PROPOSED RULES
Before an agency may permanently adopt a new or amended section or repeal an 
existing section, a proposal detailing the action must be published in the Texas 
Register at least 30 days before action is taken. The 30-day time period gives 
interested persons an opportunity to review and make oral or written comments on 
the section. Also, in the case of substantive action, a public hearing must be 
granted if requested by at least 25 persons, a governmental subdivision or 
agency, or an association having at least 25 members.
Symbology in proposed amendments. New language added to an existing section is 
indicated by the <nl> code. [Brackets] indicate deletion of existing material 
within a section.

TITLE 1. ADMINISTRATION
PART IV. Office of the Secretary of State
CHAPTER 81. Elections 
Miscellaneous
1 TAC sec.81.74
The Office of the Secretary of State, Elections Division, proposes a new rule, 
sec.81.74, concerning procedures providing for the security of voted early 
voting ballots. The new rule is being proposed to prescribe procedures for 
ballot security from the last day of early voting by personal appearance until 
the day the ballots are counted, in accordance with section 85.032(f) of the 
Texas Election Code (the "Code"). 
Ann McGeehan, Deputy Assistant Secretary of State for Elections, has determined 
that for the first five-year period this rule is in effect there will be no 
fiscal implications for state or local governments as a result of enforcing or 
administering the rule. 
Ms. McGeehan has determined also that for each year of the first five years the 
rule is in effect the public benefits anticipated as a result of enforcing the 
rule will be: (1) increased security for voted early voting ballots, and (2) 
uniformity in the method of transferring ballots between the early voting clerk 
and the early voting ballot board. The economic costs will be nominal for 
persons who are required to comply with the rule as proposed.
Comments on the proposal may be submitted to Ann McGeehan, Deputy Assistant 
Secretary of State for Elections, Office of the Secretary of State, P.O. Box 
12060, Austin, Texas 78711-2060. 
The rule is proposed under the Code, Chapter 31, Subchapter A sec.31.003, which 
provides the secretary of state with authority to promulgate rules to obtain and 
maintain uniformity in the application, operation, and interpretation of the 
Code. 
The Code, Chapter 85, Subchapter B, sec.85.032(f) is affected by this proposed 
rule. 

sec.81.74. Security of Early Voting Ballots under Election Code, sec.85.032(f).
(a) If the early voting ballot board convenes before election day, the presiding 
judge shall, upon each adjournment the board, lock and seal each ballot box 
prior to delivering the boxes back to the custodian. The judge shall complete a 
ballot box security form showing each serial number used to seal each box. The 
form shall be signed by the judge and another early ballot board member who has 
witnessed the procedure. In a general election for state and county officers, 
the early ballot board member must be from a different political party than the 
judge. The custodian of records shall also sign the form. 
(b) The presiding judge shall retain the key(s) used to lock the ballot box(es). 
In the event that the judge is unwilling to retain the key, the key shall be 
retained by the authority designated in accordance with sec.66.060(a) of the 
Code. 
(c) Upon reconvening the ballot board, the presiding judge shall ensure that 
each ballot box is intact. The presiding judge shall follow these procedures 
each day except upon final delivery to the custodian of records or delivery to 
the central counting station. 
(d) If it is impracticable for the ballot board judge to deliver the ballot 
boxes each day upon adjournment, the authority conducting the election shall 
submit an alternative plan for the security of the ballots to the Secretary of 
State for approval. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt. 
Filed with the Office of the Secretary of State on February 12, 1998.
TRD-9802121
Clark Kent Ervin
Assistant Secretary of State
Office of the Secretary of State
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-5650

PART X. Department of Information Resources
CHAPTER 201. Planning and Management of Information Resources Technologies
1 TAC sec.201.5
The Department of Information Resources proposes an amendment to sec.201.5, 
concerning agency planning. The amendment implements recent statutory changes 
which were enacted by the 75th Legislature in response to recommendations by the 
Sunset Advisory Commission regarding the statewide information resources 
planning and reporting processes, and deletes obsolete provisions. Specifically, 
the amendment: revises the due date for the department to distribute 
instructions for agency strategic plans for information resources management to 
agencies; revises the due date for agencies to submit agency strategic plans for 
information resources management to the department; revises the deadline by 
which the department must review and approve or disapprove agency strategic 
plans; establishes a due date for amendments to biennial operating plans that 
reflect significant new or changed technology initiatives in agencies' 
legislative appropriations requests; and makes other changes to conform the rule 
to current provisions in the Information Resources Management Act (Texas 
Government Code Chapter 2054). The amendment is proposed in accordance with 
Texas Government Code sec.2054.095(d), sec.2054.097(a), and sec.2054.100(c), 
which require the department to establish by rule the due dates specified above. 
Mr. Edward Serna, director of the Oversight Operations Division, has determined 
that for each year of the first five years the proposed amendments will be in 
effect, there will be no fiscal implications for state government as a result of 
enforcing or administering the amendments. There will be no foreseeable fiscal 
implications for local government as a result of enforcing or administering the 
amendments. 
Mr. Serna also has determined that for each year of the first five years the 
proposed amendments will be in effect, there will be a benefit to the public in 
that agencies' technology planning and reporting requirements will be better 
aligned with the statewide strategic planning cycle for agency  operations and 
with the budgetary planning cycle for state agencies. There will be no effect on 
small businesses. There is no anticipated economic cost to persons who are 
required to comply with the amendments as proposed. 
Comments on the proposal may be submitted to C. J. Brandt, Jr., General Counsel, 
Department of Information Resources, P.O. Box 13564, Austin, Texas 78711, no 
later than 5 p.m., within 30 days after publication. Envelopes must be clearly 
marked "Formal Comment to Proposed Action Enclosed." 
The amendment is proposed under Texas Government Code sec.2054.095(d), 
sec.2054.097(a), and sec.2054.100(c), which authorize the department to adopt 
rules as necessary to carry out its responsibilities described in those portions 
of the Information Resources Management Act. 
Texas Government Code sec.sec.2054.095(d), 2054.097(a), and 2054.100(c) are 
affected by the proposed amendments. 

sec.201.5. Agency Planning.
(a) Agency strategic plans. 
(1) Submittal procedures. 
(A)-(B) (No change.) 
(C) <nl>The format<ol> [Format] <nl>and content <ol> of the agency strategic 
plan must comply with [instructions, based on] paragraph (2) of this subsection, 
<nl>and with instructions<ol> published by the department and distributed to 
each state agency <nl>at least 60 days before the date the plan is required to 
be submitted to the department <ol> [prior to February 1 of each even numbered 
year]. <nl> These instructions are adopted by reference. Copies may be obtained 
in person or in writing at the Department of Information Resources, P.O. Box 
13564, Austin, Texas 78711. The instructions may also be obtained electronically 
via the department's Internet web page at http://www.dir.state.tx.us/.<ol>
[Content of the plan must include, in the format prescribed by the department:
[(i) an executive summary;] 
[(ii) a statement of the agency's mission, goals, and programs;] 
[(iii) a statement of the agency's planning assumptions;] 
[(iv) a description of the present status of the organizational environment, 
information resources management policies and practices, personnel resources, 
and operating environment;] 
[(v) a statement of information resources goals and strategies;] 
[(vi) a statement of agency compliance with and support for the state strategic 
plan for information resources;]
[(vii) a statement of the agency's long-term information resources needs.] 
(D) Each agency must submit the agency strategic plan <nl> to the department on 
the same date that the strategic plan for operations required by Texas 
Government Code Chapter 2056 is scheduled to be submitted to the Legislative 
Budget Board and the Governor's Office of Budget and Planning or by July 1 of 
each even-numbered year, whichever is earlier<ol> [by January 1 of each odd-
numbered year]. 
(2) Contents. Each agency strategic plan must <nl> be consistent with the State 
Strategic Plan for Information Resources Management and must<ol> include: 
(A)-(D) (No change.) 
(E) a statement of the strategic objectives of the agency relating to 
information resources management for the next five fiscal years, beginning with 
the fiscal year in which the plan is submitted, with a description of how those 
objectives help achieve the agency's programs and goals and support the goals 
and policies of the state strategic plan; <nl>and<ol> 
(F) (No change.) 
(3) Review procedures. 
(A) (No change.) 
(B) The department will review and approve or disapprove each agency strategic 
plan in writing <nl>not later than the 90th calendar day after the date the 
department receives the plan<ol> [no later than April 15 of each odd-numbered 
year]. If the department disapproves an agency's plan, it shall notify the 
agency's information resources manager and executive director in writing of the 
reasons for disapproval. The agency may appeal the department's disapproval at 
the next regularly scheduled board meeting. 
(b) Biennial operating plans. 
(1) Submittal procedures. 
(A) (No change.) 
(B) Format of the biennial operating plan <nl>and any amendments <ol> must 
comply with instructions, based on paragraph (2) of this subsection, published 
by the department and distributed to each state agency. 
(C) The [governing body of the submitting agency must approve the biennial 
operating plan, and the] information resources manager or the agency head must 
sign the biennial operating plan. 
(D) (No change.) 
(E) An agency may request an extension of the deadline for submitting its 
biennial operating plan. The request should describe the agency's need for 
additional time, and must be <nl>received by <ol> [submitted to] the department 
<nl>on or before the agency's due date<ol> [within 15 days after the General 
Appropriations Act becomes law]. 
(2) Contents. An agency's biennial operating plan must include: 
(A) (No change.) 
(B) information in the format specified by the department in the operating plan 
instructions. These instructions are adopted by reference. Copies may be 
obtained in person, or <nl>by<ol> [in] writing <nl> to<ol> [at] the Department 
of Information Resources, P.O. Box 13564, Austin, Texas 78711. <nl>The 
instructions also be obtained electronically via the department's Internet web 
page at http://www.dir.state.tx.us/.<ol>
(3) Review procedures. 
(A) The department will evaluate biennial operating plans:
(i) for consistency with the General Appropriations Act <nl> and<ol> [,] other 
legislation; 
(ii)-(vii) (No change.) 
(B) (No change.) 
(C) The department may not approve an agency's biennial operating plan unless 
the agency has submitted, and the department has approved, a current agency 
strategic plan <nl>for information resources management<ol>. 
(D) (No change.) 
(c) Plan amendments. 
(1) Submittal procedures. 
(A) A state agency shall amend its strategic plan and/or biennial operating plan 
when necessary during a biennium. <nl>At a minimum, an agency shall amend its 
biennial operating plan to reflect significant new or changed information 
resources initiatives or information resources technologies initiatives 
contained in the agency's legislative appropriation request. Such amendment 
shall be submitted to the department not later than the date the agency is 
required to submit its legislative appropriations request to the Legislative 
Budget Board. Additional information on when to submit an amendment shall be 
included in the instructions described in subparagraph (2)(B) of subsection (b) 
of this section.<ol> [An agency may amend the plans, for example, to implement 
recommendations resulting from a consulting services contract or staff report 
that may affect information resources strategies, changes in information 
resources technologies, or changes in the agency's management of information 
resources.] 
<nl>(B)<ol> A state agency that is not required by subparagraph (A) of this 
paragraph to amend its biennial operating plan shall send written notification 
to the department stating that an amendment is not required and the reasons why 
an amendment is not required. Such written notification shall be submitted to 
the department not later than the date the agency is required to submit its 
legislative appropriation request to the Legislative Budget Board. 
<nl>(C)<ol> [(B)] A state agency must submit proposed plan amendments to the 
department for approval. 
(2) Review procedures. The department will review and approve or disapprove 
<nl>all or part of<ol> each proposed plan amendment no later than 30 working 
days after it is received. Instructions for the format and content of plan 
amendments and criteria for review of these amendments <nl> are included in the 
instructions described in subsection (b)(2)(B) of this section<ol> [based on 
this paragraph for strategic plans, and this paragraph for biennial operating 
plans will be published by the department (d) Appeal procedures. 
(1) Submittal procedures. A state agency that disagrees with the department's 
disapproval of a plan, part of a plan, <nl>or<ol> plan amendment, [or analysis 
of project acquisition alternatives] may submit a written request to the 
department for special review no later than 30 days after notification of 
department disapproval. 
(2) (No change.) 
(e) Implementation of approved plans. 
(1) (No change.) 
(2) The department will identify the additional information required under this 
subsection with reasonable specificity at the time it completes its evaluation 
of a plan. <nl>Any stipulations or conditions applied to<ol> [The condition to 
the] plan approval must be satisfied prior to [the agency] implementing the 
affected portions of the plan. 
[(f) Review of state agency analyses of project acquisition alternatives.] 
[(1) Applicability.] 
[(A) Departmental review of analyses of project acquisition alternatives is 
required for:] 
[(i) state agency information resources projects over the agency threshold as 
described in an agency's biennial operating plan; or] 
[(ii) any state agency information resources project or other activity as 
stipulated by the department in its approval of the biennial operating plan; 
except 
[(iii) these provisions shall not apply for any agency projects to expand or 
enhance existing information resources capacity with no significant change in 
technical environment.] 
[(B) The provisions of this subsection shall only apply to any state agency 
specified in Article V, sec.96, subsection (6) of the General Appropriations 
Act.] 
[(2) Waivers.] 
[(A) A waiver shall be granted to any state agency on an emergency basis without 
first complying with the procedures prescribed by this section for any projects 
which may become necessary as a result of a natural or human disaster; any order 
of a court of competent jurisdiction when the ordered period of compliance is 
less than six months unless the agency has received prior approval for an 
emergency implementation period in excess of six months; any act of exemption by 
the Texas Legislature; or other documented emergency conditions. The agency must 
report and explain to the department any emergency action within 30 days after 
the action is taken.] 
[(B) A waiver shall automatically apply to any agency whose biennial operating 
plan projects are classified only as baseline operations, or growth and 
expansion, or telecommunications and where the agency's total direct costs for 
all of those projects are less than $750,000.] 
[(C) A waiver shall apply for any agency projects in progress beyond the 
planning or feasibility study stage on or before May 1, 1992. Such waivers must 
be requested in writing by the Information Resources Manager. The department 
will grant or deny waiver requests within ten working days of receipt of the 
request, based on evidence of project status.] 
[(3) Compliance; adoption by reference. Each analysis of project acquisition 
alternatives prepared by an agency and submitted to the department must include 
information in the format specified by the department in the Guide for the 
Analysis of Project Acquisition Alternatives (hereafter referred to as "Guide"). 
Information concerning the Guide adopted by reference may be obtained from the 
Department of Information Resources, P.O. Box 13564, Austin, Texas 78711.] 
[(4) Submittal procedures.] 
[(A) Before project initiation beyond the planning or feasibility stage, each 
state agency shall prepare and submit to the department an analysis of project 
acquisition alternatives for projects which meet the applicability requirements 
stated in paragraph (1) of this subsection and which do not qualify for a waiver 
under paragraph (2) of this subsection. Agency submissions of information for 
departmental review shall occur within the time frames specified in the Guide.] 
[(B) The Information Resources Manager shall sign the transmittal document for 
the analysis of alternatives.] 
[(5) Review procedures. The department may not approve an agency's analysis 
unless the agency has submitted, and the department has approved, a current 
agency strategic and operating plan.]
[(A) The department will evaluate alternative analyses:]
[(i) for completeness with respect to published instructions in the Guide. The 
analysis shall address, but not be limited to, the following factors:] 
[(I) start-up costs associated with the acquisition, including but not limited 
to the purchase price of the acquisition, site preparation costs, freight 
charges, and staff costs;] 
[(II) estimated cost of maintenance;] 
[(III) estimated cost of supplies;] 
[(IV) estimated cost of employee training;] 
[(V) estimated cost of additional long-term staff needed;] 
[(VI) estimated increase in employee productivity;
[(VII) consistency with agency plans approved by DIR;] 
[(VIII) consistency with statewide standards and policies established in the 
Statewide Strategic Plan;] 
[(ii) for cost-effectiveness in accordance with published instructions in the 
Guide or other rule of the department; and]
[(iii) for any other information the department deems necessary and 
appropriate.] 
[(B) The department will review and approve or disapprove each analysis of 
project acquisition alternatives in writing no later than 30 days after receipt 
of the documents. If the department does not act within the time allowed, the 
agency may proceed with its project; however, departmental inaction does not 
exempt the agency, its projects, or its activities from other procedural 
requirements of the department under this chapter.] 
[(i) First review. If the department disapproves an agency's initial analysis, 
the agency may perform a recertification of the analysis by an independent 
reviewer and request a second review as specified in the Guide.] 
[(ii) Second review. If the department disapproves an agency's second analysis, 
the agency may appeal the decision to the board, under the provisions of 
subsection (e) of this section, provided the request for appeal is accompanied 
by the department's disapproval notices and the independent certification of the 
analysis.] 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802164
C.J. Brandt, Jr.
General Counsel
Department of Information Resources
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 475-2153

TITLE 4. AGRICULTURE
PART I. Texas Department of Agriculture
CHAPTER 1. General Procedures
SUBCHAPTER A. General Rules of Practice
4 TAC sec.1.14
(Editor's note: The text of the following section proposed for repeal will not 
be published. The section may be examined in the offices of the Texas Department 
of Agriculture or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.)
The Texas Department of Agriculture (the department) proposes the repeal of 
sec.1.14, concerning general provisions for licensing. The repeal is proposed in 
order to allow sec.1.14 to be moved to a new Chapter 2 of this title, relating 
to general licensing requirements for the agency. The department is proposing 
new sec.2.1 to replace this section. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the repeal is in effect there 
will be no fiscal implications for state or local government as a result of 
enforcing or administering the repeal. 
Ms. Smith also has determined that for each year of the first five years the 
repeal is in effect the expected public benefit derived from enforcement and 
administration of the repeal will be a clearer, more organized licensing 
section. There will be no effect on small businesses. There will be no cost to 
persons required to comply with the repeal. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The repeal is proposed under the Texas Agriculture Code, sec.12.016, which 
provides the department with the authority to adopt rules as necessary for the 
efficient enforcement and administration of the Texas Agriculture Code. 
The Code affected by this proposal is the Texas Agriculture Code, Chapters 12, 
13, 14, 18, 71, 76, 101-103, 132, and 134. 
sec.1.14. Licenses. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802195
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 2. Licensing 
The Texas Department of Agriculture (the department) proposes new sec.sec.2.1-
2.2 and sec.sec.2.10-2.14, concerning general provisions applicable to all 
department licenses. The department proposes the new sections to implement a 
consolidated license program pursuant to Texas Agriculture Code, Chapter 12, 
sec.12.033, and to establish a chapter for licensing rules applicable to all 
agency programs. New sec.2.1 moves current sec.1.14 into new Chapter 2, 
Subchapter B. The repeal of sec.1.14 is being filed as a separate submission. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a licensing and regulatory scheme that is 
consistent and more convenient to the regulated public. The effect on small 
businesses and cost to persons who are required to comply with the new sections 
are not determinable at this time. Those holding multiple licenses, 
certifications, and/or registrations issued the department will be able to renew 
all of their department-issued licenses, certifications, and/or registrations on 
a specific date every year by means of a consolidated license. The department 
anticipates that the regulated public's fees will decrease over time as the 
department is able to assess the cost savings associated with the proposal. At 
the outset of this initiative, fees for each license, certification, and 
registration will remain the same. However, when the department is able to 
quantify the cost savings associated with the administration of the consolidated 
licensing program, fees will be adjusted to reflect the efficiencies gained by 
this proposal. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 

SUBCHAPTER A. General Provisions
4 TAC sec.2.1, sec.2.2
New sec.2.1 and sec.2.2 are proposed under the Texas Agriculture Code, 
sec.12.033, which provides that the department by rule must implement a program 
for the issuance of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapters 12, 13, 14, 18, 71, 76, 101-103, 132, and 
134. 

sec.2.1. Processing of Licenses; Notice Requirements; Criminal Convictions. 
(a) When licensing is required by stature to be preceded by notice and 
opportunity for hearing, the action shall be administered as a contested case as 
provided for in the Administrative Procedure Act (the Act) and these rules. 
(b) For licenses covered by the Texas Government Code, Chapter 2005, when 
licensing is not required by statute to be preceded by notice and opportunity 
for hearing, the following shall apply. 
(1) An applicant for an initial license or renewal of a license shall submit to 
the department in timely fashion all applications, forms, bonds, tests, data, 
fees, and other material required by law to precede the issuance of such initial 
license or renewal license. 
(2) The department shall, within 15 days of the receipt of all such submissions, 
issue a written notice to the applicant which states that the application is 
complete and accepted or that the application is deficient. If such license is 
denied, the written notice shall set forth in detail the reasons for the denial 
and specify what additional information is required.
(3) An applicant may contest the determination made by the department or the 
department's failure to comply with the time period established in paragraph (2) 
of this subsection by filing a notice of protest. A notice of protest shall be 
filed with the commissioner within 15 days of receipt by the applicant of the 
notice of such determination, or in the case of a contest of the time for 
processing, within 30 days of the department's receipt of an application. 
(4) Notice of protest being timely filed, the application shall be administered 
as a contested case as provided for in the Act and this chapter. 
(5) If notice of protest is not timely filed, such determination shall become 
final. 
(6) In the case of a timely protest as to the time for processing, if the 
commissioner determines that the specified time periods for processing have been 
exceeded and that there is no good cause for exceeding the deadline, the license 
or permit filing fee shall be reimbursed in full to the applicant. 
(7) The term "for good cause" as used in this section shall be found if: 
(A) the number of permits to be processed exceeds by 15% or more the number of 
permits processed in the same calendar quarter of the preceding year; 
(B) the department must rely on another public or private entity for all or part 
of its permit processing, and the delay is caused by the other entity; or 
(C) any other conditions exist giving the agency good cause for exceeding the 
period established for processing a permit; i.e., time delays due to public 
hearings and related matters. 
(8) When a licensee has made a timely and sufficient application for the renewal 
of a license or a new license for any activity of a continuing nature, the 
existing license does not expire until the application has been acted upon by 
the department, except as otherwise provided by applicable statute. 
(9) If timely and sufficient application for the renewal of a license is not 
made, the department may terminate the effectiveness of such license at the end 
of its stated term without notice or opportunity for a hearing. 
(c) No revocation, suspension, annulment, withdrawal, or denial of renewal of a 
license or license application shall be effective unless, prior to the 
institution of agency proceedings to revoke, suspend, annul, withdraw, or deny a 
license or license application or renewal, the department has given notice and 
provided the licensee with an opportunity to show compliance with all 
requirements of the law for retention of the license or issuance of the license 
as follows. 
(1) If, after investigation of a possible violation and the facts surrounding 
that possible violation, the department determines that a violation has occurred 
that warrants the suspension, cancellation, revocation, annulment, withdrawal, 
or denial of a license or license application or a renewal application, the 
department shall give written notice of the alleged violations by certified mail 
to the person charged. The notice shall include a brief summary of the charges 
and a statement that the department intends to revoke, suspend, annul, deny, or 
withdraw the person's license or license application, a statement that the 
person has an opportunity to show compliance with requirements of the law for 
retention of the license, and a statement that the person has a right to a 
hearing on the occurrence of the violations alleged. 
(2) Not later than the 20th day after the date on which the notice is received, 
the person charged may make a written request for a hearing on the department's 
allegations and proposed action. 
(3) If the person charged requests a hearing or fails to respond to the notice, 
the department shall set a hearing and give notice of the hearing. The hearing 
shall be held by an administrative law judge designated by the department in 
accordance with the provisions of the Act and these rules.
(d) The commissioner may revoke, suspend, annul, or amend an existing valid 
license, disqualify a person from receiving or renewing a license, or deny to a 
person the opportunity to be examined for a license because of a person's 
conviction of a felony or a misdemeanor, if the crime directly relates to the 
performance of the occupation or activity for which the license is issued and 
the prior criminal conviction directly affects such person's present fitness to 
perform such occupation or activity. 
(1) In determining whether a criminal conviction directly relates to the 
performance of a licensed occupation or activity, the commissioner shall 
consider the factors listed in Texas Civil Statutes, Article 6252-13c, sec.4(b). 
(2) Those crimes which the department considers as directly related to the 
performance of a licensed occupation or activity include, but are not limited 
to: 
(A) any felony or misdemeanor as defined in the Texas Penal Code or similar 
statute of any other state of the United States of which fraud, dishonesty, or 
deceit is an essential element; 
(B) any criminal violation of the Texas Agriculture Code or predecessor 
statutes; 
(C) any criminal violation of statutes regulating the particular occupation or 
activity for which licensing is sought; and 
(D) any crime involving moral turpitude. 
(3) In determining whether a criminal conviction directly affects a person's 
present ability to perform a licensed occupation or activity, the commissioner 
shall consider the factors listed in Texas Civil Statutes, Article 6252-13c, 
sec.4(C)(1)-(6). 
(4) It shall be the responsibility of the applicant, to the extent possible, to 
secure and provide to the department the recommendations of the prosecution, law 
enforcement, and correctional authorities. The applicant shall also furnish 
proof in such form as may be required by the department that he or she has 
maintained a record of steady employment, has supported his or her dependents, 
has otherwise maintained a record of good conduct, and has paid all outstanding 
court costs, supervision fees, fines, and restitution as may have been ordered 
in all criminal cases in which he or she has been convicted. 
(5) Proceedings held before the department to establish factors contained in 
this subsection are governed by the Act and these rules.
(6) Upon a licensee's felony conviction, felony probation revocation, revocation 
of parole, or revocation of mandatory supervision, his or her license shall be 
revoked. 

sec.2.2. Expiration Provision. 
Unless specifically acted upon by amendment or repeal and substitution of a new 
section or sections in accordance with the Texas Government Code Annotated 
sec.sec.2001.021-2001.038 (Vernon 1998) or specific reactivation by the 
department, all of the sections in this chapter shall expire on August 31, 2001. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802199
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

SUBCHAPTER B. Consolidated Licenses
4 TAC sec.sec.2.10-2.14
New sec.sec.2.10-2.14 are proposed under the Texas Agriculture Code, sec.12.033, 
which provides that the department by rule must implement a program for the 
issuance of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapters 12, 13, 14, 18, 71, 76, 101-103, 132 and 
134. 

sec.2.10. Definitions. 
The following words and terms, when used in this chapter, shall have the 
following meanings, unless the context clearly indicates otherwise. 
Component license-a license, certification, or registration issued by the 
department that is consolidated under Texas Agriculture Code sec.12.033. 

sec.2.11. License Specifications.
(a) The department may issue a consolidated license to a person who holds 
multiple licenses, certifications, and/or registrations issued by the department 
on the submission of completed application forms for the component licenses and 
submission of the appropriate fee. The department shall not issue a consolidated 
license unless and until the applicant fulfills all of the prerequisites for 
each of the component licenses. 
(b) A consolidated license authorizes each of the activities of the component 
licenses. 
(c) Application/Renewal. 
(1) An applicant for an initial consolidated license shall pay the licensing fee 
prior to the issuance of the license. The department will prorate the fee for a 
new consolidated license to coincide with the expiration date of the license. 
(2) An applicant for the renewal of a consolidated license shall pay the license 
fee on or before the expiration date of the license. A person who fails to 
submit a renewal fee on or before the expiration date of the license shall pay, 
in addition to the renewal fee, the late fee provided by the Texas Agriculture 
Code, sec.12.024. If a person's license has been expired for one year or longer, 
the person may not renew the license but must comply with the requirements and 
procedure for obtaining an original license.
(d) Expiration. A consolidated license will expire in accordance with the 
following schedule: 
(1) If one of the component licenses encompassed by the consolidated license is 
a license required by the Texas Agriculture Code, Chapter 132, and Chapter 15 of 
this title (relating to Egg Law), the consolidated license shall expire on 
August 31 of each year. 
(2) If one of the component licenses encompassed by the consolidated license is 
a license required by the Texas Agriculture Code, Chapter 14, and Chapter 13 of 
this title (relating to Grain Warehouse regulation), the consolidated license 
shall expire on May 31 of each year. 
(3) All other consolidated licenses shall expire one year from the date of 
issuance or renewal. 

sec.2.12. Fees. 
(a) Except as provided by subsection (b) of this section, the fee for a 
consolidated license equals the sum of the fees for each component license 
encompassed by the consolidated license. 
(b) The department may adjust the fee for a consolidated license to reflect the 
economic efficiency gained by the department through the operation of a 
consolidated license program. 

sec.2.13. Inspections. 
Where practicable, the department may combine all inspections required for each 
of the component licenses into a single inspection. 

sec.2.14. License Sanctions. 
If the holder of a consolidated license violates a rule or statute authorizing 
any of the component licenses encompassed by the licensee's consolidated 
license, the department may seek license sanctions on the consolidated license 
as prescribed by the Texas Agriculture Code, sec.12.0201. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802200
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 7. Pesticides
SUBCHAPTER C. Licensing
4 TAC sec.7.20, sec.7.21
The Texas Department of Agriculture (the department) proposes amendments to 
sec.7.20 and sec.7.21, concerning the expiration date and fees for pesticide 
licenses and applicator testing fees. The department proposes these amendments 
because they are necessary for the implementation of a consolidated license 
program pursuant to Texas Agriculture Code, Chapter 12, sec.12.033 and to change 
the fee for certain governmental employees. The amendments allow the department 
to adjust the expiration date and fee schedules for a pesticide license when the 
licensee's pesticide license is consolidated with another license, 
certification, or registration issued by the department and changes the 
applicator license and testing fees for certain employees of political 
subdivisions of the state of Texas or of the federal government. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal as it relates to consolidation 
of licenses. There will be a decrease in revenue to the state and a 
corresponding increase in revenue to local government for the change of 
noncommercial applicator license and testing fees for certain governmental 
employees. The estimated amount of the decrease is not determinable at this time 
and will depend on the number of applicators eligible for the decrease. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the consolidated licensing proposal will be a consolidated 
license option with the possibility of lower license fees. The public benefit 
derived from the decrease of the noncommercial applicator licensing and testing 
fees for certain governmental employees will be continued licensing of 
governmental employees at a more cost-efficient rate. The effect on small 
businesses and cost to persons who are required to comply with the amendment 
relating to consolidation of licenses are not determinable at this time. 
However, the department anticipates that licensing fees may decrease over time 
due to cost savings from the implementation of a consolidated licensing system. 
In relation to the decrease in applicator license fees and testing fees for 
certain governmental employees, there is no anticipated cost to small 
businesses. There will be a decrease in noncommercial applicator license fees 
from $100 to $10 for certain governmental employees and/or their employers and 
elimination of testing fees for those employees. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The amendments are proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license; and the Texas Agriculture Code, sec.76.106 and 
sec.76.109, which provide the department with the authority to fix and collect a 
fee for applicator testing and licensing of noncommercial applicators. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033; 
and the Texas Agriculture Code, Chapter 76. 

sec.7.20. Application. 
(a)-(b) (No change.) 
(c) <nl>Except as provided by Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses), the<ol> [The] fee for a new dealer license will be 
prorated as outlined on the License Application form to coincide with the 
December 31st expiration date. Renewals made after the expiration date are 
subject to applicable late fees. 
(d) <nl> Except as provided by Chapter 2, Subchapter B of this title (relating 
to Consolidating Licenses), licensing<ol> [Licensing] and renewal fees are: 
(1) (No change.) 
(2) Applicators: 
(A)-(B) (No change.) 
(C) Noncommercial applicators employed by a <nl>political subdivision of the 
State of Texas or of a federal agency operating in Texas <ol> [state university 
or state agency] who utilize the license <nl> solely<ol> in the course of their 
employment: $10 for one year; 
(D)-(E) (No change.) 
(e)-(h) (No change.) 

sec.7.21. Applicator Certification.
(a)-(c) (No change.) 
(d) Commercial and noncommercial applicators must meet the following 
requirements: 
(1) (No change.) 
(2) A fee of $20 shall be required for testing each applicant in each license 
use category and subcategory, and must be paid at the time the test or tests are 
given. Political subdivision employees may submit a purchase order number in 
lieu of payment at time of examination. Employees of <nl>political subdivisions 
of the State of Texas or of a federal agency operating in Texas<ol> [state 
universities and state agencies] are exempt from examination fees. 
(3) (No change.) 
(e)-(f) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802201
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 12. Weights and Measures
The Texas Department of Agriculture (the department) proposes amendments to 
sec.12.12, concerning the registration fee for weights and measures devices and 
sec.12.40 and sec.12.43, concerning the expiration date and fees for the 
licensing of weights and measures service companies. The department proposes 
these amendments because they are necessary for the implementation of a 
consolidated license program pursuant to Texas Agriculture Code, Chapter 12, 
sec.12.033. The amendments allow the department to adjust the fee schedule for 
weights and measures device registrations when the registration is consolidated 
with another license, certification, or registration issued by the department.
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses and cost to 
persons who are required to comply with the amendments as proposed are not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the implementation of a 
consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 

SUBCHAPTER B. Devices
4 TAC sec.12.12
The amendment to sec.12.12 is proposed under the Texas Agriculture Code, 
sec.12.033, which provides that the department by rule must implement a program 
for the issuance of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033, 
and the Texas Agriculture Code, Chapter 13. 

sec.12.12. Fees. 
<nl>Except as provided by Chapter 2, Subchapter B of this title (relating to 
Consolidated Licenses), fees for weights and measures device registrations are 
as follows:<ol> 
<nl>(1)<ol> [(a)] Liquid measuring device or pump: $6.25 (per nozzle). 
<nl>(2)<ol> [(b)] Bulk metering device: $25. 
<nl>(3)<ol> [(c)] LPG meter: $25. 
<nl>(4)<ol> [(d)] Scale (capacity less than 5,000 pounds): $12.50. 
<nl>(5)<ol> [(e)] Ranch scales: $12.50.
<nl>(6)<ol> [(f)] Truck Scales and other large scales (capacity 5,000 pounds or 
greater): $100. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802202
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

SUBCHAPTER E. Licensed Service Companies
4 TAC sec.12.40, sec.12.43
The amendments to sec.12.40 and sec.12.43 are proposed under the Texas 
Agriculture Code, sec.12.033, which provides that the department by rule must 
implement a program for the issuance of a consolidated license. The Code 
affected by this proposal is the Texas Agriculture Code, sec.12.033 and the 
Texas Agriculture Code, Chapter 13. 

sec.12.40. License Requirements. 
(a) A person shall not employ registered technicians to place devices into 
service or remove an out-of-order tag unless licensed as a licensed service 
company. <nl>Except as provided by Chapter 2, Subchapter B of this title 
(relating to Consolidating Licenses), the<ol> [The] license is valid for one 
year and, if not renewed, shall expire on the company's anniversary date. 
(b) (No change.) 

sec.12.43. Fees. 
<nl>Except as provided by Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses), the<ol> [The] fee for each class of license is $50. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802203
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 13. Grain Warehouse
4 TAC sec.13.3, sec.13.4
The Texas Department of Agriculture (the department) proposes amendments to 
sec.13.3 and sec.13.4, concerning the expiration date and fees for grain 
warehouse licenses. The department proposes these amendments because they are 
necessary for the implementation of a consolidated license program pursuant to 
Texas Agriculture Code, Chapter 12, sec.12.033. The amendments allow the 
department to adjust the expiration date and fee schedules for a grain warehouse 
license when the licensee's grain warehouse license is consolidated with another 
license, certification, or registration issued by the department. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses and cost to 
persons who are required to comply with the amendments as proposed are not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the implementation of a 
consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The amendments are proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapter 14. 

sec.13.3. License and Permits. 
(a)-(e) (No change.) 
(f) <nl> Except as provided by Chapter 2, Subchapter B of this title, (relating 
to Consolidating Licenses), a<ol> [A] license shall expire on May 31st of each 
year unless the license is cancelled or suspended. 
(g)-(j) (No change.) 

sec.13.4. Fees. 
(a)-(b) (No change.) 
<nl>(c)<ol> The fees provided in this section are applicable to the extent that 
they do not conflict with Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802204
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 14. Vegetable and Citrus Fruit Handling and Marketing Program
SUBCHAPTER A. General Provisions
4 TAC sec.14.3
The Texas Department of Agriculture (the department) proposes an amendment to 
sec.14.3, concerning the fee for an Agricultural Protective Act license. The 
department proposes this amendment because it is necessary for the 
implementation of a consolidated license program pursuant to Texas Agriculture 
Code, Chapter 12, sec.12.033. The amendment allows the department to adjust the 
fee schedule for an Agricultural Protective Act license when the license is 
consolidated with another license, certification, or registration issued by the 
department. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses cost to 
persons who are required to comply with the amendment as proposed are not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the implementation of a 
consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the type-name="italic"> Texas 
Register. 
The amendment is proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapters 101-103. 

sec.14.3. Fees. 
(a)-(c) (No change.) 
<nl>(d)<ol> The fees provided in this section are applicable to the extent that 
they do not conflict with Chapter 2, Subchapter B of this title (relating to 
Consolidated Licenses). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802205
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 15. Egg Law
4 TAC sec.15.4, sec.15.5
The Texas Department of Agriculture (the department) proposes amendments to 
sec.15.4 and sec.15.5, concerning the fees and special fees for egg licenses. 
The department proposes these amendments because they are necessary for the 
implementation of a consolidated license program pursuant to Texas Agriculture 
Code, Chapter 12, sec.12.033. The amendments allow the department to adjust the 
fee schedules for an egg license when the license is consolidated with another 
license, certification, or registration issued by the department. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses and cost to 
persons who are required to comply with the amendments as proposed are not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the implementation of a 
consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The amendments are proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapter 132. 

sec.15.4. Fees. 
(a)-(d) (No change.) 
<nl>(e)<ol> The fees provided in this section are applicable to the extent that 
they do not conflict with Chapter 2, Subchapter B of this title (relating to 
Consolidated Licenses). 

sec.15.5. Special Fees. 
(a)-(c) (No change.) 
<nl>(d)<ol> The fees provided in this section are applicable to the extent that 
they do not conflict with Chapter 2, Subchapter B of this title (relating to 
Consolidated Licenses). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802206
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 16. Aquaculture
4 TAC sec.16.3
The Texas Department of Agriculture (the department) proposes an amendment to 
sec.16.3, concerning the fee for an aquaculture license. The department proposes 
this amendment because it is necessary for the implementation of a consolidated 
license program pursuant to Texas Agriculture Code, Chapter 12, sec.12.033. The 
amendment allows the department to adjust the fee schedule for an aquaculture 
license when the license is consolidated with another license, registration, or 
certification issued by the department. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses and cost to 
persons who are required to comply with the amendment as proposed are not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the department's 
implementation of a consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The amendment is proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapter 134. 

sec.16.3. <nl>Fees. <ol>
<nl>Except as provided by Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses), the fee<ol> [Fee] for a license under this chapter is 
$100. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802207
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 18. Organic Standards and Certification
4 TAC sec.18.2, sec.18.5
The Texas Department of Agriculture (the department) proposes amendments to 
sec.18.2 and sec.18.5, concerning the expiration date and fees for organic 
certification. The department proposes these amendments because they are 
necessary for the implementation of a consolidated license program pursuant to 
Texas Agriculture Code, Chapter 12, sec.12.033. The amendments allow the 
department to adjust the expiration date and fee schedules for organic 
certification when the organic certification is consolidated with another 
license, certification, or registration issued by the department. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses and cost to 
persons who are required to comply with the amendments as proposed is not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the implementation of a 
consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The amendments are proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapter 18. 

sec.18.2. Certification, Application, and Inspection.
(a) Certification. 
(1)-(3) (No change) 
(4) <nl>Except as provided by Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses), producers<ol> [Producers], processors, distributors, 
and retailers will be certified on an annual basis from January 1 to December 31 
of each year, except initial applicants whose certification will expire December 
31. 
(b)-(d) (No change.) 

sec.18.5. Fees. 
(a)-(d) (No change.) 
<nl>(e)<ol> The fees provided in this section are applicable to the extent that 
they do not conflict with Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802208
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

CHAPTER 22. Nursery Products and Floral Items
4 TAC sec.22.2, sec.22.3
The Texas Department of Agriculture (the department) proposes amendments to 
sec.22.2 and sec.22.3, concerning the expiration date and fees for 
nursery/floral registrations. The department proposes these amendments because 
they are necessary for the implementation of a consolidated license program 
pursuant to Texas Agriculture Code, Chapter 12, sec.12.033. The amendments allow 
the department to adjust the expiration date and fee schedules for a 
nursery/floral registration when the nursery/floral registration is consolidated 
with another license, certification, or registration issued by the department. 
Diane B. Smith, Assistant Commissioner for Administrative Services, has 
determined that for the first five-year period the proposed amendments are in 
effect there will be no fiscal implications for state or local government as a 
result of enforcing or administering the proposal. 
Ms. Smith also has determined that for each year of the first five years the 
proposal is in effect the expected public benefit derived from enforcement and 
administration of the proposal will be a consolidated license option with the 
possibility of lower license fees. The effect on small businesses and cost to 
persons who are required to comply with the amendments as proposed is not 
determinable at this time. However, the department anticipates that licensing 
fees may decrease over time due to cost savings from the implementation of a 
consolidated licensing system. 
Comments on the proposal may be submitted to Diane B. Smith, Assistant 
Commissioner for Administrative Services, Texas Department of Agriculture, P.O. 
Box 12847, Austin, Texas, 78711. Comments must be received no later than 30 days 
from the date of publication of the proposal in the Texas Register. 
The amendments are proposed under the Texas Agriculture Code, sec.12.033, which 
provides that the department by rule must implement a program for the issuance 
of a consolidated license. 
The Code affected by this proposal is the Texas Agriculture Code, sec.12.033 and 
the Texas Agriculture Code, Chapter 71. 

sec.22.2. Application. 
(a)-(c) (No change.) 
(d) <nl>Except as provided by Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses), the<ol> [The] expiration date of registration 
certificates will be October 31st of each year. 
(e) (No change.) 

sec.22.3. Nursery/Floral Registration Classifications and Fees. 
(a)-(d) (No change.) 
<nl>(e)<ol> The fees provided in this section are applicable to the extent that 
they do not conflict with Chapter 2, Subchapter B of this title (relating to 
Consolidating Licenses). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802209
Dolores Alvarado Hibbs
Deputy General Counsel
Texas Department of Agriculture
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-7541

TITLE 16. ECONOMIC REGULATION
PART II. Public Utility Commission of Texas
CHAPTER 22.Practice and Procedure
SUBCHAPTER A.General Provisions and Definitions
16 TAC sec.22.2, sec.22.3
The Public Utility Commission of Texas proposes amendments to sec.22.2 relating 
to Definitions and sec.22.3 relating to Standards of Conduct. The proposed 
amendments to sec.22.2 of the procedural rules are to correct citations to the 
Public Utility Regulatory Act due to codification in the Texas Utilities Code; 
to clarify commission policy and procedures regarding the positions of 
administrative law judge, general counsel and secretary of the commission; and 
to delete definitions that are unnecessary. The proposed amendment to sec.22.3 
is to conform to the commission's practice for written communications. Project 
Number 17709 has been assigned to these amendments.
Paula Mueller, deputy chief, Office of Regulatory Affairs, has determined that 
for each year of the first five-year period the proposed sections are in effect 
there will be no fiscal implications for state or local government as a result 
of enforcing or administering the sections. 
Ms. Mueller also has determined that for each year of the first five years the 
proposed sections are in effect the public benefits anticipated as a result of 
enforcing the sections will be more clearly stated commission policy and 
procedures and rules that reference current statutes. There will be no effect on 
small businesses as a result of enforcing these sections. There is no 
anticipated economic cost to persons who are required to comply with the 
sections as proposed.
Ms. Mueller also has determined that for each year of the first five years the 
proposed sections are in effect there will be no impact on employment in the 
geographic area affected by implementing the requirements of the section.
Comments on the proposed amendments (16 copies) may be submitted to the Filing 
Clerk, Public Utility Commission of Texas, 1701 North. Congress Avenue, P.O. Box 
13326, Austin, Texas 78711-3326, within 30 days after publication.
The Appropriations Act of 1997, House Bill 1, Article IX, Section 167 requires 
that each state agency review and consider for readoption each rule adopted by 
that agency pursuant to the Government Code, Chapter 2001 (Administrative 
Procedure Act). Such reviews shall include, at a minimum, an assessment by the 
agency as to whether the reason for adopting or readopting the rule continues to 
exist. The commission invites specific comments regarding whether the reason for 
adopting these rules continues to exist in considering these proposed 
amendments. All comments should refer to Project Number 17709 and reference 
Procedural Rules, Subchapter A. 
These amendments are proposed under the Public Utility Regulatory Act, Texas 
Utilities Code Annotated sec.14.002 and sec.14.052 (Vernon 1998) (PURA), which 
provides the Public Utility Commission with the authority to make and enforce 
rules reasonably required in the exercise of its powers and jurisdiction, 
including rules of practice and procedure. 
Cross Index to Statutes: Public Utility Regulatory Act sec.14.002 and 
sec.14.052.

sec.22.2.Definitions.
The following terms, when used in this chapter, shall have the following 
meanings, unless the context or specific language of a section clearly indicates 
otherwise:
Administrative law judge-The person designated [by SOAH] to preside over a 
hearing. 
Affected person-The definition of affected person is that definition given in 
the Public Utility Regulatory Act, <nl>sec.11.003(1) <ol> [sec.1.003(1)]. 
APA-The Administrative Procedure Act, [The Government Code,] Chapter 2001, 
<nl>Government Code,<ol> as it may be amended from time to time. 
Applicant-A person, including <nl>the Office of Regulatory Affairs<ol> [the 
general counsel], who seeks action from the commission by written application, 
petition, complaint, notice of intent, appeal, or other pleading that initiates 
a proceeding. 
Complainant-A person, including <nl>the Office of Regulatory Affairs<ol> [the 
general counsel], who files a complaint intended to initiate a proceeding with 
the commission regarding any act or omission by the commission or any person 
subject to the commission's jurisdiction. 
Control number-Number assigned by the <nl>commission's Central Records<ol> 
[secretary] to a docket, project, or tariff. 
Major rate proceeding-Any proceeding filed pursuant to PURA, <nl> sec.sec.36.101 
- 36.111, 36.201-36.203 and 36.205<ol> [sec.2.212] or <nl>sec.sec.51.009, 53.101 
- 53.113, 53.201. and 53.202<ol> [sec.3.211] involving an increase in rates 
which would increase the aggregate revenues of the applicant more than the 
greater of $100,000 or 2.5%. In addition, a major rate proceeding is any rate 
proceeding initiated pursuant to PURA, <nl>sec.sec.36.151 - 36.156<ol> 
[sec.2.211] or <nl>sec.53.151 and sec.53.152<ol> [sec.3.210] in which the 
respondent utility is directed to file a rate filing package.
Presiding officer-The commission, any commissioner, [the commission secretary in 
an unprotested case,] or any administrative law judge presiding over a 
proceeding or any portion thereof. 
PURA-The Public Utility Regulatory Act, <nl>Texas Utilities Code, sec.sec.11.001 
- 63.063<ol> [of 1995], as it may be amended from time to time. 
[Secretary-The individual employed by the commission and charged with the duties 
of the secretary under this chapter. The secretary duties may be delegated as 
necessary.] 
[Tariff Filing-A proceeding initiated by an application filed pursuant to 
sec.23.24 - 23.28 of this title (relating to Form & Filing of Tariff and Rates), 
or PURA, sec.3.212 and sec.3.213, which is not handled as a docket or a 
rulemaking.] 

sec.22.3. Standards of Conduct.
(a) (No change.) 
(b) Communications. 
(1) (No change.) 
(2) Ex parte communications. Unless required for the disposition of ex parte 
matters authorized by law, members of the commission or administrative law 
judges assigned to render a decision or to make findings of fact and conclusions 
of law in a contested case may not communicate, directly or indirectly, in 
connection with any issue of law or fact with any agency, person, party, or 
their representatives, except on notice and opportunity for all parties to 
participate. Members of the commission or administrative law judges assigned to 
render a decision or to make findings of fact or conclusions of law in a 
contested case may communicate ex parte with employees of the commission who 
have not participated in any hearing in the case for the purpose of utilizing 
the special skills or knowledge of the commission and its staff in evaluating 
the evidence. 
<nl>(3)<ol> <nl> Communications with SOAH administrative law judges.<ol> 
Communications between <nl>SOAH<ol> administrative law judges and employees of 
the commission who have not participated in any hearing in the case shall be in 
writing or be recorded. Written communication should be the primary and 
preferred format. All oral communications shall be recorded, and a table of 
contents maintained for each recording. All such communication submitted to or 
considered by the administrative law judge shall be made available as public 
records when the proposal for decision is issued. Number running procedures 
conducted pursuant to written commission policy by employees of the commission 
who have participated in any hearing in the case do not constitute impermissible 
ex parte communications, provided memoranda memorializing such procedures are 
preserved and made available to all parties of record in the proceeding to which 
the number running procedures relate. 
(c)-(f) (No change.)
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802070
Rhonda Dempsey
Rules Coordinator
Public Utility Commission of Texas
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 936-7308

CHAPTER 23.Substantive Rules
Certification
16 TAC sec.sec.23.34, 23.35, 23.36, 23.37
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Public Utility 
Commission of Texas or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.)
The Public Utility Commission of Texas (PUC) proposes the repeal of sec.23.34 
relating to Integrated Resource Planning; sec.23.35 relating to Preliminary 
Integrated Resource Plan; sec.23.36 relating to Solicitation of Resources; and 
sec.23.37 relating to Approval of Resources Procured Through Solicitation. 
Project Number 17709 has been assigned to the proposed repeal of sec.sec.23.34-
23.37. The Appropriation Act of 1997, House Bill 1, Article IX, Section 167 
(Section 167) requires that each state agency review and consider for readoption 
each rule adopted by that agency pursuant to the Government Code, Chapter 2001 
(Administrative Procedure Act). Such reviews shall include, at a minimum, an 
assessment by the agency as to whether the reason for adopting or readopting the 
rule continues to exist. The PUC held three workshops to conduct a preliminary 
review of its rules. As a result of these workshops, the PUC is reorganizing its 
current substantive rules located in 16 Texas Administrative Code (TAC) Chapter 
23 to (1) satisfy the requirements of Section 167; (2) repeal rules no longer 
needed; (3) update existing rules to reflect changes in the industries regulated 
by the commission; (4) do clean-up amendments made necessary by changes in law 
and commission organizational structure and practices; (5) reorganize rules into 
new chapters to facilitate future amendments and provide room for expansion; and 
(6) reorganize the rules according to the industry to which they apply. As a 
result of this reorganization, sec.sec.23.34-23.37 will be duplicative of 
proposed new sections in Chapter 25 of this title (relating to Substantive Rules 
Applicable to Electric Service Providers). 
Paula Mueller, deputy chief, Office of Regulatory Affairs, has determined that 
for each year of the first five-year period these repeals are in effect there 
will be no fiscal implications for state or local government as a result of 
enforcing or administering the repeals. 
Ms. Mueller also has determined that for each year of the first five years the 
repeals are in effect, the public benefit anticipated as a result of the repeals 
will be the elimination of duplicative rules. There will be no effect on small 
businesses as a result of repealing these sections. There is no anticipated 
economic cost to persons as a result of repealing these sections. 
Ms. Mueller also has determined that for each year of the first five years the 
repeals are in effect there will be no impact on employment in the geographic 
area affected by the repeal of these sections. 
Comments on the proposed repeals (16 copies) may be submitted to the Filing 
Clerk, Public Utility Commission of Texas, 1701 North Congress Avenue, P.O. Box 
13326, Austin, Texas 78711- 3326, within 30 days after publication. All comments 
should refer to Project Number 17709, repeal of sec.sec.23.34-23.37.
These repeals are proposed under the Public Utility Regulatory Act, Texas 
Utilities Code Annotated sec.14.002 (Vernon 1998) (PURA), which provides the 
Public Utility Commission with the authority to make and enforce rules 
reasonably required in the exercise of its powers and jurisdiction.
Cross Index to Statutes: Public Utility Regulatory Act sec.14.002. 
sec.23.34.Integrated Resource Planning.
sec.23.35.Preliminary Integrated Resource Plan.
sec.23.36.Solicitation of Resources. 
sec.23.37.Approval of Resources Procured Through Solicitation.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802068
Rhonda Dempsey
Rules Coordinator
Public Utility Commission of Texas
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 936-7308

CHAPTER 25.Substantive Rules Applicable to Electric Service Providers
SUBCHAPTER H.Electrical Planning
16 TAC sec.sec.25.161-25.171
The Public Utility Commission of Texas (PUC) proposes new sec.25.161 relating to 
Integrated Resource Planning; sec.25.162 relating to Public Participation; 
sec.25.163 relating to Acquisition of Resources Outside the Solicitation 
Process; sec.25.164 relating to Statewide Integrated Resource Plan; sec.25.165 
relating to Preliminary Integrated Resource Plan; sec.25.166 relating to 
Commission Review of a Preliminary Integrated Resource Plan that Does Not 
Include a Solicitation; sec.25.167 relating to Commission Review of a 
Preliminary Integrated Resource Plan that Includes a Solicitation; sec.25.168 
relating to Solicitation of Resources; sec.25.169 relating to Approval of 
Resources Procured Through Solicitation; sec.25.170 relating to Hearing on the 
Final Integrated Resource Plan; and sec.25.171 relating to Certificate of 
Convenience and Necessity for Generation Facilities. These new sections are 
proposed for Chapter 25, Subchapter H, relating to Electrical Planning. Project 
Number 17709 has been assigned to these proposed new rules.
The Appropriation Act of 1997, House Bill 1, Article IX, Section 167 (Section 
167) requires that each state agency review and consider for readoption each 
rule adopted by that agency pursuant to the Government Code, Chapter 2001 
(Administrative Procedure Act). Such reviews shall include, at a minimum, an 
assessment by the agency as to whether the reason for adopting or readopting the 
rule continues to exist. The PUC held three workshops to conduct a preliminary 
review of its rules. As a result of these workshops, the PUC is reorganizing its 
current substantive rules located in 16 Texas Administrative Code (TAC) Chapter 
23 to (1) satisfy the requirements of Section 167; (2) repeal rules no longer 
needed; (3) update existing rules to reflect changes in the industries regulated 
by the commission; (4) do clean-up amendments made necessary by changes in law 
and commission organizational structure and practices; (5) reorganize rules into 
new chapters to facilitate future amendments and provide room for expansion; and 
(6) reorganize the rules according to the industry to which they apply. 16 TAC 
Chapter 25 has been established for all commission substantive rules applicable 
to electric service providers. The duplicative sections of Chapter 23 will be 
proposed for repeal as each new section is proposed for publication in Chapter 
25. 
The term "public utility" has been changed to "electric utility" throughout the 
proposed new rule sections to conform to the Texas Utilities Code. 
Proposed new sec.25.161 will replace corresponding sec.23.34(a)-(e), (h), (i), 
and (l) of this title (relating to Integrated Resource Planning). The proposed 
language in sec.25.161 has been changed from that in sec.23.34 to reflect 
references to new chapter sections, and to correct citations to the Public 
Utility Regulatory Act (PURA) due to codification in the Texas Utilities Code. 
The proposed change in sec.25.161(g)(1) removes the word "annual" in the term 
"ongoing annual demand-side resource solicitation" to better reflect the 
commission's intent regarding the acquisition of demand-side resources. This 
change has also been made in sec.sec.25.162(e)(5), 25.165(a)(2)(H)(viii) and 
25.165(c) for consistency. 
Proposed new sec.25.162 will replace corresponding sec.23.34(f) and (g) of this 
title. The proposed language in sec.25.162 has been changed from that in 
sec.23.34(f) and (g) to correct subsection and paragraph designations due to the 
renumbering of the rules and to reflect commission policy and procedures 
regarding the position of secretary of the commission. 
Proposed new sec.25.163 will replace corresponding sec.23.34(j) of this title. 
The only change to the proposed language in sec.25.163 to that of sec.23.34(j) 
is to reflect the correct subsection and paragraph designations due to the 
renumbering of the rules. 
Proposed new sec.25.164 will replace corresponding sec.23.34(k) of this title. 
The only change to the proposed language in sec.25.164 to that of sec.23.34(k) 
is to reflect the correct subsection, and paragraph designations due to the 
renumbering of the rules. 
Subsection (m) of sec.23.34 has no corresponding section in the new rules. It 
has been deleted as no longer necessary. 
Proposed new sec.25.165 will replace corresponding sec.23.35(a)-(c) and (e) of 
this title (relating to Preliminary Integrated Resource Plan). The proposed 
language in sec.25.165 has been changed from that in sec.23.35 to add a new 
subparagraph to make explicit the filing and approval of date(s) for filing of 
contracts for resources procured through solicitation. This new language is 
reflected in sec.25.165(a)(2)(L) (following subsection (a)(2)(K) in sec.23.35). 
Subsection (a)(2)(H)(i) requires the utility to file the dates of the proposed 
solicitation process, including the issuance of the request for proposal, the 
due date of bids, and the negotiation period. The proposed new (a)(2)(L) will 
make explicit the requirement that a utility file the proposed dates for the 
entire IRP cycle. The language in sec.25.165 has also been changed to reflect 
the correct subsection designations due to the renumbering of the rules. 
Proposed new sec.25.166 will replace corresponding sec.23.35(d) of this title. 
The proposed language in sec.25.166 has been changed from that in sec.23.35(d) 
to reflect corrections to PURA due to codification in the Texas Utilities Code 
and to reflect the correct subsection designation due to renumbering of the 
rules. 
Proposed new sec.25.167 will replace corresponding sec.23.35(f) of this title. 
The proposed language in sec.25.167 has been changed from that in sec.23.35(f) 
to amend sec.23.35(f)(2)(M) (new sec.25.167(c)(13)) to make explicit the 
commission's approval of the three-year plan to acquire resources outside the 
solicitation process; to add new sec.25.167(c)(14) to make explicit the filing 
and approval of date(s) for filing of contracts for resources procured through 
solicitation; and to amend sec.23.35(f)(3) (new sec.25.167(d)) to make the 
process more administratively efficient. The language in sec.25.167 has also 
been changed to reflect references to new chapter sections and to reflect the 
correct subsection and paragraph designations due to renumbering of the rules. 
Proposed new sec.25.168 will replace corresponding sec.23.36 of this title 
(relating to Solicitation of Resources). The proposed language in sec.25.168 has 
been changed from that in sec.23.36 to reflect changes in commission policy and 
procedures regarding the position of secretary of the commission and to reflect 
correct references to new chapter sections due to renumbering of the rules. 
Proposed new sec.25.169 will replace corresponding sec.23.37(a)-(d) of this 
title (relating to Approval of Resources Procured Through Solicitation). The 
proposed language in sec.25.169 has been changed from that in sec.23.37 to amend 
sec.23.37(c) (new sec.25.169(c)) to make explicit the need to create a new 
docket number for approval of a contract for resources to make the process more 
administratively efficient. The proposed language has also been changed to 
reflect the correct references to new chapter sections due to renumbering of the 
rules. 
Proposed new sec.25.170 will replace corresponding sec.23.37(e) of this title. 
The proposed language in sec.25.170 has been changed to reflect the correct 
subsection and paragraph designations and the correct references to new chapter 
sections due to renumbering of the rules. 
Proposed new sec.25.171 will replace corresponding sec.23.37(f) of this title. 
The proposed language in sec.25.171 has been changed to reflect the correct 
subsection designation due to renumbering of the rules. 
The cost and benefit assessment that was performed when sec.sec.23.34-23.37 were 
originally adopted at the June 26, 1996 Open Meeting of the Public Utility 
Commission of Texas is still accurate. (See 21 TexReg 477 for publication of 
proposed rule sec.sec.23.34-23.37 and 21 TexReg 6780 for publication of the 
adopted sections). The proposed changes to the rule language in new 
sec.sec.25.161-25.171 do not affect that assessment. The benefits of the rules 
exceed the costs. 
Nat Treadway, economist, Office of Policy Development, has determined that for 
each year of the first five-year period the proposed sections are in effect 
there will be no fiscal implications for state or local government as a result 
of enforcing or administering the sections. 
Mr. Treadway has determined that for each year of the first five years the 
proposed sections are in effect the public benefit anticipated as a result of 
enforcing the sections will be clarification of utility requirements and 
commission procedures related to integrated resource planning, and rules that 
are more administratively efficient, and that more accurately reflect commission 
policy and procedures. There will be no effect on small businesses as a result 
of enforcing these sections. There is no anticipated economic cost to persons 
who are required to comply with the sections as proposed. 
Mr. Treadway also has determined that for each year of the first five years the 
proposed sections are in effect there will be no impact on employment in the 
geographic area affected by implementing the requirements of the sections.
Comments on the proposed new rules (16 copies) may be submitted to the Filing 
Clerk, Public Utility Commission of Texas, 1701 North Congress Avenue, P.O. Box 
13326, Austin, Texas 78711-3326, within 30 days after publication. The 
commission invites specific comments regarding whether the reason for adopting 
the rules in Chapter 23 continues to exist in adopting its corresponding section 
in the new chapter. All comments should refer to Project Number 17709, 
Electrical Planning. 
These new rules are proposed under the Public Utility Regulatory Act, Texas 
Utilities Code Annotated sec.14.002 (PURA), which provides the Public Utility 
Commission with the authority to make and enforce rules reasonably required in 
the exercise of its powers and jurisdiction; and specifically sec.34.003 which 
requires the commission by rule to develop an integrated resource planning 
process to provide reliable energy service at the lowest reasonable system cost. 
Cross Index to Statutes: Public Utility Regulatory Act sec.sec.14.002, 34.003-
34.006, 34.021-34.024, 34.051-34.056, 34.101-34.105, 34.151-34.153, 34.171-
34.173.

sec.25.161.Integrated Resource Planning. 
(a) Purpose. The commission's regulation of utility resource planning and 
procurement is intended to ensure that utilities provide reliable energy service 
at the lowest reasonable system cost. The integrated resource planning process 
can advance the transition to a more competitive marketplace by aligning the 
utility's interest more closely with its customers. Utilities shall determine 
customer preferences with regard to planning options, consider all of the 
attributes of a broad range of resources that affect the supply or demand for 
electricity, procure resources based upon a fair and reasonable evaluation of 
the costs and attributes of resources that may be obtained in a market, and 
negotiate contracts that appropriately allocate risk. The development of a 
competitive wholesale electric market that allows for increased participation by 
both utilities and certain non-utilities is in the public interest. Nothing in 
the integrated resource planning process shall inhibit the development of 
competitive markets for electric power or for energy services. 
(b) Application. The requirements of this section and sec.25.162 of this title 
(relating to Public Participation), sec.25.163 of this title (relating to 
Acquisition of Resources Outside the Solicitation Process), sec.25.164 of this 
title (relating to Statewide Integrated Resource Plan), sec.25.165 of this title 
(relating to Preliminary Integrated Resource Plan), sec.25.166 of this title 
(relating to Commission Review of a Plan that Does Not Include a Solicitation), 
sec.25.167 of this title (relating to Commission Review of a Plan that Includes 
a Solicitation), sec.25.168 of this title (relating to Solicitation of 
Resources), sec.25.169 of this title (relating to Approval of Resources Procured 
through Solicitation), sec.25.170 of this title (relating to Hearing on the 
Final Integrated Resource Plan), and sec.25.171 of this title (relating to 
Certificate of Convenience and Necessity for Generation Facilities) apply as 
specified in this subsection.
(1) Generating electric utilities are subject to the requirements of this 
section and sec.sec.25.162 - 25.171 of this title. 
(2) Nongenerating electric utilities planning to construct generating resources 
are subject to the requirements of this section and sec.sec.25.162 - 25.171 of 
this title. 
(3) A nongenerating electric utility that seeks to purchase more than 25% of its 
peak demand or more than 70 megawatts during any three-year period is subject to 
the requirements of subsection (f), and subsection (g)(1) - (2) of this section; 
sec.25.163 of this title; sec.25.168 of this title; sec.25.169(a)(2), (b), 
(c)(1), (2)(B), (5) - (7), and (d) of this title; and sec.25.170(a), (b), 
(c)(1), (2)(B) - (C), and (5) - (7) of this title, unless the purchase is from 
its current power supplier as allowed by sec.25.163(1) of this title. If 
requested by such a utility, the commission may conduct a public hearing to 
consider the reasonableness of any contract for resources, if it determines that 
such a hearing is necessary. The commission shall issue an order approving, 
modifying, or rejecting the contract for resources resulting from the 
solicitation within 90 days of the date that the application is filed with the 
commission. 
(4) Every three years, a municipally owned utility shall submit to the 
commission a report containing all of the information required in a preliminary 
integrated resource plan under sec.sec.25.165 - 25.167 of this title, but shall 
not otherwise be subject to the requirements of this section. 
(5) A river authority subject to the Public Utility Regulatory Act (PURA) 
sec.sec.32.051 - 32.054 is subject to the requirements of this section and 
sec.sec.25.162 - 25.171 of this title with respect to the area served by the 
river authority on January 1, 1975. 
(6) An electric utility that is not otherwise subject to the requirements of 
this section or sec.sec.25.162 - 25.171 of this title shall provide information 
to and cooperate with its utility wholesale power suppliers to develop and 
implement a resource plan to the extent that such activities do not otherwise 
affect either utility's competitive strategy.
(c) Structure of integrated resource planning. The integrated resource planning 
process consists of the following steps and activities:
(1) Public participation and preparation of preliminary integrated resource 
plan. In accordance with this section, the electric utility shall solicit the 
views of the public on resource planning matters and prepare a preliminary 
integrated resource plan. 
(2) Request for approval of preliminary integrated resource plan. In accordance 
with sec.sec.25.165 - 25.167 of this title, the electric utility shall file its 
preliminary integrated resource plan. If the preliminary plan contains a 
proposed resource solicitation, the commission shall issue an order on the 
preliminary plan, including the proposed solicitation, within 180 days. In each 
case, the commission shall establish a schedule that will permit it to enter an 
order in 180 days or less. If the preliminary plan of an investor- owned utility 
does not contain a proposed resource solicitation, the commission shall issue a 
notice of the filing of the plan. 
(3) Solicitation. In accordance with sec.25.168 of this title, the electric 
utility shall conduct a resource solicitation. The utility shall evaluate the 
bids and select the best resources consistent with the approved preliminary 
plan, if any. 
(4) Approval of resources procured through solicitation. If the electric utility 
has selected resources pursuant to a solicitation in accordance with sec.25.168 
of this title, it may request commission certification of the contracts under 
sec.25.169 of this title. In accordance with sec.25.169 of this title, the 
utility shall file its final plan. The commission shall issue a final order on 
the final plan within 180 days. In each case, the commission shall establish a 
schedule that will permit it to enter an order in 180 days or less. If a utility 
is filing pursuant to subsection (b)(3) of this section, the commission shall 
issue a final order within 90 days. If the utility plans to acquire additional 
generating facilities that require an amendment of its certificate of 
convenience and necessity, the utility shall apply for such an amendment, in 
accordance with sec.25.171 of this title. 
(d) Staggered schedule. In October 1996 and no less frequently than every two 
years thereafter, the commission shall adopt a staggered schedule for the filing 
of preliminary integrated resource plans by electric utilities. The schedule 
will set forth the name of each electric utility affected by this section and 
sec.sec.25.162 - 25.171 of this title, and the date on which each utility shall 
file its preliminary plan. 
(e) Filing requirements. In October 1996 and no less frequently than every two 
years thereafter, the commission shall adopt forms for preliminary and final 
integrated resource plans. The forms shall reflect the differences in 
capabilities of small and large utilities, and of utilities with different 
structures and patterns of ownership. Electric utilities that provide service 
that is subject to rate regulation by a federal agency or an agency of another 
state shall file any information required in this section or sec.sec.25.162 - 
25.171 of this title separately identifying information for Texas-only 
operations and for total system operations. Upon a showing of good cause, a 
utility that is subject to resource planning requirements of a federal agency or 
an agency of another state may file all or part of its integrated resource plan 
in a format required by the federal agency, the regulatory agency of another 
state, or a regional planning agency. 
(f) Lowest reasonable system cost. In determining the lowest reasonable system 
cost of an electric utility's plan, the commission shall consider in addition to 
direct costs the following: 
(1) the effect on the rates and bills of various types of customers; 
(2) minimization of the risks of future fuel costs and regulations; 
(3) the appropriateness and reliability of the mix of resources; an appropriate 
and reliable mix of resources may include a portfolio of cost-effective sources 
of power including but not limited to resources that are fueled and non- fueled, 
such as renewable resources and conservation measures and a mixture of long-term 
and short-term contracts; and 
(4) the costs of compliance with the environmental protection requirements of 
all applicable state and federal laws, rules, and orders.
(g) General guidelines for evaluating and selecting resources. The commission 
finds that the development of a competitive wholesale electric market that 
allows for increased participation by both utilities and certain non-utilities 
is in the public interest. Existing markets are not fully open nor fully 
competitive; therefore, the commission finds that a formal solicitation process 
with regulatory oversight is appropriate. 
(1) All-source bidding. In formally soliciting bids, the utility shall use an 
all- source, integrated, demand-side and supply-side resource solicitation 
process. The all-source solicitation may include separate, parallel requests for 
proposals which are fully coordinated to meet the resource need, and which are 
integrated at the final stages of resource selection. The utility may conduct 
targeted solicitations upon a showing of good cause, and upon approval of the 
commission. The utility may conduct an ongoing demand- side resource 
solicitation, or other similar process, if the participants in its triennial 
public participation process support such an approach and have set limits, 
including upper bounds of costs and capacity, for such a solicitation or 
process, and if the commission approves the solicitation or process. 
(2) Quantification. In developing its specific resource selection criteria, the 
utility shall quantify, to the maximum reasonable extent, the factors it 
considers in evaluating resources. If available, the utility shall employ 
objective market valuations of environmental and other non-cost factors which 
influence its resource selection process, such as market valuations of tradable 
emissions allowances. Where appropriate, the utility may set forth a framework 
for the ranking and weighting of various factors that can not easily be 
quantified. 
(3) Resource selection criteria and weights. In developing its specific resource 
evaluation criteria and weights, the utility shall consider the lowest 
reasonable system cost, the characteristics of the resource need, the values and 
preferences of its customers, and the goals set forth in the most recently 
adopted statewide integrated resource plan. 
(h) Confidential information. Any information submitted by a utility pursuant to 
this section and sec.sec.25.162 - 25.171 of this title may be submitted by the 
utility under seal. Each page submitted under seal shall have the words 
"Confidential Information" typed or stamped on its face. The utility shall 
clearly identify each portion of the application alleged to be Confidential 
Information; identify the exemption to the Open Records Act, Government Code, 
Title 5, Chapter 552, et seq. applicable to the alleged Confidential 
Information; and provide a detailed explanation of why the alleged Confidential 
Information should be exempt from public disclosure under the Open Records Act. 
The utility may require the execution of an appropriate confidentiality 
agreement prior to providing access to such confidential information to any 
interested party. The form of any such confidentiality agreement shall be agreed 
to by the Legal Division of the Office of Regulatory Affairs prior to filing and 
included with the informational filing.

sec.25.162.Public Participation.
(a) Public participation in resource planning matters is an essential part of 
integrated resource planning. The electric utility shall consider the views of 
the public in preparing integrated resource plans, and shall reflect such views 
in any preliminary plan, regardless of whether such plan includes a proposed 
solicitation. 
(b) Purpose. The purpose of public participation is to educate the public on 
resource planning issues and the utility's planning activities, and to obtain 
the non-technical guidance of the public on planning matters, including the 
values and preferences of customers. It is not the purpose of public 
participation to establish a quasi-judicial group with authority over resource 
planning matters. 
(c) Process. Electric utilities may decide how to conduct public participation 
in their service areas subject to the requirements of this subsection and may 
limit direct participation to its customers. The utility shall ensure fair 
representation of residential, commercial, and industrial customers, 
municipalities, and the geographic areas in its service territory in the public 
participation process. The utility shall include in its preliminary plan a 
description of how it has achieved fair representation in selecting the 
participants. The utility may request the involvement of the commission or its 
staff in the public participation process. 
(d) Record. The utility is responsible for maintaining a comprehensive record of 
its public participation activities for a period of five years.
(e) Standards. Public participation requires two-way communication, and the 
utility shall facilitate the presentation of information from a broad range of 
perspectives to the participants, including the views of competitors and other 
non-customers. At a minimum, the utility shall obtain sufficient information 
from the participants regarding the values and preferences of its customers to 
allow the utility to incorporate those views in the preliminary plan. 
Specifically, the utility shall consider the views of the participants in 
determining: 
(1) the resource selection criteria and specific weights to be applied in the 
proposed resource solicitation, if any; 
(2) the ongoing strategies of the utility to achieve the lowest reasonable 
system cost for its service area; 
(3) whether targeted bidding may be justified in order to obtain an appropriate 
and reliable mix of resources; 
(4) an appropriate resource mix for the utility; and
(5) limits, including upper bounds of costs and capacity, relating to an ongoing 
demand-side resource solicitation, if any. 
(f) Information. 
(1) The utility shall make available for review at no cost to the public at 
large at convenient locations in its service area, a copy of the most recent 
resource plan and a copy of the orders of the commission concerning the plan. 
The utility shall make available to any individual making a request a copy of 
the executive summary of its most recent resource plan.
(2) Prior to distributing informational materials to the participants under this 
subsection, the utility shall make the materials planned for distribution 
available to the commission staff and to the public at large, including 
competitors and other non-customers who may address the participants, and the 
utility shall accept comments on the content of the materials. 
(3) The utility shall provide information to the participants regarding the 
operating cost, environmental or community impacts, planned capital additions 
(e.g., repowering or refurbishment), potential for productivity and efficiency 
improvements, and expected remaining life of existing generating units 
(including life extension or early retirement options), and an estimate of the 
reasonable range of direct and indirect costs, including the bill impacts and 
risks, of these and alternative supply-side resources. The utility shall provide 
information to the participants regarding existing resources, existing customer 
services, demand-side management programs, and energy service and pricing 
options, and a reasonable range of costs for providing new demand-side 
resources, programs, and services. The utility shall provide information to the 
participants regarding the resource mix and the role of demand-side resource 
solicitations in meeting both capacity and customer service needs. In addition, 
the utility shall provide information related to its existing resources which 
enables the participants to compare such resources to currently available 
options and to select an appropriate resources mix. 
(g) Notice. At least every three years, each utility shall provide reasonable 
notice regarding the opportunities for customers and non-customers to become 
involved in the public participation process. This notice shall be filed with 
the commission's central records. Such notice shall describe the process, shall 
indicate how to obtain a schedule of events, and shall include: 
(1) notice by mail to the Office of Public Utility Counsel, and the governing 
bodies of municipalities in the utility's service area;
(2) direct notice to persons who submitted to the commission a request that the 
utility notify them of resource planning matters; and 
(3) notice by publication in the service area. 
(h) Good cause exception. The commission may grant a good cause exception to any 
of the public participation requirements of this subsection for a utility's 
public participation efforts that were completed or were in progress by the 
effective date of this section. In evaluating requests for good cause exceptions 
under this paragraph, the commission shall consider whether the utility's public 
participation process was consistent with the purpose of public participation as 
prescribed in subsection (b) of this section.
(i) Lists of interested persons. The commission shall maintain lists of 
interested persons as specified in this subsection. The commission shall provide 
a copy of such lists upon request to any interested party. In implementing this 
subsection, the commission may refer interested persons to comparable lists 
maintained by utilities. This subsection expires on September 1, 2002. The 
commission shall maintain lists of persons who have requested to be notified of:
(1) resource planning matters, including opportunities for public participation 
and the filing of preliminary and final integrated resource plans. Persons 
requesting inclusion on such lists must state in writing their name and address 
and the name of the utility in which they have an interest;
(2) the issuance of any request for proposals for resources in Texas; and
(3) the issuance of any request for qualifications for independent bid 
evaluators. 

sec.25.163. Acquisition of Resources Outside the Solicitation Process.
Consistent with the utility's most recent approved integrated resource planning 
goals, if any, the utility, including a nongenerating utility, may add new or 
incremental resources outside the solicitation process. The addition of new or 
incremental resources by a utility under this subsection does not require an 
amendment to the utility's integrated resource plan. The utility shall acquire 
such resources under contract, and the utility shall put in place accounting 
procedures that allow the tracking of the costs of such resources. An electric 
cooperative may acquire such resources directly or in coordination with another 
electric cooperative. Except as provided for in the previous sentence, an 
electric utility may not acquire a resource under this subsection from an 
affiliate of the utility, except that the resources cited under paragraphs (6) 
and (7) of this subsection may be provided by the utility. The acquisition of a 
resource outside the solicitation process under paragraphs (1) - (3) and (5) - 
(6) of this subsection does not relieve the utility of its responsibility to 
demonstrate in an appropriate forum that such resources are preferable to the 
alternatives that would have been available through a resource solicitation. 
Resources may be acquired outside the solicitation process only in the following 
circumstances:
(1) contract renegotiation for existing capacity; 
(2) demand-side management resources or resources powered by renewable energy 
technologies; 
(3) capacity purchases with a term of two years or less;
(4) capacity purchases necessary to satisfy unanticipated emergency conditions; 
(5) the exercise of an option in a purchased power contract;
(6) distributed resources powered by renewable resource technologies located at 
or near the point of consumption if such resources are less costly than local 
facility extensions or upgrades; or 
(7) demand-side management programs for low-income customers that the utility 
develops through coordination with state or federally authorized weatherization 
providers.

sec.25.164.Statewide Integrated Resource Plan.
(a) Process. In November 1998 and every two years thereafter, the commission 
shall adopt a statewide integrated resource plan. The statewide plan shall 
include the commission's long-term resource planning goals. When it adopts the 
statewide plan, the commission shall send the plan and a report on the plan to 
the governor and shall notify each electric utility that a statewide plan has 
been adopted. The commission shall make the statewide plan and the report on the 
plan available to the public. 
(b) Contents of the report. The report on the statewide plan shall include the 
commission's long-term resource planning goals for the State of Texas and: 
(1) historical data for electric consumption statewide and by utility; 
(2) historical data for electric generation by utility and by type of capacity, 
including alternative energy sources; 
(3) an inventory of generation capacity statewide and by utility; 
(4) quantitative data on demand-side management programs to the extent the 
commission determines necessary; 
(5) each generating utility's forecast without adjustment;
(6) a projection of the need for electric services; 
(7) a description of the approved individual integrated resource plans of 
electric utilities; 
(8) an assessment of transmission planning being performed by utilities within 
this state; and 
(9) other information as determined by the commission.
(c) Recommendations regarding transmission system needs. In carrying out its 
duties related to the integrated resource planning process and in setting rates 
for utilities that are not required to file an integrated resource plan, the 
commission may review the state's transmission system to determine and make 
recommendations to electric utilities on the need to build new power lines, 
upgrade power lines, or make other improvements and additions.

sec.25.165.Preliminary Integrated Resource Plan.
(a) Filing requirements. 
(1) All utilities. Preliminary integrated resource plans for a ten-year period 
shall be submitted every three years and shall be accompanied by an executive 
summary and the identity, address, telephone number and facsimile number of a 
contact person to deal with matters relating to the filing. All filings made 
under this section shall be comprehensive and provide sufficient detail, work 
papers, and source materials to allow the commission to determine the accuracy 
and reasonableness of the determinations made by the utility. The utility shall 
explain any differences between the filing and the most recent resource plan 
filing with the Electric Reliability Council of Texas or other reliability 
council. A preliminary plan submitted by an electric utility or a municipal 
utility under this section must include current and ten-year projections of: 
(A) statistical data, including the utility's forecast or projections of: 
(i) summer and winter peak demand and electricity usage; 
(ii) adjustments to peak demand and electricity usage related to the acquisition 
of demand-side resources, interruptible load, and other factors that affect peak 
demand and electricity usage; 
(iii) existing system capacity, current and target reserve margins, and resource 
additions and retirements; and 
(iv) a description of existing and planned resources; and
(B) the utility's projection of major transmission line additions.
(2) Electric utilities. In addition to the information requested in paragraph 
(1) of this subsection, electric utilities shall submit:
(A) a description of energy service options and pricing options available to 
each class of customers including options relating to: 
(i) the reliability of service (variations in firmness or interruptibility); 
(ii) the quality of service (voltage fluctuation or other quality attributes); 
(iii) the stability of prices (such as rate or electric bill guarantees and 
budget plans); 
(iv) the choice of power service (such as green pricing or particular 
technologies); 
(v) the time of usage (such as seasonality, time-of-use, and real- time 
pricing); 
(vi) alternative billing or metering arrangements (such as conjunctive billing); 
(vii) backup, standby, or maintenance power service; and 
(viii) other factors of service and pricing structures that affect customer 
choice and resource planning; 
(B) an estimate of the energy savings and demand reduction the utility can 
achieve during the ten-year period through the acquisition of demand-side 
resources, and the range of possible costs for those resources;
(C) a description of how the utility will achieve equity among customer classes 
and provide demand-side management programs to each customer class including 
tenants and low-income ratepayers; 
(D) a description of how the utility promotes the development of renewable 
energy technology projects and distributed resources; 
(E) an estimate of additional supply-side resources needed to meet future 
demand, an estimate of the amount and operational characteristics of the 
additional capacity needed, the types of viable supply-side resources for 
meeting that need, the range of probable costs of those resources, and 
supporting technical data; 
(F) a record of public participation including a description of the process and 
a demonstration that the views and preferences of the utility's customers were 
considered in preparing the preliminary plan; 
(G) an evaluation of different internally-consistent planning scenarios and a 
discussion of the incidence and treatment of various factors of risk, including, 
but not limited to, performance, environmental, financial, and fuel-related 
risks; 
(H) proposed solicitations for new or replacement demand-side or supply- side 
resources including: 
(i) a description of the resource solicitation process and projected dates for 
the important events (issuance of the request for proposals, bid due date, 
negotiation period); 
(ii) the proposed request for proposals and draft model contract for resources;
(iii) proposed bidder eligibility restrictions, if any, and proposed minimum 
threshold criteria related to bids, and the justification of any such 
restrictions; 
(iv) a description of the resource selection criteria and weights the utility 
will use to evaluate and select or reject resources and a listing of the 
criteria which were considered and rejected; 
(v) an explanation and quantification of how the utility assigns value to 
important options, such as options to accelerate or delay a project; to 
characteristics of resources, such as intermittence and dispatchability; to 
factors of risk, such as fuel cost risk mitigation, and to other significant 
options, characteristics, and factors that the utility employs in the selection 
of resources; 
(vi) an explanation of how, in developing specific resource selection criteria 
and weights, the utility has taken into account the definition of the lowest 
reasonable system cost, the values and preferences of customers, the 
characteristics of the resource need, and any statewide goals; 
(vii) documentation in support of a good cause exception for a targeted 
solicitation, if any; and 
(viii) documentation in support of an ongoing demand-side resource solicitation, 
if any; 
(I) a description of how the utility intends to allocate the costs of different 
types of demand-side and supply-side resources that could be procured; 
(J) any proposed incentive factors, the justification for such factors, and the 
proposed regulatory mechanism for the recovery of incentives; and 
(K) information regarding the cost and operation of each resource acquired 
outside the solicitation process during the past three years and a projection, 
to the extent known, of the resources that will be acquired outside the 
solicitation process during the next three years. 
(L) proposed date for filing contracts for certification pursuant to sec.25.169 
of this title (relating to Approval of Resources Procured Through Solicitation). 
(b) Notice. The utility shall file copies of its application under this section 
with the filing clerk of the commission and the Office of Public Utility 
Counsel. The utility shall also provide notice of the filing by publication in 
its service area and to any persons who have requested, in writing, to be 
notified of resource planning matters. The notice shall be completed not later 
than 15 days after the filing of the application. Interested persons may 
intervene in the proceeding not later than 45 days after the date on which the 
utility files its resource plan. 
(c) No hearing required. A commission hearing is not required for a preliminary 
plan filed by a river authority or generating electric cooperative that does not 
intend to build a new generating plant, or for a preliminary plan filed by a 
municipally- owned electric utility, or for a preliminary plan filed by an 
investor-owned utility if the plan does not contain a proposed resource 
solicitation. A commission hearing is not required for a preliminary plan that 
contains a proposed ongoing demand-side management solicitation and no other 
proposed solicitation. 
(d) Deficiencies in filing. After an electric utility files a preliminary plan, 
the commission shall determine whether such plan complies with the filing 
requirements of this section. Parties may file motions alleging material 
deficiencies in the utility's application for approval of the resource plan not 
later than 21 days after the filing of the application. The utility may file 
responses to such motions not later than five working days after the receipt of 
such motions. The commission shall rule on such motions not later than 40 days 
after the date that the application was filed. If the commission concludes that 
the filing is materially deficient, it shall require the utility to supplement 
its filing or to file a new preliminary integrated resource plan within a 
specified time. The deadline for issuing an order in a utility's application for 
approval of a resource plan, and other deadlines related to the processing of 
the application, shall be calculated from the date that the utility files a plan 
that is not materially deficient.

sec.25.166. Commission Review of a Preliminary Integrated Resource Plan that 
Does Not Include a Solicitation.
The commission shall issue a final order on the preliminary plan of an investor- 
owned utility if the preliminary plan does not contain a proposed solicitation. 
In such a case the commission shall issue a notice concerning the filing of a 
preliminary plan and determine whether the plan is in compliance with applicable 
rules. The commission shall expeditiously issue a final order on the preliminary 
plan. In addition, a preliminary plan that does not contain a proposed 
solicitation may be reviewed for deficiencies pursuant to the Public Utility 
Regulatory Act (PURA) sec.sec.15.021, 15.023 - 15.027, 15.028, 15.030 and 15.032 
and the enforcement rules of the commission. 

sec.25.167. Commission Review of a Preliminary Integrated Resource Plan that 
Includes a Solicitation. 
(a) The commission may review a preliminary plan that contains a proposed 
solicitation on its own motion or on the motion of the utility or of an affected 
person. In conducting such a review, the commission shall convene a public 
hearing on the adequacy and merits of the preliminary plan.
(b) Procedure. At the hearing, any interested person may intervene, present 
evidence, and cross-examine witnesses regarding the contents and adequacy of the 
preliminary plan. Discovery is limited to issues relating to the development of 
the preliminary plan, fact issues included in the preliminary plan, and other 
issues the commission is required to decide relating to the preliminary plan. 
The time for providing responses to requests for information may be shortened on 
motion of any party, on a showing of good cause. The commission shall issue an 
order on the preliminary plan not later than 180 days after the date the utility 
files its preliminary plan. The 180-day period may be extended for a period not 
to exceed 30 days for extenuating circumstances encountered in the development 
and processing of an initial plan, if the extenuating circumstances are fully 
explained and agreed to by the commissioners. The commission may adopt a 
schedule for considering a preliminary plan in less than 180 days if the 
circumstances warrant it. 
(c) Commission determinations. After the hearing, the commission shall make the 
following determinations with regard to an electric utility's preliminary 
integrated resource plan filing: 
(1) whether the utility's plan is based on substantially accurate data, 
reasonable planning assumptions, and a reasonable method of forecasting;
(2) whether the utility's plan adequately addresses transmission needs; 
(3) whether the menu of energy service options and pricing options available to 
each class of customers is sufficiently broad to satisfy the needs of such 
customers; 
(4) whether the utility's preliminary plan identifies and takes into account any 
present and projected reductions in the demand for energy that may result from 
cost-effective measures to improve conservation and energy efficiency in the 
customer classes that the utility serves; 
(5) whether the utility's proposals to achieve equity among customer classes and 
provide demand-side programs to each customer class, including tenants and low-
income ratepayers, are adequate; 
(6) whether the utility's proposals to develop renewable energy technology 
projects and distributed resources are adequate; 
(7) if additional supply-side resources are needed to meet future demand, 
whether the utility's preliminary plan adequately demonstrates the amount and 
operational characteristics of the additional capacity needed, the types of 
viable supply-side resources for meeting that need, and the range of probable 
costs of those resources; 
(8) whether the utility's preliminary plan demonstrates that there were 
reasonable opportunities for customers to participate in the development of the 
preliminary plan, whether the utility facilitated the presentation of 
information from a broad range of perspectives, whether the utility provided 
adequate information as required by sec.25.162(f)(3) of this title (relating to 
Public Participation), and whether the views and preferences of customers were 
appropriately considered in preparing the preliminary plan; 
(9) whether the utility's plan identifies appropriate scenarios and takes into 
account the incidence and allocation of various factors of risk; 
(10) whether the specific selection criteria and weights the utility will use to 
evaluate and select or reject resources are reasonable and consistent with the 
definition of the lowest reasonable system cost, the views of its customers, the 
nature of resource need, and any statewide goals, and whether the proposed 
bidder eligibility and threshold criteria restrictions, if any, related to bids 
are justified and reasonable, and whether the solicitation procedures will 
encourage bids for a broad range of options to meet the needs of the utility's 
customers; 
(11) whether the cost allocation method proposed by the utility for different 
resource types is reasonable; 
(12) whether incentive factors are appropriate, and, if so, the levels of such 
incentive factors, and how such incentive factors will affect the resource 
selection process; 
(13) whether the utility reasonably acquired resources outside the solicitation 
process and whether the utility's plan for acquiring resources outside the 
solicitation process over the next three years is reasonable; and 
(14) whether the schedule for filing contracts for certification is reasonable. 
(d) Commission action. In order to approve a proposed preliminary plan that 
includes a solicitation, the commission must, at a minimum, make an affirmative 
finding regarding all matters set forth in subsection (c) of this section, 
except subsection (c)(2) - (3) and (6) of this section. The commission shall 
take into consideration its findings on subsection (c)(2) - (3) and (6) of this 
section in deciding whether to approve the proposed preliminary plan. In its 
order, the commission shall approve the preliminary plan, modify the preliminary 
plan, or, if necessary, remand the preliminary plan for additional proceedings. 
An order approving a preliminary plan that contains a proposed solicitation is 
interim in nature. At the time of issuance of the order for contract approval 
pursuant to sec.25.170 (relating to Hearing on the Final Integrated Resource 
Plan) or generation facility certification pursuant to sec.25.171 (relating to 
Certification of Convenience and Necessity for Generation Facilities), the 
commission shall make the interim order on the preliminary plan a final order of 
the commission.

sec.25.168.Solicitation of Resources.
(a) Purpose. The purpose of the utility's resource solicitation process is to 
obtain commitments from third parties for new and replacement resources, 
facilitate the evaluation of resources subject to the specific criteria set 
forth in the request for proposals, and serve as a starting point for further 
contract negotiations. A solicitation may be required as part of the integrated 
resource planning process, may be initiated by a utility, or may be ordered by 
the commission in the context of another proceeding.
(b) Solicitation required. The utility shall conduct solicitations for demand-
side and supply-side resources, as prescribed in an approved preliminary plan, 
if any. A utility not required to prepare a preliminary plan, but required to 
conduct a solicitation, shall conduct its solicitation in a manner consistent 
with the provisions of this section. 
(c) Notice. The utility shall provide reasonable notice of the request for 
proposals. This notice shall be filed with the commission's central records. 
Such notice shall include: 
(1) notice by mail to the Office of Public Utility Counsel; and 
(2) notice by mail to persons who requested to be notified of the request for 
proposals by submitting their name and address to the commission.
(d) Eligibility to bid. The solicitation procedures shall encourage broad 
participation by persons who are capable of providing demand-side or supply-side 
resources, including customers of the utility and small-scale resource 
providers. In addition to soliciting resources from unaffiliated third parties, 
the utility may prepare and submit a bid for a new utility demand-side 
management program as prescribed by subsection (f) of this section and may 
receive bids from one or more of its affiliates as prescribed by subsection (g) 
of this section. 
(e) Solicitation procedures. Each bidder, including the utility and its 
affiliates, shall submit two copies of its bid to the chief, Office of Policy 
Development. The chief, Office of Policy Development shall ensure that the 
utility has access to all bids at the same time, and shall keep a copy of each 
bid submitted by the utility or the utility's affiliate. A bid submitted under 
this subsection or retained under this subsection is confidential and is not 
subject to disclosure under Chapter 552, Government Code. 
(f) Utility bids for demand-side management resources. The request for proposals 
shall indicate whether the utility reserves the right to use its own proposed 
demand-side management program to meet a need identified in the preliminary 
plan. If the utility retains this right, it must prepare a bid reflecting that 
resource. A bid prepared by the utility under this subsection must comply with 
the selection criteria specified in the preliminary plan, or if there is no 
preliminary plan, the bids must comply with the criteria specified in the 
request for proposals. A bid prepared by the utility under this subsection must 
include a proposal for verification and evaluation conducted by an independent 
consultant. The utility may not give preferential treatment or consideration to 
any bid. If the utility plans to prepare a bid under this subsection, the 
utility must describe, in its preliminary plan, a reasonable process for the 
sharing of customer information with third-party bidders to satisfy the 
standards of subsection (g) of this section, taking into account the need for 
the confidentiality of customer-specific billing and usage information.
(g) Utility affiliate bids. Any bid prepared by an affiliate of the utility must 
comply with the selection criteria specified in the preliminary plan and with 
commission regulations regarding affiliate transactions. The utility may not 
give preferential treatment or consideration to a bid prepared by an affiliate 
of the utility. 
(1) Each utility must establish written procedures to ensure that all 
transactions between the utility and its affiliates are conducted on an arm's 
length basis (a code of conduct). Such utilities must maintain a written record 
of the time, date, and substance of all conversations, data, and written 
materials directly or indirectly exchanged between its personnel and the 
personnel of its affiliates that pertain to competitive market information and 
the resource acquisition process. 
(2) The utility and its affiliates must maintain separate books; must not incur 
debt in a manner that would permit the creditor of the affiliate to have 
recourse to the assets of the utility; must value any assets transferred between 
the utility and its affiliate in accordance with state and federal regulations 
to prevent cross subsidies; and must not share officers, directors, or employees 
or own property in common. The utility must not perform on behalf of its 
affiliates the hiring or training of personnel, the purchase, installation or 
maintenance of equipment (except under contract), or research and development. 
The utility must not share any information related to customers' identity, 
energy service needs, loads, end-use devices, industrial processes, costs, 
prices or any other information related to strategic planning or retail markets, 
except as shared equally with all other competitive resource bidders. The 
utility must not carry out any joint promotion, marketing, sales, or advertising 
campaigns with its affiliates, except as are available to all other competitive 
resource bidders. 
(3) If a utility signs a contract for resources with its affiliate, the utility 
must carry out transactions with independence, pursuant to the contract, and 
maintain sufficient records to permit an audit of transactions between the 
utility and the affiliate, and the utility and its affiliate must each have an 
annual compliance review conducted by an independent entity. 
(h) Independent evaluator. The utility shall use an independent evaluator if 
there is a likelihood that an affiliate bid may be included among the bids to be 
evaluated or if the utility plans to bid. If an independent evaluator is 
required, the utility shall maintain a record of communications with the 
independent evaluator. The utility may use an independent party to assist in the 
evaluation of bids as appropriate under other circumstances. The independent 
evaluator shall in writing identify the bids that are most advantageous and 
warrant negotiation and contract execution, in accordance with the criteria set 
forth in the request for proposals. The utility retains responsibility for final 
selection of resources subject to the review and approval of the commission. 
(i) Evaluation of bids. The utility or independent evaluator, as appropriate, 
shall evaluate each bid submitted in accordance with the criteria specified in 
the preliminary plan, or if there is no preliminary plan, the evaluation of bids 
shall be in accordance with the criteria specified in the request for proposals. 
(j) Negotiation. The utility shall negotiate the necessary contracts. A utility 
may negotiate a pricing structure that is suitable for the resource, considering 
such factors as the reliability of the resource, the need for security of 
performance, the availability of other means of ensuring security of 
performance, the nature of the resource, the level of risk, and other 
appropriate factors. The utility shall negotiate contract terms that 
appropriately allocate the risks of future fuel costs and other resource costs 
between the resource provider and the utility. 
(k) Rejection of third party bids. The utility is not required to accept a bid 
and may reject any or all bids in accordance with the selection criteria 
specified in the preliminary plan. If the results of the solicitations and 
contract negotiations do not meet the supply-side needs identified in the 
preliminary plan, the utility may apply for a certificate of convenience and 
necessity for a utility-owned resource addition notwithstanding the fact a 
solicitation was conducted and the addition was not included in the approved 
preliminary plan. Such a resource shall be subject to commission review pursuant 
to sec.25.171 of this title (relating to Certificate of Convenience and 
Necessity for Generation Facilities). 
(l) Time limit for filing complaint. A complaint by a bidder concerning the 
utility's decision on the acquisition of resources in a solicitation may not be 
filed later than 90 days after the person receives a notice of the outcome of 
the solicitation. If such a complaint is filed, it shall be consolidated with 
any application for the approval of contracts, under sec.25.169 of this title 
(relating to Approval of Resources Procured Through Solicitation).

sec.25.169.Approval of Resources Procured Through Solicitation.
(a) Application. An electric utility seeking commission approval or 
certification of contracts for resources shall request such approval pursuant to 
the provisions of this section. Except as provided in paragraph (2) of this 
subsection, the commission will consider a request for approval or certification 
of a contract for resources only if the commission has approved the utility's 
preliminary resource plan and the utility has conducted a competitive resource 
solicitation prior to filing of the application for approval or certification of 
a contract. 
(1) An electric utility that has conducted a competitive resource solicitation 
pursuant to sec.25.168 of this title (relating to Solicitation of Resources) 
shall submit its proposed final integrated resource plan for commission review. 
(2) A utility applying for contract approval pursuant to sec.25.161(b)(3) of 
this title (relating to Integrated Resource Plan) shall submit its proposed 
contract for resources for commission review. The commission shall certify the 
contract on finding that the contract is reasonable. Nothing in this paragraph 
is intended to alter or amend existing wholesale power supply contracts. 
(b) Procedure. The commission shall, on request by an affected person and within 
90 days after the date a utility files its final integrated resource plan under 
this section, convene a public hearing on the reasonableness and cost-
effectiveness of the proposed final plan. Interested persons may intervene in 
the proceeding not later than 45 days after the date on which the utility files 
its resource plan. The time for providing responses to requests for information 
may be shortened on motion of any party and for a showing of good cause. The 
commission shall make its determination within 90 days after the date the 
proposed contract for resources is submitted by a utility pursuant to 
sec.25.161(b)(3) of this title. Otherwise, the commission shall make its 
determination and issue a final order within 180 days after the date the utility 
files the proposed final plan. The commission may adopt a schedule for 
considering a final plan in less than 180 days if the circumstances warrant it. 
(c) Filing requirements. After conducting solicitations and negotiating 
contracts, a public utility shall submit to the commission a proposed final 
integrated resource plan. The application shall be assigned a new control 
number. The evidence and orders that are part of the utility's preliminary plan 
filing are incorporated into the final integrated resource plan proceeding by 
reference. The application shall include all testimony supporting the final 
plan. The proposed final plan must include: 
(1) the contracts for resources and the following information concerning 
resources that the utility proposes to acquire: 
(A) the reliability of the proposed resource, the financial condition of the 
provider, and the safety of that resource contract; 
(B) whether the contract would unreasonably impair the continued reliability of 
electric systems affected by the purchase after giving consideration to 
consistently applied regional or national reliability standards, guidelines, or 
criteria; and 
(C) whether the purchase can reasonably be expected to produce benefits to 
customers of the purchasing utility; 
(2) information about the integrated resource planning and solicitation 
processes including: 
(A) a copy of the order on the preliminary integrated resource plan and any 
documents required by an order of the commission or the Administrative Law 
Judge; 
(B) the results of the solicitation including: 
(i) the number, type, and size (in megawatts and megawatt-hours) of bids 
received; 
(ii) a description of the evaluation process and any related methods, manuals, 
formulas, or processes; 
(iii) a description of the negotiation process; and 
(iv) a demonstration that the solicitation, evaluation, and selection were 
conducted in accordance with the specific criteria included in the preliminary 
plan; 
(3) a description of the plan to achieve equity among customer classes and 
provide demand-side programs to each customer class including tenants and low-
income ratepayers; 
(4) an action plan covering a period of three years and the methods by which the 
utility intends to monitor resources after selection and acquisition; 
(5) if the utility accepts a bid submitted under sec.25.168(f) of this title, 
the terms and conditions under which the utility will provide resources to meet 
a need identified in the preliminary plan, the details of the verification and 
evaluation plan for the demand-side resource, and any information necessary to 
satisfy all the standards of sec.25.168(f) and (g) of this title; 
(6) if the utility signed a contract for resources with its affiliate, any 
information necessary to satisfy all the standards of sec.25.168(g) of this 
title; 
(7) proposed timely cost recovery factors, if any, and the data necessary to 
reconcile existing timely cost recovery factors, if any; and 
(8) an application for a certificate of convenience and necessity, if necessary. 
(d) Notice. The utility shall file copies of its application under this section 
with the filing clerk of the commission, the Office of Public Utility Counsel, 
and any intervenors in the proceeding. The utility shall also provide notice of 
the filing by publication in its service area, to any intervenor in its 
preliminary integrated resource plan proceeding, to any bidder in its 
solicitation, and to any person who has requested, in writing, to be notified of 
resource planning matters. The notice shall be completed not later than 15 days 
after the filing of the application. 

sec.25.170.Hearing on the Final Integrated Resource Plan.
(a) Scope. At the hearing, any interested person may intervene, present 
evidence, and cross-examine witnesses regarding the reasonableness and cost-
effectiveness of the proposed final plan. Parties will not be allowed to 
litigate or conduct discovery on issues that were litigated or could have been 
litigated in connection with the filing of the utility's preliminary plan. 
(b) Discovery. To the extent permitted by federal law, the commission may issue 
a written order for access to the books, accounts, memoranda, contracts, or 
records of any exempt wholesale generator or power marketer selling energy at 
wholesale to a utility, if the examination is required for the effective 
discharge of the commission's regulatory responsibilities under the Public 
Utility Regulatory Act, except that if the commission issues such an order, the 
books, accounts, memoranda, contracts, and records obtained by the commission 
are confidential and not subject to disclosure under Chapter 552, Government 
Code. 
(c) Commission determinations. After the hearing, the commission shall determine 
whether: 
(1) to certify the contracts. In making this determination the commission shall 
consider: 
(A) the reliability of the proposed resource, the financial condition of the 
provider, and the safety of the resource; 
(B) whether the contract would unreasonably impair the continued reliability of 
electric systems affected by the purchase after giving consideration to 
consistently applied regional or national reliability standards, guidelines, or 
criteria; and 
(C) whether the purchase can reasonably be expected to produce benefits to 
customers of the purchasing utility. Commission certification of a resource 
contract does not affect the resource provider's obligation to comply with all 
applicable environmental and siting regulations; 
(2) the utility's proposed final plan was developed in accordance with the 
preliminary plan and commission rules. In making this determination the 
commission shall consider whether: 
(A) the utility has met the requirements of applicable commission orders, if 
any; 
(B) the resource solicitations, evaluations, selections, and rejections were 
conducted in accordance with the specific criteria included in the preliminary 
plan; and 
(C) the utility's proposed final plan is cost-effective and provides reliable 
energy service at lowest reasonable system cost as defined in sec.25.161(f) of 
this title (relating to Integrated Resource Planning);
(3) the final plan is equitable among customer classes and provides demand-side 
programs to each customer class, including tenants and low-income ratepayers; 
(4) the utility has an adequate plan to acquire and monitor the resources; 
(5) the commission should certify any utility bid submitted under sec.25.168(f) 
of this title (relating to Solicitation of Resources) that resulted from the 
solicitations; 
(6) the utility treated and considered its affiliate's bid in the same manner it 
treated and considered other bids intended to meet the same resource needs and 
complied with the requirements of sec.25.168(g) of this title. Further, if the 
electric utility requests certification of a contract with the utility's 
affiliate, the commission shall determine, in connection with such purchase, 
whether: 
(A) the transaction will benefit consumers; 
(B) the transaction violates any state law, including least-cost planning; 
(C) the transaction provides the utility's affiliate any unfair competitive 
advantage by virtue of its affiliation or association with the utility; 
(D) the transaction is in the public interest; and 
(E) the commission has sufficient regulatory authority, resources, and access to 
the books and records of the utility and its affiliate to make these 
determinations; 
(7) the commission should grant any request for a timely cost recovery factor, 
and if so, the mechanism and level of such factor, including the reconciliation 
of any existing factor; and 
(8) the commission should grant a requested certificate of convenience and 
necessity for a utility-owned resource addition. 
(d) Final order. In order to approve the final plan and contracts for resources 
the commission must make an affirmative finding regarding all matters set forth 
in subsection (c) of this section, except subsection (c)(5) and (c)(7) of this 
section. The commission shall take into consideration its findings on subsection 
(c)(5) and (c)(7) of this section in deciding whether to approve the final plan. 
In its order, the commission shall approve the final plan, modify the final 
plan, or, if necessary, remand the final plan for additional proceedings.

sec.25.171.Certificate of Convenience and Necessity for Generation Facilities. 
In determining whether to grant a requested certificate of convenience and 
necessity for new generating facilities under the integrated resource planning 
process, the commission shall consider the effect of the granting of a 
certificate on the recipient of the certificate and on any electric utility of 
the same kind already serving the proximate area. The commission shall also 
consider other factors such as community values, recreational and park areas, 
historical and aesthetic values, environmental integrity, and the probable 
improvement of service or lowering of cost to consumers in that area if the 
certificate is granted. The commission shall grant the certificate as part of 
the approval of the final plan if it finds that:
(1) the proposed addition is necessary under the final plan. In making its 
determination, the commission shall consider the following factors related to 
the public interest: 
(A) whether the solicitation was conducted in a manner consistent with the 
preliminary plan and the resource selection criteria; 
(B) whether any of the bids rejected in the solicitation would result in a more 
appropriate sharing of future risks among the parties to the contract and the 
utility's customers as compared to the proposed generating unit; and 
(C) whether the utility submitted a bid for a rate-base addition in the 
solicitation and whether the cost and technical characteristics of the 
generating unit for which the certificate is requested were known to bidders at 
the time the solicitation was issued, and if not, whether there is a reasonable 
likelihood that a new solicitation would result in lower-cost and higher quality 
bids that would better serve the public interest than the proposed generating 
unit; 
(2) the proposed addition is the best and most economical choice of technology 
for that service area. If a utility conducts a solicitation, rejects all bids, 
and applies for a certificate for a new generating facility, the reported costs 
of the resource alternatives offered in the resource solicitation shall be 
considered by the commission at the time of certification and in any prudence 
proceeding to investigate the reasonable costs of the generating facility. There 
shall be a rebuttable presumption that the rejected bids constitute a market-
based assessment of the value of new generating units in the context of any 
determination of the appropriate costs to include in the rate base of the 
utility; and 
(3) cost-effective conservation and other cost-effective alternative energy 
sources cannot reasonably meet the need. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802069
Rhonda Dempsey
Rules Coordinator
Public Utility Commission of Texas
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 936-7308

PART III. Texas Alcoholic Beverage Commission
CHAPTER 31. Administration
16 TAC sec.31.5
The Texas Alcoholic Beverage Commission proposes an amendment to sec.31.5, 
governing the schedule of charges to be imposed for providing copies of public 
information. 
Lou Bright, General Counsel, has determined that the rule may affect a fiscal 
impact on units of state or local government to the extent that such units 
request copies of public documents from the Alcoholic Beverage Commission. The 
amount of fiscal impact cannot be determined as any fiscal impact imposed will 
be a function of the amount and type of documents requested. 
This amendment is proposed to bring the commission's practice into conformance 
with the guidelines of the Texas General Services Commission and the commands of 
Texas Government Code, sec.552.262 and 1 T.A.C. sec.sec.111.63-111.70. The 
public will benefit from this rule by the provision of public documents at a 
reasonable and uniform cost. Small businesses will be affected by this rule to 
the extent that they request copies of public documents from the commission. 
Small businesses will be affected to the same extent as all other businesses.
Comments on the proposal may be submitted to Lou Bright, General Counsel, Texas 
Alcoholic Beverage Commission, P. O. Box 13127, Austin, Texas 78711.
This amendment is proposed pursuant to authority granted by sec.5.31 of the 
Alcoholic Beverage Code. 
Cross reference: sec.5.31, Alcoholic Beverage Code. 

sec.31.5. Alcoholic Beverage Commission Charge Schedule.
(a) <nl>Charges made for providing copies of public information by the Texas 
Alcoholic Beverage Commission shall be assessed in accordance with the schedule 
of charges maintained by the Texas General Services Commission and found at 1 
TAC sec.sec.111.63-111.70.<ol> [The following charges will be made for providing 
copies of public information by the Texas Alcoholic Beverage Commission.] 
[Figure: 16 TAC 31.5(a)] 
(b)-(c) (No change.). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802166
Doyne Bailey
Administrator
Texas Alcoholic Beverage Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 206-3204

PART IX. Texas Lottery Commission
CHAPTER 402.Bingo Regulation and Tax
16 TAC sec.402.554
The Texas Lottery Commission proposes an amendment to sec.402.554, relating to 
instant bingo. The proposed amendment includes an alteration of the definition, 
appearance, and description of instant bingo tickets. The proposed amendment 
will allow more flexibility in the design of instant bingo tickets. The 
amendment will permit more innovative instant ticket or pull tab play for 
consumers. In addition, the proposed amendment to the rule alters the approval 
and sale processes of instant bingo cards to provide greater security and 
integrity to the play of instant bingo games. The amendment to the rule complies 
with statutory changes to the definition of instant bingo in the Bingo Enabling 
Act, Texas Revised Civil Statutes, Article 179d, sec.2 subsection (26). 
Richard Sookiasian, Budget Analyst, has determined that, for each of the first 
five years that the rule will be in effect, there will be no foreseeable fiscal 
implication for state or local government as a result of enforcing or 
administering the rule. 
Mr. Sookiasian, has determined that, for each year of the first five years that 
the rule will be in effect, there will be a foreseeable economic costs to person 
or small businesses required to comply with the rule. The economic costs will be 
to the manufacturers of instant bingo cards for the investigation of instant 
bingo cards through testing and approval by the Texas Lottery Commission.
Billy Atkins, Acting Director of the Charitable Bingo Division, has determined 
that the public benefit expected as a result of the adoption of the rule will be 
more flexibility in the manufacturing, design, and sale of instant bingo tickets 
and more innovative play for consumers. The adoption of the rule will also allow 
for the continuation of the utmost security and integrity in the games. 
The proposed amendment should not adversely affect any local economy. However, 
out of an abundance of caution, the Texas Lottery Commission will submit to the 
Texas Employment Commission a request for local employment impact statement for 
the proposed amendment to the rule. 
Comments on the proposal may be submitted to Katherine Minter Cary, Assistant 
General Counsel, Texas Lottery Commission, P.O. Box 16630, Austin, Texas 78761-
6330 or may be faxed to (512) 344-5189. 
The amendment is proposed under Texas Revised Civil Statutes, Article 179d, 
sec.2 subsection (26), regarding instant bingo, sec.27(b) and sec.16, 
subsections (a), (c) and (d), which authorize the Texas Lottery Commission to 
adopt rules for the enforcement and administration of the Bingo Enabling Act and 
the Texas Government Code, sec.467.102, which authorizes the Texas Lottery 
Commission to adopt rules for the enforcement and administration of Texas 
Government Code, Chapter 467 and the laws under the commission's jurisdiction. 
Texas Revised Civil Statutes, Article 179d, will be affected by the proposed 
amendment to the rule. 

sec.402.554. Instant Bingo. 
(a) Definitions. The following words and terms, when used in this section, shall 
have the following meanings, unless the context clearly indicates otherwise. 
(1) (No change.) 
(2) Instant Bingo Card -- <nl>The term Instant Bingo Card includes Instant 
Bingo, Pull Tab Bingo and/or Break-Open Bingo Cards. Instant Bingo means a<ol> 
[A] device used to play a [specific game of chance] <nl>form of bingo<ol> 
consisting of an individual card <nl>with perforated break-open tabs, made from 
paper or paper products <ol>, the face of which is initially hidden from view to 
conceal numbers<nl>, letters or symbols<ol>. Each individual card must: 
(A) (No change.) 
(B) contain the <nl>name of the game<ol> [letters B I N G O] on its face in a 
conspicuous location [in no less than 29-point type]; 
(C)-(E) (No change.) 
[(F) contain no other symbols, emblems, or characters;] 
<nl>(F)<ol> [(G)] be constructed of cardboard and glued or otherwise securely 
sealed along all four edges of the card and between the individual break-open 
tabs on the card; 
<nl>(G)<ol> [(H)] have <nl>letters,<ol> numbers<nl>,<ol> or symbols that are 
concealed behind perforated window tabs; 
<nl>(H)<ol> [(I)] allow such <nl>letters,<ol> numbers<nl>,<ol> or symbols to be 
revealed only after the player has physically removed the perforated window 
tabs; and 
<nl>(I)<ol> [(J)] prevent the determination of a winning or losing instant bingo 
ticket by any means other than the physical removal of the perforated window 
tabs by the player. 
(3) Instant bingo game -- A <nl>form of bingo<ol> [game of chance] played by the 
random selection of one or more individually prepackaged instant bingo cards 
from a series of instant bingo cards. Prize winners are determined by the 
preprinted appearance of <nl> letters,<ol> numbers<nl>, or symbols<ol> in a 
prescribed order, according to winning arrangements indicated on the reverse 
side of the card. 
(b) Approval of cards. 
(1) No instant bingo card may be sold or otherwise furnished to any person in 
this state or used in the conduct of bingo for public play unless and until 
<nl>three<ol> [a complete] series <nl>or deals <ol> of an identical prototype of 
that card has first been presented to the commission by its manufacturer and has 
been approved by the commission for use within this state. 
(2)-(3) (No change.) 
<nl>(4)<ol> <nl> No licensed manufacturer may display or sell any instant bingo 
card which has been disapproved by the Texas Lottery Commission, after 
inspection of the card, because the card does not properly preserve the 
integrity or security of the Texas Lottery Commission. Disapproval of and 
prohibition to use, purchase, sell or otherwise distribute such card is 
effective immediately upon notice to the licensee. <ol>
(c) Manufacturing requirements. 
(1)-(3) (No change.) 
(4) Each individual card must be constructed so that it is substantially 
impossible, in the opinion of the commission, to determine <nl> concealed 
letter(s), number(s) or symbol(s)<ol> [a concealed number or numbers] until it 
has been opened by a player. Without limiting the requirements of the previous 
sentence of this paragraph, for all instant bingo cards offered for sale by a 
licensed organization on or after February 1, 1988, such cards shall be required 
to be constructed of cardboard and in such a manner so that cardboard gluing 
occurs on all four edges of the card and between the individual break-open tabs 
on the card. The glue must be of sufficient strength and type so as to prevent 
the undetectable separation of the card.
(5)-(6) (No change.) 
(d) Prizes costs, sales, percentages. 
(1)-(3) (No change.) 
(4) No single prize on a winning instant bingo card may exceed <nl>$750<ol> 
[$500]. 
(5) A licensed organization may not withdraw a series of cards from play until 
the series is completely sold out [, all winning cards of $5.00 or more have 
been cashed, or the bingo occasion ends].
(6)-(7) (No change.) 
(e) Restrictions. 
(1) The commission's seal [and required authorization language] must be placed 
on all cards by a licensed manufacturer only.
(2)-(3) (No change.) 
(f) (No change.) 
(g) Records. 
(1) Any licensed organization selling instant bingo cards must maintain a 
purchase log showing: 
(A) (No change.) 
(B) the name, address, and <nl>taxpayer<ol> [license] number of the distributor 
from whom the cards were purchased. 
(2)-(3) (No change.) 
(4) Manufacturers or distributors must provide the following information on each 
invoice and other document used in connection with a sale:
(A)-(E) (No change.) 
(F) Texas <nl>taxpayer<ol> [bingo license]number of the purchaser. 
(5) (No change.) 
(h)-(i) (No change.)
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802193
Kimberly L. Kiplin
General Counsel
Texas Lottery Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 344-5113

16 TAC sec.402.555
The Texas Lottery Commission proposes an amendment to sec.402.555, relating to 
card-minding devices. The proposed amendment removes some of the restrictions 
and limitations that previously existed on the sale and use of bingo card-
minding devices. Additionally, the proposed amendment provides for more 
efficient and effective reporting requirements involving card-minding devices 
that will result in more accurate audits and provide for greater security. The 
amendment to the rule complies with statutory changes to the Bingo Enabling Act, 
Texas Revised Civil Statutes, Article 179d, sec.11, relating to gross sales 
limitations for card-minding devices. 
Richard Sookiasian, Budget Analyst, has determined that, for each of the first 
five years that the rule will be in effect, there will be no foreseeable fiscal 
implication for state or local government as a result of enforcing or 
administering the rule. 
Mr. Sookiasian, has determined that, for each year of the first five years that 
the rule will be in effect, there will be no foreseeable adverse economic costs 
to person or small businesses required to comply with the rule. 
Billy Atkins, Acting Director of the Charitable Bingo Division, has determined 
that the public benefit expected as a result of the adoption of the rule will be 
more latitude and free choice in the play of bingo using card-minding devices.
The proposed amendment should not adversely affect any local economy. However, 
out of an abundance of caution, the Texas Lottery Commission will submit to the 
Texas Employment Commission a request for local employment impact statement for 
the proposed amendment to the rule. 
Comments on the proposal may be submitted to Katherine Minter Cary, Assistant 
General Counsel, Texas Lottery Commission, P.O. Box 16630, Austin, Texas 78761-
6330 or may be faxed to (512) 344-5189. 
The amendment is proposed under Texas Revised Civil Statutes, Article 179d, 
sec.2, subsection (22), sec.11, and sec.16, subsections (a) and (d), which 
authorize the Texas Lottery Commission to adopt rules for the enforcement and 
administration of the Bingo Enabling Act and the Texas Government Code, 
sec.467.102, which authorizes the Texas Lottery Commission to adopt rules for 
the enforcement and administration of Texas Government Code, Chapter 467 and the 
laws under the Commission's jurisdiction. 
Texas Revised Civil Statutes, Article 179d, will be affected by the proposed 
amendment to the rule.

sec.402.555. Card-minding Device. 
(a)-(b) (No change.) 
(c) Manufacturing Requirements. 
(1) Manufacturers of card-minding devices must manufacture each card-minding 
device in such a manner to ensure that the internal accounting system of the 
card-minding device is capable of <nl>registering<ol> [continuously monitoring] 
all disposable bingo cards and cardminders sales [so that at any bingo occasion 
sales of cardminders do not exceed 30% of gross bingo receipts]. 
(2)-(6) (No change.) 
(d) <nl>Distributor<ol> [Conductor] requirements.
(1) Before initial use by a licensed authorized organization, each 
<nl>distributor<ol> [licensed authorized organization] that leases or 
<nl>sells<ol> [purchases] a card-minding device must notify the commission in 
writing <nl>on a form prescribed by the commission <ol> of the make, model, 
serial number and dial-up telephone number of the card-minding device 
<nl>installed<ol>. 
<nl>(2)<ol> <nl> Each distributor that leases or sells a card-minding device 
must notify the commission in writing on a form prescribed by the commission of 
the make, model and serial number of each player unit that will be utilized at 
multiple locations. <ol>
<nl>(3)<ol> <nl>Each distributor that leases or sells a card-minding device must 
notify the commission in writing on a form prescribed by the commission of the 
make, model, and serial number of each device that is removed from a location. 
Before the complete removal or system hardware up-grade of any device, each 
licensed authorized distributor must supply a copy of the data files to each 
conductor who utilized the device. <ol>
[(2) No conductor shall require a player to use a card-minding device in playing 
bingo. 
[(3) Prior to the start of the bingo occasion, no card-minding device may be 
reserved for use by any player, with the exception of a player who is disabled 
in accordance with the provisions of the Americans with Disabilities Act, or a 
player who is playing more than one consecutive bingo occasion. 
[(4) The price for a cardface played through a card-minding device shall be no 
less than the price as that of a disposable paper cardface or bingo hardcard, 
sold separately or in combination.
(e) (No change.) 
(f) Records. 
(1)-(4) (No change.) 
<nl>(5)<ol> <nl> Each conductor shall maintain an occasion sales transaction 
report generated from the card-minding device.<ol>
<nl>(6)<ol> [(5)] Manufacturers and distributors must provide and maintain for 
four years the following information on each invoice or other document used in 
connection with a sale or lease, as applicable:
(A) date of sale or lease; 
(B) quantity sold or leased; 
(C) cost per card-minding device; 
(D) model and serial number of each card-minding device; 
(E) name and address of the purchaser or lessee; and 
(F) Texas taxpayer identification number of the purchaser or lessee. 
<nl>(7)<ol> <nl>Each conductor shall record all bingo sales, including card-
minders sales and/or disposable cards, on the point of sale register of the 
card-minding device. <ol>
(g) Restrictions. 
(1)-(2) (No change.) 
<nl>(3)<ol> <nl> No conductor shall require a player to use a card-minding 
device in playing bingo. <ol>
(h) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802194
Kimberly L. Kiplin
General Counsel
Texas Lottery Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 344-5113

TITLE 22. EXAMINING BOARDS
PART IV. Texas Cosmetology Commission
CHAPTER 89.General Rules and Regulations
22 TAC sec.89.1
The Texas Cosmetology Commission proposes an amendment to sec.89.1, concerning 
administrative fines. The amendment is proposed as a result of the legislative 
session, and the passage of Senate Bill 1131, to include all rules enforced by 
the commission. 
Delores Alspaugh, Interim Executive Director, has determined that for the first 
five-year period the rule is in effect, there will be fiscal implications for 
state or local government as a result of enforcing or administering the rule. 
Mrs. Alspaugh also has determined that for each year of the first five years the 
rules are in effective public benefit anticipated as a result of enforcing the 
rule will be to ensure that schools comply with the requirements of the rules of 
the commission. There are anticipated economic costs to person who are required 
to comply with the rules as adopted. 
Comments on the proposal may be submitted to Delores L. Alspaugh, Interim 
Executive Director, P.O. Box 26700, Austin, TX 78755-0700. 
The amendment is proposed under Texas Civil Statutes, Article 8451a, sec.35A, 
which provides the commission with the authority to "issue rules consistent with 
this Act after a public hearing", to protect the public's health and safety. 
Texas Civil Statutes, Article 8451a, is a effected by this proposed section.

sec.89.1. Administrative Fines.
(a) The commission shall set up a schedule of administrative fines in order to 
assess civil penalties. The commission desires to be both consistent and 
equitable and to consider and evaluate each case on an individual basis. The 
actual civil penalty which the commission assesses shall be based on the 
commission's consideration of the factors in The Cosmetology Act (Texas Civil 
Statutes, Article 8451a), but the fine for any one violation or rule adopted 
under The Cosmetology Act shall not exceed $1,000. 
(b) Schedule of Fines. In accordance with Texas Civil Statutes, Article 8451a, 
the commission shall adopt the following fine schedules for the 1st, 2nd, and 
3rd violation of the following practitioner, facility, and independent 
contractor licensing rules. For the 4th and subsequent offenses, the provisions 
of Texas Civil Statutes, Article 8451a will apply: 
Figure 1:22 TAC sec.89.1(b)
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9801939
Delores Alspaugh
Interim Executive Director
Texas Cosmetology Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 454-4674

PART XXIX. Texas Board of Professional Land Surveying
CHAPTER 661. General Rules of Procedures and Practices
Applications, Examinations, and Licensing
22 TAC sec.661.41
The Texas Board of Professional Land Surveying proposes new sec.661.41, 
concerning certificate requirements for applicants who hold a certificate as a 
Surveyor-In-Traning in another jurisdiction. This proposed new rule clarifies 
the requirements for applicants who hold a certificate as a Surveyor-In-Training 
in another jurisdiction. 
Sandy Smith, Executive Director, has determined that for the first five-year 
period this rule is in effect there will be no fiscal implications for state or 
local governments as a result of enforcing or administering this rule.
Sandy Smith also has determined that for the first five-year period this rule is 
in effect the public benefits anticipated as a result of enforcing the section 
as proposed will be all applicants will be provided certification information 
regarding applicants who are certified in another jurisdiction. There will be no 
effect or economic cost to small or large businesses or persons who are required 
to comply with this rule. 
Comments may be submitted to Sandy Smith, Texas Board of Professional Land 
Surveying, 7701 North Lamar, Suite 400, Austin, Texas 78752. 
This rule is proposed under Article 5282c, sec.9, V.T.C.S., which provides the 
Texas Board of Professional Land Surveying with the authority to make and 
enforce all reasonable and necessary rules, regulations and bylaws not 
inconsistent with the Texas Constitution, the laws of this state and this Act. 
The Texas Civil Statutes, Article 5282c, is affected by this proposed amendment.

sec.661.41. Applications. 
(a)-(e) (No change.) 
<nl>(f)<ol> Certificate Requirements for Surveyors-In-Training in Other States, 
Territories or Possessions of the United States. An individual is eligible to be 
certified as a Surveyor-In-Training in Texas upon: 
(1) successfully passing the National Council of Examiners for Engineering and 
Surveying (NCEES) fundamentals of land surveying exam; and 
(2) obtaining certification as a Surveyor-In-Training by a state, territory or 
possession of the United States other than Texas.
(g) The Texas certification as a Surveyor-In-Training is valid for six years 
from the date the Surveyor-In-Training certificate was issued by the original 
issuing state, territory or possession of the United States. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 12, 1998.
TRD-9802073
Sandy Smith
Executive Director
Texas Board of Professional Land Surveying
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 452-9427

TITLE 25. HEALTH SERVICES
PART I. Texas Department of Health
CHAPTER 29.Purchased Health Services
SUBCHAPTER L.General Administration
25 TAC sec.29.1109
On behalf of the State Medicaid Director, the Texas Department of Health 
(department) submits a proposed amendment to sec.29.1109, concerning 
coordination of Title XIX with Parts A and B of Title XVIII. Specifically, the 
section covers department policies governing the payment of Medicare deductible 
and coinsurance liabilities for Medicaid recipients who are also eligible for 
Medicare coverage. 
The Balanced Budget Act of 1997, Public Law Number 105-33, sec.4714, 111 Stat. 
251, clarifies state liability for Medicare cost-sharing. This amendment allows 
the department to limit the Medicare Part A deductible/coinsurance for a 
crossover claim if the Medicare payment amount equals or exceeds the Medicaid 
payment rate. If the Medicare payment amount is less than the Medicaid payment 
rate, the department will be required to pay the Medicare Part A 
deductible/coinsurance for a crossover claim, but the amount of payment will be 
limited to the lesser of the deductible/coinsurance or the amount remaining 
after the Medicare payment amount is subtracted from the Medicaid payment rate. 
Mr. Joe Moritz, Health Care Financing Budget Director, has determined that for 
the first five-year period the section is in effect, there will be fiscal 
implications as a result of administering the section as proposed. The effect on 
state government will be an estimated savings of $1,375,000 for fiscal year 1998 
and $5,500,000 for each of the fiscal years 1999 through 2002. There will be no 
fiscal implications for local governments. 
Mr. Moritz also has determined that for each year of the five years the section 
is in effect, the public benefit anticipated as a result of enforcing the 
section will be the clarification of department policies concerning the payments 
of Medicare deductible and coinsurance liabilities for Medicaid recipients, and 
the department will be able to administer the Medicaid program in a more cost 
effective and efficient manner. The department acknowledges the potential for an 
economic impact on small businesses and persons who are required to comply with 
the proposed section, however, the impact will vary according to each entity and 
can not be estimated at this time. There is no impact on local employment. 
Comments on the proposal may be submitted to Rodger Love, Program Specialist 
III, Health Care Financing, Texas Department of Health, 1100 West 49th Street, 
Austin, Texas 78756-3168, (512) 794-6892. Comments will be accepted for 30 days 
following publication of this proposal in the Texas Register. In addition, a 
public hearing will be held at 9:00 a.m., Friday, March 6, 1998, at the Texas 
Department of Health, Stratum Building D, Room 404, 11044 Research Boulevard, 
Austin, Texas. Federal regulations require the department to have a copy of the 
proposed amendment available in each county for public review and comment. A 
copy of the proposal is being sent to all Department of Human Services offices 
to be available for review on request. 
The amendment is 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 adopt rules to administer the state's medical 
assistance program and is submitted by the Texas Department of Health under its 
agreement with the Health and Human Services Commission to operate the purchased 
health services program and as authorized under Chapter 15, sec.1.07, Acts of 
the 72nd Legislature, First Called Session (1991). 
The amendment affects Chapter 32 of the Human Resources Code. 

sec.29.1109.Coordination of Title XIX with Parts A and B of Title XVIII.
(a) If a Medicaid recipient is eligible for Medicare coverage, the department or 
its designee pays the recipient's Medicare deductible and coinsurance 
liabilities as specified in this section. Payment of deductible and coinsurance 
liabilities is subject to the reimbursement limitations of the Texas Medical 
Assistance Program. 
(1) - (2) (No change.) 
<nl>(b)<ol> <nl> The payment of the Medicare Part A deductible and coinsurance 
is based on the following:<ol> 
<nl>(1)<ol> <nl>If the Medicare payment amount equals or exceeds the Medicaid 
payment rate, the department is not required to pay the Medicare Part A 
deductible/coinsurance on a crossover claim. <ol> 
<nl>(2)<ol> <nl>If the Medicare payment amount is less than the Medicaid payment 
rate, the department is required to pay the Medicare Part A 
deductible/coinsurance on a crossover claim, but the amount of payment is 
limited to the lesser of the deductible/coinsurance or the amount remaining 
after the Medicare payment amount is subtracted from the Medicaid payment rate. 
<ol>
<nl>(c)<ol> [(b)] By paying a recipient's deductible and/or coinsurance 
liabilities, the department or its designee satisfies its obligation to provide 
coverage for services that it would have paid [for] in the absence of Medicare 
coverage.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 9, 1998.
TRD-9801870
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

CHAPTER 115.Home and Community Support Services Agencies
SUBCHAPTER A.General Provisions
25 TAC sec.115.2, sec.115.3
The Texas Department of Health (department) proposes amendments to sec.sec.115.2 
and 115.3, concerning the licensing of home and community support services 
agencies (HCSSAs). The amendment to sec.115.2 changes the definition of 
"affiliate." The amendment to sec.115.3 increases initial and renewal licensing 
fees for branch office sites. 
The change to the definition of "affiliate" changes the percentage ownership 
interest from 10% to 5% to be consistent with the rule language in 
sec.115.11(g)(2)(E), (F) and (J). The amendment to sec.115.3 is being proposed 
to comply with the General Appropriations Act, Rider 35, 75th Legislature, 1997. 
Rider 35 of the General Appropriations Act requires the department to assess 
"fees sufficient to generate, during the biennium, $1,415,762 in excess of the 
estimate for account 5018, contained in the Comptroller of Public Accounts' 
Biennial Revenue Estimate for fiscal years 1998 and 1999." The Comptroller's 
biennial revenue estimate for account 5018 is $6,757,000. Based on actual 
revenue from fiscal year 1997, the department estimates the biennial revenue 
(fiscal years 1998 and 1999) will be $7,469,486, which is $712,486 in excess of 
the revenue estimate reported in the Comptroller's Biennial Revenue Estimate for 
account 5018. Therefore, an additional $703,276 must be generated by the end of 
the biennium to comply with the Rider 35 requirement to generate an excess of 
$1,415,762. 
Specifically, the amendment to sec.115.3 increases the initial licensing fee for 
a branch office from $500 to $875, and the renewal licensing fee for a branch 
office from $300 to $875. Due to external factors occurring at the federal level 
and outside of the department's control, it is anticipated that there will be no 
additional branch office growth, but a gradual decrease in the number of branch 
offices over a period of time is expected. The proposed fee increase takes this 
anticipated decline into consideration. By the end of the biennium (August 31, 
1999), the department projects that the branch office fee increase will generate 
the amount necessary to comply with Rider 35. The fee increases have been set by 
the Board of Health (board) and are necessary to cover increased costs incurred 
by the department to regulate home and community support services agency branch 
offices. 
Bernie Underwood, Chief of Staff, Associateship for Health Care Quality and 
Standards has determined that for the first five years the amendments are in 
effect, there will be fiscal implications as a result of enforcing or 
administering the new requirements. The fiscal implications as a result of the 
amendment to sec.115.2 will be the possible increase in the number of persons 
required to report the information in sec.115.11(g)(2)(E), (F), and (J), and any 
costs to the department for processing the same information. The fiscal 
implications as a result of the amendment to sec.115.3 will be the generation of 
approximately $115,000 in revenue for the first year the amendment is in effect 
and not more than $665,000 for each additional year (there are currently about 
1,161 licensed branch offices). The additional revenue will be offset by the 
actual cost the state incurs for administering the licensing program. There will 
be no effect to local governments unless a local government owns or operates a 
home and community support services agency with a branch office. 
Ms. Underwood has also determined that for each year of the first five years the 
amendments are in effect, the public benefit anticipated as a result the 
amendments will be increased oversight by the department through quality of care 
inspections of branch offices for licensing purposes. Currently, branch office 
inspections are only conducted for the purposes of investigating a complaint. 
The amendment to sec.115.3 will impose an additional cost to persons who are 
required to comply with the amendment, including small or large businesses 
providing home and community support services. The additional costs are $375 for 
each HCSSA submitting an application for an initial branch office site license 
and $575 for each HCSSA submitting an application for a renewal branch office 
license. The additional costs apply after the fee increases become effective. 
There is no anticipated impact on local employment.
Comments on the proposal may be submitted in writing to Julia R. Beechinor, 
Director, Health Facility Licensing Division at the Texas Department of Health, 
1100 West 49th Street, Austin, Texas 78756-3199, 512-834-6647 or via fax at 512-
834-6714. Comments will be accepted for a 30-day comment period following 
publication in the Texas Register. 
The amendments are proposed under the Health and Safety Code, sec.142.010 which 
provides the board with the authority to set license fees for HCSSAs in amounts 
that are reasonable to meet the costs of administering the Health and Safety 
Code, Chapter 142, and under sec.12.001 which provides the board with the 
authority to adopt rules for the performance of every duty imposed by law upon 
the board, the department, and the commissioner of health. 
The amendments affect the Health and Safety Code, Chapter 142. 

sec.115.2.Definitions.
The following words and terms, when used in these sections, shall have the 
following meanings, unless the context clearly indicates otherwise. 
Affiliate - With respect to an applicant or owner which is:
(A) a corporation - means each officer, director, stockholder with direct 
ownership of at least <nl>5.0%<ol> [10%], subsidiary, and parent company; 
(B) (No change.) 
(C) an individual - means: 
(i)-(ii) (No change.)
(iii) each corporation in which the individual is an officer, director, or 
stockholder with a direct ownership of at least <nl>5.0%<ol> [10%]. 
(D) - (E) (No change.)

sec.115.3.Licensing Fees.
(a) The schedule of fees for licensure of an agency authorized to provide one or 
more services is as follows: 
(1)-(2) (No change.)
(3) initial branch office license fee - <nl>$875<ol> [$500]; 
(4) renewal branch office license fee - <nl>$875<ol> [$300]; 
(5)-(6) (No change.)
(b) - (d) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802212
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

CHAPTER 133.Hospital Licensing
The Texas Department of Health (department) proposes the repeal of existing 
sec.sec.133.1-133.3, 133.11-133.14, 133.21, 133.22, 133.51-133.54, 133.71, 
133.72, 133.101, 133.102, 133.111-133.113, 133.121, and 133.131; and proposes 
new sec.sec.133.1, 133.2, 133.21-133.26, 133.41-133.47, 133.61, 133.62, 133.81, 
133.101, 133.102, 133.121, 133.122, 133.141-133.143, and 133.161-133.169 
concerning hospital licensing rules. The sections proposed for repeal cover 
general provisions, application and issuance of a hospital license, operational 
requirements for all hospitals, special service requirements, physical plant and 
fire safety requirements, patient transfers, enforcement, internal 
investigation, and cooperative agreements. The proposed new sections cover 
general provisions, hospital license, operational requirements, voluntary 
agreements, waivers, inspection and investigation procedures, enforcement, fire 
prevention and safety requirements, and physical plant and construction 
requirements. This repeal of existing rules and adoption of new rules concerning 
licensing requirements for general and special hospitals is proposed for the 
following reasons. Initially all hospital licensing standards were adopted by 
reference. The current hospital licensing rules reflect the first conversion 
phase to Texas Register format and are partially adopted by reference and 
partially written in Texas Register format. In the effort to complete the 
conversion of the existing standards that are presently adopted by reference 
(Chapters 1-3 and 6-10 of the hospital licensing standards are adopted by 
reference in sec.133.21 of the hospital licensing rules) to Texas Register 
format, all of the current hospital licensing rules must be repealed. 
Incorporation of these standards vastly expands the existing sections making it 
necessary to reorganize and renumber every section. In addition, existing 
language in all sections is being amended by revising, deleting, and updating 
with new language for clarity, for regulatory and administrative simplification, 
and for the purpose of reorganizing Chapter 133.
A conversion table is published in the "In Addition" section of this issue of 
the Texas Register that shows existing rules proposed for repeal and where they 
are being moved. Some of the existing rules were relocated throughout the new 
rules. This chart may only indicate the general area in the new rules rather 
than the specific location. 
In developing the proposed rules, Health Facility Licensing Division (HFLD) 
staff considered the conditions of participation for certification under Title 
XVIII of the Social Security Act (Medicare) (42 U.S.C. Section 1395 et seq.) and 
attempted to achieve consistency with those conditions. Staff also considered 
comments made by the Texas Hospital Association (THA), hospitals, and 
individuals concerning the 1995 proposed repeal of current rules and the 
adoption of new licensing rules for hospitals. The department withdrew the 1995 
proposal and requested opinions by the attorney general (AG) concerning (1) the 
definition of a hospital premises, and (2) whether or not the definition of 
"special hospital" as contained in sec.241.003(11) of the Health and Safety Code 
(HSC) allows a special hospital to perform surgery. HFLD staff worked with THA 
staff following the rendering of the AG opinions to develop language as to what 
constitutes a hospital premises. The agreed language was subsequently included 
in amendments to HSC Chapter 241 as provided in Senate Bill 422. The 
legislation, which also added definitions for comprehensive medical 
rehabilitation hospital and pediatric and adolescent hospital, was supported by 
THA and passed by Acts of the 75th Legislature, 1997. The proposed rules also 
implement changes to HSC, Chapter 222, as provided by Senate Bill 908, passed by 
Acts of the 75th Legislature, 1997. The amendment to sec.222.024 allows the 
department to conduct inspections of hospitals certified to participate in the 
Medicare Program , or accredited by either the Joint Commission of Accreditation 
of Healthcare Organizations (JCAHO) or the American Osteopathic Association 
(AOA) prior to the issuance of a renewal hospital license if the certification 
or accreditation body has not conducted an inspection in the preceding three 
years. To offset the increased expenditures created by the new inspection 
activity, an increase in the hospital licensing fee is proposed; the fee 
increase is discussed in the fiscal note later in this preamble. 
The most notable differences between the rules and standards proposed for repeal 
and the proposed new rules are summarized as follows. 
New sec.133.2 includes new definitions for advance directive, biological 
indicator, comprehensive medical rehabilitation hospital, comprehensive medical 
rehabilitation unit, contaminated linen, dentist, dietitian, mandated provider, 
medical waste, mobile unit, outpatient, outpatient services, ownership, patient, 
pediatric and adolescent hospital, practitioner, premises, registered nurse, 
relocatable unit, transfer, transportable unit, universal precautions, and 
violation. The new definitions are a result of legislation passed by the 75th 
Legislature, from comments the department received concerning the 1995 proposed 
rules, and for the purpose of clarity. Also, in an effort to clarify that the 
definitions of "abuse" and "neglect" relate only to the rules contained in the 
new sec.133.47(b) relating to abuse and neglect issues, the definitions were 
relocated to the new section. The definition of "council" has been deleted in 
accordance with Senate Bill 1517 passed by the 75th Legislature. The definitions 
of words used in the current rules that were not used in the new rules were 
deleted. 
For administrative simplification, new sec.133.22 no longer provides for 
temporary initial licenses. The department began issuing temporary initial 
licenses in 1993. The practice was of no benefit to hospitals and was not proven 
to be efficient or cost effective for the department. The new rules provide for 
the issuance of an annual license after the hospital has complied with the 
requirements for obtaining a license. 
New sec.133.23 includes the provision that the department may conduct an 
inspection prior to issuing a renewal license in accordance with the provisions 
of Senate Bill 908 which was discussed previously in this preamble. 
New sec.133.26 contains a per bed fee increase to $10 per bed based upon the 
design bed capacity of the hospital. The section also contains new language that 
describes what constitutes the design bed capacity. Publication of these rules 
provides the required notification of fee increase required by Texas Civil 
Statutes, Article IX, sec.77. Plan review fees, construction inspection fees, 
and the cooperative agreement application fee are not changed. However, the 
information relating to the cooperative agreement application fee, which is 
presently located within the cooperative agreements and certificates of public 
advantage section of the current rules, has been relocated to new sec.133.26.
New sec.133.41 is a compilation of requirements from the current hospital 
licensing rules and standards and the Medicare Conditions of Participation. New 
sec.133.122 cites the statutory references to administrative penalties. New 
sec.133.162 concerns new construction requirements and reorganizes into one 
subsection general architectural, detail and finishes, mechanical, piping and 
plumbing systems, and electrical requirements. 
New sec.133.163 is designed to assist hospital and architectural personnel when 
contemplating new construction or remodeling of a hospital to readily locate the 
design and spatial requirements for a particular area, unit or suite. There is 
new language relating to hospital based skilled nursing units, hyperbaric 
suites, morgue, nuclear medicine suite, radiotherapy suite, renal dialysis 
suite, and special procedure suite. The Guidelines for Health Care Facilities, 
published by the American Institute of Architects, 1997 edition, which are 
recommended by the Joint Commission on Accreditation of Healthcare 
Organizations, were considered in developing rule language for this section. New 
sec.133.166 establishes minimum standards for mobile, transportable and 
relocatable units. The number of units has grown steadily in the past several 
years as necessary and valuable resources for the provision of services by 
hospitals which may not be able to independently offer a particular service. 
Because there are currently no hospital licensing rules or standards for these 
units, the department uses a directive issued by the Health Care Financing 
Administration (HCFA) for purposes of plan review and construction inspections.
The new rule language is based upon the HCFA directive. 
Bernie Underwood, Chief of Staff Services, Associateship for Health Care Quality 
and Standards, has determined that for the first five-year period the repealed 
sections and proposed new sections are in effect, there will be significant 
fiscal implications for state government as the result of administering and 
enforcing the new sections. Additional costs to the state will arise from the 
statutory duty to conduct the inspections authorized by Senate Bill 908. 
Currently the department licenses 473 hospitals. Of these, approximately 126 are 
not accredited by the JCAHO or the AOA. Hospitals accredited by the JCAHO and 
AOA receive an on-site inspection at least every three years. For those 
hospitals which are Medicare certified, funding limitations may prevent an on-
site inspection (for Medicare certification purposes) from being conducted at 
least every three years. Under HSC sec.222.024(c), the department will inspect a 
hospital which is Medicare certified or accredited by the JCAHO or AOA if the 
hospital has not received an on-site inspection by the HCFA (for Medicare 
certification) or the accrediting body for the three years preceding the renewal 
of the hospital's license. The estimated additional cost to state government is 
$304,909 for fiscal year 1998, and $418,355 each year for fiscal years 1999-
2002. Costs associated with this fiscal note will be recovered by proposed new 
revenue that will be generated by the proposed increase in the hospital license 
fee from $4 to the statutory limit of $10 per bed based on the design bed 
capacity of the hospital. The proposed license fee increase is estimated to 
result in increased revenue to the department of approximately $387,656 annually 
beginning with the adoption of final rules. The fiscal implications to local 
government will be discussed in conjunction with the fiscal implications to 
small and large businesses in the following paragraph. 
Ms. Underwood has also determined that for each year of the first five-year 
period the proposed rules will be in effect, the anticipated public benefit are 
rules that better protect and promote public health, are easier to understand, 
and more closely track statutory mandates. Publication of these rules in the 
Texas Register is also expected to facilitate public access and review. There 
will be a fiscal impact on hospitals operated by local governments and large and 
small businesses due to the increased licensing fees. The hospital license fees 
will increase from $4 per bed with a minimum fee of $200 and a maximum fee of 
$10,000, to the statutory limit of $10 per bed with a minimum fee of $200 and a 
maximum fee of $10,000. There is no anticipated cost to individuals affected by 
the proposal. There is no anticipated impact on local employment. 
Comments on the proposal may be submitted to John M. Evans, Jr., MHA, RN, 
Hospital Licensing Director, Health Facility Licensing Division, Texas 
Department of Health, 1100 West 49th Street, Austin, Texas 78756-3199, (512) 
834-6648. Comments will be accepted for a period of 45 days following the 
publication of this proposal in the Texas Register. In addition, a public 
hearing on the proposed sections will be held at 1:00 p.m. on Wednesday, April 
8, 1998, in the Texas Department of Health Lecture Hall, K-100, 1100 West 49th 
Street, Austin, Texas. 

SUBCHAPTER A.General Provisions
25 TAC sec.sec.133.1-133.3
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241.
sec.133.1.Purpose.
sec.133.2.Definitions.
sec.133.3.Fees.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802142
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER B.Application and Issuance of a Hospital License
25 TAC sec.sec.133.11-133.14
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241. 
sec.133.11.Application and Issuance of Temporary Initial License for First-Time 
Applicants.
sec.133.12.Issuance and Renewal of Annual License.
sec.133.13.Time Periods for Processing and Issuing Hospital Licenses.
sec.133.14.Change of Ownership or Services.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802143
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER C.Operational Requirements for All Hospitals
25 TAC sec.133.21, sec.133.22
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241. 
sec.133.21.Standards - Adoption by Reference.
sec.133.22.Licensure Requirements and Standards for All Hospitals.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802144
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER D.Special Service Requirements
25 TAC sec.sec.133.51-133.54
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241. 
sec.133.51.Standards for the Provision of Comprehensive Medical Rehabilitation 
Services.
sec.133.52.Standards for the Provision of Mental Health Services in an 
Identifiable Part of a Hospital.
sec.133.53.Standards for the Provision of Chemical Dependency Services in an 
Identifiable Part of a Hospital.
sec.133.54.Standards for Hospitals Providing Comprehensive Medical 
Rehabilitation, Mental Health, or Chemical Dependency Services.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802145
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER E.Physical Plant and Fire Safety Requirements
25 TAC sec.133.71, sec.133.72
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241. 
sec.133.71.Construction Plans, Specifications, and Inspections.
sec.133.72.Waiver Provisions.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802146
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER F.Patient Transfers
25 TAC sec.133.101, sec.133.102
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241. 
sec.133.101.Hospital Patient Transfer Policies.
sec.133.102.Hospital Patient Transfer Agreements.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802147
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER G.Enforcement
25 TAC sec.sec.133.111-133.113
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Health or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeals affect the Health and Safety Code, Chapter 241. 
sec.133.111.Inspections and Investigation Procedures.
sec.133.112.Audits of Billing.
sec.133.113.Disciplinary Action and Emergency Orders.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802148
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER H.Internal Investigation
25 TAC sec.133.121
(Editor's note: The text of the following section proposed for repeal will not 
be published. The section may be examined in the offices of the Texas Department 
of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 
1019 Brazos Street, Austin.)
The repeal is proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeal affects the Health and Safety Code, Chapter 241. 
sec.133.121.Complaints against 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.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802149
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER I.Cooperative Agreements
25 TAC sec.133.131
(Editor's note: The text of the following section proposed for repeal will not 
be published. The section may be examined in the offices of the Texas Department 
of Health or in the Texas Register office, Room 245, James Earl Rudder Building, 
1019 Brazos Street, Austin.)
The repeal is proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The repeal affects the Health and Safety Code, Chapter 241. 
sec.133.131.Cooperative Agreements and Certificates of Public Advantage.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802150
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER A.General Provisions
25 TAC sec.133.1, sec.133.2
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.1.Purpose.
(a) The purpose of this chapter is to implement the Health and Safety Code, 
Chapter 241, which requires general and special hospitals to be licensed by the 
Texas Department of Health. 
(b) This chapter provides procedures for obtaining a hospital license; minimum 
standards for hospital functions and services; patient rights standards; 
discrimination or retaliation standards; patient transfer and other policy and 
protocol requirements; reporting, posting and training requirements relating to 
abuse and neglect; standards for voluntary agreements; waiver provisions; 
inspection and investigation procedures; enforcement standards; fire prevention 
and protection requirements; general safety standards; physical plant and 
construction requirements for existing and new hospitals, and mobile 
transportable and relocatable units; and standards for the preparation, 
submittal, review and approval of construction documents. 
(c) Compliance with this chapter does not constitute release from the 
requirements of other applicable federal, state, or local laws, codes, rules, 
regulations and ordinances. This chapter must be followed where it exceeds other 
codes and ordinances. 

sec.133.2.Definitions.
The following words and terms, when used in this chapter, shall have the 
following meanings, unless the context clearly indicates otherwise. 
Act - The Texas Hospital Licensing Law, Health and Safety Code, Chapter 241. 
Advance directive - Written instructions recognized under state law relating to 
the provision of health care when individuals are unable to communicate their 
wishes regarding medical treatment. The advance directive may be a written 
document authorizing an agent or surrogate to make decisions on an individual's 
behalf (a durable power of attorney for health care), a written or oral 
statement (a living will), or some other form of instruction recognized under 
state law specifically addressing the provisions of health care. 
Applicant - The person legally responsible for the operation of the hospital, 
whether by lease or ownership, who seeks a hospital license from the department. 
Attorney general - The attorney general of Texas or any assistant attorney 
general acting under the direction of the attorney general of Texas.
Biological indicator- Commercially-available microorganisms (e.g., United States 
Food and Drug Administration (FDA) approved strips or vials of Bacillus species 
endospores) which can be used to verify the performance of waste treatment 
equipment and processes (or sterilization equipment and processes). 
Board - The Texas Board of Health. 
Chemical dependency services - A planned, structured, and organized program 
designed to initiate and promote a person's chemical-free status or to maintain 
the person free of illegal drugs. It includes, but is not limited to, the 
application of planned procedures to identify and change patterns of behavior 
related to or resulting from chemical dependency that are maladaptive, 
destructive, or injurious to health, or to restore appropriate levels of 
physical, psychological, or social functioning lost due to chemical dependency. 
Comprehensive medical rehabilitation - The provision of rehabilitation services 
that are designed to improve or minimize a person's physical or cognitive 
disabilities, maximize a person's functional ability, or restore a person's lost 
functional capacity through close coordination of services, communication, 
interaction, and integration among several professions that share responsibility 
to achieve team treatment goals for the person. 
Comprehensive medical rehabilitation hospital - A general hospital that 
specializes in providing comprehensive medical rehabilitation services, 
including surgery and related ancillary services. 
Comprehensive medical rehabilitation unit - An identifiable part of a hospital 
which provides comprehensive medical rehabilitation services to patients 
admitted to the unit. 
Contaminated linen - Linen which has been soiled with blood or other potentially 
infectious materials or may contain sharps. Other potentially infectious 
materials means: 
(A) the following human body fluids: semen, vaginal secretions, cerebrospinal 
fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, 
amniotic fluid, saliva in dental procedures, any body fluid that is visibly 
contaminated with blood, and all body fluids in situations where it is difficult 
or impossible to differentiate between body fluids; 
(B) any unfixed tissue or organ (other than intact skin) from a human (living or 
dead); and 
(C) Human Immunodeficiency Virus (HIV)-containing cell or tissue cultures, organ 
cultures, and HIV or Hepatitis B Virus (HBV) containing culture medium or other 
solutions; and blood, organs, or other tissues from experimental animals 
infected with HIV or HBV. 
Cooperative agreement - An agreement among two or more hospitals for the 
allocation or sharing of health care equipment, facilities, personnel, or 
services. 
Dentist - A person licensed to practice dentistry by the State Board of Dental 
Examiners. This includes a doctor of dental surgery or a doctor of dental 
medicine. 
Department - The Texas Department of Health, 1100 West 49th Street, Austin, 
Texas 78756-3199. 
Designated provider - A provider of health care services, selected by a health 
maintenance organization, a self-insured business corporation, a beneficial 
society, the Veterans Administration, CHAMPUS, a business corporation, an 
employee organization, a county, a public hospital, a hospital district, or any 
other entity to provide health care services to a patient with whom the entity 
has a contractual, statutory, or regulatory relationship that creates an 
obligation for the entity to provide the services to the patient. 
Dietitian - A person who is currently licensed by the Texas State Board of 
Examiners of Dietitians as a licensed dietitian or provisional licensed 
dietitian, or who is a registered dietitian with the American Dietetic 
Association. 
Director - The hospital licensing director, Health Facility Licensing Division, 
Texas Department of Health. 
Disciplinary action - Denial, suspension, or revocation of a license, issuance 
of an emergency order or imposition of an administrative penalty. 
Division - The Health Facility Licensing Division, Texas Department of Health. 
Emergency medical condition - A medical condition manifesting itself by acute 
symptoms of sufficient severity (including severe pain, psychiatric disturbances 
or symptoms of substance abuse) such that the absence of immediate medical 
attention could reasonably be expected to result in one or all of the following: 
(A) placing the health of the individual (or with respect to a pregnant woman, 
the health of the woman or her unborn child) in serious jeopardy; 
(B) serious impairment to bodily functions; 
(C) serious dysfunction of any bodily organ or part; or 
(D) with respect to a pregnant woman who is having contractions:
(i) that there is inadequate time to effect a safe transfer to another hospital 
before delivery; or 
(ii) that transfer may pose a threat to the health or safety of the woman or the 
unborn child. 
Fast-track projects - A construction project in which it is necessary to begin 
initial phases of construction before later phases of the construction documents 
are fully completed in order to establish other design conditions or because of 
time constraints such as mandated deadlines. 
General hospital - An establishment that:
(A) offers services, facilities, and beds for use for more than 24 hours for two 
or more unrelated individuals requiring diagnosis, treatment, or care for 
illness, injury, deformity, abnormality, or pregnancy; and 
(B) regularly maintains, at a minimum, clinical laboratory services, diagnostic 
X-ray services, treatment facilities including surgery or obstetrical care or 
both, and other definitive medical or surgical treatment of similar extent. 
Governmental unit - A political subdivision of the state, including a hospital 
district, county, or municipality, and any department, division, board, or other 
agency of a political subdivision. 
Governing body - The governing authority of a hospital which is responsible for 
a hospital's organization, management, control, and operation, including 
appointment of the medical staff; includes the owner or partners for hospitals 
owned or operated by an individual or partners.
Hospital - A general hospital or a special hospital. 
Hospital administration - Administrative body of a hospital headed by an 
individual who has the authority to represent the hospital and who is 
responsible for the operation of the hospital according to the policies and 
procedures of the hospital's governing body. 
Illegal conduct - A conduct prohibited by federal or state law. 
Inpatient - An individual admitted for an intended length of stay of 24 hours or 
greater. 
Inpatient services - Services provided to an individual admitted to a hospital 
for an intended length of stay of 24 hours or greater. 
Legally reproduced form - A medical record retained in hard copy, microform 
(microfilm or microfiche), or other electronic medium. 
Licensed vocational nurse - A person who is currently licensed under the 
Vocational Nurse Act by the Board of Vocational Nurse Examiners for the State of 
Texas as a licensed vocational nurse (LVN). 
Licensee - The person or governmental unit named in the application for issuance 
of a hospital license. 
Mandated provider - A person who provides health care services, is selected by a 
county, public hospital, or hospital district, and agrees to provide health care 
services to eligible residents. 
Medical staff - A physician or group of physicians or a podiatrist or group of 
podiatrists who by action of the governing body of a hospital are privileged to 
work in and use the facilities of a hospital for, or in connection with, the 
observation, care, diagnosis, or treatment of an individual who is or may be 
suffering from mental or physical disease or disorder, or a physical deformity 
or injury. 
Medical waste - Waste generated by health care related facilities which is 
associated with health care activities not including garbage or rubbish 
generated from offices, kitchens, or other non-health care activities. 
Mental health services - All services concerned with research, prevention, and 
detection of mental disorders and disabilities and all services necessary to 
treat, care for, supervise, and rehabilitate persons who have a mental disorder 
or disability, including persons whose mental disorders or disabilities result 
from alcoholism or drug addiction. 
Mental retardation - Significantly subaverage general intellectual functioning 
that is concurrent with deficits in adaptive behavior and originates during the 
developmental period. 
Mobile unit - Any pre-manufactured structure, trailer, or self-propelled unit 
equipped with a chassis on wheels and intended to provide shared medical 
services to the community on a temporary basis. Some of these units are equipped 
with expanding walls, and designed to be moved on a daily basis. 
Outpatient - An individual who presents for diagnostic or treatment services for 
an intended length of stay of less than 24 hours. 
Outpatient services - Services provided to patients whose medical needs can be 
met in less than 24 hours and are provided within the hospital. 
Owner - One of the following persons or governmental unit which will hold or 
does hold a license issued under the statute in the person's name or the 
person's assumed name: 
(A) a corporation; 
(B) a governmental unit; 
(C) a limited liability company; 
(D) an individual; 
(E) a partnership if a partnership name is stated in a written partnership 
agreement or an assumed name certificate; 
(F) all partners in a partnership if a partnership name is not stated in a 
written partnership agreement or an assumed name certificate; or 
(G) all co-owners under any other business arrangement. Patient - An individual 
who presents for diagnosis or treatment.
Pediatric and adolescent hospital - A general hospital that specializes in 
providing services to children and adolescents, including surgery and related 
ancillary services. 
Person - An individual, firm, partnership, corporation, association, or joint 
stock company, and includes a receiver, trustee, assignee, or other similar 
representative of those entities. 
Physician - A physician licensed by the Texas State Board of Medical Examiners. 
Podiatrist - A podiatrist licensed by the Texas State Board of Podiatry 
Examiners. 
Practitioner - A health care professional licensed in the State of Texas, other 
than a physician, podiatrist, or dentist. 
Premises- A premises may be any of the following: 
(A) a single building where inpatients receive hospital services; or 
(B) multiple buildings where inpatients receive hospital services, provided that 
the following criteria are met: 
(i) all inpatient buildings and inpatient services are subject to the control 
and direction of the governing body of the hospital; 
(ii) all inpatient buildings are within a 30-mile radius of the main address of 
the licensee; 
(iii) there is integration of the organized medical staff of the hospital; 
(iv) there is a single chief executive officer who reports directly to the 
governing body and through whom all administrative authority flows and who 
exercises control and surveillance over all administrative activities of the 
hospital;
(v) there is a single chief medical officer who reports directly to the 
governing body and who is responsible for all medical staff activities of the 
hospital; and 
(vi) each building that is geographically separate from other buildings contains 
at least one nursing unit for inpatients, unless providing only diagnostic or 
laboratory services, or a combination thereof, in the building for hospital 
inpatients.
Presurvey conference - A conference held with department staff and the applicant 
or the applicant's representative to review licensure rules and survey documents 
and provide consultation prior to the on-site licensure inspection. 
Psychiatric disorder - A clinically significant behavioral or psychological 
syndrome or pattern that occurs in an individual and that is typically 
associated with either a painful syndrome (distress) or impairment in one or 
more important areas of behavioral, psychological, or biological function and is 
more than a disturbance in the relationship between the individual and society. 
Registered nurse- A person who is currently licensed by the Board of Nurse 
Examiners for the State of Texas as a registered nurse (RN).
Relocatable unit - Any structure, not on wheels, built to be relocated at any 
time and provide medical services. These structures vary in size. 
Special hospital- An establishment that: 
(A) offers services, facilities, and beds for use for more than 24 hours for two 
or more unrelated individuals who are regularly admitted, treated, and 
discharged and who require services more intensive than room, board, personal 
services, and general nursing care; 
(B) has clinical laboratory facilities, diagnostic X-ray facilities, treatment 
facilities, or other definitive medical treatment; 
(C) has a medical staff in regular attendance; and 
(D) maintains records of the clinical work performed for each patient.
Stabilize - With respect to an emergency medical condition, to provide such 
medical treatment of the condition necessary to assure, within reasonable 
medical probability, that no material deterioration of the condition is likely 
to result from or occur during the transfer of the individual from a facility, 
or that the woman has delivered the child and the placenta. 
Transfer - The movement (including the discharge) of an individual outside a 
hospital's facilities at the direction of any person employed by (or affiliated 
or associated, directly or indirectly, with) the hospital, but does not include 
such a movement of an individual who has been declared dead, or leaves the 
facility without the permission of any such person. 
Transportable unit - Any pre-manufactured structure or trailer, equipped with a 
chassis on wheels, intended to provide shared medical services to the community 
on an extended temporary basis. These units are designed to be moved 
periodically, depending on need. 
Unethical conduct - Conduct prohibited by the ethical standards adopted by state 
or national professional organizations for their respective professions or by 
rules established by the state licensing agency for the respective profession. 
Universal precautions - Procedures for disinfection and sterilization of 
reusable medical devices and the appropriate use of infection control, including 
hand washing, the use of protective barriers, and the use and disposal of 
needles and other sharp instruments as those procedures are defined by the 
Centers for Disease Control (CDC) of the United States Public Health Service. 
This term includes standard precautions as defined by CDC which are designed to 
reduce the risk of transmission of blood borne and other pathogens in hospitals.
Violation - Failure to comply with the licensing statute, a rule or standard, 
special license provision, or an order issued by the commissioner of health or 
the commissioner's designee, adopted or enforced under the licensing statute. 
Each day a violation continues or occurs is a separate violation for purposes of 
imposing a penalty. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802151
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER B.Hospital License
25 TAC sec.sec.133.21-133.26
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.21.General.
(a) License required. 
(1) A hospital shall obtain a license prior to admitting patients.
(2) Upon written request, the Texas Department of Health (department) shall 
furnish a person with an application for a hospital license.
(3) The license application shall be submitted in accordance with sec.133.22 of 
this title (relating to Application and Issuance of Initial License). The 
applicant shall retain copies of all application documents submitted to the 
department. 
(b) Compliance. A hospital shall comply with the provisions of the Act and this 
chapter during the licensing period. 
(c) Scope of hospital license. 
(1) A hospital license is issued for the premises and person or governmental 
unit named in the application. 
(2) A hospital license shall not include off-site outpatient facilities. 
(3) Multiple hospitals may share one building. 
(A) Each hospital shall be licensed separately. 
(B) No part of the building may be dually licensed by more than one hospital; 
and 
(C) Each hospital in the building shall comply with the requirements of 
sec.133.165 (relating to Building with Multiple Occupancies). 
(d) Display. A hospital shall prominently and conspicuously display the hospital 
license in a public area of the licensed premises that is readily visible to 
patients, employees, and visitors. 
(e) Alteration. A hospital license shall not be altered. 
(f) Transfer or assignment prohibited. A hospital license shall not be 
transferred or assigned. The hospital shall comply with the provisions of 
sec.133.24 of this title (relating to Change of Ownership) in the event of a 
change in the ownership of a hospital. 
(g) Changes which affect the license. 
(1) A hospital shall notify the department in writing prior to the occurrence of 
any of the following: 
(A) addition or deletion of those services indicated on the license application; 
(B) changes in design bed capacity as the phrase is used in sec.133.26(b)(1)(A)-
(C) of this title (relating to Fees); 
(C) request to change license classification; and 
(D) any construction, renovation, or modification of the hospital buildings. 
(2) A hospital shall notify the department in writing at the time of the 
occurrence of any of the following: 
(A) cessation of operation of the hospital. The hospital shall include in the 
written notice the location where the medical records will be stored and the 
identity and telephone number of the custodian of the medical records; 
(B) change in certification or accreditation status; and 
(C) change in hospital name, telephone number or administrator.

sec.133.22.Application and Issuance of Initial License.
(a) Application submittal. The applicant shall submit the following documents to 
the Texas Department of Health (department) no earlier than 60 calendar days 
prior to the projected opening date of the hospital:
(1) an accurate and complete application form; 
(2) a copy of the hospital's patient transfer policy which is developed in 
accordance with sec.133.44 of this title (relating to Hospital Patient Transfer 
Policy) and is signed by both the chairman and secretary of the governing body 
attesting to the date the policy was adopted by the governing body and the 
effective date of the policy; 
(3) a copy of the hospital's memorandum of transfer form which contains at a 
minimum the information described in sec.133.44(b)(11)(B) of this title; 
(4) if the application is for a special hospital license, a copy of a written 
agreement the special hospital has entered into with a general hospital which 
provides for the prompt transfer to and the admission by the general hospital of 
any patient when special services are needed but are unavailable at the special 
hospital. This agreement is required and is separate from any voluntary patient 
transfer agreements the hospital may enter into in accordance with sec.133.61 of 
this title (relating to Hospital Patient Transfer Agreements); 
(5) copies of any patient transfer agreements entered into between the hospital 
and another hospital in accordance with sec.133.61 of this title; 
(6) for existing facilities, a copy of a hospital fire safety survey indicating 
approval by the local fire authority in whose jurisdiction the hospital is based 
that is dated no earlier than one year prior to the hospital opening date. For 
new construction, addition, and renovation projects, written approval by the 
local building department and local fire authority shall be submitted during the 
final construction inspection by the department;
(7) the appropriate license fee as required in sec.133.26 of this title 
(relating to Fees); and 
(8) if the applicant is a sole proprietor, partnership with individuals as a 
partner, or a corporation in which an individual has an ownership interest of at 
least 25% of the business entity, the names and social security numbers of the 
individuals. 
(b) Verification of franchise tax status. Upon receipt of the application 
documents, the department shall verify the franchise tax status of an applicant 
who is a corporation prior to the issuance of a license. In accordance with 
Article 2.45, Part Two, Texas Business Corporation Act, the department will not 
issue a hospital license to an applicant who is a corporation if the corporation 
is delinquent in franchise tax owed to the state under the Tax Code, Texas Codes 
Annotated, Chapter 171. 
(c) Additional documentation for new hospitals or conversions from nonhospital 
buildings. In addition to the document submittal requirements in subsection (a) 
of this section, and verification of the franchise tax information in subsection 
(b) of this section, the following shall be completed prior to the issuance of a 
hospital license to newly constructed hospitals or hospitals from conversions of 
nonhospital buildings. 
(1) Preliminary and final architectural plans and specifications shall be 
reviewed and approved by the department in accordance with sec.133.167 of this 
title (relating to Preparation, Submittal, Review and Approval of Plans). 
(2) For new construction, necessary preliminary inspections and final 
construction inspections shall be conducted by the department in accordance with 
sec.133.167(e)(4) of this title to determine that the hospital was constructed 
or remodeled in accordance with this chapter. 
(3) When an applicant intends to reopen and relicense a building formerly 
licensed as a hospital, an on-site inspection shall be conducted by the 
department in accordance with sec.133.167(e)(4) of this title to determine 
compliance with applicable construction and fire safety requirements. 
(4) All plan review and construction inspection fees shall be paid to the 
department. 
(5) A certificate of occupancy approved by the local fire authority, and issued 
by the city building inspector, if applicable, shall be obtained and a copy 
submitted to the department. 
(6) A complete, accurate, and notarized Affidavit for Final Construction 
Approval form shall be submitted to the department. 
(7) The project architect shall submit a statement to the department that the 
hospital's project plans and specifications have been submitted to the Texas 
Department of Licensing and Regulation. 
(d) Presurvey conference. The applicant or the applicant's representative shall 
attend a presurvey conference at the office designated by the department. The 
designated survey office may waive the presurvey conference requirement. 
(e) Issuance of license. When it is determined that the hospital has complied 
with subsections (a)-(d) of this section, the department shall issue the license 
to the applicant.
(1) Effective date. The license shall be effective on the date the hospital is 
determined to be in compliance with subsections (a)-(d) of this section. The 
effective date shall not be prior to the date of the final construction 
inspection conducted by the department. 
(2) Expiration date. 
(A) If the effective date of the license is the first day of a month, the 
license expires on the last day of the month preceding the issuance month of the 
next year. For example, if a license is effective September 1, the license 
expires on August 31 of the next year and every year thereafter unless a change 
of ownership occurs. 
(B) If the effective date of the license is the second or any subsequent day of 
a month, the license expires on the last day of the month of the next year. For 
example, if the license is effective September 2, the license expires on 
September 30 of the next year and every year thereafter unless a change of 
ownership occurs. 
(f) Withdrawal of application. If an applicant decides not to continue the 
application process for a license or renewal of a license, the application may 
be withdrawn. If a license has been issued, the applicant shall return the 
license to the department with its written request to withdraw. The department 
shall acknowledge receipt of the request to withdraw. 
(g) Denial of a license. Denial of a license shall be governed by sec.133.121 of 
this title (relating to Enforcement Action). 
(h) Inspection. During the licensing period, the department shall conduct an 
inspection of the hospital to ascertain compliance with the provisions of the 
Act and this chapter. 
(1) If a hospital has applied to participate in the federal Medicare program, 
the inspection may be conducted in conjunction with the inspection to determine 
compliance with 42 Code of Federal Regulations, Part 482 (relating to Medicare 
Conditions of Participation for Hospitals). 
(2) A hospital shall have admitted and be providing services to at least one 
inpatient in the hospital at the time of the inspection.

sec.133.23.Application and Issuance of Renewal License.
(a) Renewal notice. The Texas Department of Health (department) shall send a 
renewal notice to a hospital at least 60 calendar days before the expiration 
date of a license. 
(1) If the hospital has not received the renewal notice from the department 
within 45 calendar days prior to the expiration date, it is the duty of the 
hospital to notify the department and request a renewal application for a 
license. 
(2) If the hospital fails to submit the application and fee within 15 calendar 
days prior to the expiration date of the license, the department shall send by 
certified mail to the hospital a letter advising that unless the license is 
renewed, the hospital must cease operations upon the expiration of the 
hospital's license. 
(b) Renewal license. The department shall issue a renewal license to a hospital 
which meets the minimum requirements for a license.
(1) The hospital shall submit the following to the department prior to the 
expiration date of the license: 
(A) a complete and accurate application form; 
(B) a copy of a hospital fire safety survey indicating approval by the local 
fire authority in whose jurisdiction the hospital is based that is dated no 
earlier than one year prior to the application date; 
(C) the renewal license fee; and 
(D) if the applicant is accredited by the Joint Commission on Accreditation of 
Healthcare Organizations or the American Osteopathic Association, a copy of 
documentation from the accrediting body showing the current accreditation status 
of the hospital. 
(2) Upon receipt of the renewal documents, the department shall verify the 
franchise tax status of an applicant who is a corporation prior to the issuance 
of a license. In accordance with Article 2.45, Part Two, Texas Business 
Corporation Act, the department will not issue a hospital license to an 
applicant who is a corporation if the corporation is delinquent in franchise tax 
owed to the State under the Tax Code, Texas Codes Annotated, Chapter 171. 
(3) The department may conduct an inspection prior to issuing a renewal license 
in accordance with sec.133.101 of this title (relating to Inspection and 
Investigation Procedures). 
(c) Notice to cease operation and return license. If a hospital fails to submit 
the application, documents, and fee by the expiration date of the hospital's 
license, the department shall notify the hospital by certified mail that it must 
cease operation and immediately return the license by certified mail to the 
department. If the hospital wishes to provide services after the expiration date 
of the license, it shall apply for a license under sec.133.22 of this title 
(relating to Application and Issuance of Initial License).

sec.133.24.Change of Ownership. 
(a) Change of ownership defined. A change of ownership of a hospital occurs when 
there is a change in the person legally responsible for the operation of the 
hospital, whether by lease or by ownership. 
(b) License application required. The new owner shall submit an application for 
an initial license to the Texas Department of Health (department) prior to the 
date of the change of ownership or not later than 10 calendar days following the 
date of a change of ownership. The application shall be in accordance with 
sec.133.22 of this title (relating to the Application and Issuance of Initial 
License) except that the applicant need not submit any transfer agreements 
previously approved by the department. In addition to the documents required in 
sec.133.22 of this title, the applicant shall include the effective date of the 
change of ownership. 
(c) Inspections. The on-site construction and health inspections required by 
sec.133.22 of this title may be waived by the department. 
(d) Issuance of license. When the new owner has complied with the provisions of 
sec.133.22 of this title, the department shall issue a license which shall be 
effective the date of the change of ownership. 
(e) Expiration of license. The expiration date of the license shall be in 
accordance with sec.133.22(e)(2) of this title. 
(f) License void. The previous owner's license shall be void on the effective 
date of the new owner's license. 

sec.133.25.Time Periods for Processing and Issuing Hospital Licenses.
(a) General. 
(1) The receipt date for an application for an initial license or a renewal 
license is the date the application is received by the Health Facility Licensing 
Division (division), Texas Department of Health. 
(2) An application for an initial license is complete when the division has 
received, reviewed, and found acceptable the information described in 
sec.133.22(a)-(c) of this title (relating to Application and Issuance of Initial 
License). 
(3) An application for a renewal license is complete when the division has 
received, reviewed, and found acceptable the information described in 
sec.133.23(b) of this title (relating to Application and Issuance of Renewal 
License). 
(b) Time periods. An application for a hospital initial license or renewal 
license shall be processed in accordance with the following time periods. 
(1) The first time period begins on the date the division receives the 
application and ends on the date the hospital license is issued, or, if the 
application is received incomplete, the period ends on the date the hospital is 
issued a written notice that the application is incomplete. The written notice 
shall describe the specific information that is required before the application 
is considered complete. The first time period is 20 working days. 
(2) The second time period begins on the date the division receives the last 
item necessary to complete the application and ends on the date the hospital 
license is issued. The second time period is 20 working days. 
(c) Reimbursement of fees. 
(1) In the event the application is not processed in the time periods as stated 
in subsection (b) of this section, the applicant has the right to request the 
division to reimburse in full the fee paid in that particular application 
process. If the division does not agree that the established periods have been 
violated or finds that good cause existed for exceeding the established periods, 
the request shall be denied. 
(2) Good cause for exceeding the period established is considered to exist if: 
(A) the number of applications for licenses to be processed exceeds by 15% or 
more the number processed in the same calendar quarter the preceding year; 
(B) another public or private entity utilized in the application process caused 
the delay; or 
(C) other conditions existed which gave good cause for exceeding the established 
periods. 
(d) Appeal. If the request for full reimbursement authorized by subsection (c) 
of this section is denied, the applicant may then appeal to the commissioner of 
health (commissioner) for a resolution of the dispute. The applicant shall give 
written notice to the commissioner requesting full reimbursement of all filing 
fees paid because the application was not processed within the adopted time 
period. The division shall submit a written report of the facts related to the 
processing of the application and good cause for exceeding the established time 
periods. The commissioner shall make the final decision and provide written 
notification of the decision to the applicant and the division. 
(e) Contested case hearings. If a hearing is initiated during the processing of 
the application, the time periods in sec.1.34 of this title (relating to Time 
Periods for Conducting Contested Case Hearing) are applicable. 

sec.133.26.Fees.
(a) General. 
(1) All fees paid to the Texas Department of Health (department) are 
nonrefundable with the exception of inspection fees for inspections that were 
not conducted. 
(2) All fees shall be paid by check or money order made payable to the Texas 
Department of Health. 
(b) License fees. 
(1) The fee for an initial license or a renewal license is $10 per bed based 
upon the design bed capacity of the hospital. The total fee may not be less than 
$200 or more than $10,000. The design bed capacity of a hospital is determined 
as follows. 
(A) The design bed capacity is the maximum number of patient beds that a 
hospital can accommodate in rooms that comply with the requirements for patient 
room suites in sec.133.163 of this title (relating to Hospital Spatial 
Requirements) including beds, bassinets or cribs in critical care units 
(including neonatal nurseries), hospital-based skilled nursing units, medical 
nursing units, mental health and chemical dependency nursing units, pediatric 
and adolescent nursing units, obstetrical suites (including labor/delivery/ 
recovery/ postpartum (LDRP) beds), and surgical suites. The design bed capacity 
does not include labor/delivery/recovery (LDR) beds, newborn nursery bassinets, 
or recovery beds. 
(B) The maximum design bed capacity includes beds that comply with the 
requirements in sec.133.163 of this title even if the beds are unoccupied or the 
space is used for other purposes such as offices or storage rooms, provided such 
rooms can readily be returned to patient use. All required support and service 
areas must be maintained in place. For example, the removal of a nurse station 
in an unused patient bedroom wing of 20 beds would effectively eliminate those 
20 beds from the design capacity. Eliminating access to the medical gas outlets 
would also remove bed(s) from the design capacity.
(C) The number of licensed beds in a multiple occupancy room shall be determined 
by the design even if the number of beds actually placed in the room is less 
than the design capacity. 
(2) A hospital shall submit an additional fee with the notarized affidavit for 
final construction approval for an increase in the number of beds resulting from 
an approved construction project and an additional plan review fee if the 
construction cost increases to the next higher fee schedule according to 
subsection (c)(4) of this section. 
(3) A hospital will not receive a refund of previously submitted fees should the 
hospital's design capacity decrease as a result of an approved construction 
project. 
(c) Plan review fees. This subsection outlines the fees which must accompany the 
application for plan review and all proposed plans and specifications covering 
the construction of new buildings or alterations to existing buildings which 
must be submitted for review and approval by the department in accordance with 
sec.133.167 of this title (relating to Preparation, Submittal, Review and 
Approval of Plans). 
(1) Construction plans will not be reviewed or approved until the required fee 
and an application for plan review are received by the department.
(2) Plan review fees are based upon the estimated construction project costs 
which are the total expenditures required for a proposed project from initiation 
to completion, including at least the following items. 
(A) Construction project costs shall include expenditures for physical assets 
such as: 
(i) site acquisition; 
(ii) soil tests and site preparation; 
(iii) construction and improvements required as a result of the project; 
(iv) building, structure, or office space acquisition; 
(v) renovation; 
(vi) fixed equipment; and 
(vii) energy provisions and alternatives. 
(B) Construction project costs shall include expenditures for professional 
services including: 
(i) planning consultants; 
(ii) architectural fees; 
(iii) fees for cost estimation; 
(iv) legal fees; 
(v) management fees; and 
(vi) feasibility study. 
(C) Construction project costs shall include expenditures or costs associated 
with financing, excluding long-term interest, but including:
(i) financial advisor; 
(ii) fund-raising expenses; 
(iii) lender's or investment banker's fee; and 
(iv) interest on interim financing. 
(D) Construction project costs shall include expenditure allowances for 
contingencies including: 
(i) inflation; 
(ii) inaccurate estimates; 
(iii) unforeseen fluctuations in the money market; and 
(iv) other unforeseen expenditures. 
(3) Regarding purchases, donations, gifts, transfers, and other comparable 
arrangements whereby the acquisition is to be made for no consideration or at 
less than the fair market value, the project cost shall be determined by the 
fair market value of the item to be acquired as a result of the purchase, 
donation, gift, transfer, or other comparable arrangement. 
(4) The plan review fee schedule based on cost of construction is: 
(A) $600,000 or less: $500; 
(B) $600,001 to 2,000,000: $1,000; 
(C) $2,000,001 to 5,000,000: $1,500; 
(D) $5,000,001 to 10,000,000: $2,000; and 
(E) $10,000,001 and over: $3,000. 
(5) If an estimated construction cost cannot be established, the estimated cost 
shall be based on $105 per square foot. No construction project shall be 
increased in size, scope, or cost unless the appropriate fees are submitted with 
the proposed changes. 
(d) Construction inspection fees. A fee of $400 and an application for 
construction inspection for each inspection shall be submitted to the department 
at least three weeks prior to the anticipated inspection date. Construction 
inspections will not be conducted until all required fees are received by the 
department. If additional construction inspections of the proposed project are 
requested by the hospital, the appropriate additional fees shall be submitted 
prior to any inspections conducted by the staff of the department. When follow 
up construction inspections are performed to verify plans of correction, the fee 
shall be submitted upon completion of the inspection.
(e) Cooperative agreement application fee. The application fee for a cooperative 
agreement is $10,000. The application fee shall be submitted with an application 
for a cooperative agreement and other documents in accordance with 
sec.133.62(b)(2) of this title (relating to Cooperative Agreements).
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802152
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER C.Operational Requirements
25 TAC sec.sec.133.41-133.47
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.41.Hospital Functions and Services.
(a) Anesthesia services. If the hospital furnishes anesthesia services, these 
services shall be provided in a well-organized manner under the direction of a 
qualified physician. The anesthesia service is responsible for all anesthesia 
administered in the hospital. 
(1) Organization and staffing. The organization of anesthesia services shall be 
appropriate to the scope of the services offered. Anesthesia shall be 
administered only by: 
(A) a qualified anesthesiologist; 
(B) a physician (other than an anesthesiologist); 
(C) a dentist, oral surgeon, or podiatrist who is qualified to administer 
anesthesia under state law; or 
(D) a certified registered nurse anesthetist who is under the supervision of the 
operating physician or of an anesthesiologist who is immediately available if 
needed. 
(2) Delivery of services. Anesthesia services shall be consistent with needs and 
resources. Policies on anesthesia procedures shall include the delineation of 
pre-anesthesia and post-anesthesia responsibilities. The policies shall ensure 
that the following are provided for each patient.
(A) A pre-anesthesia evaluation by an individual qualified to administer 
anesthesia under paragraph (1) of this subsection shall be performed within 48 
hours prior to surgery. 
(B) An intraoperative anesthesia record shall be provided. The record shall 
include any complications or problems occurring during the anesthesia including 
time, description of symptoms, review of affected systems, and treatments 
rendered. The record shall correlate with the controlled substance 
administration record. 
(C) A post-anesthesia follow-up report shall be written by the person 
administering the anesthesia before transferring the patient from the recovery 
room and shall include evaluation for recovery from anesthesia, level of 
activity, respiration, blood pressure, level of consciousness, and patient 
color. 
(i) With respect to inpatients, a post-anesthesia evaluation for proper 
anesthesia recovery shall be performed after transfer from recovery and within 
48 hours after surgery by the person administering the anesthesia, registered 
nurse (RN), or physician in accordance with policies and procedures approved by 
the medical staff and using criteria written in the medical staff bylaws for 
post-operative monitoring of anesthesia. 
(ii) With respect to outpatients, immediately prior to discharge, a post-
anesthesia evaluation for proper anesthesia recovery shall be performed by the 
person administering the anesthesia, RN, or physician in accordance with 
policies and procedures approved by the medical staff and using criteria written 
in the medical staff bylaws for post-operative monitoring of anesthesia.
(b) Chemical dependency services. 
(1) Chemical dependency unit. A patient admitted to a hospital providing 
chemical dependency services shall be housed in the chemical dependency unit 
which has been approved by the Texas Department of Health (department) as 
meeting the requirements of sec.133.163(p) of this title (relating to Hospital 
Spatial Requirements). 
(2) Admission criteria. A hospital providing chemical dependency services shall 
have written admission criteria that are applied uniformly to all patients who 
are admitted to the chemical dependency unit.
(A) The hospital's admission criteria shall include procedures to prevent the 
admission of minors for a condition which is not generally recognized as 
responsive to treatment in an inpatient setting for chemical dependency 
services.
(i) The following conditions are not generally recognized as responsive to 
treatment in a treatment facility for chemical dependency unless the minor to be 
admitted is qualified because of other disabilities, such as: 
(I) cognitive disabilities due to mental retardation; 
(II) learning disabilities; or 
(III) psychiatric disorders. 
(ii) A minor may be qualified for admission based on other disabilities which 
would be responsive to chemical dependency services. 
(iii) A minor patient shall be separated from adult patients.
(B) The hospital shall have a preadmission examination procedure under which 
each patient's condition and medical history are reviewed by a member of the 
medical staff to determine whether the patient is likely to benefit 
significantly from an intensive inpatient program or assessment. 
(C) A voluntarily admitted patient shall sign an admission consent form prior to 
admission to a chemical dependency unit which includes verification that the 
patient has been informed of the services to be provided and the estimated 
charges. 
(3) Compliance. A hospital providing chemical dependency services in an 
identifiable unit within the hospital shall comply with 40 Texas Administrative 
Code (TAC), Chapter 148 (relating to Chemical Dependency Treatment Facility 
Licensure Standards) administered by the Texas Commission on Alcohol and Drug 
Abuse. 
(c) Comprehensive medical rehabilitation services. 
(1) Rehabilitation units. A patient admitted to a hospital providing 
comprehensive medical rehabilitation services shall be housed in the 
rehabilitation unit which has been approved by the department as meeting the 
requirements of sec.133.163(y) of this title. 
(2) Equipment and space. The hospital shall have the necessary equipment and 
sufficient space to implement the treatment plan described in paragraph (7)(C) 
of this subsection and allow for adequate care. Necessary equipment is all 
equipment necessary to comply with all parts of the written treatment plan. The 
equipment shall be on-site or available through an arrangement with another 
provider. Sufficient space is the physical area of a hospital which in the 
aggregate, constitutes the total amount of the space necessary to comply with 
the written treatment plan. 
(3) Emergency requirements. Emergency personnel, equipment, supplies and 
medications for hospitals providing comprehensive medical rehabilitation 
services shall be as follows. 
(A) A hospital which provides comprehensive medical rehabilitation services 
shall have emergency equipment, supplies, medications, and designated personnel 
assigned for providing emergency care to patients and visitors.
(B) The emergency equipment, supplies, and medications shall be properly 
maintained and immediately accessible to all areas of the hospital. The 
emergency equipment shall be periodically tested according to the policy 
established by the hospital. 
(C) At a minimum, the emergency equipment and supplies shall include those 
specified in subsection (e)(1)(D)(i)-(viii) of this section.
(D) The personnel providing emergency care in accordance with this subsection 
shall be staffed for 24-hour coverage and accessible to all patients receiving 
comprehensive medical rehabilitation services. At least one person who is 
qualified by training to perform advanced cardiac life support and administer 
emergency drugs shall be on duty each shift. 
(E) All direct patient care licensed personnel shall maintain current 
certification in cardiopulmonary resuscitation (CPR). 
(4) Medications. A rehabilitation hospital's governing body shall adopt and 
enforce policies and procedures that require all medications to be administered 
by licensed nurses, physicians, or other licensed professionals authorized by 
law to administer medications. 
(5) Organization and Staffing. 
(A) A hospital providing comprehensive medical rehabilitation services shall be 
organized and staffed to ensure the health and safety of the patients. 
(i) All provided services shall be consistent with accepted professional 
standards and practice. 
(ii) The organization of the services shall be appropriate to the scope of the 
services offered. 
(iii) The hospital shall have written patient care policies that govern the 
services it furnishes. 
(B) The provision of comprehensive medical rehabilitation services in a hospital 
shall be under the medical supervision of a physician who is on duty and 
available, or who is on call 24 hours each day. 
(C) A hospital providing comprehensive medical rehabilitation services shall 
have a director who supervises and administers the provision of comprehensive 
medical rehabilitation services. 
(i) The director shall be a physician who is board certified or eligible for 
board certification in physical medicine and rehabilitation, orthopedics, 
neurology, neurosurgery, internal medicine, or rheumatology as appropriate for 
the rehabilitation program. 
(ii) The director shall be qualified by training or at least two years training 
and experience to serve as medical director. A person is qualified under this 
subsection if the person has training and experience in the treatment of 
rehabilitation patients in a rehabilitation setting. 
(6) Admission criteria. A hospital providing comprehensive medical 
rehabilitation services shall have written admission criteria that are applied 
uniformly to all patients who are admitted to the comprehensive medical 
rehabilitation unit. 
(A) The hospital's admission criteria shall include procedures to prevent the 
admission of a minor for a condition which is not generally recognized as 
responsive to treatment in an inpatient setting for comprehensive medical 
rehabilitation services. 
(i) The following conditions are not generally recognized as responsive to 
treatment in an inpatient setting for comprehensive medical rehabilitation 
services unless the minor to be admitted is qualified because of other 
disabilities, such as: 
(I) cognitive disabilities due to mental retardation; 
(II) learning disabilities; or 
(III) psychiatric disorders. 
(ii) A minor may be qualified for admission based on other disabilities which 
would be responsive to comprehensive medical rehabilitation services. 
(B) The hospital shall have a preadmission examination procedure under which 
each patient's condition and medical history are reviewed by a member of the 
medical staff to determine whether the patient is likely to benefit 
significantly from an intensive inpatient program or assessment. 
(7) Care and services. 
(A) A hospital providing comprehensive medical rehabilitation services shall use 
a coordinated interdisciplinary team which is directed by a physician and which 
works in collaboration to develop and implement the patient's treatment plan. 
(i) The interdisciplinary team for comprehensive medical rehabilitation services 
shall have available to it, at the hospital at which the services are provided 
or by contract, members of the following professions as necessary to meet the 
treatment needs of the patient: 
(I) physical therapy; 
(II) occupational therapy; 
(III) speech-language pathology; 
(IV) therapeutic recreation; 
(V) social services and case management; 
(VI) dietetics; 
(VII) psychology; 
(VIII) respiratory therapy; 
(IX) rehabilitative nursing; 
(X) certified orthotics; 
(XI) certified prosthetics; 
(XII) pharmaceutical care; and 
(XIII) in the case of a minor patient, persons who have specialized education 
and training in emotional, mental health, or chemical dependency problems, as 
well as the treatment of minors. 
(ii) The coordinated interdisciplinary team approach used in the rehabilitation 
of each patient shall be documented by periodic entries made in the patient's 
medical record to denote: 
(I) the patient's status in relationship to goal attainment; and 
(II) that team conferences are held at least every two weeks to determine the 
appropriateness of treatment. 
(B) An initial assessment and preliminary treatment plan shall be performed or 
established by the physician within 24 hours of admission.
(C) The physician in coordination with the interdisciplinary team shall 
establish a written treatment plan for the patient within seven working days of 
the date of admission. 
(i) Comprehensive medical rehabilitation services shall be provided in 
accordance with the written treatment plan. 
(ii) The treatment provided under the written treatment plan shall be provided 
by staff who are qualified to provide services under state law. The hospital 
shall establish written qualifications for services provided by each discipline 
for which there is no applicable state statute for professional licensure or 
certification. 
(iii) Services provided under the written treatment plan shall be given in 
accordance with the orders of practitioners who are authorized by the governing 
body, hospital administration, and medical staff to order the services, and the 
orders shall be incorporated in the patient's record.
(iv) The written treatment plan shall delineate anticipated goals and specify 
the type, amount, frequency, and anticipated duration of service to be provided. 
(v) Within 10 working days after the date of admission, the written treatment 
plan shall be provided. It shall be in the person's primary language, if 
practicable. What is or would have been practicable shall be determined by the 
facts and circumstances of each case. The written treatment plan shall be 
provided to: 
(I) the patient; 
(II) a person designated by the patient; and 
(III) upon request, a family member, guardian, or individual who has 
demonstrated on a routine basis responsibility and participation in the 
patient's care or treatment, but only with the patient's consent unless such 
consent is not required by law. 
(vi) The written treatment plan shall be reviewed by the interdisciplinary team 
at least every two weeks. 
(vii) The written treatment plan shall be revised by the interdisciplinary team 
if a comprehensive reassessment of the patient's status or the results of a 
patient case review conference indicates the need for revision. 
(viii) The revision shall be incorporated into the patient's record within seven 
working days after the revision. 
(ix) The revised treatment plan shall be reduced to writing in the person's 
primary language, if practicable, and provided to: 
(I) the patient; 
(II) a person designated by the patient; and 
(III) upon request, a family member, guardian, or individual who has 
demonstrated on a routine basis responsibility and participation in the 
patient's care or treatment, but only with the patient's consent unless such 
consent is not required by law. 
(8) Discharge and continuing care plan. The patient's interdisciplinary team 
shall prepare a written continuing care plan that addresses the patient's needs 
for care after discharge. 
(A) The continuing care plan for the patient shall include recommendations for 
treatment and care and information about the availability of resources for 
treatment or care. 
(B) If the patient's interdisciplinary team deems it impracticable to provide a 
written continuing care plan prior to discharge, the patient's interdisciplinary 
team shall provide the written continuing care plan to the patient within two 
working days after the date of discharge. 
(C) Prior to discharge or within two working days after the date of discharge, 
the written continuing care plan shall be provided in the person's primary 
language, if practicable, to: 
(i) the patient; 
(ii) a person designated by the patient; and 
(iii) upon request, to a family member, guardian, or individual who has 
demonstrated on a routine basis responsibility and participation in the 
patient's care or treatment, but only with the patient's consent unless such 
consent is not required by law. 
(d) Dietary services. The hospital shall have organized dietary services that 
are directed and staffed by adequate qualified personnel. However, a hospital 
that has a contract with an outside food management company or an arrangement 
with another hospital may meet this requirement if the company or other hospital 
has a dietitian who serves the hospital on a full-time, part-time, or consultant 
basis, and if the company or other hospital maintains at least the minimum 
requirements specified in this section, and provides for the frequent and 
systematic liaison with the hospital medical staff for recommendations of 
dietetic policies affecting patient treatment. The hospital shall ensure that 
there are sufficient personnel to respond to the dietary needs of the patient 
population being served. 
(1) Organization. 
(A) The hospital shall have a full-time employee who: 
(i) serves as director of the food and dietetic service; 
(ii) is responsible for the daily management of the dietary services; and 
(iii) is qualified by experience or training. 
(B) There shall be a qualified dietitian who works full-time, part-time, or on a 
consultant basis. If by consultation, such services shall occur at least once 
per month for not less than eight hours. The dietitian shall: 
(i) be currently licensed under the laws of this state to use the titles of 
licensed dietitian or provisional licensed dietitian, or be a registered 
dietitian; 
(ii) maintain standards for professional practice; 
(iii) supervise the nutritional aspects of patient care; 
(iv) make an assessment of the nutritional status and adequacy of nutritional 
regimen; 
(v) provide diet counseling and teaching; 
(vi) document nutritional status and pertinent information in patient medical 
records; 
(vii) approve menus; and 
(viii) approve menu substitutions. 
(C) There shall be administrative and technical personnel competent in their 
respective duties. The administrative and technical personnel shall: 
(i) participate in established departmental or hospital training pertinent to 
assigned duties; 
(ii) conform to food handling techniques in accordance with paragraph 
(2)(E)(vii) and (viii) of this subsection; 
(iii) adhere to clearly defined work schedules and assignment sheets; and 
(iv) comply with position descriptions which are job specific.
(2) Director. The director shall: 
(A) comply with a position description which is job specific;
(B) clearly delineate responsibility and authority; 
(C) participate in conferences with administration and department heads; 
(D) establish, implement, and enforce policies and procedures for the overall 
operational components of the department to include, but not be limited to: 
(i) quality assurance; 
(ii) frequency of meals served; 
(iii) non-routine occurrences; and 
(iv) identification of patient trays; 
(E) maintain authority and responsibility for the following, but not be limited 
to: 
(i) orientation and training; 
(ii) performance evaluations; 
(iii) work assignments; 
(iv) supervision of work and food handling techniques; 
(v) procurement of food, paper, chemical, and other supplies, to include 
implementation of first-in first-out rotation system for all food items; 
(vi) menu planning; 
(vii) ensuring compliance with sec.sec.229.161-229.171 of this title (relating 
to Food Service Sanitation); and 
(viii) ensuring compliance with United States Department of Health and Human 
Services, Public Health Service, Food and Drug Administration, Food Service 
Sanitation Manual, Department of Health, Education, and Welfare Publication 
Number (FDA) 78-2081, 1976 edition, which is available from the United States 
Department of Health and Human Services, Public Health Service, Division of 
Retail Food Protection, Food and Drug Administration, Washington, D.C. 20204. 
(3) Diets. Menus shall meet the needs of the patients. 
(A) Therapeutic diets shall be prescribed by the physician(s) responsible for 
the care of the patients. The dietary department of the hospital shall: 
(i) establish procedures for the processing of therapeutic diets to include, but 
not be limited to: 
(I) accurate patient identification; 
(II) transcription from nursing to dietary services; 
(III) diet planning by a dietitian; 
(IV) regular review and updating of diet when necessary; and
(V) written and verbal instruction to patient and family. It shall be in the 
patient's primary language, if practicable, prior to discharge. What is or would 
have been practicable shall be determined by the facts and circumstances of each 
case; 
(ii) ensure that therapeutic diets are planned in writing by a qualified 
dietitian; 
(iii) ensure that menu substitutions are approved by a qualified dietitian; 
(iv) document pertinent information about the patient's response to a 
therapeutic diet in the medical record; and 
(v) evaluate therapeutic diets for nutritional adequacy. 
(B) Nutritional needs shall be met in accordance with recognized dietary 
practices and in accordance with orders of the physician(s) responsible for the 
care of the patients. The following requirements shall be met. 
(i) Menus shall provide a sufficient variety of foods served in adequate amounts 
at each meal to satisfy the Recommended Dietary Allowances (RDA) in compliance 
with the following publications: 
(I) Food and Nutrition Board, National Academy of Sciences, National Research 
Council, Tenth edition, 1989, which may be obtained by writing the National 
Academy Press, 2101 Constitution Avenue, Box 285, Washington, D.C. 20055, 
telephone (800) 624-6242; and 
(II) Nutrition and Your Health: Dietary Guidelines for Americans, Fourth 
edition, 1995, published by the United States Department of Agriculture and the 
United States Department of Health and Human Services. The document is available 
from the Food and Nutrition Information Center, USDA/National Agricultural 
Library, 10301 Baltimore Boulevard, Beltsville, MD 20705-2351.
(ii) A different written menu shall be followed each day of the week with at 
least three meals per day, seven days per week. The menu shall be posted in the 
food preparation area. 
(iii) A maximum of 15 hours shall not be exceeded between the last meal of the 
day (i.e. supper) and the breakfast meal, unless a substantial snack is 
provided. The hospital shall adopt, implement, and enforce a policy on the 
definition of "substantial" to meet each patient's varied nutritional needs. 
(iv) Current and previous menus shall meet the recommended allowances that 
include: 
(I) fats, oils, and sweets used sparingly; 
(II) 2-3 servings of the milk, yogurt, and cheese group; 
(III) 2-3 servings of the meat, poultry, fish, dry beans, eggs, and nuts group; 
(IV) 3-5 servings of the vegetable group; 
(V) 2-4 servings of the fruit group; and 
(VI) 6-11 servings of the bread, cereal, rice, and pasta group.
(C) A current therapeutic diet manual approved by the dietitian and medical 
staff shall be readily available to all medical, nursing, and food service 
personnel. The therapeutic manual shall: 
(i) be revised as needed, not to exceed 5 years; 
(ii) be appropriate for the diets routinely ordered in the hospital; 
(iii) have standards in compliance with the RDA; 
(iv) contain specific diets which are not in compliance with RDA; and 
(v) be used as a guide for ordering and serving diets. 
(e) Emergency services. 
(1) Emergency department. A general hospital shall have an emergency department 
that complies with sec.133.163(f) of this title and the following. 
(A) Organization. The organization of the emergency services shall be 
appropriate to the scope of the services offered. 
(i) The services shall be organized under the direction of a qualified member of 
the medical staff. 
(ii) The services shall be integrated with other departments of the hospital. 
(iii) The policies and procedures governing medical care provided in the 
emergency service or department shall be established by and shall be a 
continuing responsibility of the medical staff. 
(iv) Medical records indicating patient identification, complaint, physician, 
nurse, time admitted to the emergency room, treatment, time discharged, and 
disposition shall be maintained for all emergency patients. 
(B) Personnel. 
(i) There shall be adequate medical and nursing personnel qualified in emergency 
care to meet the written emergency procedures and needs anticipated by the 
hospital. 
(ii) There shall be on duty at all times at least one person qualified as 
determined by the medical staff to initiate immediate appropriate lifesaving 
measures. 
(iii) The hospital shall provide that one or more physicians shall be available 
at all times for emergencies. 
(iv) Schedules, names, and telephone numbers of all physicians and others on 
emergency call duty, including alternates, shall be maintained. Schedules shall 
be retained for no less than one year. 
(C) Supplies and equipment. Adequate supplies and equipment shall be available 
and in readiness for use. Facilities shall be available for the administration 
of intravenous medications as well as facilities for the control of bleeding and 
emergency splinting of fractures. Provision shall be made for the storage of 
blood and blood products as needed. The emergency equipment shall be 
periodically tested according to the policy established by the hospital. 
(D) Required emergency equipment. At a minimum, the emergency equipment and 
supplies shall include the following: 
(i) emergency call system; 
(ii) oxygen; 
(iii) mechanical ventilatory assistance equipment, including airways, manual 
breathing bag, and mask; 
(iv) cardiac defibrillator; 
(v) cardiac monitoring equipment; 
(vi) laryngoscopes and endotracheal tubes; 
(vii) suction equipment; and 
(viii) emergency drugs and supplies specified by the medical staff. 
(E) Exceptions. 
(i) A comprehensive medical rehabilitation hospital shall comply with 
subparagraphs (A)-(D) of this paragraph but need not comply with the requirement 
for an emergency department. At a minimum, an emergency treatment room shall be 
provided in accordance with sec.133.163(f)(1)(B)(v) of this title. The emergency 
treatment room may be located anywhere in the hospital.
(ii) A pediatric and adolescent hospital shall comply with subparagraphs (A)-(D) 
of this paragraph but need not comply with the requirement for an emergency 
department. At a minimum, an emergency treatment room shall be provided in 
accordance with sec.133.163(f)(1)(B)(v) of this title. The emergency treatment 
room may be located anywhere in the hospital. 
(2) Emergency treatment room. A special hospital shall comply with paragraph 
(1)(A)-(D) of this subsection except for the requirement in paragraph (1) 
concerning the emergency department. Each special hospital shall have at least 
an emergency treatment room that complies with sec.133.163(f)(1)(B)(v) of this 
title. The emergency treatment room may be located anywhere in the hospital. 
(f) Governing body. 
(1) Legal responsibility. There shall be a governing body responsible for the 
organization, management, control, and operation of the hospital, including 
appointment of the medical staff. For hospitals owned and operated by an 
individual or by partners, the individual or partners shall be considered the 
governing body. 
(2) Organization. The governing body shall be formally organized in accordance 
with a written constitution and bylaws which clearly set forth the 
organizational structure and responsibilities. 
(3) Meeting records. Records of governing body meetings shall be maintained. 
(4) Responsibilities relating to the medical staff. The governing body shall: 
(A) ensure that the medical staff has current bylaws, rules, and regulations 
which are implemented and enforced; 
(B) approve medical staff bylaws and other medical staff rules and regulations; 
(C) determine, in accordance with state law and with the advice of the medical 
staff, which categories of practitioners are eligible candidates for appointment 
to the medical staff; 
(D) ensure that criteria for selection include individual character, competence, 
training, experience, and judgment; 
(E) ensure that under no circumstances is the accordance of staff membership or 
professional privileges in the hospital dependent solely upon certification, 
fellowship or membership in a specialty body or society;
(F) ensure the process for considering applications for medical staff membership 
and privileges affords each physician, podiatrist, and dentist procedural due 
process; 
(G) ensure in granting or refusing medical staff membership or privileges, the 
hospital does not differentiate on the basis of the academic medical degree; 
(H) ensure that equal recognition is given to training programs accredited by 
the Accreditation Council on Graduate Medical Education and by the American 
Osteopathic Association if graduate medical education is used as a standard or 
qualification for medical staff membership or privileges for a physician; 
(I) ensure that equal recognition is given to certification programs approved by 
the American Board of Medical Specialties and the Bureau of Osteopathic 
Specialists if board certification is used as a standard or qualification for 
medical staff membership or privileges for a physician;
(J) ensure that the medical staff is accountable to the governing body for the 
quality of care provided to patients; 
(K) ensure that a hospital's credentials committee acts expeditiously and 
without unnecessary delay when a licensed physician, podiatrist, or dentist 
submits a completed application, as defined by each hospital, for medical staff 
membership or privileges, in accordance with the following: 
(i) The hospital's credentials committee shall take action on the completed 
application not later than the 90th day after the date on which the application 
is received; 
(ii) The governing body of the hospital shall take final action on the 
application for medical staff membership or privileges not later than the 60th 
day after the date on which the recommendation of the credentials committee is 
received; and 
(iii) The hospital must notify the applicant in writing of the hospital's final 
action, including a reason for denial or restriction of privileges, not later 
than the 20th day after the date on which final action is taken; 
(L) ensure that the hospital complies with the requirements concerning physician 
communication and contracts entered into or renewed on or after September 1, 
1997, as set out in Health and Safety Code (HSC) sec.241.1015 (relating to 
Physician Communication and Contracts); and 
(M) ensure the hospital complies with the requirements for reporting to the 
Texas Board of Medical Examiners the results and circumstances of any 
professional review action in accordance with the Medical Practice Act, Texas 
Civil Statutes, Article 4495b, sec.5.06(b) and (d). 
(5) Hospital administration. The governing body shall appoint a chief executive 
officer or administrator who is responsible for managing the hospital. 
(6) Patient care. In accordance with hospital policy, the governing body shall 
ensure that: 
(A) every patient is under the care of: 
(i) a physician. This provision is not to be construed to limit the authority of 
a physician to delegate tasks to other qualified health care personnel to the 
extent recognized under state law or the state's regulatory mechanism; 
(ii) a dentist who is legally authorized to practice dentistry by the state and 
who is acting within the scope of his or her license; or
(iii) a podiatrist, but only with respect to functions which he or she is 
legally authorized by the state to perform. 
(B) patients are admitted to the hospital only by members of the medical staff 
who have been granted admitting privileges; 
(C) a physician is on duty or on-call at all times; and 
(D) a physician is responsible for the care of each patient with respect to any 
medical or mental health problem that is present on admission or develops during 
hospitalization. 
(7) Contracted services. The governing body shall be responsible for services 
furnished in the hospital whether or not they are furnished directly or under 
contracts. The governing body shall ensure that a contractor of services 
(including one for shared services and joint ventures) furnishes services in a 
safe and effective manner that permits the hospital to comply with all 
applicable rules and standards for contracted services. 
(g) Infection control. The hospital shall provide a sanitary environment to 
avoid sources and transmission of infections and communicable diseases. There 
shall be an active program for the prevention, control, and investigation of 
infections and communicable diseases. 
(1) Organization and policies. A person shall be designated as infection control 
officer to develop, implement and enforce policies governing prevention, control 
and surveillance of infections and communicable diseases.
(A) The infection control officer shall develop a system for identifying, 
reporting, investigating, and controlling infections and communicable diseases 
of patients and personnel. 
(B) The infection control officer shall maintain a log of incidents related to 
infections and communicable diseases. 
(C) There shall be a written policy for reporting all reportable diseases to the 
local health authority or the Infectious Disease Epidemiology and Surveillance 
Division, Texas Department of Health, 1100 West 49th Street, Austin, TX 78756-
3199, in accordance with Article 97, Title 25, Texas Administrative Code. 
(2) Responsibilities of the chief executive officer (CEO), medical staff, and 
director of nursing (DON). The CEO, the medical staff, and the DON shall be 
responsible for the following. 
(A) The hospital-wide quality assurance program and training programs shall 
address problems identified by the infection control officer.
(B) Successful corrective action plans in affected problem areas shall be 
implemented. 
(3) Universal precautions. The hospital shall adopt, implement, and enforce a 
written policy to monitor compliance of the hospital and its personnel and 
medical staff with universal precautions in accordance with the HSC, Chapter 85, 
Subchapter I of this title (relating to the Prevention of Transmission of Human 
Immunodeficiency Virus and Hepatitis B Virus by Infected Health Care Workers). 
(h) Laboratory services. The hospital shall maintain directly, or have available 
adequate laboratory services to meet the needs of its patients.
(1) Hospital laboratory services. A hospital that provides laboratory services 
shall comply with the Clinical Laboratory Improvement Amendments of 1988 (CLIA 
1988), in accordance with the requirements specified in 42 Code of Federal 
Regulations (CFR), sec.sec.493.1-493.1780. CLIA 1988 applies to all hospitals 
with laboratories that examine human specimens for the diagnosis, prevention, or 
treatment of any disease or impairment of, or the assessment of the health of, 
human beings. 
(2) Contracted laboratory services. The hospital shall ensure that all 
laboratory services provided to its patients through a contractual agreement are 
performed in a facility certified in the appropriate specialties and 
subspecialties of service in accordance with the requirements specified in 42 
CFR Part 493 to comply with CLIA 1988. 
(3) Adequacy of laboratory services. The hospital shall ensure the following. 
(A) Emergency laboratory services shall be available 24 hours a day. 
(B) A written description of services provided shall be available to the medical 
staff. 
(C) The laboratory shall make provision for proper receipt and reporting of 
tissue specimens. 
(D) The medical staff and a pathologist shall determine which tissue specimens 
require a macroscopic (gross) examination and which require both macroscopic and 
microscopic examination. 
(E) When blood and blood components are stored, there shall be written 
procedures readily available containing directions on how to maintain them 
within permissible temperatures and including instructions to be followed in the 
event of a power failure or other disruption of refrigeration. A label or tray 
with the recipient's first and last names and identification number, donor unit 
number and interpretation of compatibility, if performed, shall be attached 
securely to the blood container. 
(4) Chemical hygiene. A hospital that provides laboratory services shall adopt, 
implement, and enforce written policies and procedures to manage, minimize, or 
eliminate the risks to laboratory personnel of exposure to potentially hazardous 
chemicals in the laboratory which may occur during the normal course of job 
performance. 
(i) Linen and laundry services. The hospital shall provide sufficient clean 
linen to ensure the comfort of the patient. The hospital, whether it operates 
its own laundry or uses commercial service, shall ensure the following. 
(1) Employees of a hospital involved in transporting, processing, or otherwise 
handling clean or soiled linen shall be given initial and follow-up inservice 
training to ensure a safe product for patients and to safeguard employees in 
their work. 
(2) Clean linen shall be handled, transported, and stored by methods that will 
ensure its cleanliness. 
(A) Clean linen shall be transported by any of the following methods: 
(i) placing clean linen in containers used exclusively for this purpose; 
(ii) placing clean linen in a hamper lined with an unused plastic liner or a 
clean reusable liner. The hamper shall be covered with a disposable cover or 
clean reusable cover or the liner closed to cover the linen; 
(iii) placing clean linen in a cart, covering it with disposable plastic or 
clean reusable material, and securing the cover; or 
(iv) placing clean linen on a linen rack and covering it with a suitable cover. 
The bottom shelf of the linen rack must be a solid surface.
(B) Separation is maintained when: 
(i) the container which is used to transport contaminated linen is properly 
cleaned before it is used to transport clean linen; 
(ii) bundles of clean linen are wrapped in plastic or other suitable material 
and sealed or taped; or 
(iii) transportation of clean and contaminated linen is done in separate 
containers. 
(C) Containers and covers shall be properly cleaned in order to maintain 
separation. Properly cleaned shall mean steam cleaned or cleaned with soap and 
water solution. In all cases, containers and covers shall be treated with a 
germicidal agent. 
(3) All contaminated linen shall be placed and transported in bags or containers 
labeled or color-coded. 
(4) Employees who have contact with contaminated linen shall wear gloves and 
other appropriate personal protective equipment. 
(5) Contaminated linen shall be handled as little as possible and with a minimum 
agitation. Contaminated linen shall not be sorted or rinsed in patient care 
areas. 
(6) All contaminated linen shall be bagged or put into carts at the location 
where it was used. 
(A) If bags are used, the bag shall have a drawstring or flap closure. The bag 
shall be filled and then closed immediately to await transfer to the laundry. 
(B) Whenever contaminated linen is wet and presents a reasonable likelihood of 
soak-through of or leakage from the bag or container, the linen shall be 
deposited and transported in bags that prevent leakage of fluids to the 
exterior. 
(C) All linen placed in chutes shall be bagged. 
(D) If chutes are not used to convey linen to a central receiving or sorting 
room, then adequate space shall be allocated on the various nursing units for 
holding the bagged contaminated linen. 
(7) Linen shall be processed as follows: 
(A) If hot water is used, linen shall be washed with detergent in water with a 
temperature of at least 71 degrees Centigrade (160 degrees Fahrenheit) for 25 
minutes. Hot water requirements specified in Table 5 of sec.133.169(e) of this 
title (relating to Tables) shall be met. 
(B) If low temperature (less than or equal to 70 degrees Centigrade) (158 
degrees Fahrenheit) laundry cycles are used, chemicals suitable for low-
temperature washing at proper use concentration shall be used. 
(C) Commercial dry cleaning of fabrics soiled with blood also renders these 
items free of the risk of pathogen transmission. 
(8) Flammable liquids shall not be used in the laundry.
(j) Medical record services. The hospital shall have a medical record service 
that has administrative responsibility for medical records. A medical record 
shall be maintained for every individual who presents to the hospital for 
evaluation or treatment. 
(1) The organization of the medical record service shall be appropriate to the 
scope and complexity of the services performed. The hospital shall employ 
adequate personnel to ensure prompt completion, filing, and retrieval of 
records. 
(2) The hospital shall have a system of coding and indexing medical records. The 
system shall allow for timely retrieval by diagnosis and procedure, in order to 
support medical care evaluation studies. 
(3) The hospital shall adopt, implement, and enforce a policy to ensure that the 
hospital complies with HSC, Chapter 241, Subchapter G (relating to Disclosure of 
Health Care Information). 
(4) The medical record shall contain information to justify admission and 
continued hospitalization, support the diagnosis, and describe the patient's 
progress and response to medications and services. Medical records shall be 
accurately written, promptly completed, properly filed and retained, and 
accessible. 
(5) The hospital shall use a system of author identification and record 
maintenance that ensures the integrity of the authentication and protects the 
security of all entries to the records. 
(A) The author of each entry shall be identified and shall authenticate his or 
her entry. 
(B) Authentication shall include signatures, written initials, or computer 
entry. 
(C) Use of signature stamps by physicians may be allowed in hospitals when the 
signature stamp is authorized by the individual whose signature the stamp 
represents. The administrative offices of the hospital shall have on file a 
signed statement to the effect that he or she is the only one who has the stamp 
and uses it. Delegation of use to another individual shall not be acceptable. 
(D) A list of computer codes and written signatures shall be readily available 
and shall be maintained under adequate safeguards. 
(E) Signatures by facsimile shall be acceptable. If received on a thermal 
machine, the facsimile document shall be copied onto regular paper. 
(6) Medical records (reports and printouts) shall be retained by the hospital in 
their original or legally reproduced form for a period of at least ten years. 
Films, scans, and other image records shall be retained for a period of at least 
five years. For retention purposes, medical records that shall be preserved for 
ten years include: 
(A) identification data; 
(B) the medical history of the patient; 
(C) evidence of a physical examination, including a health history, performed no 
more than seven days prior to admission or within 48 hours after admission; 
(D) admitting diagnosis; 
(E) diagnostic and therapeutic orders; 
(F) properly executed informed consent forms for procedures and treatments 
specified by the medical staff, or by federal or state laws if applicable, to 
require written patient consent; 
(G) clinical observations, including the results of therapy and treatment, all 
orders, nursing notes, medication records, vital signs, and other information 
necessary to monitor the patient's condition; 
(H) reports of procedures, tests, and their results, including laboratory, 
pathology, and radiology reports; 
(I) results of all consultative evaluations of the patient and appropriate 
findings by clinical and other staff involved in the care of the patient; 
(J) discharge summary with outcome of hospitalization, disposition of care, and 
provisions for follow-up care; and 
(K) final diagnosis with completion of medical records within 30 calendar days 
following discharge. 
(7) If a patient was less than 18 years of age at the time he was last treated, 
the hospital may authorize the disposal of those medical records relating to the 
patient on or after the date of his 20th birthday or on or after the 10th 
anniversary of the date on which he was last treated, whichever date is later. 
(8) The hospital shall not destroy medical records that relate to any matter 
that is involved in litigation if the hospital knows the litigation has not been 
finally resolved. 
(9) If a licensed hospital should close, the hospital shall notify the 
department at the time of closure the disposition of the medical records, 
including the location of where the medical records will be stored and the 
identity and telephone number of the custodian of the records.
(k) Medical staff. 
(1) The medical staff shall be composed of physicians and may also be composed 
of podiatrists, dentists and other practitioners appointed by the governing 
body. 
(A) The medical staff shall periodically conduct appraisals of its members 
according to medical staff bylaws. 
(B) The medical staff shall examine credentials of candidates for medical staff 
membership and make recommendations to the governing body on the appointment of 
the candidate. 
(2) The medical staff shall be well-organized and accountable to the governing 
body for the quality of the medical care provided to patients. 
(A) The medical staff shall be organized in a manner approved by the governing 
body. 
(B) If the medical staff has an executive committee, a majority of the members 
of the committee shall be doctors of medicine or osteopathy.
(C) Records of medical staff meetings shall be maintained.
(D) The responsibility for organization and conduct of the medical staff shall 
be assigned only to an individual physician. 
(E) Each medical staff member shall sign a statement signifying they will abide 
by medical staff and hospital policies. 
(3) The medical staff shall adopt, implement, and enforce bylaws, rules, and 
regulations to carry out its responsibilities. The bylaws shall: 
(A) be approved by the governing body; 
(B) include a statement of the duties and privileges of each category of medical 
staff (e.g., active, courtesy, consultant); 
(C) describe the organization of the medical staff; 
(D) describe the qualifications to be met by a candidate in order for the 
medical staff to recommend that the candidate be appointed by the governing 
body; 
(E) include criteria for determining the privileges to be granted and a 
procedure for applying the criteria to individuals requesting privileges; and 
(F) include a requirement that a physical examination and medical history be 
done no more than seven days before or 48 hours after an admission for each 
patient by a physician, or, for patients admitted only for oromaxillofacial 
surgery, by a dentist who has been granted such privileges by the medical staff. 
(l) Mental health services. 
(1) Mental health services unit. A patient admitted to a hospital providing 
mental health services shall be housed in the mental health services unit which 
has been approved by the department as meeting the requirements of 
sec.133.163(p) of this title. 
(2) Admission criteria. A hospital providing mental health services shall have 
written admission criteria that are applied uniformly to all patients who are 
admitted to the mental health services unit. 
(A) The hospital's admission criteria shall include procedures to prevent the 
admission of minors for a condition which is not generally recognized as 
responsive to treatment in an inpatient setting for mental health services. 
(i) The following conditions are not generally recognized as responsive to 
treatment in a hospital unless the minor to be admitted is qualified because of 
other disabilities, such as: 
(I) cognitive disabilities due to mental retardation; or 
(II) learning disabilities. 
(ii) A minor may be qualified for admission based on other disabilities which 
would be responsive to mental health services. 
(iii) A minor patient shall be separated from adult patients.
(B) The medical record shall contain evidence that admission consent was given 
by the patient, the patient's legal guardian, or the managing conservator, if 
applicable. 
(C) The hospital shall have a preadmission examination procedure under which 
each patient's condition and medical history are reviewed by a member of the 
medical staff to determine whether the patient is likely to benefit 
significantly from an intensive inpatient program or assessment. 
(D) A voluntarily admitted patient shall sign an admission consent form prior to 
admission to a mental health unit which includes verification that the patient 
has been informed of the services to be provided and the estimated charges. 
(3) Compliance. A hospital providing mental health services shall comply with 
the following rules administered by the Texas Board of Mental Health and Mental 
Retardation (TXMHMR). The TXMHMR rules are: 
(A) Chapter 401, Subchapter J of this title (relating to Standards of Care and 
Treatment in Psychiatric Hospitals); 
(B) Chapter 404, Subchapter E of this title (relating to Rights of Persons 
Receiving Mental Health Services); 
(C) Chapter 405, Subchapter E of this title (relating to Electroconvulsive 
Therapy); 
(D) Chapter 405, Subchapter FF of this title (relating to Consent to Treatment 
with Psychoactive Medication); and 
(E) Chapter 405, Subchapter F of this title (relating to Voluntary and 
Involuntary Behavioral Interventions in Mental Health Programs). 
(m) Mobile, transportable, and relocatable units. The hospital shall adopt, 
implement and enforce procedures which address the potential emergency needs for 
those inpatients who are taken to mobile units on the hospital's premises for 
diagnostic procedures or treatment. 
(n) Nuclear medicine services. If the hospital provides nuclear medicine 
services, these services shall meet the needs of the patients in accordance with 
acceptable standards of practice. 
(1) Policies and procedures. Policies and procedures shall be adopted, 
implemented, and enforced which will describe the services nuclear medicine 
provides in the hospital and how employee and patient safety will be maintained. 
(2) Organization and staffing. The organization of the nuclear medicine services 
shall be appropriate to the scope and complexity of the services offered. 
(A) There shall be a director who is a physician qualified in nuclear medicine. 
(B) The qualifications, training, functions, and responsibilities of nuclear 
medicine personnel shall be specified by the services director and approved by 
the medical staff. 
(3) Delivery of services. Radioactive materials shall be prepared, labeled, 
used, transported, stored, and disposed of in accordance with acceptable 
standards of practice and in accordance with state laws concerning radiation 
control. 
(A) In-house preparation of radiopharmaceuticals shall be by, or under, the 
direct supervision of an appropriately trained registered pharmacist or 
physician. 
(B) There shall be proper storage and disposal of radioactive materials. 
(C) If clinical laboratory tests are performed by the nuclear medicine services 
staff, the nuclear medicine staff shall comply with CLIA 1988 in accordance with 
the requirements specified in 42 CFR Part 493. 
(D) Nuclear medicine workers shall be checked periodically, by the use of 
exposure meters or badge tests, for amount of radiation exposure. Exposure 
reports and documentation shall be available for review. 
(4) Equipment and supplies. Equipment and supplies shall be appropriate for the 
types of nuclear medicine services offered and shall be maintained for safe and 
efficient performance. The equipment shall be inspected, tested, and calibrated 
at least annually by qualified personnel.
(5) Records. The hospital shall maintain signed and dated reports of nuclear 
medicine interpretations, consultations, and procedures.
(A) The physician approved by the medical staff to interpret diagnostic 
procedures shall sign and date the interpretations of these tests.
(B) The hospital shall maintain records of the receipt and disposition of 
radiopharmaceuticals for a period of two years. 
(C) Nuclear medicine services shall be ordered only by an individual whose scope 
of state licensure and whose defined staff privileges allow such referrals. 
(o) Nursing services. The hospital shall have an organized nursing service that 
provides 24-hour nursing services as needed. 
(1) Organization. The hospital shall have a well-organized service with a plan 
of administrative authority and delineation of responsibilities for patient 
care. 
(A) The DON shall be a licensed RN. 
(B) The DON shall be responsible for the operation of the services, including 
determining the types and numbers of nursing personnel and staff necessary to 
provide nursing care for all areas of the hospital.
(2) Staffing and delivery of care. 
(A) The nursing services shall have a procedure to ensure that hospital nursing 
personnel for whom licensure is required have valid and current licensure. 
(B) There shall be adequate numbers of RNs, licensed vocational nurses (LVNs), 
and other personnel to provide nursing care to all patients as needed. There 
shall be supervisory and staff personnel for each department or nursing unit to 
ensure, when needed, the immediate availability of an RN for bedside care of any 
patient. 
(C) An RN shall supervise and evaluate the nursing care for each patient and 
assign the nursing care to other nursing personnel in accordance with the 
patient's needs and the specialized qualifications and competence of the nursing 
staff available. 
(D) The hospital shall ensure that the nursing staff develops, and keeps 
current, a nursing plan of care for each patient which addresses the patient's 
needs. 
(E) Non-employee licensed nurses who are working in the hospital shall adhere to 
the policies and procedures of the hospital. The DON shall provide for the 
adequate orientation, supervision, and evaluation of the clinical activities of 
non-employee nursing personnel which occur within the responsibility of the 
nursing services. 
(3) Drugs and biologicals. Drugs and biologicals shall be prepared and 
administered in accordance with federal and state laws, the orders of the 
individuals granted privileges by the medical staff, and accepted standards of 
practice. 
(A) All drugs and biologicals shall be administered by, or under supervision of, 
nursing or other personnel in accordance with federal and state laws and 
regulations, including applicable licensing rules, and in accordance with the 
approved medical staff policies and procedures. 
(B) All orders for drugs and biologicals shall be in writing and signed by the 
individual responsible for the care of the patient as specified under subsection 
(f)(6)(A) of this section. When telephone or oral orders must be used, they 
shall be: 
(i) accepted only by personnel who are authorized to do so by the medical staff 
policies and procedures, consistent with federal and state laws; 
(ii) signed or initialed by the individual who ordered the medication on their 
next visit; and 
(iii) used infrequently. 
(C) There shall be a hospital procedure for immediately reporting transfusion 
reactions, adverse drug reactions, and errors in administration of drugs to the 
attending physician and, if appropriate, to the hospital-wide quality assurance 
program. 
(4) Blood transfusions. 
(A) There shall be a written protocol for the administration of blood and blood 
components and the use of infusion devices and ancillary equipment. 
(B) Personnel administering blood transfusions and intravenous medications shall 
have special training for this duty and shall have demonstrated an acceptable 
level of skill in these procedures. 
(C) Blood and blood components shall be transfused through a sterile, pyrogen-
free transfusion set that has a filter designed to retain particles potentially 
harmful to the recipient. 
(D) Transfusions shall be prescribed and administered under medical direction. 
The patient must be observed during the transfusion and for an appropriate time 
thereafter for suspected adverse reactions. 
(E) Pretransfusion and posttransfusion vital signs shall be recorded. 
(F) When warming of blood is indicated, this shall be accomplished during its 
passage through the transfusion set. The warming system shall be equipped with a 
visible thermometer and may have an audible warning system. Blood shall not be 
warmed above 42 Celsius. 
(G) Drugs or medications, including those intended for intravenous use, shall 
not be added to blood or blood components. A 0.9% sodium chloride injection, 
United States Pharmacopeia, may be added to blood or blood components. Other 
solutions intended for intravenous use may be used in an administration set or 
added to blood or blood components under either of the following conditions:
(i) they have been approved for this use by the Federal Drug Administration; or 
(ii) there is documentation available to show that addition to the component 
involved is safe and efficacious. 
(H) There shall be a system for detection, reporting and evaluation of suspected 
complications of transfusion. Any adverse event experienced by a patient in 
association with a transfusion is to be regarded as a suspected transfusion 
complication. In the event of a suspected transfusion complication, the 
personnel attending the patient shall notify immediately a responsible physician 
and the transfusion service and document the complication in the patient's 
medical record. All suspected transfusion complications shall be evaluated 
promptly according to an established procedure. 
(I) Following the transfusion, the blood transfusion record or a copy shall be 
made a part of the patient's medical record. 
(5) Professional nurse reporting and peer review. A hospital shall adopt, 
implement, and enforce a policy to ensure that the hospital complies with Texas 
Civil Statutes, Articles 4525a and 4525b Revised Statutes (relating respectively 
to Professional Nurse Reporting and Peer Review), and with the rules adopted by 
the Board of Nurse Examiners at 22 TAC sec.217.20 (relating to Minimal 
Procedural Standards during Peer Review). 
(p) Outpatient services. If the hospital provides outpatient services, the 
services shall meet the needs of the patients in accordance with acceptable 
standards of practice. 
(1) Organization. Outpatient services shall be appropriately organized and 
integrated with inpatient services. 
(2) Personnel. 
(A) The hospital shall assign an individual to be responsible for outpatient 
services. 
(B) The hospital shall have appropriate physicians on staff and other 
professional and nonprofessional personnel available. 
(q) Pharmacy services. The hospital shall provide pharmaceutical services that 
meet the needs of the patients. 
(1) Compliance. Pharmacy services shall comply with the following Acts and 
rules: 
(A) Texas Pharmacy Act, Texas Civil Statutes, (TCS), article 4542a-1, and 22 TAC 
Chapter 281 (relating to Texas State Board of Pharmacy Rules of Procedure); 
(B) Texas Dangerous Drug Act, HSC, Chapter 483; 
(C) Texas Controlled Substances Act, HSC, Chapter 481, and 37 TAC, Chapter 13 
(relating to Texas Controlled Substances Regulations); and 
(D) Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 CFR, Part 
1300 to end (relating to Drug Enforcement Administration, Department of 
Justice). 
(2) Organization. The hospital shall have a pharmacy directed by a registered 
pharmacist. 
(3) Medical staff. The medical staff shall be responsible for developing 
policies and procedures that minimize drug errors. This function may be 
delegated to the hospital's organized pharmaceutical services. 
(4) Pharmacy management and administration. The pharmacy or drug storage area 
shall be administered in accordance with accepted professional principles. 
(A) Standards of practice as defined by state law shall be followed regarding 
the provision of pharmacy services. 
(B) The pharmaceutical services shall have an adequate number of personnel to 
ensure quality pharmaceutical services including emergency services. 
(i) The staff shall be sufficient in number and training to respond to the 
pharmaceutical needs of the patient population being served. There shall be an 
arrangement for emergency services. 
(ii) Employees shall provide pharmaceutical services within the scope of their 
license and education. 
(C) Drugs and biologicals shall be properly stored to ensure ventilation, light, 
security, and temperature controls. 
(D) Records shall have sufficient detail to follow the flow of drugs from entry 
through dispensation. 
(E) There shall be adequate controls over all drugs and medications including 
the floor stock. Drug storage areas shall be approved by the pharmacist, and 
floor stock lists shall be established. 
(F) Inspections of drug storage areas shall be conducted throughout the hospital 
under pharmacist supervision. 
(G) There shall be a drug recall procedure. 
(H) A full-time, part-time, or consulting pharmacist shall be responsible for 
developing, supervising, and coordinating all the activities of the pharmacy 
services. 
(i) Direction of pharmaceutical services may not require on premises supervision 
but may be accomplished through regularly scheduled visits in accordance with 
state law. 
(ii) A job description or other written agreement shall clearly define the 
responsibilities of the pharmacist. 
(I) Current and accurate records shall be kept of the receipt and disposition of 
all scheduled drugs. 
(i) There shall be a record system in place that provides the information on 
controlled substances in a readily retrievable manner which is separate from the 
patient record. 
(ii) Records shall trace the movement of scheduled drugs throughout the 
services, documenting utilization or wastage. 
(iii) The pharmacist shall be responsible for determining that all drug records 
are in order and that an account of all scheduled drugs is maintained and 
reconciled with written orders. 
(5) Delivery of services. In order to provide patient safety, drugs and 
biologicals shall be controlled and distributed in accordance with applicable 
standards of practice, consistent with federal and state laws. 
(A) All compounding, packaging, and dispensing of drugs and biologicals shall be 
under the supervision of a pharmacist and performed consistent with federal and 
state laws. 
(B) Drugs and biologicals shall be kept in a locked storage area. 
(i) A policy shall be adopted, implemented, and enforced to ensure the 
safeguarding, transferring, and availability of keys to the locked storage area. 
(ii) Dangerous drugs as well as controlled substances shall be secure from 
unauthorized use. 
(C) Outdated, mislabeled, or otherwise unusable drugs and biologicals shall not 
be available for patient use. 
(D) When a pharmacist is not available, drugs and biologicals shall be removed 
from the pharmacy or storage area only by personnel designated in the policies 
of the medical staff and pharmaceutical service, in accordance with federal and 
state laws. 
(i) There shall be a current list of individuals identified by name and 
qualifications who are designated to remove drugs from the pharmacy.
(ii) Only amounts sufficient for immediate therapeutic needs shall be removed. 
(E) Drugs and biologicals not specifically prescribed as to time or number of 
doses shall automatically be stopped after a reasonable time that is 
predetermined by the medical staff. 
(i) Stop order policies and procedures shall be consistent with those of the 
nursing staff and the medical staff rules and regulations.
(ii) A protocol shall be established by the medical staff for the implementation 
of the stop order policy, in order that drugs shall be reviewed and renewed, or 
automatically stopped. 
(iii) A system shall be in place to determine compliance with the stop order 
policy. 
(F) Drug administration errors, adverse drug reactions, and incompatibilities 
shall be immediately reported to the attending physician and, if appropriate, to 
the hospital-wide quality assurance program. There shall be a mechanism in place 
for capturing, reviewing, and tracking medication errors and adverse drug 
reactions. 
(G) Abuses and losses of controlled substances shall be reported, in accordance 
with applicable federal and state laws, to the individual responsible for the 
pharmaceutical services, and to the chief executive officer, as appropriate.
(H) Information relating to drug interactions and information on drug therapy, 
side effects, toxicology, dosage, indications for use, and routes of 
administration shall be immediately available to the professional staff. 
(i) A pharmacist shall be readily available by telephone or other means to 
discuss drug therapy, interactions, side effects, dosage, assist in drug 
selection, and assist in the identification of drug induced problems.
(ii) There shall be staff development programs on drug therapy available to 
facility staff to cover such topics as new drugs added to the formulary, how to 
resolve drug therapy problems, and other general information as the need arises. 
(I) A formulary system shall be established by the medical staff to ensure 
quality pharmaceuticals at reasonable costs. 
(r) Quality assurance. The governing body shall ensure that there is an 
effective, hospital-wide quality assurance (QA) program to evaluate the 
provision of patient care. 
(1) Implementation plan. The hospital-wide QA program shall be on-going and have 
a written plan of implementation. 
(A) All organized services related to patient care, including services furnished 
by contract, shall be evaluated. 
(B) Nosocomial infections and medication therapy shall be evaluated. 
(C) All medical and surgical services performed in the hospital shall be 
evaluated as they relate to appropriateness of diagnosis and treatment.
(2) Medically-related patient care services. The hospital shall have an on-going 
plan, consistent with available community and hospital resources, to provide or 
make available social work, psychological, and educational services to meet the 
medically-related needs of its patients. The hospital also shall have an 
effective, on-going discharge planning program that facilitates the provision of 
follow-up care. 
(A) Discharge planning shall be initiated in a timely manner.
(B) Patients, along with necessary medical information, shall be transferred or 
referred to appropriate facilities, agencies, or outpatient services, as needed 
for follow-up or ancillary care. 
(3) Implementation. The hospital shall take and document appropriate remedial 
action to address deficiencies found through the QA program. The hospital shall 
document the outcome of the remedial action.
(s) Radiology services. The hospital shall maintain, or have available, 
diagnostic radiologic services according to needs of the patients. If 
therapeutic services are also provided, the services, as well as the diagnostic 
services, shall meet professionally approved standards for safety and personnel 
qualifications. In a special hospital, portable X-ray equipment may be 
acceptable as a minimum requirement. 
(1) Policies and procedures. Policies and procedures shall be adopted, 
implemented and enforced which will describe the radiology services provided in 
the hospital and how employee and patient safety will be maintained.
(2) Safety for patients and personnel. The radiology services, particularly 
ionizing radiology procedures, shall be free from hazards for patients and 
personnel. 
(A) Proper safety precautions shall be maintained against radiation hazards. 
This includes adequate shielding for patients, personnel, and facilities. 
(B) Inspection of equipment shall be made periodically. Defective equipment 
shall be promptly repaired or replaced. 
(C) Radiation workers shall be checked periodically, by the use of exposure 
meters or badge tests, for amount of radiation exposure. Exposure reports and 
documentation shall be available for review. 
(D) Radiology services shall be provided only on the order of individuals 
granted privileges by the medical staff. 
(3) Personnel. 
(A) A qualified full-time, part-time, or consulting radiologist shall supervise 
the ionizing radiology services and shall interpret only those radiology tests 
that are determined by the medical staff to require a radiologist's specialized 
knowledge. For purposes of this section a radiologist is a physician who is 
qualified by education and experience in radiology in accordance with medical 
staff bylaws. 
(B) Only personnel designated as qualified by the medical staff shall use the 
radiology equipment and administer procedures. 
(4) Records. Records of radiology services shall be maintained. The radiologist 
or other individuals who have been granted privileges to perform radiology 
services shall sign reports of his or her interpretations. 
(t) Respiratory care services. The hospital shall meet the needs of the patients 
in accordance with acceptable standards of practice.
(1) Policies and procedures shall be adopted, implemented, and enforced which 
describe the provision of respiratory care services in the hospital. 
(2) The organization of the respiratory care services shall be appropriate to 
the scope and complexity of the services offered.
(3) There shall be a director of respiratory care services who is a physician 
with the knowledge, experience, and capabilities to supervise and administer the 
services properly. The director may serve on either a full-time or part-time 
basis. 
(4) There shall be adequate numbers of respiratory therapists, respiratory 
therapy technicians, and other personnel who meet the qualifications specified 
by the medical staff, consistent with the state law. 
(5) Personnel qualified to perform specific procedures and the amount of 
supervision required for personnel to carry out specific procedures shall be 
designated in writing. 
(6) If blood gases or other clinical laboratory tests are performed by the 
respiratory care services staff, the respiratory care staff shall comply with 
CLIA 1988 in accordance with the requirements specified in 42 CFR, Part 493. 
(7) Services shall be provided only on, and in accordance with, the orders of a 
physician. 
(u) Sterilization and sterile supplies. 
(1) Supervision. The sterilization of all supplies and equipment shall be under 
the supervision of a person qualified by education, training and experience. 
Staff responsible for the sterilization of supplies and equipment shall 
participate in a documented continuing education program; new employees shall 
receive initial orientation and on-the-job training. 
(2) Equipment and procedures. 
(A) Sterilization. Every hospital shall provide equipment adequate for 
sterilization of supplies and equipment as needed. Equipment shall be maintained 
and operated to perform, with accuracy, the sterilization of the various 
materials required. 
(B) Written policy. Written policies and procedures for the decontamination and 
sterilization activities performed shall be adopted, implemented and enforced. 
Policies shall include the receiving, cleaning, decontaminating, disinfecting, 
preparing and sterilization of reusable items, as well as those for the 
assembly, wrapping, storage, distribution and quality control of sterile items 
and equipment. These written policies shall be reviewed at least every other 
year and approved by the infection control practitioner or committee.
(C) Separation. Where cleaning, preparation, and sterilization functions are 
performed in the same room or unit, the physical facilities, equipment, and the 
policies and procedures for their use, shall be such as to effectively separate 
soiled or contaminated supplies and equipment from the clean or sterilized 
supplies and equipment. Hand washing facilities shall be provided and a separate 
sink shall be provided for safe disposal of liquid waste. 
(D) Labeling. All containers for solutions, drugs, flammable solvents, ether, 
alcohol, and medicated supplies shall be clearly labeled to indicate contents. 
Those which are sterilized by the hospital shall be labeled so as to be 
identifiable both before and after sterilization. Sterilized items shall have a 
load control identification that indicates the sterilizer used, the cycle or 
load number, and the date of sterilization. 
(E) Preparation for sterilization. 
(i) All items to be sterilized shall be prepared to reduce the bioburden. All 
items shall be thoroughly cleaned, decontaminated and prepared in a clean, 
controlled environment. 
(ii) All articles to be sterilized shall be arranged so all surfaces will be 
directly exposed to the sterilizing agent for the prescribed time and 
temperature. 
(F) Packaging. All wrapped articles to be sterilized shall be packaged in 
materials recommended for the specific type of sterilizer and material to be 
sterilized. 
(G) External chemical indicators. 
(i) External chemical indicators, also known as sterilization process 
indicators, shall be used on each package to be sterilized, including items 
being flash sterilized to indicate that items have been exposed to the 
sterilization process. 
(ii) The indicator results shall be interpreted according to manufacturer's 
written instructions and indicator reaction specifications.
(iii) A log shall be maintained with the load identification, indicator results, 
and identification of the contents of the load. 
(H) Biological indicators. 
(i) The efficacy of the sterilizing process shall be monitored with reliable 
biological indicators appropriate for the type of sterilizer used (e.g., 
Bacillus stearothermophilus for steam sterilizers, and Bacillus subtilis variant 
(var.) niger or var. globigii for ethylene oxide (EO) and low temperature 
hydrogen peroxide plasma sterilizers). 
(ii) Biological indicators shall be included in at least one run each day of use 
for steam sterilizers and low temperature hydrogen peroxide gas sterilizers and 
every load for ethylene oxide sterilizers. 
(iii) Biological indicators shall be included in every load that contains 
implantable objects. 
(iv) A log shall be maintained with the load identification, biological 
indicator results, and identification of the contents of the load.
(v) If a test is positive, the sterilizer shall immediately be taken out of 
service. 
(I) Implantable items shall be recalled and reprocessed if a biological 
indicator test (spore test) is positive. 
(II) All available items shall be recalled and reprocessed if a sterilizer 
malfunction is found and a list of those items not retrieved in the recall shall 
be submitted to infection control. 
(III) A malfunctioning sterilizer shall not be put back into use until it has 
been serviced and successfully tested according to the manufacturer's 
recommendations. 
(I) Sterilizers. 
(i) Steam sterilizers (saturated steam under pressure) shall be utilized for 
sterilization of heat and moisture stable items. Steam sterilizers shall be used 
according to manufacturer's written instructions. 
(ii) EO sterilizers shall be used for processing heat and moisture sensitive 
items. EO sterilizers and aerators shall be used and vented according to the 
manufacturer's written instructions. 
(iii) Flash sterilizers shall be used for emergency sterilization of clean, 
unwrapped instruments and porous items only. 
(J) Disinfection. 
(i) Written policies, approved by the infection control committee, shall be 
adopted and implemented for the use of chemical disinfectants. 
(ii) The manufacturer's written instructions for the use of disinfectants shall 
be followed. 
(iii) An expiration date, determined according to manufacturer's written 
recommendations, shall be marked on the container of disinfection solution 
currently in use. 
(iv) Disinfectant solutions shall be kept covered and used in well ventilated 
areas. 
(v) Chemical germicides that are registered with the United States Environmental 
Protection Agency as "sterilants" may be used either for sterilization or high-
level disinfection. 
(vi) All staff personnel using chemical disinfectants shall have received 
training on their use. 
(K) Performance records. 
(i) Performance records for all sterilizers shall be maintained for each cycle. 
These records shall be retained and available for review for a minimum of five 
years. 
(ii) Each sterilizer shall be monitored continuously during operation for 
pressure, temperature, and time at desired temperature and pressure. A record 
shall be maintained and shall include: 
(I) the sterilizer identification; 
(II) sterilization date; 
(III) cycle number; 
(IV) contents of each load; 
(V) duration and temperature of exposure phase (if not provided on sterilizer 
recording charts); 
(VI) identification of operator(s); 
(VII) results of biological tests and dates performed; 
(VIII) time-temperature recording charts from each sterilizer;
(IX) gas concentration and relative humidity (if applicable); and 
(X) any other test results. 
(L) Storage of sterilized items. 
(i) Sterilized items shall be transported so as to maintain cleanliness and 
sterility and to prevent physical damage. 
(ii) Sterilized items shall be stored in well-ventilated, limited access areas 
with controlled temperature and humidity. 
(iii) The hospital shall adopt and implement a policy which describes the 
mechanism used to determine the shelf life of sterilized packages.
(M) Preventive maintenance. Preventive maintenance of all sterilizers shall be 
performed according to individual policy on a scheduled basis by qualified 
personnel, using the sterilizer manufacturer's service manual as a reference. A 
preventive maintenance record shall be maintained for each sterilizer. These 
records shall be retained at least two years and shall be available for review. 
(v) Surgical services. If a hospital provides surgical services, the services 
shall be well-organized and provided in accordance with acceptable standards of 
practice. If outpatient surgical services are offered, the services shall be 
consistent in quality with inpatient care in accordance with the complexity of 
services offered. A special hospital may not offer surgical services. 
(1) Organization and staffing. The organization of the surgical services shall 
be appropriate for the scope of the services offered. 
(A) The operating rooms shall be supervised by an experienced RN or physician. 
(B) Licensed vocational nurses (LVNs) and surgical technologists (operating room 
technicians) may serve as scrub nurses or technologists under the supervision of 
an RN. 
(C) Qualified RNs may perform circulating duties in the operating room. In 
accordance with approved medical staff polices and procedures, LVNs and surgical 
technologists may assist in circulatory duties under the supervision of a 
qualified RN who is immediately available to respond to emergencies.
(D) Surgical privileges shall be delineated for all physicians, podiatrists, and 
dentists performing surgery in accordance with the competencies of each. The 
surgical services shall maintain a roster specifying the surgical privileges of 
each. 
(2) Delivery of service. Surgical services shall be consistent with needs and 
resources. Written policies governing surgical care which are designed to ensure 
the achievement and maintenance of high standards of medical practice and 
patient care shall be adopted, implemented and enforced. 
(A) There shall be a complete medical history and physical examination in the 
medical record of every patient prior to surgery, except in emergencies. If this 
has been dictated, but not yet recorded in the patient's medical record, there 
shall be a statement to that effect and an admission note in the record by the 
individual who admitted the patient. 
(B) A properly executed informed consent form for the operation shall be in the 
patient's medical record before surgery, except in emergencies.
(C) The following equipment shall be available in the operating room suites: 
(i) communication system; 
(ii) cardiac monitor; 
(iii) resuscitator; 
(iv) defibrillator; 
(v) aspirator; and 
(vi) tracheotomy set. 
(D) There shall be adequate provisions for immediate post-operative care. 
(E) The operating room register shall be complete and up-to-date. The register 
shall contain, but not be limited to, the following: 
(i) patient's name and hospital identification number; 
(ii) date of operation; 
(iii) operation performed; 
(iv) operating surgeon and assistant(s); 
(v) type of anesthesia used and name of person administering it; 
(vi) time operation began and ended; 
(vii) time anesthesia began and ended; 
(viii) disposition of specimens; 
(ix) names of scrub and circulating personnel; 
(x) unusual occurrences; and 
(xi) disposition of the patient. 
(F) An operative report describing techniques, findings, and tissue removed or 
altered shall be written or dictated immediately following surgery and signed by 
the surgeon. 
(w) Therapy services. If the hospital provides physical therapy, occupational 
therapy, audiology, or speech pathology services, the services shall be 
organized and staffed to ensure the health and safety of patients.
(1) Organization and staffing. The organization of the services shall be 
appropriate to the scope of the services offered. 
(A) The director of the services shall have the necessary knowledge, experience, 
and capabilities to properly supervise and administer the services. 
(B) Physical therapy, occupational therapy, speech therapy, or audiology 
services, if provided, shall be provided by staff who meet the qualifications 
specified by the medical staff, consistent with state law.
(2) Delivery of services. Services shall be furnished in accordance with a 
written plan of treatment. Services shall be given in accordance with orders of 
the physician, podiatrist or dentist who is authorized by the medical staff to 
order the services, and the orders shall be incorporated in the patient's 
medical record. 
(x) Waste and waste disposal. 
(1) Medical waste and liquid/sewage waste management. 
(A) The hospital shall comply with the requirements set forth by the department 
in sec.sec.1.131-1.137 of this title (relating to Definition, Treatment and 
Disposition of Special Waste from Health Care Related Facilities) and the Texas 
Natural Resource Conservation Commission (TNRCC) requirements in Title 30, Texas 
Administrative Code, sec.330.1004 (relating to Generators of Medical Waste). 
(B) All sewage and liquid wastes shall be disposed of in a municipal sewerage 
system or a septic tank system permitted by the TNRCC in accordance with Title 
30, Texas Administrative Code, Chapter 285 (relating to On-Site Wastewater 
Treatment). 
(2) Waste receptacles. 
(A) Waste receptacles shall be conveniently available in all toilet rooms, 
patient areas, staff work areas, and waiting rooms. Receptacles shall be 
routinely emptied of their contents at a central location(s) into closed 
containers. 
(B) Waste receptacles shall be properly cleaned with soap and hot water, 
followed by treatment of inside surfaces of the receptacles with a germicidal 
agent. 
(C) All containers for other municipal solid waste shall be leak-resistant, have 
tight-fitting covers, and be rodent-proof. 
(D) Non-reusable containers shall be of suitable strength to minimize animal 
scavenging or rupture during collection operations. 

sec.133.42.Patient Rights.
(a) Patient rights requirements for all hospitals. 
(1) A hospital shall adopt, implement, and enforce a policy to ensure patients' 
rights. The written policy shall include: 
(A) the right of the patient to the hospital's reasonable response to his or her 
requests and needs for treatment or service, within the hospital's capacity, its 
stated mission, and applicable law and regulation;
(B) the right of the patient to considerate and respectful care; 
(i) the care of the patient includes consideration of the psychosocial, 
spiritual, and cultural variables that influence the perceptions of illness; 
(ii) the care of the dying patient optimizes the comfort and dignity of the 
patient through; 
(I) treating primary and secondary symptoms that respond to treatment as desired 
by the patient or surrogate decision maker; 
(II) effectively managing pain; and 
(III) acknowledging the psychosocial and spiritual concerns of the patient and 
the family regarding dying and the expression of grief by the patient and 
family; 
(C) the right of the patient, in collaboration with his or her physician, to 
make decisions involving his or her health care, to include the following; 
(i) the right of the patient to accept medical care or to refuse treatment to 
the extent permitted by law and to be informed of the medical consequences of 
such refusal; and 
(ii) the right of the patient to formulate advance directives and to appoint a 
surrogate to make health care decisions on his or her behalf to the extent 
permitted by law; 
(I) a hospital shall have in place a mechanism to ascertain the existence of, 
and, as appropriate, assist in the development of advance directives at the time 
of the patient's admission; 
(II) the provision of care shall not be conditioned on the existence of an 
advance directive; and 
(III) an advance directive(s) shall be in the patient's medical record and shall 
be reviewed periodically with the patient or surrogate decision maker if the 
patient has executed an advance directive; 
(D) the right of the patient to the information necessary to enable him or her 
to make treatment decisions that reflect his or her wishes; a policy on informed 
decision making shall be developed by the medical staff and governing body and 
shall be consistent with any legal requirements; 
(E) the right of the patient to receive, at the time of admission, information 
about the hospital's patient rights policy(ies) and the mechanism for the 
initiation, review, and when possible, resolution of patient complaints 
concerning the quality of care; 
(F) the right of the patient or the patient's designated representative to 
participate in the consideration of ethical issues that arise in the care of the 
patient. The hospital shall have a mechanism for the consideration of ethical 
issues arising in the care of patients and to provide education to care givers 
and patients on ethical issues in health care; 
(G) the right of the patient to be informed of any human experimentation or 
other research or educational projects affecting his or her care or treatment;
(H) the right of the patient, within the limits of law, to personal privacy and 
confidentiality of information; 
(I) the right of the patient or the patient's legally designated representative 
access to the information contained in the patient's medical record, within the 
limits of the law; and 
(J) the right of the patient's guardian, next of kin, or legally authorized 
responsible person to exercise, to the extent permitted by law, the rights 
delineated on behalf of the patient if the patient: 
(i) has been adjudicated incompetent in accordance with the law; 
(ii) is found by his or her physician to be medically incapable of understanding 
the proposed treatment or procedure; 
(iii) is unable to communicate his or her wishes regarding treatment; or 
(iv) is a minor. 
(2) The hospital patient's bill of rights shall be prominently and conspicuously 
posted for display in a public area of the facility that is readily available to 
patients, residents, employees, and visitors. 
(b) Additional patient bill of rights requirements for hospitals providing 
comprehensive medical rehabilitation services. A hospital that provides 
comprehensive medical rehabilitation services shall comply with subsection (a) 
of this section and with the following additional provisions. 
(1) The patient's bill of rights shall address the rights of minors and provide 
that a minor is entitled to: 
(A) appropriate treatment in the least restrictive setting available; 
(B) not receive unnecessary or excessive medication; 
(C) an individualized treatment plan and to participate in the development of 
the plan; 
(D) a humane treatment environment that provides reasonable protection from harm 
and appropriate privacy for personal needs; 
(E) separation from adult patients; and 
(F) regular communication between the minor patient and the patient's family. 
(2) Prior to admission or acceptance for evaluation, a written copy of the 
patient's bill of rights in the patient's primary language, if possible, shall 
be given to each patient, and, as appropriate, to the patient's parent, managing 
conservator, or guardian.
(3) The hospital shall ensure that within 24 hours after the patient is admitted 
to the hospital, the rights described in this subsection are explained to the 
patient and, if appropriate, to the patient's parent, managing conservator, or 
guardian in the following manner: 
(A) orally, in simple, nontechnical terms in the person's primary language, if 
possible; or 
(B) other reasonable means calculated to communicate with a person who has an 
impairment of vision or hearing, if applicable. 
(4) If the patient cannot comprehend the information because of illness, age, or 
other factors, or an emergency exists that precludes immediate presentation of 
the information, or the patient refused to sign the written copy of the 
patient's bill of rights as provided for in paragraph (5) of this subsection, 
the presentation of the document shall be witnessed by two members of the 
hospital staff, and the unsigned patient's bill of rights shall be placed in the 
clinical record along with a note signed by the witnesses indicating the reasons 
for their signatures. 
(5) The hospital shall obtain a signed copy of the patient's bill of rights from 
each patient, or, if appropriate, from the patient's parent, managing 
conservator, or guardian. The signed copy shall include a statement that the 
patient, patient's parent, managing conservator, or guardian has read the 
document and understands the rights specified in the document. The signed copy 
shall be made a part of the patient's medical record. 
(c) Additional patient bill of rights requirements for hospitals providing 
chemical dependency services. A hospital that provides chemical dependency 
services shall comply with subsection (a) of this section and with 40 Texas 
Administrative Code (TAC), Chapter 148, Facility Licensure Standards 
administered by the Texas Commission on Alcohol and Drug Abuse. 
(d) Additional patient bill of rights requirements for hospitals providing 
mental health services. A hospital that provides mental health services shall 
comply with subsection (a) of this section and Chapter 404, Subchapter E of this 
title (relating to Rights of Persons Receiving Mental Health Services).
(e) Posting requirements for patient bill of rights for hospitals providing 
comprehensive medical rehabilitation services, chemical dependency services, or 
mental health services. The hospital shall prominently and conspicuously post 
for display a copy of the patient's bill of rights in a public area of the 
hospital that is readily visible to patients, residents, employees, and 
visitors. The patient bill of rights posted for display shall be in English and 
in a second language appropriate to the demographic makeup of the community 
served.

sec.133.43.Discrimination or Retaliation Standards.
(a) Posting requirements for reporting a violation of law. In accordance with 
sec.161.135(h) of the Health and Safety Code (HSC), each hospital shall 
prominently and conspicuously post for display in a public area of the hospital 
that is readily visible to patients, residents, employees, and visitors a 
statement that non-employees, employees and staff are protected from 
discrimination or retaliation for reporting a violation of law. The statement 
shall be in English and in a second language appropriate to the demographic 
makeup of the community served. 
(b) Discrimination relating to employee reporting a violation of law. In 
accordance with sec.161.134(a) of the HSC, a hospital may not suspend or 
terminate the employment of, discipline, or otherwise discriminate against an 
employee for reporting to the employee's supervisor, an administrator of the 
hospital, a state regulatory agency, or a law enforcement agency a violation of 
law, including a violation of the Act or this chapter. 
(c) Retaliation relating to non-employee reporting a violation of law. In 
accordance with sec.161.135(a) of the HSC, a hospital may not retaliate against 
a person who is not an employee for reporting a violation of law, including a 
violation of the Act or this chapter. 

sec.133.44.Hospital Patient Transfer Policy.
(a) General. 
(1) The governing body of each hospital shall adopt, implement, and enforce a 
policy relating to patient transfers that is consistent with this section and 
contains each of the requirements in subsection (b) of this section. Hospital 
administration has the authority to represent a hospital during the transfer 
from or receipt of patients into the hospital. 
(2) The transfer policy shall be adopted by the governing body of the hospital 
after consultation with the medical staff. 
(3) The policy shall govern transfers not covered by a transfer agreement. 
(4) The movement of a stable patient from a hospital to another hospital is not 
considered to be a transfer under this section if it is the understanding and 
intent of both hospitals that the patient is going to the second hospital only 
for tests, the patient will not remain overnight at the second hospital, and the 
patient will return to the first hospital. This paragraph applies only when a 
patient remains stable during transport to and from hospitals and during 
testing. 
(5) The hospital's transfer policy shall include a written operational plan to 
provide for patient transfer transportation services if the hospital does not 
provide its own patient transfer transportation services. 
(6) If possible, each governing body, after consultation with the medical staff, 
shall implement its transfer policy by adopting transfer agreements with other 
hospitals in accordance with sec.133.61 of this title (relating to Hospital 
Patient Transfer Agreements). 
(7) A public hospital or a hospital district shall accept the transfer of its 
eligible residents if the public hospital or hospital district has appropriate 
facilities, services, and staff available for providing care to the patient. 
(b) Requirements for transfer of patients between hospitals.
(1) Discrimination. Except as is specifically provided in paragraphs 6 (E) and 
(F) and (7)(A) and (B) of this subsection, relating, respectively, to mandated 
providers and designated providers, the hospital policy shall provide that the 
transfer of a patient may not be predicated upon arbitrary, capricious, or 
unreasonable discrimination based upon race, religion, national origin, age, 
sex, physical condition, or economic status.
(2) Disclosure. The hospital's policy shall recognize the right of an individual 
to request transfer into the care of a physician and a hospital of his own 
choosing; however, if a patient is transferred for economic reasons and the 
patient's choice is predicated upon or influenced by representations made by the 
transferring physician or hospital administration regarding the availability of 
medical care and hospital services at a reduced cost or no cost to the patient, 
the physician or hospital administration shall fully disclose to the patient the 
eligibility requirements established by the patient's chosen physician or 
hospital. 
(3) Patient. A patient is an individual: 
(A) seeking medical treatment who may or may not be under the immediate 
supervision of a personal attending physician, has one or more undiagnosed or 
diagnosed medical conditions, and who, within reasonable medical probability, 
requires immediate or continuing hospital services and medical care; or 
(B) admitted to the hospital as a patient. 
(4) Patient evaluation. The hospital's policy shall provide that each patient 
who arrives at the hospital is: 
(A) evaluated by a physician who is present in the hospital at the time the 
patient presents or is presented or evaluated by a physician on call who is: 
(i) physically able to reach the patient within 30 minutes after being informed 
that a patient is present at the hospital who requires immediate medical 
attention; or 
(ii) available by direct, telephone, or radio communication within 30 minutes 
with authorized nursing staff at the hospital under orders to assess and report 
the patient's condition to the physician; and 
(B) personally examined and evaluated by the physician before an attempt to 
transfer is made; however: 
(i) after receiving a report on the patient's condition from the hospital's 
nursing staff by telephone or radio, if the physician on call determines that an 
immediate transfer of the patient is medically appropriate and that the time 
required to conduct a personal examination and evaluation of a patient will 
unnecessarily delay the transfer to the detriment of the patient, the physician 
on call may order the transfer by telephone or radio; and 
(ii) physician orders for the transfer of a patient which are issued by 
telephone or radio shall be reduced to writing in the patient's medical record, 
signed by the hospital staff member receiving the order, and countersigned by 
the physician authorizing the transfer as soon as possible. The patient 
transfers resulting from physician orders issued by telephone or radio shall be 
subject to automatic review by the medical staff pursuant to paragraph (9) of 
this subsection. 
(5) Hospital personnel, written protocols, standing delegation orders, 
eligibility and payment information. The policy of the transferring and 
receiving hospital shall provide that licensed nurses and other qualified 
personnel are available and on duty to assist with patient transfers and to 
provide accurate information regarding eligibility and payment practices. The 
policy shall provide that written protocols or standing delegation orders are in 
place to guide hospital personnel when a patient requires transfer to another 
hospital. 
(6) Transfer of patients who have emergency medical conditions.
(A) If a patient at a hospital has an emergency medical condition which has not 
been stabilized or when stabilization of the patient's vital signs is not 
possible because the hospital or emergency department does not have the 
appropriate equipment or personnel to correct the underlying process (e.g. 
children's hospitals, thoracic surgeon on staff, or cardiopulmonary bypass 
capability), evaluation and treatment shall be performed and transfer shall be 
carried out as quickly as possible. 
(B) The hospital's policy shall provide that the hospital may not transfer a 
patient with an emergency medical condition which has not been stabilized 
unless: 
(i) the patient or a legally responsible person acting on the patient's behalf, 
after being informed of the hospital's obligations under this section and of the 
risks and benefits of transfer, requests transfer to another hospital in 
writing; 
(ii) a physician has signed a certification, which includes a summary of the 
risks and benefits, that, based on the information available at the time of 
transfer, the medical benefits reasonably expected from the provision of 
appropriate medical treatment at another hospital outweigh the increased risks 
to the patient and, in the case of labor, to the unborn child from effecting the 
transfer; or 
(iii) if the physician who made the determination to transfer a patient with an 
emergency condition is not physically present in the emergency department at the 
time of transfer, a qualified medical person may sign a certification described 
in clause (ii) of this subparagraph after consultation with the physician. The 
physician shall countersign the physician certification within a reasonable 
period of time. 
(C) Except as provided by subparagraphs (E) and (F) of this paragraph and 
paragraphs (7)(A) and (B) of this subsection, the hospital's policy shall 
provide that the transfer of patients who have emergency medical conditions, as 
determined by a physician, shall be undertaken for medical reasons only. 
(D) Except as expressly permitted in clauses (i) and (ii) of this subparagraph, 
a hospital's policy shall provide for the receipt of patients who have an 
emergency medical condition from other hospitals so that upon notification from 
a transferring physician or a transferring hospital prior to transfer, the 
receiving hospital shall respond to the transferring hospital and transferring 
physician with the status of the transfer request within 30 minutes and either 
accept or refuse the transfer. The time period begins to run at the time a 
member of the staff of the receiving hospital receives the call initiating the 
request to transfer. 
(i) The receiving hospital's policy may permit response to the transferring 
hospital and transferring physician within a period of time in excess of 30 
minutes but no longer than one hour if there are extenuating circumstances for 
the delay. If the transfer is accepted, the reason for the delay shall be 
documented on the memorandum of transfer. 
(ii) The response time may be extended before the expiration of the initial 30 
minutes period by agreement among the transferring hospital and transferring 
physician and the receiving hospital and receiving physician. If the transfer is 
accepted, the agreed extension shall be documented in the memorandum of 
transfer. 
(E) The hospital's policy shall recognize and comply with the requirements of 
the Indigent Health Care and Treatment Act, Health and Safety Code (HSC), 
sec.sec.61.030-61.032 and sec.sec.61.057-61.059 (relating to Mandated Providers) 
since those requirements may apply to a patient.
(F) The hospital's policy shall acknowledge contractual obligations and comply 
with statutory or regulatory obligations which may exist concerning a patient 
and a designated provider. 
(G) The hospital's policy shall require that all reasonable steps are taken to 
secure the informed refusal of a patient refusing a transfer or a related 
examination and treatment or of a person acting on a patient's behalf refusing a 
transfer or a related examination and treatment. Reasonable steps include: 
(i) a factual explanation of the increased medical risks to the patient 
reasonably expected from not being transferred, examined, or treated at the 
transferring hospital; 
(ii) a factual explanation of any increased risks to the patient from not 
effecting the transfer; and 
(iii) a factual explanation of the medical benefits reasonably expected from the 
provision of appropriate treatment at another hospital.
(H) The informed refusal of a patient, or of a person acting on a patient's 
behalf, to examination, evaluation or transfer shall be documented and signed if 
possible by the patient or by a person acting on the patient's behalf, dated and 
witnessed by the attending physician or hospital employee, and placed in the 
patient's medical record. 
(I) Transfer of patients may occur routinely or as part of a regionalized plan 
for obtaining optimal care for patients at a more appropriate or specialized 
facility. 
(7) Transfer of patients who do not have emergency medical conditions. 
(A) The hospital's policy shall recognize and comply with the requirements of 
the Indigent Health Care and Treatment Act, HSC, sec.sec.61.030-61.032 and 
sec.sec.61.057-61.059 (relating to Mandated Providers) as those requirements may 
apply to a patient. 
(B) The hospital's policy shall acknowledge contractual obligations and comply 
with statutory or regulatory obligations which may exist concerning a patient 
and a designated provider. 
(C) The hospital's policy shall require that all reasonable steps are taken to 
secure the informed refusal of a patient refusing a transfer or a related 
examination and treatment or of a person acting on a patient's behalf refusing a 
transfer or a related examination and treatment. Reasonable steps include: 
(i) a factual explanation of the increased medical risks to the patient 
reasonably expected from not being transferred, examined, or treated at the 
transferring hospital; 
(ii) a factual explanation of any increased risks to the patient from not 
effecting the transfer; and 
(iii) a factual explanation of the medical benefits reasonably expected from the 
provision of appropriate treatment at another hospital.
(D) The informed refusal of a patient, or of a person acting on a patient's 
behalf, to examination, evaluation or transfer shall be documented and signed if 
possible by the patient or by a person acting on the patient's behalf, dated and 
witnessed by the attending physician or hospital employee, and placed in the 
patient's medical record. 
(E) Transfer of patients may occur routinely or as part of a regionalized plan 
for obtaining optimal care for patients at a more appropriate or specialized 
facility. 
(F) The hospital's policy shall recognize the right of an individual to request 
a transfer into the care of a physician and a hospital of the individual's own 
choosing. 
(8) Physician's duties and standard of care. 
(A) The policy shall provide that the transferring physician shall determine and 
order life support measures which are medically appropriate to stabilize the 
patient prior to transfer and to sustain the patient during transfer. 
(B) The policy shall provide that the transferring physician shall determine and 
order the utilization of appropriate personnel and equipment for the transfer. 
(C) The policy shall provide that in determining the use of medically 
appropriate life support measures, personnel, and equipment, the transferring 
physician shall exercise that degree of care which a reasonable and prudent 
physician exercising ordinary care in the same or similar locality would use for 
the transfer. 
(D) The policy shall provide that except as allowed under paragraph (4)(B) of 
this subsection, prior to each patient transfer, the physician who authorizes 
the transfer shall personally examine and evaluate the patient to determine the 
patient's medical needs and to ensure that the proper transfer procedures are 
used. 
(E) The policy shall provide that prior to transfer, the transferring physician 
shall secure a receiving physician and a receiving hospital that are appropriate 
to the medical needs of the patient and that will accept responsibility for the 
patient's medical treatment and hospital care. 
(9) Record review for standard of care. The hospital's policy shall provide that 
the hospital's medical staff review appropriate records of patients transferred 
from the hospital to determine that the appropriate standard of care has been 
met. 
(10) Medical record. 
(A) The hospital's policy shall provide that a copy of those portions of the 
patient's medical record which are available and relevant to the transfer and to 
the continuing care of the patient be forwarded to the receiving physician and 
receiving hospital with the patient. If all necessary medical records for the 
continued care of the patient are not available at the time the patient is 
transferred, the records shall be forwarded to the receiving physician and 
hospital as soon as possible. 
(B) The medical record shall contain at a minimum: 
(i) a brief description of the patient's medical history and physical 
examination; 
(ii) a working diagnosis and recorded observations of physical assessment of the 
patient's condition at the time of transfer; 
(iii) the reason for the transfer; 
(iv) the results of all diagnostic tests, such as laboratory tests; 
(v) pertinent X-ray films and reports; and 
(vi) any other pertinent information. 
(11) Memorandum of transfer. 
(A) The hospital's policy shall provide that a memorandum of transfer be 
completed for every patient who is transferred. 
(B) The memorandum shall contain the following information:
(i) the patient's full name, if known; 
(ii) the patient's race, religion, national origin, age, sex, physical handicap, 
if known; 
(iii) the patient's address and next of kin, address, and phone number if known; 
(iv) the names, telephone numbers and addresses of the transferring and 
receiving physicians; 
(v) the names, addresses, and telephone numbers of the transferring and 
receiving hospitals; 
(vi) the time and date on which the patient first presented or was presented to 
the transferring physician and transferring hospital;
(vii) the time and date on which the transferring physician secured a receiving 
physician; 
(viii) the name, date, and time hospital administration was contacted in the 
receiving hospital; 
(ix) signature, time, and title of the transferring hospital administration who 
contacted the receiving hospital; 
(x) the certification required by paragraph (6)(B)(ii) of this subsection, if 
applicable (the certification may be part of the memorandum of transfer form or 
may be on a separate form attached to the memorandum of transfer form); 
(xi) the time and date on which the receiving physician assumed responsibility 
for the patient; 
(xii) the time and date on which the patient arrived at the receiving hospital; 
(xiii) signature and date of receiving hospital administration;
(xiv) type of vehicle and company used; 
(xv) type of equipment and personnel needed in transfers;
(xvi) name and city of hospital to which patient was transported;
(xvii) diagnosis by transferring physician; and 
(xviii) attachments by transferring hospital. 
(C) The receipt of the memorandum of transfer shall be acknowledged in writing 
by the receiving hospital administration and receiving physician.
(D) A copy of the memorandum of transfer shall be retained by the transferring 
and receiving hospitals. The memorandum shall be filed separately from the 
patient's medical record and in a manner which will facilitate its inspection by 
the department. All memorandum of transfer forms filed separately shall be 
retained for five years. 
(c) Violations. A hospital violates the Act and this subchapter if: 
(1) the hospital fails to comply with the requirements of this subchapter; or 
(2) the governing body fails or refuses to: 
(A) adopt a transfer policy which is consistent with this section and contains 
each of the requirements in subsection (b) of this section;
(B) adopt a memorandum of transfer form which meets the minimum requirements for 
content contained in this section; or 
(C) enforce its transfer policy and the use of the memorandum of transfer. 

sec.133.45.Miscellaneous Policies and Protocols.
(a) Determination of death and autopsy reports. The hospital shall adopt, 
implement, and enforce protocols to be used in determining death and for filing 
autopsy reports which comply with Health and Safety Code (HSC), Title 8, 
Subtitle A, Chapter 671 (relating to Determination of Death and Autopsy 
Reports). 
(b) Organ and tissue donors. The hospital shall adopt, implement, and enforce a 
written protocol to identify potential organ and tissue donors which is in 
compliance with the Texas Anatomical Gift Act, HSC, Chapter 692. The hospital 
shall make its protocol available to the public during the hospital's normal 
business hours. 
(1) The hospital's protocol shall include all requirements in HSC, Chapter 692, 
sec.692.013 (relating to Hospital Protocol). 
(2) A hospital which performs organ transplants shall be a member of the Organ 
Procurement and Transplantation Network in accordance with 42 United States 
Code, Section 274 (relating to Organ Procurement and Transplantation Network). 
(c) Disaster preparedness. A hospital shall adopt, implement, and enforce a 
written policy for publicly known natural disaster preparedness for the 
reception, treatment, and disposition of casualties. The written policy shall: 
(1) be developed through a joint effort of the hospital governing body, 
administration, medical staff, and hospital personnel; 
(2) include a plan for the reasonable mechanism for triaging patients, the 
notification of appropriate personnel and patients in the event of a disaster, 
the identification of appropriate community resources, and the identification of 
possible evacuation procedures; and 
(3) include the applicable information contained in the National Fire Protection 
Association 99, Standard for Health Care Facilities, 1996 edition, Annex 1, 
(relating to Health Care Emergency Preparedness), published by the National Fire 
Protection Association (NFPA), and the State of Texas Emergency Management Plan. 
Information regarding the State of Texas Emergency Management Plan is available 
from the city or county emergency management coordinator. The NFPA document 
referenced in this section may be obtained by writing or calling the NFPA at the 
following address and telephone number: 1 Batterymarch Park, Post Office Box 
9101 Quincy, Massachusetts 02269-9101, (800) 344-3555. 
(d) Illegal remuneration. A hospital shall adopt, implement, and enforce a 
policy to ensure that the hospital complies with HSC, Chapter 161, Subchapter I 
(relating to Illegal Remuneration). 

sec.133.46.Hospital Billing.
(a) Itemized statements. A hospital shall adopt, implement, and enforce a policy 
to ensure that the hospital complies with the Health and Safety Code (HSC), 
sec.311.002 (relating to Itemized Statement of Billed Services). 
(b) Audits of billing. A hospital shall adopt, implement, and enforce a policy 
to ensure that the hospital complies with HSC, sec.311.0025 (relating to Audits 
of Billing). 
(c) Improper billing. A hospital shall not submit to patients or third party 
payors a bill for treatments which are improper, unreasonable or medically or 
clinically unnecessary or for treatments which were not provided.
(d) Complaint investigation procedures. 
(1) A complaint submitted to the Texas Department of Health (department) 
relating to billing must specify the patient for whom the bill was submitted. 
(2) Upon receiving a complaint warranting an investigation, the department shall 
send the complaint to the hospital requesting the hospital to conduct an 
internal investigation. Within 30 days of the hospital's receipt of the 
complaint, the hospital shall submit to the department: 
(A) a report outlining the hospital's investigative process;
(B) the resolution or conclusions reached by the hospital with the patient, 
third party payor or complainant; and 
(C) corrections, if any, in the hospital's policies or protocols which were made 
as a result of its investigative findings. 
(3) In addition to the hospital's internal investigation, the department may 
also conduct an investigation to audit any billing and patient records of the 
hospital. 
(4) The department shall inform in writing a complainant who identifies himself 
by name and address: 
(A) of the receipt of the complaint; 
(B) if the complainant's allegations are potential violations of the Act or this 
chapter warranting an investigation; 
(C) whether the complaint will be investigated by the department;
(D) if the complaint was referred to the hospital for internal investigation; 
(E) whether and to whom the complaint will be referred; 
(F) of the results of the hospital's investigation and the hospital's resolution 
with the complainant; and 
(G) of the department's findings if an on-site audit investigation was 
conducted. 
(5) The department shall refer investigative reports of billing by health care 
professionals who have provided improper, unreasonable, or medically or 
clinically unnecessary treatments or billed for treatments which were not 
provided to the appropriate licensing agency.

sec.133.47.Abuse and Neglect Issues.
(a) Abuse, neglect and exploitation reporting. The requirements of this 
subsection are applicable to all hospitals. 
(1) Abuse or neglect of a child, as defined in sec.1.204(a) and (b) of this 
title (relating to Investigations of Abuse, Neglect, or Exploitation in a 
Facility Operated, Licensed, or Certified by the Texas Department of Health), 
which occurs in a hospital shall be reported to the Texas Department of Health 
(department). 
(2) Abuse, neglect or exploitation of an elderly or disabled person, as defined 
in sec.1.204(a) and (b) of this title, which occurs in a hospital shall be 
reported to the department. 
(b) Additional abuse and neglect issues. The requirements of this subsection 
apply only to hospitals which provide comprehensive medical rehabilitation, 
mental health, or chemical dependency services in units approved by the 
department, and are in addition to the requirements of subsection (a) of this 
section which are applicable to all hospitals. 
(1) Definitions. The following definitions are in accordance with sec.161.131 of 
the Health and Safety Code and apply only to this subsection:
(A) Abuse includes: 
(i) any act or failure to act by an employee, contract personnel, and volunteer 
of a hospital which was performed, or which was failed to be performed, 
knowingly, recklessly, or intentionally, and which caused, or may have caused, 
injury or death to a patient, and includes acts such as: 
(I) the rape, sexual assault or sexual exploitation of a patient;
(II) the striking of a patient; 
(III) the use of excessive force when placing a patient in bodily restraints; 
and 
(IV) the use of bodily or chemical restraints on a patient which are not in 
compliance with federal and state laws and regulations; and
(ii) verbal abuse, coercive or restrictive actions that are illegal or not 
justified by the patient's condition and that are in response to the patient's 
request for discharge or refusal of medication, therapy or treatment. 
(B) Neglect is a negligent act or omission by any individual responsible for 
providing services in a hospital which caused or may have caused injury or death 
to a patient or which placed a patient at risk of injury or death, and includes 
an act or omission such as the failure to establish or carry out an appropriate 
individual program plan or treatment plan for a patient, the failure to provide 
adequate nutrition, clothing, or health care to a patient, or the failure to 
provide a safe environment for a patient, including the failure to maintain 
adequate numbers of appropriately trained staff. 
(2) Posting requirements. A hospital providing comprehensive medical 
rehabilitation, mental health, or chemical dependency services shall prominently 
and conspicuously post for display in a public area or the unit of the hospital 
providing such services that is readily visible to patients, residents, 
volunteers, employees, and visitors a statement of the duty to report abuse and 
neglect, or illegal, unprofessional, or unethical conduct. The statement shall 
be in English and in a second language appropriate to the demographic makeup of 
the community served and contain the number of the department's hospital patient 
information and complaint line at 1-800-228-1570.
(3) Reporting requirements. 
(A) Reporting abuse and neglect. A person, including an employee, volunteer, or 
other person associated with a hospital that provides comprehensive medical 
rehabilitation, mental health, or chemical dependency services who reasonably 
believes or who knows of information that would reasonably cause a person to 
believe that the physical or mental health or welfare of a patient of the 
hospital who is receiving comprehensive medical rehabilitation, mental health, 
or chemical dependency services has been, is, or will be adversely affected by 
abuse or neglect by any person shall as soon as possible report the information 
supporting the belief to the department or to the appropriate state health care 
regulatory agency. 
(B) Reporting illegal, unprofessional, or unethical conduct. An employee of or 
other person associated with a hospital that provides comprehensive medical 
rehabilitation, mental health, or chemical dependency services, including a 
health care professional, who reasonably believes or who knows of information 
that would reasonably cause a person to believe that the hospital or an employee 
or health care professional associated with the hospital, has, is, or will be 
engaged in conduct that is or might be illegal, unprofessional, or unethical and 
that relates to the operation of the hospital or comprehensive medical 
rehabilitation, mental health, or chemical dependency services provided in the 
hospital shall as soon as possible report the information supporting the belief 
to the department or to the appropriate state health care regulatory agency. 
(4) Training requirements. A hospital providing mental health, chemical 
dependency, or comprehensive medical rehabilitation services in a separate and 
distinct part of the hospital shall comply with the memorandum of understanding 
(MOU) as specified in sec.401.57 of this title (relating to Training 
Requirements for Identifying Abuse, Neglect, and Unprofessional or Unethical 
Conduct in Health Care Facilities) as amended July 25, 1994. The MOU shall apply 
to all employees and associate health care professionals who are assigned to or 
who provide services on such units.
(c) Investigations. 
(1) Submission of complaints. A complaint made under this section may be 
submitted in writing or verbally to the Health Facility Compliance Division, 
Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3199, 
telephone, (800) 228-1570. 
(2) Investigations by the department. A complaint containing allegations which 
are a violation of the Act or this chapter shall be investigated by the 
department. 
(3) Complaints not in violation of the Act or this chapter. A complaint 
containing allegations which are not a violation of the Act or this chapter will 
not be investigated by the department but shall be referred to law enforcement 
agencies or other agencies, as appropriate. 
(4) Notification. The department shall inform, in writing, the complainant who 
identifies themselves by name and address of the following:
(A) the receipt of the complaint; 
(B) if the complainant's allegations are potential violations of the Act or this 
chapter warranting an investigation; 
(C) whether the complaint will be investigated by the department;
(D) whether and to whom the complaint will be referred; and
(E) the findings of the complaint investigation. 
(5) Referral report. The department shall request a report from each referral 
agency of the action taken by the agency six months after the referral. 
(d) Department reporting and referral. 
(1) Reporting health care professional to licensing board. A health care 
professional who fails to report abuse and neglect or illegal, unprofessional, 
or unethical conduct as required by subsection (b)(3) of this section shall be 
referred by the department to the individual's licensing board for appropriate 
disciplinary action. 
(2) Treatment methods advisory committee. The department shall report or forward 
a copy of a complaint concerning subsection (b) of this section relating to an 
abusive treatment method to the Treatment Methods Advisory Committee with the 
Texas Department of Mental Health and Mental Retardation.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802153
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER D.Voluntary Agreements
25 TAC sec.133.61, sec.133.62
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241.

sec.133.61.Hospital Patient Transfer Agreements.
(a) General provisions. 
(1) Transfer agreements between hospitals are voluntary. 
(2) If transfer agreements are executed between hospitals that are consistent 
with the requirements of subsection (b) of this section, any patient transfers 
between the hospitals shall be governed by the agreement. The memorandum of 
transfer described in sec.133.44(b)(11) of this title (relating to Hospital 
Patient Transfer Policy) is not required between hospitals governed by an 
agreement. 
(3) The transfer agreement shall be submitted to the Texas Department of Health 
(department) for review to determine if the agreement meets the requirements of 
subsection (b) of this section.
(4) Multiple transfer agreements may be entered into by a hospital based upon 
the type or level of medical services available at other hospitals. 
(b) Rules for hospital patient transfer agreements. 
(1) A patient transfer agreement shall contain the following.
(A) Except as specifically provided in paragraph (4) of this subsection, 
relating to mandated providers, the transfer of a patient shall not be 
predicated upon arbitrary, capricious, or unreasonable discrimination based upon 
race, religion, national origin, age, sex, physical condition, or economic 
status. 
(B) The transfer or receipt of patients in need of emergency care shall not be 
based upon the individual's inability to pay for the services rendered by the 
transferring or receiving hospital. 
(2) The hospital patient transfer agreement shall require that patient transfers 
between the hospitals be accomplished in a medically appropriate manner from 
physician to physician and from hospital to hospital. 
(A) The use of medically appropriate life support measures which a reasonable 
and prudent physician in the same or similar locality exercising ordinary care 
would use to stabilize the patient prior to transfer and to sustain the patient 
during the transfer shall be provided. 
(B) The provision of appropriate personnel and equipment which a reasonable and 
prudent physician in the same or similar locality exercising ordinary care would 
use for the transfer shall be provided. 
(C) The transfer of all necessary records for continuing the care for the 
patient shall be provided. 
(D) The consideration of the availability of appropriate facilities, services, 
and staff for providing care to the patient shall be provided. 
(3) The hospitals shall recognize the right of an individual to request transfer 
into the care of a physician and hospital of the individual's own choosing. 
(4) The hospitals shall recognize and comply with the requirements of the 
Indigent Health Care and Treatment Act, Health and Safety Code, Chapter 61 
(relating to the Transfer of Patients to Mandated Providers).
(5) The hospital patient transfer agreement shall provide that the hospital 
shall not transfer a patient with an emergency medical condition which has not 
been stabilized unless the following occurs. 
(A) The patient, or a legally responsible person acting on the patient's behalf, 
after being informed of the hospital's obligations under this section and of the 
risk of transfer, has requested transfer to another hospital in writing. 
(B) A physician has signed a certification, which includes a summary of the 
risks and benefits, that, based on the information available at the time of 
transfer, the medical benefits reasonably expected from the provision of 
appropriate medical treatment at another hospital outweigh the increased risks 
to the patient and, in the case of labor, to the unborn child from effecting the 
transfer. 
(C) If a physician is not physically present in the emergency department at the 
time a patient is transferred, a qualified medical person has signed a 
certification described in subparagraph (B) of this paragraph after consultation 
with a physician who has made the determination described in subparagraph (B) of 
this paragraph and who will subsequently countersign the certification within a 
reasonable period of time. 
(c) Review of transfer agreements. 
(1) Each party to a transfer agreement may obtain the department's review of a 
transfer agreement by jointly submitting to the department: 
(A) a copy of the current or proposed agreement signed by each hospital's 
representative; 
(B) the date of the adoption of the agreement; and 
(C) the effective date of the agreement. 
(2) The department may waive the submittal of the documents required under 
paragraph (1) of this subsection to avoid the repetitious submission of required 
documentation and approved agreements. 
(3) If a governing body or a governing body's designee executes a transfer 
agreement and the entire text of that agreement consists of the entire text of 
an agreement that has been previously approved by the department, the governing 
body or the governing body's designee is not required to submit the later 
agreement for review. On the date the later agreement is fully executed and 
before the later agreement is implemented, the governing body or the governing 
body's designee must give adequate notice to the department that the later 
agreement has been executed. 
(4) The department shall review the agreement within 30 calendar days after the 
department's receipt of the agreement to determine if the agreement is 
consistent with the requirements of this section. 
(5) After the department's review of the agreement, if the department determines 
that the agreement is consistent with the requirements contained in this 
section, the department shall notify the hospital administration that the 
agreement has been approved. 
(6) If the department has reason to believe that the agreement is not consistent 
with the requirements contained in this section, the department shall give 
notice to the hospital administration that the agreement is deficient. 
(A) The deficiency notice shall contain a complete statement of the deficiencies 
and shall contain recommendations for correction or an offer of consultation. 
(B) The deficiency notice shall contain a statement of caution to the submitting 
hospitals that a rejection of the transfer agreement by the department has the 
effect of continuing each hospital's respective hospital patient transfer 
policy. 
(d) Appeals. 
(1) If the department rejects a patient transfer agreement, the hospitals that 
are parties to the agreement may jointly request an internal reconsideration of 
the department's decision. 
(2) A hospital that is party to a rejected agreement shall appeal the rejection 
jointly with an appeal by other appealing parties or waive that hospital's 
opportunity to appeal. 
(3) To initiate the appeal process, the party hospitals shall notify the 
department, in writing, that each party hospital requests a hearing on the 
decision. 
(4) The request must be received by the department within 20 calendar days from 
the receipt of the department's rejection notice by the hospital that submitted 
the proposed agreement for review and approval.
(5) Failure of the party hospitals to provide a written request for appeal shall 
be deemed a waiver of the opportunity for an internal reconsideration by the 
department, and the rejection shall become final. 
(6) An internal review of a rejection shall consist of a review of the actions 
taken to-date concerning the rejection of the agreement.
(7) The review shall be conducted by a three member panel. The members shall be 
appointed by the commissioner of health. The panel members shall not have 
participated in the department's decision. 
(A) The panel shall meet as necessary. 
(B) The panel shall review all agreement submissions for which an appeal has 
been requested. 
(C) The review shall be based primarily on the documentation provided with the 
request for an appeal, but the party requesting the appeal may appear before the 
panel, if they desire. 
(D) The panel's decision is binding on the department and the hospital(s). 
(e) Amendments to an agreement. 
(1) The governing body of a hospital or governing body's designee may adopt 
proposed amendments to a transfer agreement which has been approved by the 
department. However, before the amendments are implemented, the governing body 
or the governing body's designee shall submit the proposed amendments to the 
department for review in the same manner as the agreement to be amended was 
submitted. 
(2) The department shall review the amendments and shall approve or reject them 
in the same manner as provided for the review of the agreement to be amended. 
(f) Complaints. Complaints alleging a violation of a transfer agreement shall be 
treated in the same manner as complaints alleging violations of the Act or this 
chapter. 
(g) Enforcement. 
(1) After investigation of the complaint, if it is determined that the violation 
alleged in the complaint is not a violation of a rule required by subsection (b) 
of this section, the department shall notify the complainant that the complaint 
is not within the jurisdiction of the department and that the complainant may 
proceed by undertaking private resolution. 
(2) After investigation of the complaint, if the department determines that a 
hospital has violated a rule required by subsection (b) of this section, the 
department may proceed against the violating hospital in the same manner as 
provided for enforcement of the Act and this chapter.

sec.133.62.Cooperative Agreements.
(a) Purpose. The purpose of this section is to establish procedures to implement 
the Health and Safety Code (HSC), Chapter 314, by which hospitals may enter into 
cooperative agreements with other hospitals in the state. 
(b) Application requirements. 
(1) Hospitals which are parties to a cooperative agreement shall file an 
application with the Texas Department of Health (department) for a certificate 
of public advantage governing the cooperative agreement.
(A) Only persons licensed as a hospital under HSC, Chapters 241 or 577, may be 
parties to the cooperative agreement. 
(B) The cooperative agreement shall be filed at least 120 calendar days prior to 
the effective date of the agreement. 
(C) The cooperative agreement shall be executed by all parties.
(D) The application shall be filed jointly by all parties to the cooperative 
agreement; however, the parties shall designate one person authorized to receive 
notices and communications with respect to the application to be the contact 
person with the department. 
(2) The application shall include: 
(A) a table of contents; 
(B) a written copy of the cooperative agreement; 
(C) the exact name of each party and the address of the principal business 
office of each party; 
(D) the name of the registered agent and address of the registered office for 
each party which is a corporation; 
(E) the name, address, and telephone number of the contact person referenced in 
paragraph (1)(D) of this subsection; 
(F) a notarized statement by a responsible officer or partner, as appropriate, 
of each party attesting to the accuracy and completeness of the enclosed 
information; 
(G) a brief summary of the nature and scope of the cooperative agreement; 
(H) a description of any consideration passing to any party;
(I) a statement of the likely benefits resulting from the cooperative agreement 
addressing one or more of the benefits of the cooperative agreement listed in 
the HSC, sec.314.002(e) and any other benefits; 
(J) a statement of the disadvantages attributable to a reduction in competition 
that might result from the cooperative agreement addressing each appropriate 
factor listed in the HSC, sec.314.002 (f) and any other factors which the 
applicant wants considered; 
(K) a statement of how and why the likely benefits resulting from the 
cooperative agreement outweigh the disadvantages attributable to a reduction in 
competition that might result from the cooperative agreement;
(L) a description of the geographic territory to be served by the health care 
equipment, facilities, personnel, or services which are the subject of the 
cooperative agreement; 
(M) if the geographic territory described in subparagraph (L) of this paragraph 
is different from the territory in which the parties have provided similar 
health care equipment, facilities, personnel, or services over the last five 
years, a description of how and why the geographic territory differs; 
(N) identification of whether and how any services, personnel, facilities, or 
health care equipment similar to those covered by the cooperative agreement are 
currently being offered to or utilized by other health care providers, 
facilities, or patients in the geographic territory described in subparagraph 
(L) of this paragraph; 
(O) identification of the steps necessary under current market and regulatory 
conditions for other parties to enter the territory described in subparagraph 
(L) of this paragraph and compete with the parties to the cooperative agreement 
in the delivery of health care services which are the subject of the cooperative 
agreement; 
(P) a description of the previous history of business transactions involving the 
delivery of health care services which are the subject of the cooperative 
agreement between the parties to the cooperative agreement; 
(Q) a detailed explanation of the projected effects, including expected volume, 
change in price, and increased revenue, of the proposed cooperative agreement on 
each party; 
(R) the present share of the health care services which are the subject of the 
cooperative agreement of each party to the cooperative agreement and of other 
health care providers or facilities affected by the cooperative agreement and 
projected shares of that health care market after implementation of the 
cooperative agreement; 
(S) a statement of why the projected levels of cost, access, or quality could 
not be achieved in the existing market without the cooperative agreement; 
(T) an explanation of how the cooperative agreement relates to any likely 
adverse impact or reduction in competition effecting negotiation of optimal 
payment and service arrangements or the furnishing of goods or services 
including quality, availability, and price; 
(U) an explanation of the availability of arrangements that are less restrictive 
to competition and achieve similar benefits; 
(V) a detailed explanation of how the cooperative agreement will affect cost, 
access, and quality of services provided by each party;
(W) a nonrefundable application fee in the amount of $10,000;
(X) the proposed effective date of the agreement; and 
(Y) if the parties to the application desire a public hearing, a written request 
for a public hearing. 
(3) Duplicate originals of the application and copies of all additional related 
materials shall be submitted to the Office of the Attorney General, Antitrust 
Division, Austin, Texas and to the Texas Department of Health (department) at 
the same time. 
(c) Review of application. 
(1) The department shall determine whether the application is complete within 30 
calendar days of receipt of an application. If the department determines that an 
application is unclear, incomplete, or provides an insufficient basis on which 
to base a decision, the department shall specify the additional information 
required. The applicant shall complete or revise the information and submit it. 
(2) The application shall not be considered to be filed until a complete 
application is received by the department, including additional information 
requested under paragraph (1) of this subsection. 
(3) Any person may request a public hearing within 30 calendar days of the 
filing of an application. 
(A) The department shall inform the applicants in writing and publish in the 
Texas Register the date, time, and location of the public hearing. 
(B) The purpose of the hearing shall be to receive public comments on the 
application. 
(C) The comments shall be considered by the department and the attorney general 
in the determination on the request for a certificate of public advantage. 
(4) Any person may request a copy of the application with the supporting 
documentation at the person's expense. 
(5) The department shall consult with the attorney general on every application. 
(6) The department shall grant or deny the application within 120 calendar days 
of the date of filing of the completed application.
(d) Issuance of certificate of public advantage. The department shall issue a 
certificate of public advantage for a cooperative agreement if it determines 
that the applicants have demonstrated by clear and convincing evidence that the 
likely benefits resulting from the agreement outweigh any disadvantages 
attributable to a reduction in competition that may result from the agreement. 
(1) The certificate of public advantage shall include the terms by which the 
application was approved and shall contain any conditions by which the 
department and the attorney general shall monitor the benefits and disadvantages 
resulting from the approved agreement. 
(2) The certificate of public advantage shall be signed by the commissioner of 
health. 
(e) Denial of an application. If the department determines that there is not 
clear and convincing evidence that the likely benefits resulting from the 
agreement outweigh any disadvantages attributable to a reduction in competition 
that may result from the cooperative agreement, the department shall deny the 
application. The department's informal hearing procedures in Chapter 1 of this 
title (relating to Texas Board of Health) shall apply. 
(f) Periodic submission of measurable data. A decision approving an application 
shall require the periodic submission of specific data relating to cost, access, 
and quality and, to the extent feasible, identify objective standards of cost, 
access, and quality by which the success of the arrangement will be measured. If 
the department determines that the scope of a particular proposed arrangement is 
such that the arrangement is certain to have neither a positive nor negative 
impact on one or two of the criteria, the department's decision need not require 
the submission of data or establish an objective standard relating to those 
criteria. 
(g) Monitoring of cooperative agreements. The department shall appropriately 
supervise, monitor, and regulate approved arrangements. 
(1) The department shall require the parties to an approved cooperative 
agreement to submit information and supporting data on an annual basis regarding 
the current status of the agreement, including information relative to the 
continued benefits and any disadvantages of the agreement.
(2) The information and supporting data that must be submitted to the department 
by hospitals under paragraph (1) of this subsection shall include: 
(A) any proposed change in the cooperative agreement; 
(B) any change in the name or address of the principal business office of each 
party; 
(C) any change in the address of the registered agent or the address of the 
registered office of each party which is a corporation; 
(D) a statement concerning how and why the benefits resulting from the 
cooperative agreement outweigh any disadvantages attributable to a reduction in 
competition resulting from the agreement; 
(E) any change in the geographic territory that is served by the health care 
equipment, facilities, personnel, or services which are subject of the 
cooperative agreement; 
(F) a detailed explanation of the actual effects of the agreement on each party, 
including any change in volume, market share, prices, and revenues;
(G) an explanation of how the cooperative agreement has impacted the ability of 
health care payors to negotiate optimal payment and service arrangements with 
health care providers; and 
(H) a detailed explanation of how the cooperative agreement has affected the 
cost, access, and quality of services provided by each party.
(3) If, at any time following the approval of a cooperative agreement, the 
department determines that there may have been a change in the facts or 
circumstances under which the agreement was approved, the department may require 
the parties to the agreement to submit information required by paragraph (2) of 
this subsection and any other information needed by the department to determine 
whether the benefits of the approved agreement continue to outweigh any 
disadvantages attributable to a reduction in competition resulting from the 
agreement. If requested, the department shall hold a public hearing to solicit 
additional information concerning the effects of the cooperative agreement. 
(4) Following its review of information submitted or received under paragraphs 
(1)-(3) of this subsection, the department shall notify the parties to the 
cooperative agreement whether they are in compliance with the approved 
certificate of public advantage. If the parties are not in compliance with the 
requirements of the certificate, the department shall identify the manner in 
which the parties are out of compliance and shall provide an opportunity for the 
parties to bring the agreement into compliance. 
(5) Hospitals receiving notification that an arrangement is not in compliance 
with the certificate of public advantage have 30 calendar days from their 
respective receipt of the notice in which to respond with additional data or 
rationale concerning the validity of the cooperative agreement. This response 
shall include a proposal and a time schedule by which the hospitals will bring 
the arrangement into compliance with a certificate of public advantage. If the 
arrangement is not in compliance and the department and the hospitals cannot 
agree to the terms of bringing the arrangement into compliance, the matter shall 
be set for a contested case hearing. 
(6) If the department determines that as a result of changed circumstances, the 
benefits from an approved agreement no longer outweigh any disadvantages 
attributable to a reduction in competition resulting from the agreement, the 
department may initiate proceedings to terminate the certificate of public 
advantage. 
(h) Termination. 
(1) The department may terminate a certificate of public advantage in accordance 
with HSC, sec.314.004 and the department's informal hearing procedures in 
Chapter 1 of this title (relating to Board of Health) if: 
(A) the arrangement is not in substantial compliance with the terms of the 
application; 
(B) the arrangement is not in substantial compliance with the conditions of 
approval; 
(C) the arrangement has not achieved and is not likely to substantially achieve 
the improvements in cost, access, or quality identified in the approval order as 
the basis for the department's approval of the arrangement; or 
(D) the conditions in the marketplace have changed to such an extent that 
competition would promote reductions in cost and improvements in access and 
quality to a greater extent than does the arrangement at issue. In order to 
terminate on the basis that conditions in the marketplace have changed, the 
department's order shall identify specific changes in the marketplace and 
articulate why those changes warrant termination. 
(2) The department shall begin a proceeding to terminate approval by providing 
written notice to the applicant describing in detail the basis for the proposed 
termination. 
(3) A proceeding to terminate an approval shall be conducted as a contested case 
proceeding upon the written request of the applicant. Decisions of the 
department in a proceeding to terminate approval are subject to judicial review. 
(4) In deciding whether to terminate an approval, the department shall take into 
account the hardship that the termination may impose on the applicant and any 
potential disruption of the market as a whole. The department shall not 
terminate an approval if the arrangement can be modified, restructured, or 
regulated so as to remedy the problem upon which the termination proceeding is 
based. The applicant may submit proposals for alternatives to termination. An 
approved modified or restructured arrangement is subject to appropriate 
supervision. 
(5) The applicant cannot be held liable under federal or state antitrust laws 
for acts that occurred while the approval was in effect, except to the extent 
that the applicant failed to substantially comply with the terms of its 
application or failed to substantially comply with the terms of the approval. 
The applicant is fully subject to federal and state antitrust laws after the 
termination becomes effective and shall be held liable for acts that occur after 
the termination. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802154
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER E.Waivers
25 TAC sec.133.81
The new section is proposed under the Health and Safety Code, sec.161.132 which 
provides the Texas Board of Health (board) with the authority to adopt rules 
prescribing procedures for the investigation, coordination, and referral of 
reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new section affects the Health and Safety Code, Chapter 241. 

sec.133.81.Waiver Provisions.
(a) Request for a waiver. A hospital may submit a written request to the 
director for a waiver or modification of a particular provision of the Texas 
Hospital Licensing Act (Act) or a minimum standard in this chapter, except fire 
safety requirements. The written request shall specify the section(s) of the Act 
or this chapter for which a waiver is requested. 
(b) Consideration. In considering the waiver or modification request, the 
director shall consider whether the waiver or modification: 
(1) will adversely affect the health and safety of the hospital patients, 
employees, or the general public; 
(2) will adversely impact the hospital's participation in the federal Medicare 
program or accreditation by the Joint Commission on Accreditation of Healthcare 
Organizations or the American Osteopathic Association;
(3) if not granted, would impose an unreasonable hardship on the hospital in 
providing adequate care for patients; 
(4) will facilitate the creation or operation of the hospital; and 
(5) is appropriate when balanced against the best interests of the individuals 
served or to be served by the hospital. 
(c) Supporting documentation. The director may request written documentation 
from the hospital to support the waiver or modification including, but not 
limited to: 
(1) a statement addressing each of the criteria in subsection (b) of this 
section; 
(2) evidence of approval by the local building and fire authorities; 
(3) evidence of provisions in the Act or this chapter which will mitigate any 
adverse effect of the waiver or modification; and
(4) evidence of any mitigating act in excess of the Act or this chapter which 
will be used by the hospital to offset any adverse effect of the waiver or 
modification. 
(d) Written recommendation. The director shall submit his written recommendation 
for granting or denying the waiver to the commissioner of health (commissioner). 
The director's recommendation shall address each of the criteria in subsection 
(b) of this section. 
(e) Granting order. If the director recommends that the waiver or modification 
be granted, the commissioner may issue a written order granting the waiver or 
modification. 
(f) Denial of order. If the director recommends that the waiver or modification 
be denied, the commissioner may issue a written order denying the waiver or 
modification. 
(g) File documentation. The licensing file for the hospital maintained by the 
Texas Department of Health shall contain a copy of the request, the documents 
requested in subsection (c) of this section (if applicable), the written 
recommendation of the director, and the order. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802155
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER F.Inspection and Investigation Procedures
25 TAC sec.133.101, sec.133.102
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.101.Inspection and Investigation Procedures.
(a) Routine inspections. The Texas Department of Health (department) may conduct 
an inspection of each hospital prior to the issuance or renewal of a hospital 
license. 
(1) A hospital is not subject to routine inspections subsequent to the issuance 
of the initial license while the hospital maintains: 
(A) certification under Title XVIII of the Social Security Act, 42 United States 
Code (USC), sec.sec.1395 et seq; or 
(B) accreditation by the Joint Commission on Accreditation of Healthcare 
Organizations or by the American Osteopathic Association. 
(2) The department may conduct an inspection of a hospital exempt from an annual 
licensing inspection under paragraph (1) of this subsection before issuing a 
renewal license to the hospital if the certification or accreditation body has 
not conducted an on-site inspection of the hospital in the preceding three years 
and the department determines that an inspection of the hospital by the 
certification or accreditation body is not scheduled within 60 days. 
(b) Complaint investigations. 
(1) Complaint investigations are conducted if the department finds that 
reasonable cause exists to believe that the hospital has violated provisions of 
the Act, this chapter, special license conditions, or orders of the commissioner 
of health (commissioner). 
(2) Complaints received by the department concerning abuse and neglect, or 
illegal, unprofessional, or unethical conduct will be conducted in accordance 
with sec.133.47(c) of this title (relating to Abuse and Neglect Issues). 
(3) Complaint investigations are coordinated with the federal Health Care 
Financing Administration and its agents responsible for the inspection of 
hospitals to determine compliance with the conditions of participation under 
Title XVIII of the Social Security Act, (42 USC, sec.sec.1395 et seq), so as to 
avoid duplicate investigations. 
(4) Complaint investigations are generally unannounced.
(c) Reinspection. 
(1) Reinspections may be conducted by the department if a hospital applies for 
the reissuance of its license after the suspension or revocation of the 
hospital's license, the assessment of administrative or civil penalties, or the 
issuance of an injunction against the hospital for violations of the Act, this 
chapter, a special license condition, or an order of the commissioner. 
(2) A reinspection may be conducted to ascertain compliance with either health 
or construction requirements or both. 
(d) General. 
(1) The department may make any inspection, survey, or investigation that it 
considers necessary. A representative of the department may enter the premises 
of a hospital at any reasonable time to make an inspection or an investigation 
to ensure compliance with or prevent a violation of the Act, the rules adopted 
under the Act, an order or special order of the commissioner, a special license 
provision, a court order granting injunctive relief, or other enforcement 
procedures. Ensuring compliance includes permitting photocopying of any records 
or other information by or on behalf of the department as necessary to determine 
or verify compliance with the statute or rules adopted under the statute. 
(2) The department or a representative of the department is entitled to access 
to all books, records, or other documents maintained by or on behalf of the 
hospital to the extent necessary to enforce the Act, this chapter, an order or 
special order of the commissioner, a special license provision, a court order 
granting injunctive relief, or other enforcement procedures. The department 
shall maintain the confidentiality of hospital records as applicable under 
federal or state law. 
(3) By applying for or holding a hospital license, the hospital consents to 
entry and inspection or investigation of the hospital by the department or a 
representative of the department in accordance with the Act and this chapter. 
(e) Inspection and investigation protocol. 
(1) The department surveyor(s) shall hold a conference with the hospital 
administrator or designee before beginning the on-site inspection or 
investigation to explain the nature, scope, and estimated time schedule of the 
inspection or investigation. 
(2) Department surveyor(s) may conduct interviews with any person with knowledge 
of the facts. 
(3) The department surveyor(s) shall inform the hospital administrator or 
designee of the preliminary findings of the inspection or investigation and 
shall give the person a reasonable opportunity to submit additional facts or 
other information to the department's authorized representative in response to 
those findings. 
(4) Following an inspection or investigation of a hospital by the department, 
the department surveyor(s) shall hold an exit conference with the hospital 
administrator or designee and other invited staff and provide the following to 
the hospital administrator or designee: 
(A) the specific nature of the inspection or investigation;
(B) any alleged violations of a specific statute or rule;
(C) identity of any records that were duplicated; 
(D) the specific nature of any finding regarding an alleged violation or 
deficiency; 
(E) if the deficiency is alleged, the severity of the deficiency; and 
(F) if there are no deficiencies found, a statement indicating this fact. 
(5) If deficiencies are cited, the department surveyor(s) shall obtain either at 
the time of the exit conference or within 10 days of the hospital's receipt of 
the statement of deficiencies a plan of correction which is provided by the 
hospital and indicates the date(s) by which correction(s) will be made and any 
other written comments, if any, by the hospital administrator or designee 
concerning the inspection or investigation. Additional facts, written comments, 
or other information provided by the hospital in response to the findings shall 
be made a part of the record of the inspection or investigation for all 
purposes. 
(6) The department surveyor(s) shall obtain the signature of the hospital 
administrator or designee acknowledging the receipt of the statement of 
deficiencies and plan of correction form. 
(7) The department surveyor(s) shall inform the administrator or designee of the 
hospital's right to an informal administrative review when there is disagreement 
with the surveyor's findings and recommendations or when additional information 
bearing on the findings is available. 
(8) If deficiencies are cited and the plan of correction is not acceptable, the 
department shall notify the hospital in writing and request that the plan of 
correction be resubmitted within 10 calendar days of the hospital's receipt of 
the department's written notice. Upon resubmission of an acceptable plan of 
correction, written notice shall be sent by the department to the hospital 
acknowledging same. 
(9) Responses to the department may be submitted by facsimile.
(10) The hospital shall come into compliance by the completion date provided on 
the statement of deficiencies and plan of correction form.
(11) The department shall verify the correction of deficiencies either by mail 
or by an on-site inspection or investigation. 
(12) Acceptance of a plan of correction does not preclude the department from 
taking enforcement action under sec.133.121 of this title (relating to 
Enforcement Action) or under sec.133.122 of this title (relating to 
Administrative Penalty). 
(f) Release of information by the department. 
(1) Upon written request, the department shall provide information on the 
identity, including the signature, of each department representative conducting, 
reviewing, or approving the results of the inspection or investigation, and the 
date on which the department representative acted on the matter.
(2) Upon written request, the department shall release inspection documents in 
accordance with state and federal law. 

sec.133.102.Complaint Against a Texas Department of Health Surveyor.
(a) A hospital may register a complaint against a Texas Department of Health 
surveyor who conducts an inspection or investigation in accordance with 
sec.133.101 of this title (relating to Inspection and Investigation Procedures). 
(b) A complaint against a surveyor shall be registered with the Health Facility 
Compliance Division, Texas Department of Health, 1100 West 49th Street, Austin, 
Texas 78756-3199, telephone (512) 834-6650 or (800) 228-1570. 
(1) A complaint against a surveyor which is received by telephone will be 
referred within two working days to the appropriate supervisor. The caller will 
be requested to submit the complaint in writing. 
(2) When a complaint is received in writing, it will be forwarded to the 
appropriate supervisor within two working days. Within 10 calendar days of 
receipt of the complaint, the Health Facility Compliance Division or the Health 
Facility Licensing Division will inform the complainant in writing that the 
complaint has been forwarded to the appropriate supervisor.
(3) Within 10 calendar days of the supervisor's receipt of the complaint, the 
supervisor will notify the complainant in writing that an investigation will be 
done. 
(4) The supervisor will review the documentation in the survey packet and 
interview the surveyor identified in the complaint to obtain facts and assess 
the objectivity of the surveyor in the surveyor's application of this chapter 
during the hospital's inspection or investigation. 
(5) The supervisor will review the applicable rules, personnel policies, and 
review the training and qualifications of the surveyor as it relates to the 
inspection or investigation. 
(6) The supervisor will document the investigation. A report of the 
investigation will be placed in the hospital's file if the complaint and 
investigation affected the inspection process. A counseling form will be used 
and placed in the surveyor's personnel file if the complaint relates to 
personnel performance. 
(7) The supervisor shall offer to meet with the complainant to resolve the 
issue. The surveyor identified in the complaint will participate in the 
discussion. The resolution meeting may be conducted at the division's office or 
during an on-site follow-up visit to the hospital. 
(8) Changes and deletions will be made to the inspection report, if necessary. 
(9) The supervisor will notify the complainant in writing of the status of the 
investigation within 30 calendar days of the date the supervisor received the 
complaint. 
(10) The supervisor will forward all final documentation to the director or the 
Health Facility Compliance Division director and notify the complainant of the 
results. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802156
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER G.Enforcement
25 TAC sec.133.121, sec.133.122
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.121.Enforcement Action.
(a) Reasons for enforcement action. 
(1) The Texas Department of Health (department) may deny, suspend, or revoke a 
hospital's license in accordance with Health and Safety Code (HSC), sec.241.053 
if the applicant or licensee: 
(A) fails to comply with any provision of the Act; 
(B) fails to comply with any provision of this chapter; 
(C) fails to comply with a special license condition; 
(D) fails to comply with an order of the commissioner of health (commissioner) 
or another enforcement procedure under the statute; 
(E) has a history of noncompliance with the rules adopted under this chapter 
relating to patient health, safety, and rights which reflects more than nominal 
noncompliance; 
(F) has aided, abetted or permitted the commission of an illegal act; 
(G) fails to provide the required application or renewal information; or 
(H) fails to pay administrative penalties in accordance with the Act. 
(2) The department may suspend or revoke an existing valid license or disqualify 
a person from receiving a license because of a person's conviction of a felony 
or misdemeanor if the crime directly relates to the duties and responsibilities 
of the ownership or operation of a hospital.
(A) In determining whether a criminal conviction directly relates, the 
department shall consider the provisions of Texas Civil Statutes (TCS), Article 
6252-13c. 
(B) The following felonies and misdemeanors directly relate because these 
criminal offenses indicate an ability or a tendency for the person to be unable 
to own or operate a hospital: 
(i) a misdemeanor violation of the statute; 
(ii) a misdemeanor or felony involving moral turpitude; 
(iii) a conviction relating to deceptive business practices;
(iv) a misdemeanor of practicing any health-related profession without a 
required license; 
(v) a conviction under any federal or state law relating to drugs, dangerous 
drugs, or controlled substances; 
(vi) an offense under the Texas Penal Code (TPC), Title 5, involving a patient 
or a client of any health care facility, a home and community support services 
agency or a health care professional; 
(vii) a misdemeanor or felony offense under various titles of the TPC, as 
follows: 
(I) Title 5 concerning offenses against the person; 
(II) Title 7 concerning offenses against property; 
(III) Title 9 concerning offenses against public order and decency; 
(IV) Title 10 concerning offenses against public health, safety, and morals; or 
(V) Title 4 concerning offenses of attempting or conspiring to commit any of the 
offenses in this subsection; and 
(viii) other misdemeanors and felonies which indicate an inability or tendency 
for the person to be unable to own or operate a hospital if action by the 
department will promote the intent of the Act, this chapter, or TCS, Article 
6252-13c. 
(C) Upon a licensee's felony conviction, felony probation revocation, revocation 
of parole, or revocation of mandatory supervision, the license shall be revoked. 
(b) Notification and opportunity for hearing. If the department proposes to 
deny, suspend, or revoke a license, the department shall notify the applicant or 
the hospital by certified mail, return receipt requested, or personal delivery 
of the reasons for the proposed action and offer the applicant or hospital an 
opportunity for a hearing. 
(1) The applicant or hospital shall request a hearing within 15 calendar days of 
receipt of the notice. Receipt of the notice is presumed to occur on the tenth 
day after the notice is mailed to the last address known to the department 
unless another date is reflected on a United States Postal Service return 
receipt. 
(2) The request for a hearing shall be in writing and submitted to the Hospital 
Licensing Director, Health Facility Licensing Division, Texas Department of 
Health, 1100 West 49th Street, Austin, Texas 78756-3199.
(3) A hearing shall be conducted pursuant to the Administrative Procedure Act, 
Texas Government Code, Chapter 2001, and the department's formal hearing 
procedures in Chapter 1 of this title (relating to Texas Board of Health). 
(4) If the applicant or hospital does not request a hearing, in writing, within 
15 calendar days of receipt of the notice, the applicant or hospital is deemed 
to have waived the opportunity for a hearing, and the proposed action shall be 
taken. 
(5) If the applicant or hospital fails to appear or be represented at the 
scheduled hearing, the applicant or hospital has waived the right to a hearing 
and the proposed action shall be taken. 
(c) Emergency order. Following notice to the hospital and opportunity for 
hearing, the commissioner or a person designated by the commissioner may issue 
an emergency order, either mandatory or prohibitory in nature, in relation to 
the operation of a hospital if the commissioner or the commissioner's designee 
determines that the hospital is violating or threatening to violate the Act, 
this chapter, a special licensing provision, injunctive relief, an order of the 
commissioner or the commissioner's designee, or another enforcement procedure 
permitted under the Act and the provision, rule, license provision, injunctive 
relief, order, or enforcement procedure relates to the health or safety of the 
hospital's patients in accordance with HSC sec.241.0531. 
(d) License suspension. If the department suspends a license, the suspension 
shall remain in effect until the department determines that the reason for 
suspension no longer exists. An authorized representative of the department 
shall conduct an investigation prior to making a determination.
(1) During the time of suspension, the suspended license holder shall return the 
license to the department. 
(2) If a suspension overlaps a renewal date, the suspended license holder shall 
comply with the renewal procedures in this chapter; however, the department may 
not renew the license until the department determines the reason for suspension 
no longer exists. 
(e) Revocation or nonrenewal. 
(1) If the department revokes or does not renew a license, a person may reapply 
for a license by complying with the requirements and procedures in this chapter 
at the time of reapplication. 
(2) The department may refuse to issue a license if the reason for revocation or 
nonrenewal continues to exist. 
(3) Upon revocation or nonrenewal, a license holder shall return the license to 
the department. 

sec.133.122.Administrative Penalty.
(a) The department may assess an administrative penalty against a hospital that 
violates the Act, this chapter, a special license provision, an order or 
emergency order issued by the commissioner of health or the commissioner's 
designee, or another enforcement procedure permitted under the Act in accordance 
with Health and Safety Code (HSC), sec.241.059. 
(b) The department may assess an administrative penalty against a person 
licensed or regulated under the Act who violates the Act or this chapter 
relating to the provision of mental health, chemical dependency, or 
rehabilitation services in accordance with HSC, sec.241.060. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802157
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER H.Fire Prevention and Safety Requirements
25 TAC sec.sec.133.141-133.143
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.141.Fire Prevention and Protection.
(a) Fire inspections. 
(1) Annual inspection. Approval of the fire protection of a hospital by the 
local fire department shall be a prerequisite for licensure.
(2) Purpose of inspection. The purpose of these inspections shall be to 
ascertain and to cause to be corrected any conditions liable to cause fire or 
violations of any of the provisions or intent of these rules, or of any other 
applicable ordinances, which affect fire safety in any way.
(3) Hazardous or dangerous conditions or materials. Whenever any of the 
officers, members, or inspectors of the fire department or bureau of fire 
prevention find in any building or upon any premises dangerous or hazardous 
conditions or materials, removal or remedy of dangerous conditions or materials 
shall be carried out in a manner specified by the head of the local fire 
department. 
(4) Access for inspection. At all reasonable hours, the chief of the fire 
department, the chief of the bureau of fire prevention, or any of the fire 
inspectors may enter any building or premises for the purpose of making an 
inspection or investigation which may be deemed necessary under the provisions 
of these rules. 
(b) Fire reporting. All occurrences of fire shall be reported to the local fire 
authority and shall be reported in writing to the hospital licensing director as 
soon as possible but not later than 10 calendar days following the occurrence. 
(c) Fire protection. Fire protection shall be provided in accordance with the 
requirements of National Fire Protection Association 101, Code for Safety to 
Life from Fire in Buildings and Structures, 1997 edition (NFPA 101), sec.12-7, 
and sec.133.161(a)(1) and (2) of this title (relating to Requirements for 
Buildings in which Existing Licensed Hospitals are Located), and 
sec.133.162(a)(1) and (d) of this title (relating to New Construction 
Requirements). When required or installed, sprinkler systems for exterior fire 
exposures shall comply with National Fire Protection Association 80A, 
Recommended Practice for Protection of Buildings from Exterior Fire Exposures, 
1996 edition. All documents published by NFPA as referenced in this section may 
be obtained by writing or calling the NFPA at the following address or telephone 
number: National Fire Protection Association, 1 Batterymarch Park, Post Office 
Box 9101, Quincy, MA 02269-9101 or (800) 344-3555. 
(d) Smoking rules. Each hospital shall adopt, implement and enforce a smoking 
policy. The policy shall include the minimal provisions of NFPA 101, sec.12-7.4. 
(e) Fire extinguishing systems. Inspection, testing, and maintenance of fire-
fighting equipment shall be conducted by each hospital. 
(1) Water-based fire protection systems. All fire sprinkler systems, fire pumps, 
fire standpipe and hose systems, water storage tanks, and valves and fire 
department connections shall be inspected, tested and maintained in accordance 
with National Fire Protection Association 25, Standard for the Inspection, 
Testing and Maintenance of Water-Based Fire Protection Systems, 1995 edition. 
(2) Range hood extinguishers. Fire extinguishing systems for commercial cooking 
equipment, such as at range hoods, shall be inspected and maintained in 
accordance with National Fire Protection Association 96, Standard for 
Ventilation Control and Fire Protection of Cooking Operations, 1994 edition. 
(3) Portable fire extinguishers. Every portable fire extinguisher located in a 
hospital or upon hospital property shall be installed, tagged, and maintained in 
accordance with National Fire Protection Association 10, Standard for Portable 
Fire Extinguishers, 1994 edition. 
(f) Fire protection and evacuation plan. A plan for the protection of patients 
in the event of fire and their evacuation from the building when necessary shall 
be formulated according to NFPA 101, sec.12-7. Copies of the plan shall be 
available to all staff. 
(1) Posting requirements. An evacuation floor plan shall be prominently and 
conspicuously posted for display throughout the hospital in public areas that 
are readily visible to patients, residents, employees, and visitors. 
(2) Annual training. Each hospital shall conduct an annual training program for 
instruction of all personnel in the location and use of fire-fighting equipment. 
All employees shall be instructed regarding their duties under the fire 
protection and evacuation plan. 
(g) Fire drills. The hospital shall conduct at least 12 fire drills each year, 
one fire drill per shift per quarter, which shall include communication of 
alarms, simulation of evacuation of patients and other occupants, and use of 
fire-fighting equipment. 
(h) Fire alarm system. Every hospital and building used for patient care shall 
have an approved fire alarm system. Each fire alarm system shall be installed 
and tested as required by National Fire Protection Association 72, National Fire 
Alarm Code, 1996 edition, NFPA 101, sec.12-3.4, and the requirements of 
sec.133.162(d)(5)(N) of this title (relating to New Construction Requirements). 
(i) System for communicating an alarm of fire. A reliable communication system 
shall be provided as a means of reporting a fire to the fire department. This is 
in addition to the automatic alarm transmission to the fire department required 
by NFPA 101, sec.12-3.4.3.2. 
(j) Fire department access. As an aid to fire department services, every 
hospital shall provide the following. 
(1) Driveways. The hospital shall maintain driveways, free from all 
obstructions, to main buildings for fire department apparatus use.
(2) Submission of plans. Upon request, the hospital shall submit a copy of the 
floor plans of the building to the local fire department officials. 
(3) Outside identification. The hospital shall place proper identification on 
the outside of the main building showing the locations of siamese connections 
and standpipes as required by the local fire department services. 
(k) Fire department protection. When a hospital is located outside of the 
service area or range of the public fire protection, arrangements shall be made 
to have the nearest fire department respond in case of a fire.

sec.133.142.General Safety.
(a) Safety committee. Each hospital shall have a multi-disciplinary safety 
committee. The hospital chief executive officer (CEO) shall appoint the chairman 
and members of the safety committee. 
(1) Safety officer. The CEO shall appoint a safety officer who is knowledgeable 
in safety practices in health care facilities. The safety officer shall be a 
member of the safety committee, and shall carry out the functions of the safety 
program. 
(2) Safety committee meetings. The safety committee shall meet as required by 
the chairman, but not less than quarterly. Written minutes of each meeting shall 
be retained for at least one year. 
(3) Safety activities. 
(A) Incident reports. The safety committee shall establish an incident reporting 
system which includes a mechanism to ensure that all incidents recorded in 
safety committee minutes are evaluated, and documentation is provided to show 
follow-up and corrective actions. 
(B) Safety policies and procedures. Safety policies and procedures for each 
department or service shall be developed, implemented and enforced.
(C) Safety training and continuing education. Safety training shall be 
established as part of new employee orientation and in the continuing education 
of all employees. 
(4) Written authority. The authority of the safety committee to take action when 
conditions exist that are a possible threat to life, health, or building damage, 
shall be defined in writing and approved by the governing body. 
(b) Safety manual. Each department or service shall have a safety policy and 
procedure manual within their own area that becomes a part of the overall 
facility safety manual. 
(c) Emergency preparedness. 
(1) Disaster management. Each hospital shall develop plans for effective 
preparedness, mitigation, response, and recovery from disasters.
(2) Disaster plans. National Fire Protection Association 99, Standard for Health 
Care Facilities, 1996 edition, Chapter 11, and the State of Texas Emergency 
Management Plan shall be used as references to plan and establish the disaster 
plans. All documents published by National Fire Protection Association (NFPA) as 
referenced in this section may be obtained by writing or calling the NFPA at the 
following address or telephone number: National Fire Protection Association, 1 
Batterymarch Park, Post Office Box 9101, Quincy, MA 02269-9101 or (800) 344-
3555. Information regarding the State of Texas Emergency Management Plan is 
available from the city or county emergency management coordinator. 
(3) Annual rehearsal. The hospital shall practice the disaster plans at least 
one time per year and shall document the rehearsal of the plans. Documentation 
of rehearsals for the last three years shall be retained. 
(d) Emergency communication system. An emergency communication system shall be 
provided in each facility. The system shall be self-sufficient and capable of 
operating without reliance on the building's service or emergency power supply. 
Such system shall have the capability of communicating with the available 
community or state emergency networks, including police and fire departments. 

sec.133.143.Handling and Storage of Gases, Anesthetics, and Flammable Liquids.
(a) Flammable germicides. Flammable germicides shall not be used for 
preoperative preparation of the surgical field. 
(b) Flammable and nonflammable gases and liquids. Flammability of liquids and 
gases shall be determined by National Fire Protection Association 325, Guide to 
Fire Hazard Properties of Flammable Liquids, Gases, and Volatile Solids, 1994 
edition. All documents published by National Fire Protection Association (NFPA) 
as referenced in this section may be obtained by writing or calling the NFPA at 
the following address or telephone number: National Fire Protection Association, 
1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800) 344-3555. 
(1) Nonflammable gases (examples include, but are not limited to, oxygen and 
nitrous oxide) shall be stored and distributed in accordance with Chapter 4 of 
the National Fire Protection Association 99, Standard for Health Care 
Facilities, 1996 edition (NFPA 99). 
(A) Medical gases and liquefied medical gases shall be handled in accordance 
with the requirements of NFPA 99, Chapter 8. 
(B) Oxygen shall be administered in accordance with NFPA 99, sec.8-6. 
(2) Piped flammable gas systems intended for use in laboratories and piping 
systems for fuel gases shall comply with requirements of NFPA 99, sec.4-6. 
(3) Flammable gases shall be stored in accordance with NFPA 99, sec.4-6.1.1. 
(4) Flammable and combustible liquids used in laboratories shall be handled and 
stored in accordance with NFPA 99, sec.10-7, and National Fire Protection 
Association 101, Code for Safety to Life from Fire in Buildings and Structures, 
1997 edition, sec.12-3.2. 
(5) Other flammable agents shall be stored in accordance with NFPA 99, Chapter 
6. 
(c) Gasoline and gasoline powered equipment. No motor vehicles including 
gasoline powered standby generators or any amount of gasoline shall be located 
within the hospital building. Other devices which may cause or communicate fire, 
and which are not necessary for patient treatment or care, shall not be stored 
within the hospital building. All such devices and materials which are necessary 
shall be used within the building only with precautions which ensure a 
reasonable degree of safety from fire. 
(d) Gas fired appliances. The installation, use and maintenance of gas fired 
appliances and gas piping installations shall comply with the National Fire 
Protection Association 54, National Fuel Gas Code, 1996 edition. The use of 
portable gas heaters and unvented open flame heaters is specifically prohibited. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802158
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

SUBCHAPTER I.Physical Plant and Construction Requirements
25 TAC sec.sec.133.161-133.169
The new sections are proposed under the Health and Safety Code, sec.161.132 
which provides the Texas Board of Health (board) with the authority to adopt 
rules prescribing procedures for the investigation, coordination, and referral 
of reports of concerning abuse and neglect or of illegal, unprofessional or 
unethical conduct in hospitals; sec.222.026 which provides the board with the 
authority to adopt rules concerning a procedure for the acceptance and timely 
review of complaints received from hospitals concerning the objectivity, 
training, and qualifications of the persons conducting the inspection; 
sec.241.026 which provides the board with the authority to adopt rules 
concerning hospital staffing, services, fire prevention, safety and sanitation, 
patient care, patient bill of rights, and compliance with other state and 
federal laws affecting the health, safety, and rights of hospital patients; 
sec.241.027 which provides authority for the board to adopt rules to govern the 
transfer of patients between hospitals; sec.241.104 which provides authority for 
the board to adopt fees for hospital plans reviews and construction inspections; 
sec.241.123 which provides authority for the board to adopt standards for the 
provision of rehabilitation services; sec.313.008 which provides the board with 
the authority to adopt rules concerning cooperative agreements; sec.321.002 
which provides the board with the authority to adopt rules concerning patient 
bill of rights to protect the health, safety, and rights of a patient receiving 
voluntary or involuntary mental health, chemical dependency, or comprehensive 
medical rehabilitation services; and sec.12.001 which provides the board with 
the authority to adopt rules for the performance of every duty imposed by law 
upon the board, the department, and the commissioner of health. 
The new sections affect the Health and Safety Code, Chapter 241. 

sec.133.161. Requirements for Buildings in which Existing Licensed Hospitals are 
Located. 
(a) Compliance. All buildings in which existing hospitals licensed by the Texas 
Department of Health (department) are located shall comply with this subsection. 
(1) Minimum fire safety and construction requirements. 
(A) Existing licensed hospitals shall meet the requirements for health care 
occupancies contained in the 1967, 1973, 1981, 1985, 1991 or 1997 editions of 
the National Fire Protection Association 101, Code for Safety to Life from Fire 
in Buildings and Structures, (NFPA 101), the Hospital Licensing Standards (1969 
or 1985 editions as amended), and the hospital licensing rules under which the 
buildings or sections of buildings were constructed. All documents published by 
NFPA as referenced in this section may be obtained by writing or calling the 
NFPA at the following address or telephone number: National Fire Protection 
Association, 1 Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800) 
344-3555. 
(B) Existing hospitals or portions of existing hospitals constructed prior to 
the adoption of any of the editions of NFPA 101, the Hospital Licensing 
Standards, and the hospital licensing rules listed in subparagraph (A) of this 
paragraph, shall comply with this section and Chapter 13, NFPA 101, 1997 
edition. 
(C) Compliance with the requirements of Chapter 3 of the National Fire 
Protection Association 101A, Alternative Approaches to Life Safety, 1995 
edition, (relating to Fire Safety Evaluation System for Health Care Occupancies) 
will be acceptable in lieu of complying with the requirements of NFPA 101, 
Chapter 13. 
(2) Seclusion room. When mental health services are offered in an existing 
hospital for inpatients, seclusion room(s) meeting the requirements of 
sec.133.163(p)(1)(B)(viii)(I) of this title (relating to Hospital Spatial 
Requirements) shall be provided. 
(3) Remodeling of existing facilities. All requirements listed in this chapter 
relating to new construction are applicable to renovations, additions and 
alterations unless stated otherwise. 
(A) Alteration or installation of new equipment. Any alteration or any 
installation of new equipment shall be accomplished as nearly as practicable 
with the requirements for new construction, except that when existing conditions 
make changes impractical to accomplish, minor deviations from functional 
requirements may be permitted if the intent of the requirements is met and if 
the care and safety of patients will not be jeopardized. 
(B) Installation, alteration, or extension approval. No new system of 
mechanical, electrical, plumbing, fire protection, or piped medical gas system 
may be installed or any such existing system may be replaced, materially altered 
or extended in an existing building licensed as a hospital, until complete plans 
and specifications for the replacement, installation, alteration, or extension 
have been submitted to the department, reviewed and approved in accordance with 
sec.133.167 of this title (relating to Preparation, Submittal, Review and 
Approval of Plans). 
(C) Minor remodeling or alterations. All remodeling or alterations which do not 
involve alterations to load bearing members or partitions, change functional 
operation, affect fire safety, add or subtract beds or services for which the 
hospital is licensed, and do not involve changes listed in subparagraph (B) of 
this paragraph, shall be submitted for approval without submitting contract 
documents. Such approval shall be requested in writing with a brief description 
of the proposed changes and accompanied by plans or sketches of the area being 
remodeled. 
(D) Major remodeling or alterations. Plans shall be submitted in accordance with 
sec.133.167 of this title for all major remodeling or alterations. All 
remodeling or alterations which involve alterations to load bearing members or 
partitions, change functional operation, affect fire safety, or add beds or 
services over those for which the hospital is licensed are considered as major 
remodeling and alterations. 
(E) Phasing of construction in existing facilities. Projects involving 
alterations of and additions to existing buildings shall be programmed and 
phased so that on-site construction will minimize disruptions of existing 
functions. Access, exit access, and fire protection shall be maintained so that 
the safety of the occupants will not be jeopardized during construction. Dust 
and vapor barriers shall be provided to separate areas undergoing demolition and 
construction from occupied areas. Temporary sound barriers shall be provided 
where intense prolonged construction noises will disturb patients or staff in 
the occupied portions of the building. 
(F) Nonconforming conditions. When doing renovation work, if it is found to be 
infeasible to correct all of the nonconforming conditions in the existing 
hospital in accordance with these rules, a conditional approval may be granted 
by the department if the operation of the hospital, necessary access by the 
handicapped, and safety of the patients are not jeopardized by the nonconforming 
condition. 
(b) Previously licensed hospitals. Buildings which have been licensed previously 
as hospitals but have been vacated or used for purposes other than as hospitals 
and which are not in compliance with the 1967, 1973, 1981, 1985, 1991 or 1997 
editions of the NFPA 101, the Hospital Licensing Standards (1969 or 1985 
editions as amended), and hospital licensing rules under which the building or 
sections of buildings were constructed shall comply with the requirements of 
sec.133.162 of this title (relating to New Construction Requirements), 
sec.133.163 of this title, sec.133.165 of this title (relating to Building with 
Multiple Occupancies), sec.133.167 of this title, and sec.133.168 of this title 
(relating to Record Drawings, Manuals and Design Data), inclusively.

sec.133.162. New Construction Requirements.
(a) Hospital location. Any proposed new hospital shall be easily accessible to 
the community and to service vehicles such as delivery trucks, ambulances, and 
fire protection apparatus. No building may be converted for use as a hospital 
which, because of its location, physical condition, state of repair, or 
arrangement of facilities, would be hazardous to the health and safety of the 
patients. 
(1) Hazardous locations. 
(A) Underground and above ground hazards. New hospitals or additions to existing 
hospitals shall not be constructed near hazardous locations including but not 
limited to underground liquid butane or propane, liquid petroleum or natural gas 
transmission lines, high pressure lines, and not under high voltage electrical 
lines. 
(B) Fire hazards. New hospitals shall not be built within 300 feet of above 
ground or underground storage tanks containing liquid petroleum or other 
flammable liquids used in connection with a bulk plant, marine terminal, 
aircraft refueling, bottling plant of a liquefied petroleum gas installation, or 
near other hazardous or hazard producing plants. 
(2) Undesirable locations. 
(A) Nuisance producing sites. New hospitals shall not be located near nuisance 
producing industrial sites, feed lots, sanitary landfills, or manufacturing 
plants producing excessive noise or air pollution. 
(B) Cemeteries. New hospitals shall not be located near a cemetery in a manner 
that allows direct view of the cemetery from patient windows. 
(C) Flood plains. Construction of new hospitals shall be avoided in designated 
flood plains. Where such is unavoidable, access and required functional hospital 
components shall be constructed above the designated flood plain. This 
requirement also applies to new additions to existing hospitals and facilities 
or portions of facilities which have been licensed previously as hospitals but 
which have been vacated or used for purposes other than hospitals. This 
requirement does not apply to remodeling of existing licensed hospitals.
(D) Airports. Construction of new hospitals shall be avoided in close proximity 
to airports. When hospitals are proposed to be located near airports, 
recommendations of the Texas Aviation Authority and the Federal Aviation 
Authority shall apply. A hospital may not be constructed within a rectangular 
area formed by lines perpendicular to and two miles (10,560 feet) from each end 
of any runway and by lines parallel to and one-half mile (2,640 feet) from each 
side of any runway. 
(b) Environmental considerations. Development of a hospital site and hospital 
construction shall be governed by state and local regulations and requirements 
with respect to the effect of noise and traffic on the community and the 
environmental impact on air and water. 
(c) Hospital site. 
(1) Paved roads and walkways. Paved roads shall be provided within the lot lines 
to provide access from public roads to the main entrance, emergency entrance, 
entrances serving community activities, and to service entrances, including 
loading and unloading docks for delivery trucks. 
(A) Emergency entrance. Hospitals having an organized emergency services 
department shall have the emergency entrance well marked to facilitate entry 
from the public roads or streets serving the site. 
(B) Access to emergency department. Access to the emergency entrance shall not 
conflict with other vehicular traffic or pedestrian traffic and shall be located 
so as not to be compromised by floods. 
(C) Pedestrian traffic. Finished surface walkways shall be provided for 
pedestrians. 
(2) Parking. Off-street parking shall be available for visitors, employees, and 
staff. Parking structures directly accessible from a hospital shall comply with 
National Fire Protection Association 88A, Standard for Parking Structures, 1995 
edition. This requirement does not apply to freestanding parking structures. All 
documents published by National Fire Protection Association (NFPA) as referenced 
in this section may be obtained by writing or calling the NFPA at the following 
address or telephone number: National Fire Protection Association, 1 
Batterymarch Park, P.O. Box 9101, Quincy, MA 02269-9101 or (800) 344-3555. 
(A) Number of parking places. In the absence of a formal parking study, one 
parking space shall be provided for each day shift employee plus one space for 
each patient bed. This ratio may be reduced in an area convenient to a public 
transportation system or to public parking facilities on the basis of a formal 
parking study. Parking facilities shall be increased accordingly when the size 
of existing facilities is increased. 
(B) Additional parking. Additional parking shall be required to accommodate 
medical staff, outpatient and other services when such services are provided. 
(C) Emergency and delivery parking. Separate parking facilities shall be 
provided for emergency and delivery vehicles. 
(D) Handicapped parking. Parking spaces for handicapped persons shall be 
provided in accordance with the Texas Accessibility Standards of the 
Architectural Barriers Act, Texas Civil Statutes, Article 9102, administered by 
the Texas Department of Licensing and Regulation (TDLR). 
(d) Building design and construction requirements. Every building and every 
portion thereof shall be designed and constructed to sustain all dead and live 
loads in accordance with accepted engineering practices and standards and the 
local governing building codes. Where there is no local governing building code, 
one of the following codes shall be adhered to: Uniform Building Code, 1997 
edition, published by the International Conference of Building Officials, 5360 
Workman Mill Road, Whittier, California 90601, telephone (562) 699-0541; or the 
Standard Building Code, 1997 edition, published by the Southern Building Code 
Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-
1206, telephone (205) 591-1853. 
(1) General architectural requirements. All new construction, including 
conversion of an existing building to a hospital, and establishing a separately 
licensed hospital in a building with an existing licensed hospital, shall comply 
with Chapter 12 of the National Fire Protection Association 101, Code for Safety 
to Life from Fire in Buildings and Structures, 1997 edition (NFPA 101), and 
subchapters H and I of this chapter (relating to Fire Prevention and Safety 
Requirements, and Physical Plant and Construction Requirements, respectively). 
(A) Special design provisions. Special provisions shall be made in the design of 
a hospital in regions where local experience shows loss of life or extensive 
damage to buildings resulting from hurricanes, tornadoes, or floods. 
(B) Foundations. Foundations shall rest on natural solid bearing if satisfactory 
bearing is available. Proper soil-bearing values shall be established in 
accordance with recognized requirements. If solid bearing is not encountered at 
practical depths, the structure shall be supported on driven piles or drilled 
piers designed to support the intended load without detrimental settlement, 
except that one-story buildings may rest on a fill designed by a soils engineer. 
When engineered fill is used, site preparation and placement of fill shall be 
done under the direct full-time supervision of the soils engineer. The soils 
engineer shall issue a final report on the compacted fill operation and 
certification of compliance with the job specifications. All footings shall 
extend to a depth not less than one foot below the estimated maximum frost line. 
(C) Physical environment. A physical environment that protects the health and 
safety of patients, personnel, and the public shall be provided in each 
hospital. The physical premises of the hospital and those areas of the 
hospital's physical structure that are used by the patients (including all 
stairwells, corridors, and passageways) shall meet the local building and fire 
safety codes and subchapters H and I of this chapter. 
(D) Construction type. A hospital may occupy an entire building or portion of a 
building, provided the entire building complies with new construction 
requirements (type of construction permitted for hospitals by NFPA 101, sec.12-
1.6.2), and the entire building is protected with a fire sprinkler system 
conforming with requirements of National Fire Protection Association 13, 
Standard for the Installation of Sprinkler Systems, 1996 Edition (NFPA 13). 
(E) Separate buildings. Portions of a building divided horizontally with four-
hour fire rated walls which are continuous (without offsets) from the foundation 
to above the roof shall be considered as a separate building. Only communicating 
openings are permitted in the dividing fire barriers which shall occur only in 
corridors and shall be protected by three-hour, Class A fire doors. 
(F) Design for the handicapped. Special considerations benefitting handicapped 
staff, visitors, and patients shall be provided. 
(i) A hospital shall be designed in accordance with the Texas Accessibility 
Standards of the Architectural Barriers Act, Texas Civil Statutes, Article 9102. 
Plans shall be submitted to the TDLR in accordance with 16 Texas Administrative 
Code, Chapter 68. Proof of submittal to TDLR shall be submitted to the Texas 
Department of Health (department) by the architect. Any waiver of accessibility 
standards by TDLR must be approved by the department. 
(ii) Each hospital shall comply with the Americans with Disabilities Act of 
1990, Public Law 101-336, 42 United States Code, Chapter 126, and Title 36 Code 
of Federal Regulations, Part 1191, Appendix A, Accessibility Guidelines for 
Buildings and Facilities. 
(G) Other regulations. Certain projects may be subject to other regulations, 
including those of federal, state, and local authorities. The more stringent 
standard or requirement shall apply when a difference in requirements for 
construction exists. 
(H) Exceeding minimum requirements. Nothing in this subchapter shall be 
construed to prohibit a better type of building construction, more exits, or 
otherwise safer conditions than the minimum requirements specified in this 
subchapter. 
(I) Equivalency. Nothing in this subchapter is intended to prevent the use of 
systems, methods, or devices of equivalent or superior quality, strength, fire 
resistance, effectiveness, durability, and safety to those prescribed by this 
subchapter, providing technical documentation which demonstrates equivalency is 
submitted to the department for approval.
(J) Freestanding buildings (not for patient use). Separate freestanding 
buildings for nonpatient use such as the heating plant, boiler plant, laundry, 
repair workshops, or general storage may be of unprotected non-combustible 
construction, protected non-combustible construction, or fire-resistive 
construction and be designed in accordance with other occupancy classifications 
requirements listed in NFPA 101. 
(K) Freestanding buildings (for patient use other than sleeping). Buildings 
containing areas for patient use which do not contain patient sleeping areas and 
in which care or treatment is rendered to ambulatory inpatients who are capable 
of judgment and appropriate physical action for self-preservation under 
emergency conditions, may be classified as business or ambulatory care 
occupancies as listed in NFPA 101, Chapter 26 and sec.12-6, respectively, 
instead of hospital occupancy. 
(L) Energy conservation. In new construction and in major alterations and 
additions to existing buildings and in new buildings, electrical and mechanical 
components shall be selected for efficient utilization of energy.
(M) Heliports. Heliports located on hospital buildings shall comply with 
National Fire Protection Association 418, Standard for Heliports, 1995 edition. 
(2) General detail and finish requirements. Details and finishes in new 
construction projects, including additions and alterations, shall be in 
compliance with this paragraph, with NFPA 101, Chapter 12, with local building 
codes, and with any specific detail and finish requirements for the particular 
unit as contained in sec.133.163 of this title (relating to Hospital Spatial 
Requirements). 
(A) General detail requirements. 
(i) Fire safety. Fire safety features, including compartmentation, means of 
egress, automatic extinguishing systems, inspections, smoking regulations, and 
other details relating to fire prevention and fire protection shall comply with 
sec.133.161 of this title (relating to Requirements for Buildings in which 
Existing Licensed Hospitals are Located), and NFPA 101, Chapter 12 requirements 
for hospitals. The Fire Safety Evaluation System for Health Care Occupancies 
contained in the National Fire Protection Association 101A, Alternative 
Approaches to Life Safety, 1995 edition, Chapter 3, shall not be used in new 
building construction, renovations or additions to existing hospitals. 
(ii) Access to exits. Corridors providing access to all rooms and exits shall be 
at least eight feet in clear and unobstructed width (except as allowed by NFPA 
101, sec.12-2.3.3, Exceptions 1 and 2), not less than eight feet in height, and 
constructed in accordance with requirements listed in NFPA 101, sec.12-3.6. 
(iii) Corridors in other occupancies. Public corridors in outpatient, 
administrative, and service areas which are designed to other than hospital 
requirements and are the required means of egress from the hospital shall be not 
less than five feet in width. 
(iv) Encroachment into the means of egress. Items such as drinking fountains, 
telephone booths or stations, vending machines, and portable equipment shall be 
so located as to not project into and restrict exit corridor traffic or reduce 
the exit corridor width below the required minimum. 
(v) Doors in means of egress. All door leaves in the means of egress shall be 
not less than 44 inches wide or as otherwise permitted for hospitals by NFPA 
101, sec.12-2.3.5. 
(vi) Sliding doors. When sliding doors are provided to a means of egress 
corridor, the sliding doors shall have break-away provisions, positive latching 
devices, and shall be installed to resist passage of smoke. 
(vii) Control doors. Cross-corridor control doors shall consist of two 44-inch 
wide leaves which swing in a direction opposite from the other, or of the double 
acting type. 
(viii) Emergency access. Rooms containing bathtubs, showers, and water closets, 
intended for patient use shall be provided with at least one door having 
hardware which will permit access from the outside in any emergency. Door leaf 
width of such doors shall not be less than 36 inches.
(ix) Obstruction of corridors. All doors which swing towards the corridor must 
be recessed. Corridor doors to rooms not subject to occupancy (walk-in type 
closets are considered as rooms subject to occupancy) may swing into the 
corridor, provided that such doors comply with the requirements of NFPA 101, 
sec.5-2.1.4.3. 
(x) Stair landing. Doors shall not open immediately onto a stair without a 
landing. The landing shall be 44 inches deep or have a depth at least equal to 
the door width, whichever is greater. 
(xi) Doors to rooms subject to occupancy. All doors to rooms subject to 
occupancy shall be of the swing type except that horizontal sliding doors 
complying with the requirements of NFPA 101, sec.12-2.2.2.9 are permitted. Door 
leaves to rooms subject to occupancy shall not be less than 36 inches wide. 
(xii) Operable windows and exterior doors. Windows that can be opened without 
tools or keys and outer doors without automatic closing devices shall be 
provided with insect screens. 
(xiii) Glazing. Glass doors, lights, sidelights, borrowed lights, and windows 
located within 12 inches of a door jamb or with a bottom-frame height of less 
than 18 inches above the finished floor shall be glazed with safety glass or 
plastic glazing material that will resist breaking and will not create dangerous 
cutting edges when broken. Similar materials shall be used for wall openings in 
activity areas such as recreation and exercise rooms, unless otherwise required 
for fire safety. Safety glass, tempered or plastic glazing materials shall be 
used for shower doors and bath enclosures, interior windows and doors. Plastic 
and similar materials used for glazing shall comply with the flame-spread 
ratings of NFPA 101, sec.12-3.3. 
(xiv) Fire doors. All fire doors shall be listed by an independent testing 
laboratory and shall meet the construction requirements for fire doors in 
National Fire Protection Association 80, Standard for Fire Doors and Fire 
Windows, 1995 edition . Reference to a labeled door shall be construed to 
include labeled frame and hardware. 
(xv) Elevator doors. Elevator shaft openings shall be protected with a B labeled 
one-hour fire protection rated doors in buildings less than four stories; and 
one and one-half hour fire protection rated doors in buildings four or more 
stories. 
(xvi) Elevator lobbies. Elevator lobbies shall have at least 10 feet of clear 
floor space in front of the elevator doors. 
(xvii) Grab bars. Grab bars shall be provided at patient toilets, showers and 
tubs. The bars shall be one and one-half inches in diameter, shall have one and 
one-half inches clearance to walls, and shall have sufficient strength and 
anchorage to sustain a concentrated vertical or horizontal load of 250 pounds. 
Grab bars are not permitted at bathing and toilet fixtures in mental health and 
chemical dependency units unless designed and installed to eliminate the 
possibility of patients harming themselves. 
(xviii) Soap dishes. Recessed soap dishes shall be provided at all showers and 
bathtubs. 
(xix) Hand washing facilities. Location and arrangement of fittings for hand 
washing facilities shall permit their proper use and operation. Hand washing 
fixtures with hands-free operable controls shall be provided within each 
procedure room, workroom, examination, and treatment room. Particular care shall 
be given to the clearances required for blade-type operating handles. Lavatories 
and hand washing facilities shall be securely anchored to withstand an applied 
vertical load of not less than 250 pounds on the front of the fixture. In 
addition to the specific areas noted, hand washing facilities shall be provided 
and conveniently located for staff use throughout the hospital where patient 
care and services are provided. 
(xx) Hand drying. Provisions for hand drying shall be included at all hand 
washing facilities except scrub sinks. There shall be hot air dryers or 
individual paper or cloth units enclosed in such a way as to provide protection 
against dust or soil and ensure single unit dispensing. 
(xxi) Mirrors. Mirrors shall not be installed at hand washing fixtures where 
asepsis control and sanitation requirements would be lessened by hair combing. 
(xxii) Ceiling heights. The minimum ceiling height shall be eight feet with the 
following exceptions. 
(I) Boiler rooms. Boiler rooms shall have ceiling clearances not less than 2 
feet 6 inches above the main boiler header and connecting piping. 
(II) Rooms with ceiling mounted equipment. Rooms containing ceiling mounted 
equipment shall have the ceiling height clearance increased to accommodate the 
equipment or fixtures. 
(III) Overhead clearance. Suspended tracks, rails, pipes, signs, lights, door 
closures, exit signs, and other fixtures that protrude into the path of normal 
traffic shall not be less than 6 feet 8 inches above the finished floor. 
(IV) Lesser ceiling heights. Ceilings in storage rooms, toilet rooms, and other 
minor rooms shall be not less than 7 feet 6 inches. 
(xxiii) Areas producing impact noises. Recreation rooms, exercise rooms, and 
similar spaces where impact noises may be generated shall not be located 
directly over patient bed area or operating rooms unless special provisions are 
made to minimize noise. 
(xxiv) Noise reduction. Noise reduction criteria in accordance with the Table 1 
in sec.133.169(a) of this title (relating to Tables) shall apply to partitions, 
floor, and ceiling construction in patient areas. 
(xxv) Rooms with heat producing equipment. Rooms containing heat-producing 
equipment such as heater rooms, laundries, etc. shall be insulated and 
ventilated to prevent any occupied floor surface above from exceeding a 
temperature differential of 10 degrees Fahrenheit above the ambient room 
temperature. 
(xxvi) Chutes. Linen and refuse chutes shall comply with the requirements of 
National Fire Protection Association 82, Standard on Incinerators and Waste and 
Linen Handling Systems and Equipment, 1994 edition, and NFPA 101, sec.12-5.4. 
(xxvii) Thresholds and expansion joint covers. Thresholds and expansion joint 
covers shall be flush with the floor surface to facilitate the use of 
wheelchairs and carts. Expansion and seismic joints shall be constructed to 
restrict the passage of smoke and fire and shall be listed by a nationally 
recognized testing laboratory. 
(xxviii) Housekeeping room. 
(I) In addition to the housekeeping room(s) required in certain departments, 
sufficient housekeeping rooms shall be provided throughout the hospital as 
required to maintain a clean and sanitary environment. 
(II) Each housekeeping room shall contain a floor receptor or service sink and 
storage space for housekeeping equipment and supplies.
(B) General finish requirements. 
(i) Cubicle curtains and draperies. 
(I) Cubicle curtains, draperies and other hanging fabrics shall be 
noncombustible or flame retardant and shall pass both the small scale and the 
large scale tests of National Fire Protection Association 701, Standard Methods 
of Fire Tests for Flame-Resistant Textiles and Films, 1996 edition. Copies of 
laboratory test reports for installed materials shall be submitted to the 
department at the time of the final construction inspection. 
(II) Cubicle curtains shall be provided to assure patient privacy. 
(ii) Flame spread, smoke development and noxious gases. Flame spread and smoke 
developed limitations of finishes shall comply with Table 2 of sec.133.169(b) of 
this title and NFPA 101, sec.6-5.1 and sec.31-4.5. The use of materials known to 
produce large or concentrated amounts of noxious or toxic gases shall not be 
used in exit accesses or in patient areas. Copies of laboratory test reports for 
installed materials tested in accordance with National Fire Protection 
Association 255, Standard Method of Test of Surface Burning Characteristics of 
Building Materials, 1996 edition, shall be provided.
(iii) Floor finishes. Flooring shall be easy to clean and have wear resistance 
appropriate for the location involved. Floors that are subject to traffic while 
wet (such as shower and bath areas, kitchens, and similar work areas) shall have 
a nonslip surface. In all areas frequently subject to wet cleaning methods, 
floor materials shall not be physically affected by germicidal and cleaning 
solutions. The following are acceptable floor finishes:
(I) painted concrete; 
(II) vinyl and vinyl composition tiles and sheets; 
(III) seamless vinyl and seamless composition flooring. Where required, seamless 
flooring shall be impervious to water, coved and installed integral with the 
base, tightly sealed to the wall, and without voids that can harbor insects or 
retain dirt particles. Welded flooring is acceptable;
(IV) ceramic and quarry tile; 
(V) wood floors; 
(VI) carpet flooring. Carpeting installed in intensive care units, nurseries, 
patient rooms and similar patient care areas shall be treated to prevent 
bacterial and fungal growth; and 
(VII) terrazzo. 
(iv) Wall finishes. Wall finishes shall be smooth, washable, moisture resistant, 
and cleanable by standard housekeeping practices. Wall finishes shall comply 
with requirements contained in Table 2 of sec.133.169(b) of this title, and NFPA 
101, sec.12-3.3. 
(I) Wall finishes shall be water resistant in the immediate area of plumbing 
fixtures. 
(II) Wall finishes in areas subject to frequent wet cleaning methods shall be 
impervious to water, tightly sealed and without voids. 
(v) Floor, wall and ceiling penetrations. Floor, wall and ceiling penetrations 
by pipes, ducts, and conduits shall be tightly sealed to minimize entry of dirt 
particles, rodents and insects. Joints of structural elements shall be similarly 
sealed. 
(vi) Ceiling types. All occupied rooms and spaces shall be provided with 
finished ceilings. Ceilings which are a part of a rated roof/ceiling assembly or 
a floor/ceiling assembly shall be constructed of listed components and installed 
in accordance with the listing. Three types of ceilings that are required in 
various areas of the hospital are: 
(I) Ordinary ceilings. Ceilings such as acoustical tiles installed in a metal 
grid which are dry cleanable with equipment used in daily housekeeping 
activities such as dusters and vacuum cleaners. 
(II) Washable ceilings. Ceilings that are made of washable, smooth, moisture 
impervious materials such as painted lay-in gypsum wallboard or vinyl faced 
acoustic tile in a metal grid. 
(III) Monolithic ceilings. Ceilings which are monolithic from wall to wall 
(painted solid gypsum wallboard), smooth and without fissures, open joints, or 
crevices and with a washable and moisture impervious finish.
(vii) Special construction. Special conditions may require special wall and 
ceiling construction for security in areas such as storage of controlled 
substances and areas where patients are likely to attempt suicide or escape. 
(viii) Flammable anesthetizing locations. Flammable anesthetic locations in 
which flammable anesthetic agents are stored or administered shall comply with 
Annex 2 of the National Fire Protection Association 99, Standard for Health Care 
Facilities, 1996 edition (NFPA 99). 
(ix) Materials finishes. Materials known to produce noxious gases when burned 
shall not be used for mattresses, upholstery, and wall finishes.
(3) General mechanical requirements. This paragraph contains common requirements 
for mechanical systems; steam and hot and cold water systems; air-conditioning, 
heating and ventilating systems; plumbing fixtures; piping systems; and thermal 
and acoustical insulation. The hospital shall comply with the requirements of 
this paragraph and any specific mechanical requirements for the particular unit 
of the hospital in accordance with sec.133.163 of this title. 
(A) Cost. All mechanical systems shall be designed for overall efficiency and 
life cycle costing, including operational costs. Recognized engineering 
procedures shall be followed to achieve the most economical and effective 
results. In no case shall patient care or safety be sacrificed for conservation. 
(B) Equipment location. Mechanical equipment may be located indoors or outdoors 
(when in a weatherproof enclosure), or in separate building(s).
(C) Vibration isolation. Mechanical equipment shall be mounted on vibration 
isolators as required to prevent unacceptable structure-borne vibration. Ducts, 
pipes, etc. connected to mechanical equipment which is a source of vibration 
shall be isolated from the equipment with vibration isolators.
(D) Performance and acceptance. Prior to completion and acceptance of the 
facility, all mechanical systems shall be tested, balanced, and operated to 
demonstrate to the design engineer or his representative that the installation 
and performance of these systems conform to the requirements of the plans and 
specifications. 
(i) Material lists. Upon completion of the contract, the owner shall be provided 
with parts lists and procurement information with numbers and description for 
each piece of equipment. 
(ii) Instructions. Upon completion of the contract, the owner shall be provided 
with instructions in the operational use of systems and equipment as required. 
(E) Heating, ventilating and air conditioning (HVAC) systems. All HVAC systems 
shall comply with and shall be installed in accordance with the requirements of 
National Fire Protection Association 90A, Standard for the Installation of Air 
Conditioning and Ventilating Systems, 1996 edition, (NFPA 90A), NFPA 99, Chapter 
5, the requirements contained in this subparagraph, and the specific 
requirements for a particular unit in accordance with sec.133.163 of this title. 
(i) General ventilation requirements. All rooms and areas in the hospital shall 
have provision for positive ventilation. Fans serving exhaust systems shall be 
located at the discharge end and shall be conveniently accessible for service. 
Exhaust systems may be combined, unless otherwise noted, for efficient use of 
recovery devices required for energy conservation. The ventilation rates shown 
in Table 3 of sec.133.169(c) of this title shall be used only as minimum 
requirements since they do not preclude the use of higher rates that may be 
appropriate. 
(I) Cost reduction methods. To reduce utility costs, facility design shall 
utilize energy conserving procedures including recovery devices, variable air 
volume, load shedding, systems shut down or reduction of ventilation rates (when 
specifically permitted) in certain areas when unoccupied, insofar as patient 
care is not jeopardized. 
(II) Economizer cycle. Mechanical ventilation shall be arranged to take 
advantage of outside air supply by using an economizer cycle when appropriate to 
reduce heating and cooling systems loads. Innovative design that provides for 
additional energy conservation while meeting the intent of this section for 
acceptable patient care will be considered. 
(III) Outside air intake locations. Outside air intakes shall be located at 
least 25 feet from exhaust outlets of ventilating systems, combustion equipment 
stacks, medical-surgical vacuum systems, plumbing vents, or areas which may 
collect vehicular exhaust or other noxious fumes. (Prevailing winds and 
proximity to other structures may require other arrangements). Plumbing and 
vacuum vents that terminate five feet above the level of the top of the air 
intake may be located as close as 10 feet. 
(IV) Low air intake location limit. The bottom of outside air intakes serving 
central systems shall be located as high as practical but at least six feet 
above ground level, or if installed above the roof, three feet above the roof 
level. 
(V) Contaminated air exhaust outlets. Exhaust outlets from areas (kitchen hoods, 
ethylene oxide sterilizers, etc.) that exhaust contaminated air shall be above 
the roof level and arranged to exhaust upward. 
(VI) Directional air flow. Ventilation systems shall be designed and balanced to 
provide directional flow as shown in Table 3 of sec.133.169(c) of this title. 
For reductions and shut down of ventilation systems when a room is unoccupied, 
the provisions in Note 4 of Table 3 of sec.133.169(c) of this title shall be 
followed. 
(VII) Areas requiring fully ducted systems. Fully ducted supply, return and 
exhaust air for HVAC systems shall be provided for all critical care areas, 
sensitive care areas, all areas requiring a sterile regimen and where required 
for fire safety purposes. Combination systems, utilizing both ducts and plenums 
for movement of air in these areas shall not be permitted. Such areas include, 
but are not limited to, surgical facilities, delivery rooms, intensive care 
units (ICUs), cardiac care units (CCUs), protective environment suites, neonatal 
care unit, special procedure rooms, nurseries, LDR and LDRP rooms, isolation 
rooms, sterile processing, sterile storage rooms and food preparation areas. 
(VIII) Ventilation start-up requirements. Air handling systems shall not be 
started up and operated without the filters installed in place. This includes 
the 90% and 99.97% efficiency filters where required. Ducts shall be cleaned 
thoroughly by an air duct cleaning contractor when the air handling systems have 
been operating without the required filters in place.
(IX) Humidifier location. When duct humidifiers are located upstream of the 
final filters, they shall be located at least 15 feet from the filters. Ductwork 
with duct-mounted humidifiers shall be provided with a means of removing water 
accumulation. An adjustable high-limit humidistat shall be located downstream of 
the humidifier to reduce the potential of condensation inside the duct. All duct 
take-offs should be sufficiently downstream of the humidifier to ensure complete 
moisture absorption. Reservoir-type water spray or evaporative pan humidifiers 
shall not be used. 
(ii) Filtration requirements. All central air handling systems serving patient 
care areas, including nursing unit corridors, shall be equipped with filters 
having efficiencies equal to, or greater than, those specified in Table 4 of 
sec.133.169(d) of this title. Filter efficiencies shall be average efficiencies 
tested in accordance with American Society of Heating, Refrigerating, and Air-
conditioning Engineers (ASHRAE), Inc., Standard 52, 1992 edition, (relating to 
Graviometric and Dust Spot Procedures for Testing Air Cleaning Devices Used in 
General Ventilation for Removing Particulate Matter). All joints between filter 
segments, and between filter segments and the enclosing ductwork, shall have 
gaskets and seals to provide a positive seal against air leakage. Air handlers 
serving more than one room shall be considered as central air handlers. All 
documents published by ASHRAE as referenced in this section may be obtained by 
writing or calling the ASHRAE, Inc. at the following address or telephone 
number: ASHRAE, Inc., 1791 Tullie Circle, N. E., Atlanta, GA 30329; telephone 
(404) 636-8400. 
(I) Filtration requirements for air handling units serving single rooms 
requiring asepsis control. Dedicated air handlers serving only one room where 
asepsis control is required, such as, but not limited to, operating rooms, 
delivery rooms, special procedure rooms, and nurseries shall be equipped with 
filters having efficiencies equal to, or greater than, those specified for 
patient care areas in Table 4 of sec.133.169(d) of this title. 
(II) Filtration requirements for air handling units serving other single rooms. 
Dedicated air handlers serving all other single rooms shall be equipped with 
nominal filters installed at the return air grille.
(III) Location of multiple filters. Where two filter beds are required by Table 
4 of sec.133.169(d) of this title, filter bed number one shall be located 
upstream of the air-conditioning equipment, and filter bed number two shall be 
downstream of the supply fan or blowers. 
(IV) Location of single filters. Where only one filter bed is required by Table 
4 of sec.133.169(d) of this title, it shall be located upstream of the supply 
fan. Filter frames shall be durable and constructed to provide an airtight fit 
with the enclosing ductwork. 
(V) Pressure monitoring devices. A manometer or draft gauge shall be installed 
across each filter bed having a required efficiency of 75% or more including 
hoods requiring high efficiency particulate air (HEPA) filters. 
(iii) Thermal and acoustical insulation for air handling systems. Asbestos 
insulation shall not be used. 
(I) Thermal duct insulation. Air ducts and casings with outside surface 
temperature below ambient dew point or temperature above 80 degrees Fahrenheit 
shall be provided with thermal insulation. 
(II) Insulation in air plenums and ducts. Linings in air ducts and equipment 
shall meet the Erosion Test Method described in Underwriters' Laboratories, 
Inc., Standard Number 181 (relating to Factory-Made Duct Materials and Air Duct 
Connectors). This document may be obtained from the Underwriters' Laboratories, 
Inc., 333 Pfingsten Road, Northbrook, IL 60062-2096. 
(III) Insulation flame spread and smoke developed ratings. Interior and exterior 
insulation, including finishes and adhesives on the exterior surfaces of ducts 
and equipment, shall have a flame spread rating of 25 or less and a smoke 
developed rating of 50 or less as required by NFPA 90A, Chapters 2 and 3. 
(IV) Linings and acoustical traps. Duct lining and acoustical traps exposed to 
air movement shall not be used in ducts serving critical care areas. This 
requirement shall not apply to mixing boxes and acoustical traps that have 
approved nonabrasive coverings over such linings. 
(V) Frangible insulation. Insulation of soft and spray-on types shall not be 
used where it is subject to air currents or mechanical erosion or where loose 
particles may create a maintenance problem. 
(VI) Existing duct linings. Internal linings shall not be used in ducts, 
terminal boxes, or other air system components supplying operating rooms, 
delivery rooms, birthing rooms, labor rooms, recovery rooms, nurseries, trauma 
rooms, isolation rooms, and intensive care units unless terminal filters of at 
least 90% efficiency are installed downstream of linings. 
(iv) Ventilation for anesthetizing locations. Ventilation for anesthetizing 
locations, as defined in NFPA 99, sec.2-2, shall comply with NFPA 99, sec.12-
4.1.2.1, and any specific ventilation requirements for the particular unit in 
accordance with sec.133.163 of this title. 
(I) Smoke removal systems for windowless anesthetizing locations. Smoke removal 
systems shall be provided in all windowless anesthetizing locations in 
accordance with NFPA 99, sec.5-4.1.2. 
(II) Smoke removal systems for surgical suites. Smoke removal systems shall be 
provided in all surgical suites in accordance with NFPA 99, sec.5-4.1.3. 
(III) Smoke exhaust grilles. Exhaust grilles for smoke evacuation systems shall 
be ceiling mounted. 
(v) Location of return and exhaust air devices. The bottoms of wall mounted 
return and exhaust air openings shall be at least four inches above the floor. 
Return air openings located less than six inches above the floor shall be 
provided with nominal filters. All exhaust air openings and return air openings 
located higher than six inches but less than seven feet above the floor shall be 
protected with grilles or screens having openings through which a one-half inch 
sphere will not pass. 
(vi) Ray protection. Ducts which penetrate construction intended for X-ray or 
other ray protection shall not impair the effectiveness of the protection. 
(vii) Fire damper requirements. Fire dampers shall be located and installed in 
all ducts at the point of penetration of a two-hour or higher fire rated wall or 
floor in accordance with the requirements of NFPA 101, sec.12-5.2. 
(viii) Smoke damper requirements. Smoke dampers shall be located and installed 
in accordance with the requirements of NFPA 101, sec.12-3.7.3, and NFPA 90A, 
Chapter 3. 
(I) Fail-safe installation. Smoke dampers shall close on activation of the fire 
alarm system by smoke detectors installed and located as required by National 
Fire Protection Association 72, National Fire Alarm Code, 1996 edition (NFPA 
72), Chapter 5; NFPA 90A, Chapter 4; and NFPA 101, sec.12-3.7; the fire 
sprinkler system; and upon loss of power. Smoke dampers shall not close by fan 
shut-down alone. This requirement applies to all existing and new installations. 
(II) Interconnection of air handling fans and smoke dampers. Air handling fans 
and smoke damper controls may be interconnected so that closing of smoke dampers 
will not damage the ducts. 
(III) Frangible devices. Use of frangible devices for shutting smoke dampers is 
not permitted. 
(ix) Acceptable damper assemblies. Only fire damper and smoke damper assemblies 
integral with sleeves and listed for the intended purpose shall be acceptable. 
(x) Duct access doors. Unobstructed access to duct openings in accordance with 
NFPA 90A, sec.2-3.4, shall be provided in ducts within reach and sight of every 
fire damper, smoke damper and smoke detector. Each opening shall be protected by 
an internally insulated door which shall be labeled externally to indicate the 
fire protection device located within.
(xi) Restarting controls. Controls for restarting fans may be installed for 
convenient fire department use to assist in evacuation of smoke after a fire is 
controlled, provided that provisions are made to avoid possible damage to the 
system because of closed dampers. To accomplish this, smoke dampers shall be 
equipped with remote control devices. 
(xii) Make-up air. If air supply requirements in Table 3 of sec.133.169(c) of 
this title do not provide sufficient air for use by exhaust hoods and safety 
cabinets, filtered make-up air shall be ducted to maintainthe required air flow 
direction in that room. Make-up systems for hoods shall be arranged to minimize 
short circuiting of air and to avoid reduction in air velocity at the point of 
contaminant capture. 
(4) General piping systems and plumbing fixture requirements. All piping systems 
and plumbing fixtures shall be designed and installed in accordance with the 
requirements of the National Standard Plumbing Code published by the National 
Association of Plumbing-Heating-Cooling Contractors (PHCC), 1996 edition, and 
this paragraph. The National Standard Plumbing Code may be obtained by writing 
or calling the PHCC at the following address or telephone number: Plumbing-
Heating-Cooling Contractors, P. O. Box 6808, Falls Church, VA 22040; telephone 
(800) 533-7694. 
(A) Piping systems. 
(i) Water supply systems. Water service pipe to point of entrance to the 
building shall be brass pipe, copper tube (not less than type M when buried 
directly), copper pipe, cast iron water pipe, galvanized steel pipe, or approved 
plastic pipe. Water distribution system piping within buildings shall be brass 
pipe, copper pipe, copper tube, or galvanized steel pipe. 
(I) Valves. Each water service main, branch main, riser, and branch to a group 
of fixtures shall be valved. Stop valves shall be provided at each fixture. 
(II) Backflow preventers. Backflow preventers (vacuum breakers) shall be 
installed on hose bibbs, laboratory sinks, janitor sinks, bedpan flushing 
attachments, autopsy tables, and on all other fixtures to which hoses or tubing 
can be attached. 
(III) Flushing valves. Flush valves installed on plumbing fixtures shall be of a 
quiet operating type, equipped with silencers. 
(IV) Capacity of water heating equipment. Water heating equipment shall have 
sufficient capacity to supply water for clinical, dietary and laundry use at the 
temperatures and amounts specified in Table 5 of sec.133.169(e) of this title. 
(V) Water temperature measurements. Water temperatures shall be measured at hot 
water point of use or at the inlet to processing equipment.
(VI) Water storage tanks. Water storage tank(s) shall be fabricated of 
corrosion-resistant metal or lined with noncorrosive material. 
(VII) Hot water distribution. Water distribution systems shall be arranged to 
provide hot water at each hot water outlet at all times. 
(VIII) Emergency water supply. Emergency potable water storage facilities shall 
be provided. The storage tank capacity shall not be less than 500 gallons or 12 
gallons per patient bed, whichever is greater. Capacity of hot water storage 
tanks may be included as part of the required emergency water capacity when 
valves and piping systems are arranged to make this water available at all 
times. 
(ii) Fire sprinkler systems. Fire sprinkler systems shall be provided in 
hospitals as required by NFPA 101, sec.12-3.5. All fire sprinkler systems shall 
be designed, installed, and maintained in accordance with the requirements of 
NFPA13, and shall be certified as required by sec.133.167(d)(3)(C) of this title 
(relating to Preparation, Submittal, Review and Approval of Plans). 
(iii) Nonflammable medical gas and clinical vacuum systems. Nonflammable medical 
gas and clinical vacuum system installations shall be designed, installed and 
certified in accordance with the requirements of NFPA 99, sec.4-3 for Level I 
systems and the requirements of this clause. 
(I) Outlets. Nonflammable medical gas and clinical vacuum outlets shall be 
provided in accordance with in Table 6 of sec.133.169(f) of this title. 
(II) Installer qualifications. All installations of the medical gas piping 
systems shall be done only by, or under the direct supervision of a holder of a 
master plumber license or a journeyman plumber license with a medical gas piping 
installation endorsement issued by the Texas State Board of Plumbing Examiners. 
(III) Installer tests. Prior to closing of walls, the installer shall perform an 
initial pressure test, a blowdown test, a secondary pressure test, a cross-
connection test, and a purge of the piping system as required by NFPA 99. 
(IV) Qualifications for conducting verification tests and inspections. 
Verification tests and inspections by a party, other than the installer, shall 
be conducted by individuals who are technically competent and experienced in the 
field of piped medical gas systems. 
(V) Verification tests. Upon completion of the installer inspections and tests 
and after closing of walls, verification tests of the medical gas piping 
systems, the warning system, and the gas supply source shall be conducted. The 
verification tests shall include a cross-connection test, valve test, flow test, 
piping purge test, piping purity test, final tie-in test, operational pressure 
tests, and medical gas concentration test. 
(VI) Verification test requirements. Verification tests of the medical gas 
piping system, the warning system, shall be performed on all new piped medical 
gas systems, additions, renovations, or repaired portions of an existing system. 
All systems that are breached and components that are added, renovated, or 
replaced shall be inspected and appropriately tested. The breached portions of 
the systems subject to inspection and testing shall be all of the new and 
existing components in the immediate zone or area located upstream of the point 
or area of intrusion and downstream to the end of the system or a properly 
installed isolation valve. 
(VII) Warning system verification tests. Verification tests of piped medical gas 
systems shall include tests of the source alarms and monitoring safeguards, 
master alarm systems, and the area alarm systems. 
(VIII) Source equipment verification tests. Source equipment verification tests 
shall include medical gas supply sources (bulk and manifold) and the compressed 
air source systems (compressors, dryers, filters, and regulators).
(IX) Written certification. Upon successful completion of all verification 
tests, written certification for affected piped medical gas systems and piped 
medical vacuum systems including the supply sources and warning systems shall be 
provided by a party technically competent and experienced in the field of 
medical gas pipeline testing stating that the provisions of NFPA 99 have been 
adhered to and systems integrity has been achieved. The written certification 
shall be submitted directly to the hospital and the installer. A copy shall be 
forwarded to the department by the hospital. 
(X) Hospital responsibility. Before new piped medical gas systems, additions, 
renovations, or repaired portions of an existing system are put into use, the 
hospital shall be responsible for ensuring that the gas delivered at the outlet 
is the gas shown on the outlet label and that the proper connecting fittings are 
checked against their labels. 
(XI) Documentation of medical gas and clinical vacuum outlets. Documentation of 
the installed, modified, extended or repaired medical gas piping system shall be 
submitted to the department by the same party certifying the piped medical gas 
systems. The number and type of medical gas outlets (oxygen, vacuum, medical 
air, nitrogen, nitrous oxide, etc.) shall be documented and arranged tabularly 
by room numbers and room types. 
(iv) Waste anesthetic gas disposal (WAGD) systems. Each space routinely used for 
administering inhalation anesthesia shall be provided with a WAGD system as 
required by NFPA 99, sec.4-3.3. 
(v) Steam and hot water systems. 
(I) Boilers. Boilers shall have the capacity, based upon the net ratings 
published by the Hydronics Institute, to supply the normal requirements of all 
systems and equipment. The number and arrangement of boilers shall be such that, 
when one boiler breaks down or routine maintenance requires that one boiler be 
temporarily taken out of service, the capacity of the remaining boiler(s) shall 
be sufficient to provide hot water service for clinical, dietary, and patient 
use, steam for sterilization and dietary purposes, and heating for operating, 
delivery, emergency, labor, recovery, intensive care, nursery, treatment, and 
general patient rooms. However, reserve capacity for space heating of 
noncritical care areas (e.g. general patient rooms and administrative areas) is 
not required in geographical areas where a design dry bulb temperature equals 25 
degrees Fahrenheit or higher as based on the 99% design value shown in the 
Handbook of Fundamentals, 1993 edition, published by ASHRAE, Inc.
(II) Boiler accessories. Boiler feed pumps, heating circulating pumps, 
condensate return pumps, and fuel oil pumps shall be connected and installed to 
provide normal and standby service. 
(III) Valves. Supply and return mains and risers of cooling, heating, and 
process steam systems shall be valved to isolate the various sections of each 
system. Each piece of equipment shall be valved at the supply and return ends 
except that vacuum condensate returns need not be valved at each piece of 
equipment. 
(vi) Drainage systems. 
(I) Above ground piping. Soil stacks, drains, vents, waste lines, and leaders 
installed above ground within buildings shall be drain-waste-vent (DWV) weight 
or heavier and shall be: copper pipe, copper tube, cast iron pipe, or galvanized 
iron pipe. 
(II) Underground piping. All underground building drains shall be: cast iron 
soil pipe, hard temper copper tube (DWV or heavier), acrylonitrile-butodiene-
styrene (ABS) plastic pipe (DWV Schedule 40 or heavier), polyvinyl chloride 
(PVC) plastic pipe (DWV Schedule 40 or heavier), or extra strength vitrified 
clay pipe (VCP) with compression joints or couplings with at least 12 inches of 
earth cover. 
(III) Drains for chemical wastes. Separate drainage systems for chemical wastes 
(acids and other corrosive materials) shall be provided. Materials acceptable 
for chemical waste drainage systems shall include chemically resistant glass 
pipe, high silicone content cast iron pipe, VCP, plastic pipe, or plastic lined 
pipe. 
(vii) Thermal insulation for piping systems and equipment. Insulation shall be 
provided for the following: 
(I) boilers, smoke breeching, and stacks; 
(II) steam supply and condensate return piping; 
(III) hot water piping and all hot water heaters, generators, converters, and 
storage tanks; 
(IV) chilled water, refrigerant, other process piping, equipment operating with 
fluid temperatures below ambient dew point, and water supply and drainage piping 
on which condensation may occur. Insulation on cold surfaces shall include an 
exterior vapor barrier; 
(V) other piping, ducts, and equipment as necessary to maintain the efficiency 
of the system. 
(viii) Pipe and equipment insulation rating. Flame spread shall not exceed 25 
and smoke development rating shall not exceed 150 for pipe insulation as 
determined by an independent testing laboratory in accordance with National Fire 
Protection Association 255, Standard Method of Test of Surface Burning 
Characteristics of Building Materials, 1996 edition. Smoke development rating 
for pipe insulation located in environmental air areas shall not exceed 50. 
(ix) Asbestos insulation. Asbestos insulation shall not be used. 
(B) Plumbing fixtures. Plumbing fixtures shall be made of nonabsorptive acid-
resistant materials and shall comply with the recommendations of the National 
Standard Plumbing Code and this paragraph. 
(i) Sink and lavatory controls. All fixtures used by medical and nursing staff 
and all lavatories used by patients and food handlers shall be trimmed with 
valves which can be operated without the use of hands. Blade handles used for 
this purpose shall not be less than four inches in length. Single lever or wrist 
blade devices may be used. 
(ii) Clinical sink traps. Clinical sinks shall have an integral trap in which 
the upper portion of a visible trap seal provides a water surface.
(iii) Sinks for disposal of plaster of paris. Sinks used for the disposal of 
plaster of paris shall have a plaster trap. 
(iv) Back flow or siphoning. All plumbing fixtures and equipment shall be 
designed and installed to prevent the back-flow or back-siphonage of any 
material into the water supply. The over-the-rim type water inlet shall be used 
wherever possible. Vacuum-breaking devices shall be properly installed when an 
over-the-rim type water inlet cannot be utilized. 
(v) Drinking fountain. Each drinking fountain shall be designed so that the 
water issues at an angle from the vertical, the end of the water orifice is 
above the rim of the bowl, and a guard is located over the orifice to protect it 
from lip contamination. 
(vi) Sterilizing equipment. All sterilizing equipment shall be designed and 
installed to prevent not only the contamination of the water supply but also the 
entrance of contaminating materials into the sterilizing units. 
(vii) Hose attachment. No hose shall be affixed to any faucet if the end of the 
hose can become submerged in contaminated liquid unless the faucet is equipped 
with an approved, properly installed vacuum-breaker.
(viii) Bedpan washers and sterilizers. Bedpan washers and sterilizers shall be 
designed and installed so that both hot and cold water inlets shall be protected 
against back-siphonage at maximum water level. 
(ix) Flood level rim clearance. The water supply spout for lavatories and sinks 
required in patient care areas shall be mounted so that its discharge point is a 
minimum of five inches above the rim of the fixture.
(x) Scrub sink controls. Freestanding scrub sinks and lavatories used for 
scrubbing in procedure rooms shall be trimmed with foot, knee, or ultrasonic 
controls. Single lever wrist blades are not acceptable at scrub sinks. 
(xi) Floor drains or floor sinks. Where floor drains or floor sinks are 
installed, they shall be of a type that can be easily cleaned by removal of the 
cover. Removable stainless steel mesh shall be provided in addition to grilled 
drain cover to prevent entry of large particles of waste which might cause 
stoppages. 
(xii) Under counter piping. Under counter piping and above floor drains shall be 
arranged (raised) so as not to interfere with cleaning of floor below the 
equipment. 
(xiii) Ice machines. All icemaking machines shall be of the self-dispensing 
type, unless otherwise specified. 
(5) General electrical requirements. This paragraph contains common electrical 
requirements. The hospital shall comply with the requirements of this paragraph 
and with any specific electrical requirements for the particular unit of the 
hospital in accordance with sec.133.163 of this title. 
(A) Electrical installations. All new electrical material and equipment, 
including conductors, controls, and signaling devices, shall be installed in 
compliance with applicable sections of the National Fire Protection Association 
70, National Electrical Code, 1996 edition (NFPA 70), and NFPA 99 and as 
necessary to provide a complete electrical system. Electrical systems and 
components shall be listed by nationally recognized listing agencies as 
complying with available standards and shall be installed in accordance with the 
listings and manufacturers' instructions. 
(i) All fixtures, switches, sockets, and other pieces of apparatus shall be 
maintained in a safe and working condition. 
(ii) Extension cords and cables shall not be used for permanent wiring. 
(iii) All electrical heating devices shall be equipped with a pilot light to 
indicate when the device is in service, unless equipped with a temperature 
limiting device integral with the heater. 
(iv) All equipment, fixtures, and appliances shall be properly grounded in 
accordance with NFPA 70. 
(v) Under-counter receptacles and conduits shall be arranged (raised) to not 
interfere with cleaning of floor below the equipment. 
(B) Installation testing and certification. 
(i) Installation testing. The electrical installations, including alarm, nurses 
calling system and communication systems, shall be tested to demonstrate that 
equipment installation and operation is appropriate and functional.
(I) Grounding continuity shall be tested as described in NFPA 99 for new or 
existing work. 
(II) A written record of performance tests on special electrical systems and 
equipment shall show compliance with applicable codes and standards.
(ii) Installation certification. Certifications in affidavit form signed by a 
registered electrical engineer attesting that the electrical service, electrical 
equipment, and electrical appliances have been installed in compliance with the 
approved plans and/or applicable standards, shall be submitted to the department 
when requested. 
(C) Electrical safeguards. Shielded isolation transformers, voltage regulators, 
filters, surge suppressors, and other safeguards shall be provided as required 
where power line disturbances are likely to affect fire alarm components, data 
processing, equipment used for treatment, and automated laboratory diagnostic 
equipment. 
(D) Services and switchboards. Main switchboards shall be located in an area 
separate from plumbing and mechanical equipment and shall be accessible to 
authorized persons only. Switchboards shall be convenient for use, readily 
accessible for maintenance, away from traffic lanes, and located in dry, 
ventilated spaces free of corrosive or explosive fumes, gases, or any flammable 
material. Overload protective devices shall operate properly in ambient 
temperatures. 
(E) Panelboards. Panelboards serving normal lighting and appliance circuits 
shall be located on the same floor as the circuits they serve. Panelboards 
serving critical branch emergency circuits shall be located on each floor that 
has major users (operating rooms, delivery suites, intensive care, etc.) and may 
also serve the floor above and the floor below. Panelboards serving life safety 
branch circuits may serve three floors, the floor where the panelboard is 
located, and the floors above and below. 
(F) Wiring. All conductors for controls, equipment, lighting and power operating 
at 100 volts or higher shall be installed in accordance with the requirements of 
NFPA 70, Article 517. All surface mounted wiring operating at less than 100 
volts shall be protected from mechanical injury with metal raceways to a height 
of seven feet above the floor. Conduits and cables shall be supported in 
accordance with NFPA 70, Article 300. 
(G) Lighting. 
(i) Lighting intensity for staff and patient needs shall comply with guidelines 
for health care facilities set forth in the Illuminating Engineering Society of 
North America (IES) Handbook. 
(I) Consideration should be given to controlling intensity and wavelength to 
prevent harm to the patient's eyes (i.e., retina damage to premature infants and 
cataracts due to ultraviolet light). 
(II) Approaches to buildings and parking lots, and all spaces within buildings 
shall have fixtures that can be illuminated as necessary. All rooms including 
storerooms, electrical and mechanical equipment rooms, and all attics shall have 
sufficient artificial lighting so that all parts of these spaces shall be 
clearly visible. 
(III) Consideration should be given to the special needs of the elderly. 
Excessive contrast in lighting levels that makes effective sight adaptation 
difficult shall be minimized. 
(ii) Means of egress and exit sign lighting intensity shall comply with NFPA 
101, sec.sec.5-8, 5-9 and 5-10. 
(iii) Electric lamps which may be subject to breakage or which are installed in 
fixtures in confined locations when near woodwork, paper, clothing, or other 
combustible materials, shall be protected by wire guards, or plastic shields. 
(iv) Ceiling mounted surgical and examination light fixtures shall be suspended 
from rigid support structures mounted above the ceiling.
(H) Receptacles. Only listed hospital grade single-grounding or duplex-grounding 
receptacles shall be used throughout the facility. This does not apply to 
special purpose receptacles. 
(i) Installations of multiple ganged receptacles shall not be permitted in 
patient care areas. 
(ii) At least 50% of electrical outlets at each patient care location shall be 
connected to the critical branch of the emergency electrical system and be 
labeled with panel and circuit number. At least one receptacle at each patient 
treatment or procedure location shall be powered from the normal power panel. 
(iii) Replacement of malfunctioning receptacles and installation of new 
receptacles powered from the critical branch in existing facilities shall be 
accomplished with receptacles of the same distinct color as the existing 
receptacles. 
(iv) In locations where mobile X-ray or other equipment requiring special 
electrical configuration is used, the additional receptacles shall be 
distinctively marked for the special use. 
(v) Each receptacle shall be grounded to the reference grounding point by means 
of a green insulated copper equipment grounding conductor.
(I) Equipment. 
(i) Equipment required for safe operation of the hospital shall be powered from 
the equipment system in accordance with the requirements contained in NFPA 99, 
sec.3-4.2.2.3. 
(ii) Boiler accessories including feed pumps, heat-circulating pumps, condensate 
return pumps, fuel oil pumps, and waste heat boilers shall be connected and 
installed to provide both normal and standby service. 
(iii) Laser equipment shall be installed according to manufacturer 
recommendations and shall be registered with the Bureau of Radiation Control, 
Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756. 
(J) Ground fault circuit interrupters (GFCI). GFCIs shall comply with NFPA 70. 
When GFCIs are used in critical areas, provisions shall be made to ensure that 
other essential equipment is not affected by activation of one interrupter. 
(K) Grounding requirements. In areas such as critical care units and special 
nurseries where a patient may be treated with an internal probe or catheter 
connected to the heart, the ground system shall comply with applicable sections 
of NFPA 99 and NFPA 70. 
(L) Nurses calling systems. Three different types of nurses calling systems are 
required to be installed in a hospital: a nurses regular calling system; a 
nurses emergency calling system; and a staff emergency assistance calling 
system. The hospital shall comply with the requirements of this paragraph and 
any specific requirements for nurses calling systems for the particular unit of 
the hospital in accordance with sec.133.163 of this title. 
(i) A nurses regular calling system is intended for routine communication 
between each patient and the nursing staff. Activation of the system at a 
patient's regular calling station will sound a repeating (every 20 seconds) 
audible signal at the nurse station, indicate type and location of call on the 
system monitor, and activate a distinct visible signal in the corridor at the 
patient suites door. In multi-corridor nursing units, additional visible signals 
shall be installed at corridor intersections. The audible signal shall be 
canceled and two-way voice communication between the patient room and the 
nursing staff shall be established at the unit's nursing station when the call 
is answered by the nursing staff. The visible signal(s) in the corridor shall be 
canceled upon termination of the call. An alarm shall activate at the nurses 
station when the call cable is unplugged. 
(ii) A nurses emergency calling system shall be installed in all toilets used by 
all patients to summon nursing staff in an emergency. Activation of the system 
shall sound a repeating (every 5 seconds) audible signal at the nurse station, 
indicate type and location of call on the system monitor, and activate a 
distinct visible signal in the corridor at the patient suites door. In multi-
corridor nursing units, additional visible signals shall be installed at 
corridor intersections. The visible and audible signals shall be cancelable only 
at the patient calling station. Activation of the system shall also activate 
distinct visible signals in the clean workroom, in the soiled workroom, 
medication, charting, clean linen storage, nourishment, and equipment storage. 
When conveniently located and accessible from both the bathing and toilet 
fixtures, one emergency call station may serve one bathroom. A nurses emergency 
call system shall be accessible to a collapsed patient lying on the floor. 
Inclusion of a pull cord extending to within six inches of the floor will 
satisfy this requirement. 
(iii) A staff emergency assistance calling system (code blue) is intended to be 
used by staff to summon additional help in an emergency. In open suites, an 
emergency assistant call system device shall be located at the head of each bed 
and in each individual room. The emergency assistance calling device can be 
shared between two beds if conveniently located. Activation of the system will 
sound an audible signal at the nursing unit's nurses station, indicate type and 
location of call on the system monitor and activate a distinct visible signal in 
the corridor at the patient suites door. In multi-corridor nursing units, 
additional visible signals shall be installed at corridor intersections. 
Activation of the system shall also activate visible and audible signals in the 
clean workroom, in the soiled workroom, medication, charting, clean linen 
storage, nourishment, equipment storage, and examination/treatment room(s) with 
back up to a continuously staffed area (other than the nurse station or an 
administrative center) from which assistance can be summoned. In critical care 
units, recovery and preoperative areas, the call system shall include provisions 
for an emergency code resuscitation alarm to summon assistance from outside the 
unit. The system shall have voice communication capabilities so that the type of 
emergency or help required may be specified. 
(M) Emergency electric service. A Type I essential electrical system shall be 
provided in each hospital in accordance with requirements of NFPA 99; NFPA 101, 
and National Fire Protection Association 110, Standard for Emergency and Standby 
Power Systems, 1996 edition. 
(N) Fire alarm system. A fire alarm system which complies with NFPA 101, sec.12-
3.4, and with NFPA 72, Chapter 3 requirements, shall be provided in each 
facility. The required fire alarm system components are as follows: 
(i) A fire alarm control panel (FACP) shall be installed at a continuously 
attended (24 hour) location. A remote fire alarm annunciator listed for fire 
alarm service and installed at a continuously attended location and is capable 
of indicating both visual and audible alarm, trouble and supervisory signals in 
accordance with the requirements of NFPA 72 may be substituted for the FACP. 
(ii) Manual fire alarm pull stations shall be installed in accordance with NFPA 
101, sec.12-3.4. 
(iii) Smoke detectors for door release service shall be installed on the ceiling 
at each door opening in the smoke partition in accordance with NFPA 72, sec.5-
10.7.4, where the doors are held open with electromagnetic devices conforming 
with NFPA 101, sec.12-2.2.6. 
(iv) Ceiling mounted smoke detector(s) shall be installed in room containing the 
FACP when this room is not attended continuously by staff as required by NFPA 
72, sec.3-8.2. 
(v) Smoke detectors shall be installed in supply air ducts in accordance with 
NFPA 72, sec.5-10.5.2.1 and sec.5-10.6, and with NFPA 90A, sec.4-4.1. 
(vi) Smoke detectors shall be installed in return air ducts in accordance with 
requirements of NFPA 72, sec.5-10.5.2.2 and sec.5-10.6, and NFPA 90A, sec.4-
4.1(b). 
(vii) Fire sprinkler system water flow switches shall be installed in accordance 
with requirements of NFPA 101, sec.7-6.2; NFPA 13, sec.3-12; and NFPA 72, sec.3-
8.5. 
(viii) Sprinkler system valve supervisory switches shall be installed in 
accordance with the requirements of NFPA 72, sec.3-8.6. 
(ix) Audible alarm indicating devices shall be installed in accordance with the 
requirements of NFPA 101, sec.12-3.4., and NFPA 72, sec.6-3. 
(x) Visual fire alarm indicating devices which comply with the requirements of 
sec.133.162(d)(1)(F)(ii) of this title (relating to New Construction 
Requirements) and NFPA 72, sec.6-4, shall be provided.
(xi) Devices for transmitting alarm for alerting the local fire brigade or 
municipal fire department of fire or other emergency shall be provided. The 
devices shall be listed for the fire alarm service by a nationally recognized 
laboratory, and be installed in accordance with such listing and the 
requirements of NFPA 72. 
(xii) A smoke detection system for spaces open to corridor(s) shall be provided 
when required by NFPA 101, sec.12-3.6.1. 
(xiii) A fire alarm signal notification which complies with NFPA 101, sec.7-6.3, 
shall be provided to alert occupants of fire or other emergency. 
(xiv) Wiring for fire alarm detection circuits and fire alarm notification 
circuits shall comply with requirements of NFPA 70, Article 760.
(xv) A smoke detection system for elevator recall shall be located in elevator 
lobbies, elevator machine rooms and at the top of elevator hoist ways as 
required by NFPA 72, sec.3-8.14.6. 
(I) The elevator recall smoke detection system in new construction shall comply 
with requirements of American Society of Mechanical Engineers/American National 
Standards Institute (ASME/ANSI) A17.1, Safety Code for Elevators and Escalators, 
1996 edition. The publications of the ASME/ANSI referenced in this section may 
be obtained by writing ASME/ANSI, United Engineering Center, 345 East 47th 
Street, New York, N.Y. 10017. 
(II) The elevator recall smoke detection system in existing hospitals shall 
comply with requirements of ASME/ANSI A17.3, Safety Code for Existing Elevators 
and Escalators, 1995 edition. 
(xvi) Smoke detectors for initiating smoke removal from windowless anesthetizing 
areas shall be provided in accordance with NFPA 99, Section 5-4.1.2.
(xvii) Smoke detectors for initiating smoke removal from surgical suites shall 
be provided in accordance with NFPA 99, sec.5-4.1.3. 
(xviii) A smoke detection system for initiating smoke removal from atriums shall 
be located above the highest floor level of the atrium and at return intakes 
from the atrium in accordance with National Fire Protection Association 92B, 
Guide for Smoke Management Systems in Malls, Atria, and Large Areas, 1995 
edition. 
(xix) Smoke detector(s) for shut-down of air handling units shall be provided. 
The detectors shall be installed in accordance with NFPA 90A, sec.4-4.2. 
(O) Telecommunications and information systems. Telecommunications and 
information systems central equipment shall be installed in a separate location 
designed for the intended purpose. Special air conditioning and voltage 
regulation shall be provided as recommended by the manufacturer. 
(P) Lightning protection systems. When installed, lightning protection systems 
shall comply with National Fire Protection Association 780, Standard for the 
Installation of Lightning Protection Systems, 1995 edition.

sec.133.163. Hospital Spatial Requirements.
(a) Administration and public suite. The following rooms or areas shall be 
provided. 
(1) Primary entrance. An entrance at grade level shall be accessible and 
protected from inclement weather with a drive-under canopy for loading and 
unloading passengers. 
(2) Lobby. A main lobby shall be located at the primary entrance and shall 
include a reception and information counter or desk, waiting space(s), public 
toilet facilities, public telephones, drinking fountain(s), and storage room or 
alcove for wheelchairs. 
(3) Admissions area. An admissions area shall include a waiting area, work 
counters or desk, private interview spaces, and storage room or alcove for 
wheelchairs. The waiting area and wheelchair storage may be shared with similar 
areas located in the main lobby. 
(4) General or individual office(s). Office space shall be provided for business 
transactions, medical and financial records, and administrative and professional 
staffs. 
(5) Multipurpose room(s). Room(s) shall be provided for conferences, meetings, 
and health education purposes including provisions for showing visual aids. 
(6) Storage. Storage for office equipment and supplies shall be provided. The 
construction protection for the storage room or area shall be in accordance with 
the National Fire Protection Association 101, Code for Safety to Life from Fire 
in Buildings and Structures, 1997 edition (NFPA 101), sec.12-3.1. All documents 
published by the NFPA as referenced in this section may be obtained by writing 
or calling the NFPA at the following address and telephone number: Post Office 
Box 9101, 1 Batterymarch Park, Quincy, Massachusetts 02269-9101, (800) 344-3555. 
(b) Cart cleaning and sanitizing unit. 
(1) Architectural requirements. 
(A) Cart cleaning, sanitizing and storage facilities shall be provided for carts 
serving central services, dietary services, and linen services. 
(B) Cart facilities may be provided for each service or be centrally located. 
(C) Hand washing fixtures shall be provided in cart cleaning, sanitizing and 
storage areas. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title (relating to New Construction Requirements) and 
this paragraph. 
(A) Flooring in the cart cleaning and sanitizing unit shall be of the seamless 
type, or ceramic or quarry tile as required by sec.133.162(d)(2)(B)(iii)(III) or 
(IV) of this title. 
(B) Ceilings in the cart cleaning and sanitizing unit shall be the monolithic 
type as required by sec.133.162(d)(2)(B)(vi)(III) of this title. 
(3) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) Hand washing fixtures shall be provided with hot and cold water. Hot and 
cold water fixtures shall be provided in cart cleaning and sanitizing locations. 
(B) Where floor drains or floor sinks are installed, they shall be of a type 
that can be easily cleaned by removal of the cover. Removable stainless steel 
mesh shall be provided in addition to a grilled drain cover to prevent entry of 
large particles of waste which might cause stoppages. Floor drains and floor 
sinks shall be located to avoid conditions where removal of covers for cleaning 
is difficult. 
(c) Central sterile supply suite. 
(1) Architectural requirements. 
(A) General. When obstetrical or surgical services are provided, the following 
rooms or areas shall be provided. 
(i) Decontamination room. This room shall be physically separated from all other 
areas of the suite. The room shall include work counters or tables, flush type 
utility sink, equipment for initial disinfection, and hand washing facilities 
with hands-free operable controls. Materials shall be transferred from the 
decontamination room to the clean assembly room by way of pass-through doors, 
windows or washer equipment. 
(ii) Clean assembly room. The room shall include counters or tables, equipment 
for sterilizing and hand washing facilities with hands-free operable controls. 
Clean and soiled work areas shall be physically separated.
(iii) Supply storage. A storage room for clean and sterile supplies shall be 
provided. The storage room shall have adequate areas and counters for breakdown 
of prepackaged supplies. 
(iv) Equipment storage. An equipment storage room shall be provided. 
(v) Cart storage room. The storage room for distribution carts shall be adjacent 
to clean and sterile storage and close to main distribution points. 
(B) Service areas. The central supply suite shall provide the following. 
(i) Office space. Office space for director of central services.
(ii) Staff toilets. Facilities may be outside the unit but must be convenient 
for staff use and shall contain hand washing fixtures with hands-free operable 
controls. 
(iii) Locker room. When provided, the locker room for staff shall include male 
and female dressing areas, lockers, toilets, lavatories, and showers. A central 
changing locker room may be shared and made available within the immediate area 
of the central sterile supply suite. 
(iv) Housekeeping room. A housekeeping room shall be provided and contain a 
floor receptor or service sink and storage space for housekeeping supplies and 
equipment. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. Mirrors shall not be installed at hand washing fixtures in clean 
and sterile supply areas. 
(B) Finishes. 
(i) Flooring used in the decontamination room and the clean assembly room shall 
be of the seamless type as required by sec.133.162(d)(2)(B)(iii)(III).
(ii) Ceilings in the decontamination room, clean assembly room, and supply 
storage room shall be the monolithic type in accordance with 
sec.133.162(d)(2)(B)(vi)(III). 
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) The sterile supply room and clean assembly room shall include provisions for 
ventilation, humidity, and temperature control. 
(B) When provided, installations of ethylene oxide (EO) sterilizers shall comply 
with the requirements of 30 Texas Administrative Code, sec.106.417 relating to 
ethylene oxide sterilizers, administered by the Texas Natural Resource 
Conservation Commission, and the following requirements. 
(i) All source areas shall be exhausted, including the sterilizer equipment 
room, service and aeration areas, over sterilizer door, and the aerator. If the 
EO cylinders are not located in a well ventilated unoccupied equipment space, an 
exhaust hood shall be provided over the cylinders. The relief valve shall be 
terminated in a well ventilated, unoccupied equipment space, or outside the 
building. If the floor drain which the sterilizer(s) discharge to is not located 
in a well ventilated, unoccupied equipment space, an exhaust drain cap shall be 
provided. 
(ii) General airflow shall be away from sterilizer operators and towards the 
sterilizers. 
(iii) A dedicated exhaust fan and an exhaust duct system shall be provided for 
EO sterilizers. The exhaust outlet to the atmosphere shall be located on the 
highest roof, directed upward, and not less than 25 feet from any air intake. 
(C) Filtration requirements for air handling units serving the central sterile 
supply suite shall be equipped with filters efficiencies equal to, or greater 
than specified in Table 4 of sec.133.169(d) of this title (relating to Tables). 
(D) Duct linings exposed to air movement shall not be used in ducts serving the 
central sterile supply suite unless terminal filters of at least 90% efficiency 
are installed downstream of linings. This requirement shall not apply to mixing 
boxes and acoustical traps that have special coverings over such lining. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title. When medical gas 
systems are provided, the systems shall comply with sec.133.162(d)(4) of this 
title. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph. Electrical circuit(s) to 
equipment in wet areas shall be provided with five milliampere GFCIs. 
(d) Critical care unit. 
(1) Architectural requirements. 
(A) General. When a critical care unit(s) (CCU) (also known as intensive care 
unit) is provided, the unit(s) may be classified as general CCU, coronary CCU 
(CCCU), pediatric CCU (PCCU) or newborn CCU (NCCU). 
(i) The CCU(s) shall be a separate suite(s) operated separately from other units 
of the hospital. The location shall be arranged to eliminate the need for 
through traffic. 
(ii) When elevator transport is required for critically ill patients, the size 
of the elevator cab, mechanisms and controls shall meet the specialized needs. 
(B) CCU services and facilities. The following services and facilities shall 
apply to all classifications of CCUs unless otherwise noted.
(i) The patient area (whether separate rooms, cubicles, or multiple bed space) 
shall have a minimum clear floor area of 150 square feet per bed exclusive of 
anterooms, vestibules, toilet rooms, closets, lockers, wardrobes, and/or 
alcoves. A minimum of 12 feet width shall be provided for the head wall for each 
bed. 
(ii) When an open ward plan is used, at least one private room for every six 
ward beds shall be provided for medical isolation or psychological needs. 
(iii) A minimum of one airborne infection isolation room shall be provided for 
each type of CCU suite. The number of airborne infection isolation rooms shall 
be determined based on an infection control risk assessment. Each room shall 
comply with requirements of sec.133.163(s)(1)(C)(ii), (v) and (vi) of this 
title. 
(iv) When private rooms or cubicles are provided, view panels in the door or 
walls of these rooms are required. Curtains or other means shall be provided to 
cover the viewing panels when visual privacy is required.
(v) Provisions for visual privacy shall be provided at each patient bed. In 
adult and pediatric units a minimum of six feet shall be provided between beds 
in an open ward, five feet between a bed and side wall, three feet between a bed 
and head wall, and four feet of passage space at the foot of each bed. 
(vi) Each room and ward shall be located on an exterior wall and shall have a 
window. In a ward, one window may serve more than one patient. The window sill 
height shall not exceed five feet above the floor. Patient beds shall not be 
located more than 50 feet from an exterior window. Patients' views to outside 
windows shall be direct and not through other clear vision panels. 
(vii) Hand washing fixtures with hands-free operable controls shall be located 
in or adjacent to the nurse station, in each room near the entrance to the room, 
at a ratio of one fixture to each four beds. Hand washing fixtures shall be 
sized to minimize splashing and conveniently distributed throughout the ward. 
(viii) The nurse station shall be located to permit direct visual observation of 
each patient served. Video cameras or mirrors shall not be substituted for 
direct visual observation. The nurse station shall have space for counters and 
storage. The nurse station may be combined with or include centers for reception 
and communication. 
(ix) Storage and preparation of medication may be done from a room, alcove area 
or from a self-contained dispensing unit but must be under visual control of 
nursing staff. A work counter, hand washing fixtures with hands-free operable 
controls, refrigerator, and double-locked storage for controlled substances 
shall be provided. Standard cup-sinks are not acceptable for hand washing. 
(x) An intravenous solution support shall be provided at each patient crib, bed 
or bassinet. The intravenous solution shall not be suspended directly over the 
patient. 
(xi) Storage space shall be provided for emergency equipment in the unit. 
(C) CCCU. When a CCCU is provided, the CCCU shall comply with the requirements 
contained in subparagraph (B) of this paragraph and the following.
(i) Each CCCU bed shall be in a separate room. Equipment for monitoring cardiac 
patients shall be provided by visual display both at the bed location and at the 
nurse station. 
(ii) Each coronary patient shall have direct access to a toilet and a hand 
washing fixture with hands-free operable controls (swivel type commodes may be 
utilized in lieu of individual toilet rooms, but provision must be made for 
patient privacy and odor control). The toilet room exhaust rate in accordance 
with Table 3 of sec.133.169(c) of this title. 
(iii) When medical, surgical, and coronary critical care services are combined 
in one CCU suite, at least 50% of the beds shall be located in private rooms. 
(Note: Medical/surgical patients may utilize open areas or private critical care 
rooms as needed and available but, insofar as possible, coronary patients should 
not be accommodated in open ward areas.) 
(D) PCCU. When a PCCU is provided, the unit shall comply with the requirements 
contained in subparagraph (B) of this paragraph and the following.
(i) The PCCU may be an open ward, private rooms, or combination of both. When an 
open ward plan is used, one private room is required for each 10 beds or 
fraction thereof. 
(ii) The clearances between cribs, beds and bassinets shall be at least eight 
feet. Aisles shall be at least eight feet wide. 
(iii) A sleeping space shall be provided for parents who spend long hours with 
the patient. This space may be within the patient room or separate from the 
patient area but shall be in communication with the PCCU staff. 
(iv) Hand washing fixtures with hands-free operable controls shall be provided 
in each room near the entrance to the room, and in open wards at a minimum ratio 
of one fixture to each four cribs, beds or bassinets. Hand washing fixtures 
shall be sized to contain splashing. 
(v) A room shall be provided for private discussions and shall be located 
within, or convenient to, the PCCU. The multipurpose room noted in subparagraph 
(G)(v) of this paragraph will meet this requirement if conveniently located. 
(vi) Storage space for infant formula shall be provided. This functional space 
may be outside the PCCU but shall be available for use at all times. 
(vii) Storage cabinets or closets for toys and games shall be provided within 
the unit. 
(viii) Storage area for cots, bed linens, and other items needed for overnight 
accommodation of parents shall be provided in the general location of sleeping 
accommodations. 
(ix) An examination/treatment room with a minimum of 120 square feet of clear 
floor area shall be located in or near the PCCU suite. The room shall contain a 
hand washing fixture with hands-free operable controls, storage facilities, 
counter, or shelf space for writing. 
(E) NCCU. When an NCCU is provided, the unit shall comply with the requirements 
contained in subparagraph (B) of this paragraph and the following: 
(i) The NCCU shall be conveniently located near the obstetrical suite and be 
arranged to preclude unrelated traffic. The NCCU shall be located on an exterior 
wall and have windows in accordance with subparagraph (B)(vi) of this paragraph. 
(ii) The NCCU shall have a clearly identified public entrance and reception area 
arranged to permit visual observation and contact with all traffic entering the 
unit. A scrub area shall be provided at each public entrance to the patient care 
area(s) of the NCCU. All sinks shall be hands-free operable and large enough to 
contain splashing. 
(iii) A control station shall be provided in a central area and shall have space 
for counters and storage, and shall have convenient access to hand washing 
fixtures with hands-free operable controls. The control station may be combined 
with or include centers for reception, communication and patient monitoring. 
(iv) NCCU patients may be housed in private rooms or a room with multiple 
bassinets or cribs. Each unit shall not exceed 24 bassinets or cribs. There 
shall be at least one enclosed private room for every six bassinets or cribs. 
(v) Clearance between warmers, incubators and bassinets shall be at least six 
feet and aisles shall be at least eight feet wide. Single-bed rooms and cubicles 
shall have a minimum clear area of 100 square feet. 
(vi) A lavatory equipped for hand washing with hands-free operable controls 
shall be provided in each single-bed room. In rooms with multiple beds, one 
lavatory with hands-free operable controls for each four patient stations shall 
be provided. These lavatories shall be located convenient to infant stations. 
(vii) Each NCCU shall be served by a connecting workroom containing gowning 
facilities at the entrance for staff and housekeeping personnel, a work space 
with counter, storage facilities, a lavatory or sink equipped for hand washing 
with hands-free operable controls, and individual closets or lockers for 
personal effects of nursing personnel. One workroom may serve not more than two 
NCCUs. 
(viii) Storage space for infant formula shall be provided. This functional space 
may be outside the NCCU but shall be available for use at all times. 
(ix) A breast feeding or pump room shall be provided convenient to the unit. 
Provision shall be made, either within the room or conveniently located nearby, 
for a sink with hands-free operable controls, counter, refrigeration and 
freezer, storage for pump and attachments, and educational materials.
(x) A sleeping space shall be required for parents who spend long hours with the 
neonate. This space may be separate from the unit, but must be in communication 
with the NCCU staff. 
(xi) At least one transition room shall be provided within or immediately 
adjacent to the NCCU that allows parents and infant extended private time 
together. This room shall have direct, private access to a sink with hands-free 
operable controls and toilet facilities, a bed for the parents, and 
communication linkage with NCCU staff. The room(s) can be used for other family 
educational, counseling, parent sleeping, or demonstration purposes when not 
needed as a transitional room. 
(xii) Charting and dictation space for physicians and nurses shall be provided. 
(xiii) A respiratory therapy work area and storage room shall be provided. 
(xiv) Blood gas lab facilities shall be immediately accessible to the NCCU. 
(xv) Physician sleeping facilities with access to a toilet and shower shall be 
provided. If not contained within the unit itself, the area shall have a 
telephone or intercom connection to the NCCU. 
(xvi) A separate toilet is not required in the airborne infection isolation room 
in the NCCU. 
(F) Additional service spaces. The following additional service spaces shall be 
immediately available within each type of CCU(s). These may be shared by more 
than one CCU (unless otherwise noted) provided that direct access is available 
from each. 
(i) Securable closets. Securable closets or cabinet compartments for the 
personal effects of nursing personnel, located in or near the nurse station, 
shall be provided. At a minimum, these shall be large enough for purses and 
billfolds. Coats may be stored in closets or cabinets on each floor or in a 
central staff locker area. 
(ii) Charting and dictation area(s) for physicians. Space for recording, record 
storage and reviews shall be provided near cribs, beds or bassinets. Dictation 
space may be in a separate room or alcove. Suitable space shall be provided when 
computers are used for the clinical records.
(iii) X-ray viewing area. Each type of CCU shall be provided with an x-ray 
viewing area and film illuminators for handling at least four films 
simultaneously. 
(iv) Nourishment station. The nourishment station shall contain a sink with 
hands-free operable controls, work counter, refrigerator, cabinets, and not be 
located in the medication room or the clean workroom. Space shall be included 
for temporary holding of unused or soiled dietary trays. A nourishment station 
is not required in the NCCU. 
(v) Ice machine. The ice machine shall provide ice for treatment and patient 
use. Ice-making equipment for treatment may be in the clean workroom or the 
nourishment station. 
(vi) Equipment storage. An equipment storage room shall have not less than 20 
square feet for each patient station. These storage areas shall be out of the 
way of the corridor traffic. 
(vii) Stretcher storage alcove. The alcove provided for stretcher or bassinet 
storage shall be located out of direct line of traffic. 
(viii) Clean workroom. The room shall contain a work counter, a hand washing 
fixture with hands-free operable controls, and storage facilities for clean and 
sterile supplies. 
(ix) Clean linen storage. There shall be a designated area for clean linen 
storage. This may be within a clean workroom, a separate closet, or an approved 
distribution system. If a closed cart system is used, storage of the cart may be 
in an alcove. 
(x) Soiled workroom. The soiled workroom shall contain a work counter, a 
clinical sink with hands-free operable controls or equivalent flushing rim type 
fixture with hot and cold mixing faucet, separate hand washing facilities, and 
separate waste and soiled linen receptacles. There shall be a designated soiled 
workroom strictly for the use of the NCCU. 
(xi) Soiled holding room. When provided, soiled holding rooms used only for 
temporary holding of soiled material may omit the clinical sink and work 
counter. 
(xii) Housekeeping room. A housekeeping room shall be provided within or 
immediately adjacent to the CCU. It shall not be shared with other nursing units 
or departments. 
(G) Other required areas/rooms. The following areas/rooms shall be provided and 
may be located outside the unit if conveniently accessible.
(i) Waiting space. A visitors' waiting space shall be provided with toilet 
facility(ies), public telephone(s), and drinking fountain(s). One waiting space 
may serve other CCUs. 
(ii) Offices. Room(s) shall be provided for critical care medical and nursing 
management and administrative personnel. The offices shall be large enough to 
permit consulting with members of the critical care team and visitors. The 
offices shall be linked with the unit by telephone or an intercommunications 
system. 
(iii) Staff lounge. A staff lounge shall include male and female toilet 
facilities with hand washing fixtures with hands-free operable controls. The 
lounge(s) shall be located so that staff may be recalled quickly to the patient 
area in emergencies. One lounge may serve multiple CCUs when the lounge is 
adjacent to the units. 
(iv) On-call rooms. Physicians and other staff on 24-hour on-call work schedules 
shall be provided with sleeping rooms with access to a shower(s), toilet(s), and 
lavatory(ies). If on-call room(s) are not within the CCU served, a dedicated 
telephone or intercom system shall connect the on-call room(s) to the CCU(s). 
(v) Multipurpose room(s). A multipurpose room for staff, patients, and patients' 
families for patient conferences, reports, education, training sessions, and 
consultation shall be provided. This room(s) must be accessible to each nursing 
unit. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) At least one door to a CCU room shall be not less than four feet wide and 
arranged to minimize interference with movement of beds and large equipment. 
(ii) Sliding doors in CCUs shall not have floor tracks and shall have hardware 
that minimizes jamming possibilities. 
(iii) Glazing in viewing panels shall be safety glass, wire glass, or clear 
plastic. 
(iv) When viewing windows are provided in an NCCU, provision shall be made to 
control casual viewing of infants. 
(v) Noise control and sound attenuation in an NCCU shall be a design factor and 
meet the requirements contained in Table 1 of sec.133.169(a) of this title. 
(vi) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where 
impact noises may be generated shall not be located directly over CCU(s), unless 
special provisions are made to minimize such noise. 
(B) Finishes. 
(i) Flooring used in soiled workrooms shall be of the seamless type as required 
by sec.133.162(d)(2)(B)(iii)(III). 
(ii) Ceilings in the soiled workroom shall be monolithic type as required by 
sec.133.162(d)(2)(B)(vi)(III). 
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph. Room recirculating units 
shall not be used. 
(4) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) Receptacles at each bed location in a CCU(s) shall be served by two branch 
circuits, one or more from the critical branch panel of the emergency electrical 
system and one or more from the normal system. One critical branch circuit shall 
serve only one bed location. All branch circuits from the normal system shall be 
from a single panelboard. All branch circuits from the emergency electrical 
system shall be from a single panelboard.
(ii) A minimum of seven hospital grade duplex outlets shall be conveniently 
located at the head of each bed, crib or bassinet. At least three of the these 
duplex outlets shall be on the critical branch of the emergency electrical 
system. 
(iii) Hospital grade receptacles in the PCCU shall be tamper resistant or 
provided with GFCIs. 
(iv) Indirect lighting and high-intensity lighting shall be provided in the 
NCCU(s). Ambient lighting levels shall be adjustable through a range of at least 
10 to 60 lux (approximately one to six foot candles), as measured at each 
patient care station. Separate procedure lighting shall be available at each 
patient care station that provides no more than 1500 to 2000 lux (150 to 200 
foot candles) of illumination. This lighting shall minimize shadow and glare and 
be adjustable and highly framed so babies at adjacent patient care stations will 
not experience an increase in illumination. General lighting shall not be 
located directly above the neonate. 
(B) Nurses calling systems. 
(i) Nurses regular calling system. The nurses regular calling system shall be 
provided for any CCU individual patient bed in accordance with 
sec.133.162(d)(5)(L)(i) of this title. A nurses regular calling system is not 
required for an NCCU. In critical care areas where patients are under constant 
visual surveillance, the nurses regular calling system may be limited to a 
bedside button or station that activates a signal readily seen at the control 
station. 
(ii) Nurses emergency calling system. A nurse emergency call station shall be 
provided at each patient toilet, bath, and shower room in accordance with 
sec.133.162(d)(5)(L)(ii). 
(iii) Staff emergency assistance calling system. A staff emergency assistance 
calling system (code blue) shall be provided in any CCU in accordance with 
section sec.133.162(d)(5)(L)(iii) of this title. 
(e) Dietary suite. 
(1) Architectural requirements. 
(A) General. Construction, equipment, and installation shall comply with the 
standards specified in United States Department of Health and Human Services, 
Public Health Service, Food and Drug Administration, Food Service Sanitation 
Manual, Department of Health, Education, and Welfare publication number (FDA) 
78-2081, and sec.sec.229.161-229.171 of this title (relating to Rules on Food 
Service Sanitation). 
(B) Food service facilities. Food services shall be provided by an on-site food 
preparation system or an off-site food service system or a combination of the 
two. The following minimum functional elements shall be provided on-site 
regardless of the type of dietary services. 
(i) Dining area. Provide dining space(s) for ambulatory patients, staff, and 
visitors. These spaces shall be separate from the food preparation and 
distribution areas. 
(ii) Receiving area. This receiving area shall have direct access to the outside 
for incoming dietary supplies or off-site food preparation service and shall be 
separate from the general receiving area. The receiving area shall contain a 
control station and an area for breakout for loading, unloading, uncrating, and 
weighing supplies. The entrance area to the receiving area shall be covered from 
the weather. 
(iii) Storage spaces. Storage spaces shall be convenient to receiving area and 
food preparation area and shall be located to exclude traffic through the food 
preparation area. Regardless of the type of food services provided, the facility 
shall provide storage of food for emergency use for a minimum of four calendar 
days. 
(I) Storage space(s). Storage space(s) shall be provided for bulk, refrigerated, 
and frozen foods. 
(II) Cleaning supply storage. This room or closet shall be used to store non-
food items that might contaminate edibles. This storage area may be combined 
with the housekeeping room. 
(iv) Food preparation area. Counter space shall be provided for food prep work, 
equipment, and an area to assemble trays for distribution for patient meals. 
(v) Icemaking equipment. Icemaking equipment shall be provided for both drinks 
and food products (self-dispensing equipment) and for general use (storage-bin 
type equipment). 
(vi) Hand washing. Hand washing fixtures with hands-free operable controls shall 
be conveniently located at all food preparation areas and serving areas. 
(vii) Food service carts. When a cart distribution system is provided, space 
shall be provided for storage, loading, distribution, receiving, and sanitizing 
of the food service carts. The cart traffic shall be designed to eliminate any 
danger of cross-circulation between outgoing food carts and incoming soiled 
carts, and the cleaning and sanitizing process. Cart circulation shall not be 
through food processing areas. 
(viii) Ware washing room. A ware washing room equipped with commercial type 
dishwasher equipment shall be located separate from the food preparation and 
serving areas. Space shall be provided for receiving, scraping, sorting, and 
stacking soiled tableware and for transferring clean tableware to the using 
areas. Hand washing facilities with hands-free operable controls shall be 
located within the soiled dish wash area. A physical separation to prevent cross 
traffic between "dirty side" and "clean side" of the dish wash areas shall be 
provided. 
(ix) Pot washing facilities. A three compartmented sink of adequate size for 
intended use shall be provided convenient to the food preparation area. 
Supplemental heat for hot water to clean pots and pans shall be by booster 
heater or by steam jet. 
(x) Waste storage room. A food waste storage room shall be conveniently located 
to the food preparation and ware washing areas but not within the food 
preparation area. It shall have direct access to the hospital's waste collection 
and disposal facilities. 
(xi) Sanitizing facilities. Storage areas and sanitizing facilities for garbage 
or refuse cans, carts, and mobile tray conveyors shall be provided. All 
containers for trash storage shall have tight-fitting lids. 
(xii) Housekeeping room. A housekeeping room shall be provided for the exclusive 
use of the dietary department. Where hot water or steam is used for general 
cleaning, additional space within the room shall be provided for the storage of 
hoses and nozzles. 
(xiii) Office spaces. An office shall be provided for the use of the food 
service manager or the dietary service manager. In smaller facilities, a 
designated alcove may be located in an area that is part of the food preparation 
area. 
(xiv) Toilets and locker spaces. A toilet room(s) shall be provided for the 
exclusive use of the dietary staff. Toilets shall not open directly into the 
food preparation areas, but must be in close proximity to them. For larger 
facilities, a locker room or space for lockers shall be provided for staff 
belongings. 
(C) Additional service areas, rooms and facilities. When an on-site food 
preparation system is used, in addition to the items required in subparagraph 
(B), the following service areas, rooms and facilities shall be provided. 
(i) Food preparation facilities. When food preparation systems are provided, 
there shall be space and equipment for preparing, cooking, and baking. 
(ii) Tray assembly line. A patient tray assembly and distribution area shall be 
located within close proximity to the food preparation and distribution areas. 
(iii) Food storage. When food is prepared on-site, the storage room shall be 
adequate to accommodate food for a seven calendar day menu cycle.
(iv) Additional storage room(s). An additional room(s) shall be provided for the 
storage of cooking wares, extra trays, flatware, plastic and paper products, and 
portable equipment. 
(v) Drying storage area. Provisions shall be made for drying and storage of pots 
and pans from the pot washing room. 
(D) Equipment. Equipment for use in the dietary suite shall meet the following 
requirements. 
(i) Mechanical devices shall be heavy duty, suitable for the use intended, and 
easily cleaned. Where equipment is movable, provide heavy duty locking casters. 
Equipment with fixed utility connections shall not be equipped with casters. 
(ii) Floor, wall, and top panels of walk-in coolers, refrigerators, and freezers 
shall be insulated. Coolers and refrigerators shall be capable of maintaining a 
temperature down to freezing. Freezers shall be capable of maintaining a 
temperature of 20 degrees below 0 degrees Fahrenheit. Coolers, refrigerators, 
and freezers shall be thermostatically controlled to maintain desired 
temperature settings in increments of two degrees or less. Interior temperatures 
shall be indicated digitally and visible from the exterior. Controls shall 
include audible and visible high and low temperature alarm. The time of alarm 
shall be automatically recorded. 
(iii) Walk-in units may be lockable from the outside but must have a release 
mechanism for exit from inside at all times. The interior shall be lighted. All 
shelving shall be corrosion resistant, easily cleaned, and constructed and 
anchored to support a loading of at least 100 pounds per linear foot. 
(iv) All cooking equipment shall be equipped with automatic shut-off devices to 
prevent excessive heat buildup. 
(E) Vending services. When vending machines are provided for unscheduled meals, 
a dedicated room with a seating area shall be located so that access into the 
room is available at all times. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Food storage shelves shall not be less than four inches above the finished 
floor and the space below the bottom shelf shall be closed in and sealed tight 
for ease of cleaning. 
(ii) Operable windows and doors not equipped with automatic closing devices 
shall be equipped with insect screens. 
(iii) Food processing areas in the central dietary kitchen shall have ceiling 
heights not less than nine feet. Ceiling mounted equipment shall be supported 
from rigid structures located above the finished ceiling.
(iv) Mirrors shall not be installed at hand washing fixtures in the food 
preparation areas. 
(B) Finishes. 
(i) Floors in areas used for food preparation, food assembly, soiled and clean 
ware cleaning shall be water-resistant and grease-proof. Floor surfaces, 
including tile joints, shall be resistant to food acids.
(ii) Wall bases in food preparation, food assembly, soiled and clean ware 
cleaning and other areas which are frequently subject to wet cleaning methods 
shall be made integral and coved with the floor, tightly sealed to the wall, 
constructed without voids that can harbor insects, retain dirt particles, and be 
impervious to water. 
(iii) In the dietary and food preparation areas, the wall construction, 
finishes, and trim, including the joints between the walls and the floors, shall 
be free of voids, cracks, and crevices. 
(iv) The ceiling in food preparation and food assembly areas shall be washable 
as required by sec.133.162(d)(2)(B)(vi)(II). 
(v) The ceiling in the soiled and clean ware cleaning area shall be of the 
monolithic type as required by sec.133.162(d)(2)(B)(vi)(III).
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) Exhaust hoods handling grease-laden vapors in food preparation centers shall 
comply with National Fire Protection Association 96, Standard for Ventilation 
Control and Fire Protection of Commercial Cooking Operations, 1994 edition. All 
hoods over cooking ranges shall be equipped with grease filters, fire 
extinguishing systems, and heat-actuated fan controls. Clean out openings shall 
be provided every 20 feet and at any changes in direction in the horizontal 
exhaust duct systems serving these hoods. (Horizontal runs of ducts serving 
range hoods should be kept to a minimum.) 
(B) When air change standards in Table 3 of sec.133.169(c) of this title do not 
provide sufficient air for proper operation of exhaust hoods (when in use), 
supplementary filtered makeup air shall be provided in these rooms to maintain 
the required airflow direction and exhaust velocity. Makeup systems for hoods 
shall be arranged to minimize "short circuiting" of air and to avoid reduction 
in air velocity at the point of contaminant capture. 
(C) Air handling units serving the dietary suite shall be equipped with filters 
having efficiencies equal to, or greater than specified in Table 4 of 
sec.133.169(d) of this title. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) The kitchen grease traps shall be located and arranged to permit easy access 
without the need to enter food preparation or storage areas. Grease traps shall 
be of capacity required and shall be accessible from outside of the building 
without need to interrupt any services. 
(B) Grease traps or grease interceptors shall be located outside the food 
preparation area and shall comply with the requirements in the National 
Association of Plumbing-Heating-Cooling Contractors (PHCC), National Standard 
Plumbing Code, 1996 edition. This publication may be obtained from the National 
Association of Plumbing-Heating-Cooling Contractors, 180 South Washington 
Street, Falls Church, VA 22046; telephone (703) 237-8100. 
(C) The material used for plumbing fixtures shall be non-absorptive and acid-
resistant. 
(D) Water spouts used at lavatories and sinks shall have clearances adequate to 
avoid contaminating utensils and containers. 
(E) Hand washing fixtures used by food handlers shall be trimmed with valves 
that can be operated without hands. Single lever or wrist blade devices may be 
used. Blade handles used for this purpose shall not be less than four inches in 
length. 
(F) Drainage and waste piping shall not be installed within the ceiling or 
installed in an exposed location in food preparation centers, food serving 
facilities and food storage areas unless special precautions are taken to 
protect the space below from leakage and condensation from necessary overhead 
piping. 
(G) No plumbing lines may be exposed overhead or on walls where possible leaks 
would create a potential for food contamination. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) Exhaust hoods shall have an indicator light indicating that the exhaust fan 
is in operation. 
(B) The electrical circuit(s) to equipment in wet areas shall be provided with 
five milliampere GFCI. 
(f) Emergency suite. 
(1) Architectural requirements. 
(A) General. Levels of emergency care range from elementary first aid to 
emergency surgical procedures. However, for these rules, emergency services are 
described in three broad categories: first aid, trauma, and emergency clinic. 
(i) General hospitals shall comply with at least subparagraph
(B) of this paragraph. 
(ii) Special hospitals shall comply with at least subparagraph (B)(v) of this 
paragraph. In special hospitals, the emergency treatment room may be located 
anywhere in the hospital. 
(B) Emergency first aid suite. The emergency first aid suite shall be located on 
the grade level. The following minimum facilities shall be provided. 
(i) Entrances. Separate ambulance and pedestrian entrances at grade level shall 
be well-illuminated, identified by signs, and protected from inclement weather. 
The emergency access to permit discharge of patients from automobile and 
ambulances shall be paved. Parking shall be provided near and convenient to the 
pedestrian entrance. 
(ii) Control station. A registration, reception, discharge, triage, and control 
station shall be located to permit staff observation and control of access to 
treatment room(s), pedestrian and ambulance entrances, and public waiting 
area(s). 
(iii) Public waiting room. A public waiting room shall be provided. 
(iv) Public facilities. Toilet facilities, public telephone(s), and drinking 
fountain(s) shall be provided for the exclusive use of the waiting room. 
(v) Emergency treatment room. As a minimum requirement, a hospital shall provide 
at least one emergency treatment room to handle emergencies. Such room shall 
meet the following requirements. 
(I) The emergency treatment room for a single patient shall have a minimum clear 
area of 120 square feet clear floor area exclusive of fixed and movable cabinets 
and shelves. The minimum clear room dimension exclusive of fixed cabinets and 
built-in shelves shall be 10 feet. The emergency treatment room shall contain 
cabinets, medication storage, work counter, examination light, and hand washing 
fixtures with hands-free operable controls. 
(II) A multiple-bed emergency treatment room shall have a minimum of 80 square 
feet clear floor area per patient cubicle with a minimum dimension of eight feet 
exclusive of fixed and movable cabinets and shelves. The multiple-bed emergency 
treatment room shall contain cabinets, medication storage, work counter, 
examination light, and hand washing fixtures with hands-free operable controls. 
(III) Storage space shall be provided within the room or suite and be under 
staff control for general medical surgical emergency supplies and medications. 
Adequate space shall be provided for emergency equipment such as emergency 
treatment trays, ventilator, defibrillator, splints, cardiac monitor, etc. 
(vi) Holding area. When a holding area is provided, each patient holding unit 
shall have a minimum clear floor area of 100 square feet. The area shall include 
a nurse station, storage space for medical supplies, cubicle curtains, and one 
hand washing fixture with hands-free operable controls per each four patient 
holding units. 
(vii) Isolation room. The need for an airborne infection isolation room in the 
emergency suite shall be determined by the hospital and the infection control 
risk assessment. When the hospital provides treatment rooms to perform 
procedures on persons who are known or suspected of having an airborne 
infectious disease, these procedures shall be performed in a designated 
treatment room meeting airborne infection isolation ventilation requirements. 
The isolation room shall have functional space in accordance with subsection 
(s)(1)(c) of this section, and meet the ventilation requirements contained in 
Table 3 of sec.133.169(c) of this title. 
(viii) Secured holding room. When provided, this room shall be constructed to 
allow for security, patient and staff safety, patient observation, and sound 
proofing. 
(ix) Orthopedic and cast room. When provided, these may be in separate room(s) 
or in the trauma room. The room(s) shall contain a work counter, storage for 
splints and orthopedic supplies, traction hooks, medication storage, examination 
light, and hand washing fixtures with hands-free operable controls. When a cast 
room is provided it shall be equipped with hand washing facilities, plaster 
sink, storage, and other provisions required for cast procedures. 
(x) Service areas. The following service areas shall be provided.
(I) Diagnostic radiographic (X-ray) room. Imaging facilities for diagnostic 
services shall be readily available to the emergency suite. If a separate 
radiographic (X-ray) room is installed within the emergency suite, it shall 
comply with the requirements in subsection (l) of this section and have a clear 
floor space of not less than 180 square feet. 
(II) Film processing room. When a radiographic (X-ray) room is provided, a 
darkroom for processing film shall be provided unless the processing equipment 
does not require a darkroom for loading and transfer. When daylight processing 
is used, the darkroom may be minimal for emergency and special uses. Film 
processing shall be located convenient to the darkroom. 
(III) Laboratory unit. Laboratory services shall be made available to the 
emergency suite. If a separate laboratory unit is installed within the emergency 
suite, it shall comply with the requirements in subsection (m) of this section. 
All laboratory services provided on-site or by contractual arrangement shall 
comply with sec.133.41(h) of this title (relating to Hospital Functions and 
Services). 
(IV) Medical staff work area and charting area(s). A medical staff work area and 
charting area(s) shall be provided. The area may be combined with the reception 
and control area. 
(V) Locked storage space. Locked storage space shall be provided for drugs and 
an area for preparation of medication with a work counter, refrigerator, and 
hand washing fixture with hands-free operable controls. 
(VI) Stretcher and wheelchair storage alcove. The alcove provided for stretcher 
and wheelchair storage shall be located out of line of traffic.
(VII) Clean storage room. A clean storage room shall be provided for clean 
supplies, linens and medications as needed. Hand washing fixtures shall be 
provided with hands-free operable controls. 
(VIII) Soiled workroom. The workroom shall contain a work counter, a clinical 
sink or equivalent flushing type fixture, hand washing fixture with hands-free 
operable controls, waste receptacles, and soiled linen receptacles. 
(IX) Housekeeping room. The housekeeping room shall contain a floor receptor or 
service sink, storage space for housekeeping supplies and equipment, and be 
located within the suite. When automatic film processors are used, a receptacle 
of adequate size with hot and cold water for cleaning the processor racks shall 
be provided. 
(X) Patient toilet(s). Toilet room(s) shall be provided and shall be convenient 
to treatment rooms, examination rooms, and holding rooms.
(XI) Staff toilets. Toilets may be outside the suite but shall be convenient for 
staff use and include hand washing fixtures with hands-free operable controls. 
When a suite has four or more treatment or examination rooms, toilet facilities 
shall be in the suite. 
(C) Trauma center. When provided, a trauma center shall comply with subparagraph 
(B) of this paragraph and in addition contain the following.
(i) Trauma room. A minimum of one trauma room shall be provided with 250 square 
feet of clear floor area exclusive of aisles and fixed and moveable cabinets and 
shelves. The minimum clear dimension between fixed cabinets and built-in shelves 
shall be 12 feet. The trauma room shall contain a work counter, cabinets, 
medication storage, examination light, and hand washing fixture with hands-free 
operable controls. 
(ii) Multiple station trauma room. When multiple patient stations are provided, 
a minimum clear floor area of 250 square feet shall be provided for each patient 
station. Provisions shall be made for sound reduction and visual privacy between 
multiple stations. 
(iii) Scrub facilities. A scrub station shall be located in or near the entrance 
to each trauma room. Scrub facilities shall be arranged to minimize any 
incidental splatter on nearby personnel or supply carts. 
(iv) Doorways. All doorways openings from the ambulance entrance to the trauma 
room shall be a minimum of five feet wide. 
(D) Emergency clinic. When an emergency clinic (which may also be referred to as 
"urgent care," "fast track," "express care," "minor care", etc.) is provided, 
the clinic shall be separate and distinct from the emergency first aide and 
trauma suite and shall meet all the requirements of subparagraph (B) of this 
paragraph. All facilities required by subparagraph (B) of this paragraph may be 
shared except for the public waiting room, the public facilities, and the 
emergency treatment room. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. Trauma rooms shall have ceiling heights not less than nine feet. 
(B) Finishes. 
(i) Flooring used in trauma rooms, treatment room, examination room, holding 
area, and soiled workroom shall be of the seamless type as required by 
sec.133.162(d)(2)(B)(iii)(III) of this title. 
(ii) Ceilings in soiled workrooms, isolation rooms, and trauma rooms shall be of 
the monolithic type as required by sec.133.162(d)(2)(B)(vi)(III) of this title. 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph. Duct linings exposed to air 
movement shall not be used in ducts serving any trauma rooms, treatment rooms, 
examination rooms, holding areas, and clean room. This requirement shall not 
apply to mixing boxes and acoustical traps that have special coverings over such 
lining. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) Medical gas systems. Medical gas systems shall be provided in accordance 
with sec.133.162(d)(4)(A)(iii) of this title. 
(B) An ice machine shall be provided and shall be located in the clean utility 
room. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) Each treatment and examination room in the emergency first aid suite and 
trauma center shall have a minimum of six duplex electrical receptacles located 
convenient to the head of each bed. 
(ii) Each treatment and examination room in the emergency clinic suite shall 
have a minimum of four duplex electrical receptacles located convenient to the 
head of each bed/table. 
(iii) Each work counter and table shall have access to two duplex receptacles 
connected to the critical branch of the emergency electrical system and be 
labeled with panel and circuit number. 
(iv) The hospital shall provide X-ray film illuminators for handling at least 
four films simultaneously in all treatment, examination, and trauma rooms. 
(B) Nurses calling systems. 
(i) Nurses regular calling system. A nurses regular calling system shall be 
provided for treatment room, examination room, isolation room, holding and 
observation rooms/area in accordance with sec.133.162(d)(5)(L)(i) of this title. 
In areas such as multiple-bed examination or treatment room, holding and 
observation areas where patients are under constant visual surveillance, the 
nurses regular calling system may be limited to a bedside button or station that 
activates a signal readily seen at the control station. 
(ii) Staff emergency assistance calling system. A staff emergency assistance 
call system (code blue), in accordance with section sec.133.162(d)(5)(L)(iii) of 
this title, shall be provided for staff to summon additional assistance to each 
examination room, treatment room and multiple purpose room. 
(g) Employees suite. 
(1) General. In addition to employee facilities such as locker rooms, lounges, 
toilets, or showers required in certain departments, a sufficient number of such 
facilities shall be provided to accommodate the needs of all personnel and 
volunteers. 
(2) Physician locker rooms. If both male and female physicians are members of 
the hospital staff, then, in reasonable proportion to the ratio of male-to-
female physicians on the hospital staff, equitable locker facilities including 
equipment, similar luxuries, and equal access to uniforms shall be provided for 
both sexes. 
(h) Engineering suite and equipment areas. 
(1) General. The following facilities shall be provided: 
(A) an engineer's office with file space and provisions for protected storage of 
facility drawings, records, manuals, etc.; 
(B) a general maintenance shop(s) for repair and maintenance;
(C) a separate room(s) for building maintenance supplies and equipment. Storage 
of bulk solvents and flammable liquids shall be in a separate building and not 
within the hospital building; 
(D) a medical equipment room which includes provisions for the storage, repair, 
and testing of electronic and other medical equipment;
(E) a separate room or building for yard maintenance equipment and supplies. 
When a separate room is within the physical plant the room shall be located so 
that equipment may be moved directly to the exterior. Yard equipment or vehicles 
using flammable liquid fuels shall not be stored or housed within the general 
hospital building; and 
(F) sufficient space in all mechanical and electrical equipment rooms for proper 
maintenance of equipment. Provisions shall also be made for removal and 
replacement of equipment. 
(2) Additional areas or room(s). Additional areas or room(s) for mechanical, and 
electrical equipment shall be provided within the physical plant or installed in 
separate buildings or weatherproof enclosures with the following exceptions. 
(A) An area shall be provided for cooling towers and heat rejection equipment 
when such equipment is used. 
(B) An area for the medical gas park and equipment shall be provided. For 
smaller medical gas systems, the equipment may be housed in a room within the 
physical plant in accordance with National Fire Protection Association 99, 
Standard for Health Care Facilities, 1996 edition (NFPA 99), Chapters 4 and 8. 
(C) When provided, compactors, dumpsters, and incinerators shall be located in 
an area remote from public entrances. 
(i) General stores. 
(1) General. In addition to storage facilities in individual departments, a 
central storage room shall also be provided. General stores may be located in a 
separate building on-site with provisions for protection against inclement 
weather during transfer of supplies. 
(2) Receiving. Facilities for central storage areas shall be provided with an 
off-street unloading and receiving area protected from inclement weather. 
(3) General storage room. General storage room with a total area of not less 
than 20 square feet per inpatient bed shall be provided. The storage room may be 
within the facility, or separate building on-site. A portion of the storage may 
be provided off-site. 
(4) Outpatient suite storage room. A storage room for the outpatient services 
shall be provided at least equal to 5.0% of the total area of the outpatient 
suite. This required storage room area may be combined with general stores. 
(j) Hospital based skilled nursing units. 
(1) Architectural requirements. When a hospital based skilled nursing unit is 
provided, each unit shall comply with the requirements contained in 
subsection(s)(1) of this section and the requirements listed below. The skilled 
nursing unit may be separated from the rest of the hospital with two-hour fire 
protection rated construction in order to define areas for certification 
inspections. 
(A) At least 50% of patient rooms and bathrooms and all public and common use 
areas in a newly constructed, or in an existing nursing unit which is totally 
reconstructed to a hospital based skilled nursing unit, are required to be 
handicapped accessible in accordance with sec.133.162(d)(1)(F) of this title. 
(B) At least 10% of patient rooms and bathrooms and all public and common use 
areas shall be made handicapped accessible in accordance with 
sec.133.162(d)(1)(F) of this title when remodeling an existing nursing unit to a 
hospital based skilled nursing unit. 
(C) Activity and dining space shall be part of the unit. It may be located in a 
separate room or open to the corridor. The floor area of this space shall 
provide at least 30 square feet per patient bed with a minimum of 160 square 
feet. Additional space may be required if this space is also used for other 
programs. 
(D) When physical and occupational therapy services are provided for 
rehabilitating patients, spaces and equipment that conform to program intent 
shall be provided. These spaces may be located in the unit or elsewhere in the 
hospital. 
(E) A toilet training room shall be provided with three feet of clearance at the 
front and at each side of the water closet fixture. A hand washing fixture with 
hands-free operable controls shall be located within the training toilet room. 
The room shall be designed to comply with the handicapped accessibility 
requirements of sec.133.162(d)(1)(F) of this title. 
(F) Each unit shall have at least one wheelchair shower room or tub room per 
floor or nursing unit sized to permit assisted bathing. The bathtub shall be 
accessible to patients in wheelchairs and the shower shall accommodate a shower 
gurney. The room shall be centrally located and shall be directly accessible 
from the corridor. The room shall have space for drying and dressing and 
provided with hand washing and toilet facilities with three feet of clear space 
on sides and front of the water closet. 
(G) A housekeeping room shall be provided for the exclusive use of the unit. It 
shall be located adjacent to or shall be accessible from the activity and dining 
space. 
(2) Details and finishes. Each unit shall comply with the requirements contained 
in subsection (s)(2) of this section and this paragraph. 
(A) All portions of corridor walls in the unit with an uninterrupted length of 
two feet or more shall have graspable handrails. The handrails shall comply with 
NFPA 101, sec.5-2.2.4, and the provisions found in the Texas Assessibility 
Standards of the Architectural Barriers Act, Texas Civil Statutes, Article 9102. 
No handrail shall protrude more than three and one-half inches into the egress 
corridor. All handrail ends shall be returned to the wall.
(B) Floor finishes shall comply with the requirements of 
sec.133.162(d)(2)(B)(iii)(III) of this title. 
(3) Mechanical requirements. Mechanical requirements in each unit shall be in 
accordance with subsection (s)(3) of this section.
(4) Plumbing fixtures and piping systems. The plumbing fixtures and piping 
systems shall be in accordance with subsection (s)(4) of this section. 
(5) Electrical Requirements. Electrical requirements shall be in accordance with 
subsection (s)(5) of this section. 
(k) Hyperbaric suite. 
(1) Architectural requirements. When a hyperbaric suite is provided, it shall 
meet the requirements of Chapter 19, NFPA 99, and Chapter 12, NFPA 101. 
(A) Hyperbaric chamber clearances. Minimum clearances between individual (Class 
B) hyperbaric chambers shall be as follows: Chamber and side wall, five feet; 
between chambers, six feet; and between the chamber headboard and the wall, 
three feet. A minimum passage space of four feet shall be provided at the foot 
of each chamber. 
(B) Service areas. The following minimum service areas and facilities shall be 
provided. 
(i) Patient waiting area. The area shall be out of traffic, under staff control, 
and shall have seating capacity in accordance with the functional program. When 
the hyperbaric suite is routinely used for outpatients and inpatients at the 
same time, separate waiting areas shall be provided with screening for visual 
privacy between the waiting areas. Patient waiting areas may be omitted for two 
or less individual hyperbaric chamber units.
(ii) Control desk and reception area. A control desk and reception area shall be 
provided. 
(iii) Holding area. A holding area under staff control shall accommodate 
inpatients on stretchers or beds. Stretcher patients shall be out of the direct 
line of normal traffic. The patient holding area may be omitted for two or less 
individual hyperbaric chamber units. 
(iv) Patient toilet rooms. Toilet rooms shall be provided with hand washing 
fixtures with hands-free operable controls with direct access from the 
hyperbaric suite. 
(v) Patient dressing rooms. Dressing rooms for outpatients shall be provided and 
shall include a seat or bench, mirror, and provisions for hanging patients' 
clothing and for securing valuables. At least one dressing room shall be 
provided to accommodate wheelchair patients. 
(vi) Staff facilities. Toilets with hand washing fixtures with hands-free 
operable controls may be outside the suite but shall be convenient for staff 
use. 
(vii) Consultation room. An appropriate room for individual consultation with 
referring clinicians shall be provided for outpatients.
(viii) Storage space. A clean storage space shall be provided for clean supplies 
and linens. Hand washing fixtures shall be provided with hands-free operable 
controls. When a separate storage room is provided, it may be shared with 
another department. 
(ix) Soiled holding room. A soiled holding room shall be provided with waste 
receptacles and soiled linen receptacles. 
(x) Hand washing. A lavatory equipped for hand washing with hands-free operable 
controls shall be located in the room where the hyperbaric chambers are located. 
(xi) Housekeeping room. The housekeeping room shall contain a floor receptor or 
service sink, storage space for housekeeping supplies and equipment, and be 
located nearby. 
(2) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) Grounding of hyperbaric chambers shall be connected only to the equipment 
ground in accordance with NFPA 99, sec.3-3.2.1.2, and National Fire Protection 
Association 70, National Electrical Code, 1996 edition, (NFPA 70), Article 250 
(A)-(C), and Article 517. 
(B) Additional grounds such as earth or driven grounds shall not be permitted. 
(l) Imaging suite. 
(1) Architectural requirements. 
(A) General. Each hospital shall have a diagnostic radiographic (X-ray) room 
convenient to emergency, surgery, cystoscopy, and outpatient suites. 
(i) When additional diagnostic imaging services such as fluoroscopy, 
mammography, tomography, computerized tomography scanning, ultrasound, magnetic 
resonance, angiography, and other similar techniques are provided, room(s) sizes 
shall be sufficient to house equipment and allow a minimum of five feet of clear 
working space on all sides of the equipment accessible to staff and patient. 
(ii) When radiation protection is required for any diagnostic imaging room, a 
qualified physicist shall specify the type, location, and amount of radiation 
protection to be installed for the layout and equipment selections. 
(iii) Each X-ray room shall include a shielded control alcove. The control 
alcove shall be provided with a view window designed to permit full view of the 
examination table and the patient at all times. 
(iv) Warning signs capable of indicating that the equipment is in use shall be 
provided. 
(v) Diagnostic and procedure room intended for patients with airborne infectious 
diseases shall meet the ventilation requirements as contained in Table 3 of 
sec.133.169(c) of this title. 
(B) Diagnostic X-ray and radiographic and fluoroscopy (R & F) rooms. X-ray and R 
& F rooms shall have a minimum clear floor area of 250 square feet exclusive of 
built-in shelves or cabinets. Area requirement does not apply to a dedicated 
chest X-ray room. 
(i) A control alcove shall be provided with a view window designed to provide 
full view of the patient at all times. 
(ii) A toilet room shall be provided including a hand washing fixture with 
hands-free operable controls and have direct access to each R & F room and a 
corridor. 
(C) Angiography imaging room. When provided, the room shall have minimum clear 
floor area of 400 square feet exclusive of built-in shelves or cabinets. 
(i) A control alcove shall be provided with a view window designed to provide 
full view of the patient at all times. 
(ii) A viewing room or area shall be provided and shall be a minimum of 10 feet 
in length. The viewing room or area may be provided in combination with the 
control room. 
(iii) A scrub sink shall be near the entrance to each angiographic room and 
shall be recessed out of the main traffic areas or corridor. Scrub facilities 
shall be arranged to minimize any incidental splatter on nearby personnel or 
supply carts. 
(iv) Storage space for portable equipment and catheters shall be provided. 
(v) When angiographic services for outpatients are provided, a room for extended 
post-procedure observation of patients shall be provided.
(D) Computerized tomography (CT) scanning. When CT services are provided, the CT 
room(s) size shall be sufficient to house equipment and allow a minimum of five 
feet of clear working space on all sides of equipment.
(i) A control room shall be provided with a view window permitting view of the 
patient. The control room shall be located to allow convenient film processing. 
(ii) A separate computer room shall be provided to accommodate the equipment. 
(iii) A patient toilet shall be provided conveniently to the procedure room. 
When directly accessible to the scan room, the toilet shall be arranged so that 
a patient may leave the toilet room without having to re-enter the scan room. 
The toilet room shall have a hand washing fixture with hands-free operable 
controls. 
(E) Mammography. When mammography services are provided, the room(s) shall have 
a minimum clear floor area of 100 square feet exclusive of built-in shelves or 
cabinets. 
(i) A control alcove shall be provided with a view window designed to provide 
full view of the patient at all times. 
(ii) When mammography machines with built-in shielding for the operator are 
provided, the alcove may be omitted when approved by the qualified physicist. 
(F) Magnetic resonance imaging (MRI). When MRI services are provided, the room 
shall be of sufficient size to house equipment but no less than 325 square feet 
of clear floor area exclusive of built-in shelves or cabinets. 
(i) A control alcove shall be provided with a view window designed to provide 
full view of the patient at all times. 
(ii) A separate computer room shall be provided to accommodate the equipment. 
(iii) When cryogen is provided, a storage room or closet shall have a minimum 
clear floor area of 50 square feet for two large dewars of cryogen. A storage 
room or closet shall be required in areas where service to replenish supplies is 
not readily available. 
(iv) When a darkroom is provided, the room shall be located near the required 
control room and shall be outside the l0-gauss field. 
(v) When spectroscopy is provided, caution should be exercised in locating it in 
relation to the magnetic fringe fields. 
(vi) Magnetic shielding may be required to restrict the magnetic field plot. 
Radio frequency shielding is required to attenuate stray radio frequencies. 
(vii) A patient holding area shall be provided. The holding area shall be 
located near the MRI unit and be large enough to accommodate stretchers. 
(viii) A freestanding hand washing fixture with hands-free controls shall be 
provided near the entrance to the MRI room and shall be recessed out of the main 
traffic areas or corridor. 
(G) Ultrasound room. When ultrasound services are provided, the room(s) size 
shall be sufficient to house equipment and allow a minimum of five feet of clear 
working space on all sides of the equipment accessible to staff and patient. A 
patient toilet room shall be provided convenient to the procedure room and a 
corridor. The toilet room shall have a hand washing fixture with hands-free 
operable controls. 
(H) Cardiac catheterization laboratory. The cardiac catheterization laboratory 
is normally a separate suite, but may be within the imaging suite. If provided, 
a cardiac catheterization laboratory shall comply with the requirements of 
subsection (cc)(1)(C) of this section. 
(I) Service areas. The following common service areas shall be provided. 
(i) Patient waiting area. The area shall be out of traffic and under direct 
staff visual control. When the waiting area serves both outpatient and 
inpatients, separate areas shall be provided and include visual privacy between 
the waiting areas. 
(ii) Control desk and reception area. A control desk and reception area shall be 
provided. 
(iii) Holding area. The holding area shall be out of direct traffic patterns and 
under visual control by staff. A minimum of two stretcher stations shall be 
provided for the first procedure room and one additional stretcher station shall 
be provided for each additional procedure room. 
(iv) Patient toilet rooms. Toilet room(s) with hand washing facilities shall be 
located convenient to the waiting area. 
(v) Patient dressing rooms. Dressing rooms shall be convenient to the waiting 
areas and X-ray rooms. Each room shall include a seat or bench, mirror, and 
provisions for hanging patients' clothing and for securing valuables. At least 
one dressing room shall be provided to accommodate wheelchair patients.
(vi) Hand washing facilities. A freestanding hand washing fixture with hands-
free controls shall be provided in or near the entrance to each diagnostic and 
procedure room unless noted otherwise. Hand washing facilities shall be arranged 
to minimize any incidental splatter on nearby personnel or equipment. 
(vii) Staff facilities. Toilets may be outside the suite and may be shared with 
other departments but shall be convenient for staff use. When four or more 
diagnostic or procedure imaging rooms are provided, lockers and male and female 
staff toilets shall be required. 
(viii) Contrast media preparation. This room shall include a work counter, a 
sink with hands-free operable controls, and storage. One preparation room may 
serve any number of rooms. When prepared media is used, this area may be 
omitted, but storage shall be provided for the media. 
(ix) Film processing room. A darkroom shall be provided for processing film 
unless the processing equipment normally used does not require a darkroom for 
loading and transfer. When daylight processing is used, the darkroom may be 
minimal for emergency and special uses. Film processing shall be located 
convenient to the procedure rooms and to the quality control area.
(x) Quality control area or room. An area or room for film viewing shall be 
located near the film processor. All view boxes shall be illuminated to provide 
light of the same color value and intensity. 
(xi) Film storage (active). A room shall include a cabinet or shelves for filing 
patient film for immediate retrieval. 
(xii) Film storage (inactive). A room for inactive film storage shall be 
provided. It may be outside the imaging suite, but must be under the 
administrative control of imaging suite personnel and be properly secured to 
protect films against loss or damage. 
(xiii) Storage for unexposed film. Storage facilities for unexposed film shall 
include protection of film against exposure or damage.
(xiv) Storage of cellulose nitre film. When used, cellulose nitrate film shall 
be stored in accordance with the requirements of National Fire Protection 
Association 40, Standard for the Storage and Handling of Cellulose Nitrate 
Motion Picture Film, 1994 edition. 
(xv) Additional spaces. When four or more diagnostic or procedure rooms are 
provided, the following shall be required: 
(I) office(s) for radiologist(s) and assistant(s); 
(II) clerical office spaces, as necessary for the functional program; and 
(III) consultation area/room; 
(IV) medication station. Storage and preparation of medication may be done from 
a room, alcove area, or from a self-contained dispensing unit but must be under 
visual control of nursing staff. A work counter, hand washing fixture with 
hands-free operable controls, refrigerator, and double-locked storage for 
controlled substances shall be provided. Standard cup-sinks are not acceptable 
for hand washing; 
(V) clean storage room. Clean storage room shall be provided for clean supplies 
and linens. Hand washing fixtures shall be provided with hands-free operable 
controls. When conveniently located, the clean storage room may be shared with 
another department; and 
(VI) soiled workroom. The soiled workroom shall not have direct connection to 
the diagnostic and procedure rooms. The room shall contain a clinical sink or 
equivalent flushing type fixture, work counter, hand washing fixture with hands-
free operable controls, waste receptacle, and soiled linen receptacle. When 
contaminated soiled material or fluid waste is not handled, only a soiled 
holding room shall be required. 
(xvi) Housekeeping room. The room may serve multiple departments when 
conveniently located. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Radiation protection shall be designed, tested and approved by a medical 
physicist licensed under the Texas Medical Physics Practice Act, Art. 4512n. 
(I) Room shielding calculations for linear accelerators, teletherapy units and 
remote control brachytherapy units must be submitted to the Texas Department of 
Health's Bureau of Radiation Control (BRC) for approval prior to use. Shielding 
in diagnostic radiographic rooms will be reviewed by BRC inspectors, in the 
field, subsequent to use. Any changes in design or shielding which affects 
radiation exposure levels adjacent to those rooms, requires prior approval by 
BRC. The BRC mailing address is: Bureau of Radiation Control, Texas Department 
of Health, 1100 West 49th Street, Austin, Texas 78756. 
(II) Facility design and environmental controls associated with licensable 
quantities of radioactive material in laboratories and/or imaging rooms shall be 
approved by BRC prior to licensed authorizations. 
(ii) Where protected alcoves with view windows are required, provide a minimum 
of 1 foot 6 inches between the view window edge/frame and the outside partition 
edge. 
(iii) Imaging procedure rooms shall have ceiling heights not less than nine 
feet. Ceilings containing ceiling-mounted equipment shall be of sufficient 
height to accommodate the equipment of fixtures and their normal movement. 
(B) Finishes. 
(i) Flooring used in contrast media preparation and soiled workroom shall be of 
the seamless type as required by sec.133.162(d)(2)(B)(iii)(III).
(ii) A lay-in type ceiling is acceptable for the diagnostic and procedure rooms. 
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) The cryogen gas venting from the MRI unit shall be exhausted to the 
exterior. When a cryogen storage room is provided to replenish supplies, the 
storage room shall be vented and exhausted to the exterior. 
(B) Self-contained air conditioning to supplement the cooling capacity in 
computer rooms is permitted. 
(C) Air handling units serving the imaging suite shall be equipped with filters 
efficiencies equal to, or greater than specified in Table 4 of sec.133.169(d) of 
this title. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
When automatic film processors are used, a receptacle of adequate size with hot 
and cold water for cleaning the processor racks shall be provided. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) Each imaging procedure room shall have at least four duplex electrical 
receptacles. 
(ii) A special grounding system in areas such as imaging procedures rooms where 
a patient may be treated with an internal probe or catheter shall comply with 
Chapter 9 of NFPA 99, and Article 517 of NFPA 70. 
(iii) General lighting with at least one light fixture powered from a normal 
circuit shall be provided in imaging procedures rooms in addition to special 
lighting units at the procedure or diagnostic tables. 
(B) Nurses calling system. 
(i) Nurses regular calling system. The nurses regular calling system shall be 
provided for holding area(s) and patient dressing room(s) in accordance with 
sec.133.162(d)(5)(L)(i) of this title. In areas such as holding and preparation 
area(s) and recovery rooms where patients are under constant visual 
surveillance, the nurses calling system may be limited to a bedside button or 
station that activates a signal readily seen at the control station. 
(ii) Nurses emergency calling system. In toilet room(s) used by inpatients and 
outpatients, a nurses emergency call station shall be provided in accordance 
with sec.133.162(d)(5)(L)(ii) of this title. 
(iii) Staff emergency assistance calling system. A staff emergency assistance 
calling system (code blue) shall be provided for staff to summon additional 
assistance for each imaging procedure room in accordance with section 
sec.133.162(d)(5)(L)(iii) of this title. 
(m) Laboratory suite. 
(1) Architectural requirements. 
(A) General. 
(i) Laboratory facilities shall be provided for the laboratory services provided 
within the hospital such as hematology, clinical chemistry, urinalysis, 
cytology, anatomic pathology, immunohematology, microbiology and bacteriology. 
(ii) Each laboratory unit shall meet the requirements of Chapter 10 of NFPA 99 
(relating to Laboratories), and Chapter 12 of NFPA 101 (relating to New Health 
Care Occupancies). 
(B) Minimum laboratory facilities. When laboratory services are provided off-
site by contract, the following minimum facilities shall be provided within the 
hospital. 
(i) Laboratory work room. The laboratory workroom shall include a counter and a 
sink with hands-free operable controls. 
(ii) General storage. Cabinets or closets shall be provided for supplies and 
equipment used in obtaining samples for testing. A refrigerator or other similar 
equipment shall be provided for specimen storage waiting for transfer to off-
site testing. 
(iii) Blood storage facilities. Refrigerated blood storage facilities for 
transfusions shall be provided. The blood storage refrigerator shall be equipped 
with temperature monitoring and alarm signals. 
(iv) Specimen collection facilities. A blood collection area shall be provided 
with a counter, space for seating, and hand washing fixture with hands-free 
operable controls. A toilet and lavatory with hands-free operable controls shall 
be provided for specimen collection. This facility may be outside the laboratory 
suite if conveniently located. 
(C) On-site laboratory facilities. When the hospital provides on-site laboratory 
services, the following facilities shall be provided in addition to the 
requirements in paragraph (1)(A) and (B) of this subsection.
(i) Laboratory workroom(s). The laboratory work room shall include counter(s), 
space appropriately designed for laboratory equipment, sink(s) with hands-free 
operable controls, vacuum, gases, air, and electrical services as needed. 
(ii) General storage. Storage, including refrigeration for reagents, standards, 
supplies, and stained specimen microscope slides, etc. shall be provided. 
Separate facilities shall be provided for such incompatible materials as acids 
and bases, and vented storage shall be provided for volatile solvents. 
(iii) Chemical safety facilities. When chemical safety is a requirement, 
provisions shall be made for an emergency shower and eye flushing devices. 
(iv) Flammable liquids. When flammable or combustible liquids are used, the 
liquids shall be stored in approved containers, in accordance with National Fire 
Protection Association 30, Flammable and Combustible Liquids Code, 1996 edition. 
(v) Radioactive materials. When radioactive materials are employed, storage 
facilities shall be provided. 
(D) Bone marrow laboratory. A cryopreservation laboratory and a human leukocyte 
antigen laboratory shall be provided in hospitals providing bone marrow 
transplantation services. 
(E) Service areas and facilities. The following service areas and facilities 
shall be provided. 
(i) Hand washing facilities. Each laboratory room or work area shall be provided 
with a hand washing fixture(s) with hands-free operable controls. 
(ii) Office spaces. The scope of laboratory services shall determine the size 
and quantity for administrative areas including offices as well as space for 
clerical work, filing, and record maintenance. At a minimum, an office space 
shall be provided for the use of the laboratory service director.
(iii) Staff facilities. Lounge, locker, and toilet facilities shall be 
conveniently located for male and female laboratory staff. These may be outside 
the laboratory area and shared with other departments. 
(iv) Housekeeping room. A housekeeping room shall be located within the suite or 
conveniently located nearby. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title. Floors in laboratories shall comply with the 
requirements of sec.133.162(d)(2)(B)(iii) of this title except that carpet 
flooring shall not be used. 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) No air from the laboratory areas shall be recirculated to other parts of the 
facility. Recirculation of air within the laboratory suite is allowed. 
(B) When laboratory hoods are provided, they shall meet the following general 
requirements. 
(i) The average face velocity of each exhaust hood shall be at least 75 feet per 
minute. 
(ii) The exhaust shall be connected to an exhaust system to the outside which is 
separate from the building exhaust system. 
(iii) The exhaust fan shall be located at the discharge end of the system. 
(iv) The exhaust duct system shall be of noncombustible and corrosion resistant 
material.
(C) When special laboratory hoods are provided, they shall meet the following 
special standards for these types of hoods. 
(i) Fume hoods, and their associated equipment in the air stream, intended for 
use with perchloric acid and other strong oxidants, shall be constructed of 
stainless steel or other material consistent with special exposures, and be 
provided with a water wash and drain system to permit periodic flushing of duct 
and hood. Electrical equipment intended for installation within such ducts shall 
be designed and constructed to resist penetration by water. Duct systems serving 
these hoods shall be constructed of acid resistant stainless steel for at least 
10 feet from the hood. Lubricants and seals shall not contain organic materials. 
When perchloric acid or other strong oxidants are only transferred from one 
container to another, standard laboratory fume hoods and the associated 
equipment may be used in lieu of stainless steel construction. 
(ii) Each laboratory hood used to process infectious or radioactive materials 
shall have a minimum face velocity of 100 feet per minute, be connected to an 
independent exhaust system, with suitable pressure-independent air modulating 
devices and alarms to alert staff of fan shutdown or loss of airflow. Each hood 
shall also have filters with a 99.97% efficiency (based on the dioctyl-phthalate 
(DOP) test method) in the exhaust stream, and be designed and equipped to permit 
the safe removal, disposal, and replacement of contaminated filters. Filters 
shall be as close to the hood as practical to minimize duct contamination.
(iii) Fume hoods intended for use with radioactive isotopes shall be constructed 
of stainless steel or other material suitable for the particular exposure and 
shall comply with National Fire Protection Association 801, Standard for 
Facilities Handling Radioactive Materials, 1995 edition, sec.5-2, and NFPA 99, 
sec.5-4.3. 
(D) Filtration requirements for air handling units serving the laboratory suite 
shall be equipped with filters efficiencies equal to, or greater than specified 
in Table 4 of sec.133.169(d) of this title. 
(E) Duct linings exposed to air movement shall not be used in ducts serving any 
laboratory room and clean room unless terminal filters of at least 80% 
efficiency are installed downstream of linings. This requirement shall not apply 
to mixing boxes and acoustical traps that have special coverings over such 
lining. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) General. 
(i) Faucet spouts at lavatories and sinks shall have clearances adequate to 
avoid contaminating utensils and the contents of beakers, test tubes, etc. 
(ii) Drain lines from sinks used for acid waste disposal shall be made of acid-
resistant material. 
(iii) Drain lines serving some types of automatic blood-cell counters must be of 
carefully selected material that will eliminate potential for undesirable 
chemical reactions (and/or explosions) between sodium azide wastes and copper, 
lead, brass, and solder, etc. 
(B) Medical gas systems. When provided, medical gas systems shall comply with 
sec.133.162(d)(4)(A)(iii) of this title. The number of outlets in the laboratory 
for vacuum, gases, and air shall be determined by the functional program 
requirements. 
(n) Laundry suite. Laundry facilities may be provided on-site or off-site. On-
site laundry services may be within the hospital or in a separate building. 
(1) Architectural requirements. 
(A) General. The following facilities are required for both on-site or off-site 
commercial laundry services. 
(i) Soiled and clean linen processing areas shall be physically separated. 
(ii) Adequate hand washing facilities shall be available to laundry personnel in 
both the soiled and clean processing areas. 
(iii) A receiving, holding, and sorting room for control and distribution of 
soiled linen shall be provided. This area may be combined with the soiled linens 
processing room. Discharge from soiled linen chutes may be received within this 
room or in a separate dedicated room. 
(iv) A laundry processing room shall be provided which shall contain commercial 
type equipment capable of processing at least a seven-day laundry supply within 
the regular scheduled work week. 
(v) A clean linen processing room shall be provided and shall include built-in 
dryers and folding counters or tables. This area shall have provisions for 
inspections, folding, packing and mending of linen. 
(vi) A holding room or area for storage and issuing of clean linen shall be 
provided but may be combined with clean linen processing room.
(B) Off-site laundry processing. When linen is processed off the hospital site, 
the following minimum requirements shall be provided on-site:
(i) a service entrance which shall have protection from inclement weather, for 
loading and unloading of linen; 
(ii) control station for pickup and receiving; 
(iii) soiled linen holding room; 
(iv) a central clean linen storage room and issuing room in addition to linen 
storage required at the individual patient units. This central holding area 
shall include provisions for inspecting, sorting, and mending; and 
(v) cart storage areas. The areas shall be located out of pedestrian traffic and 
shall be provided separately for clean and soiled linen.
(C) Service areas for on-site laundry processing. The laundry shall be separated 
from patient rooms, areas of food preparation and storage, and areas in which 
clean supplies and equipment are stored. An on-site laundry shall have the 
following services areas and facilities: 
(i) office space for director of laundry services; 
(ii) equipment layout for soiled and clean linen. The laundry equipment 
processing shall be arranged to permit an orderly work flow and minimize cross-
traffic that might mix clean and soiled operations; 
(iii) storage. Storage space and cabinets for soaps, stain removers, and other 
laundry processing agents shall be located in the soiled and clean processing 
rooms; 
(iv) cart sanitizing facilities which comply with subsection (c) of this 
section; 
(v) staff toilets. Toilets may be outside the unit but shall be convenient for 
staff use and shall contain hand washing fixtures with hands-free operable 
controls; 
(vi) staff lockers. Lockers may be in laundry suite or part of a central locker 
area when convenient to the laundry; and 
(vii) housekeeping room. 
(2) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) The ventilation system shall include adequate intake, filtration, exchange 
rate, and exhaust in accordance with Table 3 and Table 4 of sec.133.169(c) and 
(d) of this title. 
(B) Filtration requirements for air handling units serving the laundry suite 
shall be equipped with filters efficiencies equal to, or greater than specified 
in Table 4 of sec.133.169(d) of this title. 
(C) Direction of air flow of the HVAC systems shall be from clean to soiled 
areas. 
(D) The ventilation system for soiled processing area shall have negative air 
pressure while the clean processing area shall have positive pressure. 
(o) Medical records suite. The following rooms, areas, or offices shall be 
provided in the medical records suite: 
(1) medical records administrator or technician office; 
(2) review and dictating rooms or spaces; 
(3) work area which includes provisions for sorting, recording, or microfilming 
records; and 
(4) file storage room. Rooms containing open file systems or moveable filing 
storage systems shall be considered as hazardous. The construction protection 
for the storage room or area shall comply with Chapter 12 of NFPA 101, sec.12-
3.2. 
(p) Mental health and chemical dependency nursing unit. 
(1) Architectural requirements. When mental health and chemical dependency 
patient care services are provided, the unit(s) shall comply with the 
requirements contained in subsection (s)(1) of this section and the requirements 
of this paragraph. 
(A) Patient rooms. Because operable windows are required in all patient sleeping 
rooms, it may be necessary to provide detention screens on windows or limit the 
amount of window operation in order to inhibit possible tendency for suicide or 
elopement. The type and the degree of security required in mental health and 
chemical dependency units shall be determined by the hospital administration. 
When detention screens are provided, windows shall be capable of opening with 
the screens in place. Where glass fragments may create a hazard, safety glazing 
or other appropriate security features shall be incorporated. 
(B) Service areas. Service areas shall be provided in accordance with the 
requirements of subsection (s)(1)(F) of this section and the following 
additional requirements. 
(i) Nurses and doctor's charting areas shall be provided with separation needed 
for acoustical privacy as well as space required for the function. A view window 
to permit observation of patient area by the charting nurse or physician may be 
used provided that it is located so that patient files cannot be read from 
outside the charting space. 
(ii) A minimum of two separate social spaces, one appropriate for noisy 
activities and the other for quiet activities, shall be provided. The combined 
total area shall be not less than 40 square feet per bed with not less than 120 
square feet for each of the two spaces, whichever is greater.
(iii) A room for group therapy shall be provided. The room shall not be less 
than 250 square feet. The group therapy room may be combined with the quiet 
space required in clause (ii) of this subparagraph when the unit accommodates 
not more than 12 patients. 
(iv) Space shall be provided for occupational therapy at the rate of 15 square 
feet per bed with a minimum total area of 200 square feet, whichever is greater. 
Space shall include hand washing, work counters, storage, and displays. When the 
mental health and chemical dependency nursing unit contains less than 12 beds, 
the occupational therapy functions may be performed within the noisy activities 
area, if at least 10 additional square feet per patient served is included. 
(v) A consultation room for each 12 beds or any portion thereof shall be 
provided. Each consultation room shall have a minimum floor space of 100 square 
feet. Each room shall be designed for acoustical and visual privacy. 
(vi) A small kitchen for patient use shall be provided. It shall contain a sink, 
refrigerator, residential type dishwasher, kitchen cabinets, ice dispenser, and 
an electric range or a microwave. This kitchen may serve as a nourishment center 
for patients between meals. It may be located in the noisy activity area. 
(vii) Patient laundry facilities with automatic washer and an electric dryer 
shall be provided. This requirement may be omitted in nursing units intended 
only for adolescent and gero-psychiatric patients. 
(viii) There shall be a suite in each nursing unit for mental health and 
chemical dependancy patients intended for short-term occupancy by a single 
person requiring security and protection from self or others. The seclusion 
suite shall consist of seclusion room(s), an anteroom or a vestibule, and a 
toilet. 
(I) Each seclusion room shall be located and designed in a manner affording 
direct visual supervision by nursing staff and shall be constructed to prevent 
patient hiding, escape, injury, or suicide. There shall be a minimum of one 
seclusion room for each 24 beds or any portion thereof. 
(-a-) The floor area of each seclusion room shall be not less than 60 square 
feet. The minimum room dimension shall be six feet. 
(-b-) The seclusion room shall have a minimum ceiling height of nine feet. 
(-c-) The door to each seclusion room shall have no hardware on the room side 
and shall open out. A vision panel shall be provided in each door to permit 
staff observation of the entire room while maintaining privacy from the public 
and other patients. 
(-d-) Each seclusion room shall have natural light (skylight or window) in order 
to maintain a therapeutic environment. Skylight wells or windows shall be not 
less than 400 square inches in area. 
(II) Access to the seclusion room from any public space such as a corridor shall 
be through an anteroom. When the seclusion suite is directly accessible from the 
nurse station, a vestibule may be provided in place of an anteroom. A cased 
opening to the vestibule in lieu of a door may be provided as long as the 
arrangement assures privacy from the public and other patients.
(-a-) The minimum dimension of the anteroom or vestibule shall be eight feet. 
(-b-) The door to the anteroom shall swing in. 
(III) There shall be at least one toilet room directly accessible from the 
anteroom or vestibule. 
(-a-) The toilet room shall be large enough to safely manage the patient. 
(-b-) The toilet room door shall swing out into the anteroom or vestibule. 
(-c-) A water closet and hand washing facilities shall be provided in the toilet 
room. An unbreakable wall hung mirror may be provided.
(2) Details and finishes. Details and finishes in each mental health and 
chemical dependancy nursing unit shall comply with the requirements contained in 
subsection (s)(2) of this section and this paragraph. 
(A) Details. 
(i) All areas of the mental health unit, including entrances to patient rooms, 
shall be visible from the nurse station(s). Observation by video cameras of 
seclusion rooms, entrances, hallways, and activity areas shall be acceptable. 
(ii) All exposed and accessible fasteners shall be tamper-resistant.
(iii) Suitable hardware shall be provided on doors to toilet rooms for mental 
health and chemical dependancy patients so that access to these rooms can be 
controlled by staff. Hardware shall be utilized which is appropriate to prevent 
patient injury. 
(iv) Only break-away or collapsible clothes bars in wardrobes, lockers, and 
closets and shower curtain rods shall be permitted in nursing units for mental 
health and chemical dependancy patients. 
(v) Wire coat hangers shall not be permitted in nursing units for mental health 
and chemical dependancy patients. 
(vi) Special fixtures, hardware, and tamper-proof screws shall be used 
throughout the patient suites of nursing units for mental health and chemical 
dependancy patients. 
(vii) Horizontal grab bars are not permitted at bathing and toilet fixtures. 
(B) Finishes. Special conditions may require monolithic or bonded wall and 
ceiling construction for patient safety and security measures.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
subsection (s)(3) of this section and this paragraph.
(A) Special consideration shall be given to the type of heating and cooling 
units, ventilation outlets, and appurtenances installed in patient-occupied 
areas of mental health nursing units. The following shall apply: 
(B) All air grilles and diffusers shall be of a type that prevents the insertion 
of foreign objects. 
(C) All convector or HVAC enclosures exposed in the room shall be constructed 
with rounded corners and shall have enclosures fastened with tamper-resistant 
fasteners. 
(D) HVAC equipment shall be of a type that minimizes the need for maintenance 
within the room. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with subsection (s)(4) of this section and this 
paragraph. 
(A) Piping systems. 
(i) Piped medical gas systems are not required. 
(ii) Only special, tamper proof sprinkler heads from which it is not possible to 
suspend any objects shall be installed in mental health and chemical dependancy 
units. 
(B) Plumbing fixtures. 
(i) Faucet controls shall not be equipped with handles that may be easily broken 
off. 
(ii) Bedpan washers are not required in patient bathrooms.
(5) Electrical requirements. Electrical requirements shall be in accordance with 
subsection (s)(5) of this section and this paragraph.
(A) A nurses calling system is not required in patient rooms for mental health 
and chemical dependancy patients. However, when a nurses calling system is 
provided, the system shall meet the requirements of sec.133.162(d)(5)(L), pull 
cords shall not exceed 18 inches in length, and provisions shall be made to 
permit removal of call buttons and use of blank plates as required for security. 
(B) Each patient room shall have duplex-grounded receptacles. There shall be one 
receptacle at each side of the head of each bed and one on every other wall. 
Receptacles in areas intended for mental health and chemical dependancy patients 
of all ages shall be protected by GFCI breakers installed in distribution panel 
enclosures serving the unit. 
(C) Fifteen-ampere and 20-ampere, 125-volt receptacles intended to supply 
patient care areas of mental health and chemical dependency wards, rooms, or 
areas shall be tamper resistant as permitted by NFPA 70, sec.517-18, or shall be 
protected by GFCI breakers which limit the ground fault current to 5 
milliamperes. A tamper-resistant receptacle is one that is constructed to limit 
improper access to its energized contacts. 
(q) Morgue. 
(1) Architectural requirements. 
(A) General. The morgue shall be directly accessible through an exterior 
entrance and shall be located to avoid the need for transporting bodies of 
deceased patients through public areas. 
(B) Autopsy performed within hospital. When autopsies are performed within the 
hospital, the following rooms, areas, and equipment shall be provided. 
(i) Refrigerated facilities shall be provided for body-holding.
(ii) The autopsy room shall contain work counters, hand washing facilities with 
hands-free operable controls, autopsy table and storage space for supplies, 
equipment and specimens. 
(iii) A deep sink shall be provided for washing specimens.
(iv) A clothing change area shall be provide with shower, toilet, hand washing 
facilities and lockers. 
(C) Service areas. The following service areas shall be provided:
(i) a pathologist office; 
(ii) staff toilets. Toilets may be outside the unit but be convenient for staff 
use. Hand washing fixture(s) shall have with hands-free operable controls; and 
(iii) a housekeeping room. A housekeeping room which meets the requirements of 
sec.133.162(d)(2)(A)(xxviii) of this title shall be provided for the exclusive 
use of the morgue when autopsies are performed.
(D) Minimum requirements. When autopsy facilities are not provided within the 
hospital, bodies of deceased patients shall be kept in a ventilated and 
temperature controlled body holding room prior to transport to a destination off 
the hospital premises. The body holding room shall be directly accessible from 
the exterior and located to avoid the need for transporting bodies through 
public areas. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) The body holding and autopsy room shall have ceiling heights not less than 
eight feet. 
(ii) Hand drying devices shall be provided at all hand washing facilities. 
Devices shall be enclosed type fixtures supplying paper or cloth in single-unit. 
(B) Finishes. 
(i) Flooring used in the autopsy room shall be the seamless type as required by 
sec.133.162(d)(2)(B)(iii)(III). 
(ii) Ceilings in the autopsy rooms shall be monolithic as required by 
sec.133.162(d)(2)(B)(vi)(III). 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) The autopsy room shall be equipped with low exhaust grilles.
(B) The body holding room shall be ventilated in accordance with Table 3 of 
sec.133.169(c) of this title. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph. Refrigerators for body 
holding in the autopsy room shall be connected to the equipment branch of the 
essential electrical distribution system. 
(r) Nuclear medicine suite. 
(1) Architectural requirements. 
(A) General. When nuclear medicine services are provided, the facilities may be 
in a separate suite or combined with an imaging suite.
(i) When nuclear medicine requires radiation protection, a qualified medical 
physicist shall specify the type, location, and amount of radiation protection 
to be installed for the layout and equipment selections.
(ii) When patients with airborne infectious diseases are subject to nuclear 
medicine services, the diagnostic and/or procedural room shall meet the 
infection isolation ventilation requirements as contained in Table 3 of 
sec.133.169(c) of this title. 
(iii) The nuclear medicine room shall be sufficiently sized to house all fixed 
and moveable equipment and allow a minimum of five feet of clear working space 
on all sides of equipment accessible to staff and patient.
(B) Radiopharmacy room. When radiopharmaceutical preparation is performed on-
site, the room shall include sufficient space for equipment, storage of 
radionuclides, chemicals for preparation, dose calibrators, and record keeping. 
When prepared materials are used, storage and calculation area may be 
considerably smaller than for on-site preparation. Radiopharmacy facilities 
shall be appropriately shielded. 
(C) Positron emission tomography (PET). When PET services are provided, scanner 
and cyclotron rooms shall be provided with a minimum clear floor areas of 300 
and 225 square feet respectively exclusive of built-in shelves or cabinets. 
(i) The cyclotron room shall have an area of 16 square feet dedicated for safe 
storage of parts that may need to cool down for a year or more. 
(ii) A hot (radioactive) laboratory and a cold (non-radioactive) laboratory 
shall be provided and each space shall be minimum of 250 square feet in size. 
(iii) A blood laboratory shall be provided in the suite and the space shall be 
minimum of 80 square feet in size. 
(iv) A gas storage area/room shall be provided and be large enough to 
accommodate bottles of gas. Each gas will be piped individually and shall go to 
the cyclotron or the laboratory. The cylinders shall be secured to racks or 
adequately fastened. 
(v) Radiation shielding shall be provided. 
(D) Service areas. 
(i) Patient waiting area. The patient waiting area shall be out of traffic and 
under staff control. If the suite is routinely used for outpatients and 
inpatients at the same time, separate waiting areas shall be provided with 
screening for visual privacy between the areas for inpatients and outpatients. 
(ii) Control desk and reception area. A control desk and reception area shall be 
provided. 
(iii) Dictation and report preparation area. The dictation and report 
preparation area may be incorporated with the control station.
(iv) Holding area. The holding area shall be under direct staff control, out of 
the direct line of traffic, and have space for stretchers. The holding area 
shall accommodate two stretchers for the first procedure room with one 
additional station for each additional procedure room. When services are 
provided for both inpatients and outpatients, separate holding areas with 
screening for visual privacy between the waiting areas shall be provided. 
(v) Patient toilet facilities. A toilet room with hand washing fixtures with 
hands-free operable controls shall be provided convenient to the waiting room 
and procedure room. 
(vi) Staff toilet facilities. Toilets and hand washing fixtures with hands-free 
operable controls may be outside the suite but shall be convenient for staff 
use. In larger suites with three or more procedure/diagnostic rooms, staff 
lounge with lockers, dressing area and toilet facilities shall be provided.
(vii) Patient dressing rooms. Dressing rooms shall be provided convenient to the 
waiting areas and procedure rooms. Each room shall include a seat or bench, 
mirror, and provisions for hanging patients' clothing and for securing 
valuables. At least one dressing room shall be provided to accommodate 
wheelchair patients. At least one space large enough for staff-assisted dressing 
shall be provided. 
(viii) Exam room(s). When examination rooms are provided, each room shall have a 
minimum of 100 square feet of clear floor area exclusive of built-in shelves or 
cabinets. Each exam room shall be equipped with a work counter and hand washing 
fixtures with hands-free operable controls. 
(ix) Dose administration area. When a dose administration area is provided, the 
area shall be located near the preparation area and include visual privacy for 
the patients. 
(x) Computer control area/room. Computer control area shall be located just 
outside the entry to the treatment room(s). When a centralized computer area is 
provided, it shall be a separate room with access terminals available within the 
treatment rooms. 
(xi) Film processing room. A darkroom shall be provided for film processing 
unless the processing equipment normally used does not require a darkroom for 
loading and transfer. When daylight processing is used, the darkroom may be 
minimal for emergency and special uses. Film processing shall be located 
convenient to the treatment room(s) and to the quality control area. 
(xii) Quality control area or room. A consultation area/room shall include view 
boxes illuminated with light of the same color value and intensity for 
appropriate comparison of several adjacent films. Space shall be provided for 
computer access and display terminals if such are included in the functional 
program. 
(xiii) Film storage room (active). A room with cabinet or shelves for filing 
patient film for immediate retrieval shall be provided.
(xiv) Film storage room (inactive). A room for inactive film storage may be 
located outside the nuclear medicine suite, but must be under the administrative 
control of nuclear medicine personnel and properly secured to protect films 
against loss or damage. 
(xv) Storage for unexposed film. Storage facilities for unexposed film shall 
include protection of film against exposure or damage and shall not be warmer 
than the air of adjacent occupied spaces. 
(xvi) Hypothermia room. When a hypothermia room is provided, the room may be 
combined with an exam room. 
(xvii) Dosimetry equipment area/room. A dosimetry equipment area/room is 
optional. 
(xviii) Offices for physicians, oncologist, physicists, and assistants. Offices 
shall include provisions for equipped for individual consultation, viewing, and 
charting of film. 
(xix) Clerical office(s) spaces. Clerical office(s) spaces shall be provided. 
(xx) Consultation area or room. A consultation area or room shall be provided. 
(xxi) Clean storage room. A clean storage room shall be provided for clean 
supplies and linens. Hand washing fixtures shall be provided with hands-free 
operable controls. When conveniently located, the clean storage room may be 
shared with another department. 
(xxii) Soiled workroom. When a soiled workroom is provided, the workroom shall 
not have direct connection to the nuclear medicine procedure or diagnostic rooms 
or sterile activity rooms. The room shall contain a clinical sink or equivalent 
flushing type fixture, work counter, hand washing fixture with hands-free 
operable controls, waste receptacle, and soiled linen receptacle. When 
contaminated soiled material or fluid waste is not handled, only a soiled 
holding room is required. 
(xxiii) Housekeeping room. The housekeeping room shall be located within the 
suite. When automatic film processors are used, a receptacle of adequate size 
with hot and cold water for cleaning the processor racks shall be provided. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Radiation protection shall be designed, tested and approved by a medical 
physicist licensed under the Texas Medical Physics Practice Act, Art. 4512n. 
(I) Room shielding calculations for linear accelerators, teletherapy units and 
remote control brachytherapy units must be submitted to the Texas Department of 
Health's Bureau of Radiation Control (BRC) for approval prior to use. Shielding 
in diagnostic radiographic rooms will be reviewed by BRC inspectors, in the 
field, subsequent to use. Any changes in design or shielding which affects 
radiation exposure levels adjacent to those rooms, requires prior approval by 
BRC. 
(II) Facility design and environmental controls associated with licensable 
quantities of radioactive material in laboratories or imaging rooms must be 
approved by BRC prior to licensed authorizations. 
(ii) The nuclear medicine treatment rooms and linear accelerator room shall have 
ceiling heights not less than nine feet. Ceilings containing ceiling-mounted 
equipment shall be of sufficient height to accommodate the equipment of fixtures 
and their normal movement. 
(iii) Ceiling mounted equipment shall be supported by properly designed rigid 
structures located above the finished ceiling. 
(iv) Hand drying devices shall be provided at all hand washing facilities. 
Devices shall be enclosed type fixtures supplying paper or cloth in single-unit. 
(B) Finishes. 
(i) In areas that are subject to accidental radioactive spills, floors and walls 
shall be constructed of materials that are easily decontaminated.
(ii) Flooring used in the nuclear medicine procedure room, any work or treatment 
areas where radioactive material is handled, and soiled workroom shall be of the 
seamless monolithic type as required by sec.133.162(d)(2)(B)(iii)(III).
(iii) Ceilings in radiopharmacy, hot laboratory, mold laboratory and soiled 
workrooms shall be monolithic as required by sec.133.162(d)(2)(B)(vi)(III).
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) When radiopharmaceutical preparations are performed, vents and traps for 
radioactive gases shall be provided. 
(B) Direction of air flow of the HVAC system shall be from the coldest 
(radiationwise) areas to the hottest areas. Redundancy may be required. 
(C) In the PET suite, special ventilation systems together with monitors, 
sensors, and alarm systems shall be required to vent gases and chemicals. The 
ventilation shall be directly to the exterior. 
(D) Filtration requirements for air handling units serving the nuclear medicine 
suite shall be equipped with filters efficiencies equal to, or greater than 
specified in Table 4 of sec.133.169(d) of this title.
(E) Duct linings. Duct linings exposed to air movement shall not be used in 
ducts serving any nuclear medicine rooms, procedure rooms, diagnostic rooms, 
isolation rooms, clean room, and processing rooms. This requirement shall not 
apply to mixing boxes and acoustical traps that have special coverings over such 
lining. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) In the PET suite, the cyclotron is water cooled with de-ionized water 
system. A heat exchanger and connection to a compressor or to chilled water may 
be required. 
(B) A redundant plumbing system connection to a holding tank may be required to 
prevent accidental leakage of contaminated water into the regular plumbing 
system. 
(C) In the PET suite, compressed air shall be required for pressurized water 
circulation system for the cyclotron. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) Each nuclear medicine procedure room shall have at least four duplex 
electrical hospital grade receptacles. 
(ii) Nuclear medicine procedures rooms shall have general lighting in addition 
to that provided by special lighting units at the procedure tables. 
(B) Nurses calling systems. 
(i) Nurses regular calling system. A nurses regular calling system shall be 
provided for holding rooms/area, observation and patient dressing room(s) in 
accordance with sec.133.162(d)(5)(L)(i) of this title. In areas such as holding 
and observation where patients are under constant visual surveillance, the 
nurses regular calling system may be limited to a bedside button or station that 
activates a signal readily seen at the control station. 
(ii) Nurses emergency calling system. In patient toilet room(s), a nurses 
emergency calling system shall be provided for each patient toilet in accordance 
with sec.133.162(d)(5)(L)(ii) of this title. 
(iii) A staff emergency assistance calling system (code blue) shall be provided 
for staff to summon additional assistance for each nuclear medicine procedure 
room in accordance with section sec.133.162(d)(5)(L)(iii) of this title. 
(s) Nursing unit. The requirements in this subsection apply to nursing units in 
hospitals for all types of inpatient care. Facilities providing care to less 
than 15 pediatric inpatients may be included with an adult nursing unit. 
Additional requirements for a nursing unit providing care to 15 or more 
pediatric patients are contained in sec.133.163(v) of this title. 
(1) Architectural requirements. Architectural requirements shall be in 
accordance with sec.133.162(d)(1) of this title and this paragraph.
(A) Handicapped accessibility requirements. At least 10% of patient rooms, 
bathing units and toilets in medical/surgical, medical, antepartum, postpartum, 
mental health, chemical dependency, and pediatric nursing units and all public 
and common use areas shall be designed and constructed to be handicapped 
accessible. These requirements shall apply in all new construction and when an 
existing nursing unit or a portion thereof is converted from one service to 
another, i.e. mental health care to medical or surgical nursing care. 
(B) Patient room suites. A patient room suite shall consist of the patient room 
and a bathroom. Patient room suites shall comply with the following 
requirements. 
(i) Maximum patient room capacity. The maximum patient room capacity shall be 
two patients. In existing facilities where renovation work is undertaken and the 
present capacity is more than two patients, the maximum room capacity shall be 
no more than the present capacity with a maximum of four patients. 
(ii) Single-bed patient room. In a single-bed patient room, the minimum clear 
floor area shall be 100 square feet. The minimum clear floor area in an 
accessible private patient room shall be 120 square feet. 
(iii) Multi-bed patient room. In a multi-bed patient room, the minimum clear 
floor area shall be 80 square feet per bed. Minimum clear floor space in an 
accessible multi-bed room shall be 110 square feet per bed.
(iv) Arrangement of patient rooms. Minor encroachments including columns and 
wall hung lavatories that do not interfere with functions may be ignored when 
determining space requirements for patient rooms. 
(I) Required clear floor space in patient rooms shall be exclusive of toilet 
rooms, closets, lockers, built-in cabinets, wardrobes, alcoves, or vestibules. 
(II) A clearance of 3 feet 8 inches shall be available at the foot of each bed 
in multi-bed patient rooms to permit the passage of equipment and beds. A 
minimum distance of three feet between a wall and the side of a bed and four 
feet between beds shall be provided. A minimum distance of five feet between a 
wall and the side of a bed and four feet between beds shall be provided in an 
accessible semi-private room or one intended for rehabilitation patients. 
Arrangement of beds shall be such that sufficient space is provided within each 
privacy curtain for a bed and maneuvering space for a wheelchair.
(III) Visual privacy shall be provided each patient in multi-bed rooms. Design 
for privacy shall not restrict independent patient access to the corridor, 
lavatory, or bathroom. 
(v) Patient bathroom. Each patient shall have access to a bathroom without 
having to enter the general corridor area. Each bathroom shall contain a toilet, 
hand washing and bathing facilities, and storage shelf or cabinet. Hand washing 
facilities may be located in the patient room. 
(vi) Patient storage. Each patient shall have a separate wardrobe, locker, or 
closet that is suitable for hanging full-length garments and for storing 
personal effects. A minimum of 12 lineal inches of hanging space shall be 
provided per patient. 
(C) Airborne infection isolation suites. A minimum of one isolation suite shall 
be provided for each 30 acute care beds or fraction thereof. The suite may be 
located within a nursing unit or in a separate isolation unit. When a pediatric 
patient suite is located in an adult nursing unit and is not part of a pediatric 
or adolescent nursing unit, a minimum of one isolation room shall be designated 
for pediatric patient care. Each airborne infection isolation suite shall 
consist of a work area, a patient room, and a patient bathroom. 
(i) The work area may be a separately enclosed anteroom or a vestibule that is 
open to and is located immediately inside the door to the patient room. It shall 
have facilities for hand washing, gowning, and storage of clean and soiled 
materials. One enclosed anteroom may serve multiple isolation rooms. 
(ii) Each patient room shall have a clear floor area of 120 square feet 
exclusive of the work area and shall contain only one bed. 
(iii) Each bathroom shall be designed for the use of the handicapped and shall 
contain bathing facilities, toilet facilities and hand washing facilities. Each 
bathroom shall be arranged to provide access from the patient room without 
entering or passing through the work area. 
(iv) In a general hospital, at least one airborne infection isolation suite with 
an enclosed anteroom shall be provided. 
(v) Ventilation requirements for the isolation rooms shall be in accordance with 
Table 3 of sec.133.169(c) of this title. 
(vi) Doors to airborne infection isolation rooms shall be provided with self-
closing devices. 
(D) Protective environment suite. When specialized services for patients with 
extreme susceptibility to infection are provided, spatial requirements for the 
suite shall be identical to those for airborne infection isolation suites 
contained in subparagraph (C) of this paragraph with the exception that an 
enclosed anteroom shall be provided. 
(E) Room for disturbed medical patients. Each hospital shall provide at least 
one private patient room for patients needing close supervision for medical 
and/or psychiatric care. The room may be part of the mental health and chemical 
dependency nursing unit described in subsection (p) of this section. If the room 
is part of a nursing unit, the provisions of subparagraph (B)(ii) of this 
paragraph for an accessible single-bed patient room shall apply. Each room shall 
be designed to minimize potential for escape, hiding, injury, or suicide. 
(F) Service areas. Service areas shall be located in, or readily available to, 
each nursing unit. Each service area may be arranged and located to serve more 
than one nursing unit, but at least one service area shall be provided on each 
nursing floor. The following service areas shall be provided:
(i) an administrative center or nurses station with an adjacent but separate 
dictation space; 
(ii) a nurses office; 
(iii) an area for charting. The area may be combined with the nurses station 
when adequate space is provided for both; 
(iv) a medication room, medicine alcove area, or a self-contained medicine 
dispensing unit under visual control of nursing staff. The room, area or unit 
shall contain a work counter, hand washing fixture with hands-free operable 
controls, refrigerator, and double-locked storage for controlled substances. 
Standard cup-sinks provided in many self-contained units are not adequate for 
hand washing; 
(v) a nourishment station containing a work counter with sink, microwave, 
refrigerator and storage cabinets and not located in the clean workroom; 
(vi) a multipurpose room for staff and patient conferences, education, 
demonstrations, and consultation. The room shall be conveniently accessible to 
each nursing unit and may serve several nursing units or departments. The room 
may be located on another floor if convenient for regular use; 
(vii) a conveniently located examination/treatment room which may serve several 
nursing units located on the same floor. The room shall have a minimum clear 
floor area of 100 square feet and contain a counter for writing and hand washing 
facilities. This room may be omitted if all patient rooms on the floor are 
single-bed patient rooms; 
(viii) special bathing facilities, including space for attendant, for patients 
on stretchers, carts, and wheelchairs at the ratio of one per 100 beds or a 
fraction thereof. This may be on another floor if convenient for use. The 
central bathing room shall contain a hand washing fixture and a water closet 
with three feet of clearance at the front and each side of the fixture; 
(ix) staff lounge with separate female and male dressing areas containing 
lockers, showers, toilets and hand washing facilities. These facilities may be 
on another floor; 
(x) securable closets or cabinet compartments for personal articles of nursing 
unit staff. The closets or lockers shall be located at or near the nurse 
station. At a minimum, these shall be large enough for purses and billfolds. 
Coats may be stored in closets or cabinets on each floor or in a central staff 
locker area; 
(xi) clean workroom or clean supply room. When used for preparing patient care 
items, it shall contain a work counter, hand washing facilities, and storage 
facilities for clean and sterile supplies. When used only for storage and 
holding as part of a distribution system of clean and sterile supplies, the work 
counter and hand washing facilities may be omitted; 
(xii) clean linen storage for each nursing unit. This may be within a clean 
workroom, a separate closet, or an approved distribution system on each floor. 
If a closed cart system is used, storage may be in an alcove, but must be out of 
the path of normal traffic and under staff control;
(xiii) a soiled workroom or soiled holding room. The room shall contain a 
clinical sink or equivalent flushing rim fixture, hand washing facilities, both 
with hot and cold water. The room shall have a work counter and space for 
separate covered containers for soiled linen and waste. When facilities for 
cleaning bedpans are provided elsewhere, the flushing rim clinical sink may be 
omitted; 
(xiv) an equipment storage room located on each floor which may serve multiple 
nursing units; 
(xv) an emergency equipment storage room or alcove under direct visual control 
of the nursing staff; 
(xvi) a housekeeping room which may also serve adjacent nursing units; 
(xvii) stretcher and wheelchair storage space which is located without 
restricting normal traffic; 
(xviii) separate male and female accessible public toilets with hand washing 
facilities. The toilets shall be located on each floor containing a nursing 
unit; 
(xix) staff toilet at each nurse station; and 
(xx) an ice dispensing machine for each nursing unit which is located at the 
nourishment station or the clean work room. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Egress. Means of egress from each patient suite shall comply with the 
requirements of NFPA 101, sec.12-2. 
(ii) Patient bathroom and toilet room doors. Door leaves to all patient 
bathrooms and toilet rooms shall be at least 36 inches wide and shall swing 
outward or be double acting so that nursing staff may gin access to a patient 
who has collapsed against the door. Doors lockable from the inside shall have 
hardware that allows staff to open the door from the outside. 
(iii) Vision panels. Vision panels shall be provided in the door between an 
anteroom and an airborne infection isolation room or a protective environment 
room. 
(iv) Operable windows. Each patient sleeping room shall have an outside door or 
an outside operable window. Where the operation of windows requires the use of 
tools or keys, the tools or keys shall be located at each nurses station, on the 
same floor, and easily accessible to staff. The bottom of the window opening 
shall not exceed 36 inches above the floor. 
(v) Location of patient room windows. Windows required for ventilation of 
patient sleeping rooms shall be operable and shall be located on an outside 
wall. These windows may open onto an atrium, an inner court, or an outer court 
provided the following requirements are met. 
(I) Atria windows. Atria onto which the required windows open shall comply with 
the requirements of NFPA 101, sec.6-2.4.6 and shall be provided with an 
engineered smoke control system in accordance with National Fire Protection 
Association 92B, Guide for Smoke Management Systems in Malls, Atria, and Large 
Areas, 1995 edition. 
(II) Outer courts. Outer court (not enclosed by building on one side) onto which 
the required windows open shall have a minimum width, at all levels, of not less 
than three inches for each foot, or fraction thereof, of the height (average 
height of enclosing walls) of such court, but in no case shall the width be less 
than five feet. An outer court shall have a horizontal cross sectional area not 
greater than four times the square of its width.
(III) Inner courts. Inner court (enclosed by building on all sides) onto which 
the required windows open shall have minimum width, at all levels, of not less 
than one foot for each foot, or fraction thereof, of the height (average height 
of enclosing walls) of such courts, but in no case shall the width be less than 
10 feet. A horizontal, unobstructed, and permanently open air intake or passage 
having a cross-sectional area of not less than 21 square feet shall be provided 
at or near the bottom of the court. Metal decorative grilles not effectively 
reducing the open area by more than 5.0% shall be permitted at the ends. Walls, 
partitions, floor, and floor-ceiling assemblies forming intakes or passages 
shall be noncombustible and shall be constructed in accordance with NFPA 101, 
sec.12-3.1(b) and (c). An inner court shall have a horizontal cross sectional 
area of not less than one and one-half times the square of its width. 
(vi) Fixed windows. Windows may be fixed when the building is provided with an 
engineered smoke control system throughout in accordance with National Fire 
Protection Association 90A, Standard for the Installation of Air Conditioning 
and Ventilating Systems, 1996 edition, and National Fire Protection Association 
92A, Recommended Practice for Smoke-Control Systems, 1996 edition, where each 
smoke compartment is a smoke control zone, and an automatic sprinkler system is 
installed throughout the entire building in accordance with NFPA 101, sec.12-
3.5, and National Fire Protection Association 13, Standard for the Installation 
of Sprinkler Systems, 1996 edition. 
(vii) Hand washing facilities. Hand washing facilities shall be conveniently 
located near the nurses station and in the medication area. One lavatory in an 
open medication area can meet this requirement. 
(viii) Elevator lobbies. Elevator lobbies shall be physically separated from the 
required means of egress with one hour fire rated construction which resist the 
passage of smoke on all floors containing patient rooms.
(ix) Patient's privacy. Cubicle curtains to assure privacy for each patient 
shall be provided in all multi-bed patient rooms. 
(x) Telephone access. Each patient shall have access to a telephone directly 
from each bed. 
(B) Finishes. 
(i) Seamless floors with coved wall bases described in 
sec.133.162(d)(2)(B)(iii)(III) of this title shall be provided in soiled 
workrooms. 
(ii) Wall bases in the soiled workroom shall be made integral and coved with the 
floor, tightly sealed to the wall, constructed without voids that can harbor 
insects, retain dirt particles, and impervious to water.
(iii) Monolithic ceilings described in sec.133.162(d)(2)(B)(vi)(III) of this 
title shall be provided in airborne infection isolation rooms and protective 
environment rooms. 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) Outside air shall be supplied to each patient room by a central air handling 
unit to provide make-up air for air exhausted from the bathroom in accordance 
with Note 3 of Table 3 of sec.133.169(c) of this title. 
(B) Each patient room bathroom shall be exhausted continuously to the exterior 
in accordance with Table 3 of sec.133.169(c) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) Each patient bathroom shall contain a water closet with a bedpan washer, 
bathtub or shower and a lavatory. The lavatory may be located in a single bed 
patient room instead of in the bathroom. 
(B) An additional lavatory shall be placed in each patient room proper where the 
bathroom serves more than two beds. 
(C) A lavatory shall be provided in each postpartum patient room proper and in 
the required adjacent toilet room regardless of the number of beds served. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) Electric receptacles in nursing units. 
(i) Each receptacle shall be grounded to the reference grounding point by means 
of an insulated copper grounding conductor. 
(ii) Each patient bed location shall be supplied by at least two branch 
circuits, one from the critical branch of the emergency system as required by 
NFPA 99, sec.3-4 and one from the normal system. All branch circuits from the 
normal system shall originate in the same panelboard. 
(iii) One duplex receptacle connected to a normal branch circuit and one duplex 
outlet connected to the critical branch circuit shall be located on opposite 
sides of the head of each bed. In addition at least one duplex outlet shall be 
located on each wall. A dedicated outlet shall be provided at the television 
location. 
(iv) Each examination table shall have access to two duplex receptacles. 
(v) Each work table or counter shall have access to two duplex receptacles. 
(vi) One duplex receptacle protected with a GFCI shall be installed in the 
bathroom to permit the use of electrical appliances in front of the mirror. 
(vii) Duplex receptacles shall be installed not more than 50 feet apart in 
corridors and within 25 feet of corridor ends. 
(viii) Special receptacles marked for X-ray use shall be installed in corridors 
so that mobile equipment may be used anywhere within a patient room using a cord 
length of 50 feet or less. Where capacitive discharge or battery powered X-ray 
units are used, special X-ray receptacles will not be required in corridors. 
(ix) Additional duplex receptacles shall be installed as required to satisfy 
operational needs of the nursing unit. 
(B) Nurses calling systems. The following types of nurses calling systems shall 
be provided in nursing units: a nurses regular calling system, a nurses 
emergency calling system, and a staff emergency assistance calling system. The 
systems shall comply with sec.133.162(d)(5)(L) of this title. 
(i) Nurses regular calling system. Each patient room shall be served by at least 
one calling station for two-way voice communication. Each patient bed shall be 
provided with a call button. Two call buttons serving adjacent beds may be 
served by one calling station. In rooms containing two or more calling stations, 
indicating lights shall be provided at each station. Nurses calling systems 
shall be equipped with an indicating light at each calling station which remains 
lighted as long as the voice circuit is operating.
(ii) Nurses emergency calling system. A nurses emergency calling system shall be 
provided at each inpatient water closet, bathtub, sitz bath, and shower in 
accordance with sec.133.162(d)(5)(L)(ii) of this title. When conveniently 
located one emergency call station may serve one bathroom. 
(iii) A staff emergency assistance calling system for staff to summon additional 
assistance shall be provided in central bathing facility rooms and 
exam/treatment rooms in accordance with sec.133.162(d)(5)(L)(iii) of this title. 
(C) Illumination requirements. 
(i) General illumination requirements. Nursing unit corridors shall have general 
illumination with provisions for reducing light levels at night. Illumination of 
corridors for egress purposes shall comply with NFPA 101, sec.sec.12-2.8 and 12-
2.9. 
(ii) Illumination of the nurses station. Illumination of the nurses station and 
all nursing support areas shall be with fixtures powered from the critical 
branch of the emergency electrical system NFPA 99, sec.3-4.2.2.2(c).
(iii) Patient suite lighting. 
(I) Each patient room shall be provided with general lighting and night 
lighting. General lighting and night lighting shall be controlled at the room 
entrance. All controls for lighting in patient areas shall be of the quiet 
operating type. Control of night lighting circuits may be achieved by automatic 
means and in such instances control of night lighting at the room entrance shall 
not be required. 
(II) A reading light shall be provided for each patient. Reading light control 
shall be readily accessible from each patient bed. Flexible light arms, if used, 
shall be mechanically controlled to prevent the bulb from coming in contact with 
bed linen. High heat producing light sources such as incandescent and halogen 
shall be avoided to prevent burns to patients and/or bed linen. Light sources 
shall be covered by a diffuser or a lens.
(III) Each patient bathroom shall have a ceiling mounted lighting fixture for 
general illumination. The bathroom general illumination fixture shall be 
controlled with a wall mounted switch located in the patient room proper or at 
the latch side of the door within the bathroom. 
(IV) A wall or ceiling mounted lighting fixture shall be provided above each 
lavatory. 
(t) Obstetrical suite. 
(1) Architectural requirements. 
(A) General. When obstetrical services are provided, the obstetrical suite shall 
be located and arranged to preclude unrelated traffic through the suite. 
(B) Caesarean section (c-section) operating room(s). A minimum of one dedicated 
c-section operating room shall be located in either the obstetrical or surgical 
suite. This room shall have a minimum clear floor area of 360 square feet with a 
minimum dimension of 18 feet exclusive of built-in shelves or cabinets. There 
shall be no direct access between operating rooms. 
(C) Delivery room(s). A minimum of one delivery room shall be provided in every 
obstetrical suite. The delivery room shall have a minimum clear floor area of 
300 square feet with a minimum dimension of 16 feet exclusive of built-in 
shelves or cabinets exclusive of fixed cabinets and built-in shelves. In 
facilities having only one delivery room the delivery room shall be designed to 
function as an emergency caesarean operating room. 
(D) Infant resuscitation area. An infant resuscitation space shall be provided 
within the c-section room and delivery room with a minimum clear floor area of 
40 square feet in addition to the required area of each room or may be provided 
in a separate but immediately accessible room with a clear floor area of 150 
square feet. 
(E) Labor room(s). A minimum of two labor beds shall be provided for each 
delivery room. Each labor room shall be designed for one or two beds with a 
minimum clear floor area of 120 square feet per bed. 
(i) A labor, delivery, and recovery room (LDR) may be substituted for a labor 
room. 
(ii) In facilities having only one delivery room, one of the two required labor 
beds shall be in a separate room with a minimum clear floor area of 160 square 
feet to serve as an emergency delivery room. Medical gas outlets shall be the 
same as for delivery room. 
(iii) Each labor room shall contain a lavatory equipped with hands-free operable 
controls. Each labor room shall have direct access to a toilet room. One toilet 
room may serve two labor rooms. 
(iv) Labor rooms shall be arranged so that doors are visible from a nurses work 
station. 
(v) A minimum of one shower shall be provided for each four labor beds. Each 
shower room shall contain a toilet and hand washing fixture with hands-free 
operable controls. 
(F) Recovery room(s). Recovery room(s) shall contain not less than two beds and 
have a nurse station with charting facilities (located to permit staff to have 
visual control of all beds), facilities for medicine dispensing, hand washing 
fixtures, a clinical sink with bedpan flushing device, and storage for supplies 
and equipment. There shall be enough space for baby and crib and a chair for the 
support person. Visual privacy of the new family shall be provided. The recovery 
room may be omitted in hospitals with fewer than 1500 annual births. 
(G) Postpartum unit. Postpartum patient suites shall be provided in accordance 
with subsection (s)(1)(B) of this section. 
(H) Labor, delivery and recovery room (LDR). 
(i) When provided, each LDR room shall have controlled access and shall be 
located so that a patient may be transported to the caesarean operating room 
without the need to pass through other functional areas. 
(ii) Each LDR room shall be designed for single occupancy and have a minimum 
clear floor area of 160 square feet exclusive of built-in shelves or cabinets, 
alcove, vestibule or other adjoining rooms. The minimum clear room dimension 
shall not be less than 11 feet. 
(I) Labor, delivery, recovery and postpartum room (LDRP). When provided, each 
LDRP room shall have controlled access and shall be located on an exterior wall 
and have an operable window. 
(i) Each room shall be designated for single occupancy and have a minimum clear 
floor area of 200 square feet exclusive of built-in shelves or cabinets, alcove, 
vestibules, or other adjoining rooms. The minimum clear room dimension shall not 
be less than 11 feet. 
(ii) A hand washing fixture with hands-free operable controls shall be provided 
in each LDRP room. 
(iii) Each LDRP shall have direct access to and exclusive use of a bathroom with 
a shower and toilet. 
(J) Infant resuscitation space. Resuscitation space shall be provided within 
each LDR and LDRP room with a minimum clear floor area of 40 square feet in 
addition to the required area of each room. 
(K) Isolation rooms. When patients who have airborne infectious diseases are 
treated, an isolation room shall be provided in the obstetrical suite which 
complies with the functional space requirements as specified in subsection 
(s)(1)(C) of this section, and with the ventilation requirements for infection 
isolation rooms in Table 3 of sec.133.169(c) of this title.
(L) Newborn nursery suite. One infant station for each LDRP and each postpartum 
bed shall be provided in the nursery. Nurseries shall be located and arranged 
convenient to the postpartum nursing unit and near or part of the obstetrical 
suite. The nurseries shall be located and arranged to preclude the need for non-
related pedestrian traffic. Each nursery unit shall meet the following 
requirements. 
(i) Full term nursery. A full-term nursery shall have a maximum of 16 infant 
stations and a minimum clear floor area of 24 square feet for each infant 
station exclusive of auxiliary spaces including aisles within the nursery. There 
shall be at least three feet between and at all sides of bassinets. Additional 
area shall be provided to accommodate workroom functions if these are located 
within the nursery area as specified in subparagraph (M) of this paragraph. 
(I) When a rooming-in program is used, the total number of bassinets in nursery 
units shall be not less than one bassinet for every two LDRP and postpartum 
beds. 
(II) When a rooming-in program is used but all infants are returned to the 
nursery at night, a reduction in bassinets shall not be allowed.
(ii) Continuing care nursery. Hospitals with 25 or more maternity beds shall 
provide a continuing care nursery for infants requiring close observation. The 
unit shall have a maximum of 16 infant stations and a minimum clear floor area 
of 50 square feet for each station exclusive of auxiliary spaces such as aisles 
within the nursery. There shall be at least four feet between and at all sides 
of bassinets. Additional area shall be provided to accommodate workroom 
functions if these are located within the nursery area as specified in 
subparagraph (M)(v) of this paragraph. 
(M) General requirements for nurseries. Each nursery regardless of type shall 
meet the following requirements: 
(i) There shall be a minimum of one lavatory with hands-free operable controls 
for each eight infant stations. 
(ii) Observation windows to permit the viewing of infants from public areas, 
workrooms, and adjacent nurseries shall be provided. 
(iii) Convenient, accessible storage for linens and infant supplies shall be 
available at each nursery room. 
(iv) A room for consultation, demonstration, breast feeding or breast pumping 
shall be provided convenient to the unit. A counter with sink with hands-free 
operable controls, refrigeration and freezer, storage for pump and attachments, 
and educational materials shall be provided in or convenient to the room. 
(v) Each nursery room shall be served by a connecting workroom(s). The workroom 
shall contain scrubbing and gowning facilities at the entrance for staff and 
housekeeping personnel, work counter, refrigerator, storage for supplies, and 
hand washing fixture with hands-free operable controls. One workroom may serve 
no more than two nursery rooms provided that required services are convenient to 
each. No nursery shall open directly into another nursery. 
(vi) The workroom serving the full-term and continuing care nurseries may be 
omitted if equivalent work and storage areas and facilities, including those for 
scrubbing and gowning, are provided within that nursery at the entrance. Space 
required for work areas located within the nursery is in addition to the area 
required for infant care. Adequate provisions shall be made for storage of 
emergency carts and equipment, and for sanitary storage and disposal of soiled 
waste for the nursery. 
(vii) Charting and dictation facilities shall be provided for physicians and 
nurses. This may be in a separate room or part of the workroom.
(viii) An examination/treatment room or space shall be provided and shall 
contain a work counter, storage, and lavatory equipped for hand washing with 
hands-free operable controls. The examination/treatment room or space shall have 
a minimum clear area of 80 square feet in addition to the required area of each 
workroom exclusive of fixed and movable cabinets and shelves. The examination 
treatment space shall be located within the nursery.
(ix) An airborne infection isolation room is required in at least one level of 
nursery care. The isolation room shall be enclosed and separated from the 
nursery unit with provisions for observation of the infant from adjacent 
nurseries or control area(s). The isolation room shall meet the functional space 
requirements in subsection (s)(1)(C) of this section except that a separate 
toilet, bathtub, or shower is not required, and comply with the ventilation 
requirements in Table 3 of sec.133.169(c) of this title.
(N) Infant formula facilities. Infant formula facilities shall meet the 
following requirements. 
(i) When infant formula is prepared on-site, the infant formula preparation room 
shall contain a lavatory equipped for hand washing with hands-free operable 
controls, warming facilities, refrigerator, work counter, formula sterilizer, 
and storage facilities. The formula room may be located near the nurseries or at 
another appropriate place within the hospital. Direct access from the formula 
preparation room to any nursery room is prohibited. 
(ii) An infant formula clean up room shall be provided and include a hand 
washing fixture with hands-free operable controls, facilities for bottle 
washing, a work counter, and sterilization equipment. 
(iii) When commercial infant formula is used, the separate clean-up and formula 
preparation rooms may be omitted. The storage and handling may be done in the 
nursery workroom or in another appropriate room in the hospital that is 
conveniently accessible at all hours. 
(iv) A refrigerated storage and warming facilities for infant formula shall be 
provided and be accessible for use by nursery personnel at all times. 
(v) A housekeeping room shall be provided for the exclusive use of the nursery. 
(O) Service areas. The following service areas shall be provided to support an 
obstetrical suite unless otherwise noted. 
(i) Control station. The control station shall be located to permit direct 
visual surveillance of all traffic which enters the obstetrical suite. 
(ii) Office. A supervisor's office shall be provided. 
(iii) Waiting room/area. A waiting room/area shall be provided and contain 
toilet room(s) with hand washing facilities, public telephone(s), and drinking 
fountain(s). 
(iv) Scrub facilities. Two scrub stations shall be near the entrance to each 
caesarean operating room and delivery room. Two scrub stations may serve two 
caesarean operating rooms or delivery rooms if the scrub stations are located 
adjacent to the entrance of each caesarean operating room or delivery room. 
Scrub facilities shall be arranged to minimize any incidental splatter on nearby 
personnel or supply carts. Viewing panels shall be provided for observation of 
caesarean operating rooms and delivery rooms from the scrub area. 
(v) Sterilizing facilities. Sterilizing facilities with high speed sterilizers 
shall be conveniently located to serve all c-section rooms and delivery rooms. A 
work space and hand washing fixtures with hands-free operable controls shall be 
included. High speed autoclaves should only be used in an emergency situation 
(e.g. replacements unavailable for dropped instruments). Sterilization 
facilities would not be necessary when spare instruments are available. 
(vi) Anesthesia workroom. An anesthesia workroom shall be provided with work 
counter, sink with hands free operable controls, and storage space for medical 
gas cylinders and other anesthesia equipment. 
(vii) Medication station. Storage and preparation of medication may be done from 
a medicine preparation room, medicine alcove area or from a self-contained 
medicine dispensing unit but must be under visual control of nursing staff. A 
work counter, hand washing fixture with hands-free operable controls, 
refrigerator, and double-locked storage for controlled substances shall be 
provided. Standard cup-sinks provided in many self-contained units are not 
adequate for hand washing. 
(viii) Nourishment station. The nourishment station shall contain sink with 
hands-free operable controls, work counter, self-dispensing ice machine, 
refrigerator, cabinets, and not located in the clean work room. Space shall be 
included for temporary holding of unused or soiled dietary trays. A nourishment 
station is not required in the nursery suite. 
(ix) General storage room(s). A minimum of 30 square feet per operating room is 
required for general storage space(s). The minimum requirements for three 
operating rooms or less is 100 square feet. The storage space is exclusive of 
soiled holding, sterile supplies, clean storage, drug storage, locker rooms. 
(x) Emergency storage. Equipment used for emergencies shall be stored in a room 
or alcove under direct visual control of the nursing staff.
(xi) Storage alcove. The alcove provided for stretcher storage, portable X-ray 
equipment, warming devices, auxiliary lamps, etc. shall be located out of direct 
line of traffic. 
(xii) Changing rooms for obstetrical surgical or delivery room suite. 
Appropriate areas shall be provided for male and female personnel working within 
the obstetrical surgical or delivery room suite. The areas shall contain 
lockers, showers, toilets, hand washing fixtures with hands-free operable 
controls, and space to change into scrub suits and boots. These areas shall be 
arranged to provide a traffic pattern so that personnel entering from outside 
the surgical suite can shower, change, and move directly into the surgical or 
delivery suite. 
(xiii) Staff changing areas. Male and female clothing changing areas shall 
include dressing areas, lockers, showers, toilets, hand washing fixtures with 
hands-free operable controls, and space for donning and disposing scrub suits 
and booties. The staff changing room may be incorporated with the surgical suite 
provided the required services are convenient to each.
(xiv) Lounge. A lounge shall be provided with toilet and hand washing facilities 
for obstetrical staff conveniently located to the delivery, labor, recovery 
areas and nurseries in facilities having a total of four or more c-section and 
delivery rooms. The staff lounge may be incorporated with the staff change 
areas. 
(xv) Staff toilet facilities. Toilet facilities located in the obstetrical suite 
for exclusive staff use shall be provided with hand washing facilities. When a 
lounge is provided, the staff toilets shall be accessible from the lounge. 
(xvi) Nurses' toilet. A nurses' toilet room shall be provided at the labor and 
recovery area(s) and shall include hand washing fixture with hands-free operable 
controls. 
(xvii) Dictation and report preparation area. This may be accessible from the 
lounge area. 
(xviii) Bathtub. When only showers are provided in the LDRs, LDRPs and labor 
rooms, there shall be at least one bathtub for each six beds or fraction 
thereof. Each bathtub shall be in an individual room or enclosure which provides 
space for the private use for drying, dressing and space for an assistant 
attendant. 
(xix) On-call rooms. Physicians and staff on 24-hour on-call work schedules 
shall be provided with sleeping rooms with access to a toilet, lavatory and 
shower. If not contained within the unit itself, the area shall have a telephone 
or intercom connection to the obstetrical suite(s). 
(xx) Clean workroom or clean supply room. A clean workroom is required. It shall 
contain a work counter, a hand washing fixture, storage facilities for clean 
supplies, and a space to package reusable items. The storage for sterile 
supplies must be in a separated room. When the room is used only for storage and 
holding as part of a system for distribution of clean and sterile supply 
materials, the work counter and hand washing fixture may be omitted. 
(xxi) Soiled workroom. The soiled workroom shall be for the exclusive use of the 
obstetrical suite and shall be in addition to the soiled workroom required for 
the obstetrical surgical suite. The soiled workroom for the obstetrical 
caesarean room or delivery room suite shall not have direct connection with 
operating rooms or other sterile activity rooms. The soiled workroom shall 
contain a clinical sink with hands-free operable controls or equivalent flushing 
type fixture, work counter, sink equipped for hand washing, waste receptacle, 
and linen receptacle. 
(xxii) Housekeeping rooms. A separate housekeeping room containing a floor 
receptor or service sink and storage space for housekeeping supplies and 
equipment shall be provided for the exclusive use of the obstetrical suite and 
the c-section or delivery room suite (one for each). 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) C-section rooms and delivery rooms shall have ceiling heights not less than 
nine feet. 
(ii) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where 
impact noises may be generated shall not be located directly over operating 
rooms or delivery rooms, unless special provisions are made to minimize such 
noise as contained in Table 1 of sec.133.169(a) of this title. 
(iii) When vision panels are provided in labor rooms, LDRs, and LDRPs, the 
windows shall be located, draped, or otherwise arranged to preserve patient 
privacy from casual observation from outside the labor room.
(iv) Shower controls shall be outside the wet area for use by nursing staff for 
labor room showers. In the LDRP rooms shower control outside of the wet area may 
be omitted. 
(v) Hand drying devices shall be provided at all hand washing facilities. 
Devices shall be enclosed type fixtures supplying paper or cloth in single-unit. 
(vi) Mirrors shall not be installed at hand washing fixtures where asepsis 
control would be lessened by hair combing such as scrub sinks and sinks in clean 
and sterile supply areas. 
(B) Finishes. 
(i) Finishes for LDR and LDRP rooms shall be selected for ease of cleaning and 
resistance to strong detergents. 
(ii) Flooring in c-section rooms, delivery rooms, labor rooms, and soiled 
workroom shall be of the seamless type in accordance with the requirements of 
sec.133.163(d)(2)(B)(iii)(III) of this title. 
(iii) Ceilings and walls in c-section rooms, delivery rooms, soiled workroom, 
and sterile processing room shall be of the monolithic type in accordance with 
sec.133.163(d)(2)(B)(vi)(III). Acoustic lay-in ceiling is permissible in the LDR 
and LDRP rooms. 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) The air supply for the c-section room and delivery room shall be from 
ceiling outlets near the center of the work area. Return air shall be from near 
the floor level. Each c-section room and delivery room shall have at least two 
return air inlets located as remotely from each other as practical. (Design 
should consider turbulence and other factors of air movement to minimize fall of 
particulate into a wound site). 
(B) Air supply for LDRs and LDRPs shall be from ceiling outlets or high wall 
outlets. Return air shall be from near the floor level. Each LDR and LDRP shall 
have at least two return air inlets located as remotely from each other as 
practical. 
(C) The ventilation system for anesthesia storage rooms shall conform to the 
requirements of NFPA 99, sec.4-3.1.1.2. 
(D) Each caesarean operating room, delivery room, LDR, LDRP and nursery shall 
have temperature and humidity indicating devices mounted at eye level. 
(E) Air handling units serving the obstetrical and surgical suite shall be 
equipped with filter having efficiencies equal to, or greater than specified in 
Table 4 of sec.133.169(d) of this title. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) General. 
(i) Drainage and waste piping shall not be installed within the ceiling or 
installed in an exposed location in caesarean operating rooms and delivery rooms 
unless special precautions are taken to protect these areas from possible 
leakage or condensation from necessary overhead piping systems.
(ii) Floor drains shall not be installed in c-section rooms and delivery rooms. 
(iii) Bedpan-flushing devices shall be installed in all patient toilet rooms 
serving LDRs and LDRPs. 
(B) Medical gas systems. Medical gas systems shall be provided in accordance 
with sec.133.162(d)(4)(A)(iii). 
(i) Nonflammable medical gas and clinical vacuum outlets shall be provided in 
accordance with Table 6 of sec.133.169(f) of this title.
(ii) Nonflammable medical gas and clinical vacuum outlets for the infant 
resuscitation area or room shall be provided in addition to the required medical 
gas and vacuum for the mother in accordance with Table 6 of sec.133.169(f) of 
this title. 
(iii) When a labor room is intended to function as an emergency delivery room 
the nonflammable medical gas and clinical vacuum outlets shall be provide 
accordance with Table 6 of sec.133.169(f) of this title. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) X-ray film illuminators. X-ray film illuminators for handling at least four 
films simultaneously shall be provided in each caesarean operating room, labor, 
and delivery room. 
(ii) Each c-section room shall have at least eight duplex hospital grade 
receptacles. 
(iii) Each delivery room, LDR and LDRP shall have at least six duplex hospital 
grade receptacles. 
(iv) Operating rooms and delivery rooms shall have at least three of the 
required duplex hospital grade receptacles located convenient to the head of the 
procedure table. 
(v) In the infant resuscitation area or room, three duplex hospital grade 
receptacles shall be provided for the infant in addition to those required for 
the mother. 
(vi) The electrical circuit(s) to equipment in wet areas shall be provided with 
five milliampere GFCI. GFCI circuits shall not be used in caesarean operating 
rooms and delivery rooms. When GFCIs are used in critical areas, provisions 
shall be made to ensure that other essential equipment is not affected by 
activation of one interrupter. 
(vii) C-section rooms and delivery rooms shall have general lighting in addition 
to that provided by special lighting units at the surgical and obstetrical 
tables. Each fixed special lighting unit at the operating or delivery table 
shall be connected to an independent circuit. Portable units may share circuits. 
(B) Nurses calling system. 
(i) Nurses calling system. The nurses regular calling system shall be provided 
for pre-op, labor rooms, recovery rooms, LDRs and LDRPs rooms in accordance with 
sec.133.162(d)(5)(L)(i) of this title. In areas such as labor, recovery, and 
pre-op, where patients are under constant visual surveillance, the nurses 
regular calling system may be limited to a bedside button or station that 
activates a signal readily seen at the control station.
(ii) Nurses emergency calling system. An nurse emergency call station shall be 
provided for patient use at each patient toilet, bath, and shower in accordance 
with sec.133.162(d)(5)(L)(ii) of this title. 
(iii) A staff emergency assistance calling system (code blue) shall be provided 
in the operating rooms, delivery rooms, labor rooms, infant resuscitation 
area/rooms, recovery rooms, birthing rooms, nurseries, in accordance with 
section sec.133.162(d)(5)(L)(iii) of this title. 
(u) Outpatient suite. 
(1) Architectural requirements. 
(A) General. When outpatient facilities are provided, these may be either within 
or apart from the hospital. Requirements for an outpatient facility located 
apart from the hospital need not comply with these licensing standards. 
Outpatient facilities physically connected to the hospital with a common wall or 
an enclosed connection shall comply with the requirements of NFPA 101, Chapter 
12 and contain, as a minimum, all the elements described in this subsection. 
(i) Entrance. A separate, well-illuminated, wheelchair accessible entrance 
identified by signs and protected from inclement weather shall be provided. When 
surgical services are provided, a covered drive at the entrance shall be 
required for pickup of patients. 
(ii) Location. The outpatient suite shall be located so that outpatients do not 
traverse inpatient areas. 
(iii) Provisions for privacy. Provisions shall be made for privacy and dignity 
of the patient during interview, examination, and treatment.
(B) Site, administration and public areas. The following shall be provided. 
(i) Parking. When outpatient services are provided, four parking spaces shall be 
required for each surgical procedure room, treatment room, and diagnostic room, 
plus additional spaces for each staff member. Parking spaces shall be located 
convenient to the outpatient suite. 
(ii) Public waiting area. Toilet facilities, public telephone, and drinking 
fountain shall be provided. When pediatric services are provided, pediatric and 
adult patients waiting areas shall be separate. 
(iii) Control station. A control station shall be located to permit staff 
observation of waiting area and control of access to treatment rooms, procedure 
rooms, diagnostic rooms, and the surgical suite. 
(iv) Wheelchair storage alcove. The alcove provided for wheelchair storage shall 
be located out of line of traffic. 
(v) Interview space. Interview spaces shall be provided for social services, 
credit, and admissions. Provisions shall be made for privacy and dignity of the 
patient during interview, examination, and treatment. 
(vi) Offices. General or individual offices shall be provided for business 
transaction, records, and administrative and professional staff.
(vii) Medical records room. The room shall have provisions for dictating, 
recording, and retrieval. 
(viii) Multipurpose rooms. Multipurpose rooms for conferences, meetings, and 
health education purposes shall be provided. 
(C) Examination, treatment, and observation rooms. When examination, treatment, 
or observation facilities are provided, the following shall be included. 
(i) Examination room. The room shall have a minimum clear floor area of 100 
square feet exclusive of fixed cabinets and shelves. Each examination room shall 
contain a work counter, cabinets, examination light and hand washing fixture 
with hands-free operable controls. A clearance of three feet shall be provided 
at each side and the foot of the examination table. 
(ii) Special purpose examination rooms. The special purpose examination room 
shall comply with the requirements of an examination room as described in clause 
(i) of this subparagraph, but room size and configuration may be modified for 
specialized equipment. 
(iii) Treatment room. The room shall have a minimum clear floor area of 120 
square feet exclusive of fixed and movable cabinets and shelves. The minimum 
clear dimension between fixed cabinets and built-in shelves shall be 10 feet. 
The treatment room shall contain a work counter, cabinets, medication storage, 
examination light and hand washing fixtures with hands-free operable controls. 
(iv) Observation room. The room shall be located to permit close observation 
from either a nurse station or the control station. The room shall have a 
minimum clear area of 80 square feet exclusive of fixed and movable cabinets and 
shelves. Patients shall have access to a toilet room without entering the 
general corridor area. 
(D) Diagnostic facilities. 
(i) Radiology. Services shall be available to the outpatient suite. When 
separate radiology units are located within the outpatient suite, the 
requirements in subsection (l) of this section shall be met. 
(ii) Laboratory. Services shall be made available to the outpatient suite. When 
a separate laboratory unit is installed within the outpatient suite, the 
requirements in subsection (m) of this section shall be met. All laboratory 
services provided within the outpatient suite or by a written contractual 
arrangement shall comply with the requirements of sec.133.41(h) of this title. 
(E) Surgical facilities. Outpatient surgical facilities may be provided 
separately or may be shared with the inpatient facilities. 
(i) When a separate outpatient surgery suite is provided, it shall meet the 
requirements in subsection (dd) of this section. 
(ii) The following additional rooms and areas shall be provided in each surgical 
suite wherever outpatient surgical procedures are performed.
(I) A preoperative area for outpatient use shall be provided. The area shall 
include a waiting room, change area with lockers, toilet facilities, and sitting 
space for ambulatory patients. Traffic patterns shall be arranged for patients 
to enter the preoperative area from outside the surgical suite, prepare for 
surgical procedure and then move directly into the restricted corridor of the 
operating suite. 
(II) A secondary recovery lounge (for outpatients requiring additional 
observation) with a nurses' station and hand washing facilities shall be 
provided. One lavatory shall be provided for every eight recovery stations. Each 
recovery station shall be not less than 60 square feet, exclusive of four foot 
wide access aisles and the area for the nurses' station and provisions for each 
patient's privacy. 
(III) A toilet room for use by outpatients shall be provided directly accessible 
from the outpatient recovery and lounge areas. The toilet room shall contain 
hand washing facilities and a water closet with clearances of three feet at both 
sides and front. 
(F) Special procedure room(s). When outpatient special procedures services are 
provided within the outpatient suite, the special procedure room(s) shall comply 
with the requirements in subsection (cc) of this section. 
(G) Service areas. The following service areas and facilities shall be provided 
within the outpatient suite unless noted otherwise. 
(i) Nurse station(s). The nurse station shall contain a work counter, 
communication system, space for supplies, and provisions for charting.
(ii) Hand washing fixtures. Hand washing fixtures with hands-free operable 
controls shall be available at all patient care areas. 
(iii) Patient toilet room(s). Toilet room(s) shall be conveniently located to 
treatment room(s), examination room(s), and diagnostic room(s) and shall include 
hand washing fixtures. 
(iv) Staff toilet facilities. Toilets with hand washing fixtures shall be 
provided for the exclusive staff use. Toilet facilities may be provided in 
conjunction with the staff locker rooms or staff lounge. 
(v) Staff locker rooms. Separate male and female staff locker rooms or common 
closets shall be provided for personal belongings. Staff locker rooms may be 
provided in conjunction with the staff lounge. 
(vi) Staff lounge. A staff lounge with separate male and female staff clothing 
change rooms and toilets with hand washing facilities shall be provided in 
hospitals having a total of six or more diagnostic and treatment rooms. 
(vii) Medication station. Storage and preparation of medication may be done from 
a medicine preparation room, medicine alcove area or from a self-contained 
medicine dispensing unit but must be under visual control of nursing staff. A 
work counter, hand washing fixtures with hands-free operable controls, 
refrigerator, and double-locked storage for controlled substances shall be 
provided. Standard cup-sinks provided in many self-contained units are not 
acceptable for hand washing. 
(viii) Dictation and report preparation area. This area may be accessible from 
the lounge. 
(ix) Cast room. When a cast room is provided, it shall be equipped with hand 
washing facilities, plaster sink, storage, and other provisions required for 
cast procedures. 
(x) Wheelchair and stretcher storage. Wheelchair and stretcher storage space or 
alcove shall be provided and located out of direct line of traffic. 
(xi) Storage. Storage facilities shall be provided for office supplies, sterile 
supplies, pharmaceutical supplies, splints and other orthopedic supplies, and 
housekeeping supplies and equipment. 
(xii) Ice machine. A self-dispensing ice machine shall be provided. 
(xiii) Clean workroom. A clean workroom or clean supply room shall be provided. 
(xiv) Soiled workroom. A soiled workroom shall be provided. It shall not have 
direct access to any patient treatment, examination, diagnostic rooms, or 
sterile rooms. The room shall contain a clinical sink or equivalent flushing rim 
fixture, work counter, hand washing fixture, waste receptacle, and linen 
receptacle. The workroom may be shared with an adjacent emergency suite when 
directly accessible from both suites. 
(xv) Housekeeping room. The housekeeping room shall be located within the suite. 
The room may be shared with an adjacent emergency suite when directly accessible 
from both sides. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph. Treatment rooms shall be 
provided with seamless flooring in accordance with requirements contained in 
sec.133.162(d)(2)(B)(iii)(III) of this title.
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph. Filtration requirements for 
air handling units serving the outpatient and surgical suite shall be equipped 
with filters efficiencies equal to, or greater than specified for patient care 
areas in Table 4 of sec.133.169(d) of this title. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
Sinks used for the disposal of plaster of paris shall have a plaster trap. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) A nurses emergency call station shall be provided in all outpatient toilet 
rooms in accordance with sec.133.162(d)(5)(L)(ii) of this title. 
(B) A staff emergency assistance calling system (code blue) shall be provided 
for staff to summon additional assistance for each treatment room, diagnostic 
room, observation room, and secondary recovery lounge in accordance with 
sec.133.162(d)(5)(L)(iii) of this title. 
(v) Pediatric and adolescent nursing unit. 
(1) Architectural requirements. When a facility offers pediatric care services 
and the nursing unit contains a total of 15 or more patient beds, cribs or 
bassinets, the unit shall meet the requirements contained in this subsection. 
Units containing less than 15 beds, cribs or bassinets, may be a part of the 
medical/surgical nursing unit. Each pediatric and adolescent nursing unit shall 
comply with the requirements contained in subsection(s)(1) of this section and 
the following requirements. 
(A) Patient rooms. Patient rooms in a pediatric and adolescent nursing unit 
containing hospital beds or cribs shall comply with subsection (s)(1)(B) of this 
section with the following exceptions: 
(i) The minimum clear floor space in a private patient room within a dedicated 
pediatric unit intended for a crib shall be 80 square feet.
(ii) Patient rooms used for multiple cribs may contain a minimum of 60 square 
feet of clear area for each crib with no more than six cribs in a room. 
(B) Airborne infection isolation suites and protective environment suites. 
(i) Airborne infection isolation suites shall comply with the requirements 
contained in subsection (s)(1)(C) of this section and shall be located within 
the pediatric and adolescent nursing unit. 
(ii) Protective environment suites shall comply with the requirements contained 
in subsection (s)(1)(D) of this section and shall be located within the 
pediatric and adolescent nursing unit. 
(C) Pediatric nursery suite. When provided, the pediatric nursery suite shall be 
located in the pediatric nursing unit and shall consist of a nursery, 
examination/treatment room, workroom, and formula preparation room and contain 
the following elements. 
(i) Nursery. Each pediatric nursery shall contain not more than eight bassinets 
with 40 square feet of clear floor space provided for each bassinet. There shall 
be at least three feet between and at all sides of bassinets. Additional area 
shall be provided to accommodate workroom functions if these are located within 
the nursery area as specified in clauses (ii) and (iii) of this subparagraph. 
(I) Each pediatric nursery shall contain hand washing facilities.
(II) Each pediatric nursery shall be provided with viewing windows for observing 
infants from public areas and workroom(s). 
(ii) Nursery workroom. A connecting workroom shall be provided which shall 
contain gowning facilities at the entrance for staff, visitors, and housekeeping 
personnel, work space with counter, refrigerator, lavatory or sink equipped for 
hand washing, and storage. One workroom shall serve no more than two nurseries 
provided that required services are convenient to each. The workroom may be 
omitted if only one nursery is provided and the equivalent work area and 
facilities are provided within the nursery in which case the gowning facilities 
shall be located near the entrance to the nursery and shall be separated from 
the work area. 
(iii) Examination/treatment room or area. An examination/treatment room or area 
shall be provided. The examination/treatment area may be located in a separate 
room or a designated part of the nursery. It shall contain a work counter, 
storage facilities, and a lavatory for hand washing. 
(iv) On-site formula preparation. Where infant formula is prepared on the 
hospital site, the hospital shall provide cleanup facilities for washing and 
sterilizing supplies. These shall consist of a lavatory or sink equipped for 
hand washing, a bottle washer, work counter space, and an equipment sterilizer. 
A separate room for preparing infant formula shall be provided. The room shall 
contain a lavatory or sink equipped for hand washing, hot plate, refrigerator, 
work counter, formula sterilizer, and storage facilities. It may be located in 
the pediatric nursery or in another appropriate place within the hospital. There 
shall be no direct access from the formula room to a nursery. 
(v) Commercially prepared formula. If a commercial infant formula is used, the 
storage and handling may be done in the nursery workroom or in another 
appropriate room elsewhere in the hospital which has a work counter, sink 
equipped for hand washing, and storage facilities. 
(vi) Housekeeping room. A housekeeping room shall be located in the pediatric 
nursery suite. 
(D) Service areas. The service areas in the pediatric and adolescent nursing 
unit shall comply with the requirements listed in subparagraph (s)(1)(F) of this 
section and the following requirements. 
(i) Multipurpose or individual room(s) shall be provided for dining, 
educational, and play purposes. Special provision shall be made to minimize the 
impact noise transmission through the floor of the multipurpose room(s) to 
occupied spaces below. Requirements in Table 1 of sec.133.169(a) of this title 
shall be met. 
(ii) Patient toilet room(s) shall be provided convenient to multipurpose room(s) 
and central bathing facilities. 
(iii) Storage closets or cabinets for toys and educational and recreational 
equipment shall be provided. 
(iv) Storage space shall be provided for replacement of cribs and adult beds to 
provide flexibility for interchange of patient accommodations.
(2) Details and finishes. Each pediatric and adolescent nursing unit shall 
comply with the requirements contained in subsection(s)(2) of this section. 
(3) Mechanical requirements. Mechanical requirements in each pediatric and 
adolescent nursing unit shall comply with the requirements contained in 
subsection(s)(3) of this section and this paragraph. 
(A) Special consideration for safety shall be given to the type of heating and 
cooling units, ventilation outlets, and appurtenances installed in patient areas 
of pediatric and adolescent nursing units. 
(B) All air grilles and diffusers shall be of a type that prevents the insertion 
of foreign objects. 
(C) All convector or HVAC enclosures exposed in the room shall be constructed 
with rounded corners and shall have enclosures fastened with tamper-resistant 
fasteners. 
(D) The air supply for pediatric nurseries shall be at or near the ceiling. 
Return air inlets shall be not lower than three inches nor higher than 12 inches 
from floor level. 
(4) Plumbing fixtures and piping systems. Plumbing fixtures and piping systems 
shall be in accordance with subsection (s)(4) of this section. In addition, 
drainage and waste piping shall not be installed within the ceiling or installed 
in an exposed location in nurseries and other critical areas unless special 
precautions are taken to protect these areas from possible leakage or 
condensation from necessary overhead piping systems.
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) A staff emergency assistance calling system as described in 
sec.133.162(d)(5)(L)(iii) of this section shall be provided in each pediatric 
nursery. 
(B) Fifteen-ampere and 20-ampere, 125-volt receptacles intended to supply 
patient care areas of pediatric wards, rooms, or areas shall be tamper resistant 
in accordance with NFPA 70, sec.517-18, or shall be protected by GFCI breakers 
which limit the ground fault current to five milliamperes.
(w) Pharmacy suite. 
(1) Architectural requirements. 
(A) General. The pharmacy room or suite shall be located for convenient access, 
staff control, and security for drugs and personnel. 
(B) Dispensing area. The pharmacy room or suite shall include the following 
functional spaces and facilities: 
(i) area(s) for pickup, receiving, reviewing and recording;
(ii) extemporaneous compounding area with sufficient counter space for drug 
preparation and sink with hands-free operable controls; 
(iii) work counter space for automated and manual dispensing activities; 
(iv) storage or areas for temporary storage, exchange, and restocking of carts; 
and 
(v) security provisions for drugs and personnel in the dispensing counter area. 
(C) Manufacturing. The pharmacy room or suite shall provide the following 
functional spaces and facilities for the manufacturing area(s):
(i) bulk compounding area with work space and counters; and
(ii) area(s) for packaging, labeling and quality control.
(D) Storage. The following spaces shall be provided in cabinets, shelves, and/or 
separate rooms or closets: 
(i) space for bulk storage, active storage, and refrigerated storage; 
(ii) storage in a fire safety cabinet or storage room that is constructed under 
the requirements for protection from hazardous areas in accordance with NFPA 
101, Chapter 12, for alcohol or other volatile fluids, when used; 
(iii) storage in a secure vault, safe, or double locking wall cabinet for 
narcotics and controlled drugs; and 
(iv) storage space for general supplies and equipment not in use. 
(E) Administrative area(s). The following functional spaces and facilities shall 
be included for the administrative area(s): 
(i) office area for the chief pharmacist and any other offices areas required 
for records, reports, accounting activities, and patients profiles;
(ii) poison control center with storage facilities for reaction data and drug 
information centers; and 
(iii) a room or area for counseling and instruction when individual medication 
pick-up is available for inpatients or outpatients. 
(F) Service areas and facilities. The following service areas and facilities 
shall be provided. 
(i) Intravenous (IV) solutions area. When IV solutions are prepared in a 
pharmacy, a sterile work area with a laminar-flow workstation designed for 
product protection shall be provided. 
(ii) Satellite pharmacy facilities. When provided, the room(s) shall include a 
work counter, a sink with hands-free operable controls, storage facilities, and 
refrigerator for medications. As applicable, items required in subparagraphs (B) 
and (C) of this paragraph may be incorporated into the satellite pharmacy. 
(iii) Hand washing facilities. A hand washing fixture with hands-free operable 
controls shall be located in each room where open medication is handled. 
(iv) Staff facilities. Toilets may be outside the suite but shall be convenient 
for staff use. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title. 
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph. When IV solutions are 
prepared, the required laminar-flow system shall include a non-hygroscopic 
filter rated at 99.97% (HEPA). A pressure gauge shall be installed for detection 
of filter leaks or defects. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) Material used for plumbing fixtures shall be non-absorptive and acid-
resistant. 
(B) Water spouts used at lavatories and sinks shall have clearances adequate to 
avoid contaminating utensils and the contents of carafes, etc.
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) Under-counter receptacles and conduits shall be arranged (raised) to not 
interfere with cleaning of the floor below or of the equipment.
(B) Exhaust hoods shall have an indicator light indicating that the exhaust fan 
is in operation. 
(C) Electrical circuit(s) to equipment in wet areas shall be provided with five 
milliampere GFCI. 
(x) Radiotherapy suite. When radiotherapy services are provided, the suite may 
contain equipment for electron beam therapy, radiation therapy, or both. The 
following facilities shall be provided. 
(1) Architectural requirements. 
(A) Cobalt, linear accelerators, and simulation rooms require radiation 
protection. A certified medical physicist shall specify the type, location, and 
amount of radiation protection to be installed for the layout and equipment 
selections. Room layouts and construction shall prevent the escape of 
radioactive particles. Openings into the room, including doors, ductwork, vents, 
and electrical raceways and conduits, shall be baffled to prevent direct 
exposure to other areas of the facility. 
(B) Cobalt, linear accelerator, and simulator rooms shall be sized in accordance 
with the installed equipment requirements, patient access on a stretcher, 
medical staff access to the equipment and patient, and access for servicing the 
equipment. 
(C) A mold room shall have direct access to the linear accelerator room and 
contain a ventilation hood exhausted to the outside and hand washing facilities 
with hands-free operable controls. 
(D) A block room with storage for the linear accelerator may be combined with 
the mold room. 
(E) A hot laboratory in support of cobalt therapy shall be provided. 
(F) The following service areas shall be provided unless these are accessible 
from other departments such as imaging or outpatient areas:
(i) a stretcher hold area adjacent to the treatment rooms, screened for privacy, 
and combined with a seating area for outpatients; 
(ii) exam rooms for each treatment room. The rooms shall be a minimum of 100 
square feet and shall be provided with hand washing facilities;
(iii) a darkroom convenient to the treatment rooms and a quality control area; 
(iv) a patient gowning area with provisions for safe storage of valuables and 
clothing. At least one space shall be sized to allow for staff assisted 
dressing; 
(v) convenient access to a housekeeping room; 
(vi) film file area; and 
(vii) film storage area for unprocessed film. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Radiation protection shall be designed, tested and approved by a medical 
physicist licensed under the Texas Civil Statutes, Article 4512n, Medical 
Physics Practice Act. 
(ii) Room shielding calculations for linear accelerators, cobalt and simulation 
rooms shall be submitted to the Texas Department of Health's Bureau of Radiation 
Control (BRC) for approval prior to use. Shielding in diagnostic radiographic 
rooms will be reviewed by BRC inspectors, in the field, subsequent to use. Any 
changes in design or shielding in design or shielding which affects radiation 
exposure levels adjacent to those rooms, requires prior approval by BRC. 
(iii) The cobalt, simulation and linear accelerator rooms shall have ceiling 
heights not less than nine feet. Ceilings containing ceiling-mounted equipment 
shall be of sufficient height to accommodate the equipment of fixtures and their 
normal movement. 
(iv) Properly designed rigid support structures for ceiling mounted equipment 
shall be located above the finished ceiling. 
(B) Finishes. 
(i) Flooring in the soiled workroom and any work or treatment areas in the 
radiotherapy suite where radioactive materials are handled shall be of the 
seamless type as required by sec.133.162(d)(2)(B)(iii)(III). 
(ii) Walls shall be constructed of materials that are easily decontaminated from 
accidental radioactive spills and finished in accordance with 
sec.133.162(d)(2)(B)(iv). 
(iii) Ceilings in the hot laboratory, mold laboratory, and soiled workroom shall 
be monolithic as required by sec.133.162(d)(2)(B)(vi)(III).
(3) Mechanical requirements. Each radiotherapy suite shall comply with the 
requirements of sec.133.162(d)(3). 
(4) Plumbing fixtures and piping systems. Each radiotherapy suite shall comply 
with the requirements of sec.133.162(d)(4). 
(5) Electrical requirements. Each radiotherapy suite shall comply with the 
requirements of sec.133.162(dd)(5) and this paragraph.
(A) Each radiotherapy procedure room shall have at least four electrical 
receptacles. 
(B) Ground fault circuit interrupters shall not be used in radiotherapy 
procedure rooms. 
(y) Rehabilitation nursing unit. 
(1) Architectural requirements. When provided, each rehabilitation nursing unit 
shall comply with the requirements contained in subsection(s)(1) and the 
following requirements. 
(A) Accessibility requirements. All patient rooms, bathing units and toilets in 
each rehabilitation nursing unit and all public and common use areas shall be 
designed and constructed to be handicapped accessible in accordance with 
sec.133.162(d)(1)(F) of this title. These requirements shall apply in all new 
construction and when an existing nursing unit or a portion thereof is converted 
to rehabilitation nursing care from other nursing care, e.g. mental health care 
to rehabilitation care. 
(B) Patient room suites. Patient room suites shall comply with the requirements 
of subsection (s)(1)(B) and the following requirements.
(i) Private patient room. The minimum floor area in a private (single-bed) 
patient room shall be 120 square feet. 
(ii) Semi-private patient room. The minimum floor area in a semi-private patient 
room intended for rehabilitation patients shall be 110 square feet per patient. 
A clearance of four feet shall be available at the foot of each bed in semi-
private rooms to permit the passage of equipment and beds. A minimum distance of 
five feet between a wall and the side of a bed and four feet between beds shall 
be provided. 
(iii) When a training toilet room is provided, there shall be three fee of 
clearance on both sides and front of the water closet fixture. The room shall be 
designed to comply with accessibility requirements of sec.133.162(d)(1)(F) of 
this title. 
(2) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with subsection (s)(4) of this section. All plumbing 
fixtures shall comply with the requirements for the handicapped in accordance 
with sec.133.162(d)(1)(F) of this title.
(z) Rehabilitation therapy suite. 
(1) Occupational therapy. When occupational therapy services are provided, the 
following rooms or areas shall be included: 
(A) an activity area with work areas, counters and a hand washing fixture with 
hands-free operable controls; 
(B) an area for teaching daily living activities with space for a bed, kitchen 
counter with appliances and sink, bathroom, and a table and chair. The daily 
living activities area may be combined with the activity area; 
(C) an office for the occupational therapist; and 
(D) a storage room for supplies and equipment. 
(2) Physical therapy. When physical therapy services are provided, the following 
rooms or areas shall be included. 
(A) When services for thermotherapy, diathermy, ultrasonics, and hydrotherapy 
are provided, individual treatment areas are required. 
(B) An individual treatment area(s) shall be a minimum of 70 square feet of 
clear floor area exclusive of four foot aisle space. Privacy screens or curtains 
shall be provided at each treatment station. 
(C) A hand washing fixture with hands-free operable controls shall be provided 
in each treatment room/space. A hand washing fixture may serve several patient 
stations when cubicles or open room concepts are used and when the fixture is 
conveniently located. 
(D) An area shall be provided for exercise and may be combined with treatment 
areas in open plan concepts. 
(E) An office for the physical therapist shall be provided.
(F) Provisions for the collection and storage of wet and soiled linen shall be 
provided. 
(G) A storage area or room for equipment, clean linen, and supplies shall be 
provided. 
(H) When outpatient physical therapy services are provided, the suite shall have 
as a minimum patient dressing areas, showers and lockers.
(3) Prosthetics and orthotics. When prosthetics and orthotics services are 
provided, the following rooms or areas shall be included: 
(A) work space with counters and shelves for technicians;
(B) a treatment space for evaluating and fitting with privacy screens or 
curtains; and 
(C) a storage area or room for equipment and supplies. 
(4) Speech and hearing. When speech and hearing services are provided, the 
following rooms or areas shall be included: 
(A) a space for evaluating and treatment with privacy screens or curtains; and 
(B) a storage area or room for equipment and supplies. 
(5) Service areas. The following areas or items shall be provided in a 
rehabilitative therapy suite, but may be shared when multiple rehabilitation 
services are offered: 
(A) patient waiting area(s) with space for wheelchairs; 
(B) patient toilet facilities containing hand washing fixtures with hands-free 
operable controls; 
(C) reception and control station(s). The reception and control station shall be 
located to provide supervision of activities areas. The control station may be 
combined with office and clerical spaces; 
(D) office and clerical space; 
(E) wheelchair and stretcher storage room or alcove which shall be in addition 
to other storage requirements; 
(F) lockable closets, lockers or cabinets for securing staff personal effects; 
(G) staff toilets. The toilets may be outside the suite but shall be convenient 
for staff use and contain hand washing fixtures with hands-free operable 
controls; 
(H) soiled holding room; and 
(I) housekeeping room, conveniently accessible. 
(aa) Renal dialysis suite (acute and chronic). 
(1) Architectural requirements. 
(A) General. When renal dialysis services are included, the following spaces 
shall be provided. 
(i) Space and equipment shall be provided as necessary to accommodate the 
functional programs which may include acute (inpatient services) and chronic 
cases, home treatment, and kidney reuse facilities. 
(ii) Inpatient services (acute) may be performed in critical care units and 
designated areas in the hospital, with appropriate equipment and space. 
(B) Treatment area(s). Treatment rooms shall be located on outside walls and 
provided with windows as required by NFPA 101, sec.12-3.8.
(i) The treatment area(s) shall be separate from administrative and waiting 
areas. 
(ii) Individual patient treatment areas shall have a minimum of 80 square feet 
of clear floor area exclusive of aisles, fixed and movable cabinets and shelves. 
Opposing treatment areas in an open plan configuration shall be separated by a 
four foot aisle exclusive of the 80 square feet requirement.
(iii) A nurse station shall be located within the dialysis treatment area(s) and 
designed to provide visual observation of all patient stations. The nurse 
station shall have counters for storage and access to a hand washing fixture(s) 
with hands-free operable controls. 
(iv) Privacy shall be provided for each patient in the open treatment area with 
cubicle curtains or moveable screens. 
(v) Storage and preparation of medication may be done from a medicine 
preparation room, medicine alcove or from a self-contained medicine dispensing 
unit and shall be under visual control of nursing staff. A work counter, a hand 
washing fixture that is operable without the use of hands, a refrigerator, and 
double-locked storage for controlled substances shall be provided. (Standard 
cup-sinks provided in many self-contained units are not adequate for hand 
washing.) 
(vi) An examination room shall be provided with a minimum of 100 square feet of 
clear floor area exclusive of fixed and movable cabinets and shelves. The 
examination room shall be equipped with a hand washing fixture with hands-free 
operable controls and writing surface. 
(C) Home training room. When home training is provided in the unit, a private 
treatment area of at least 120 square feet exclusive of fixed and movable 
cabinets and shelves shall be provided. This room shall contain a work counter, 
a hand washing fixture with hands-free operable controls, and a separate drain 
for fluid disposal. 
(D) Isolation rooms. 
(i) When renal dialysis treatment is provided for persons who are known or 
suspected of having airborne infectious disease, these procedures shall be 
performed in a designed treatment room of not less than 100 square feet of floor 
area meeting airborne infection isolation ventilation requirements as contained 
in Table 3 of sec.133.169(c) of this title. Bathing facilities are not required. 
(ii) When medical isolation for hepatitis "B" surface antigen (HbsAg) is 
provided, it shall be in a separate dedicated treatment room for a single 
patient with a minimum of 100 square feet clear area exclusive of fixed and 
movable cabinets and shelves. The treatment room shall include a work counter 
and a hand washing fixture with hands-free operable controls, and space for 
patient care supplies and equipment. The dialyzed equipment shall be designated 
and reserved for individual renal dialysis patients. The equipment shall be 
disinfected after each use. Disinfection of equipment shall occur in the 
treatment room. 
(E) Laboratory. Laboratory services shall be made available to the renal 
dialysis suite. All laboratory services provided on-site or by contractual 
arrangement shall comply with the requirements in sec.133.41(h) of this title. 
(F) Service areas and facilities. 
(i) Waiting room. The waiting room shall include a public toilet room(s), a 
drinking fountain, public telephone, and seating accommodations for waiting 
periods. When outpatient dialysis services are not provided, a waiting room is 
not required. 
(ii) Patient toilet(s). Patient toilet rooms shall be convenient to the 
treatment area(s), treatment room(s), and examination room(s) and include hand 
washing fixtures with hands-free operable controls. 
(iii) Patient storage. Storage for patients' belongings shall be under the 
visual control and supervision of the nursing staff when outpatient services are 
provided. 
(iv) Storage space. A storage space shall be available for wheelchairs, supply 
carts and stretchers. This storage shall be located out of the direct line of 
traffic and in addition to other storage requirements.
(v) Water treatment room. The water treatment and equipment for the dialysis 
shall be located in a dedicated enclosed room. 
(vi) Mixing room. Dialysis solutions may be processed from a central batch 
delivery system or prepared in an on-site mixing room. When provided, a mixing 
room shall include a work counter, sink with hands-free operable controls, 
storage space, and holding tanks. 
(vii) Dialyzers reprocessing room. When provided, the room shall be arranged for 
the separation and one-way movement of soiled and clean materials. This room 
shall include a work counter, service sink, separate hand washing fixture with 
hands-free operable controls, refrigerator and storage space. 
(viii) Breakdown room. When provided, the room shall include a work counter, 
service sink, separate hand washing fixture with hands-free operable controls, 
and storage space. This function may be included as part of the soiled 
processing area of the dialysis processing room. 
(ix) Nourishment station. The nourishment station shall include a work counter, 
a sink with hands-free operable controls, refrigerator, microwave, and storage 
cabinets. 
(x) Hand washing facilities. Hand washing facilities shall be provided in each 
examination room and treatment room. In an open multiple treatment area one hand 
washing fixture shall be provided for every two treatment stations. 
(xi) Dictation and report preparation area. This area may be incorporated with 
the nurse station if adequate work space is provided.
(xii) Staff facilities. Toilets may be outside the suite but shall be convenient 
for staff use. 
(xiii) Offices work area. Office space and clinical work area shall include 
space for records storage and report preparation. 
(xiv) Clean workroom. When the functional program dictates preparing patient 
care items, a clean workroom shall be provided and contain a work counter, a 
hand washing fixture with hands-free operable controls, and storage facilities 
for clean and sterile supplies. This function may be within the mixing room. 
(xv) Clean linen storage. There shall be a designated area for clean linen 
storage. This may be within a clean workroom, a mixing room, a separate closet, 
or an approved distribution system. If a closed cart system is used, storage of 
the cart shall be in an alcove. 
(xvi) Soiled workroom. The soiled workroom shall contain a work counter, a 
clinical sink with hands-free operable controls or equivalent flushing type 
fixture, separate hand washing facilities, and separate waste and linen 
receptacles. 
(xvii) Housekeeping room. A housekeeping room shall be available.
(2) Details and finishes. 
(A) Details. Details shall be in accordance with sec.133.162(d)(2)(A) of this 
title. 
(B) Finishes. Finishes shall be in accordance with sec.133.162(d)(2)(B) of this 
title and this paragraph. 
(i) Flooring in a treatment room, examination room, and soiled workroom shall be 
of the seamless type as required by sec.133.162(d)(2)(B)(iii)(III) of this 
title. 
(ii) Wall finishes shall be in accordance with the requirements of 
sec.133.162(d)(2)(B(iv) of this title. 
(iii) Ceilings in the isolation and hepatitis "B" rooms shall be of the 
monolithic type as required by sec.133.162(d)(2)(B)(vi)(III) of this title. 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph. Air handling units serving 
the renal dialysis suite shall be equipped with filters with efficiencies equal 
to, or greater than specified for patient care areas in Table 4 of 
sec.133.169(d) of this title. 
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) The dialysis water treatment shall meet the standards as described in the 
American National Standard, Hemodialysis Systems, March 1992 edition, published 
by the American Association for the Advancement of Medical Instrumentation 
(AAMI), 3330 Washington Boulevard, Suite 400, Arlington, Virginia 22201. 
(B) Standards for reuse systems shall meet the standards as described in the 
American National Standards, Reuse of Hemodialyzers, 1993 edition, published by 
AAMI. 
(C) Provision shall be made to have continuously circulated filtered cold water. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. Each treatment area, treatment room and examination room shall have 
at least two duplex electrical receptacles located on each side of a patient bed 
or lounge chair. 
(B) Nurses calling system. 
(i) Nurses regular calling system. The nurses regular calling system shall be 
provided for individual treatment area(s) and examination rooms in accordance 
with sec.133.162(d)(5)(L)(i) of this title. In areas such as treatment areas 
where patients are under constant visual surveillance, the nurses calling system 
may be limited to a bedside button or station that activates a signal readily 
seen at the control station. 
(ii) Nurses emergency calling system. A nurses emergency call station shall be 
provided for each patient toilet in the renal dialysis suite in accordance with 
sec.133.162(d)(5)(L)(ii) of this title. 
(iii) A staff emergency assistance calling system (code blue) station shall be 
provided for staff to summon additional assistance in each treatment area, 
individual treatment room, and examination room in accordance with section 
sec.133.162(d)(5)(L)(iii) of this title. 
(bb) Respiratory therapy suite. 
(1) Respiratory therapy suite. When respiratory services are provided, the 
following rooms or areas shall be included: 
(A) an office for the respiratory therapist; 
(B) office and clerical space with provision for filing and retrieval of patient 
records; 
(C) receiving/decontamination workroom with work counter or table, a clinical 
sink, and a hand washing fixture with hands-free operable controls; and 
(D) a storage room for clean and sterile supplies which is separate from the 
receiving/decontamination workroom. 
(2) Outpatient respiratory therapy services. When respiratory therapy services 
are provided for outpatients, the following additional areas and facilities 
shall be included in the respiratory therapy suite: 
(A) patient waiting area with space for wheelchairs; 
(B) reception and control station(s) with visual control of waiting and 
activities areas; 
(C) patient toilet facilities which include hand washing fixtures with hands-
free operable controls; 
(D) office and clerical space; and 
(E) consultation/education room. 
(3) Cough-inducing and aerosol-generating procedures. All cough-inducing 
procedures performed on patients who may have infectious Mycobacterium 
tuberculosis shall be performed in rooms, booths or special enclosures using 
local exhaust ventilation devices with HEPA filters located at the discharge end 
and exhaust directly to the outside. 
(4) Service areas. The following areas and facilities shall be provided for the 
respiratory therapy suite but may be shared with other departments when 
conveniently located: 
(A) wheelchair and stretcher storage room or alcove which is in addition to 
other storage requirements; 
(B) lockable closets, lockers or cabinets for securing staff personal effects; 
(C) staff toilets which include a hand washing fixture with hands-free operable 
controls. Staff toilets may be located outside suite if location is near and 
convenient; and 
(D) housekeeping room. The housekeeping room shall be located within the suite 
or nearby. 
(cc) Special procedure suite. 
(1) Architectural requirements. 
(A) General. When special procedures such as endoscopy, bronchoscopy, and 
cardiac catheterization and other similar special procedures are provided, 
procedures rooms may be in separate suite or may be part of the surgical suite.
(i) Special procedure rooms may be incorporated in an outpatient suite. 
(ii) When special procedure rooms are part of the surgical suite and non-
invasive procedures are performed, these rooms are not required to be part of 
the sterile environment. 
(iii) When general anesthesia or inhalation anesthetizing agents are used during 
special procedures, these rooms shall comply with the detail, finish, mechanical 
and electrical requirements for an operating room contained in subsection (dd) 
of this section. 
(B) Special procedure rooms for surgical cystoscopic and other endo-urologic 
procedures. 
(i) The procedure room shall have a minimum clear floor area of 350 square feet 
exclusive of fixed cabinets and shelves. The minimum clear dimension between 
fixed cabinets and built-in shelves shall be 15 feet. 
(ii) Procedure rooms shall be designed for visual and acoustical privacy for the 
patient. 
(iii) When patients with airborne infectious disease are treated, there shall be 
an enclosed ante room. The ante room shall have facilities for a scrub sink, 
gowning and storage for clean and soiled material. The ante room shall be sized 
to accommodate passage of a full length stretcher or gurney and to allow closure 
of either doors before proceeding into the special procedure isolation room or 
back into the corridor. 
(C) Cardiac catheterization laboratory. A cardiac catheterization procedure room 
may be in a separate suite, part of a special procedure suite or in the imaging 
suite. The following items and facilities shall be provided.
(i) The room(s) shall be located in an area restricted to authorized personnel. 
(ii) The procedure room shall be a minimum of 400 square feet of clear floor 
area exclusive of fixed and movable cabinets and shelves. The minimum clear 
dimension between fixed cabinets and built-in shelves shall be 18 feet. 
(iii) A control room shall have a view window which permits complete observation 
of the patient from the control console. The control room shall be large enough 
to contain the efficient functioning of the X-ray and image recording equipment. 
(iv) A film viewing room and film file room shall be provided.
(v) An equipment room large enough to contain X-ray transformers, power modules, 
and necessary electronics and electrical gear shall be provided.
(vi) Appropriate areas shall be provided for male and female changing rooms and 
shall be arranged to provide a traffic pattern so that personnel entering from 
outside the catheterization laboratory procedure suite can shower, change, and 
move directly into the catheterization laboratory procedure room. The changing 
area shall include lockers, dressing areas, showers, toilets, hand washing 
fixtures with hands-free operable controls. 
(vii) Scrub facilities shall be located adjacent to the entrance of each cardiac 
catheterization laboratory procedure room. Scrub facilities shall be arranged to 
minimize any incidental splatter on nearby personnel or supply carts. The scrub 
sinks shall be recessed out of the main traffic areas. The alcove shall be 
located off the restricted areas of the cardiac catheterization laboratory 
suite. Scrub sinks shall not be located inside the sterile area. 
(viii) Sterilizing facilities for immediate or emergency use shall be provided. 
A work space and hand washing fixture with hands-free operable controls shall be 
included. 
(D) Patient holding and preparation area. In suites with two or more special 
procedure rooms, a patient holding and preparation area shall be provided to 
accommodate ambulatory and stretcher patients. The following items and 
facilities shall be included: 
(i) two-stretcher stations for one procedure room with one additional station 
for each additional procedure room; 
(ii) a control station and charting area arranged to permit staff visual 
observation of holding and preparation area; 
(iii) a work counter with hand washing fixture with hands-free operable controls 
located in the preparation area; and 
(iv) cubicle curtains at each station for patient privacy.
(E) Recovery room or area. In suites with two or more special procedure rooms, a 
recovery room or area shall be provided to accommodate ambulatory and stretcher 
patients. The following items and facilities shall be provided: 
(i) a minimum of one patient recovery station per each special procedure room. 
The clearance between a recovery bed and a wall shall not be less than five 
feet. The minimum clearance between the bed headboard and the wall shall be 
three feet and in addition provide passage space at the foot of each bed of not 
less than four feet. The distance between each patient bed shall not be less 
than six feet clear; 
(ii) nurse station and charting area arranged to provide visual observation of 
recovery room area; 
(iii) a staff toilet room and hand washing fixtures with hands-free operable 
controls at the recovery room/area; and 
(iv) cubicle curtains at each station for patient privacy.
(F) Instrument processing room. When instruments and equipment are processed, 
cleaned and disinfected within the suite, a dedicated room shall be provided. 
The room may serve multiple procedure rooms. The following rooms shall include 
the following items. 
(i) A clean room shall be provided and the process of cleaning the instruments 
or equipment shall flow from the contaminated area to the clean area, and 
finally, to storage. The room shall include a work counter hand washing sink 
fixtures with hands-free operable controls. Instruments and equipment shall be 
protected from contamination. 
(ii) The decontamination room shall be equipped with work counters, two utility 
sinks remote from each other and a freestanding hand washing fixture with hands-
free operable controls. 
(G) Service areas. The following services shall be provided for all types of 
special procedure rooms unless noted otherwise. 
(i) Control station. In facilities with two or more special procedure rooms in a 
suite, a nurse station shall be located to permit visual surveillance of all 
traffic which enters the special procedure rooms suite shall be provided. 
(ii) Dictation and report preparation area. This area may be incorporated with 
the control station. 
(iii) Hand washing facilities or scrub sinks. Freestanding hand washing fixture 
or scrub sinks with hands-free controls shall be provided at or near the 
entrance to each special procedure room. Hand washing facilities shall be 
arranged to minimize any incidental splatter on nearby personnel or supply carts 
and recessed out of the main traffic areas. 
(iv) Medication station. Provision shall be made for the storage and preparation 
of medication to be administered to patients. This may be done from a medicine 
preparation room, medicine alcove area or from a self-contained medicine 
dispensing unit. The medicine preparation room, medicine alcove area or self-
contained medicine dispensing unit shall be under visual control of nursing 
staff. A work counter, hand washing fixtures with hands-free operable controls, 
refrigerator, and double-locked storage for controlled substances shall be 
provided. Standard cup-sinks provided in many self-contained units are not 
acceptable for hand washing. 
(v) Outpatient services. When outpatient services are provided in the special 
procedure suite, a separate waiting/change area shall include waiting room, 
dressing/gowning area with lockers, and toilet facilities and hand washing 
fixtures with hands-free operable controls. 
(vi) Patient toilet room(s). Toilet room(s) shall be conveniently located to 
special procedure rooms and patient changing areas and shall include hand 
washing fixtures. 
(vii) Staff toilet facilities. Facilities shall be provided for exclusive staff 
use and include hand washing fixtures. The toilet may be accessible from a staff 
lounge, when a staff lounge is provided. A nurses toilet room and hand washing 
fixture with hands-free operable controls shall be provided near the recovery 
rooms(s). 
(viii) Storage. A room for equipment and supplies shall be provided. 
(ix) Wheelchair and stretcher storage. Wheelchair and stretcher storage 
space/alcove shall be provided and located out of direct line of traffic.
(x) Staff storage. Storage space for employees' personal effects shall be 
provided. 
(xi) Ice machine. An ice machine shall be provided. 
(xii) Clean storage room. A clean storage room shall be provided for clean 
supplies and linens. Hand washing fixtures shall be provided with hands-free 
operable controls. 
(xiii) Soiled workroom. The soiled workroom shall not have direct connection to 
the special procedure or diagnostic rooms or other sterile or clean activity 
rooms. The room shall contain a clinical sink or equivalent flushing type 
fixture, work counter, hand washing fixture with hands-free operable controls, 
waste receptacle, and linen receptacle. 
(xiv) Housekeeping room. A housekeeping room shall be provided for the exclusive 
use of the special procedure suite. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Viewing panel(s) shall be provided for observation of each patient by staff 
from an ante room. 
(ii) Special procedure rooms shall have ceiling heights not less than nine feet. 
(B) Finishes. 
(i) Flooring used in special procedure rooms, decontamination room, and in the 
soiled workroom shall be of the seamless type as required by 
sec.133.162(d)(2)(B)(iii)(III) of this title. 
(ii) Ceiling finishes in special surgical procedure rooms and isolation rooms, 
soiled workroom and sterile processing rooms shall be monolithic as required by 
sec.133.162(d)(2)(B)(vi)(III) of this title. 
(iii) A lay-in type ceiling is acceptable in non surgical special procedure 
rooms. 
(3) Mechanical Requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) Air supply for the special procedures rooms shall be from ceiling outlets 
near the center of the work area to efficiently control air movement. A minimum 
of two low return inlets shall be located remotely from one another. 
(B) Return air inlets shall be not lower than four inches nor higher than 12 
inches from floor level. 
(C) The decontamination room shall meet the ventilation requirements that are 
contained in Table 3 of sec.133.169(c) of this title. 
(D) Each special procedure room and recovery room shall have wall mounted 
temperature and humidity indicating devices. 
(E) When patients with airborne infectious disease are treated, the room shall 
meet requirements for airborne infection ventilation for patient care areas in 
accordance with Table 3 of sec.133.169(c) of this title. 
(F) Filtration requirements for air handling units serving the special procedure 
suite shall be equipped with filters efficiencies equal to, or greater than 
specified in Table 4 of sec.133.169(d) of this title.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) Drainage and waste piping shall not be installed within the ceiling or 
installed in an exposed location in special procedures rooms and sterile 
processing rooms unless special precautions are taken to protect these areas 
from possible leakage or condensation from necessary overhead piping systems. 
(B) In an endoscopy suite or similar speciality spaces, plumbing fixtures for 
automatic cleaners, sonic processor, and flash sterilizers may require special 
connections. 
(C) A medical gas system shall be provided in accordance with 
sec.133.162(d)(4)(A)(iii), and Table 6 of sec.133.169(f) of this title.
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) X-ray film illuminators for handling at least four films simultaneously 
shall be provided in each special procedure room. 
(ii) Each special procedures rooms, shall have at least six duplex electrical 
hospital grade receptacles. 
(iii) In locations where mobile X-ray, laser, or other equipment requiring 
special electrical configuration is used, the additional receptacles shall be 
distinctively marked for the special use. 
(iv) The electrical circuit(s) to equipment in wet areas shall be provided with 
GFCIs with six milliampere GFCI. GFCI circuits shall not be used in special 
procedure rooms. When ground fault circuit interrupters are used in critical 
areas, provisions shall be made to ensure that other essential equipment is not 
affected by activation of one interrupter. 
(v) Special grounding system in areas such as special procedures rooms where a 
patient may be treated with an internal probe or catheter the ground system 
shall comply with Chapter 9, NFPA 99 and Article 517, NFPA 70.
(vi) Special procedures rooms shall have general lighting in addition to that 
provided by special lighting units at the procedure tables.
(B) Nurses calling system.
(i) Nurses regular calling system. The nurses regular calling system shall be 
provided for pre-op, holding area, and recovery rooms in accordance with 
sec.133.162(d)(5)(L)(i) of this title. In areas such as labor, recovery, and 
pre-op where patients are under constant visual surveillance, the nurses calling 
system may be limited to a bedside button or station that activates a signal 
readily seen at the control station. 
(ii) Nurses emergency calling system. A nurses emergency call station shall be 
provided for patient use at each patient toilet in accordance with 
sec.133.162(d)(5)(L)(ii) of this title. 
(iii) A staff emergency assistance calling system (code blue) shall be provided 
in the special procedure, treatment rooms, bronchoscopy, cardiac catheterization 
laboratory, and recovery rooms in accordance with section 
sec.133.162(d)(5)(L)(iii) of this title. 
(dd) Surgical suite. 
(1) Architectural requirements. 
(A) General. The surgical suite shall be located and arranged to preclude 
unrelated traffic through the suite. The suite shall meet the following 
requirements. 
(B) General operating room(s). A minimum of one operating room shall be provided 
and shall have a minimum clear floor area of 360 square feet exclusive of fixed 
and movable cabinets and shelves. The minimum clear dimension between fixed 
cabinets and built-in shelves shall be 18 feet. There shall be no direct access 
between operating rooms. 
(C) Isolation operating room(s). When invasive procedures are performed on 
persons who are known or suspected of having airborne infectious disease, these 
procedures shall be performed in a designated operating room designed to meet 
airborne infection isolation ventilation requirements. 
(i) The isolation operating room shall have the functional space and ventilation 
requirements as contained in subparagraph (B) of this paragraph, and Table 3 of 
sec.133.169(c) of this title. 
(ii) The entrance to this designated operating room shall be through an enclosed 
ante room. The ante room shall have facilities for a scrub sink, gowning and 
storage for clean and soiled material. The ante room shall be sized to 
accommodate passage of a full length stretcher or gurney and to allow closure of 
either door before proceeding into the operating room or back into the corridor. 
(D) Operating rooms for cardiovascular, orthopedic, neurological, and other 
special surgical procedures that require additional personnel and large 
equipment. 
(i) When provided, these rooms shall have a minimum clear floor area of 600 
square feet, with a minimum of 20 feet clear dimension exclusive of fixed or 
wall-mounted cabinets and built-in shelves. 
(ii) An additional room shall be provided in the restricted area of the surgical 
suite, preferably adjoining this operating room, where extra corporeal pump(s), 
supplies and accessories can be stored and serviced.
(iii) When complex orthopedic and neurosurgical surgery is performed, additional 
rooms shall be provided in the restricted area of the surgical suite, preferably 
adjoining the specialty operating rooms, for storage of equipment used during 
these procedures. 
(E) Special surgical procedures room(s). When general anesthesia or inhalation 
anesthetizing agents are used in such special surgical procedure rooms as 
surgical cystoscopy, surgical endoscopy, other surgical endo-urologic 
procedures, such rooms shall be equipped with a smoke evacuation system 
complying with requirements of sec.133.162(d)(3)(E)(iv)(II). These special 
procedure rooms may be part of the surgical suite. 
(F) Laser procedures room(s). Surgical rooms that are dedicated to laser 
procedures shall have a minimum clear floor area of 400 square feet exclusive of 
fixed and movable cabinets and shelves. The minimum clear dimension between 
fixed cabinets and built-in shelves shall be 18 feet. 
(G) Pre-operative patient holding area(s). In facilities with two or more 
operating rooms, a patient holding area shall be provided to accommodate 
stretcher patients. These areas shall be under the visual control of the nursing 
staff. 
(H) Post-anesthesia care units. 
(i) Post-anesthesia care units (PACU) for surgical patients shall contain a 
medication distribution station, nurse station with charting facilities, 
clinical sink provisions for bedpan cleaning, and storage space for stretchers, 
supplies and equipment. 
(ii) A minimum of two patient stations per operating room shall be provided for 
post-anesthesia care. 
(iii) The clearance between a recovery bed and a wall shall not be less than 
five feet. The minimum clearance between the bed headboard and the wall shall be 
three feet and in addition provide passage space at the foot of each bed of not 
less than four feet. The distance between each patient bed shall not be less 
than six feet clear. 
(iv) Special provisions shall be made to keep medical isolation infectious 
patients separate during surgical recovery. An isolation room meeting the 
requirements in subsection (s)(1)(C) of this section may meet this requirement 
if conveniently located near the operating room suite and otherwise comply with 
requirements for a PACU. In addition, the recovery isolation room medical gas 
system outlet requirements shall be in accordance with Table 6 of sec.133.169(f) 
of this title for recovery room(s). 
(v) The pediatric PACU shall be separate from the adult area. There shall be 
space provided for parents at each recovery bed. 
(vi) Cubicle curtains shall be provided for patient privacy.
(vii) At least one door to the PACU room shall be within the surgical suite. 
(viii) Staff toilet facilities and hand washing fixtures with hands-free 
operable controls shall be located within the PACU. 
(ix) One hand washing fixture shall be provided for every four recovery beds or 
fraction thereof. Fixtures shall be uniformly distributed.
(I) Separation of recovery patients. Provisions shall be made for separating all 
patients (inpatients and outpatients) subject to general anesthesia from those 
that were not. This requirement may be satisfied by providing separate recovery 
rooms or scheduling of procedures. 
(J) Service areas. Services, except for the enclosed soiled workroom and the 
housekeeping room may be shared with the obstetrical facilities if the 
functional program reflects this concept. Service areas, when shared with 
delivery rooms, shall be designed to avoid the passing of patients or staff 
between the operating room and the delivery room areas. 
(i) Control station. A control station located to permit visual surveillance of 
all traffic entering the surgical suite shall be provided.
(ii) Office. A supervisor's office or station shall be provided.
(iii) Scrub facilities. Two scrub stations shall be located near the entrance of 
each operating room. Two scrub stations may serve two operating rooms if the 
scrub stations are located adjacent to the entrance of both operating rooms. 
Scrub facilities shall be arranged to minimize any incidental splatter on nearby 
personnel or supply carts. The scrub sinks shall be recessed out of the main 
traffic areas. The alcove shall be located within the restricted areas of the 
surgical suite. Scrub sinks shall not be located inside the sterile area. 
(iv) Sterilizing facilities. Sterilizing facilities located conveniently to the 
operating rooms for immediate or emergency use with work counter space and hand 
washing fixture(s) with hands-free operable controls shall be provided. 
(v) Anesthesia workroom. The anesthesia workroom shall contain a work counter, 
sink with hands free operable controls and storage space for medical gas 
cylinders and other anesthesia equipment. 
(vi) Medication station. Storage and preparation of medication may be done from 
a medicine preparation room, medicine alcove area or from a self-contained 
medicine dispensing unit but must be under visual control of nursing staff. A 
work counter, hand washing fixture with hands-free operable controls, 
refrigerator, and double-locked storage for controlled substances shall be 
provided. Standard cup-sinks provided in many self-contained units are not 
acceptable for hand washing. 
(vii) General storage room(s). A minimum of 50 square feet per operating room is 
required for general storage space(s). The minimum requirement for three 
operating rooms or less is 150 square feet. This storage room is exclusive of 
soiled holding, sterile supplies, clean storage, drug storage, locker rooms and 
storage alcoves. 
(viii) Orthopedic surgery storage. Splints and traction equipment shall be 
stored in an enclosed storage room. Storage shall be outside the operating room 
but must be conveniently located. 
(ix) Storage alcove. An alcove(s) located out of the direct line of traffic 
shall be provided for the storage of stretchers, portable X-ray equipment, 
fracture tables, warming devices, auxiliary lamps, etc. 
(x) Medical and nursing staff clothing change rooms. Appropriately sized areas 
shall be provided for male and female personnel. These areas shall contain 
lockers, showers, toilets with hand washing fixtures, and space to change into 
scrub suits and boots. These areas shall be arranged to provide a traffic 
pattern so that personnel entering from outside the surgical suite can shower, 
change, and move directly into the restricted portions of the surgical suite. 
(xi) Lounge. A lounge shall be provided adjacent to the medical and nursing 
staff clothing change rooms in facilities with three or more operating rooms 
located to permit staff use without leaving the surgical suite. When the lounge 
is remote from the clothing change rooms, toilet facilities with hand washing 
fixtures accessible from the lounge shall be provided. 
(xii) Staff toilet facilities. Toilet facilities located in the surgical suite 
for exclusive staff use shall be provided and contain hand washing fixtures. The 
toilet may be accessible from a staff lounge, when provided.
(xiii) Nurses' toilet facilities. At least one toilet room with one water closet 
and a hand washing fixture shall be provided within or adjacent to the recovery 
rooms(s). 
(xiv) Dictation and report preparation area. This may be accessible from the 
lounge area. 
(xv) Cast room. When a cast room is provided it shall be equipped with hand 
washing facilities, plaster sink, storage, and other provisions required for 
cast procedures. This room may be located in the emergency room.
(xvi) Ice machine. An ice machine shall be provided. 
(xvii) Clean workroom or clean supply room. A clean workroom is required when 
clean materials are assembled within the surgical suite prior to use or 
following the decontamination cycle. It shall contain a work counter, a hand 
washing fixture with hands-free operable controls, storage facilities for clean 
supplies, and a space to package reusable items. The storage for sterile 
supplies must be in a separate room. When the room is used only for storage and 
holding as part of a system for distribution of clean and sterile supply 
materials, the work counter and hand washing fixture may be omitted.
(xviii) Sterile area. When a surgical suite contains a sterile area , it shall 
be free of any cross traffic of staff and supplies from the 
decontaminated/soiled areas to the sterile/clean areas. The use of facilities 
outside the operating room for soiled/decontaminated processing, clean assembly 
and sterile processing shall be designed to move the flow of goods and personnel 
from dirty to clean without compromising universal precautions or aseptic 
techniques in both departments. 
(xix) Soiled workroom. The soiled workroom shall contain a clinical sink or 
equivalent flushing type fixture, work counter, hand washing fixture with hands-
free operable controls, waste receptacle, and linen receptacle. The soiled 
workroom shall be provided for the exclusive use of the surgical suite and shall 
not have direct connection with operating rooms, delivery rooms or other sterile 
activity rooms. 
(xx) Housekeeping room. A housekeeping room containing a floor receptor or 
service sink and storage space for housekeeping supplies and equipment shall be 
provided for the exclusive use of the surgical suite. 
(xxi) Medical gas storage facilities. Main storage of medical gases may be 
outside or inside the hospital in accordance with NFPA 99, sec.4-3. Provision 
shall be made for additional separate storage of reserve gas cylinders necessary 
to complete at least one day's procedures. 
(2) Details and finishes. Details and finishes shall be in accordance with 
sec.133.162(d)(2) of this title and this paragraph.
(A) Details. 
(i) Operating rooms and special surgical procedure rooms shall have ceiling 
heights not less than nine feet. 
(ii) Recreation rooms, exercise rooms, equipment rooms, and similar spaces where 
impact noises may be generated shall not be located directly over operating 
suites, unless special provisions are made to minimize such noise. 
(B) Finishes. 
(i) Flooring within operating rooms, special procedures rooms, and soiled 
workrooms shall be of the seamless type as required by 
sec.133.162(2)(B)(iii)(III) of this title. 
(ii) Walls in operating rooms, special procedures rooms, soiled workrooms shall 
comply with the requirements of sec.133.162(d)(2)(B)(iv)(II).
(iii) Ceilings in operating rooms, special procedures rooms, isolation rooms, 
soiled workroom and sterile processing rooms shall be monolithic as required by 
sec.133.162(d)(2)(B)(vi)(III) of this title. 
(3) Mechanical requirements. Mechanical requirements shall be in accordance with 
sec.133.162(d)(3) of this title and this paragraph.
(A) Air supply for the operating rooms and special procedures rooms shall be 
from ceiling outlets near the center of the work area to efficiently control air 
movement. A minimum of two return air inlets located remotely from one another 
and near floor level shall be provided. Design should consider turbulence and 
other factors of air movement to minimize airborne particulate matter. Where 
extraordinary procedures require special designs, the installation shall be 
reviewed on a case by case basis. 
(B) Smoke removal systems shall be provided in accordance with sec.133.162 
(d)(3)(E)(iv)(II) of this title. 
(C) The ventilation system for anesthesia storage rooms shall conform to the 
requirements of Chapter 4, NFPA 99, sec.4-3. The ventilation requirements for 
medical gases in the workroom shall comply with NFPA 99, Chapter 4, sec.4-3. 
(D) Each operating room, PACU, and recovery room shall be provided with 
conveniently mounted temperature and humidity indicating devices.
(4) Piping systems and plumbing fixtures. Piping systems and plumbing fixtures 
shall be in accordance with sec.133.162(d)(4) of this title and this paragraph. 
(A) General. 
(i) Drainage and waste piping shall not be installed above or below ceilings in 
operating rooms, and sterile processing rooms unless special precautions are 
taken to protect these areas from possible leakage or condensation from 
necessary overhead piping systems. 
(ii) Floor drains shall not be installed in operating rooms, and special 
procedures rooms. Flushing rim type floor drains may be installed in cystoscopic 
operating rooms. If a floor drain is installed in cystoscopy, it shall contain a 
non-splash, horizontal-flow flushing bowl beneath the drain plate. 
(iii) Sinks used for the disposal of plaster of paris shall have plaster trap. 
(B) Medical gas systems. Medical gas systems and outlets shall be provided in 
accordance with sec.133.162(d)(4)(A)(iii) and Table 6 of sec.133.169(f) of this 
title. 
(5) Electrical requirements. Electrical requirements shall be in accordance with 
sec.133.162(d)(5) of this title and this paragraph.
(A) General. 
(i) X-ray film illuminators for handling at least four films simultaneously 
shall be provided in each operating room and special procedure room. 
(ii) Each operating room, special procedure room, shall have at least eight 
duplex electrical hospital grade receptacles of which three shall be located 
convenient to the head of the procedure table.
(iii) Special grounding system for critical care areas such as operating rooms, 
and special procedure rooms where patients are subjected to invasive procedures 
and connected to line-operated, electromedical devices shall comply with NFPA 
99, Chapter 9, and NFPA 70, Article 517. 
(iv) Operating rooms and special procedure rooms, shall have general lighting in 
addition to that provided by special lighting units at the surgical tables. Each 
fixed special lighting unit at the operating or delivery table shall be 
connected to an independent circuit. Portable units may share circuits. At least 
one general lighting fixture shall be served from a normal branch panel. 
(B) Nurses calling system. 
(i) Nurses calling system. The nurses regular calling system shall be provided 
for pre-op, PACU, recovery room, isolation recovery room, and holding area in 
accordance with sec.133.162(d)(5)(L)(i) of this title. In areas such as pre-op, 
PACU, recovery, and holding area where patients are under constant visual 
surveillance, the nurses calling system may be limited to a bedside button or 
station that activates a signal readily seen at the control station. 
(ii) Nurses emergency calling system. A nurses emergency call station shall be 
provided for patient use at each patient toilet in accordance with 
sec.133.162(d)(5)(L)(ii) of this title. 
(iii) A staff emergency assistance calling system (Code Blue) shall be provided 
in the operating rooms, special procedure rooms, PACU, and recovery room in 
accordance with sec.133.162(d)(5)(L)(iii) of this title.

sec.133.164. Elevators, Escalators, and Conveyors. 
(a) General. All hospitals with two or more floor levels shall have at least one 
electrical or electrical hydraulic elevator. Elevators shall also give access to 
all building levels normally used by the public. Escalators and conveyors are 
not required but, when provided, shall comply with these requirements and the 
requirement of sec.12-3 of the National Fire Protection Association 101, Code 
for Safety to Life from Fire in Buildings and Structures, 1997 edition (NFPA 
101), published by the National Fire Protection Association. All documents 
published by the NFPA as referenced in this section may be obtained by writing 
or calling the NFPA at the following address and telephone number: Post Office 
Box 9101, 1 Batterymarch Park, Quincy, Massachusetts 02269-9101, (800) 344-3555. 
(b) Requirements for new elevators, escalators, and conveyors. New elevators, 
escalators and conveyors shall be installed in accordance with the requirements 
of A17.1, Safety Code for Elevators and Escalators, 1990 edition, published by 
the American Society of Mechanical Engineers (ASME) and the American National 
Standards Institute (ANSI). All documents published by the ASME/ANSI as 
referenced in this section may be obtained by writing the ANSI, United 
Engineering Center, 345 East 47th Street, New York, N.Y. 10017. 
(1) Cars and doors. Cars of hospital-type elevators shall be at least 5 feet 8 
inches wide by nine feet deep. The car door opening shall be not less than four 
feet wide and seven feet high. 
(2) Leveling. All elevators shall be equipped with an automatic leveling device 
of the two-way automatic maintaining type with an accuracy of one-half inch. 
(3) Operation. All elevators, except freight elevators, shall be equipped with a 
two-way service key-operated switch to permit cars to bypass all landing button 
calls and be dispatched directly to any floor.
(4) Accessibility of controls and alarms. Elevator controls, alarm buttons, and 
telephones shall be accessible to wheelchair occupants.
(5) Type of controls and alarms. Elevator call buttons, controls, and door 
safety stops shall be of a type that will not be activated by heat or smoke. 
(6) Location. Conveyors, elevators, dumbwaiters, and pneumatic conveyors serving 
various stories of a building shall not open to an exit. 
(c) Requirements for existing elevators, escalators, and conveyors. Existing 
elevators, escalators, and conveyors shall comply with ASME/ANSI A17.3, Safety 
Code for Existing Elevators and Escalators, 1990 edition. 
(d) Testing. All elevators and escalators shall be subject to routine and 
periodic inspections and tests as specified in ASME/ANSI A17.1, Safety Code for 
Elevators and Escalators, 1990 edition. All elevators equipped with fire fighter 
service shall be subject to a monthly operation with a written record of the 
findings made and kept on the premises as required by NFPA101, sec.7-4.8. 
(e) Certification. A certificate of inspection evidencing that the elevators, 
escalators, and related equipment were inspected in accordance with the 
requirements in Health and Safety Code (HSC), Chapter 754, Subchapter B, and 
determined to be in compliance with the safety standards adopted under HSC, 
sec.754.014, administered by the Texas Department of Licensing and Regulation, 
shall be on record in each hospital. 
(f) Requirements for new hospitals. All new hospitals having patient facilities 
(such as patient sleeping rooms, dining rooms, or recreation areas) or critical 
services (such as operating, delivery, diagnostic, or therapy) on floors other 
than on the main entrance floor shall have the following number of elevators: 
(1) two elevators for the first 200 bed spaces; 
(2) three elevators for 201 to 350 bed spaces; 
(3) for hospitals with over 350 beds, as determined from a study of the hospital 
plan and the estimated vertical transportation requirements for the facility. 

sec.133.165. Building with Multiple Occupancies. 
(a) Multiple hospitals located within one building. 
(1) Identifiable location. Each hospital shall be in one separately identifiable 
location and conform with all the requirements contained in Chapter 12 of the 
National Fire Protection Association 101, Code for Safety to Life from Fire in 
Buildings and Structures, 1997 edition (NFPA 101), relating to New Health Care 
Occupancies. All documents published by NFPA as referenced in this section may 
be obtained by writing or calling the NFPA at the following address or telephone 
number: National Fire Protection Association, 1 Batterymarch Park, Post Office 
Box 9101, Quincy, MA 02269-9101 or (800) 344-3555. 
(2) Separate facilities. Each hospital shall provide the following separate 
facilities: 
(A) a nursing unit in accordance with the requirements of sec.133.163(s) of this 
title (relating to Hospital Spatial Requirements);
(B) an administration office with an adjacent waiting room or waiting area; 
(C) a medical records room which conforms with the requirements of 
sec.133.163(o) of this title; 
(D) a pharmacy suite in accordance with sec.133.163(w) of this title; 
(E) employee locker facilities which comply with requirements of 
sec.133.163(g)(1) of this title; 
(F) a housekeeping room in accordance with the requirements of 
sec.133.162(d)(2)(A)(xxviii) of this title (relating to New Construction 
Requirements);
(G) emergency facilities. At least one general hospital shall provide emergency 
facilities as required by sec.133.163(f) of this title. All other hospitals 
shall provide an emergency treatment room as required by 
sec.133.163(f)(1)(B)(iv) of this title; 
(H) surgical or obstetrical facilities for each general hospital, in accordance 
with sec.133.163(t) and sec.133.163(dd) of this title; 
(I) external signage at the building entrance which identifies each hospital; 
and 
(J) internal signage which provides directions to each hospital.
(3) Means of egress. Means of egress from the hospital shall not be through a 
psychiatric hospital or a crisis stabilization unit or other area subject to 
locking. Means of egress may traverse through a hospital which conforms with the 
requirements of sec.133.161 of this title (relating to Requirements for 
Buildings in which Existing Licensed Hospitals are Located) or sec.133.162 of 
this title. 
(4) Additional services and facilities. Additional services and facilities when 
required in each licensed hospital may be provided by contractual agreement with 
the other hospital when the services and facilities comply with the specific 
requirements of sec.133.41 of this title (relating to Hospital Functions and 
Services) and sec.133.163 of this title. Some services may be provided by 
contractual agreement with a commercial contractor; however, the following 
minimal facilities shall be provided on site: 
(A) dietary services and dietary suite, including staff dining facilities, which 
comply with sec.133.41(d) of this title and sec.133.163(e) of this title 
respectively; 
(B) cart cleaning and sanitizing services and facilities which comply with 
sec.133.163(b) of this title; 
(C) general stores services and facilities which comply with sec.133.163(i) of 
this title; 
(D) laboratory services and a laboratory suite which comply with sec.133.41(h) 
of this title, and sec.133.163(m) of this title respectively;
(E) housekeeping rooms as required in sec.133.162(d)(2)(xxviii) of this title; 
(F) parking facilities, in accordance with sec.133.162(c)(2) of this title; 
(G) physical and/or occupational therapy services and facilities, in accordance 
with sec.133.41(w) of this title, and sec.133.163(z) of this title respectively; 
(H) imaging and other diagnostic services and facilities, in accordance with 
sec.133.41(s) of this title and sec.133.163(l) of this title respectively; 
(I) patient activity facilities. The patient activity facilities shall comply 
with the requirements for the specific service in accordance with sec.133.163 of 
this title as follows: hospital based skilled units sec.133.163(j)(2)(B); mental 
health and chemical dependency nursing units sec.133.163(p)(1)(B)(ii); pediatric 
and adolescent nursing unit sec.133.163(v)(1)(D)(i); and rehabilitation therapy 
suite sec.133.163(z)(1)(A)(i) and (ii); 
(J) respiratory care services and respiratory therapy suite which comply with 
sec.133.41(t) of this title and sec.133.163(bb) of this title respectively; 
(K) body holding room which complies with sec.133.163(q)(1)(D) of this title; 
(L) central sterile supply which complies with sec.133.41(u)(2)(L) of this title 
and sec.133.163(c) of this title respectively; and 
(M) waste and waste disposal services, and waste processing and storage units 
shall comply with sec.133.41(x) of this title. 
(5) Building systems and equipment. 
(A) The following systems shall be provided separately in each hospital. 
(i) Nurses calling systems shall be provided separately in each hospital in 
accordance with sec.133.162(d)(5)(L). 
(ii) Medical gas alarms shall be provided in each hospital.
(B) Where applicable, the following systems may serve more than one hospital 
provided the systems meet the new construction requirements of sec.133.162 of 
this title: 
(i) air-conditioning, heating and ventilating systems; 
(ii) drainage systems; 
(iii) elevators; 
(iv) fire sprinkler systems; 
(v) medical piping systems; 
(vi) stand pipe systems; 
(vii) steam systems; 
(viii) water supply systems, hot and cold (including emergency water storage); 
and 
(ix) electrical service and equipment. 
(I) Where applicable, the building electrical service, lighting, essential 
electrical system, and fire alarm system, may be a part of or extension of those 
in the existing hospital, provided the existing systems meet these requirements. 
Power and lighting distribution panels shall be within the hospital served and 
comply with the requirements of sec.133.162(d)(5)(E). Electrical installation 
details shall conform with all requirements contained in sec.133.162(d)(5)(A).
(II) When the existing essential electrical system is non-conforming, the 
following options are available: 
(-a-) a separate conforming essential electrical system shall be provided in the 
new hospital; or 
(-b-) separate transfer switches connected to the existing on-site generator(s) 
shall be provided when adequate capacity is available and the existing non-
conforming system shall be corrected. Corrections shall be made in accordance 
with a plan of correction approved by the department.
(b) Hospitals located in buildings with licensed health care facilities other 
than hospitals. 
(1) Before a hospital is licensed in a building containing other licensed health 
care facilities, the following requirements shall be met. 
(A) The hospital shall be in one identifiable location and shall be separated 
(vertically and horizontally) with two-hour fire rated noncombustible 
construction from the other licensed health care facility and comply with the 
requirements of this chapter. 
(i) Access to the hospital shall be directly from a main lobby or an elevator 
lobby, if on an upper floor. The required means of egress from the hospital may 
be through the other licensed health care facility except not through a 
psychiatric hospital or a crisis stabilization unit or other area subject to 
locking. 
(I) Each hospital shall be identified with external signage at the building 
entrance. 
(II) Internal signage shall provide direction to the hospital.
(ii) The hospital shall have services and facilities separate from the other 
health care facility. The required facilities shall be located within the 
proposed hospital proper. 
(iii) Common use of facilities using time-sharing concepts may be permitted on a 
case by case basis when the other health care facilities comply with the 
requirements contained in NFPA 101, Chapter 12, and sec.133.163 of this title, 
and provided this chapter and the other health care facility licensing 
regulations allow. 
(B) Building equipment and systems. The equipment and systems required in each 
new hospital may be provided exclusively for the hospital or by contractual 
agreement with a licensed health care facility. The equipment and systems shall 
be in accordance with sec.133.162 of this title. 
(i) The following equipment and systems shall be provided for the exclusive use 
of the hospital: 
(I) electrical service for power and lighting and the essential electrical 
system; 
(II) emergency water storage located within the hospital;
(III) a fire alarm system; 
(IV) air conditioning, heating and ventilating systems; 
(V) medical piping systems with alarm; and 
(VI) nurses calling systems. 
(ii) Where applicable, the following systems may be a part or extension of those 
in the existing licensed health care facility, provided the existing systems 
meet the requirements of this chapter for new construction:
(I) drainage systems; 
(II) elevators; 
(III) fire sprinkler systems. 
(IV) stand pipe systems; 
(V) steam systems; and 
(VI) water supply systems, hot and cold. 
(2) When hospitals and psychiatric hospitals share one building, the building 
systems and equipment may be shared in accordance with subsection (a)(5)(B) of 
this section, or be provided separately. 
(c) Hospitals in buildings with non health care occupancies. Before a hospital 
is licensed in a building also containing occupancies other than health care 
occupancies, all requirements of this chapter and the following requirements 
shall be met. 
(1) Construction of the building shall conform to the requirements of NFPA 101, 
Chapter 12, and the hospital shall be in one identifiable location.
(A) Access to the hospital shall be through a dedicated hospital lobby or from 
the building's main lobby. The building's main lobby shall be part of the 
hospital and shall comply with the requirements of sec.133.162 of this title. 
(B) The required means of egress from the hospital shall be independent of and 
shall not traverse through the other occupancies. 
(2) Services and facilities. Services and facilities shall be provided 
exclusively for the hospital in accordance with subchapters C, H, and I of this 
title (relating to Operational Requirements, Fire Prevention and Safety 
Requirements, and Physical Plant and Construction Requirements, respectively). 
Required services and facilities shall not be shared with the other occupancies. 
(3) Building equipment and facilities. The equipment and facilities shall be 
provided for the exclusive use of a hospital in accordance with this subchapter. 

sec.133.166. Mobile, Transportable, and Relocatable Units. 
(a) General. When mobile, transportable and relocatable units are utilized to 
provide patient treatment services on the hospital premises, these units shall 
be treated as buildings and constructed to the required occupancy as follows: 
(1) When such units are provided for diagnostic, treatment or procedural 
services to patients that are litter borne, under general anesthesia, or 
incapable of self-preservation, the unit shall be constructed in accordance with 
Chapter 12 of the National Fire Protection Association 101, Code for Safety to 
Life from Fire in Buildings and Structures, 1997 edition (NFPA 101), relating to 
health care occupancy, published by the National Fire Protection Association. 
All documents published by the NFPA as referenced in this section may be 
obtained by writing or calling the NFPA at the following address and telephone 
number: Post Office Box 9101, 1 Batterymarch Park, Quincy, Massachusetts 02269-
9101, (800) 344-3555. 
(2) When such units provide diagnostic, treatment, or procedural services to 
patients, or types of services that are not litter borne, not under general 
anesthesia, and are capable of self-preservation, the unit may be constructed in 
accordance with Chapter 26 of NFPA 101 (relating to Business Occupancy). 
(b) Common elements. 
(1) Site requirements. 
(A) Sites shall be designed for the structural loads of the unit. 
(B) The sites shall provide hazard-free drop-off zones and adequate parking for 
patients. The site and location of the unit shall not restrict access for fire 
or emergency vehicles. 
(C) Each site shall provide access to the unit for the handicapped, and wheel- 
chair and stretcher patients. 
(D) The location of the unit shall be such that engine exhaust fumes from the 
unit are kept away from any fresh air intake of the hospital.
(E) Each unit shall be provided with approved fire alarm connections. Properly 
sized power, including emergency power, water, waste, and telephone services 
shall be provided as necessary. 
(2) Support services. Support services such as waiting areas, toilet facilities, 
and storage spaces shall be provided either within the unit or located within 
the hospital adjacent to the site if convenient for use. 

sec.133.167. Preparation, Submittal, Review and Approval of Plans. 
(a) General. Plans, specifications and a functional program narrative describing 
the construction of new buildings, alterations, additions, conversions, 
modernizations, or renovations to existing buildings, shall be prepared by 
design professionals. 
(b) Preliminary documents. Preliminary documents shall consist of preliminary 
plans, a functional program narrative and outline specifications. These 
documents shall contain sufficient information to establish the project scope, 
description of functions to be performed, project location, required fire safety 
and exiting requirements, building construction type, compartmentation showing 
fire and smoke barriers, bed count and services, and the usage of all spaces, 
areas, and rooms on every floor level. 
(1) Preparation of preliminary plans. Preliminary plans shall be of a 
sufficiently large scale to clearly illustrate the proposed design but not less 
than one-eighth inch equals one foot. Preliminary plans shall provide the 
following information. 
(A) Floor area and bed distribution. The total floor area on each level involved 
in construction, together with the proposed bed distribution, shall be shown on 
the drawings. 
(B) Floor plan. Each floor plan shall indicate and identify all individual 
spaces, doors, windows and means of egress. 
(C) Existing floor plan. An overall floor plan showing existing spaces, smoke 
partitions, smoke compartments, and exits and their relationship to the new 
construction shall be submitted on all renovations or additions to an existing 
facility. Plans for remodeling of spaces above or below the level of discharge 
shall include the level of discharge floor plan, showing all exits at that 
level. When there are two different levels of discharge, plans for both levels 
shall be submitted. 
(D) Construction type and fire rating. Building sections shall be provided to 
illustrate construction type and fire protection rating. Section(s) shall be 
drawn at a scale sufficiently large to clearly present the proposed construction 
system. 
(E) Area map. A map of the area within a two mile radius of the hospital site 
shall be provided and any hazardous and undesirable location noted in 
sec.133.162(a) of this title (relating to New Construction Requirements) shall 
be identified. 
(F) Site plan. A site plan shall be submitted and shall indicate the location of 
the proposed building(s) in relation to property lines, existing buildings or 
structures, access and approach roads, and parking areas and drives. Any 
overhead or underground utilities or service lines shall also be indicated. 
(G) Outline specifications. Outline specifications shall provide a general 
description of the construction, materials, and finishes that are not shown on 
the drawings. 
(2) Functional program narrative. The narrative shall include the description 
and scope of the project, type of hospital (general or special), type of 
construction (existing or proposed) as stated in Table 12-1.6.2 of National Fire 
Protection Association 101, Code for Safety to Life from Fire in Buildings and 
Structures,1997 edition (NFPA 101), published by the National Fire Protection 
Association, functional description of each space (may be shown on plans), 
energy conservation measures included in building, mechanical and electrical 
designs, number of patient beds in each category, and the number of births per 
year. All documents published by the NFPA as referenced in this section may be 
obtained by writing or calling the NFPA at the following address and telephone 
number: Post Office Box 9101, 1 Batterymarch Park, Quincy, Massachussetts 02269-
9101, (800) 344-3555. 
(3) Submission of preliminary plans. One set of preliminary plans and outline 
specifications covering the construction of new buildings or alterations, 
additions, conversions, modernizations, or renovations to existing buildings, 
shall be submitted to the Texas Department of Health (department) for review and 
approval. For convenience, preliminary plans may be reduced for preliminary 
submittal. 
(A) Preliminary plans and specifications must be accompanied by a completed 
Application for Plan Review and the plan review fee as required by sec.133.26 of 
this title (relating to Fees). The cost of submitting plans and specifications 
shall be borne by the sender. 
(B) All deficiencies noted in the preliminary plan review shall be 
satisfactorily resolved. Written department approval of preliminary plans must 
be obtained prior to proceeding with final plans and specifications. This 
requirement also applies to fast-track projects. 
(c) Construction documents. Construction documents or final plans and 
specifications shall be submitted to the department for review and approval 
prior to start of construction. All final plans and specifications shall be 
appropriately sealed and signed by a registered architect and a professional 
engineer licensed by the State of Texas. 
(1) Preparation of construction documents. Construction documents shall be well 
prepared so that clear and distinct prints may be obtained, shall be accurately 
and adequately dimensioned, and shall include all necessary explanatory notes, 
schedules, and legends and shall be adequate for contract purposes. Compliance 
with model building codes and this chapter shall be indicated. The type of 
construction, as classified by National Fire Protection Association 220, 
Standard on Types of Building Construction, 1995 edition, shall be provided for 
existing and new facilities. Final plans shall be drawn to a sufficiently large 
scale to clearly illustrate the proposed design but not less than one-eighth 
inch equals one foot. All rooms shall be identified by usage on all plans 
(architectural, fire safety, mechanical, electrical, etc.) submitted. Separate 
drawings shall be prepared for each of the following branches of work. 
(A) Architectural plans. Architectural drawings shall include the following: 
(i) site plan showing all new topography, newly established levels and grades, 
existing structures on the site (if any), new buildings and structures, 
roadways, walks, and the extent of the areas to be landscaped. All structures 
which are to be removed under the construction contract and improvements shall 
be shown. A general description of the immediate area surrounding the site shall 
be provided; 
(ii) plan of each floor and roof to include fire and smoke separation, means of 
egress, and identification of all spaces; 
(iii) schedules of doors, windows, and finishes; 
(iv) elevations of each facade; 
(v) sections through building; and 
(vi) scaled details as necessary. 
(B) Fire safety plans. These drawings shall be provided for all newly 
constructed buildings, conversions of existing buildings for hospitals, 
additions to existing licensed hospitals, and remodeled portions of existing 
buildings containing licensed hospitals. Fire safety plans shall be of a 
sufficiently large scale to clearly illustrate the proposed design but not less 
than one-sixteenth inch equals one foot and shall include the following 
information: 
(i) separate fire safety plans (preferably one floor plan per sheet) shall 
indicate location of fire protection rated walls and partitions, location and 
fire resistance rating of each fire damper, and the required means of egress 
(corridors, stairs, exits, exit passageways); and 
(I) when a new building is to contain a proposed hospital, when an existing 
building is converted to a hospital, or when an addition is made to an existing 
hospital building, plans of each floor and roof shall be provided; 
(II) when a portion of a building is remodeled or when a new service is added, 
only the plan of the floor where the remodeling will take place or new service 
will be introduced and the plan of the floor of discharge shall be provided; 
(ii) designated smoke compartments with floor areas of each compartment, 
location and fire resistance rating (one or two hour) of each smoke partition, 
location, type and fire resistance rating of each smoke damper;
(iii) location of all required fire alarm devices, including all fire alarm 
control panels, manual pull stations, audible and visual fire alarm signaling 
devices, smoke detectors (ceiling and duct mounted), fire alarm annunciators, 
fire alarm transmission devices, fire sprinkler flow switches and control valve 
supervisory switches on each of the floor plans; and 
(iv) areas protected with fire sprinkler systems (pendant, sidewall or upright, 
normal or quick response, and temperature rating shall be indicated), stand pipe 
system risers and sizes with valves and inside and outside fire department 
connections, fire sprinkler risers and sizes, location and type of portable fire 
extinguishers. 
(C) Equipment drawings. Equipment drawings shall include the following: 
(i) all equipment necessary for the operation of the hospital as planned. The 
design shall indicate provisions for the installation of large and special items 
of equipment and for service accessibility; 
(ii) fixed equipment (equipment which is permanently affixed to the building or 
which must be permanently connected to a service distribution system designed 
and installed during construction for the specific use of the equipment). The 
term "fixed equipment" includes items such as laundry extractors, walk-in 
refrigerators, communication systems, and built-in casework (cabinets); 
(iii) movable equipment (equipment not described in clause (ii) of this 
subparagraph as fixed). The term "moveable equipment" includes wheeled 
equipment, plug-in type monitoring equipment, and relocatable items such as 
operating tables and obstetrical tables; and 
(iv) equipment which is not included in the construction contract but which 
requires mechanical or electrical service connections or construction 
modifications. The equipment described in this clause shall be identified on the 
drawings to ensure its coordination with the architectural, mechanical, and 
electrical phases of construction. 
(D) Structural drawings. Structural drawings shall include:
(i) plans for foundations, floors, roofs, and all intermediate levels; 
(ii) a complete design with sizes, sections, and the relative location of the 
various members; 
(iii) a schedule of beams, girders, and columns; 
(iv) dimensioned floor levels, column centers, and offsets;
(v) details of all special connections, assemblies, and expansion joints; and 
(vi) special openings and pipe sleeves dimensioned or otherwise noted for easy 
reference. 
(E) Mechanical drawings. Documentation for selection of the type of heating and 
cooling system based on requirements contained in sec.133.162(d)(3)(A) of this 
title shall be included with the mechanical plans. Mechanical drawings shall 
include: 
(i) complete ventilation systems (supply, return, exhaust), all fire and smoke 
partitions, locations of all dampers, registers, and grilles, air volume flow at 
each device, and identification of all spaces (e.g. corridor, patient room, 
operating room); 
(ii) boilers, chillers, heating and cooling piping systems (steam piping, hot 
water, chilled water), and associated pumps; 
(iii) cold and warm water supply systems, water heaters, storage tanks, 
circulating pumps, plumbing fixtures, emergency water storage tank(s), and 
special piping systems such as for deionized water; 
(iv) non-flammable medical gas piping (oxygen, compressed medical air, vacuum 
systems, nitrous oxide), emergency shut-off valves, pressure gages, alarm 
modules, gas outlets; 
(v) drain piping systems (waste and soiled piping systems, laboratory drain 
systems, roof drain systems); 
(vi) fire protection piping systems (sprinkler piping systems, fire standpipe 
systems, water or chemical extinguisher piping system for cooking equipment); 
(vii) piping riser diagrams, equipment schedules, control diagrams or narrative 
description of controls, filters, and location of all duct mounted smoke 
detectors; and 
(viii) laboratory exhaust and safety cabinets. 
(F) Electrical drawings. Electrical drawings shall include:
(i) electrical service entrance with service switches, service feeders to the 
public service feeders, and characteristics of the light and power current 
including transformers and their connections; 
(ii) location of all normal electrical system and essential electrical system 
conduits, wiring, receptacles, light fixtures, switches and equipment which 
require permanent electrical connections, on plans of each building level: 
(I) light fixtures marked distinctly to indicate connection to critical or life 
safety branch circuits or to normal lighting circuits; and 
(II) outlets marked distinctly to indicate connection to critical, life safety 
or normal power circuits. 
(iii) telephone and communication, fixed computers, terminals, connections, 
outlets, and equipment; 
(iv) nurses calling system showing all stations, signals, and annunciators on 
the plans; 
(v) in addition to electrical plans, single line diagrams prepared for: 
(I) complete electrical system consisting of the normal electrical system and 
the essential electrical system including the on-site generator(s), transfer 
switch(es), emergency system (life safety branch and critical branch), equipment 
system, panels, subpanels, transformers, conduit, wire sizes, main switchboard, 
power panels, light panels, and equipment for additions to existing buildings, 
proposed new hospitals, and remodeled portions of existing hospitals. Feeder and 
conduit sizes shall be shown with schedule of feeder breakers or switches; 
(II) complete nurses calling system with all stations, signals, annunciators, 
etc. with room number noted by each device and indicating the type of system 
(nurses regular calling system, nurses emergency calling system, or staff 
emergency assistance calling system); and 
(III) a single line diagram of the complete fire alarm system showing all 
control panels, signaling and detection devices and the room number where each 
device is located; and 
(vi) schedules of all panels indicating connection to life safety branch, 
critical branch, equipment system or normal system, and connected load at each 
panel. 
(2) Correction of final plan deficiencies. All deficiencies noted in the final 
plan review shall be satisfactorily resolved before approval of project for 
construction will be granted. 
(3) Construction approval. Construction shall not begin until written approval 
by the department is received by the owner of the hospital.
(4) Construction document changes. Any changes to construction documents which 
affect or change the function, design, or designated use of an area shall be 
submitted to the department for approval prior to authorization of the 
modifications. 
(d) Special submittals. 
(1) Designer certified construction documents. In an effort to shorten the plan 
review and approval process, design professionals may submit, at the discretion 
of the department, a set of final construction documents, the department's 
completed checklist of licensing requirements and a certification letter which 
states that the plans and specifications, based on the department's checklist 
comply with the requirements of this chapter. Project certification letter and 
checklist shall be signed by the architect and engineer(s) of record.
(2) Fast-track projects. Submittal of fast-track projects shall be at the 
discretion of the department and shall be submitted in not more than three 
separate packages. 
(A) First package. The first package shall include: 
(i) a map showing the location of the proposed hospital site and adjacent 
surrounding area at least two miles in radius identifying any hazardous and 
undesirable location noted in sec.133.162(a) of this title;
(ii) preliminary architectural plans and a detailed building site plan showing 
all adjacent streets, site work, underslab mechanical, electrical, and plumbing 
work, and related specifications; and 
(iii) foundation and structural plans. 
(B) Second package. The second package shall include complete architectural 
plans and details with specifications and fire safety plans as described in 
subsection (c) of this section. 
(C) Third package. The third package shall include complete mechanical, 
electrical, equipment and furnishings, and plumbing plans and specifications, as 
described in subsection (c) of this section. 
(3) Fire sprinkler systems. Fire sprinkler systems shall comply with the 
requirements of National Fire Protection Association 13, Standard for the 
Installation of Sprinkler systems, 1996 edition (NFPA 13). Fire sprinkler 
systems shall be designed or reviewed by an engineer who is registered by the 
Texas State Board of Registration for Professional Engineers in fire protection 
specialty or is experienced in hydraulic design and fire sprinkler system 
installation. A short resume shall be submitted if registration is not in fire 
protection specialty. 
(A) Fire sprinkler working plans, complete hydraulic calculations and water 
supply information shall be prepared in accordance with NFPA 13, sec.sec.6-1, 6-
2 and 6-3, for new fire sprinkler systems, alterations of and additions to 
existing ones. 
(B) Certification of changes in an existing system is not required when 
relocation of not more than twenty sprinkler heads is involved.
(C) One set of fire sprinkler working plans (sealed by the engineer), 
calculations and water supply information shall be forwarded to the department 
together with the engineer's certification letter stating that the sprinkler 
system design complies with the requirements of NFPA 13. Certification of the 
fire sprinkler system shall be submitted prior to system installation.
(D) Upon completion of the fire sprinkler system installation and any required 
corrections, written certification by the engineer, stating that the fire 
sprinkler system is installed in accordance with NFPA 13 requirements, shall be 
submitted prior to or with the written request for the final construction 
inspection of the project. 
(e) Construction and inspections. 
(1) Major construction. Construction, of other than minor alterations, shall not 
commence until the final plan review deficiencies have been satisfactorily 
resolved, the appropriate plan review fee according to the plan review schedule 
in sec.133.26 of this title has been paid, and the department has issued a 
letter granting approval to begin construction. Such authorization does not 
constitute release from the requirements contained in this chapter. If the 
construction takes place in or near occupied areas, adequate provision shall be 
made for the safety and comfort of occupants.
(2) Construction commencement notification. The architect of record shall 
provide written notification to the department when construction will commence. 
The department shall be notified in writing of any change in the completion 
schedules. 
(3) Completion. Construction shall be completed in compliance with the 
construction documents including all addenda or modifications approved for the 
project. 
(4) Construction inspections. The department shall determine the number of 
required inspections necessary to complete all proposed construction projects. 
All hospitals including those which maintain certification under Title XVIII of 
the Social Security Act (42 United States Code sec.1395 et seq), and those which 
maintain accreditation by the Joint Commission on Accreditation of Healthcare 
Organizations (JCAHO), or by the American Osteopathic Association (AOA) are 
subject to construction inspections. 
(A) Number of construction inspections. A minimum of two construction 
inspections of the project shall normally be scheduled for the purpose of 
verifying compliance with subchapters H and I of this chapter and the approved 
plans and specifications. The final construction approval letter will inform the 
architect of record and the owner as to the minimum number of inspections 
required for the project. 
(i) Intermediate and final inspections shall be requested only by the architect 
of record or the licensee by the submission of an Application for Construction 
Inspection form and the construction inspection fee in accordance with 
sec.133.26(d) of this title for each inspection. The requested inspection will 
be scheduled three weeks from the date the application and fee is received.
(I) The intermediate construction inspection shall be scheduled at approximately 
80% completion. All major work above the ceiling shall be completed at the time 
of the intermediate inspection. 
(II) The final construction inspection shall be requested by the architect of 
record or the licensee at 100% completion. One-hundred percent completion means 
that the project is completed to the extent that all equipment is operating in 
accordance with specifications, all necessary furnishings are in place, and 
patients could be admitted and treated in all areas of the project. Inspection 
requests by contractors will not be honored.
(ii) Follow-up and plan of correction inspections will be scheduled by the 
department. 
(B) Certification of sprinkler system installations. Sprinkler system 
installations shall be inspected by the engineer who certified the fire 
sprinkler system design to determine that the fire sprinkler system is installed 
in accordance with NFPA 13 requirements prior to the final construction 
inspection conducted by the department. 
(5) Approval for occupancy. A facility shall not occupy a new structure or 
remodeled or renovated space until the appropriate approval has been received 
from the local building and fire authorities and the department. 
(6) Resubmittal of construction documents. When construction is delayed for 
longer than one year from the plan approval date, construction documents shall 
be resubmitted to the department for review and approval. The plans shall be 
accompanied by a new Application for Plan Review and a plan review fee. 
(7) Project cancellation. The department shall be notified in writing by the 
licensee or the owner when a project has been canceled or abandoned. 

sec.133.168. Record Drawings, Manuals and Design Data. 
(a) As built drawings. Upon occupancy of the building or portion thereof, the 
department shall be provided with a complete set of legible architectural plans 
of each building level, fire safety plans as described in sec.133.167(c)(1)(B) 
of this title (relating to Preparation, Submittal, Review and Approval of Plans) 
for each floor reflecting fire safety requirements, and all single line diagrams 
described in sec.133.167(c)(1)(F)(v) of this title, drawings for fixed 
equipment, and mechanical and electrical systems, as installed or built. 
(b) Manuals. Upon completion of the contract, the owner shall be furnished with 
a complete set of manufacturers' operating, maintenance, and preventive 
maintenance instructions; parts lists; and procurement information with numbers 
and a description for each piece of equipment. Hospital staff shal1 also be 
provided with instructions on how to properly operate systems and equipment. 
Required information shall include energy ratings as needed for future 
conservation calculations. 
(c) Design data. The owners shall be provided with complete design data for the 
facility. This shall include structural design loadings; summary of heat loss 
assumption and calculations; estimated water consumption; medical gas outlet 
listing; list of applicable codes; and electric power requirements of installed 
equipment. All such data shall be supplied to facilitate future alterations, 
additions, and changes, including, but not limited to, energy audits and 
retrofit for energy conservation. 

sec.133.169. Tables.
(a) Table 1. Sound transmission limitations in hospitals. 
Figure 1: 25 TAC sec.133.169(a) 
(b) Table 2. Flame spread and smoke production limitations for interior 
finishes. 
Figure 2: 25 TAC sec.133.169(b) 
(c) Table 3. Ventilation requirements for areas affecting patient care in 
hospitals and outpatient facilities. 
Figure 3: 25 TAC sec.133.169(c) 
(d) Table 4. Filter efficiencies for central ventilation and air conditioning 
systems. 
Figure 4: 25 TAC sec.133.169(d) 
(e) Table 5. Hot water use. 
Figure 5: 25 TAC sec.133.169(e) 
(f) Table 6. Station outlets for oxygen, vacuum, and medical air systems. 
Figure 6: 25 TAC sec.133.169(f) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802159
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

CHAPTER 229.Food and Drug
Minimum Standards for Licensure of Tattoo Studios
25 TAC sec.sec.229.402-229.411
The Texas Department of Health (department) proposes amendments to 
sec.sec.229.402 - 229.411, concerning the operating standards for all tattoo 
studios. Specifically, the sections cover definitions; licensing fee, 
procedures, and exemptions; physical facilities; personnel responsibilities; 
client qualifications, disclosure, and records; sterilization; care of the 
tattoo; tattooing equipment; report of infection or allergic reactions; and 
disposal of infectious waste. Section 229.402 will add three new definitions and 
amend two others to clarify the intent of the rules. Section 229.403 will 
increase licensure fees to allow the department to recover the costs associated 
with inspecting tattoo studios and administering the program. Section 229.404 
will clarify existing requirements that all tattoo studios be in compliance with 
applicable building codes in conformance with Texas Health and Safety Code, 
Chapter 146. Sections 229.404 - 229.409 will clarify existing requirements for 
the location of the hand-washing facilities, prohibit reuse of needles and 
razors, provide for consistent record-keeping requirements, and will clarify and 
update sterilization and sanitation requirements. Section 229.410 will require 
the report of infection to include the specific colors of the tattoo, where the 
tattoo was applied, and if available the manufacturer's identification number of 
each color used. Section 229.411 will clarify and update existing requirements 
for the disposal of waste generated by the tattoo studio. 
Cynthia T. Culmo, R.Ph., Director, Drugs and Medical Devices Division, has 
determined that for the first five-year period the sections are in effect, there 
will be fiscal implications as a result of enforcing or administering the 
sections as proposed. The effect on state government will be an estimated annual 
gain of $89,920 in fee-generated revenue. The proposed increase in tattoo studio 
licensure fees will recover the department's cost in conducting inspections and 
processing licensure applications. There will be no fiscal implications for 
local governments. 
Ms. Culmo has also determined that for each year of the first five years the 
sections as proposed are in effect, the public benefit anticipated as a result 
of enforcing or administering the sections will be to ensure appropriate and 
adequate regulatory control of tattoo studio operations, to avert possible 
health risks to the tattooist and the general public. The anticipated economic 
costs to persons or small businesses will be an additional $320 annually in 
licensure fees, as well as the possibility of an increase in operational costs 
that will be incurred by the tattooist due to the expense of single-service 
needles and razors. There will be no impact on local employment. 
Comments on the proposed amendments may be submitted to Dana L. Pearce, Drugs 
and Medical Devices Division, Texas Department of Health, 1100 West 49th Street, 
Austin, Texas 78756, (512) 719-0237. Comments will be accepted for 30 days from 
the date of publication of this proposal in the Texas Register. 
The amendments are proposed under the Health and Safety Code, sec.146.010(a) and 
sec.146.015(a), which provides the department with the authority to adopt 
necessary regulations pursuant to the enforcement of this Chapter; and 
sec.12.001, which provides the Texas Board of Health (board) with the authority 
to adopt rules for the performance of every duty imposed by law on the board, 
the department, and the commissioner of health. 
The amendments affect Health and Safety Code, Chapter 146. 

sec.229.402.Definitions.
The following words and terms when used in these sections, shall have the 
following meanings, unless the context clearly indicates otherwise.
<nl>Contaminated waste<ol><nl>- Any liquid or semi-liquid blood or other 
potentially infectious materials; contaminated items that would release blood or 
other potentially infectious materials in a liquid or semi-liquid state if 
compressed; items that are caked with dried blood or other potentially 
infectious materials and are capable of releasing these materials during 
handling; contaminated sharps and pathological and microbiological wastes 
containing blood and other potentially infectious material, as defined in 29 
Code of Federal Regulations Part 1910.1030, known as "Occupational Exposure to 
Bloodborne Pathogens." Copies of this provision are indexed and filed in the 
office of the Drugs and Medical Devices Division, Texas Department of Health, 
1100 West 49th Street, Austin, Texas 78756, and are available for inspection 
during normal working hours.<ol>
<nl>Disinfectant<ol><nl> - An agent that destroys disease-causing microorganisms 
on inanimate objects or surfaces. <ol> 
License holder - A person who <nl>owns<ol> [conducts], operates<nl>,<ol> or 
maintains a tattoo studio or temporary location in compliance with these 
sections. 
Single-service [items] - Articles intended for one-time, one-person use and 
which are to be discarded after such use. 
<nl>Tattoo area <ol><nl>- The portion of the tattoo studio used for applying 
tattoos and for cleaning, disinfecting, and sterilizing equipment, including all 
surrounding areas which are likely to come into contact with contaminated waste. 
<ol>
Tattoo studio - A permanent, nondwelling building or portion of a building, 
designated by a license holder and located in accordance with applicable local 
zoning codes where tattooing or intradermal cosmetic application is 
performed<nl>, completely separated from living quarters.<ol> [Studios attached 
to a residence shall maintain a separate entrance which shall not open from a 
residential quarter.] 

sec.229.403.Licensing Fee, Procedures<nl>,<ol> and Exemptions.
(a) License fee. All tattoo studios shall obtain a license annually except as 
indicated below from the Texas Department of Health (department) and shall pay 
<nl>an annual, non-refundable<ol> [a] license fee of $<nl>450<ol> [130] for each 
place of business operated as follows: 
(1) $<nl>450<ol> [130] per tattoo studio; and
(2) $<nl>450<ol> [130] for each temporary location license for a specified 
length of time not to exceed seven days.
(b) (No change.) 
(c) License application. The <nl>initial license application for each<ol> tattoo 
studio or temporary location [license application] shall be signed and 
verified<nl>, shall be made<ol> on the license application furnished by the 
department, and shall contain the following information:
(1) (No change.) 
(2) the address of <nl>the<ol> [each] tattoo studio or temporary location that 
is to be licensed. Sufficient descriptive information must be included if the 
studio or temporary location is located in a portion of the building with other 
license holders; 
(3) - (5) (No change.) 
(6) the usual days and hours of operation of each tattoo studio or temporary 
location; <nl>and<ol> 
(7) a description of all services to be provided at the tattoo studio or 
temporary location<nl>.<ol> [;and] 
[(8) an application form which shall be verified and signed by the applicant.] 
(d) Pre-licensing inspection. On receipt of the initial license application, an 
agent of the department shall inspect the proposed tattoo studio or temporary 
location to determine compliance with these sections<nl>.<ol> [and to determine 
compliance with existing building and zoning codes applicable to the studio or 
temporary location.] 
(e) Issuance of license. The department may issue a license to the owner of a 
tattoo studio or temporary location after determining that the studio or 
temporary location is in compliance with applicable statutes, rules, and 
building and zoning codes. 
(1) (No change.) 
(2) The renewal tattoo studio license shall be valid for one year from the 
anniversary date upon payment of a $<nl>450<ol> [130] renewal fee. 
(3) (No change.) 
(f) Renewal of license - applicable to tattoo studios only.
(1) (No change.) 
(2) The license holder shall renew the license by filing an application for 
renewal on the form prescribed by the department accompanied by the 
<nl>required<ol> [appropriate] licensure fee. A licensee must file for renewal 
before the expiration date of the current license. A person who files a renewal 
application after the expiration date must pay an additional $100 as a 
delinquency fee. 
(3) (No change.) 
(g) (No change.) 

sec.229.404.Physical Facilities.
(a) A tattoo studio must be in a permanent, nondwelling building <nl> or portion 
of a building which is in compliance with applicable building codes and must 
be<ol> [located in an area in which the] <nl>in a<ol> location <nl>which<ol> is 
permissible under local zoning codes, if any. <nl> The tattoo studio shall be 
separated from living quarters by complete floor to ceiling partitioning and 
shall contain no access to living quarters.<ol>
(b) The tattoo studio or temporary location shall be maintained in a sanitary 
condition. 
(1) <nl>Work surfaces shall be cleaned and sanitized with <ol> [There shall be 
written procedures assigning responsibility for sanitation and describing in 
sufficient detail the cleaning methods, equipment, and the use of] hospital 
(grade) United States Environmental Protection Agency registered disinfectants 
or a 1:100 dilution of household bleach and water (1/4 cup bleach and 1 gallon 
of water) [to be used in disinfecting all work surfaces]. 
(2) (No change.) 
(c) The walls, ceilings, and floors shall be kept in good repair. Tattooing 
areas [and restrooms] shall be constructed of smooth, hard, surfaces that are 
<nl>non-porous, free of open holes or cracks, light colored, and<ol> easily 
cleaned. 
(d) - (e) (No change.) 
(f) Each tattoo studio or temporary location shall be <nl> equipped<ol> 
[provided] with [adequate, conveniently located] hand-washing facilities for its 
personnel[, including a lavatory or lavatories equipped with hot and cold or 
tempered running water,] <nl> with unobstructed access to the tattoo area such 
that tattooists can return to the tattoo area without having to touch anything 
with their hands. Hand-washing facilities shall be equipped with hot and cold or 
tempered running water, liquid<ol> germicidal soap, single-service towels or 
other approved hand-drying devices, and <nl>a covered<ol> refuse container. Such 
facilities shall be kept clean and in good repair. 
(g) (No change.) 
(h) Smoking<nl>, eating, and drinking<ol> shall be prohibited in <nl>the 
tattoo<ol> [tattooing] area. Consumption of alcoholic beverages shall be 
prohibited in tattoo studios or temporary locations. 
(i)- (j) (No change.) 
[(k) The tattoo studio or temporary location shall have available a closed area, 
screen, or curtain to accommodate those clients who request privacy during 
tattooing.] 

sec.229.405.Personnel Responsibilities.
(a) (No change.) 
(b) All tattooists shall wash their hands thoroughly using hot or tempered water 
with a <nl>liquid<ol> germicidal soap before and after applying a tattoo and as 
often as necessary to remove contaminants.
(c) All tattooists must wear single-service examination gloves <nl> while 
handling tattoo equipment and<ol> while applying tattoos and intradermal 
cosmetics. 
(d) - (e) (No change.) 
(f) The area of the client's skin to be tattooed shall be [adequately] cleaned 
with a germicidal skin preparation and the tattooist shall treat the skin with 
70% isopropyl alcohol, iodophor, or other United States Food and Drug 
Administration approved antiseptic products.
(g) If shaving is required, razors shall be single-service<nl>.<ol> [, or if 
reused, they shall be washed thoroughly in soap and water and disinfected with a 
hospital (grade) United States Environmental Protection Agency registered 
disinfectant solution before reuse.] 
(h) (No change.) 

sec.229.406.Client Qualifications, Disclosure, and Records.
(a) Except as permitted in subsection (b) of this section, a client must be a 
minimum of 18 years of age and have a positive identification card such as a 
driver's license, passport, or other picture identification in their possession. 
<nl>The tattooist shall verify and document in the permanent client record the 
client's age, date of birth, and the<ol> [Documentation of verification of a 
client's age, and] type of identification provided [shall be recorded by the 
tattooist]. 
(b) - (h) (No change.) 
(i) The tattoo studio or temporary location shall maintain proper records of 
each client. The information shall be permanently recorded and made available 
for examination by the authorized agent [in a tattoo studio]<nl>. Records shall 
be maintained at the tattoo studio<ol> for at least <nl>two years<ol> [one year] 
following the date of the last entry. The temporary location client records 
shall be maintained by the license holder. These permanent records shall include 
<nl>the following <ol>: 
(1) - (2) (No change.) 
(3) the client's <nl>age,<ol> date of birth <nl>, and type of positive 
identification provided to the tattooist<ol>; 
(4) (No change.) 
<nl>(5)<ol> <nl> the location on the body where the tattoo is applied; <ol>
<nl>(6)<ol> [(5)] the name of the tattooist; [and] 
<nl>(7)<ol> <nl> a statement that the client has received a copy of written care 
instructions, and that the client has read and understands the care 
instructions; and <ol>
<nl>(8)<ol> [(6)] the signature of the client. 

sec.229.407.Sterilization.
(a) <nl>Only sterile needles shall be used in the tattooing process and needles 
shall be single-service. A new needle or a set of new needles shall be used on 
each client.<ol> 
<nl>(b)<ol> [(a)] A tattoo studio or temporary location is required to utilize 
tools and equipment for tattooing that have been properly sterilized and kept in 
a sterile condition. The tattoo studio or temporary location shall use 
sterilization equipment that is approved by the United States Food and Drug 
Administration for the purpose of sterilization, and adequate in size to 
accommodate needles, tubes, tips, and other necessary utensils and equipment. 
<nl>A copy of the manufacturer's recommended procedures for operation of the 
sterilization unit(s) must be available for inspection by an authorized 
agent.<ol> 
<nl>(c)<ol> [(b)] Each [tattooist, or any] person [performing any cosmetic 
procedure in the tattoo studio or temporary location is] responsible for <nl>the 
sterilization of equipment<ol> [always performing and]<nl> shall be<ol> [being] 
able to demonstrate to the department's authorized agent the correct 
sterilization procedures and the proper operation of autoclave and/or dry heat 
sterilization equipment. 
<nl>(d)<ol> [(c)] After each use, the <nl> reusable<ol> tattooing equipment 
shall be cleansed to remove blood and tissue residue before sterilization as 
described in sec.229.409(h) of this title (relating to Tattooing Equipment). 
<nl>(e)<ol> [(d)] Each <nl>package<ol> [batch] of equipment sterilized shall be 
monitored for sterilization by the use of chemical/heat sensitive indicators. 
<nl>(f)<ol> [(e)] <nl>Equipment requiring sterilization shall be packed 
individually in packages approved for the sterilization unit. Each package shall 
be labeled with the date of sterilization and the initials of the person 
sterilizing. Packaged sterilized<ol> [Sterilized] equipment shall be stored[, 
wrapped, or covered in a manner which will ensure that it will remain sterile 
until used.] <nl>in a clean dust-tight container when not in use.<ol> [Each 
batch shall be labeled with the date of sterilization and the initials of the 
person sterilizing.] 
<nl>(g)<ol> [(f)] Each tattoo studio or temporary location shall maintain 
sterilization records. The information shall be permanently recorded and made 
available for examination by an authorized agent in the tattoo studio for at 
least <nl>two years<ol> [one year] from the date of the last entry. These 
permanent records <nl>shall be maintained at the studio and<ol> shall include 
<nl>the following<ol>: 
(1) date of sterilization; 
(2) quantity and type of equipment to be sterilized; and 
(3) name of individual sterilizing the equipment. 
<nl>(h)<ol> [(g)] Sterilized equipment stored in an approved manner and not used 
within 30 days after sterilization shall no longer be considered sterile and 
shall be resterilized before use, unless the studio or temporary location 
utilizes presterilized equipment <nl>sterilized by<ol> [purchased directly from] 
the manufacturer<nl>. If presterilized equipment is used<ol>, [in which case] 
the tattooist <nl>shall obtain documentation from the manufacturer that 
describes the method of sterilization utilized by the manufacturer and the 
manufacturer's recommendations for storage and maintenance of sterility. This 
documentation shall be available for inspection by an authorized agent. The 
tattooist<ol> shall follow the manufacturer's instructions for storage and 
maintenance of sterility. 
<nl>(i)<ol> [(h)] One of the following methods of sterilization shall be used. 
(1) Autoclave - steam under pressure: 
(A) 121 degrees Celsius (250 degrees Fahrenheit) and a pressure of at least 15 
pounds per square inch for not less than 30 minutes after the chamber of the 
autoclave has been evacuated of air and has reached temperature; <nl> or<ol> 
[and] 
(B) as specified in the manufacturer's operator's manual.
(2) Dry heat sterilization: 
(A) 160 degrees Celsius (320 degrees Fahrenheit) for not less than <nl>one 
hour<ol> [two hours] under atmospheric pressure after the sterilizer has reached 
the required temperature; <nl>or<ol> [and] 
(B) as specified in the manufacturer's operator's manual.

sec.229.408.Care of the Tattoo.
(a) Each time a tattoo is applied the client shall receive oral and written 
instructions on the care of the newly applied tattoo. <nl> The client shall sign 
a written statement in the permanent client record acknowledging that the client 
has received a copy of the written care instructions, and that the client has 
read and understands the instructions<ol>. 
[(b) The client shall sign a written statement acknowledging that the client has 
read and understood the recommended instructions for the care of the newly 
applied tattoo. A copy of the signed instruction statement must be kept by the 
operator at the tattoo studio for at least six months after the application of 
the tattoo.] 
<nl>(b)<ol> [(c)] The written <nl>care instructions <ol> [statement] shall 
contain at least the following items:
(1) for at least two weeks, the need to minimize exposure to the sun, and to 
discourage swimming in fresh, salt, or chlorinated pool water; 
(2) to properly cleanse the tattooed area; 
(3) to apply antibiotic ointment or cream; 
(4) to use sterile bandage(s) or other sterile dressing(s) when necessary; 
(5) the name of the tattooist, the name, address, and telephone number of the 
tattoo studio or temporary location[, and the instructions for the client to 
advise the tattooist of any infection, allergic or adverse reaction resulting 
from the application of the tattoo]; <nl> and<ol> 
(6) the instructions for the client to consult a health care provider at the 
first sign of infection or an allergic reaction<nl>, and to report to the 
tattooist and to the Texas Department of Health, Drugs and Medical Devices 
Division, any infection, allergic reaction, or adverse reaction resulting from 
the application of the tattoo.<ol>[;]
[(7) the signature of the client; and
[(8) the instructions for the client to report to the Texas Department of 
Health, Drugs and Medical Devices Division any infection, adverse reaction, or 
allergic reaction resulting from the application of a tattoo.] 

sec.229.409.Tattooing Equipment.
(a) <nl>Reusable<ol> [Needles,] bars [,] and tubes shall be constructed in a 
manner that permits easy cleaning and sterilization. 
(b) - (d) (No change.) 
(e) All [acetate] tattoo stencils shall be single-service. <nl> Petroleum 
jellies, soaps, and other products used in the application of stencils shall be 
dispensed and applied using aseptic technique and in a manner to prevent 
contamination of the original container and its contents. The applicator shall 
be single-service.<ol> 
(f) Contaminated <nl>reusable tattoo equipment<ol> [needles and tubes]<nl> 
shall<ol> [will] be placed in a covered container of <nl>disinfectant<ol> 
[germicidal] solution such as 2.0% alkaline glutaraldehyde (not to be construed 
as all-inclusive), until <nl>it<ol> [they] can be cleaned and sterilized. 
(g) All containers holding contaminated <nl>tattoo equipment <ol> [needles and 
tubes] and container lids <nl>shall<ol> [will] be <nl>emptied of contaminated 
solution and<ol> cleaned and sanitized daily or as often as needed. 
(h) <nl>Reusable tattoo equipment<ol> [Needles and tubes (items)] <nl>shall<ol> 
[will] be cleaned by gloved personnel prior to sterilization by one of the 
following methods: 
(1) (No change.) 
(2) clean the items in an ultrasonic cleaning unit used according to 
manufacturer's instruction<nl>. A copy of the manufacturer's recommended 
procedures for operation of the ultrasonic cleaning unit must be available for 
inspection by an authorized agent<ol>; and 
(3) (No change.) 

sec.229.410.Report of Infection or Allergic Reactions.
<nl>(a)<ol> The tattoo studio shall provide a [A] written report of any 
infection or allergic reaction resulting from the application of a tattoo [shall 
be forwarded] to the Texas Department of Health (department) [by the tattoo 
studio] within five working days of its occurrence or knowledge thereof. 
[(1)] The report shall include: 
<nl>(1)<ol> [(A)] the name of the affected client; 
<nl>(2)<ol> [(B)] the name and location of the tattoo studio or temporary 
location; 
<nl>(3)<ol> <nl>the name of the tattooist; <ol>
<nl>(4)<ol> <nl> the date the tattoo was applied;<ol> 
<nl>(5)<ol> <nl> the specific color or colors of the tattoo and when available, 
the manufacturer's catalogue or identification number of each color used; <ol> 
<nl>(6)<ol> [(C)] the location of the infection <nl> and the location on the 
body where the tattoo was applied<ol>; 
<nl>(7)<ol> [(D)] the name and address of the health care provider, if any; 
<nl>and<ol> 
[(E) the name of the tattooist; and]
<nl>(8)<ol> [(F)] any other information considered relevant to the situation. 
<nl>(b)<ol> [(2)] The department shall utilize these reports in their efforts to 
identify the source of the adverse reaction(s) and to take action to prevent its 
recurrence. 

sec.229.411.Disposal of Infectious Waste.
(a) (No change.) 
(b) Other studio waste generated during the tattoo process, i.e., cotton balls, 
<nl>cotton tip applicators<ol> [Q-tips], <nl> tissues<ol> [Kleenex], paper 
towels, gloves, <nl>and<ol> pigment containers[, and soiled linens] (not to be 
construed as all-inclusive) shall be disposed of [in a sanitary landfill] in 
accordance with <nl> sec.1.136(a)(2) of this title (relating to Approved Methods 
of Treatment and Disposition) or Title 30, Texas Administrative Code, Chapter 
330.<ol> [Solid Waste Management rules (30 Texas Administrative Code, 
sec.330.136(b)(1)).
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802160
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

CHAPTER 289.Radiation Control
General
25 TAC sec.289.204
The Texas Department of Health (department) proposes an amendment to 
sec.289.204, concerning fees for certificates of registration, radioactive 
material(s) licenses, emergency planning and implementation, and other 
regulatory services. The amendment to sec.289.204 adds a definition to clarify a 
license category, assesses additional fees for licenses that contain 
authorizations for more than one license category, deletes the provision for 
proration of fees, restructures the method by which fees for certificates of 
registration are assessed, and separates the fees for evaluation of sealed 
sources and devices into fees for initial evaluations and amendments requiring 
re-valuation. The amendment also increases the majority of license fees by 50% 
to correct an imbalance in the percentage of costs recovered from certificate of 
registration fees versus license fees when compared to the percentage of program 
costs charged against certification of registration activities versus license 
activities. This amendment is part of the department's ongoing evaluation of 
program fees to comply with the provisions of Health and Safety Code 
sec.401.301. 
Mrs. Ruth E. McBurney, C.H.P., Director, Division of Licensing, Registration and 
Standards, Bureau of Radiation Control, has determined that for each year of the 
first five-year period the section will be in effect, there will be fiscal 
implications for state or local government as a result of enforcing or 
administering the section as proposed. The department will receive an additional 
$1,283,491 in revenue for each year of the first five-year period. State or 
local government entities that possess a radioactive material license will have 
an increase of at least 50% over the current annual fee. The fiscal impact to 
state or local government entities that possess a certificate of registration 
will range from a decrease in annual fees of $3,250 to an increase in annual 
fees of $11,280, depending on the type and number of x-ray machines possessed.
Mrs. McBurney also has determined that for each year of the first five years the 
proposed section will be in effect, the public benefit anticipated as a result 
of enforcing the section will be to ensure continued protection of the public, 
workers, and the environment from unnecessary exposure to radiation by 
recovering the majority of the costs of the regulatory program from those 
entities possessing sources of radiation. The effect on small businesses and 
persons who are required to comply with the section as proposed will vary 
depending on the uses of radioactive material authorized on a license and the 
types and number of radiation machines authorized on a certificate of 
registration. The increase in fees for licenses will range from $190 to $28,633. 
Approximately 86% of licensees will recognize an increase in fees of between 50% 
and 75%. The change in fees for certificates of registration ranges from a 
decrease of $3,250 to an increase of $11,280. Approximately 57% of registrants 
will see no change in the annual fee, 25% will see an increase in the annual 
fee, and 18% will recognize a decrease in the annual fee. There is no 
anticipated impact on local employment. 
Comments on the proposal may be presented to Ruth E. McBurney, C.H.P., Director, 
Division of Licensing, Registration and Standards, Bureau of Radiation Control, 
Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3189, 
Telephone (512)834-6688 or electronic mail at rmcburne@brc1.tdh.state.tx.us. 
Public comments will be accepted for 30 days following publication of this 
proposal in the Texas Register. In addition, a public meeting to accept oral 
comments will be held at 9:00 a.m., Thursday, March 5, 1998, in Conference Room 
N218, Texas Department of Health, Bureau of Radiation Control, located at the 
Exchange Building, 8407 Wall Street, Austin, Texas. 
The amendment is proposed under the Health and Safety Code, Chapter 401, which 
provides the Texas Board of Health (board) with authority to adopt rules and 
guidelines relating to the control of radiation; and sec.12.001, which 
authorizes the board to adopt rules for the performance of every duty imposed by 
law on the board, the department and the commissioner of health.
The amendment affects Health and Safety Code, Chapter 401. 

sec.289.204.Fees for Certificates of Registration, Radioactive Material(s) 
Licenses, Emergency Planning and Implementation, and Other Regulatory Services.
(a) (No change.) 
(b) Scope. Except as otherwise specifically provided, the requirements in this 
section apply to any person who is the following: 
(1) an applicant for, or holder of: 
(A) a radioactive material license issued in accordance with sec.289.127 of this 
title (relating to Licensing of Naturally Occurring Radioactive Material 
(NORM)), sec.289.252 of this title (relating to Licensing of Radioactive 
Material)<nl>,<ol> [;] sec.289.254 of this title (relating to Licensing of 
Radioactive Waste Processing and Storage Facilities), or sec.289.260 of this 
title (relating to Licensing of Uranium Recovery and Byproduct Material Disposal 
Facilities); or 
(B) (No change.) 
(C) a certificate of registration for radiation machines and/or services, or 
sources of laser radiation, issued in accordance with <nl>sec.289.226 <ol> 
[sec.289.122] of this title (relating to Registration of Radiation <nl>Machine 
Use<ol> [Machines] and Services), <nl> sec.289.230 of this title (relating to 
Certification of Mammography Systems), <ol> or sec.289.2 of this title (relating 
to Control of Laser Radiation Hazards); or 
(2) the holder of a fixed nuclear facility construction permit or operating 
license issued by the United States Nuclear Regulatory Commission (NRC) in 
accordance with 10 <nl>Code of Federal Regulations<ol> [CFR] Part 50; or 
(3) (No change.) 
(c) Definitions. The following words and terms when used in this section shall 
have the following meaning, unless the context clearly indicates otherwise. 
(1)-(4) (No change.) 
<nl>(5)<ol> <nl> Limited manufacturer - A manufacturer/distributor of 
radioactive material that is not required to submit a decommissioning funding 
plan or an emergency plan in accordance with sec.289.252 of this title. <ol>
<nl>(6)<ol> [(5)] Post-closure - The time period after which closure activities 
have been completed by the conventional mill licensee and prior to transfer of 
land ownership of tailings disposal sites to the State of Texas or the United 
States of America and termination of the license or after which confirmatory 
surveys have been conducted by the agency of an in-situ facility and before 
termination of the license or site. 
(d) (No change.) 
(e) Payment of fees. 
(1) Each application for a license, general license acknowledgment, or 
certificate of registration for which a fee is prescribed in subsections (f), 
(h), or (i) of this section shall be accompanied by a nonrefundable fee equal to 
the appropriate annual fee. [An application for a license covering more than one 
fee category shall be accompanied by the prescribed fee for the highest fee 
category. An application for a certificate of registration shall be accompanied 
by a fee for all applicable categories. No application will be accepted for 
filing or processed prior to payment of the full amount specified.] 
<nl>(A)<ol> <nl> An application for a license covering more than one license or 
general license category shall be accompanied by the prescribed fee for the 
highest category and 25% of the applicable prescribed fee for each additional 
requested category. <ol>
<nl>(B)<ol> <nl>An application for a certificate of registration shall be 
accompanied by the prescribed base fee for the highest category of use plus the 
prescribed machine or service fee for each category of use. <ol>
<nl>(C)<ol> <nl> No application will be accepted for filing or processed prior 
to payment of the full amount specified. <ol>
(2) A nonrefundable fee, in accordance with subsection (f) of this section shall 
be paid annually for each radioactive material license and/or for each general 
license acknowledgment. The fee shall be paid in full each year on or before the 
last day of the expiration month of the license or general license 
acknowledgment. For example, if the license or general license acknowledgment 
expires May 31, 1994, annual fees are due on or before May 31 of each calendar 
year. In the case of a single license that authorizes more than one category of 
use, <nl>the annual fee shall be the prescribed fee for the highest license 
category plus 25% of the applicable prescribed fee for each additional license 
category authorized.<ol> [only one fee shall be paid. The category assigned the 
higher fee will apply.]
(3) A nonrefundable fee, in accordance with subsections (f) or (i) of this 
section, shall be paid annually for each certificate of registration for 
radiation machines and/or services, <nl>or<ol> sources of laser radiation. The 
fee consists of a base fee for all registrants plus a fee where specified for 
each machine possessed or registrable service offered.
(4) In the case of a <nl>single<ol> certificate of registration that authorizes 
more than one category of use, the category listed in subsection (i) of this 
section and assigned the higher <nl>fee, or base fee plus corresponding 
machine/service fee, as applicable, will be used.<ol> [fee will apply.] 
[(5) The annual fee for a certificate of registration for radiation machines and 
services listed in subsection (i) of this section shall not exceed $4,000 per 
year. The annual fee for a certificate of registration for sources of laser 
radiation other than laser light shows shall not exceed $400 per year.] 
[(6) An application for an amendment to a license that results in a change to a 
category with a higher fee shall result in a fee being charged equal to the pro-
rated difference between the fee for the current category and the one to which 
the amended license will escalate. The prorated costs shall be based on monthly 
intervals and will be charged from the first day of the month the amendment is 
effective until the end of the current billing period. For example, if a nuclear 
medicine license amendment to change its classification from Diagnostic Only to 
Diagnostic/Therapy becomes effective June 1, 1994, and the expiration month of 
the license is December, the licensee will be billed $235, calculated in the 
following method: $1,040 - 570 = $470; $470 x 1/2 = $235, where 1/2 = 6 
months/12 months. The agency will bill the licensee.] 
<nl>(5)<ol> [(7)] Each application for reciprocal recognition of an out-of-state 
license in accordance with sec.289.252(s) of this title, an out-of-state 
registration in accordance with <nl>sec.289.226 <ol> [sec.289.122] of this 
title, or an out-of-state laser registration in accordance with sec.289.2 of 
this title shall be accompanied by the applicable annual fee, provided that no 
such fee has been submitted within 12 months of the date of commencement of the 
proposed activity. 
<nl>(6)<ol> [(8)] Each holder of a fixed nuclear facility construction permit or 
operating license or an operator of any other fixed nuclear facility shall 
submit an annual fee for services received. This fee shall recover for the State 
of Texas the actual expenses arising from environmental surveillance and 
emergency planning and implementation activities. Payment shall be made within 
90 days following the date of invoice.
<nl>(7)<ol> [(9)] Fee payments shall be in cash or by check or money order made 
payable to the Texas Department of Health. The payments may be made by personal 
delivery to the central office, Bureau of Radiation Control, Texas Department of 
Health, 1100 West 49th Street, Austin, Texas, or mailed to the Bureau of 
Radiation Control, Texas Department of Health, 1100 West 49th Street, Austin, 
Texas, 78756-3189.
<nl>(8) Any applicant requesting authorization for any of the categories in 
subsection (f) of this section for veterinary use will be assessed the annual 
fee for the corresponding category.<ol>
(f) Schedule of annual fees for radioactive material licenses. The following 
schedule contains the annual fees for radioactive material licenses:
<nl>Figure 1: 25 TAC sec.289.204(f)<ol>
[Figure 1: 25 TAC sec.289.204(f)] 
(g) <nl>Fee for Evaluation of a Sealed Source and/or Device <ol> [Other fee 
assessments]. 
(1) Each time a manufacturer submits a request for [initial] evaluation of a 
unique sealed source, <nl>one of the following fees<ol> [a one-time fee of 
$2,435] shall be paid<nl>:<ol>
<nl>(A)<ol> <nl> for an initial evaluation, a fee of $3,285; or <ol>
<nl>(B)<ol> <nl> for an amendment requiring re-evaluation, a fee of $1,640. <ol>
(2) Each time a manufacturer submits a request for [initial] evaluation of a 
unique device, <nl>one of the following fees<ol> [a one-time fee of $4,870] 
shall be paid <nl>:<ol>
<nl>(A)<ol> <nl>for an initial evaluation, a fee of $6,575; or <ol>
<nl>(B)<ol> <nl> for an amendment requiring re-evaluation, a fee of $3,290. <ol>
(3) No request for evaluation will be processed prior to payment of the full 
amount specified. 
(h) <nl>Fees<ol> [Schedule of fees] for certification of mammography systems. 
[The following schedule contains the fees for certification of mammography 
systems:] 
<nl>(1)<ol> <nl>An application for certification of mammography systems shall be 
accompanied by a fee of $325 for each unit. <ol>
<nl>(2)<ol> <nl>The annual fee for mammography systems is $325 for each 
unit.<ol>
[Figure 2: 25 TAC sec.289.204(h)] 
(i) Schedule of annual fees for certificates of registration for radiation 
machines, lasers, and services. The following schedule contains the annual fees 
for certificates of registration for radiation machines, lasers, and services:
<nl>Figure 2: 25 TAC sec.289.204(i)<ol> 
[Figure 3: 25 TAC sec.289.204(i)] 
(j)-(k) (No change.) 
(l) Schedule of fees for uranium recovery and byproduct <nl> material<ol> 
disposal facility licenses. The following schedule contains the fees for uranium 
recovery and byproduct <nl>material<ol> disposal facility licenses: 
<nl>Figure 3: 25 TAC sec.289.204(l)<ol> 
[Figure 4: 25 TAC sec.289.204(l)] 
(m) Adjustments to annual fees for uranium recovery and byproduct <nl> 
material<ol> disposal facility licenses. 
(1)-(2) (No change.) 
(n) One-time fee adjustments for uranium recovery and byproduct <nl> 
material<ol> disposal facility licenses. For the addition of the following items 
after an environmental assessment has been completed on a facility, a one-time 
fee corresponding to the item shall be paid: 
(1)-(5) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802211
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

PART VI. Statewide Health Coordinating Council
CHAPTER 571. Health Planning and Resource Development
25 TAC sec.sec.571.2, 571.4, 571.5
The Statewide Health Coordinating Council (council) proposes amendments to 
sec.sec.571.2, 571.4, and 571.5, concerning conflict of interest, meetings, and 
committees. In accordance with the Texas Health and Safety Code, Chapter 104, 
the composition of the council has been revised. The council proposes the 
following changes to reflect the new structure of the council. 
Section 571.2 defines "conflict of interest" as specified in the Government 
Code, sec.572.058. Section 571.4 provides for notification of the appointing 
authority if a member of the council is unable to discharge his or her duties as 
prescribed, defines the number for a quorum, and revises the number of members 
who can request a called meeting. Section 571.5 proposes revised minimum sizes 
for the plan development committee, the legislative committee, and the 
nominating committee. 
Ben G. Raimer, M.D., Chair of the Council, has determined that for the first 
five-year period the sections are in effect, there will be no fiscal 
implications to state or local government as a result of enforcing or 
administering the sections as proposed. 
Dr. Raimer has also determined that for each of the first five years the 
sections are in effect, the public benefit anticipated as a result of enforcing 
the sections will be the revisions of the bylaws of the council ensuring more 
efficient exercise of the council's duties. There will be no effect on small 
businesses since the rules affect only the procedural operations of the council. 
There are no anticipated economic costs to persons who are required to comply 
with the sections as proposed. There is no anticipated impact on local 
employment.
Comments on the proposal may be submitted to Dora McDonald, Bureau of State 
Health Data and Policy Analysis, Texas Department of Health, 1100 West 49th 
Street, Austin, Texas 78756, (512) 458-7261. Comments will be accepted for 30 
days following publication of this proposal in the Texas Register. 
The amendments are proposed under the Health and Safety Code, sec.104.012 which 
provides the council with the authority to adopt rules concerning the 
development and implementation of the state health plan.
The amendments will affect the Health and Safety Code, Chapters 104 and 105. 

sec.571.2. <nl>Conflict of Interest<ol>. [General Provisions.] 
[(a) Fiscal year. For all fiscal and administrative purposes, the reporting year 
of the Statewide Health Coordinating Council (council) shall be identical to 
that of the Texas Department of Health (department).] 
[(b) Conflict of Interest.] <nl>A member who has a personal or private interest 
in a measure, proposal, or decision pending before the council shall publicly 
disclose the fact to the council in a meeting. The member may not vote or 
otherwise participate in the decision or discussion. The disclosure shall be 
entered in the minutes of the meeting. An individual does not have a "personal 
or private interest" in a measure, proposal, or decision if the individual is 
engaged in a profession, trade, or occupation and the individual's interest is 
the same as all others similarly engaged in the profession, trade, or 
occupation.<ol> 
[(1) Prior to taking his or her position on the council, each member shall 
submit in writing to the chair a list of all business or other organizations of 
which he or she is an officer, director, trustee, member, owner (either as a 
sole proprietor or partner), shareholder with a 5.0% or greater interest in all 
outstanding voting shares, employee, or agent, if said relationship might 
reasonably result in a conflict of interest involving issues considered by the 
council. The members' written statements will be resubmitted with any necessary 
changes each year. Each year the chair shall provide all members' written 
statements to council members.]
[(2) When any matter before the council raises the question of a conflict of 
interest, the affected member shall make known the potential conflict, whether 
previously disclosed by his or her written statement or not, and after answering 
any questions council members may have, shall withdraw from the discussion for 
so long as the matter remains under discussion, but may remain in the room. If 
the affected member fails to withdraw during the discussion and/or the vote on 
the matter, the chair may require that the member withdraw. If the conflict 
affects the chair, the vice chair may require that the chair withdraw from the 
meeting in the same manner.] 

sec.571.4. Meetings. 
(a)-(b) (No change.) 
(c) Attendance. <nl>If a member cannot discharge the member's duties, or is 
absent from more than half of the regularly scheduled council meetings that the 
member is eligible to attend during a calendar year, unless the absence is 
excused by majority vote of the council, the council shall report such to the 
authority that appointed that member.<ol> [Department staff shall maintain a 
record of each member's attendance at council meetings. If any member fails to 
attend two consecutive regular meetings without authorization from the chair, a 
motion to notify the member officially of such absences shall be voted on by the 
council. If approved, a copy of the notification shall also be forwarded to the 
governor with a request for appropriate action.
(d) Quorum. A majority of the council shall be defined as <nl> nine<ol> [more 
than one-half the voting] members of the council. [A majority of the council 
shall constitute a quorum for the transaction of business at any meeting.] 
(e)-(g) (No change.) 
(h) Called meetings. Meetings of the council may be called by the chair and one 
other officer, or at the request of any <nl>three<ol> [eight] members. 

sec.571.5. Committees. 
(a) (No change.) 
(b) Plan development committee. The plan development committee shall include all 
members who wish to serve, but no fewer than <nl>four<ol> [eight] members who 
serve two-year terms. The committee shall provide guidance to the department 
during the development of the proposed state health plan. 
(c) Legislative committee. The legislative committee is a committee of no fewer 
than <nl>four<ol> [seven] members who shall serve two-year terms. The 
legislative committee shall make recommendations to the council regarding the 
following: 
(1)-(4) (No change.) 
(d) Nominating committee. The chair shall appoint a nominating committee [of 
five members] prior to each meeting at which an election is scheduled. [The 
nominating committee shall consist of five members.] The nominating committee 
shall submit its nominations to the chair in time to allow the chair to provide 
the list of nominees to each member of the council. Each nominating committee 
shall dissolve itself upon completion of its purpose each year. 
(e) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802210
Ben G. Raimer, M.D.
Chair
Statewide Health Coordinating Council
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 458-7236

TITLE 28. INSURANCE
PART II. Texas Workers' Compensation Commission
CHAPTER 130.Impairment and Supplemental Income Benefits
SUBCHAPTER B.Supplemental Income Benefits
28 TAC sec.sec.130.101-130.106, 130.108, 130.110-130.112
The Texas Workers' Compensation Commission (the Commission) proposes amendments 
to the following rules contained in Chapter 130 regarding supplemental income 
benefits: sec.130.101, concerning Definitions; sec.130.102 concerning 
Determination of Entitlement to Supplemental Income Benefits, Calculation of 
Amount; sec.130.103 concerning Initial Entitlement to Supplemental Income 
Benefits; sec.130.104 concerning Continuing Entitlement to Supplemental Income 
Benefits; sec.130.105 concerning Reinstated or Delayed Entitlement to 
Supplemental Income Benefits; sec.130.106 concerning Permanent Loss of 
Entitlement to Supplemental Income Benefits; sec.130.108 concerning Contesting 
Entitlement or Amount of Supplemental Income Benefits, Attorney Fees; 
sec.130.110 concerning Commission Review of Employment Status During the 
Supplemental Income Benefit Period. In addition, the Commission proposes new 
sec.130.111 concerning Disputes Regarding Direct Result and new sec.130.112 
concerning Carrier Sponsored Vocational Case Managers. 
These proposed changes to existing rules and proposed new rules are in response 
to the ever increasing number of disputes related to the entitlement to 
supplemental income benefits. Over the last several years, the number of 
disputes regarding entitlement to supplemental income benefits has increased at 
a dramatic rate. There are several areas in the state where these disputes now 
represent over 50% of all the disputes that are adjudicated in the formal 
dispute resolution process. Commission staff conducted a review of the types of 
issues that were causing these disputes and determined that many of the disputes 
were the result of the lack of specific direction provided in the existing 
provisions of the Act and rules. The Commission's experience with the current 
rule, which was adopted in 1991, has shown that many of the issues regarding 
entitlement to supplemental income benefits are left to the discretion of the 
finder of fact in the dispute resolution process. This approach causes some 
inconsistencies in the decisions regarding entitlement to supplemental income 
benefits in similar factual situations. These inconsistencies encourage parties 
to pursue a dispute through the formal dispute resolution process because of the 
possibility of securing a favorable decision despite previous decisions to the 
contrary in similar cases. 
The specific areas where potential problems were identified related to both 
procedural and entitlement issues. These issues are discussed in more detail in 
the descriptions of the areas that are proposed for changes and in the 
explanation of the need for new and amended rules. By providing additional 
direction regarding the implementation of the provisions of the Act and by 
providing specific procedures and standards for many of the areas that have 
resulted in disputes, it is anticipated that the number of administrative 
proceedings may be reduced. The process for developing these changes involved 
presentations during public meetings and general direction being provided by the 
Commissioners regarding the various issues and areas for clarification. Given 
the nature and extent of the changes contained in the proposed rules, the 
Commission will develop ways to educate the various parties after the rules are 
adopted. Education efforts may include the addition of an information sheet with 
the letters that are sent to injured employees regarding initial entitlement to 
supplemental income benefits which would address the new requirements and 
provisions of the rules. Similar information could be provided by the Field 
Offices to individuals who are currently in the supplemental income benefit 
entitlement period. In addition, public information releases can be sent to 
persons listed on the public distribution list. These informational releases 
will help ensure that the affected individuals will receive the necessary 
information about the changes to existing rules and new rules. 
The Texas Registers published text shows words proposed to be added to or 
deleted from the current text, and should be read to determine all proposed 
changes. 
The proposed amendment to sec.130.101 adds definitions and clarifies the 
definition of terms currently in the rule. The addition of a definition of 
"actual wages" will eliminate disputes regarding the earnings that will be 
considered in the calculation of the amount of supplemental income benefits. The 
addition of a definition for "contacts for employment" specifies the type of 
communications that an injured employee is expected to use to seek employment, 
specifies that the employment sought be within the injured employee's 
educational background and experience, and specifies that the contacts must 
occur throughout the period during which the injured employee has the ability to 
return to work. This definition does not penalize the injured employee if a 
contact is made with an employer and the employer does not have any available 
positions. This type of contact is still a valid contact in determining the 
injured employee's efforts to find employment. 
Other changes contained in this section are proposed to provide clarification 
and to update citations to the Workers' Compensation Act. The proposal would add 
a sentence to the definition of "filing period" to clarify that the filing 
period used for reviewing the wages earned or job search efforts can be adjusted 
upon request, but that the compensable quarters cannot be changed. Statutory 
references to the Workers' Compensation Act would be updated in the definition 
of "impairment income benefits period" and a clarification was added regarding 
when the period begins. The definition of "offered wages" would be amended to 
correct the reference to "bona fide position of employment" by changing it to "a 
position of employment which constitutes a bona fide offer of employment." In 
subparagraph (B) of the definition of "statement of employment status" the term 
"earned wages" would be changed to "actual wages" to make this definition 
consistent with the definition of "actual wages" added to sec.130.101.
The proposed amendment to sec.130.102 updates the reference to the Workers' 
Compensation Act. 
The proposed amendment to sec.130.103 includes additional directions for 
determining if an injured employee has made a good faith effort to obtain 
employment commensurate with his or her ability to work. Subsection (c) has been 
added to define the minimum activities that must be performed for the Commission 
to presume that the injured employee has made a good faith effort to obtain 
employment. This subsection establishes the number of contacts for employment 
that an injured employee must make to be presumed to have made a good faith 
effort to obtain employment. These numbers are based on a survey of the opinions 
of Commission Ombudsmen, Benefit Review Officers, and Benefit Contested Case 
Hearing Officers regarding the number of contacts for employment which they felt 
constitute a good faith effort. The results of the opinion survey were averaged 
to arrive at the number of contacts proposed in the rule. Because these 
Commission employees have extensive experience in the resolution of disputes 
related to employment efforts, their expertise was utilized to arrive at a 
rebuttable standard. The text of (c) makes it clear that a showing of good faith 
effort is not limited to the list in (c); the list is the minimum that must be 
done to create a presumption that a good faith effort was made. Subsection (d) 
of this proposal was added to clarify that the presumption of a good faith 
effort to obtain employment established in subsection (c) may be rebutted if the 
disputing party presents credible evidence during a dispute resolution 
proceeding. Subsection (h) would be added to set out the manner in which the 
Commission will act on requests for supplemental income benefits when there is a 
pending dispute regarding the date of maximum medical improvement or the injured 
employee's impairment rating. In addition, new subsection (h) would clarify that 
if there was no dispute regarding maximum medical improvement or impairment 
rating prior to the expiration of the initial compensable quarter, the date of 
maximum medical improvement and impairment rating would be final except in cases 
of newly discovered evidence. Subsection (i) (currently subsection (e)) retains 
the requirement for the Commission to make a referral to the Texas 
Rehabilitation Commission if the injured employee needs vocational 
rehabilitation or training, but provides the notice to be in the form of a 
separate letter to more efficiently process notification. The proposed changes 
to sec.130.104 more specifically set out the criteria for continuing entitlement 
to supplemental income benefits. The changes to subsection (a) further defines 
continuing entitlement to the actual payment and receipt of benefits. This is 
important due to the nature of the dispute resolution process which may impact 
entitlement to multiple quarters. The amendment to subsection (b) requires the 
insurance carrier to send the Statement of Employment Status by certified mail - 
providing the carriers a means to document that the form was sent and helping to 
ensure that the injured employee was actually sent the form when required. In 
subsection (c) the term "statement" is changed to the more specific "statement 
of employment status." The changes to subsection (d) add a presumption of good 
faith effort to obtain employment similar to the presumption in sec.130.103(c) 
on initial entitlement, but changes the job search effort criteria to a change 
of condition standard. This means that when the injured employee performs a 
certain type of job search effort for one quarter and is found entitled to 
supplemental income benefits, if he or she performs the same type of search and 
there is no other change in condition, then he or she is entitled to the 
subsequent quarter. The proposed changes to subsection (h) (currently subsection 
(g)) make references to the Statement of Employment Status consistent with the 
rest of the rule and note the good cause exception for failure to file the 
Statement of Employment Status. New subsection (i) would add provisions for good 
cause findings regarding the failure to timely submit the Statement of 
Employment Status. Proposed new subsection (j) states when an insurance 
carrier's dispute of continuing entitlement to supplement income benefits would 
be considered an administrative violation for an unreasonable dispute. 
The proposed amendments to sec.130.105 involve some minor improvements in the 
language of the rule and the addition of a provision in subsection (b) adopting 
the change of condition standard. Therefore, the change of condition standard 
applies also when the injured employee was found not to be entitled to benefits 
for the previous quarter and no change in condition is shown. The proposed 
amendment to sec.130.106 adds subsection (b) to ensure that when an insurance 
carrier is relieved of liability because of the injured employee's failure to 
timely file a Statement of Employment Status, that particular time period would 
not count toward the accrual of the 12-month permanent loss of entitlement 
provision of the statute. 
The proposed amendment to sec.130.108(c) clarifies when an insurance carrier is 
required to file a request for a benefit review conference to contest the 
continuing entitlement to supplemental income benefits. This provision is 
similar to the provision on continuing entitlement in sec.130.103 
The proposed amendments to sec.130.110 removes the requirement for the 
Commission to perform an annual review of the employment status of employees 
receiving supplemental income benefits. Each quarter is reviewed independently 
and may be disputed by the insurance carrier if they believe the injured 
employee is not entitled to benefits for a particular quarter. Because these 
situations are reviewed every quarter by the carrier, a required annual review 
is duplicate work with little benefit to the parties. This provision still 
allows the parties to request the review and allows the commission to perform a 
review when it is determined necessary. The proposed changes to subsection (d) 
add the direction that a dispute regarding the Commission's determination of 
employment status may be filed pursuant to sec.130.111. 
Proposed new sec.130.111 defines the evaluation of whether or not the injured 
employee's unemployment or underemployment is a direct result of the employee's 
impairment from the compensable injury and provides an expeditious method to 
resolve any disputes on this issue. Proposed subsection (a) limits the time 
periods when such a dispute can be raised to help eliminate the same dispute 
being raised every three months. Proposed subsection (b) requires the dispute to 
be raised in a manner which is proscribed by the commission and includes the 
requirement for the carrier to request a required medical examination which will 
be necessary to resolve the dispute. Proposed subsection (c) provides that a 
medical opinion will be secured from three different doctors regarding the 
direct result issue. Proposed subsection (d) specifies the time frames for the 
doctors to provide an appointment and send copies of the medical reports 
containing the doctors' opinions. Proposed subsection (f) provides that if a 
majority of the doctors' opinions conclude that the injured employee's 
impairment is a producing cause of the employee's unemployment or 
underemployment, then the Commission shall presume that the unemployment or 
underemployment is a direct result of the impairment. Proposed subsection (g) 
requires the Commission to notify the parties of the majority opinion. Proposed 
subsection (h) outlines the appeal process to be followed if either party 
disagrees with the majority medical opinion of the doctors. Proposed subsection 
(i) defines the disputes for which this particular rule will be effective. 
Proposed new sec.130.112 establishes parameters on the use of carrier sponsored 
vocational case managers for assisting injured employees during the supplemental 
income benefit period. Proposed subsection (a) provides definitions while 
subsection (b) provides that if the carrier elects to provide vocational case 
management services the carrier is liable for the reasonable and necessary cost 
of such services. Proposed subsection (c) requires the injured employee to 
cooperate with the carrier sponsored vocational case manager if one is provided. 
Proposed subsection (d) allows the vocational case manager to communicate with 
the treating doctor regarding the ability to return to work and similar issues. 
Proposed subsection (e) lists the basic types of services that vocational case 
managers may provide, while proposed subsection (f) requires that any ancillary 
services be provided under the direction of the vocational case manager. 
Proposed subsection (g) requires the vocational case manager to communicate with 
the injured employee's treating doctor to become informed regarding the 
condition of the injured employee. In addition, subsection (g) requires the 
insurance carrier to inform the injured employee of the qualifications of the 
individual who will be performing vocational case management services, the types 
of services that may be provided, and the impact of failure to cooperate with 
the vocational case manager. 
Janet Chamness, Chief of Budget, has determined that for the first five-year 
period the proposed new and amended rules are in effect there will be limited 
fiscal implications for state and no fiscal impact for local governments as a 
result of enforcing or administering the new and amended rules. Local government 
and state government as a covered regulated entity will be impacted in the same 
manner as described later in this preamble for persons required to comply with 
the rule as proposed. The proposed new and amended rules will provide parties 
with guiding principles which may result in resolving disputes without the need 
for formal proceedings. While the exact reduction in the number of formal 
disputes cannot be predicted, such a reduction will reduce the costs to the 
state associated with conducting these proceedings. It is not anticipated that 
these changes will result in either an increase or a decrease in the cost to the 
state as a result of enforcing or administering these rules. While these rules 
are anticipated to reduce the number of proceedings, there will be an increase 
in the number of other activities associated with the administration of these 
rules. Any reductions in the number of proceedings will also be offset by the 
increasing number of claims that may result in a proceeding as each new year 
increases the number of claims subject to the provisions of the Act and rules. 
With an injured employee being entitled to all reasonable and necessary medical 
treatment without any time limitations, even claims with no additional income 
benefits being paid will need proceedings to resolve disputes on extent of 
injury and similar matters. Finally, the demand for proceedings on other issues 
would not realistically reduce the number of staff or resources required to 
conduct proceedings even with a reduction in supplemental income benefit cases. 
These proposed rules are not anticipated to effect the revenue of the state in 
any direct manner. The revenue of the state for workers' compensation activities 
is primarily based on a maintenance tax on the total amount of premiums paid for 
workers' compensation insurance. While any increase in the amount of benefits 
paid would increase the cost of individual claims, the reduction in the costs of 
proceedings would be reduced, thereby negating much impact to premiums and the 
amount of the maintenance tax. It is possible that an increase in the 
enforcement of administrative violations under the proposed rules could slightly 
increase revenue to the state, but this increase would be minimal in comparison 
to the revenue generated by the maintenance tax.
Ms. Chamness also has determined that for each year of the first five years the 
new and amended rules are in effect, the public benefit anticipated will include 
the ability of the parties to clearly recognize and understand the entitlement 
process for supplemental income benefits. The new and amended rules will also 
provide more consistency and predictability in the resolution of disputes 
related to supplemental income benefits. This clarification may result in 
disputes being resolved in a more expeditious fashion by providing guidance 
regarding what must be done to establish entitlement to supplemental income 
benefits. The clarification of the entitlement and process requirements, 
combined with the potential reduction in the number of proceedings, will have a 
positive impact on the overall administration of the workers' compensation 
system. The injured employee will benefit from the amendments and new rules by 
knowing specifically what must be done in order to qualify for supplemental 
income benefits. This type of information will allow the injured employee to 
perform the appropriate actions in making a good faith effort to obtain 
employment which may expedite the supplemental income benefit process and ensure 
that income benefits are paid promptly when they are due. The presumptions 
regarding what constitutes a good faith effort may allow a limited number of 
injured employees to receive supplemental income benefits that previously would 
not have been entitled to these benefits. For example, injured employees who are 
participating in vocational rehabilitation training with the Texas 
Rehabilitation Commission will have an easier standard for qualifying for 
supplemental income benefits. Any reduction in the number of disputes will save 
the injured employees the time and frustration of the formal dispute resolution 
process and associated attorney fees in certain cases. The insurance carriers 
will benefit from the amendments and new rules by being provided the information 
necessary to properly determine entitlement or non-entitlement to supplemental 
income benefits and thereby avoiding the need to proceed through the dispute 
resolution process on multiple quarters with similar factual situations. Any 
reduction in the number of disputes and proceedings will have a positive fiscal 
impact by reducing the costs associated with litigating disputes through the 
formal dispute resolution process and the payment of attorney fees in cases 
where the insurance carrier disputed entitlement and did not prevail. These 
limited situations require the insurance carrier to pay attorney fees directly 
to the injured employee's attorney and are not paid from the benefits paid to 
the injured employee. If the number of proceedings are reduced by the additional 
guidance contained in the rules, the insurance carriers will avoid these 
additional costs. It is anticipated that the insurance carriers may have an 
increase in the amount of supplemental income benefits paid in limited 
situations as described previously. It is not anticipated that the provisions 
regarding vocational case managers will affect the costs of insurance carriers 
because the proposed rules do not require the carrier to provide these services. 
There will be additional expenses for insurance carriers as a result of the 
additional medical examinations required by the proposed new and amended rules 
regarding resolution of disputes regarding whether unemployment or under 
employment is a direct result of the employee's impairment. However, the payment 
of these services are governed by the Medical Fee Guidelines and are not 
anticipated to be a significant cost. If a dispute on whether or not an injured 
employee has made a good faith effort to obtain employment must be adjudicated 
through the proceeding process, there does not appear to be any additional costs 
because the current dispute resolution process for these types of disputes is 
not changed by the proposed amendments and new rules.
There will be no difference in the costs of compliance for small businesses as 
compared to large businesses. An analysis and comparison of the costs of 
compliance for small businesses with the cost of compliance for large businesses 
does not demonstrate any realistic increase or decrease for either entity. While 
any increase in the amount of benefits paid would increase the cost of 
individual claims, the reduction in the costs of proceedings would be reduced, 
thereby negating much impact to premiums. In addition, currently workers' 
compensation insurance is a competitive market which affords businesses 
different alternatives for securing insurance or the amount and types of 
deductibles. It must be noted that if an individual case on a small employer 
results in high costs, the cost of workers' compensation premiums may increase. 
This is true for any increase in cost, including all types of income benefits or 
medical benefits. However, the changes in these proposed rules are not 
anticipated to have this type of impact on either small or large businesses. 
Comments on the proposal or requests for a public hearing must be submitted to 
Sue Cutler by 5:00 p.m., March 30, 1998 at the Office of the General Counsel, 
Mailstop #4-D, Texas Workers' Compensation Commission, Southfield Building, 4000 
South IH-35, Austin, Texas 78704-7491. A public hearing on this proposed rule is 
tentatively scheduled for March 4, 1998 at the Austin office of the Commission. 
Those persons interested in attending the public hearing should contact the 
Commission's Office of Executive Communication at (512) 440-5690 to confirm the 
date, time, and location of the public hearing. 
The amendments and new rules are proposed under the Texas Labor Code, 
sec.402.061, which authorizes the Commission to adopt rules necessary to 
administer the Act; the Texas Labor Code, sec.408.061, which establishes the 
maximum weekly temporary income benefit; the Texas Labor Code, sec.408.121, 
which addresses impairment income benefits; the Texas Labor Code, sec.408.141, 
which addresses the award of supplemental income benefits; the Texas Labor Code, 
sec.408.142, which sets out the requirements for an employee's eligibility to 
receive supplemental income benefits; Texas Labor Code, sec.408.143, which 
requires an employee to file with the insurance carrier a quarterly statement 
regarding employment after the Commission's initial determination of 
supplemental income benefits; the Texas Labor Code, sec.408.144, which sets out 
how supplemental income benefits are to be calculated; the Texas Labor Code, 
sec.408.145, which sets out when supplemental income benefits are to be paid; 
the Texas Labor Code, sec.408.146, which sets out when supplemental income 
benefits are to be terminated and how they can be reinitiated; the Texas Labor 
Code, sec.408.147, which sets out the procedures for contest of supplemental 
income benefits by an insurance carrier and provides that the insurance carrier 
is liable for the attorney's fees of an employee who prevails in such a contest; 
the Texas Labor Code, sec.408.148, which provides for reinstatement of 
supplemental income benefits after termination of employment under certain 
circumstances; the Texas Labor Code, sec.408.149, which provides for Commission 
review of the employment status of the employee, for Commission determination 
whether unemployment or under employment is a direct result of the impairment 
from the compensable injury, and for contest of the determination through 
benefit review conference; the Texas Labor Code, sec.408.150, which provides for 
Commission referral to the Texas Rehabilitation Commission for vocational 
rehabilitation or training; and Chapter 410 of the Labor Code, regarding 
adjudication of disputes. 
The proposed amendments and new rules affect the following statutes: the Texas 
Labor Code, sec.402.061, which authorizes the Commission to adopt rules 
necessary to administer the Act; the Texas Labor Code, sec.408.061, which 
establishes the maximum weekly temporary income benefit; the Texas Labor Code, 
sec.408.121, which addresses impairment income benefits; the Texas Labor Code, 
sec.408.141, which addresses the award of supplemental income benefits; the 
Texas Labor Code, sec.408.142, which sets out the requirements for an employee's 
eligibility to receive supplemental income benefits; Texas Labor Code, 
sec.408.143, which requires an employee to file with the insurance carrier a 
quarterly statement regarding employment after the Commission's initial 
determination of supplemental income benefits; the Texas Labor Code, 
sec.408.144, which sets out how supplemental income benefits are to be 
calculated; the Texas Labor Code, sec.408.145, which sets out when supplemental 
income benefits are to be paid; the Texas Labor Code, sec.408.146, which sets 
out when supplemental income benefits are to be terminated and how they can be 
reinitiated; the Texas Labor Code, sec.408.147, which sets out the procedures 
for contest of supplemental income benefits by an insurance carrier and provides 
that the insurance carrier is liable for the attorney's fees of an employee who 
prevails in such a contest; the Texas Labor Code, sec.408.148, which provides 
for reinstatement of supplemental income benefits after termination of 
employment under certain circumstances; the Texas Labor Code, sec.408.149, which 
provides for Commission review of the employment status of the employee, for 
Commission determination whether unemployment or under employment is a direct 
result of the impairment from the compensable injury, and for contest of the 
determination through benefit review conference; the Texas Labor Code, 
sec.408.150, which provides for Commission referral to the Texas Rehabilitation 
Commission for vocational rehabilitation or training; and Chapter 410 of the 
Texas Labor Code, regarding adjudication of disputes. 

sec.130.101.Definitions.
The following words and terms when used in this chapter, shall have the 
following meanings, unless the context clearly indicates otherwise: 
<nl>Actual wages<ol><nl>&mdash;The gross wages earned by an employee during a 
defined filing period before any deductions. This includes the gross income from 
a self-employment enterprise before any deductions for expenses or costs.<ol>
<nl>Contacts for employment <ol><nl>&mdash; verbal or written communications 
made by the injured employee requesting employment with employers where there 
may be a potential for employment given the injured employee's educational 
background and work experience. These contacts are documented on the Statement 
of Employment Status and must be made throughout the time period during which 
the injured employee is able to return to work. <ol>
Filing period. A period of at least 90 days during which the employee's actual 
and offered wages, if any, are reviewed to determine entitlement to, and amount 
of, supplemental income benefits. <nl> Upon request by either party, the filing 
period used for reviewing either the wages earned or the job search efforts may 
be adjusted, but the dates of the compensable quarters shall not be changed.<ol>
Impairment income benefits period The number of weeks computed under the Act, 
<nl>Texas Labor Code, sec.408.121<ol> [Article 8308-4.26(c)(1)], for which the 
injured employee is entitled to receive impairment income benefits, starting 
with <nl>the day after<ol> the date the employee reached maximum medical 
improvement.
Offered wages The wages of a [bona fide] position of employment, <nl>which 
constitutes a bona fide offer of employment<ol> as defined in sec.129.5 of this 
title (relating to Bona Fide Offers of Employment).
Statement of employment status A commission-prescribed form filed with the 
carrier containing the following information: 
(A) (No change.)
(B) the amount of the employee's <nl>actual<ol> [earned] and offered wages 
during the filing period; and
(C) (No change.)

sec.130.102.Determination of Entitlement to Supplemental Income Benefits; 
Calculation of Amount.
(a)-(c) (No change.) 
(d) Calculation. The monthly supplemental income benefit payment is calculated 
as follows: 
(1)-(3) (No change.) 
(4) multiply the remainder by .80, not to exceed the maximum weekly income 
benefit under the Act, <nl>Texas Labor Code, sec.408.06l <ol> [Article 8308-
4.11]; and 
(5) (No change.) 
(e) (No change.) 

sec.130.103.Initial Entitlement to Supplemental Income Benefits.
(a) Initial entitlement criteria. An injured employee who received an impairment 
rating of 15% or greater, and who has not commuted any impairment income 
benefits, is entitled to receive supplemental income benefits upon termination 
of the impairment income benefits period if the employee: 
(1) (No change.) 
(2) has made <nl>a<ol> good faith <nl>effort<ol> [efforts] to obtain employment 
commensurate with the employee's ability to work<nl>, as set out in subsection 
(c) of this section<ol>.
(b) Review of employment status. As provided by sec.130.10 of this title 
(relating to <nl>Commission<ol> Review of Employment Status During the 
Impairment Income Benefits Period), not later than 10 days before the last day 
of the impairment income benefit period, the commission shall review the 
employment status of each injured employee who received an impairment rating of 
15% or greater, and who has not commuted any impairment income benefits.
<nl>(c)<ol> <nl> Good faith effort. For the determination of entitlement to 
supplemental income benefits for the initial quarter, the injured employee may 
present information to show that a good faith effort to obtain employment has 
been made. Although a showing of good faith effort is not limited to the 
following list, the injured employee shall be presumed to have made a good faith 
effort to obtain employment if: <ol>
<nl>(1)<ol> <nl> the injured employee has returned to work in a position which 
is equal to the injured employee's physical ability to work as determined by the 
treating doctor; <ol>
<nl>(2)<ol> <nl>the injured employee has been enrolled in, and satisfactorily 
participated in a full time vocational training or rehabilitation program 
sponsored by the Texas Rehabilitation Commission or an approved private provider 
throughout the entire filing period (full time enrollment means the equivalent 
of 12 college semester hours); <ol>
<nl>(3)<ol> <nl>the injured employee has entered into a self-employed enterprise 
and submits sufficient supporting documentation such as, business plans, 
contacts, sales tax registration, and any other pertinent documentation to 
document all efforts to establish a self-employed enterprise during the filing 
period; <ol>
<nl>(4)<ol> <nl> the injured employee's treating doctor reports that the injured 
employee cannot return to any type of employment during the filing period, the 
treating doctor provides a reasonable explanation regarding the inability to 
perform any work, and there is no other medical report to document that the 
injured employee has the ability to work; or, <ol>
<nl>(5)<ol> <nl> during the filing period, the injured employee has been 
released to return to work by the treating doctor, and the injured employee: 
<ol>
<nl>(A)<ol> <nl>resides in or within 30 miles of a city with a population 
greater than 75,000 people and has made at least 39 contacts for employment as 
defined in sec.130.101 of this title (relating to Definitions); or, <ol>
<nl>(B)<ol> <nl> resides more than 30 miles from any city with a population 
greater than 75,000 people and has made at least 21 contacts for employment as 
defined in sec.130.101 of this title. <ol>
<nl>(d)<ol> <nl>Rebuttable presumption. The presumption of a good faith effort 
to obtain employment contained in subsection (c) of this section may be rebutted 
by credible evidence presented during the dispute resolution process.<ol> 
<nl>(e)<ol> [(c)] Notice of determination. Not later than the last day of the 
impairment income benefit period, the commission shall: 
(1) determine entitlement or non-entitlement to supplemental income benefits; 
and 
(2) send written notice of this determination to the injured employee and the 
carrier by first class mail or personal delivery.
<nl>(f)<ol> [(d)] Determination of entitlement. If the commission determines 
that the employee is entitled to supplemental income benefits, the notice shall: 
(1) state the beginning and end dates of the first compensable quarter; 
(2) specify the amount of the monthly payment; 
(3) specify the wages used to calculate the monthly payment;
(4) advise the parties of the procedures for contesting the commission's 
determination and calculation of amount, as provided by sec.130.108 of this 
title (relating to Contesting Entitlement or Amount of Supplemental Income 
Benefits<nl>; Attorney Fees<ol>); and 
(5) enclose instructions for filing the Statement of Employment Status, a filing 
schedule, and a description of the consequences of late filing and failing to 
file. 
[(e) Referral to the Texas Rehabilitation Commission. If the commission 
determines that the employee may be materially assisted by vocational 
rehabilitation or training, the notice described in subsection (d) of this 
section shall additionally contain: ]
[(1) a referral to the Texas Rehabilitation Commission for appropriate services; 
and ]
[(2) a warning to the employee that refusing such services, or refusing to 
cooperate with such services, will result in loss of entitlement to supplemental 
income benefits.] 
<nl>(g)<ol> [(f)] Determination of non-entitlement. If the commission determines 
that the employee is not entitled to supplemental income benefits, the notice 
shall: 
(1) state the grounds for this determination; 
(2) advise the parties of the procedures for contesting the commission's 
determination, as provided by sec.130.108 of this title (relating to Contesting 
Entitlement or Amount of Supplemental Income Benefits<nl>; Attorney Fees<ol>); 
and 
(3) enclose a Statement of Employment Status and filing instructions for 
claiming delayed entitlement to supplemental income benefits, as provided by 
sec.130.105 of this title (relating to Reinstated or Delayed Entitlement to 
Supplemental Income Benefits). 
<nl>(h)<ol> <nl>Disputes Regarding the Date of Maximum Medical Improvement or 
the Impairment Rating. If there is no dispute:<ol>
<nl>(1)<ol> <nl> that the impairment rating is 15% or greater, the commission 
shall make the initial determination of entitlement to supplemental income 
benefits based on the reasonable assessment made by the insurance carrier. If 
either party disputes that the impairment rating is 15% or greater, the 
commission shall not make any determination regarding the entitlement to 
supplemental income benefits until there is a valid written agreement regarding 
the impairment rating, a stipulation regarding the impairment rating during a 
benefit contested case hearing, or a decision from a benefit contested case 
hearing which resolves the impairment rating dispute; <ol>
<nl>(2)<ol> <nl> regarding the date of maximum medical improvement or the 
impairment rating prior to the expiration of the initial compensable quarter and 
the commission determined that the injured employee was entitled to supplemental 
income benefits for the initial quarter, the date of maximum medical improvement 
and the impairment rating shall be final and binding, except in situations where 
a party provides newly discovered evidence or information that was not available 
during the pendency of the initial quarter. <ol>
<nl>(i)<ol> <nl>Referral to the Texas Rehabilitation Commission. If the 
commission determines that the employee may be materially assisted by vocational 
rehabilitation or training, the commission shall send the injured employee 
notice containing:<ol> 
<nl>(1)<ol> <nl>a referral to the Texas Rehabilitation Commission for 
appropriate services; and <ol>
<nl>(2)<ol> <nl> a warning to the employee that refusing such services, or 
refusing to cooperate with such services, will result in loss of entitlement to 
supplemental income benefits. <ol>

sec.130.104.Continuing Entitlement to Supplemental Income Benefits.
(a) Continuing entitlement criteria. An injured employee <nl> who was entitled 
to and received<ol> [initially determined by the commission to be entitled to] 
supplemental income benefits <nl>during a particular quarter<ol> will continue 
to be entitled to supplemental income benefits for <nl>the<ol> [subsequent] 
compensable quarters <nl>immediately following that quarter<ol> if the employee, 
during <nl>the applicable<ol> [each] filing period: 
(1) (No change.)
(2) has made <nl>a<ol> good faith efforts to obtain employment commensurate with 
the employee's ability to work <nl>subject to subsection (d) of this 
section<ol>. 
(b) Statement of Employment Status. Unless this requirement has been expressly 
modified by the commission, an employee claiming continuing entitlement to 
supplemental income benefits must send the carrier a Statement of Employment 
Status. The carrier shall <nl>send to the employee by certified mail<ol> 
[enclose] a copy of the <nl>Statement of Employment Status<ol> [statement] with 
the supplemental income benefit payment for the third month of the compensable 
quarter, accompanied by filing instructions and a description of the 
consequences of late filing and failing to file.
(c) Filing the statement. The employee shall file the <nl> Statement of 
Employment Status<ol> [statement] with the carrier by first class mail or 
personal delivery. To ensure no lapse in benefits, the statement should be filed 
no later than the 15th day after receipt of the statement. 
(d) Procedure for determining continuing entitlement and amount. Not later than 
10 days after receiving the <nl>Statement of Employment Status <ol> [statement], 
the carrier shall determine continuing entitlement to supplemental income 
benefits, and send written notice of determination to the injured employee and 
the commission. <nl>For the determination of entitlement to supplemental income 
benefits for continuing entitlement, the injured employee shall be presumed to 
have made a good faith effort to obtain employment if: <ol>
<nl>(1)<ol> <nl> the injured employee has returned to work in a position which 
is equal to the injured employee's physical ability to work as determined by the 
treating doctor; <ol>
<nl>(2)<ol> <nl> the injured employee has been enrolled in, and satisfactorily 
participated in a full time vocational training or rehabilitation program 
sponsored by the Texas Rehabilitation Commission or a approved private provider 
throughout the entire filing period (full time enrollment means the equivalent 
time equal to 12 college semester hours);<ol>
<nl>(3)<ol> <nl>the injured employee has entered into a self-employed enterprise 
and submits sufficient supporting documentation of business plans, contacts, 
sales tax registration, and any other pertinent documentation to document all 
efforts to establish a self-employed enterprise during the filing period; or 
<ol>
<nl>(4)<ol> <nl> the injured employee was entitled to and received supplemental 
income benefits during the compensable quarter immediately preceding the current 
quarter and there is no change in condition with regard to the injured 
employee's ability to work or the number of job search efforts as performed in 
the previous filing period. <ol>
<nl>(e)<ol> <nl> Rebuttable presumption. The presumption of a good faith effort 
to obtain employment contained in subsection (d) of this section may be rebutted 
by credible evidence presented during the dispute resolution process. <ol>
<nl>(f)<ol> [(e)] Determination of continuing entitlement and amount. If the 
carrier determines that the employee continues to be entitled to supplemental 
income benefits at an amount the same or greater than that paid during the prior 
compensable quarter, the notice shall: 
(1) state the beginning and end dates of the next compensable quarter; 
(2) specify the amount of the monthly payment; and 
(3) specify the wages used to calculate the monthly payment.
<nl>(g)<ol> [(f)] Determination of non-entitlement or reduced amount. If the 
carrier determines that the employee has lost entitlement to supplemental income 
benefits, or continues to be entitled at an amount less than that paid during 
the prior compensable quarter, the notice shall:
(1) state the grounds for this determination; and 
(2) request the commission to set a benefit review conference, as provided by 
sec.130.108 of this title (relating to Contesting Entitlement or Amount of 
Supplemental Income Benefits<nl>; Attorney Fees<ol>). 
<nl>(h)<ol> [(g)] Accrual date. If the employee is entitled to supplemental 
income benefits under this section, the benefits begin to accrue on the later 
of: 
(1) the day after the last day of the prior compensable quarter; or 
(2) the date the <nl>Statement of Employment Status <ol> [statement] is filed 
with the carrier, <nl>unless the commission determines that good cause exists 
for the failure to file the statement. <ol>
<nl>(i)<ol> <nl>Good cause for failure to file statement of employment status. 
Good cause for failing to timely file the Statement of Employment Status 
includes, but is not limited to: <ol>
<nl>(1)<ol> <nl>the failure of the insurance carrier to mail the form to the 
injured employee as required by subsection (b) of this section; <ol>
<nl>(2)<ol> <nl> the failure of the commission to make the initial determination 
when the compensable quarter(s) in question are the first quarters for which the 
injured employee has applied for supplemental income benefits; or <ol>
<nl>(3)<ol> <nl> the lack of knowledge by an injured employee about the 
potential entitlement to supplemental income benefits because of a pending 
dispute regarding the date of maximum medical improvement or the impairment 
rating. <ol>
<nl>(j)<ol> <nl>Administrative violation. An insurance carrier commits an 
administrative violation under Texas Labor Code, sec.415.002(12), if the 
insurance carrier disputes continuing entitlement to supplemental income 
benefits and does not provide documentation to show that there was any change in 
condition with regard to the injured employee's ability to work or the number of 
job search efforts as performed in the previous filing period.<ol>

sec.130.105.Reinstated or Delayed Entitlement to Supplemental Income Benefits.
(a) Reinstated entitlement criteria. Except as provided by sec.130.106 of this 
title (relating to Permanent Loss of Entitlement to Supplemental Income 
Benefits), an injured employee initially determined by the commission to be 
entitled to supplemental income benefits, but who thereafter loses entitlement, 
will regain entitlement if the employee, for one filing period: 
(1) is unemployed, or underemployed as defined in sec.130.101 of this title 
(relating to Definitions), as a direct result of the impairment from the 
compensable injury; and 
(2) has made <nl>a<ol> good faith efforts to obtain employment commensurate with 
the employee's ability to work. 
<nl>(b)<ol> <nl>Presumption of non-entitlement. If the injured employee was not 
entitled to or paid supplemental income benefits during the previous compensable 
quarter and there is no change in condition with regard to the injured 
employee's ability to work or the number of job search efforts as performed in 
the previous filing period; the injured employee shall be presumed not to be 
entitled to supplemental income benefits for the subsequent quarter.<ol> 
<nl>(c)<ol> [(b)] Delayed entitlement criteria. Except as provided by 
sec.130.106 of this title (relating to Permanent Loss of Entitlement to 
Supplemental Income Benefits), an injured employee initially determined by the 
commission not to be entitled to supplemental income benefits will become 
entitled if the employee, for one filing period: 
(1) is unemployed, or underemployed as defined in sec.130.101 of this title 
(relating to Definitions), as a direct result of the impairment from the 
compensable injury; and 
(2) has made <nl>a<ol> good faith efforts to obtain employment commensurate with 
the employee's ability to work. 
<nl>(d)<ol> [(c)] Statement of employment status. An injured employee seeking 
reinstated or delayed entitlement to supplemental income benefits must send the 
carrier a Statement of Employment Status by first class mail or personal 
delivery. 
<nl>(e)<ol> [(d)] Procedure for determining reinstated or delayed entitlement 
and amount. Not later than 10 days after receiving the <nl>Statement of 
Employment Status<ol> [statement], the carrier shall determine reinstated or 
delayed entitlement to supplemental income benefits, and send written notice of 
determination to the injured employee and the commission. 
<nl>(f)<ol> [(e)] Determination of entitlement and amount. If the carrier 
determines that the employee is entitled to reinstated or delayed supplemental 
income benefits, the notice shall: 
(1) state the beginning and end dates of the compensable quarter;
(2) specify the amount of the monthly payment; 
(3) specify the wages used to calculate the monthly payment;
(4) advise the employee of the procedures for contesting the carrier's 
calculation of amount, as provided by sec.130.108 of this title (relating to 
Contesting Entitlement or Amount of Supplemental Income Benefits<nl>; Attorney 
Fees<ol>); and 
(5) enclose instructions for filing the Statement of Employment Status, a filing 
schedule, and a description of the consequences of late filing and failing to 
file. 
<nl>(g)<ol> [(f)] Determination of non-entitlement. If the carrier determines 
that the employee is not entitled to reinstated or delayed supplemental income 
benefits, the notice shall: 
(1) state the grounds for this determination; 
(2) advise the employee of the procedures for contesting the carrier's 
determination, as provided by sec.130.108 of this title (relating to Contesting 
Entitlement or Amount of Supplemental Income Benefits); and
(3) enclose a Statement of Employment Status and filing instructions for 
claiming reinstated or delayed entitlement to supplemental income benefits, as 
provided by sec.130.105 of this title (relating to Reinstated or Delayed 
Entitlement to Supplemental Income Benefits). 
<nl>(h)<ol> [(g)] Accrual date. If the employee is entitled to supplemental 
income benefits under this section, the benefits begin to accrue on the date the 
statement is filed with the carrier. 

sec.130.106.Permanent Loss of Entitlement to Supplemental Income Benefits.
(a) (No change.) 
<nl>(b)<ol> <nl> Any period of time during which the carrier was relieved of 
liability to pay supplemental income benefits under Texas Labor Code sec.408.143 
due to the injured employee's failure to timely file a Statement of Employment 
Status shall not be included in the calculation of the 12 month period if the 
injured employee has otherwise met the requirements provided by sec.130.104(a) 
of this title (relating to Continuing Entitlement to Supplemental Income 
Benefits), and sec.130.105(a) and (c) of this title (relating to Reinstated or 
Delayed Entitlement to Supplemental Income Benefits).<ol>
<nl>(c)<ol> [(b)] All injured employees permanently lose entitlement to 
supplemental income benefits at the end of the 401st week after the date of 
injury. 

sec.130.108.Contesting Entitlement or Amount of Supplemental Income Benefits; 
Attorney Fees.
(a) - (b) (No change.) 
(c) A carrier waives the right to contest continuing entitlement to amount of 
supplemental income benefits for that compensable quarter if the carrier fails 
to request a benefit review conference within 10 days after receipt of the 
employee's Statement of Employment Status. <nl> This subsection applies when the 
injured worker was entitled to and received supplemental income benefits during 
a particular quarter and the insurance carrier disputes entitlement to 
supplemental income benefits for the compensable quarter immediately following 
that quarter.<ol> 
(d) (No change.) 

sec.130.110.Commission Review of Employment Status During the Supplemental 
Income Benefit Period.
(a) The commission will review the employment status of each employee receiving 
supplemental income benefits to determine whether the unemployment, or 
underemployment as defined by sec.130.101 of this title (relating to 
Definitions) is a direct result of the impairment from the compensable injury:
(1) <nl>as determined necessary by the commission; or<ol> [at least annually 
during the supplemental income benefits period; and
(2) (No change.)
(b)-(c) (No change.) 
(d) After each review, the commission will send written notice of its 
determination <nl>of employment status<ol> to the employee and the carrier. 
<nl>If either party disputes the results of the commission review of employment 
status, the parties may file a dispute as described in sec.130.111 of this title 
(relating to Disputes Regarding Direct Result).<ol> 
(e) (No change.) 

sec.130.111.Disputes Regarding Direct Result.
(a) A dispute regarding whether or not the injured employee's unemployment or 
underemployment is a direct result of the impairment from the compensable injury 
may be raised: 
(1) within 10 days of the date the parties received the commission's 
determination regarding entitlement to supplemental income benefits for the 
initial quarter; 
(2) within 10 days of the date the parties received the results of a commission 
review of employment status; or 
(3) upon the expiration of six months after a previous dispute on direct result 
is resolved through a binding agreement or decision.
(b) Any such dispute shall be submitted to the commission in the form and manner 
prescribed by the commission. Further, any such dispute raised by an insurance 
carrier shall also contain a request for a required medical examination 
consistent with sec.126.5 and sec.126.6 of this title (relating to Procedure for 
Requesting Required Medical Examinations and Order for Required Medical 
Examinations). 
(c) Within seven days after receipt of such dispute in the field office handling 
the claim, the commission will: 
(1) notify the treating doctor pursuant to sec.126.9 of this title (relating to 
Choice of Treating Doctor and Liability for Payment) to schedule an examination 
of the injured employee; 
(2) issue the order for a required medical examination selected in accordance 
with sec.126.5 and sec.126.6 of this title (relating to Procedure for Required 
Medical Examinations and Order for Required Medical Examinations) to allow the 
insurance carrier to schedule an examination by their doctor of choice; and 
(3) direct the injured employee to be examined by a doctor selected by the 
commission pursuant to Texas Labor Code, sec. 408.004. 
(d) The treating doctor, the carrier selected required medical examination 
doctor, and the commission-selected doctor must provide appointments for the 
examinations referred to in subsection (c) of this section within 30 days from 
the date the dispute was filed with the commission field office handling the 
claim. The doctors shall send a copy of the medical report to the injured 
employee, the injured employee's representative, the insurance carrier, and the 
commission within seven days after the examination of the injured employee.
(e) The medical report shall clearly provide the doctor's medical opinion on 
whether or not the impairment from the compensable injury is a producing cause 
of the injured employee's unemployment or underemployment. If the medical report 
is not received by the commission in a timely manner, the commission shall begin 
the process under sec.102.9 of this title (relating to the Submission of 
Information Requested by the Commission) to order production of this document.
(f) The commission shall presume that the unemployment or underemployment is a 
direct result of the impairment from the compensable injury if a majority of the 
opinions contained in these medical reports conclude that the impairment is a 
producing cause of the unemployment or underemployment.
(g) Upon receipt of these reports, the commission will notify the parties of the 
majority opinion regarding the dispute on direct result.
(h) Appeal to a Benefit Contested Case Hearing: 
(1) Either party may appeal the majority medical opinion by submitting a request 
for a Benefit Contested Case Hearing with the field office handling the claim. 
(2) The request for a Benefit Contested Case Hearing must be filed within 10 
days after receipt of notice from the commission regarding the majority opinion 
on the direct result issue. 
(3) Of the three medical opinions (the treating doctor, the carrier selected 
required medical examination doctor, and the commission-selected doctor), the 
two which had the same result will create a rebuttable presumption in favor of 
those opinions. 
(4) The only medical opinions admissible at the hearing are the opinions of the 
treating doctor, the carrier selected required medical examination doctor, and 
the commission-selected doctor. 
(i) This section is applicable to all disputes regarding direct result filed 
with the commission on or after June 1, 1998. 

sec.130.112.Carrier Sponsored Vocational Case Managers.
(a) Definitions. The following terms when used in this section, shall have the 
following meanings, unless the context clearly indicates otherwise.
(1) Return to work - The employee's return to employment based on the physical 
condition of the employee and the geographic accessibility of the position to 
the employee. 
(2) Vocational assistance - Services provided by a vocational case manager to 
assist the injured employee in the identification of physical abilities, 
vocational abilities, and other activities to enhance the potential to return to 
work. 
(3) Vocational case manager - An individual who is an approved private provider 
and who is credentialed as a Certified Case manager (CCM), Certified 
Rehabilitation Counselor (CRC), Certified Vocational Evaluator (CVE), or 
Certified Disability Management Specialist (CDMS) who provides vocational 
assessments and opinions regarding an injured employee's ability to work and 
alternatives available. 
(b) The insurance carrier may provide a vocational case manager as defined in 
subsection (a) of this section to assist the injured employee to return to work. 
The insurance carrier is liable for the reasonable and necessary costs of such 
services. The insurance carrier shall not provide vocational assistance by any 
individual or company that does not meet the qualifications of this section. 
(c) The injured employee is required to cooperate with a vocational case manager 
sponsored by the insurance carrier provided that the individual qualifies as a 
vocational case manager as defined in subsection (a) of this section and the 
carrier is liable for the costs of such services. Failure of an injured employee 
to cooperate with vocational assistance may be considered in determining whether 
or not the injured employee has made a good faith effort to obtain employment 
for entitlement to supplemental income benefits. 
(d) The vocational case manager may communicate with the treating doctor without 
a signed release or authorization from the injured employee to determine any 
specific restrictions related to physical requirements including but not limited 
to tasks, posture/postures, movement patterns, endurance, and strength. 
(e) The vocational case manager may provide or coordinate, as applicable, the 
following types of services: 
(1) vocational assessment and evaluation; 
(2) vocational exploration counseling; 
(3) functional capacity assessments; 
(4) ergonomic assessments or job site visits to determine accommodations; 
(5) coordination of training programs or efforts; 
(6) self-employment plans; or 
(7) job readiness and job placement services. 
(f) Ancillary services during the vocational rehabilitation process may be 
performed by other providers but must be performed under the direct supervision 
of the assigned vocational case manager. 
(g) Prior to the initiation of vocational assistance, the vocational case 
manager shall communicate with the treating doctor regarding the condition of 
the injured employee. Prior to the initiation of vocational assistance, the 
insurance carrier shall send to the injured employee a notice regarding the 
provisions of this rule. The notice shall state: 
(1) that the insurance carrier will be providing a vocational case manager to 
assist the injured employee to return to work; 
(2) the name of the vocational case manager; 
(3) the qualifications of the vocational case manager;
(4) that the services may be provided by or coordinated by the case manager; 
(5) that the injured employee is required to cooperate with the vocational case 
manager; and 
(6) that the failure to cooperate with the vocational assistance may be 
considered in determining if the injured employee has made a good faith effort 
and should be entitled to future supplemental income benefits.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802198
Susan M. Cory
General Counsel
Texas Workers' Compensation Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 440-3972

CHAPTER 133.General Medical Provisions
SUBCHAPTER B.Required Reports
28 TAC sec.133.101
The Texas Workers' Compensation Commission (the Commission) proposes an 
amendment to sec.133.101, concerning the TWCC-61 "Initial Medical Report". The 
amendment is proposed to reduce the number of forms and amount of paper that the 
Commission receives. 
Current sec.133.101 requires the injured employee's treating doctor to complete 
an Initial Medical Report, form TWCC-61, for every occupational disease, and 
every accidental injury resulting in loss of more than one full day or more than 
one full shift from work, and submit this form to the insurance carrier, the 
Commission, and the injured employee or his/her representative within ten days 
of the injured employee's initial visit to the treating doctor. The proposed 
amendment to sec.133.101 would remove the requirement that the treating doctor 
submit the TWCC-61 form to the Commission unless it is requested. In the past, 
the TWCC-61 forms have been used by the Commission to create injury record 
files. Creating injury records from the TWCC-61 report was initiated back in 
1992 to meet certain service requirements related to mailing information packets 
to injured workers, and for employer injury occurrence information. However, 
these medical reports and the supporting rules were originally designed to 
provide data to supplement injury data previously provided by one or more of the 
primary reporters: employees, employers, and insurance carriers. As such, 
creating injury records from these medical reports is less efficient, and may 
result in conflicts with other more reliable data sources. The number of injury 
record files reflect injuries, but not necessarily injuries that require action 
or assistance from the Commission. Many of these injury record files created 
from the TWCC-61 are claims which do not result in any lost time and require 
medical services only. The Commission receives other notice forms (Employer's 
First Report, and the employee's Notice of Injury Claim) from which injury 
records can be created. These other sources have provided more reliable data 
than the TWCC-61. For instance, the doctor's TWCC-61 form often reports all 
treated work injuries, even when the employer is not covered under the workers' 
compensation system and the doctor's report is not always a true measure of 
actual time lost from work. 
The Legislature through The General Appropriations Act, 75th Legislature, 
Regular Session, Chapter 1452, sec.175, encouraged agencies to reduce the amount 
of information required to be submitted by its customers. This proposed 
amendment is a means to accomplish this legislative goal and to focus efforts on 
injuries that are more likely to require assistance. 
The Texas Registers published text shows words proposed to be added to or 
deleted from the current text, and should be read to determine all proposed 
changes. 
Janet Chamness, Chief of Budget, has determined that for the first five-year 
period the proposed rule amendment is in effect there will be no fiscal 
implications for local governments as a result of enforcing or administering the 
rule as proposed. Local government and state government as a covered regulated 
entity will be impacted in the same manner as described later in this preamble 
for persons required to comply with the rule as proposed. The Commission will 
experience an estimated reduction in costs as a result of enforcing or 
administering the rule as proposed, resulting from the reduction in forms which 
must be processed. A cost analysis performed by the Commission's Records 
division estimated that elimination of the requirement in sec.133.101 to file 
TWCC-61 forms with the Commission will result in a total annual savings of 
$88,420. An estimated total of 260,000 TWCC-61 forms are received annually by 
the Commission. Each of these forms are initially processed by the Records 
Division at an estimated cost of $.29 per form (260,000 at $.29 = $75,400). Of 
these 260,000 forms, approximately 89,000 are posted to an existing claim or 
used to create reportable (X) claims. Those created as reportable claims, 
approximately 42,000, generate an additional cost of $13,020 (42,000 at $.31 per 
form). The remaining 171,000 forms are destroyed as not meeting filing criteria. 
Under the rule amendment as proposed, these 260,000 forms will not be received 
by the Commission, and the Commission will not be creating approximately 42,000 
new reportable injury record files. 
Ms. Chamness also has determined that for each year of the first five years the 
rule as amended is in effect, the public benefit anticipated will include the 
reduction in paper work and paper handling by the Commission resulting in a 
savings to state government. Health care providers will realize an estimated 
savings of $96,200 (260,000 forms at $.37 - $.32 postage plus $.05 copying cost) 
as a result of not copying and mailing the TWCC-61 form to the Commission. 
Insurance carriers should experience no impact as a result of the proposed rule 
amendment because they will continue to receive the TWCC-61 forms as in the 
past. 
Currently, the Commission sends information to injured employees based on the 
approximate 42,000 TWCC-61 forms for which injury record files are created. The 
injured employees for which the remaining 171,000 TWCC-61 forms were filed do 
not currently receive this information upon the filing of the TWCC-61. Text 
changes to the TWCC-61 form are planned which would add information regarding 
the procedure for obtaining assistance, information regarding rights and 
responsibilities, and information regarding the claim filing process. By 
including this information on the TWCC-61 form, the information will be 
available to approximately 171,000 more injured employees, because the rule as 
proposed will still require the healthcare provider to send the TWCC-61 to the 
employee. There will be no adverse impact on injured employee's receipt of 
information because those who received the information in the past will continue 
to receive it via the revised TWCC-61 form. 
There will be no anticipated economic costs to persons who are required to 
comply with the rule as proposed because it reduces the paper work requirement 
of those affected. There will be no adverse economic impact on businesses and 
therefore no difference in the costs of compliance for small businesses as 
compared to large businesses. 
Comments on the proposal or requests for a public hearing must be submitted to 
Sue Cutler by 5:00 p.m., March 30, 1998, at the Office of the General Counsel, 
Mailstop #4-D, Texas Workers' Compensation Commission, Southfield Building, 4000 
South IH-35, Austin, Texas 78704-7491. A public hearing on this proposed 
amendment is tentatively scheduled for March 4, 1998 at the Austin office of the 
Commission. Those persons interested in attending the public hearing should 
contact the Commission's Office of Executive Communication at (512) 440-5690 to 
confirm the date, time, and location of the public hearing. 
The amendment is proposed under the Texas Labor Code, sec.402.061, which 
authorizes the Commission to adopt rules necessary to administer the Act; and 
the Texas Labor Code, sec.408.025, which requires the Commission to adopt rules 
regarding the requirements for reports and records from health care providers; 
Texas Labor Code, sec.402.042(11), which authorizes the Executive Director to 
prescribe the form, manner, and procedure for transmission of information to the 
Commission; Texas Labor Code, sec.409.005(g), which requires the employer to 
provide a summary of the employee's rights and responsibilities; Texas Labor 
Code, sec.409.003, regarding an employee's claim for compensation; and the Texas 
Labor Code, sec.409.010, regarding information from the Commission to the 
employers. 
The proposed amendment affects the following statutes: the Texas Labor Code, 
sec.402.061, which authorizes the Commission to adopt rules necessary to 
administer the Act; the Texas Labor Code, sec.408.025, which requires the 
Commission to adopt rules regarding the requirements for reports and records 
from health care providers; Texas Labor Code, sec.402.042(11), which authorizes 
the Executive Director to prescribe the form, manner, and procedure for 
transmission of information to the Commission; Texas Labor Code, sec.409.005(g), 
which requires the employer to provide a summary of the employee's rights and 
responsibilities; Texas Labor Code, sec.409.003, regarding an employee's claim 
for compensation; and the Texas Labor Code, sec.409.010, regarding information 
from the Commission to the employers. 

sec.133.101.Initial Medical Report.
(a) The treating doctor shall complete Form TWCC-61, Initial Medical Report, for 
every occupational disease, and every accidental injury resulting in loss of 
more than one full day or more than one full shift from work, and submit it to 
the carrier, [the commission,] and the injured employee or his/her 
representative within ten days of the initial visit. <nl> Upon commission 
request only, the treating doctor shall provide a copy of the Form TWCC-61 to 
the commission.<ol> 
(b)-(d) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802196
Susan M. Cory
General Counsel
Texas Workers' Compensation Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 440-3972

CHAPTER 134.Benefits-Guidelines for Medical Services, Charges, and Payments
SUBCHAPTER K.Treatment Guidelines
28 TAC sec.134.1002
The Texas Workers' Compensation Commission ("Commission") proposes an amendment 
to sec.134.1002, concerning the Upper Extremities Treatment Guideline. 
The Upper Extremities Treatment Guideline clarifies those services that are 
reasonable and medically necessary for nonoperative care of the upper 
extremities for the injured workers of Texas. The guideline is not to be used as 
a fixed treatment protocol, but rather identifies a normal course of treatment 
and reflects typical courses of intervention, while recognizing that there will 
be injured workers who will require less or more treatment than is outlined. The 
guideline also acknowledges that in atypical cases, treatment falling outside 
the guideline will occasionally be necessary. However, those cases that exceed 
the guideline level of treatment are subject to more careful scrutiny and review 
and require documentation of the special circumstances that justify the 
treatment. The guideline does not prescribe the type and frequency of treatment; 
treatment must be based on patient need and professional judgement. The rule is 
designed to function as a guideline and is not to be used as the sole reason for 
denial of treatments and services. 
The clinical and diagnostic treatment guidelines contained in the rule were 
developed in conjunction with health care providers and other parties in the 
workers' compensation system. The guideline is designed to achieve the following 
goals: (1) to assist all parties with regard to the appropriate treatment and 
management of upper extremities injuries; (2) to establish elements against 
which aspects of care can be compared; (3) to establish a guideline to identify 
clinically acceptable courses of treatment for specific disorders; (4) to 
establish documentation standards which support the appropriateness of the level 
of service; and (5) to provide a mechanism of prospective, concurrent, and 
retrospective review for efficient and effective health care utilization. The 
guideline promotes quality health care, injury specific treatment and 
appropriateness of care, by identifying clinically acceptable courses of care 
for specific upper extremities injuries, and by facilitating communication 
between all parties to achieve rapid recovery from the effects of an injury. 
Communication promotes a timely return to modified or full duty work that takes 
into account the job demands and the functional capabilities of the injured 
worker. 
The clinical and diagnostic treatment guidelines contained in this proposed 
amendment have been developed in conjunction with health care providers and 
other parties in the workers' compensation system. The Commission's Medical 
Review Division examined the TWCC medical bills database to extract the most 
frequently occurring diagnoses between April 1, 1996 to March 31, 1997. The 
result of this extract indicated that the top 200 diagnostic codes represented 
80% of all workers' compensation cases. The remaining 20% of cases were 
distributed among several hundred codes and thus were not used. Diagnostic codes 
specific to upper extremities were extracted from the top-200 list and compared 
to codes currently in the Upper Extremities Treatment Guideline to ensure that 
the UETG continues to reflect the most common upper extremities diagnoses in the 
workers' compensation system. This analysis revealed that two diagnostic codes, 
726.0 Adhesive Capsulitis and 813.42 Dupuytren's fracture, should be added to 
the UETG and that all codes currently contained in the UETG continue to occur 
with enough frequency to remain listed in the guideline. 
The Medical Review Division also contacted the Upper Extremities Treatment 
Guideline workgroup members, composed of members from the following professions: 
chiropractic, medicine, physical therapy, occupational therapy and osteopathic. 
The Upper Extremities Treatment Guideline Workgroup assisted in drafting the 
guideline in 1995. Workgroup members were asked to review the guideline, 
recommend changes, and give feedback on the guideline's use and effectiveness 
since it was adopted. The Medical Review Division also conducted focus groups 
with medical doctors and chiropractors in Austin, Dallas, and Houston to obtain 
input regarding the guideline's use, effectiveness, and to obtain 
recommendations for changes. In addition, the Medical Review Division requested 
and received input from insurance carriers. The recommendations from these 
groups were presented to the MAC where they either concurred or differed with 
the recommendations. Where the MAC concurred, the recommendations were included 
in this revision.
The Commission's Medical Review Division, in conjunction with the Commission's 
Medical Advisory Committee (MAC) and a broad representation from the medical 
community, have worked together to develop the amendments to the Upper 
Extremities Treatment Guideline. By statute, the MAC advises the division in 
developing and administering the medical policies, fee guidelines, and 
utilization guidelines established under the Texas Labor Code, sec.413.011. The 
MAC is composed of members from the following fields, appointed by the 
Commission: public health care facility, private health care facility, a doctor 
of medicine, a doctor of osteopathic medicine, a chiropractor, a dentist, a 
physical therapist, a pharmacist, a podiatrist, an occupational therapist, a 
medical equipment supplier, a registered nurse, a representative of employers, a 
representative of employees, and two representatives of the general public. 
The Texas Registers published text shows words proposed to be added to or 
deleted from the current text, and should be read to determine all proposed 
changes. 
A number of changes are proposed to make the text portion of the Upper 
Extremities Treatment Guideline consistent with the recently adopted Lower 
Extremities Treatment Guideline. Because musculoskeletal injuries of the lower 
and upper extremities are similar in the workers' compensation system and 
involve similar treatments, consistency between these two guidelines will 
minimize confusion and ensure that the guidelines are addressing similar issues 
in the same way. 
In addition, a number of changes are proposed for grammatical and form 
consistency between the Upper Extremities Treatment Guideline and the Lower 
Extremities Treatment Guideline and do not substantively alter the guideline. 
Proposed subsection (a)(1) corrects references to other subsections of the rule 
in the table of contents. 
The term "Primary Gatekeeper" has been changed to "Treating Doctor" in proposed 
subsections (a)(2), and (c) to make it consistent with the Lower Extremities 
Treatment Guideline and with terms used generally in the workers' compensation 
system. 
Proposed subsection (b)(1) removes the expiration date of July 1, 1998 and 
specifies that the guideline applies to treatments provided after the effective 
date of the rule amendment. The Commission believes that the rule is functioning 
as intended and therefore proposes to remove the expiration date previously 
included in the guideline. As with all other guidelines, a periodic review of 
this guideline would be performed to determine its continued utility. In 
addition, there is no expiration date in any other treatment guideline. Proposed 
subsections (b)(2) and (b)(3) change the Purpose and Goal statements to make 
them consistent with Lower Extremities Treatment Guideline. 
Throughout the proposed rule the term "plan of treatment" has been replaced with 
"treatment plan" for consistency with the Lower Extremities Treatment Guideline. 
In a number of places throughout the guideline terms such as "will" and "should" 
have been changed to "shall". Also passive language has been replaced with 
active tense. These changes make the Upper Extremities Treatment Guideline more 
consistent with the Lower Extremities Treatment Guideline and, also, provide 
additional clarity. In addition, these changes make the Upper Extremities 
Treatment Guideline more consistent with the Insurance Code, Article 21.58A, as 
amended by House Bill 3197, enacted by Acts, 75th Legislature, 1997. Such 
language changes were placed in proposed subsections (d)(1), (d)(2), (e)(1), 
(e)(2), (e)(3), and (e)(4). 
The term "chronic disability" in subsection (f)(2)(B) and (C) would be changed 
to "a chronic condition" because the term "disability" in the Texas Workers' 
Compensation Act refers to an inability to obtain and retain employment. The 
term "disability" was used in the guideline to refer to its more general 
definition and not the Texas Workers' Compensation Act definition. Therefore, it 
has been replaced to more accurately reflect the original intent of the 
guideline. 
Other changes to subsections (b), (c), (d), (e), and (f) are proposed for 
clarity of language, consistency with the Lower Extremities Treatment Guideline, 
and/or grammatical improvement. 
Functional capacity evaluations (FCE) have been deleted from all primary 
treatment tables to make the Upper Extremities Treatment Guideline consistent 
with the Lower Extremities Treatment Guideline. The focus groups and the MAC 
advised that these FCE's were not appropriate at the primary level of treatment 
because this evaluation is more appropriate later in the treatment of injuries. 
In the primary treatment tables under treatment interventions "medication 
modification" has been changed to "medications" and all medications are now 
listed under this heading for clarity and consistency. "Job site analysis" has 
been moved from the Treatment Intervention section to the Return to Work Issues 
section. Under the Return to Work Issues section of the primary treatment 
tables, the sentence "A mild level of severity allows return to work within 0-3 
months, with or without modified/transitional work and /or orthoses." was 
deleted as a result of focus group and MAC recommendations because this 
statement was redundant and already a part of the definitions of levels of care. 
This change also makes the Upper Extremities Treatment Guideline consistent with 
the Lower Extremities Treatment Guideline. 
Proposed changes to secondary treatment tables include the following. Under 
treatment interventions "medication modification" has been changed to 
"medications" and all medications are now listed under this heading for clarity. 
"Job site analysis" and "functional capacity evaluations" have been moved from 
the Treatment Intervention Section to Return To Work Issues Section. These 
changes were made as a result of MAC and focus group recommendations that these 
evaluations were not treatments and were more appropriately listed under the 
Return to Work Issues section. These changes provide consistency between the 
Upper Extremities Treatment Guideline and the Lower Extremities Treatment 
Guideline. An additional item, "Transitional return to work" would be added to 
Return To Work Issues as a result of MAC recommendations because Transitional 
return to work is appropriate at this level of care and to provide consistency 
with the Lower Extremities Treatment Guideline. 
Proposed changes to all tertiary treatment tables include the following. Under 
treatment interventions "medication modification" has been changed to 
"medications" and all medications are now listed under this heading for clarity. 
"Job site analysis" and "functional capacity evaluations" have been moved from 
the Treatment Intervention Section to Return To Work Issues Section. These 
changes were made as a result of MAC and focus group recommendations that these 
evaluations were not treatments and were more appropriately listed under the 
Return to Work Issues section. These changes provide consistency between the 
Upper Extremities Treatment Guideline and the Lower Extremities Treatment 
Guideline. An additional item, "Transitional return to work" would be added to 
Return To Work Issues as a result of MAC recommendations because Transitional 
return to work is appropriate at this level of care and to provide consistency 
with the Lower Extremities Treatment Guideline. Specific programs were deleted 
from "Treatment Interventions" because they fit under the general heading of 
"single or interdisciplinary program". An additional treatment intervention was 
listed, "Outpatient evaluation and therapy" as a result of MAC recommendations 
because this intervention is appropriate for this level of care and to make the 
Upper Extremities Treatment Guideline consistent with the Lower Extremities 
Treatment Guideline. 
Focus groups recommended that manipulation and acupuncture be removed as 
treatment interventions in the nonoperative treatment tables because they did 
not see these treatment interventions as reasonable and medically necessary 
normal courses of treatment for various upper extremities diagnoses. The MAC 
could not reach consensus on the focus group recommendations. A Commission 
analysis of the TWCC medical bills database for the period of April 1, 1996 
through March 31, 1997 showed that these treatments are used in certain upper 
extremities diagnoses. Manipulation and acupuncture have been included in those 
diagnosis-specific treatment tables where the TWCC database of medical bills 
showed 5.0% or more of claimants with that diagnosis received these treatments. 
The 5.0% threshold was chosen because it offers a conservative measure that 
allows for the inclusion of treatment interventions that occur frequently enough 
in the workers' compensation system to indicate, in the absence of other data or 
information, a typical course of intervention. This is the same methodology used 
in the development of the Lower Extremities Treatment Guideline. 
During the development phase of the Lower Extremities Treatment Guideline, 
health care providers in the Lower Extremities Treatment Guideline Workgroup and 
the Commission's Medical Advisory Committee reviewed the guideline and provided 
input. Neither group reached consensus on the use of manipulation and 
acupuncture as reasonable and medically necessary normal courses of treatment 
for various lower extremities diagnoses. An analysis of the TWCC medical bills 
database for the period April 1, 1996 through April 1, 1997 showed that these 
treatments are used in certain lower extremities diagnoses. The MAC Chairman 
asked MAC members to submit scientific, peer-reviewed studies to the Medical 
Review division to support the MAC members' respective positions on the use of 
manipulation and acupuncture for treatment of lower extremity diagnoses. The 
materials received by the Commission were reviewed and evaluated. The materials 
showed little evidence of peer review and were mostly single-subject case 
studies. Staff research revealed that single-subject case studies rank low as an 
accepted method for establishing the efficacy of treatment methods. Manipulation 
and acupuncture were included in the Lower Extremities Treatment Guideline in 
those diagnosis-specific treatment tables where the TWCC database of medical 
bills showed 5.0% or more of claimants with that diagnosis received these 
treatments. The 5.0% threshold was chosen because it offers a conservative 
measure that allows for the inclusion of treatment interventions that occur 
frequently enough in the workers' compensation system to indicate, in the 
absence of other data or information, a typical course of intervention. 
The diagnosis of 726.0 Adhesive Capsulitis is proposed to be added to the 
primary treatment table for Rotator Cuff: Sprain/Strain (figure 13: (f)(5)(D)). 
This diagnoses appeared in the top 200 most frequent diagnoses in the TWCC 
medical bills database. The MAC recommended this diagnosis be included in this 
group of diagnoses because this was the most appropriate section of the 
guideline to include Adhesive Capsulitis. 
A tertiary level of care treatment table is proposed to be added to the 
diagnosis of Intra-articular pathology, Traumatic Arthritis (figure 30: 
(f)(6)(O)) as a result of focus group and MAC recommendations that said this was 
confusing and inconsistent with the rest of the guideline and to make the Upper 
Extremities Treatment Guideline consistent with the Lower Extremities Treatment 
Guideline. The diagnosis of 813.42 Dupuytren's fracture, radius is proposed to 
be added to the diagnoses of Fractures (figure 22: (f)(6)(G)) as a result of 
focus group recommendations because this diagnosis presented itself frequently 
among healthcare providers in focus groups. This diagnosis also appeared in the 
top 200 most frequent diagnosis in the TWCC medical bills database. 
Sympathetic blocks are proposed to be added to the Diagnostic Procedures section 
for the primary, secondary, and tertiary treatment tables for Reflect 
Sympathetic Dystrophy (figures 40, 41, and 42: (f)(6)(Y),(Z), and (AA)) as a 
result of focus group and MAC recommendation because according to their medical 
expertise, this is an appropriate diagnostic for this diagnosis. The MAC also 
recommended that the sympathetic blocks be limited to a maximum of three when 
used as a diagnostic procedure because based on their expertise three blocks 
should be sufficient. This is noted in the proposed language. Changes to the 
Surgical Indications subsection (g) are proposed for clarification purposes and 
were recommended by the MAC. Subsection (g)(1)(A) was changed to read "six week 
trial of conservative treatment" instead of "four to eight week trial of 
conservative treatment." The M.D. Medical Advisory Committee (MAC) 
representative recommended six weeks as a more medically reasonable conservative 
frame. 
The M.D. MAC representative recommended that subsection (g)(1)(C) be deleted 
because it is duplicative since it can be included under subsection (g)(1)(A). 
This deletion was made. 
Subsection (g)(2)(A)(i) was changed from "failure to respond to non-operative 
treatment program after six to 12 months" to "failure to respond to non-
operative treatment program for six months". The M.D. MAC representative 
recommended this change because an evaluation is medically reasonable at six 
months of failure to respond to non-operative treatment program. The current 
wording could allow the non-operative treatment to continue up to 12 months. 
Subsection (g)(3)(C) was changed based on the M.D. MAC representative's 
recommendation to add "No response to six months of conservative care." because 
the need for surgery should be evaluated if a patient has not responded to six 
months of conservative care. 
Changes to the glossary, subsection (h), are proposed for clarification and to 
make the Upper Extremities Treatment Guideline consistent with the Lower 
Extremities Treatment Guideline. The addition to subsection (h)(30), the 
definition of Maximum Medical Improvement is proposed to make that definition 
consistent with the definition of that term in the Texas Labor Code, 
sec.401.011(30), following recent legislative revisions. The following terms 
were added to the glossary: acute, chronic, exacerbation. These additions were 
made as a result of focus group and MAC recommendations and the proposed 
definitions were taken from Mosby's Medical Nursing and Allied Health 
Dictionary, 3rd ed. TWCC staff evaluated definitions from Mosby's Medical 
Nursing and Allied Health Medical Dictionary, 3rd. ed., Steadman's Medical 
Dictionary, 26th ed., Dorland's Illustrated Medical Dictionary, 27th ed. and 
Taber's Cyclopedic Medical Dictionary, Edition 17. Staff concurred on using 
Mosby's definitions because the definitions described the conditions most 
accurately and Mosby's is a standard, recognized medical source. 
The Commission considered all relevant statutory and policy mandates and 
objectives and designed this rule to achieve those mandates and objectives, 
including the following: 
(1) the establishment of medical policies and guidelines relating to use of 
medical services by employees who suffer compensable injuries; 
(2) the establishment of medical policies relating to necessary treatments for 
injuries which are designed to ensure the quality of medical care and designed 
to achieve effective medical cost control; 
(3) the establishment of a program for prospective, concurrent, and 
retrospective review and resolution of a dispute regarding health care treatment 
and services; and 
(4) the establishment of a program for systematic monitoring of the necessity of 
treatments administered, for detection of practices and patterns by insurance 
carriers in unreasonably denying authorization of payment, and for increasing 
the intensity of review for compliance with medical policies or fee guidelines. 
Amended sec.134.1002 will achieve these objectives by: 
(1) identifying services that are reasonable and medically necessary for 
treatment of upper extremity injuries; 
(2) assisting all parties with regard to the appropriate treatment and 
management of disorders of the upper extremities in workers' compensation 
healthcare; 
(3) establishing a guideline against which aspects of care can be compared;
(4) identifying clinically acceptable courses of care for specific upper 
extremity injuries; 
(5) establishing documentation standards which support the appropriateness of 
the level of service for assessment/evaluation and on-going treatment;
(6) providing a mechanism for prospective, concurrent, and retrospective review 
to ensure efficient and effective health care utilization; and 
(7) establishing normal courses of treatment based on clinical indicators at 
different levels of healing. 
In accordance with the statutory objectives and Commission policy, the Upper 
Extremities Treatment Guideline seeks to balance the need for cost control and 
review with the need for access to quality medical care by establishing typical 
courses of treatment, but allowing treatment outside the set parameters with 
additional documentation of the need for the treatment. 
Quality of medical care is ensured by reliance upon input from experts and 
recognized studies in the field of upper extremities treatment, and  
establishment of normal courses of treatment and treatment parameters for 
specific upper extremity injuries. The guideline ensures access to health care 
and that quality care will be available in each individual case by its ground 
rules that allow for treatment outside the stated parameters. 
Effective medical cost control is achieved by establishing parameters for 
eligibility and termination of certain treatments, by setting documentation 
standards which support the appropriateness of the treatment; by requiring 
additional documentation for treatment falling outside the guideline's 
parameter; and by providing that treatments for upper extremities are subject to 
the Commission's separate rule requiring carrier preauthorization for certain 
treatments as a prerequisite to payment for the services. 
The guideline allows for prospective, concurrent, and retrospective review of 
treatment by: setting standards for eligibility and treatment and setting 
documentation standards. These standards are to be used by health care providers 
as a basis for prospective review of possible treatment. The guideline and the 
documentation requirements should also provide the health care provider with a 
means to justify treatments when questioned concurrently or retrospectively by 
an insurance carrier. 
The guideline and documentation also provide a starting point for carriers in 
conducting prospective, concurrent, or retrospective review of treatment. The 
Medical Review Division and the Compliance and Practices Division will use the 
guideline and documentation as a tool for prospective, concurrent, and 
retrospective review of treatment, including use in conducting audits of health 
care providers and insurance carriers, use in the establishment of a program for 
systematic monitoring of the necessity of treatments administered, and use in 
medical dispute resolution. 
The guideline also promotes quality health care, injury specific treatment and 
appropriateness of care, by facilitating communication between all parties in 
order to achieve rapid recovery from the effects of an injury. This 
communication will also promote a timely return to modified or full duty work 
that takes into account the job demands and the functional capabilities of the 
injured worker. 
The rule will promote quality health care and injury specific treatment for 
injured workers by identifying clinically acceptable courses of care for 
specific upper extremities injuries. Another benefit will be that the rule will 
provide a mechanism to monitor the necessity of treatment administered and 
establish treatment parameters, thus providing greater efficiency in the 
provision of treatment to the injured worker for upper extremity injury. The 
number of disputes regarding upper extremities treatments and preauthorization 
requests should be reduced because the guideline clarifies what is a normal 
course of treatment and reflects typical courses of intervention. In addition, 
fewer disputes should result in a reduction of costs to the workers' 
compensation system and in more timely and appropriate treatment of an injured 
worker.
Janet Chamness, Chief of Budget, has determined that for the first five-year 
period the rule is in effect there will be no fiscal implications as a result of 
enforcing or administering the amended rule. 
For the first five years the amended rule is in effect, local government as a 
regulating entity is expected to have no additional or reduced costs and no loss 
or increase in revenue because it does not regulate under this rule. Local 
government and state government as a covered entity will be impacted in the same 
manner as described later in this preamble for persons required to comply with 
the rule as proposed. State government as a regulator may realize a savings in 
costs or resources, as the number of disputes regarding upper extremities 
treatments and preauthorization requests could be reduced because the guideline 
clarifies a normal course of treatment and reflects typical courses of 
intervention. 
Ms. Chamness has also determined that for each year of the first five years the 
rule as amended is in effect the public benefit anticipated as a result of 
enforcing the rule will be the promotion of quality health care and injury 
specific treatment for injured workers by identifying clinically acceptable 
courses of care for specific upper extremities injuries. Another benefit will be 
that the rule will provide a mechanism to monitor the necessity of treatment 
administered and establish treatment parameters, and guidelines relevant to 
prospective, concurrent, and retrospective review of treatment, thus providing 
greater efficiency in the provision of upper extremities treatment to the 
injured worker. 
Additional public benefits are those previously listed in this document as the 
mandates and objectives this guideline and amendments are designed to achieve, 
and the items previously listed and described in this document as the way in 
which the Guideline and the proposed amendments achieve those objectives. 
At this time, the Commission is unable to measure the effect of the Upper 
Extremities Treatment Guideline on the number of disputes regarding upper 
extremities treatments since its adoption. However, the number of disputes 
regarding upper extremities treatments and preauthorization requests could be 
reduced because the guideline clarifies what is a normal course of treatment and 
reflects typical courses of intervention. Fewer disputes should result in more 
timely and appropriate treatment of an injured worker. Data is being collected 
which could enable the Commission in the future to evaluate the effect of this 
guideline on the number of disputes regarding upper extremities treatments. 
Persons required to comply with the rule as proposed may experience a reduction 
in costs because the number of disputes regarding upper extremities treatments 
and preauthorization requests could be reduced by clarification of what is a 
normal course of treatment and typical courses of intervention. This will in 
turn reduce costs for all participants in the workers' compensation system. 
Minimal fiscal impact to health care providers is expected as a result of the 
removal of acupuncture and manipulation from treatment tables for certain 
diagnoses because, as explained previously, less than 5.0% of the workers' 
compensation claimants with these diagnoses received these acupuncture or 
manipulation treatments and because they can be provided with proper 
documentation. There will be no difference in cost of compliance for small 
businesses compared to larger businesses because the guideline is already in 
effect. Therefore, there should be no impact in cost of compliance for small or 
large businesses. 
Comments on the proposed amendment must be received by 5:00 p.m. on March 30, 
1998, and must be submitted to Sue Cutler, Office of the General Counsel, Mail 
Stop #4D, Texas Workers' Compensation Commission, Southfield Building, 4000 
South IH-35, Austin, Texas 78704-7491. A public hearing on this proposed amended 
rule is tentatively scheduled for March 4, 1998. Those persons interested in 
attending the public hearing should contact the Commission's Office of Executive 
Communication at (512) 440-5690 to confirm the date, time, and location of the 
public hearing. 
The amendment is proposed under the Texas Labor Code, sec.402.061, which 
authorizes the commission to adopt rules necessary to administer the Act, the 
Texas Labor Code, sec.413.011, which authorizes the commission to establish by 
rule medical policies and guidelines relating to necessary treatments for 
injuries, and the Texas Labor Code, sec.413.013, which authorizes the commission 
to establish by rule a program for prospective, concurrent, and retrospective 
review and resolution of a dispute regarding health care treatments and 
services; and to establish by rule a program for the systematic monitoring of 
the necessity of treatments administered and fees charged and paid for medical 
treatments or services, including the authorization of prospective, concurrent, 
or retrospective review under the medical policies of the commission to ensure 
that the medical policies or guidelines are not exceeded. These statutory 
provisions clearly authorize the Commission to adopt a rule such as sec.134.1002 
which includes guidelines relating to necessary treatments for injuries and 
promotes resolution of disputes regarding health care treatments and services. 
This rule affects the Texas Labor Code, sec.sec.402.061, 413.011, and 413.013. 

sec.134.1002.Upper Extremities Treatment Guideline.
(a) Table of Contents. The following headings and their corresponding 
subdivisions comprise a table of contents for this section: 
(1) Introduction - subsection (b); 
(A) <nl>Effective Date - subsection (b)(1); <ol>
<nl>(B)<ol> [(A)] Purpose - subsection (b)<nl>(2)<ol>[(1)]; 
<nl>(C)<ol> [(B)] Goals - subsection (b)<nl>(3)<ol>[(2)]; 
<nl>(D)<ol> [(C)] Development Process - subsection (b)<nl>(4)<ol>[(3)]; 
<nl>(E)<ol> [(D)] Philosophy of Care - subsection(b)<nl>(5)<ol>[(4)]; 
(2) Role of the <nl>Treating Doctor<ol> [Primary Gatekeeper] - subsection (c): 
(A) (No change.) 
(B) <nl>Treating Doctor<ol>[Primary Gatekeeper] Responsibilities - subsection 
(c)(2); 
(C)-(E) (No change.) 
(3)-(8) (No change.) 
(b) Introduction. 
(1) <nl>Effective Date.<ol> This <nl>version of the<ol> guideline shall <nl>be 
effective for all medical treatments and services provided on or after the 
effective date of this guideline. Medical treatments and services provided prior 
to the effective date of this version of the guideline shall be subject to the 
version of the Upper Extremities Treatment Guideline in effect at the time the 
medical treatments and services were provided<ol> [become effective February 1, 
1996, and remain effective until July 1, 1998
(2) Purpose. The purpose of this guideline is to clarify those services that are 
reasonable and medically necessary for treatment of upper extremity injuries for 
the injured workers of Texas. [This guideline identifies a normal course of 
treatment. It is anticipated that there will] <nl>There may<ol> be injured 
workers who will require <nl>more or<ol> less treatment than <nl>is recommended 
in this guideline.<ol>[the average and other injured workers who will require 
more treatment] This is a guideline and shall not be used as the sole reason for 
[requirement or] denial of treatments and services. 
(3) Goals. The [following outlines the ]primary goals of this guideline 
<nl>are<ol>: 
(A)-(B) (No change.) 
(C) to establish a guideline to identify <nl>services that are reasonable and 
medically necessary for treatment of specific diagnoses <ol> [clinically 
acceptable courses of treatment for specific disorders (D)-(E) (No change.) 
(4)-(5) (No change.) 
(c) Role of <nl>Treating Doctor (<ol>Primary<nl> Doctor\<ol>Gatekeeper<nl>)<ol>. 
(1) (No change.) 
(2) <nl>Treating Doctor<ol> [Primary Gatekeeper] Responsibilities. 
(A)-(B) (No change.) 
(3)-(4) (No change.) 
(5) Expectation and Compliance. 
(A) All health care providers must encourage injured workers to be active 
participants in their health care treatment regimens and must communicate to the 
injured worker realistic expectations regarding the potential outcome of this 
treatment as it relates to his/her physical functioning and/or ability to return 
to work. Therefore, <nl>documenting<ol> [it is important to document] the 
injured worker's compliance with his/her treatment regimen <nl>is important<ol> 
when reporting the progress of his/her recovery.
(B) (No change.) 
(d) Application Instructions for Involved Parties - Concepts and Governing 
Principles. 
(1) Health care provider. This guideline <nl>shall<ol> [is to] be used as a tool 
by the health care provider to establish the required elements [for all 
providers] to initiate and continue treatment. If, [for example,] a 
<nl>healthcare<ol> provider's treatment deviates from <nl>this<ol> [the] 
guideline, <nl> documentation of the medical condition that specifically 
requires treatment outside the guideline parameters would be required to clearly 
delineate the need for the treatment<ol>[this would require documentation of a 
clearly delineated rationale for the need for this treatment]. 
(A) (No change.) 
(B) <nl>This guideline recognizes that a subset of injured workers<ol> [It is 
expected that a subset of injured workers] will be found to be outside the 
parameters of <nl>this guideline <ol> [these guidelines]. <nl>If a healthcare 
provider's treatment deviates from this guideline, documentation would be 
required to clearly delineate the need for the treatment.<ol> 
(C)-(E) (No change.) 
(F) This guideline recommends <nl>timely<ol> [early] return to work <nl>of 
either full or modified job duties<ol> based upon the injured worker's 
functional capacity which includes ability, clinical status, and either full or 
modified job requirements. 
(G) The health care provider is responsible for formulating a [plan of] 
treatment <nl>plan<ol> and revising the <nl>treatment <ol> plan [of treatment] 
based on response to treatment. The [plan of] treatment <nl>plan<ol> should be 
provided to the insurance carrier as early as possible. 
(2) Insurance Carriers. The insurance carrier <nl> shall<ol> [should] use this 
guideline to compare treatment prospectively, concurrently and retrospectively 
with the predetermined elements contained in the guides. 
(A) This document and its parameters serve only as a guideline and <nl>shall<ol> 
[are] not [to] be used as the sole reason for denial or requirement of 
treatments and services. 
(B)-(C) (No change.) 
(D) This guideline <nl>shall<ol> [is] not [to] be used to direct care toward a 
specific health care discipline or to a specific type of treatment. <nl>The<ol> 
[It is the responsibility of the] insurance carrier <nl>is responsible for 
providing<ol> [to provide] their specific documentation and rationale if 
treatment is denied. This rationale may include elements of the guideline. 
Additional information regarding the rationale for denial of treatment may also 
be derived from the injured worker's medical records and from the professional 
opinion of a peer review, if utilized. 
(E) <nl>A subset<ol> [It is expected that a subset] of injured workers will be 
found to be outside the parameters of this guideline. <nl>If a healthcare 
provider's treatment deviates from this guideline, documentation would be 
required to clearly delineate the need for the treatment.<ol> 
(F) The insurance carrier is responsible for performing a focus review of 
injury. This focus review <nl>shall<ol> [will] primarily consist of case 
management. The focus review must clarify and attempt to reach agreement that 
the proposed treatment is appropriate as early as possible. Concurrent case 
management and bill review activities should address and focus on [adherence to 
treatment plans, clinical progress, return to work issues, medical necessity and 
the following]: 
<nl>(i)<ol> <nl>adherence to treatment plans<ol>; 
<nl>(ii)<ol> <nl>clinical progress; <ol>
<nl>(iii)<ol> <nl> return to work issues; <ol>
<nl>(iv)<ol> <nl>medical necessity; <ol>
<nl>(v)<ol> [(i) Injured] <nl>injured<ol> worker compliance with the treatment;
<nl>(vi)<ol> [(ii) Services] <nl>services<ol> provided consistent with treatment 
plan;
<nl>(vii)<ol> [(iii) Response] <nl>response<ol> to treatment; 
<nl>(viii)<ol> [(iv) Improvement] <nl>improvement<ol> in injured workers' 
progress;
<nl>(ix)<ol> [(v) Recommendations] <nl>recommendations<ol> for changes in 
treatment in situations where there is no compliance, plateau, and/or there is 
minimal or no progress; <nl> and <ol>
<nl>(x)<ol> [(vi) Achievement] <nl>achievement<ol> of goals, improvement sooner 
than treatment plan indicated.
(3) Medical Review Division. The Medical Review Division <nl>shall<ol> [will] 
use the guideline as a tool for the basis of their administrative review of 
prospective, concurrent and retrospective treatment. <nl>This guideline 
shall<ol> [It will] also be used as a tool in conducting on-site <nl>and 
desk<ol> audits for both health care providers and insurance carriers. 
(4) Consulting or Peer Review Health Care Provider. This guideline <nl>shall<ol> 
[should] be used as a reference <nl> in<ol> [when] advising the Medical Review 
Division and <nl> to determine<ol> when the need for an unbiased medical opinion 
is indicated. The peer reviewer should use his/her clinical expertise in 
conjunction with the clinical intent of the guideline to address issues. 
(5) Injured Worker. <nl>The<ol> [It is essential that the] injured worker 
<nl>must understand his or her <ol> [understands his/her] role in complying with 
recommended treatment. The recovery [and return to work] process requires active 
cooperation of the injured worker. <nl> The health care provider is responsible 
for educating the injured worker about health care treatment appropriate to the 
workers' compensation injury. (as stated in paragraph (1)(E) of this 
subsection).<ol> 
(6) Employer.<nl> The employer shall be responsible for reporting<ol> [It is the 
responsibility of the employer to report] the compensable injury in a timely 
fashion to ensure that there is no delay in the treatment of the compensable 
injury. <nl>The employer should, when appropriate, be responsible for working 
with<ol> [It is also the responsibility of the employer to work with] the 
insurance carrier and health care providers to ensure that the injured worker is 
afforded the opportunity to return to work in either a modified or full 
employment capacity as rapidly as possible within the medical limitations of 
<nl>his or her<ol> [his/her] injury. 
(e) Ground Rules. 
(1) Introduction. <nl>Texas Workers' Compensation Commission treatment<ol> [The] 
guidelines are not to be used as fixed treatment protocols. The guidelines 
reflect <nl> services that are reasonable and medically necessary for treatment 
of upper extremity injuries. The guidelines recognize that a subset of injured 
workers will be found to be outside the guidelines' parameters.<ol>[typical 
courses of intervention. It is acknowledged that, in atypical cases, treatment 
may fall outside these guidelines.] However, [those] cases <nl>exceeding<ol> 
[that exceed] the guidelines' level of treatment <nl>shall<ol>[will] be subject 
to more careful scrutiny and review and <nl>shall<ol> [will] require 
documentation of the special circumstances justifying that treatment. The 
guidelines should not be seen as prescribing the type, frequency, or duration of 
treatment. Treatment must be based on <nl>the<ol> injured worker's need and the 
doctor's professional judgment. 
(2) Ground Rules. 
(A) Notwithstanding any other provision of this rule, treatment of a work 
related injury must be: 
(i)-(iv) (No change.) 
(v) consistent with this guideline <nl>which may include providing<ol> [or 
contain] a documented clinical rationale for deviation from this guideline; 
(vi) objectively measured and demonstrate functional gains; and 
(vii) consistent in demonstrating ongoing progress in the recovery process by 
appropriate re-evaluation of the treatment. 
(B) Communication between all health care providers involved in treating the 
injured worker must ensure that all previous treatment and diagnostic tests are 
considered when developing a [plan of] treatment <nl> plan<ol>. All reports and 
records <nl>shall<ol> [should] be made available to all health care providers to 
prevent unnecessary duplication of tests and examinations. (<nl>Refer to<ol>[As 
provided in] subsection (c)(2), (3) and (4) of this section.) 
(C) Patient education is an essential component in ensuring patient compliance 
to all treatment. Education is essential for the active cooperation of the 
patient in all aspects of health care and as a means to prevent re-injury. 
<nl>The<ol> [It is essential that the] patient <nl> must<ol> understand <nl>his 
or her<ol> [his/her] role in the recovery and return to work <nl>processes<ol> 
[process]. <nl> The health care provider is responsible for educating the 
injured worker about health care treatment appropriate to the workers' 
compensation injury. (as stated in subsection (d)(1)(E) of this section).<ol> 
(D) All parties in the workers' compensation system should work together to 
ensure that the injured worker returns to work at the earliest medically 
appropriate time. Return-to-work is an important therapeutic approach which 
benefits the injured worker. The health care provider <nl>shall<ol> [should] 
communicate with the injured worker, employer and the insurance carrier to 
coordinate a successful return to work. 
(E) The level of service <nl>shall<ol> [should] be the same as the health care 
provider's usual and customary level of service regardless of the payor system. 
(F) (No change.) 
(G) All health care providers <nl>treating<ol> [providing services to] an 
injured worker <nl>are responsible for substantiating <ol> [have the 
responsibility to substantiate] in their documentation the level of service for 
which they request reimbursement. All payors have the responsibility to review 
all documentation submitted as the basis for the treatment and services 
provided. 
(H) Treatment durations are cumulative; [however] it <nl>may<ol> [should] not 
always be necessary to use full durations for any given level of care. 
(I) Any new treatment must meet acceptable standards of care <nl> (as defined in 
the Glossary - subsection (h) of this section)<ol> and may be subject to review 
by Texas Workers' Compensation Commission. 
(J) Preauthorization of any treatments or services <nl>shall <ol> [will] be as 
required in the Commission's preauthorization rule. 
(K) When the injured worker displays signs and symptoms which may require 
further evaluation by a Qualified Mental Health Provider, refer to 
<nl>sec.134.1000 of this title (relating to<ol> the Mental Health Treatment 
Guideline<nl>)<ol> for parameters regarding documentation, evaluation and 
treatment. 
<nl>(L)<ol> <nl>When an injured worker must travel in order to obtain 
appropriate and necessary medical care for a compensable injury, reimbursement 
for travel expenses is governed by sec.134.6 of this title (relating to Travel 
Expenses). <ol>
(3) General Documentation Requirements. 
(A) The health care provider's documentation is vital as an information source 
of the injured worker's injury and treatment, <nl>and <ol> [it] also provides 
information which impacts income benefits. For these reasons, many of the 
Commission's rules have set time requirements for submission of required 
reports. <nl>For more information, refer to Chapter 133 Subchapter B of this 
title, (relating to Required Reports).<ol>[For example, the TWCC 61 could be the 
first report submitted which informs the insurance carrier of the injury, and 
the TWCC 69 provides the determination of MMI and an impairment rating which may 
result in a change in income benefits.
(B) Documentation <nl>shall<ol> [should] be provided by the health care provider 
to determine the level of care to be provided and the necessity for that care. 
The elements of the documentation may include: 
(i)-(ii) (No change.) 
(iii) a [plan of] treatment <nl>plan,<ol> including proposed methods of 
treatment, expected outcomes, and probable duration of treatment; 
(iv) updates to the [plan of] treatment <nl>plan <ol> as needed, including the 
clinical progress of the injured worker, and any revisions needed to the [plan 
of] treatment <nl>plan based on <ol> [in light of] the injured worker's response 
to treatment;
(v) education/information provided to the injured worker regarding his <nl>or 
her<ol> injury and [plan of] treatment <nl>plan <ol>, and the injured worker's 
compliance with this [plan of] treatment <nl>plan<ol>; and 
(vi) (No change.) 
(C) Permanent impairment for compensable injuries in workers' compensation 
<nl>shall<ol> [should] be limited to those injuries and illnesses for which 
doctors are able to demonstrate objective findings.
(D) The need for emergency treatment must be based on the doctor's professional 
judgment. This documentation must provide a clear explanation of the nature of 
the emergency, the injured worker's medical condition, complications which could 
occur, as well as any irreversible conditions which occurred or could occur, as 
a result of <nl>the emergency<ol> [this event].
(4) Documentation Requirements for Unrelated or Intercurrent Illness. Situations 
may arise where certain medical conditions need to be delineated or clarified 
prior to intervention. Treatment administered to other body areas (not a part of 
the original injury) or for a pre-existing medical condition(s) must be 
identified and the relation of this treatment to the compensable injury <nl>must 
be<ol> documented by the health care provider. If [it appears that] this 
treatment <nl>appears<ol> [is] not <nl>to be<ol> related to the compensable 
injury, <nl> then the<ol>[the injured worker should be informed by the] health 
care provider <nl>should inform the injured worker<ol> that this treatment may 
not be covered by the insurance carrier. <nl>The health care provider should 
clearly document the rationale for such treatment and its relation to the 
compensable injury<ol> [The rationale for such treatment and its relation to the 
compensable injury should also be clearly documented for the insurance carrier 
by the health care provider]. 
(f) Nonoperative Treatment Tables. <nl> (Refer to subsection (g) of this section 
for Surgical Indications). <ol> 
(1) Introduction to Nonoperative Treatment Tables. The treatments, set out in 
the following tables, represent <nl>treatment that is reasonable and medically 
necessary<ol> [typical appropriate treatment] for a given period of time 
according to the diagnosis(es). The "Treatment Interventions" sections and 
"Diagnostic Procedures" sections of the Treatment Tables are in alphabetical 
order and do not infer numerical sequence. <nl>There<ol> [It is anticipated that 
there] will be some injured workers who [will] require less treatment, and other 
injured workers who [will] require more treatment than is outlined. This 
document serves as a guideline and should not be used as the sole reason for 
denial or requirement of treatment. The provision of specific services to an 
injured worker is dependent on the injured worker's diagnosis, and response to 
treatment. 
(2) Definition of Levels of Care. 
(A) Primary <nl>Level<ol> [level] of <nl>Care <ol> [care]. This level of care is 
generally considered to be appropriate for injured workers immediately following 
the compensable injury; however, the injured worker in this level of care may 
also be an early postoperative patient or may be experiencing an acute 
exacerbation of <nl>his or her<ol> [his/her] chronic <nl>condition<ol> [pain]. 
Since partial or total cessation of work over a brief period of time [(i.e., two 
to three days maximum)] is also considered to be part of the primary level of 
care, further treatment by a health care provider may not be considered 
necessary at this level of care. Little or no deconditioning has occurred due to 
the injury, immobilization or decreased activity. The goals are <nl> to prevent 
<ol> [the prevention of] disease, <nl>alleviate<ol> [alleviating] or 
<nl>minimize<ol> [minimizing] the effects of the illness or injury and to 
maintain function[, thereby reducing lost time and enabling return to work in 
some capacity]. 
(B) Secondary <nl>Level<ol> [level] of <nl> Care<ol> [care]. This level of care 
is [the first stage of rehabilitation] for those injured workers who have not 
returned to productivity <nl>after<ol> [through] the normal healing process. 
<nl> This level of care<ol> [It] is designed to facilitate return to 
productivity, including return to work in either full or modified duty, before 
the onset of <nl>a<ol> chronic <nl>condition<ol> [disability]. This level of 
care may also be indicated for the injured worker whose physical capacity to 
work still does not meet the job requirements for heavy physical labor after 
adequate treatment, thereby causing an inability to return to full duty. It is 
individualized, time limited and of limited intensity. The injured worker has a 
history of a limited-to-good response to early primary treatment with persistent 
symptoms limiting activities of daily living. The objective physical examination 
demonstrates findings suggestive of early deconditioning including loss of range 
of motion and/or strength with limitation of activities of daily living. 
Evidence of mental health or psychosocial barriers may be present which impede 
the injured worker's clinical progress. 
(C) Tertiary <nl>Level<ol> [level] of <nl> Care<ol> [care]. This level of care 
is interdisciplinary, individualized, coordinated, and intensive<nl>.<ol> [,] 
<nl>It is<ol> designed for the injured worker who demonstrates physical and 
psychological changes consistent with <nl>a<ol> chronic <nl>condition<ol> 
[disability]. In general, differentiation from secondary treatment includes 
medical direction, intensity of services, severity of injury, individualized 
programmatic protocols with integration of physician, mental health, and 
disability or pain management services and specificity of physical/psychosocial 
assessment. <nl> This level includes<ol> [There is] a documented history of 
persistent failure to respond to nonoperative or operative treatment which 
surpasses the usual healing period for that injury. Psychosocial issues such as 
substance abuse, affective disorders, and other psychological disorders may be 
present. <nl> This level of care is indicated by<ol> [There is] a documented 
inhibition of physical functioning evidenced by pain sensitivity, loss of 
sensation, and nonorganic signs such as fear which produce a physical inhibition 
or limited response to reactivation treatment. This level of care may also be 
indicated for the injured worker whose physical capacity to work still does not 
meet the job requirements for heavy physical labor after adequate treatment, 
thereby causing an inability to return to full duty. This situation would be 
evidenced by an excessive transitional period of light duty or significant 
episodes of lost work time due to the need for continued medical treatment. This 
level of care is also indicated for those injured workers who cannot tolerate 
either primary or secondary levels of care. 
(D) Criteria to <nl>Distinguish Between Secondary<ol> [distinguish between 
secondary] and <nl>Tertiary Level<ol> [tertiary level] of <nl>Care<ol> [care]. 
Many factors may determine the choice between secondary and tertiary levels of 
care. In general, if lower cost secondary treatment can be effective, this level 
of care is preferred over the more expensive tertiary care. However, if the 
documented condition of the injured worker [is] <nl>indicates<ol> [indicative 
of] the need for more intensive treatment, the tertiary level of care may be 
more appropriate. Key factors in determining the need for secondary versus 
tertiary care include: 
(i) (No change.) 
(ii) the presence of psychosocial barriers to recovery such as <nl> but not 
limited to<ol> depression, substance abuse, personality disorder, etc., and the 
severity of these barriers; 
(iii)-(v) (No change.) 
(3) Hand and Wrist Treatment Tables. 
(A) Figure 1: 28 TAC sec.134.1002 (f)(3)(A). 
(B) Figure 2: 28 TAC sec.134.1002 (f)(3)(B). 
(C) Figure 3: 28 TAC sec.134.1002 (f)(3)(C). 
(4) Elbow Treatment Tables. 
(A) Figure 4: 28 TAC sec.134.1002 (f)(4)(A). 
(B) Figure 5: 28 TAC sec.134.1002 (f)(4)(B). 
(C) Figure 6: 28 TAC sec.134.1002 (f)(4)(C). 
(D) Figure 7: 28 TAC sec.134.1002 (f)(4)(D). 
(E) Figure 8: 28 TAC sec.134.1002 (f)(4)(E). 
(F) Figure 9: 28 TAC sec.134.1002 (f)(4)(F). 
(5) Shoulder Treatment Tables. 
(A) Figure 10: 28 TAC sec.134.1002 (f)(5)(A). 
(B) Figure 11: 28 TAC sec.134.1002 (f)(5)(B). 
(C) Figure 12: 28 TAC sec.134.1002 (f)(5)(C). 
(D) Figure 13: 28 TAC sec.134.1002 (f)(5)(D). 
(E) Figure 14: 28 TAC sec.134.1002 (f)(5)(E). 
(F) Figure 15: 28 TAC sec.134.1002 (f)(5)(F). 
(6) Upper Extremities Tables. 
(A) Figure 16: 28 TAC sec.134.1002 (f)(6)(A). 
(B) Figure 17: 28 TAC sec.134.1002 (f)(6)(B). 
(C) Figure 18: 28 TAC sec. 134.1002 (f)(6)(C). 
(D) Figure 19: 28 TAC sec. 134.1002 (f)(6)(D). 
(E) Figure 20: 28 TAC sec. 134.1002 (f)(6)(E). 
(F) Figure 21: 28 TAC sec. 134.1002 (f)(6)(F). 
(G) Figure 22: 28 TAC sec. 134.1002 (f)(6)(G). 
(H) Figure 23: 28 TAC sec. 134.1002 (f)(6)(H). 
(I) Figure 24: 28 TAC sec. 134.1002 (f)(6)(I). 
(J) Figure 25: 28 TAC sec. 134.1002 (f)(6)(J). 
(K) Figure 26: 28 TAC sec. 134.1002 (f)(6)(K). 
(L) Figure 27: 28 TAC sec. 134.1002 (f)(6)(L). 
(M) Figure 28 : 28 TAC sec. 134.1002 (f)(6)(M). 
(N) <nl>Figure 29<ol>: 28 TAC sec.134.1002 (f)(6)<nl> (N)<ol>[(M)]. 
(O) Figure <nl>30<ol>[29]: 28 TAC sec. 134.1002 (f)(6)<nl>(O)<ol>[(N)]. 
(P) <nl>Figure 31<ol>[Figure 30]: 28 TAC sec. 134.1002 (f)(6)<nl>(P)<ol>[(N)]. 
(Q) Figure <nl>32<ol>[31]: 28 TAC sec. 134.1002 (f)(6)<nl>(Q)<ol>[(N)]. 
(R) Figure <nl>33<ol>[32]: 28 TAC sec. 134.1002 (f)(6)<nl>(R)<ol>[(O)]. 
(S) Figure <nl>34<ol>[33]: 28 TAC sec. 134.1002 (f)(6)<nl>(S)<ol>[(P)]. 
(T) Figure <nl>35<ol> [34]: 28 TAC sec. 134.1002 (f)(6)<nl>(T)<ol>[(P)]. 
(U) Figure <nl>36<ol> [35]: 28 TAC sec. 134.1002 (f)(6)<nl>(U)<ol>[(Q)]. 
(V) Figure <nl>37<ol> [36]: 28 TAC sec. 134.1002 (f)(6)<nl>(V)<ol>[(R)]. 
(W) Figure <nl>38<ol>[37]: 28 TAC sec. 134.1002 (f)(6)<nl>(W)<ol>[(S)]. 
(X) Figure <nl>39<ol>[38]: 28 TAC sec. 134.1002 (f)(6)<nl>(X)<ol>[(T)]. 
(Y) Figure <nl>40<ol>[39]: 28 TAC sec. 134.1002 (f)(6)<nl>(Y)<ol>[(U)]. 
(Z) Figure <nl>41<ol>[40]: 28 TAC sec. 134.1002 (f)(6)<nl>(Z)<ol>[(V)].
<nl>(AA) <ol> <nl>Figure 42<ol>[41]: 28 TAC sec.134.1002 (f)(6) 
<nl>(AA)<ol>[(W)].
<nl>(BB) <ol> <nl>Figure 43<ol>[42]: 28 TAC sec.134.1002 (f)(6) 
<nl>(BB)<ol>[(X)]. 
<nl>(CC)<ol> <nl> Figure 44<ol>[43]: 28 TAC sec.134.1002 (f)(6) 
<nl>(CC)<ol>[(Y)]. 
<nl>(DD)<ol> <nl> Figure 45<ol>[44]: 28 TAC sec.134.1002 (f)(6) 
<nl>(DD)<ol>[(Z)]. 
(g) Surgical Indications. Indications for surgery include but are not limited to 
the following list. 
(1) Hand and Wrist. <nl>Indications for surgery in<ol> Tendinitis/Stenosing 
Tenosynovitis/Musculotendinitis/Musculotendinous Problems[. Indications for 
surgery] include, but are not limited to: 
(A) unresponsive to at least a <nl>six<ol> [four to eight] week trial of 
conservative treatment; 
(B) tendon is locked in position<nl>.<ol>[; and/or
[(C) severe pain is present in the finger, thumb or wrist which is unresponsive 
to conservative therapy.] 
(2) Elbow. 
(A) <nl>Indications for surgery in <ol>Musculotendinitis/Tendinitis (Lateral 
Epicondylitis, Medial Epicondylitis, Musculotendinous and Periarticular Problems 
of the Elbow). [Indications for surgery] include, but are not limited to: 
(i) failure to respond to non-operative treatment program <nl> for<ol> [after] 
six [to 12] months; 
(ii)-(iii) (No change.) 
(iv) early surgical intervention (before six months), [which] may be considered 
if the patient is severely disabled.
(B) <nl>Indications for surgery in <ol>Olecranon Bursitis[. Indications for 
surgery] include, but are not limited to: 
(i) infection is present; <nl>or<ol>[and/or]
(ii) bursitis is recurrent despite aspiration. 
(3) Shoulder. <nl>Indications for surgery in<ol>Rotator Cuff (Sprain/Strain, 
Tear, Shoulder Impingement Syndrome)[. Indications for surgery] include, but are 
not limited to: 
(A) confirmed tear <nl>on Magnetic Resonance Imaging (MRI) <ol>[unresponsive to 
physical medicine; and/or] 
(B) profound weakness<nl>;<ol>[.] 
<nl>(C)<ol> <nl> No response to six months of conservative care. <ol>
(4) Upper Extremities. 
(A) Neuropathy. 
(i) (No change.) 
(ii) General Indications[. Indications] for surgery include, but are not limited 
to EMG/NC studies indicative of <nl>compressive <ol> neuropathy accompanying 
positive physical findings and symptoms that are persistent despite conservative 
management. 
(B) Muscle/Ligament/Capsular Injuries (Acute/Chronic). 
(i) Indications for Surgery in Ulnar Collateral Ligament Injury of the Thumb 
(Sprain/Tear)[. Indications for surgery] include, but are not limited to: 
(I) any displaced or avulsed fracture <nl>of joint<ol> with ligament attachment; 
(II)-(III) (No change.) 
(IV) open <nl>joint injury;<ol>[ wound; and/or]
(V) [open] contaminated wound. 
(ii) Indications for Surgery in DeQuervain's Stenosing Tenosynovitis[. 
Indications for surgery] include, but are not limited to: 
(I) [no response or] incomplete response to nonoperative treatment after six [to 
12] weeks of treatment; [and/or]
(II) presence of a condition which is not amenable to nonsurgical treatment 
(e.g., separate abductor pollicis longus and extensor pollicis brevis tendon 
compartments). 
(iii) General Indications[. Indications] for surgery include, but are not 
limited to: 
(I) joint instability; 
(II) joint malalignment; [and/or] 
(III) pain impairing the functional use of the joint; 
(C) Fractures. 
(i) Indications for Surgery in Clavicle Fracture[. Indications for surgery] 
include, but are not limited to<nl>:<ol> 
<nl>(I)<ol> displaced fractures <nl>or<ol>[.]
<nl>(II)<ol> <nl>open fractures. <ol>
(ii) Indications for Surgery in Fracture Surgical Neck, Humerus[. Indications 
for surgery] include, but are not limited to: 
(I) displaced or angulated fracture [that needs closed] reduction; 
(II) <nl>joint involvement;<ol>[displaced or angulated fracture needing open 
reduction and internal fixation of the fragments; and/or
(III) associated neurologic or vascular injury present<nl>;<ol>[.] 
<nl>(IV)<ol> <nl>open fracture. <ol>
(iii) Indications for Surgery in Distal Radius Fracture[. Indications for 
surgery] include, but are not limited to: 
(I) displaced fracture [requiring reduction and immobilization
(II) <nl>intra-articular fracture<ol>[comminuted displaced fracture requiring 
reduction and fixation]; 
(III) open fracture; [and/or] 
(IV) acute carpal tunnel syndrome; 
(V) associated complex soft-tissue injury (consideration of compartment 
syndrome)<nl>.<ol>[; and/or 
[(VI) failure of outpatient treatment.]
(iv) General Indications[. Indications] for surgery include, but are not limited 
to: 
(I) displaced fracture [requiring reduction and immobilization
(II) <nl>intra-articular fracture<ol>[comminuted displaced fracture requiring 
reduction and fixation]; 
(III) open fracture; [and/or] 
(IV) nonunion of [the] fracture. 
(D) Avascular Necrosis. 
(E) Intraarticular Pathology (Traumatic Arthritis). Indications for surgery 
include, but are not limited to: 
(i) persistent synovitis; 
(ii) locking of the joint; [and/or] 
(iii) painful [traumatic] arthritis documented radiologically<nl>, 
uncontrollable with NSAID<ol>. 
(F) Joint Instability. Indications for surgery include, but are not limited to 
repeated episodes of instability despite conservative therapy.
(G) Lacerations (Tendons, Nerves). Indications for surgery include, but are not 
limited to: 
(i) <nl>loss of function;<ol>[open wound; and/or]
(ii) [open] contaminated wound. 
(H) Crush Injuries<nl>Indications for surgery include, but are not limited 
to:<ol>[.] 
<nl>(i)<ol> <nl>open fracture(s); <ol>
<nl>(ii)<ol> <nl>nail bed disruption: <ol>
<nl>(iii)<ol> <nl>malalignment of fragments. <ol>
(h) Glossary. 
(1) (No change.) 
(2) Active care vs. passive care. 
(A) Active care - modes of treatment or care requiring that the injured worker 
participate in the level of care received. 
(B) Passive care - modes of treatment or care which do not require the injured 
worker to participate in his <nl>or<ol>[/] her care; i.e., the care is "done to" 
or "applied to" the injured worker (e.g., hot packs or cold packs) 
<nl>(3)<ol> <nl>Acute - beginning abruptly with marked intensity or sharpness 
then subsiding after a relatively short period of time.<ol> 
<nl>(4)<ol> [(3)] Algorithm - a step-by-step procedural pathway for solving a 
problem or accomplishing some end. 
<nl>(5)<ol> [(4)] Assessment/Evaluation - the act or process of inspecting or 
testing for evidence of injury, disease or abnormality. 
<nl>(6)<ol> <nl>Chronic - developing slowly and persisting for a long period of 
time, often for the remainder of the lifetime of the individual. <ol>
<nl>(7)<ol> [(5)] Chronic pain management - a program which provides 
coordinated, goal-oriented, interdisciplinary team services to reduce pain, 
improve functioning, and decrease the dependence on the health care system of 
persons with chronic pain syndrome. 
<nl>(8)<ol> [(6)] Clinical plateau - a period of time of relative stability in 
which the injured worker displays minimal or minor changes in his/her condition. 
<nl>(9)<ol> [(7)] Clinical progress <nl> versus<ol>[vs.] lack of clinical 
progress. 
(A) Clinical progress--documented improvement in the condition of the injured 
worker, in response to the injured worker's current treatment program. 
(B) Lack of clinical progress--documented absence of change in the condition of 
the injured worker over a period of time of no less than one month, requiring 
re-evaluation of the injured worker's condition and re-evaluation of the current 
treatment program. 
<nl>(10)<ol> [(8)] Consulting doctor - a doctor who provides an opinion or 
advice regarding the evaluation and/or management of a specific problem, as 
requested by the treating doctor, the Commission, or the insurance carrier. A 
consulting doctor may only initiate diagnostic and/or therapeutic services with 
approval from the treating doctor <nl> (see the definition of "referral doctor" 
in paragraph (39) of this subsection <ol>. 
<nl>(11)<ol> [(9)] Decompensation - the inability of the body to maintain 
adequate functioning in the presence of an injured, abnormal, or nonfunctioning 
body system 
<nl>(12)<ol> [(10)] Denial parameters - a set of established elements or 
boundaries beyond which testing or treatment may be denied. 
<nl>(13)<ol> [(11)] Diagnosis - the art or act of identifying a disease or 
injury from evaluation of its signs and symptoms. 
<nl>(14)<ol> [(12)] Diagnostic module - a standard which establishes normal 
parameters or boundaries of time within which to perform studies to assist in 
identifying a disease, injury, or abnormality.
<nl>(15)<ol> [(13)] Diagnostic tests - objective studies performed to assist in 
identifying a disease, injury, or abnormality.
<nl>(16)<ol> [(14)] Doctor - a doctor of medicine, osteopathic medicine, 
optometry, dentistry, podiatry, or chiropractic who is licensed and authorized 
to practice. 
<nl>(17)<ol> <nl>Exacerbation - an increase in the seriousness of a disease or 
disorder as marked by greater intensity in the signs or symptoms of the patient 
being treated. <ol>
<nl>(18)<ol> [(15)] Examination - the act or process of inspecting or testing 
for evidence of disease, injury, or abnormality.
<nl>(19)<ol> [(16)] First doctor.
(A) First--preceding all others in time. 
(B) First doctor--the initial doctor who evaluates and treats the injured 
worker, and who may or may not ultimately become the treating doctor. 
<nl>(20)<ol> [(17)] Focus review - to critically examine the prospective, 
concurrent, and retrospective care received by the injured worker as related to 
the compensable injury. 
<nl>(21)<ol> [(18) Frequency of intervention.
[(A) Intervention - the process of interfering with a condition to modify or 
change its course. ]
[(B)] Frequency of intervention - the number of occurrences in a specified time 
in which the health care provider acts to treat the injured worker. 
<nl>(22)<ol> [(19)] Functional capacity evaluation - a battery of tests 
administered and evaluated to determine the injured worker's ability to perform 
tasks related to both his <nl>or her <ol> daily activities and his <nl>or 
her<ol> job performance. This evaluation consists of the following elements: 
(A) a physical examination and neurological evaluation which includes an 
assessment of the physical appearance of the injured worker, flexibility of the 
extremity joint or spinal region, posture and deformities, vascular integrity, 
the presence or absence of sensory deficit, muscle strength and reflex symmetry; 
(B) a physical capacity evaluation which includes quantitative measurements of 
range of motion and muscular strength and endurance; and
(C) a dynamic functional abilities test which includes activities of daily 
living, hand function tests, cardiovascular endurance tests, and static 
positional tolerance. 
<nl>(23)<ol> [(20)] Health care facility - a hospital, emergency clinic, 
outpatient clinic, or other facility providing health care. 
<nl>(24)<ol> [(21)] Health care practitioner <nl> -<ol> [. A health care 
practitioner is:] 
(A) an individual who is licensed to provide or render and provides or renders 
health care; or 
(B) a <nl>non-licensed<ol>[nonlicensed] individual who provides or renders 
health care under the direction or supervision of a doctor. 
<nl>(25)<ol> [(22)] Health care provider - a health care facility or health care 
practitioner. 
<nl>(26)<ol> [(23)] Impairment - any anatomic or functional abnormality or loss 
existing after maximum medical improvement that results from a compensable 
injury and is reasonably presumed to be permanent.
<nl>(27)<ol> [(24)] Interdisciplinary programs - programs in which the delivery 
of services is provided by more than one type of health care service (e.g., 
occupational therapy, physical therapy, counseling services, medical services) 
and in which there is a coordination between the disciplines regarding the care 
plan and the delivery of care to the injured worker. <nl>This<ol>[Examples of 
this] type of program <nl> includes<ol>[include] work hardening, outpatient 
medical rehabilitation[,] and chronic pain management. 
<nl>(28)<ol> [(25)] Intervention - the act or fact of interfering with a 
condition to modify it or with a process to change its course. 
<nl>(29)<ol> [(26)] Level of service - refers to primary, secondary, or tertiary 
care. 
<nl>(30)<ol> [(27)] Maximum Medical Improvement (MMI) - the earlier of the 
following <nl>three<ol>[two] items:
(A) the earliest date after which, based on reasonable medical probability, 
further material recovery from or lasting improvement to an injury can no longer 
reasonably be anticipated; or 
(B) the expiration of 104 weeks from the date on which income benefits begin to 
accrue<nl>;or<ol>[.] 
<nl>(C)<ol> <nl> the date determined as provided by sec.408.104 of the Texas 
Labor Code. <ol>
<nl>(31)<ol> [(28)] Medical necessity - the determination that the tests or 
treatment provided is required based on the presenting signs and symptoms. 
<nl>(32)<ol> [(29)] Module - a standard or unit of measurement 
<nl>(33)<ol> [(30) Objective findings. ]
[(A) Objective - perceptible to persons other than the affected individual. ]
[(B)] Objective findings - signs, or test results that can be measured or 
quantified or are otherwise perceptible to persons other than the affected 
individual. <nl>A medical finding of impairment resulting from a compensable 
injury, based on competent medical evidence, that is independently confirmable 
by a doctor, including a designated doctor, without reliance on the subjective 
symptoms perceived by the employee.<ol> 
<nl>(34)<ol> [(31)] Outpatient medical rehabilitation - a program of coordinated 
and integrated services, evaluation, and/or treatment with emphasis on improving 
the functional levels of the persons served. The program is interdisciplinary in 
nature and is applicable to those persons who have severe functional limitations 
of recent onset or recent regression or progression or those persons who have 
not had prior exposure to rehabilitation. Services may be directed toward the 
development and/or maintenance of the optimal level of functioning and community 
integration of the persons served.
<nl>(35)<ol> [(32)] Primary/secondary/tertiary levels of care. 
(A) Primary <nl>Level<ol> [level] of <nl>Care <ol>[care] - <nl>This<ol>[ this] 
level of care is generally considered to be appropriate for injured workers 
immediately following the compensable injury; however, the injured worker in 
this level of care may also be an early postoperative patient or may be 
experiencing an acute exacerbation of <nl>his or her<ol> [his/her] chronic <nl> 
condition<ol>[ pain]. Since partial or total cessation of work over a brief 
period of time [(i.e., two to three days maximum)] is also considered to be part 
of the primary level of care, further treatment by a health care provider may 
not be considered necessary at this level of care. Little or no deconditioning 
has occurred due to the injury, immobilization or decreased activity. The goals 
are <nl>to prevent<ol>[ the prevention of] disease, <nl>alleviate<ol> 
[alleviating] or <nl> minimize<ol>[minimizing] the effects of the illness or 
injury and to maintain function. 
(B) Secondary <nl>Level<ol>[level] of <nl> Care<ol>[care] - <nl>This<ol>[this] 
level of care is [the first stage of rehabilitation] for those injured workers 
who have not returned to productivity <nl>after<ol>[through] the normal healing 
process. <nl>This level of care<ol> [It] is designed to facilitate return to 
productivity before the onset of <nl> a<ol> chronic <nl>condition<ol> 
[disability]. <nl>This level of care may also be indicated for the injured 
worker whose physical capacity to work still does not meet the job requirements 
for heavy physical labor after adequate treatment, thereby causing an inability 
to return to full duty. <ol> It is individualized, time limited and of limited 
intensity. The injured worker has a history of a limited-to-good response to 
early primary treatment with persistent symptoms limiting activities of daily 
living. The objective physical examination demonstrates findings suggestive of 
early deconditioning including loss of range of motion and/or strength with 
limitation of activities of daily living. Evidence of mental health or 
psychosocial barriers may be present which impede the injured worker's clinical 
progress. 
(C) Tertiary <nl>Level<ol> [level] of <nl> Care<ol> [care] - <nl>This<ol> [this] 
level of care is interdisciplinary, individualized, coordinated, and 
intensive<nl>.<ol>[,] <nl>It is <ol> designed for the injured worker who 
demonstrates physical and psychological changes consistent with <nl>a<ol> 
chronic <nl>condition<ol> [disability]. <nl>In general, differentiation from 
secondary treatment includes medical direction, intensity of services, severity 
of injury, individualized programmatic protocols with integration of physician, 
mental health, and disability or pain management services and specificity of 
physical/psychosocial assessment. This level includes <ol> [There is] a 
documented history of persistent failure to respond to nonoperative or operative 
treatment which surpasses the usual healing period for that injury. Psychosocial 
issues such as substance abuse, affective disorders, and other psychological 
disorders may be present. <nl> This level of care is indicated by<ol> [There is] 
a documented inhibition of physical functioning evidenced by pain sensitivity, 
loss of sensation, and nonorganic signs such as fear which produce a physical 
inhibition or limited response to reactivation treatment. This level of care may 
also be indicated for the injured worker whose physical capacity to work still 
does not meet the job requirements for heavy physical labor after adequate 
treatment, thereby causing an inability to return to full duty. This situation 
would be evidenced by an excessive transitional period of light duty or 
significant episodes of lost work time due to the need for continued medical 
treatment. This level of care is also indicated for those injured workers who 
cannot tolerate either primary or secondary levels of care. 
<nl>(36)<ol> [(33)] Proper clinical documentation - written records which meet 
the requirements outlined by statute and rule and which convey the following 
information to the required parties:
(A) a description of the injury, including the [events surrounding that injury 
and the] extent<nl>,<ol> [and] severity <nl>and events surrounding<ol> [of] that 
injury; 
(B) a description of any pre-existing [condition(s)], complicating [conditions], 
and/or any non-related conditions; 
(C) a [plan of] treatment <nl>plan<ol>, including proposed methods<nl>,<ol> 
frequency<nl>,<ol> and probable duration of treatment,<nl>with<ol> [and] 
expected outcomes; 
(D) updates to the [plan of] treatment <nl>plan <ol> as needed, including the 
clinical progress of the injured worker[,] and any revisions needed to the 
treatment plan in light of the injured worker's response to treatment; 
(E) education/information provided to the injured worker regarding his <nl>or 
her<ol> injury and [plan of] treatment <nl>plan <ol>, and the injured worker's 
compliance with this [plan of] treatment <nl>plan<ol>; and 
(F) documentation substantiating the need for deviation from the guideline, if 
necessary. 
<nl>(37)<ol> [(34)] Reason for denial - <nl>refer to paragraph (12) of this 
subsection on denial parameters <ol> [see denial parameters]. 
<nl>(38)<ol> [(35)] Referral - the process of directing or redirecting (as a 
medical case or a patient) to an appropriate specialist or agency for definitive 
treatment. 
<nl>(39)<ol> [(36)] Referral doctor - a consulting doctor who initiates health 
care treatments at the request <nl> or with the consent<ol> of the treating 
doctor. 
<nl>(40)<ol> [(37)] Secondary treatment -<nl>refer to paragraph (35)(B) of this 
subsection regarding secondary levelof care<ol> [see secondary level of care 
under primary/secondary/tertiary level of care]. 
<nl>(41)<ol> [(38)] Self-referral - the direction of a patient to another 
doctor, institution or facility <nl>wherein <ol> [whereby] the referring doctor 
has a financial or conflict of interest element. 
<nl>(42)<ol> [(39)] Significant neurological deficit - rapidly progressing 
symptoms of sensory impairment, progressive numbness, or increased physiological 
impairment such as severe weakness, bowel or bladder dysfunction directly 
related to the spinal injury. 
<nl>(43)<ol> [(40)] Single point of contact - one person whom the doctor/health 
care provider(s) may contact for all questions regarding a specific injured 
worker. 
<nl>(44)<ol> [(41)] Sprain - an injury to a ligament. 
(A) Mild (Grade 1) - only a few fibers are torn; ligament is mostly intact and 
the joint is stable<nl>.<ol>[;] 
(B) Moderate (Grade 2) - more fibers are torn, resulting in some instability 
with abnormal joint motion and some functional loss<nl>.<ol>[;] 
(C) Severe (Grade 3) - ligaments are completely disrupted and instability may be 
severe (synonymous with marked). 
<nl>(45)<ol> [(42)] Static - characterized by a lack of movement or change. 
<nl>(46)<ol> [(43)] Strain - an injury to a muscle. 
(A) Mild (Grade 1) - only a few fibers are torn; muscle is mostly intact and 
functional<nl>.<ol>[;] 
(B) Moderate (Grade 2) - more muscle fibers are torn resulting in muscle pain 
with contraction<nl>.<ol>[;] 
(C) Severe (Grade 3) - tendons are completely disrupted, extreme pain and loss 
of use of muscle. 
<nl>(47)<ol> <nl>Tertiary treatment - refer to paragraph (35)(C) of this 
subsection regarding tertiary levelof care.<ol>
<nl>(48)<ol> [(44)] Subjective complaints - report of signs or symptoms, 
perceivable only by the injured employee, relating to the injury and which 
cannot be independently verified or confirmed by recognized laboratory or 
diagnostic tests or signs observable by physical examination.
<nl>(49)<ol> [(45)] Time limited - a specific duration of clock or calendar time 
which is not exceeded on a routine basis.
<nl>(50)<ol> [(46)] Treating doctor - the doctor primarily responsible for 
[coordinating] the employee's health care for an injury[.] (synonymous with 
<nl>the terms "primary gatekeeper" and "gatekeeper" <ol>[Primary 
Gatekeeper])<nl>.<ol> 
<nl>(51)<ol> [(47)] Treatment duration - calendar time allowed for treatment for 
a specific level of care. 
<nl>(52)<ol> [(48)] Treatment module - a standard which establishes routine 
parameters of time within which to provide therapy for the illness or injury. 
<nl>(53)<ol> [(49)] Treatment plan - [this is] a written document which must 
contain the following components:
(A) type of intervention/treatment modality; 
(B) frequency of treatment; 
(C) expected duration of treatment; 
(D) expected clinical response to treatment; and 
(E) specification of a re-evaluation timeframe. 
<nl>(54)<ol> [(50) ]Work conditioning - a highly structured, goal-oriented, 
individualized treatment program using real or simulated work activities in 
conjunction with conditioning tasks. Work conditioning is a single disciplinary 
approach. 
<nl>(55)<ol> [(51)] Work hardening - a highly structured, goal-oriented, 
individualized treatment program designed to maximize the ability of the persons 
served to return to work. Work <nl>hardening<ol>[Hardening] programs are 
interdisciplinary in nature with a capability of addressing the functional, 
physical, behavioral, and vocational needs of the injured worker. Work 
<nl>hardening<ol>[Hardening] provides a transition between management of the 
initial injury and return to work while addressing the issues of productivity, 
safety, physical tolerances, and work behaviors. Work 
<nl>hardening<ol>[Hardening] programs use real or simulated work activities in a 
relevant work environment in conjunction with physical conditioning tasks. These 
activities are used to progressively improve the biomechanical, neuromuscular, 
cardiovascular/metabolic, behavioral, attitudinal, and vocational functioning of 
the persons served. 
(i) Bibliography. The following items comprise a bibliography for this 
guideline. 
(1) The American Academy of Orthopaedic Surgeons. REVISED CLINICAL POLICY 
DRAFTS. May, 1995. 
(2) The American Academy of Orthopaedic Surgeons. PHASE ONE DRAFT ALGORITHMS. 
National Orthopaedic Leadership Conference. May, 1995.
(3) The American College of Occupational and Environmental Medicine, Committee 
on Practice Parameters. UPPER EXTREMITY GUIDELINE. Unpublished, 1994. 
(4) American Society for Surgery of the Hand. REGIONAL REVIEW COURSE IN HAND 
SURGERY SYLLABUS. 1993. 
(5) Bonebrake, Alan R., Fernandez,Jeffrey E., Marley, Robert J., Dahalan, 
Jalauddin B., and Kilmer, Kelvin J. "A Treatment for Carpal Tunnel Syndrome: 
Evaluation of Objective and Subjective Measures." JOURNAL OF MANIPULATIVE AND 
PHYSIOLOGICAL THERAPEUTICS. Vol. 13, No. 9. November/December, 1990. 
(6) Brier, Steven R. "Rotator Cuff Disease: Current Trends in Orthopedic 
Management." JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. Vol. 15, 
No. 2. February, 1992. 
(7) Brox, Jens Ivar, Staff, Peer H., Ljunggren, Anne Elisabeth, and Brevik, John 
Ivar. "Arthroscopic Surgery Compared with Supervised Exercises in Patients with 
Rotator Cuff Disease (Stage II Impingement Syndrome)." BMJ. Vol. 307. October 9, 
1993. 
(8) Cantu, Robert I. and Grodin, Alan J. MYOFASCIAL MANIPULATION: THEORY AND 
CLINICAL APPLICATION. Aspen Publishers, Inc. 1992. 
(9) Crawford, John P. and Noble, William John. "Anterior Interosseous Nerve 
Paralysis: Cubital Tunnel (Kiloh-Nevin) Syndrome." JOURNAL OF MANIPULATIVE AND 
PHYSIOLOGICAL THERAPEUTICS. Vol. 11, No. 3. June, 1988.
(10) Dobrusin, Richard. "An Osteopathic Approach to Conservative Management of 
Thoracic Outlet Syndromes." THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION. 
Vol. 89, No. 8. August, 1989. 
(11) Feinberg, Ed. "Bicipital Tendinitis: The Glass Arm Pitcher." ICA 
INTERNATIONAL REVIEW OF CHIROPRACTIC. Vol. 49. May/June, 1993.
(12) Gelvberman, Richard H., Eaton, Richard, and Urbaniak, James R. "Peripheral 
Nerve Compression." INSTRUCTIONAL COURSE LECTURES. The American Academy of 
Orthoapaedic Surgeons, James D. Heckman, Editor. March, 1994. 
(13) Gilkey, David P. and Williams, Holly A. "Ergonomics & CTDs: The Problems, 
Causes, Enforcement and Solutions." ACA JOURNAL OF CHIROPRACTIC. August, 1994. 
(14) Goff, Charles W., Alden, John O., and Aldes, John H. TRAUMATIC CERVICAL 
SYNDROME AND WHIPLASH. J.B. Lippincott Company. 
(15) Greenman, Philip E. PRINCIPLES OF MANUAL MEDICINE. Williams & Wilkins. 
(16) Hammer, Warren I. FUNCTIONAL SOFT TISSUE EXAMINATION AND TREATMENT BY 
MANUAL METHODS: THE EXTREMITIES. Aspen Publishers, Inc. 1991.
(17) Hosshmand, Hooshang. CHRONIC PAIN: REFLEX SYMPATHETIC DYSTROPHY PREVENTION 
AND MANAGEMENT. CRC Press, Inc. 1993. 
(18) Irowa, G. Ozin. "Avascular Necrosis of the Carpal Lunate: A Case Report." 
JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. Vol. 10, No. 6. 
December, 1987. 
(19) Jahn, Warren T. "Spontaneously Reduced Partial Shoulder Dislocation: A Case 
Report and Literature Review." JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL 
THERAPEUTICS. Vol. 5, No. 1. March, 1982. 
(20) Jaskoviak, Paul A. and Schafer, R.C. APPLIED PHYSIOTHERAPY: PRACTICAL 
CLINICAL APPLICATIONS WITH EMPHASIS ON THE MANAGEMENT OF PAIN AND RELATED 
SYNDROMES. Second Edition. The American Chiropractic Association.
(21) Kushner, Shirley and Reid, David C. "Manipulation in the Treatment of 
Tennis Elbow." THE JOURNAL OF ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY. Vol. 7, 
No. 5. March, 1986. 
(22) Lea & Febiger, Publisher. ARTHRITIS AND ALLIED CONDITIONS: A TEXTBOOK OF 
RHEUMATOLOGY. Vol. 12. Twelfth Edition. 1993. 
(23) Levine, David Z. "Burning Pain in an Extremity: Breaking the Destructive 
Cycle of Reflex Sympathetic Dystrophy." POSTGRADUATE MEDICINE. Vol. 90, No. 2. 
August, 1991. 
(24) Liebenson, Craig S. "Thoracic Outlet Syndrome: Diagnosis and Conservative 
Management." JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. Vol. 11, 
No. 6. December, 1988. 
(25) Mariano, Kurt A., McDougle, Mark A., and Tanksley, Gary W. "Double Crush 
Syndrome: Chiropractic Care of an Entrapment Neuropathy." JOURNAL OF 
MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. Vol. 14, No. 4. May, 1991. 
(26) Mior, Silvano A. and Dombrowsky, N. "Scapholunate Failure: A Long-Term 
Clinical Follow-Up." JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. 
Vol. 15, No. 4. May, 1992. 
(27) Reed, Presley, Editor. THE MEDICAL DISABILITY ADVISOR. Second Edition. LRP 
Publications. 1994. 
(28) Rogoff, Joseph B., Editor. MANIPULATION, TRACTION AND MASSAGE. Second 
Edition. Williams & Wilkins. 
(29) Schafer, R.C. CHIROPRACTIC MANAGEMENT OF SPORTS AND RECREATIONAL INJURIES. 
Williams & Wilkins. 
(30) Schnatz, Peter and Steiner, Charles. "Tennis Elbow: A Biomechanical and 
Therapeutic Approach." THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION. Vol. 
93, No. 7. July, 1993. 
(31) Schultz, August L. THE SHOULDER, ARM AND HAND SYNDROME.
(32) Shrode, Larry W. "Treating Shoulder Impingement Using the Supraspinatus 
Synchronization Exercise." JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL 
THERAPEUTICS. Vol. 17, No. 1. January 1994. 
(33) Sin, Y.M., Sedgewick, A.D., Muckay, A.R., Bates, M.B., and Willoughby, D.A. 
"Effect of Electric Acupuncture Stimulation on Acute Inflammation." AMERICAN 
JOURNAL OF ACUPUNCTURE. Vol 11, No. 4. October-December, 1983. 
(34) State of California, Department of Industrial Relations, Division of 
Workers' Compensation. UPPER EXTREMITY GUIDELINES. Unpublished.
(35) State of Oregon, Department of Consumer and Business Services, Workers' 
Compensation Division. CARPAL TUNNEL SYNDROME: DIAGNOSIS AND TREATMENT 
GUIDELINE. Draft, 10/10/94. 
(36) Steiner, Charles. "Osteopathic Manipulative Treatment: What Does It Really 
Do?" THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION. Vol. 94, No. 1. 
January, 1994. 
(37) Sucher, Benjamin M. "Myofascial Manipulative Release of Carpal Tunnel 
Syndrome: Documentation with Magnetic Resonance Imaging." THE JOURNAL OF THE 
AMERICAN OSTEOPATHIC ASSOCIATION. Vol. 93, No. 12. December, 1993. 
(38) Sucher, Benjamin M. "Myofascial Release of Carpal Tunnel Syndrome." THE 
JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION. Vol. 93, No. 1. January, 1993. 
(39) Sucher, Benjamin M. "Palpatory Diagnosis and Manipulative Management of 
Carpal Tunnel Syndrome." THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION. 
Vol. 94, No. 8. August, 1994. 
(40) Sucher, Benjamin M. "Thoracic Outlet Syndrome -- A Myofascial Variant: Part 
1. Pathology and Diagnosis." THE JOURNAL OF THE AMERICAN OSTEOPATHIC 
ASSOCIATION. Vol. 90. No. 8. August, 1990. 
(41) Sucher, Benjamin M. "Thoracic Outlet Syndrome -- A Myofascial Variant: Part 
2. Treatment." THE JOURNAL OF THE AMERICAN OSTEOPATHIC ASSOCIATION. Vol. 90, No. 
9. September, 1990. 
(42) Thomas, D., Williams, R.A., and Smith, D.S. "The Frozen Shoulder: A Review 
of Manipulative Treatment." RHEUMATOLOGY AND REHABILITATION. Vol. 19, No. 3. 
1980. 
(43) Urist, Marshall R., Editor-in-Chief. CLINICAL ORTHOPAEDICS AND RELATED 
RESEARCH. Number Two Hundred Eighty-Two. J.B. Lippincott Co. 
(44) Vernon, Howard. "The Role of Plethysmography in the Chiropractic Management 
of Costoclavicular Syndromes: Review of Principles and a Case Report." JOURNAL 
OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS. Vol. 5, No. 1. March, 1982. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802197
Susan M. Cory
General Counsel
Texas Workers' Compensation Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 440-3972

TITLE 37. PUBLIC SAFETY AND CORRECTIONS
PART III. Texas Youth Commission
CHAPTER 87.Treatment
SUBCHAPTER B.Special Needs Offender Programs
37 TAC sec.87.91
The Texas Youth Commission (TYC) proposes amendment to sec.87.91, concerning 
family reintegration of sex offenders. The amendment will specify that certain 
requirements involving therapy treatment apply to the family members of a sex 
offender committed to TYC as well as to the offender and the victim when the 
victim and offender are in the same family. In addition, the reference to 
sec.81.35 of this title, concerning involvement of victims has been corrected. 
Terry Graham, Assistant Deputy Executive Director for Finance, has determined 
that for the first five-year period the section is in effect there will be no 
fiscal implications for state or local government as a result of enforcing or 
administering the section. 
Mr. Graham also has determined that for each year of the first five years the 
section is in effect the public benefit anticipated as a result of enforcing the 
section will be greater protection for the public. There will be no effect on 
small businesses. There is no anticipated economic cost to persons who are 
required to comply with the section as proposed. No private real property rights 
are affected by adoption of this rule. 
Comments on the proposal may be submitted to Gail Graham, Policy and Manuals 
Coordinator, Texas Youth Commission, 4900 North Lamar Boulevard, P.O. Box 4260, 
Austin, Texas 78765. 
The amendment is proposed under the Human Resources Code, sec.61.0761, which 
provides the Texas Youth Commission with the authority to develop programs that 
encourage family involvement in the rehabilitation of the child. 
The proposed rule implements the Human Resource Code, sec.61.034.

sec.87.91.Family Reintegration of Sex Offenders.
(a) (No change.)
<nl>(b)<ol> <nl>Explanation of Terms Used. Family - As used herein, shall refer 
to the family members and/or the victim or potential victim who live in the home 
to which the TYC designated youth will return.<ol>
<nl> (c) <ol>[(b)] The offender <nl> , the <ol> [and the] victim and <nl> the 
<ol> [offender's] family must have received treatment specific to the sexual 
offense prior to the youth's return to his/her home such that: 
(1) the family demonstrates knowledge and understanding of the sex offender's 
behavior; 
(2) the family agrees to implement specific strategies to ensure the ongoing 
safety of the victim or potential victims; 
(3) the victim has demonstrated sufficient progress in therapy to be ready for 
the offender to return home. See (GAP)<nl> sec.81.35 <ol> [sec.81.13] of this 
title (relating to Involvement of Victims); <nl> and <ol> 
(4) the offender has demonstrated sufficient progress in therapy to be ready for 
the offender to return home. See (GAP), <nl> sec.81.35 <ol> [sec.81.13]of this 
title (relating to Involvement of Victims).[and]
<nl> (d) <ol> [(c)] Direct contact must occur between the therapists in which a 
specific reintegration plan is defined and mutually agreed upon. 
<nl> (e) <ol>[(d)] At a minimum, the reintegration plan must include at least 
one face-to-face contact between offender and victim facilitated by one or both 
therapists and not in the home. 
<nl> (f) <ol> [(e)] Based upon a successful initial meeting between offender and 
victim, an overnight furlough is arranged.
<nl> (g) <ol> [(f)] Actual home placement should occur only after mutual 
agreement between PSW(s), therapists, victim and offender that trial visits have 
been successful. 
<nl> (h) <ol> [(g)] There must be a specific plan for continued treatment and 
supervision for the offender in the community.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802082
Steve Robinson
Executive Director
Texas Youth Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 424-6244

CHAPTER 91.Program Services
SUBCHAPTER A.Basic Services
37 TAC sec.91.21
(Editor's note: The text of the following section proposed for repeal will not 
be published. The section may be examined in the offices of the Texas Youth 
Commission or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.)
The Texas Youth Commission (TYC) proposes the repeal of sec.91.21, concerning 
moral values, worship and religious education. This section is being repealed to 
allow for the publication of a new section. 
Terry Graham, Assistant Executive Deputy Director of Finance, has determined 
that for the first five-year period the repeal as proposed is in effect there 
will be no fiscal implications for state or local government as a result of 
enforcing or administering the repeal. 
Mr. Graham also has determined that for each year of the first five years the 
repeal is in effect the public benefit anticipated as a result of enforcing the 
repeals will be greater protection for TYC youth and the public. There will be 
no effect on small businesses. There is no anticipated economic cost to persons 
who are required to comply with the repeal as proposed. 
Comments on the proposal may be submitted to Gail Graham, Policy and Manuals 
Manager, Texas Youth Commission, 4900 North Lamar Boulevard, P.O. Box 4260, 
Austin, Texas 78765. 
The repeal is proposed 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.
sec.91.21.Moral Values, Worship and Religious Education.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802084
Steve Robinson
Executive Director
Texas Youth Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 424-6244

The Texas Youth Commission (TYC) proposes new sec.91.21, concerning moral 
values, worship and religious education. The new section will expand religious 
education programs and services provided for TYC youth. Youth shall have access 
to religious services and programs which are non-discriminatory, voluntary, and 
community-based. TYC shall provide access to adult clergy and encourage 
volunteer participation among religious groups. 
Terry Graham, Assistant Deputy Executive Director for Finance, has determined 
that for the first five-year period the section is in effect there will be no 
fiscal implications for state or local government as a result of enforcing or 
administering the section. 
Mr. Graham also has determined that for each year of the first five years the 
section is in effect the public benefit anticipated as a result of enforcing the 
section will be greater protection for the public. There will be no effect on 
small businesses. There is no anticipated economic cost to persons who are 
required to comply with the section as proposed. No private real property rights 
are affected by adoption of this rule. 
Comments on the proposal may be submitted to Gail Graham, Policy and Manuals 
Manager, Texas Youth Commission, 4900 North Lamar Boulevard, P.O. Box 4260, 
Austin, Texas 78765. 
The new section is proposed under the Human Resources Code, sec.61.046, which 
provides the Texas Youth Commission with the authority to provide for the 
religious and spiritual training of children in its custody according to the 
children's individual choices. 
The proposed rule implements the Human Resource Code, sec.61.034.

sec.91.21.Moral Values, Worship and Religious Education.
(a) Purpose. The purpose of this rule is to provide for the opportunity to and 
encourage youth to develop and internalize a set of personal moral values. 
(b) Texas Youth Commission (TYC) shall provide youth the opportunity to 
participate in religious education programs and services for youth. 
(c) Participation in religious services and counseling shall be voluntary. 
(d) Arbitrary and discriminatory restrictions of religious freedoms are 
prohibited. 
(e) Halfway house and contract residential programs shall provide for reasonable 
access to religious programs, counseling and other such resources in the 
community. 
(f) Participation in religious programs and services shall be limited only when 
documentation indicates threat to the safety of persons involved or the activity 
disrupts facility order and/or discipline. 
(g) Youth will be given the opportunity to participate in the practices of their 
declared religious faiths that are deemed essential by the faith's judicatory or 
tradition, limited only by documentation showing threat to the safety of persons 
involved in such activity or that the activity itself disrupts order in the 
facility. 
(h) Youth in TYC operated facilities may request that a specific religious 
practice or item be made available to him or her. A youth's request is subject 
to an assessment and approval process. 
(i) TYC shall provide access to adult clergy. 
(j) TYC shall encourage the participation of volunteer religious groups and 
individuals in its religious services and programs. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802083
Steve Robinson
Executive Director
Texas Youth Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 424-6244

SUBCHAPTER D.Health Care Services
37 TAC sec.91.89
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas Youth 
Commission or in the Texas Register office, Room 245, James Earl Rudder 
Building, 1019 Brazos Street, Austin.)
The Texas Youth Commission (TYC) proposes the repeal of sec.91.89, concerning 
suicide alert. This section is being repealed to allow for the publication of a 
new section. 
Terry Graham, Assistant Executive Deputy Director of Finance, has determined 
that for the first five-year period the repeal as proposed is in effect there 
will be no fiscal implications for state or local government as a result of 
enforcing or administering the repeal. 
Mr. Graham also has determined that for each year of the first five years the 
repeal is in effect the public benefit anticipated as a result of enforcing the 
repeals will be greater protection for TYC youth and the public. There will be 
no effect on small businesses. There is no anticipated economic cost to persons 
who are required to comply with the repeal as proposed. 
Comments on the proposal may be submitted to Gail Graham, Policy and Manuals 
Manager, Texas Youth Commission, 4900 North Lamar Boulevard, P.O. Box 4260, 
Austin, Texas 78765. 
The repeal is proposed 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.
sec.91.89.Suicide Alert.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802081
Steve Robinson
Executive Director
Texas Youth Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 424-6244

The Texas Youth Commission (TYC) proposes new sec.91.89, concerning suicide 
alert. The new section establishes a process whereby mental health 
professional(s) assess suicide risk and assign a suicide alert status or remove 
a youth from the status. 
Terry Graham, Assistant Deputy Executive Director for Finance, has determined 
that for the first five-year period the section is in effect there will be no 
fiscal implications for state or local government as a result of enforcing or 
administering the section. 
Mr. Graham also has determined that for each year of the first five years the 
section is in effect the public benefit anticipated as a result of enforcing the 
section will be greater protection for youth placed in TYC facilities. There 
will be no effect on small businesses. There is no anticipated economic cost to 
persons who are required to comply with the section as proposed. No private real 
property rights are affected by adoption of this rule. 
Comments on the proposal may be submitted to Gail Graham, Policy and Manuals 
Manager, Texas Youth Commission, 4900 North Lamar Boulevard, P.O. Box 4260, 
Austin, Texas 78765. 
The new section is proposed 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.
The proposed rule implements the Human Resource Code, sec.61.034. sec.91.89 
Suicide Alert. 

sec.91.89.Suicide Alert.
(a) Purpose. The purpose of this rule is to establish procedures by which youth 
who may be at risk for suicide are assessed and treated in order to minimize the 
risk of self injury. 
(b) Applicability. This rule applies to all youth who are currently assigned to 
placement in TYC institutions, halfway houses and contract residential 
facilities. This policy does not apply to youth living at home or in a home 
substitute except where specifically stated. 
(c) Explanation of Terms Used. Mental Health Professional (MHP) - An individual 
who is a Psychiatrist, doctoral level Psychologist, Associate Psychologist 
(masters level), or a Social Worker with an Advanced Clinical Practitioner 
designation (LMSW-ACP). Designated Mental Health Professional(s) - The 
individual having the primary responsibility and accountability for the 
evaluation, monitoring and treatment of all youth referred as suicide risks. 
This individual shall be a Psychiatrist or a licensed Psychologist.
(d) Suicide Alert Assignment/Removal Process. 
(1) At risk youth will receive suicide screenings and/or assessments.
(A) A suicide risk screening will be initiated by a Primary Service Worker (PSW) 
or the professional equivalent in contract care when a youth expresses suicidal 
intent through words, or when the youth's record indicates a history of prior 
suicidal ideation. 
(B) A suicide risk assessment will be initiated by a MHP when a screening 
indicates a risk for suicidal action, when youth expresses suicidal intent 
through actions, or when the youth's record indicates a history of prior 
suicidal actions. 
(2) A designated MHP shall determine whether a youth is a suicide risk based 
upon a clinical assessment. The professional may initiate a suicide alert 
process or authorize the youth's return to regular schedule.
(3) A youth may be removed from suicide alert status only by the designated MHP 
who placed the youth on alert. 
(4) Youth on suicide alert will receive appropriate counseling/treatment. This 
youth will be removed from suicide alert after the youth has stabilized.
(5) Youth on suicide alert status may not be moved to another placement unless: 
(A) the receiving placement is a TYC institution, residential treatment center 
or other placement having on-site psychiatric or psychological staff; or 
(B) the designated MHP at the sending site approves the transfer following 
consultation between the MHPs at the sending and receiving sites.
(6) Youth who have been on suicide alert within six months prior to a placement 
change are reevaluated by a MHP at the receiving facility following a placement 
change. 
(e) Implementation Rules. 
(1) All staff, including parole officers, are responsible for reporting a youth 
believed to be at risk for suicide to a designated qualified MHP in a TYC 
facility. 
(2) Facility staff shall be informed when a youth in placed on suicide alert 
status. 
(3) All staff of a contract residential setting shall be informed when a youth 
is placed on suicide alert status and are responsible for following that 
setting's approved suicide alert procedure. 
(4) All direct care staff in TYC operated facilities and in contract residential 
settings will receive suicide prevention training.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 12, 1998.
TRD-9802080
Steve Robinson
Executive Director
Texas Youth Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 424-6244

TITLE 40. SOCIAL SERVICES AND ASSISTANCE
PART I. Texas Department of Human Services
CHAPTER 18.Nursing Facility Administrators
The Texas Department of Human Services (DHS) proposes the repeal of 
sec.sec.18.17-18.20, concerning formal hearing procedures, informal disposition, 
standards of conduct, and administrative penalties; and proposes new 
sec.sec.18.17-18.20, concerning formal hearing procedures, informal review, 
standards of conduct, and administrative penalties, in its Nursing Facility 
Administrators chapter. The purpose of the repeals and new sections is to alter 
the procedures for the assessment of an administrative penalty by allowing 
consideration of several factors when determining the amount of the penalty to 
assess an administrator, including but not limited to: the seriousness of the 
violation, including the nature, circumstances, extent, and gravity of any 
prohibited acts, and the hazard or potential hazard to the health, safety, or 
economic welfare of the public; the economic harm to property or the environment 
caused by the violation; the administrator's history of previous violations; and 
the efforts to correct the violations. The formal hearing, informal hearing, and 
standards of conduct procedures are also revised to reflect DHS policy and 
procedures. 
Eric M. Bost, commissioner, has determined that for the first five-year period 
the sections are in effect there will be no fiscal implications for state or 
local government as a result of enforcing or administering the sections. Mr. 
Bost also has determined that for each year of the first five years the sections 
are in effect the public benefit anticipated as a result of enforcing the 
sections will be a better protection of the health and safety of nursing 
facility residents by allowing consideration of factors such as the seriousness 
of the violation and the administrator's history of previous violations when 
determining the amount of the penalty to assess an administrator for a violation 
of the Texas Health and Safety Code, Chapter 242, Subchapter I, (Nursing 
Facility Administration, sec.sec.242.301, added by Acts 1997, 75th Legislature, 
Chapter 1280, sec.1.01), or rules adopted under that chapter. The rule has no 
adverse economic effect on small businesses. There is no anticipated economic 
cost to persons who are required to comply with the proposed sections. 
Questions about the content of this proposal may be directed to Renee Clack at 
(512) 231-5821 in DHS's Credentialing Department. Written comments on the 
proposal may be submitted to Supervisor, Rules and Handbooks Unit-164, Texas 
Department of Human Services E-205, P.O. Box 149030, Austin, Texas 78714-9030, 
within 30 days of publication in the Texas Register.

40 TAC sec.sec.18.17-18.20
(Editor's note: The text of the following sections proposed for repeal will not 
be published. The sections may be examined in the offices of the Texas 
Department of Human Services or in the Texas Register office, Room 245, James 
Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Texas Health and Safety Code, Chapter 242, 
Subchapter I, (Nursing Facility Administration, sec.sec.242.301, added by Acts 
1997, 75th Legislature, Chapter 1280, sec.1.01), which authorizes the department 
to license nurse facility administrators. The repeals implement the Texas Health 
and Safety Code, Chapter 242.302, as added by Acts 1997, 75th Legislature, 
Chapter 1280, sec.1.01. 
sec.18.17.Formal Hearing Procedures.
sec.18.18. Informal Disposition.
sec.18.19.Standards of Conduct.
sec.18.20.Administrative Penalties.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802175
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Proposed date of adoption: May 15, 1998
For further information, please call: (512) 438-3765

The new sections are proposed under the Texas Health and Safety Code, Chapter 
242, Subchapter I, (Nursing Facility Administration, sec.sec.242.301, added by 
Acts 1997, 75th Legislature, Chapter 1280, sec.1.01), which authorizes the 
department to license nurse facility administrators. 
The new sections implement the Texas Health and Safety Code, sec.sec.242.301-
242.322, (Nursing Facility Administration, sec.sec.242.301, added by Acts 1997, 
75th Legislature, Chapter 1280, sec.1.01). 

sec.18.17. Formal Hearing Procedures.
(a) This section covers the formal hearing procedures and practices that shall 
be used by the Texas Department of Human Services (DHS) if imposing one or more 
of the sanctions specified in paragraphs (1)-(6) of this subsection: 
(1) revocation of a license; 
(2) suspension of a license; 
(3) denial of an application to renew a license; 
(4) issuance of a written reprimand to a licensee; 
(5) requirement of a licensee to participate in additional continuing education 
programs; or 
(6) placement of a nursing facility administrator's license on probation. 
(b) Formal hearings shall be conducted under the provisions of the APA, 
Government Code, sec.2001 and hearing procedures in Chapter 79 of this title 
(relating to Legal Services). 

sec.18.18.Informal Review. 
(a) Before the institution of proceedings to revoke or suspend a license or deny 
an application for the renewal of a license, the Texas Department of Human 
Services (DHS) gives the licensee: 
(1) notice of the facts or conduct alleged to warrant the proposed action; and 
(2) an opportunity to demonstrate compliance with all requirements of law for 
the retention of the license by sending the Credentialing Department Director or 
designee a written request for an informal review. The request must: 
(A) be received within ten calendar days of the date of receipt of DHS's notice; 
and 
(B) contain specific documentation refuting DHS's allegations.
(b) DHS's review shall be limited to a review of documentation submitted by the 
licensee and information DHS used as the basis for its proposed action and shall 
not be conducted as an adversary hearing. DHS shall give the licensee a written 
affirmation or reversal of the proposed action. 

sec.18.19.Standards of Conduct.
The Texas Department of Human Services (DHS) shall impose sanctions for a 
violation of the Texas Health and Safety Code, Chapter 242, Subchapter I, or 
rules adopted under that chapter, including the standards of conduct specified 
in paragraphs (1)-(26) of this section. 
(1) A licensee shall employ sufficient staff to adequately meet the needs of 
facility residents as determined by care outcomes. 
(2) A licensee shall ensure that sufficient resources are present to provide 
adequate nutrition, medications and treatments to facility residents in 
accordance with physician orders as determined by care outcomes.
(3) A licensee shall promote and protect the rights of facility residents and 
ensure that employees, contractors, and others respect the rights of residents. 
(4) A licensee shall ensure that residents remain free of chemical and physical 
restraints unless required by a physician's order to protect a resident's health 
and safety. 
(5) A licensee shall report and direct facility staff to report any suspected 
case of abuse, neglect, or misappropriation of resident property as defined in 
sec.18.1(b) of this title (relating to Introduction), to the appropriate 
government agency. 
(6) A licensee shall ensure that the nursing facility is physically maintained 
in a manner that protects the health and safety of residents and the public. 
(7) A licensee shall notify and direct employees to notify an appropriate 
governmental agency of any suspected cases of criminal activity as defined by 
state and federal laws. 
(8) A licensee shall post in a conspicuous place and in clearly legible type, in 
the facility where employed, the notice provided by DHS which gives the 
Credentialing Department's address and telephone number for reporting complaints 
against an administrator. 
(9) A licensee shall not knowingly or through negligence, commit, direct, or 
allow actions which result or could result in inadequate care, harm, or injury 
to a resident. 
(10) A licensee shall not knowingly or through negligence allow nursing facility 
employees to harm facility residents by coercion, threat, intimidation, 
solicitation, harassment, theft of personal property, or cruelty.
(11) A licensee shall not knowingly or through negligence allow or direct 
employees to contradict or alter in any manner, the orders of a physician 
regarding a resident's medical or therapeutic care. 
(12) A licensee shall not knowingly commit or through negligence allow another 
individual to commit an act of abuse, neglect, or misappropriation of resident 
property as defined in sec.18.1(b) of this title (relating to Introduction). 
(13) A licensee shall not permit another individual to use his or her license or 
allow a facility to falsely post his or her license.
(14) A licensee shall not advertise or knowingly participate in the 
advertisement of nursing facility services in a manner which is fraudulent, 
false, deceptive, or misleading in form or content. 
(15) A licensee shall not knowingly allow, aid, abet, sanction, or condone a 
violation by another licensed nursing facility administrator of the Texas Health 
and Safety Code, Chapter 242, Subchapter I or the department's rules adopted 
under that section and shall report such violations to DHS.
(16) A licensee shall not make or allow employees, contractors, or volunteers to 
make misrepresentations or fraudulent statements about the operation of a 
nursing facility. 
(17) A licensee shall not allow or direct facility employees, contractors, or 
others in a manner which results in the harassment or intimidation of any person 
for purposes of coercing that person to use the services or equipment of a 
particular health agency or facility. 
(18) A licensee shall not falsely bill for goods or services or allow another 
person to bill for goods or services other than those that have actually been 
rendered. 
(19) A licensee shall not make or file false reports or allow an employee, 
contractor, or volunteer to make or file a report that the licensee knows to be 
false. 
(20) A licensee shall not intentionally fail to file a report or record required 
by state or federal law; impede or obstruct such filings; or induce another 
person to impede or obstruct such filings. 
(21) A licensee shall not use or knowingly allow employees or others to use 
alcohol, narcotics, or other drugs in a manner which interferes with the 
performance of the administrator's or other person's duties. 
(22) A licensee shall not knowingly or through negligence violate any 
confidentiality provisions as prescribed by state or federal law concerning a 
resident. 
(23) A licensee shall not interfere or impede an investigation by withholding or 
misrepresenting fact to DHS representatives, or by using threats or harassment 
against any person involved or participating in the investigation. 
(24) A licensee shall not display a license issued by DHS which has been 
reproduced, altered, expired, suspended, or revoked. 
(25) A licensee shall not knowingly or through negligence allow employees or 
other individuals to mismanage the personal funds of residents deposited with 
the facility. 
(26) A licensee shall not bribe, attempt to bribe, harass or intimidate 
employees of DHS or other governmental agencies or its representatives in regard 
to the administration of the nursing facility.

sec.18.20. Administrative Penalties.
(a) The Texas Department of Human Services (DHS) may impose an administrative 
penalty against a person licensed or regulated under the Texas Health and Safety 
Code, Chapter 242, Subchapter I. 
(b) The penalty for a violation may be in an amount not to exceed $1,000. Each 
day a violation occurs or continues is a separate violation for purposes of 
imposing a penalty. 
(c) The amount of the penalty shall be based on: 
(1) the seriousness of the violation, including the nature, circumstances, 
extent, and gravity of any prohibited acts, and the hazard or potential hazard 
created to the health, safety, or economic welfare of the public; 
(2) the economic harm to property or the environment caused by the violation; 
(3) the history of previous violations; 
(4) the amount necessary to deter future violations;
(5) efforts to correct the violations; and 
(6) any other matter that justice may require. 
(d) If DHS determines a violation has occurred, then DHS shall give written 
notice by certified mail to the person alleged to have committed the violation. 
The notice shall include a: 
(1) brief summary of the alleged violation; 
(2) statement of the amount of the recommended penalty; and 
(3) statement informing the person of the right to a hearing on the occurrence 
of the violation, the amount of the penalty, or both the occurrence of the 
violation and the amount of the penalty. 
(e) Within 20 calendar days after the date the person receives the notice, the 
person may accept, in writing, the determination and the penalty recommended by 
DHS or may make a written request for a hearing. 
(f) If the person accepts DHS's determination and the penalty that is 
recommended, DHS shall impose the recommended penalty. 
(g) If the person requests a hearing or fails to respond timely to the notice, 
DHS shall set a hearing and give notice of the hearing to the person. The 
hearing shall be held in accordance with DHS's rules on contested case hearings. 
(h) The notice of the hearing decision given to the person under Chapter 2001, 
Government Code, must include a statement of the right of the person to judicial 
review of the decision. 
(i) Within 30 calendar days after the date DHS's decision is final as provided 
by sec.2001.144, Government Code, the person shall:
(1) pay the amount of the penalty; or 
(2) petition for judicial review as provided for in the Health and Safety Code, 
sec.242.316 and the Government Code, sec.2001.176; or 
(3) do both actions stated in paragraphs (1) and(2) of this subsection. 
(j) The proceedings under this section are subject to Chapter 2001, Government 
Code. 
(k) DHS shall categorize violations in one of the following severity levels: 
(1) Level I - violations that have or had an adverse impact on resident health 
and/or safety that includes serious harm, permanent injury, or death to a 
resident. 
(2) Level II - violations that have or had a potential or adverse impact on the 
health and safety of a resident, but less than Level I; or 
(3) Level III - violations that have minimal or no significant impact on 
resident health and/or safety. 
(l) DHS shall impose an administrative penalty based on the severity level of 
the violation as follows: 
(1) Level I - $500 - $1,000; 
(2) Level II - $250 - $500; and 
(3) Level III - $250 or less. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802176
Glenn Scott
General Counsel, Legal Services
Texas Department of Human Services
Proposed date of adoption: May 15, 1998
For further information, please call: (512) 438-3765

PART XX. Texas Workforce Commission
CHAPTER 827.Communities in Schools
The Texas Workforce Commission (Commission) proposes new sec.sec.827.1-827.2, 
827.11-827.14, 827.21, 827.31-827.33, 827.41-827.43 and 827.51-827.55 concerning 
the administration of the Communities In Schools (CIS) program. The new chapter 
is proposed along with Subchapters A-F as the location of the rules pertaining 
to Communities In Schools. 
New Subchapter A is added concerning General Provisions. 
New sec.827.1 of Subchapter A, Purpose, states that these rules are to implement 
and interpret the requirements of Texas Labor Code, Chapter 305 and the 
provisions of the Communities In Schools Memorandum of Understanding with the 
Texas Education Agency. 
New sec.827.2 defines words and terms used in these rules. 
New Subchapter B is added concerning approval of new local applicant proposals. 
New sec.827.11 states that, subject to funding availability, the Commission 
shall publicly solicit proposals for new CIS programs on an annual basis, either 
through the Texas Register or as otherwise determined by the Commission.
New sec.827.12 details the various components that local applicants must specify 
in their proposals for CIS programs. 
New sec.827.13 sets forth the procedure for proposal evaluation. 
New sec.827.14 states that no change or amendment may be made to proposals after 
submission, and provides exceptions. 
New Subchapter C is added concerning approval of renewal and expansion 
proposals. 
New sec.827.21 sets forth the continuation re-application procedures applicable 
to local programs currently contracting with the Commission for administration 
of the CIS program. 
New Subchapter D is added concerning the funding of CIS local programs. New 
sec.827.31 sets forth the funding formula for Compensatory Education Funds. In 
accordance with Chapter 305 of the Texas Labor Code, those CIS programs 
participating as of August 31, 1995 shall have the funds contributed by the 
state reduced up to 50% over the next three years. Beginning in Fiscal Year 
2002, all Compensatory Education Funds will be allocated to local workforce 
development areas based on the proportion of low-income students and financial 
resources in the area. 
New sec.827.32 sets forth the funding formula for JTPA funds. 
New sec.827.33 sets forth the funding method for CIS TANF funds. 
New Subchapter E is added concerning the program administration after approval 
as a local program. 
New sec.827.41 sets forth the program policy requirements. 
New sec.827.42 sets forth the operational plan requirements. 
New sec. 827.43 sets forth the monitoring requirements applicable to local 
programs. 
New Subchapter F is added concerning compliance. 
New sec.827.51 sets forth the preventive maintenance and fiscal accountability 
provisions. 
New sec.827.52 sets forth the sanctions for non-compliance. 
New sec.827.53 sets forth the violations resulting in sanctions. 
New sec.827.54 sets forth the provisions for notice of sanctions. 
New sec.827.55 sets forth the provision for appeals. 
Randy Townsend, Director of Finance, has determined that for the first five-year 
period the sections are in effect, there will be no fiscal impact to state or to 
local governments as a result of enforcing or administering the rules. There 
will be no foreseeable cost reductions to the state and to local governments, no 
net effect on revenues as a result of enforcing and administering the rules, and 
no foreseeable implications relating to costs or revenues to the state or to 
local governments associated with implementing these sections. There will be no 
effect on small businesses. There are no anticipated costs to persons who are 
required to comply with the sections as proposed. 
Mark Hughes, Director of Labor Market Information, has determined that the 
proposed rules would have no impact upon public or private employment. Alan 
Miller, Director of Workforce Development Division, has determined that for each 
year of the first five years the sections are in effect, the public benefit 
anticipated as a result of enforcing the sections will be providing funding to 
assist in reducing youth drop-out rates. 
Comments on the proposal may be submitted to Sandra Smith, Education and Special 
Services, Texas Workforce Commission Building, 101 East 15th Street, Room 526BT, 
Austin, Texas 78778, fax (512) 305-9182. Comments may also be submitted via e-
mail to Ms. Smith at sandra.smith@twc.state.tx.us.

SUBCHAPTER A.General Provisions
40 TAC sec.827.1, sec.827.2
The new rules are proposed under Texas Labor Code, sec.301.061 which provides 
the Texas Workforce Commission with the authority to adopt such rules as it 
deems necessary for the effective administration of the Act. Texas Labor Code, 
Chapter 305 will be affected by this proposal.

sec.827.1. Purpose. 
(a) The purpose of these rules is to implement and interpret the requirements of 
Texas Labor Code, Chapter 305, as may be amended, and the provisions of the 
Communities In Schools Memorandum of Understanding with the Central Education 
Agency. 
(b) The mission of the Communities In Schools program in Texas is to help young 
people stay in school. 

sec.827.2. Definitions.
The following words and terms, when used in this chapter, shall have the 
following meanings, unless the context clearly indicates otherwise. 
(1) At-risk student- student at risk of dropping out of school, as defined in 
the Texas Education Code, Title 2, Subchapter C, sec.29.081.
(2) Base year - Fiscal year 1996 (FY96). 
(3) Board development/board orientation - The technical support, training, and 
customer service given to the local program board of directors by state, 
national, or regional CIS offices. 
(4) Campus needs assessment - An annual survey conducted at each CIS campus to 
determine services that are provided through other sources, services needed but 
not provided, and the potential for CIS to provide additional needed services or 
integrate services to more effectively serve students.
(5) CIS - The Communities In Schools program authorized under the Texas Labor 
Code, Chapter 305. 
(6) CISCMS - The Communities In Schools Case Management System that is an 
automated data collection system that tracks services and outcomes of the case 
managed students entered into CIS. 
(7) Commission - The Texas Workforce Commission as established in Texas Labor 
Code, sec.301.001. 
(8) Community support - An active community based organization consisting of 
representatives from key entities in the community, representing both the public 
and private sectors of the community as well as reflecting its ethnic and 
demographic makeup. This group, indicating community support, takes the 
initiative in spearheading the establishment of a CIS program in the community 
prior to the formation of a board of directors which then administers the CIS 
program. 
(9) Compensatory education funds - General Revenue allocated by the State 
Legislature for operation of programs and/or provision of services designed for 
students in at-risk situations as stipulated in the Texas Education Code, 
sec.29.081. 
(10) Continuation program - a local CIS program which has contracted with the 
Commission and provided CIS services for one or more years. 
(11) Contract - The agreement entered into by the local program board of 
directors and the Commission to administer the CIS program.
(12) Educationally disadvantaged student - Those students who are eligible for 
free or reduced-price meals in the national school lunch program. See Texas 
Education Code, sec.42.152. 
(13) Expansion - The process of an existing local program establishing CIS 
services on a new school campus or in a new school district.
(14) Financial resources - The appraisal value of the taxable property assessed 
by the local appraisal districts located in the local workforce development area 
divided by the total student population in the local workforce development area. 
(15) JTPA - The Job Training Partnership Act and the various programs 
established under such Act to prepare youths and adults facing serious barriers 
to employment for participation in the labor force by providing job training and 
other job services (29 U.S.C. sec.sec.1501 et seq.).
(16) Local applicant - A community based organization which desires to establish 
a new CIS program in a local workforce development area not previously having a 
CIS program. 
(17) Local financial support - Funds or in-kind contributions from local 
entities for use in operation of the CIS program. 
(18) Local program - A non-profit corporation, established in a given community 
with the purpose of administering the CIS program, that has a contract with the 
Commission to administer the CIS program. Each local program is governed by a 
local board of directors which hires an executive director to administer the 
program. 
(19) Local workforce development area - The area as defined by the Texas 
Government Code, sec.2308.252. 
(20) Local workforce development board - The area as defined by the Texas 
Government Code, sec.2308.253. 
(21) Low-income student - A student who is eligible for free or reduced-price 
meals under the National School Lunch and Child Nutrition Program or other 
public assistance. 
(22) Program year - The period from September 1 to the following August 31. 
(23) Replication - The process of establishing a new CIS local program in a 
local workforce development area previously not served by CIS. 
(24) Replication program - A program that will have the status of a "replication 
program" for the first year following establishment of the program. This 
indicates that it is in a developing stage and distinguishes it from a 
continuation program which is established and on-going. 
(25) School district support - Written support from the school district 
indicating willingness and desire to have the CIS program on its campus. 
(26) School-to-Work - A voluntary system that facilitates the understanding of 
students and their parents of expectations of employers and community 
professionals and provides multiple opportunities for students to experience 
success in meeting those expectations in the workplace and in the community. 
(27) State office - The Texas Workforce Commission office that oversees and 
administers the Communities In Schools program, funded through legislatively 
appropriated funds, throughout the state. 
(28) TANF- Temporary Assistance to Needy Families; cash assistance and services 
for eligible individuals as defined in the federal Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996, (7 U.S.C. sec.sec.201.1, et seq.). 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13 1998.
TRD-9802178
J. Ferris Duhon
Acting Deputy Director of Legal Services
Texas Workforce Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8812

SUBCHAPTER B.Approval of New Local Applicant Proposals
40 TAC sec.sec.827.11-827.14
The new rules are proposed under Texas Labor Code, sec.301.061 which provides 
the Texas Workforce Commission with the authority to adopt such rules as it 
deems necessary for the effective administration of the Act. Texas Labor Code, 
Chapter 305 will be affected by this proposal.

sec.827.11.Proposal Solicitation.
Subject to funding availability, the Commission shall place a public notice 
soliciting proposals for new CIS programs in the Texas Register annually, or as 
otherwise determined by the Commission.

sec.827.12. Proposal Requirements.
(a) The local applicant must specify in the proposal to establish a CIS program 
how each of the following components will be provided, as well as any other 
information requested in the Request for Proposal (RFP). 
(1) Supportive guidance - Individual and group services that address areas of a 
student's needs to assist in bringing about positive results in the student's 
life. This includes, but is not limited to, services such as one-on-one 
counseling, support groups, crisis interventions, court advocacy, or probation 
monitoring. 
(2) Health and Human Services coordination - Services that promote increased 
health awareness and healthy life-styles in participants, and which coordinate 
the provision of social services in conjunction with other community service 
providers. This includes, but is not limited to, services such as health fairs 
and screenings, parenting classes, presentations on health issues, first aid 
classes, or fitness classes. 
(3) Parental involvement - Services and activities to increase the participation 
of parents in the student's educational experience. This includes, but is not 
limited to, services such as parents' night, newsletters, parent surveys, or 
home visits. 
(4) Pre-employment/employment training and services -Services planned and 
conducted to promote career awareness, job readiness skills, and preparation for 
and attainment of employment. This includes, but is not limited to, services 
such as job clubs, employment skills training, job shadowing, career fairs, or 
employment referrals. 
(5) Enrichment activities and experiences - Services which provide training in 
positive social, cultural, recreational, and interpersonal skills and provide 
experiences to broaden and expand a student's life understanding. This includes, 
but is not limited to, services such as field trips, plays, after-school 
programs, clothes drives, or arts and crafts. 
(6) Educational enhancement - The provision of support in all educational areas 
as needed to encourage student achievement and success in the school experience. 
This includes, but is not limited to, services such as tutoring, homework club, 
college field trips, English as a Second Language classes, General Equivalency 
Degree classes, or study skills. 
(b) The local applicant must specify in the proposal to establish a CIS program 
a plan for increasing local financial support. 
(c) The local applicant must include a description of strategies and activities 
demonstrating how the CIS program will be coordinated with other youth programs 
in the local workforce development area. At a minimum, coordination must include 
School-to-Work, Titles IIB and IIC of the JTPA, Youth Opportunities Unlimited 
(YOU), Youth Fair Chance, and Tech-Prep. 
(d) All grant applications for CIS funding must be reviewed and approved by the 
local workforce development board serving the local workforce development area 
in which the local CIS program operates prior to submission of the grant 
application to the Commission.

sec.827.13.Procedure for Proposal Evaluation. 
Funds shall be awarded for implementation of local programs based on evaluation 
of the proposals received in relationship to the criteria specified in the 
Request for Proposal (RFP), and based upon funding availability. The RFP will 
specify the relative weight given to each criteria. In the event that funds are 
not sufficient for all proposals to be funded, funds shall be awarded on the 
basis of evaluation criteria specified in the RFP.

sec.827.14. Proposal Amendments.
No change or amendment may be made to the proposal after it has been submitted 
unless the local applicant can demonstrate to the Commission that the change: 
(1) is necessary due to circumstances beyond its control;
(2) materially affects the proposal; 
(3) will enable the local applicant to meet the purposes and goals of the 
program; and 
(4) will avoid adversely affecting a substantial number of persons in the 
targeted population. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13 1998.
TRD-9802179
J. Ferris Duhon
Acting Deputy Director of Legal Services
Texas Workforce Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8812

SUBCHAPTER C.Approval of Renewal and Expansion Proposals
40 TAC sec.827.21
The new rule is proposed under Texas Labor Code, sec.301.061 which provides the 
Texas Workforce Commission with the authority to adopt such rules as it deems 
necessary for the effective administration of the Act. Texas Labor Code, Chapter 
305 will be affected by this proposal. 

sec.827.21. Continuation Re-Application Procedures.
(a) Annually, a local program currently contracting with the Commission for 
administration of the CIS program must file a reapplication for continuation of 
funding. A notice will be issued to local programs by the Commission advising 
them of the information required, the filing deadline, and any other criteria 
for reapplication. 
(b) Continued funding shall be granted, based upon funding availability, if the 
local program meets the following criteria: 
(1) continued community and school district support; 
(2) continued local financial support; 
(3) continues to operate in school districts with at least 10% of students 
identified as at-risk; 
(4) compliance with contract provisions; 
(5) absence of any unresolved contract issues; and 
(6) coordination of services with the local workforce development boards. 
Coordination of services may be evidenced by board members serving on both the 
local workforce development board and the CIS board; references in the workforce 
development area plan of coordinated activities with CIS; CIS functioning as a 
service provider for the workforce development board; and/or references in the 
CIS plan to involvement in programs or activities administered by the local 
workforce development board. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13 1998.
TRD-9802180
J. Ferris Duhon
Acting Deputy Director of Legal Services
Texas Workforce Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8812

SUBCHAPTER D.Funding of CIS Local Programs
40 TAC sec.sec.827.31-827.33
The new rules are proposed under Texas Labor Code, sec.301.061 which provides 
the Texas Workforce Commission with the authority to adopt such rules as it 
deems necessary for the effective administration of the Act. Texas Labor Code, 
Chapter 305 will be affected by this proposal.

sec.827.31. Compensatory Education Funds.
(a) This Compensatory Education Funds reduction formula shall only apply to 
those CIS programs participating as of August 31, 1995. 
(b) Based on funds awarded to CIS programs in the base year, fiscal year 1996, 
each program shall have the funds annually contributed by the state reduced by 
50% over the next three years. 
(c) Funds to CIS programs shall be reduced as follows: 
(1) in FY99, by 30% from the base year; 
(2) in FY2000, by 40% from the base year; and 
(3) in FY2001, by 50% from the base year. 
(d) Savings accomplished through the reduction in funds to participating CIS 
programs shall be allocated to local workforce development areas of the state 
that are not served by a participating CIS program. The allocation formula shall 
use the following factors: 
(1) percentage of low-income students in the local workforce development area; 
and 
(2) the financial resources of the local workforce development area. 
(e) Funds for new programs shall be awarded through a competitive RFP process. 
(f) Funds not awarded through the Request for Proposal (RFP) process shall be 
reallocated among contracted CIS programs as described in subsection (d) of this 
section. Reallocated funds shall be limited to program expansion and shall not 
be used to replace funds lost through funding reduction.

sec.827.32. JTPA Funds. 
In the event that JTPA funds are made available for the CIS program, the formula 
for allocating savings accomplished through the reduction in Compensatory 
Education Funds to participating CIS programs described in sec.827.31(d) shall 
be utilized to determine the allocation of JTPA funds. 

sec.827.33. Temporary Assistance for Needy Families (TANF) Funding. 
TANF funding shall be subject to a competitive Request for Proposal (RFP) 
process for FY99. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13 1998.
TRD-9802181
J. Ferris Duhon
Acting Deputy Director of Legal Services
Texas Workforce Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8812

SUBCHAPTER E.Program Administration After Approval as a Local Program
40 TAC sec.sec.827.41-827.43
The new rules are proposed under Texas Labor Code, sec.301.061 which provides 
the Texas Workforce Commission with the authority to adopt such rules as it 
deems necessary for the effective administration of the Act. Texas Labor Code, 
Chapter 305 will be affected by this proposal.

sec.827.41. Program Policy Requirements.
(a) Expenditure policies. The local programs shall adhere to the Commission's 
policies regarding procurement of goods and services in expenditure of funds. 
(b) Records retention. Local programs shall maintain all documentation for a 
minimum of three years. In the event of litigation or an unresolved audit 
discrepancy, the local program shall retain the records until the litigation or 
discrepancy is resolved. 
(c) Information requests. The local programs shall comply with all Commission 
requests for additional information for purposes of evaluation.
(d) Identification. The local programs shall use the name "Communities In 
Schools of Texas" for purposes of identification. Only those programs which have 
complied with all requirements set forth by the Commission are entitled to use 
the name "Communities In Schools of Texas." 
(e) Governance. Each local board is governed by a local board of directors. 
(f) Training. Each local program must meet national and state training 
requirements, as stated in its contract with the Commission. Local programs that 
fail to meet such requirements may be deemed out of compliance and shall be 
subject to withholding of funds until the local program is in compliance. 
(g) Data collection. Each local program shall utilize the CISCMS or other system 
as designated by the Commission to track all students served by the CIS program. 
(h) Cost limitations. The administrative costs for operation of a local CIS 
program shall not exceed 15%.

sec.827.42.Operational Plan.
(a) The local program shall prepare an annual operational plan (plan) which 
shall be submitted in accordance with the date established by the Commission in 
the annual planning guidelines. 
(b) Prior to submission of the plan to the Commission, all annual plans for CIS 
funding must be reviewed and approved by the local workforce development board 
serving the local workforce development area in which the local CIS program 
operates. 
(c) The Commission shall issue planning guidelines by August of each year. In 
addition to the content specified in the planning guidelines, the plan shall 
include the following: 
(1) the program goals and objectives; 
(2) the services necessary to implement all six CIS components on each campus; 
(3) the needs and resource assessment, which includes a letter of agreement 
between the local CIS program and the school district;
(4) a description of the linkage between community and campus needs and 
available and provided services; 
(5) a self-evaluation and monitoring plan; 
(6) an annual marketing plan which defines the CIS mission, identifies target 
markets, and establishes a strategy for implementation;
(7) a Program Profile Document; 
(8) a Program Volunteer Plan; 
(9) a description of strategies for developing additional local financial 
resources; and 
(10) a description of strategies and activities demonstrating how the CIS 
program will coordinate with other youth programs in the local workforce 
development area. At a minimum, coordination must include School-to-Work, Titles 
IIB and IIC of the JTPA, Youth Opportunities Unlimited (YOU), Youth Fair Chance, 
and Tech-Prep. 
(d) The Commission shall review the CIS board's plan along with any comments 
from local workforce development boards. The Commission may approve the plan, 
require modifications to the plan, or disapprove the plan.

sec.827.43.Monitoring
(a) The local programs shall evaluate their programs on an ongoing basis and 
submit two reports per program year in accordance with the contract. 
(b) The local programs shall comply with Commission audits, monitorings, and 
evaluations. 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13 1998.
TRD-9802182
J. Ferris Duhon
Acting Deputy Director of Legal Services
Texas Workforce Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8812

SUBCHAPTER F.Compliance
40 TAC sec.sec.827.51-827.55
The new rules are proposed under Texas Labor Code, sec.301.061 which provides 
the Texas Workforce Commission with the authority to adopt such rules as it 
deems necessary for the effective administration of the Act. Texas Labor Code, 
Chapter 305 will be affected by this proposal.

sec.827.51.Preventive Maintenance.
(a) Local programs that fail to meet the requirements stated in the contract 
with the Commission shall be deemed out of compliance and may be subject to 
withholding of funds. 
(b) Preventive maintenance measures, developed to ensure program outcome and 
provide fiscal accountability, will include technical assistance, timely and 
effective program and fiscal monitoring, and quality assurance reviews. 
(1) Technical assistance is performance-driven and outcome-based, stressing the 
sharing of information and best practice models. The focus is on providing 
assistance to front-line staff as they deliver basic services. Assistance is 
provided for both fiscal and program issues. 
(2) Program and Fiscal Monitoring assistance may include site visits, desk 
reviews, and analysis of both financial and program outcomes to help identify 
potential weaknesses before such weaknesses result in sub-standard performance 
or questioned costs. Monitoring may result in recommendations that provide 
practical solutions that can be used to take immediate corrective action. 
(3) Quality Assurance assistance includes routine evaluation of essential 
quality indicators and certification systems which will be enhanced with timely 
and relevant professional training to help develop and maintain the knowledge, 
skills, and abilities required across program lines.

sec.827.52.Sanctions for Non-Compliance.
The Commission may impose the following levels of sanctions, as a result of non-
compliance by a local program.
(1) Level One Sanctions may be imposed as a response to a contractual breach or 
failure to comply with specific state and federal requirements and Commission 
policies. Level One Sanctions may include, but are not limited to, one or more 
of the following actions: 
(A) a requirement that the local program staff participate in technical training 
and quality assurance workshops designated by the Commission;
(B) development and implementation of a formal corrective action plan to address 
the weaknesses identified; 
(C) submission of additional or more detailed financial or performance reports; 
(D) designation as a high-risk program, requiring additional monitoring visits; 
or 
(E) repayment of disallowed costs. 
(2) Level Two Sanctions may be imposed as a response to a severe problem and the 
potential negative impact such a problem may have on the local workforce 
development area or the state. Level Two Sanctions may include, but are not 
limited to, one or more of the following actions:
(A) imposition of one or more Level One sanctions; 
(B) restrictions on the local program's ability to draw down funds; 
(C) possible delay, suspension, or denial of contract payments;
(D) requirement of advance approval by Commission for program actions; 
(E) requirement that a Commission representative be present at all meetings; or 
(F) reduction of contract allocations in future periods; 
(3) Level Three Sanctions may be imposed where a severe or continued failure to 
comply with state or federal laws, regulations or Commission policies has gone 
uncorrected. Level Three Sanctions may include, but are not limited to, one or 
more of the following actions: 
(A) imposition of one or more Level One sanctions; 
(B) imposition of one or more Level Two sanctions; 
(C) deobligation of current year funds; 
(D) contract suspension or termination; or 
(E) submission and Commission approval of a corrective action plan.

sec.827.53.Violations Resulting in Sanctions.
(a) Violations which may result in the imposition of Level One Sanctions 
include, but are not limited to, the following: 
(1) failure to attain or maintain annual performance within 90% of the 
contracted standards; 
(2) failure to submit required financial or performance reports; 
(3) failure to take corrective action to resolve findings identified during 
monitoring, investigative reviews or program reviews; 
(4) breach of administrative and service contract requirements; or 
(5) failure to retain required service delivery and financial records. 
(b) Violations which may result in the imposition of Level Two Sanctions 
include, but are not limited to, the following: 
(1) failure to rectify a Level One sanction within 180 days of notice; 
(2) committing a second violation within the same fiscal year; 
(3) failure to rectify reported threats to the health and safety of program 
participants within thirty days of notice; and 
(4) failure to attain or maintain annual performance within 75% of contracted 
standards. 
(c) Violations which may result in the imposition of Level Three Sanctions 
include, but are not limited to, the following: 
(1) failure to rectify a Level One sanction within 360 days of notice; 
(2) failure to rectify a Level Two sanction within 180 days of notice; 
(3) committing three or more Level One violations or two or more Level Two 
violations within the same fiscal year; 
(4) failure to rectify reported threats to the health and safety of program 
participants within 90 days of notice; and 
(5) failure to return annual performance to 75% of contracted standards within 
two program years.

sec.827.54.Notice of Sanctions.
(a) The specific sanctions to be imposed on a local program by this policy shall 
be determined by Commission staff. 
(b) The Commission shall issue a written notice of pending sanctions indicating 
the violation, the corrective action, and the level of sanction. 
(c) The written notice of pending sanctions shall be sent, at least five working 
days prior to the effective date of the sanction, to the CIS Board Chair, the 
CIS Executive Director, and the local workforce development area Board Chair. 
(d) All notices of sanctions shall be sent by facsimile (fax) transmission, and 
by regular mail for Level One sanctions, or by certified mail, return receipt 
requested, for Level Two or Level Three sanctions.
(e) The effective date of notice shall be the date the facsimile transmission 
notice is sent to the CIS Board. If the notice is transmitted or recorded as 
delivered after 5:00 p.m., then the following business day shall be considered 
the date of notice. 

sec.827.55.Appeals.
(a) CIS Boards may appeal a decision by the Commission under this Chapter. 
(b) A CIS Board must submit a request for appeal within ten days of the date of 
a notice of sanctions. The request for appeal must be directed to the General 
Counsel, Texas Workforce Commission, 101 East 15th Street, Room 614, Austin, 
Texas 78778. 
(c) All appeals and hearings shall be referred to a hearing officer, and shall 
be conducted under the applicable hearing provisions depending on the source of 
funding. The hearing officer will receive oral and written evidence from both 
parties and shall prepare a written proposal for decision.
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on February 13, 1998.
TRD-9802183
J. Ferris Duhon
Acting Deputy Director of Legal Services
Texas Workforce Commission
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8812

TITLE 43. TRANSPORTATION
PART I. Texas Department of Transportation
CHAPTER 9. Contract Management
SUBCHAPTER C. Contracting for Architectural <nl>,<ol> [and] Engineering<nl>, and 
Surveying Services<ol>
43 TAC sec.sec.9.30-9.33, 9.37-9.39, 9.41-9.43
The Texas Department of Transportation proposes amendments to sec.sec.9.30-9.33, 
9.37-9.39, and 9.41-9.43, concerning contracts for architectural, engineering, 
and surveying services. 
The amendments to sec.sec.9.30-9.33, 9.37-9.39, and 9.41-9.43, are necessary to 
comply with Senate Bill 626, 75th Legislature, 1997, which amended Government 
Code, Chapter 2254, Subchapter A, the Professional Services Procurement Act. The 
subchapter specified a two-step hiring procedure for hiring architects and 
engineers. The first step is to find the most highly qualified provider, and the 
second step is to negotiate a fair and reasonable price. Although land surveying 
services were previously included in the subchapter, land surveyors were not 
required to be hired using the two-step procedure. Senate Bill 626 added land 
surveying services to this required procedure. 
The amendments are also necessary to comply with Senate Bill 370, sec.1.23, 75th 
Legislature, 1997, which amended Transportation Code, sec.223.041 to require the 
department to use private sector engineering-related services in accomplishing 
its activities in providing transportation projects. 
Section 9.30 includes land surveying service providers in the purpose of the 
subchapter. 
Section 9.31 clarifies existing terms and deletes terms that are no longer 
necessary. 
Section 9.32 provides that surveying and mapping services will be included in 
the types of work for which the department may contract, and the policy of the 
department to use private sector engineering services to assist in 
transportation projects. 
Section 9.33 eliminates the use of the Texas Register for publication of notices 
and provides that the department will advertise the project in the local 
newspaper. The section clarifies that in the letter of interest the proposed 
team must demonstrate that the provider has a professional engineer, architect, 
landscape architect or surveyor registered in Texas that will sign and/or seal 
the work to be performed on the contract, and the letter of interest should 
include similar project-related experience. 
Section 9.37 clarifies the negotiation period and extensions of that period, and 
that federally-funded contracts are not based on a percentage of construction 
cost. The section provides that a contract may be canceled if negotiations are 
unsuccessful and that a written complaint relating to the selection process may 
be sent to the deputy executive director. 
Section 9.38 clarifies that the provider will correct errors and omissions in 
the work, and a subprovider will be evaluated in the quality of performance 
category, and not in the categories of management, cost administration, and 
timeliness. The section provides that an interim audit may be performed at any 
time and the final audit does not need to be performed as a site audit. Section 
9.39 provides that the provider will be selected on a random basis with no 
provider receiving more than one contract more than any other provider.
Section 9.41 provides the precertification requirements for registered 
professional land surveyors in accordance with Senate Bill 626 and extends the 
department's time to process precertification information from 30 to 60 days. 
The section deletes the standard evaluation form from the documents to be 
included in the precertification questionnaire packet, all references to 
deadline dates that have already passed, and the provision that the department 
will publish a notice requesting submittal for precertification in the Texas 
Register. The section provides that the department will publish instructions 
concerning submittal of information for precertification annually in the Texas 
Register and daily on an electronic bulletin board, and a written complaint 
relating to the selection procedure may be sent to the deputy executive 
director.
Section 9.42 clarifies the audit process, allows more flexibility in obtaining 
an overhead rate audit, and establishes a deadline for the audit report. The 
section clarifies that compensation for provider services may be based on a lump 
sum contract, and administrative qualification is not necessary for the 
providers that are compensated based on units of service rates or percent of 
construction. The section provides that an independent audit organization may 
perform the overhead rate audit, and requires that the end of the fiscal period 
of the audit report must be within 18 months of the provider selection.
Section 9.43 clarifies: existing qualification categories and adds a category 
for registered professional surveyors; that precertification only applies to a 
contract which requires a professional engineer, registered architect, 
registered landscape architect or registered professional land surveyor; that 
for precertification, the department will accept experience gained in other 
states for which that experience is recognized by the appropriate Texas Board, 
but that for contract execution, the provider must be licensed in Texas; and 
category 2.1 to provide that projects must be accurately completed. This 
section: increases the department's access to a broader range of firms with 
qualified personnel in categories 2.10 and 2.11.1; specifies certification 
levels for work categories 12.1.1 and 12.2.1; establishes actual number of years 
of experience required for work categories 14.1.1, 14.2.1, 14.3.1, and 14.4.1; 
and establishes work category 15.5.1 - state land surveying, to include 
precertification requirements for registered professional land surveyors as 
mandated by Senate Bill 626.
Frank J. Smith, Director, Budget and Finance Division, has determined that for 
the first five years the sections are in effect, there will be fiscal 
implications as a result of enforcing or administering the sections. The 
anticipated estimated increase in cost to the state is $82,570 for each year in 
Fiscal Years 1998-2002. There are no anticipated fiscal implications for local 
governments as a result of enforcing or administering the sections. 
The cost of compliance with the section for small businesses who do not 
currently provide an annual overhead audit, will be between $3,000 and $7,500 
per year if a provider of surveying services is awarded a contract or 
subcontract greater than $250,000. The cost of personnel to complete the 
precertification documents is estimated at $1,200. 
There is no anticipated economic cost to persons who are required to comply with 
the rules as proposed. The average provider of surveying services should save 
between $14,000 and $16,000 each year of the next five fiscal years.
Robert L. Wilson, Director, Design Division, has certified that there will be no 
significant impact on local economies or overall employment as a result of 
enforcing or administering the sections. 
Mr. Wilson has determined that for each year of the first five years the 
sections are in effect the public benefit anticipated as a result of the 
amendments will be to expedite the time required between the publication of 
notice and execution of a contract with a provider of surveying services, reduce 
repetitive paperwork, and ensure the competence and capabilities of providers. 
There is no effect on small businesses. 
Written comments on the proposal may be submitted to Mr. Robert L. Wilson, 
Director, Design Division, Texas Department of Transportation, 125 East 11th 
Street, Austin, Texas 78701. The deadline for receipt of written comments will 
be 5:00 p.m. on March 30, 1998. 
The amendments are proposed under Transportation Code, sec.201.101, which 
provides the Texas Transportation Commission with the authority to establish 
rules for the conduct of the work of the Texas Department of Transportation; and 
Government Code, Chapter 2254, Subchapter A, the Professional Services 
Procurement Act, which sets forth requirements for selection and contracting of 
architectural and engineering services. 
No statutes, articles, or codes are affected by the proposed amendments.

sec.9.30. Purpose. 
This subchapter establishes standard procedures for selection and contract 
management of architectural, [and] professional engineering, <nl> and land 
surveying<ol> service providers in accordance with Government Code, Chapter 
2254, Subchapter A, the Professional Services Procurement Act <nl> and 
Transportation Code, sec.223.041. This subchapter only applies to a contract 
which requires a professional engineer, registered architect, registered 
landscape architect, or registered professional land surveyor. Subproviders may 
be precertified for contracts which require architectural, engineering, or 
surveying services.<ol> 

sec.9.31. Definitions. 
The following words and terms, when used in this subchapter, shall have the 
following meanings, unless the context clearly indicates otherwise.
Constructability - The ability of a project to be easily and accurately 
constructed from information presented in plans and specifications[, and 
requiring few clarifications or revisions].
[Consultant approval team (CAT) - The district, division, or special office team 
that approves the provider for the contract.
[Current dollar volume of contract - The total dollar amount of fees under an 
active, authorized contract to a provider by the department, on which the work 
is less than 90% complete, including fees as a prime provider (less any fees for 
work subcontracted), and fees resulting from a subcontract through another prime 
provider.] 
[District, division or special office consultants review committee (DCRC) - A 
department committee that drafts RFPs, evaluates proposals, and recommends 
providers for selection.] 
[Preproposal meeting - A meeting held to answer questions regarding the contract 
and the RFP.] 
Professional services provider (provider) - An individual or entity that 
provides engineering, [or] architectural, <nl> or surveying<ol> services. 

sec.9.32. Provider Services Policy. 
Pursuant to Transportation Code, sec.223.041, it is the policy of the department 
<nl>to<ol> [regarding the regular] use [of] private sector professional services 
<nl>to assist in accomplishing its activities in providing transportation 
projects. Beginning in fiscal year 2000, the department will increase its 
expenditure to private sector providers for engineering-related services at 
least one percentage point per year until the expenditure level for a fiscal 
year reaches a minimum of 35%. In addition, <ol> for preliminary construction 
engineering and engineering design, <nl> the department will seek<ol> to achieve 
a balance between the use of department employees and the use of private 
contractors, provided the costs are equivalent. In order to do so, the 
department may contract the following types of work:
(1)-(5) (No change.) 
(6) architectural observation and inspection; [and] 
<nl>(7)<ol> surveying and mapping; and 
<nl>(8)<ol> [(7)] other engineering,[or] architectural, <nl>or surveying<ol> 
services as defined in Government Code, Chapter 2254, Subchapter A. 

sec.9.33. Notice and Letter of Interest. 
(a) Notice. 
(1) <nl>Electronic notice. Not less than 21 days before the letter of interest 
due date, the<ol> [Texas Register. The] department will <nl>post on an 
electronic bulletin board<ol> [prepare] a notice identifying <nl>the:<ol> 
<nl>(A)<ol> [a] proposed contract or RFP number<nl>;<ol>[,] 
<nl>(B)<ol> work category codes<nl>;<ol> [,]
<nl>(C)<ol> type of selection <nl>in accordance with sec.9.39 of this title 
(relating to Selection Types);<ol>[,] 
<nl>(D)<ol> general description of the project and work to be done<nl>;<ol>[,] 
<nl>(E)<ol> [and] a due date for providers to send letters of interest to the 
department<nl>; and<ol> 
<nl>(F)<ol> <nl>qualification information if the work type is not listed as a 
category in sec.9.43 of this title (relating to Qualification Requirements by 
Work Group)<ol>. [The department will file this notice with the Texas Register 
to be published no later than the 14th day preceding the deadline for receiving 
the letter of interest. If the notice fails to appear in the Texas Register, the 
department will consider the notice posted.] 
<nl>(2)<ol> Newspaper notice. Not less than 21 days before the letter of 
interest due date, the department will publish in a local newspaper within the 
district in which the work will be performed a notice. If the notice fails to 
appear in the local newspaper, the department will consider the notice posted. 
The notice will contain the:
(A) proposed contract or RFP number; 
(B) general description of the project and work to be done;
(C) due date for providers to send letters of interest to the department; 
(D) contact person; and 
(E) location of the electronic bulletin board that contains more information. 
[(2) Electronic notice. Not later than the 10th day preceding the deadline for 
receiving the letter of interest, the department will post on an electronic 
bulletin board a notice containing the same information as the notice published 
in the Texas Register.]
(3) Organizations. The department will publish quarterly a statewide list of 
projected contracts for consulting engineering<nl>,<ol> [and] architectural<nl>, 
and surveying<ol> services and will provide a copy of each list to community, 
business, and professional organizations for dissemination to their membership. 
(b) Letter of interest. 
(1)-(2) (No change.) 
(3) To be considered<nl>:<ol> 
<nl>(A)<ol> <nl>a prime provider or a subprovider<ol> [, providers] must be 
precertified by the deadline for receiving the letter of interest in accordance 
with sec.9.41 of this title (relating to Precertification) unless the work 
category is not listed in sec.9.43 of this title (relating to Qualification 
Requirements by Work Group)<nl>; and<ol> [. (A notice for a category not listed 
in sec.9.43 of this title (relating to Qualification Requirements by Work Group) 
will state the deadlines for submittal of the letter of interest and 
qualification information.)
<nl>(B)<ol> the proposed team must demonstrate that they have a professional 
engineer, architect, landscape architect, or surveyor registered in Texas who 
will sign and/or seal the work to be performed on the contract. 
(4) The letter of interest shall include; 
(A)-(C) (No change.) 
(D) <nl>similar<ol> [special] project related experience; 
(E)-(G) (No change.) 

sec.9.37. Selection. 
(a)-(c) (No change.) 
(d) Submittal of selection. The managing officer will submit the contract 
evaluation summary, evaluation documentation, certification that the [current 
approved] procedures <nl>provided by this subchapter <ol> were used and 
recommendation for selection to the CRC for review. After review, the CRC will 
advise the deputy executive director, or designee, if approved procedures were 
followed in the selection. If the procedural review is acceptable, the deputy 
executive director will concur with the selection.
(e) (No change.) 
(f) Negotiations. 
(1) Selected provider. The department will enter into negotiations with the 
selected provider. The provider shall submit the information required for the 
contract, including a work outline, work schedule, and cost proposal. If the 
information is not submitted to the department prior to selection, the provider 
shall meet requirements for administrative qualification in accordance with 
sec.9.42 of this title (relating to Administrative Qualification) to determine 
the fairness and reasonableness of the contract price. State funded 
architectural contracts are based on percentage of construction cost as provided 
in the General Appropriations Act. <nl>Federally funded contracts are not based 
on percentage of construction cost.<ol> 
(2) Contract execution. The provider shall sign the contract within 35 working 
days from the date of notification to the provider. The CRC may grant a 30-
working day extension. <nl>The deputy executive director may authorize an 
additional extension, for a period not to exceed 30 days. <ol> An extension must 
be authorized before the expiration of the negotiation period or 
<nl>previous<ol> extension. [Additional extensions must be authorized by the 
deputy executive director, for a period not to exceed 30 days.] 
(3) Selection of alternative providers. If the department is unable to execute a 
satisfactory contract containing a fair and reasonable price within the allotted 
time period with the selected provider, negotiations shall formally end with 
that provider and negotiations shall, upon written approval of the managing 
officer, begin with the provider ranked next. Negotiations shall be undertaken 
in this sequence until a contract is awarded <nl>or canceled <ol>. 
(4) DBE/HUB goal documentation. The selected provider shall provide written 
documentation that the provider has met the specified DBE/HUB goal or made a 
good faith effort to meet the goal in accordance with sec.9.38(a) of this title 
(relating to Contract Management), [and] sec.9.40 of this title (relating to 
DBE/HUB Goals)<nl>, and sec.9.55 of this title (relating to Good Faith 
Effort)<ol>. If the provider does not submit such documentation, the department 
will cease negotiation with the provider and enter into negotiation with the 
next provider in the order of preference for this contract. Evidence of good 
faith effort shall be submitted to the managing officer, through the 
department's project manager, for review and acceptance. 
<nl>(g)<ol> Appeal. A provider may file a written complaint concerning the 
selection process with the deputy executive director of transportation planning 
and development or his or her designee.

sec.9.38. Contract Management.
(a) DBE/HUB participation. 
(1) DBE/HUB program goals may be satisfied by the prime provider. <nl> DBE/HUB 
participation opportunities are more specifically addressed in sec.sec.9.50-9.61 
of this title (relating to Business Opportunity Programs).<ol> 
(2) If the prime provider or the subprovider is a DBE/HUB, all work in the trade 
<nl>or profession<ol> of that DBE/HUB provider must be accomplished by employees 
of that provider in accordance with <nl>Government Code, Chapter 2161<ol> [Texas 
Civil Statutes, Article 601i].
(b) Subcontracts. 
(1) A prime provider shall perform at least 30% of the contracted work with its 
own work force. No <nl>subprovider<ol> [subcontractor] may perform a higher 
percentage of the work than the prime provider.
(2)-(4) (No change.) 
(c) Operations. 
(1)-(3) (No change.) 
(4) Suspension of work. The department may suspend the work by: 
(A) verbally notifying the provider; <nl>and<ol> 
(B) providing written notification of the suspension<nl>, including:<ol>[;] 
<nl>(i)<ol> [(C)] identifying the reason for suspension; and 
<nl>(ii)<ol> [(D)] identifying approximate length of suspension and payment 
based on actual work completed as of the date of suspension. 
(5) Payment on <nl>provider<ol> [engineering] contracts. Payment for eligible 
costs will be made within 30 days after receiving a correct invoice. Payment may 
be withheld pending verification of satisfactory work performed. To receive 
payment for services, the provider shall submit to the department project 
manager: 
(A)-(C) (No change.) 
(6) Interim audit. The department may <nl>perform interim audits<ol> [require 
the services of the provider during the construction phase to review shop 
drawings, plans or procedures, or perform other services related to its design. 
If these services are anticipated, the department may request an interim audit 
upon completion and approval of the plans, specifications, and cost estimate.] 
(d) (No change.) 
(e) Errors and omissions. 
(1) Policy. It is the department's policy to require providers to [perform such 
additional work as may be necessary to] correct errors or omissions in the work 
[required under the contract] without undue delay and without additional cost to 
the department. 
(2) (No change.) 
(f) Contract close out. 
(1) Final audit. The department audit office will perform <nl> an<ol> [a site] 
audit of the provider's records in accordance with the terms of the contract. 
(2) (No change.) 
(g) Provider performance evaluations. 
<nl>(1)<ol> If the contract duration is greater than 18 months, the 
<nl>department<ol> project manager will evaluate the prime provider's or 
subprovider's performance [in the categories of management, cost administration, 
quality, and timeliness] upon completion of a phase, upon exemplary performance, 
[and] on an interim basis, <nl>and on completion of the contract<ol>. The 
interim basis evaluation will occur <nl> at least<ol> [not less than] once every 
12 months, or when the managing office determines that the work is behind 
schedule or not being performed according to the contract. [In all contracts, 
the prime provider and subprovider will also be evaluated upon completion of the 
contract.] An evaluation of constructability will be performed on an interim 
basis <nl> at least<ol> [not less than] every 12 months and upon completion of 
the construction contract, if applicable. 
<nl>(2)<ol> <nl>The department will evaluate a prime provider, using a numerical 
score, in the categories of management, cost administration, quality, and 
timeliness.<ol> [The prime provider and subprovider will receive a numerical 
score in each evaluation category for each work category they performed.] The 
prime provider will also receive an overall contract evaluation in each of the 
evaluation categories. 
<nl>(3)<ol> The department will evaluate a subprovider's quality of performance 
using a numerical score. 
<nl>(4)<ol> These performance evaluations will be entered into the CCIS database 
identified in sec.9.41 of this title (relating to Precertification), and will be 
used in determining the qualifications of the prime provider or subprovider in 
accordance with sec.9.34 of this title (relating to Determination of the Short 
List). 
<nl>(5)<ol> The evaluations will be given to the prime provider or subprovider 
for review and comment. Prime provider or subprovider comments, if submitted to 
the department, will be noted in the database. 

sec.9.39. Selection Types. 
The department will perform three types of contract selections. 
(1) (No change.) 
(2) Multiple contract selection. More than one contract, of similar work types 
<nl>and estimated amounts<ol>, will result from the contract notice. The 
<nl>notice<ol> [RFP] will indicate the number <nl>and type<ol> of contracts to 
result from the <nl>advertisement <ol> [notice], and specify a range of scores 
for prime providers that will be considered equally qualified to perform the 
work. 
<nl>(A)<ol> If more prime providers fall within the specified range than the 
anticipated number of contracts, prime providers will be selected on a random 
basis. 
<nl>(B)<ol> If the anticipated number of contracts is greater than the number of 
prime providers that fall within the specified range, then each prime provider 
will be selected for one contract on a random basis for the excess contracts. 
Each of the remaining contracts will be randomly awarded to the prime providers 
who fall within the specific range until all providers have two contracts or all 
contracts have been awarded. If there is still an excess of contracts, then the 
process repeats. 
(3) (No change.) 

sec.9.41. Precertification. 
(a) (No change.) 
(b) Application. 
(1) <nl>Registered<ol> [Professional] architects, [and] professional 
engineers<nl>, landscape architects, and registered professional surveyors<ol> 
or their related subproviders who desire to be precertified by the department to 
perform work on architectural<nl>, <ol> [or] engineering<nl>, or surveying<ol> 
contracts shall submit a completed precertification questionnaire to the CRC for 
review and determination of precertification status. 
(2) A questionnaire, in a form prescribed by the department, or a 
precertification information packet may be obtained by contacting the Texas 
Department of Transportation, Design Division - Consultant Review Committee, 125 
East 11th Street, Austin, Texas <nl>78701-2483<ol> [78701].
(3) (No change.) 
(4) The precertification information packet will include:
(A)-(C) (No change.) 
[(D) copies of the department's standard evaluation forms;] 
<nl>(D)<ol> [(E)] copies of the department's standard contracts, with 
attachments; 
<nl>(E)<ol> [(F)] instructions for administrative qualification; and 
<nl>(F)<ol> [(G)] department overhead guidelines.
(5)-(6) (No change.) 
(c) <nl>Instructions<ol> [Notice]. The department will <nl>publish instructions 
concerning submittal of information for precertification <ol> [have published a 
notice] annually in the Texas Register and <nl>daily<ol> on an electronic 
bulletin board [requesting prime providers and subproviders to submit 
information for precertification].
(d) (No change.) 
(e) CCIS. The department will maintain the CCIS containing qualification 
information submitted in the precertification questionnaire by the prime 
provider or subprovider. [The department will use information obtained from the 
CCIS effective April 1, 1997.] 
(f) (No change.) 
(g) Precertification review. 
[(1) Prime providers and subproviders submitting applications for 
precertification at least 90 days prior to April 1, 1997, will be precertified 
by April 1, 1997, or notified in writing that they did not meet the requirements 
for precertification or that additional information is required for review.] 
[(2) Prime providers and subproviders submitting applications between 90 days 
prior to and 60 days after April 1, 1997, will be precertified within 90 days 
after April 1, 1997, or notified in writing within the same time period that 
they did not meet the requirements for precertification or that additional 
information will be required for review.] 
<nl>(1)<ol> [(3)] Prime providers and subproviders [submitting more than 60 days 
after April 1, 1997,] will be precertified within <nl>60<ol> [30] days of 
receipt of the submittal or notified in writing within the same time period that 
they did not meet the requirements for precertification or that additional 
submittals will be required for review.
<nl>(2)<ol> [(4)] If requested to submit additional information for review, the 
prime provider or subprovider shall submit such information within 30 days of 
receipt of the department's request for such information. If the information is 
not provided within 30 days after receipt of the request, the application for 
precertification will be processed with the information available. The 
department will make a determination on precertification status within 
<nl>60<ol> [30] days of receipt of the additional information [, or by the date 
specified in paragraph (1) or (2) of this subsection, whichever time period is 
longer]. 
<nl>(3)<ol> [(5)] The department will consider the following factors in 
reviewing the precertification questionnaires as specified in sec.9.43 of this 
title (relating to Qualification Requirements by Work Group): 
(A) current [State of Texas] license or registration;
(B) personal experience and training; and 
(C) other requirements of sec.9.43 of this title (relating to Qualification 
Requirements by Work Group). 
(h) (No change.) 
(i) Appeal. A prime provider or subprovider may appeal denial of 
precertification by submitting additional information within 30 days of receipt 
of written notification of denial to the CRC in Austin. This information shall 
justify why the prime provider or subprovider meets the requirements for 
precertification. The CRC will review the information and make a determination 
regarding precertification. <nl>A provider may file a written complaint 
regarding selection for precertification with the deputy executive director of 
transportation planning and development or his or her designee<ol> [The decision 
of the CRC shall be final]. 

sec.9.42. Administrative Qualification.
(a) Exception. <nl>Administrative qualification is not necessary for 
provider<ol> [Providers' compensation for] services included in Group 6 - bridge 
inspection, Group 12 - materials inspection and testing, Group 14 - geotechnical 
services, Group 15 - surveying and mapping<nl>,<ol> and/or Group 16 - 
architecture of sec.9.43 of this title (relating to Qualification Requirements 
by Work Group)<nl>. Providers compensation for these services <ol> is based on 
units of service rates or <nl>a lump sum contract<ol> [percent of construction 
and administrative qualification is not necessary (b) Time to provide 
information. Prime providers and subproviders may provide information described 
in this section prior to selection. This information must be provided after 
selection. The administrative qualification submittal is a separate submittal 
from the precertification submittal, and is submitted to the Texas Department of 
Transportation, Audit Office, 8th Floor, <nl>125<ol> [125th] E. 11th Street, 
Austin, Texas <nl> 78701-2483<ol> [78701]. Administrative qualification 
submittals will not be received by the CRC. Submission prior to selection is 
encouraged to facilitate timely contract execution requirements. 
(c) Evaluation factors. The department will consider the following factors in 
determining qualifications of prime providers or subproviders.
(1) (No change.) 
(2) Overhead rate audit. The prime provider or subprovider must submit an 
overhead rate audit for the most recently completed fiscal year performed by an 
independent certified public accountant<nl>, an independent audit 
organization,<ol> or governmental agency <nl>except as provided in subparagraphs 
(E) and (F) of this paragraph<ol>. [Prime providers or subproviders who have 
been in business for less than one complete fiscal year of the provider, have 
reorganized to the extent that the most recent overhead rate audit does not 
reflect a currently valid overhead rate, or have established and operated an 
accounting system acceptable to the department for a period of less than one 
year shall prepare a projected overhead rate which will be supported by 
estimated expenditures in accordance with the department's overhead rate audit 
guidelines for the first fiscal year's operations since organization, 
reorganization, or implementation of the acceptable accounting system. The 
department's external audit section shall review the estimate and establish a 
provisional combined overhead rate, which may be used in department contracts 
until the firm has completed its first fiscal year of operation, at which time 
the firm shall submit an annual overhead rate audit performed by an independent 
certified public accountant or governmental agency.] 
(A) The audit report shall include statements that the audit was performed in 
accordance with the criteria required by the department and generally accepted 
auditing standards including: 
(i) Federal Acquisition Regulations, 48 CFR 31; <nl>and<ol>
(ii) department overhead guidelines, a copy of which will be included in the 
precertification information packet. 
(B)-(C) (No change.) 
<nl>(D)<ol> The end of the fiscal period of the audit report must be within 
eighteen months of the provider selection.
<nl>(E)<ol> [D] The department may contract with a prime provider or allow 
utilization of a subprovider lacking an approved overhead rate audit if: 
(i) the value of the contract is less than $250,000; 
(ii) the prime provider or subprovider can adequately document and support all 
proposed costs; and 
(iii) all other qualification requirements of this subsection are met. 
[(E) The audit report must be provided within six months after the end of the 
fiscal year observed by the prime provider or subprovider.] 
<nl>(F)<ol> Prime providers or subproviders who have been in business for less 
than one complete fiscal year of the provider, have reorganized to the extent 
that the most recent overhead rate audit does not reflect a currently valid 
overhead rate, or have established and operated an accounting system acceptable 
to the department for a period of less than one year shall prepare a projected 
overhead rate which will be supported by estimated expenditures in accordance 
with the department's overhead rate audit guidelines for the first fiscal year's 
operations since organization, reorganization, or implementation of the 
acceptable accounting system. The department's audit office shall review the 
estimate and establish a provisional combined overhead rate for use in contract 
negotiations. 
(3)-(4) (No change.) 
(d)-(e) (No change.) 

sec.9.43. Qualification Requirements by Work Group.
(a) Requirements. 
<nl>(1)<ol> <nl>Eligible employees.<ol> Prime providers and subproviders may be 
precertified in the technical groups and categories in accordance with 
subsection (b) of this section by providing the listed requirements. A firm may 
only use an individual who is employed by that firm at the time of submittal for 
precertification. [Unless stated otherwise, when a professional license or 
registration is required, the experience requirement includes experience gained 
after professional licensure or registration. Such licenses or registrations 
shall be those issued by the appropriate Texas professional licensing board.] 
<nl>(2)<ol> Experience. For the purpose of experience for precertification, the 
professional provider may be licensed to practice in any state for which that 
experience is recognized by the: 
(A) Texas Board of Professional Engineers for engineers; 
(B) Texas Board of Architectural Examiners for architects and landscape 
architects; or 
(C) Texas Board of Professional Land Surveying for land surveyors.
<nl>(3)<ol> Contract execution. For the purposes of executing a contract and 
doing work in the state, the professional provider must be licensed by the: 
<nl>(A)<ol> Texas Board of Professional Engineers for engineers;
<nl>(B)<ol> Texas Board of Architectural Examiners for architects and landscape 
architects; or 
<nl>(C)<ol> Texas Board of Professional Land Surveying for land surveyors. 
(b) Work Categories. 
(1) (No change.) 
(2) Group 2 - environmental studies. 
(A) Category 2.1.1 - traffic noise analysis. This category includes the 
performance of a traffic noise analysis for a roadway project. The firm must 
employ one person with: 
(i) a bachelor's degree or equivalent experience in environmental studies, urban 
planning, civil or environmental engineering, or a related field; and 
(ii) demonstration of experience in use/application of Traffic Noise Guidelines, 
traffic noise modeling software, and appropriate sound measuring equipment 
through <nl>the accurate<ol> completion of a <nl>traffic noise analysis for 
a<ol> minimum of two highway projects at the FONSI level or above. 
(B)-(C) (No change.) 
(D) Category <nl>2.4<ol> [2.4.0] - U.S. Army Corps of Engineers permits. This 
category includes the following permits:
(i)-(iii) (No change.) 
(E) Category 2.5.1 - water pollution abatement plan. This category includes 
geologic field assessment and the preparation of pollution abatement plans 
<nl>as it relates to the Edwards Aquifer Rules<ol>. The firm must employ one 
person with: 
(i)-(ii) (No change.) 
(F) Category <nl>2.6<ol> [2.6.0] - protected species coordination. This category 
includes the following types of biological coordination. 
(i)-(iii) (No change.) 
(G) (No change.) 
(H) Category 2.8.1 - surveys, research and documentation of historic buildings, 
structures, and objects. This category includes surveys, research, and 
documentation efforts carried out in accordance with the Secretary of the 
Interior's Standards and Guidelines for Archeology and Historic Preservation 
(Volume 48 of the Federal Register, 44716) to comply with sec.106 (Title 16, 
United States Code, sec.470f) of the national Historic Preservation Act of 1966, 
as amended, and other state and federal historic preservation related laws and 
regulations. Associated activities include: delineation of the area of potential 
effects for projects with the potential to affect historic properties; field 
surveys and photographic and written documentation on historic properties 
located within a project's area of potential effects; development of historic 
contexts that provide an organizational and thematic format for evaluating 
historic properties; determinations of National Register eligibility for 
identified historic properties; preparation of historic documentation on 
affected properties in accordance with the documentation requirements of the 
Historic American Buildings Survey and the Historic American Engineering Record; 
evaluation of the effect of projects on significant properties; and the 
development of management and preservation plans for historic properties. The 
firm must employ one person with experience working with the Secretary of the 
Interior's Standards and Guidelines for Archeology and Historic Preservation 
(Volume 48 of the Federal Register, 44716), 36 CFR Part 800, and documentation 
requirements of the Historic American Buildings Survey and Historic American 
Engineering Record and: 
(i) (No change.) 
(ii) a bachelor's degree in architectural history, historic preservation or a 
closely-related field, with course work in American architectural history and a 
minimum of <nl>two<ol> [three] years of direct experience performing surveys, 
research or documentation of historic buildings, structures, and objects. 
(I) (No change.) 
(J) Category 2.10.1 - archaeological surveys, documentation, excavations, 
testing reports and data recovery plans. This category includes: reconnaissance 
or intensive archeological surveys performed in accordance with the criteria 
listed in the Secretary of the Interior's Standards and Guidelines for 
Archeology and Historic Preservation (1982), Reports Relating to Archeological 
Permits in the Rules of Practice and Procedure for the Antiquities Code of 
Texas, and performance standards as outlined in the Council of Texas 
Archaeologists (CTA) Guidelines; documentation of operations that use 
archeological techniques to obtain and record evidence of human activity or 
behavior important in history or prehistory; testing and preparation of testing 
reports to describe the results of work following the investigation and 
evaluation of archeological sites and/or other historic properties; and data 
recovery plans that address appropriate strategies and methodologies for 
excavation and data recovery. The firm must employ a principal investigator: 
(i) (No change.) 
(ii) who has a minimum of one year of supervised field and analytic experience 
in [Texas] archaeology; 
(iii)-(v) (No change.) 
(K) Category 2.11.1 - historical and archival research. This category includes 
historical and archival research on historic properties or historic 
archeological sites, the development of research designs to guide historical 
research efforts, and the development of historic contexts to provide an 
organizational and thematic format for further research and evaluation of 
historic properties and historic archaeological sites. The firm must employ one 
person with: 
(i) a master's degree in history or a closely related field with a minimum of 
one year of full-time experience <nl>in<ol> [managing] historical <nl>research, 
writing, teaching, or other demonstrable professional historical activity<ol> 
and archival research and documentation; or 
(ii) (No change.) 
(L)-(N) (No change.) 
(3)-(11) (No change.) 
(12) Group 12 - materials inspection and testing. 
(A) Category <nl>12.1<ol> [12.1.0] - material testing. The firm must have 
available in-house equipment and employ qualified, certified staff necessary to 
perform the work specified in this category.
(i) Category 12.1.1 - asphaltic concrete. This category includes testing of 
asphaltic concrete material. The firm must employ a minimum of one professional 
engineer with three years of experience in testing roadway construction 
materials and a minimum of one person with the proper Hot Mix Asphalt Specialist 
Certification <nl>(Level 1A minimum)<ol>. 
(ii) Category 12.1.2 - portland cement concrete. This category includes testing 
of portland cement concrete. The firm must employ a minimum of one professional 
engineer with three years of experience in testing roadway and bridge 
construction materials, and a minimum of one person with the proper concrete 
certification <nl>(ACI certification Grade 1)<ol>. 
(B) (No change.) 
(13) (No change.)
(14) Group 14 - geotechnical services. 
(A) Category 14.1.1 - soil exploration. This category includes acquisition and 
reporting of subsurface material to be used for the planning, design, 
construction, and performance of transportation facilities. The field 
classification of materials and acquisition of soil and rock samples is also 
included. The firm must: 
(i) employ a minimum of one professional engineer with <nl> at least one 
year<ol> demonstrated experience in the activities normally associated with the 
category under consideration; and 
(ii) have available the equipment necessary to perform the work. 
(B) Category 14.2.1 - geotechnical testing. This category includes sampling and 
conducting tests on soil and rock according to the department's approved 
procedures for the purpose of classifying materials and/or identifying their 
physical properties. The firm must: 
(i) employ a minimum of one professional engineer with <nl> at least one 
year<ol> demonstrated experience in the activities normally associated with the 
category under consideration; and 
(ii) have available in-house equipment and employ qualified staff necessary to 
perform the work. 
(C) Category 14.3.1 - transportation foundation studies. This category includes 
producing reports which contain selection of the type and depth of foundation 
for bridges, retaining walls, signs, and other types of transportation 
foundations. Working with bearing capacity, predicted settlement, stabilization, 
and construction on soft ground will be required. The firm must employ a minimum 
of one professional engineer with <nl>at least three years<ol> demonstrated 
experience in the activities normally associated with this category. 
(D) Category 14.4.1 - building foundation studies. This category includes 
producing reports which contain selection of the type and depth of foundation 
for buildings. Working with bearing capacity, predicted settlement, 
stabilization and construction on soft ground will be required. The firm must 
employ a minimum of one professional engineer with <nl>at least three years <ol> 
demonstrated experience in the activities normally associated with this 
category.
(15) Group 15 - surveying and mapping. 
(A) Category <nl>15.1<ol> [15.1.0] - right of way surveys. This category 
includes the performance of on the ground surveys and preparation of parcel 
maps, legal descriptions, and right of way maps. The firm must employ a minimum 
of one registered professional land surveyor and two technical personnel, all 
with demonstrated experience in the applicable category of work and the 
following subcategories: 
(i)-(iv) (No change.) 
(B)-(D) (No change.)
<nl>(E)<ol> Category 15.5.1 - state land surveying. This category includes the 
performance of land surveying associated with "the location or relocation of 
original land grant boundaries and corners; the calculation of area and the 
preparation of field note descriptions of both surveyed and unsurveyed land or 
any land in which the state or the public free school fund has an interest; the 
preparation of maps showing such survey results; and the field notes and/or maps 
of which are to be filed in the General Land Office," as quoted in the Surveyors 
Act. The firm must employ a minimum of one licensed state land surveyor with 
demonstrated experience in state land surveying as defined in the category 
description. 
(16)-(18) (No change.)
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State on February 13, 1998.
TRD-9802177
Bob Jackson
Acting General Counsel
Texas Department of Transportation
Earliest possible date of adoption: March 29, 1998
For further information, please call: (512) 463-8630