Bill Text: TX SB831 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to the prescribing and ordering authority of certain advanced practice registered nurses who are military veterans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-02-27 - Referred to Health & Human Services [SB831 Detail]
Download: Texas-2017-SB831-Introduced.html
85R5768 EES-D | ||
By: Rodríguez | S.B. No. 831 |
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relating to the prescribing and ordering authority of certain | ||
advanced practice registered nurses who are military veterans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
ARTICLE 1. PRESCRIPTIVE AUTHORITY FOR CERTAIN ADVANCED PRACTICE | ||
REGISTERED NURSES WHO ARE MILITARY VETERANS | ||
SECTION 1.001. Section 301.002, Occupations Code, is | ||
amended by amending Subdivision (2) and adding Subdivisions (6), | ||
(7), (8), (9), and (10) 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 [ |
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(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, or Section 301.357; | ||
(G) the performance of an act delegated by a | ||
physician under Section 157.0512, 157.054, 157.058, or 157.059; | ||
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(H) the development of the nursing care plan; and | ||
(I) the prescribing and ordering of drugs and | ||
devices by an advanced practice registered nurse as authorized by | ||
the board under Section 301.357. | ||
(6) "Controlled substance" has the meaning assigned by | ||
Section 157.051. | ||
(7) "Dangerous drug" has the meaning assigned by | ||
Section 157.051. | ||
(8) "Device" has the meaning assigned by Section | ||
157.051. | ||
(9) "Nonprescription drug" has the meaning assigned by | ||
Section 157.051. | ||
(10) "Prescribe or order a drug or device" has the | ||
meaning assigned by Section 157.051. | ||
SECTION 1.002. Section 301.152(b), Occupations Code, is | ||
amended to read as follows: | ||
(b) The board shall adopt rules to: | ||
(1) license a registered nurse as an advanced practice | ||
registered nurse; | ||
(2) establish: | ||
(A) any specialized education or training, | ||
including pharmacology, that an advanced practice registered nurse | ||
must have to prescribe or order a drug or device as delegated by a | ||
physician under Section 157.0512 or 157.054 or as authorized by the | ||
board under Section 301.357; | ||
(B) a system for approving an advanced practice | ||
registered nurse to prescribe or order a drug or device as delegated | ||
by a physician under Section 157.0512 or 157.054 or as authorized by | ||
the board under Section 301.357 on the receipt of evidence of | ||
completing the specialized education and training requirement | ||
under Paragraph (A); and | ||
(C) a system for issuing a prescription | ||
authorization number to an advanced practice registered nurse | ||
approved under Paragraph (B); and | ||
(3) concurrently renew any license or approval granted | ||
to an advanced practice registered nurse under this subsection and | ||
a license renewed by the advanced practice registered nurse under | ||
Section 301.301. | ||
SECTION 1.003. Subchapter H, Chapter 301, Occupations Code, | ||
is amended by adding Section 301.357 to read as follows: | ||
Sec. 301.357. PRESCRIBING AND ORDERING AUTHORITY OF CERTAIN | ||
ADVANCED PRACTICE REGISTERED NURSES. (a) In this section, "active | ||
duty" and "military veteran" have the meanings assigned by Section | ||
55.001. | ||
(b) The board may authorize an advanced practice registered | ||
nurse to prescribe and order drugs and devices, including | ||
controlled substances listed in Schedules III, IV, and V, dangerous | ||
drugs, and nonprescription drugs, if the advanced practice | ||
registered nurse: | ||
(1) is a military veteran; | ||
(2) practiced as an advanced practice registered nurse | ||
while on active duty; and | ||
(3) has been issued a prescription authorization | ||
number under Section 301.152(b). | ||
(c) The board may authorize an advanced practice registered | ||
nurse described by Subsection (b) to prescribe and order controlled | ||
substances listed in Schedule II only: | ||
(1) in a hospital facility-based practice in | ||
accordance with policies approved by the hospital's medical staff | ||
or a committee of the hospital's medical staff as provided by the | ||
hospital bylaws to ensure patient safety, and as part of the care | ||
provided to a patient who: | ||
(A) has been admitted to the hospital and is | ||
expected to remain in the hospital for a period of 24 hours or more; | ||
or | ||
(B) is receiving services in the emergency | ||
department of the hospital; or | ||
(2) as part of the plan of care for the treatment of a | ||
person who has executed a written certification of a terminal | ||
illness, has elected to receive hospice care, and is receiving | ||
hospice treatment from a qualified hospice provider. | ||
ARTICLE 2. CONFORMING AMENDMENTS | ||
SECTION 2.001. Section 38.151(1), Education Code, is | ||
amended to read as follows: | ||
(1) "Advanced practice nurse" has the meaning assigned | ||
to "advanced practice registered nurse" by Section 301.152, | ||
Occupations Code. | ||
SECTION 2.002. Section 671.001(b), Government Code, is | ||
amended to read as follows: | ||
(b) The pilot program must provide for the following: | ||
(1) a licensed advanced practice registered nurse as | ||
defined by Section 301.152, Occupations Code, or a licensed | ||
physician assistant as described by Chapter 204, Occupations Code, | ||
who is employed by the state or whose services are acquired by | ||
contract, who will be located at a state office complex; | ||
(2) if applicable, a licensed physician, who is | ||
employed by a state governmental entity for purposes other than the | ||
pilot program or whose services are acquired by contract, who will | ||
delegate to and supervise the advanced practice registered nurse or | ||
physician assistant under a prescriptive authority agreement under | ||
Chapter 157, Occupations Code; | ||
(3) appropriate office space and equipment for the | ||
advanced practice registered nurse or physician assistant to | ||
provide basic medical care to employees at the state office complex | ||
where the nurse or physician assistant is located; and | ||
(4) professional liability insurance covering | ||
services provided by the advanced practice registered nurse or the | ||
physician assistant. | ||
SECTION 2.003. 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, advanced practice registered | ||
nurse, 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, advanced | ||
practice registered nurse, 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 2.004. 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 Board of Nursing, 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 2.005. 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 Board of Nursing, 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 2.006. Section 481.076(c), Health and Safety Code, | ||
is amended to read as follows: | ||
(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, [ |
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the Texas Board of Nursing 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 2.007. Sections 483.001(4) and (12), Health and | ||
Safety Code, are amended to read as follows: | ||
(4) "Designated agent" means: | ||
(A) a licensed nurse, physician assistant, | ||
pharmacist, or other individual designated by a practitioner to | ||
communicate prescription drug orders to a pharmacist; | ||
(B) a licensed nurse, physician assistant, or | ||
pharmacist employed in a health care facility to whom the | ||
practitioner communicates a prescription drug order; or | ||
(C) [ |
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physician assistant authorized by a practitioner to carry out a | ||
prescription drug order for dangerous drugs under Subchapter B, | ||
Chapter 157, Occupations Code, or an advanced practice registered | ||
nurse authorized by a practitioner to carry out a prescription drug | ||
order for dangerous drugs under other law. | ||
(12) "Practitioner" means: | ||
(A) a person licensed by the Texas Medical Board, | ||
State Board of Dental Examiners, Texas State Board of Podiatric | ||
Medical Examiners, Texas Optometry Board, Texas Board of Nursing, | ||
or State Board of Veterinary Medical Examiners 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 2.008. Section 32.03141, Human Resources Code, is | ||
amended to read as follows: | ||
Sec. 32.03141. AUTHORITY OF ADVANCED PRACTICE REGISTERED | ||
NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL | ||
EQUIPMENT AND SUPPLIES. To the extent allowed by federal law, in | ||
addition to other health care practitioners authorized by federal | ||
law, the following persons may order and prescribe durable medical | ||
equipment and supplies under the medical assistance program: | ||
(1) an advanced practice registered nurse authorized | ||
to prescribe and order drugs and devices under Section 301.357, | ||
Occupations Code; and | ||
(2) an advanced practice registered nurse or physician | ||
assistant acting under adequate physician supervision and to whom a | ||
physician has delegated the authority to prescribe and order drugs | ||
and devices under Chapter 157, Occupations Code[ |
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SECTION 2.009. Section 843.312, Insurance Code, is amended | ||
to read as follows: | ||
Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE | ||
REGISTERED NURSES. (a) A health maintenance organization may not | ||
refuse a request by a physician participating in the health | ||
maintenance organization delivery network and a physician | ||
assistant or advanced practice registered nurse who is authorized | ||
by the physician to provide care under Subchapter B, Chapter 157, | ||
Occupations Code, or an advanced practice registered nurse who is | ||
authorized to provide care by the physician under other law, to | ||
identify a physician assistant or advanced practice registered | ||
nurse as a provider in the network. | ||
(b) A health maintenance organization may refuse a request | ||
under Subsection (a) if the physician assistant or advanced | ||
practice registered nurse does not meet the quality of care | ||
standards previously established by the health maintenance | ||
organization for participation in the network by physician | ||
assistants and advanced practice registered nurses. | ||
SECTION 2.010. Section 1301.001(1-a), Insurance Code, is | ||
amended to read as follows: | ||
(1-a) "Health care provider" means a practitioner, | ||
institutional provider, or other person or organization that | ||
furnishes health care services and that is licensed or otherwise | ||
authorized to practice in this state. The term includes a | ||
pharmacist, [ |
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nurse. The term does not include a physician. | ||
SECTION 2.011. Section 1301.052, Insurance Code, is amended | ||
to read as follows: | ||
Sec. 1301.052. DESIGNATION OF ADVANCED PRACTICE REGISTERED | ||
NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer | ||
offering a preferred provider benefit plan may not refuse a request | ||
made by a physician participating as a preferred provider under the | ||
plan and an advanced practice registered nurse or physician | ||
assistant to have the advanced practice registered nurse or | ||
physician assistant included as a preferred provider under the plan | ||
if: | ||
(1) the advanced practice registered nurse or | ||
physician assistant is authorized by the physician to provide care | ||
under Subchapter B, Chapter 157, Occupations Code, or the advanced | ||
practice registered nurse is authorized to provide care by the | ||
physician under other law; and | ||
(2) the advanced practice registered nurse or | ||
physician assistant meets the quality of care standards previously | ||
established by the insurer for participation in the plan by | ||
advanced practice registered nurses and physician assistants. | ||
SECTION 2.012. Section 1451.001(2), Insurance Code, is | ||
amended to read as follows: | ||
(2) "Advanced practice registered nurse" means an | ||
individual licensed by the Texas Board of Nursing as a registered | ||
nurse and licensed [ |
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practice registered nurse. | ||
SECTION 2.013. Section 1451.104(c), Insurance Code, is | ||
amended to read as follows: | ||
(c) Notwithstanding Subsection (a), a health insurance | ||
policy may provide for a different amount of payment or | ||
reimbursement for scheduled services or procedures performed by an | ||
advanced practice registered nurse, nurse first assistant, | ||
licensed surgical assistant, or physician assistant if the | ||
methodology used to compute the amount is the same as the | ||
methodology used to compute the amount of payment or reimbursement | ||
when the services or procedures are provided by a physician. | ||
SECTION 2.014. Section 1451.106, Insurance Code, is amended | ||
to read as follows: | ||
Sec. 1451.106. SELECTION OF ADVANCED PRACTICE REGISTERED | ||
NURSE. An insured may select an advanced practice registered nurse | ||
to provide the services scheduled in the health insurance policy | ||
that are within the scope of the nurse's license. | ||
SECTION 2.015. Section 1452.051(1), Insurance Code, is | ||
amended to read as follows: | ||
(1) "Advanced practice nurse" has the meaning assigned | ||
to "advanced practice registered nurse" by Section 301.152, | ||
Occupations Code. | ||
SECTION 2.016. Sections 551.003(14) and (34), Occupations | ||
Code, are amended to read as follows: | ||
(14) "Designated agent" means: | ||
(A) an individual, including a licensed nurse, | ||
physician assistant, or pharmacist: | ||
(i) who is designated by a practitioner and | ||
authorized to communicate a prescription drug order to a | ||
pharmacist; and | ||
(ii) for whom the practitioner assumes | ||
legal responsibility; | ||
(B) a licensed nurse, physician assistant, or | ||
pharmacist employed in a health care facility to whom a | ||
practitioner communicates a prescription drug order; or | ||
(C) a registered nurse or physician assistant | ||
authorized by a practitioner to administer a prescription drug | ||
order for a dangerous drug under Subchapter B, Chapter 157, or an | ||
advanced practice registered nurse authorized by a practitioner to | ||
administer a prescription drug order for a dangerous drug under | ||
other law. | ||
(34) "Practitioner" means: | ||
(A) a person licensed 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, advanced practice registered | ||
nurse, 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 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, | ||
advanced practice registered nurse, 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 2.017. Section 563.053, Occupations Code, is | ||
amended to read as follows: | ||
Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN | ||
RURAL AREAS. (a) In this section, "reimbursement for cost" means | ||
an additional charge, separate from that imposed for the | ||
physician's or advanced practice registered nurse's professional | ||
services, that includes the cost of the drug product and all other | ||
actual costs to the physician or advanced practice registered nurse | ||
incidental to providing the dispensing service. The term does not | ||
include a separate fee imposed for the act of dispensing the drug | ||
itself. | ||
(b) This section applies to an area located in a county with | ||
a population of 5,000 or less, or in a municipality or an | ||
unincorporated town with a population of less than 2,500, that is | ||
within a 15-mile radius of the physician's or advanced practice | ||
registered nurse's office and in which a pharmacy is not located. | ||
This section does not apply to a municipality or an unincorporated | ||
town that is adjacent to a municipality with a population of 2,500 | ||
or more. | ||
(c) A physician who practices medicine or an advanced | ||
practice registered nurse who is authorized to prescribe and order | ||
drugs and devices under Section 301.357 and who practices advanced | ||
practice registered nursing in an area described by Subsection (b) | ||
may: | ||
(1) maintain a supply of dangerous drugs in the | ||
physician's or advanced practice registered nurse's office to be | ||
dispensed in the course of treating the physician's or advanced | ||
practice registered nurse's patients; and | ||
(2) be reimbursed for the cost of supplying those | ||
drugs without obtaining a license under Chapter 558. | ||
(d) A physician or advanced practice registered nurse who | ||
dispenses dangerous drugs under Subsection (c) shall: | ||
(1) comply with each labeling provision under this | ||
subtitle applicable to that class of drugs; and | ||
(2) oversee compliance with packaging and | ||
recordkeeping provisions applicable to that class of drugs. | ||
(e) A physician who desires to dispense dangerous drugs | ||
under this section shall notify both the board and the Texas Medical | ||
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in an area described by Subsection (b). An advanced practice | ||
registered nurse who desires to dispense dangerous drugs under this | ||
section shall notify both the board and the Texas Board of Nursing | ||
that the advanced practice registered nurse practices in an area | ||
described by Subsection (b). The physician or advanced practice | ||
registered nurse may continue to dispense dangerous drugs in the | ||
area until the board determines, after notice and hearing, that the | ||
physician or advanced practice registered nurse no longer practices | ||
in an area described by Subsection (b). | ||
SECTION 2.018. Section 605.002(14), Occupations Code, is | ||
amended to read as follows: | ||
(14) "Orthotics" means the science and practice of | ||
measuring, designing, fabricating, assembling, fitting, adjusting, | ||
or servicing an orthosis under an order from a licensed physician, | ||
chiropractor, [ |
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registered nurse, or from an advanced practice registered nurse or | ||
physician assistant acting under the delegation and supervision of | ||
a licensed physician as provided by Subchapter B, Chapter 157, and | ||
rules adopted by the Texas Medical Board, for the correction or | ||
alleviation of a neuromuscular or musculoskeletal dysfunction, | ||
disease, injury, or deformity. | ||
SECTION 2.019. Section 605.2515, Occupations Code, is | ||
amended to read as follows: | ||
Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A | ||
person licensed to practice orthotics or prosthetics who measures, | ||
designs, fabricates, fits, assembles, adjusts, or services an | ||
orthosis or a prosthesis under an order from a licensed physician, | ||
chiropractor, [ |
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registered nurse, or from an advanced practice registered nurse or | ||
physician assistant acting under the delegation and supervision of | ||
a licensed physician as provided by Subchapter B, Chapter 157, and | ||
rules adopted by the Texas Medical Board, for a specific patient is | ||
exempt from licensing as a device manufacturer under Subchapter L, | ||
Chapter 431, Health and Safety Code. A person licensed to practice | ||
orthotics or prosthetics who fabricates or assembles an orthosis or | ||
a prosthesis without an order from a licensed physician, | ||
chiropractor, [ |
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registered nurse, or from an advanced practice registered nurse or | ||
physician assistant acting under the delegation and supervision of | ||
a licensed physician as provided by Subchapter B, Chapter 157, and | ||
rules adopted by the Texas Medical Board, for a specific patient is | ||
required to be licensed as a device manufacturer under Subchapter | ||
L, Chapter 431, Health and Safety Code. | ||
ARTICLE 3. TRANSITION AND EFFECTIVE DATE | ||
SECTION 3.001. Not later than February 1, 2018, the Texas | ||
Board of Nursing shall adopt the rules necessary to implement the | ||
changes in law made by this Act. | ||
SECTION 3.002. This Act takes effect September 1, 2017. |