TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 123. RESPIRATORY CARE PRACTITIONER CERTIFICATION

25 TAC §§123.1-123.15

The Respiratory Care Practitioner Certification Program (advisory committee) with the approval of the Texas Board of Health proposes (board) amendments to §§123.1-123.14 and new §123.15 concerning the certification of respiratory care practitioners. Specifically the amendments cover the purpose and scope; definitions, advisory committee, fees, exemptions, application requirements and procedures, types of certificates and temporary permits and applicant eligibility, examination, certificate renewal, continuing education requirements, changes of name or address, and violations, complaints and subsequent actions. The proposed new section covers informal disposition.

The Government Code, §2001.39 requires each state agency to review and consider for readoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act). Title 25 Texas Administrative Code (TAC), Chapter 123 which includes §§123.1-123.14 has been revised in its entirety and the advisory committee and staff has determined that reasons for adopting the sections continue to exist.

The Notice of Intention to Review the sections as required by Government Code, §2001.039 was published in the Texas Register on December 17, 1999 (24 TexReg 11542). No comments were received in response to the notice.

The advisory committee held a meeting to conduct a preliminary review of its rules. As a result of this meeting, the advisory committee is amending its existing rules located in Chapter 123 to satisfy the requirements of Government Code, §2001.39; delete language that is no longer necessary; add fees for returned check and continuing education extension fee; amend the rules pursuant to the codification of the Respiratory Care Practitioner Certification Act into the new Texas Occupations Code, Chapter 604; and update and clarify existing language. Additional, proposed new §123.15 concerning informal disposition is being added.

L. Jann Melton-Kissel, Associateship for Health Care Quality and Standards, has determined that for each year of the first five years the sections are in effect, there will be a fiscal impact on state government sections as proposed are in effect. There will be no fiscal implication for local government.

Ms. Melton-Kissel has also determined that for each of the first five years the sections are in effect, the public benefit anticipated as a result of enforcing the sections as proposed will continue to assure the appropriate regulations of respiratory therapists. There will be no adverse affect on small businesses and micro-businesses that require respiratory therapists services who utilize proper business management practices. The fiscal impact to the respiratory care practitioners requesting a continuing education extension which would require a $30 fee and returned checks would require a $50 collection fee. There will be no impact on local employment.

Comments on the proposal may be submitted Pam K. Kaderka, Program Administrator, Respiratory Care Practitioners Certification Program, 1100 West 49th Street, Austin, Texas 78756-3183, (512) 834 6632. Comments will be accepted for 30 days following publication of the proposal in the Texas Register .

The amendments and new section are proposed under Texas Occupations Code, §604.052, which requires the Respiratory Care Practitioners Certification Program to adopt rules, with the approval of the Texas Board of Health; and the Health and Safety Code §12.001 that are reasonable necessary to properly perform its duties under this Act.

The amendments and new section affect the Occupations Code, Title 3. Health Professions, Subtitle K, Chapter 604; Texas Civil Statutes, Article 4512l; and Government Code §2001.039.

Context [ Purpose and Scope ]

[(a)

Purpose. These sections are intended to implement the provisions of Texas Civil Statutes, Article 4512l, as amended concerning the regulation and certification of respiratory care practitioners.]

[ (b)

Scope. ] These sections cover definitions; the advisory committee's operation; fees; exceptions to certification; application requirements and procedures; types of certificates, temporary permits, and applicant eligibility; examination; certificate renewal; continuing education requirements; changes of name or address; professional and ethical standards; certifying or permitting persons with criminal background to be respiratory care practitioners; violations, complaints and subsequent actions.

§123.2.Definitions.

The following words and terms when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise:

(1)

(No change.)

(2)

Act-- Texas Occupations Code, Chapter 604; and Texas Revised Civil Statutes portions of 4512l, as amended) [ Texas Civil Statutes, Article 4512l ], as amended.

(3)-(7)

(No change.)

(8)

Appropriate educational agency--The Texas Education Agency or other governmental agency authorized by law or statute to approve educational institutions and curriculum, or an educational accrediting body of a professional organization, such as the Committee on [ Allied Health Education and ] Accreditation for Respiratory Care (COARC) and its predecessor or [ of the American Medical Association (CAHEA) or its ] successor organization.

(9)-(12)

(No change.)

(13)

Delegated authority--As defined in the Texas Medical Practice Act, Texas Occupations Code Chapter 157 [ Texas Civil Statutes, Article 4495b, §3.06(d)(1) ] and the rules pertaining thereto adopted by the BME.

(14)

(No change.)

(15)

Diagnostic--Of or relating to or used in the art or act of identifying a disease or disorder [ disorders. ]

(16)-(20)

(No change.)

[(21)

Practitioner--A person who holds a certificate or temporary permit issued under the Act to practice respiratory care.]

(21)

[ (22) ] Qualified medical director--A physician licensed and in good standing with the BME, and who has special interest and knowledge in the diagnosis and treatment of respiratory care problems who is actively engaged in the practice of medicine. This physician must be a member of the active medical staff of a health care facility, agency or organization who supervises the provision of respiratory care.

(22)

[ (23) ] Respiratory care--The treatment, management, control, diagnostic evaluation, and care of inpatients or outpatients who have deficiencies and abnormalities associated with the cardiorespiratory system. Respiratory care does not include the delivery, assembly, set up, testing, and demonstration of respiratory care equipment upon the order of a licensed physician. Demonstration is not to be interpreted here as the actual patient assessment and education, administration, or performance of the respiratory care procedure(s).

(23)

[ (24) ] Respiratory care education program--

(A)

a program in respiratory care approved by the educational accrediting body;

(B)

a program approved by an appropriate education agency and working toward becoming an approved program in respiratory care. A program will qualify as a respiratory care education program under this subparagraph only for a period of one year from the date of the first class offered by the program; after that one year, the program must be an approved program in respiratory care; or

(C)

a program accredited by the Canadian Medical Association and whose graduates are eligible to take the national registry exam given by the Canadian Board of Respiratory Care.

(24)

[ (25) ] Respiratory care practitioner (RCP)--A person permitted or certified under the Act to practice respiratory care.

(25)

[ (26) ] Respiratory care procedure--Respiratory care provided by the therapeutic and diagnostic use of medical gases, humidifiers, and aerosols, the administration of drugs and medications to the cardiorespiratory system, ventilatory assistance and ventilatory control, postural drainage, chest drainage, chest percussion or vibration, breathing exercises, respiratory rehabilitation, cardiopulmonary resuscitation, maintenance of natural airways, and the insertion and maintenance of artificial airways. The term includes a technique employed to assist in diagnosis, monitoring, treatment, and research, including the measurement of ventilatory volumes, pressures and flows, the specimen collection of blood and other materials, pulmonary function testing, and hemodynamic and other related physiological forms of monitoring or treating, as ordered by the patient's physician, the cardiorespiratory system. These procedures include:

(A)

administration of medical gases--such as nitric oxide, helium and carbon dioxide;

(B)

providing ventilatory assistance and ventilatory control--including high frequency oscillatory ventilation and high frequency jet ventilation;

(C)

providing artificial airways--including insertion, maintenance and removal;

(D)

performing pulmonary function testing--including neonatal and pediatric studies;

(E)

hyperbaric oxygen therapy;

(F)

monitoring--including pulse oximeter, end-tidal carbon dioxide and apnea monitoring;

(G)

extracorporeal membrane oxygenation (ECMO);

(H)

patient assessment, respiratory patient care planning; and

(I)

implementation of respiratory care protocols.

(26)

[ (27) ] Respiratory therapist--A person permitted or certified under the Act to practice respiratory care.

[(28)

Temporary certificate--A certificate which expires August 31, 1987, issued to a person who at the time of application to the department, is not registered or certified by the NBRC, and who is practicing respiratory care under the direction of a qualified medical director or other physician licensed by and in good standing with the BME.]

(27)

[ (29) ] Temporary permit--A permit issued in accordance with §123.7(d) of this title (relating to Types of Certificates, Temporary Permits, and Applicant Eligibility) for a period of six months.

(28)

[ (30) ] Therapeutic--Of or relating to the treatment of disorders by remedial agents or methods.

(29)

[ (31) ] Under the direction--Assuring that established policies are carried out; monitoring and evaluating the quality, safety, and appropriateness of respiratory care services and taking action based on findings; and providing consultation whenever required, particularly on patients receiving continuous ventilatory or oxygenation support.

§123.3.Respiratory Care Practitioners Advisory Committee

(a)-(f)

(No change).

(g)

Terms of office. The term of office of each member shall be six years , and members [ . Members ] shall serve after expiration of their term until a replacement is appointed.

(1)-(2)

(No change).

(h)-(p)

(No change).

§123.4.Fees.

The following fees are prescribed by the board and are required to be paid to the department before any certificate or permit is issued. All fees shall be submitted in the form of a check or money order and are nonrefundable. The department may direct examination applicants to submit examination fees to the National Board for Respiratory Care, Inc. (NBRC).

(1)

Schedule of fees for certification as a respiratory care practitioner:

(A)-(D)

(No change.)

(E)

certificate fee for upgrade of temporary permit--$30; [ and ]

(F)

written verification of certication status--$10 ; [ . ]

(G)

returned check fee--$50; and

(H)

continuing education extension fee--$30.

(2)

Schedule of fees for a temporary permit as a respiratory care practitioner:

(A)-(B)

(No change.)

(C)

temporary permit and/or identification card replacement fee--$20; [ and ]

(D)

written verification of certification status--$10 ; [ . ]

(E)

returned check fee--$50.

(3)

An applicant whose check for the application fee is returned due to insufficient funds, account closed, or payment stopped shall be allowed to reinstate the application by remitting to the department a money order or check for guaranteed funds in the amount of the application fee plus the returned check fee within 30 days of the date of receipt of the department's notice. An application will be considered incomplete until the fee has been received and cleared through the appropriate financial institution.

(4)

An approved applicant whose check for the temporary permit or certificate fee is returned marked [ due to ] insufficient funds, account closed, or payment stopped shall remit to the department a money order or check for guaranteed funds in the amount of the temporary permit or certificate fee plus the returned check fee within 30 days of the date of receipt of the department's notice. Otherwise, the application and the approval shall be invalid.

(5)

A temporary permit holder whose check for the temporary permit extension fee is returned due to insufficient funds, account closed or payment stopped shall remit to the department a money order or check for guaranteed funds in the amount of the temporary permit extension fee plus the returned check fee within 30 days of the date of the department's notice. Otherwise, the temporary permit shall not be extended, or if already extended shall be invalid.

(6)

A certificate holder whose check for the renewal fee is returned due to insufficient funds , account closed or payment stopped shall remit to the department a money order or check for guaranteed funds in the amount of the renewal fee plus the returned check fee within 30 days of the date of receipt of the department's notice. Otherwise, the certificate shall not be renewed. If a renewal certificate has already been issued, it shall be invalid.

(7)

If the department's notice, as set out in paragraphs (3)-(6) of this section, is returned unclaimed, the department shall mail the notice to the applicant or certificate holder by first class mail. If a money order or check for guaranteed funds is not received by the department's cashier within 30 days of the postmarked [ (postmark) ] date on the second mailing, the approval or certificate issued shall be invalid. The department shall notify the applicant's or certificate holder's employer that the person has failed to comply with this section.

(8)

(No change.)

Exemptions . [ Exceptions to Certification. ]

[(a)

The purpose of this section is to set out who is exempt from certification under the Act and who must be certified under the Act.]

(a)

[ (b) ] Except as specifically exempted by subsection (b) [ (c) ] of this section, the provisions of the Act and this chapter apply to any person representing that he or she practices or provides respiratory care services.

(b)

[ (c) ] These sections do not prohibit:

(1)

the practice of respiratory care that is an integral part of the program of study by a student enrolled in a respiratory care education program approved by the department;

(2)

the employment by a health care facility of a person to deliver limited respiratory care support services under the supervision of an individual who holds a certificate issued under this Act, if such a person does not perform an invasive procedure related to critical respiratory care, including therapeutic, diagnostic, or palliative procedures as part of the person's employment and if the person:

(A)

is enrolled for credit in the clinical portion of an approved respiratory care education program; or

(B)

has completed all of the clinical portion of an approved respiratory care education program within the preceding 12 months and is actively pursuing a course of study leading to graduation from the program;

(3)

the gratuitous care of the ill by a friend or member of the family or care provided in an emergency situation by a person who does not claim to be a respiratory care practitioner who holds a temporary permit or certificate issued under the provisions of the Act;

(4)

a respiratory care practitioner from performing advances in the art and techniques of respiratory care, as defined in the Act and in §123.2 of this title (relating to Definitions), learned through formal or specialized training;

(5)

the practice of respiratory care by health care personnel who have been formally trained in the care used and who are:

(A)

licensed under the practice acts regulating their professions; or

(B)

acting under the delegated authority of a physician licensed by the Board of Medical Examiners;

(6)

the practice of any legally qualified respiratory care practitioner employed by the United States government while in the discharge of official duties; or

(7)

any person who is licensed, registered, or certified under another law of this state from engaging in the profession or occupation for which the person is licensed, registered, or certified.

(c)

[ (d) ] Student status . [ is further clarified as follows. ]

(1)

Students who are not enrolled in the clinical portion or have not completed the clinical portion of their respiratory care education program within the preceding 12 months may not be employed by a health care facility to provide limited respiratory care services unless they hold a temporary permit.

(2)

Students in a nontraditional accredited respiratory care education program may be considered as being engaged in the clinical portion of their education program during its entire duration. For the purposes of this section nontraditional shall mean those respiratory care education programs recognized as nontraditional education systems by the Committee on Accreditation for Respiratory Care [ Joint Review Committee for Respiratory Care Education of the AMA ] or its successor organization.

(3)

A clinical student who is employed by any health care facility, agency or organization to provide limited respiratory care services should provide his or her employer, on a semi-annual basis, verification that he or she is a bona fide student in an approved respiratory care education program. Acceptable verification shall be a letter on program letterhead with the original signature of the program director attesting to the student's bona fide status as an active student in the clinical portion of that program or that the student has completed the clinical portion of the course within the preceding 12 months and is actively pursing a course of study leading to graduation from the program.

(4)

Limited respiratory care services provided by an employed clinical student must be supervised by a practitioner certified under this Act. Students may not perform invasive procedures related to critical respiratory care.

(5)

Students who are within 45 days of graduation may apply to the department for a temporary permit in accordance with §123.6 of this title (relating to Application Requirements and Procedures). A person who holds a temporary permit may perform any and all respiratory care procedures which he or she has been trained to perform.

(d)

[ (e) ] All persons who apply to become certified or permitted as a practitioner, all persons who believe they are exempt under the Act and this chapter, and all other persons who are interested in practicing respiratory care need to be aware of the:

(1)

penalty provisions under the Texas Occupations Code §604.351 [ Act, §13 ], violations. Any person who knowingly or intentionally violates a provision of the Act commits a Class B misdemeanor; and

(2)

prohibited acts provisions under the Texas Occupations Code §604.102 [ Act, §4 ]. Persons who are not certified or permitted under the Act may not use in connection with their practice or employment the words "respiratory care," "respiratory therapist," "respiratory care practitioner," "certified respiratory care practitioner," or the letters "RCP," or any other words, letters, abbreviations, or insignia indicating or implying that the person is a respiratory care practitioner.

§123.6.Application Requirements and Procedures.

[(a)

Purpose. The purpose of this section is to set out the application procedures for examination and certification.]

(a)

[ (b) ] General.

(1)

Unless otherwise indicated, an applicant must submit all required information and documentation of credentials on official department forms.

(2)

The department shall not consider an application as officially submitted until the applicant pays the application fee and the fee clears the appropriate financial institution. The fee must accompany the application form.

(3)

The administrator shall send a notice listing the additional materials required to an applicant who does not complete the application in a timely manner. An application not completed within 30 days after the date of the notice shall be invalid.

(b)

[ (c) ] Required application materials.

(1)

Application form. The application form shall contain:

(A)

specific information regarding personal data, social security number, birth month and day, place of employment, other state licenses and certifications held, misdemeanor and felony convictions, educational and training background, and work experience;

(B)

a statement that the applicant has read the Act and these sections and agrees to abide by them;

(C)

the applicant's permission to the department to seek any information or references it deems fit to determine the applicant's qualifications;

(D)

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

(E)

a statement that the applicant understands that fees submitted are nonrefundable;

(F)

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

(G)

a statement that the information in the application is truthful and that the applicant understands that providing false information of any kind may result in the voiding of the application and failure to be granted a [ any ] certificate or permit, or the revocation of a [ any ] certificate or permit issued;

(H)

a statement that if issued a [ any ] certificate or permit the practitioner shall keep the department advised of his or her current mailing address; and

(I)

the signature of the applicant which has been dated and notarized; [ and ]

(J)

a full-face color photograph 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 to the department and the minimum size is one and one-half inches by one and one-half inches.

(2)

Educational records. Applicants for a certificate, who were not certified or registered in respiratory care by the NBRC on or before September 1, 1985, or a temporary permit must submit:

(A)

a photocopy which has been notarized as a true and exact copy of an unaltered:

(i)

an official diploma or official transcript indicating graduation from high school;

(ii)

certificate of high school equivalency issued by the appropriate educational agency; or

(iii)

official transcript from an accredited college or university indicating that the applicant received a high school diploma or equivalency or was awarded an associate, baccalaureate, or post-baccalaureate degree; and

(B)

a photocopy which has been notarized as a true and exact copy of an unaltered certificate of completion from a respiratory care education program. The certificate must contain:

(i)

name and number of the program (exactly as listed with the educational accrediting body);

(ii)

name of the graduate;

(iii)

exact day and month individual is recognized as a program graduate;

(iv)

accreditation statement; and

(v)

signatures of the medical director, program director and administrative official; or

(C)

an expected graduation statement signed by the program director. Within 30 days of the completion date noted in the statement, the department must receive either:

(i)

a notarized copy of the certificate of completion, as set out in subparagraph (B) of this paragraph; or

(ii)

a notarized statement signed by the program director indicating that the applicant officially completed the program but the certificate is not available within 30 days of the completion date.

(3)

Examination results.

(A)

If the applicant is making application for a temporary permit, an examination score release form shall be signed allowing the department to obtain the applicant's examination results from the NBRC , or other agency administering the examination prescribed by the board.

(B)

If an applicant for a regular certificate is:

(i)

recognized as certified respiratory therapist [ therapy technician ] or registered respiratory therapist by the NBRC at the time of application, a photocopy of the certificate issued by NBRC shall be submitted in lieu of examination results; or

(ii)

unable to show proof of successful completion or otherwise provide documentation acceptable to the department of the applicant's examination results, the application shall be disapproved.

(4)

Employment/experience documentation report form. Persons applying for any certificate or permit who are not recognized as a certified respiratory therapist [ therapy technician ] or registered respiratory therapist by the NBRC and who are licensed, registered, or otherwise regulated in another state, territory, or country at the time of application must submit with their applications a properly completed employment/experience documentation report form signed by their medical director as defined in §123.2 of this title (relating to Definitions), attesting that the applicant is currently practicing, or has practiced respiratory care within the 12-month period immediately preceding application to the department.

(5)

Medical direction requirement. If the applicant is practicing respiratory care in Texas at the time of application to the department, the applicant shall obtain on the application form the signature and the license number of the qualified medical director as defined in §123.2 of this title (relating to Definitions) or other Texas licensed physician directing the provision of respiratory care services.

(c)

[ (d) ] Information/Documentation form. Persons applying for any certificate or permit who are licensed, registered, or otherwise regulated in any profession at the time of application to the department must submit with their applications a properly completed information/documentation form signed by an agency official. The signature must be notarized if the agency does not have or does not affix its official seal on the form.

(d)

[ (e) ] Application processing.

(1)

Time periods. The department shall comply with the following procedures in processing applications for a permit or certificate.

(A)

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. 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 time periods are as follows:

(i)

letter of acceptance of application for permit or certification--14 working days. The notice of acceptance may include a statement that an application for temporary permit received more than 45 days from the date of the applicant's graduation will be held pending until the applicant is within 45 days of graduation; and

(ii)

letter of application deficiency--14 working days.

(B)

The following periods of time shall apply from the receipt of the last item necessary to complete the application until the date of issuance of written notice approving or denying the application. The time periods for denial include notification of the proposed decision and of the opportunity, if required, to show compliance with the law, and of the opportunity for a formal hearing. The time periods are as follows:

(i)

letter of approval--14 working days; and

(ii)

letter of denial of permit or certificate--180 working days.

(2)

Reimbursement of fees.

(A)

In the event an application is not processed in the time periods stated in paragraph (1) of this subsection, the applicant has the right to request reimbursement of all fees paid in that particular application process. Requests [ Application ] for reimbursement shall be made to the program administrator. If the program administrator does not agree that the time period has been violated or finds that good cause existed for exceeding the time period, the request will be denied.

(B)

Good cause for exceeding the time period is considered to exist if the number of applications for licensure and licensure renewal exceeds by 15% or more the number of applications processed in the same calendar quarter the preceding year, another public or private entity relied upon by the department in the application process caused the delay, or any other condition exists giving the department good cause for exceeding the time period.

(3)

Appeal. If a request for reimbursement under paragraph (2) of this subsection is denied by the program administrator, the applicant may appeal to the commissioner of health for a timely resolution of any dispute arising from a violation of the time periods. The applicant shall give written notice to the commissioner of health at the address of the department that he or she requests full reimbursement of all fees paid because his or her application was not processed within the applicable time period. The program administrator shall submit a written report of the facts related to the processing of the application and of any good cause for exceeding the applicable time period. The commissioner of health shall provide written notice of the decision to the applicant and the program administrator. An appeal shall be decided in favor of the applicant if the applicable time period was exceeded and good cause was not established. If the appeal is decided in favor of the applicant, full reimbursement of all fees paid in that particular application process shall be made.

(4)

Contested cases. The time periods for contested cases related to the denial of licensure or license renewals are not included with the time periods stated in paragraph (1) of this subsection. The time period for conducting a contested case hearing runs from the date the department receives a written request for a hearing and ends when the decision of the department is final and appealable. A hearing may be completed within one to four months, but may extend for a longer period of time depending on the particular circumstances of the hearing

(e)

[ (f) ] Application approval.

(1)

The administrator shall be responsible for reviewing all applications.

(2)

The administrator shall approve all applications which are in compliance with subsections (a)-(c) [ (b)-(d) ] of this section and which properly document applicant eligibility, unless the application is disapproved under the provisions of subsection (f) [ (g) ] of this section.

(f)

[ (g) ] Disapproved applications.

(1)

The department shall disapprove the application if the person:

(A)

has not completed the requirements in subsection (b) [ (c) ] of this section;

(B)

has failed to pass the examination prescribed by the board as set out in §123.8 of this title (relating to Examination) during the period for which the temporary certificate, or temporary permit or temporary permit extension, was valid, if applicable;

(C)

has failed to remit any applicable fees required in §123.4 of this title (relating to Fees);

(D)

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

(E)

has been in violation of the Act, §123.14 of this title (relating to Violations, Complaints, and Subsequent Actions), the code of ethics as set out in §123.12 of this title (relating to Professional and Ethical Standards), or any other applicable provision of this chapter;

(F)

has been convicted of a felony or misdemeanor, if the crime directly relates to the duties and responsibilities of a respiratory care practitioner as set out in §123.13 of this title (relating to Certifying or Permitting Persons with Criminal Backgrounds To Be Respiratory Care Practitioners);

(G)

holds a license, certification, or registration to practice respiratory care in another state or jurisdiction and that license, certification, or registration has been suspended, revoked, or otherwise restricted by the licensing entity in that state or jurisdiction for reasons relating to the person's professional competence or conduct which could adversely affect the health and welfare of a patient;

(H)

is not currently practicing, or has not practiced within the 12-month period preceding the date of application, respiratory care, as set out in §123.7(d)(1)(B) of this title (relating to Types of Certificates and Temporary Permits and Applicant Eligibility); or

(I)

has submitted a copy of a National Board for Respiratory Care, Inc. (NBRC) certificate in lieu of examination results in accordance with subsection (b) [ (c) ](3)(B)(i) of this section, but is not recognized by the NBRC as a certified respiratory therapist [ therapy technician ] or registered respiratory therapist.

(2)

If after review the administrator determines that the application should not be approved, the administrator shall give the applicant written notice of the reason for the proposed decision and of the opportunity for a formal hearing. The formal hearing shall be conducted according to the Administrative Procedure Act, Texas Government Code §2001, et seq. [ department's formal hearing procedures in Chapter 1 of this title (relating to Texas Board of Health) ] Within 10 days after receipt of the written notice, the applicant shall give written notice to the administrator that the applicant either waives the hearing, or wants the hearing. Receipt of the written notice is deemed to occur on the tenth [ (10th) ] day after the notice is mailed unless another date of receipt is reflected on a United States Postal Service return receipt. If the applicant fails to respond within 10 days after receipt of the notice of opportunity, or if the applicant notifies the administrator that the hearing be waived, the applicant is deemed to have waived the hearing. If the hearing has been waived, the department shall disapprove the application.

(3)

An applicant whose application has been disapproved under paragraph (1)(E) and (F) of this subsection shall be permitted to reapply after a period of not less than one year from the date of the disapproval and shall submit with the reapplication proof satisfactory to the department of compliance with all rules of the board and the provisions of the Act in effect at the time of reapplication. The date of disapproval is the effective date of a disapproval order signed by the commissioner of health.

§123.7.Types of Certificates and Temporary Permits and Applicant Eligibility.

(a)

General. This section sets [ The purpose of this section is to set ] out the types of certificates and permits issued, and the qualifications of applicants for certification as respiratory care practitioners.

(1)-(6)

(No change.)

(b)-(c)

(No change.)

(d)

Applicant eligibility.

(1)

Temporary permit. The department shall issue a temporary permit to practice respiratory care to:

(A)

(No change.)

(B)

an applicant who has applied on the forms prescribed by the department; who has paid the prescribed application fee; who is currently practicing respiratory care or has within the 12-month period immediately preceding the date of the application to the department practiced respiratory care in another state, territory, or country; who holds a valid license or other form of registration to practice respiratory care in that state, territory, or country; who is in good standing in that state, territory, or country and who is not recognized, at the time of application to the department, as a certified respiratory therapist [ therapy technician ] or registered respiratory therapist by the National Board for Respiratory Care, Inc. (NBRC). A regular certificate may be issued by the department upon approval of the application and payment of prescribed fees to an applicant who submits evidence, satisfactory to the department, that he or she has passed the examination, as set out in §123.8 of this title (relating to Examination), and is in good standing with the agency or organization with which they are licensed or registered to practice respiratory care. Applicants for a temporary permit under this paragraph who have not passed the examination, as set out in §123.8 of this title (relating to Examination), shall not be issued a regular certificate; or

(C)

an applicant who holds a valid temporary permit pending reexamination who has applied for an extension of the temporary permit on the form prescribed by the department and who has paid the additional prescribed fee. This temporary permit shall expire not more than 12 months from the date of issuance of the original permit. A temporary permit holder is not entitled to an extension if the person has not submitted a certificate of completion from a respiratory care education program in accordance with §123.6 (b) [ (c) ](2)(C) of this title (relating to Application Requirements and Procedures). After the applicant passes the examination as set out in §123.8 of this title (relating to Examination) and has paid the prescribed fee, a regular certificate shall be issued and the temporary permit shall become null and void.

(2)

Regular certificate. The department shall issue a regular certificate to practice respiratory care to an applicant who has applied on a form prescribed by the department, who has paid the prescribed application fee and who:

(A)

has, prior to making application to the department, passed the entry level certified respiratory therapist [ therapy technician ] examination administered by or under the auspices of the NBRC with a score equal to or exceeding the pass rate determined by the NBRC at the time of examination or reexamination; [ or ]

(B)

has, prior to making application to the department, passed the registered respiratory therapist (RRT) examination administered by or under the auspices of the NBRC; [ or ]

(C)-(D)

(No change.)

(3)

Out-of-State License/Certification/Registration. The department shall issue a regular certificate to practice respiratory care to an applicant who is in good standing and holds a valid license or other form of registration to practice respiratory care in another state, territory, or country, whose requirements for licensure or certification were at the time of approval substantially equal to the requirements set forth in the Act and this chapter, and who:

(A)-(D)

(No change.)

(E)

has submitted satisfactory evidence on a form prescribed by the department that the applicant is currently practicing or has within the 12-month period immediately preceding the date of application to the department practiced respiratory care in the state, territory, or country in which the applicant is licensed or otherwise regulated if the applicant is not recognized, at the time of application to the department, as a certified respiratory therapist [ therapy technician ] or registered respiratory therapist; and

(F)

(No change.)

§123.8.Examination.

[(a)

Purpose. This section sets out the rules governing the administration, content, grading, and other procedures for examination for certification.]

(a)

[ (b) ] Examination eligibility. Holders of temporary permits are allowed to take the examination provided the holder complies with the requirements of the Act and these sections. Persons who are certified or registered in respiratory care by the NBRC at the time of application to the department are not required to be reexamined for state certification.

(b)

[ (c) ] Approved examination. The approved examination for all applicants consists of an entry level certified respiratory therapist (CRT) [ therapy technician (CRTT) ] examination administered for [ under the auspices of ] the National Board for Respiratory Care, Inc. (NBRC) or its designee, or the advisory committee may recommend an equivalent examination.

(c)

[ (d) ] Standards of acceptable performance. The cut-score determined by the NBRC at the time of examination or reexamination shall be the cut-score utilized by the department to determine pass or fail performance.

(d)

[ (e) ] Completion of application forms. Each applicant shall be responsible for completing and transmitting appropriate application forms and paying appropriate fees by the deadlines set by the NBRC, if an NBRC examination is prescribed.

(e)

[ (f) ] Results.

(1)

Results of an examination prescribed by the board but administered under the auspices of another agency will be communicated to the applicant by the department, unless the contract between the department and that agency provides otherwise.

(2)

The applicant or temporary permit holder is responsible for arranging to have examination scores forwarded to the department. If the score report does not come directly from the NBRC in writing or on data tape, the results shall be in the form of a copy which has been notarized as a true and exact copy of the original of either:

(A)

a letter , or other official notification , from the examining agency to the examinee; or

(B)

the CRT [ certified respiratory therapy technician ] certificate issued by the NBRC.

(3)

If the examination is graded by a national or state testing service, or by the NBRC or its designee, the department shall notify each examinee of the examination results within 14 days of the date the department receives the results.

(4)

If the examination is graded by the department or its designee, the department shall notify each examinee of the results of the examination within 60 days of the date of the exam. If the results will be delayed for more than 60 days after the examination, the department shall notify each applicant of the reason for the delay.

(5)

If the department is required to provide official notice of examination results to the applicant, no matter what numerical or other scoring system is used in arriving at examination results, the results shall be stated in terms of pass or fail.

(f)

[ (g) ] Refunds. Examination fee refunds to persons who fail to appear for the examination will be in accordance with policies and procedures of the NBRC, or other agency approved by the board to administer an examination prescribed in this section.

§123.9.Certificate Renewal.

[(a)

Purpose. The purpose of this section is to set out the rules governing certificate renewal.]

(a)

[ (b) ] General. Except as provided by subsection (b) of this section, a practitioner shall renew the certificate annually.

[(1)

When issued, a certificate is valid until the practitioner's next birth month except as provided by subsection (c) of this section.]

[ (2) ]

A practitioner shall renew the certificate annually.

(1)

[ (3) ] The renewal date of a certificate shall be the last day of the practitioner's birth month.

(2)

[ (4) ] Each practitioner shall be responsible for renewing the certificate on or before the expiration date and shall not be excused from paying reinstatement fees. Failure to receive notification from the department prior to the expiration date will not excuse failure to file for renewal or reinstatement.

(3)

[ (5) ] The department may not renew the certificate or permit of the practitioner who is in violation of the Act or board rules at the time of application for renewal.

(4)

[ (6) ] The department shall deny renewal of a certificate or permit if renewal is prohibited by the Education Code, §57.491, concerning guaranteed student loan defaults.

(b)

[ (c) ] Staggered renewals. The department shall use a staggered system for certificate renewals. [ Certificates issued within six months of a practitioner's birth month shall be issued for that period of time plus the next full year. ]

(c)

[ (d) ] Certificate renewal.

(1)

At least 30 days prior to the expiration date of a person's certificate, the department shall send notice to the practitioner of the expiration date of the certificate, the amount of the renewal fee due, and a renewal form which the practitioner must complete and return to the department with the required renewal fee.

(2)

The renewal form for all practitioners shall require the provision of the preferred mailing address, primary employment address and telephone number, and category of employment, misdemeanor and felony convictions, statement concerning status with The National Board for Respiratory Care, Inc., and continuing education completed. If the applicant is practicing as a respiratory care practitioner at the time of renewal the name, signature and license number of the physician directing the provision of respiratory care and the physician's institutional affiliation(s), if any, shall be provided on the renewal form[ , ] if requested by the department.

(3)

A practitioner has renewed the certificate when the department has received the completed renewal form, continuing education as set out in §123.10 of this title (relating to Continuing Education Requirements), and the required renewal fee on or prior to the expiration date of the certificate. The postmark date shall be considered as the date of mailing.

(4)

The department shall issue identification cards for the current renewal period to a practitioner who has met all requirements for renewal.

(d)

[ (e) ] Late renewal or reapplication.

(1)

A person whose certificate has expired may renew the certificate by submitting to the department the renewal form, continuing education as set out in §123.10 of this title (relating to Continuing Education Requirements) completed since the last renewal, and if respiratory care procedures were performed after the certificate expired, a notarized statement indicating how the person complied with the Act, §604.003 [ §9 of the Act ].

(A)

If renewal is requested from one day up to 90 days after expiration, the applicant shall submit a fee that is equal to one and one half times the renewal fee, as set out in §123.4 of this title (relating to Fees).

(B)

If renewal is requested more than 90 days after expiration but less than one year after expiration, the applicant shall submit a fee that is equal to two times the renewal fee, as set out in §123.4 of this title.

(C)

If the person received a 90-day extension of the person's certificate pursuant to §123.10 (f) [ (i) ] of this title (relating to Continuing Education Requirements), the expiration date under subparagraphs (A)-(B) of this paragraph is the expiration date of the person's last annual certificate.

(D)

After the certificate is renewed, the next continuing education reporting period starts on the date the certificate is renewed and continues until the next expiration [ renewal ] date.

(2)

The department shall inform a person who has not renewed a certificate by the expiration date of the amount of the fee required for renewal, the continuing education required for renewal, and the date the certificate expired.

(3)

A person whose certificate has been expired for one year or more may apply for a new certificate by complying with the then-current requirements for obtaining a certificate.

(4)

After a certificate is expired and until a person has renewed the certificate, a person may not practice [ as a ] respiratory care [ practitioner ] in violation of the Act.

(5)

A person who fails to renew a certificate within one year may obtain a new certificate without examination if the person:

(A)

pays a fee that is equal to two times the renewal fee;

(B)

is currently certified as a respiratory care practitioner in another state;

(C)

has been practicing respiratory care in the state where the certification is held for the two years preceding the date of application for renewal; and

(D)

submits proof of completion of the continuing education requirements as set out in §123.10 of this title within the 12 month period preceding the date of application for a new certificate.

(e)

[ (f) ] Renewal Processing.

(1)

The department shall issue a certificate renewal within 14 working days after receipt of documentation of all renewal requirements.

(2)

The reimbursement of fees, appeals, and contested cases relating to renewals shall be governed by the provisions of §123.6 (d) [ (e) ](2)-(4) of this title (relating to Application Requirements and Procedures).

(f)

[ (g) ] Military duty. If a practitioner fails to timely renew his or her permit or certificate [ on or after August 1, 1990, ] because the practitioner is or was on active duty with the armed forces of the United States of America, serving outside the State of Texas, the practitioner may renew the permit or certificate pursuant to this subsection.

(1)

Renewal of the permit or certificate may be requested by the practitioner, the practitioner's spouse, or an individual having power of attorney from the practitioner. The renewal form shall include a current address and telephone number for the individual requesting the renewal.

(2)

Renewal may be requested before or after expiration of the permit or certificate.

(3)

A copy of the official orders or other official military documentation showing that the practitioner is or was on active duty, serving outside the State of Texas, shall be filed with the department along with the renewal form.

(4)

A copy of the power of attorney from the practitioner shall be filed with the department along with the renewal form if the individual having the power of attorney executes any of the documents required in this subsection.

(5)

A practitioner renewing under this subsection shall pay the renewal fee.

(6)

A practitioner renewing under this subsection shall submit proof of having earned any clock hours of continuing education prior to being called to active duty serving outside the State of Texas and no further continuing education hours shall be required for renewal.

(g)

[ (h) ] Inactive status. A respiratory care practitioner who holds a certificate under the Act and who is not actively engaged in the practice of respiratory care may make application to the department in writing on a form prescribed by the department to be placed on an inactive status list maintained by the department. The application for inactive status must be postmarked prior to the expiration of the practitioner's annual certificate. No refund will be made of any fees paid prior to application for inactive status

(1)

A person on inactive status is not required to pay the annual renewal fee.

(2)

A person on inactive status may not perform any activities regulated under this [ the ] Act. Practice as a respiratory care practitioner in any capacity for compensation or as a volunteer is prohibited, and the person may not use the title respiratory care practitioner while on inactive status.

(3)

A person on inactive status is not required to complete the requirements in accordance with §123.10 of this title (relating to Continuing Education Requirements), except as provided in paragraph (4)(D) of this subsection.

(4)

If a person on inactive status desires to reenter active practice, the person shall :

(A)

notify the department in writing;

(B)

complete appropriate forms;

(C)

pay a renewal fee for the current renewal period plus a reinstatement fee equal to one-half the renewal fee; and

(D)

submit to the department proof of successful completion, within the 12-month period prior to reentering active status, of the continuing education hours as set out in §123.10 of this title.

(5)

A person in compliance with this subsection is not subject to subsection (d) [ (e) ] of this section.

(h)

[ (i) ] Expiration of certificate. A person whose certificate has expired may not use the title or represent or imply that he has the title of certified respiratory care practitioner, respiratory care practitioner, or respiratory therapist, or use the letters RCP, and may not use any facsimile of those titles in any manner. Until a person has renewed the certificate, a person may not practice respiratory care in violation of the Act. [ Any person who practices respiratory care with an expired certificate is in violation of the Act. ]

§123.10.Continuing Education Requirements.

[(a)

Purpose. The purpose of this section is to establish the continuing education requirements which a respiratory care practitioner must complete annually to maintain certification. These requirements are intended to maintain and improve the quality of professional services in respiratory care provided to the public and keep the practitioner knowledgeable of current research, techniques, and practice and provide other resources which will improve skill and competence in respiratory care.]

(a)

[ (b) ] General. Continuing education requirements for renewal shall be fulfilled each renewal year.

(1)

The initial period shall begin with the date the department issues the certificate and end on the last day of the birth month at the time of the second renewal.

(2)

At the time the certificate is mailed, each practitioner shall be notified of the beginning and ending dates of the continuing education period.

(3)

A practitioner must complete 12 clock hours of continuing education acceptable to the department during each renewal year.

(4)

A clock hour shall be 50 minutes of attendance and participation in an acceptable continuing education experience.

(b)

[ (c) ] Types of acceptable continuing education. Continuing education must be in skills relevant to the practice of respiratory care and must have a direct benefit to patients and clients and shall be acceptable if the experience falls in one or more of the following categories:

(1)

respiratory care course work seminars, workshops, review sessions, or other organized educational programs completed at or through any respiratory care education program;

(2)

participation in any program (e.g., in-service educational training programs, institutes, seminars, workshops and conferences) which is:

(A)

directly related to the profession of respiratory care;

(B)

instructor directed; and

(C)

approved, recognized, accepted, or assigned continuing education credits by professional organizations or associations or offered by a federal, state, or local governmental entity. A list approved by the advisory committee is available from the department upon request;

(3)

instruction or teaching in programs set out in paragraphs (1) and (2) of this subsection, provided that such instruction or teaching is not a part of, or required as a part of, one's employment, or;

(4)

up to four credit hours during each renewal period of self-directed Internet-based or computer-based studies, including a post-test, which meets the requirements described in paragraphs (2)(A) and (2)(C) of this subsection.

(c)

[ (d) ] Determination of clock hours. The department shall credit continuing education experiences as follows.

(1)

Completion of course work at or through a respiratory care educational program as set out in subsection (b) [ (c) ](1) of this section shall be credited on the basis of 15 clock hours for each semester hour successfully completed for credit or audit, evidenced by a certificate of successful completion or official transcript.

(2)

Parts of programs, activities, workshops, seminars, sessions, etc., which meet the criteria of subsections (b) [ (c) ](1) or (2) of this section shall be credited on a one-for-one basis with one clock hour for each clock hour spent in the continuing education activity.

(3)

Teaching in programs which meet the department's criteria as set out in subsection (b) [ (c) ](3) of this section shall be credited on the basis of two clock hours for each hour actually taught.

(4)

Passing the certified respiratory therapist recredentialing examination shall be credited on the basis of ten clock hours.

(5)

Passing the written registry examination for advanced respiratory therapy practitioners for credentialing or recredentialing shall be credited on the basis of nine clock hours.

(6)

Passing the registered respiratory therapist clinical simulation examination for credentialing or recredentialing shall be credited on the basis of nine clock hours.

(7)

Passing the National Board for Respiratory Care, Inc. (NBRC) pediatric specialty examination shall be credited on the basis of ten clock hours.

(8)

Successful completion of the initial course in advanced cardiac life-support, pediatric advanced life-support, the neonatal advanced life-support course, basic trauma life-support or pre-hospital trauma life-support shall be credited on the basis of 12 clock hours. Recertification courses shall be credited for the number of hours actually completed during the recertification course, but shall not count for more than 12 hours.

(9)

Passing the certification examination for entry level pulmonary function technologists or the registry examination for advanced pulmonary function technologists for credentialing shall be credited on the basis of ten clock hours.

(10)

Passing the registration examination offered by the Board of Registered Polysomnographic Technologists shall be credited on the basis of ten clock hours.

(d)

[ (e) ] Reporting of continuing education. Each practitioner shall be responsible for reporting to the department the continuing education activities completed.

(1)

A practitioner shall report the number of hours of continuing education completed during the renewal period. If requested by the department, each practitioner shall submit proof of completion of the required continuing education activity to the department at the time of certificate renewal, or at other times as directed by the department. However, if an extension has been granted in accordance with subsection (f) [ (g) ] of this section, the practitioner shall file the continuing education hours immediately following completion of the activity.

(2)

Each continuing education activity filed by a practitioner must be accompanied by appropriate documentation of the continuing education claimed as follows:

(A)

for a program attended, signed certification by a program leader or instructor of the practitioner's participation in the program by certificate, or letter on letterhead of the sponsoring agency, or official continuing education validation form or official transcript of the sponsoring agency accompanied by a brochure, agenda, program, or other applicable information, indicating content of the program;

(B)

for teaching or instruction in approved programs, a letter on sponsoring agency's letterhead giving name of program, location, dates, and subjects taught, and giving total clock hours of teaching or instruction;

(C)

for completion of course work at or through respiratory care education programs, a certificate of successful completion or an official transcript.

(e)

[ (f) ] Activities unacceptable as continuing education. The department may not grant continuing education credit to any practitioner for:

(1)

education incidental to the regular professional activities of a practitioner such as learning occurring from experience or research;

(2)

organization activity such as serving on committees or councils or as an officer in a professional organization;

(3)

any program or activity which is not approved in accordance with subsection (b) [ (c) ](2) of this section;

(4)

any experience which does not fit the types of acceptable continuing education in subsection (b) [ (c) ] of this section;

(5)

any continuing education activity completed before or after the renewal year for which the continuing education credit is submitted except as allowed under subsection (f) [ (g) ](1) of this section;

(6)

self-study continuing education programs or activities except those set out in subsection (b) [ (c) ](4) of this section; or

(7)

activities which have been completed more than once during the continuing education period.

(f)

[ (g) ] Failure to complete required continuing education.

(1)

A practitioner who has failed to complete the requirements for continuing education as specified in subsection (a) [ (b) ] of this section may be granted up to a 90-day extension to a reporting period if the renewal fee and continuing education extension fee is paid on or prior to the expiration date. The 90-day extension is the maximum that may be granted and there will be no exceptions.

(A)

Following the receipt of the current renewal form , renewal fee and continuing education extension fee, the department shall issue identification cards [ which are certificates ] valid for a 90-day period beginning with the day following the expiration date of the practitioner's annual certificate and a written notice that the continuing education period has been extended.

(B)

If the deficiency is made up prior to the end of the extension, the department will notify the practitioner that the next reporting period commences on the day following the completion of the credits to correct the deficiency. The new reporting period shall end on the next renewal date. In other words, whenever an extension is granted, the time is borrowed from the next reporting period.

(C)

If an excess number of credits were earned during an extension, the excess will be credited toward the new reporting period.

(D)

A practitioner may not receive another extension at the end of the 90-day extension.

(2)

A practitioner who has failed to complete the requirements for continuing education as specified in subsection (a) [ (b) ] of this section and who has not completed the continuing education requirement during the 90-day extension shall return the certificate and identification cards to the department and shall not advertise or represent himself or herself as a respiratory care practitioner in any manner. The person may renew the certificate or reapply for a new certificate in accordance with §123.9 (d) [ (e) ] of this title (relating to Certificate Renewal).

(g)

[ (h) ] Other miscellaneous provisions.

(1)

Audiovisual programs may be accepted by the department if such a program represents one of the instructional methods or strategies rather than constituting the entire program and provided the program meets the criteria as set out in subsection (b) [ (c) ] of this section.

(2)

A practitioner who also holds a current license, registration, or certification in another health care profession or a current license, registration, or certification as a respiratory care practitioner in another state, territory, or country may satisfy the continuing education requirements for renewal in Texas with hours counted toward renewal of another license, registration, or certification as long as all of the hours meet all of the requirements of this section.

(3)

Hardships will be considered and granted by the department on a case by case basis.

(4)

The department may conduct random audits of continuing education completed by practitioners to determine compliance with this section.

(5)

No continuing education hours may be carried over from one renewal period to another renewal period unless the hours were earned during a continuing education extension as set out in subsection (f) [ (g) ] of this section.

§123.11.Changes of Name or Address.

[(a)

The purpose of this section is to set out the responsibilities and procedures for name and address changes.]

(a)

[ (b) ] The practitioner shall notify the department of changes in name, preferred mailing address, or place(s) of business or employment within 30 days of such change(s).

(b)

[ (c) ] Notification of address changes shall be made in writing, including the name, mailing address, and zip code [ codes ] and be mailed to the administrator.

(c)

[ (d) ] All notices required by this chapter shall be addressed to the last known preferred mailing address of the practitioner or applicant.

(d)

[ (e) ] Before any certificate or permit and identification cards will be issued by the department, notification of name changes must be mailed to the administrator and shall include a notarized copy of a marriage certificate, court decree evidencing such change, or a social security card reflecting the new name. The practitioner shall [ return any previously issued certificate or permit and identification cards and ] remit the appropriate replacement fee as set out in §123.4 of this title (relating to Fees).

§123.12.Professional and Ethical Standards.

The purpose of this section shall be to establish the standards of professional and ethical conduct required of a practitioner pursuant to the Act, §604.201(b)(4).

(1)

Professional representation and responsibilities.

(A)-(L)

(No change.)

(M)

A practitioner shall conform to medically accepted principles and standards of respiratory care which are those generally recognized by the profession as appropriate for the situation presented, including those promulgated or interpreted by or under the American Association for Respiratory Care [ AART ], the National Board for Respiratory Care [ NBRC ], the Texas Society for Respiratory Therapy, the board, the department, and other professional or governmental bodies.

(N)

A practitioner shall not delegate respiratory care functions or responsibilities to a person who lacks the ability or knowledge to perform the function or responsibility. A practitioner providing respiratory care services may be assisted by an aide or orderly. Aides, orderlies and other unlicensed assistive personnel [ Aides/orderlies ] may not perform respiratory care procedures.

(O)-(P)

(No change.)

(2)-(6)

(No change.)

§123.13.Certifying or Permitting Persons with Criminal Backgrounds To Be Respiratory Care Practitioners.

[(a)

Purpose. This section is designed to establish guidelines and criteria on the eligibility of persons with criminal backgrounds to obtain certificates or temporary permits as respiratory care practitioners.]

(a)

[ (b) ] Criminal convictions which directly relate to the profession of respiratory care.

(1)

The department may suspend or revoke any existing certificate or permit, disqualify a person from receiving any certificate or permit, or deny to a person the opportunity to be examined for a certificate because of a person's conviction of a felony or misdemeanor if the crime directly relates to the duties and responsibilities of a respiratory care practitioner.

(2)

In considering whether a criminal conviction directly relates to the occupation of a respiratory care practitioner, the department shall consider:

(A)

the nature and seriousness of the crime;

(B)

the relationship of the crime to the purposes for certification as a respiratory care practitioner. The following felonies and misdemeanors relate to any certificate or permit of a respiratory care practitioner because these criminal offenses indicate an inability or a tendency to be unable to perform as a respiratory care practitioner:

(i)

the misdemeanor of knowingly or intentionally acting as a respiratory care practitioner without any certificate or permit under the Texas Occupations Code, §604.352 [ Act, §13 ];

(ii)

any misdemeanor and/or felony offense defined as a crime of moral turpitude by statute or common law;

(iii)

a misdemeanor or felony offense under various titles of the Texas Penal Code:

(I)

offenses against the person (Title 5);

(II)

offenses against property (Title 7);

(III)

offenses against public order and decency (Title 9);

(IV)

offenses against public health, safety, and morals (Title 10); and

(V)

offenses of attempting or conspiring to commit any of the offenses in this subsection (Title 4);

(C)

the extent to which any certificate or permit might offer an opportunity to engage in further criminal activity of the same type as that in which the person previously had been involved; and

(D)

the relationship of the crime to the ability, capacity, or fitness required to perform the duties and discharge the responsibility of a respiratory care practitioner. In making this determination, the department will apply the criteria outlined in Texas Occupations Code, Chapter 53 [ Texas Civil Statutes, Article 6252-13c, §4(c)(1)-(7) ], the legal authority for the provisions of this section.

(3)

The misdemeanors and felonies listed in paragraph (2)(B)(i)-(iii) of this subsection are not inclusive in that the department may consider other particular crimes in special cases in order to promote the intent of the Act and these sections.

(b)

[ (c) ] Procedures for revoking, suspending, suspending on an emergency basis, or denying a certificate or temporary permit to persons with criminal backgrounds.

(1)

The administrator shall give written notice to the person that the department intends to deny, suspend, or revoke the certificate or temporary permit after hearing in accordance with the provisions of the Administrative Procedure [ and Texas Register ] Act, §2001, Texas Government Code, Texas Occupations Code, Chapter 53 [ Texas Civil Statutes, Article 6252-13a, and the department's formal hearing procedures in Chapter 1 of this title (relating to Texas Board of Health) ].

(2)

If the department denies, suspends, suspends on an emergency basis, or revokes a certificate or temporary permit under these sections after hearing, the administrator shall give the person written notice:

(A)

of the reasons for the decision;

(B)

that the person, after exhausting administrative appeals, may file an action in a district court of Travis County , Texas for review of the evidence presented to the department and its decision;

(C)

that the person must begin the judicial review by filing a petition with the court within 30 days after the department's action is final and appealable; and

(D)

of the earliest date the person may appeal.

§123.14.Violations, Complaints, and Subsequent Actions.

(a)

General. [ Purpose. The purpose of this ] This section [ is to ] establishes [ establish ] standards relating to:

(1)

offenses and prohibited actions under Texas Occupations Code, §604.102 [ §4 of the Act ] which result in the penalty of a Class B misdemeanor;

(2)-(4)

(No change.)

(b)

Types of offenses and prohibited actions. A person is guilty of a Class B misdemeanor if:

(1)-(8)

(No change.)

(9)

a person who holds a certificate or permit to practice respiratory care practices medicine, as defined by the Medical Practice Act, Texas Occupations Code, Chapter 157 [ (Texas Civil Statutes, Article 4495b) ] without holding an appropriate license issued by the BME; or

(10)

a person otherwise violates Texas Occupations Code, §§604.002, 604.102, 604.351, or 604.352 [ §§4, 10, or 13 ].

(c)

Filing of complaints.

(1)

Anyone may complain to the department alleging that a person has committed an offense or action prohibited under the Act or that a certificate or permit holder has violated the Act or a this chapter [ board rule ].

(2)

A person wishing to complain about an offense, prohibited action, or alleged violation against a practitioner or other person shall notify the administrator. The initial notification of a complaint may be in writing, by telephone, or by personal visit to the administrator's office. (Mailing address: 1100 West 49th Street, Austin, Texas 78756-3183, Phone: 512-834-6632 [ (512) 458-7111 ].

(3)-(4)

(No change.)

(d)

Investigation of complaints.

(1)

The administrator and the department are responsible for handling complaints.

(2)

The administrator, or his or her designee, shall make the initial investigation and report the findings to the director of Professional Licensing and Certification Division or his or her designee, or the director or designee of its successor.

(e)

The department's action.

(1)-(3)

(No change.)

(4)

Whenever the department dismisses a complaint or closes a complaint file, the department shall give a summary report of the final action to the advisory committee , [ board ] the complainant, and the accused party.

(f)

(No change.)

(g)

Formal hearing.

(1)

The formal hearing shall be conducted according to the Administrative Procedure Act (APA), Texas Government Code Chapter 2001, [ department's formal hearing procedures in Chapter 1 of this title (relating to Texas Board of Health) or §123.13 of this title (relating to Certifying or Permitting Persons with Criminal Backgrounds to be Respiratory Care Practitioners). ]

(2)

(No change.)

(3)

To initiate formal hearing procedures, the administrator shall give the practitioner written notice of the opportunity for hearing. The notice shall state the basis for the proposed action. Within 10 days after receipt of the notice, the practitioner must give written notice to the administrator that he or she either waives the hearing or wants the hearing. Receipt of the notice is deemed to occur on the 10th day after the notice is mailed unless another date of receipt is reflected on a United States Postal Service return receipt.

(A)

(No change.)

(B)

If the practitioner requests a hearing within 10 days after receiving the notice of opportunity for hearing, APA, Texas Government Code §2001, [ the department shall initiate formal hearing procedures in accordance with §§1.21-1.34 of this title (relating to Formal Hearing Procedures) ].

(h)

Final action.

(1)

If the department [ commissioner ] suspends a certificate or permit, the suspension remains in effect until the administrator or the department determines that the reasons for suspension no longer exist. The practitioner whose certificate or permit has been suspended is responsible for securing and providing to the department such evidence, as may be required by the department that the reasons for the suspension no longer exist. The administrator or the department shall investigate prior to making a determination.

(2)-(3)

(No change.)

(4)

If the department [ commissioner ] suspends a temporary permit and the suspension is in effect at the time of the expiration of the temporary permit, the former temporary permit holder must reapply in order to obtain a new temporary permit. The department may not issue a new temporary permit until the administrator or the department determines that the reasons for suspension have been removed.

(5)

A person whose application is denied or whose temporary permit or certificate is revoked or surrendered is ineligible for a temporary permit or certificate under this Act for one year from the date of the denial or revocation or surrender .

(6)

(No change.)

§123.15.Informal Disposition.

(a)

Informal disposition of any complaint or contested case involving a temporary permit or certificate holder or an applicant for licensure may be made through an informal settlement conference held to determine whether an agreed settlement order may be approved.

(b)

If the program administrator determines that the public interest would be served by attempting to resolve a complaint or contested case by an agreed order in lieu of a formal hearing, the provisions of this section shall apply. A temporary permit or applicant may request an informal settlement conference; however, the decision to hold a conference shall be made by the program administrator.

(c)

An informal conference shall be voluntary. It shall not be a prerequisite to a formal hearing.

(d)

The program administrator shall decide upon the time, date, and place of the settlement conference and provide written notice to the temporary permit or certificate holder or applicant of the same. Notice shall be provided no less than ten days prior to the date of the conference by certified mail, return receipt requested to the last known address of the temporary permit or certificate holder or applicant or by personal delivery. The ten days shall begin on the date of mailing or personal delivery. The temporary permit or certificate or applicant may waive the ten-day notice requirement.

(1)

The notice shall inform the temporary permit or certificate holder or applicant of the following:

(A)

the nature of the alleged violation;

(B)

that the temporary permit or certificate holder or applicant may be represented by legal counsel;

(C)

that the temporary permit or certificate holder or applicant may offer the testimony of witnesses and present other evidence as may be appropriate;

(D)

that the temporary permit or certificate holder or applicant's attendance and participation is voluntary;

(E)

that the complainant may be present; and

(F)

that the settlement conference shall be canceled if the temporary permit or certificate holder or applicant notifies the program administrator that he or she or his or her legal counsel will not attend.

(2)

A copy of this section concerning informal disposition shall be enclosed with the notice of the settlement conference.

(e)

The notice of the settlement conference shall be sent by certified mail, return receipt requested, to the complainant at his or her last known address or personally delivered to the complainant. The complainant shall be informed that he or she may appear and testify or may submit a written statement for consideration at the settlement conference. The complainant shall be notified if the conference is canceled.

(f)

The settlement conference shall be informal and shall not follow the procedures established in this chapter for contested cases and formal hearings.

(g)

The temporary permit or certificate holder or applicant's attorney, and department staff may question witnesses, make relevant statements, present statements of persons not in attendance, and present such other evidence as may be appropriate.

(h)

The program's legal counsel will be requested to attend each settlement conference. The program administrator may call upon the program's attorney at any time for assistance in the settlement conference.

(i)

The respondent shall be afforded the opportunity to make statements that are material and relevant.

(j)

Access to the investigative file may be prohibited or limited in accordance with the APA, Texas Government Code, Chapter 552.

(k)

At the discretion of the program administrator, a tape recording may be made of none or all of the settlement conference.

(l)

The complainant shall not be considered a party in the settlement conference but shall be given the opportunity to be heard if the complainant attends. Any written statement submitted by the complainant shall be reviewed at the conference.

(m)

At the conclusion of the settlement conference, the program administrator may make recommendations for informal disposition of the complaint or contested case. The recommendations may include any disciplinary action authorized by the Act. They may also conclude that the department lacks jurisdiction, conclude that a violation of the Act or this chapter has not been established, or refer the matter for further investigation.

(n)

The temporary permit or certificate holder or applicant may either accept or reject at the conference the settlement recommendations. If the recommendations are accepted, an agreed settlement order shall be prepared by the program staff and approved by the program's legal counsel and forwarded to the temporary permit or certificate holder or applicant. The order shall contain agreed findings of fact and conclusions of law. The temporary permit or certificate holder or applicant shall execute the order and return the signed order to the department office within ten days of his or her receipt of the order. If the temporary permit or certificate holder or applicant fails to return the signed order within the stated time period, the inaction shall constitute rejection of the settlement recommendations.

(o)

If the temporary permit or certificate holder or applicant rejects the proposed settlement, the matter shall be referred to the program administrator for appropriate action.

(p)

If the temporary permit or certificate holder or applicant signs and accepts the recommendations, the agreed order shall be submitted to the program administrator for its approval.

(q)

The program administrator shall enter an agreed order approving the accepted settlement recommendations. The program administrator may not change the terms of a proposed order but may only approve or disapprove an agreed order unless the temporary permit or certificate holder or applicant agrees to other terms proposed by the program administrator.

(r)

If the program administrator does not approve a proposed agreed order, the temporary permit or certificate holder or applicant and the complainant shall be so informed.

(s)

A temporary permit or certificate holder or applicant's opportunity for an informal conference under this section shall satisfy the requirement of the APA, §2001.054(c).

(1)

If the program administrator determines that an informal conference shall not be held, the program administrator shall give written notice to the temporary permit or certificate holder or applicant of the facts or conduct alleged to warrant the intended disciplinary action and the temporary permit or certificate holder or applicant shall be given the opportunity to show, in writing and as described in the notice, compliance with all requirements of the Act and this chapter.

(2)

The complainant shall be sent a copy of the written notice described in paragraph (1) of this subsection. The complainant shall be informed that he or she may also submit a written statement to the program administrator.

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 March 1, 2001.

TRD-200101220

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: April 15, 2001

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


Part 2. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Chapter 403. OTHER AGENCIES AND THE PUBLIC

Subchapter B. CHARGES FOR COMMUNITY-BASED SERVICES

25 TAC §§403.41 - 403.53

(Editor's note: The text of the following sections proposed for repeal will not be published. The sections may be examined in the offices of the Texas Department of Mental Health and Mental Retardation or in the Texas Register office, Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes the repeals of §§403.41 - 403.53 of Chapter 403, Subchapter B, concerning charges for community-based services. New §§412.101 - 412.114 of Chapter 412, Subchapter C, concerning charges for community services, which would replace the repealed sections, are contemporaneously proposed in this issue of the Texas Register .

The repeals would allow for the adoption of new and more current rules governing the same matters. The proposal would also fulfill the requirements of the Texas Government Code, §2001.039, concerning the periodic review of agency rules.

Gerry McKimmey, deputy commissioner for community programs, has determined that for each year of the first five years the proposed repeals are in effect, the proposed repeals do not have foreseeable implications relating to costs or revenues of the state or local governments.

Sam Shore, director, Behavioral Health Services, has determined that, for each year of the first five years the proposed repeals are in effect, the public benefit expected is the adoption of new and more current rules governing the same matters. It is anticipated that there would be no economic cost to persons required to comply with the proposed repeals.

It is not anticipated that the proposed repeals will affect a local economy.

It is not anticipated that the proposed repeals will have an adverse economic effect on small businesses or micro-businesses because the proposed repeals do not place requirements on small businesses or micro-businesses.

Written comments on the proposed repeals may be sent to Linda Logan, director, Policy Development, Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas 78711-2668, within 30 days of publication.

These sections are proposed for repeal under the Texas Health and Safety Code, §532.015, which provides the Texas Board of Mental Health and Mental Retardation (board) with broad rulemaking authority, and §534.067, which requires TDMHMR to establish a uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue.

The proposed sections would affect the Texas Health and Safety Code, §534.067.

§403.41.Purpose.

§403.42.Application.

§403.43.Definitions.

§403.44.Principles.

§403.45.Financial Assessment.

§403.46.Determination of Ability to Pay.

§403.47.Rates.

§403.48.Billing Procedures.

§403.49.Monthly Ability-to-Pay Fee Schedule.

§403.50.Training.

§403.51.Information for Persons.

§403.52.References.

§403.53.Distribution.

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 March 5, 2001.

TRD-200101270

Andrew Hardin

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: April 15, 2001

For further information, please call: (512) 206-5216


Chapter 412. LOCAL AUTHORITY RESPONSIBILITIES

Subchapter C. CHARGES FOR COMMUNITY SERVICES

25 TAC §§412.101 - 412.114

The Texas Department of Mental Health and Mental Retardation (TDMHMR) proposes new §§412.101 - 412.114 of new Chapter 412, Subchapter C, concerning charges for community services. The repeals of §§403.41 - 403.53 of Chapter 403, Subchapter B, concerning charges for community-based services, which the new sections would replace, are contemporaneously proposed in this issue of the Texas Register .

The proposed new sections describe TDMHMR's uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue as required by the Texas Health and Safety Code, §534.067.

Although the subchapter proposed for repeal states that the Monthly Ability-To-Pay Fee Schedule is based on 150% of the current Federal Poverty Guidelines, the current fee schedule actually begins charging for services at 150% of the current Federal Poverty Guidelines for a family of one person . This current calculation results in families of two or more being charged a higher percentage of their income than families of one. The proposed new rules would continue to state that the Monthly Ability-To-Pay Fee Schedule is based on 150% of the current Federal Poverty Guidelines; however, the fee schedule calculation would be revised to begin charging for services at 150% of the current Federal Poverty Guidelines for a family of two persons, three persons, four persons, and so on. For example, 150% of the 2000 Federal Poverty Guidelines for a family of two is $16, 875. A family of two whose annual income is less than $16, 875 would have a maximum monthly fee of zero. A family of two whose annual income is more than $16, 875 would have a maximum monthly fee of greater than zero. The revised fee schedule would also be calculated using smaller increments between each annual/monthly gross income level.

The proposed sections would fulfill the requirements of the Texas Government Code, §2001.039, concerning the periodic review of agency rules.

Cindy Brown, chief financial officer, has determined that for each year of the first five years the proposed new sections are in effect, enforcing or administering the sections does not have foreseeable implications relating to costs or revenues of the state government. There will be some impact to revenues of local governments (i.e., local mental health and mental retardation authorities) due to revisions in the fee schedule's calculation; however, the extent of the impact cannot be determined because TDMHMR does not require local authorities to report consumer fee collection data based on income levels. The revised fee schedule calculation applies the same formula to all family sizes, which has a negative fiscal impact because families of two or more persons will not be charged a fee until their income is 150% of Federal Poverty Guidelines. To offset this impact, the fee schedule will have slightly smaller increments between each income level, which will result in the next higher fee being reached more frequently.

Sam Shore, director, Behavioral Health Services, has determined that, for each year of the first five years the proposed sections are in effect, the public benefit expected is the implementation of a uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue. It is anticipated that there would be no additional economic cost to persons required to comply with the proposed sections because the sections do not place additional requirements related to costs on such persons than those in the sections proposed for repeal.

It is not anticipated that the proposed sections will affect a local economy.

It is not anticipated that the proposed sections will have an adverse economic effect on small businesses or micro-businesses because the sections do not place additional requirements on small or micro-businesses than those in the sections proposed for repeal.

Written comments on the proposed sections may be sent to Linda Logan, director, Policy Development, Texas Department of Mental Health and Mental Retardation, P.O. Box 12668, Austin, Texas 78711-2668, within 30 days of publication.

These new sections are proposed under the Texas Health and Safety Code, §532.015, which provides the Texas Board of Mental Health and Mental Retardation (board) with broad rulemaking authority, and §534.067, which requires TDMHMR to establish a uniform fee collection policy for all local authorities that is equitable, provides for collections, and maximizes contributions to local revenue.

The proposed sections would affect the Texas Health and Safety Code, §534.067.

§412.101.Purpose.

(a)

The purpose of this subchapter is to comply with the Texas Health and Safety Code, §534.067, and the Health Care Financing Administration's interpretation of the Social Security Act, Section 1902(a)(17)(B) (which prohibits Medicaid payments for a free service), by establishing a uniform fee collection policy for local authorities for community services contracted for through the performance contract that are funded by TDMHMR and required local match and provided to members of the priority population that:

(1)

is equitable;

(2)

provides for collections; and

(3)

maximizes contributions to local revenue.

(b)

The provisions of this subchapter are not intended to preempt payment for community services by other funding sources (e.g., Texas Commission on Alcohol and Drug Abuse, Texas Department of Criminal Justice, third-party coverage).

§412.102.Application.

(a)

This subchapter applies to all local authorities for community services contracted for through the performance contract that are funded by TDMHMR and required local match and provided to members of the priority population.

(b)

This subchapter does not apply to:

(1)

programs and services that are prohibited by statute or regulation from charging fees to persons served (e.g., Early Childhood Intervention Program);

(2)

the TDMHMR In-Home and Family Support Program;

(3)

community-based residential services and inpatient services; and

(4)

specialized services mandated by the Omnibus Budget Reconciliation Act (OBRA) of 1987, as amended by OBRA 90, for preadmission screening and annual resident reviews (PASARR) provided to non-Medicaid eligible persons.

§412.103.Definitions.

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

(1)

Ability to pay - A person has third-party coverage that will pay for needed services, the person's maximum monthly fee is greater than zero, or the person has identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ).

(2)

Community services or services - Mental health and mental retardation services required to be available in each local service area pursuant to the Texas Health and Safety Code, §534.053(a), for which TDMHMR contracts through the performance contract, and which are:

(A)

24-hour emergency screening and rapid crisis stabilization services, (e.g., crisis hotline, mobile crisis intervention, crisis walk-in, and crisis support);

(B)

community-based crisis residential services;

(C)

community-based assessments, including the development of interdisciplinary treatment plans (e.g., assessment treatment planning, eligibility determination, and initial enrollment assessment), and diagnosis and evaluation services;

(D)

family support services, including respite care;

(E)

case management services (or service coordination);

(F)

medication-related services, including medication clinics, laboratory monitoring, medication education, mental health maintenance education, and the provision of medication; and

(G)

psychosocial rehabilitation programs, including social support activities, independent living skills, and vocational training.

(3)

Family members -

(A)

Unmarried person under the age of 18 - The person, the person's parents, and the dependents of the parents, if residing in the same household.

(B)

Unmarried person age 18 or older - The person and his/her dependents.

(C)

Married person of any age - The person, his/her spouse, and their dependents.

(4)

Gross income - Revenue from all sources before taxes and other payroll deductions.

(5)

Inability to pay - A person's maximum monthly fee is zero and:

(A)

the person does not have third-party coverage;

(B)

the person has third-party coverage, but the person has exceeded the maximum benefit of the covered service(s) or the third-party coverage will not pay because the services needed by the person are not covered services; or

(C)

the person has not identified payment for a needed service or services in an approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ).

(6)

Income-based public insurance - Government funded third-party coverage that bases eligibility and/or co-payments and deductibles on a person's (or parents') income (i.e., Medicaid and CHIP).

(7)

Local authority - An entity designated by the TDMHMR commissioner in accordance with the Texas Health and Safety Code, §533.035(a).

(8)

Local match - Funds or in-kind support from a local authority as required by the Texas Health and Safety Code, §534.066.

(9)

Performance contract - The contract between TDMHMR and a local authority in which TDMHMR agrees to pay the local authority a specified sum and in which the local authority agrees to provide local match, for, at a minimum, ensuring and/or monitoring the provision of specified mental health and mental retardation services in a local service area.

(10)

Person - A person in the priority population who is seeking or receiving services through a local authority.

(11)

Priority population - Those groups of persons with mental illness or mental retardation identified in TDMHMR's current strategic plan as being most in need of mental health and/or mental retardation services.

(12)

Rate - A fixed price for a service that represents the service's monetary value.

(13)

Third-party coverage - A public or private payor of community services that is not the person (e.g., Medicaid, Medicare, private insurance, CHIP, CHAMPUS).

§412.104.Principles.

TDMHMR supports the following principles:

(1)

Persons are charged for services based on their ability to pay.

(2)

Procedures for determining ability to pay are fair, equitable, and consistently implemented.

(3)

Paying for services in accordance with his/her ability to pay acknowledges the dignity of the person.

(4)

Paying for services in accordance with his/her ability to pay reinforces the role of the person as a customer, having the right and responsibility to influence the provision of those services.

(5)

Earned revenues are optimized.

§412.105.Accountability.

(a)

Prohibition from denying services. Local authorities are prohibited from denying services:

(1)

to a person because of the person's inability to pay for the services;

(2)

to a person in a crisis or emergency because a financial assessment has not been completed, financial responsibility has not been determined, or the person has a past-due account; or

(3)

pending resolution of an issue relating solely to payment for services, including failure of the person (or parent) to comply with any requirement in subsections (b)-(e) of this section.

(b)

Requirement to apply for Medicaid benefits. Parents whose children may be eligible for Medicaid and persons who may be eligible for Medicaid must apply for Medicaid or provide documentation that they have been denied Medicaid or that their Medicaid application is pending.

(c)

Requirement to enroll in CHIP. Parents of children who may be eligible for the Childrens Health Insurance Program (CHIP) must enroll in CHIP or provide documentation that they have been denied CHIP benefits or that their CHIP enrollment is pending.

(d)

Financial documentation. If requested by the local authority, persons (or parents) must provide the following financial documentation:

(1)

annual or monthly gross income/earnings, if any;

(2)

extraordinary expenses (i.e. major medical or health related expenses; major casualty losses; child care expenses for the previous year or projections for the next year);

(3)

number of family members; and

(4)

proof of any third-party coverage.

(e)

Permission to bill third-party coverage. Persons with third-party coverage must execute an assignment of benefits (i.e., give the local authority permission to bill the third-party coverage).

(f)

Failure to comply. A person's (or parent's) failure to comply with any requirement in subsections (b)-(e) of this section will result in the person (or parent) being charged the standard rate(s) for services, established in accordance with §412.107(a) of this title (relating to Rates), unless the person's interdisciplinary or multidisciplinary team makes a clinical determination that failure to comply is related to the person's mental illness or mental retardation or enforcement of the requirement would result in a reduction in functioning of the person or the person's refusal or rejection of the needed services. This determination requires clinical documentation and must be reassessed by the team at least every three months.

§412.106 Determination of Ability to Pay.

(a)

Financial assessment. A financial assessment must be completed and documented for each person within the first 30 days of services and updated at least annually, or whenever significant financial changes occur, as long as the person continues to receive services. The financial assessment is accomplished using the financial documentation listed in §412.105(d) of this title (relating to Accountability), which represents the finances of the:

(1)

person who is age 18 or older and the person's spouse; or

(2)

parents of the person who is under 18 years of age.

(b)

Maximum monthly fee. A person's maximum monthly fee is based on the financial assessment and calculated using the Monthly Ability-To-Pay Fee Schedule, referenced as Exhibit A in §412.112 of this title (relating to Exhibit). The calculation is based on the number of family members, annual gross income reduced by extraordinary expenses paid during the past 12 months or projected for the next 12 months. No other sliding scale is used.

(1)

A maximum monthly fee that is greater than zero is established for persons who are determined as having an ability to pay. If two or more members of the same family are receiving services, then the maximum monthly fee is for the family.

(2)

A maximum monthly fee of zero is established for persons who are determined as having an inability to pay.

(c)

Third-party coverage.

(1)

A person with third-party coverage that will pay for needed services is determined as having an ability to pay for those services.

(2)

If the person's third-party coverage will not pay for needed services because the local authority provider is not an approved provider, then the local authority will refer the person to his/her third-party coverage to identify a provider for which the third-party coverage will pay.

(3)

An exception to the provision described in paragraph (2) of this subsection is if the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(d)

Social Security work incentive provisions. A person has an ability to pay if the person identified payment for a needed service or services in his/her approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ). Persons are not required to identify payment for any service for which they may be eligible as part of their approved plan for utilizing the Social Security work incentive provisions.

(e)

Notification. Written notification is provided to the person (or parents) that includes:

(1)

the determination of whether the person (or parent) has an ability or an inability to pay;

(2)

a copy of the financial assessment form that is signed by the person (or parent) and a copy of the Monthly Ability-to-Pay Fee Schedule, with the applicable areas indicated (i.e., annual gross income, number of household members, etc.);

(3)

the amount of the maximum monthly fee;

(4)

a statement that the person (or parent) may discuss with the interdisciplinary or multidisciplinary team any concerns the person (or parent) may have regarding the information contained in the written notification; and

(5)

a statement that the person (or parent) may voluntarily pay more than the maximum monthly fee.

§412.107.Standard Rates.

(a)

Each local authority must establish, at least annually, a reasonable standard rate for each community service.

(b)

The rate for a service provided to a Medicaid recipient that is reimbursed by Medicaid is the current approved Medicaid rate for the service. The rate for the same service provided to a person who is not a Medicaid recipient may not be less than the current approved Medicaid rate, but may be more if the current approved Medicaid rate does not cover the actual cost of the service.

§412.108.Billing Procedures.

(a)

Monthly services charge. All services provided during a month, and the standard rates for those services, are listed as the person's monthly services charge. Each service listed is identified as being covered by third-party coverage or as not being covered by third-party coverage. If a person has exceeded the maximum benefit of a particular covered service, then that service is identified as not being covered by third-party coverage.

(b)

Billing third-party coverage. The third-party coverage is billed the monthly services charge for covered services.

(1)

Third-party coverage that is not income-based public insurance.

(A)

If the local authority has a contract with the person's third-party coverage, then payment made by the third-party coverage for a covered service plus any applicable co-payment made by the person is full payment for that service.

(B)

If the local authority does not have a contract with the person's third-party coverage and if a balance remains after payment from the third-party coverage or if the third-party coverage will not pay for a covered service because the deductible hasn't been met, then the balance or deductible is applied toward the person's maximum monthly fee.

(2)

Income-based public insurance. Payment made by income-based public insurance for a covered service plus payment made by the person for any applicable co-payment and/or deductible is full payment for that service, (i.e.,:

(A)

for Medicaid recipients, Medicaid reimbursement is full payment; and

(B)

for CHIP recipients, CHIP reimbursement plus the recipient's co-payment and/or deductible payment is full payment).

(c)

Billing the person (or parents).

(1)

No third-party coverage. If the monthly services charge amount:

(A)

exceeds the person's maximum monthly fee, then the amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(B)

is less than the person's maximum monthly fee, then the person (or parent) is billed the amount.

(2)

Third-party coverage that is not income-based public insurance.

(A)

If the local authority has a contract with the person's third-party coverage and:

(i)

the amount of all co-payments described in subsection (b)(1)(A) of this section exceeds the person's maximum monthly fee, then the amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee. The person (or parent) is not billed for services not covered by third-party coverage, if any; or

(ii)

the amount of all co-payments described in subsection (b)(1)(A) of this section does not exceed the person's maximum monthly fee, then the monthly services charge amount for services not covered by third-party coverage is added to equal the total amount. If the total amount:

(I)

exceeds the person's maximum monthly fee, then the total amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(II)

is less than the person's maximum monthly fee, then the person (or parent) is billed the total amount.

(B)

If the local authority does not have a contract with the person's third-party coverage, then the balance or deductible applied toward the person's maximum monthly fee as described in subsection (b)(1)(B) of this section is added to the monthly services charge amount for services not covered by third-party coverage to equal the total amount. If the total amount:

(i)

exceeds the person's maximum monthly fee, then the total amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(ii)

is less than the person's maximum monthly fee, then the person (or parent) is billed the total amount.

(3)

Income-based public insurance.

(A)

If the amount of all co-payments and deductibles described in subsection (b)(2) of this section exceeds the person's maximum monthly fee, then the person (or parent) is billed the amount. The person (or parent) is not billed for services not covered by third-party coverage, if any.

(B)

If the amount of co-payments and deductibles described in subsection (b)(2) of this section does not exceed the person's maximum monthly fee, then the monthly services charge amount for services not covered by third-party coverage is added to equal the total amount. If the total amount:

(i)

exceeds the person's maximum monthly fee, then the total amount is reduced to equal the maximum monthly fee and the person (or parent) is billed the maximum monthly fee; or

(ii)

is less than the person's maximum monthly fee, then the person (or parent) is billed the total amount.

(4)

Social Security work incentive provisions. A person may be charged for specific services listed on the monthly services charge if the person identified payment for such services in his/her approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ).

(d)

Statements.

(1)

Persons (and parents) who have been determined as having the ability to pay are sent monthly or quarterly statements that include:

(A)

an itemized list, at least by date and by type, of all services received;

(B)

the standard rate for each service;

(C)

the total charge for the period;

(D)

the amount paid (or to be paid) by third-party coverage, if any;

(E)

the amount that is being reduced, if any; and

(F)

the amount to be paid.

(2)

Unless requested, statements are not sent to persons with an ability to pay if they maintain a zero balance (i.e., the person does not currently owe any money).

(3)

Unless requested, statements are not be sent to persons who have been determined as having an inability to pay.

§412.109.Payment and Exemptions.

(a)

Payment.

(1)

Persons (and parents) are expected to promptly pay all charges owed.

(2)

If a person (or parent) claims, and provides documentation, that financial hardship prevents prompt payment of all charges owed, then the local authority may arrange for the person (or parent) to pay a lesser amount each month. Although the person (or parent) will pay a lesser amount each month because a portion of the charges will be deferred, the person (or parent) is still responsible for paying all charges owed.

(b)

Receipts. Receipts must be provided for all cash payments.

(c)

Waiver of charges. If a person's interdisciplinary or multidisciplinary team makes a clinical determination that being charged for services and receiving statements will result in a reduction in the functioning level of the person or the person's refusal or rejection of the needed services, then charges will cease and statements will no longer be sent. This determination requires clinical documentation and must be reassessed by the team at least every three months.

(d)

Termination of services for cause. A person's services may be terminated in accordance with this subsection.

(1)

Irresponsible actions by a person that result in resources being wasted (e.g., missing multiple appointments without canceling, consistently losing medications) shall be referred to the person's interdisciplinary or multidisciplinary team. The team is responsible for making reasonable efforts to assist the person in stopping or reducing the irresponsible actions. (For example, if the team determines that the actions are related to the person's mental illness or mental retardation, then the team may modify the person's treatment. If the team determines that the actions are related to external circumstances, such as unreliable transportation, then the team may assist the person (or parent) in accessing reliable transportation.) If the team makes a clinical determination that the actions are not related to the person's mental illness or mental retardation and the team has been unsuccessful in assisting the person in stopping or reducing the actions, then the team may decide to terminate the person's services. The team may not terminate the person's services if termination is clinically contraindicated or if the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(2)

Past-due accounts of persons (or parents) who are not making payments are referred to the persons' interdisciplinary or multidisciplinary teams. The team is responsible for addressing the issue of non-payment with the person (or parent) and making reasonable efforts that will result in the person (or parent) making payments. (For example, if the team determines that non-payment is related to the person's mental illness or mental retardation, then the team may modify the person's treatment to address the non-payment. If the team determines that non-payment is related to financial hardship, then the team may assist the person (or parent) in making arrangements to pay a lesser amount each month in accordance with subsection (a) of this section.) If the team makes a clinical determination that non-payment is not related to the person's mental illness or mental retardation and, despite the team's efforts, the person (or parent) does not pay, then the team may decide to terminate the person's services. The team may not terminate the person's services if termination is clinically contraindicated or if the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(3)

If the team decides to terminate the person's services, then:

(A)

the team must provide clinical documentation that justifies its decision, including the basis for determining that termination is not clinically contraindicated; and

(B)

the person (or parent) shall be notified in writing of the decision and provided an opportunity to appeal the decision in accordance with §401.464 of this title (relating to Notification and Appeals Process). The notification shall prescribe the time frames and process for requesting an appeal and include a copy of this subchapter. If the person (or parent) requests an appeal within the prescribed time frame, then the person's services may not be terminated while the appeal is pending.

(4)

If a person (or parent) is dissatisfied with the decision of the appeal as described in paragraph (3)(B) of this subsection, then the person (or parent) may request a review by the Office of Consumer Services and Rights Protection - Ombudsman at TDMHMR Central Office.

(A)

The person (or parent) must request a review within 10 working days of receipt of notification of the appeal decision.

(B)

The person (or parent) may choose to have the staff conducting the review:

(i)

conduct the review by telephone conference with the person (or parent) and a representative from the local authority and make a decision based upon verbal testimony made during the telephone conference and any documents provided by the person (or parent) and the local authority; or

(ii)

conduct the review by making a decision based solely upon documents provided by the person (or parent) and the local authority without the presence of any of the parties involved.

(C)

The review:

(i)

will be conducted no sooner than 10 working days and no later than 30 working days of receipt of the request for a review unless an extension is granted by the director of the Office of Consumer Services and Rights Protection - Ombudsman;

(ii)

will include a review of the pertinent information concerning termination of the person's services and may include consultation with TDMHMR clinical staff and staff who oversee implementation of this subchapter;

(iii)

will result in a final decision which will either uphold, reverse, or modify the original decision to terminate the person's services; and

(iv)

is the final step of the appeal process for termination of services for cause.

(D)

Within five working days after the review, the staff who conducted the review will send written notification of the final decision to the person (or parent) and the local authority.

(e)

Prohibition of financial penalties. Financial penalties may not be imposed on a person (or parent).

(f)

Debt collection. Local authorities must make reasonable efforts to collect debts before an account is referred to a debt collection agency. Local authorities must document their efforts at debt collection.

(1)

Local authorities must incorporate into a written agreement or contract for debt collection provisions that state that both parties shall:

(A)

maintain the confidentiality of the information and not disclose the identity of the person or any other identifying information; and

(B)

not harass, threaten, or intimidate persons and their families.

(2)

Local authorities will enforce the provisions contained in paragraph (1) of this subsection.

§412.110.Training.

All local authority staff who are involved in implementing or explaining the content of this subchapter must annually demonstrate competency in accordance with a prescribed training program developed by TDMHMR, in consultation with local authorities and consumer representatives.

§412.111.Information for Persons.

Persons and families must be provided TDMHMR-approved information on TDMHMR's policy of charges for community services contained in this subchapter prior to entry into services except in a crisis or emergency.

§412.112.Exhibit.

Exhibit A - The Monthly Ability-To-Pay Fee Schedule, is referenced in this subchapter. Copies of Exhibit A are available by contacting TDMHMR, Policy Development, P.O. Box 12668, Austin, TX 78711-2668. The Monthly Ability-To-Pay Fee Schedule is based on 150% of the current Federal Poverty Guidelines. TDMHMR may revise the Monthly Ability-To-Pay Fee Schedule, based on any changes in the Federal Poverty Income Guidelines, to be effective on September 1 of the next state fiscal year. TDMHMR will distribute the revised fee schedule to all local authorities, who are responsible for ensuring that their affected contractors are provided a copy.

§412.113.References.

Reference is made to the following statutes:

(1)

Texas Health and Safety Code, §534.067;

(2)

Social Security Act, Section 1902(a)(17)(B); and

(3)

Omnibus Budget Reconciliation Act (OBRA) of 1987, as amended by OBRA 90.

§412.114.Distribution.

This subchapter is distributed to:

(1)

all members of the Texas Board of Mental Health and Mental Retardation;

(2)

executive, management, and program staff of TDMHMR Central Office;

(3)

executive directors of all local authorities; and

(4)

advocacy organizations.

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 March 5, 2001.

TRD-200101271

Andrew Hardin

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: April 15, 2001

For further information, please call: (512) 206-5216


Part 16. TEXAS HEALTH CARE INFORMATION COUNCIL

Chapter 1301. HEALTH CARE INFORMATION

Subchapter A. HOSPITAL DISCHARGE DATA RULES

25 TAC §§1301.11-1301.13, 1301.16-1301.20

The Texas Health Care Information Council (Council) proposes to amend §§1301.11-1301.13 and §§1301.16-1301.19. The Council proposes new §1301.20 Scientific Review Panel. The Council is required by its enabling legislation in Chapter 108 of the Health and Safety Code, specifically §108.006, to "develop a statewide health care data collection system to collect health care charges, utilization data, provider quality date, and outcome data to facilitate the promotion and accessibility of cost-effective, good quality health care." The proposed amendments to the existing sections establish the uniform physician identifier characters, provide clarification, or removes version specific language that is amended frequently or is no longer applicable within the rules. Section 1301.20 is proposed new to establish guidelines for the Scientific Review Panel (Panel). The Panel will make decisions regarding the release of data elements that were not either summarized or modified in the public use data file to qualified researchers for predetermined projects.

The amendments to the Hospital Discharge Data Rules proposed hereby results from 1) House Bill 1513 and Senate Bill 1591 enacted by the 76th Texas Legislature, 2) input from the Council's Hospital Discharge Data Committee, 3) input from the Council's Health Information Systems Technical Advisory Committee (HIS TAC), and 4) comments from the providers of the data and the public.

The Council proposes to amend the definition of "Discharge File" to delete the exception clause for submitting one or more files for newborn. Section 1301.12(b)(1) is amended also to require separate discharge files for newborns and the mother.

The Council proposes to amend the definition of "Ethnicity" to include the ethnic types to from which to report: Hispanic or Non-Hispanic. The amendment corresponds with the language defining "Race".

The Council proposes to amend the definition name of "Geographic Identifier" to "Geographic Identifiers" to clarify that more than one geographic identifier will be assigned to the data.

The Council proposes to amend the definition of "Required minimum data set" to establish consistent language with in the rules and clarify that for each inpatient discharge file regardless of the payer source the required minimum data set must be submitted to the Council.

The Council proposes a new definition of "Research Data File" to describe the customized data file that qualified researchers may request and purchase provided the Scientific Review Panel grants authorization. The file will contain data element that were received by the Council, were not on the list of public use data elements, and probably have not been checked for errors.

The Council proposes a new definition of "Scientific Review Panel" to describe the Council's appointed committee or contracted agent to review, deny or grant authorization of requests from qualified researchers for data elements that are not included on the public use data file.

The Council proposes a new definition of "Treating Physician" to describe the "Physicians" or "Other health professionals" that are reported in the fields of the approved formats that are not reported or labeled as the "Attending physician", such as "Operating or other physician", "Other physician #1" or "Other physician #2".

The Council proposes to amend the definition of "Uniform facility identifier" to clarify the language and provide an objective measure for the assignment of separate identifiers for hospitals with multiple facilities included under one license number assigned by the Bureau of Facility Licensing, Texas Department of Health.

The Council proposes to delete the definition of "Uniform other health profession identifier" because the "Physicians" and "Other health professionals" are included in the definition of "Uniform Physician identifier" and therefore provides a greater pool of individuals to decrease the risk of "Physician" and "Other health professional identification".

The Council proposes to amend the definition of "Uniform Patient Identifier" by deleting the word "number" and replacing it with "identifier' to clarify that a unique identifier will be assigned and that it is not limited to numeric characters.

The Council proposes to amend the definition of "Uniform Physician Identifier" to establish consistent language in the rules, clarify the language by deleting the word "admitting" and replacing it with the word "attending", and specify the type of characters to be used in response to §108.011(c) of the Texas Health and Safety Code.

The Council proposes to amend §1301.12(a) to clarify that data on all discharged inpatients that are attended or treated by physicians must be submitted to the Council and that hospitals may submit discharges on patients attended or treated by "Other health professionals".

The Council proposes to amend §1301.12(b)(1) to require hospitals to submit separate discharge files for the mother and each newborn for all newborn deliveries.

The Council proposes to amend §1301.12(b)(2) to delete the words "bills" and "bill" are replaced with "discharge files and "discharge file", respectively to establish consistent language within the rules.

The Council proposes to delete §1301.12(b)(3). This will remove the conditions for submitting multiple discharge files for patients who were served in more than one unit within the hospital. The amended section requires that hospitals submit one discharge file for the patients stay regardless of how many service units or payer types.

The Council proposes to amend §1301.12(b)(4). The amended section removes the language and requirement to submit any additional data elements other than the required data elements specified in §1301.19.

The Council proposes to amend §1301.12(b)(5). The amended section removes the requirement to submit any additional data elements other than the required data elements specified in §1301.19 and deletes the word "bill", and replaces it with "discharge file" to establish consistent language within the rules.

The Council proposes to amend §1301.12(f). The amended section clarifies that a hospital must notify the Council 30 "calendar" days prior to any change in submission agent or submitters.

The Council proposes to remove §1301.13(b) because this subsection is no longer valid.

The Council proposes to amend §1301.16(c)(2). The amended paragraph removes the requirement to submit a written justification during the correction prior to certification phase. The written justification would be required during the certification phase of the proposed amendment to §1301.17(b). The amended paragraph, also provides for the option for the hospital to mark a discharge file to be "accepted as is" if the data cannot be corrected using the Council supplied Data Correction Software.

The Council proposes to amend §1301.16(c)(3). The amended paragraph removes the requirement to submit a written explanation during the correction prior to certification phase. This would be required during the certification phase of the proposed amendment to §1301.17(b). The amended paragraph also establishes specific dates for returning corrected data and establishes that no individual hospital extension will be granted, but the executive director could grant an extension for all hospitals.

The Council proposes to add a new §1301.16(c)(4) to establish which additional discharge files may be submitted and the deadlines for their submission.

The Council proposes to amend §1301.16(e). The amended section clarifies that civil penalties may be assessed if errant data is not corrected or commented on regarding the errors.

The Council proposes to amend §1301.17(a). The amended subsection clarifies that the executive director is returning one or more files, which includes reports to the hospitals for the hospital's review and usage for certifying the data. The amended section also clarifies some terminology usage in the rules, the word "admitting is removed and the word "attending" replaces it.

The Council proposes to amend §1301.17(b). The amended subsection provides an option for the chief executive officer's designee to sign for the chief executive officer and clarifies that the chief executive officer or their designee shall respond to the statements on the certification form and return the form by the date specified in §1301.17(d). Section 1301.17(b) is also amended by establishing the option to provide comments about errant data or requesting in writing to correct data if the chief executive officer or their designee does not believe the data submitted accurately reflects their hospital. Dates for submitting corrections are also established. Notices are also provided to warn hospitals, that do not correct or comment on errors or elect to not certify the data, does not prevent the data from being published in the public use data file.

The Council proposes to amend §1301.17(c) by deleting the original text and rewriting the subsection, including inserting paragraphs that explain what a signed certification form represents and that the data has been corrected or comments have been made stating the problems in the data and why the could not be corrected. The amended subsection also requires that the hospital has provided the physicians an opportunity to review and comment on the patients that the hospital assigned them to on the reported discharge files. The amended subsection also requires the chief executive officer or designee to provide a written explanation of any unresolved issues concerning the accuracy and completeness of the data. These are to be included on the certification form when submitted.

The Council proposes to amend §1301.17(d). The amended subsection establishes specific dates for the return of the signed certification forms. The proposed dates are approximately 30 days longer than the current rule. Also included in amended §1301.17(d) is the authorization for the Executive Director to extend the established deadline and the clarification that individual hospital requests for extension will not be granted.

The Council proposes to amend §1301.17(e) to synchronize the deadline for returning the comments with the deadline for submitting the signed certification forms.

The Council proposes to amend §1301.17(f) to clarify that the certification form must be signed and returned on or prior to the deadlines established in §1301.17(d).

The Council proposes new §1301.17(g), establishing the Councils authority to pursue civil penalties if either corrections are not submitted on or prior to the dates specified in §1301.17(b) or comments are not submitted on or prior to the dates specified in §1301.17(d).

The Council proposes to amend §1301.18(c)(5) by establishing that alphanumeric characters will be used for creating and assigning uniform physician identifiers as required by §108.011(c) and §108.013(c) of the Health and Safety Code.

The Council proposes to amend §1301.18(e) to provide for the option to release the public use data file on electronic or optical media.

The Council proposes to amend §1301.18(e)(1) by referencing the dates specified in §1301.17(d) as the deadline for returning the certification forms to the Council. The Council also proposes to remove the rule-imposed requirement on the executive director from withholding data from the public use data file if the data contains material errors because the executive director with the recommendation from the Hospital Discharge Data Committee may suppress one or more data elements for a particular quarter. The amended paragraph also removes the inclusion of the number of discharge files from each hospital and the number of discharge files included in the public use data file for the hospital. The Council cannot reasonably ascertain how many times discharge files that are corrected through the Council's Data Correction Software or are deleted by contract and resubmitted by the hospital.

The Council proposes to amend §1301.18(e)(2) to include language that specifies that the Council will only accept previously unsubmitted discharge files for discharged inpatients for the same calendar year and the prior calendar year only through the first quarter of the following calendar year. Discharge files of corrected data for previously submitted discharge files will not be processed or appended to existing public use data files.

The Council proposes to delete §1301.18(e)(4). The deleted paragraph is no longer applicable.

The Council proposes to amend §1301.18(f) to establish the requirement that other state agencies abide by the data users agreement.

The Council proposes to add a new §1301.18(l) and six paragraphs with new language to establish criteria for the potential release of a research data file with the approval of the Council's Scientific Review Panel as established in §108.135, Health and Safety Code.

The Council proposes to amend §1301.19(a)(1) and (2) to remove references to specific HCFA UB92 electronic versions and establish that the Council will accept data in the approved formats and versions from hospitals that are currently accepted by HCFA or was accepted by HCFA for the dates of service on the claim.

The Council proposes to amend §1301.19(b) to require hospitals to submit data according to data element specifications that are required by HCFA at the time of submission or the data elements specifications acceptable by HCFA at the time of discharge.

The Council proposes to amend §1301.19(c) and the subparagraphs to remove references to specific HCFA UB92 electronic versions to prevent multiple rule amendments with version upgrades and removes references to the Texas UB-92 Manual. Also inserted is information that the data element content, format and locations may change in regards to Public Law 104-191, Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification.

The Council proposes to amend §1301.19(c)(4) to clarify that the primary and secondary payer source codes are required to be submitted. These codes will include "Non-Standard" Source of Payment codes for HCFA UB92 data format submissions, if applicable. The "Non-Standard" Source of Payment code positions are located on the "22 Record".

The Council proposes to delete §1301.19(c)(5) to remove a data element that is no longer in use.

The Council proposes to amend §1301.19(e) to remove the option that hospital should submit what they submit to their payers and maintain a consistent requirement throughout the rules. The Council requires that the required minimum data set be submitted on all patients.

The Council proposes to amend §1301.19(e)(12) to clarify that the "Source of Payment Codes" include "Standard" codes and may include "Non-standard" codes depending on the payer type for submissions on the accepted HCFA Formats.

The Council proposes to amend §1301.19(e)(39), (40) and (41) that the State License number is required to be submitted for "Physicians" and "Other health professionals" in the appropriate locations as required by the acceptable electronic formats specified in §1301.19. This amendment establishes a clear standard for submitting "Physician" and "Other health professional" data.

The Council proposes to amend §1301.19(e)(42), (43) and (44) to establish that hospitals should submit the name of the "Physicians" and "Other health professionals", as reported to the state licensing boards in the appropriate locations on acceptable electronic formats. This amendment establishes a clear standard for submitting "Physician" and "Other health professional" data.

The Council proposes to add a new §1301.19(e)(48)--"Reason for no Social Security number". This data element is required when a default value for Social Security number is submitted to the Council (For example, all X's, all 9's or all 0's).

The Council proposes to amend §1301.19(g) and remove specific HCFA UB92 electronic version language, as the two versions listed are no longer acceptable.

The Council proposes new §1301.20 to establish guidelines for evaluating the release of data elements that are collected by the Council that are not considered as public use data and may be included in a customized research file. Also added are guidelines for membership, meetings, decision-making guidelines and reports the Scientific Review Panel will perform for the Council.

Jim Loyd, Executive Director, has determined that for the first five-year period that the proposed sections are in effect, there will be the following anticipated costs ($65,978) for the State in regards to the implementation of the following amended sections: §1301.12(b)(4), a one-time programming cost of $44,000 ($71/hr times 160/hrs) for having the computer systems at Commonwealth Clinical Systems remove the extraneous data; §1301.20 will incur anticipated recurring costs of $3,600 (an estimate of four (4) request for the Research data file each year will require a cost of $500 dollars for the review of these by the Scientific Review Panel and anticipated four (4) meetings in which THCIC staff will be required to attend and travel costs are estimated to be $400 for each meeting) for holding the meetings in open forum as required by §108.004, Health and Safety Code. A ten percent increase each year is estimated to the first year cost for holding the meetings (Second year--$3,960, Third year--$4,356, Fourth year--$4,792, Fifth year--$ 5,271).

Mr. Loyd has also determined that for the first five-year period the proposed sections are in effect there, will be the following anticipated costs to local government affected by as a result of enforcing or administering the amended section §1301.19(e)(12), the Council anticipates a one-time cost of $11,695. The Council estimates that the one-time programming costs associated with the requirements in the following sections: §1301.19(e)(12) and §1301.19(e)(39)-(44) to be $8,960 (Estimating a cost of programmers to be $28 per hour {40% above the average hourly salary of programmers in 1999 in Texas} times an estimated 320 hours of programming) to hospitals for assuring the submission of secondary non-standard codes when applicable. The Council estimates recurring costs for maintaining the physician reference file to be $2,735 ($448 for the first year this is based on estimate 4 hours per quarter times 4 quarters times (Estimating a cost of programmers to be $28 per hour {40% above the average hourly salary of programmers in 1999 in Texas}. This assumes ten percent increase per year: (Second Year--$493, Third Year--$542, Fourth year--$596, Fifth year--$656))

Mr. Loyd also has determined that for each year the of the first five year period the rules are in effect the costs to persons or hospitals who are required to comply with the amended and new sections is $11,695. The Council estimates that the one-time programming costs associated with the requirements in the following sections: §1301.19(e)(12) and §1301.19(e)(39-44) to be $8,960 (Estimating a cost of programmers to be $28 per hour {40% above the average hourly salary of programmers in 1999 in Texas} times an estimated 320 hours of programming) to hospitals for assuring the submission of secondary non-standard codes when applicable. The Council estimates recurring costs for maintaining the physician reference file to be $2,735 ($448 for the first year this is based on estimate 4 hours per quarter times 4 quarters times (Estimating a cost of programmers to be $28 per hour {40% above the average hourly salary of programmers in 1999 in Texas}. This assumes ten percent increase per year: (Second Year--$493, Third Year--$542, Fourth year--$596, Fifth year--$656))

Mr. Loyd also has determined that for each year of the first five-year period that the proposed sections are in effect the anticipated public benefit will be a more accurate data picture of health care in Texas that includes rural hospitals be released in the public use data file so that consumers can review and analyze unbiased data and make decisions regarding health care services offered, and established guidelines for protecting the confidentiality of patients and physicians.

Comments on the proposed sections may be submitted to Jim Loyd, Executive Director, Texas Health Care Information Council, Two Commodore Plaza, 206 East 9th Street, Suite 19.140, Austin, Texas 78701 no later than 30 calendar days from the date that these proposed sections are published in the Texas Register .

The Council will entertain requests for a public hearing until the 25th day after the date the rules are published in the Texas Register .

The amendments and new section are proposed under the Health and Safety Code, §108.006 and §108.009. The Council interprets §108.006 as authorizing it to adopt rules necessary to carry out Chapter 108, including rules concerning data dissemination requirements. The Council interprets §108.009 as authorizing the Council to adopt rules regarding the collection of data from hospitals in uniform submission formats in order for the incoming data to be substantially valid, consistent, compatible and manageable.

The Health and Safety Code, §§108.002, 108.006, 108.009, 108.011, 108.012 and 108.013 are affected by these amendments and new section.

§1301.11.Definitions.

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

(1)-(9)

(No change.)

(10)

Discharge file--A set of computer records as specified in §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) relating to a specific patient. [ Except for some normal newborn infants there will be one or more discharge files for each inpatient. ]

(11)-(14)

(No change.)

(15)

Electronic filing--The submission of computer records in machine readable form by modem transfer from one computer to another (EDI) or by recording the records on a nine track magnetic tape, computer diskette or other magnetic media acceptable to the executive director.

(16)

(No change.)

(17)

Ethnicity--The status of patients relative to Hispanic background. Hospitals shall report this data element according to the following ethnic types: Hispanic or Non-Hispanic.

(18)

(No change.)

(19)

Facility Type Indicators--An indicator that provides information to the data user as to the type of facility or the primary health services delivered at that facility (e.g. Teaching, Acute Care, Rehabilitation, Psychiatric, Pediatric, Cancer, Skilled Nursing or other Long Term Care Facility) . [ , ] A facility may have more than one indicator. Hospitals may request updates to this field.

(20)

Geographic identifiers [ identifier ]--A set of codes indicating the public health region and county in which the patient resides.

(21)-(32)

(No change.)

(33)

Required minimum data set--The list of data elements which hospitals are required to submit in a discharge file for each inpatient stay in the hospital [ regardless of whether or not the hospital would have prepared a bill for the inpatient ]. The required minimum data set is specified in §1301.19(d) of this title (relating to Discharge Reports--Records, Data Fields and Codes).

(34)

Research data file--A customized data file, which includes the data elements in the public use file and may include data elements other than the required minimum data set submitted to the Council, except those data elements that could reasonably identify a patient or physician. The data elements maybe released to a requestor when the requirements specified in §1301.18(f) of this title (relating to Hospital Discharge Data Release) are completed.

(35)

[ (34) ] Risk adjustment--A statistical method to account for a patient's severity of illness at the time of admission and the likelihood of development of a disease or outcome, prior to any medical intervention.

(36)

[ (35) ] Rural provider--A health care facility located in a county with a population of not more than 35,000 as of July 1 of the most recent year according to the most recent United States Bureau of the Census estimate; or located in a county with a population of more than 35,000 but with 100 or fewer licensed hospital beds and not located in an area that is delineated as an urbanized area by the United States Bureau of the Census; and is not state owned, or not managed or directly or indirectly owned by an individual, association, partnership, corporation, or other legal entity that owns or manages one or more other hospitals. A health care facility is not a rural provider if an individual or legal entity that manages or owns one or more other hospitals owns or controls more than 50% of the voting rights with respect to the governance of the facility.

(37)

Scientific Review Panel--The Council appointees or agent who have experience and expertise in ethics, patient confidentiality, and health care data who review and approve or disapprove requests for data or information other than the public use data. Described in §1301.20 of this title (relating to Scientific Review Panel).

(38)

[ (36) ] Service Unit Indicator--An indicator derived from submitted data (based on Bill type or Revenue Codes) and represents the type of service unit or units (e.g., Coronary Care Unit, Detoxification Unit, Intensive Care Unit, Hospice Unit, Nursery, Obstetric Unit, Oncology Unit, Pediatric Unit, Psychiatric Unit, Rehabilitation Unit, Sub acute Care Unit or Skilled Nursing Unit) where the patient received treatment.

(39)

[ (37) ] Severity adjustment--A method to stratify patient groups by degrees of illness and mortality.

(40)

[ (38) ] Submission--A set of computer records as specified in §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) that constitutes the discharge report for one or more hospitals.

(41)

[ (39) ] Submitter--The person or organization, which physically prepares discharge reports for one or more hospitals and submits them to the Council. A submitter may be a hospital or an agent designated by a hospital or its owner.

(42)

[ (40) ] THCIC Identification Number--A string of six characters assigned by the Council to identify health care facilities for reporting and tracking purposes.

(43)

Treating Physician--For the purposes of this title, the person licensed under the Medical Practice Act or any other health professional licensed by the state who has been reported as having treated the patient or who has consulted on the patient's case. The term includes any physician or other health professional listed on the discharge file other than the attending physician.

(44)

[ (41) ] Uniform facility identifier--A unique number assigned by the Council to each health care facility licensed in the state. For hospitals this will include [ be ] the hospital's state license number. For hospitals operating [ Where a hospital operates ] multiple facilities under one license number and duplicating services , the Council will assign a distinguishable uniform facility identifier [ suffix ] for each separate facility. The relationship between facility identifier and the name[ , ] and license number[ , and assigned suffix ] of the facility is public information.

[(42)

Uniform other health professional identifier--A unique number assigned by the Council to an individual other health professional who is reported as admitting or treating a hospital inpatient, and composed of numeric, alpha, or alphanumeric characters, which remains constant across hospitals. The relationship of the identifier to the health professional-specific data elements used to assign it is confidential.]

(45)

[ (43) ] Uniform patient identifier--A unique identifier [ number ] assigned by the Council to an individual patient and composed of numeric, alpha, or alphanumeric characters, which remains constant across hospitals and inpatient admissions. The relationship of the identifier to the patient-specific data elements used to assign it is confidential.

(46)

[ (44) ] Uniform physician identifier--A unique identifier [ number ] assigned by the Council to a [ any ] physician or other health professional who is reported as attending [ admitting ] or treating a hospital inpatient and which remains constant across hospitals. The relationship of the identifier to the physician-specific data elements used to assign it is confidential. The uniform physician identifier shall consist of alphanumeric characters.

(47)

[ (45) ] Validation--The process by which a provider verifies the accuracy and completeness of data and corrects any errors identified before certification.

§1301.12.Collection of Hospital Discharge Data.

(a)

All hospitals in operation for all or any of the reporting periods described in §1301.13 of this title (relating to Schedule for Filing Discharge Reports) shall submit discharge files as specified in §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) on all discharged inpatients attended or treated by physicians to the Council. Hospitals may also submit discharge files on all discharged inpatients treated by other health professionals to the Council. Hospitals owned by the federal government and hospitals exempted as rural providers may submit hospital discharge files.

(b)

All inpatient discharges shall be reported. Except as noted in paragraphs (1)-(5) of this subsection, one or more discharge files shall be submitted for each patient for each discharge covering all services and charges from admission through discharge.

(1)

Separate discharge files shall [ normally ] be submitted for mothers and newborns. [ Hospitals are not required to create a separate discharge file for a normal newborn infant if the delivery is covered by a third party payer and the third party payor does not require separate bills for the mother and the infant. For any birth where there is no third party coverage, separate discharge files are required for the mother and the infant. ]

(2)

Hospitals shall either submit separate discharge files corresponding to each interim, revised, or final discharge files [ bills ] or submit a single consolidated final discharge file [ bill ] for each discharged patient.

[(3)

Where a patient has been served in multiple units of a hospital (e.g. acute care, skilled nursing care, comprehensive medical rehabilitation, substance abuse) during a single continuous stay, some third party payers require that separate bills be prepared for services in acute and sub-acute units while others do not. Where a patient has third party coverage, the discharge files submitted by the hospital shall correspond to the bills submitted to the payer. Where a patient has no third party coverage, the hospital shall submit a separate discharge file for each unit.]

(3)

[ (4) ] For all patients for which the hospital prepares one or more bills for inpatient services, the hospital shall submit a discharge file corresponding to each bill containing the required data elements required by §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) [ and all other data elements included on the bill whether included because of the requirements of third party payers or because of hospital policy ]. For all patients for which the hospital does not prepare a bill for inpatient services, the hospital shall submit a discharge file containing the required minimum data set.

(4)

[ (5) ] For all patients that are covered by 42 USC 290dd-2 and 42 CFR Part 2.1, a hospital shall submit a discharge file [ bill ] containing the required data elements specified [ required ] by §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) [ and all other data elements included on the bill, whether included because of the requirements of third party payers or because of hospital policy ]. The hospital shall replace the patient identifying information with the default values specified in §1301.19(f) of this title (relating to Discharge Reports--Records, Data Fields and Codes) or submit the patient identifying information if release of patient identifying information is authorized in writing by the patient or patient's guardian.

(c)-(e)

(No change.)

(f)

Hospitals may submit discharge reports, or may designate an agent to submit the reports. If a hospital designates an agent, it shall inform the Council of the designation in writing at least 30 calendar days prior to the agent's submission of any discharge report. The hospital shall inform the Council in writing at least 30 calendar days prior to changing agents or making the submissions itself. Designation of an agent does not relieve the hospital of responsibility for compliance with this chapter or other related law.

(g)

(No change.)

§1301.13.Schedule for Filing Discharge Reports.

(a)

(No change.)

[(b)

On or before May 31, 1998, hospitals shall submit a discharge report drawn from inpatient discharges occurring between January 1, 1998, and March 31, 1998, inclusive. This discharge report shall be used for test and certification purposes only. The discharge report may include all discharges for the quarter, but the hospital is only required to submit discharge files covering discharges for any consecutive 30 days of the quarter.]

(b)

[ (c) ] Extensions to processing due dates may be granted by the executive director for a maximum of ten working days in response to a written request signed by the hospital's chief executive officer. Requests must be in writing, must be received at least five working days prior to the due date and must be accompanied by adequate justification for the delay.

(c)

[ (d) ] Failure to file a discharge report on or before the due date without an extension, is punishable by a civil penalty pursuant to Health and Safety Code, §108.014.

§1301.16.Acceptance of Discharge Reports and Correction of Errors.

(a)-(b)

(No change.)

(c)

Correction of Errors.

(1)

The executive director shall review all discharge reports accepted for processing and will process all discharge files against the editing criteria established by [ the ] this section and by the executive director. Within 30 days of receipt of an accepted discharge report the executive director shall notify the hospital in detail of all errors detected in the discharge report.

(2)

Within 30 days of receiving initial notice of errors in a discharge report, the hospital shall correct all discharge files containing errors, add any discharge files determined to be missing from the initial discharge report and resubmit the corrected and previously missing discharge files. If the hospital disagrees with any identified error, the hospital may indicate that the discharge file is as accurate as it can be or cannot be corrected [ shall submit written justification of the correctness or completeness of its data ]. Each hospital shall submit such modified and/or additional discharge files as may be required to allow the chief executive officer or the chief executive officer's designated agent to certify the quarterly discharge report as required by §1301.17 of this title (relating to Certification of Discharge Reports). Corrections to a discharge report shall be submitted on approved media [ in the same medium ] and formats [ format ] as specified in §1301.14 of this title (relating to Instructions for Filing Discharge Reports) and §1301.19 of this title (relating to Discharge Reports-Records, Data Fields and Codes) [ the original discharge report ] unless the executive director approves another medium or format .

(3)

Within ten days of receiving corrections to a discharge report from a hospital, the executive director shall notify the hospital of any remaining errors. The hospital shall have ten days from receipt of this notice to correct the errors noted or indicate [ submit a written explanation of ] why the data should be deemed acceptable [ correct ] and complete. This process may [ shall ] be repeated until the [ executive director is satisfied that the ] data [ submitted by the hospital ] is substantially accurate and [ until ] the hospital is able to certify the discharge report as required by §1301.17 of this title (relating to Certification of Discharge Reports) or the deadline for submitting corrections prior to certification is reached. Corrected data is required to be submitted on or before the following dates for the respective quarter's discharges; Quarter 1--July 15, Quarter 2--October 15, Quarter 3--January 15, Quarter 4--April 15. No individual hospitals will be granted extensions to the dates. The executive director may grant an extension to all hospitals when deemed necessary.

(4)

Discharge files that have not been previously submitted shall be submitted prior to June 1 of the following year. Correction and certification of these previously missing or additional discharge files for the prior calendar year shall be made according to the deadlines established for Quarter 1 data in §1301.13(a)(1) of this title (relating to the Schedule for Filing Discharge Reports), paragraph (3) of this subsection (relating to the Acceptance of Discharge Reports and Correction of Errors) and §1301.17 (b) and (d) of this title (relating to the Certification of Discharge Encounter Data). Corrections to discharge files previously submitted or have a discharge date prior to January 1 of the prior calendar year will not be processed.

(d)

(No change.)

(e)

Failure to correct or comment on a discharge report which has been filed but contains errors or omissions within the due dates in §1301.13 of this title (relating to Schedule for Filing Discharge Reports) is punishable by a civil penalty pursuant to Health and Safety Code, §108.014.

§1301.17.Certification of Discharge Reports.

(a)

Within 120 days after the end of each reporting quarter the executive director shall compile one or more [ an ] electronic data files [ file ] for each reporting hospital using all discharge files received from each hospital. The file shall have one record for each patient discharged during the reporting quarter and one record for any patient discharged during a previous reporting quarter for whom additional discharge files have been received. This file will include all data submitted by the hospital which the executive director intends to use in the creation of the public use data file. The data files, including reports and any additional information returned to the hospital, allows the hospital to [ file will ] provide physicians and other health professionals the opportunity to review, request correction of, and comment on records of discharged patients for whom they are shown as attending [ admitting ] or treating. The executive director shall determine the format and medium in which the quarterly file will be delivered to hospitals.

(b)

The chief executive officer or chief executive officer's designated agent of each hospital shall indicate whether the hospital is certifying or not certifying the discharge encounter data specified in subsection (a) of this section, sign and return the form corresponding to [ certify that ] the discharge report for each quarter [ is accurate ] using forms supplied by the Council. The certification form may be signed by a person designated by the chief executive officer and acting as the officer's agent. Designation of an agent does not relieve the chief executive officer of personal responsibility for the certification. If the chief executive officer or chief executive officer's designated agent does not believe the quarterly file is accurate, the officer shall provide the executive director with detailed comments regarding the errors or submit a written request (on a form supplied by the Council) and provide the data [ and data ] necessary to correct any inaccuracy and certify the file subject to those corrections being made prior to the deadlines specified in this subsection. Corrections to certification discharge data shall be submitted on or prior to the following schedule: Quarter 1--September 15; Quarter 2--December 15; Quarter 3--March 15; Quarter 4--June 15. Chief Executive Officers or designees that elect not to certify shall submit a reasoned justification explaining their decision to not certify their discharge encounter data and attach to the certification form. Election to not certify data does not prevent data from appearing in the public use data file. Data that is not corrected and submitted by the deadline may appear in the public use data file.

(c)

The signed certification form shall represent that: [ The certification shall represent that a complete review of hospital records was accomplished to assure the accuracy of the discharge report and any corrections submitted, that all errors and omissions known to the hospital have been corrected, and that to the best of their knowledge and belief, the data submitted is accurate and complete. The certification shall also represent that the hospital has provided physicians and other health professionals on its medical staff a reasonable opportunity to review the discharge files for which they were the admitting or treating physician or other health professional prior to certification, have corrected any errors brought to the hospital's attention and have included with the discharge report any comments on the accuracy of the data submitted by physicians or other health professionals. Written explanation of any unresolved disagreements with the executive director concerning the accuracy and completeness of the data at the time of the certification shall be attached to the certification form. ]

(1)

policies and procedures are in place within the hospital's processes to validate and assure the accuracy of the discharge encounter data and any corrections submitted; and

(2)

all errors and omissions known to the hospital have been corrected or the hospital has submitted comments describing the errors and the reasons why they could not be corrected; and

(3)

to the best of their knowledge and belief, the data submitted, accurately represents the hospital's administrative status of discharged inpatients for the reporting quarter; and

(4)

the hospital has provided physicians and other health professionals a reasonable opportunity to review and comment on the discharge data of patients for which they were reported in one of the available physician number and name fields provided on the acceptable formats specified in §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) (for example, "attending physician", "operating or other physician", "other physician #1" or "other physician #2 positions"). The physicians or other health professionals may write comments and have errors brought to the attention of the chief executive officer or the chief executive officer's designated agent and the chief executive officer or the chief executive officer's designated agent, shall address any comments by the physicians or other health professionals.

(5)

if the chief executive officer or the officer's designee elects not to certify the discharge encounter data for a specific quarter, a written justification of any unresolved data issues concerning the accuracy and completeness of the data at the time of the certification shall be included on the certification form. Discharge data that has been edited, returned to hospital and is not certified may be released and published in the public use data file.

(d)

Each hospital shall submit [ must file ] its certification form for [ of ] each quarter's data to [ with ] the Council by the first day of the eighth month (Quarter 1--November 1; Quarter 2--February 1; Quarter 3--May 1; Quarter 4--August 1) [ within six months ] following the last day of the reporting quarter as specified in §1301.13 (a) (1)-(4) of this title (relating to Schedule for Filing Discharge Reports) . Individual hospital requests for an [ Extensions ] extension to these deadlines [ this period ] will not be granted. The executive director may extend the deadline for all hospitals when deemed necessary.

(e)

Hospitals, physicians or other health professionals may submit concise written comments regarding any data submitted by them or relating to services they have delivered which may be released as public use data. Comments shall be submitted to the Council on or before the dates specified in subsection (d) of this section, regarding the submission of the certification form [ no later than six months following the last day of the reporting quarter ]. Commenters are responsible for assuring that the comments contain no patient or physician identifying information. Comments shall be submitted electronically using the method described in §1301.14(a) and (b) of this title (relating to Instructions for Filing Discharge Reports).

(f)

Failure to submit [ timely file ] a signed certification form that is supplied by the Council on or before the dates specified in subsection (d) of this section corresponding to [ of ] discharge data previously submitted is punishable by a civil penalty pursuant to Health and Safety Code, §108.014.

(g)

Failure to either correct a discharge report which has been submitted and contains errors or omissions on or prior to the dates specified in subsection (b) of this section or to address in the comments the errors contained in the data and return the comments on or prior to the dates specified in subsection (d) of this section is punishable by a civil penalty pursuant to Health and Safety Code, §108.014(b).

§1301.18.Hospital Discharge Data Release.

(a)-(b)

(No change.)

(c)

Creation of public use data file. The executive director will create a public use data file by creating a single record for each inpatient discharge and adding, modifying or deleting data elements in the following manner as listed in paragraphs (1)-(11) of this subsection:

(1)-(4)

(No change.)

(5)

delete physician and other health professional names and numbers and assign a alphanumeric uniform physician identifier for the physicians and other health professionals who were reported as attending or treating discharged patients ;

(6)

(No change.)

(7)

the minimum cell size required by §108.011(i)(2) of the Health and Safety Code shall be five, unless the executive director determines that a higher cell size is required to protect the confidentiality of an individual patient or physician. When determining a higher cell size, the executive director shall consider comments submitted by a hospital and recommendations submitted by the technical advisory committee as identified in the Texas Health and Safety Code §108.003(g)(5)[ . ];

(8)-(11)

(No change.)

(d)

(No change.)

(e)

The executive director will make available a public use data file on electronic, magnetic or optical media for each quarter:

(1)

The executive director shall release public use data from hospitals that have certified the data as required by §1301.17 of this title (relating to Certification of Discharge Reports). A hospital's failure to execute the certification form by the dates specified in §1301.17(d) of this title, or elects to not certify the discharge encounter data [ after six months ] shall not prevent the executive director from releasing the hospital's data if the director believes the data submitted is reasonably accurate and complete. The executive director, [ shall not include in the public use data file records derived from hospital discharge files which contain material errors and ] with the recommendation of the Hospital Discharge Data Committee, may suppress for any quarter's data one or more data elements if deemed necessary to comply with provisions of the statutes. If an element is ordered suppressed by a judicial authority the executive director [ Executive Director ] may suppress the element without the recommendation of the Hospital Discharge Data Committee. [ The executive director will include with the public use data file information on the number of discharge files received from each hospital and the number of discharge files from each hospital included on the public use data file. ]

(2)

If additional discharge files (not previously submitted as specified in §1301.16(c)(4) of this title (relating to Acceptance of Discharge Reports and Correction of Errors) , excluding replacement, adjustments and void/cancel discharge files) become available after the initial release of the public use data file for any quarter, the executive director will add the discharge files, that are received on or prior to the date specified in §1301.13(a)(1) of this title (relating to Schedule for Filing Discharge Reports) of the following year, [ these records ] to the public use data file and make the additional records available to the public.

(3)

(No change.)

[(4)

The first public use data file available for release will cover discharges for the first and second quarter of 1999. The Council will initially release six months of data in order to provide a more reliable body of data for analysis and decision-making and to make available public use data files on a quarterly schedule thereafter.]

(f)

[ The Council shall not charge ] Texas State agencies that request [ a fee for ] data [ requested ] solely for [ the ] internal use in accordance [ of the agency to comply ] with Health and Safety Code, §108.012(b) shall abide by the data users agreement . [ Prior to filling the request of a state agency without fee, the executive director shall secure an interagency agreement imposing restrictions on distribution, republication or reuse of the data in ways that would diminish user fees to the Council. ]

(g)-(k)

(No change.)

(l)

A research data file may be released provided the following criteria are met:

(1)

the Texas Health Care Information Council Research Data Request Form is completed and submitted to the Council's executive director; and,

(2)

the requestor has made payment according to the Council's fee schedule. The Council's fee includes a non-refundable "Review of Request Fee"; and,

(3)

the Scientific Review Panel reviews the research request and has determined the proposed research outcome can be achieved with the requested data; and

(4)

the Council's Scientific Review Panel grants authorization to the request or restricts access to specified data elements determined to be inappropriate for the research proposal in accordance with this subsection of this title (relating to Scientific Review Panel); and,

(5)

the requestor agrees to dispose of the research data using authorized methods by the established end date stated on the written data release agreement.

(6)

the requestor has signed a written data release agreement.

§1301.19.Discharge Reports--Records, Data Fields and Codes.

(a)

Hospitals that have not obtained an exemption letter authorized by §1301.15 of this title (relating to Exemptions from Filing) shall submit discharge reports in one of the following formats as listed in paragraphs (1)-(3) of this subsection:

(1)

electronically in the national standard flat file format for inpatient hospital bills defined by the United States Department of Health and Human Services, Health Care Finance Administration (HCFA), commonly known as the HCFA UB-92 Electronic Format [ (Versions 005.0 and 004.1) ]. HCFA updates this format from time to time by issuing new versions. The Council will accept discharge reports in the latest version or versions accepted [ in the immediately preceding version or as mandated ] by HCFA at the service end date specified in the discharge file or at the time of submission . [ For the purposes of this paragraph and the immediately preceding version is version 004.1 (HCFA's Program Memorandum to Intermediaries, Department of Health and Human Services, HCFA, Transmittal No. A-98-29, October 1998, Change Request No. 655, Subject: UB92-claims that are not millennium compliant, states that Fiscal Intermediaries will allow the submission of HCFA UB-92 Electronic Format Versions 005.0 and 004.1 until June 30, 1999 at which time only Version 005.0 will be accepted.) The Council will make detailed specifications for these formats available to submitters and to the public for the cost of reproduction; ]

(2)

electronically in the file format for inpatient hospital bills defined by the American National Standards Institute (ANSI), commonly known as the ANSI X12N [ X.12 ] form 837. ANSI updates this format from time to time by issuing new versions. The Council will accept discharge reports in the latest version or in a [ the immediately preceding ] version approved by HCFA at the service end date specified in the discharge file or at the time of submission . [ As of October 1, 1997, the latest version will be version 30.70 and the immediately preceding version will be version 30.51. The Council will make detailed specifications for these formats available to submitters at no charge and to the public for the cost of reproduction; ]

(3)

(No change.)

(b)

Except as otherwise provided in this section, discharge reports shall be submitted using the [ national uniform billing ] data element specifications as required by HCFA [ developed by the National Uniform Billing Committee (NUBC) as published by the State Uniform Billing Committee (SUBC) with instructions specific to Texas third party fiscal intermediaries in the Texas UB-92 Manual. The NUBC revises these data element specifications from time to time and the SUBC publishes revisions showing the effective date for changes to each data element ]. Hospitals shall submit discharge reports using the data element specifications in effect as of the date of the discharge or as of the date submitted . The Council will make detailed specifications for these data elements available to submitters and to the public.

(c)

In addition to the data elements contained in the Texas UB-92 Manual, the Council has defined the following data elements shown in this subsection and has defined the location in the HCFA UB-92 Electronic Format [ (Versions 005.0 and 004.1) ] where each element is to be reported. Data element content, format and locations may change as federal and state legislative requirements change in regards to Public Law 104-191, Health Insurance Portability and Accountability Act of 1996 (HIPAA) is implemented.

(1)-(3)

(No change.)

(4)

Source of payment code--This data element shall be reported at Record 30, Field 04, Beginning Position 25 as an alphanumeric value. Primary and secondary payer source codes shall be submitted when the hospital submits claim data for the patient to more than one payer.

(A)-(B)

(No change.)

[(5)

Submission purpose code--This data element shall be reported at Record 01, Field 20.8, Beginning Position 183 as an alphanumeric value. Acceptable codes are C = Claim, D = Discharge Statement, and B = Both. This code is required if a hospital bill clearinghouse is utilized in the data collection effort. Once published these codes and formats may not be changed without 90 days prior notice to hospitals required to submit discharge reports to the Council.]

(5)

[ (6) ] Facility Name--This data element shall be the name of the hospital where the services were rendered and shall be reported at Record Type 10, Field 12.

(6)

[ (7) ] Facility Address--This data element shall be the actual physical address of the hospital where the services were rendered and shall be reported at Record Type 10, Field 13.

(7)

[ (8) ] Facility City--This data element shall be the name of the city where the hospital that rendered the services is located and shall be reported in Record Type 10, Field 14.

(d)

(No change.)

(e)

Hospitals shall submit the required minimum data set for all patients for which a discharge file is required by this title. [ For patients with any form of insurance, hospitals shall submit to the Council all data elements submitted to any third party payer in addition to data elements in the required minimum data set. ] The required minimum data set includes the following data elements as listed in paragraphs (1)- (48) [ (47) ] of this subsection:

(1)-(11)

(No change.)

(12)

Source of Payment Code (Primary and Secondary payers, including standard and non-standard codes) ;

(13)-(38)

(No change.)

(39)

Attending physician number (State License Number) ;

(40)

Operating or other physician number (if applicable) (State License Number) ;

(41)

Other physician number (all applicable) (State License Number) ;

(42)

Attending physician name (as reported to the State licensing boards) ;

(43)

Operating or other physician name (if applicable) (as reported to the State licensing boards) ;

(44)

Other physician name (all applicable) (as reported to the State licensing boards) ;

(45)-(47)

(No change.)

(48)

Reason for no Social Security number.

(f)

(No change.)

(g)

A submission will consist of a set of the following types of records from the HCFA UB-92 Electronic Format [ (Versions 004.1 and 004.0) ] specification as shown in paragraphs (1)-(13) of this subsection.

(1)-(13)

(No change.)

§1301.20.Scientific Review Panel.

(a)

The Council establishes the Scientific Review Panel (Panel) for the purposes of:

(1)

evaluating applications for various measures or variables that are found in the Council's hospital discharge data "research" file; and

(2)

deciding whether the data requests should be granted.

(b)

The Scientific Review Panel is abolished at such time as the Council ceases to maintain a hospital discharge data "research" file.

(c)

The Council may establish the scientific review function through a contract with an existing institutional review board that meets federal guidelines or by appointing a separate review panel.

(d)

Membership, if scientific review panel is appointed.

(1)

A person interested in membership on the Scientific Review Panel must submit an application, on a form specified by the Council, to the Executive Director of the Council.

(2)

The Scientific Review Panel will consist of five members.

(3)

The Council's Appointments Committee shall review all applications for membership and make recommendations to the Council. When making its recommendations, the Appointments Committee shall consider the qualification criteria in the Health and Safety Code, §108.0135 for each member and the restrictions on composition of committees in Government Code §2110.002.

(4)

The Council, at its, discretion, shall appoint persons to the Scientific Review Panel. Members shall have experience and expertise in ethics, patient confidentiality, and health care data.

(5)

Members shall be appointed for three-year terms, except that for the initial appointees, the terms of one-third of the members shall be for three years, another one-third for two years, and the remaining members for one year. The Appointments Committee shall assign the initial term of each member or position so as to provide for a staggered system of terms.

(6)

The Council may remove a member from the Scientific Review Panel if he or she is absent from three consecutive meetings. The Chair of the Scientific Review Panel may recommend the removal of a member for non-attendance to the Council's appointments committee which shall review the matter and make a recommendation to the Council.

(7)

If a vacancy on the Scientific Review Panel occurs, the Council shall appoint an individual to serve the unexpired portion of that term.

(8)

The Chair of the Scientific Review Panel is designated by the Chair of the Council from current members of the Panel. This person shall serve in that capacity at the pleasure of the Council Chair.

(e)

Meetings.

(1)

The Scientific Review Panel shall meet as necessary to conduct business, but in any case, at least once every two months if applications for all or part of the research file are pending.

(2)

A simple majority of the members of the Scientific Review Panel shall constitute a quorum for the purpose of transacting business. All action of the Panel must be approved by majority vote. Each member shall have one vote and may not vote by proxy or in absentia.

(3)

Meetings of the Panel or Subcommittees of the Panel shall be posted and conducted in accordance with the Texas Open Meets Act, Government Code, Chapter 551. All meetings of the Panel or any Subcommittee will be recorded.

(4)

Minutes of all Panel and Subcommittee meetings shall be maintained by Council staff and shall include the names of members in attendance and a record of all formal actions and votes taken.

(5)

Council staff shall provide administrative support for the Panel and any Subcommittees, including making of meeting arrangements. Each Panel or Subcommittee member shall be informed of a meeting at least ten days prior to a meeting.

(6)

The Panel and Subcommittees 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.

(f)

Decision-Making Guidelines.

(1)

Requests should reasonably identify and justify the requested data elements. Requesters who have detailed information that would assist in justifying the records request are urged to provide such information in order to expedite the handling of the request. Envelopes in which written requests are submitted should be clearly identified as Open Records requests. Requests should include the fee or request determination of the fee.

(2)

Fee structures for the public use data file and the research file shall be set by the Executive Director, in consultation with the Council.

(3)

Waiver or reduction of the fees charged for the public use data file or the research file may be made upon a determination by the Executive Director when such waiver or reduction is in the Council's interest.

(4)

All requests for data must be submitted in writing, either on the form provided by the Council or on a similar form containing all of the same information. Denials of written requests will be in writing and will contain the reasons for the denial including, as appropriate, a statement that a document or data element requested is nonexistent or not reasonably described, or is subject to one or more clearly described exemption(s). Denials will also provide the requester with appropriate information on how to exercise the right of appeal.

(5)

In cases where there is an alleged conflict between the Texas Open Records Act and the Council's procedures, the Executive Director will refer the issue to the Office of the Attorney General.

(6)

Records will not be created by compiling selected items from the files, and records will not be created to provide the requester with such data as ratios, proportions, percentages, per capitas, frequency distributions, trends, correlations, and comparisons. If such data have been compiled and are available in the form of a record, the record may be made available as provided herein.

(g)

Reports to the Council. The Chair of the Scientific Review Panel shall file with the Executive Director of the Council a written report of all action taken at any meeting of the Panel or a Subcommittee within 3 working days of such meeting, including a detailed list of how each participating member voted.

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 March 5, 2001.

TRD-200101267

Jim Loyd

Executive Director

Texas Health Care Information Council

Earliest possible date of adoption: March 15, 2001

For further information, please call: (512) 482-3312