Bill Text: TX HB915 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to the authority of advanced practice registered nurses to make medical diagnoses and to prescribe and order prescription drugs and devices.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2011-04-20 - Left pending in committee [HB915 Detail]
Download: Texas-2011-HB915-Introduced.html
82R3310 NC-D | ||
By: Christian | H.B. No. 915 |
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relating to the authority of advanced practice registered nurses to | ||
make medical diagnoses and to prescribe and order prescription | ||
drugs and devices. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 157.051(1), Occupations Code, is amended | ||
to read as follows: | ||
(1) "Advanced practice nurse" has the meaning assigned | ||
to that term by Section 301.152, except the term does not include an | ||
advanced practice registered nurse granted prescribing and | ||
ordering authority under Section 301.357. The term includes an | ||
advanced nurse practitioner. | ||
SECTION 2. Section 157.052(3), Occupations Code, is amended | ||
to read as follows: | ||
(3) "Registered nurse" means a registered nurse | ||
recognized by the Texas Board of Nursing as having the specialized | ||
education and training required under Section 301.152 to carry out | ||
a prescription drug order under this subchapter. | ||
SECTION 3. 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 under | ||
Section 301.357. Professional nursing involves: | ||
(A) the observation, assessment, intervention, | ||
evaluation, rehabilitation, care and counsel, or health teachings | ||
of a person who is ill, injured, infirm, or experiencing a change in | ||
normal health processes; | ||
(B) the maintenance of health or prevention of | ||
illness; | ||
(C) the administration of a medication or | ||
treatment as ordered by a practitioner, as that term is defined by | ||
Section 551.003 [ |
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(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 | ||
authorized advanced practice registered nurse or at sites in which | ||
a registered nurse is authorized to sign prescription drug orders | ||
as provided by Subchapter B, Chapter 157; | ||
(G) 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; [ |
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(H) the prescribing of controlled substances and | ||
dangerous drugs and medical devices by an authorized advanced | ||
practice registered nurse; and | ||
(I) the development of the nursing care plan. | ||
SECTION 4. Section 301.152, Occupations Code, is amended by | ||
amending Subsections (a) and (b) and adding Subsection (c-1) to | ||
read as follows: | ||
(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" and "advanced | ||
practice registered nurse." | ||
(b) The board shall adopt rules to: | ||
(1) establish: | ||
(A) any specialized education or training, | ||
including pharmacology, that a registered nurse must have to: | ||
(i) carry out a prescription drug order | ||
under Section 157.052; or | ||
(ii) prescribe and order drugs and medical | ||
devices under Section 301.357; and | ||
(B) a system for assigning an identification | ||
number to a registered nurse who provides the board with evidence of | ||
completing the specialized education and training requirement | ||
under Paragraph (A)(i) or (ii) [ |
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(2) approve a registered nurse as an advanced practice | ||
nurse; and | ||
(3) initially approve and biennially renew an advanced | ||
practice nurse's authority to: | ||
(A) carry out or sign a prescription drug order | ||
under Chapter 157; or | ||
(B) prescribe and order drugs and medical devices | ||
under Section 301.357. | ||
(c-1) For initial approval under Subsection (b)(3)(B), the | ||
rules must require the completion of 3,600 hours of practice as an | ||
advanced practice nurse with authority to carry out or sign | ||
prescription drug orders under Chapter 157. | ||
SECTION 5. Subchapter H, Chapter 301, Occupations Code, is | ||
amended by adding Section 301.357 to read as follows: | ||
Sec. 301.357. PRESCRIBING AND ORDERING AUTHORITY OF CERTAIN | ||
NURSES. (a) The board may grant prescribing and ordering authority | ||
to an advanced practice registered nurse who is qualified for the | ||
authority under the rules adopted by the board under Section | ||
301.152(c-1). | ||
(b) As authorized by the board, an advanced practice | ||
registered nurse may: | ||
(1) prescribe, procure, administer, and dispense | ||
dangerous drugs and controlled substances; | ||
(2) diagnose, prescribe, and institute therapy or | ||
referrals of patients to health care agencies, health care | ||
providers, and community resources; and | ||
(3) 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. | ||
(c) An advanced practice registered nurse granted | ||
prescribing and ordering authority under this section shall | ||
practice professional nursing in accordance with standards | ||
established and recognized by the board to protect the public | ||
health and safety. | ||
(d) An advanced practice registered nurse may apply to the | ||
board for prescribing and ordering authority under this section by | ||
submitting to the board an application on the form prescribed by the | ||
board, paying any required fee, and providing any other information | ||
required by the board. | ||
SECTION 6. 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) 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 7. Section 563.053, Occupations Code, is amended to | ||
read as follows: | ||
Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN | ||
RURAL AREAS. (a) In this section: | ||
(1) "Advanced practice registered nurse" means an | ||
advanced practice registered nurse granted prescribing and | ||
ordering authority under Section 301.357. | ||
(2) "Reimbursement [ |
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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 [ |
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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 8. 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) 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 9. Section 483.001(12), Health and Safety Code, is | ||
amended to read as follows: | ||
(12) "Practitioner" means a person who is [ |
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(A) licensed by the Texas [ |
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Medical Board [ |
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State Board of Podiatric Medical Examiners, Texas Optometry Board, | ||
or State Board of Veterinary Medical Examiners to prescribe and | ||
administer dangerous drugs; | ||
(B) licensed by another state in a health field | ||
in which, under the laws of this state, a licensee may legally | ||
prescribe dangerous drugs; | ||
(C) licensed in Canada or Mexico in a health | ||
field in which, under the laws of this state, a licensee may legally | ||
prescribe dangerous drugs; [ |
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(D) 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; or | ||
(E) an advanced practice registered nurse to whom | ||
the Texas Board of Nursing has granted prescribing and ordering | ||
authority under Section 301.357, Occupations Code. | ||
SECTION 10. 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. | ||
SECTION 11. This Act takes effect September 1, 2011. |