Texas has recently had a significant revision regarding the ability of physicians to delegate prescribing devices, drugs and other controlled substances to advanced practice registered nurses (APRNs) and physician assistants (Pas).
SB 406, which was passed in the 2013 Texas legislature, has recently been implemented through new Texas Board of Nursing (BON) and Texas Medical Board (TMB) regulations.
SB 406 substantially revises Chapter 157 of the Texas Occupations Code, which governs the authority of a physician to delegate certain medical acts, and expands the ability of APRNs and PAs to prescribe or order Schedule II controlled substances in certain practice settings. SB 406 also eliminates the old concept of “alternate” and “primary” practice site requirements and authorizes the use of a “Prescriptive Authority Agreement” (PAA) in order to delegate prescription writing authority to APRNs and PAs. The new statute increases to seven (from four) the number of APRNs and PAs to whom a physician can delegate prescribing authority, and provides an exception to that limit when the PAA is exercised in a facility-based practice or elsewhere. However, the new rules also have increased the continuing educations requirements of APRNs who receive this delegation of authority and provide for substantial documentation requirements, as well as enforcement actions by the BON, the Texas Medical Board and the Texas Physician Assistant Board.
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