Bill Text: TX HB4362 | 2021-2022 | 87th Legislature | Introduced

Bill Title: Relating to the licensing and regulation of certain health professions; requiring an occupational certificate to perform certain surgical procedures.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2021-03-29 - Referred to Public Health [HB4362 Detail]

Download: Texas-2021-HB4362-Introduced.html
  87R5482 BEE-D
 
  By: Klick H.B. No. 4362
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the licensing and regulation of certain health
  professions; requiring an occupational certificate to perform
  certain surgical procedures.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
  ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES
         SECTION 1.01.  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 1.02.  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 1.03.  Section 263.001(a)(1), Family Code, is
  amended to read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  to "advanced practice registered nurse" by Section 301.002
  [157.051], Occupations Code.
         SECTION 1.04.  Section 266.001(1), Family Code, is amended
  to read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  to "advanced practice registered nurse" by Section 301.002
  [157.051], Occupations Code.
         SECTION 1.05.  Section 531.0217(k), Government Code, is
  amended to read as follows:
         (k)  This section does not affect any requirement relating
  to:
               (1)  a rural health clinic; or
               (2)  physician delegation of the authority to carry out
  or sign prescription drug orders to a [an advanced practice nurse
  or] physician assistant.
         SECTION 1.06.  Section 671.001(b), Government Code, is
  amended to read as follows:
         (b)  The pilot program must provide for the following:
               (1)  a licensed advanced practice registered nurse as
  defined by Section 301.002 [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;
               (2)  if applicable, a licensed physician, who is
  employed by a state governmental entity for purposes other than the
  pilot program or whose services are acquired by contract, who will
  delegate to and supervise the [advanced practice registered nurse
  or] physician assistant under a prescriptive authority agreement
  under Chapter 157, Occupations Code;
               (3)  appropriate office space and equipment for the
  advanced practice registered nurse or physician assistant to
  provide basic medical care to employees at the state office complex
  where the nurse or physician assistant is located; and
               (4)  professional liability insurance covering
  services provided by the advanced practice registered nurse or the
  physician assistant.
         SECTION 1.07.  Section 47.001(3), Health and Safety Code, is
  amended to read as follows:
               (3)  "Health care provider" means:
                     (A)  [a registered nurse recognized as] an
  advanced practice registered nurse as defined by Section 301.002,
  Occupations Code; [the Texas Board of Nursing] or
                     (B)  a physician assistant licensed by the Texas
  Physician Assistant Board.
         SECTION 1.08.  Section 47.011(a), Health and Safety Code, is
  amended to read as follows:
         (a)  In this section, "midwife" has the meaning assigned by
  Section 203.002, Occupations Code, and includes a nurse midwife
  [described by Section 301.152, Occupations Code].
         SECTION 1.09.  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 a
  physician assistant on behalf of a physician, 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 a physician assistant on behalf of
  a physician, 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 1.10.  Section 241.003(1), Health and Safety Code,
  is amended to read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  to "advanced practice registered nurse" by Section 301.002,
  Occupations Code [means a registered nurse recognized as an
  advanced practice nurse by the Texas Board of Nursing].
         SECTION 1.11.  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, 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)  a [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 1.12.  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 1.13.  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 1.14.  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;
               (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 1.15.  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)  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)  a [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[, registered nurse,] or physician assistant,
  legibly printed or stamped, if signed by a licensed midwife[,
  registered nurse,] or physician assistant.
         SECTION 1.16.  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 a [an advanced practice 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.
         SECTION 1.17.  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 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 [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)  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 [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 1.18.  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 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 1.19.  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; and
               (2)  a [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 1.20.  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 nurse] who is authorized by the
  physician to provide care under Subchapter B, Chapter 157,
  Occupations Code, or an advanced practice registered nurse, as
  defined by Section 301.002, 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 1.21.  Section 1301.001(1-a), Insurance Code, is
  amended to read as follows:
               (1-a)  "Health care provider" means a practitioner,
  institutional provider, or other person or organization that
  furnishes health care services and that is licensed or otherwise
  authorized to practice in this state.  The term includes a
  pharmacist, [and] a pharmacy, and an advanced practice registered
  nurse.  The term does not include a physician.
         SECTION 1.22.  Section 1301.052, Insurance Code, is amended
  to read as follows:
         Sec. 1301.052.  DESIGNATION OF ADVANCED PRACTICE REGISTERED
  NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
  offering a preferred provider benefit plan may not refuse a request
  made by a physician participating as a preferred provider under the
  plan and an advanced practice registered nurse or physician
  assistant to have the advanced practice registered nurse or
  physician assistant included as a preferred provider under the plan
  if, as applicable:
               (1)  the [advanced practice nurse or] physician
  assistant is authorized by the physician to provide care under
  Subchapter B, Chapter 157, Occupations Code; and
               (2)  the advanced practice registered nurse or
  physician assistant meets the quality of care standards previously
  established by the insurer for participation in the plan by
  advanced practice registered nurses and physician assistants.
         SECTION 1.23.  Section 1451.001(2), Insurance Code, is
  amended to read as follows:
               (2)  "Advanced practice registered nurse" has the
  meaning assigned by Section 301.002, Occupations Code [means an
  individual licensed by the Texas Board of Nursing as a registered
  nurse and recognized by that board as an advanced practice nurse].
         SECTION 1.24.  Section 1451.104(c), Insurance Code, is
  amended to read as follows:
         (c)  Notwithstanding Subsection (a), a health insurance
  policy may provide for a different amount of payment or
  reimbursement for scheduled services or procedures performed by an
  advanced practice registered nurse, nurse first assistant,
  licensed surgical assistant, or physician assistant if the
  methodology used to compute the amount is the same as the
  methodology used to compute the amount of payment or reimbursement
  when the services or procedures are provided by a physician.
         SECTION 1.25.  Section 1451.106, Insurance Code, is amended
  to read as follows:
         Sec. 1451.106.  SELECTION OF ADVANCED PRACTICE REGISTERED
  NURSE. An insured may select an advanced practice registered nurse
  to provide the services scheduled in the health insurance policy
  that are within the scope of the nurse's license.
         SECTION 1.26.  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 1.27.  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; or
               (2)  an advanced practice registered nurse, as defined
  by Section 301.002, 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) [this subsection].
         SECTION 1.28.  The heading to Subchapter B, Chapter 157,
  Occupations Code, is amended to read as follows:
  SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE REGISTERED NURSES
  AND] PHYSICIAN ASSISTANTS
         SECTION 1.29.  Sections 157.051(11) and (14), Occupations
  Code, are amended to read as follows:
               (11)  "Practice serving a medically underserved
  population" means:
                     (A)  a practice in a health professional shortage
  area;
                     (B)  a clinic designated as a rural health clinic
  under 42 U.S.C. Section 1395x(aa);
                     (C)  a public health clinic or a family planning
  clinic under contract with the Health and Human Services Commission
  or the Department of State Health Services;
                     (D)  a clinic designated as a federally qualified
  health center under 42 U.S.C. Section 1396d(l)(2)(B);
                     (E)  a county, state, or federal correctional
  facility;
                     (F)  a practice:
                           (i)  that either:
                                 (a)  is located in an area in which the
  Department of State Health Services determines there is an
  insufficient number of physicians providing services to eligible
  clients of federally, state, or locally funded health care
  programs; or
                                 (b)  is a practice that the Department
  of State Health Services determines serves a disproportionate
  number of clients eligible to participate in federally, state, or
  locally funded health care programs; and
                           (ii)  for which the Department of State
  Health Services publishes notice of the department's determination
  in the Texas Register and provides an opportunity for public
  comment in the manner provided for a proposed rule under Chapter
  2001, Government Code; or
                     (G)  a practice at which a physician was
  delegating prescriptive authority to an advanced practice
  registered nurse, as defined by Section 301.002, or physician
  assistant on or before March 1, 2013, based on the practice
  qualifying as a site serving a medically underserved population.
               (14)  "Prescriptive authority agreement" means an
  agreement entered into by a physician and a [an advanced practice
  registered nurse or] physician assistant through which the
  physician delegates to the [advanced practice registered nurse or]
  physician assistant the act of prescribing or ordering a drug or
  device.
         SECTION 1.30.  Section 157.0511(b-2), Occupations Code, is
  amended to read as follows:
         (b-2)  The board shall adopt rules that require a physician
  who delegates the prescribing or ordering of a drug or device to
  register with the board the name and license number of the physician
  assistant [or advanced practice registered nurse] to whom a
  delegation is made.  The board may develop and use an electronic
  online delegation registration process for registration under this
  subsection.
         SECTION 1.31.  Sections 157.0512(a), (b), (c), (e), (f),
  (g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended
  to read as follows:
         (a)  A physician may delegate to a [an advanced practice
  registered nurse or] physician assistant, acting under adequate
  physician supervision, the act of prescribing or ordering a drug or
  device as authorized through a prescriptive authority agreement
  between the physician and the [advanced practice registered nurse
  or] physician assistant[, as applicable].
         (b)  A physician and a [an advanced practice registered nurse
  or] physician assistant are eligible to enter into or be parties to
  a prescriptive authority agreement only if:
               (1)  [if applicable, the Texas Board of Nursing has
  approved the advanced practice registered nurse's authority to
  prescribe or order a drug or device as authorized under this
  subchapter;
               [(2)]  the [advanced practice registered nurse or]
  physician assistant:
                     (A)  holds an active license to practice in this
  state as a [an advanced practice registered nurse or] physician
  assistant[, as applicable,] and is in good standing in this state;
  and
                     (B)  is not currently prohibited by the [Texas
  Board of Nursing or the] Texas Physician Assistant Board[, as
  applicable,] from executing a prescriptive authority agreement;
  and
               (2) [(3)]  before executing the prescriptive authority
  agreement, the physician and the [advanced practice registered
  nurse or] physician assistant disclose to the other prospective
  party to the agreement any prior disciplinary action by the board[,
  the Texas Board of Nursing,] or the Texas Physician Assistant
  Board[, as applicable].
         (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 may not exceed seven [advanced practice
  registered nurses and] physician assistants or the full-time
  equivalent of seven [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)  if alternate physician supervision is to be
  utilized, designate one or more alternate 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, with the number of charts to be
  reviewed determined by the physician and [advanced practice
  registered nurse or] physician assistant; 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; and
               (3)  take place at least once a month in a manner
  determined by the physician and the [advanced practice registered
  nurse or] physician assistant.
         (g)  The prescriptive authority agreement may include other
  provisions agreed to by the physician and [advanced practice
  registered nurse or] physician assistant.
         (i)  The prescriptive authority agreement need not describe
  the exact steps that a [an advanced practice registered nurse or]
  physician assistant must take with respect to each specific
  condition, disease, or symptom.
         (j)  A physician[, advanced practice registered nurse,] or
  physician assistant who is a party to a prescriptive authority
  agreement must retain a copy of the agreement until the second
  anniversary of the date the agreement is terminated.
         (l)  In the event that a party to a prescriptive authority
  agreement is notified that the individual has become the subject of
  an investigation by the board[, the Texas Board of Nursing,] or the
  Texas Physician Assistant Board, the individual shall immediately
  notify the other party to the prescriptive authority agreement.
         (m)  The prescriptive authority agreement and any amendments
  must be reviewed at least annually, dated, and signed by the parties
  to the agreement.  The prescriptive authority agreement and any
  amendments must be made available to the board[, the Texas Board of
  Nursing,] or the Texas Physician Assistant Board not later than the
  third business day after the date of receipt of request, if any.
         (n)  The prescriptive authority agreement should promote the
  exercise of professional judgment by the [advanced practice
  registered nurse or] physician assistant commensurate with the
  [advanced practice registered nurse's or] physician assistant's
  education and experience and the relationship between the [advanced
  practice registered nurse or] physician assistant and the
  physician.
         (o)  This section shall be liberally construed to allow the
  use of prescriptive authority agreements to safely and effectively
  utilize the skills and services of [advanced practice registered
  nurses and] physician assistants.
         SECTION 1.32.  Section 157.0513, Occupations Code, is
  amended to read as follows:
         Sec. 157.0513.  PRESCRIPTIVE AUTHORITY AGREEMENT:
  INFORMATION. (a)  The board[, the Texas Board of Nursing,] and the
  Texas Physician Assistant Board shall jointly develop a process:
               (1)  to exchange information regarding the names,
  locations, and license numbers of each physician[, advanced
  practice registered nurse,] and physician assistant who has entered
  into a prescriptive authority agreement;
               (2)  by which each board shall immediately notify the
  other board [boards] when a license holder of the board becomes the
  subject of an investigation involving the delegation and
  supervision of prescriptive authority, as well as the final
  disposition of any such investigation;
               (3)  by which each board shall maintain and share a list
  of the board's license holders who have been subject to a final
  adverse disciplinary action for an act involving the delegation and
  supervision of prescriptive authority; and
               (4)  to ensure that each [advanced practice registered
  nurse or] physician assistant who has entered into a prescriptive
  authority agreement authorizing the prescribing of opioids is
  required to complete not less than two hours of continuing
  education annually regarding safe and effective pain management
  related to the prescription of opioids and other controlled
  substances, including education regarding:
                     (A)  reasonable standards of care;
                     (B)  the identification of drug-seeking behavior
  in patients; and
                     (C)  effectively communicating with patients
  regarding the prescription of an opioid or other controlled
  substance.
         (b)  If the board[, the Texas Board of Nursing,] or the Texas
  Physician Assistant Board receives a notice under Subsection
  (a)(2), the board that received notice may open an investigation
  against a license holder of the board who is a party to a
  prescriptive authority agreement with the license holder who is
  under investigation by the board that provided notice under
  Subsection (a)(2).
         (c)  The board shall maintain and make available to the
  public a searchable online list of physicians[, advanced practice
  registered nurses,] and physician assistants who have entered into
  a prescriptive authority agreement authorized under Section
  157.0512 and identify the physician[, advanced practice registered
  nurse, or physician assistant] with whom each [physician, advanced
  practice registered nurse, and] physician assistant has entered
  into a prescriptive authority agreement.
         (d)  The board shall collaborate with the [Texas Board of
  Nursing and the] Texas Physician Assistant Board to maintain and
  make available to the public a list of physicians[, advanced
  practice registered nurses,] and physician assistants who are
  prohibited from entering into or practicing under a prescriptive
  authority agreement.
         SECTION 1.33.  Sections 157.054(a), (a-1), (b), and (c),
  Occupations Code, are amended to read as follows:
         (a)  One or more physicians licensed by the board may
  delegate, to one or more physician assistants [or advanced practice
  registered nurses] acting under adequate physician supervision
  whose practice is facility-based at a hospital or licensed
  long-term care facility, the administration or provision of a drug
  and the prescribing or ordering of a drug or device if each of the
  delegating physicians is:
               (1)  the medical director or chief of medical staff of
  the facility in which the physician assistant [or advanced practice
  registered nurse] practices;
               (2)  the chair of the facility's credentialing
  committee;
               (3)  a department chair of a facility department in
  which the physician assistant [or advanced practice registered
  nurse] practices; or
               (4)  a physician who consents to the request of the
  medical director or chief of medical staff to delegate the
  prescribing or ordering of a drug or device at the facility in which
  the physician assistant [or advanced practice registered nurse]
  practices.
         (a-1)  The limit [limits] on the number of [advanced practice
  registered nurses or] physician assistants to whom a physician may
  delegate under Section 157.0512 does [do] not apply to a physician
  under Subsection (a) whose practice is facility-based under this
  section, provided that the physician is not delegating in a
  freestanding clinic, center, or practice of the facility.
         (b)  A physician's authority to delegate under Subsection
  (a) is limited as follows:
               (1)  the delegation must be made under a physician's
  order, standing medical order, standing delegation order, or
  another order or protocol developed in accordance with policies
  approved by the facility's medical staff or a committee of the
  facility's medical staff as provided by the facility bylaws;
               (2)  the delegation must occur in the facility in which
  the physician is the medical director, the chief of medical staff,
  the chair of the credentialing committee, a department chair, or a
  physician who consents to delegate under Subsection (a)(4);
               (3)  the delegation may not permit the prescribing or
  ordering of a drug or device for the care or treatment of the
  patients of any other physician without the prior consent of that
  physician; and
               (4)  delegation in a long-term care facility must be by
  the medical director and is limited to the prescribing or ordering
  of a drug or device to not more than seven [advanced practice
  registered nurses or] physician assistants or their full-time
  equivalents.
         (c)  Physician supervision of the prescribing or ordering of
  a drug or device must conform to what a reasonable, prudent
  physician would find consistent with sound medical judgment but may
  vary with the education and experience of the particular [advanced
  practice registered nurse or] physician assistant.  A physician
  shall provide continuous supervision, but the constant physical
  presence of the physician is not required.
         SECTION 1.34.  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 [advanced practice registered nurse
  and] physician assistant 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
  [an advanced practice registered nurse 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 1.35.  Section 157.056, Occupations Code, is amended
  to read as follows:
         Sec. 157.056.  PRESCRIPTION INFORMATION. The following
  information must be provided on each prescription subject to this
  subchapter:
               (1)  the patient's name and address;
               (2)  the drug to be dispensed;
               (3)  directions to the patient regarding the taking of
  the drug and the dosage;
               (4)  the intended use of the drug, if appropriate;
               (5)  the name, address, and telephone number of the
  physician;
               (6)  the name, address, telephone number, and
  identification number of the [registered nurse or] physician
  assistant completing or signing the prescription drug order;
               (7)  the date; and
               (8)  the number of refills permitted.
         SECTION 1.36.  Sections 157.059(b), (e), (f), (g), (h), and
  (i), Occupations Code, are amended to read as follows:
         (b)  A physician may delegate to a physician assistant
  offering obstetrical services and certified by the board as
  specializing in obstetrics [or an advanced practice registered
  nurse recognized by the Texas Board of Nursing as a nurse midwife]
  the act of administering or providing controlled substances to the
  physician assistant's [or nurse midwife's] clients during
  intrapartum and immediate postpartum care.
         (e)  The physician's orders, medical orders, standing
  delegation orders, prescriptive authority agreements, or protocols
  must require the reporting of or monitoring of each client's
  progress, including complications of pregnancy and delivery and the
  administration and provision of controlled substances by the [nurse
  midwife or] physician assistant to the clients of the [nurse
  midwife or] physician assistant.
         (f)  The authority of a physician to delegate under this
  section is limited to:
               (1)  seven [nurse midwives or] physician assistants or
  their full-time equivalents; and
               (2)  the designated facility at which the [nurse
  midwife or] physician assistant provides care.
         (g)  The controlled substance must be supplied in a suitable
  container that is labeled in compliance with the applicable drug
  laws and must include:
               (1)  the patient's name and address;
               (2)  the drug to be provided;
               (3)  the name, address, and telephone number of the
  physician;
               (4)  the name, address, and telephone number of the
  [nurse midwife or] physician assistant; and
               (5)  the date.
         (h)  This section does not authorize a physician or [,]
  physician assistant[, or nurse midwife] to operate a retail
  pharmacy as defined under Subtitle J.
         (i)  This section authorizes a physician to delegate the act
  of administering or providing a controlled substance to a [nurse
  midwife or] physician assistant but does not require physician
  delegation of[:
               [(1)  further acts to a nurse midwife; or
               [(2)]  the administration of medications by a physician
  assistant [or registered nurse] other than as provided by this
  section.
         SECTION 1.37.  Section 157.060, Occupations Code, is amended
  to read as follows:
         Sec. 157.060.  PHYSICIAN LIABILITY FOR DELEGATED
  ACT.  Unless the physician has reason to believe the physician
  assistant [or advanced practice registered nurse] lacked the
  competency to perform the act, a physician is not liable for an act
  of a physician assistant [or advanced practice registered nurse]
  solely because the physician signed a standing medical order, a
  standing delegation order, or another order or protocol, or entered
  into a prescriptive authority agreement, authorizing the physician
  assistant [or advanced practice registered nurse] to administer,
  provide, prescribe, or order a drug or device.
         SECTION 1.38.  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 as defined by Section
  301.002 who is [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 1.39.  Section 204.1025, Occupations Code, is
  amended to read as follows:
         Sec. 204.1025.  DUTIES REGARDING PRESCRIPTIVE AUTHORITY
  AGREEMENTS. The physician assistant board shall in conjunction
  with the Texas Medical Board [and the Texas Board of Nursing]
  perform the functions and duties relating to prescriptive authority
  agreements assigned to the physician assistant board in Sections
  157.0512 and 157.0513.
         SECTION 1.40.  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 authorized for an advanced practice
  registered nurse.  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 of an act by an advanced
  practice registered nurse [delegated by a physician under Section
  157.0512, 157.054, 157.058, or 157.059]; and
                     (G) [(H)]  the development of the nursing care
  plan.
               [(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 1.41.  Section 301.005(b), Occupations Code, is
  amended to read as follows:
         (b)  A reference in any other law to an "advanced nurse
  practitioner," [or] "advanced practice nurse," or "advanced
  practice registered nurse" means an advanced practice registered
  nurse.
         SECTION 1.42.  Section 301.152, Occupations Code, is
  transferred to Subchapter H, Chapter 301, Occupations Code,
  redesignated as Section 301.357, Occupations Code, and amended to
  read as follows:
         Sec. 301.357 [301.152].  ADVANCED PRACTICE REGISTERED NURSES
  [RULES REGARDING SPECIALIZED TRAINING]. (a)  Advanced practice
  registered nursing 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. [In this section, "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.  The term is synonymous with "advanced nurse
  practitioner" and "advanced practice nurse."]
         (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 authorized
  [delegated] by the board [a physician] under Section 301.358
  [157.0512 or 157.054];
                     (B)  a system for approving an advanced practice
  registered nurse to prescribe or order a drug or device as
  authorized [delegated] by the board [a physician] under Section
  301.358 [157.0512 or 157.054] 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.
         (c)  At a minimum, the rules adopted under Subsection (b)(2)
  must:
               (1)  require completion of pharmacology and related
  pathophysiology education for initial approval; and
               (2)  require continuing education in clinical
  pharmacology and related pathophysiology in addition to any
  continuing education otherwise required under Section 301.303.
         (d)  The signature of an advanced practice registered nurse
  attesting to the provision of a legally authorized service by the
  advanced practice registered nurse satisfies any documentation
  requirement for that service established by a state agency.
         (e)  An advanced practice registered nurse shall practice as
  a licensed independent practitioner in accordance with standards
  established and recognized by the board to protect the public
  health and safety.
         (f)  An advanced practice registered nurse 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.
         (g)  This section does not limit or modify the scope of
  practice of a registered nurse who is not an advanced practice
  registered nurse.
         (h)  Notwithstanding any other law, an advanced practice
  registered nurse performing an act described by Subsection (a) is
  not considered to be practicing medicine without a license.
         SECTION 1.43.  Section 301.354(a), Occupations Code, is
  amended to read as follows:
         (a)  In this section, "nurse first assistant" means a
  registered nurse who:
               (1)  has completed a nurse first assistant educational
  program approved or recognized by an organization recognized by the
  board; and
               (2)  [is] either:
                     (A)  is certified in perioperative nursing by an
  organization recognized by the board; or
                     (B)  is [recognized by the board as] an advanced
  practice registered nurse [and] qualified by education, training,
  or experience to perform the tasks involved in perioperative
  nursing.
         SECTION 1.44.  Subchapter H, Chapter 301, Occupations Code,
  is amended by adding Section 301.358 to read as follows:
         Sec. 301.358.  PRESCRIBING AND ORDERING AUTHORITY OF
  ADVANCED PRACTICE REGISTERED NURSE. (a)  The board may authorize an
  advanced practice registered nurse to prescribe and order drugs and
  devices, including controlled substances listed in Schedules III,
  IV, and V, dangerous drugs, and nonprescription drugs.
         (b)  Except as provided by Subsection (c), the board may
  authorize an advanced practice registered nurse to prescribe and
  order controlled substances listed in Schedule II only:
               (1)  in a hospital facility-based practice in
  accordance with policies approved by the hospital's medical staff
  or a committee of the hospital's medical staff as provided by the
  hospital bylaws to ensure patient safety, and as part of the care
  provided to a patient who:
                     (A)  has been admitted to the hospital and is
  expected to remain in the hospital for a period of 24 hours or more;
  or
                     (B)  is receiving services in the emergency
  department of the hospital; or
               (2)  as part of the plan of care for the treatment of a
  person who has executed a written certification of a terminal
  illness, has elected to receive hospice care, and is receiving
  hospice treatment from a qualified hospice provider.
         (c)  The board may authorize a certified registered nurse
  anesthetist practicing in an ambulatory surgical center to order
  drugs and devices necessary for the nurse anesthetist to administer
  an anesthetic or anesthesia-related service.
         SECTION 1.45.  Sections 551.003(14) and (34), Occupations
  Code, are amended to read as follows:
               (14)  "Designated agent" means:
                     (A)  an individual, including a licensed nurse,
  physician assistant, or pharmacist:
                           (i)  who is designated by a practitioner and
  authorized to communicate a prescription drug order to a
  pharmacist; and
                           (ii)  for whom the practitioner assumes
  legal responsibility;
                     (B)  a licensed nurse, physician assistant, or
  pharmacist employed in a health care facility to whom a
  practitioner communicates a prescription drug order; or
                     (C)  a [registered nurse or] physician assistant
  authorized by a practitioner to administer a prescription drug
  order for a dangerous drug under Subchapter B, Chapter 157.
               (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)  a [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 1.46.  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 a [an advanced practice 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.
         SECTION 1.47.  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 [an] advanced practice
  registered nurse, or from a 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 [an] advanced practice
  registered nurse, or from a 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 1.48.  Section 605.2515, Occupations Code, is
  amended to read as follows:
         Sec. 605.2515.  ADDITIONAL LICENSE: DEVICE MANUFACTURER. A
  person licensed to practice orthotics or prosthetics who measures,
  designs, fabricates, fits, assembles, adjusts, or services an
  orthosis or a prosthesis under an order from a licensed physician,
  chiropractor, [or] podiatrist, or [an] advanced practice
  registered nurse, or from a physician assistant acting under the
  delegation and supervision of a licensed physician as provided by
  Subchapter B, Chapter 157, and rules adopted by the Texas Medical
  Board, for a specific patient is exempt from licensing as a device
  manufacturer under Subchapter L, Chapter 431, Health and Safety
  Code. A person licensed to practice orthotics or prosthetics who
  fabricates or assembles an orthosis or a prosthesis without an
  order from a licensed physician, chiropractor, [or] podiatrist, or
  [an] advanced practice registered nurse, or from a 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.
         SECTION 1.49.  The following provisions are repealed:
               (1)  Section 533.005(d), Government Code;
               (2)  Section 62.1551(b), Health and Safety Code; and
               (3)  Sections 157.051(1), 157.058, and 301.168,
  Occupations Code.
         SECTION 1.50.  Not later than February 1, 2022, the Texas
  Board of Nursing shall adopt the rules necessary to implement the
  changes in law made by this Act.
         SECTION 1.51.  Notwithstanding any changes in law made by
  this Act, an advanced practice registered nurse who has been
  delegated the authority to prescribe and order drugs and medical
  devices by a physician's protocol or order under Section 157.0511,
  157.0512, or 157.054, Occupations Code, may continue to exercise
  that authority until February 1, 2022.
  ARTICLE 2. DENTAL HYGIENISTS
         SECTION 2.01.  Section 258.001, Occupations Code, is amended
  to read as follows:
         Sec. 258.001.  [IMPERMISSIBLE] DELEGATIONS.  (a)  A dentist
  may not delegate:
               (1)  an act to an individual who, by board order, is
  prohibited from performing the act;
               (2)  any of the following acts to a person not licensed
  as a dentist or dental hygienist:
                     (A)  the removal of calculus, deposits, or
  accretions from the natural and restored surfaces of exposed human
  teeth and restorations in the human mouth;
                     (B)  root planing or the smoothing and polishing
  of roughened root surfaces or exposed human teeth; or
                     (C)  any other act the delegation of which is
  prohibited by board rule; or
               (3)  any of the following acts to a person not licensed
  as a dentist:
                     (A)  comprehensive examination or diagnosis and
  treatment planning;
                     (B)  a surgical or cutting procedure on hard or
  soft tissue;
                     (C)  the prescription of a drug, medication, or
  work authorization;
                     (D)  the taking of an impression for a final
  restoration, appliance, or prosthesis;
                     (E)  the making of an intraoral occlusal
  adjustment;
                     (F)  direct pulp capping, pulpotomy, or any other
  endodontic procedure;
                     (G)  the final placement and intraoral adjustment
  of a fixed or removable appliance; or
                     (H)  the placement of any final restoration.
         (b)  A dentist may delegate[; or
               [(4)  the authority] to an individual the authority to
  administer a local anesthetic agent, inhalation sedative agent,
  parenteral sedative agent, or general anesthetic agent if the
  individual is [not] licensed as:
               (1) [(A)]  a dentist, with a permit issued by the board
  for the procedure being performed[,] if a permit is required;
               (2) [(B)]  a certified registered nurse anesthetist
  [licensed] by the Texas Board of Nursing, only if the delegating
  dentist holds a permit issued by the board for the procedure being
  performed[,] if a permit is required; [or]
               (3) [(C)]  a physician anesthesiologist [licensed] by
  the Texas Medical Board; or
               (4)  a dental hygienist, only if:
                     (A)  the procedure is the administration of a
  local anesthetic agent under Section 262.002(a)(6);
                     (B)  the dental hygienist has passed a
  certification examination approved by the board; and
                     (C)  the dental hygienist:
                           (i)  has completed a course approved by the
  board to train dental hygienists to administer local anesthetic
  agents; or
                           (ii)  has been licensed in good standing
  within the preceding year to administer local anesthetic agents:
                                 (a)  by a branch of the United States
  armed forces; or
                                 (b)  by another state.
         SECTION 2.02.  Section 262.002(a), Occupations Code, is
  amended to read as follows:
         (a)  A person practices dental hygiene if the person:
               (1)  removes accumulated matter, tartar, deposits,
  accretions, or stains, other than mottled enamel stains, from the
  natural and restored surface of exposed human teeth and
  restorations in the human mouth;
               (2)  smoothes roughened root surfaces;
               (3)  polishes exposed human teeth, restorations in the
  human mouth, or roughened root surfaces;
               (4)  topically applies drugs to the surface tissues of
  the human mouth or the exposed surface of human teeth;
               (5)  makes dental x-rays; [and]
               (6)  administers intraoral block or infiltration
  anesthesia under the authorization and direct supervision of a
  dentist; and
               (7)  performs any other service, task, or procedure
  prescribed by board rule.
         SECTION 2.03.  (a)  Not later than January 1, 2022, the State
  Board of Dental Examiners shall:
               (1)  prescribe by rule the requirements for a course to
  train dental hygienists to administer local anesthetic agents; and
               (2)  develop a procedure for the approval of courses
  described by Subdivision (1) of this subsection.
         (b)  A rule adopted under Subsection (a) of this section must
  require that a course be offered in a classroom setting at an
  educational institution accredited by the Commission on Dental
  Accreditation of the American Dental Association.
  ARTICLE 3. OPTOMETRISTS AND THERAPEUTIC OPTOMETRISTS
         SECTION 3.01.  Section 351.002(7), Occupations Code, is
  amended to read as follows:
               (7)  "Practice of therapeutic optometry" means using
  objective or subjective means, [not] including surgery, except as
  prohibited by Section 351.4521 [or laser surgery], to:
                     (A)  determine or measure the powers of vision of
  the human eye as provided by Section 351.355;
                     (B)  examine or diagnose visual defects, abnormal
  conditions, or diseases of the human eye or adnexa;
                     (C)  prescribe or fit lenses or prisms to correct
  or remedy a defect or abnormal condition of vision as provided by
  Section 351.356;
                     (D)  administer or prescribe a drug or physical
  treatment in the manner authorized by this chapter; or
                     (E)  treat the visual system, including the eye or
  adnexa as authorized by this chapter.
         SECTION 3.02.  The heading to Section 351.151, Occupations
  Code, is amended to read as follows:
         Sec. 351.151.  RULES; INTERPRETATION OF CHAPTER AND RULES.
         SECTION 3.03.  Section 351.151, Occupations Code, is amended
  by adding Subsection (c) to read as follows:
         (c)  The board may provide an interpretation of a provision
  of this chapter or a rule adopted under this chapter, including by
  issuing an advisory opinion or declaratory ruling.
         SECTION 3.04.  Subchapter D, Chapter 351, Occupations Code,
  is amended by adding Section 351.170 to read as follows:
         Sec. 351.170.  SOLE AUTHORITY OVER PRACTICE OF OPTOMETRY.
  The board has sole authority to regulate optometrists and
  therapeutic optometrists and to determine the scope of practice of
  an optometrist or therapeutic optometrist.
         SECTION 3.05.  Section 351.358, Occupations Code, is amended
  by amending Subsections (b) and (c) and adding Subsection (f) to
  read as follows:
         (b)  A therapeutic optometrist may[:
               [(1)]  administer, perform, or prescribe ophthalmic
  devices, procedures, and appropriate medications administered by
  any [topical or oral] means[, in accordance with this section and
  Section 351.3581,] to diagnose or treat visual defects, abnormal
  conditions, or diseases of the human vision system, including the
  eye and adnexa[; or
               [(2)  administer medication by parenteral means for a
  purpose and in a manner prescribed by Subsection (e)].
         (c)  A therapeutic optometrist may prescribe not more than 
  [oral medications only in the following classifications of oral
  pharmaceuticals]:
               (1)  [one 10-day supply of oral antibiotics;
               [(2)  one 72-hour supply of oral antihistamines;
               [(3)  one seven-day supply of oral nonsteroidal
  anti-inflammatories;
               [(4)]  one three-day supply of any medication
  classified as a controlled substance under Schedule [analgesic
  identified in Schedules] III, IV, or [and] V of 21 U.S.C. Section
  812; and
               (2)  one three-day supply of hydrocodone or a
  hydrocodone combination medication classified as a controlled
  substance under Schedule II of 21 U.S.C. Section 812 [(5)  any
  other oral pharmaceutical recommended by the Optometric Health Care
  Advisory Committee and approved by the board and the Texas State
  Board of Medical Examiners].
         (f)  A therapeutic optometrist may administer, perform,
  prescribe, or order diagnostic studies, analyses, tests, imaging
  studies, or laboratory tests necessary to diagnose or treat visual
  defects, abnormal conditions, or diseases of the human vision
  system, including the eye and adnexa.
         SECTION 3.06.  The heading to Section 351.3581, Occupations
  Code, is amended to read as follows:
         Sec. 351.3581.  [DIAGNOSIS AND] TREATMENT OF GLAUCOMA.
         SECTION 3.07.  Section 351.3581(a), Occupations Code, is
  amended to read as follows:
         (a)  A therapeutic optometrist may not administer or
  prescribe an oral or parenteral medication or treat glaucoma unless
  the therapeutic optometrist holds a certificate issued by the
  board. A therapeutic optometrist certified under this section 
  [subsection] shall be known as an optometric glaucoma specialist.
  To obtain a certificate, a therapeutic optometrist must [as
  required under Section 351.165(c)]:
               (1)  complete an instructional clinical review course;
  and
               (2)  pass an examination approved by the board.
         SECTION 3.08.  Subchapter H, Chapter 351, Occupations Code,
  is amended by adding Section 351.3582 to read as follows:
         Sec. 351.3582.  CERTAIN SURGICAL PROCEDURES: CERTIFICATE
  REQUIRED. A therapeutic optometrist may not perform a surgical
  procedure described by Section 351.4521(b) unless the therapeutic
  optometrist holds a certificate issued by the board. To obtain a
  certificate, a therapeutic optometrist must:
               (1)  complete an instructional clinical review course;
  and
               (2)  pass an examination approved by the board.
         SECTION 3.09.  Section 351.4521, Occupations Code, is
  amended to read as follows:
         Sec. 351.4521.  PERFORMANCE OF CERTAIN SURGICAL PROCEDURES
  BY THERAPEUTIC OPTOMETRISTS [SURGERY] PROHIBITED. (a) A
  therapeutic optometrist may not perform the following surgical
  procedures:
               (1)  retinal laser procedures;
               (2)  laser-assisted in situ keratomileusis (LASIK),
  photorefractive keratectomy (PRK), or laser epithelial
  keratomileusis (LASEK);
               (3)  penetrating keratoplasty, corneal transplant, or
  lamellar keratoplasty;
               (4)  a surgical procedure that requires the
  administration of general anesthesia;
               (5)  intraocular injection;
               (6)  a surgical procedure relating to the removal of
  the eye from a living person;
               (7)  surgical intraocular implants;
               (8)  surgery of the eyelid for a suspected eyelid
  malignancy;
               (9)  tarsorrhaphy;
               (10)  surgery of the bony orbit, including orbital
  implants; and
               (11)  retrobulbar injection or injection into the
  extraocular orbital space.
         (b)  A therapeutic optometrist may not perform the following
  surgical procedures unless the therapeutic optometrist holds a
  certificate under Section 351.3582 and the procedure is performed
  using laser or any form of ionizing or non-ionizing radiation:
               (1)  a surgical procedure requiring full-thickness
  incision or excision of the cornea or sclera other than
  paracentesis in an emergency situation requiring immediate
  reduction of the pressure inside of the eye;
               (2)  a surgical procedure requiring incision or
  excision of the iris and ciliary body;
               (3)  a surgical procedure requiring incision or
  excision of the vitreous;
               (4)  a surgical procedure requiring incision or
  excision of the retina;
               (5)  a surgical procedure requiring incision or
  excision of the crystalline lens;
               (6)  a surgical procedure requiring incision or
  excision of the extraocular muscles;
               (7)  the incisional or excisional repair of
  blepharochalasis, dermatochalasis, or ptosis;
               (8)  a surgical procedure requiring incision or
  excision of the lacrimal system other than lacrimal probing and
  related procedures;
               (9)  a surgical procedure requiring conjunctivoplasty
  with graft or flap; and
               (10)  a surgical procedure requiring incision or
  excision of pterygium [surgery or laser surgery].
         (c)  This section does not:
               (1)  prevent a therapeutic optometrist from providing
  preoperative or postoperative care relating to a surgical procedure
  listed in Subsection (a) or (b); or
               (2)  limit the use of a diagnostic or therapeutic
  instrument necessary to perform surgical treatments or procedures
  to the eye or adnexa except for those treatments or procedures
  specifically prohibited by this section.
         SECTION 3.10.  Section 453.001(9), Occupations Code, is
  amended to read as follows:
               (9)  "Referring practitioner" means a qualified
  licensed health care professional who, within the scope of
  professional licensure, may refer a person for health care
  services. The term includes:
                     (A)  a physician licensed to practice medicine by
  a state board of medical examiners;
                     (B)  a dentist licensed by a state board of dental
  examiners;
                     (C)  a chiropractor licensed by a state board of
  chiropractic examiners; [and]
                     (D)  a podiatrist licensed by a state board of
  podiatric medical examiners; and
                     (E)  an optometrist or therapeutic optometrist
  licensed by a state board of optometry.
         SECTION 3.11.  Section 454.213(b), Occupations Code, is
  amended to read as follows:
         (b)  Implementation of direct occupational therapy to a
  person for a specific health care condition must be based on a
  referral from:
               (1)  a physician licensed by a state board of medical
  examiners;
               (2)  a dentist licensed by a state board of dental
  examiners;
               (3)  a chiropractor licensed by a state board of
  chiropractic examiners;
               (4)  a podiatrist licensed by a state board of
  podiatric medical examiners; [or]
               (5)  an optometrist or therapeutic optometrist
  licensed by a state board of optometry; or
               (6)  another qualified, licensed health care
  professional who is authorized to refer for health care services
  within the scope of the professional's license.
         SECTION 3.12.  Not later than December 1, 2021, the Texas
  Optometry Board shall adopt rules necessary to implement the
  changes in law made by this Act to Chapter 351, Occupations Code.
         SECTION 3.13.  The following provisions of the Occupations
  Code are repealed:
               (1)  Section 351.160;
               (2)  Section 351.358(d); and
               (3)  Sections 351.3581(b), (c), (d), (e), (f), (g),
  (h), (i), and (j).
  ARTICLE 4. EFFECTIVE DATE
         SECTION 4.01.  This Act takes effect September 1, 2021.

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