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.

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.

It depends upon when the agreement was executed.  For prescriptive authority agreements entered into prior to September 1, 2019, factors such as the type of delegate licensure and amount of time spent practicing under an agreement determined the required frequency and manner of meetings.  If your agreement was entered into prior to September 1, 2019, you may want to seek the advice of private legal counsel to better understand the law’s requirements.

For prescriptive authority agreements entered on or after September 1, 2019, the law changed so that all prescriptive authority agreements must be conducted on at least a monthly basis, no matter the length of time that the physicians have been practicing with the delegates under the agreement.

Yes, potentially. Although physicians are not required to supervise CRNA’s for delegated tasks, they nonetheless remain subject to potential liability for violations of the standard of care by CRNAs, depending on federal and state statutes and regulations. The degree to which a physician is required to supervise a CRNA during the performance of a task in anesthesia services is left to the “physician’s professional judgment in light of other relevant federal and state laws, facility policies, medical staff bylaws, and ethical standards.” (Texas Attorney General Opinion No. JC-0117). However, physician supervision during the medical management of a patient while undergoing an anesthetic may require supervision dependent on federal and state statutes and regulations.

Additionally, Texas Attorney General Opinion No. KP-0353 found “In authorizing physicians to delegate the administration of anesthesia to CRNAs, the Legislature did not expressly limit the liability of the delegating physician. See TEX. OCC. CODE § 157.058; cf. id. § 157.004(c) (providing that in specified circumstances a physician who issues a standing delegation under chapter 203 generally “is not liable in connection with an act performed under that standing delegation order”). Thus, we cannot conclude that the liability of a physician delegating the administration of anesthesia to a CRNA is limited solely to the determination of competency. Questions of physician liability in any specific context are highly factual and not an appropriate determination for the opinion process. See Tex. Att’y Gen. Op. No. GA-0446 (2006) at 18 (“Questions of fact are not appropriate to the opinion process.”) (Page 4 with emphasis added.)

For physicians only:

If another state board requires your examination grades, please be advised that most physicians will have to contact the Federation of State Medical Boards to obtain examination scores.

Federation of State Medical Boards
400 Fuller Wiser Rd.
Suite 300
Euless, TX 76039-3855
Tel. (817) 868-4000

A small percentage of physicians can obtain verification of examination scores from TMB.

• If you were licensed before 1976 and
• you took the Texas State Board Medical Exam,

please call the Pre-Licensure, Registration and Consumer Services at (512) 305-7030 to confirm the location of your scores.

There is no fee for this verification.

Physicians and anesthesiologists shall maintain current competency in ACLS, PALS, or a course approved by the board. In all settings under Chapter 173, at a minimum, at least two persons, including the surgeon or anesthesiologist, shall maintain current competency in basic life support.

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 173.

In the 2017 legislative session, SB 674 changed the law so that the Texas Medical Board is no longer required to register NCTs who work for physicians.  What remains is the requirement that NCTs obtain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting practice.

In the 2017 legislative session, SB 674 changed the law so that the Texas Medical Board is no longer required to register NCTs who work for physicians.  What remains is the requirement that NCTs obtain placement on the MRT Board’s general registry, or have an approved a hardship exemption, prior to starting practice.

The NCT Registry and the NCT Permit were renewed separately. Under current rules and regulations, the NCT registry is on a biennial (2 year) renewal schedule.  Before elimination by statutory changes, the NCT permit was  an annual renewal.

You will need to continue to renew your NCT Registry listing or hardship exemption to continue to practice as an NCT in Texas. 

You must register your supervising physician with the TMB prior to applying with the DEA.  For information or questions on applying for a DEA under a temporary license, please contact the DEA directly.   https://www.deadiversion.usdoj.gov/index.html

Yes, if you are a physician or a physician assistant. 

Physicians are required to register all PAs and APRNs that they supervise prior to the delegates beginning to work for them.  If there is a change to the scope of the delegation, physicians must notify the Board within 30 days of this change.

PAs are likewise required to register their supervising physicians with the Board prior to beginning to practice under the employment or prescriptive authority agreement.  They are also required to notify the Board within 30 days of any change to the scope of the delegation. 

APRNs should look to guidance provided by the Texas Board of Nursing for how to register their delegating physicians, as the Medical Board does not have licensing authority for nurses.

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.

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.