|
|
|
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. |