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FAQs - FACILITY-BASED DELEGATED PRESCRIBING OF SCHEDULE II CONTROLLED SUBSTANCES
Where and when may a physician assistant (PA) or advanced practice registered nurse (APRN) prescribe a Schedule II Controlled Substance?
Properly authorized APRNs and PAs may issue prescriptions for Schedule II ... ”
“Senate Bill 202 transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupa ... ”
“Senate Bill 202 transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupa ... ”
“Senate Bill 202 transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupa ... ”
“Senate Bill 202 transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupa ... ”
“Application and Application-Related Fees
Application Fee: The current base fee for a Respiratory Care Practitioner application in Texas is $125.00. The entire fee must be submitted before your application can be assigned and processed.
The application fee includes a $5 Office of Patient Protection f ... ”
“Senate Bill 202 transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each o ... ”
“NEW - TMB Transitions to electronic licenses
The Texas Medical Board is transitioning to electronic licenses for a more paperless experience and to allow for enhanced licensee control. As of September 1, 2019 the Board will no longer issue paper licenses after a completed registration/ ... ”
“All of those licensed by the TMB to practice in Texas are currently required to register regularly with the board, and pay a fee. Registration fees and renewal periods vary according to license type. A licensee or permit holder may obtain a registration permit by completing the online re ... ”
“Senate Bill 202 transferred four occupational regulatory programs from the Department of State Health Services (DSHS) to the Texas Medical Board (TMB). Medical Physicists, Medical Radiologic Technologists, Perfusionists, and Respiratory Care Practitioners are now regulated by the TMB and each occupa ... ”
“NEW - TMB Transitions to electronic licenses
As a way of increasing efficiency in existing processes, while reducing costs, the Board has been developing innovations to its online licensing systems to create a better user experience with added features.
The Board is pleased to announce it is transi ... ”
“Registrations are available online 60-90 days prior to your current expiration date. If you cannot proceed with online registration, try again closer to your expiration date. Registration reminders will be sent out on postcards at least 60 days in advance of the expiration date.
Respira ... ”
“There is no grace period for the expiration date of a Respiratory Care Practitioner permit. Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration fee. If a license has be ... ”
“A respiratory care practitioner with a currently active certificate may decide to obtain an “inactive” registration status. Current regulations state that a RCP certificate may remain on an inactive status for no longer than 3 years.
Please read the relevant board rule, Tex. Admin. ... ”
“As required by SB 202 passed in 2015 by the 84th Texas Legislature, the Medical Physicists Licensure Advisory Committee is an informal advisory committee to the Texas Medical Board and consists of seven members appointed by the president of the medical board as follows:
(1) four medical p ... ”
Description: Medical Board 2007 - February - Minutes of the Disciplinary Process Review Committee
Document: TEXAS MEDICAL BOARD DISCIPLINARY PROCESS REVIEW COMMITTEE MINUTES February 15, 2007 The meeting was called to order at 12:48 p.m. by Chairman Lawrence Anderson, M.D. Other committee members present were Roberta Kalafut, D.O., Amanullah Khan, M.D., Margaret C. McNeese, M.D., Irwin E. Zeitler, Jr, D.O ...
Description: Medical Board 2007 - November - Full Board Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD BOARD MEETING MINUTES November 29-30, 2007
The meeting was called to order on November 29, 2007 at 4:30 p.m. by Board President, Roberta Kalafut, D.O. Board members present were Lawrence L. Anderson, M.D.; Michael Arambula, M.D.; Julie Attebury; Jose M. Benavides, M.D.; Patricia ...
Description: Medical Board 2008 - April - Standing Orders Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD STANDING ORDERS COMMITTEE MEETING MINUTES April 10, 2008
The meeting was called to order at 9:30 a.m. by Chair, Annette Raggette. Committee members present were Melinda Fredricks, Amanullah Khan, M.D., Margaret C. McNeese, M.D., and Irvin E. Zeitler, Jr., D.O.
Agenda item #2, r ...
Description: Medical Board 2008 - December - Full Board Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD BOARD MEETING MINUTES December 12, 2008 The meeting was called to order December 12, 2008 at 8:02 a.m. by Roberta Kalafut, D.O., Board President. Board members present were Michael Arambula, M.D.; Julie Attebury; David Baucom; Jose M. Benavides, M.D.; Manuel Guajardo, M.D.; Melin ...
Description: Medical Board 2008 - June - Full board Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD BOARD MEETING MINUTES June 27, 2008 The meeting was called to order June 27, 2008 at 8:07 a.m. by Board President, Roberta Kalafut, D.O. Board members present were Michael Arambula, M.D.; Julie Attebury; Jose M. Benavides, M.D.; Patricia S. Blackwell; Melinda S. Fredricks; Melind ...
Description: Medical Board 2008 - October - Licensure Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD LICENSURE COMMITTEE MEETING MINUTES October 9, 2008
The meeting was called to order at 10:03 a.m. by Chair, Michael Arambula, M.D. Committee members present were Jose M. Benavides, M.D.; Roberta Kalafut, D.O.; Paulette B. Southard; Timothy J. Turner; Timothy Webb; and Irvin Zeit ...
Description: Medical Board 2009 - August - Full Board Committee Meeting Minutes
Document: Texas Medical Board
BOARD MEETING MINUTES August 21, 2009 The meeting was called to order August 21, 2009 at 8:30 a.m. by Irvin E. Zeitler, Jr., D.O., Board President. Board members present were Melinda McMichael, M.D.; Timothy J. Turner, Secretary/ Treasurer; Michael Arambula; David Baucom; Jose M. ...
Description: Medical Board 2009 - August - Standing Orders Committee Meeting Minutes
Document: TEXAS MEDICAL BOARD STANDING ORDERS COMMITTEE MEETING MINUTES August 20, 2009
The meeting was called to order at 9:40 a.m. by Chair, Margaret C. McNeese, M.D. Committee members present were Patricia S. Blackwell, David Baucom, Wynne M. Snoots, M.D., George Willeford III, M.D.and Irvin E. Zeitler, J ...
Description: Medical Board 2009 - August - Telemedicine Committee Meeting Minutes
Document: TELEMEDICINE COMMITTEE August 20, 2009 The meeting was called to order at 9:40 a.m. by the Chair, Timothy Turner. Committee members present were Jose Benavides, M.D.; Pat J. Crocker, D.O.; Manuel Guajardo, M.D.; Margaret McNeese, M.D.; and Timothy Webb. Other members present were David Baucom; Patri ...
Description: Medical Board 2009 - November - Full board Committee Meeting Minutes
Document: Texas Medical Board
BOARD MEETING MINUTES November 6, 2009 The meeting was called to order November 6, 2009 at 8:03 a.m. by Irvin E. Zeitler, Jr., D.O., Board President. Board members present were Melinda McMichael, M.D.; Timothy J. Turner, Secretary/ Treasurer; Michael Arambula; Julie Attebury; Dav ...
Description: Medical Board 2010 - August - Full board Committee Meeting Minutes
Document: Texas Medical Board
August 27, 2010 BOARD MEETING MINUTES The meeting was called to order August 27, 2010 at 8:30 a.m. by Board President Irvin E. Zeitler, Jr., D.O. Board members present were Melinda McMichael, M.D., Vice-President; Timothy J. Turner, Secretary/Treasurer; Michael Arambula; Julie At ...
Description: Medical Board 2010 - August - Standing Orders Committee Meeting Minutes
Document: STANDING ORDERS COMMITTEE MEETING MINUTES August 25, 2010
The meeting was called to order at 2:08 p.m. by Acting Chair, George Willeford III, M.D. Committee members present were Patricia S. Blackwell, David Baucom, Wynne M. Snoots, M.D., and Irvin E. Zeitler, Jr., D.O.
Charles Oswalt, M.D. joined ...
Description: Medical Board 2010 - June - Full board Committee Meeting Minutes
Document: Texas Medical Board
June 4, 2010 BOARD MEETING MINUTES The meeting was called to order June 4, 2010 at 8:32 a.m. by Board President Irvin E. Zeitler, Jr., D.O. Board members present were Melinda McMichael, M.D., Vice-President; Timothy J. Turner, Secretary/Treasurer; Michael Arambula; Julie Attebury ...
Description: Medical Board 2010 - June - Standing Orders Committee - Agenda Item 6 - Prescriptive Delegation Waiver Requests
Document: Prescriptive Delegation Waiver Requests
Texas Medical Board
P. O. Box 2029, MC-242 Austin, Texas 78768-2029 (512) 305-7030 Prescriptive delegation requirements vary according to the setting in which the prescribing occurs: Sites serving certain medically underserved Alternate practice sites populati ...
Description: Medical Board 2010 - June - Standing Orders Committee - Agenda Item 6 - Site-Specific Prescriptive Delegation Statute & Rule
Document: Quick Reference Site-Specific Prescriptive Delegation Statute & Rule
5/22/2010
Use the table below to compare requirements between the four site types. Click on the underlines to see the relevant statute or rule. Full statute and rule regarding prescriptive delegation is at the end of this documen ...
“It is recommended, but not required, that a physician have a third party such as a staff or family member serve as a chaperone during such an exam. If a chaperone is unavailable, the patient may decline the exam and may wish to consider finding another physician. ... ”
It is recommended, but not required, that a physician have a third party such as a staff or family member serve as a chaperone during such an exam. If a chaperone is unavailable, the patient may decline the exam and may wish to consider finding another physician.
“The corporate practice of medicine is a legal doctrine, which generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine.A general summary of the corporate practice of medicine doctrine is that it prohibits physicians from entering into partnerships, emp ... ”
What is the "corporate practice of medicine"?
The corporate practice of medicine is a legal doctrine, which generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine.
A general summary of the corporate practice of medicine doctrine is that it prohibits physicians from entering into partnerships, employee relationships, fee splitting, or other situations with non-physicians where the physician's practice of medicine is in any way controlled or directed by, or fees shared with a non-physician. Generally, physicians may enter into independent contractor arrangements with non-physicians. However, whether an independent contractor situation exists is a question of law and attendant facts.
Section 165.156 of the Medical Practice Act makes it unlawful for any individual, partnership, trust, association or corporation by use of any letters, words, or terms, as an affix on stationery or advertisements or in any other manner, to indicate the individual, partnership, trust, association or corporation is entitled to practice medicine if the individual or entity is not licensed to do so.
Section 164.052(a)(13) of the Medical Practice Act authorizes disciplinary action against any licensee for impersonation of a licensed practitioner or permitting another to use his license to practice medicine. Section 164.052(a)(17) authorizes disciplinary action against a practitioner for aiding or abetting, directly or indirectly, the practice of medicine by non-licensed individuals or entities.
Beginning in 2011, the Texas Legislature enacted laws authorizing certain types of hospitals and specific hospital districts to directly hire physicians.
Because of the highly technical aspects of this doctrine, a physician should consult with private counsel regarding any actual or contemplated arrangement. Please be advised that the Board staff is not authorized to provide private legal advice.
The following case law/legal authority may be helpful in the analysis and are available from any local law library or private counsel:
a. Garcia v. Texas State Board of Medical Examiners, 384 F.Supp. 434 (W.D. Texas 1974);
b. F.W.B. Rockett v. Texas State Board of Medical Examiners, 287 S.W.2d 190 (Tex. Civ.App.- San Antonio 1956, writ ref'd n.r.e.);
c. Watt v. Texas State Board of Medical Examiners, 303 S.W.2d 884 (Tex. Civ. App.- Dallas 1957, writ ref'd n.r.e.);
d. Flynn Brothers, Inc. v. First Medical Associates, 715 S.W.2d 782 (Tex. Civ. App.- Dallas 1986, writ ref'd n.r.e.)
e. Woodson v. Scott & White Hospital, 186 S.W.2d 720 (Tex. App. 1945, writ ref'd w.o.m.)
f. Tex. Atty. Gen. Op. JM-1042 (1989)
g. Tex. Atty. Gen. Op. WW-278 (1957).
h. Tex. Atty. Gen. Op. JM 369 (1985)
i. Tex. Atty. Gen. Op. DM-138 (1992)
j. Tex. Atty. Gen. Op. M-551 (1970)
k. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
l. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
m. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, 151.055.
n. Occupations Code, section 102.001.
“Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s presc ... ”
Is the Prescription Monitoring Program (PMP) check mandated each and every time a physician or authorized delegate prescribes one of the four scheduled drug types?
Yes. Prior to and each and every time a physician or advanced practice professional (such as a physician assistant or advanced practice registered nurse acting under a physician’s delegated authority) prescribes opioids, benzodiazepines, barbiturates, or carisoprodol, the patient’s prescribing history must be reviewed by the physician or advanced practice professional issuing the prescription. For providers seeking information on how to access the PMP, please review Pharmacy Board PMP information at https://www.pharmacy.texas.gov/pmp/.
“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 b ... ”
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.
“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 pa ... ”
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.)
“Registration/renewal through TMB will be completed on a different schedule than DSHS, with all permits expiring during specific set times of year (as opposed to expiring in the permit holder’s birth month). Moving forward respiratory care practitioner licensees will expire twice a year, on May ... ”
Will I continue to renew my license in my birth month?
Registration/renewal through TMB will be completed on a different schedule than DSHS, with all permits expiring during specific set times of year (as opposed to expiring in the permit holder’s birth month). Moving forward respiratory care practitioner licensees will expire twice a year, on May 31st or November 30th.
As part of the transition from DSHS to TMB, existing RCP licenses will have their first registration with TMB per the existing permit expiration date. The renewal fee charged at the time of the first renewal with TMB will be pro-rated to bring the permits in line with the new expiration dates.
“There is no grace period for the expiration date of a Respiratory Care Practitioner permit. Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration fee. If a license has be ... ”
What is the penalty for renewing past the expiration date?
There is no grace period for the expiration date of a Respiratory Care Practitioner permit. Once the expiration date has occurred, a penalty fee equal to one half of the registration fee will be added. After 90 days, the penalty fee will increase to equal a full registration fee. If a license has been expired for one year or longer it is automatically cancelled.
“No, neither the Medical Practice Act nor the Nursing Practice Act authorize independent practice by a CRNA. Additionally, Texas Attorney General Opinion No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without del ... ”
Are CRNA’s authorized to practice independent of physician supervision and delegation?
No, neither the Medical Practice Act nor the Nursing Practice Act authorize independent practice by a CRNA. Additionally, Texas Attorney General Opinion No. KP-0266 found “A certified registered nurse anesthetist does not possess independent authority to administer anesthesia without delegation by a physician.” (Page 5). Since the selection and administration of anesthesia is a medical act, CRNAs must be properly delegated this act by a physician. A CRNA who administers anesthesia without proper delegation from a physician would be liable for the unlicensed practice of medicine.
“If the supervising physician has a waiver, then the prescribing delegate is also covered under that waiver. So long as the prescribing delegate is prescribing under the authority of a physician who has been granted a waiver, then the prescribing delegate may use non-electronic prescribing means.&nbs ... ”
Do delegates who have prescribing authority have to apply for their own waiver or are they covered by the supervising physician’s waiver?
If the supervising physician has a waiver, then the prescribing delegate is also covered under that waiver. So long as the prescribing delegate is prescribing under the authority of a physician who has been granted a waiver, then the prescribing delegate may use non-electronic prescribing means. If a prescribing delegate is issuing a prescription under the authority of a physician who does not have a waiver, then the prescribing delegate must issue the prescription via e-prescribing.
If an individual wants to look up whether a prescribing delegate has a waver they can do so as listed below:
For physician assistants: A PA’s waiver status will not be viewable on their TMB public profile. Each PA’s public profile has a link to their supervising physician’s profile page. The physician’s profile page will list the waiver status.
For nurse practitioners: APRN waivers are determined by the Texas Board of Nursing. Information on the waiver process for the APRNs is available on the Texas Board of Nursing Website.
“ If a physician has a waiver from e-prescribing, it is viewable on their public profile page, under the section entitled “Verified Information.” If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s ... ”
How can someone determine if a practitioner has a waiver?
If a physician has a waiver from e-prescribing, it is viewable on their public profile page, under the section entitled “Verified Information.” If you want to verify that a PA or nurse practitioner has a waiver, you will have to look at the delegating physician’s public profile. You can look up a prescriber’s public profile here: Look up a License
NOTE: Per the Texas State Board of Pharmacy, a “pharmacist is not responsible for ensuring there is a waiver. In addition, there is no requirement of the pharmacist to ensure an appropriate waiver is granted.”