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A BILL TO BE ENTITLED
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AN ACT
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relating to the delegation of prescriptive authority by physicians |
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to and the supervision by physicians of certain advanced practice |
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registered nurses and physician assistants. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Subchapter B, Chapter 157, |
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Occupations Code, is amended to read as follows: |
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SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE REGISTERED NURSES |
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AND PHYSICIAN ASSISTANTS |
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SECTION 2. Section 157.051, Occupations Code, is amended to |
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read as follows: |
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Sec. 157.051. DEFINITIONS. In this subchapter: |
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(1) "Advanced practice registered nurse" has the |
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meaning assigned to that term by Section 301.152. The term includes |
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an advanced nurse practitioner and advanced practice nurse. |
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(2) ["Carrying out or signing a prescription drug
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order" means completing a prescription drug order presigned by the
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delegating physician, or the signing of a prescription by a
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registered nurse or physician assistant.
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[(2-a)] "Controlled substance" has the meaning |
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assigned to that term by Section 481.002, Health and Safety Code. |
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(3) [(2-b)] "Dangerous drug" has the meaning assigned |
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to that term by Section 483.001, Health and Safety Code. |
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(4) "Health professional shortage area" means: |
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(A) an urban or rural area of this state that: |
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(i) is not required to conform to the |
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geographic boundaries of a political subdivision but is a rational |
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area for the delivery of health services; |
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(ii) the secretary of health and human |
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services determines has a health professional shortage; and |
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(iii) is not reasonably accessible to an |
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adequately served area; |
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(B) a population group that the secretary of |
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health and human services determines has a health professional |
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shortage; or |
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(C) a public or nonprofit private medical |
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facility or other facility that the secretary of health and human |
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services determines has a health professional shortage, as |
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described by 42 U.S.C. Section 254e(a)(1). |
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(5) "Hospital" means: |
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(A) a general hospital or a special hospital, as |
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those terms are defined by Section 241.003, Health and Safety Code, |
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including a hospital maintained or operated by the state; or |
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(B) a mental hospital licensed under Chapter 577, |
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Health and Safety Code. |
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(6) "Medication order" has the meanings assigned by |
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Section 551.003 of this code and Section 481.002, Health and Safety |
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Code. |
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(7) "Nonprescription drug" has the meaning assigned by |
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Section 551.003. |
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(8) [(3)] "Physician assistant" means a person who |
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holds a license issued under Chapter 204. |
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(9) "Physician group practice" means an entity through |
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which two or more physicians deliver health care to the public |
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through the practice of medicine on a regular basis and that is: |
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(A) owned and operated by two or more physicians; |
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or |
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(B) a freestanding clinic, center, or office of a |
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nonprofit health organization certified by the board under Section |
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162.001(b) that complies with the requirements of Chapter 162. |
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(10) "Practice serving a medically underserved |
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population" means: |
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(A) a practice in a health professional shortage |
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area; |
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(B) a clinic designated as a rural health clinic |
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under 42 U.S.C. Section 1395x(aa); |
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(C) a public health clinic or a family planning |
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clinic under contract with the Health and Human Services Commission |
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or the Department of State Health Services; |
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(D) a clinic designated as a federally qualified |
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health center under 42 U.S.C. Section 1396d(l)(2)(B); |
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(E) a county, state, or federal correctional |
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facility; |
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(F) a practice: |
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(i) that either: |
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(a) is located in an area in which the |
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Department of State Health Services determines there is an |
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insufficient number of physicians providing services to eligible |
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clients of federally, state, or locally funded health care |
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programs; or |
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(b) is a practice that the Department |
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of State Health Services determines serves a disproportionate |
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number of clients eligible to participate in federally, state, or |
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locally funded health care programs; and |
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(ii) for which the Department of State |
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Health Services publishes notice of the department's determination |
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in the Texas Register and provides an opportunity for public |
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comment in the manner provided for a proposed rule under Chapter |
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2001, Government Code; or |
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(G) a practice at which a physician was |
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delegating prescriptive authority to an advanced practice |
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registered nurse or physician assistant on or before March 1, 2013, |
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based on the practice qualifying as a site serving a medically |
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underserved population. |
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(11) "Prescribe or order a drug or device" means |
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prescribing or ordering a drug or device, including the issuing of a |
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prescription drug order or a medication order. |
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(12) "Prescription drug" has the meaning assigned by |
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Section 551.003. |
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(13) "Prescriptive authority agreement" means an |
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agreement entered into by a physician and an advanced practice |
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registered nurse or physician assistant through which the physician |
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delegates to the advanced practice registered nurse or physician |
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assistant the act of prescribing or ordering a drug or device. |
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SECTION 3. Section 157.0511, Occupations Code, is amended |
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to read as follows: |
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Sec. 157.0511. DELEGATION OF PRESCRIBING AND ORDERING DRUGS |
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AND DEVICES [PRESCRIPTION DRUG ORDERS]. (a) A physician's |
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authority to delegate the prescribing or ordering of a drug or |
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device [carrying out or signing of a prescription drug order] under |
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this subchapter is limited to: |
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(1) nonprescription drugs; |
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(2) dangerous drugs; and |
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(3) [(2)] controlled substances to the extent |
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provided by Subsections [Subsection] (b) and (b-1). |
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(b) Except as provided by Subsection (b-1), a [A] physician |
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may delegate the prescribing or ordering of [carrying out or
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signing of a prescription drug order for] a controlled substance |
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only if: |
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(1) the prescription is for a controlled substance |
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listed in Schedule III, IV, or V as established by the commissioner |
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of the Department of State Health Services [public health] under |
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Chapter 481, Health and Safety 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 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) A physician may delegate the prescribing or ordering |
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of a controlled substance listed in Schedule II as established by |
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the commissioner of the Department of State Health Services under |
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Chapter 481, Health and Safety Code, only: |
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(1) in a hospital facility-based practice under |
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Section 157.054 and in accordance with policies approved by the |
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facility's medical staff or a committee of the facility's medical |
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staff as provided by the facility bylaws to ensure patient safety; |
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or |
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(2) as part of the plan of care for the treatment of a |
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person who has executed a written certification of a terminal |
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illness, has elected to receive hospice care, and is receiving |
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hospice treatment from a qualified hospice provider. |
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(b-2) The board shall adopt rules that require a physician |
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who delegates the prescribing or ordering of a drug or device |
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[carrying out or signing of a prescription drug order under this
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subchapter] to register with the board the name and license number |
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of the physician assistant or advanced practice registered nurse to |
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whom a delegation is made. The board may develop and use an |
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electronic online delegation registration process for registration |
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under this subsection. |
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(c) This subchapter does not modify the authority granted by |
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law for a licensed registered nurse or physician assistant to |
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administer or provide a medication, including a controlled |
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substance listed in Schedule II as established by the commissioner |
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of the Department of State Health Services [public health] under |
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Chapter 481, Health and Safety Code, that is authorized by a |
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physician under a physician's order, standing medical order, |
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standing delegation order, or protocol. |
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SECTION 4. Subchapter B, Chapter 157, Occupations Code, is |
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amended by adding Sections 157.0512, 157.0513, and 157.0514 to read |
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as follows: |
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Sec. 157.0512. PRESCRIPTIVE AUTHORITY AGREEMENT. (a) A |
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physician may delegate to an advanced practice registered nurse or |
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physician assistant, acting under adequate physician supervision, |
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the act of prescribing or ordering a drug or device as authorized |
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through a prescriptive authority agreement between the physician |
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and the advanced practice registered nurse or physician assistant, |
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as applicable. |
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(b) A physician and an advanced practice registered nurse or |
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physician assistant are eligible to enter into or be parties to a |
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prescriptive authority agreement only if: |
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(1) if applicable, the Texas Board of Nursing has |
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approved the advanced practice registered nurse's authority to |
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prescribe or order a drug or device as authorized under this |
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subchapter; |
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(2) the advanced practice registered nurse or |
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physician assistant: |
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(A) holds an active license to practice in this |
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state as an advanced practice registered nurse or physician |
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assistant, as applicable, and is in good standing in this state; and |
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(B) is not currently prohibited by the Texas |
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Board of Nursing or the Texas Physician Assistant Board, as |
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applicable, from executing a prescriptive authority agreement; and |
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(3) before executing the prescriptive authority |
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agreement, the physician and the advanced practice registered nurse |
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or physician assistant disclose to the other prospective party to |
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the agreement any prior disciplinary action by the board, the Texas |
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Board of Nursing, or the Texas Physician Assistant Board, as |
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applicable. |
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(c) Except as provided by Subsection (d), the combined |
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number of advanced practice registered nurses and physician |
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assistants with whom a physician may enter into a prescriptive |
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authority agreement may not exceed seven advanced practice |
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registered nurses and physician assistants or the full-time |
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equivalent of seven advanced practice registered nurses and |
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physician assistants. |
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(d) Subsection (c) does not apply to a prescriptive |
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authority agreement if the prescriptive authority is being |
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exercised in: |
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(1) a practice serving a medically underserved |
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population; or |
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(2) a facility-based practice in a hospital under |
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Section 157.054. |
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(e) A prescriptive authority agreement must, at a minimum: |
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(1) be in writing and signed and dated by the parties |
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to the agreement; |
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(2) state the name, address, and all professional |
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license numbers of the parties to the agreement; |
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(3) state the nature of the practice, practice |
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locations, or practice settings; |
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(4) identify the types or categories of drugs or |
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devices that may be prescribed or the types or categories of drugs |
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or devices that may not be prescribed; |
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(5) provide a general plan for addressing consultation |
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and referral; |
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(6) provide a plan for addressing patient emergencies; |
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(7) state the general process for communication and |
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the sharing of information between the physician and the advanced |
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practice registered nurse or physician assistant to whom the |
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physician has delegated prescriptive authority related to the care |
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and treatment of patients; |
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(8) if alternate physician supervision is to be |
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utilized, designate one or more alternate physicians who may: |
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(A) provide appropriate supervision on a |
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temporary basis in accordance with the requirements established by |
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the prescriptive authority agreement and the requirements of this |
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subchapter; and |
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(B) participate in the prescriptive authority |
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quality assurance and improvement plan meetings required under this |
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section; and |
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(9) describe a prescriptive authority quality |
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assurance and improvement plan and specify methods for documenting |
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the implementation of the plan that includes the following: |
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(A) chart review, with the number of charts to be |
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reviewed determined by the physician and advanced practice |
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registered nurse or physician assistant; and |
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(B) periodic face-to-face meetings between the |
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advanced practice registered nurse or physician assistant and the |
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physician at a location determined by the physician and the |
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advanced practice registered nurse or physician assistant. |
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(f) The periodic face-to-face meetings described by |
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Subsection (e)(9)(B) must: |
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(1) include: |
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(A) the sharing of information relating to |
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patient treatment and care, needed changes in patient care plans, |
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and issues relating to referrals; and |
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(B) discussion of patient care improvement; and |
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(2) be documented and occur: |
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(A) except as provided by Paragraph (B): |
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(i) at least monthly until the third |
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anniversary of the date the agreement is executed; and |
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(ii) at least quarterly after the third |
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anniversary of the date the agreement is executed, with monthly |
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meetings held between the quarterly meetings by means of a remote |
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electronic communications system, including videoconferencing |
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technology or the Internet; or |
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(B) if during the seven years preceding the date |
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the agreement is executed the advanced practice registered nurse or |
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physician assistant for at least five years was in a practice that |
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included the exercise of prescriptive authority with required |
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physician supervision: |
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(i) at least monthly until the first |
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anniversary of the date the agreement is executed; and |
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(ii) at least quarterly after the first |
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anniversary of the date the agreement is executed, with monthly |
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meetings held between the quarterly meetings by means of a remote |
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electronic communications system, including videoconferencing |
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technology or the Internet. |
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(g) The prescriptive authority agreement may include other |
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provisions agreed to by the physician and advanced practice |
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registered nurse or physician assistant. |
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(h) If the parties to the prescriptive authority agreement |
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practice in a physician group practice, the physician may appoint |
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one or more alternate supervising physicians designated under |
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Subsection (e)(8), if any, to conduct and document the quality |
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assurance meetings in accordance with the requirements of this |
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subchapter. |
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(i) The prescriptive authority agreement need not describe |
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the exact steps that an advanced practice registered nurse or |
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physician assistant must take with respect to each specific |
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condition, disease, or symptom. |
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(j) A physician, advanced practice registered nurse, or |
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physician assistant who is a party to a prescriptive authority |
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agreement must retain a copy of the agreement until the second |
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anniversary of the date the agreement is terminated. |
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(k) A party to a prescriptive authority agreement may not by |
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contract waive, void, or nullify any provision of this section or |
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Section 157.0513. |
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(l) In the event that a party to a prescriptive authority |
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agreement is notified that the individual has become the subject of |
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an investigation by the board, the Texas Board of Nursing, or the |
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Texas Physician Assistant Board, the individual shall immediately |
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notify the other party to the prescriptive authority agreement. |
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(m) The prescriptive authority agreement and any amendments |
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must be reviewed at least annually, dated, and signed by the parties |
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to the agreement. The prescriptive authority agreement and any |
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amendments must be made available to the board, the Texas Board of |
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Nursing, or the Texas Physician Assistant Board not later than the |
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third business day after the date of receipt of request, if any. |
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(n) The prescriptive authority agreement should promote the |
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exercise of professional judgment by the advanced practice |
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registered nurse or physician assistant commensurate with the |
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advanced practice registered nurse's or physician assistant's |
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education and experience and the relationship between the advanced |
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practice registered nurse or physician assistant and the physician. |
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(o) This section shall be liberally construed to allow the |
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use of prescriptive authority agreements to safely and effectively |
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utilize the skills and services of advanced practice registered |
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nurses and physician assistants. |
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(p) The board may not adopt rules pertaining to the elements |
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of a prescriptive authority agreement that would impose |
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requirements in addition to the requirements under this section. |
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(q) The board, the Texas Board of Nursing, and the Texas |
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Physician Assistant Board shall jointly develop responses to |
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frequently asked questions relating to prescriptive authority |
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agreements not later than January 1, 2014. This subsection expires |
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January 1, 2015. |
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Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT: |
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INFORMATION. (a) The board, the Texas Board of Nursing, and the |
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Texas Physician Assistant Board shall jointly develop a process: |
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(1) to exchange information regarding the names, |
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locations, and license numbers of each physician, advanced practice |
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registered nurse, and physician assistant who has entered into a |
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prescriptive authority agreement; |
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(2) by which each board shall immediately notify the |
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other boards when a license holder of the board becomes the subject |
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of an investigation involving the delegation and supervision of |
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prescriptive authority, as well as the final disposition of any |
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such investigation; and |
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(3) by which each board shall maintain and share a list |
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of the board's license holders who have been subject to a final |
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adverse disciplinary action for an act involving the delegation and |
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supervision of prescriptive authority. |
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(b) If the board, the Texas Board of Nursing, or the Texas |
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Physician Assistant Board receives a notice under Subsection |
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(a)(2), the board that received notice may open an investigation |
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against a license holder of the board who is a party to a |
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prescriptive authority agreement with the license holder who is |
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under investigation by the board that provided notice under |
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Subsection (a)(2). |
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(c) The board shall maintain and make available to the |
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public a searchable online list of physicians, advanced practice |
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registered nurses, and physician assistants who have entered into a |
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prescriptive authority agreement authorized under Section 157.0512 |
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and identify the physician, advanced practice registered nurse, or |
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physician assistant with whom each physician, advanced practice |
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registered nurse, and physician assistant has entered into a |
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prescriptive authority agreement. |
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(d) The board shall collaborate with the Texas Board of |
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Nursing and the Texas Physician Assistant Board to maintain and |
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make available to the public a list of physicians, advanced |
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practice registered nurses, and physician assistants who are |
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prohibited from entering into or practicing under a prescriptive |
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authority agreement. |
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Sec. 157.0514. PRESCRIPTIVE AUTHORITY AGREEMENT: |
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INSPECTIONS. If the board receives a notice under Section |
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157.0513(a)(2), the board or an authorized board representative may |
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enter, with reasonable notice and at a reasonable time, unless the |
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notice would jeopardize an investigation, a site where a party to a |
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prescriptive authority agreement practices to inspect and audit any |
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records or activities relating to the implementation and operation |
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of the agreement. To the extent reasonably possible, the board and |
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the board's authorized representative shall conduct any inspection |
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or audit under this section in a manner that minimizes disruption to |
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the delivery of patient care. |
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SECTION 5. Section 157.054, Occupations Code, is amended by |
|
amending Subsections (a), (b), and (c) and adding Subsections (a-1) |
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and (b-1) to read as follows: |
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(a) One or more physicians [A physician] licensed by the |
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board may delegate, to one or more physician assistants or advanced |
|
practice registered nurses acting under adequate physician |
|
supervision whose practice is facility-based at a [licensed] |
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hospital or licensed long-term care facility, the administration or |
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provision of a drug and the prescribing or ordering of a drug or |
|
device [carrying out or signing of a prescription drug order] if |
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each of the delegating physicians [physician] is: |
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(1) the medical director or chief of medical staff of |
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the facility in which the physician assistant or advanced practice |
|
registered nurse practices; |
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(2) the chair of the facility's credentialing |
|
committee; |
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(3) a department chair of a facility department in |
|
which the physician assistant or advanced practice registered nurse |
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practices; or |
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(4) a physician who consents to the request of the |
|
medical director or chief of medical staff to delegate the |
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prescribing or ordering of a drug or device [carrying out or signing
|
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of a prescription drug order] at the facility in which the physician |
|
assistant or advanced practice registered nurse practices. |
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(a-1) The limits on the number of advanced practice |
|
registered nurses or physician assistants to whom a physician may |
|
delegate under Section 157.0512 do not apply to a physician under |
|
Subsection (a) whose practice is facility-based under this section, |
|
provided that the physician is not delegating in a freestanding |
|
clinic, center, or practice of the facility. |
|
(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, |
|
or a physician who consents to delegate under Subsection (a)(4); |
|
(3) the delegation may not permit the prescribing or |
|
ordering of a drug or device [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; |
|
and |
|
(4) delegation in a long-term care facility must be by |
|
the medical director and is limited to the prescribing or ordering |
|
of a drug or device [carrying out and signing of prescription drug
|
|
orders] to not more than seven [four] advanced practice registered |
|
nurses or physician assistants or their full-time equivalents.[;
|
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and] |
|
(b-1) A facility-based [(5) a] physician may not delegate |
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at more than one [licensed] hospital or more than two long-term care |
|
facilities under this section unless approved by the board. The |
|
facility-based physician may not be prohibited from delegating the |
|
prescribing or ordering of drugs or devices under Section 157.0512 |
|
at other practice locations, including hospitals or long-term care |
|
facilities, provided that the delegation at those locations |
|
complies with all the requirements of Section 157.0512. |
|
(c) Physician supervision of the prescribing or ordering of |
|
a drug or device [carrying out and signing of prescription drug
|
|
orders] must conform to what a reasonable, prudent physician would |
|
find consistent with sound medical judgment but may vary with the |
|
education and experience of the particular advanced practice |
|
registered nurse or physician assistant. A physician shall provide |
|
continuous supervision, but the constant physical presence of the |
|
physician is not required. |
|
SECTION 6. Section 157.055, Occupations Code, is amended to |
|
read as follows: |
|
Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other |
|
order shall be defined in a manner that promotes the exercise of |
|
professional judgment by the advanced practice registered nurse and |
|
physician assistant commensurate with the education and experience |
|
of that person. Under this section, an order or protocol used by a |
|
reasonable and prudent physician exercising sound medical |
|
judgment: |
|
(1) is not required to describe the exact steps that an |
|
advanced practice registered nurse or a physician assistant must |
|
take with respect to each specific condition, disease, or symptom; |
|
and |
|
(2) may state the types or categories of medications |
|
that may be prescribed or the types or categories of medications |
|
that may not be prescribed. |
|
SECTION 7. Section 157.057, Occupations Code, is amended to |
|
read as follows: |
|
Sec. 157.057. ADDITIONAL IMPLEMENTATION METHODS. The board |
|
may adopt additional methods to implement: |
|
(1) a physician's prescription; or |
|
(2) the delegation of prescriptive authority [the
|
|
signing of a prescription under a physician's order, standing
|
|
medical order, standing delegation order, or other order or
|
|
protocol]. |
|
SECTION 8. Subsections (b), (d), (e), (f), and (j), Section |
|
157.059, Occupations Code, are amended to read as follows: |
|
(b) A physician may delegate to a physician assistant |
|
offering obstetrical services and certified by the board as |
|
specializing in obstetrics or an advanced practice registered nurse |
|
recognized by the Texas Board of Nursing as a nurse midwife the act |
|
of administering or providing controlled substances to the |
|
physician assistant's or nurse midwife's clients during intrapartum |
|
and immediate postpartum care. |
|
(d) The delegation of authority to administer or provide |
|
controlled substances under Subsection (b) must be under a |
|
physician's order, medical order, standing delegation order, |
|
prescriptive authority agreement, or protocol that requires |
|
adequate and documented availability for access to medical care. |
|
(e) The physician's orders, medical orders, standing |
|
delegation orders, prescriptive authority agreements, or protocols |
|
must require the reporting of or monitoring of each client's |
|
progress, including complications of pregnancy and delivery and the |
|
administration and provision of controlled substances by the nurse |
|
midwife or physician assistant to the clients of the nurse midwife |
|
or physician assistant. |
|
(f) The authority of a physician to delegate under this |
|
section is limited to: |
|
(1) seven [four] 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. |
|
(j) This section does not limit the authority of a physician |
|
to delegate the prescribing or ordering of [carrying out or signing
|
|
of a prescription drug order involving] a controlled substance |
|
under this subchapter. |
|
SECTION 9. Section 157.060, Occupations Code, is amended to |
|
read as follows: |
|
Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED ACT. |
|
Unless the physician has reason to believe the physician assistant |
|
or advanced practice registered nurse lacked the competency to |
|
perform the act, a physician is not liable for an act of a physician |
|
assistant or advanced practice registered nurse solely because the |
|
physician signed a standing medical order, a standing delegation |
|
order, or another order or protocol, or entered into a prescriptive |
|
authority agreement, authorizing the physician assistant or |
|
advanced practice registered nurse to administer, provide, |
|
prescribe, or order a drug or device [carry out, or sign a
|
|
prescription drug order]. |
|
SECTION 10. Section 156.056, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 156.056. CERTAIN VOLUNTEER SERVICES. (a) In this |
|
section, "practice [site] serving a medically underserved |
|
population" has the meaning assigned by Section 157.051 [157.052]. |
|
(b) The board by rule shall permit a license holder to |
|
complete half of any informal continuing medical education hours |
|
required under this subchapter by providing volunteer medical |
|
services at a practice [site] serving a medically underserved |
|
population other than a site that is a primary practice site of the |
|
license holder. |
|
SECTION 11. Subchapter C, Chapter 204, Occupations Code, is |
|
amended by adding Section 204.1025 to read as follows: |
|
Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY |
|
AGREEMENTS. The physician assistant board shall in conjunction |
|
with the Texas Medical Board and the Texas Board of Nursing perform |
|
the functions and duties relating to prescriptive authority |
|
agreements assigned to the physician assistant board in Sections |
|
157.0512 and 157.0513. |
|
SECTION 12. Section 204.1565, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 204.1565. INFORMAL CONTINUING MEDICAL EDUCATION. |
|
(a) In this section, "practice [site] serving a medically |
|
underserved population" has the meaning assigned by Section 157.051 |
|
[157.052]. |
|
(b) The physician assistant board by rule shall permit a |
|
license holder to complete half of any informal continuing medical |
|
education hours required to renew a license under this chapter by |
|
providing volunteer medical services at a practice [site] serving a |
|
medically underserved population, other than a site that is a |
|
primary practice site of the license holder. |
|
SECTION 13. Subsection (b), Section 204.202, Occupations |
|
Code, is amended to read as follows: |
|
(b) Medical services provided by a physician assistant may |
|
include: |
|
(1) obtaining patient histories and performing |
|
physical examinations; |
|
(2) ordering or performing diagnostic and therapeutic |
|
procedures; |
|
(3) formulating a working diagnosis; |
|
(4) developing and implementing a treatment plan; |
|
(5) monitoring the effectiveness of therapeutic |
|
interventions; |
|
(6) assisting at surgery; |
|
(7) offering counseling and education to meet patient |
|
needs; |
|
(8) requesting, receiving, and signing for the receipt |
|
of pharmaceutical sample prescription medications and distributing |
|
the samples to patients in a specific practice setting in which the |
|
physician assistant is authorized to prescribe pharmaceutical |
|
medications and sign prescription drug orders as provided by |
|
Section 157.0512 or [157.052, 157.053,] 157.054[, 157.0541, or
|
|
157.0542 or as otherwise authorized by physician assistant board
|
|
rule]; |
|
(9) prescribing or ordering a drug or device [signing
|
|
or completing a prescription] as provided by Subchapter B, Chapter |
|
157; and |
|
(10) making appropriate referrals. |
|
SECTION 14. Subdivision (2), Section 301.002, 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. 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 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 at practices |
|
at [sites in] which an advanced practice [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 157.0512 [157.052, 157.053], 157.054, |
|
[157.0541, 157.0542,] 157.058, or 157.059; and |
|
(H) the development of the nursing care plan. |
|
SECTION 15. Section 301.005, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 301.005. REFERENCE IN OTHER LAW. (a) A reference in |
|
any other law to the former Board of Nurse Examiners means the Texas |
|
Board of Nursing. |
|
(b) A reference in any other law to an "advanced nurse |
|
practitioner" or "advanced practice nurse" means an advanced |
|
practice registered nurse. |
|
SECTION 16. Section 301.152, Occupations Code, is amended |
|
to read as follows: |
|
Sec. 301.152. RULES REGARDING SPECIALIZED TRAINING. |
|
(a) In this section, "advanced practice registered nurse" means a |
|
registered nurse licensed [approved] by the board to practice as an |
|
advanced practice registered 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 nurse." |
|
(b) The board shall adopt rules to: |
|
(1) license a registered nurse as an advanced practice |
|
registered nurse; |
|
(2) establish: |
|
(A) any specialized education or training, |
|
including pharmacology, that an advanced practice [a] registered |
|
nurse must have to prescribe or order a drug or device as delegated |
|
by a physician [carry out a prescription drug order] under Section |
|
157.0512 or 157.054 [157.052]; [and] |
|
(B) a system for approving an advanced practice |
|
registered nurse to prescribe or order a drug or device as delegated |
|
by a physician under Section 157.0512 or 157.054 on the receipt of |
|
[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) |
|
[Subdivision (1)(A)]; and |
|
(C) a system for issuing a prescription |
|
authorization number to an advanced practice registered nurse |
|
approved under Paragraph (B) [(2)
approve a registered nurse as an
|
|
advanced practice nurse]; and |
|
(3) concurrently [initially approve and biennially] |
|
renew any license or approval granted to an advanced practice |
|
registered nurse under this subsection and a license renewed by the |
|
advanced practice registered nurse under Section 301.301 [an
|
|
advanced practice nurse's authority to carry out or sign a
|
|
prescription drug order under Chapter 157]. |
|
(c) At a minimum, the rules adopted under Subsection (b)(2) |
|
[(b)(3)] must: |
|
(1) require completion of pharmacology and related |
|
pathophysiology [pathology] education for initial approval; and |
|
(2) require continuing education in clinical |
|
pharmacology and related pathophysiology [pathology] in addition |
|
to any continuing education otherwise required under Section |
|
301.303[; and
|
|
[(3)
provide for the issuance of a prescription
|
|
authorization number to an advanced practice nurse approved under
|
|
this section]. |
|
(d) The signature of an advanced practice registered nurse |
|
attesting to the provision of a legally authorized service by the |
|
advanced practice registered nurse satisfies any documentation |
|
requirement for that service established by a state agency. |
|
SECTION 17. Subchapter D, Chapter 301, Occupations Code, is |
|
amended by adding Section 301.168 to read as follows: |
|
Sec. 301.168. DUTIES REGARDING PRESCRIPTIVE AUTHORITY |
|
AGREEMENTS. The board shall in conjunction with the Texas Medical |
|
Board and the Texas Physician Assistant Board perform the functions |
|
and duties relating to prescriptive authority agreements assigned |
|
to the board in Sections 157.0512 and 157.0513. |
|
SECTION 18. Subdivisions (34) and (45), Section 551.003, |
|
Occupations Code, are 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, 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, 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 registered nurse or |
|
physician assistant to whom a physician has delegated the authority |
|
to prescribe or order a drug or device [carry out or sign
|
|
prescription drug orders] under Section 157.0511, 157.0512 |
|
[157.052, 157.053], or 157.054[, 157.0541, or 157.0542]. |
|
(45) "Written protocol" means a physician's order, |
|
standing medical order, standing delegation order, or other order |
|
or protocol as defined by rule of the Texas Medical [State] Board |
|
[of Medical Examiners] under Subtitle B. |
|
SECTION 19. Subsection (b), Section 671.001, Government |
|
Code, is amended to read as follows: |
|
(b) The pilot program must provide for the following: |
|
(1) a licensed advanced practice registered nurse as |
|
defined by Section 301.152, Occupations Code, or a licensed |
|
physician assistant as described by Chapter 204, Occupations Code, |
|
who is employed by the state or whose services are acquired by |
|
contract, who will be located at a state office complex; |
|
(2) a licensed physician, who is employed by a state |
|
governmental entity for purposes other than the pilot program or |
|
whose services are acquired by contract, who will delegate to and |
|
supervise the advanced practice registered nurse or physician |
|
assistant under a prescriptive authority agreement under Chapter |
|
157 [perform all supervisory functions described by Section
|
|
157.052(e)], Occupations Code; |
|
(3) appropriate office space and equipment for the |
|
advanced practice registered nurse or physician assistant to |
|
provide basic medical care to employees at the state office complex |
|
where the nurse or physician assistant is located; and |
|
(4) professional liability insurance covering |
|
services provided by the advanced practice registered nurse or the |
|
physician assistant. |
|
SECTION 20. Subdivision (39), Section 481.002, Health and |
|
Safety Code, is amended to read as follows: |
|
(39) "Practitioner" means: |
|
(A) a physician, dentist, veterinarian, |
|
podiatrist, scientific investigator, 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, 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 registered nurse or |
|
physician assistant to whom a physician has delegated the authority |
|
to prescribe or order a drug or device [carry out or sign
|
|
prescription drug orders] under Section 157.0511, 157.0512 |
|
[157.052, 157.053], or 157.054, [157.0541, or 157.0542,] |
|
Occupations Code. |
|
SECTION 21. Subdivision (12), Section 483.001, Health and |
|
Safety Code, is amended to read as follows: |
|
(12) "Practitioner" means [a person licensed]: |
|
(A) a person 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) a person licensed by another state in a |
|
health field in which, under the laws of this state, a licensee may |
|
legally prescribe dangerous drugs; |
|
(C) a person 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 registered nurse or |
|
physician assistant to whom a physician has delegated the authority |
|
to prescribe or order a drug or device [carry out or sign
|
|
prescription drug orders] under Section 157.0511, 157.0512 |
|
[157.052, 157.053], or 157.054, [157.0541, or 157.0542,] |
|
Occupations Code. |
|
SECTION 22. Sections 157.052, 157.053, 157.0541, and |
|
157.0542, Occupations Code, are repealed. |
|
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. |
|
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. |
|
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. |
|
SECTION 26. This Act takes effect September 1, 2013. |