EMERGENCY RULES An agency may adopt a new or amended section or repeal an existing section on an emergency basis if it determines that such action is necessary for the public health, safety, or welfare of this state. The section may become effective immediately upon filing with the Texas Register, or on a stated date less than 20 days after filing and remaining in effect no more than 120 days. The emergency action is renewable once for no more than 60 additional days. Symbology in amended emergency sections. 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 25. HEALTH SERVICES Part I. Texas Department of Health Chapter 38. Chronically Ill and Disabled Children's Services Program 25 TAC sec.38.6 The Texas Department of Health (department) adopts on an emergency basis an amendment to sec.38.6, concerning providers in the Chronically Ill and Disabled Children's Services (CIDC) Program. The amendment will allow the commissioner of health to reimburse an out-of-state provider when a CIDC provider (a Texas physician), the CIDC program, and the patient, parent or guardian have determined that an out of state provider is the provider of choice, that the service cannot be obtained in Texas, and that obtaining the service out of state is cost effective to the CIDC Program. The amendment requires that the treatment must be accepted medical practice, not an experimental procedure. Travel costs will be negotiated, with approval based on the overall cost effectiveness of the out of state treatment. The amendment is adopted for the following reasons. Although infrequently, a medical or surgical procedure is sometimes available out of state, but not currently in Texas, which could significantly improve the quality of life for a CIDC-eligible child and also could reduce CIDC expenditures. The CIDC Program has projected budget shortfalls for fiscal years 1995 through 1997. Currently sec.38.6 restricts payment to Texas physicians only. Reimbursement for transportation, meals, and lodging is restricted to in-state travel. The amendment to sec.38.6 is adopted on an emergency basis to prevent a particular child now eligible for CIDC services which are not available in Texas from being forced to consider undergoing less effective and possibly more expensive treatment, due to CIDC funding restrictions. This amendment is proposed for permanent adoption in this issue of the Texas Register. The amendment is adopted on an emergency basis under Health and Safety Code, sec.35.004, which authorizes the Texas Board of Health (board) to adopt rules concerning the selection of providers in the CIDC program; and under Health and Safety Code, sec.12.001, which authorizes the board to adopt rules for the performance of every duty imposed by law on the board, the department, and on the commissioner of health. The amendment is adopted on an emergency basis under Government Code sec.2001.034, which provides the board with the authority to adopt rules on an emergency basis. sec.38.6. Providers. (a)-(f) (No change.) (g) Out-of-state coverage. The commissioner of health may allow CIDC payment to out-of-state providers in unique circumstances in which a CIDC provider (Texas physician) and the patient, parent or guardian and the CIDC medical director agree that an out of state provider is the provider of choice for quality care, the same treatment or another treatment of equal benefit or cost is not available through Texas CIDC providers, and the treatment results in a decrease in the patient's cost of treatment to the CIDC program. The medical literature must indicate that the out of state treatment is accepted medical practice and is anticipated to improve the patient's quality of life. The cost of transportation, meals and lodging may be reimbursed for the CIDC-approved out-of-state treatment. Travel costs will be negotiated, with approval based on overall cost effectiveness. Issued in Austin, Texas, on August 29, 1994 TRD-9447297 Susan K. Steeg General Counsel Texas Department of Health Effective date: August 29, 1994 Expiration date: December 27, 1994 For further information, please call: (512) 458-7355 Chapter 98. HIV and STD Control Subchapter C. Texas HIV and Medication Program General Provisions 25 TAC sec.98.104, sec.98.105 The Texas Department of Health (department) adopts on an emergency basis amendments to sec.98.104 and sec.98.105, concerning the Texas HIV Medication Program. The amended sections implement the provisions of the "Communicable Disease Prevention and Control Act," Health and Safety Code, Chapter 85.063, Subchapter C, concerning the Texas HIV Medication Program. The program assists hospital districts, local health departments, public or nonprofit hospitals and clinics, nonprofit community organizations, and HIV infected individuals in the purchase of medications approved by the Texas Board of Health (board) that have been shown to be effective in reducing hospitalizations due to HIV related conditions. Generally, the sections cover eligibility for participation and medication coverage. The amendments expand coverage of the program to include Stavudine for eligible participants. The amendments are adopted on an emergency basis in order to provide medications to HIV infected individuals expeditiously. It is imperative to address this serious and imminent peril to public health by providing approved medications as soon as possible. The amendments are adopted on an emergency basis under the Health and Safety Code, sec.85.063, which provides the board with the authority to adopt rules concerning the Texas HIV Medication Program; under Health and Safety Code, sec.12.001, which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; and under Government Code, sec.2001.034, which provides the board with the authority to adopt rules on an emergency basis. sec.98.104. Medication coverage.
    The following medications will be provided to each eligible participant. (1) Zidovudine capsules must be provided in increments of 100 not to exceed 400 capsules per month. Zidovudine syrup must be provided in eight ounce bottles. IV Zidovudine must be provided intrapartum in 10mg/ml-2 ml vials. (2)-(15) (No change.) (16) Dapsone must be provided in increments of 100 not to exceed 100 tablets per month. (17) Stavudine must be provided in increments of 60 not to exceed 60 capsules per month. sec.98.105. Drug Specific Eligibility Criteria. A person is eligible for: (1) Zidovudine, Didanosine, and Zalcitabine
      if he or she is younger than 18 years of age and has a diagnosis of HIV infection; or, has a positive HIV antibody test and is classified in Category B or C
        [Group III or IV] according to the Centers for Disease Control 1993 Revised
          Classification System for HIV Infection
            ;[,] or,
              pending available funding,
                is classified in [Group I or II with a CD4 cell count of 500 or less] Category A2 or A3 according to the Centers for Disease Control 1993 Revised Classification System for HIV Infection; (2) Zidovudine if she has a positive HIV antibody test and is a female in the second trimester or later of pregnancy, regardless of classification according to the Centers for Disease Control 1993 Revised Classification System for HIV Infection; or, is the biological newborn infant of a female with a diagnosis of HIV infection; (3)
                  [(2)] Pentamidine for inhalation solution, sulfamethoxazole- trimethoprim (DS) tablets, dapsone, and sulfamethoxazole-trimethoprim suspension if he or she is diagnosed with HIV infection and has a CD4 cell count of 200 or less; or constitutional symptoms such as thrush or unexplained fever greater than 100 degrees Fahrenheit for greater than two weeks;
                    and, children under the age of 13 with the following clinical indicators: (A) [all children who have had a] previous episode of Pneumocystis carinii Pneumonia (PCP); (B) [all children less than 13 years of age who] meet the Centers for Disease Control (CDC) definitions of HIV infection in children and who have CD4 counts less than 400/mm3; (C) all children less than 15 months of age who have HIV isolated from blood, cerebrospinal fluid (CSF), or tissues; or P24 antigen detected in blood/plasma or CSF, regardless of CD4 count; and (D) all children less than 15 months of age who are HIV-seropositive and have symptoms as defined by CDC class P2, regardless of CD4 count. Children will qualify in class P2a if they have one symptom and persistent hypergammaglobulinemia (2 measurements, one month apart); [(3) Didanosine if he or she has advanced HIV infection and is intolerant of zidovudine therapy of who have demonstrated significant clinical or immunological deterioration during zidovudine therapy.] (4)-(5) (No change.) (6) Fluconazole if he or she has [an] established cryptococcal [infection] meningitis or candida esophagitis
                      and for prophylaxis after diagnosis. The total amount to be expended on this drug is up to $350,000, then pending available funding
                        ; (7) (No change.) [(8) Zalcitabine in combination with zidovudine is indicated for the treatment of adult patients with advanced HIV infection (CD4 cell count less than or equal to 300) who have demonstrated significant clinical orimmunologic deterioration;] (8)
                          [(9)] IV Pentamidine for children 13 years of age or younger for the treatment of PCP and prophylaxis against PCP in HIV infected children; (9)
                            [(10)] Interferon-Alpha for the treatment of disseminated Kaposi's sarcoma in HIV infected persons with T-cell counts over 200. The total amount to be expended on this drug is up to
                              $122,600. The requesting physician must complete a form to be returned to the program which will allow the program to evaluate the benefits of providing this medication; (10)
                                [(11)] Amphotericin-B for the treatment of patients with progressive and potentially fatal disseminated fungal infections. The total amount to be expended on this drug is up to
                                  $46,200. The requesting physician must complete a form to be returned to the program which will allow the program to evaluate the benefits of providing this medication; (11)
                                    [(12)] Atovaquone for the oral treatment of acute mild to moderate Pneumocystis carinii Pneumonia (PCP) in patients who are intolerant to trimethoprim-sulfamethoxazole (TMP-SMZ); (12)
                                      [(13)] Rifabutin for the prevention of disseminated mycobacterium avium complex disease in patients with a CD4 cell count of 100 or less. The total amount to be expended on this drug is up to $100,000, then pending available funding ; and
                                        [.] (13)
                                          [(14)] Itraconazole for the treatment of Blastomycosis and Histoplasmosis. (14) Stavudine for the treatment of adults with advanced HIV infection who are unable to tolerate Zidovudine, Didanosine, or Zalcitabine or who have experienced significant clinical or immunologic deterioration while receiving these antiretrovirals or for whom such antiretrovirals are contraindicated. Issued in Austin, Texas, on August 29, 1994 TRD-9447327 Susan K. Steeg General Counsel Texas Department of Health Effective date: August 30, 1994 Expiration date: December 28, 1994 For further information, please call: (512) 458-7357 Chapter 122. Sedation/Anesthesia Permits for Dentists 25 TAC sec.sec.122.1-122.5 The Texas Department of Health (department) adopts on an emergency basis new sec.sec.122.1-122.5 concerning sedation/anesthesia permits for dentists. The emergency adoption is effective September 1, 1994. The new section is being adopted on an emergency basis due to imminent peril to public health, safety and welfare and to carry on certain functions after the sunset of the Texas State Board of Dental Examiners on September 1, 1994. Without these new sections, the public receiving dental/oral and maxillofacial surgical procedures would not be adequately protected. The sections will insure that individuals are qualified to administer sedation/anesthesia in dental settings. These new sections are proposed for permanent adoption in this issue of the Texas Register. The new sections are adopted on an emergency basis under the Texas Health and Safety Code, sec.12.001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, Texas Department of Health and the commissioner of health. sec.122.1. Definitions. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. Analgesia-The diminution or production of increased tolerance to pain in the conscious patient. General anesthesia -A controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to verbal command, produced by a pharmacologic or non- pharmacologic method, or a combination thereof. Direct supervision -The dentist responsible for the sedation/anesthesia procedure shall be physically present in the office and shall be continuously aware of the patient's physical status and well being. Local anesthesia-The elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of a drug. May or could -Indicates freedom or liberty to follow a suggested alternative. Must or shall -Indicates an imperative need and/or duty; an essential or indispensable item; mandatory. Nitrous oxide/oxygen inhalation conscious sedation-The administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and/or verbal command. Parenteral conscious sedation-A minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination thereof. Parenteral deep sedation-A controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including inability to respond purposefully to verbal command, produced by a pharmacologic or non- pharmacologic method, or a combination thereof. Personal supervision -The dentist responsible for the sedation/anesthesia procedure shall be physically present in the room with the patient at all times during the induction and maintenance of the procedure. Should-Indicates the recommended manner to obtain the standard; highly desirable. sec.122.2. Minimum Standard of Care. (a) This section describes the standard of care for patients on whom a dentist will utilize nitrous oxide/oxygen inhalation conscious sedation, parenteral conscious sedation, parenteral deep sedation or general anesthesia. (b) Each dentist licensed and practicing in Texas shall conduct his or her practice in a manner consistent with that of a reasonable and prudent dentist under the same or similar circumstances. Further, each dentist: (1) shall maintain a patient record: (A) from which a diagnosis may be made; (B) which includes a description of treatment rendered; (C) includes the date on which treatment is performed; and (D) which includes any information a reasonable and prudent dentist in the same or similar circumstances would include; (2) shall maintain and review an initial medical history and limited physical evaluation for all dental patients. (A) The initial medical history shall include, but shall not necessarily be limited to, known allergies to drugs, serious illness, current medications, previous hospitalizations and significant surgery, and a review of the physiologic systems obtained by patient history. A "check list," for consistency, may be utilized in obtaining initial information. The dentist shall review the medical history with the patient at any time a reasonable and prudent dentist in the same or similar circumstance would so do. (B) The initial limited physical examination shall include, but shall not necessarily be limited to, blood pressure and pulse/heart rate as may be indicated for each patient; (3) shall obtain and review an updated medical history and limited physical evaluation when a reasonable and prudent dentist under the same or similar circumstances would determine it is indicated; (4) shall for office emergencies: (A) maintain a positive pressure breathing apparatus including oxygen which shall be in working order; (B) maintain other emergency equipment and/or currently dated drugs as a reasonable and prudent dentist with the same or similar training and experience in the same or similar circumstances would maintain; and (C) provide training to dental office personnel in emergency procedures which shall include, but not necessarily be limited to, basic cardiac life support, inspection and utilization of emergency equipment in the dental office, and office procedures to be followed in the event of an emergency as determined by a reasonable and prudent dentist in the same or similar circumstances; and (5) shall complete a course in basic cardiopulmonary resuscitation every two years offered by either the American Heart Association or the American Red Cross; and (6) shall obtain an informed consent in all situations where required by law. sec.122.3. Sedation/Anesthesia Permit. (a) From the effective date of these sections, each dentist licensed and practicing in Texas who desires to utilize nitrous oxide/oxygen inhalation conscious sedation, parenteral conscious sedation, and/or parenteral deep sedation, and general anesthesia, must obtain a permit of authorization from the Texas Department of Health for the requested procedure. (b) Any dentist approved by the former Texas State Board of Dental Examiners under previous rules prior to the effective date of this section for the utilization of nitrous oxide/oxygen inhalation conscious sedation, parenteral conscious sedation, or general anesthesia may qualify for a new permit. (c) Each holder of an existing permit shall be required to complete and submit a new application for the procedure(s) desired within one year from the effective date of these sections to the department. If the new permit application is not received within this designated period, the prior permit shall be cancelled. Each new application shall be reviewed to determine if the permit holder meets the standard of care requirements for the permit requested. If the requirements are met, a new permit shall be issued. If the requirements are not met, the permit applicant shall be notified and provided an appropriate period, at the discretion of the department, to correct the deficiency. (d) For new applicants who are otherwise properly qualified, a temporary provisional permit may be issued for one year by the department, based solely upon the credentials contained in the application. (e) Prior to or after the issuance of any permit, the department may, at its discretion, require an on-site office evaluation to determine if all standards of these sections are being met. (f) Once a permit is issued, the department shall automatically renew the permit annually unless the holder of said permit is informed by the department that an evaluation of the permit is required. Prior to an evaluation of an existing permit, the department shall consider factors to include patient complaints, morbidity, mortality, and staff recommendations. (g) New permit issuances will be charged a $25 fee payable with the application for permit. (h) The department may contract with another state agency to administer this chapter. Enforcement of this section shall be done by the Office of the Attorney General. sec.122.4. Permit Requirements. (a) Nitrous oxide/oxygen inhalation conscious sedation. To induce and maintain this type of conscious sedation on patients having dental/oral and maxillofacial surgical procedures in the State of Texas, the following requirements must be met. (1) Professional requirements. (A) Each dentist wishing to utilize this technique must produce satisfactory evidence of completion of a didactic and clinical course of instruction in this technique. Such courses of instruction shall: (i) be directed by qualified instructors with advanced education in comprehensive pain control and with broad clinical experience in this technique; (ii) include a minimum of four hours of didactic work in pharmacodynamics of nitrous oxide/oxygen inhalation conscious sedation; and (iii) include a minimum of six hours of clinical experience under personal supervision. (B) Each dentist must produce satisfactory evidence of completion of a continuing education course in the nitrous oxide/oxygen inhalation conscious sedation which includes the prevention and management of emergencies in the dental office; or (C) Each dentist must have successfully completed qualifications governing the use of parenteral conscious sedation as noted in subsection (b) of this section or deep sedation/general anesthesia as noted in subsection (c) of this section. (2) Standard of care requirements. (A) Each dentist must maintain the minimum standard of care as noted in sec.122.2 of this title (relating to Minimum Standard of Care). (B) Each dentist shall induce, monitor, and provide continuous personal supervision of the inhalation conscious sedation procedure, or the dentist shall induce and may delegate under direct supervision, as defined in sec.122.1 of this title (relating to Definitions), the monitoring of the nitrous oxide inhalation conscious sedation procedure to a dental auxiliary who has successfully completed a written examination on said subject offered by the former Texas State Board of Dental Examiners or the department. (b) Parenteral conscious sedation (intravenous, intramuscular, subcutaneous, submucosal. To induce and maintain this type of conscious sedation of patients having dental/oral and maxillofacial surgical procedures in the State of Texas, the following requirements must be met. (1) Parenteral conscious sedation shall be induced and maintained by a dentist licensed by the State of Texas and practicing in Texas, a physician anesthesiologist licensed by the Texas State Board of Medical Examiners, or a certified registered nurse anesthetist licensed in Texas (see paragraph (3)(G) of this subsection). (2) Professional requirements are as follows: (A) has satisfactorily completed an intensive course that meets the Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry published by the American Dental Association Council on Dental Education for the parenteral conscious sedation technique requested; or (B) has satisfactorily completed an approved graduate program by the Commission on Dental Accreditation of the American Dental Association where training to competence in parenteral conscious sedation is a minimum standard required in the training guidelines (oral and maxillofacial surgery, pediatric dentistry, periodontics, and some general practice residencies); or (C) has satisfactorily completed qualifications governing use of general anesthesia. (3) Standard of care requirements. Each dentists shall utilize the following standard of care in addition to the minimum standards noted in sec.122.2 of this title (relating to Minimum Standard of Care) for each parenteral conscious sedation procedure: (A) maintain an informed conscious sedation consent by each dental patient on whom each procedure is performed, which consent shall specify that the risks related to the procedure include brain damage and death; (B) maintain an adequate written sedation record which shall include physiologic vital sign monitoring during the course of the procedure; (C) maintain continuous direct supervision of the sedation procedure and patient vital sign monitoring during the course of the procedure; (D) maintain current certification in basic cardiopulmonary resuscitation for the assistant staff by having them pass a course sponsored by the American Heart Association or the American Red Cross; (E) in utilizing parenteral conscious sedation via an intravenous route of administration, the dentist shall: (i) maintain personal supervision of the patient during the induction of conscious sedation and for a period of time necessary to establish pharmacologic and physiologic vital sign stability. When a certified registered nurse anesthetist provides the conscious sedation care, he/she shall be under the direct supervision of the dentist. Delegation of personal supervision may occur if a second dentist or anesthesiologist is delivering the anesthesia care; and (ii) utilize visual and mechanical methods for vital sign monitoring which shall include, but shall not necessarily be limited to, pulse rate, patient color/texture, blood pressure respiration, blood, and tissue oxygenation. Mechanical monitoring shall include a minimum of pulse oximetry; (F) maintain direct supervision of auxiliary personnel who shall be capable of reasonably assisting in the procedures, problems, and emergencies incident to the use of parenteral conscious sedation; and (G) not allow a parenteral conscious sedation procedure to be performed in his/her office by a certified registered nurse anesthetist unless the dentist holds a permit for the procedure from the Texas Department of Health. (c) Parenteral deep sedation and/or general anesthesia. To induce and maintain deep sedation/general anesthesia on patients having dental/oral and maxillofacial surgical procedures in the State of Texas, the following requirements must be met. (1) Deep sedation/general anesthesia shall be induced and maintained by a dentist licensed by the State of Texas and practicing in Texas, a physician anesthesiologist licensed by the Texas State Board of Medical Examiners, or a certified registered nurse anesthetist licensed in Texas (see paragraph (3)(G) of this subsection). (2) Professional requirements are as follows: (A) has completed a minimum of one year of advanced training in anesthesia and related academic subjects beyond the undergraduate dental school level in a training program as described in Part II of the Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry of the American Dental Association Council on Dental Education; or (B) has completed an approved graduate program by the Commission on Dental Accreditation of the American Dental Association where training to competence in general anesthesia is a minimum standard in the training guidelines and maintains an equivalency to one year of anesthesia training (oral and maxillofacial surgery); or (C) has completed the requirements for admission to and has passed the fellowship exam in the American Dental Society of Anesthesiology. (3) Standard of care requirements. Each dentist shall utilize the following standard of care in addition to the minimum standards noted in sec.122.2 of this title (relating to Minimum Standard of Care): (A) maintain an informed deep sedation/general anesthesia consent by each dental patient on whom this technique is performed, which consent shall specify that the risks related to the procedure include brain damage and death; (B) maintain an adequate written anesthesia record which shall include, but shall not necessarily be limited to, physiologic vital signs and all medications administered during the course of the procedure; (C) maintain personal supervision of the patient during the induction and maintenance of the anesthesia. When a certified registered nurse anesthetist provides the deep sedation/anesthesia care, he/she shall be under the direct supervision of the dentist. Delegation of personal supervision may occur if a second dentist or anesthesiologist is delivering the deep sedation/anesthesia care. Vital sign monitoring shall utilize visual and mechanical methods which shall include, but shall not necessarily be limited to, pulse rate, patient color/texture, blood pressure, respiration, blood and tissue oxygenation, and heart rhythm. Mechanical monitoring shall include a minimum of pulse oximetry and an electrocardioscope; (D) maintain original certification in advanced cardiac life support from a course sponsored by the American Heart Association. The dentist shall require his/her assistant staff to maintain current certification in basic life support as obtained by courses offered by the American Heart Association or the American Red Cross; (E) maintain the necessary emergency equipment and medications to perform advanced cardiac life support under the guidelines of the American Heart Association (airway equipment, required intravenous equipment and medication, defibrillator, electrocardioscope, etc.); (F) maintain a minimum of two auxiliary personnel who shall be capable of reasonably assisting in procedures, problems, and emergencies incident to the use of deep sedation/general anesthesia; and (G) not allow a deep sedation/general anesthesia procedure to be performed on a dental patient in his/her office by a certified registered nurse anesthetist unless the dentist maintains a permit for deep sedation/general anesthesia issued by the Texas Department of Health. sec.122.5. Report of Injury (Morbidity) or Death (Mortality) in the Dental Office or Hospital. (a) All licensees engaged in the practice of dentistry in the State of Texas must submit a written report within a period of 30 days to the Texas Department of Health after the occurrence of any death (mortality), incident, injury (morbidity). Morbidity means temporary or permanent, physical or mental disability, or physical or mental injury to any patient for whom said dentist has rendered any dental service. Routine hospitalization to guard against postoperative complication for patient comfort need not be reported where complications do not thereafter result in injury (morbidity) or death (mortality) as provided in this section. Additional patient records may be requested at the discretion of the department. (b) In the evaluation of sedation/anesthesia morbidity or mortality, the Texas Department of Health shall consider the standard of care necessary to be that applicable to the patient's state of consciousness during the procedure. Issued in Austin, Texas, on August 29, 1994 TRD-9447318 Susan K. Steeg General Counsel Texas Department of Health Effective date: September 1, 1994 Expiration date: December 30, 1994 For further information, please call: (512) 834-6628 Chapter 143. Medical Radiologic Technologists 25 TAC sec.143.16 The Texas Department of Health (department) adopts on an emergency basis new sec.143.16, concerning dental radiologic procedures (x-rays). The emergency adoption is effective September 1, 1994. The new section is being adopted on an emergency basis due to imminent peril to public health, safety and welfare and to carry on certain functions after the sunset of the Texas State Board of Dental Examiners on September 1, 1994. Without this new section, most persons now performing dental x-rays would not be able to continue to do so on an after September 1, 1994. This new section is proposed for permanent adoption in this issue of the Texas Register. The new section is adopted on an emergency basis under Texas Civil Statutes, Article 4512m, sec.2.05(e), which provide the Texas Board of Health with the authority to adopt rules necessary to implement the Medical Radiologic Technologist Certification Act; and under the Texas Health and Safety Code, sec.12.001, which provides the Texas Board of Halth with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, Texas Department of Health and commissioner of health. sec.143.16. Dental Radiologic Procedures. (a) Any person performing radiologic procedures under the supervision of a Texas licensed dentist must register with the Texas Department of Health (department). This registrant may perform, by the direct oral or written order(s) of the licensed dentist, any radiographs required for the diagnosis of the maxillofacial complex. (b) This section does not apply to registered nurses or persons holding a general or limited certificate under the Medical Radiologic Technologist Certification Act. (c) A dental hygienist who is licensed and currently registered in this state shall be deemed to be registered for the purpose of performing radiologic procedures. (d) There will be no additional fee for the registration of qualified people defined under this section. The current registration fee paid by the employing licensee will adequately cover costs. An examination materials charge, not to exceed $30, payable to the Texas Department of Health, will be assessed to those requiring examination. (e) Dental assistants who meet the minimum standards established by these rules shall be listed on the annual registration notice of their present employing dentist. This notice will be available for inspection in the office of the licensee. (f) A registered dentist may certify that a dental assistant is qualified to perform radiographic procedures if any one of the following criteria is met: (1) be a currently certified dental assistant by meeting criteria established by the Dental Assisting National Board, Inc.; (2) have taken and passed the dental radiation health and safety examination administered by the Dental Assisting National Board, Inc.; or (3) has taken and passed the dental radiation health and safety examination specified by the department. Essential areas of testing shall include, but not be limited to, the following areas: (A) radiation protection for the patient and others; (B) radiographic equipment including safety standards, operations, and maintenance; (C) image production and evaluation; (D) applied human dental anatomy; and (E) radiographic techniques. (g) Dental assistants who are not qualified under the provisions of this section, shall be allowed to perform necessary diagnostic radiographs under the direct supervision of the dentist as a part of their training and as a part of their examination. (h) Any new dental assistants, with no previous experience in dentistry, will have up to six months to come into compliance with the provisions of these regulations if they are to perform radiographic procedures. (i) Any dental assistant (who qualifies under this rule) hired by the licensee after he or she has submitted his or her annual registration notice, shall be deemed registered if the licensee lists the assistant's name and date of employment on the back of the registration notice. (j) All dental radiologic procedures can be performed by any person qualified and certified under this section. (k) Registration may be suspended, revoked, or not renewed for the following reasons: (1) violation of the rules of the department; (2) violation of the Medical Radiologic Technologist Certification Act or rules promulgated thereunder; or (3) violation of the Texas Dental Practice Act. (l) All registrants must comply with the rules and regulations of the department for control of radiation. (m) The department may contract with another state agency to administer this section. Enforcement of this section shall be done by the Office of the Attorney General. (n) A person allowed to perform dental radiologic procedures under this section shall be considered to hold a type of certificate under the Medical Radiologic Technologist Certification Act. Issued in Austin, Texas, on August 29, 1994 TRD-9447299 Susan K. Steeg General Counsel Texas Department of Health Effective date: September 1, 1994 Expiration date: December 30, 1994 For further information, please call: (512) 834-6628