The board by rule shall design and implement a system
497	497	for submission of information to the board by electronic or other
498	498	means and for retrieval of information submitted to the board under
499	499	this section and Sections 481.074 and 481.075. The board shall use
500	500	automated information security techniques and devices to preclude
501	501	improper access to the information. The board shall submit the
502	502	system design to the director, [and] the Texas Medical Board, and
503	503	the Texas Board of Nursing for review and comment a reasonable time
504	504	before implementation of the system and shall comply with the
505	505	comments of those agencies unless it is unreasonable to do so.
506	506	SECTION 3.012. Section 481.0767(b), Health and Safety Code,
507	507	is amended to read as follows:
508	508	(b) The board shall appoint the following members to the
509	509	advisory committee:
510	510	(1) a physician licensed in this state who practices
511	511	in pain management;
512	512	(2) a physician licensed in this state who practices
513	513	in family medicine;
514	514	(3) a physician licensed in this state who performs
515	515	surgery;
516	516	(4) a physician licensed in this state who practices
517	517	in emergency medicine at a hospital;
518	518	(5) a physician licensed in this state who practices
519	519	in psychiatry;
520	520	(6) an oral and maxillofacial surgeon;
521	521	(7) a physician assistant or advanced practice
522	522	registered nurse to whom a physician has delegated the authority to
523	523	prescribe or order a drug or an advanced practice registered nurse
524	524	authorized to prescribe and order drugs and devices under Section
525	525	301.358, Occupations Code;
526	526	(8) a pharmacist working at a chain pharmacy;
527	527	(9) a pharmacist working at an independent pharmacy;
528	528	(10) an academic pharmacist; and
529	529	(11) two representatives of the health information
530	530	technology industry, at least one of whom is a representative of a
531	531	company whose primary line of business is electronic medical
532	532	records.
533	533	SECTION 3.013. Sections 483.001(4), (12), and (13), Health
534	534	and Safety Code, are amended to read as follows:
535	535	(4) "Designated agent" means:
536	536	(A) a licensed nurse, physician assistant,
537	537	pharmacist, or other individual designated by a practitioner to
538	538	communicate prescription drug orders to a pharmacist;
539	539	(B) a licensed nurse, physician assistant, or
540	540	pharmacist employed in a health care facility to whom the
541	541	practitioner communicates a prescription drug order; or
542	542	(C) an advanced practice [a] registered nurse or
543	543	physician assistant authorized by a practitioner to carry out a
544	544	prescription drug order for dangerous drugs under Subchapter B,
545	545	Chapter 157, Occupations Code.
546	546	(12) "Practitioner" means:
547	547	(A) a person licensed by:
548	548	(i) the Texas Medical Board, State Board of
549	549	Dental Examiners, Texas Optometry Board, or State Board of
550	550	Veterinary Medical Examiners to prescribe and administer dangerous
551	551	drugs; or
552	552	(ii) the Texas Department of Licensing and
553	553	Regulation, with respect to podiatry, to prescribe and administer
554	554	dangerous drugs;
555	555	(B) a person licensed by another state in a
556	556	health field in which, under the laws of this state, a licensee may
557	557	legally prescribe dangerous drugs;
558	558	(C) a person licensed in Canada or Mexico in a
559	559	health field in which, under the laws of this state, a licensee may
560	560	legally prescribe dangerous drugs; [or]
561	561	(D) an advanced practice registered nurse or
562	562	physician assistant to whom a physician has delegated the authority
563	563	to prescribe or order a drug or device under Section 157. 0511,
564	564	157.0512, or 157.054, Occupations Code; or
565	565	(E) an advanced practice registered nurse
566	566	authorized to prescribe and order drugs and devices under Section
567	567	301.358, Occupations Code.
568	568	(13) "Prescription" means an order from a
569	569	practitioner, or an agent of the practitioner designated in writing
570	570	as authorized to communicate prescriptions, or an order made in
571	571	accordance with Subchapter B, Chapter 157, Occupations Code, or
572	572	Section 203.353, Occupations Code, to a pharmacist for a dangerous
573	573	drug to be dispensed that states:
574	574	(A) the date of the order's issue;
575	575	(B) the name and address of the patient;
576	576	(C) if the drug is prescribed for an animal, the
577	577	species of the animal;
578	578	(D) the name and quantity of the drug prescribed;
579	579	(E) the directions for the use of the drug;
580	580	(F) the intended use of the drug unless the
581	581	practitioner determines the furnishing of this information is not
582	582	in the best interest of the patient;
583	583	(G) the name, address, and telephone number of
584	584	the practitioner at the practitioner's usual place of business,
585	585	legibly printed or stamped; and
586	586	(H) the name, address, and telephone number of
587	587	the licensed midwife, advanced practice registered nurse, or
588	588	physician assistant, legibly printed or stamped, if signed by a
589	589	licensed midwife, advanced practice registered nurse, or physician
590	590	assistant.
591	591	SECTION 3.014. Section 483.022(f), Health and Safety Code,
592	592	is amended to read as follows:
593	593	(f) A practitioner may designate a person who is a licensed
594	594	vocational nurse or has an education equivalent to or greater than
595	595	that required for a licensed vocational nurse to communicate
596	596	prescriptions of an advanced practice registered nurse or physician
597	597	assistant authorized by the practitioner to sign prescription drug
598	598	orders under Subchapter B, Chapter 157, Occupations Code, or of an
599	599	advanced practice registered nurse authorized to prescribe and
600	600	order drugs and devices under Section 301.358, Occupations Code.
601	601	SECTION 3.015. Section 483.042(a), Health and Safety Code,
602	602	is amended to read as follows:
603	603	(a) A person commits an offense if the person delivers or
604	604	offers to deliver a dangerous drug:
605	605	(1) unless:
606	606	(A) the dangerous drug is delivered or offered
607	607	for delivery by a pharmacist under:
608	608	(i) a prescription issued by a practitioner
609	609	described by Section 483.001(12)(A), [or] (B), or (E);
610	610	(ii) a prescription signed by an advanced
611	611	practice [a] registered nurse or physician assistant in accordance
612	612	with Subchapter B, Chapter 157, Occupations Code; or
613	613	(iii) an original written prescription
614	614	issued by a practitioner described by Section 483.001(12) (C); and
615	615	(B) a label is attached to the immediate
616	616	container in which the drug is delivered or offered to be delivered
617	617	and the label contains the following information:
618	618	(i) the name and address of the pharmacy
619	619	from which the drug is delivered or offered for delivery;
620	620	(ii) the date the prescription for the drug
621	621	is dispensed;
622	622	(iii) the number of the prescription as
623	623	filed in the prescription files of the pharmacy from which the
624	624	prescription is dispensed;
625	625	(iv) the name of the practitioner who
626	626	prescribed the drug and, if applicable, the name of the advanced
627	627	practice registered nurse or physician assistant who signed the
628	628	prescription;
629	629	(v) the name of the patient and, if the drug
630	630	is prescribed for an animal, a statement of the species of the
631	631	animal; and
632	632	(vi) directions for the use of the drug as
633	633	contained in the prescription; or
634	634	(2) unless:
635	635	(A) the dangerous drug is delivered or offered
636	636	for delivery by:
637	637	(i) a practitioner in the course of
638	638	practice; or
639	639	(ii) an advanced practice [a] registered
640	640	nurse or physician assistant in the course of practice in
641	641	accordance with Subchapter B, Chapter 157, Occupations Code; and
642	642	(B) a label is attached to the immediate
643	643	container in which the drug is delivered or offered to be delivered
644	644	and the label contains the following information:
645	645	(i) the name and address of the
646	646	practitioner who prescribed the drug, and if applicable, the name
647	647	and address of the advanced practice registered nurse or physician
648	648	assistant;
649	649	(ii) the date the drug is delivered;
650	650	(iii) the name of the patient and, if the
651	651	drug is prescribed for an animal, a statement of the species of the
652	652	animal; and
653	653	(iv) the name of the drug, the strength of
654	654	the drug, and directions for the use of the drug.
655	655	SECTION 3.016. Section 773.0145(k), Health and Safety Code,
656	656	is amended to read as follows:
657	657	(k) A physician, a [or] person who has been delegated
658	658	prescriptive authority under Chapter 157, Occupations Code, or an
659	659	advanced practice registered nurse authorized to prescribe and
660	660	order drugs and devices under Section 301.358, Occupations Code,
661	661	may prescribe epinephrine auto-injectors in the name of an entity.
662	662	SECTION 3.017. Section 32.024(gg), Human Resources Code, is
663	663	amended to read as follows:
664	664	(gg) Notwithstanding any other law, including Sections
665	665	843.312 and 1301.052, Insurance Code, the commission shall ensure
666	666	that advanced practice registered nurses and physician assistants
667	667	may be selected by and assigned to recipients of medical assistance
668	668	as the primary care providers of those recipients regardless of
669	669	whether, if applicable, the physician supervising the advanced
670	670	practice registered nurse is included in any directory of providers
671	671	of medical assistance maintained by the commission. This
672	672	subsection may not be construed as authorizing the commission to
673	673	supervise or control the practice of medicine as prohibited by
674	674	Subtitle B, Title 3, Occupations Code. The commission must require
675	675	that advanced practice registered nurses and physician assistants
676	676	be treated in the same manner as primary care physicians with regard
677	677	to:
678	678	(1) selection and assignment as primary care
679	679	providers; and
680	680	(2) inclusion as primary care providers in any
681	681	directory of providers of medical assistance maintained by the
682	682	commission.
683	683	SECTION 3.018. Section 32.03141, Human Resources Code, is
684	684	amended to read as follows:
685	685	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
686	686	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
687	687	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
688	688	addition to other health care practitioners authorized by federal
689	689	law, the following persons may order and prescribe durable medical
690	690	equipment and supplies under the medical assistance program:
691	691	(1) an advanced practice registered nurse authorized
692	692	to prescribe and order drugs and devices under Section 301. 358,
693	693	Occupations Code; and
694	694	(2) an advanced practice registered nurse or physician
695	695	assistant acting under adequate physician supervision and to whom a
696	696	physician has delegated the authority to prescribe and order drugs
697	697	and devices under Chapter 157, Occupations Code[, may order and
698	698	prescribe durable medical equipment and supplies under the medical
699	699	assistance program].
700	700	SECTION 3.019. Section 42.067(b), Human Resources Code, is
701	701	amended to read as follows:
702	702	(b) A physician, [or] a person who has been delegated
703	703	prescriptive authority under Chapter 157, Occupations Code, or an
704	704	advanced practice registered nurse authorized to prescribe and
705	705	order drugs and devices under Section 301.358, Occupations Code,
706	706	may prescribe epinephrine auto-injectors in the name of a day-care
707	707	center.
708	708	SECTION 3.020. Section 843.312, Insurance Code, is amended
709	709	to read as follows:
710	710	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
711	711	REGISTERED NURSES. (a) A health maintenance organization may not
712	712	refuse a request by a physician participating in the health
713	713	maintenance organization delivery network and a physician
714	714	assistant or advanced practice registered nurse who is authorized
715	715	by the physician to provide care under Subchapter B, Chapter 157,
716	716	Occupations Code, or an advanced practice registered nurse
717	717	authorized to prescribe and order drugs and devices under Section
718	718	301.358, Occupations Code, to identify a physician assistant or
719	719	advanced practice registered nurse as a provider in the network.
720	720	(b) A health maintenance organization may refuse a request
721	721	under Subsection (a) if the physician assistant or advanced
722	722	practice registered nurse does not meet the quality of care
723	723	standards previously established by the health maintenance
724	724	organization for participation in the network by physician
725	725	assistants and advanced practice registered nurses.
726	726	SECTION 3.021. Section 1301.001(1-a), Insurance Code, is
727	727	amended to read as follows:
728	728	(1-a) "Health care provider" means a practitioner,
729	729	institutional provider, or other person or organization that
730	730	furnishes health care services and that is licensed or otherwise
731	731	authorized to practice in this state. The term includes a
732	732	pharmacist, [and] a pharmacy, and an advanced practice registered
733	733	nurse authorized to practice under Section 301.357, Occupations
734	734	Code. The term does not include a physician.
735	735	SECTION 3.022. Section 1452.051(1), Insurance Code, is
736	736	amended to read as follows:
737	737	(1) "Advanced practice nurse" has the meaning assigned
738	738	to "advanced practice registered nurse" by Section 301.002
739	739	[301.152], Occupations Code.
740	740	SECTION 3.023. Section 408.025, Labor Code, is amended by
741	741	amending Subsection (a-1) and adding Subsection (a-2) to read as
742	742	follows:
743	743	(a-1) A [treating doctor may delegate to a physician
744	744	assistant who is licensed to practice in this state under Chapter
745	745	204, Occupations Code, or an advanced practice registered nurse who
746	746	is licensed to practice in this state under Chapter 301,
747	747	Occupations Code, the authority to complete and sign a] work status
748	748	report regarding an injured employee's ability to return to work
749	749	may be completed and signed by:
750	750	(1) a physician assistant licensed to practice in this
751	751	state under Chapter 204, Occupations Code, who has been delegated
752	752	the authority by a treating doctor;
753	753	(2) an advanced practice registered nurse licensed to
754	754	practice in this state under Chapter 301, Occupations Code, who has
755	755	been delegated the authority by a treating doctor; or
756	756	(3) an advanced practice registered nurse authorized
757	757	to practice under Section 301.357, Occupations Code.
758	758	(a-2) The delegating treating doctor is responsible for the
759	759	acts of a [the] physician assistant [or advanced practice
760	760	registered nurse] under Subsection (a-1)(1) or an advanced practice
761	761	registered nurse under Subsection (a-1)(2) [this subsection].
762	762	SECTION 3.024. Section 157.051(1), Occupations Code, is
763	763	amended to read as follows:
764	764	(1) "Advanced practice registered nurse" has the
765	765	meaning assigned [to that term] by Section 301.002 [301.152]. [The
766	766	term includes an advanced nurse practitioner and advanced practice
767	767	nurse.]
768	768	SECTION 3.025. Section 203.002(2), Occupations Code, is
769	769	amended to read as follows:
770	770	(2) "Certified nurse-midwife" means an advanced
771	771	practice [a person who is:
772	772	[(A) a] registered nurse [under Chapter 301;
773	773	[(B) recognized as an advanced nurse
774	774	practitioner by the Texas Board of Nursing; and
775	775	[(C)] certified by the American College of
776	776	Nurse-Midwives.
777	777	SECTION 3.026. Sections 551.003(14) and (34), Occupations
778	778	Code, are amended to read as follows:
779	779	(14) "Designated agent" means:
780	780	(A) an individual, including a licensed nurse,
781	781	physician assistant, or pharmacist:
782	782	(i) who is designated by a practitioner and
783	783	authorized to communicate a prescription drug order to a
784	784	pharmacist; and
785	785	(ii) for whom the practitioner assumes
786	786	legal responsibility;
787	787	(B) a licensed nurse, physician assistant, or
788	788	pharmacist employed in a health care facility to whom a
789	789	practitioner communicates a prescription drug order; or
790	790	(C) an advanced practice [a] registered
791	791	nurse or physician assistant authorized by a practitioner to
792	792	administer a prescription drug order for a dangerous drug under
793	793	Subchapter B, Chapter 157.
794	794	(34) "Practitioner" means:
795	795	(A) a person licensed or registered to prescribe,
796	796	distribute, administer, or dispense a prescription drug or device
797	797	in the course of professional practice in this state, including a
798	798	physician, dentist, podiatrist, advanced practice registered nurse
799	799	authorized to prescribe and order drugs and devices under Section
800	800	301.358, or veterinarian but excluding a person licensed under this
801	801	subtitle;
802	802	(B) a person licensed by another state, Canada,
803	803	or the United Mexican States in a health field in which, under the
804	804	law of this state, a license holder in this state may legally
805	805	prescribe a dangerous drug;
806	806	(C) a person practicing in another state and
807	807	licensed by another state as a physician, dentist, veterinarian,
808	808	advanced practice registered nurse, or podiatrist, who has a
809	809	current federal Drug Enforcement Administration registration
810	810	number and who may legally prescribe a Schedule II, III, IV, or V
811	811	controlled substance, as specified under Chapter 481, Health and
812	812	Safety Code, in that other state; or
813	813	(D) an advanced practice registered nurse or
814	814	physician assistant to whom a physician has delegated the authority
815	815	to prescribe or order a drug or device under Section 157.0511,
816	816	157.0512, or 157.054.
817	817	SECTION 3.027. Section 563.051(e), Occupations Code, is
818	818	amended to read as follows:
819	819	(e) A practitioner may designate a licensed vocational
820	820	nurse or a person having education equivalent to or greater than
821	821	that required for a licensed vocational nurse to communicate the
822	822	prescriptions of an advanced practice registered nurse or physician
823	823	assistant authorized by the practitioner to sign prescription drug
824	824	orders under Subchapter B, Chapter 157, or of an advanced practice
825	825	registered nurse authorized to prescribe and order drugs and
826	826	devices under Section 301.358.
827	827	SECTION 3.028. Section 563.053, Occupations Code, is
828	828	amended to read as follows:
829	829	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
830	830	RURAL AREAS. (a) In this section:
831	831	(1) "Advanced practice registered nurse" has the
832	832	meaning assigned by Section 301.002.
833	833	(2) "Reimbursement [, "reimbursement] for cost" means
834	834	an additional charge, separate from that imposed for the
835	835	physician's or advanced practice registered nurse's professional
836	836	services, that includes the cost of the drug product and all other
837	837	actual costs to the physician or advanced practice registered nurse
838	838	incidental to providing the dispensing service. The term does not
839	839	include a separate fee imposed for the act of dispensing the drug
840	840	itself.
841	841	(a-1) This section applies to an advanced practice
842	842	registered nurse only to the extent that the advanced practice
843	843	registered nurse is authorized to prescribe and order drugs and
844	844	devices under Section 301.358.
845	845	(b) This section applies to an area located in a county with
846	846	a population of 5,000 or less, or in a municipality or an
847	847	unincorporated town with a population of less than 2,500, that is
848	848	within a 15-mile radius of the physician's or advanced practice
849	849	registered nurse's office and in which a pharmacy is not located.
850	850	This section does not apply to a municipality or an unincorporated
851	851	town that is adjacent to a municipality with a population of 2,500
852	852	or more.
853	853	(c) A physician who practices medicine or advanced practice
854	854	registered nurse who practices advanced practice registered
855	855	nursing in an area described by Subsection (b) may:
856	856	(1) maintain a supply of dangerous drugs in the
857	857	physician's or advanced practice registered nurse's office to be
858	858	dispensed in the course of treating the physician's or advanced
859	859	practice registered nurse's patients; and
860	860	(2) be reimbursed for the cost of supplying those
861	861	drugs without obtaining a license under Chapter 558.
862	862	(d) A physician or advanced practice registered nurse who
863	863	dispenses dangerous drugs under Subsection (c) shall:
864	864	(1) comply with each labeling provision under this
865	865	subtitle applicable to that class of drugs; and
866	866	(2) oversee compliance with packaging and
867	867	recordkeeping provisions applicable to that class of drugs.
868	868	(e) A physician who desires to dispense dangerous drugs
869	869	under this section shall notify both the board and the Texas Medical
870	870	[State] Board [of Medical Examiners] that the physician practices
871	871	in an area described by Subsection (b). An advanced practice
872	872	registered nurse who desires to dispense dangerous drugs under this
873	873	section shall notify both the board and the Texas Board of Nursing
874	874	that the advanced practice registered nurse practices in an area
875	875	described by Subsection (b). The physician or advanced practice
876	876	registered nurse may continue to dispense dangerous drugs in the
877	877	area until the board determines, after notice and hearing, that the
878	878	physician or advanced practice registered nurse no longer practices
879	879	in an area described by Subsection (b).
880	880	SECTION 3.029. Sections 605.002(14) and (18), Occupations
881	881	Code, are amended to read as follows:
882	882	(14) "Orthotics" means the science and practice of
883	883	measuring, designing, fabricating, assembling, fitting, adjusting,
884	884	or servicing an orthosis under an order from a licensed physician,
885	885	chiropractor, [or] podiatrist, or advanced practice registered
886	886	nurse authorized to prescribe and order drugs and devices under
887	887	Section 301. 358, or an advanced practice registered nurse or
888	888	physician assistant acting under the delegation and supervision of
889	889	a licensed physician as provided by Subchapter B, Chapter 157, and
890	890	rules adopted by the Texas Medical Board, for the correction or
891	891	alleviation of a neuromuscular or musculoskeletal dysfunction,
892	892	disease, injury, or deformity.
893	893	(18) "Prosthetics" means the science and practice of
894	894	measuring, designing, fabricating, assembling, fitting, adjusting,
895	895	or servicing a prosthesis under an order from a licensed physician,
896	896	chiropractor, [or] podiatrist, or advanced practice registered
897	897	nurse authorized to prescribe and order drugs and devices under
898	898	Section 301.358, or an advanced practice registered nurse or
899	899	physician assistant acting under the delegation and supervision of
900	900	a licensed physician as provided by Subchapter B, Chapter 157, and
901	901	rules adopted by the Texas Medical Board.
902	902	SECTION 3.030. Section 605.2515, Occupations Code, is
903	903	amended to read as follows:
904	904	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
905	905	person licensed to practice orthotics or prosthetics who measures,
906	906	designs, fabricates, fits, assembles, adjusts, or services an
907	907	orthosis or a prosthesis under an order from a licensed physician,
908	908	chiropractor, [or] podiatrist, or advanced practice registered
909	909	nurse authorized to prescribe and order drugs and devices under
910	910	Section 301.358, or an advanced practice registered nurse or
911	911	physician assistant acting under the delegation and supervision of
912	912	a licensed physician as provided by Subchapter B, Chapter 157, and
913	913	rules adopted by the Texas Medical Board, for a specific patient is
914	914	exempt from licensing as a device manufacturer under Subchapter L,
915	915	Chapter 431, Health and Safety Code. A person licensed to practice
916	916	orthotics or prosthetics who fabricates or assembles an orthosis or
917	917	a prosthesis without an order from a licensed physician,
918	918	chiropractor, [er] podiatrist, or advanced practice registered
919	919	nurse authorized to prescribe and order drugs and devices under
920	920	Section 301.358, or an advanced practice registered nurse or
921	921	physician assistant acting under the delegation and supervision of
922	922	a licensed physician as provided by Subchapter B, Chapter 157, and
923	923	rules adopted by the Texas Medical Board, for a specific patient is
924	924	required to be licensed as a device manufacturer under Subchapter
925	925	L, Chapter 431, Health and Safety Code.
926	926	SECTION 3.031. Section 1701.703(a), Occupations Code, is
927	927	amended to read as follows:
928	928	(a) A physician, [or] a person who has been delegated
929	929	prescriptive authority under Chapter 157, or an advanced practice
930	930	registered nurse authorized to prescribe and order drugs and
931	931	devices under Section 301.358 [Occupations Code,] may prescribe
932	932	epinephrine auto-injectors in the name of a law enforcement agency.
933	933	ARTICLE 4. REPEALER
934	934	SECTION 4.001. Section 301.152(a), Occupations Code, is
935	935	repealed.
936	936	ARTICLE 5. TRANSITIONS AND EFFECTIVE DATE
937	937	SECTION 5.001. Not later than February 1, 2026, the Texas
938	938	Board of Nursing shall adopt the rules necessary to implement the
939	939	changes in law made by this Act.
940	940	SECTION 5.002. This Act takes effect September 1, 2025.