Bill Text: TX SB2438 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to the authority of certain advanced practice registered nurses.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2019-05-16 - Left pending in committee [SB2438 Detail]

Download: Texas-2019-SB2438-Introduced.html
  86R5023 BEE-F
 
  By: Rodríguez S.B. No. 2438
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the authority of certain 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 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 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.
               (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 1.002.  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 1.003.  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:
               (1)  is a nurse practitioner, nurse midwife, or
  clinical nurse specialist;
               (2)  has practiced for at least 1,000 hours under the
  delegation of a physician under Chapter 157; 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)  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 by the board 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 by the board 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 by the board
  under this section.
         (f)  The board by rule shall:
               (1)  prescribe the application process for
  authorization to practice under this section; and
               (2)  establish guidelines for continuing education for
  advanced practice registered nurses authorized to practice under
  this section, including:
                     (A)  a requirement that the advanced practice
  registered nurse complete not less than 48 hours of continuing
  education in each two-year period as a condition of license
  renewal; and
                     (B)  a provision authorizing the advanced
  practice registered nurse to complete up to 24 hours of the
  continuing education required under Paragraph (A) through informal
  self-study or attendance at hospital lectures.
         Sec. 301.358.  PRESCRIBING AND ORDERING AUTHORITY OF
  ADVANCED PRACTICE REGISTERED NURSE. (a)  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 III,
  IV, and V, dangerous drugs, and nonprescription drugs.
         (b)  The board may authorize an advanced practice registered
  nurse authorized to practice by the board under Section 301.357 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
         SECTION 2.001.  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 2.002.  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 2.003.  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 2.004.  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 2.005.  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 2.006.  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 State Board of Podiatric Medical
  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 2.007.  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 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 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 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 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, 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 authorized to practice under Section 301.357, Occupations
  Code. 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; 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.  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), 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 2.017.  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 2.018.  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.
         (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 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 2.019.  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 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.
         SECTION 2.020.  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.
  ARTICLE 3. TRANSITION; CONFLICT WITH OTHER LEGISLATION; EFFECTIVE
  DATE
         SECTION 3.001.  Not later than December 1, 2019, 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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