Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 97.
COMMUNICABLE DISEASES
The Texas Department of Health (department) adopts amendments to §§97.2,
97.3, 97.5 and 97.135, concerning perinatal hepatitis B screening and the
reporting of positive test results obtained through perinatal hepatitis B
screening. Section 97.135 is being adopted with changes to the proposed text
as published in the December 3, 1999, issue of the
Texas Register
(24 TexReg 10718). Sections 97.2, 97.3, and 97.5 are
adopted without changes, and therefore the sections will not be republished.
Specifically, the amendments to §97.2 and §97.5 include persons
who attend pregnant women during gestation or delivery among those persons
who are required to report communicable diseases. The amendment to §97.3
adds confirmed or suspected chronic hepatitis B infection in a pregnant woman
to the list of reportable diseases and specifies the minimum information which
must be reported. The amendment to §97.135 adds hepatitis B to the list
of diseases for which a pregnant woman must be screened at her first prenatal
visit and upon admission for delivery. These amendments will implement Senate
Bill 519 (Chapter 573, 76th Legislative Session), which amends Health and
Safety Code §81.090 and will assure that physicians, birthing centers,
hospitals and midwives are aware of their responsibility to assure that all
pregnant women are tested for infection with the hepatitis B virus (HBV) at
the first prenatal visit and at delivery. Amendments to §97.135 also
incorporate the instruction of Senate Bill 519 that a blood sample drawn from
the mother at admission for delivery be used for the syphilis and human immunodeficiency
virus (HIV) tests already required by law.
The department received no public comments during the comment period for
these amendments. However, the department is making the following minor changes
due to staff comments.
Change: Concerning §97.135(e), the reference to subsection (a)(4)(B)
was deleted and reference to (a)(5)(B) was made because the section was renumbered
as part of the changes proposed.
Change: Concerning §97.135(g), the word "sections" was deleted because
it was redundant.
Subchapter A. CONTROL OF COMMUNICABLE DISEASES
25 TAC §§97.2, 97.3, 97.5
The amendments are adopted under Health and Safety Code, §81.090,
which requires the Texas Board of Health (board) to approve standard serologic
tests for specified diseases to be administered during gestation and delivery, §81.004
which allows the board to adopt rules necessary for the effective administration
of Health and Safety Code, Chapter 81, and §12.001, which provides the
board with the authority to adopt rules for the performance of every duty
imposed by law on the board, the department, and the commissioner of health.
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 March 6, 2000.
TRD-200001700
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 26, 2000
Proposal publication date: December 3, 1999
For further information, please call: (512) 458-7236
25 TAC §97.135
The amendment is adopted under Health and Safety Code, §81.090,
which requires the Texas Board of Health (board) to approve standard serologic
tests for specified diseases to be administered during gestation and delivery, §81.004
which allows the board to adopt rules necessary for the effective administration
of Health and Safety Code, Chapter 81, and §12.001, which provides the
board with the authority to adopt rules for the performance of every duty
imposed by law on the board, the department, and the commissioner of health.
§97.135. Serological Testing during Pregnancy and Delivery.
(a)
At the time of first examination and visit, every physician
or other person permitted by law to attend a pregnant woman during gestation
or at the delivery of the infant resulting from such pregnancy shall for every
woman so attended:
(1)
distribute to the woman printed materials about HIV, AIDS,
hepatitis B, and syphilis which shall be provided by the Texas Department
of Health and note on the woman's medical chart or health care record that
the distribution was made;
(2)
verbally notify the woman that an HIV test will be
performed if the patient does not object and note on the medical records that
verbal notification was given;
(3)
verbally notify the woman that a hepatitis B test
will be performed and note on the medical chart or health care record that
verbal notification was given;
(4)
advise the woman that the result of the test taken
under this section is not anonymous, and explain the difference between an
anonymous and confidential test; and
(5)
take or cause to be taken a sample of the blood of
the woman and submit such sample to a laboratory certified by the Clinical
Laboratory Improvement Amendments of 1988 (CLIA-88; 42 United States Code §263a),
for:
(A)
a standard serological test for syphilis; and
(B)
a standard serological test for HIV infection in accordance
with §97.131 of this title (relating to Definitions); and
(C)
a standard serological test for hepatitis B infection.
(b)
Upon admission for delivery, the physician or other person
in attendance shall take or cause to be taken a sample of blood from the mother
of the infant and submit the sample to a laboratory certified by the Clinical
Laboratory Improvement Amendments of 1988 (CLIA-88) for HIV and syphilis testing.
(c)
If the woman objects to the test for HIV infection under
subsection (a)(4)(B) of this section, the physician or other person may not
conduct the test. The physician or other person shall refer the woman who
objects to the test to an anonymous testing site or instruct the woman about
anonymous testing methods.
(d)
Every physician or other person required to report births
or fetal deaths shall state on each birth or fetal death certificate whether
a blood test for syphilis was performed during the pregnancy.
(e)
If the serologic screening and confirmatory test for HIV
conducted under subsection (a)(5)(B) of this section shows that the woman
is or may be infected with HIV, the physician or other person who submitted
the sample for the test shall:
(1)
provide or make available to the woman information relating
to the treatment of HIV infection and acquired immune deficiency syndrome,
or refer the woman to an entity that provides treatment for individuals infected
with HIV or acquired immune deficiency syndrome; and
(2)
provide or make available to the woman post-test
counseling which includes:
(A)
the meaning of the test result;
(B)
the possible need for additional testing;
(C)
measures to prevent the transmission of HIV, especially
the reduction of perinatal transmission;
(D)
the availability of appropriate health services;
(E)
the benefits of partner notification and the availability
of partner notification programs;
(F)
increased understanding of HIV infection;
(G)
explanation of the potential need for confirmatory testing;
(H)
explanation of behavior changes to decrease the potential
of HIV transmission;
(I)
encouragement to seek appropriate medical care; and
(J)
encouragement to notify persons with whom there has been
contact capable of transmitting HIV.
(f)
Upon admission for delivery, the physician or other person
in attendance shall take or cause to be taken a sample of blood from the mother
of the infant and submit the sample to a laboratory certified by the Clinical
Laboratory Improvement Amendments of 1988 (CLIA-88) for hepatitis B testing.
Each woman shall be given printed materials about hepatitis B infection provided
by the Texas Department of Health and a note made on the woman's medical chart
or health care record that the distribution was made. The material shall include
information on:
(1)
the incidence and mode of transmission of the hepatitis
B virus;
(2)
how being infected with the hepatitis B virus could
affect the health of the infant;
(3)
the available treatment for maternal infection and
treatment and prophylaxis for perinatal infection; and
(4)
methods to prevent the transmission of hepatitis
B.
(g)
If the hepatitis B testing conducted under subsection
(a)(5)(C) of this section shows that the woman is or may be infected with
hepatitis B, the physician or other person who submitted the sample for the
test shall provide or make available to the woman disease-specific information,
including information on how to prevent hepatitis B transmission in adults
and prophylactic treatment for the newborn which will prevent hepatitis B
infection. Hepatitis B shall be reported in accordance with §§97.2
- 97.5 of this title (relating to Control of Communicable Diseases).
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 March 6, 2000.
TRD-200001701
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 26, 2000
Proposal publication date: December 3, 1999
For further information, please call: (512) 458-7236
25 TAC §97.201, §97.202
The Texas Department of Health (department) adopts new §97.201
and §97.202, concerning immunizations required to be offered to nursing
home residents and staff, without changes to the proposed text as published
in the October 29, 1999, issue of the
Texas Register
(24 TexReg 9533).
Nursing homes are required to offer pneumococcal vaccine to residents for
whom it is recommended and to offer influenza vaccine annually to residents
and staff. These rules specify the period each year during which influenza
vaccine must be offered, the source of current recommendations for influenza
and pneumococcal vaccination, and the documentation required under this rule.
The Centers for Disease Control and Prevention's Advisory Committee on
Immunization Practices (ACIP) recommends that all persons 65 years or older
should: (1) be vaccinated against pneumococcal disease, and (2) receive influenza
vaccine every year. Persons less than 65 years of age should also be vaccinated
if they have chronic illnesses that place them at high risk for complications
or death if they become infected with
Streptococcus
pneumoniae
or influenza virus. Despite ACIP recommendations for vaccine
use, immunization rates remain low among persons 65 years and older. National
goals for the year 2000 are 80% among residents of long-term care facilities.
Data for 1997 show Texas levels to be 68% for influenza vaccination and 44.4%
for pneumococcal vaccination. An investigation into a 1997 Texas outbreak
of three cases of
Streptococcal pneumoniae
infections in a nursing home with 90 residents showed that only 10 of the
90 had received pneumococcal vaccine. Two of the cases died and all residents
had to receive immediate vaccination and antibiotic prophylaxis. As adults
become older and more frail, administration of vaccine is less effective,
so it is important to immunize persons as they enter nursing homes, rather
than wait until their conditions worsen.
The department received no public comments during the comment period on
the proposed rules.
These new sections are adopted under Health and Safety Code §161.0051
which requires the Texas Board of Health (board) to adopt rules requiring
nursing homes to offer pneumococcal vaccine to residents and influenza vaccine
to residents and staff; and §12.001 which allows the board to adopt rules
for the performance of each duty imposed by law on the board, the department,
or the commissioner.
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 March 6, 2000.
TRD-200001702
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 26, 2000
Proposal publication date: December 3, 1999
For further information, please call: (512) 458-7236
Subchapter K. REGISTRATION OF SANITARIANS
25 TAC §§265.141 - 265.158
The Texas Department of Health (department) adopts new §§265.141
- 265.158 concerning the registration of sanitarians. Sections 265.141 and
265.144 are adopted with changes to the proposed text as published in the
December 3, 1999, issue of the
Texas Register
(24 TexReg 10744). Sections 265.142, 265.143 and 265.145 - 265.158 are adopted
without changes.
These rules are adopted to implement House Bill (HB) 1838, 76th Legislature
(1999). This legislation requires the Texas Board of Health (board) to set
the fee for the registration of sanitarians. HB 1838 also requires any person
applying for registration to have had not less than two years of full-time
experience in the field of sanitation; to have graduated from an accredited
college or university with at least a bachelor's degree that includes at least
30 semester hours in basic or applied science; to pay an examination fee prescribed
by the board; to pay a renewal fee prescribed by the board; and to provide
proof of completion of continuing education units as established by the board.
The new provisions became effective on September 1, 1999, except the change
to the educational requirements. The change in law made to the educational
requirements takes effect on September 1, 2001. Specifically, the new sections
cover the purpose of the rules; scope; transition; definitions; fees; application
procedures; qualifications for registration as a sanitarian or sanitarian-in-training;
educational requirements; continuing education; examinations; application
approval or disapproval; sanitarians-in-training preceptorship; sanitarian
registration procedures; sanitarian license renewal; grounds for suspension
or revocation; registration of persons with criminal backgrounds; violations,
complaints, investigations, and disciplinary actions; processing applications;
exemptions; and advertising. The rules for registration of sanitarians §337.181;
and §§337.183 - 337.187 are repealed so they can be replaced by
new §§265.141 - 265.158 in Chapter 265 on General Sanitation which
is the more appropriate place.
The following comment was received concerning the proposed section. Following
the comment is the department's response and any resulting change.
Comment: Concerning §265.147, the commenter stated a provision is
necessary allowing sanitarians with less than the proposed twelve continuing
education units to renew their registration if a market for continuing education
courses does not materialize.
Response: The department disagrees. The Texas Environmental Health Association
has developed courses for continuing education credit and will offer them
at its annual meeting and at quarterly meetings of its statewide chapters.
Additionally, education activities offered by organizations such as the Texas
Public Health Association and the Texas Mosquito Control Association as well
as the department will offer sanitarians adequate opportunities for obtaining
the required continuing education units. No change was made as a result of
this comment.
The commenter was a sanitarian employed by the Austin-Travis County Health
Department.
The department is making the following minor changes due to staff comments
to clarify the intent and improve the accuracy of the section.
Change: Concerning §265.141(c)(3), the department changed the word
"complete" to "completed" in order to be grammatically correct.
Change: Concerning §265.144(c)(9), the word "or" was deleted to correct
a duplicate publication of that word in the proposed rules "...the applicant's
qualifications may result in the voiding of the application, or denial or
or ....".
The new sections are adopted under the Sanitarian Registration
Act, Texas Civil Statutes, Article 4477- 3, which provides the Texas Board
of Health (board) with authority to adopt rules concerning the registration
of sanitarians; and Health and Safety Code, §12.001, which provides the
board with authority to adopt rules to implement every duty imposed by law
on the board, the department and the commissioner of health.
§265.141. Purpose and Scope.
(a)
Purpose. This subchapter implements the Sanitarian Registration
Act, Article 4477-3, Vernon's Texas Civil Statutes, which requires the Texas
Department of Health to adopt rules to implement a program for the registration
of sanitarians under the authority of the Texas Board of Health.
(b)
Scope. These sections apply to persons whose duties in
consumer health require the application of scientific knowledge to recognize,
evaluate, and control hazards associated with the distribution of contaminated,
adulterated, unsafe and misbranded foods, drugs, medical devices, and cosmetics
and to persons whose duties in environmental health or sanitation require
the application of scientific knowledge to recognize, evaluate, and control
environmental hazards and to preserve and improve environmental factors for
the achievement of the health, safety, comfort, and well-being of humans.
The sections cover purpose, scope and transition; definitions; fees; application
procedures; qualifications for registration as a sanitarian or sanitarian-in-training;
educational requirements; continuing education; examinations; application
approval or disapproval; sanitarians-in-training preceptorship; sanitarian
registration procedures; sanitarian license renewal; grounds for suspension
or revocation; registration of persons with criminal backgrounds; violations,
complaints, investigations, and disciplinary actions; processing applications;
exemptions; and advertising.
(c)
Transition.
(1)
Effective September 1, 1999, registered sanitarians presently
licensed by the department must obtain no less than twelve continuing education
contact hours related to the fields of consumer health, environmental health
or sanitation within the twelve months preceding renewal of their license
after final adoption of these rules and after the department establishes an
anniversary date for each registered sanitarian. The requirement of two years
of full-time experience, effective September 1, 1999, does not apply to sanitarians
already licensed by the department unless the sanitarians allow their licenses
to lapse. The educational requirement concerning 30 semester hours or its
equivalent in basic or applied science, effective September 1, 2001, does
not apply to sanitarians already licensed by the department unless the sanitarians
allow their licenses to lapse.
(2)
The requirement of two years of full-time experience,
effective September 1, 1999, does not apply to sanitarians-in-training already
licensed by the department unless the sanitarians-in-training allow their
license to lapse. The continuing education contact hours requirement, effective
September 1, 1999, does not apply to sanitarians-in-training already licensed
with the department. The continuing education contact hours requirement will
apply only after the sanitarians-in-training upgrade to sanitarian status.
For all sanitarians, the hours must be accrued in the twelve months preceding
renewal of their sanitarian license based on their anniversary date. The educational
requirement concerning 30 semester hours or its equivalent in basic or applied
science, effective September 1, 2001, does not apply to sanitarians-in-training
already licensed with the department unless the sanitarians-in-training allow
their license to lapse.
(3)
Effective September 1, 1999, applicants for registration
as a sanitarian must have graduated from an accredited college or university
with no less that fifteen semester hours or its equivalent in basic or natural
science; have not less than two years of full-experience in consumer health,
environmental health or sanitation; have completed all required department
application forms; have paid all required fees; and have successfully completed
an examination prescribed by the department. An applicant with less than two
years of full-time experience will be registered as a sanitarian-in-training
and be issued a license remaining in effect for a period not to exceed two
years after date of issue.
(4)
Effective September 1, 2001, the educational requirements
for registration as a sanitarian will require graduation with a bachelor's
degree from an accredited college or university with not less than thirty
semester hours or its equivalent in a basic or applied science.
§265.144. Application Procedures.
(a)
Purpose. The purpose of this section is to set the application
requests and procedures for registration as a sanitarian. Applications may
be submitted for registration as a sanitarian or sanitarian-in-training.
(b)
General.
(1)
Unless otherwise indicated, an applicant must submit all
required information and documentation of credentials on official department
forms.
(2)
The department must receive all required application
materials at least 45 days prior to the date the applicant wishes to take
the examination, including the application fee.
(3)
An application not completed within 30 days after
the date of the department's notice of deficiency may be voided.
(4)
An application is not considered complete until the
required prescribed examination has been taken by the applicant.
(c)
General application materials. The application packet
must contain the following items to be complete:
(1)
specific information regarding personal data, social security
number (used to coordinate information with the applicant's college or university
transcript), birth date, place of employment, other state registrations and
certifications held, and misdemeanor or felony convictions;
(2)
the date of the application;
(3)
the educational qualifications of the applicant (graduation
with a bachelor's degree from an accredited college or university that included
not less than fifteen semester hours or its equivalent in basic or natural
science or any combination of basic or natural science. Effective September
1, 2001, the educational requirements for registration as a sanitarian will
require graduation with a bachelor's degree from an accredited college or
university with not less than thirty semester hours or its equivalent in a
basic or applied science);
(4)
qualifying experience (not less than two years of
full-time experience in the fields of consumer health, environmental health
or sanitation including training in the basic sciences and/or public health
to the extent deemed necessary by the Board in order to effectively serve
as a registered sanitarian);
(5)
a statement that the applicant has read Texas Civil
Statutes, Article 4477-3 (Act) and these rules and agrees to abide by them;
(6)
a statement that the applicant shall return to the
department any license upon the expiration and nonrenewal, revocation, or
suspension of the license;
(7)
a statement that the applicant understands that fees
submitted in the registration process are nonrefundable unless the processing
time is exceeded without good cause as set out in §265.156 of this title
(relating to Processing Applications);
(8)
a statement that the applicant understands that materials
submitted in the registration process become the property of the department
and are not returnable;
(9)
a statement that the information in the application
is truthful and that the applicant understands that providing false and misleading
information on items which are material in determining the applicant's qualifications
may result in the voiding of the application, or denial or the revocation
of any license issued; and
(10)
the signature of the applicant which has been dated
and notarized.
(d)
Documents. The following documents shall be submitted:
(1)
a full-face photo of a minimum size of 1-1/2 by 1-1/2
inches signed on the reverse side with the applicant's signature as it appears
on the application. The photograph must have been taken within the two-year
period prior to application; and
(2)
an official transcript from an accredited college
or university (sealed as a true and exact copy of an unaltered original) showing
graduation with a bachelor's degree from an accredited college or university
that included not less than fifteen semester hours or its equivalent in basic
or natural science or any combination of basic or natural science. Effective
September 1, 2001, the educational requirements for registration as a sanitarian
will require graduation with a bachelor's degree from an accredited college
or university with not less than thirty semester hours or its equivalent in
a basic or applied science; and
(3)
proof of the successful completion of the prescribed
examination if administered by the department's designee.
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 March 6, 2000.
TRD-200001708
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: March 26, 2000
Proposal publication date: December 3, 1999
For further information, please call: (512) 458-7236
Subchapter D. REGISTRATION OF PROFESSIONAL SANITARIANS
Subchapter F. SEXUALLY TRANSMITTED DISEASES INCLUDING ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AND HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Subchapter I. IMMUNIZATION REQUIREMENTS FOR RESIDENTS OF TEXAS NURSING HOMES
Chapter 265.
GENERAL SANITATION
Chapter 337.
WATER HYGIENE