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A BILL TO BE ENTITLED
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AN ACT
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relating to the authority of advanced practice registered nurses |
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practicing in certain areas. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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ARTICLE 1. INDEPENDENT PRACTICE AND PRESCRIPTIVE AUTHORITY FOR |
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ADVANCED PRACTICE REGISTERED NURSES PRACTICING IN CERTAIN AREAS |
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SECTION 1.001. Section 301.002, Occupations Code, is |
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amended by amending Subdivision (2) and adding Subdivisions (6) and |
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(7) to read as follows: |
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(2) "Professional nursing" means the performance of an |
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act that requires substantial specialized judgment and skill, the |
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proper performance of which is based on knowledge and application |
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of the principles of biological, physical, and social science as |
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acquired by a completed course in an approved school of |
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professional nursing. The term does not include acts of medical |
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diagnosis or the prescription of therapeutic or corrective |
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measures. Professional nursing involves: |
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(A) the observation, assessment, intervention, |
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evaluation, rehabilitation, care and counsel, or health teachings |
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of a person who is ill, injured, infirm, or experiencing a change in |
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normal health processes; |
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(B) the maintenance of health or prevention of |
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illness; |
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(C) the administration of a medication or |
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treatment as ordered by a health care practitioner legally |
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authorized to prescribe the medication or treatment [physician,
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podiatrist, or dentist]; |
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(D) the supervision or teaching of nursing; |
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(E) the administration, supervision, and |
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evaluation of nursing practices, policies, and procedures; |
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(F) the requesting, receiving, signing for, and |
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distribution of prescription drug samples to patients at practices |
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at which an advanced practice registered nurse is authorized to |
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sign prescription drug orders as provided by Subchapter B, Chapter |
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157, or Section 301.357; |
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(G) the performance of an act delegated by a |
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physician under Section 157.0512, 157.054, 157.058, or 157.059; |
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[and] |
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(H) the development of the nursing care plan; and |
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(I) the prescribing and ordering of drugs and |
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devices by an advanced practice registered nurse as authorized by |
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the board under Section 301.357. |
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(6) "Controlled substance" has the meaning assigned by |
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Section 157.051. |
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(7) "Prescribe or order a drug or device" has the |
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meaning assigned by Section 157.051. |
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SECTION 1.002. Section 301.152(b), Occupations Code, is |
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amended to read as follows: |
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(b) The board shall adopt rules to: |
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(1) license a registered nurse as an advanced practice |
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registered nurse; |
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(2) establish: |
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(A) any specialized education or training, |
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including pharmacology, that an advanced practice registered nurse |
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must have to prescribe or order a drug or device as delegated by a |
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physician under Section 157.0512 or 157.054 or as authorized by the |
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board under Section 301.357; |
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(B) a system for approving an advanced practice |
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registered nurse to prescribe or order a drug or device as delegated |
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by a physician under Section 157.0512 or 157.054 or as authorized by |
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the board under Section 301.357 on the receipt of evidence of |
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completing the specialized education and training requirement |
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under Paragraph (A); and |
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(C) a system for issuing a prescription |
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authorization number to an advanced practice registered nurse |
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approved under Paragraph (B); and |
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(3) concurrently renew any license or approval granted |
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to an advanced practice registered nurse under this subsection and |
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a license renewed by the advanced practice registered nurse under |
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Section 301.301. |
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SECTION 1.003. Subchapter H, Chapter 301, Occupations Code, |
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is amended by adding Section 301.357 to read as follows: |
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Sec. 301.357. INDEPENDENT PRACTICE BY AND PRESCRIBING AND |
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ORDERING AUTHORITY OF CERTAIN ADVANCED PRACTICE REGISTERED NURSES. |
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(a) An advanced practice registered nurse may practice as a |
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licensed independent practitioner if the advanced practice |
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registered nurse is practicing in a county: |
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(1) in which there are no practicing primary care |
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physicians; and |
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(2) that: |
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(A) has been designated as a medically |
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underserved area under state or federal law; or |
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(B) contains a medically underserved population. |
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(b) The board may authorize an advanced practice registered |
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nurse practicing in a county described by Subsection (a) to |
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prescribe and order drugs and devices, excluding controlled |
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substances, if the advanced practice registered nurse has been |
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issued a prescription authorization number under Section |
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301.152(b). |
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ARTICLE 2. CONFORMING AMENDMENTS |
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SECTION 2.001. Section 38.151(1), Education Code, is |
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amended to read as follows: |
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(1) "Advanced practice nurse" has the meaning assigned |
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to "advanced practice registered nurse" by Section 301.152, |
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Occupations Code. |
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SECTION 2.002. Section 671.001(b), Government Code, is |
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amended to read as follows: |
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(b) The pilot program must provide for the following: |
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(1) a licensed advanced practice registered nurse as |
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defined by Section 301.152, Occupations Code, or a licensed |
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physician assistant as described by Chapter 204, Occupations Code, |
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who is employed by the state or whose services are acquired by |
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contract, who will be located at a state office complex; |
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(2) if applicable, a licensed physician, who is |
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employed by a state governmental entity for purposes other than the |
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pilot program or whose services are acquired by contract, who will |
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delegate to and supervise the advanced practice registered nurse or |
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physician assistant under a prescriptive authority agreement under |
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Chapter 157, Occupations Code; |
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(3) appropriate office space and equipment for the |
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advanced practice registered nurse or physician assistant to |
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provide basic medical care to employees at the state office complex |
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where the nurse or physician assistant is located; and |
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(4) professional liability insurance covering |
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services provided by the advanced practice registered nurse or the |
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physician assistant. |
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SECTION 2.003. Sections 483.001(4) and (12), Health and |
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Safety Code, are amended to read as follows: |
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(4) "Designated agent" means: |
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(A) a licensed nurse, physician assistant, |
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pharmacist, or other individual designated by a practitioner to |
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communicate prescription drug orders to a pharmacist; |
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(B) a licensed nurse, physician assistant, or |
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pharmacist employed in a health care facility to whom the |
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practitioner communicates a prescription drug order; or |
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(C) [a] an advanced practice registered nurse or |
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physician assistant authorized by a practitioner to carry out a |
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prescription drug order for dangerous drugs under Subchapter B, |
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Chapter 157, Occupations Code, or an advanced practice registered |
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nurse authorized by a practitioner to carry out a prescription drug |
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order for dangerous drugs under other law. |
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(12) "Practitioner" means: |
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(A) a person licensed by the Texas Medical Board, |
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State Board of Dental Examiners, Texas State Board of Podiatric |
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Medical Examiners, Texas Optometry Board, Texas Board of Nursing, |
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or State Board of Veterinary Medical Examiners to prescribe and |
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administer dangerous drugs; |
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(B) a person licensed by another state in a |
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health field in which, under the laws of this state, a licensee may |
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legally prescribe dangerous drugs; |
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(C) a person licensed in Canada or Mexico in a |
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health field in which, under the laws of this state, a licensee may |
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legally prescribe dangerous drugs; or |
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(D) an advanced practice registered nurse or |
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physician assistant to whom a physician has delegated the authority |
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to prescribe or order a drug or device under Section 157.0511, |
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157.0512, or 157.054, Occupations Code. |
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SECTION 2.004. Section 32.03141, Human Resources Code, is |
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amended to read as follows: |
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Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED |
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NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL |
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EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in |
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addition to other health care practitioners authorized by federal |
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law, the following persons may order and prescribe durable medical |
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equipment and supplies under the medical assistance program: |
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(1) an advanced practice registered nurse authorized |
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to prescribe and order drugs and devices under Section 301.357, |
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Occupations Code; and |
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(2) an advanced practice registered nurse or physician |
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assistant acting under adequate physician supervision and to whom a |
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physician has delegated the authority to prescribe and order drugs |
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and devices under Chapter 157, Occupations Code[, may order and
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prescribe durable medical equipment and supplies under the medical
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assistance program]. |
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SECTION 2.005. Section 843.312, Insurance Code, is amended |
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to read as follows: |
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Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE |
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REGISTERED NURSES. (a) A health maintenance organization may not |
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refuse a request by a physician participating in the health |
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maintenance organization delivery network and a physician |
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assistant or advanced practice registered nurse who is authorized |
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by the physician to provide care under Subchapter B, Chapter 157, |
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Occupations Code, or an advanced practice registered nurse who is |
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authorized to provide care by the physician under other law, to |
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identify a physician assistant or advanced practice registered |
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nurse as a provider in the network. |
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(b) A health maintenance organization may refuse a request |
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under Subsection (a) if the physician assistant or advanced |
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practice registered nurse does not meet the quality of care |
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standards previously established by the health maintenance |
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organization for participation in the network by physician |
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assistants and advanced practice registered nurses. |
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SECTION 2.006. Section 1301.001(1-a), Insurance Code, is |
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amended to read as follows: |
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(1-a) "Health care provider" means a practitioner, |
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institutional provider, or other person or organization that |
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furnishes health care services and that is licensed or otherwise |
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authorized to practice in this state. The term includes a |
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pharmacist, [and] a pharmacy, and an advanced practice registered |
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nurse. The term does not include a physician. |
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SECTION 2.007. Section 1301.052, Insurance Code, is amended |
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to read as follows: |
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Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED |
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NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer |
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offering a preferred provider benefit plan may not refuse a request |
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made by a physician participating as a preferred provider under the |
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plan and an advanced practice registered nurse or physician |
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assistant to have the advanced practice registered nurse or |
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physician assistant included as a preferred provider under the plan |
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if: |
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(1) the advanced practice registered nurse or |
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physician assistant is authorized by the physician to provide care |
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under Subchapter B, Chapter 157, Occupations Code, or the advanced |
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practice registered nurse is authorized to provide care by the |
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physician under other law; and |
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(2) the advanced practice registered nurse or |
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physician assistant meets the quality of care standards previously |
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established by the insurer for participation in the plan by |
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advanced practice registered nurses and physician assistants. |
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SECTION 2.008. Section 1451.001(2), Insurance Code, is |
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amended to read as follows: |
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(2) "Advanced practice registered nurse" means an |
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individual licensed by the Texas Board of Nursing as a registered |
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nurse and licensed [recognized] by that board as an advanced |
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practice registered nurse. |
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SECTION 2.009. Section 1451.104(c), Insurance Code, is |
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amended to read as follows: |
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(c) Notwithstanding Subsection (a), a health insurance |
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policy may provide for a different amount of payment or |
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reimbursement for scheduled services or procedures performed by an |
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advanced practice registered nurse, nurse first assistant, |
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licensed surgical assistant, or physician assistant if the |
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methodology used to compute the amount is the same as the |
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methodology used to compute the amount of payment or reimbursement |
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when the services or procedures are provided by a physician. |
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SECTION 2.010. Section 1451.106, Insurance Code, is amended |
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to read as follows: |
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Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED |
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NURSE. An insured may select an advanced practice registered nurse |
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to provide the services scheduled in the health insurance policy |
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that are within the scope of the nurse's license. |
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SECTION 2.011. Section 1452.051(1), Insurance Code, is |
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amended to read as follows: |
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(1) "Advanced practice nurse" has the meaning assigned |
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to "advanced practice registered nurse" by Section 301.152, |
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Occupations Code. |
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SECTION 2.012. Sections 551.003(14) and (34), Occupations |
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Code, are amended to read as follows: |
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(14) "Designated agent" means: |
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(A) an individual, including a licensed nurse, |
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physician assistant, or pharmacist: |
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(i) who is designated by a practitioner and |
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authorized to communicate a prescription drug order to a |
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pharmacist; and |
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(ii) for whom the practitioner assumes |
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legal responsibility; |
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(B) a licensed nurse, physician assistant, or |
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pharmacist employed in a health care facility to whom a |
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practitioner communicates a prescription drug order; or |
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(C) a registered nurse or physician assistant |
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authorized by a practitioner to administer a prescription drug |
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order for a dangerous drug under Subchapter B, Chapter 157, or an |
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advanced practice registered nurse authorized by a practitioner to |
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administer a prescription drug order for a dangerous drug under |
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other law. |
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(34) "Practitioner" means: |
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(A) a person licensed or registered to prescribe, |
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distribute, administer, or dispense a prescription drug or device |
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in the course of professional practice in this state, including a |
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physician, dentist, podiatrist, advanced practice registered |
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nurse, or veterinarian but excluding a person licensed under this |
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subtitle; |
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(B) a person licensed by another state, Canada, |
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or the United Mexican States in a health field in which, under the |
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law of this state, a license holder in this state may legally |
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prescribe a dangerous drug; |
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(C) a person practicing in another state and |
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licensed by another state as a physician, dentist, veterinarian, or |
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podiatrist, who has a current federal Drug Enforcement |
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Administration registration number and who may legally prescribe a |
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Schedule II, III, IV, or V controlled substance, as specified under |
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Chapter 481, Health and Safety Code, in that other state; or |
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(D) an advanced practice registered nurse or |
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physician assistant to whom a physician has delegated the authority |
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to prescribe or order a drug or device under Section 157.0511, |
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157.0512, or 157.054. |
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SECTION 2.013. Section 563.053, Occupations Code, is |
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amended to read as follows: |
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Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN |
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RURAL AREAS. (a) In this section, "reimbursement for cost" means |
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an additional charge, separate from that imposed for the |
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physician's or advanced practice registered nurse's professional |
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services, that includes the cost of the drug product and all other |
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actual costs to the physician or advanced practice registered nurse |
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incidental to providing the dispensing service. The term does not |
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include a separate fee imposed for the act of dispensing the drug |
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itself. |
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(b) This section applies to an area located in a county with |
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a population of 5,000 or less, or in a municipality or an |
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unincorporated town with a population of less than 2,500, that is |
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within a 15-mile radius of the physician's or advanced practice |
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registered nurse's office and in which a pharmacy is not located. |
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This section does not apply to a municipality or an unincorporated |
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town that is adjacent to a municipality with a population of 2,500 |
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or more. |
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(c) A physician who practices medicine or an advanced |
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practice registered nurse who is authorized to prescribe and order |
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drugs and devices under Section 301.357 and who practices advanced |
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practice registered nursing in an area described by Subsection (b) |
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may: |
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(1) maintain a supply of dangerous drugs in the |
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physician's or advanced practice registered nurse's office to be |
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dispensed in the course of treating the physician's or advanced |
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practice registered nurse's patients; and |
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(2) be reimbursed for the cost of supplying those |
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drugs without obtaining a license under Chapter 558. |
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(d) A physician or advanced practice registered nurse who |
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dispenses dangerous drugs under Subsection (c) shall: |
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(1) comply with each labeling provision under this |
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subtitle applicable to that class of drugs; and |
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(2) oversee compliance with packaging and |
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recordkeeping provisions applicable to that class of drugs. |
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(e) A physician who desires to dispense dangerous drugs |
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under this section shall notify both the board and the Texas Medical |
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[State] Board [of Medical Examiners] that the physician practices |
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in an area described by Subsection (b). An advanced practice |
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registered nurse who desires to dispense dangerous drugs under this |
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section shall notify both the board and the Texas Board of Nursing |
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that the advanced practice registered nurse practices in an area |
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described by Subsection (b). The physician or advanced practice |
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registered nurse may continue to dispense dangerous drugs in the |
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area until the board determines, after notice and hearing, that the |
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physician or advanced practice registered nurse no longer practices |
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in an area described by Subsection (b). |
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SECTION 2.014. Section 605.002(14), Occupations Code, is |
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amended to read as follows: |
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(14) "Orthotics" means the science and practice of |
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measuring, designing, fabricating, assembling, fitting, adjusting, |
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or servicing an orthosis under an order from a licensed physician, |
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chiropractor, [or] podiatrist, or [an] advanced practice |
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registered nurse, or from an advanced practice registered nurse or |
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physician assistant acting under the delegation and supervision of |
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a licensed physician as provided by Subchapter B, Chapter 157, and |
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rules adopted by the Texas Medical Board, for the correction or |
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alleviation of a neuromuscular or musculoskeletal dysfunction, |
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disease, injury, or deformity. |
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SECTION 2.015. Section 605.2515, Occupations Code, is |
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amended to read as follows: |
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Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A |
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person licensed to practice orthotics or prosthetics who measures, |
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designs, fabricates, fits, assembles, adjusts, or services an |
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orthosis or a prosthesis under an order from a licensed physician, |
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chiropractor, [or] podiatrist, or [an] advanced practice |
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registered nurse, or from an advanced practice registered nurse or |
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physician assistant acting under the delegation and supervision of |
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a licensed physician as provided by Subchapter B, Chapter 157, and |
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rules adopted by the Texas Medical Board, for a specific patient is |
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exempt from licensing as a device manufacturer under Subchapter L, |
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Chapter 431, Health and Safety Code. A person licensed to practice |
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orthotics or prosthetics who fabricates or assembles an orthosis or |
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a prosthesis without an order from a licensed physician, |
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chiropractor, [or] podiatrist, or [an] advanced practice |
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registered nurse, or from an advanced practice registered nurse or |
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physician assistant acting under the delegation and supervision of |
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a licensed physician as provided by Subchapter B, Chapter 157, and |
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rules adopted by the Texas Medical Board, for a specific patient is |
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required to be licensed as a device manufacturer under Subchapter |
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L, Chapter 431, Health and Safety Code. |
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ARTICLE 3. TRANSITION AND EFFECTIVE DATE |
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SECTION 3.001. Not later than February 1, 2018, the Texas |
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Board of Nursing shall adopt the rules necessary to implement the |
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changes in law made by this Act. |
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SECTION 3.002. This Act takes effect September 1, 2017. |