Bill Text: TX HB4071 | 2023-2024 | 88th Legislature | Introduced


Bill Title: Relating to the licensing and regulation of advanced practice registered nurses.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2023-03-20 - Referred to Public Health [HB4071 Detail]

Download: Texas-2023-HB4071-Introduced.html
  88R13845 BEE-F
 
  By: Klick H.B. No. 4071
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the licensing and regulation of advanced practice
  registered nurses.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
  ARTICLE 1. REGULATION OF ADVANCED PRACTICE REGISTERED NURSES
         SECTION 1.001.  Section 301.002, Occupations Code, is
  amended to read as follows:
         Sec. 301.002.  DEFINITIONS. In this chapter:
               (1)  "Advanced practice registered nurse" means a
  registered nurse licensed by the board to practice as an advanced
  practice registered nurse on the basis of completion of an advanced
  educational program.  The term includes a nurse practitioner, nurse
  midwife, nurse anesthetist, and clinical nurse specialist.
               (2) [(1)]  "Board" means the Texas Board of Nursing.
               (3)  [(1-a)]  "Chief nursing officer" means the
  registered nurse who is administratively responsible for the
  nursing services at a facility.
               (4)  "Controlled substance" has the meaning assigned by
  Section 481.002, Health and Safety Code.
               (5)  "Dangerous drug" has the meaning assigned by
  Section 483.001, Health and Safety Code.
               (6)  "Device" has the meaning assigned by Section
  551.003, and includes durable medical equipment.
               (7)  "Nonprescription drug" has the meaning assigned by
  Section 551.003.
               (8)  "Nurse" means a person required to be licensed
  under this chapter to engage in professional or vocational nursing.
               (9)  "Nursing" means professional or vocational
  nursing.
               (10) [(1-b)]  "Patient safety committee" has the
  meaning assigned by Section 303.001.
               (11)  "Prescribe or order a drug or device" has the
  meaning assigned by Section 157.051.
               (12) [(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, except as performed by an advanced practice
  registered nurse authorized to practice by the board under Section
  301.357.  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;
                     (G)  the performance by an advanced practice
  registered nurse 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 performance of an act by an advanced
  practice registered nurse authorized to practice by the board under
  Section 301.357.
               [(3)  "Nurse" means a person required to be licensed
  under this chapter to engage in professional or vocational nursing.
               [(4)  "Nursing" means professional or vocational
  nursing.]
               (13) [(5)]  "Vocational nursing" means a directed
  scope of nursing practice, including the performance of an act that
  requires 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 vocational nursing.  The term does
  not include acts of medical diagnosis or the prescription of
  therapeutic or corrective measures.  Vocational nursing involves:
                     (A)  collecting data and performing focused
  nursing assessments of the health status of an individual;
                     (B)  participating in the planning of the nursing
  care needs of an individual;
                     (C)  participating in the development and
  modification of the nursing care plan;
                     (D)  participating in health teaching and
  counseling to promote, attain, and maintain the optimum health
  level of an individual;
                     (E)  assisting in the evaluation of an
  individual's response to a nursing intervention and the
  identification of an individual's needs; and
                     (F)  engaging in other acts that require education
  and training, as prescribed by board rules and policies,
  commensurate with the nurse's experience, continuing education,
  and demonstrated competency.
         SECTION 1.002.  Section 301.005(b), Occupations Code, is
  amended to read as follows:
         (b)  A reference in any other law to an "advanced nurse
  practitioner," [practitioner" or] "advanced practice nurse," or
  "advanced practice registered nurse" means an advanced practice
  registered nurse.
         SECTION 1.003.  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 authorized by the
  board under Section 301.358;
                     (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 authorized by
  the board under Section 301.358 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 1.004.  Section 301.303(b), Occupations Code, is
  amended to read as follows:
         (b)  Except as provided by a rule adopted under Section
  301.357(g) for an advanced practice registered nurse authorized by
  the board to practice under that section, the [The] board may not
  require participation in more than a total of 20 hours of continuing
  education in a two-year licensing period.
         SECTION 1.005.  Subchapter H, Chapter 301, Occupations Code,
  is amended by adding Sections 301.357 and 301.358 to read as
  follows:
         Sec. 301.357.  INDEPENDENT PRACTICE BY CERTAIN ADVANCED
  PRACTICE REGISTERED NURSES. (a)  The board shall authorize the
  practice under this section of an advanced practice registered
  nurse who applies for authorization under this section in the
  manner prescribed by the board.
         (b)  The scope of practice of an advanced practice registered
  nurse authorized to practice under this section includes:
               (1)  ordering, performing, and interpreting diagnostic
  tests;
               (2)  formulating primary and differential medical
  diagnoses and advanced assessments;
               (3)  treating actual and potential health problems;
               (4)  prescribing therapeutic and corrective measures,
  including nutrition and diagnostic support services, home health
  care, hospice care, physical therapy, and occupational therapy, and
  delegating and assigning the performance of therapeutic and
  corrective measures to assistive personnel;
               (5)  to the extent authorized by the board under
  Section 301.358, prescribing, ordering, procuring, administering,
  and dispensing drugs and devices, including blood and blood
  products, controlled substances listed in Schedules II, III, IV,
  and V, dangerous drugs, and nonprescription drugs;
               (6)  providing referrals to health care agencies,
  health care providers, and community resources;
               (7)  serving as the primary care provider of record;
  and
               (8)  performing other acts that require education and
  training consistent with professional standards and that are
  commensurate with the advanced practice registered nurse's
  education, licensure, and demonstrated competencies and
  experience.
         (c)  Subject to Subsection (d), an advanced practice
  registered nurse authorized to practice under this section shall
  practice as a licensed independent practitioner in accordance with
  standards established and recognized by the board to protect the
  public health and safety.
         (d)  An advanced practice registered nurse authorized to
  practice under this section may practice as a licensed independent
  practitioner only:
               (1)  if the advanced practice registered nurse holds a
  nationally recognized board certification in psychiatric or mental
  health nursing; or
               (2)  if practicing in:
                     (A)  a rural county as defined by Section 487.301,
  Government Code; or
                     (B)  a practice serving a medically underserved
  population as defined by Section 157.051.
         (e)  An advanced practice registered nurse authorized to
  practice under this section is accountable to patients, the nursing
  profession, and the board for:
               (1)  complying with the requirements of this chapter;
               (2)  providing quality advanced nursing care;
               (3)  recognizing the nurse's limits of knowledge;
               (4)  planning for the management of situations beyond
  the nurse's expertise; and
               (5)  consulting with or referring patients to other
  health care providers as appropriate.
         (f)  This section does not limit or modify the scope of
  practice of a nurse who is not authorized to practice under this
  section.
         (g)  The board by rule shall establish:
               (1)  the application process for authorization to
  practice under this section; and
               (2)  guidelines for continuing education for advanced
  practice registered nurses authorized to practice under this
  section.
         Sec. 301.358.  PRESCRIBING AND ORDERING AUTHORITY OF
  ADVANCED PRACTICE REGISTERED NURSE.  The board may authorize an
  advanced practice registered nurse authorized to practice by the
  board under Section 301.357 to prescribe and order drugs and
  devices, including controlled substances listed in Schedules II,
  III, IV, and V, dangerous drugs, and nonprescription drugs.
  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 301.002
  [301.152], Occupations Code.
         SECTION 2.002.  Section 61.601, Education Code, as amended
  by Chapters 891 (H.B. 3083) and 1101 (H.B. 3808), Acts of the 85th
  Legislature, Regular Session, 2017, is reenacted and amended to
  read as follows:
         Sec. 61.601.  DEFINITION. In this subchapter, "mental
  health professional" means:
               (1)  a licensed physician who is:
                     (A)  a graduate of an accredited psychiatric
  residency training program; or
                     (B)  certified in psychiatry by:
                           (i)  the American Board of Psychiatry and
  Neurology; or
                           (ii)  the American Osteopathic Board of
  Neurology and Psychiatry;
               (2)  a psychologist, as defined by Section 501.002,
  Occupations Code;
               (3)  a licensed professional counselor, as defined by
  Section 503.002, Occupations Code;
               (4)  an advanced practice registered nurse, as defined
  by Section 301.002 [301.152], Occupations Code, who holds a
  nationally recognized board certification in psychiatric or mental
  health nursing;
               (5)  a licensed clinical social worker, as defined by
  Section 505.002, Occupations Code; [and]
               (6)  a licensed marriage and family therapist, as
  defined by Section 502.002, Occupations Code; and
               (7) [(6)]  a chemical dependency counselor, as defined
  by Section 504.001, Occupations Code.
         SECTION 2.003.  Section 671.001(b), Government Code, is
  amended to read as follows:
         (b)  The pilot program must provide for the following:
               (1)  either:
                     (A)  both:
                           (i)  a licensed advanced practice registered
  nurse as defined by Section 301.002 [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;
  and
                           (ii) [(2)]  a licensed physician, who is
  employed by a state governmental entity for purposes other than the
  pilot program or whose services are acquired by contract, who will
  delegate to and supervise the advanced practice registered nurse or
  physician assistant under a prescriptive authority agreement under
  Chapter 157, Occupations Code; or
                     (B)  an advanced practice registered nurse
  authorized to practice under Section 301.357, Occupations Code;
               (2) [(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
               (3) [(4)]  professional liability insurance covering
  services provided by the advanced practice registered nurse or the
  physician assistant.
         SECTION 2.004.  Sections 161.0052(b) and (c), Health and
  Safety Code, are amended to read as follows:
         (b)  The executive commissioner by rule shall require a
  hospital to inform each elderly person admitted to the hospital for
  a period of 24 hours or more that the pneumococcal and influenza
  vaccines are available.  If the elderly person requests a vaccine,
  and if a physician, or an advanced nurse practitioner or physician
  assistant on behalf of a physician, or an advanced practice
  registered nurse authorized to prescribe and order drugs and
  devices under Section 301.358, Occupations Code, determines that
  the vaccine is in the person's best interest, the hospital must make
  the vaccination available to the person before the person is
  discharged from the hospital.
         (c)  The executive commissioner by rule shall require an end
  stage renal disease facility to offer, to the extent possible as
  determined by the facility, the opportunity to receive the
  pneumococcal and influenza vaccines to each elderly person who
  receives ongoing care at the facility if a physician, or an advanced
  nurse practitioner or physician assistant on behalf of a physician,
  or an advanced practice registered nurse authorized to prescribe
  and order drugs and devices under Section 301.358, Occupations
  Code, determines that the vaccine is in the person's best
  interest.  If the facility decides it is not feasible to offer the
  vaccine, the facility must provide the person with information on
  other options for obtaining the vaccine.
         SECTION 2.005.  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, advanced practice registered
  nurse authorized to prescribe and order drugs and devices under
  Section 301.358, Occupations Code, 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, advanced
  practice registered nurse, 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 2.006.  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 Board of Nursing, 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 2.007.  Section 481.076(c), Health and Safety Code,
  is amended to read as follows:
         (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, [and] the Texas Medical Board, and
  the Texas Board of Nursing 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 2.008.  Section 481.0767(b), Health and Safety Code,
  is amended to read as follows:
         (b)  The board shall appoint the following members to the
  advisory committee:
               (1)  a physician licensed in this state who practices
  in pain management;
               (2)  a physician licensed in this state who practices
  in family medicine;
               (3)  a physician licensed in this state who performs
  surgery;
               (4)  a physician licensed in this state who practices
  in emergency medicine at a hospital;
               (5)  a physician licensed in this state who practices
  in psychiatry;
               (6)  an oral and maxillofacial surgeon;
               (7)  a physician assistant or advanced practice
  registered nurse to whom a physician has delegated the authority to
  prescribe or order a drug or an advanced practice registered nurse
  authorized to prescribe and order drugs and devices under Section
  301.358, Occupations Code;
               (8)  a pharmacist working at a chain pharmacy;
               (9)  a pharmacist working at an independent pharmacy;
               (10)  an academic pharmacist; and
               (11)  two representatives of the health information
  technology industry, at least one of whom is a representative of a
  company whose primary line of business is electronic medical
  records.
         SECTION 2.009.  Sections 483.001(4), (12), and (13), 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)  an advanced practice [a] 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.
               (12)  "Practitioner" means:
                     (A)  a person licensed by:
                           (i)  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; or
                           (ii)  the Texas Department of Licensing and
  Regulation, with respect to podiatry, 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; or
                     (E)  an advanced practice registered nurse
  authorized to prescribe and order drugs and devices under Section
  301.358, Occupations Code.
               (13)  "Prescription" means an order from a
  practitioner, or an agent of the practitioner designated in writing
  as authorized to communicate prescriptions, or an order made in
  accordance with Subchapter B, Chapter 157, Occupations Code, or
  Section 203.353, Occupations Code, to a pharmacist for a dangerous
  drug to be dispensed that states:
                     (A)  the date of the order's issue;
                     (B)  the name and address of the patient;
                     (C)  if the drug is prescribed for an animal, the
  species of the animal;
                     (D)  the name and quantity of the drug prescribed;
                     (E)  the directions for the use of the drug;
                     (F)  the intended use of the drug unless the
  practitioner determines the furnishing of this information is not
  in the best interest of the patient;
                     (G)  the name, address, and telephone number of
  the practitioner at the practitioner's usual place of business,
  legibly printed or stamped; and
                     (H)  the name, address, and telephone number of
  the licensed midwife, advanced practice registered nurse, or
  physician assistant, legibly printed or stamped, if signed by a
  licensed midwife, advanced practice registered nurse, or physician
  assistant.
         SECTION 2.010.  Section 483.022(f), Health and Safety Code,
  is amended to read as follows:
         (f)  A practitioner may designate a person who is a licensed
  vocational nurse or has an education equivalent to or greater than
  that required for a licensed vocational nurse to communicate
  prescriptions of an advanced practice registered nurse or physician
  assistant authorized by the practitioner to sign prescription drug
  orders under Subchapter B, Chapter 157, Occupations Code, or of an
  advanced practice registered nurse authorized to prescribe and
  order drugs and devices under Section 301.358, Occupations Code.
         SECTION 2.011.  Section 483.042(a), Health and Safety Code,
  is amended to read as follows:
         (a)  A person commits an offense if the person delivers or
  offers to deliver a dangerous drug:
               (1)  unless:
                     (A)  the dangerous drug is delivered or offered
  for delivery by a pharmacist under:
                           (i)  a prescription issued by a practitioner
  described by Section 483.001(12)(A), [or] (B), or (E);
                           (ii)  a prescription signed by an advanced
  practice [a] registered nurse or physician assistant in accordance
  with Subchapter B, Chapter 157, Occupations Code; or
                           (iii)  an original written prescription
  issued by a practitioner described by Section 483.001(12)(C); and
                     (B)  a label is attached to the immediate
  container in which the drug is delivered or offered to be delivered
  and the label contains the following information:
                           (i)  the name and address of the pharmacy
  from which the drug is delivered or offered for delivery;
                           (ii)  the date the prescription for the drug
  is dispensed;
                           (iii)  the number of the prescription as
  filed in the prescription files of the pharmacy from which the
  prescription is dispensed;
                           (iv)  the name of the practitioner who
  prescribed the drug and, if applicable, the name of the advanced
  practice registered nurse or physician assistant who signed the
  prescription;
                           (v)  the name of the patient and, if the drug
  is prescribed for an animal, a statement of the species of the
  animal; and
                           (vi)  directions for the use of the drug as
  contained in the prescription; or
               (2)  unless:
                     (A)  the dangerous drug is delivered or offered
  for delivery by:
                           (i)  a practitioner in the course of
  practice; or
                           (ii)  an advanced practice [a] registered
  nurse or physician assistant in the course of practice in
  accordance with Subchapter B, Chapter 157, Occupations Code; and
                     (B)  a label is attached to the immediate
  container in which the drug is delivered or offered to be delivered
  and the label contains the following information:
                           (i)  the name and address of the
  practitioner who prescribed the drug, and if applicable, the name
  and address of the advanced practice registered nurse or physician
  assistant;
                           (ii)  the date the drug is delivered;
                           (iii)  the name of the patient and, if the
  drug is prescribed for an animal, a statement of the species of the
  animal; and
                           (iv)  the name of the drug, the strength of
  the drug, and directions for the use of the drug.
         SECTION 2.012.  Section 32.024(gg), Human Resources Code, is
  amended to read as follows:
         (gg)  Notwithstanding any other law, including Sections
  843.312 and 1301.052, Insurance Code, the commission shall ensure
  that advanced practice registered nurses and physician assistants
  may be selected by and assigned to recipients of medical assistance
  as the primary care providers of those recipients regardless of
  whether, if applicable, the physician supervising the advanced
  practice registered nurse is included in any directory of providers
  of medical assistance maintained by the commission. This
  subsection may not be construed as authorizing the commission to
  supervise or control the practice of medicine as prohibited by
  Subtitle B, Title 3, Occupations Code. The commission must require
  that advanced practice registered nurses and physician assistants
  be treated in the same manner as primary care physicians with regard
  to:
               (1)  selection and assignment as primary care
  providers; and
               (2)  inclusion as primary care providers in any
  directory of providers of medical assistance maintained by the
  commission.
         SECTION 2.013.  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 301.358,
  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 2.014.  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
  authorized to prescribe and order drugs and devices under Section
  301.358, Occupations Code, 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 2.015.  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 authorized to practice under Section 301.357, Occupations
  Code.  The term does not include a physician.
         SECTION 2.016.  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 301.002
  [301.152], Occupations Code.
         SECTION 2.017.  Section 408.025, Labor Code, is amended by
  amending Subsection (a-1) and adding Subsection (a-2) to read as
  follows:
         (a-1)  A [treating doctor may delegate to a physician
  assistant who is licensed to practice in this state under Chapter
  204, Occupations Code, or an advanced practice registered nurse who
  is licensed to practice in this state under Chapter 301,
  Occupations Code, the authority to complete and sign a] work status
  report regarding an injured employee's ability to return to work
  may be completed and signed by:
               (1)  a physician assistant licensed to practice in this
  state under Chapter 204, Occupations Code, who has been delegated
  the authority by a treating doctor;
               (2)  an advanced practice registered nurse licensed to
  practice in this state under Chapter 301, Occupations Code, who has
  been delegated the authority by a treating doctor; or
               (3)  an advanced practice registered nurse authorized
  to practice under Section 301.357, Occupations Code.
         (a-2)  The delegating treating doctor is responsible for the
  acts of a [the] physician assistant [or advanced practice
  registered nurse] under Subsection (a-1)(1) or an advanced practice
  registered nurse under Subsection (a-1)(2) [this subsection].
         SECTION 2.018.  Section 157.051(1), Occupations Code, is
  amended to read as follows:
               (1)  "Advanced practice registered nurse" has the
  meaning assigned [to that term] by Section 301.002 [301.152].  [The
  term includes an advanced nurse practitioner and advanced practice
  nurse.]
         SECTION 2.019.  Section 203.002(2), Occupations Code, is
  amended to read as follows:
               (2)  "Certified nurse-midwife" means an advanced
  practice [a person who is:
                     [(A)  a] registered nurse [under Chapter 301;
                     [(B)  recognized as an advanced nurse
  practitioner by the Texas Board of Nursing; and
                     [(C)]  certified by the American College of
  Nurse-Midwives.
         SECTION 2.020.  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)  an advanced practice [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.
               (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
  authorized to prescribe and order drugs and devices under Section
  301.358, 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,
  advanced practice registered nurse, 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 2.021.  Section 563.051(e), Occupations Code, is
  amended to read as follows:
         (e)  A practitioner may designate a licensed vocational
  nurse or a person having education equivalent to or greater than
  that required for a licensed vocational nurse to communicate the
  prescriptions of an advanced practice registered nurse or physician
  assistant authorized by the practitioner to sign prescription drug
  orders under Subchapter B, Chapter 157, or of an advanced practice
  registered nurse authorized to prescribe and order drugs and
  devices under Section 301.358.
         SECTION 2.022.  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:
               (1)  "Advanced practice registered nurse" has the
  meaning assigned by Section 301.002.
               (2)  "Reimbursement [, "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.
         (a-1)  This section applies to an advanced practice
  registered nurse only to the extent that the advanced practice
  registered nurse is authorized to prescribe and order drugs and
  devices under Section 301.358.
         (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 advanced practice
  registered nurse 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 2.023.  Sections 605.002(14) and (18), Occupations
  Code, are 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 advanced practice registered
  nurse authorized to prescribe and order drugs and devices under
  Section 301.358, or 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.
               (18)  "Prosthetics" means the science and practice of
  measuring, designing, fabricating, assembling, fitting, adjusting,
  or servicing a prosthesis under an order from a licensed physician,
  chiropractor, [or] podiatrist, or advanced practice registered
  nurse authorized to prescribe and order drugs and devices under
  Section 301.358, or 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.
         SECTION 2.024.  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 advanced practice registered
  nurse authorized to prescribe and order drugs and devices under
  Section 301.358, or 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 advanced practice registered
  nurse authorized to prescribe and order drugs and devices under
  Section 301.358, or 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. REPEALER
         SECTION 3.001.  Section 301.152(a), Occupations Code, is
  repealed.
  ARTICLE 4. TRANSITIONS AND EFFECTIVE DATE
         SECTION 4.001.  Not later than February 1, 2024, the Texas
  Board of Nursing shall adopt the rules necessary to implement the
  changes in law made by this Act.
         SECTION 4.002.  This Act takes effect September 1, 2023.
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