HBA-MPM S.B. 1166 77(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1166 By: Madla Public Health 4/12/2001 Engrossed BACKGROUND AND PURPOSE Under current law, physicians may delegate prescriptive authority to advanced practice nurses (APNs) and physician assistants (PAs) at sites where a medically underserved population is treated, a physician's primary practice site, and a facility-based practice in a hospital or nursing home. This can limit the ability of physicians, APNs, and PAs to provide health care services to patients. Senate Bill 1166 expands prescriptive authority to APNs and PAs to include APNs and PAs at alternate sites. The bill also gives the Texas State Board of Medical Examiners the authority to waive certain site requirements for a physician to delegate prescriptive authority to an APN or PA. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas State Board of Medical Examiners in SECTION 2 (Section 157.0541, Occupations Code) of this bill. ANALYSIS Senate Bill 1166 amends the Occupations Code to authorize a physician to delegate to an advanced practice nurse (APN) or physician assistant (PA) acting under adequate physician supervision the act of administering, providing, or carrying out or signing a prescription drug order at an alternate site, located within 60 miles of the delegating physician's primary practice site, where services similar to the services provided at the primary practice site are provided (Secs. 157.0541, 204.202, and 301.002). The bill specifies that the authority of a physician to delegate the carrying out or signing of prescription drug orders is limited to dangerous drugs. The bill establishes circumstances under which physician supervision is adequate. The bill authorizes an alternative physician to provide appropriate supervision to an APN or PA on a temporary basis as provided by Texas State Board of Medical Examiners (board) rule. The bill limits the combined number of APNs and PAs to whom a physician may delegate prescribing at a primary and an alternate practice site to three APNs or PAs or the full-time equivalent (Sec. 157.0541). The bill sets forth circumstances under which the board is authorized to waive or modify the site or supervision requirements for a physician to delegate the carrying out or signing of prescription drug orders to an APN or PA at a primary, facility-based, or alternate practice site or a site serving certain medically underserved populations and requires the board to establish procedures for granting waivers, including a process for providing, if the board denies a waiver, written explanation for the denial and a notice and opportunity for hearing when a waiver is revoked, suspended, or modified. The board is authorized to probate an order to revoke, suspend, or modify a waiver. The board is prohibited from waiving the limitation on the number of primary or alternate practice sites at which a physician may delegate the carrying out or signing of prescription drug orders or the number of APNs or PAs to whom a physician may delegate these duties (Sec. 157.0542). The bill requires the board to appoint an advisory committee (committee) to review and make recommendations on applications for waivers and sets forth composition requirements for the committee. The bill requires the committee to recommend whether to grant a waiver after making the determinations required of the board. The bill authorizes the board to grant a waiver only if the committee recommends that the waiver be granted, unless the board determines good cause exists to grant a waiver the committee does not recommend. The bill authorizes the committee to recommend that the board approve a waiver with modifications and sets forth provisions regarding the required vote for approving a waiver with or without modifications (Sec. 157.0542). The board is required to report to the legislature no later than December 1, 2004 the number of waiver applications received and granted (SECTION 9). S.B. 1166 amends the Occupations and Health and Safety codes to include an APN or PA to whom a physician has delegated the authority to carry out or sign prescription drug orders under the definition of "practitioner" for the purposes of the provisions of this bill and other state law (Sec. 551.003, Occupations Code, and Secs. 483.001, 483.003 and 483.004, Health and Safety Code). EFFECTIVE DATE On passage, of if the Act does not receive the necessary vote, the Act takes effect September 1, 2001.