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  By: Nelson S.B. No. 406
 
 
 
   
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the delegation and supervision of prescriptive
  authority by physicians to certain advanced practice registered
  nurses and physician assistants.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Subchapter B, Chapter 157,
  Occupations Code, is amended to read as follows:
  SUBCHAPTER B. DELEGATION TO ADVANCED PRACTICE REGISTERED NURSES
  AND PHYSICIAN ASSISTANTS
         SECTION 2.  Section 157.051, Occupations Code, is amended to
  read as follows:
               (1)  "Advanced practice registered nurse" has the
  meaning assigned to that term by Section 301.152. The term includes
  an advanced nurse practitioner and advanced practice nurse.
               (2)     "Carrying out or signing a prescription drug
  order" means completing a prescription drug order presigned by the
  delegating physician, or the signing of a prescription by a
  registered nurse or physician assistant.
               (2-a) "Controlled substance" has the meaning assigned
  to that term by Section 481.002, Health and Safety Code.
               (2-b3) "Dangerous drug" has the meaning assigned to
  that term by Section 483.001, Health and Safety Code.
               (2-c4) "Health professional shortage area" means:
                     (A)  an urban or rural area of this state that:
                           (i)  is not required to conform to the
  geographic boundaries of a political subdivision but is a rational
  area for the delivery of health service;
                           (ii)  the secretary of health and human
  services determines has a health professional shortage; and
                           (iii)  is not reasonably accessible to an
  adequately served area;
                     (B)  a population group that the secretary of
  health and human services determines has a health professional
  shortage; or
                     (C)  a public or nonprofit private medical
  facility or other facility that the secretary of health and human
  services determines has a health professional shortage, as
  described by 42 U.S.C. Section 254e(a)(1).
               (5)  "Hospital" means:
                     (A)  a general hospital or a special hospital, as
  those
  terms are defined by Section 241.003, including a hospital
  maintained or operated by this state; or
                     (B)  a mental hospital licensed under Chapter 577.
               (6)  "Medication order" has the meaning assigned by
  Sections 551.003(24), Occupations Code and 481.002(28), Health and
  Safety Code.
               (7)  "Nonprescription drug" has the meaning assigned by
  Section 551.003(25).
               (38) "Physician assistant" means a person who holds a
  license issued under Chapter 204.
               (9)  "Physician group practice" means an entity for
  which two or more physicians deliver health care to the public
  through the practice of medicine on a regular basis and that is:
                     (A)  owned and operated by two or more physicians;
  or
                     (B)  a freestanding clinic, center, or office of a
  nonprofit health organization certified by the board under Section
  162.001(b) that complies with the requirements of Chapter 162.
               (10)  "Practice serving a medically underserved
  population" means:
                     (A)  a practice in a health professional shortage
  area;
                     (B)  a clinic designated as a rural health clinic
  under 42 U.S.C. Section 1395x(aa);
                     (C)  a public health clinic or a family planning
  clinic under contract with the Health and Human Services Commission
  or the Texas Department of State Health Services;
                     (D)  a clinic designated as a federally qualified
  health clinic under 42 U.S.C. Section 1396d(1)(2)(B); or
                     (E)  a practice:
                           (i)  that is either:
                                 (a)  located in an area in which the
  Texas Department of State Health Services determines there is an
  insufficient number of physicians providing services to eligible
  clients of federal, state, or locally funded health care programs;
  or
                                 (b)  a practice that the Texas
  Department of State Health Services determines serves a
  disproportionate number of clients eligible to participate in
  federal, state, or locally funded health care programs; and
                           (ii)  for which the Texas Department of
  State Health Services publishes notice of its determination in the
  Texas Register and provides an opportunity for public comment in
  the manner provided for a proposed rule under Chapter 2001,
  Government Code;
                     (F)  a practice at which a physician was
  delegating prescriptive authority to an advanced practice
  registered nurse or physician assistant on or before March 1, 2013
  based on the practice qualifying as a site serving a medically
  underserved population.
               (11)  "Prescribe or order a drug or device" means
  prescribing or ordering a drug or device, including the issuing of a
  "prescription drug order" or a "medication order."
               (12)  "Prescription drug" has the meaning assigned by
  Section 551.003(36).
               (13)  "Prescriptive authority agreement" means an
  agreement entered into by a physician and an advanced practice
  registered nurse or physician assistant through which the physician
  delegates to the advanced practice registered nurse or physician
  assistant the act of prescribing or ordering a drug or device.
         SECTION 3.  Sections 157.0511(a), (b) and (b-1), Occupations
  Code, are amended, and a new Section (b-1) is added, to read as
  follows:
         (a)  A physician's authority to delegate the carrying out or
  signing of a prescription drug order prescribing and ordering of a
  drug or device under this subchapter is limited to:
               (1)  non prescription drugs;
               (2)  dangerous drugs; and
               (3)  controlled substances to the extent provided by
  Subsection (b) and (b-1).
         (b)  Except as provided in (b-1), a A physician may delegate
  the carrying out or signing of a prescription drug order
  prescribing or ordering of a drug or device for a controlled
  substance only if:
               (1)  the prescription is for a controlled substance
  listed in Schedule III, IV, or V as established by the commissioner
  of State Health Services under Chapter 481, Health and Safety Code;
               (2)  the prescription, including a refill of the
  prescription, is for a period not to exceed 90 days;
               (3)  with regard to the refill of a prescription, the
  refill is authorized after consultation with the delegating
  physician and the consultation is noted in the patient's chart; and
               (4)  with regard to a prescription for a child less than
  two years of age, the prescription is made after consultation with
  the delegating physician and the consultation is noted in the
  patient's chart.
         (b-1)  A physician may delegate the prescribing or ordering
  of a controlled substance listed in Schedule II as established by
  the commissioner of state health services under Chapter 481, Health
  and Safety Code only:
               (1)  in a hospital facility-based practice under
  Section 157.054 and in accordance with policies approved by the
  facility's medical staff or a committee of the facility's medical
  staff as provided by the facility bylaws to ensure patient safety;
  or
               (2)  as part of the plan of care, for the treatment of a
  person that 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.
         (b-12)  The board shall adopt rules that require a physician
  who delegates the prescribing or ordering of a drug or device 
  carrying out or signing of a prescription drug order [under this
  subchapter] to register with the board the name and license number
  of the physician assistant or advanced practice registered nurse to
  whom a delegation is made. The board may develop and use an
  electronic online delegation registration process for registration
  under this subsection.
         SECTION 4.  Subchapter B, Chapter 157, Occupations Code, is
  amended by adding Sections 157.0512, 157.0513, and 157.0514 to read
  as follows:
         Sec. 157.0512.  PRESCRIPTIVE AUTHORITY AGREEMENT.
         (a)  A physician may delegate to an advanced practice
  registered nurse or physician assistant, acting under adequate
  physician supervision, the act of prescribing or ordering a drug or
  device as authorized through a prescriptive authority agreement
  between the physician and the advanced practice registered nurse or
  physician assistant, as applicable.
         (b)  A physician and an advanced practice registered nurse or
  physician assistant are eligible to enter into or be a party to a
  prescriptive authority agreement only if:
               (1)  the Texas Board of Nursing has approved the
  advanced practice registered nurse's authority to prescribe or
  order a drug or device as authorized in this Chapter this
  Subchapter;
               (2)  the advanced practice registered nurse or
  physician assistant:
                     (A)  holds an active license to practice in this
  state as a registered nurse or physician assistant, as applicable,
  and is in good standing in this state; and
                     (B)  is not currently prohibited by the Texas
  Board of Nursing or Texas Board of Physician Assistants, as
  applicable, from executing a prescriptive authority agreement; and
               (3) prior to executing a prescriptive authority
  agreement, an advanced practice registered nurse, physician
  assistant, and physician must disclose to the other prospective
  party any prior disciplinary action by the board, Texas Board of
  Nursing, or Texas Board of Physician Assistants, as applicable.
         (c)  Except as provided in Subsection (d), the combined
  number of advanced practice registered nurses and physician
  assistants with whom a physician may enter into a prescriptive
  authority agreement may not exceed seven advanced practice
  registered nurses and physician assistants or the full-time
  equivalent of seven advanced practice registered nurses and
  physician assistants.
         (d) Subsection (c) does not apply to a prescriptive authority
  agreement if the prescriptive authority is being exercised in:
               (1)  a practice serving a medically underserved
  population; or
               (2) a hospital facility-based practice in a hospital
  under Section 157.054.
         (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
  sharing of information between the physician and an advanced
  practice registered nurse or physician assistant to whom the
  physician has delegated prescriptive authority related to the care
  and treatment of patients.
               (8)  if alternate physician supervision is to be
  utilized, designate one or more alternate physicians who may
  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 who may
  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 includes the following:
                     (A)  chart review with the number of charts
  reviewed determined by the physician and advanced practice
  registered nurse or physician assistant;
                     (B)  periodic face-to-face meetings of the
  advanced practice registered nurse or physician assistant with the
  physician at a location determined by the physician and advanced
  practice registered nurse or physician assistant. The meetings
  shall include:
                           (i)  sharing of information relating to
  patients' treatment and care, needed changes in patient care plans,
  and issues relating to referrals; and
                           (ii)  discussion of patient care
  improvement.
                     (C)  The periodic face-to-face meetings described
  in (9)(B) shall be documented and occur:
                           (i)(a) no less frequently than monthly for
  three years beginning on the date of execution of the agreement; and
                                 (b)  no less frequently than quarterly
  after three years with monthly meetings held between the quarterly
  meetings by means of a remote electronic communications system,
  including videoconferencing technology or the Internet; or
                           (ii)  if during the seven year period
  immediately preceding execution of the prescriptive authority
  agreement, the advanced practice registered nurse or physician
  assistant was in practice for at least five years that included the
  exercise of prescriptive authority with required physician
  supervision:
                           (a)  no less frequently than monthly for one
  year beginning on the date of execution of the agreement; and (b) no
  less frequently than quarterly after one year with monthly meetings
  held between the quarterly meetings by means of a remote electronic
  communications system, including videoconferencing technology or
  the Internet.
         (f)  The prescriptive authority agreement may include other
  provisions agreed to by the physician and advanced practice
  registered nurse or physician assistant.
         (g)  If the parties to the prescriptive authority agreement
  practice in a physician group practice, the physician may appoint
  one or more alternate supervising physicians designated under
  (E)(8) of this Section, if any, to conduct and document the quality
  assurance meeting in accordance with the requirements of this
  Subchapter.
         (h)  The prescriptive authority agreement need not describe
  the exact steps that an advanced practice registered nurse or
  physician assistant must take with respect to each specific
  condition, disease, or symptom.
         (i)  A physician, advanced practice registered nurse, or
  physician assistant who is a party to a prescriptive authority
  agreement must retain a copy of the agreement until the second
  anniversary of the date the agreement is terminated.
         (j)  A party to a prescriptive authority agreement may not by
  contract waive, void, or nullify any provision of this section or
  Section 157.0513.
         (k)  In the event a party to a prescriptive authority
  agreement is notified that he or she has become the subject of an
  investigation by the board, Texas Board of Nursing, or Texas Board
  of Physician Assistants, the individual must immediately notify the
  other party to the prescriptive authority agreement.
         (l)  The prescriptive authority agreement and any amendments
  must be reviewed at least annually, dated, and signed by the parties
  to the agreement, and made available to the board, Texas Board of
  Nursing, or Texas Board of Physician Assistants within three
  business days of receipt of request, if any.
         (m)  The prescriptive authority agreement should promote the
  exercise of professional judgment by the advanced practice
  registered nurse or physician assistant commensurate with the
  advanced practice registered nurse's or physician assistant's
  education and experience and the relationship between the advanced
  practice registered nurse or physician assistant and physician.
         (n)  This section shall be liberally construed to allow the
  use of prescriptive authority agreements to safely and effectively
  utilize the skills and services of advanced practice registered
  nurses and physician assistants.
         (o)  The board may not adopt rules pertaining to the elements
  of the prescriptive authority agreement that would impose
  requirements in addition to those required under this Section. The
  board, Texas Board of Nursing, and Texas Board of Physician
  Assistants will jointly develop Frequently Asked Questions (FAQs)
  by January 2014.
         SECTION 5.  Sec. 157.0513.  PRESCRIPTIVE AUTHORITY
  AGREEMENT:  INFORMATION.
         (a)  The board shall jointly with the Texas Board of Nursing
  and the Texas Physician Assistant Board develop a process:
               (1)  to exchange information regarding the names,
  locations, and license numbers of each physician, advanced practice
  registered nurse, and physician assistant who has entered into a
  prescriptive authority agreement;
               (2)  by which each board shall immediately notify the
  other boards when one of its licensees becomes the subject of an
  investigation involving the delegation and supervision of
  prescriptive authority, as well as the final disposition of any
  such investigation; and
               (3)  for each board to maintain and share a list of its
  licensees who have been subject to a final adverse disciplinary
  action for an act involving the delegation and supervision of
  prescriptive authority.
         (b)  The board, Texas Board of Nursing, or Texas Physician
  Assistant Board may use a notice received under Section (a)(2) to
  open an investigation against a licensee who is a party to a
  prescriptive authority agreement with the licensee who is under
  investigation by the board which provided notice under Section
  (a)(2).
         (c)  The board shall maintain and make available to the
  public an online searchable list of physician, advanced practice
  registered nurses, and physician assistants who have entered into a
  prescriptive authority agreement authorized under Section 157.0512
  and identify the physician with whom each advanced practice
  registered nurse and physician assistant has entered into an
  agreement.
         (d)  The board shall collaborate with the Texas Board of
  Nursing and Texas Physician Assistant Board to maintain and make
  available to the public a list of physicians, advanced practice
  registered nurses, and physician assistants who are prohibited from
  entering into or practicing under a prescriptive authority
  agreement.
         SECTION 6.  Sec. 157.0514.  PRESCRIPTIVE AUTHORITY
  AGREEMENT: INSPECTIONS. If the board is notified under Section
  157.0513(a)(2), the board or an authorized board representative may
  enter, with reasonable notice and at a reasonable time, unless the
  notice would jeopardize an investigation, a site where a party to a
  prescriptive authority agreement practices to inspect and audit any
  records or activities relating to the implementation and operation
  of the agreement. To the extent reasonably possible, the board and
  the board's authorized representative shall conduct any inspection
  or audit under this subsection in a manner that minimizes
  disruption to the delivery of patient care.
         SECTION 7.  Section 157.054, Occupations Code, is amended to
  read as follows:
         Sec. 157.054.  PRESCRIBING AT FACILITY-BASED PRACTICE
  SITES. (a)  One or more physicians licensed by the board may
  delegate, to one or more physician assistants or advanced practice
  registered nurses acting under adequate physician supervision
  whose practice is facility-based at a licensed hospital as defined
  under Section 157.051 or licensed long-term care facility, the
  administration or provision of a drug and the carrying out or
  signing of a prescription drug order prescribing or ordering of a
  drug or device if the physician is:
               (1)  the medical director or chief of medical staff of
  the facility in which the physician assistant or advanced practice
  registered nurse practices;
               (2)  the chair of the facility's credentialing
  committee;
               (3)  a department chair of a facility department in
  which the physician assistant or advanced practice nurse practices;
  or
               (4)  one or more physicians who consent to the request
  of the medical director or chief of medical staff to delegate the
  carrying out or signing of a prescription drug order prescribing or
  ordering of a drug or device at the facility in which the physician
  assistant or advanced practice nurse practices.
         (a-1)  The limits on the number of Advanced Practice
  Registered Nurses or Physician Assistants to whom a physician may
  delegate under Section 157.0512 do not apply to a physician under
  (a)(4) whose practice is facility-based under this Section,
  provided that the physician is not delegating in a freestanding
  clinic, center, or practice of the facility.
         (b)  A physician's authority to delegate under Subsection
  (a) is limited as follows:
               (1)  the delegation must be made under a physician's
  order, standing medical order, standing delegation order, or
  another order or protocol developed in accordance with policies
  approved by the facility's medical staff or a committee of the
  facility's medical staff as provided by the facility bylaws;
               (2)  the delegation must occur in the facility in which
  the physician is the medical director, the chief of medical staff,
  the chair of the credentialing committee, or a department chair, or
  a physician who consents to delegate under (a)(4);
               (3)  the delegation may not permit the carrying out or
  signing of prescription drug orders prescribing or ordering of a
  drug or device for the care or treatment of the patients of any
  other physician without the prior consent of that physician; and
               (4)  delegation in a long-term care facility must be by
  the medical director and is limited to the carrying out and signing
  of prescription drug orders prescribing or ordering of a drug or
  device to not more than four seven advanced practice nurses or
  physician assistants or their full-time equivalents.; and
               (5)  a facility based physician may not delegate at
  more than one licensed hospital or more than two long-term care
  facilities unless approved by the board.
         (c)  Physician supervision of the carrying out and signing of
  prescription drug orders prescribing or ordering of a drug or
  device must conform to what a reasonable, prudent physician would
  find consistent with sound medical judgment but may vary with the
  education and experience of the particular advanced practice
  registered nurse or physician assistant. A physician shall provide
  continuous supervision, but the constant physical presence of the
  physician is not required.
         (d)  An alternate physician may provide appropriate
  supervision on a temporary basis as defined and established by
  board rule.
         SECTION 8.  Section 156.056(a) and (b), Occupations Code,
  are amended to read as follows:
         (a)  In this section, "site practice serving a medically
  underserved population" has the meaning assigned by Section 157.051
  157.052.
         (b)  The board by rule shall permit a license holder to
  complete half of any informal continuing medical education hours
  required under this subchapter by providing volunteer medical
  services at a site practice serving a medically underserved
  population other than a site that is a primary practice site of the
  license holder.
         SECTION 9.  Section 157.057, Occupations Code, is amended to
  read as follows:
         Sec. 157.057.  ADDITIONAL IMPLEMENTATION METHODS. The board
  may adopt additional methods to implement:
               (1)  a physician's prescription; or
               (2)  the delegation of prescriptive authority the
  signing of a prescription under a physician's order, standing
  medical order, standing delegation order, or other order or
  protocol.
         SECTION 10.  Sec. 157.059.  DELEGATION REGARDING CERTAIN
  OBSTETRICAL SERVICES.
         (a)  In this section, "provide" means to supply, for a term
  not to exceed 48 hours, one or more unit doses of a controlled
  substance for the immediate needs of a patient.
         (b)  A physician may delegate to a physician assistant
  offering obstetrical services and certified by the board as
  specializing in obstetrics or an advanced practice registered
  nurse recognized by the Texas Board of Nursing as a nurse midwife
  the act of administering or providing controlled substances to the
  physician assistant's or nurse midwife's clients during intrapartum
  and immediate postpartum care.
         (c)  The physician may not delegate:
               (1)  the use of a prescription sticker or the use or
  issuance of an official prescription form; or
               (2)  the authority to issue an electronic prescription
  under Section 481.075, Health and Safety Code.
         (d)  The delegation of authority to administer or provide
  controlled substances under Subsection (b) must be under a
  physician's order, medical order, standing delegation order,
  prescriptive authority agreement, or protocol that requires
  adequate and documented availability for access to medical care.
         (e)  The physician's orders, medical orders, standing
  delegation orders, or protocols must require the reporting of or
  monitoring of each client's progress, including complications of
  pregnancy and delivery and the administration and provision of
  controlled substances by the nurse midwife or physician assistant
  to the clients of the nurse midwife or physician assistant.
         (f)  The authority of a physician to delegate under this
  section is limited to:
               (1)  four seven nurse midwives or physician assistants
  or their full-time equivalents; and
               (2)  the designated facility at which the nurse midwife
  or physician assistant provides care.
         (g)  The controlled substance must be supplied in a suitable
  container that is labeled in compliance with the applicable drug
  laws and must include:
               (1)  the patient's name and address;
               (2)  the drug to be provided;
               (3)  the name, address, and telephone number of the
  physician;
               (4)  the name, address, and telephone number of the
  nurse midwife or physician assistant; and
               (5)  the date.
         (h)  This section does not authorize a physician, physician
  assistant, or nurse midwife to operate a retail pharmacy as defined
  under Subtitle J.
         (i)  This section authorizes a physician to delegate the act
  of administering or providing a controlled substance to a nurse
  midwife or physician assistant but does not require physician
  delegation of:
               (1)  further acts to a nurse midwife; or
               (2)  the administration of medications by a physician
  assistant or registered nurse other than as provided by this
  section.
         (j)  This section does not limit the authority of a physician
  to delegate the carrying out or signing of a prescription drug order
  involving the prescribing or ordering a controlled substance under
  this subchapter.
         SECTION 11.  Section 157.060, Occupations Code, is amended
  to read as follows:
         Sec. 157.060.  PHYSICIAN LIABILITY FOR DELEGATED ACT.
  Unless the physician has reason to believe the physician assistant
  or advanced practice registered nurse lacked the competency to
  perform the act, a physician is not liable for an act of a physician
  assistant or advanced registered practice nurse solely because the
  physician signed a standing medical order, a standing delegation
  order, or another order or protocol or entered into a prescriptive
  authority agreement authorizing the physician assistant or
  advanced practice registered nurse to administer, provide, carry
  out, prescribe or order a drug or device. sign a prescription drug
  order.
         SECTION 12.  Section 204.1565(a) and (b), Occupations Code,
  are amended to read as follows:
         (a)  In this section, "site practice serving a medically
  underserved population" has the meaning assigned by Section
  157.051. 157.052.
         (b)  The physician assistant board by rule shall permit a
  license holder to complete half of any informal continuing medical
  education hours required to renew a license under this chapter by
  providing volunteer medical services at a site practice serving a
  medically underserved population, other than a site that is a
  primary practice site of the license holder.
         SECTION 13.  Section 204.202(b), Occupations Code, is
  amended to read as follows:
         (b)  Medical services provided by a physician assistant may
  include:
               (1)  obtaining patient histories and performing
  physical examinations;
               (2)  ordering or performing diagnostic and therapeutic
  procedures;
               (3)  formulating a working diagnosis;
               (4)  developing and implementing a treatment plan;
               (5)  monitoring the effectiveness of therapeutic
  interventions;
               (6)  assisting at surgery;
               (7)  offering counseling and education to meet patient
  needs;
               (8)  requesting, receiving, and signing for the receipt
  of pharmaceutical sample prescription medications and distributing
  the samples to patients in a specific practice setting in which the
  physician assistant is authorized to prescribe pharmaceutical
  medications and sign prescription drug orders as provided by
  Section 157.0512 [157.052, 157.053], or 157.054, [157.0541,] or
  157.0542 [or as otherwise authorized by physician assistant board
  rule];
               (9)  signing or completing a prescription prescribing
  or ordering a drug or device as provided by Subchapter B, Chapter
  157; and
               (10)  making appropriate referrals.
         SECTION 14.  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 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 sites in
  practices at which an advanced practice registered nurse is
  authorized to sign prescription drug orders or a medication order
  as provided by Subchapter B, Chapter 157;
                     (G)  the performance of an act delegated by a
  physician under Section 157.0512 [157.052, 157.053], 157.054,
  [157.0541,] 157.0542, 157.058, or 157.059; and
                     (H)  the development of the nursing care plan.
         SECTION 15.  Section 301.152 (a) and (b), Occupations Code,
  are amended to read as follows:
         (a)  In this section, "advanced practice registered nurse"
  means a registered nurse approved licensed by the board to practice
  as an advanced practice registered nurse on the basis of completion
  of an advanced educational program. The term includes a nurse
  practitioner, nurse midwife, nurse anesthetist, and clinical nurse
  specialist. The term is synonymous with "advanced nurse
  practitioner" and "advanced practice nurse."
         (b)  The board shall adopt rules to:
               (1)  license a registered nurse as an advanced practice
  registered nurse;
               (12)  establish:
                     (A)  any specialized education or training,
  including pharmacology, that an advanced practice registered nurse
  must have to carry out a prescription drug order prescribe or order
  a drug or device as delegated by a physician under Section 157.0512,
  or 157.054, or 157.0542 [Section 157.052]; and
                     (B)  a system for:
                           (i)  approving an advanced practice
  registered nurse to prescribe and order a drug or device as
  delegated by a physician under Section 157.0512 or 157.054 upon the
  providing of assigning an identification number to a registered
  nurse who provides the board with evidence of completing the
  specialized education and training requirement under Subdivision
  (1)(A); and
                           (ii)  issuing a prescription authorization
  number to advanced practice registered nurses approved under (i).
               (3)  renew the license issued under (1) and the
  approval granted under (2)(B) concurrently with renewal of the
  advanced practice registered nurse's professional nursing license
  under Section 301.301.
               (2)     approve a registered nurse as an advanced
  registered practice nurse; and practice nurse; and
               (3)     initially approve and biennially renew an advanced
  practice registered nurse's authority to carry out or sign a
  prescription drug order under Chapter 157.
         (c)  At a minimum, the rules adopted under Subsection (b)([3]
  2) must:
               (1)  require completion of pharmacology and related
  pathology pathophysiology education for initial approval; and
               (2)  require continuing education in clinical
  pharmacology and related pathology pathophysiology in addition to
  any continuing education otherwise required under Section
  301.303.; and
               (3)     provide for the issuance of a prescription
  authorization number to an advanced practice nurse approved under
  this section.
         (d)  The signature of an advanced practice registered nurse
  attesting to the provision of a legally authorized service by the
  advanced practice registered nurse satisfies any documentation
  requirement for that service established by a state agency.
         SECTION 16.  Sections 551.003(34) and (45), Occupations
  Code, are amended to read as follows:
               (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, 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, 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 carry out or sign prescription drug orders prescribe or order a
  drug or device under Section 157.0511, 157.0512 [157.052, 157.053],
  or 157.054, [157.0541,] or 157.0542.
               (45)  "Written protocol" means a physician's order,
  standing medical order, standing delegation order, or other order
  or protocol as defined by rule of the Texas Medical [State] Board
  [of Medical Examiners] under Subtitle B.
         SECTION 17.  Section 671.001, Government Code, is amended by
  amending Subsection (b) and adding Subsection (b-1) 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)  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 pursuant to a prescriptive authority agreement under
  Chapter 157, Occupations Code. [perform all supervisory functions
  described by Section 157.052(e), 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 18.  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, 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, 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 carry out or sign prescription drug orders prescribe or order a
  drug or device under Section 157.0511, 157.0512 [157.052, 157.053],
  or 157.054, [157.0541,] or 157.0542, Occupations Code.
         SECTION 19.  Section 483.001(12), Health and Safety Code, is
  amended to read as follows:
               (12)  "Practitioner" means [a person licensed]:
                     (A)  a person licensed by the Texas [State Board
  of] Medical Board [Examiners], State Board of Dental Examiners,
  Texas State Board of Podiatric Medical Examiners, Texas Optometry
  Board, 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 carry out or sign prescription drug orders prescribe or order a
  drug or device under Section 157.0511, 157.0512 [157.052, 157.053],
  or 157.054, [157.0541,] or 157.0542, Occupations Code.
         SECTION 20.  Sections 157.052, 157.053, 157.0541, and
  157.0542, Occupations Code, are repealed.
         SECTION 21.  (a)  The changes in law made by this Act apply
  only to a delegation of prescriptive authority by a physician to an
  advanced practice registered nurse or physician assistant made or
  amended on or after January 31, 2014. A delegation of prescriptive
  authority made or amended before January 31, 2014, is governed by
  the law in effect on the date the delegation was made or amended,
  and the former law is continued in effect for that purpose.
         (b)  Any calculation under this Act requiring the amount of
  time an advanced practice registered nurse or physician assistant
  has practiced under the delegated prescriptive authority of a
  physician pursuant to a prescriptive authority agreement shall
  include the amount of time the advanced practice registered nurse
  or physician assistant practiced under the delegated prescriptive
  authority of that physician prior to the effective date of this Act.
         SECTION 22.  Not later than December 31, 2013, the Texas
  Medical Board shall adopt the rules necessary to implement the
  changes in law made by this Act.
         SECTION 23.  This Act takes effect September 1, 2013.