By Capelo H.B. No. 2940
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the authority of certain advanced practice nurses and
1-3 physician assistants to prescribe drugs.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 157.053(e), Occupations Code, is amended
1-6 to read as follows:
1-7 (e) A physician's authority to delegate the carrying out or
1-8 signing of a prescription drug order [at the physician's primary
1-9 practice site under this section] is limited to:
1-10 (1) three physician assistants or advanced practice
1-11 nurses or their full-time equivalents practicing at the physician's
1-12 primary practice site or at an alternate practice site under
1-13 Section 157.0541; and
1-14 (2) the patients with whom the physician has established or
1-15 will establish a physician-patient relationship.
1-16 SECTION 2. Subchapter B, Chapter 157, Occupations Code, is
1-17 amended by adding Sections 157.0541 and 157.0542 to read as
1-18 follows:
1-19 Sec. 157.0541. PRESCRIBING AT ALTERNATE SITES. (a) In this
1-20 section, "alternate site" means a practice site:
1-21 (1) where services similar to the services provided at
1-22 the delegating physician's primary practice site are provided; and
1-23 (2) located within 60 miles of the delegating
2-1 physician's primary practice site.
2-2 (b) A physician may delegate to an advanced practice nurse
2-3 or physician assistant, at an alternate site under adequate
2-4 physician supervision, the act of administering, providing, or
2-5 carrying out or signing a prescription drug order as authorized
2-6 through a physician's order, a standing medical order, a standing
2-7 delegation order, or another order or protocol as defined by the
2-8 board. The authority of a physician to delegate the carrying out
2-9 or signing of prescription drug orders under this section is
2-10 limited to dangerous drugs.
2-11 (c) Physician supervision is adequate for the purposes of
2-12 this section if the delegating physician:
2-13 (1) is on site with the advanced practice nurse or
2-14 physician assistant at least 20 percent of the time;
2-15 (2) reviews at least 10 percent of the medical charts
2-16 at the site; and
2-17 (3) is available through direct telecommunication for
2-18 consultation, patient referral, or assistance with a medical
2-19 emergency.
2-20 (d) An alternative physician may provide appropriate
2-21 supervision to an advanced practice nurse or physician assistant
2-22 under this section on a temporary basis as provided by board rule.
2-23 (e) The combined number of advanced practice nurses and
2-24 physician assistants to whom a physician may delegate under this
2-25 section and at a primary practice site under Section 157.053 may
2-26 not exceed three physician assistants or advanced practice nurses
3-1 or the full-time equivalent of three physician assistants or
3-2 advanced practice nurses.
3-3 Sec. 157.0542. BOARD WAIVER OF DELEGATION REQUIREMENTS. (a)
3-4 The board shall waive any of the requirements for a physician to
3-5 delegate the signing of prescription drug orders to an advanced
3-6 practice nurse or physician assistant under Sections 157.052,
3-7 157.053, 157.054, and 157.0541, or under board rules, if the board
3-8 determines that:
3-9 (1) the practice site where the physician is seeking
3-10 to delegate prescriptive authority does not meet the requirements
3-11 of this chapter or board rules, or compliance would cause an undue
3-12 burden without a corresponding benefit to patient care;
3-13 (2) safeguards exist for patient care and for
3-14 fostering a collaborative practice between the physician and the
3-15 advanced practice nurses and physician assistants; and
3-16 (3) if the requirement for which the waiver is sought
3-17 is the amount of time the physician is on site, the frequency and
3-18 duration of time the physician is on site when the advanced
3-19 practice nurse or physician assistant is present is sufficient for
3-20 collaboration to occur taking into consideration the other ways the
3-21 physician collaborates with the advanced practice nurse or
3-22 physician assistant, including at other sites.
3-23 (b) The board shall establish procedures for granting
3-24 waivers under this section.
3-25 (c) The board shall appoint an advisory committee to review
3-26 and make recommendations on applications for waivers under this
4-1 section. Each committee member must be actively practicing as a
4-2 physician, advanced practice nurse, or physician assistant in
4-3 collaborative practices under which the advanced practice nurse or
4-4 physician assistant is authorized by the physician to sign or carry
4-5 out prescription drug orders under this subchapter. The committee
4-6 consists of 15 members appointed as follows:
4-7 (1) five advanced practice nurses appointed from a
4-8 list of persons recommended by professional associations
4-9 representing advanced practice nurses;
4-10 (2) five physician assistants appointed from a list of
4-11 persons recommended by professional associations representing
4-12 physician assistants; and
4-13 (3) five physicians appointed from a list of persons
4-14 recommended by professional associations representing physicians.
4-15 (d) The committee shall recommend whether to grant a waiver
4-16 after making the determinations required of the board under
4-17 Subsection (a). The board may grant a waiver only if the committee
4-18 recommends that the waiver be granted, unless the board determines
4-19 good cause exists to grant a waiver the committee does not
4-20 recommend.
4-21 (e) The committee may recommend that the board approve a
4-22 waiver with modifications.
4-23 (f) A committee recommendation of the approval of a waiver,
4-24 with or without modifications, requires a vote of at least:
4-25 (1) three advanced practice nurse committee members;
4-26 (2) three physician assistant committee members; and
5-1 (3) three physician committee members.
5-2 (g) This section expires on September 1, 2005.
5-3 SECTION 3. Section 204.202(b), Occupations Code, is amended
5-4 to read as follows:
5-5 (b) Medical services provided by a physician assistant may
5-6 include:
5-7 (1) obtaining patient histories and performing
5-8 physical examinations;
5-9 (2) ordering or performing diagnostic and therapeutic
5-10 procedures;
5-11 (3) formulating a working diagnosis;
5-12 (4) developing and implementing a treatment plan;
5-13 (5) monitoring the effectiveness of therapeutic
5-14 interventions;
5-15 (6) assisting at surgery;
5-16 (7) offering counseling and education to meet patient
5-17 needs;
5-18 (8) requesting, receiving, and signing for the receipt
5-19 of pharmaceutical sample prescription medications and distributing
5-20 the samples to patients in a specific practice setting in which the
5-21 physician assistant is authorized to prescribe pharmaceutical
5-22 medications and sign prescription drug orders as provided by
5-23 Section 157.052, 157.053, [or] 157.054, 157.0541, or 157.0542, or
5-24 as otherwise authorized by physician assistant board rule;
5-25 (9) signing or completing a prescription as provided
5-26 by Subchapter B, Chapter 157; and
6-1 (10) making appropriate referrals.
6-2 SECTION 4. Section 301.002(2), Occupations Code, is amended
6-3 to read as follows:
6-4 (2) "Professional nursing" means the performance for
6-5 compensation of an act that requires substantial specialized
6-6 judgment and skill, the proper performance of which is based on
6-7 knowledge and application of the principles of biological,
6-8 physical, and social science as acquired by a completed course in
6-9 an approved school of professional nursing. The term does not
6-10 include acts of medical diagnosis or prescription of therapeutic or
6-11 corrective measures. Professional nursing involves:
6-12 (A) the observation, assessment, intervention,
6-13 evaluation, rehabilitation, care and counsel, or health teachings
6-14 of a person who is ill, injured, infirm, or experiencing a change
6-15 in normal health processes;
6-16 (B) the maintenance of health or prevention of
6-17 illness;
6-18 (C) the administration of a medication or
6-19 treatment as ordered by a physician, podiatrist, or dentist;
6-20 (D) the supervision or teaching of nursing;
6-21 (E) the administration, supervision, and
6-22 evaluation of nursing practices, policies, and procedures;
6-23 (F) the requesting, receiving, signing for, and
6-24 distribution of prescription drug samples to patients at sites in
6-25 which a registered nurse is authorized to sign prescription drug
6-26 orders as provided by Subchapter B, Chapter 157; and
7-1 (G) the performance of an act delegated by a
7-2 physician under Section 157.052, 157.053, 157.054, 157.0541,
7-3 157.0542, 157.058, or 157.059.
7-4 SECTION 5. Section 551.003(34), Occupations Code, is amended
7-5 to read as follows:
7-6 (34) "Practitioner" means:
7-7 (A) a person licensed or registered to
7-8 prescribe, distribute, administer, or dispense a prescription drug
7-9 or device in the course of professional practice in this state,
7-10 including a physician, dentist, podiatrist, or veterinarian but
7-11 excluding a person licensed under this subtitle;
7-12 (B) a person licensed by another state, Canada,
7-13 or the United Mexican States in a health field in which, under the
7-14 law of this state, a license holder in this state may legally
7-15 prescribe a dangerous drug; [or]
7-16 (C) a person practicing in another state and
7-17 licensed by another state as a physician, dentist, veterinarian, or
7-18 podiatrist, who has a current federal Drug Enforcement
7-19 Administration registration number and who may legally prescribe a
7-20 Schedule II, III, IV, or V controlled substance, as specified under
7-21 Chapter 481, Health and Safety Code, in that other state; or
7-22 (D) an advanced practice nurse or physician
7-23 assistant authorized by a physician to sign prescription drug
7-24 orders under Section 157.052, 157.053, 157.054, 157.0541, or
7-25 157.0542.
7-26 SECTION 6. Section 483.001(12), Health and Safety Code, is
8-1 amended to read as follows:
8-2 (12) "Practitioner" means a person licensed:
8-3 (A) by the Texas State Board of Medical
8-4 Examiners, State Board of Dental Examiners, State Board of
8-5 Podiatric Medical Examiners, Texas Optometry Board, or State Board
8-6 of Veterinary Medical Examiners to prescribe and administer
8-7 dangerous drugs;
8-8 (B) by another state in a health field in which,
8-9 under the laws of this state, a licensee may legally prescribe
8-10 dangerous drugs; [or]
8-11 (C) in Canada or Mexico in a health field in
8-12 which, under the laws of this state, a licensee may legally
8-13 prescribe dangerous drugs; or
8-14 (D) an advanced practice nurse or physician
8-15 assistant authorized by a physician to sign prescription drug
8-16 orders under Section 157.052, 157.053, 157.054, 157.0541, or
8-17 157.0542, Occupations Code.
8-18 SECTION 7. Section 483.003(b), Health and Safety Code, is
8-19 amended to read as follows:
8-20 (b) On making that finding, the Texas Board of Health may
8-21 limit the availability of the abused drug by permitting its
8-22 dispensing only on the prescription of a practitioner described by
8-23 Section 483.001(12)(A), [or] (B), or (D).
8-24 SECTION 8. Section 483.004, Health and Safety Code, is
8-25 amended to read as follows:
8-26 Sec. 483.004. Commissioner of Health Emergency Authority
9-1 Relating to Dangerous Drugs. If the commissioner of health has
9-2 compelling evidence that an immediate danger to the public health
9-3 exists as a result of the prescription of a dangerous drug by
9-4 practitioners described by Section 483.001(12)(C), the commissioner
9-5 may use the commissioner's existing emergency authority to limit
9-6 the availability of the drug by permitting its prescription only by
9-7 practitioners described by Section 483.001(12)(A), [or] (B), or
9-8 (D).
9-9 SECTION 9. This Act takes effect immediately if it receives
9-10 a vote of two-thirds of all the members elected to each house, as
9-11 provided by Section 39, Article III, Texas Constitution. If this
9-12 Act does not receive the vote necessary for immediate effect, this
9-13 Act takes effect September 1, 2001.