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“... Actions
Physician Assistant Supervision
Advanced Practice Nurse Delegation
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“... s State Board of Acupuncture Examiners (TSBAE) to practice acupuncture, which is defined as the insertion of an acupuncture needle and the application of moxibustion to specific areas of the human body as a primary mode of therapy to treat and mitigate a human condition, including the evaluation and ... ”
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Texas Statutes regarding acupuncture practice are at http://www.statutes.legis.state.tx.us/?link=OC.
Acupuncture Board Rules ”
“... d, please do so in writing. Provide full name and practice address of practitioner. Also, provide dates and details of any incident, being as specific as possible. If your complaint is within the Board's jurisdiction, it will be assigned for proper study. Complainants are advised of an investigation ... ”
“... icensee but not verified by the TMB (e.g. primary practice address, hospital privileges, delegation information, etc.) All verifications also include a description of any action taken by the Board against a licensee.
Data is updated daily and may be considered the most current information available. ... ”
“... gery by performing certain tasks like opening and closing surgical sites, harvesting grafts, dissecting and removing tissue, and implanting devices to name a few. Under the Occupations Code, the practice of a surgical assistant is limited to surgical assisting performed under the direct supervision ... ”
“... lled, the acupuncturist will no longer be able to practice in the state of Texas as an acupuncturist. In order to practice again in Texas following cancellation, a acupuncturist must file an application for relicensure and meet all requirements for licensure in effect at that time.
To r ... ”
“...
practice clinical medicine,
prescribe dangerous drugs or controlled substances, or
delegate medical acts or prescriptive authority.
The holder of an Ad ... ”
“... ng standards of excellence used in regulating the practice of medicine and ensuring quality health care for the citizens of Texas through licensure, discipline, and education”.
TMB is dedicated to a workplace that values differences and respect of each other at all levels of the organization. ... ”
“... oard certified" in any advertising for his or her practice if:
the specialty board that conferred the certification and the certifying organization is:
a member board of the American Board of Medical Specialties (ABMS),
a member board of the American Osteopathic Association Bureau of Osteopathic S ... ”
“... ng course content: that it must be related to the practice of acupuncture or oriental medicine, and be related to the knowledge and/or technical skills required to practice acupuncture or related to direct and/or indirect patient care (Board Rule 183.20(n)(1)). In addition, preferred providers must ... ”
“... eral Acupuncture, Biomedicine, Ethics, Herbal and Practice Management/Business Administration. For information on the courses available, please contact the providers directly.
List of Current Approved Providers: CAE Approved Provider Numbers ... ”
“... w able to offer the ability to update mailing and practice addresses online for the majority of our licensees.
To update your mailing or practice address online click the link below, and create a “My TMB” account if you do not have one already. (Note - if you already have an ... ”
“... ses
Per Board rule 166.2(a)(8), a physician whose practice includes the treatment of tick-borne diseases should complete CME in the treatment of tick-borne diseases that meet the requirements described in the formal category above.
EMS Medical Director (also known as Off-Line Medical Director ... ”
“... an one year's duration outside the state;
medical practice and residence of longer than one year's duration outside the United States; or
good cause shown on written application of the licensee that gives satisfactory evidence to the board that the licensee is unable to comply with the requirement f ... ”
Description: TMB Bulletin March 2012
Document: ... e calls and email. Anecdotal reports indicate the practice is widespread among physicians. What modern doctor wouldn't want to use it? confused. It is dangerous and unethical as it puts the patient at risk and potential death if the wrong order is given. This is a huge liability."
New law clarifies ...
Description: TMB Bulletin January 2012
Document: ... udication for child molestation might continue to practice medicine. Prior to the passage of SB 263, in order for a physician's license to be suspended, the physician had to be convicted of a felony related to child molestation.
CONTINUED PAGE THREE
Safeguarding a doctor's independent judgment
Sena ...
Description: TMB Bulletin December 2012
Document: ... ian delegating prescriptive authority to advanced practice nurses or physician assistants. But the board's rules state that the board may grant a waiver only if it determines good cause exists to grant a waiver. So what factors does the board take into account? · Whether the existing prescriptive de ...
Description: Rule Changes December 30, 2007
Document: ... rment, updating language. Chapter 198, Unlicensed Practice, amending 198.2, Complaints, to make appropriate updates; and 198.3, Investigation of Complaints, to clarify provisions and make appropriate updates. Chapter 199, Public Information, amending 199.1, Public Information Committee, to require t ...
Description: Rule Changes December 4, 2011
Document: ... ion. The amendment to §163.11, relating to Active Practice of Medicine, provides that applicants for licensure who have not actively practiced medicine within either of the two years prior to the date of application, must submit proof of passage of a monitored examination for board certification iss ...
Description: Rule Changes November 30, 2009
Document: ... ored examination; and §163.11, relating to Active Practice of Medicine, clarifies that if an applicant for licensure is unable to demonstrate that the applicant has actively practiced medicine prior to the date of application, the applicant can present proof of board certification obtained within tw ...
Description: Rule Changes October 17, 2010
Document: ... ry to establish uniform definitions for those who practice telemedicine in Texas. Amendments to §174.3, concerning Telemedicine Medical Services, deletes reference to the Telecommunications Infrastructure Fund Board (TIFB). The Board has determined that references to the TIFB must be eliminated sinc ...
Description: Rule Changes September 27, 2007
Document: ... enewal; 194.5 Non-Certified Technician s Scope of Practice; 194.6 Suspension, Revocation or Nonrenewal of Registration. Provides updates regarding the names of the Texas medical Board and Department of State Health Services, and clarifies that NCT registrations that are not renewed within 90 days wi ...
Description: Rule Changes September 21, 2012
Document: ... with other provisions of the rule and the Medical Practice Act. The amendment to §187.83 deletes language requiring a panel member to sign cease and desist order, as rule already provides for executive director to sign order. Chapter 189 COMPLIANCE PROGRAM 22 TAC §§189.1, 189.3, 189.5, 189.7, 189.9, ...
Description: Rule Changes September 19, 2010
Document: ... that the rule applies to determinations on active practice. Amendment to §185.7, relating to Temporary License, provides that the PA Board may revoke a temporary license when necessary. Amendment to §185.16, relating to Employment Guidelines, deletes language based on recent statutory changes, and c ...
Description: Rule Changes September 19, 2002
Document: ... 0.1 concerning clarification of the definition of practice inconsistent with public health and welfare and general clean-up of the section.
Description: Rule Changes September 18, 2011
Document: ... ease and desist hearing related to the unlicensed practice of medicine. http://www.sos.state.tx.us/texreg/archive/September92011/adopted/22.EXAMINI NG%20BOARDS.html#306
Description: Rule Changes August 20, 2009
Document: ... upations Code; §185.13, Notification of Intent to Practice and Supervise, provides that if a primary supervising physician of a physician assistant is not able to supervise for more than 30 days, then a new primary supervising physician must provide supervision; §185.16, Employment Guidelines, clari ...
Description: Rule Changes August 10, 2008
Document: ... or could have impaired an applicant's ability to practice medicine; §163.6, Examinations Accepted for Licensure , provides an exception to the three-attempt limit to conform to statutory requirements adopted by the Legislature in 2007; §163.10, Relicensure, updates requirements to conform to previo ...
Description: Rule Changes July 04, 2012
Document: ... 163.11 of the Board's rules related to the active practice of medicine. Chapter 172 TEMPORARY AND LIMITED LICENSES 22 TAC §§172.8, 172.15, 172.16 The amendment to §172.8, relating to Faculty Temporary License, provides that applicants for Faculty Temporary Licenses (FTLs) shall be determined ineligi ...
“... authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. 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 distance ... ”
How many miles from my delegating physician can my practice site be?
SB 406 eliminated site based prescriptive authority. The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. 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 distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision.
“... n requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all ti ... ”
What are the Texas Medical Board’s requirements for a physician who delegates to an APRN or PA?
All prescriptive delegation requires adequate supervision under the Medical Practice Act. As such, a physician delegating to an APRN or PA must adequately supervise those individuals. An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.
“... eed not describe the exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however. ”
Do I need to have a protocol in addition to a prescriptive authority agreement?
APRNs and PAs are required to have delegated authority from a licensed physician in order to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than requiring multiple documents, delegation protocols can now be included in one document the prescriptive authority agreement. The prescriptive authority agreement need not describe the exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however.
“A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement. ... ”
What constitutes a license that is in good standing for purposes of entering a prescriptive authority agreement?
A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement.
Note that if a licensee’s authority to supervise, delegate, or prescribe devices is limited under a board order, the licensee may enter into a prescriptive authority agreement and practice under the agreement only to the extent permitted by the board order.
“... o the agreement;(3) state the nature of the practice, practice locations, or practice settings;(4) identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;(5) provide a general plan for ad ... ”
What must be included in a prescriptive authority agreement?
It depends upon when the agreement was executed. Note that there have been several changes to the law affecting this area in recent legislative sessions. To understand how the law might apply to your situation, you may want to seek the advice of private legal counsel.
For a prescriptive authority agreement executed on or after September 1, 2019, the agreement must, at a minimum:
(1) be in writing and reviewed, signed and dated by the parties to the agreement on an annual basis;
(2) state the name, address, and all professional license numbers of the parties to the agreement;
(3) state the nature of the practice, practice locations, or practice settings;
(4) identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;
(5) provide a general plan for addressing consultation and referral;
(6) provide a plan for addressing patient emergencies;
(7) state the general process for communication and the sharing of information related to the care and treatment of patients;
(8) if alternate physician supervision is to be utilized, designate one or more alternate physicians; and
(9) describe a prescriptive authority quality assurance and improvement plan and how it will be implemented. The plan must require chart reviews and periodic meetings.
“... ity 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 t ... ”
How many charts must be reviewed?
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.
“... locations at which the physician and delegate(s) practice. ”
Can we skip conducting periodic meetings if the physician and APRN or PA practice together at the same location?
No. Periodic meetings are required, regardless of the distance between or locations at which the physician and delegate(s) practice.
“No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive au ... ”
If I work in a clinic owned by the hospital, is this considered a facility-based practice?
No. Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices. Prescriptive authority agreements are required in these settings.
“... nt in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms. ”
Is a prescriptive authority agreement required in a hospital or long term care facility-based practice?
Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required. You may continue to practice under protocols in these settings. APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms.
“In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate. &n ... ”
Who may delegate prescriptive authority in a hospital facility-based practice?
In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate.
“In a long term care facility based practice, delegation is by the medical director. ”
Who may delegate prescriptive authority in a long term care facility based practice?
In a long term care facility based practice, delegation is by the medical director.
“... or valid medical purpose and in course of medical practice). And a CRNA may not obtain an anesthetic that is a dangerous drug unless a physician has listed that CRNA as the physician’s designated agent. See id. §§ 483.001(4) (defining “designated agent”), .022(a) (requiri ... ”
When is Physician supervision of a CRNA required?
Regardless of the circumstances when supervision is or is not required, it is important to remember that the delegating physician must abide by all required federal and state statutes and regulations regarding delegation. The physician retains responsibility of the medical management of the patient. Therefore, the delegating physician must consider the delegatee’s education, training, and experience prior to delegating. Additionally, delegation may be revoked by the delegating physician at any time.
The Texas Attorney General has issued three opinions on CRNA supervision. The latest opinion found that although physician supervision of a CRNA is not required in Texas Occupations Code Sec. 157.058, other federal and state statutes and regulations may require physician supervision of a CRNA, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician, and the Legislature did not expressly limit the liability of the delegating physician.
Specifically, Texas Attorney General Opinion KP-0353 found “Section 157.058 of the Occupations Code does not, by itself, require a physician who properly delegates anesthesia-related tasks to a certified registered nurse anesthetist (“CRNA”) to supervise the performance of those acts.” (Page 5)
However, KP-0353 also found “…the language of chapter 157 is not the only relevant authority to consider in addressing the question of physician supervision over acts delegated to a CRNA. Federal regulations limiting Medicare coverage and conditioning hospital participation in Medicare and Medicaid programs require physician supervision of a CRNA when administering anesthesia in certain circumstances. See, e.g., 42 C.F.R. §§ 416.42(b)(2), 482.52(a)(4), 485.639(c)(1)(v), (2) (requiring a CRNA to operate under a physician’s supervision when administering anesthesia in certain circumstances). Furthermore, a CRNA may not administer an anesthetic that is a controlled substance outside the presence of a physician. See TEX. HEALTH & SAFETY CODE §§ 481.002(1)(A) (defining “administer” to require agent to apply controlled substance in presence of physician), .071(a) (prohibiting physician from causing controlled substance to be administered under physician’s “direction and supervision” except for valid medical purpose and in course of medical practice). And a CRNA may not obtain an anesthetic that is a dangerous drug unless a physician has listed that CRNA as the physician’s designated agent. See id. §§ 483.001(4) (defining “designated agent”), .022(a) (requiring physician to name each designated agent in writing). (Page 3 with emphasis added.)
Finally, KP-0353 found “Whether and the extent to which physician supervision is required for an act delegated to a CRNA will depend on the specific act delegated, the type of facility in which the CRNA performs the act, and any relevant regulations of that facility. And while section 157.058 authorizes a physician to delegate to a CRNA, a physician is never required to do so. If a physician is concerned about a CRNA’s ability to perform a delegated act or desires to limit the delegation, the physician retains the authority to refrain from delegating, to limit the delegation, or to supervise the delegation to whatever extent the physician determines necessary. In sum, the authority to delegate provided by section 157.058 of the Occupations Code does not eliminate the need to comply with all other applicable statutes, regulations, bylaws, ethical standards, and a physician’s own professional judgment. See TEX. OCC. CODE § 157.007 (“An act delegated by a physician under [chapter 157] must comply with other applicable laws.”). (Page 4 with emphasis added.)
“... situations: (1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who: (A) has be ... ”
Who can prescribe Schedule II drugs under physician delegation?
APRNs or PAs may prescribe schedule II drugs in the following situations:
(1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
(A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department of the hospital; or
(2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
“... gal authorization issued by a licensing agency to practice in a specific occupation or profession that is provided to the licensing agency is confidential and is not subject to disclosure under the open records law."The law was passed in the House on March 18 and in the Senate on May 17 and went int ... ”
Is my social security number subject to open records through TMB?
The 76th Legislature passed HB 692, which states in part: "The social security number of an applicant for or holder of a license, certificate of registration, or other legal authorization issued by a licensing agency to practice in a specific occupation or profession that is provided to the licensing agency is confidential and is not subject to disclosure under the open records law."
The law was passed in the House on March 18 and in the Senate on May 17 and went into effect after being signed by Governor George W. Bush on May 29, 1999.
“OBA registration does not apply to physicians who practice in the following settings: An outpatient setting in which only local anesthesia, peripheral nerve blocks, or both are used. Any setting physically located outside the State of Texas. A licensed hospital, including an outpatient facility of t ... ”
Who does not need to register for office-based anesthesia?
OBA registration does not apply to physicians who practice in the following settings:
Note: physicians that provide only level I services, must still meet all other requirements under Chapter 192.