Prescriptive authority agreements must, at a minimum:
  (1) be in writing and signed and dated by the parties to the agreement;
  (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 between the physician and physician assistant to whom the physician has delegated prescriptive authority related to the care and treatment of patients;
  (8) if alternate physician supervision is to be utilized, designate one or more alternate physicians who may:
    (A) provide appropriate supervision on a temporary basis in accordance with the requirements established by the prescriptive authority agreement and the requirements of Chapter 157 of the Medical Practice Act and Chapter 193 of this title (relating to Standing Delegation Orders); and
    (B) participate in the prescriptive authority quality assurance and improvement plan meetings required under this section; and
  (9) describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that includes the following:
    (A) chart review, with the number of charts to be reviewed determined by the physician and physician assistant; and
    (B) periodic meetings between the physician assistant and the physician at a location determined by the physician and the physician assistant.
  (10) The periodic meetings described by paragraph (9)(B) of this section must include:
    (A) the sharing of information relating to patient treatment and care, needed changes in patient care plans, and issues relating to referrals;
    (B) discussion of patient care improvement; and
    (C) documentation of the periodic meetings.
  (11) The periodic meetings shall take place at least once a month in a manner determined by the physician and physician assistant.
  (12) The prescriptive authority agreement may include other provisions agreed to by the physician and the physician assistant.
  (13) If the parties to the prescriptive authority agreement practice in a physician group practice, the physician may appoint one or more alternate supervising physicians designated, if any, to conduct and document the quality assurance meetings in accordance with the requirements of Chapter 157 of the Medical Practice Act and Chapter 193 of this title.
  (14) The prescriptive authority agreement need not describe the exact steps that a physician assistant must take with respect to each specific condition, disease, or symptom.
  (15) A physician or physician assistant who is a party to a prescriptive authority agreement must retain a copy of the agreement until the second anniversary of the date the agreement is terminated.
  (16) A party to a prescriptive authority agreement may not by contract waive, void, or nullify any provision of this section or requirements for prescriptive authority agreements set forth by Chapter 157 of the Medical Practice Act and Chapter 193 of this title.
  (17) In the event that a party to a prescriptive authority agreement is notified that the individual has become the subject of an investigation by the board or the Texas Medical Board, the individual shall immediately notify the other party to the prescriptive authority agreement.
  (18) The prescriptive authority agreement and any amendments must be reviewed at least annually, dated, and signed by the parties to the agreement. The prescriptive authority agreement and any amendments must be made available to the board, the Texas Board of Nursing, or the Texas Medical Board not later than the third business day after the date of receipt of request, if any.
  (19) The prescriptive authority agreement should promote the exercise of professional judgment by the physician assistant commensurate with the physician assistant's education and experience and the relationship between the physician assistant and the physician.
  (20) This section shall be liberally construed to allow the use of prescriptive authority agreements to safely and effectively utilize the skills and services of physician assistants.

Source Note: The provisions of this §185.31 adopted to be effective June 5, 2014, 39 TexReg 4255; amended to be effective July 19, 2018, 43 TexReg 4747