TITLE 22. EXAMINING BOARDS

PART 11. TEXAS BOARD OF NURSING

CHAPTER 216. CONTINUING COMPETENCY

22 TAC §216.8

The Texas Board of Nursing (Board) adopts amendments to §216.8, concerning Relicensure Process. The amendments are adopted with a minor editorial change to subsection (e) to include the term "applicable" for consistency with the other amended subsections of the section. The remainder of the adopted text is unchanged from the proposed text as published in the November 29, 2019, issue of the Texas Register (44 TexReg 7293). This rule will be republished.

Reasoned Justification. The amendments make conforming changes to the section for consistency with 22 TAC §216.3, which was amended and adopted by the Board on November 19, 2019. The changes to §216.3 were adopted under the authority of the Texas Occupations Code §§301.151, 157.0513 and 301.308, the Texas Health and Safety Code §481.0764 and §481.07635, and House Bills (HB) 2454, 2059, 3285, and 2174, enacted by the 86th Texas Legislature. Those adopted amendments affected §216.3(c) and added new §216.3(i), making the current references in §216.8 inconsistent and outdated. The adopted changes to §216.8 align the section with the provisions of newly amended §216.3.

How the Section Will Function. Section 216.8(b) - (e) eliminates the references to §216.3(d) because targeted continuing competency requirements are contained in other subsections of §216.3 and may apply when a nurse seeks reinstatement pursuant to §216.8.

Summary of Comments. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the Occupations Code §301.151. Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

§216.8.Relicensure Process.

(a) Renewal of license.

(1) Upon renewal of the license, the licensee shall sign a statement attesting that the CNE contact hours or approved national nursing certification requirement has been met.

(2) The contact hours must have been completed within the licensing period and by the time of application for license renewal. Contact hours from a previous licensing period will not be accepted. Additional contact hours earned may not be used for subsequent licensure renewals.

(b) Persons licensed by examination. A candidate licensed by examination shall be exempt from the CNE contact hours or approved national nursing certification requirement for issuance of the initial Texas license and for the immediate licensing period following initial Texas licensure with the exception of applicable targeted continuing competency requirements in §216.3 of this chapter (relating to Continuing Competency Requirements).

(c) Persons licensed by endorsement. An applicant licensed by endorsement shall be exempt from the CNE contact hours or approved national nursing certification requirement for issuance of the initial Texas license and for the immediate licensing period following initial Texas licensure with the exception of applicable targeted continuing competency requirements in §216.3 of this chapter (relating to Continuing Competency Requirements).

(d) Delinquent license.

(1) A license that has been delinquent for less than four years may be renewed by the licensee submitting proof of having completed 20 contact hours of acceptable CNE or a current approved national nursing certification in his or her prior area of practice within the two years immediately preceding application for relicensure and by meeting all other Board requirements. A licensee shall be exempt from the continuing competency requirements for the immediate licensing period following renewal of the delinquent license with the exception of applicable targeted continuing competency requirements in §216.3 of this chapter (relating to Continuing Competency Requirements).

(2) A license that has been delinquent for four or more years may be renewed upon completion of requirements listed in §217.6 of this title (relating to Failure to Renew License).

(e) Reactivation of a license.

(1) A license that has been inactive for less than four years may be reactivated by the licensee submitting proof of having completed 20 contact hours of acceptable CNE or a current approved national nursing certification in his or her prior area of practice within the two years immediately preceding application for reactivation and by meeting all other Board requirements. A licensee shall be exempt from the continuing competency requirements for the immediate licensing period following reactivation of the license with the exception of applicable targeted continuing competency requirements in §216.3 of this chapter (relating to Continuing Competency Requirements).

(2) A license that has been inactive for four or more years may be reactivated upon completion of requirements listed in §217.9 of this title (relating to Inactive and Retired Status).

(f) Reinstatement of a license. A licensee whose license has been revoked and subsequently applies for reinstatement must show evidence that the continuing competency requirements and other Board requirements have been met prior to reinstatement of the license by the Board.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 7, 2020.

TRD-202000038

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: January 27, 2020

Proposal publication date: November 29, 2019

For further information, please call: (512) 305-6822


CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE

22 TAC §217.3

The Texas Board of Nursing (Board) adopts an amendment to §217.3, concerning Temporary Authorization to Practice/Temporary Permit. The amendment is adopted without changes to the proposed text published in the November 29, 2019, issue of the Texas Register (44 TexReg 7294). The rules will not be republished.

Reasoned Justification. The amendment is necessary to allow temporary authorizations to practice/temporary permits to be re-issued if a nurse is unable to complete the required courses/orientation within a six-month period. Due to scheduling challenges and an individual's performance pace, it sometimes takes a nurse longer than six months to complete a refresher course, extensive orientation, or academic course. The intent of §217.3 is to provide a mechanism for nurses to demonstrate their competency to return to nursing practice. Since they cannot practice nursing while completing a refresher course, extensive orientation, or academic course, they pose no risk of harm to the public during this time. The amendment merely allows the nurse a sufficient amount of time to re-establish current licensure after demonstrating he/she is safe and competent to do so. There is no cost associated with the issuance of a temporary authorization to practice/temporary permit under this section.

How the Section Will Function. Section 217.3 removes the current limitation from the rule that a temporary authorization to practice/temporary permit is unable to be re-issued/renewed. Under the adoption, a temporary authorization to practice/temporary permit may be re-issued/renewed if the nurse is unable to complete a refresher course, extensive orientation, or academic course within a six-month time period in order to grant the nurse additional time to complete the course/orientation.

Summary of Comments. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the Occupations Code §301.151.

Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 7, 2020.

TRD-202000037

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: January 27, 2020

Proposal publication date: November 29, 2019

For further information, please call: (512) 305-6822


22 TAC §217.5

The Texas Board of Nursing (Board) adopts amendments to §217.5, concerning Temporary License and Endorsement. The amendments are adopted without changes to the proposed text as published in the November 29, 2019, issue of the Texas Register (44 TexReg 7295) and will not be republished.

Reasoned Justification. The amendments are adopted under the authority of the Texas Occupations Code §301.151 and §301.253 and implement the requirements of Senate Bill (SB) 1200, enacted by the 86th Texas Legislature, effective September 1, 2019.

SB 1200

SB 1200 requires agencies like the Board to establish a process to allow qualifying military spouses to practice nursing in Texas without obtaining a license. In order to qualify for this licensure exemption, the military spouse must be currently licensed in good standing by another jurisdiction that has licensing requirements that are substantially equivalent to the requirements in this state. Further, the military spouse must notify the agency of his/her intent to practice in this state; submit proof of the individual's residency in this state and a copy of the individual's military identification card; and receive confirmation from the agency that the agency has verified the individual's license in the other jurisdiction and that the individual is authorized to practice nursing in this state. The individual may not practice nursing in this state for a period to extend beyond three years from the date the agency approves the individual's practice. The bill also permits an agency to issue a license to a qualifying military spouse if the agency chooses to do so. However, the agency is prohibited from charging the military spouse a fee for the issuance of the license.

Because employers, consumers, and other members of the public routinely utilize the Board's on-line licensure verification system to determine the licensure status of nurses in Texas, the Board has determined that issuing licenses to qualifying military spouses is most consistent with its current licensure and verification processes. These licenses will be limited to three-year terms and will be searchable through the Board's on-line verification system in the same manner as other license types. Further, individuals receiving a license under the rule will not be required to complete continuing education requirements for the duration of the license, which is limited to a three-year time period.

Canadian NCLEX-RN

The remainder of the adopted changes are necessary to allow the successful completion of the Canadian NCLEX-RN and licensure from a Canadian province by NCLEX-RN to satisfy a portion of the Board's endorsement requirements. On January 5, 2015, the NCLEX-RN replaced the CRNE as Canada's national examination for those applying to be a registered nurse. The Board currently requires the successful completion of the U.S. NCLEX-RN for licensure as a registered nurse in Texas if the applicant is applying by endorsement. The Board also currently requires licensure by another U.S. jurisdiction for licensure as a registered nurse in Texas if the applicant is applying by endorsement. The adopted amendments extend this licensure opportunity to applicants successfully passing the Canadian NCLEX-RN and holding licensure from a Canadian province by NCLEX-RN. This opportunity will only apply to applicants seeking registered nurse licensure because the Canadian NCLEX-PN has not been approved for use at this time.

How the Section Will Function. Adopted 217.5(a)(2) allows a nurse to qualify for licensure in Texas through endorsement if he/she has successfully completed the Canadian NCLEX-RN in January 2015 or after. Adopted §217.5(a)(3) allows a nurse to qualify for licensure in Texas through endorsement if the nurse is licensed by a Canadian province by NCLEX-RN. The adopted amendments to §217.5(b) make similar conforming changes to the section.

Adopted §217.5(g)(1) sets forth the criteria that a military spouse must meet in order to be eligible for licensure under SB 1200. First, a military spouse must hold an active, current license to practice nursing in another state or territory that has licensing requirements, including education requirements, that are determined by the Board to be substantially equivalent to the requirements for nursing licensure in Texas. Second, the military spouse's license may not be subject to any current restriction, eligibility order, disciplinary order, probation, suspension, or other encumbrance. Third, the military spouse must submit proof of the military spouse's residency in Texas and a copy of the spouse's military identification card. Fourth, the military spouse must notify the Board of the military spouse's intent to practice nursing in Texas on a form prescribed by the Board. Finally, the military spouse must meet the Board's fitness to practice and eligibility criteria set forth in §213.27 (relating to Good Professional Character), §213.28 (relating to Licensure of Individuals with Criminal History), and §213.29 (relating to Fitness to Practice). Adopted §217.5(g)(2) provides that, if the military spouse meets this specified criteria, the Board will issue a license to the military spouse to practice nursing in Texas. Further, the license will expire no later than the third anniversary of the date of the issuance of the license and may not be renewed. The military spouse will not be charged a fee for the issuance of the license. Adopted §217.5(g)(3) provides that a military spouse who is unable to meet the specified criteria in (g)(1) may still seek licensure in Texas, pursuant to the requirements in §217.2 (relating to Licensure by Examination for Graduates of Nursing Education Programs Within the United States, its Territories, or Possessions), §217.4 (relating to Requirements for Initial Licensure by Examination for Nurses Who Graduate from Nursing Education Programs Outside of United States' Jurisdiction), §213.30 (relating to Declaratory Order of Eligibility for Licensure), §221.3 (relating to APRN Education Requirements for Licensure), §221.4 (relating to Licensure as an APRN ), or the other remaining subsections of §217.5, as applicable. Finally, adopted §217.5(g)(4) requires a military spouse issued a license to practice nursing in Texas to comply with all laws and regulations applicable to the practice of nursing in Texas.

Summary of Comments. The Board did not receive any comments on the proposal.

Statutory Authority. The amendments are adopted under the Occupations Code §§301.151, 301.253, and 55.0041.

Section 301.151 authorizes the Board to adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

Section 301.253(a) states that, except as provided by §301.452, an applicant is entitled to take the examination prescribed by the Board if: (1) the Board determines that the applicant meets the qualifications required by §301.252; and (2) the applicant pays the fees required by the Board.

Section 301.253(b) states that each examination administered under Section 301.253 must be prepared by a national testing service or the Board. The Board shall ensure that the examination is administered in various cities throughout the state.

Section 301.253(c) provides that the examination shall be designed to determine the fitness of the applicant to practice professional nursing or vocational nursing.

Section 301.253(c-1) states that the Board shall: (1) adopt policies and guidelines detailing the procedures for the testing process, including test admission, test administration, and national examination requirements; and (2) post on the Board's Internet website the policies that reference the testing procedures by the national organization selected by the board to administer an examination.

Section 301.253(d) states that the Board shall determine the criteria that determine a passing score on the examination. The criteria may not exceed those required by the majority of the states.

Section 301.253(e) provides that a written examination prepared, approved, or offered by the Board, including a standardized national examination, must be validated by an independent testing professional.

Section 301.253(f) states that the Board shall develop a written refund policy regarding examination fees that: (1) defines the reasonable notification period and the emergencies that would qualify for a refund; and (2) does not conflict with any examination fee or refund policy of the testing service involved in administering the examination.

Section 301.253(g) states that the Board may recommend to a national testing service selected by the Board to offer examinations under this section the Board's written policy for refunding an examination fee for an applicant who: (1) provides advance notice of the applicant's inability to take the examination; or (2) is unable to take the examination because of an emergency.

Section 55.041(a) provides that, notwithstanding any other law, a military spouse may engage in a business or occupation for which a license is required without obtaining the applicable license if the spouse is currently licensed in good standing by another jurisdiction that has licensing requirements that are substantially equivalent to the requirements for the license in this state.

Section 55.041(b) states that before engaging in the practice of the business or occupation, the military spouse must: (1) notify the applicable state agency of the spouse's intent to practice in this state; (2) submit to the agency proof of the spouse's residency in this state and a copy of the spouse's military identification card; and (3) receive from the agency confirmation that: (A) the agency has verified the spouse's license in the other jurisdiction; and (B) the spouse is authorized to engage in the business or occupation in accordance with this section.

Section 55.041(c) provides that the military spouse shall comply with all other laws and regulations applicable to the business or occupation in this state.

Section 55.041(d) states that a military spouse may engage in the business or occupation under the authority of this section only for the period during which the military service member to whom the military spouse is married is stationed at a military installation in this state but not to exceed three years from the date the spouse receives the confirmation described §55.041(b)(3).

Section 55.041(e) provides that a state agency that issues a license shall adopt rules to implement this section. The rules must establish a process for the agency to: (1) identify, with respect to each type of license issued by the agency, the jurisdictions that have licensing requirements that are substantially equivalent to the requirements for the license in this state; and (2) verify that a military spouse is licensed in good standing in a jurisdiction described by Subdivision (1).

Section 55.041(f) provides that, in addition to the rules adopted under §55.041(e), a state agency that issues a license may adopt rules to provide for the issuance of a license to a military spouse to whom the agency provides confirmation under §55.041 (b)(3). A license issued under this subsection must expire not later than the third anniversary of the date the agency provided the confirmation and may not be renewed. A state agency may not charge a fee for the issuance of the license.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 7, 2020.

TRD-202000042

Jena Abel

Deputy General Counsel

Texas Board of Nursing

Effective date: January 27, 2020

Proposal publication date: November 29, 2019

For further information, please call: (512) 305-6822


PART 24. TEXAS BOARD OF VETERINARY MEDICAL EXAMINERS

CHAPTER 573. RULES OF PROFESSIONAL CONDUCT

SUBCHAPTER G. OTHER PROVISIONS

22 TAC §573.68

The Texas Board of Veterinary Medical Examiners (Board) adopts new §573.68, concerning telemedicine. The new rule is adopted without changes to the proposed text as published in the August 16, 2019, issue of the Texas Register (44 TexReg 4288) and will not be republished.

Reasoned Justification and Factual Basis

The purpose of the new rule is to compile current regulations concerning telemedicine for the ease and convenience of the regulated population. The new rule merely restates existing law and does not add or modify existing regulations in any manner.

Summary of Comments and Agency Response

The agency received no public comment on this proposed rule.

Statutory Authority

The new rule is adopted under the authority of §801.151(a), Occupations Code, which states that the Board may adopt rules necessary to administer the chapter.

No other statutes, articles, or codes are affected by the adoption.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 7, 2020.

TRD-202000093

John Helenberg

Executive Director

Texas Board of Veterinary Medical Examiners

Effective date: January 27, 2020

Proposal publication date: August 16, 2019

For further information, please call: (512) 305-7573


CHAPTER 575. PRACTICE AND PROCEDURE

22 TAC §575.25

The Texas Board of Veterinary Medical Examiners (Board) adopts the repeal of §575.25, concerning Recommended Schedule of Sanctions. The repeal is adopted without changes to the proposed text as published in the August 16, 2019, issue of the Texas Register (44 TexReg 4289) and will not be republished.

Reasoned Justification and Factual Basis

This repeal is necessary because the Board is simultaneously adopting a new rule that outlines a new and updated schedule of sanctions. It is the goal of this new schedule of sanctions to bring more uniformity and predictability to the Board's disciplinary process.

Summary of Comments and Agency Response

The agency did not receive any public comments that concerned the proposed repeal of this rule.

Statutory Authority

The repeal is adopted under the authority of §801.151(a), Occupations Code, which states that the Board may adopt rules necessary to administer the chapter, and the authority of 801.411, Occupations Code, which states that the Board shall adopt a schedule of penalties, disciplinary actions, and other sanctions the board may impose under this chapter.

No other statutes, articles, or codes are affected by the adoption.

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 7, 2020.

TRD-202000090

John Helenberg

Executive Director

Texas Board of Veterinary Medical Examiners

Effective date: January 27, 2020

Proposal publication date: August 16, 2019

For further information, please call: (512) 305-7573


22 TAC §575.25

The Texas Board of Veterinary Medical Examiners (Board) adopts new §575.25, concerning Schedule of Sanctions. The new rule is adopted with changes to the proposed text as published in the August 16, 2019, issue of the Texas Register (44 TexReg 4290) and will be republished.

Reasoned Justification and Factual Basis

The purpose of the new rule is to provide greater uniformity and fairness in the Board's disciplinary process. This schedule of sanctions should provide clarity to both the licensees and the public about the recourse available to the Board in pursuing a complaint.

Summary of Comments and Agency Response

The Board received public comment regarding the application of the schedule of sanctions, the confidentiality provision and the standard of care provision.

In response to the concerns expressed over the applicability of the proposed rule, the proposed schedule of sanctions should be utilized by any finder of fact, which includes any Board disciplinary processes or proceedings before the State Office of Administrative Hearings. In addition, there were questions about utilizing all listed disciplinary actions in each grid on the schedule of sanctions chart. It is not the Board's intention to utilize each listed disciplinary action but allow the Board the flexibility to choose which sanctions are most appropriate in any given scenario.

The Board received comments on the provision in the confidentiality section that creates a Class C offense should a veterinarian reveal confidential information when rebutting a social media post. Commenters wanted a harsher penalty, but the Board felt that there was sufficient flexibility in the aggravating factors that a harsher punishment would be inconsistent with the rest of the proposed schedule of sanctions.

Finally, the Board received comments on the standard of care provisions in the proposed schedule of sanctions. A proposal for considering the emotional suffering by an animal's owner as an aggravating factor was ultimately rejected. The Board felt that the quality of veterinary care should not be contingent on the quality of the relationship between pet and owner.

Statutory Authority

The new rule is adopted under the authority of §801.151(a), Occupations Code, which states that the Board may adopt rules necessary to administer the chapter, and the authority of 801.411, Occupations Code, which states that the Board shall adopt a schedule of penalties, disciplinary actions and other sanctions that the board may impose under this chapter.

No other statutes, articles, or codes are affected by the adoption.

§575.25.Schedule of Sanctions.

This Schedule of Sanctions shall be used to assess the appropriate sanction to be imposed upon a licensee that is subject to disciplinary action.

Figure: 22 TAC §575.25 (.pdf)

The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 7, 2020.

TRD-202000091

John Helenberg

Executive Director

Texas Board of Veterinary Medical Examiners

Effective date: January 27, 2020

Proposal publication date: August 16, 2019

For further information, please call: (512) 305-7573