Bill Text: TX HB1055 | 2013-2014 | 83rd Legislature | Introduced
Bill Title: Relating to the delegation and supervision of prescriptive authority by physicians to certain advanced practice registered nurses and physician assistants.
Spectrum: Slight Partisan Bill (Democrat 4-2)
Status: (Introduced - Dead) 2013-02-19 - Referred to Public Health [HB1055 Detail]
Download: Texas-2013-HB1055-Introduced.html
By: Kolkhorst | H.B. No. 1055 |
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relating to the delegation and supervision of prescriptive | ||
authority by physicians to certain advanced practice registered | ||
nurses and physician assistants. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. The heading to Subchapter B, Chapter 157, | ||
Occupations Code, is amended to read as follows: | ||
SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE REGISTERED NURSES | ||
AND PHYSICIAN ASSISTANTS | ||
SECTION 2. Section 157.051, Occupations Code, is amended to | ||
read as follows: | ||
(1) "Advanced practice registered nurse" has the | ||
meaning assigned to that term by Section 301.152. The term includes | ||
an advanced nurse practitioner and advanced practice nurse. | ||
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to that term by Section 481.002, Health and Safety Code. | ||
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that term by Section 483.001, Health and Safety Code. | ||
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(A) an urban or rural area of this state that: | ||
(i) is not required to conform to the | ||
geographic boundaries of a political subdivision but is a rational | ||
area for the delivery of health service; | ||
(ii) the secretary of health and human | ||
services determines has a health professional shortage; and | ||
(iii) is not reasonably accessible to an | ||
adequately served area; | ||
(B) a population group that the secretary of | ||
health and human services determines has a health professional | ||
shortage; or | ||
(C) a public or nonprofit private medical | ||
facility or other facility that the secretary of health and human | ||
services determines has a health professional shortage, as | ||
described by 42 U.S.C. Section 254e(a)(1). | ||
(5) "Hospital" means: | ||
(A) a general hospital or a special hospital, as | ||
those terms are defined by Section 241.003, including a hospital | ||
maintained or operated by this state; or | ||
(B) a mental hospital licensed under Chapter 577. | ||
(6) "Medication order" has the meaning assigned by | ||
Sections 551.003(24), Occupations Code and 481.002(28), Health and | ||
Safety Code. | ||
(7) "Nonprescription drug" has the meaning assigned by | ||
Section 551.003(25). | ||
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license issued under Chapter 204. | ||
(9) "Physician group practice" means an entity for | ||
which two or more physicians deliver health care to the public | ||
through the practice of medicine on a regular basis and that is: | ||
(A) owned and operated by two or more physicians; | ||
or | ||
(B) a freestanding clinic, center, or office of a | ||
nonprofit health organization certified by the board under Section | ||
162.001(b) that complies with the requirements of Chapter 162. | ||
(10) "Practice serving a medically underserved | ||
population" means: | ||
(A) a practice in a health professional shortage | ||
area; | ||
(B) a clinic designated as a rural health clinic | ||
under 42 U.S.C. Section 1395x(aa); | ||
(C) a public health clinic or a family planning | ||
clinic under contract with the Health and Human Services Commission | ||
or the Texas Department of State Health Services; | ||
(D) a clinic designated as a federally qualified | ||
health clinic under 42 U.S.C. Section 1396d(1)(2)(B); or | ||
(E) a practice: | ||
(i) that is either: | ||
(a) located in an area in which the | ||
Texas Department of State Health Services determines there is an | ||
insufficient number of physicians providing services to eligible | ||
clients of federal, state, or locally funded health care programs; | ||
or | ||
(b) a practice that the Texas | ||
Department of State Health Services determines serves a | ||
disproportionate number of clients eligible to participate in | ||
federal, state, or locally funded health care programs; and | ||
(ii) for which the Texas Department of | ||
State Health Services publishes notice of its determination in the | ||
Texas Register and provides an opportunity for public comment in | ||
the manner provided for a proposed rule under Chapter 2001, | ||
Government Code; | ||
(F) a practice at which a physician was | ||
delegating prescriptive authority to an advanced practice | ||
registered nurse or physician assistant on or before March 1, 2013 | ||
based on the practice qualifying as a site serving a medically | ||
underserved population. | ||
(11) "Prescribe or order a drug or device" means | ||
prescribing or ordering a drug or device, including the issuing of a | ||
"prescription drug order" or a "medication order." | ||
(12) "Prescription drug" has the meaning assigned by | ||
Section 551.003(36). | ||
(13) "Prescriptive authority agreement" means an | ||
agreement entered into by a physician and an advanced practice | ||
registered nurse or physician assistant through which the physician | ||
delegates to the advanced practice registered nurse or physician | ||
assistant the act of prescribing or ordering a drug or device. | ||
SECTION 3. Sections 157.0511(a), (b) and (b-1), Occupations | ||
Code, are amended, and a new Section (b-1) is added, to read as | ||
follows: | ||
(a) A physician's authority to delegate the |
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drug or device under this subchapter is limited to: | ||
(1) non prescription drugs; | ||
(2) dangerous drugs; and | ||
(3) controlled substances to the extent provided by | ||
Subsection (b) and (b-1). | ||
(b) Except as provided in (b-1), a |
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prescribing or ordering of a drug or device for a controlled | ||
substance only if: | ||
(1) the prescription is for a controlled substance | ||
listed in Schedule III, IV, or V as established by the commissioner | ||
of State Health Services under Chapter 481, Health and Safety Code; | ||
(2) the prescription, including a refill of the | ||
prescription, is for a period not to exceed 90 days; | ||
(3) with regard to the refill of a prescription, the | ||
refill is authorized after consultation with the delegating | ||
physician and the consultation is noted in the patient's chart; and | ||
(4) with regard to a prescription for a child less than | ||
two years of age, the prescription is made after consultation with | ||
the delegating physician and the consultation is noted in the | ||
patient's chart. | ||
(b-1) A physician may delegate the prescribing or ordering | ||
of a controlled substance listed in Schedule II as established by | ||
the commissioner of state health services under Chapter 481, Health | ||
and Safety Code only: | ||
(1) in a hospital facility-based practice under | ||
Section 157.054 and in accordance with policies approved by the | ||
facility's medical staff or a committee of the facility's medical | ||
staff as provided by the facility bylaws to ensure patient safety; | ||
or | ||
(2) as part of the plan of care, for the treatment of a | ||
person that 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. | ||
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who delegates the prescribing or ordering of a drug or device | ||
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of the physician assistant or advanced practice registered nurse to | ||
whom a delegation is made. The board may develop and use an | ||
electronic online delegation registration process for registration | ||
under this subsection. | ||
SECTION 4. Subchapter B, Chapter 157, Occupations Code, is | ||
amended by adding Sections 157.0512, 157.0513, and 157.0514 to read | ||
as follows: | ||
Sec. 157.0512. PRESCRIPTIVE AUTHORITY AGREEMENT. (a) A | ||
physician may delegate to an advanced practice registered nurse or | ||
physician assistant, acting under adequate physician supervision, | ||
the act of prescribing or ordering a drug or device as authorized | ||
through a prescriptive authority agreement between the physician | ||
and the advanced practice registered nurse or physician assistant, | ||
as applicable. | ||
(b) A physician and an advanced practice registered nurse or | ||
physician assistant are eligible to enter into or be a party to a | ||
prescriptive authority agreement only if: | ||
(1) the Texas Board of Nursing has approved the | ||
advanced practice registered nurse's authority to prescribe or | ||
order a drug or device as authorized in this Chapter this | ||
Subchapter; | ||
(2) the advanced practice registered nurse or | ||
physician assistant: | ||
(A) holds an active license to practice in this | ||
state as a registered nurse or physician assistant, as applicable, | ||
and is in good standing in this state; and | ||
(B) is not currently prohibited by the Texas | ||
Board of Nursing or Texas Board of Physician Assistants, as | ||
applicable, from executing a prescriptive authority agreement; and | ||
(3) prior to executing a prescriptive authority | ||
agreement, an advanced practice registered nurse, physician | ||
assistant, and physician must disclose to the other prospective | ||
party any prior disciplinary action by the board, Texas Board of | ||
Nursing, or Texas Board of Physician Assistants, as applicable. | ||
(c) Except as provided in Subsection (d), the combined | ||
number of advanced practice registered nurses and physician | ||
assistants with whom a physician may enter into a prescriptive | ||
authority agreement may not exceed seven advanced practice | ||
registered nurses and physician assistants or the full-time | ||
equivalent of seven advanced practice registered nurses and | ||
physician assistants. | ||
(d) Subsection (c) does not apply to a prescriptive authority | ||
agreement if the prescriptive authority is being exercised in: | ||
(1) a practice serving a medically underserved | ||
population; or | ||
(2) a hospital facility-based practice in a hospital | ||
under Section 157.054. | ||
(e) A prescriptive authority agreement must, at a minimum: | ||
(1) be in writing and signed and dated by the parties | ||
to the agreement; | ||
(2) state the name, address and all professional | ||
license numbers of the parties to the agreement; | ||
(3) state the nature of the practice, practice | ||
locations, or practice settings; | ||
(4) identify the types or categories of drugs or | ||
devices that may be prescribed or the types or categories of drugs | ||
or devices that may not be prescribed; | ||
(5) provide a general plan for addressing consultation | ||
and referral; | ||
(6) provide a plan for addressing patient emergencies; | ||
(7) state the general process for communication and | ||
sharing of information between the physician and an advanced | ||
practice registered nurse or physician assistant to whom the | ||
physician has delegated prescriptive authority related to the care | ||
and treatment of patients. | ||
(8) if alternate physician supervision is to be | ||
utilized, designate one or more alternate physicians who may | ||
provide appropriate supervision on a temporary basis in accordance | ||
with the requirements established by the prescriptive authority | ||
agreement and the requirements of this Subchapter and who may | ||
participate in the prescriptive authority quality assurance and | ||
improvement plan meetings required under this Section; and | ||
(9) describe a prescriptive authority quality | ||
assurance and improvement plan and specify methods for documenting | ||
the implementation of the plan that includes the following: | ||
(A) chart review with the number of charts | ||
reviewed determined by the physician and advanced practice | ||
registered nurse or physician assistant; | ||
(B) periodic face-to-face meetings of the | ||
advanced practice registered nurse or physician assistant with the | ||
physician at a location determined by the physician and advanced | ||
practice registered nurse or physician assistant. The meetings | ||
shall include: | ||
(i) sharing of information relating to | ||
patients' treatment and care, needed changes in patient care plans, | ||
and issues relating to referrals; and | ||
(ii) discussion of patient care | ||
improvement. | ||
(C) The periodic face-to-face meetings described | ||
in (9)(B) shall be documented and occur: | ||
(i)(a) no less frequently than monthly for | ||
three years beginning on the date of execution of the agreement; and | ||
(b) no less frequently than quarterly | ||
after three years with monthly meetings held between the quarterly | ||
meetings by means of a remote electronic communications system, | ||
including videoconferencing technology or the Internet; or | ||
(ii) if during the seven year period | ||
immediately preceding execution of the prescriptive authority | ||
agreement, the advanced practice registered nurse or physician | ||
assistant was in practice for at least five years that included the | ||
exercise of prescriptive authority with required physician | ||
supervision: | ||
(a) no less frequently than monthly for one | ||
year beginning on the date of execution of the agreement; and | ||
(b) no less frequently than quarterly after | ||
one year with monthly meetings held between the quarterly meetings | ||
by means of a remote electronic communications system, including | ||
videoconferencing technology or the Internet. | ||
(f) The prescriptive authority agreement may include other | ||
provisions agreed to by the physician and advanced practice | ||
registered nurse or physician assistant. | ||
(g) If the parties to the prescriptive authority agreement | ||
practice in a physician group practice, the physician may appoint | ||
one or more alternate supervising physicians designated under | ||
(E)(8) of this Section, if any, to conduct and document the quality | ||
assurance meeting in accordance with the requirements of this | ||
Subchapter. | ||
(h) The prescriptive authority agreement need not describe | ||
the exact steps that an advanced practice registered nurse or | ||
physician assistant must take with respect to each specific | ||
condition, disease, or symptom. | ||
(i) A physician, advanced practice registered nurse, or | ||
physician assistant who is a party to a prescriptive authority | ||
agreement must retain a copy of the agreement until the second | ||
anniversary of the date the agreement is terminated. | ||
(j) A party to a prescriptive authority agreement may not by | ||
contract waive, void, or nullify any provision of this section or | ||
Section 157.0513. | ||
(k) In the event a party to a prescriptive authority | ||
agreement is notified that he or she has become the subject of an | ||
investigation by the board, Texas Board of Nursing, or Texas Board | ||
of Physician Assistants, the individual must immediately notify the | ||
other party to the prescriptive authority agreement. | ||
(l) The prescriptive authority agreement and any amendments | ||
must be reviewed at least annually, dated, and signed by the parties | ||
to the agreement, and made available to the board, Texas Board of | ||
Nursing, or Texas Board of Physician Assistants within three | ||
business days of receipt of request, if any. | ||
(m) The prescriptive authority agreement should promote the | ||
exercise of professional judgment by the advanced practice | ||
registered nurse or physician assistant commensurate with the | ||
advanced practice registered nurse's or physician assistant's | ||
education and experience and the relationship between the advanced | ||
practice registered nurse or physician assistant and physician. | ||
(n) This section shall be liberally construed to allow the | ||
use of prescriptive authority agreements to safely and effectively | ||
utilize the skills and services of advanced practice registered | ||
nurses and physician assistants. | ||
(o) The board may not adopt rules pertaining to the elements | ||
of the prescriptive authority agreement that would impose | ||
requirements in addition to those required under this Section. The | ||
board, Texas Board of Nursing, and Texas Board of Physician | ||
Assistants will jointly develop Frequently Asked Questions (FAQs) | ||
by January 2014. | ||
SECTION 5. Sec. 157.0513. PRESCRIPTIVE AUTHORITY | ||
AGREEMENT: INFORMATION. (a) The board shall jointly with the Texas | ||
Board of Nursing and the Texas Physician Assistant Board develop a | ||
process: | ||
(1) to exchange information regarding the names, | ||
locations, and license numbers of each physician, advanced practice | ||
registered nurse, and physician assistant who has entered into a | ||
prescriptive authority agreement; | ||
(2) by which each board shall immediately notify the | ||
other boards when one of its licensees becomes the subject of an | ||
investigation involving the delegation and supervision of | ||
prescriptive authority, as well as the final disposition of any | ||
such investigation; and | ||
(3) for each board to maintain and share a list of its | ||
licensees who have been subject to a final adverse disciplinary | ||
action for an act involving the delegation and supervision of | ||
prescriptive authority. | ||
(b) The board, Texas Board of Nursing, or Texas Physician | ||
Assistant Board may use a notice received under Section (a)(2) to | ||
open an investigation against a licensee who is a party to a | ||
prescriptive authority agreement with the licensee who is under | ||
investigation by the board which provided notice under Section | ||
(a)(2). | ||
(c) The board shall maintain and make available to the | ||
public an online searchable list of physician, advanced practice | ||
registered nurses, and physician assistants who have entered into a | ||
prescriptive authority agreement authorized under Section 157.0512 | ||
and identify the physician with whom each advanced practice | ||
registered nurse and physician assistant has entered into an | ||
agreement. | ||
(d) The board shall collaborate with the Texas Board of | ||
Nursing and Texas Physician Assistant Board to maintain and make | ||
available to the public a list of physicians, advanced practice | ||
registered nurses, and physician assistants who are prohibited from | ||
entering into or practicing under a prescriptive authority | ||
agreement. | ||
SECTION 6. Sec. 157.0514. PRESCRIPTIVE AUTHORITY | ||
AGREEMENT: INSPECTIONS. If the board is notified under Section | ||
157.0513(a)(2), the board or an authorized board representative may | ||
enter, with reasonable notice and at a reasonable time, unless the | ||
notice would jeopardize an investigation, a site where a party to a | ||
prescriptive authority agreement practices to inspect and audit any | ||
records or activities relating to the implementation and operation | ||
of the agreement. To the extent reasonably possible, the board and | ||
the board's authorized representative shall conduct any inspection | ||
or audit under this subsection in a manner that minimizes | ||
disruption to the delivery of patient care. | ||
SECTION 7. Section 157.054, Occupations Code, is amended to | ||
read as follows: | ||
Sec. 157.054. PRESCRIBING AT FACILITY-BASED PRACTICE | ||
SITES. (a) One or more physicians licensed by the board may | ||
delegate, to one or more physician assistants or advanced practice | ||
registered nurses acting under adequate physician supervision | ||
whose practice is facility-based at a |
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under Section 157.051 or licensed long-term care facility, the | ||
administration or provision of a drug and the |
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drug or device if the physician is: | ||
(1) the medical director or chief of medical staff of | ||
the facility in which the physician assistant or advanced practice | ||
registered nurse practices; | ||
(2) the chair of the facility's credentialing | ||
committee; | ||
(3) a department chair of a facility department in | ||
which the physician assistant or advanced practice nurse practices; | ||
or | ||
(4) one or more physicians who consent to the request | ||
of the medical director or chief of medical staff to delegate the | ||
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ordering of a drug or device at the facility in which the physician | ||
assistant or advanced practice nurse practices. | ||
(a-1) The limits on the number of Advanced Practice | ||
Registered Nurses or Physician Assistants to whom a physician may | ||
delegate under Section 157.0512 do not apply to a physician under | ||
(a)(4) whose practice is facility-based under this Section, | ||
provided that the physician is not delegating in a freestanding | ||
clinic, center, or practice of the facility. | ||
(b) A physician's authority to delegate under Subsection | ||
(a) is limited as follows: | ||
(1) the delegation must be made under a physician's | ||
order, standing medical order, standing delegation order, or | ||
another order or protocol developed in accordance with policies | ||
approved by the facility's medical staff or a committee of the | ||
facility's medical staff as provided by the facility bylaws; | ||
(2) the delegation must occur in the facility in which | ||
the physician is the medical director, the chief of medical staff, | ||
the chair of the credentialing committee, |
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a physician who consents to delegate under (a)(4); | ||
(3) the delegation may not permit the |
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drug or device for the care or treatment of the patients of any | ||
other physician without the prior consent of that physician; and | ||
(4) delegation in a long-term care facility must be by | ||
the medical director and is limited to the |
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device to not more than |
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physician assistants or their full-time equivalents. |
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(c) Physician supervision of the |
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device must conform to what a reasonable, prudent physician would | ||
find consistent with sound medical judgment but may vary with the | ||
education and experience of the particular advanced practice | ||
registered nurse or physician assistant. A physician shall provide | ||
continuous supervision, but the constant physical presence of the | ||
physician is not required. | ||
(d) An alternate physician may provide appropriate | ||
supervision on a temporary basis as defined and established by | ||
board rule. | ||
SECTION 8. Section 156.056(a) and (b), Occupations Code, | ||
are amended to read as follows: | ||
(a) In this section, " |
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underserved population" has the meaning assigned by Section 157.051 | ||
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(b) The board by rule shall permit a license holder to | ||
complete half of any informal continuing medical education hours | ||
required under this subchapter by providing volunteer medical | ||
services at a |
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population other than a site that is a primary practice site of the | ||
license holder. | ||
SECTION 9. Section 157.057, Occupations Code, is amended to | ||
read as follows: | ||
Sec. 157.057. ADDITIONAL IMPLEMENTATION METHODS. The board | ||
may adopt additional methods to implement: | ||
(1) a physician's prescription; or | ||
(2) the delegation of prescriptive authority |
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SECTION 10. Sec. 157.059. DELEGATION REGARDING CERTAIN | ||
OBSTETRICAL SERVICES. | ||
(a) In this section, "provide" means to supply, for a term | ||
not to exceed 48 hours, one or more unit doses of a controlled | ||
substance for the immediate needs of a patient. | ||
(b) A physician may delegate to a physician assistant | ||
offering obstetrical services and certified by the board as | ||
specializing in obstetrics or an advanced practice registered | ||
nurse recognized by the Texas Board of Nursing as a nurse midwife | ||
the act of administering or providing controlled substances to the | ||
physician assistant's or nurse midwife's clients during intrapartum | ||
and immediate postpartum care. | ||
(c) The physician may not delegate: | ||
(1) the use of a prescription sticker or the use or | ||
issuance of an official prescription form; or | ||
(2) the authority to issue an electronic prescription | ||
under Section 481.075, Health and Safety Code. | ||
(d) The delegation of authority to administer or provide | ||
controlled substances under Subsection (b) must be under a | ||
physician's order, medical order, standing delegation order, | ||
prescriptive authority agreement, or protocol that requires | ||
adequate and documented availability for access to medical care. | ||
(e) The physician's orders, medical orders, standing | ||
delegation orders, or protocols must require the reporting of or | ||
monitoring of each client's progress, including complications of | ||
pregnancy and delivery and the administration and provision of | ||
controlled substances by the nurse midwife or physician assistant | ||
to the clients of the nurse midwife or physician assistant. | ||
(f) The authority of a physician to delegate under this | ||
section is limited to: | ||
(1) |
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or their full-time equivalents; and | ||
(2) the designated facility at which the nurse midwife | ||
or physician assistant provides care. | ||
(g) The controlled substance must be supplied in a suitable | ||
container that is labeled in compliance with the applicable drug | ||
laws and must include: | ||
(1) the patient's name and address; | ||
(2) the drug to be provided; | ||
(3) the name, address, and telephone number of the | ||
physician; | ||
(4) the name, address, and telephone number of the | ||
nurse midwife or physician assistant; and | ||
(5) the date. | ||
(h) This section does not authorize a physician, physician | ||
assistant, or nurse midwife to operate a retail pharmacy as defined | ||
under Subtitle J. | ||
(i) This section authorizes a physician to delegate the act | ||
of administering or providing a controlled substance to a nurse | ||
midwife or physician assistant but does not require physician | ||
delegation of: | ||
(1) further acts to a nurse midwife; or | ||
(2) the administration of medications by a physician | ||
assistant or registered nurse other than as provided by this | ||
section. | ||
(j) This section does not limit the authority of a physician | ||
to delegate the |
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this subchapter. | ||
SECTION 11. Section 157.060, Occupations Code, is amended | ||
to read as follows: | ||
Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED ACT. | ||
Unless the physician has reason to believe the physician assistant | ||
or advanced practice registered nurse lacked the competency to | ||
perform the act, a physician is not liable for an act of a physician | ||
assistant or advanced registered practice nurse solely because the | ||
physician signed a standing medical order, a standing delegation | ||
order, or another order or protocol or entered into a prescriptive | ||
authority agreement authorizing the physician assistant or | ||
advanced practice registered nurse to administer, provide, |
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SECTION 12. Section 204.1565(a) and (b), Occupations Code, | ||
are amended to read as follows: | ||
(a) In this section, " |
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underserved population" has the meaning assigned by Section | ||
157.051. |
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(b) The physician assistant board by rule shall permit a | ||
license holder to complete half of any informal continuing medical | ||
education hours required to renew a license under this chapter by | ||
providing volunteer medical services at a |
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medically underserved population, other than a site that is a | ||
primary practice site of the license holder. | ||
SECTION 13. Section 204.202(b), Occupations Code, is | ||
amended to read as follows: | ||
(b) Medical services provided by a physician assistant may | ||
include: | ||
(1) obtaining patient histories and performing | ||
physical examinations; | ||
(2) ordering or performing diagnostic and therapeutic | ||
procedures; | ||
(3) formulating a working diagnosis; | ||
(4) developing and implementing a treatment plan; | ||
(5) monitoring the effectiveness of therapeutic | ||
interventions; | ||
(6) assisting at surgery; | ||
(7) offering counseling and education to meet patient | ||
needs; | ||
(8) requesting, receiving, and signing for the receipt | ||
of pharmaceutical sample prescription medications and distributing | ||
the samples to patients in a specific practice setting in which the | ||
physician assistant is authorized to prescribe pharmaceutical | ||
medications and sign prescription drug orders as provided by | ||
Section 157.0512 [ |
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or ordering a drug or device as provided by Subchapter B, Chapter | ||
157; and | ||
(10) making appropriate referrals. | ||
SECTION 14. Section 301.002(2), Occupations Code, is | ||
amended to read as follows: | ||
(2) "Professional nursing" means the performance of an | ||
act that requires substantial specialized judgment and skill, the | ||
proper performance of which is based on knowledge and application | ||
of the principles of biological, physical, and social science as | ||
acquired by a completed course in an approved school of | ||
professional nursing. The term does not include acts of medical | ||
diagnosis or the prescription of therapeutic or corrective | ||
measures. Professional nursing involves: | ||
(A) the observation, assessment, intervention, | ||
evaluation, rehabilitation, care and counsel, or health teachings | ||
of a person who is ill, injured, infirm, or experiencing a change in | ||
normal health processes; | ||
(B) the maintenance of health or prevention of | ||
illness; | ||
(C) the administration of a medication or | ||
treatment as ordered by a 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 |
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practices at which an advanced practice registered nurse is | ||
authorized to sign prescription drug orders or a medication order | ||
as provided by Subchapter B, Chapter 157; | ||
(G) the performance of an act delegated by a | ||
physician under Section 157.0512 [ |
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(H) the development of the nursing care plan. | ||
SECTION 15. Section 301.152 (a) and (b), Occupations Code, | ||
are amended to read as follows: | ||
(a) In this section, "advanced practice registered nurse" | ||
means a registered nurse |
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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. The term is synonymous with "advanced nurse | ||
practitioner" and "advanced practice nurse." | ||
(b) The board shall adopt rules to: | ||
(1) license a registered nurse as an advanced practice | ||
registered nurse; | ||
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(A) any specialized education or training, | ||
including pharmacology, that an advanced practice registered nurse | ||
must have to |
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a drug or device as delegated by a physician under Section 157.0512, | ||
or 157.054 |
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(B) a system for: | ||
(i) approving an advanced practice | ||
registered nurse to prescribe and order a drug or device as | ||
delegated by a physician under Section 157.0512 or 157.054 upon the | ||
providing of |
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specialized education and training requirement under Subdivision | ||
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(ii) issuing a prescription authorization | ||
number to advanced practice registered nurses approved under (i). | ||
(3) renew the license issued under (1) and the | ||
approval granted under (2)(B) concurrently with renewal of the | ||
advanced practice registered nurse's professional nursing license | ||
under Section 301.301. | ||
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registered |
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(c) At a minimum, the rules adopted under Subsection (b)([ |
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2) must: | ||
(1) require completion of pharmacology and related | ||
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(2) require continuing education in clinical | ||
pharmacology and related |
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any continuing education otherwise required under Section | ||
301.303. |
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(d) The signature of an advanced practice registered nurse | ||
attesting to the provision of a legally authorized service by the | ||
advanced practice registered nurse satisfies any documentation | ||
requirement for that service established by a state agency. | ||
SECTION 16. Sections 551.003(34) and (45), Occupations | ||
Code, are amended to read as follows: | ||
(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, 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, 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 |
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drug or device under Section 157.0511, 157.0512 [ |
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or 157.054, [ |
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(45) "Written protocol" means a physician's order, | ||
standing medical order, standing delegation order, or other order | ||
or protocol as defined by rule of the Texas Medical [ |
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[ |
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SECTION 17. Section 671.001, Government Code, is amended by | ||
amending Subsection (b) and adding Subsection (b-1) to read as | ||
follows: | ||
(b) The pilot program must provide for the following: | ||
(1) a licensed advanced practice registered nurse as | ||
defined by Section 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; | ||
(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 pursuant to a prescriptive authority agreement under | ||
Chapter 157, Occupations Code. [ |
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(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 | ||
(4) professional liability insurance covering | ||
services provided by the advanced practice registered nurse or the | ||
physician assistant. | ||
SECTION 18. 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, 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, 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 |
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drug or device under Section 157.0511, 157.0512 [ |
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or 157.054 |
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SECTION 19. Section 483.001(12), Health and Safety Code, is | ||
amended to read as follows: | ||
(12) "Practitioner" means [ |
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(A) a person licensed by the Texas [ |
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Texas State Board of Podiatric Medical Examiners, Texas Optometry | ||
Board, or State Board of Veterinary Medical Examiners 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 |
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drug or device under Section 157.0511, 157.0512 [ |
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or 157.054 |
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SECTION 20. Sections 157.052, 157.053, 157.0541, and | ||
157.0542, Occupations Code, are repealed. | ||
SECTION 21. (a) The changes in law made by this Act apply | ||
only to a delegation of prescriptive authority by a physician to an | ||
advanced practice registered nurse or physician assistant made or | ||
amended on or after January 31, 2014. A delegation of prescriptive | ||
authority made or amended before January 31, 2014, is governed by | ||
the law in effect on the date the delegation was made or amended, | ||
and the former law is continued in effect for that purpose. | ||
(b) Any calculation under this Act requiring the amount of | ||
time an advanced practice registered nurse or physician assistant | ||
has practiced under the delegated prescriptive authority of a | ||
physician pursuant to a prescriptive authority agreement shall | ||
include the amount of time the advanced practice registered nurse | ||
or physician assistant practiced under the delegated prescriptive | ||
authority of that physician prior to the effective date of this Act. | ||
SECTION 22. Not later than December 31, 2013, the Texas | ||
Medical Board shall adopt the rules necessary to implement the | ||
changes in law made by this Act. | ||
SECTION 23. This Act takes effect September 1, 2013. |