TITLE health-services

Part I. Texas Department of Health

Chapter 1. Texas Board of Health

Subchapter L. Medical Advisory Board

25 TAC §1.151

(Editor's note: The text of the following section proposed for repeal will not be published.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

The Texas Department of Health (department) proposes the repeal of §1.151 and new §1.151 and §1.152, concerning the operation of the Medical Advisory Board (MAB). As called for by Health and Safety Code, §12.095, the MAB makes recommendations to the Texas Department of Public Safety (DPS) regarding the possible medical limitations of driver licensees/applicants, and/or factors which may affect the sound judgment of concealed handgun licensees/applicants.

The General Appropriations Act, HB1, Article IX, Rider 167, passed by the 75th Legislature, requires that each state agency review and consider for re-adoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act). Section 1.151 has been reviewed and the department has determined that reason for-adopting the section continues to exist in that a rule on this subject is needed; however, the rule needs revision as described in the preamble.

New §1.151 and §1.152 became necessary due to legislation in the 75th Legislature, Regular Session. Specifically, HB 2909 amended §12.092 and §12.095 of the Health and Safety Code to additionally require the MAB to assist DPS in determining whether an applicant for or a holder of a license to carry a concealed handgun is capable of exercising sound judgment with respect to the proper use and storage of a handgun. References to the Medical Standards on Motor Vehicle Operations Division (MSMVO) have been replaced with language referring to the Medical Advisory Board or the bureau. New §1.152 creates a department physician to serve as permanent chair of the MAB for quality improvement, to ensure stability and to increase the efficiency of the panel.

The department published a Notice of Intention to review §1.151 as required by Rider 167 in the Texas Register (23 TexReg 9076) on September 4, 1998. No comments were received by the department on this section.

Gene Weatherall, Bureau Chief, has determined that for each year of the first five-year period the sections are in effect, there will be no fiscal implications to state or local government as a result of enforcing or administering the sections as proposed.

Mr. Weatherall also has determined that for each year of the first five years the sections are in effect, the public benefit anticipated as a result of enforcing the sections will be fewer, but more effective meetings and more thorough deliberation of the cases. There will be no effect on small business. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated impact on local employment.

Comments on the proposal may be submitted in writing to Gene Weatherall, Chief, Bureau of Emergency Management, 1100 West 49th Street, Austin, Texas 78756-3199, (512) 834-6700. Comments will be accepted for 30 days following publication of this proposal in the Texas Register .

The repeal is proposed under the Health and Safety Code, §§12.001, 12.092, 12.094 and 12.095, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the Commissioner of Health.

The repeal affects the Health and Safety Code, §12.094, the Health and Safety Code, Chapter 12; and the General Appropriations Act, House Bill 1, Article IX, Rider 167, passed by the 75th Legislature.

§1.151.Operation of the Medical Advisory Board and the Medical Standards on Motor Vehicle Operations Division.

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 12, 1999.

TRD-9900940

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


25 TAC §1.151, §1.152

The new sections are proposed under the Health and Safety Code, §§12.001, 12.092, 12.094 and 12.095, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the Commissioner of Health.

The new sections affect the Health and Safety Code, §12.094, the Health and Safety Code, Chapter 12; and the General Appropriations Act, House Bill 1, Article IX, Rider 167, passed by the 75th Legislature.

§1.151.Definitions.

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

(1)

Applicant - An individual referred by the Texas Department of Public Safety (DPS) to the Medical Advisory Board (MAB) for medical review.

(2)

Bureau - The Texas Department of Health, Bureau of Emergency Management staff, responsible for administering MAB activities.

(3)

Commissioner - The Commissioner of Health.

(4)

DPS -The Department of Public Safety.

(5)

MAB -The Medical Advisory Board (MAB) is the body of physicians and optometrists licensed by the State of Texas and established under authority of the Health and Safety Code, §12.092, from which a panel is to be convened when opinions are requested by the DPS.

(6)

MAB Chair - The Health Care Quality & Standards medical consultant physician appointed by the Commissioner of Health (commissioner) to chair the MAB, and to act in the capacity of a MAB member.

(7)

MAB panel - A body of at least three MAB members, convened to review applicants and provide opinions at the request of the DPS.

§1.152.Operation of the Medical Advisory Board.

(a)

Purpose. The purpose of this section is to establish the requirements governing the operation and administration of the Medical Advisory Board (MAB).

(b)

Appointment and terms of office.

(1)

The present MAB is divided into four groups:

(A)

Group One's term will expire January 1 of even numbered years;

(B)

Group Two's term will expire July 1 of even numbered years;

(C)

Group Three's term will expire January 1 of odd numbered years; and

(D)

Group Four's term will expire July 1 of odd numbered years.

(2)

The commissioner shall appoint MAB members from:

(A)

persons licensed to practice medicine in Texas, including physicians who are board certified in medicine, psychiatry, neurology, physical medicine, or ophthalmology, and who are jointly recommended by the Texas Department of Health (department) and the Texas Medical Association; and

(B)

persons licensed to practice optometry in this state who are jointly recommended by the department and the Texas Optometric Association.

(3)

The Health Care Quality and Standards medical consultant to the MAB shall serve as MAB chair.

(c)

Meetings.

(1)

Upon request by the Department of Public Safety (DPS), the Bureau of Emergency Management (bureau) shall convene a MAB panel.

(A)

To take action as a panel, at least three members of the MAB must be present.

(B)

Each panel member shall prepare an individual independent written report that states the member's opinion as to the ability of an applicant or licensee to operate a motor vehicle safely or to exercise sound judgment with respect to the proper use and storage of a handgun.

(2)

Failure to attend scheduled meetings may result in a recommendation for the member's dismissal from the MAB by the MAB chair.

(3)

The MAB shall meet in closed session to discuss records, reports, or testimony relating to the medical condition of an applicant or licensee. All such records, reports, and testimony are for the confidential use of the MAB and DPS and may not be disclosed to others except as authorized by the Transportation Code, Chapter 521, Subchapter N.

(d)

Official records.

(1)

The bureau may collect and maintain the individual medical records from a physician, hospital, or other health care provider necessary for use by the MAB. All records provided shall be kept confidential. Health care providers may request and shall be mailed a copy of any medical information they provided.

(2)

The applicant shall provide current medical information to the MAB which is pertinent to the medical condition(s) for which DPS requested the review. Information shall be provided within 20 days by a licensed physician or a licensed medical facility. In lieu of a physician, any department-approved health care provider who treated the applicant may provide information regarding the candidate's fitness to operate a motor vehicle safely; or to the ability to exercise sound judgment with respect to the proper use and storage of a handgun.

(3)

In its deliberations, the MAB panel may examine any medical records or reports containing material which may be relevant to the ability of the licensee or applicant to operate a motor vehicle safely or the ability to exercise sound judgment with respect to the proper use and storage of a hand gun. Additional information supplied to the bureau or DPS may be utilized. Any decision will be held in abeyance until the applicant provides all additional information deemed necessary by the MAB.

(4)

An affidavit of MAB proceedings shall be prepared for DPS upon request.

(5)

The members on the MAB shall issue recommendations or opinions to DPS. The final decision to issue, renew, restrict, or revoke a license shall rest entirely with DPS.

(6)

MAB members other than the MAB chair shall be paid a meeting attendance fee in the amount of $100 per meeting.

(e)

Impartiality. Any MAB member who is unable to be impartial as to any applicant before the MAB shall so declare this partiality to the members present and shall not participate in any MAB proceedings involving that applicant.

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 12, 1999.

TRD-9900941

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 14. County Indigent Health Care Program

Subchapter F. Advisory Committee

25 TAC §14.501

The Texas Department of Health (department) proposes an amendment to §14.501, concerning the Indigent Health Care Advisory Committee (committee). The committee provides advice to the Texas Board of Health (board) in the area of the Indigent Health Care 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 on advisory committees. The rules must state the purpose 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's existence.

In 1995, the board established a rule relating to the Indigent Health Care Advisory Committee. The rule states that the committee will automatically be abolished on July 1, 1999. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until July 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 July 1, 2003; to change the composition of the committee; to clarify that members holdover until their replacement is appointed; to standardize the time of the appointment process at every two years instead of every year; 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; to require the committee's annual report in July rather than January; and reimbursement for a committee member's expenses if authorized by General Appropriations Act or budget execution process. These changes will clarify procedures for the committee and emphasize the advisory nature of the committee.

Debbie Blount, Associate Commissioner for Health Care Financing Program and Policy, has determined that for each year of the first five years the proposed section is in effect, there will be no fiscal implications for state or local governments as a result of enforcing or administering this section.

Ms. Blount also has determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be better information and advice provided to the board and the department on the issues addressed by the advisory committee and clarification of the role and procedures of the committee. There will be no effect on small businesses. There are no economic costs to persons who are required to comply with the section as proposed. There will be no effect on local employment.

Comments may be submitted to Rose Marie Linan, Indigent Health Care Program, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 338-6458. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The amendment is proposed 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.

The amendment affects the Health and Safety Code, Chapter 11, and the Government Code, Chapter 2110.

§14.501.Indigent Health Care Advisory Committee.

(a)

(No change.)

(b)

Applicable law. The committee is subject to the Government Code, Chapter 2110 [ Texas Civil Statutes, Article 6252-33 ], concerning state agency advisory committees.

(c)-(d)

(No change.)

(e)

Review and duration. By July 1, 2003 [ 1999 ], 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 consisting of four [ two ] consumer and seven [ nine ] other representatives appointed by the board.

(2)

Since the composition of the committee as it existed on March 1, 1999, 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 terms until a replacement is appointed.

(1)

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

(2)

(No change.)

(h)

Officers. The chairman of the board [ committee ] shall appoint [ elect ] a presiding officer and an assistant presiding officer to begin serving on July 1 of each odd-numbered year [ at its first meeting after August 31st of each year ].

(1)

Each officer shall serve until the June 30th of each odd-numbered year. Each officer may holdover until his or her replacement is appointed by the chairman of the board [ next regular election of officers ].

(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 [ elected ] 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 [ A vacancy which occurs in the offices of presiding officer or assistant presiding officer ] may be filled temporarily by vote of the committee until a successor if appointed by the chairman of the board [ at the next committee meeting ].

(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 [ 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.)

[ (4)

The attendance records of the members shall be reported to the board. The report shall include attendance at committee and subcommittee meetings. ]

(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[ , and any amendments to this section requested by the committee ].

(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 July [ January ]. 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 [ Texas Civil Statutes, Article 6252-33 ], 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 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 12, 1999.

TRD-9900936

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 29. Purchased Health Services

Subchapter D. Medicaid Home Health Services

25 TAC §29.303, §29.305

Subject to the approval of the State Medicaid Director, the Texas Department of Health (department) proposes amendments to §29.303 and §29.305, concerning recipient qualifications for home health services and home health services benefits and limitations.

The department has determined the need to amend its rules to ensure access to medically necessary diabetic supplies and related testing equipment, and to expedite the delivery of medically necessary home health services to recipients. The amendments remove the homebound requirement for receiving diabetic supplies and related testing equipment and permits the department to eliminate the prior authorization requirement for certain services.

Joe Moritz, Health Care Financing Budget Director, has determined that for the first five-year period the sections are in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the sections as proposed.

Mr. Moritz also has determined that for each year of the five years the sections are in effect, the public benefit anticipated as a result of enforcing the sections will be to ensure accessibility to medically necessary services. There will be no effect on small businesses and there are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no impact on local employment.

Comments on the proposal may be submitted to Nancy Nichols, Program Specialist III, Health Care Financing, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3168, (512) 338-6511. Comments will be accepted for 30 days following publication of this proposal in the Texas Register .

The amendments are proposed under the Human Resources Code, §32.021 and Government Code §531.02, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program and is submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program and as authorized under Chapter 15, §1.07, Acts of the 72nd Legislature, First Called Session (1991).

These proposed amendments affect Chapter 32 of the Human Resources Code and Chapter 531 of the Government Code.

§29.303.Recipient Qualifications for Home Health Services.

An eligible Medicaid recipient must meet the following requirements to qualify for Medicaid home health services:

(1)-(3)

(No change.)

(4)

receive prior authorization from the department for home health services unless otherwise specified by the department ; and

(5)

(No change.)

§29.305.Home Health Services Benefits and Limitations.

(a)

Home health service benefits include the following.

(1)-(2)

(No change.)

(3)

Medical supplies. Medical supplies are covered benefits if they meet the following criteria.

(A)

Medical supplies must be:

(i)-(iii)

(No change.)

(iv)

prior authorized unless otherwise specified by the department.

(B)-(C)

(No change.)

(4)

Durable medical equipment (DME). Durable Medical Equipment [ DME ] must meet the following requirements to qualify for reimbursement under Medicaid home health services.

(A)

DME must:

(i)

(No change.)

(ii)

be prior authorized unless otherwise specified by the department;

(iii)-(vi)

(No change.)

(B)-(D)

(No change.)

(5)-(7)

(No change.)

(8)

Diabetic supplies and related testing equipment. Diabetic supplies and related testing equipment must meet the following requirements to qualify for reimbursement under Medicaid home health services:

(A)

diabetic supplies and related testing equipment must be prescribed by a physician;

(B)

prior authorization is required unless otherwise specified by the department; and

(C)

an eligible recipient is not required to be homebound to obtain diabetic supplies and related testing equipment.

(b)

Home health service limitations include the following.

(1)-(3)

(No change.)

(4)

Prior approval. Services or supplies furnished without prior approval , unless otherwise specified by the department , are not benefits.

(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 22, 1999.

TRD-9901038

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 37. Maternal and Child Health Services

Subchapter H. Midwives

25 TAC §§37.171-37.174, 37.176, 37.177, 37.179, 37.181-37.185

The Texas Department of Health (department) proposes the repeal of §§37.171- 37.174, 37.176-37.177, 37.179, 37.181-37.185, concerning midwives. Specifically, the sections cover purpose; definitions, duties of the Texas Board of Health, the Midwifery Board, the Texas Department of Health, and the midwifery program coordinator; Midwifery Board meetings; additional information collected by the midwifery program; informed choice and disclosure statement; publishing of reports; newborn screening; injunctions and civil and criminal penalties; provision of support services; eye prophylaxis; and midwifery practice standards and principles.

The department proposes repeal of the sections in 25 Texas Administrative Code (TAC) in order that new sections may be proposed by the Texas Midwifery Board for adoption at 22 TAC, Examining Boards, Chapter 831, Midwives. The Texas Midwifery Board is authorized by the Texas Midwifery Act (the Act), Texas Civil Statutes, Article 4512i, §8A(b), to adopt rules concerning documentation of midwives; standards for approval of midwifery education courses, instructors, and facilities; standards for midwifery practice; basic and continuing midwifery education requirements; reporting and processing complaints; disciplinary procedures; procedures for reciprocity for initial documentation; and any additional rules necessary to implement any duty imposed on the board by the Act, subject to the approval of the Texas Board of Health. Effective December 1, 1998, the Midwifery Program and the Midwifery Board were administratively transferred from the department's Women's Health Division to the department's Professional Licensing and Certification Division. The new rules proposed by the Midwifery Board in 22 TAC, Chapter 831, can be found in this issue of the Texas Register in the Proposed Rule section.

Jack Baum, D.D.S., Acting Associate Commissioner for Community Resources and Development, has determined that for the first five-year period the sections are in effect, there will be no fiscal implications for state or local government as a result of the repeals.

Dr. Baum also has determined that for each of the first five years the repeals are in effect, the public benefit anticipated is more effective regulation of the midwifery practice. There are no anticipated economic costs to small businesses or to persons who will be affected by the repeals. No effect on local employment is anticipated.

Written comments on the proposed repeals may be submitted to Yvonne Feinleib, Midwifery Program Director, Professional Licensing and Certification Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3189, telephone (512) 834-4523. Comments will be accepted for 30 days following publication of the proposed repeals in the Texas Register .

The repeals are proposed under Health and Safety Code, §12.001(b), 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.

The repeals affect the Texas Midwifery Act, Texas Civil Statutes, Article 4512i.

Sections proposed for Repeal:

§37.171.Purpose.

§37.172.Definitions.

§37.173. Duties of the Texas Board of Health, the Midwifery Board, the Texas Department of Health and the Midwifery Program Coordinator.

§37.174. Midwifery Board.

§37.176. Additional Information.

§37.177. Informed Choice and Disclosure Statement.

§37.179. Publishing Reports.

§37.181. Newborn Screening.

§37.182. Injunctions and Civil and Criminal Penalties.

§37.183. Provision of Support Services.

§37.184. Eye Prophylaxis.

§37.185. Midwifery Practice Standards and Principles.

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 12, 1999.

TRD-9900956

Edna Dougherty

Chair

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 39. Primary Health Care Services Program

Subchapter B. State Primary Care Program Advisory Committee

25 TAC §39.41

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

The Texas Department of Health (department) proposes the repeal of §39.41, concerning the Community Oriented Primary Care Advisory Committee (committee). The committee has provided advice to the Texas Board of Health (board) and the department in planning, coordinating, and administering the development of a community-based comprehensive system of primary care, encompassing a full spectrum of psychosocial, preventive, acute/urgent, case management, and dental services.

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 on advisory committees. The rules must state the purpose 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's existence.

In 1995, the board established a rule relating to the Community Oriented Primary Care Advisory Committee. The rule states that the committee will automatically be abolished on July 1, 1999. The board has now reviewed and evaluated the committee and has determined that the committee should be abolished. Issues relating to the type of advice previously provided by the committee may be addressed through the establishment of ad hoc committees

Janet Lawson, M.D., Acting Chief, Bureau of Community Oriented Public Health, has determined that for each year of the first five years the repeal is in effect, there will be no fiscal implications for state or local governments as a result of enforcing or administering this section since the section will no longer exist.

Dr. Lawson also has determined that for each year of the first five years the repeal is in effect, the public benefit anticipated as a result of enforcing the section will be nonexistent since the section will no longer exist. There will be no effect on small businesses. There are no economic costs to persons as a result of this repeal. There will be no effect on local employment.

Comments may be submitted to Janet Lawson, M.D., Acting Chief, Bureau of Community Oriented Public Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-2177. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The repeal is proposed 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.

The repeal affects the Health and Safety Code, Chapter 11, and the Government Code, Chapter 2110.

§39.41.Community Oriented Primary Care Advisory Committee

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 12, 1999.

TRD-9900945

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 115. Home and Community Support Services Agencies

Subchapter F. Advisory Committee

25 TAC §115.71

The Texas Department of Health (department) proposes an amendment to §115.71, concerning the Home and Community Support Services Advisory Committee (committee). The committee provides advice to the Texas Board of Health (board) in the area of licensing of home and community support services agencies and was established under the Health and Safety Code, §142.015.

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 on advisory committees. The rules must state the purpose 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's existence.

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

This section amends provisions relating to the operation of the committee. Specifically, language is revised to reference the Government Code; to add the task of advising the department on enforcement provisions as specified in the Health and Safety Code, §142.015(c); to continue the committee until July 1, 2003; to clarify who may call a meeting; 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; to require the committee's annual report in July rather than January; and to reference reimbursement of a member's expenses if authorized by the General Appropriations Act or budget execution process. These changes will clarify procedures for the committee and emphasize the advisory nature of the committee.

C. Thomas Camp, Chief, Bureau of Licensing and Compliance, has determined that for each year of the first five years the proposed section is in effect, there will be no fiscal implications for state or local governments as a result of enforcing or administering this section.

Mr. Camp also has determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be better information and advice provided to the board and the department on the issues addressed by the advisory committee and clarification of the role and procedures of the committee. There will be no effect on small businesses. There are no economic costs to persons who are required to comply with the section as proposed. There will be no effect on local employment.

Comments may be submitted to Veronda Durden, Health Facility Licensing Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, 512/834-6647. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The amendment is proposed 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.

The amendment affects the Health and Safety Code, Chapter 11, and the Government Code, Chapter 2110.

§115.71. Home and Community Support Services Advisory Committee.

(a)

(No change.)

(b)

Applicable law. The committee is subject to the Government Code, Chapter 2110 [ Texas Civil Statutes, Article 6252-33 ], concerning state agency advisory committees.

(c)

( No change.)

(d)

Tasks.

(1)-(2)

(No change.)

(3)

The committee may advise the Texas Department of Health (department) on the implementation of enforcement provisions of the Health and Safety Code, Chapter 142.

(4)

[ (3) ]The committee shall carry out any other tasks given to the committee by the board.

(e)

Review and duration. By July 1, 2003 [ 1999 ], 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)-(h)

(No change.)

(i)

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

(1)

A meeting may be called by department [ agreement of Texas Department of Health (department) ] staff , [ and either ] the presiding officer , or any three members of the committee.

(2)

(No change.)

(3)

The committee is not a "governmental body" as defined in the Open Meeting Act. However, in order to promote public participation, each [ 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.)

[ (4)

The attendance records of the members shall be reported to the board. The report shall include attendance at committee and subcommittee meetings. ]

(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[ , and any amendments to this section requested by the committee ].

(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 July [ January ]. 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 [ A ] committee member may [ not ] receive reimbursement for the member's expenses incurred for each day the member engages in official business [ unless allowed under the Texas Civil Statutes, Article 6252-33 ] if authorized by the General Appropriations Act or budget execution process .

(1)-(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 12, 1999.

TRD-9900942

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


25 TAC §115.72

The Texas Department of Health (department) proposes an amendment to §115.72, concerning the Texas Department of Health/Board of Nurse Examiners (TDH/BNE) Memorandum of Understanding Advisory Committee (committee). The committee provides advice to the Texas Board of Health (board) and the Board of Nurse Examiners (BNE) regarding circumstances under which the provision of health-related tasks or services provided by a home and community support services agency are not considered to be the practice of professional nursing under the personal assistance services licensure category. The committee was established under the Health and Safety Code, §142.016(b).

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 on advisory committees. The rules must state the purpose 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's existence.

In 1995, the board established a rule relating to the TDH/BNE Memorandum of Understanding Advisory Committee. The rule states that the committee will automatically be abolished on July 1, 1999. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until July 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 July 1, 2003; to clarify that members holdover until their replacement is appointed; 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, the BNE, or the committee except with certain approval; to require the committee's annual report in July rather than January; and reimbursement for a committee member's expenses if authorized by General Appropriations Act or budget execution process. These changes will clarify procedures for the committee and emphasize the advisory nature of the committee.

C. Thomas Camp, Chief, Bureau of Licensing and Compliance, has determined that for each year of the first five years the proposed section is in effect, there will be no fiscal implications for state or local governments as a result of enforcing or administering this section.

Mr. Camp also has determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of enforcing the section will be better information and advice provided to the board and the department on the issues addressed by the advisory committee and clarification of the role and procedures of the committee. There will be no effect on small businesses. There are no economic costs to persons who are required to comply with the section as proposed. There will be no effect on local employment.

Comments may be submitted to Veronda Durden, Health Facility Compliance Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 834-6647. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The amendment is proposed 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.

The amendment affects the Health and Safety Code, Chapter 11, and the Government Code, Chapter 2110.

§115.72.Texas Department of Health/Board of Nurse Examiners Memorandum of Understanding Advisory Committee.

(a)

(No change.)

(b)

Applicable law. The committee is subject to the Government Code, Chapter 2110 [ Texas Civil Statutes, Article 6252-33 ], concerning state agency advisory committees.

(c)-(d)

(No change.)

(e)

Review and duration. By July 1, 2003 [ 1999 ], 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 ten members [ jointly appointed by the board and the BNE ]. The members of the committee shall be appointed as follows:

(A)

[ (1) ] one representative from the BNE and one representative from the Texas Department of Health (department);

(B)

[ (2) ] one representative from the Texas Department of Mental Health and Mental Retardation;

(C)

[ (3) ] one representative from the Texas Department of Human Services;

(D)

[ (4) ] one representative from the Texas Nurses Association;

(E)

[ (5) ] one representative from the Texas Association for Home Care, Incorporated, or its successor;

(F)

[ (6) ] one representative from the Texas Hospice Organization, Incorporated, or its successor;

(G)

[ (7) ] one representative of the Texas Respite Resource Network or its successor; and

(H)

[ (8) ] two representatives of organizations such as the Personal Assistance Task Force or the Disability Consortium that advocate for clients in community-based settings.

(2)

The representatives from the organizations listed in subparagraphs (1)-(7) may serve without further approval of the board or the BNE. The representatives of organizations described in subparagraph (8) must be approved by the board and the BNE before serving.

(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 January 31 of each even-numbered year.

(2)

(No change.)

(h)

(No change.)

(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 [ 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.)

[ (4)

The attendance records of the members shall be reported to the board. The report shall include attendance at committee and subcommittee meetings. ]

(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, the BNE, 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 and the BNE [ in sufficient detail to allow each agency to report to the legislative budget board pursuant to Texas Revised Civil Statutes Annotated, Article 6252-33, §7 ].

(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[ , and any amendments to this section requested by the committee ].

(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 and the BNE each July [ January ]. It shall be signed by the co-chairmen and appropriate department staff.

(p)

Reimbursement for expenses. Except in accordance with the requirements set forth in the Government Code, Chapter 2110 [ Texas Revised Civil Statutes Annotated, Article 6252-33, §4 ], a committee member shall [ not ] be reimbursed for 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 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 12, 1999.

TRD-9900944

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 143. Medical Radiologic Technologists

25 TAC §§143.1, 143.2, 143.4, 143.7-143.9, 143.11, 143.14, 143.16–143.20

The Texas Department of Health (department) proposes amendments to §§143.1, 143.2, 143.4, 143.7-143.9, 143.11, 143.14, and 143.16-143.20, concerning persons performing radiologic procedures. The amendments cover purpose and scope; definitions; fees; types of certificates and applicant eligibility; examinations; standards for the approval of curricula and instructors; continuing education requirements; disciplinary actions; dangerous or hazardous procedures; mandatory training programs for non-certified technicians; registry of non-certified technicians; hardship exemptions; and alternate training requirements.

The amendments add definitions for physician assistant, mobile radiography, mobile x-ray equipment and portable x-ray equipment. All definitions are included with numbers to comply with the new Texas Register format required by 1 Texas Administrative Code, §91.1, effective February 17, 1998. Also, the amendments will add a waiver for training program fees for programs accredited by the Texas Higher Education Coordinating Board; list what is considered directly related continuing education topics; clarify dangerous or hazardous procedures for registered nurses and physician assistants; add qualifications for non-certified technician training program instructors; and update and clarify existing language.

Bernie Underwood, C.P.A., Chief of Staff Services, Health Care Quality and Standards, has determined that for each of the first five years the sections will be in effect, there will be fiscal implications as a result of enforcing or administering the sections as proposed. The effect on state government will be an estimated decrease in revenue to the state of approximately $600 per year. There will be no fiscal implication for local government.

Ms. Underwood has determined that for each year of the first five years the sections as proposed are in effect, the public benefit anticipated as a result of enforcing the sections as proposed will be to assure the appropriate regulation of medical radiologic technologists and continue to identify competent medical radiologic technologists. There will be no effect on small businesses. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated impact on local employment.

Comments on the proposal may be submitted to Jeanette Hilsabeck, Administrator, Medical Radiologic Technologist Certification Program, Professional Licensing and Certification Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas, 78756-3183, (512) 834-6617; FAX (512) 834-6677. Comments will be accepted for 30 days following publication of this proposal in the Texas Register .

The amendments are proposed under the Medical Radiologic Technologist Certification Act, Texas Civil Statutes, Article 4512m, §2.05(e) which provides the Texas Board of Health (board)with the authority to adopt rules necessary to implement the Act; and the Texas Health and Safety Code §12.001, which provides the board 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.

These proposed amendments implement the Medical Radiologic Technologist Certification Act, Texas Civil Statutes, 4512m.

§143.1.Purpose and Scope.

(a)

(No change.)

(b)

Scope. These sections cover definitions; the Medical Radiologic Technologist Advisory Committee; fees; applicability (exceptions to certification); application requirements and procedures; types of certificates; examinations; standards for curricula and instructor approval; certificate renewal; continuing education requirements; changes of name or address; certifying persons with criminal backgrounds to be medical radiologic technologists; disciplinary actions; alternate eligibility requirements; dangerous or hazardous procedures; mandatory training programs for non-certified technicians; registry of non-certified technicians; [ and ] hardship exemptions ; and alternate training requirements .

§143.2.Definitions.

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

(1)

Act - The Medical Radiologic Technologist Certification Act, Texas Civil Statutes, Article 4512m, Acts 1987, 70th Legislature, Chapter 1096, §3.01.

(2)

Administrator - The department employee designated as the administrator of regulatory activities authorized by the Act.

(3)

AMA - The American Medical Association.

(4)

AP - Anterior/posterior.

(5)

Applicant - A person who applies to the Texas Department of Health for a certificate or temporary certificate, general or limited.

(6)

ARCRT - American Registry of Clinical Radiography Technologists and its successor organizations.

(7)

ARRT - The American Registry of Radiologic Technologists and its predecessor or successor organizations.

(8)

BCE - The Texas State Board of Chiropractic Examiners.

(9)

BDE - The Texas State Board of Dental Examiners.

(10)

Biennial - Occurring every two years.

(11)

BME - The Texas State Board of Medical Examiners.

(12)

BNE - The Texas State Board of Nurse Examiners.

(13)

Board - The Texas Board of Health.

(14)

BPE - The Texas State Board of Podiatry Examiners.

(15)

Cardiovascular (CV) - Limited to the coronary vessels, atria, ventricula, ascending aorta and aortic arch.

(16)

Certificate - A medical radiologic technologist certificate, general or limited, unless the wording specifically refers to one or the other, issued by the Texas Department of Health.

(17)

Chiropractor - A person licensed by the Board of Chiropractic Examiners (BCE) to practice chiropractic.

(18)

Committee - The Medical Radiologic Technologist Advisory Committee.

(19)

Dentist - A person licensed by the Board of Dental Examiners (BDE) to practice dentistry.

(20)

Department - The Texas Department of Health.

(21)

Federally qualified health center (FQHC) - A health center as defined by 42 United States Code, §1396d(2)(B).

(22)

Fluoroscopy - The practice of examining tissues using a fluorescent screen, including digital and conventional methods.

(23)

Fluorography - Hard copy of a fluoroscopic image; also known as spot films.

(24)

General certification - An authorization to perform radiologic procedures.

(25)

Instructor - An individual approved by the department to provide instruction and training in the discipline of medical radiologic technology in an educational setting.

(26)

JCAHO - The Joint Commission on Accreditation of Healthcare Organizations.

(27)

JRCENMT - The Joint Review Committee on Education in Nuclear Medicine Technology and its successor organizations.

(28)

JRCERT - The Joint Review Committee on Education in Radiologic Technology and its successor organizations.

(29)

JRCCVT - The Joint Review Committee in Cardiovascular Technology.

(30)

Limited certification - An authorization to perform radiologic procedures that are limited to specific parts of the human body.

(31)

Limited Medical Radiologic Technologist (LMRT) - A person who holds a limited certificate issued under the Act, and who under the direction of a practitioner, intentionally administers radiation to specific parts of the bodies of other persons for medical reasons. The limited categories are the skull, chest, spine, extremities, podiatric , [ and ] chiropractic and cardiovascular .

(32)

Medical radiologic technologist (MRT) - A person who holds a general certificate issued under the Act, and who, under the direction of a practitioner, intentionally administers radiation to other persons for medical reasons.

(33)

Mobile radiography - Includes mobile x-ray equipment and portable x-ray equipment.

(34)

Mobile x-ray equipment - Equipment mounted on a permanent base with wheels and/or casters for moving while completely assembled.

(35)

NMTCB - Nuclear Medicine Technology Certification Board and its successor organizations.

(36)

Non-Certified Technician (NCT) - A person who has completed a training program and who is listed on the registry. An NCT may not perform a radiologic procedure which has been identified as dangerous or hazardous.

(37)

PA - Posterior/anterior.

(38)

Physician - A person licensed by the Board of Medical Examiners (BME) to practice medicine.

(39)

Physician assistant - A person licensed as a physician assistant by the Texas State Board of Physician Assistant Examiners. 40) Podiatrist - A person licensed by the Board of Podiatry Examiners (BPE) to practice podiatry.

(41)

Portable x-ray equipment - Equipment designed to be hand-carried.

(42)

Practitioner - A doctor of medicine, osteopathy, podiatry, dentistry, or chiropractic who is licensed under the laws of this state and who prescribes radiologic procedures for other persons for medical reasons.

(43)

Radiation - Ionizing radiation in amounts beyond normal background levels from sources such as medical and dental radiologic procedures.

(44)

Radiologic procedure - Any procedure or article intended for use in the diagnosis of disease or other medical or dental conditions in humans (including diagnostic x-rays or nuclear medicine procedures) or the cure, mitigation, treatment, or prevention of disease in humans that achieves its intended purpose through the emission of ionizing radiation.

(45)

Registered nurse - A person licensed by the Board of Nurse Examiners (BNE) to practice professional nursing.

(46)

Registry - A list of names and other identifying information of non-certified technicians.

(47)

Sponsoring institution - A hospital, educational, or other facility, or a division thereof, that offers or intends to offer a course of study in medical radiologic technology.

(48)

Supervision - Responsibility for and control of quality, radiation safety and protection, and technical aspects of the application of ionizing radiation to human beings for diagnostic and/or therapeutic purposes.

(49)

Temporary certification, general or limited - An authorization to perform radiologic procedures for a limited period, not to exceed one year.

(50)

TRCR - Texas Regulations for the Control of Radiation, 25 Texas Administrative Code, Chapter 289 of this title (relating to Texas Regulations for the Control of Radiation). The regulations are available from the Standards Branch, Bureau of Radiation Control, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3189 (phone 1-512-834-6688).

§143.4.Fees.

(a)

(No change.)

(b)

The schedule of fees is as follows:

(1)-(16)

(No change.)

(17)

training program application fee - $350 (the application fee for training programs accredited by the Texas Higher Education Coordinating Board shall be waived) ;

(18)

training program amendment fee - $40 (the amendment fee for training programs accredited by the Texas Higher Education Coordinating Board shall be waived) ;

(19)

training program renewal fee - $150 (the renewal fee for training programs accredited by the Texas Higher Education Coordinating Board shall be waived) ;

(20)-(21)

(No change.)

§143.7.Types of Certificates and Applicant Eligibility.

(a)

General. The purpose of this section is to set out the types of certificates issued and the qualifications of applicants for certification as a medical radiologic technologist (MRT) or limited medical radiologic technologist (LMRT).

(1)-(3)

(No change.)

(4)

A person certified as an MRT or LMRT shall carry or display the original certificate or current identification card at the place of employment. Photocopies shall not be carried or displayed [ but may be kept in a file ].

(5)

A person certified as an MRT or LMRT shall only allow his or her certificate to be copied for the purpose of verification by employers, licensing boards, professional organizations 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 certification.

(6)

[ (5) ] No one shall display, present, or carry a certificate or an identification card which has been altered, photocopied, or otherwise reproduced.

(7)

[ (6) ] No one shall make any alteration on any certificate or identification card issued by the department.

(b)-(e)

(No change.)

(f)

Limited medical radiologic technologist. To qualify for a limited certificate, an applicant shall meet the requirements in paragraph (4) of this subsection and subsection (d) of this section.

(1)-(2)

(No change.)

(3)

Persons holding a limited certificate in one or more categories may not perform radiologic procedures involving the use of contrast media, utilization of fluoroscopic equipment, mammography, tomography, mobile radiography [ bedside radiography ], nuclear medicine, and/or radiation therapy procedures. However, a person holding a limited certificate in the cardiovascular category may perform radiologic procedures involving the use of contrast media and fluoroscopic equipment for the purposes of diagnosing or treating a disease or condition of the cardiovascular system.

(4)

(No change.)

(g)-(j)

(No change.)

§143.8.Examinations.

(a)-(b)

(No change.)

(c)

Approved examination for the general certificate. A general certificate shall be issued upon successful completion of the Nuclear Medicine Technology Certification Board (NMTCB) examination or the appropriate examination of the American Registry of Radiologic [ Clinical Radiography ] Technologists (ARRT). The three disciplines are radiography, nuclear medicine technology, and radiation therapy technology. Determination of the appropriate examination shall be made on the basis of the type of educational program completed by the general temporary certificate holder.

(d)

(No change.)

(e)

Applicants approved for the limited certification examination will be allowed three attempts to pass the examination. The three attempts must be made within a three- year period of time. When either three unsuccessful attempts have been made or three years have expired, the individual is no longer considered eligible under this section. To be eligible for an additional examination the applicant must submit documentation indicating completion of remedial activities. The fourth attempt must occur within the one-year period following the third unsuccessful attempt. Those failing the fourth attempt, or waiting longer than one year following the third unsuccessful attempt, may only become eligible by re-entering and completing an approved limited certification program. Upon the applicant's successful completion of the examination, the department shall issue an approval letter for the limited certificate.

(f)

[ (e) ] Examination schedules. A schedule of examinations indicating the date(s), location(s), fee(s) and application procedures shall be provided by the agency or organization administering the examination(s) for the department to each person issued any temporary certificate or approved under the provisions of §143.15 of this title.

(g)

[ (f) ] Standards of acceptable performance. The scaled score to determine pass or fail performance shall be 75.

(h)

[ (g) ] Completion of examination application forms. Each applicant shall be responsible for completing and transmitting appropriate examination application forms and paying appropriate examination fees by the deadlines set by the department or the agency or organization administering the examinations prescribed by the department.

(i)

[ (h) ] Results.

(1)

Notification of examinees. Results of an examination prescribed by the department but administered under the auspices of another agency will be communicated to the applicant by the department, unless the contract between the department and that agency provides otherwise.

(2)

Score release. The applicant is responsible for submitting a signed score release to the examining agency or organization or otherwise arranging to have examination scores forwarded to the department.

(3)

Deadlines. The department shall notify each examinee of the examination results within 14 days of the date the department receives the results.

(j)

[ (i) ] Refunds. Examination fee refunds will be in accordance with policies and procedures of the department or the agency or organization prescribed by the department to administer an examination. No refunds will be made to examination candidates who fail to appear for an examination.

§143.9.Standards for the Approval of Curricula and Instructors.

(a)-(c)

(No change.)

(d)

Application procedures for limited certificate programs which are not accredited by JRCERT or JRCCVT. An application shall be submitted to the department at least ten weeks prior to the starting date of the program to be offered by a sponsoring institution. Official application forms are available from the department and must be completed and signed by the program director of the sponsoring institution's program. Program directors shall be responsible for the curriculum, the organization of classes, the maintenance and availability of facilities and records, and all other policies and procedures related to the program or course of study.

(1)-(5)

(No change.)

(6)

The application shall include:

(A)-(H)

(No change.)

(I)

a letter or other documentation from the Texas Workforce Commission, Proprietary Schools Section indicating that the proposed training program has complied with or has been granted exempt status under the Texas Proprietary School Act, Texas Education Code, Chapter 32 and 19 Texas Administrative Code, Chapter 175 or verification of accreditation by the Texas Higher Education Coordinating Board ; and

(J)

(No change.)

(7)-(10)

(No change.)

(e)

Curricula requirements. Each student must complete a curriculum which meets or exceeds the following requirements:

(1)

(No change.)

(2)

a clinical practicum for each category of limited curriculum is required. The practicum must include clinical instruction and clinical experience under the instruction or direction of a practitioner and an MRT or LMRT in accordance with the following chart.

Figure: 25 TAC §143.9(e)(2)

(A)-(B)

(No change.)

(C)

For the skull category, the 100 hours of clinical experience must include a minimum of 4 [ 15 ] independently performed procedures to include the skull (posterior/anterior, anterior/posterior, lateral and occipital), paranasal sinuses, facial bones, and the mandible. At least two procedures must be the mandible. Only one student shall receive credit for any one radiologic procedure performed.

(D)

(No change.)

(f)-(i)

(No change.)

(j)

Application procedures for limited certificate programs accredited by JRCERT or JRCCVT.

(1)

(No change.)

(2)

The application must be notarized and shall be accompanied by the following items:

(A)

(No change.)

(B)

a copy of the current accreditation issued to the program by the JRCERT or JRCCVT ;

(C)-(D)

(No change.)

§143.11.Continuing Education Requirements.

(a)-(b)

(No change.)

(c)

Content. All continuing education activities should provide for the professional growth of the technologist.

(1)

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

(2)-(3)

(No change.)

(d)

(No change.)

(e)

Additional acceptable activities. The additional activities for which continuing education credit will be awarded are as follows:

(1)

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

(A)

three hours credit during a renewal period[ ; ] for a cardiopulmonary resuscitation course or basic cardiac life support course; or

(B)

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

(2)-(4)

(No change.)

(f)

Reporting of continuing education. Each MRT or LMRT is responsible for and shall complete and file with the department at the time of renewal or to be considered for renewal when in an extension, a continuing education report form approved by the department listing the title, date and number of hours for each activity for which credit is claimed. In the alternative, a technologist may request an exemption as set out in subsection (j) of this section or may submit a copy of the technologist's current and active annual registration or credential card indicating that the technologist is in good standing and not on probation in accordance with subsection (b)(8) of this section, with a signed statement that the technologist completed during the renewal period at least 50% of the required number of hours [ 12 clock hours ] of continuing education directly related to the performance of a procedure utilizing ionizing radiation for medical purposes and that no more than 50% of the required number of hours shall be verifiable independent self-study activities .

(1)

At the time of renewal [ Following each renewal month ] or at other times determined by the department, the department will select a random sample of technologists to verify compliance with the continuing education requirements. The technologists selected in the random sample shall submit at the time of renewal or within 30 days following notification from the department:

(A)-(B)

(No change.)

(2)-(3)

(No change.)

(g)

(No change.)

(h)

Activities unacceptable as continuing education. The department shall not grant credit for:

(1)-(9)

(No change.)

(10)

activities in accordance with subsection (e)(3) of this section in excess of the one-time credit per topic of instruction or in excess of a total of five contact hours during a continuing education period; [ or ]

(11)

activities in accordance with subsection (e)(4) of this section in excess of five contact hours during a continuing education period ; or [ . ]

(12)

activities that are an employment requirement or concerning specific institutional policies and procedures.

(i)

(No change.)

(j)

Exemptions. The department will consider granting an exemption from the continuing education requirement on a case-by-case basis if:

(1)-(2)

(No change.)

[ (3)

a technologist is a nonresident of Texas for the entire renewal period and submits a sworn statement that the continuing education requirements of the resident state or country have been met; ]

(3)

[ (4) ] a technologist shows reasons of health, certified by a licensed physician, that prevent compliance with the continuing education requirement for the entire renewal period. The technologist must complete and forward to the department a sworn affidavit and provide documentation that clearly establishes the period of disability and resulting physical limitations;

(4)

[ (5) ] a technologist submits a sworn statement and shows reason which prevents compliance and the reason is acceptable to the department; [ or ]

(5)

[ (6) ] a technologist is called to or on active duty with the armed forces of the United States for the entire renewal period and so long as the technologist does not administer a radiologic procedure in a setting outside of the active duty responsibilities during the time on active duty. The technologist must file a copy of orders to active military duty with the department; or

(6)

[ (7) ] a technologist submits proof of successful completion of an advanced level examination or an entry level examination in another discipline of radiologic technology administered by or for the ARRT during the renewal period. All examinations shall be topics dealing with ionizing forms of radiation administered to human beings for medical purposes.

(k)-(m)

(No change.)

§143.14.Disciplinary Actions.

(a)-(b)

(No change.)

(c)

Engaging in unprofessional conduct means the following:

(1)-(32)

(No change.)

(33)

failing reasonably to protect the certificate from fraudulent or unlawful use.

(d)-(j)

(No change.)

(k)

Pursuant to the Act, §2.15, the department is authorized to assess an administrative penalty against a person who violates the Act or this chapter.

§143.16.Dangerous or Hazardous Procedures.

(a)

Purpose. The purpose of this section is to identify the radiologic procedures which are dangerous or hazardous and may only be performed by a practitioner, medical radiologic technologist (MRT) or limited medical radiologic technologist (LMRT). There are specific procedures identified in subsections (b) and (c) of this section which may be performed by a registered nurse (RN) or a [ certified ] physician assistant [ (PA) ] trained under §143.17 of this title (relating to Mandatory Training Programs for Non-Certified Technicians) or §143.20 of this title (relating to Alternative Training Programs). A person trained under §143.17 or §143.20 of this title and placed on a registry under §143.18 of this title (relating to Registry of Non-Certified Technicians) is not an MRT, LMRT or otherwise certified under the Medical Radiologic Technologist Certification Act (Act) and shall not perform a dangerous or hazardous procedure identified in this section unless expressly permitted under this section.

(b)

Dangerous procedures identified. Unless otherwise noted, the list of dangerous procedures which may only be performed by a practitioner or MRT are:

(1)

(No change.)

(2)

administration of radio-pharmaceuticals, unless performed by an RN or physician assistant [ PA ] who is appropriately trained as authorized by the department's Bureau of Radiation Control for licensure of radioactive materials;

(3)

radiation therapy, including simulation and brachytherapy;

(4)-(5)

(No change.)

(6)

fluoroscopy and/or fluorography, unless performed by an LMRT with a certificate issued in the cardiovascular category, or by an RN or physician assistant [ PA ] who assists in the performance of [ performs ] the procedure under the [ direction and ] supervision of a practitioner; and

(7)

cineradiography (including digital acquisition techniques) , unless performed by an LMRT with a certificate issued in the cardiovascular category.

(c)

Hazardous procedures identified. Unless otherwise noted, the list of hazardous procedures which may only be performed by a practitioner or MRT are:

(1)-(4)

(No change.)

(5)

spine radiography, excluding lumbar oblique views performed by an RN or physician assistant who performs the procedure under the supervision of a practitioner;

(6)

[ (5) ] shoulder girdle radiographs, excluding AP and lateral shoulder views, AP clavicle and AP scapula, unless performed by an RN or physician assistant [ PA ] who performs the procedure under the direction and supervision of a practitioner;

(7)

[ (6) ] pelvic girdle radiographs, excluding AP or PA views;

(8)

[ (7) ] sternum radiographs, unless performed by an RN or physician assistant [ PA ] who performs the procedure under the direction and supervision of a practitioner; and

(9)

[ (8) ] radiographic procedures which utilize contrast media, unless performed by an RN or physician assistant [ PA ] who assists in the performance of [ performs ] the procedure under the [ direction and ] supervision of a practitioner.

(d)-(h)

(No change.)

(i)

Effective date.

(1)

(No change.)

(2)

[ Until January 1, 1998, an RN or PA may perform procedures listed in subsections (b)(2), (b)(6), (c)(5), (c)(7), or (c)(8) of this section under the direction and supervision of a practitioner. ] On or after January 1, 1998, an RN or physician assistant [ PA ] must be trained under §143.17 of this title or §143.20 of this title, or have been approved to perform radiologic procedures under a hardship exemption granted under §143.19 of this title (relating to Hardship Exemptions), in addition to performing the listed procedure under the direction and supervision of a practitioner. Subsections (b)(6) and (c)(8) shall not be construed to authorize an RN or physician assistant to independently perform fluoroscopy, fluorography or procedures utilizing contrast media.

(j)

(No change.)

§143.17.Mandatory Training Programs for Non-Certified Technicians.

(a)-(b)

(No change.)

(c)

Instructor qualifications [ Approved instructors ].

(1)

An instructor(s) shall have education and not less than six months classroom or clinical experience teaching the subjects assigned, shall meet the standards required by a sponsoring institution, if any, and shall meet at least one or more of the following qualifications: [ For purposes of this section, an individual is approved by the Texas Department of Health (department) to teach in a training program if the individual meets the requirements of §143.9(h)(1)-(2) of this title (relating to Standards for the Approval of Curricula and Instructors). The application for the training program must demonstrate that the instructors meet the qualifications. No application for individual instructor approval is required. ]

(A)

be a currently certified MRT who is also currently credentialed as a radiographer by the American Registry of Radiologic Technologists (ARRT);

(B)

be a currently certified LMRT (excluding a temporary certificate) whose limited certificate category(ies) matches the category(ies) of instruction and training; or

(C)

be a practitioner who is in good standing with all appropriate regulatory agencies including, but not limited to, the department, the Texas State Board of Chiropractic Examiners (BCE), Texas State Board of Medical Examiners (BME), or Texas State Board of Podiatry Examiners (BPE), the Texas Department of Human Services, the United States Department of Health and Human Services.

(2)

(No change.)

(d)-(e)

(No change.)

(f)

Application materials. The application shall include, at a minimum:

(1)-(9)

(No change.)

(10)

a letter or other documentation from the Texas Workforce Commission, Proprietary Schools Section indicating that the proposed training program has complied with or has been granted exempt status under the Texas Proprietary School Act, Texas Education Code, Chapter 32 and 19 Texas Administrative Code, Chapter 175 . If approval has been granted by the Texas Higher Education Coordinating Board, a letter or other documentation from the Texas Workforce Commission, Proprietary Schools Section is not necessary ; and

(11)

(No change.)

(g)-(i)

(No change.)

[(j)

Previously completed training. A person who has completed part or all of the training described in subsection (d) of this section shall be considered to have completed an approved training program for part or all of the training but shall be required to complete the remainder of the training program described in subsection (d) of this section prior to the person's placement on the registry, as set out in §143.18 of this title (relating to Registry of Non- Certified Technicians). ]

[ (1)

Unless the person is a registered nurse or certified physician assistant, the previously completed training shall be acceptable only if completed within two years of the time of the person's initial placement on the registry. ]

[ (2)

Previously completed training shall be acceptable only if it was:]

[ (A)

completed at an education program approved under §143.9 of this title;]

[ (B)

live, interactive, and instructor-directed and meets the requirements for acceptance as continuing education credit for MRTs and LMRTs as set out in §143.11 of this title (relating to Continuing Education Requirements); or]

[ (C)

accepted for continuing education credits by the Board of Nurse Examiners.]

[ (3)

If a person has completed part of the training described in subsection (d) of this section, the program director of the training program shall verify that the previously completed hours comply with this section.]

[ (4)

If a person has completed all of the training described in subsection (d) of this section, the department shall verify that the previously completed hours comply with this section at the time of the person's placement on the registry.]

[ (5)

Verification of previously completed training shall be made by reviewing only original certificates, official transcripts, printed course curriculum, syllabi, outlines or other documentation acceptable to the department issued in the name of the person who is seeking credit for previously approved training. Photocopied certificates or transcripts will not be accepted for review.]

[ (6)

This subsection shall expire on January 1, 1998.]

[(k)

The Board of Health shall consider adopting rules later this year to describe the training programs for RNs, PAS, and podiatric procedures.]

§143.18.Registry of Non-Certified Technicians.

(a)

Purpose. The purpose of this section is to set out the rules for administering the registry of non-certified technicians performing radiologic procedures, established in accordance with the Medical Radiologic Technologist Certification Act (Act), §2.05(a)(4). The purpose of the department's registry is to provide a mechanism for consumers or employers to ascertain or verify that a person performing radiologic procedures has complied with the Act, §2.05(f) by successfully completing a training program in accordance with §143.17 of this title (relating to Mandatory Training Programs for Non-Certified Technicians) or §143.20 of this title (relating to Alternate Training Requirements) .

(b)

(No change.)

(c)

Initial placement on the registry. In order to be listed on the registry for the first time, the information described in subsection (b) of this section shall be reported to the Texas Department of Health (department) by the training program approved under §143.17 or §143.20 of this title after the person's successful completion of the training. A person who has completed all the training program through previously completed courses in accordance with §143.17(j) of this title may apply directly to the department to be placed on the registry.

(d)-(h)

(No change.)

§143.19.Hardship Exemptions.

(a)-(b)

(No change.)

(c)

Required application materials.

(1)-(3)

(No change.)

(4)

The application must include a list of the person(s) performing radiologic procedures who is not a MRT, LMRT, or NCT.

(5)

[ (4) ] The application shall be accompanied by one or more of the following:

(A)

if the applicant is unable to attract or retain an MRT or LMRT, a sworn affidavit describing in narrative form the applicant's attempts to attract and retain an MRT or LMRT at a comparable salary for the area;

(B)

if the applicant is located more than 50 highway miles from the nearest school of medical radiologic technology approved in accordance with §143.9 of this title (relating to Standards for the Approval of Curricula and Instructors), a sworn affidavit describing in narrative form the physical address of the nearest school of medical radiologic technology; the physical address of the applicant hospital, FQHC, or primary practice location of the practitioner; and the actual distance in highway miles between the school and the applicant hospital, FQHC, or practitioner's primary practice. The applicant shall include a map of the area clearly indicating the locations of each entity;

(C)

if the nearest school of medical radiologic technology approved in accordance with §143.9 of this title has a waiting list of school applicants due to a lack of faculty or space, a sworn affidavit from the applicant indicating that admissions to the school are pending because of a lack of faculty or space;

(D)

if the need for graduates in medical radiologic technology of the applicant exceeds the number of graduates from the nearest school of medical radiologic technology approved in accordance with §143.9 of this title, a sworn affidavit from the applicant indicating that the number of graduates from the nearest school does not meet the applicant's needs for radiologic technologists;

(E)

if emergency conditions have occurred during the 90 days prior to making application for the hardship exemption, a sworn affidavit from the applicant describing the emergency conditions, the hardship(s) the emergency conditions have created and how long the hardship(s) is anticipated to continue. For the purposes of this subparagraph, emergency conditions may include a disaster, epidemic, or other catastrophic event;

(F)

documentation that the United States government has declared a state of war;

(G)

if the equipment operated is a bone densitometry unit(s) which utilizes x-radiation, a sworn affidavit from the applicant indicating the name of the person operating the equipment and proof that the person is a certified densitometry technologist in good standing with the International Society for Clinical Densitometry (ISCD) or has completed at least 20 hours of training as follows:

(i)

specific bone densitometry equipment utilizing x-radiation to be used by the operator--16 hours presented by a medical radiologic technologist (MRT) or an equipment applications specialist knowledgeable of the specific equipment to be utilized; and

(ii)

radiation safety and protection for the patient, self and others--four hours presented by an MRT or a licensed medical physicist within the 24-month period prior to application or reapplication for a hardship exemption;

(H)

if the applicant uses only a hand-held fluoroscope with a maximum operating capability of 65 kilovolts and 1 milliampere, or a similar type of x-ray unit for imaging upper extremities only, at the location indicated on the application form and the applicant believes that the radiation produced by the radiographic equipment represents a minimal threat to the patient and the operator of the equipment, the following is required to be submitted:

(i)

a copy of the current certificate of registration issued by the Bureau of Radiation Control; and

(ii)

a sworn affidavit describing the equipment used; the types of radiographs performed; the training completed by the operator of the equipment within the 24-month period prior to application or reapplication for a hardship exemption; the date(s) the training was completed by the operator; the radiation safety measures taken for the patient, operator and others; the level or amount of supervision provided by an MRT or a practitioner(s) to the operator while performing the radiographic procedure; and the equipment manufacturer's specifications for the diagnostic radiographic equipment utilized at the location indicated on the application form, including the maximum operating capability;

(I)

if the applicant employs, for the purpose of performing radiologic procedures, a person registered in accordance with rules adopted under §2.08 of the Act on or before January 1, 1998, a sworn affidavit indicating the name(s) of the person(s) and proof that the person(s) was registered on or before January 1, 1998. Such affidavit shall be on a form attesting that the training under §143.17 of this title (relating to Mandatory Training Programs for Non-Certified Technicians) or §143.20 of this title (relating to Alternate Training Requirements) causes a fiscal hardship for the applicant. The affidavit shall include a statement that the person(s) performing radiologic procedures is adequately supervised and trained for the procedures being performed. If the applicant is a practitioner or FQHC, the person who will perform radiologic procedures must be registered in accordance with rules adopted under §2.08 of the Act at the time of application for the hardship exemption. If the person who will perform radiologic procedures is not an RN, the name of the practitioner for whom the radiologic procedures are performed, as named on the current registration permit, shall match the name or location of the applicant for whom the hardship is granted;

(J)

if the applicant is a hospital accredited by the Joint Commission on the Accreditation of Health Care Organizations or which participates in the federal Medicare cost reimbursement program, an original letter on hospital letterhead stating the name(s) of the person(s) performing radiologic procedures in compliance with § 2.07(d) of the Act on or before January 1, 1998. The letter shall be accompanied by a sworn affidavit from the applicant attesting that the training under §143.17 or §143.20 of this title causes a fiscal hardship for the applicant. The affidavit shall include a statement that the person(s) performing radiologic procedures is adequately supervised and trained for the procedures being performed;

[(K)

if the applicant employs for the purpose of performing radiologic procedures, a person enrolled on or before December 31, 1997, in a training program approved by the department under §143.17 of this title or §143.20 of this title. Applications under this hardship postmarked after October 31, 1998, will not be processed. This subparagraph and all letters of exemption issued under this subparagraph shall expire on December 31, 1998. The following items must be submitted:]

[ (i)

a sworn affidavit indicating the name(s) of the person(s) enrolled in training on or before December 31, 1997, and attending classes at the time of application;]

[ (ii)

an original verification statement from a department approved training program indicating that the person(s) named in the hardship application was enrolled on or before December 31, 1997, and was currently attending classes. The enrollment and attendance verification must be dated within 15 days of the date of application under this section to the department; and]

[ (iii)

proof that the person(s) was registered in accordance with rules adopted under §2.08 of the Act at the time of enrollment or at the time of application under this section, if the applicant is a practitioner or FQHC; or]

(K)

[ (L) ] if the applicant employs for the purpose of performing radiologic procedures, a person who had at least one year of experience performing radiologic procedures and who, by July 31, 1999, has completed four hours of study in radiation safety and protection in a program approved by the department under §143.9 of this title, §143.11 of this title (relating to Continuing Education Requirements), §143.17 of this title, or §143.20 of this title, or provided by a person who meets the requirements of §143.9(h)(1)-(2) of this title, excluding the phrase, "the subjects assigned." This subparagraph shall expire October 1, 1999. The following items must be submitted:

(i)

a sworn affidavit indicating the name(s) of the person(s) who will perform radiologic procedures pursuant to this hardship exemption;

(ii)

a sworn affidavit or other documentation stating the person(s) had at least one year of experience performing radiologic procedures between January 1, 1993, and July 1, 1998;

(iii)

an original verification statement, certificate of completion or transcript indicating that the person(s) named in the hardship exemption application has completed or will complete by July 31, 1999, a four-hour course of study in radiation safety and protection. Documentation of completion of the four-hour course of study in radiation safety and protection shall be submitted prior to placement on the department's registry under §143.18 of this title (relating to the Registry of Non-Certified Technicians);

(iv)

if the applicant is a practitioner or FQHC, proof that the person(s) was registered in accordance with rules adopted under §2.08 of the Act at the time of application under this section;

(v)

an acknowledgment that the persons performing radiologic procedures, as an alternative to training, will take and pass the core section of the limited certificate examination, as described in §143.8 of this title (relating to Examinations) covering radiation protection, radiographic equipment operation and maintenance, image production and evaluation, and patient care and management. An examination candidate must pass the examination on or before July 1999. A person who passes the examination described in this clause shall be included on the department's registry under §143.18 of this title. A person listed on the registry is not required to complete the training described in §143.17 of this title or §143.20 of this title. A person who does not pass the examination by the third attempt will be notified by the department that the person may no longer perform radiologic procedures under this hardship exemption. The following shall apply to this hardship exemption and the special examination administered under this clause:

(I)

the passing score shall be an unscaled 55;

(II)

a schedule of examinations indicating the dates, locations, fees, examination application procedures, and application deadlines will be provided to the person(s) named on the hardship exemption application as person(s) performing radiologic procedures;

(III)

a maximum of three examination attempts shall be allowed for each person covered by the hardship exemption;

(IV)

all examination application fees are non-refundable and must be paid by the examination application deadlines established by the department. A person who applied for a specific examination and who failed to appear for the examination shall forfeit the examination fee, even if notification is made prior to the examination that the person will be unable to take the examination;

(V)

applications under this hardship exemption may be postmarked up to and including October 31, 1998; and

(VI)

in no event shall any letters of exemption issued under this subparagraph extend beyond the expiration date of October 1, 1999. If the person(s) performing radiologic procedures does not apply for the examination to be administered on July 1999, the hardship exemption will expire on the examination application deadline which is two months prior to that examination.

(6)

[ (5) ] All application materials and information are subject to verification by the department.

(7)

[ (6) ] The department shall send a written notice listing the additional materials required to an applicant whose application is incomplete. An application not completed within 30 days after the date of the written notice shall be invalid unless the applicant has advised the department of a valid reason for the delay.

(d)-(g)

(No change.)

§143.20.Alternate Training Requirements.

(a)

Purpose. The purpose of this section is to set out the minimum standards for registered nurses (RNs), physician assistants [ (PAs) ] and podiatric medical assistants (PMAs).

(b)

Instructor direction required. All hours of the training program completed for the purposes of this section must be live and interactive and directed by an approved instructor. Distance learning activities and audiovisual teleconferencing may be utilized, provided these include two-way, interactive communications which are broadcast or transmitted at the actual time of occurrence. Appropriate on-site supervision of persons participating in the distance learning activities or teleconferencing shall be provided by the approved training program. No credit will be given for training completed by self-directed study or correspondence.

(1)

Effective January 1, 1998, before an RN or physician assistant [ PA ] performs a radiologic procedure, the RN or physician assistant [ PA ] must complete the hours stated in subsection (d) of this section, or the hours stated in §143.17 of this title (relating to Mandatory Training Programs for Non-Certified Technicians).

(2)-(3)

(No change.)

(c)

(No change.)

(d)

Training requirements for registered nurses and physician assistants. A training program preparing RNs and physician assistants [ PAs ] to perform radiologic procedures shall be designed to build on the health care knowledge base and skills acquired through completion of an educational program that qualifies the person for licensure as an RN or physician assistant [ PA ]. The training shall consist of:

(1)

a minimum of 30 [ 32 ] classroom hours of coursework that are fundamental to diagnostic radiologic procedures covering all of the following items:

(A)-(C)

(No change.)

[ (D)

methods of patient care and management essential to radiologic procedures, excluding CPR, BCLS, ACLS and similar subjects - 2 classroom hours; and ]

(2)

one or more of the following units of classroom instruction in radiologic procedures:

(A)

(No change.)

(B)

spine (non-pediatric) - 10 [ eight ] classroom hours;

(C)-(D)

(No change.)

(3)

if the RN or physician assistant [ PA ] will perform pediatric radiologic procedures other than extremities, a minimum of two classroom hours for each of the areas identified in paragraph (2)(A)-(C) of this subsection.

(e)-(j)

(No change.)

[(k)

Previously completed training. A person who has completed part or all of the training described in subsections (d) or (e) of this section shall be considered to have completed an approved training program for part or all of the training but shall be required to complete the remainder of the training program described in subsections (d) or (e) of this section prior to the person's placement on the registry, as set out in §143.18 of this title (relating to Registry of Non-Certified Technicians).]

[ (1)

Unless the person is an RN or PA, the previously completed training shall be acceptable only if completed within two years of the time of the person's initial placement on the registry.]

[ (2)

Previously completed training shall be acceptable only if it was:]

[ (A)

completed at an education program approved under §143.9 of this title (relating to Standards for the Approval of Curricula and Instructors) or §143.17 of this title;]

[ (B)

live, interactive, and instructor-directed and meets the requirements for acceptance as continuing education credit for medical radiologic technologists or LMRTs as set out in §143.11 of this title (relating to Continuing Education Requirements); or]

[ (C)

accepted for continuing education credits by the Board of Nurse Examiners.]

[ (3)

If a person has completed part of the training described in subsections (d) or (e) of this section, the program direcator of the training program shall verify that the previously completed hours comply with this section.]

[ (4)

If a person has completed all of the training described in subsections (d) or (e) of this section, the department shall verify that the previously completed hours comply with this section at the time of the person's placement on the registry.]

[ (5)

Verification of previously completed training shall be made by reviewing only original certificates, official transcripts, printed course curriculum, syllabi, outlines or other documentation acceptable to the department issued in the name of the person who is seeking credit for previously approved training. Photocopied certificates or transcripts will be not accepted for review.]

[ (6)

This subsection shall expire on January 1, 1998.]

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 12, 1999.

TRD-9900937

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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


Chapter 181. Vital Statistics

Subchapter A. Miscellaneous Provisions

25 TAC §181.14

The Texas Department of Health (department) proposes new §181.14, concerning the form and content of death and fetal death certificates. The section requires the State Registrar to determine the required items of information on certificates of death and fetal death.

Richard B. Bays, Chief, Bureau of Vital Statistics has determined that for the first five year period the section is in effect, there will be no fiscal implications to state or local government.

Mr. Bays also has determined that for each of the first five years the section is in effect, the public benefit anticipated will be a formal process for establishing the form and content of death and fetal death certificates. There will also be no cost to the funeral industry and no impact on local employment.

Comments on the proposed new section may be submitted to Richard B. Bays, State Registrar, Bureau of Vital Statistics, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3191 or faxed to his attention at (512) 458-7130. Public comments will be accepted for 30 days after publication in the Texas Register .

The new section is proposed under the authority of the Health and Safety Code, §191.003, which provides the Board of Health with authority to adopt necessary rules for collecting, recording, transcribing, compiling, and preserving vital statistics; and §193.001 which allows the department to prescribe the form and content of the death and fetal death certificates; and §12.001 which provides the board with authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health.

The new section affects the Health and Safety Code, Chapters 191 and 193.

§181.14.Death and Fetal Death Certificate Form and Content.

(a)

The State Registrar shall determine the items of information to be contained on certificates of death and fetal death. The format of the items will be designated in forms VS-112 entitled "Certificate of Death" and VS-113 entitled "Certificate of Fetal Death".

(b)

Only funeral directors or persons in charge of interment or in charge of removal for disposition may prepare and file the certificate of death and fetal death on the forms VS-112 and VS-113.

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 12, 1999.

TRD-9900943

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 4, 1999

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