Revised TMB rules now in effect

The rules that govern the practice of medicine in Texas have been overhauled by the Texas Medical Board. These rules have been re-organized, and in some cases the language has been simplified and shortened.

How the rules have been re-organized (a table published by the TMB)

Proposed rule changes (published in the Texas Register, September 24, 2024)
TMB final rules
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Background

As a state agency, the TMB is required to regularly review all of their rules in the Texas Administrative Code. The 2025 rule changes are the result of that review.

“Some of the most common complaints the agency receives about the current rules are that they are poorly organized, the volume makes it difficult to find specific provisions, and the language is not clear. These criticisms were kept front of mind during the review process and the ultimate result was a reduction in the number of chapters from 40 to 25. This was largely achieved by reorganizing and combining some existing rules, as well as by removing unnecessary, superfluous statutory language from the Texas Administrative Code.” (1)

The revised rules were published for public comment in the September 24, 2024 issue of the Texas Register and were finalized and published by the Board on January 9, 2025.

Preliminary analysis

The TMLT Risk Management Department has conducted a preliminary analysis on the rule changes and these findings are summarized below. Content in many of the moved chapters below has changed. (Please note that this is not a comprehensive list. Any questions you have about the revised rules should be directed to the Texas Medical Board.)

Chapter 165 Medical Records is now Chapter 163. The rules are shorter and contain less detailed requirements for the contents of a medical record.

Chapter 169 Authority of Physician to Supply Drugs has been removed. Much of the content of the old rule remains in the Texas Occupations Code Chapter 158 Authority of Physician to Provide Certain Drugs and Supplies  and Section. 157.002. General Delegation of Administration and Provision of Dangerous Drugs. 

Chapter 170 Prescription of Controlled Substances has been repealed. This chapter included requirements for physicians treating pain. Some of the prior rule’s requirements may still be found in the Texas Health and Safety Code.

•         Electronic prescribing of schedule II drugs 
•        Exceptions to electronic prescribing of controlled substances
•        Opioid prescription limits
•        Prescription Monitoring Program checks and exceptions

 
Chapter 174 Telemedicine has moved to Chapter 175. The rules are shorter and refer to the requirements found in the Texas Occupations Code Chapter 111 Telemedicine, Teledentistry, and Telehealth .

Chapter 180 Texas Physician Health Program has moved to Chapter 182.

Chapter 190 Disciplinary Guidelines has moved to Chapter 180.

Chapter 193 Standing Delegation Orders has been repealed. Delegation is now outlined in Chapter 169. See also Chapter 183 Physician Assistants and Texas Occupations Code Chapter 157 Authority to Delegate Certain Medical Acts, including Delegation to Advanced Practice Registered Nurses and Physician Assistants.

Chapter 195 Pain Management Clinics has moved to Chapter 172.

Chapter 192 Office-Based Anesthesia is now in Chapter 173.

Chapter 200 Complementary & Alternative Medicine has moved to Chapter 171.

Source

1. Zaafran SZ. Insights on TMB enforcement matters. TMB Bulletin. September 2024. Available at https://www.tmb.state.tx.us/dl/2F1397E1-FB99-58A7-C60A-5DAE5125D7E4 . Accessed January 14, 2025.
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Updated February 21, 2025