PROPOSED RULES 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 action is 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 action, 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 25. HEALTH SERVICES Part I. Texas Department of Health Chapter 98. HIV and STD Control Subchapter C. Texas HIV Medication Program General Provisions 25 TAC sec.98.104, sec.98.105 The Texas Department of Health (department) proposes 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 Ganciclovir, Megestrol Acetate and Azithromycin for eligible participants. In addition, these rules were adopted on an emergency basis in the December 9, 1994, issue of the Texas Register, effective November 29, 1994. The emergency rules also included the drugs Stavudine, Clarithromycin, and Ethambutol which were proposed and published for public comment in the October 4, 1994, issue of the Texas Register ; these drugs were formally approved for final adoption by the Board of Health at it's November meeting. The rules covering these drugs were permanently adopted and published in the December 6, 1994 issue to be effective December 19, 1994. The drugs were included in the December 9 emergency adoption to cover the period between November 29 and December 19. Anita Martinez, Chief of Staff Services for the Disease Control and Prevention Associateship, Texas Department of Health, has determined that for the first five-year period the sections will be in effect, there will be no fiscal implications for state government or local government as a result of enforcing or administering the amended sections as proposed. Ms. Martinez also has determined that for each year of the first five-year period the sections are in effect, the public benefit anticipated as a result of enforcing the amended sections will be to include Ganciclovir, Megestrol Acetate and Azithromycin for eligible participants. There is no anticipated economic cost to small or large businesses to comply with the sections as proposed. No costs for persons affected by this proposal are anticipated, and no effect on local employment is anticipated. Comments on the proposed amendments may be submitted to Charles E. Bell, M. D., Chief, Bureau of HIV and STD Prevention, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756. Telephone inquiries also may be made to Sheral Skinner at (512) 458-7357. Comments will be accepted for 30 days after publication of the proposal in the Texas Register. The amendments are proposed 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. The amendments effect Chapter 85 of the Health and Safety Code. sec.98.104. Medication Coverage.
    The following medications will be provided to each eligible participant. (1)-(19) (No change.) (20) Azithromycin must be provided in increments of 18 not to exceed 72 capsules per month. (21) Ganciclovir must be provided in increments of 500 mg/10 ml vials not to exceed 26 vials for the first 31-day treatment period, and 16 vials per month thereafter. (22) Megestrol Acetate suspension must be provided in increments of 40 mg/ml/eight ounce bottles not to exceed three bottles per month. sec.98.105. Drug Specific Eligibility Criteria. A person is eligible for: (1)-(15) (No change.) (16) Azithromycin for the treatment and prophylaxis of Disseminated Mycobacterium avium Complex (MAC) for individuals who have failed therapy on, or are intolerant to, Clarithromycin. (17) Ganciclovir for the treatment of Cytomegalovirus (CMV) disease to include retinitis and infections of major organs or organ systems, pending available funding. (18) Megestrol Acetate suspension for cachectic and anorexic patients living with AIDS who are characterized by profound, involuntary, acute weight loss of greater than or equal to 10% of baseline body weight or chronic weight loss of greater than or equal to 20% of baseline body weight, pending available funding. 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 December 28, 1994. TRD-9452960 Susan K. Steeg General Counsel Texas Department of Health Earliest possible date of adoption: February 6, 1995 For further information, please call: (512) 458-7236 Chapter 157. Emergency Medical Services EMS Training and Course Approval 25 TAC sec.sec.157.32-157.35 The Texas Department of Health (department) proposes amendments to sec.sec.157.32-157.35, concerning emergency medical training courses. The revisions give course coordinators responsibility for skills proficiency verification and latitude in determining CPR training; provide that each student successfully completing the course be given a course completion certificate; and establishes a fee for course approval applications from which volunteers are exempt. The amendments are needed to clarify existing certification requirements and to address current educational standards. Bernie Underwood, Chief of Staff Services, Health Care Quality and Standards Associateship, has determined that for the first five-year period the revised sections are in effect there will be fiscal implications. The additional cost for the first year the proposed amendments are in effect is estimated to be $35,631, and the cost for each of the four following years is expected to be $35,631. Revenues for each of the five years are expected to total $35,250. Mr. Underwood also has determined that for each year of the first five years the proposed amendments are in effect, the public will benefit from improved educational oversight of EMS courses. The cost to small business will be less than $100 each year. Comments on the proposed rules may be submitted to Gene Weatherall, Chief, Bureau of Emergency Management, 1100 West 49th Street, Austin, Texas 78756, (512) 834-6700. Comments will be accepted for 90 days after publication of these rules in the Texas Register. The amendments are proposed under Health and Safety Code, Chapter 773, which provides the Board of Health with the authority to adopt rules to implement the Emergency Medical Services Act; and sec.12.001, which provides the Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Board of Health, the Department of Health, and the Commissioner of Health. The codes and/or articles affected are: Health and Safety Code, Chapter 773, including sec.sec.773.046, 773.047, 773.048, 773.049, 773.050, 773.054, 773.056; and Health and Safety Code, sec.12.001. sec.157.32. Emergency Care Attendant Training [Course]. (a) Course curricula. (1) The minimum curricula shall be the Department of Transportation (DOT) Emergency Medical Services (EMS) First Responder Training Course and the current Federal Emergency Management Agency document entitled "Recognizing and Identifying Hazardous Materials", 1993
      which are adopted by reference. Copies may be reviewed during normal working hours in the library of the
        Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (2) In addition to the minimum curricula in paragraph (1) of this subsection, the course shall include curricula on the following subjects: (A)-(E) (No change.) (F) adult, child, and infant cardiopulmonary resuscitation. At the option of the coordinator, cardiopulmonary resuscitation (CPR) curriculum requirements may be met by: (i) including the American Heart Association(AHA) Basic Life Support for Health Care Providers course or its equivalent in the training course and testing each student for CPR proficiency using AHA or American Red Cross (ARC) standards; and/or (ii) requiring each student to show CPR proficiency as evidenced by AHA or ARC proof of completion of an AHA Basic Life Support for Health Care Providers course or its equivalent within 12 months of the course application. (3)-(4) (No change.) (5) A student shall successfully complete all course requirements as defined by the course coordinator including at a minimum course written examinations and skills proficiency verification before receiving a course completion certificate and becoming eligible to take the state certification examination. The skills verification process shall be supervised by a state certified course coordinator and shall be administered by state certified examiners using state approved skills criteria.
          [A student shall successfully complete all course requirements including course written and skills examinations prior to being placed on a course completion certificate and becoming eligible for state certification skills and written examinations.] (b) Application procedures. The application procedures are outlined in the EMS Education and Training Manual which is adopted by reference. The manual is available for review during normal working hours in the library of the
            Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (c) Course approval criteria. (1) (No change.) (2) Approval of an emergency care attendant training course application shall be dependent upon: (A) submitting a nonrefundable $25 processing fee. A coordinator who receives no remuneration for providing the course shall be exempt from the fee; (B)
              [(A)] meeting the requirements in subsections (a) and (b) of this section; [and] (C)
                [(B)] meeting all the requirements in the EMS Education and Training Manual relating to ECA training courses; and
                  [.] (D) maintaining a minimum of one instructor to ten students for skills instruction. (3) (No change.) (d) Criteria for course denial. (1) A course may be denied for, but not limited to, the following reasons. If the applicant: (A)-(B) (No change.) (C) has a history of a 20%
                    [high] failure rate
                      [rates of students in previous courses] on certification examinations by students from previous courses
                        ; (D) has a history of consistently critical
                          [poor] course evaluations from students in previous courses; (E) fails to meet standards for training facilities as defined in the EMS Education and Training Manual based on a site evaluation; [and/or] (F) submits names of instructors and/or examiners
                            who are not certified to the appropriate level for the training course as required in sec.157.62 of this title (relating to Program Instructor Certification and sec.157.63 of this title (relating to Examiner Certification)
                              [sec.157.61 of this title (relating to Certification of Course Coordinator, Program Instructor, and Examiner] and who are not listed as guest lecturers; and/or
                                [.] (G) starts course without prior approval from the department. (2) (No change.) sec.157.33. Emergency Medical Technician Training [Course]. (a) Course curricula. (1) The minimum curricula for the Emergency Medical Technician (EMT) training course shall be the 1984
                                  Department of Transportation (DOT) Basic Training program for EMT-Ambulance and the current Federal Emergency Management Agency document titled "Recognizing and Identifying Hazardous Materials" (HazMat), 1993
                                    which are adopted by reference. (A) Copies of the DOT curriculum and the HazMat document
                                      may be reviewed during normal working hours in the library of the
                                        Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (B) At the option of the coordinator, cardiopulmonary resuscitation (CPR) curriculum requirements may be met by: (i) including the American Heart Association (AHA)Basic Life Support Health Care Provider Course or its equivalent in the training course and testing each student for CPR proficiency using AHA or American Red Cross (ARC) standards; and/or (ii) requiring each student to show CPR proficiency as evidenced by AHA or ARC proof of completion of an AHA Basic Life Support Health Care Provider Course or its equivalent within 12 months of the course application. (2)-(5) (No change.) (6) Twelve hours of clinical in-hospital training may be completed in a primary care facility which is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the Accreditation Association of
                                          Ambulatory Health Care (AAAHC), such as a minor emergency health care facility, if an exception to paragraph (5) of this subsection is requested from and approved by
                                            the department. (7) The student shall be required to complete a minimum of three supervised ambulance runs with a licensed provider
                                              [on an authorized EMS vehicle]. The supervision of these runs shall be provided by an individual certified as at least an EMT or by an appropriately qualified program instructor as determined by the course coordinator. An ambulance run is one in which a patient is transported from the scene to a primary care facility because the patient's condition requires care or one in which the student observes or assists with care at the scene, but the patient is transported by a helicopter, advanced life support (ALS), or mobile intensive care unit (MICU) vehicle. The approval of any other run will be left to the course coordinator who will weigh the educational merits. (8) A student shall successfully complete all course requirements as defined by the course coordinator including at a minimum course written examinations, skills proficiency verification, clinical training, and EMS field internship before receiving a Course Completion Certificate and becoming eligible to take the state certification examination. The skills verification process shall be supervised by a state certified course coordinator and shall be administered by state certified examiners using state approved skills criteria.
                                                [A student shall successfully complete all course requirements including course written, course skills examinations, clinical training, and EMS field internship prior to being placed on a course completion certificate and becoming eligible for state certification skills and written examinations]. (b) Application procedures. Procedures
                                                  are outlined in the EMS Education and Training Manual which is adopted by reference. The manual is available for review during normal working hours in the library of the
                                                    Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (c) Course approval criteria. (1) (No change.) (2) Approval of an EMT training course application shall be dependent upon: (A) submitting a nonrefundable $25 processing fee. A coordinator who receives no remuneration for providing the course shall be exempt from the fee; (B)
                                                      [(A)] meeting the requirements in subsections (a) and (b) of this section; [and] (C)
                                                        [(B)] meeting all the requirements in the EMS Education and Training Manual relating to basic emergency medical technician training courses; and
                                                          [. ] (D) maintaining a minimum of one instructor to ten students for skills instruction. (3) (No change.) (d) Criteria for course denial. (1) A course may be denied for, but not limited to, the following reasons. If the applicant: (A)-(B) (No change.) (C) has a history of a 20%
                                                            [high] failure rate
                                                              [rates of students in previous courses] on certification examinations by students from previous courses
                                                                ; (D) has a history of consistently critical
                                                                  [poor] course evaluations from students in previous courses; (E)-(F) (No change.) (G) fails to meet standards for EMS field internship as defined in the EMS Education and Training Manual based on a site evaluation; [and/or] (H) submits names of instructors or examiners
                                                                    who are not certified to the appropriate level for the training course as required in sec.157.62 of this title (relating to Program Instructor Certification) and sec.157.63 of this title (relating to Examiner Certification)
                                                                      [sec.157.61 of this title (relating to Certification of Course Coordinator, Program Instructor, and Examiner) and who are not listed as guest lecturers.]; and/or (I) starts the course without prior approval from the department. (2) (No change.) (e) EMT completion course. (1) (No change.) (2) The minimum curriculum for the EMT Completion Training Course shall be the Texas Department of Health EMT Completion Training Course, 1991,
                                                                        which is adopted by reference. Copies of this curricula may be reviewed during normal working hours in the library of the
                                                                          Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (3) (No change.) (4) The AED curriculum as adopted by reference in s157.31 of this title [(relating to Automated External Defibrillator Training Course)] is optional and shall be taught only with the approval of an EMS medical director or course medical director
                                                                            and shall be in addition to the 60 hours of instruction in paragraph (5) of this subsection and in addition to the clinical and field internship requirements in paragraphs (6) and (7) of this subsection. (5)-(6) (No change.) (7) Twelve hours of clinical in-hospital training may be completed in a JCAHO or AAAHC accredited primary care facility, such as a minor emergency health care facility, if an exception to paragraph (5) of this subsection is requested from and approved by
                                                                              the department. (8) The student shall be required to complete a minimum of three supervised ambulance runs with a licensed EMS provider
                                                                                [on an authorized EMS vehicle]. The supervision of these runs shall be provided by an individual certified as at least an EMT or by an appropriately qualified program instructor as determined by the course coordinator. An ambulance run is one in which a patient is transported from the scene to a primary care facility because the patient's condition requires care or one in which the student observes or assists with care at the scene, but the patient is transported by a helicopter, ALS, or MICU vehicle. The approval of any other run will be left to the course coordinator who will weigh the educational merits. (9)-(10) (No change.) (11) A student shall successfully complete all course requirements as defined by the course coordinator including at a minimum course written examinations, skills proficiency verification, clinical training, and EMS field internship before receiving a Course Completion Certificate and becoming eligible to take the state certification examination. The skills verification process shall be supervised by a state certified course coordinator and shall be administered by state certified examiners using state approved skills criteria.
                                                                                  [A student shall successfully complete all course requirements including course written, course skills examinations, clinical training, and EMS field internship prior to being placed on a course completion certificate and becoming eligible for state certification skills and written examinations]. (12) A coordinator may waive clinical and/or ambulance internship for an ECA with three years of verifiable EMS experience with a licensed EMS provider or registered first responder organization. Approval of the waiver will be dependent upon substantiation of qualifying experience including, but not limited to: (A) at least five documented run critiques; and (B) at least three written case studies on medical and trauma patients. (13) All approved waivers and qualifying documentation shall be audited during site visit evaluations. All documentation shall be dated and signed by the director of the EMS provider or first responder to include a letter verifying work experience. sec.157.34. EMT-Intermediate Training [Course]. (a) Course curricula. (1) The minimum curricula for the Emergency Medical Technician-Intermediate (EMT-I) training course shall be the Department of Transportation (DOT) EMT-I training curriculum, 1985,
                                                                                    adopted by reference. (A) Copies of the DOT curriculum
                                                                                      may be reviewed during normal working hours in the library of the
                                                                                        Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (B) At the option of the coordinator, cardiopulmonary resuscitation (CPR) curriculum requirements may be met by: (i) including the American Heart Association (AHA) Basic Life Support Health Care Provider Course or its equivalent in the training course and testing each student for CPR proficiency using AHA or American Red Cross (ARC) standards; and/or (ii) requiring each student to show CPR proficiency as evidenced by AHA or ARC proof of completion of an AHA Basic Life Support Health Care Provider Course or its equivalent within 12 months of the course application. (2)-(7) (No change.) (8) The student shall be required to complete a minimum of 50 hours of supervised experience with a licensed EMS provider
                                                                                          [on an authorized EMS vehicle] operating as at least an advanced life support vehicle. (9) -(10) (No change.) (11) A student shall successfully complete all course requirements as defined by the course coordinator including at a minimum course written examinations, skills proficiency verification, clinical training, and EMS field internship before receiving a Course Completion Certificate and becoming eligible to take the state certification examination. The skills verification process shall be supervised by a state certified course coordinator and shall be administered by state certified examiners using state approved skills criteria.
                                                                                            [A student shall successfully complete all course requirements including course written examination, course skills examination, clinical training, and EMS field internship prior to being placed on a course completion certificate and becoming eligible for state certification skills and written examinations.] (b) Enrollment. (1)-(3) (No change.) (4) An EMT who is enrolled in an EMT-I course and whose certification expires before the end of the course shall continue to be certified for a period not to exceed 90 days past the expiration date if, before the expiration date of the EMT certificate;
                                                                                              [An EMT who is enrolled in an EMT-I course and whose EMT certification expires before the end of the EMT-I course shall have a period not to exceed 90 days to complete recertification requirements for the EMT certificate if:] [(A) an application and fee for the EMT recertification is received before the expiration date of the EMT certificate; or [(B) an application and fee for the EMT-I certification is received before the expiration date of the EMT certificate.] (A) a letter of intent to apply for the higher level certification, and evidence of course enrollment is submitted; or (B) an application and nonrefundable fee for EMT recertification is received. (c) Application procedures. Procedures
                                                                                                are outlined in the EMS Education and Training Manual, 1993,
                                                                                                  which is adopted by reference. The manual is available for review during normal working hours in the library of the
                                                                                                    Texas Department of Health, [Bureau of Emergency Management offices] 1100 West 49th Street, Austin, Texas 78756. (d) Course coordinator qualifications. The course coordinator shall have the following qualifications in order to submit an EMT-I course application: (1) be currently certified as at least an active status EMT-I; (2) have successfully coordinated at least two basic courses, if applying for EMT-I course for the first time. Exceptions to the basic courses may be granted to new coordinators in a college setting who have demonstrated teaching ability; (3) have successfully completed a self study/site visit evaluation for an EMT-I course; and (4) have experience teaching advanced classes. (e)
                                                                                                      [(d)] Course approval criteria. (1) Criteria for course approval shall be outlined in the EMS Education and Training Manual which is adopted by reference in subsection (c) of this section. (2) Approval of an EMT-I training course application shall be dependent upon: (A) submitting a nonrefundable $50 processing fee. A coordinator who receives no remuneration for providing the course, shall be exempt from the fee; (B)
                                                                                                        [(A)] meeting the requirements in subsections (a)-(c) of this section; [and] (C) a letter of agreement with a course medical director; (D)
                                                                                                          [(B)] meeting all the requirements in the EMS Education and Training Manual relating to emergency medical technician-intermediate training courses; and
                                                                                                            [.] (E) maintaining a minimum of one instructor to ten students for the skills instruction. (3) If the application meets the criteria in [this subsection or] this section, the training program shall receive a letter of approval from the department with an assigned course number. (f)
                                                                                                              [(e)] Criteria for course denial. (1) A course may be denied for, but not limited to, the following reasons. If the applicant: (A) submits an incomplete application; (B) fails to submit an application in accordance with requirement in subsection (c) of this section; (C) has a history of a 20%
                                                                                                                [high] failure rate
                                                                                                                  [rates of students in previous courses] on certification examinations by students from previous courses
                                                                                                                    ; (D) has a history of consistently critical
                                                                                                                      [poor] course evaluations from students in previous courses; (E) fails to meet standards for training facilities as defined in the EMS Education and Training Manual based on a site evaluation; (F) fails to meet standards for clinical training as defined in the EMS Education and Training Manual based on a site evaluation; (G) fails to meet standards for EMS field internship as defined in the EMS Education and Training Manual based on a site evaluation; and/or (H) submits names of instructors or examiners who are not certified to the appropriate level for the training course as required in sec.157.62 of this title (relating to Program Instructor Certification and s157.63 of this title (relating to Examiner Certification)
                                                                                                                        [sec.157.61 of this title (relating to Certification of Course Coordinator, Program Instructor and Examiner and who are not listed as guest lecturers.]; and/or (I) starts the course without prior approval from the department. (2) If an application is denied, a letter will be forwarded to the applicant detailing specific reasons for the denial. sec.157.35. EMT-Paramedic Training [Course]. (a) Course Curricula. (1) The minimum curricula for the Emergency Medical Technician-Paramedic (EMT- P) training course shall be the Department of Transportation (DOT) EMT-P, 1983,
                                                                                                                          adopted by reference. (A) Copies of the DOT curriculum
                                                                                                                            may be reviewed during normal working hours in the library of the
                                                                                                                              Texas Department of Health, [Bureau of Emergency Management] 1100 West 49th Street, Austin, Texas 78756. (B) At the option of the coordinator, cardiopulmonary resuscitation (CPR) curriculum requirements may be met by: (i) including the American Heart Association (AHA) Basic Life Support Health Care Provider Course or its equivalent in the training course and testing each student for CPR proficiency using AHA or American Red Cross (ARC) standards; and/or (ii) requiring each student to show CPR proficiency as evidenced by AHA or ARC proof of completion of an AHA Basic Life Support Health Care Provider Course or its equivalent within 12 months of the course application. (2)-(4) (No change.) (5) The student shall be required to complete a minimum of 100 hours of supervised experience with a licensed
                                                                                                                                [on an authorized] emergency medical services (EMS) provider
                                                                                                                                  [vehicle] operating as an mobile intensive care unit (MICU) which has capabilities of voice telecommunication with on-line medical direction. (6)-(7) (No change.) (8) A student shall successfully complete all course requirements as defined by the course coordinator including at a minimum course written examinations, skills proficiency verification, clinical training, and EMS field internship before receiving a Course Completion Certificate and becoming eligible to take the state certification examination. The skills verification process shall be supervised by a state certified course coordinator and shall be administered by state certified examiners using state approved skills criteria.
                                                                                                                                    [A student shall successfully complete all course requirements including course written examinations, course skills examinations, clinical training, and EMS field internship prior to being placed on a course completion certificate and becoming eligible for state certification skills and written examinations]. (b) Enrollment. (1)-(2) (No change.) (3) An EMT or EMT-I
                                                                                                                                      whose certification expires while enrolled in an EMT-P course is not certified at any level until: (A) successfully completing the recertification requirements for EMT or EMT-I
                                                                                                                                        certification; or (B) (No change.) (4) An EMT or EMT-I who is enrolled in an EMT-P course and whose certification expires before the end of the course shall continue to be certified for a period not to exceed 90 days past the expiration date if before the expiration date of the EMT or EMT-I certificate
                                                                                                                                          [An EMT who is enrolled in an EMT-P course and whose EMT certification expires before the end of the EMT-P course shall have a period not to exceed 90 days to complete recertification requirements for the EMT certificate if]: (A) a letter of intent to apply for the higher level certification and evidence of course enrollment is submitted
                                                                                                                                            [an application and fee for the EMT recertification is received before the expiration date of the EMT certificate]; or (B) an application and nonrefundable
                                                                                                                                              fee for EMT or EMT-I recertification
                                                                                                                                                [the EMT-P certification] is received [before the expiration date of the EMS certificate]. (c) Application procedures. Procedures
                                                                                                                                                  are outlined in the EMS Education and Training Manual, 1993,
                                                                                                                                                    which is adopted by reference. The manual is available for review during normal working hours in the library of the
                                                                                                                                                      Texas Department of Health, [Bureau of Emergency Management offices,] 1100 West 49th Street, Austin, Texas 78756. (1) Non-accredited
                                                                                                                                                        EMS training entities [without accreditation from the Committee on Allied Health Education Accreditation (CAHEA)] may obtain an application for course approval from the Texas Department of Health (department) [or the public health region EMS offices]. (2) (No change.) (3) An EMS training entity which has been recognized by the department as accredited by a national accrediting organization
                                                                                                                                                          [accredited by CAHEA] shall submit to the department a copy of the self-study for accreditation and a copy of the formal accreditation approval [from CAHEA]. The EMS training entity shall submit to the department: (A) copies of updates submitted to the national accrediting organization
                                                                                                                                                            [CAHEA] as well as any correspondence from the organization
                                                                                                                                                              [CAHEA] affecting the EMS training entity's accreditation; and (B) (No change.) (d) Course coordinator qualifications. The course coordinator shall have the following qualifications in order to submit an EMT-P course application: (1) be currently certified as at least an active status EMT-P; (2) have successfully coordinated at least two basic courses if applying for EMT-P course for the first time. Exceptions to the basic courses may be granted to new coordinators in a college setting who have demonstrated teaching ability; (3) have successfully completed a self study/site visit evaluation for an EMT-P course; and (4) have experience teaching advanced classes. (e)
                                                                                                                                                                [(d)] Course approval criteria. (1) Criteria for course approval shall be outlined in the EMS Education and Training Manual which is adopted by reference in subsection (c) of this section. (2) Approval of an EMT-P training course application shall be dependent upon: (A) submitting a nonrefundable $50 processing fee. A coordinator who receives no remuneration for providing the course, shall be exempt from the fee; (B)
                                                                                                                                                                  [(A)] meeting the requirements in subsections (a)-(c) of this section; and (C)
                                                                                                                                                                    [(B)] meeting all the requirements in the EMS Education and Training Manual relating to EMT-P training courses and/or the national accrediting organization
                                                                                                                                                                      [CAHEA accredited programs]; (D) submitting a letter of agreement with a course medical director as well as the course medical director's plan and protocols for comprehensive advanced skills (megacode) testing of each student to evaluate paramedic competency; and (E) maintaining a minimum of one instructor to ten students for skills instruction. (3) If the application meets the criteria in this subsection, the training program shall receive a letter of approval from the department with an assigned course number. (f)
                                                                                                                                                                        [(e)] Criteria for course denial. (1) A course may be denied for, but not limited to, the following reasons. If the applicant: (A) submits an incomplete application; (B) fails to submit an application in accordance with requirement in subsection (c) of this section; (C) has a history of a 20%
                                                                                                                                                                          [high] failure rate
                                                                                                                                                                            [rates of students in previous courses] on certification examinations by students from previous courses
                                                                                                                                                                              ; (D) has a history of consistently critical
                                                                                                                                                                                [poor] course evaluations from students in previous courses; (E) fails to meet standards for training facilities as defined in the EMS Education and Training Manual based on a site evaluation; (F) fails to meet standards for clinical training as defined in the EMS Education and Training Manual based on a site evaluation; (G) fails to meet standards for EMS field internship as defined in the EMS Education and Training Manual based on a site evaluation; [and/or] (H) submits names of instructors or examiners who are not certified to the appropriate level for the training course as required in sec.157.62 of this title (relating to Program Instructor Certification and s157.63 of this title (relating to Examiner Certification)
                                                                                                                                                                                  [sec.157.61 of this title (relating to Certification of Course Coordinator, Program Instructor and Examiner] and who are not listed as guest lecturers[.]; and/or (I) starts the course without prior approval from the department. (2) If an application is denied, a letter will be forwarded to the applicant detailing specific reasons for the denial. (g)
                                                                                                                                                                                    [(f)] EMT-P completion course. (1) Enrollment. (A) Students enrolling in an EMT-P completion course shall be currently certified as an EMT-I; or may be enrolled in an EMT-I training course and shall have completed the classroom portion of the course. (B) The student shall successfully complete the EMT-I training course [and be certified at the EMT-I level] before certification at the EMT-P level. (C) An EMT-I whose certification expires while enrolled in an EMT-P completion course is not certified at any level until: (i) successfully completing the recertification requirements for EMT-I certification; or (ii) successfully completing the certification requirements for EMT-P certification. (D) An EMT-I who is enrolled in an EMT-P course and whose EMT-I certification expires before the end of the course shall continue to be certified for a period not to exceed 90 days past the expiration date if a letter of intent to apply for the higher level certification and evidence of course enrollment or an application and nonrefundable fee for EMT-I recertification is submitted before the expiration date of the EMT-I certificate.
                                                                                                                                                                                      [An EMT-I who is enrolled in an EMT-P completion course and whose EMT-I certification expires before the end of the EMT-P course shall have a period not to exceed 90 days to complete recertification requirements for the EMT-I certificate if:] [(i) an application and fee for the EMT-I recertification is received before the expiration date of the EMT-I certificate; or [(ii) an application and fee for the EMT-P certification is received] before the expiration date of the EMT-I certificate.] (2) Course curricula. (A) The minimum curriculum for the EMT-P completion course
                                                                                                                                                                                        [Training Course] shall be the department EMT-P Completion Training Course which is adopted by reference. Copies may be reviewed during normal working hours in the library of the Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756.
                                                                                                                                                                                          [following divisions of the Department of Transportation (DOT) national training course Emergency Medical Technician-Paramedic, as adopted by reference:] [(i) Division 1 to include 1.4.3, 1.4.4, 1.4.7-1.4.14, SL.4.29b, 1.5.1-1.5.11, 1.6.1-1.6.13, and 1.7.1-1.7.13; [(ii) Division 2 to include 2.2.5, 2.2.9, 2.2.12, 2.2.22, 2.3.9, 2.4.2, 2.4.8, 2.4.28-2.4.30, 2.4.42, 2.5.1-2.5.40, and S2.5. 41-S2.5.44; and [(iii) Divisions 3-6 to include all sections.] (B) Objectives pertaining to the use of rotating tourniquets may be included at the discretion of the course medical director, but if taught shall be in addition to the 100 hours in subparagraph (C)
                                                                                                                                                                                            [(E)] of this paragraph. (C) The course shall include a minimum of 100 hours of didactic instruction on the approved curriculum. (D) The student shall be required to complete a minimum of 90 hours of clinical in-hospital training. (E) A minimum of 24 hours shall be required in the emergency department. (F) The student shall be required to complete a minimum of 50 hours of supervised experience on an authorized EMS vehicle operating as an MICU which has capabilities of voice telecommunication with on-line medical direction. (G) At least five runs shall be completed during which the patient receives ALS care. The supervision of this experience shall be provided by an individual certified as an EMT-P or by an appropriately qualified program instructor as determined by the course coordinator. [An ambulance run is one in which a patient is transported from the scene to a primary care facility because the patient's condition requires care or one in which the student observes or assists with care at the scene, but the patient is transported by a helicopter or other MICU vehicle.] (H) During the clinical and/or EMS field internship, the student shall be required to successfully demonstrate proficiency in endotracheal intubations, peripheral intravenous needle or catheter insertions, and patient assessments, including cardiac monitoring, to the satisfaction of the course medical director and course coordinator. (I) A student shall successfully complete all course requirements as defined by the course coordinator including at a minimum course written examinations, skills proficiency verification, clinical training, and EMS field internship before receiving a course completion certificate and becoming eligible to take the state certification examination. The skills verification process shall be supervised by a state certified course coordinator and shall be administered by state certified examiners using state approved skills criteria.
                                                                                                                                                                                              [A student shall successfully complete all course requirements including course written examinations, course skills examinations, clinical training, and EMS field internship prior to being placed on a course completion certificate and becoming eligible for state certification skills and written examinations.] (3) Application procedure for an EMT-P completion course shall be as outlined in subsection (c) of this section. (4) Approval or denial of an EMT-P completion course shall be as outlined in this subsection and in subsections (d) and (e) of this section. 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 December 29, 1994. TRD-9452961 Susan K. Steeg General Counsel Texas Department of Health Proposed date of adoption: April 2, 1995 For further information, please call: (512) 458-7236 TITLE 37. PUBLIC SAFETY AND CORRECTIONS Part I. Texas Department of Public Safety Chapter 11. Commercial Vehicle Registration Commercial Vehicle Registration Enforcement 37 TAC sec.sec.11.1, 11.4., 11.5 The Texas Department of Public Safety proposes amendments to sec.sec.11.1, 11. 4, and 11.5, concerning commercial vehicle registration enforcement. The amendments to the sections change the name State Department of Highways and Public Transportation to the Texas Department of Transportation. The amendments are necessary to comply with the requirements of the 72nd Legislature, First Called Session, 1991. Tom Haas, Chief of Finance, has determined that for the first five year period the amendments are in effect, there will be no fiscal implications for local or state government as a result of enforcing or administering the amendments. There will be no effect on local employment or the local economy. Mr. Haas also has determined that for each year of the first five years the amendments are in effect the public benefit anticipated as a result of enforcing the amendments will be clarification and consistency with the statute. There will be no effect on small or large businesses. There is no anticipated economic cost to persons who are required to comply with the amendments as proposed. Comments on the proposal may be submitted to John C. West, Jr., Chief of Legal Services, Texas Department of Public Safety, Box 4087, Austin, Texas 78773-0001, (512) 465-2890. The amendments are proposed under Texas Government Code s411.006(4), which provides the director with the authority to adopt rules, subject to commission approval, considered necessary for the control of the department. Texas Government Code sec.411.006(4) is affected by this proposal. sec.11.1. Basic Enforcement Guidelines. The Department of Public Safety is charged with the responsibility of enforcing registration requirements of commercial vehicles. This enforcement will be based on the statutory provisions of Texas Civil Statutes
                                                                                                                                                                                                [V.C.S.] 6675a and on policies and reciprocal agreements promulgated by the Texas [State] Department of [Highways and Public] Transportation, as amended. sec.11.4. Enforcement Guidelines Relating to Reciprocal Agreements With Various States. The Texas [State] Department of [Highways and Public] Transportation has entered into bilateral reciprocity agreements with several states and is also a member of the International Registration Plan. For enforcement purposes, the Department of Public Safety defines the term apportionable vehicle to mean a vehicle that: (1)-(3) (No change.) sec.11.5. Basic Enforcement Guidelines For Enforcement Registration and Permit Requirements of Oil Well Servicing Equipment.
                                                                                                                                                                                                  The Department of Public Safety, under the authority of Government Code, Chapter 411, sec. 411.002
                                                                                                                                                                                                    [V.C.S. 4413], is charged with the responsibility of enforcing laws protecting public safety, including, but not limited to the
                                                                                                                                                                                                      registration requirements. This enforcement will be based on the statutory provisions of Texas Civil Statutes
                                                                                                                                                                                                        [V.C.S.] 6701d-11 and 6701d-16 and the rules promulgated by the Texas [State] Department of [Highways and Public] Transportation, as amended. 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 December 20, 1994. TRD-9452926 James R. Wilson Director Texas Department of Public Safety Earliest possible date of adoption: February 6, 1995 For further information, please call: (512) 465-2890 TITLE 40. SOCIAL SERVICES AND ASSISTANCE Part III. Texas Commission on Alcohol and Drug Abuse Chapter 150. Licensure of Chemical Dependency Counselors 40 TAC sec.150.1 The Texas Commission on Alcohol and Drug Abuse Proposes an amendment to sec.150.1, concerning licensure requirements for licensed chemical dependency counselors. The amendment is being proposed to change the definition of Criminal Justice Peer Intern. Otis E. Williams, Deputy Executive Director for Finance and Administration, has determined that for the first five-year period the amendment is in effect there will be no fiscal implications for state or local government as a result of enforcing or administering this amendment. Mr. Williams also has determined that for each year of the first five years the amendment as proposed is in effect the public benefit anticipated will be improved enforcement of licensure requirements. There will be no effect on small businesses. There is no anticipated economic cost to persons who are required to comply with the amendment as proposed. Comments on the proposal may be submitted to Denise F. Mosel, Executive Assistant, Texas Commission on Alcohol and Drug Abuse, 710 Brazos Street, Austin, Texas 78701. The amendment is proposed under Texas Civil Statutes, Article 4512o, which provide the Texas Commission on Alcohol and Drug Abuse with the authority to adopt rules and standards for licensure of chemical dependency counselors. The code affected by the proposed amendment is the Texas Civil Statutes, Article 4512o. sec.150.1. Definitions. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. Criminal justice peer intern-A student, intern, or trainee pursuing a course of study in chemical dependency counseling and working in the Texas Criminal Justice Chemical Dependency Treatment Initiative. (A) Approval as a criminal justice peer intern requires an individual to: (i) make application to the commission; (ii) pay the application fee; (iii) complete 135 approved classroom hours in chemical dependency treatment; (iv) have two letters of reference from licensed chemical dependency counselors; (v)
                                                                                                                                                                                                          [(iv)] complete a chemical dependency treatment program that utilizes the therapeutic community model [and complete immersion training (which shall not be considered part of the 135 hours of required classroom training); (vi)
                                                                                                                                                                                                            [(v)] complete treatment requirements of the continuum of care;
                                                                                                                                                                                                              [be on annual report, if a parolee or Level 4 status, if a probationer.] (vii) have successful transition to Phase III Supervised Recovery; (viii) maintain 12 months of continued abstinence from mind altering substances. (B)-(E) (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 December 27, 1994. TRD-9452943 J. Ben Bynum Executive Director Texas Commission on Alcohol and Drug Abuse Earliest possible date of adoption: February 6, 1995 For further information, please call: (512) 867-8720