TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 133. HOSPITAL LICENSING

Subchapter B. HOSPITAL LICENSE

25 TAC §133.26

The Texas Department of Health (department) adopts an amendment to §133.26 concerning the regulation of hospitals with changes to the proposed text as published in the March 17, 2000, issue of the Texas Register (25 TexReg 2288).

The amendment establishes a new plan review fee schedule and a new fee for field surveys in accordance with Health and Safety Code §241.104, as amended by House Bill 2085, 76th Legislature, 1999. The plan review fees formerly ranged from $500 to $3,000 based upon the cost of construction. The new plan review fees range from $300 to $5,000. The former fee charged for field surveys, generally referred to as construction inspections, was $400 per inspection; the new fee is $500.

No comments were received on the proposal during the comment period. However, due to staff comments, the following change was made.

Change: Concerning §133.26(c)(4)(E), a comma was added to $4,000.

The amendment is adopted under Health and Safety Code, Chapter 241, the Texas Hospital Licensing Act; Health and Safety Code, §241.104, regarding hospital plan reviews; and Health and Safety Code, §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 commissioner of health.

§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 §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 §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 §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)

$100,000 or less: $300;

(B)

$100,001 to $600,000: $850;

(C)

$600,001 to 2,000,000: $2,000;

(D)

$2,000,001 to 5,000,000: $3,000;

(E)

$5,000,001 to 10,000,000: $4,000; and

(F)

$10,000,001 and over: $5,000.

(5)

If an estimated construction cost cannot be established, the estimated cost shall be based on $125 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 $500 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 followup 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 §133.62(b)(2) of this title (relating to Cooperative Agreements).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 27, 2000.

TRD-200004461

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: August 1, 2000

Proposal publication date: March 17, 2000

For further information, please call: (512) 458-7236

Chapter 134. PRIVATE PSYCHIATRIC HOSPITALS AND CRISIS STABILIZATION UNITS

Subchapter A. GENERAL PROVISIONS

25 TAC §134.3

The Texas Department of Health (department) adopts the repeal of §134.3, and new §134.3 concerning the regulation of private psychiatric hospitals and crisis stabilization units. New §134.3 is adopted with changes to the proposed text as published in the March 17, 2000, issue of the Texas Register (25 TexReg 2289). The repeal of §134.3 is adopted without changes and will not be republished.

The repeal and new section are in accordance with Health and Safety Code §577.006, as amended by House Bill 2085, 76th Legislature, 1999. The repeal of §134.3 allows the section to be substantially expanded. A majority of the language in new §134.3 matches language and current license fees for general and special hospitals as set out in 25 Texas Administrative Code §133.26. The plan review fee schedule and fee for field surveys of construction projects reviewed, generally referred to as construction inspections, in new §134.3 are being concurrently adopted as amendments to 25 Texas Administrative Code §133.26.

New §134.3 provides a new license fee, the basis of which is the design bed capacity of the private psychiatric hospital, and an explanation of what constitutes design bed capacity. The license fee for an annual initial license or a renewal license changed from $250 for each hospital to $10 per bed based upon the design capacity of the hospital with a minimum license fee of $200 and a maximum fee of $10,000. The new plan review fee schedule changed from $650 each for stage one and stage two plan review, to a fee schedule based upon estimated construction costs with fees ranging from $300 to $5,000. Language that sets out what costs should be included in the estimated construction costs is also included. The section decreases the fee for construction inspections, from $650 for each inspection to $500 for each inspection. Finally, the section includes language from repealed §134.3 concerning compliance for crisis stabilization units.

No comments were received during the comment period. However, due to staff comments, the following changes were made.

Change: Concerning §134.3(c)(4)(B), a semicolon was added to the end of the subparagraph.

Change: Concerning §134.3(c)(4)(E), a comma was added to $4,000.

The repeal is adopted under Health and Safety Code, §577.006, regarding license fees, plan review fees, and construction inspection fees; and Health and Safety Code, §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 commissioner of health.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 27, 2000.

TRD-200004460

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: August 1, 2000

Proposal publication date: March 17, 2000

For further information, please call: (512) 458-7236

The new section is adopted under Health and Safety Code, §577.006, regarding license fees, plan review fees, and construction inspection fees; and Health and Safety Code, §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 commissioner of health.

§134.3.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 nursing units in §134.53 of this title (relating to General Considerations).

(B)

The maximum design bed capacity includes beds that comply with the requirements in §134.53 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.

(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 §134.51 of this title (relating to Construction Plans, Specifications, and Inspections).

(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)

$100,000 or less: $300;

(B)

$100,001 to $600,000: $850;

(C)

$600,001 to 2,000,000: $2,000;

(D)

$2,000,001 to 5,000,000: $3,000;

(E)

$5,000,001 to 10,000,000: $4,000; and

(F)

$10,000,001 and over: $5,000.

(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 $500 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 followup construction inspections are performed to verify plans of correction, the fee shall be submitted upon completion of the inspection.

(e)

Compliance. Fees paid to the department for licensure applications, plan reviews, and construction inspections for crisis stabilization units shall comply with 25 TAC, Part II, Chapter 401, Subchapter K (relating to Licensure of Crisis Stabilization Units).

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 27, 2000.

TRD-200004459

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: August 1, 2000

Proposal publication date: March 17, 2000

For further information, please call: (512) 458-7236

Chapter 146. TRAINING AND REGULATION OF PROMOTORAS

25 TAC §§146.1 - 146.10

The Texas Department of Health (department) adopts new §§146.1-146.10 relating to the creation of a voluntary training and regulation program for promotores(as) or community health workers. Sections 146.1-146.10 are adopted with changes to the proposed text as published in the January 28, 2000, issue of the Texas Register (25 TexReg 511). There are minor changes to all sections. Therefore all should be republished.

These rules are to implement a portion of Chapter 857, 76th Legislature, 1999, creating Health and Safety Code Chapter 46, which creates the voluntary training and regulation program for promotores(as) and community health workers. The rules add a definition of "health"; change the composition of the advisory committee; amend the number of hours per core competency for promotores(as) or community health workers and instructors; amend the number of hours for continuing education for promotores(as) or community health workers and instructors; and, add an appeals process if applications are disapproved. Additional minor changes were made to clarify the proposed rules.

Changes made to the proposed text resulted from more than 150 comments received during the comment period. The details of the changes are described in the summary of comments that follow. Minor editorial changes were made for clarification purposes.

The following comments were received concerning the proposed rules. Following each comment is the department's response and any resulting changes.

Comment: Concerning the term "promotora," numerous comments were made concerning the proper use of non-gender biased terms in the text. It was suggested that promotor(a) be used in the singular form and promotores(as) be used in the plural form.

Response: The department agrees. The text will reflect this editorial change.

Comment: The Promotora Program Development Committee recommends that "health" be defined in §146.1 and that the World Health Organization (WHO) definition be adopted.

Response: The department agrees. The WHO definition of "health" has been added to §146.1 as §146.1(7). The definition of "health" will read " the extent to which an individual or a group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources as well as physical capabilities."

Comment: Concerning the definition of "Promotor(a) or Community Health Worker" in proposed §146.1(9), the Promotora Program Development Committee, the temporary committee established by Chapter 857 of the 76th Legislature to advise the department on the development of a promotor(a) training and certification program, was concerned about promotores(as) or community health workers providing direct services as this is beyond the scope of work for a promotor(a). The Promotora Program Development Committee recommended that the definition be amended to read "provides referral and follow-up services."

Response: The department agrees. The definition of "Promotor(a) or Community Health Worker" in renumbered §146.1(10) has been amended accordingly.

Comment: Concerning the definition of "promotor(a) or community health worker" in proposed §146.1(9), a commenter was concerned that the term "cultural mediation" needs to be more thoroughly defined.

Response: The department agrees; however, this comment does not affect rule language. In addition, no recommendation was made for a change in language. No changes were made to the rule as a result of this comment.

Comment: Concerning the definition of "promotor(a) or community health worker" in proposed §146.1(9), a commenter suggested that "health" be replaced with "health, human services, adult education, youth and elderly".

Response: The department disagrees because the department, in response to another comment, provided a broader definition of "health." No changes were made to the rule as a result of this comment.

Comment: Concerning the word "health" in the definition of instructor in proposed §146.1(7), several commenters suggested that it be deleted.

Response: The department disagrees. The definition of "health" is essential to the practice of a certified instructor. No changes were made to the rule as a result of this comment.

Comment: Concerning the term "community health worker" in its use throughout the text, one commenter suggested that it be replaced with community outreach worker.

Response: The department disagrees with the comment. Community outreach worker does not fully describe the services provided by a promotor(a) or community health worker. The Promotora Program Development Committee also ruled that "community health worker" is the correct term. No changes were made to the rules as a result of this comment.

Comment: Concerning what a promotor(a) or community health worker does, one commenter suggested that their practice reflects the totality of well-being including social, political and spiritual dimensions.

Response: The department agrees. No changes were made to the rules as a result of this comment because the commenter did not indicate the need for a change.

Comment: Concerning the intent of the rules, one commenter noted that the true meaning of this work is to build infrastructure to empower the community to help itself.

Response: The department agrees. No changes were made to the rules as a result of this comment because the commenter did not indicate the need for a change.

Comment: Concerning the use of the term "health," one commenter felt that it did not reflect the social dimension or a holistic approach to what a promotor(a) or community health worker does.

Response: The department agrees and has adopted the WHO definition of health which incorporates these concepts into section §146.1(7).

Comment: One commenter noted that promotores(as) are about service to the community, trust, compassion, sensitivity, and heart and that it is hard to regulate, teach or document these attributes.

Response: The department agrees. No changes were made to the rules as a result of these comments because the commenter did not indicate the need for a change.

Comment: Concerning the composition of the Promotor(a) or Community Health Worker Training and Certification Advisory Committee in §146.2(f), numerous comments were received which recommended that promotores(as) have a stronger role in regulating promotores(as).

Response: The department agrees. The number of certified promotores(as) or community health workers has been increased from two to four on the Promotor(a) or Community Health Worker Training and Certification Advisory Committee in §146.2(f)(1).

Comment: Concerning §146.2(f)(1), commenters questioned what is meant by the "equivalent" and whether it is realistic to have certified promotores(as) on the committee given the timetable.

Response: The department realizes the Promotor(a) or Community Health Worker Training and Certification Advisory Committee will not have certified promotores(as) or community health workers because none will exist at the start. Therefore, an equivalent means those promotores(as) or community health workers in good standing with their communities who can serve in that capacity. No changes were made to the rule as a result of this comment because the commenter did not indicate the need for a change.

Comment: Concerning §146.2(f), commenters suggested the committee must be diverse with a balance of gender, race, ethnic and geographic representation.

Response: The department agrees. However based upon federal civil rights law and Texas Board of Health policy, the Board of Health will insist on this at the time advisory committee members are selected. Geographic diversity is required by Health and Safety Code §11.016(6). No changes were made to the rule as a result of this comment.

Comment: Concerning §146.2(f), staff commented that Health and Safety Code §11.016(b)(2) requires "the inclusion on the advisory committee of at least two members who represent the interest of the public."

Response: The department agrees. Public members will be increased from one to two in accordance with Health and Safety Code §11.016(b)(2) and §146.2(f)(2) has been amended.

Comment: Concerning §146.2(f), the Promotora Program Development Committee and staff have recommended that the composition of the advisory committee include four promotores(as) or community health workers, two public members, two professionals who work with promotores(as) or community health workers in a community setting, and one member from the Texas Higher Education Coordinating Board or higher education faculty who has teaching experience in community health, public health or adult education and has trained promotores(as) or community health workers.

Response: The department agrees. Section 146.2(f) has been modified to reflect this change.

Comment: Concerning §146.2(f), commenters recommended the committee be composed of individuals who know and understand the issues faced/lived by promotores(as) and should include representatives from health and human services, social work, outreach programs, advocacy groups and training programs.

Response: The department agrees. The composition of the Promotor(a) or Community Health Worker Training and Certification Advisory Committee has been changed to reflect those representatives who have working knowledge of and experience with promotor(a) or community health worker activities and issues. The composition includes: four promotores(as) or community health workers, two public members, two professionals who work with promotores(as) or community health workers in a community setting, and one member from the Texas Higher Education Coordinating Board or higher education faculty who have teaching experience in community health, public health or adult education and has trained promotores(as) or community health workers.

Comment: Concerning §146.2(f), numerous commenters suggested that future composition of the committee should ensure that at least 50% of its members have ongoing and day to day work experience with promotores(as) or community health workers.

Response: The department agrees. Rule language has been amended to reflect this recommendation. Each committee member, with the exception of the public members, must be a promotor(a) or community health worker or have experience working with or teaching promotores(as) or community health workers.

Comment: Concerning §146.2(f), commenters recommended that the Promotora Program Development Committee, the temporary committee established by House Bill 1864 of the 76th Legislature, become the Promotor(a) or Community Health Worker Training and Certification Advisory Committee and that PPDC members be given three years to serve.

Response: The department disagrees. The Promotora Program Development Committee is a temporary committee established by the legislature in Article 1. of Chapter 857 whose responsibility will end in September 1, 2001, and whose function is different than the proposed Promotor(a) or Community Health Worker Training and Certification Advisory Committee. No change was made to the rule as a result of this comment.

Comment: Concerning §146.2(f), several commenters noted that they were not convinced that the most appropriate individuals to serve on such an important committee would be selected and asked who else can elect or assist the board to elect the committee members.

Response: The department disagrees. The Texas Board of Health's nominating and selection processes for advisory committee members is open. Nominations are solicited widely from across the state and selection is made by the board's human relations committee and the full board in open meetings with opportunity for public comment. The board will insist on appropriate and diverse representation to the committee.

Comment: Concerning §146.2(f), one commenter noted that "we don't want to create some kind of standard without promotor(a) input and loose the essence of what promotores(as) are about."

Response: The department agrees. No changes were made to the rule as a result of this comment because no specific changes to the rule was suggested.

Comment: Concerning §146.2(f), one commenter asked "are we birthing a new profession or are you trying to regulate it to extinction?" In addition, the commenter mentioned that lawyers regulate lawyers, physicians regulate physicians and that promotores(as) should also be recognized for their expertise.

Response: The department agrees that promotores(as) or community health workers should have a stronger voice on the proposed committee. The changes to the Promotor(a) or Community Health Worker Training and Certification Advisory Committee noted in response to previous comments to take into consideration the need for more representation by promotores(as) or community health workers. No changes were made to the rule as a result of the commenter's question, because changes that address these concerns were made in response to a previous comment.

Comment: Concerning §146.2(f), one commenter suggested that certification needs to be placed in the hands of the promotores(as).

Response: The department agrees. The changes to the Promotor(a) or Community Health Worker Training and Certification Advisory Committee take into consideration the need for more representation by promotores(as) or community health workers. No change was made to the rule

Comment: Concerning §146.2(f)(5), one commenter recommended that university faculty members have experience with either the education of, or in working with community health workers.

Response: The department agrees. This change has been reflected by language added in §146.2(f)(5).

Comment: Concerning §146.2, several commenters recommended that each committee appointee be accompanied by a promotor(a) counterpart.

Response: The department disagrees. The department has amended the composition of the advisory committee to ensure a balance of promotores(as) or community health workers and agency/professional representatives. No change was made to the rule as a result of this comment.

Comment: Concerning §146.3, numerous commenters were concerned about the benefits of becoming a certified promotor(a), and who will benefit from this process.

Response: The intent of the legislation, Chapter 857 enacted by the 76th Legislature, was to bring uniformity to the training of promotores(as) or community health workers and to validate and recognize promotores(as) or community health workers for their work. The department agrees with this intent. It is expected that by becoming certified, a promotor(a) or community health worker will have more options for future employment and employers will have the option of selecting a community workforce which is qualified and well-trained. No changes to the rules were made as a result of this comment, because no specific changes to the rule was suggested.

Comment: Concerning §146.3, several commenters were concerned about what will happen to those promotores(as) who are not certified.

Response: The training and certification program is voluntary as required by Health and Safety Code, §46.002. Regardless of whether promotores(as) or community health workers seek certification or not, they may continue to practice. No changes to the rule were made as a result of this comment, because no specific changes to the rule was suggested.

Comment: Concerning §146.3, several commenters were concerned that there would not be anyone to advocate for promotores(as) who are not affiliated with organizations and are not paid for their work or that there would not be access to the training and certification program.

Response: The department disagrees. Access to the voluntary training and certification cannot and will not be denied on the basis of compensation or organizational affiliation. No changes to the rule were made as a result of this comment.

Comment: Concerning §146.3, several commenters were concerned about the financial cost to the promotor(a) for attaining this voluntary certification.

Response: The department agrees with these concerns. The department recommends that the sponsoring institution or training program not require fees from the individual promotor(a) or community health worker. The department under the present legislation is not authorized to collect fees from the promotor(a) or community health worker, instructor or sponsoring institution or training program. No changes to the rule were made as a result of this comment, because the department has no control over the fees charged by the institutions in question.

Comment: Concerning §146.3, several commenters asked "what will happen with local training and credentialing efforts by entities such as El Paso Community College?"

Response: Nothing will happen to this effort. El Paso Community College may apply to become a sponsoring institution or training program for promotores(as) who seek certification. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.3, one commenter noted that "people need to tell us that we are doing a good job and you can go to school and get a certification."

Response: The department agrees. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter said "without certification we can't get recognized and without certification and recognition we can't get paid."

Response: The department disagrees with this comment; this is a voluntary training and certification program and does not preclude employment or compensation. Employment qualifications will be up to individual employers as they are now. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter wanted to know "what is going to be the basic salary for the promotores(as)?"

Response: The department is not responsible for determining a salary structure for paid promotores(as) or community health workers. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.3, one commenter said "you can reward with better pay, better benefits, more opportunities to be integrated and to be respected but it is extremely difficult to regulate something you cannot regulate."

Response: The department agrees that certification could bring about greater benefits for promotores(as) or community health workers. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter noted that there needs to be a linkage between the academic sector and the health and human service sector so that there are positions and market created for community health workers.

Response: The department agrees. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.3, one commenter noted that programs do not pay for training promotores(as) and suggested that the rules identify who should pay for training.

Response: The department disagrees. The issues of the cost of training and who will pay these costs are beyond the scope of these rules. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter said " there should be very clear guidance that says that certification is extremely valuable if it is going to improve the working conditions and the opportunities for promotores(as)."

Response: The department disagrees. While the department believes the rules can serve these goals, working conditions and opportunities will ultimately be decided upon by employers. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter said that she speaks in favor of any action which would enhance, which would recognize and which would promote the promotores(as) movement and that the regulations should seek to be inclusive rather than exclusive.

Response: The department agrees and thanks the commenter for her encouragement. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter said "promotores(as), if they are going to become part of the workforce that contributes to wellness, need to be respected not only in the area of education and in the area of giving them the knowledge to do their work, but in the areas of giving them the salary, giving them the benefit, giving them everything that they go around talking to the community about."

Response: The department agrees but notes that these issues are beyond the scope of these rules. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, one commenter noted that promotores(as) should be looked at as providers of the same knowledge that they themselves need to impart and give them a certificate.

Response: The department agrees with providing a promotor(a) or community health worker an instructor certificate if they meet the eligibility exemption or successfully complete an instructor's training program. No changes were made to the rules as a result of this comment, because no specific changes were suggested by the commenter.

Comment: Concerning §146.3, one commenter noted that "what I ask you is to value our desire, our willingness and to allow us to have that pride when some people ask us to have some paper in writing and to be able to obtain that dignity to say here it is, I do have it."

Response: The department agrees. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the commenter.

Comment: Concerning §146.3, several commenters are concerned that the rules and regulations are too restrictive and that doors will close as a result.

Response: The department disagrees. This is a voluntary training and certification program only. Promotores(as) or community health workers can continue to practice regardless of certification status. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.3, several commenters felt that the rules put up barriers and restrictions to their practice.

Response: The department disagrees. This is a voluntary training and certification program only. A community health worker can continue to practice regardless of certification status. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.4(c)(1), several commenters said that requiring specific personal data, social security number or status will deny access to many promotores(as) who would be interested in being certified.

Response: The department disagrees. The proposed rules do not specify what personal information will be collected. The department will make the referenced information optional data items on application materials. No change was made as a result of the comments.

Comment: Concerning §146.4(c)(1), several commenters asked, "does this imply that only permanent residents and/or citizens could be certified?"

Response: The department disagrees. There are no requirements associated with citizenship or residency. No changes were made to the rules as a result of this comment.

Comment: Concerning §146.4(c)(1), a large majority of the commenters spoke about an educational requirement such as a GED or high school diploma as a major barrier to obtaining their certificate.

Response: The department disagrees. The rules do not contain any requirement specific to educational attainment. No changes were made to the rule as a result of these comments.

Comment: Concerning §146.4 in general, many commenters were concerned that the rules would require them to speak both English and Spanish.

Response: The department disagrees. The definition of promotor(a) or community health workers does not include a bilingual requirement but only states that "culturally and linguistically appropriate health education" be provided. The department recognizes that promotores(as) or community health workers must relate to their communities in the language residents understand. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.4 in general, a couple of commenters asked if persons do not speak English will they have the same opportunities as those that do.

Response: The department disagrees. The rules do not speak to a bilingual requirement. All promotores(as) or community health workers will have the same opportunity to be certified regardless of language spoken. Employment qualifications are up to individual employers. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.4(e)(1)(D), several commenters suggested that "unprofessional conduct" be replaced with "unethical" conduct since promotores(as) are paraprofessionals.

Response: The department agrees. "Unethical conduct" has replaced "professional conduct" in §146.4(e)(1)(D).

Comment: Concerning §146.4(e)(1)(D), one commenter asked if there will be provisions for a code of ethics or required coursework in unethical conduct.

Response: The department disagrees. Coursework should address unethical conduct; however, the rules do not include a code of ethics. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.4(e)(1)(E), one commenter mentioned that she was blind but was able to perform as a promotor(a) and said this physical limitation would prevent her from receiving a certificate.

Response: The department disagrees. The rules state that the department may disapprove the application if the applicant has developed an incapacity, which in accordance with the Americans with Disabilities Act, prevents the practice of promotor(a) or community health worker service with reasonable skill, competence, and safety to the public as the result of: (i) an illness; (ii) drug or alcohol dependency; or (iii) another physical or mental condition or illness. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.4 in general, the Promotora Program Development Committee recommended than an appeals process be added.

Response: The department agrees and has added a reconsideration process as §146.4(e)(4).

Comment: Concerning §146.7(a)(1), one commenter recommended that promotores(as) that are currently practicing should be "grandfathered in" and that other "levels" should exist for those that wish to volunteer only and those that wish to seek an "entry level" certification to be as inclusive in the process as possible.

Response: The department disagrees. A certificate will recognize all those who have performed promotor(a) or community health worker services during the three-year period preceding the effective date of these rules and not less than 1000 cumulative hours during any 12 consecutive months. This certificate recognizes those promotores(as) or community health workers who can be "grandfathered in." Secondly, a certificate will recognize all those promotores(as) or community health workers who have successfully completed an entry-level training and certification program. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.7(a)(1), one commenter thought there should be categories of promotores(as) which would reflect paid and non-paid status.

Response: The department disagrees and recognizes that any promotor(a) or community health worker may or may not be compensated with or without certification. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.7(a)(1), one commenter noted that social worker certification has levels and wanted to know if the department envisions a similar process.

Response: The department disagrees and recognizes that any promotor(a) or community health worker may or may not be compensated with or without certification. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.7(a)(1), one commenter recommended that there should be a distinction between "volunteer" promotores(as) and those who are certified and/or paid.

Response: The department disagrees and recognizes that any promotor(a) or community health worker may or may not be compensated with or without certification. No changes were made to the rules as a result of this comment.

Comment: Concerning §146.7(a)(2), one commenter suggested that identification cards should have a picture of the promotor(a) on it so that community residents can identify them as a promotor(a).

Response: The department agrees. For §146.7(a)(2), the second sentence will read "The identification card issued to a promotor(a) or community health worker and instructor shall bear the signature of the commissioner and contain a photo of the promotor(a) or community health worker and instructor."

Comment: Concerning §146.7(b), several commenters recommended that the wording "not less than 12 consecutive months" be replaced with the following "not less than 1000 cumulative hours during any 12 consecutive months."

Response: The department agrees and will amend §146.7(b) with "not less than 1000 cumulative hours during any 12 consecutive months" to ensure that migrant health workers have the opportunity to seek certification.

Comment: Concerning §146.7(c), several commenters suggested an inclusion to the existing rule which reads "licensed/certified social workers, nurses, physicians in good standing who have acted as supervisors, trainers, coordinators and /or have experience in performing community outreach."

Response: The department disagrees. To act as a supervisor or coordinator or to perform community outreach does not indicate the ability to instruct. However, the department has amended this rule to read "other licensed/certified healthcare professionals including social workers in good standing who have acted as instructors of promotores(as) or community health workers."

Comment: Concerning §146.7(c), one commenter asked if individuals enrolled under the special provisions rule would be expected to complete the required approved training to maintain certification or whether acquisition of continuing education units would be sufficient to maintain certification.

Response: Those enrolled under §146.7(b) and (c) will not be required to go through training to receive their certificate; however, they must maintain their certificate through the required continuing education process. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the commenter.

Comment: Concerning §146.7(c), one commenter said that close attention should be paid to the selection of trainers/instructors because they will influence how well prepared and equipped community health workers will be.

Response: The department agrees and has specified the basic requirements for instructors but their selection will ultimately be up to the educational institution. No changes were made to the rules as a result of this comment.

Comment: Concerning §146.7(e), one commenter asked "who will train and determine the competency of instructors?"

Response: The sponsoring institution or training program will be responsible for training and determining competence of instructors. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the commenter.

Comment: Concerning §146.7(e), several commenters suggested that promotores(as) would benefit from instructors who are bilingual and multicultural; are able to train on the topic and understand the principles of adult and community education; have ongoing work experience with promotores(as); are native to the area; and/or have been promotores(as) or outreach workers.

Response: The department agrees. These criteria should be considered by training programs and sponsoring institutions when employing instructors and nothing in the rules prevent the consideration of these criteria. No changes were made to the rule as a result of these comments, because no specific changes were suggested by the commenters.

Comment: Concerning §146.7(f), several commenters said that "to a certain degree the regulation and certification of promotores(as) is good for the field, if the certification also brings in recognition, respect and rewards from all community institutions."

Response: The department agrees. No changes to the rule were made as a result of this comment, because no specific changes were suggested by the commenters.

Comment: Concerning §146.7(f), several commenters indicated that certification training can be done by qualified health and social service organizations working with promotores(as), community colleges, and vocational colleges.

Response: The department agrees. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the commenters.

Comment: Concerning §146.7(f), several commenters said "that training institutions should provide morning and evening classes."

Response: The department disagrees. Training programs or sponsoring institutions will need to accommodate adult learners, but the timing of classes is best left to the educational institutions which best understand community needs. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.7(f), several commenters recommended that there be a partnership established with training institutions that will assist with the cost of training and certification.

Response: The department agrees. Organizations that employ or use promotores(as) or community health workers should provide feedback for improving training programs and should partner with training programs or sponsoring institutions so that the promotor(a) or community health worker does not incur costs. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the commenters.

Comment: Concerning §146.7 in general, several commenters asked, "will TDH guidelines for certification be the only ones, and if so, how can we make sure that TDH is aware of the strengths and contents of the promotor(a) training programs at the local level? Will these programs be approved, supported, recognized, or discarded?"

Response: The department is required by legislation to establish and operate a program designed to train and certify persons who act as promotores(as) or community health workers. To do so, the Texas Board of Health must adopt rules that provide minimum standards and guidelines. These rules will be the only ones established by the State of Texas that relate to the training and certification of persons who act as promotores(as) or community health workers. Local level programs may apply to the Texas Department of Health to become a certified training program or sponsoring institution. No local level program will be discarded as this is a voluntary training and certification program and nothing prohibits local level programs from operating. No changes were made to the rules as a result of this comment.

Comment: Concerning §146.7 in general, one commenter said "you are going to channel promotores(as) into a box and they won't be able to get out and you are going to be able to exclude with this system. As it is written, you are going to be able to exclude some of the most wonderful people that can't fit into your box. So my recommendation is to start over and this time don't be the culprit."

Response: The department disagrees. This is a voluntary training and certification program and does not prevent anyone who has been practicing as a promotor(a) or community health worker, or who wishes to start such a practice, from doing so. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.7 in general, one commenter was concerned that the rules would exclude immigrants.

Response: The department disagrees. Immigrants will not be excluded from the training and certification program if they are providing community health worker services. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.7 in general, one commenter said that these trainings are going to help promotores(as) to continue with their careers and to advance their education in a more professional manner with regards to health.

Response: The department agrees and thanks the commenter. No changes were made to the rules as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8(b)(1), one commenter said that using the National Community Health Advisor Study was ludicrous because it didn't contain the word promotor(a) in it nor was it appropriate to use as a guideline to determine the rules for certifying promotores(as).

Response: The department disagrees. The National Community Health Advisor Study was a collaborative effort of many from across the country including significant contribution by Texas leaders and promotores(as) or community health workers. This documentation can be found in the study. The term promotor(a) is one of about 30 terms used to represent individuals who provide community health services. This study provides very clear guidance concerning the importance of certification in improving the working conditions and opportunities for promotores(as). No changes were made to the rules as a result of this comment.

Comment: Concerning §146.8(b)(1), several commenters suggested the addition of "skill" and "knowledge" in the rule to read "eight core skill and knowledge competencies."

Response: The department agrees and has added the words "skill and knowledge" to clarify the rule.

Comment: Concerning §146.8(b)(1), several commenters suggested that more emphasis be placed on cultural competency within the core skill competencies.

Response: The department agrees; however, this comment does not affect the rule language. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8(b)(2), several commenters and the Promotora Program Development Committee recommended that 5 clock hours per core competency is insufficient and have recommended that 20 hours per core competency is more appropriate.

Response: The department agrees with 20 clock hours per core competency. This certificate is an entry-level certificate and it is felt that to require 20 hours would indicate a commitment to quality and standards of practice. The department has amended the 5 clock hours to "at a minimum 20 clock hours of knowledge and skill-building per core competency for promotores(as) or community health workers."

Comment: Concerning §146.8(b)(2), one commenter suggested that a minimum of 20 clock hours of knowledge training for promotores(as) or community health workers as to the nature and extent of each of the following categories of programs that are available to the population those promotores(as) or community health workers are to serve: health, human services, adult education, youth and elderly programs.

Response: The department agrees. The rules have already been amended to include at a minimum of 20 clock hours of knowledge and skill building per core competency in response to previous comment. The department acknowledges that there will be a need for significant content knowledge as entry-level promotores(as) or community health workers expand into serving different age groups and programs. Emphasis is placed on "at a minimum" in this rule. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8(b)(2), one commenter said that she understood that the proposed rules required 500 hours of training. She said " you know promotores(as) also have to see their families and put food on the table. So it is very hard for them to go to a 500 clock hour training especially if they are not given any compensation and any kind of money to this."

Response: The department disagrees for reasons expressed in the two preceding comments and responses. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8 in general, a commenter wanted to know what kind of training and courses will be offered and whether this will duplicate efforts already done by TDH to certify Community Health Aides.

Response: The department disagrees. There are no efforts to certify community health aides. These individuals provide distinctly different services from what a promotor(a) or community health worker provides. Competency-based training will be offered to promotores(as) or community health workers. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8 in general, several commenters asked "what are the mechanics that involve certification, that is, what do you need to be a promotor(a) or community health worker and what do you need to be a trainer."

Response: Promotores(as) and instructors must apply to the department to become a certified promotor(a) or instructor. This application must document the successful completion of a training and certification program. Procedures for applying are contained in §146.7. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment

Comment: Concerning §146.8(b)(3), several commenters suggested that evaluation and documentation of knowledge and mastery of skills be defined.

Response: The department disagrees. The department is adopting the recommended performance measures framework identified within the National Community Health Advisor Study, June 1998 as a reference point for evaluating mastery of skills and documenting knowledge acquisition. No changes were made to the rule as a result of these comments.

Comment: Concerning §146.8(b)(3), several commenters asked "what tools will be used to evaluate and will they be culturally competent and bilingual? Who will identify and/or design the evaluation tools? It will be important to be specific on the level of the evaluation framework."

Response: The department agrees that the evaluation tools need to be specific to the competencies being taught and accurately measure competence. Evaluation tools will be designed by the training program or sponsoring institution and will be used to evaluate the mastery of skills and knowledge acquired by promotores(as) or community health workers and instructors. Training programs or sponsoring institutions will have to submit these tools when applying for certification to the department. The department will insist that these tools are linguistically appropriate and culturally competent. No changes were made to the rule as a result of these comments, because no specific changes were suggested by the comment.

Comment: Concerning §146.8(b)(3), several commenters asked "what is the definition of hours of knowledge and skills, will hours be more important, will skills, how will the committee assess that promotores(as) have both?"

Response: Knowledge and skills are categorized by the eight competencies including communication skills, interpersonal skills, service coordination skills, capacity-building skills, advocacy skills, teaching and organization skills and knowledge base, for example content knowledge in diabetes, infectious or communicable diseases. Skills will be more important; however, there is a minimum number of hours per knowledge and skill competency that must be acquired. The committee will require a signature from the training program or sponsoring institution verifying that promotores(as) or community health workers or instructors have successfully completed and mastered the required skills and knowledge. No changes were made to the rule as a result of these comments, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, the Texas Agricultural Extension Service noted that they would like to be recognized and supported as a potential training institution for volunteers and promotores(as) because they have structure and a model that is based on success of their existing training efforts.

Response: The department will look forward to receiving an application from the Texas Agricultural Extension Service requesting approval as a training program or sponsoring institution. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, one commenter suggested that more emphasis be placed on diabetes because of its devastating affects on people especially in South Texas.

Response: The department agrees that knowledge should be acquired by promotores(as) or community health workers in disease specific conditions that are disproportionately severe in population groups they intend to serve. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, one commenter noted that it is more important to serve the community than receive certification and that the community will not value certification but the service delivered by a promotor(a).

Response: The department agrees but, the training and certification program is voluntary and does not prevent promotores(as) or community health workers from providing service to their communities. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, one commenter suggested that a promotor(a) instructor training tool that is a step by step guide would be helpful.

Response: The department agrees and will recommend that training programs or sponsoring institutions develop best practice guides to support both promotores(as) or community health workers and instructors. The department believes that such a recommendation does not require amending the rules. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, one commenter said " I think we should just be given one (a certificate) because we are promotores(as) and we put our heart into it."

Response: The department agrees that promotores(as) put their heart into the work; however, promotores(as) must apply for a certificate as provided by the rules. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8 in general, one commenter recommended that more community studies and research is needed.

Response: The Promotora Program Development Committee was created by the 76th Legislature, 1999, to study issues associated with the training and certification of promotores(as) and to report its findings to the governor, the legislature and the department by December, 2000. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8(b)(12), one commenter said, "the rule does not recognize the possibilities for technology to be used to expand this resource into remote areas of the state. There are many models for interactive technology that might be employed effectively to train promotores(as)."

Response: The department agrees. Applications received from training programs or sponsoring institutions, which utilize interactive technology, will be considered for approval. The rule has been amended to read "be live and interactive and directed by an approved instructor or delivered by an approved instructor through interactive technology in real time."

Comment: Concerning §146.8 in general, one commenter recommended that the education take into account individual community differences.

Response: The department agrees, but believes the rules already permit this. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8(b)(6), one commenter asked, "will tests be necessary?"

Response: Evaluation of promotor(a) or instructor skills and knowledge will be the responsibility of the training program or sponsoring institution and may require a written or oral test to ascertain competence. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, one commenter recommended that promotores(as) need to determine what the certification process is and what training components are needed and together with their community they need to determine who is certified at all.

Response: The department agrees. Promotores(as) or community health workers are members of the Promotora Program Development Committee which identifies skill and knowledge competencies for training. Promotores(as) or community health workers will also be members of the Promotor(a) or Community Health Worker Training and Certification Advisory Committee. This committee will recommend to the department who should be certified. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.8 in general, one commenter suggested that the Promotora Program Development Committee should look at identifying "best practices" within the promotor(a) or community health worker field.

Response: The department agrees, but the activities of this committee are not addressed by these rules. One of the charges to the Promotora Program Development Committee is to make recommendations regarding the curriculum for promotores(as) or community health workers and instructors to the department. These recommendations will be based on extensive research and study of "best practices." No changes were made to the rule as a result of these comments.

Comment: Concerning §146.8 in general, one commenter said "we want to make sure that one of the things we put on the table is the heart and soul of the person who is going to be doing this. The fact that it should be a holistic approach, not one limited by convenience, not one limited by medical practices, and not one limited by any type of requirement."

Response: The department agrees. The certification process is open to all who wish to obtain a certificate. The training will take into consideration a holistic approach and will be sensitive to the adult learner and needs of the community. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8 in general, one commenter recommended the training build on the positive elements that promotores(as) bring to the table and not to replace those elements with something new.

Response: The department agrees. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.8 in general, one commenter suggested that the training not give the promotor(a) a specialization in one knowledge area but the knowledge to maneuver through the complicated maze of health care that we has developed as a result of managed care.

Response: The department agrees. One of the skill and knowledge competencies includes service coordination in addition to acquiring a knowledge base. No changes were made to the rules as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.9(c), several commenters were concerned that certification was for only two years.

Response: The department disagrees. Certification must be renewed every two years. Renewal is based on receiving an adequate number of continuing education hours as noted in §146.10 during a two year period and reporting the number of hours attained to the department at the end of each two year period. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.10 in general, one commenter noted that continuing education would serve to better a promotor(a)'s reputation in their community.

Response: The department agrees. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.10 in general, one commenter noted that requesting renewal of the certificate would guarantee that promotores(as) are trained to do the job better.

Response: The department agrees. No changes were made to the rule as a result of this comment, because no specific changes were suggested by the comment.

Comment: Concerning §146.10 in general, one commenter asked "why are we going to limit the experiences, the service and the work they do?

Response: The department disagrees. This process is voluntary and does not prohibit the promotor(a) or community health worker from practicing. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.10(f), one commenter said "you are tying them to rules that say you have 120 days to bring me your certification. Because it doesn't belong to you, it is only lent to you."

Response: The department disagrees. The "120 days" comment refers to a one time only extension in §146.10(f)(1), which refers to the completion of the continuing education requirement. Every opportunity will be given to the promotor(a) or community health worker to renew his/her certificate. No changes were made to the rule as a result of this comment.

Comment: Concerning §146.10(b), one commenter suggested it be replaced in its entirety with "continuing education requirements for recertification shall be fulfilled during each biennial renewal period. A promotor(a) or community health worker must complete 200 contact hours of continuing education acceptable to the department during each biennial renewal period. An instructor must complete 64 contact hours of continuing education acceptable to the department each biennial renewal period."

Response: The department disagrees. The number of hours recommended may present or be perceived as a barrier to many promotores(as) or community health workers who wish to voluntarily seek training and certification. However, the department will adjust the number of hours to read "A promotor(a) or community health worker must complete at a minimum 80 contact hours of continuing education acceptable to the department during each biennial renewal period. An instructor must complete at a minimum 32 contact hours of continuing education acceptable to the department during each biennial renewal period.

Comment: Concerning §146.10 in general, one commenter asked " who will develop the continuing education requirements for promotores(as)?"

Response: The number of hours and types of continuing education are set by the department through the rules. Continuing education will be developed and delivered by certified training programs or sponsoring institutions. No changes were made to the rule as a result of this comment.

The comments on the proposed rules received by the department during the comment period were neither for nor against the rules in their entirety; however, they raised questions, offered comments for clarification purposes, and suggested clarifying language concerning specific provisions in the rules.

The commenters were Representative Roberto Gutierrez, Avance, Bienstar Familiar, Brownsville Community Health Center, Cancer Consortium of El Paso, Cancer Information Service, Centro Mujeres de la Esperanza, Centro de Salud Familiar, City of Fort Worth Health Department, City of Laredo Health Department, College of Health Sciences of the University of Texas at El Paso, Crockett Elementary School in Harlingen, El Paso Community College, Houston African-American Health Coalition, Houston Asian-American Health Coalition, Houston Mexican-American Health Coalition, Houston Native-American Health Coalition, Kellogg Community Partnership, La Clinica de Valle, La Fe Clinic, Mano a Mano, Mercy Hospital in Laredo, Migrant Health Promotion, Paso del Norte Health Foundation, Planned Parenthood, Project Arise, Promotora Program Development Committee, Region Six Department of Health and Human Services, Rio Grande Valley Council, San Mateo Episcopal Church, South Texas Community College, South Texas Promotora Association, TAMIU, Texas A&M University Family Community Center, Texas A&M University Colonias Program, Texas A&M University, Texas Agricultural Extension Service, US/Mexico Border Health Educators, University of Texas Border Health, Weslaco School District. In addition, numerous individuals commented. All commenters were not against the rules in their entirety, however they expressed concerns, asked questions and suggested recommendations for change as discussed in the summary of comments.

These sections are adopted under Texas Health and Safety Code §46.003 which requires the department to adopt rules that provide minimum standards and guidelines, for issuance of a certificate to persons who act as promotores(as); and §12.001 which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of each duty imposed by law on the board, the department and the commissioner of health.

§146.1.Definitions.

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1)

Administrator - The department employee designated as the administrator of regulatory activities authorized by the Health and Safety Code Chapter 46.

(2)

Applicant - A promotor(a) or community health worker who applies to the Texas Department of Health for a certificate of competence, a sponsoring institution or training program who applies to the department to offer training or an instructor who applies to the department to train promotores(as) or community health workers.

(3)

Board - The Texas Board of Health.

(4)

Certificate of Competence - Promotor(a) or community health worker certificates issued by the Texas Department of Health.

(5)

Committee - The Promotor(a) and Community Health Worker Training and Certification Advisory Committee established by §146.2 of this title.

(6)

Department - The Texas Department of Health.

(7)

Health - The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources as well as physical capabilities.

(8)

Instructor - An individual approved by the department to provide instruction and training in public health education to promotores(as) or community health workers in an educational setting.

(9)

Instructor certification - An authorization to train or instruct promotores(as) or community health workers in public health education services.

(10)

" Promotor(a)" or "Community Health Worker" - A person who, with or without compensation: provides cultural mediation between communities and health and human service systems; informal counseling and social support; and culturally and linguistically appropriate health education; advocates for individual and community health needs; assures people get the health services they need; builds individual and community capacity; or provides referral and follow-up services.

(11)

Sponsoring institution or training program - An approved educational, community health, training program or other program or facility that offers or intends to offer promotor(a) or community health worker training or instructor preparation.

(12)

Sponsoring institution or training program certification - An authorization to offer promotor(a) or community health worker training or instructor preparation.

§146.2.Promotor(a) or Community Health Worker Training and Certification Advisory Committee.

(a)

The committee. An advisory committee shall be appointed under and governed by this section.

(1)

The name of the committee shall be the Promotor(a) or Community Health Worker Training and Certification Advisory Committee.

(2)

The committee is established under the Health and Safety Code, §11.016, which allows the Board of Health (board) to establish advisory committees.

(b)

Applicable law. The committee is subject to Texas Government Code, Chapter 2110, concerning state agency advisory committees.

(c)

Purpose. The purpose of the committee is to review applications and to recommend to the department qualifying applicants as sponsoring institutions, training instructors or as promotores(as) or community health workers. The committee shall also recommend new or amended rules for the approval of the board.

(d)

Tasks.

(1)

The committee shall advise the board concerning rules to implement standards adopted under the Health and Safety Code, Chapter 46 relating to the training and regulation of persons working as promotores(as) or community health workers.

(2)

The committee shall recommend to the department qualifying sponsoring institutions or training programs, instructors, and promotores(as) or community health workers.

(3)

The committee shall carry out any other tasks given to the committee by the board.

(e)

Review and duration. By November 1, 2003, the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee or abolished.

(f)

Composition. The committee shall be composed of nine members appointed by the board. The composition of committee shall include:

(1)

four certified promotores(as) or community health workers or the equivalent;

(2)

two public members;

(3)

one member from the Texas Higher Education Coordinating Board, or a higher education faculty member who has teaching experience in community health, public health or adult education and has trained promotores(as) or community health workers;

(4)

two professionals who work with promotores(as) or community health workers in a community setting;

(g)

Terms of office. The term of office each member shall be four years, and may be reappointed.

(1)

If a vacancy occurs, a person shall be appointed to serve the unexpired portion of that term.

(2)

Members shall be appointed for staggered terms so that the terms of three members will expire on January 1 of each even-numbered year.

(h)

Officers. The committee shall elect a presiding officer and an assistant presiding officer at its first meeting after August 31st of each year.

(1)

Each officer shall serve until the next regular election of officers.

(2)

The presiding officer shall preside at all committee meetings at which he or she is in attendance, call meetings in accordance with this section, appoint subcommittees of the committee as necessary, and cause proper reports to be made to the board. The presiding officer may serve as an ex-officio member of any subcommittee of the committee.

(3)

The assistant presiding officer shall perform the duties of the presiding officer in case of the absence or disability of the presiding officer. In case the office of presiding officer becomes vacant, the assistant presiding officer will serve until a successor is elected to complete the unexpired portion of the term of the office of presiding officer.

(4)

A vacancy which occurs in the offices of presiding officer or assistant presiding officer may be filled at the next committee meeting.

(5)

A member shall serve no more than two consecutive terms as presiding officer and/or assistant presiding officer.

(6)

The committee may reference its officers by other terms, such as chairperson and vice-chairperson.

(i)

Meetings. The committee shall meet only as necessary to conduct committee business.

(1)

A meeting may be called by agreement of Texas Department of Health (department) staff and either the presiding officer or at least three members of the committee.

(2)

Meeting arrangements shall be made by department staff. Department staff shall contact committee members to determine availability for a meeting date and place.

(3)

Each meeting of the committee shall be announced and conducted in accordance with the Open Meetings Act, Texas Government Code, Chapter 551.

(4)

Each member of the committee shall be informed of a committee meeting at least five working days before the meeting.

(5)

A simple majority of the members of the committee shall constitute a quorum for the purpose of transacting official business.

(6)

The committee is authorized to transact official business only when in a legally constituted meeting with quorum present.

(7)

The agenda for each committee meeting shall include an item entitled public comment under which any person will be allowed to address the committee on matters relating to business. The presiding officer may establish procedures for public comment, including a time limit on each comment.

(j)

Attendance. Members shall attend committee meetings as scheduled. Members shall attend meetings of subcommittees to which the member is assigned.

(1)

A member shall notify the presiding officer or appropriate department staff if he or she is unable to attend a scheduled meeting.

(2)

It is grounds for removal from the committee if a member cannot discharge the member's duties for a substantial part of the term for which the member is appointed because of illness or disability, is absent from more than half of the committee and subcommittee meetings during a calendar year, or is absent from at least three consecutive committee meetings.

(3)

The validity of an action of the committee is not affected by the fact that it is taken when a ground for removal of a member exists.

(4)

The attendance records of the members shall be reported to the board. The report shall include attendance at committee and subcommittee meetings.

(k)

Staff. Staff support for the committee shall be provided by the department.

(l)

Procedures. Roberts Rules of Order, Newly Revised, shall be the basis of parliamentary decisions except where otherwise provided by law or rule.

(1)

Any action taken by the committee must be approved by a majority vote of the members present once quorum is established.

(2)

Each member shall have one vote.

(3)

A member may not authorize another individual to represent the member by proxy.

(4)

The committee shall make decisions in the discharge of its duties without discrimination based on any person's race, creed, gender, religion, national origin, age, physical condition, or economic status.

(5)

Minutes of each committee meeting shall be taken by department staff.

(A)

A draft of the minutes approved by the presiding officer shall be provided to the board and each member of the committee within 30 days of each meeting.

(B)

After approval by the committee, the minutes shall be signed by the presiding officer.

(m)

Subcommittees. The committee may establish subcommittees as necessary to assist the committee in carrying out its duties.

(1)

The presiding officer shall appoint members of the committee to serve on subcommittees and to act as subcommittee chairpersons. The presiding officer may also appoint nonmembers of the committee to serve on subcommittees.

(2)

Subcommittees shall meet when called by the subcommittee chairperson or when so directed by the committee.

(3)

A subcommittee chairperson shall make regular reports to the advisory committee at each committee meeting or in interim written reports as needed. The reports shall include an executive summary or minutes of each subcommittee meeting.

(n)

Statement by members. The board, the department, and the committee shall not be bound in any way by any statement or action on the part of any committee member except what a statement or action is in pursuit of specific instructions from the board, department, or committee.

(o)

Reports to board. The committee shall file an annual written report with the board.

(1)

The report shall list the meeting dates of the committee and any subcommittees, the attendance records of its members, a brief description of actions taken by the committee, a description of how the committee has accomplished the tasks given to the committee by the board, the status of any rules which were recommended by the committee to the board, anticipated activities of the committee for the next year, and any amendments to this section requested by the committee.

(2)

The report shall identify the costs related to the committee's existence, including the cost of agency staff time spent in support of the committee's activities.

(3)

The report shall cover the meetings and activities in the immediate preceding 12 months and shall be filed with the board each January. It shall be signed by the presiding officer and appropriate department staff.

§146.3.Applicability.

(a)

The purpose of this section is to describe who is eligible for this voluntary training and certification program under the Health and Safety Code, Chapter 46.

(b)

The provisions of this chapter apply to any promotor(a) or community health worker, and instructor, representing that he or she performs or will perform as a certified promotor(a) or community health worker or, trains or will train promotores(as) or community health workers respectively. It also applies to any institution or training program that will sponsor or sponsors or provides training programs for promotores(as) or community health workers, who will expect certification under this chapter.

(c)

Nothing in this chapter requires promotores(as) or community health workers, instructors, sponsoring institutions or training programs to participate in this voluntary training and certification program.

§146.4.Application Requirements and Procedures for Promotores(as) or Community Health Workers.

(a)

Purpose. The purpose of this section is to set out the application procedures for certification of promotores(as) or community health workers.

(b)

Promotor(a) or community health worker certificate of competence.

(1)

Unless otherwise indicated, an applicant must complete all required information and documentation on official department forms and submit the required information and documentation electronically or in hard copy to the department.

(2)

The department shall send a notice listing the additional materials required to an applicant whose application is incomplete. An application not completed within 30 days after the date of notice shall be invalid unless the applicant has advised the department of a valid reason for the delay.

(c)

Required application materials. The application form shall contain the following items:

(1)

specific personal data, social security number or status (optional), birth date, current and previous promotor(a) or community health worker activity (if applicable), and any educational and training background;

(2)

a statement that the applicant understands the Health and Safety, Chapter 46 and this chapter and agrees to abide by them;

(3)

the applicant's permission to the department to seek any information or references which are material in determining the applicant's qualifications;

(4)

a statement that the applicant, if issued a certificate, shall return the certificate and identification card(s) to the department upon the expiration, revocation, or suspension of the certificate;

(5)

a statement that the applicant understands that the materials submitted become the property of the department and are nonreturnable (unless prior arrangements have been made);

(6)

a statement that the information in the application is truthful and that the applicant understands that providing false or misleading information which is material in determining the applicant's qualifications may result in the voiding of the application and failure to be granted any certificate or the revocation of any certificate issued;

(7)

a statement that the applicant shall advise the department of his or her current mailing address within 30 days of any changes of address;

(8)

the dated signature of the applicant certifying the truth of the information submitted; and

(9)

the signature of the instructor, sponsoring institution or training program indicating successful completion of the promotor(a) or community health worker training and the date when the training was successfully completed.

(d)

Application approval.

(1)

The committee shall be responsible for reviewing all applications and recommending promotores(as) or community health workers to be certified to the administrator.

(2)

The administrator shall approve any application which is in compliance with this chapter and which properly documents applicant eligibility, unless the application is disapproved under the provisions of subsection (e) of this section.

(e)

Disapproved applications.

(1)

The department may disapprove the application if the applicant:

(A)

has not met the eligibility and application requirements set out in this section;

(B)

has not successfully completed an approved competency-based promotor(a) or community health worker training;

(C)

has failed or refused to properly complete or submit any application form(s) or has knowingly presented false or misleading information on the application form, or any other form or documentation required by the department to verify the applicant's qualifications for certification;

(D)

has engaged in unethical conduct; or

(E)

has developed an incapacity, which in accordance with the Americans with Disabilities Act, prevents the practice of promotor(a) or community health worker service with reasonable skill, competence, and safety to the public as the result of:

(i)

an illness;

(ii)

drug or alcohol dependency; or

(iii)

another physical or mental condition or illness;

(2)

If the administrator determines that the application should not be approved, the administrator shall give the applicant written notice of the reason for the disapproval and of the opportunity for re-application or for appeal;

(3)

The applicant whose application has been disapproved under paragraph one of this subsection shall be permitted to reapply after a period of not less than six months from the date of the disapproval and shall submit a current application satisfactory to the department, of compliance with the then current requirements of this chapter and the provisions of the Act.

(4)

The applicant whose application has been disapproved under paragraph (1) of the subsection shall be permitted to ask for a reconsideration in writing after a period of not less than six months from the date of the disapproval to the department.

(f)

Application processing. A written notice stating that the application has been approved may be sent in lieu of the notice of acceptance of a complete application. The following periods of time shall apply from the date of receipt of an application until the date of issuance of a written notice that the application is complete and accepted for filing or that the application is deficient and additional specific information is required.

(1)

Letter of acceptance of application for certification - 30 days.

(2)

Letter of application deficiency - 30 days.

§146.5.Application Requirements and Procedures for Instructors.

(a)

Purpose. The purpose of this section is to set out the application procedure for certification of instructors.

(b)

Instructor certificate.

(1)

Unless otherwise indicated, an applicant must complete all required information and documentation of credentials on official department forms and submit the required information and documentation electronically or in hard copy to the department.

(2)

The department shall send a notice listing the additional materials required to an applicant whose application is incomplete. An application not completed within 30 days after the date of notice shall be invalid unless the applicant has advised the department of a valid reason for the delay.

(c)

Required application materials. The application form shall contain the following items:

(1)

specific personal data, social security number or status (optional), birth date, current and previous places of employment, other state licenses and certificates held, and educational and training background;

(2)

a statement that the applicant understands the Health and Safety Code, Chapter 46 and this chapter and agrees to abide by them;

(3)

the applicant's permission to the department to seek any information or references which are material in determining the applicant's qualifications;

(4)

a statement that the applicant, if issued a certificate, shall return the certificate and identification card(s) to the department upon the expiration, revocation, or suspension of the certificate;

(5)

a statement that the applicant understands that the materials submitted become the property of the department and are nonreturnable (unless prior arrangements have been made);

(6)

a statement that the information in the application is truthful and that the applicant understands that providing false or misleading information which is material in determining the applicant's qualifications may result in the voiding of the application and failure to be granted any certificate or the revocation of any certificate issued;

(7)

a statement that the applicant shall advise the department of his or her current mailing address within 30 days of any changes of address;

(8)

the dated signature of the applicant certifying the truth of the information submitted; and

(9)

the signature of the executive officer of a sponsoring institution or training program which attests to the competence of the instructor.

(d)

Application approval.

(1)

The committee shall be responsible for reviewing all applications and recommending those to be certified by the administrator.

(2)

The administrator shall approve any application which is in compliance with this chapter and which properly documents applicant eligibility, unless the application is disapproved under the provisions of subsection (e) of this section.

(e)

Disapproved applications.

(1)

The department may disapprove the application if the applicant:

(A)

has not met the eligibility and application requirements set out in this chapter;

(B)

does not have the appropriate training or experience to qualify as an instructor;

(C)

has failed or refused to properly complete or submit any application form(s) or has knowingly presented false or misleading information on the application form, or any other form or documentation required by the department to verify the applicant's qualifications for certification;

(D)

has engaged in unprofessional conduct; or

(E)

has developed an incapacity, and in accordance with the Americans with Disabilities Act, that prevents the instructor from practicing with reasonable skill, competence, and safety to the public as the result of:

(i)

illness;

(ii)

drug or alcohol dependency; or

(iii)

another physical or mental condition or illness;

(2)

If the administrator determines that the application should not be approved, the administrator shall give the applicant written notice of the reason for the disapproval and of the opportunity for re-application;

(3)

The applicant whose application has been disapproved under paragraph (1) of this subsection shall be permitted to reapply after a period of not less than six months from the date of the disapproval and shall submit a current application satisfactory to the department, of compliance with the then current requirements of this chapter and the provisions of the Health and Safety Code, Chapter 46.

(f)

Application processing. A written notice stating that the application has been approved may be sent in lieu of the notice of acceptance of a complete application. The following periods of time shall apply from the date of receipt of an application until the date of issuance of a written notice that the application is complete and accepted for filing or that the application is deficient and additional specific information is required.

(1)

Letter of acceptance of application for certification -30 days.

(2)

Letter of application deficiency - 30 days.

§146.6.Application Requirements and Procedures for Sponsoring Institutions and Training Programs.

(a)

Purpose. The purpose of this section is to set out the application procedures for certification of sponsoring institutions and training programs.

(b)

Sponsoring institution or training program certificate.

(1)

Unless otherwise indicated, an applicant must complete all required information and documentation of credentials on official department forms and submit the required information and documentation electronically or in hard copy.

(2)

The department shall send a notice listing the additional materials required to an applicant whose application is incomplete. An application not completed within 30 days after the date of notice shall be invalid unless the applicant has advised the department of a valid reason for the delay.

(c)

Required application materials. The application form shall contain the following items:

(1)

specific organizational data, current and previous experience with training or sponsoring training for promotores(as) or community health workers, educational and training qualifications of staff, accrediting information, curricula and collateral materials, workplace assurances, registration policies and procedures for promotores(as) or community health workers.

(2)

a statement that the applicant understands Health and Safety Code, Chapter 46 and this chapter and agrees to abide by them;

(3)

the applicant's permission to the department to seek any information or references which are material in determining the applicant's qualifications;

(4)

a statement that the applicant, if issued a certificate, shall return the certificate(s) to the department upon the expiration, revocation, or suspension of the certificate(s);

(5)

a statement that the applicant understands that the materials submitted become the property of the department and are nonreturnable (unless prior arrangements have been made);

(6)

a statement that the information in the application is truthful and that the applicant understands that providing false or misleading information which is material in determining the applicant's qualifications may result in the voiding of the application and failure to be granted any certificate or the revocation of any certificate issued;

(7)

a statement that the applicant shall advise the department of the organization's current mailing address within 30 days of any changes of address; and

(8)

the dated signature of the chief executive officer certifying the truth of the information submitted.

(d)

Application approval.

(1)

The committee shall be responsible for reviewing all applications and recommending those to be certified to the administrator.

(2)

The administrator shall approve any application which is in compliance with this chapter and which properly documents applicant eligibility, unless the application is disapproved under the provisions of subsection (e) of this section.

(e)

Disapproved applications.

(1)

The department may disapprove the application if the applicant:

(A)

has not met the eligibility and application requirements set out in this chapter; or

(B)

has failed or refused to properly complete or submit any application form(s) or has knowingly presented false or misleading information on the application form, or any other form or documentation required by the department to verify the applicant's qualifications for certification.

(2)

If the administrator determines that the application should not be approved, the administrator shall give the applicant written notice of the reason for the disapproval and of the opportunity for re-application;

(3)

The applicant whose application has been disapproved under paragraph (1) of this subsection shall be permitted to reapply after a period of not less than six months from the date of the disapproval and shall submit a current application satisfactory to the department, of compliance with the then current requirements of this chapter and the provisions of the Act.

(f)

Application processing. A written notice stating that the application has been approved may be sent in lieu of the notice of acceptance of a complete application. The following periods of time shall apply from the date of receipt of an application until the date of issuance of a written notice that the application is complete and accepted for filing or that the application is deficient and additional specific information is required.

(1)

Letter of acceptance of application for certification - 30 days.

(2)

Letter of application deficiency - 30 days.

§146.7.Types of Certificates and Applicant Eligibility.

(a)

Purpose. The purpose of this section is to set out the types of certificates issued and the qualifications of applicants.

(1)

The Texas Department of Health (department) shall issue promotor(a) or community health worker certificates of competence, instructor certificates, and sponsoring institutions or training program certificates. A certificate will recognize all those who have performed promotor(a) or community health worker services during the three-year period preceding the effective date of these rules and not less than 1000 cumulative hours during any 12 consecutive months. A certificate will recognize all those who have successfully completed an entry-level training and certification program.

(2)

Certificates shall be signed by the commissioner of the department and presiding officer of the advisory committee. The identification card issued to a promotor(a) or community health worker and instructor shall bear the signature of the commissioner and contain a photo of the promotor(a) or community health worker and instructor.

(3)

Any certificate or identification card(s) issued by the department remains the property of the department and shall be surrendered to the department on demand.

(4)

A promotor(a) or community health worker and instructor shall carry the original identification card. A sponsoring institution or training program shall display the original certificate at the training or educational site. Photocopies shall not be carried or displayed.

(5)

A person certified as a promotor(a) or community health worker shall only allow his or her certificate to be copied for the purpose of verification by employers, professional organizations, and third party payors for credentialing and reimbursement purposes. Other persons and/or agencies may contact the administrator in writing or by phone to verify certification.

(6)

No one shall display, present, or carry a certificate or an identification card which has been altered, photocopied, or otherwise reproduced.

(7)

No one shall make any alteration on any certificate or identification card issued by the department.

(b)

Special provisions for persons who have performed promotor(a) or community health worker services during the three year period, preceding the effective date of these rules. Upon submission of the application forms by the practicing promotor(a) or community health worker and upon approval by the department, the department shall issue a certificate of competence to a person who has performed promotor(a) or community health worker services for not less than 1000 cumulative hours during any 12 consecutive months, as documented on form(s) prescribed by the department.

(c)

Special provisions for persons who are nationally certified health education specialists in good standing, other licensed/certified healthcare professionals including social workers in good standing who have acted as instructors of promotores(as), and for promotores(as) or community health workers who have acted as supervisors or as trainers, have experience in performing promotor(a) or community health worker services for not less than 1000 cumulative hours during any 12 consecutive months, or have attended a competency-based training program within the three years from the date these rules are final. Upon submission of the application forms by an instructor, other licensed/certified healthcare professional or certified health education specialist and upon approval by the department, the department shall issue an instructor certificate to a person who is certified by the National Commission for Health Education Credentialing, Inc., or who is a licensed/certified healthcare professional and to a promotor(a) or community health worker who meets the above qualifications.

(d)

Minimum eligibility requirements for promotor(a) or community health worker certification. The following requirements apply to all individuals applying for certification who do not meet the requirements of subsection (b) of this section:

(1)

attainment of 18 years of age or an eligible and informed minor as determined by the committee;

(2)

freedom from physical or mental impairment, in accordance with the Americans with Disabilities Act, interferes with the performance of duties or otherwise constitutes a hazard to the health or safety of the persons being served;

(3)

submission of a satisfactory completed application on a form supplied by the department; and

(4)

successful completion of an approved competency-based training program.

(e)

Minimum eligibility requirements for instructor certification. The following requirements apply to all individuals applying for certification who do not meet the requirements of subsections (c) of this section:

(1)

graduation from high school or its equivalent as determined by the sponsoring institution or the training program or six years of continuous service as a promotor(a) or community health worker;

(2)

attainment of 18 years of age or an eligible and informed minor as determined by the committee;

(3)

attendance at an instructor/trainer program by an approved sponsoring institution or training program;

(4)

freedom from physical or mental impairment, which in accordance with the Americans with Disabilities Act, interferes with the performance of duties or otherwise constitutes a hazard to the health or safety of participants; and

(5)

submission of a satisfactory completed application on a form supplied by the department.

(f)

Minimum eligibility requirements for sponsoring institution or training program certification. The following requirements apply to all institutions or programs applying for certification:

(1)

usage of an approved curriculum for promotor(a) or community health worker training, instructor certification and/or for continuing education of promotores(as) or community health workers and instructors that meets the standards and guidelines established by the department and as set forth in §146.8 of this title; and

(2)

submission of a satisfactory completed application on a form supplied by the department.

§146.8.Standards for the Approval of Curricula.

(a)

Purpose. The purpose of this section is to establish the minimum standards for approval of curricula and programs to train persons to perform promotor(a) or community health worker services and to quality for the certificate of competence.

(b)

All curricula to be used and programs developed to train individuals to perform promotor(a) or community health worker services or to act as instructors must:

(1)

assure that the eight core skill and knowledge competencies, identified in the National Community Health Advisor Study, June 1998 for promotores(as) or community health workers, including communication, interpersonal, service coordination, capacity-building, advocacy, teaching and organizational skills and knowledge base are addressed;

(2)

include at a minimum 20 clock hours of knowledge and skill-building per core competency for promotores(as) or community health workers and include at a minimum 20 clock hours for instructor training in each of the core competencies that affect promotores(as) or community health workers;

(3)

evaluate and document the acquisition of knowledge and mastery of skills by the individual and the success of the training program according to the performance measures framework established within the National Community Health Advisor Study, June 1998;

(4)

be approved by the department and be offered within the geographic limits of the State of Texas;

(5)

be submitted to the department at least ten weeks prior to the starting date of the program to be offered by a sponsoring institution;

(6)

be submitted to the department along with supporting materials in a three-ring binder with all pages clearly legible and consecutively numbered with a table of contents and divided with tabs identified to correspond to the core competencies, including evaluation materials and other programmatic information and assurances required within this section;

(7)

provide a list of approved instructors, facilities and locations for the training program;

(8)

provide a yearly calendar of scheduled training events by dates, times and locations;

(9)

identify the method for recruiting persons to the program;

(10)

report the names of individuals to the department who have successfully completed the training program within 30 days of program completion;

(11)

maintain an accurate record of each person's attendance and participation for not less than five years;

(12)

be live and interactive and directed by an approved instructor or delivered by an approved instructor through interactive technology in real time; and

(13)

focus on the eight core roles of the promotor(a) or community health worker as noted in the definition of promotor(a) or community health worker.

§146.9.Certificate Issuance and Renewals.

(a)

Purpose. The purpose of this section is to set out the rules for issuing certificates and certificate renewal.

(b)

Issuance of certificates.

(1)

Upon approval of the application, the department shall issue the promotor(a) or community health worker, instructor or sponsoring institution or training program a certificate with an expiration date and a certificate number. An identification card shall be included for the promotor(a) or community health worker and the instructor.

(2)

The department shall replace a lost, damaged, or destroyed certificate or identification card upon written request.

(c)

Certificate renewal. Each promotor(a) or community health worker, instructor and sponsoring institution or training program shall renew the certificate biennially.

(1)

Each promotor(a) or community health worker, instructor and sponsoring institution is responsible for renewing the certificate before the expiration date. Failure to receive notification from the department prior to the expiration date will not excuse failure to file for renewal.

(2)

Each promotor(a) or community health worker, instructor and sponsoring institution is responsible for completing a renewal form.

(3)

The department may not renew the certificate of a promotor(a) or community health worker, instructor or sponsoring institution or training program who is in violation of the Act or this chapter at the time of renewal.

(d)

Expired certificates. The department, by certified mail using the last address known, shall attempt to inform each promotor(a) or community health worker, instructor, or sponsoring institution or training program who has not timely renewed a certificate, after a period of more than ten days after the expiration of the certificate that the certificate has automatically expired. A person or institution or training program whose certificate automatically expires is required to surrender the certificate and identification cards to the department.

(e)

Right to inspect. The department reserves the right to inspect facilities and documentation and to monitor sponsoring institutions, training programs, and instructors.

§146.10.Continuing Education Requirements.

(a)

Purpose. The purpose of this section is to establish the continuing education requirements which a promotor(a) or community health worker and instructor must complete to maintain certification. The requirements are intended to maintain and improve the quality of professional services provided by promotores(as) or community health workers and instructors and to keep these individuals knowledgeable of current programs, techniques and practices. Approved sponsoring institutions and/or training programs can offer continuing education opportunities for promotores(as) or community health workers and instructors.

(b)

General. Continuing education requirements for recertification shall be fulfilled during each biennial renewal period. A promotor(a) or community health worker must complete 80 contact hours of continuing education acceptable to the department during each biennial renewal period. An instructor must complete at a minimum 32 contact hours of continuing education acceptable to the department during each biennial renewal period.

(1)

At least 50% of the required number of hours shall be satisfied by attendance and participation in instructor-directed activities.

(2)

No more than 50% of the required number of hours may be satisfied through verifiable independent self-study. These activities include reading materials, audio materials, audiovisual materials, or a combination thereof which meet the requirements set out in this section.

(3)

A contact hour shall be defined as 50 minutes of attendance and participation. One-half contact hour shall be defined as 30 minutes of attendance and participation during a 30- minute period.

(c)

Content. All continuing education activities should provide for the professional growth of the community health worker or promotor(a) and instructor.

(1)

At least 50% of the required hours must be skill-based activities which are directly related to promotor(a) or community health worker competencies.

(2)

The remaining 50% can be related to new knowledge base or programmatic activity.

(d)

Types of acceptable continuing education. Continuing education shall be acceptable if the experience or activity is at least 30 consecutive minutes in length and is offered by an approved sponsoring institution and/or training program.

(e)

Reporting of continuing education. Each promotor(a) or community health worker and instructor is responsible for and shall complete and file with the department at the time of renewal a continuing education report form approved by the department listing the title, date and number of hours for each activity for which credit is claimed. The sponsoring institution or training program must provide a list of instructors, promotores(as) or community health workers who successfully complete continuing education contact hours within 30 days of the continuing education event.

(f)

Failure to complete the required continuing education.

(1)

An instructor, promotor(a) or community health worker may request a one time only 120-day extension in order to complete the continuing education requirement.

(2)

An instructor, promotor(a), or community health worker who has not corrected the deficiency by the expiration date of the 120-day extension shall be considered as noncompliant with the renewal requirements and may no longer be certified under the expired certificate.

(3)

An instructor, promotor(a) or community health worker may take the required training again to become an instructor, promotor(a) or community health worker if deadlines for renewal were not met.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on June 30, 2000.

TRD-200004554

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: July 20, 2000

Proposal publication date: January 28, 2000

For further information, please call: (512) 458-7236