75R11239 SKB-D
By Van de Putte H.B. No. 1284
Substitute the following for H.B. No. 1284:
By Berlanga C.S.H.B. No. 1284
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the authority of pharmacists to administer
1-3 immunizations and vaccinations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 5(38), Texas Pharmacy Act (Article
1-6 4542a-1, Vernon's Texas Civil Statutes), is amended to read as
1-7 follows:
1-8 (38) "Practice of pharmacy" means:
1-9 (A) provision of those acts or services
1-10 necessary to provide pharmaceutical care;
1-11 (B) interpretation and evaluation of
1-12 prescription drug orders or medication orders;
1-13 (C) participation in drug and device selection
1-14 as authorized by law, drug administration, drug regimen review, or
1-15 drug or drug-related research;
1-16 (D) provision of patient counseling;
1-17 (E) responsibility for:
1-18 (i) dispensing of prescription drug orders
1-19 or distribution of medication orders;
1-20 (ii) compounding and labeling of drugs and
1-21 devices, except labeling by a manufacturer, repackager, or
1-22 distributor of nonprescription drugs and commercially packaged
1-23 prescription drugs and devices;
1-24 (iii) proper and safe storage of drugs and
2-1 devices; or
2-2 (iv) maintenance of proper records for
2-3 drugs and devices; [and]
2-4 (F) performance of a specific act of drug
2-5 therapy management for a patient delegated to a pharmacist by a
2-6 written protocol from a physician licensed in this state in
2-7 compliance with the Medical Practice Act (Article 4495b, Vernon's
2-8 Texas Civil Statutes); and
2-9 (G) administration of immunizations and
2-10 vaccinations under a physician's written protocol.
2-11 SECTION 2. Section 17, Texas Pharmacy Act (Article 4542a-1,
2-12 Vernon's Texas Civil Statutes), is amended by amending Subsection
2-13 (a) and by adding Subsections (y), (z), and (aa) to read as
2-14 follows:
2-15 (a) The board is responsible for the regulation of the
2-16 practice of pharmacy in this state, including the following:
2-17 (1) the licensing by examination or by reciprocity of
2-18 applicants who are qualified to engage in the practice of pharmacy
2-19 and the licensing of pharmacies under this Act;
2-20 (2) the renewal of licenses to engage in the practice
2-21 of pharmacy and licenses to operate pharmacies;
2-22 (3) the determination and issuance of standards for
2-23 recognition and approval of degree requirements of colleges of
2-24 pharmacy whose graduates shall be eligible for licensing in this
2-25 state and the specification and enforcement of requirements for
2-26 practical training, including internship;
2-27 (4) the enforcement of those provisions of this Act
3-1 relating to the conduct or competence of pharmacists practicing in
3-2 this state and the conduct of pharmacies operating in this state
3-3 and the suspension, revocation, fining, reprimanding, cancellation,
3-4 or restriction of licenses to engage in the practice of pharmacy or
3-5 to operate a pharmacy;
3-6 (5) the specifications of conditions under which a
3-7 pharmacist may administer medications, including immunizations and
3-8 vaccinations, which at a minimum shall include the following:
3-9 (A) a licensed health care provider authorized
3-10 to administer the medication is not reasonably available to
3-11 administer the medication;
3-12 (B) failure to administer the medication, other
3-13 than an immunization or vaccination, might result in a significant
3-14 delay or interruption of a critical phase of drug therapy;
3-15 (C) the pharmacist possesses the necessary
3-16 skill, [and] education, and certification to administer the
3-17 medication as specified by the board;
3-18 (D) the pharmacist notifies the appropriate
3-19 licensed health care provider responsible for the patient's care
3-20 within a reasonable time that the medication was administered;
3-21 (E) a pharmacist may not administer medications
3-22 to a patient where the patient resides, except in a licensed
3-23 nursing home or hospital;
3-24 (F) the pharmacist administers immunizations or
3-25 vaccinations under a physician's written protocol and meets the
3-26 standards established by the board;
3-27 (G) the authority of the pharmacist to
4-1 administer medications may not be delegated;
4-2 (H) [(G)] nothing in this subdivision shall be
4-3 construed to prohibit a pharmacist from preparing or manipulating
4-4 biotechnological agents or devices; and
4-5 (I) [(H)] nothing in this subdivision shall be
4-6 construed as prohibiting a pharmacist from performing an act
4-7 delegated by a physician in accordance with the provisions of
4-8 Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
4-9 Vernon's Texas Civil Statutes), and the pharmacist performing such
4-10 a delegated medical act shall be considered to be performing a
4-11 medical act and not as engaged in the practice of pharmacy;
4-12 (6) the regulation of the training, qualifications,
4-13 and employment of pharmacist-interns; and
4-14 (7) the enforcement of this Act and any rules adopted
4-15 under this Act.
4-16 (y) The board by rule shall require pharmacists to notify a
4-17 physician who prescribes an immunization or vaccination within 24
4-18 hours of administering the immunization or vaccination and shall
4-19 establish minimum education and continuing education standards for
4-20 pharmacists who administer immunizations and vaccinations. The
4-21 standards must include Center for Disease Prevention and Control
4-22 training, basic life support training, and hands-on training in
4-23 techniques for administering immunizations and vaccinations.
4-24 (z) Physician supervision is considered to be adequate for
4-25 the purposes of this section if a delegating physician:
4-26 (1) is responsible for the formulation or approval of
4-27 the physician's order, standing medical order, standing delegation
5-1 order, or other order or protocol and periodically reviews the
5-2 order or protocol and the services provided to a patient under the
5-3 order or protocol;
5-4 (2) has established a physician-patient relationship
5-5 with each patient under 14 years of age and referred the patient to
5-6 the pharmacist;
5-7 (3) is geographically located so as to be easily
5-8 accessible to the pharmacy administering the immunization or
5-9 vaccination;
5-10 (4) receives, as appropriate, a periodic status report
5-11 on the patient, including any problem or complication encountered;
5-12 and
5-13 (5) is available through direct telecommunication for
5-14 consultation, assistance, and direction.
5-15 (aa) The Texas State Board of Medical Examiners by rule
5-16 shall establish the minimum content of a written order or protocol.
5-17 The order or protocol may not permit the delegation of medical
5-18 diagnosis.
5-19 SECTION 3. Subchapter E, Chapter 21, Insurance Code, is
5-20 amended by adding Article 21.53K to read as follows:
5-21 Art. 21.53K. PROVISION OF SERVICES RELATED TO IMMUNIZATIONS
5-22 AND VACCINATIONS UNDER MANAGED CARE PLANS
5-23 Sec. 1. PROHIBITION. (a) A managed care entity may not
5-24 require a physician participating in a managed care plan to issue
5-25 an immunization or vaccination protocol for an immunization or
5-26 vaccination to be administered to an enrollee in the plan.
5-27 (b) This section prohibits a managed care entity from:
6-1 (1) limiting benefits to enrollees for immunizations
6-2 or vaccinations to circumstances in which an immunization or
6-3 vaccination protocol is issued;
6-4 (2) providing financial incentives to physicians to
6-5 issue an immunization or vaccination protocol; or
6-6 (3) imposing a financial or other penalty on a
6-7 physician who refuses to issue an immunization or vaccination
6-8 protocol.
6-9 Sec. 2. RULES. The commissioner may adopt rules to
6-10 implement this article.
6-11 SECTION 4. This Act takes effect September 1, 1997.
6-12 SECTION 5. Article 21.53K, Insurance Code, as added by this
6-13 Act, applies only to a managed care plan that is delivered, issued
6-14 for delivery, or renewed on or after January 1, 1998. A managed
6-15 care plan that is delivered, issued for delivery, or renewed before
6-16 January 1, 1998, is governed by the law as it existed immediately
6-17 before the effective date of this Act, and that law is continued in
6-18 effect for that purpose.
6-19 SECTION 6. The importance of this legislation and the
6-20 crowded condition of the calendars in both houses create an
6-21 emergency and an imperative public necessity that the
6-22 constitutional rule requiring bills to be read on three several
6-23 days in each house be suspended, and this rule is hereby suspended.