(a) General.
  (1) A person may not administer medication to a client unless the person:
    (A) holds a current license under state law that authorizes the licensee to administer medication;
    (B) holds a current permit issued under this section and acts under the delegated authority of an RN to administer medication;
    (C) administers a medication to a client in accordance with rules of the BON that permit delegation of the administration of medication to a person not holding a permit under this section; or
    (D) administers noninjectable medication under circumstances authorized by the memorandum of understanding between the BON and HHSC.
  (2) A HCSSA that provides licensed and certified home health services, licensed home health services, hospice services, or personal assistance services may use a home health medication aide. If there is a direct conflict between the requirements of this chapter and federal regulations, the requirements that are more stringent apply to the licensed and certified HCSSA.
  (3) Exemptions are as follows.
    (A) A person may administer medication to a client without the license or permit as required in paragraph (1) of this subsection if the person is:
      (i) a graduate nurse holding a temporary permit issued by the BON;
      (ii) a student enrolled in an accredited school of nursing or program for the education of RNs who is administering medications as part of the student's clinical experience;
      (iii) a graduate vocational nurse holding a temporary permit issued by the BON;
      (iv) a student enrolled in an accredited school of vocational nursing or program for the education of vocational nurses who is administering medications as part of the student's clinical experience; or
      (v) a trainee in a medication aide training program approved by HHSC under this chapter who is administering medications as part of the trainee's clinical experience.
    (B) Supervision of an exempt person described in subparagraph (A) of this paragraph is as follows.
      (i) A person described in:
        (I) subparagraph (A)(i) of this paragraph shall be supervised by an RN;
        (II) subparagraph (A)(ii) or (iv) of this paragraph shall be supervised by the student's instructor; or
        (III) subparagraph (A)(iii) of this paragraph shall be supervised by an RN or LVN.
      (ii) Supervision must be on-site.
    (C) An exempt person described in this subsection may not be used in a supervisory or charge position.
(b) Required actions.
  (1) If a HCSSA provides home health medication aide services, the HCSSA must employ a home health medication aide to provide the home health medication aide services. The HCSSA must employ or contract with an RN to perform the initial health assessment, prepare the client care plan, establish the medication list, medication administration record, and medication aide assignment sheet, and supervise the home health medication aide. The RN must be available to supervise the home health medication aide when home health medication aide services are provided.
  (2) The clinical records of a client using a home health medication aide must include a statement signed by the client or family acknowledging receipt of the list of permitted and prohibited acts of a home health medication aide.
  (3) The RN must be knowledgeable of HHSC rules governing home health medication aides and must ensure that the home health medication aide is in compliance with the Texas Health and Safety Code, Chapter 142, Subchapter B.
  (4) A home health medication aide must:
    (A) function under the supervision of an RN;
    (B) comply with applicable law and this chapter relating to administration of medication and operation of the HCSSA;
    (C) comply with HHSC rules applicable to personnel used in a HCSSA; and
    (D) comply with this section and §558.701 of this title (relating to Home Health Aides) if the person will be used as a home health aide and a home health medication aide.
  (5) The RN must make a supervisory visit while the medication aide is in the client's residence in accordance with §558.298 of this title (relating to Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel and Tasks Not Requiring Delegation).
(c) Permitted actions. A home health medication aide is permitted to:
  (1) observe and report to the HCSSA RN and document in the clinical record any reactions and side effects to medication shown by a client;
  (2) take and record vital signs of a client before administering medication that could affect or change the vital signs;
  (3) administer regularly prescribed medication to a client if the medication aide:
    (A) is trained to administer the medication;
    (B) personally prepares the medication or sets up the medication to be administered; and
    (C) documents the administration of the medication in the client's clinical record;
  (4) administer oxygen per nasal cannula or a non-sealing face mask only in an emergency, after which the medication aide must verbally notify the supervising RN and appropriately document the action and notification;
  (5) apply specifically ordered ophthalmic, otic, nasal, vaginal, topical, and rectal medication unless prohibited by subsection (d)(10) of this section;
  (6) administer medications only from the manufacturer's original container or the original container in which the medication had been dispensed and labeled by the pharmacy with all information mandated by the Texas State Board of Pharmacy;
  (7) administer previously ordered PRN medication if:
    (A) the HCSSA's RN authorizes the medication;
    (B) the medication aide documents in the client's clinical notes the symptoms indicating the need for medication and the time the symptoms occurred;
    (C) the medication aide documents in the client's clinical notes that the HCSSA's RN was contacted, symptoms were described, and the HCSSA's RN granted permission to administer the medication, including the time of contact;
    (D) the medication aide obtains authorization to administer the medication each time the symptoms occur; and
    (E) the medication aide ensures that the client's clinical record is co-signed by the RN who gave permission within seven days after the notes are incorporated into the clinical record;
  (8) measure a prescribed amount of a liquid medication to be administered;
  (9) break a tablet for administration to a client if:
    (A) the client's medication administration record accurately documents how the tablet must be altered before administration; and
    (B) the licensed nurse on duty or on call has calculated the dosage;
  (10) crush medication, if:
    (A) authorization has been given in the original physician's order or the medication aide obtains authorization from the HCSSA's RN; and
    (B) the medication aide documents the authorization on the client's medication administration record.
(d) Prohibited actions. A home health medication aide must not:
  (1) administer a medication by any injectable route, including:
    (A) intramuscular route;
    (B) intravenous route;
    (C) subcutaneous route;
    (D) intradermal route; and
    (E) hypodermoclysis route;
  (2) administer medication used for intermittent positive pressure breathing treatment or any form of medication inhalation treatments;
  (3) administer previously ordered PRN medication except in accordance with subsection (c)(7) of this section;
  (4) administer medication that, according to the client's clinical records, has not been previously administered to the client;
  (5) calculate a client's medication doses for administration;
  (6) crush medication, except in accordance with subsection (c)(10) of this section;
  (7) administer medications or feedings by way of a tube inserted in a cavity of the body except as specified in §558.404(h) of this title (relating to Standards Specific to Agencies Licensed to Provide Personal Assistance Services);
  (8) receive or assume responsibility for reducing to writing a verbal or telephone order from a physician, dentist, podiatrist or advanced practice nurse;
  (9) order a client's medication from a pharmacy;
Cont'd...