TITLE health-services

Part I. Texas Department of Health

Chapter 31. Nutrition Services

25 TAC §31.1

The Texas Department of Health (department) adopts under federal mandate an amendment to §31.1, concerning the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Section 31.1(b) adopts by reference the Fiscal Year 1999 (FY1999) WIC State Plan of Operations. Section 31.1(c) adopts by reference the WIC Policy and Procedure Manual.

Federal regulations at 7 CFR Part 246 require the United States Department of Agriculture (USDA) to approve an annual update of the WIC State Plan of Operations. The amendment to §31.1(b) covers the annual update for the FY1999, which was approved by the USDA effective October 1, 1998. The FY1999 update covers the state agency's goals and objectives for improving program operations; the affirmative action plan; and local agency identification - WIC project information. The amendments to the WIC Policy and Procedure Manual cover new and revised USDA policies, which became effective when the federal regulations and federal circulars became effective, and are incorporated into policies that were approved by USDA. The latest federal requirements which are being incorporated into the WIC Policy and Procedure Manual by the amendment to §31.1(c) cover property management; allowable costs for equipment; allowable costs for nonprofessional contract services; program initiation and expansion; monthly reimbursement maximum; services to families with special health care needs; identification of WIC applicant; Texas WIC income guidelines; least expensive brands declaration; temporary grocer/vendor agreements; issuance of noncontract formulas and medical nutritional products; and access to appointments.

The amendment is adopted under federal mandate for the following reasons. Under federal and state law (the Child Nutrition Act of 1966, as amended, 42 U.S.C.A. §1786, and the Omnibus Hunger Act of 1985, Acts 1985, 69th Legislature, Chapter 150, Title II), the WIC Program is 99% federally funded and governed by federal regulations. Funds are made available to the department by a federal grant. The federal statute (42 USC §1786), federal regulations (7 CFR Part 246), and the federal grant (Federal-State Special Supplemental Food Program Agreement) authorize the USDA to make the funds available to the department to administer the WIC Program in the State of Texas, provided that the department administers the program in accordance with the federal regulations. Therefore, the department under federal mandate adopts an amendment, effective October 1, 1998.

The amendment is adopted under Health and Safety Code, §12.001(b), which provides the Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law upon the board, the department, and the commissioner of health; the Texas Omnibus Hunger Act of 1985, Acts 1985, 69th Legislature, Chapter 150, Title II; Human Resources Code, Chapter 33; the Child Nutrition Act of 1966, 42 USC §1786, as amended; and 7 CFR Part 246.

§31.1.Special Supplemental Food Program for Women, Infants, and Children (WIC).

(a)

(No change.)

(b)

WIC State Plan of Operations.

(1)

The department adopts by reference the publication titled "WIC State Plan of Operations," as amended effective October 1, 1998. This plan has been developed by the department's WIC Program and approved by the United States Department of Agriculture.

(2)

(No change.)

(c)

WIC Policy and Procedure Manual.

(1)

The department adopts by reference the publication titled "WIC Policy and Procedure Manual," which the department developed, as amended effective October 1, 1998. This policy and procedure manual has been developed by the department's WIC Program and approved by the United States Department of Agriculture.

(2)

(No change.)

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 14, 1999.

TRD-9900205

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: October 1, 1998

For further information, please call: (512) 458-7236


Chapter 37. Maternal and Child Health Services

Subchapter P. Surveillance and Control of Birth Defects

25 TAC §37.307

The Texas Department of Health (department) adopts an amendment to §37.307, concerning the Scientific Advisory Committee on Birth Defects in Texas (committee) with changes to the proposed text as published in the October 30, 1998, issue of the Texas Register (23 TexReg 11037). The committee provides advice to the board in the area of implementing an effective birth defects registry and related research, referral, and educational activities.

In 1993, the Texas Legislature passed Senate Bill 383 (now codified in the Government Code, Chapter 2110) which requires that each state agency adopt rules to establish advisory committees. The rules must state the purpose of each committee, state the composition of the committee, describe the tasks of the committee, describe the manner in which the committee will report to the agency, and establish a date on which the committee will be automatically abolished unless the governing body of the agency affirmatively votes to continue the committee in existence.

In 1995, the Texas Board of Health (board) established a rule relating to the Scientific Advisory Committee on Birth Defects in Texas. The rule states that the committee will automatically be abolished on March 1, 1999. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until March 1, 2003.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to reference the Government Code; to continue the committee until March 1, 2003; to address changes to the composition of the committee; to clarify that members holdover until their replacement is appointed; to require that the presiding officer and the assistant presiding officer of the committee will be selected by the chairman of the board for a term of two years; to allow a temporary vacancy in the office of assistant presiding officer to be filled by vote of the committee until appointment by the chairman of the board occurs; to clarify that the committee is prohibited from holding an executive session (closed meeting) for any reason; and to clarify that the committee and its members may not participate in legislative activity in the name of the board, the department, or the committee except with certain approval. These changes will clarify procedures for the committee and emphasize the advisory nature of the committee.

The department is making the following minor changes due to staff comments to clarify the intent and improve the accuracy of the section.

Change: Concerning §37.307(f)(2), the language was revised to acknowledge that the composition of the committee is changing from the composition described in the rules existing on December 31, 1998.

Change: Concerning §37.307(g), the language was revised to clarify that members holdover past the expiration of their term until their successor is appointed.

Change: Concerning §37.307(h)(4), the language was revised to recognize that the committee would temporarily fill only the position of the assistant presiding officer, if vacant. If the position of presiding officer was vacant, the assistant presiding officer serves pursuant to subsection (h)(3).

Change: Concerning §37.307(h)(7), the language was revised so that the chairman of the board may appoint officers at any time after the effective date of the rule.

Change: Concerning §37.307(i)(3), the reference to "governmental body" was corrected.

The amendment is adopted under the Health and Safety Code, §11.016, which allows the board to establish advisory committees; the Government Code, Chapter 2110, which sets standards for the evaluation of advisory committees by the agencies for which they function; and the Health and Safety Code, §12.001, which provides the board with authority to adopt rules for the performance of every duty imposed by law upon the board, the department, and the commissioner of health.

§37.307.Scientific Advisory Committee on Birth Defects in Texas.

(a)

The committee. The Scientific Advisory Committee on Birth Defects in Texas shall be appointed under and governed by this section.

(1)

(No change.)

(2)

The committee is established under the Health and Safety Code, §11.016, which allows the Board of Health (board) to establish advisory committees.

(b)

Applicable law. The committee is subject to the Government Code, Chapter 2110, concerning state agency advisory committees.

(c)

(No change.)

(d)

Tasks.

(1)

(No change.)

(2)

The committee shall:

(A)

provide practical and scientific advice to the Texas Department of Health (department) in implementing an effective birth defects registry and related research through:

(i)

referral and educational activities; and

(ii)

review and advice to the department on all proposed projects and programs prior to and during implementation;

(B)

(No change.)

(C)

make recommendations to the department, as appropriate.

(3)

(No change.)

(e)

Committee abolished. By March 1, 2003, the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee, or abolished. If the committee is not continued or consolidated, the committee shall be abolished on that date.

(f)

Composition. The committee shall be composed of 11 members appointed by the board.

(1)

The composition of the committee shall include scientific experts in the field of birth defects, genetics, epidemiology, and medicine.

(A)

Four members shall be from the general public.

(B)

If the board implements a pilot birth defects registry in selected regions of the state, membership of the committee must include persons who work or live in the areas where the pilot birth defects registry activity is implemented.

(2)

Since the composition of the committee as it existed on December 31, 1998, is changed under this section, existing members shall continue to serve until the board appoints members under the new composition.

(g)

Terms of office. The term of office of each member shall be six years. Members shall serve after expiration of their term until a replacement is appointed.

(1)-(2)

(No change.)

(h)

Officers. The chairman of the board shall appoint a presiding officer and an assistant presiding officer to begin serving on March 1 of each odd-numbered year.

(1)

Each officer shall serve until February 27th of each odd-numbered year. Each officer may holdover until his or her replacement is appointed by the chairman of the board.

(2)

(No change.)

(3)

The assistant presiding officer shall perform the duties of the presiding officer in case of the absence or disability of the presiding officer. In case the office of presiding officer becomes vacant, the assistant presiding officer will serve until a successor is appointed to complete the unexpired portion of the term of the office of presiding officer.

(4)

If the office of assistant presiding officer becomes vacant, it may be filled temporarily by vote of the committee until a successor is appointed by the chairman of the board.

(5)-(6)

(No change.)

(7)

The presiding officer and assistant presiding officer serving on January 1, 1999, will continue to serve until the chairman of the board appoints their successors.

(i)

Meetings. The committee shall meet only as necessary to conduct committee business.

(1)-(2)

(No change.)

(3)

The committee is not a "governmental body" as defined in the Open Meetings Act. However, in order to promote public participation, each meeting of the committee shall be announced and conducted in accordance with the Open Meetings Act, Texas Government Code, Chapter 551, with the exception that the provisions allowing executive sessions shall not apply.

(4)-(7)

(No change.)

(j)

Attendance. Members shall attend committee meetings as scheduled. Members shall attend meetings of subcommittees to which the member is assigned.

(1)-(3)

(No change.)

(k)-(m)

(No change.)

(n)

Statement by members.

(1)

The board, the department, and the committee shall not be bound in any way by any statement or action on the part of any committee member except when a statement or action is in pursuit of specific instructions from the board, department, or committee.

(2)

The committee and its members may not participate in legislative activity in the name of the board, the department, or the committee except with approval through the department's legislative process. Committee members are not prohibited from representing themselves or other entities in the legislative process.

(o)

Reports to board. The committee shall file an annual written report with the board.

(1)

The report shall list the meeting dates of the committee and any subcommittees, the attendance records of its members, a brief description of actions taken by the committee, a description of how the committee has accomplished the tasks given to the committee by the board, the status of any rules which were recommended by the committee to the board, and anticipated activities of the committee for the next year.

(2)-(3)

(No change.)

(p)

Reimbursement for expenses. In accordance with the requirements set forth in the Government Code, Chapter 2110, a committee member may receive reimbursement for the member's expenses incurred for each day the member engages in official committee business if authorized by the General Appropriations Act or budget execution process.

(1)-(5)

(No change.)

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900291

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 30, 1998

For further information, please call: (512) 458-7236


Chapter 61. Chronic Diseases

Subchapter A. Kidney Health Care Program

25 TAC §61.12

The Texas Department of Health (department) adopts an amendment to §61.12 concerning the Kidney Health Care Advisory Committee (committee) with changes to the proposed text as published in the October 30, 1998, issue of the Texas Register (23 TexReg 11039). The committee provides advice to the Texas Board of Health (board) in the area of end-stage renal disease (ESRD) and on current state-of-the-art treatment modalities, medication therapies, and prioritization of the needs of ESRD patients in Texas.

In 1993, the Texas Legislature passed Senate Bill 383 (now codified in the Government Code, Chapter 2110) which requires that each state agency adopt rules to establish advisory committees. The rules must state the purpose of each committee, state the composition of the committee, describe the tasks of the committee, describe the manner in which the committee will report to the agency, and establish a date on which the committee will be automatically abolished unless the governing body of the agency affirmatively votes to continue the committee in existence.

In 1994, the board established a rule relating to the Kidney Health Care Advisory Committee. The rule states that the committee will automatically be abolished on March 1, 1999. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until March 1, 2003.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to state that the committee is established under the Health and Safety Code, §11.016 which allows the board to establish advisory committees; to reference the Government Code; to continue the committee until March 1, 2003; to revise the composition of the committee; to clarify that members holdover until their replacement is appointed; to require that the presiding officer and the assistant presiding officer of the committee will be selected by the chairman of the board for a term of two years; to allow a temporary vacancy in the office of assistant presiding officer to be filled by vote of the committee until appointment by the chairman of the board occurs; to clarify that the committee is prohibited from holding an executive session (closed meeting) for any reason; to clarify that the committee and its members may not participate in legislative activity in the name of the board, the department, or the committee except with certain approval; and to require the committee's annual report in March rather than in September. These changes will clarify procedures for the committee and emphasize the advisory nature of the committee.

The department is making the following minor changes due to staff comments to clarify the intent and improve the accuracy of the section.

Change: Concerning §61.12(f)(2), the language was revised to acknowledge that the composition of the committee is changing from the composition described in the rules existing on December 31, 1998.

Change: Concerning §61.12(g), the language was revised to clarify that members holdover past the expiration of their term until their successor is appointed.

Change: Concerning §61.12(h)(4), the language was revised to recognize that the committee would temporarily fill only the position of the assistant presiding officer, if vacant. If the position of presiding officer was vacant, the assistant presiding officer serves pursuant to subsection (h)(3).

Change: Concerning §61.12(h)(7), the language was revised so that the chairman of the board may appoint officers at any time after the effective date of the rule.

The amendment is adopted under the Health and Safety Code, §11.016, which allows the board to establish advisory committees; the Government Code, Chapter 2110, which sets standards for the evaluation of advisory committees by the agencies for which they function; and the Health and Safety Code, §12.001, which provides the board with authority to adopt rules for the performance of every duty imposed by law upon the board, the department, and the commissioner of health.

§61.12.Kidney Health Care Advisory Committee.

(a)

The committee. An advisory committee shall be appointed under and governed by this section.

(1)

(No change.)

(2)

The committee is established under the Health and Safety Code, §11.016 which allows the Board of Health (board) to establish advisory committees.

(b)

Applicable law. The committee is subject to the Government Code, Chapter 2110, concerning state agency advisory committees.

(c)-(d)

(No change.)

(e)

Committee abolished. By March 1, 2003, the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee, or abolished. If the committee is not continued or consolidated, the committee shall be abolished on that date.

(f)

Composition. The committee shall be composed of nine members appointed by the board. The composition of the committee shall include three consumer representatives and six nonconsumer representatives.

(1)

The six nonconsumer representatives shall be as follows:

(A)

three physicians who are nephrologists or renal transplant surgeons; and

(B)

three persons who are renal social workers, renal nurses, renal dietitians, dialysis technicians, renal administrators or pharmacists.

(2)

Since the composition of the committee as it existed on December 31, 1998, is changed under this section, existing members shall continue to serve until the board appoints members under the new composition.

(g)

Terms of office. The term of office of each member shall be six years. Members shall serve after expiration of their term until a replacement is appointed.

(1)-(2)

(No change.)

(h)

Officers. The chairman of the board shall appoint a presiding officer and an assistant presiding officer to begin serving on March 1 of each odd-numbered year.

(1)

Each officer shall serve until February 27th of each odd-numbered year. Each officer may holdover until his or her replacement is appointed by the chairman of the board.

(2)

(No change.)

(3)

The assistant presiding officer shall perform the duties of the presiding officer in case of the absence or disability of the presiding officer. In case the office of presiding officer becomes vacant, the assistant presiding officer will serve until a successor is appointed to complete the unexpired portion of the term of the office of presiding officer.

(4)

If the office of assistant presiding officer becomes vacant, it may be filled temporarily by vote of the committee until a successor is appointed by the chairman of the board.

(5)-(6)

(No change.)

(7)

The presiding officer and assistant presiding officer serving on January 1, 1999, will continue to serve until the chairman of the board appoints their successors.

(i)

Meetings. The committee shall meet only as necessary to conduct committee business.

(1)-(2)

(No change.)

(3)

The committee is not a "governmental body" as defined in the Open Meetings Act. However, in order to promote public participation, each meeting of the committee shall be announced and conducted in accordance with the Open Meetings Act, Texas Government Code, Chapter 551, with the exception that the provisions allowing executive sessions shall not apply.

(4)-(7)

(No change.)

(j)

Attendance. Members shall attend committee meetings as scheduled. Members shall attend meetings of subcommittees to which the member is assigned.

(1)-(3)

(No change.)

(k)-(m)

(No change.)

(n)

Statement by members.

(1)

The board, the department, and the committee shall not be bound in any way by any statement or action on the part of any committee member except when a statement or action is in pursuit of specific instructions from the board, department, or committee.

(2)

The committee and its members may not participate in legislative activity in the name of the board, the department, or the committee except with approval through the department's legislative process. Committee members are not prohibited from representing themselves or other entities in the legislative process.

(o)

Reports to board. The committee shall file an annual written report with the board.

(1)

The report shall list the meeting dates of the committee and any subcommittees, the attendance records of its members, a brief description of actions taken by the committee, a description of how the committee has accomplished the tasks given to the committee by the board, the status of any rules which were recommended by the committee to the board, and anticipated activities of the committee for the next year.

(2)

(No change.)

(3)

The report shall cover the meetings and activities in the immediate preceding 12 months and shall be filed with the board each March. It shall be signed by the presiding officer and appropriate department staff.

(p)

Reimbursement for expenses. In accordance with the requirements set forth in the Government Code, Chapter 2110, a committee member may receive reimbursement for the member's expenses incurred for each day the member engages in official committee business if authorized by the General Appropriations Act or budget execution process.

(1)-(5)

(No change.)

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900247

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 30, 1998

For further information, please call: (512) 458-7236


Chapter 98. HIV and STD Prevention

The Texas Department of Health (department), adopts the repeal of §§98.26, 98.28 and 98.29, amendments to §§98.1 - 98.4, 98.6, 98.8, 98.21 - 98.25, 98.27, 98.30, 98.31, 98.41 - 98.44, and new §98.28 concerning the administration of treatment, health, and social service programs for persons with human immunodeficiency virus (HIV) infection. Section 98.41 is adopted with changes to the proposed text as published in the October 2, 1998, issue of the Texas Register (23 TexReg 9912). The repeal of §98.26, 98.28, and 98.29, and the amendments and new §§98.1 - 98.4, 98.6, 98.8, 98.21 - 98.25, 98.27, 98.28, 98.30, 98.31, and 98.42 - 98.44 are adopted without changes, and therefore will not be republished.

These amended and new sections update and improve the ability of the department to administer state and federal funds in a manner which will best serve the needs of local HIV infected populations. The repealed sections delete obsolete fiscal language while the amended sections contain a change in the title of the chapter and in the title of this subchapter, revisions in the format and content of text within these sections to improve understanding, reflect statutory and department policy changes, and are necessary to clarify contractor performance requirements and to improve service delivery programs to persons infected with the human immunodeficiency virus (HIV) and/or who have acquired immunodeficiency syndrome (AIDS). New §98.28 provides a process through which an applicant for funds may dispute the department's decision to deny the application.

No comments were received on the proposal during the comment period; however, the department is making minor editorial changes for format and grammatical accuracy.

Subchapter A. HIV Services Grant Program

1. General Provisions

25 TAC §§98.1-98.4, 98.6, 98.8

The amendments are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for treatment, health, and social service programs for persons with HIV infection; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900288

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


2. AIDS/HIV Services Providers

25 TAC §§98.21-98.25, 98.27, 98.28, 98.30, 98.31

The amendments and new section are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for treatment, health, and social service programs for persons with HIV infection; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900289

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


25 TAC §§98.26, 98.28, 98.29

The repeals are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for treatment, health, and social service programs for persons with HIV infection; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900287

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


3. AIDS/HIV Services; Clients

25 TAC §§98.41-98.44

The amendments are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for treatment, health, and social service programs for persons with HIV infection; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

§98.41.Client Eligibility Requirements.

(a)

Full eligibility.

(1)

An individual will be eligible to receive services when the individual receives provider approval after meeting all of the following requirements except as provided in paragraph (2) of this subsection:

(A)

have laboratory or physician documentation of HIV infection or AIDS diagnosis;

(B)

is a resident of Texas, and furnishes documentation of residency as required by §98.43 of this title (relating to Residency; Documentation of Residency). An individual is considered to be a Texas resident if:

(i)

the individual actually maintains an abode within the state (i.e., house or apartment, not merely a post office box) and has an intent to remain within the state, whether permanently or for an indefinite period; and

(ii)

the individual does not claim residency in any other state or country; or

(iii)

the individual is under 18 years of age and his/her parent(s), managing conservator, or guardian is a bona fide resident of Texas; or

(iv)

the individual is a person residing in Texas and his/her legally dependent spouse is a bona fide resident of Texas; or

(v)

the individual is an adult residing in Texas and his/her legal guardian is a bona fide resident of Texas.

(C)

makes application through a provider in the HSDA.

(2)

Family members are exempt from eligibility requirements for paragraph (1)(A) of this subsection for purposes of receiving certain specified services which provide a direct or indirect benefit to the person with HIV or AIDS.

(3)

To maintain eligibility, a client must inform the provider of any changes in residency or other information required by the provider which is necessary to provide services.

(4)

To regain eligibility for receipt of services, a former client must reapply for services under the eligibility requirements outlined in paragraph (1) of this subsection in addition to any service eligibility requirements the provider may have.

(b)

Conditional eligibility.

(1)

Conditional eligibility is available pending final approval of an application for services.

(A)

(No change.)

(B)

Conditional eligibility may be granted, unless not allowed by the program, only for one or more of the following reasons:

(i)

full eligibility is pending collection of the applicant's required documentation;

(ii)

translation of the applicant's required documentation into English; or

(iii)

review of the application by the provider and the provider's final decision to grant or refuse full eligibility to the applicant is being considered.

(2)

A provider may not grant conditional eligibility to any applicant that the provider knows is not and will not be fully eligible for services.

(3)

The contract of a provider may be terminated and provider approval revoked if a provider grants conditional eligibility to an applicant that the provider knows is not and will not be fully eligible for services.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900290

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


Subchapter B. HIV Prevention Grant Program

The Texas Department of Health (department), adopts the repeal of §§98.85 and 98.87 - 98.89, amendments to §§98.61 - 98.64, 98.66, 98.68, 98.81 - 98.84, 98.86 and 98.90, and new §§98.87 and 98.89 concerning the administration of human immunodeficiency virus (HIV) prevention, education, and risk reduction programs without changes to the proposed text as published in the October 2, 1998, issue of the Texas Register (23 TexReg 9923), and therefore the sections will not be republished.

These amended sections and new sections update and improve upon the ability of the department to administer state and federal funds and to improve the delivery of HIV prevention programs in Texas. The repealed sections delete obsolete fiscal language, delete the process for denying applications and applying sanctions on contracts, and deletes the appeals process from the rules for disputing the department's fiscal decisions. The amended sections contain a change in the title of the chapter and in the title of this subchapter, revisions in the format and content of text within these sections to improve understanding, reflect statutory and department policy changes, and are necessary to clarify contractor performance requirements and to improve the delivery of HIV prevention programs in Texas. New §98.87 provides a process through which an applicant for funds may dispute the department's decision to deny the applicant's application. New §98.89 does not allow for a dispute process if an application is denied, or a contract modified, suspended, or terminated if the department's actions result from an exhaustion of funds.

No comments were received on the proposal during the comment period.

1. General Provisions

25 TAC §§98.61-98.64, 98.66, 98.68

The amendments are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for delivery of HIV prevention, education, and risk reduction programs; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900308

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


2. AIDS/HIV Education Providers

25 TAC §§98.81-98.84, 98.86, 98.87, 98.89, 98.90

The amendments and new sections are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for delivery of HIV prevention, education, and risk reduction programs; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900309

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


25 TAC §§98.85, 98.87-98.89

The repeals are adopted under the Health and Safety Code, Chapter 85, Subchapter B, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a state grant program to nonprofit community organizations for delivery of HIV prevention, education, and risk reduction programs; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900307

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


Subchapter C. Texas HIV Medication Program

1. General Provisions

The Texas Department of Health (department), adopts the repeal of §§98.102 - 98.104 and 98.106 - 98.108, amendments to §§98.101 and 98.109 - 98.112, and new §§98.102 - 98.108 and 98.113 - 98.117 concerning the administration of the Texas HIV Medication Program. Sections 98.101 and 98.114 are adopted with changes to the proposed text as published in the October 2, 1998, issue of the Texas Register (23 TexReg 9929). The repeal of §§98.102 - 98.104 and 98.106 - 98.108, and the amendments and new §§98.102 - 98.113 and 98.115 - 98.117 are adopted without changes to the proposed text, and therefore the sections will not be republished.

These amended and new sections improve the program's ability to administer funds allocated to the department for the purpose of providing HIV-related medications to individuals with HIV disease. The repeal of §§98.102 - 98.104 and 98.106 - 98.108 were necessary for the reorganization of the subchapter; the repealed sections were re-offered as new §§98.103, 98.105, 98.106, 98.107, 98.108, and 98.115. The amendments replace obsolete language, clarify that services provided to a person will cease the day that person is withdrawn from the program, allow dispensing of program medications to only those pharmacies which have been approved by the program, and allow for the collection of a copayment by pharmacies in accordance with their signed Memorandum of Understanding with the department. New §98.102 provides a definition of terms used in the subchapter; new §98.103 was renumbered from the repealed §98.104 and describes the method used to determine what medications are covered by the program; new §98.104 relates to nondiscrimination of applicants or clients; new §98.105 was renumbered from the repealed §98.106 and details the client eligibility criteria; new §98.106 was renumbered from the repealed §98.102 and clarifies that the drug-specific eligibility criteria is determined by the program; new §98.107 was renumbered from the repealed §98.103 which allows coverage of clients who have exhausted Medicaid benefits for a given month and provides a process for adjusting an applicant's annual gross income; new §98.108 was renumbered from the repealed §98.107 and details the necessary application forms; new §98.113 requires the applicant or client to be a resident of the state; new §98.114 describes the circumstances under which an applicant or client will be denied services; new §98.115 was renumbered from the repealed §98.108 and redefines the composition of the appeals review panel, new §98.116 excludes appeals when the department's decision to terminate or deny services results from an exhaustion of funds; and new §98.117 provides a process for filing public complaints.

No comments were received on the proposal during the comment period; however, the department has made minor changes due to staff comments.

Change: Concerning §98.101, a reference to the authorizing statute was clarified.

Change: Concerning §98.114(a)(2)(C), the number of months a client record may remain inactive is changed from 12 months to 6 months.

25 TAC §§98.101-98.117

The amendments and new sections are adopted under the Health and Safety Code, Chapter 85, Subchapter C, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a program to assist hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV-infected individuals in the purchase of medications approved by the board that have been shown to be effective in reducing hospitalizations due to HIV-related conditions; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

§98.101.Purpose.

These sections implement the provisions of the Texas HIV Medication Program (program) as authorized by the Human Immunodeficiency Virus Services Act, Health and Safety Code, §§85.061-85.066. The program shall assist hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV-infected individuals in obtaining medications that have been shown to be effective in reducing hospitalizations due to HIV-related conditions and approved by the Texas Board of Health for program coverage.

§98.114.Denial of Application or Termination of Client Benefits.

(a)

Individuals applying for services or clients already receiving services will have their application denied or services terminated for any of the following reasons.

(1)

Services will be denied or terminated if:

(A)

the person is not a resident of the state as required in §98.106 of this title (relating to Eligibility);

(B)

the adjusted annual gross income does not meet the criteria set in §98.107 of this title (relating to Criteria for Financial Eligibility);

(C)

the person receiving services does not have documentation of at least an HIV infection;

(D)

the client notifies the program in writing that he/she no longer wants to receive services.

(2)

Services may be terminated if:

(A)

the applicant or client submits an application form or any document required in support of the application which contains a misstatement of fact which is material to determining program eligibility;

(B)

the client submits false claims to a participating pharmacy;

(C)

the client has not requested or used services during any period of six consecutive months;

(D)

program funds are curtailed; or

(E)

funds allocated for payments on behalf of the client are exhausted.

(b)

Denial, modification, suspension, or termination of services to a client will be governed by the procedures required by §98.115 of this title (relating to Appeal Procedures), and §98.116 of this title (relating to Exceptions from Appeal Procedure).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900283

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


25 TAC §§98.102-98.104, 98.106-98.108

The repeals are adopted under the Health and Safety Code, Chapter 85, Subchapter C, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a program to assist hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV-infected individuals in the purchase of medications approved by the board that have been shown to be effective in reducing hospitalizations due to HIV-related conditions; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900282

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


Subchapter C. Texas HIV Medication Program Advisory Committee

25 TAC §98.121

The Texas Department of Health (department) adopts an amendment to §98.121 concerning the Texas HIV Medication Advisory Committee (committee) with changes to the proposed text as published in the October 30, 1998, issue of the Texas Register (23 TexReg 11040). The committee provides assistance to the Texas Board of Health (board) and the department in the development of procedures and guidelines for the HIV Medication Program (program).

In 1993, the Texas Legislature passed Senate Bill 383 (now codified in the Government Code, Chapter 2110) which requires that each state agency adopt rules to establish advisory committees. The rules must state the purpose of each committee, state the composition of the committee, describe the tasks of the committee, describe the manner in which the committee will report to the agency, and establish a date on which the committee will be automatically abolished unless the governing body of the agency affirmatively votes to continue the committee in existence.

In 1995, the board established a rule relating to the Texas HIV Medication Advisory Committee. The rule states that the committee will automatically be abolished on March 1, 1999. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until March 1, 2003.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to state that the committee is established under the Health and Safety Code, §11.016 which allows the board to establish advisory committees; to reference the Government Code; to continue the committee until March 1, 2003; to address changes to the composition of the committee; to clarify that members holdover until their replacement is appointed; to require that the presiding officer and the assistant presiding officer of the committee will be selected by the chairman of the board for a term of two years; to allow a temporary vacancy in the office of assistant presiding officer to be filled by vote of the committee until appointment by the chairman of the board occurs; to clarify that the committee is prohibited from holding an executive session (closed meeting) for any reason; to clarify that the committee and its members may not participate in legislative activity in the name of the board, the department, or the committee except with certain approval; and to require the committee's annual report in March rather than October. These changes will clarify procedures for the committee and emphasize the advisory nature of the committee.

The department is making the following minor changes due to staff comments to clarify the intent and improve the accuracy of the section.

Change: Concerning §98.121(f)(2), the language was revised to acknowledge that the composition of the committee is changing from the composition described in the rules existing on December 31, 1998.

Change: Concerning §98.121(g), the language was revised to clarify that members holdover past the expiration of their term until their successor is appointed.

Change: Concerning §98.121(h)(4), the language was revised to recognize that the committee would temporarily fill only the position of the assistant presiding officer, if vacant. If the position of presiding officer was vacant, the assistant presiding officer serves pursuant to subsection (h)(3).

Change: Concerning §98.121(h)(7), the language was revised so that the chairman of the board may appoint officers at any time after the effective date of the rule.

Change: Concerning §98.121(i)(3), the reference to "governmental body" was corrected.

The amendment is adopted under the Health and Safety Code, §11.016, which allows the board to establish advisory committees; the Government Code, Chapter 2110, which sets standards for the evaluation of advisory committees by the agencies for which they function; and the Health and Safety Code, §12.001, which provides the board with authority to adopt rules for the performance of every duty imposed by law upon the board, the department, and the commissioner of health.

§98.121.Texas HIV Medication Advisory Committee.

(a)

The committee. An advisory committee shall be appointed under and governed by this section.

(1)

(No change.)

(2)

The committee is established under the Health and Safety Code, §85.066, which allows the Board of Health (board) to establish an HIV medication committee and Health and Safety Code, §11.016 which allows the board to establish advisory committees.

(b)

Applicable law. The committee is subject to the Government Code, Chapter 2110, concerning state agency advisory committees.

(c)

(No change.)

(d)

Tasks. The committee shall:

(1)-(4)

(No change.)

(5)

develop criteria and standards for the program; and

(6)

(No change.)

(e)

Committee abolished. By March 1, 2003, the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee, or abolished. If the committee is not continued or consolidated, the committee shall be abolished on that date.

(f)

Composition.

(1)

The committee shall be composed of 11 members appointed as follows:

(A)

three physicians actively engaged in the treatment of adults with HIV infection;

(B)

one pediatrician actively engaged in the treatment of infants and children with HIV infection;

(C)

four persons who must be diagnosed as HIV positive;

(D)

one member who is an administrator of a public, nonprofit hospital involved in the delivery of services to persons with HIV infection;

(E)

one social worker currently working with persons with HIV infection; and

(F)

one pharmacist who participates in the HIV Medication Program.

(2)

Since the composition of the committee as it existed on December 31, 1998, is changed under this section, existing members shall continue to serve until the board appoints members under the new composition.

(g)

Terms of office. The term of office of each member shall be six years. Members shall serve after expiration of their term until a replacement is appointed.

(1)

Members shall be appointed for staggered terms so that the terms of a substantially equivalent number of members will expire on December 31st of each even-numbered year.

(2)

(No change.)

(h)

Officers. The chairman of the board shall appoint a presiding officer and an assistant presiding officer to begin serving on March 1 of each odd-numbered year.

(1)

Each officer shall serve until February 27th of each odd-numbered year. Each officer may holdover until his or her replacement is appointed by the chairman of the board.

(2)

(No change.)

(3)

The assistant presiding officer shall perform the duties of the presiding officer in case of the absence or disability of the presiding officer. In case the office of presiding officer becomes vacant, the assistant presiding officer will serve until a successor is appointed to complete the unexpired portion of the term of the office of presiding officer.

(4)

If the office of assistant presiding officer becomes vacant, it may be filled temporarily by vote of the committee until a successor is appointed by the chairman of the board.

(5)-(6)

(No change.)

(7)

The presiding officer and assistant presiding officer serving on January 1, 1999, will continue to serve until the chairman of the board appoints their successors.

(i)

Meetings. The committee shall meet only as necessary to conduct committee business.

(1)-(2)

(No change.)

(3)

The committee is not a "governmental body" as defined in the Open Meetings Act. However, in order to promote public participation, each meeting of the committee shall be announced and conducted in accordance with the Open Meetings Act, Texas Government Code, Chapter 551, with the exception that the provisions allowing executive sessions shall not apply.

(4)-(7)

(No change.)

(j)

Attendance. Members shall attend committee meetings as scheduled. Members shall attend meetings of subcommittees to which they are assigned.

(1)-(3)

(No change.)

(k)

(No change.)

(l)

Procedures. Robert's Rules of Order, Newly Revised shall be the basis of parliamentary decisions except where otherwise provided by law or rule.

(1)-(3)

(No change.)

(4)

The committee shall make decisions in the discharge of its duties without discrimination based on any person's race, creed, gender, religion, national origin, age, physical condition, or economic status.

(5)

(No change.)

(m)

(No change.)

(n)

Statements by members.

(1)

The board, the department, and the committee shall not be bound in any way by any statement or action on the part of any committee member except when a statement or action is in pursuit of specific instructions from the board, department, or committee.

(2)

The committee and its members may not participate in legislative activity in the name of the board, the department, or the committee except with approval through the department's legislative process. Committee members are not prohibited from representing themselves or other entities in the legislative process.

(o)

Reports to board. The committee shall file an annual written report with the board.

(1)

The report shall list the meeting dates of the committee and any subcommittees, the attendance records of its members, a brief description of actions taken by the committee, a description of how the committee has accomplished the tasks given to the committee by the board, the status of any rules which were recommended by the committee to the board, and anticipated activities of the committee for the next year.

(2)

(No change.)

(3)

The report shall cover the meetings and activities in the immediate preceding 12 months and shall be filed with the board each March. It shall be signed by the presiding officer and appropriate department staff.

(p)

Reimbursement for expenses. In accordance with the requirements set forth in the Government Code, Chapter 2110, a committee member may receive reimbursement for the member's expenses incurred for each day the member engages in official committee business if authorized by the General Appropriations Act or budget execution process.

(1)-(5)

(No change.)

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900248

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 30, 1998

For further information, please call: (512) 458-7236


Subchapter C. Texas HIV Medication Program

3. Medication Pilot Program

25 TAC §§98.131-98.141

The Texas Department of Health (department), adopts the repeal of §§98.131 - 98.141 and new §§98.131 - 98.146 concerning the administration of the HIV H.O.P.E. (Health Options to Promote Employment) Project. Section 98.143 is adopted with changes to the proposed text as published in the October 2, 1998, issue of the Texas Register (23 TexReg 9932). The repeal of §§98.131-98.141 and new §§98.131 - 98.142 and 98.144 - 98.146 are adopted without changes to the proposed text, and therefore the sections will not be republished.

These new sections cover the project's purpose, definitions, client eligibility, documentation of residency, criteria for financial eligibility, benefits provided under the project, priority, the client application process, confidentiality, payment for approved services, pharmacy participation, prescription fees, denial of application or termination of client benefits, appeal procedures, exceptions from the appeals procedures, and public complaints.

No comments were received on the proposal during the comment period; however, the department has made a minor change due to staff comments. The change reduces the amount of time a client record may remain inactive before the client is terminated from the program.

Change: Concerning §98.143(a)(2)(B), the number of months a client record may remain inactive is changed from 12 months to 6 months.

The repeals are adopted under the Health and Safety Code, Chapter 85, Subchapter C, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a program to assist hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV-infected individuals in the purchase of medications approved by the board that have been shown to be effective in reducing hospitalizations due to HIV-related conditions; under Rider 54 of the General Appropriations Act of the 75th legislature which gave the department the authority to establish the project; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900310

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


Subchapter D. HIV H.O.P.E. (Health Options to Promote Employment) Project

25 TAC §§98.131-98.146

The new sections are adopted under the Health and Safety Code, Chapter 85, Subchapter C, State Grant Program to Community Organizations, which provides the department with the authority to establish and administer a program to assist hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV-infected individuals in the purchase of medications approved by the board that have been shown to be effective in reducing hospitalizations due to HIV-related conditions; under Rider 54 of the General Appropriations Act of the 75th legislature which gave the department the authority to establish the project; and under the Health and Safety Code, §12.001, Chapter 12, Subchapter A, Powers and Duties of Board, which provides the Texas Board of Health with the authority to adopt rules for the performance of each duty imposed by law on the board, the department, or the commissioner.

§98.143.Denial of Application or Termination of Client Benefits; Criteria.

(a)

Individuals applying for services or clients already receiving services will have their application denied or services terminated for any of the following reasons.

(1)

Services will be denied or terminated if:

(A)

the person is not a resident of the state required in §98.133 of this title (relating to Eligibility);

(B)

the annual gross income does not meet the criteria set in §98.135 of this title (relating to Criteria for Financial Eligibility and Specific Benefits);

(C)

the person receiving services does not have documentation of at least an HIV infection; or

(D)

the client notifies the provider in writing that he/she no longer wants to receive services.

(2)

Services may be terminated if:

(A)

the applicant or client submits an application form or any document required in support of the application which contains a misstatement of fact which is material to determining project eligibility;

(B)

the client has not requested or used services during any period of six consecutive months;

(C)

project funds are curtailed; or

(D)

funds allocated for payments on behalf of the client are exhausted.

(b)

Appeals of the program's decision to deny, modify, suspend, or terminate client services will be governed by the procedures required by §98.144 of this title (relating to Appeals Procedures), and §98.145 of this title (relating to Exceptions from Appeals Procedure).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900311

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: October 2, 1998

For further information, please call: (512) 458-7236


Chapter 157. Emergency Medical Care

Subchapter C. Emergency Medical Services Training and Course Approval

25 TAC §157.40

The Texas Department of Health (department) adopts new §157.40 concerning paramedic licensure with changes to the proposed text as published in the September 25, 1998, issue of the Texas Register (23 TexReg 9695).

House Bill 1407, passed by the 75th Legislature, 1997, amended Health and Safety Code, Chapter 773, to allow the department to establish a program for paramedic licensure. This section encourages paramedics to improve their education level by the requirement of college level course work as well as enhance their assessment skills and judgement.

The department is making the following changes due to staff comments to clarify the intent and improve the accuracy of the section.

Change: Concerning §157.40(b)(3), the word "active" was added to clarify that an inactively certified paramedic does not qualify as a prerequisite for licensure.

Change: Concerning §157.40(b)(6), (h)(4)(C), (k)(1)(C), and (k)(2)(D), the words "in lieu of the state exam" were removed because they were unnecessary.

Change: Concerning §157.40(f), the procedures for accruing and reporting continuing education (CE) hours were inadvertently omitted. The department added instructions in §157.40(f)(3) to refer to the current CE rule §157.38, for all requirements other than §157.38(b) hour requirements and (c) content requirements.

Change: Concerning §157.40(h)(3), the language referred to a certificant's existing license as the "most recent" license. The department replaced the words "most recent" license with "current" license.

Change: Concerning §157.40(h)(4)(A) the complete paragraph reference was inadvertently omitted. The department changed the cite from "subsection (f)" to "subsection (f)(1)".

Change: Concerning §157.40(h)(4)(D), subsection (i) and (i)(2), language existed allowing candidates a three month grace period for relicensure. At the advice of legal counsel, the department eliminated such language.

Change: Concerning §157.40(j), the phrase "and/or training institution records" was referred to as a way to verify a candidate's previous licensure. The department eliminated this language, as training institution records are not verification of licensure.

Change: Concerning §157.40(k), the language did not clearly indicate that reentry is an option after license expiration. The department added language for the allowance.

Change: Concerning §157.40(k)(1)(D) and (k)(2)(D), the phrase "no later than six months after" was used to describe the period for completion of requirements. The department replaced "no later than six months after" with "within six months after".

Change: Concerning §157.40(k)(2)(B), the complete paragraph reference was inadvertently omitted. The department changed the cite from "subsection (f)" to "subsection (f)(1)".

Change: Concerning §157.40(l)(2) and (3), the language is unnecessarily addressing relicensure requirements which are addressed in §157.40(h), (i), (j), and (k). The department eliminated these two paragraphs. With the deletion of paragraph (2) and (3), language in paragraph (1) becomes a part of subsection (l).

Change: Concerning §157.40(m)(7)(A), the word "of" was changed to "after", to clarify that retesting is to occur only after initial testing.

Change: Concerning §157.40(n), the word "his" is unnecessarily specific and the word "return" is ambiguous. The department eliminated each inclusion of the word "his" and replaced "return" with "reassignment".

The following comments were received concerning the proposed new section. Following each comment is the department's response and any resulting change(s).

Comment: One commenter stated that the rule should not be adopted at all.

Response: The department disagrees because the level of licensed paramedic has been legislatively mandated.

Comment: Concerning §157.40(a)(1)(A), (a)(1)(D), (a)(3)(C), and (b)(5), a commenter recommended that the words "regionally accredited college or university" be added for accuracy and consistency.

Response: The department agrees and added the language.

Comment: Concerning §157.40 (a)(1)(A) and (a)(3), two commenters recommended reducing college hours to 30.

Response: The department disagrees because this would effectively eliminate the core curriculum from the hours. No change was made as a result of the comments.

Comment: Concerning §157.40(b)(3), four commenters recommended elimination of the Advanced Cardiac Life Support (ACLS) requirement, while five commenters recommended retaining the requirement or its equivalent.

Response: The department agrees with removing §157.40(b)(3) because the Emergency Health Care Advisory Committee also recommended the elimination of the requirement. The department has deleted this requirement from the subsection.

Comment: Concerning renumbered §157.40(b)(6), two commenters recommended that passing the National Registry exam be a requirement for initial paramedic licensure.

Response: The department disagrees because there is no proof that the National Registry exam is superior to the department's exam, and because it would require an additional fee, sitting for the National Registry exam would increase the expense for individuals seeking licensure. No change was made as a result of this comment.

Comment: Concerning §157.40(g), two commenters recommended that Continuing Education be allowed in other than medical content.

Response: The department disagrees with this recommendation, as it was not finally agreed on by the Emergency Health Care Advisory Committee. This would require a change in the required number of continuing education hours. The necessity for all continuing education courses to be medically related has a higher relevance than non-medical content. No change was made as a result of these comments.

Comment: Concerning §157.40(g), five commenters agreed that all continuing education should be in medical subject areas, as proposed.

Response: The department agrees with those commenting that the hours should be all medical. No change has been made to the section.

Comment: Concerning §157.40(h)(1), a commenter recommended that the department provide E-mail notification to all recertifying candidates to save the department money.

Response: The department disagrees with this comment because of the unreliability of E- mail notifications compared to United States mail. The department deleted the language "including an electronic address if one was listed on the original application".

Comment: Concerning §157.40(h)(4)(C), six commenters recommended that applicants who achieve a passing grade on the initial attempt of the first renewal of the department's written exam be exempt from all future department renewal exam requirements; four commenters support the requirement for testing for relicensure as proposed; one commenter recommended eliminating the relicensure exam requirement completely; and two commenters recommended that the test for relicensure be a different test that would better measure competency of experienced paramedics.

Response: The department worked with a representative group, consisting of five physicians and five paramedics, to reach a compromise regarding testing for licensure renewal. The department has added language that outlines a new process for licensees to waive the renewal exam when authorized by the medical director. The process also requires the candidate to accrue additional CE hours to qualify for the renewal exam waiver. It also allows a paramedic with an EMS degree to extend the license for two years if authorized by the medical director. Language was added as new §157.40(h)(5) and (6).

Comment: Concerning §157.40(h)(4)(C), one commenter recommended against creating a unique exam for paramedic license renewal because no studies have determined the specific capabilities of paramedics in relation to their years of experience.

Response: The department agrees that creating a unique renewal exam for licensed paramedics would be inappropriate at this time. Section 773.0495 of the Health and Safety Code states "An individual qualifies as a licensed paramedic if the department determines that the individual is minimally proficient to provide advanced life support . . . ". To require higher standards for a licensed paramedic to renew would be in conflict with the law which specifically directs the department to determine minimal proficiency. No change was necessary as a result of this comment.

Comment: Concerning §157.40(m)(2), one commenter suggested that the department require all documentation be submitted in English.

Response: The department acknowledges the need for documentation translation and evaluation. The department has changed the language in §157.40(m)(2) to require the course work evaluation be completed by a department approved foreign credentials evaluation service, at the applicant's expense.

The following organizations, associations, or provider groups commented on the rule: The Texas Medical Association; Texas College of Emergency Physicians and the EMS Medical Directors of Texas; Calhoun County Emergency Medical Services; Emergency Medical Services Association of Texas, Inc.; Harlingen Community Emergency Care Foundation, Inc.; and the Washington County Emergency Medical Services. All commenters were not against the rules in their entirety, however they expressed concerns, asked questions and suggested recommendations for change as discussed in the summary of comments.

The new section is adopted under the Health and Safety Code, Chapter 773, which provides the Board of Health (board) with the authority to adopt rules to implement the Emergency Medical Services Act; and §12.001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the Commissioner of Health.

§157.40.Paramedic Licensure.

(a)

Application Requirements for paramedic licensure.

(1)

From the effective date of this section through August 31, 2002, a currently certified paramedic may apply for a paramedic license if the candidate has met at least one of the following requirements:

(A)

at least 60 hours of college credit from a regionally accredited college or university which includes the Academic Core Curricula as defined by the Texas Higher Education Coordinating Board;

(B)

an associate degree;

(C)

a baccalaureate degree; or

(D)

a post graduate degree from a regionally accredited college or university.

(2)

This section shall not be interpreted as limiting the authority of a regionally accredited college or university to grant academic credit for non-traditional educational experiences to persons who are able to demonstrate competence through examination or other methods consistent with institutional policy and procedure.

(3)

Beginning September 1, 2002, a currently certified paramedic may apply for a paramedic license if the candidate has at least one of the following requirements:

(A)

an associate degree in emergency medical services (EMS);

(B)

a baccalaureate degree; or

(C)

a post graduate degree from a regionally accredited college or university.

(b)

Process for those applying for a paramedic license. A candidate for licensure under this section shall:

(1)

be at least 18 years of age;

(2)

submit an application and a nonrefundable fee, if applicable, of $100;

(3)

have completed a Texas Department of Health (department) approved paramedic course. If the candidate is not currently certified as an active paramedic, the candidate shall submit a paramedic course completion certificate;

(4)

have met the appropriate requirements in subsection (a) of this section;

(5)

submit a certified copy of a transcript from a regionally accredited college or university;

(6)

achieve a passing grade on the department's written examination or pass the National Registry examination, if the candidate is not currently certified as an paramedic; and

(7)

complete the department's examination within six months of the course completion date:

(A)

one retest may be taken within six months of the course completion date if the candidate fails to pass the written exam; and

(B)

a fee of $25 shall accompany the request for a retest.

(c)

Examination scheduling. The department has final authority for scheduling all examination sessions.

(1)

Examinations shall be administered at regularly scheduled times in regional test centers.

(2)

The candidate shall make appropriate arrangements for the examination.

(3)

The department is not required to set special examination schedules for a single candidate or for a specific group of candidates.

(d)

Verification of information. After verification by the department of the information submitted by the candidate, a candidate who meets the requirements shall be licensed for a period of four years from the effective date.

(1)

The license is not transferable. A wallet-size copy of the license shall be issued and carried by the licensee while on EMS duty.

(2)

Duplicate copies of the license and wallet-size copy may be issued to replace lost credentials for a fee of $5.00.

(e)

A licensed paramedic may not hold a department EMS certificate except for that of EMS coordinator, EMS examiner or EMS instructor.

(f)

Continuing education (CE) hours. During the four-year licensure period, each licensee shall complete at least the following minimum number of contact hours of approved CE to be eligible for renewal of a license. Licensees shall accrue at least one-half of the required number of hours in the first two years of the licensure period.

(1)

Licensed paramedics are required to complete 96 hours to be eligible for renewal of their license.

(2)

Employers and/or medical directors may require licensees under their supervision to complete additional requirements.

(3)

All CE shall meet the requirements of §157.38 of this title (relating to Continuing Education) except for §157.38(b) hour requirements and (c) content requirements.

(g)

CE subject areas. CE hours shall be accrued within one or more of the following medical subject areas:

(1)

patient assessment and management;

(2)

cardiac disorders;

(3)

pulmonary disorders;

(4)

endocrine disorders;

(5)

neurological disorders;

(6)

other medical disorders;

(7)

behavioral disorders;

(8)

obstetrics/gynecology;

(9)

pediatrics;

(10)

geriatrics;

(11)

trauma; or

(12)

protocols.

(h)

Renewal.

(1)

Prior to the expiration of a license, the department shall mail a notice of expiration by United States mail or electronic mail to the licensee at the address shown in current records of the Bureau of Emergency Management (bureau). It is the responsibility of the licensed paramedic to notify the bureau of any change of address.

(2)

If a licensed paramedic has not received notice of expiration from the department 45 days prior to the expiration of the license, it is the duty of the license holder to notify the department and request an application for renewal of the license. Failure to apply for renewal of the license shall result in expiration of the license.

(3)

An application for renewal of a license shall be submitted and all requirements for renewal of the license shall be completed no later than the expiration date of the current license.

(4)

A licensed paramedic shall meet the following requirements for renewal of the license:

(A)

complete within the previous four years the number of approved CE hours for the licensed paramedic as required in subsection (f)(1) of this section within one or more of the medical subject areas listed in subsection (g) of this section and submit a CE summary form listing the completed hours;

(B)

submit an application for renewal of the license to the department along with the appropriate nonrefundable fee as required in subsection (b)(2) of this section;

(C)

achieve a passing grade on the National Registry examination; however,

(i)

the test shall be waived if the candidate submits authorization from the medical director; and

(ii)

documentation of an additional ten hours of CE per year for a four year total of 136 CE hours;

(D)

complete the examination before the current license expiration date:

(i)

one retest may be taken no later than the expiration date of the current license if the candidate fails the written exam;

(ii)

a fee of $25 shall accompany the request for a retest; and

(iii)

the National Registry examination may be taken in lieu of the department's retest.

(E)

completion of the process in this paragraph establishes eligibility for licensure renewal only. Other requirements may be levied by an employer and/or medical director as a condition of employment/volunteering.

(5)

A licensed paramedic with an EMS degree shall meet the following requirements to extend the license for two more years:

(A)

complete within the previous four years the number of approved CE hours for the licensed paramedic as required in subsection (f)(1) of this section within one or more of the medical subject areas listed in subsection (g) of this section; and

(i)

submit a CE summary form listing the completed hours plus an additional 10 hours of CE per year for a four year total of 136 CE hours;

(ii)

submit an application for extension of the license to the department along with a fee of $50; and

(iii)

submit authorization from the medical director to waive the exam at the four-year mark.

(B)

completion of the process in this paragraph establishes eligibility for licensure extension only. Other requirements may be levied by an employer and/or medical director as a condition of employment/volunteering.

(6)

A licensed paramedic with an EMS degree who has received a two year extension, shall meet the following requirements for renewal of the license:

(A)

complete 68 hours of CE within the previous two years, for a total of 204 hours for six years, within one or more of the medical subject areas listed in subsection (g) of this section and submit a CE summary form listing the completed hours;

(B)

submit an application for renewal of the license to the department along with the a nonrefundable fee of $100;

(C)

achieve a passing grade on the department's written examination or pass the National Registry examination; however, the test shall be waived if the candidate submits authorization from the medical director; and

(D)

complete the examination before the extended license expiration date:

(i)

one retest may be taken no later than the current extended license expiration date if the candidate fails the written exam;

(ii)

a fee of $25 shall accompany the request for a retest; and

(iii)

the National Registry examination may be taken in lieu of the department's retest.

(E)

completion of the process in this paragraph establishes eligibility for licensure renewal only. Other requirements may be levied by an employer and/or medical director as a condition of employment/volunteering.

(7)

After verification by the department of the information submitted, the license will be renewed or inactive status will be initiated, whichever is appropriate, for four years beginning on the day following the expiration date of the license. A new wallet-size card signed by department officials shall be issued.

(i)

Late renewal of a license. An application for renewal of a license shall be considered late if requirements for renewal are received after the most recent license has expired.

(1)

Late applications shall be accompanied by a late fee of $25 in addition to the regular fee.

(2)

Persons who do not complete the relicensure process by their expiration date are not licensed.

(j)

Inactive status. A licensed paramedic may make application to the department for inactive status at any time during or within three years after the license expiration date, if the license can be verified by the department.

(1)

If the request is made to change a current license to an inactive status, there is no fee.

(2)

The initial inactive status period shall remain in effect until the end of the current license period for those candidates who are currently licensed and shall be renewable every four years thereafter. The candidate shall submit an application and the full fee as stated in subsection (b)(2) of this section.

(3)

The initial inactive status period shall remain in effect for four years from the date of issuance for those candidates not currently licensed.

(4)

While on inactive status a person shall not provide patient care as that of certified or licensed personnel and may only act as a bystander. Failure to comply shall be cause for revocation of the inactive status license and may cause denial of future applications for licensure.

(k)

Reentry. Reentry is the process for regaining EMS licensure after a period of inactive or expired status, or when an application for renewal is postmarked and/or the requirements for relicensure are met more than three months after the expiration of the most recent license.

(1)

To reenter from inactive status the candidate shall:

(A)

complete a department-approved formal paramedic refresher course;

(B)

submit an application and nonrefundable fee as required in subsection (b)(2) of this section, in addition to a late fee as in subsection (i)(1) of this section;

(C)

pass the department's written examination or pass the National Registry examination; and

(D)

all reentry requirements shall be completed within six months after the application date.

(2)

To reenter after a license has expired, the candidate shall:

(A)

apply within the department's record retention requirements for the prior license, which is no later than three years past the license expiration;

(B)

have completed, within the previous four years, the number of approved CE hours for the licensed paramedic as required in subsection (f)(1) of this section within one or more of the subject areas listed in subsection (g) of this section and submit a CE summary form listing the completed hours;

(C)

submit an application for relicensure and the nonrefundable fee as required in subsection (b)(2) of this section; in addition to the late fee as in subsection (i)(1) of this section; and

(D)

pass the department's written examination or pass the National Registry examination, within six months after the application date.

(l)

Reciprocity. A person currently certified by the National Registry and/or certified or licensed as a paramedic in another state and who meets all the requirements of this section may apply for licensure by submitting an application and a fee of $100. After the department evaluates the application, verifies the licensure and assures that the requirements in subsection (b) of this section have been met, the candidate will be licensed in Texas for four years from the issuance date of the current Texas licensure.

(m)

Equivalency. A candidate from outside the United States applying for a paramedic license shall:

(1)

submit a personnel application and a nonrefundable fee of $150;

(2)

submit a copy of the curriculum for the course completed, after having it translated and evaluated (course-by-course) by a foreign credentials evaluation service at the applicant's expense;

(3)

submit evidence of successful course completion and licensure;

(4)

complete any deficiencies identified during the curriculum review or completion of a department-approved paramedic refresher course;

(5)

submit evidence that the requirements of this section have been met;

(6)

achieve a passing grade on the department's written examination or pass the National Registry examination; and

(7)

complete the examination within six months of the application date:

(A)

one retest may be taken within six months after the application date;

(B)

a fee of $25 shall accompany the request for a retest; and

(C)

the National Registry examination may be taken in lieu of the department's retest.

(n)

Military personnel. A certificant who fails to renew a license within three months of the expiration date because of active duty in the United States military outside the State of Texas shall have one year from the date of discharge or the date of reassignment to Texas (whichever is first) to complete all requirements for relicensure.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on January 15, 1999.

TRD-9900246

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 4, 1999

Proposal publication date: September 25, 1998

For further information, please call: (512) 458-7236