State Overview: Texas

State law or statute prohibits or limits the use of prior authorization for buprenorphine containing products by either the state Medicaid plan or private insurance companies.

Medicaid is prohibited from requiring prior authorization for medication-assisted opioid or substance use disorder treatment, including: methadone, buprenorphine, oral buprenorphine/naloxone or naltrexone, "except as needed to minimize the opportunity for fraud, waste, or abuse." Provision expires on Aug. 31, 2023. Tex. Human Resources Code §32.03115

Texas credentials one type of addiction counselor. A Licensed Chemical Dependency Counselor requires, at minimum, an associate degree or higher and 4,000 hours of supervised experience. An individual may be exempt from some supervised hours if they hold a qualifying graduate degree. Tex. Occupations Code Ann. §504.001 and Texas Licensed Chemical Dependency Counselor Program

Licensed professional counselors (LPCs) prevent, assess, evaluate and treat mental, emotional or behavioral disorders and associated distresses that interfere with mental health. Counselors conduct assessments and evaluations to establish treatment goals and objectives and plan, implement, and evaluate treatment plans. Diagnostic ability not outlined in statute. Tex. Occupations Code §503.003

Certification requirements for peer support specialists were recently proposed by the Texas Health and Human Services Commission. The proposed certification standards include minimum qualifications, training, continuing education, and employment supervision requirements.

Physician relationship required for practice and prescriptive authority.

Written agreement is required between the NM and the supervising physician. The protocols should be jointly developed and reviewed annually. Tex. Admin. Code §22-11-221.13

An advanced practice registered nurse recognized by the board as a nurse midwife may provide one or more unit doses of a controlled substance during intra-partum or immediate post-partum care subject if delegated by a physician, must meet certain documentation and monitoring requirements. Tex. Admin. Code §22-11-221.14

Physician relationship required for practice and prescriptive authority.

Written agreement is required between the NP and the supervising physician. The protocols should be jointly developed and reviewed annually. Tex. Admin. Code §22-11-221.13

The agreement must outline which drugs and devices may be prescribed among other items. Tex. Admin. Code §22-11-222.5

Only physicians are authorized to sign medical orders for scope of treatment forms. Tex. Health and Safety Code Ann. §166

NPs are recognized in state policy as primary care providers. A managed care organization or other entity must ensure that advanced practice registered nurses and physician assistants are available as primary care providers in a provider network. Tex. Health & Safety Code §62.1551

Physician relationship required for practice and prescriptive authority.

In a licensed hospital or ambulatory surgical center, CRNAs may select, obtain and administer drugs, including determination of appropriate dosages, techniques and medical devices for their administration and in maintaining the patient in sound physiologic status pursuant to a physician’s order for anesthesia or an anesthesia-related service. Tex. Admin. Code §22-11-221.15

In an outpatient setting, where a physician has delegated to a CRNA the ordering of drugs and devices necessary for the nurse anesthetist to administer an anesthetic or an anesthesia-related service ordered by a physician, a CRNA may select, obtain and administer drugs, including determination of appropriate dosages, techniques and medical devices for their administration and in maintaining the patient in sound physiologic status. Tex. Admin. Code §22-11-221.16

APRNs, including CRNAs, with full licensure, a valid prescriptive authorization number and a physician are eligible to obtain authority to order and prescribe certain categories of controlled substances. They may enter into a prescriptive authority agreement that outlines which drugs and devices may be prescribed among other items. Orders and prescriptions for controlled substances in Schedules III through V may be authorized, provided certain criteria are met. Tex. Admin. Code §22-11-222.5 and Tex. Admin. Code §22-11-222.8

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Tex. Occupations Code Ann. §351.002

Optometrists may inject medication for patients having an anaphylactic reaction. Tex. Occupations Code Ann. §351.358

Optometrists may prescribe Schedule III-V controlled substances. Tex. Occupations Code Ann. §351.358

A dental hygienist may provide services for up to six months without dentist seeing the patient. Services may be performed in school-based health centers, nursing facility, or community health centers. The dental hygienist must have at least two years of experience. Tex. Occupations Code §262.1515

Statute does not identify dental therapists as an oral health provider.

Teledentistry means a health care service delivered by a dentist, or a health professional acting under the delegation and supervision of a dentist, acting within the scope of the dentist's or health professional's license or certification to a patient at a different physical location than the dentist or health professional using telecommunications or information technology. Tex. Occupations Code §111.001

Texas has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Texas does not allow pharmacists to modify prescriptions.

Texas does not allow pharmacists to prescribe hormonal contraceptives.

Texas does not allow pharmacists to prescribe tobacco cessation aids.

Supervision by a physician required for practice and prescriptive authority.

The practice of a PA includes providing medical services delegated by a supervising physician that are within the education, training and experience of the physician assistant. Medical services provided by a PA may include: (1) obtaining patient histories and performing physical examinations; (2) ordering or performing diagnostic and therapeutic procedures; (3) formulating a working diagnosis; (4) developing and implementing a treatment plan; (5) monitoring the effectiveness of therapeutic interventions; (6) assisting at surgery; (7) offering counseling and education to meet patient needs; (8) requesting, receiving and signing for the receipt of pharmaceutical sample prescription medications and distributing the samples to patients in a specific practice setting in which the PA is authorized to prescribe pharmaceutical medications and sign prescription drug orders as provided by Section 157.0512 or 157.054; (9) prescribing or ordering a drug or device as provided by Subchapter B, Chapter 157; and (10) making appropriate referrals.

A physician's authority to delegate the prescribing or ordering of a drug or device under this subchapter is limited to: (1) nonprescription drugs; (2) dangerous drugs; and (3) controlled substances to the extent provided by Subsections (b) and (b-1).

A physician may delegate the prescribing or ordering of a controlled substance for controlled substances listed in Schedule III-V. Schedule II authority can only be delegated in certain circumstances and settings. Tex. Occupations Code Ann. §157.0511

Statute limits the number of PAs a physician may supervise.

The combined number of advanced practice registered nurses and PAs with whom a physician may enter into a prescriptive authority agreement may not exceed seven (7) advanced practice registered nurses and PAs or the full-time equivalent of seven (7) advanced practice registered nurses and PAs. This provision does not apply to practices serving a medically underserved population or a facility-based practice in a hospital. Tex. Occupations Code Ann. §157.0512(c),(d)

Texas does not currently have provisions related to chart review or chart co-signatures.

Statute allows adaptable proximity.

Supervision of a PA by a supervising physician must be continuous. The supervision does not require the constant physical presence of the supervising physician where PA services are being performed, but, if a supervising physician is not present, the supervising physician and the PA must be, or must be able to easily be, in contact with one another by radio, telephone or another telecommunication device. Tex. Occupations Code Ann. §204.204

Medical services are delegated by the supervising physician and must be within the education, training and experience of the PA. Tex. Occupations Code Ann. §204.202