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