New law, TMA tools simplify delegation/supervision of prescribing privileges
Texas physicians can now take advantage of a new Texas Medical Association-backed law that simplifies the process by which they supervise and delegate prescribing privileges to physician assistants (PAs) and advanced practice registered nurses (APRNs). The Texas Medical Board (TMB) finalized the rules in November, putting the law into effect. Senate Bill 406 by Sen. Jane Nelson (R-Flower Mound) and Rep. Lois Kolkhorst (R-Brenham) still recognizes diagnosing and prescribing as the practice of medicine. But it replaces the site-based regulatory structure with a more collaborative model based on periodic quality assurance reviews and a new prescrip- tive authority agreement (PAA). The law does not establish a specific form for the
PAA, but TMA developed a sample template for physi- cians to use. Accompanying the sample PAA is a fact sheet summarizing the details of the law. Both are available on TMA’s website at
www.texmed.org/PAA template. The PAA must meet these minimum requirements:
• Be in writing and signed and dated by the parties to the agreement;
• State the name, address, and all professional license numbers of the parties to the agreement;
• State the nature of the practice, practice locations, or practice settings;
• 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;
• Provide a general plan for addressing consultation and referral;
• Provide a plan for addressing patient emergencies; • State the general process for communication and the sharing of information between the physician and the APRN or PA to whom the physician has del-
26 TEXAS MEDICINE January 2014
egated prescriptive authority related to the care and treatment of patients;
• If alternate physician supervision is to be used, designate one or more alternate physicians who may provide appropriate supervision on a temporary basis in accordance with the require- ments established by the PAA; and
• Describe a prescriptive authority quality assur- ance and improvement plan, and specify meth- ods for documenting its implementation that include chart review and periodic face-to-face meetings.
Once physicians and delegated APRNs and PAs fill out the form, they must each keep a copy on file for possible future audits by TMB. Physicians do no need to file a copy of the PAA with the medi- cal board. But they must register any prescribing delegations they make to APRNs/PAs with TMB, which they can do any time online at
www.tmb
.state.tx.us. SB 406 passed the 2013 Legislature with sup-
port from TMA, the Texas Academy of Family Phy- sicians, the Texas Association of Physician Assis- tants, and the various groups representing APRNs. TMA leaders say it reinforces the importance of physician-led medical care teams, recognizes the skills all practitioners bring to patient care, and al- lows the delegating/supervising physician greater flexibility in tailoring the PAA to his or her practice.
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