Proposed Sections 
 Before an agency may permanently adopt a new or amended section, or repeal an 
existing section, a proposal detailing the action must be published in the Texas 
Register at least 30 days before any action may be taken. The 30-day time period 
gives interested persons an opportunity to review and make oral or written 
comments on the section. Also, in the case of substantive sections, a public 
hearing must be granted if requested by at least 25 persons, a governmental 
subdivision or agency, or an association having at least 25 members. 
 Symbology in proposed amendments. New language added to an existing section is 
indicated by the use of bold text. [Brackets] indicate deletion of existing 
material within a section. 
 
   
  TITLE 1. ADMINISTRATION 
 Part V. General Services Commission 
  Chapter 113. Purchasing 
  
  Purchases of Information Resources Technology 
 
  1 TAC sec.113.18 
 
  (Editor's note: The text of the following section proposed for repeal will not 
be published.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 General Services 
Commission or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.) 
   
  The General Services Commission proposes the repeal of  s113.18, concerning 
purchases of information resources technology. The repeal of sec.113. 18 is to 
conform to Senate Bill 381, sec.1.28, 73rd Legislature, which repeals Texas 
Civil Statutes, Article 601b, sec.3.021, concerning purchases or leases of 
automated information and telecommunications items. 
 Charlie Bertero, purchasing manager, Purchasing Division, has determined that 
for the first five-year period the repeal is in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the repeal. 
 Mr. Bertero 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 
repeal will be administrative rules that are consistent with applicable 
statutory provisions. There will be no effect on small businesses. There is no 
anticipated economic cost to persons who are required to comply with the repeal 
as proposed. 
 Comments on the proposal may be submitted to Judith M. Porras, Director, Legal 
Information and Human Resources Division, General Services Commission, P. O. Box 
13047, Austin, Texas 78711-3047. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
 The repeal is proposed under Texas Civil Statutes, Article 601b, Article 3, 
which provide the General Services Commission with the authority to promulgate 
rules necessary to accomplish the purpose of Article 3. 
 
 
  sec.113.18. Purchases of Information Resources Technology. 
 This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9325011 
  Judith M. Porras 
 Director, Legal Information and Human Resources Division 
 General Services Commission 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3583 
         
         
  Purchase of Motor Vehicles 
 
  1 TAC sec.113.25 
 
  The General Services Commission proposes an amendment to  s113.25, concerning 
purchase of motor vehicles. The amendment of this section is to conform to House 
Bill 2626, 73rd Legislature, sec.20, which amends Texas Civil Statutes, Article 
601b,  s3.29, to allow the purchase of larger vehicles if they are converted to 
use compressed natural gas or another alternative fuel. 
 Tommy L. Crowe, purchasing manager, Purchasing Division, has determined that 
for the first five-year period the rule is in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the rule. 
 Mr. Crowe also has determined that for each year of the first five years the 
rule is in effect the public benefit anticipated as a result of enforcing the 
rule will be administrative rules that conform to new statutory provisions 
regarding vehicle size and the use of alternative fuels. There will be no effect 
on small businesses. There is no anticipated economic cost to persons who are 
required to comply with the rule as proposed. 
 Comments on the proposal may be submitted to Judith M. Porras, Director, Legal 
Information and Human Resources Division, General Services Commission, P. O. Box 
13047, Austin, Texas 78711-3047. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
 The amendment is proposed under Texas Civil Statutes, Article 601b, which 
provide the General Services Commission with the authority to promulgate rules 
necessary to accomplish the purpose of the Article. 
 
 
  sec.113.25. Purchase of Motor Vehicle. 
 
  (a) A state agency may not purchase or lease a vehicle designed or used 
primarily for the transportation of persons, including a station wagon, that has 
a wheel base longer than 113 inches or that has more than 160 SAE net 
horsepower<nl>, except that the vehicle may have a wheel base of up to 116 
inches or SAE net horsepower of up to 280 if the vehicle will be converted so 
that it is capable of using compressed natural gas or another alternative fuel 
that results in comparably lower emissions of oxides of nitrogen, volatile 
organic compounds, carbon monoxide, or particulates<ol>. <nl>The wheel base and 
horsepower limitations prescribed by this subsection do<ol> [This provision 
does] not apply to the purchase or lease of a vehicle to be used primarily for 
criminal law enforcement or a bus, motorcycle, pickup, van, truck, three-wheel 
vehicle, tractor, or ambulance. 
   
  (b)-(d) (No change.) 
 This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9325010 
  Judith M. Porras 
 Director, Legal Information and Human Resources Division 
 General Services Commission 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3583 
         
           
  Competitive Cost Review 
 
  1 TAC sec.sec.113.91, 113.93, 113.95, 113.97, 113.99 
 
  (Editor's note: The text of the following sections proposed for repeal will 
not be published. The sections may be examined in the offices of the General 
Services Commission or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.) 
   
  The General Services Commission proposes the repeal of  ssec.113.91, 113.93, 
113.95, 113.97, and 113.99, concerning competitive cost review. The repeal of 
these sections is to conform to House Bill 2626, sec.68, 73rd Legislature, 
effective September 1, 1993, which repeals Texas Civil Statutes, Article 601b, 
Article 13, concerning the competitive cost review program. 
 Sal Valdez, director, Policy and Staff Services, has determined that for the 
first five-year period the repeals are in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the repeals. 
 Mr. Valdez also has determined that for each year of the first five years the 
repeals are in effect the public benefit anticipated as a result of enforcing 
the repeals will be administrative rules that are consistent with applicable 
statutes. There will be no effect on small businesses. There is no anticipated 
economic cost to persons who are required to comply with the repeals as 
proposed. 
 Comments on the proposal may be submitted to Judith M. Porras, Director, Legal 
Information and Human Resources Division, General Services Commission, P. O. Box 
13047, Austin, Texas 78711-3047. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
 The repeals are proposed under Texas Civil Statutes, Article 601b, which 
provide the General Services Commission with the authority to promulgate rules 
necessary to accomplish the purpose of the Article. 
 
 
  sec.113.91. General. 
 
   
  sec.113.93. Definitions. 
 
   
  sec.113.95. State Agency Responsibilities. 
 
   
  sec.113.97. State Auditor Responsibilities. 
 
   
  sec.113.99. General Services Commission Responsibilities. 
 This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9325014 
  Judith M. Porras 
 Director, Legal Information and Human Resources Division 
 General Services Commission 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3583 
         
           Chapter 117. Centralized Services Division 
  
  Interagency Cooperation Contracts 
 
  1 TAC sec.sec.117.11-117.18 
 
  (Editor's note: The text of the following sections proposed for repeal will 
not be published. The sections may be examined in the offices of the General 
Services Commission or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.) 
   
  The General Services Commission proposes the repeal of  ssec.117.11-117.18, 
concerning interagency cooperation contracts. The repeal of these sections is to 
conform to House Bill 2626, 73rd Legislature, sec.sec.19, 53-56, and 68, which 
eliminate former requirements for commission approval and audit of interagency 
contracts. 
 Judith M. Porras, director, Legal Information and Human Resources Division, has 
determined that for the first five-year period the repeals are in effect there 
will be no fiscal implications for state or local government as a result of 
enforcing or administering the repeals. 
 Ms. Porras also has determined that for each year of the first five years the 
repeals are in effect the public benefit anticipated as a result of enforcing 
the repeals will be applicable administrative rules that are consistent with 
statutes. There will be no effect on small businesses. There is no anticipated 
economic cost to persons who are required to comply with the repeals as 
proposed. 
 Comments on the proposal may be submitted to Judith M. Porras, Director, Legal 
Information and Human Resources Division, General Services Commission, P. O. Box 
13047, Austin, Texas 78711-3047. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
 The repeals are proposed under Texas Civil Statutes, Article 601b, which 
provide the General Services Commission with the authority to promulgate rules 
necessary to accomplish the purpose of the Article. 
 
 
  sec.117.11. General. 
 
   
  sec.117.12. Definition of Terms and Phrases. 
 
   
  sec.117.13. Guidelines to Determine Validity of Proposed Interagency Contract. 
 
   
  sec.117.14. Review and Approval. 
 
   
  sec.117.15. Basic Contract Requirements. 
 
   
  sec.117.16. Prohibited Contracts. 
 
   
  sec.117.17. Amending an Interagency Contract. 
 
   
  sec.117.18. Submission of Vouchers for Reimbursement. 
 This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9325012 
  Judith M. Porras 
 Director, Legal Information and Human Resources Division 
 General Services Commission 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3583 
         
           Chapter 125. Travel and Transportation Division 
  
  Reduction and/or Waiver of Required Fleet Percentages 
 
  1 TAC sec.125.65 
 
  The General Services Commission proposes an amendment to  s125.65, concerning 
the Texas Alternative Fuels Program. The amendments reflect changes made by 
legislation affecting the commissions authority to issue waivers to school 
districts from the requirements of this program. 
 Michael N. Powers, director, Travel and Transportation Division, has determined 
that for the first five-year period the rule is in effect there will be no 
fiscal implications for state or local government as a result of enforcing or 
administering the rule. 
 Mr. Powers also has determined that for each year of the first five years the 
rule is in effect the public benefit anticipated as a result of enforcing the 
rule will be a streamlined process for school districts to seek waivers from the 
requirements of this program in compliance with applicable statutes. 
 Comments on the proposal may be submitted to Judith M. Porras, General Counsel, 
General Services Commission, P.O. Box 13047, Austin, Texas 78711-3037. Written 
comments must be received no later than 30 days from the date of publication of 
the proposal in the Texas Register. 
 The amendment is proposed under Texas Civil Statutes, Article 601b, Article 14, 
which provide the General Services Commission with the authority to promulgate 
rules necessary to implement that article. 
 
 
  sec.125.65. Reduction and/or Waiver of Required Fleet Percentages. 
 
  (a) Any state agency operating a fleet of more than 15 motor vehicles, 
excluding law enforcement and emergency vehicles, [and any school district 
operating more than 50 motor vehicles used for transporting school children] 
shall have a fleet percentage of alternative fuel vehicles equal to or greater 
than 30% of the total number of such vehicles operated by September 1, 1994, and 
a percent equal to or greater than 50% by September 1, 1996. Contingent upon a 
determination by the Texas Air Control Board by December 31, 1996, that the 
alternative fuel program reduced total annual emissions from vehicles, state 
agencies [and school districts] shall have a fleet percentage equal to or 
greater than 90% of alternative fuel vehicles by September 1, 1998, and 
thereafter. 
   
  (b) An agency [or school district] desiring a waiver or reduction from 
subsection (a) of this section shall submit a certification that: 
 
  (1) the vehicles will be operating primarily in an area in which neither the 
agency [or school district] nor a supplier has or can reasonably be expected to 
establish a central refueling station for alternative fuels; 
   
  (2) the agency [or school district] is unable to acquire or be provided 
equipment or refueling facilities necessary to operate vehicles using an 
alternative fuel at a projected cost that is reasonably expected to result in no 
greater net costs than the continued use of traditional gasoline or diesel fuels 
measured over the expected useful life of the equipment or facilities supplied; 
or 
   
  (3) the agency [or school district] is unable to acquire or be provided any 
alternative fuel vehicles or equipment necessary for such vehicles. 
     
  (c)-(f) (No change.) 
   
  (g) The travel and transportation division keeps these waivers for up to two 
years for use in waiving the purchasing restrictions for state agencies [and 
school districts] in  s113.21 of this title (relating to Purchases of Motor 
Vehicles). 
 This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9325013 
  Judith M. Porras 
 Director, Legal Information and Human Resources Division 
 General Services Commission 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3583 
         
                 
  TITLE 4. AGRICULTURE 
 Part I. Texas Department of Agriculture 
  Chapter 5. Quarantines 
  
  Pink Bollworm Quarantine 
 
  4 TAC sec.sec.5.172, 5.175-5.179 
 
  The Texas Department of Agriculture proposes amendments to sec.sec.5.172, 5. 
175-5.179, concerning Pink Bollworm Quarantine. The amendments add the 
definition of "destruction", clarify the sections and the destruction 
methodology to be utilized by farmers, and establish rules for deadline 
extension requests. In addition, the amendments to sec.5.178 and sec.5.179 
reestablish zones to delete those areas already covered for boll weevil control 
in Chapter 6 of this title (relating to Boll Weevil Control). 
 David Davis, director, plant quality program, has determined that for the first 
five-year period the rules are in effect there will be no fiscal implications 
for state or local government as a result of enforcing or administering the 
rules. 
 Mr. Davis, also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be a reduced need for chemical treatment to control pink bollworm. 
There will be no effect on small businesses. There is no anticipated economic 
cost to persons who are required to comply with the rule as proposed. 
 Comments on the proposal may be submitted to Darrell Williams, Texas Department 
of Agriculture, P.O. Box 12847, Austin, Texas 78711. 
 The amendments are proposed under Texas Agriculture Code, sec.74.054 which 
provides the Texas Department of Agriculture with the authority to adopt rules 
necessary for the control and eradication of the pink bollworm. 
 
 
  sec.5.172. Definitions.  The following words and terms, when used in this 
chapter, shall have the following meanings, unless the context clearly indicates 
otherwise <nl>.<ol> [:] 
   
   Inspector-An authorized inspector or <nl>other employee<ol> of the Texas 
State Department of Agriculture, or an inspector of the United States Department 
of Agriculture. 
   
  <nl>   Mechanical destruction -Plowing, shredding, disking, or any other 
cultivation practice prescribed by the department that destroys the cotton 
plants, and prevents regrowth of stalks, fruit, bolls, squares, blooms, foliage, 
terminals, and root system. 
   
   Moved (movement and <nl>move<ol> [moved]) -Shipped, offered for shipment to a 
common carrier, received for transportation or transported, moved, or allowed to 
be moved by any person within or from any quarantined area. (Movement and move 
shall be construed accordingly.) 
   
   Quarantined area -Any portion of the State of Texas which has been placed 
under quarantine on account of the pink bollworm of cotton by [proclamation of] 
the Commissioner of Agriculture of Texas. 
   
   Quarantined articles -Products and articles that may move under the 
restrictions in this quarantine <nl>as further defined in sec.5.174 of this 
title (relating to Quarantined Articles). 
   
   Treatment <nl>(treated) <ol>-A treatment applied under the observation of an 
inspector in accordance with methods selected by him from administratively 
authorized procedures known to be effective under the conditions applied. 
 
   
  sec.5.175. Movement of Quarantined Articles. 
 
  (a) Within quarantined areas. There are no restrictions to movement of 
quarantined articles within quarantined areas under normal conditions. The only 
restriction to movement within the quarantined area <nl>is<ol> [are] where 
<nl>an inspector <ol> [the commissioner of agriculture or one of his inspectors] 
decides that the movement may result in expansion of the quarantined area or in 
increased infestation<nl>, in<ol> [. In] which case a [movement] permit may be 
required. 
   
  (b) Within free areas. There are no restrictions to movement of quarantined 
articles within free areas under normal conditions. However, if <nl>an 
inspector<ol> [the commissioner of agriculture or one of his inspectors] 
determines that such movement may result in expansion of the quarantined area or 
in increased infestation, a permit may be required. 
   
  (c) From a quarantined area to a free area. A permit is required except where 
<nl>an inspector <ol> [the commissioner of agriculture or one of his inspectors] 
determines that there will be little or no danger of increased infestation or 
expansion of the quarantined area by such movement<nl>, in which case<ol> [. 
Under this exception] a permit [requirement] may be waived. 
   
  (d) From a free area into or through a quarantined area. No permit is required 
except where <nl>an inspector <ol> [the commissioner of agriculture or one of 
his inspectors] determines that the movement may cause an increase in 
infestation or expansion of a quarantined area. A permit may then be required. 
 
     
  sec.5.176. Permits. 
 
  (a) Issuing authority. <nl>Permits<ol> [Movement permits] are issued by 
<nl>inspectors of the Texas Department of Agriculture or by inspectors of the 
United States Department of Agriculture<ol> [the commissioner of agriculture or 
one of his inspectors]. 
   
  (b) Attachments. When permits are required, they shall be securely fastened to 
the outside of the container in which the <nl>quarantined<ol> articles are being 
moved, except where the permit is attached to the shipping documents and the 
quarantined articles are adequately described on the shipping documents or on 
the permit. The attachment of the permit to each of the containers is not 
required. 
   
  (c) Conditions of issuance. Permits may be issued by an inspector if the 
quarantined articles: 
 
  (1) (No change.) 
   
  (2) are being moved for particular handling, utilization, processing, or for 
treatment in accordance with approved procedures, provided that the inspector 
has determined that such movement will not result in the spread of the <nl>pink 
bollworm <ol> [the above identified pests]. 
     
  (d)  Exemptions. An inspector may exempt any <nl>quarantined <ol> article from 
any condition governing movement of <nl>guarantined<ol> articles if he 
determines that such movement will not result in the spread of the <nl>pink 
bollworm <ol> [the above described pest]. 
   
  (e) Cancellation. Any permits issued under these regulations may be withdrawn 
or canceled and further permits refused, whenever, in the judgment of <nl>an 
inspector<ol> [the commissioner of agriculture], the further use of such permits 
might result in the dissemination of the pink bollworm. 
 
     
  sec.5.177. Inspection and Disposal. 
 
  (a) Individuals authorized to inspect and dispose. Any properly identified 
inspector is authorized to stop and inspect, without a warrant, any person or 
means of conveyance moving within or from the State of Texas upon probable cause 
to believe that such <nl>is a<ol> means of conveyance of quarantined articles 
infested with the <nl>pink bollworm<ol> [above named pest]; and such inspector 
is authorized to seize, treat, or cause to be treated, destroy, or otherwise 
dispose of articles found to be moving in violation of these regulations. 
   
  (b) Articles subject to inspection and destruction. All quarantined articles 
imported into the State of Texas or transported [from county] within the state 
in violation of these regulations [rules] are subject to destruction or return 
to the point of origin at the discretion of <nl>an inspector <ol> [the 
commissioner of agriculture or his duly authorized agent]. 
 
     
  sec.5.178. [Pink Bollworm] Quarantine Zones. 
 
  [(a) Zone 1. Includes the following listed whole and partial counties: 
 
  [(1) Whole counties. Cameron and Willacy. 
   
  [(2) Partial counties. 
 
  [(A)  Hidalgo. The part of Hidalgo County subject hereto is that portion lying 
south and east of the boundary line described and located as: "Beginning at the 
intersection of the west line of Hidalgo County with the east boundary line of 
Starr County, Texas, at a point of the south boundary line of the Los Maguelles 
Grant in Hidalgo County, Texas; thence east along the south line of the Los 
Maguelles and Los Guagues Grants and continuing along the south line of League 
Number 1 of the Hidalgo County School lands to the southeast corner of said 
League Number 1 and the intersection of County Road; thence south along said 
County Road running through Section 212 of said county to a curve in the said 
County Road; thence following said curve turning east and following along said 
county Road through Sections 212 and 211 and through Jackson Subdivision of 
lands in the San Salvador Del Tule Grant in Hidalgo County, Texas, and following 
along said County road through the Old Monte Christo Townsite to the 
intersection of said County Road with the Railroad right-of-way running north 
and south; thence north along said Railroad right-of-way to a point where said 
Railroad right-of-way turns to the east; thence east along said Railroad right-
of-way running through the said Jackson Subdivision, the Rio Grande Development 
Company Subdivision and Tract Number 160 of the Brazil Pasture, all in the San 
Salvador Del Tule Grant in said county; thence continuing along the said 
Railroad right-of-way running east through Lots 35 and 36 of the Baker 
Subdivision of said San Salvador Del Tule Grant to a point in the east line of 
Faysville Townsite; thence northeasterly following along said Railroad right-of-
way through Lots 37, 38, 30, 29 of the said Baker Subdivision and continuing 
along said Railroad right-of-way running northeasterly through Tracts Number 
154, 136, and 155 in the said San Salvador Del Tule Grant at a point on the 
northeast corner of said Tract Number 155 and the intersection of the west line 
of the Las Mestenas Grant in Hidalgo County, Texas; thence north along the west 
line of the Las Mestenas Grant and the east line of the San Salvador Del Tule 
Grant to a point on the intersection of State Highway running easterly from San 
Manuel in Hidalgo County, Texas, to Raymondville in Willacy County, Texas, and 
being a point also on the southwest corner of west 1/2 of Share Number 3 in the 
said Las Mestenas Grant; thence east along said State Highway and the south 
boundary line of said west 1/2 of Share Number 3 Las Mestenas Grant to the 
intersection of the east boundary line of Hidalgo County, Texas, and the west 
boundary line of Willacy County, Texas, all according to the official map and 
plat of Hidalgo County, Texas, reference to which said map is here made for a 
more particular description of said proposed boundary line as above described." 
   
  [(B) Starr County. The part of Starr County subject hereto is that portion of 
Starr County lying south of U.S. Highway 83 (main highway from Mission to 
Laredo, Texas). 
       
  [(b) Zone 2. Includes the following listed whole and partial counties: 
 
  [(1) Whole counties. Aransas, Brooks, Duval, Jim Hogg, Jim Wells, Kenedy, 
Kleberg, Nueces, San Patricio, Webb, and Zapata. 
   
  [(2) Partial counties. 
 
  [(A) Hidalgo County. Subject hereto is that portion lying north and west of 
the boundary line described and located as: "Beginning at the intersection of 
the west line of Hidalgo County with the east boundary line of Starr County, 
Texas, at a point on the south boundary of the Los Maguelles Grant in Hidalgo 
County; thence east along the south line of the Los Maguelles and Los Guagues 
Grants and continuing along the south line of League Number 1 of the Hidalgo 
County lands to the southeast corner of said League Number 1; thence east along 
the south line of the Los Maguelles and Los Gaugues Grants and continuing along 
the south line of League Number 1 of the Hidalgo County lands to the southeast 
corner of said League Number 1 and the intersection of County Road thence south 
along said County Road running through Section 212 of said county to a curve in 
the said County Road; thence following said curve turning east and following 
along said County Road through Sections 212 and 211 and through the Jackson 
Subdivision of lands in the San Salvador Del Tule Grant in Hidalgo County, 
Texas, and following along said County Road through the Old Monte Christo 
Townsite to the intersection of said County Road with the Railroad right-of-way 
running north and south thence north along said Railroad right- of-way to a 
point where said Railroad right-of-way turns to the east; thence east along said 
Railroad right-of-way running through the said Jackson Subdivision, the Rio 
Grande Development Company Subdivision and Tract Number 160 of the Brazil 
Pasture, all in the San Salvador Del Tule Grant in said County, thence 
continuing along the said Railroad right-of-way running east through Lots 35 and 
36 of the Baker Subdivision of said San Salvador Del Tule Grant to a point in 
the east line of Faysville Townsite; thence northeasterly following along said 
Railroad right-of-way through Lots 37, 38, 31, 30, 29 of the said Baker 
Subdivision and continuing along said Railroad right-of-way running 
northeasterly through Tracts 154, 136, and 155 in the said San Salvador Del Tule 
Grant to a point on the northeast corner of said Tract Number 155 and the 
intersection of State Highway running easterly from San Manuel in Hidalgo 
County, Texas, to Raymondville in Willacy County, Texas, and being a point also 
on the southwest corner of west 1/2 of Share Number 3 in the said Las Mestenas 
Grant; thence east along said State Highway and the south boundary line of said 
west 1/2 of Share Number 3 Las Mestenas Grant to the intersection of the east 
boundary line of Hidalgo County, Texas, and the west boundary line of Willacy 
County, Texas, all according to the official map and plat of Hidalgo County, 
Texas, reference to which said map is here made for a more particular 
description of the said proposed boundary line as above described." Starr 
County--the part of Starr County subject hereto is that portion of Starr County 
lying North of U.S. Highway 83 (main highway from Mission to Laredo, Texas). 
   
  [(B) Bee County. That part of Bee County subject hereto is that portion of Bee 
County lying South and East of U.S. Highway 59.] 
       
  <nl>(a)<ol>[(c)] Zone  <nl>1<ol> [3]. Includes the following listed whole [and 
partial] counties: 
 
  (1) Whole counties. Atascosa, Bexar, [Calhoun,] DeWitt, [Dimmitt,] Frio, 
Goliad, [Jackson,] Karnes, Kinney, [LaSalle,] Live Oak, Maverick, [McMullen,] 
Medina, [Refugio,] Uvalde, Val Verde, [Victoria,] Wilson, <nl>and<ol> Zavala. 
   
  (2) Partial counties. Bee County: That part of Bee County subject hereto is 
that portion lying North and West of U. S. Highway 59.] 
     
  <nl>(b) [(d)]Zone  <nl>2<ol> [4]. Includes the following listed whole 
counties: [Austin, Brazoria,] Chambers, Colorado, Fayette, [Fort Bend,] 
Galveston, Gonzales, Harris, Jefferson, Lavaca, Liberty, [Matagorda,] Orange, 
Waller, <nl>and<ol> Washington [, and Wharton]. 
   
  <nl>(c)<ol>[(e)]  Zone <nl>3<ol> [5]. Includes the following listed whole 
counties: Bastrop, Caldwell, Comal, Guadalupe, Hays, Lee, Travis, and 
Williamson. 
   
  <nl>(d) <ol>[(f)] Zone <nl>4<ol> [6]. Includes the following listed whole 
counties: Anderson, Angelina, Bell, Bosque, Brazos, Burleson, Burnet, Coryell, 
Cherokee, Ellis, Falls, Freestone, Grimes, Hamilton, Hardin, Henderson, Hill, 
Hood, Houston, Jasper, Johnson, Lampasas, Leon, Limestone, McLennan, Madison, 
Milam, Montgomery, Nacogdoches, Navarro, Newton, Panola, Polk, Robertson, Rusk, 
Sabine, San Augustine, San Jacinto, Shelby, Smith, Somervell, Trinity, Tyler, 
and Walker. 
   
  <nl>(e)<ol>[(g)] Zone  <nl>5<ol> [7]. Includes the following listed whole 
counties: Pecos, Ward, and Reeves. 
   
  [(h) Zone 8. Includes the following listed whole and partial counties: 
 
  [(1)  Includes the following listed whole county: E1 Paso County. 
   
  [(2) Hudspeth County. That portion of Hudspeth County bounded by Interstate 
Highway 10 on the north, El Paso County line on the west, the Rio Grande River 
on the south, and a line from old Fort Whitman, north along Highway 34 to 
Interstate 10 on the east.] 
 
       
  sec.5.179. Authorized Planting and Stalk Destruction Dates. 
 
  (a)  All cotton plants in any of the quarantine zones <nl>set forth in sec.5. 
178<ol> must be  <nl>planted and mechanically<ol> destroyed by the 
<nl>authorized planting and stalk<ol> [plant] destruction <nl>deadlines <ol> 
[deadline] indicated below for each zone. <nl>This must<ol> [In zones (1)-(7), 
this may] be accomplished by shredding or plowing out the plants in such a way 
as to absolutely prevent further growth and to the point where there are no 
<nl>standing<ol> [live] cotton stalks  <nl>or regrowth<ol> [containing, squares, 
blooms, or bolls present on plants during that time period]. [See paragraph (8) 
of this section for zone (8).] 
 
  [(1) Zone 1. 
 
  [(A) Planting dates. February 1 through midnight March 31. 
   
  [(B) Stalk destruction date. By midnight August 31.] 
     
  [(2) Zone 2. 
 
  [(A) Planting dates. February 15 through midnight April 20. 
   
  [(B) Stalk destruction date. By midnight September 28. 
     
  <nl>(1)<ol>[(3)] Zone  <nl>1<ol> [3]. 
 
  (A) Planting dates<nl>:<ol>[.] March 5 through [midnight] May 10. 
   
  (B) Stalk destruction date<nl>:<ol>[.] <nl>by<ol> [By midnight] October 10. 
     
  <nl>(2)<ol>[(4)] Zone  <nl>2<ol> [4]. 
 
  (A)  Planting <nl>dates:<ol> [date.] March 10 through [midnight] May 20. 
   
  (B) Stalk destruction date<nl>:<ol>[.] <nl>by<ol> [By midnight] October 20. 
     
  <nl>(3)<ol>[(5)] Zone  <nl>3<ol> [5]. 
 
  (A)  Planting <nl>dates:<ol> [date.] March 10 through [midnight] May 20. 
   
  (B) Stalk destruction date<nl>:<ol>[.] <nl>by<ol> [By midnight] October 31. 
     
  <nl>(4)<ol>[(6)] Zone  <nl>4<ol> [6]. 
 
  (A)  <nl>Planting dates<ol>: [Planting date.] March 20 through [midnight] May 
31. 
   
  (B) Stalk destruction date<nl>:<ol>[.] <nl>by<ol> [By midnight] November 30. 
     
  <nl>(5)<ol>[(7)] Zone  <nl>5<ol> [7]. Stalk destruction date<nl>:<ol> [-] by 
[midnight] February 1. 
   
  [(8) Zone 8. 
 
  [(A)  complete shredding of stalks and turning under all debris by plowing to 
a depth of six inches by midnight, February 1, or 
   
  [(B) shredding stalks and disced and cross-disced to a depth of four inches by 
February 1 and irrigating prior to March 1. 
   
  [(C) The Texas Department of Agriculture may grant permission to extend the 
deadlines in subparagraphs (A) and (B) of this paragraph under the following 
conditions: 
 
  [(i) the grower applies for such extension before February 1 of each year; and 
   
  [(ii)  the grower grazes the land, completing such grazing by March 1 of each 
year. 
         
  <nl>(b)<ol>[(9)] Granting extensions of dates. <nl>The commissioner may, on 
written request by a farm owner or operator, grant an extension of the planting 
or stalk destruction dates.<ol> [The commissioner of agriculture or his 
authorized inspectors have the authority to grant extensions to either the 
planting or stalk destruction deadlines if it is deemed warranted or necessary. 
 
  <nl>(1) A written request must include the ASCS Farm/Tract Number, the reason 
for the request, the amount of acreage subject to the request, and the amount of 
time needed to complete planting or destruction. If an extension is requested on 
more than one farm, the farm operator or farm owner must submit a separate 
request for each farm or tract. 
   
  <nl>(2) All requests for extensions must be postmarked prior to the last 
planting date or stalk destruction date, whichever is applicable. 
     
  <nl>(c)<ol>[(10)] Responsibility for compliance. The owner of the land in 
question and the tenant, if any, leasing such land [for which a permit] to grow 
cotton [has been granted,] shall be jointly and/or severally responsible for 
conducting cotton production within the limitation of these regulations and any 
infraction of the law as incorporated in these regulations as a part of the pink 
bollworm law shall apply against both the owner, or his duly authorized agent, 
and tenant involved. 
   
  [(b) These regulations shall be effective on and after December 16, 1975, and 
shall supersede any previous rule, regulation, proclamation, or quarantine of 
the Pink Bollworm.] 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9325044 
  Dolores Alvarado Hibbs 
 Chief Administrative Law Judge 
 Texas Department of Agriculture 
    Earliest possible date of adoption: July 6, 1993 
 For further information, please call: (512) 463-7583 
         
                   
  TITLE 16. ECONOMIC REGULATION 
 Part IV. Texas Department of Licensing and Regulation 
  Chapter 68. Elimination of Architectural Barriers 
  
  16 TAC sec.68.100 
 
  The Texas Department of Licensing and Regulation proposes new sec.68.100, 
concerning accessibility standards for the elimination of architectural barriers 
encountered by persons with disabilities in buildings and facilities subject to 
the Architectural Barriers Act, Texas Civil Statutes, Article 9102. The section 
is being proposed to allow for the adoption of new accessibility standards 
intended to be consistent with those adopted under federal law in accordance 
with the Act, sec.5(c). The format of the proposed standards differs from the 
Administrative Code format and does not appear in this notification. This 
deviation was necessary to maintain the numbering sequence of the federal 
Americans with Disabilities Act Accessibility Guidelines (ADAAG) and the 
capability to distinguish between the ADAAG and language added by the department 
using italics. Copies of the proposed Texas Accessibility Standards (TAS) are 
available from the Office of the Secretary of State, Texas Register Division, 
P.O. Box 13824, Austin, Texas 78711-3824, 1019 Brazos Street, Room 245, Austin, 
Texas 78701, (512) 463-5561, TTD (800) 735-2989, FAX (512) 463-5569. The cost is 
$10 per copy, check, Visa, and MasterCard are accepted. 
 James D. Brush, director, policies and standards division, has determined that 
for the first five-year period the rule is in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the rule. 
 Mr. Brush also has determined that for each year of the first five years the 
rule is in effect the public benefit anticipated as a result of enforcing the 
rule will be improved accessibility for persons with disabilities and increased 
compliance with state and federal laws. There will be no effect on small 
businesses who construct or substantially renovate, modify, or alter their 
facilities. There is anticipated economic costs to persons who are required to 
comply with the rule as proposed; however, cost are not expected to exceed 1 
1/2% of the total construction cost. Cost may be slightly higher in revocations 
or multi-level facilities. 
 Written comments on the proposal may be submitted to Rick Baudoin, Texas 
Department of Licensing and Regulation, P.O. Box 12157, Austin, Texas 78711. 
Comments should be received not later than August 20, 1993. 
 The new section is proposed under Texas Civil Statutes, Article 9102, which 
provide the Texas Department of Licensing and Regulation with the authority to 
adopt standards that are consistent with federal law. 
 
 
  sec.68.100. Technical Standards. <ol> The Texas Department of Licensing and 
Regulation adopts by reference the Texas Accessibility Standards (TAS), July 6, 
1993, edition. Copies may be obtained from the Office of the Secretary of State, 
Texas Register Division, P.O. Box 13824, Austin, Texas 78711-3824, 1019 Brazos 
Street, Room 245, Austin, Texas 78701, (512) 463-5561, TTD (800) 735-2989, FAX 
(512) 463-5569. The cost is $10 per copy and check, Visa, and MasterCard are 
accepted. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9324980 
  Jack W. Garison 
 Executive Director 
 Texas Department of Licensing and Regulation 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3127 
         
         
  16 TAC sec.68.112 
 
  (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 Licensing and Regulation, or in the Texas Register office, Room 245, James 
Earl Rudder Building, 1019 Brazos Street, Austin.) 
   
  The Texas Department of Licensing and Regulation proposes the repeal of 
sec.68.112, concerning standards for the elimination of architectural barriers 
encountered by persons with disabilities in buildings and facilities subject to 
the Architectural Barriers Act, Texas Civil Statutes, Article 9102. The section 
is being repealed to allow for the adoption of new accessibility standards 
intended to be consistent with those adopted under federal law in accordance 
with the Act sec.5(c). 
 James D. Brush, director, policies and standards division, has determined that 
for the first five-year period the repeal is in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the repeal. 
 Mr. Brush 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 
repeal will be improved accessibility for persons with disabilities and 
increased compliance with state and federal law. There will be no effect on 
small businesses. There is no anticipated economic cost to persons who are 
required to comply with the repeal as proposed. 
 Comments on the proposal may be submitted to Rick Baudoin, Texas Department of 
Licensing and Regulation, P.O. Box 12157, Austin, Texas 78711. 
 The repeal is proposed under Texas Civil Statutes, Article 9102, which provide 
the Texas Department of Licensing and Regulation with the authority to adopt 
standards that are consistent with federal law. 
 
 
  sec.68.112. Standards and Specifications. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9324979 
  Jack W. Garison 
 Executive Director 
 Texas Department of Licensing and Regulation 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 463-3127 
         
               
  TITLE 22. EXAMINING BOARDS 
 Part IX. Texas State Board of Medical Examiners 
  Chapter 193. Standing Delegation Orders 
  
  22 TAC sec.193.9 
 
  The Texas State Board of Medical Examiners proposes new  s193.9, concerning 
Electromyographic (EMG) and Nurse Conduction Velocity (NCV) testing. The Board, 
having determined that EMG and NCV testing constitute the practice of medicine, 
is proposing rules to maximize the safety in the utilization of these 
procedures. 
 Tim Weitz, senior attorney, has determined that for the first five-year period 
the rule are in effect there will be no fiscal implications for state or local 
government as a result of enforcing or administering the rule. 
 Pat Wood, secretary to the executive director, also has determined that for 
each year of the first five years the rule is in effect the public benefit 
anticipated as a result of enforcing the will be to maximize the safety in EMG 
and NCV testing by defining what tasks can and cannot be delegated to 
nonphysicians. There will be no effect on small businesses. There is no 
anticipated economic cost to persons who are required to comply with the rule as 
proposed. 
 Comments on the proposal may be submitted to Pat Wood, P.O. Box 149134, Austin, 
Texas 78714-9134. A public hearing will be held at a later date. 
 The new section is proposed under Texas Civil Statutes, Article 4495b, which 
provide the Texas State Board of Medical Examiners with the authority to make 
rules, regulations, and bylaws not inconsistent with this Act as may be 
necessary for the governing of its own proceedings, the performance of its 
duties, the regulation of the practice of medicine in this state, and the 
enforcement of this Act. 
 
 
  sec.193.9. Electromyography and Nerve Conduction Velocity Testing. 
 
  (a) Electromyography (EMG) and Nerve Conduction Velocity (NCV) testing involve 
the exercise of medical judgment in a diagnostic process which constitutes the 
practice of medicine under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b. To maximize safety in the utilization of these procedures, 
delegation of tasks involved in EMG and NCV procedures to non-physicians is 
limited as follows. 
 
  (1) In needle EMG, the insertion of needles shall be performed only by a 
licensed physician and shall not be delegated. 
   
  (2) The interpretation of EMG and NCV test results and any diagnosis based on 
such results shall be made only by licensed physicians and shall not be 
delegated. 
   
  (3) The performance of the following EMG related tasks may be delegated by a 
licensed physician to an individual qualified to perform such task by training, 
experience, or licensure so long as the delegee acts under the supervision and 
direction of the delegating physician which is sufficiently appropriate for the 
delegee's qualifications: 
 
  (A) explaining the testing process and procedures to the patient; 
   
  (B) obtaining and recording basic patient information, characteristics, and 
histories; 
   
  (C) preparation of the patient for the examination, but specifically not 
including the insertion of needles; 
   
  (D) recording of data in writing or in another form as directed by the 
delegating physician, so long as any written descriptions of needle electrode 
recordings are recorded as dictated by the delegating physician; 
   
  (E) care and maintenance of equipment, including, but not limited to, 
sterilization, calibration, and set up of equipment. 
     
  (4) The performance of NCV testing may be delegated by a licensed physician to 
an individual qualified to perform such tests by training, experience, or 
licensure so long as the delegee acts under the direct supervision of the 
delegating physician. 
     
  (b) A licensed physician who violates subsection (a)(1) or (2) of this section 
shall be subject to discipline under the Medical Practice Act, sec.3. 08(15), 
Texas Civil Statutes, Article 4495b, for aiding or abetting, directly or 
indirectly, the practice of medicine by any person, partnership, association, or 
corporation not duly licensed to practice medicine by the board. 
   
  (c) A physician who delegates EMG or NCV procedures in violation of 
subsections (a)(3) and (4) of this section shall be subject to discipline under 
the Medical Practice Act, sec.3.08(4)(H) and sec.3.08(4)(I) Texas Civil 
Statutes, Article 4495b, for failing to supervise adequately the activities of 
those acting under the supervision of the physician or for delegating 
professional medical responsibility or acts to a person the physician knew or 
should have known was not qualified by training, experience, or licensure to 
perform the responsibility or acts. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324965 
  Homer R. Goehrs, M.D. 
 Executive Director 
 Texas State Board of Medical Examiners 
    Earliest possible date of adoption: August 7, 1993 
 For further information, please call: (512) 834-4502 
         
               Part XII. Board of Vocational Nurse Examiners 
  Chapter 231. Administration 
  
  General Practice and Procedure 
 
  22 TAC sec.sec.231.12, 231.16, 231.22, 231.27, 231.32, 231.34, 231.36, 231.40, 
231.41, 231.43, 231.46, 231.48, 231.49 
 
  The Board of Vocational Nurse Examiners proposed amendments to sec.sec.231.12, 
231.16, 231.22, 231.27, 231.32, 231.34, 231.36, 231.40, 231.41, 231.43, 231. 46, 
231.48, and 231.49 concerning General Practice and Procedure. The amendment of 
these rules is to comply with the revised statute which governs vocational 
nurses. This revised statute will be effective September 1, 1993. 
 Marjorie A. Bronk, executive director, has determined that for the first five 
year period the rules are in effect there will be no fiscal implication for 
local government as a result of enforcing or administering the rules. The fiscal 
impact on state government will be the expenses for three additional board 
members. This cost is estimated at $10,500 per year. 
 Ms. Bronk also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be the addition of three public members to the board. There will be 
no effect on small businesses. There is no anticipated economic cost to persons 
who are required to comply with the rules as proposed. 
 Comments on the proposed amendments may be submitted to Marjorie A. Bronk, 
R.N., M.S.H.P., Executive Director, Board of Vocational Nurse Examiners, 9101 
Burnet Road, Suite 105, Austin, Texas 78758, (512) 835-2071. 
 The amendments are proposed under Texas Civil Statutes, Article 4528c, 
sec.5(g), which provide the Board of Vocational Nurse Examiners with the 
authority to make such rules and regulations as may be necessary to carry in 
effect the purposes of the law. 
 
 
  sec.231.12. Organization of the Board. The board is composed of <nl>15 <ol> 
[12] duly appointed members, seven licensed vocational nurses, one registered 
nurse, one physician, one hospital administrator, and <nl>five <ol> [two] Public 
members appointed for a term of six years. 
 
   
  sec.231.16. Officers of the Board. The officers of the Board shall consist of 
a president, vice-president, and secretary-treasurer. <nl>The Governor shall 
designate from the members of the board the president of the board. The person 
designated as president serves in that capacity at the will of the Governor. The 
vice president and secretary-treasurer shall be elected by members of the board 
at the yearly annual meeting<ol> [Officers shall be elected at the annual 
meeting to serve for a term of one year]. 
 
   
  sec.231.22. Vacancies in the Board. A vacancy occurring in the office of the 
president shall be <nl>temporarily<ol> filled by the vice- president. [for the 
unexpired term]. A vacancy occurring in the office of the vice-president or 
secretary-treasurer shall be filled by appointment by the president of the board 
for the unexpired term. 
 
   
  sec.231.26. Board Meetings (Special). Special meetings may be called by the 
President or upon request of <nl>five<ol> [six] members of the board. 
 
   
  sec.231.27. Quorum of the Board.<nl> Eight<ol> [six] members of the board 
shall constitute a quorum for the transaction of business. Should a quorum not 
be present on the day appointed for any meeting, those persons present may 
adjourn from day to day until a quorum shall be present, providing that such 
period shall not be longer than three successive days as specified in the Act, 
sec.5<nl>(h)<ol>[(j)]. 
 
   
  sec.231.32. Record of Meeting. The Secretary-Treasurer shall keep a record of 
all meetings and such records shall be retained as a permanent record of the 
transactions of the board. A certified copy of the minutes of each meeting shall 
be filed in the <nl>Texas State Library<ol> [Office of the Governor, the 
Legislative Budget Board, and the Texas State Library]. 
 
   
  sec.231.34. Auditing of Books. The State Auditor shall audit the books of the 
board. [annually]. 
 
   
  sec.231.36. Executive Director. <ol> The executive director shall be employed 
by the board and shall perform the administrative functions of the board. The 
executive director shall be a licensed nurse holding a current license in Texas 
and have had experience in business administration. Necessary expenses incurred 
in traveling in performance of the duties of the executive director shall be 
paid on vouchers. [The executive director shall be the custodian of the seal of 
the board and shall affix same to all official documents upon order of the 
president, secretary-treasurer of the board and/or the board.] The executive 
director shall conduct and care for all correspondence in the name of the board 
[; keep a record of all meetings and maintain a proper account of all business 
of the board; approve and co-sign all bills and vouchers for board expenditures; 
publish annually a roster of LVNs as required by the Act; prepare annual report 
of the board for the Governor, the presiding officer of each house of the 
Legislature, the Legislative Budget Board and State Auditor; arrange for audits 
by the State Auditor] and perform such other duties and responsibilities as may 
be assigned or delegated by the board not otherwise precluded by law. 
 
   
  sec.231.40. State Board Examination. It shall be the responsibility of the 
board to ascertain the qualifications of the vocational nurse by examination. 
The board shall contract with the National Council of State Boards of Nursing 
and specified testing service for use of the examination. The examination shall 
be administered [at least twice each year] in various cities throughout the 
state for qualified applicants for licensure. 
 
   
  sec.231.41. Fees.  The board shall establish reasonable and necessary fees for 
the administration of the Act [in the following amounts: 
 
  [(1) examination and application fee: $80 (effective May 1, 1990); 
   
  [(2) reexamination fee: $80 (effective May 1, 1990); 
   
  [(3)  renewal fee: $10/year (effective September 1, 1990); 
   
  [(4)  endorsement fee: $50; 
   
  [(5) approval of new programs fee: $75; 
   
  [(6) duplicate temporary permit or license fee: $10;. 
   
  [(7)  filing of affidavits in rechange of name fee: $5.00; 
   
  [(8)  endorsement to another state fee: $30; 
   
  [(9) reactivating from inactive status fee: $30 plus renewal fee (effective 
September 1, 1990); 
   
  [(10) penalty fees: $40 before 90 days; $80 after 90 days (effective September 
1, 1990); 
   
  [(11) Texas Peer Assistance Program for Nurses (TPAPN) Surcharge: $4.00 
(effective July 1, 1990)]. 
 
     
  sec.231.46. Identifying Insignia [on White Caps or Uniforms].  Any nurse who 
is licensed under the provisions of this Act, when on duty, shall wear 
<nl>insignia<ol> identifying [insignia] <nl>the nurse as a Licensed Vocational 
Nurse<ol> [on white caps or uniforms as stated in the Act, sec.6]. 
 
   
  sec.231.48. Bylaws. 
 
  (a) Article I, title and purposes. 
 
  (1) The name shall be the "Board of Vocational Nurse Examiners," House Bill 
47-Chapter 118, Acts 52nd Legislature, 1951. 
   
  (2) The purposes of the Board shall be: 
 
  (A) administer the Act; 
   
  (B) safeguard the public health and welfare; 
   
  (C) elect officers; 
   
  (D)  employ a full time executive director, and other persons as the board 
deems necessary to carry out the provisions of the Act; 
   
  (E) the board shall institute disciplinary proceedings as outlined in Roberts' 
Rules of Order, newly revised, in all cases in which they are applicable, and 
which are inconsistent with the Vocational Nurse Act, and these bylaws; 
   
  (F) establish rules and policies as are necessary to carry out the provisions 
of the Vocational Nurse Act; 
   
  (G) prepare curriculum and set standards for schools of vocational nursing, 
preparing persons for licensure under this Act; 
   
  (H) provide through the Director of Education surveys of schools and 
curriculum approved by the board and the Act; 
   
  (I) approve schools and courses that meet the board curriculum and standards; 
   
  (J) deny or withdraw approval from vocational nursing programs for failure to 
meet curriculum and standards set by the board; 
   
  (K) to provide for examination of graduates of approved schools [, at least 
twice a year]; 
   
  (L) to examine and approve credentials of applicants for endorsement; 
   
  (M) to renew biennially the licenses of persons licensed under the Vocational 
Nurse Act; 
   
  (N) record all proceedings of the board and make an annual report to the 
Governor; 
   
  (O) revoke or suspend any license issued under the provisions of the Act, 
sec.10. 
       
  (b) Article II, officers and duties. 
 
  (1) The officers of the board shall be: president, vice-president, and 
secretary-treasurer. 
   
  (2) The term of office <nl>for the vice president and secretary-treasurer <ol> 
shall be for one year. <nl>The president serves at the will of the Governor. 
   
  (3)  The annual meeting shall be September for election of officers. 
   
  (4)  The officers of the board shall perform such duties as are usually 
performed by such officers, as specified in the Vocational Nurse Act and these 
bylaws. 
     
  (c) Article III, Amendments. These bylaws may be amended, with or without 
previous notice, at any meeting by <nl>eight <ol> [two-thirds of] members 
present and voting. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 25, 1993. 
 TRD-9324957 
  Marjorie A. Bronk, R.N., M.S.H.P. 
 Executive Director 
 Board of Vocational Nurse Examiners 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 835-2071 
         
                 Part XIV. Texas Optometry Board 
  Chapter 271. Examinations 
  
  22 TAC sec.sec.271.1-271.3, 271.6 
 
  The Texas Optometry Board proposes amendments to sec. s271.1-271.3, and 271. 
6, concerning procedural rules for examinations. As a result of changes to the 
Texas Optometry Act by the 73rd Legislature (House Bill 1479), including fee 
changes, the amendments as proposed are basically those of a house-keeping 
nature to bring all rule language into compliance, as well as to eliminate 
gender specifics. The rules, as amended, will keep candidates for licensure 
fully informed of the application process. 
 Lois Ewald, executive director, has determined that there will be fiscal 
implications as a result of enforcing or administering the rules. During the 
first-year period the rules are in effect, the estimated cost to state 
government will be $30,000 in 1994, $30,000 in 1995, $30,000 in 1996, $30,000 in 
1997, and $30,000 in 1998. The estimated increase in revenue during the same 
five-year period will be $30,000 in 1994, $30,000 in 1995, $30,000 in 1996, 
$30,000 in 1997, and $30,000 in 1998. The fees are based on cost recovery. There 
will be no effect on local government. 
 Ms. Ewald also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be that the public will benefit from qualified candidates for 
licensure obtaining a license to practice, following examination. There will be 
no effect on small businesses. The anticipated economic cost to persons required 
to comply with the rules as proposed will be $150 per person taking the board 
examination. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The amendments are proposed under Texas Civil Statutes, Article 4552, sec.2. 
14, which provide the Texas Optometry Board with the authority to promulgate 
procedural and substantive rules. 
 
 
  sec.271.1. Definitions.  The following words and terms, when used in this 
chapter, shall have the following meanings, unless the context clearly indicates 
otherwise. 
   
  <nl>   Act-The Texas Optometry Act, Texas Civil Statutes, Article 4552. 
   
  <nl>   APTRA<ol> [APA] -The Administrative Procedure and Texas Register Act, 
Texas Civil Statutes, Article 6252-13a. 
   
   Board-Texas Optometry Board. 
   
   Executive director -Executive director of the Texas Optometry Board. 
   
   Respondent-A person against whom a formal charge has been made alleging 
conduct that violates the Act or rules, regulations, or orders of the board and 
whose legal rights are to be determined by the board after the opportunity for 
an adjudicative hearing in a contested case as defined by the <nl>APTRA<ol> 
[APA]. 
   
  <nl>   Contested case -A proceeding, including but not restricted to 
licensing, in which the legal rights, duties, or privileges of a party are to be 
determined by the board after an opportunity for adjudicative hearing. 
   
  <nl>   SOAH-State Office of Administrative Hearings. 
   
  <nl>   PFD-Proposal for Decision. 
 
   
  sec.271.2. Applications. 
 
  (a) The applicant shall make application furnishing to the executive director, 
on forms to be furnished by the board, satisfactory sworn evidence that <nl>the 
applicant <ol> [he] has attained the age of 21 years, is of good moral 
character, and has [at least graduated from a first grade high school or has] a 
preliminary education equivalent to permit [him to] <nl>matriculation <ol> 
[matriculate] in the University of Texas, and that <nl>the applicant <ol> [he] 
has attended and graduated from a reputable university or college of optometry 
which meets with the requirements of the board and such other information as the 
board may deem necessary for the enforcement of the Act. 
   
  (b) (No change.) 
   
  (c) In such application, the applicant shall state that <nl>the applicant<ol> 
[he] will abide by the laws of this state regulating the practice of optometry. 
   
  (d) Such application shall be subscribed <nl>and sworn to<ol> by the applicant 
[and sworn to be him] before any officer legally qualified to administer oaths. 
   
  (e) (No change.) 
   
  (f) <nl>Certified<ol> [A certificate of graduation from a first grade high 
school and certified] copies of the transcript of record from the preoptometry 
and optometry colleges attended by the applicant shall accompany each 
application, which certified transcript of record shall show the total number of 
hours of attendance, the subjects studied, the grades or marks given, and the 
date of graduation of the applicant. 
   
  (g) (No change.) 
   
  (h) The fee for taking the initial examination shall be <nl>$150<ol> [$55]. 
Any applicant who is refused a license because of failure to pass the first 
examination shall be permitted to take a second examination on the payment of  
<nl>$150<ol> [$20], provided the second examination is taken within a period of 
one year. 
   
  (i) Any applicant required to take the examination any subsequent times after 
the second examination shall pay a [$55] fee <nl>of $150<ol> to the board. No 
application fee for examination will be returned to any applicant after 
<nl>the<ol> [his] application has been approved by the board, because of the 
decision of the applicant not to stand for the examination or [his] failure for 
any reason to take the examination. 
 
     
  sec.271.3. Examination Administration. 
 
  (a)-(c) (No change.) 
   
  (d) [Applicants shall be permitted to bring computer calculators to the 
examination room.] Applicants shall not communicate any words or signs with 
another applicant while the examination is in progress without the permission of 
the presiding examiner, nor leave the examination room except when so permitted 
by the presiding examiner. Violations of this rule shall subject the offender to 
expulsion. 
   
  (e) (No change.) 
   
  (f) At the beginning of an examination each applicant shall be assigned a 
number. Applicants shall use the number assigned to them for purposes of 
identification throughout the examination, and no applicant's <nl>name<ol> 
[shall enter his or her name] or any other identification mark other than 
<nl>the assigned<ol> [his or her] number <nl>shall be entered <ol> on any paper 
containing answers to the questions of an examination. Members of the board 
shall in every way endeavor to avoid identification of an applicant prior to the 
awarding of the general averages. 
   
  (g) (No change.) 
 
     
  sec.271.6. National Board Examination. 
 
  (a) The <nl>board<ol> [Board] determines that the written examination by the 
National Board of Examiners in Optometry (NBEO) complies in all material 
respects with the requirements of the Act, sec.3.05 and sec.3.06. The passing 
score on each <nl>Part<ol> [part] of the <nl>National Board examination<ol> 
[national board] is determined by a criterion-referenced standard setting 
approach, in which the passing score is set at a scaled score of 300. 
   
  (b) (No change.) 
   
  (c) All applicants must comply with the application process and qualification 
criteria of the Act, sec.3.02, as well as all applicable <nl>board<ol> [Board] 
rules. 
   
  (d) All applicants must pay an examination fee of  <nl>$150<ol> [$55] to the 
Texas Optometry Board. No fee for examination will be returned to any applicant 
after the application has been approved by the <nl>board<ol> [Board] . 
   
  (e) (No change.) 
   
  (f) Each applicant shall submit a true and correct copy of the applicant's 
score report to the executive director, and such other evidence of having 
achieved a passing grade on each <nl>Part<ol> [part] of the NBEO examination as 
the executive director [in hers discretion] may determine. Such satisfactory 
evidence of passage of the NBEO written examination must be submitted to the 
executive director prior to approval by the board of the issuance of a license 
to an applicant. 
   
  (g)-(h) (No change.) 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324969 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: August 7, 1993 
 For further information, please call: (512) 835-1938 
         
           
  22 TAC sec.271.5 
 
  (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 Optometry 
Board or in the Texas Register office, Room 245, James Earl Rudder Building, 
1019 Brazos Street, Austin.) 
   
  The Texas Optometry Board proposes the repeal of sec.271.5, concerning 
endorsement of licensure. The 73rd Legislature amended the Texas Optometry Act 
and eliminated endorsement language from sec.3.01. In lieu of endorsement, 
provisional licensure was established, which will be addressed under Chapter 273 
of the Board Rules. 
 Lois Ewald, executive director, has determined that for the first five-year 
period the repeal is in effect there will be no fiscal implications for state or 
local government as a result of enforcing or administering the repeal. 
 Ms. Ewald also has determined that for each year of the first five years the 
repeal as proposed is in effect there will be no public benefit anticipated as a 
result of enforcing the repeal as proposed. There will be no effect on small 
businesses. There is no anticipated economic cost to persons who are required to 
comply with the repeal as proposed. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The repeal is proposed under Texas Civil Statutes, Article 4552, sec.2.14, 
which provide the Texas Optometry Board with the authority to promulgate 
procedural and substantive rules. 
 
 
  sec.271.5. Endorsement of Licensure. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 29, 1993. 
 TRD-9324968 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: August 7, 1993 
 For further information, please call: (512) 835-1938 
         
           Chapter 273. General Rules 
  
  22 TAC sec.273.1, sec.273.4 
 
  The Texas Optometry Board proposes an amendment to sec.273.1, and sec.273.4, 
concerning the surrender of a license and setting of fees, respectively. As a 
result of passage of House Bill 1479 by the 73rd Legislature, housekeeping 
language was required to be made in sec.273.1 for compliance; sec.273.4 
establishes all fees for revenue to cover appropriations request for the agency. 
 Lois Ewald, executive director, has determined that for the first five-year 
period the rules are in effect there will be fiscal implications for state or 
local government as a result of enforcing or administering the rules. During the 
first five-year period the rule will be in effect, the effect on state 
government will be an estimated additional cost of $394,362 in 1994, $376,216 in 
1995, $376,216 in 1996, $376,216 in 1997, and $376,216 in 1998. Also during the 
first five-year period, the estimated increase in revenue will be $394,362 in 
1994, sec.376,216 in 1995, $376,216 in 1996, $376,216 in 1997, and $376,216 in 
1998. The revenue generated will offset appropriations/cost. There will be no 
effect on local government. 
 Ms. Ewald also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be that procedural rules regarding procedures involving expired 
licenses will serve to protect the general public and assure that only 
competent, current optometrists are licensed to practice in the state. The fees 
generated from fee increases will allow the agency to be self-supporting in 
meeting appropriations' obligations with no assistance from General Revenue. 
There will be no effect on small businesses. The fees will be assessed 
individually. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The amendments are proposed under Texas Civil Statutes, Article 4552, sec.2. 
14, which provide the Texas Optometry Board with the authority to promulgate 
procedural and substantive rules. 
 
 
  sec.273.1. Surrender of License. Any person formerly licensed to practice 
optometry in this state, who receives notification from the  <nl>board<ol> 
[Board] that <nl>the person's<ol> [his or her] license to practice optometry has 
expired for failure to pay the annual renewal fee, shall within ten days of 
receipt of such notification from the <nl>board<ol> [Board] either pay the 
applicable renewal fee or surrender <nl>the <ol> [his or her] license by mailing 
or otherwise delivering such license to the Board Office. Alternatively, rather 
than physically surrender the license, the person may file with the  
<nl>board<ol> [Board] an affidavit in the form acceptable to the executive 
director to the effect that such person is not and will not practice optometry. 
 
   
  sec.273.4. Fees (Not Refundable). 
 
  <nl>(a) Examination Fee-$150. 
   
  <nl>(b) Initial Therapeutic License -$50. 
   
  <nl>(c) Provisional License-$75. 
   
  <nl>(d) Limited Faulty License -$50. 
   
  <nl>(e) Duplicate License (lost, destroyed, or name change) -$25. 
   
  <nl>(f) Duplicate/Amended Renewal Certificate (lost, destroyed, inactive, 
active)-$25. 
   
  <nl>(g) License Renewal-$140. 
   
  <nl>(h) Late fees (for all renewals, one to 90 days)-$75. 
   
  <nl>(i) Late fees (for all renewals, (for all renewals, 90 days to 2 years)-
$150. 
   
  <nl>(j) Late fees (for all renewals with delayed continuing education) -$140. 
   
  <nl>(k) Therapeutic Certification Application-$55. 
   
  <nl>(l) Therapeutic Certificate -$25. 
   
  <nl>(m) Certificates of Licensure Status-$25. 
   
  [(a) Examination Fee (First)-$55. 
   
  [(b) Examination Fee (Second)-$20. 
   
  [(c) Examination Fee (Third and Subsequent)-$55. 
   
  [(d) License-$25. 
   
  [(e) License Renewal-$125. 
   
  [(f) Duplicate License [(lost, destroyed, or name change) -$10. 
   
  [(g) Late fees (for all renewals), One to 180 days, -$27.50; 181 days to less 
than three years-$55. 
   
  [(h) Therapeutic Certification Application-$55. 
   
  [(i) Therapeutic Certificate-$25.] 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324971 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: July 7, 1993 
 For further information, please call: (512) 835-1938 
         
                 
  TITLE 22. EXAMINING BOARDS 
 Part XIV. Texas Optometry Board 
  Chapter 273. General Rules 
  
  22 TAC sec.sec.273.5-273.8 
 
  The Texas Optometry Board proposes new sec.sec.273.5-273.8, concerning limited 
faculty license, provisional licensure (in lieu of endorsement, inactive 
licensure, and renewal of license respectively). House Bill 1479 passed by the 
73rd Legislature authorizes the issuance of the licenses referenced, as well as 
establishes certain renewal procedures, thus, new rules to implement such 
licensure was required in order to fully inform candidates and licensees. 
 Lois Ewald, executive director, has determined that there will be fiscal 
implications as a result of enforcing or administering the rules. For the first 
five-year period the rule will be in effect the effect on state government 
cannot be determined; however, any costs will be offset by licensure fees. There 
will be no effect on local government. 
 Ms. Ewald also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be that the public can be assured that only competent licensees 
obtain and retain a license to practice optometry. Further, by providing limited 
faculty licenses, the State can be reimbursed by third-parties for examination 
fees incurred at the teaching institution. There will be no effect on small 
businesses. There is no anticipated economic cost to persons who are required to 
comply with the rules as proposed. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The new sections are proposed under Texas Civil Statutes, Article 4552, 
sec.2.14, which provide the Texas Optometry Board with the authority to 
promulgate procedural and substantive rules. 
 
 
  sec.273.5. Limited License for Clinical Faculty. 
 
  (a) Issuance of Limited License. The Board hereby designates the University of 
Houston College of Optometry In Houston, Texas, as approved by the board for the 
issuance of limited licenses (teaching permits) to those faculty members 
performing professional optometric services in programs of the school. 
   
  (b) Duties and Responsibilities of Dean of College. As a condition to 
continued approval of this college, the board imposes the following duties and 
responsibilities upon the dean of the college relating to those faculty members 
performing professional optometric services in programs of the school. The dean 
shall: 
 
  (1) annually certify to the board the names and addresses of the members of 
the college faculty who are not currently licensed to practice optometry in 
Texas; 
   
  (2) promptly notify the board of any changes in personnel on the faculty; 
   
  (3) furnish each applicant for a limited faculty license a certificate that 
such applicant is a bona fide member of the college faculty; 
   
  (4) report immediately to the board any information received relating in any 
way to a member of the faculty holding only a limited license who is performing 
professional optometric services other than as an adjunct to such faculty 
member's function at the school. Every reasonable means to prevent such unlawful 
practice shall be used by the dean; and 
   
  (5) cooperate fully and completely with the board toward the end that the 
limited license provided hereby will be used only for the purpose for which it 
is intended. 
     
  (c) Application and Renewal. Each member of the faculty desiring a limited 
license shall make written application to the executive director of the board 
and attach to the application the original certificate of the dean herein above 
provided and shall enclose therewith the payment of a fee of $50 for the 
issuance of the limited license or teaching permit and the fee imposed by the 
Act, sec.3.03B. The annual renewal fee for a limited license is equal to the fee 
charged for a regular license as specified in sec.273.4 of this title (relating 
to Optometry Fees). Holders of limited licenses shall also be required to meet 
the same continuing education requirements as holders of regular licenses. Said 
renewal fee shall be due on January 1 and expire after December 31 of each year. 
Failure to pay the renewal fee on or before January 1 shall subject the license 
to the same requirements of renewal as a regular license, including late 
penalties. 
   
  (d) Validity of Limited License. The limited license shall be valid as long as 
the holder thereof remains a member of the faculty of the school and abides by 
all regulations of the Board. 
   
  (e) Limitation of Limited License. It shall be a violation of this rule for 
the holder of a limited license who is not regularly licensed under the statutes 
to perform optometric services in any manner except as part of the program of 
the college and as an adjunct to teaching functions in the college. 
   
  (f) Revocation of Limited License. Those persons granted a limited license 
shall be subject to the same disciplinary procedures as the holder of a regular 
license. If, after disciplinary proceedings as set out in board rules, a holder 
of a limited license is found to be in violation of the Texas Optometry Act or 
board rules, the board may revoke the limited license. In such an event, the 
executive director shall promptly notify the limited licensee and the dean of 
College of Optometry at the University of Houston. 
 
     
  sec.273.6. Provisional License. 
 
  (a) Requirements for Provisional License. On application for examination, a 
candidate may apply for a provisional license under the following circumstances. 
 
  (1) The applicant must be licensed in good standing as a therapeutic 
optometrist in another state, the District of Columbia, or a territory of the 
United States, that has licensing requirements that are substantially equivalent 
to the requirements of the Texas Optometry Act, and must furnish proof of such 
licensure on board forms provided. 
   
  (2) The applicant must have passed the National Board of Examiners in 
Optometry (NBEO) Examination after January 1, 1984, as well as the Treatment and 
Management of Ocular Disease (TMOD) Examination after January of 1985, and must 
submit a true and correct copy of the applicant's score report. 
   
  (3) The applicant must not have failed an examination for a license conducted 
by the board. 
   
  (4) The applicant's license to practice optometry must not have been revoked 
or suspended in any jurisdiction. 
     
  (b) Sponsorship. A candidate for provisional licensure must be sponsored by a 
therapeutic optometrist who is currently licensed by the board with the 
following conditions applicable. 
 
  (1) Prior to practice in Texas, on forms provided by the board, the sponsor 
licensee will certify to the board the following: 
 
  (A) that such candidate will be working within the same office as the 
licensee, under direct supervision of the sponsor licensee; and 
   
  (B) that such sponsor licensee is aware of the Act and rules governing 
provisional licensure and that the sponsorship will cease upon the invalidity of 
the provisional license. 
     
  (2) Sponsor licensee will be held responsible for the unauthorized practice of 
optometry should such provisional license expire. 
     
  (c) Hardship. An applicant for a provisional license may be excused from the 
requirements of sponsorship if the Board determines that compliance constitutes 
a hardship to the applicant. 
   
  (d) Application and Fee. 
 
  (1) The candidate for provisional licensure will be subject to all application 
requirements required by Chapter 271 of this title (relating to Examinations) 
and subject to the applicable examination fees established under sec.273.4 of 
this title (relating to Optometry Fees). In addition, the candidate will be 
subject to a fee for issuance of a provisional license, as established under 
sec.273.4. 
   
  (2) No provisional license can be issued until all application forms and fees 
are received in the Board Office and the application is approved. 
   
  (3) A provisional license expires upon the earlier to occur of the passage of 
180 days or notice by the board of the candidate's successful passage or failure 
of all examinations required by Chapter 271 of this title. It shall be the 
responsibility of the candidate and sponsor to return the provisional license to 
the Board Office upon expiration. 
   
  (4) The candidate's failure to sit for the first scheduled board examination 
following application for examination invalidates the provisional license, 
unless in the discretion of the board, sufficient and reasonable evidence 
regarding nonappearance exists. 
   
  (5) Each candidate for provisional license shall receive only one nonrenewable 
license prior to the issuance of a therapeutic optometry license. 
     
  (e) If at any time during the provisional licensure period it is determined 
that the holder of such provisional license has violated the Optometry Act or 
board rules, such provisional license will be subject to termination. 
 
     
  sec.273.7. Inactive Licenses. 
 
  (a) Placing a license on inactive status. A person who is licensed by the 
board to practice optometry but who is not engaged in the practice of optometry 
in this state may place the license on inactive status at the time of license 
renewal or during a license year as follows. 
 
  (1) To place a license on inactive status at the time of renewal, the licensee 
shall: 
 
  (A) complete and submit before the expiration date of January 1 of each year a 
license renewal application provided by the board; 
   
  (B) state on the renewal application that the license is to be placed on 
inactive status and that the licensee shall not practice optometry in Texas 
while the license is inactive; 
   
  (C) pay the fee for renewal of license as specified in sec.273.4 of this title 
(relating to Optometry Fees). The fee for renewal of license shall not be 
subject to the Texas Optometry Act, sec.3.03B. Penalty fees as provided by the 
Act, sec.4.01, will apply to those received after December 31 of the applicable 
renewal period. 
     
  (2) To place a license on inactive status at a time other than the time of 
license renewal, the licensee shall: 
 
  (A) return the current renewal certificate to the Board Office; 
   
  (B) submit a signed statement stating that the licensee shall not practice 
optometry in Texas while the license is inactive, and the date the license is to 
be placed on inactive status; 
   
  (C) pay the fee for issuance of an amended renewal certificate as specified in 
sec.273.4 of this title. 
       
  (b) Reactivation of an Inactive License. 
 
  (1) A holder of a license that is on inactive status may return the license to 
active status by: 
 
  (A) applying for active status on a form prescribed by the board; 
   
  (B) providing proof of completion certificates from approved continuing 
education programs as specified in Chapter 275 of this title (relating to 
Continuing Education Requirements) for the number of hours that would otherwise 
have been required for the renewal of the license. Approved continuing education 
earned within the calendar year prior to the licensee applying for the return to 
active status may be applied toward the continuing education requirement; 
   
  (C) paying the fee for issuance of an amended renewal certificate as specified 
in sec.273.4 of this title; 
   
  (D) paying the fee imposed by sec.3.03B if the licensee begins practice within 
the state. 
     
  (2) If the application for reactivation of the license is made at the time of 
license renewal, the applicant shall pay the license renewal fee specified in 
sec.273.4 of this title. If the application for reactivation of the license is 
made at a time other than the time license renewal, the applicant shall pay the 
license renewal fee as well as a fee for issuance of an amended certificate to 
practice optometry as specified in sec.273.4 of this title. 
     
  (c) Prohibition against Practicing Optometry in Texas. A holder of a license 
that is on inactive status shall not practice optometry in this state. The 
practice of optometry by a holder of a license that is on inactive status 
constitutes the practice of optometry without a license. 
 
     
  sec.273.8. Renewal of License. 
 
  (a) Expired license. 
 
  (1) If a license is not renewed on or before January 1 of each year, it 
becomes expired. 
   
  (2) If a person's license has been expired for 90 days or less, the person may 
renew the license by paying to the board the required renewal fee and a fee that 
is one-half of the examination fee for the license as established by sec.273.4 
(relating to Optometry Fees). 
   
  (3) If a person's license has been expired for longer than 90 days but less 
than two years, the person may renew the license by paying to the board all 
unpaid renewal fees and a fee that is equal to the examination fee for the 
license. 
   
  (4) If a person's license has been expired for two years or longer, the person 
may not renew the license but may obtain a new license by submitting to 
reexamination and complying with the requirements and procedures for obtaining 
an initial license. 
   
  (5) The board, however, may renew without examination an expired license of a 
person who was previously licensed in Texas, is currently licensed in another 
state, and has been in practice for two years immediately preceding application 
for renewal. The person shall be required to furnish documentation of continuous 
practice for the two-year period, pay the renewal fee as established by 
sec.273.4 of this title, and a fee that is equal to the examination fee for the 
license. 
   
  (6) The annual renewal application will be deemed to be written notice of the 
impending license expiration forwarded to the person at the person's last known 
address, according to the records of the board. 
     
  (b) Mandatory Continuing Education for Renewal of License. 
 
  (1) The board may not issue a renewal license to a licensee who has not 
complied with the mandatory continuing education requirements, unless an 
exemption provided by sec.275.1 of this title (relating to Continuing Education) 
is applicable. 
   
  (2) If a licensee has not fulfilled the required continuing education 
requirements within the calendar year preceding the license renewal date, the 
license shall expire. To renew that expired license, the licensee may obtain and 
provide the Board with certified attendance records that the licensee has, since 
the expiration of the license, completed sufficient hours of approved continuing 
education courses to satisfy any deficiency in the previous year. Education 
obtained for renewal of an expired license cannot be applied toward renewal of 
license for the following year. 
   
  (3) The licensee cannot practice optometry until such time as education is 
obtained and the expired license has been renewed. 
   
  (4) The licensee must pay to the Board the license renewal fee plus a penalty 
in an amount equal to the amount of the license renewal fee. 
   
  (5) The executive director shall determine if all requirements for renewal of 
license have been fulfilled, and will notify the licensee when the practice of 
optometry can resume. 
   
  (6) To practice optometry with an expired license shall constitute the 
practice of optometry without a license. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324970 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 835-1938 
         
               Chapter 275. Continuing Education 
  
  22 TAC sec.275.1, sec.275.2 
 
  The Texas Optometry Board proposes amendments to sec.275.1 and sec.275.2, 
concerning continuing education requirements for licensees. House Bill 1479 
passed by the 73rd Legislature, amended the Texas Optometry Act and specifically 
addressed changes to the mandatory continuing education language. Licensees are 
required to obtain 16 hours of education per year, and a portion of those hours 
must be in a specialty of diagnostic or therapeutic education. Rule changes as 
proposed are housekeeping changes to incorporate the statutory language. 
 Lois Ewald, executive director, has determined that there will be fiscal 
implications as a result of enforcing or administering the rules. The effect on 
state government for the first five-year period the rules will be in effect will 
be additional costs, however any costs will be offset by licensure fees. No 
excess revenue is expected. There will be no effect on local government. 
 Ms. Ewald, also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be that all optometrists licensed by the Texas Optometry Board will 
maintain proficiency in the practice of optometry, thereby assuring the general 
public of competency and resultant examinations. There will be no effect on 
small businesses. The anticipated economic cost to persons who are required to 
comply with the rules as proposed will relate only to attendance at courses, but 
should not increase over current cost requirements. The specific cost is unable 
to be determined. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The amendments are proposed under Texas Civil Statutes, Article 4552, sec.2. 
14, which provide the Texas Optometry Board with the authority to promulgate 
procedural and substantive rules. 
 
 
  sec.275.1. General Requirements. 
 
  (a) The Act requires each optometrist licensed in this state to take 
<nl>16<ol> [12] hours of continuing education per calendar year. The calendar 
year is considered to begin January 1 and run through December 31. 
   
  (b) The board accepts for continuing education credit all courses sponsored by 
any board-accredited college or schools of optometry and such other programs or 
courses of other organizations as are approved by the board upon recommendation 
from the Continuing Education Committee, appointed by the <nl>Board Chair<ol> 
[chairman of the board]. The Continuing Education Committee will consider, among 
other things in its discretion, the following criteria in approving courses: 
 
  (1)-(8) (No change.) 
     
  (c) Licensees who have not complied with the education requirements may not be 
issued a renewal license unless such person is entitled to an exemption under 
sec.4.01B: 
 
  (1) a licensee who holds a Texas license, but does not practice optometry in 
Texas; provided, however, that if at any time during the calendar year for which 
such exemption has been obtained such person desires to practice optometry, such 
person shall not be entitled to practice optometry in Texas until  <nl>16<ol> 
[12] hours of continuing education credits are obtained and the board has been 
notified of the completion of such continuing education requirements; 
   
  (2) (No change.) 
   
  (3) a licensee who submits proof satisfactory to the board that <nl>the 
licensee<ol> [he] suffered a serious or disabling illness or physical disability 
which prevented <nl>the licensee<ol> [him] from complying with the requirements 
of this section during the 12 months immediately preceding the annual license 
renewal date; or 
   
  (4) (No change.) 
     
  (d)-(e) (No change.) 
   
  (f) Written proof of attendance and completion of approved courses must be 
supplied by the licensed optometrist to the board in conjunction with 
<nl>the<ol> [his] renewal application for  <nl>an<ol> [his] optometry license. 
If the licensed optometrist is practicing in Texas, <nl>the licensee <ol> [he] 
should submit the original proof of attendance or the approved sponsors of 
continuing education may submit to the  <nl>board<ol> [Board] written proof of 
attendance and completion of approved courses on behalf of the licensed 
optometrist. Information such as the following will be required: sponsoring 
organizations; location and dates; course names; <nl>instructors<ol> 
[instructor]; name of attendee; number of education hours completed; and any 
other information deemed necessary by the board. Forms must be properly signed 
by the education chairman  <nl>or<ol> [and] an education session assistant 
verifying attendance at the particular course. Applicable forms will be 
available from the Texas Optometry Board Office. 
   
  [(g)  Names of the educational committee chairman and education assistants 
must be received by the board one month prior to the occurrence of the session.] 
 
     
  sec.275.2. Required Education. 
 
  (a) Education for an advanced degree in optometric field or optometrically-
related field. One hour credit will be given for each semester hour earned, and 
a total of <nl>16 <ol> [12] credit hours will be allowed for each full academic 
year of study. 
   
  (b)  Research in lieu of training. Credit will be given only for full-time 
research. <nl>Sixteen<ol> [Twelve] credit hours will be given for each full year 
of research. 
   
  (c)-(f) (No change.) 
   
  (g) Diagnostic or therapeutic education courses. Beginning January 1, 1993, a 
minimum of six hours of the mandatory  <nl>sixteen<ol> [twelve] hours will be 
required per calendar year in diagnostic or therapeutic continuing education. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324972 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 835-1938 
         
             Chapter 279. Interpretations 
  
  22 TAC sec.sec.279.2, 279.5-279.7, 279.11-279.13 
 
  The Texas Optometry Board proposes amendments to sec. s279.2, 279.5-279.7, 
279.11-279.13, concerning interpretations of statute regarding general practice 
matters. House Bill 1479, 73rd Legislature, was passed which affected Texas 
Optometry Act, and necessitated housekeeping changes to the above-referenced 
rules. Such changes included basic competency requirements, specifically in 
sec.279.5 and sec.279.7. The remainder of the rules is basically incorporating 
therein the classification or certification of a therapeutic optometrist, with 
no substantive change to the rules. 
 Lois Ewald, executive director, has determined that for the first five-year 
period the rules are in effect there will be no fiscal implications for state or 
local government as a result of enforcing or administering the rules. 
 Ms. Ewald also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be that licensees will practice within the parameters of the law, 
thereby assuring the public of the best care possible. The Basic Competence 
requirements incorporates new procedures which can only serve to enhance the 
quality of care given to a patient by an optometrist. There will be no effect on 
small businesses. There is no anticipated economic cost to persons who are 
required to comply with the rules as proposed. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The amendments are proposed under Texas Civil Statutes, Article 4552, sec.2. 
14, which provide the Texas Optometry Act with the authority to promulgate 
substantive and procedural rules. 
 
 
  sec.279.2. Board Interpretation Number Two. It is the interpretation of the 
board that the Texas Optometry Act requires that the fitting of contact lenses 
may be done only by a licensed physician <nl>,<ol> [or] optometrist <nl>or 
therapeutic optometrist <ol> and that ophthalmic dispensers may make mechanical 
adjustments to contact lenses and dispense contact lenses only after receipt of 
a fully written contact lens prescription from a licensed optometrist<nl>, 
therapeutic optometrist, or a licensed physician,<ol> (Texas Optometry Act, 
sec.1.02), [or a licensed physician,] that includes the specifications listed in 
sec.279.1 of this title (relating to Board Interpretation Number One) (Texas 
Optometry Act, sec.1.02), whereupon the ophthalmic dispenser may fabricate or 
order the contact lenses and dispense them to the patient with appropriate 
instructions for the care and handling of the lenses, but an ophthalmic 
dispenser shall make no measurement of the eye or the cornea or evaluate the 
physical fit of the contact lenses, by any means whatever, subject solely and 
only to the exception contained in the Act, sec.5. 17. 
 
   
  sec.279.5. Board Interpretation Number Five. 
 
  (a) The Texas Optometry Act makes no provision for nonlicensed employees 
performing any of those acts defined as the practice of optometry which requires 
professional judgment but expressly forbids same. There is no such thing as 
supervision of nonlicensed employees by an optometrist <nl>or therapeutic 
optometrist<ol> while performing those acts which only optometrists <nl>or 
therapeutic optometrists<ol> can do under the Texas Optometry Act. For anyone 
other than an optometrist <nl>or therapeutic optometrist<ol> to do any thing or 
act defined as the practice of optometrist <nl>or therapeutic optometry<ol> is 
in violation of the Act, sec.1.02(3)(c), which states: "It shall be construed as 
a violation of this Act for any person not a licensed optometrist<nl>, 
therapeutic optometrist,<ol> or [a licensed] physician to do any one thing or 
act<nl>, or any combination of<ol> things or acts <nl>,<ol> named or described 
in this Article. 
   
  (b) The Act, sec.1.02, defines the practice of optometry <nl>and therapeutic 
optometry <ol>, and only a licensed optometrist <nl>or therapeutic 
optometrist<ol> can do those things set out in that section. 
   
  (c) Assistants to optometrists are permitted to perform the following duties 
or acts, or both, under the direction and supervision of a licensed optometrist 
<nl>or therapeutic optometrist<ol>, when working in the same office, which do 
not necessarily require the use of professional judgment: 
 
  (1)-(9) (No change.) 
     
  (d) (No change.) 
   
  (e)  The optometrist <nl>or therapeutic optometrist<ol> shall, in the initial 
examination of the patient, make and record, if possible, the following findings 
of the condition of the patient, but not necessarily limited to, the following 
findings: 
 
  (1) <nl>biomicroscopy<ol> [external] examination (lids, cornea, sclera, etc.); 
   
  (2)-(4) (No change.) 
   
  (5)  <nl>assessment of binocular function<ol> [phorias or ductions, far and 
near, lateral and vertical]; 
   
  (6)-(7) (No change.) 
     
  (f) The willful or repeated failure or refusal of an optometrist <nl>or 
therapeutic optometrist <ol> to comply with any of the requirements in the Texas 
Optometry Act, sec.5.12(a) and (b), shall be considered by the board to 
constitute prima facie evidence that <nl>the licensee<ol> [he] is unfit or 
incompetent by reason of negligence within the meaning of the Act,  s4.04(a)(3), 
and shall be sufficient ground for the filing of charges to cancel, revoke, or 
suspend <nl>the<ol> [his] license. The charges shall state the specific 
instances in which it is alleged that the rule was not complied with. At a 
hearing pursuant to the filing of such charges, the person charged shall have 
the burden of establishing that compliance with the rule in each instance in 
which proof is adduced that it was not complied with was not necessary to a 
proper examination of the patient in that particular case (sec.5.12). 
 
     
  sec.279.6. Board Interpretation Number Six. 
 
  (a) The Texas Optometry Act, sec.5.15(b), requires that "the space occupied by 
the optometrist <nl>or therapeutic optometrist<ol> shall be separated from the 
space occupied by the dispensing optician by solid partitions or walls from 
floor to ceiling." The intent of the legislature in passing sec.5.15 is 
specifically spelled out in sec.5.15(a) and is "to insure that the <nl>practices 
<ol> [practice] of optometry <nl>and therapeutic optometry <ol> shall be 
<nl>carried out in such a manner that they are<ol> [...] completely and totally 
separated from the business of any dispensing optician." 
   
  (b)  In light of the overriding legislative intent in passing sec.5.15 that 
the <nl>practices<ol> [practice] of optometry  <nl>and therapeutic optometry<ol> 
be completely and totally separate from the business of any dispensing optician, 
it is the interpretation of the board that the quoted portion of the Act, 
sec.5.15(b), set forth in subsection (a) of this section prohibits the space 
occupied by an optometrist <nl>or therapeutic optometrist<ol> and space occupied 
by a dispensing optician from being joined by a wall in which there is a door, 
either locked or unlocked. 
 
     
  sec.279.7. Board Interpretation Number Seven. 
 
  (a) In order to insure an adequate examination of a patient for whom an 
optometrist <nl>or therapeutic optometrist<ol> prescribes contact lenses, in the 
initial examination of the patient, the optometrist <nl>or therapeutic 
optometrist<ol> shall make and record, if possible, the following findings of 
the condition of the patient: 
 
  (1) (No change.) 
   
  (2)  <nl>visual<ol> [far point] acuity [,O.D., O.S., O.U., unaided; with old 
glasses or contact lenses, if available, and with new contact lenses, if any]; 
   
  (3) <nl>biomicroscopy<ol> [external] examination (lids, cornea, sclera, etc.); 
   
  (4) (No change.) 
   
  (5) static retinoscopy O.D., O.D. <nl>or autorefractor<ol>; 
   
  (6) (No change.) 
   
  (7)  <nl>assessment of binocular function<ol> [phorias or ductions, far and 
near, lateral and vertical]; 
   
  (8) (No change.) 
   
  (9)  <nl>tonometry<ol> [amplitude or range of convergence]; 
   
  (10) (No change.) 
     
  (b) In addition to the steps required under the Act, sec.5.12, the optometrist 
<nl>or therapeutic optometrist<ol> shall perform and record keratometry testing 
[and slit lamp examination]. 
   
  (c) At a minimum, the optometrist <nl>or therapeutic optometrist<ol> must 
schedule one follow-up visit for examination within 30 days of the contact lens 
fitting, and must inform the patient on the initial visit regarding the 
requirement of the follow-up care. 
   
  (d) The optometrist <nl>or therapeutic optometrist<ol> must observe proper 
hygiene in the handling and dispensing of the contact lenses and in the conduct 
of the examination. Proper hygiene includes sanitary office conditions, running 
water in the office where contact lenses are dispensed, and proper sterilization 
of diagnostic lenses and instruments. 
   
  (e) The optometrist <nl>or therapeutic optometrist<ol>, or <nl>staff <ol> 
members [of his/her staff], must instruct the patient in the proper care of 
lenses, including proper hygiene. 
   
  (f) (No change.) 
 
     
  sec.279.11. Board Interpretation Number Eleven. The Texas Optometry Act was 
enacted in part to safeguard the visual welfare of the public and the 
optometrist-patient relationship and to fix professional responsibility with 
respect to the patient. In order to comply with these objectives and to assure 
patients will have adequate follow-up care, licensed optometrists <nl>or 
therapeutic optometrists<ol> who practice optometry <nl>or therapeutic 
optometry<ol>, including the prescribing or supplying of lenses to patients 
confined in nursing homes or other abodes, must have an office location or place 
of practice within 100 miles of such nursing home or other abode, or, in the 
alternative must have made arrangements, confirmed in writing prior to offering 
or providing services, for continued care with a qualified eye health 
professional with an office location or place of practice within one hundred 
(100) miles of such nursing home or other abode. Failure to comply with this 
rule shall be deemed as practicing from house-to-house and the improper 
solicitation of patients in violation of the Act, sec.5.04(5). In addition, the 
optometrist must comply with the requirements of sec.5.02 to <nl>maintain 
current information regarding practice locations with the Board Office<ol> 
[record and register his or her license in all counties in which the optometrist 
examines patients]. 
 
   
  sec.279.12. Board Interpretation Number Twelve. Under the Texas Optometry Act, 
sec.1.02(3)(a), the practice of optometry <nl>and therapeutic optometry <ol> 
includes prescribing lenses or prisms, and an ophthalmic dispenser is charged to 
fill such prescription in accordance with the specific directions of a written 
prescription signed by a licensed physician<nl>, optometrist, <ol> or 
<nl>therapeutic <ol> optometrist. It is the interpretation of the <nl>board<ol> 
[Board] that the prescribing optometrist  <nl>or therapeutic optometrist<ol> has 
the authority to specify any and all parameters of an optical prescription for 
the therapeutic and visual health and welfare of a patient, but the prescription 
shall not contain restrictions limiting the parameters to private labels not 
available to the optical industry as a whole. The specifications of the 
prescription may not be altered without the consent of the prescribing doctor. 
 
   
  sec.279.13. Board Interpretation Number Thirteen. The Texas Optometry Act was 
enacted in part to safeguard the visual welfare of the public and the 
optometrist-patient relationship and to fix professional responsibility with 
respect to the patient. In order to comply with these objectives and to assure 
patients will have adequate follow-up care, licensed optometrists <nl>or 
therapeutic optometrists<ol> who, when requested to do so, practice optometry 
<nl>or therapeutic optometry<ol> at an industrial site, including the 
examination and prescribing or supplying of lenses to patients, must have an 
office location or place of practice within 100 miles of such examination site, 
or, in the alternative must have made arrangements, confirmed in writing prior 
to offering or providing services, for continued care with a qualified eye 
health professional with an office location or place of practice within 100 
miles of such examination site. Failure to comply with this rule shall be deemed 
as practicing from house-to-house and the improper solicitation of patients in 
violation of the Act, sec.5.04(5). In addition, the optometrist must comply with 
the requirements of sec.5.02 to <nl>maintain current information regarding 
practice locations with the Board Office<ol> [record and register his or her 
license in all counties in which the optometrist examines patients]. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324973 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 835-1938 
         
           Chapter 280. Therapeutic Optometry 
  
  22 TAC sec.280.1 
 
  The Texas Optometry Board proposes an amendment to sec.280.1, concerning the 
issuance of a duplicate certificate authorizing therapeutic optometry. This 
proposed rule amendment was required due to a fee change. House Bill 1479 passed 
by the 73rd Legislature required a number of changes to rules, as well as fee 
changes. 
 Lois Ewald, executive director, has determined that for the first five-year 
period the rule is in effect there will be no fiscal implications for state or 
local government as a result of enforcing or administering the rule. 
 Ms. Ewald also has determined that for each year of the first five years the 
rule is in effect the public benefit anticipated as a result of enforcing the 
rule will be that the public is made aware of those optometrists who have been 
certified as a therapeutic optometrist by the certificate being displayed in the 
principal office of the optometrist; this rule would provide for a duplicate 
certificate in certain instances. There will be no effect on small businesses. 
There is no anticipated economic cost to persons who are required to comply with 
the rule as proposed. 
 Comments on the proposal may be submitted to Lois Ewald, Executive Director, 
Texas Optometry Board, 9101 Burnet Road, Suite 214, Austin, Texas 78758. 
 The amendment is proposed under Texas Civil Statutes, Article 4552, sec.2.14, 
which provide the Texas Optometry Board with the authority to promulgate 
substantive and procedural rules. 
 
 
  sec.280.1. Application for Certification. 
 
  (a)-(e) (No change.) 
   
  (f) In the event the original certification is lost or destroyed, the board 
may issue a duplicate certificate; the person entitled thereto must make written 
application to the board for a duplicate, under affidavit setting forth that 
such certificate was lost or destroyed, and the circumstances under which loss 
or destruction occurred. Should the original subsequently be found, it must be 
forwarded immediately to the board and not used by the person to whom issued 
originally or by any other person. A fee of <nl>$25<ol> [$10] must be submitted 
to the board along with the affidavit for the duplicate issue. 
   
  (g) (No change.) 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 28, 1993. 
 TRD-9324974 
  Lois Ewald 
 Executive Director 
 Texas Optometry Board 
    Earliest possible date of adoption: August 6, 1993 
 For further information, please call: (512) 835-1938 
         
                 
  TITLE 40. SOCIAL SERVICES AND ASSISTANCE 
 Part I. Texas Department of Human Services 
  Chapter 10. Family Self-Support Services 
  
  Child Care Management Services Statewide Implementation 
 
  40 TAC sec.sec.10.3413, 10.3428, 10.3429 
 
  The Texas Department of Human Services (DHS) proposes amendments to 
sec.sec.10.3413, 10.3428, and 10.3429, concerning eligibility for Title IV-A 
funded child care services, attendance requirements, and termination of 
enrollment due to excessive absences in its Family Self-Support Services 
chapter. The purpose of the amendments is to clarify the circumstances for 
terminating child care services based on absences from care and to facilitate 
collaboration between DHS and the Texas Education Agency for the provision of 
IV-A At-risk Child Care to children enrolled in certain pre-kindergarten 
programs. 
 Burton F. Raiford, commissioner, has determined that for the first five-year 
period the rules are in effect there will be no fiscal implications for state or 
local government as a result of enforcing or administering the rules. 
 Mr. Raiford also has determined that for each year of the first five years the 
rules are in effect the public benefit anticipated as a result of enforcing the 
rules will be that limited child care benefits will be used effectively and 
efficiently and the number of children served will be increased. There will be 
no effect on small businesses. There is no anticipated economic cost to persons 
who are required to comply with the proposed rules. 
 Questions about the content of the proposal may be directed to Mary Beth 
O'Hanlon at (512) 450-4169 in DHS's Self-support Services. Comments on the 
proposal may be submitted to Nancy Murphy, Agency Liaison, Policy and Document 
Support-151, Texas Department of Human Services E-503, P.O. Box 149030, Austin, 
Texas 78714-9030, within 30 days of publication in the Texas Register. 
 The amendments are proposed under the Human Resources Code, Title 2, Chapters 
22 and 44, which provides the department with the authority to administer public 
assistance and day care programs. 
 
 
  sec.10.3413. Eligibility for Title IV-A Funded Child Care Services. 
 
  (a) (No change.) 
   
  (b) To be eligible for At-risk Title IV-A funded child care, a family must 
meet the following eligibility requirements: 
 
  (1) (No change.) 
   
  (2) the parent(s) must need child care in order to work; [and,] 
   
  (3)  the family's total gross income must be equal to or less than 150% of the 
applicable, current federal poverty income level (FPIL). These families will 
continue to receive child care for 1 year after the family income exceeds 150 
<nl>%<ol> [percent] of the FPIL, provided the family income remains below 
185<nl>%<ol> [percent] of the FPIL<nl>;  <ol>[.] <nl>or 
   
  <nl>(4) the family must have children enrolled in a State pre-kindergarten 
program offered by a school district participating in Title IV-A At-risk Child 
Care certification. Only those children enrolled in the pre-kindergarten program 
will be eligible for Title IV-A At-risk Child Care services provided through the 
Texas Education Agency (TEA). 
     
  (c)  (No change.) 
 
     
  sec.10.3428. Attendance Requirements. <ol> Vendors must document and maintain 
a record of each child's attendance. When an enrolled child is absent, vendors 
must inform the Child Care Management Services (CCMS) contractor and must follow 
procedures required by the Texas Department of Human Services (DHS) and the CCMS 
contractor. The CCMS contractor must follow up on each child's absences, as 
required by the [Texas Department of Human Services (DHS)]  <nl>DHS<ol>. 
<nl>Failure by the CCMS contractor to follow up each child's absences as 
required by DHS may result in withholding payment from the CCMS contractor. 
Failure by the vendor to keep attendance records as required by DHS may result 
in withholding payment from the vendor or in termination of the vendor 
agreement. 
 
   
  sec.10.3429. Termination of Enrollment Due to Excessive Absences. 
 
  (a) The Child Care Management Services (CCMS) contractor <nl>must<ol> [is 
permitted to] terminate a child's enrollment for excessive absences. 
   
  (b) (No change.) 
   
  (c) Termination of enrollment based on excessive absences may result from the 
following: 
 
  (1) an absence of 5 consecutive days without parental notice to the vendor or 
CCMS contractor. This is considered a voluntary withdrawal from child care 
services and constitutes grounds for immediate termination of the absent child's 
enrollment. The parent(s) may appeal the determination of absence without 
notice, but the effective date of the termination is not delayed by the appeal. 
The termination is effective at the end of the fifth consecutive day of absence. 
[When the child is a Child Protective Services (CPS) referral for child care, 
the caseworker who authorized the child care must concur with the decision to 
terminate child care services]; 
   
  <nl>(2) an absence of 30 days in a 1-year period. The CCMS contractor must 
notify the parent(s) in writing that the child's enrollment will be terminated. 
The parent(s) may appeal the determination of excessive absences, but the 
effective date of the termination is not delayed by the appeal.<ol> [(2)An 
absence of at least 10 days in one billing period is considered grounds for 
termination. If the CCMS contractor authorizes continued care or the child is a 
CPS referral and a caseworker concurs that child care must continue, child care 
must not be terminated.] 
     
  [(d) DHS purchased services staff must review and approve the authorizations 
to continue care. 
   
  [(e)  Procedures for termination of enrollment based on excessive absences 
include the following. 
 
  [(1) When a child's enrollment is terminated for absence without parental 
notice, the CCMS contractor must give the parent(s) written notification of the 
effective date of the termination. 
   
  [(2)  When a child's enrollment is terminated for absence of at least 10 days, 
the CCMS contractor must give the parent(s) written notification at least 10 
calendar days before the termination date. If the notice is mailed, it must be 
mailed at least 12 calendar days before the termination date. The child's 
enrollment continues until the termination date, unless the parent(s) requests 
an appeal before the termination date. If the parent(s) requests an appeal, the 
enrollment continues until the appeal decision.] 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 30, 1993. 
 TRD-9325059 
  Nancy Murphy 
 Section Manager, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: October 1, 1993 
 For further information, please call: (512) 450-3765 
         
                 Chapter 48. Community Care for Aged and Disabled 
  
  1915(c) Medicaid Home and Community-based Waiver Services for Aged and 
Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care 
 
  40 TAC sec.sec.48.6001-48.6014, 48.6020 
 
  The Texas Department of Human Services (DHS) proposes new sec.sec.48.6001- 
48.6014 and sec.48.6020, concerning the nursing facility waiver, in its 
Community Care for Aged and Disabled chapter. The purpose of the new sections is 
to provide home and community-based services as cost-effective alternatives to 
nursing facility placement for aged and disabled adults who choose to remain in 
the community. 
 Burton F. Raiford, commissioner, has determined that for the first five-year 
period the proposed sections will be in effect there will be fiscal implications 
for state government as a result of enforcing or administering the sections. The 
effect on state government for the first five-year period the sections will be 
in effect is an estimated additional cost of $830,754 in fiscal year (FY) 1993, 
and an estimated reduction in cost of $973,076 in fiscal year (FY) 1994; 
$7,788,109 in FY 1995; $13,032,814 in FY 1996; and $15, 329,467 in FY 1997. 
There will be no fiscal implications for local government. The estimated cost in 
FY 1993 is due to start-up costs for the program. 
 Mr. Raiford 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 that clients who have been determined eligible for nursing 
facility care will be allowed to receive waiver services outside of 
institutions. There will be no effect on small businesses. There is no 
anticipated economic cost to persons who are required to comply with the 
proposed sections. 
 Questions about the content of this proposal may be directed to Anita Anderson 
at (512) 450-3195 in DHS's Community Care Section. Comments on the proposal may 
be submitted to Nancy Murphy, Policy and Document Support-163, Texas Department 
of Human Services E-503, P.O. Box 149030, Austin, Texas 78714-9030, within 30 
days of publication in the Texas Register. 
 The new sections are proposed under the Human Resources Code, Title 2, Chapters 
22 and 32, which authorizes the department to administer public and medical 
assistance programs, and under Texas Civil Statutes, Article 4413(502), sec.16, 
which provides the Health and Human Services Commission with the authority to 
administer federal medical assistance funds. 
 
 
  sec.48.6001. Introduction.  Effective September 1, 1993, the Social Security 
Act, sec.1915(c) Medicaid Home and Community-based Waiver Program for Aged and 
Disabled Adults Who Meet Criteria for Alternatives to Nursing Facility Care will 
begin operation. 
 
   
  sec.48.6002. Definitions.  The following words and terms, when used in this 
undesignated head, shall have the following meanings, unless the context clearly 
indicates otherwise. 
   
   Waiver Program -A Medicaid program that provides home and community-based 
services to a limited number of eligible adults who are aged and/or disabled as 
an alternative to institutional care in a nursing facility in accordance with 
the waiver provisions of the Social Security Act, sec.1915(c) . 
   
   Waiver Program Services-Medicaid home and community-based services provided 
under waiver provisions of the Social Security Act, sec.1915(c). 
 
   
  sec.48.6003. Client Eligibility Criteria. 
 
  (a) To be determined eligible by the Texas Department of Human Services (DHS) 
for the Social Security Act, sec.1915(c) Medicaid waiver program provided as an 
alternative to care in a nursing facility, an applicant must: 
 
  (1) be age 21 or above; 
   
  (2) meet the level-of-care criteria for nursing facility care in accordance 
with sec.sec.19.1601-19.1612 of this title (relating to Medical Review and 
Revaluation); 
   
  (3) meet the requirements for Preadmission Screening and Annual Resident 
Review (PASARR) and be determined appropriate for nursing facility care; 
   
  (4)  choose home and community-based waiver services as an alternative to 
nursing facility placement based on an informed choice with approval conditional 
on feasible alternatives available under the waiver in accordance with 42 Code 
of Federal Regulations sec.441.302(d)(1); 
   
  (5) meet one of the requirements in subparagraphs (A), (B), or (C) of this 
paragraph: 
 
  (A) have ongoing needs for personal assistance services (including health-
related tasks requiring delegation by a registered nurse); 
   
  (B) have ongoing needs for foster care, or assisted living; or 
   
  (C) meet the Priority One criteria described in sec.48.6004 of this title 
(relating to Priority One Criteria); 
     
  (6)  have an individual plan of care for waiver services as specified in 
sec.48. 6006 of this title (relating to Individual Plan of Care for Waiver 
Services); 
   
  (7) meet the financial eligibility criteria for waiver services as specified 
in sec.48.6007 of this section (relating to Financial Eligibility Criteria); and 
   
  (8) receive waiver services at least monthly. 
     
  (b) Enrollment in this waiver program is limited to the number of participants 
approved by the Health Care Financing Administration (HCFA). 
   
  (c) Participants may be enrolled in only one waiver program at a time. 
 
     
  sec.48.6004. Priority One Criteria. Establishment of a priority one level for 
enrollment into the waiver program is made by the Texas Department of Human 
Services (DHS) case manager based on an assessment of the client's circumstances 
and on discussions with the applicant and others actively involved with the 
applicant. A priority one waiver client is an individual who is dependent upon 
the services of an attendant for certain personal care and health-related tasks 
and whose health, safety, or well being may be jeopardized if services on a 
normally-scheduled service shift were not provided. An individual is considered 
a priority one client if the following criteria are met: 
 
  (1) the individual is completely unable to perform one or more of the 
following activities without hands-on assistance from another person: 
 
  (A) transferring to a bed, chair or toilet; 
   
  (B) feeding; 
   
  (C) getting to or using the toilet; 
   
  (D) preparing a meal; or 
   
  (E) taking self-administered prescribed medications. 
     
  (2)  during a normally-scheduled service shift, as prescribed on the plan of 
care, no one other than the attendant is readily available or willing and 
capable of providing the needed assistance; 
   
  (3) the DHS case manager determines that there is a high likelihood that the 
individual's health, safety, or well-being would be jeopardized if waiver home 
care services were not provided in a single given shift. 
 
     
  sec.48.6005. Level-of-Care Criteria. 
 
  (a) Waiver participants must meet the level-of-care/medical necessity criteria 
for nursing facility placement according to applicable state and federal 
regulations, and as verified by a current assessment. 
   
  (b) A preadmission level of care and medical necessity determination expires 
90 days from its issuance. 
   
  (c) Level-of-care assessments/medical necessity determinations must be 
performed annually for all waiver clients. 
 
     
  sec.48.6006. Individual Plan of Care for Waiver Services. 
 
  (a)  Waiver clients must have an individual plan of care for waiver services 
developed by the interdisciplinary team as described in the waiver request. The 
individual plan of care must specify the type of waiver services required to 
support the individual in the community, the units of waiver services and their 
frequency. 
   
  (b) The individual plan of care must be signed and dated by the 
interdisciplinary team prior to implementation. The interdisciplinary team must 
certify in writing that the waiver services are necessary as an alternative to 
institutionalization and appropriate to meet the needs of the individual in the 
community. 
   
  (c) The individual plan of care must be approved by the Texas Department of 
Human Services (DHS) and updated by the interdisciplinary team at least 
annually. 
 
     
  sec.48.6007. Financial Eligibility Criteria. To be determined financially 
eligible by the Texas Department of Human Services (DHS) for home and community-
based services through this waiver program, an applicant must: 
 
  (1) be eligible for Supplemental Security Income (SSI) benefits, 
   
  (2) have been eligible for and received SSI benefits and continue to be 
eligible for Medicaid as a result of protective coverage mandated by federal 
law, or 
   
  (3) be eligible for SSI benefits in the community except for income and meet 
the special institutional income limit for Medicaid benefits in Texas without 
regard to spousal income. 
 
     
  sec.48.6008. Spousal Impoverishment Provisions. 
 
  (a) For waiver recipients with community spouses, the income and resource 
eligibility requirements are determined in accordance with the spousal 
impoverishment provisions in the Social Security Act, sec.1924, and as specified 
in the Medicaid State Plan and in sec.48.6007 of this title (relating to 
Financial Eligibility Criteria). 
   
  (b) After the recipient is determined to be eligible for Medicaid, a 
determination is made by the Texas Department of Human Services regarding the 
amount of the recipient's income applicable to payment. 
 
     
  sec.48.6009. Calculation of Client Copayment. 
 
  (a) Clients who are determined to be financially eligible based on the special 
institutional income limit are required to share in the cost of waiver services. 
The method for determining the client's copayment is described in subsection (b) 
of this section and documented on the Texas Department of Human Services (DHS) 
copayment worksheet for the Social Security Act, sec.1915(c), waiver programs. 
When calculating the copayment amount for clients with incomes that exceed the 
SSI federal benefit rate (FBR), DHS staff deduct the following: 
 
  (1) the cost of the client's maintenance needs which must be equivalent to: 
 
  (A) the special institutional income limit for waiver recipients residing in 
their own homes; or 
   
  (B) the SSI federal benefit rate per month for individuals residing in foster 
homes and assisted living settings; 
     
  (2)  the cost of a couple's maintenance needs must be equivalent to $2604 per 
month, which for couples residing in adult foster care or assisted living must 
be equivalent to the federal benefit rate for couples living in other community 
living arrangements; 
   
  (3) the cost of the maintenance needs of the client's spouse. This amount is 
equivalent to the amount of the SSI federal benefit rate, less the spouse's own 
income; 
   
  (4) the cost of the maintenance needs of the client's dependent children. This 
amount is equivalent to the Aid to Families with Dependent Children (AFDC) basic 
monthly grant for children, or a spouse with children, using the recognizable 
needs amounts in the AFDC Budgetary Allowances Chart; and 
   
  (5) the costs incurred for medical or remedial care which are necessary but 
are not subject to payment by Medicare, Medicaid, or any other third party. 
These include the cost of health insurance premiums, deductibles, and 
coinsurance. 
     
  (b) The copayment amount is the client's remaining income after all allowable 
expenses have been deducted. The copayment amount is applied only to the cost of 
home and community-based services which are funded through this waiver program 
and specified on the client's individual plan of care. The copayment must not 
exceed the cost of services actually delivered. 
   
  (c) Clients must pay the cost-sharing amount directly to the providers 
contracted to deliver authorized waiver services. 
 
     
  sec.48.6010. Client's Right to Appeal. Any applicant or client who is denied 
waiver program services is entitled to a fair hearing conducted by the Texas 
Department of Human Services (DHS) according to DHS's fair hearing rules in 
Chapter 79 of this title (relating to Legal Services). 
 
   
  sec.48.6011. Provider Claims Payment. 
 
  (a) The organizations contracted to provide waiver program services are 
reimbursed based on a fee-for-service reimbursement methodology. The following 
conditions must be met for payment. 
 
  (1) Services must be delivered to eligible clients based on an individual plan 
of care. 
   
  (2) Units of service that have been provided must be documented according to 
the individual plan of care. 
   
  (3) The organizations contracted to provide waiver program services must 
accept the payment from the Texas Department of Human Services (DHS) plus the 
client's copayment as determined by DHS as payment in full for waiver program 
services. 
     
  (b) Room and board are not included in the reimbursement rate to providers 
except for respite care services which must not exceed 30 calendar days per year 
per client. 
   
  (c) The organizations providing waiver program services are not entitled to 
payment if: 
 
  (1) the client is ineligible for Medicaid benefits or is an inpatient of a 
hospital, intermediate care facility, skilled nursing facility, or intermediate 
care facility for persons with mental retardation or related conditions; 
   
  (2) DHS has not authorized client enrollment; 
   
  (3) the initial claim for service is not received in the DHS Provider Services 
Section within 95 calendar days from the end of the month of service; or 
   
  (4)  the provider fails to deliver the services authorized on the individual 
plan of care for waiver program services. 
 
       
  sec.48.6012. Delegation of Signature Authority. Organizations providing waiver 
program services and delegating signature authority to employees or to a billing 
service for claims preparation are responsible for the accuracy of the claim 
submitted for payment. 
 
   
  sec.48.6013. Rejected Claims. <ol> If the Texas Department of Human Services 
(DHS) rejects a claim for payment of waiver program services because of errors, 
the provider must research the errors, initiate appropriate corrective action, 
and submit a corrected claim to DHS with supporting documentation within 95 
calendar days from the date of rejection. Providers may not attempt to obtain 
payment from waiver participants when failure to be paid by Medicaid was due to 
billing errors on the part of the provider. 
 
   
  sec.48.6014. Provider's Right to Appeal. Any provider who is denied payment 
for waiver program services is entitled to a contract appeal conducted by the 
Texas Department of Human Services (DHS) according to Subchapter Q of Chapter 79 
of this title (relating to Contract Appeals). 
 
   
  sec.48.6020. Reimbursement Methodology. 
 
  (a) General. The Texas Department of Human Services (DHS) will reimburse 
qualified Texas Medicaid contracted providers for waiver services provided to 
individuals who meet the criteria for alternatives to nursing facility care. 
Additionally, DHS will reimburse qualified Texas Medicaid contracted providers 
for an initial assessment of potential waiver participants. The initial 
assessment covers care planning for the participant and will be reimbursed by a 
one-time administrative expense fee which is not included in the waiver services 
but will be paid from Medicaid administrative funds. 
 
  (1) The Texas Board of Human Services determines, for Medicaid waiver services 
and the one-time administrative expense fee, reimbursement rates that are 
uniform, prospective, and cost-related. DHS staff submit rate recommendations to 
the DHS Board. 
   
  (2) DHS determines waiver service and the administrative expense fee rates at 
least annually. Rates may be determined more often if the DHS Board determines 
that it is necessary. 
     
  (b)  Public Rate Hearing. DHS holds a public hearing before the Texas Board of 
Human Services sets payment rates. The purpose of the hearing is to give 
interested persons an opportunity to comment on DHS's proposed rates. DHS must 
provide notice of the hearing to the public; and at least ten working days 
before the hearing takes place, DHS must make material pertinent to the proposed 
rates available to the public. At a minimum, this material must include DHS's 
proposed rates. DHS furnishes this material to anyone who requests it from the 
DHS division responsible for rate recommendations. After the hearing, DHS 
provides the Texas Board of Human Services with a written summary of the 
comments made during the public hearing. 
   
  (c)  Waiver Rate Determination Methodology. The Texas Board of Human Services 
determines for each waiver service and the administrative expense fee, 
reimbursement rates which will reimburse the reasonable and prudent costs of a 
provider. Recommended rates are determined in the following manner. 
 
  (1) Providers will be reimbursed using a method based on modeled projected 
expenses. Modeled projected expenses will be developed by using data from 
surveys; cost report data from other similar programs or services; information 
from professionals experienced in the delivery of similar services; and other 
relevant sources. The room and board payments for Adult Foster Care and Assisted 
Living Services are not covered in these rates and will be paid to providers 
from the client's Supplemental Security Income, less a personal needs allowance. 
   
  (2) The approved reimbursement rates and administrative fee that are 
calculated will be: 
 
  (A)  within budgetary constraints; 
   
  (B) adequate to reimburse the cost of operations for an efficient and economic 
provider; and 
   
  (C) justifiable given current economic conditions. 
     
  (3) DHS may adjust rates according to sec.24.501 of this title (relating to 
Adjusting Rates When New Legislation, Regulations, or Economic Factors Affect 
Costs) if new legislation, regulations, or economic factors affect costs. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 30, 1993. 
 TRD-9325058 
  Nancy Murphy 
 Section Manager, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: September 1, 1993 
 For further information, please call: (512) 450-3765 
         
                 Chapter 56. Family Planning 
  
  Subchapter E. Joint TDH/DHS Family Planning Agency Standards <nl>(Titles XIX 
and XX) 
 
  The Texas Department of Human Services (DHS) proposes the repeal of 
sec.sec.56.503-56.511, 56.515, 56.519, and 56.522-56.524; new sec.sec.56. 503-
56.511, 56.515, 56.519, and 56.522-56.524; and amendments to sec.sec.56. 512-
56.514, 56.516-56.518, 56.520, and 56.521, concerning the joint Texas Department 
of Health and Texas Department of Human Services family planning agency 
standards for the Title XIX and XX programs. The purpose of the repeals, new 
sections and amendments is to update the family planning agency standards. 
 Burton F. Raiford, commissioner, has determined that for the first five-year 
period the proposed section will be in effect there will be no fiscal 
implications for state or local governments as a result of enforcing or 
administering the section. 
 Mr. Raiford 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 that the quality of care for indigent family planning agency 
clients will be consistent across all four federal funding sources. There will 
be no effect on small businesses. There is no anticipated economic cost to 
persons who are required to comply with the proposed section. 
 Questions about the content of the proposal may be directed to Beth Weber at 
(512) 338-6460 in DHS's Family Planning/Genetic Services Section. Comments on 
the proposal may be submitted to Nancy Murphy, Agency Liaison, Policy and 
Document Support-150, Texas Department of Human Services E-503, P.O. Box 149030, 
Austin, Texas 78714-9030, within 30 days of publication in the Texas Register. 
   
  40 TAC sec.sec.56.503-56.511, 56.515, 56.519, 56.522-56.524 
 
  The repeals are proposed under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs. 
 
 
  sec.56.503. Health History, Laboratory Tests, and Examination. 
 
   
  sec.56.504. Plan of Care. 
 
   
  sec.56.505. Education and Counseling. 
 
   
  sec.56.506. Written Informed Consent. 
 
   
  sec.56.507. Office or Medical Clinic Visits. 
 
   
  sec.56.508. Management and Referral for Abnormal Findings. 
 
   
  sec.56.509. Provision of Contraceptive Method. 
 
   
  sec.56.510. Family Planning Services for Adolescents. 
 
   
  sec.56.511. Clients Requesting Pregnancy Testing. 
 
   
  sec.56.515. Timeliness. 
 
   
  sec.56.519. Staff Qualifications. 
 
   
  sec.56.522. Community Participation. 
 
   
  sec.56.523. Client Education Component. 
 
   
  sec.56.524. Accessibility to Services. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 30, 1993. 
 TRD-9325057 
  Nancy Murphy 
 Section Manager, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: August 31, 1993 
 For further information, please call: (512) 450-3765 
         
         
  40 TAC sec.sec.56.503-56.511, 56.515, 56.519, 56.522-56. 524 
 
  The new sections are proposed under the Human Resources Code, Title 2, 
Chapters 22 and 32, which provides the department with the authority to 
administer public and medical assistance programs. 
 
 
  sec.56.503. Client Assessment: Health History, Physical Examination, and 
Laboratory Tests. 
 
  (a) Every client requesting family planning medical services or a surgical or 
prescriptive contraceptive method must be provided an assessment. 
   
  (b) For female clients, the assessment must include the following. 
 
  (1) Health history. The following information must be obtained initially and 
annually: 
 
  (A) gynecologic history including sexual history and STD/HIV risk; 
   
  (B) menstrual history; 
   
  (C) contraceptive history; 
   
  (D) obstetric history; 
   
  (E)  medical and surgical history; 
   
  (F) family/genetic history; and 
   
  (G) social history, i.e., tobacco, substance abuse, alcohol, and domestic 
violence. 
     
  (2) Physical examination. The following physical examination procedures must 
be performed initially and annually: 
 
  (A)  height (annually for clients until they are five years post-menarcheal); 
   
  (B) weight; 
   
  (C) blood pressure; 
   
  (D) head, neck (including thyroid); 
   
  (E) lymph nodes; 
   
  (F) heart; 
   
  (G)  lungs; 
   
  (H) breasts (including instruction in self-examination initially, 
reinforcement annually); 
   
  (I) abdomen; 
   
  (J) back; 
   
  (K) extremities; 
   
  (L) pelvic examination; and 
   
  (M)  rectal examination, as indicated. 
     
  (3) Laboratory tests. The following laboratory tests must be provided 
initially and annually: 
 
  (A)  hemoglobin or hematocrit (initially for all clients; annually for IUD 
clients; as indicated otherwise); 
   
  (B) pap smear; 
   
  (C) tests for gonorrhea and chlamydia for clients requesting IUD insertion 
(only required pre IUD insertion, not annually); and 
   
  (D) urinalysis for sugar and protein (initially for all clients and as 
indicated thereafter). 
     
  (4) Additional laboratory tests. The following tests must be provided directly 
or by referral, if medically indicated: 
 
  (A) tests for gonorrhea, chlamydia, and herpes; 
   
  (B) complete urinalysis (dipstik and micro) and urine culture and sensitivity; 
   
  (C) syphilis serology; 
   
  (D) rubella titer; 
   
  (E) tests for abnormal lipid and/or glucose levels (or equivalent multiple 
test profile); 
   
  (F) pregnancy test (must be available on-site); 
   
  (G) microscopic examination of wet mount of vaginal smear; 
   
  (H) sickle-cell test; 
   
  (I) TB test; and 
   
  (J) HIV test. 
       
  (c) For male clients, the assessment will vary according to the scope of 
services requested and provided. A complete male assessment must include a 
similarly appropriate history, physical exam, and set of laboratory studies. 
 
     
  sec.56.504. Education and Counseling. 
 
  (a) Initial client education. Every new client requesting contraceptive 
services or family planning medical services must be provided initial client 
education either verbally, in writing, or by audio/visual materials. Over-the-
counter contraceptive methods may be provided before the client receives the 
initial client education but must be accompanied by written instructions on 
correct use. The following initial client education content may vary according 
to the educator's evaluation of the client's current knowledge: 
 
  (1) general benefits of family planning services and contraception; 
   
  (2)  information on male and female basic reproductive anatomy and physiology; 
   
  (3) information regarding particular benefits and potential side effects and 
complications of all available contraceptive methods; 
   
  (4)  information concerning all of the clinic's available services, the 
purpose and sequence of clinic procedures and routine schedule of return visits; 
   
  (5) breast self-examination rationale and instruction unless provided during 
physical exam (for females); and 
   
  (6) information on HIV/STD infection and prevention and safer sex discussion. 
     
  (b) Post assessment counseling. There must be a discussion of the findings 
from the client's history, physical exam and lab tests. Information regarding 
the recommended schedule of return visits must be discussed. If a new method is 
initiated then method specific counseling must be given to include: 
 
  (1)  verbal and written instructions for correct use of the method and self 
monitoring; 
   
  (2) information regarding the method's mode of action, safety, benefits and 
effectiveness; 
   
  (3) information regarding risks, potential side effects and complications of 
the method and what to do if they occur; 
   
  (4) back up method review when appropriate and instructions on the correct 
use; and 
   
  (5) demonstration of appropriate insertion and removal of diaphragms or caps 
by the client at the time of the fitting. 
     
  (c) Preconceptional counseling. Clients who may become pregnant and in whom 
the assessment reveals potential pregnancy risk(s), must receive counseling 
regarding the modification/reduction of that risk(s). 
   
  (d)  Education/counseling. Other client education and/or referral must be 
provided as indicated, based on the client assessment. 
 
     
  sec.56.505. Written Informed Consent. The client's general consent must be 
obtained for receipt of medical services and an informed consent must be 
obtained for receipt of a prescriptive or surgical contraceptive method. A 
consent form must be obtained whenever a client begins a new form of 
prescriptive contraception or undergoes a reinsertion procedure. (Does not apply 
to pill changes). The following standards apply. 
 
  (1)  Only the client may consent to her/his contraceptive care; neither 
spousal nor parental consent may be requested or required. 
   
  (2) The client's consent must be voluntary. 
   
  (3) The client's consent must be in writing. 
   
  (4) The client's consent for a prescriptive or surgical method must be 
obtained before provision of the method. 
   
  (5) If the client does not understand the language of the consent form, it 
must be interpreted. Consent information must be effectively communicated to 
every client including those who are blind, deaf, or otherwise have a 
disability. 
   
  (6) The consent form for contraception must contain a statement that the 
client has been counseled, and has received appropriate information about the 
chosen method. 
   
  (7) If sterilization services using federal funds are provided or arranged, 
the federal sterilization consent guidelines must be followed. 
 
     
  sec.56.506. Office or Medical Clinic Visits. 
 
  (a) During any visit for a medical problem or follow-up visit the following 
must occur: 
 
  (1) an update of the client's relevant history; 
   
  (2) physical exam, if indicated; 
   
  (3) laboratory tests, if indicated; 
   
  (4)  treatment and/or referral, if indicated; 
   
  (5) education/counseling or referral, if indicated; and 
   
  (6) scheduling of follow up visit if indicated. 
     
  (b) The first routine follow-up visit after a contraceptive method is 
initially provided must be scheduled to occur as follows, unless specifically 
indicated otherwise: 
 
  (1) between three and four months for oral contraceptors (visit must include 
blood pressure and weight); 
   
  (2) one week and three to four months for Norplant users or, in accordance 
with protocols (three to four month visit must include blood pressure and 
weight); 
   
  (3) after the next normal menses or no more than six weeks after an IUD is 
inserted. 
     
  (c) Subsequent routine visits for non-high-risk clients must not occur more 
frequently than annually unless indicated. 
   
  (d) Supply visits for oral contraceptive refills must not be more frequent 
than every three months, unless specifically indicated. Annual supply visits are 
encouraged. Other supply-only visits must occur as indicated. More frequent 
supply visits may be scheduled for reasons other than medical indications. 
 
     
  sec.56.507. Management and/or Referral for Abnormal Findings. 
 
  (a)  The provider must have a system for: 
 
  (1) informing the client or making at least three attempts within 30 days 
after diagnosis to inform the client of a diagnosed or suspected disorder. All 
attempts must be documented with dates; the final attempt must be in writing; 
   
  (2) counseling the client about diagnosed or suspected abnormalities; and 
   
  (3) offering the client treatment or referral for treatment when counseled 
about diagnosed or suspected abnormalities. 
     
  (b) Clients must be offered treatment or referral for treatment of sexually 
transmitted diseases (STD) when diagnosed. STD clients must be counseled to have 
their partner(s) evaluated and treated. Providers must comply with state STD 
reporting requirements. 
 
     
  sec.56.508. Provision of Contraceptive Method. 
 
  (a) A contraceptive method must not be provided to the client if an absolute 
medical contraindication exists for that client in accordance with the 
provider's protocols. 
   
  (b) If a contraceptive method is provided for a client for whom a relative 
medical contraindication exists, a specific inquiry and evaluation regarding the 
relative contraindication must be made at all contraceptive surveillance visits. 
 
     
  sec.56.509. Family Planning Services for Adolescents. 
 
  (a)  Adolescents age 17 and younger must be provided counseling and medical 
services that meet their special needs. 
   
  (b) The provider must ensure that: 
 
  (1) appointment schedules are flexible enough to accommodate immediate access 
for adolescents requesting services; 
   
  (2) counseling informs adolescents regarding use of all medically approved 
birth control methods including abstinence; 
   
  (3) counseling encourages them to discuss their family planning needs with a 
trusted or significant adult if they choose to do so; 
   
  (4) for the adolescent electing a nonprescriptive method, full participation 
in medical procedures is encouraged but may be deferred by the client; and 
   
  (5) the adolescent is assured that all services are confidential and that any 
necessary follow-up contact will protect the client's privacy. 
 
       
  sec.56.510. Pregnancy Testing. 
 
  (a) Clients having a pregnancy test must be provided an assessment, counseling 
and a referral, if indicated. 
   
  (b) At a minimum, the following must be obtained or updated prior to the 
laboratory test being performed: 
 
  (1) date of last normal menstrual period; and 
   
  (2) current contraceptive method. 
     
  (c)  Clients must be advised that the laboratory test for pregnancy cannot be 
considered 100% accurate. 
   
  (d) Clients with positive results must receive a pelvic examination or be 
advised to have a pelvic examination within 15 days to confirm the pregnancy and 
must be provided basic pregnancy education and counseling; and if: 
 
  (1) desiring to maintain the pregnancy, must be encouraged to enroll in 
prenatal care as soon as possible; or 
   
  (2) requesting information about options for an unintended pregnancy, must be 
provided non-directive counseling and a referral for the following: 
 
  (A) prenatal care and delivery; 
   
  (B) infant care, foster care, or adoption; and 
   
  (C) pregnancy termination (not required of natural family planning agencies). 
       
  (e) Clients with bleeding, pain, or any symptoms of an abnormal pregnancy, 
must receive appropriate management immediately or a timely referral for further 
evaluation. 
   
  (f) Clients with negative results who are not seeking pregnancy must be 
offered information about contraception, at least a non-prescriptive 
contraceptive method and a return appointment for a family planning visit. 
Clients seeking pregnancy must be appropriately counseled. 
   
  (g) If the results of the pregnancy test are inconclusive, the client must be 
instructed to return to the clinic or referral source for another assessment 
within one week. 
 
     
  sec.56.511. Documentation.  All services provided to a client must be 
appropriately documented in an appropriate medical record. 
 
   
  sec.56.515. Timeliness. 
 
  (a) Clients requesting contraception and who cannot be seen immediately must 
be offered a non-prescriptive method without delay. 
   
  (b) Complete family planning services must be provided within 30 calendar days 
after the client's request, unless the desired method is unavailable. 
 
     
  sec.56.519. Staff Qualifications. 
 
  (a) Medical director. The provider's medical care services must be provided 
under the supervision, direction, and responsibility of a qualified medical 
director. 
 
  (1) At all times, the provider must have a medical director who is a physician 
currently licensed to practice medicine in Texas. The medical director must be 
responsible for the overall direction, supervision, and coordination of medical 
services provided by the provider, and assume final responsibility for the 
content of all medical information and services given to clients. Licensure 
verification and qualifications must be available in the personnel records. 
   
  (2) The medical director must participate in quality assurance activities. 
     
  (b) Other staff. The provider must ensure that all medical, educational, 
counseling and administrative staff are qualified, and appropriately licensed, 
certified, registered, and/or recognized to function in their respective roles 
as follows. 
 
  (1) Physicians must be currently licensed by the Texas Board of Medical 
Examiners and nurses must be currently licensed by the Texas Board of Nurse 
Examiners for Registered Nurses or Vocational Nurses. Physician assistants must 
be registered with the Texas Board of Medical Examiners. All must meet the 
provider's qualifications. 
   
  (2) Other staff must be properly trained in the area they are assigned to 
work. 
   
  (3) Performance of all medical duties by staff must be defined by the medical 
director and approved based upon the director or delegate's evaluation of the 
individual's education, experience and clinical expertise. 
   
  (4) Documentation of educational credentials, professional training, 
licensure, certification, recognition, registration, and periodic work 
performance evaluations must be maintained in the personnel files of all staff. 
 
       
  sec.56.522. Community Outreach/Education. <ol> The provider must provide 
community education in order to inform the public of its purpose, to disseminate 
basic family planning knowledge, to enlist community support and to attract 
potential clients. 
 
   
  sec.56.523. Provider Protocols. <ol> The provider must have written protocols 
and standing delegation orders which are comprehensive enough to cover all 
services offered. They must be approved by the medical director, reviewed and 
signed at least annually by both director and all appropriate staff. There must 
be a complete copy of the protocols and standing delegation orders at all 
clinical sites. 
 
   
  sec.56.524. Quality Assurance. <ol> The provider must have a written quality 
assurance plan which outlines a systematic approach to assess and monitor 
services provided and to correct problems identified in the assessment. The plan 
must include at least the following activities to occur at least annually: 
 
  (1) formalized patient record review/audit; 
   
  (2)  staff performance review; 
   
  (3) facility review; 
   
  (4)  formalized patient complaint process; and 
   
  (5) systematic review and follow-up for adverse patient outcomes. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 30, 1993. 
 TRD-9325056 
  Nancy Murphy 
 Section Manager, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: August 31, 1993 
 For further information, please call: (512) 450-3765 
         
           
  40 TAC sec.sec.56.512-56.514, 56.516-56.518, 56.520, 56.521 
 
  The amendments are proposed under the Human Resources Code, Title 2, Chapters 
22 and 32, which provides the department with the authority to administer public 
and medical assistance programs. 
 
 
  sec.56.512. Range of Methods. All [family planning services and] medically 
approved methods of contraception must be made available to the client, either 
directly or by referral to a subcontractor. This does not mean that all brands 
of the different contraceptive methods need to be available <nl>, but each major 
contraceptive category must be made available<ol>. 
 
   
  sec.56.513. Confidentiality. 
 
  (a) The [agency] provider must ensure client confidentiality and provide 
safeguards for clients against the invasion of personal privacy. 
   
  (b)-(c) (No change.) 
   
  (d) The [agency] provider must obtain the client's written consent to release 
information to a specific entity or entities when it is requested. 
   
  (e) -(f) (No change.) 
 
     
  sec.56.514. Privacy. 
 
  (a) (No change.) 
   
  (b) There must be private offices, rooms, or areas for interviewing, 
counseling, <nl>educating<ol> [informing], and referring clients. 
   
  (c) (No change. ) 
   
  (d) The examining rooms or areas must permit complete privacy for the 
examination and any discussion between the client and the <nl>clinic staff<ol> 
[physician or nurse]. 
 
     
  sec.56.516. Protection Against Discrimination. 
 
  (a) (No change. ) 
   
  (b) The [agency] provider must have a written policy statement that prohibits 
discrimination on the basis of marital status, parenthood, handicap, age, color, 
religion, sex,  <nl>sexual orientation,<ol> ethnicity, national origin, [or] 
contraceptive preference<nl>, or medical condition<ol>. This statement must be 
displayed in a public viewing area. 
   
  (c) (No change.) 
   
  <nl>(d) The provider must comply with Title VI of the Civil Rights Act of 1964 
(Public Law 88-352), Section 504 of the Rehabilitation Act of 1973 (Public Law 
93-112), The Americans with Disabilities Act of 1990 (Public Law 101-336), and 
all amendments to each, and all requirements imposed by the regulations issued 
pursuant to these Acts. 
 
     
  sec.56.517. Voluntary Participation. 
 
  (a) Clients must not be subjected to any coercion to receive services. Also 
acceptance of services must not be a  <nl>prerequisite<ol> [requisite] for 
eligibility for any other service or program. 
   
  (b) The [agency] provider must have a policy statement that prohibits coercion 
of clients to receive services or to use any particular method of contraception. 
During the orientation of paid staff and volunteers, the [agency] provider must 
stress this policy. 
 
     
  sec.56.518. Client Understanding. 
 
  (a) (No change.) 
   
  (b)  Bilingual <nl>interpreters, agreed to by both the client and 
provider,<ol> [staff] must be [made] available for clients who do not speak 
English. 
   
  (c) Written communication <nl>and selected educational materials<ol> must be 
available in <nl>English and Spanish<ol> [the language that the client 
understands]. 
   
  [(d) During staff orientation, the provider must stress sensitivity to client 
differences in cultural expectations or disabling conditions. 
   
  [(e) Services must be accessible to clients who have disabilities.] 
   
  <nl>(d)<ol>[(f)] During staff orientation, the [agency] provider must stress 
sensitivity to client differences in cultural expectations or disabling 
conditions. 
 
     
  sec.56.520. Staff Development. 
 
  (a) The [agency] provider must have a documented plan of organized staff 
development based on an assessment of training needs. 
   
  (b) The [agency] provider's plan for a staff development program must include 
orientation and inservice training for all personnel, including volunteers. 
 
     
  sec.56.521. Emergencies. 
 
  (a) The [agency] provider must be adequately prepared to handle emergency 
situations. 
   
  (b) Each site must have a written plan for the management of onsite medical 
emergencies, [for] emergencies requiring ambulance services and hospital 
admission, and [for] emergencies requiring evacuation of the premises<nl>; 
evacuation plans for the premises must be posted<ol>. 
   
  (c) Each site where sterilization procedures are performed must have <nl>a<ol> 
[an]  <nl>written<ol> arrangement with a licensed facility for emergency 
treatment of any surgical complication. 
   
  (d) Each site must have [at least one] staff trained in <nl>Cardio-Pulmonary 
Resuscitation (<ol>CPR<nl>)<ol> and emergency medical action<nl>; staff trained 
in CPR must be present during all hours of clinic operation <ol>. 
   
  (e) (No change.) 
   
  (f) If sterilization procedures are performed in a free-standing surgical care 
center or on an in-patient basis in a hospital, [standards of the Joint 
Commission for the Accreditation of Hospitals (JCAH) or] Medicare standards 
applicable to the facility and staff must be met. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on June 30, 1993. 
 TRD-9325055 
  Nancy Murphy 
 Section Manager, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: August 31, 1993 
 For further information, please call: (512) 450-3765