86R1543 MAW-F
 
  By: Zedler H.B. No. 1092
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the prescriptive authority of certain psychologists;
  authorizing a fee.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 501.002, Occupations Code, is amended by
  adding Subdivision (2-a) to read as follows:
               (2-a)  "Prescription drug" and "prescription drug
  order" have the meanings assigned by Section 551.003.
         SECTION 2.   Section 501.003(a)(1), Occupations Code, is
  amended to read as follows:
               (1)  "Practice of psychology" means:
                     (A)  the observation, description, diagnosis,
  evaluation, assessment, interpretation, or treatment of and
  intervention in human behavior by applying education, training,
  methods, and procedures for the purpose of:
                           (i)  preventing, predicting, treating,
  remediating, or eliminating:
                                 (a)  symptomatic, maladaptive, or
  undesired behavior;
                                 (b)  emotional, interpersonal,
  learning, substance use, neuropsychological, cognitive, or
  behavioral disorders or disabilities, including those that
  accompany medical problems; or
                                 (c)  mental illness;
                           (ii)  evaluating, assessing, or
  facilitating, by a license holder or a person who represents the
  person to the public by a title or description of services that
  includes the word "psychological," "psychologist," or
  "psychology," the enhancement of individual, group, or
  organizational effectiveness, including evaluating, assessing, or
  facilitating:
                                 (a)  personal effectiveness;
                                 (b)  adaptive behavior;
                                 (c)  interpersonal relationships;
                                 (d)  academic, vocational, and life
  adjustment;
                                 (e)  health; or
                                 (f)  individual, group, or
  organizational performance;
                           (iii)  providing psychological,
  neuropsychological, and psychoeducational evaluation, therapy, and
  remediation as well as counseling, psychoanalysis, psychotherapy,
  hypnosis, and biofeedback; or
                           (iv)  consulting with others, including
  other mental health professionals, physicians, school personnel,
  or organizations within the scope of the provider's competency and
  training with respect to services provided for a specific
  individual; [or]
                     (B)  action taken under the authority granted by a
  prescriptive authority certificate issued under Section 501.353;
  or
                     (C)  the supervision of an activity or service
  described by Paragraph (A) or (B).
         SECTION 3.  Section 501.051(b), Occupations Code, is amended
  to read as follows:
         (b)  To ensure adequate representation on the board of the
  diverse fields of psychology, the governor in making appointments
  under Subsection (a)(1) shall appoint:
               (1)  at least two members who provide psychological
  services, at least one of whom holds a prescriptive authority
  certificate issued under Section 501.353;
               (2)  at least one member who conducts research in the
  field of psychology; and
               (3)  at least one member who teaches as a member of the
  faculty of a psychological training institution.
         SECTION 4.  Subchapter D, Chapter 501, Occupations Code, is
  amended by adding Section 501.163 to read as follows:
         Sec. 501.163.  ADVISORY COMMITTEE ON PRESCRIPTIVE
  AUTHORITY. (a) The board shall appoint an advisory committee on
  prescriptive authority for psychologists.
         (a-1)  Effective September 1, 2019, the advisory committee
  consists of six members as follows:
               (1)  three members who each hold a prescriptive
  authority certificate issued under Section 501.353;
               (2)  one member who is a psychiatrist;
               (3)  one member who is a pediatrician; and
               (4)  one member who represents the public.
         (a-2)  This subsection and Subsection (a-1) expire September
  1, 2022.
         (b)  Effective September 1, 2022, the advisory committee
  consists of six members as follows:
               (1)  five members who each hold a prescriptive
  authority certificate issued under Section 501.353; and
               (2)  one member who represents the public.
         (c)  The advisory committee shall make recommendations to
  the board regarding the regulation of psychologists who hold
  prescriptive authority certificates issued under Section 501.353,
  including recommendations concerning board rules to establish:
               (1)  eligibility requirements; and
               (2)  standards of practice for certificate holders. 
         (d)  Chapter 2110, Government Code, does not apply to the
  composition or duration of the advisory committee.
         SECTION 5.  Section 501.304, Occupations Code, is amended by
  adding Subsection (a-1) to read as follows:
         (a-1)  The rules adopted under Subsection (a) must require
  that, of the minimum number of hours of continuing education
  required to renew a license as a psychologist, half of that number
  of hours or 10 hours, whichever is less, must be in the areas of
  pharmacology and pathophysiology if the psychologist holds a
  prescriptive authority certificate.
         SECTION 6.  Subchapter H, Chapter 501, Occupations Code, is
  amended by adding Sections 501.353 and 501.354 to read as follows:
         Sec. 501.353.  PRESCRIPTIVE AUTHORITY CERTIFICATE. (a) The
  board shall issue a prescriptive authority certificate to a
  psychologist who:
               (1)  meets the eligibility requirements of Subsection
  (b);
               (2)  submits an application on a form prescribed by the
  board;
               (3)  has not, in the two-year period preceding the date
  of the application, had a prescriptive authority certificate
  revoked; and
               (4)  pays the fee set by the board.
         (b)  To be eligible for a prescriptive authority certificate
  a psychologist must:
               (1)  have completed a training program in
  psychopharmacology from an institution of higher education or a
  provider of continuing education approved by the board that
  includes instruction in: 
                     (A)  basic life sciences;
                     (B)  neuroscience;
                     (C)  clinical and research pharmacology and
  psychopharmacology;
                     (D)  clinical pathophysiology;
                     (E)  physical assessments and laboratory
  examinations;
                     (F)  clinical pharmacotherapeutics; and
                     (G)  ethical and legal issues relevant to
  prescriptive authority and associated research;
               (2)  pass a nationally recognized examination approved
  by the board in the area of prescriptive authority; and
               (3)  provide evidence of professional liability
  coverage.
         (c)  A psychologist who holds a prescriptive authority
  certificate is authorized to:
               (1)  issue a prescription drug order;
               (2)  administer or dispense a prescription drug;
               (3)  order tests commonly associated with monitoring
  the use of prescription drugs; and
               (4)  represent that the psychologist holds a
  prescriptive authority certificate.
         (d)  The authority of a psychologist to issue a prescription
  drug order or administer or dispense a prescription drug under a
  prescriptive authority certificate is limited to a drug or device
  related to the diagnosis, treatment, or management of emotional,
  interpersonal, learning, substance use, neuropsychological,
  cognitive, or behavioral disorders or disabilities, or mental
  illness. A prescriptive authority certificate does not authorize
  the prescribing, administering, or dispensing of an opioid. 
         (e)  A psychologist who holds a prescriptive authority
  certificate may only practice under the supervision of a physician
  or a psychologist who meets the requirements of Section 501.354
  until the certificate holder satisfies the supervised experience
  requirement of that section.
         (f)  The board shall adopt rules to protect the health of
  patients by requiring a psychologist who holds a prescriptive
  authority certificate to notify a patient's primary care physician
  or provider, if any, before the psychologist:
               (1)  issues a prescription drug order for a drug or
  otherwise changes the type or dosage of any drug prescribed for the
  patient; or
               (2)  administers or dispenses a prescription drug to
  the patient.
         (g)  A primary care provider is not liable for an act of a
  psychologist acting under a prescriptive authority certificate
  based solely on the provider receiving a notification under
  Subsection (f).
         Sec. 501.354.  REQUIRED SUPERVISED EXPERIENCE FOR
  PRESCRIPTIVE AUTHORITY CERTIFICATE HOLDER. (a) Not later than the
  second anniversary of the date of issuance of a prescriptive
  authority certificate, the psychologist who holds the certificate
  must complete at least 2,000 hours of practice under the authority
  of the certificate treating not less than 100 patients under the
  supervision of a physician or a psychologist who has maintained a
  prescriptive authority certificate for the three years preceding
  the date the supervision began. The supervision must be under a
  written agreement approved by the board that requires periodic
  meetings between the psychologist and supervising provider.
         (b)  A physician or psychologist may not at any time
  supervise under this section more than the full-time equivalent of
  seven psychologists.
         (c)  Unless the supervising provider has reason to believe
  the psychologist lacked the competency to perform the act, a
  supervising provider is not liable for an act of a psychologist
  solely because the provider entered into an agreement to supervise
  the psychologist.
         (d)  The board shall revoke the prescriptive authority
  certificate of a psychologist who does not complete the supervised
  experience as required by Subsection (a).
         SECTION 7.  Section 481.002(39), Health and Safety Code, is
  amended to read as follows:
               (39)  "Practitioner" means:
                     (A)  a physician, dentist, veterinarian,
  podiatrist, scientific investigator, psychologist, 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, psychologist,
  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 under Section 157.0511,
  157.0512, or 157.054, Occupations Code.
         SECTION 8.  Section 481.073(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Only a practitioner defined by Section 481.002(39)(A)
  and an agent designated in writing by the practitioner in
  accordance with rules adopted by the board may communicate a
  prescription by telephone. A pharmacy that receives a
  telephonically communicated prescription shall promptly write the
  prescription and file and retain the prescription in the manner
  required by this subchapter. A practitioner who designates an
  agent to communicate prescriptions shall maintain the written
  designation of the agent in the practitioner's usual place of
  business and shall make the designation available for inspection by
  investigators for the Texas Medical Board, the State Board of
  Dental Examiners, the State Board of Veterinary Medical Examiners,
  the Texas State Board of Examiners of Psychologists, the board, and
  the department. A practitioner who designates a different agent
  shall designate that agent in writing and maintain the designation
  in the same manner in which the practitioner initially designated
  an agent under this section.
         SECTION 9.  Section 481.074(d), Health and Safety Code, is
  amended to read as follows:
         (d)  Except as specified in Subsections (e) and (f), the
  board, by rule and in consultation with the Texas Medical Board and
  the Texas State Board of Examiners of Psychologists, shall
  establish the period after the date on which the prescription is
  issued that a person may fill a prescription for a controlled
  substance listed in Schedule II. A person may not refill a
  prescription for a substance listed in Schedule II.
         SECTION 10.  Sections 481.076(a) and (c), Health and Safety
  Code, are amended to read as follows:
         (a)  The board may not permit any person to have access to
  information submitted to the board under Section 481.074(q) or
  481.075 except:
               (1)  the board, the Texas Medical Board, the Texas
  Department of Licensing and Regulation [State Board of Podiatric
  Medical Examiners], the State Board of Dental Examiners, the State
  Board of Veterinary Medical Examiners, the Texas Board of Nursing,
  [or] the Texas Optometry Board, or the Texas State Board of
  Examiners of Psychologists for the purpose of:
                     (A)  investigating a specific license holder; or
                     (B)  monitoring for potentially harmful
  prescribing or dispensing patterns or practices under Section
  481.0762;
               (2)  an authorized officer or member of the department
  or authorized employee of the board engaged in the administration,
  investigation, or enforcement of this chapter or another law
  governing illicit drugs in this state or another state;
               (3)  the department on behalf of a law enforcement or
  prosecutorial official engaged in the administration,
  investigation, or enforcement of this chapter or another law
  governing illicit drugs in this state or another state;
               (4)  a medical examiner conducting an investigation;
               (5)  provided that accessing the information is
  authorized under the Health Insurance Portability and
  Accountability Act of 1996 (Pub. L. No. 104-191) and regulations
  adopted under that Act:
                     (A)  a pharmacist or a pharmacy technician, as
  defined by Section 551.003, Occupations Code, acting at the
  direction of a pharmacist; or
                     (B)  a practitioner who:
                           (i)  is a physician, dentist, veterinarian,
  podiatrist, optometrist, psychologist, or advanced practice nurse
  or is a physician assistant described by Section 481.002(39)(D) or
  an employee or other agent of a practitioner acting at the direction
  of a practitioner; and
                           (ii)  is inquiring about a recent Schedule
  II, III, IV, or V prescription history of a particular patient of
  the practitioner;
               (6)  a pharmacist or practitioner who is inquiring
  about the person's own dispensing or prescribing activity; or
               (7)  one or more states or an association of states with
  which the board has an interoperability agreement, as provided by
  Subsection (j).
         (c)  The board by rule shall design and implement a system
  for submission of information to the board by electronic or other
  means and for retrieval of information submitted to the board under
  this section and Sections 481.074 and 481.075. The board shall use
  automated information security techniques and devices to preclude
  improper access to the information. The board shall submit the
  system design to the director, [and] the Texas Medical Board, and
  the Texas State Board of Examiners of Psychologists for review and
  comment a reasonable time before implementation of the system and
  shall comply with the comments of those agencies unless it is
  unreasonable to do so.
         SECTION 11.  Section 483.001(12), Health and Safety Code, is
  amended to read as follows:
               (12)  "Practitioner" means:
                     (A)  a person:
                           (i)  licensed or certified by the Texas
  Medical Board, State Board of Dental Examiners, [Texas State Board
  of Podiatric Medical Examiners,] Texas Optometry Board, Texas State
  Board of Examiners of Psychologists, or State Board of Veterinary
  Medical Examiners to prescribe and administer dangerous drugs; or
                           (ii)  licensed by the Texas Department of
  Licensing and Regulation, with respect to podiatry, 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 under Section 157.0511,
  157.0512, or 157.054, Occupations Code.
         SECTION 12.  Sections 576.025(b), (c), (e), and (f), Health
  and Safety Code, are amended to read as follows:
         (b)  Consent to the administration of psychoactive
  medication given by a patient or by a person authorized by law to
  consent on behalf of the patient is valid only if:
               (1)  the consent is given voluntarily and without
  coercive or undue influence;
               (2)  the treating physician, a treating psychologist
  who holds a prescriptive authority certificate, or a person
  designated by the physician or psychologist, provided the following
  information, in a standard format approved by the department, to
  the patient and, if applicable, to the patient's representative
  authorized by law to consent on behalf of the patient:
                     (A)  the specific condition to be treated;
                     (B)  the beneficial effects on that condition
  expected from the medication;
                     (C)  the probable health and mental health
  consequences of not consenting to the medication;
                     (D)  the probable clinically significant side
  effects and risks associated with the medication;
                     (E)  the generally accepted alternatives to the
  medication, if any, and why the physician or psychologist
  recommends that they be rejected; and
                     (F)  the proposed course of the medication;
               (3)  the patient and, if appropriate, the patient's
  representative authorized by law to consent on behalf of the
  patient is informed in writing that consent may be revoked; and
               (4)  the consent is evidenced in the patient's clinical
  record by a signed form prescribed by the facility or by a statement
  of the [treating] physician or psychologist described by
  Subdivision (2), or a person designated by the physician or the
  psychologist, that documents that consent was given by the
  appropriate person and the circumstances under which the consent
  was obtained.
         (c)  If the [treating] physician or psychologist described
  by Subsection (b)(2) designates another person to provide the
  information under Subsection (b), then, not later than two working
  days after that person provides the information, excluding weekends
  and legal holidays, the physician or psychologist shall meet with
  the patient and, if appropriate, the patient's representative who
  provided the consent, to review the information and answer any
  questions.
         (e)  In prescribing psychoactive medication, a [treating]
  physician or psychologist described by Subsection (b)(2) shall:
               (1)  prescribe, consistent with clinically appropriate
  medical care, the medication that has the fewest side effects or the
  least potential for adverse side effects, unless the class of
  medication has been demonstrated or justified not to be effective
  clinically; and
               (2)  administer the smallest therapeutically
  acceptable dosages of medication for the patient's condition.
         (f)  If a physician or psychologist described by Subsection
  (b)(2) issues an order to administer psychoactive medication to a
  patient without the patient's consent because the patient is having
  a medication-related emergency:
               (1)  the physician or psychologist shall document in
  the patient's clinical record in specific medical or behavioral
  terms the necessity of the order and that the physician or
  psychologist has evaluated but rejected other generally accepted,
  less intrusive forms of treatment, if any; and
               (2)  treatment of the patient with the psychoactive
  medication shall be provided in the manner, consistent with
  clinically appropriate medical care, least restrictive of the
  patient's personal liberty.
         SECTION 13.  Section 301.002(2), Occupations Code, is
  amended to read as follows:
               (2)  "Professional nursing" means the performance of an
  act that requires substantial specialized judgment and skill, the
  proper performance of which is based on knowledge and application
  of the principles of biological, physical, and social science as
  acquired by a completed course in an approved school of
  professional nursing. The term does not include acts of medical
  diagnosis or the prescription of therapeutic or corrective
  measures. 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 health care practitioner legally
  authorized to prescribe the medication or treatment [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 which an advanced practice 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, 157.054, 157.058, or 157.059; and
                     (H)  the development of the nursing care plan.
         SECTION 14.  Section 551.003(34), Occupations Code, is
  amended to read as follows:
               (34)  "Practitioner" means:
                     (A)  a person licensed, certified, 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, psychologist, 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 or certificate 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,
  psychologist, 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 under Section 157.0511,
  157.0512, or 157.054.
         SECTION 15.  Section 501.051(b), Occupations Code, as
  amended by this Act, does not affect the entitlement of a member
  serving on the Texas State Board of Examiners of Psychologists
  immediately before the effective date of this Act to continue to
  serve for the remainder of the member's term. With the first
  appointment of a member described by Section 501.051(a)(1),
  Occupations Code, to be made by the governor on or after the
  effective date of this Act, the governor shall appoint a member to
  the board who has the qualifications required by Section
  501.051(b), Occupations Code, as amended by this Act.
         SECTION 16.  (a) Not later than December 1, 2019, the Texas
  State Board of Examiners of Psychologists shall appoint members of
  the advisory committee in accordance with Section 501.163(a-1),
  Occupations Code, as added by this Act.
         (b)  Not later than June 1, 2020, the advisory committee
  shall make initial recommendations to the Texas State Board of
  Examiners of Psychologists as described by Section 501.163(c),
  Occupations Code, as added by this Act.
         (c)  Not later than December 1, 2022, the Texas State Board
  of Examiners of Psychologists shall appoint members to the advisory
  committee so that the composition of the committee complies with
  Section 501.163(b), Occupations Code, as added by this Act.
         SECTION 17.  Not later than September 1, 2020, the Texas
  State Board of Examiners of Psychologists shall adopt rules and
  procedures necessary to implement Sections 501.353 and 501.354,
  Occupations Code, as added by this Act.
         SECTION 18.  This Act takes effect September 1, 2019.