HBA-MPM H.B. 2940 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2940 By: Capelo Public Health 3/21/2001 Introduced 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. House Bill 2940 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 House Bill 2940 amends the Occupations Code to authorize a physician to delegate to an advanced practice nurse (APN) or physician assistant (PA) 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, under adequate physician supervision (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 required to waive the requirements for a physician to delegate the 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. The board is required 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). H.B. 2940 amends the Occupations and Health and Safety codes to include an APN or PA authorized by a physician to 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.