82R14695 T
 
  By: Zaffirini S.B. No. 1857
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the administration of medications for persons with
  intellectual and developmental disabilities.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 301, Occupations Code, is amended to add
  a new Subchapter O to read as follows:
  SUBCHAPTER O.  ADMINISTRATION OF MEDICATIONS FOR PERSONS WITH
  INTELLECTUAL AND DEVELOPMENTAL DISABILITIES.
         Sec. 301.701.  DEFINITIONS. In this subsection:
               (1)  "Assistance with self-administered medication"
  means any needed ancillary aid provided to a client in the client's
  self-administered medication or treatment regimen, such as
  reminding a client to take a medication at the prescribed time,
  opening and closing a medication container, pouring a predetermined
  quantity of liquid to be ingested, returning a medication to the
  proper storage area, and assisting in reordering medications from a
  pharmacy.
               (2)  "Administration of medication" means the removal
  of an individual/unit dose from a previously dispensed, properly
  labeled container, verifying it with the medication order, giving
  the correct medication and the correct dose to the proper client at
  the proper time by the proper route; and accurately recording the
  time and dose given.
               (3)  "Client" means a person with an intellectual and
  developmental disability receiving services from a facility or
  program listed in Section 301.702.
               (4)  "Unlicensed person" means an individual, not
  licensed as health care provider:
                     (A)  who is monetarily compensated to provide
  certain health related tasks and functions in a complementary or
  assistive role to the licensed nurse in providing direct client
  care or carrying out common nursing functions;
                     (B)  who provides those tasks and functions as a
  volunteer but does not qualify as a friend providing gratuitous
  care for the sick under Section 301.004(1);
                     (C)  including, but not limited to, nurse aides,
  orderlies, assistants, attendants, technicians, home health aides,
  medication aides permitted by a state agency, and other individuals
  providing personal care/assistance of health related services; or
                     (D)  who is a professional nursing student, not
  licensed as a nurse, providing care for monetary compensation and
  not as part of their formal educational program shall be considered
  to be unlicensed persons and must provide that care in conformity
  with this chapter.
         Sec. 301.702.  APPLICABILITY. This subsection applies only
  to administration of medications provided to certain persons with
  intellectual and developmental disabilities who are served in:
               (1)  a facility licensed and certified under Chapter
  252, Health and Safety Code; or
               (2)  one of the following Section 1915(c) waiver
  programs administered by the Department of Aging and Disability
  Services to serve persons with intellectual and developmental
  disabilities:
                     (A)  Community Living Assistance and Support
  Services waiver;
                     (B)  Home and Community Based Services waiver; or
                     (C)  Texas Home Living waiver.
         Sec. 301.703.  ADMINISTRATION OF MEDICATION. (a)  The board
  by rule shall authorize the administration of medication by
  unlicensed persons without the requirement that a registered nurse
  delegate each administration of
               (1)  oral medication;
               (2)  topical medication; or
               (3)  metered dose inhaler.
         (b)  Medications that must be administered other than those
  listed under subsection (a) are subject to the board's rules
  regarding the delegation of nursing tasks to unlicensed persons in
  independent living environments such as those listed in Section
  301.702.
         (c)  The board by rule shall:
               (1)  require that a licensed nurse assess each client
  with intellectual and developmental disabilities described by
  Section 301.702 to:
                     (A)  determine the appropriate level of
  assistance the client needs with the administration of medication;
  and
                     (B)  establish criteria related to the necessary
  skills and knowledge that must be demonstrated to permit the client
  to have medications administered by an unlicensed person under this
  subchapter.
         Sec. 301.704.  UNLICENSED PERSONS AUTHORIZED TO PROVIDE
  ADMINISTRATION OF MEDICATION. (a) An unlicensed person who is a
  member of the staff of a facility or an employee or contractor of a
  person licensed or certified to provide Section 1915(c) waiver
  program services as described by Section 301.702 may be authorized
  to administer medication to a client described by Section 301.702
  only if the staff member, employee or contractor:
               (1)  is trained by a registered nurse or licensed
  vocational nurse under the direction of a registered nurse
  regarding the requirements to administer medications.
         SECTION 2.  In developing the rules required by Chapter 301,
  Occupations Code, Subchapter O, as added by this Act, the executive
  director of the Texas Board of Nursing shall convene a work group of
  affected stakeholders, including public and private providers and
  registered and licensed vocational nurses employed by the
  facilities or providers of services described by Section 301.702,
  Occupations Code, as added by this Act, and other persons or
  entities the executive director of the Texas Board of Nursing
  considers appropriate.
         SECTION 3.  Chapter 161, Human Resources Code, is amended to
  add a new Section 161.078 to read as follows:
         Sec. 161.078.  ASSISTANCE WITH ADMINISTRATION OF
  MEDICATIONS FOR PERSONS WITH INTELLECTUAL AND DEVELOPMENTAL
  DISABILITIES.  The department shall ensure that medications
  administered by an unlicensed person under Chapter 301, Occupations
  Code, Subchapter O are:
               (1)  overseen by a registered nurse or a licensed
  vocational nurse under the supervision of a registered nurse;
               (2)  performed after receiving training to address the
  client's identified skill and knowledge deficits until the client
  demonstrates competence in independent medication management; and
               (3)  administered in such a way as to ensure the
  greatest degree of independence in determining the type of
  assistance needed, including the use of an adaptive or assistive
  aid, device, or strategy as allowed under program rule.
         SECTION 4.  The Texas Board of Nursing and the Texas
  Department of Aging and Disability Services shall enter into a
  Memorandum of Understanding regarding the administration of
  medications to persons with intellectual and developmental
  disabilities.
         SECTION 5.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution. If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2011.