85R2865 EES-F     By: Klick H.B. No. 1415       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 by amending Subdivision (2) and adding Subdivisions (6),   (7), (8), (9), and (10) to read as follows:                (2)  "Professional nursing" means the performance of an   act that requires substantial specialized judgment and skill, the   proper performance of which is based on knowledge and application   of the principles of biological, physical, and social science as   acquired by a completed course in an approved school of   professional nursing.  The term does not include acts of medical   diagnosis or the prescription of therapeutic or corrective   measures, except as authorized for advanced practice registered   nurses.  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 performance of an act by an advanced   practice registered nurse in accordance with Section 301.357 [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 delegated by a   physician under Section [157.0512, 157.054,] 157.058[,] or   157.059; and                      (H)  the development of the nursing care plan.                (6)  "Controlled substance" has the meaning assigned by   Section 157.051.                (7)  "Dangerous drug" has the meaning assigned by   Section 157.051.                (8)  "Device" has the meaning assigned by Section   157.051.                (9)  "Nonprescription drug" has the meaning assigned by   Section 157.051.                (10)  "Prescribe or order a drug or device" has the   meaning assigned by Section 157.051.          SECTION 1.002.  Section 301.152, 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)  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."          (a-1)  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 or delegated by a physician under Section 157.058   or 157.059, 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.          (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.          SECTION 1.003.  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, with a prescription   authorization number issued as required under Section 301.357(b),   to prescribe and order drugs and devices, including controlled   substances listed in Schedules III, IV, and V, dangerous drugs, and   nonprescription drugs.          (b)  The board may authorize an advanced practice registered   nurse, with a prescription authorization number issued as required   under Section 301.357(b), to prescribe and order controlled   substances listed in Schedule II only:                (1)  in a hospital facility-based practice in   accordance with policies approved by the hospital's medical staff   or a committee of the hospital's medical staff as provided by the   hospital bylaws to ensure patient safety, and as part of the care   provided to a patient who:                      (A)  has been admitted to the hospital and is   expected to remain in the hospital for a period of 24 hours or more;   or                      (B)  is receiving services in the emergency   department of the hospital; or                (2)  as part of the plan of care for the treatment of a   person who has executed a written certification of a terminal   illness, has elected to receive hospice care, and is receiving   hospice treatment from a qualified hospice provider.   ARTICLE 2. CONFORMING AMENDMENTS 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 AND CERTAIN ADVANCED PRACTICE REGISTERED   NURSES          SECTION 2.002.  Sections 157.051(1) and (14), Occupations   Code, are amended to read as follows:                (1)  "Advanced practice registered nurse" has the   meaning assigned to that term by Section 301.357 [301.152].  The   term includes an advanced nurse practitioner and advanced practice   nurse.                (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 includes 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 face-to-face meetings between the   [advanced practice registered nurse or] physician assistant and the   physician at a location determined by the physician and the   [advanced practice registered nurse or] physician assistant.          (f)  The periodic face-to-face 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; and                (2)  be documented and occur:                      (A)  except as provided by Paragraph (B):                            (i)  at least monthly until the third   anniversary of the date the agreement is executed; and                            (ii)  at least quarterly after the third   anniversary of the date the agreement is executed, with monthly   meetings held between the quarterly meetings by means of a remote   electronic communications system, including videoconferencing   technology or the Internet; or                      (B)  if during the seven years preceding the date   the agreement is executed the [advanced practice registered nurse   or] physician assistant for at least five years was in a practice   that included the exercise of prescriptive authority with required   physician supervision:                            (i)  at least monthly until the first   anniversary of the date the agreement is executed; and                            (ii)  at least quarterly after the first   anniversary of the date the agreement is executed, with monthly   meetings held between the quarterly meetings by means of a remote   electronic communications system, including videoconferencing   technology or the Internet.          (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; and                (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.          (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 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   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.  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 301.357   [301.152], Occupations Code.          SECTION 3.002.  Section 61.601, Education Code, is 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 301.357 [301.152], Occupations Code, who holds a   nationally recognized board certification in psychiatric or mental   health nursing; and                (5)  a licensed clinical social worker, as defined by   Section 505.002, Occupations Code.          SECTION 3.003.  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 301.357 [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 3.004.  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 301.357 [301.152], Occupations Code.          SECTION 3.005.  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 3.006.  Section 481.073(a), Health and Safety Code,   is amended to read as follows:          (a)  Only a practitioner defined by Section 481.002(39)(A)   and an agent designated in writing by the practitioner in   accordance with rules adopted by the board may communicate a   prescription by telephone. A pharmacy that receives a   telephonically communicated prescription shall promptly write the   prescription and file and retain the prescription in the manner   required by this subchapter. A practitioner who designates an   agent to communicate prescriptions shall maintain the written   designation of the agent in the practitioner's usual place of   business and shall make the designation available for inspection by   investigators for the Texas Medical Board, the State Board of   Dental Examiners, the State Board of Veterinary Medical Examiners,   the Texas Board of Nursing, the board, and the department. A   practitioner who designates a different agent shall designate that   agent in writing and maintain the designation in the same manner in   which the practitioner initially designated an agent under this   section.          SECTION 3.007.  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 3.008.  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 3.009.  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, or an advanced practice registered nurse authorized by a   practitioner to carry out a prescription drug order for dangerous   drugs.                (12)  "Practitioner" means:                      (A)  a person licensed by the Texas Medical Board,   State Board of Dental Examiners, Texas State Board of Podiatric   Medical Examiners, Texas Optometry Board, Texas Board of Nursing,   or State Board of Veterinary Medical Examiners to prescribe and   administer dangerous drugs;                      (B)  a person licensed by another state in a   health field in which, under the laws of this state, a licensee may   legally prescribe dangerous drugs;                      (C)  a person licensed in Canada or Mexico in a   health field in which, under the laws of this state, a licensee may   legally prescribe dangerous drugs; or                      (D)  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.                (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 3.010.  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 3.011.  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);                            (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 3.012.  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 3.013.  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 who is   authorized to provide care under Section 301.357, 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 3.014.  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 3.015.  Section 1301.052, Insurance Code, is amended   to read as follows:          Sec. 1301.052.  DESIGNATION OF ADVANCED PRACTICE REGISTERED   NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer   offering a preferred provider benefit plan may not refuse a request   made by a physician participating as a preferred provider under the   plan and an advanced practice registered nurse or physician   assistant to have the advanced practice registered nurse or   physician assistant included as a preferred provider under the plan   if:                (1)  the [advanced practice nurse or] physician   assistant is authorized by the physician to provide care under   Subchapter B, Chapter 157, Occupations Code, or the advanced   practice registered nurse is authorized to provide care under   Section 301.357, 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 3.016.  Section 1451.001(2), Insurance Code, is   amended to read as follows:                (2)  "Advanced practice registered nurse" means an   individual licensed by the Texas Board of Nursing as a registered   nurse and licensed [recognized] by that board as an advanced   practice registered nurse.          SECTION 3.017.  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 3.018.  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 3.019.  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 301.357   [301.152], Occupations Code.          SECTION 3.020.  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 3.021.  Sections 551.003(14) and (34), Occupations   Code, are amended to read as follows:                (14)  "Designated agent" means:                      (A)  an individual, including a licensed nurse,   physician assistant, or pharmacist:                            (i)  who is designated by a practitioner and   authorized to communicate a prescription drug order to a   pharmacist; and                            (ii)  for whom the practitioner assumes   legal responsibility;                      (B)  a licensed nurse, physician assistant, or   pharmacist employed in a health care facility to whom a   practitioner communicates a prescription drug order; or                      (C)  a [registered nurse or] physician assistant   authorized by a practitioner to administer a prescription drug   order for a dangerous drug under Subchapter B, Chapter 157, or an   advanced practice registered nurse authorized by a practitioner to   administer a prescription drug order for a dangerous drug.                (34)  "Practitioner" means:                      (A)  a person licensed or registered to prescribe,   distribute, administer, or dispense a prescription drug or device   in the course of professional practice in this state, including a   physician, dentist, podiatrist, advanced practice registered   nurse, or veterinarian but excluding a person licensed under this   subtitle;                      (B)  a person licensed by another state, Canada,   or the United Mexican States in a health field in which, under the   law of this state, a license holder in this state may legally   prescribe a dangerous drug;                      (C)  a person practicing in another state and   licensed by another state as a physician, dentist, veterinarian,   advanced practice registered nurse, or podiatrist, who has a   current federal Drug Enforcement Administration registration   number and who may legally prescribe a Schedule II, III, IV, or V   controlled substance, as specified under Chapter 481, Health and   Safety Code, in that other state; or                      (D)  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 3.022.  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 3.023.  Section 563.053, Occupations Code, is   amended to read as follows:          Sec. 563.053.  DISPENSING OF DANGEROUS DRUGS IN CERTAIN   RURAL AREAS. (a) In this section, "reimbursement for cost" means   an additional charge, separate from that imposed for the   physician's or advanced practice registered nurse's professional   services, that includes the cost of the drug product and all other   actual costs to the physician or advanced practice registered nurse   incidental to providing the dispensing service. The term does not   include a separate fee imposed for the act of dispensing the drug   itself.          (b)  This section applies to an area located in a county with   a population of 5,000 or less, or in a municipality or an   unincorporated town with a population of less than 2,500, that is   within a 15-mile radius of the physician's or advanced practice   registered nurse's office and in which a pharmacy is not located.   This section does not apply to a municipality or an unincorporated   town that is adjacent to a municipality with a population of 2,500   or more.          (c)  A physician who practices medicine or an advanced   practice registered nurse who practices advanced practice   registered nursing in an area described by Subsection (b) may:                (1)  maintain a supply of dangerous drugs in the   physician's or advanced practice registered nurse's office to be   dispensed in the course of treating the physician's or advanced   practice registered nurse's patients; and                (2)  be reimbursed for the cost of supplying those   drugs without obtaining a license under Chapter 558.          (d)  A physician or advanced practice registered nurse who   dispenses dangerous drugs under Subsection (c) shall:                (1)  comply with each labeling provision under this   subtitle applicable to that class of drugs; and                (2)  oversee compliance with packaging and   recordkeeping provisions applicable to that class of drugs.          (e)  A physician who desires to dispense dangerous drugs   under this section shall notify both the board and the Texas Medical   [State] Board [of Medical Examiners] that the physician practices   in an area described by Subsection (b). An advanced practice   registered nurse who desires to dispense dangerous drugs under this   section shall notify both the board and the Texas Board of Nursing   that the advanced practice registered nurse practices in an area   described by Subsection (b). The physician or advanced practice   registered nurse may continue to dispense dangerous drugs in the   area until the board determines, after notice and hearing, that the   physician or advanced practice registered nurse no longer practices   in an area described by Subsection (b).          SECTION 3.024.  Section 605.002(14), Occupations Code, is   amended to read as follows:                (14)  "Orthotics" means the science and practice of   measuring, designing, fabricating, assembling, fitting, adjusting,   or servicing an orthosis under an order from a licensed physician,   chiropractor, [or] podiatrist, or [an] advanced practice   registered nurse, or from 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.          SECTION 3.025.  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.  Section 301.168, Occupations Code, is   repealed.   ARTICLE 5. TRANSITION AND EFFECTIVE DATE          SECTION 5.001.  Not later than February 1, 2018, the Texas   Board of Nursing shall adopt the rules necessary to implement the   changes in law made by this Act.          SECTION 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, 2018.          SECTION 5.003.  This Act takes effect September 1, 2017.