85R5768 EES-D
	By: Rodríguez	S.B. No. 831

	A BILL TO BE ENTITLED
	AN ACT
	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 [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, 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;
	[and]
	(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, [and] the Texas Medical Board, and
	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)  [a] an advanced practice registered nurse or
	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[, may order and
	prescribe durable medical equipment and supplies under the medical
	assistance program].
	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, [and] a pharmacy, and an advanced practice registered
	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 [recognized] by that board as an advanced
	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
	[State] Board [of Medical Examiners] that the physician practices
	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, [or] podiatrist, or [an] advanced practice
	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, [or] podiatrist, or [an] advanced practice
	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, [or] podiatrist, or [an] advanced practice
	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.