Menéndez Bill Lets Psychologists Prescribe Controlled Substances And Injections

The text as introduced · 4,412 words

89R2533 JTZ-D

By: Menéndez
S.B. No. 2999

A BILL TO BE ENTITLED

AN ACT

relating to the prescriptive authority of certain psychologists;

authorizing a fee.

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

SECTION 1. Section 501.003(a)(1), Occupations Code, is

amended to read as follows:

(1) "Practice of psychology" means:

(A) the observation, description, diagnosis,

evaluation, assessment, interpretation, or treatment of and

intervention in human behavior by applying education, training,

methods, and procedures for the purpose of:

(i) preventing, predicting, treating,

remediating, or eliminating:

(a) symptomatic, maladaptive, or

undesired behavior;

(b) emotional, interpersonal,

learning, substance use, neuropsychological, cognitive, or

behavioral disorders or disabilities, including those that

accompany medical problems; or

(c) mental illness;

(ii) evaluating, assessing, or

facilitating, by a license holder or a person who represents the

person to the public by a title or description of services that

includes the word "psychological," "psychologist," or

"psychology," the enhancement of individual, group, or

organizational effectiveness, including evaluating, assessing, or

facilitating:

(a) personal effectiveness;

(b) adaptive behavior;

(c) interpersonal relationships;

(d) academic, vocational, and life

adjustment;

(e) health; or

(f) individual, group, or

organizational performance;

(iii) providing psychological,

neuropsychological, and psychoeducational evaluation, therapy, and

remediation as well as counseling, psychoanalysis, psychotherapy,

hypnosis, and biofeedback; or

(iv) consulting with others, including

other mental health professionals, physicians, school personnel,

or organizations within the scope of the provider's competency and

training with respect to services provided for a specific

individual; [ or ]

(B) action taken under the authority granted by a

certificate issued under Subchapter H-1; or

(C) the supervision of an activity or service

described by Paragraph (A) or (B) .

SECTION 2. Section 501.051, Occupations Code, is amended by

amending Subsection (b) and adding Subsection (b-1) to read as

follows:

(b) To ensure adequate representation on the board of the

diverse fields of psychology, the governor in making appointments

under Subsection (a)(1) shall appoint:

(1) at least two members who provide psychological

services;

(2) at least two members who hold certificates issued

under Subchapter H-1;

(3) at least one member who conducts research in the

field of psychology; and

(4) [ (3) ] at least one member who teaches as a member

of the faculty of a psychological training institution.

(b-1) Notwithstanding Subsection (b)(2), a person satisfies

the requirement of that subdivision if the person has completed the

requirements of Sections 501.372(b)(1) and (2), regardless of

whether the person has been issued a certificate under Subchapter

H-1. This subsection expires October 31, 2029.

SECTION 3. Subchapter D, Chapter 501, Occupations Code, is

amended by adding Section 501.152 to read as follows:

Sec. 501.152. ADVISORY COMMITTEE ON PRESCRIPTIVE

AUTHORITY. (a) The executive council shall appoint an advisory

committee on prescriptive authority for psychologists.

(a-1) Effective September 1, 2025, the advisory committee

consists of six members as follows:

(1) three members who are psychologists, each of whom

has completed the requirements of Sections 501.372(b)(1) and (2);

(2) one member who is a psychiatrist;

(3) one member who is a pediatrician or primary care

physician with experience in child and adolescent medicine; and

(4) one member who represents the public.

(a-2) In appointing members under Subsection (a-1)(1), the

executive council shall give preference to psychologists who have

previously been licensed or certified to prescribe drugs in another

jurisdiction. This subsection and Subsection (a-1) expire

September 1, 2028.

(b) Effective September 1, 2028, the advisory committee

consists of six members as follows:

(1) five members who each hold a certificate issued

under Subchapter H-1; and

(2) one member who represents the public.

(c) A member appointed to represent the public may not have

a significant financial interest, as determined by executive

council rule, in the practice of psychology or prescriptive

authority for psychologists.

(d) The advisory committee shall make recommendations to

the executive council and board regarding the regulation of

psychologists who hold certificates issued under Subchapter H-1,

including recommendations concerning rules to establish:

(1) eligibility requirements;

(2) standards of practice for certificate holders;

(3) continuing education requirements;

(4) requirements regarding the use of appropriate

prescription drug monitoring programs by a psychologist with a

certificate issued under Subchapter H-1;

(5) requirements for training programs described by

Section 501.372(b)(1)(B);

(6) guidelines and procedures for peer review of a

psychologist with a conditional prescription certificate issued

under Section 501.372;

(7) procedures for the review of an applicant under

Section 501.379; and

(8) procedures for the review of a complaint involving

a psychologist with a certificate issued under Subchapter H-1.

(e) Chapter 2110, Government Code, does not apply to the

composition or duration of the advisory committee.

SECTION 4. Chapter 501, Occupations Code, is amended by

adding Subchapter H-1 to read as follows:

SUBCHAPTER H-1. PRESCRIPTION CERTIFICATE

Sec. 501.371. DEFINITIONS. In this subchapter:

(1) "Prescribing psychologist" means a psychologist

to whom a prescription certificate or conditional prescription

certificate has been issued under this subchapter.

(2) "Prescription drug" and "prescription drug order"

have the meanings assigned by Section 551.003.

(3) "Psychotropic medication" means a controlled

substance, as defined by Section 481.002, Health and Safety Code,

or dangerous drug, as defined by Section 483.001, Health and Safety

Code, that is used for the diagnosis, treatment, or management of

mental, nervous, emotional, behavioral, substance use, or

cognitive disorders.

(4) "Supervising clinician" means a physician or

psychologist who meets the requirements of Section 501.382 to

supervise a psychologist with a conditional prescription

certificate.

Sec. 501.372. CONDITIONAL PRESCRIPTION CERTIFICATE. (a)

The executive council shall issue a conditional prescription

certificate to a psychologist who:

(1) meets the eligibility requirements of Subsection

(b);

(2) submits an application on a form prescribed by the

executive council;

(3) has not, in the two-year period preceding the date

of the application, had a certificate under this subchapter

revoked; and

(4) pays the fee set by the executive council.

(b) To be eligible for a conditional prescription

certificate a psychologist must:

(1) have completed a training program in

psychopharmacology from:

(A) a postdoctoral education and training

program that has received designation in psychopharmacology from

the American Psychological Association; or

(B) a psychopharmacology training program

approved by the executive council that includes instruction in:

(i) basic life sciences;

(ii) neuroscience;

(iii) clinical and research pharmacology

and psychopharmacology;

(iv) clinical pathophysiology;

(v) physical assessments and laboratory

examinations;

(vi) clinical pharmacotherapeutics; and

(vii) ethical and legal issues relevant to

prescriptive authority and associated research;

(2) pass a nationally recognized examination approved

by the executive council in the area of prescriptive authority;

(3) provide evidence of professional liability

coverage in amounts required by executive council rule;

(4) have completed a practicum in clinical assessment

and pathophysiology under the supervision of a physician that

included not less than 80 hours of supervised practice;

(5) have completed, under the supervision of a

physician or psychologist with a prescription certificate issued

under Section 501.373, a practicum consisting of not less than 400

hours observing, participating in, or assisting in the treatment of

mental disorders with psychotropic medication in not less than 100

patients;

(6) have completed training approved by the executive

council on the administration of psychotropic medications by

injection; and

(7) satisfy any other requirement of executive council

rule.

(c) A psychologist who holds a conditional prescription

certificate is authorized to:

(1) issue a prescription drug order;

(2) administer or dispense a prescription drug;

(3) order tests commonly associated with monitoring

the use of prescription drugs;

(4) represent that the psychologist holds a

conditional prescription certificate; and

(5) under the supervision of a supervising clinician,

administer a psychotropic medication by injection.

(d) A psychologist who holds a conditional prescription

certification shall notify the executive council of the name of the

psychologist's supervising clinician in accordance with executive

council rule.

Sec. 501.373. PRESCRIPTION CERTIFICATE. (a) The executive

council shall issue a prescription certificate to a psychologist

who:

(1) meets the eligibility requirements of Subsection

(b);

(2) submits an application on a form prescribed by the

executive council;

(3) has not, in the two-year period preceding the date

of the application, had a certificate under this subchapter

revoked; and

(4) pays the fee set by the executive council.

(b) To be eligible for a prescription certificate a

psychologist must:

(1) have a conditional prescription certificate

issued under Section 501.372;

(2) have not less than two years of experience

prescribing psychotropic medication under a supervising clinician;

(3) have completed an independent peer review of the

applicant's experience described by Subdivision (2) as provided by

executive council rule;

(4) have completed training approved by the executive

council on the administration of psychotropic medications by

injection;

(5) provide evidence of professional liability

coverage in amounts required by executive council rule; and

(6) satisfy any other requirement of executive council

rule.

(c) A psychologist who holds a prescription certificate is

authorized to:

(1) issue a prescription drug order;

(2) administer or dispense a prescription drug;

(3) order tests commonly associated with monitoring

the use of prescription drugs;

(4) represent that the psychologist holds a

prescription certificate; and

(5) administer a psychotropic medication by

injection.

Sec. 501.374. REQUIREMENTS FOR PRESCRIPTION DRUG ORDER. A

prescription drug order issued by a prescribing psychologist must:

(1) comply with applicable state and federal law; and

(2) include:

(A) a statement that the order is issued by a

"psychologist certified to prescribe"; and

(B) the psychologist's certificate number.

Sec. 501.375. NOTICE TO PRIMARY CARE PRACTITIONER. (a) A

prescribing psychologist shall notify a patient's primary care

practitioner not later than:

(1) 72 hours after the time the psychologist issues

for the patient a prescription drug order for a psychotropic

medication or changes the type or dosage of a psychotropic

medication for the patient; and

(2) the 20th day after the date the psychologist

issues for the patient a prescription drug order for a drug to

manage or protect from a side effect of a psychotropic medication.

(b) A primary care practitioner is not liable for an act of a

prescribing psychologist based solely on the practitioner

receiving a notice under Subsection (a).

(c) This section does not require a prescribing

psychologist to give notice to or obtain approval from the

patient's primary care practitioner before prescribing a drug to a

patient with whom the psychologist has established a

psychologist-patient relationship.

Sec. 501.376. DRUG ENFORCEMENT ADMINISTRATION REGISTRATION

NUMBER. A prescribing psychologist who has a current federal Drug

Enforcement Administration registration number shall submit

information regarding that registration to the executive council in

accordance with executive council rule.

Sec. 501.377. RECORDS. A prescribing psychologist shall

maintain a record of all prescription drug orders issued by the

psychologist with the applicable patient record.

Sec. 501.378. DELEGATION PROHIBITED. A prescribing

psychologist may not delegate to any other person the authority to

perform any act for which a certificate issued under this

subchapter is required.

Sec. 501.379. ISSUANCE OF CERTIFICATE TO PRESCRIBING

PSYCHOLOGIST FROM ANOTHER JURISDICTION. The executive council

shall issue a prescription certificate under Section 501.373 to a

psychologist who:

(1) has previously been authorized to prescribe

psychotropic medication for not less than three years in another

jurisdiction if the other jurisdiction's requirements for the

authorization are substantially equal to the requirements of

Section 501.373;

(2) provides evidence of professional liability

coverage in amounts required by executive council rule; and

(3) satisfies any other requirement adopted by

executive council rule.

Sec. 501.380. EXPIRATION AND RENEWAL. The executive

council shall adopt rules providing for the expiration and renewal

of a certificate under this subchapter. The rules must provide that

a license holder's certificate expires on the same date as the

license under this chapter.

Sec. 501.381. CONTINUING EDUCATION. The executive council

shall adopt rules requiring a psychologist with a prescription

certificate issued under Section 501.373 to complete continuing

education on the prescribing of psychotropic medications as a

requirement to renew the certificate.

Sec. 501.382. REQUIREMENT OF SUPERVISING CLINICIAN. (a) A

person may not act as a supervising clinician for a psychologist

with a conditional prescription certificate unless the person:

(1) is a physician or psychologist with a prescription

certificate issued under Section 501.373; and

(2) has not less than three years of experience

prescribing psychotropic medications.

(b) A physician or psychologist acting as a supervising

clinician shall notify the Texas Medical Board or the executive

council, as applicable, of that fact and of the name of each

psychologist being supervised in accordance with rules of the Texas

Medical Board or executive council.

(c) A supervising clinician may not supervise more than the

full-time equivalent of seven psychologists, as determined by

executive council rule.

(d) A supervising clinician may supervise a psychologist

with a conditional prescription certificate through in-person

meetings or by use of telecommunications technology.

Sec. 501.383. LIMITATION ON LIABILITY OF SUPERVISING

CLINICIAN. A supervising clinician is not liable for any injury or

loss resulting from the acts of a psychologist under the

clinician's supervision unless the injury or loss arose from an act

under the direction or control of the clinician.

Sec. 501.384. DISCIPLINARY ACTION. The executive council

may deny, revoke, suspend, or refuse to renew a certificate issued

under this subchapter if the certificate holder violates this

chapter or a rule adopted under this chapter.

Sec. 501.385. RULES. The executive council shall adopt

rules to implement this subchapter.

SECTION 5. 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, psychologist, 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, psychologist,

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 6. 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 Behavioral Health Executive Council , 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 7. Sections 481.076(a) and (c), Health and Safety

Code, are amended to read as follows:

(a) The board may not permit any person to have access to

information submitted to the board under Section 481.074(q) or

481.075 except:

(1) the board, the Texas Medical Board, the Texas

Department of Licensing and Regulation, with respect to the

regulation of podiatrists, the State Board of Dental Examiners, the

State Board of Veterinary Medical Examiners, the Texas Board of

Nursing, [ or ] the Texas Optometry Board , or the Texas Behavioral

Health Executive Council, with respect to the regulation of

psychologists, for the purpose of:

(A) investigating a specific license holder; or

(B) monitoring for potentially harmful

prescribing or dispensing patterns or practices under Section

481.0762;

(2) an authorized employee of the board engaged in the

administration, investigation, or enforcement of this chapter or

another law governing illicit drugs in this state or another state;

(3) the department or other law enforcement or

prosecutorial official engaged in the administration,

investigation, or enforcement of this chapter or another law

governing illicit drugs in this state or another state, if the board

is provided a warrant, subpoena, or other court order compelling

the disclosure;

(4) a medical examiner conducting an investigation;

(5) provided that accessing the information is

authorized under the Health Insurance Portability and

Accountability Act of 1996 (Pub. L. No. 104-191) and regulations

adopted under that Act:

(A) a pharmacist or a pharmacist-intern,

pharmacy technician, or pharmacy technician trainee, as defined by

Section 551.003, Occupations Code, acting at the direction of a

pharmacist, who is inquiring about a recent Schedule II, III, IV, or

V prescription history of a particular patient of the pharmacist;

or

(B) a practitioner who:

(i) is a physician, dentist, veterinarian,

podiatrist, optometrist, psychologist, or advanced practice nurse

or is a physician assistant described by Section 481.002(39)(D) or

an employee or other agent of a practitioner acting at the direction

of a practitioner; and

(ii) is inquiring about a recent Schedule

II, III, IV, or V prescription history of a particular patient of

the practitioner;

(6) a pharmacist or practitioner who is inquiring

about the person's own dispensing or prescribing activity or a

practitioner who is inquiring about the prescribing activity of an

individual to whom the practitioner has delegated prescribing

authority;

(7) one or more states or an association of states with

which the board has an interoperability agreement, as provided by

Subsection (j);

(8) a health care facility certified by the federal

Centers for Medicare and Medicaid Services; or

(9) the patient, the patient's parent or legal

guardian, if the patient is a minor, or the patient's legal

guardian, if the patient is an incapacitated person, as defined by

Section 1002.017(2), Estates Code, inquiring about the patient's

prescription record, including persons who have accessed that

record.

(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 Behavioral Health Executive Council 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 8. Section 483.001(12), Health and Safety Code, is

amended to read as follows:

(12) "Practitioner" means:

(A) a person [ licensed by ]:

(i) licensed by 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) licensed by the Texas Department of

Licensing and Regulation, with respect to podiatry, to prescribe

and administer dangerous drugs; or

(iii) certified by the Texas Behavioral

Health Executive Council, with respect to psychology, to prescribe

and administer dangerous drugs;

(B) a person licensed by another state in a

health field in which, under the laws of this state, a licensee may

legally prescribe dangerous drugs;

(C) a person licensed in Canada or Mexico in a

health field in which, under the laws of this state, a licensee may

legally prescribe dangerous drugs; or

(D) an advanced practice registered nurse or

physician assistant to whom a physician has delegated the authority

to prescribe or order a drug or device under Section 157.0511,

157.0512, or 157.054, Occupations Code.

SECTION 9. Sections 576.025(b), (c), (e), and (f), Health

and Safety Code, are amended to read as follows:

(b) Consent to the administration of psychoactive

medication given by a patient or by a person authorized by law to

consent on behalf of the patient is valid only if:

(1) the consent is given voluntarily and without

coercive or undue influence;

(2) the treating physician , a treating psychologist

who holds a certificate issued under Subchapter H-1, Chapter 501,

Occupations Code, or a person designated by the physician or

psychologist, provided the following information, in a standard

format approved by the department, to the patient and, if

applicable, to the patient's representative authorized by law to

consent on behalf of the patient:

(A) the specific condition to be treated;

(B) the beneficial effects on that condition

expected from the medication;

(C) the probable health and mental health

consequences of not consenting to the medication;

(D) the probable clinically significant side

effects and risks associated with the medication;

(E) the generally accepted alternatives to the

medication, if any, and why the physician or psychologist

recommends that they be rejected; and

(F) the proposed course of the medication;

(3) the patient and, if appropriate, the patient's

representative authorized by law to consent on behalf of the

patient is informed in writing that consent may be revoked; and

(4) the consent is evidenced in the patient's clinical

record by a signed form prescribed by the facility or by a statement

of the [ treating ] physician or psychologist described by

Subdivision (2), or a person designated by the physician or the

psychologist, that documents that consent was given by the

appropriate person and the circumstances under which the consent

was obtained.

(c) If the [ treating ] physician or psychologist described

by Subsection (b)(2) designates another person to provide the

information under Subsection (b), then, not later than two working

days after that person provides the information, excluding weekends

and legal holidays, the physician or psychologist shall meet with

the patient and, if appropriate, the patient's representative who

provided the consent, to review the information and answer any

questions.

(e) In prescribing psychoactive medication, a [ treating ]

physician or psychologist described by Subsection (b)(2) shall:

(1) prescribe, consistent with clinically appropriate

medical care, the medication that has the fewest side effects or the

least potential for adverse side effects, unless the class of

medication has been demonstrated or justified not to be effective

clinically; and

(2) administer the smallest therapeutically

acceptable dosages of medication for the patient's condition.

(f) If a physician or psychologist described by Subsection

(b)(2) issues an order to administer psychoactive medication to a

patient without the patient's consent because the patient is having

a medication-related emergency:

(1) the physician or psychologist shall document in

the patient's clinical record in specific medical or behavioral

terms the necessity of the order and that the physician or

psychologist has evaluated but rejected other generally accepted,

less intrusive forms of treatment, if any; and

(2) treatment of the patient with the psychoactive

medication shall be provided in the manner, consistent with

clinically appropriate medical care, least restrictive of the

patient's personal liberty.

SECTION 10. Section 301.002(2), Occupations Code, is

amended to read as follows:

(2) "Professional nursing" means the performance of an

act that requires substantial specialized judgment and skill, the

proper performance of which is based on knowledge and application

of the principles of biological, physical, and social science as

acquired by a completed course in an approved school of

professional nursing. The term does not include acts of medical

diagnosis or the prescription of therapeutic or corrective

measures. Professional nursing involves:

(A) the observation, assessment, intervention,

evaluation, rehabilitation, care and counsel, or health teachings

of a person who is ill, injured, infirm, or experiencing a change in

normal health processes;

(B) the maintenance of health or prevention of

illness;

(C) the administration of a medication or

treatment as ordered by a health care practitioner legally

authorized to prescribe the medication or treatment [ physician,

podiatrist, or dentist ];

(D) the supervision or teaching of nursing;

(E) the administration, supervision, and

evaluation of nursing practices, policies, and procedures;

(F) the requesting, receiving, signing for, and

distribution of prescription drug samples to patients at practices

at which an advanced practice registered nurse is authorized to

sign prescription drug orders as provided by Subchapter B, Chapter

157;

(G) the performance of an act delegated by a

physician under Section 157.0512, 157.054, 157.058, or 157.059; and

(H) the development of the nursing care plan.

SECTION 11. Section 551.003(34), Occupations Code, is

amended to read as follows:

(34) "Practitioner" means:

(A) a person licensed , certified, 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, psychologist, 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 or certificate 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,

psychologist, 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 12. Section 501.051(b), Occupations Code, as

amended by this Act, does not affect the entitlement of a member

serving on the Texas State Board of Examiners of Psychologists

immediately before the effective date of this Act to continue to

serve for the remainder of the member's term. With the first

appointment of a member described by Section 501.051(a)(1),

Occupations Code, to be made by the governor on or after the

effective date of this Act, the governor shall appoint a member to

the board who has the qualifications required by Section

501.051(b), Occupations Code, as amended by this Act.

SECTION 13. (a) Not later than December 1, 2025, the Texas

Behavioral Health Executive Council shall appoint members of the

advisory committee in accordance with Section 501.152(a-1),

Occupations Code, as added by this Act.

(b) Not later than June 1, 2026, the advisory committee

shall make initial recommendations to the Texas Behavioral Health

Executive Council and the Texas State Board of Examiners of

Psychologists as described by Section 501.152(d), Occupations

Code, as added by this Act.

(c) Not later than September 1, 2028, the Texas Behavioral

Health Executive Council shall appoint members to the advisory

committee so that the composition of the committee complies with

Section 501.152(b), Occupations Code, as added by this Act.

SECTION 14. Not later than December 1, 2026, the Texas

Behavioral Health Executive Council shall adopt rules and

procedures necessary to implement Subchapter H-1, Chapter 501,

Occupations Code, as added by this Act.

SECTION 15. This Act takes effect September 1, 2025.