bill letting advanced practice nurses practice independently

The text as introduced · 9,367 words

89R2558 BEE-F

By: Manuel
H.B. No. 1756

A BILL TO BE ENTITLED

AN ACT

relating to the licensing and authority of advanced practice

registered nurses.

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

ARTICLE 1. SHORT TITLE

SECTION 1.001. This Act may be cited as the Healthcare

Expanded and Accessed Locally for Texans (HEAL Texans) Act.

ARTICLE 2. ADVANCED PRACTICE REGISTERED NURSES

SECTION 2.001. 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 authorized for an advanced practice

registered nurse . 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 by an advanced

practice registered nurse [ delegated by a physician under Section

157.0512, 157.054, 157.058, or 157.059 ]; and

(G) [ (H) ] the development of the nursing care

plan.

[ (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 2.002. Section 301.005(b), Occupations Code, is

amended to read as follows:

(b) A reference in any other law to an "advanced nurse

practitioner , " [ or ] "advanced practice nurse , " or "advanced

practice registered nurse" means an advanced practice registered

nurse.

SECTION 2.003. Section 301.152, Occupations Code, is

transferred to Subchapter H, Chapter 301, Occupations Code,

redesignated as Section 301.357, Occupations Code, and amended to

read as follows:

Sec. 301.357 [ 301.152 ]. ADVANCED PRACTICE REGISTERED NURSES

[ RULES REGARDING SPECIALIZED TRAINING ]. (a) Advanced practice

registered nursing 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. [ In this section, "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. The term is synonymous with "advanced nurse

practitioner" and "advanced practice nurse." ]

(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 authorized

[ delegated ] by the board [ a physician ] under Section 301.358

[ 157.0512 or 157.054 ];

(B) a system for approving an advanced practice

registered nurse to prescribe or order a drug or device as

authorized [ delegated ] by the board [ a physician ] under Section

301.358 [ 157.0512 or 157.054 ] 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.

(c) At a minimum, the rules adopted under Subsection (b)(2)

must:

(1) require completion of pharmacology and related

pathophysiology education for initial approval; and

(2) require continuing education in clinical

pharmacology and related pathophysiology in addition to any

continuing education otherwise required under Section 301.303.

(d) The signature of an advanced practice registered nurse

attesting to the provision of a legally authorized service by the

advanced practice registered nurse satisfies any documentation

requirement for that service established by a state agency.

(e) An advanced practice registered nurse shall practice as

a licensed independent practitioner in accordance with standards

established and recognized by the board to protect the public

health and safety.

(f) An advanced practice registered nurse 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.

(g) This section does not limit or modify the scope of

practice of a registered nurse who is not an advanced practice

registered nurse.

(h) Notwithstanding any other law, an advanced practice

registered nurse performing an act described by Subsection (a) is

not considered to be practicing medicine without a license.

SECTION 2.004. Section 301.354(a), Occupations Code, is

amended to read as follows:

(a) In this section, "nurse first assistant" means a

registered nurse who:

(1) has completed a nurse first assistant educational

program approved or recognized by an organization recognized by the

board; and

(2) [ is ] either:

(A) is certified in perioperative nursing by an

organization recognized by the board; or

(B) is [ recognized by the board as ] an advanced

practice registered nurse [ and ] qualified by education, training,

or experience to perform the tasks involved in perioperative

nursing.

SECTION 2.005. Subchapter H, Chapter 301, Occupations Code,

is amended by adding Section 301.358 to read as follows:

Sec. 301.358. PRESCRIBING AND ORDERING AUTHORITY OF

ADVANCED PRACTICE REGISTERED NURSE. The board may authorize an

advanced practice registered nurse to prescribe and order drugs and

devices, including controlled substances listed in Schedules II,

III, IV, and V, dangerous drugs, and nonprescription drugs.

ARTICLE 3. CONFORMING AMENDMENTS REGARDING DELEGATION

SECTION 3.001. The heading to Subchapter B, Chapter 157,

Occupations Code, is amended to read as follows:

SUBCHAPTER B. DELEGATION TO [ ADVANCED PRACTICE REGISTERED NURSES

AND ] PHYSICIAN ASSISTANTS

SECTION 3.002. Sections 157.051(11) and (14), Occupations

Code, are amended to read as follows:

(11) "Practice serving a medically underserved

population" means:

(A) a practice in a health professional shortage

area;

(B) a clinic designated as a rural health clinic

under 42 U.S.C. Section 1395x(aa);

(C) a public health clinic or a family planning

clinic under contract with the Health and Human Services Commission

or the Department of State Health Services;

(D) a clinic designated as a federally qualified

health center under 42 U.S.C. Section 1396d(l)(2)(B);

(E) a county, state, or federal correctional

facility;

(F) a practice:

(i) that either:

(a) is located in an area in which the

Department of State Health Services determines there is an

insufficient number of physicians providing services to eligible

clients of federally, state, or locally funded health care

programs; or

(b) is a practice that the Department

of State Health Services determines serves a disproportionate

number of clients eligible to participate in federally, state, or

locally funded health care programs; and

(ii) for which the Department of State

Health Services publishes notice of the department's determination

in the Texas Register and provides an opportunity for public

comment in the manner provided for a proposed rule under Chapter

2001, Government Code; or

(G) a practice at which a physician was

delegating prescriptive authority to an advanced practice

registered nurse , as defined by Section 301.002, or physician

assistant on or before March 1, 2013, based on the practice

qualifying as a site serving a medically underserved population.

(14) "Prescriptive authority agreement" means an

agreement entered into by a physician and a [ an advanced practice

registered nurse or ] physician assistant through which the

physician delegates to the [ advanced practice registered nurse or ]

physician assistant the act of prescribing or ordering a drug or

device.

SECTION 3.003. Section 157.0511(b-2), Occupations Code, is

amended to read as follows:

(b-2) The board shall adopt rules that require a physician

who delegates the prescribing or ordering of a drug or device to

register with the board the name and license number of the physician

assistant [ or advanced practice registered nurse ] to whom a

delegation is made. The board may develop and use an electronic

online delegation registration process for registration under this

subsection.

SECTION 3.004. Sections 157.0512(a), (b), (c), (e), (f),

(g), (i), (j), (l), (m), (n), and (o), Occupations Code, are amended

to read as follows:

(a) A physician may delegate to a [ an advanced practice

registered nurse or ] physician assistant, acting under adequate

physician supervision, the act of prescribing or ordering a drug or

device as authorized through a prescriptive authority agreement

between the physician and the [ advanced practice registered nurse

or ] physician assistant[ , as applicable ].

(b) A physician and a [ an advanced practice registered nurse

or ] physician assistant are eligible to enter into or be parties to

a prescriptive authority agreement only if:

(1) [ if applicable, the Texas Board of Nursing has

approved the advanced practice registered nurse's authority to

prescribe or order a drug or device as authorized under this

subchapter;

[ (2) ] the [ advanced practice registered nurse or ]

physician assistant:

(A) holds an active license to practice in this

state as a [ an advanced practice registered nurse or ] physician

assistant[ , as applicable, ] and is in good standing in this state;

and

(B) is not currently prohibited by the [ Texas

Board of Nursing or the ] Texas Physician Assistant Board[ , as

applicable, ] from executing a prescriptive authority agreement;

and

(2) [ (3) ] before executing the prescriptive authority

agreement, the physician and the [ advanced practice registered

nurse or ] physician assistant disclose to the other prospective

party to the agreement any prior disciplinary action by the board[ ,

the Texas Board of Nursing, ] or the Texas Physician Assistant

Board[ , as applicable ].

(c) Except as provided by Subsection (d), the [ combined ]

number of [ advanced practice registered nurses and ] physician

assistants with whom a physician may enter into a prescriptive

authority agreement may not exceed seven [ advanced practice

registered nurses and ] physician assistants or the full-time

equivalent of seven [ advanced practice registered nurses and ]

physician assistants.

(e) A prescriptive authority agreement must, at a minimum:

(1) be in writing and signed and dated by the parties

to the agreement;

(2) state the name, address, and all professional

license numbers of the parties to the agreement;

(3) state the nature of the practice, practice

locations, or practice settings;

(4) identify the types or categories of drugs or

devices that may be prescribed or the types or categories of drugs

or devices that may not be prescribed;

(5) provide a general plan for addressing consultation

and referral;

(6) provide a plan for addressing patient emergencies;

(7) state the general process for communication and

the sharing of information between the physician and the [ advanced

practice registered nurse or ] physician assistant to whom the

physician has delegated prescriptive authority related to the care

and treatment of patients;

(8) if alternate physician supervision is to be

utilized, designate one or more alternate physicians who may:

(A) provide appropriate supervision on a

temporary basis in accordance with the requirements established by

the prescriptive authority agreement and the requirements of this

subchapter; and

(B) participate in the prescriptive authority

quality assurance and improvement plan meetings required under this

section; and

(9) describe a prescriptive authority quality

assurance and improvement plan and specify methods for documenting

the implementation of the plan that include the following:

(A) chart review, with the number of charts to be

reviewed determined by the physician and [ advanced practice

registered nurse or ] physician assistant; and

(B) periodic meetings between the [ advanced

practice registered nurse or ] physician assistant and the

physician.

(f) The periodic meetings described by Subsection (e)(9)(B)

must:

(1) include:

(A) the sharing of information relating to

patient treatment and care, needed changes in patient care plans,

and issues relating to referrals; and

(B) discussion of patient care improvement;

(2) be documented; and

(3) take place at least once a month in a manner

determined by the physician and the [ advanced practice registered

nurse or ] physician assistant.

(g) The prescriptive authority agreement may include other

provisions agreed to by the physician and [ advanced practice

registered nurse or ] physician assistant.

(i) The prescriptive authority agreement need not describe

the exact steps that a [ an advanced practice registered nurse or ]

physician assistant must take with respect to each specific

condition, disease, or symptom.

(j) A physician[ , advanced practice registered nurse, ] or

physician assistant who is a party to a prescriptive authority

agreement must retain a copy of the agreement until the second

anniversary of the date the agreement is terminated.

(l) In the event that a party to a prescriptive authority

agreement is notified that the individual has become the subject of

an investigation by the board[ , the Texas Board of Nursing, ] or the

Texas Physician Assistant Board, the individual shall immediately

notify the other party to the prescriptive authority agreement.

(m) The prescriptive authority agreement and any amendments

must be reviewed at least annually, dated, and signed by the parties

to the agreement. The prescriptive authority agreement and any

amendments must be made available to the board[ , the Texas Board of

Nursing, ] or the Texas Physician Assistant Board not later than the

third business day after the date of receipt of request, if any.

(n) The prescriptive authority agreement should promote the

exercise of professional judgment by the [ advanced practice

registered nurse or ] physician assistant commensurate with the

[ advanced practice registered nurse's or ] physician assistant's

education and experience and the relationship between the [ advanced

practice registered nurse or ] physician assistant and the

physician.

(o) This section shall be liberally construed to allow the

use of prescriptive authority agreements to safely and effectively

utilize the skills and services of [ advanced practice registered

nurses and ] physician assistants.

SECTION 3.005. Section 157.0513, Occupations Code, is

amended to read as follows:

Sec. 157.0513. PRESCRIPTIVE AUTHORITY AGREEMENT:

INFORMATION. (a) The board[ , the Texas Board of Nursing, ] and the

Texas Physician Assistant Board shall jointly develop a process:

(1) to exchange information regarding the names,

locations, and license numbers of each physician[ , advanced

practice registered nurse, ] and physician assistant who has entered

into a prescriptive authority agreement;

(2) by which each board shall immediately notify the

other board [ boards ] when a license holder of the board becomes the

subject of an investigation involving the delegation and

supervision of prescriptive authority, as well as the final

disposition of any such investigation;

(3) by which each board shall maintain and share a list

of the board's license holders who have been subject to a final

adverse disciplinary action for an act involving the delegation and

supervision of prescriptive authority; and

(4) to ensure that each [ advanced practice registered

nurse or ] physician assistant who has entered into a prescriptive

authority agreement authorizing the prescribing of opioids is

required to complete not less than two hours of continuing

education annually regarding safe and effective pain management

related to the prescription of opioids and other controlled

substances, including education regarding:

(A) reasonable standards of care;

(B) the identification of drug-seeking behavior

in patients; and

(C) effectively communicating with patients

regarding the prescription of an opioid or other controlled

substance.

(b) If the board[ , the Texas Board of Nursing, ] or the Texas

Physician Assistant Board receives a notice under Subsection

(a)(2), the board that received notice may open an investigation

against a license holder of the board who is a party to a

prescriptive authority agreement with the license holder who is

under investigation by the board that provided notice under

Subsection (a)(2).

(c) The board shall maintain and make available to the

public a searchable online list of physicians[ , advanced practice

registered nurses, ] and physician assistants who have entered into

a prescriptive authority agreement authorized under Section

157.0512 and identify the physician[ , advanced practice registered

nurse, or physician assistant ] with whom each [ physician, advanced

practice registered nurse, and ] physician assistant has entered

into a prescriptive authority agreement.

(d) The board shall collaborate with the [ Texas Board of

Nursing and the ] Texas Physician Assistant Board to maintain and

make available to the public a list of physicians[ , advanced

practice registered nurses, ] and physician assistants who are

prohibited from entering into or practicing under a prescriptive

authority agreement.

SECTION 3.006. Sections 157.054(a), (a-1), (b), and (c),

Occupations Code, are amended to read as follows:

(a) One or more physicians licensed by the board may

delegate, to one or more physician assistants [ or advanced practice

registered nurses ] acting under adequate physician supervision

whose practice is facility-based at a hospital or licensed

long-term care facility, the administration or provision of a drug

and the prescribing or ordering of a drug or device if each of the

delegating physicians is:

(1) the medical director or chief of medical staff of

the facility in which the physician assistant [ or advanced practice

registered nurse ] practices;

(2) the chair of the facility's credentialing

committee;

(3) a department chair of a facility department in

which the physician assistant [ or advanced practice registered

nurse ] practices; or

(4) a physician who consents to the request of the

medical director or chief of medical staff to delegate the

prescribing or ordering of a drug or device at the facility in which

the physician assistant [ or advanced practice registered nurse ]

practices.

(a-1) The limit [ limits ] on the number of [ advanced practice

registered nurses or ] physician assistants to whom a physician may

delegate under Section 157.0512 does [ do ] not apply to a physician

under Subsection (a) whose practice is facility-based under this

section, provided that the physician is not delegating in a

freestanding clinic, center, or practice of the facility.

(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, a department chair, or a

physician who consents to delegate under Subsection (a)(4);

(3) the delegation may not permit the prescribing or

ordering of a drug or device for the care or treatment of the

patients of any other physician without the prior consent of that

physician; and

(4) delegation in a long-term care facility must be by

the medical director and is limited to the prescribing or ordering

of a drug or device to not more than seven [ advanced practice

registered nurses or ] physician assistants or their full-time

equivalents.

(c) Physician supervision of the prescribing or ordering of

a drug or device must conform to what a reasonable, prudent

physician would find consistent with sound medical judgment but may

vary with the education and experience of the particular [ advanced

practice registered nurse or ] physician assistant. A physician

shall provide continuous supervision, but the constant physical

presence of the physician is not required.

SECTION 3.007. Section 157.055, Occupations Code, is

amended to read as follows:

Sec. 157.055. ORDERS AND PROTOCOLS. A protocol or other

order shall be defined in a manner that promotes the exercise of

professional judgment by the [ advanced practice registered nurse

and ] physician assistant commensurate with the education and

experience of that person. Under this section, an order or

protocol used by a reasonable and prudent physician exercising

sound medical judgment:

(1) is not required to describe the exact steps that

[ an advanced practice registered nurse or ] a physician assistant

must take with respect to each specific condition, disease, or

symptom; and

(2) may state the types or categories of medications

that may be prescribed or the types or categories of medications

that may not be prescribed.

SECTION 3.008. Section 157.056, Occupations Code, is

amended to read as follows:

Sec. 157.056. PRESCRIPTION INFORMATION. The following

information must be provided on each prescription subject to this

subchapter:

(1) the patient's name and address;

(2) the drug to be dispensed;

(3) directions to the patient regarding the taking of

the drug and the dosage;

(4) the intended use of the drug, if appropriate;

(5) the name, address, and telephone number of the

physician;

(6) the name, address, telephone number, and

identification number of the [ registered nurse or ] physician

assistant completing or signing the prescription drug order;

(7) the date; and

(8) the number of refills permitted.

SECTION 3.009. Sections 157.059(b), (e), (f), (g), (h), and

(i), Occupations Code, are amended to read as follows:

(b) A physician may delegate to a physician assistant

offering obstetrical services and certified by the board as

specializing in obstetrics [ or an advanced practice registered

nurse recognized by the Texas Board of Nursing as a nurse midwife ]

the act of administering or providing controlled substances to the

physician assistant's [ or nurse midwife's ] clients during

intrapartum and immediate postpartum care.

(e) The physician's orders, medical orders, standing

delegation orders, prescriptive authority agreements, or protocols

must require the reporting of or monitoring of each client's

progress, including complications of pregnancy and delivery and the

administration and provision of controlled substances by the [ nurse

midwife or ] physician assistant to the clients of the [ nurse

midwife or ] physician assistant.

(f) The authority of a physician to delegate under this

section is limited to:

(1) seven [ nurse midwives or ] physician assistants or

their full-time equivalents; and

(2) the designated facility at which the [ nurse

midwife or ] physician assistant provides care.

(g) The controlled substance must be supplied in a suitable

container that is labeled in compliance with the applicable drug

laws and must include:

(1) the patient's name and address;

(2) the drug to be provided;

(3) the name, address, and telephone number of the

physician;

(4) the name, address, and telephone number of the

[ nurse midwife or ] physician assistant; and

(5) the date.

(h) This section does not authorize a physician or [ , ]

physician assistant[ , or nurse midwife ] to operate a retail

pharmacy as defined under Subtitle J.

(i) This section authorizes a physician to delegate the act

of administering or providing a controlled substance to a [ nurse

midwife or ] physician assistant but does not require physician

delegation of[ :

[ (1) further acts to a nurse midwife; or

[ (2) ] the administration of medications by a physician

assistant [ or registered nurse ] other than as provided by this

section.

SECTION 3.010. Section 157.060, Occupations Code, is

amended to read as follows:

Sec. 157.060. PHYSICIAN LIABILITY FOR DELEGATED

ACT. Unless the physician has reason to believe the physician

assistant [ or advanced practice registered nurse ] lacked the

competency to perform the act, a physician is not liable for an act

of a physician assistant [ or advanced practice registered nurse ]

solely because the physician signed a standing medical order, a

standing delegation order, or another order or protocol, or entered

into a prescriptive authority agreement, authorizing the physician

assistant [ or advanced practice registered nurse ] to administer,

provide, prescribe, or order a drug or device.

ARTICLE 4. GENERAL CONFORMING AMENDMENTS

SECTION 4.001. 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 4.002. 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 4.003. 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 4.004. 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 4.005. Section 263.001(a)(1), Family Code, is

amended to read as follows:

(1) "Advanced practice nurse" has the meaning assigned

to "advanced practice registered nurse" by Section 301.002

[ 157.051 ], Occupations Code.

SECTION 4.006. Section 266.001(1), Family Code, is amended

to read as follows:

(1) "Advanced practice nurse" has the meaning assigned

to "advanced practice registered nurse" by Section 301.002

[ 157.051 ], Occupations Code.

SECTION 4.007. Section 548.0109, Government Code, as

effective April 1, 2025, is amended to read as follows:

Sec. 548.0109. EFFECT ON OTHER REQUIREMENTS. This

subchapter does not affect any requirement relating to:

(1) a rural health clinic; or

(2) physician delegation to a [ an advanced practice

nurse or ] physician assistant of the authority to carry out or sign

prescription drug orders.

SECTION 4.008. 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 301.002 [ 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;

(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 4.009. Section 47.001(3), Health and Safety Code,

is amended to read as follows:

(3) "Health care provider" means :

(A) [ a registered nurse recognized as ] an

advanced practice registered nurse as defined by Section 301.002,

Occupations Code; [ the Texas Board of Nursing ] or

(B) a physician assistant licensed by the Texas

Physician Assistant Board.

SECTION 4.010. 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 4.011. 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 a

physician assistant on behalf of a physician, 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 a physician assistant on behalf of

a physician, 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 4.012. Section 241.003(1), Health and Safety Code,

is amended to read as follows:

(1) "Advanced practice nurse" has the meaning assigned

to "advanced practice registered nurse" by Section 301.002,

Occupations Code [ means a registered nurse recognized as an

advanced practice nurse by the Texas Board of Nursing ].

SECTION 4.013. Section 481.002(39), Health and Safety Code,

is amended to read as follows:

(39) "Practitioner" means:

(A) a physician, dentist, veterinarian,

podiatrist, scientific investigator, advanced practice registered

nurse, or other person licensed, registered, or otherwise permitted

to distribute, dispense, analyze, conduct research with respect to,

or administer a controlled substance in the course of professional

practice or research in this state;

(B) a pharmacy, hospital, or other institution

licensed, registered, or otherwise permitted to distribute,

dispense, conduct research with respect to, or administer a

controlled substance in the course of professional practice or

research in this state;

(C) a person practicing in and licensed by

another state as a physician, dentist, veterinarian, advanced

practice registered nurse, or podiatrist, having a current Federal

Drug Enforcement Administration registration number, who may

legally prescribe Schedule II, III, IV, or V controlled substances

in that state; or

(D) a [ 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 4.014. 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 4.015. 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 4.016. 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 ;

(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 4.017. 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) 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) a [ 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[ , registered nurse, ] or physician assistant,

legibly printed or stamped, if signed by a licensed midwife[ ,

registered nurse, ] or physician assistant.

SECTION 4.018. 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 a [ an advanced practice 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 .

SECTION 4.019. 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 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 [ 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) 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 [ 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 4.020. 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 4.021. 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 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 4.022. 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 ; and

(2) a [ 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 4.023. 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 4.024. 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 nurse ] who is authorized by the

physician to provide care under Subchapter B, Chapter 157,

Occupations Code, or an advanced practice registered nurse, as

defined by Section 301.002, 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 4.025. Section 1301.001(1-a), Insurance Code, is

amended to read as follows:

(1-a) "Health care provider" means a practitioner,

institutional provider, or other person or organization that

furnishes health care services and that is licensed or otherwise

authorized to practice in this state. The term includes a

pharmacist , [ and ] a pharmacy , and an advanced practice registered

nurse . The term does not include a physician.

SECTION 4.026. 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 , as applicable :

(1) the [ advanced practice 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 4.027. Section 1451.001(2), Insurance Code, is

amended to read as follows:

(2) "Advanced practice registered nurse" has the

meaning assigned by Section 301.002, Occupations Code [ means an

individual licensed by the Texas Board of Nursing as a registered

nurse and recognized by that board as an advanced practice nurse ].

SECTION 4.028. 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 4.029. 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 4.030. 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 4.031. 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; or

(2) an advanced practice registered nurse, as defined

by Section 301.002, 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) [ this subsection ].

SECTION 4.032. 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 as defined by Section

301.002 who is [ 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 4.033. Section 204.1025, Occupations Code, is

amended to read as follows:

Sec. 204.1025. DUTIES REGARDING PRESCRIPTIVE AUTHORITY

AGREEMENTS. The physician assistant board shall in conjunction

with the Texas Medical Board [ and the Texas Board of Nursing ]

perform the functions and duties relating to prescriptive authority

agreements assigned to the physician assistant board in Sections

157.0512 and 157.0513.

SECTION 4.034. Sections 551.003(14) and (34), Occupations

Code, are amended to read as follows:

(14) "Designated agent" means:

(A) an individual, including a licensed nurse,

physician assistant, or pharmacist:

(i) who is designated by a practitioner and

authorized to communicate a prescription drug order to a

pharmacist; and

(ii) for whom the practitioner assumes

legal responsibility;

(B) a licensed nurse, physician assistant, or

pharmacist employed in a health care facility to whom a

practitioner communicates a prescription drug order; or

(C) a [ registered nurse or ] physician assistant

authorized by a practitioner to administer a prescription drug

order for a dangerous drug under Subchapter B, Chapter 157.

(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) a [ 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 4.035. 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 a [ an advanced practice 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 .

SECTION 4.036. 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 [ an ] advanced practice

registered nurse , or from a 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 [ an ] advanced practice

registered nurse , or from a 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 4.037. Section 605.2515, Occupations Code, is

amended to read as follows:

Sec. 605.2515. ADDITIONAL LICENSE: DEVICE MANUFACTURER. A

person licensed to practice orthotics or prosthetics who measures,

designs, fabricates, fits, assembles, adjusts, or services an

orthosis or a prosthesis under an order from a licensed physician,

chiropractor, [ or ] podiatrist, or [ an ] advanced practice

registered nurse , or from a physician assistant acting under the

delegation and supervision of a licensed physician as provided by

Subchapter B, Chapter 157, and rules adopted by the Texas Medical

Board, for a specific patient is exempt from licensing as a device

manufacturer under Subchapter L, Chapter 431, Health and Safety

Code. A person licensed to practice orthotics or prosthetics who

fabricates or assembles an orthosis or a prosthesis without an

order from a licensed physician, chiropractor, [ or ] podiatrist, or

[ an ] advanced practice registered nurse , or from a 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 4.038. 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.

SECTION 4.039. Section 681.003(f), Transportation Code, is

amended to read as follows:

(f) This subsection applies only to the first application

for a disabled parking placard submitted by a person. The notarized

written statement or prescription may be issued by:

(1) a person acting under the delegation and

supervision of a licensed physician in conformance with Subchapter

B, Chapter 157, Occupations Code; [ or ]

(2) a physician assistant licensed to practice in this

state acting as the agent of a licensed physician under Section

204.202(e), Occupations Code ; or

(3) an advanced practice registered nurse authorized

to prescribe and order drugs and devices under Section 301.358,

Occupations Code .

ARTICLE 5. REPEALER

SECTION 5.001. The following provisions are repealed:

(1) Section 540.0269(b), Government Code, as

effective April 1, 2025;

(2) Section 62.1551(b), Health and Safety Code; and

(3) Sections 157.051(1), 157.058, and 301.168,

Occupations Code.

ARTICLE 6. TRANSITION AND EFFECTIVE DATE

SECTION 6.001. 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 6.002. Notwithstanding any changes in law made by

this Act, an advanced practice registered nurse who has been

delegated the authority to prescribe and order drugs and medical

devices by a physician's protocol or order under Section 157.0511,

157.0512, or 157.054, Occupations Code, may continue to exercise

that authority until February 1, 2026.

SECTION 6.003. This Act takes effect September 1, 2025.