Bill Text: TX HB927 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to the practice of certain advanced practice registered nurses in certain rural counties; authorizing a fee.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2019-03-13 - Referred directly to subcommittee by chair [HB927 Detail]

Download: Texas-2019-HB927-Introduced.html
  86R4821 BEE-D
 
  By: White H.B. No. 927
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the practice of certain advanced practice registered
  nurses in certain rural counties; authorizing a fee.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
  ARTICLE 1. PRACTICE OF ADVANCED PRACTICE REGISTERED NURSES IN
  CERTAIN RURAL COUNTIES
         SECTION 1.001.  Chapter 487, Government Code, is amended by
  adding Subchapter S to read as follows:
  SUBCHAPTER S. REQUEST TO AUTHORIZE PRACTICE OF ADVANCED PRACTICE
  REGISTERED NURSES IN CERTAIN RURAL COUNTIES
         Sec. 487.851.  IDENTIFICATION OF HEALTH PROFESSIONAL
  SHORTAGE AREAS. (a)  Not later than October 1 of each year, the
  office shall:
               (1)  identify the rural counties of this state that are
  determined to be health professional shortage areas by the United
  States Department of Health and Human Services; and
               (2)  provide a list of the counties identified under
  Subdivision (1) to:
                     (A)  each county judge in this state; and
                     (B)  the Texas Board of Nursing.
         (b)  The department by rule shall establish the criteria for
  a county to be identified as a rural county for the purposes of
  Subsection (a).
         Sec. 487.852.  REQUEST FOR AUTHORIZATION OF PRACTICE OF
  ADVANCED PRACTICE REGISTERED NURSES. Not later than December 1 of
  each year, the county commissioners court of a county identified
  under Section 487.851(a)(1) or of an adjacent county may direct the
  county judge to submit to the Texas Board of Nursing a written
  request for the board to authorize the practice in the county of
  advanced practice registered nurses under Section 301.357,
  Occupations Code.
         SECTION 1.002.  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 with respect to an advanced practice registered
  nurse authorized to practice 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, or Section 301.357;
                     (G)  the performance of an act delegated by a
  physician under Section 157.0512, 157.054, 157.058, or 157.059;
  [and]
                     (H)  the development of the nursing care plan; and
                     (I)  the performance of an act by an advanced
  practice registered nurse in accordance with Section 301.357.
               (6)  "Controlled substance" has the meaning assigned by
  Section 481.002, Health and Safety Code.
               (7)  "Dangerous drug" has the meaning assigned by
  Section 483.001, Health and Safety Code.
               (8)  "Device" has the meaning assigned by Section
  551.003, and includes durable medical equipment.
               (9)  "Nonprescription drug" has the meaning assigned by
  Section 551.003.
               (10)  "Prescribe or order a drug or device" has the
  meaning assigned by Section 157.051.
         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 as authorized by the
  board under Section 301.357;
                     (B)  a system for approving an advanced practice
  registered nurse to prescribe or order a drug or device as delegated
  by a physician under Section 157.0512 or 157.054 or as authorized by
  the board under Section 301.357 on the receipt of evidence of
  completing the specialized education and training requirement
  under Paragraph (A); and
                     (C)  a system for issuing a prescription
  authorization number to an advanced practice registered nurse
  approved under Paragraph (B); and
               (3)  concurrently renew any license or approval granted
  to an advanced practice registered nurse under this subsection and
  a license renewed by the advanced practice registered nurse under
  Section 301.301.
         SECTION 1.004.  Subchapter H, Chapter 301, Occupations Code,
  is amended by adding Section 301.357 to read as follows:
         Sec. 301.357.  PRACTICE OF CERTAIN ADVANCED PRACTICE
  REGISTERED NURSES IN CERTAIN RURAL COUNTIES.  (a)  The board shall
  authorize the practice under this section of an advanced practice
  registered nurse who:
               (1)  practices in a county:
                     (A)  identified under Section 487.851(a)(1),
  Government Code; and
                     (B)  the county judge of which has submitted a
  request under Section 486.852, Government Code;
               (2)  has been issued a prescription authorization
  number as provided by Section 301.152(b); and
               (3)  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)  subject to Subsection (c), prescribing and
  ordering drugs and devices, including 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 may 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.
         (d)  The board by rule:
               (1)  shall prescribe the application process for
  authorization to practice under this section;
               (2)  shall establish criteria to determine the county
  in which an advanced practice registered nurse practices for
  purposes of Subsection (a)(1); and
               (3)  may set a fee for an application for authorization
  under this section in a reasonable amount that is sufficient to
  cover the costs of administering this section.
         (e)  An authorization under this section remains in effect as
  long as the advanced practice registered nurse practices in a
  county described by Subsection (a)(1).
  ARTICLE 2. CONFORMING AMENDMENTS
         SECTION 2.001.  Section 38.151(1), Education Code, is
  amended to read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  to "advanced practice registered nurse" by Section 301.152,
  Occupations Code.
         SECTION 2.002.  Section 671.001(b), Government Code, is
  amended to read as follows:
         (b)  The pilot program must provide for the following:
               (1)  a licensed advanced practice registered nurse as
  defined by Section 301.152, Occupations Code, or a licensed
  physician assistant as described by Chapter 204, Occupations Code,
  who is employed by the state or whose services are acquired by
  contract, who will be located at a state office complex;
               (2)  if applicable, a licensed physician, who is
  employed by a state governmental entity for purposes other than the
  pilot program or whose services are acquired by contract, who will
  delegate to and supervise the advanced practice registered nurse or
  physician assistant under a prescriptive authority agreement under
  Chapter 157, Occupations Code;
               (3)  appropriate office space and equipment for the
  advanced practice registered nurse or physician assistant to
  provide basic medical care to employees at the state office complex
  where the nurse or physician assistant is located; and
               (4)  professional liability insurance covering
  services provided by the advanced practice registered nurse or the
  physician assistant.
         SECTION 2.003.  Section 481.002(39), Health and Safety Code,
  is amended to read as follows:
               (39)  "Practitioner" means:
                     (A)  a physician, dentist, veterinarian,
  podiatrist, scientific investigator, advanced practice registered
  nurse, or other person licensed, registered, or otherwise permitted
  to distribute, dispense, analyze, conduct research with respect to,
  or administer a controlled substance in the course of professional
  practice or research in this state;
                     (B)  a pharmacy, hospital, or other institution
  licensed, registered, or otherwise permitted to distribute,
  dispense, conduct research with respect to, or administer a
  controlled substance in the course of professional practice or
  research in this state;
                     (C)  a person practicing in and licensed by
  another state as a physician, dentist, veterinarian, advanced
  practice registered nurse, or podiatrist, having a current Federal
  Drug Enforcement Administration registration number, who may
  legally prescribe Schedule II, III, IV, or V controlled substances
  in that state; or
                     (D)  an advanced practice registered nurse or
  physician assistant to whom a physician has delegated the authority
  to prescribe or order a drug or device under Section 157.0511,
  157.0512, or 157.054, Occupations Code.
         SECTION 2.004.  Section 481.073(a), Health and Safety Code,
  is amended to read as follows:
         (a)  Only a practitioner defined by Section 481.002(39)(A)
  and an agent designated in writing by the practitioner in
  accordance with rules adopted by the board may communicate a
  prescription by telephone. A pharmacy that receives a
  telephonically communicated prescription shall promptly write the
  prescription and file and retain the prescription in the manner
  required by this subchapter. A practitioner who designates an
  agent to communicate prescriptions shall maintain the written
  designation of the agent in the practitioner's usual place of
  business and shall make the designation available for inspection by
  investigators for the Texas Medical Board, the State Board of
  Dental Examiners, the State Board of Veterinary Medical Examiners,
  the Texas Board of Nursing, the board, and the department. A
  practitioner who designates a different agent shall designate that
  agent in writing and maintain the designation in the same manner in
  which the practitioner initially designated an agent under this
  section.
         SECTION 2.005.  Section 481.074(d), Health and Safety Code,
  is amended to read as follows:
         (d)  Except as specified in Subsections (e) and (f), the
  board, by rule and in consultation with the Texas Medical Board and
  the Texas Board of Nursing, shall establish the period after the
  date on which the prescription is issued that a person may fill a
  prescription for a controlled substance listed in Schedule II.  A
  person may not refill a prescription for a substance listed in
  Schedule II.
         SECTION 2.006.  Section 481.076(c), Health and Safety Code,
  is amended to read as follows:
         (c)  The board by rule shall design and implement a system
  for submission of information to the board by electronic or other
  means and for retrieval of information submitted to the board under
  this section and Sections 481.074 and 481.075. The board shall use
  automated information security techniques and devices to preclude
  improper access to the information. The board shall submit the
  system design to the director, [and] the Texas Medical Board, and
  the Texas Board of Nursing for review and comment a reasonable time
  before implementation of the system and shall comply with the
  comments of those agencies unless it is unreasonable to do so.
         SECTION 2.007.  Sections 483.001(4) and (12), Health and
  Safety Code, are amended to read as follows:
               (4)  "Designated agent" means:
                     (A)  a licensed nurse, physician assistant,
  pharmacist, or other individual designated by a practitioner to
  communicate prescription drug orders to a pharmacist;
                     (B)  a licensed nurse, physician assistant, or
  pharmacist employed in a health care facility to whom the
  practitioner communicates a prescription drug order; or
                     (C)  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, or an advanced practice registered
  nurse authorized to practice under Section 301.357, Occupations
  Code.
               (12)  "Practitioner" means:
                     (A)  a person licensed by:
                           (i)  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; 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.
         SECTION 2.008.  Section 32.03141, Human Resources Code, is
  amended to read as follows:
         Sec. 32.03141.  AUTHORITY OF ADVANCED PRACTICE REGISTERED
  NURSES AND PHYSICIAN ASSISTANTS REGARDING DURABLE MEDICAL
  EQUIPMENT AND SUPPLIES.  To the extent allowed by federal law, in
  addition to other health care practitioners authorized by federal
  law, the following persons may order and prescribe durable medical
  equipment and supplies under the medical assistance program:
               (1)  an advanced practice registered nurse authorized
  to practice under Section 301.357, Occupations Code; and
               (2)  an advanced practice registered nurse or physician
  assistant acting under adequate physician supervision and to whom a
  physician has delegated the authority to prescribe and order drugs
  and devices under Chapter 157, Occupations Code[, may order and
  prescribe durable medical equipment and supplies under the medical
  assistance program].
         SECTION 2.009.  Section 843.312, Insurance Code, is amended
  to read as follows:
         Sec. 843.312.  PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE
  REGISTERED NURSES. (a) A health maintenance organization may not
  refuse a request by a physician participating in the health
  maintenance organization delivery network and a physician
  assistant or advanced practice registered nurse who is authorized
  by the physician to provide care under Subchapter B, Chapter 157,
  Occupations Code, or an advanced practice registered nurse who is
  authorized to practice 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 2.010.  Section 1301.001(1-a), Insurance Code, is
  amended to read as follows:
               (1-a)  "Health care provider" means a practitioner,
  institutional provider, or other person or organization that
  furnishes health care services and that is licensed or otherwise
  authorized to practice in this state.  The term includes a
  pharmacist, [and] a pharmacy, and an advanced practice registered
  nurse.  The term does not include a physician.
         SECTION 2.011.  Section 1301.052, Insurance Code, is amended
  to read as follows:
         Sec. 1301.052.  DESIGNATION OF ADVANCED PRACTICE REGISTERED
  NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER. An insurer
  offering a preferred provider benefit plan may not refuse a request
  made by a physician participating as a preferred provider under the
  plan and an advanced practice registered nurse or physician
  assistant to have the advanced practice registered nurse or
  physician assistant included as a preferred provider under the plan
  if:
               (1)  the advanced practice registered nurse or
  physician assistant is authorized by the physician to provide care
  under Subchapter B, Chapter 157, Occupations Code, or the advanced
  practice registered nurse is authorized to practice 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 2.012.  Section 1451.001(2), Insurance Code, is
  amended to read as follows:
               (2)  "Advanced practice registered nurse" means an
  individual licensed by the Texas Board of Nursing as a registered
  nurse and licensed [recognized] by that board as an advanced
  practice registered nurse.
         SECTION 2.013.  Section 1451.104(c), Insurance Code, is
  amended to read as follows:
         (c)  Notwithstanding Subsection (a), a health insurance
  policy may provide for a different amount of payment or
  reimbursement for scheduled services or procedures performed by an
  advanced practice registered nurse, nurse first assistant,
  licensed surgical assistant, or physician assistant if the
  methodology used to compute the amount is the same as the
  methodology used to compute the amount of payment or reimbursement
  when the services or procedures are provided by a physician.
         SECTION 2.014.  Section 1451.106, Insurance Code, is amended
  to read as follows:
         Sec. 1451.106.  SELECTION OF ADVANCED PRACTICE REGISTERED
  NURSE. An insured may select an advanced practice registered nurse
  to provide the services scheduled in the health insurance policy
  that are within the scope of the nurse's license.
         SECTION 2.015.  Section 1452.051(1), Insurance Code, is
  amended to read as follows:
               (1)  "Advanced practice nurse" has the meaning assigned
  to "advanced practice registered nurse" by Section 301.152,
  Occupations Code.
         SECTION 2.016.  Sections 551.003(14) and (34), Occupations
  Code, are amended to read as follows:
               (14)  "Designated agent" means:
                     (A)  an individual, including a licensed nurse,
  physician assistant, or pharmacist:
                           (i)  who is designated by a practitioner and
  authorized to communicate a prescription drug order to a
  pharmacist; and
                           (ii)  for whom the practitioner assumes
  legal responsibility;
                     (B)  a licensed nurse, physician assistant, or
  pharmacist employed in a health care facility to whom a
  practitioner communicates a prescription drug order; or
                     (C)  a registered nurse or physician assistant
  authorized by a practitioner to administer a prescription drug
  order for a dangerous drug under Subchapter B, Chapter 157, or an
  advanced practice registered nurse authorized to practice under
  Section 301.357.
               (34)  "Practitioner" means:
                     (A)  a person licensed or registered to prescribe,
  distribute, administer, or dispense a prescription drug or device
  in the course of professional practice in this state, including a
  physician, dentist, podiatrist, advanced practice registered
  nurse, or veterinarian but excluding a person licensed under this
  subtitle;
                     (B)  a person licensed by another state, Canada,
  or the United Mexican States in a health field in which, under the
  law of this state, a license holder in this state may legally
  prescribe a dangerous drug;
                     (C)  a person practicing in another state and
  licensed by another state as a physician, dentist, veterinarian,
  advanced practice registered nurse, or podiatrist, who has a
  current federal Drug Enforcement Administration registration
  number and who may legally prescribe a Schedule II, III, IV, or V
  controlled substance, as specified under Chapter 481, Health and
  Safety Code, in that other state; or
                     (D)  an advanced practice registered nurse or
  physician assistant to whom a physician has delegated the authority
  to prescribe or order a drug or device under Section 157.0511,
  157.0512, or 157.054.
         SECTION 2.017.  Section 563.053, Occupations Code, is
  amended to read as follows:
         Sec. 563.053.  DISPENSING OF DANGEROUS DRUGS IN CERTAIN
  RURAL AREAS. (a) In this section, "reimbursement for cost" means
  an additional charge, separate from that imposed for the
  physician's or advanced practice registered nurse's professional
  services, that includes the cost of the drug product and all other
  actual costs to the physician or advanced practice registered nurse
  incidental to providing the dispensing service. The term does not
  include a separate fee imposed for the act of dispensing the drug
  itself.
         (b)  This section applies to an area located in a county with
  a population of 5,000 or less, or in a municipality or an
  unincorporated town with a population of less than 2,500, that is
  within a 15-mile radius of the physician's or advanced practice
  registered nurse's office and in which a pharmacy is not located.
  This section does not apply to a municipality or an unincorporated
  town that is adjacent to a municipality with a population of 2,500
  or more.
         (c)  A physician who practices medicine or an advanced
  practice registered nurse who is authorized to practice under
  Section 301.357 and who practices advanced practice registered
  nursing in an area described by Subsection (b) may:
               (1)  maintain a supply of dangerous drugs in the
  physician's or advanced practice registered nurse's office to be
  dispensed in the course of treating the physician's or advanced
  practice registered nurse's patients; and
               (2)  be reimbursed for the cost of supplying those
  drugs without obtaining a license under Chapter 558.
         (d)  A physician or advanced practice registered nurse who
  dispenses dangerous drugs under Subsection (c) shall:
               (1)  comply with each labeling provision under this
  subtitle applicable to that class of drugs; and
               (2)  oversee compliance with packaging and
  recordkeeping provisions applicable to that class of drugs.
         (e)  A physician who desires to dispense dangerous drugs
  under this section shall notify both the board and the Texas Medical
  [State] Board [of Medical Examiners] that the physician practices
  in an area described by Subsection (b). An advanced practice
  registered nurse who desires to dispense dangerous drugs under this
  section shall notify both the board and the Texas Board of Nursing
  that the advanced practice registered nurse practices in an area
  described by Subsection (b). The physician or advanced practice
  registered nurse may continue to dispense dangerous drugs in the
  area until the board determines, after notice and hearing, that the
  physician or advanced practice registered nurse no longer practices
  in an area described by Subsection (b).
         SECTION 2.018.  Section 605.002(14), Occupations Code, is
  amended to read as follows:
               (14)  "Orthotics" means the science and practice of
  measuring, designing, fabricating, assembling, fitting, adjusting,
  or servicing an orthosis under an order from a licensed physician,
  chiropractor, [or] podiatrist, or [an] advanced practice
  registered nurse, or from an advanced practice registered nurse or
  physician assistant acting under the delegation and supervision of
  a licensed physician as provided by Subchapter B, Chapter 157, and
  rules adopted by the Texas Medical Board, for the correction or
  alleviation of a neuromuscular or musculoskeletal dysfunction,
  disease, injury, or deformity.
         SECTION 2.019.  Section 605.2515, Occupations Code, is
  amended to read as follows:
         Sec. 605.2515.  ADDITIONAL LICENSE: DEVICE MANUFACTURER.  A
  person licensed to practice orthotics or prosthetics who measures,
  designs, fabricates, fits, assembles, adjusts, or services an
  orthosis or a prosthesis under an order from a licensed physician,
  chiropractor, [or] podiatrist, or [an] advanced practice
  registered nurse, or from an advanced practice registered nurse or
  physician assistant acting under the delegation and supervision of
  a licensed physician as provided by Subchapter B, Chapter 157, and
  rules adopted by the Texas Medical Board, for a specific patient is
  exempt from licensing as a device manufacturer under Subchapter L,
  Chapter 431, Health and Safety Code. A person licensed to practice
  orthotics or prosthetics who fabricates or assembles an orthosis or
  a prosthesis without an order from a licensed physician,
  chiropractor, [or] podiatrist, or [an] advanced practice
  registered nurse, or from an advanced practice registered nurse or
  physician assistant acting under the delegation and supervision of
  a licensed physician as provided by Subchapter B, Chapter 157, and
  rules adopted by the Texas Medical Board, for a specific patient is
  required to be licensed as a device manufacturer under Subchapter
  L, Chapter 431, Health and Safety Code.
  ARTICLE 3. TRANSITION; CONFLICT WITH OTHER LEGISLATION; EFFECTIVE
  DATE
         SECTION 3.001.  (a)  Notwithstanding the deadline provided
  by Section 487.851, Government Code, as added by this Act, the
  Office of Rural Affairs established in the Department of
  Agriculture shall produce the initial list required under that
  section not later than December 1, 2019. Notwithstanding the
  deadline provided by Section 487.852, Government Code, as added by
  this Act, a county judge may submit an initial request as provided
  by that section not later than February 1, 2020.
         (b)  Not later than February 1, 2020, the Texas Board of
  Nursing shall adopt the rules necessary to implement the changes in
  law made by this Act.
         SECTION 3.002.  To the extent of any conflict, this Act
  prevails over another Act of the 86th Legislature, Regular Session,
  2019, relating to nonsubstantive additions to and corrections in
  enacted codes.
         SECTION 3.003.  This Act takes effect September 1, 2019.
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