H.B. No. 1095


   AN ACT


  relating to the authority of advanced practice nurses
and physician assistants to administer, provide, and
carry out or sign a prescription drug order.


	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:


	SECTION 1.  Section 157.051, Occupations Code, is amended
by adding Subdivisions (2-a) and (2-b) to read as follows:


		(2-a)  "Controlled substance" has the meaning assigned
to that term by Section 481.002, Health and Safety
Code.


		(2-b)  "Dangerous drug" has the meaning assigned
to that term by Section 483.001, Health and Safety
Code.


	SECTION 2.  Subchapter B, Chapter 157, Occupations Code,
is amended by adding Section 157.0511 to read as follows:


	Sec. 157.0511.  PRESCRIPTION DRUG ORDERS.  (a)  A
physician's authority to delegate the carrying out
or signing of a prescription drug order under this
subchapter is limited to:


		(1)  dangerous drugs; and


		(2)  controlled substances to the extent provided
by Subsection (b).


	(b)  A physician may delegate the carrying out or
signing of a prescription drug order for a controlled
substance only if:


		(1)  the prescription is for a controlled substance
listed in Schedules III, IV, or V as established by
the commissioner of public health under Chapter 481,
Health and Safety Code;


		(2)  the prescription is for a period not to exceed
30 days;


		(3)  with regard to the refill of a prescription,
the refill is authorized after consultation with the
delegating physician and the consultation is noted
in the patient's chart; and


		(4)  with regard to a prescription for a child less
than two years of age, the prescription is made after
consultation with the delegating physician and the
consultation is noted in the patient's chart.


	(c)  This subchapter does not modify the authority
granted by law for a licensed registered nurse or physician
assistant to administer or provide a medication, including
a controlled substance listed in Schedule II as established
by the commissioner of public health under Chapter
481, Health and Safety Code, that is authorized by
a physician under a physician's order, standing medical
order, standing delegation order, or protocol.


	SECTION 3.  Section 157.052(c), Occupations Code, is
amended to read as follows:


	(c)  At a site serving a medically underserved population,
a physician licensed by the board may delegate to a
registered nurse or physician assistant acting under
adequate physician supervision the act of administering,
providing, or carrying out or signing a prescription
drug order, as authorized by the physician through
a physician's order, a standing medical order, a standing
delegation order, or another order or protocol as defined
by the board. [The authority of a physician
to delegate the carrying out or signing of prescription
drug orders is limited to dangerous drugs.]


	SECTION 4.  Section 157.053(b), Occupations Code, is
amended to read as follows:


	(b)  At a physician's primary practice site, a physician
licensed by the board may delegate to a physician assistant
or an advanced practice nurse acting under adequate
physician supervision the act of administering, providing,
or carrying out or signing a prescription drug order
as authorized through a physician's order, a standing
medical order, a standing delegation order, or another
order or protocol as defined by the board. [Providing
a drug and carrying out or signing a prescription drug
order under this section is limited to dangerous drugs.]


	SECTION 5.  Section 157.054(b), Occupations Code, is
amended to read as follows:


	(b)  A physician's authority to delegate under Subsection
(a) is limited as follows:


		(1)  the delegation must be made under a physician's
order, standing medical order, standing delegation
order, or another order or protocol developed in accordance
with policies approved by the facility's medical staff
or a committee of the facility's medical staff as provided
by the facility bylaws;


		(2)  the delegation must occur in the facility in which
the physician is the medical director, the chief of
medical staff, the chair of the credentialing committee,
or a department chair;


		(3)  the delegation may not permit the carrying out
or signing of prescription drug orders for the care
or treatment of the patients of any other physician
without the prior consent of that physician;


		(4)  delegation in a long-term care facility must be
by the medical director and is limited to the carrying
out and signing of prescription drug orders to not
more than three advanced practice nurses or physician
assistants or their full-time equivalents; and


		(5)  a physician may not delegate at more than one licensed
hospital or more than two long-term care facilities
unless approved by the board[; and


		[(6)  the authority of a physician to delegate
the carrying out or signing of a prescription drug
order under this section is limited to dangerous drugs].


	SECTION 6.  Section 157.0541(b), Occupations Code, is
amended to read as follows:


	(b)  At an alternate site, a physician licensed by the
board may delegate to an advanced practice nurse or
physician assistant, acting under adequate physician
supervision, the act of administering, providing, or
carrying out or signing a prescription drug order as
authorized through a physician's order, a standing
medical order, a standing delegation order, or another
order or protocol as defined by the board. [The
authority of a physician to delegate the carrying out
or signing of prescription drug orders under this section
is limited to dangerous drugs.]


	SECTION 7.  Section 157.059, Occupations Code, is amended
by adding Subsection (j) to read as follows:


	(j)  This section does not limit the authority of
a physician to delegate the carrying out or signing
of a prescription drug order involving a controlled
substance under this subchapter.


	SECTION 8.  Section 551.003(34), Occupations Code, is
amended to read as follows:


		(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, 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,
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 nurse or physician assistant
to whom a physician has delegated the authority to
carry out or sign prescription drug orders under Section
157.0511, 157.052, 157.053, 157.054, 157.0541,
or 157.0542.


	SECTION 9.  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, 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;  [or]


			(C)  a person practicing in and licensed by another
state as a physician, dentist, veterinarian, 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 nurse or physician assistant
to whom a physician has delegated the authority to
carry out or sign prescription drug orders under Section
157.0511, 157.052, 157.053, 157.054, 157.0541, or 157.0542,
Occupations Code.


	SECTION 10.  Section 483.001(12), Health and Safety
Code, is amended to read as follows:


		(12)  "Practitioner" means a person licensed:


			(A)  by the Texas State Board of Medical Examiners,
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;


			(B)  by another state in a health field in which, under
the laws of this state, a licensee may legally prescribe
dangerous drugs;


			(C)  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 nurse or physician assistant
to whom a physician has delegated the authority to
carry out or sign prescription drug orders under Section
157.0511, 157.052, 157.053, 157.054, 157.0541,
or 157.0542, Occupations Code.


	SECTION 11.  Article 21.58D, Insurance Code, is amended
to read as follows:


	Art. 21.58D.  STANDARDIZED FORM FOR VERIFICATION OF
CERTAIN [PHYSICIAN] CREDENTIALS


	Sec. 1.  DEFINITIONS [DEFINITION].
 In this article:


		(1)  "Physician"[, "physician"]
means an individual licensed to practice medicine in
this state.


		(2)  "Advanced practice nurse" has the meaning assigned
by Section 301.152, Occupations Code.


		(3)  "Physician assistant" means a person who holds
a license issued under Chapter 204, Occupations Code.


	Sec. 2.  STANDARDIZED FORM.  (a)  The commissioner by
rule shall:


		(1)  adopt a standardized form for the verification
of the credentials of a physician, an advanced practice
nurse, or a physician assistant; and


		(2)  require that a public or private hospital, a health
maintenance organization operating under the Texas
Health Maintenance Organization Act (Chapter 20A, Vernon's
Texas Insurance Code), or a preferred provider organization
operating under Article 3.70-3C, Insurance Code, as
added by Chapter 1024, Acts of the 75th Legislature,
Regular Session, 1997, use the form for verification
of credentials.


	(b)  In adopting a form under Subsection (a) of this
section, the commissioner shall consider any credentialing
application form that is widely used in this state
or a form currently used by the department.


	SECTION 12.  This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected
to each house, as provided by Section 39, Article III,
Texas Constitution.  If this Act does not receive the
vote necessary for immediate effect, this Act takes
effect September 1, 2003.
______________________________ ______________________________ 

   President of the Senate		Speaker of the House

I certify that H.B. No. 1095 was passed by the House on April 3, 2003, by the following vote: Yeas 141, Nays 0, 2 present, not voting.

______________________________

Chief Clerk of the House

I certify that H.B. No. 1095 was passed by the Senate on May 6, 2003, by the following vote: Yeas 31, Nays 0.

______________________________

Secretary of the Senate

APPROVED: _____________________

Date

_____________________

Governor