Per Board Rule 195.4(e), the medical director or owner/operator of the pain management clinic, must on annual basis, ensure all personnel are properly licensed and, if applicable, have the requisite training to include 10 hours of continuing medical education (CME) annually in the area of pain management. This CME requirement applies to all personnel providing medical services to the patients (including, but not limited to: PAs, x-ray techs, phlebotomists, RNs, MAs, etc.). Office staff, such as managers, janitors, etc. who do not provide medical services, would not be required to meet the CME requirement, but would need to be listed in response to a pain clinic audit which requires listing all clinic personnel for that clinic. Documentation of the completed CME course shall be required to be made available upon request by Board Staff, including, but not limited to, during an on-site audit of the clinic, or during the certificate renewal process. The Board does have the authority to conduct audits and inspections at clinics to ensure compliance with all requirements and regulations pertaining to registered pain clinics, including audits of CME training as required.

Yes, the physician’s name, address and telephone number are required to be included on the prescription drug order.  If the prescription is for a controlled substance, the physician’s DEA number is also required to be included on the prescription.  SB 406 did not change the requirements for what needs to be included on a prescription drug order.   

Texas is one of just a few states that use the term “dangerous drugs.”  The Dangerous Drug Act defines a dangerous drug as a device or drug that is unsafe for self-medication and that is not included in Schedules I through V or Penalty Groups 1 through 4 of Chapter 481, Health and Safety Code (Texas Controlled Substances Act). The term includes a device or drug that bears, or is required to bear, the legend: “Caution: federal law prohibits dispensing without prescription” or “Rx only” or another legend that complies with federal law.  Many other states use the term “legend drugs.”

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.)

No.  A free standing emergency department is not located within the hospital anddoes not qualify as an eligible site for delegation of schedule II authority.  The physician may only delegate authority to prescribe controlled substances in schedules III through V in this setting.  Authority to prescribe dangerous drugs, nonprescription drugs and devices may be delegated in any setting.  

 APRNs and PAs must consult with the delegating physician for refills of a prescription for controlled substances after the initial 90 day supply.  Consultation is also required when prescribing controlled substances for children under the age of two years.  In both cases, the consultation must be documented in the patient’s medical record.

Yes.  Nothing changed for delegation of prescriptive authority for controlled substances in schedules III through V.

1. A physician who provides level II-IV anesthesia services in an outpatient setting (including analgesics and anxiolytics).
2. A physician who performs a procedure for which level II-IV anesthesia services are provided in an outpatient setting (including analgesics and anxiolytics).

OBA registration does not apply to physicians who practice in the following settings:

1. An outpatient setting in which only local anesthesia, peripheral nerve blocks, or both are used.
2. Any setting physically located outside the State of Texas.
3. A licensed hospital, including an outpatient facility of the hospital that is located apart from the hospital.
4. A licensed ambulatory surgical center.
5. A clinic located on land recognized as tribal land by the federal government and maintained or operated by a federally recognized Indian tribe or tribal organization as listed by the United States secretary of the interior under 25 U.S.C. (479-1) or as listed under a successor federal statute or regulation.
6. A facility maintained or operated by a state or governmental entity.
7. A clinic directly maintained or operated by the United States or by any of its departments, officers, or agencies.
8. An outpatient setting accredited by:
1. the Joint Commission on Accreditation of Healthcare Organizations relating to ambulatory surgical centers;
2. the American Association for the Accreditation of Ambulatory Surgery Facilities; or
3. the Accreditation Association for Ambulatory Health Care.
9. The performance of Mohs micrographic surgery.
10. Provide only level I services.

Note: physicians that provide only level I services, must still meet all other requirements under Chapter 192.

Applicants are informed of their fingerprints being rejected by IdentoGo prior to that information being sent to the TMB. Fingerprints can be rejected by either DPS or the FBI. Our office will not communicate that a reprint is needed until we receive your unique reference code, which you may then use on the IdentoGo site to waive the fee for a required reprint.

As part of the “My TMB” system, we are now 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 “My TMB” link in the upper right hand corner of our website (near the “search” box), and create an account if you do not have one already.

Renewal notices are sent out to the mailing address of record 60-90 days prior to the expiration date of a permit.  Currently, extensions are not granted on the basis of not receiving a renewal reminder in the mail.

There are no extensions for temporary permits at this time. However, upon completion of the application process, the TMB issues General and Limited MRT permits each week.

To return to practice from retired status, a physician must obtain approval of the Board after submitting a written request.  If a physician has been on official retired status for two years or longer, the request must be reviewed by the Licensure Committee of the Board.  Please contact the Registration department for information on the approval procedure.

The TMB cannot tell providers how to use the information they obtain through the PMP check.  Providers should follow the standard of care and utilize the information they gain to make educated and informed prescribing decisions.