87R3775 BEE-F     By: Hancock S.B. No. 915       A BILL TO BE ENTITLED   AN ACT   relating to the licensing and authority of advanced practice   registered nurses.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:   ARTICLE 1. ADVANCED PRACTICE REGISTERED NURSES          SECTION 1.001.  Section 301.002, Occupations Code, is   amended to read as follows:          Sec. 301.002.  DEFINITIONS. In this chapter:                (1)  "Advanced practice registered nurse" means a   registered nurse 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.                (2) [(1)]  "Board" means the Texas Board of Nursing.                (3)  [(1-a)]  "Chief nursing officer" means the   registered nurse who is administratively responsible for the   nursing services at a facility.                (4)  "Controlled substance" has the meaning assigned by   Section 481.002, Health and Safety Code.                (5)  "Dangerous drug" has the meaning assigned by   Section 483.001, Health and Safety Code.                (6)  "Device" has the meaning assigned by Section   551.003, and includes durable medical equipment.                (7)  "Nonprescription drug" has the meaning assigned by   Section 551.003.                (8)  "Nurse" means a person required to be licensed   under this chapter to engage in professional or vocational nursing.                (9)  "Nursing" means professional or vocational   nursing.                (10) [(1-b)]  "Patient safety committee" has the   meaning assigned by Section 303.001.                (11)  "Prescribe or order a drug or device" has the   meaning assigned by Section 157.051.                (12) [(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, except as authorized for an advanced practice   registered nurse.  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;                      [(G)]  the performance of an act by an advanced   practice registered nurse [delegated by a physician under Section   157.0512, 157.054, 157.058, or 157.059]; and                      (G) [(H)]  the development of the nursing care   plan.                [(3)  "Nurse" means a person required to be licensed   under this chapter to engage in professional or vocational nursing.                [(4)  "Nursing" means professional or vocational   nursing.]                (13) [(5)]  "Vocational nursing" means a directed   scope of nursing practice, including the performance of an act that   requires 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 vocational nursing.  The term does   not include acts of medical diagnosis or the prescription of   therapeutic or corrective measures.  Vocational nursing involves:                      (A)  collecting data and performing focused   nursing assessments of the health status of an individual;                      (B)  participating in the planning of the nursing   care needs of an individual;                      (C)  participating in the development and   modification of the nursing care plan;                      (D)  participating in health teaching and   counseling to promote, attain, and maintain the optimum health   level of an individual;                      (E)  assisting in the evaluation of an   individual's response to a nursing intervention and the   identification of an individual's needs; and                      (F)  engaging in other acts that require education   and training, as prescribed by board rules and policies,   commensurate with the nurse's experience, continuing education,   and demonstrated competency.          SECTION 1.002.  Section 301.005(b), Occupations Code, is   amended to read as follows:          (b)  A reference in any other law to an "advanced nurse   practitioner," [or] "advanced practice nurse," or "advanced   practice registered nurse" means an advanced practice registered   nurse.          SECTION 1.003.  Section 301.152, Occupations Code, is   transferred to Subchapter H, Chapter 301, Occupations Code,   redesignated as Section 301.357, Occupations Code, and amended to   read as follows:          Sec. 301.357 [301.152].  ADVANCED PRACTICE REGISTERED NURSES   [RULES REGARDING SPECIALIZED TRAINING]. (a)  Advanced practice   registered nursing includes:                (1)  ordering, performing, and interpreting diagnostic   tests;                (2)  formulating primary and differential medical   diagnoses and advanced assessments;                (3)  treating actual and potential health problems;                (4)  prescribing therapeutic and corrective measures,   including nutrition and diagnostic support services, home health   care, hospice care, physical therapy, and occupational therapy, and   delegating and assigning the performance of therapeutic and   corrective measures to assistive personnel;                (5)  to the extent authorized by the board under   Section 301.358, prescribing, ordering, procuring, administering,   and dispensing drugs and devices, including blood and blood   products, controlled substances listed in Schedules II, III, IV,   and V, dangerous drugs, and nonprescription drugs;                (6)  providing referrals to health care agencies,   health care providers, and community resources;                (7)  serving as the primary care provider of record;   and                (8)  performing other acts that require education and   training consistent with professional standards and that are   commensurate with the advanced practice registered nurse's   education, licensure, and demonstrated competencies and   experience. [In this section, "advanced practice registered nurse"   means a registered nurse 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;                (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 authorized   [delegated] by the board [a physician] under Section 301.358   [157.0512 or 157.054];                      (B)  a system for approving an advanced practice   registered nurse to prescribe or order a drug or device as   authorized [delegated] by the board [a physician] under Section   301.358 [157.0512 or 157.054] 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.          (c)  At a minimum, the rules adopted under Subsection (b)(2)   must:                (1)  require completion of pharmacology and related   pathophysiology education for initial approval; and                (2)  require continuing education in clinical   pharmacology and related pathophysiology in addition to any   continuing education otherwise required under Section 301.303.          (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.          (e)  An advanced practice registered nurse shall practice as   a licensed independent practitioner in accordance with standards   established and recognized by the board to protect the public   health and safety.          (f)  An advanced practice registered nurse is accountable to   patients, the nursing profession, and the board for:                (1)  complying with the requirements of this chapter;                (2)  providing quality advanced nursing care;                (3)  recognizing the nurse's limits of knowledge;                (4)  planning for the management of situations beyond   the nurse's expertise; and                (5)  consulting with or referring patients to other   health care providers as appropriate.          (g)  This section does not limit or modify the scope of   practice of a registered nurse who is not an advanced practice   registered nurse.          (h)  Notwithstanding any other law, an advanced practice   registered nurse performing an act described by Subsection (a) is   not considered to be practicing medicine without a license.          SECTION 1.004.  Section 301.354(a), Occupations Code, is   amended to read as follows:          (a)  In this section, "nurse first assistant" means a   registered nurse who:                (1)  has completed a nurse first assistant educational   program approved or recognized by an organization recognized by the   board; and                (2)  [is] either:                      (A)  is certified in perioperative nursing by an   organization recognized by the board; or                      (B)  is [recognized by the board as] an advanced   practice registered nurse [and] qualified by education, training,   or experience to perform the tasks involved in perioperative   nursing.          SECTION 1.005.  Subchapter H, Chapter 301, Occupations Code,   is amended by adding Section 301.358 to read as follows:          Sec. 301.358.  PRESCRIBING AND ORDERING AUTHORITY OF   ADVANCED PRACTICE REGISTERED NURSE. (a)  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.          (b)  Except as provided by Subsection (c), the board may   authorize an advanced practice registered nurse 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.          (c)  The board may authorize a certified registered nurse   anesthetist practicing in an ambulatory surgical center to order   drugs and devices necessary for the nurse anesthetist to administer   an anesthetic or anesthesia-related service.   ARTICLE 2. CONFORMING AMENDMENTS REGARDING DELEGATION          SECTION 2.001.  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 2.002.  Sections 157.051(11) and (14), Occupations   Code, are amended to read as follows:                (11)  "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 Department of State Health Services;                      (D)  a clinic designated as a federally qualified   health center under 42 U.S.C. Section 1396d(l)(2)(B);                      (E)  a county, state, or federal correctional   facility;                      (F)  a practice:                            (i)  that either:                                  (a)  is located in an area in which the   Department of State Health Services determines there is an   insufficient number of physicians providing services to eligible   clients of federally, state, or locally funded health care   programs; or                                  (b)  is a practice that the Department   of State Health Services determines serves a disproportionate   number of clients eligible to participate in federally, state, or   locally funded health care programs; and                            (ii)  for which the Department of State   Health Services publishes notice of the department's 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; or                      (G)  a practice at which a physician was   delegating prescriptive authority to an advanced practice   registered nurse, as defined by Section 301.002, or physician   assistant on or before March 1, 2013, based on the practice   qualifying as a site serving a medically underserved population.                (14)  "Prescriptive authority agreement" means an   agreement entered into by a physician and a [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 2.003.  Section 157.0511(b-2), Occupations Code, is   amended to read as follows:          (b-2)  The board shall adopt rules that require a physician   who delegates the prescribing or ordering of a drug or device 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 2.004.  Sections 157.0512(a), (b), (c), (e), (f),   (g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended   to read as follows:          (a)  A physician may delegate to a [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 a [an advanced practice registered nurse   or] physician assistant are eligible to enter into or be parties to   a prescriptive authority agreement only if:                (1)  [if applicable, the Texas Board of Nursing has   approved the advanced practice registered nurse's authority to   prescribe or order a drug or device as authorized under this   subchapter;                [(2)]  the [advanced practice registered nurse or]   physician assistant:                      (A)  holds an active license to practice in this   state as a [an advanced practice 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 the] Texas Physician Assistant Board[, as   applicable,] from executing a prescriptive authority agreement;   and                (2) [(3)]  before executing the prescriptive authority   agreement, the physician and the [advanced practice registered   nurse or] physician assistant disclose to the other prospective   party to the agreement any prior disciplinary action by the board[,   the Texas Board of Nursing,] or the Texas Physician Assistant   Board[, as applicable].          (c)  Except as provided by Subsection (d), the [combined]   number of [advanced practice registered nurses and] physician   assistants with whom a physician may enter into a prescriptive   authority agreement 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.          (e)  A prescriptive authority agreement must, at a minimum:                (1)  be in writing and signed and dated by the parties   to the agreement;                (2)  state the name, address, and all professional   license numbers of the parties to the agreement;                (3)  state the nature of the practice, practice   locations, or practice settings;                (4)  identify the types or categories of drugs or   devices that may be prescribed or the types or categories of drugs   or devices that may not be prescribed;                (5)  provide a general plan for addressing consultation   and referral;                (6)  provide a plan for addressing patient emergencies;                (7)  state the general process for communication and   the sharing of information between the physician and the [advanced   practice registered nurse or] physician assistant to whom the   physician has delegated prescriptive authority related to the care   and treatment of patients;                (8)  if alternate physician supervision is to be   utilized, designate one or more alternate physicians who may:                      (A)  provide appropriate supervision on a   temporary basis in accordance with the requirements established by   the prescriptive authority agreement and the requirements of this   subchapter; and                      (B)  participate in the prescriptive authority   quality assurance and improvement plan meetings required under this   section; and                (9)  describe a prescriptive authority quality   assurance and improvement plan and specify methods for documenting   the implementation of the plan that include the following:                      (A)  chart review, with the number of charts to be   reviewed determined by the physician and [advanced practice   registered nurse or] physician assistant; and                      (B)  periodic meetings between the [advanced   practice registered nurse or] physician assistant and the   physician.          (f)  The periodic meetings described by Subsection (e)(9)(B)   must:                (1)  include:                      (A)  the sharing of information relating to   patient treatment and care, needed changes in patient care plans,   and issues relating to referrals; and                      (B)  discussion of patient care improvement;                (2)  be documented; and                (3)  take place at least once a month in a manner   determined by the physician and the [advanced practice registered   nurse or] physician assistant.          (g)  The prescriptive authority agreement may include other   provisions agreed to by the physician and [advanced practice   registered nurse or] physician assistant.          (i)  The prescriptive authority agreement need not describe   the exact steps that a [an advanced practice registered nurse or]   physician assistant must take with respect to each specific   condition, disease, or symptom.          (j)  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.          (l)  In the event that a party to a prescriptive authority   agreement is notified that the individual has become the subject of   an investigation by the board[, the Texas Board of Nursing,] or the   Texas Physician Assistant Board, the individual shall immediately   notify the other party to the prescriptive authority agreement.          (m)  The prescriptive authority agreement and any amendments   must be reviewed at least annually, dated, and signed by the parties   to the agreement.  The prescriptive authority agreement and any   amendments must be made available to the board[, the Texas Board of   Nursing,] or the Texas Physician Assistant Board not later than the   third business day after the date of receipt of request, if any.          (n)  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 the   physician.          (o)  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.          SECTION 2.005.  Section 157.0513, Occupations Code, is   amended to read as follows:          Sec. 157.0513.  PRESCRIPTIVE AUTHORITY AGREEMENT:   INFORMATION. (a)  The board[, the Texas Board of Nursing,] and the   Texas Physician Assistant Board shall jointly 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 board [boards] when a license holder of the board becomes the   subject of an investigation involving the delegation and   supervision of prescriptive authority, as well as the final   disposition of any such investigation;                (3)  by which each board shall maintain and share a list   of the board's license holders who have been subject to a final   adverse disciplinary action for an act involving the delegation and   supervision of prescriptive authority; and                (4)  to ensure that each [advanced practice registered   nurse or] physician assistant who has entered into a prescriptive   authority agreement authorizing the prescribing of opioids is   required to complete not less than two hours of continuing   education annually regarding safe and effective pain management   related to the prescription of opioids and other controlled   substances, including education regarding:                      (A)  reasonable standards of care;                      (B)  the identification of drug-seeking behavior   in patients; and                      (C)  effectively communicating with patients   regarding the prescription of an opioid or other controlled   substance.          (b)  If the board[, the Texas Board of Nursing,] or the Texas   Physician Assistant Board receives a notice under Subsection   (a)(2), the board that received notice may open an investigation   against a license holder of the board who is a party to a   prescriptive authority agreement with the license holder who is   under investigation by the board that provided notice under   Subsection (a)(2).          (c)  The board shall maintain and make available to the   public a searchable online list of physicians[, advanced practice   registered nurses,] and physician assistants who have entered into   a prescriptive authority agreement authorized under Section   157.0512 and identify the physician[, advanced practice registered   nurse, or physician assistant] with whom each [physician, advanced   practice registered nurse, and] physician assistant has entered   into a prescriptive authority agreement.          (d)  The board shall collaborate with the [Texas Board of   Nursing and the] 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 2.006.  Sections 157.054(a), (a-1), (b), and (c),   Occupations Code, are amended to read as follows:          (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 hospital or licensed   long-term care facility, the administration or provision of a drug   and the prescribing or ordering of a drug or device if each of the   delegating physicians 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 registered   nurse] practices; or                (4)  a physician who consents to the request of the   medical director or chief of medical staff to delegate the   prescribing or ordering of a drug or device at the facility in which   the physician assistant [or advanced practice registered nurse]   practices.          (a-1)  The limit [limits] on the number of [advanced practice   registered nurses or] physician assistants to whom a physician may   delegate under Section 157.0512 does [do] not apply to a physician   under Subsection (a) 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, a department chair, or a   physician who consents to delegate under Subsection (a)(4);                (3)  the delegation may not permit the 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 prescribing or ordering   of a drug or device to not more than seven [advanced practice   registered nurses or] physician assistants or their full-time   equivalents.          (c)  Physician supervision of the 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.          SECTION 2.007.  Section 157.055, Occupations Code, is   amended to read as follows:          Sec. 157.055.  ORDERS AND PROTOCOLS.  A protocol or other   order shall be defined in a manner that promotes the exercise of   professional judgment by the [advanced practice registered nurse   and] physician assistant commensurate with the education and   experience of that person.  Under this section, an order or   protocol used by a reasonable and prudent physician exercising   sound medical judgment:                (1)  is not required to describe the exact steps that   [an advanced practice registered nurse or] a physician assistant   must take with respect to each specific condition, disease, or   symptom; and                (2)  may state the types or categories of medications   that may be prescribed or the types or categories of medications   that may not be prescribed.          SECTION 2.008.  Section 157.056, Occupations Code, is   amended to read as follows:          Sec. 157.056.  PRESCRIPTION INFORMATION. The following   information must be provided on each prescription subject to this   subchapter:                (1)  the patient's name and address;                (2)  the drug to be dispensed;                (3)  directions to the patient regarding the taking of   the drug and the dosage;                (4)  the intended use of the drug, if appropriate;                (5)  the name, address, and telephone number of the   physician;                (6)  the name, address, telephone number, and   identification number of the [registered nurse or] physician   assistant completing or signing the prescription drug order;                (7)  the date; and                (8)  the number of refills permitted.          SECTION 2.009.  Sections 157.059(b), (e), (f), (g), (h), and   (i), Occupations Code, are amended to read as follows:          (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.          (e)  The physician's orders, medical orders, standing   delegation orders, prescriptive authority agreements, 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)  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 or [,]   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.          SECTION 2.010.  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 practice registered 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, prescribe, or order a drug or device.   ARTICLE 3. GENERAL CONFORMING AMENDMENTS          SECTION 3.001.  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 301.002   [301.152], Occupations Code.          SECTION 3.002.  Section 61.601, Education Code, as amended   by Chapters 891 (H.B. 3083) and 1101 (H.B. 3808), Acts of the 85th   Legislature, Regular Session, 2017, is reenacted and amended to   read as follows:          Sec. 61.601.  DEFINITION. In this subchapter, "mental   health professional" means:                (1)  a licensed physician who is:                      (A)  a graduate of an accredited psychiatric   residency training program; or                      (B)  certified in psychiatry by:                            (i)  the American Board of Psychiatry and   Neurology; or                            (ii)  the American Osteopathic Board of   Neurology and Psychiatry;                (2)  a psychologist, as defined by Section 501.002,   Occupations Code;                (3)  a licensed professional counselor, as defined by   Section 503.002, Occupations Code;                (4)  an advanced practice registered nurse, as defined   by Section 301.002 [301.152], Occupations Code, who holds a   nationally recognized board certification in psychiatric or mental   health nursing;                (5)  a licensed clinical social worker, as defined by   Section 505.002, Occupations Code; [and]                (6)  a licensed marriage and family therapist, as   defined by Section 502.002, Occupations Code; and                (7) [(6)]  a chemical dependency counselor, as defined   by Section 504.001, Occupations Code.          SECTION 3.003.  Section 263.001(a)(1), Family Code, is   amended to read as follows:                (1)  "Advanced practice nurse" has the meaning assigned   to "advanced practice registered nurse" by Section 301.002   [157.051], Occupations Code.          SECTION 3.004.  Section 266.001(1), Family Code, is amended   to read as follows:                (1)  "Advanced practice nurse" has the meaning assigned   to "advanced practice registered nurse" by Section 301.002   [157.051], Occupations Code.          SECTION 3.005.  Section 531.0217(k), Government Code, is   amended to read as follows:          (k)  This section does not affect any requirement relating   to:                (1)  a rural health clinic; or                (2)  physician delegation of the authority to carry out   or sign prescription drug orders to a [an advanced practice nurse   or] physician assistant.          SECTION 3.006.  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 301.002 [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 3.007.  Section 47.001(3), Health and Safety Code,   is amended to read as follows:                (3)  "Health care provider" means:                      (A)  [a registered nurse recognized as] an   advanced practice registered nurse as defined by Section 301.002,   Occupations Code; [the Texas Board of Nursing] or                      (B)  a physician assistant licensed by the Texas   Physician Assistant Board.          SECTION 3.008.  Section 47.011(a), Health and Safety Code,   is amended to read as follows:          (a)  In this section, "midwife" has the meaning assigned by   Section 203.002, Occupations Code, and includes a nurse midwife   [described by Section 301.152, Occupations Code].          SECTION 3.009.  Sections 161.0052(b) and (c), Health and   Safety Code, are amended to read as follows:          (b)  The executive commissioner by rule shall require a   hospital to inform each elderly person admitted to the hospital for   a period of 24 hours or more that the pneumococcal and influenza   vaccines are available.  If the elderly person requests a vaccine,   and if a physician, [or] an advanced nurse practitioner, or a   physician assistant on behalf of a physician, determines that the   vaccine is in the person's best interest, the hospital must make the   vaccination available to the person before the person is discharged   from the hospital.          (c)  The executive commissioner by rule shall require an end   stage renal disease facility to offer, to the extent possible as   determined by the facility, the opportunity to receive the   pneumococcal and influenza vaccines to each elderly person who   receives ongoing care at the facility if a physician, [or] an   advanced nurse practitioner, or a physician assistant on behalf of   a physician, determines that the vaccine is in the person's best   interest.  If the facility decides it is not feasible to offer the   vaccine, the facility must provide the person with information on   other options for obtaining the vaccine.          SECTION 3.010.  Section 241.003(1), Health and Safety Code,   is amended to read as follows:                (1)  "Advanced practice nurse" has the meaning assigned   to "advanced practice registered nurse" by Section 301.002,   Occupations Code [means a registered nurse recognized as an   advanced practice nurse by the Texas Board of Nursing].          SECTION 3.011.  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)  a [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 3.012.  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 3.013.  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 3.014.  Section 481.0767(b), Health and Safety Code,   is amended to read as follows:          (b)  The board shall appoint the following members to the   advisory committee:                (1)  a physician licensed in this state who practices   in pain management;                (2)  a physician licensed in this state who practices   in family medicine;                (3)  a physician licensed in this state who performs   surgery;                (4)  a physician licensed in this state who practices   in emergency medicine at a hospital;                (5)  a physician licensed in this state who practices   in psychiatry;                (6)  an oral and maxillofacial surgeon;                (7)  a physician assistant [or advanced practice   registered nurse] to whom a physician has delegated the authority   to prescribe or order a drug or an advanced practice registered   nurse;                (8)  a pharmacist working at a chain pharmacy;                (9)  a pharmacist working at an independent pharmacy;                (10)  an academic pharmacist; and                (11)  two representatives of the health information   technology industry, at least one of whom is a representative of a   company whose primary line of business is electronic medical   records.          SECTION 3.015.  Sections 483.001(4), (12), and (13), 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 [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.                (12)  "Practitioner" means:                      (A)  a person licensed by:                            (i)  the Texas Medical Board, State Board of   Dental Examiners, Texas Optometry Board, or State Board of   Veterinary Medical Examiners to prescribe and administer dangerous   drugs; or                            (ii)  the Texas Department of Licensing and   Regulation, with respect to podiatry, 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)  a [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; or                      (E)  an advanced practice registered nurse   authorized to prescribe and order drugs and devices under Section   301.358, Occupations Code.                (13)  "Prescription" means an order from a   practitioner, or an agent of the practitioner designated in writing   as authorized to communicate prescriptions, or an order made in   accordance with Subchapter B, Chapter 157, Occupations Code, or   Section 203.353, Occupations Code, to a pharmacist for a dangerous   drug to be dispensed that states:                      (A)  the date of the order's issue;                      (B)  the name and address of the patient;                      (C)  if the drug is prescribed for an animal, the   species of the animal;                      (D)  the name and quantity of the drug prescribed;                      (E)  the directions for the use of the drug;                      (F)  the intended use of the drug unless the   practitioner determines the furnishing of this information is not   in the best interest of the patient;                      (G)  the name, address, and telephone number of   the practitioner at the practitioner's usual place of business,   legibly printed or stamped; and                      (H)  the name, address, and telephone number of   the licensed midwife[, registered nurse,] or physician assistant,   legibly printed or stamped, if signed by a licensed midwife[,   registered nurse,] or physician assistant.          SECTION 3.016.  Section 483.022(f), Health and Safety Code,   is amended to read as follows:          (f)  A practitioner may designate a person who is a licensed   vocational nurse or has an education equivalent to or greater than   that required for a licensed vocational nurse to communicate   prescriptions of a [an advanced practice nurse or] physician   assistant authorized by the practitioner to sign prescription drug   orders under Subchapter B, Chapter 157, Occupations Code, or of an   advanced practice registered nurse.          SECTION 3.017.  Section 483.042(a), Health and Safety Code,   is amended to read as follows:          (a)  A person commits an offense if the person delivers or   offers to deliver a dangerous drug:                (1)  unless:                      (A)  the dangerous drug is delivered or offered   for delivery by a pharmacist under:                            (i)  a prescription issued by a practitioner   described by Section 483.001(12)(A), [or] (B), or (E);                            (ii)  a prescription signed by a [registered   nurse or] physician assistant in accordance with Subchapter B,   Chapter 157, Occupations Code; or                            (iii)  an original written prescription   issued by a practitioner described by Section 483.001(12)(C); and                      (B)  a label is attached to the immediate   container in which the drug is delivered or offered to be delivered   and the label contains the following information:                            (i)  the name and address of the pharmacy   from which the drug is delivered or offered for delivery;                            (ii)  the date the prescription for the drug   is dispensed;                            (iii)  the number of the prescription as   filed in the prescription files of the pharmacy from which the   prescription is dispensed;                            (iv)  the name of the practitioner who   prescribed the drug and, if applicable, the name of the [registered   nurse or] physician assistant who signed the prescription;                            (v)  the name of the patient and, if the drug   is prescribed for an animal, a statement of the species of the   animal; and                            (vi)  directions for the use of the drug as   contained in the prescription; or                (2)  unless:                      (A)  the dangerous drug is delivered or offered   for delivery by:                            (i)  a practitioner in the course of   practice; or                            (ii)  a [registered nurse or] physician   assistant in the course of practice in accordance with Subchapter   B, Chapter 157, Occupations Code; and                      (B)  a label is attached to the immediate   container in which the drug is delivered or offered to be delivered   and the label contains the following information:                            (i)  the name and address of the   practitioner who prescribed the drug, and if applicable, the name   and address of the [registered nurse or] physician assistant;                            (ii)  the date the drug is delivered;                            (iii)  the name of the patient and, if the   drug is prescribed for an animal, a statement of the species of the   animal; and                            (iv)  the name of the drug, the strength of   the drug, and directions for the use of the drug.          SECTION 3.018.  Section 32.024(gg), Human Resources Code, is   amended to read as follows:          (gg)  Notwithstanding any other law, including Sections   843.312 and 1301.052, Insurance Code, the commission shall ensure   that advanced practice registered nurses and physician assistants   may be selected by and assigned to recipients of medical assistance   as the primary care providers of those recipients [regardless of   whether the physician supervising the advanced practice registered   nurse is included in any directory of providers of medical   assistance maintained by the commission]. This subsection may not   be construed as authorizing the commission to supervise or control   the practice of medicine as prohibited by Subtitle B, Title 3,   Occupations Code. The commission must require that advanced   practice registered nurses and physician assistants be treated in   the same manner as primary care physicians with regard to:                (1)  selection and assignment as primary care   providers; and                (2)  inclusion as primary care providers in any   directory of providers of medical assistance maintained by the   commission.          SECTION 3.019.  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; and                (2)  a [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 3.020.  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 nurse] who is authorized by the   physician to provide care under Subchapter B, Chapter 157,   Occupations Code, or an advanced practice registered nurse, as   defined by Section 301.002, Occupations Code, 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 3.021.  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 3.022.  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, as applicable:                (1)  the [advanced practice nurse or] physician   assistant is authorized by the physician to provide care under   Subchapter B, Chapter 157, Occupations Code; 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 3.023.  Section 1451.001(2), Insurance Code, is   amended to read as follows:                (2)  "Advanced practice registered nurse" has the   meaning assigned by Section 301.002, Occupations Code [means an   individual licensed by the Texas Board of Nursing as a registered   nurse and recognized by that board as an advanced practice nurse].          SECTION 3.024.  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 3.025.  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 3.026.  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 301.002   [301.152], Occupations Code.          SECTION 3.027.  Section 408.025, Labor Code, is amended by   amending Subsection (a-1) and adding Subsection (a-2) to read as   follows:          (a-1)  A [treating doctor may delegate to a physician   assistant who is licensed to practice in this state under Chapter   204, Occupations Code, or an advanced practice registered nurse who   is licensed to practice in this state under Chapter 301,   Occupations Code, the authority to complete and sign a] work status   report regarding an injured employee's ability to return to work   may be completed and signed by:                (1)  a physician assistant licensed to practice in this   state under Chapter 204, Occupations Code, who has been delegated   the authority by a treating doctor; or                (2)  an advanced practice registered nurse, as defined   by Section 301.002, Occupations Code.          (a-2)  The delegating treating doctor is responsible for the   acts of a [the] physician assistant [or advanced practice   registered nurse] under Subsection (a-1) [this subsection].          SECTION 3.028.  Section 203.002(2), Occupations Code, is   amended to read as follows:                (2)  "Certified nurse-midwife" means an advanced   practice [a person who is:                      [(A)  a] registered nurse as defined by Section   301.002 who is [under Chapter 301;                      [(B)  recognized as an advanced nurse   practitioner by the Texas Board of Nursing; and                      [(C)]  certified by the American College of   Nurse-Midwives.          SECTION 3.029.  Section 204.1025, Occupations Code, is   amended to read as follows:          Sec. 204.1025.  DUTIES REGARDING PRESCRIPTIVE AUTHORITY   AGREEMENTS. The physician assistant board shall in conjunction   with the Texas Medical Board [and the Texas Board of Nursing]   perform the functions and duties relating to prescriptive authority   agreements assigned to the physician assistant board in Sections   157.0512 and 157.0513.          SECTION 3.030.  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.                (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   authorized to prescribe and order drugs and devices under Section   301.358, 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)  a [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 3.031.  Section 563.051(e), Occupations Code, is   amended to read as follows:          (e)  A practitioner may designate a licensed vocational   nurse or a person having education equivalent to or greater than   that required for a licensed vocational nurse to communicate the   prescriptions of a [an advanced practice nurse or] physician   assistant authorized by the practitioner to sign prescription drug   orders under Subchapter B, Chapter 157, or of an advanced practice   registered nurse.          SECTION 3.032.  Sections 605.002(14) and (18), Occupations   Code, are 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 a 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.                (18)  "Prosthetics" means the science and practice of   measuring, designing, fabricating, assembling, fitting, adjusting,   or servicing a prosthesis under an order from a licensed physician,   chiropractor, [or] podiatrist, or [an] advanced practice   registered nurse, or from a 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.          SECTION 3.033.  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 a 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 a 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 4. REPEALER          SECTION 4.001.  The following provisions are repealed:                (1)  Section 533.005(d), Government Code;                (2)  Section 62.1551(b), Health and Safety Code; and                (3)  Sections 157.051(1), 157.058, and 301.168,   Occupations Code.   ARTICLE 5. TRANSITION AND EFFECTIVE DATE          SECTION 5.001.  Not later than February 1, 2022, the Texas   Board of Nursing shall adopt the rules necessary to implement the   changes in law made by this Act.          SECTION 5.002.  Notwithstanding any changes in law made by   this Act, an advanced practice registered nurse who has been   delegated the authority to prescribe and order drugs and medical   devices by a physician's protocol or order under Section 157.0511,   157.0512, or 157.054, Occupations Code, may continue to exercise   that authority until February 1, 2022.          SECTION 5.003.  This Act takes effect September 1, 2021.