Part I. Texas Board of Architectural Examiners

Chapter 1. Architects

Subchapter B. Registration

22 TAC §1.27

The Texas Board of Architectural Examiners proposes an amendment to §1.27 concerning Continuance. The proposed amendment is to change the date when notices of annual record maintenance fees must be paid. The effects are expected to be that record maintenance fees will be paid by the end of each fiscal year.

Cathy L. Hendricks, Executive Director, Texas Board of Architectural Examiners, has determined that for the first five years the section as proposed is in effect, there will be no fiscal implications as a result of enforcing or administering the section.

Ms. Hendricks has also determined that for each year of the first five years the section as proposed is in effect, no public benefits are anticipated as a result of enforcing the section as proposed. There will be no effect on small business. There is no anticipated economic cost to persons who are required to comply with the rule as proposed.

Comments may be submitted to Cathy L. Hendricks, ASID/IIDA, Executive Director, Texas Board of Architectural Examiners, P.O. Box 12337, Austin, Texas, 78711-2337.

The amendment is proposed under Texas Civil Statutes, Article 249a which provides the Texas Board of Architectural Examiners with authority to promulgate rules necessary to the performance of its duties.

This proposed amendment does not affect any other statutes.

§1.27.Continuance.

(a)

(No change.)

(b)

Candidates approved for examination will be required to pay an annual record maintenance fee each August [ December ] or the file will be closed. After three years the closed file will be destroyed and any credit for divisions previously passed will be forfeited. Candidates will be allowed to reopen files during the three year period only upon payment of the record maintenance fees for the current year and each year the file has been closed.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 3, 1999.

TRD-9900743

Cathy L. Hendricks, ASID/IIDA

Executive Director

Texas Board of Architectural Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-8535

Chapter 89. General Rules and Regulations

22 TAC §§89.6, 89.8, 89.11, 89.16, 89.23, 89.24, 89.28-89.30, 89.32, 89.34–89.36, 89.40, 89.41, 89.43, 89.44, 89.47, 89.49, 89.52–89.54, 89.72, 89.74, 89.75

The Texas Cosmetology Commission proposes amendments to §89.6, concerning new locations and floor plans of schools, §89.8, concerning student registration, §89.11, concerning daily attendance, §89.16, concerning license cancellation, §89.23, concerning transfer of hours between courses, §89.24, concerning transfer of hours, §89.28, concerning withdrawal from school, §89.29, concerning practical application of the curriculum, §89.30, concerning examination applications, §89.32, concerning models for examination, §89.34, concerning applicants for license through reciprocity, §89.35, concerning uniforms, §89.36, concerning postmarks, §89.40, concerning cosmetology establishment transfers, §89.43, concerning items to be posted in salons or schools, §89.44, concerning Salons in connection with other business, §89.47, concerning definition of a facial specialty salon, §89.49, concerning definition of a manicure specialty salon, §89.53, concerning minimum requirements for public and private cosmetology schools, §89.54, concerning independent contractors, §89.72, concerning cosmetology curriculums, §89.74, concerning continuing education, §89.75, concerning field trip hours and new §89.41, concerning change of location, and §89.52, concerning definition of a complaint, are being proposed all in accordance with House Bill 1, of the General Appropriations Act, §167.

Delores Alspaugh, Executive Director, has determined that for the first five-year period the rule is in effect, there will be fiscal implications for state or local government as a result of enforcing or administering the rules. In addition, there will fiscal implications for small and large businesses, as well as individuals as a result of administering the rules.

Comments on the proposals may be submitted to Delores L. Alspaugh, Executive Director, P.O. Box 26700, Austin, TX 78755-0700.

Mrs. Alspaugh also has determined that for each year of the first five years the rules are in effect the public benefit anticipated as a result of enforcing the rule will be to ensure that cosmetology establishments and licensees comply with the requirements of the rules of the commission. There are anticipated economic costs to persons who are required to comply with the rules as adopted.

Comments on the proposals may be submitted to Delores L. Alspaugh, Executive Director, P.O. Box 26700, Austin, TX 78755-0700.

The amendments and new sections are proposed in accordance with Article 8451a, V.T.C.S., which provides the commission with the authority to "issue rules consistent with this Act", to protect the public's health and safety.

Article 8451a, V.T.C.S., is a effected by these proposed new and amended sections.

§89.6. New Location or Change in Floor Plan of School.

(a)

To be approved for continued operation on a current license, facilities shall be inspected and approved. A private cosmetology school moving to a new location or altering the floor plan will submit the following prior to requesting the inspection :

(1)-(2)

(No change.)

(3)

notarized statement which must include equipment established by the commission sufficient to instruct a minimum of 50 students. Upon receipt of the notarized statement in the commission office, temporary authorization to begin operations in the new facility may be granted pending inspection. Should the inspection determine deficiencies, they will request an additional inspection and pay the $200 inspection fee. [ 10 days will be given to correct the deficiencies ]

(4)

(No change.)

(b)

To be approved for continued operation on a current permit, facilities shall be inspected and approved. A public secondary cosmetology program moving to a new location or altering the floor plan will submit the following prior to requesting the inspection :

(1)-(2)

(No change.)

(3)

notarized statement which must include equipment established by the commission in §89.53(b) of this title (relating to Minimum Requirements for both Private and Public Cosmetology Schools). Upon receipt of the notarized statement in the commission office, temporary authorization to begin operations in the new facility may be granted pending inspection. Should the inspection determine deficiencies, they will request an additional inspection and pay the $200 inspection fee [ 10 days will be given to correct deficiencies ].

(4)

(No change.)

§89.8. Student Registration.

(a)

For each student enrolling , transferring, or re-enrolling in an introduction to cosmetology or cosmetology-related course in a school of cosmetology, the school must submit a properly completed registration form with a copy of the student's enrollment contract and a $25 fee, [ if necessary, ] to the commission office within 10 days of enrollment in order for the student to receive credit for hours accrued.

(b)

Each student enrolling in a school of cosmetology must obtain the current Texas Cosmetology Commission General Rules and Regulations book.

§89.11. Daily Attendance Register.

(a)

Each cosmetology school or program shall maintain a daily record of attendance with each student personally punching the time clock. Attendance records will be maintained in the school and available to authorized personnel of the Texas Cosmetology Commission, for a period of 48 months after the student completes or terminates attendance. All schools will be required to use a time clock to track student hours. All schools shall be required to post a sign at the time clock which states:

(1)-(3)

(No change.)

(4)

students leaving the facility for any reason must clock out, except if an instructional area on a campus is located outside the approved facility, those areas must be approved by the commission and the students must be under the supervision of an instructor.

(A)

Each cosmetology school or program may utilize locations away from any area approved by the original floor plan for cosmetology instruction if the instruction at any such location is identified as field trip hours. [ Private schools can utilize locations away from the building for instruction in the approved cosmetology school curriculum. The instruction at these locations must be identified as a field trip. If the private school is located in facilities that consist of more that one building the public rule shall apply ].

[ (B)

Public schools,: all areas of the school or campus are acceptable as instructional areas; if the instructor is teaching content approved in the cosmetology curriculum]

(B)

[ (C) ] A licensed instructor must be physically present during all activities included in this rule.

(b)-(c)

(No change.)

§89.16. Educational Programs for Licensees [ License Cancellation ].

Nothing in these rules and regulations shall be construed to apply to the educational activities conducted with any monthly, annual, or other special educational programs of any association utilizing licensed cosmetologists in Texas or elsewhere, from which the general public is excluded. This will apply only to a specific day or days of any monthly or other special program of any association of licensed cosmetologists. A licensed cosmetologist from Texas, or any other state, may not, however, hold classes when it is not in conjunction with a bona fide association unless they seek clearance, in writing, from the Executive Director of the Cosmetology Commission, ten days prior to said classes.

§89.23. Transfer of Hours between Courses.

A student enrolled for a specialty course may withdraw and transfer hours acquired to the operator course not to exceed the amount of hours of that subject in the operator curriculum. Students enrolled in the operator course may withdraw and transfer up to the maximum specialty hours within the operator curriculum for that course. Once a license is obtained, hours may not be transferred to another course.

§89.24. General Provisions Regarding Transfer of Hours.

(a)

(No change.).

(b)

A student transferring to a school who desires to claim hours and practical applications earned must inform the school transferred to prior to enrollment of his/her prior attendance and must furnish to that school and the executive director a record of hours claimed and practical applications completed. This record may be in the form of a transcript from the prior school or an extract from records of the commission. Upon re-entry to a school or transferring to another school, previously accrued hours must be applied to the first months hour report. The school must provide this information within 10 working days.

§89.28. Withdrawal from School.

(a)-(b)

(No change.)

(c)

Whenever a student withdraws from a school, a transcript must be prepared showing the number of hours and practical applications completed and a copy of the transcript shall be sent to the commission within 10 days . A copy of the transcript and practical applications must be kept in the student's file for 48 months and the copy must be made available at the request of the commission inspector.

(d)

(No change.)

§89.29. Practical Applications of the Curriculum.

(a)

Each student in a school of cosmetology enrolling after January 1, 1994, must complete practical applications of the curriculum according to the school's published rules on minimum practical applications, or the following schedule whichever is greater:

Figure: 22 TAC §89.29(a)

(b)-(c)

(No change.)

§89.30. Examination Application.

Application for examination must be filed and processed and the examinee will be notified 10 days prior to his/her examination date. The examination application consists of the verification of the applicant's completion of the total hours and practical applications required, a statement that the agreed tuition and fees have been tendered, or arrangements made to tender the agreed tuition and fees, a current health certificate, not more than one year old, and a current photograph. A copy of the student permit and photograph must be posted in the school should the student continue to attend to accrue hours between the time of application and date scheduled for exam. The applicant for examination will be required to furnish a picture I.D. that includes the date of birth prior to the exam from one of the following: valid driver's license, a Texas Department of Public Safety identification card, a military identification card, a high school identification card [ with a picture ], or a resident alien card [ as proof of identification prior to admittance for examination ]. No other proof will be accepted. Students holding dates scheduled for exam who do not appear without a seven-day notice to the commission of cancellation may be denied scheduling for at least 60 days.

§89.32. Models for Examination.

Applicants for [ operator ] examination will furnish an adult model, a slip-on hairpiece, or mannequin. Applicants for the instructor examination will furnish at least one mannequin for the haircut. An adult model may be used for the other portions of the examination. Models will wear appropriate street clothes , be at least 16 years of age, and furnish valid photo identification .

§89.34. Applicants for Licensure through Reciprocity.

(a)

Any person who seeks licensure in the State of Texas through reciprocity from any other state or nation shall:

(1)-(2)

(No change.)

(3)

complete his application for reciprocity on a form prescribed by the commission and submit a $100 reciprocity fee, plus a license fee , and the law book fee ; and

(4)

(No change.)

[ (5)

in addition, the state or nation from which the applicant holds a current license or certificate must grant reciprocity for Texas license or certificate holders.]

(b)

All [ out-of-country reciprocity ] applicants from another state of the United States, District of Columbia, territory, or foreign nation applying for reciprocity who cannot provide documentation of standards equivalent to those in Texas, or six years of verifiable licensed work experience, must pass a written and practical examination.

§89.35. Uniforms.

(a)

Cosmetology school students shall wear a uniform of washable material with armpits and chest covered as prescribed by the school. Tank tops, lingerie, see-through fabric, topless and bottomless uniforms, and bare feet are not allowed.

(b)

School employees, salon employees, and independent contractors shall wear attire of washable material with armpits and chest covered. Tank tops, lingerie, see-through fabric, topless and bottomless uniforms, and bare feet are not allowed.

(c)

Applicants for a commission examination must appear in a lab coat, and black or white dress slacks or skirt, or an all white professional uniform.

(1)

(No change.)

(2)

Dress blouse or shirt: [ with collar, ] white only, no knits or tee shirts ; must be plain and clean.

(3)-(4)

(No change.)

(5)

Shoes: black or white, no combination, no heels over one-inch tall. Must be clean and plain: no sandals, [ no boots, no demi-boots, ] no open-heeled, open-toed shoes, or open side shoes, no high-topped tennis shoes. Any shoe which has loops or holes for laces must be laced. Slip-on style shoes are acceptable.

§89.36. Postmark.

(a)

The postmark will be considered the filing date for any completed application or transaction required to meet a deadline. Failure to meet the deadline as specified in rules speaking to registration, withdrawal, application for examination , or graduation of a student will be sufficient cause for the issuance of a violation to the filing school.

(b)

In determining whether a license has expired and the length of time since its expiration, the following factors must be determined prior to writing a violation:

(1)

the date of license expiration as stated on the license; and

(2)

the postmark noted on any renewal application received in the commission offices.

§89.40. Cosmetology Establishment Transfer.

Whenever a cosmetology salon or school changes ownership, the salon or school shall be officially closed under the former owner and the new owner must [ shall ] apply for an original license within 30 days after the change of ownership and meet all necessary current requirements prior to final inspection . In the case of school ownership transfers, all facilities must be inspected [ and approved ] prior to a student's hours being accepted for credit. Notwithstanding the provisions of this section, when an owner of a salon or school dies or becomes incompetent, the remaining owners (if jointly owned) or the heirs, devises, executors, administrators, or guardians (if a sole proprietorship), or any combination of the foregoing, may operate the school or salon for the duration of the owner's license. This provision does not excuse noncompliance with other applicable licensing requirements. Any applicable bonding requirements must be maintained in effect.

§89.41. Change of Location of a Salon or School.

(a)

A salon or school may move and continue to operate with the current license, but must be inspected and approved under the current requirements in the new location. The salon or school must notify the commission office in writing of the change of address as soon as the change of address becomes available.

(b)

When the commission receives notification of the change of location, a form will be sent to the salon or school to be properly filled out. The salon or school will mail the form back to the commission accompanied with the appropriate inspection fee:

(1)

salon inspection fee - $35;

(2)

school inspection fee -$200.

§89.43. Items To Be Posted in Salon or School.

(a)-(b)

(No change.)

(c)

Each establishment at which the instruction or practice of cosmetology is being conducted shall prominently display to the public its normal business hours.

(1)

(No change.).

(2)

Schools must post rules and regulations on behavior, attendance, dress, and progress, and the school may suspend or terminate a student for noncompliance. Schools must place the current commission rules and regulations book in a place where it will be readily accessible to students.

(3)

[ (2) ] In a disciplinary proceeding involving the requirements of this section, the commission shall take official notice of the licensee's normal business hours on file with the commission.

Cosmetology Establishments with Other Business [ Salon in Connection with Other Business ].

A beauty salon, specialty salon, or cosmetology school shall not prepare for selling and/or sell food and drink except by vending machine, and should be separated by a solid wall and have a separate entrance if located in the same building with a restaurant or lunch counter. This rule will not apply to a licensed establishment in a department store when the sale of food and drink is not immediately adjacent to the salon. Salons connected with another business that does not sell food and drink must have adequate working space for each operator actually engaged in their practice in order to be licensed.

§89.47. Definition of a Facial Specialty Salon.

(a)

A facial specialty salon is an establishment where only the following services may be performed:

(1)-(6)

(No change.)

(b)

Only those specialties may be practiced in a specialty salon for which the salon is licensed , meets the equipment requirements, and has the services performed by the appropriate licensed specialist, a licensed operator, or a licensed instructor .

§89.49. Definition of a Manicuring Specialty Salon.

A manicuring salon is defined as an establishment where only manicuring, [ and ] pedicuring , artificial nails, skin care treatments (hand/arm/foot/leg), skin and nail diagnosis how to recognize skin conditions, nail conditions, and disorders, cosmetic chemistry and formulation of nail product and nail art are [ is ] practiced. Only those specialties may be practiced in a specialty salon for which the salon is licensed, meets the equipment requirements, and has the services performed by the appropriate licensed specialist, a licensed operator, or a licensed instructor."

§89.52. Definition of a Complaint.

In order for the commission to act on complaints against cosmetologists or cosmetology establishments filed with the commission by persons other than the commission's inspectors or the commission's enforcement staff, the complaint shall be submitted in writing and notarized by the complainant and sent or faxed to the commission office.

§89.53. Minimum Requirements for both Private and Public Cosmetology Schools.

(a)-(b)

(No change.)

(c)

The classroom must be separated from the laboratory area by walls extending to the ceiling and equipped with the following:

(1)-(5)

(No change.)

(6)

minimum visual aid requirements: television and VCR; [ equipment: ]

(d)

[ (A) ] Dispensary of not less than 50 contiguous square feet with a double sink with hot and cold running water and space for storage and dispensing of supplies and equipment (applicable for schools approved after August [ 8- ] 21 , 1985 [ -85 ])

(e)

[ (B) ] Lockers and dressing rooms /restrooms are to be provided.

(f)

[ (C) ] The school equipment list shall contain:

(1)

[ (i) ] six shampoo bowls and six shampoo chairs; [ morma ]

(2)

[ (ii) ] eight hair dryers with chairs;

(3)

[ (iii) ] one heat cap or therapeutic light;

(4)

[ (iv) ] eight dozen cold wave rods;

(5)

[ (v) ] three electric irons, or marcel stoves and irons;

(6)

[ (vi) ] 16 styling stations covered with Formica or similar material, with mirror, and 16 styling chairs (swivel or hydraulic);

(7)

[ (vii) ] 12 mannequins with sufficient hair with table or attached to styling stations;

(8)

[ (viii) ] one day/date formatted computer time clock;

(9)

[ (ix) ] one pair of professional hand clippers;

(10)

[ (x) ] three professional hand held dryers;

(11)

[ (xi) ] four manicure tables and four stools;

(12)

[ (xii) ] one closed cabinet for clean towels;

(13)

[ (xiii) ] one covered [ closed ] container for soiled towels;

(14)

[ (xiv) ] four covered trash cans in lab area;

(15)

[ (xv) ] one large wet disinfectant soaking container;

(16)

[ (xvi) ] one dry storage container for disinfectant implements.

[ (7)

As enrollment increases, required equipment is subject to increase; all equipment must be in good and sanitary condition.]

(g)

[ (8) ] equipment requirements for the facialist course are as follows:

(1)

[ (A) ] facial chair;

(2)

[ (B) ] magnifying lamp;

(3)

[ (C) ] Woods lamp;

(4)

[ (D) ] dry sanitizer;

(5)

[ (E) ] steamer;

(6)

[ (F) ] brush machine for cleaning;

(7)

[ (G) ] vacuum machine that includes spray device;

(8)

[ (H) ] high frequency for disinfection, product penetration, stimulation;

(9)

[ (I) ] galvanic for deincrustration, product penetration;

(10)

[ (J) ] paraffin bath and paraffin wax.

(h)

[ (9) ] The school [ salon ] must be properly ventilated with an exhaust fan or air filtering device extracting fumes and gases out of the facility.

§89.54. Independent Contractor/Booth Rental License.

(a)

Before [ To qualify as ] an independent contractor may practice, he/she [ an applicant ] must make application and obtain for a booth rental salon license and have an area of 30 sq. ft. clearly defined , not including the common area, that is his/her [ their ] responsibility as far as sanitation is concerned.

(1)-(3)

(No change.)

(b)

(No change.)

[ (c)

To qualify as an independent contractor the following guidelines apply:]

[ (1)

Any person licensed by the Texas Cosmetology Commission, responsible for reporting their own federal withholding taxes (IRS), social security taxes, unemployment taxes (Texas Workforce Commission), or any other self employment taxes must obtain an independent contractor/booth rental license.]

[ (2)

The independent contractor has sufficient floor space and equipment within their jurisdiction to adequately carry out the duties of his/her license.]

[ (3)

Independent contractors advertise only his/her own services, and/or has individual business cards.]

[ (4)

Independent contractor must control his/her own business hours.]

[ (5)

Independent contractors represent themselves to the public that they are independent contractors.]

[ (6)

A written contract is in effect with the lessor and the lessor does not exercise any control over the independent contractor.]

(c)

[ (d) ] Independent contractor may do any service in a licensed beauty salon, or specialties in a licensed specialty salon, provided they are properly licensed.

(d)

[ (e) ] The original and renewal Booth Rental license fee shall be $55 [ $50 ] and shall be valid for two years from date of issue. If a booth rental license is delinquent for less than 30 days, the delinquency fee shall be $10, over 30 days the delinquency fee shall be $35 [ $25 ].

(e)

[ (f) ] Independent contractors practicing cosmetology in more than one location must exhibit an original booth rental license or a duplicate issued by T.C.C. at each location.

(f)

[ (g) ] Independent Contractors must post in a location visible at all times the following information. It must be posted on the outside of the booth or the door where it can be read by visitors or prospective clients:

(1)

operator's name;

(2)

operator's license number;

(3)

hours of business.

(g)

[ (h) ] The lessor to an independent contractor must maintain a list of all renters that includes:

(1)

name of renter;

(2)

cosmetology license number of the renter;

(3)

hours of business of the renter.

(h)

[ (i) ] The lessor must supply the inspector with a list of renters upon request. Failure to provide the list can result in a violation of such significance to require a hearing.

§89.72. Curriculum Posted.

The curriculum listed has been established by the Texas Cosmetology Commission and must be followed by all cosmetology schools. The curriculum shall be posted in a conspicuous place in the school. A current syllabus and lesson plans for each course shall be maintained by the school and be available for inspection. Operator Curriculum:

(1)

Private, Public Post-Secondary Cosmetology Schools, and Adult Education Programs:

(A)

orientation and T.C.C. Rules and Regulations [ (theory) ]--100 hours;

(B)

shampoo and related theory-- 100 [ 150 ] hours;

(C)-(H)

(No change.)

(I)

haircutting, styling and related theory-- 500 [ 600 ] hours [ . ] ; [ Total: 1,500 hours. ]

(J)

Chemistry - 75 hours;

(K)

Salon Management and Practices - 75 hours; Total: 1,500 hours.

(2)

Public Secondary Program for High School Students: The Principal or Program Administrator must certify that each student has successfully completed 1,000 clocked cosmetology hours and 500 academic hours of related high school courses showing title and grade obtained in each course successfully completed. The T.C.C. may grant 500 academic hours for successfully passing academically approved courses to include math, lab science, and English. All documentation must be submitted to the commission office prior to any student being scheduled for examination [ before 500 academic hours can be granted by the Texas Cosmetology Commission for successfully passing academically approved courses to include math, lab science and English ]:

(A)

orientation and T.C.C. Rules and Regulations [ (theory) ]--75 hours;

(B)-(E)

(No change.)

(F)

hair coloring and related theory-- 100 [ 150 ] hours;

(G)-(H)

(No change.)

(I)

haircutting, styling, and related theory--400 hours ; [ . Total:1,000 hours. ]

(J)

Salon Management and Practices - 50 hours; Total: 1,000 hours.

(3)

Facial specialist curriculum (total 600 hours):

(A)

orientation and T.C.C. Rules and Regulations --25 hours;

(B)-(M)

(No change.)

(4)

Manicure curriculum:

(A)

orientation and T.C.C. Rules and Regulations --15 hours;

(B)-(F)

(No change.)

(G)

bacteriology, sanitation and safety measures--100 hours:

(i)

sanitation:

(I)-(II)

(No change.)

(III)

rules and regulations [ regulations ] (T.C.C.); and

(IV)

(No change.)

(ii)-(iv)

(No change.)

(H)-(I)

(No change.)

(J)

Theory is construed to mean any topic of instruction (listed in this paragraph [ subparagraph ]) in the classroom or practical area.

(5)

Instructor curriculum (total 750 hours):

(A)

orientation and T.C.C. Rules and Regulations [ (theory) ]--50 hours;

(B)-(C)

(No change.)

(6)

Instructor with two years experience curriculum (total 250 hours):

(A)

orientation and T.C.C. Rules and Regulations --10 hours;

(B)-(H)

(No change.)

(7)

(No change.)

(8)

Shampoo and conditioning specialist curriculum (total 150 hours). Under no conditions will the certificate holder do any other skills but those prescribed in this paragraph [ subparagraph ] by the commission:

(A)-(G)

(No change.):

(9)

Wig specialist curriculum (total 300 hours):

(A)-(Q)

(No change.)

(R)

sanitation and disinfecting as recommended by T.C.C. Rules and Regulations --10 hours;

(S)

history, background, and salesmanship--three hours.

§89.74. Program for Voluntary Continuing Education.

(a)

(No change.)

(b)

The recognition of instructors will be as follows.

(1)-(2)

(No change.)

(3)

In order to maintain " the master's teaching certificate " the teacher must attend a minimum of 16 hours of in-service each year. If they do not attend the 16 hours during one year the certificate will be reissued after two years of continuous in-service (32 hours).

(c)-(k)

(No change.)

(l)

A year is from January 1 through December 31 [ the first day of the month following the licensee's birth month through the last day of the licensee's birth month ].

§89.75. Field Trips.

Field trips are permitted under the following conditions for students enrolled in the following courses. The following guidelines are to be strictly adhered to and cosmetology related .

(1)

A maximum of 75 [ 40 ] hours out of the 1,500 hours permitted per student:

(A)

a maximum of 30 [ 20 ] hours for the manicure course;

(B)

a maximum of 30 [ 20 ] hours for the facial course;

(C)

a maximum of 30 [ 20 ] hours for students taking the 750 hour student instructor course;

(D)

a maximum of 50 hours out of the 1,000 hours operator course [ 8 hours for students taking the 250 hour student instructor course ]

(E)

(No change.)

(2)-(5)

(No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 3, 1999.

TRD-9900740

Delores Alspaugh

Executive Director

Texas Cosmetology Commission

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 454-4675

Chapter 216. Continuing Education

22 TAC §§216.1-216.11

The Board of Nurse Examiners proposes new §§216.1-216.11 concerning Definitions; Purpose; Requirements; Criteria for acceptable continuing education activity; Additional criteria for specific continuing education programs; Activities which are not acceptable as continuing education; Responsibilities of individual licensee; Relicensure process; Audit process; Appeals; and Consequences of non-compliance.

Chapter 217 was reviewed by the licensing, practice, education, compliance and legal departments of the Board of Nurse Examiners. Revisions were suggested based on current statutes, board actions, and procedures and problems identified by staff that required amending. In reviewing Chapter 217, staff determined that §217.15, Continuing Education, would better serve the licensed registered nurses if it were a separate chapter. Therefore, continuing education is being removed from Chapter 217 and will be proposed as new chapter 216. Included in the new chapter is recognition of Category 1, Continuing Medical Education for Type I Continuing Nursing Education for advanced practice nurses. These suggestions were presented to the members of the Board of Nurse Examiners at their January 21-22, 1999 meeting and the board concurred.

Katherine A. Thomas, MN, RN, executive director, has determined that for the first five-year period there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

There will be no effect on local government nor businesses to comply with the rule.

Katherine A. Thomas, MN, RN, executive director, has determined that for each year of the first five years the rule as proposed will be in effect the public is assured enhanced protection.

Written comments on the proposed amendments may be submitted to Katherine A. Thomas, Board of Nurse Examiners, P.O. Box 430; Austin, Texas 78767-0430.

The amendments are proposed under the Nursing Practice Act, (Texas Civil Statutes), Article 4514, §1, which provides the Board of Nurse Examiners with the authority and power to make and enforce all rules and regulations necessary for the performance of its duties and conducting of proceedings before it.

Cross Reference to Statute: Article 4518, §7, which provides the Board of Nurse Examiners authority to require participation in a Continuing Education Program as a condition of renewal of an Registered Nurse License.

§216.1. Definitions.

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

(1)

Academic course - A specific set of learning experiences offered in an accredited school, college or university. Academic credit will convert on the following basis: One academic quarter hour = 10 contact hours; one academic semester hour = 15 contact hours.

(2)

Advanced Practice Nurse (APN) - A professional nurse, currently licensed in the State of Texas, who is prepared for advanced nursing practice by virtue of knowledge and skills obtained in an advanced educational program of study acceptable to the board and meets requirements of Rule 221 and/or Rule 222.

(3)

Approved - Recognized as having met established standards and pre- determined criteria of the credentialing agencies recognized by the board. Applies to providers and programs.

(4)

Audit - A random sample of licensees taken to verify satisfactory completion of the board's requirements for continuing education during a biennial license renewal period.

(5)

Classroom instruction - Workshops, seminars, institutes, conferences or short-term courses which the individual attends which may be acceptable for continuing education credit.

(6)

Clinical learning experiences - Faculty-planned and guided learning experiences designed to assist students to meet the course objectives and to apply nursing knowledge and skills in the direct care of patients/clients. This includes laboratories, acute care facilities, extended care facilities, and other community resources.

(7)

Contact hour - Fifty consecutive minutes of participation in a learning activity.

(8)

Continuing Education (CE) - Programs beyond the basic preparation which are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public. Nurse refresher courses are not accepted for continuing education credit.

(9)

Continuing education program - An organized educational activity designed and evaluated to meet a set of behavioral objectives which may be presented in one session or a series of sessions.

(10)

Credentialing agency - An organization recognized by the board as having met nationally predetermined criteria to approve programs and providers of CE.

(11)

Inservice programs - Educational activities sponsored by the employing agency to provide specific information about the work setting. Orientation or other programs which address the institution's philosophy, policies and procedures, on-the-job training; basic cardiopulmonary resuscitation; and equipment demonstration are not acceptable for continuing education credit.

(12)

Institutional-based instruction - Planned programs conducted by the employing agency for the development of its nursing staff's knowledge and improvement of skills. Institutional-based instruction which qualifies under §216.3(1) of this title (relating to Type I) is acceptable for Type I credit. Type II credit may be obtained for programs which comply with §216.4 of this title (relating to Criteria for Acceptable Continuing Education Activity).

(13)

Limited Prescriptive Authority - Authorization granted to an advanced practice nurse who meets the requirements to carry out or sign a prescription drug order.

(14)

Orientation - A program designed to introduce employees to the philosophy, goals, policies, procedures, role expectations and physical facilities of a specific work place. This does not meet the continuing education criteria as intended by these rules.

(15)

Program number - A unique number assigned to a program upon approval which shall identify it regardless of the number of times it is presented.

(16)

Provider - An individual, partnership, organization, agency or institution which offers continuing education programs.

(17)

Provider number - A unique number assigned to the provider upon approval by the credentialing agency or organization.

(18)

Self-directed study - An educational activity wherein the learner takes the initiative and the responsibility for assessing, planning, implementing and evaluating the activity. Self-directed study may include program development, auditing of academic course, initial specialty certification, home study, programmed instruction and authorship.

(19)

Type I - Programs(s) approved through an external review process based on a predetermined set of criteria. The review is conducted by an organization(s) recognized by the board to approve programs and providers.

(20)

Type II - Program(s) which meet the criteria for acceptable continuing education activity but which have not undergone an external review process.

§216.2. Purpose.

Continuing education in nursing includes programs beyond the basic preparation which are designed to promote and enrich knowledge, improve skills and develop attitudes for the enhancement of nursing practice, thus improving health care to the public. Pursuant to authority set forth in Texas Civil Statutes, Article 4518, §7, the board is establishing rules requiring participation in continuing education activities for license renewal. The procedures set forth in these rules provide a variety of means for licensees to comply with this requirement. The board assumes licensed nurses will maintain the high standards of the profession in selecting quality educational programs to fulfill the continuing education requirement. The board also assumes that providers will plan and implement quality educational programs which meet the criteria of the board.

§216.3. Requirements.

Twenty contact hours of continuing education within the two years immediately preceding renewal of registration are required.

(1)

Type I. Ten contact hours shall be obtained by participation in programs approved by a credentialing agency recognized by the board. The program shall meet all criteria listed in §216.4 of this title (relating to Criteria for Acceptable Continuing Education Activity). In addition, there shall be a nurse on the planning committee and target audience shall include nurses. The board recognizes agencies/organizations to approve providers and/or programs for Type I credit. A list of these agencies/organizations may be obtained from the board's office.

(2)

Type II. The remaining 10 contact hours shall be obtained by participation in additional Type I programs or by participation in activities listed in §216.4 of this title.

(3)

Requirements for the Advanced Practice Nurse. The licensee authorized by the Board as an advanced practice nurse (APN) is required to obtain 20 contact hours of continuing education within the previous two years of licensure.

(A)

The required hours are not in addition to the requirements of paragraphs (1) and (2) of this section.

(B)

The 20 contact hours of continuing education must be appropriate to the advanced specialty area and role recognized by the Board.

(C)

The APN who holds limited prescriptive authority must complete, in addition to the required contact hours in subparagraph (B) of this paragraph, at least 5 contact hours of continuing education in pharmacotherapeutics.

(D)

Category I Continuing Medical Education (CME) contact hours will meet requirements for Type I contact hours as described in this chapter.

§216.4. Criteria for Acceptable Continuing Education Activity.

The following criteria have been established to guide the licensed nurse in selecting appropriate programs and to guide the provider in planning and presenting continuing education programs. Activities which may meet these criteria include: classroom instruction, individualized instruction, academic courses, self-directed study, and institutional-based instruction.

(1)

Length. The program shall be at least one contact hour (50 consecutive minutes) in length.

(2)

Learner objectives.

(A)

Objectives shall be written and shall be the basis for determining content, learning experience, teaching methodologies, and evaluation.

(B)

Objectives shall be specific, attainable, measurable, and describe expected outcomes of the learner.

(3)

Target audience. The target audience for the program is identified.

(4)

Planned program. There shall be evidence of program planning based on needs of potential target audience.

(5)

Content.

(A)

The content shall be relevant to nursing practice and/or health care and provide for the professional growth of the licensee.

(B)

Content is related to and consistent with the program objectives.

(6)

Instructor qualification.

(A)

There shall be documentation of the instructor's expertise in the content area. The instructor should apply principles of adult learning.

(B)

If the program includes a clinical nursing component, a licensed nurse with expertise in that specific component shall provide supervision with a ratio of no more than 12 participants to one faculty.

(C)

If the program includes a clinical component other than nursing, an instructor possessing the appropriate credentials of the discipline shall provide supervision.

(7)

Teaching methods.

(A)

Learning experiences and teaching methods shall be appropriate to achieve the objectives of the program.

(B)

Principles of adult education shall be used in the design of the program.

(C)

Time allotted for each activity shall be sufficient for the learner to meet the objectives of the program.

(D)

A schedule of the program shall be provided which describes content with corresponding time frames.

(E)

Facilities and educational resources shall be adequate to implement the program.

(8)

Evaluation.

(A)

Participants shall complete a written evaluation of the:

(i)

teaching effectiveness of each instructor;

(ii)

learner's achievement of objectives;

(iii)

relevance of content to stated objectives;

(iv)

effectiveness of teaching methods; and

(v)

appropriateness of physical facilities and educational resources.

(B)

If participation is in an academic course or other program in which grades are granted, a grade equivalent to "C" or better shall be required, or "Pass" on a Pass/Fail grading system.

(9)

Records.

(A)

Records of programs shall be kept by the provider for a minimum period of four years from the date of completion.

(B)

Records shall include target audience, program planning materials, content, objectives, outline of instructor qualifications, teaching methods and materials, evaluation tools and summary and a list of participants.

(C)

The provider shall furnish each participant a record of attendance specifying the provider; title, date and location of program; number of contact hours; and provider number, grades and organization granting approval, if applicable. This record shall be kept by the nurse for a minimum period of four years from the date of completion.

§216.5. Additional Criteria for Specific Continuing Education Programs.

In addition to those listed in §216.4 of this title (relating to Criteria for Acceptable Continuing Education Activity), the following guidelines shall apply to the selection and/or planning and implementation of specific CE programs:

(1)

Academic course.

(A)

The course shall be within the framework of a curriculum that leads to an academic degree in nursing or any academic course relevant to nursing practice/health care.

(B)

Participants, upon audit by the board, shall be able to present an official transcript indicating completion of the course with a grade of "C" or better, or a "Pass" on a Pass/Fail grading system.

(C)

Academic courses in this category are acceptable for Type I CE credit.

(2)

Individualized instruction (home study/programmed instruction). The program shall:

(A)

be developed by a professional group such as an educational institution, corporation, professional association or other provider of continuing education;

(B)

follow a logical sequence;

(C)

involve the learner by requiring an active response to the educational materials presented;

(D)

contain a means to measure achievement of learning objectives of the program; and

(E)

provide a record of attendance which complies with §216.4(9)(C) of this title concerning records indicating completion of the program.

(F)

Up to 20 contact hours of Type I or five contact hours of Type II credit for one renewal period may be obtained through individualized instruction.

(3)

Self-directed study.

(A)

Program development and presentation.

(i)

The program or presentation must not be a part of the licensee's primary employment responsibilities.

(ii)

Credit shall be awarded only once regardless of the number of times the program/work was presented.

(iii)

Upon audit by the board, the licensee must submit program objectives and an outline including date and location of the presentation not to exceed one page.

(iv)

Two hours of Type II credit per program topic may be obtained through this means.

(B)

Auditing of academic courses.

(i)

Academic courses in nursing or health care may be audited. Audited courses meet Type II requirements.

(ii)

Upon audit by the board, the licensee must submit a letter from the course instructor on the academic institution's letterhead indicating that the licensee attended the course.

(iii)

Two hours of Type II credit per course may be obtained through this means.

(C)

Certification.

(i)

A licensee who completes the requirements for certification in a nursing specialty by a national credentialing body may receive Type II continuing education credit.

(ii)

This is a one-time approval for initial certification only.

(iii)

Upon audit by the board, the licensee must furnish a letter from the national specialty organization indicating initial certification.

(iv)

Five hours of Type II credit for initial certification may be obtained through this means.

(D)

Authorship.

(i)

A licensee may receive CE credit for development and publication of a manuscript related to nursing and health care.

(ii)

Credit for publication shall be awarded only once per renewal period.

(iii)

Upon audit by the board, the licensee must submit a letter from the publisher indicating acceptance of manuscript for publication or a copy of the published work.

(iv)

Five contact hours of Type II credit may be obtained through this means.

(4)

Out-of-state programs.

(A)

A continuing education program attended or undertaken in a jurisdiction outside of Texas may be accepted:

(i)

for Type I credit if all criteria are met and if it is approved by one of the board's recognized credentialing agencies/organizations; and

(ii)

for Type II credit if it meets the criteria listed in §216.4 of this title and §216.5 of this section concerning criteria for acceptable continuing education activity and additional criteria for specific continuing education programs.

§216.6. Activities Which are not Acceptable as Continuing Education.

The following activities do not meet continuing education requirements for licensure renewal.

(1)

Basic cardiopulmonary resuscitation (CPR) courses.

(2)

Inservice programs. Programs sponsored by the employing agency to provide specific information about the work setting and orientation or other programs which address the institution's philosophy, policies and procedures; on-the-job training; basic cardiopulmonary resuscitation; and equipment demonstration are not acceptable for CE credit.

(3)

Refresher courses. Programs designed to update knowledge or current nursing theory and clinical practice, which consist of a didactic and clinical component to ensure entry level competencies into professional practice are not accepted for CE credit.

(4)

Orientation programs. A program designed to introduce employees to the philosophy, goals, policies, procedures, role expectations and physical facilities of a specific work place are not acceptable for CE credit.

(5)

Courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga.

(6)

Economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview.

(7)

Courses which focus on personal appearance in nursing.

(8)

Liberal art courses in music, art, philosophy, and others when unrelated to patient/client care.

(9)

Courses designed for lay people.

§216.7. Responsibilities of Individual Licensee.

(a)

It shall be the licensee's responsibility to select and participate in continuing education activities that will meet the criteria listed in §216.4 of this title (relating to Criteria for Acceptable Continuing Education Activity).

(b)

The licensee shall be responsible for maintaining a record of CE activities. These records shall document attendance as evidenced by original certificates of attendance, contact hour certificates, academic transcripts, or grade slips and copies of these shall be submitted to the board upon audit.

(c)

These records shall be maintained by the licensee for a minimum of two consecutive renewal periods or four years.

§216.8. Relicensure Process.

(a)

Renewal of license.

(1)

Upon renewal of the license, the licensee shall sign a statement attesting that the CE requirements have been met.

(2)

The contact hours must have been completed in the biennium immediately preceding the license renewal. CE contact hours from a previous renewal period will not be accepted. Additional contact hours earned may not be used for subsequent renewal periods.

(b)

Persons licensed by examination. A candidate licensed by examination shall be exempt from the CE requirement for issuance of the initial license and for the immediate renewal period following licensure.

(c)

Persons licensed by endorsement. An applicant licensed by endorsement shall be exempt from the CE requirement for the issuance of the initial Texas license and for the immediate renewal period following initial Texas licensure.

(d)

Delinquent license.

(1)

A license that has been delinquent for less than four years may be renewed by the licensee showing evidence of having completed 20 contact hours of acceptable continuing education within two years immediately preceding the application for relicensure and by meeting all other board requirements. A licensee shall be exempt from the continuing education requirement for the immediate renewal period following renewal of the delinquent license.

(2)

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

(e)

Reactivation of a license.

(1)

A license that has been inactive for less than four years may be reactivated by the licensee submitting verification of having completed at least 20 contact hours of continuing education within the past two years immediately prior to application for reactivation.

(2)

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

(f)

Reinstatement of a license. A licensee whose license has been revoked and subsequently applies for reinstatement must show evidence that the CE requirement and other board requirements have been met prior to reinstatement of the license by the board.

§216.9. Audit Process.

The board shall select a random sample of licensees for each renewal month. Audit forms shall be sent to selected licensees to substantiate compliance with the continuing education requirements.

(1)

Within 30 days following notification of audit these selected licensees shall submit audit form, documentation as specified in §216.4 and §216.5 of this title (relating to Criteria for Acceptable Continuing Education Activity and Additional Criteria for Specific Continuing Education Programs) and any additional documentation the board deems necessary to verify compliance with continuing education requirements for the period of licensure being audited.

(2)

The board shall notify the licensee of the results of the audit.

(3)

Failure to notify the board of a current mailing address will not absolve the licensee from audit requirements.

(4)

By this rule, an audit shall be automatic for a licensee who has been found non-compliant in an immediately preceding audit.

(5)

Failure to complete the audit satisfactorily or falsification of records shall constitute unprofessional conduct and provide grounds for disciplinary action.

§216.10. Appeals.

(a)

Any individual who wishes to appeal a determination of non-compliance with continuing education requirements must submit a letter of appeal within 20 days of notification of the audit results.

(b)

The board or its designee shall conduct a review in which the appellant may appear in person to present reasons why the audit decision should be set aside or modified.

(c)

The decision of the board after the appeal shall be considered final and binding.

§216.11. Consequences of Non-Compliance.

Licensees found non-compliant shall be referred to the board's practice and compliance department for possible disciplinary action.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 8, 1999.

TRD-9900793

Katherine A. Thomas, MN, RN

Executive Director

Board of Nurse Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6816

22 TAC §§217.1-217.20

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Board of Nurse Examiners or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Board of Nurse Examiners proposes the repeal of §§217.1-217.20 concerning Definitions; Licensure by Examination for Graduates of Basic Nursing Education Programs; Temporary Permit; Accustomation Course; Temporary License and Endorsement; Requirements for Licensure of Nurses Not Eligible for Temporary Licensure or Endorsement Under §217.5; Failure to Renew License; Inactive Status; Duplicate or Substitute Credentials; Change of Name and/or Address; Standards of Professional Nursing Practice; Designations for Registered Nurse/Titles Deemed Misleading; Unprofessional Conduct; Overpayment; Continuing Education; Peer Assistance Programs; Registered Nurses Performing Radiologic Procedures; Copying the License/Permit/Permanent Certificate of a Registered Nurse/Graduate Nurse; Minor Incidents; and Minimum Procedural Standards During Peer Review.

The repeal would allow for the adoption of new sections.

Katherine A. Thomas, MN, RN, executive director, has determined that for each year of the first five-years there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

There will be no effect on local government nor businesses to comply with the rule.

Katherine A. Thomas, MN, RN, executive director, has determined that for each year of the first five years the rule as proposed the public is not effected.

Written comments on the proposed repeal may be submitted to Katherine A. Thomas, Board of Nurse Examiners, Post Office Box 430; Austin, Texas 78767-0430.

The repeal is proposed under the Nursing Practice Act, (Texas Civil Statutes, Article 4514), §1, which provides the Board of Nurse Examiners with the authority and power to make and enforce all rules and regulations necessary for the performance of its duties and conducting of proceedings before it.

There are no other rules, codes, or statutes that will be effected by this proposal.

§217.1. Definitions.

§217.2. Licensure by Examination for Graduates of Basic Nursing Education Programs.

§217.3. Temporary Permit.

§217.4. Accustomation Course.

§217.5. Temporary License and Endorsement.

§217.6. Requirements for Licensure of Nurses Not Eligible for Temporary Licensure or Endorsement Under §217.5.

§217.7. Failure to Renew License.

§217.8. Inactive Status.

§217.9. Duplicate or Substitute Credentials.

§217.10. Change of Name and/or Address.

§217.11. Standards of Professional Nursing Practice.

§217.12. Designations for Registered Nurse/Titles Deemed Misleading.

§217.13. Unprofessional Conduct.

§217.14. Overpayment.

§217.15. Continuing Education.

§217.16. Peer Assistance Programs.

§217.17. Registered Nurses Performing Radiologic Procedures.

§217.18. Copying the License/Permit/Permanent Certificate of a Registered Nurse/ Graduate Nurse.

§217.19. Minor Incidents.

§217.20. Minimum Procedural Standards During Peer Review.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 8, 1999.

TRD-9900791

Katherine A. Thomas, MN, RN

Executive Director

Board of Nurse Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6816

22 TAC §§217.1-217.17

The Board of Nurse Examiners proposes new §§217.1-217.17 concerning Definitions; Licensure by Examination for Graduates of Basic Nursing Education Programs Within the United States, its Territories or Possessions; Temporary Authorization to Practice/Temporary Permit; Requirements for Initial Licensure by Examination for Nurses Who Graduate from Professional Nursing Programs Outside of the United States' Jurisdictions; Temporary License and Endorsement; Failure to Renew License; Change of Name and/or Address; Duplicate or Substitute Credentials; Inactive Status; Restrictions to Use of Designations for Registered Nurse; Standards of Professional Nursing Practice; Unprofessional Conduct; Peer Assistance Programs; Registered Nurses Performing Radiologic Procedures; Copying the License/Permit/Permanent Certificate of a Registered Nurse/Graduate Nurse/Advanced Practice Nurse; Minor Incidents; and Minimum Procedural Standards During Peer Review.

Chapter 217 was reviewed by the licensing, practice, education, compliance and legal departments of the Board of Nurse Examiners. Revisions were suggested based on current statutes, board actions, and procedures and problems identified by staff that required amending. In reviewing Chapter 217, staff determined that §217.15, Continuing Education, would better serve the licensed registered nurses if it were a separate chapter. Major revisions were suggested throughout Chapter 217, leading staff to recommend the repeal of the current chapter, including the creation of a separate Chapter 216 for Continuing Education and the proposal of a new Chapter 217. This recommendation was submitted to the members of the Board of Nurse Examiners at their meeting on January 21-22, 1999 and the Board concurred.

Katherine A. Thomas, MN, RN, executive director, has determined that there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

There will be no effect on local government nor businesses to comply with the rule.

Katherine A. Thomas, MN, RN, executive director, has determined that for each year of the first five years the rule as proposed will be in effect the public is assured enhanced protection. The new rules allow easier reference by titling changes which better reflect content as well as appropriate sequencing of licensure procedures. Revised standards and unprofessional conduct sections provide additions, better organization, and clarity. Editorial changes and simplification of terms and language make content easier to understand.

Written comments on the proposed amendments may be submitted to Katherine A. Thomas, Board of Nurse Examiners, P.O. Box 430; Austin, Texas 78767-0430.

The amendments are proposed under the Nursing Practice Act, (Texas Civil Statutes), Article 4514, §1, which provides the Board of Nurse Examiners with the authority and power to make and enforce all rules and regulations necessary for the performance of its duties and conducting of proceedings before it.

Cross Reference to Statute: Articles 4518, 4519, 4519a, 4520, 4521, 4522, 4523, 4525, 4525a, 4525b, 4525d, 4526 and 4526b are affected by this section.

§217.1. Definitions.

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

(1)

Academic course - A specific set of learning experiences offered in an accredited school, college or university. Academic credit will convert on the following basis: One academic quarter hour = 10 contact hours; one academic semester hour = 15 contact hours.

(2)

Accredited nursing program - A school, department, or division of nursing accredited/approved by a nursing board or other licensing authority which has jurisdiction over accreditation/approval of nursing programs.

(3)

Advanced Practice Nurse (APN) - A professional nurse, currently licensed in the State of Texas, who is prepared for advanced nursing practice by virtue of knowledge and skills obtained in an advanced educational program of study acceptable to the board, who meets requirements of Rule 221 and/or Rule 222, and has received authorization to practice as an APN in Texas.

(4)

Applicant - An individual who has completed an accredited nursing program and has applied to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN), or an individual who has applied for Temporary Licensure/Endorsement into Texas.

(5)

Approved - Recognized as having met established standards and predetermined criteria of the credentialing agencies recognized by the board. Applies to providers and programs.

(6)

Board - The Board of Nurse Examiners for the State of Texas.

(7)

Commission on Graduates of Foreign Nursing Schools (CGFNS) Certificate - Documentation that verifies the educational credentials and CGFNS examination results of graduates of foreign nursing schools.

(8)

Declaratory order - An order issued by the Board pursuant to Texas Civil Statutes, Article 4519a, determining the eligibility of an individual for initial licensure as a registered nurse and setting forth both the basis for potential ineligibility and the Board's determination of the disclosed eligibility issues.

(9)

Delinquent license - A license lapsed due to failure to renew the certificate of reregistration.

(10)

Direct supervision - Requires a registered professional nurse to be immediately available to coordinate, direct, and observe at firsthand another individual for whom the RN is responsible.

(11)

Eligibility order - An order, issued by the Board pursuant to Texas Civil Statutes, Article 4519, 4519a, or 4521(a) determining the eligibility of an individual for licensure.

(12)

Endorsement - The process of issuing a permanent license without further examination to a registered nurse from another jurisdiction or licensing authority after determination is made that the applicant meets the same standards as those required of Texas registered nurses.

(13)

First level, general nurse - Refers to the International Council of Nurses (ICN) classification of nurses. A first-level nurse is called a registered or professional nurse in most countries. A general nurse has studied theory and had clinical practice in a variety of nursing areas. Second level nurses, who may be called enrolled, vocational, or practical nurses or nurse assistants, and those nurses who have specialized in one area without being educated and registered/licensed as a general nurse (for instance, midwife, pediatric nurse, or psychiatric nurse) are not eligible to take the CGFNS qualifying exam.

(14)

Graduate of a foreign nursing school - An individual who graduated from a post-secondary nursing education program that prepares professional nurse generalists for licensure and is accredited by a governmental authority.

(15)

Impaired professional nurse - A registered professional nurse, licensed by the Board of Nurse Examiners for the State of Texas, who is unable to perform the essential functions of professional nursing due to impairment by chemical dependency on drugs and/or alcohol or by mental illness.

(16)

Jurisdiction - A state or territory of the United States using the National Council Licensure Examination for Registered Nurses (NCLEX-RN) as the licensing examination.

(17)

Licensing authority - A legislated or governmentally appointed agency which approves, accredits or otherwise regulates legally defined behaviors of institutions or individuals.

(18)

National Council Licensure Examination for Registered Nurses (NCLEX-RN) - The test used by the board to measure minimal competence for licensure as a registered professional nurse.

(19)

Nursing curriculum - The equivalent of all nursing courses in the program of study within an accredited nursing program.

(20)

Nursing program - The equivalent of all non-nursing and nursing courses in the program of study within an accredited program.

(21)

Peer Assistance Program - An approved program designed to help impaired professional nurses and which meets the minimum criteria established by the Texas Commission on Alcohol and Drug Abuse and the additional criteria established by the Board of Nurse Examiners for the State of Texas.

(22)

Practitioner - As related to radiology practice, a doctor of medicine, osteopathy, podiatry, dentistry, or chiropractic who is licensed under the laws of Texas and who prescribes radiologic procedures for other persons (See 25 TAC §143.2).

(23)

Professional boundaries - Refers to the provision of professional nursing services within the limits of the nurse/client relationship which promote the client's dignity, independence and best interests and refrain from inappropriate involvement in the client's personal relationships and the obtainment of the nurse's personal gain at the client's expense.

(24)

Professional nursing education program (general) - Post-secondary general nursing program of at least two academic years in length that provides both theory and clinical instruction in nursing care of:

(A)

the adult to include both medical and surgical nursing;

(B)

maternal/infant nursing;

(C)

nursing care of children; and

(D)

psychiatric/mental health nursing

(25)

Professional nursing practice - The performance of services for compensation appropriate for RNs employed in clinical practice, administration, education, research or other practices within the scope of the definition of professional nursing.

(26)

Program of study - The courses and learning experiences that constitute the requirements for completion of a basic nursing program (associate degree program, baccalaureate degree program, master's degree program, or diploma program) or a post-licensure nursing program.

(27)

Radiologic procedure - Any procedure or article used with clients, including diagnostic x-rays or nuclear medicine procedures, through the emission of ionizing radiation as stated in 25 TAC §143.2.

(28)

Reactivation - The process of making a license current when a registered nurse has allowed his or her license to become delinquent and/or is in inactive/retired status.

(29)

Refresher course - A program designed to update knowledge of current nursing theory and clinical practice consisting of didactic and clinical components to ensure entry level competencies into professional nursing practice. Refresher courses are not accepted for continuing education credit.

(30)

Registered nurse - A person currently licensed by the board to practice professional nursing.

(31)

Registered nurse, retired - An individual on inactive status, 65 or older, who has met the requirements for using the title as stated in §217.9(b) of this title (relating to Inactive Status).

(32)

Renewal period -Two-year period determined by the licensee's birth month and year.

(33)

Shall, will and must - Mandatory requirements.

(34)

State Board Test Pool Examination (SBTPE) - The test formerly used by the board prior to the NCLEX-RN to measure minimal competence for licensure as a registered nurse.

(35)

Temporary authorization - An authorization to practice professional nursing for a specified period of time.

(36)

Temporary license - A license that authorizes an individual licensed as a registered nurse in other jurisdictions to practice professional nursing in Texas for a specified period of time.

(37)

Temporary permit - A permit issued to a registered nurse for a specific period of time which allows the RN to complete specific requirements in order for the license to be reissued.

§217.2. Licensure by Examination for Graduates of Basic Nursing Education Programs Within the United States, its Territories or Possessions.

(a)

An applicant for initial licensure by examination shall:

(1)

file a complete application containing data required by the board; notarized affidavit; and the required application processing fee which is not refundable;

(2)

submit verification of completion of all requirements for graduation from an accredited nursing program or certification from the nursing program director of completion of all baccalaureate degree requirements which are prerequisites of an accredited masters degree program leading to a first degree in professional nursing; and

(3)

pass the NCLEX-RN.

(b)

Should it be ascertained from the application filed, or from other sources, that the applicant should have had an eligibility issue determined by way of a Petition for Declaratory Order, (see §213.30 of this title (relating to Declaratory Order of Eligibility for Licensure) and Texas Civil Statutes, Article 4519a) then the application will be treated and processed as a Petition for Declaratory Order and the applicant will be required to pay the appropriate non-refundable fees for determination of eligibility. Should the Board in its final determination find that the individual is not eligible for licensure, then that individual is precluded from again petitioning, or applying to the Board for admission to the examination except when the impediment to eligibility for licensure has been removed, such as when an applicant receives a full and unconditional pardon for prior criminal convictions.

(c)

An applicant for initial licensure by examination shall pass the NCLEX-RN within three attempts and within four years of completion of requirements for graduation.

(1)

An applicant who fails the NCLEX-RN may retake the examination no more than two times without additional education.

(2)

An applicant who is unsuccessful after three attempts within four years of completion of the requirements for graduation, must complete a professional nursing curriculum in order to be eligible to retake the examination.

(3)

An applicant who has not passed the NCLEX-RN within four years from the date of completion of requirements for graduation must complete a professional nursing program in order to take or retake the examination.

(d)

Upon initial licensure by examination, the license is issued for a period ranging from six months to 29 months depending on the birth date. Licensees born in even numbered years shall renew their licenses in even numbered years; licensees born in odd numbered years shall renew their licenses in odd numbered years.

§217.3. Temporary Authorization to Practice/Temporary Permit.

(a)

A new graduate who completes an accredited basic nursing education program within the United States, its Territories or Possessions and who applies for initial licensure by examination in Texas may be temporarily authorized to practice professional nursing as a graduate nurse (GN) pending the results of the licensing examination.

(1)

In order to receive temporary authorization to practice as a GN and obtain a Graduate Nurse Permit, the new graduate must:

(A)

file a completed application, including verification of completion of graduation requirements and the non-refundable application processing fee (see §217.2(a)(1)-(2) of this title (relating to Licensure by Examination for Graduates of Basic Nursing Education Programs Within the United States, its Territories or Possessions));

(B)

have no outstanding eligibility issues (see §213.30 of this title (relating to Declaratory Order of Eligibility for Licensure), Texas Civil Statutes, Article 4519a);

(C)

have never taken the NCLEX-RN. Temporary authorization to practice as a GN will not be issued to any applicant who has previously failed the licensing examination; and

(D)

have registered to take the NCLEX-RN with the examination administration service.

(2)

The temporary authorization to practice as a GN, which is not renewable, is valid for 60 days from the date of eligibility, receipt of permanent license, or upon receipt of a notice of failing the examination from the Board, whichever date is the earliest. The GN must immediately inform employers of receipt of notification of failing the examination and cease professional nursing practice.

(3)

The new graduate who has been authorized to practice professional nursing as a GN pending the results of the licensing examination must work under the direct supervision of a registered professional nurse who is physically present in the facility or practice setting and who is readily available to the GN for consultation and assistance. If the facility is organized into multiple units that are geographically distanced from each other, then the supervising RN must be working on the same unit to which the GN is assigned. The GN shall not be placed in supervisory or charge positions and shall not work in independent practice settings.

(4)

The nurse administrator of facilities that employ Graduate Nurses must ensure that the GN has a valid temporary authorization to practice as a GN pending the results of the licensing examination, has scheduled a date to take the NCLEX-RN, and does not continue to practice after expiration of the 60 days of eligibility or receipt of a notice of failing the examination from the Board, whichever date is earlier.

(b)

A registered nurse who has not practiced nursing for four or more years may be issued a temporary permit for the limited purpose of completing a refresher course, extensive orientation to the practice of professional nursing or academic course. The permit is valid for six months and is nonrenewable.

(c)

A registered nurse whose license has been suspended, revoked, or surrendered through action by the board, may be issued a temporary permit for the limited purpose of meeting any requirement(s) imposed by the board in order for the nurse's license to be reissued. The permit is valid for six months and is nonrenewable.

§217.4. Requirements for Initial Licensure by Examination for Nurses Who Graduate from Professional Nursing Programs Outside of United States' Jurisdictions.

(a)

An applicant for initial licensure applying under this section must:

(1)

provide a Commission on Graduates of Foreign Nursing Schools (CGFNS) certificate or the equivalent which verifies that the applicant:

(A)

has the educational credentials equivalent to graduation from a governmentally accredited/approved, post-secondary general nursing program of at least two academic years in length;

(B)

received both theory and clinical education in each of the following: nursing care of the adult which includes both medical and surgical nursing, maternal/infant nursing, nursing care of children, and psychiatric/mental health nursing;

(C)

received initial registration/license as a first-level, general nurse in the country where the applicant completed general nursing education;

(D)

is currently registered/licensed as a first-level general nurse;

(E)

demonstrated proficiency in the English language; and

(F)

passed the CGFNS Qualifying Exam;

(2)

file a complete, notarized application for registration containing data required by the board and the required application processing fee which is not refundable; and

(3)

pass the NCLEX-RN as a Texas applicant

(A)

within four years of completion of the requirements for graduation from the nursing program if the applicant has not practiced as a professional registered nurse at least two of the four years since completing the requirements for graduation; or

(B)

within four years of the date of eligibility for the NCLEX-RN if the applicant has practiced as a professional registered nurse at least two of the past four years.

(b)

An applicant who fails the NCLEX-RN may retake the examination no more than two times without additional education.

(1)

An applicant who is unsuccessful after three attempts and within four years of completion of the requirements for graduation or within four years of the date of eligibility must complete a professional nursing curriculum in order to be eligible to retake the examination.

(2)

An applicant who has not passed the NCLEX-RN within four years of completion of the requirements for graduation or within four years of the date of eligibility must complete a professional nursing program in order to be eligible to take the examination.

(c)

An applicant who graduated more than four years prior to the date of filing an application and who has not practiced as a professional registered nurse two of the past four years must complete a professional nursing program in order to be eligible for licensure under this section.

(d)

Should it be ascertained from the application filed, or from other sources, that the applicant should have had an eligibility issue settled by way of a Petition for Declaratory Order, (see §213.30 of this title (relating to Declaratory Order of Eligibility for Licensure) and Texas Civil Statutes, Article 4519a) then the application will be treated and processed as a Petition for Declaratory Order and the applicant will be required to pay the appropriate non-refundable processing fees. Should the Board finally determine that the individual is not eligible to be admitted to the examination, then that individual is precluded from again petitioning, or applying to the Board for admission to the examination except when the impediment to eligibility for licensure has been removed, such as when an applicant receives a full and unconditional pardon for prior criminal convictions.

(e)

Upon initial licensure by examination, the license is issued for a period ranging from six months to 29 months depending on the birth date. Licensees born in even numbered years shall renew their licenses in even numbered years; licensees born in odd numbered years shall renew their licenses in odd numbered years.

§217.5. Temporary License and Endorsement.

(a)

The requirements to obtain a non-renewable temporary license which is valid for 12 weeks, or a permanent license for endorsement are as follows:

(1)

Graduation from an accredited or approved professional nursing education program (general).

(2)

Satisfactory completion of the licensure examination according to board established minimum passing scores:

(A)

Prior to July 1982 - a score of 350 on each of the five parts of the SBTPE.

(B)

Prior to February 1989 - a minimum score of 1600 on NCLEX-RN.

(C)

February 1989 and after, must have achieved a passing report on NCLEX-RN.

(3)

Licensure by another jurisdiction.

(4)

For an applicant who has graduated from a professional nursing school outside of the United States or National Council jurisdictions - verification of licensure must be submitted from their country or evidence of completion of CGFNS requirements, as well as meeting all other requirements in paragraphs (2)-(3) of this subsection.

(5)

Filing a completed notarized "Application for Temporary License/Endorsement" containing:

(A)

personal identification and verification of required information in paragraphs (1)-(3) of this subsection;

(B)

attestation that the applicant meets current Texas licensure requirements and has never had disciplinary action taken by any licensing authority or jurisdiction in which the applicant holds, or has held licensure;

(C)

a recent, fade-proof passport sized identification photograph, properly identified; and

(6)

the required application processing licensure fee, which is not refundable.

(b)

A nurse who has not practiced professional nursing within the four years immediately preceding the request for temporary licensure, shall meet the requirements as stated in §217.9 of this title (relating to Inactive Status).

(c)

A nurse who has had disciplinary action at any time by any licensing authority is not eligible for temporary licensure until completion of the eligibility determination.

(d)

Upon initial licensure by endorsement, the license is issued for a period ranging from six months to 29 months depending on the birth date. Licensees born in even numbered years shall renew their licenses in even numbered years; licensees born in odd numbered years shall renew their licenses in odd numbered years.

(e)

Should it be ascertained from the application filed, or from other sources, that the applicant should have had an eligibility issue settled in accordance with Texas Civil Statutes, Article 4525(a) and §§213.27, 213.28 and 213.29 (relating to Good Professional Character, Licensure of Persons with Criminal Convictions and Eligibility and Disciplinary Criteria Regarding Intemperate Use and Lack of Fitness), then the application will be treated and processed as a Petition for Eligibility Order for RN Endorsement and the applicant will be required to pay the appropriate processing fees which are not refundable.

(f)

Should the Board in its final determination find that the individual is not eligible for licensure as a professional nurse in Texas, then that individual is precluded from again petitioning, or applying to the Board for licensure until the impediment to eligibility for licensure has been removed, such as when an applicant receives a full and unconditional pardon for prior criminal convictions.

§217.6. Failure to Renew License.

(a)

A registered nurse who is not practicing professional nursing in Texas and who fails to maintain a current Texas license for a period of time less than four years may bring his or her license up-to-date by filing such forms as the board may require, showing evidence of having completed 20 contact hours of acceptable continuing education within two years immediately preceding the application for relicensure, and paying the current licensure fee plus a late fee and any applicable fines, which are not refundable.

(b)

A registered nurse who is not practicing professional nursing and who fails to maintain a current license from any licensing authority for four or more years will be required to:

(1)

complete a board approved refresher course, extensive orientation to the practice of professional nursing, or completion of a nursing program of study. The applicant will submit an application for temporary permit for the limited purpose of completing a refresher course, extensive orientation to the practice of professional nursing, or program of study;

(2)

submit evidence of the successful completion of the requirements of paragraph (1) of this subsection;

(3)

submit a completed reactivation application;

(4)

submit the current non-refundable licensure fee, plus a late fee and any applicable fines which are not refundable; and

(5)

submit evidence of completion of 20 contact hours of acceptable continuing education within the previous two years.

(c)

A registered nurse who fails to maintain a current Texas license for four years or more and who is licensed and has practiced in another state a minimum of two of the previous four years preceding the application for relicensure in Texas, shall be exempt from requirements of subsection (b)(1) and (2) of this section.

(d)

The issuance of a license renewal may be refused to an individual who:

(1)

fails to submit an application for renewal; or

(2)

submits an application which:

(A)

is incomplete;

(B)

does not show that the person meets the requirements for renewal; or

(C)

is not accompanied by the correct fee(s).

(e)

The refusal to renew the license for reasons in subsection (d)(1) and (2) of this section does not entitle the individual to a hearing.

(f)

The individual refused a license renewal who wishes to reactivate his or her license will be required to:

(1)

correctly complete the reactivation application form;

(2)

show evidence of meeting all current requirements for licensure, including 20 contact hours of continuing education according to requirements in Chapter 216 of this title (relating to Continuing Education); and

(3)

submit payment of the correct non-refundable reactivation fee as follows:

(A)

if the license has been delinquent less than 90 days, the required fee will equal the renewal fee plus one-half the examination fee (see §223.1(13)(A)), plus any applicable fines; or

(B)

if the license has been delinquent for more than 90 days, the required fee will equal the renewal fee plus the full examination fee (see §223.1(13)(B)), plus any applicable fines.

§217.7. Change of Name and/or Address.

(a)

A registered nurse/applicant for licensure shall notify the board in writing within ten days of a change of name by submitting a legal document reflecting this name change.

(b)

A registered nurse/applicant for licensure shall notify the board in writing within 10 days of a change of address, providing the new address and his or her license number.

§217.8. Duplicate or Substitute Credentials.

(a)

A registered nurse whose original certificate of registration or wallet size license is lost or destroyed may obtain a duplicate by filing a form containing identifying information, notarized affidavit, and paying a non-refundable fee.

(b)

A registered nurse who wants to change his/her name on the original certificate of registration or current wallet size license must submit:

(1)

a duly executed affidavit;

(2)

the required non-refundable fee;

(3)

a legal document reflecting this name change; and

(4)

the original certificate of registration if the requested change is for the original certificate.

§217.9. Inactive Status.

(a)

A registered nurse who elects to change from active licensure status to inactive status must:

(1)

submit a written request to the board prior to the expiration of his/her license;

(2)

designate "inactive" on the renewal form if at the time of renewal.

(b)

A registered nurse on inactive status, who is 65 or older, and requests to use the title "Registered Nurse, Retired" or "RN, Retired" must submit the following:

(1)

a written request to use the title; and

(2)

the required, non-refundable fee.

(c)

An individual who is permitted under Article 4526b to use the title "Registered Nurse, Retired" or "R.N., Retired", may not use that title to practice as a professional registered nurse for compensation.

(d)

A registered nurse who has not practiced professional nursing and whose license has been in an inactive status for less than four years may reactivate the license by completing the reactivation application form, paying the required reactivation fee and the current licensure fee which are non-refundable, and submitting verification of completion of 20 contact hours of continuing education in compliance with Chapter 216 of this title (relating to Continuing Education).

(e)

A registered nurse who has not practiced professional nursing in Texas and whose license has been in an inactive status for more than four years must submit:

(1)

a reactivation application form;

(2)

verification of completion of a refresher course, extensive orientation to the practice of professional nursing or program of study which meets the board's requirements and was completed within the last year;

(3)

evidence of completion of 20 contact hours of CE in compliance with Chapter 216 (relating to Continuing Education);

(4)

the required reactivation fee plus the current licensure fee, which are non-refundable.

(f)

A registered nurse who has not practiced professional nursing in Texas or another jurisdiction within the last four years and has not participated in a refresher course within the last year must submit:

(1)

an application for a six month temporary permit to be used only for completion of a refresher course, extensive orientation to the practice of professional nursing or program of study which meets the board's requirements; and

(2)

the required six-month temporary permit fee which is non-refundable.

(g)

A registered nurse completing refresher course requirements in another jurisdiction is exempt from requirements of subsection (f)(1) and (2) of this section.

(h)

Upon completion of the refresher course, extensive orientation to the practice of professional nursing, or program of study which meets the board's requirements, the nurse shall then comply with subsection (e) of this section.

§217.10. Restrictions to Use of Designations for Registered Nurse.

(a)

A person who holds a valid current license issued by the Board of Nurse Examiners for the State of Texas may use the title registered nurse or RN.

(b)

An applicant for initial licensure by examination in Texas who has valid temporary authorizations to practice professional nursing as a graduate nurse pending the results of the licensing examination may use the initials GN or the title graduate nurse.

(c)

A person who is eligible for licensure by endorsement in Texas, holding a valid Texas temporary license, may use the title registered nurse or RN.

(d)

No other person, other than designated in subsections (a), (b) and (c) of this section, may use, where applicable, titles or abbreviations such as staff nurse, head nurse, charge nurse, supervisor of nursing or nurses, or any other title tending to imply to the public that the person holds a license to practice professional nursing in Texas.

(e)

Any person other than as permitted by law or rule who uses any of the above titles or abbreviations deemed by the board misleading or implying that the individual is a licensed professional nurse may be subject to potential violation or prosecution under the applicable law.

(f)

If a registered nurse holds herself or himself out to the public as being engaged in the practice of professional nursing, or uses the term registered nurse or "RN" or any combination or variation of those terms and abbreviations, alone or in combination with any other terms, then they must practice in accordance with the Nursing Practice Act and the Rules and Regulations Relating to Professional Nurse Education, Licensure and Practice.

§217.11. Standards of Professional Nursing Practice.

The responsibility of the Texas Board of Nurse Examiners (board) is to regulate the practice of professional nursing within the State of Texas. The purpose of defining standards of practice is to identify roles and responsibilities of the registered professional nurse (RN) in any health care setting. The standards for professional nursing practice shall establish a minimum acceptable level of professional nursing practice. The RN shall:

(1)

know and conform to the Texas Nursing Practice Act and the board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the RN's current area of nursing practice;

(2)

use a systematic approach to provide individualized, goal-directed nursing care by:

(A)

performing nursing assessments regarding the health status of the client;

(B)

making nursing diagnoses which serve as the basis for the strategy of care;

(C)

developing a plan of care based on the assessment and nursing diagnosis;

(D)

implementing nursing care; and

(E)

evaluating the client's responses to nursing interventions;

(3)

know the rationale for and the effects of medications and treatments and shall correctly administer the same;

(4)

accurately and completely report and document:

(A)

the client's status including signs, symptoms and responses;

(B)

nursing care rendered;

(C)

physician orders;

(D)

administration of medications, and treatments; and

(E)

client response(s);

(5)

implement measures to promote a safe environment for clients and others;

(6)

respect the client's right to privacy by protecting confidential information unless obligated or allowed by law to disclose the information;

(7)

promote and participate in client education and counseling based on health needs;

(8)

ensure the verification of current Texas licensure and credentials of personnel for whom the RN is administratively responsible, when acting in the role of nurse administrator;

(9)

make assignments to others that take into consideration client safety and which are commensurate with the educational preparation, experience, knowledge and ability of the persons to whom the assignments are made;

(10)

delegate nursing tasks which are in compliance with §218.3 (relating to General Criteria for Delegation) and §218.4 (relating to Supervision);

(11)

supervise nursing care provided by others for whom the RN is administratively or professionally responsible;

(12)

accept only those nursing assignments that are commensurate with one's own educational preparation, experience, knowledge and physical and emotional ability;

(13)

obtain instruction and supervision as necessary when implementing nursing procedures or practices;

(14)

notify the appropriate supervisor when leaving a nursing assignment;

(15)

know, recognize, and maintain professional boundaries of the nurse-client relationship;

(16)

report unsafe nursing practice by an RN which a nurse has reasonable cause to suspect has exposed or is likely to expose a client unnecessarily to risk of harm as a result of failing to provide client care that conforms to the minimum standards of acceptable and prevailing professional practice. The RN should report unsafe practice conditions or other practitioners to the appropriate authority or licensing board;

(17)

provide, without discrimination, nursing services regardless of the age, disability, economic status, gender, national origin, race, religion, or health problems of the client served;

(18)

institute appropriate nursing intervention which might be required to stabilize a client's condition and/or prevent complications;

(19)

clarify any order or treatment regimen that the nurse has reason to believe is inaccurate, non-efficacious or contraindicated by consulting with the appropriate licensed practitioner and notifying the ordering practitioner when the RN makes the decision not to administer the medication or treatment;

(20)

implement measures to prevent exposure to infectious pathogens and communicable conditions;

(21)

collaborate with the client, members of the health care team and, when appropriate, the client's significant other(s) in the interest of the client's health care;

(22)

consult with, utilize and make referrals to appropriate community agencies and health care resources to provide continuity of care;

(23)

be responsible for one's own continuing competence in nursing practice and individual professional growth.

§217.12. Unprofessional Conduct.

The unprofessional conduct rules are intended to protect clients and the public from incompetent, unethical, or illegal conduct of licensees. The purpose of these rules is to identify unprofessional or dishonorable behaviors of the registered professional nurse (RN) which the board believes are likely to deceive, defraud or injure clients or the public. These behaviors include but are not limited to:

(1)

failing to know and conform to the Texas Nursing Practice Act and the board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the RN's current area of nursing practice;

(2)

failing to assess and evaluate a client's status or failing to institute nursing interventions which might be required to stabilize a client's condition or prevent complications;

(3)

failing to administer medications or treatments or both in a responsible manner;

(4)

failing to accurately and completely report and document:

(A)

the client's status including signs, symptoms and responses;

(B)

nursing care rendered;

(C)

physician orders;

(D)

administration of medications, and treatments; and

(E)

client response(s);

(5)

failing to implement measures to promote a safe environment for clients and others (e.gs. bed rails up, universal precautions);

(6)

disclosing confidential information or knowledge concerning the client except where required or allowed by law;

(7)

failing to provide client education and counseling based on client health care needs;

(8)

failing to ensure the verification the current Texas licensure and credentials of personnel for whom he/she is administratively responsible, when acting in the role of nurse administrator;

(9)

assigning nursing care functions to others who lack the educational preparation, experience, knowledge or ability to perform these functions;

(10)

delegating nursing tasks which are not in compliance with §218.3 (relating to General Criteria for Delegation) and §218.4 (relating to Supervision);

(11)

failing to supervise the delivery of nursing care for which the RN is administratively or professionally responsible;

(12)

accepting an assignment when one's physical or emotional condition prevents the safe and effective delivery of care or accepting an assignment for which one lacks the educational preparation, experience, knowledge or ability;

(13)

failing to obtain instruction or supervision when implementing nursing procedures or practices for which one lacks the educational preparation, ability, knowledge and/or experience;

(14)

leaving a nursing assignment without notifying one's appropriate supervisor;

(15)

violating professional boundaries of the nurse/client relationship including but not limited to physical, sexual, emotional or financial exploitation of the client or the client's significant other(s), or of the RN's employer;

(16)

causing or permitting physical, emotional or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority and/or licensing board;

(17)

failing to report to the board or to a board approved peer assistance program, if applicable, within a reasonable time of the occurrence, any violation or attempted violation of the Nursing Practice Act or duly promulgated rules, regulations or orders;

(18)

failing to follow the policy and procedure in place for the wastage of medications at the facility where the RN was employed or working at the time of the incident(s);

(19)

misappropriating, in connection with the practice of nursing, anything of value or benefit, including but not limited to, any property, real or personal, tangible or intangible of the client, employer, or any other person or entity, or failing to take precautions to prevent such misappropriation;

(20)

failing to make entries, destroying entries, and/or making false entries in records pertaining to care of clients;

(21)

passing, or attempting to pass forged, altered, falsified or unauthorized prescription(s) by electronic, telephonic, written communication or any other means;

(22)

providing information which was false, deceptive, or misleading in connection with the practice of professional nursing;

(23)

failing to answer specific questions that would have affected the decision to license, employ, certify or otherwise utilize an RN;

(24)

offering, giving, soliciting, or receiving or agreeing to receive, directly or indirectly, any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services;

(25)

failing to report the unauthorized practice of professional nursing;

(26)

failing to repay a guaranteed student loan, as provided in Section 57.491 of the Texas Education Code.

§217.13. Peer Assistance Programs.

A peer assistance program for registered, professional nurses will identify, assist, and monitor professional colleagues with job impairing mental health, alcohol, or drug problems so they may continue to practice nursing.

(1)

Additional criteria.

(A)

The program will provide statewide peer advocacy services available to all registered nurses impaired by chemical abuse or mental illness.

(B)

The program shall have a statewide monitoring system that will be able to track the nurse while preserving anonymity.

(C)

The program shall provide a network of trained peer intervenors located throughout the state.

(D)

The program shall have a written plan for the education and training of intervenors and other program personnel.

(E)

The program shall have a written plan for the education of registered nurses, other practitioners, and employers.

(F)

The program shall have a mechanism for documenting program compliance and for timely reporting of noncompliance to the board. Reports of noncompliance shall include information regarding registered nurses who have been reported in accordance with the requirements of Texas Civil Statutes, Article 4525a.

(G)

The program shall demonstrate financial stability and funding sufficient to operate the program.

(H)

The program shall collect and make available to the board and other appropriate persons data relating to impaired professional nurses and the success/ failure of peer assistance.

(I)

The program shall have a written plan for a systematic total program evaluation.

(J)

The program shall be subject to periodic evaluation by the board or its designee.

(K)

Counselors utilized by the peer assistance program shall meet the minimum criteria for counselors as established by the board or its designee.

(L)

The program shall establish a plan to verify previous disciplinary action relative to impairment prior to admitting a nurse to the peer assistance program.

(M)

If there has been any prior disciplinary action by the board, the program may report the impaired nurse to the board.

(2)

Contractual agreement. The approved program(s) will enter into a contractual agreement with the board to provide the services of an impaired professional program. Said contract can be withdrawn for noncompliance and is subject to annual review and renewal.

§217.14. Registered Nurses Performing Radiologic Procedures.

(a)

A registered nurse who performs radiologic procedures other than in a hospital that participates in the federal Medicare program or that is accredited by the Joint Commission on Accreditation of Hospitals shall submit an application for registration to the board and shall submit evidence including, but not limited to, the following:

(1)

current licensure as a registered nurse in the State of Texas; and

(2)

the name and business address of the practitioner or director of radiological services under whose instruction or direction the radiologic procedures are performed.

(b)

After review by the board, notification of registration shall be mailed to the registered nurse informing him/her that the registration with the board has been completed.

(c)

The registered nurse who is registered to perform radiologic procedures pursuant to subsection (a) of this section shall notify the board within 30 days of any changes that would render the information on the nurse's application incorrect, including but not limited to any changes in the identity of the practitioner or director of radiological procedures under whose instruction or direction the radiologic procedures are performed.

(d)

The registered nurse whose functions include radiologic procedures must act within the scope of the Texas Nursing Practice Act and the Board's Rules and shall comply with the training requirements and limitations of the Medical Radiological Technologist Certification Act and Texas Department of Health Rules, 25 TAC §§143.15-143.20. In addition, the registered nurse must be in compliance with the Texas Medical Practice Act, the Texas Pharmacy Act, or any applicable laws of the State of Texas.

(e)

Any nurse who violates these rules shall be subject to disciplinary action by the board under Texas Civil Statutes, Article 4525.

§217.15. Copying the License/Permit/Permanent Certificate of a Registered Nurse/Graduate Nurse/Advanced Practice Nurse.

(a)

The licensee or permit holder has the responsibility to protect his or her license/permit/permanent certificate from loss and potential fraudulent or unlawful use.

(b)

A licensee or permit holder shall only allow his or her license/permit certificate to be copied for the purpose of licensure verification by employers, licensing boards, professional organizations, nursing programs, and third party payors for credentialing and reimbursement purposes. Other persons and/or agencies may contact the board's office in writing or by phone to verify licensure.

§217.16. Minor Incidents.

(a)

The Board believes protection of the public is not enhanced by the reporting of every minor incident that may be a violation of the Texas Nursing Practice Act. This is particularly true when there are mechanisms in place in the RN's employment setting to take corrective action, remediate deficits and detect patterns of behavior. This rule is intended to clarify both what constitutes a minor incident and when a minor incident need not be reported to the board.

(b)

A "minor incident" is defined by Texas Civil Statutes, Article 4525a, §6A(b) as "conduct that does not indicate the nurse's continuing to practice professional nursing poses a risk of harm to the client or other person." An RN involved in an incident which is determined to be minor need not be reported to the board or the Peer Review Committee if all of the following factors exist:

(1)

the potential risk of physical, emotional or financial harm to the client due to the incident is very low;

(2)

the incident is a singular event with no pattern of poor practice by the RN;

(3)

the RN exhibits a conscientious approach to and accountability for his/her practice; and

(4)

the RN appears to have the knowledge and skill to practice safely.

(c)

Other conditions which may be considered in determining that mandatory reporting is not required are:

(1)

the significance of the event in the particular practice setting;

(2)

the situation in which the event occurred; and

(3)

the presence of contributing or mitigating circumstances in the nursing care delivery system.

(d)

A minor incident need not be reported to the Board or the Peer Review Committee. When a decision is made that the incident is minor the following steps are required:

(1)

an incident/variance report shall be completed according to the employing facility's policy;

(2)

the nurse's manager shall maintain a record of each minor incident involving those RNs under his/her supervision;

(3)

the nurse's manager shall assure that the incident/variance report contains a complete description of the incident, patient record number, witnesses, RN involved and the action taken to correct or remediate the problem;

(4)

the nurse's manager shall report an RN to the Peer Review Committee if three minor incidents involving the RN are documented within a one-year time period; and

(5)

the Peer Review Committee shall review the three minor incidents and make a determination as to whether a report to the Board is warranted.

(e)

In employment settings where no Peer Review Committee is required to exist, the nurse's manager shall review minor incidents involving those RNs under his/her supervision and keep the same reports as required in subsection (c)(1),(2), and (3) of this section. A nurse's manager shall report any RN involved in three minor incidents within one year to the Board.

(f)

Nothing in this rule is intended to prevent reporting of a potential violation directly to the Board.

(g)

Failure to classify an event appropriately in order to avoid reporting may result in violation of the mandatory reporting statute.

§217.17. Minimum Procedural Standards During Peer Review.

(a)

Texas Civil Statutes, Article 4525b §1(2) states, "Peer review means the evaluation of professional nursing services, the qualifications of professional nurses, the quality of patient care rendered by professional nurses, the merits of complaints concerning professional nurses and professional nursing care, and determinations or recommendations regarding complaints". The peer review process is one of fact finding, analysis and study of events by registered nurses in a climate of collegial problem solving focused on obtaining all relevant information about an event. Once a decision is made that a nurse is subject to peer review, Texas Civil Statutes, Article 4525b, §1A(4) provides that the nurse is entitled to minimum due process. The purpose of this rule is to define minimum due process, to provide guidance to facilities in developing peer review plans, to assure that nurses have knowledge of the plan, and to provide guidance to the peer review committee in its fact finding process.

(b)

In order to meet the minimum due process required by the NPA, the Peer Review Committee must:

(1)

provide written notice to the nurse that his/her practice is being evaluated, that the peer review committee will meet on a specified date not more than 30 calendar days from date of notice, and enclose a written copy of the peer review plan, policies and procedures;

(2)

include in the written notice:

(A)

a description of the event(s) to be evaluated in sufficient detail to inform the nurse of the incident, circumstances and conduct (error or omission), including date(s), time(s), location(s), and individual(s) involved. The patient/client shall be identified by initials or number;

(B)

name, address, telephone number of contact person to receive the nurse's response;

(3)

provide the nurse the opportunity to review, in person or by attorney, the documents concerning the event under review, at least 15 calendar days prior to appearing before the committee;

(4)

provide the nurse the opportunity to:

(A)

appear before the committee;

(B)

make a verbal statement;

(C)

ask questions and respond to questions of the committee; and

(D)

provide a written statement regarding the event under review;

(5)

conclude its evaluation no more than 14 calendar days from the committee meeting stated in the notice;

(6)

provide written notice to the nurse of the findings of the committee when the review has been completed; and

(7)

provide the nurse with reasonable opportunity to rebut the committee's findings in writing which shall become a permanent part of the record.

(c)

The peer review process is not a hearing or substitute for a legal procedure; therefore, court procedures and rules and the presence of attorneys are not required. Although legal representation is not required, should the Peer Review Committee have an attorney as a member or in a representative capacity, the nurse is entitled to legal representation and parity of participation by counsel. "Parity of participation by counsel" means that the nurse's attorney is able to participate in the peer review process to the same extent and level as the facility's attorney; e.g., if the facility's attorney can question witnesses, the nurse's attorney must have the same right.

(d)

Peer review plans shall contain written procedures to maintain confidentiality of information presented to and/or considered by the peer review committee which is not subject to disclosure except as provided by Texas Civil Statutes, Article 4525b, §3. Disclosure/discussion by a nurse with the nurse's attorney is proper because the attorney is bound to the same confidentiality requirements as the nurse.

(e)

The 74th Legislature expressly included vocational nurses in the peer review provisions of the Texas Civil Statutes, Article 4525b. The procedural standards found in subsections (a)-(d) of this section apply to LVNs.

(f)

The 75th Legislature added provisions for an RN to request Peer Review when a nurse is requested to engage in conduct that the nurse believes is in violation of his/her duty to a patient. The procedure for a request of Peer Review must be made on forms provided by the board at the time the RN is requested to engage in the conduct in accordance with Texas Civil Statutes, Article 4525d.(c).

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 8, 1999.

TRD-9900792

Katherine A. Thomas, MN, RN

Executive Director

Board of Nurse Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6816

Chapter 321. Definitions

22 TAC §321.1

The Texas Board of Physical Therapy Examiners proposes an amendment to §321.1, concerning Definitions. This amendment will delete the definitions of "physical therapist assistant" and "physical therapy aide" from the rule to reflect the proposal of new Chapter 322, Practice, in which previously adopted rules regarding the actual practice of physical therapy will be collected. The amendment to this rule will also incorporate several definitions previously found in §343.3, Referral requirements and exceptions to referral requirements.

John P. Maline, Executive Director of the Executive Council of Physical Therapy and Occupational Therapy Examiners, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Maline also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be easier access to rules describing how and by whom physical therapy services may be provided. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the rule as proposed.

Comments on the proposed amendment may be submitted to Nina Hurter, PT Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite 2-510, Austin, Texas 78701.

The amendment is proposed under the Physical Therapy Practice Act, Texas Civil Statutes, Article 4512e, which provides the Texas Board of Physical Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Texas Civil Statutes, Article 4512e is affected by this amended section.

§321.1. Definitions.

The following words, terms, and phrases, when used in the rules of the Texas Board of Physical Therapy Examiners, shall have the following meanings, unless the context clearly indicates otherwise.

(1)

Accredited curriculum in physical therapy education - A body of courses in a physical therapy program at a school, college, or university which has satisfied the accreditation standards of the Commission on Accreditation for Physical Therapy Education.

(2)

Accredited physical therapist assistant program - A body of courses at a school, college, or university which has satisfied the accreditation standards of the Commission on Accreditation for Physical Therapy Education.

(3)

Asymptomatic - Without any significant perceptible change in the body or its functions that indicates disease.

(4)

Emergency circumstances - Instances where emergency medical care is called for, including first aid.

(5)

Emergency medical care - Bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(6)

[ (3) ] Evidence satisfactory to the board - Should all official school records be destroyed, sworn affidavits satisfactory to the board must be received from three persons having personal knowledge of the applicant's physical therapy education. These affidavits will not be used when official school records are available.

(7)

[ (4) ] Foreign-trained applicant - Any applicant whose education is from a country outside the United States, the District of Columbia, or Territories of the United States.

(8)

[ (5) ] Hearing - An adjudicative proceeding concerning the issuance, denial, suspension, reprimand, revocation of license, after which the legal rights of an applicant or licensee are to be determined by the board.

(9)

[ (6) ] On-site supervision - The physical therapist or physical therapist assistant is on the premises and readily available to respond.

[ (7)

Physical therapist assistant - The supervision of the physical therapist assistant shall include the following:]

[ (A)

The supervising physical therapist is responsible for and will participate in the patient's care.]

[ (B)

The supervising physical therapist must be on call and readily available.]

[ (C)

A current written plan of care will be formulated for each patient by the physical therapist. The plan of care shall be revised following periodic reevaluations by the physical therapist, not to exceed 30 days. The physical therapist is responsible for the content and validity of the discharge summary and must sign the discharge summary.]

[ (D)

Each progress note in a patient's chart made by a physical therapist assistant must include the name of the supervising physical therapist.]

[ (E)

The physical therapist may assign responsibilities to the physical therapist assistant to:]

[ (i)

provide physical therapy services as specified in the written plan of care developed by the physical therapist prior to treatment by a physical therapist assistant which includes:]

[ (I)

preparing patients, treatment areas, and equipment;]

[ (II)

implementing treatment programs that include therapeutic exercises; gait training and techniques; ADL training techniques; administration of therapeutic heat and cold; administration of ultrasound; administration of therapeutic electric current; administration of ultraviolet; application of traction; performance of intermittent venous compression; application of external bandages, dressings, and support; performance of goniometric measurement;]

[ (III)

modifying treatment techniques as indicated in the plan of care;]

[ (ii)

respond to acute changes in physiological state;]

[ (iii)

teach other health care providers, patients, and families to perform selected treatment procedures and functional activities;]

[ (iv)

identify architectural barriers;]

[ (v)

interact with patients and families in a manner which provides the desired psycho-social support by:]

[ (I)

recognizing his own reaction to illness and disability;]

[ (II)

recognizing patients' and families' reactions to illness and disability;]

[ (III)

respecting individual cultural, religious, and socioeconomic differences in people;]

[ (IV)

utilizing appropriate communicative processes;]

[ (vi)

demonstrate appropriate and effective written, oral, and nonverbal communication with patients and their families, colleagues, and the public;]

[ (vii)

recognize his own strengths and limitations and interpret for others his scope and function;]

[ (viii)

demonstrate safe, ethical, and legal practice;]

[ (ix)

understand basic concepts related to the health care system, including multidisciplinary team approach, quality care, governmental agencies, private sector, role of other health care providers, health care facilities, issues, and problems;]

[ (x)

understand basic principles of levels of authority and responsibility, planning, time management, supervisory process, performance evaluations, policies and procedures, and fiscal consideration (provider and consumer).]

[ (F)

The physical therapist assistant may not:]

[ (i)

specify and/or perform definitive (decisive, conclusive, final) evaluative and assessment procedures; however, physical therapist assistants may screen patients designated by the physical therapist by gathering information using a uniform predetermined format and reporting the findings on all patients screened to the physical therapist. Further intervention will be determined by the physical therapist;]

[ (ii)

alter a plan of care or goals;]

[ (iii)

recommend wheelchairs, orthoses, prostheses, other assistive devices, or alterations to architectural barriers to persons;]

[ (iv)

sign progress notes which include assessments used to design or modify patient care.]

(10)

[ (8) ] Physical therapy - The evaluation, examination, and utilization of exercises, rehabilitative procedures, massage, manipulations, and physical agents including, but not limited to, mechanical devices, heat, cold, air, light, water, electricity, and sound in the aid of diagnosis or treatment. Physical therapists may perform evaluations without referrals. Physical therapy practice includes the use of modalities, procedures, and tests to make evaluations. Physical therapy practice includes, but is not limited to the use of: Electromyographic (EMG) Tests, Nerve Conduction Velocity (NCV) Tests, Thermography, Transcutaneous Electrical Nerve Stimulation (TENS), bed traction, application of topical medication to open wounds, sharp debridement, provision of soft goods, inhibitive casting and splinting, Phonophoresis, Iontophoresis, and biofeedback services.

[ (9)

Physical therapy aide - All rules governing the direction of the physical therapist assistant are further modified for the physical therapy aide.]

[ (A)

The physical therapist or physical therapist assistant is responsible for the supervision of the physical therapy aide.]

[ (B)

The physical therapy aide may support physical therapy activities within the scope of on-the-job training and with on-site supervision by a physical therapist or physical therapist assistant within reasonable proximity of the physical therapy aide. The physical therapist or physical therapist assistant must interact with the patient regarding the patient's condition, progress and/or achievement of goals during each treatment session.]

[ (C)

The physical therapy aide may not:]

[ (i)

evaluate, assess, and/or initiate physical therapy treatment including exercise instruction; or]

[ (ii)

write or sign physical therapy documents in the permanent record. However, an aide may record quantitative data for tasks delegated by the supervising PT or PTA. Any document reflecting aide activities must identify the aide and the supervising PT or PTA.]

(11)

[ (10) ] Supervision -The delegation and continuing direction by a person or persons responsible for the practice of physical therapist, physical therapist assistant, or physical therapy aide as specified in the Physical Therapy Practice Act.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 5, 1999.

TRD-9900771

John P. Maline

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6900

22 TAC §§322.1-322.4

The Texas Board of Physical Therapy Examiners proposes new chapter 322, §322.1- 322.4, concerning Practice. This chapter represents a reorganization of existing rules governing the practice of physical therapy currently found in §§321.1, 343.3, and 343.4, which are being amended or deleted to reflect the proposal of Chapter 322.

John P. Maline, Executive Director of the Executive Council of Physical Therapy and Occupational Therapy Examiners, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Maline also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be easier access to rules describing how and by whom physical therapy services should be provided. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the rule as proposed.

Comments on the proposed new rule may be submitted to Nina Hurter, PT Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite 2-510, Austin, Texas 78701.

The new rule is proposed under the Physical Therapy Practice Act, Texas Civil Statutes, Article 4512e, which provides the Texas Board of Physical Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Texas Civil Statutes, Article 4512e is affected by this new rule.

§322.1. Provision of Services.

(a)

Initiation of physical therapy services

(1)

Referral requirement. A physical therapist is subject to discipline from the board for providing physical therapy treatment without a referral from a qualified healthcare practitioner licensed by the appropriate state licensing board in any of the United States or its territories, or the District of Columbia, who within the scope of the professional licensure is authorized to prescribe treatment of individuals. The list of qualifying referral sources includes physicians, dentists, chiropractors, podiatrists, physician assistants, and advanced nurse practitioners.

(2)

Exceptions to referral requirement

(A)

A PT may evaluate without referral.

(B)

A PT may provide instructions to any person who is asymptomatic relating to the instructions being given without a referral.

(C)

Emergency Circumstances. A PT may provide emergency medical care to a person after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity without referral if the absence of immediate medical attention could reasonably be expected to result in a serious threat to the patient's health, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(D)

Prior referrals. A physical therapist may treat a patient for an injury or condition that is the subject of a prior referral if all of the following conditions are met.

(i)

The physical therapist must notify the original referring healthcare personnel of the commencement of therapy by telephone within five days, or by letter postmarked within five business days;

(ii)

The physical therapy provided must not be for more than 20 treatment sessions or 30 consecutive calendar days, whichever occurs first. At the conclusion of this time or treatment, the physical therapist must confer with the referring healthcare personnel before continuing treatment.

(iii)

The treatment can only be provided to a client/patient who received the referral not more than one year previously.

(iv)

The physical therapist providing treatment must have been licensed for one year. The physical therapist responsible for the treatment of the patient may delegate appropriate duties to another physical therapist having less than one year of experience or to a physical therapist assistant. A physical therapist licensed for more than one year must retain responsibility for and supervision of the treatment.

(3)

Methods of referral. A referral may be transmitted by a qualifying referral source in the following ways:

(A)

a document (including an electronically transmitted document or facsimile); or

(B)

verbally, in person or by telephone. If a referral is transmitted verbally, whether in person or by telephone, it must be received, recorded and signed by the PT, PTA or other authorized personnel, and include all of the information that would appear on a written referral.

(b)

Evaluation and screening

(1)

Physical therapy treatment may not be provided prior to the completion of an evaluation of the patient's condition by a PT.

(2)

Reevaluation. A patient receiving treatment must be evaluated at least every 30 days by a PT.

(3)

PTAs may screen patients designated by a PT as possible candidates for physical therapy services. Screening entails the collection of uniform information from all patients screened using a predetermined, standardized format. The information collected is delivered to the supervising PT. Only a PT may determine whether further intervention for patients screened is necessary.

(c)

Physical therapy plan of care development and implementation

(1)

A written plan of care must be developed for each patient by a PT.

(2)

The plan of care must be updated following the periodic reevaluation of the patient's condition.

(3)

The plan of care or treatment goals may only be changed or modified by a PT.

(4)

Physical therapy treatment may not be provided by a PTA or an aide until a written plan of care, based on an evaluation by a PT, has been completed.

(5)

A PTA may modify treatment techniques as indicated in the plan of care.

(6)

A PT or PTA must interact with the patient regarding his/her condition, progress and/or achievement of goals during each treatment session.

(d)

Documentation of treatment

(1)

Each progress note in a patient's permanent record completed by a PTA must include the name of the supervising PT.

(2)

A PTA may not sign progress notes which design or modify the plan of care.

(3)

Physical therapy aides may not write or sign physical therapy documents in the permanent record. However, a physical therapy aide may record quantitative data for tasks delegated by the supervising PT or PTA. Any document reflecting aide activities must identify the aide and the supervising PT or PTA.

(e)

Discharge. The supervising PT is responsible for the content and validity of the discharge summary and must sign it. A PTA may provide clerical assistance with a discharge summary.

§322.2. Role Delineation.

(a)

The role of the PTA

(1)

A PTA may provide physical therapy services only under the supervision of a PT (See §322.3 of this title, (relating to Supervision))

(2)

A PTA may be assigned responsibilities by a supervising PT to:

(A)

screen patients designated by a PT as possible candidates for physical therapy services (See §322.1(b) of this chapter, (relating to Evaluation and screening));

(B)

provide physical therapy services as specified in the physical therapy plan of care (See §322.1(c) of this chapter, (relating to Physical therapy plan of care development and implementation)) which may include:

(i)

preparing patients, treatment areas, and equipment;

(ii)

implementing treatment programs that include therapeutic exercises; gait training and techniques; ADL training techniques; administration of therapeutic heat and cold; administration of ultrasound; administration of therapeutic electric current; administration of ultraviolet; application of traction; performance of intermittent venous compression; application of external bandages, dressings, and support; performance of goniometric measurement;

(iii)

modifying treatment techniques as indicated in the plan of care;

(C)

respond to acute changes in physiological state;

(D)

teach other health care providers, patients, and families to perform selected treatment procedures and functional activities;

(E)

identify architectural barriers;

(F)

interact with patients and families in a manner which provides the desired psycho-social support by:

(i)

recognizing his own reaction to illness and disability;

(ii)

recognizing patients' and families' reactions to illness and disability;

(iii)

respecting individual cultural, religious, and socioeconomic differences in people;

(iv)

utilizing appropriate communicative processes;

(G)

demonstrate appropriate and effective written, oral, and nonverbal communication with patients and their families, colleagues, and the public;

(H)

recognize his own strengths and limitations and interpret for others his scope and function;

(I)

demonstrate safe, ethical, and legal practice;

(J)

understand basic concepts related to the health care system, including multidisciplinary team approach, quality care, governmental agencies, private sector, role of other health care providers, health care facilities, issues, and problems;

(K)

understand basic principles of levels of authority and responsibility, planning, time management, supervisory process, performance evaluations, policies and procedures, and fiscal consideration (provider and consumer).

(3)

The PTA may not:

(A)

specify and/or perform definitive (decisive, conclusive, final) evaluative and assessment procedures;

(B)

alter a plan of care or goals;

(C)

recommend wheelchairs, orthoses, prostheses, other assistive devices, or alterations to architectural barriers to persons;

(D)

sign progress notes which design or modify the plan of care.

(b)

The role of the physical therapy aide

(1)

All rules governing the services provided by a PTA are further modified for the physical therapy aide.

(2)

A physical therapy aide may be assigned responsibilities by the supervising PT or PTA to provide services as specified in the physical therapy plan of care (See §322.1(e) of this chapter, (relating to Physical Therapy Plan of Care development and implementation)) within the scope of on-the-job training with onsite supervision by a PT or PTA within reasonable proximity.

(3)

A physical therapy aide may not:

(A)

perform any evaluative or assessment activities;

(B)

initiate physical therapy treatment, to include exercise instruction; or

(C)

write or sign physical therapy documents in the permanent record, except as provided for in §322.1(d), Documentation of treatment.

§322.3. Supervision.

(a)

Supervision of PTAs

(1)

A supervising PT is responsible for and will participate in the patient's care.

(2)

A supervising PT must be on call and readily available when physical therapy services are being provided.

(3)

A PT may assign responsibilities to a PTA to provide physical therapy services, based on the PTA's training, that are within the scope of activities listed in §322.1, Provision of Services.

(b)

Supervision of physical therapy aides

(1)

A supervising PT or PTA is responsible for the supervision of, and the physical therapy services provided by, the PT aide.

(2)

A PT or PTA must provide onsite supervision of a physical therapy aide, and remain within reasonable proximity during the aide's interaction with the patient.

§322.4. Practicing in a Manner Detrimental to the Public Health and Welfare.

(a)

The board may deny a license to or discipline an applicant/respondent who is found to be practicing in a manner detrimental to the public health and welfare. The board may deny a registration for a physical therapy facility to an applicant or discipline a physical therapy facility required to be registered by the act which is found to be practicing in a manner detrimental to the public health and welfare.

(b)

Practicing in a manner detrimental to the public health and welfare may include, but is not limited to, the following:

(1)

inaccurately recording, falsifying, or otherwise altering patient/client records;

(2)

obtaining or attempting to obtain or deliver medications through means of misrepresentation, fraud, forgery, deception, and/or subterfuge;

(3)

failing to supervise and maintain the supervision of supportive personnel, licensed or unlicensed, in compliance with the Act and rule requirements;

(4)

aiding, abetting, authorizing, condoning, or allowing the practice of physical therapy by any person not licensed to practice physical therapy;

(5)

permitting another person to use an individual's physical therapist's or physical therapist assistant's license for any purpose;

(6)

failing to cooperate with the agency by not furnishing papers or documents requested or by not responding to subpoenas issued by the agency;

(7)

interfering with an investigation or disciplinary proceeding by willful misrepresentation of facts before the agency or the board, or by the use of threats or harassment against any patient/client or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal action;

(8)

engaging in sexual contact with a patient/client as the result of the patient/client relationship;

(9)

practicing or having practiced with an expired temporary or permanent license;

(10)

failing to conform to the minimal standards of acceptable prevailing practice, regardless of whether or not actual injury to any person was sustained, including, but not limited to:

(A)

failing to assess and evaluate a patient's/client's status;

(B)

performing or attempting to perform techniques or procedures or both in which the physical therapist or physical therapist assistant is untrained by education or experience;

(C)

delegating physical therapy functions or responsibilities to an individual lacking the ability or knowledge to perform the function or responsibility in question; or

(D)

causing, permitting, or allowing physical or emotional injury or impairment of dignity or safety to the patient/client;

(11)

intentionally or knowingly offering to pay or agreeing to accept any remuneration directly or indirectly, overtly or covertly, in cash or in kind, to or from any person, firm, association of persons, partnership, or corporation for receiving or soliciting patients or patronage, regardless of source of reimbursement, unless said business arrangement or payments practice is acceptable under 42 United States Code §1320a-7b(b) or its regulations;

(12)

advertising in a manner which is false, misleading, or deceptive;

(13)

knowingly falsifying and/or forging a referring practitioner's referral for physical therapy;

(14)

failing to register a physical therapy facility which is not exempt or failing to renew the registration of a physical therapy facility which is not exempt;

(15)

practicing in an unregistered physical therapy facility which is not exempt.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 5, 1999.

TRD-9900770

John P. Maline

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6900

22 TAC §323.4

The Texas Board of Physical Therapy Examiners proposes an amendment to §323.4, concerning Applications Review Committee. This amendment will delete outdated requirements concerning the review of credentialing entities by the committee, remove the names of board-approved credentialing entities from rule so that they may be established by policy, and update a reference to a related rule.

John P. Maline, Executive Director of the Executive Council of Physical Therapy and Occupational Therapy Examiners, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Maline also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be a higher quality of physical therapy service, as the board's ability to add or remove credentialing entities from the approved list in a more timely fashion will strengthen its ability to license only applicants whose credentials have been evaluated according to rule. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the rule as proposed.

Comments on the proposed amendment may be submitted to Nina Hurter, PT Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite 2-510, Austin, Texas 78701.

The amendment is proposed under the Physical Therapy Practice Act, Texas Civil Statutes, Article 4512e, which provides the Texas Board of Physical Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Texas Civil Statutes, Article 4512e is affected by this amended section.

§323.4. Applications Review Committee.

(a)

The Applications Review Committee is established to review the educational credentials of an applicant. If it is determined that a board-approved credentialing evaluator failed to adhere to the guidelines established by §329.5 (h) [ (g) ] of this title (relating to Licensing Procedures for Foreign-Trained Applicants), the Applications Review Committee may override the evaluation [ may overrule the credentialing of an applicant ].

[ (b)

The Applications Review Committee by September 1, 1995, will have reviewed potential credentialing evaluators and have made a recommendation to the board as to which evaluator(s) should be board-approved. The board must then adopt an evaluator(s) by rule.]

[ (c)

The Applications Review Committee by September 1, 1996, will have reviewed potential credentialing evaluators and have made a recommendation to the board as to which evaluator(s) should be board-approved. The board must then adopt an evaluator(s) by rule.]

[ (d)

The Applications Review Committee by September 1, 1998, will have reviewed potential credentialing evaluators and have made a recommendation to the board as to which evaluator(s) should be board-approved. The board must then adopt an evaluator(s) by rule. Thereafter, the Applications Review Committee on a biennial basis will review potential credential evaluators and make a recommendation to the board as to which evaluator(s) should be board-approved, and on a biennial basis the board will adopt an evaluator(s) by rule.]

[ (e)

The Applications Review Committee may conduct the reviews of credentialing evaluators more or less frequently.] [ The board approved credentialing review agencies are International Credentialing Associates (ICA), International Consultants of Delaware (ICD) and The University of Texas at Austin. ]

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 5, 1999.

TRD-9900769

John P. Maline

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6900

22 TAC §329.5

The Texas Board of Physical Therapy Examiners proposes amendments to §329.5, concerning Licensing procedures for foreign-trained applicants. The amendments will do the following: add a requirement for prescreening if required by federal law; establish that the prescreening must be done by a board-approved prescreening entity as named in board policy; establish that board-approved credentialing entities will by named in policy rather than rule; eliminate redundant references to certain educational requirements; and eliminate confusing terminology.

John P. Maline, Executive Director of the Executive Council of Physical Therapy and Occupational Therapy Examiners, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Maline also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be added assurance of quality care and increased efficiency of administrative processes. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the rule as proposed.

Comments on the proposed amendment may be submitted to Nina Hurter, PT Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite 2-510, Austin, Texas 78701.

The amendment is proposed under the Physical Therapy Practice Act, Texas Civil Statutes, Article 4512e, which provides the Texas Board of Physical Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Texas Civil Statutes, Article 4512e is affected by this amended section.

§329.5. Licensing Procedures for Foreign-Trained Applicants.

(a)

The provisions of §329.1 of this title (relating to General Licensing Procedure) apply to foreign-trained applicants with the exception of §329.1(a)(1)(A)-(C) [ §329.1(1)(a)-(c) ].

(b)

If required by §343 of the U.S. Illegal Immigration Reform and Immigrant Responsibility Act, the foreign-trained applicant must present a prescreening certificate issued by a board-approved prescreening entity. The board will establish by policy a list of board-approved prescreening entities, which will be made available to foreign-trained applicants on request.

[ (b)

The foreign-trained applicant's transcripts will be evaluated by a board-approved credentialing entity. The credentialing review agency will determine if the education is equivalent to a U.S. degree in physical therapy and if the applicant has a minimum of 60 academic semester credits or the equivalent from an accredited institution of higher learning. In the event that the board-approved entity in an evaluation does not adhere to the guidelines of subsection (g) of this section, the Applications Committee can override the evaluation. An evaluation by a board-approved education credentialing agency is valid for the purpose of licensing in this state for not more than two years after the date of issuance of the evaluation.]

(c)

The foreign-trained applicant's educational credentials and qualifications will be evaluated by a board-approved credentialing entity in accordance with the requirements of subsection (h) of this section. The board will establish by policy a list of approved credentialing entities, which will be made available to the foreign-trained applicant on request. In the event that the board-approved entity in an evaluation does not adhere to the guidelines of subsection (h) of this section, the Applications Review Committee may override the evaluation. An evaluation by a board-approved education credentialing entity is valid for the purpose of licensing in this state for not more than two years after the date of issuance of the evaluation.

(d)

[ (c) ] If the evaluation is accepted by the board, the applicant will be considered for a temporary license. Following approval of all application materials, the foreign-trained applicant will be notified in writing that he or she has fulfilled all requirements for license by examination in Texas and is eligible for a temporary license. A temporary license may be issued under requirements set by §329.3 [ Chapter 333 ] of this title (relating to Temporary License for Examination Candidates).

(e)

[ (d) ] After arrival in the United States, the applicant must submit a United States residential address and pay all remaining fees. The residential address must be received before the second deadline set for the examination.

(f)

[ (e) ] Falsification of any documents required by the board for issuance of a temporary license will result in such temporary license being null and void and prohibition against the issuance of another temporary license to the applicant.

(g)

[ (f) ] Designated representative letter.

(1)

An applicant may designate a person as a representative by providing in writing to the board the name, telephone number, and address of the person and by stating in the letter that the person will be the designated representative for the applicant.

(2)

This letter must be notarized by a notary of the country in which the applicant resides and sent directly to the board. A copy should be sent to the representative by the applicant.

(3)

A designated representative may obtain confidential information regarding the application.

(4)

A designated representative of an applicant will remain so until the applicant receives his permanent license or until the board is notified in writing by the applicant that the designated representative has been eliminated or replaced. An applicant may have only one designated representative at any time.

(5)

The designated representative is not required by the board to have power of attorney for the applicant. A person who does have power of attorney for an applicant may not submit any document that is required by the board to be signed by the applicant and notarized. Documents submitted by a person with power of attorney for the applicant must be submitted in accordance with all requirements set by the Act and rules regarding these documents. Any falsification of documents required for licensing submitted by a designated representative or a person with power of attorney for the applicant may result in denial of license or other penalties to the applicant.

(h)

[ (g) ] Guidelines for board-approved education credentialing entities [ agencies ].

(1)

The credentialing entity [ agency ] will review all of an applicant's post-secondary professional education credentials earned outside of the United States. The entity [ agency ] will evaluate allowable transfer credit for the 13th year based on recommendations of the National Council on the Evaluation of Educational Credentials or on current published reference materials. The applicant must have completed 60 semester hours credit or the equivalent in general education courses including courses in biological, social and physical sciences from an accredited institution of higher learning. This requirement may be met by credits earned at U.S. colleges or universities, by College Level Examination Program (CLEP) credits, or Advanced Placement (AP) according to standards of the American Council on Education. The number of credits earned by CLEP or AP may not exceed 12 semester credits.

(2)

The credentialing entity [ agency ] must attest that the institution attended by the applicant has the recognition of the Ministry of Education or the equivalent in that country. All applicants must demonstrate proficiency in the English Language. The credentialing entity [ review agency ] will certify if the applicant's physical therapy course work has been taught in English. Applicants whose physical therapy course work has not been taught in English are required to take the Test of English as a Foreign Language (TOEFL), Test of Spoken English (TSE), and Test of Written English (TWE), as required in the Act, Section 8c. All three tests must be passed with the following minimum scores: TOEFL 580, TSE 55, AND TWE 5.

(3)

Licensing procedures for foreign-trained applicants. The credentialing entity [ agency ] must attest that the applicant is licensed/registered/authorized to practice in the country in which the education and training were accomplished if the country has a licensure/registration/authorization system in place. Otherwise, the applicant must be eligible for unrestricted practice in that country.

(4)

The credentialing entity [ agency ] adopts the policy of "scaling" as defined by the National Council on the Evaluation of Foreign Educational Credentials, American Association of Collegiate Registrar and Admissions Officers, Washington D.C.; i.e., a year of foreign study is worth no more than a year of American study, regardless of contact hours, or general education is converted to equate to approximately 30-32 United States semester credit hours per year, and professional education to approximately 36 semester credit hours per year.

(5)

The credentialing entity [ agency ] must use a method to convert classroom hours to semester units which has a ratio no greater than the following: 15 contact lecture hours = one semester unit/hour; 55 contact laboratory hours = one semester unit/hour. When lecture/lab hours are not delineated on the transcript, the evaluator may use an appropriate ratio and indicate the ratio used in the evaluation.

(6)

The credentialing entity [ agency ] must list and assign a grade for each course taken by the applicant, by assigning the grade of A, B, C, D, F, Pass, Fail, Credit or No Credit. Those grades assigned by the credentialing entity [ agency ] must be the grades that are converted to the U.S. equivalent, in accordance with the most current version of the National Association for Foreign Student Affairs Handbook on the Placement of Foreign Graduate Students. The credentialing entity [ agency ] must identify and list those courses which would not transfer to the U.S. as a C or above or Pass or Credit in accordance with the most current version of the National Association for Foreign Student Affairs Handbook on the Placement of Foreign Graduate Students. An applicant must earn a grade of A, B, C, or Pass or Credit in any professional physical therapy education courses. An applicant with a grade of D, F, Fail, or no credit appearing for a professional physical therapy education course on his/her evaluation who has not successfully retaken the course with a grade of A, B, C, Pass or Credit is not eligible for licensure in Texas.

(7)

The entity [ agency ] must attest that the applicant has successfully completed an educational program equivalent to U.S. programs accredited by the Commission on Accreditation of Physical Therapy Education (CAPTE) and has earned the equivalent of a minimum of 72 semester hours of professional physical therapy education. The applicant must have completed courses in each of the following areas: basic sciences, clinical science, and physical therapy theory and procedures. The applicant must have also successfully completed United States required equivalent courses/hours (no less than eight and will receive credit for no more than 15 U.S. semester credit hours at the Upper Division Level) in clinical education. If the applicant has completed the required course work in clinical education but the transcript does not reflect the required credit hours then the credentialing entity [ review agency ] may use the conversion formula of 55 contact hours per one semester credit.

(8)

The credentialing entity [ agency ] must certify that the program covering at least four years of full-time post-secondary study and awarding a degree[ /diploma/certificate ] is equivalent in level and purpose to the Bachelor of Science in Physical Therapy, as awarded by regionally accredited colleges and universities in the United States. [ Deficiencies must be identified and must show the subjects and credit hours necessary to be considered equivalent to the United States Bachelor of Science in Physical Therapy. ]

(9)

If the degree received is equivalent to a four-year BS degree in physical therapy as awarded by regionally accredited colleges and universities in the United States, the credentialing entity must use the approved evaluation checklist when considering an applicant's credentials. Deficiencies must be identified and must show the subjects and credit hours necessary to satisfy the requirements of the evaluation checklist.

[ (9)

The credentialing agency must submit to the board the resumes of any and all credential analysts and the physical therapy consultants involved in the evaluation of foreign-trained applicants for licensure in Texas. This must be submitted to the council at least 30 days prior to any analysis performed by that person.]

(10)

The credentialing entity must submit to the board the resumes of any and all credential analysts and the physical therapy consultants involved in the evaluation of foreign-trained applicants for licensure in Texas. This must be submitted to the council at least 30 days prior to any analysis performed by that person.

[ (10)

The credentialing agency must submit to the board a board-approved form, properly signed and notarized, in which it agrees to use the board's guidelines to evaluate transcripts of applicants seeking licensure in Texas.]

(11)

The credentialing entity must submit to the board a board-approved form, properly signed and notarized, in which it agrees to use the board's guidelines to evaluate transcripts of applicants seeking licensure in Texas.

[ (11)

The credentialing agency must use the approved evaluation checklist when considering an applicant's credentials.]

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 5, 1999.

TRD-9900768

John P. Maline

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6900

22 TAC §341.8

The Texas Board of Physical Therapy Examiners proposes an amendment to §341.8, concerning Inactive Status. This amendment will remove the requirement that Continuing Education Units (CEUs) be submitted prior to the board changing a license to inactive status, and establish that all CEUs must be submitted when returning to active status. It also clarifies that if a licensee is requesting that their license be put on inactive status they must notify the board prior to the expiration date, and that a completed inactive status application must be received by the board no later than one month after the expiration date of the license.

John P. Maline, Executive Director of the Executive Council of Physical Therapy and Occupational Therapy Examiners, has determined that for the first five-year period the rule is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Maline also has determined that for each year of the first five years the rule is in effect the public benefit anticipated as a result of enforcing the rule will be that experienced physical therapists will be able to resume practice after a period of inactivity. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the rule as proposed.

Comments on the proposed amendment may be submitted to Nina Hurter, PT Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite 2-510, Austin, Texas 78701.

The amendment is proposed under the Physical Therapy Practice Act, Texas Civil Statutes, Article 4512e, which provides the Texas Board of Physical Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Texas Civil Statutes, Article 4512e is affected by this amended section.

§341.8. Inactive Status.

(a)

Requirements for Inactive Status. Inactive status indicates the voluntary termination of the right or privilege to practice physical therapy in Texas by a licensee in good standing with the board.

(1)

A licensee who is not actively engaged in the practice of physical therapy in the state may request in writing a change to inactive status, to be effective on the next license renewal date. On or by that date, the licensee must submit to the board a written request to be placed on inactive status. A completed inactive status application must be received by the board no later than one month after the expiration date of the license. [ the following listed in subparagraphs (A)-(B) of this paragraph: ]

[ (A)

proof of having met the continuing education requirement for the current renewal period; and]

[ (B)

a completed inactive status application as provided by the board.]

(2)-(3)

(No Change.)

(b)

Reinstatement of active status. A licensee on inactive status may request a return to active status at any time. After the licensee has fulfilled the requirements for reinstatement, the board will send a renewal certificate for the current two-year renewal period to the licensee for display purposes. To return to active status, a licensee must submit the following listed in paragraphs (1)-(4) of this subsection:

(1)-(3)

(No change.)

(4)

proof of the required amount of continuing education for each two-year renewal period on inactive status, including the current period and the renewal period prior to the effective date of the inactive status. [ The continuing education must be obtained during the time spent on inactive status. ] Alternatively, the licensee applying for reinstatement to active status may substitute one of the following actions for the continuing education requirements listed in subparagraphs (A)-(C) of this paragraph:

(A)-(C)

(No Change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 5, 1999.

TRD-9900767

John P. Maline

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6900

22 TAC §343.3, §343.4

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Board of Physical Therapy Examiners or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Board of Physical Therapy Examiners proposes the repeal of §343.3, concerning Referral requirements and exceptions to referral requirements, and §343.4, concerning Practicing in a manner detrimental to the public health and welfare. The rules in these sections are being incorporated with no substantive changes into new Chapter 322, Practice.

John P. Maline, Executive Director of the Executive Council of Physical Therapy and Occupational Therapy Examiners, has determined that for the first five-year period the rule is repealed there will be no fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Maline also has determined that for each year of the first five years the rule is repealed the public benefit anticipated as a result of repealing the rule will be easier access to information describing how and by whom physical therapy services should be provided. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the rule as proposed.

Comments on the proposed repeals may be submitted to Nina Hurter, PT Coordinator, Texas Board of Physical Therapy Examiners, 333 Guadalupe, Suite 2-510, Austin, Texas 78701.

The repeal is proposed under the Physical Therapy Practice Act, Texas Civil Statutes, Article 4512e, which provides the Texas Board of Physical Therapy Examiners with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

Texas Civil Statutes, Article 4512e is affected by this amended section.

§343.3. Referral Requirement and Exceptions to Referral Requirement.

§343.4. Practicing in a Manner Detrimental to the Public Health and Welfare.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State, on February 5, 1999.

TRD-9900772

John P. Maline

Executive Director

Texas Board of Physical Therapy Examiners

Earliest possible date of adoption: March 21, 1999

For further information, please call: (512) 305-6900