Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
Chapter 183.
ACUPUNCTURE
22 TAC §§183.10, 183.20, 183.22
The Texas State Board of Medical Examiners proposes amendments
to §183.10 and §183.20 and new §183.22, concerning Acupuncture.
The amendment to §183.10 and new §183.22 specify written instructions
in medical records and the amendment to §183.20 concerns continuing acupuncture
education.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rules are in effect,
it is anticipated that there will be a cost to continuing education providers
who wish to be approved. The fee schedule has not been set at this time. There
will be no affect to state or local government.
Ms. Shackelford also has determined that for each year of the first five
years the rules as proposed are in effect the public benefit anticipated as
a result of enforcing the rules will be updated rules. There will be no effect
on small or micro businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments and new rule are proposed under the authority
of the Occupations Code Annotated, §153.001, which provides the Texas
State Board of Medical Examiners to adopt rules and bylaws as necessary to:
govern its own proceedings; perform its duties; regulate the practice of medicine
in this state; and enforce this subtitle.
The following are affected by the proposal: Texas Occupations Code Annotated, §205.255.
§183.10.Patient Records.
(a)
Acupuncturists licensed under the Act shall keep and maintain
adequate records of all patient visits or consultations which shall, at a
minimum,
be written in English and
include:
(1) - (11)
(No change.)
(b) - (g)
(No change.)
§183.20.Continuing Acupuncture Education.
(a)
(No change.)
(b)
Minimum Continuing Acupuncture Education. As a prerequisite
to the annual registration of the license of an acupuncturist, the acupuncturist
shall complete 17 hours of continuing acupuncture education (CAE) each year.
(1)
The required hours shall be from courses that
:
(A)
are designated or otherwise approved for credit
by the Texas State Board of Acupuncture Examiners at the time the courses
were taken based on a review and recommendation of the
course content
by the
Education Committee of the board as described in subsection (n)
of this section
;
[
(B)
are offered by approved providers; or
(C)
have been approved for CAE credit for
a minimum of three years by another state acupuncture board having first gone
through a formal approval process.
(2)
(No change.)
(3)
At least one of the required hours shall be from a course
in ethics.
An ethics course completed for purposes of maintenance of
licensure for another health profession shall satisfy this requirement.
(4)
(No change.)
(5)
No more than two of the required hours
may be from courses that primarily relate to practice enhancement or business
or office administration.
(6)
Courses may be taught through live lecture,
distance learning, or the Internet.
(c) - (m)
(No change.)
(n)
Required Content for
[
(1)
the content of the course, program, or activity is related
to the practice of acupuncture or oriental medicine,
and shall:
[
(A)
be related to the knowledge and/or technical
skills required to practice acupuncture; or
(B)
be related to direct and/or indirect patient
care.
(2) - (7)
(No change.)
(8)
the education provider
obtains
[
(o) - (q)
(No change.)
(r)
Criteria for Provider Approval.
(1)
In order to be an approved provider, a provider shall submit
to the board a provider application on a form approved by the board, along
with any required fee. All provider applications and documentation submitted
to the board shall be typewritten and in English.
(2)
To become an approved provider, a provider shall submit
to the board evidence that the provider has three years previous experience
providing CAE courses in Texas that were approved by the board. In addition
the provider must have no history of complaints or reprimands with the board.
(3)
The approval of the provider shall expire three years after
it is issued by the board and may be renewed upon the filing of the required
application, along with any required fee.
(4)
Acupuncture schools and colleges which have been approved
by the board, as defined under §183.2(2) of this title, who seek to be
approved providers shall be required to submit an application for an approved
provider number to the board.
(s)
Requirements of Approved Providers.
(1)
For the purpose of this chapter, the title "approved provider"
can only be used when a person or organization has submitted a provider application
form, and has been issued a provider number unless otherwise provided.
(2)
A person or organization may be issued only one provider
number. When two or more approved providers co-sponsor a course, the course
shall be identified by only one provider number and that provider shall assume
responsibility for recordkeeping, advertising, issuance of certificates and
instructor(s) qualifications.
(3)
An approved provider shall offer CAE programs that are
presented or instructed by persons who meet the minimum criteria as described
in subsection (t) of this section.
(4)
An approved provider shall keep the following records for
a period of four years in one identified location:
(A)
Course outlines of each course given.
(B)
Record of time and places of each course given.
(C)
Course instructor curriculum vitaes or resumes.
(D)
The attendance record for each course which shows the name,
signature and license number of any Texas licensed acupuncturists taking the
course and a record of any certificates issued to them.
(E)
Participant evaluation forms for each course given.
(5)
An approved provider shall submit to the board the following
within ten days of the board's request:
(A)
A copy of the attendance record showing the name, signature
and license number of any licensed acupuncturists who attended the course.
(B)
The participant evaluation forms of the course.
(6)
Approved providers shall issue, within 60 days of the conclusion
of a course, to each participant who has completed the course, a certificate
of completion that contains the following information:
(A)
Provider's name and number.
(B)
Course title.
(C)
Participant's name and, if applicable, his or her acupuncture
license number.
(D)
Date and location of course.
(E)
Number of continuing education hours completed.
(F)
Description of hours indicating whether hours completed
are in general acupuncture, ethics, herbology, or practice management.
(G)
Statement directing the acupuncturist to retain the certificate
for at least four years from the date of completion of the course.
(7)
Approved providers shall notify the board within 30 days
of any changes in organizational structure of a provider and/or the person(s)
responsible for the provider's continuing education course, including name,
address, or telephone number changes.
(8)
Provider approval is non-transferable.
(9)
The board may audit during reasonable business hours records,
courses, instructors and related activities of an approved provider.
(t)
Instructors.
(1)
Minimum qualifications of an acupuncturist instructor.
The instructor must:
(A)
hold a current valid license to practice acupuncture in
Texas or other state and be free of any disciplinary order or probation by
a state licensing authority, and
(B)
be knowledgeable, current and skillful in the subject matter
of the course as evidenced through one of the following:
(i)
hold a minimum of a master's degree from an accredited
college or university or a post-secondary educational institution, with a
major in the subject directly related to the content of the program to be
presented;
(ii)
have experience in teaching similar subject matter content
within the last two years in the specialized area in which he or she is teaching;
(iii)
have at least one year's experience within the last two
years in the specialized area in which he or she is teaching; or
(iv)
have graduated from an acceptable acupuncture school,
as defined under §183.2(2) of this title, and have completed 3 years
of professional experience in the licensed practice of acupuncture.
(2)
Minimum qualifications of a non-acupuncturist instructor.
The instructor must:
(A)
be currently licensed or certified in his or her area of
expertise if appropriate;
(B)
show written evidence of specialized training or experience,
which may include, but not be limited to, a certificate of training or an
advanced degree in a given subject area; and
(C)
have at least one year's teaching experience within the
last two years in the specialized area in which he or she teaches.
(u)
[
(v)
Denial and Withdrawal of Approval.
(1)
The board may withdraw its approval of a provider or deny
an application for approval if the provider is convicted of a crime substantially
related to the activities of a provider.
(2)
Any material misrepresentation of fact by a provider or
applicant in any information required to be submitted to the board is grounds
for withdrawal of approval or denial of an application.
(3)
The board may withdraw its approval of a provider after
giving the provider written notice setting forth its reasons for withdrawal
and after giving the provider a reasonable opportunity to be heard by the
board or its designee.
(4)
Should the board deny approval of a provider, the provider
may appeal the action by filing a letter stating the reason(s) with the board.
The letter of appeal shall be filed with the board within ten days of the
mailing of the applicant's notification of the board's denial. The appeal
shall be considered by the board.
§183.22.Language Requirements.
(a)
All medical records and prescriptions are to be written
in English with the exception of acupuncture terms, including herbs, that
are more frequently known by their Chinese or Pinyin translation, if appropriate.
(b)
All written instructions to patients must be in English.
If the patient does not speak English then the acupuncturist shall make reasonable
efforts to translate to the patient's native language.
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 June 30, 2003.
TRD-200303973
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 10, 2003
For further information, please call: (512) 305-7016
22 TAC §193.11
The Texas State Board of Medical Examiners proposes new §193.11,
regarding delegation and supervision of the use of lasers. The Board has studied
this issue for the past three years and has held sessions with workgroups,
participated in stakeholders meetings, and gathered information from all interested
parties prior to making the proposal. After serious consideration, the Board
has determined that it is in the best interest of the public and believes
it will ensure the safety of the citizens of Texas to propose this new section
regarding the delegation and supervision of the use of lasers.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the new section is in effect
there will be training costs for those required to comply with the new regulations,
both for the physician and non-physician practitioner. The exact costs cannot
be determined at this time. There will be fiscal implications to those persons
who previously practiced without physician supervision who must now practice
under the supervision of a licensed physician. There is the potential for
increased revenue for small businesses due to the possible development of
training courses. There is no anticipated cost to state or local government.
Ms. Shackelford also has determined that for each year of the first five
years the new section as proposed is in effect the public benefit anticipated
as a result of enforcing the section will be rules regarding delegation and
supervision of the use of lasers. There will be no effect on small or micro
businesses.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed rule: Texas Occupations Code
Annotated, §157.001.
§193.11.Use of Lasers.
(a)
Purpose. As the use of lasers/pulsed light devices is the
practice of medicine, the purpose of this section is to provide guidelines
for the use of these devices for ablative and non-ablative treatment by physicians.
Nothing in these rules shall be construed to relieve the supervising physician
of the professional or legal responsibility for the care and treatment of
the physician's patients.
(b)
Definitions. For the purpose of this section, the following
definitions will apply.
(1)
Advanced health practitioner--An advanced health practitioner
is a physician assistant or an advanced practice nurse.
(2)
Non-ablative treatment--Non-ablative treatment shall include
any laser/intense pulsed light treatment that is not expected or intended
to remove, burn, or vaporize the epidermal surface of the skin. This shall
include treatments related to laser hair removal.
(3)
On-site supervision--On-site supervision shall mean continuous
supervision in which the individual is in the same office space.
(4)
Physician--A physician licensed by the Texas State Board
of Medical Examiners.
(c)
Use of lasers in the practice of medicine.
(1)
The use of lasers/pulsed light devices for the purpose
of treating a physical disease, disorder, deformity or injury shall constitute
the practice of medicine pursuant to §151.002(a)(13) of the Medical Practice
Act.
(2)
The use of lasers/pulsed light devices for non-ablative
procedures cannot be delegated to non-physician delegates, other than an advanced
health practitioner, without the delegating/supervising physician being on-site
and immediately available.
(3)
The use of lasers/pulsed light devices for ablative procedures
may only be performed by a physician.
(d)
Delegation.
(1)
If the physician provides on-site supervision, the physician
may delegate the performance of non-ablative treatment through the use of
written protocols to a properly trained delegate acting under adequate supervision.
(2)
If the physician does not provide on-site supervision during
a non-ablative treatment, the performance of non-ablative treatments may only
be delegated to and performed by an advanced health practitioner.
(3)
Prior to any non-ablative initial treatment, the physician
or advanced health practitioner must examine the patient and sign the patient's
chart.
(e)
Supervision. Supervision by the delegating physician shall
be considered adequate for purposes of this section if the physician is in
compliance with this section and the physician:
(1)
ensures that patients are adequately informed and have
signed consent forms prior to treatment that outline reasonably foreseeable
side effects and untoward complications that may result from the non-ablative
treatment;
(2)
is responsible for the formulation or approval of a written
protocol and any patient-specific deviation from the protocol;
(3)
reviews and signs, at least annually, the written protocol
and any patient-specific deviations from the protocol regarding care provided
to a patient under the protocol on a schedule defined in the written protocol;
(4)
receives, on a schedule defined in the written protocol,
a periodic status report on the patient, including any problems or complications
encountered;
(5)
remains on-site for non-ablative treatments performed by
delegates consistent with subsection (d)(1) of this section and immediately
available for consultation, assistance, and direction;
(6)
personally attends to, evaluates, and treats complications
that arise; and
(7)
evaluates the technical skills of the delegate performing
non-ablative treatment by documenting and reviewing at least quarterly the
assistant's ability:
(A)
to properly operate the devices and provide safe and effective
care; and
(B)
to respond appropriately to complications and untoward
effects of the procedures.
(f)
Alternate physicians.
(1)
If a delegating physician will be unavailable to supervise
a delegate as required by this section, arrangements shall be made for another
physician to provide that supervision.
(2)
The physician providing that supervision shall affirm in
writing that he or she is familiar with the protocols or standing delegation
orders in use at the site and is accountable for adequately supervising care
provided pursuant to those protocols or standing delegation orders.
(3)
An alternate physician must have the same training in performance
of non-ablative treatments as the primary supervising physician.
(g)
Written protocols. Written protocols for the purpose of
this section shall mean a physician's order, standing delegation order, standing
medical order, or other written order that is maintained on site. A written
protocol must provide at a minimum the following:
(1)
a statement identifying the individual physician authorized
to utilize the specified device and responsible for the delegation of the
performance of the specified procedure;
(2)
a statement of the activities, decision criteria, and plan
the delegate shall follow when performing delegated procedures;
(3)
selection criteria to screen patients for the appropriateness
of non-ablative treatments;
(4)
identification of devices and settings to be used for patients
who meet selection criteria;
(5)
methods by which the specified device is to be operated;
(6)
a description of appropriate care and follow-up for common
complications, serious injury, or emergencies as a result of the non-ablative
treatment; and
(7)
a statement of the activities, decision criteria, and plan
the delegate shall follow when performing delegated procedures, including
the method for documenting decisions made and a plan for communication or
feedback to the authorizing physician concerning specific decisions made.
Documentation shall be recorded within a reasonable time after each procedure,
and may be performed on the patient's record or medical chart.
(h)
Educational requirements for physicians and advanced health
practitioners. Physicians and advanced health practitioners who are involved
in the performance of non-ablative treatments must:
(1)
complete basic training devoted to the principles of lasers,
intense pulsed light devices and thermal, radiofrequency and other non-ablative
devices, their instrumentation, physiological effects and safety requirements.
For each device, the physician and advanced health practitioner must attend
an initial training program. The initial training must last at least 24 hours,
and include clinical applications of various wavelengths and hands-on practical
sessions with each device and their appropriate surgical or therapeutic delivery
systems; and
(2)
maintain competence to perform non-ablative procedures
and obtain at least eight hours of documented training annually regarding
the appropriate standard of care in the field of non-ablative procedures.
(i)
Educational requirements for delegates. A physician may
delegate non-ablative procedures to a qualified delegate. The physician must
ensure that the delegate complies with paragraphs (1) - (5) of this subsection
prior to performing the non-ablative procedure in order to properly assess
the delegate's competency.
(1)
The delegate has completed and is able to document clinical
and academic training in the subjects listed in subparagraphs (A) - (G) of
this paragraph:
(A)
fundamentals of laser operation;
(B)
bioeffects of laser radiation on the eye and skin;
(C)
significance of specular and diffuse reflections;
(D)
non-beam hazards of lasers;
(E)
non-ionizing radiation hazards;
(F)
laser and laser system classifications; and
(G)
control measures.
(2)
The delegate has read and signed the facility's policies
and procedures regarding the safe use of non-ablative devices.
(3)
The delegate has received or participated in at least 16
hours of documented initial training in the field of non-ablative devices.
(4)
The delegate has attended at least eight hours of additional
hours of documented training annually in the field of non-ablative procedures.
(5)
The delegate has completed at least ten procedures of precepted
training for each non-ablative procedure to assess competency.
(j)
Quality assurance. The physician must ensure that there
is a quality assurance program for the facility at which non-ablative procedures
are performed in order for the purpose of continuously improving the selection
and treatment of patients. An appropriate quality assurance program shall
consist of the elements listed in paragraphs (1) - (5) of this subsection.
(1)
A mechanism to identify complications and untoward effects
of treatment and to determine their cause.
(2)
A mechanism to review the adherence of delegates to standing
delegation orders, standing medical orders and written protocols.
(3)
A mechanism to monitor the quality of non-ablative treatments.
(4)
A mechanism by which the findings of the quality assurance
program are reviewed and incorporated into future standing delegation orders,
standing medical orders, written protocols, and supervising responsibility.
(5)
Ongoing training to improve the quality and performance
of delegates.
(k)
The deadline for compliance with the provisions of this
section will be one year following the final adoption of this rule.
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 June 30, 2003.
TRD-200303974
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: August 10, 2003
For further information, please call: (512) 305-7016
Chapter 391.
POLYGRAPH EXAMINER INTERNSHIP
.
]
Approval of
]
Continuing Acupuncture Education
Courses
. Continuing Acupuncture
Education
courses must meet the following requirements
[
credit
hours shall be approved by the Texas State Board of Acupuncture Examiners
based on the recommendation of the Education Committee of the board in regard
to courses, programs, and activities submitted by licensees to satisfy the
CAE requirements of this section. Approval shall be based on a showing by
the education provider that
]:
and is not a course on practice enhancement, business, or office administration;
]
obtain
] written evaluations at the end of each program, collate the evaluations
in a statistical summary, and
makes
[
make
] the summary
available to the board upon request.
(r)
] CAE Credit for Course Instruction.
Instructors of board-approved CAE courses
or courses taught through a
program offered by an approved provider for CAE credit
may receive three
hours of CAE credit for each hour of lecture, not to exceed six hours of continuing
education credit per year, regardless of how many hours taught. Participation
as a member of a panel presentation for the approved course shall not entitle
the participant to earn CAE credit as an instructor. No CAE credit shall be
granted to school faculty members as credit for their regular teaching assignments.
Chapter 193.
STANDING DELEGATION ORDERS
Part 19.
POLYGRAPH EXAMINERS BOARD