Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 13.
HEALTH PLANNING AND RESOURCE DEVELOPMENT
Subchapter F. MEDICALLY UNDERSERVED AREAS AND RESIDENT PHARMACISTS
25 TAC §13.61
The Texas Department of Health (department) proposes new §13.61
concerning medically underserved areas. The new section is proposed in response
to the Education Code, Chapter 61, §61.854 which directs each college
of pharmacy to give priority consideration to an applicant for a resident
pharmacy position who demonstrates willingness to practice pharmacy in medically
underserved areas, as defined by the department.
The proposed definition for "medically underserved areas" is an appropriate
definition because for over twenty years it has been used by the department
and other agencies to denote areas that have a shortage of specific health
professionals and/or health care services. It is a federal term defined by
the U.S. Department of Health and Human Services (DHHS) and encompasses two
medically underserved designation types - Health Professional Shortage Area
and Medically Underserved Area. Numerous state and federal programs use one
or more of these designation types to identify "medically underserved areas"
for their programmatic activities. The department identifies medically underserved
areas in the state for designation by DHHS.
Frederic E. Shaw, M.D., J.D., Assistant Commissioner for Policy and Planning,
has determined that for each year of the first five-year period the section
is in effect, there will be no fiscal implications to state or local government
as a result of enforcing or administering the new section as proposed.
Dr. Shaw has also determined that for each year of the first five years
the section is in effect, the public benefit anticipated as a result of this
section will be clarification of the term "medically underserved area" for
use in determining preference for applicants for resident pharmacy positions
in colleges of pharmacy. There will be no effect on small businesses or micro-businesses
because those businesses are not subject to this section. There are no economic
costs to persons who are required to comply with this section as proposed.
There will be no effect on local employment.
Comments on the proposal may be submitted to Ann Henry, Acting Director,
Office of Policy and Planning, Texas Department of Health, 1100 West 49th
Street, Austin, Texas 78756, (512) 458-7261. Comments will be accepted for
30 days following publication of the proposal in the
Texas Register
.
The new section is proposed under the Education Code, §61.854
which authorizes the department to define the term "medically underserved
areas," and the Health and Safety Code, §12.001 which authorizes the
Texas Board of Health (board) to adopt rules for the performance of every
duty imposed by law on the board, the department, and the commissioner of
health.
The section will affect the Education Code, §61.854.
§13.61.Medically Underserved Areas and Resident Pharmacists.
(a)
This section implements the responsibility of the Texas
Department of Health to define the term "medically underserved areas" under
the Education Code, §61.854. That section provides that each college
of pharmacy shall give priority consideration to an applicant for a resident
pharmacist position who demonstrates a willingness to practice pharmacy in
medically underserved areas of this state, as defined by the Texas Department
of Health.
(b)
The term, "medically underserved areas," is defined as
meeting any of the criteria:
(1)
an area in a metropolitan or non-metropolitan area of Texas
(which need not conform to the geographic boundaries of a political subdivision
and which is a rational area for the delivery of health services) which the
United States Secretary of Health and Human Services (secretary) determines
has a primary care physician shortage and which is not reasonably accessible
to an adequately served area as delineated in 42 United States Code (U.S.C.), §254e
(42 Code of Federal Regulations (C.F.R.), Part 5);
(2)
a population group which the secretary determines
to have such a primary care physician shortage as delineated in 42 U.S.C., §254e
(42 C.F.R. Part 5);
(3)
a public or nonprofit private medical facility or
other facility which the secretary determines has such a primary care physician
shortage as delineated in 42 U.S.C., §254e (42 C.F.R., Part 5); or
(4)
an area with a medically underserved population designated
by the secretary as having a shortage of primary care physicians and personal
health services as defined in 42 U.S.C., §254c (42 C.F.R., Part 491.5,
Subpart A).
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of
the Secretary of State, on May 26, 2000.
TRD-200003750
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: July 9, 2000
For further information, please call: (512) 458-7236
Subchapter T. SCHOOL-BASED HEALTH CENTERS
25 TAC §§37.531 - 37.538
The Texas Department of Health (department) proposes new §§37.531-37.538
concerning school-based health centers. The new sections are proposed to implement
House Bill 2202, Acts 1999, 76th Legislature, §1, which added Education
Code, §38.011. This legislation requires the Texas Board of Health (board)
to adopt rules to establish procedures for awarding grants to assist school
districts with the costs of operating school-based health centers, and to
establish standards for health care centers supported by such grants. Specifically,
the sections cover the purpose of the rules; definitions; number of awards;
dollar amount of awards; matching funds; competitive process, guidelines for
requests for proposals; and standards for school-based health centers.
Roy Middleton, Director, Division of Financial Management, Associateship
for Community Health and Resources Development, has determined that for the
first five-year period the sections are in effect, there will be no loss or
increase in revenue, no additional estimated costs, and no estimated reductions
in costs. As a result of administering the proposed rules, therefore, there
will be no fiscal implications for state government. The proposed rules are
simply procedural in nature and specify the means by which funds are to be
awarded, subject to the availability of funds, and the standards under which
the funded centers will operate. Fiscal implications for local government
are variable based on the amount of the grant provided to a particular school
district in support of a school-based health center. The maximum possible
increase in the school district's biennial budget as a result of its selection
for funding through a department grant under this section will be $250,000,
all of which must be earmarked for support of the school-based health center
described in the funded applicant's proposal. An additional fiscal implication
for local government is that any school district receiving funding must provide
matching funds and/or in- kind match equal to a proportion of the grant funds,
an amount that is indeterminate at present but will be specified in the Request
for Proposals.
Roy Middleton has also determined that for the first five years the sections
are in effect, the public benefit will be the support of school-based health
centers in at least two geographic areas. Mr. Middleton has further determined
that there will be no adverse economic effect on any micro- businesses or
small businesses, no cost to any persons, and no impact on local employment
as a result of the implementation of the new sections, because expenditures
for services delivered by health care providers not employed by school districts
will increase absolutely, rather than being shifted among current providers.
Comments on the proposal may be submitted in writing to Ruth E. Andersen,
School Health Program, Texas Department of Health, 1100 West 49th Street,
Austin, Texas 78756; by fax at (512) 458-7256; or by telephone at (512) 458-7111,
ext. 3014. Comments will be accepted for 30 days following publication of
this proposal in the
Texas Register
.
The new sections are proposed under Education Code, §38.011(n),
which requires the commissioner of health to adopt rules to establish procedures
for awarding grants in accordance with the section; Education Code, §38.011(q),
which requires the commissioner of health to adopt rules establishing standards
for health care centers funded through said grants; and Health and Safety
Code, §12.001, which authorizes the Texas Board of Health (board) to
adopt rules for its procedure and for the performance of each duty imposed
by law on the board, the department, or the commissioner of health.
The proposed new sections will affect Health and Safety Code, Chapter 32;
and Education Code, §§38.0095, 38.011, and 38.012.
§37.531.Purpose.
The purpose of these sections is to establish rules for awarding grants
to assist school districts with the costs of operating school-based health
centers and to establish standards for the funded centers.
§37.532.Definitions.
The following words and terms, when used in these sections, shall have
the following meanings, unless the context clearly indicates otherwise:
(1)
Applicant - A school district applying for a grant from
the Texas Department of Health to assist with the costs of operating a school-based
health center.
(2)
Conventional health services Family and home support;
health care, including immunizations; dental health care; health education;
and preventive health strategies.
(3)
Department The Texas Department of Health.
(4)
Funded applicant A school district that applies for
a grant from the Texas Department of Health to assist with the costs of operating
a school-based health center and with which the Texas Department of Health
subsequently executes a contract to operate a school-based health center.
(5)
Grant - A sum of money awarded to a selected applicant
on the basis of a Request for Proposals that results in a contract.
(6)
Local health education and health care advisory council
- Persons appointed by the board of trustees of a school district to make
recommendations to the district concerning the establishment of school-based
health centers and to assist the district in ensuring that local community
values are reflected in the operation of each center. In addition to the majority
of appointees who shall be parents of students, the board of trustees shall
also appoint at least one person from each of the following groups:
(A)
teachers;
(B)
school administrators;
(C)
licensed health care professionals;
(D)
the clergy;
(E)
law enforcement;
(F)
the business community;
(G)
senior citizens; and
(H)
students.
(7)
Low property wealth per student - An assessed
valuation per student in the applicant school district of no more than 25%
of the state average assessed valuation per student.
(8)
Rural area - A county with a population of not greater
than 50,000, or an area that has been designated under state or federal law
as:
(A)
a health professional shortage area;
(B)
a medically underserved area; or
(C)
a medically underserved community as defined by the Center
for Rural Health Initiatives.
(9)
School-based health center - An entity established
by a school district or by a school district jointly with a public health
agency at one or more campuses in the school district to deliver cooperative
health care programs, prevention of emerging health threats that are specific
to the district, and conventional health services for students and their families.
(10)
Treatment occasion - A number of instances of treatment
that constitute a course of treatment for an identified problem or condition.
§37.533.Number of Awards.
The department shall award grants to at least two applicants each state
Fiscal Year.
§37.534.Dollar Amount of Awards.
Grants awarded by the department shall not exceed $250,000 per applicant
per biennium.
§37.535.Matching Funds.
Funded applicants shall assure the department that matching funds obtained
from nonfederal sources, including in-kind contributions, community or foundation
grants, individual contributions, and local government agency operating funds,
shall be available to the school-based health center project.
§37.536.Competitive Process.
The department shall award grants to applicants annually through a
competitive Request for Proposals (RFP) process administered in accord with
all applicable policies and procedures of the department, including the RFP
guidelines that appear in §37.537 of this title (related to Guidelines
for Requests for Proposals).
§37.537.Guidelines for Requests for Proposals.
The department shall complete one Request for Proposals (RFP) process
for school-based health centers per state fiscal year according to the following
guidelines.
(1)
Proposals submitted in response to the RFP for school-based
health centers shall be screened, reviewed, and evaluated according to a competitive
process described in full in the RFP.
(2)
The department's School Health Program shall utilize
a standard evaluation instrument for scoring applicants' proposals. A copy
of the instrument shall be included in the RFP.
(3)
A primary review of all applicants' proposals shall
be performed by a member of the School Health Program staff. The reviewer
shall award the same number of bonus points to each applicant located in a
rural area and/or that has low property wealth per student.
(4)
The School Health Program shall select and train evaluators
to score proposals after primary review.
(5)
Proposals shall be evaluated based on the applicant's
ability to comply with the department's standards for school-based health
centers described in §37.538 of this title (relating to Standards for
School-Based Health Centers).
§37.538.Standards for School-Based Health Centers.
Funded applicants shall comply with the following standards for school-based
health care centers.
(1)
Community-based solutions. The funded applicant shall facilitate
collaboration among families, schools, and members of the community to assess
and meet the health needs of the community's children and families. The funded
applicant shall utilize the following strategies for facilitating community-based
solutions:
(A)
Establish a local health education and health care advisory
council to make recommendations to the district on the establishment of school-based
health centers and to assist the district in ensuring that local community
values are reflected in the operation of each center and in the provision
of health education.
(B)
Establish and/or enhance links between school personnel,
school-based health center personnel, other health/social services providers
and agencies in the community, and other supportive community sectors.
(C)
Enable students and families to be responsible decision-makers
in promoting their own health and well-being, making connections with community
systems that help to prevent the social isolation and alienation of individuals
and families, and using the health care system wisely.
(D)
Encourage parental involvement in and management of the
health care of children receiving services from the center; encourage parental
accompaniment of any child younger than 15 years of age at visits to the center;
notify the child's parent in writing at least one week in advance of the scheduled
appointment; and encourage the parent to attend the appointment.
(2)
Administration. The funded applicant shall plan
and administer a school-based health center that meets the health needs of
the community's children and families by use of the following strategies:
(A)
Deliver primary and preventive health services to children
and families in a school-based setting.
(B)
Establish efficient, client-friendly procedures for utilizing
all available sources of funding to compensate the district for services provided
by the school-based health center, including money available under the state
Medicaid program, a state children's health plan program, private health insurance
or health benefit plans, and the ability of those using a school-based health
center to pay for the services.
(C)
Contract for provision of services at the school-based
health center if necessary and appropriate.
(D)
Develop and present a specific, detailed plan for future
funding of the school-based health center that demonstrates how the center
will continue to operate when grant funding is no longer available.
(E)
Research, develop, and implement the forms and administrative
procedures necessary to remain in compliance with all applicable and relevant
legislation and regulations. Required procedures contained in applicable legislation
for operation of school-based health centers include but are not limited to
the following:
(i)
provision of services to a student only if the school district
or the provider with whom the district contracts has obtained written consent
to the services from the student's parent or guardian within the one-year
period preceding the date on which the services are provided, and the consent
has not been revoked;
(ii)
joint identification by school-based health center staff
and the student's parent or guardian of any health-related concerns of the
student that may affect the student's health and/or success in school;
(iii)
provision of neither reproductive services, counseling,
nor referrals through the school-based health center using grant funds awarded
under this subchapter;
(iv)
provision of all services by only appropriately licensed,
certified, or credentialed professionals as required by law;
(v)
referral of a student for mental health services only upon
notification of and with the written consent of the student's parent, guardian,
or other person having legal control of the student;
(vi)
a good faith effort by staff of a school-based health
center located in a rural area described by §37.532(8) of this title
(relating to Definitions) to identify and coordinate with existing health
care providers;
(vii)
provision of notice by the staff of the school-based
health center to the primary care physician of a student who has received
services;
(viii)
coordination by the staff of the school-based health
center with the primary care physician of any person who has a primary care
physician under the state Medicaid program or another health plan before delivering
a service;
(ix)
utilization of all available sources of funding to compensate
the school district or provider with whom the district contracts for services
provided by a school- based health center; and
(x)
conduct or facilitation of the conduct of client surveys
in school-based health centers by funded applicants.
(3)
Emphasis on prevention. A funded applicant
shall provide for primary emphasis on the delivery of conventional health
services and secondary emphasis on the implementation of population-based
models that prevent emerging health threats by use of the following strategies:
(A)
increasing substantially the number of children in the
community with health-care (medical) homes;
(B)
facilitating access to appropriate primary and preventive
care for children and families;
(C)
educating, enabling, and empowering individuals for healthier
lifestyles;
(D)
involving the community in identifying priorities and developing
health promotion strategies; and
(E)
relying on the evidence of effective prevention to develop
interventions that can demonstrate impact.
(4)
Focus on outcomes. A funded applicant shall focus
on the achievement of outcomes that can be documented, using the following
strategies:
(A)
delivering conventional health services and disease prevention
of emerging health threats through access to appropriate primary and preventive
care for children and families through a program designed to achieve the following
goals:
(i)
a reduction in student absenteeism and drop-out rates;
(ii)
an increase in each student's ability to meet his or her
academic potential; and
(iii)
stabilization of each student's physical well-being.
(B)
A funded applicant shall research, document, analyze, and
evaluate outcomes, including the goals listed in subparagraph (A) of this
paragraph, by activities that include but are not limited to the following:
(i)
gathering data and statistics, monitoring outcomes, and
producing data by use of quantitative measurement systems to report on project
impact as required by the Request For Proposals;
(ii)
providing quarterly reports as required by the department;
(iii)
conducting client surveys and other qualitative measures
of client satisfaction; and
(iv)
producing an annual written report that includes a project
evaluation with baseline data; data and analysis from client surveys; any
available statistics related to increased academic success, improved student
health, and improved performance on student assessment instruments administered
under Education Code, Chapter 39, Subchapter B; and other information as specified
by the department.
This agency hereby certifies that the proposal
has been reviewed by legal counsel and found to be within the agency's legal
authority to adopt.
Filed with the Office of
the Secretary of State, on May 26, 2000.
TRD-200003768
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: July 9, 2000
For further information, please call: (512) 458-7236
Subchapter E. CANNED FOODS
Chapter 37.
MATERNAL AND INFANT HEALTH SERVICES
Chapter 229.
FOOD AND DRUG