ADOPTED RULES
An agency may take final action on a section 30 days after a proposal has been 
published in the Texas Register. The section becomes effective 20 days after the 
agency files the correct document with the Texas Register, unless a later date 
is specified or unless a federal statute or regulation requires implementation 
of the action on shorter notice.
If an agency adopts the section without any changes to the proposed text, only 
the preamble of the notice and statement of legal authority will be published. 
If an agency adopts the section with changes to the proposed text, the proposal 
will be republished with the changes.

TITLE 16. ECONOMIC REGULATION
PART I. Railroad Commission of Texas
CHAPTER 3.Oil and Gas Division
Conservation Rules and Regulations
16 TAC sec.3.26, sec.3.27
The Railroad Commission of Texas adopts amendments to sec.3.26, concerning 
separating devices and tanks, and sec.3.27, concerning gas to be measured, with 
changes to the proposed text as published in the March 21, 1997, issue of the 
Texas Register (22 TexReg 2944). The amendments were proposed to conform the 
sections to Texas Natural Resources Code sec.85.046(c), as amended, and to 
clarify existing provisions regarding administrative approval of surface 
commingling of oil and gas. The amendments authorize the commission, after 
notice and an opportunity for affected parties to request a hearing, to approve 
surface commingling of produced hydrocarbons. 
The amendments delineate the procedures for seeking approval of surface 
commingling when an application for surface commingling is protested, and for 
seeking administrative approval when an application is unprotested. 
Administrative approval is authorized when notice has been given to all working 
interest and royalty interest owners, no protest to the proposed commingling has 
been received by the commission, and the commission finds that surface 
commingling will prevent waste, promote conservation or protect correlative 
rights. The amendments set out the requirements for a reasonable allocation of 
commingled hydrocarbons among royalty and working interests. The amendments also 
clarify existing commission procedures concerning circumstances in which the 
commission may authorize surface commingling administratively. 
The language in sec.3.26(b), concerning procedures for approval of surface 
commingling of oil, was selected because it tracks the amendment to the 
underlying statute and concisely outlines the circumstances in which surface 
commingling applications may be administratively approved. The amendments to 
this subsection simplify the existing text of the rule and clarify existing 
commission procedures regarding circumstances in which surface commingling may 
be administratively approved without notice or hearing. Paragraph (b)(4) of 
sec.3.26 requires notice to certain offset operators for any application 
proposing to surface commingle one or more wells producing from a field having 
special field rules. Section 3.27(e), concerning approval of surface commingling 
of gas, references and incorporates the procedures for approval of commingling 
set out in sec.3.26(b). The amendments to the existing provisions in sec.3.27, 
relating to gas to be measured, remove redundant and obsolete portions of the 
section. The amendments also eliminate unnecessary measuring requirements by 
providing an exemption for de minimis gas releases and, in some circumstances, 
for wells producing less than 20 mcf per day.
Comments were received from two entities - the Texas Mid- Continent Oil & Gas 
Association ("TMOGA") and Conoco, Inc ("Conoco"). Both comments supported the 
proposed amendments. Conoco specifically noted that it "supports the entire rule 
as proposed." 
TMOGA indicated that it generally supported the amendments but recommended 
several changes to the rules as published. TMOGA noted that the proposed 
amendments require that allocation be based on quarterly testing in some 
circumstances and commented that it considers semi-annual reporting of well 
tests to be adequate. 
The commission declines to make any change to this provision because surface 
commingling has historically been used as a means of prolonging the production 
life of economically marginal wells. Marginal, low-production wells generally 
have relatively flat declines, very little fluctuation in production rate over 
long periods of time, and relatively small cumulative annual production. As a 
result, improper allocation caused by errors in testing or changes in the 
producing characteristics of the well between tests tends to be insignificant. 
By contrast, any well having production sufficient to require quarterly testing 
under the published rule is an economic well and a relatively strong producer 
which is much more likely to rapidly decline or to have significant fluctuations 
in production rate and to produce a significant cumulative volume of 
hydrocarbons. As a result, improper allocations due to inaccurate tests or 
changes in producing characteristics are much more likely to occur and, when 
they do occur, to have a significant adverse impact on the correlative rights of 
interest holders in one or more wells being commingled. 
TMOGA commented that it agreed with the intent of sec.3.26(b)(3)(A), but that 
the language of that provision should be changed to eliminate redundant 
references to other commission rules. The commission agrees and has amended 
sec.3.26(b)(3)(A) to clarify that provision and remove the repetitive reference 
to other commission rules. TMOGA also recommended minor changes to sec.3.27(c) 
if the definition of "measured" was re-located within the rule. TMOGA specified 
that if the definition of measured was not moved, the language of sec.3.27(c) 
should remain as published. The commission declines to move the location of the 
definitions in the rule as this change is unnecessary and potentially confusing. 
Accordingly, no change has been made to the language of sec.3.27(c). The 
commission adopts the amendments pursuant to Texas Natural Resources Code, 
sec.sec.81.052, 85.201, and 86.042, which authorize the commission to prevent 
waste of oil and gas and to protect correlative rights.

sec.3.26.Separating Devices, Tanks, and Surface Commingling of Oil. 
(a) Where oil and gas are found in the same stratum and it is impossible to 
separate one from the other, or when a well has been classified as a gas well 
and such gas well is not connected to a cycling plant and such well is being 
produced on a lease and the gas is utilized under Texas Natural Resources Code 
86.181- 86.185, the operator shall install a separating device of approved type 
and sufficient capacity to separate the oil and liquid hydrocarbons from the 
gas. 
(1) The separating device shall be kept in place as long as a necessity for it 
exists, and, after being installed, such device shall not be removed nor the use 
thereof discontinued without the consent of the commission. 
(2) All oil and any other liquid hydrocarbons as and when produced shall be 
adequately measured according to the pipeline rules and regulations of the 
commission before the same leaves the lease from which they are produced, except 
for gas wells where the full well stream is moved to a plant or central 
separation facility in accordance with sec.3.55 of this title (Statewide Rule 
55, relating to reports on gas wells commingling liquid hydrocarbons before 
metering) and the full well stream is measured, with each completion being 
separately measured, before the gas leave the lease. 
(3) Sufficient tankage and separator capacity shall be provided by the producer 
to adequately take daily gauges of all oil and any other liquid hydrocarbons 
unless LACT equipment, installed and operated in accordance with the latest 
revision of American Petroleum Institute (API) Manual of Petroleum Measurement 
Standards, Chapter 6.1 or another method approved by the commission or its 
delegate, is being used to effect custody transfer. 
(b) In order to prevent waste, to promote conservation or to protect correlative 
rights, the commission may approve surface commingling of oil, gas, or oil and 
gas production from two or more tracts of land producing from the same 
commission-designated reservoir or from one or more tracts of land producing 
from different commission-designated reservoirs as follows:
(1) Administrative approval. Upon written application, the commission may grant 
approval for surface commingling administratively when any one of the following 
conditions is met: 
(A) The tracts or commission-designated reservoirs have identical working 
interest and royalty interest ownership in identical percentages and therefore 
there is no commingling of separate interests; 
(B) Production from each tract and each commission-designated reservoir is 
separately measured and therefore there is no commingling of separate interests; 
or 
(C) When the tracts or commission-designated reservoirs do not have identical 
working interest and royalty interest ownership in identical percentages and the 
commission has not received a protest to an application within 21 days of notice 
of the application being mailed by the applicant to all working and royalty 
interest owners or, if publication is required, within 21 days of the date of 
last publication and the applicant provides:
(i) a method of allocating production to ensure the protection of correlative 
rights, in accordance with paragraph (3) of this subsection; and 
(ii) an affidavit or other evidence that all working interest and royalty 
interest owners have been notified of the application by certified mail or have 
provided applicant with waivers of notice requirements, or 
(iii) in the event the applicant is unable, after due diligence, to provide 
notice by certified mail to all working interest and royalty interest owners, a 
publisher's affidavit or other evidence that the commission's notice of 
application has been published once a week for four consecutive weeks in a 
newspaper of general circulation in the county or counties in which the tracts 
that are the subject of the application are located. 
(2) Request for hearing. When the tracts or commission-designated reservoirs do 
not have identical working interest and royalty interest ownership in identical 
percentages and a person entitled to notice of the application has filed a 
protest to the application with the commission, the applicant may request a 
hearing on the application. The commission shall give notice of the hearing to 
all working interest and royalty interest owners. The commission may permit the 
commingling if the applicant demonstrates that the proposed commingling will 
protect the rights of all interest owners in accordance with paragraph (3) of 
this subsection and will prevent waste, promote conservation or protect 
correlative rights. 
(3) Reasonable allocation required. The applicant must demonstrate to the 
Commission or its designee that the proposed commingling of hydrocarbons will 
not harm the correlative rights of the working or royalty interest owners of any 
of the wells to be commingled. The method of allocation of production to 
individual interests must accurately attribute to each interest its fair share 
of aggregated production. 
(A) In the absence of contrary information, such as indications of material 
fluctuations in the monthly production volume of a well proposed for 
commingling, the Commission will presume that allocation based on the daily 
production rate for each well as determined and reported to the Commission by 
periodic well tests conducted at the intervals provided in this section will 
accurately attribute to each interest its fair share of production without harm 
to correlative rights. As used in this section, "daily production rate" for a 
well means the 24 hour production rate determined by the most recent well test 
conducted and reported to the commission in accordance with Statewide Rules 28, 
52, 53, and 55 (sec.sec.3.28, 3.52, 3.53, and 3.55 of this title, relating to 
potential and deliverability of gas wells to be ascertained and reported, oil 
well allowable production, well status reports required, and reports of gas 
wells commingling liquid hydrocarbons before metering). 
(i) For applications proposing to commingle production from wells which each 
have a daily production rate of 100 mcf of gas or less and four barrels or less 
of oil or condensate, the production rate for each well shall be measured by 
well tests conducted annually; 
(ii) For applications proposing to commingle production from wells which each 
have a daily production rate of 250 mcf of gas or less and less than 10 barrels 
of oil or condensate, the production rate for each well shall be measured by 
well tests conducted semi-annually; and, 
(iii) For applications proposing to commingle production from one or more wells 
having a daily production rate of more than 250 mcf of gas or 10 or more barrels 
of oil or condensate, the production rate for each well shall be measured by 
well test conducted quarterly. 
(B) An applicant may test less frequently than the applicable minimum 
frequencies set out in subparagraph (A)(ii) and (iii) of this paragraph with the 
written consent of all royalty and working interest owners. Allocation of 
commingled production shall not be based on well tests conducted less frequently 
than annually. 
(C) Nothing in this section prohibits allocations based on more frequent well 
tests than the minimums set out in subparagraph (A) of this paragraph. 
Additional tests used for allocation do not have to be filed with the commission 
but must be available for inspection at the request of the commission, working 
interest owners or royalty interest owners. 
(D) Allocations may be based on a method other than periodic well tests if the 
Commission or its designee determines that the alternative allocation method 
will insure a reasonable allocation of production as required by this paragraph. 
(4) Additional notice required. In addition to giving notice to the persons 
entitled to notice under paragraph (1)(C) of this subsection, an applicant for a 
surface commingling exception must give notice of the application to the 
operator of each tract adjacent to one or more of the tracts proposed for 
commingling that has one or more wells producing from the same commission-
designated reservoir as any well proposed for commingling if: 
(A) any one of the wells proposed for commingling produces from a commission-
designated reservoir for which special field rules have been adopted; or 
(B) any one of the wells proposed for commingling produces from multiple 
commission-designated reservoirs, unless: 
(i) an exception to sec.3.10 of this title (relating to restriction of 
production of oil and gas from different strata) has previously been obtained 
for production from the well; or, 
(ii) the applicant continues to separately measure production from each 
different commission-designated reservoir produced from the same wellbore. 
(c)-(d) (No change.) 

sec.3.27. Gas to be Measured and Surface Commingling of Gas.
(a) All natural gas, except casinghead gas, produced from wells shall be 
measured, with each completion being measured separately, before the gas leaves 
the lease, and the producer shall report the volume produced from each 
completion to the commission. Exceptions to this provision may be granted by the 
commission upon written application. 
(b) All casinghead gas sold, processed for its gasoline content, used in a field 
other than that in which it is produced, or used in cycling or repressuring 
operations, shall be measured before the gas leaves the lease, and the producer 
shall report the volume produced to the commission. Exceptions to this provision 
may be granted by the commission upon written application.
(c) All casinghead gas produced in this state which is not covered by the 
provisions of subsection (b) of this section, shall be measured before the gas 
leaves the lease, is used as fuel, or is released into the air, based on its use 
or on periodic tests, and reported to the commission by the producer. The volume 
of casinghead gas produced by wells exempt from gas/oil ratio surveys must be 
estimated, based on general knowledge of the characteristics of the wells. 
Exceptions to this provision may be granted by the commission upon written 
application. 
(d) Releases and production of gas at a volume or daily flow rate, commonly 
referred to as "too small to measure" (TSTM), which, due to minute quantity, 
cannot be accurately determined or for which a determination of gas volume is 
not reasonably practical using routine oil and gas industry methods, practices, 
and techniques are exempt from compliance with this rule and are not required to 
be reported to the commission or charged against lease allowable production. 
(e) In order to prevent waste, to promote conservation or to protect correlative 
rights, the commission may approve surface commingling of gas or oil and gas 
described in subsections (a), 
(b) or (c) of this section and produced from two or more tracts of land 
producing from the same commission-designated reservoir or from one or more 
tracts of land producing from different commission-designated reservoirs in 
accordance with sec.3.26(b) of this title (relating to separating devices, 
tanks, and surface commingling of oil). 
(f) In reporting gas well production, the full-well stream gas shall be reported 
and charged against each gas well for allowable purposes. All gas produced, 
including all gas used on the lease or released into the air, must be reported 
regardless of its disposition. 
(g) If gas is produced from a lease or other property covered by the coastal or 
inland waters of the state, the gas produced may, at the option of the operator, 
be measured on a shore or at a point removed from the lease or other property 
from which it was produced. 
(h) All natural hydrocarbon gas produced and utilized from wells completed in 
geothermal resource reservoirs shall be measured and allocated to each 
individual lease based on semiannual test conducted on full well stream lease 
production. 
(i) For purposes of this rule, "measured" shall mean a determination of gas 
volume in accordance with this rule and other rules of the commission, including 
accurate estimates of unmetered gas volumes released into the air or used as 
fuel. 
(j) No meter or meter run used for measuring gas as required by this rule shall 
be equipped with a manifold which will allow gas flow to be diverted or bypassed 
around the metering element in any manner unless it is of the type listed in 
paragraphs (1) or (2) of this subsection: 
(1) double chambered orifice meter fittings with proper meter manifolding to 
allow equalized pressure across the meter during servicing;
(2) double chambered or single chambered orifice meter fittings equipped with 
proper meter manifolding or other types of metering devices accompanied by one 
of the following types of meter inspection manifolds:
(A) a manifold with block valves on each end of the meter run and a single block 
valve in the manifold complete with provisions to seal and a continuously 
maintained seal record; 
(B) an inspection manifold having block valves at each end of the meter run and 
two block valves in the manifold with a bleeder between the two and with one 
valve equipped with provisions to seal and continuously maintained seal records; 
(C) a manifold equipped with block valves at each end of the meter run and one 
or more block valves in the manifold, when accompanied by a documented waiver 
from the owner or owners of at least 60% of the royalty interest and the owner 
or owners of at least 60% of the working interest of the lease from which the 
gas is produced. 
(k) Whenever sealing procedures are used to provide security in the meter 
inspection manifold systems, the seal records shall be maintained for at least 
three years at an appropriate office and made available for Railroad Commission 
inspection during normal working hours. At any time a seal is broken or 
replaced, a notation will be made on the orifice meter chart along with graphic 
representation of estimated gas flow during the time the meter is out of 
service. 
(l) All meter requirements apply to all meters which are used to measure lease 
production, including sales meters if sales meter volumes are allocated back to 
individual leases. 
(m) The commission may grant an exception to measurement requirements under 
subsections (a), (b) and (c) of this section if the requirements of this 
subsection are met. An exception granted under this subsection will be revoked 
if the most recent well test or production reported to the commission reflects a 
production rate of more than 20 MCF of gas per day or if any of the other 
requirements for an exception under this subsection are no longer satisfied. An 
applicant seeking an exception under this subsection must file an application 
establishing: 
(1) the most recent production test reported to the commission demonstrates that 
the gas well or oil lease for which an exception is sought produces at a rate of 
no more than 20 MCF of gas per day; 
(2) an annual test of the production of the gas well or oil lease provides an 
accurate estimate of the daily rate of gas flow; 
(3) the flow rate established in paragraph (2) of this subsection multiplied by 
the recorded duration determined by any device or means that accurately records 
the duration of production each month yields an accurate estimate of monthly 
production; and 
(4) the operator of the pipeline connected to the gas well or oil lease concurs 
in writing with the application. 
(n) Failure to comply with the provisions of this rule will result in severance 
of the producing well, lease, facility, or gas pipeline or other appropriate 
enforcement proceeding. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on June 3, 1997.
TRD-9707184
Mary Ross McDonald
Deputy General Counsel, Office of General Counsel
Railroad Commission of Texas
Effective date: June 23, 1997
Proposal publication date: March 21, 1997
For further information, please call: (512) 463-7008

TITLE 22. EXAMINING BOARDS
PART XXVI. Texas Board of Licensure for Professional Medical Physicists
CHAPTER 601.Medical Physicists
22 TAC sec.sec.601.2, 601.20-601.21
The Texas Board of Licensure for Professional Medical Physicists (board) with 
the approval of the Texas Department of Health (department) adopts an amendment 
to sec.601.2; and new sec.601.20 and sec.601.21 concerning licensed medical 
physicists and temporary licensed medical physicists. Sections 601.2, 601.20 and 
601.21 are adopted with changes to the proposed text as published in the 
December 6, 1996, issue of the Texas Register (21 TexReg 11712). 
The rules will clarify when a license as a medical physicist is required, will 
clarify what the physicists scope of practice may include, and will establish 
continuing education requirements to ensure competent licensees. Specifically, 
the amendment adds a definition for "quality assurance" and "quality control." 
The new sections describe the practice of each of the specialty areas of medical 
physics and establish continuing education requirements. Changes made to the 
proposed text result from comments received during the comment period. The 
details of the changes are described in the summary of comments that follow. 
Other minor editorial changes were made for clarification purposes. 
Comment: Concerning the definition of "quality assurance," in sec.601.2, a 
commenter remarked that a definition of quality assurance was to be provided, 
but there was no true definition only the words "Quality assurance - Quality 
control." Another commenter noted that "quality assurance" and "quality control" 
have similar attributes, but they are not the same. 
Response: The board agrees with both commenters and has added definitions for 
both "quality assurance" and "quality control" in sec.601.2. 
Comment: Concerning sec.601.20(b), a commenter recommended that a licensee's 
renewal year needed to be defined. 
Response: A licensee's renewal year is defined in existing sec.601.11(b)(1)(B) 
which states that "The renewal date of an annual license shall be the last day 
of the licensee's birth month." 
Comment: Concerning sec.601.20, two commenters requested that a statement be 
added exempting temporary license holders from continuing education 
requirements.
Response: The board agrees with the commenters and has added the language "an 
annual" to sec.601.20(a). 
Comment: Concerning sec.601.20, a commenter noted that medical physicists renew 
their license annually but that continuing education was necessary biannually. 
It would seem that changing the renewal to biannually would be more consistent 
with the continuing education cycle. 
Response: The board disagrees. The annual renewal of licenses would keep the 
renewal fees at a reasonable level. 
Comment: Concerning sec.601.20, a commenter requested that the form for 
reporting continuing education be put on the Web site. 
Response: The board agrees and will place the continuing education form along 
with the Act, rules, and application on the web site. 
Comment: Concerning sec.601.20(c), several comments were received concerning the 
use of formal and informal continuing education, and requested a definition for 
each. 
Response: The board agrees and has deleted all references to formal and informal 
continuing education in sec.601.20. The types of acceptable continuing education 
hours are listed in subsection (d). 
Comment: Concerning sec.601.20(c), several comments were received concerning the 
number of hours to be used as formal or informal continuing education and if all 
hours could be used as formal continuing education. 
Response: The board agrees and has eliminated the categories of formal and 
informal from the continuing education requirements in sec.601.20(c).
Comment: Concerning sec.601.20, one commenter indicated that continuing 
education was not necessary and another commenter suggested that only six hours 
of continuing education would be appropriate. 
Response: The board disagrees. Continuing education is necessary to maintain and 
improve the quality of the professional services to the public, to keep the 
physicists knowledgeable and competent in the practice of medical physics.
Comment: Concerning sec.601.20, a commenter remarked that requiring 24 hours of 
continuing education was excessive and suggested that six hours of continuing 
education would be more appropriate. 
Response: The board disagrees. Twenty-four hours of continuing education every 
two years is not excessive. Continuing education is necessary to keep the 
physicists knowledgeable and competent in the practice of medical physics.
Comment: Concerning sec.601.20, one commenter asked "how was a requirement of 24 
hours of continuing education determined?" 
Response: The board reviewed continuing education requirements for other 
professional licensing programs, and determined that requiring 24 hours of 
continuing education every two years would not place a hardship on any licensee.
Comment: Concerning sec.601.20(c), one commenter remarked that "a contact hour" 
and "clock hour" were used throughout the section on continuing education and 
recommended consistency. 
Response: The board agrees with the commenter and has deleted the word "clock" 
and replaced it with "contact" for consistency. 
Comment: Concerning sec.601.20(d), a commenter asked if credit for continuing 
education would be given for teaching part or all of a course related to 
physics, medical physics or health physics at an accredited university or 
college. 
Response: The board disagrees with the commenter. Teaching a part or an entire 
course at an accredited university or college would be considered as part of 
their work. 
Comment: Concerning sec.601.20, a commenter wanted the board to recognize an 
educator's preparation for lectures, attending lectures, and attending seminars 
at their own institution as acceptable hours for continuing education.
Response: The board disagrees with the commenter. Preparation for lectures, 
attending lectures and seminars at their own institution was part of their work. 
Comment: There were several comments received concerning sec.601.20(c)(3), 
requesting that becoming board certified or recertified in the preceding 24 
months by American Board of Health Physics and American Board of Science in 
Nuclear Medicine be added to the list as meeting the continuing education 
requirements. 
Response: The board agrees and has added the American Board of Health Physics 
and American Board of Science in Nuclear Medicine to sec.601.20(c)(3).
Comment: Concerning 601.20(d)(1), comments were received requesting that 
references of attendance be added to include local chapter functions of the 
regional and national organizations listed. 
Response: The board agrees and has added language to include as acceptable 
continuing education attendance at courses, conferences, seminars or scientific 
sessions sponsored by the organizations listed in sec.601.20(d)(1). 
Comment: Concerning sec.601.20(e), comments were received concerning the 
submission of continuing education only when an audit would be requested after 
the renewal of a license. Another concern was what type of documentation that 
would be acceptable to meet the audit. 
Response: The board disagrees with the commenter. The licensee would submit a 
completed continuing education report form listing the title, date, and number 
of hours for each activity for which credit would be claimed. If the licensee 
was selected as a random sample to verify compliance with the continuing 
education requirement, appropriate documentation would need to be submitted 
along with the continuing education report form. The board has added what would 
be considered acceptable continuing education documentation in sec.601.20(e)(3).
Comment: Concerning sec.601.20(e), several comments were received recommending 
that documentation for continuing education be submitted at the time of renewal.
Response: The board disagrees. Submission of a continuing education report form 
listing continuing education taken must be submitted at the time of renewal, 
having two years to list 24 hours of continuing education. If documentation of 
continuing education hours is requested, it would be at times determined by the 
board to verify the licensed medical physicist's compliance with the continuing 
education requirements. 
Comment: Concerning sec.601.21, comments were received indicating that the 
section was so vague that it would be nonenforceable. 
Response: The board agrees. Introductory paragraphs were added to include a 
purpose statement, an exemption statement, and the role of service engineers in 
sec.601.21(a), (b), and (c). Each medical physics specialty was reevaluated. The 
board has added language to clarify the scope of practice for each specialty 
area. Language was added for the specialty area of diagnostic radiological 
physics in sec.601.21(c)(1); for the specialty area of therapeutic radiological 
physics in sec.601.21(c)(2); for the specialty area of medical nuclear physics 
in sec.601.21(c)(3); and for the specialty area of medical health physics in 
sec.601.21(c)(4). 
The commenters were from the GE Medical Systems; National Physics Consultants, 
Ltd.; Scott and White; Service & Compliance Consultants, Inc.; Texas Department 
of Health Bureau of Radiation Control; The University of Texas at Houston; and 
The University of Texas Medical Branch at Galveston. In addition, numerous 
individuals commented. The commenters were neither for nor against the rules in 
their entirety, however they expressed concerns, asked questions and suggested 
recommendations for change as discussed in the summary of comments. The 
amendment and new sections are adopted under the Texas Medical Physics Practice 
Act, Texas Civil Statutes, Article 4512n, sec.11, which provides the Texas Board 
of Licensure for Professional Medical Physicists to adopt rules, with the 
approval of the Texas Department of Health, that are reasonably necessary for 
the proper performance of its duties under the Act. 

sec.601.2.Definitions.
The following words and terms, when used in this chapter, shall have the 
following meaning, unless the context clearly indicates otherwise. 
Quality assurance-for the purpose of these rules, quality assurance shall be 
construed as quality control. 
Quality control-an aggregate of activities designed to ensure adequate quality. 

sec.601.20. Continuing Education Requirements.
(a) Purpose. The purpose of this section is to establish the continuing 
education requirements which a medical physicist holding an annual license must 
complete biannually to maintain licensure. These requirements are intended to 
maintain and improve the quality of professional services in medical physics 
provided to the public and keep the licensed medical physicist knowledgeable of 
current research, techniques, and practice, and provide other resources which 
will improve skill and competence in the practice of medical physics. 
(b) General. Continuing education requirements for license renewal shall be 
fulfilled during a 2 year period beginning on the first day following the 
licensee's birth month and ending with the second license renewal on the last 
day of each licensee's birth month. 
(1) The initial two year period shall begin on the first day of the licensee's 
renewal year (first day following licensee's birth month) which occurs on or 
after September 1, 1997. 
(2) Each licensee shall be notified of continuing education requirements with 
the first annual renewal notice sent after September 1, 1997. 
(c) Hour requirements for continuing education. A licensee must complete 24 
contact hours of continuing education acceptable to the board within a 24 month 
period. 
(1) A contact hour shall be defined as 50 minutes of attendance and 
participation. 
(2) A licensed medical physicist must complete acceptable continuing education 
as identified in subsection (d) of this section. 
(3) A licensed medical physicist shall be presumed to have complied with this 
section if in the preceding 24 months the licensee becomes board certified or 
recertified by the American Board of Radiology (ABR), American Board of Medical 
Physics (ABMP), American Board of Science in Nuclear Medicine (ABSNM), or 
American Board of Health Physics (ABHP).
(d) Types of acceptable continuing education. Continuing education shall be 
acceptable if the experience falls into one or more of the following categories: 
(1) Attendance at courses, conferences, seminars or scientific sessions 
sponsored by the following national or regional organizations: American 
Association of Physicists in Medicine (AAPM), American College of Medical 
Physics (ACMP), American College of Radiology (ACR), Health Physics Society 
(HPS), Society of Nuclear Medicine (SNM), Radiological Society of North America 
(RSNA), American Society for Therapeutic Radiology and Oncology (ASTRO), or 
other professional organizations acceptable to the board; 
(2) Participation in conferences sponsored by regulatory organizations such as 
the Texas Department of Health Bureau of Radiation Control (BRC) or other 
organizations acceptable to the board, or 
(3) Participation in courses, refresher courses, conferences, and seminars 
sponsored by state and private universities that have an accredited graduate 
medical physics program. 
(e) Reporting of continuing education. Each licensed medical physicist is 
responsible for and shall complete and file with the board at the time of annual 
license renewal, a continuing education report form approved by the board 
listing the title, date, location and number of hours for each activity for 
which credit is claimed. The licensee shall maintain documentation of continuing 
education. 
(1) At times determined by the board, the board will select a random sample of 
licensed medical physicists to verify compliance with the continuing education 
requirements. The licensed medical physicists selected in the random sample 
shall submit to the board documentation of participation in and completion of 
acceptable continuing education and shall include: 
(A) a certificate of completion or a certificate of attendance signed by the 
sponsoring organization; or 
(B) a letter on letterhead of the sponsoring organization verifying attendance; 
or 
(C) an official continuing education validation form of the sponsoring 
organization accompanied by a brochure, agenda, program, or other applicable 
information indicating content of the program; or 
(D) evidence of registration and attendance at a scientific meeting; and 
(E) any additional information or documentation deemed necessary by the board to 
verify the licensed medical physicist's compliance with the continuing education 
requirements. 
(2) The board shall review the documentation submitted to verify compliance with 
the continuing education requirements, and notify the licensed medical physicist 
of the results. 
(3) If the board determines that the licensed medical physicist failed to 
successfully complete the continuing education requirements or failed to submit 
the required documentation, disciplinary action may be taken against the 
licensee in accordance with sec.601.16(c) of this title (relating to Violations, 
Complaints, and Subsequent Action). 
(4) In the alternative, a licensed medical physicist may request an exemption as 
set out in subsection (f) of this section. 
(f) Exemptions. The board will consider granting an exemption from the 
continuing education requirement on a case-by-case basis if: 
(1) A licensee shows reasons of health, certified by a licensed physician, that 
prevent compliance with the continuing education requirement for the entire 
renewal period. The licensee must complete and forward to the board a sworn 
affidavit and provide documentation that clearly establishes the period of 
disability and resulting physical limitations; 
(2) A licensee is called to or is on active duty with the armed forces of the 
United States for the entire renewal period and so long as the licensee does not 
engage in the practice of medical physics in a setting outside of the active 
duty responsibilities during the time on active duty. The licensee must file a 
copy of orders to active military duty with the board; or 
(3) A licensee submits proof of attendance as a student in an approved academic 
program.

sec.601.21.Medical Physics Specialties and Scope of Practice.
(a) Purpose. Recognizing that assessing the degree of radiation safety is a 
complex task of balancing radiation risk with optimizing the benefit of the 
procedure to the patient, rules are provided which identify certain specific 
activities or tests as the practice of medical physics. The purpose of the 
Medical Physics Practice Act (Act) and these rules is to ensure the radiation 
safety of the citizens of Texas by restricting the practice of medical physics 
to qualified medical physicists. The Act and these rules are fully consistent 
with, and implement, the recommendations of the National Council of Radiation 
Protection and Measurement (NCRP) as they pertain to the conduct of certain 
activities related to medical radiation safety and the efficacy of the use of 
radiation in medicine as well as the recommendations of the NCRP for the 
qualifications of individuals who conduct or supervise those activities. They 
are also consistent with published standards of practice of relevant 
professional and scientific organizations. 
(b) Exemption. These rules shall not prohibit any licensed physician from 
performing any procedure or activity judged by the Texas Board of Medical 
Examiners to be the practice of medicine. Similarly, these rules shall not be 
construed to prohibit any licensed health care provider from conducting 
procedures or activities on patients under their care determined to be the 
practice of that particular profession by the profession's respective licensing 
board. This section does not apply to a person providing the services who is 
exempt from the Act. These rules shall not be construed as qualifying a licensed 
medical physicist to install or perform corrective maintenance on medical 
equipment. 
(c) Role of the service engineers. Service engineers, when installing or 
maintaining medical equipment, conduct tests or activities which are similar or 
identical to tests or activities identified in these rules. Such activity does 
not constitute the practice of medical physics provided that: 
(1) the service engineer or his employer does not represent that the outcome of 
the test or activity or the intent of performing the test or activity ensures 
the radiation safety of the use of the medical equipment for either the user, 
the patient, or a member of the public; or 
(2) the service engineer or his employer does not conclude that the medical 
equipment is radiologically safe, effective or suitable for use on humans based 
on the tests or activities performed by the service engineer; or 
(3) the service engineer or his employer does not certify that the medical 
equipment is radiologically safe and consequently compliant with any state or 
federal regulation for the control of radiation; and 
(4) the test or activity performed by the service engineer is required to 
install or repair the medical equipment. 
(d) Scope of practice. 
(1) The diagnostic radiological physics specialty services include the 
following: 
(A) providing evidence that imaging equipment continues to meet applicable rules 
and regulations of radiation safety and performance standards required by 
accrediting and regulatory agencies; 
(B) acceptance testing or monitoring diagnostic imaging equipment;
(C) evaluating policies and procedures pertaining to radiation and its safe and 
appropriate application in imaging procedures; 
(D) providing consultation in development and management of the quality control 
program; 
(E) measurement and characterization of radiation from diagnostic equipment; 
(F) specification of instrumentation to be used in the practice of diagnostic 
radiological physics; 
(G) providing consultation on patient or personnel radiation dose (effective 
dose equivalent, fetal dose calculations, specific organ dose determination, 
etc.) and the associated risk; and 
(H) protective shielding design and evaluation of a diagnostic imaging facility. 
(I) conducting performance evaluations of medical radiologic and fluoroscopic 
imaging systems which include the following physical tests and assessments: 
(i) kilovolts peak (kVp) and timer accuracy; 
(ii) exposure reproducibility and linearity; 
(iii) exposure geometry, e.g. source to image distance (SID) and collimation; 
(iv) entrance skin exposure and exposure rate; 
(v) beam quality; and 
(vi) image quality. 
(2) The therapeutic radiological physics specialty services include the 
following: 
(A) development of specifications for radiotherapy treatment and simulation 
equipment; 
(B) development of procedures for testing and evaluating performance levels of 
radiotherapy treatment and simulation equipment; 
(C) acceptance testing of radiotherapy treatment and simulation equipment; 
(D) calibration and characterization of radiation beams from therapeutic 
equipment including radiation quantity, quality, and distribution 
characteristics, and assessment of the mechanical and geometric optics for 
proper placement of the beam; 
(E) providing documentation that radiotherapy treatment and simulation equipment 
meet accreditation and regulatory compliance requirements;
(F) calibration and/or verification of the physical and radiological 
characteristics of brachytherapy sources; 
(G) specification of the physics instrumentation used in the measurement and 
performance testing of therapeutic equipment; 
(H) acceptance testing, management, and supervision of computer systems used for 
treatment planning and calculation of treatment times or monitor units. This 
includes measurement and input of dosimetry data base and verification of output 
for external beam radiotherapy and brachytherapy;
(I) implementation and management of dosimetric and beam delivery aspects of 
external beam source brachytherapy irradiation. External beam delivery aspects 
include treatment aids, beam modifiers, and geometrical arrangements. Special 
procedures are included for both external beam (e.g. radiosurgery, total body 
irradiation, total skin irradiation, intraoperative therapy) and brachytherapy 
(e.g. high dose rate, pulsed dose rate); 
(J) provision of consultation to the physician in assuring accurate delivery of 
prescribed radiation dosage to a specific human patient, and the associated 
risk; 
(K) development and management of quality control program for a radiation 
treatment facility which includes applicable facility accreditation 
requirements, and the review of policies and procedures pertaining to 
therapeutic radiation and its safe and appropriate use; 
(L) development and/or evaluation of a radiation safety program in a therapeutic 
radiation facility including written procedures for the protection of patients, 
workers, and the public; and 
(M) protective shielding design and radiation safety surveys in a radiotherapy 
facility. 
(3) The medical nuclear physics specialty services include the following: 
(A) development of procedures for continuing evaluations of performance levels 
of radionuclide imaging devices and ancillary equipment;
(B) providing evidence that radionuclide imaging equipment continues to meet 
applicable rules and regulations of performance and radiation safety required by 
accrediting and regulatory agencies; 
(C) acceptance testing of radionuclide imaging equipment; 
(D) development and/or evaluation of a radiation safety program in a nuclear 
medicine facility; 
(E) determination of radiation shielding necessary to protect workers, patients, 
and the public in a nuclear medicine facility; 
(F) development of specifications for radionuclide imaging instrumentation or 
equipment; 
(G) development and monitoring of a quality control program for radionuclide 
imaging equipment, computers and other patient related radiation detectors such 
as uptake probes, well counters and dose calibrators; 
(H) providing consultation on patient or personnel radiation dose (effective 
dose equivalent, fetal dose calculations, specific organ dose determination, 
etc.) and the associated risk; 
(I) evaluating policies and procedures pertaining to the safe and appropriate 
application of radionuclides; 
(J) specification of instrumentation used in the practice of medical nuclear 
physics; and 
(K) verification of calculated radiation absorbed doses from unsealed 
radioactive sources. 
(4) The medical health physics specialty services include, but are not limited 
to, the following: 
(A) planning and design of radiation shielding needed to protect workers, 
patients, and the general public from radiation produced incident to the 
diagnosis or treatment of humans. This includes calculation of required 
shielding thickness, selection of shielding material and specification of 
source-shield geometry; 
(B) assessment and evaluation of installed shielding, installed shielding 
apparatus or portable shielding designed to protect workers, patients, and the 
general public from radiation produced incident to the diagnosis or treatment of 
humans. Such evaluation specifically includes determination of whether the 
shielding is adequate to ensure compliance with state or federal regulatory 
requirements for limiting the effective dose equivalent and organ dose 
equivalent of medical radiation workers and members of the public. This includes 
the selection of appropriate radiation measurement instrumentation to conduct 
such evaluation as well as the methodology to be employed; 
(C) providing consultation, by which determination of the presence and extent of 
any radiological hazard, in any controlled, restricted, uncontrolled or 
unrestricted area, resulting from the use of ionizing radiation or radioactivity 
in the treatment or diagnosis of disease in humans, is made. This includes the 
design, conduct, and evaluation of results of radiation surveys of health care 
facilities and the immediate environs intended to determine whether occupancy by 
medical radiation workers, patients, and members of the public is compliant with 
state and federal regulations for the control of ionizing radiations. A survey 
includes the directing of physical measurements of radiation levels and 
radioactivity, the interpretation of those measurements, and the provision of 
any conclusions or recommendations intended to limit or prevent exposure of 
workers, members of the public, and patients. 
(D) performing dose and associated risk assessment in which an effective dose 
equivalent, committed effective dose equivalent, organ dose equivalent, or 
committed organ dose equivalent is determined by measurement or calculation or 
both, to any worker, member of the public, fetus or patient who received 
exposure to ionizing radiation or radioactivity from radiation sources used to 
treat or diagnose disease in humans. This does not include either the 
prospective or retrospective determination of absorbed doses to patients 
undergoing radiation therapy; and 
(E) consultation which consists of the evaluation or assessment of the radiation 
safety aspects of policies or procedures which pertain to the safe and 
appropriate use of radiation or radioactivity, administrated to human research 
volunteers or used to treat or diagnose conditions in humans, when such 
evaluation or assessment provides conclusions or recommendation regarding does 
equivalent assessment, the overall radiation safety afforded to individuals 
resulting from activities conducted in compliance with the evaluated policies or 
procedures, or the compliance of any or all provisions of the policies or 
procedures with either state or federal regulatory requirements for the control 
of radiation. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on June 3, 1997.
TRD-9707161
Susan K. Steeg
General Counsel
Texas Board of Licensure for Professional Medical Physicists
Effective date: July 23, 1997
Proposal publication date: December 6, 1996
For further information, please call: (512) 458-7236

TITLE 25. HEALTH SERVICES
PART I. Texas Department of Health
CHAPTER 33.Early and Periodic Screening, Diagnosis and Treatment 
SUBCHAPTER J.Texas Health Steps Medical Case Management
25 TAC sec.sec.33.501-33.507
On behalf of the State Medicaid Director, the Texas Department of Health 
(department) submits proposed new sec.sec.33.501-33.507 concerning Title XIX 
Texas Health Steps (THSteps) medical case management services. These sections 
cover definitions; eligible recipients; THSteps medical case management 
services; service limitations; applicant and provider qualifications; 
application, review, and monitoring processes; and reimbursement methodology. 
Medical case management assists eligible Medicaid recipients in gaining access 
to medically necessary and appropriate medical, social, educational, and other 
services. Medical case management services are mandated by the federal Early and 
Periodic Screening, Diagnosis and Treatment (EPSDT) program, and the new 
sections will bring the State of Texas into compliance with federal law. These 
sections are also proposed pursuant to the terms of the Consent Decree in Frew 
et al vs. McKinney et al. 
Ray Krzesniak, Budget Director, Health Care Delivery Associateship, has 
determined that for the first five-year period the new sections are in effect, 
there will be fiscal implications for the state as a result of enforcing the new 
sections as proposed. When fully implemented, these services are projected to 
increase total federal and State Medicaid expenditures by $19.1 million 
annually. However, since this is a new service, there will be less funds 
expended during the upcoming biennium. The impact on state government is 
estimated to be $3.5 million in SFY 1998, $5.8 million in SFY 1999, and $7.3 
million for SFY 2000 through 2002. When THSteps medical case management is 
implemented, any additional increase in Early and Periodic Screening, Diagnosis, 
and Treatment--Comprehensive Care Program (EPSDT-CCP) expenditures for health 
and health related services incurred by state government is expected to be 
offset by a decrease in more costly EPSDT-CCP expenditures, such as emergency 
room visits and inpatient services. There will be no fiscal implications for 
local government as a result of enforcing or administering the new sections.
Mr. Krzesniak also has determined that for each year of the first five years the 
new sections are in effect, the public benefit anticipated as a result of 
enforcing the new sections will be increased access by EPSDT-CCP eligible 
recipients to medically necessary health care and case management services. 
There will be no effect on small or large businesses. There are no anticipated 
economic costs to persons who are required to comply with the new sections as 
proposed. There will be no impact on local employment. Comments on the proposal 
may be sent to Margaret Drummond-Borg, M.D., Health Care Delivery, Texas 
Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-
7111, ext. 3101. Comments will be accepted for 60 days following publication of 
this proposal in the Texas Register. In addition, public hearings will be held 
on the proposal on June 17, 1997, at 9:30 a.m., Room 1420, Brown-Heatly 
Building, 4900 North Lamar Boulevard, Austin, Texas, 78751, and on June 24, 
1997, at 1:00 p.m., Room K-100, Texas Department of Health, 1100 West 49th 
Street, Austin, Texas, 78756. A copy of this proposal also will be sent to each 
Texas Department of Human Services field office for public review and comment. 
The new sections are proposed under the Human Resources Code sec.32.021, and 
Government Code, sec.531.021, which provide the Health and Human Services 
Commission with the authority to propose rules to administer the state's medical 
assistance program and are submitted by the Texas Department of Health under its 
agreement with the Health and Human Services Commission to operate the EPSDT 
program, and as authorized under Chapter 15, sec.1.07, Acts of the 72nd 
Legislature, First Called Session (1991). 
The new sections affect Chapter 33 of the Human Resources Code.

sec.33.501.Definitions. 
The following words and terms when used in this subchapter shall have the 
following meanings unless the context clearly indicates otherwise.
Access-The ability of a Texas Health Steps (THSteps)-eligible recipient to 
obtain health and health-related services, as determined by factors such as the 
availability of THSteps services, their acceptability to the child and family, 
the location of health care facilities and other resources, transportation, 
hours of operation, and length of time to see the provider. 
Applicant-An agency, organization, or individual who applies to the Texas 
Department of Health (department) to provide medically necessary THSteps medical 
case management services under this subchapter and who meets the requirement for 
providers as stated in sec.33.505 of this title (relating to Applicant and 
Provider Qualifications).
Application process-Completion of an application issued by the department to 
potential applicants for approval to deliver medically necessary THSteps medical 
case management services and the ensuing the department's review and disposition 
of the application.
Billable contact-A documented face-to-face, home visit or phone contact with an 
eligible recipient by a qualified case manager who provides an eligible case 
management service.
Case manager-A qualified provider of approved Medicaid case management services.
Children with Special Health Care Needs (CSHCN)-Children who:
(A) range in age from birth up to 21 years; 
(B) have a health condition(s) that has a biologic, psychological, and/or 
cognitive basis that has lasted or is anticipated to last for at least a year; 
(C) have a health condition(s) that results in limitation of function, 
activities, or social roles in comparison with healthy age peers in the general 
areas of physical, cognitive, emotional, or social growth and development; and 
(D) need health and health-related services over and above the usual for the 
child's age. 
Continuity of care-The degree to which the care of a child is provided by the 
same medical home or primary care provider, the system of care remains stable, 
and services are consistent and unduplicated.
Department-The Texas Department of Health. EPSDT - Early and Periodic Screening, 
Diagnosis and Treatment. See definition for Texas Health Steps (THSteps).
Health condition/health risk-Children who:
(A) range in age from birth up to 21 years; 
(B) have or are at risk for a medical condition, illness, injury, or disability 
that results in limitation of function, activities or social roles in comparison 
with healthy age peers in the general areas of physical, cognitive, emotional, 
or social growth and development; and
(C) have a need for health and health-related services over and above the usual 
for the child's age. 
Health and health-related services-Services which are provided to meet the 
comprehensive (preventive, primary, and specialty) health needs of the THSteps-
eligible recipient, including but not limited to well child and dental check 
ups, immunizations, acute care visits, pediatric specialty consultations, 
physical therapy, occupational therapy, audiology, speech language therapy, 
psychological counseling, pharmaceuticals, medical supplies, durable medical 
equipment, nutritional supplements, prosthetics, eye glasses, and hearing aids.
Medical home- A physician, primary care provider, or clinic that is known to the 
THSteps-eligible recipient and family as the source for the child's preventive 
and primary care services; continuity of care; access to acute health needs 24 
hours a day; and referral to specialty care, other health and health-related 
services, and medical case management.
Medically complexChildren who:
(A) range in age from birth up to 21 years; 
(B) have a serious, ongoing illness or condition(s) that has lasted or is 
anticipated to last at least a year; 
(C) require daily, ongoing medical treatments and monitoring by appropriately 
trained personnel which may include parents or other family members; and 
(D) require access to a complex array of health and health-related services. 
Medically fragile-Children who: 
(A) range in age from birth up to 21 years; 
(B) have a serious, ongoing illness or condition(s) that has lasted or is 
anticipated to last at least a year or has required at least one month of 
hospitalization in the year; 
(C) require daily, ongoing medical treatments and monitoring by appropriately 
trained personnel which may include parents or other family members; 
(D) require the routine use of a medical technical device to compensate for the 
loss of a body function needed to participate in activities of daily living; and 
(E) lives with the ongoing threat to continued life. Medically necessary-
Services which are: 
(A) reasonably necessary to prevent illness(es) or medical condition(s), or to 
provide early screenings, interventions, care, and/or provide care or treatment 
for eligible recipients who have medical condition(s) that cause suffering or 
pain, cause physical deformity or limitations in function, threaten to cause or 
worsen a handicap, cause illness or infirmity, or endanger life; 
(B) provided at appropriate locations and at the appropriate levels of care for 
the treatment of the medical condition(s); 
(C) consistent with health care practice guidelines and standards endorsed by 
professionally recognized health care organizations or governmental agencies; 
(D) consistent with the diagnosis(es) of the condition(s); and 
(E) no more intrusive or restrictive than necessary to provide a proper balance 
of safety, effectiveness, and efficiency.
Primary care provider (PCP)-A health care professional licensed in Texas who 
agrees with the child and family to provide the medical home. PCPS may include 
pediatricians, obstetricians, internists, family practice physicians, general 
practice physicians, certified nurse midwives, advanced nurse practitioners and 
physician's assistants practicing within the scope of their respective Texas 
licensure boards. A specialty physician may be a PCP if he/she agrees to provide 
all the benefits of a medical home. 
State -The State of Texas.
THSteps-A federal program known as EPSDT which is required of states by Medicaid 
for children under 21 years who meet certain economic criteria for eligibility. 
In Texas, EPSDT is called the Texas Health Steps Program.
THSteps administrative case management-The enhancement service which assists 
eligible recipients to gain access to medically necessary health and health-
related services including informing and outreach functions. 
(A) Informing is the effort to educate the eligible recipient and their families 
concerning the periodic health checkups needed by children at certain ages. 
(B) Outreach is the effort to contact eligible recipient and their families 
about missed check ups, and to assist them in overcoming barriers to access 
(such as language, transportation, and/or unfamiliarity with qualified service 
providers). 
THSteps medical case management-The federally allowable enhancement service 
which assists eligible recipients in gaining access to medically necessary and 
appropriate medical, social, educational, and other services.

sec.33.502.Eligible Recipients.
Children eligible for THSteps medical case management services under this 
subchapter must be:
(1) from one year up to 21 years of age; 
(2) Medicaid eligible in Texas; 
(3) determined to have a health condition/health risk, to have special health 
care needs, to be medically complex, or to be medically fragile; and 
(4) referred by their PCPs, other health provider(s), appropriate local or state 
agency(ies), dentist(s), or by themselves or their families. 

sec.33.503.THSteps Medical Case Management Services. 
THSteps medical case management services are provided to assist eligible 
recipients, as defined in sec.33.501 of this title (relating to Definitions), in 
gaining access to medically necessary medical, social, educational and other 
services to reduce morbidity and mortality among children, to encourage the use 
of cost-effective health and health-related care, to make referrals to 
appropriate providers, and to discourage over utilization or duplication of 
services. THSteps medical case management, however, is not a "gatekeeper" 
function. The department shall include the following elements in developing 
policies and procedures to implement THSteps medical case management.
(1) Screening/intake. The screening/intake process includes recording 
demographic information about the eligible recipient, as well as documenting the 
child's health problem(s) and whether the child needs a medical home. 
(2) Family assessment. A family assessment shall include an in-depth evaluation 
of all issues that impact the short and long term health and well being of the 
eligible recipient and his/her family. 
(3) Identification of service needs. Providers of medical case management 
services shall assess the medically necessary medical, social, educational and 
other service needs of the eligible recipient. 
(4) Written Service Plan (WSP) development. The WSP is based upon a 
determination of the medically necessary services to meet the identified service 
needs, and a description of the course(s) of action to meet those needs. The WSP 
is the written summary which documents the services to be accessed, those who 
are responsible for contacting the appropriate service providers, and the time 
frame within which the eligible recipient should access services. In accordance 
with the limits of confidentiality, the WSP shall be sent to the medical home, 
as soon as one has been established, and to the appropriate referring and 
service providers. 
(5) Service provision and coordination. Service provision and coordination is 
the implementation of the service plan, and the linkage between the eligible 
recipient, the family and the providers, including the appropriate use of 
available resources to meet the needs of the eligible recipient. 
(6) Follow up. Providers of medical case management services shall ascertain, on 
an ongoing basis, what services specified in the WSP have been received by the 
eligible recipient, reassess the eligible recipient's needs, develop appropriate 
modifications of the WSP based upon medical evaluations and reassessments by 
other providers, and evaluate the satisfaction of the eligible recipient, family 
and medical home provider with the services provided.

sec.33.504.Service Limitations.
(a) THSteps medical case management services are not reimbursable if they are 
duplicative of other Medicaid case management services. Case management 
activities associated with the following are not reimbursable as THSteps medical 
case management: 
(1) case management services provided to children participating in THSteps as 
part of an existing service by a provider such as a primary care or specialty 
physician, another professional or health-related provider, or a person 
referring the child to medical case management services; 
(2) administrative case management services provided to THSteps eligible 
recipients by a state health and human service agency, the department, or the 
department's designee for activities necessary for the proper and efficient 
administration of the Medicaid program; and 
(3) targeted case management services and/or case management services provided 
through a 1915(c) Waiver Program; i.e., case management services already 
existing as approved Medicaid services in Texas. 
(b) THSteps Medical Case Management Services are reimbursable each year for one 
comprehensive service and up to five coordination/follow up services without 
prior authorization. 
(c) Prior authorization for additional THSteps medical case management services 
must be requested by the eligible recipient's PCP or a physician who has agreed 
to provide THSteps medical check ups and signature authority for prescriptions 
of pharmaceuticals, durable medical equipment, and therapies until a PCP is 
secured. Requests must be properly documented and submitted to the department 
for review. 

sec.33.505.Applicant and Provider Qualifications. 
(a) In order to become a provider of medically necessary THSteps medical case 
management services, an applicant must be a health service provider of primary, 
preventive and/or tertiary health services or have written letters of agreement 
documenting referral relationships with providers of preventive, primary, and 
tertiary health and health-related services. 
(b) An applicant that has met the requirements of subsection (a) of this section 
must: 
(1) agree to comply with the department rules on medically necessary THSteps 
medical case management and the statutory provisions applicable to the provision 
of medically necessary THSteps medical case management;
(2) develop and maintain a THSteps medical case management program which assists 
eligible recipients to access medically necessary medical, social, educational, 
and other services and which incorporates the following elements: 
(A) assurance that THSteps medical case management services will be provided in 
locations convenient for the eligible recipient; 
(B) a comprehensive resource directory, updated at least annually, which 
contains the names, addresses, and telephone numbers of providers of health and 
health-related services including, but not limited to: physicians; other primary 
care providers; Early Childhood Intervention (ECI); Chronically Ill and Disabled 
Children's (CIDC) Program; Special Supplemental Nutrition Program for Women, 
Infants and Children (WIC); rehabilitation services; Medicaid Medical 
Transportation Program; the Texas Information and Referral Network; and locally 
active community services; 
(C) written letters of agreement with other Medicaid case management 
providers/applicants for determining when other approved Medicaid case managers 
are providing case management for eligible recipients and can extend that role 
beyond a single case management program or service, as required by subsection 
(b)(5) of this section; 
(D) a written procedure for triage and transfer of eligible recipients to other 
Medicaid case management providers within the same service area; 
(E) an internal evaluation process that includes, but is not limited to, 
assessments of satisfaction of eligible recipients, PCPs and case managers; 
(F) contacts with community social and education resources; and 
(G) assistance for recipients in accessing THSteps administrative case 
management service providers for needs including: 
(i) completing applications; 
(ii) scheduling timely appointments; 
(iii) arranging for transportation to health and health-related services; or 
(iv) other activities required to effectively carry out the medically necessary 
THSteps medical case management written service plan.
(3) assure that THSteps medical case management services will be: 
(A) initiated through an integrated communication with the eligible recipient's 
PCP and/or referral source as described in sec.33.502 of this title (relating to 
Eligible Recipients); 
(B) committed to securing a PCP, in a timely manner, if one does not exist, who 
will provide a medical home for each eligible recipient accessing THSteps 
medical case management services; 
(C) planned, developed, and evaluated with the input of case manager(s) who meet 
the qualifications defined in this section; and 
(D) provided by qualified case managers as defined in this section. 
(4) assure that qualified case managers: 
(A) have the opportunity to participate in appropriate Medicaid case management 
and THSteps workshops, seminars, and training; 
(B) assume responsibility for all THSteps medical case management services 
provided to eligible recipients including services by their designated support 
staff; 
(C) participate in relevant time/motion or cost studies; 
(D) agree to permit the department or its designee to have access to the THSteps 
medical case management provider's records, and permit direct observation of 
case management activities for the purpose of determining the provider's 
suitability to continue participation as a THSteps medical case management 
provider; and 
(E) participate in local and/or regional case management systems to assure 
cooperation and coordination with local health departments, the department's 
public health region, school districts and other Medicaid-approved case 
management providers as evidenced by: 
(i) participation in community coalition meetings; 
(ii) collaboration in planning case management and service delivery systems; and 
(iii) involvement in resolving case management problems. 
(5) maintain on file interagency letters of agreement which: 
(A) define the scope of case management services of each entity;
(B) describe the population to be served; and 
(C) demonstrate a reciprocal and cooperative relationship with other Medicaid-
approved case management providers. 
(6) share information, within the limits of confidentiality, with the department 
and collaborating agencies to facilitate referral and monitoring of eligible 
recipients; 
(7) comply in a timely manner with all department application, data collection, 
and reporting requirements; 
(8) meet applicable state and federal laws governing participation of providers 
in the Medicaid program; 
(9) sign a Medicaid provider agreement and maintain provider status with the 
department which administers the federal Medical Assistance Program; 
(10) submit reports regarding health and case management services as requested 
by the department; and 
(11) maintain documentation that the THSteps medical case management providers 
meet the following requirements: 
(A) have a minimum of one year of pediatric education and/or work experience in 
accordance with department policy; and 
(B) have received education and training regarding THSteps medical case 
management activities; and 
(C) be registered nurses (R.N. with B.S. or M.S. degree) or licensed social 
workers (with B.S.W. or M.S.W.) with a minimum of one year's medical experience 
in accordance with department policy, and have maintained their professional 
licenses as determined by their respective Texas licensure boards; and 
(D) provide professional services in compliance with federal, state, and local 
laws. 

sec.33.506.Application, Review and Monitoring Processes. 
(a) Applications to become a THSteps medical case management provider may be 
obtained by contacting the department, Bureau of Children's Health, Health Care 
Delivery Associateship, 1100 West 49th Street, Austin, Texas, 78756-3199, (512) 
458-7700. 
(b) Applications must be typed and must be accompanied by all required 
supporting documentation set out in this subchapter. An original and one copy of 
the application must be submitted to the Bureau of Children's Health at the 
address described in subsection (a) of this section. 
(c) Incomplete applications shall not be considered and shall be returned to the 
applicant. 
(d) All complete applications shall be reviewed by the department staff. The 
review process shall be completed within 60 days following receipt of a 
completed application. 
(e) Applicants meeting all provider requirements shall be approved by the 
department. Approved applicants will be notified in writing by the department, 
and the department shall initiate the enrollment process. 
(f) Applicants who are not approved will be given written notification of the 
reasons for the department's decision. 
(g) Approved applicants and providers will be monitored on an annual or as 
needed basis. Applicants and/or providers who do not comply with program 
requirements may be terminated, placed on probationary status, referred to 
appropriate professional licensure entities for review, and/or referred for 
fraud and abuse investigation as described in department policies and 
procedures. 

sec.33.507. Case Management Reimbursement Methodology. 
(a) The department will reimburse qualified providers for billable contacts with 
eligible recipients. 
(b) Providers will be reimbursed based on rates set for other Medicaid case 
management services administered by the department. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt. 
Issued in Austin, Texas, on June 4, 1997.
TRD-9707219
Susan K. Steeg
General Counsel
Texas Department Health 
Earliest possible date of adoption: July 4, 1997
For further information, please call: (512) 458-7236

CHAPTER 123.Respiratory Care Practitioners Certification 
25 TAC sec.sec.123.1-123.10, 123.12, 123.14
The Texas Department of Health (department) adopts amendments to sec.sec.123.1-
123.10, sec.123.12 and sec.123.14, concerning the certification of respiratory 
care practitioners. Sections 123.2, 123.4, 123.9, 123.10, and 123.12 are adopted 
with changes to the proposed text as published in the December 17, 1996, issue 
of the Texas Register (21 TexReg 12043). Sections 123.1, 123.3, 123.5-123.8, and 
123.14 are adopted without changes, and therefore the sections will not be 
republished. The amendments will update and clarify existing language; combine 
application and certificate fees in order to simplify administrative procedures; 
increase renewal fees to cover the cost for implementation of the respiratory 
care practitioners certification program; and double the number of continuing 
education hours necessary to renew a certificate to ensure continued competency. 
Specifically, the amendments add a definition for an educational accrediting 
body; clarify the terms used in the definition of respiratory care procedures; 
increase the certificate renewal fee; combine the application and initial 
certification/temporary permit fees; increase the fee for a duplicate 
certificate/identification cards/temporary permit; changes the number of 
continuing education hours needed for certificate renewal; add billing 
information to be provided by the practitioner; and add language for determining 
disciplinary action. 
Changes made to the proposed text result from comments received during the 
comment period. The details for the changes are described in the summary of 
comments that follow. Other minor editorial changes were made for clarification 
purposes. 
Comment: Concerning sec.123.2, several comments were received concerning the 
typographical error in the definition of respiratory care procedure subparagraph 
(A) of sec.123.2, Definitions. 
Response: The committee agrees and has changed "nitrous" to "nitric." 
Comment: Concerning the definition of "Respiratory care procedure" in sec.123.2, 
one commenter recommended wording changes adding language to clarify the 
definition. 
Response: The committee agrees and added the suggested wording to enhance the 
definition to include (G), (H), and (I). 
Comment: Concerning sec.123.4, one commenter was opposed to raising or 
increasing the fee to renew a certificate. 
Response: The committee disagrees. The renewal fee is being increased to offset 
the cost of administering the respiratory care practitioners certification 
program. 
Comment: Concerning sec.123.4, one commenter feels that the fee increase would 
do absolutely nothing to promote or improve respiratory care being delivered to 
the citizens of this state and would only serve to financially burden the 
respiratory care practitioner in order to increase licensing fee revenues for 
the state. 
Response: The committee disagrees. The fees are being increased to offset the 
cost of administering the respiratory care practitioners certification program. 
Comment: Concerning sec.123.4, several commenters opposed the increase in fees 
indicating that the increase would only serve to financially burden the 
respiratory care practitioner in order to increase licensing fee revenues for 
the state. 
Response: The committee disagrees. The fees are being increased only to offset 
the cost of administration of the respiratory care practitioners certification 
program. 
Comment: Concerning sec.123.4, a commenter was in support of the fee increase if 
the increase is used to the benefit of certified respiratory care practitioners. 
Response: The committee agrees. The fees are being increased only to offset the 
cost of administration of the respiratory care practitioners certification 
program. 
Comment: Concerning sec.123.9(d)(2), two comments were received questioning why 
the department needed information concerning their status with the National 
Board for Respiratory Care, Inc. (NBRC). 
Response: The committee is requesting the information only for statistical 
purposes. It is beneficial for the committee to know the level of credentials 
held by an individual, either registered respiratory therapists or certified 
respiratory therapy technicians. 
Comment: Concerning sec.123.10, a commenter disagreed to increasing the 
continuing education hours by 100%. 
Response: The committee disagrees. The increase in continuing education hours 
from six hours to 12 hours a year would be comparable to other health care 
professionals. 
Comment: Concerning sec.123.10, a commenter felt that to increase continuing 
education would further financially burden the respiratory care practitioner 
while doing nothing to promote respiratory care or improve the delivery of that 
care to the citizens of Texas. 
Response: The committee disagrees. The increase in continuing education hours 
from six hours to 12 hours a year would be comparable to other health care 
professionals. 
Comment: Concerning sec.123.10, one commenter asked "why respiratory care 
practitioners are only allowed to obtain continuing education presented by live' 
presentations and not allowed to obtain continuing education using other 
avenues?" 
Response: Some committee members agreed while others disagreed. It was decided 
that the continuing education section of the rules would need to be reopened at 
a later date to address the use of other avenues to obtain continuing education 
hours. 
Comment: Concerning sec.123.10, several comments were received in opposition of 
raising the continuing education hours from six to 12. 
Response: The committee disagrees and fully supports the increase in continuing 
education hours. 
Comment: Concerning sec.123.10, one commenter recommended increasing the hours 
gradually by increasing the hours to nine for new with a goal of being at 12 
hours within the next four to five years. Another commenter recommended 
increasing the hours the first year to nine hours and the second year to 12 
hours. 
Response: The committee disagrees. If there is an increase in the total number 
of continuing education hours it would be less confusing if the increase is at 
one time. 
Comment: Concerning sec.123.10, a commenter is opposed to the increase in the 
continuing education requirement because it will financially burden the 
respiratory care practitioner. 
Response: The committee disagrees. The increase in continuing education hours 
from six hours to 12 hours a year would be comparable to other health care 
professionals. 
Comment: Concerning sec.123.10, a commenter is opposed to the change in the 
continuing education requirement because with hospitals downsizing staff it will 
make it more difficult to get the time off to obtain more continuing education 
hours. Another concern addressed was the infrequency of available seminars, 
conferences, and meetings in certain areas of Texas to obtain continuing 
education hours. 
Response: The committee agrees and will reopen the section of continuing 
education to address the possibility of alternate means of obtaining continuing 
education hours. The following are comments received that did not address a 
specific rule change. 
Comment: Concerning the 60-day comment period, a commenter indicated that upon 
receipt of the proposed rules there was only two and half weeks remained to 
comment on the rules. It was also noted that all parties were not forwarded the 
proposed rules. 
Response: The proposed rules were sent to all certified and permitted 
respiratory care practitioners. The program requested a 60-day comment period to 
allow time to reproduce and mail the proposed rules. The program mailed the 
proposed rules to all certified and permitted respiratory care practitioners 
using the current mailing address on file for each practitioner. The program 
regrets that the mailing took longer to reach some certified or permitted 
respiratory care practitioners. 
Comment: One commenter expressed opposition to proposed changes because in their 
opinion the respiratory care practitioners' regulations have done very little to 
insure quality respiratory care for the citizens of Texas, and even less to 
promote the respiratory care profession. Their other concern addressed the fact 
that other allied health professionals are not prohibited from practicing 
respiratory care. 
Response: Other allied health professional may be practicing respiratory care as 
an exception to certification in Texas Civil Statutes, Article 4512l (Act) and 
cannot be addressed by the respiratory care advisory committee.
Comment: One commenter responded that if quality respiratory care delivery to 
the citizens of Texas was to be assured, then changes need to be made to the 
respiratory care practitioner Act to prohibit anyone without a respiratory care 
practitioner certificate from providing respiratory care. The commenter further 
indicated that "the respiratory care practitioner certificate is a little more 
than a joke, which the individual doesn't find the least bit funny." 
Response: The committee does not have the authority to change the language in 
the Act. 
Comment: One commenter indicated that the determination in the preamble having 
"no effect on small businesses" regarding respiratory care practitioners 
obtaining the additional six hours of continuing education was wrong. There are 
small rural hospitals whose therapists would be gone from their jobs for two or 
more days to attend a seminar and that would greatly affect small businesses. 
The question asked was "Who would pay for the missed hours of work?" The 
commenter believes that this effects small businesses. The commenter believes 
that each individual should give every effort to make the profession better, but 
mandates such as increasing the continuing education hours is not the only 
answer. 
Response: The committee disagrees. The respiratory care practitioners 
certification program has required only six hours of continuing education since 
the beginning of certification, September 1, 1985. The committee feels that 
submitting 12 hours of continuing education hours to renew a certification 
annually would bring the state of Texas continuing education requirements 
comparable to other respiratory care professionals. 
Comment: One commenter has been in support of the respiratory care practitioners 
certification since it was first proposed but feels that health care 
institutions are pushing the law to the limit by utilizing the provision in the 
law which allows the delegated authority of a physician and that this needs to 
be investigated statewide. 
Response: The committee has no authority since delegation by a licensed 
physician is listed as an exception to certification in Texas Civil Statutes, 
Articles 4512l, Section 9(5). 
Comment: One commenter stated that "ER TECH'S" can administer aerosolized 
bronchodilators, draw blood samples, and initiate oxygen therapy while noting it 
is not a violation of the Act, if performing these procedures under the 
delegation of a licensed physician. 
Response: The committee does not have the authority to change the Act. Comment: 
One commenter recommended that an investigative team needed to do random field 
surveys to verify if individuals providing respiratory care are either 
appropriately certified, if their letter of delegated authority is properly 
written, and if proper, that documented training has been provided.
Response: There are no rules proposed on this issue. Individuals who do not hold 
a respiratory care practitioner certificate can perform respiratory care 
procedures if they have been formally trained in the care used and who are 
acting under the delegated authority of a licensed physician. 
Comment: Several comments were received indicating that there would be an 
"effect on small businesses" because small respiratory businesses now find it 
hard to find extra coverage for therapists who must travel to obtain six 
continuing education hours, and the proposal states an increase to 12 hours. 
Another commenter recommended that an alternative for "live" presentations be 
established. 
Response: The committee agrees and will reopen the section of continuing 
education to address the possibility of alternate means of obtaining continuing 
education hours. 
The commenters were the AccuLab Diagnostics, L.P.; Amarillo College; Baylor 
College of Medicine; Baylor Health Care System; Ben Taub General Hospital; El 
Paso Community College; Houston Community College System; Huguley Memorial 
Medical Center; JPS Health Network; Living Centers of America; Respiratory Care, 
Inc.; Sierra Medical Center; Texas Society for Respiratory Care; The University 
of Texas Health Science Center at San Antonio; Tomball Regional Hospital; and 
Spectra Rehab. In addition, numerous individuals commented. All commenters were 
neither for nor against the rules in their entirety, however they expressed 
concerns, asked questions and suggested recommendations for change as discussed 
in the summary of comments. 
The amendments are adopted under the Respiratory Care Practitioners Act, Texas 
Civil Statutes, Articles 4512l, sec.3(e) which provides the Texas Board of 
Health (board) with the authority to adopt rules necessary to implement the Act 
and 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. 

sec.123.2.Definitions. 
The following words and terms, when used in these sections, shall have the 
following meanings, unless the context clearly indicates otherwise.
Advisory committee-The Respiratory Care Practitioners Advisory Committee. 
Educational accrediting body-The Committee on Allied Health Education and 
Accreditation of the American Medical Association, or its successor organization 
which approves respiratory care education programs.
Respiratory care-The treatment, management, control, diagnostic evaluation, and 
care of inpatients or outpatients who have deficiencies and abnormalities 
associated with the cardiorespiratory system. Respiratory care does not include 
the delivery, assembly, set up, testing, and demonstration of respiratory care 
equipment upon the order of a licensed physician. Demonstration is not to be 
interpreted here as the actual patient assessment and education, administration, 
or performance of the respiratory care procedure(s).
Respiratory care education program-
(A) a program in respiratory care approved by the educational accrediting body; 
(B) a program approved by an appropriate education agency and working toward 
becoming an approved program in respiratory care. A program will qualify as a 
respiratory care education program under this subparagraph only for a period of 
one year from the date of the first class offered by the program; after that one 
year, the program must be an approved program in respiratory care; or 
(C) (No change.) 
Respiratory care procedure-Respiratory care provided by the therapeutic and 
diagnostic use of medical gases, humidifiers, and aerosols, the administration 
of drugs and medications to the cardiorespiratory system, ventilatory assistance 
and ventilatory control, postural drainage, chest drainage, chest percussion or 
vibration, breathing exercises, respiratory rehabilitation, cardiopulmonary 
resuscitation, maintenance of natural airways, and the insertion and maintenance 
of artificial airways. The term includes a technique employed to assist in 
diagnosis, monitoring, treatment, and research, including the measurement of 
ventilatory volumes, pressures and flows, the specimen collection of blood and 
other materials, pulmonary function testing, and hemodynamic and other related 
physiological forms of monitoring or treating, as ordered by the patient's 
physician, the cardiorespiratory system. These procedures include: 
(A) administration of medical gases - such as nitric oxide, helium and carbon 
dioxide; 
(B) providing ventilatory assistance and ventilatory control - including high 
frequency oscillatory ventilation and high frequency jet ventilation; 
(C) providing artificial airways - including insertion, maintenance and removal; 
(D) performing pulmonary function testing - including neonatal and pediatric 
studies; 
(E) hyperbaric oxygen therapy; 
(F) monitoring - including pulse oximeter, end-tidal carbon dioxide and apnea 
monitoring; 
(G) extracorporeal membrane oxygenation (ECMO); 
(H) patient assessment, respiratory patient care planning; and 
(I) implementation of respiratory care protocols. 

sec.123.4. Fees.
The following fees are prescribed by the board and are required to be paid to 
the department before any certificate or permit is issued. All fees shall be 
submitted in the form of a check or money order and are nonrefundable. The 
department may direct examination applicants to submit examination fees to the 
National Board for Respiratory Care, Inc. (NBRC). 
(1) Schedule of fees for certification as a respiratory care practitioner 
effective September 1, 1997: 
(A) application (includes initial certificate) fee - $60; 
(B) renewal fee - $45; 
(C) reinstatement fee - $60; 
(D) reactivation fee - $45; 
(E) certificate and/or identification card replacement fee - $20; 
(F) NBRC examination fee - the fee designated by the NBRC at the time of 
examination or reexamination; and 
(G) certificate fee for upgrade of temporary permit - $30.
(2) Schedule of fees for a temporary permit as a respiratory care practitioner 
effective September 1, 1997: 
(A) application (including initial permit) fee - $50; 
(B) temporary permit extension fee - $20; 
(C) temporary permit and/or identification card replacement fee - $20; and 
(3)-(7) (No change.) 
(8) The administrator, on behalf of the board, shall make periodic reviews of 
the fee schedule and recommend any adjustments necessary to provide sufficient 
funds to meet the expenses of the respiratory care practitioner certification 
program without creating an unnecessary surplus. Such adjustments shall be made 
through rule amendments approved by the board.

sec.123.9. Certificate Renewal. 
(a)-(b) (No change.) 
(c) Staggered renewals. The department shall use a staggered system for 
certificate renewals. Certificates issued within three months of a 
practitioner's birth month shall be issued for that period of time plus the next 
full year. 
(d) Certificate renewal. 
(1) (No change.) 
(2) The renewal form for all practitioners shall require the provision of the 
preferred mailing address, primary employment address and telephone number, and 
category of employment, misdemeanor and felony convictions, statement concerning 
status with The National Board for Respiratory Care, Inc., and continuing 
education completed. If the applicant is practicing as a respiratory care 
practitioner at the time of renewal the name signature and license number of the 
physician directing the provision of respiratory care and the physician's 
institutional affiliation(s), if any, shall be provided on the renewal form. 
(3) A practitioner has renewed the certificate when the department has received 
the completed renewal form, continuing education as set out in sec.123.10 of 
this title (relating to Continuing Education Requirements), and the required 
renewal fee on or prior to the expiration date of the certificate. The postmark 
date shall be considered as the date of mailing. 
(4) (No change.) 
(e) Reinstatement or reapplication. 
(1) A person whose certificate has expired may reinstate the certificate by 
submitting to the department the renewal form, continuing education completed 
since the expiration date, the required reinstatement fee, and if respiratory 
care procedures were performed, a notarized statement to show compliance with 
sec.9 of the Act. 
(A) If reinstatement is requested during the first renewal year after 
expiration, 12 hours of continuing education completed since the expiration date 
must be documented. 
(B) If reinstatement is requested on the first renewal date or during the second 
year after expiration, 24 hours of continuing education completed since the 
expiration date must be documented. 
(C) If reinstatement is requested on the second renewal date after expiration, 
36 hours of continuing education completed since the expiration date must be 
documented. 
(D)-(E) (No change.) 
(2)-(4) (No change.) 
(f)-(g) (No change.) 
(h) Inactive status. A respiratory care practitioner who holds a certificate 
under the Act and who is not actively engaged in the practice of respiratory 
care may make application to the department in writing on a form prescribed by 
the department to be placed on an inactive status list maintained by the 
department. The application for inactive status must be postmarked prior to the 
expiration of the practitioner's annual certificate. No refund will be made of 
any fees paid prior to application for inactive status. 
(1)-(3) (No change.) 
(4) If a person on inactive status desires to reenter active practice, the 
person shall: 
(A)-(C) (No change.) 
(D) submit to the department proof of successful completion, within the 12-month 
period prior to reentering active status, of the following continuing education 
hours as set out in sec.123.10 of this title (relating to Continuing Education 
Requirements): 
(i) persons inactive for three years or less shall complete not less than 12 
clock hours; 
(ii) persons inactive for more than three years but less than six years shall 
complete not less than 24 clock hours; and 
(iii) persons inactive for six or more years shall complete not less than 36 
clock hours. 
(5) (No change.) 
(i) (No change.) 

sec.123.10.Continuing Education Requirements.
(a)-(b) (No change.) 
(c) Hour requirements for continuing education. A practitioner must complete 12 
clock hours of continuing education acceptable to the department during each 
renewal year as described in subsection (b) of this section.
(1)-(2) (No change.) 
(d) Types of acceptable continuing education. Continuing education undertaken by 
a practitioner for renewal shall be acceptable if the experience falls in one or 
more of the following categories: 
(1) (No change.) 
(2) participation in any program (e.g., in-service educational training 
programs, institutes, seminars, workshops and conferences) which is: 
(A)-(B) (No change.) 
(C) approved, recognized, accepted, or assigned continuing education credits by 
professional organizations or associations or offered by a federal, state, or 
local governmental entity. A list approved by the advisory committee is 
available from the department upon request; or 
(3) (No change.) 
(e) (No change.) 
(f) Determination of clock hours. The department shall credit continuing 
education experiences as follows. 
(1)-(7) (No change.) 
(8) Passing the advanced cardiac life-support, pediatric advanced life-support, 
the neonatal advanced life-support course, basic trauma life-support or pre-
hospital trauma life-support, issued by or through the American Heart 
Association shall be credited on the basis of eight clock hours. 
(9) (No change.) 
(g) Reporting of continuing education. Each practitioner shall complete and file 
with the department each continuing education activity for which credit is 
claimed. 
(1) A practitioner shall submit the required continuing education activity to 
the department at the time of certificate renewal. However, if an extension has 
been granted in accordance with subsection (i) of this section, the practitioner 
shall file the continuing education hours immediately following completion of 
the activity. 
(2) Each continuing education activity filed by a practitioner must be 
accompanied by appropriate documentation of the continuing education claimed as 
follows: 
(A)-(C) (No change). 
(h)-(k) (No change.) 

sec.123.12.Professional and Ethical Standards.
The purpose of this section shall be to establish the standards of professional 
and ethical conduct required of a practitioner pursuant to the Act, 
sec.11(b)(4). 
(1) Professional representation and responsibilities. 
(A) A practitioner shall not misrepresent any professional qualifications or 
credentials or provide any information that is false, deceptive, or misleading 
in connection with one's own application for certification, for employment or 
work assignment as a respiratory care practitioner, or fail to disclose any 
information that could affect the decision to employ or assign a task as a 
respiratory care practitioner. 
(B)-(G) (No change.) 
(H) A practitioner shall have the responsibility of reporting alleged 
misrepresentations or violations of the Act or these sections to the department. 
(I) The practitioner shall be responsible for competent and efficient 
performance of his assigned duties and shall report to the department 
incompetence and illegal or unethical conduct of members of the profession.
(J) A practitioner shall not retaliate against any person who reported in good 
faith to the department alleged incompetence; illegal, unethical, or negligent 
conduct of any practitioner; or alleged misrepresentation or any violation(s) of 
the Act or these sections. 
(K) A practitioner shall keep his or her file updated by notifying the 
department of changes in preferred mailing address and telephone number.
(L) A practitioner shall not make any false, misleading, or deceptive claims in 
any advertisement, announcement, presentation, or in competitive bidding. 
(M) A practitioner shall conform to medically accepted principles and standards 
of respiratory care which are those generally recognized by the profession as 
appropriate for the situation presented, including those promulgated or 
interpreted by or under the AART, the NBRC, the Texas Society for Respiratory 
Therapy, the board, the department, and other professional or governmental 
bodies. 
(N) A practitioner shall not delegate respiratory care functions or 
responsibilities to a person who lacks the ability or knowledge to perform the 
function or responsibility. A practitioner providing respiratory care services 
may be assisted by an aide or orderly. Aides/orderlies may not perform 
respiratory care procedures. 
(O) A practitioner shall not leave an assignment without being properly relieved 
by appropriate personnel. 
(P) The department shall consider the failure of a practitioner to respond to a 
request for information or other correspondence relating to the certification 
process or these sections as unprofessional conduct and grounds for disciplinary 
proceedings in accordance with sec.123.14 of this title (relating to Violations, 
Complaints and Subsequent Actions).
(2) Relationships with patients/clients. 
(A)-(E) (No change.) 
(F) A practitioner shall not violate any provision of any federal or state 
statute relating to confidentiality of patient/client communication and/or 
records. All inquiries shall be referred to the physician in charge of the 
patient's medical care. 
(G) A practitioner shall not engage in any activities that seek to meet the 
practitioner's personal needs at the expense or detriment of a patient/client. 
(H) A practitioner shall practice respiratory care only under the direction of a 
qualified medical director or other physician licensed by the Texas State Board 
of Medical Examiners. For the purpose of this section direction shall mean: 
(i) assuring that established policies are carried out; 
(ii) monitoring and evaluating the quality, safety, and appropriateness of 
respiratory care services and taking action based on findings; and 
(iii) providing consultation whenever required, particularly on patients 
receiving continuous ventilatory or oxygenation support. 
(3) Billing information required; prohibited practice. 
(A) On the written request of a client, a client's guardian, or a client's 
parent, if the client is a minor, a practitioner shall provide, in plain 
language, a written explanation of the charges for respiratory care services 
previously made on a bill or a statement for the client. This requirement 
applies even if the charges are to be paid by a third party. 
(B) A practitioner may not persistently or flagrantly overcharge or overtreat a 
client. 
(4) Sanctions. A practitioner shall be subject to disciplinary action by the 
board if the practitioner is issued a public letter of reprimand, is assessed a 
civil penalty by a court, or has an administrative penalty imposed by the 
attorney general's office under the Crime Victims Compensation Act, Code of 
Criminal Procedure, Article 56.31 et seq.. 
(5) Disclosure. A practitioner shall make a reasonable attempt to notify each 
client of the name, mailing address, and telephone number of the department for 
the purpose of directing complaints to the department by providing notification: 
(A) on each written contract for services of a practitioner;
(B) on a sign prominently displayed in the primary place of business of each 
practitioner; or 
(C) in a bill for service provided by a practitioner to a client or third party. 
(6) Unlawful false, misleading, or deceptive advertising.
(A) A practitioner shall not use advertising that is false, misleading, or 
deceptive or that is not readily subject to verification.
(B) False, misleading, or deceptive advertising or advertising that is not 
readily subject to verification includes advertising that; 
(i) makes a material misrepresentation of fact or omits a fact necessary to make 
the statement as a whole not materially misleading; 
(ii) makes a representation likely to create an unjustified expectation about 
the results of a health care service or procedure; 
(iii) compares a health care professional's services with another health care 
professional's services unless the comparison can be factually substantiated; 
(iv) contains a testimonial; 
(v) causes confusion or misunderstanding as to the credentials, education, or 
licensure of a health care professional; 
(vi) advertises or represents that health care insurance deductibles or 
copayments may be waived or are not applicable to health care services to be 
provided if the deductibles or copayments are required; 
(vii) advertises or represents that the benefits of a health benefit plan will 
be accepted full payment when deductibles or copayments are required; 
(viii) makes a representation that is designed to take advantage of the fears or 
emotions of a particularly susceptible type of patient; or
(ix) advertises or represents in the use of a professional name a title or 
professional identification that is expressly or commonly reserved to or used by 
another profession or professional. A "health care professional" includes a 
certified respiratory care practitioner, temporary permitted respiratory care 
practitioner, or any other person licensed, certified, or registered by the 
state in a health-related profession. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on June 3, 1997.
TRD-9707188
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: June 23, 1997
Proposal publication date: December 6, 1996
For further information, please call: (512) 458-7236

TITLE 37. PUBLIC SAFETY AND CORRECTIONS
PART III. Texas Youth Commission
CHAPTER 87.Treatment
SUBCHAPTER B.Special Needs Offender Programs
37 TAC sec.87.67
The Texas Youth Commission (TYC) adopts the repeal of sec.87.67, concerning 
Corsicana Stabilization Unit, without changes to the proposed text as published 
in the February 28, 1997, issue of the Texas Register (22 TexReg 2340). 
The justification for the repeal is the replacement by a new rule which, as a 
result of enforcing the section, will provide more efficient use of resources. 
The repealed section will be replaced by new replacement section proposed in 
this issue. 
No comments were received regarding adoption of the repeal. 
The repeal is adopted under the Human Resources Code, sec.61.034, which provides 
the Texas Youth Commission with the authority to make rules appropriate to the 
accomplishment of its functions. 
The proposed repeal implements the Human Resource Code, sec.61.034.
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on June 4, 1997.
TRD-9707223
Steve Robinson
Executive Director
Texas Youth Commission
Effective date: June 24, 1997
Proposal publication date: February 28, 1997
For further information, please call: (512) 424-6244

The Texas Youth Commission (TYC) adopts new sec.87.67, concerning Corsicana 
Stabilization Unit, with changes to the proposed text as published in the 
February 28, 1997, issue of the Texas Register (22 TexReg 2340). The policy 
requires that staff conduct a due process hearing to extend the time to treat 
the psychiatric disturbance beyond 90 days. The change allows the hearing to be 
postponed until the youth's return to the facility if the youth is in a state 
hospital at the time the hearing is required. 
The new section is justification to provide more efficient use of resources for 
youth in need of specialized treatment. 
The new rule will replace a similar rule being repealed simultaneously. The new 
rule establishes criteria whereby youth in the TYC system may be referred to the 
Corsicana Stabilization Unit for specialized treatment of a mental health 
disturbance. TYC youth may be referred from any TYC program in the system and, 
if accepted, moved into the unit. Requirements for formal due process reviews at 
96 hours and at 90 days in the unit are included. Following treatment, youth may 
be returned to the referring unit or referred to a transitional placement for 
additional follow-up treatment. 
No comments were received regarding adoption of the new rule. 
The new rule is adopted under the Human Resources Code, sec.61.075, which 
provides the Texas Youth Commission with the authority to order the child's 
confinement under conditions it believes best designed for the child's welfare 
and the interests of the public, and sec.61.076, which provides the Texas Youth 
Commission with the authority to provide any medical or psychiatric treatment 
that is necessary.
The proposed rule implements the Human Resource Code, sec.61.034. 

sec.87.67.Corsicana Stabilization Unit.
(a) Purpose. The purpose of this rule is to establish, for psychiatrically 
disturbed TYC youth, criteria and procedure for admission and evaluation for 
specialized treatment services in the Corsicana Stabilization Unit and 
subsequent treatment at different sites. 
(b) Applicability. 
(1) The mental health status review due process procedures are found in (GAP) 
sec.95.71 of this title (relating to Mental Health Status Review Hearing 
Procedure). 
(2) See (GAP) sec.95.55 of this title, (relating to Level II Hearing Procedure). 
(3) See (GAP) sec.95.51 of this title (relating to Level I Hearing Procedure). 
(4) For emergency mental health placements, see (GAP)

sec.87.71 of this title (relating to Emergency Mental Health Admission).
(c) Admissions. 
(1) Admission Criteria. Youth who may be admitted to the Corsicana Stabilization 
Unit at the Corsicana Residential Treatment Center are those who meet the 
following criteria. 
(A) Youth demonstrates serious dysfunction in behavior, judgment, thinking, or 
mood; and 
(B) The dysfunction is the result of a current neurological deficit and/or 
emotional disturbance and/or psychiatric disorder, e.g. psychosis, major 
affective disorder, organic disorder, or anxiety disorder; and the dysfunction 
is not the result of a primary conduct disorder or antisocial personality 
disorder; and 
(C) The dysfunction presents a risk of serious harm to the youth or others; and 
(D) A stabilization unit is the least-restrictive intervention alternative that 
is appropriate and available to safely meet the treatment needs and to control 
the dysfunction. 
(2) Admission Process. 
(A) Referrals. Complete current psychiatric and psychological evaluations by a 
licensed psychiatrist and a psychologist must be included in order to be 
considered. 
(i) For youth referred from the Corsicana main campus program, referrals must be 
sent directly to the stabilization unit admissions panel.
(ii) For youth referred from other locations, referrals must be sent by TYC 
staff to the centralized placement unit (CPU) for screening.
(B) Emergency Referrals. If an emergency exists, procedures in (GAP) sec.87.71 
of this title (relating to Emergency Mental Health Admission) must be followed. 
Consistent with emergency criteria, staff may request of the superintendent 
immediate placement of the youth in the Corsicana Stabilization Unit. On 
admission, requirements in this policy are effective for all emergency 
admissions. 
(3) 96 Hour Admission Review Process. A mental health status review hearing 
shall be held for all youth within 96 hours of arrival at the unit. If the 96 
hour period ends on a Saturday, Sunday or Legal Holiday, the hearing must be 
held on the next regular working day. The hearing is held to determine whether 
criteria for unit admission have been met. 
(A) If the youth is deemed not to be appropriate for admission, he/she is not 
retained in the program. Youth referred from the main campus program are 
returned to that program. Youth from all other locations are referred to CPU for 
appropriate placement. 
(B) If the youth is deemed appropriate for admission, he/she is retained and 
treated in the program. 
(d) Program requirements. 
(1) The program focus will be on stabilization of the psychiatric dysfunction. 
(2) Services are provided in a self-contained unit at the TYC Corsicana 
Residential Treatment Center. 
(3) An individualized treatment program reflecting treatment goals and 
objectives shall be developed for and with each youth. 
(4) The treatment team shall review the youth's progress weekly. 
(5) By the end of 90 days from the date of the admission due process hearing, a 
youth shall be returned to the referring source or referred to CPU for 
appropriate placement unless an extension becomes effective at that time. 
(e) Extension of Time Beyond 90 Days to Treat the Psychiatric Dysfunction. 
(1) Extension Criteria. 
(A) Youth continues to meet admission criteria; and 
(B) The youth's treatment plan has been implemented appropriately.
(2) Extension Due Process Requirements. 
(A) The due process required to determine whether extension criteria have been 
met is: 
(i) a level I hearing for all youth on parole. Parole is not revoked. 
(ii) a mental health status review hearing for all nonparole youth. 
(B) The due process hearing shall be conducted: 
(i) two weeks immediately preceding the youth's 90th day from the admission 
hearing unless the youth is being considered for transition out of the unit 
before the end of the initial 90 day stay. 
(ii) two weeks immediately preceding the youth's transition for a youth being 
considered for transition during the initial 90 day stay.
(iii) as soon as the youth returns to the unit if s/he is in a state hospital at 
the time the hearing is required. 
(3) The Effect of an Extension. 
(A) Extension shall be in effect only if extension criteria are found in a due 
process hearing. 
(B) An extension granted means that the period of time, beyond the initial 90 
day stay, during which a youth may be treated for a psychiatric dysfunction 
under rules of this policy, shall be extended for up to 12 months from the date 
of the extension due process hearing. 
(C) As long as the extension is in effect the youth may be retained in the unit, 
transitioned to another placement, and/or returned to the unit without further 
hearings. 
(4) Release and Transition Options. 
(A) The treatment team shall determine by majority vote that the youth is ready 
to leave the stabilization unit. 
(B) Release options are consistent with the youth's residential placement at 
referral. 
(i) Youth residing in their homes or home substitutes on parole status at the 
time of referral to the unit, shall be transitioned to a placement having a less 
restrictive environment prior to their return home. The transition placement may 
be the Corsicana main campus program or a medium restriction placement where the 
youth will continue to receive mental health treatment. Parole status is not 
revoked by any process in this policy. 
(ii) Youth residing in any other placement at the time of referral to the unit, 
will be referred to CPU for appropriate placement. Transition to the main campus 
will occur for youth referred from the main campus program and for youth 
referred from other locations only upon recommendation of the treatment team. 
(C) The extension of time to treat the psychiatric dysfunction shall be 
terminated when placement is no longer needed for the primary purpose of 
treatment of the dysfunction. 
(D) Following termination of the extension, future placement decisions, 
including the youth's return to his home parole placement, are made in 
accordance with other applicable policies and procedures. 
(E) No youth may be discharged from TYC jurisdiction directly from a Corsicana 
Stabilization Unit unless TYC's jurisdiction ends by statute.
(f) Professional Reviews During the Extension Period. 
(1) A professional review shall be conducted, regardless of placement, every 30 
days following the extension due process hearing, for up to 12 months to 
determine whether extension criteria continues to be met.
(2) The review shall be conducted in conjunction with the individual Case Plan 
(ICP) review and documented by mental health professionals in the youth's 
placement. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on June 4, 1997.
TRD-9707224
Steve Robinson
Executive Director
Texas Youth Commission
Effective date: June 24, 1997
Proposal publication date: February 28, 1997
For further information, please call: (512) 424-6244

TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART I. Texas Department of Human Services
CHAPTER 15. Medicaid Eligibility
The Texas Department of Human Services (DHS) adopts amendments to 
sec.sec.15.100, 15.442, 15.455, and 15.503 in its Medicaid Eligibility rule 
chapter. The amendment to sec.15.442 is adopted with changes to the proposed 
text as published in the April 4, 1997, issue of the Texas Register (22 TexReg 
3287). The amendments to sec.sec.15.100, 15.455, and 15.503 are adopted without 
changes and will not be republished. The amendments are justified to clarify the 
definition of rent, include additional rental situations, and clarify when the 
purchase of an irrevocable annuity is a transfer of assets; and to provide a 
formula for hearing officers to use when a client appeals to have the protected 
resource amount increased to produce additional income for the community spouse. 
The amendments will function by ensuring that DHS policy will be appropriately 
and consistently applied statewide. 
The department received comments on the proposed rental income rules from the 
Texas Chapter of the National Academy of Elder Law Attorneys (NAELA). The 
department is not able to incorporate these comments because the proposed rules 
track eligibility policy for the federal Supplemental Security Income (SSI) 
program. In its contract with the Social Security Administration, under Section 
1634 of the Social Security Act, the department agrees to use SSI eligibility 
policy for its Medical Assistance Only program. Therefore, sec.15.100 and 
sec.15.455 are adopted without change. 
The department received comments on the proposed rules regarding annuities from 
the Texas Chapter of NAELA and from an individual. Several comments from NAELA 
concerned confusion about whether the rules applied to the community spouse. 
These comments have been addressed by adding to sec.15.442(g)(2) a phrase to 
clarify that the annuity must be purchased by or for the client. Language is 
added to sec.15.442(g)(3) to clarify that the life expectancy
of the client must equal or exceed the stated life of the annuity. The effective 
date of the annuity rules is given in this rule filing. 
An individual commented on the requirement that the state of Texas be named as 
residuary beneficiary to the extent that Medicaid funds were spent on the 
client's behalf. He contended that this constituted estate recovery and was in 
violation of the Attorney General's opinion on placing liens on the estates of 
clients. The department believes that the rule is neither estate recovery nor a 
Medicaid lien program because the principal of an annuity that names a residuary 
beneficiary does not become a part of the deceased's estate. The requirement to 
name the state as residuary beneficiary is a contractual arrangement and is 
independent of estate recovery law. The recommendation to delete the requirement 
was not accepted. 
No comments were received on the proposed rules in sec.15.503; these are adopted 
without change. 

SUBCHAPTER A. General Information
40 TAC sec.15.100
The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Government Code, sec.531.021, 
which provides the Health and Human Services Commission with the Authority to 
administer federal assistance funds. 
The amendment implements the Human Resources Code sec.sec.22.001-22.030 and 
sec.sec.32.001-32.042. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on June 3, 1997.
TRD-9707168
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Effective date: July 1, 1997
Proposal publication date: April 4, 1997
For further information, please call: (512) 438-3765

SUBCHAPTER D. Resources
40 TAC sec.15.442
The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Government Code, sec.531.021, 
which provides the Health and Human Services Commission with the Authority to 
administer federal assistance funds. 
The amendment implement the Human Resources Code sec.sec.22.001-22.030 and 
sec.sec.32.001-32.042. 

sec.15.442. Personal Property. 
(a)-(f) (No change.) 
(g) Annuities. A client may purchase an annuity to provide income. An annuity 
can be revocable or irrevocable. 
(1) A revocable annuity is a countable resource. An irrevocable annuity is a 
transfer of assets if it does not pay back the principal (original purchase 
price) to the client during his life expectancy. To qualify for exemption from 
transfer of assets rules, an annuity must be issued by an insurance company 
licensed and approved to do business in the state of Texas. The eligibility 
specialist must review the terms of an annuity contract or agreement to 
determine if the principal of the annuity is an available resource or considered 
a transfer of assets. 
(2) To avoid a transfer of assets penalty, an annuity purchased by or for the 
client must: 
(A) be irrevocable; 
(B) pay out principal and interest in equal monthly installments to the client 
in sufficient amounts that the principal is paid out during the life expectancy 
of the client; and 
(C) name the state of Texas, Texas Department of Human Services or its successor 
agency as the residual beneficiary of funds remaining in the annuity, not to 
exceed any Medicaid funds expended on the client during his lifetime. 
(3) The average number of years of expected life remaining for the client must 
equal or exceed the stated life of the annuity. If the client is not reasonably 
expected to live longer than the guarantee period of the annuity, the client 
will not receive fair market value for the annuity based on projected returns. 
In this case, the annuity is not actuarilly sound and a transfer of assets for 
less than fair market value of the premium has taken place to the extent of the 
portion not anticipated to be repaid in the client's lifetime. The penalty is 
assessed based on a transfer of assets that is considered to have occurred at 
the time the annuity was purchased, minus any principal paid to the client prior 
to the file date for Medicaid benefits. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority.
Issued in Austin, Texas, on June 3, 1997.
TRD-9707164
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Effective date: July 1, 1997
Proposal publication date: April 4, 1997
For further information, please call: (512) 438-3765

SUBCHAPTER E. Income
40 TAC sec.15.455
The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Government Code, sec.531.021, 
which provides the Health and Human Services Commission with the Authority to 
administer federal assistance funds. 
The amendment implements the Human Resources Code sec.sec.22.001-22.030 and 
sec.sec.32.001-32.042. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on June 3, 1997.
TRD-9707165
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Effective date: July 1, 1997
Proposal publication date: April 4, 1997
For further information, please call: (512) 438-3765

SUBCHAPTER F. Budgets and Payment Plans
40 TAC sec.15.503
The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Government Code, sec.531.021, 
which provides the Health and Human Services Commission with the Authority to 
administer federal assistance funds. 
The amendment implements the Human Resources Code sec.sec.22.001-22.030 and 
sec.sec.32.001-32.042. 
This agency hereby certifies that the adoption has been reviewed by legal 
counsel and found to be a valid exercise of the agency's legal authority. 
Issued in Austin, Texas, on June 3, 1997.
TRD-9707166
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Effective date: July 1, 1997
Proposal publication date: April 4, 1997
For further information, please call: (512) 438-3765