What constitutes a license that is in good standing for purposes of entering a prescriptive authority agreement?
An APRN or PA may enter into a prescriptive authority agreement unless his/her license is revoked, suspended, delinquent, inactive, has been voluntarily surrendered, or is subject to a disciplinary order that specifically prohibits entering into a prescriptive authority agreement. If the Texas Board of Nursing or Texas Medical Board limits an APRN’s or PA’s authority to order or prescribe drugs or devices, the licensee may enter into a prescriptive authority agreement and order or prescribe drugs and devices only to the extent permitted by the board order.
A physician may not may enter into a prescriptive authority agreement if the physician’s license has been revoked, suspended, is delinquent, is inactive, has been voluntarily surrendered, or is subject to a disciplinary order that restricts his or her practice.
Do I have to disclose information regarding investigations and discipline? If so, to whom must this information be disclosed
Yes. Prior to signing a prescriptive authority agreement, you must disclose to the other party/parties to the prescriptive authority agreement if you have been disciplined in the past. This includes disciplinary action taken by licensing boards in other states. Once you are a party to a prescriptive authority agreement, you are required to immediately notify the other party/parties to the agreement if you receive notice that you are the subject of an investigation.
Prescriptive authority agreements must include the following elements:
- Name, address, and all professional license numbers of all parties to the agreement;
- State the nature of the practice, practice location or practice settings;
- Identify the types of categories or drugs or devices that may be prescribed OR the types or categories of drugs or devices that may not be prescribed;
- Provide a general plan for addressing consultations and referrals;
- Provide a plan for addressing patient emergencies;
- State the general process for communication and sharing information related to the care and treatment of patients; and
- Describe a quality assurance and improvement plan and how it will be implemented. The plan must include plans for chart reviews and periodic face to face meetings.
Can we skip doing face to face meetings if the physician and APRN or PA practices together at the same location?
No. You must have the face to face meetings as part of your quality assurance and improvement plan.
The meetings must occur at least monthly until the third anniversary of the date the agreement is executed. However, if the APRN or PA was in a prescriptive authority agreement with required physician supervision for at least five of the last seven years, face to face meetings must occur at least monthly until the first anniversary of the date the agreement is signed. Once the required period of time for monthly face to face meetings has been completed, the parties to the prescriptive agreement must have face to face meetings at least quarterly with monthly meetings held between the quarterly meetings via remote electronic communication systems such as videoconferencing technology or the internet. If for any reason the APRN’s or PA’s delegating physician changes, face to face meetings will be required at least monthly as indicated.
Yes as agreed to by the parties to the prescriptive authority agreement. The requirements for monthly and quarterly meetings are the minimum requirements specified in Texas law. You may meet more frequently than required by law. You may not meet less frequently than what is required by law. An APRN or PA should meet the requirements of the prescriptive authority agreement which may have more frequent meetings required.
The law does not provide a specific number or percentage of charts that must be reviewed. Rather, the law provides that the number of charts to be reviewed is determined by the parties to the prescriptive authority agreement. The number may vary from one practice setting to another. Factors such as the length of time the APRN or PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether the parties to the prescriptive authority agreement practice together in the same practice setting, and the complexity of patient care needs should be given consideration when making this determination. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the number or percentage of charts reviewed may be an important factor in determining the quality of the physician’s supervision.
Is credit given for time practiced in a supervised prescriptive authority arrangement prior to November 1, 2013?
The calculation under Chapter 157, Texas Occupations Code, of the amount of time an APRN or PA has practiced under the delegated prescriptive authority of a physician under a prescriptive authority agreement shall include the amount of time the APRN or PA practiced under the delegated prescriptive authority of that same physician prior to November 1, 2013. You must be practicing with the same physician you practiced with prior to November 1, 2013 in order to get credit under this provision.
What if an alternate physician is involved in delegation of prescriptive authority on a temporary basis?
The prescriptive authority agreement designates who may serve as an alternate physician if alternate physician supervision will be utilized. If an alternate physician(s) will participate in the quality assurance and improvement meetings with the APRN or PA, this information must be included in the prescriptive authority agreement.
APRNs and PAs are required to have delegated authority to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than have two documents, this delegation can now be included in a prescriptive authority agreement if both parties agree to do so.