Delegation rules waived during COVID-19 crisis

April 10, 2020

To help further fight the spread of the coronavirus, Governor Greg Abbott has waived certain regulations for physicians and the physician assistants and advance practice registered nurses they supervise.

Specifically, for the duration of the disaster declaration, the limit on the number of prescriptive delegates has been lifted and supervisory relationships do not need to be in writing or registered with the Texas Medical Board (TMB).

The TMB has offered the following guidance.

1. “The PAs, APRNs, and their delegating supervising physicians do not need to register the delegation relationship. During this disaster declaration, supervision will work similarly to how it currently works in a facility-based practice setting.”
    
2. The prescriptive authority for a PA or APRN does not have to be in writing. “During the disaster declaration a verbal agreement between physician and delegate is sufficient to establish and maintain the relationship.”
    
3. “The limit of seven full-time PAs or APRNs has been suspended for the duration of the state of disaster. However, both PAs, APRNs, and their supervising physicians remain responsible for meeting the standard of care for delegated acts.”
    
4. The supervising physician does not have to be at the same location as the delegates, but a supervising physician must be available to answer questions. Being available by telephone is required.
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Please note that once the COVID-19 disaster declaration has ended, any delegated relationship that continues “will be subject to standard requirements such as maintaining a written prescriptive authority agreement and registering the relationship through the TMB website.”

COVID-19 resources
This is a developing issue, and we encourage you to use the following resources to stay informed with the most up-to-date and reliable information.

• Texas Medical Association (TMA) COVID-19 Resource Center
• Texas Medical Board (TMB) COVID-19 page
• Centers for Disease Control and Prevention (CDC) COVID-19 resource page
• Texas Department of State Health Services (DSHS) COVID-19 webpage
• The Institute for Health Metrics and Evaluation (IHME) COVID-19 projections
• Johns Hopkins Coronavirus Resource Center
• TMLT Resource Hub - Coronavirus updates and resources

About the Author

Laura Hale Brockway is the Vice President of Marketing at TMLT. She can be reached at laura-brockway@tmlt.org.

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