Bill Text: TX HB3395 | 2017-2018 | 85th Legislature | Introduced

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Bill Title: Relating to the authority of advanced practice registered nurses practicing in certain areas.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2017-04-25 - Left pending in committee [HB3395 Detail]

Download: Texas-2017-HB3395-Introduced.html

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85R13070 EES-D
By: Price H.B. No. 3395

A BILL TO BE ENTITLED
AN ACT
relating to the authority of advanced practice registered nurses
practicing in certain areas.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. INDEPENDENT PRACTICE AND PRESCRIPTIVE AUTHORITY FOR
ADVANCED PRACTICE REGISTERED NURSES PRACTICING IN CERTAIN AREAS
SECTION 1.001. Section 301.002, Occupations Code, is
amended by amending Subdivision (2) and adding Subdivisions (6) and
(7) 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 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, or Section 301.357;
(G) the performance 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 prescribing and ordering of drugs and
devices by an advanced practice registered nurse as authorized by
the board under Section 301.357.
(6) "Controlled substance" has the meaning assigned by
Section 157.051.
(7) "Prescribe or order a drug or device" has the
meaning assigned by Section 157.051.
SECTION 1.002. 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 as authorized by the
board under Section 301.357;
(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 as authorized by
the board under Section 301.357 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 1.003. Subchapter H, Chapter 301, Occupations Code,
is amended by adding Section 301.357 to read as follows:
Sec. 301.357. INDEPENDENT PRACTICE BY AND PRESCRIBING AND
ORDERING AUTHORITY OF CERTAIN ADVANCED PRACTICE REGISTERED NURSES.
(a) An advanced practice registered nurse may practice as a
licensed independent practitioner if the advanced practice
registered nurse is practicing in a county:
(1) in which there are no practicing primary care
physicians; and
(2) that:
(A) has been designated as a medically
underserved area under state or federal law; or
(B) contains a medically underserved population.
(b) The board may authorize an advanced practice registered
nurse practicing in a county described by Subsection (a) to
prescribe and order drugs and devices, excluding controlled
substances, if the advanced practice registered nurse has been
issued a prescription authorization number under Section
301.152(b).
ARTICLE 2. CONFORMING AMENDMENTS
SECTION 2.001. 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 301.152,
Occupations Code.
SECTION 2.002. Section 671.001(b), Government Code, is
amended 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) if applicable, 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;
(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 2.003. Sections 483.001(4) and (12), 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) [a] an advanced practice 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, or an advanced practice registered
nurse authorized by a practitioner to carry out a prescription drug
order for dangerous drugs under other law.
(12) "Practitioner" means:
(A) a person licensed by the Texas Medical Board,
State Board of Dental Examiners, Texas State Board of Podiatric
Medical Examiners, Texas Optometry Board, Texas Board of Nursing,
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 prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054, Occupations Code.
SECTION 2.004. 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 301.357,
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 2.005. 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 who is
authorized to provide care by the physician under other law, 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 2.006. 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. The term does not include a physician.
SECTION 2.007. Section 1301.052, Insurance Code, is amended
to read as follows:
Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED
NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
offering a preferred provider benefit plan may not refuse a request
made by a physician participating as a preferred provider under the
plan and an advanced practice registered nurse or physician
assistant to have the advanced practice registered nurse or
physician assistant included as a preferred provider under the plan
if:
(1) the advanced practice registered nurse or
physician assistant is authorized by the physician to provide care
under Subchapter B, Chapter 157, Occupations Code, or the advanced
practice registered nurse is authorized to provide care by the
physician under other law; and
(2) the advanced practice registered nurse or
physician assistant meets the quality of care standards previously
established by the insurer for participation in the plan by
advanced practice registered nurses and physician assistants.
SECTION 2.008. Section 1451.001(2), Insurance Code, is
amended to read as follows:
(2) "Advanced practice registered nurse" means an
individual licensed by the Texas Board of Nursing as a registered
nurse and licensed [recognized] by that board as an advanced
practice registered nurse.
SECTION 2.009. Section 1451.104(c), Insurance Code, is
amended to read as follows:
(c) Notwithstanding Subsection (a), a health insurance
policy may provide for a different amount of payment or
reimbursement for scheduled services or procedures performed by an
advanced practice registered nurse, nurse first assistant,
licensed surgical assistant, or physician assistant if the
methodology used to compute the amount is the same as the
methodology used to compute the amount of payment or reimbursement
when the services or procedures are provided by a physician.
SECTION 2.010. Section 1451.106, Insurance Code, is amended
to read as follows:
Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED
NURSE. An insured may select an advanced practice registered nurse
to provide the services scheduled in the health insurance policy
that are within the scope of the nurse's license.
SECTION 2.011. 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 301.152,
Occupations Code.
SECTION 2.012. 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) 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, or an
advanced practice registered nurse authorized by a practitioner to
administer a prescription drug order for a dangerous drug under
other law.
(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, 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 prescribe or order a drug or device under Section 157.0511,
157.0512, or 157.054.
SECTION 2.013. 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, "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.
(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 an advanced
practice registered nurse who is authorized to prescribe and order
drugs and devices under Section 301.357 and 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 2.014. Section 605.002(14), Occupations Code, is
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 [an] advanced practice
registered nurse, or from 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.
SECTION 2.015. 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 [an] advanced practice
registered nurse, or from 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 [an] advanced practice
registered nurse, or from 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.
ARTICLE 3. TRANSITION AND EFFECTIVE DATE
SECTION 3.001. Not later than February 1, 2018, the Texas
Board of Nursing shall adopt the rules necessary to implement the
changes in law made by this Act.
SECTION 3.002. This Act takes effect September 1, 2017.