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SENATE ENGROSSED
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HOUSE COMMITTEE
SUBSTITUTE
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SECTION 1. The heading to
Subchapter B, Chapter 157, Occupations Code, is amended.
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SECTION 1. Same as engrossed
version.
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SECTION 2. Section 157.051,
Occupations Code, is amended to read as follows:
Sec. 157.051. DEFINITIONS.
In this subchapter:
(1) "Advanced practice registered
nurse" has the meaning assigned to that term by Section 301.152. The
term includes an advanced nurse practitioner and advanced practice nurse.
(2) ["Carrying out
or signing a prescription drug order" means completing a prescription
drug order presigned by the delegating physician, or the signing of a
prescription by a registered nurse or physician assistant.
[(2-a)]
"Controlled substance" has the meaning assigned to that term by
Section 481.002, Health and Safety Code.
(3) [(2-b)]
"Dangerous drug" has the meaning assigned to that term by Section
483.001, Health and Safety Code.
(4) "Health
professional shortage area" means:
(A) an urban or rural
area of this state that:
(i) is not required to
conform to the geographic boundaries of a political subdivision but is a
rational area for the delivery of health services;
(ii) the secretary of health
and human services determines has a health professional shortage; and
(iii) is not reasonably
accessible to an adequately served area;
(B) a population group
that the secretary of health and human services determines has a health
professional shortage; or
(C) a public or nonprofit
private medical facility or other facility that the secretary of health and
human services determines has a health professional shortage, as described
by 42 U.S.C. Section 254e(a)(1).
(5) "Hospital"
means:
(A) a general hospital or
a special hospital, as those terms are defined by Section 241.003, Health
and Safety Code, including a hospital maintained or operated by the state;
or
(B) a mental hospital
licensed under Chapter 577, Health and Safety Code.
(6) "Medication
order" has the meanings assigned by Section 551.003 of this code and
Section 481.002, Health and Safety Code.
(7) "Nonprescription
drug" has the meaning assigned by Section 551.003.
(8) [(3)]
"Physician assistant" means a person who holds a license issued
under Chapter 204.
(9) "Physician group
practice" means an entity through which two or more physicians deliver
health care to the public through the practice of medicine on a regular
basis and that is:
(A) owned and operated by
two or more physicians; or
(B) a freestanding
clinic, center, or office of a nonprofit health organization certified by
the board under Section 162.001(b) that complies with the requirements of
Chapter 162.
(10) "Practice
serving a medically underserved population" means:
(A) a practice in a
health professional shortage area;
(B) a clinic designated
as a rural health clinic under 42 U.S.C. Section 1395x(aa);
(C) a public health
clinic or a family planning clinic under contract with the Health and Human
Services Commission or the Department of State Health Services;
(D) a clinic designated
as a federally qualified health center under 42 U.S.C. Section
1396d(l)(2)(B);
(E) a county, state, or
federal correctional facility;
(F) a practice:
(i) that either:
(a) is located in an area
in which the Department of State Health Services determines there is an
insufficient number of physicians providing services to eligible clients of
federally, state, or locally funded health care programs; or
(b) is a practice that
the Department of State Health Services determines serves a
disproportionate number of clients eligible to participate in federally,
state, or locally funded health care programs; and
(ii) for which the
Department of State Health Services publishes notice of the department's
determination in the Texas Register and provides an opportunity for public
comment in the manner provided for a proposed rule under Chapter 2001,
Government Code; or
(G) a practice at which a
physician was delegating prescriptive authority to an advanced practice
registered nurse or physician assistant on or before March 1, 2013, based
on the practice qualifying as a site serving a medically underserved
population.
(11) "Prescribe or
order a drug or device" means prescribing or ordering a drug or
device, including the issuing of a prescription drug order or a medication
order.
(12) "Prescription
drug" has the meaning assigned by Section 551.003.
(13) "Prescriptive
authority agreement" means an agreement entered into by a physician
and an advanced practice registered nurse or physician assistant through
which the physician delegates to the advanced practice registered nurse or
physician assistant the act of prescribing or ordering a drug or device.
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SECTION 2. Section 157.051,
Occupations Code, is amended to read as follows:
Sec. 157.051. DEFINITIONS.
In this subchapter:
(1) "Advanced practice registered
nurse" has the meaning assigned to that term by Section 301.152. The
term includes an advanced nurse practitioner and advanced practice nurse.
(2) ["Carrying out
or signing a prescription drug order" means completing a prescription
drug order presigned by the delegating physician, or the signing of a
prescription by a registered nurse or physician assistant.
[(2-a)]
"Controlled substance" has the meaning assigned to that term by
Section 481.002, Health and Safety Code.
(3) [(2-b)]
"Dangerous drug" has the meaning assigned to that term by Section
483.001, Health and Safety Code.
(4) "Device" has the meaning assigned by Section 551.003,
and includes durable medical equipment.
(5) "Health
professional shortage area" means:
(A) an urban or rural
area of this state that:
(i) is not required to
conform to the geographic boundaries of a political subdivision but is a
rational area for the delivery of health services;
(ii) the secretary of
health and human services determines has a health professional shortage;
and
(iii) is not reasonably
accessible to an adequately served area;
(B) a population group
that the secretary of health and human services determines has a health
professional shortage; or
(C) a public or nonprofit
private medical facility or other facility that the secretary of health and
human services determines has a health professional shortage, as described
by 42 U.S.C. Section 254e(a)(1).
(6) "Hospital"
means a facility that:
(A) is:
(i) a general hospital or
a special hospital, as those terms are defined by Section 241.003, Health
and Safety Code, including a hospital maintained or operated by the state;
or
(ii) a mental hospital
licensed under Chapter 577, Health and Safety Code; and
(B) has an organized medical staff.
(7) "Medication
order" has the meanings assigned by Section 551.003 of this code and
Section 481.002, Health and Safety Code.
(8) "Nonprescription
drug" has the meaning assigned by Section 551.003.
(9) [(3)]
"Physician assistant" means a person who holds a license issued
under Chapter 204.
(10) "Physician
group practice" means an entity through which two or more physicians
deliver health care to the public through the practice of medicine on a
regular basis and that is:
(A) owned and operated by
two or more physicians; or
(B) a freestanding
clinic, center, or office of a nonprofit health organization certified by
the board under Section 162.001(b) that complies with the requirements of
Chapter 162.
(11) "Practice
serving a medically underserved population" means:
(A) a practice in a
health professional shortage area;
(B) a clinic designated
as a rural health clinic under 42 U.S.C. Section 1395x(aa);
(C) a public health
clinic or a family planning clinic under contract with the Health and Human
Services Commission or the Department of State Health Services;
(D) a clinic designated
as a federally qualified health center under 42 U.S.C. Section 1396d(l)(2)(B);
(E) a county, state, or
federal correctional facility;
(F) a practice:
(i) that either:
(a) is located in an area
in which the Department of State Health Services determines there is an
insufficient number of physicians providing services to eligible clients of
federally, state, or locally funded health care programs; or
(b) is a practice that
the Department of State Health Services determines serves a
disproportionate number of clients eligible to participate in federally,
state, or locally funded health care programs; and
(ii) for which the
Department of State Health Services publishes notice of the department's
determination in the Texas Register and provides an opportunity for public
comment in the manner provided for a proposed rule under Chapter 2001,
Government Code; or
(G) a practice at which a
physician was delegating prescriptive authority to an advanced practice
registered nurse or physician assistant on or before March 1, 2013, based
on the practice qualifying as a site serving a medically underserved
population.
(12) "Prescribe or
order a drug or device" means prescribing or ordering a drug or
device, including the issuing of a prescription drug order or a medication
order.
(13) "Prescription
drug" has the meaning assigned by Section 551.003.
(14) "Prescriptive
authority agreement" means an agreement entered into by a physician
and an advanced practice registered nurse or physician assistant through
which the physician delegates to the advanced practice registered nurse or
physician assistant the act of prescribing or ordering a drug or device.
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SECTION 3. Section 157.0511,
Occupations Code, is amended to read as follows:
Sec. 157.0511. DELEGATION
OF PRESCRIBING AND ORDERING DRUGS AND DEVICES [PRESCRIPTION DRUG
ORDERS]. (a) A physician's authority to delegate the prescribing
or ordering of a drug or device [carrying out or signing of a
prescription drug order] under this subchapter is limited to:
(1) nonprescription
drugs;
(2) dangerous drugs;
and
(3) [(2)]
controlled substances to the extent provided by Subsections [Subsection]
(b) and (b-1).
(b) Except as provided by
Subsection (b-1), a [A] physician may delegate the prescribing
or ordering of [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 III, IV, or V as established by
the commissioner of the Department of State Health Services [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 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) A physician may
delegate the prescribing or ordering of a controlled substance listed in
Schedule II as established by the commissioner of the Department of State
Health Services under Chapter 481, Health and Safety Code, only:
(1) in a hospital
facility-based practice under Section 157.054 and 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 to ensure patient safety; or
(2) as part of the plan
of care for the treatment of a person who has executed a written
certification of a terminal illness, has elected to receive hospice care,
and is receiving hospice treatment from a qualified hospice provider.
(b-2) The board shall
adopt rules that require a physician who delegates the prescribing or
ordering of a drug or device [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 registered nurse to whom a delegation is made. The board
may develop and use an electronic online delegation registration process
for registration under this subsection.
(c) This subchapter does not
modify the authority granted by law for a licensed registered nurse or
physician assistant to administer or provide a medication, including a
controlled substance listed in Schedule II as established by the
commissioner of the Department of State Health Services [public
health] under Chapter 481, Health and Safety Code, that is authorized
by a physician under a physician's order, standing medical order, standing
delegation order, or protocol.
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SECTION 3. Section 157.0511,
Occupations Code, is amended to read as follows:
Sec. 157.0511. DELEGATION
OF PRESCRIBING AND ORDERING DRUGS AND DEVICES [PRESCRIPTION DRUG
ORDERS]. (a) A physician's authority to delegate the prescribing
or ordering of a drug or device [carrying out or signing of a
prescription drug order] under this subchapter is limited to:
(1) nonprescription
drugs;
(2) dangerous drugs;
and
(3) [(2)] controlled
substances to the extent provided by Subsections [Subsection]
(b) and (b-1).
(b) Except as provided by
Subsection (b-1), a [A] physician may delegate the prescribing
or ordering of [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 III, IV, or V as established by
the commissioner of the Department of State Health Services [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
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) A physician may
delegate the prescribing or ordering of a controlled substance listed in
Schedule II as established by the commissioner of the Department of State
Health Services under Chapter 481, Health and Safety Code, only:
(1) in a hospital
facility-based practice under Section 157.054, in accordance with policies
approved by the hospital's medical
staff or a committee of the hospital's
medical staff as provided by the hospital
bylaws to ensure patient safety, and as part
of the care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay
of 24 hours or greater; or
(B) is receiving services in the emergency department of the
hospital; or
(2) as part of the plan
of care for the treatment of a person who has executed a written certification
of a terminal illness, has elected to receive hospice care, and is
receiving hospice treatment from a qualified hospice provider.
(b-2) The board shall
adopt rules that require a physician who delegates the prescribing or
ordering of a drug or device [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 registered nurse to whom a delegation is made. The board
may develop and use an electronic online delegation registration process
for registration under this subsection.
(c) This subchapter does not
modify the authority granted by law for a licensed registered nurse or
physician assistant to administer or provide a medication, including a
controlled substance listed in Schedule II as established by the
commissioner of the Department of State Health Services [public
health] under Chapter 481, Health and Safety Code, that is authorized
by a physician under a physician's order, standing medical order, standing
delegation order, or protocol.
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SECTION 4. Subchapter B,
Chapter 157, Occupations Code, is amended by adding Sections 157.0512,
157.0513, and 157.0514 to read as follows:
Sec. 157.0512.
PRESCRIPTIVE AUTHORITY AGREEMENT. (a) A physician may delegate to an
advanced practice registered nurse or physician assistant, acting under
adequate physician supervision, the act of prescribing or ordering a drug
or device as authorized through a prescriptive authority agreement between the
physician and the advanced practice registered nurse or physician
assistant, as applicable.
(b) A physician and an
advanced practice registered nurse or physician assistant are eligible to
enter into or be parties to a prescriptive authority agreement only if:
(1) if applicable, the
Texas Board of Nursing has approved the advanced practice registered
nurse's authority to prescribe or order a drug or device as authorized
under this subchapter;
(2) the advanced practice
registered nurse or physician assistant:
(A) holds an active
license to practice in this state as an advanced practice registered nurse
or physician assistant, as applicable, and is in good standing in this
state; and
(B) is not currently
prohibited by the Texas Board of Nursing or the Texas Physician Assistant
Board, as applicable, from executing a prescriptive authority agreement;
and
(3) before executing the
prescriptive authority agreement, the physician and the advanced practice
registered nurse or physician assistant disclose to the other prospective
party to the agreement any prior disciplinary action by the board, the
Texas Board of Nursing, or the Texas Physician Assistant Board, as
applicable.
(c) Except as provided by
Subsection (d), the combined number of advanced practice registered nurses
and physician assistants with whom a physician may enter into a
prescriptive authority agreement may not exceed seven advanced practice
registered nurses and physician assistants or the full-time equivalent of
seven advanced practice registered nurses and physician assistants.
(d) Subsection (c) does
not apply to a prescriptive authority agreement if the prescriptive
authority is being exercised in:
(1) a practice serving a
medically underserved population; or
(2) a facility-based
practice in a hospital under Section 157.054.
(e) A prescriptive
authority agreement must, at a minimum:
(1) be in writing and
signed and dated by the parties to the agreement;
(2) state the name,
address, and all professional license numbers of the parties to the
agreement;
(3) state the nature of
the practice, practice locations, or practice settings;
(4) identify the types or
categories of drugs or devices that may be prescribed or the types or
categories of drugs or devices that may not be prescribed;
(5) provide a general
plan for addressing consultation and referral;
(6) provide a plan for
addressing patient emergencies;
(7) state the general
process for communication and the sharing of information between the
physician and the advanced practice registered nurse or physician assistant
to whom the physician has delegated prescriptive authority related to the
care and treatment of patients;
(8) if alternate
physician supervision is to be utilized, designate one or more alternate
physicians who may:
(A) provide appropriate
supervision on a temporary basis in accordance with the requirements
established by the prescriptive authority agreement and the requirements of
this subchapter; and
(B) participate in the
prescriptive authority quality assurance and improvement plan meetings
required under this section; and
(9) describe a
prescriptive authority quality assurance and improvement plan and specify
methods for documenting the implementation of the plan that includes the
following:
(A) chart review, with
the number of charts to be reviewed determined by the physician and
advanced practice registered nurse or physician assistant; and
(B) periodic face-to-face
meetings between the advanced practice registered nurse or physician
assistant and the physician at a location determined by the physician and
the advanced practice registered nurse or physician assistant.
(f) The periodic
face-to-face meetings described by Subsection (e)(9)(B) must:
(1) include:
(A) the sharing of
information relating to patient treatment and care, needed changes in
patient care plans, and issues relating to referrals; and
(B) discussion of patient
care improvement; and
(2) be documented and
occur:
(A) except as provided by
Paragraph (B):
(i) at least monthly
until the third anniversary of the date the agreement is executed; and
(ii) at least quarterly
after the third anniversary of the date the agreement is executed, with
monthly meetings held between the quarterly meetings by means of a remote
electronic communications system, including videoconferencing technology or
the Internet; or
(B) if during the seven
years preceding the date the agreement is executed the advanced practice
registered nurse or physician assistant for at least five years was in a
practice that included the exercise of prescriptive authority with required
physician supervision:
(i) at least monthly
until the first anniversary of the date the agreement is executed; and
(ii) at least quarterly
after the first anniversary of the date the agreement is executed, with
monthly meetings held between the quarterly meetings by means of a remote
electronic communications system, including videoconferencing technology or
the Internet.
(g) The prescriptive
authority agreement may include other provisions agreed to by the physician
and advanced practice registered nurse or physician assistant.
(h) If the parties to the
prescriptive authority agreement practice in a physician group practice,
the physician may appoint one or more alternate supervising physicians
designated under Subsection (e)(8), if any, to conduct and document the
quality assurance meetings in accordance with the requirements of this
subchapter.
(i) The prescriptive
authority agreement need not describe the exact steps that an advanced
practice registered nurse or physician assistant must take with respect to
each specific condition, disease, or symptom.
(j) A physician, advanced
practice registered nurse, or physician assistant who is a party to a
prescriptive authority agreement must retain a copy of the agreement until
the second anniversary of the date the agreement is terminated.
(k) A party to a
prescriptive authority agreement may not by contract waive, void, or
nullify any provision of this section or Section 157.0513.
(l) In the event that a
party to a prescriptive authority agreement is notified that the individual
has become the subject of an investigation by the board, the Texas Board of
Nursing, or the Texas Physician Assistant Board, the individual shall
immediately notify the other party to the prescriptive authority agreement.
(m) The prescriptive
authority agreement and any amendments must be reviewed at least annually,
dated, and signed by the parties to the agreement. The prescriptive
authority agreement and any amendments must be made available to the board,
the Texas Board of Nursing, or the Texas Physician Assistant Board not
later than the third business day after the date of receipt of request, if
any.
(n) The prescriptive
authority agreement should promote the exercise of professional judgment by
the advanced practice registered nurse or physician assistant commensurate
with the advanced practice registered nurse's or physician assistant's
education and experience and the relationship between the advanced practice
registered nurse or physician assistant and the physician.
(o) This section shall be
liberally construed to allow the use of prescriptive authority agreements
to safely and effectively utilize the skills and services of advanced
practice registered nurses and physician assistants.
(p) The board may not
adopt rules pertaining to the elements of a prescriptive authority
agreement that would impose requirements in addition to the requirements
under this section.
(q) The board, the Texas
Board of Nursing, and the Texas Physician Assistant Board shall jointly
develop responses to frequently asked questions relating to prescriptive
authority agreements not later than January 1, 2014. This subsection
expires January 1, 2015.
Sec. 157.0513.
PRESCRIPTIVE AUTHORITY AGREEMENT: INFORMATION.
Sec. 157.0514.
PRESCRIPTIVE AUTHORITY AGREEMENT: INSPECTIONS.
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SECTION 4. Subchapter B,
Chapter 157, Occupations Code, is amended by adding Sections 157.0512,
157.0513, and 157.0514 to read as follows:
Sec. 157.0512. PRESCRIPTIVE
AUTHORITY AGREEMENT. (a) A physician may delegate to an advanced practice
registered nurse or physician assistant, acting under adequate physician
supervision, the act of prescribing or ordering a drug or device as
authorized through a prescriptive authority agreement between the physician
and the advanced practice registered nurse or physician assistant, as
applicable.
(b) A physician and an
advanced practice registered nurse or physician assistant are eligible to
enter into or be parties to a prescriptive authority agreement only if:
(1) if applicable, the
Texas Board of Nursing has approved the advanced practice registered
nurse's authority to prescribe or order a drug or device as authorized
under this subchapter;
(2) the advanced practice
registered nurse or physician assistant:
(A) holds an active
license to practice in this state as an advanced practice registered nurse
or physician assistant, as applicable, and is in good standing in this
state; and
(B) is not currently
prohibited by the Texas Board of Nursing or the Texas Physician Assistant
Board, as applicable, from executing a prescriptive authority agreement;
and
(3) before executing the
prescriptive authority agreement, the physician and the advanced practice
registered nurse or physician assistant disclose to the other prospective
party to the agreement any prior disciplinary action by the board, the
Texas Board of Nursing, or the Texas Physician Assistant Board, as
applicable.
(c) Except as provided by
Subsection (d), the combined number of advanced practice registered nurses
and physician assistants with whom a physician may enter into a
prescriptive authority agreement may not exceed seven advanced practice
registered nurses and physician assistants or the full-time equivalent of seven
advanced practice registered nurses and physician assistants.
(d) Subsection (c) does
not apply to a prescriptive authority agreement if the prescriptive
authority is being exercised in:
(1) a practice serving a
medically underserved population; or
(2) a facility-based
practice in a hospital under Section 157.054.
(e) A prescriptive
authority agreement must, at a minimum:
(1) be in writing and
signed and dated by the parties to the agreement;
(2) state the name,
address, and all professional license numbers of the parties to the
agreement;
(3) state the nature of
the practice, practice locations, or practice settings;
(4) identify the types or
categories of drugs or devices that may be prescribed or the types or
categories of drugs or devices that may not be prescribed;
(5) provide a general
plan for addressing consultation and referral;
(6) provide a plan for
addressing patient emergencies;
(7) state the general
process for communication and the sharing of information between the
physician and the advanced practice registered nurse or physician assistant
to whom the physician has delegated prescriptive authority related to the
care and treatment of patients;
(8) if alternate
physician supervision is to be utilized, designate one or more alternate
physicians who may:
(A) provide appropriate
supervision on a temporary basis in accordance with the requirements
established by the prescriptive authority agreement and the requirements of
this subchapter; and
(B) participate in the
prescriptive authority quality assurance and improvement plan meetings
required under this section; and
(9) describe a
prescriptive authority quality assurance and improvement plan and specify
methods for documenting the implementation of the plan that includes the
following:
(A) chart review, with
the number of charts to be reviewed determined by the physician and
advanced practice registered nurse or physician assistant; and
(B) periodic face-to-face
meetings between the advanced practice registered nurse or physician
assistant and the physician at a location determined by the physician and
the advanced practice registered nurse or physician assistant.
(f) The periodic
face-to-face meetings described by Subsection (e)(9)(B) must:
(1) include:
(A) the sharing of information
relating to patient treatment and care, needed changes in patient care
plans, and issues relating to referrals; and
(B) discussion of patient
care improvement; and
(2) be documented and
occur:
(A) except as provided by
Paragraph (B):
(i) at least monthly
until the third anniversary of the date the agreement is executed; and
(ii) at least quarterly
after the third anniversary of the date the agreement is executed, with
monthly meetings held between the quarterly meetings by means of a remote
electronic communications system, including videoconferencing technology or
the Internet; or
(B) if during the seven
years preceding the date the agreement is executed the advanced practice
registered nurse or physician assistant for at least five years was in a
practice that included the exercise of prescriptive authority with required
physician supervision:
(i) at least monthly
until the first anniversary of the date the agreement is executed; and
(ii) at least quarterly
after the first anniversary of the date the agreement is executed, with
monthly meetings held between the quarterly meetings by means of a remote
electronic communications system, including videoconferencing technology or
the Internet.
(g) The prescriptive
authority agreement may include other provisions agreed to by the physician
and advanced practice registered nurse or physician assistant.
(h) If the parties to the
prescriptive authority agreement practice in a physician group practice,
the physician may appoint one or more alternate supervising physicians
designated under Subsection (e)(8), if any, to conduct and document the
quality assurance meetings in accordance with the requirements of this
subchapter.
(i) The prescriptive
authority agreement need not describe the exact steps that an advanced
practice registered nurse or physician assistant must take with respect to
each specific condition, disease, or symptom.
(j) A physician, advanced
practice registered nurse, or physician assistant who is a party to a
prescriptive authority agreement must retain a copy of the agreement until
the second anniversary of the date the agreement is terminated.
(k) A party to a
prescriptive authority agreement may not by contract waive, void, or
nullify any provision of this section or Section 157.0513.
(l) In the event that a
party to a prescriptive authority agreement is notified that the individual
has become the subject of an investigation by the board, the Texas Board of
Nursing, or the Texas Physician Assistant Board, the individual shall immediately
notify the other party to the prescriptive authority agreement.
(m) The prescriptive
authority agreement and any amendments must be reviewed at least annually,
dated, and signed by the parties to the agreement. The prescriptive
authority agreement and any amendments must be made available to the board,
the Texas Board of Nursing, or the Texas Physician Assistant Board not
later than the third business day after the date of receipt of request, if
any.
(n) The prescriptive
authority agreement should promote the exercise of professional judgment by
the advanced practice registered nurse or physician assistant commensurate
with the advanced practice registered nurse's or physician assistant's
education and experience and the relationship between the advanced practice
registered nurse or physician assistant and the physician.
(o) This section shall be
liberally construed to allow the use of prescriptive authority agreements
to safely and effectively utilize the skills and services of advanced
practice registered nurses and physician assistants.
(p) The board may not
adopt rules pertaining to the elements of a prescriptive authority
agreement that would impose requirements in addition to the requirements
under this section. The board may adopt
other rules relating to physician delegation under this chapter.
(q) The board, the Texas
Board of Nursing, and the Texas Physician Assistant Board shall jointly
develop responses to frequently asked questions relating to prescriptive
authority agreements not later than January 1, 2014. This subsection
expires January 1, 2015.
Sec. 157.0513.
PRESCRIPTIVE AUTHORITY AGREEMENT: INFORMATION.
Sec. 157.0514.
PRESCRIPTIVE AUTHORITY AGREEMENT: INSPECTIONS.
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SECTION 5. Section 157.054,
Occupations Code, is amended.
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SECTION 5. Same as engrossed
version.
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SECTION 6. Section 157.055,
Occupations Code, is amended.
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SECTION 6. Same as engrossed
version.
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SECTION 7. Section 157.057,
Occupations Code, is amended.
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SECTION 7. Same as engrossed
version.
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SECTION 8. Subsections (b),
(d), (e), (f), and (j), Section 157.059, Occupations Code, are amended.
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SECTION 8. Same as engrossed
version except for recitation.
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SECTION 9. Section 157.060,
Occupations Code, is amended.
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SECTION 9. Same as engrossed
version.
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SECTION 10. Section 156.056,
Occupations Code, is amended.
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SECTION 10. Same as engrossed
version.
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SECTION 11. Subchapter C,
Chapter 204, Occupations Code, is amended.
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SECTION 11. Same as engrossed
version.
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SECTION 12. Section
204.1565, Occupations Code, is amended.
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SECTION 12. Same as engrossed
version.
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SECTION 13. Subsection (b),
Section 204.202, Occupations Code, is amended.
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SECTION 13. Same as engrossed
version except for recitation.
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No
equivalent provision.
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SECTION 14. Section 204.204,
Occupations Code, is amended by adding Subsection (c) to read as follows:
(c) The number of
physician assistants a physician may supervise in a practice setting may
not be less than the number of physician assistants to whom a physician may
delegate the authority to prescribe or order a drug or device in that
practice setting under Subchapter B, Chapter 157.
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SECTION 14. Subdivision (2),
Section 301.002, Occupations Code, is amended.
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SECTION 15. Same as engrossed
version except for recitation.
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SECTION 15. Section 301.005,
Occupations Code, is amended.
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SECTION 16. Same as engrossed
version.
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SECTION 16. Section 301.152,
Occupations Code, is amended.
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SECTION 17. Same as engrossed
version.
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SECTION 17. Subchapter D,
Chapter 301, Occupations Code, is amended.
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SECTION 18. Same as engrossed
version.
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SECTION 18. Subdivisions
(34) and (45), Section 551.003, Occupations Code, are amended.
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SECTION 19. Same as engrossed
version except for recitation.
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No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
No
equivalent provision.
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SECTION 20. Section
533.005(a), Government Code, is amended to read as follows:
(a) A contract between a
managed care organization and the commission for the organization to
provide health care services to recipients must contain:
(1) procedures to ensure
accountability to the state for the provision of health care services,
including procedures for financial reporting, quality assurance,
utilization review, and assurance of contract and subcontract compliance;
(2) capitation rates that
ensure the cost-effective provision of quality health care;
(3) a requirement that the
managed care organization provide ready access to a person who assists
recipients in resolving issues relating to enrollment, plan administration,
education and training, access to services, and grievance procedures;
(4) a requirement that the
managed care organization provide ready access to a person who assists
providers in resolving issues relating to payment, plan administration,
education and training, and grievance procedures;
(5) a requirement that the
managed care organization provide information and referral about the
availability of educational, social, and other community services that
could benefit a recipient;
(6) procedures for recipient
outreach and education;
(7) a requirement that the
managed care organization make payment to a physician or provider for
health care services rendered to a recipient under a managed care plan not
later than the 45th day after the date a claim for payment is received with
documentation reasonably necessary for the managed care organization to
process the claim, or within a period, not to exceed 60 days, specified by
a written agreement between the physician or provider and the managed care
organization;
(8) a requirement that the
commission, on the date of a recipient's enrollment in a managed care plan
issued by the managed care organization, inform the organization of the
recipient's Medicaid certification date;
(9) a requirement that the
managed care organization comply with Section 533.006 as a condition of
contract retention and renewal;
(10) a requirement that the
managed care organization provide the information required by Section
533.012 and otherwise comply and cooperate with the commission's office of
inspector general and the office of the attorney general;
(11) a requirement that the
managed care organization's usages of out-of-network providers or groups of
out-of-network providers may not exceed limits for those usages relating to
total inpatient admissions, total outpatient services, and emergency room
admissions determined by the commission;
(12) if the commission finds
that a managed care organization has violated Subdivision (11), a
requirement that the managed care organization reimburse an out-of-network
provider for health care services at a rate that is equal to the allowable
rate for those services, as determined under Sections 32.028 and 32.0281,
Human Resources Code;
(13) a requirement that,
notwithstanding any other law, including Sections 843.312 and 1301.052,
Insurance Code, the organization:
(A) use advanced
practice registered nurses and physician assistants in
addition to physicians as primary care providers to increase the
availability of primary care providers in the organization's provider
network; and
(B) treat advanced
practice registered nurses and physician assistants in the same manner as
primary care physicians with regard to:
(i) selection and
assignment as primary care providers;
(ii) inclusion as primary
care providers in the organization's provider network; and
(iii) inclusion as
primary care providers in any provider network directory maintained by the
organization;
(14) a requirement that the
managed care organization reimburse a federally qualified health center or
rural health clinic for health care services provided to a recipient
outside of regular business hours, including on a weekend day or holiday,
at a rate that is equal to the allowable rate for those services as determined
under Section 32.028, Human Resources Code, if the recipient does not have
a referral from the recipient's primary care physician;
(15) a requirement that the
managed care organization develop, implement, and maintain a system for
tracking and resolving all provider appeals related to claims payment,
including a process that will require:
(A) a tracking mechanism to
document the status and final disposition of each provider's claims payment
appeal;
(B) the contracting with
physicians who are not network providers and who are of the same or related
specialty as the appealing physician to resolve claims disputes related to
denial on the basis of medical necessity that remain unresolved subsequent
to a provider appeal; and
(C) the determination of the
physician resolving the dispute to be binding on the managed care
organization and provider;
(16) a requirement that a
medical director who is authorized to make medical necessity determinations
is available to the region where the managed care organization provides
health care services;
(17) a requirement that the
managed care organization ensure that a medical director and patient care
coordinators and provider and recipient support services personnel are
located in the South Texas service region, if the managed care organization
provides a managed care plan in that region;
(18) a requirement that the
managed care organization provide special programs and materials for
recipients with limited English proficiency or low literacy skills;
(19) a requirement that the
managed care organization develop and establish a process for responding to
provider appeals in the region where the organization provides health care
services;
(20) a requirement that the
managed care organization develop and submit to the commission, before the
organization begins to provide health care services to recipients, a
comprehensive plan that describes how the organization's provider network
will provide recipients sufficient access to:
(A) preventive care;
(B) primary care;
(C) specialty care;
(D) after-hours urgent care;
and
(E) chronic care;
(21) a requirement that the
managed care organization demonstrate to the commission, before the
organization begins to provide health care services to recipients, that:
(A) the organization's
provider network has the capacity to serve the number of recipients
expected to enroll in a managed care plan offered by the organization;
(B) the organization's
provider network includes:
(i) a sufficient number of
primary care providers;
(ii) a sufficient variety of
provider types; and
(iii) providers located
throughout the region where the organization will provide health care
services; and
(C) health care services
will be accessible to recipients through the organization's provider
network to a comparable extent that health care services would be available
to recipients under a fee-for-service or primary care case management model
of Medicaid managed care;
(22) a requirement that the
managed care organization develop a monitoring program for measuring the
quality of the health care services provided by the organization's provider
network that:
(A) incorporates the
National Committee for Quality Assurance's Healthcare Effectiveness Data
and Information Set (HEDIS) measures;
(B) focuses on measuring
outcomes; and
(C) includes the collection
and analysis of clinical data relating to prenatal care, preventive care,
mental health care, and the treatment of acute and chronic health
conditions and substance abuse;
(23) subject to Subsection
(a-1), a requirement that the managed care organization develop, implement,
and maintain an outpatient pharmacy benefit plan for its enrolled
recipients:
(A) that exclusively employs
the vendor drug program formulary and preserves the state's ability to
reduce waste, fraud, and abuse under the Medicaid program;
(B) that adheres to the
applicable preferred drug list adopted by the commission under Section
531.072;
(C) that includes the prior
authorization procedures and requirements prescribed by or implemented
under Sections 531.073(b), (c), and (g) for the vendor drug program;
(D) for purposes of which
the managed care organization:
(i) may not negotiate or
collect rebates associated with pharmacy products on the vendor drug
program formulary; and
(ii) may not receive drug
rebate or pricing information that is confidential under Section 531.071;
(E) that complies with the
prohibition under Section 531.089;
(F) under which the managed
care organization may not prohibit, limit, or interfere with a recipient's
selection of a pharmacy or pharmacist of the recipient's choice for the
provision of pharmaceutical services under the plan through the imposition
of different copayments;
(G) that allows the managed
care organization or any subcontracted pharmacy benefit manager to contract
with a pharmacist or pharmacy providers separately for specialty pharmacy
services, except that:
(i) the managed care
organization and pharmacy benefit manager are prohibited from allowing
exclusive contracts with a specialty pharmacy owned wholly or partly by the
pharmacy benefit manager responsible for the administration of the pharmacy
benefit program; and
(ii) the managed care
organization and pharmacy benefit manager must adopt policies and
procedures for reclassifying prescription drugs from retail to specialty
drugs, and those policies and procedures must be consistent with rules
adopted by the executive commissioner and include notice to network
pharmacy providers from the managed care organization;
(H) under which the managed
care organization may not prevent a pharmacy or pharmacist from
participating as a provider if the pharmacy or pharmacist agrees to comply
with the financial terms and conditions of the contract as well as other
reasonable administrative and professional terms and conditions of the
contract;
(I) under which the managed
care organization may include mail-order pharmacies in its networks, but
may not require enrolled recipients to use those pharmacies, and may not
charge an enrolled recipient who opts to use this service a fee, including
postage and handling fees; and
(J) under which the managed
care organization or pharmacy benefit manager, as applicable, must pay
claims in accordance with Section 843.339, Insurance Code; and
(24) a requirement that the
managed care organization and any entity with which the managed care
organization contracts for the performance of services under a managed care
plan disclose, at no cost, to the commission and, on request, the office of
the attorney general all discounts, incentives, rebates, fees, free goods,
bundling arrangements, and other agreements affecting the net cost of goods
or services provided under the plan.
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SECTION 19. Subsection (b),
Section 671.001, Government Code, is amended.
|
SECTION 21. Same as engrossed
version except for recitation.
|
|
No
equivalent provision.
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SECTION 22. Subchapter D,
Chapter 62, Health and Safety Code, is amended by adding Section 62.1551 to
read as follows:
Sec. 62.1551. INCLUSION
OF CERTAIN HEALTH CARE PROVIDERS IN PROVIDER NETWORKS. Notwithstanding any
other law, including Sections 843.312 and 1301.052, Insurance Code, the
executive commissioner of the commission shall adopt rules to require a
managed care organization or other entity to ensure that advanced practice
registered nurses and physician assistants are available as primary care
providers in the organization's or entity's provider network. The rules
must require advanced practice registered nurses and physician assistants
to be treated in the same manner as primary care physicians with regard to:
(1) selection and
assignment as primary care providers;
(2) inclusion as primary
care providers in the provider network; and
(3) inclusion as primary
care providers in any provider network directory maintained by the organization
or entity.
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SECTION 20. Subdivision
(39), Section 481.002, Health and Safety Code, is amended.
|
SECTION 23. Same as engrossed
version except for recitation.
|
|
SECTION 21. Subdivision
(12), Section 483.001, Health and Safety Code, is amended.
|
SECTION 24. Same as engrossed
version except for recitation.
|
|
No
equivalent provision.
|
SECTION 25. Section 32.024,
Human Resources Code, is amended by adding Subsection (gg) to read as
follows:
(gg) Notwithstanding any
other law, including Sections 843.312 and 1301.052, Insurance Code, the
department shall ensure that advanced practice registered nurses and
physician assistants may be selected by and assigned to recipients of
medical assistance as the primary care providers of those recipients. The
department must require that advanced practice registered nurses and
physician assistants be treated in the same manner as primary care
physicians with regard to:
(1) selection and
assignment as primary care providers; and
(2) inclusion as primary
care providers in any directory of providers of medical assistance
maintained by the department.
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No
equivalent provision.
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SECTION 26. Subchapter B,
Chapter 32, Human Resources Code, is amended by adding Section 32.03141 to
read as follows:
Sec. 32.03141. AUTHORITY
OF ADVANCED PRACTICE REGISTERED NURSES AND PHYSICIAN ASSISTANTS REGARDING
DURABLE MEDICAL EQUIPMENT AND SUPPLIES. To the extent allowed by federal
law, an advanced practice registered nurse or physician assistant acting
under adequate physician supervision and to whom a physician has delegated
the authority to prescribe and order drugs and devices under Chapter 157,
Occupations Code, may order and prescribe durable medical equipment and
supplies under the medical assistance program.
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|
SECTION 22. Sections 157.052,
157.053, 157.0541, and 157.0542, Occupations Code, are repealed.
|
SECTION 27. Same as engrossed
version.
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|
SECTION 23. The changes in
law made by this Act apply only to a delegation of prescriptive authority
by a physician to an advanced practice registered nurse or physician
assistant made or amended on or after January 31, 2014. A delegation of
prescriptive authority made or amended before January 31, 2014, is governed
by the law in effect immediately before the effective date of this Act, and
the former law is continued in effect for that purpose.
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No
equivalent provision.
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SECTION 24. The calculation
under Chapter 157, Occupations Code, as amended by this Act, of the amount
of time an advanced practice registered nurse or physician assistant has
practiced under the delegated prescriptive authority of a physician under a
prescriptive authority agreement shall include the amount of time the
advanced practice registered nurse or physician assistant practiced under
the delegated prescriptive authority of that physician before the effective
date of this Act.
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SECTION 28. Same as engrossed
version.
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SECTION 25. Not later than December 31, 2013, the Texas Medical Board,
the Texas Board of Nursing, and the Texas Physician Assistant Board shall
adopt the rules necessary to implement the changes in law made by this Act.
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SECTION 29. Not later than November 1, 2013, the Texas Medical Board,
the Texas Board of Nursing, and the Texas Physician Assistant Board shall
adopt the rules necessary to implement the changes in law made by this Act.
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SECTION 26. This Act takes
effect September 1, 2013.
|
SECTION 30. This Act takes
effect November 1, 2013.
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