Amend CSSB 532 (house committee printing) as follows:                        
	(1)  In SECTION 2 of the bill, in amended Section 
157.053(e)(1), Occupations Code (page 3, line 4), strike "three" 
and substitute "four [three]".
	(2)  In SECTION 3 of the bill, in amended Section 
157.0541(e), Occupations Code (page 4, lines 17 and 18), strike 
"three" both times the word appears in Subsection (e) and 
substitute "four [three]".
	(3)  In the recital to SECTION 4 of the bill (page 4, line 21) 
between "by" and "adding", insert "amending Subsection (a) and".
	(4)  In SECTION 4 of the bill, immediately before proposed 
Section 157.0542(b-1), Occupations Code (page 4, between lines 21 
and 22), insert the following:
	(a)  On determining that the conditions of Subsection (b) 
have been met, the board may waive or modify any of the site or 
supervision requirements for a physician to delegate the carrying 
out or signing of prescription drug orders to an advanced practice 
nurse or physician assistant under Sections 157.052, 157.053, 
157.054, and 157.0541, or under board rules.  The board may not 
waive the limitation on the number of primary or alternate practice 
sites at which a physician may delegate the carrying out or signing 
of prescription drug orders or the number of advanced practice 
nurses or physician assistants to whom a physician may delegate the 
carrying out or signing of prescription drug orders, except as 
provided by Subsection (b-1)(1).
	(5)  Add the following appropriately numbered SECTIONS to 
the bill and renumber the SECTIONS of the bill accordingly:
	SECTION ____.  Section 157.054(b), Occupations Code, is 
amended to read as follows:
	(b)  A physician's authority to delegate under Subsection 
(a) is limited as follows:
		(1)  the delegation must be made under a physician's 
order, standing medical order, standing delegation order, or 
another order or protocol developed in accordance with policies 
approved by the facility's medical staff or a committee of the 
facility's medical staff as provided by the facility bylaws;
		(2)  the delegation must occur in the facility in which 
the physician is the medical director, the chief of medical staff, 
the chair of the credentialing committee, or a department chair;
		(3)  the delegation may not permit the carrying out or 
signing of prescription drug orders for the care or treatment of the 
patients of any other physician without the prior consent of that 
physician;
		(4)  delegation in a long-term care facility must be by 
the medical director and is limited to the carrying out and signing 
of prescription drug orders to not more than four [three] advanced 
practice nurses or physician assistants or their full-time 
equivalents;  and
		(5)  a physician may not delegate at more than one 
licensed hospital or more than two long-term care facilities unless 
approved by the board.
	SECTION ____.  Section 157.059(f), Occupations Code, is 
amended to read as follows:
	(f)  The authority of a physician to delegate under this 
section is limited to:
		(1)  four [three] nurse midwives or physician 
assistants or their full-time equivalents;  and
		(2)  the designated facility at which the nurse midwife 
or physician assistant provides care.