5300, Prescriptive Authority Agreements, Clinical Protocols, Standing Delegation Orders and Client Education

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Revision 24-2; Effective Sept. 16, 2024

Grantees that provide clinical services must develop and maintain written clinical prescriptive authority agreements (PAAs), protocols and standing delegation orders (SDOs) in compliance with statutes and rules governing medical, dental, and nursing practice and consistent with national evidence-based clinical guidelines. When HHSC revises a policy, grantees need to incorporate the revised policy into their written procedures.

5310 Prescriptive Authority Agreements

Revision 25-3; Effective Nov. 14, 2025

When an advanced practice registered nurse (APRN) or physician assistant (PA) provides services, the grantee must ensure a properly executed prescriptive authority agreement (PAA) is set for each mid-level provider. The PAA must meet all the requirements in Texas Occupations Code, Chapter 157, including, but not limited to, the following criteria:

  • be in writing and signed and dated by the parties to the agreement;
  • be reviewed at least annually including amendments;
  • kept on-site where the APRN or PA provides care;
  • include the name, address and all professional license numbers of all parties to the agreement;
  • state the nature of the practice, practice locations or practice settings;
  • identify the types or categories of drugs or devices that may or may not be prescribed;
  • provide a general plan to address consultation and referral;
  • provide a plan to address client emergencies;
  • describe the process to communicate and share information between the physician and the APRN or PA that the physician has delegated prescriptive authority for the care and treatment of clients;
  • if alternate physician supervision is used, appoint one or more alternate physicians who may:
    • provide proper temporary supervision after the requirements established by the PAA and of this section; and
    • participate in the prescriptive authority quality assurance and improvement plan meetings required under this section.
  • describe a prescriptive authority quality assurance and improvement plan; and
  • specify methods for documenting the implementation of the plan that includes:
    • chart review, with the number of charts reviewed charts determined by the physician and APRN or PA; and
    • periodic meetings between the APRN or PA and the physician at a location determined by the physician, APRN or physician assistant.

References

5320 Protocols

Revision 25-3; Effective Nov. 14, 2025

Grantees that employ advanced practice nurses or physician assistants must have written protocols to delegate authorization to initiate medical aspects of client care. Historically, this delegation happened through a protocol or other written authorization. Instead of two documents, this delegation can now be included in a prescriptive authority agreement (PAA). Both parties must agree to this. The PAA or protocols does not need to describe exact steps that an APRN or a PA must take regarding each specific condition, disease or symptom.

The protocols must be reviewed, agreed upon, signed and dated by the supervising physician and the PA or APRN at least annually. It must be maintained on-site per the Texas Administrative Code Title 22, Chapter 22.

5330 Standing Delegation Orders

Revision 25-3; Effective Nov. 14, 2025

Standing Delegation Orders (SDOs) are written instructions, orders, rules, or procedures. SDOs are designed for a patient population with specific diseases, disorders, health problems, or sets of symptoms. This type of order provides conditions and circumstances when action can be instituted before being examined or evaluated by a physician. Clinics must have written SDOs in place as outlined in TAC Title 22, Part 9, Chapter 169, Subchapter A.

Standing delegation orders may permit administering or providing of the following types of dangerous drugs if ordered by or using a pre-signed prescription from the delegating physician:

  • oral contraceptives;
  • diaphragms and contraceptive creams and jellies;
  • topical anti-infectives for vaginal use;
  • oral anti-parasitic drugs for treatment of pinworms;
  • topical anti-parasitic drugs;
  • antibiotic drugs for treatment of venereal disease; or
  • immunizations.

General standards for Standing Delegation Orders, Standing Medical Orders, and Protocols require:

  • development and approval by the delegating physician per facility bylaws and policies;
  • the order or protocol to be in writing and signed by the delegating physician;
  • a description of the specific instructions, orders, protocols, or procedures to follow;
  • a notation of the level of supervision required, unless specified by other law;
  • plans for addressing patient emergencies;
  • annual review signed by the delegating physician; and
  • maintenance at the facility or practice site.

References

5340 Client Education

Revision 23-2; Effective Sept. 15, 2023

In addition to the above, grantees must have written plans for client education that include goals and content outlines to ensure consistency and accuracy of information provided. Grantees’ plans for client education must be reviewed and signed by the clinic medical director.