Texas expands prescriptive authority rules on Nov 1, 2013. Are you ready?



Advanced practice registered nurses and physician assistants in Texas will find themselves with fewer restrictions placed on their practice, and on how they collaborate with their physician counterparts, when they go to work on November 1, 2013. Earlier this year, Senate Bill 406 was passed by the Texas Legislature. Signed into law by Governor Rick Perry, the new bill will provide better access to care for patients by allowing physicians, nurse practitioners, and physician assistants to work together with greater ease. This will be especially helpful in the vast rural areas of the Lone Star State.

Here are some of the highlights of the new law:

  • Physicians will now be able to delegate prescriptive authority to as many as seven (7) NPs or PAs; this was previously limited to four (4).
  • In rural or medically-underserved areas there will be no limit on the number of mid-levels to whom physicians can delegate.
  • Physicians will be allowed to delegate authority of schedule II controlled substances to hospice- or hospital-based mid-level providers.
  • One standardized prescriptive authority agreement will be used going forward, as opposed to site-based restrictions

With the expanded supervisory roles, however, physicians need to be aware of the increased medical liability risk. Some physician medical malpractice insurance policies consider these collaborations as part of a physician’s “standard practice” while others do not. Be sure to discuss with your malpractice insurance provider any new Prescriptive Authority Agreement signed with another provider, in order to ensure that you are covered properly on your existing insurance policy. Furthermore, it is important to consider the role of vicarious liability exposure (as outlined in a previous post), especially if one is thinking about collaborating with more nurse practitioners or physician assistants.

These are exciting and much needed changes, especially in the medically-underserved communities around Texas. Our well-educated and well-trained nurse practitioners and physician assistants will now be able to practice medicine to the full extent of their training, and the law’s implementation will foster a team-based approach to Texas patient care.


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