89R8356 BEE/SCL-F     By: Middleton, et al. S.B. No. 1859       A BILL TO BE ENTITLED   AN ACT   relating to the licensing and regulation of advanced practice   registered nurses and the payment of independent advanced practice   registered nurses in certain government employee health plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:   ARTICLE 1. REGULATION OF 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 performed by an advanced practice   registered nurse authorized to practice by the board under Section   301.357.  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 by an advanced practice   registered nurse of an act delegated by a physician under Section   157.0512, 157.054, 157.058, or 157.059; [and]                      (H)  the development of the nursing care plan; and                      (I)  the performance of an act by an advanced   practice registered nurse authorized to practice by the board under   Section 301.357.                [(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," [practitioner" or] "advanced practice nurse," or   "advanced practice registered nurse" means an advanced practice   registered nurse.          SECTION 1.003.  Section 301.152(b), Occupations Code, is   amended to read as follows:          (b)  The board shall adopt rules to:                (1)  license a registered nurse as an advanced practice   registered nurse;                (2)  establish:                      (A)  any specialized education or training,   including pharmacology, that an advanced practice registered nurse   must have to prescribe or order a drug or device as delegated by a   physician under Section 157.0512 or 157.054 or authorized by the   board under Section 301.358;                      (B)  a system for approving an advanced practice   registered nurse to prescribe or order a drug or device as delegated   by a physician under Section 157.0512 or 157.054 or authorized by   the board under Section 301.358 on the receipt of evidence of   completing the specialized education and training requirement   under Paragraph (A); and                      (C)  a system for issuing a prescription   authorization number to an advanced practice registered nurse   approved under Paragraph (B); and                (3)  concurrently renew any license or approval granted   to an advanced practice registered nurse under this subsection and   a license renewed by the advanced practice registered nurse under   Section 301.301.          SECTION 1.004.  Section 301.303(b), Occupations Code, is   amended to read as follows:          (b)  Except as provided by a rule adopted under Section   301.357(f) for an advanced practice registered nurse authorized by   the board to practice under that section, the [The] board may not   require participation in more than a total of 20 hours of continuing   education in a two-year licensing period.          SECTION 1.005.  Subchapter H, Chapter 301, Occupations Code,   is amended by adding Sections 301.357 and 301.358 to read as   follows:          Sec. 301.357.  INDEPENDENT PRACTICE BY CERTAIN ADVANCED   PRACTICE REGISTERED NURSES. (a)  The board shall authorize the   practice under this section of an advanced practice registered   nurse who applies for authorization under this section in the   manner prescribed by the board.          (b)  The scope of practice of an advanced practice registered   nurse authorized to practice under this section 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.          (c)  An advanced practice registered nurse authorized to   practice under this section shall practice as a licensed   independent practitioner in accordance with standards established   and recognized by the board to protect the public health and safety.          (d)  An advanced practice registered nurse authorized to   practice under this section 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.          (e)  This section does not limit or modify the scope of   practice of a nurse who is not authorized to practice under this   section.          (f)  The board by rule shall establish:                (1)  the application process for authorization to   practice under this section;                (2)  eligibility requirements for authorization to   practice under this section, including any specialized education or   training, including pharmacology, that an advanced practice   registered nurse must obtain to practice under this section; and                (3)  systems to:                      (A)  authorize an advanced practice registered   nurse to prescribe or order a drug or device under Section 301.358   when the board receives evidence of the completion of the   specialized education and training required under Subdivision (2);   and                      (B)  concurrently renew for an advanced practice   registered nurse:                            (i)  an authorization issued under this   section or Section 301.358; and                            (ii)  a license issued under Section 301.152   or renewed under Section 301.301.          (g)  Rules adopted under Subsection (f)(2) must require that   the applicant:                (1)  hold:                      (A)  an active, unencumbered license to practice   as an advanced practice registered nurse in this state;                      (B)  current national certification in the role   and population focus of the advanced practice registered nurse; and                      (C)  a bachelor's degree and a master's or   doctoral degree from a nationally accredited educational program;                (2)  have completed academic coursework in physical   assessment, advanced pharmacology, and advanced pathophysiology;   and                (3)  not be the subject of any pending disciplinary   action or substantially equivalent action.          (h)  This section does not require an advanced practice   registered nurse to apply for authorization to practice under this   section.          Sec. 301.358.  PRESCRIBING AND ORDERING AUTHORITY OF   ADVANCED PRACTICE REGISTERED NURSE.  The board may authorize an   advanced practice registered nurse authorized to practice by the   board under Section 301.357 to prescribe and order drugs and   devices, including controlled substances listed in Schedules II,   III, IV, and V, dangerous drugs, and nonprescription drugs.   ARTICLE 2.  INDEPENDENT ADVANCED PRACTICE REGISTERED NURSES AS   PROVIDERS IN CERTAIN GOVERNMENT EMPLOYEE HEALTH PLANS          SECTION 2.001.  Subchapter E, Chapter 1551, Insurance Code,   is amended by adding Section 1551.232 to read as follows:          Sec. 1551.232.  SERVICES PROVIDED BY INDEPENDENT ADVANCED   PRACTICE REGISTERED NURSE.  (a)  In this section, "independent   advanced practice registered nurse" means an advanced practice   registered nurse authorized to practice under Section 301.357,   Occupations Code.          (b)  An administrator of the basic coverage plan provided   under this chapter shall pay for a covered health care service   provided to a participant by an independent advanced practice   registered nurse at a reimbursement rate applicable to services   provided by an independent advanced practice registered nurse   unless a physician supervising the independent advanced practice   registered nurse:                (1)  made a decision regarding the participant's care   or treatment on the same date the independent advanced practice   registered nurse provided the service; and                (2)  documented the decision in the participant's   medical record.          (c)  A physician who does not make a decision regarding a   participant's care or treatment on the same date that an   independent advanced practice registered nurse supervised by the   physician provides a health care service to the participant shall   certify on a claim for reimbursement that the service was wholly   provided by the independent advanced practice registered nurse.          (d)  An administrator of the basic coverage plan provided   under this chapter may consider independent advanced practice   registered nurses for purposes of network adequacy standards.          SECTION 2.002.  Subchapter D, Chapter 1575, Insurance Code,   is amended by adding Section 1575.175 to read as follows:          Sec. 1575.175.  SERVICES PROVIDED BY INDEPENDENT ADVANCED   PRACTICE REGISTERED NURSE.  (a)  In this section, "independent   advanced practice registered nurse" means an advanced practice   registered nurse authorized to practice under Section 301.357,   Occupations Code.          (b)  An administrator of a basic plan provided under this   chapter shall pay for a covered health care service provided to an   enrollee by an independent advanced practice registered nurse at a   reimbursement rate applicable to services provided by an   independent advanced practice registered nurse unless a physician   supervising the independent advanced practice registered nurse:                (1)  made a decision regarding the enrollee's care or   treatment on the same date the independent advanced practice   registered nurse provided the service; and                (2)  documented the decision in the enrollee's medical   record.          (c)  A physician who does not make a decision regarding an   enrollee's care or treatment on the same date that an independent   advanced practice registered nurse supervised by the physician   provides a health care service to the enrollee shall certify on a   claim for reimbursement that the service was wholly provided by the   independent advanced practice registered nurse.          (d)  An administrator of a basic plan provided under this   chapter may consider independent advanced practice registered   nurses for purposes of network adequacy standards.          SECTION 2.003.  Subchapter C, Chapter 1579, Insurance Code,   is amended by adding Section 1579.113 to read as follows:          Sec. 1579.113.  SERVICES PROVIDED BY INDEPENDENT ADVANCED   PRACTICE REGISTERED NURSE.  (a)  In this section, "independent   advanced practice registered nurse" means an advanced practice   registered nurse authorized to practice under Section 301.357,   Occupations Code.          (b)  An administrator of the primary care coverage plan   provided under this chapter shall pay for a covered health care   service provided to an enrollee by an independent advanced practice   registered nurse at a reimbursement rate applicable to services   provided by an independent advanced practice registered nurse   unless a physician supervising the independent advanced practice   registered nurse:                (1)  made a decision regarding the enrollee's care or   treatment on the same date the independent advanced practice   registered nurse provided the service; and                (2)  documented the decision in the enrollee's medical   record.          (c)  A physician who does not make a decision regarding an   enrollee's care or treatment on the same date that an independent   advanced practice registered nurse supervised by the physician   provides a health care service to the enrollee shall certify on a   claim for reimbursement that the service was wholly provided by the   independent advanced practice registered nurse.          (d)  An administrator of the primary care coverage plan   provided under this chapter may consider independent advanced   practice registered nurses for purposes of network adequacy   standards.          SECTION 2.004.  Subchapter C, Chapter 1601, Insurance Code,   is amended by adding Section 1601.112 to read as follows:          Sec. 1601.112.  SERVICES PROVIDED BY INDEPENDENT ADVANCED   PRACTICE REGISTERED NURSE.  (a)  In this section, "independent   advanced practice registered nurse" means an advanced practice   registered nurse authorized to practice under Section 301.357,   Occupations Code.          (b)  An administrating carrier of basic coverage provided   under this chapter shall pay for a covered health care service   provided to an enrollee by an independent advanced practice   registered nurse at a reimbursement rate applicable to services   provided by an independent advanced practice registered nurse   unless a physician supervising the independent advanced practice   registered nurse:                (1)  made a decision regarding the enrollee's care or   treatment on the same date the independent advanced practice   registered nurse provided the service; and                (2)  documented the decision in the enrollee's medical   record.          (c)  A physician who does not make a decision regarding an   enrollee's care or treatment on the same date that an independent   advanced practice registered nurse supervised by the physician   provides a health care service to the enrollee shall certify on a   claim for reimbursement that the service was wholly provided by the   independent advanced practice registered nurse.          (d)  An administrating carrier of basic coverage provided   under this chapter may consider independent advanced practice   registered nurses for purposes of network adequacy standards.          SECTION 2.005.  Not later than December 1, 2026, an   administrator to which Section 1551.232, 1575.175, 1579.113, or   1601.112, Insurance Code, as added by this article, applies shall   develop and submit a written report to the governor, lieutenant   governor, and members of the legislature on the cost savings   resulting from implementation of the applicable section.          SECTION 2.006.  Sections 1551.232, 1575.175, 1579.113, and   1601.112, Insurance Code, as added by this article, apply only to a   health care service provided on or after January 1, 2026.   ARTICLE 3.  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 38.211(a), Education Code, is   amended to read as follows:          (a)  A physician, a [or] person who has been delegated   prescriptive authority under Chapter 157, Occupations Code, or an   advanced practice registered nurse authorized to prescribe and   order drugs and devices under Section 301.358, Occupations Code,   may prescribe epinephrine auto-injectors or medication for   respiratory distress in the name of a school district,   open-enrollment charter school, or private school.          SECTION 3.003.  Section 38.225(a), Education Code, is   amended to read as follows:          (a)  A physician, a [or] person who has been delegated   prescriptive authority under Chapter 157, Occupations Code, or an   advanced practice registered nurse authorized to prescribe and   order drugs and devices under Section 301.358, Occupations Code,   may prescribe opioid antagonists in the name of a school district,   open-enrollment charter school, or private school.          SECTION 3.004.  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 301.002 [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;                (6)  a licensed specialist in school psychology, as   defined by Section 501.002, Occupations Code;                (7)  a chemical dependency counselor, as defined by   Section 504.001, Occupations Code; and                (8)  a licensed marriage and family therapist, as   defined by Section 502.002, Occupations Code.          SECTION 3.005.  Section 1101.100(1), Estates Code, is   amended to read as follows:                (1)  "Advanced practice registered nurse" has the   meaning assigned by Section 301.002 [301.152], Occupations Code.          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)  either:                      (A)  both:                            (i)  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;   and                            (ii) [(2)]  a licensed physician, who is   employed by a state governmental entity for purposes other than the   pilot program or whose services are acquired by contract, who will   delegate to and supervise the advanced practice registered nurse or   physician assistant under a prescriptive authority agreement under   Chapter 157, Occupations Code; or                      (B)  an advanced practice registered nurse   authorized to practice under Section 301.357, Occupations Code;                (2) [(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                (3) [(4)]  professional liability insurance covering   services provided by the advanced practice registered nurse or the   physician assistant.          SECTION 3.007.  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 3.008.  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 physician   assistant on behalf of a physician, or an advanced practice   registered nurse authorized to prescribe and order drugs and   devices under Section 301.358, Occupations Code, 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 physician assistant on behalf of a physician,   or an advanced practice registered nurse authorized to prescribe   and order drugs and devices under Section 301.358, Occupations   Code, 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 3.009.  Section 401.504(d), Health and Safety Code,   is amended to read as follows:          (d)  This subchapter does not apply to a physician, [or to] a   physician's employee or delegate acting under Chapter 157,   Occupations Code, or an advanced practice registered nurse   authorized to prescribe and order drugs and devices under Section   301.358, Occupations Code.          SECTION 3.010.  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 authorized to prescribe and order drugs and devices under   Section 301.358, Occupations Code, or other person licensed,   registered, or otherwise permitted to distribute, dispense,   analyze, conduct research with respect to, or administer a   controlled substance in the course of professional practice or   research in this state;                      (B)  a pharmacy, hospital, or other institution   licensed, registered, or otherwise permitted to distribute,   dispense, conduct research with respect to, or administer a   controlled substance in the course of professional practice or   research in this state;                      (C)  a person practicing in and licensed by   another state as a physician, dentist, veterinarian, advanced   practice registered nurse, or podiatrist, having a current Federal   Drug Enforcement Administration registration number, who may   legally prescribe Schedule II, III, IV, or V controlled substances   in that state; or                      (D)  an advanced practice registered nurse or   physician assistant to whom a physician has delegated the authority   to prescribe or order a drug or device under Section 157.0511,   157.0512, or 157.054, Occupations Code.          SECTION 3.011.  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 3.012.  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 3.013.  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   authorized to prescribe and order drugs and devices under Section   301.358, Occupations Code;                (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 3.014.  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)  an advanced practice [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)  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, advanced practice registered nurse, or   physician assistant, legibly printed or stamped, if signed by a   licensed midwife, advanced practice registered nurse, or physician   assistant.          SECTION 3.015.  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 an advanced practice registered 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 authorized to prescribe and   order drugs and devices under Section 301.358, Occupations Code.          SECTION 3.016.  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 an advanced   practice [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 advanced   practice 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)  an advanced practice [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 advanced practice 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 3.017.  Section 773.0145(k), Health and Safety Code,   is amended to read as follows:          (k)  A physician, a [or] person who has been delegated   prescriptive authority under Chapter 157, Occupations Code, or an   advanced practice registered nurse authorized to prescribe and   order drugs and devices under Section 301.358, Occupations Code,   may prescribe epinephrine auto-injectors in the name of an entity.          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, if applicable, 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 authorized   to prescribe and order drugs and devices under Section 301.358,   Occupations Code; and                (2)  an advanced practice registered nurse or physician   assistant acting under adequate physician supervision and to whom a   physician has delegated the authority to prescribe and order drugs   and devices under Chapter 157, Occupations Code[, may order and   prescribe durable medical equipment and supplies under the medical   assistance program].          SECTION 3.020.  Section 42.067(b), Human Resources Code, is   amended to read as follows:          (b)  A physician, [or] a person who has been delegated   prescriptive authority under Chapter 157, Occupations Code, or an   advanced practice registered nurse authorized to prescribe and   order drugs and devices under Section 301.358, Occupations Code,   may prescribe epinephrine auto-injectors in the name of a day-care   center.          SECTION 3.021.  Section 843.312, Insurance Code, is amended   to read as follows:          Sec. 843.312.  PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE   REGISTERED NURSES. (a) A health maintenance organization may not   refuse a request by a physician participating in the health   maintenance organization delivery network and a physician   assistant or advanced practice registered nurse who is authorized   by the physician to provide care under Subchapter B, Chapter 157,   Occupations Code, or an advanced practice registered nurse   authorized to prescribe and order drugs and devices under Section   301.358, 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 3.022.  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 authorized to practice under Section 301.357, Occupations   Code.  The term does not include a physician.          SECTION 3.023.  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 3.024.  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;                (2)  an advanced practice registered nurse licensed to   practice in this state under Chapter 301, Occupations Code, who has   been delegated the authority by a treating doctor; or                (3)  an advanced practice registered nurse authorized   to practice under Section 301.357, 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)(1) or an advanced practice   registered nurse under Subsection (a-1)(2) [this subsection].          SECTION 3.025.  Section 157.051(1), Occupations Code, is   amended to read as follows:                (1)  "Advanced practice registered nurse" has the   meaning assigned [to that term] by Section 301.002 [301.152].  [The   term includes an advanced nurse practitioner and advanced practice   nurse.]          SECTION 3.026.  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 [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 3.027.  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)  an advanced practice [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)  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 3.028.  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 an advanced practice registered 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 authorized to prescribe and order drugs and   devices under Section 301.358.          SECTION 3.029.  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:                (1)  "Advanced practice registered nurse" has the   meaning assigned by Section 301.002.                (2)  "Reimbursement [, "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.          (a-1)  This section applies to an advanced practice   registered nurse only to the extent that the advanced practice   registered nurse is authorized to prescribe and order drugs and   devices under Section 301.358.          (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 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 3.030.  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 advanced practice registered   nurse authorized to prescribe and order drugs and devices under   Section 301.358, or an advanced practice registered nurse or   physician assistant acting under the delegation and supervision of   a licensed physician as provided by Subchapter B, Chapter 157, and   rules adopted by the Texas Medical Board, for the correction or   alleviation of a neuromuscular or musculoskeletal dysfunction,   disease, injury, or deformity.                (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 advanced practice registered   nurse authorized to prescribe and order drugs and devices under   Section 301.358, or an advanced practice registered nurse or   physician assistant acting under the delegation and supervision of   a licensed physician as provided by Subchapter B, Chapter 157, and   rules adopted by the Texas Medical Board.          SECTION 3.031.  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 advanced practice registered   nurse authorized to prescribe and order drugs and devices under   Section 301.358, or an advanced practice registered nurse or   physician assistant acting under the delegation and supervision of   a licensed physician as provided by Subchapter B, Chapter 157, and   rules adopted by the Texas Medical Board, for a specific patient is   exempt from licensing as a device manufacturer under Subchapter L,   Chapter 431, Health and Safety Code. A person licensed to practice   orthotics or prosthetics who fabricates or assembles an orthosis or   a prosthesis without an order from a licensed physician,   chiropractor, [or] podiatrist, or advanced practice registered   nurse authorized to prescribe and order drugs and devices under   Section 301.358, or an advanced practice registered nurse or   physician assistant acting under the delegation and supervision of   a licensed physician as provided by Subchapter B, Chapter 157, and   rules adopted by the Texas Medical Board, for a specific patient is   required to be licensed as a device manufacturer under Subchapter   L, Chapter 431, Health and Safety Code.          SECTION 3.032.  Section 1701.703(a), Occupations Code, is   amended to read as follows:          (a)  A physician, [or] a person who has been delegated   prescriptive authority under Chapter 157, or an advanced practice   registered nurse authorized to prescribe and order drugs and   devices under Section 301.358, [Occupations Code,] may prescribe   epinephrine auto-injectors in the name of a law enforcement agency.   ARTICLE 4. REPEALER          SECTION 4.001.  Section 301.152(a), Occupations Code, is   repealed.   ARTICLE 5. TRANSITION AND EFFECTIVE DATE          SECTION 5.001.  Not later than February 1, 2026, the Texas   Board of Nursing shall adopt the rules necessary to implement the   changes in law made by this Act.          SECTION 5.002.  This Act takes effect September 1, 2025.