(a) APRNs with full licensure and a valid prescription authorization number are eligible to obtain authority to order and prescribe certain categories of controlled substances. The APRN must comply with all federal and state laws and regulations relating to the ordering and prescribing of controlled substances in Texas, including but not limited to, requirements set forth by the United States Drug Enforcement Administration.
(b) Orders and prescriptions for controlled substances in Schedules III through V may be authorized, provided the following criteria are met:
  (1) Prescriptions for a controlled substance in Schedules III through V, including a refill of the prescription, shall not exceed a 90 day supply. This requirement includes a prescription, either in the form of a new prescription or in the form of a refill, for the same controlled substance that a patient has been previously issued within the time period described by this subsection.
  (2) Beyond the initial 90 days, the refill of a prescription for a controlled substance in Schedules III through V shall not be authorized prior to consultation with the delegating physician and notation of the consultation in the patient's chart.
  (3) A prescription of a controlled substance in Schedules III through V shall not be authorized for a child less than two years of age prior to consultation with the delegating physician and notation of the consultation in the patient's chart.
(c) Orders and prescriptions for controlled substances in Schedule II may be authorized only:
  (1) in a hospital facility-based practice, in accordance with policies approved by the hospital's medical staff or a committee of the hospital's medical staff as provided by the hospital's bylaws to ensure patient safety and as part of care provided to a patient who:
    (A) has been admitted to the hospital for an intended length of stay of 24 hours or greater; or
    (B) is receiving services in the emergency department of the hospital; or
  (2) as part of the plan of care for the treatment of a person who has executed a written certification of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
(d) Prescription Monitoring Program (PMP).
  (1) APRNs should access and review the prescription monitoring program (PMP) authorized by Chapter 481, Health and Safety Code, prior to prescribing any controlled substance for patients being treated for pain.
  (2) APRNs must access and review the PMP before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol unless:
    (A) the patient has been diagnosed with cancer or the patient is receiving hospice care; and
    (B) the APRN clearly notes on the prescription or in the electronic prescription record that the patient was diagnosed with cancer or is receiving hospice care, as applicable.
  (3) An APRN will not be subject to disciplinary action if the APRN:
    (A) makes a good faith attempt to access and review the PMP prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol, but is unable to access the information because of circumstances outside the control of the APRN; and
    (B) clearly notes on the patient's prescription or in the patient's electronic prescription record the APRN's attempt to access and review the PMP and the circumstances that prevented the APRN from being able to do so.
  (4) Documentation that the review of the PMP occurred and rationale for prescribing a controlled substance must be included in the patient's medical record.
  (5) This section takes effect September 1, 2019.

Source Note: The provisions of this §222.8 adopted to be effective November 20, 2013, 38 TexReg 8212; amended to be effective September 1, 2019, 43 TexReg 7462