88R12746 DIO-F
 
  By: Allison H.B. No. 3567
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to requirements for the renewal of a physician's
  registration permit and the delegation by a physician of certain
  medical acts.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 156.001, Occupations Code, is amended by
  adding Subsection (d-1) to read as follows:
         (d-1)  A license holder who has entered into a prescriptive
  authority agreement under Section 157.0512 shall, at the time the
  license holder submits a registration renewal application, make an
  electronically signed attestation to the board that periodic
  meetings required by Section 157.0512(e)(9)(B) have taken place in
  accordance with Section 157.0512(f).
         SECTION 2.  Section 157.001, Occupations Code, is amended by
  amending Subsections (a) and (c) and adding Subsections (a-1) and
  (a-2) to read as follows:
         (a)  A physician may delegate to a qualified and properly
  trained person acting under the physician's supervision any medical
  act that a reasonable and prudent physician would find within the
  scope of sound medical judgment to delegate if, in the opinion of
  the delegating physician:
               (1)  the act:
                     (A)  can be properly and safely performed by the
  person to whom the medical act is delegated;
                     (B)  is performed in its customary manner; [and]
                     (C)  is not in violation of any other statute; and
                     (D)  is within the scope of practice of the
  physician's primary specialty during the five-year period
  preceding the delegation; and
               (2)  the person to whom the delegation is made does not
  represent to the public that the person is authorized to practice
  medicine.
         (a-1)  The performance of a delegated medical act by a
  qualified person must be supervised:
               (1)  at the location and for the period the delegated
  medical act is performed; and
               (2)  by:
                     (A)  the delegating physician; or
                     (B)  an advanced practice registered nurse or
  physician assistant supervised by the delegating physician and to
  whom the delegating physician has delegated the supervision of the
  qualified person.
         (a-2)  A delegated medical act may not be performed at a
  location that is more than 75 miles from the physician's primary
  practice location.
         (c)  The board may determine whether:
               (1)  an act constitutes the practice of medicine, not
  inconsistent with this chapter; and
               (2)  a medical act may be properly or safely delegated
  and supervised by a physician with a thorough knowledge of the
  delegated medical act [physicians].
         SECTION 3.  Section 157.002(b), Occupations Code, is amended
  to read as follows:
         (b)  A physician may delegate to any qualified and properly
  trained person acting under the physician's supervision the act of
  administering or providing dangerous drugs in the physician's
  office, as ordered by the physician, that are used or required to
  meet the immediate needs of the physician's patients. The
  administration or provision of the dangerous drugs must be
  performed in compliance with laws relating to the practice of
  medicine and state and federal laws relating to those dangerous
  drugs, including a requirement that the proper dosage of a
  dangerous drug may be determined only by:
               (1)  the delegating physician; or
               (2)  an advanced practice registered nurse or physician
  assistant acting under the physician's delegation through a
  standing order.
         SECTION 4.  Section 157.051(4), Occupations Code, is amended
  to read as follows:
               (4)  "Device" has the meaning assigned by Section
  551.003, and includes durable medical equipment, laser and
  intense-pulsed light devices, and injectable implant devices.
         SECTION 5.  Sections 157.0512(c), (e), and (f), Occupations
  Code, are amended to read as follows:
         (c)  Except as provided by Subsection (d), the combined
  number of advanced practice registered nurses and physician
  assistants with whom a physician may enter into a prescriptive
  authority agreement and whom a physician may supervise may not
  exceed five [seven] advanced practice registered nurses and
  physician assistants or the full-time equivalent of five [seven]
  advanced practice registered nurses and physician assistants.
         (e)  A prescriptive authority agreement must, at a minimum:
               (1)  be in writing and signed and dated by the parties
  to the agreement;
               (2)  state the name, address, and all professional
  license numbers of the parties to the agreement;
               (3)  state the nature of the practice, practice
  locations, or practice settings;
               (4)  identify the types or categories of drugs or
  devices that may be prescribed or the types or categories of drugs
  or devices that may not be prescribed;
               (5)  provide a general plan for addressing consultation
  and referral;
               (6)  provide a plan for addressing patient emergencies;
               (7)  state the general process for communication and
  the sharing of information between the physician and the advanced
  practice registered nurse or physician assistant to whom the
  physician has delegated prescriptive authority related to the care
  and treatment of patients;
               (8)  provide that [if] alternate physician supervision
  will [is to] be utilized during any period during which the
  supervising physician is more than 75 miles from the advanced
  practice registered nurse's or physician assistant's primary
  practice location and [,] designate one or more alternate
  physicians who may:
                     (A)  provide appropriate supervision on a
  temporary basis in accordance with the requirements established by
  the prescriptive authority agreement and the requirements of this
  subchapter; and
                     (B)  participate in the prescriptive authority
  quality assurance and improvement plan meetings required under this
  section; and
               (9)  describe a prescriptive authority quality
  assurance and improvement plan and specify methods for documenting
  the implementation of the plan that include the following:
                     (A)  chart review, including provisions for the
  physician to sign a chart to denote that the physician reviewed the
  chart and for [with the number of charts to be reviewed determined
  by] the physician to review the charts of at least 10 percent of the
  patients treated under the prescriptive authority agreement by the
  [and] advanced practice registered nurse or physician assistant, as
  applicable; and
                     (B)  periodic meetings between the advanced
  practice registered nurse or physician assistant and the physician.
         (f)  The periodic meetings described by Subsection (e)(9)(B)
  must:
               (1)  include:
                     (A)  the sharing of information relating to
  patient treatment and care, needed changes in patient care plans,
  and issues relating to referrals; and
                     (B)  discussion of patient care improvement;
               (2)  be documented in writing; [and]
               (3)  identify the patients whose treatment and care is
  discussed; and
               (4) [(3)]  take place at least once a month in a manner
  determined by the physician and the advanced practice registered
  nurse or physician assistant.
         SECTION 6.  Section 157.055, Occupations Code, is amended to
  read as follows:
         Sec. 157.055.  ORDERS AND PROTOCOLS. A protocol or other
  order shall be defined in a manner that promotes the exercise of
  professional judgment by the clinical nurse specialist or [advanced
  practice registered nurse and] physician assistant, as applicable,
  commensurate with the education and experience of that person.
  Under this section, an order or protocol used by a reasonable and
  prudent physician exercising sound medical judgment:
               (1)  is not required to describe the exact steps that a
  clinical nurse specialist [an advanced practice registered nurse]
  or a physician assistant must take with respect to each specific
  condition, disease, or symptom; and
               (2)  may state the types or categories of medications
  that may be prescribed or the types or categories of medications
  that may not be prescribed.
         SECTION 7.  Not later than December 1, 2023, the Texas
  Medical Board shall adopt the rules necessary to implement the
  changes in law made by this Act, including a rule prescribing the
  method by which a physician may make and electronically sign the
  attestation required by Section 156.001(d-1), Occupations Code, as
  added by this Act.
         SECTION 8.  Section 156.001(d-1), Occupations Code, as added
  by this Act, applies only to an application for renewal of a
  registration permit submitted on or after January 1, 2024.
         SECTION 9.  Section 157.0512, Occupations Code, as amended
  by this Act, applies only to a prescriptive authority agreement
  entered into on or after the effective date of this Act. An
  agreement entered into before the effective date of this Act is
  governed by the law in effect on the date the agreement was entered
  into, and the former law is continued in effect for that purpose.
         SECTION 10.  This Act takes effect September 1, 2023.