Bill Text: TX HB2174 | 2019-2020 | 86th Legislature | Enrolled

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Bill Title: Relating to controlled substance prescriptions and reimbursement for treatment for certain substance use disorders; authorizing a fee.

Sponsorship: Partisan Bill (Republican 5)

Status: (Passed) 2019-06-14 - Effective on 9/1/19 [HB2174 Detail]

Download: Texas-2019-HB2174-Enrolled.html

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H.B. No. 2174

AN ACT
relating to controlled substance prescriptions and reimbursement
for treatment for certain substance use disorders; authorizing a
fee.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 552.118, Government Code, is amended to
read as follows:
Sec. 552.118. EXCEPTION: CONFIDENTIALITY OF OFFICIAL
PRESCRIPTION PROGRAM INFORMATION. Information is excepted from the
requirements of Section 552.021 if it is:
(1) information on or derived from an official
prescription form filed with the Texas State Board of Pharmacy
under Section 481.0755, Health and Safety Code, or an electronic
prescription record filed with the Texas State Board of Pharmacy
under Section 481.075, Health and Safety Code; or
(2) other information collected under Section 481.075
or 481.0755 of that code.
SECTION 2. Sections 481.002(10) and (47), Health and Safety
Code, are amended to read as follows:
(10) "Designated agent" means an individual
designated under Section 481.074(b-2) [481.073] to communicate a
practitioner's instructions to a pharmacist in an emergency.
(47) "Official prescription form" means a
prescription form that is used for a Schedule II controlled
substance under Section 481.0755 and contains the prescription
information required by Section 481.0755(e) [481.075].
SECTION 3. Section 481.003(a), Health and Safety Code, is
amended to read as follows:
(a) The director may adopt rules to administer and enforce
this chapter, other than Sections [481.073,] 481.074, 481.075,
481.0755, 481.0756, 481.076, 481.0761, 481.0762, 481.0763,
481.07635, 481.07636, 481.0764, 481.0765, and 481.0766. The board
may adopt rules to administer Sections [481.073,] 481.074, 481.075,
481.0755, 481.0756, 481.076, 481.0761, 481.0762, 481.0763,
481.07635, 481.07636, 481.0764, 481.0765, and 481.0766.
SECTION 4. Section 481.074, Health and Safety Code, is
amended by amending Subsections (b), (c), (e), (f), (g), (h), (k),
and (q) and adding Subsections (b-1) and (b-2) to read as follows:
(b) Except in an emergency as defined by board rule under
Subsection (b-1) [of the board] or as otherwise provided by
[Subsection (o) or] Section 481.075(j) or (m) or 481.0755, a person
may not dispense or administer a controlled substance [listed in
Schedule II without a written prescription of a practitioner on an
official prescription form or] without an electronic prescription
that meets the requirements of and is completed by the practitioner
in accordance with Section 481.075.
(b-1) In an emergency as defined by board rule, a person may
dispense or administer a controlled substance [listed in Schedule
II] on the oral or telephonically communicated prescription of a
practitioner. The person who administers or dispenses the
substance shall:
(1) if the person is a prescribing practitioner or a
pharmacist, promptly comply with Subsection (c); or
(2) if the person is not a prescribing practitioner or
a pharmacist, promptly write the oral or telephonically
communicated prescription and include in the written record of the
prescription the name, address, and Federal Drug Enforcement
Administration number issued for prescribing a controlled
substance in this state of the prescribing practitioner, all
information required to be provided by a practitioner under Section
481.075(e)(1), and all information required to be provided by a
dispensing pharmacist under Section 481.075(e)(2).
(b-2) In an emergency described by Subsection (b-1), an
agent designated in writing by a practitioner defined by Section
481.002(39)(A) may communicate a prescription by telephone. A
practitioner who designates a different agent shall designate that
agent in writing and maintain the designation in the same manner in
which the practitioner initially designated an agent under this
subsection. On the request of a pharmacist, a practitioner shall
furnish a copy of the written designation. This subsection does not
relieve a practitioner or the practitioner's designated agent from
the requirement of Subchapter A, Chapter 562, Occupations Code. A
practitioner is personally responsible for the actions of the
designated agent in communicating a prescription to a pharmacist.
(c) Not later than the seventh day after the date a
prescribing practitioner authorizes an emergency oral or
telephonically communicated prescription, the prescribing
practitioner shall cause an [a written or] electronic prescription,
completed in the manner required by Section 481.075, to be
delivered to the dispensing pharmacist at the pharmacy where the
prescription was dispensed. [A written prescription may be
delivered in person or by mail. The envelope of a prescription
delivered by mail must be postmarked not later than the seventh day
after the date the prescription was authorized. On receipt of a
written prescription, the dispensing pharmacy shall file the
transcription of the telephonically communicated prescription and
the pharmacy copy and shall send information to the board as
required by Section 481.075.] On receipt of the [an] electronic
prescription, the pharmacist shall annotate the electronic
prescription record with the original authorization and date of the
emergency oral or telephonically communicated prescription.
(e) The partial filling of a prescription for a controlled
substance listed in Schedule II is permissible in accordance with
applicable federal law[, if the pharmacist is unable to supply the
full quantity called for in a written or electronic prescription or
emergency oral prescription and the pharmacist makes a notation of
the quantity supplied on the face of the written prescription, on
the written record of the emergency oral prescription, or in the
electronic prescription record. The remaining portion of the
prescription may be filled within 72 hours of the first partial
filling; however, if the remaining portion is not or cannot be
filled within the 72-hour period, the pharmacist shall so notify
the prescribing individual practitioner. No further quantity may
be supplied beyond 72 hours without a new prescription].
(f) A prescription for a Schedule II controlled substance
for a patient in a long-term care facility (LTCF) or for a hospice
patient with a medical diagnosis documenting a terminal illness may
be filled in partial quantities to include individual dosage units.
If there is any question about whether a hospice patient may be
classified as having a terminal illness, the pharmacist must
contact the practitioner before partially filling the
prescription. Both the pharmacist and the practitioner have a
corresponding responsibility to assure that the controlled
substance is for a terminally ill hospice patient. The pharmacist
must record the prescription [on an official prescription form or]
in the electronic prescription record and must indicate [on the
official prescription form or] in the electronic prescription
record whether the patient is a "terminally ill hospice patient" or
an "LTCF patient." A prescription that is partially filled and does
not contain the notation "terminally ill hospice patient" or "LTCF
patient" is considered to have been filled in violation of this
chapter. For each partial filling, the dispensing pharmacist shall
record [on the back of the official prescription form or] in the
electronic prescription record the date of the partial filling, the
quantity dispensed, the remaining quantity authorized to be
dispensed, and the identification of the dispensing pharmacist.
Before any subsequent partial filling, the pharmacist must
determine that the additional partial filling is necessary. The
total quantity of Schedule II controlled substances dispensed in
all partial fillings may not exceed the total quantity prescribed.
Schedule II prescriptions for patients in a long-term care facility
or hospice patients with a medical diagnosis documenting a terminal
illness are valid for a period not to exceed 60 days following the
issue date unless sooner terminated by discontinuance of the
medication.
(g) A person may not dispense a controlled substance in
Schedule III or IV that is a prescription drug under the Federal
Food, Drug, and Cosmetic Act (21 U.S.C. Section 301 et seq.) without
a [written, electronic, oral, or telephonically communicated]
prescription of a practitioner defined by Section 481.002(39)(A) or
(D), except that the practitioner may dispense the substance
directly to an ultimate user. A prescription for a controlled
substance listed in Schedule III or IV may not be filled or refilled
later than six months after the date on which the prescription is
issued and may not be refilled more than five times, unless the
prescription is renewed by the practitioner. A prescription under
this subsection must comply with other applicable state and federal
laws.
(h) A pharmacist may dispense a controlled substance listed
in Schedule III, IV, or V under a [written, electronic, oral, or
telephonically communicated] prescription issued by a practitioner
defined by Section 481.002(39)(C) [and] only if the pharmacist
determines that the prescription was issued for a valid medical
purpose and in the course of professional practice. A prescription
described by [issued under] this subsection may not be filled or
refilled later than six months after the date the prescription is
issued and may not be refilled more than five times, unless the
prescription is renewed by the practitioner.
(k) A prescription for a controlled substance must show:
(1) the quantity of the substance prescribed:
(A) [numerically, followed by the number written
as a word, if the prescription is written;
[(B)] numerically, if the prescription is
electronic; or
(B) [(C)] if the prescription is communicated
orally or telephonically, as transcribed by the receiving
pharmacist;
(2) the date of issue;
(2-a) if the prescription is issued for a Schedule II
controlled substance to be filled at a later date under Subsection
(d-1), the earliest date on which a pharmacy may fill the
prescription;
(3) the name, address, and date of birth or age of the
patient or, if the controlled substance is prescribed for an
animal, the species of the animal and the name and address of its
owner;
(4) the name and strength of the controlled substance
prescribed;
(5) the directions for use of the controlled
substance;
(6) the intended use of the substance prescribed
unless the practitioner determines the furnishing of this
information is not in the best interest of the patient; and
(7) the name, address, Federal Drug Enforcement
Administration number, and telephone number of the practitioner at
the practitioner's usual place of business[, which must be legibly
printed or stamped on a written prescription; and
[(8) if the prescription is handwritten, the signature
of the prescribing practitioner].
(q) Each dispensing pharmacist shall send all required
information[, including any information required to complete the
Schedule III through V prescription forms,] to the board by
electronic transfer or another form approved by the board not later
than the next business day after the date the prescription is
completely filled.
SECTION 5. The heading to Section 481.075, Health and
Safety Code, is amended to read as follows:
Sec. 481.075. SCHEDULE II PRESCRIPTIONS [OFFICIAL
PRESCRIPTION PROGRAM].
SECTION 6. Sections 481.075(a), (e), (g), (h), (i), and
(j), Health and Safety Code, are amended to read as follows:
(a) A practitioner who prescribes a controlled substance
listed in Schedule II shall, except as provided by Section
481.074(b-1) or 481.0755 or a rule adopted under Section 481.0761,
record the prescription [on an official prescription form or] in an
electronic prescription that includes the information required by
this section.
(e) Each [official prescription form or electronic]
prescription used to prescribe a Schedule II controlled substance
must contain:
(1) information provided by the prescribing
practitioner, including:
(A) the date the prescription is issued;
(B) the controlled substance prescribed;
(C) the quantity of controlled substance
prescribed, shown[:
[(i)] numerically[, followed by the number
written as a word, if the prescription is written; or
[(ii) numerically, if the prescription is
electronic];
(D) the intended use of the controlled substance,
or the diagnosis for which the controlled substance [it] is
prescribed, and the instructions for use of the substance;
(E) the practitioner's name, address, and
Federal Drug Enforcement Administration number issued for
prescribing a controlled substance in this state;
(F) the name, address, and date of birth or age of
the person for whom the controlled substance is prescribed; and
(G) if the prescription is issued to be filled at
a later date under Section 481.074(d-1), the earliest date on which
a pharmacy may fill the prescription;
(2) information provided by the dispensing
pharmacist, including the date the prescription is filled; and
(3) [for a written prescription, the signatures of the
prescribing practitioner and the dispensing pharmacist or for an
electronic prescription,] the prescribing practitioner's
electronic signature or other secure method of validation
authorized by federal law.
(g) Except for an emergency oral or telephonically
communicated prescription described by [prescribed under] Section
481.074(b-1) [481.074(b)], the prescribing practitioner shall:
(1) record [legibly fill in,] or direct a designated
agent to record [legibly fill in, on the official prescription form
or] in the electronic prescription[,] each item of information
required to be provided by the prescribing practitioner under
Subsection (e)(1), unless the practitioner determines that:
(A) under rule adopted by the board for this
purpose, it is unnecessary for the practitioner or the
practitioner's agent to provide the patient identification number;
or
(B) it is not in the best interest of the patient
for the practitioner or practitioner's agent to provide information
regarding the intended use of the controlled substance or the
diagnosis for which it is prescribed; and
(2) [sign the official prescription form and give the
form to the person authorized to receive the prescription or, in the
case of an electronic prescription,] electronically sign or
validate the electronic prescription as authorized by federal law
and transmit the prescription to the dispensing pharmacy.
(h) In the case of an emergency oral or telephonically
communicated prescription described by [prescribed under] Section
481.074(b-1) [481.074(b)], the prescribing practitioner shall give
the dispensing pharmacy the information needed to complete the
[official prescription form or] electronic prescription record.
(i) Each dispensing pharmacist shall:
(1) [fill in on the official prescription form or]
note in the electronic prescription record each item of information
given orally to the dispensing pharmacy under Subsection (h) and
the date the prescription is filled[,] and[:
[(A) for a written prescription, fill in the
dispensing pharmacist's signature; or
[(B) for an electronic prescription,]
appropriately record the identity of the dispensing pharmacist in
the electronic prescription record;
(2) retain with the records of the pharmacy for at
least two years:
(A) [the official prescription form or] the
electronic prescription record[, as applicable]; and
(B) the name or other patient identification
required by Section 481.074(m) or (n); and
(3) send all required information, including any
information required to complete an [official prescription form or]
electronic prescription record, to the board by electronic transfer
or another form approved by the board not later than the next
business day after the date the prescription is completely filled.
(j) A medication order written for a patient who is admitted
to a hospital at the time the medication order is written and filled
is not required to be recorded [on an official prescription form or]
in an electronic prescription record that meets the requirements of
this section.
SECTION 7. Subchapter C, Chapter 481, Health and Safety
Code, is amended by adding Sections 481.0755 and 481.0756 to read as
follows:
Sec. 481.0755. WRITTEN, ORAL, AND TELEPHONICALLY
COMMUNICATED PRESCRIPTIONS. (a) Notwithstanding Sections 481.074
and 481.075, a prescription for a controlled substance is not
required to be issued electronically and may be issued in writing if
the prescription is issued:
(1) by a veterinarian;
(2) in circumstances in which electronic prescribing
is not available due to temporary technological or electronic
failure, as prescribed by board rule;
(3) by a practitioner to be dispensed by a pharmacy
located outside this state, as prescribed by board rule;
(4) when the prescriber and dispenser are in the same
location or under the same license;
(5) in circumstances in which necessary elements are
not supported by the most recently implemented national data
standard that facilitates electronic prescribing;
(6) for a drug for which the United States Food and
Drug Administration requires additional information in the
prescription that is not possible with electronic prescribing;
(7) for a non-patient-specific prescription pursuant
to a standing order, approved protocol for drug therapy,
collaborative drug management, or comprehensive medication
management, in response to a public health emergency or in other
circumstances in which the practitioner may issue a
non-patient-specific prescription;
(8) for a drug under a research protocol;
(9) by a practitioner who has received a waiver under
Section 481.0756 from the requirement to use electronic
prescribing;
(10) under circumstances in which the practitioner has
the present ability to submit an electronic prescription but
reasonably determines that it would be impractical for the patient
to obtain the drugs prescribed under the electronic prescription in
a timely manner and that a delay would adversely impact the
patient's medical condition; or
(11) before January 1, 2021.
(b) A dispensing pharmacist who receives a controlled
substance prescription in a manner other than electronically is not
required to verify that the prescription is exempt from the
requirement that it be submitted electronically. The pharmacist
may dispense a controlled substance pursuant to an otherwise valid
written, oral, or telephonically communicated prescription
consistent with the requirements of this subchapter.
(c) Except in an emergency, a practitioner must use a
written prescription to submit a prescription described by
Subsection (a). In an emergency, the practitioner may submit an
oral or telephonically communicated prescription as authorized
under Section 481.074(b-1).
(d) A written prescription for a controlled substance other
than a Schedule II controlled substance must include the
information required under Section 481.074(k) and the signature of
the prescribing practitioner.
(e) A written prescription for a Schedule II controlled
substance must be on an official prescription form and include the
information required for an electronic prescription under Section
481.075(e), the signature of the practitioner, and the signature of
the dispensing pharmacist after the prescription is filled.
(f) The board by rule shall authorize a practitioner to
determine whether it is necessary to obtain a particular patient
identification number and to provide that number on the official
prescription form.
(g) On request of a practitioner, the board shall issue
official prescription forms to the practitioner for a fee covering
the actual cost of printing, processing, and mailing the forms.
Before mailing or otherwise delivering prescription forms to a
practitioner, the board shall print on each form the number of the
form and any other information the board determines is necessary.
(h) Each official prescription form must be sequentially
numbered.
(i) A person may not obtain an official prescription form
unless the person is a practitioner as defined by Section
481.002(39)(A) or an institutional practitioner.
(j) Not more than one Schedule II prescription may be
recorded on an official prescription form.
(k) Not later than the 30th day after the date a
practitioner's Federal Drug Enforcement Administration number or
license to practice has been denied, suspended, canceled,
surrendered, or revoked, the practitioner shall return to the board
all official prescription forms in the practitioner's possession
that have not been used for prescriptions.
(l) Each prescribing practitioner:
(1) may use an official prescription form only to
submit a prescription described by Subsection (a);
(2) shall date or sign an official prescription form
only on the date the prescription is issued; and
(3) shall take reasonable precautionary measures to
ensure that an official prescription form issued to the
practitioner is not used by another person to violate this
subchapter or a rule adopted under this subchapter.
(m) In the case of an emergency oral or telephonically
communicated prescription described by Section 481.074(b-1), the
prescribing practitioner shall give the dispensing pharmacy the
information needed to complete the official prescription form if
the pharmacy is not required to use the electronic prescription
record.
(n) Each dispensing pharmacist receiving an oral or
telephonically communicated prescription under Subsection (m)
shall:
(1) fill in on the official prescription form each
item of information given orally to the dispensing pharmacy under
Subsection (m) and the date the prescription is filled and fill in
the dispensing pharmacist's signature;
(2) retain with the records of the pharmacy for at
least two years:
(A) the official prescription form; and
(B) the name or other patient identification
required by Section 481.074(m) or (n); and
(3) send all required information, including any
information required to complete an official prescription form, to
the board by electronic transfer or another form approved by the
board not later than the next business day after the date the
prescription is completely filled.
Sec. 481.0756. WAIVERS FROM ELECTRONIC PRESCRIBING. (a)
The appropriate regulatory agency that issued the license,
certification, or registration to a prescriber is authorized to
grant a prescriber a waiver from the electronic prescribing
requirement under the provisions of this section.
(b) The board shall convene an interagency workgroup that
includes representatives of each regulatory agency that issues a
license, certification, or registration to a prescriber.
(c) The work group described by Subsection (b) shall
establish recommendations and standards for circumstances in which
a waiver from the electronic prescribing requirement is appropriate
and a process under which a prescriber may request and receive a
waiver.
(d) The board shall adopt rules establishing the
eligibility for a waiver, including:
(1) economic hardship;
(2) technological limitations not reasonably within
the control of the prescriber; or
(3) other exceptional circumstances demonstrated by
the prescriber.
(e) Each regulatory agency that issues a license,
certification, or registration to a prescriber shall adopt rules
for the granting of waivers consistent with the board rules adopted
under Subsection (d).
(f) A waiver may be issued to a prescriber for a period of
one year. A prescriber may reapply for a subsequent waiver not
earlier than the 30th day before the date the waiver expires if the
circumstances that necessitated the waiver continue.
SECTION 8. Sections 481.0761(c) and (d), Health and Safety
Code, are amended to read as follows:
(c) The board by rule may:
(1) [permit more than one prescription to be
administered or dispensed and recorded on one prescription form for
a Schedule III through V controlled substance;
[(1-a)] establish a procedure for the issuance of
multiple prescriptions of a Schedule II controlled substance under
Section 481.074(d-1);
(2) remove from or return to the official prescription
program any aspect of a practitioner's or pharmacist's hospital
practice, including administering or dispensing;
(3) waive or delay any requirement relating to the
time or manner of reporting;
(4) establish compatibility protocols for electronic
data transfer hardware, software, or format, including any
necessary modifications for participation in a database described
by Section 481.076(j);
(5) establish a procedure to control the release of
information under Sections 481.074, 481.075, and 481.076; and
(6) establish a minimum level of prescription activity
below which a reporting activity may be modified or deleted.
(d) The board by rule shall authorize a practitioner to
determine whether it is necessary to obtain a particular patient
identification number and to provide that number [on the official
prescription form or] in the electronic prescription record.
SECTION 9. Subchapter C, Chapter 481, Health and Safety
Code, is amended by adding Sections 481.07635 and 481.07636 to read
as follows:
Sec. 481.07635. CONTINUING EDUCATION. (a) A person
authorized to receive information under Section 481.076(a)(5)
shall, not later than the first anniversary after the person is
issued a license, certification, or registration to prescribe or
dispense controlled substances under this chapter, complete two
hours of professional education related to approved procedures of
prescribing and monitoring controlled substances.
(b) A person authorized to receive information may annually
take the professional education course under this section to fulfil
hours toward the ethics education requirement of the person's
license, certification, or registration.
(c) The regulatory agency that issued the license,
certification, or registration to a person authorized to receive
information under Section 481.076(a)(5) shall approve professional
education to satisfy the requirements of this section.
Sec. 481.07636. OPIOID PRESCRIPTION LIMITS. (a) In this
section, "acute pain" means the normal, predicted, physiological
response to a stimulus such as trauma, disease, and operative
procedures. Acute pain is time limited. The term does not include:
(1) chronic pain;
(2) pain being treated as part of cancer care;
(3) pain being treated as part of hospice or other
end-of-life care; or
(4) pain being treated as part of palliative care.
(b) For the treatment of acute pain, a practitioner may not:
(1) issue a prescription for an opioid in an amount
that exceeds a 10-day supply; or
(2) provide for a refill of an opioid.
(c) Subsection (b) does not apply to a prescription for an
opioid approved by the United States Food and Drug Administration
for the treatment of substance addiction that is issued by a
practitioner for the treatment of substance addiction.
(d) A dispenser is not subject to criminal, civil, or
administrative penalties for dispensing or refusing to dispense a
controlled substance under a prescription that exceeds the limits
provided by Subsection (b).
SECTION 10. Section 481.128(a), Health and Safety Code, is
amended to read as follows:
(a) A registrant or dispenser commits an offense if the
registrant or dispenser knowingly:
(1) distributes, delivers, administers, or dispenses
a controlled substance in violation of Subchapter C [Sections
481.070-481.075];
(2) manufactures a controlled substance not
authorized by the person's Federal Drug Enforcement Administration
registration or distributes or dispenses a controlled substance not
authorized by the person's registration to another registrant or
other person;
(3) refuses or fails to make, keep, or furnish a
record, report, notification, order form, statement, invoice, or
information required by this chapter;
(4) prints, manufactures, possesses, or produces an
official prescription form without the approval of the board;
(5) delivers or possesses a counterfeit official
prescription form;
(6) refuses an entry into a premise for an inspection
authorized by this chapter;
(7) refuses or fails to return an official
prescription form as required by Section 481.0755(k) [481.075(k)];
(8) refuses or fails to make, keep, or furnish a
record, report, notification, order form, statement, invoice, or
information required by a rule adopted by the director or the board;
or
(9) refuses or fails to maintain security required by
this chapter or a rule adopted under this chapter.
SECTION 11. Section 481.129(a), Health and Safety Code, is
amended to read as follows:
(a) A person commits an offense if the person knowingly:
(1) distributes as a registrant or dispenser a
controlled substance listed in Schedule I or II, unless the person
distributes the controlled substance as authorized under the
federal Controlled Substances Act (21 U.S.C. Section 801 et seq.);
(2) uses in the course of manufacturing, prescribing,
or distributing a controlled substance a Federal Drug Enforcement
Administration registration number that is fictitious, revoked,
suspended, or issued to another person;
(3) issues a prescription bearing a forged or
fictitious signature;
(4) uses a prescription issued to another person to
prescribe a Schedule II controlled substance;
(5) possesses, obtains, or attempts to possess or
obtain a controlled substance or an increased quantity of a
controlled substance:
(A) by misrepresentation, fraud, forgery,
deception, or subterfuge;
(B) through use of a fraudulent prescription
form; [or]
(C) through use of a fraudulent oral or
telephonically communicated prescription; or
(D) through the use of a fraudulent electronic
prescription; or
(6) furnishes false or fraudulent material
information in or omits material information from an application,
report, record, or other document required to be kept or filed under
this chapter.
SECTION 12. Section 32.024, Human Resources Code, is
amended by adding Subsection (z-2) to read as follows:
(z-2) The limits on prescription drugs and medications
under the medical assistance program provided by Subsections (z)
and (z-1) do not apply to a prescription for an opioid for the
treatment of acute pain under Section 481.07636, Health and Safety
Code.
SECTION 13. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.03115 to read as follows:
Sec. 32.03115. REIMBURSEMENT FOR MEDICATION-ASSISTED
TREATMENT FOR OPIOID OR SUBSTANCE USE DISORDER. (a) In this
section, "medication-assisted opioid or substance use disorder
treatment" means the use of methadone, buprenorphine, oral
buprenorphine/naloxone, or naltrexone to treat opioid or substance
use disorder.
(b) Notwithstanding Sections 531.072 and 531.073,
Government Code, or any other law and subject to Subsections (c) and
(d), the commission shall provide medical assistance reimbursement
for medication-assisted opioid or substance use disorder treatment
without requiring a recipient of medical assistance or health care
provider to obtain prior authorization or precertification for the
treatment, except as needed to minimize the opportunity for fraud,
waste, or abuse.
(c) The duty to provide medical assistance reimbursement
for medication-assisted opioid or substance use disorder treatment
under Subsection (b) does not apply with respect to:
(1) a prescription for methadone;
(2) a recipient for whom medication-assisted opioid or
substance use disorder treatment is determined to be medically
contraindicated by the recipient's physician; or
(3) a recipient who is subject to an age-related
restriction applicable to medication-assisted opioid or substance
use disorder treatment.
(d) The commission may provide medical assistance
reimbursement for medication-assisted opioid or substance use
disorder treatment only if the treatment is prescribed to a
recipient of medical assistance by a licensed health care provider
who is authorized to prescribe methadone, buprenorphine, oral
buprenorphine/naloxone, or naltrexone.
(e) This section expires August 31, 2023.
SECTION 14. Section 554.051(a-1), Occupations Code, is
amended to read as follows:
(a-1) The board may adopt rules to administer Sections
[481.073,] 481.074, 481.075, 481.0755, 481.0756, 481.076,
481.0761, 481.0762, 481.0763, 481.07635, 481.07636, 481.0764,
481.0765, and 481.0766, Health and Safety Code.
SECTION 15. Section 565.003, Occupations Code, is amended
to read as follows:
Sec. 565.003. ADDITIONAL GROUNDS FOR DISCIPLINE REGARDING
APPLICANT FOR OR HOLDER OF NONRESIDENT PHARMACY LICENSE. Unless
compliance would violate the pharmacy or drug statutes or rules in
the state in which the pharmacy is located, the board may discipline
an applicant for or the holder of a nonresident pharmacy license if
the board finds that the applicant or license holder has failed to
comply with:
(1) Section 481.074, [or] 481.075, 481.0755,
481.0756, 481.076, 481.0761, 481.0762, 481.0763, 481.07635,
481.07636, 481.0764, 481.0765, or 481.0766, Health and Safety Code;
(2) Texas substitution requirements regarding:
(A) the practitioner's directions concerning
generic substitution;
(B) the patient's right to refuse generic
substitution; or
(C) notification to the patient of the patient's
right to refuse substitution;
(3) any board rule relating to providing drug
information to the patient or the patient's agent in written form or
by telephone; or
(4) any board rule adopted under Section 554.051(a)
and determined by the board to be applicable under Section
554.051(b).
SECTION 16. Sections 481.073, 481.074(o) and (p), and
481.075(b), (c), (d), (f), (k), and (l), Health and Safety Code, are
repealed.
SECTION 17. A person who holds a license, certification, or
registration to prescribe or dispense a controlled substance issued
before September 1, 2020, is required to take the continuing
education course provided by Section 481.07635, Health and Safety
Code, as added by this Act, not later than September 1, 2021.
SECTION 18. (a) In this section, "qualifying
practitioner" has the meaning assigned by 21 U.S.C. Section
823(g)(2)(G)(iii).
(
b) Not later than November 1, 2019, the Health and Human
Services Commission shall amend the commission's Medicaid
Substance Use Disorder Services Medical Policy and any other
provider or claims payment policy or manual necessary to authorize
Medicaid medical benefits reimbursement for the prescribing of
buprenorphine for the treatment of an opioid use disorder by an
advanced practice registered nurse recognized by the Texas Board of
Nursing as a clinical nurse specialist, nurse anesthetist, or nurse
midwife, provided that the advanced practice registered nurse:
(1) is a qualifying practitioner;
(2) has obtained a waiver from registration
requirements as provided by 21 U.S.C. Section 823(g); and
(3) is acting under adequate physician supervision and
a physician's delegation under Section 157.0512 or 157.054,
Occupations Code.
SECTION 19. If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 20. This Act takes effect September 1, 2019.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 2174 was passed by the House on April
25, 2019, by the following vote: Yeas 129, Nays 4, 1 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 2174 on May 24, 2019, by the following vote: Yeas 131, Nays 9,
3 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 2174 was passed by the Senate, with
amendments, on May 21, 2019, by the following vote: Yeas 28, Nays
3.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor