Prescriptive Delegation Waiver Requests

Chapter 193.6 (i) of the Board Rules contains information regarding requests for Prescriptive Delegation Waivers.

Which delegation requirements can be waived by the Board?

The board may waive or modify any of the site or supervision requirements for a physician to delegate the carrying out or signing of prescription drug orders to an advanced practice nurse or physician assistant at facilities serving medically underserved populations, at physician primary and alternate practice sites, and at facility-based practice sites.

If the board determines that the types of health care services provided by a physician assistant or advanced practice nurse at a primary practice site or an alternate practice site are limited in nature and duration and are within the scope of delegated authority, and that patient health care will not be adversely affect, the board may modify or waive:

• the limitation on the number of physician assistants or advanced practice nurses, or their full-time equivalents, if the board does not authorize more than six physician assistants or advanced practice nurses or their full-time equivalents;
• the mileage limitation (relevant only to alternate practice sites);
• the onsite-supervision requirements, except that the physician must be available on-site at regular intervals and when on-site must be available to treat patients.

A granted modification or waiver may not validate or authorize a contract provision that prohibits a physician from seeing, diagnosing, or treating any patient.

Note:

• The limitation on the number of primary or alternate sites cannot be waived.
• Only physicians may submit prescriptive delegation waiver requests

What factors does the Board take into account?

The board’s rules state that the board may grant a waiver only if the board determines good cause exists to grant a waiver. When considering a modification/waiver request, the board takes into account many factors, including:

• Whether the existing prescriptive delegation requirements cause an undue burden, not only to the requestor, but to the patient population in the practice area for which the modification/waiver request is made, without corresponding benefit to patient care;
• If the requirement for which the modification/waiver is sought is the amount of time the physician is on-site, whether the frequency and duration of time the physician is on-site when the advanced practice nurse or physician assistant is present is sufficient for collaboration to occur, taking into consideration the other ways the physician collaborates with the advanced practice nurse or physician assistant at other sites;
• The quality and viability of safeguards that are proposed to ensure continued quality of patient care under the requested modification/waiver;
• The quality and viability of safeguards that are proposed to foster, and to maintain, a collaborative practice between the physician and the physician assistant or advanced practice nurse under the proposed modification/waiver; and,
• The requestor’s type of primary practice and the type of practice conducted at the site for which a waiver is requested, including the populations served by the practices and duties assigned to mid-level practitioners.

Violations

Violation of Board rule 193.6 by the delegating physician may result in a refusal to approve supervision or the cancellation of the physician's authority to delegate to a physician assistant or an advanced practice nurse under this section. Violation of this section may also subject the physician to disciplinary action.

If an advanced practice nurse violates this section or the Act, §§157.051 - 157.060, the board shall promptly notify the Texas Board of Nursing of the alleged violation.

If a physician assistant violates this section or the Act, §§157.051 - 157.060, the board shall promptly notify the Texas Physician Assistant Board.

Instructions, Application and Information

• Prescriptive Delegation Waiver Requests Form (Word file, updated 2-7-2011)
• Quick Reference - Site-Specific Prescriptive Delegation Statute & Rule (PDF)

Prior to review by the Board, Prescriptive Delegation Waiver Requests will be placed on our website for a minimum of 14 days for public comment. Current requests, if any, are listed below. Public commentary may be sent to:

Email -
verifcic@tmb.state.tx.us For most efficient routing, please make the subject of your email “Public Comments for PDW Request” and include the last name of the physician requesting a waiver.

Fax -
(512) 305-7009 ATTN: “Public Comments for PDW Request.” Include the last name of the physician requesting a waiver

Mail -
Texas Medical Board
Attn: Public Comments for PDW - Insert last name of physician requesting waiver
PO Box 2029
Austin TX 78768-2029

Prescriptive Delegation Waiver Requests
Published for Public Comment

There are no requests at this time.