Bill Text: TX HB343 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to the prescriptive authority of certain psychologists; authorizing a fee.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2023-02-23 - Referred to Public Health [HB343 Detail]
Download: Texas-2023-HB343-Introduced.html
88R1577 DIO-D | ||
By: Goodwin | H.B. No. 343 |
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relating to the prescriptive authority of certain psychologists; | ||
authorizing a fee. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 501.002, Occupations Code, is amended by | ||
adding Subdivision (2-a) to read as follows: | ||
(2-a) "Prescription drug" and "prescription drug | ||
order" have the meanings assigned by Section 551.003. | ||
SECTION 2. Section 501.003(a)(1), Occupations Code, is | ||
amended to read as follows: | ||
(1) "Practice of psychology" means: | ||
(A) the observation, description, diagnosis, | ||
evaluation, assessment, interpretation, or treatment of and | ||
intervention in human behavior by applying education, training, | ||
methods, and procedures for the purpose of: | ||
(i) preventing, predicting, treating, | ||
remediating, or eliminating: | ||
(a) symptomatic, maladaptive, or | ||
undesired behavior; | ||
(b) emotional, interpersonal, | ||
learning, substance use, neuropsychological, cognitive, or | ||
behavioral disorders or disabilities, including those that | ||
accompany medical problems; or | ||
(c) mental illness; | ||
(ii) evaluating, assessing, or | ||
facilitating, by a license holder or a person who represents the | ||
person to the public by a title or description of services that | ||
includes the word "psychological," "psychologist," or | ||
"psychology," the enhancement of individual, group, or | ||
organizational effectiveness, including evaluating, assessing, or | ||
facilitating: | ||
(a) personal effectiveness; | ||
(b) adaptive behavior; | ||
(c) interpersonal relationships; | ||
(d) academic, vocational, and life | ||
adjustment; | ||
(e) health; or | ||
(f) individual, group, or | ||
organizational performance; | ||
(iii) providing psychological, | ||
neuropsychological, and psychoeducational evaluation, therapy, and | ||
remediation as well as counseling, psychoanalysis, psychotherapy, | ||
hypnosis, and biofeedback; or | ||
(iv) consulting with others, including | ||
other mental health professionals, physicians, school personnel, | ||
or organizations within the scope of the provider's competency and | ||
training with respect to services provided for a specific | ||
individual; [ |
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(B) action taken under the authority granted by a | ||
prescriptive authority certificate issued under Section 501.353; | ||
or | ||
(C) the supervision of an activity or service | ||
described by Paragraph (A) or (B). | ||
SECTION 3. Section 501.051(b), Occupations Code, is amended | ||
to read as follows: | ||
(b) To ensure adequate representation on the board of the | ||
diverse fields of psychology, the governor in making appointments | ||
under Subsection (a)(1) shall appoint: | ||
(1) at least two members who provide psychological | ||
services, at least one of whom holds a prescriptive authority | ||
certificate issued under Section 501.353; | ||
(2) at least one member who conducts research in the | ||
field of psychology; and | ||
(3) at least one member who teaches as a member of the | ||
faculty of a psychological training institution. | ||
SECTION 4. Subchapter D, Chapter 501, Occupations Code, is | ||
amended by adding Section 501.152 to read as follows: | ||
Sec. 501.152. ADVISORY COMMITTEE ON PRESCRIPTIVE | ||
AUTHORITY. (a) The executive council shall appoint an advisory | ||
committee on prescriptive authority for psychologists. | ||
(a-1) Effective September 1, 2023, the advisory committee | ||
consists of six members as follows: | ||
(1) three members who each hold a prescriptive | ||
authority certificate issued under Section 501.353; | ||
(2) one member who is a psychiatrist; | ||
(3) one member who is a pediatrician; and | ||
(4) one member who represents the public. | ||
(a-2) This subsection and Subsection (a-1) expire September | ||
1, 2026. | ||
(b) Effective September 1, 2026, the advisory committee | ||
consists of six members as follows: | ||
(1) five members who each hold a prescriptive | ||
authority certificate issued under Section 501.353; and | ||
(2) one member who represents the public. | ||
(c) The advisory committee shall make recommendations to | ||
the executive council and board regarding the regulation of | ||
psychologists who hold prescriptive authority certificates issued | ||
under Section 501.353, including recommendations concerning rules | ||
to establish: | ||
(1) eligibility requirements; and | ||
(2) standards of practice for certificate holders. | ||
(d) Chapter 2110, Government Code, does not apply to the | ||
composition or duration of the advisory committee. | ||
SECTION 5. Subchapter G, Chapter 501, Occupations Code, is | ||
amended by adding Section 501.302 to read as follows: | ||
Sec. 501.302. CONTINUING EDUCATION. The executive council | ||
by rule shall require that, of the minimum number of hours of | ||
continuing education required to renew a license as a psychologist, | ||
half of that number of hours or 10 hours, whichever is less, must be | ||
in the areas of pharmacology and pathophysiology if the | ||
psychologist holds a prescriptive authority certificate issued | ||
under Section 501.353. | ||
SECTION 6. Subchapter H, Chapter 501, Occupations Code, is | ||
amended by adding Sections 501.353 and 501.354 to read as follows: | ||
Sec. 501.353. PRESCRIPTIVE AUTHORITY CERTIFICATE. (a) The | ||
executive council shall issue a prescriptive authority certificate | ||
to a psychologist who: | ||
(1) meets the eligibility requirements of Subsection | ||
(b); | ||
(2) submits an application on a form prescribed by the | ||
executive council; | ||
(3) has not, in the two-year period preceding the date | ||
of the application, had a prescriptive authority certificate | ||
revoked; and | ||
(4) pays the fee set by the executive council. | ||
(b) To be eligible for a prescriptive authority certificate | ||
a psychologist must: | ||
(1) have completed a training program in | ||
psychopharmacology from an institution of higher education or a | ||
provider of continuing education approved by the executive council | ||
that includes instruction in: | ||
(A) basic life sciences; | ||
(B) neuroscience; | ||
(C) clinical and research pharmacology and | ||
psychopharmacology; | ||
(D) clinical pathophysiology; | ||
(E) physical assessments and laboratory | ||
examinations; | ||
(F) clinical pharmacotherapeutics; and | ||
(G) ethical and legal issues relevant to | ||
prescriptive authority and associated research; | ||
(2) pass a nationally recognized examination approved | ||
by the executive council in the area of prescriptive authority; and | ||
(3) provide evidence of professional liability | ||
coverage. | ||
(c) A psychologist who holds a prescriptive authority | ||
certificate is authorized to: | ||
(1) issue a prescription drug order; | ||
(2) administer or dispense a prescription drug; | ||
(3) order tests commonly associated with monitoring | ||
the use of prescription drugs; and | ||
(4) represent that the psychologist holds a | ||
prescriptive authority certificate. | ||
(d) The authority of a psychologist to issue a prescription | ||
drug order or administer or dispense a prescription drug under a | ||
prescriptive authority certificate is limited to a drug or device | ||
related to the diagnosis, treatment, or management of emotional, | ||
interpersonal, learning, substance use, neuropsychological, | ||
cognitive, or behavioral disorders or disabilities, or mental | ||
illness. A prescriptive authority certificate does not authorize | ||
the prescribing, administering, or dispensing of an opioid. | ||
(e) A psychologist who holds a prescriptive authority | ||
certificate may only practice under the supervision of a physician | ||
or a psychologist who meets the requirements of Section 501.354 | ||
until the certificate holder satisfies the supervised experience | ||
requirement of that section. | ||
(f) The executive council shall adopt rules to protect the | ||
health of patients by requiring a psychologist who holds a | ||
prescriptive authority certificate to notify a patient's primary | ||
care physician or provider, if any, before the psychologist: | ||
(1) issues a prescription drug order for a drug or | ||
otherwise changes the type or dosage of any drug prescribed for the | ||
patient; or | ||
(2) administers or dispenses a prescription drug to | ||
the patient. | ||
(g) A primary care provider is not liable for an act of a | ||
psychologist acting under a prescriptive authority certificate | ||
based solely on the provider receiving a notification under | ||
Subsection (f). | ||
Sec. 501.354. REQUIRED SUPERVISED EXPERIENCE FOR | ||
PRESCRIPTIVE AUTHORITY CERTIFICATE HOLDER. (a) Not later than the | ||
second anniversary of the date of issuance of a prescriptive | ||
authority certificate, the psychologist who holds the certificate | ||
must complete at least 2,000 hours of practice under the authority | ||
of the certificate treating not less than 100 patients under the | ||
supervision of a physician or a psychologist who has maintained a | ||
prescriptive authority certificate for the three years preceding | ||
the date the supervision began. The supervision must be under a | ||
written agreement approved by the executive council that requires | ||
periodic meetings between the psychologist and supervising | ||
provider. | ||
(b) A physician or psychologist may not at any time | ||
supervise under this section more than the full-time equivalent of | ||
seven psychologists. | ||
(c) Unless the supervising provider has reason to believe | ||
the psychologist lacked the competency to perform the act, a | ||
supervising provider is not liable for an act of a psychologist | ||
solely because the provider entered into an agreement to supervise | ||
the psychologist. | ||
(d) The executive council shall revoke the prescriptive | ||
authority certificate of a psychologist who does not complete the | ||
supervised experience as required by Subsection (a). | ||
SECTION 7. 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, psychologist, 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, psychologist, | ||
or podiatrist, having a current Federal Drug Enforcement | ||
Administration registration number, who may legally prescribe | ||
Schedule II, III, IV, or V controlled substances in that state; or | ||
(D) an advanced practice registered nurse or | ||
physician assistant to whom a physician has delegated the authority | ||
to prescribe or order a drug or device under Section 157.0511, | ||
157.0512, or 157.054, Occupations Code. | ||
SECTION 8. Section 481.074(d), Health and Safety Code, is | ||
amended to read as follows: | ||
(d) Except as specified in Subsections (e) and (f), the | ||
board, by rule and in consultation with the Texas Medical Board and | ||
the Texas Behavioral Health Executive Council, shall establish the | ||
period after the date on which the prescription is issued that a | ||
person may fill a prescription for a controlled substance listed in | ||
Schedule II. A person may not refill a prescription for a substance | ||
listed in Schedule II. | ||
SECTION 9. Sections 481.076(a) and (c), Health and Safety | ||
Code, are amended to read as follows: | ||
(a) The board may not permit any person to have access to | ||
information submitted to the board under Section 481.074(q) or | ||
481.075 except: | ||
(1) the board, the Texas Medical Board, the Texas | ||
Department of Licensing and Regulation, with respect to the | ||
regulation of podiatrists, the State Board of Dental Examiners, the | ||
State Board of Veterinary Medical Examiners, the Texas Board of | ||
Nursing, [ |
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Health Executive Council, with respect to the regulation of | ||
psychologists, for the purpose of: | ||
(A) investigating a specific license holder; or | ||
(B) monitoring for potentially harmful | ||
prescribing or dispensing patterns or practices under Section | ||
481.0762; | ||
(2) an authorized employee of the board engaged in the | ||
administration, investigation, or enforcement of this chapter or | ||
another law governing illicit drugs in this state or another state; | ||
(3) the department or other law enforcement or | ||
prosecutorial official engaged in the administration, | ||
investigation, or enforcement of this chapter or another law | ||
governing illicit drugs in this state or another state, if the board | ||
is provided a warrant, subpoena, or other court order compelling | ||
the disclosure; | ||
(4) a medical examiner conducting an investigation; | ||
(5) provided that accessing the information is | ||
authorized under the Health Insurance Portability and | ||
Accountability Act of 1996 (Pub. L. No. 104-191) and regulations | ||
adopted under that Act: | ||
(A) a pharmacist or a pharmacist-intern, | ||
pharmacy technician, or pharmacy technician trainee, as defined by | ||
Section 551.003, Occupations Code, acting at the direction of a | ||
pharmacist, who is inquiring about a recent Schedule II, III, IV, or | ||
V prescription history of a particular patient of the pharmacist; | ||
or | ||
(B) a practitioner who: | ||
(i) is a physician, dentist, veterinarian, | ||
podiatrist, optometrist, psychologist, or advanced practice nurse | ||
or is a physician assistant described by Section 481.002(39)(D) or | ||
an employee or other agent of a practitioner acting at the direction | ||
of a practitioner; and | ||
(ii) is inquiring about a recent Schedule | ||
II, III, IV, or V prescription history of a particular patient of | ||
the practitioner; | ||
(6) a pharmacist or practitioner who is inquiring | ||
about the person's own dispensing or prescribing activity or a | ||
practitioner who is inquiring about the prescribing activity of an | ||
individual to whom the practitioner has delegated prescribing | ||
authority; | ||
(7) one or more states or an association of states with | ||
which the board has an interoperability agreement, as provided by | ||
Subsection (j); | ||
(8) a health care facility certified by the federal | ||
Centers for Medicare and Medicaid Services; or | ||
(9) the patient, the patient's parent or legal | ||
guardian, if the patient is a minor, or the patient's legal | ||
guardian, if the patient is an incapacitated person, as defined by | ||
Section 1002.017(2), Estates Code, inquiring about the patient's | ||
prescription record, including persons who have accessed that | ||
record. | ||
(c) The board by rule shall design and implement a system | ||
for submission of information to the board by electronic or other | ||
means and for retrieval of information submitted to the board under | ||
this section and Sections 481.074 and 481.075. The board shall use | ||
automated information security techniques and devices to preclude | ||
improper access to the information. The board shall submit the | ||
system design to the director, [ |
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the Texas Behavioral Health Executive Council for review and | ||
comment a reasonable time before implementation of the system and | ||
shall comply with the comments of those agencies unless it is | ||
unreasonable to do so. | ||
SECTION 10. Section 483.001(12), Health and Safety Code, is | ||
amended to read as follows: | ||
(12) "Practitioner" means: | ||
(A) a person [ |
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(i) licensed by the Texas Medical Board, | ||
State Board of Dental Examiners, Texas Optometry Board, or State | ||
Board of Veterinary Medical Examiners to prescribe and administer | ||
dangerous drugs; [ |
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(ii) licensed by the Texas Department of | ||
Licensing and Regulation, with respect to podiatry, to prescribe | ||
and administer dangerous drugs; or | ||
(iii) certified by the Texas Behavioral | ||
Health Executive Council, with respect to psychology, 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 11. Sections 576.025(b), (c), (e), and (f), Health | ||
and Safety Code, are amended to read as follows: | ||
(b) Consent to the administration of psychoactive | ||
medication given by a patient or by a person authorized by law to | ||
consent on behalf of the patient is valid only if: | ||
(1) the consent is given voluntarily and without | ||
coercive or undue influence; | ||
(2) the treating physician, a treating psychologist | ||
who holds a prescriptive authority certificate, or a person | ||
designated by the physician or psychologist, provided the following | ||
information, in a standard format approved by the department, to | ||
the patient and, if applicable, to the patient's representative | ||
authorized by law to consent on behalf of the patient: | ||
(A) the specific condition to be treated; | ||
(B) the beneficial effects on that condition | ||
expected from the medication; | ||
(C) the probable health and mental health | ||
consequences of not consenting to the medication; | ||
(D) the probable clinically significant side | ||
effects and risks associated with the medication; | ||
(E) the generally accepted alternatives to the | ||
medication, if any, and why the physician or psychologist | ||
recommends that they be rejected; and | ||
(F) the proposed course of the medication; | ||
(3) the patient and, if appropriate, the patient's | ||
representative authorized by law to consent on behalf of the | ||
patient is informed in writing that consent may be revoked; and | ||
(4) the consent is evidenced in the patient's clinical | ||
record by a signed form prescribed by the facility or by a statement | ||
of the [ |
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Subdivision (2), or a person designated by the physician or the | ||
psychologist, that documents that consent was given by the | ||
appropriate person and the circumstances under which the consent | ||
was obtained. | ||
(c) If the [ |
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by Subsection (b)(2) designates another person to provide the | ||
information under Subsection (b), then, not later than two working | ||
days after that person provides the information, excluding weekends | ||
and legal holidays, the physician or psychologist shall meet with | ||
the patient and, if appropriate, the patient's representative who | ||
provided the consent, to review the information and answer any | ||
questions. | ||
(e) In prescribing psychoactive medication, a [ |
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physician or psychologist described by Subsection (b)(2) shall: | ||
(1) prescribe, consistent with clinically appropriate | ||
medical care, the medication that has the fewest side effects or the | ||
least potential for adverse side effects, unless the class of | ||
medication has been demonstrated or justified not to be effective | ||
clinically; and | ||
(2) administer the smallest therapeutically | ||
acceptable dosages of medication for the patient's condition. | ||
(f) If a physician or psychologist described by Subsection | ||
(b)(2) issues an order to administer psychoactive medication to a | ||
patient without the patient's consent because the patient is having | ||
a medication-related emergency: | ||
(1) the physician or psychologist shall document in | ||
the patient's clinical record in specific medical or behavioral | ||
terms the necessity of the order and that the physician or | ||
psychologist has evaluated but rejected other generally accepted, | ||
less intrusive forms of treatment, if any; and | ||
(2) treatment of the patient with the psychoactive | ||
medication shall be provided in the manner, consistent with | ||
clinically appropriate medical care, least restrictive of the | ||
patient's personal liberty. | ||
SECTION 12. 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 health care practitioner legally | ||
authorized to prescribe the medication or treatment [ |
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(D) the supervision or teaching of nursing; | ||
(E) the administration, supervision, and | ||
evaluation of nursing practices, policies, and procedures; | ||
(F) the requesting, receiving, signing for, and | ||
distribution of prescription drug samples to patients at practices | ||
at which an advanced practice registered nurse is authorized to | ||
sign prescription drug orders as provided by Subchapter B, Chapter | ||
157; | ||
(G) the performance 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. | ||
SECTION 13. Section 551.003(34), Occupations Code, is | ||
amended to read as follows: | ||
(34) "Practitioner" means: | ||
(A) a person licensed, certified, 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, psychologist, 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 or certificate 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, | ||
psychologist, 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 14. Section 501.051(b), Occupations Code, as | ||
amended by this Act, does not affect the entitlement of a member | ||
serving on the Texas State Board of Examiners of Psychologists | ||
immediately before the effective date of this Act to continue to | ||
serve for the remainder of the member's term. With the first | ||
appointment of a member described by Section 501.051(a)(1), | ||
Occupations Code, to be made by the governor on or after the | ||
effective date of this Act, the governor shall appoint a member to | ||
the board who has the qualifications required by Section | ||
501.051(b), Occupations Code, as amended by this Act. | ||
SECTION 15. (a) Not later than December 1, 2023, the Texas | ||
Behavioral Health Executive Council shall appoint members of the | ||
advisory committee in accordance with Section 501.152(a-1), | ||
Occupations Code, as added by this Act. | ||
(b) Not later than June 1, 2024, the advisory committee | ||
shall make initial recommendations to the Texas Behavioral Health | ||
Executive Council and the Texas State Board of Examiners of | ||
Psychologists as described by Section 501.152(c), Occupations | ||
Code, as added by this Act. | ||
(c) Not later than December 1, 2026, the Texas Behavioral | ||
Health Executive Council shall appoint members to the advisory | ||
committee so that the composition of the committee complies with | ||
Section 501.152(b), Occupations Code, as added by this Act. | ||
SECTION 16. Not later than September 1, 2024, the Texas | ||
Behavioral Health Executive Council shall adopt rules and | ||
procedures necessary to implement Sections 501.353 and 501.354, | ||
Occupations Code, as added by this Act. | ||
SECTION 17. This Act takes effect September 1, 2023. |