By: West S.B. No. 1339

A BILL TO BE ENTITLED

AN ACT

relating to the authority of advanced practice registered nurses to make medical diagnoses and to prescribe and order prescription drugs and devices.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 157.051(1), Occupations Code, is amended to read as follows:

(1) "Advanced practice nurse" has the meaning assigned to that term by Section 301.152, except the term does not include an advanced practice registered nurse granted prescribing and ordering authority under Section 301.357. The term includes an advanced nurse practitioner.

SECTION 2. Section 157.052(3), Occupations Code, is amended to read as follows:

(3) "Registered nurse" means a registered nurse recognized by the Texas Board of Nursing as having the specialized education and training required under Section 301.152 to carry out or sign a prescription drug order under this subchapter.

SECTION 3. Section 301.002(2), Occupations Code, is amended to read as follows:

(2) "Professional nursing" means the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures except as authorized for advanced practice registered nurses under Section 301.357. Professional nursing involves:

(A) the observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes;

(B) the maintenance of health or prevention of illness;

(C) the administration of a medication or treatment as ordered by a practitioner, as that term is defined by Section 551.003 [physician, podiatrist, or dentist];

(D) the supervision or teaching of nursing;

(E) the administration, supervision, and evaluation of nursing practices, policies, and procedures;

(F) the requesting, receiving, signing for, and distribution of prescription drug samples to patients by an advanced practice registered nurse with prescriptive authority or at sites in which a registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157;

(G) the performance of an act delegated by a physician under Section 157.052, 157.053, 157.054, 157.0541, 157.0542, 157.058, or 157.059; [and]

(H) the prescribing of controlled substances and dangerous drugs and medical devices by an advanced practice registered nurse with provisional or full prescriptive authority; and

(I) the development of the nursing care plan.

SECTION 4. Section 301.152, Occupations Code, is amended by amending Subsections (a) and (b) and adding Subsection (c-1) and (c-2) to read as follows:

(a) In this section, "advanced practice nurse" means a registered nurse approved by the board to practice as an advanced practice nurse on the basis of completion of an advanced educational program. The term includes a nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. The term is synonymous with "advanced nurse practitioner" and "advanced practice registered nurse."

(b) The board shall adopt rules to:

(1) establish:

(A) any specialized education or training, including pharmacology, that a registered nurse must have to:

(i) prescribe and order drugs and medical devices under Chapter 157; or[carry out a prescription drug order under Section 157.052; and]

(ii) prescribe and order drugs and medical devices under Section 301.357; and

(B) a system for assigning an identification number to a registered nurse who provides the board with evidence of completing the specialized education and training requirement under Paragraph (A)(i) or (ii) [Subdivision (1)(A)];

(2) approve a registered nurse as an advanced practice nurse; and

(3) initially approve and biennially renew provisional prescriptive authority to an advanced practice nurse ['s authority] to:[carry out or sign a prescription drug order under Chapter 157.]

(A) prescribe and order drugs and medical devices under Chapter 157; or

(B) prescribe and order drugs and medical devices during a post-graduate preceptorship supervised by an advanced practice nurse with full prescriptive authority under Section 301.357.

(4) finally approve and biennially renew full prescriptive authority to an advanced practice nurse to prescribe and order drugs and medical devices under Section 301.357.

(c-1) At a minimum, the rules adopted under Subsection (b)(4) must allow for approval of an advanced practice nurse who has practiced for a minimum of 500 hours with the authority to prescribe and order drugs and medical devices granted by the Board of Nursing in another state and is otherwise qualified.

(c-2) For final approval under Subsection (b)(4), the rules must require the completion of 500 hours of practice as an advanced practice nurse with prescribing and ordering authority under:

(1) Subsection (b)(3)(A);

(2) Subsection (b)(3)(B);

(3) Subsection (c-1); or

(4) a combination of hours gained under (b)(3)(A), (b)(3)(B), or (c-1).

SECTION 5. Subchapter H, Chapter 301, Occupations Code, is amended by adding Section 301.357 to read as follows:

Sec. 301.357. PRESCRIBING AND ORDERING AUTHORITY OF CERTAIN NURSES. (a) The board may grant provisional prescribing and ordering authority to an advanced practice registered nurse who is qualified for the authority under the rules adopted by the board under Section 301.152(b)(3). The board may grant full prescribing and ordering authority to an advanced practice registered nurse who is qualified for the authority under the rules adopted by the board under Section 301.152 (c-1) and (c-2).

(b) As authorized by the board, an advanced practice registered nurse may:

(1) prescribe, procure, administer, and order dangerous drugs, controlled substances, and medical devices;

(2) diagnose, prescribe, and institute therapy or referrals of patients to health care agencies, health care providers, and community resources; and

(3) plan and initiate a therapeutic regimen that includes ordering and prescribing medical devices and equipment, nutrition, and diagnostic and supportive services, including home health care, hospice, physical therapy, and occupational therapy.

(c) An advanced practice registered nurse granted prescribing and ordering authority under this section shall practice professional nursing in accordance with standards established and recognized by the board to protect the public health and safety.

(d) An advanced practice registered nurse may apply to the board for prescribing and ordering authority under this section by submitting to the board an application on the form prescribed by the board, paying any required fee, and providing any other information required by the board.

(e) Upon application for prescriptive authority in an additional role or population focus area by an advanced practice registered nurse with full prescriptive authority, the board shall grant full prescriptive authority to the advanced practice registered nurse who is otherwise qualified.

(f) Nothing in this chapter requires an advanced practice registered nurse who issues medication orders in a licensed hospital to obtain provisional or full prescriptive authority if the advanced practice registered nurse does not issue prescription drug orders. For purposes of this section, medication orders and prescription drug orders have the same meaning as in Chapter 551.003, Occupations Code.

SECTION 6. Section 551.003(34), Occupations Code, is amended to read as follows:

(34) "Practitioner" means:

(A) a person licensed or registered to prescribe, distribute, administer, or dispense a prescription drug or device in the course of professional practice in this state, including a physician, dentist, podiatrist, advanced practice registered nurse, or veterinarian but excluding a person licensed under this subtitle;

(B) a person licensed by another state, Canada, or the United Mexican States in a health field in which, under the law of this state, a license holder in this state may legally prescribe a dangerous drug;

(C) a person practicing in another state and licensed by another state as a physician, dentist, veterinarian, advanced practice registered nurse, or podiatrist, who has a current federal Drug Enforcement Administration registration number and who may legally prescribe a Schedule II, III, IV, or V controlled substance, as specified under Chapter 481, Health and Safety Code, in that other state; or

(D) an advanced practice nurse or physician assistant to whom a physician has delegated the authority to carry out or sign prescription drug orders under Section 157.0511, 157.052, 157.053, 157.054, 157.0541, or 157.0542.

SECTION 7. Section 563.053, Occupations Code, is amended to read as follows:

Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN RURAL AREAS. (a) In this section:

(1) "Advanced practice registered nurse" means an advanced practice registered nurse granted prescribing and ordering authority under Section 301.357.

(2) "Reimbursement [, "reimbursement] for cost" means an additional charge, separate from that imposed for the physician's or advanced practice registered nurse's professional services, that includes the cost of the drug product and all other actual costs to the physician or advanced practice registered nurse incidental to providing the dispensing service. The term does not include a separate fee imposed for the act of dispensing the drug itself.

(b) This section applies to an area located in a county with a population of 5,000 or less, or in a municipality or an unincorporated town with a population of less than 2,500, that is within a 15-mile radius of the physician's or advanced practice registered nurse's office and in which a pharmacy is not located. This section does not apply to a municipality or an unincorporated town that is adjacent to a municipality with a population of 2,500 or more.

(c) A physician who practices medicine or an advanced practice registered nurse who practices advanced practice nursing in an area described by Subsection (b) may:

(1) maintain a supply of dangerous drugs in the physician's or advanced practice registered nurse's office to be dispensed in the course of treating the physician's or advanced practice registered nurse's patients; and

(2) be reimbursed for the cost of supplying those drugs without obtaining a license under Chapter 558.

(d) A physician or advanced practice registered nurse who dispenses dangerous drugs under Subsection (c) shall:

(1) comply with each labeling provision under this subtitle applicable to that class of drugs; and

(2) oversee compliance with packaging and recordkeeping provisions applicable to that class of drugs.

(e) A physician who desires to dispense dangerous drugs under this section shall notify both the board and the Texas [State Board of] Medical Board [Examiners] that the physician practices in an area described by Subsection (b). An advanced practice registered nurse who desires to dispense dangerous drugs under this section shall notify both the board and the Texas Board of Nursing that the advanced practice registered nurse practices in an area described by Subsection (b). The physician or advanced practice registered nurse may continue to dispense dangerous drugs in the area until the board determines, after notice and hearing, that the physician or advanced practice registered nurse no longer practices in an area described by Subsection (b).

SECTION 8. Section 481.002(39), Health and Safety Code, is amended to read as follows:

(39) "Practitioner" means:

(A) a physician, dentist, veterinarian, podiatrist, scientific investigator, advanced practice registered nurse, or other person licensed, registered, or otherwise permitted to distribute, dispense, analyze, conduct research with respect to, or administer a controlled substance in the course of professional practice or research in this state;

(B) a pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or administer a controlled substance in the course of professional practice or research in this state;

(C) a person practicing in and licensed by another state as a physician, dentist, veterinarian, advanced practice registered nurse, or podiatrist, having a current Federal Drug Enforcement Administration registration number, who may legally prescribe Schedule II, III, IV, or V controlled substances in that state; or

(D) an advanced practice nurse or physician assistant to whom a physician has delegated the authority to carry out or sign prescription drug orders under Section 157.0511, 157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations Code.

SECTION 9. Section 483.001(12), Health and Safety Code, is amended to read as follows:

(12) "Practitioner" means a person who is [licensed]:

(A) licensed by the Texas [State Board of] Medical Board [Examiners], State Board of Dental Examiners, Texas State Board of Podiatric Medical Examiners, Texas Optometry Board, or State Board of Veterinary Medical Examiners to prescribe and administer dangerous drugs;

(B) licensed by another state in a health field in which, under the laws of this state, a licensee may legally prescribe dangerous drugs;

(C) licensed in Canada or Mexico in a health field in which, under the laws of this state, a licensee may legally prescribe dangerous drugs; [or]

(D) an advanced practice nurse or physician assistant to whom a physician has delegated the authority to carry out or sign prescription drug orders under Section 157.0511, 157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations Code; or

(E) an advanced practice registered nurse to whom the Texas Board of Nursing has granted prescribing and ordering authority under Section 301.357, Occupations Code.

SECTION 10. Not later than January 1, 2012, the Texas Board of Nursing shall adopt the rules necessary to implement the changes in law made by this Act.

SECTION 11. The Board shall develop an expedited process to grant final prescriptive authority to advanced practice nurses who have prescribed or ordered drugs or medical devices for a minimum of 500 hours under Chapter 157 prior to the effective date of this Act.

SECTION 12. This Act takes effect September 1, 2011.