89R8171 BEE-F
By: Blanco, et al. S.B. No. 911
A BILL TO BE ENTITLED
AN ACT
relating to the licensing and regulation of certain advanced
practice registered nurses; authorizing a fee.
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. The term includes a nurse practitioner, nurse
midwife, nurse anesthetist, and clinical nurse specialist.
(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. Section 301.152(b), Occupations Code, is
amended to read as follows:
(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 and 301.358 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:
(1) is a nurse practitioner, nurse midwife, or
clinical nurse specialist;
(2) subject to Subsection (b), has completed in any
state at least 3,000 clinical practice hours within the five years
preceding the authorization request; and
(3) pays the fee established by the board and applies
for authorization under this section in the manner prescribed by
the board.
(b) The clinical practice hours requirement of Subsection
(a)(2) may be satisfied by successful completion of any combination
of:
(1) instruction hours that are provided by a clinical
faculty member to the applicant in a clinical setting, or received
by the applicant as a student in a clinical setting, as part of a
graduate program leading to a master's or doctoral degree in a
clinical nursing specialty area; and
(2) either:
(A) if the applicant is currently licensed or
authorized by the board to practice as a registered nurse in this
state, clinical practice hours received while practicing as an
advanced practice registered nurse under the supervision of a
physician who held an active, unencumbered license issued by any
state during the period of supervision; or
(B) if the applicant is applying for licensure by
endorsement as an advanced practice registered nurse in this state,
clinical practice hours received while practicing as an advanced
practice registered nurse.
(c) To be eligible for authorization to practice under this
section, an applicant must:
(1) be licensed or authorized by the board to practice
as a registered nurse in this state;
(2) have graduated from an advanced practice
registered nurse graduate or post-graduate education program that
is recognized by the board and the United States Secretary of
Education or the Council for Higher Education Accreditation or its
successor organization and that includes completion of three
separate graduate level courses in:
(A) advanced physiology and pathophysiology;
(B) advanced health assessment; and
(C) advanced pharmacology which includes
pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of
all broad categories of agents; and
(3) successfully complete and be currently certified
on passage of an appropriate board-recognized advanced practice
registered nurse national certification examination.
(d) 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 II, 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 the 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.
(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.
(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 nurse's limits of 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; and
(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.
(i) Notwithstanding any other law, an advanced practice
registered nurse authorized to practice under this section who is
performing an act described by Subsection (d) is not considered to
be practicing medicine without a license.
Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF
ADVANCED PRACTICE REGISTERED NURSE. (a) 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.
(b) The board may authorize an advanced practice registered
nurse authorized to practice by the board under Section 301.357 to
prescribe and order controlled substances listed in Schedule II
only:
(1) in a hospital facility-based practice in
accordance with policies approved by the hospital's medical staff
or a committee of the hospital's medical staff as provided by the
hospital bylaws to ensure patient safety and as part of the care
provided to a patient who:
(A) has been admitted to the hospital and is
expected to remain in the hospital for a period of 24 hours or more;
or
(B) is receiving services in the emergency
department of the hospital; or
(2) as part of the plan of care for the treatment of a
person who has executed a written certification of a terminal
illness, has elected to receive hospice care, and is receiving
hospice treatment from a qualified hospice provider.
ARTICLE 3. CONFORMING AMENDMENTS
SECTION 3.001. 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 3.002. 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 3.003. 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 3.004. 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 3.005. 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 3.006. 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 3.007. 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 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
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 3.008. 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 3.009. 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 3.010. 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 3.011. 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 3.012. 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 3.013. 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 3.014. 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 3.015. 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 3.016. 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 3.017. 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 3.018. 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 3.019. 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 3.020. 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 3.021. 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 3.022. 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 3.023. 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 3.024. 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 3.025. 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 3.026. 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 3.027. 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 3.028. 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 3.029. 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 3.030. 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 3.031. 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 4. REPEALER
SECTION 4.001. Section 301.152(a), Occupations Code, is
repealed.
ARTICLE 5. TRANSITIONS AND EFFECTIVE DATE
SECTION 5.001. 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 5.002. This Act takes effect September 1, 2025.