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.