Bill Text: TX HB708 | 2011-2012 | 82nd Legislature | Introduced

---

Bill Title: Relating to licensing, regulation, and prescribing and ordering authority of advanced practice registered nurses and the regulation of registered nurses and physician assistants.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2011-04-20 - Left pending in committee [HB708 Detail]

Download: Texas-2011-HB708-Introduced.html

---

82R2711 EES-F
By: Hancock H.B. No. 708

A BILL TO BE ENTITLED
AN ACT
relating to licensing, regulation, and prescribing and ordering
authority of advanced practice registered nurses and the regulation
of registered nurses and physician assistants.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES
SECTION 1.001. Chapter 301, Occupations Code, is amended by
adding Subchapter O to read as follows:
SUBCHAPTER O. ADVANCED PRACTICE REGISTERED NURSES
Sec. 301.701. SCOPE OF PRACTICE. (a) Advanced practice
registered nursing by a nurse practitioner, nurse anesthetist,
nurse-midwife, or clinical nurse specialist is based on:
(1) knowledge and skills acquired in basic nursing
education;
(2) licensure as a registered nurse;
(3) successful completion of a graduate-level
advanced practice registered nursing program accredited by a
national accrediting organization recognized by the board;
(4) current certification in accordance with this
chapter by a national certifying body recognized by the board in the
appropriate advanced practice registered nursing role approved by
the board; and
(5) nursing care provided in an area with at least one
targeted population group recognized and approved by the board.
(b) Practice as an advanced practice registered nurse is an
expanded scope of nursing practice in a role approved by the board
and in an area with a targeted population group recognized and
approved by the board, with or without compensation or other
personal profit, and includes the scope of practice of a registered
nurse.
(c) The scope of practice of an advanced practice registered
nurse includes advanced assessment, diagnosing, prescribing, and
ordering.
(d) An advanced practice registered nurse may serve as a
primary care provider of record.
Sec. 301.702. APPLICABILITY OF SUBCHAPTER TO REGISTERED
NURSES. (a) This subchapter does not limit or modify the scope of
practice of a registered nurse who is not an advanced practice
registered nurse approved by the board.
(b) The scope of practice of a registered nurse includes any
act of professional nursing the nurse is authorized to perform
under this chapter.
Sec. 301.703. LICENSE REQUIRED. A person may not practice
or offer to practice advanced practice registered nursing in this
state unless the person is licensed as an advanced practice
registered nurse under this subchapter.
Sec. 301.704. APPLICATION. An applicant for an advanced
practice registered nurse license shall submit to the board an
application on the form prescribed by the board, any required fee,
and any other information required by the board.
Sec. 301.705. PRACTICE BY ADVANCED PRACTICE REGISTERED
NURSE. (a) An advanced practice registered nurse who holds a
license issued under this subchapter may:
(1) diagnose, prescribe, and institute therapy or
referrals of patients to health care agencies, health care
providers, and community resources; and
(2) plan and initiate a therapeutic regimen that
includes ordering and prescribing medical devices and equipment,
nutrition, and diagnostic and supportive services, including home
health care, hospice, physical therapy, and occupational therapy.
(b) 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.
(c) 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 and
experience;
(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.
Sec. 301.706. PRESCRIBING AND ORDERING AUTHORITY. (a) The
board may grant prescribing and ordering authority in accordance
with this chapter through the issuance of an advanced practice
registered nursing license to a registered nurse approved by the
board to practice as an advanced practice registered nurse.
(b) As authorized by the board, an advanced practice
registered nurse may prescribe, procure, administer, and dispense
dangerous drugs and controlled substances.
SECTION 1.002. Subchapter A, Chapter 301, Occupations Code,
is amended by adding Section 301.0021 to read as follows:
Sec. 301.0021. DEFINITION OF ADVANCED PRACTICE REGISTERED
NURSE. (a) In this chapter, "advanced practice registered nurse"
means a registered nurse who holds a license issued under
Subchapter O and who:
(1) has successfully completed a graduate-level
education program accredited by a national accrediting
organization recognized by the board that prepares the nurse to
function as a nurse practitioner, nurse anesthetist,
nurse-midwife, or clinical nurse specialist;
(2) if the education program required under
Subdivision (1) was completed after January 1, 1996, has met
requirements established or recognized by the board for national
certification;
(3) is licensed by the board to provide advanced
practice registered nursing in an area with a targeted population
group recognized and approved by the board; and
(4) meets requirements established by the board for
continued competence.
(b) The term "advanced practice registered nurse" is
synonymous with "advanced nurse practitioner" and "advanced
practice nurse."
ARTICLE 2. CONFORMING AMENDMENTS REGARDING DELEGATION
SECTION 2.001. The heading to Subchapter B, Chapter 157,
Occupations Code, is amended to read as follows:
SUBCHAPTER B. DELEGATION TO [ADVANCED PRACTICE NURSES AND]
PHYSICIAN ASSISTANTS
SECTION 2.002. Section 157.051(2), Occupations Code, is
amended to read as follows:
(2) "Carrying out or signing a prescription drug
order" means completing a prescription drug order presigned by the
delegating physician, or the signing of a prescription by a
[registered nurse or] physician assistant.
SECTION 2.003. Section 157.0511(b-1), Occupations Code, is
amended to read as follows:
(b-1) The board shall adopt rules that require a physician
who delegates the carrying out or signing of a prescription drug
order under this subchapter to register with the board the name and
license number of the physician assistant [or advanced practice
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 2.004. Sections 157.052(c) and (e), Occupations
Code, are amended to read as follows:
(c) At a site serving a medically underserved population, a
physician licensed by the board may delegate to a [registered nurse
or] physician assistant acting under adequate physician
supervision the act of administering, providing, or carrying out or
signing a prescription drug order, as authorized by the physician
through a physician's order, a standing medical order, a standing
delegation order, or another order or protocol as defined by the
board.
(e) Physician supervision is adequate for the purposes of
this section if a delegating physician:
(1) is responsible for the formulation or approval of
the physician's order, standing medical order, standing delegation
order, or other order or protocol, and periodically reviews the
order and the services provided patients under the order;
(2) is on-site to provide medical direction and
consultation at least once every 10 business days during which the
[advanced practice nurse or] physician assistant is on-site
providing care;
(3) receives a daily status report from the [advanced
practice nurse or] physician assistant on any problem or
complication encountered; and
(4) is available through direct telecommunication for
consultation, patient referral, or assistance with a medical
emergency.
SECTION 2.005. Sections 157.053(a), (b), (c), and (e),
Occupations Code, are amended to read as follows:
(a) In this section, "primary practice site" means:
(1) the practice location of a physician at which the
physician spends the majority of the physician's time;
(2) a licensed hospital, a licensed long-term care
facility, or a licensed adult care center where both the physician
and the physician assistant [or advanced practice nurse] are
authorized to practice;
(3) a clinic operated by or for the benefit of a public
school district to provide care to the students of that district and
the siblings of those students, if consent to treatment at that
clinic is obtained in a manner that complies with Chapter 32, Family
Code;
(4) the residence of an established patient;
(5) another location at which the physician is
physically present with the physician assistant [or advanced
practice nurse]; or
(6) a location where a physician assistant [or
advanced practice nurse] who practices on-site with the physician
more than 50 percent of the time and in accordance with board rules
provides:
(A) health care services for established
patients;
(B) without remuneration, voluntary charity
health care services at a clinic run or sponsored by a nonprofit
organization; or
(C) without remuneration, voluntary health care
services during a declared emergency or disaster at a temporary
facility operated or sponsored by a governmental entity or
nonprofit organization and established to serve persons in this
state.
(b) At a physician's primary practice site, a physician
licensed by the board may delegate to a physician assistant [or an
advanced practice nurse] acting under adequate physician
supervision the act of administering, providing, or carrying out or
signing a prescription drug order as authorized through a
physician's order, a standing medical order, a standing delegation
order, or another order or protocol as defined by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders 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 nurse or] physician assistant. A physician shall provide
continuous supervision, but the constant physical presence of the
physician is not required.
(e) A physician's authority to delegate the carrying out or
signing of a prescription drug order is limited to:
(1) four physician assistants [or advanced practice
nurses] or their full-time equivalents practicing at the
physician's primary practice site or at an alternate practice site
under Section 157.0541 unless a waiver is granted under Section
157.0542(b-1); and
(2) the patients with whom the physician has
established or will establish a physician-patient relationship.
SECTION 2.006. Sections 157.054(a), (b), and (c),
Occupations Code, are amended to read as follows:
(a) A physician licensed by the board may delegate, to one
or more physician assistants [or advanced practice nurses] acting
under adequate physician supervision whose practice is
facility-based at a licensed hospital or licensed long-term care
facility, the administration or provision of a drug and the
carrying out or signing of a prescription drug order if the
physician is:
(1) the medical director or chief of medical staff of
the facility in which the physician assistant [or advanced practice
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 nurse]
practices; or
(4) a physician who consents to the request of the
medical director or chief of medical staff to delegate the carrying
out or signing of a prescription drug order at the facility in which
the physician assistant [or advanced practice nurse] practices.
(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, or a department chair;
(3) the delegation may not permit the carrying out or
signing of prescription drug orders for the care or treatment of the
patients of any other physician without the prior consent of that
physician;
(4) delegation in a long-term care facility must be by
the medical director and is limited to the carrying out and signing
of prescription drug orders to not more than four [advanced
practice nurses or] physician assistants or their full-time
equivalents; and
(5) a physician may not delegate at more than one
licensed hospital or more than two long-term care facilities unless
approved by the board.
(c) Physician supervision of the carrying out and signing of
prescription drug orders 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 nurse or] physician assistant. A physician shall provide
continuous supervision, but the constant physical presence of the
physician is not required.
SECTION 2.007. Sections 157.0541(b), (c), (d), and (e),
Occupations Code, are amended to read as follows:
(b) At an alternate site, a physician licensed by the board
may delegate to a [an advanced practice nurse or] physician
assistant, acting under adequate physician supervision, the act of
administering, providing, or carrying out or signing a prescription
drug order as authorized through a physician's order, a standing
medical order, a standing delegation order, or another order or
protocol as defined by the board.
(c) Physician supervision is adequate for the purposes of
this section if:
(1) the delegating physician:
(A) is on-site with the [advanced practice nurse
or] physician assistant at least 10 percent of the hours of
operation of the site each month that the physician assistant [or
advanced practice nurse] is acting with delegated prescriptive
authority and is available while on-site to see, diagnose, treat,
and provide care to those patients for services provided or to be
provided by the physician assistant [or advanced practice nurse] to
whom the physician has delegated prescriptive authority; and
(B) is not prohibited by contract from seeing,
diagnosing, or treating a patient for services provided or to be
provided by the physician assistant [or advanced practice nurse]
under delegated prescriptive authority;
(2) the delegating physician reviews at least 10
percent of the medical charts, including through electronic review
of the charts from a remote location, for each [advanced practice
nurse or] physician assistant at the site; and
(3) the delegating physician is available through
direct telecommunication for consultation, patient referral, or
assistance with a medical emergency.
(d) An alternate physician may provide appropriate
supervision to a [an advanced practice nurse or] physician
assistant under this section on a temporary basis as provided by
board rule.
(e) Unless a waiver is granted under Section 157.0542(b-1),
the combined number of [advanced practice nurses and] physician
assistants to whom a physician may delegate under this section and
at a primary practice site under Section 157.053 may not exceed four
physician assistants [or advanced practice nurses] or the full-time
equivalent of four physician assistants [or advanced practice
nurses].
SECTION 2.008. Sections 157.0542(a), (b), and (b-1),
Occupations Code, are amended to read as follows:
(a) On determining that the conditions of Subsection (b)
have been met, the board may waive or modify any of the site or
supervision requirements for a physician to delegate the carrying
out or signing of prescription drug orders to a [an advanced
practice nurse or] physician assistant under Sections 157.052,
157.053, 157.054, and 157.0541, or under board rules. The board may
not waive the limitation on the number of primary or alternate
practice sites at which a physician may delegate the carrying out or
signing of prescription drug orders or the number of [advanced
practice nurses or] physician assistants to whom a physician may
delegate the carrying out or signing of prescription drug orders,
except as provided by Subsection (b-1)(1).
(b) The board may grant a waiver under Subsection (a) if the
board determines that:
(1) the practice site where the physician is seeking
to delegate prescriptive authority is unable to meet the
requirements of this chapter or board rules or compliance would
cause an undue burden without a corresponding benefit to patient
care;
(2) safeguards exist for patient care and for
fostering a collaborative practice between the physician and the
[advanced practice nurses and] physician assistants; and
(3) if the requirement for which the waiver is sought
is the amount of time the physician is on-site, the frequency and
duration of time the physician is on-site when the [advanced
practice nurse or] physician assistant is present is sufficient for
collaboration to occur, taking into consideration the other ways
the physician collaborates with the [advanced practice nurse or]
physician assistant, including at other sites.
(b-1) If the board determines that the types of health care
services provided by a physician assistant [or advanced practice
nurse] under Section 157.0541 are limited in nature and duration
and are within the scope of delegated authority under this
subchapter, as defined by board rule, and that patient health care
will not be adversely affected, the board may modify or waive:
(1) the limitation on the number of physician
assistants [or advanced practice nurses], or their full-time
equivalents, if the board does not authorize more than six
physician assistants [or advanced practice nurses] or their
full-time equivalents;
(2) the mileage limitation; or
(3) the on-site supervision requirements, except that
the physician must be available on-site at regular intervals and
when on-site the physician must be available to treat patients.
SECTION 2.009. 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 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 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 2.010. 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 2.011. 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 nurse] lacked the competency to perform the
act, a physician is not liable for an act of a physician assistant
[or advanced practice nurse] solely because the physician signed a
standing medical order, a standing delegation order, or another
order or protocol authorizing the physician assistant [or advanced
practice nurse] to administer, provide, carry out, or sign a
prescription drug order.
ARTICLE 3. GENERAL CONFORMING AMENDMENTS
SECTION 3.001. Section 301.002(2), Occupations Code, is
amended to read as follows:
(2) "Professional nursing" means the performance of an
act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application
of the principles of biological, physical, and social science as
acquired by a completed course in an approved school of
professional nursing. The term does not include acts of medical
diagnosis or the prescription of therapeutic or corrective measures
except as authorized for advanced practice registered nurses.
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 practitioner, as that term is defined by
Section 551.003 [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 by an
advanced practice [at sites in which a] registered nurse [is
authorized to sign prescription drug orders as provided by
Subchapter B, Chapter 157];
(G) the prescribing of controlled substances and
dangerous drugs by an advanced practice registered nurse [the
performance of an act delegated by a physician under Section
157.052, 157.053, 157.054, 157.0541, 157.0542, 157.058, or
157.059]; and
(H) the development of the nursing care plan.
SECTION 3.002. Section 301.005, Occupations Code, is
amended to read as follows:
Sec. 301.005. REFERENCE IN OTHER LAW. (a) A reference in
any other law to the former Board of Nurse Examiners means the Texas
Board of Nursing.
(b) A reference in any other law to an "advanced nurse
practitioner" or "advanced practice nurse" means an "advanced
practice registered nurse."
SECTION 3.003. Section 301.152, Occupations Code, is
amended to read as follows:
Sec. 301.152. RULES REGARDING ADVANCED PRACTICE REGISTERED
NURSES [SPECIALIZED TRAINING]. (a) [In this section, "advanced
practice nurse" means a registered nurse approved by the board to
practice as an advanced practice 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."
[(b)] The board shall adopt rules to:
(1) establish:
(A) any specialized education or training,
including pharmacology, that an advanced practice [a] registered
nurse must have to prescribe and [carry out a prescription drug]
order drugs and medical devices [under Section 157.052]; and
(B) a system for assigning a prescriptive
authorization [an identification] number to an advanced practice
[a] registered nurse who provides the board with evidence of
completing the specialized education and training requirement
under Subdivision (1)(A); and
(2) [approve a registered nurse as an advanced
practice nurse; and
[(3)] initially approve and biennially renew an
advanced practice registered nurse's authority to prescribe and
[carry out or sign a prescription drug] order drugs and medical
devices [under Chapter 157].
(b) [(c)] At a minimum, the rules adopted under Subsection
(a)(2) [(b)(3)] must:
(1) require completion of pharmacology and related
pathology education for initial approval;
(2) require continuing education in clinical
pharmacology and related pathology in addition to any continuing
education otherwise required under Section 301.303; and
(3) provide for the issuance of a prescription
authorization number to an advanced practice registered nurse
approved under this section.
(c) [(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.
SECTION 3.004. Section 551.003(34), Occupations Code, is
amended to read as follows:
(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, 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 nurse or] physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542.
SECTION 3.005. 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.
SECTION 3.006. 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, "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.
(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 an advanced
practice registered nurse who practices advanced practice 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 [State
Board of] Medical Board [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 3.007. 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 301.0021 [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) 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 perform all
supervisory functions described by Section 157.052(e), Occupations
Code, with respect to the physician assistant;
(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 3.008. 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 nurse or] physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations
Code.
SECTION 3.009. Sections 483.001(12) and (13), Health and
Safety Code, are amended to read as follows:
(12) "Practitioner" means a person licensed:
(A) by the Texas [State Board of] Medical Board
[Examiners], State Board of Dental Examiners, Texas State Board of
Podiatric Medical Examiners, Texas Optometry Board, Texas Board of
Nursing, or State Board of Veterinary Medical Examiners to
prescribe and administer dangerous drugs;
(B) by another state in a health field in which,
under the laws of this state, a licensee may legally prescribe
dangerous drugs;
(C) 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 nurse or] physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542, 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 3.010. 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 a [an advanced practice nurse or] physician
assistant authorized by the practitioner to sign prescription drug
orders under Subchapter B, Chapter 157, Occupations Code.
SECTION 3.011. 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 who is
authorized to provide care under Subchapter O, Chapter 301,
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 3.012. 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:
(1) the [advanced practice nurse or] physician
assistant is authorized by the physician to provide care under
Subchapter B, Chapter 157, Occupations Code, or the advanced
practice registered nurse is authorized to provide care under
Subchapter O, Chapter 301, 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 3.013. Section 1452.051(1), Insurance Code, is
amended to read as follows:
(1) "Advanced practice nurse" means an advanced
practice registered nurse as defined by Section 301.0021, [has the
meaning assigned by Section 301.152,] Occupations Code.
ARTICLE 4. REPEALER
SECTION 4.001. The following sections of the Occupations
Code are repealed:
(1) Section 157.051(1);
(2) Section 157.052(a)(3);
(3) Section 157.058; and
(4) Section 157.059.
ARTICLE 5. TRANSITION AND EFFECTIVE DATE
SECTION 5.001. (a) Not later than January 1, 2012, the
Texas Board of Nursing shall adopt the rules necessary to implement
the changes in law made by this Act.
(b) Notwithstanding Subchapter O, Chapter 301, Occupations
Code, as added by this Act, an advanced practice registered nurse
who has been approved by the Texas Board of Nursing to provide
advanced practice registered nursing care is not required to hold a
license as an advanced practice registered nurse under Subchapter O
until March 1, 2012.
SECTION 5.002. This Act takes effect September 1, 2011.