By: Madla, Turner S.B. No. 673
West, Cain
A BILL TO BE ENTITLED
AN ACT
1-1 relating to health care, including powers and duties of the center
1-2 for rural health initiatives, powers and duties of registered
1-3 nurses and physician assistants, managed health care plans for
1-4 certain inmates, and health facilities and services for the elderly
1-5 or disabled.
1-6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-7 SECTION 1. Chapter 105, Health and Safety Code, is amended
1-8 by adding Section 105.007 to read as follows:
1-9 Sec. 105.007. CLEARINGHOUSE. (a) As part of the
1-10 comprehensive health professions resource center, the department
1-11 shall develop and establish a clearinghouse for health
1-12 professionals seeking collaborative practice.
1-13 (b) The department may:
1-14 (1) set and collect a reasonable fee to offset the
1-15 cost of complying with this section;
1-16 (2) solicit, receive, and spend grants, gifts, and
1-17 donations from public and private sources to comply with this
1-18 section; and
1-19 (3) contract with public or private entities in the
1-20 performance of its responsibilities under this section.
1-21 SECTION 2. Subsection (a), Section 106.025, Health and
1-22 Safety Code, is amended to read as follows:
1-23 (a) The center shall:
2-1 (1) educate the public and recommend appropriate
2-2 public policies regarding the continued viability of rural health
2-3 care delivery in this state;
2-4 (2) monitor and work with state and federal agencies
2-5 to assess the impact of proposed rules on rural areas;
2-6 (3) provide impact statements of proposed rules as
2-7 considered appropriate by the center;
2-8 (4) streamline regulations to assist in the
2-9 development of service diversification of health care facilities;
2-10 (5) target state and federal programs to rural areas;
2-11 (6) promote and develop community involvement and
2-12 community support in maintaining, rebuilding, or diversifying local
2-13 health services;
2-14 (7) promote and develop diverse and innovative health
2-15 care service models in rural areas;
2-16 (8) encourage the use of advanced communications
2-17 technology to:
2-18 (A) ensure that rural areas receive the maximum
2-19 benefits of telemedicine and distance learning by promoting a
2-20 transmission rate structure that accommodates rural needs and by
2-21 improving the telecommunications infrastructure in rural areas; and
2-22 (B) provide access to specialty expertise,
2-23 clinical consultation, and continuing education;
2-24 (9) assist rural health care providers, communities,
2-25 and individuals in applying for public and private grants and
3-1 programs;
3-2 (10) encourage the development of regional emergency
3-3 transportation networks;
3-4 (11) work with state agencies, universities, and
3-5 private interest groups to conduct and promote research on rural
3-6 health issues, maintain and collect a timely data base, and develop
3-7 and maintain a rural health resource library;
3-8 (12) solicit the assistance of other offices or
3-9 programs of rural health in this state that are university-based to
3-10 carry out the duties of this chapter;
3-11 (13) disseminate information and provide technical
3-12 assistance to communities, health care providers, and individual
3-13 consumers of health care services; <and>
3-14 (14) develop plans to implement a fee-for-service
3-15 health care professional recruitment service and a medical supplies
3-16 group purchasing program within the center;
3-17 (15) develop and initiate, in conjunction with the
3-18 Texas State Board of Medical Examiners, the Board of Nurse
3-19 Examiners, the Texas Department of Health, the Bureau of State
3-20 Health Data and Policy Analysis, the Texas State Board of Physician
3-21 Assistant Examiners, or other appropriate agencies, a study of
3-22 rural health clinics to:
3-23 (A) determine the efficiency and effectiveness
3-24 of rural health clinics;
3-25 (B) review the health outcomes of rural patients
4-1 treated in rural health clinics and report those outcomes in the
4-2 center's biennial report to the legislature;
4-3 (C) identify and address efficiency barriers for
4-4 the professional clinical relationship of physicians, nurses, and
4-5 physician assistants;
4-6 (D) assess the success of attracting primary
4-7 care physicians and allied health professionals to rural areas; and
4-8 (E) assess the appropriateness of the current
4-9 clinic designation process;
4-10 (16) develop and initiate a quality assessment program
4-11 to evaluate the health outcomes of rural patients treated in rural
4-12 health clinics; and
4-13 (17) encourage the active participation by physicians
4-14 and other health care providers in the early periodic diagnosis and
4-15 treatment program.
4-16 SECTION 3. Section 262.034, Health and Safety Code, is
4-17 amended to read as follows:
4-18 Sec. 262.034. FACILITIES AND SERVICES FOR ELDERLY AND
4-19 DISABLED <NURSING HOMES>. (a) <This section applies to an
4-20 authority created by a municipality with a population of more than
4-21 24,000 that is located in a county with a population of 1.5 million
4-22 or more.>
4-23 <(b)> The authority may construct, acquire, own, operate,
4-24 enlarge, improve, furnish, or equip one or more of the following
4-25 types of facilities or services for the care of the elderly or
5-1 disabled:
5-2 (1) a nursing home or similar long-term care facility;
5-3 (2) elderly housing;
5-4 (3) assisted living;
5-5 (4) home health;
5-6 (5) personal care;
5-7 (6) special care;
5-8 (7) continuing care; and
5-9 (8) durable medical equipment <one or more nursing
5-10 homes or similar facilities for the care of the elderly. The
5-11 nursing home or similar facility may be located outside the
5-12 municipal limits>.
5-13 (b) <(c)> The authority may lease or enter into an
5-14 operations or management agreement relating to all or part of a
5-15 <nursing home or similar> facility or service for the care of the
5-16 elderly or disabled that is owned by the authority. The authority
5-17 may sell, transfer, otherwise convey, or close all or part of the
5-18 <nursing home or similar> facility and may discontinue a service.
5-19 (c) <(d)> The authority may issue revenue bonds and other
5-20 notes in accordance with this chapter to acquire, construct, or
5-21 improve a <nursing home or similar> facility for the care of the
5-22 elderly or disabled or to implement the delivery of a service for
5-23 the care of the elderly or disabled.
5-24 (d) <(e)> For the purposes of this section, a <nursing home
5-25 or similar> facility or service described by Subsection (a) <for
6-1 the care of the elderly> is considered to be a hospital project
6-2 under Chapter 223 (Hospital Project Financing Act).
6-3 (e) This section applies only to an authority that owns or
6-4 operates a hospital licensed under Chapter 241 and that is located
6-5 in:
6-6 (1) a county with a population of 35,000 or less;
6-7 (2) those portions of extended municipalities that the
6-8 federal census bureau has determined to be rural; or
6-9 (3) an area that is not delineated as an urbanized
6-10 area by the federal census bureau.
6-11 SECTION 4. Chapter 285, Health and Safety Code, is amended
6-12 by adding Subchapter H to read as follows:
6-13 SUBCHAPTER H. LONG-TERM CARE AND RELATED FACILITIES
6-14 Sec. 285.101. FACILITIES OR SERVICES FOR ELDERLY OR
6-15 DISABLED. (a) This subchapter applies only to a hospital,
6-16 hospital district, or authority created and operated under Article
6-17 IX, Texas Constitution, under a special law, or under this title
6-18 that is located in:
6-19 (1) a county with a population of 35,000 or less;
6-20 (2) those portions of extended municipalities that the
6-21 federal census bureau has determined to be rural; or
6-22 (3) an area that is not delineated as an urbanized
6-23 area by the federal census bureau.
6-24 (b) A hospital, hospital district, or authority covered by
6-25 this subchapter may:
7-1 (1) construct, acquire, own, operate, enlarge,
7-2 improve, furnish, or equip one or more of the following types of
7-3 facilities or services for the care of the elderly or disabled:
7-4 (A) a nursing home or similar long-term care
7-5 facility;
7-6 (B) elderly housing;
7-7 (C) assisted living;
7-8 (D) home health;
7-9 (E) personal care;
7-10 (F) special care;
7-11 (G) continuing care; or
7-12 (H) durable medical equipment;
7-13 (2) lease or enter into an operations or management
7-14 agreement relating to all or part of a facility or service
7-15 described in Subdivision (1) that is owned by the hospital district
7-16 or authority;
7-17 (3) close, transfer, sell, or otherwise convey all or
7-18 part of a facility and discontinue services; and
7-19 (4) issue revenue bonds and other notes to acquire,
7-20 construct, or improve a facility for the care of the elderly or
7-21 disabled or to implement the delivery of a service for the care of
7-22 the elderly or disabled.
7-23 (c) For the purpose of this section, a facility or service
7-24 created under Subsection (b) is considered to be a hospital project
7-25 under Chapter 223.
8-1 SECTION 5. Subdivision (13), Section 483.001, Health and
8-2 Safety Code, is amended to read as follows:
8-3 (13) "Prescription" means an order from a
8-4 practitioner, or an agent of the practitioner designated in writing
8-5 as authorized to communicate prescriptions, or an order made in
8-6 accordance with Section 3.06(d)(5) or (6), Medical Practice Act
8-7 (Article 4495b, Vernon's Texas Civil Statutes), to a pharmacist for
8-8 a dangerous drug to be dispensed that states:
8-9 (A) the date of the order's issue;
8-10 (B) the name and address of the patient;
8-11 (C) if the drug is prescribed for an animal, the
8-12 species of the animal;
8-13 (D) the name and quantity of the drug
8-14 prescribed;
8-15 (E) the directions for the use of the drug; <and>
8-16 <(F) the legibly printed or stamped name,
8-17 address, Federal Drug Enforcement Administration registration
8-18 number, and telephone number of the practitioner at the
8-19 practitioner's usual place of business.>
8-20 (F) the intended use of the drug unless the
8-21 practitioner determines the furnishing of this information is not
8-22 in the best interest of the patient; and
8-23 (G) the name, address, and telephone number of
8-24 the practitioner at the practitioner's usual place of business,
8-25 legibly printed or stamped.
9-1 SECTION 6. Subsection (d), Section 671.001, Health and
9-2 Safety Code, is amended to read as follows:
9-3 (d) A registered nurse or physician assistant may determine
9-4 and pronounce a person dead in situations other than those
9-5 described by Subsection (b) if permitted by written policies of a
9-6 licensed health care facility, institution, or entity providing
9-7 services to that person. Those policies must consider physician
9-8 assistants who are credentialed or otherwise permitted to practice
9-9 at the facility, institution, or entity. If the facility,
9-10 institution, or entity has an organized nursing staff and an
9-11 organized medical staff or medical consultant, the nursing staff
9-12 and medical staff or consultant shall jointly develop and approve
9-13 those policies. The board shall adopt rules to govern policies for
9-14 facilities, institutions, or entities that do not have organized
9-15 nursing staffs and organized medical staffs or medical consultants.
9-16 SECTION 7. Section 671.002, Health and Safety Code, is
9-17 amended to read as follows:
9-18 Sec. 671.002. Limitation of Liability. (a) A physician who
9-19 determines death in accordance with Section 671.001(b) or a
9-20 registered nurse or physician assistant who determines death in
9-21 accordance with Section 671.001(d) is not liable for civil damages
9-22 or subject to criminal prosecution for the physician's, <or>
9-23 registered nurse's, or physician assistant's actions or the actions
9-24 of others based on the determination of death.
9-25 (b) A person who acts in good faith in reliance on a
10-1 physician's, <or> registered nurse's, or physician assistant's
10-2 determination of death is not liable for civil damages or subject
10-3 to criminal prosecution for the person's actions.
10-4 SECTION 8. Subsection (c), Section 51.918, Education Code,
10-5 is amended to read as follows:
10-6 (c) The Center for Rural Health Initiatives shall develop
10-7 relief service programs for rural physicians and allied health
10-8 personnel to facilitate ready access to continuing medical
10-9 education or practice coverage for purposes other than continuing
10-10 medical education.
10-11 SECTION 9. Section 501.059, Government Code, as added by
10-12 Chapter 238, Acts of the 73rd Legislature, 1993, is amended to read
10-13 as follows:
10-14 Sec. 501.059. MANAGED HEALTH CARE ADVISORY COMMITTEE.
10-15 (a) The Managed Health Care Advisory Committee to the Texas
10-16 Department of Criminal Justice is established.
10-17 (b) The committee consists of:
10-18 (1) two members employed full-time by the department,
10-19 at least one of whom is a physician, appointed by the executive
10-20 director;
10-21 (2) two members employed full-time by The University
10-22 of Texas Medical Branch at Galveston, at least one of whom is a
10-23 physician, appointed by the president of the medical branch; and
10-24 (3) two members employed full-time by the Texas Tech
10-25 University Health Sciences Center, at least one of whom is a
11-1 physician, appointed by the president of the university.
11-2 (c) A committee member serves at the pleasure of the
11-3 appointing official or until termination of the member's employment
11-4 with the entity the member represents.
11-5 (d) An appointment to the committee shall be made without
11-6 regard to the race, creed, sex, religion, or national origin of the
11-7 appointee.
11-8 (e) A committee member serves without compensation but is
11-9 entitled to reimbursement for actual and necessary expenses
11-10 incurred in the performance of the duties of the committee.
11-11 (f) The committee may hire a managed health care
11-12 administrator and may employ personnel necessary for the
11-13 administration of the committee's duties.
11-14 (g) The committee shall develop a managed health care plan
11-15 for all inmates at the institutional division that includes:
11-16 (1) the establishment of a managed care network of
11-17 physicians and hospitals that will serve the institutional division
11-18 as the exclusive health care provider for inmates at each facility
11-19 of the institutional division;
11-20 (2) cost containment studies; <and>
11-21 (3) care case management and utilization management
11-22 studies performed exclusively for the institutional division; and
11-23 (4) concerning the establishment of criteria for
11-24 hospitals, home health, or hospice providers, a provision requiring
11-25 the managed health care plan to accept certification by the
12-1 Medicare program under Title XVIII, Social Security Act, as amended
12-2 (42 U.S.C. Section 1395 et seq.), as an alternative to
12-3 accreditation by the Joint Commission on Accreditation of
12-4 Healthcare Organizations.
12-5 (h) To the extent possible the committee shall integrate the
12-6 managed care network with the public medical schools of this state
12-7 and the component and affiliated hospitals of those medical
12-8 schools.
12-9 (i) For those services for which the public medical schools
12-10 and their components and affiliates cannot provide, the committee
12-11 shall initiate a competitive bidding process for contracts with
12-12 other providers for medical care to inmates confined in the
12-13 institutional division.
12-14 (j) The committee may enter into a contract on behalf of the
12-15 department to fully implement the managed health care plan under
12-16 Subsection (g).
12-17 (k) The department shall pay necessary costs for the
12-18 operation of the committee, including costs of personnel, from
12-19 funds appropriated by the legislature to the department.
12-20 (l) The managed health care plan, inclusive of the health
12-21 care administrator and necessary personnel proposed by the
12-22 committee, must cost the state less than what is presently
12-23 provided, otherwise the status quo shall be maintained.
12-24 SECTION 10. Subdivision (42), Section 5, Texas Pharmacy Act
12-25 (Article 4542a-1, Vernon's Texas Civil Statutes), is amended to
13-1 read as follows:
13-2 (42) "Prescription drug order" means:
13-3 (A) an order from a practitioner or a
13-4 practitioner's designated agent to a pharmacist for a drug or
13-5 device to be dispensed; or
13-6 (B) an order pursuant to Subdivision (5) or (6),
13-7 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
13-8 Vernon's Texas Civil Statutes).
13-9 SECTION 11. Subdivision (5), Subsection (d), Section 3.06,
13-10 Medical Practice Act (Article 4495b, Vernon's Texas Civil
13-11 Statutes), is amended to read as follows:
13-12 (5)(A) At a site serving a medically underserved
13-13 population, a physician licensed by the board shall be authorized
13-14 to delegate to a registered nurse or physician assistant acting
13-15 under adequate physician supervision, the act or acts of
13-16 administering, providing, or carrying out or signing a prescription
13-17 drug order as authorized by the physician through physician's
13-18 orders, standing medical orders, standing delegation orders, or
13-19 other orders or protocols as defined by the board.
13-20 (B)(i) The carrying out or signing of
13-21 prescription drug orders under this subsection shall comply with
13-22 other applicable laws.
13-23 (ii) The authority of a physician to
13-24 delegate the carrying out or signing of prescription drug orders is
13-25 limited to dangerous drugs.
14-1 (C) Physician supervision shall be adequate if a
14-2 delegating physician:
14-3 (i) is responsible for the formulation or
14-4 approval of such physician's orders, standing medical orders,
14-5 standing delegation orders, or other orders or protocols and
14-6 periodically reviews such orders and the services provided patients
14-7 under such orders;
14-8 (ii) is on site at least once a week to
14-9 provide medical direction and consultation;
14-10 (iii) receives a daily status report from
14-11 the registered nurse or physician assistant on any problems or
14-12 complications encountered; and
14-13 (iv) is available through direct
14-14 telecommunication for consultation, assistance with medical
14-15 emergencies, or patient referral.
14-16 (D) In this subsection:
14-17 (i) "Registered nurse" means a registered
14-18 nurse recognized by the Board of Nurse Examiners as having the
14-19 specialized education and training required under Section 7,
14-20 Article 4514, Revised Statutes.
14-21 (ii) "Physician assistant" has the meaning
14-22 assigned to that term by Section 2(3), Physician Assistant
14-23 Licensing Act, and its subsequent amendments.
14-24 (iii) "Carrying out or signing a
14-25 prescription drug order" means the completion of <to complete> a
15-1 prescription drug order presigned by the delegating physician or
15-2 the signing of a prescription by a registered nurse or physician
15-3 assistant after the delegating physician notifies the board that
15-4 the person is a person to whom the physician has delegated the
15-5 authority to sign the prescription. The following information
15-6 shall be provided on each prescription <by providing the following
15-7 information>: the patient's name and address; the drug to be
15-8 dispensed; directions to the patient in regard to the taking and
15-9 dosage; the name, address, and telephone number of the physician;
15-10 the name, address, telephone and identification number of the
15-11 registered nurse or physician assistant completing or signing the
15-12 prescription drug order; the date; and the number of refills
15-13 permitted. The board may adopt additional methods to carry into
15-14 effect or put into force a physician's prescription or delegation
15-15 of a prescription under physician's orders, standing medical
15-16 orders, standing delegation orders, or other orders or protocols.
15-17 (iv) "A site serving a medically
15-18 underserved population" means:
15-19 (a) a site located in a medically
15-20 underserved area;
15-21 (b) a site located in a health
15-22 manpower shortage area;
15-23 (c) a clinic designated as a rural
15-24 health clinic under the Rural Health Clinic Services Act of 1977
15-25 (Pub. L. No. 95-210);
16-1 (d) a public health clinic or a
16-2 family planning clinic under contract with the Texas Department of
16-3 Human Services or the Texas Department of Health;
16-4 (e) a site located in an area in
16-5 which the Texas Department of Health determines there exists an
16-6 insufficient number of physicians providing services to eligible
16-7 clients of federal, state, or locally funded health care programs;
16-8 or
16-9 (f) a site that the Texas Department
16-10 of Health determines serves a disproportionate number of clients
16-11 eligible to participate in federal, state, or locally funded health
16-12 care programs.
16-13 (v) "Health manpower shortage area" means
16-14 (1) an area in an urban or rural area of Texas (which need not
16-15 conform to the geographic boundaries of a political subdivision and
16-16 which is a rational area for the delivery of health services) which
16-17 the secretary of health and human services determines has a health
16-18 manpower shortage and which is not reasonably accessible to an
16-19 adequately served area; (2) a population group which the secretary
16-20 determines to have such a shortage; or (3) a public or nonprofit
16-21 private medical facility or other facility which the secretary
16-22 determines has such a shortage as delineated in 42 U.S.C. Section
16-23 254(e)(a)(1).
16-24 (vi) "Medically underserved area" means an
16-25 area in Texas with a medically underserved population or an urban
17-1 or rural area designated by the secretary of health and human
17-2 services as an area in Texas with a shortage of personal health
17-3 services or a population group designated by the secretary as
17-4 having a shortage of such services (as defined in 42 U.S.C. Section
17-5 300(e)-1(7)). The term also includes an area defined by rule
17-6 adopted by the Texas Board of Health that is based on demographics
17-7 specific to this state, geographic factors that affect access to
17-8 health care, and environmental health factors.
17-9 (E) After making a determination under <either>
17-10 Subdivision (D)(iv)(e), <or> (D)(iv)(f), or (D)(vi) that a site
17-11 serves a medically underserved population, the Texas Department of
17-12 Health shall publish notice of its determination in the Texas
17-13 Register and provide an opportunity for public comment in the same
17-14 manner as for a proposed rule under Chapter 2001, Government Code
17-15 <the Administrative Procedure and Texas Register Act (Article
17-16 6252-13a, Vernon's Texas Civil Statutes)>.
17-17 (F) The authority granted to a physician to
17-18 delegate under this subdivision shall not be construed as limiting
17-19 the authority of a physician to delegate under any other
17-20 subdivision of this subsection.
17-21 (G) An advertisement for a site serving a
17-22 medically underserved population shall include the name and
17-23 business address of the supervising physician for the site.
17-24 SECTION 12. Subsection (d), Section 3.06, Medical Practice
17-25 Act (Article 4495b, Vernon's Texas Civil Statutes), is amended by
18-1 adding Subdivision (6) to read as follows:
18-2 (6)(A) At a physician's primary practice site or a
18-3 location as described by Paragraph (H) of this subdivision, a
18-4 physician licensed by the board may delegate to a physician
18-5 assistant or an advanced nurse practitioner acting under adequate
18-6 physician supervision the act or acts of administering, providing,
18-7 carrying out, or signing a prescription drug order as authorized
18-8 through physician's orders, standing medical orders, standing
18-9 delegation orders, or protocols as defined by the board. Providing
18-10 and carrying out or signing a prescription drug order under this
18-11 subdivision is limited to dangerous drugs.
18-12 (B) Protocols and other orders shall be defined
18-13 to promote the exercise of professional judgment by the advanced
18-14 nurse practitioner and physician assistant commensurate with their
18-15 education and experience. Under this subdivision, protocols and
18-16 other orders used by a reasonable and prudent physician exercising
18-17 sound medical judgment:
18-18 (i) need not describe the exact steps that
18-19 an advanced nurse practitioner or a physician assistant must take
18-20 with respect to each specific condition, disease, or symptom; and
18-21 (ii) may state the types or categories of
18-22 medications that may be prescribed or state in terms of categories
18-23 or types the medications that may not be prescribed.
18-24 (C) Physician supervision of the carrying out
18-25 and signing of prescription drug orders shall conform to what a
19-1 reasonable, prudent physician would find consistent with sound
19-2 medical judgment but may vary with the education and experience of
19-3 the advanced nurse practitioner or physician assistant. A
19-4 physician shall provide continuous supervision, but the constant
19-5 physical presence of the physician is not required.
19-6 (D) An alternate physician may provide
19-7 appropriate supervision on a temporary basis as defined and
19-8 established by the board by rule.
19-9 (E) The carrying out or signing of prescription
19-10 drug orders under this subdivision shall comply with other
19-11 applicable laws.
19-12 (F) A physician's authority to delegate the
19-13 carrying out or signing of a prescription drug order at his primary
19-14 practice site under this subdivision is limited to:
19-15 (i) three physician assistants or advanced
19-16 nurse practitioners or their full-time equivalents practicing at
19-17 the physician's primary practice site; and
19-18 (ii) the patients with whom the physician
19-19 has established or will establish a physician-patient relationship,
19-20 but this shall not be construed as requiring the physician to see
19-21 the patient within a specific period of time.
19-22 (G) In this subdivision:
19-23 (i) "Advanced nurse practitioner" has the
19-24 meaning assigned to that term by Section 8, Article 4514, Revised
19-25 Statutes.
20-1 (ii) "Physician assistant" has the meaning
20-2 assigned to that term by Section 2(3), Physician Assistant
20-3 Licensing Act (Article 4495b-1, Vernon's Texas Civil Statutes).
20-4 (iii) "Primary practice site" means:
20-5 (a) the practice location
20-6 where the physician spends the majority of the physician's time;
20-7 (b) a licensed hospital,
20-8 licensed long-term care facility, licensed adult care center where
20-9 both the physician and the physician assistant or advanced nurse
20-10 practitioner are authorized to practice, or an established
20-11 patient's residence; or
20-12 (c) where the physician is
20-13 physically present with the physician assistant or advanced nurse
20-14 practitioner.
20-15 (iv) "Carrying out or signing a
20-16 prescription drug order" means either the completion of a
20-17 prescription drug order presigned by a delegating physician or the
20-18 signing of a prescription by a physician assistant or advanced
20-19 nurse practitioner after the person has been designated with the
20-20 board by the delegating physician as a person delegated to sign a
20-21 prescription. The following information shall be provided on each
20-22 prescription: the patient's name and address; the drug to be
20-23 dispensed; directions to the patient in regard to the taking and
20-24 dosage; the intended use of the drug, if appropriate; the name,
20-25 address, and telephone number of the physician; the name, address,
21-1 and telephone and identification number of the physician assistant
21-2 or advanced nurse practitioner completing or signing the
21-3 prescription drug order; the date; and the number of refills
21-4 permitted. The board may adopt additional methods to carry into
21-5 effect or put into force a physician's prescription under
21-6 physician's orders, standing medical orders, standing delegation
21-7 orders, protocols, or other orders.
21-8 (H) A physician licensed by the board shall be
21-9 authorized to delegate, to one or more physician assistants or
21-10 advanced nurse practitioners acting under adequate supervision by a
21-11 physician whose practice is facility-based at a licensed hospital
21-12 or licensed long-term care facility, the carrying out or signing of
21-13 prescription drug orders if the physician is the medical director
21-14 or chief of medical staff of the facility in which the physician
21-15 assistant or advanced nurse practitioner practices, the chair of
21-16 the facility's credentialing committee, a department chair of a
21-17 facility department in which the physician assistant or advanced
21-18 nurse practitioner practices, or a physician who consents to the
21-19 request of the medical director or chief of medical staff to
21-20 delegate the carrying out or signing of prescription drug orders at
21-21 the facility in which the physician assistant or advanced nurse
21-22 practitioner practices. A physician's authority to delegate under
21-23 this subdivision is limited as follows:
21-24 (i) the delegation is pursuant to a
21-25 physician's order, standing medical order, standing delegation
22-1 order, or protocol developed in accordance with policies approved
22-2 by the facility's medical staff or a committee thereof as provided
22-3 in facility bylaws;
22-4 (ii) the delegation occurs in the facility
22-5 in which the physician is the medical director, the chief of
22-6 medical staff, the chair of the credentialing committee, or a
22-7 department chair;
22-8 (iii) the delegation does not permit the
22-9 carrying out or signing of prescription drug orders for the care or
22-10 treatment of the patients of any other physician without the prior
22-11 consent of that physician;
22-12 (iv) delegation in a long-term care
22-13 facility must be by the medical director, and the medical director
22-14 is limited to delegating the carrying out and signing of
22-15 prescription drug orders to no more than three advanced nurse
22-16 practitioners or physician assistants or their full-time
22-17 equivalents; and
22-18 (v) under this paragraph, a physician may
22-19 not delegate at more than one licensed hospital or more than one
22-20 long-term care facility unless approved by the board.
22-21 (I) In a licensed hospital or ambulatory
22-22 surgical center, a physician may delegate to a certified registered
22-23 nurse anesthetist the ordering of drugs and devices necessary to
22-24 enable the certified registered nurse anesthetist to administer an
22-25 anesthetic or an anesthesia-related service ordered by the
23-1 physician. The physician's order for anesthesia or
23-2 anesthesia-related services need not be drug-specific,
23-3 dose-specific, or administration-technique-specific. Pursuant to
23-4 the order and in accordance with facility policies or medical staff
23-5 bylaws, the nurse anesthetist may select, obtain, and administer
23-6 those drugs and apply the appropriate medical devices necessary to
23-7 accomplish the order and maintain the patient within a sound
23-8 physiological status.
23-9 (J) A physician shall not be liable for the act
23-10 or acts of a physician assistant or advanced nurse practitioner
23-11 solely on the basis of having signed an order, a standing medical
23-12 order, a standing delegation order, or protocols authorizing a
23-13 physician assistant or advanced nurse practitioner to perform the
23-14 act or acts of administering, providing, carrying out, or signing a
23-15 prescription drug order unless the physician has reason to believe
23-16 the physician assistant or advanced nurse practitioner lacked the
23-17 competency to perform the act or acts.
23-18 (K) The authority granted to a physician to
23-19 delegate under this subdivision shall not be construed as limiting
23-20 the authority of a physician to delegate under any other
23-21 subdivision of this subsection.
23-22 SECTION 13. Article 4514, Revised Statutes, is amended by
23-23 adding Section 8 to read as follows:
23-24 Sec. 8. APPROVAL OF REGISTERED NURSE FOR ADVANCED STATUS.
23-25 (a) The board shall adopt rules for approval of a registered nurse
24-1 as an advanced nurse practitioner or an advanced practice nurse.
24-2 "Advanced nurse practitioner" or "advanced practice nurse" means a
24-3 registered nurse approved by the board to practice as an advanced
24-4 practice nurse on the basis of completion of an advanced
24-5 educational program. The term includes a nurse practitioner, nurse
24-6 midwife, nurse anesthetist, and clinical nurse specialist.
24-7 (b) The board shall adopt rules for the initial approval and
24-8 biennial renewal of an advanced nurse practitioner to carry out or
24-9 sign prescription drug orders under Section 3.06(d)(5) and (6),
24-10 Medical Practice Act (Article 4495b, Vernon's Texas Civil
24-11 Statutes). The rules at a minimum shall:
24-12 (1) require completion of pharmacology and related
24-13 pathology for initial approval;
24-14 (2) require continuing education in clinical
24-15 pharmacology and related pathology in addition to any continuing
24-16 education otherwise required under Article 4518, Revised Statutes;
24-17 and
24-18 (3) provide for the issuing of a prescription
24-19 authorization number to an advanced nurse practitioner approved
24-20 under this section.
24-21 SECTION 14. Section 5, Article 4518, Revised Statutes, is
24-22 amended to read as follows:
24-23 Sec. 5. Insofar as any of the following acts require
24-24 substantial specialized judgment and skill and insofar as the
24-25 proper performance of any of the following acts is based upon
25-1 knowledge and application of the principles of biological,
25-2 physical, and social science as acquired by a completed course in
25-3 an approved school of professional nursing, "Professional Nursing"
25-4 shall be defined as the performance for compensation of any nursing
25-5 act (a) in the observation, assessment, intervention, evaluation,
25-6 rehabilitation, care and counsel and health teachings of persons
25-7 who are ill, injured or infirm or experiencing changes in normal
25-8 health processes; (b) in the maintenance of health or prevention of
25-9 illness; (c) in the administration of medications or treatments as
25-10 ordered by a licensed physician, including a podiatric physician
25-11 licensed by the Texas State Board of Podiatry Examiners, or
25-12 dentists; (d) in the supervision or teaching of nursing; (e) in the
25-13 administration, supervision, and evaluation of nursing practices,
25-14 policies, and procedures; <or> (f) in <the requesting,> receiving
25-15 <, and signing for> professional samples which have been requested
25-16 and presigned for by the supervising physician and distributing the
25-17 samples to patients at sites to which Sections <a site serving
25-18 underserved populations, as provided by Section> 3.06(d)(5) and
25-19 (6), Medical Practice Act (Article 4495b, Vernon's Texas Civil
25-20 Statutes), apply; or (g) in the performing of acts delegated by a
25-21 physician under Sections 3.06(d)(5) and (6), Medical Practice Act
25-22 (Article 4495b, Vernon's Texas Civil Statutes) <and rules
25-23 implementing that section>. The foregoing shall not be deemed to
25-24 include acts of medical diagnosis or prescription of therapeutic or
25-25 corrective measures. Nothing in this section shall be construed as
26-1 prohibiting a registered nurse recognized by the board as having
26-2 the specialized education and training required under Section 7,
26-3 Article 4514, Revised Statutes, and functioning under adequate
26-4 physician supervision from carrying out prescription drug orders or
26-5 treatments under physician's orders, standing medical orders,
26-6 standing delegation orders, or other orders or protocols.
26-7 SECTION 15. The importance of this legislation and the
26-8 crowded condition of the calendars in both houses create an
26-9 emergency and an imperative public necessity that the
26-10 constitutional rule requiring bills to be read on three several
26-11 days in each house be suspended, and this rule is hereby suspended,
26-12 and that this Act take effect and be in force from and after its
26-13 passage, and it is so enacted.