TITLE 22. EXAMINING BOARDS

PART 5. STATE BOARD OF DENTAL EXAMINERS

CHAPTER 104. CONTINUING EDUCATION

22 TAC §104.1

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §104.1, concerning continuing education. The proposed rule is necessary to implement the requirements of House Bill 2059 of the 86th Texas Legislature, Regular Session (2019), and the Texas Occupations Code Chapter 116, requiring human trafficking prevention training for health care practitioners prior to the renewal of a license.

FISCAL NOTE: Casey Nichols, Executive Director, has determined that for the first five-year period the proposed rule is in effect, the proposed rule does not have foreseeable implications relating to cost or revenues of the state or local governments.

PUBLIC BENEFIT-COST NOTE: Casey Nichols, has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the agency's implementation of legislative direction for the protection of public safety and welfare.

LOCAL EMPLOYMENT IMPACT STATEMENT: Casey Nichols has also determined that the proposed rule does not affect local economies and employment.

SMALL AND MICRO-BUSINESS, RURAL COMMUNITY IMPACT STATEMENT: Casey Nichols has determined that no economic impact statement and regulatory flexibility analysis for small businesses, micro-businesses, and rural communities is necessary for this rule.

GOVERNMENT GROWTH IMPACT STATEMENT: The Board has determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: (1) the rule does not create or eliminate a government program; (2) implementation of the proposed rule does not require the creation or elimination of employee positions; (3) the implementation of the proposed rule does not require an increase or decrease in future appropriations; (4) the proposed rule does not require an increase in fees paid to the agency; (5) the proposed rule does not create a new regulation; (6) the proposed rule does not expand an existing regulation; (7) the proposed rule does not increase or decrease the number of individuals subject to it; and (8) the proposed rule does not positively or adversely affect the state's economy.

COST TO REGULATED PERSONS: This proposed rule does not impose a cost on a regulated person and, therefore, is not subject to Tex. Gov't. Code §2001.0045.

Comments on the proposed new rule may be submitted to Casey Nichols, Executive Director, 333 Guadalupe Street, Suite 3-800, Austin, Texas 78701, by fax to (512) 649-2482, or by email to official_rules_comments@tsbde.texas.gov for 30 days following the date that the proposed rule is published in the Texas Register. To be considered for purposes of this rulemaking, comments must be: (1) postmarked or shipped by the last day of the comment period; or (2) faxed or e-mailed by midnight on the last day of the comment period.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

The statutory provision affected by this proposed rule is set forth in Texas Occupations Code, Chapter 116.

§104.1.Requirement.

As a prerequisite to the biennial renewal of a dental or dental hygiene license, proof of completion of 24 hours of acceptable continuing education is required.

(1) Each licensee shall select and participate in the continuing education courses endorsed by the providers identified in §104.2 of this title (relating to Providers). A licensee, other than a licensee who resides outside of the United States, who is unable to meet education course requirements may request that alternative courses or procedures be approved by the Licensing Committee.

(A) Such requests must be in writing and submitted to and approved by the Licensing Committee prior to the expiration of the biennial period for which the alternative is being requested.

(B) A licensee must provide supporting documentation detailing the reason why the continuing education requirements set forth in this section cannot be met and must submit a proposal for alternative education procedures.

(C) Acceptable causes may include unanticipated financial or medical hardships or other extraordinary circumstances that are documented.

(D) A licensee who resides outside of the United States may, without prior approval of the Licensing Committee, complete all required hours of coursework by self-study.

(i) These self-study hours must be provided by those entities cited in §104.2 of this title. Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses.

(ii) Upon being audited for continuing education compliance, a licensee who submits self-study hours under this subsection must be able to demonstrate residence outside of the United States for all periods of time for which self-study hours were submitted.

(E) Should a request to the Licensing Committee be denied, the licensee must complete the requirements of this section.

(2) Effective September 1, 2018, the following conditions and restrictions shall apply to coursework submitted for renewal purposes:

(A) At least 16 hours of coursework must be either technical or scientific as related to clinical care. The terms "technical" and "scientific" as applied to continuing education shall mean that courses have significant intellectual or practical content and are designed to directly enhance the practitioner's knowledge and skill in providing clinical care to the individual patient.

(B) Effective January 1, 2021, a licensed dentist whose practice includes direct patient care must complete not less than 2 hours of continuing education annually, and not less than 4 hours for each biennial renewal, regarding safe and effective pain management related to the prescription of opioids and other controlled substances. These 4 hours may be used to satisfy the 16-hour technical and scientific requirement. The courses taken to satisfy the safe and effective pain management requirement must include education regarding:

(i) reasonable standards of care;

(ii) the identification of drug-seeking behavior in patients; and

(iii) effectively communicating with patients regarding the prescription of an opioid or other controlled substance.

(C) Up to 8 hours of coursework may be in risk-management courses. Acceptable "risk management" courses include courses in risk management, record-keeping, and ethics. Dentists may complete continuing education courses described by §111.1 of this title (relating to Additional Continuing Education Required) to satisfy a portion of the risk-management requirement.

(D) Up to 8 hours of coursework may be self-study. These self-study hours must be provided by those entities cited in §104.2 of this title. Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses.

(E) Hours of coursework in the standards of the Occupational Safety and Health Administration (OSHA) annual update course or in cardiopulmonary resuscitation (CPR) basic life support training may not be considered in the 24-hour requirement.

(F) Hours of coursework in practice finance may not be considered in the 24-hour requirement.

(3) As part of the 24-hour requirement, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed.

(4) [(3)] Each licensee shall complete the jurisprudence assessment every four (4) years. This requirement is in addition to the twenty-four (24) hours of continuing education required biennially for the renewal of a license.

(5) [(4)] A licensee may carry forward continuing education hours earned prior to a renewal period which are in excess of the 24-hour requirement and such excess hours may be applied to subsequent years' requirements. Excess hours to be carried forward must have been earned in a classroom setting and within the one year immediately preceding the renewal period. A maximum of 24 total excess credit hours may be carried forward.

(6) [(5)] Examiners for the Western Regional Examining Board (WREB) and for Central Regional Dental Testing Services Inc. (CRDTS) will be allowed credit for no more than 12 hours biennially, obtained from calibration and standardization exercises associated with the examinations.

(7) [(6)] Any individual or entity may petition one of the providers listed in §104.2 of this title to offer continuing education.

(8) [(7)] Providers cited in §104.2 of this title will approve individual courses and/or instructors.

(9) [(8)] A consultant for the SBDE who is also a licensee of the SBDE is eligible to receive up to 12 hours of continuing education credit biennially to apply towards the biennial renewal continuing education requirement under this section.

(A) Continuing education credit hours shall be awarded for the issuance of an expert opinion based upon the review of SBDE cases and for providing assistance to the SBDE in the investigation and prosecution of cases involving violations of the Dental Practice Act and/or the Rules of the SBDE.

(B) The amount of continuing education credit hours to be granted for each consultant task performed shall be determined by the Executive Director, Division Director or manager that authorizes the consultant task to be performed. The award of continuing education credit shall be confirmed in writing and based upon a reasonable assessment of the time required to complete the task.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 22, 2020.

TRD-202004447

Lauren Studdard

General Counsel

State Board of Dental Examiners

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-8910


CHAPTER 111. STANDARDS FOR PRESCRIBING CONTROLLED SUBSTANCES AND DANGEROUS DRUGS

22 TAC §111.5

The State Board of Dental Examiners (Board) proposes new rule 22 TAC §111.5 concerning Electronic Prescribing Waivers. The new rule is proposed to comply with the requirements of HB 2174 (86th Regular Legislative Session), which requires practitioners to electronically prescribe all controlled substances. The law allows for prescriber waivers which may be renewed annually, if the prescriber is experiencing: 1) economic hardship; 2) technological limitations not reasonably within the control of the prescriber; or 3) other exceptional circumstances demonstrated by the prescriber.

FISCAL NOTE: Casey Nichols, Executive Director, has determined that for the first five-year period the proposed rule is in effect, the proposed rule does not have foreseeable implications relating to cost or revenues of the state or local governments.

PUBLIC BENEFIT-COST NOTE: Casey Nichols has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the protection of public safety and welfare.

LOCAL EMPLOYMENT IMPACT STATEMENT: Casey Nichols has also determined that the proposed rule does not affect local economies and employment.

SMALL AND MICRO-BUSINESS, RURAL COMMUNITY IMPACT STATEMENT: Casey Nichols has determined that no economic impact statement and regulatory flexibility analysis for small businesses, micro-businesses, and rural communities is necessary for this rule.

GOVERNMENT GROWTH IMPACT STATEMENT: The Board has determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: (1) the rule does not create or eliminate a government program; (2) implementation of the proposed rule does not require the creation or elimination of employee positions; (3) the implementation of the proposed rule does not require an increase or decrease in future appropriations; (4) the proposed rule does not require an increase in fees paid to the agency; (5) the proposed rule does not create a new regulation; (6) the proposed rule does expand an existing regulation; (7) the proposed rule does not increase or decrease the number of individuals subject to it; and (8) the proposed rule does not positively or adversely affect the state's economy.

COST TO REGULATED PERSONS: This proposed rule does not impose a cost on a regulated person and, therefore, is not subject to Tex. Gov't. Code §2001.0045.

Comments on the proposed amendments may be submitted to Casey Nichols, Executive Director, 333 Guadalupe Street, Suite 3-800, Austin, Texas 78701, by fax to (512) 649-2482, or by email to official_rules_comments@tsbde.texas.gov for 30 days following the date that the proposed rule is published in the Texas Register. To be considered for purposes of this rulemaking, comments must be: (1) postmarked or shipped by the last day of the comment period; or (2) faxed or e-mailed by midnight on the last day of the comment period.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are implemented or affected by this proposed rule.

§111.5Electronic Prescribing Waivers

(a) Effective January 1, 2021, the Board shall issue an electronic prescribing waiver to dentists who submit a waiver request form.

(b) The dentist must demonstrate circumstances necessitating a waiver from the electronic prescribing requirement, which include:

(1) economic hardship. Economic hardship shall be determined on a case by case basis, taking into account factors including:

(A) any special situational factors affecting either the cost of compliance or the ability to comply;

(B) the likely impact of compliance on profitability or viability; and

(C) the availability of measures that would mitigate the economic impact of compliance;

(2) technological limitations not reasonably within the control of the dentist; or

(3) other exceptional circumstances demonstrated by the dentist. Exceptional circumstances include, but are not limited to, prescribing fewer than twenty-five prescriptions per year.

(c) The dentist must submit a written statement and supporting documentation describing the circumstances necessitating a waiver as described in subsection (b) of this section.

(d) The waiver shall be issued for a period of one year. A dentist may reapply for a subsequent waiver not earlier than the 30th day before the date the waiver expires if the circumstances that necessitated the waiver continue.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 22, 2020.

TRD-202004449

Lauren Studdard

General Counsel

State Board of Dental Examiners

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-8910


CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL--DENTAL ASSISTANTS

22 TAC §114.12

The State Board of Dental Examiners (Board) proposes this amendment to 22 TAC §114.12, concerning continuing education for certificate holders. The proposed rule is necessary to implement the requirements of House Bill 2059 of the 86th Texas Legislature, Regular Session (2019), and the Texas Occupations Code Chapter 116, requiring human trafficking prevention training for health care practitioners prior to the renewal of a license.

FISCAL NOTE: Casey Nichols, Executive Director, has determined that for the first five-year period the proposed rule is in effect, the proposed rule does not have foreseeable implications relating to cost or revenues of the state or local governments.

PUBLIC BENEFIT-COST NOTE: Casey Nichols has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the agency's implementation of legislative direction for the protection of public safety and welfare.

LOCAL EMPLOYMENT IMPACT STATEMENT: Casey Nichols has also determined that the proposed rule does not affect local economies and employment.

SMALL AND MICRO-BUSINESS, RURAL COMMUNITY IMPACT STATEMENT: Casey Nichols has determined that no economic impact statement and regulatory flexibility analysis for small businesses, micro-businesses, and rural communities is necessary for this rule.

GOVERNMENT GROWTH IMPACT STATEMENT: The Board has determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: (1) the rule does not create or eliminate a government program; (2) implementation of the proposed rule does not require the creation or elimination of employee positions; (3) the implementation of the proposed rule does not require an increase or decrease in future appropriations; (4) the proposed rule does not require an increase in fees paid to the agency; (5) the proposed rule does not create a new regulation; (6) the proposed rule does not expand an existing regulation; (7) the proposed rule does not increase or decrease the number of individuals subject to it; and (8) the proposed rule does not positively or adversely affect the state's economy.

COST TO REGULATED PERSONS: This proposed rule does not impose a cost on a regulated person and, therefore, is not subject to Tex. Gov't. Code §2001.0045.

Comments on the proposed rule may be submitted to Casey Nichols, Executive Director, 333 Guadalupe Street, Suite 3-800, Austin, Texas 78701, by fax to (512) 649-2482, or by email to official_rules_comments@tsbde.texas.gov for 30 days following the date that the proposed rule is published in the Texas Register. To be considered for purposes of this rulemaking, comments must be: (1) postmarked or shipped by the last day of the comment period; or (2) faxed or e-mailed by midnight on the last day of the comment period.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

The statutory provision affected by this proposed rule is set forth in Texas Occupations Code, Chapter 116.

§114.12.Continuing Education for Certificate Holders.

(a) To renew a certificate of registration issued under this chapter, a dental assistant must complete six (6) hours of continuing education each year in areas covering dental assistant duties. At least three (3) of these six (6) hours must be clinical continuing education.

(b) A dental assistant may fulfill the continuing education requirement through board-approved self-study, interactive computer courses, or lecture courses. All continuing education must be offered by providers approved under 22 Texas Administrative Code §104.2.

(c) As a prerequisite to the renewal of a dental assistant's certificate of registration, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 22, 2020.

TRD-202004448

Lauren Studdard

General Counsel

State Board of Dental Examiners

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-8910


PART 9. TEXAS MEDICAL BOARD

CHAPTER 161. GENERAL PROVISIONS

22 TAC §161.11

The Texas Medical Board (Board or TMB) proposes new rule 22 TAC §161.11, entitled Memorandum of Understanding between Texas Medical Board (TMB) and Texas Physician Health Program (TXPHP).

The proposed rule §161.11 would adopt the Memorandum of Understanding entered into by the Texas Medical Board (TMB) and the Texas Physician Health Program (TXPHP), pursuant to H.B. 1504 (86th Legislature TMB Sunset Bill (2019)). H.B. 1504 added provision Texas Occupations Code §167.012 directing the TMB and TXPHP to enter into a memorandum of understanding to establish performance measures for the TXPHP, include a list of services provided by TMB to TXPHP, and require an internal audit of TXPHP to be completed once every three years.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed rule are in effect, the public benefit anticipated as a result of enforcing the proposed rule will be to have increased coordination between TXPHP and TMB pursuant to their various shared duties to protect the public health and welfare and to have rules that comport with statutes.

Mr. Freshour has also determined that for the first five-year period the proposed rule is in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed rule.

Mr. Freshour has also determined that for the first five-year period the proposed rule is in effect there will be no probable economic cost to individuals required to comply with the proposed rule.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule and has determined that for each year of the first five years the proposed rule will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed rule is in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed rule;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed rule;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed rule; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed rule.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed rule will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rule. For each year of the first five years the proposed rule will be in effect, Mr. Freshour has determined the following:

(1) The proposed rule will not create or eliminate a government program.

(2) Implementation of the proposed rule will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed rule will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed rule will not require an increase or decrease in fees paid to the agency.

(5) The proposed rule will not create a new regulation.

(6) The proposed rule will not expand an existing regulation as described above.

(7) The proposed rule will not increase the number of individuals subject to the rule's applicability.

(8) The proposed rule will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The rule are proposed under the authority of Texas Occupations Code §164.0015, as amended by H.B. 1504 (86th Leg. (2019)), Texas Occupations Code §153.001, related to the Board's general rulemaking authority, and Texas Occupations Code, Chapter 167, related to TXPHP and the Board's rulemaking authority. No other statutes, articles or codes are affected by this proposal.

§161.11.Memorandum of Understanding between Texas Medical Board (TMB) and Texas Physician Health Program (TXPHP).

(a) Statement of Purpose. Texas Occupations Code, § 167.012, added by the 86th Legislature, provides that the Texas Medical Board (TMB) and the Texas Physician Health Program (TXPHP) by rule shall adopt a memorandum of understanding (MOU) to better coordinate services and operations of TXPHP. Additionally, this MOU shall inform the public of each agency's responsibilities and the procedures for providing support to TXPHP as a program administratively attached to the TMB.

(b) Scope of Administrative Attachment. TXPHP shall receive services in the same manner as a department within the TMB. TXPHP shall have the reciprocal obligation to comply with all policies and procedures of all other respective departments of TMB providing services to TXPHP. The following services shall be provided by TMB:

(1) Executive services;

(2) Financial and support services;

(3) Human resources;

(4) Information technology resources;

(5) General counsel legal services;

(6) Governmental affairs and communication services; and

(7) Other administrative services as necessary.

(c) Performance Measures. TXPHP shall report to the TMB at every scheduled Disciplinary Process Review Committee meeting those performance measures listed in the TMB Legislative Appropriations Report as well as additional measures as necessary to perform internal audits.

(d) Internal Audit. TMB shall review TXPHP's operations and program once every three years to ascertain whether the results are consistent with established objectives and goals, and whether the operations or programs are being carried out as planned. TMB shall set out performance and accountability standards.

(e) Other Duties and Obligations. TMB and TXPHP agree to share information in a timely manner in order to implement their various duties regarding licensees, applicants, and participants. Any such information shared between TMB and TXPHP is confidential, pursuant to the Texas Occupations Code including §§ 164.007 and 167.010, and other relevant statutes. All information will be safeguarded and its confidentiality maintained in accordance with such laws.

(1) TMB agrees to timely provide to TXPHP information as necessary for TXPHP to process a referral pursuant to Texas Occupations Code, § 167.009, including all available contact information of the individual being referred. TXPHP agrees to timely provide TMB with information regarding the resolution of referrals, as needed for TMB's resolution of such referrals.

(2) TXPHP agrees to report participant information as provided by Texas Occupations Code, § 167.010(b) and (c). A report under subsection shall include all information in the possession or control of TXPHP not subject to other state or federal confidentiality protections prohibiting its release to TMB.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 19, 2020.

TRD-202004355

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 180. TEXAS PHYSICIAN HEALTH PROGRAM

22 TAC §180.4

The Texas Medical Board (Board or TMB) proposes amendments to 22 TAC §180.4 concerning Operation of Program.

The proposed §180.4 would correct an error in the rule and is necessary to ensure that the rules are consistent with Texas Occupations Code Section 153.051(d)(10). The erroneous fee increase was implemented for a period of two weeks only and all fees received in excess of the statutory cap have been reimbursed or prorated.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to have rules that comport with statutes.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will not create a new regulation.

(6) The proposed amendments will not expand an existing regulation as described above.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of Texas Occupations Code §164.0015, as amended by H.B. 1504 (86th Leg. (2019)), Texas Occupations Code §153.001, related to the Board's general rulemaking authority, and Texas Occupations Code, Chapter 167, related to TXPHP and the Board's rulemaking authority.

No other statutes, articles or codes are affected by this proposal.

§180.4.Operation of Program.

(a) Referrals.

(1) The program shall accept a self-referral from a licensure applicant or licensee, or a referral from an individual, a physician health and rehabilitation committee, a physician assistant organization, a state physician health program, a state acupuncture program, a hospital or hospital system licensed in this state, a residency program, or the Agency.

(2) The Agency may publicly or privately refer an applicant or licensee to the Program.

(b) Eligible Program Participants. An individual who has or may have mental or physical impairment or substance use disorder is eligible to participate in the Program.

(c) Drug Testing.

(1) The Program's drug testing shall be provided under contract for services with the vendor approved by the Texas Medical Board.

(2) The Program shall adopt policies and protocols for drug-testing that are consistent with those of the Agency.

(3) The Agency may monitor the test results for all program participants, provided that the identities of the program participants are not disclosed to the agency.

(d) Reports to the Agency.

(1) If an individual who has been referred by the Agency and does not enter into an agreement for services or a program participant is found to have committed a substantive violation of an Agreement, the Governing Board shall report that individual to the Agency for possible disciplinary action.

(2) A positive drug screen that is not attributed to a therapeutic prescription by a treating physician, shall be determined to be substantive violation of an Agreement by the program participant.

(3) A committee of the Board shall review the report and may accept the individual or program participant for possible disciplinary action. The Agency has the option of referring the individual back to the Program.

(e) Fees.

(1) Program participants shall pay an annual fee of $1,200.00 [$1,400.00] for physicians and PAs and $1,000.00 for all other licensees. Half of the annual fee shall be due upon scheduling of the intake interview. This fee is in addition to costs owed by program participants for completion of monitoring associated with a program participant's Agreement.

(2) The Program may waive all or part of the annual fee for a program participant upon a showing of good cause. Good cause may include documented financial hardship. All fee waivers shall be reported on at the next scheduled meeting of the Governing Board.

(f) Process.

(1) Interview by Medical Director.

(A) Upon receipt of a referral as described in subsection (a) of this section, the applicant or licensee shall meet with the TXPHP Medical Director or a member of the Advisory Committee designated by the Medical Director or Governing Board President for an interview to determine eligibility for the Program.

(B) An interview may be waived if the Medical Director determines that good cause exists.

(C) The performance of an intake interview may be delegated to another qualified medical professional as necessary.

(2) Review by Case Advisory Panel.

(A) A case advisory panel shall include three members. These members shall be the President of the Governing Board, the Secretary of the Governing Board, another member of the Governing Board who shall serve for a four-month term on a rotating basis with the other members, and one member of the Advisory Board who shall serve for a three-month term on a rotating basis. In the event that the President and/or the Secretary is unavailable or must recuse themselves, additional members of the Governing Board may serve on the panel.

(B) After an interview has occurred, a case advisory panel may be convened at the discretion of the Medical Director for the purpose of seeking advice and direction.

(C) All cases reviewed by a case advisory panel shall be reported on at the next scheduled meeting of the Governing Board.

(3) After the requirements in paragraph (1) of this subsection have been completed, the applicant or licensee shall be offered an agreement, determined ineligible for the program, or discharged from TXPHP.

(4) Agreements are effective upon signature by the program participant.

(5) All agreements are subject to review by the Governing Board.

(g) Evaluations. The TXPHP may request that an applicant or licensee undergo a clinically appropriate evaluation after the person has been interviewed. The evaluation shall be considered a term of an agreement and the person will be considered a program participant at that time. If an individual refuses to undergo an evaluation, he or she may be referred to the Agency on an emergent basis or as described in subsection (d) of this section.

(h) Agreements. Agreements between program participants and the TXPHP may include, but are not limited to, the following terms and conditions:

(1) abstinence from prohibited substances and drug testing;

(2) agreement not to treat one's own family and friends or receive treatment from family or friends;

(3) agreement not to manage one's own medical care;

(4) participation in mutual help groups such as Alcoholics Anonymous;

(5) participation in support groups for recovering professionals;

(6) worksite monitor;

(7) worksite restrictions; and

(8) treatment by an appropriate health care provider.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 19, 2020.

TRD-202004356

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 183. ACUPUNCTURE

22 TAC §183.20

The Texas Medical Board (Board) proposes amendments to 22 TAC §183.20, concerning Continuing Acupuncture Education.

The proposed amendments to §183.20, relating to Continuing Acupuncture Education, proposes amendments to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that acupuncturists complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Carry forward hours will not apply to the new course. Other changes proposed to §183.20 are made to reorganize and format the rule.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to increase acupuncturist knowledge about human trafficking prevention, which is a critical health and social issue affecting Texas.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will create a new regulation.

(6) The proposed amendments will not expand, limit, or repeal an existing regulation as described above, as the proposed amendments set forth new regulations about required topics of CE, but do not increase the number of CE hours to be completed each biennial renewal period.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of Texas Occupations Code §153.001 and 205.101(b) which provide authority for the Board to adopt rules necessary to regulate acupuncturists. The amendments are further proposed under H.B. 2059, passed by the 86th Legislature, Regular Session (2019).

No other statutes, articles or codes are affected by this proposal.

§183.20.Continuing Acupuncture Education.

(a) Purpose. This section is promulgated to promote the health, safety, and welfare of the people of Texas through the establishment of minimum requirements for continuing acupuncture education (CAE) for licensed Texas acupuncturists so as to further enhance their professional skills and knowledge.

(b) Minimum Continuing Acupuncture Education. As a prerequisite to the biennial registration of the license of an acupuncturist, the acupuncturist shall complete 34 hours of CAE every 24 months.

(1) The required hours shall be from courses that meet one of the following criteria at the time the hours are taken:

(A) are designated or otherwise approved for credit by the Texas State Board of Acupuncture Examiners based on a review and recommendation of the course content by the Education Committee of the board as described in subsection (n) of this section;

(B) are offered by providers approved by the Texas State Board of Acupuncture Examiners;

(C) have been approved for CAE credit for a minimum of three years by another state acupuncture board, having first gone through a formal approval process in such state;

(D) approved by the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) for professional development activity credit; or

(E) are provided outside of the United States by a provider of continuing acupuncture education that is acceptable to the Board.

(2) The required CAE hours shall include the following core hours:

(A) at least eight hours shall be in general acupuncture therapies;

(B) at least two of the required hours shall be from a course in ethics and safety;

(C) at least six of the required hours shall be in herbology; and

(D) at least four hours of biomedicine.

(3) The remaining CAE hours may be from other courses approved under paragraph (1) of this subsection, subject to the limitations under paragraphs (5) through (7) of this subsection.

(4) Courses may be taught through live lecture, distance learning, or the Internet.

(5) No more than four hours in courses that relate to business practices or office administration may be applied to the total hours required for each registration period.

(6) No more than a total of 16 hours completed under paragraph (1)(D) or (E) of this subsection may be applied to the total hours required each registration period.

(7) At least 18 hours applied to the total hours required each registration period must be approved under paragraph (1)(A) - (C) of this subsection.

(8) The required CAE shall include the completion of a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission.The course may be counted as part of the minimum 18 hours approved under paragraph 1(A) - (C) of this subsection.

(c) Reporting Continuing Acupuncture Education. An acupuncturist must report on the licensee's registration form whether the licensee has completed the required acupuncture education during the previous two years.

(d) Grounds for Exemption from Continuing Acupuncture Education. An acupuncturist may request in writing and may be exempt from the biennial minimum continuing acupuncture education requirements for one or more of the following reasons:

(1) the licensee's catastrophic illness;

(2) the licensee's military service of longer than one year in duration;

(3) the licensee's acupuncture practice and residence of longer than one year in duration outside the United States; and/or

(4) good cause shown on written application of the licensee which gives satisfactory evidence to the board that the licensee is unable to comply with the requirements of continuing acupuncture education.

(e) Exemption Requests. Exemption requests shall be subject to the approval of the executive director of the board, and shall be submitted in writing at least 30 days prior to the expiration of the license.

(f) Exemption Duration and Renewal. An exemption granted under subsections (d) and (e) of this section may not exceed one year, but may be renewed biennially upon written request submitted at least 30 days prior to the expiration of the current exemption.

(g) Verification of Credits. The board may require written verification of continuing acupuncture education hours from any licensee and the licensee shall provide the requested verification within 30 calendar days of the date of the request. Failure to timely provide the requested verification may result in disciplinary action by the board.

(h) Nonrenewal for Insufficient Continuing Acupuncture Education. Unless exempted under the terms of this section, the apparent failure of an acupuncturist to obtain and timely report the 34 hours of continuing education hours as required and provided for in this section shall result in nonrenewal of the license until such time as the acupuncturist obtains and reports the required hours; however, the executive director of the board may issue to such an acupuncturist a temporary license numbered so as to correspond to the non-renewed license. Such a temporary license issued pursuant to this subsection may be issued to allow the board to verify the accuracy of information related to the continuing acupuncture education hours of the acupuncturist and to allow the acupuncturist who has not obtained or timely reported the required number of hours an opportunity to correct any deficiency so as not to require termination of ongoing patient care.

(i) Fee for Issuance of Temporary License. The fee for issuance of a temporary license pursuant to the provisions of this section shall be in the amount specified under §175.1 of this title (relating to Application Fees); however, the fee need not be paid prior to the issuance of the temporary license, but shall be paid prior to the renewal of a permanent license.

(j) Application of Additional Hours. Continuing acupuncture education hours that are obtained to comply with the requirements for the preceding registration period, as a prerequisite for licensure renewal, shall first be credited to meet the requirements for that previous registration period. Once the requirements of the previous registration period are satisfied, any additional hours obtained shall be credited to meet the continuing acupuncture education requirements of the current registration period. A licensee may carry forward CAE hours earned prior to a biennial registration report, which are in excess of the 34-hour biennial requirement and such excess hours may be applied to the following registration periods' requirements, except for the required course under subsection (b)(8) of this section. A maximum of 34 total excess hours may be carried forward. Excess CAE hours may not be carried forward or applied to a biennial report of CAE more than two years beyond the date of the registration following the period during which the hours were earned.

(k) False Reports/Statements. An intentionally false report or statement to the board by a licensee regarding continuing acupuncture education hours reportedly obtained shall be a basis for disciplinary action by the board pursuant to the Act, §205.351(a)(2) and (6).

(l) Monetary Penalty. Failure to obtain and timely report the continuing acupuncture education hours for renewal of a license shall subject the licensee to a monetary penalty for late registration in the amount set forth in §175.2 and §175.3 of this title (relating to Registration and Renewal Fees and Penalties).

(m) Disciplinary Action, Conditional Licensure, and Construction. This section shall be construed to allow the board to impose requirements for completion of additional continuing acupuncture education hours for purposes of disciplinary action and conditional licensure.

(n) Required Content for Continuing Acupuncture Education Courses. Continuing Acupuncture Education courses must meet the following requirements:

(1) the content of the course, program, or activity is related to the practice of acupuncture or oriental medicine, and shall:

(A) be related to the knowledge and/or technical skills required to practice acupuncture; or

(B) be related to direct and/or indirect patient care;

(2) the method of instruction is adequate to teach the content of the course, program, or activity;

(3) the credentials of the instructor(s) indicate competency and sufficient training, education, and experience to teach the specific course, program, or activity;

(4) the education provider maintains an accurate attendance/participation record on individuals completing the course, program, or activity;

(5) each credit hour for the course, program, or activity is equal to no less than 50 minutes of actual instruction or training;

(6) the course, program, or activity is provided by a knowledgeable health care provider or reputable school, state, or professional organization;

(7) the course description provides adequate information so that each participant understands the basis for the program and the goals and objectives to be met; and

(8) the education provider obtains written evaluations at the end of each program, collate the evaluations in a statistical summary, and makes the summary available to the board upon request.

(o) Continuing Acupuncture Education Approval Requests. All requests for approval of courses, programs, or activities for purposes of satisfying CAE credit requirements shall be submitted in writing to the Education Committee of the board on a form approved by the board, along with any required fee, and accompanied by information, documents, and materials accurately describing the course, program, or activity, and necessary for verifying compliance with the requirements set forth in subsection (n) of this section. At the discretion of the board or the Education Committee, supplemental information, documents, and materials may be requested as needed to obtain an adequate description of the course, program, or activity and to verify compliance with the requirements set forth in subsection (n) of this section. At the discretion of the board or the Education Committee, inspection of original supporting documents may be required for a determination on an approval request. The Acupuncture Board shall have the authority to conduct random and periodic checks of courses, programs, or activities to ensure that criteria for education approval as set forth in subsection (n) of this section have been met and continue to be met by the education provider. Upon requesting approval of a course, program, or activity, the education provider shall agree to such checks by the Acupuncture Board or its designees, and shall further agree to provide supplemental information, documents, and material describing the course, program, or activity which, in the discretion of the Acupuncture Board, may be needed for approval or continued approval of the course, program, or activity. Failure of an education provider to provide the necessary information, documents, and materials to show compliance with the standards set forth in subsection (n) of this section shall be grounds for denial of CAE approval or rescission of prior approval in regard to the course, program, or activity.

(p) Reconsideration of Denials of Approval Requests. Determinations to deny approval of a CAE course, program, or activity may be reconsidered by the Education Committee or the board based on additional information concerning the course, program, or activity, or upon a showing of good cause for reconsideration. A decision to reconsider a denial determination shall be a discretionary decision based on consideration of the additional information or the good cause showing. Requests for reconsideration shall be made in writing by the education provider, and may be made orally or in writing by board staff or a committee of the board.

(q) Reconsideration of Approvals. Determinations to approve a CAE course, program, or activity may be reconsidered by the Education Committee or the board based on additional information concerning the course, program, or activity, or upon a showing of good cause. A decision to reconsider an approval determination shall be a discretionary decision based on consideration of the additional information or the good cause showing. Requests for reconsideration may be made in writing by a member of the public or may be made orally or in writing by board staff or a committee of the board.

(r) Criteria for Provider Approval.

(1) In order to be an approved provider, a provider shall submit to the board a provider application on a form approved by the board, along with any required fee. All provider applications and documentation submitted to the board shall be typewritten and in English.

(2) To become an approved provider, a provider shall submit to the board evidence that the provider has three continuous years of previous experience providing at least one different CAE course in Texas in each of those years that were approved by the board. In addition the provider must have no history of complaints or reprimands with the board.

(3) The approval of the provider shall expire three years after it is issued by the board and may be renewed upon the filing of the required application, along with any required fee.

(4) Acupuncture schools and colleges which have been approved by the board, as defined under §183.2(2) of this title (relating to Definitions), who seek to be approved providers shall be required to submit an application for an approved provider number to the board.

(s) Requirements of Approved Providers.

(1) For the purpose of this chapter, the title "approved provider" can only be used when a person or organization has submitted a provider application form, and has been issued a provider number unless otherwise provided.

(2) A person or organization may be issued only one provider number. When two or more approved providers co-sponsor a course, the course shall be identified by only one provider number and that provider shall assume responsibility for recordkeeping, advertising, issuance of certificates and instructor(s) qualifications.

(3) An approved provider shall offer CAE programs that are presented or instructed by persons who meet the minimum criteria as described in subsection (t) of this section.

(4) An approved provider shall keep the following records for a period of four years in one identified location:

(A) course outlines of each course given;

(B) record of time and places of each course given;

(C) course instructor curriculum vitaes or resumes;

(D) the attendance record for each course; and

(E) participant evaluation forms for each course given.

(5) An approved provider shall submit to the board the following within ten days of the board's request:

(A) a copy of the attendance record showing the name, signature and license number of any licensed acupuncturists who attended the course; and

(B) the participant evaluation forms of the course.

(6) Approved providers shall issue, within 60 days of the conclusion of a course, to each participant who has completed the course, a certificate of completion that contains the following information:

(A) provider's name and number;

(B) course title;

(C) participant's name and, if applicable, his or her acupuncture license number;

(D) date and location of course;

(E) number of continuing education hours completed;

(F) description of hours indicating whether hours completed are in general acupuncture, ethics, herbology, biomedicine, or practice management; and

(G) statement directing the acupuncturist to retain the certificate for at least four years from the date of completion of the course.

(7) Approved providers shall notify the board within 30 days of any changes in organizational structure of a provider and/or the person(s) responsible for the provider's continuing education course, including name, address, or telephone number changes.

(8) Provider approval is non-transferable.

(9) The board may audit during reasonable business hours records, courses, instructors and related activities of an approved provider.

(t) Instructors.

(1) Minimum qualifications of an acupuncturist instructor. The instructor must:

(A) hold a current valid license to practice acupuncture in Texas or other state and be free of any disciplinary order or probation by a state licensing authority; and

(B) be knowledgeable, current and skillful in the subject matter of the course as evidenced through one of the following:

(i) hold a minimum of a master's degree from an accredited college or university or a post-secondary educational institution, with a major in the subject directly related to the content of the program to be presented;

(ii) have experience in teaching similar subject matter content within the last two years in the specialized area in which he or she is teaching;

(iii) have at least one year's experience within the last two years in the specialized area in which he or she is teaching; or

(iv) have graduated from an acceptable acupuncture school, as defined under §183.2(2) of this title, and have completed 3 years of professional experience in the licensed practice of acupuncture.

(2) Minimum qualifications of a non-acupuncturist instructor. The instructor must:

(A) be currently licensed or certified in his or her area of expertise if appropriate;

(B) show written evidence of specialized training or experience, which may include, but not be limited to, a certificate of training or an advanced degree in a given subject area; and

(C) have at least one year's teaching experience within the last two years in the specialized area in which he or she teaches.

(u) CAE Credit for Course Instruction. Instructors of board-approved CAE courses or courses taught through a program offered by an approved provider for CAE credit may receive three hours of CAE credit for each hour of lecture, not to exceed six hours of continuing education credit per year, regardless of how many hours taught. Participation as a member of a panel presentation for the approved course shall not entitle the participant to earn CAE credit as an instructor. No CAE credit shall be granted to school faculty members as credit for their regular teaching assignments.

(v) Expiration, Denial and Withdrawal of Approval.

(1) Approval of any CAE course shall expire three years after the date of approval.

(2) The board may withdraw its approval of a provider or deny an application for approval if the provider is convicted of a crime substantially related to the activities of a provider.

(3) Any material misrepresentation of fact by a provider or applicant in any information required to be submitted to the board is grounds for withdrawal of approval or denial of an application.

(4) The board may withdraw its approval of a provider after giving the provider written notice setting forth its reasons for withdrawal and after giving the provider a reasonable opportunity to be heard by the board or its designee.

(5) Should the board deny approval of a provider, the provider may appeal the action by filing a letter stating the reason(s) with the board. The letter of appeal shall be filed with the board within ten days of the mailing of the applicant's notification of the board's denial. The appeal shall be considered by the board.

(w) An acupuncturist, who is a military service member, may request an extension of time, not to exceed two years, to complete any CAE requirements.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004363

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 184. SURGICAL ASSISTANTS

22 TAC §184.4, §184.25

The Texas Medical Board (Board) proposes amendments to 22 TAC §184.4, concerning Qualifications for Licensure, and §184.25, concerning Continuing Education.

The proposed amendments to §184.4, relating to Qualifications for Licensure, proposes to repeal language requiring an applicant for a surgical assistant license to attest to good moral character in order to obtain a license, pursuant to H.B. 1504 (86th Legislature (2019)).

Amendments are further proposed for §184.25, relating to Continuing Education, to implement new continuing education requirements set forth by H.B. 2059 (86th Leg.). The new language requires that licensed surgical assistants complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Carry forward hours will not apply to the new course requirement. Other changes proposed to 184.25 remove references to annual requirements, as the hours are required on a biennial basis. Remaining changes reorganize and format the rule.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to have rules that comport with statutes and increased knowledge amongst health care practitioners about human trafficking prevention, a critical health and social issue affecting Texas.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will create a new regulation.

(6) The proposed amendments will expand, limit, or repeal an existing regulation as described above.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of Texas Occupations Code §206.203, as amended by H.B. 1504 (86th Leg. (2019)) and §206.101(5) which provides authority for the Board to adopt rules necessary to regulate minimum continuing education requirements for licensed surgical assistants. The amendments are further proposed under H.B. 2059, passed by the 86th Legislature, Regular Session (2019).

No other statutes, articles or codes are affected by this proposal.

§184.4.Qualifications for Licensure.

(a) Except as otherwise provided in this section, an individual applying for licensure must:

(1) submit an application on forms approved by the board;

(2) pay the appropriate application fee;

(3) certify that the applicant is mentally and physically able to function safely as a surgical assistant;

(4) not have a license, certification, or registration in this state or from any other licensing authority or certifying professional organization that is currently revoked, suspended, or subject to probation or other disciplinary action for cause;

(5) have no proceedings that have been instituted against the applicant for the restriction, cancellation, suspension, or revocation of certificate, license, or authority to practice surgical assisting in the state, Canadian province, or uniformed service of the United States in which it was issued;

(6) have no prosecution pending against the applicant in any state, federal, or Canadian court for any offense that under the laws of this state is a felony;

[(7) be of good moral character;]

(7) [(8)] not have been convicted of a felony or a crime involving moral turpitude;

(8) [(9)] not use drugs or alcohol to an extent that affects the applicant's professional competency;

(9) [(10)] not have engaged in fraud or deceit in applying for a license;

(10) [(11)] pass an independently evaluated surgical or first assistant examination approved by the board;

(11) [(12)] have been awarded at least an associate's degree at a two or four year institution of higher education;

(12) [(13)] have successfully completed an educational program as set forth in subparagraphs (A) and (B) of this paragraph;

(A) A surgical assistant program accredited, for the entire duration of applicant's attendance, by the Commission on Accreditation of Allied Health Education Programs (CAAHEP); or

(B) a substantially equivalent program that is one of the following:

(i) a medical school whereby the applicant can verify completion of basic and clinical sciences coursework;

(ii) a registered nurse first assistant program that is approved or recognized by an organization recognized by the Texas Board of Nursing for purposes of licensure as a registered nurse first assistant; or

(iii) a post graduate clinical physician assistant program accredited, for the entire duration of applicant's attendance, by the Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA), or by that committee's predecessor or successor entities designed to prepare the physician assistant for a surgical specialty.

(C) The curriculum of an educational program listed in subparagraphs (A) and (B) of this paragraph must include at a minimum, either as a part of that curriculum or as a required prerequisite, successful completion of college level instruction in the following courses:

(i) anatomy;

(ii) physiology;

(iii) basic pharmacology;

(iv) aseptic techniques;

(v) operative procedures;

(vi) chemistry;

(vii) microbiology; and

(viii) pathophysiology.

(13) [(14)] demonstrate to the satisfaction of the board the completion of full-time work experience performed in the United States under the direct supervision of a physician licensed in the United States consisting of at least 2,000 hours of performance as an assistant in surgical procedures for the three years preceding the date of the application;

(14) [(15)] be currently certified by a national certifying board approved by the board; and

(15) [(16)] submit to the board any other information the board considers necessary to evaluate the applicant's qualifications.

(b) An applicant must provide documentation that the applicant has passed a surgical or first assistant examination required for certification by one of the following certifying boards:

(1) American Board of Surgical Assistants;

(2) National Board of Surgical Technology and Surgical Assisting (NBSTSA) formerly known as Liaison Council on Certification for the Surgical Technologist (LCC-ST); or

(3) the National Surgical Assistant Association provided that the exam was administered on or after March 29, 2003.

(c) Alternative License Procedures for Military Service Members, Military Veterans, and Military Spouses.

(1) An applicant who is a military service member, military veteran, or military spouse may be eligible for alternative demonstrations of competency for certain licensure requirements. Unless specifically allowed in this subsection, an applicant must meet the requirements for licensure as specified in this chapter.

(2) To be eligible, an applicant must be a military service member, military veteran, or military spouse and meet one of the following requirements:

(A) holds an active unrestricted surgical assistant license issued by another state that has licensing requirements that are substantially equivalent to the requirements for a Texas surgical assistant license; or

(B) within the five years preceding the application date held a surgical assistant license in this state.

(3) The executive director may waive any prerequisite to obtaining a license for an applicant described by this subsection after reviewing the applicant's credentials.

(4) Applications for licensure from applicants qualifying under this section, shall be expedited by the board's licensure division. Such applicants shall be notified, in writing or by electronic means, as soon as practicable, of the requirements and process for renewal of the license.

(5) Alternative Demonstrations of Competency Allowed. Applicants qualifying under this section, notwithstanding:

(A) the one year expiration in §184.5(a)(2) of this title (relating to Procedural Rules for Licensure Applicants), are allowed an additional six months to complete the application prior to it becoming inactive; and

(B) the 20 day deadline in §184.5(a)(6) of this title, may be considered for permanent licensure up to five days prior to the board meeting; and

(C) the requirement to produce a copy of a valid and current certificate from a board approved national certifying organization in §184.6(b)(4) of this title (relating to Licensure Documentation), may substitute certification from a board approved national certifying organization if it is made on a valid examination transcript.

(d) Applicants with Military Experience.

(1) For applications filed on or after March 1, 2014, the Board shall, with respect to an applicant who is a military service member or military veteran as defined in §184.2 of this title (relating to Definitions), credit verified military service, training, or education toward the licensing requirements, other than an examination requirement, for a license issued by the Board.

(2) This section does not apply to an applicant who:

(A) has had a surgical assistant license suspended or revoked by another state or a Canadian province;

(B) holds a surgical assistant license issued by another state or a Canadian province that is subject to a restriction, disciplinary order, or probationary order; or

(C) has an unacceptable criminal history.

§184.25.Continuing Education.

(a) As a prerequisite to the registration of a surgical assistant's license, 36 [18] hours of continuing education (CE) in surgical assisting or in courses that enhance the practice of surgical assisting are required to be completed every 24 [12] months in the following categories:

(1) at least 18 [9] of the [annual ] hours are to be from formal courses that are:

(A) designated for AMA/PRA Category I credit by a CE sponsor accredited by the Accreditation Council for Continuing Medical Education;

(B) approved for prescribed credit by the Association of Surgical Technologists/ Association of Surgical Assistants, the American Board of Surgical Assistants, or the National Surgical Assistants Association;

(C) approved by the Texas Medical Association based on standards established by the AMA; or

(D) designated for AOA Category 1-A credit approved by the American Osteopathic Association.

(2) At least two [one] of the [annual] formal hours of CE which are required by paragraph (1) of this subsection must involve the study of medical ethics and/or professional responsibility. Whether a particular hour of CE involves the study of medical ethics and/or professional responsibility shall be determined by the organizations which are enumerated in paragraph (1) of this subsection as part of their course planning.

(3) As part of the required hours set forth under paragraph (1) of this subsection, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed. The course shall be approved by the Board to be credited toward the required medical ethics or professional responsibility hours set forth under paragraph (2) of this subsection.

(4) [(3)] The remaining 18 [9] hours [each year] may be composed of informal self-study, attendance at hospital lectures or grand rounds not approved for formal CE, or case conferences and shall be recorded in a manner that can be easily transmitted to the board upon request.

(b) A licensed surgical assistant must report on the license renewal application if he or she has completed the required continuing education since the licensee last registered with the board. A licensee who timely registers, may apply CE credit hours retroactively to the preceding biennial registration period [year's annual] requirement, however, those hours may be counted only toward one registration permit. A licensee may carry forward CE credit hours earned prior to a registration report which are in excess of the 36-hour [18-hour annual] requirement and such excess hours may be applied to the renewal period's [years'] requirements, except for the course in human trafficking prevention required under subsection (a)(3) of this section. A maximum of 36 total excess credit hours may be carried forward and shall be reported according to the categories set out in subsection (a) of this section. Excess CE credit hours of any type may not be carried forward or applied to a [an annual] report of CE more than two years beyond the date of the [annual] registration following the period during which the hours were earned.

(c) A licensed surgical assistant may request in writing an exemption for the following reasons:

(1) the licensee's catastrophic illness;

(2) the licensee's military service of longer than one year's duration outside the state;

(3) the licensee's residence of longer than one year's duration outside the United States; or

(4) good cause shown submitted in writing by the licensee that gives satisfactory evidence to the board that the licensee is unable to comply with the requirement for continuing education.

(d) Exemptions are subject to the approval of the executive director of the board and must be requested in writing at least 30 days prior to the expiration date of the license.

(e) An exception under subsection (c) of this section may not exceed two years [one year] but may be requested biennially [annually], subject to the approval of the executive director of the board.

(f) This section does not prevent the board from taking board action with respect to a licensee or an applicant for a license by requiring additional hours of continuing education or of specific course subjects.

(g) The board may require written verification of both formal and informal credits from any licensee within 30 days of request. Failure to provide such verification may result in disciplinary action by the board.

(h) Unless exempted under the terms of this section, a licensee's apparent failure to obtain and timely report the 36 [18] hours of CE as required [annually] and provided for in this section shall result in the denial of licensure renewal until such time as the licensee obtains and reports the required CE hours; however, the executive director of the board may issue to such a surgical assistant a temporary license numbered so as to correspond to the nonrenewed license. Such a temporary license shall be issued at the direction of the executive director for a period of no longer than 90 days. A temporary license issued pursuant to this subsection may be issued to allow the surgical assistant who has not obtained or timely reported the required number of hours an opportunity to correct any deficiency so as not to require termination of ongoing patient care.

(i) CE hours that are obtained to comply with the CE requirements for the prior biennial period [for the preceding year] as a prerequisite for obtaining licensure renewal, shall first be credited to meet the CE requirements for the previous period [year]. Once the previous period's [year's] CE requirement is satisfied, any additional hours obtained shall be credited to meet the CE requirements for the current period [year].

(j) A false report or statement to the board by a licensee regarding CE hours reportedly obtained shall be a basis for disciplinary action by the board pursuant to §§206.302-.304 of the Act and §§164.051-.053 of the Medical Practice Act, Tex. Occ. Code Ann. A licensee who is disciplined by the board for such a violation may be subject to the full range of actions authorized by the Act including suspension or revocation of the surgical assistant's license, but in no event shall such action be less than an administrative penalty of $500.

(k) Unless otherwise exempted under the terms of this section, failure to obtain and timely report CE hours for the renewal of a license shall subject the licensee to a monetary penalty for late registration in the amount set forth in Chapter 175 of this title (relating to Fees, Penalties, and Applications). Any temporary CE licensure fee and any administrative penalty imposed for failure to obtain and timely report the 36 [18] hours of CE required [annually] for renewal of a license shall be in addition to the applicable penalties for late registration or as set forth in Chapter 175 of this title (relating to Fees, Penalties and Applications).

(l) A surgical assistant, who is a military service member, may request an extension of time, not to exceed two years, to complete any CE requirements.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004364

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 185. PHYSICIAN ASSISTANTS

22 TAC §185.6

The Texas Medical Board (Board) proposes amendments to 22 TAC §185.6, concerning Biennial Renewal of License.

The proposed amendments to §185.6, relating to Biennial Renewal of License, proposes amendments to implement new continuing education requirements set forth by H.B. 2059 passed by the 86th Legislature, Regular Session (2019). The new language requires that physician assistants complete a course in the topic of human trafficking prevention. The new courses are to be completed as part of the formal course hours required each biennial registration period. Carry forwards will not be allowed toward the new requirements. Other changes are proposed to §185.6 are made to reorganize and format the rule.

Requiring all physician assistants to complete the new education requirements will fulfill legislative intent and better protect the public.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to increase physician assistant knowledge about human trafficking prevention, a critical health and social issue affecting Texas.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will create a new regulation.

(6) The proposed amendments will not expand, limit, or repeal an existing regulation as described above, as the proposed amendments set forth new regulations about required topics of CME, but do not increase the number of CME hours to be completed each biennial renewal period.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of Texas Occupations Code §153.001 and 204.102, which provides authority for the Board to adopt rules necessary to administer and enforce the Medical Practice Act and to adopt rules necessary to regulate and license physician assistants. The amendments are further proposed under H.B. 2059, passed by the 86th Legislature, Regular Session (2019).

No other statutes, articles or codes are affected by this proposal.

§185.6.Biennial Renewal of License.

(a) Physician assistants licensed under the Physician Assistant Licensing Act shall register biennially and pay a fee. A physician assistant may, on notification from the board, renew an unexpired license by submitting the required form and documents and by paying the required renewal fee to the board on or before the expiration date of the permit. The fee shall accompany the required form which legibly sets forth the licensee's name, mailing address, business address, and other necessary information prescribed by the board.

(b) [The following documentation shall be submitted as part of the renewal process:]

[(1)] Continuing Medical Education. As a prerequisite to the biennial registration of a physician assistant's license, 40 hours of continuing medical education (CME) are required to be completed. [in the following categories:]

(1) [(A)] At [at] least 20 [one-half of the] hours are to be from formal courses:

(A) [(i)] that are designated for Category I credit by a CME sponsor approved by the American Academy of Physician Assistants; or

(B) [(ii)] approved by the board for course credit.

(2) As part of the 20 formal hours required, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed.

(3) [(B)] The remaining hours may be from Category II composed of informal self-study, attendance at hospital lectures, grand rounds, case conferences, or by providing volunteer medical services at a site serving a medically underserved population, other than at a site that is the primary practice site of the license holder, and shall be recorded in a manner that can be easily transmitted to the board upon request.

(4) [(C)] A physician assistant shall receive one credit of continuing medical education for each hour of time spent up to 6 hours per year, as required by paragraph (1) of this subsection [subparagraph (A) of this paragraph] based on participation in a program sponsored by the board and approved for CME credit for the evaluation of a physician assistant's competency or practice monitoring.

(5) [(2)] A physician assistant must report on the biennial registration form if she or he has completed the required continuing medical education during the previous year.

(6) A licensee may carry forward CME credit hours earned prior to registration which are in excess of the 40 hour biennial requirement, except that excess credits may not be applied to requirements set forth under paragraph (2) of this subsection, and such excess hours may be applied to the following years' requirements. A maximum of 80 total excess credit hours may be carried forward and shall be reported according to whether the hours are Category I and/or Category II. Excess CME credit hours of any type may not be carried forward or applied to a report of CME more than two years beyond the date of the biennial registration following the period during which the hours were earned.

(7) [(3)] A physician assistant may request in writing an exemption for the following reasons:

(A) catastrophic illness;

(B) military service of longer than one year's duration outside the United States;

(C) residence of longer than one year's duration outside the United States; or

(D) good cause shown on written application of the licensee that gives satisfactory evidence to the board that the licensee is unable to comply with the requirement for continuing medical education.

(8) [(4)] Exemptions are subject to the approval of the licensure committee of the board.

(9) [(5)] An exemption [A temporary exception] under paragraph (8) [ (4) of this subsection] may not exceed two years but may be renewed biennially, subject to the approval of the board.

(10) [(6)] This section does not prevent the board from taking disciplinary action with respect to a licensee or an applicant for a license by requiring additional hours of continuing medical education or of specific course subjects.

(11) [(7)] The board may require written verification of both formal and informal credits from any licensee within 30 days of request. Failure to provide such verification may result in disciplinary action by the board.

(12) [(8)] Unless exempted under the terms of this section, a physician assistant licensee's apparent failure to obtain and timely report the 40 hours of CME as required and provided for in this section shall result in nonrenewal of the license until such time as the physician assistant obtains and reports the required CME hours; however, the executive director of the board may issue to such a physician assistant a temporary license numbered so as to correspond to the nonrenewed license. Such a temporary license shall be issued at the direction of the executive director for a period of no longer than 90 days. A temporary license issued pursuant to this subsection may be issued to allow the physician assistant who has not obtained or timely reported the required number of hours an opportunity to correct any deficiency so as not to require termination of ongoing patient care.

(13) [(9)] A physician assistant, who is a military service member, may request an extension of time, not to exceed two years, to complete any CME requirements.

(14) [(10)] A physician assistant must provide a complete and legible set of fingerprints to the board, unless fingerprints were already submitted with their initial license application or a previous renewal request.

(c) Falsification of an affidavit or submission of false information to obtain renewal of a license shall subject a physician assistant to denial of the renewal and/or to discipline pursuant to the Act, §§204.301-204.303.

(d) If the renewal fee and completed application form are not received on or before the expiration date of the permit, the fees set forth in Chapter 175 of this title (relating to Fees and Penalties) shall apply.

(e) The board shall not waive fees or penalties.

(f) The board shall stagger biennial registration of physician assistants proportionally on a periodic basis.

(g) Practicing as a physician assistant as defined in the Act without a biennial registration permit for the current year as provided for in the board rules has the same force and effect as and is subject to all penalties of practicing as a physician assistant without a license.

(h) Expired Biennial Registration Permits.

(1) If a physician assistant's registration permit has been expired for less than one year, the physician assistant may obtain a new permit by submitting to the board a completed permit application, the registration fee, as defined in §175.2(2) of this title (relating to Registration and Renewal Fees) and the penalty fee, as defined in §175.3(2) of this title (relating to Penalties).

(2) If a physician assistant's registration permit has been expired for one year or longer, the physician assistant's license is automatically canceled, unless an investigation is pending, and the physician assistant may not obtain a new permit.

(3) A person whose license has expired may not engage in activities that require a license until the licensed has been renewed. Practicing as a physician assistant after a physician assistant's permit has expired under subsection (a) of this section without obtaining a new registration permit for the current registration period has the same effect as, and is subject to all penalties of, practicing as a physician assistant without a license. The Board interprets §204.156 of the Act to provide the exclusive sanction that may be imposed by the board for practicing medicine after the expiration of the permit.

(i) A military service member who holds a physician assistant license in Texas is entitled to two years of additional time to complete any other requirement related to the renewal of the military service member's license.

(j) The physician assistant board may refuse to renew a license if the licensee is in violation of a physician assistant board order.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004365

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 186. RESPIRATORY CARE PRACTITIONERS

22 TAC §186.10

The Texas Medical Board (Board) proposes amendments to 22 TAC §186.10, concerning Continuing Education Requirements.

The proposed amendments to §186.10, relating to Continuing Education Requirements, propose amendments to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that respiratory care practitioners complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Other changes proposed to 186.10 are made to reorganize and format the rule.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to increase respiratory care practitioners' knowledge about human trafficking prevention, which is a critical health and social issue affecting Texas.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will create a new regulation.

(6) The proposed amendments will not expand, limit, or repeal an existing regulation as described above, as the proposed amendments set forth new regulations about required topics of CE, but do not increase the number of CE hours to be completed each biennial renewal period.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The proposed amendments are proposed under the authority of Texas Occupations Code §153.001 and 604.0522(a)(1) which provide authority for the Board to adopt rules necessary to administer and enforce the Respiratory Care Practitioners Act and to adopt rules necessary to regulate and license Respiratory Care Practitioners. The proposed amendments are further proposed under H.B. 2059, passed by the 86th Legislature, Regular Session (2019).

No other statutes, articles or codes are affected by this proposal.

§186.10.Continuing Education Requirements.

(a) General. Each respiratory care practitioner is required to complete 24 contact hours of approved continuing education (CE) every two (2) years as a condition of renewal of a certificate. At least 12 contact hours must be in traditional courses. Of the required contact hours, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed. The remainder of contact hours may be in non-traditional courses or from passage of examinations detailed in subsection (b)(3) of this section. At least 2 contact hours must be in ethics. These ethics hours may be completed via traditional courses or non-traditional courses. The board shall credit completion of the human trafficking prevention course toward required ethics hours.

(1) A contact hour shall be 60 minutes of attendance and participation in an acceptable continuing education experience.

(2) A retired respiratory care practitioner providing only voluntary charity care who is approved by the advisory board for renewal may complete reduced CE requirements equal to half of the number of CE hours required for renewal for a certified respiratory care practitioner.

(3) Notwithstanding paragraph (1) of this subsection, completion of one academic semester unit or hour that is a part of the curriculum of a respiratory care education program or a similar education program in another health-care related field offered by an accredited institution shall be credited 15 contact hours of non-traditional CE.

(4) No CE hours may be carried over from one renewal period to another renewal period.

(b) Types of acceptable continuing education. Continuing education must be in skills relevant to the practice of respiratory care and must have a direct benefit to patients and clients and shall be acceptable if the experience falls in one or more of the following categories:

(1) Traditional CE. Provider-directed educational activities directly related to the profession of respiratory care that require the learner and provider to interact in real time, including, but not limited to, live lectures, courses, seminars, workshops, review sessions, or distance learning activities such as webcasts, videoconferences, and audio conferences in which the learner can interact with the provider. Traditional CE must be approved, recognized, accepted, or assigned CE credit by a professional organization or association (such as TSRC, NBRC or AARC) or offered by a federal, state, or local government entity.

(2) Non-traditional CE.

(A) Self-directed study directly related to the profession of respiratory care that does not include interaction between the learner and the instructor. A test at the conclusion of the self-directed study is required. Non-traditional CE must be approved, recognized, accepted, or assigned CE credit by a professional organization or association (such as TSRC, NBRC or AARC) or offered by a federal, state, or local government entity.

(B) A respiratory care practitioner who teaches or instructs a CE course shall be credited one (1) contact hour in non-traditional CE for each contact hour actually taught. CE credit will be given only once for teaching a particular course.

(C) A respiratory care practitioner who teaches or instructs a course in a respiratory care educational program accredited by the Commission on Accreditation for Respiratory Care or other accrediting body approved by the board shall be credited one (1) contact hour in non-traditional CE for each contact hour actually taught. CE credit will be given only once per renewal period for teaching a particular course.

(3) Passage of an official credentialing or proctored self-evaluation examination, as follows:

(A) NBRC Therapist Multiple Choice (TMC) credentialing or re-credentialing examination - 10 contact hours;

(B) NBRC Clinical Simulation Examination (credentialing or re-credentialing) - 10 contact hours;

(C) NBRC Neonatal/Pediatric Respiratory Care Specialist (NPS) examination (credentialing or re-credentialing) - 10 contact hours;

(D) NBRC Adult Critical Care Specialist (ACCS) examination (credentialing or re-credentialing) - 10 contact hours;

(E) NBRC Sleep Disorder Specialist (SDS) examination (credentialing or re-credentialing) - 10 contact hours;

(F) NBRC Certified Pulmonary Function Technologist (CPFT) examination or NBRC Registered Pulmonary Function Technologist (RPFT) examination (credentialing or re-credentialing) - 10 contact hours;

(G) Board of Registered Polysomnographic Technologists (BRPT) registration examination (credentialing or re-credentialing) - 10 contact hours;

(H) National Asthma Educator Certification Board (NAECB) Certified Asthma Educator (AE-C) examination (credentialing or re-credentialing) - 10 contact hours;

(I) Advanced cardiac life-support (ACLS), pediatric advanced life-support (PALS), neonatal advanced life-support (NALS) or neonatal resuscitation program (NRP), basic trauma life-support, or pre-hospital trauma life-support (credentialing or re-credentialing) - 8 contact hours;

(J) Examinations listed in subparagraphs (A) - (I) of this paragraph may be counted only once for credit. If an initial credentialing examination is counted towards fulfillment of CE requirements, the same examination taken later for re-credentialing purposes may only be applied towards fulfillment of CE requirements once every three (3) renewal periods.

(c) Verification of continuing education. The advisory board may conduct random audits of CE reported to be completed by respiratory care practitioners to determine compliance with this section. The advisory board may require written verification of CE hours from a respiratory care practitioner within 30 days of request. Failure to provide such verification may result in disciplinary action by the advisory board.

(d) Exemptions.

(1) A respiratory care practitioner may request in writing an exemption from the CE requirement for the following reasons:

(A) documented catastrophic illness;

(B) military service of longer than one year's duration outside the United States;

(C) residence of longer than one year's duration outside the United States; or

(D) good cause shown on written application of the respiratory care practitioner that gives satisfactory evidence to the advisory board that he or she is unable to comply with the CE requirement.

(2) Exemptions are subject to the approval of the Executive Director of the Medical Board and must be requested in writing at least 30 days prior to the expiration date of the certificate.

(3) An approved exemption may not exceed one renewal period but may be requested biennially, subject to the approval of the Executive Director of the Medical Board.

(e) CE hours that are obtained to comply with the CE requirements for the preceding renewal period as a prerequisite for obtaining the renewal of a certificate shall first be credited to meet the CE requirements for the previous renewal period. Once the previous renewal period's CE requirement is satisfied, any additional hours obtained shall be credited to meet the CE requirements for the current renewal period.

(f) A false report or statement to the advisory board by a respiratory care practitioner regarding CE hours reportedly obtained shall be a basis for disciplinary action by the board pursuant to §604.201 of the Act. A respiratory care practitioner who is disciplined by the advisory board for such a violation may be subject to the full range of actions authorized by the Act including suspension or revocation of the practitioner's certificate.

(g) A respiratory care practitioner who is a military service member may request an extension of time, not to exceed two years, to complete any CE requirements. A request for such extension is subject to the approval of the Executive Director of the Medical Board.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004367

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 187. PROCEDURAL RULES

The Texas Medical Board (Board) proposes amendments to 22 TAC §187.9, concerning Board Actions; §187.35, concerning Presentation of Proposal for Decision; §187.37, concerning Final Decisions and Orders; and repeal of 187.38, concerning Motions for Rehearing.

The proposed amendments to §187.9 propose to repeal language limiting the board's authority to issue more than one remedial plan to resolve complaints of violations of laws by licensees, pursuant to H.B. 1504 (86th Legislature TMB Sunset Bill (2019)). H.B. 1504 changed Texas Occupations Code §164.0015 so that the board is permitted to issue remedial plans to address minor law violations if the licensee has not received a remedial plan in the preceding five years. Remaining amendments delete language related to non-disciplinary orders, a type of order that the board has had no authority to issue since approximately 2009. Finally, the amendments delete an unnecessary reference to chapter 175 of the board rules.

Proposed amendments are made to §187.35, Presentation of Proposal for Decision, and §187.37, Final Decisions and Orders; pursuant to Texas Occupations Code Section 164.0072, added by H.B.1504 (86th Legislature TMB Sunset Bill (2019)). Section 187.38, pertaining to Motions for Rehearing, is proposed for repeal, as Texas Government Code Chapter 2001 provides for a specific and clear process requiring no regulatory clarification.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to have increased options to address minor violations by licensees with remedial measures and to have rules that comport with statutes.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will not create a new regulation.

(6) The proposed amendments will not expand, but will limit or repeal an existing regulation as described above.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

SUBCHAPTER A. GENERAL PROVISIONS AND DEFINITIONS

22 TAC §187.9

The amendments are proposed under the authority of Texas Occupations Code §164.0015, as amended by H.B. 1504 (86th Leg. (2019)). The amendments are further authorized by S.B. 292 (81st Leg. R.S. (2009)) (repealing statutes under Chapter 164 and 204 of the Texas Occupations Code authorizing non-disciplinary orders); and Texas Occupations Code Section 153.001, related to the Board's general rulemaking authority.

No other statutes, articles or codes are affected by this proposal.

§187.9.Board Actions.

(a) Pursuant to the Act, §164.001, and in accordance with Chapter 190 of this title (relating to Disciplinary Guidelines), the board, upon finding that an applicant or licensee has committed a prohibited act under the Act or board rules, or has violated an order of the board, shall enter an order imposing any action authorized by law:

(b) The board may stay enforcement of any order and place the person on probation. The board shall retain the right to vacate the probationary stay and enforce the original order for noncompliance with the terms of the probation or to impose any other disciplinary action authorized by law in addition to or instead of enforcing the original order.

(c) An agreed order[, including a private nondisciplinary rehabilitation order,] may impose actions as agreed to by the board and person subject to the order.

(d) An agreed order may include a refund, as provided by §164.206, Texas Occupations Code. A refund may only be ordered to be paid to a patient of the licensee who is the subject of disciplinary action and shall not exceed the amounts that the patient paid directly to the licensee related to medical services provided by the licensee that are the subject of the complaint involved. Refunds may be ordered to be paid by the licensee directly to a patient, with proof of payment provided to the board to show compliance with the board order. As used in this subsection, "patient" includes the legal guardian of a patient, but does not include any third-party payer.

(e) The time period of an order shall be extended for any period of time in which a person subject to an order subsequently resides or practices outside the State of Texas, for any period during which the person's license is subsequently cancelled for nonpayment of licensure fees, or as provided in a board order. This subsection does not apply to locum tenens practice if the licensee maintains a residence in this state and fully cooperates with his compliance officer.

(f) Notwithstanding [Nothwithstanding] subsections (a) - (d) of this section, the board may issue and establish the terms of a nondisciplinary remedial plan to resolve an investigation of a complaint.

(1) A remedial plan may not contain a provision that:

(A) revokes, suspends, limits, or restricts a person's license or other authorization to practice medicine; or

(B) assesses an administrative penalty against a person.

(2) A remedial plan may not be imposed to resolve a complaint:

(A) concerning:

(i) a patient death;

(ii) the commission of a felony; or

(iii) a matter in which the physician engaged in inappropriate sexual behavior or contact with a patient or became financially involved with a patient in an inappropriate manner; or

(B) in which the appropriate resolution may involve a restriction on the manner in which a license holder practices medicine.

(3) A remedial plan may not be issued to resolve a complaint against a licensee if the licensee previously entered into a remedial plan in the preceding five year period [with the board for the resolution of a different complaint relating to a violation of the Act or board rules].

(4) A fee may be assessed against a licensee participating in a remedial plan in an amount necessary to recover the costs of administering the plan [as set out in Chapter 175 of this title (relating to Fees and Penalties)].

(5) A remedial plan may not be entered into to resolve an investigation of a complaint, once a SOAH complaint or petition has been filed.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004372

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


SUBCHAPTER D. FORMAL BOARD PROCEEDINGS

22 TAC §187.35

The amendments are proposed under the authority of Texas Occupations Code §164.0015, as amended by H.B. 1504 (86th Leg. (2019)). The amendments are further authorized by S.B. 292 (81st Leg. R.S. (2009)) (repealing statutes under Chapter 164 and 204 of the Texas Occupations Code authorizing non-disciplinary orders); and Texas Occupations Code Section 153.001, related to the Board's general rulemaking authority. No other statutes, articles or codes are affected by this proposal.

§187.35.Presentation of Proposal for Decision.

(a) Notice of oral argument. All parties shall be given notice of the opportunity to attend and provide oral argument concerning a proposal for decision before the board. The ALJ who issued the proposal for decision shall be given notice of the opportunity to attend and provide a summation of the proposal for decision before the board. The ALJ is not required to attend the presentation of the proposal for decision before the board. Notice shall be sent to the party or the party's attorney of record as set out in Texas Government Code, §2001.142(a). Notice to the ALJ may be provided by facsimile, e-mail, telephone, hand delivery, regular mail, certified mail - return receipt requested, courier service, or registered service.

(b) Arguments before the Board. The order of the proceeding shall be as follows:

(1) the ALJ may present and explain the proposal for decision;

(2) the party adversely affected shall briefly state the party's reasons for being so affected supported by the evidence of record;

(3) the other party or parties shall be given the opportunity to respond;

(4) the party with the burden of proof shall have the right to close;

(5) board members may question any party as to any matter relevant to the proposal for decision and evidence presented at the hearing;

(6) at the end of all arguments by the parties, the board may deliberate in closed session and any action shall be taken [take action on a final decision or final order] in open session.

(c) Limitation. A party shall not inquire into the mental processes used by the board in arriving at its decision, nor be disruptive of the orderly procedure of the board's routines.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004373

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


22 TAC §187.37

The amendments are proposed under the authority of Texas Occupations Code §164.0015, as amended by H.B. 1504 (86th Leg. (2019)). The amendments are further authorized by S.B. 292 (81st Leg. R.S. (2009)) (repealing statutes under Chapter 164 and 204 of the Texas Occupations Code authorizing non-disciplinary orders); and Texas Occupations Code Section 153.001, related to the Board's general rulemaking authority.

No other statutes, articles or codes are affected by this proposal.

§187.37.Board Action on Proposal for Decision [Final Decisions and Orders].

(a) For purposes of this section a Final Order is defined as the disposition of a contested case based on the administrative law judge's findings of fact and conclusions of law resulting in a disciplinary order or dismissal issued by the board. A Final Order shall be in writing and shall be signed by the president, vice-president, or secretary and reported in the minutes of the meeting. Notice of the Final Order shall be delivered in accordance with Texas Government Code, Chapter 2001, Section 2001.142. [For purposes of this section a Final Decision is defined as the findings of fact and conclusions of law issued by the ALJ after the filing of exceptions and replies to exceptions, in the form of a proposal for decision. A Final Decision shall include only findings of fact and conclusions of law, separately stated.]

(b) If the board does not file an appeal pursuant Section 164.0072 of the Texas Occupations Code, then a licensee may appeal a final order of the Board as allowed by Subchapter F of the Texas Government Code, Chapter 2001. [For purposes of this section a Final Order is defined as the findings of fact and conclusions of law, separately stated, and the sanctions, if any, issued by the board.]

(c) Board action on a Motion for Rehearing must be done in accordance with Texas Government Code, Chapter 2001, Section 2001.145 and 2001.146. [The board shall notify the licensee if it will present a Final Decision or a Final Order when providing the notice required in §187.35 of this title (relating to Presentation of Proposal for Decision).]

[(d) The determination to enter a Final Decision or issue a Final Order rests solely with the board. The board may only appeal a Final Decision.]

[(e) If a Final Decision is appealed, the determination of that appeal is conclusive to both the board and licensee as to the findings of fact and conclusions of law and only the sanction can subsequently be appealed after the issuance of a Final Order.]

[(f) If the board issues only a Final Order, the licensee retains the rights under the APA to appeal the findings of fact, conclusions of law, and the sanctions.]

[(g) Board action. Notice of the and Final Decision, if applicable, and/or Final Order, including a copy of the Final Decision and/or Final Order, shall be delivered in accordance with Texas Government Code, §2001.142(a). The Board shall keep a record documenting the provision of notice to each party.]

[(h) Recorded. All Final Decisions and Final Orders of the board shall be in writing and shall be signed by the president, vice-president, or secretary and reported in the minutes of the meeting.]

[(i) Imminent peril. If the board finds that imminent peril to the public's health, safety, or welfare requires immediate effect of a final decision or order in a contested case, it shall recite the finding in the decision or order as well as the fact that the decision or order is final and effective on the date rendered, in which event the decision or order is final and appealable on the date rendered and no motion for rehearing is required as a prerequisite for appeal.]

[(j) Changes to findings of fact and conclusions of law. The board may not change a finding of fact or conclusion of law or vacate or modify an order of the administrative law judge. The board may, however, obtain judicial review of any findings of fact or conclusions of law as provided by the APA].

[(k) In the case where the board intends to seek judicial review of a Final Decision, the board shall file a motion for rehearing as described in §187.38 of this title (relating to Motions for Rehearing).]

[(1) Determination and Imposition of Sanctions in a Final Order. The agency is charged by the legislature to protect the public interest, is an independent agency of the executive branch of the government of the State of Texas, and is the primary means of licensing, regulating and disciplining physicians and surgeons, physician assistants, and acupuncturists, to ensure that sound medical principles govern the decisions of the board.]

[(2) Sanctions. After receiving the ALJ's proposal for decision, the board may enter it as a Final Decision and seek judicial review. Upon the appeal's resolution, the board shall determine the charges on the merits, and issue a Final Order. The board has the sole authority and discretion to determine the appropriate sanction or action to impose on a licensee. The board determination regarding appropriate sanctions shall be based on the findings of fact and conclusions of law as set out in the Proposal for Decision or Final Decision and shall be set out in a Final Order.]

[(l) Administrative finality. A final order or final decision is administratively final:]

[(1) upon a finding of imminent peril to the public's health, safety or welfare, as outlined in subsection (i) of this section;]

[(2) when no motion for rehearing has been filed within 25 days after the date the final order or board decision is entered; or]

[(3) when a timely motion for rehearing is filed and the motion for rehearing is denied by board order or operation of law as outlined in §187.38 of this title.]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004374

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


22 TAC §187.38

The repeal is proposed under the authority of Texas Occupations Code §164.0015, as amended by H.B. 1504 (86th Leg. (2019)). The repeal is further authorized by S.B. 292 (81st Leg. R.S. (2009)) (repealing statutes under Chapter 164 and 204 of the Texas Occupations Code authorizing non-disciplinary orders); and Texas Occupations Code Section 153.001, related to the Board’s general rulemaking authority.

No other statutes, articles or codes are affected by this proposal.

§187.38.Motions for Rehearing.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004375

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 188. PERFUSIONISTS

22 TAC §188.24

The Texas Medical Board (Board) proposes amendments to 22 TAC §188.24, concerning Continuing Education.

The proposed amendments to §188.24, relating to Continuing Education, proposes amendments to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that perfusionists complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Other changes proposed to §188.24 are made to make language consistent with requirements being on a biennial basis, remove outdated language, and otherwise to reorganize and format the rule.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to increase perfusionists' knowledge about human trafficking prevention, which is a critical health and social issue affecting Texas.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will create a new regulation.

(6) The proposed amendments will not expand, limit, or repeal an existing regulation as described above, as the proposed amendments set forth new regulations about required topics of CE, but do not increase the number of CE hours to be completed each biennial renewal period.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or email comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of Texas Occupations Code §603.304 which provides authority for the Board to adopt rules necessary to regulate minimum continuing education requirements for perfusionists. The amendments are further proposed under H.B. 2059, passed by the 86th Legislature, Regular Session (2019).

No other statutes, articles or codes are affected by this proposal.

§188.24.Continuing Education.

(a) Completion of continuing education (CE) requirements by licensee with current certification by the ABCP or its successor agency. Completion of continuing education requirements may be documented by demonstrating current certification by the ABCP annual license renewal.

(b) Completion of CE requirements by licensee without current certification by the ABCP. A licensee without current certification by the ABCP at the time of license renewal must meet the following criteria.

(1) Document a minimum of 30 continuing education credits [credit] (CEUs) every 24 months (24 month timeline is in relation to the biennial registration period, not the calendar year). A licensee must report during registration if she or he has completed the required CE. Documentation of CE courses shall be made available to the Board upon request but should not be mailed with the registration payment. Random audits will be made to assure compliance. Of the required CEUs, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed. A minimum of 15 hours of CEU must be earned in Category I. The activity period covered in the professional activity report is from the date of licensure to the third licensure renewal date and every subsequent third license renewal date.

(2) Document a minimum of 40 clinical perfusion cases in a two-year period by submitting a clinical activity report upon renewal, on the approved form, demonstrating completion of 40 cases each biennial as the Primary Perfusionist for Cardiopulmonary bypass (instructor or primary), ECMO, VAD, Isolated Limb Perfusion, or VENO-VENO bypass.

(3) One CEU or contact hour activity is defined as 50 minutes spent in an organized, structured or unstructured learning experience. Categories of CEU activities are:

(A) Category I--Perfusion Meetings and Other Perfusion Related Activity--Perfusion meetings are those programs and seminars in which a minimum of 75% of the contact hours consist of perfusion related material. Only those meetings approved by the ABCP will qualify for Category 1 hours. Examples:

(i) International, national, regional, and state perfusion meetings.

(ii) Publication of perfusion related book chapter or paper in a professional journal.

(iii) Presentation at an international, national, regional, or state perfusion journal.

(B) Category II--Non-Accredited Perfusion Meetings and Other Medical Meetings--This category includes international, national, regional, and state meetings that have not been approved by the ABCP, local perfusion meetings, and all other medically related meetings. Examples:

(i) International, national, regional, and state [National, Regional, and State,] perfusion meetings that have not been accredited by the ABCP.

(ii) Local perfusion meetings (do not require ABCP accreditation). Any perfusion meeting NOT EQUALLY ACCESSIBLE to the general CCP community, this includes manufacturer-specific and company-sponsored educational activities.

(iii) International, national, regional, or local [National, Regional, or Local] medically-related meetings.

(C) Category III--Individual Education and Other Self-Study Activities Credit in this category is acquired on an hour for hour basis of the time spent in these non-accredited or non-supervised activities. Examples:

(i) Reading or viewing medical journals, audio-visual, or other educational material.

(ii) Participation in electronic forums.

(iii) Participation in a Journal Club.

(iv) Participation in degree-oriented, professional-related course work.

(v) Presentation of perfusion topic at a non-perfusion meeting.

(4) Documentation of activities. Licensees are responsible for reporting completion of their professional activities. This information must be reported to the board at the time of registration and renewal and documentation must be submitted to the board upon request. Credit will not be granted for activities that are not documented. The suitable documentation is outlined as follows:

(A) Category I--Perfusion meetings [--Approved perfusion meetings held before June 30, 1998, may be documented by copies of registration receipts or official meeting name tags]. For approved perfusion meetings [held after June 30, 1998], an official document from the meeting sponsor documenting attendance and the number of hours received must be provided.

(i) Perfusion Publications must have complete reference of book or article (authors, title, journal, and date/volume of journal).

(ii) Perfusion Presentations must have copy of program agenda.

(B) Category II--International, national, regional, and state perfusion meetings not accredited by the ABCP, local perfusion meetings and all other medical meetings--must provide an official document stating CEUs awarded and copy of the meeting program.

(C) Category III--All self-study activities will require an official record of completion or written summary of the activity.

(D) Submission of a clinical activity report upon renewal, on the approved form, demonstrating completion of 40 cases each biennial as the Primary Perfusionist for Cardiopulmonary bypass (instructor or primary), ECMO, VAD, Isolated Limb Perfusion, or VENO-VENO bypass.

(c) A licensee may request in writing an exemption for the following reasons:

(1) the licensee's catastrophic illness;

(2) the licensee's military service of longer than one year's duration outside the state;

(3) the licensee's residence of longer than one year's duration outside the United States; or

(4) good cause shown submitted in writing by the licensee that gives satisfactory evidence to the board that the licensee is unable to comply with the requirement for continuing education.

(d) Exemptions are subject to the approval of the executive director of the board and must be requested in writing at least 30 days prior to the expiration date of the license.

(e) An exception under subsection (c) of this section may not exceed one renewal [year] but may be requested again [annually], subject to the approval of the executive director of the board.

(f) This section does not prevent the board from taking board action with respect to a licensee or an applicant for a license by requiring additional hours of continuing education or of specific course subjects.

(g) The board may require written verification of both formal and informal credits from any licensee within 30 days of request. Failure to provide such verification may result in disciplinary action by the board.

(h) Unless exempted under the terms of this section, a licensee's apparent failure to obtain and timely report the number of hours of CE as required [annually] and provided for in this section shall result in the denial of licensure renewal until such time as the licensee obtains and reports the required CE hours.

(i) CE hours that are obtained to comply with the CE requirements for the preceding renewal period [year] as a prerequisite for obtaining licensure renewal[,] shall first be credited to meet the CE requirements for the previous renewal period [year]. Once the previous renewal period [year's] CE requirements are [requirement is] satisfied, any additional hours obtained shall be credited to meet the CE requirements for the current renewal period [year].

(j) A false report or statement to the board by a licensee regarding CE hours reportedly obtained shall be a basis for disciplinary action by the board pursuant to §603.401 of the Act. A licensee who is disciplined by the board for such a violation may be subject to the full range of actions authorized by the Act including suspension or revocation of the perfusionist's license, but such action shall not be less than an administrative penalty of $500.

(k) A perfusionist, who is a military service member, may request an extension of time, not to exceed two years, to complete any CE requirements.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004368

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016


CHAPTER 194. MEDICAL RADIOLOGIC TECHNOLOGY

SUBCHAPTER A. CERTIFICATE HOLDERS, NON-CERTIFIED TECHNICIANS, AND OTHER AUTHORIZED INDIVIDUALS OR ENTITIES

22 TAC §194.7

The Texas Medical Board (Board) proposes amendments to 22 TAC §194.7, concerning Biennial Renewal of Certificate or Placement on the Board's Non-Certified Technician Registry.

The proposed amendments to §194.7, relating to Biennial Renewal of Certificate or Placement on the Board's Non-Certified Technician Registry, proposes amendments to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that radiologist assistants, medical radiologic technologists, and non-certified technicians complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Carry forward hours will not apply to the new course requirement. For radiologist assistants, the course will be required in addition to the formal course hours. Other changes proposed to 194.7 reorganize and format the rule.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the proposed amendments are in effect, the public benefit anticipated as a result of enforcing the proposed amendments will be to increase knowledge in the radiologic technology field about human trafficking prevention, a critical health and social issue affecting Texas.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed amendments.

Mr. Freshour has also determined that for the first five-year period the proposed amendments are in effect there will be no probable economic cost to individuals required to comply with the proposed amendments.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years the proposed amendments are in effect:

(1) there will be no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendments;

(2) there will be no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendments;

(3) there will be no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendments; and

(4) there will be no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the proposed amendments.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and local employment.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed amendments. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed amendments will not create or eliminate a government program.

(2) Implementation of the proposed amendments will not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed amendments will not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendments will not require an increase or decrease in fees paid to the agency.

(5) The proposed amendments will create a new regulation.

(6) The proposed amendments will not expand, limit, or repeal an existing regulation as described above, as the proposed amendments set forth new regulations about required topics of CE, but do not increase the number of CE hours to be completed each biennial renewal period.

(7) The proposed amendments will not increase the number of individuals subject to the rule's applicability.

(8) The proposed amendments will not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of Texas Occupations Code §601.0522(a)(1) which provides authority for the Board to adopt rules necessary to regulate individuals who perform radiologic procedures. The amendments are further proposed under H.B. 2059, passed by the 86th Legislature, Regular Session (2019).

No other statutes, articles or codes are affected by this proposal.

§194.7.Biennial Renewal of Certificate or Placement on the Board's Non-Certified Technician Registry.

(a) Temporary Certificates.

(1) A temporary certificate shall expire one year from the date of issue. A person whose temporary certificate has expired is not eligible to reapply for another temporary certificate.

(2) A temporary certificate is not subject to a renewal or extension for any reason.

(3) Persons who hold temporary certificates, either radiologist assistant, general, or limited, are not subject to continuing education requirements set forth under subsection (c) of this section.

(b) Biennial Registration and Fee Required.

(1) Certificate holders and NCTs registered under the Act shall renew authorization to practice biennially and pay a fee. Upon notification from the board, unexpired authorization may be renewed by submitting the required form and documents and by paying the required renewal fee to the board on or before the expiration date of the authorization.

(2) The fee shall accompany the required form which legibly sets forth the certificate or NCT registration holder's name, mailing address, business address, and other necessary information prescribed by the board. The certificate or NCT registration holder must include with the required forms and fee documentation of continuing education completed during the previous two years to the date of renewal ("biennial renewal period").

(c) Continuing education requirements.

(1) Generally.

(A) RA. As a prerequisite to the biennial renewal of a radiologist assistant certificate, the following must be completed:

(i) a minimum of 23 [24] hours of continuing education hours must be completed during each biennial renewal period. The hours must be in activities that are designated for Category A or A+ credits of continuing education evaluated by an organization recognized by ARRT as a Recognized Continuing Education Evaluation Mechanism (RCEEM) or RCEEM+ during the biennial renewal period; and[.]

(ii) a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission.

(B) MRT. As a prerequisite to the biennial renewal of an MRT certificate, a minimum of 24 hours of continuing education hours must be completed during each biennial renewal period. The continuing education must be completed as follows [in the following categories]:

(i) at [At] least 12 hours of the required number of hours must be satisfied by completing activities that are designated for Category A or A+ credits of continuing education evaluated by an organization recognized by ARRT as a RCEEM or RCEEM+ during the biennial renewal period;[.]

(ii) the required hours must include a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission;

(iii) [(ii)]the [The ] remaining [12] credits for the biennial renewal period may be composed of self-study or courses not approved for formal CE, and shall be recorded in a manner that can be easily transmitted to the board upon request; and[.]

(iv) any additional hours completed through self-study must be verifiable, through activities that include reading materials, audio materials, audiovisual materials, or a combination thereof.

(C) LMRT. As a prerequisite to the biennial renewal of a limited certificate, a minimum of 18 hours of continuing education acceptable to the board must be completed during each biennial renewal period. [The hours completed must be in the topics of general radiation health and safety or related to the categories of limited certificate held.] The continuing education must be completed as follows [in the following categories]:

(i) at [At] least nine hours of the required number of hours must be satisfied by completing activities that are designated for Category A or A+ credits of continuing education evaluated by an organization recognized by ARRT as a RCEEM or RCEEM+ during the biennial renewal period; [.]

(ii) the required hours must include a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission; and the [The ] remaining [nine] credits for the biennial renewal period may be composed of self-study or courses not approved for formal CE, and shall be recorded in a manner that can be easily transmitted to the board upon request. The hours completed must be in the topics of general radiation health and safety or related to the categories of limited certificate held.

(iii) Any additional hours completed through self-study must be verifiable, through activities that include reading materials, audio materials, audiovisual materials, or a combination thereof.

(D) An RA, MRT, or LMRT who also holds a current Texas license, registration, or certification in another health profession may satisfy the continuing education requirement for renewal of a certificate with hours counted toward renewal of the other license, registration, or certification, provided such hours meet all the requirements of this subsection.

(E) An RA or MRT who holds a current and active annual registration or credential card issued by ARRT indicating that the certificate holder is in good standing and not on probation satisfies the continuing education requirement for renewal of a certificate, except for the human trafficking prevention course, provided the hours accepted by ARRT were completed during the certificate holder's biennial renewal period and meet or exceed the [hour the] requirements set out in this subsection. The board must be able to verify the status of the card presented by the certificate holder electronically or by other means acceptable to the board. The board may review documentation of the continuing education activities in accordance with paragraph (5) of this subsection.

(F) NCTs. As a prerequisite to the biennial renewal of a placement on the NCT registry, the individual must complete a minimum of 12 hours of continuing education during each biennial renewal period. The continuing education must be completed as follows [in the following categories]:

(i) at [At] least six hours of the required number of hours must be satisfied by completion of activities that are designated for Category A or A+ credits of continuing education evaluated by an organization recognized by ARRT as a RCEEM or RCEEM+ during the biennial renewal period; [.]

(ii) the required hours must include a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission; and

(iii) [(ii)] the [The ] remaining hours [six credits] for the biennial renewal period may be composed of self-study or courses not approved for formal CE, and shall be recorded in a manner that can be easily transmitted to the board upon request.

iv [(iii)] Any additional hours completed through independent self-study must be verifiable, through activities that include reading materials, audio materials, audiovisual materials, or a combination thereof.

(2) Content Requirements.

(A) At least 50% of the required number of hours must be activities which are directly related to the use and application of ionizing forms of radiation to produce diagnostic images and/or administer treatment to human beings for medical purposes. For the purpose of this section, directly related topics include, but are not limited to: radiation safety, radiation biology and radiation physics; anatomical positioning; radiographic exposure technique; radiological exposure technique; emerging imaging modality study; patient care associated with a radiologic procedure; radio pharmaceutics, pharmaceutics, and contrast media application; computer function and application in radiology; mammography applications; nuclear medicine application; and radiation therapy applications.

(B) No more than 50% of the required number of hours may be satisfied by completing or participating in learning activities which are related to the use and application of non-ionizing forms of radiation for medical purposes.

(C) No more than 50% of the required number of hours may be satisfied by completing or participating in learning activities which are indirectly related to radiologic technology. For the purpose of the section, indirectly related topics include, but are not limited to, patient care, computer science, computer literacy, introduction to computers or computer software, physics, human behavioral sciences, mathematics, communication skills, public speaking, technical writing, management, administration, accounting, ethics, adult education, medical sciences, and health sciences. Other courses may be accepted for credit provided there is a demonstrated benefit to patient care.

(3) Alternative Continuing Education Accepted by the Board. The following may not be applied toward compliance with the required human trafficking prevention course. The additional activities for which continuing education credit will be awarded are as follows:

(A) successful completion of an entry-level or advanced-level examination previously passed in the same discipline of radiologic technology administered by or for the ARRT during the renewal period. The examinations shall be topics dealing with ionizing forms of radiation administered to human beings for medical purposes. Such successful completion shall be limited to not more than one-half of the continuing education hours required;

(B) successful completion or recertification in a cardiopulmonary resuscitation course, basic cardiac life support course, or advanced cardiac life support course during the continuing education period. Such successful completion or recertification shall be limited to not more than:

(i) three hours credit during a renewal period for a cardiopulmonary resuscitation course or basic cardiac life support course; or

(ii) six hours credit during a renewal period for an advanced cardiac life support course;

(C) attendance and participation in tumor conferences (limited to six hours), in-service education and training offered or sponsored by Joint Commission-accredited or Medicare certified hospitals, provided the education/training is properly documented and is related to the profession of radiologic technology;

(D) teaching in a program accredited by a regional accrediting organization such as the Southern Association of Colleges and Schools; or an institution accredited by JRCERT, JRCNMT, JTCCVT, CCE, ABHES, ASRT, professional organizations or associations, or a federal, state, or local governmental entity, with a limit of one contact hour of credit for each hour of instruction per topic item once during the continuing education reporting period for up to a total of 6 hours. No credit shall be given for teaching that is required as part of one's employment. Credit may be granted in direct, indirect or non-ionizing radiation based on the topic; or

(E) developing and publishing a manuscript of at least 1,000 words in length related to radiologic technology with a limit of six contact hours of credit during a continuing education period. Upon audit by the board, the certificate holder must submit a letter from the publisher indicating acceptance of the manuscript for publication or a copy of the published work. The date of publication will determine the continuing education period for which credit will be granted. Credit may be granted in direct, indirect or non-ionizing radiation based on the topic.

(4) Reporting Requirements. A certificate holder or NCT must report on the biennial renewal application form if she or he has completed the required continuing education during the previous renewal period.

(A) A certificate holder or NCT may carry forward continuing education credit hours that meet the requirements under this subsection and earned prior to the biennial registration renewal period which are in excess of the biennial hour requirement, and apply such hours to the subsequent renewal period requirements, except for the required course in human trafficking prevention.

(B) For RAs or MRTs, a maximum of 48 total excess credit hours meeting the requirements under this subsection may be carried forward, except for the required course in human trafficking prevention. Excess continuing education credits may not be carried forward or applied to a report of continuing education more than two years beyond the date of the registration following the period during which the credits were earned.

(C) For LMRTs, a maximum of 24 hours meeting the requirements of this subsection may be carried forward, except for the required course in human trafficking prevention. Excess continuing education credits may not be carried forward or applied to a report of continuing education more than two years beyond the date of the registration following the period during which the credits were earned.

(D) For NCTS, a maximum of 12 total excess credit hours meeting the requirements of this subsection may be carried forward, except for the required course in human trafficking prevention. Excess continuing education credits may not be carried forward or applied to a report of continuing education more than two years beyond the date of the registration following the period during which the credits were earned.

(5) Exemptions.

(A) A certificate holder or NCT may request in writing an exemption for the following reasons, subject to the approval of the certification committee of the board:

(i) catastrophic illness;

(ii) military service of longer than one year's duration outside the United States;

(iii) residence of longer than one year's duration outside the United States; or

(iv) good cause shown on written application of the certificate holder that gives satisfactory evidence to the board that the certificate holder is unable to comply with the requirement for continuing medical education.

(B) An exception under paragraph (5) of this subsection may not exceed one registration period, but may be renewed biennially, subject to the approval of the board.

(6) A certificate holder or NCT who is a military service member may request an extension of time, not to exceed two years, to complete any continuing education requirements.

(7) This subsection does not prevent the board from taking disciplinary action with respect to a NCT or certificate holder or an applicant for such authorization by requiring additional hours of continuing education or of specific course subjects.

(8) The board may require written verification of continuing education credits from any certificate holder or NCT within 30 days of request. Failure to provide such verification may result in disciplinary action by the board.

(9) Unless exempted under the terms of this subsection, a certificate holder or NCT's failure to obtain and timely report required hours of continuing education as required and provided for in this subsection shall result in the nonrenewal of the authorization to practice until such time as the certificate holder or NCT obtains and reports the required continuing education hours; however, the executive director of the Medical board may issue a temporary certificate or NCT registration numbered so as to correspond to the nonrenewed certificate or NCT registration. Such a temporary authorization to practice shall be issued at the direction of the executive director for a period of no longer than 90 days. A temporary authorization to practice issued pursuant to this subsection may be issued to allow the opportunity to correct any deficiency so as not to require termination of practice.

(10) Determination of contact hour credits. A contact hour shall be defined as 50 minutes of attendance and participation. One-half contact hour shall be defined as 30 minutes of attendance and participation during a 30-minute period.

(d) Criminal History Requirement for Registration Renewal.

(1) An applicant must submit a complete and legible set of fingerprints for purposes of performing a criminal history check.

(2) The board may not renew the certificate or NCT registration of a person who does not comply with the requirement of paragraph (1) of this subsection.

(3) A certificate holder or NCT is not required to submit fingerprints under this section for the renewal of the certificate or registration if the holder has previously submitted fingerprints for the initial issuance or prior renewal of a certificate or NCT registration.

(e) Report of Impairment on Registration Form.

(1) A certificate holder or NCT who reports an impairment that affects his or her ability to actively practice shall be given written notice of the following:

(A) based on the individual's impairment, he or she may request:

(i) to be placed on retired status pursuant to §194.10 of this title (relating to Retired Certificate or NCT Registration);

(ii) to voluntarily surrender the certificate or NCT registration pursuant to §194.33 of this title (relating to Voluntary Relinquishment or Surrender of Certificate or Permit); or

(iii) to be referred to the Texas Physician Health Program pursuant to Chapter 180 of this title (relating to Texas Physician Health Program and Rehabilitation Orders); and

(B) that failure to respond to the written notice or otherwise not comply with paragraph (1) of this subsection within 45 days shall result in a referral to the board's investigation division for possible disciplinary action.

(2) The board shall provide written notice as described in paragraph (1) of this subsection within 30 days of receipt of the renewal application form indicating the impairment.

(f) The board shall deny an application for renewal of an authorization to practice upon notice of the certificate or NCT registration holder's default of child support payments, as provided under Chapter 232 of the Texas Family Code.

(g) The board shall deny an application for renewal of a certificate or NCT registration or take and/or impose other disciplinary action against such an individual who falsifies an affidavit or otherwise submits false information to obtain renewal of a certificate or NCT registration, pursuant to the Act, §601.302.

(h) If the renewal fee and completed application form are not received on or before the expiration date of the certificate or NCT registration, the fees set forth in Chapter 175 of this title (relating to Fees and Penalties) shall apply.

(i) Except as otherwise provided, the board shall not waive fees or penalties.

(j) The board shall stagger biennial renewal of a certificate or NCT registration proportionally on a periodic basis.

(k) Expired Biennial Renewal.

(1) Generally.

(A) If a certificate or NCT registration has been expired for less than one year, the certificate or NCT registration may be renewed by submitting to the board a completed renewal application, and the renewal and penalty fees, as set forth under Chapter 175 (relating to Fees and Penalties).

(B) If a certificate or NCT registration has been expired for one year or longer, the certificate or NCT registration will be automatically canceled, unless an investigation is pending, and the certificate or NCT registration may not be renewed.

(C) A person whose certificate or NCT registration has expired may not engage in activities that require a certificate or NCT registration until the authorization has been renewed. Performing activities requiring a certificate or NCT registration during the period in which the authority has expired has the same effect as, and is subject to all penalties of, practicing radiologic technology in violation of the Act.

(D) If a certificate or NCT registration has been expired for one year or longer, it is considered to have been canceled, unless an investigation is pending. A new certificate or NCT registration may be obtained by complying with the requirements and procedures for obtaining an original certificate or NCT registration.

(2) Renewal for technologists on active military duty with expired certificate or NCT registration. A holder of a certificate or NCT registration that has been expired for longer than a year may file a complete application for another certificate or NCT registration of the same type as that which expired.

(A) The application shall be on official board forms and be filed with required fees.

(B) An applicant shall be entitled to a certificate of the same type as that which expired based upon the applicant's previously accepted qualification and no further qualifications or examination shall be required.

(C) The application must include a copy of the official orders or other official military documentation showing that the holder was on active duty during any portion of the period for which the applicant was last certified or registered as an NCT with the board.

(D) An applicant for a different type of certificate than that which expired must meet the requirements of this chapter generally applicable to that type of certificate.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on October 20, 2020.

TRD-202004369

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 6, 2020

For further information, please call: (512) 305-7016