By:  Madla, et al.                                     S.B. No. 931
                                A BILL TO BE ENTITLED
                                       AN ACT
 1-1     relating to the support of graduate pharmacy education and resident
 1-2     pharmacists.
 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-4           SECTION 1.  Chapter 61, Education Code, is amended by adding
 1-5     Subchapter T to read as follows:
 1-6                    SUBCHAPTER T.  ROBERTA HIGH MEMORIAL
 1-7                         PHARMACY RESIDENCY PROGRAM
 1-8           Sec. 61.851.  DEFINITIONS.  In this subchapter:
 1-9                 (1)  "College of pharmacy" means a college, school, or
1-10     university of pharmacy in this state that has an accredited
1-11     pharmacy degree program approved by the Texas State Board of
1-12     Pharmacy as provided by the Texas Pharmacy Act (Article 4542a-1,
1-13     Vernon's Texas Civil Statutes).
1-14                 (2)  "Community pharmacy" means a pharmacy that holds a
1-15     Class A pharmacy license or a community pharmacy license as those
1-16     terms are defined by Section 5, Texas Pharmacy Act (Article
1-17     4542a-1, Vernon's Texas Civil Statutes).
1-18                 (3)  "Compensation" includes a stipend, a payment for
1-19     services rendered, and a fringe benefit.
1-20                 (4)  "Institutional pharmacy" means a pharmacy that
1-21     holds a Class C pharmacy license or an institutional pharmacy
1-22     license as those terms are defined by Section 5, Texas Pharmacy Act
1-23     (Article 4542a-1, Vernon's Texas Civil Statutes).
1-24                 (5)  "Nuclear pharmacy" means a pharmacy that holds a
 2-1     Class B pharmacy license or a nuclear pharmacy license as those
 2-2     terms are defined by Section 5, Texas Pharmacy Act (Article
 2-3     4542a-1, Vernon's Texas Civil Statutes).
 2-4                 (6)  "Pharmacy residency program" means a postgraduate
 2-5     residency program approved by the Texas State Board of Pharmacy as
 2-6     provided by the Texas Pharmacy Act (Article 4542a-1, Vernon's Texas
 2-7     Civil Statutes).
 2-8                 (7)  "Primary teaching pharmacy" means a pharmacy that
 2-9     holds a permit issued by the Texas State Board of Pharmacy at which
2-10     a college of pharmacy educates and trains both resident pharmacists
2-11     and undergraduate pharmacy students, pursuant to a resident
2-12     pharmacist affiliation agreement between the pharmacy and the
2-13     college.
2-14                 (8)  "Residency preceptor" means a licensed pharmacist
2-15     who:
2-16                       (A)  is affiliated with a college of pharmacy;
2-17                       (B)  meets the qualifications established by the
2-18     board to teach resident pharmacists; and
2-19                       (C)  has been designated as a preceptor by the
2-20     Texas State Board of Pharmacy.
2-21                 (9)  "Resident pharmacist" means a person who:
2-22                       (A)  has received a professional practice degree
2-23     from an accredited pharmacy degree program approved by the Texas
2-24     State Board of Pharmacy as provided by the Texas Pharmacy Act
2-25     (Article 4542a-1, Vernon's Texas Civil Statutes);
2-26                       (B)  is licensed to practice pharmacy by the
 3-1     Texas State Board of Pharmacy; and
 3-2                       (C)  is appointed to a resident pharmacist
 3-3     position by a college of pharmacy.
 3-4           Sec. 61.852.  COMPENSATION OF RESIDENT PHARMACIST.  A college
 3-5     of pharmacy shall compensate each resident pharmacist being
 3-6     educated, trained, developed, and prepared for a career in pharmacy
 3-7     while the person is undergoing education, training,   development,
 3-8     and preparation at or under the direction and supervision of the
 3-9     college.
3-10           Sec. 61.853.  NUMBER OF AVAILABLE RESIDENT PHARMACIST
3-11     POSITIONS.  (a)  In each year, the total number of compensated
3-12     first-year resident pharmacists may not exceed the total number of
3-13     persons in the preceding year's combined graduating classes of all
3-14     colleges of pharmacy.
3-15           (b)  At least 50 percent of the combined total number of
3-16     resident pharmacist positions must be in community pharmacy
3-17     practice.
3-18           Sec. 61.854.  PREFERENCE TO APPLICANT FOR PRACTICE IN
3-19     MEDICALLY UNDERSERVED AREAS.  Each college of pharmacy shall give
3-20     priority consideration to an applicant for a resident pharmacist
3-21     position who demonstrates a willingness to practice pharmacy in
3-22     medically underserved areas of this state, as defined by the Texas
3-23     Department of Health.
3-24           Sec. 61.855.  DURATION OF PHARMACIST RESIDENCY.  A person may
3-25     not hold a resident pharmacist position for more than two years, or
3-26     for a period longer than the period usually required for a resident
 4-1     pharmacist to complete a graduate pharmacy education program
 4-2     approved by the Texas State Board of Pharmacy for the specialty in
 4-3     which the resident pharmacist seeks certification.
 4-4           Sec. 61.856.  PROGRAM FUNDING.  (a)  The legislature may
 4-5     appropriate revenue to the board to fund the pharmacy residency
 4-6     program.
 4-7           (b)  Funds appropriated and distributed under this subchapter
 4-8     may not be transferred or diverted from the pharmacy residency
 4-9     program.
4-10           (c)  From program funds, the comptroller shall issue a
4-11     warrant to a college of pharmacy or other entity designated by the
4-12     board to receive funds under this subchapter.
4-13           (d)  After August 31, 2001, general revenue funds may not be
4-14     used to fund pharmacy residencies other than in the manner
4-15     prescribed by this subchapter.
4-16           Sec. 61.857.  STATE SUPPORT OF RESIDENT PHARMACIST
4-17     COMPENSATION.  (a)  To supplement the compensation of resident
4-18     pharmacists, the board may provide grants to colleges of pharmacy
4-19     in amounts not to exceed $10,000 in a fiscal year for each resident
4-20     pharmacist position approved by the board and filled by the
4-21     applicable college for that year.
4-22           (b)  A college of pharmacy may receive funds under this
4-23     section for a resident pharmacist position in any year only if the
4-24     college and the primary teaching pharmacy each contribute at least
4-25     $10,000 toward the compensation of the resident pharmacist for that
4-26     year.
 5-1           (c)  If a resident pharmacist does not perform in that
 5-2     capacity during an entire fiscal year, the college of pharmacy
 5-3     shall reduce proportionately the compensation paid to the person to
 5-4     cover only the part of the fiscal year during which the person
 5-5     performed the person's duties as a resident pharmacist.
 5-6           (d)  If a person is compensated by an agency or institution
 5-7     of the federal government or by any other agency or institution,
 5-8     other than a primary teaching pharmacy, for the person's
 5-9     performance of the person's duties as a resident pharmacist, the
5-10     college of pharmacy shall reduce the compensation that would
5-11     otherwise be paid to the person by an amount equal to the amount of
5-12     the compensation received by the person from the agency or
5-13     institution.
5-14           (e)  If the college receives from an agency or institution of
5-15     the federal government or from any other agency or institution,
5-16     other than a primary teaching pharmacy, compensation for a person's
5-17     performance of the person's duties as a resident pharmacist to or
5-18     for the benefit of the agency or institution, the compensation that
5-19     may be paid to the resident pharmacist from funds awarded for that
5-20     position under this section is reduced by the amount received from
5-21     the other agency or institution.
5-22           (f)  To qualify for supplemental compensation provided under
5-23     this section, a resident pharmacist must enroll for at least nine
5-24     semester credit hours each fall and spring semester and for at
5-25     least six semester credit hours each summer term in graduate
5-26     pharmacy education experiential courses.  The resident pharmacist
 6-1     is exempt from fees required for enrollment, other than tuition.
 6-2           Sec. 61.858.  PLACEMENT OF RESIDENT PHARMACISTS IF FULL
 6-3     FUNDING NOT AVAILABLE.  (a)  If a college of pharmacy determines
 6-4     that it does not have sufficient available funds from legislative
 6-5     appropriations and other sources to support adequately the full
 6-6     number of resident pharmacists that the college considers necessary
 6-7     to carry out the purposes of the college, the college may assign
 6-8     and place for education and training a resident pharmacist who
 6-9     cannot be supported adequately with available funds in a primary
6-10     teaching pharmacy with which the college has a resident pharmacist
6-11     affiliation agreement.
6-12           (b)  During the period for which a resident pharmacist is
6-13     assigned and placed in a primary teaching pharmacy under this
6-14     section, the resident pharmacist shall receive compensation
6-15     primarily from the pharmacy.
6-16           (c)  A resident pharmacist affiliation agreement between the
6-17     college of pharmacy and the primary teaching pharmacy must describe
6-18     the exact method and manner of compensating the resident
6-19     pharmacist.
6-20           Sec. 61.859.  ADDITIONAL FUNDING TO SUPPORT GRADUATE PHARMACY
6-21     EDUCATION PROGRAMS.  (a)  The board shall administer a program to
6-22     support graduate pharmacy education programs in this state
6-23     consistent with the needs of this state for graduate pharmacy
6-24     education and the training of resident pharmacists in appropriate
6-25     fields and specialties.
6-26           (b)  From funds available to the program, the board may make
 7-1     grants or formula distributions to a college of pharmacy or other
 7-2     entity to:
 7-3                 (1)  support appropriate graduate pharmacy education
 7-4     programs or activities for which adequate funds are not otherwise
 7-5     available; or
 7-6                 (2)  foster new or expanded graduate pharmacy education
 7-7     programs or activities that the board determines will address the
 7-8     state's needs for graduate pharmacy education.
 7-9           (c)  To be eligible for a grant or distribution under this
7-10     section, a college of pharmacy or other entity must incur the costs
7-11     of faculty education or supervision in a graduate pharmacy
7-12     education program or the costs of compensating a resident
7-13     pharmacist in the program.  The board shall take those incurred
7-14     costs into account in making grants or formula distributions under
7-15     this section.
7-16           (d)  The program is funded by appropriations, by gifts,
7-17     grants, and donations made to support the program, and by any other
7-18     funds the board obtains for the program, including federal funds.
7-19           (e)  An amount granted or distributed to a college of
7-20     pharmacy or other entity under the program may be used only to
7-21     cover expenses of training resident pharmacists participating in
7-22     the particular program or activity for which the grant or
7-23     distribution is made in accordance with any conditions imposed by
7-24     the board.  The amount may not be spent for the general support of
7-25     the college or other entity.
7-26           Sec. 61.860.  ADVISORY COMMITTEE.  (a)  The board shall
 8-1     establish an advisory committee to advise the board regarding the
 8-2     development and administration of the pharmacy residency program,
 8-3     including evaluating requests for grants and establishing formulas
 8-4     for distribution of funds under the program.
 8-5           (b)  The advisory committee consists of:
 8-6                 (1)  the executive director of the Texas State Board of
 8-7     Pharmacy or the executive director's designee;
 8-8                 (2)  a physician serving as a program director of a
 8-9     health-related residency program appointed by the Texas State Board
8-10     of Medical Examiners;
8-11                 (3)  the dean of each college of pharmacy, or the
8-12     dean's designee, who serve as nonvoting members; and
8-13                 (4)  the following members appointed by the board:
8-14                       (A)  four pharmacists in private practice, who
8-15     are recommended to the board by the Texas State Board of Pharmacy;
8-16                       (B)  one resident pharmacist, who serves as a
8-17     nonvoting member; and
8-18                       (C)  one pharmacy student, who serves as a
8-19     nonvoting member.
8-20           (c)  Of the pharmacist members in private practice, two must
8-21     be active in community pharmacy practice, and two must be active in
8-22     hospital pharmacy practice.
8-23           (d)  The appointed voting members of the advisory committee
8-24     serve staggered three-year terms.  The Texas State Board of Medical
8-25     Examiners shall appoint the initial member appointed under
8-26     Subsection (b)(2) to a three-year term.  The board shall appoint
 9-1     the initial members appointed under Subsection (b)(4) to terms of
 9-2     one, two, or three years as necessary so that one-third of the
 9-3     appointed committee members' terms expire each year, as nearly as
 9-4     practicable.
 9-5           (e)  The advisory committee shall elect one of its members as
 9-6     presiding officer for a one-year term.
 9-7           (f)  The advisory committee shall meet at least once each
 9-8     year and as often as requested by the board or called into meeting
 9-9     by the committee's presiding officer.
9-10           (g)  A member of the advisory committee may not receive
9-11     compensation for committee service but may receive reimbursement
9-12     for travel to official meetings according to policies established
9-13     by the board.
9-14           Sec. 61.861.  DUTIES OF ADVISORY COMMITTEE.  The advisory
9-15     committee shall:
9-16                 (1)  review applications for the funding of graduate
9-17     pharmacy education programs and make recommendations for approval
9-18     or disapproval of those applications;
9-19                 (2)  make recommendations relating to the standards and
9-20     criteria for approval of grants and for the development of formulas
9-21     for distribution of funds under the pharmacy residency program;
9-22                 (3)  recommend to the board an allocation of funds
9-23     among colleges of pharmacy;
9-24                 (4)  review applications for the funding of residency
9-25     preceptor positions, make recommendations for approval or
9-26     disapproval of those applications, make recommendations relating to
 10-1    the standards and criteria for approval of those applications,
 10-2    monitor compliance with the contractual conditions associated with
 10-3    funding residency preceptor positions, and evaluate success in
 10-4    increasing the number of those positions; and
 10-5                (5)  perform other duties assigned by the board.
 10-6          Sec. 61.862.  APPLICATION BY COLLEGE OF PHARMACY FOR FUNDING.
 10-7    A college of pharmacy must include in an application for funds
 10-8    under this subchapter:
 10-9                (1)  the names of the college and the dean of the
10-10    college, the mailing address of the college, and the accreditation
10-11    status for the undergraduate and graduate pharmacy programs of the
10-12    college;
10-13                (2)  the number of resident pharmacist positions and
10-14    primary teaching pharmacies for which the college is requesting
10-15    funding;
10-16                (3)  for each primary teaching pharmacy, the names of
10-17    the pharmacy, as recorded on its permit, and of the
10-18    pharmacist-in-charge, the mailing address of the pharmacy, and the
10-19    accreditation status of the pharmacy;
10-20                (4)  a description of the learning objectives and
10-21    minimum competencies required of resident pharmacists at each
10-22    primary teaching pharmacy;
10-23                (5)  a description of the learning activities and
10-24    resident pharmacists' duties at each primary teaching pharmacy, and
10-25    the time associated with each activity or duty;
10-26                (6)  the name of the residency preceptor responsible
 11-1    for the learning program at each primary teaching pharmacy, and a
 11-2    description of the preceptor's credentials;
 11-3                (7)  the amount and form of compensation to be provided
 11-4    to each resident pharmacist;
 11-5                (8)  a copy of the resident pharmacist affiliation
 11-6    agreement between the college and the primary teaching pharmacy;
 11-7    and
 11-8                (9)  other information required by the board.
 11-9          Sec. 61.863.  FUNDING OF RESIDENCY PRECEPTOR POSITIONS.
11-10    (a)  A college of pharmacy may apply and receive a grant under this
11-11    section to support full-time faculty members who are residency
11-12    preceptors supervising accredited pharmacy residencies.
11-13          (b)  The advisory committee shall recommend to the board an
11-14    allocation of residency preceptor positions that are to receive
11-15    funds under this section.
11-16          (c)  An allocation of funds under this section must take into
11-17    account the following factors:
11-18                (1)  the faculty-student ratio in community pharmacy
11-19    residencies at each applicant college of pharmacy;
11-20                (2)  the length of time a budgeted residency preceptor
11-21    position has gone unfilled and whether the position is a new
11-22    residency preceptor position; and
11-23                (3)  other factors determined by the board.
11-24          (d)  Once funds are granted to support a residency preceptor
11-25    position affiliated with a college of pharmacy, the board shall
11-26    continue to grant funds to support that position for a period not
 12-1    to exceed one additional calendar year.  After that time, the
 12-2    college shall provide an amount equal to the annualized amount of
 12-3    the grant in its operating budget to maintain the level of
 12-4    compensation for the position for two years after the grant period
 12-5    has ended.
 12-6          (e)  The board may use not more than 10 percent of the total
 12-7    amount appropriated for the pharmacy residency program under this
 12-8    subchapter to fund residency preceptor positions under this
 12-9    section.
12-10          (f)  The board may solicit, receive, and spend grants, gifts,
12-11    and donations from public and private sources for purposes of this
12-12    section.
12-13          SECTION 2.  Subsection (a), Section 17, Texas Pharmacy Act
12-14    (Article 4542a-1, Vernon's Texas Civil Statutes), is amended to
12-15    read as follows:
12-16          (a)  The board is responsible for the regulation of the
12-17    practice of pharmacy in this state, including the following:
12-18                (1)  the licensing by examination or by reciprocity of
12-19    applicants who are qualified to engage in the practice of pharmacy
12-20    and the licensing of pharmacies under this Act;
12-21                (2)  the renewal of licenses to engage in the practice
12-22    of pharmacy and licenses to operate pharmacies;
12-23                (3)  the determination and issuance of standards for
12-24    recognition and approval of degree requirements of colleges of
12-25    pharmacy whose graduates shall be eligible for licensing in this
12-26    state and the specification and enforcement of requirements for
 13-1    practical training, including internship;
 13-2                (4)  the enforcement of those provisions of this Act
 13-3    relating to the conduct or competence of pharmacists practicing in
 13-4    this state and the conduct of pharmacies operating in this state
 13-5    and the suspension, revocation, fining, reprimanding, cancellation,
 13-6    or restriction of licenses to engage in the practice of pharmacy or
 13-7    to operate a pharmacy;
 13-8                (5)  the specifications of conditions under which a
 13-9    pharmacist may administer medications, including immunizations and
13-10    vaccinations, which at a minimum shall include the following:
13-11                      (A)  a licensed health care provider authorized
13-12    to administer the medication is not reasonably available to
13-13    administer the medication;
13-14                      (B)  failure to administer the medication, other
13-15    than an immunization or vaccination, might result in a significant
13-16    delay or interruption of a critical phase of drug therapy;
13-17                      (C)  the pharmacist possesses the necessary
13-18    skill, education, and certification to administer the medication as
13-19    specified by the board;
13-20                      (D)  the pharmacist notifies the appropriate
13-21    licensed health care provider responsible for the patient's care
13-22    within a reasonable time that the medication was administered;
13-23                      (E)  a pharmacist may not administer medications
13-24    to a patient where the patient resides, except in a licensed
13-25    nursing home or hospital;
13-26                      (F)  the pharmacist administers immunizations or
 14-1    vaccinations under a physician's written protocol and meets the
 14-2    standards established by the board;
 14-3                      (G)  the authority of the pharmacist to
 14-4    administer medications may not be delegated;
 14-5                      (H)  nothing in this subdivision shall be
 14-6    construed to prohibit a pharmacist from preparing or manipulating
 14-7    biotechnological agents or devices; and
 14-8                      (I)  nothing in this subdivision shall be
 14-9    construed as prohibiting a pharmacist from performing an act
14-10    delegated by a physician in accordance with the provisions of
14-11    Subsection (d), Section 3.06, Medical Practice Act (Article 4495b,
14-12    Vernon's Texas Civil Statutes), and the pharmacist performing such
14-13    a delegated medical act shall be considered to be performing a
14-14    medical act and not as engaged in the practice of pharmacy;
14-15                (6)  the regulation of the training, qualifications,
14-16    and employment of pharmacist-interns; [and]
14-17                (7)  the determination and issuance of standards for
14-18    recognizing and approving a pharmacy residency program for purposes
14-19    of Subchapter T, Chapter 61, Education Code; and
14-20                (8)  the enforcement of this Act and any rules adopted
14-21    under this Act.
14-22          SECTION 3.  (a)  On the effective date of this Act, the
14-23    comptroller of public accounts shall transfer $850,000 from the
14-24    Texas State Board of Pharmacy account to the undedicated portion of
14-25    the general revenue fund.
14-26          (b)  The legislature may appropriate funds transferred under
 15-1    Subsection (a) of this section only for the pharmacy residency
 15-2    program established under Subchapter T, Chapter 61, Education Code,
 15-3    as added by this Act.
 15-4          SECTION 4.  This Act takes effect September 1, 1999.
 15-5          SECTION 5.  The importance of this legislation and the
 15-6    crowded condition of the calendars in both houses create an
 15-7    emergency and an imperative public necessity that the
 15-8    constitutional rule requiring bills to be read on three several
 15-9    days in each house be suspended, and this rule is hereby suspended.