89R21662 BEE-D
By: Middleton, Blanco S.B. No. 3055
A BILL TO BE ENTITLED
AN ACT
relating to the licensing and regulation of advanced practice
registered nurses and the number of advanced practice registered
nurses and physician assistants with whom a physician may enter
into a prescriptive authority agreement.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. SHORT TITLE
SECTION 1.001. This Act may be cited as the Healthcare
Expanded and Accessed Locally for Texans (HEAL Texans) Act.
ARTICLE 2. REGULATION OF ADVANCED PRACTICE REGISTERED NURSES
SECTION 2.001. Section 301.002, Occupations Code, is
amended to read as follows:
Sec. 301.002. DEFINITIONS. In this chapter:
(1) "Advanced practice registered nurse" means a
registered nurse licensed by the board to practice as an advanced
practice registered nurse on the basis of completion of an advanced
educational program.
(2) [(1)] "Board" means the Texas Board of Nursing.
(3) [(1-a)] "Chief nursing officer" means the
registered nurse who is administratively responsible for the
nursing services at a facility.
(4) "Controlled substance" has the meaning assigned by
Section 481.002, Health and Safety Code.
(5) "Dangerous drug" has the meaning assigned by
Section 483.001, Health and Safety Code.
(6) "Device" has the meaning assigned by Section
551.003, and includes durable medical equipment.
(7) "Nonprescription drug" has the meaning assigned by
Section 551.003.
(8) "Nurse" means a person required to be licensed
under this chapter to engage in professional or vocational nursing.
(9) "Nursing" means professional or vocational
nursing.
(10) [(1-b)] "Patient safety committee" has the
meaning assigned by Section 303.001.
(11) "Prescribe or order a drug or device" has the
meaning assigned by Section 157.051.
(12) [(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, except as performed by an advanced practice
registered nurse authorized to practice by the board under Section
301.357. 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 by an advanced practice
registered nurse 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; and
(I) the performance of an act by an advanced
practice registered nurse authorized to practice by the board under
Section 301.357.
[(3) "Nurse" means a person required to be licensed
under this chapter to engage in professional or vocational nursing.
[(4) "Nursing" means professional or vocational
nursing.]
(13) [(5)] "Vocational nursing" means a directed
scope of nursing practice, including the performance of an act that
requires 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 vocational nursing. The term does
not include acts of medical diagnosis or the prescription of
therapeutic or corrective measures. Vocational nursing involves:
(A) collecting data and performing focused
nursing assessments of the health status of an individual;
(B) participating in the planning of the nursing
care needs of an individual;
(C) participating in the development and
modification of the nursing care plan;
(D) participating in health teaching and
counseling to promote, attain, and maintain the optimum health
level of an individual;
(E) assisting in the evaluation of an
individual's response to a nursing intervention and the
identification of an individual's needs; and
(F) engaging in other acts that require education
and training, as prescribed by board rules and policies,
commensurate with the nurse's experience, continuing education,
and demonstrated competency.
SECTION 2.002. Section 301.005(b), Occupations Code, is
amended to read as follows:
(b) A reference in any other law to an "advanced nurse
practitioner," [practitioner" or] "advanced practice nurse," or
"advanced practice registered nurse" means an advanced practice
registered nurse.
SECTION 2.003. Sections 301.152(a) and (b), Occupations
Code, are amended to read as follows:
(a) [In this section, "advanced practice registered nurse"
means a registered nurse licensed by the board to practice as an
advanced practice registered nurse on the basis of completion of an
advanced educational program.] The term "advanced practice
registered nurse" includes a nurse practitioner, nurse midwife,
nurse anesthetist, and clinical nurse specialist. [The term is
synonymous with "advanced nurse practitioner" and "advanced
practice nurse."]
(b) The board shall adopt rules to:
(1) license a registered nurse as an advanced practice
registered nurse;
(2) establish:
(A) any specialized education or training,
including pharmacology, that an advanced practice registered nurse
must have to prescribe or order a drug or device as delegated by a
physician under Section 157.0512 or 157.054 or authorized by the
board under Section 301.358;
(B) a system for approving an advanced practice
registered nurse to prescribe or order a drug or device as delegated
by a physician under Section 157.0512 or 157.054 or authorized by
the board under Section 301.358 on the receipt of evidence of
completing the specialized education and training requirement
under Paragraph (A); and
(C) a system for issuing a prescription
authorization number to an advanced practice registered nurse
approved under Paragraph (B); and
(3) concurrently renew any license or approval granted
to an advanced practice registered nurse under this subsection and
a license renewed by the advanced practice registered nurse under
Section 301.301.
SECTION 2.004. Section 301.303(b), Occupations Code, is
amended to read as follows:
(b) Except as provided by a rule adopted under Section
301.357(h) for an advanced practice registered nurse authorized by
the board to practice under that section, the [The] board may not
require participation in more than a total of 20 hours of continuing
education in a two-year licensing period.
SECTION 2.005. Subchapter H, Chapter 301, Occupations Code,
is amended by adding Sections 301.357, 301.358, and 301.359 to read
as follows:
Sec. 301.357. INDEPENDENT PRACTICE BY CERTAIN ADVANCED
PRACTICE REGISTERED NURSES. (a) The board shall authorize the
practice under this section of an advanced practice registered
nurse who applies for authorization under this section in the
manner prescribed by the board and who:
(1) is a nurse practitioner, nurse midwife, or
clinical nurse specialist; and
(2) either:
(A) has held an active unencumbered license as an
advanced practice registered nurse in any state for at least 10
years or 20,000 hours, as determined by the board; or
(B) has:
(i) graduated from a program of nursing
education that has a physical presence in this state and has a
requirement of in-person clinical experience; and
(ii) practiced as an advanced practice
registered nurse under a prescriptive authority agreement with a
physician for at least four years or 8,000 hours, as determined by
the board.
(b) To be eligible for authorization to practice under this
section, an applicant described by Subsection (a) must:
(1) hold an active, unencumbered license to practice
as an advanced practice registered nurse in this state;
(2) hold a current national certification in the role
and population focus of the advanced practice registered nurse;
(3) have a bachelor's degree in nursing and a master's
or doctoral degree in nursing from a nationally accredited
educational program;
(4) have completed academic coursework in physical
assessment, advanced pharmacology, and advanced pathophysiology;
and
(5) not be the subject of any pending disciplinary
action or substantially equivalent action.
(c) The scope of practice of an advanced practice registered
nurse authorized to practice under this section includes:
(1) ordering, performing, and interpreting diagnostic
tests;
(2) formulating primary and differential medical
diagnoses and advanced assessments;
(3) treating actual and potential health problems;
(4) prescribing therapeutic and corrective measures,
including nutrition and diagnostic support services, home health
care, hospice care, physical therapy, and occupational therapy, and
delegating and assigning the performance of therapeutic and
corrective measures to assistive personnel;
(5) to the extent authorized by the board under
Section 301.358, prescribing, ordering, procuring, administering,
and dispensing drugs and devices, including blood and blood
products, controlled substances listed in Schedules III, IV, and V,
dangerous drugs, and nonprescription drugs;
(6) providing referrals to health care agencies,
health care providers, and community resources;
(7) serving as a primary care provider of record; and
(8) performing other acts that require education and
training consistent with professional standards and that are
commensurate with the advanced practice registered nurse's
education, licensure, and demonstrated competencies and
experience.
(d) Subject to Subsection (e), an advanced practice
registered nurse authorized to practice under this section shall
practice as a licensed independent practitioner in accordance with
standards established and recognized by the board to protect the
public health and safety.
(e) An advanced practice registered nurse authorized to
practice under this section may practice as a licensed independent
practitioner only in a county with a population of less than 68,750.
(f) An advanced practice registered nurse authorized to
practice under this section is accountable to patients, the nursing
profession, and the board for:
(1) complying with the requirements of this chapter;
(2) providing quality advanced nursing care;
(3) recognizing the limits of the nurse's knowledge;
(4) planning for the management of situations beyond
the nurse's expertise; and
(5) consulting with or referring patients to other
health care providers as appropriate.
(g) This section does not limit or modify the scope of
practice of a nurse who is not authorized to practice under this
section.
(h) The board by rule shall establish:
(1) the application process for authorization to
practice under this section;
(2) a requirement that an advanced practice registered
nurse authorized to practice under this section complete at least
48 hours of continuing education, including 10 hours of continuing
education in pharmacology, every two years; and
(3) systems to:
(A) authorize an advanced practice registered
nurse to prescribe or order a drug or device under Section 301.358
when the board receives evidence of the completion of any education
or training required by board rule; and
(B) concurrently renew for an advanced practice
registered nurse:
(i) an authorization issued under this
section or Section 301.358; and
(ii) a license issued under rules adopted
under Section 301.152 or renewed under Section 301.301.
Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
ADVANCED PRACTICE REGISTERED NURSE. The board may authorize an
advanced practice registered nurse authorized to practice by the
board under Section 301.357 to prescribe and order drugs and
devices, including controlled substances listed in Schedules III,
IV, and V, dangerous drugs, and nonprescription drugs.
Sec. 301.359. REPORT TO BOARD. (a) An advanced practice
registered nurse authorized to practice by the board under Section
301.357 shall, not later than January 15 of each year, submit to the
board a report that includes for the preceding calendar year:
(1) the location of each setting in which the advanced
practice registered nurse practiced as an independent
practitioner, including the county in which the setting is located;
(2) the number of patients to whom the advanced
practice registered nurse practiced as an independent
practitioner; and
(3) the number of instances in which the advanced
practice registered nurse:
(A) referred the patient to a physician for the
prescription of a controlled substance listed in Schedule II; or
(B) prescribed a controlled substance listed in
Schedule II to a patient under a prescriptive authority agreement
with a physician.
(b) An advanced practice registered nurse authorized to
practice by the board under Section 301.357 shall notify the board
if the advanced practice registered nurse practices as an
independent practitioner at a location other than the practice
setting identified in the report submitted to the board under
Subsection (a) for the previous calendar year.
(c) The board shall annually aggregate, anonymize, and
publish on the board's Internet website the information submitted
by each advanced practice registered nurse under Subsection (a).
ARTICLE 3. DELEGATION AND PRESCRIPTIVE AUTHORITY AGREEMENTS
SECTION 3.001. Section 157.0512(c), Occupations Code, is
amended to read as follows:
(c) Except as provided by Subsection (d), the combined
number of advanced practice registered nurses and physician
assistants with whom a physician may enter into a prescriptive
authority agreement may not exceed nine [seven] advanced practice
registered nurses and physician assistants or the full-time
equivalent of seven advanced practice registered nurses and
physician assistants.
SECTION 3.002. Chapter 157, Occupations Code, is amended by
adding Subchapter D to read as follows:
SUBCHAPTER D. DELEGATION AGREEMENTS WITH
ADVANCED PRACTICE REGISTERED NURSES
Sec. 157.151. NONDISCLOSURE AGREEMENTS. A delegation
agreement, including a prescriptive authority agreement, between a
physician and an advanced practice registered nurse may not include
or be the subject of a nondisclosure agreement.
Sec. 157.152. REPORTING BY PHYSICIAN; REPORT TO BOARD. (a)
A physician who enters into a delegation agreement with an advanced
practice registered nurse, including a prescriptive authority
agreement under Section 157.0512, shall, not later than January 15
of each year, submit to the board a report that includes for the
preceding calendar year:
(1) the amount of any fee the physician charges the
advanced practice registered nurse to enter into the agreement;
(2) any restriction or limitation the physician places
on the advanced practice registered nurse's practice under the
agreement;
(3) any instance in which the physician changes the
diagnosis or course of treatment of a patient of the advanced
practice registered nurse; and
(4) the number of case files the physician reviews
each month.
(b) The board shall annually aggregate, anonymize, and
publish on the board's Internet website the information submitted
by each physician under Subsection (a).
Sec. 157.153. COMPLAINT REGARDING ADVANCED PRACTICE
REGISTERED NURSE UNDER DELEGATION AGREEMENT. (a) The board shall
disaggregate from information the board maintains regarding
complaints against a physician any information regarding a
complaint against an advanced practice registered nurse practicing
under a delegation agreement with the physician.
(b) The board shall separately maintain information
regarding complaints against an advanced practice registered nurse
practicing under a delegation agreement with the physician. The
information maintained under this subsection must include:
(1) the specialization of the advanced practice
registered nurse who is the subject of the complaint; and
(2) the disposition of the complaint, including any
disciplinary action taken.
ARTICLE 4. CONFORMING AMENDMENTS
SECTION 4.001. Section 38.151(1), Education Code, is
amended to read as follows:
(1) "Advanced practice nurse" has the meaning assigned
to "advanced practice registered nurse" by Section 301.002
[301.152], Occupations Code.
SECTION 4.002. Section 38.211(a), Education Code, is
amended to read as follows:
(a) A physician, a [or] person who has been delegated
prescriptive authority under Chapter 157, Occupations Code, or an
advanced practice registered nurse authorized to prescribe and
order drugs and devices under Section 301.358, Occupations Code,
may prescribe epinephrine auto-injectors or medication for
respiratory distress in the name of a school district,
open-enrollment charter school, or private school.
SECTION 4.003. Section 38.225(a), Education Code, is
amended to read as follows:
(a) A physician, a [or] person who has been delegated
prescriptive authority under Chapter 157, Occupations Code, or an
advanced practice registered nurse authorized to prescribe and
order drugs and devices under Section 301.358, Occupations Code,
may prescribe opioid antagonists in the name of a school district,
open-enrollment charter school, or private school.
SECTION 4.004. Section 61.601, Education Code, is amended
to read as follows:
Sec. 61.601. DEFINITION. In this subchapter, "mental
health professional" means:
(1) a licensed physician who is:
(A) a graduate of an accredited psychiatric
residency training program; or
(B) certified in psychiatry by:
(i) the American Board of Psychiatry and
Neurology; or
(ii) the American Osteopathic Board of
Neurology and Psychiatry;
(2) a psychologist, as defined by Section 501.002,
Occupations Code;
(3) a licensed professional counselor, as defined by
Section 503.002, Occupations Code;
(4) an advanced practice registered nurse, as defined
by Section 301.002 [301.152], Occupations Code, who holds a
nationally recognized board certification in psychiatric or mental
health nursing;
(5) a licensed clinical social worker, as defined by
Section 505.002, Occupations Code;
(6) a licensed specialist in school psychology, as
defined by Section 501.002, Occupations Code;
(7) a chemical dependency counselor, as defined by
Section 504.001, Occupations Code; and
(8) a licensed marriage and family therapist, as
defined by Section 502.002, Occupations Code.
SECTION 4.005. Section 1101.100(1), Estates Code, is
amended to read as follows:
(1) "Advanced practice registered nurse" has the
meaning assigned by Section 301.002 [301.152], Occupations Code.
SECTION 4.006. Section 671.001(b), Government Code, is
amended to read as follows:
(b) The pilot program must provide for the following:
(1) either:
(A) both:
(i) a licensed advanced practice registered
nurse as defined by Section 301.002 [301.152], Occupations Code, or
a licensed physician assistant as described by Chapter 204,
Occupations Code, who is employed by the state or whose services are
acquired by contract, who will be located at a state office complex;
and
(ii) [(2)] a licensed physician, who is
employed by a state governmental entity for purposes other than the
pilot program or whose services are acquired by contract, who will
delegate to and supervise the advanced practice registered nurse or
physician assistant under a prescriptive authority agreement under
Chapter 157, Occupations Code; or
(B) an advanced practice registered nurse
authorized to practice under Section 301.357, Occupations Code;
(2) [(3)] appropriate office space and equipment for
the advanced practice registered nurse or physician assistant to
provide basic medical care to employees at the state office complex
where the nurse or physician assistant is located; and
(3) [(4)] professional liability insurance covering
services provided by the advanced practice registered nurse or the
physician assistant.
SECTION 4.007. Section 47.011(a), Health and Safety Code,
is amended to read as follows:
(a) In this section, "midwife" has the meaning assigned by
Section 203.002, Occupations Code, and includes a nurse midwife
[described by Section 301.152, Occupations Code].
SECTION 4.008. Sections 161.0052(b) and (c), Health and
Safety Code, are amended to read as follows:
(b) The executive commissioner by rule shall require a
hospital to inform each elderly person admitted to the hospital for
a period of 24 hours or more that the pneumococcal and influenza
vaccines are available. If the elderly person requests a vaccine,
and if a physician, or an advanced practice registered nurse
[practitioner] or physician assistant on behalf of a physician, or
an advanced practice registered nurse authorized to prescribe and
order drugs and devices under Section 301.358, Occupations Code,
determines that the vaccine is in the person's best interest, the
hospital must make the vaccination available to the person before
the person is discharged from the hospital.
(c) The executive commissioner by rule shall require an end
stage renal disease facility to offer, to the extent possible as
determined by the facility, the opportunity to receive the
pneumococcal and influenza vaccines to each elderly person who
receives ongoing care at the facility if a physician, or an advanced
practice registered nurse [practitioner] or physician assistant on
behalf of a physician, or an advanced practice registered nurse
authorized to prescribe and order drugs and devices under Section
301.358, Occupations Code, determines that the vaccine is in the
person's best interest. If the facility decides it is not feasible
to offer the vaccine, the facility must provide the person with
information on other options for obtaining the vaccine.
SECTION 4.009. Section 401.504(d), Health and Safety Code,
is amended to read as follows:
(d) This subchapter does not apply to a physician, [or to] a
physician's employee or delegate acting under Chapter 157,
Occupations Code, or an advanced practice registered nurse
authorized to prescribe and order drugs and devices under Section
301.358, Occupations Code.
SECTION 4.010. 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, advanced practice registered
nurse authorized to prescribe and order drugs and devices under
Section 301.358, Occupations Code, 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, advanced
practice registered nurse, 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 4.011. 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 Board of Nursing, 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 4.012. Section 481.076(c), Health and Safety Code,
is amended to read as follows:
(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 Board of Nursing 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 4.013. Section 481.0767(b), Health and Safety Code,
is amended to read as follows:
(b) The board shall appoint the following members to the
advisory committee:
(1) a physician licensed in this state who practices
in pain management;
(2) a physician licensed in this state who practices
in family medicine;
(3) a physician licensed in this state who performs
surgery;
(4) a physician licensed in this state who practices
in emergency medicine at a hospital;
(5) a physician licensed in this state who practices
in psychiatry;
(6) an oral and maxillofacial surgeon;
(7) a physician assistant or advanced practice
registered nurse to whom a physician has delegated the authority to
prescribe or order a drug or an advanced practice registered nurse
authorized to prescribe and order drugs and devices under Section
301.358, Occupations Code;
(8) a pharmacist working at a chain pharmacy;
(9) a pharmacist working at an independent pharmacy;
(10) an academic pharmacist; and
(11) two representatives of the health information
technology industry, at least one of whom is a representative of a
company whose primary line of business is electronic medical
records.
SECTION 4.014. Sections 483.001(4), (12), and (13), Health
and Safety Code, are amended to read as follows:
(4) "Designated agent" means:
(A) a licensed nurse, physician assistant,
pharmacist, or other individual designated by a practitioner to
communicate prescription drug orders to a pharmacist;
(B) a licensed nurse, physician assistant, or
pharmacist employed in a health care facility to whom the
practitioner communicates a prescription drug order; or
(C) an advanced practice [a] registered nurse or
physician assistant authorized by a practitioner to carry out a
prescription drug order for dangerous drugs under Subchapter B,
Chapter 157, Occupations Code.
(12) "Practitioner" means:
(A) a person licensed by:
(i) 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) the Texas Department of Licensing and
Regulation, with respect to podiatry, 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; or
(E) an advanced practice registered nurse
authorized to prescribe and order drugs and devices under Section
301.358, Occupations Code.
(13) "Prescription" means an order from a
practitioner, or an agent of the practitioner designated in writing
as authorized to communicate prescriptions, or an order made in
accordance with Subchapter B, Chapter 157, Occupations Code, or
Section 203.353, Occupations Code, to a pharmacist for a dangerous
drug to be dispensed that states:
(A) the date of the order's issue;
(B) the name and address of the patient;
(C) if the drug is prescribed for an animal, the
species of the animal;
(D) the name and quantity of the drug prescribed;
(E) the directions for the use of the drug;
(F) the intended use of the drug unless the
practitioner determines the furnishing of this information is not
in the best interest of the patient;
(G) the name, address, and telephone number of
the practitioner at the practitioner's usual place of business,
legibly printed or stamped; and
(H) the name, address, and telephone number of
the licensed midwife, advanced practice registered nurse, or
physician assistant, legibly printed or stamped, if signed by a
licensed midwife, advanced practice registered nurse, or physician
assistant.
SECTION 4.015. Section 483.022(f), Health and Safety Code,
is amended to read as follows:
(f) A practitioner may designate a person who is a licensed
vocational nurse or has an education equivalent to or greater than
that required for a licensed vocational nurse to communicate
prescriptions of an advanced practice registered nurse or physician
assistant authorized by the practitioner to sign prescription drug
orders under Subchapter B, Chapter 157, Occupations Code, or of an
advanced practice registered nurse authorized to prescribe and
order drugs and devices under Section 301.358, Occupations Code.
SECTION 4.016. Section 483.042(a), Health and Safety Code,
is amended to read as follows:
(a) A person commits an offense if the person delivers or
offers to deliver a dangerous drug:
(1) unless:
(A) the dangerous drug is delivered or offered
for delivery by a pharmacist under:
(i) a prescription issued by a practitioner
described by Section 483.001(12)(A), [or] (B), or (E);
(ii) a prescription signed by an advanced
practice [a] registered nurse or physician assistant in accordance
with Subchapter B, Chapter 157, Occupations Code; or
(iii) an original written prescription
issued by a practitioner described by Section 483.001(12)(C); and
(B) a label is attached to the immediate
container in which the drug is delivered or offered to be delivered
and the label contains the following information:
(i) the name and address of the pharmacy
from which the drug is delivered or offered for delivery;
(ii) the date the prescription for the drug
is dispensed;
(iii) the number of the prescription as
filed in the prescription files of the pharmacy from which the
prescription is dispensed;
(iv) the name of the practitioner who
prescribed the drug and, if applicable, the name of the advanced
practice registered nurse or physician assistant who signed the
prescription;
(v) the name of the patient and, if the drug
is prescribed for an animal, a statement of the species of the
animal; and
(vi) directions for the use of the drug as
contained in the prescription; or
(2) unless:
(A) the dangerous drug is delivered or offered
for delivery by:
(i) a practitioner in the course of
practice; or
(ii) an advanced practice [a] registered
nurse or physician assistant in the course of practice in
accordance with Subchapter B, Chapter 157, Occupations Code; and
(B) a label is attached to the immediate
container in which the drug is delivered or offered to be delivered
and the label contains the following information:
(i) the name and address of the
practitioner who prescribed the drug, and if applicable, the name
and address of the advanced practice registered nurse or physician
assistant;
(ii) the date the drug is delivered;
(iii) the name of the patient and, if the
drug is prescribed for an animal, a statement of the species of the
animal; and
(iv) the name of the drug, the strength of
the drug, and directions for the use of the drug.
SECTION 4.017. Section 773.0145(k), Health and Safety Code,
is amended to read as follows:
(k) A physician, a [or] person who has been delegated
prescriptive authority under Chapter 157, Occupations Code, or an
advanced practice registered nurse authorized to prescribe and
order drugs and devices under Section 301.358, Occupations Code,
may prescribe epinephrine auto-injectors in the name of an entity.
SECTION 4.018. Section 32.024(gg), Human Resources Code, is
amended to read as follows:
(gg) Notwithstanding any other law, including Sections
843.312 and 1301.052, Insurance Code, the commission shall ensure
that advanced practice registered nurses and physician assistants
may be selected by and assigned to recipients of medical assistance
as the primary care providers of those recipients regardless of
whether, if applicable, the physician supervising the advanced
practice registered nurse is included in any directory of providers
of medical assistance maintained by the commission. This
subsection may not be construed as authorizing the commission to
supervise or control the practice of medicine as prohibited by
Subtitle B, Title 3, Occupations Code. The commission must require
that advanced practice registered nurses and physician assistants
be treated in the same manner as primary care physicians with regard
to:
(1) selection and assignment as primary care
providers; and
(2) inclusion as primary care providers in any
directory of providers of medical assistance maintained by the
commission.
SECTION 4.019. Section 32.03141, Human Resources Code, is
amended to read as follows:
Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
addition to other health care practitioners authorized by federal
law, the following persons may order and prescribe durable medical
equipment and supplies under the medical assistance program:
(1) an advanced practice registered nurse authorized
to prescribe and order drugs and devices under Section 301.358,
Occupations Code; and
(2) an advanced practice registered nurse or physician
assistant acting under adequate physician supervision and to whom a
physician has delegated the authority to prescribe and order drugs
and devices under Chapter 157, Occupations Code[, may order and
prescribe durable medical equipment and supplies under the medical
assistance program].
SECTION 4.020. Section 42.067(b), Human Resources Code, is
amended to read as follows:
(b) A physician, [or] a person who has been delegated
prescriptive authority under Chapter 157, Occupations Code, or an
advanced practice registered nurse authorized to prescribe and
order drugs and devices under Section 301.358, Occupations Code,
may prescribe epinephrine auto-injectors in the name of a day-care
center.
SECTION 4.021. Section 843.312, Insurance Code, is amended
to read as follows:
Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
REGISTERED NURSES. (a) A health maintenance organization may not
refuse a request by a physician participating in the health
maintenance organization delivery network and a physician
assistant or advanced practice registered nurse who is authorized
by the physician to provide care under Subchapter B, Chapter 157,
Occupations Code, or an advanced practice registered nurse
authorized to prescribe and order drugs and devices under Section
301.358, Occupations Code, to identify a physician assistant or
advanced practice registered nurse as a provider in the network.
(b) A health maintenance organization may refuse a request
under Subsection (a) if the physician assistant or advanced
practice registered nurse does not meet the quality of care
standards previously established by the health maintenance
organization for participation in the network by physician
assistants and advanced practice registered nurses.
SECTION 4.022. Section 1301.001(1-a), Insurance Code, is
amended to read as follows:
(1-a) "Health care provider" means a practitioner,
institutional provider, or other person or organization that
furnishes health care services and that is licensed or otherwise
authorized to practice in this state. The term includes a
pharmacist, [and] a pharmacy, and an advanced practice registered
nurse authorized to practice under Section 301.357, Occupations
Code. The term does not include a physician.
SECTION 4.023. Section 1452.051(1), Insurance Code, is
amended to read as follows:
(1) "Advanced practice nurse" has the meaning assigned
to "advanced practice registered nurse" by Section 301.002
[301.152], Occupations Code.
SECTION 4.024. Section 408.025, Labor Code, is amended by
amending Subsection (a-1) and adding Subsection (a-2) to read as
follows:
(a-1) A [treating doctor may delegate to a physician
assistant who is licensed to practice in this state under Chapter
204, Occupations Code, or an advanced practice registered nurse who
is licensed to practice in this state under Chapter 301,
Occupations Code, the authority to complete and sign a] work status
report regarding an injured employee's ability to return to work
may be completed and signed by:
(1) a physician assistant licensed to practice in this
state under Chapter 204, Occupations Code, who has been delegated
the authority by a treating doctor;
(2) an advanced practice registered nurse licensed to
practice in this state under Chapter 301, Occupations Code, who has
been delegated the authority by a treating doctor; or
(3) an advanced practice registered nurse authorized
to practice under Section 301.357, Occupations Code.
(a-2) The delegating treating doctor is responsible for the
acts of a [the] physician assistant [or advanced practice
registered nurse] under Subsection (a-1)(1) or an advanced practice
registered nurse under Subsection (a-1)(2) [this subsection].
SECTION 4.025. Section 157.051(1), Occupations Code, is
amended to read as follows:
(1) "Advanced practice registered nurse" has the
meaning assigned [to that term] by Section 301.002 [301.152]. [The
term includes an advanced nurse practitioner and advanced practice
nurse.]
SECTION 4.026. Section 203.002(2), Occupations Code, is
amended to read as follows:
(2) "Certified nurse-midwife" means an advanced
practice [a person who is:
[(A) a] registered nurse [under Chapter 301;
[(B) recognized as an advanced nurse
practitioner by the Texas Board of Nursing; and
[(C)] certified by the American College of
Nurse-Midwives.
SECTION 4.027. Sections 551.003(14) and (34), Occupations
Code, are amended to read as follows:
(14) "Designated agent" means:
(A) an individual, including a licensed nurse,
physician assistant, or pharmacist:
(i) who is designated by a practitioner and
authorized to communicate a prescription drug order to a
pharmacist; and
(ii) for whom the practitioner assumes
legal responsibility;
(B) a licensed nurse, physician assistant, or
pharmacist employed in a health care facility to whom a
practitioner communicates a prescription drug order; or
(C) an advanced practice [a] registered nurse or
physician assistant authorized by a practitioner to administer a
prescription drug order for a dangerous drug under Subchapter B,
Chapter 157.
(34) "Practitioner" means:
(A) a person licensed 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, advanced practice registered nurse
authorized to prescribe and order drugs and devices under Section
301.358, 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 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,
advanced practice registered nurse, 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 4.028. Section 563.051(e), Occupations Code, is
amended to read as follows:
(e) A practitioner may designate a licensed vocational
nurse or a person having education equivalent to or greater than
that required for a licensed vocational nurse to communicate the
prescriptions of an advanced practice registered nurse or physician
assistant authorized by the practitioner to sign prescription drug
orders under Subchapter B, Chapter 157, or of an advanced practice
registered nurse authorized to prescribe and order drugs and
devices under Section 301.358.
SECTION 4.029. Section 563.053, Occupations Code, is
amended to read as follows:
Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
RURAL AREAS. (a) In this section:
(1) "Advanced practice registered nurse" has the
meaning assigned by Section 301.002.
(2) "Reimbursement [, "reimbursement] for cost" means
an additional charge, separate from that imposed for the
physician's or advanced practice registered nurse's professional
services, that includes the cost of the drug product and all other
actual costs to the physician or advanced practice registered nurse
incidental to providing the dispensing service. The term does not
include a separate fee imposed for the act of dispensing the drug
itself.
(a-1) This section applies to an advanced practice
registered nurse only to the extent that the advanced practice
registered nurse is authorized to prescribe and order drugs and
devices under Section 301.358.
(b) This section applies to an area located in a county with
a population of 5,000 or less, or in a municipality or an
unincorporated town with a population of less than 2,500, that is
within a 15-mile radius of the physician's or advanced practice
registered nurse's office and in which a pharmacy is not located.
This section does not apply to a municipality or an unincorporated
town that is adjacent to a municipality with a population of 2,500
or more.
(c) A physician who practices medicine or advanced practice
registered nurse who practices advanced practice registered
nursing in an area described by Subsection (b) may:
(1) maintain a supply of dangerous drugs in the
physician's or advanced practice registered nurse's office to be
dispensed in the course of treating the physician's or advanced
practice registered nurse's patients; and
(2) be reimbursed for the cost of supplying those
drugs without obtaining a license under Chapter 558.
(d) A physician or advanced practice registered nurse who
dispenses dangerous drugs under Subsection (c) shall:
(1) comply with each labeling provision under this
subtitle applicable to that class of drugs; and
(2) oversee compliance with packaging and
recordkeeping provisions applicable to that class of drugs.
(e) A physician who desires to dispense dangerous drugs
under this section shall notify both the board and the Texas Medical
[State] Board [of Medical Examiners] that the physician practices
in an area described by Subsection (b). An advanced practice
registered nurse who desires to dispense dangerous drugs under this
section shall notify both the board and the Texas Board of Nursing
that the advanced practice registered nurse practices in an area
described by Subsection (b). The physician or advanced practice
registered nurse may continue to dispense dangerous drugs in the
area until the board determines, after notice and hearing, that the
physician or advanced practice registered nurse no longer practices
in an area described by Subsection (b).
SECTION 4.030. Sections 605.002(14) and (18), Occupations
Code, are amended to read as follows:
(14) "Orthotics" means the science and practice of
measuring, designing, fabricating, assembling, fitting, adjusting,
or servicing an orthosis under an order from a licensed physician,
chiropractor, [or] podiatrist, or advanced practice registered
nurse authorized to prescribe and order drugs and devices under
Section 301.358, or an advanced practice registered nurse or
physician assistant acting under the delegation and supervision of
a licensed physician as provided by Subchapter B, Chapter 157, and
rules adopted by the Texas Medical Board, for the correction or
alleviation of a neuromuscular or musculoskeletal dysfunction,
disease, injury, or deformity.
(18) "Prosthetics" means the science and practice of
measuring, designing, fabricating, assembling, fitting, adjusting,
or servicing a prosthesis under an order from a licensed physician,
chiropractor, [or] podiatrist, or advanced practice registered
nurse authorized to prescribe and order drugs and devices under
Section 301.358, or an advanced practice registered nurse or
physician assistant acting under the delegation and supervision of
a licensed physician as provided by Subchapter B, Chapter 157, and
rules adopted by the Texas Medical Board.
SECTION 4.031. Section 605.2515, Occupations Code, is
amended to read as follows:
Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
person licensed to practice orthotics or prosthetics who measures,
designs, fabricates, fits, assembles, adjusts, or services an
orthosis or a prosthesis under an order from a licensed physician,
chiropractor, [or] podiatrist, or advanced practice registered
nurse authorized to prescribe and order drugs and devices under
Section 301.358, or an advanced practice registered nurse or
physician assistant acting under the delegation and supervision of
a licensed physician as provided by Subchapter B, Chapter 157, and
rules adopted by the Texas Medical Board, for a specific patient is
exempt from licensing as a device manufacturer under Subchapter L,
Chapter 431, Health and Safety Code. A person licensed to practice
orthotics or prosthetics who fabricates or assembles an orthosis or
a prosthesis without an order from a licensed physician,
chiropractor, [or] podiatrist, or advanced practice registered
nurse authorized to prescribe and order drugs and devices under
Section 301.358, or an advanced practice registered nurse or
physician assistant acting under the delegation and supervision of
a licensed physician as provided by Subchapter B, Chapter 157, and
rules adopted by the Texas Medical Board, for a specific patient is
required to be licensed as a device manufacturer under Subchapter
L, Chapter 431, Health and Safety Code.
SECTION 4.032. Section 1701.703(a), Occupations Code, is
amended to read as follows:
(a) A physician, [or] a person who has been delegated
prescriptive authority under Chapter 157, or an advanced practice
registered nurse authorized to prescribe and order drugs and
devices under Section 301.358, [Occupations Code,] may prescribe
epinephrine auto-injectors in the name of a law enforcement agency.
ARTICLE 5. LEGISLATION IMPACT STUDY
SECTION 5.001. (a) The Texas Board of Nursing shall conduct
a study of the effect this Act has had on:
(1) access to primary health care in counties with a
population of less than 68,750 as compared to counties with a
population of 68,750 or greater;
(2) patient outcomes in counties with a population of
less than 68,750;
(3) trends in the practice location of advanced
practice registered nurses; and
(4) costs incurred by rural hospitals.
(b) Not later than September 1, 2028, the Texas Board of
Nursing shall submit to the governor, the lieutenant governor, and
the speaker of the house of representatives:
(1) the study conducted under Subsection (a) of this
section;
(2) the information published by:
(A) the Texas Medical Board under Section
157.152(b), Occupations Code, as added by this Act; and
(B) the Texas Board of Nursing under Section
301.359(c), Occupations Code, as added by this Act; and
(3) recommendations to the legislature to improve
rural access to health care and patient outcomes.
SECTION 5.002. This article expires December 31, 2029.
ARTICLE 6. TRANSITION AND EFFECTIVE DATE
SECTION 6.001. Not later than February 1, 2026, the Texas
Board of Nursing shall adopt the rules necessary to implement the
changes in law made by this Act.
SECTION 6.002. This Act takes effect September 1, 2025.