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.

89(R) HB 3794 - Introduced version - Bill Text

89R8356 BEE/SCL-F

By: Darby

H.B. No. 3794

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.