S.B. No. 532
 
 
 
 
AN ACT
  relating to a physician's delegation of prescriptive authority to
  physician assistants or advanced practice nurses.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subsections (b) and (b-1), Section 157.0511,
  Occupations Code, are amended to read as follows:
         (b)  A physician may delegate the carrying out or signing of
  a prescription drug order for a controlled substance only if:
               (1)  the prescription is for a controlled substance
  listed in Schedule [Schedules] III, IV, or V as established by the
  commissioner of public health under Chapter 481, Health and Safety
  Code;
               (2)  the prescription, including a refill of the
  prescription, is for a period not to exceed 90 [30] days;
               (3)  with regard to the refill of a prescription, the
  refill is authorized after consultation with the delegating
  physician and the consultation is noted in the patient's chart; and
               (4)  with regard to a prescription for a child less than
  two years of age, the prescription is made after consultation with
  the delegating physician and the consultation is noted in the
  patient's chart.
         (b-1)  The board shall adopt rules that require a physician
  who delegates the carrying out or signing of a prescription drug
  order under this subchapter to register with the board the name and
  license number of the physician assistant or advanced practice
  nurse [maintain records that show when and] to whom a delegation is
  made.  The board may develop and use an electronic online delegation
  registration process for registration under this subsection
  [access the physician's records under this subsection as necessary
  for an investigation].
         SECTION 2.  Subsections (a) and (e), Section 157.053,
  Occupations Code, are amended to read as follows:
         (a)  In this section, "primary practice site" means:
               (1)  the practice location of a physician at which the
  physician spends the majority of the physician's time;
               (2)  a licensed hospital, a licensed long-term care
  facility, or a licensed adult care center where both the physician
  and the physician assistant or advanced practice nurse are
  authorized to practice;
               (3)  a clinic operated by or for the benefit of a public
  school district to provide care to the students of that district and
  the siblings of those students, if consent to treatment at that
  clinic is obtained in a manner that complies with Chapter 32, Family
  Code;
               (4)  the residence of an established patient; [or]
               (5)  another location at which the physician is
  physically present with the physician assistant or advanced
  practice nurse; or
               (6)  a location where a physician assistant or advanced
  practice nurse who practices on-site with the physician more than
  50 percent of the time and in accordance with board rules provides:
                     (A)  health care services for established
  patients;
                     (B)  without remuneration, voluntary charity
  health care services at a clinic run or sponsored by a nonprofit
  organization; or
                     (C)  without remuneration, voluntary health care
  services during a declared emergency or disaster at a temporary
  facility operated or sponsored by a governmental entity or
  nonprofit organization and established to serve persons in this
  state.
         (e)  A physician's authority to delegate the carrying out or
  signing of a prescription drug order is limited to:
               (1)  four [three] physician assistants or advanced
  practice nurses or their full-time equivalents practicing at the
  physician's primary practice site or at an alternate practice site
  under Section 157.0541 unless a waiver is granted under Section
  157.0542(b-1); and
               (2)  the patients with whom the physician has
  established or will establish a physician-patient relationship.
         SECTION 3.  Subsection (b), Section 157.054, 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 4.  Subsections (a), (c), and (e), Section 157.0541,
  Occupations Code, are amended to read as follows:
         (a)  In this section, "alternate site" means a practice site:
               (1)  where services similar to the services provided at
  the delegating physician's primary practice site are provided; and
               (2)  located within 75 [60] miles of the delegating
  physician's residence or primary practice site.
         (c)  Physician supervision is adequate for the purposes of
  this section if [the delegating physician]:
               (1)  the delegating physician:
                     (A)  is on-site with the advanced practice nurse
  or physician assistant at least 10 [20] percent of the hours of
  operation of the site each month that the physician assistant or
  advanced practice nurse is acting with delegated prescriptive
  authority and is available while on-site to see, diagnose, treat,
  and provide care to those patients for services provided or to be
  provided by the physician assistant or advanced practice nurse to
  whom the physician has delegated prescriptive authority; and
                     (B)  is not 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 [time];
               (2)  the delegating physician reviews at least 10
  percent of the medical charts, including through electronic review
  of the charts from a remote location, for each advanced practice
  nurse or physician assistant at the site; and
               (3)  the delegating physician is available through
  direct telecommunication for consultation, patient referral, or
  assistance with a medical emergency.
         (e)  Unless a waiver is granted under Section 157.0542(b-1),
  the [The] combined number of advanced practice nurses and physician
  assistants to whom a physician may delegate under this section and
  at a primary practice site under Section 157.053 may not exceed four 
  [three] physician assistants or advanced practice nurses or the
  full-time equivalent of four [three] physician assistants or
  advanced practice nurses.
         SECTION 5.  Section 157.0542, Occupations Code, is amended
  by amending Subsection (a) and adding Subsections (b-1), (b-2), and
  (b-3) to read as follows:
         (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).
         (b-1)  If the board determines that the types of health care
  services provided by a physician assistant or advanced practice
  nurse under Section 157.0541 are limited in nature and duration and
  are within the scope of delegated authority under this subchapter,
  as defined by board rule, and that patient health care will not be
  adversely affected, the board may modify or waive:
               (1)  the limitation on the number of physician
  assistants or advanced practice nurses, or their full-time
  equivalents, if the board does not authorize more than six
  physician assistants or advanced practice nurses or their full-time
  equivalents;
               (2)  the mileage limitation; or
               (3)  the on-site supervision requirements, except that
  the physician must be available on-site at regular intervals and
  when on-site the physician must be available to treat patients.
         (b-2)  A modification or waiver granted under this section
  may not validate or authorize a contract provision that prohibits a
  physician from seeing, diagnosing, or treating any patient.
         (b-3)  In granting a modification or waiver under Subsection
  (b-1), the board may not limit the authority of the physician to
  delegate to less than the requirements established under Section
  157.0541(a)(2) or Section 157.0541(e) or greater than the
  requirements established under Section 157.0541(c)(1)(A).
         SECTION 6.  Subsection (f), Section 157.059, 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.
         SECTION 7.  Not later than January 31, 2010, the Texas
  Medical Board shall adopt the rules necessary to implement Chapter
  157, Occupations Code, as amended by this Act.
         SECTION 8.  This Act takes effect September 1, 2009.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 532 passed the Senate on
  March 26, 2009, by the following vote: Yeas 31, Nays 0; and that
  the Senate concurred in House amendments on May 28, 2009, by the
  following vote: Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 532 passed the House, with
  amendments, on May 20, 2009, by the following vote: Yeas 145,
  Nays 0, two present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor