Bill Text: TX HB3567 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to requirements for the renewal of a physician's registration permit and the delegation by a physician of certain medical acts.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2023-03-16 - Referred to Public Health [HB3567 Detail]
Download: Texas-2023-HB3567-Introduced.html
88R12746 DIO-F | ||
By: Allison | H.B. No. 3567 |
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relating to requirements for the renewal of a physician's | ||
registration permit and the delegation by a physician of certain | ||
medical acts. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 156.001, Occupations Code, is amended by | ||
adding Subsection (d-1) to read as follows: | ||
(d-1) A license holder who has entered into a prescriptive | ||
authority agreement under Section 157.0512 shall, at the time the | ||
license holder submits a registration renewal application, make an | ||
electronically signed attestation to the board that periodic | ||
meetings required by Section 157.0512(e)(9)(B) have taken place in | ||
accordance with Section 157.0512(f). | ||
SECTION 2. Section 157.001, Occupations Code, is amended by | ||
amending Subsections (a) and (c) and adding Subsections (a-1) and | ||
(a-2) to read as follows: | ||
(a) A physician may delegate to a qualified and properly | ||
trained person acting under the physician's supervision any medical | ||
act that a reasonable and prudent physician would find within the | ||
scope of sound medical judgment to delegate if, in the opinion of | ||
the delegating physician: | ||
(1) the act: | ||
(A) can be properly and safely performed by the | ||
person to whom the medical act is delegated; | ||
(B) is performed in its customary manner; [ |
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(C) is not in violation of any other statute; and | ||
(D) is within the scope of practice of the | ||
physician's primary specialty during the five-year period | ||
preceding the delegation; and | ||
(2) the person to whom the delegation is made does not | ||
represent to the public that the person is authorized to practice | ||
medicine. | ||
(a-1) The performance of a delegated medical act by a | ||
qualified person must be supervised: | ||
(1) at the location and for the period the delegated | ||
medical act is performed; and | ||
(2) by: | ||
(A) the delegating physician; or | ||
(B) an advanced practice registered nurse or | ||
physician assistant supervised by the delegating physician and to | ||
whom the delegating physician has delegated the supervision of the | ||
qualified person. | ||
(a-2) A delegated medical act may not be performed at a | ||
location that is more than 75 miles from the physician's primary | ||
practice location. | ||
(c) The board may determine whether: | ||
(1) an act constitutes the practice of medicine, not | ||
inconsistent with this chapter; and | ||
(2) a medical act may be properly or safely delegated | ||
and supervised by a physician with a thorough knowledge of the | ||
delegated medical act [ |
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SECTION 3. Section 157.002(b), Occupations Code, is amended | ||
to read as follows: | ||
(b) A physician may delegate to any qualified and properly | ||
trained person acting under the physician's supervision the act of | ||
administering or providing dangerous drugs in the physician's | ||
office, as ordered by the physician, that are used or required to | ||
meet the immediate needs of the physician's patients. The | ||
administration or provision of the dangerous drugs must be | ||
performed in compliance with laws relating to the practice of | ||
medicine and state and federal laws relating to those dangerous | ||
drugs, including a requirement that the proper dosage of a | ||
dangerous drug may be determined only by: | ||
(1) the delegating physician; or | ||
(2) an advanced practice registered nurse or physician | ||
assistant acting under the physician's delegation through a | ||
standing order. | ||
SECTION 4. Section 157.051(4), Occupations Code, is amended | ||
to read as follows: | ||
(4) "Device" has the meaning assigned by Section | ||
551.003, and includes durable medical equipment, laser and | ||
intense-pulsed light devices, and injectable implant devices. | ||
SECTION 5. Sections 157.0512(c), (e), and (f), Occupations | ||
Code, are amended to read as follows: | ||
(c) Except as provided by Subsection (d), the combined | ||
number of advanced practice registered nurses and physician | ||
assistants with whom a physician may enter into a prescriptive | ||
authority agreement and whom a physician may supervise may not | ||
exceed five [ |
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physician assistants or the full-time equivalent of five [ |
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advanced practice registered nurses and physician assistants. | ||
(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 | ||
the sharing of information between the physician and the advanced | ||
practice registered nurse or physician assistant to whom the | ||
physician has delegated prescriptive authority related to the care | ||
and treatment of patients; | ||
(8) provide that [ |
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will [ |
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supervising physician is more than 75 miles from the advanced | ||
practice registered nurse's or physician assistant's primary | ||
practice location and [ |
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physicians who may: | ||
(A) 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 | ||
(B) 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 include the following: | ||
(A) chart review, including provisions for the | ||
physician to sign a chart to denote that the physician reviewed the | ||
chart and for [ |
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patients treated under the prescriptive authority agreement by the | ||
[ |
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applicable; and | ||
(B) periodic meetings between the advanced | ||
practice registered nurse or physician assistant and the physician. | ||
(f) The periodic meetings described by Subsection (e)(9)(B) | ||
must: | ||
(1) include: | ||
(A) the sharing of information relating to | ||
patient treatment and care, needed changes in patient care plans, | ||
and issues relating to referrals; and | ||
(B) discussion of patient care improvement; | ||
(2) be documented in writing; [ |
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(3) identify the patients whose treatment and care is | ||
discussed; and | ||
(4) [ |
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determined by the physician and the advanced practice registered | ||
nurse or physician assistant. | ||
SECTION 6. Section 157.055, Occupations Code, is amended to | ||
read as follows: | ||
Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other | ||
order shall be defined in a manner that promotes the exercise of | ||
professional judgment by the clinical nurse specialist or [ |
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commensurate with the education and experience of that person. | ||
Under this section, an order or protocol used by a reasonable and | ||
prudent physician exercising sound medical judgment: | ||
(1) is not required to describe the exact steps that a | ||
clinical nurse specialist [ |
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or a physician assistant must take with respect to each specific | ||
condition, disease, or symptom; and | ||
(2) may state the types or categories of medications | ||
that may be prescribed or the types or categories of medications | ||
that may not be prescribed. | ||
SECTION 7. Not later than December 1, 2023, the Texas | ||
Medical Board shall adopt the rules necessary to implement the | ||
changes in law made by this Act, including a rule prescribing the | ||
method by which a physician may make and electronically sign the | ||
attestation required by Section 156.001(d-1), Occupations Code, as | ||
added by this Act. | ||
SECTION 8. Section 156.001(d-1), Occupations Code, as added | ||
by this Act, applies only to an application for renewal of a | ||
registration permit submitted on or after January 1, 2024. | ||
SECTION 9. Section 157.0512, Occupations Code, as amended | ||
by this Act, applies only to a prescriptive authority agreement | ||
entered into on or after the effective date of this Act. An | ||
agreement entered into before the effective date of this Act is | ||
governed by the law in effect on the date the agreement was entered | ||
into, and the former law is continued in effect for that purpose. | ||
SECTION 10. This Act takes effect September 1, 2023. |