Texas 2025 - 89th Regular

Texas Senate Bill SB3055 Compare Versions

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1	1	89R21662 BEE-D
2	2	By: Middleton, Blanco S.B. No. 3055
3	3
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5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the licensing and regulation of advanced practice
10	10	registered nurses and the number of advanced practice registered
11	11	nurses and physician assistants with whom a physician may enter
12	12	into a prescriptive authority agreement.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	ARTICLE 1. SHORT TITLE
15	15	SECTION 1.001. This Act may be cited as the Healthcare
16	16	Expanded and Accessed Locally for Texans (HEAL Texans) Act.
17	17	ARTICLE 2. REGULATION OF ADVANCED PRACTICE REGISTERED NURSES
18	18	SECTION 2.001. Section 301.002, Occupations Code, is
19	19	amended to read as follows:
20	20	Sec. 301.002. DEFINITIONS. In this chapter:
21	21	(1) "Advanced practice registered nurse" means a
22	22	registered nurse licensed by the board to practice as an advanced
23	23	practice registered nurse on the basis of completion of an advanced
24	24	educational program.
25	25	(2) [(1)] "Board" means the Texas Board of Nursing.
26	26	(3) [(1-a)] "Chief nursing officer" means the
27	27	registered nurse who is administratively responsible for the
28	28	nursing services at a facility.
29	29	(4) "Controlled substance" has the meaning assigned by
30	30	Section 481.002, Health and Safety Code.
31	31	(5) "Dangerous drug" has the meaning assigned by
32	32	Section 483.001, Health and Safety Code.
33	33	(6) "Device" has the meaning assigned by Section
34	34	551.003, and includes durable medical equipment.
35	35	(7) "Nonprescription drug" has the meaning assigned by
36	36	Section 551.003.
37	37	(8) "Nurse" means a person required to be licensed
38	38	under this chapter to engage in professional or vocational nursing.
39	39	(9) "Nursing" means professional or vocational
40	40	nursing.
41	41	(10) [(1-b)] "Patient safety committee" has the
42	42	meaning assigned by Section 303.001.
43	43	(11) "Prescribe or order a drug or device" has the
44	44	meaning assigned by Section 157.051.
45	45	(12) [(2)] "Professional nursing" means the
46	46	performance of an act that requires substantial specialized
47	47	judgment and skill, the proper performance of which is based on
48	48	knowledge and application of the principles of biological,
49	49	physical, and social science as acquired by a completed course in an
50	50	approved school of professional nursing. The term does not include
51	51	acts of medical diagnosis or the prescription of therapeutic or
52	52	corrective measures, except as performed by an advanced practice
53	53	registered nurse authorized to practice by the board under Section
54	54	301.357. Professional nursing involves:
55	55	(A) the observation, assessment, intervention,
56	56	evaluation, rehabilitation, care and counsel, or health teachings
57	57	of a person who is ill, injured, infirm, or experiencing a change in
58	58	normal health processes;
59	59	(B) the maintenance of health or prevention of
60	60	illness;
61	61	(C) the administration of a medication or
62	62	treatment as ordered by a health care practitioner legally
63	63	authorized to prescribe the medication or treatment [physician,
64	64	podiatrist, or dentist];
65	65	(D) the supervision or teaching of nursing;
66	66	(E) the administration, supervision, and
67	67	evaluation of nursing practices, policies, and procedures;
68	68	(F) the requesting, receiving, signing for, and
69	69	distribution of prescription drug samples to patients at practices
70	70	at which an advanced practice registered nurse is authorized to
71	71	sign prescription drug orders as provided by Subchapter B, Chapter
72	72	157;
73	73	(G) the performance by an advanced practice
74	74	registered nurse of an act delegated by a physician under Section
75	75	157.0512, 157.054, 157.058, or 157.059; [and]
76	76	(H) the development of the nursing care plan; and
77	77	(I) the performance of an act by an advanced
78	78	practice registered nurse authorized to practice by the board under
79	79	Section 301.357.
80	80	[(3) "Nurse" means a person required to be licensed
81	81	under this chapter to engage in professional or vocational nursing.
82	82	[(4) "Nursing" means professional or vocational
83	83	nursing.]
84	84	(13) [(5)] "Vocational nursing" means a directed
85	85	scope of nursing practice, including the performance of an act that
86	86	requires specialized judgment and skill, the proper performance of
87	87	which is based on knowledge and application of the principles of
88	88	biological, physical, and social science as acquired by a completed
89	89	course in an approved school of vocational nursing. The term does
90	90	not include acts of medical diagnosis or the prescription of
91	91	therapeutic or corrective measures. Vocational nursing involves:
92	92	(A) collecting data and performing focused
93	93	nursing assessments of the health status of an individual;
94	94	(B) participating in the planning of the nursing
95	95	care needs of an individual;
96	96	(C) participating in the development and
97	97	modification of the nursing care plan;
98	98	(D) participating in health teaching and
99	99	counseling to promote, attain, and maintain the optimum health
100	100	level of an individual;
101	101	(E) assisting in the evaluation of an
102	102	individual's response to a nursing intervention and the
103	103	identification of an individual's needs; and
104	104	(F) engaging in other acts that require education
105	105	and training, as prescribed by board rules and policies,
106	106	commensurate with the nurse's experience, continuing education,
107	107	and demonstrated competency.
108	108	SECTION 2.002. Section 301.005(b), Occupations Code, is
109	109	amended to read as follows:
110	110	(b) A reference in any other law to an "advanced nurse
111	111	practitioner," [practitioner" or] "advanced practice nurse," or
112	112	"advanced practice registered nurse" means an advanced practice
113	113	registered nurse.
114	114	SECTION 2.003. Sections 301.152(a) and (b), Occupations
115	115	Code, are amended to read as follows:
116	116	(a) [In this section, "advanced practice registered nurse"
117	117	means a registered nurse licensed by the board to practice as an
118	118	advanced practice registered nurse on the basis of completion of an
119	119	advanced educational program.] The term "advanced practice
120	120	registered nurse" includes a nurse practitioner, nurse midwife,
121	121	nurse anesthetist, and clinical nurse specialist. [The term is
122	122	synonymous with "advanced nurse practitioner" and "advanced
123	123	practice nurse."]
124	124	(b) The board shall adopt rules to:
125	125	(1) license a registered nurse as an advanced practice
126	126	registered nurse;
127	127	(2) establish:
128	128	(A) any specialized education or training,
129	129	including pharmacology, that an advanced practice registered nurse
130	130	must have to prescribe or order a drug or device as delegated by a
131	131	physician under Section 157.0512 or 157.054 or authorized by the
132	132	board under Section 301.358;
133	133	(B) a system for approving an advanced practice
134	134	registered nurse to prescribe or order a drug or device as delegated
135	135	by a physician under Section 157.0512 or 157.054 or authorized by
136	136	the board under Section 301.358 on the receipt of evidence of
137	137	completing the specialized education and training requirement
138	138	under Paragraph (A); and
139	139	(C) a system for issuing a prescription
140	140	authorization number to an advanced practice registered nurse
141	141	approved under Paragraph (B); and
142	142	(3) concurrently renew any license or approval granted
143	143	to an advanced practice registered nurse under this subsection and
144	144	a license renewed by the advanced practice registered nurse under
145	145	Section 301.301.
146	146	SECTION 2.004. Section 301.303(b), Occupations Code, is
147	147	amended to read as follows:
148	148	(b) Except as provided by a rule adopted under Section
149	149	301.357(h) for an advanced practice registered nurse authorized by
150	150	the board to practice under that section, the [The] board may not
151	151	require participation in more than a total of 20 hours of continuing
152	152	education in a two-year licensing period.
153	153	SECTION 2.005. Subchapter H, Chapter 301, Occupations Code,
154	154	is amended by adding Sections 301.357, 301.358, and 301.359 to read
155	155	as follows:
156	156	Sec. 301.357. INDEPENDENT PRACTICE BY CERTAIN ADVANCED
157	157	PRACTICE REGISTERED NURSES. (a) The board shall authorize the
158	158	practice under this section of an advanced practice registered
159	159	nurse who applies for authorization under this section in the
160	160	manner prescribed by the board and who:
161	161	(1) is a nurse practitioner, nurse midwife, or
162	162	clinical nurse specialist; and
163	163	(2) either:
164	164	(A) has held an active unencumbered license as an
165	165	advanced practice registered nurse in any state for at least 10
166	166	years or 20,000 hours, as determined by the board; or
167	167	(B) has:
168	168	(i) graduated from a program of nursing
169	169	education that has a physical presence in this state and has a
170	170	requirement of in-person clinical experience; and
171	171	(ii) practiced as an advanced practice
172	172	registered nurse under a prescriptive authority agreement with a
173	173	physician for at least four years or 8,000 hours, as determined by
174	174	the board.
175	175	(b) To be eligible for authorization to practice under this
176	176	section, an applicant described by Subsection (a) must:
177	177	(1) hold an active, unencumbered license to practice
178	178	as an advanced practice registered nurse in this state;
179	179	(2) hold a current national certification in the role
180	180	and population focus of the advanced practice registered nurse;
181	181	(3) have a bachelor's degree in nursing and a master's
182	182	or doctoral degree in nursing from a nationally accredited
183	183	educational program;
184	184	(4) have completed academic coursework in physical
185	185	assessment, advanced pharmacology, and advanced pathophysiology;
186	186	and
187	187	(5) not be the subject of any pending disciplinary
188	188	action or substantially equivalent action.
189	189	(c) The scope of practice of an advanced practice registered
190	190	nurse authorized to practice under this section includes:
191	191	(1) ordering, performing, and interpreting diagnostic
192	192	tests;
193	193	(2) formulating primary and differential medical
194	194	diagnoses and advanced assessments;
195	195	(3) treating actual and potential health problems;
196	196	(4) prescribing therapeutic and corrective measures,
197	197	including nutrition and diagnostic support services, home health
198	198	care, hospice care, physical therapy, and occupational therapy, and
199	199	delegating and assigning the performance of therapeutic and
200	200	corrective measures to assistive personnel;
201	201	(5) to the extent authorized by the board under
202	202	Section 301.358, prescribing, ordering, procuring, administering,
203	203	and dispensing drugs and devices, including blood and blood
204	204	products, controlled substances listed in Schedules III, IV, and V,
205	205	dangerous drugs, and nonprescription drugs;
206	206	(6) providing referrals to health care agencies,
207	207	health care providers, and community resources;
208	208	(7) serving as a primary care provider of record; and
209	209	(8) performing other acts that require education and
210	210	training consistent with professional standards and that are
211	211	commensurate with the advanced practice registered nurse's
212	212	education, licensure, and demonstrated competencies and
213	213	experience.
214	214	(d) Subject to Subsection (e), an advanced practice
215	215	registered nurse authorized to practice under this section shall
216	216	practice as a licensed independent practitioner in accordance with
217	217	standards established and recognized by the board to protect the
218	218	public health and safety.
219	219	(e) An advanced practice registered nurse authorized to
220	220	practice under this section may practice as a licensed independent
221	221	practitioner only in a county with a population of less than 68,750.
222	222	(f) An advanced practice registered nurse authorized to
223	223	practice under this section is accountable to patients, the nursing
224	224	profession, and the board for:
225	225	(1) complying with the requirements of this chapter;
226	226	(2) providing quality advanced nursing care;
227	227	(3) recognizing the limits of the nurse's knowledge;
228	228	(4) planning for the management of situations beyond
229	229	the nurse's expertise; and
230	230	(5) consulting with or referring patients to other
231	231	health care providers as appropriate.
232	232	(g) This section does not limit or modify the scope of
233	233	practice of a nurse who is not authorized to practice under this
234	234	section.
235	235	(h) The board by rule shall establish:
236	236	(1) the application process for authorization to
237	237	practice under this section;
238	238	(2) a requirement that an advanced practice registered
239	239	nurse authorized to practice under this section complete at least
240	240	48 hours of continuing education, including 10 hours of continuing
241	241	education in pharmacology, every two years; and
242	242	(3) systems to:
243	243	(A) authorize an advanced practice registered
244	244	nurse to prescribe or order a drug or device under Section 301.358
245	245	when the board receives evidence of the completion of any education
246	246	or training required by board rule; and
247	247	(B) concurrently renew for an advanced practice
248	248	registered nurse:
249	249	(i) an authorization issued under this
250	250	section or Section 301.358; and
251	251	(ii) a license issued under rules adopted
252	252	under Section 301.152 or renewed under Section 301.301.
253	253	Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
254	254	ADVANCED PRACTICE REGISTERED NURSE. The board may authorize an
255	255	advanced practice registered nurse authorized to practice by the
256	256	board under Section 301.357 to prescribe and order drugs and
257	257	devices, including controlled substances listed in Schedules III,
258	258	IV, and V, dangerous drugs, and nonprescription drugs.
259	259	Sec. 301.359. REPORT TO BOARD. (a) An advanced practice
260	260	registered nurse authorized to practice by the board under Section
261	261	301.357 shall, not later than January 15 of each year, submit to the
262	262	board a report that includes for the preceding calendar year:
263	263	(1) the location of each setting in which the advanced
264	264	practice registered nurse practiced as an independent
265	265	practitioner, including the county in which the setting is located;
266	266	(2) the number of patients to whom the advanced
267	267	practice registered nurse practiced as an independent
268	268	practitioner; and
269	269	(3) the number of instances in which the advanced
270	270	practice registered nurse:
271	271	(A) referred the patient to a physician for the
272	272	prescription of a controlled substance listed in Schedule II; or
273	273	(B) prescribed a controlled substance listed in
274	274	Schedule II to a patient under a prescriptive authority agreement
275	275	with a physician.
276	276	(b) An advanced practice registered nurse authorized to
277	277	practice by the board under Section 301.357 shall notify the board
278	278	if the advanced practice registered nurse practices as an
279	279	independent practitioner at a location other than the practice
280	280	setting identified in the report submitted to the board under
281	281	Subsection (a) for the previous calendar year.
282	282	(c) The board shall annually aggregate, anonymize, and
283	283	publish on the board's Internet website the information submitted
284	284	by each advanced practice registered nurse under Subsection (a).
285	285	ARTICLE 3. DELEGATION AND PRESCRIPTIVE AUTHORITY AGREEMENTS
286	286	SECTION 3.001. Section 157.0512(c), Occupations Code, is
287	287	amended to read as follows:
288	288	(c) Except as provided by Subsection (d), the combined
289	289	number of advanced practice registered nurses and physician
290	290	assistants with whom a physician may enter into a prescriptive
291	291	authority agreement may not exceed nine [seven] advanced practice
292	292	registered nurses and physician assistants or the full-time
293	293	equivalent of seven advanced practice registered nurses and
294	294	physician assistants.
295	295	SECTION 3.002. Chapter 157, Occupations Code, is amended by
296	296	adding Subchapter D to read as follows:
297	297	SUBCHAPTER D. DELEGATION AGREEMENTS WITH
298	298	ADVANCED PRACTICE REGISTERED NURSES
299	299	Sec. 157.151. NONDISCLOSURE AGREEMENTS. A delegation
300	300	agreement, including a prescriptive authority agreement, between a
301	301	physician and an advanced practice registered nurse may not include
302	302	or be the subject of a nondisclosure agreement.
303	303	Sec. 157.152. REPORTING BY PHYSICIAN; REPORT TO BOARD. (a)
304	304	A physician who enters into a delegation agreement with an advanced
305	305	practice registered nurse, including a prescriptive authority
306	306	agreement under Section 157.0512, shall, not later than January 15
307	307	of each year, submit to the board a report that includes for the
308	308	preceding calendar year:
309	309	(1) the amount of any fee the physician charges the
310	310	advanced practice registered nurse to enter into the agreement;
311	311	(2) any restriction or limitation the physician places
312	312	on the advanced practice registered nurse's practice under the
313	313	agreement;
314	314	(3) any instance in which the physician changes the
315	315	diagnosis or course of treatment of a patient of the advanced
316	316	practice registered nurse; and
317	317	(4) the number of case files the physician reviews
318	318	each month.
319	319	(b) The board shall annually aggregate, anonymize, and
320	320	publish on the board's Internet website the information submitted
321	321	by each physician under Subsection (a).
322	322	Sec. 157.153. COMPLAINT REGARDING ADVANCED PRACTICE
323	323	REGISTERED NURSE UNDER DELEGATION AGREEMENT. (a) The board shall
324	324	disaggregate from information the board maintains regarding
325	325	complaints against a physician any information regarding a
326	326	complaint against an advanced practice registered nurse practicing
327	327	under a delegation agreement with the physician.
328	328	(b) The board shall separately maintain information
329	329	regarding complaints against an advanced practice registered nurse
330	330	practicing under a delegation agreement with the physician. The
331	331	information maintained under this subsection must include:
332	332	(1) the specialization of the advanced practice
333	333	registered nurse who is the subject of the complaint; and
334	334	(2) the disposition of the complaint, including any
335	335	disciplinary action taken.
336	336	ARTICLE 4. CONFORMING AMENDMENTS
337	337	SECTION 4.001. Section 38.151(1), Education Code, is
338	338	amended to read as follows:
339	339	(1) "Advanced practice nurse" has the meaning assigned
340	340	to "advanced practice registered nurse" by Section 301.002
341	341	[301.152], Occupations Code.
342	342	SECTION 4.002. Section 38.211(a), Education Code, is
343	343	amended to read as follows:
344	344	(a) A physician, a [or] person who has been delegated
345	345	prescriptive authority under Chapter 157, Occupations Code, or an
346	346	advanced practice registered nurse authorized to prescribe and
347	347	order drugs and devices under Section 301.358, Occupations Code,
348	348	may prescribe epinephrine auto-injectors or medication for
349	349	respiratory distress in the name of a school district,
350	350	open-enrollment charter school, or private school.
351	351	SECTION 4.003. Section 38.225(a), Education Code, is
352	352	amended to read as follows:
353	353	(a) A physician, a [or] person who has been delegated
354	354	prescriptive authority under Chapter 157, Occupations Code, or an
355	355	advanced practice registered nurse authorized to prescribe and
356	356	order drugs and devices under Section 301.358, Occupations Code,
357	357	may prescribe opioid antagonists in the name of a school district,
358	358	open-enrollment charter school, or private school.
359	359	SECTION 4.004. Section 61.601, Education Code, is amended
360	360	to read as follows:
361	361	Sec. 61.601. DEFINITION. In this subchapter, "mental
362	362	health professional" means:
363	363	(1) a licensed physician who is:
364	364	(A) a graduate of an accredited psychiatric
365	365	residency training program; or
366	366	(B) certified in psychiatry by:
367	367	(i) the American Board of Psychiatry and
368	368	Neurology; or
369	369	(ii) the American Osteopathic Board of
370	370	Neurology and Psychiatry;
371	371	(2) a psychologist, as defined by Section 501.002,
372	372	Occupations Code;
373	373	(3) a licensed professional counselor, as defined by
374	374	Section 503.002, Occupations Code;
375	375	(4) an advanced practice registered nurse, as defined
376	376	by Section 301.002 [301.152], Occupations Code, who holds a
377	377	nationally recognized board certification in psychiatric or mental
378	378	health nursing;
379	379	(5) a licensed clinical social worker, as defined by
380	380	Section 505.002, Occupations Code;
381	381	(6) a licensed specialist in school psychology, as
382	382	defined by Section 501.002, Occupations Code;
383	383	(7) a chemical dependency counselor, as defined by
384	384	Section 504.001, Occupations Code; and
385	385	(8) a licensed marriage and family therapist, as
386	386	defined by Section 502.002, Occupations Code.
387	387	SECTION 4.005. Section 1101.100(1), Estates Code, is
388	388	amended to read as follows:
389	389	(1) "Advanced practice registered nurse" has the
390	390	meaning assigned by Section 301.002 [301.152], Occupations Code.
391	391	SECTION 4.006. Section 671.001(b), Government Code, is
392	392	amended to read as follows:
393	393	(b) The pilot program must provide for the following:
394	394	(1) either:
395	395	(A) both:
396	396	(i) a licensed advanced practice registered
397	397	nurse as defined by Section 301.002 [301.152], Occupations Code, or
398	398	a licensed physician assistant as described by Chapter 204,
399	399	Occupations Code, who is employed by the state or whose services are
400	400	acquired by contract, who will be located at a state office complex;
401	401	and
402	402	(ii) [(2)] a licensed physician, who is
403	403	employed by a state governmental entity for purposes other than the
404	404	pilot program or whose services are acquired by contract, who will
405	405	delegate to and supervise the advanced practice registered nurse or
406	406	physician assistant under a prescriptive authority agreement under
407	407	Chapter 157, Occupations Code; or
408	408	(B) an advanced practice registered nurse
409	409	authorized to practice under Section 301.357, Occupations Code;
410	410	(2) [(3)] appropriate office space and equipment for
411	411	the advanced practice registered nurse or physician assistant to
412	412	provide basic medical care to employees at the state office complex
413	413	where the nurse or physician assistant is located; and
414	414	(3) [(4)] professional liability insurance covering
415	415	services provided by the advanced practice registered nurse or the
416	416	physician assistant.
417	417	SECTION 4.007. Section 47.011(a), Health and Safety Code,
418	418	is amended to read as follows:
419	419	(a) In this section, "midwife" has the meaning assigned by
420	420	Section 203.002, Occupations Code, and includes a nurse midwife
421	421	[described by Section 301.152, Occupations Code].
422	422	SECTION 4.008. Sections 161.0052(b) and (c), Health and
423	423	Safety Code, are amended to read as follows:
424	424	(b) The executive commissioner by rule shall require a
425	425	hospital to inform each elderly person admitted to the hospital for
426	426	a period of 24 hours or more that the pneumococcal and influenza
427	427	vaccines are available. If the elderly person requests a vaccine,
428	428	and if a physician, or an advanced practice registered nurse
429	429	[practitioner] or physician assistant on behalf of a physician, or
430	430	an advanced practice registered nurse authorized to prescribe and
431	431	order drugs and devices under Section 301.358, Occupations Code,
432	432	determines that the vaccine is in the person's best interest, the
433	433	hospital must make the vaccination available to the person before
434	434	the person is discharged from the hospital.
435	435	(c) The executive commissioner by rule shall require an end
436	436	stage renal disease facility to offer, to the extent possible as
437	437	determined by the facility, the opportunity to receive the
438	438	pneumococcal and influenza vaccines to each elderly person who
439	439	receives ongoing care at the facility if a physician, or an advanced
440	440	practice registered nurse [practitioner] or physician assistant on
441	441	behalf of a physician, or an advanced practice registered nurse
442	442	authorized to prescribe and order drugs and devices under Section
443	443	301.358, Occupations Code, determines that the vaccine is in the
444	444	person's best interest. If the facility decides it is not feasible
445	445	to offer the vaccine, the facility must provide the person with
446	446	information on other options for obtaining the vaccine.
447	447	SECTION 4.009. Section 401.504(d), Health and Safety Code,
448	448	is amended to read as follows:
449	449	(d) This subchapter does not apply to a physician, [or to] a
450	450	physician's employee or delegate acting under Chapter 157,
451	451	Occupations Code, or an advanced practice registered nurse
452	452	authorized to prescribe and order drugs and devices under Section
453	453	301.358, Occupations Code.
454	454	SECTION 4.010. Section 481.002(39), Health and Safety Code,
455	455	is amended to read as follows:
456	456	(39) "Practitioner" means:
457	457	(A) a physician, dentist, veterinarian,
458	458	podiatrist, scientific investigator, advanced practice registered
459	459	nurse authorized to prescribe and order drugs and devices under
460	460	Section 301.358, Occupations Code, or other person licensed,
461	461	registered, or otherwise permitted to distribute, dispense,
462	462	analyze, conduct research with respect to, or administer a
463	463	controlled substance in the course of professional practice or
464	464	research in this state;
465	465	(B) a pharmacy, hospital, or other institution
466	466	licensed, registered, or otherwise permitted to distribute,
467	467	dispense, 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	(C) a person practicing in and licensed by
471	471	another state as a physician, dentist, veterinarian, advanced
472	472	practice registered nurse, or podiatrist, having a current Federal
473	473	Drug Enforcement Administration registration number, who may
474	474	legally prescribe Schedule II, III, IV, or V controlled substances
475	475	in that state; or
476	476	(D) an advanced practice registered nurse or
477	477	physician assistant to whom a physician has delegated the authority
478	478	to prescribe or order a drug or device under Section 157.0511,
479	479	157.0512, or 157.054, Occupations Code.
480	480	SECTION 4.011. Section 481.074(d), Health and Safety Code,
481	481	is amended to read as follows:
482	482	(d) Except as specified in Subsections (e) and (f), the
483	483	board, by rule and in consultation with the Texas Medical Board and
484	484	the Texas Board of Nursing, shall establish the period after the
485	485	date on which the prescription is issued that a person may fill a
486	486	prescription for a controlled substance listed in Schedule II. A
487	487	person may not refill a prescription for a substance listed in
488	488	Schedule II.
489	489	SECTION 4.012. Section 481.076(c), Health and Safety Code,
490	490	is amended to read as follows:
491	491	(c) The board by rule shall design and implement a system
492	492	for submission of information to the board by electronic or other
493	493	means and for retrieval of information submitted to the board under
494	494	this section and Sections 481.074 and 481.075. The board shall use
495	495	automated information security techniques and devices to preclude
496	496	improper access to the information. The board shall submit the
497	497	system design to the director, [and] the Texas Medical Board, and
498	498	the Texas Board of Nursing for review and comment a reasonable time
499	499	before implementation of the system and shall comply with the
500	500	comments of those agencies unless it is unreasonable to do so.
501	501	SECTION 4.013. Section 481.0767(b), Health and Safety Code,
502	502	is amended to read as follows:
503	503	(b) The board shall appoint the following members to the
504	504	advisory committee:
505	505	(1) a physician licensed in this state who practices
506	506	in pain management;
507	507	(2) a physician licensed in this state who practices
508	508	in family medicine;
509	509	(3) a physician licensed in this state who performs
510	510	surgery;
511	511	(4) a physician licensed in this state who practices
512	512	in emergency medicine at a hospital;
513	513	(5) a physician licensed in this state who practices
514	514	in psychiatry;
515	515	(6) an oral and maxillofacial surgeon;
516	516	(7) a physician assistant or advanced practice
517	517	registered nurse to whom a physician has delegated the authority to
518	518	prescribe or order a drug or an advanced practice registered nurse
519	519	authorized to prescribe and order drugs and devices under Section
520	520	301.358, Occupations Code;
521	521	(8) a pharmacist working at a chain pharmacy;
522	522	(9) a pharmacist working at an independent pharmacy;
523	523	(10) an academic pharmacist; and
524	524	(11) two representatives of the health information
525	525	technology industry, at least one of whom is a representative of a
526	526	company whose primary line of business is electronic medical
527	527	records.
528	528	SECTION 4.014. Sections 483.001(4), (12), and (13), Health
529	529	and Safety Code, are amended to read as follows:
530	530	(4) "Designated agent" means:
531	531	(A) a licensed nurse, physician assistant,
532	532	pharmacist, or other individual designated by a practitioner to
533	533	communicate prescription drug orders to a pharmacist;
534	534	(B) a licensed nurse, physician assistant, or
535	535	pharmacist employed in a health care facility to whom the
536	536	practitioner communicates a prescription drug order; or
537	537	(C) an advanced practice [a] registered nurse or
538	538	physician assistant authorized by a practitioner to carry out a
539	539	prescription drug order for dangerous drugs under Subchapter B,
540	540	Chapter 157, Occupations Code.
541	541	(12) "Practitioner" means:
542	542	(A) a person licensed by:
543	543	(i) the Texas Medical Board, State Board of
544	544	Dental Examiners, Texas Optometry Board, or State Board of
545	545	Veterinary Medical Examiners to prescribe and administer dangerous
546	546	drugs; or
547	547	(ii) the Texas Department of Licensing and
548	548	Regulation, with respect to podiatry, to prescribe and administer
549	549	dangerous drugs;
550	550	(B) a person licensed by another state in a
551	551	health field in which, under the laws of this state, a licensee may
552	552	legally prescribe dangerous drugs;
553	553	(C) a person licensed in Canada or Mexico in a
554	554	health field in which, under the laws of this state, a licensee may
555	555	legally prescribe dangerous drugs; [or]
556	556	(D) an advanced practice registered nurse or
557	557	physician assistant to whom a physician has delegated the authority
558	558	to prescribe or order a drug or device under Section 157.0511,
559	559	157.0512, or 157.054, Occupations Code; or
560	560	(E) an advanced practice registered nurse
561	561	authorized to prescribe and order drugs and devices under Section
562	562	301.358, Occupations Code.
563	563	(13) "Prescription" means an order from a
564	564	practitioner, or an agent of the practitioner designated in writing
565	565	as authorized to communicate prescriptions, or an order made in
566	566	accordance with Subchapter B, Chapter 157, Occupations Code, or
567	567	Section 203.353, Occupations Code, to a pharmacist for a dangerous
568	568	drug to be dispensed that states:
569	569	(A) the date of the order's issue;
570	570	(B) the name and address of the patient;
571	571	(C) if the drug is prescribed for an animal, the
572	572	species of the animal;
573	573	(D) the name and quantity of the drug prescribed;
574	574	(E) the directions for the use of the drug;
575	575	(F) the intended use of the drug unless the
576	576	practitioner determines the furnishing of this information is not
577	577	in the best interest of the patient;
578	578	(G) the name, address, and telephone number of
579	579	the practitioner at the practitioner's usual place of business,
580	580	legibly printed or stamped; and
581	581	(H) the name, address, and telephone number of
582	582	the licensed midwife, advanced practice registered nurse, or
583	583	physician assistant, legibly printed or stamped, if signed by a
584	584	licensed midwife, advanced practice registered nurse, or physician
585	585	assistant.
586	586	SECTION 4.015. Section 483.022(f), Health and Safety Code,
587	587	is amended to read as follows:
588	588	(f) A practitioner may designate a person who is a licensed
589	589	vocational nurse or has an education equivalent to or greater than
590	590	that required for a licensed vocational nurse to communicate
591	591	prescriptions of an advanced practice registered nurse or physician
592	592	assistant authorized by the practitioner to sign prescription drug
593	593	orders under Subchapter B, Chapter 157, Occupations Code, or of an
594	594	advanced practice registered nurse authorized to prescribe and
595	595	order drugs and devices under Section 301.358, Occupations Code.
596	596	SECTION 4.016. Section 483.042(a), Health and Safety Code,
597	597	is amended to read as follows:
598	598	(a) A person commits an offense if the person delivers or
599	599	offers to deliver a dangerous drug:
600	600	(1) unless:
601	601	(A) the dangerous drug is delivered or offered
602	602	for delivery by a pharmacist under:
603	603	(i) a prescription issued by a practitioner
604	604	described by Section 483.001(12)(A), [or] (B), or (E);
605	605	(ii) a prescription signed by an advanced
606	606	practice [a] registered nurse or physician assistant in accordance
607	607	with Subchapter B, Chapter 157, Occupations Code; or
608	608	(iii) an original written prescription
609	609	issued by a practitioner described by Section 483.001(12)(C); and
610	610	(B) a label is attached to the immediate
611	611	container in which the drug is delivered or offered to be delivered
612	612	and the label contains the following information:
613	613	(i) the name and address of the pharmacy
614	614	from which the drug is delivered or offered for delivery;
615	615	(ii) the date the prescription for the drug
616	616	is dispensed;
617	617	(iii) the number of the prescription as
618	618	filed in the prescription files of the pharmacy from which the
619	619	prescription is dispensed;
620	620	(iv) the name of the practitioner who
621	621	prescribed the drug and, if applicable, the name of the advanced
622	622	practice registered nurse or physician assistant who signed the
623	623	prescription;
624	624	(v) the name of the patient and, if the drug
625	625	is prescribed for an animal, a statement of the species of the
626	626	animal; and
627	627	(vi) directions for the use of the drug as
628	628	contained in the prescription; or
629	629	(2) unless:
630	630	(A) the dangerous drug is delivered or offered
631	631	for delivery by:
632	632	(i) a practitioner in the course of
633	633	practice; or
634	634	(ii) an advanced practice [a] registered
635	635	nurse or physician assistant in the course of practice in
636	636	accordance with Subchapter B, Chapter 157, Occupations Code; and
637	637	(B) a label is attached to the immediate
638	638	container in which the drug is delivered or offered to be delivered
639	639	and the label contains the following information:
640	640	(i) the name and address of the
641	641	practitioner who prescribed the drug, and if applicable, the name
642	642	and address of the advanced practice registered nurse or physician
643	643	assistant;
644	644	(ii) the date the drug is delivered;
645	645	(iii) the name of the patient and, if the
646	646	drug is prescribed for an animal, a statement of the species of the
647	647	animal; and
648	648	(iv) the name of the drug, the strength of
649	649	the drug, and directions for the use of the drug.
650	650	SECTION 4.017. Section 773.0145(k), Health and Safety Code,
651	651	is amended to read as follows:
652	652	(k) A physician, a [or] person who has been delegated
653	653	prescriptive authority under Chapter 157, Occupations Code, or an
654	654	advanced practice registered nurse authorized to prescribe and
655	655	order drugs and devices under Section 301.358, Occupations Code,
656	656	may prescribe epinephrine auto-injectors in the name of an entity.
657	657	SECTION 4.018. Section 32.024(gg), Human Resources Code, is
658	658	amended to read as follows:
659	659	(gg) Notwithstanding any other law, including Sections
660	660	843.312 and 1301.052, Insurance Code, the commission shall ensure
661	661	that advanced practice registered nurses and physician assistants
662	662	may be selected by and assigned to recipients of medical assistance
663	663	as the primary care providers of those recipients regardless of
664	664	whether, if applicable, the physician supervising the advanced
665	665	practice registered nurse is included in any directory of providers
666	666	of medical assistance maintained by the commission. This
667	667	subsection may not be construed as authorizing the commission to
668	668	supervise or control the practice of medicine as prohibited by
669	669	Subtitle B, Title 3, Occupations Code. The commission must require
670	670	that advanced practice registered nurses and physician assistants
671	671	be treated in the same manner as primary care physicians with regard
672	672	to:
673	673	(1) selection and assignment as primary care
674	674	providers; and
675	675	(2) inclusion as primary care providers in any
676	676	directory of providers of medical assistance maintained by the
677	677	commission.
678	678	SECTION 4.019. Section 32.03141, Human Resources Code, is
679	679	amended to read as follows:
680	680	Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED
681	681	NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
682	682	EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in
683	683	addition to other health care practitioners authorized by federal
684	684	law, the following persons may order and prescribe durable medical
685	685	equipment and supplies under the medical assistance program:
686	686	(1) an advanced practice registered nurse authorized
687	687	to prescribe and order drugs and devices under Section 301.358,
688	688	Occupations Code; and
689	689	(2) an advanced practice registered nurse or physician
690	690	assistant acting under adequate physician supervision and to whom a
691	691	physician has delegated the authority to prescribe and order drugs
692	692	and devices under Chapter 157, Occupations Code[, may order and
693	693	prescribe durable medical equipment and supplies under the medical
694	694	assistance program].
695	695	SECTION 4.020. Section 42.067(b), Human Resources Code, is
696	696	amended to read as follows:
697	697	(b) A physician, [or] a person who has been delegated
698	698	prescriptive authority under Chapter 157, Occupations Code, or an
699	699	advanced practice registered nurse authorized to prescribe and
700	700	order drugs and devices under Section 301.358, Occupations Code,
701	701	may prescribe epinephrine auto-injectors in the name of a day-care
702	702	center.
703	703	SECTION 4.021. Section 843.312, Insurance Code, is amended
704	704	to read as follows:
705	705	Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
706	706	REGISTERED NURSES. (a) A health maintenance organization may not
707	707	refuse a request by a physician participating in the health
708	708	maintenance organization delivery network and a physician
709	709	assistant or advanced practice registered nurse who is authorized
710	710	by the physician to provide care under Subchapter B, Chapter 157,
711	711	Occupations Code, or an advanced practice registered nurse
712	712	authorized to prescribe and order drugs and devices under Section
713	713	301.358, Occupations Code, to identify a physician assistant or
714	714	advanced practice registered nurse as a provider in the network.
715	715	(b) A health maintenance organization may refuse a request
716	716	under Subsection (a) if the physician assistant or advanced
717	717	practice registered nurse does not meet the quality of care
718	718	standards previously established by the health maintenance
719	719	organization for participation in the network by physician
720	720	assistants and advanced practice registered nurses.
721	721	SECTION 4.022. Section 1301.001(1-a), Insurance Code, is
722	722	amended to read as follows:
723	723	(1-a) "Health care provider" means a practitioner,
724	724	institutional provider, or other person or organization that
725	725	furnishes health care services and that is licensed or otherwise
726	726	authorized to practice in this state. The term includes a
727	727	pharmacist, [and] a pharmacy, and an advanced practice registered
728	728	nurse authorized to practice under Section 301.357, Occupations
729	729	Code. The term does not include a physician.
730	730	SECTION 4.023. Section 1452.051(1), Insurance Code, is
731	731	amended to read as follows:
732	732	(1) "Advanced practice nurse" has the meaning assigned
733	733	to "advanced practice registered nurse" by Section 301.002
734	734	[301.152], Occupations Code.
735	735	SECTION 4.024. Section 408.025, Labor Code, is amended by
736	736	amending Subsection (a-1) and adding Subsection (a-2) to read as
737	737	follows:
738	738	(a-1) A [treating doctor may delegate to a physician
739	739	assistant who is licensed to practice in this state under Chapter
740	740	204, Occupations Code, or an advanced practice registered nurse who
741	741	is licensed to practice in this state under Chapter 301,
742	742	Occupations Code, the authority to complete and sign a] work status
743	743	report regarding an injured employee's ability to return to work
744	744	may be completed and signed by:
745	745	(1) a physician assistant licensed to practice in this
746	746	state under Chapter 204, Occupations Code, who has been delegated
747	747	the authority by a treating doctor;
748	748	(2) an advanced practice registered nurse licensed to
749	749	practice in this state under Chapter 301, Occupations Code, who has
750	750	been delegated the authority by a treating doctor; or
751	751	(3) an advanced practice registered nurse authorized
752	752	to practice under Section 301.357, Occupations Code.
753	753	(a-2) The delegating treating doctor is responsible for the
754	754	acts of a [the] physician assistant [or advanced practice
755	755	registered nurse] under Subsection (a-1)(1) or an advanced practice
756	756	registered nurse under Subsection (a-1)(2) [this subsection].
757	757	SECTION 4.025. Section 157.051(1), Occupations Code, is
758	758	amended to read as follows:
759	759	(1) "Advanced practice registered nurse" has the
760	760	meaning assigned [to that term] by Section 301.002 [301.152]. [The
761	761	term includes an advanced nurse practitioner and advanced practice
762	762	nurse.]
763	763	SECTION 4.026. Section 203.002(2), Occupations Code, is
764	764	amended to read as follows:
765	765	(2) "Certified nurse-midwife" means an advanced
766	766	practice [a person who is:
767	767	[(A) a] registered nurse [under Chapter 301;
768	768	[(B) recognized as an advanced nurse
769	769	practitioner by the Texas Board of Nursing; and
770	770	[(C)] certified by the American College of
771	771	Nurse-Midwives.
772	772	SECTION 4.027. Sections 551.003(14) and (34), Occupations
773	773	Code, are amended to read as follows:
774	774	(14) "Designated agent" means:
775	775	(A) an individual, including a licensed nurse,
776	776	physician assistant, or pharmacist:
777	777	(i) who is designated by a practitioner and
778	778	authorized to communicate a prescription drug order to a
779	779	pharmacist; and
780	780	(ii) for whom the practitioner assumes
781	781	legal responsibility;
782	782	(B) a licensed nurse, physician assistant, or
783	783	pharmacist employed in a health care facility to whom a
784	784	practitioner communicates a prescription drug order; or
785	785	(C) an advanced practice [a] registered nurse or
786	786	physician assistant authorized by a practitioner to administer a
787	787	prescription drug order for a dangerous drug under Subchapter B,
788	788	Chapter 157.
789	789	(34) "Practitioner" means:
790	790	(A) a person licensed or registered to prescribe,
791	791	distribute, administer, or dispense a prescription drug or device
792	792	in the course of professional practice in this state, including a
793	793	physician, dentist, podiatrist, advanced practice registered nurse
794	794	authorized to prescribe and order drugs and devices under Section
795	795	301.358, or veterinarian but excluding a person licensed under this
796	796	subtitle;
797	797	(B) a person licensed by another state, Canada,
798	798	or the United Mexican States in a health field in which, under the
799	799	law of this state, a license holder in this state may legally
800	800	prescribe a dangerous drug;
801	801	(C) a person practicing in another state and
802	802	licensed by another state as a physician, dentist, veterinarian,
803	803	advanced practice registered nurse, or podiatrist, who has a
804	804	current federal Drug Enforcement Administration registration
805	805	number and who may legally prescribe a Schedule II, III, IV, or V
806	806	controlled substance, as specified under Chapter 481, Health and
807	807	Safety Code, in that other state; or
808	808	(D) an advanced practice registered nurse or
809	809	physician assistant to whom a physician has delegated the authority
810	810	to prescribe or order a drug or device under Section 157.0511,
811	811	157.0512, or 157.054.
812	812	SECTION 4.028. Section 563.051(e), Occupations Code, is
813	813	amended to read as follows:
814	814	(e) A practitioner may designate a licensed vocational
815	815	nurse or a person having education equivalent to or greater than
816	816	that required for a licensed vocational nurse to communicate the
817	817	prescriptions of an advanced practice registered nurse or physician
818	818	assistant authorized by the practitioner to sign prescription drug
819	819	orders under Subchapter B, Chapter 157, or of an advanced practice
820	820	registered nurse authorized to prescribe and order drugs and
821	821	devices under Section 301.358.
822	822	SECTION 4.029. Section 563.053, Occupations Code, is
823	823	amended to read as follows:
824	824	Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
825	825	RURAL AREAS. (a) In this section:
826	826	(1) "Advanced practice registered nurse" has the
827	827	meaning assigned by Section 301.002.
828	828	(2) "Reimbursement [, "reimbursement] for cost" means
829	829	an additional charge, separate from that imposed for the
830	830	physician's or advanced practice registered nurse's professional
831	831	services, that includes the cost of the drug product and all other
832	832	actual costs to the physician or advanced practice registered nurse
833	833	incidental to providing the dispensing service. The term does not
834	834	include a separate fee imposed for the act of dispensing the drug
835	835	itself.
836	836	(a-1) This section applies to an advanced practice
837	837	registered nurse only to the extent that the advanced practice
838	838	registered nurse is authorized to prescribe and order drugs and
839	839	devices under Section 301.358.
840	840	(b) This section applies to an area located in a county with
841	841	a population of 5,000 or less, or in a municipality or an
842	842	unincorporated town with a population of less than 2,500, that is
843	843	within a 15-mile radius of the physician's or advanced practice
844	844	registered nurse's office and in which a pharmacy is not located.
845	845	This section does not apply to a municipality or an unincorporated
846	846	town that is adjacent to a municipality with a population of 2,500
847	847	or more.
848	848	(c) A physician who practices medicine or advanced practice
849	849	registered nurse who practices advanced practice registered
850	850	nursing in an area described by Subsection (b) may:
851	851	(1) maintain a supply of dangerous drugs in the
852	852	physician's or advanced practice registered nurse's office to be
853	853	dispensed in the course of treating the physician's or advanced
854	854	practice registered nurse's patients; and
855	855	(2) be reimbursed for the cost of supplying those
856	856	drugs without obtaining a license under Chapter 558.
857	857	(d) A physician or advanced practice registered nurse who
858	858	dispenses dangerous drugs under Subsection (c) shall:
859	859	(1) comply with each labeling provision under this
860	860	subtitle applicable to that class of drugs; and
861	861	(2) oversee compliance with packaging and
862	862	recordkeeping provisions applicable to that class of drugs.
863	863	(e) A physician who desires to dispense dangerous drugs
864	864	under this section shall notify both the board and the Texas Medical
865	865	[State] Board [of Medical Examiners] that the physician practices
866	866	in an area described by Subsection (b). An advanced practice
867	867	registered nurse who desires to dispense dangerous drugs under this
868	868	section shall notify both the board and the Texas Board of Nursing
869	869	that the advanced practice registered nurse practices in an area
870	870	described by Subsection (b). The physician or advanced practice
871	871	registered nurse may continue to dispense dangerous drugs in the
872	872	area until the board determines, after notice and hearing, that the
873	873	physician or advanced practice registered nurse no longer practices
874	874	in an area described by Subsection (b).
875	875	SECTION 4.030. Sections 605.002(14) and (18), Occupations
876	876	Code, are amended to read as follows:
877	877	(14) "Orthotics" means the science and practice of
878	878	measuring, designing, fabricating, assembling, fitting, adjusting,
879	879	or servicing an orthosis under an order from a licensed physician,
880	880	chiropractor, [or] podiatrist, or advanced practice registered
881	881	nurse authorized to prescribe and order drugs and devices under
882	882	Section 301.358, or an advanced practice registered nurse or
883	883	physician assistant acting under the delegation and supervision of
884	884	a licensed physician as provided by Subchapter B, Chapter 157, and
885	885	rules adopted by the Texas Medical Board, for the correction or
886	886	alleviation of a neuromuscular or musculoskeletal dysfunction,
887	887	disease, injury, or deformity.
888	888	(18) "Prosthetics" means the science and practice of
889	889	measuring, designing, fabricating, assembling, fitting, adjusting,
890	890	or servicing a prosthesis under an order from a licensed physician,
891	891	chiropractor, [or] podiatrist, or advanced practice registered
892	892	nurse authorized to prescribe and order drugs and devices under
893	893	Section 301.358, or an advanced practice registered nurse or
894	894	physician assistant acting under the delegation and supervision of
895	895	a licensed physician as provided by Subchapter B, Chapter 157, and
896	896	rules adopted by the Texas Medical Board.
897	897	SECTION 4.031. Section 605.2515, Occupations Code, is
898	898	amended to read as follows:
899	899	Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
900	900	person licensed to practice orthotics or prosthetics who measures,
901	901	designs, fabricates, fits, assembles, adjusts, or services an
902	902	orthosis or a prosthesis under an order from a licensed physician,
903	903	chiropractor, [or] podiatrist, or advanced practice registered
904	904	nurse authorized to prescribe and order drugs and devices under
905	905	Section 301.358, or an advanced practice registered nurse or
906	906	physician assistant acting under the delegation and supervision of
907	907	a licensed physician as provided by Subchapter B, Chapter 157, and
908	908	rules adopted by the Texas Medical Board, for a specific patient is
909	909	exempt from licensing as a device manufacturer under Subchapter L,
910	910	Chapter 431, Health and Safety Code. A person licensed to practice
911	911	orthotics or prosthetics who fabricates or assembles an orthosis or
912	912	a prosthesis without an order from a licensed physician,
913	913	chiropractor, [or] podiatrist, or advanced practice registered
914	914	nurse authorized to prescribe and order drugs and devices under
915	915	Section 301.358, or an advanced practice registered nurse or
916	916	physician assistant acting under the delegation and supervision of
917	917	a licensed physician as provided by Subchapter B, Chapter 157, and
918	918	rules adopted by the Texas Medical Board, for a specific patient is
919	919	required to be licensed as a device manufacturer under Subchapter
920	920	L, Chapter 431, Health and Safety Code.
921	921	SECTION 4.032. Section 1701.703(a), Occupations Code, is
922	922	amended to read as follows:
923	923	(a) A physician, [or] a person who has been delegated
924	924	prescriptive authority under Chapter 157, or an advanced practice
925	925	registered nurse authorized to prescribe and order drugs and
926	926	devices under Section 301.358, [Occupations Code,] may prescribe
927	927	epinephrine auto-injectors in the name of a law enforcement agency.
928	928	ARTICLE 5. LEGISLATION IMPACT STUDY
929	929	SECTION 5.001. (a) The Texas Board of Nursing shall conduct
930	930	a study of the effect this Act has had on:
931	931	(1) access to primary health care in counties with a
932	932	population of less than 68,750 as compared to counties with a
933	933	population of 68,750 or greater;
934	934	(2) patient outcomes in counties with a population of
935	935	less than 68,750;
936	936	(3) trends in the practice location of advanced
937	937	practice registered nurses; and
938	938	(4) costs incurred by rural hospitals.
939	939	(b) Not later than September 1, 2028, the Texas Board of
940	940	Nursing shall submit to the governor, the lieutenant governor, and
941	941	the speaker of the house of representatives:
942	942	(1) the study conducted under Subsection (a) of this
943	943	section;
944	944	(2) the information published by:
945	945	(A) the Texas Medical Board under Section
946	946	157.152(b), Occupations Code, as added by this Act; and
947	947	(B) the Texas Board of Nursing under Section
948	948	301.359(c), Occupations Code, as added by this Act; and
949	949	(3) recommendations to the legislature to improve
950	950	rural access to health care and patient outcomes.
951	951	SECTION 5.002. This article expires December 31, 2029.
952	952	ARTICLE 6. TRANSITION AND EFFECTIVE DATE
953	953	SECTION 6.001. Not later than February 1, 2026, the Texas
954	954	Board of Nursing shall adopt the rules necessary to implement the
955	955	changes in law made by this Act.
956	956	SECTION 6.002. This Act takes effect September 1, 2025.