By: VanDeaver H.B. No. 3009
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the health care providers authorized to examine a
  person to determine whether the person is incapacitated for
  purposes of certain guardianship proceedings.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter C, Chapter 1101, Estates Code, is
  amended by adding Sections 1101.100 and 1101.1011 to read as
  follows:
         Sec. 1101.100.  DEFINITIONS.  In this subchapter:
               (1)  "Advanced practice registered nurse" has the
  meaning assigned by Section 301.152, Occupations Code.
               (2)  "Physician" means an individual licensed by the
  Texas Medical Board to practice medicine in this state.
         Sec. 1101.1011.  LIMITATION ON ACTS BY ADVANCED PRACTICE
  REGISTERED NURSE.  An advanced practice registered nurse may act
  under this subchapter only if the advanced practice registered
  nurse is acting under a physician's delegation authority and
  supervision in accordance with Chapter 157, Occupations Code.
         SECTION 2.  Section 1101.103, Estates Code, is amended to
  read as follows:
         Sec. 1101.103.  DETERMINATION OF INCAPACITY OF CERTAIN
  ADULTS: HEALTH CARE PROVIDER [PHYSICIAN] EXAMINATION. (a) Except
  as provided by Section 1101.104, the court may not grant an
  application to create a guardianship for an incapacitated person,
  other than a minor or person for whom it is necessary to have a
  guardian appointed only to receive funds from a governmental
  source, unless the applicant presents to the court a written letter
  or certificate from a physician or advanced practice registered
  nurse [licensed in this state] that is:
               (1)  dated not earlier than the 120th day before the
  date the application is filed; and
               (2)  based on an examination the physician or advanced
  practice registered nurse performed not earlier than the 120th day
  before the date the application is filed.
         (b)  The letter or certificate must:
               (1)  describe the nature, degree, and severity of the
  proposed ward's incapacity, including any functional deficits
  regarding the proposed ward's ability to:
                     (A)  handle business and managerial matters;
                     (B)  manage financial matters;
                     (C)  operate a motor vehicle;
                     (D)  make personal decisions regarding residence,
  voting, and marriage; and
                     (E)  consent to medical, dental, psychological,
  or psychiatric treatment;
               (2)  in providing a description under Subdivision (1)
  regarding the proposed ward's ability to operate a motor vehicle
  and make personal decisions regarding voting, state whether in the
  physician's opinion the proposed ward:
                     (A)  has the mental capacity to vote in a public
  election; and
                     (B)  has the ability to safely operate a motor
  vehicle;
               (3)  provide an evaluation of the proposed ward's
  physical condition and mental functioning and summarize the
  proposed ward's medical history if reasonably available;
               (3-a) in providing an evaluation under Subdivision (3),
  state whether improvement in the proposed ward's physical condition
  and mental functioning is possible and, if so, state the period
  after which the proposed ward should be reevaluated to determine
  whether a guardianship continues to be necessary;
               (4)  state how or in what manner the proposed ward's
  ability to make or communicate responsible decisions concerning
  himself or herself is affected by the proposed ward's physical or
  mental health, including the proposed ward's ability to:
                     (A)  understand or communicate;
                     (B)  recognize familiar objects and individuals;
                     (C)  solve problems;
                     (D)  reason logically; and
                     (E)  administer to daily life activities with and
  without supports and services;
               (5)  state whether any current medication affects the
  proposed ward's demeanor or the proposed ward's ability to
  participate fully in a court proceeding;
               (6)  describe the precise physical and mental
  conditions underlying a diagnosis of a mental disability, and state
  whether the proposed ward would benefit from supports and services
  that would allow the individual to live in the least restrictive
  setting;
               (6-a) state whether a guardianship is necessary for the
  proposed ward and, if so, whether specific powers or duties of the
  guardian should be limited if the proposed ward receives supports
  and services; and
               (7)  include any other information required by the
  court.
         (b-1)  For purposes of Subsection (b)(2), the opinion of an
  advanced practice registered nurse that is based on an examination
  of a proposed ward conducted by the advanced practice registered
  nurse under delegation from and supervision by a physician and is
  signed by the supervising physician is considered the delegating
  physician's opinion.
         (c)  If the court determines it is necessary, the court may
  appoint the necessary physicians or advanced practice registered
  nurses to examine the proposed ward. The court must make its
  determination with respect to the necessity for a physician's or
  advanced practice registered nurse's examination of the proposed
  ward at a hearing held for that purpose. Not later than the fourth
  day before the date of the hearing, the applicant shall give to the
  proposed ward and the proposed ward's attorney ad litem written
  notice specifying the purpose and the date and time of the hearing.
         (d)  A physician or advanced practice registered nurse who
  examines the proposed ward, other than a physician, advanced
  practice registered nurse, or psychologist who examines the
  proposed ward under Section 1101.104(2), shall make available for
  inspection by the attorney ad litem appointed to represent the
  proposed ward a written letter or certificate from the physician or
  advanced practice registered nurse that complies with the
  requirements of Subsections (a) and (b).
         SECTION 3.  Section 1101.104, Estates Code, is amended to
  read as follows:
         Sec. 1101.104.  EXAMINATIONS AND DOCUMENTATION REGARDING
  INTELLECTUAL DISABILITY. (a)  If an intellectual disability is the
  basis of the proposed ward's alleged incapacity, the court may not
  grant an application to create a guardianship for the proposed ward
  unless the applicant presents to the court a written letter or
  certificate that:
               (1)  complies with Sections 1101.103(a) and (b); or
               (2)  shows that not earlier than 24 months before the
  hearing date:
                     (A)  the proposed ward has been examined by a
  physician or advanced practice registered nurse or by a 
  psychologist licensed in this state or certified by the Health and
  Human [Department of Aging and Disability] Services Commission to
  perform the examination, in accordance with rules of the executive
  commissioner of the commission [Health and Human Services
  Commission] governing examinations of that kind, and the
  [physician's or psychologist's] written findings and
  recommendations include a determination of an intellectual
  disability; or
                     (B)  a physician or advanced practice registered
  nurse or a psychologist licensed in this state or certified by the
  Health and Human [Department of Aging and Disability] Services
  Commission to perform examinations described by Paragraph (A)
  updated or endorsed in writing a prior determination of an
  intellectual disability for the proposed ward made by a physician
  or by a psychologist licensed in this state or certified by the
  commission [department].
         (b)  For purposes of Subsection (a)(2)(B), the determination
  of an advanced practice registered nurse that is based on an
  examination of a proposed ward conducted by the advanced practice
  registered nurse under delegation from and supervision by a
  physician and is signed by the supervising physician is considered
  the delegating physician's determination.
         SECTION 4.  Section 1102.002, Estates Code, is amended to
  read as follows:
         Sec. 1102.002.  ESTABLISHMENT OF PROBABLE CAUSE FOR
  INVESTIGATION.  (a)  In this section:
               (1)  "Advanced practice registered nurse" has the
  meaning assigned by Section 301.152, Occupations Code.
               (2)  "Physician" has the meaning assigned by Section
  1101.100.
         (b)  An advanced practice registered nurse may act under this
  section only if the advanced practice registered nurse is acting
  under a physician's delegation authority and supervision in
  accordance with Chapter 157, Occupations Code.
         (c)  To establish probable cause under Section 1102.001, the
  court may require:
               (1)  an information letter about the person believed to
  be incapacitated that is submitted by an interested person and
  satisfies the requirements of Section 1102.003; or
               (2)  a written letter or certificate from a physician
  or advanced practice registered nurse who has examined the person
  believed to be incapacitated that satisfies the requirements of
  Section 1101.103, except that the letter must be:
                     (A)  dated not earlier than the 120th day before
  the date of the appointment of a guardian ad litem or court
  investigator under Section 1102.001; and
                     (B)  based on an examination the physician or
  advanced practice registered nurse performed not earlier than the
  120th day before that date.
         SECTION 5.  Section 1202.054(b-1), Estates Code, is amended
  to read as follows:
         (b-1)  A written letter or certificate from a physician or
  advanced practice registered nurse as described by Section 1202.152
  is not required before the appointment of the court investigator or
  a guardian ad litem under Subsection (b).
         SECTION 6.  Section 1202.152, Estates Code, is amended to
  read as follows:
         Sec. 1202.152.  HEALTH CARE PROVIDER'S [PHYSICIAN'S] LETTER
  OR CERTIFICATE REQUIRED. (a) In this section:
               (1)  "Advanced practice registered nurse" has the
  meaning assigned by Section 301.152, Occupations Code.
               (2)  "Physician" has the meaning assigned by Section
  1101.100.
         (b)  An advanced practice registered nurse may act under this
  section only if the advanced practice registered nurse is acting
  under a physician's delegation authority and supervision in
  accordance with Chapter 157, Occupations Code.
         (c) The court may not grant an order completely restoring a
  ward's capacity or modifying a ward's guardianship under an
  application filed under Section 1202.051 unless the applicant
  presents to the court a written letter or certificate from a
  physician or advanced practice registered nurse licensed in this
  state that is dated:
               (1)  not earlier than the 120th day before the date the
  application was filed; or
               (2)  after the date the application was filed but
  before the date of the hearing.
         (d) [(b)]  A letter or certificate presented under
  Subsection (c) [(a)] must:
               (1)  describe the nature and degree of incapacity,
  including the medical history if reasonably available, or state
  that, in the physician's opinion, the ward has the capacity, or
  sufficient capacity with supports and services, to:
                     (A)  provide food, clothing, and shelter for
  himself or herself;
                     (B)  care for the ward's own physical health; and
                     (C)  manage the ward's financial affairs;
               (2)  provide a medical prognosis specifying the
  estimated severity of any incapacity;
               (3)  state how or in what manner the ward's ability to
  make or communicate responsible decisions concerning himself or
  herself is affected by the ward's physical or mental health;
               (4)  state whether any current medication affects the
  ward's demeanor or the ward's ability to participate fully in a
  court proceeding;
               (5)  describe the precise physical and mental
  conditions underlying a diagnosis of senility, if applicable; and
               (6)  include any other information required by the
  court.
         (e)  For purposes of Subsection (d), the opinion of an
  advanced practice registered nurse that is based on an examination
  of a ward conducted by the advanced practice registered nurse under
  delegation from and supervision by a physician and is signed by the
  supervising physician is considered the delegating physician's
  opinion.
         (f) [(c)]  If the court determines it is necessary, the court
  may appoint the necessary physicians or advanced practice
  registered nurses to examine the ward in the same manner and to the
  same extent as a ward is examined by a physician or advanced
  practice registered nurse under Section 1101.103 or 1101.104.
         SECTION 7.  The changes in law made by this Act apply only to
  an application for the appointment of a guardian, for the complete
  restoration of a ward's capacity, or for the modification of a
  guardianship that is filed on or after the effective date of this
  Act. An application filed before the effective date of this Act is
  governed by the law in effect on the date the application was filed,
  and the former law is continued in effect for that purpose.
         SECTION 8.  This Act takes effect September 1, 2023.