Amend CSSB 532 as follows:
(1) Strike the recital to Section 1 of the bill (page 1,
lines 5 and 6), and substitute:
SECTION 1. Section 157.0511, Occupations Code, is amended
by amending Subsections (b) and (b-1) and adding Subsection (b-2)
to read as follows:
(2) In Section 1 of the bill, immediately following amended
Subsection (b-1), Section 157.0511, Occupations Code (page 2,
between lines 6 and 7), insert:
(b-2) Physician supervision of the carrying out and signing
of prescription drug orders must conform to what a reasonable and
prudent physician would find consistent with sound medical judgment
but may vary with the education and experience of the particular
advanced practice nurse or physician assistant. A physician shall
provide continuous supervision, but the constant physical presence
of the physician is not required. Board rules regarding
supervision shall promote the ability of physicians to:
(1) exercise medical judgment in supervising the
carrying out and signing of prescription drug orders; and
(2) promote the full use of health information
technology, including telemedicine, telehealth, and electronic
medical records.
(3) In Section 3 of the bill, strike amended Section
157.0541(c), Occupations Code (page 3, line 18, through page 4,
line 12), and substitute the following:
(c) The delegating physician may not be prohibited by
contract from seeing, diagnosing, or treating a patient for
services provided or to be provided by the physician assistant or
advanced practice nurse under delegated prescriptive authority
[Physician supervision is adequate for the purposes of this section
if the delegating physician:
(1) is on-site with the advanced practice nurse or
physician assistant at least 20 percent of the time;
(2) reviews at least 10 percent of the medical charts
at the site; and
(3) is available through direct telecommunication for
consultation, patient referral, or assistance with a medical
emergency].
(4) In Section 4 of the bill, in the recital (page 4, line
21), strike "by adding" and substitute "by amending Subsection (b)
and adding".
(5) In Section 4 of the bill, between the recital and added
Section 157.0542(b-1), Occupations Code (page 4, between lines 21
and 22), insert the following:
(b) The board may grant a waiver under Subsection (a) if the
board determines that:
(1) the practice site where the physician is seeking
to delegate prescriptive authority is unable to meet the
requirements of this chapter or board rules or compliance would
cause an undue burden without a corresponding benefit to patient
care; and
(2) safeguards exist for patient care and for
fostering a collaborative practice between the physician and the
advanced practice nurses and physician assistants[; and
(3) if the requirement for which the waiver is sought
is the amount of time the physician is on-site, the frequency and
duration of time the physician is on-site when the advanced
practice nurse or physician assistant is present is sufficient for
collaboration to occur, taking into consideration the other ways
the physician collaborates with the advanced practice nurse or
physician assistant, including at other sites].
(6) In Section 4 of the bill, in proposed Subdivision (1),
Subsection (b-1), Section 157.0542, Occupations Code (page 5, line
5), following "equivalents;" add "or".
(7) In Section 4 of the bill, in proposed Subdivision (2),
Subsection (b-1), Section 157.0542, Occupations Code (page 5, line
6), strike "; or" and substitute an underscored period.
(8) In Section 4 of the bill (page 5, lines 7-9), strike
proposed Subdivision (3), Subsection (b-1), Section 157.0542,
Occupations Code.
(9) Add the following sections to the bill, numbered
appropriately, and renumber any subsequent sections of the bill
accordingly:
SECTION ____. Section 671.001(b), Government Code, is
amended to read as follows:
(b) The pilot program must provide for the following:
(1) a licensed advanced practice nurse as defined by
Section 301.152, Occupations Code, or a licensed physician
assistant as described by Chapter 204, Occupations Code, who is
employed by the state or whose services are acquired by contract,
who will be located at a state office complex;
[(2) a licensed physician, who is employed by a state
governmental entity for purposes other than the pilot program or
whose services are acquired by contract, who will perform all
supervisory functions described by Section 157.052(e), Occupations
Code;]
(2)[(3)] appropriate office space and equipment for
the advanced practice nurse or physician assistant to provide basic
medical care to employees at the state office complex where the
nurse or physician assistant is located; and
(3)[(4)] professional liability insurance covering
services provided by the advanced practice nurse or the physician
assistant.
SECTION ____. Sections 157.052(e), 157.053(c), and
157.054(c), Occupations Code, are repealed.