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Behavioral Health Providers
Prior Authorization Requirements For Providers Prescribing Buprenorphine-Containing Products

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

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Education Required for Addiction Counselor Credentialing

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

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Licensed Professional Counselor Ability to Diagnose

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

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Peer Support Specialist Certification or Credentialing Authority

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.

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Advanced Practice Registered Nurses
Certified Nurse Midwife Practice and Prescriptive Authority

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

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Nurse Practitioner Practice and Prescriptive Authority

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

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Nurse Practitioner Authority to Sign POLST Forms

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

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Nurse Practitioner as a Primary Care Provider

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

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Optometrists
Authority to Perform Ophthalmic Procedures

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

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Injectable Authority

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

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Prescription of Controlled Substances

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

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Oral Health Providers
Dental Hygienists with Direct Access

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

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Dental Therapists

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

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Practice of Teledentistry

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

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Pharmacists
Administration of COVID-19 Vaccine

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

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Prescription Adaptation

Texas does not allow pharmacists to modify prescriptions.

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Prescription of Hormonal Contraceptives

Texas does not allow pharmacists to prescribe hormonal contraceptives.

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Prescription of Tobacco Cessation Aids

Texas does not allow pharmacists to prescribe tobacco cessation aids.

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Physician Assistants
Physician Assistant Practice and Prescriptive Authority

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

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Number of PAs Supervised

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)

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Chart Co-Signatures

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

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Adaptable Proximity Requirements

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

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Scope of Practice Determination

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

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