Texas Register, Volume 35, Number 6, Pages 711-960, February 5, 2010 Page: 866
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This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's
Filed with the Office of the Secretary of State on January 15,
Adriana A. Gonzales
Public Utility Commission of Texas
Effective date: February 4, 2010
Proposal publication date: October 9, 2009
For further information, please call: (512) 936-7223
TITLE 22. EXAMINING BOARDS
TEXAS BOARD OF NURSING
CHAPTER 222. ADVANCED PRACTICE
REGISTERED NURSES WITH PRESCRIPTIVE
22 TAC 222.1 - 222.12
INTRODUCTION. The Texas Board of Nursing (Board) adopts
amendments to Chapter 222, 222.1 - 222.12, concerning Ad-
vanced Practice Registered Nurses With Prescriptive Authority.
Sections 222.1, 222.3 - 222.6, and 222.8 - 222.12 are adopted
without changes to the proposed text published in the November
27, 2009, issue of the Texas Register (34 TexReg 8437) and will
not be re-published. Sections 222.2 and 222.7 are adopted with
two minor changes to correct typographical errors.
REASONED JUSTIFICATION. The amendments to Chapter
222 are adopted under the Occupations Code 301.151 and
301.152 and are necessary to: (i) clarify changes made to
the Medical Practice Act by Senate Bill (SB) 532, enacted by
the 81st Legislature, Regular Session, effective September
1, 2009, which amends the Occupations Code Chapter 157;
and (ii) provide guidance to advanced practice registered
nurses (APRNs) who exercise prescriptive authority in this
state. Specifically, the adopted amendments: (i) amend and
add new definitions to Chapter 222; (ii) eliminate references to
"provisional authorization" throughout Chapter 222; (iii) clarify
the content requirements of a Clinical Nurse Specialist's course
work; (iv) clarify the content requirements of a prescription for
a controlled substance; (v) clarify the circumstances under
which an APRN may issue a prescription for the partner of an
established patient; (vi) clarify the limitations associated with
prescribing "off label" medications; and (vii) update outdated
references and correct grammatical and typographical errors.
The proposed amendments were considered at the July 30,
2009, and September 23, 2009, meetings of the Advanced
Practice Nursing Advisory Committee (Committee). The Com-
mittee reviewed SB 532 and considered its impact on the
prescriptive authority of APRNs in this state. The Committee
also considered issues associated with prescribing medications
for the treatment of sexually transmitted infections for the part-
ners of established patients. Further, the Committee considered
limitations associated with writing "off label" prescriptions. Fol-
lowing its discussions, the Committee approved the proposed
amendments and recommended their adoption to the Board.
At the January 2010, Board meeting, the Board approved the
adoption of the proposed amendments.
The Board has made changes to 222.2 and 222.7 as adopted
to correct minor typographical errors. First, the word "subsec-
tion" in 222.2(a)(2)(A)(ii) as proposed has been changed to
"subparagraph" and the reference to "(a)" has been restored
to "(A)". This change is necessary to correctly reference
222.2(a)(2)(A), which corresponds to the content areas ref-
erenced in 222.2(a)(2)(A)(ii). Second, the word "shall" in
222.7(4) as proposed has been struck in order to eliminate
SB 532, enacted by the 81st Legislature, Regular Session, effec-
tive September 1, 2009, amends portions of the Medical Practice
Act relating to a physician's delegation of prescriptive authority.
These amendments directly impact the prescriptive authority of
APRNs in this state. The adopted amendments to Chapter 222
are necessary: (i) to clarify the provisions of SB 532 that affect
the prescriptive authority of APRNs; and (ii) for consistency with
the provisions of SB 532.
Prior to the enactment of SB 532, a physician was not able to
delegate the carrying out or signing of a prescriptive drug order
for a controlled substance if the prescription period exceeded 30
days. Further, it was unclear as to whether a refill of the pre-
scription was included in this restriction. SB 532 amends the
Occupations Code 157.0511(b) to permit a physician to dele-
gate the carrying out or signing of a prescriptive drug order for a
controlled substance for a period not to exceed 90 days. SB 532
also clarifies that this time period includes a refill of the prescrip-
tion. A physician may delegate the carrying out or signing of a
prescriptive drug order for a controlled substance to an APRN.
In such event, the limitations of 157.0511(b) also apply to the
APRN prescribing the medication. As such, adopted 222.6(b)
clarifies that an APRN may not authorize or issue a prescription
for a controlled substance, including a refill of the prescription,
for a period exceeding 90 days. Further, adopted 222.6(b) pro-
hibits an APRN from authorizing the refill of a prescription for a
controlled substance beyond 90 days without consulting the del-
egating physician. These adopted amendments are necessary
for consistency with the limitations imposed by 157.0511(b).
SB 532 also expands the definition of primary practice site in
157.053(a). Under the new definition, a physician's primary
practice site may include a location where an APRN, who
practices on-site with the physician more than 50 percent of
the time, provides health care services for established patients.
The physician's primary practice site may also include a location
where an APRN practices on-site with the physician more than
50 percent of the time and provides, without remuneration, vol-
untary charity health care services at a clinic run or sponsored
by a nonprofit organization or voluntary health care services
during a declared emergency or disaster at a temporary facility
established for that purpose. The adopted amendments to
222.1(14) are necessary for consistency with the new definition
of primary practice site in 157.053(a). Adopted 222.1(14)
clarifies that an APRN may prescribe medications in a setting in
which health care services are provided for established patients
if the APRN spends at least 50 percent of the time in a setting
with the delegating physician. Further, adopted 222.1(14)
clarifies that an APRN may prescribe medications in a clinic run
or sponsored by a nonprofit organization that provides voluntary
charity health care services if the APRN spends at least 50
35 TexReg 866 February 5, 2010
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Texas. Secretary of State. Texas Register, Volume 35, Number 6, Pages 711-960, February 5, 2010, periodical, February 5, 2010; Austin, Texas. (texashistory.unt.edu/ark:/67531/metapth101170/m1/153/: accessed April 24, 2017), University of North Texas Libraries, The Portal to Texas History, texashistory.unt.edu; crediting UNT Libraries Government Documents Department.