TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 31. NUTRITION SERVICES

Subchapter C. SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC)

25 TAC §§31.21, 31.30, 31.32 - 31.37

The Texas Department of Health (department) adopts amendments to §§31.21, 31.30, and 31.32-31.37 concerning the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Sections 31.30, 31.32, 31.33, 31.34, and 31.36 are adopted with changes to the proposed text as published in the October 5, 2001, issue of the Texas Register (26 TexReg 7750). Sections 31.21, 31.35, and 31.37 are adopted without changes, and therefore the sections will not be republished.

The United States Department of Agriculture (USDA) provides federal grant funds to the department to administer the WIC Program, provided the department does so in accordance with federal regulations. The WIC Program is 100% funded by a combination of federal grant funds and monies received from infant cereal and formula manufacturers in the form of rebates to the department. Rebate monies are considered dedicated general revenue and can only be expended to offset WIC food costs. Costs to the state for implementing these rules will be paid for by federal funds.

The amendments to §§31.21, 31.30, and 31.32-31.36 are required to implement new federal regulations governing the WIC Program. The amendment to §31.37 will enable the program to respond in a more timely, efficient, and flexible manner to changes in packaging of WIC-issued foods by manufacturers and to changes in allowable foods requested by vendors and clients.

The department is making the following minor changes to clarify the intent and improve the accuracy of the section.

Change: Concerning §31.30(a), the conjunction "or" has been added to improve the clarity of the section.

Change: Concerning §31.30(e), the Investigation section formerly attached to the Office of General Counsel has been reorganized and redesignated the department's Office of Criminal Investigations.

Change: Concerning §31.30(f), the Investigation section formerly attached to the Office of General Counsel has been reorganized and redesignated the department's Office of Criminal Investigations.

Change: Concerning §31.36(a), the conjunction "and" has been moved from the beginning of §31.36(a)(3) to the end of §31.36(a)(2).

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

Comment: Concerning §31.32(h)(1)(D), one commenter suggested the required advance notice for a vendor to notify the state agency of the opening of a new store should be less than 30 days. The commenter added that a 30-day advance notice was not fair to WIC clients using the services in that area because a vendor may not always know a new store's opening date 30 days in advance and may change the date depending on several factors.

Response: The department agrees and has deleted the specific 30-day timeframe from the advance notice requirement.

Comment: Concerning §31.33(c)(1) and §31.33(c)(2), one commenter suggested that these sections are already covered in federal WIC regulations and are therefore unnecessary.

Response: The department agrees and deleted the paragraphs.

Comment: Concerning §31.34, one commenter pointed out that federal regulations authorize the department to issue warnings to vendors who fail to meet competitive pricing criteria prior to terminating the vendor's contract, and suggested that the department should do so.

Response: The department agrees and added language to allow the department to conduct a preliminary review of a vendor's compliance with competitive pricing criteria and to issue a warning if the preliminary review indicates noncompliance. The amended section requires that if a subsequent review indicates noncompliance, the vendor's contract shall be terminated.

The commenters were the USDA Food and Nutrition Service and the Gulf Coast Retailers Association. The commenters were not against the rules in their entirety, but made recommendations for change as discussed in the summary of comments.

The amendments to the rules are adopted under Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; the Texas Omnibus Hunger Act of 1985, 69th Legislature, Chapter 150, Title II, Human Resources Code, Chapter 33; the Child Nutrition Act of 1966, 42 USC §1786; and 7 CFR Part 246.

§31.30.Participant Fraud and Abuse.

(a) Participants and parents, guardians, client-designated proxies, state agency- appointed proxies, or caretakers of participants identified and documented as having abused the WIC Program shall be sanctioned.

(b) In all cases where it is found by the state agency that a participant or parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant unlawfully received benefits due to WIC Program abuse, including but not limited to dual participation, the state agency has the option to refer the matter for criminal prosecution.

(c) Program violations means any intentional act of a participant, parent, guardian or caretaker of an infant or child participant, client-designated proxy or state agency-designated proxy that violates Federal or State statutes, regulations, rules, policies or procedures governing the WIC Program. Violations include, but are not limited to, intentionally making a false or misleading statement; intentionally misrepresenting, concealing, or withholding facts to obtain benefits; exchanging food instruments or food for cash, credit, non-food items, or unauthorized foods, including foods in excess of that authorized; threatening to harm or physically harming local agency, vendor or state agency staff; and simultaneous participation in the Program in one or more than one WIC clinic or participation in the Commodity Supplemental Food Program during the same period of time

(d) If prosecution is declined by the appropriate jurisdiction, the violation does not involve a violation of criminal law, or final disposition of criminal prosecution has occurred the state agency shall direct the local agency to initiate sanctions which may include disqualification from the Program for up to one year.

(e) Upon a final determination by the department's Office of Criminal Investigations that a program violation has occurred and that final disposition of any criminal prosecution has occurred, the following mandatory disqualifications shall apply.

(1) For an offense where a claim of $100 or more is assessed, the participant shall be disqualified for one year.

(2) For an offense where a participant illegally received benefits at more than one WIC office and the state agency assesses a claim for such dual participation, the participant shall be disqualified for one year.

(3) When the state agency assesses a second or subsequent claim of any amount, the participant shall be disqualified for one year.

(f) Upon a final determination by the department's Office of Criminal Investigations that a program violation which does not warrant a one year mandatory disqualification has occurred and final disposition of any criminal prosecution has occurred, the following sanctions shall apply.

(1) When a participant or a parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant exchanges food instruments or food for cash or credit, the participant shall be disqualified for a period of six months for a first offense and 12 months for a second or subsequent offense.

(2) When a participant or a parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant exchanges food instruments or food for firearms, explosives, ammunition, controlled substances, alcohol, or tobacco products, the participant shall be disqualified for a period of six months for a first offense and 12 months for a second or subsequent offense.

(3) When a participant or a parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant exchanges food instruments or food for non-food items not listed in §31.30(f)(2), the participant shall receive a warning for the first offense and shall be disqualified for a period of 12 months for a second or subsequent offense.

(4) When a participant or a parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant exchanges food instruments or food for unauthorized food including foods in excess of that authorized, the participant shall receive a warning for the first offense to and shall be disqualified for a period of 12 months for a second or subsequent offense.

(5) When a participant or a parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant threatens to harm local agency, vendor, or state agency staff, the participant shall be disqualified for a period of six months for a first offense and 12 months for a second or subsequent offense.

(6) When a participant or a parent, guardian, client-designated proxy, state agency-appointed proxy, or caretaker of a participant physically harms local agency, vendor, or state agency staff, the participant shall be disqualified for a period of 12 months for a first offense and 12 months for a second or subsequent offense.

(g) Exceptions to disqualification:

(1) The state agency may decide not to impose a disqualification if, for violations which resulted in a claim assessed by the state agency against the participant, parent, guardian, client designated proxy, state agency-appointed proxy, or caretaker of a participant, full restitution is made within 30 days of receipt of a letter demanding repayment or a repayment schedule is agreed on.

(2) The state agency may permit a disqualified participant to reapply for the program before the end of a disqualification period if, in the case of a violation where a claim was assessed by the state agency against the participant or parent, guardian, client-designated proxy, state-agency appointed proxy, or caretaker of a participant, full restitution is made or a repayment schedule is agreed upon.

(3) At the recommendation of the local agency's competent professional authority, the state agency may issue a waiver to appoint a person as a special proxy to transact food instruments and receive nutrition education for an infant, child, or participant under age 18 when the infant, child, or participant under age 18 will incur a serious health risk from the suspension of benefits.

(h) The state agency shall attempt to recover, in cash, the value of the benefits received by a participant or the parent, guardian, client-designated proxy, state agency-appointed proxy or caretaker of a participant as a result of participant abuse.

(1) The state agency shall determine the amount of the benefits improperly received by a participant through an independent review of local agency records and such other procedures as the state agency considers necessary under the specific circumstances.

(2) In cases involving criminal prosecutions for violations of law, repayment of the cash value of benefits improperly received shall become a part of any restitution agreement with the prosecutor. In such cases, the participant shall not have the right to a fair hearing by the department.

(3) In cases involving an administrative claim but no criminal prosecution, the state agency shall notify the participant or parent, caretaker, or guardian of a participant in writing that a financial claim has been established and shall request repayment of an amount equal to the value of the benefits improperly received. The written notification shall include the reasons for the claim, the value of the benefits improperly received, and the participant's right to a fair hearing.

(i) Collection of a financial claim assessed against a participant by offset of future benefits is not authorized.

§31.32.Selection of Vendors for WIC Initial Authorization for Participation.

(a) A representative from the state agency or the nearest local agency shall perform an on-site evaluation of a vendor applying for authorization to redeem WIC food instruments.

(1) The state or local agency representative shall complete a vendor evaluation form during the visit to the vendor indicating the type of WIC-authorized foods in stock and their shelf prices.

(2) The state or local agency representative shall recommend approval or disapproval of the vendor's application based on the observations during the store visit.

(3) The owner or manager or a store representative shall have the opportunity to review the information on the vendor evaluation form and shall sign the form to acknowledge accuracy of shelf prices listed at the time of the evaluation. The evaluator shall provide a copy of the form, including the date, local agency number, and the name of the evaluator, to the vendor at the time of the in-store evaluation.

(b) The state agency shall base its decision to authorize a vendor on the following criteria:

(1) The vendor's shelf prices for approved WIC foods in stock are competitive for the local agency area.

(2) The vendor has sufficient quantities of authorized milk, evaporated milk, cheese, cereal, contract infant formula, contract infant cereal, eggs, peanut butter, and dried beans.

(A) pharmacy may elect to provide only the designated contract milk and soy formulas and special formulas.

(B) A vendor may elect not to provide infant formula.

(C) For vendors who elect to provide all authorized foods, the following amounts of each food type shall constitute sufficient quantities:

(i) a total of at least 108 ounces of adult cereal, including 36 ounces each of at least three of the following types of cereal: oat, corn, wheat, rice, and multi-grain;

(ii) at least six dozen Grade A or AA large, medium, or small size eggs;

(iii) a total of at least 18 containers of juice, including at least two varieties of juice in 46-ounce fluid cans and/or 12-ounce frozen cans;

(iv) a total of at least six pounds of cheese;

(v) a total of at least nine gallons of milk, some of which must be available in one-half gallon containers;

(vi) at least three one-pound bags of dry beans;

(vii) at least three 18-ounce jars of peanut butter;

(viii) at least eight 12-ounce cans of evaporated milk;

(ix) at least 31 cans of milk or soy concentrate infant formula (contract brand) and either eight cans of milk-based powder formula or nine cans of soy powder formula (contract brand); and

(x) at least two 8-ounce boxes or one 16-ounce box of infant cereal.

(3) The vendor provides milk in gallon and half-gallon containers and juice in 46-ounce or 12-ounce containers.

(4) The vendor's shelf prices do not exceed the maximum prices on WIC food instruments.

(5) The recommendation by the state or local agency representative who conducted the on-site evaluation.

(6) The vendor has a retail food operations permit or food manufacturer's permit from the applicable city, county, district, or state health authority.

(7) The vendor's store is clean, with fresh merchandise (no expired food items).

(8) The vendor has no apparent conflict of interest with the local agency in the vendor's service area or with the state agency.

(9) The vendor has posted prices for food items.

(10) If applicable, the vendor's history of WIC Program noncompliance.

(11) The vendor has business integrity as indicated by a lack of activities during the past six years including fraud, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, receiving stolen property, making false claims, obstruction of justice, or tax evasion.

(12) The vendor is not currently disqualified from the Food Stamp Program or has not been assessed a civil money penalty for hardship by the Food Stamp Program and the disqualification period that would otherwise have been imposed by the Food Stamp Program has not expired unless denying WIC Program authorization would result in inadequate participant access.

(13) The vendor operates and will transact food instruments at a fixed location unless a mobile store is necessary to meet special needs as described in the state agency's state plan and approved by USDA.

(14) The vendor has participated in vendor interactive training.

(c) If the state agency disapproves the application by a vendor for authorization, the reasons for the disapproval shall be provided to the vendor in writing.

(d) Vendors who apply for authorization who have been evaluated twice within a six-month period and denied approval both times shall not be evaluated again until at least six months from the last evaluation.

(e) In the event a vendor purchases or acquires a store location or business which was in the process of being disqualified or which is disqualified from the WIC Program at the time of acquisition, the vendor's application for that store location or business shall not be considered until the state agency makes a determination that the sale was a bona fide arms-length transaction. The state agency will make this determination no later than six months from the date of application. If the state agency determines that the transfer was not an arms-length transaction, the application shall not be considered until the disqualification period has been served.

(f) If the state agency has allowed the vendor agreement for a previous owner of a store location or business to expire for noncompliance or notified the previous owner that the vendor agreement for the store location or business will be allowed to expire for noncompliance, a new owner's application for that store location or business shall not be considered until at least six months from the expiration date of the previous owner's last vendor agreement unless the state agency makes an earlier determination that the sale was a bona fide arms-length transaction.

(g) The state agency may waive the requirement for an on-site evaluation when a grocery chain comprising 20 or more outlets authorized to participate in the WIC Program purchases or merges with another chain with 20 or more authorized outlets if the merger or purchase does not materially change the stores' staff or pricing structure

(h) Upon request, the state agency may provide an applicant vendor with tentative authorization to redeem WIC food instruments starting the day the store opens.

(1) To obtain tentative authorization, the vendor shall comply with all of the following criteria:

(A) The owner of the applicant store owns ten or more stores that have been participating in the WIC Program under the current ownership for at least the six-month period prior to application for authorization.

(B) For the six month period prior to application for authorization, fewer than 20% of the applicant's participating stores' authorizations have been terminated for exceeding the competitive pricing criteria for either the woman/child package or the infant food package for their respective local agency vendor bands.

(C) None of the participating stores has been disqualified from program participation for two or more months within the 12-month period prior to application for authorization.

(D) The applicant store notifies the state agency prior to the official opening date.

(E) The applicant store's manager or assistant manager acknowledges receipt and understanding of the vendor agreement including its attachments, training materials and manuals, the allowable foods list, and vendor rules and policies.

(F) The applicant store's manager or assistant manager has scored at least 70% on a written test provided by the state agency and returned to the state agency no later than five days prior to the applicant store's opening date.

(2) If, after evaluation, a store which has received tentative authorization from the state agency does not meet all authorization criteria, the store shall be notified of its tentative agreement expiration date and instructed to discontinue redeeming the WIC Program food instruments. The state agency shall honor properly redeemed food instruments from the opening date until the tentative agreement expiration.

(i) On a temporary basis, the state agency may consider and approve applications from new vendors for the following reasons:

(1) the vendor has been authorized to accept Food Stamps;

(2) the disqualification of an existing authorized vendor in a local agency service area would create inadequate access for WIC Program participants;

(3) a currently-authorized vendor outlet(s) changes ownership; or

(4) authorization of a new vendor would result in a significant cost advantage to the WIC Program.

(j) The state agency may deny an application to participate as a vendor if an owner, partner, principal stockholder, officer, director, manager, or operator of the applicant was an owner, partner, principal stockholder, officer, director, manager, or operator of another vendor which has been disqualified or which has violated WIC Program vendor agreement procedures, policies, rules or regulations.

(k) The state agency may hold an authorized vendor individually responsible for previous violations by an owner, partner, manager, or principal stockholder of the vendor when considering renewal of the vendor's agreement or future applications for vendor agreements.

(l) A history of noncompliance with the WIC Program's federal and state statutes and regulations, rules, policies, and procedures shall be considered by the state agency when evaluating an authorized vendor's application for authorization of new outlets. The state agency will not authorize new outlets for a vendor where 50% of the vendor's outlets are in a disqualification or termination status at the time of a request to authorize new outlets.

§31.33.Selection of Vendors for Reauthorization for Participation.

(a) Vendors with a current vendor agreement who seek reauthorization shall reapply and shall be evaluated for issuance of a subsequent vendor agreement under WIC Program procedures, policies, rules, and regulations and shall be reauthorized unless notified in writing by the state agency at least 15 days before expiration of the vendor agreement.

(b) Prior to reauthorization, the state agency shall assess and review the qualifications of all vendors to assure that each continues to meet the WIC Program's goals. Criteria utilized in assessment and determination of qualifications for reauthorization include, but are not limited to.

(1) Competitive prices for the local agency area. A vendor's prices shall be considered competitive if the combined prices for the items included in the standard woman/child and/or infant food package do not exceed 108% of the local agency food package averages for the vendor's band.

(2) Volume of WIC sales. The vendor's volume of WIC sales exceeds $300 a month. If monthly sales fall below $300 a month for three consecutive months prior to the time of the vendor agreement reauthorization evaluation, the vendor agreement may not be renewed.

(3) Previous compliance with WIC Program procedures, policies, rules, and regulations. The vendor has satisfactorily complied with food instrument redemption and submission procedures, policies, rules, and regulations.

(4) Continuing to meet selection criteria. The vendor continues to meet the selection criteria as stated in this section and in §31.32 of this title (related to Selection of Vendors for WIC Initial Authorization for Participation).

(5) Use of the WIC acronym or WIC logo. If the state agency determines that the vendor failed to comply with the prohibitions on the use of the WIC acronym or WIC logo, after having received a written warning, the state agency shall allow the vendor agreement to expire without renewal.

(6) Failure to attend training. The vendor agreement shall not be renewed if a vendor or vendor representative has not attended a WIC vendor interactive training within three years from the last date a representative attended a WIC vendor interactive training.

(c) A history of noncompliance with WIC Program procedures, policies, rules, and regulations shall be considered by the state agency in determining if the vendor is eligible for a subsequent contract.

(d) The state agency may allow a vendor's agreement to expire and not be renewed if the vendor has a history of noncompliance with provisions in the vendor agreement or the WIC Program procedures, policies, rules, and/or regulations.

(1) Expiration of the vendor agreement is not subject to appeal.

(2) In the event the vendor's agreement has been allowed to expire due to previous noncompliance, a vendor's request for reauthorization shall not be considered until at least six months from the expiration date of the vendor's last agreement.

(e) All vendors must have a retail food operation permit or food manufacturers' permit from the applicable city, county, district, or state health authority.

§31.34.Calculation and Use of Vendor Competitive Pricing Data.

(a) The state agency shall use the following calculation to determine whether a vendor's prices are competitive with those of similar vendors in the local agency service area.

(1) The state agency data system calculates by vendor outlet the average unit costs to the state agency for each food type based on the food instruments redeemed by that vendor outlet.

(2) Authorized vendor outlets within a local agency service area are grouped into volume vendor bands.

(3) Utilizing food-type averages for each vendor outlet within a vendor band, the state agency determines the local agency average standard food package costs for an infant and/or a woman/child participant for each vendor band.

(4) A vendor outlet's average standard food package costs are determined based on the store evaluation for an applicant vendor or actual WIC redemption data for authorized vendors.

(5) The state agency compares the vendor outlet's standard food package costs to the local agency's average standard food package costs for that vendor band. Local agency averages for a prior period will be used. An outlet's standard food package costs are considered competitive if they are less than or equal to 108% of the local agency's average standard food package costs for that vendor band.

(6) The state agency may make adjustments to the local agency averages due to anomalies, such as those caused by sharp wholesale price increases or crop failures since the prior period in which the averages were calculated.

(7) The state agency may reassign a vendor to an alternative comparison group when the vendor, such as a high-volume, national discount superstore, is not characteristic of other vendors in the band; when the vendor is the only store in a rural area within the local agency; or when the vendor is the sole occupant of a band.

(b) The state agency may perform a preliminary review of the vendor's compliance with competitive pricing at any time during the term of the vendor agreement. The state agency shall provide a noncompliant vendor with written notification of noncompliance determined from the preliminary review. If, on a subsequent assessment within the term of the vendor agreement, the noncompliant vendor fails to comply with competitive pricing, the state agency shall provide a vendor with written notification of noncompliance with competitive pricing and the vendor agreement shall be terminated.

§31.36.The Right of a Vendor or Local Agency to Appeal.

(a) A local agency or vendor has the right to appeal when an application for participation is denied and/or any other adverse action affecting participation is taken. The only exceptions to this rule are:

(1) expiration of the vendor agreement or local agency contract;

(2) disqualification of a vendor as a result of disqualification from the Food Stamp Program; and

(3) a determination by the state agency WIC Program concerning whether disqualification of a vendor would result in inadequate participant access.

(b) The state agency shall provide a local agency or vendor with written notification of an adverse action, the cause(s) for the action, the effective date of the action, and the right to appeal the adverse action.

(c) The state agency shall provide a local agency notice of disqualification at least 60 days prior to the effective date.

(d) The state agency shall provide a vendor notice of an adverse action at least 15 days prior to the effective date of the action except when the adverse action results from conviction for trafficking in food instruments or selling firearms, ammunition, explosives, or controlled substances in exchange for food instruments, which is effective on receipt of the notice.

(e) A local agency or vendor shall provide the state agency with a written request for a hearing within 15 days of the receipt of the notice of denial or adverse action. The written request shall, at a minimum, describe the action being appealed.

(f) When a participating local agency appeals an adverse action, the adverse action shall be postponed until a hearing decision is reached.

(g) When a vendor appeals an adverse action, the adverse action may be postponed until a hearing decision is reached at the discretion of the state agency WIC Program.

(h) Appealing an adverse action does not relieve a local agency or a vendor permitted to continue participating in the program while an appeal is pending from the obligation of continued compliance with the terms of the written agreement or contract with the state agency.

(i) The state agency shall provide the local agency or vendor the following:

(1) at least ten days advance notice of the time and place for the hearing;

(2) the opportunity to reschedule the hearing one time;

(3) the opportunity to review all written case records prior to the hearing;

(4) the opportunity to be represented by counsel if desired;

(5) the opportunity to call witnesses;

(6) the opportunity to confront and cross-examine adverse witnesses except that such examination shall be conducted behind a protective screen or other device when necessary to protect the identity of WIC Program monitors;

(7) an impartial decision-maker who will prepare a written decision based solely on whether the state agency has correctly applied federal and state statutes, regulations, rules, policies and procedures governing the program according to the evidence presented at the hearing; and

(8) written notification of the final decision within 90 days from the date of receipt of the request for a hearing by a vendor and within 60 days from the date of receipt of a local agency's request for a hearing. These timeframes are only administrative requirements for the state agency and do not provide a basis for overturning the state agency's adverse action if a decision is not made within the specified timeframes.

(j) The state agency is not responsible for losses incurred by the local agency or vendor as a result of disqualification and/or denial of an application to participate.

(k) If the hearing results in a final decision adverse to the local agency or vendor, the appellant may seek judicial review of the decision to the extent authorized by state law. The state agency or its legal counsel shall not provide legal advice to adverse parties concerning judicial review of final decisions in administrative hearings. Appellants must seek advice from their own attorneys.

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

Filed with the Office of the Secretary of State on February 25, 2002.

TRD-200201173

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: April 1, 2002

Proposal publication date: November 5, 2001

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


Chapter 289. RADIATION CONTROL

Subchapter D. GENERAL

25 TAC §289.202

The Texas Department of Health (department) adopts an amendment to §289.202 concerning the standards for protection against radiation from radioactive material with changes to the proposed text as published in the December 14, 2001, issue of the Texas Register (26 TexReg 10217).

The revision allows disposal, without regard to its radioactivity, of certain concentrations of americium-241 in emission control dust as a result of unintentional melting of a radioactive source in electric arc furnaces or foundries. When the specific handling, treatment, transport, and radiation dose conditions of the proposed amendment are met, the contaminated material is required to be managed as a hazardous waste rather than a mixed waste. The amendment provides a safe additional disposal option for a very limited category of material that would otherwise be considered mixed waste. Language that was adopted in the July 3, 1998 (23 TexReg 6960) issue of the Texas Register and was inadvertently omitted during the 2000 adoption submission in May 26, 2000, (25 TexReg 4834) issue of the Texas Register is being reinstated in §289.202(ff)(2)(J)-(L) and (3). An additional revision addresses a licensee's responsibility to record summaries of annual dosimetry information on monitored individuals. The amendment changes the time frame from within 60 days of the end of the year to April 30 of the following year to complete the records. The revised requirement will allow companies and facilities with large numbers of monitored employees a more realistic time frame to comply with the requirement. This amendment is also part of the department's continuing effort to update, clarify, and simplify its rules regarding the control of radiation based upon technological advances, public concerns, legislative directives, or other factors.

Government Code §2001.039 requires that each state agency review and consider for readoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedure Act). Section 289.202 has been reviewed and the department has determined that the reasons for adopting the section continue to exist; however, revisions to the rule were necessary.

The department published a Notice of Intention to Review for §289.202 as required by Government Code §2001.039 in the Texas Register (26 TexReg 8197) on October 12, 2001. No comments were received by the department on this section.

The department received no public comments during the comment period for these amendments. However, the department is making the following changes due to staff comments to clarify the intent and improve the accuracy of the section.

Change: Concerning proposed §289.202(ff)(2)(G) and (I), the scientific notation 3 pCi/g is stated incorrectly. The department changed the notation from 3 pCi/gm to 3 pCi/g.

Change: Concerning proposed §289.202(ff)(3)-(5), these requirements specifically concern emission control and should be subparagraphs under paragraph (2). The paragraphs in this subsection were renumbered. Change is reflected in §289.202(ff)(2)(J) through §289.202(ff)(3).

The amendment is adopted under the Health and Safety Code, §401.051, which provides the Texas Board of Health (board) with the authority to adopt rules and guidelines relating to the control of radiation; and §12.001, which provides the board the authority to adopt rules for its procedures and for the performance of each duty imposed by law on the board, the department, or the commissioner of health.

§289.202.Standards for Protection Against Radiation from Radioactive Materials.

(a) Purpose.

(1) This section establishes standards for protection against ionizing radiation resulting from activities conducted in accordance with licenses issued by the agency.

(2) The requirements in this section are designed to control the receipt, possession, use, and transfer of sources of radiation by any licensee so the total dose to an individual, including doses resulting from all sources of radiation other than background radiation, does not exceed the standards for protection against radiation prescribed in this section. However, nothing in this section shall be construed as limiting actions that may be necessary to protect health and safety in an emergency.

(b) Scope.

(1) Except as specifically provided in other sections of this chapter, this section applies to persons who receive, possess, use, or transfer sources of radiation, unless otherwise exempted. No person may use, manufacture, produce, transport, transfer, receive, acquire, own, possess, process, or dispose of sources of radiation unless that person has a license or exemption from the agency. The dose limits in this section do not apply to doses due to background radiation, to exposure of patients to radiation for the purpose of medical diagnosis or therapy, to exposure from individuals administered radioactive material and released in accordance with this chapter, or to voluntary participation in medical research programs. However, no radiation may be deliberately applied to human beings except by or under the supervision of an individual authorized by and licensed in accordance with Texas' statutes to engage in the healing arts.

(2) Licensees who are also registered by the agency to receive, possess, use, and transfer radiation machines must also comply with the requirements of §289.231 of this title (relating to General Provisions and Standards for Protection Against Machine-Produced Radiation).

(c) Definitions. The following words and terms when used in this section shall have the following meaning, unless the context clearly indicates otherwise.

(1) Annual limit on intake (ALI)--The derived limit for the amount of radioactive material taken into the body of an adult worker by inhalation or ingestion in a year. ALI is the smaller value of intake of a given radionuclide in a year by Reference Man that would result in a committed effective dose equivalent of 5 rems (0.05 sievert (Sv)) or a committed dose equivalent of 50 rems (0.5 Sv) to any individual organ or tissue. ALI values for intake by ingestion and by inhalation of selected radionuclides are given in Columns 1 and 2 of Table I of subsection (ggg)(2) of this section.

(2) Class--A classification scheme for inhaled material according to its rate of clearance from the pulmonary region of the lung. Materials are classified as D, W, or Y, which apply to a range of clearance half-times: for Class D, Days, of less than 10 days; for Class W, Weeks, from 10 to 100 days, and for Class Y, Years, of greater than 100 days. For purposes of this section, lung class and inhalation class are equivalent terms.

(3) Declared pregnant woman--A woman who has voluntarily informed the licensee, in writing, of her pregnancy and the estimated date of conception. The declaration remains in effect until the declared pregnant woman voluntarily withdraws the declaration in writing or is no longer pregnant.

(4) Derived air concentration (DAC)--The concentration of a given radionuclide in air that, if breathed by Reference Man for a working year of 2,000 hours under conditions of light work, results in an intake of 1 ALI. For purposes of this section, the condition of light work is an inhalation rate of 1.2 cubic meters of air per hour for 2,000 hours in a year. DAC values are given in Column 3 of Table I of subsection (ggg)(2) of this section.

(5) Derived air concentration-hour (DAC-hour)--The product of the concentration of radioactive material in air, expressed as a fraction or multiple of the derived air concentration for each radionuclide, and the time of exposure to that radionuclide, in hours. A licensee may take 2,000 DAC-hours to represent ALI, equivalent to a committed effective dose equivalent of 5 rems (0.05 Sv).

(6) Dosimetry processor--A registrant that processes and evaluates personnel monitoring devices in order to determine the radiation dose delivered to the monitoring devices.

(7) Inhalation class (see definition for Class).

(8) Lung class (see definition for Class).

(9) Nonstochastic effect--A health effect, the severity of which varies with the dose and for which a threshold is believed to exist. Radiation-induced cataract formation is an example of a nonstochastic effect. For purposes of this section, deterministic effect is an equivalent term.

(10) Planned special exposure--An infrequent exposure to radiation, separate from and in addition to the annual occupational dose limits.

(11) Quarter--A period of time equal to one-fourth of the year observed by the licensee, approximately 13 consecutive weeks, providing that the beginning of the first quarter in a year coincides with the starting date of the year and that no day is omitted or duplicated in consecutive quarters.

(12) Reference man--A hypothetical aggregation of human physical and physiological characteristics determined by international consensus. These characteristics may be used by esearchers and public health employees to standardize results of experiments and to relatebiological insult to a common base. A description of Reference Man is contained in the International Commission on Radiological Protection report, ICRP Publication 23, "Report of the Task Group on Reference Man."

(13) Respiratory protective equipment--An apparatus, such as a respirator, used to reduce an individual's intake of airborne radioactive materials.

(14) Sanitary sewerage--A system of public sewers for carrying off waste water and refuse, but excluding sewage treatment facilities, septic tanks, and leach fields owned or operated by the licensee or registrant.

(15) Stochastic effect--A health effect that occurs randomly and for which the probability of the effect occurring, rather than its severity, is assumed to be a linear function of dose without threshold. Hereditary effects and cancer incidence are examples of stochastic effects. For purposes of this section probabilistic effect is an equivalent term.

(16) Weighting factor wT for an organ or tissue (T)--The proportion of the risk of stochastic effects resulting from irradiation of that organ or tissue to the total risk of stochastic effects when the whole body is irradiated uniformly. For calculating the effective dose equivalent, the values of wT are:

Figure: 25 TAC §289.202(c)(16) (No change.)

(d) Implementation.

(1) Any existing license condition that is more restrictive than this section remains in force until there is an amendment or renewal of the license that modifies or removes this condition.

(2) If a license condition exempts a licensee from a provision of this section in effect on or before January 1, 1994, it also exempts the licensee from the corresponding provision of this section.

(3) If a license condition cites provisions of this section in effect prior to January 1, 1994, that do not correspond to any provisions of this section, the license condition remains in force until there is an amendment or renewal of the license that modifies or removes this condition.

(e) Radiation protection programs.

(1) Each licensee shall develop, document, and implement a radiation protection program sufficient to ensure compliance with the provisions of this section. See subsection (mm) of this section for recordkeeping requirements relating to these programs. Documentation of the radiation protection program may be incorporated in the licensee's operating, safety, and emergency procedures.

(2) The licensee shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).

(3) The licensee shall, at intervals not to exceed 12 months, ensure the radiation protection program content and implementation is reviewed.

(4) To implement the ALARA requirement in paragraph (2) of this subsection and notwithstanding the requirements in subsection (n) of this section, a constraint on air emissions of radioactive material to the environment, excluding radon-222 and its daughters, shall be established by licensees such that the individual member of the public likely to receive the highest dose will not be expected to receive a total effective dose equivalent in excess of 10 millirems (mrem) (0.1 mSv) per year from these emissions. If a licensee subject to this requirement exceeds this dose constraint, the licensee shall report the exceedance as required in subsection (yy) of this section and promptly take appropriate corrective action.

(f) Occupational dose limits for adults.

(1) The licensee shall control the occupational dose to individuals, except for planned special exposures in accordance with subsection (k) of this section, to the following dose limits.

(A) An annual limit shall be the more limiting of:

(i) the total effective dose equivalent being equal to 5 rems (0.05 Sv); or

(ii) the sum of the deep dose equivalent and the committed dose equivalent to any individual organ or tissue other than the lens of the eye being equal to 50 rems (0.5 Sv).

(B) The annual limits to the lens of the eye, to the skin, and to the extremities shall be:

(i) a lens dose equivalent of 15 rems (0.15 Sv); and

(ii) a shallow dose equivalent of 50 rems (0.5 Sv) to the skin or to any extremity.

(2) Doses received in excess of the annual limits, including doses received during accidents, emergencies, and planned special exposures, shall be subtracted from the limits for planned special exposures that the individual may receive during the current year and during the individual's lifetime. See subsection (k)(6)(A) and (B) of this section.

(3) The assigned deep dose equivalent and shallow dose equivalent shall be for the portion of the body receiving the highest exposure.

(4) The deep dose equivalent, lens dose equivalent and shallow dose equivalent may be assessed from surveys, calculations, or radiation measurements for the purpose of demonstrating compliance with the occupational dose limits, if the individual monitoring device was not in the region of highest potential exposure, or the results of individual monitoring are unavailable.

(5) Derived air concentration (DAC) and annual limit on intake (ALI) values are specified in Table I of subsection (ggg)(2) of this section and may be used to determine the individual's dose and to demonstrate compliance with the occupational dose limits. See subsection (rr) of this section.

(6) Notwithstanding the annual dose limits, the licensee shall limit the soluble uranium intake by an individual to 10 milligrams (mg) in a week in consideration of chemical toxicity. See footnote 3 of subsection (ggg)(2) of this section.

(7) The licensee shall reduce the dose that an individual may be allowed to receive in the current year by the amount of occupational dose received while employed by any other person. See subsection (j)(4) of this section.

(g) Compliance with requirements for summation of external and internal doses.

(1) If the licensee is required to monitor in accordance with both subsection (q)(1) and (3) of this section, the licensee shall demonstrate compliance with the dose limits by summing external and internal doses. If the licensee is required to monitor only in accordance with subsection (q)(1) of this section or only in accordance with subsection (q)(3) of this section, then summation is not required to demonstrate compliance with the dose limits. The licensee may demonstrate compliance with the requirements for summation of external and internal doses in accordance with paragraphs (2)-(4) of this subsection. The dose equivalents for the lens of the eye, the skin, and the extremities are not included in the summation, but are subject to separate limits.

(2) If the only intake of radionuclides is by inhalation, the total effective dose equivalent limit is not exceeded if the sum of the deep dose equivalent divided by the total effective dose equivalent limit, and one of the following, does not exceed unity:

(A) the sum of the fractions of the inhalation ALI for each radionuclide; or

(B) the total number of derived air concentration-hours (DAC-hours) for all radionuclides divided by 2,000; or

(C) the sum of the calculated committed effective dose equivalents to all significantly irradiated organs or tissues (T) calculated from bioassay data using appropriate biological models and expressed as a fraction of the annual limit. For purposes of this requirement, an organ or tissue is deemed to be significantly irradiated if, for that organ or tissue, the product of the weighting factors, wT, and the committed dose equivalent, H T,50, per unit intake is greater than 10% of the maximum weighted value of HT,50, that is, wT HT,50, per unit intake for any organ or tissue.

(3) If the occupationally exposed individual receives an intake of radionuclides by oral ingestion greater than 10% of the applicable oral ALI, the licensee shall account for this intake and include it in demonstrating compliance with the limits.

(4) The licensee shall evaluate and, to the extent practical, account for intakes through wounds or skin absorption. The intake through intact skin has been included in the calculation of DAC for hydrogen-3 and does not need to be evaluated or accounted for in accordance with this paragraph.

(h) Determination of external dose from airborne radioactive material.

(1) Licensees shall, when determining the dose from airborne radioactive material, include the contribution to the deep dose equivalent, eye dose equivalent, and shallow dose equivalent from external exposure to the radioactive cloud. See footnotes 1 and 2 of subsection (ggg)(2) of this section.

(2) Airborne radioactivity measurements and DAC values shall not be used as the primary means to assess the deep dose equivalent when the airborne radioactive material includes radionuclides other than noble gases or if the cloud of airborne radioactive material is not relatively uniform. The determination of the deep dose equivalent to an individual shall be based upon measurements using instruments or individual monitoring devices.

(i) Determination of internal exposure.

(1) For purposes of assessing dose used to determine compliance with occupational dose equivalent limits, the licensee shall, when required in accordance with subsection (q) of this section, take suitable and timely measurements of:

(A) concentrations of radioactive materials in air in work areas;

(B) quantities of radionuclides in the body;

(C) quantities of radionuclides excreted from the body; or

(D) combinations of these measurements.

(2) Unless respiratory protective equipment is used, as provided in subsection (x) of this section, or the assessment of intake is based on bioassays, the licensee shall assume that an individual inhales radioactive material at the airborne concentration in which the individual is present.

(3) When specific information on the physical and biochemical properties of the radionuclides taken into the body or the behavior of the material in an individual is known, the licensee may:

(A) use that information to calculate the committed effective dose equivalent, and, if used, the licensee shall document that information in the individual's record;

(B) upon prior approval of the agency, adjust the DAC or ALI values to reflect the actual physical and chemical characteristics of airborne radioactive material, for example, aerosol size distribution or density; and

(C) separately assess the contribution of fractional intakes of Class D, W, or Y compounds of a given radionuclide to the committed effective dose equivalent. See subsection (ggg)(2) of this section.

(4) If the licensee chooses to assess intakes of Class Y material using the measurements given in paragraph (1)(A) or (B) of this subsection, the licensee may delay the recording and reporting of the assessments for periods up to seven months, unless otherwise required by subsections (xx) or (yy) of this section. This delay permits the licensee to make additional measurements basic to the assessments.

(5) If the identity and concentration of each radionuclide in a mixture are known, the fraction of the DAC applicable to the mixture for use in calculating DAC-hours shall be either:

(A) the sum of the ratios of the concentration to the appropriate DAC value, that is, D, W, or Y, from subsection (ggg)(2) of this section for each radionuclide in the mixture; or

(B) the ratio of the total concentration for all radionuclides in the mixture to the most restrictive DAC value for any radionuclide in the mixture.

(6) If the identity of each radionuclide in a mixture is known, but the concentration of one or more of the radionuclides in the mixture is not known, the DAC for the mixture shall be the most restrictive DAC of any radionuclide in the mixture.

(7) When a mixture of radionuclides in air exists, a licensee may disregard certain radionuclides in the mixture if:

(A) the licensee uses the total activity of the mixture in demonstrating compliance with the dose limits in subsection (f) of this section and in complying with the monitoring requirements in subsection (q)(3) of this section;

(B) the concentration of any radionuclide disregarded is less than 10% of its DAC; and

(C) the sum of these percentages for all of the radionuclides disregarded in the mixture does not exceed 30%.

(8) When determining the committed effective dose equivalent, the following information may be considered.

(A) In order to calculate the committed effective dose equivalent, the licensee may assume that the inhalation of 1 ALI, or an exposure of 2,000 DAC-hours, results in a committed effective dose equivalent of 5 rems (0.05 Sv) for radionuclides that have their ALIs or DACs based on the committed effective dose equivalent.

(B) For an ALI and the associated DAC determined by the nonstochastic organ dose limit of 50 rems (0.5 Sv), the intake of radionuclides that would result in a committed effective dose equivalent of 5 rems (0.05 Sv), that is, the stochastic ALI, is listed in parentheses in Table I of subsection (ggg)(2) of this section. The licensee may, as a simplifying assumption, use the stochastic ALI to determine committed effective dose equivalent. However, if the licensee uses the stochastic ALI, the licensee shall also demonstrate that the limit in subsection (f)(1)(A)(ii) of this section is met.

(j) Determination of occupational dose for the current year.

(1) For each individual who is likely to receive, in a year, an occupational dose requiring monitoring in accordance with subsection (q) of this section, the licensee shall determine the occupational radiation dose received during the current year.

(2) In complying with the requirements of paragraph (1) of this subsection, a licensee may:

(A) accept, as a record of the occupational dose that the individual received during the current year, BRC Form 202-2 from prior or other current employers, or other clear and legible record, of all information required on that form and indicating any periods of time for which data are not available; or

(B) accept, as a record of the occupational dose that the individual received during the current year, a written signed statement from the individual, or from the individual's prior or other current employer(s) for work involving radiation exposure, that discloses the nature and the amount of any occupational dose that the individual received during the current year; or

(C) obtain reports of the individual's dose equivalent from prior or other current employer(s) for work involving radiation exposure, or the individual's current employer, if the individual is not employed by the licensee, by telephone, telegram, facsimile, or letter. The licensee shall request a written verification of the dose data if the authenticity of the transmitted report cannot be established.

(3) The licensee shall record the exposure data for the current year, as required by paragraph (1) of this subsection, on BRC Form 202-3, or other clear and legible record, of all the information required on that form.

(4) If the licensee is unable to obtain a complete record of an individual's current occupational dose while employed by any other licensee, the licensee shall assume in establishing administrative controls in accordance with subsection (f)(8) of this section for the current year, that the allowable dose limit for the individual is reduced by 1.25 rems (12.5 millisieverts (mSv)) for each quarter; or 416 mrem (4.16 mSv) for each month for which records were unavailable and the individual was engaged in activities that could have resulted in occupational radiation exposure.

(5) If an individual has incomplete (e.g., a lost or damaged personnel monitoring device) current occupational dose data for the current year and that individual is employed solely by the licensee during the current year, the licensee shall:

(A) assume that the allowable dose limit for the individual is reduced by 1.25 rems (12.5 mSv) for each quarter;

(B) assume that the allowable dose limit for the individual is reduced by 416 mrem (4.16 mSv) for each month; or

(C) assess an occupational dose for the individual during the period of missing data using surveys, radiation measurements, or other comparable data for the purpose of demonstrating compliance with the occupational dose limits.

(6) Administrative controls established in accordance with paragraph (4) of this subsection shall be documented and maintained for inspection by the agency. Occupational dose assessments made in accordance with paragraph (5) of this subsection and records of data used to make the assessment shall be maintained for inspection by the agency. The licensee shall retain the records in accordance with subsection (rr) of this section.

(k) Planned special exposures. A licensee may authorize an adult worker to receive doses in addition to and accounted for separately from the doses received under the limits specified in subsection (f) of this section provided that each of the following conditions is satisfied.

(1) The licensee authorizes a planned special exposure only in an exceptional situation when alternatives that might avoid the doses estimated to result from the planned special exposure are unavailable or impractical.

(2) The licensee and employer, if the employer is not the licensee, specifically authorizes the planned special exposure, in writing, before the exposure occurs.

(3) Before a planned special exposure, the licensee ensures that each individual involved is:

(A) informed of the purpose of the planned operation;

(B) informed of the estimated doses and associated potential risks and specific radiation levels or other conditions that might be involved in performing the task; and

(C) instructed in the measures to be taken to keep the dose ALARA considering other risks that may be present.

(4) Prior to permitting an individual to participate in a planned special exposure, the licensee shall determine:

(A) the internal and external doses from all previous planned special exposures;

(B) all doses in excess of the limits, including doses received during accidents and emergencies, received during the lifetime of the individual; and

(C) all lifetime cumulative occupational radiation doses.

(5) In complying with the requirements of paragraph (4)(C) of this subsection, a licensee may:

(A) accept, as the record of lifetime cumulative radiation dose, an up-to-date BRC Form 202-2 or equivalent, signed by the individual and countersigned by an appropriate official of the most recent employer for work involving radiation exposure, or the individual's current employer, if the individual is not employed by the licensee; and

(B) obtain reports of the individual's dose equivalent from prior employer(s) for work involving radiation exposure, or the individual's current employer, if the individual is not employed by the licensee, by telephone, telegram, facsimile, or letter. The licensee shall request a written verification of the dose data if the authenticity of the transmitted report cannot be established.

(6) Subject to subsection (f)(2) of this section, the licensee shall not authorize a planned special exposure that would cause an individual to receive a dose from all planned special exposures and all doses in excess of the limits to exceed:

(A) the numerical values of any of the dose limits in subsection (f)(1) of this section in any year; and

(B) five times the annual dose limits in subsection (f)(1) of this section during the individual's lifetime.

(7) The licensee maintains records of the conduct of a planned special exposure in accordance with subsection (qq) of this section and submits a written report to the agency in accordance with subsection (zz) of this section.

(8) The licensee records the best estimate of the dose resulting from the planned special exposure in the individual's record and informs the individual, in writing, of the dose within 30 days from the date of the planned special exposure. The dose from planned special exposures shall not be considered in controlling future occupational dose of the individual in accordance with subsection (f)(1) of this section but shall be included in evaluations required by paragraphs (4) and (6) of this subsection.

(9) The licensee shall record the exposure history, as required by paragraph (4) of this subsection, on BRC Form 202-2, or other clear and legible record, of all the information required on that form. The form or record shall show each period in which the individual received occupational exposure to radiation or radioactive material and shall be signed by the individual who received the exposure. For each period for which the licensee obtains reports, the licensee shall use the dose shown in the report in preparing BRC Form 202-2 or equivalent.

(l) Occupational dose limits for minors. The annual occupational dose limits for minors are 10% of the annual occupational dose limits specified for adult workers in subsection (f) of this section.

(m) Dose equivalent to an embryo/fetus.

(1) If a woman declares her pregnancy, the licensee shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv). If a woman chooses not to declare pregnancy, the occupational dose limits specified in subsection (f)(1) of this section are applicable to the woman. See subsection (rr) of this section for recordkeeping requirements.

(2) The licensee shall make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman so as to satisfy the limit in paragraph (1) of this subsection. The National Council on Radiation Protection and Measurements recommended in NCRP Report No. 91 "Recommendations on Limits for Exposure to Ionizing Radiation" (June 1, 1987) that no more than 0.05 rem (0.5 mSv) to the embryo/fetus be received in any one month.

(3) The dose equivalent to an embryo/fetus shall be taken as:

(A) the dose equivalent to the embryo/fetus from radionuclides in the embryo/fetus and radionuclides in the declared pregnant woman; and

(B) the dose equivalent that is most representative of the dose equivalent to the embryo/fetus from external radiation, that is, in the mother's lower torso region.

(i) If multiple measurements have not been made, assignment of the highest deep dose equivalent for the declared pregnant woman shall be the dose equivalent to the embryo/fetus.

(ii) If multiple measurements have been made, assignment of the deep dose equivalent for the declared pregnant woman from the individual monitoring device that is most representative of the dose equivalent to the embryo/fetus shall be the dose equivalent to the embryo/fetus. Assignment of the highest deep dose equivalent for the declared pregnant woman to the embryo/fetus is not required unless that dose equivalent is also the most representative deep dose equivalent for the region of the embryo/fetus.

(4) If by the time the woman declares pregnancy to the licensee, the dose equivalent to the embryo/fetus has exceeded 0.45 rem (4.5 mSv), the licensee shall be deemed to be in compliance with paragraph (1) of this subsection, if the additional dose equivalent to the embryo/fetus does not exceed 0.05 rem (0.5 mSv) during the remainder of the pregnancy.

(n) Dose limits for individual members of the public.

(1) Each licensee shall conduct operations so that:

(A) except as provided in subparagraph (B) of this paragraph, the total effective dose equivalent to individual members of the public from the licensed and/or registered operation does not exceed 0.1 rem (1 mSv) in a year, exclusive of the dose contribution from background radiation, from any medical administration the individual has received, from exposure to individuals administered radioactive material and released in accordance with this chapter, from voluntary participation in medical research programs, and from the licensee's disposal of radioactive material into sanitary sewerage in accordance with subsection (gg) of this section; and

(B) the dose in any unrestricted area from licensed and/or registered external sources, exclusive of the dose contributions from patients administered radioactive material and released in accordance with this chapter, does not exceed 0.002 rem (0.02 mSv) in any one hour.

(2) If the licensee permits members of the public to have access to restricted areas, the limits for members of the public continue to apply to those individuals.

(3) A licensee or an applicant for a license may apply for prior agency authorization to operate up to an annual dose limit for an individual member of the public of 0.5 rem (5 mSv). This application shall include the following information:

(A) demonstration of the need for and the expected duration of operations in excess of the limit in paragraph (1) of this subsection;

(B) the licensee's program to assess and control dose within the 0.5 rem (5 mSv) annual limit; and

(C) the procedures to be followed to maintain the dose ALARA.

(4) In addition to the requirements of this section, a licensee subject to the provisions of the United States Environmental Protection Agency's (EPA) generally applicable environmental radiation standards in 40 Code of Federal Regulations (CFR), §190 shall comply with those requirements.

(5) The agency may impose additional restrictions on radiation levels in unrestricted areas and on the total quantity of radionuclides that a licensee may release in effluents in order to restrict the collective dose.

(o) Compliance with dose limits for individual members of the public.

(1) The licensee shall make or cause to be made surveys of radiation levels in unrestricted areas and radioactive materials in effluents released to unrestricted areas to demonstrate compliance with the dose limits for individual members of the public as required in subsection (n) of this section.

(2) A licensee shall show compliance with the annual dose limit in subsection (n) of this section by:

(A) demonstrating by measurement or calculation that the total effective dose equivalent to the individual likely to receive the highest dose from the licensed or registered operation does not exceed the annual dose limit; or

(B) demonstrating that:

(i) the annual average concentrations of radioactive material released in gaseous and liquid effluents at the boundary of the unrestricted area do not exceed the values specified in Table II of subsection (ggg)(2) of this section; and

(ii) if an individual were continuously present in an unrestricted area, the dose from external sources of radiation would not exceed 0.002 rem (0.02 mSv) in an hour and 0.05 rem (0.5 mSv) in a year.

(3) Upon approval from the agency, the licensee may adjust the effluent concentration values in Table II, of subsection (ggg)(2) of this section, for members of the public, to take into account the actual physical and chemical characteristics of the effluents, such as, aerosol size distribution, solubility, density, radioactive decay equilibrium, and chemical form.

(p) General surveys and monitoring.

(1) Each licensee shall make, or cause to be made, surveys that:

(A) are necessary for the licensee to comply with this section; and

(B) are necessary under the circumstances to evaluate:

(i) the magnitude and extent of radiation levels;

(ii) concentrations or quantities of radioactive material; and

(iii) the potential radiological hazards.

(2) The licensee shall ensure that instruments and equipment used for quantitative radiation measurements, for example, dose rate and effluent monitoring, are operable and calibrated:

(A) by a person licensed or registered by the agency, another agreement state, a licensing state, or the United States Nuclear Regulatory Commission (NRC) to perform such service;

(B) at intervals not to exceed 12 months unless a different time interval is specified in another section of this chapter;

(C) after each instrument or equipment repair;

(D) for the types of radiation used and at energies appropriate for use; and

(E) at an accuracy within 20% of the true radiation level.

(3) All individual monitoring devices, except for direct and indirect reading pocket dosimeters, electronic personal dosimeters, and those individual monitoring devices used to measure the dose to any extremity, that require processing to determine the radiation dose and that are used by licensees to comply with subsection (f) of this section, with other applicable provisions of this chapter, or with conditions specified in a license, shall be processed and evaluated by a dosimetry processor:

(A) holding current personnel dosimetry accreditation from the National Voluntary Laboratory Accreditation Program (NVLAP) of the National Institute of Standards and Technology;

(B) approved in this accreditation process for the type of radiation or radiations included in the NVLAP program that most closely approximates the type of radiation or radiations for which the individual wearing the dosimeter is monitored; and

(C) holding a current certificate of registration from the agency authorizing dosimetry processing.

(q) Conditions requiring individual monitoring of external and internal occupational dose. Each licensee shall monitor exposures from sources of radiation at levels sufficient to demonstrate compliance with the occupational dose limits of this section. As a minimum:

(1) each licensee shall monitor occupational exposure to radiation and shall supply and require the use of individual monitoring devices by:

(A) adults likely to receive, in one year from sources external to the body, a dose in excess of 10% of the limits in subsection (f)(1) of this section;

(B) minors likely to receive, in one year from sources of radiation external to the body, a deep dose equivalent in excess of 0.1 rem (1 mSv), a lens dose equivalent in excess of 0.15 rem (1.5 mSv), or a shallow dose equivalent to the skin or to the extremities in excess of 0.5 rem (5 mSv);

(C) declared pregnant women likely to receive during the entire pregnancy, from sources of radiation external to the body, a deep dose equivalent in excess of 0.1 rem (1 mSv); and

(D) individuals entering a high or very high radiation area;

(2) notwithstanding paragraph (1)(C) of this subsection, a licensee is exempt from supplying individual monitoring devices to healthcare personnel who may enter a high radiation area while providing patient care if:

(A) the personnel are not likely to receive, in one year from sources external to the body, a dose in excess of 10% of the limits in subsection (f)(1) of this section; and

(B) the licensee complies with the requirements of subsection (e)(2) of this section; and

(3) each licensee shall monitor, to determine compliance with subsection (i) of this section, the occupational intake of radioactive material by and assess the committed effective dose equivalent to:

(A) adults likely to receive, in one year, an intake in excess of 10% of the applicable ALI in Columns 1 and 2 of Table I of subsection (ggg)(2) of this section;

(B) minors likely to receive, in one year, a committed effective dose equivalent in excess of 0.1 rem (1 mSv); and

(C) declared pregnant women likely to receive, during the entire pregnancy, a committed effective dose equivalent in excess of 0.1 rem (1 mSv).

(r) Location and use of individual monitoring devices.

(1) Each licensee shall ensure that individuals who are required to monitor occupational doses in accordance with subsection (q)(l) of this section wear and use individual monitoring devices as follows.

(A) An individual monitoring device used for monitoring the dose to the whole body shall be worn at the unshielded location of the whole body likely to receive the highest exposure. When a protective apron is worn, the location of the individual monitoring device is typically at the neck (collar).

(B) If an additional individual monitoring device is used for monitoring the dose to an embryo/fetus of a declared pregnant woman, in accordance with subsection (m)(1) of this section, it shall be located at the waist under any protective apron being worn by the woman.

(C) An individual monitoring device used for monitoring the lens dose equivalent, to demonstrate compliance with subsection (f)(1)(B)(i) of this section, shall be located at the neck (collar) or at a location closer to the eye, outside any protective apron being worn by the monitored individual.

(D) An individual monitoring device used for monitoring the dose to the extremities, to demonstrate compliance with subsection (f)(1)(B)(ii) of this section, shall be worn on the extremity likely to receive the highest exposure. Each individual monitoring device, to the extent practicable, shall be oriented to measure the highest dose to the extremity being monitored.

(E) An individual monitoring device shall be assigned to and worn by only one individual.

(F) An individual monitoring device shall be worn for the period of time authorized by the dosimetry processor's certificate of registration or for no longer than three months, whichever is more restrictive.

(2) Each licensee shall ensure that individual monitoring devices are returned to the dosimetry processor for proper processing.

(3) Each licensee shall ensure that adequate precautions are taken to prevent a deceptive exposure of an individual monitoring device.

(s) Control of access to high radiation areas.

(1) The licensee shall ensure that each entrance or access point to a high radiation area has one or more of the following features:

(A) a control device that, upon entry into the area, causes the level of radiation to be reduced below that level at which an individual might receive a deep dose equivalent of 0.1 rem (1 mSv) in one hour at 30 centimeters (cm) from the source of radiation from any surface that the radiation penetrates;

(B) a control device that energizes a conspicuous visible or audible alarm signal so that the individual entering the high radiation area and the supervisor of the activity are made aware of the entry; or

(C) entryways that are locked, except during periods when access to the areas is required, with positive control over each individual entry.

(2) In place of the controls required by paragraph (1) of this subsection for a high radiation area, the licensee may substitute continuous direct or electronic surveillance that is capable of preventing unauthorized entry.

(3) The licensee may apply to the agency for approval of alternative methods for controlling access to high radiation areas.

(4) The licensee shall establish the controls required by paragraphs (1) and (3) of this subsection in a way that does not prevent individuals from leaving a high radiation area.

(5) The licensee is not required to control each entrance or access point to a room or other area that is a high radiation area solely because of the presence of radioactive materials prepared for transport and packaged and labeled in accordance with the regulations of the United States Department of Transportation (DOT) provided that:

(A) the packages do not remain in the area longer than three days; and

(B) the dose rate at 1 meter from the external surface of any package does not exceed 0.01 rem (0.1 millisievert) per hour.

(6) The licensee is not required to control entrance or access to rooms or other areas in hospitals solely because of the presence of patients containing radioactive material, provided that there are personnel in attendance who are taking the necessary precautions to prevent the exposure of individuals to sources of radiation in excess of the established limits in this section and to operate within the ALARA provisions of the licensee's radiation protection program.

(t) Control of access to very high radiation areas. In addition to the requirements in subsection (s) of this section, the licensee shall institute measures to ensure that an individual is not able to gain unauthorized or inadvertent access to areas in which radiation levels could be encountered at 500 rads (5 grays) or more in one hour at 1 m from a source of radiation or any surface through which the radiation penetrates at this level.

(u) Control of access to very high radiation areas for irradiators.

(1) This subsection applies to licensees with sources of radiation in non-self-shielded irradiators. This subsection does not apply to sources of radiation that are used in teletherapy, in industrial radiography, or in completely self-shielded irradiators in which the source of radiation is both stored and operated within the same shielding radiation barrier and, in the designed configuration of the irradiator, is always physically inaccessible to any individual and cannot create high levels of radiation in an area that is accessible to any individual.

(2) Each area in which there may exist radiation levels in excess of 500 rads (5 grays) in one hour at 1 m from a source of radiation that is used to irradiate materials shall meet the following requirements.

(A) Each entrance or access point shall be equipped with entry control devices that:

(i) function automatically to prevent any individual from inadvertently entering a very high radiation area;

(ii) permit deliberate entry into the area only after a control device is actuated that causes the radiation level within the area, from the source of radiation, to be reduced below that at which it would be possible for an individual to receive a deep dose equivalent in excess of 0.1 rem (1 mSv) in one hour; and

(iii) prevent operation of the source of radiation if it would produce radiation levels in the area that could result in a deep dose equivalent to an individual in excess of 0.1 rem (1 mSv) in one hour.

(B) Additional control devices shall be provided so that, upon failure of the entry control devices to function as required by subparagraph (A) of this paragraph:

(i) the radiation level within the area, from the source of radiation, is reduced below that at which it would be possible for an individual to receive a deep dose equivalent in excess of 0.1 rem (1 mSv) in one hour; and

(ii) conspicuous visible and audible alarm signals are generated to make an individual attempting to enter the area aware of the hazard and at least one other authorized individual, who is physically present, familiar with the activity, and prepared to render or summon assistance, aware of the failure of the entry control devices.

(C) The licensee shall provide control devices so that, upon failure or removal of physical radiation barriers other than the sealed source's shielded storage container:

(i) the radiation level from the source of radiation is reduced below that at which it would be possible for an individual to receive a deep dose equivalent in excess of 0.1 rem (1 mSv) in one hour; and

(ii) conspicuous visible and audible alarm signals are generated to make potentially affected individuals aware of the hazard and the licensee or at least one other individual, who is familiar with the activity and prepared to render or summon assistance, aware of the failure or removal of the physical barrier.

(D) When the shield for stored sealed sources is a liquid, the licensee shall provide means to monitor the integrity of the shield and to signal, automatically, loss of adequate shielding.

(E) Physical radiation barriers that comprise permanent structural components, such as walls, that have no credible probability of failure or removal in ordinary circumstances, need not meet the requirements of subparagraphs (C) and (D) of this paragraph.

(F) Each area shall be equipped with devices that will automatically generate conspicuous visible and audible alarm signals to alert personnel in the area before the source of radiation can be put into operation and in time for any individual in the area to operate a clearly identified control device, which must be installed in the area and which can prevent the source of radiation from being put into operation.

(G) Each area shall be controlled by use of such administrative procedures and such devices as are necessary to ensure that the area is cleared of personnel prior to each use of the source of radiation.

(H) Each area shall be checked by a radiation measurement to ensure that, prior to the first individual's entry into the area after any use of the source of radiation, the radiation level from the source of radiation in the area is below that at which it would be possible for an individual to receive a deep dose equivalent in excess of 0.1 rem (1 mSv) in one hour.

(I) The entry control devices required in subparagraph (A) of this paragraph shall be tested for proper functioning. See subsection (uu) of this section for recordkeeping requirements.

(i) Testing shall be conducted prior to initial operation with the source of radiation on any day, unless operations were continued uninterrupted from the previous day.

(ii) Testing shall be conducted prior to resumption of operation of the source of radiation after any unintentional interruption.

(iii) The licensee shall submit and adhere to a schedule for periodic tests of the entry control and warning systems.

(J) The licensee shall not conduct operations, other than those necessary to place the source of radiation in safe condition or to effect repairs on controls, unless control devices are functioning properly.

(K) Entry and exit portals that are used in transporting materials to and from the irradiation area, and that are not intended for use by individuals, shall be controlled by such devices and administrative procedures as are necessary to physically protect and warn against inadvertent entry by any individual through these portals. Exit portals for irradiated materials shall be equipped to detect and signal the presence of any loose radioactive material that is carried toward such an exit and automatically to prevent loose radioactive material from being carried out of the area.

(3) Licensees or applicants for licenses for sources of radiation within the purview of paragraph (2) of this subsection that will be used in a variety of positions or in locations, such as open fields or forests, which make it impracticable to comply with certain requirements of paragraph (2) of this subsection, such as those for the automatic control of radiation levels, may apply to the Agency for approval of alternative safety measures. Alternative safety measures shall provide personnel protection at least equivalent to those specified in paragraph (2) of this subsection. At least one of the alternative measures shall include an entry-preventing interlock control based on a measurement of the radiation that ensures the absence of high radiation levels before an individual can gain access to the area where such sources of radiation are used.

(4) The entry control devices required by paragraphs (2) and (3) of this subsection shall be established in such a way that no individual will be prevented from leaving the area.

(v) Use of process or other engineering controls. The licensee shall use, to the extent practicable, process or other engineering controls, such as containment or ventilation, to control the concentrations of radioactive material in air.

(w) Use of other controls. When it is not practicable to apply process or other engineering controls to control the concentrations of radioactive material in air to values below those that define an airborne radioactivity area, the licensee shall, consistent with maintaining the total effective dose equivalent ALARA, increase monitoring and limit intakes by one or more of the following means:

(1) control of access;

(2) limitation of exposure times;

(3) use of respiratory protection equipment; or

(4) other controls.

(x) Use of individual respiratory protection equipment.

(1) If the licensee uses respiratory protection equipment to limit intakes in accordance with subsection (w) of this section.

(A) Except as provided in subparagraph (B) of this paragraph, the licensee shall use only respiratory protection equipment that is tested and certified or had certification extended by the National Institute for Occupational Safety and Health (NIOSH) and the Mine Safety and Health Administration (MSHA).

(B) If the licensee wishes to use equipment that has not been tested or certified by the NIOSH and the MSHA, or has not had certification extended by the NIOSH and the MSHA, or for which there is no schedule for testing or certification, the licensee shall submit an application for authorized use of that equipment, including a demonstration by testing, or a demonstration on the basis of test information, that the material and performance characteristics of the equipment are capable of providing the proposed degree of protection under anticipated conditions of use.

(C) The licensee shall implement and maintain a respiratory protection program that includes:

(i) air sampling sufficient to identify the potential hazard, permit proper equipment selection, and estimate exposures;

(ii) surveys and bioassays, as appropriate, to evaluate actual intakes;

(iii) testing of respirators for operability immediately prior to each use;

(iv) written procedures regarding selection, fitting, issuance, maintenance, and testing of respirators, including testing for operability immediately prior to each use; supervision and training of personnel; monitoring, including air sampling and bioassays; and recordkeeping; and

(v) determination by a physician prior to initial fitting of respirators, and either every 12 months thereafter or periodically at a frequency determined by a physician, that the individual user is physically able to use the respiratory protection equipment.

(D) The licensee shall issue a written policy statement on respirator usage covering:

(i) the use of process or other engineering controls, instead of respirators;

(ii) the routine, nonroutine, and emergency use of respirators; and

(iii) the length of periods of respirator use and relief from respirator use.

(E) The licensee shall advise each respirator user that the user may leave the area at any time for relief from respirator use in the event of equipment malfunction, physical or psychological distress, procedural or communication failure, significant deterioration of operating conditions, or any other conditions that might require such relief.

(F) The licensee shall use respiratory protection equipment within the equipment manufacturer's expressed limitations for type and mode of use and shall provide proper visual, communication, and other special capabilities, such as adequate skin protection, when needed.

(2) When estimating exposure of individuals to airborne radioactive materials, the licensee may make allowance for respiratory protection equipment used to limit intakes in accordance with subsection (w) of this section, provided that the following conditions, in addition to those in paragraph (1) of this subsection, are satisfied.

(A) The licensee selects respiratory protection equipment that provides a protection factor, asspecified in subsection (ggg)(1) of this section, greater than the multiple by which peak concentrations of airborne radioactive materials in the working area are expected to exceed the values specified in Column 3 of Table I of subsection (ggg)(2) of this section. However, if the election of respiratory protection equipment with a protection factor greater than the peak concentration is inconsistent with the goal specified in subsection (w) of this section of keeping the total effective dose equivalent ALARA, the licensee may select respiratory protection equipment with a lower protection factor provided that such a selection would result in a total effective dose equivalent that is ALARA. The concentration of radioactive material in the air that is inhaled when respirators are worn may be initially estimated by dividing the average concentration in air, during each period of uninterrupted use, by the protection factor. If the exposure is later found to be greater than initially estimated, the corrected value shall be used; if the exposure is later found to be less than initially estimated, the corrected value may be used.

(B) The licensee shall obtain authorization from the agency before assigning respiratory protection factors in excess of those specified in subsection (ggg)(1) of this section. The agency may authorize a licensee to use higher protection factors on receipt of an application that:

(i) describes the situation for which a need exists for higher protection factors; and

(ii) demonstrates that the respiratory protection equipment provides these higher protection factors under the proposed conditions of use.

(3) In an emergency, the licensee shall use as emergency equipment only respiratory protection equipment that has been specifically certified or had certification extended for emergency use by the NIOSH and the MSHA.

(4) The licensee shall notify the agency in writing at least 30 days before the date that respiratory protection equipment is first used in accordance with either paragraphs (1) or (2) of this subsection.

(y) Security and control of licensed sources of radiation.

(1) The licensee shall secure radioactive material from unauthorized removal or access.

(2) The licensee shall maintain constant surveillance, using devices and/or administrative procedures to prevent unauthorized use of radioactive material that is in an unrestricted area and that is not in storage.

(z) Caution signs.

(1) Unless otherwise authorized by the agency, the standard radiation symbol prescribed shall use the colors magenta, or purple, or black on yellow background. The standard radiation symbol prescribed is the three-bladed design as follows:

Figure: 25 TAC §289.202(z)(1) (No change.)

(A) the cross-hatched area of the symbol is to be magenta, or purple, or black; and

(B) the background of the symbol is to be yellow.

(2) Notwithstanding the requirements of paragraph (1) of this subsection, licensees are authorized to label sources, source holders, or device components containing sources of radiation that are subjected to high temperatures, with conspicuously etched or stamped radiation caution symbols and without a color requirement.

(aa) Posting requirements.

(1) The licensee shall post each radiation area with a conspicuous sign or signs bearing the radiation symbol and the words "CAUTION, RADIATION AREA."

(2) The licensee shall post each high radiation area with a conspicuous sign or signs bearing the radiation symbol and the words "CAUTION, HIGH RADIATION AREA" or "DANGER, HIGH RADIATION AREA."

(3) The licensee shall post each very high radiation area with a conspicuous sign or signs bearing the radiation symbol and words "GRAVE DANGER, VERY HIGH RADIATION AREA." If the very high radiation area involves medical treatment of patients, the licensee may omit the word "GRAVE" from the sign or signs.

(4) The licensee shall post each airborne radioactivity area with a conspicuous sign or signs bearing the radiation symbol and the words "CAUTION, AIRBORNE RADIOACTIVITY AREA" or "DANGER, AIRBORNE RADIOACTIVITY AREA."

(5) The licensee shall post each area or room in which there is used or stored an amount of licensed material exceeding 10 times the quantity of such material specified in subsection (ggg)(3) of this section with a conspicuous sign or signs bearing the radiation symbol and the words "CAUTION, RADIOACTIVE MATERIAL(S)" or "DANGER, RADIOACTIVE MATERIAL(S)."

(bb) Exceptions to posting requirements.

(1) A licensee is not required to post caution signs in areas or rooms containing sources of radiation for periods of less than 8 hours, if each of the following conditions is met:

(A) the sources of radiation are constantly attended during these periods by an individual who takes the precautions necessary to prevent the exposure of individuals to sources of radiation in excess of the limits established in this section; and

(B) the area or room is subject to the licensee's control.

(2) Rooms or other areas in hospitals that are occupied by patients are not required to be posted with caution signs in accordance with subsection (aa) of this section provided that the patient could be released from licensee control in accordance with this chapter.

(3) A room or area is not required to be posted with a caution sign because of the presence of a sealed source(s) provided the radiation level at 30 centimeters from the surface of the sealed source container(s) or housing(s) does not exceed 0.005 rem (0.05 mSv) per hour.

(4) Rooms in medical facilities that are used for teletherapy are exempt from the requirement to post caution signs in accordance with subsection (aa) of this section provided the following conditions are met.

(A) Access to the room is controlled in accordance with this chapter; and

(B) Personnel in attendance take necessary precautions to prevent the inadvertent exposure of workers, other patients, and members of the public to radiation in excess of the limits established in this section.

(cc) Labeling containers.

(1) The licensee shall ensure that each container of licensed material bears a durable, clearly visible label bearing the radiation symbol and the words "CAUTION, RADIOACTIVE MATERIAL" or "DANGER, RADIOACTIVE MATERIAL." The label shall also provide information, such as the radionuclides present, an estimate of the quantity of radioactivity, the date for which the activity is estimated, radiation levels, kinds of materials, and mass enrichment, to permit individuals handling or using the containers, or working in the vicinity of the containers, to take precautions to avoid or minimize exposures.

(2) Each licensee shall, prior to removal or disposal of empty uncontaminated containers to unrestricted areas, remove or deface the radioactive material label or otherwise clearly indicate that the container no longer contains radioactive materials.

(dd) Exemptions to labeling requirements. A licensee is not required to label:

(1) containers holding licensed material in quantities less than the quantities listed in subsection (ggg)(3) of this section;

(2) containers holding licensed material in concentrations less than those specified in Table III of subsection (ggg)(2) of this section;

(3) containers attended by an individual who takes the precautions necessary to prevent the exposure of individuals in excess of the limits established by this section;

(4) containers when they are in transport and packaged and labeled in accordance with the rules of the DOT (labeling of packages containing radioactive materials is required by the DOT if the amount and type of radioactive material exceeds the limits for an excepted quantity or article as defined and limited by DOT regulations 49 CFR §§173.403(m) and (w) and 173.424);

(5) containers that are accessible only to individuals authorized to handle or use them, or to work in the vicinity of the containers, if the contents are identified to these individuals by a readily available written record. Examples of containers of this type are containers in locations such as water-filled canals, storage vaults, or hot cells. The record shall be retained as long as the containers are in use for the purpose indicated on the record; or

(6) installed manufacturing or process equipment, such as piping and tanks.

(ee) Procedures for receiving and opening packages.

(1) Each licensee who expects to receive a package containing quantities of radioactive material in excess of a Type A quantity, as defined in §289.201(b) of this title and specified in §289.257(s)(1) of this title (relating to Packaging and Transportation of Radioactive Material), shall make arrangements to receive:

(A) the package when the carrier offers it for delivery; or

(B) the notification of the arrival of the package at the carrier's terminal and to take possession of the package expeditiously.

(2) Each licensee shall:

(A) monitor the external surfaces of a labeled package, labeled with a Radioactive White I, Yellow II, or Yellow III label as specified in DOT regulations 49 CFR §§172.403 and 172.436-440, for radioactive contamination unless the package contains only radioactive material in the form of gas or in special form as defined in §289.201(b) of this title; and

(B) monitor the external surfaces of a labeled package, labeled with a Radioactive White I, Yellow II, or Yellow III label as specified in DOT regulations 49 CFR §§172.403 and §§172.436-440, for radiation levels unless the package contains quantities of radioactive material that are less than or equal to the Type A quantity, as defined in §289.201(b) of this title and specified in §289.257(s)(1) of this title; and

(C) monitor all packages known to contain radioactive material for radioactive contamination and radiation levels if there is evidence of degradation of package integrity, such as packages that are crushed, wet, or damaged.

(3) The licensee shall perform the monitoring required by paragraph (2) of this subsection as soon as practicable after receipt of the package, but not later than three hours after the package is received at the licensee's facility if it is received during the licensee's normal working hours. If a package is received after working hours, the package shall be monitored no later than three hours from the beginning of the next working day. If the licensee discovers there is evidence of degradation of package integrity, such as a package that is crushed, wet, or damaged, the package shall be surveyed immediately.

(4) The licensee shall immediately notify the final delivery carrier and, by telephone and telegram, mailgram, or facsimile, the agency when removable radioactive surface contamination or external radiation levels exceed the limits established in subparagraphs (A) and (B) of this paragraph.

(A) Limits for removable radioactive surface contamination levels.

(i) The level of removable radioactive contamination on the external surfaces of each package offered for shipment shall be ALARA. The level of removable radioactive contamination may be determined by wiping an area of 300 square centimeters (cm2) of the surface concerned with an absorbent material, using moderate pressure, and measuring the activity on the wiping material. Sufficient measurements must be taken in the most appropriate locations to yield a representative assessment of the removable contamination levels. Except as provided in clause (iii) of this subparagraph, the amount of radioactivity measured on any single wiping material, when averaged over the surface wiped, must not exceed the limits given in clause (ii) of this subparagraph at any time during transport. If other methods are used, the detection efficiency of the method used must be taken into account and in no case may the removable contamination on the external surfaces of the package exceed 10 times the limits listed in clause (ii) of this subparagraph.

(ii) Removable external radioactive contamination wipe limits are as follows.

Figure: 25 TAC §289.202(ee)(4)(A)(ii) (No change.)

(iii) In the case of packages transported as exclusive use shipments by rail or highway only, the removable radioactive contamination at any time during transport must not exceed 10 times the levels prescribed in clause (ii) of this subparagraph. The levels at the beginning of transport must not exceed the levels in clause (ii) of this subparagraph.

(B) Limits for external radiation levels.

(i) External radiation levels around the package and around the vehicle, if applicable, will not exceed 200 millirems per hour (mrem/hr) (2 millisiverts per hour (mSv/hr)) at any point on the external surface of the package at any time during transportation. The transport index shall not exceed 10.

(ii) For a package transported in exclusive use by rail, highway or water, radiation levels external to the package may exceed the limits specified in clause (i) of this subparagraph but shall not exceed any of the following:

(I) 200 mrem/hr (2 mSv/hr) on the accessible external surface of the package unless the following conditions are met, in which case the limit is 1,000 mrem/hr (10 mSv/hr):

(-a-) the shipment is made in a closed transport vehicle;

(-b-) provisions are made to secure the package so that its position within the vehicle remains fixed during transportation; and

(-c-) there are no loading or unloading operations between the beginning and end of the transportation;

(II) 200 mrem/hr (2 mSv/hr) at any point on the outer surface of the vehicle, including the upper and lower surfaces, or, in the case of a flat-bed style vehicle, with a personnel barrier, at any point on the vertical planes projected from the outer edges of the vehicle, on the upper surface of the load (or enclosure, if used), and on the lower external surface of the vehicle (a flat-bed style vehicle with a personnel barrier shall have radiation levels determined at vertical planes. If no personnel barrier, the package cannot exceed 200 mrem/hr (2 mSv/hr) at the surface.);

(III) 10 mrem/hr (0.1 mSv/hr) at any point 2 m from the vertical planes represented by the outer lateral surfaces of the vehicle, or, in the case of a flat-bed style vehicle, at any point 2 m from the vertical planes projected from the outer edges of the vehicle; and

(IV) 2 mrem/hr (0.02 mSv/hr) in any normally occupied positions of the vehicle, except that this provision does not apply to private motor carriers when persons occupying these positions are provided with special health supervision, personnel radiation exposure monitoring devices, and training in accordance with §289.203(c) of this title (relating to Notices, Instructions, and Reports to Workers; Inspections).

(5) Each licensee shall:

(A) establish, maintain, and retain written procedures for safely opening packages in which radioactive material is received; and

(B) ensure that the procedures are followed and that due consideration is given to special instructions for the type of package being opened.

(6) Licensees transferring special form sources in vehicles owned or operated by the licensee to and from a work site are exempt from the contamination monitoring requirements of paragraph (2) of this subsection, but are not exempt from the monitoring requirement in paragraph (2) of this subsection for measuring radiation levels that ensures that the source is still properly lodged in its shield.

(ff) General requirements for waste management.

(1) Unless otherwise exempted, a licensee shall discharge, treat, or decay licensed material or transfer waste for disposal only:

(A) by transfer to an authorized recipient as provided in subsection (jj) of this section, §289.252 of this title, §289.254 of this title (relating to Licensing of Radioactive Waste Processing and Storage Facilities), §289.257 of this title, §289.259 of this title (relating to Licensing of Naturally Occurring Radioactive Material (NORM)), or to the United States Department of Energy (DOE);

(B) by decay in storage with prior approval from the agency;

(C) by release in effluents within the limits in subsection (n) of this section; or

(D) as authorized in accordance with paragraph (2) of this subsection, and subsections (gg) and (hh) of this section.

(2) Upon agency approval, emission control dust and other material from electric arc furnaces or foundries contaminated as a result of inadvertent melting of cesium-137 or americium-241 sources may be transferred for disposal to a hazardous waste disposal facility authorized by the Texas Natural Resource Conservation Commission (Commission) or its successor, another state's regulatory agency with jurisdiction to regulate hazardous waste as classified under Subtitle C of the Resource Conservation and Recovery Act (RCRA), or the EPA. The material may be transferred for disposal without regard to its radioactivity if the following conditions are met.

(A) Contaminated material described in paragraph (2) of this subsection, whether packaged or unpackaged (i.e., bulk), must be treated through stabilization to comply with all waste treatment requirements of the appropriate state or federal regulatory agency as listed in this paragraph. The treatment operations must be undertaken by either of the following:

(i) the owner/operator of the electric arc furnace or foundry licensed to possess, treat or transfer cesium-137 or americium-241 contaminated incident-related material; or

(ii) a service contractor licensed by the agency, NRC, or an agreement state to possess, treat, or transfer cesium-137 or americium-241 contaminated incident-related material.

(B) The emission control dust and other incident-related materials have been stored (if applicable) and transferred in accordance with operating and emergency procedures approved by the agency.

(C) The total cesium-137 or americium-241 activity contained in emission control dust and other incident-related materials to be transferred to a hazardous waste disposal facility has been specifically approved by NRC or the appropriate agreement state(s) and does not exceed the total activity associated with the inadvertent melting incident.

(D) The hazardous waste disposal facility operator has been notified in writing of the impending transfer of the incident-related materials and has agreed in writing to receive and dispose of the packaged or unpackaged materials. Copies of the notification and agreement shall be submitted to the agency.

(E) The licensee, as listed in subparagraph (A)(i) or (ii) of this paragraph, notifies the NRC or agreement state(s) in which the transferor and transferee are located, in writing, of the impending transfer, at least 30 days before the transfer.

(F) The packaged stabilized material has been packaged for transportation and disposal in non-bulk steel packaging as defined in DOT regulations at 49 CFR §173.213.

(G) The emission control dust and other incident-related materials that have been stabilized and packaged as described in subparagraph (F) of this paragraph shall contain pretreatment average concentrations of cesium-137 that do not exceed 130 pCi/g of material, above background, or pretreatment average concentrations of americium-241 that do not exceed 3 pCi/g of material, above background.

(H) The dose rate at 3.28 feet (1 m) from the surface of any package containing stabilized waste shall not exceed 20 µrem per hour or 0.20 µSv per hour, above background.

(I) The unpackaged stabilized material shall contain pretreatment average concentrations of cesium-137 that do not exceed 100 pCi/g of material, above background, or pretreatment average concentrations of americium-241 that do not exceed 3 pCi/g of material, above background.

(J) The licensee transferring the cesium-137 or americium -241 contaminated incident-related material must consult with the agency, the Commission or its successor, another state's regulatory agency with jurisdiction to regulate hazardous waste as classified under RCRA, or the EPA and other authorized parties, including state and local governments, and obtain all necessary approvals, in addition to those of NRC and/or appropriate agreement states, for the transfers described in paragraph (2) of this subsection.

(K) Nothing in this subsection shall be or is intended to be construed as a waiver of any RCRA permit condition or term, of any state or local statute or regulation, or of any federal RCRA regulation.

(L) The total incident-related cesium-137 activity described in paragraph (2) of this subsection received by a facility over its operating life shall not exceed 1 Ci (37 GBq). The total incident-related americium-241 activity described in paragraph (2) of this subsection received by a facility over its operating life shall not exceed 30 mCi (1.11MBq). The agency will maintain a record of the total incident-related cesium-137 or americium-241 activity shipped by a person licensed by the agency. Upon consultation with the Commission, the agency will determine if the total incident-related activity received by a hazardous waste disposal facility over its operating life has reached 1 Ci (37 GBq) of cesium-137 or 30 mCi (1.11MBq) of americium-241. The agency will not approve shipments of cesium-137 or americium-241 contaminated incident-related material that will cause this limit to be exceeded.

(3) A person shall be specifically licensed to receive waste containing licensed material from other persons for:

(A) treatment prior to disposal;

(B) treatment by incineration;

(C) decay in storage;

(D) disposal at an authorized land disposal facility; or

(E) storage until transferred to a storage or disposal facility authorized to receive the waste.

(gg) Discharge by release into sanitary sewerage.

(1) A licensee may discharge licensed material into sanitary sewerage if each of the following conditions is satisfied:

(A) the material is readily soluble, or is readily dispersible biological material, in water;

(B) the quantity of licensed radioactive material that the licensee releases into the sewer in one month divided by the average monthly volume of water released into the sewer by the licensee does not exceed the concentration listed in Table III of subsection (ggg)(2) of this section; and

(C) if more than one radionuclide is released, the following additional conditions must also be satisfied:

(i) the fraction of the limit in Table III of subsection (ggg)(2) of this section represented by discharges into sanitary sewerage determined by dividing the actual monthly average concentration of each radionuclide released by the licensee into the sewer by the concentration of that radionuclide listed in Table III of subsection (ggg)(2) of this section; and

(ii) the sum of the fractions for each radionuclide required by clause (i) of this subparagraph does not exceed unity; and

(D) the total quantity of licensed radioactive material that the licensee releases into the sanitary sewerage in a year does not exceed 5 curies (Ci) (185 gigabecquerels (GBq)) of hydrogen-3, 1 Ci (37 GBq) of carbon-14, and 1 Ci (37 GBq) of all other radioactive materials combined.

(2) Excreta from individuals undergoing medical diagnosis or therapy with radioactive material are not subject to the limitations contained in paragraph (1) of this subsection.

(hh) Treatment by incineration. A licensee may treat licensed material by incineration only in the form and concentration specified in subsection (fff)(1) of this section or as authorized by the agency.

(ii) Discharge by release into septic tanks. No licensee shall discharge radioactive material into a septic tank system except as specifically approved by the agency.

(jj) Transfer for disposal and manifests.

(1) The control of transfers of LLRW intended for disposal at a licensed low-level radioactive waste disposal facility, the establishment of a manifest tracking system, and additional requirements concerning transfers and recordkeeping for those wastes are found in §289.257(s)(5) of this title.

(2) Each person involved in the transfer of waste for disposal including the waste generator, waste collector, and waste processor, shall comply with the requirements specified in §289.257(s)(5) of this title.

(kk) Compliance with environmental and health protection regulations. Nothing in subsections (ff), (gg), (hh), or (jj) of this section relieves the licensee from complying with other applicable federal, state, and local regulations governing any other toxic or hazardous properties of materials that may be disposed of in accordance with subsections (ff), (gg), (hh), or (jj) of this section.

(ll) General provisions for records.

(1) Each licensee shall use the SI units becquerel, gray, sievert, and coulomb per kilogram, or the special units curie, rad, rem, and roentgen, including multiples and subdivisions, and shall clearly indicate the units of all quantities on records required by this section. Disintegrations per minute may be indicated on records of surveys performed to determine compliance with subsection (ggg)(6) of this section. To ensure compatibility with international transportation standards, all limits in this section are given in terms of dual units: The International System of Units (SI) followed or preceded by United States (U.S.) standard or customary units. The U.S. customary units are not exact equivalents, but are rounded to a convenient value, providing a functionally equivalent unit. For the purpose of this section, either unit may be used.

(2) Notwithstanding the requirements of paragraph (1) of this subsection, when recording information on shipment manifests, as required in §289.257 of this title, information must be recorded in SI units or in SI and units as specified in paragraph (1) of this subsection.

(3) The licensee shall make a clear distinction among the quantities entered on the records required by this section, such as, total effective dose equivalent, total organ dose equivalent, shallow dose equivalent, lens dose equivalent, deep dose equivalent, or committed effective dose equivalent.

(4) Records required in accordance with §289.201(d) of this title, and subsections (mm)-(oo), (tt), and (uu) of this section shall include the date and the identification of individual(s) making the record, and, as applicable, a unique identification of survey instrument(s) used, and an exact description of the location of the survey. Records of receipt, transfer, and disposal of sources of radiation shall uniquely identify the source of radiation.

(5) Copies of records required in accordance with §289.201(d) of this title, and subsections (mm)-(uu) of this section, and by license condition that are relevant to operations at an additional authorized use/storage site shall be maintained at that site in addition to the main site specified on a license.

(mm) Records of radiation protection programs.

(1) Each licensee shall maintain records of the radiation protection program, including:

(A) the provisions of the program; and

(B) audits and other reviews of program content and implementation.

(2) The licensee shall retain the records required by paragraph (1)(A) of this subsection until the agency terminates each pertinent license requiring the record. The licensee shall retain the records required by paragraph (1)(B) of this subsection for three years after the record is made.

(nn) Records of surveys.

(1) Each licensee shall maintain records showing the results of surveys and calibrations required by subsections (p) and (ee)(2) of this section. The licensee shall retain these records for three years after the record is made.

(2) The licensee shall retain each of the following records until the agency terminates each pertinent license requiring the record:

(A) the results of surveys to determine the dose from external sources of radiation used, in the absence of or in combination with individual monitoring data, in the assessment of individual dose equivalents; and

(B) results of measurements and calculations used to determine individual intakes of radioactive material and used in the assessment of internal dose; and

(C) results of air sampling, surveys, and bioassays required in accordance with subsection (x)(1)(C)(i) and (ii) of this section; and

(D) results of measurements and calculations used to evaluate the release of radioactive effluents to the environment.

(oo) Records of tests for leakage or contamination of sealed sources. Records of tests for leakage or contamination of sealed sources required by §289.201(g) of this title shall be kept in units of becquerel or microcurie and retained for inspection by the agency for five years after the records are made.

(pp) Records of lifetime cumulative occupational radiation dose. The licensee shall retain the records of lifetime cumulative occupational radiation dose as specified in subsection (k) of this section on BRC Form 202-2 or equivalent until the agency terminates each pertinent license requiring this record. The licensee shall retain records used in preparing BRC Form 202-2 or equivalent for three years after the record is made.

(qq) Records of planned special exposures.

(1) For each use of the provisions of subsection (k) of this section for planned special exposures, the licensee shall maintain records that describe:

(A) the exceptional circumstances requiring the use of a planned special exposure;

(B) the name of the management official who authorized the planned special exposure and a copy of the signed authorization;

(C) what actions were necessary;

(D) why the actions were necessary;

(E) what precautions were taken to assure that doses were maintained ALARA;

(F) what individual and collective doses were expected to result; and

(G) the doses actually received in the planned special exposure.

(2) The licensee shall retain the records until the agency terminates each pertinent license requiring these records.

(rr) Records of individual monitoring results.

(1) Each licensee shall maintain records of doses received by all individuals for whom monitoring was required in accordance with subsection (q) of this section, and records of doses received during planned special exposures, accidents, and emergency conditions. Assessments of dose equivalent and records made using units in effect before January 1, 1994, need not be changed. These records shall include, when applicable:

(A) the deep dose equivalent to the whole body, lens dose equivalent, shallow dose equivalent to the skin, and shallow dose equivalent to the extremities;

(B) the estimated intake of radionuclides, see subsection (g) of this section;

(C) the committed effective dose equivalent assigned to the intake of radionuclides;

(D) the specific information used to calculate the committed effective dose equivalent in accordance with subsection (i)(1) and (3) of this section and when required by subsection (q)(1) of this section;

(E) the total effective dose equivalent when required by subsection (g) of this section;

(F) the total of the deep dose equivalent and the committed dose to the organ receiving the highest total dose; and

(G) the data used to make occupational dose assessments in accordance with subsection (j)(5) of this section.

(2) The licensee shall make entries of the records specified in paragraph (1) of this subsection at intervals not to exceed 1 year and by April 30 of the following year.

(3) The licensee shall maintain the records specified in paragraph (1) of this subsection on BRC Form 202-3, in accordance with the instructions for BRC Form 202-3, or in clear and legible records containing all the information required by BRC Form 202-3.

(4) The licensee shall maintain the records of dose to an embryo/fetus with the records of dose to the declared pregnant woman. The declaration of pregnancy, including the estimated date of conception, shall also be kept on file, but may be maintained separately from the dose records.

(5) The licensee shall retain each required form or record until the agency terminates each pertinent license requiring the record. The licensee shall retain records used in preparing BRC Form 202-3 or equivalent for three years after the record is made.

(ss) Records of dose to individual members of the public.

(1) Each licensee shall maintain records sufficient to demonstrate compliance with the dose limit for individual members of the public. See subsection (n) of this section.

(2) The licensee shall retain the records required by paragraph (1) of this subsection until the agency terminates each pertinent license requiring the record.

(tt) Records of discharge, treatment, or transfer for disposal.

(1) Each licensee shall maintain records of the discharge or treatment of licensed materials made in accordance with subsection (gg) and (hh) of this section and of transfers for disposal made in accordance with subsection (jj) of this section and §289.257 of this title.

(2) The licensee shall retain the records required by paragraph (1) of this subsection until the agency terminates each pertinent license requiring the record.

(uu) Records of testing entry control devices for very high radiation areas.

(1) Each licensee shall maintain records of tests made in accordance with subsection (u)(2)(I) of this section on entry control devices for very high radiation areas. These records must include the date, time, and results of each such test of function.

(2) The licensee shall retain the records required by paragraph (1) of this subsection for three years after the record is made.

(vv) Form of records. Each record required by this chapter shall be legible throughout the specified retention period. The record shall be the original or a reproduced copy or a microform, provided that the copy or microform is authenticated by authorized personnel and that the microform is capable of producing a clear copy throughout the required retention period or the record may also be stored in electronic media with the capability for producing legible, accurate, and complete records during the required retention period. Records, such as letters, drawings, and specifications, shall include all pertinent information, such as stamps, initials, and signatures. The licensee shall maintain adequate safeguards against tampering with and loss of records.

(ww) Reports of stolen, lost, or missing licensed sources of radiation.

(1) Each licensee shall report to the agency by telephone as follows:

(A) immediately after its occurrence becomes known to the licensee, stolen, lost, or missing licensed radioactive material in an aggregate quantity equal to or greater than 1,000 times the quantity specified in subsection (ggg)(3) of this section, under such circumstances that it appears to the licensee that an exposure could result to individuals in unrestricted areas; or

(B) within 30 days after its occurrence becomes known to the licensee, lost, stolen, or missing licensed radioactive material in an aggregate quantity greater than 10 times the quantity specified in subsection (ggg)(3) of this section that is still missing.

(2) Each licensee required to make a report in accordance with paragraph (1) of this subsection shall, within 30 days after making the telephone report, make a written report to the agency setting forth the following information:

(A) a description of the licensed source of radiation involved, including, for radioactive material, the kind, quantity, and chemical and physical form;

(B) a description of the circumstances under which the loss or theft occurred;

(C) a statement of disposition, or probable disposition, of the licensed source of radiation involved;

(D) exposures of individuals to radiation, circumstances under which the exposures occurred, and the possible total effective dose equivalent to persons in unrestricted areas;

(E) actions that have been taken, or will be taken, to recover the source of radiation; and

(F) procedures or measures that have been, or will be, adopted to ensure against a recurrence of the loss or theft of licensed sources of radiation.

(3) Subsequent to filing the written report, the licensee shall also report additional substantive information on the loss or theft within 30 days after the licensee learns of such information.

(4) The licensee shall prepare any report filed with the agency in accordance with this subsection so that names of individuals who may have received exposure to radiation are stated in a separate and detachable portion of the report.

(xx) Notification of incidents.

(1) Notwithstanding other requirements for notification, each licensee shall immediately report each event involving a source of radiation possessed by the licensee that may have caused or threatens to cause:

(A) an individual to receive:

(i) a total effective dose equivalent of 25 rems (0.25 Sv) or more;

(ii) a lens dose equivalent of 75 rems (0.75 Sv) or more; or

(iii) a shallow dose equivalent to the skin or extremities or a total organ dose equivalent of 250 rads (2.5 grays) or more; or

(B) the release of radioactive material, inside or outside of a restricted area, so that, had an individual been present for 24 hours, the individual could have received an intake five times the occupational ALI. This provision does not apply to locations where personnel are not normally stationed during routine operations, such as hot-cells or process enclosures.

(2) Each licensee shall, within 24 hours of discovery of the event, report to the agency each event involving loss of control of a licensed source of radiation possessed by the licensee that may have caused, or threatens to cause:

(A) an individual to receive, in a period of 24 hours:

(i) a total effective dose equivalent exceeding 5 rems (0.05 Sv);

(ii) a lens dose equivalent exceeding 15 rems (0.15 Sv); or

(iii) a shallow dose equivalent to the skin or extremities or a total organ dose equivalent exceeding 50 rems (0.5 Sv); or

(B) the release of radioactive material, inside or outside of a restricted area, so that, had an individual been present for 24 hours, the individual could have received an intake in excess of one occupational ALI. This provision does not apply to locations where personnel are not normally stationed during routine operations, such as hot-cells or process enclosures.

(3) Licensees shall make the initial notification reports required by paragraphs (1) and (2) of this subsection by telephone to the agency and shall confirm the initial notification report within 24 hours by telegram, mailgram, or facsimile to the agency.

(4) The licensee shall prepare each report filed with the agency in accordance with this section so that names of individuals who have received exposure to sources of radiation are stated in a separate and detachable portion of the report.

(5) The provisions of this section do not apply to doses that result from planned special exposures, provided such doses are within the limits for planned special exposures and are reported in accordance with subsection (zz) of this section.

(6) Each licensee shall notify the agency as soon as possible but not later than four hours after the discovery of an event that prevents immediate protective actions necessary to avoid exposures to radioactive materials that could exceed regulatory limits or releases of radioactive materials that could exceed regulatory limits (events may include fires, explosions, toxic gas releases, etc.).

(7) Each licensee shall notify the agency within 24 hours after the discovery of any of the following events involving radioactive material:

(A) an unplanned contamination event that:

(i) requires access to the contaminated area, by workers or the public, to be restricted for more than 24 hours by imposing additional radiological controls or by prohibiting entry into the area;

(ii) involves a quantity of material greater than five times the lowest annual limit on intake specified in subsection (ggg)(2) of this section for the material; and

(iii) has access to the area restricted for a reason other than to allow isotopes with a half-life of less than 24 hours to decay prior to decontamination.

(B) an event in which equipment is disabled or fails to function as designed when:

(i) the equipment is required by rule or license condition to prevent releases exceeding regulatory limits, to prevent exposures to radioactive materials exceeding regulatory limits, or to mitigate the consequences of an accident;

(ii) the equipment is required to be available and operable when it is disabled or fails to function; and

(iii) no redundant equipment is available and operable to perform the required safety function;

(C) an event that requires unplanned medical treatment at a medical facility of an individual with spreadable radioactive contamination on the individual's clothing or body; or

(D) an unplanned fire or explosion damaging any radioactive material or any device, container, or equipment containing radioactive material when:

(i) the quantity of material involved is greater than five times the lowest annual limit on intake specified in subsection (ggg)(2) of this section for the material; and

(ii) the damage affects the integrity of the radioactive material or its container.

(8) Preparation and submission of reports. Reports made by licensees in response to the requirements of paragraphs (6) and (7) of this subsection shall be made as follows.

(A) Licensees shall make reports required by paragraphs (6) and (7) of this subsection by telephone to the agency. To the extent that the information is available at the time of notification, the information provided in these reports shall include:

(i) the caller's name and call back telephone number;

(ii) a description of the event, including date and time;

(iii) the exact location of the event;

(iv) the isotopes, quantities, and chemical and physical form of the radioactive material involved; and

(v) any personnel radiation exposure data available.

(B) Each licensee who makes a report required by paragraphs (6) and (7) of this subsection shall submit to the agency a written follow-up report within 30 days of the initial report. Written reports prepared in accordance with other requirements of this chapter may be submitted to fulfill this requirement if the reports contain all of the necessary information and the appropriate distribution is made. The reports must include the following:

(i) a description of the event, including the probable cause and the manufacturer and model number (if applicable) of any equipment that failed or malfunctioned;

(ii) the exact location of the event;

(iii) the isotopes, quantities, and chemical and physical form of the radioactive material involved;

(iv) date and time of the event;

(v) corrective actions taken or planned and the results of any evaluations or assessments; and

(vi) the extent of exposure of individuals to radioactive materials without identification of individuals by name.

(yy) Reports of exposures, radiation levels, and concentrations of radioactive material exceeding the limits.

(1) In addition to the notification required by subsection (xx) of this section, each licensee shall submit a written report within 30 days after learning of any of the following occurrences:

(A) incidents for which notification is required by subsection (xx) of this section;

(B) doses in excess of any of the following:

(i) the occupational dose limits for adults in subsection (f) of this section;

(ii) the occupational dose limits for a minor in subsection (l) of this section;

(iii) the limits for an embryo/fetus of a declared pregnant woman in subsection (m) of this section;

(iv) the limits for an individual member of the public in subsection (n) of this section;

(v) any applicable limit in the license; or

(vi) the ALARA constraints for air emissions as required by subsection (e)(4) of this section;

(C) levels of radiation or concentrations of radioactive material in:

(i) a restricted area in excess of applicable limits in the license; or

(ii) an unrestricted area in excess of 10 times the applicable limit set forth in this section or in the license, whether or not involving exposure of any individual in excess of the limits in subsection (n) of this section; or

(D) for licensees subject to the provisions of the EPA's generally applicable environmental radiation standards in 40 CFR §190, levels of radiation or releases of radioactive material in excess of those standards, or of license conditions related to those requirements.

(2) Each report required by paragraph (1) of this subsection shall describe the extent of exposure of individuals to radiation and radioactive material, including, as appropriate:

(A) estimates of each individual's dose;

(B) the levels of radiation and concentrations of radioactive material involved;

(C) the cause of the elevated exposures, dose rates, or concentrations; and

(D) corrective steps taken or planned to ensure against a recurrence, including the schedule for achieving conformance with applicable limits, ALARA constraints, generally applicable environmental standards, and associated license conditions.

(3) Each report filed in accordance with paragraph (1) of this subsection shall include for each individual exposed: the name, identification number, and date of birth. With respect to the limit for the embryo/fetus in subsection (m) of this section, the identifiers should be those of the declared pregnant woman. The report shall be prepared so that this information is stated in a separate and detachable portion of the report.

(4) All licensees who make reports in accordance with paragraph (1) of this subsection shall submit the report in writing to the agency.

(zz) Reports of planned special exposures. The licensee shall submit a written report to the agency within 30 days following any planned special exposure conducted in accordance with subsection (k) of this section, informing the agency that a planned special exposure was conducted and indicating the date the planned special exposure occurred and the information required by subsection (qq) of this section.

(aaa) Notifications and reports to individuals.

(1) Requirements for notification and reports to individuals of exposure to sources of radiation are specified in §289.203 of this title.

(2) When a licensee is required in accordance with subsection (yy) or (zz) of this section to report to the agency any exposure of an identified occupationally exposed individual, or an identified member of the public, to sources of radiation, the licensee shall also notify the individual and provide a copy of the report submitted to the agency, to the individual. Such notice shall be transmitted at a time not later than the transmittal to the agency, and shall comply with the provisions of §289.203(d)(1) of this title.

(bbb) Reports of leaking or contaminated sealed sources. The licensee shall immediately notify the agency if the test for leakage or contamination required in accordance with §289.201(g) of this title indicates a sealed source is leaking or contaminated. A written report of a leaking or contaminated source shall be submitted to the agency within five days. The report shall include the equipment involved, the test results and the corrective action taken.

(ccc) Vacating premises.

(1) Each licensee or person possessing non-exempt sources of radiation shall, no less than 30 days before vacating and relinquishing possession or control of premises, notify the agency, in writing, of the intent to vacate.

(2) The licensee or person possessing non-exempt radioactive material shall decommission the premises to a degree consistent with subsequent use as an unrestricted area and in accordance with the requirements of subsection (ddd) of this section or, for uranium recovery and byproduct material disposal facilities licensed in accordance with §289.260 of this title, subsection (eee) of this section.

(ddd) Radiological requirements for license termination.

(1) General provisions and scope.

(A) The requirements in this section apply to the decommissioning of facilities licensed in accordance with §289.252 of this title (relating to Licensing of Radioactive Material), §289.254 of this title (relating to Licensing of Radioactive Waste Processing and Storage Facilities), §289.255 of this title (relating to Radiation Safety Requirements and Licensing and Registration Procedures for Industrial Radiography), and §289.258 of this title (relating to Licensing and Radiation Safety Requirements for Irradiators). The requirements do not apply to uranium recovery and byproduct material disposal facilities already subject to the requirements of §289.260 of this title (relating to Licensing of Uranium Recovery and Byproduct Material Disposal Facilities).

(B) The requirements in this section do not apply to the following:

(i) sites that have been decommissioned prior to October 1, 2000, in accordance with requirements identified in this section and in §289.252 of this title; or

(ii) sites that have previously submitted and received approval on a decommissioning plan by October 1, 2000.

(C) After a site has been decommissioned and the license terminated in accordance with the requirements in the subsection, the agency will require additional cleanup if it determines that the requirements of the subsection were not met and residual radioactivity remaining at the site could result in significant threat to public health and safety.

(D) When calculating TEDE to the average member of the critical group, the licensee shall determine the peak annual TEDE dose expected within the first 1,000 years after decommissioning.

(2) Radiological requirements for unrestricted use. A site will be considered acceptable for unrestricted use if the residual radioactivity that is distinguishable from background radiation results in a TEDE to an average member of the critical group that does not exceed 25 mrem (0.25 mSv) per year, including that from groundwater sources of drinking water, and the residual radioactivity has been reduced to levels that are ALARA. Determination of the levels that are ALARA must take into account consideration of any detriments, such as deaths from transportation accidents, expected to potentially result from decontamination and waste disposal.

(3) Alternate requirements for license termination.

(A) The agency may terminate a license using alternate requirements greater than the dose requirements specified in paragraph (2) of this subsection if the licensee does the following:

(i) provides assurance that public health and safety would continue to be protected, and that it is unlikely that the dose from all man-made sources combined, other than medical, would be more than the 1 mSv per year (100 mrem per year) limit specified in subsection (o) of this section, by submitting an analysis of possible sources of exposure;

(ii) reduces doses to ALARA levels, taking into consideration any detriments such as traffic accidents expected to potentially result from decontamination and waste disposal; and

(iii) has submitted a decommissioning plan to the agency indicating the licensee's intent to decommission in accordance with the requirements in §289.252(l)(7) of this title, and specifying that the licensee proposes to decommission by use of alternate requirements. The licensee shall document in the decommissioning plan how the advice of individuals and institutions in the community who may be affected by the decommissioning has been sought and addressed, as appropriate, following analysis of that advice. In seeking such advice, the licensee shall provide for the following:

(I) participation by representatives of a broad cross section of community interests who may be affected by the decommissioning;

(II) an opportunity for a comprehensive, collective discussion on the issues by the participants represented; and

(III) a publicly available summary of the results of all such discussions, including a description of the individual viewpoints of the participants on the issues and the extent of agreement and disagreement among the participants on the issues.

(B) The use of alternate requirements to terminate a license requires the approval of the agency after consideration of the agency's recommendations that will address any comments provided by the EPA and any public comments submitted in accordance with paragraph (4) of this subsection.

(4) Public notification and public participation. Upon receipt of a decommissioning plan from the licensee, or a proposal from the licensee for release of a site in accordance with paragraph (3) of this subsection, or whenever the agency deems such notice to be in the public interest, the agency will do the following:

(A) notify and solicit comments from the following:

(i) local and state governments in the vicinity of the site and any Indian Nation or other indigenous people that have treaty or statutory rights that could be affected by the decommissioning; and

(ii) the EPA for cases where the licensee proposes to release a site in accordance with paragraph (3) of this subsection; and

(B) publish a notice in the Texas Register and a forum, such as local newspapers, letters to state of local organizations, or other appropriate forum, that is readily accessible to individuals in the vicinity of the site, and solicit comments from affected parties.

(5) Minimization of contamination. Applicants for licenses, other than renewals, after October 1, 2000, shall describe in the application how facility design and procedures for operation will minimize, to the extent practical, contamination of the facility and the environment, facilitate eventual decommissioning, and minimize, to the extent practical, the generation of LLRW.

(eee) Limits for contamination of soil, surfaces of facilities and equipment, and vegetation.

(1) No licensee shall possess, receive, use, or transfer radioactive material in such a manner as to cause contamination of surfaces of facilities or equipment in unrestricted areas to the extent that the contamination exceeds the limits specified in subsection (ggg)(6) of this section.

(2) No licensee shall possess, receive, use, or transfer radioactive material in such a manner as to cause contamination of soil in unrestricted areas, to the extent that the contamination exceeds, on a dry weight basis, the concentration limits specified in:

(A) subsection (ggg)(8) of this section; or

(B) the effluent concentrations in Table II, Column 2 of subsection (ggg)(2)(F) of this section, with the units changed from microcuries per milliliter to microcuries per gram, for radionuclides not specified in subsection (ggg)(8) of this section or paragraph (4) of this subsection.

(3) Where combinations of radionuclides are involved, the sum of the ratios between the concentrations present and the limits specified in paragraph (2) of this subsection shall not exceed one.

(4) Notwithstanding the limits specified in paragraph (2) of this subsection, no licensee shall cause the concentration of radium-226 or radium-228 in soil in unrestricted areas, averaged over any 100 square meters (m2), to exceed the background level by more than:

(A) 5 picocuries per gram (pCi/g) (0.185 becquerel per gram (Bq/g)), averaged over the first 15 cm of soil below the surface; and

(B) 15 pCi/g (0.555 Bq/g), averaged over 15 cm thick layers of soil more than 15 cm below the surface.

(5) No licensee shall possess, receive, use, or transfer radioactive material in such a manner as to cause contamination of vegetation in unrestricted areas to exceed 5 pCi/g (0.185 Bq/g), based on dry weight, for radium-226 or radium-228.

(6) Notwithstanding the limits specified in paragraph (2) of this subsection, no licensee shall cause the concentration of natural uranium with no daughters present, based on dry weight and averaged over any 100 m2 of area, to exceed the following limits:

(A) 30 pCi/g (1.11 Bq/g), averaged over the top 15 cm of soil below the surface; and

(B) 150 pCi/g (5.55 Bq/g), average concentration at depths greater than 15 centimeters below the surface so that no individual member of the public will receive an effective dose equivalent in excess of 100 mrem (1 mSv) per year.

(fff) Exemption of specific wastes.

(1) A licensee may discard the following licensed material without regard to its radioactivity:

(A) 0.05 microcurie (µCi) (1.85 kilobecquerels (kBq)), or less, of hydrogen-3, carbon-14, or iodine-125 per gram of medium used for liquid scintillation counting or in vitro clinical or in vitro laboratory testing; and

(B) 0.05 µCi (1.85 kBq), or less, of hydrogen-3, carbon-14, or iodine-125, per gram of animal tissue, averaged over the weight of the entire animal.

(2) A licensee shall not discard tissue in accordance with paragraph (1)(B) of this subsection in a manner that would permit its use either as food for humans or as animal feed.

(3) The licensee shall maintain records in accordance with subsection (tt) of this section.

(4) Any licensee may, upon agency approval of procedures required in paragraph (6) of this subsection, discard licensed material included in subsection (ggg)(7) of this section, provided that it does not exceed the concentration and total curie limits contained therein, in a Type I municipal solid waste site as defined in the Municipal Solid Waste Regulations of the authorized regulatory agency (31 Texas Administrative Code Chapter 330), unless such licensed material also contains hazardous waste, as defined in §3(15) of the Solid Waste Disposal Act, Health and Safety Code, Chapter 361. Any licensed material included in subsection (ggg)(7) of this section and which is a hazardous waste as defined in the Solid Waste Disposal Act may be discarded at a facility authorized to manage hazardous waste by the authorized regulatory agency.

(5) Each licensee who discards material described in paragraphs (1) or (4) of this subsection shall:

(A) make surveys adequate to assure that the limits of paragraphs (1) or (4) of this subsection are not exceeded; and

(B) remove or otherwise obliterate or obscure all labels, tags, or other markings that would indicate that the material or its contents is radioactive.

(6) Prior to authorizations in accordance with paragraph (4) of this subsection, a licensee shall submit procedures to the agency for:

(A) the physical delivery of the material to the disposal site;

(B) surveys to be performed for compliance with paragraph (5)(A) of this subsection;

(C) maintaining secure packaging during transportation to the site; and

(D) maintaining records of any discards made under paragraph (4) of this subsection.

(7) Nothing in this section relieves the licensee of maintaining records showing the receipt, transfer, and discard of such radioactive material as specified in §289.201(d) of this title.

(8) Nothing in this section relieves the licensee from complying with other applicable federal, state, and local regulations governing any other toxic or hazardous property of these materials.

(9) Licensed material discarded under this section is exempt from the requirements of §289.252(t) of this title.

(ggg) Appendices.

(1) Protection factors for respirators. The following table contains protection factors for respiratorsa:

Figure: 25 TAC §289.202(ggg)(1) (No change.)

(2) Annual limits on intake (ALI) and derived air concentrations (DAC) of radionuclides for occupational exposure; effluent concentrations; concentrations for release to sanitary sewerage.

(A) Introduction.

(i) For each radionuclide, Table I of subparagraph (F) of this paragraph indicates the chemical form that is to be used for selecting the appropriate ALI or DAC value. The ALIs and DACs for inhalation are given for an aerosol with an activity median aerodynamic diameter (AMAD) of 1 micron, and for three classes (D, W, Y) of radioactive material, which refer to their retention (approximately days, weeks, or years) in the pulmonary region of the lung. This classification applies to a range of clearance half-times for D if less than 10 days, for W from 10 to 100 days, and for Y greater than 100 days. Table II of subparagraph (F) of this paragraph provides concentration limits for airborne and liquid effluents released to the general environment. Table III of subparagraph (F) of this paragraph provides concentration limits for discharges to sanitary sewerage.

(ii) The values in Tables I, II, and III of subparagraph (F) of this paragraph are presented in the computer "E" notation. In this notation a value of 6E-02 represents a value of 6 x 10-2 or 0.06, 6E+2 represents 6 x 102 or 600, and 6E+0 represents 6 x 100 or 6.

(B) Occupational values.

(i) Note that the columns in Table I of subparagraph (F) of this paragraph captioned "Oral Ingestion ALI," "Inhalation ALI," and "DAC," are applicable to occupational exposure to radioactive material.

(ii) The ALIs in subparagraph (F) of this paragraph are the annual intakes of given radionuclide by "Reference Man" that would result in either a committed effective dose equivalent of 5 rems (0.05 Sv), stochastic ALI, or a committed dose equivalent of 50 rems (0.5 Sv) to an organ or tissue, non-stochastic ALI. The stochastic ALIs were derived to result in a risk, due to irradiation of organs and tissues, comparable to the risk associated with deep dose equivalent to the whole body of 5 rems (0.05 Sv). The derivation includes multiplying the committed dose equivalent to an organ or tissue by a weighting factor, wT. This weighting factor is the proportion of the risk of stochastic effects resulting from irradiation of the organ or tissue, T, to the total risk of stochastic effects when the whole body is irradiated uniformly. The values of w T are listed under the definition of "weighting factor" in subsection (c) of this section. The non-stochastic ALIs were derived to avoid non-stochastic effects, such as prompt damage to tissue or reduction in organ function.

(iii) A value of wT = 0.06 is applicable to each of the five organs or tissues in the "remainder" category receiving the highest dose equivalents, and the dose equivalents of all other remaining tissues may be disregarded. The following portions of the GI tract; stomach, small intestine, upper large intestine, and lower large intestine, are to be treated as four separate organs.

(iv) The dose equivalents for an extremity, skin, and lens of the eye are not considered in computing the committed effective dose equivalent, but are subject to limits that must be met separately.

(v) When an ALI is defined by the stochastic dose limit, this value alone is given. When an ALI is determined by the non-stochastic dose limit to an organ, the organ or tissue to which the limit applies is shown, and the ALI for the stochastic limit is shown in parentheses. Abbreviated organ or tissue designations are used as follows:

(I) LLI wall = lower large intestine wall;

(II) St. wall = stomach wall;

(III) Blad wall = bladder wall; and

(IV) Bone surf = bone surface.

(vi) Figure: 25 TAC §289.202(ggg)(2)(B)(vi) (No change.)

(vii) The dose equivalents for an extremity, skin, and lens of the eye are not considered in computing the committed effective dose equivalent, but are subject to limits that must be met separately.

(viii) The DAC values are derived limits intended to control chronic occupational exposures. The relationship between the DAC and the ALI is given by:

Figure: 25 TAC §289.202(ggg)(2)(B)(viii) (No change.)

(ix) The DAC values relate to one of two modes of exposure: either external submersion or the internal committed dose equivalents resulting from inhalation of radioactive materials. DACs based upon submersion are for immersion in a semi-infinite cloud of uniform concentration and apply to each radionuclide separately.

(x) The ALI and DAC values include contributions to exposure by the single radionuclide named and any in-growth of daughter radionuclides produced in the body by decay of the parent. However, intakes that include both the parent and daughter radionuclides should be treated by the general method appropriate for mixtures.

(xi) The values of ALI and DAC do not apply directly when the individual both ingests and inhales a radionuclide, when the individual is exposed to a mixture of radionuclides by either inhalation or ingestion or both, or when the individual is exposed to both internal and external irradiation. See subsection (g) of this section. When an individual is exposed to radioactive materials which fall under several of the translocation classifications of the same radionuclide, such as, Class D, Class W, or Class Y, the exposure may be evaluated as if it were a mixture of different radionuclides.

(xii) It should be noted that the classification of a compound as Class D, W, or Y is based on the chemical form of the compound and does not take into account the radiological half-life of different radionuclides. For this reason, values are given for Class D, W, and Y compounds, even for very short-lived radionuclides.

(C) Effluent concentrations.

(i) The columns in Table II of subparagraph (F) of this paragraph captioned "Effluents," "Air," and "Water" are applicable to the assessment and control of dose to the public, particularly in the implementation of the provisions of subsection (o) of this section. The concentration values given in Columns 1 and 2 of Table II of subparagraph (F) of this paragraph are equivalent to the radionuclide concentrations which, if inhaled or ingested continuously over the course of a year, would produce a total effective dose equivalent of 0.05 rem (0.5 mSv).

(ii) Consideration of non-stochastic limits has not been included in deriving the air and water effluent concentration limits because non-stochastic effects are presumed not to occur at or below the dose levels established for individual members of the public. For radionuclides, where the non-stochastic limit was governing in deriving the occupational DAC, the stochastic ALI was used in deriving the corresponding airborne effluent limit in Table II of subparagraph (F) of this paragraph. For this reason, the DAC and airborne effluent limits are not always proportional as they were in the previous radiation protection standards.

(iii) The air concentration values listed in Column I of Table II of subparagraph (F) of this paragraph were derived by one of two methods. For those radionuclides for which the stochastic limit is governing, the occupational stochastic inhalation ALI was divided by 2.4 x 109, relating the inhalation ALI to the DAC, as explained in subparagraph (B)(viii) of this paragraph, and then divided by a factor of 300. The factor of 300 includes the following components:

(I) a factor of 50 to relate the 5 rems (0.05 Sv) annual occupational dose limit to the 0.1 rem limit for members of the public;

(II) a factor of 3 to adjust for the difference in exposure time and the inhalation rate for a worker and that for members of the public; and

(III) a factor of 2 to adjust the occupational values, derived for adults, so that they are applicable to other age groups.

(iv) For those radionuclides for which submersion, that is external dose, is limiting, the occupational DAC in Column 3 of Table I of subparagraph (F) of this paragraph was divided by 219. The factor of 219 is composed of a factor of 50, as described in clause (iii) of this subparagraph, and a factor of 4.38 relating occupational exposure for 2,000 hours per year to full-time exposure (8,760 hours per year). Note that an additional factor of 2 for age considerations is not warranted in the submersion case.

(v) The water concentrations were derived by taking the most restrictive occupational stochastic oral ingestion ALI and dividing by 7.3 x 107. The factor of 7.3 x 10 7 milliliters (ml) includes the following components:

(I) the factors of 50 and 2 described in clause (iii) of this subparagraph; and

(II) a factor of 7.3 x 105 (ml) which is the annual water intake of "Reference Man."

(vi) Note 2 of subparagraph (F) of this paragraph provides groupings of radionuclides that are applicable to unknown mixtures of radionuclides. These groupings, including occupational inhalation ALIs and DACs, air and water effluent concentrations, and releases to sewer, require demonstrating that the most limiting radionuclides in successive classes are absent. The limit for the unknown mixture is defined when the presence of one of the listed radionuclides cannot be definitely excluded as being present either from knowledge of the radionuclide composition of the source or from actual measurements.

(D) Releases to sewers. The monthly average concentrations for release to sanitary sewerage are applicable to the provisions in subsection (gg) of this section. The concentration values were derived by taking the most restrictive occupational stochastic oral ingestion ALI and dividing by 7.3 x 106 (ml). The factor of 7.3 x 10 6(ml) is composed of a factor of 7.3 x 105 (ml), the annual water intake by "Reference Man," and a factor of 10, such that the concentrations, if the sewage released by the licensee were the only source of water ingested by a "Reference Man" during a year, would result in a committed effective dose equivalent of 0.5 rem.

(E) List of elements.

Figure: 25 TAC §289.202(ggg)(2)(E) (No change.)

(F) Tables--Values for annual limits. The following tables contain values for annual limits on intake (ALI) and derived air concentrations (DAC) of radionuclides for occupational exposure; effluent concentrations; concentrations for release to sanitary sewerage:

Figure: 25 TAC §289.202(ggg)(2)(F) (No change.)

(3) Quantities of licensed material requiring labeling. The following tables contain quantities of licensed material requiring labeling:

Figure: 25 TAC §289.202(ggg)(3) (No change.)

(4) Classification and characteristics of low-level radioactive waste (LLRW).

(A) Classification of radioactive waste for land disposal.

(i) Considerations. Determination of the classification of LLRW involves two considerations. First, consideration must be given to the concentration of long-lived radionuclides (and their shorter-lived precursors) whose potential hazard will persist long after such precautions as institutional controls, improved waste form, and deeper disposal have ceased to be effective. These precautions delay the time when long-lived radionuclides could cause exposures. In addition, the magnitude of the potential dose is limited by the concentration and availability of the radionuclide at the time of exposure. Second, consideration must be given to the concentration of shorter-lived radionuclides for which requirements on institutional controls, waste form, and disposal methods are effective.

(ii) Classes of waste.

(I) Class A waste is waste that is usually segregated from other waste classes at the disposal site. The physical form and characteristics of Class A waste must meet the minimum requirements set forth in subparagraph (B)(i) of this paragraph. If Class A waste also meets the stability requirements set forth in subparagraph (B)(ii) of this paragraph, it is not necessary to segregate the waste for disposal.

(II) Class B waste is waste that must meet more rigorous requirements on waste form to ensure stability after disposal. The physical form and characteristics of Class B waste must meet both the minimum and stability requirements set forth in subparagraph (B) of this paragraph.

(III) Class C waste is waste that not only must meet more rigorous requirements on waste form to ensure stability but also requires additional measures at the disposal facility to protect against inadvertent intrusion. The physical form and characteristics of Class C waste must meet both the minimum and stability requirements set forth in subparagraph (B) of this paragraph.

(iii) Classification determined by long-lived radionuclides. If the radioactive waste contains only radionuclides listed in subclause (V) of this clause, classification shall be determined as follows.

(I) If the concentration does not exceed 0.1 times the value in subclause (V) of this clause, the waste is Class A.

(II) If the concentration exceeds 0.1 times the value in Table I, but does not exceed the value in subclause (V) of this clause, the waste is Class C.

(III) If the concentration exceeds the value in subclause (V) of this clause, the waste is not generally acceptable for land disposal.

(IV) For wastes containing mixtures of radionuclides listed in subclause (V) of this clause, the total concentration shall be determined by the sum of fractions rule described in clause (vii) of this subparagraph.

(V) Classification table for long-lived radionuclides.

Figure: 25 TAC §289.202(ggg)(4)(A)(iii)(V) (No change.)

(iv) Classification determined by short-lived radionuclides. If the waste does not contain any of the radionuclides listed in clause (iii)(V) of this subparagraph, classification shall be determined based on the concentrations shown in subclause (VI) of this clause. However, as specified in clause (vi) of this subparagraph, if radioactive waste does not contain any nuclides listed in either clause (iii)(V) of this subparagraph or subclause (VI) of this clause, it is Class A.

(I) If the concentration does not exceed the value in Column 1 of subclause (VI) of this clause, the waste is Class A.

(II) If the concentration exceeds the value in Column 1 of subclause (VI) of this clause but does not exceed the value in Column 2 of subclause (VI) of this clause, the waste is Class B.

(III) If the concentration exceeds the value in Column 2 of subclause (VI) of this clause but does not exceed the value in Column 3 of subclause (VI) of this clause, the waste is Class C.

(IV) If the concentration exceeds the value in Column 3 of subclause (VI) of this clause, the waste is not generally acceptable for near-surface disposal.

(V) For wastes containing mixtures of the radionuclides listed in subclause (VI) of this clause, the total concentration shall be determined by the sum of fractions rule described in clause (vii) of this subparagraph.

(VI) Classification table for short-lived radionuclides.

Figure: 25 TAC §289.202(ggg)(4)(A)(iv)(VI) (No change.)

(v) Classification determined by both long- and short-lived radionuclides. If the radioactive waste contains a mixture of radionuclides, some of which are listed in clause (iii)(V) of this subparagraph and some of which are listed in clause (iv)(VI) of this subparagraph, classification shall be determined as follows:

(I) If the concentration of a radionuclide listed in clause (iii)(V) of this subparagraph is less than 0.1 times the value listed in clause (iii)(V) of this subparagraph, the class shall be that determined by the concentration of radionuclides listed in clause (iv)(VI) of this subparagraph.

(II) If the concentration of a radionuclide listed in clause (iii)(V) of this subparagraph exceeds 0.1 times the value listed in clause (iii)(V) of this subparagraph, but does not exceed the value listed in clause (iii)(V) of this subparagraph, the waste shall be Class C, provided the concentration of radionuclides listed in clause (iv)(VI) of this subparagraph does not exceed the value shown in Column 3 of clause (iv)(VI) of this subparagraph.

(vi) Classification of wastes with radionuclides other than those listed in clauses (iii)(V) and (iv)(VI) of this subparagraph. If the waste does not contain any radionuclides listed in either clauses (iii)(V) and (iv)(VI) of this subparagraph, it is Class A.

(vii) The sum of the fractions rule for mixtures of radionuclides. For determining classification for waste that contains a mixture of radionuclides, it is necessary to determine the sum of fractions by dividing each radionuclide's concentration by the appropriate limit and adding the resulting values. The appropriate limits must all be taken from the same column of the same table. The sum of the fractions for the column must be less than 1.0 if the waste class is to be determined by that column. Example: A waste contains Sr-90 in a concentration of 50 curies per cubic meter (Ci/m 3) (1.85 terabecquerels per cubic meter (TBq/m 3)) and Cs-137 in a concentration of 22 Ci/m 3 (814 gigabecquerels per cubic meter (GBq/m 3)). Since the concentrations both exceed the values in Column 1 of clause (iv)(VI) of this subparagraph, they must be compared to Column 2 values. For Sr-90 fraction, 50/150 = 0.33, for Cs-137 fraction, 22/44 = 0.5; the sum of the fractions = 0.83. Since the sum is less than 1.0, the waste is Class B.

(viii) Determination of concentrations in wastes. The concentration of a radionuclide may be determined by indirect methods such as use of scaling factors, which relate the inferred concentration of one radionuclide to another that is measured, or radionuclide material accountability, if there is reasonable assurance that the indirect methods can be correlated with actual measurements. The concentration of a radionuclide may be averaged over the volume of the waste, or weight of the waste if the units are expressed as nanocurie (becquerel) per gram.

(B) Radioactive waste characteristics.

(i) The following are minimum requirements for all classes of waste and are intended to facilitate handling and provide protection of health and safety of personnel at the disposal site.

(I) Wastes shall be packaged in conformance with the conditions of the license issued to the site operator to which the waste will be shipped. Where the conditions of the site license are more restrictive than the provisions of this section, the site license conditions shall govern.

(II) Wastes shall not be packaged for disposal in cardboard or fiberboard boxes.

(III) Liquid waste shall be packaged in sufficient absorbent material to absorb twice the volume of the liquid.

(IV) Solid waste containing liquid shall contain as little free-standing and non-corrosive liquid as is reasonably achievable, but in no case shall the liquid exceed 1.0% of the volume.

(V) Waste shall not be readily capable of detonation or of explosive decomposition or reaction at normal pressures and temperatures, or of explosive reaction with water.

(VI) Waste shall not contain, or be capable of generating, quantities of toxic gases, vapors, or fumes harmful to persons transporting, handling, or disposing of the waste. This does not apply to radioactive gaseous waste packaged in accordance with subclause (VIII) of this clause.

(VII) Waste must not be pyrophoric. Pyrophoric materials contained in wastes shall be treated, prepared, and packaged to be nonflammable.

(VIII) Wastes in a gaseous form shall be packaged at an absolute pressure that does not exceed 1.5 atmospheres at 20 degrees Celsius. Total activity shall not exceed 100 Ci (3.7 terabecquerels (TBq)) per container.

(IX) Wastes containing hazardous, biological, pathogenic, or infectious material shall be treated to reduce to the maximum extent practicable the potential hazard from the non-radiological materials.

(ii) The following requirements are intended to provide stability of the waste. Stability is intended to ensure that the waste does not degrade and affect overall stability of the site through slumping, collapse, or other failure of the disposal unit and thereby lead to water infiltration. Stability is also a factor in limiting exposure to an inadvertent intruder, since it provides a recognizable and nondispersible waste.

(I) Waste shall have structural stability. A structurally stable waste form will generally maintain its physical dimensions and its form, under the expected disposal conditions such as weight of overburden and compaction equipment, the presence of moisture, and microbial activity, and internal factors such as radiation effects and chemical changes. Structural stability can be provided by the waste form itself, processing the waste to a stable form, or placing the waste in a disposal container or structure that provides stability after disposal.

(II) Notwithstanding the provisions in clause (i)(III) and (IV) of this subparagraph, liquid wastes, or wastes containing liquid, shall be converted into a form that contains as little free-standing and non-corrosive liquid as is reasonably achievable, but in no case shall the liquid exceed 1.0% of the volume of the waste when the waste is in a disposal container designed to ensure stability, or 0.5% of the volume of the waste for waste processed to a stable form.

(III) Void spaces within the waste and between the waste and its package shall be reduced to the extent practicable.

(C) Labeling. Each package of waste shall be clearly labeled to identify whether it is Class A, Class B, or Class C waste, in accordance with subparagraph (A) of this paragraph.

(5) Time requirements for record keeping.

Figure: 25 TAC §289.202(ggg)(5) (No change.)

(6) Acceptable surface contamination levels.

Figure: 25 TAC §289.202(ggg)(6) (No change.)

(7) Concentration and activity limits of nuclides for disposal in a Type I municipal solid waste site or a hazardous waste facility (for use in subsection (fff) of this section). The following table contains concentration and activity limits of nuclides for disposal in a Type I municipal solid waste site or a hazardous waste facility.

Figure: 25 TAC §289.202(ggg)(7) (No change.)

(8) Soil contamination limits for selected radionuclides (for use in subsection (ddd) of this section).

Figure: 25 TAC §289.202(ggg)(8) (No change.)

(9) Cumulative occupational exposure form. The following, BRC Form 202-2, is to be used to document cumulative occupational exposure history: (Please find BRC Form 202-2 at the end of this section.)

Figure: 25 TAC §289.202(ggg)(9) (No change.)

(10) Occupational exposure form. The following, BRC Form 202-3, is to be used to document occupational exposure record for a monitoring period: (Please find BRC Form 202-3 at the end of this section.)

Figure: 25 TAC §289.202(ggg)(10) (No change.)

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

Filed with the Office of the Secretary of State on February 26, 2002.

TRD-200201188

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: April 1, 2002

Proposal publication date: December 14, 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

The Texas Department of Mental Health and Mental Retardation (TDMHMR) adopts the repeals of §§403.41 - 403.53 of Chapter 403, Subchapter B, concerning charges for community-based services, without changes to the proposal as published in the December 28, 2001, issue of the Texas Register (26 TexReg 10764-10765). New §§412.101 - 412.115 of Chapter 412, Subchapter C, concerning charges for community services, which replace the repealed sections, are contemporaneously adopted in this issue of the Texas Register .

The repeals allow for the adoption of new sections governing the same matters.

No comment on the proposal was received.

These sections are repealed 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.

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

Filed with the Office of the Secretary of State on February 28, 2002.

TRD-200201256

Andrew Hardin

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2002

Proposal publication date: December 28, 2001

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


Chapter 412. LOCAL AUTHORITY RESPONSIBILITIES

Subchapter C. CHARGES FOR COMMUNITY SERVICES

25 TAC §§412.101 - 412.115

The Texas Department of Mental Health and Mental Retardation (TDMHMR) adopts new §§412.101 - 412.115 of Chapter 412, Subchapter C, concerning charges for community services. Sections 412.103, 412.105, 412.106, 412.108, and 412.109 are adopted with changes to the proposed text as published in the December 28, 2001, issue of the Texas Register (26 TexReg 10765-10772). Sections 412.101, 412.102, 412.104, 412.107, and 412.110 - 412.115 are adopted without changes and will not be republished. The repeals of §§403.41 - 403.53 of Chapter 403, Subchapter B, concerning charges for community-based services, which the new sections replace, are contemporaneously adopted in this issue of the Texas Register .

The new rules 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 new rules add several new requirements for local authorities and others, the overall policy for charging for community services in the new rules is not significantly different from the policy contained in the repealed rules. A substantive new provision is the requirement for parents of minor children seeking or receiving services, who may be eligible, to enroll their children in Medicaid or the Childrens Health Insurance Program (CHIP) or provide documentation that they have been denied or that their enrollment is pending. Another substantive new provision is the requirement for adults seeking or receiving services, who may be eligible, to apply for Supplemental Security Income (SSI) in order to become eligible for Medicaid or provide documentation that they have been denied or that their application is pending.

A new provision that would affect persons receiving services as well as local authorities is the process for referring persons to their third-party coverage when the third-party coverage will not pay the local authority for services because the local authority does not have an approved provider on its network. The process includes notifying the person of the local authority's intent to refer and providing the person with an opportunity to appeal. The person is also offered the opportunity to request a review of the appeal decision. Another new provision that would affect persons receiving services and local authorities is the process that allows the local authority to involuntarily reduce or terminate a person's services for non-payment by the person (or parent). The process provides safeguards and includes the same prior notification, and appeal and review opportunities as the process for referring persons to their third-party coverage.

The new rules also contain extensive clarification of TDMHMR's policy for charging for community services, including stating that earned revenues are optimized and that TDMHMR is the payer of last resort; requiring local authorities to identify and access, and assist persons (and parents) in identifying and accessing, available funding sources other than TDMHMR; describing the process for billing third-parties and persons (and parents); and stating that persons (and parents) are responsible for paying all charges owed and that local authorities are responsible for making reasonable efforts to collect payments from all available funding sources.

Although the repealed subchapter stated that the Monthly Ability-To-Pay Fee Schedule was based on 150% of the current Federal Poverty Guidelines (FPG), the fee schedule actually began charging for services at 150% of the current FPG for a family of one person . This calculation resulted in families of two or more being charged a higher percentage of their income than families of one. The new rules continue to state that the Monthly Ability-To-Pay Fee Schedule is based on 150% of the current FPG; however, the fee schedule calculation has been revised to begin charging for services at 150% of the current FPG for a family of two persons, three persons, four persons, and so on. For example, 150% of the 2001 FPG for a family of two is $17,415. A family of two whose annual income is less than $17,415 would have a maximum monthly fee of zero. A family of two whose annual income is more than $17,415 would have a maximum monthly fee of greater than zero. Also, the increments between each annual/monthly gross income level on the revised fee schedule have been calculated so that every third increment is precisely 150% FPG for the next family size. The revised fee schedule that will be in effect on effective date of this subchapter (i.e., September 1, 2002), will be calculated using the 2002 FPG, which are expected to be published in the Federal Register in late February 2002.

A definition of "significant financial change" has been added to §412.103, to mean any change in the person's (or parent's) financial documentation (i.e., income/earnings, extraordinary expenses, number of family members, third-party coverage) that affects the person's (or parent's) ability to pay. Language has been added to §412.105(b) and §412.108(b) that lists the Qualified Medicare Beneficiary (QMB) Program as a possible available funding source. A reference to the definition of "significant financial change" has been added to §412.106(a). Language has been added to §412.108(d)(2) to clarify that nothing in the paragraph related to charging persons with Medicare is intended to conflict with any applicable law, rule, or regulation with which a local authority must comply. Language has been added to §412.109(b) requiring the local authority to determine whether a person (or parent) who claims financial hardship has experienced a significant financial change, and if so, to update the person's financial assessment. The toll-free phone number for the Office of Consumer Services and Rights Protection - Ombudsman has been added to §412.109(e)(2). Language regarding discontinuing charges to persons (or parents) in §412.109(c) has been modified to address all services instead of services not covered by third-party coverage . Language has also been modified to require local authority to discontinue charging and stop sending statements if it makes a decision, based on 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 (or parent's) refusal or rejection of the needed services.

Written comments on the proposal were received from Advocacy, Incorporated, Austin; The Arc of Texas, Austin; The Mental Health Association in Texas, Austin; Texana MHMR Center, Wharton; The Texas Council of Community MHMR Centers, Austin; Parent Association for the Retarded of Texas (PART), Austin; and the parent of a state school resident, Garland.

One commenter expressed concern that no mention is made of the rules' applicability to the legally authorized representatives (LARs) of consumers in the priority populations. The commenter recommended adding language to make the rules applicable to LARs who have financial responsibility for consumers' treatment. TDMHMR responds that an LAR, as defined in its other rules, means a individual who represents the person by making treatment decisions or consenting to treatment on behalf of the person. There are very few LARs who have financial responsibility for consumers' treatment. Adding language as recommended by the commenter creates the potential for confusion between the majority of LARs who don't have financial responsibility and the very few LARs who do. TDMHMR notes that any LAR who is financially responsible for a person is required by a court of law to take financial responsibility in all aspects of the person's life.

Regarding §412.105(a)(2), one commenter supported the rule's position that services cannot be denied to individuals in crisis. The commenter stated that the same protection should be extended to individuals in an emergency, as stated in the previous proposal. TDMHMR responds that the term "emergency" was not included because, for the purposes of this subchapter, there is no difference. TDMHMR notes that rules governing mental health community services standards (25 TAC Chapter 412, Subchapter G) contain a definition of crisis, which means "a situation in which a person believes that because of a mental health condition, he/she presents an immediate danger to self or others or that his/her mental or physical health is at risk of serious deterioration."

Regarding trusts in §412.105(b), one commenter requested that language be modified "to ensure that only those trusts that have been specified to provide for an individual's healthcare and rehabilitative needs will be accessed in identifying a person's funding sources." TDMHMR responds that modifying the rule's language is unnecessary because the proposed language clearly states as a possible available funding source trusts that provide for the person's healthcare and rehabilitative needs .

Regarding §412.105(c) and (g), one commenter supported the requirement for parents to enroll their children in income-based public insurance and for adults to apply for SSI in order to become eligible for Medicaid. The commenter also supported the requirement that the local authority provide necessary assistance to individuals during the enrollment/application process. TDMHMR responds that it appreciates the commenter's support.

Regarding the local authority's decision of whether or not a person's failure to comply with the rules' requirements is related to the person's mental illness or mental retardation in §412.105(f)(2) and §412.109(c), two commenters objected to the local authority making such a decision. The commenters supported the language in a previous proposal in which the person's interdisciplinary team (IDT) or treatment team was responsible for making the decision. The commenters stated that the decision should be made by those most knowledgeable about and closest to the person, which, the commenter stated, is the IDT or treatment team. The commenters noted that "it is not clear in the current proposal as to who at the 'local authority' will act as the decision maker. Is this a CEO, a financial officer, or perhaps the board of Directors?" TDMHMR responds that the separation of authority functions from provider functions prompted the rule change. The Texas Health and Safety Code authorizes the TDMHMR commissioner to designate the local authority (§533.035(a)); authorizes TDMHMR to contract with the local authority for community services (§533.035(b)); and authorizes the local authority to use TDMHMR funds to ensure community services are provided in the local service area (§533.035(c)). Since the local authority is responsible for ensuring the provision of services in the local service area, all decision-making authority must remain at the authority level. TDMHMR notes that the rule requires the local authority's decision to be based upon a documented clinical determination that includes input from the person's IDT or treatment team. The local authority is responsible for identifying which staff are most capable of making such decisions and clinical determinations.

Regarding retroactively adjusting the person's account in §412.105(f)(1), one commenter suggested that the rule include a time frame in which the local authority must adjust the person's account. TDMHMR responds the key issue of the provision is that the local authority will adjust the person's account to retroactively reflect the person's compliance; prescribing a time frame for adjustment is unnecessary.

Regarding the requirement for adult persons to apply for SSI to become eligible for Medicaid in §412.105(g), one commenter suggested modifying the language to state, "Adult persons who meet the Social Security Administration criteria for Supplemental Security Income (SSI) must apply for SSI or provide documentation that they..." TDMHMR responds that it declines to change the language as suggested because only Social Security Administration/Disability Determination Services can determine whether or not a person actually meets the criteria for SSI. The local authority is responsible for identifying which adult persons may be eligible for Medicaid, most likely through a screening process using the SSI criteria.

Regarding financial assessment in §412.106(a), one commenter suggested that the language be modified to consider financial hardship as a significant financial change. The commenter stated that the modification will ensure that a person's ability to pay is reassessed when the person is struck with financial hardship before the local authority arranges for the person to pay a lesser amount each month as provided in §412.109(b). TDMHMR responds that it agrees with the commenter's concern, but disagrees with the commenter's suggested modification. TDMHMR notes that the term "significant financial change," as it is used in §412.106(a), is intended to mean any change in the person's (or parent's) financial documentation (i.e., income/earnings, extraordinary expenses, number of family members, third-party coverage) that affects the person's (or parent's) ability to pay. While a significant financial change could result in financial hardship, financial hardship is not always caused by a significant financial change. Language has been added to three sections of the subchapter to address the commenter's concern: a definition of "significant financial change" has been added to §412.103; a reference to the definition has been added to §412.106(a); and language has been added to §412.109(b) requiring the local authority to determine whether a person (or parent) who claims financial hardship has experienced a significant financial change, and if so, to update the person's financial assessment.

Regarding the financial assessment in §412.106(a), one commenter stated that the rule should contain a requirement for the local authority to educate the person (or parent) regarding charges for community services and the rights and responsibilities of consumers. The commenter recommended adding language on training (persons and parents) regarding charges for community services, including information regarding the right to appeal, a description of any and all exemptions from charges, and the fact that individuals who are facing what they believe to be "financial hardship" can contact the local authority to set up a payment plan. TDMHMR responds that §412.112 provides for persons (and parents) to be informed of the policies for charging for community services contained in this subchapter, including information related to claiming financial hardship. Regarding information about the right to appeal, TDMHMR responds that these rules require the local authority to notify persons (and parents) of their right to appeal a specific action taken in accordance with these rules (see §412.106(c)(2)(B) and §412.109(d)(3)(B) and §412.109(e)). Additionally, §401.464(c) of this title (relating to Notification and Appeals Process) requires the local authority to provide persons and their legally authorized representatives written notification of the local authority's policy for addressing concerns or dissatisfaction with services/supports at the time of admission into services and annually thereafter.

Regarding notification in §412.106(e), one commenter strongly supported the inclusion of the name and telephone number of at least one local authority staff member who can be contacted to discuss the information in the notice. The commenter requested that the notification include "contact information for how to appeal the determination or correct any inaccurate information that is included on the notification." TDMHMR responds that adding language as requested by the commenter is unnecessary because the person (or parent) may contact the local authority staff whose name and telephone number is on the notification in order to correct any inaccurate information that is on the notification or that was used to determine ability to pay. TDMHMR notes that the rules do not contain a process for the person (or parent) to appeal his/her determination of ability (or inability) to pay.

Regarding standard charges in §412.107, one commenter objected to the language that "allows each community center to inflate the cost of the service, at the center's discretion, without any stated guidelines." The commenter supported the provision in a previous proposal requiring standard charges to be based on costs and calculated using a TDMHMR-approved costing methodology. TDMHMR responds the stated guidelines for establishing standard charges are that the charges be "reasonable" and "cover, at a minimum, the local authority's cost of ensuring the provision of the service." TDMHMR interprets "reasonable" to mean within the range of current market value. TDMHMR notes that a local authority must first determine its cost of ensuring the provision of a service before it can establish a standard charge and that local authorities are required by contract to calculate its operating costs using TDMHMR's approved cost accounting methodology.

Regarding monthly account in §412.108(a), one commenter recommended that the subsection consider individuals whose third-party payer denies covered services because the third-party payer does not believe the covered service is medically necessary. The commenter stated that if these services are believed by the individual's treatment team to be medically necessary, then the services should be indicated as not covered by third-party coverage on the monthly account. The commenter also stated that in such cases, the local authority should be responsible for assisting the individual or parent in filing any necessary appeals with the third-party payer, including requests for an external review (managed by the Texas Department of Insurance) or a Medicaid fair hearing. TDMHMR responds that the monthly account listings should reflect the current status of the person's services by payer source, which means the listing may change depending upon prior and subsequent approvals or denials by third-party coverage. Regarding assistance with appealing to the third-party coverage, TDMHMR responds that the provider who identified the service as being medically necessary would be responsible for assisting the person in filing any necessary appeals with the third-party coverage or requesting an external review.

Regarding billing persons with non-Medicare third-party coverage in §412.108(d)(3)(A), one commenter stated that her organization requested an official opinion from the Texas Department of Insurance (TDI) regarding whether a local authority could waive co-payments or deductibles that exceed the maximum monthly fee (MMF) of persons with third-party coverage. The commenter asked that TDMHMR not move forward on these rules until TDI has responded. The commenter also stated, "We believe the Department does have the authority to waive co-payments as a managed care provider. In that case, we recommend no greater fee than the maximum monthly fee be charged to any individual who gets services from the Department, since the sliding fee scale which determines the maximum monthly fee is developed in an effort to make services reasonable affordable." TDMHMR responds that it declines to delay the rules' adoption because the majority of the provisions contained in the proposal are uncontested and provide necessary policy clarifications that will result in the subchapter being more uniformly implemented. Further, in TDMHMR's discussions with TDI, TDI's position was not that waiving co-payments or deductibles was prohibited, rather TDI expressed concern that the proposed policy of waiving the portion of co-payments and deductibles that exceeded the person's MMF could discourage private insurers from contracting with a local authority. This would have a negative impact on the local authority's ability to maximize contributions to local revenue and is contrary to the state law on which this subchapter is promulgated -- that the fee collection policy maximize contributions to local revenue. TDMHMR notes that it is not a managed care provider. TDMHMR provides funds to local authorities who are responsible for ensuring the provision of community services to people in the priority population. The contract between the person's third-party coverage and the person's provider governs whether the provider is permitted to waive co-payments, co-insurance, and deductibles. And in the case of Medicare, federal laws and regulations as well as the Medicare Provider Reimbursement Manual (HCFA Pub. 15-1) describe the conditions under which the provider is permitted to waive co-payments, co-insurance, and deductibles.

One commenter stated that, although the proposed rules reflect productive deliberations conducted by TDMHMR with key stakeholders, the rules put forward a new concept that remains contentious: procedures for billing persons with Medicare (§412.108(d)(2)) that differ from procedures for billing persons with other types of third-party coverage (§412.108(d)(3)). The commenter stated, "We remain of the opinion that it is beyond the scope of the statutes governing charges for community-based services for the Department to use its own provider experience (operating state facilities) as the basis for regulating centers' compliance with requirements of any third-party payer alternative to the performance contract, including Medicare." The commenter requested that language in §412.108(d)(2) be replaced with, "It is the Department's expectation that local authorities comply with contractual obligations of any third-party contracts." The commenter also requested that §412.108(d)(3) be modified so as to not differentiate between Medicare and other types of third-party coverage. TDMHMR responds that these rules are promulgated in order to comply with the state statute (Texas Health and Safety Code, §534.067), which requires TDMHMR to establish a uniform fee collection policy for local authorities that is equitable, provides for collections, and maximizes contributions to local revenue. The rules describe how local authorities are to charge persons in the priority population for community services. The rules do not attempt to regulate or interpret a local authority's contractual compliance with its third-party payers, including Medicare. Nothing in this subchapter is intended to adversely affect a local authority's ability to comply with any other applicable law, rule, or regulation. TDMHMR has conducted extensive research of Medicare regulations regarding the commenter's concern and has not identified any provision in these rules that conflicts with or is contrary to any Medicare requirement concerning waiver of co-payments and deductibles. TDMHMR notes that local authorities are able to comply with this subchapter as well as with all applicable Medicare requirements. Although TDMHMR supports the commenter's statement that TDMHMR expects a local authority to comply with the contractual obligations of its third-party payer contracts, it declines to modify the language in §412.108(d)(2) and (d)(3).

Regarding billing statements in §412.108(e), one commenter suggested adding language requiring the statement to contain contact information for directing questions or comments about the statement. TDMHMR responds that it is standard business practice for statements to include contact information. TDMHMR declines to add language to the rule as suggested.

Regarding financial hardship and deferred payment in §412.109(b), one commenter stated that the provision will be helpful to staff responsible for making reasonable efforts to collect payments. TDMHMR responds that it appreciates the commenter's support.

Regarding financial hardship and deferred payment in §412.109(b)(1), one commenter recommended modifying the paragraph "so that if a person (or parent) claims and provides documentation of a financial hardship, then his/her ability to pay will be immediately re-assessed then updated annually, or as needed as long as the person continues to receive services as stated in §412.106(a)." The commenter stated that the modification will translate into added safeguards to protect the person from incurring charges that he/she is unable to pay because of significant financial changes. TDMHMR responds it agrees with the commenter that deferred payment is not appropriate when financial hardship is caused by significant financial changes; significant financial changes warrant an updated financial assessment. Language has been added to three sections of the subchapter to address the commenter's concern: a definition of "significant financial change" has been added to §412.103; a reference to the definition has been added to §412.106(a); and language has been added to §412.109(b) requiring the local authority to determine whether a person (or parent) who claims financial hardship has experienced a significant financial change, and if so, to update the person's financial assessment.

Regarding financial hardship and deferred payment in §412.109(b)(1) and in the example for addressing a past-due account in §412.109(b)(1), two commenters objected to the local authority having the option of arranging for deferred payments if the person provides documentation that he/she is experiencing financial hardship. The commenters recommended that the local authority be required to arrange for deferred payments. TDMHMR responds that the permissive language allows the local authority flexibility in determining the cause and/or validity of the financial hardship and responding to the person's claim of financial hardship in an appropriate manner. Mandating deferred payment each time a person provides documentation of financial hardship prevents the local authority from taking other actions that may be more appropriate or beneficial to the person. TDMHMR declines to modify the rule as recommended by the commenter.

Regarding §412.109(d), two commenters expressed vehement opposition to the provision that allows for involuntary reduction or termination of services for non-payment. The commenters stated that such a provision in TDMHMR's rules governing charges for community services is evidence that financial, rather than clinical, reasons will dictate when a person's services should be reduced or terminated. The commenters recommended deleting the subsection to ensure local authorities will remain the "safety net for our most disabled citizens." One of the commenters reminded TDMHMR "that the very reasons which a local authority may use to justify the termination of services are often closely associated with the symptoms of the person's disability." The commenter also noted that TDMHMR's rules governing charges for services in TDMHMR facilities do not contain such a provision. TDMHMR responds that the provision is intended to reinforce the concept that financial participation is a clinical issue. Multiple provisions in the rules support this concept and require the local authority to consider clinical aspects as well as financial aspects in the therapeutic relationship with each person. In a resource-poor environment, in which the need for services far exceeds the availability, prudent use of funds is necessary to reduce the likelihood of persons abusing the public mental health system by not participating financially when they have an ability to pay, while others wait for needed services. TDMHMR notes that the rules governing charges for services in facilities does not contain a similar provision because facilities are responsible for providing court ordered in-patient or residential services to the person. TDMHMR also notes that this subchapter prohibits involuntarily reducing or terminating a person's services for non-payment when the local authority is identified as being responsible for providing the court ordered outpatient services to the person.

Regarding §412.109(d)(2), one commenter stated that the definition of "clinically contraindicated" to mean "at imminent risk of serious deterioration" will be helpful in making consistent decisions to waive charges rather than discontinue services for non-payment. Another commenter stated that the proposed language is more restrictive than the language in the previous proposal which stated "clinically contraindicated." The commenter recommended using the language contained in the previous proposal. TDMHMR responds that it appreciates the commenter's support and notes that the language change was made in response to comments received on the previous proposal, which indicated the term "clinically contraindicated" was too vague and would likely result in the provision being inconsistently applied. Regarding the other commenter's preference for "clinically contraindicated," TDMHMR responds that the more restrictive criteria actually clarifies TDMHMR's intent; that local authorities are prohibited from involuntarily reducing or terminating a person's services if it would cause the person's mental or physical health to be at imminent risk of serious deterioration. The clarification will provide for maximum uniformity in the rule's implementation.

Regarding notice of a Medicaid fair hearing §412.109(e)(1), four commenters opposed the deletion of language that requires Medicaid recipients to be provided notice of the involuntary reduction or termination of Medicaid services and the opportunity to request a Medicaid fair hearing. TDMHMR responds that language regarding notice of a Medicaid fair hearing was not included in the proposal because Medicaid services are not involuntarily reduced or terminated for non-payment by the person (or parent). TDMHMR notes that its rules governing Medicaid services, service coordination (25 TAC Chapter 412, Subchapter J) and rehabilitative services (25 TAC Chapter 419, Subchapter L), require the Medicaid provider (i.e., the local authority) to provide Medicaid recipients with notice of termination, suspension, or reduction of covered services. Additionally, rules governing Medicaid fair hearings (1 TAC Chapter 357) state that the notice must contain an explanation of the Medicaid recipient's right to request a fair hearing as well as the procedures for doing so.

Regarding debt collection in §412.109(g), two commenters strongly opposed the provision that permitted local authorities to use a debt collection agency. The commenters stated that the Texas Health and Safety Code, §534.017(d), provides for the county or district attorney of the county to represent a local authority in collecting fees. The commenter noted that the law does not authorize the use of a private debt collection agency by a local authority. The commenters requested that the subsection be modified to "delete the language that a debt collection agency may be used to collect debts and add the provision that only the county or district attorney may represent the local authority in collecting fees owed by persons receiving services." TDMHMR responds that, although the Texas Health and Safety Code, §534.017(d), provides for the county or district attorney of the county to represent a community center in collecting fees, the statute does not restrict a community center's debt collection efforts to representation by the county or district attorney. Additionally, TDMHMR responds that it carefully considered the issue of debt collection agencies and determined that it had three options for addressing the issue: (1) prohibiting the use of debt collection agencies in the rule; (2) not addressing use of debt collection agencies in the rule; or (3) permitting the use of debt collection agencies in the rule, but with strict parameters. The first option was problematic because it is not clear whether or not TDMHMR has the authority to prohibit a local authority's use of debt collection agencies. The second option, which essentially would allow each local authority to decide for itself whether or not it was authorized to use a debt collection agency, could result in a fee collection policy that was not uniform. TDMHMR chose the third option because it: (a) does not exceed its statutory authority; (b) ensures a uniform fee collection policy; and (c) provides safeguards for the person if a local authority elects to use a debt collection agency.

Regarding the Monthly Ability-to-Pay Fee Schedule in §412.110, two commenters supported the revised fee schedule that reflects 150% of the Federal Poverty Guidelines (FPG) for all family sizes, although one of the commenters stated a preference that the fee schedule be based on 200-250%. TDMHMR responds that it appreciates the commenters' support.

Regarding training in §412.111, one commenter requested that the section be modified to require TDMHMR to consider input from local authorities, consumers, and other stakeholders (e.g., family members and advocates) in developing the training program. TDMHMR responds that it intends to consider input from local authorities, consumers, and other stakeholders (e.g., family members and advocates) in developing the training program.

Regarding §412.111, one commenter strongly supported the requirement for training contained in the rule. TDMHMR responds that is appreciates the commenter's support.

Another commenter stated that local authorities will benefit from technical assistance in understanding and applying the components of the rules. The commenter expressed an understanding that TDMHMR does not intend to follow the adoption of the rules with training. The commenter urged TDMHMR to designate one person to receive questions and formulate answers until at least the end of the calendar year. The commenter offered to have her organization "designate several knowledgeable center staff to serve as an 'expert panel' to assist the Department in receiving questions, developing answers and conveying this information to all Local MHMR Authorities." TDMHMR responds that it will provide training and agrees that technical assistance will support uniform implementation the rules. Additionally, TDMHMR will designate an agency contact person who will be responsible for receiving questions and relaying answers. Regarding the commenter's offer of appointing an "expert panel" to help disseminate information, TDMHMR responds that it appreciates the offer and will work closely with the commenter to identify "experts" for technical assistance with this subchapter.

Regarding the brochure for persons (and parents) in §412.112, one commenter appreciated the work done on the section and stated that it would ensure each person is provided information about policies for charging for community services, including statutory trust exemptions. Another commenter stated that the brochure would assist local authorities in providing consistent information. TDMHMR responds that it appreciate the commenters' support.

Also regarding the brochure in §412.112, a third commenter stated that, because the information contained in the rules is potentially confusing, the components that are included in the brochure should be discussed in person with individuals, parents, and/or LARs at least once, preferably during the initial financial assessment. The commenter recommended that the brochure contain information regarding how enrollees with third-party payers can assert their rights, how to request a Medicaid Fair Hearing, or how to appeal a private insurer's denial of a covered service. TDMHMR responds that, currently, the training program developed by TDMHMR requires a face-to-face explanation of the information contained in the brochure as part of the financial assessment. Additionally, the brochure provides the name and phone number of a staff member whom the person can contact to discuss the information in the brochure. Regarding including additional information in the brochure, TDMHMR responds that since the information suggested by the commenter is not contained in the rules' policies for charging for community services, it would be inappropriate for inclusion in the brochure. TDMHMR notes that the person's third-party coverage is responsible for providing information to its members on how they can assert their rights or appeal the denial of a covered service. TDMHMR also notes that the right to request a Medicaid fair hearing is limited to certain actions by a Medicaid operating agency or its designee as described in rules governing Medicaid fair hearings (1 TAC Chapter 357); governing service coordination (25 TAC Chapter 412, Subchapter J); and governing rehabilitative services (25 TAC Chapter 419, Subchapter L).

The new rules are adopted 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.

§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--The 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--Except for inpatient services in a state MH facility and non-crisis residential services, the required and optional mental health and mental retardation services described in the performance contract, including:

(A) 24-hour emergency screening and rapid crisis stabilization services;

(B) community-based crisis residential services or inpatient services in a mental health facility that is not a state MH facility;

(C) community-based assessments, including the development of interdisciplinary treatment plans, and diagnosis and evaluation services;

(D) family support services, including respite care;

(E) case management services (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) Extraordinary expenses--Major medical or health related expenses, major casualty losses, and child care expenses for the previous year or projections for the next year.

(4) Family members--

(A) For an unmarried person under the age of 18 years--The person, the person's parents, and the dependents of the parents, if residing in the same household;

(B) For an unmarried person age 18 years or older--The person and his/her dependents;

(C) For a married person of any age--The person, his/her spouse, and their dependents.

(5) Gross income--Revenue from all sources before taxes and other payroll deductions. The term does not include child support received.

(6) Inability to pay--The person's maximum monthly fee is zero and the person:

(A) does not have third-party coverage;

(B) has third-party coverage, but 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) 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 ).

(7) Income-based public insurance--Government funded third-party coverage that bases eligibility on income (i.e., CHIP and Medicaid).

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

(9) Performance contract--A written agreement between TDMHMR and a local authority for the provision of one or more functions as described in the Texas Health and Safety Code, §533.035(a).

(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 mental retardation services.

(12) Significant financial change--Any change in the person's (or parent's) financial documentation, as described in §412.105(d) of this title (relating to Accountability), that affects the person's (or parent's) ability to pay. Examples of a significant financial change are:

(A) a reduction in income due to the loss of a job or due to a reduction in hours worked on a job;

(B) an increase in income because of an inheritance or a salary increase;

(C) an increase or decrease in the number of family members;

(D) the gain or loss of third-party coverage; and

(E) an increase or decrease in extraordinary expenses.

(13) Standard charge--A fixed price for a community service or unit of service.

(14) State MH facility--A state hospital or a state center with an inpatient component.

(15) Team--The interdisciplinary team, multidisciplinary team, or treatment team.

(16) Third-party coverage--A public or private payer of community services for a specific person that is not the person (e.g., Medicaid, Medicare, private insurance, CHIP, TRICARE).

§412.105.Accountability.

(a) Prohibition from denying services. Local authorities are prohibited from denying services to a person:

(1) because of the person's inability to pay for the services;

(2) in crisis because:

(A) a financial assessment has not been completed;

(B) financial responsibility has not been determined;

(C) the person has a past-due account; or

(D) the person had his/her services involuntarily reduced or terminated for non-payment under §412.109(d) of this title (relating to Payments, Collections, and Non-payment); 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 (c), (d), (e), and (g) of this section.

(b) Identifying funding sources. Local authorities are responsible for identifying and accessing available funding sources other than TDMHMR, and for assisting persons (and parents) in identifying and accessing available funding sources other than TDMHMR, to pay for services. Available funding sources may include third-party coverage, state and/or local governmental agency funds (e.g., crime victims fund), Qualified Medicare Beneficiary (QMB) Program, indigent pharmaceutical programs, or a trust that provides for the person's healthcare and rehabilitative needs.

(c) Requirement for parents to enroll their children in income-based public insurance. Parents of children who may be eligible for Medicaid or the Childrens Health Insurance Program (CHIP) must enroll their children in Medicaid or CHIP or provide documentation that they have been denied Medicaid or CHIP benefits or that their Medicaid or CHIP enrollment is pending. The local authority shall provide assistance as needed to facilitate the enrollment process.

(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 (as defined) paid during the past 12 months or projected for the next 12 months;

(3) number of family members (as defined); and

(4) proof of any third-party coverage.

(e) Authorizing third-party coverage payment to the local authority. Persons (and parents) with third-party coverage must execute an assignment of benefits authorizing third-party coverage payment to the local authority.

(f) Failure to comply.

(1) Except as provided by paragraph (2) of this subsection, if the person (or parent) fails to comply with any requirement in subsections (c)-(e) of this section, then the local authority will charge the person (or parent) the standard charge(s) for services. If, within 30 days after the person (or parent) initially failed to comply, the person (or parent) complies with the requirements, then the local authority will adjust the person's account to retroactively reflect compliance.

(2) The local authority will not charge the person the standard charge(s) for services if the local authority makes a decision, based on a clinical determination that is documented and includes input from the person's team, that the person's failure to comply is related to the person's mental illness or mental retardation. The clinical determination must be reassessed at least every three months. If the local authority decides that a person's failure to comply is related to the person's mental illness or mental retardation, then the local authority must develop and implement a plan to reduce or eliminate the barriers related to the person's failure to comply.

(g) Requirement for adult persons to apply for SSI to become eligible for Medicaid. Adult persons who may be eligible for Medicaid must apply for Supplemental Security Income (SSI) or provide documentation that they have been denied SSI or that their SSI application is pending. The local authority shall provide assistance as needed to facilitate all aspects of the application process. If the adult person is unable to act in accordance with the requirement because of the person's mental illness or mental retardation, then the local authority must develop and implement a plan to reduce or eliminate the barriers related to the person's inability to act in accordance with the requirement.

§412.106.Determination of Ability to Pay.

(a) Financial assessment. The local authority must conduct and document a financial assessment for each person within the first 30 days of services. The local authority must update each person's financial assessment at least annually and whenever a significant financial change (as defined) occurs 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 years or older and the person's spouse; or

(2) parents of the person who is under age 18 years.

(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 §412.113 of this title (relating to Exhibit). The calculation is based on the number of family members and 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) Third-party coverage that will pay. A person with third-party coverage that will pay for needed services is determined as having an ability to pay for those services.

(2) Third-party coverage that will not pay.

(A) If the person's third-party coverage will not pay for needed services because the local authority does not have an approved provider on its network, then the local authority will propose to refer the person to his/her third-party coverage to identify a provider for which the third-party coverage will pay unless:

(i) the local authority is identified as being responsible for providing court-ordered outpatient services to the person;

(ii) the local authority is able to negotiate adequate payment for services with the person's third-party coverage; or

(iii) the person (or parent) voluntarily agrees to pay the standard charge(s) for the needed service(s).

(B) If the local authority proposes to refer the person to his/her third-party coverage as described in paragraph (2)(A) of this subsection, then the local authority will provide written notification to the person (or parent) in accordance with §412.109(e)(1) of this title (relating to Payments, Collections, and Non-payment), which provides an opportunity to appeal. The local authority must also comply with §412.109(e)(2)-(3) as initiated by the person (or parent).

(C) If the local authority refers the person to his/her third-party coverage, then the local authority will assist the person (or parent) in identifying a provider for which the third-party coverage will pay.

(D) If a person who has been referred to his/her third-party coverage is unable to identify or access needed services from an approved provider or if access will be unduly delayed, then the local authority will:

(i) assist the person (or parent) in resolving the matter with the third-party coverage (e.g., contacting customer service at the third-party coverage, filing a complaint with the third-party coverage or the Texas Department of Insurance); and

(ii) if clinically indicated, ensure the provision of the needed services to the person pending resolution.

(E) The local authority will maintain documentation of:

(i) all referrals as described in paragraph (2)(C) of this subsection;

(ii) all assistance as described in paragraph (2)(D)(i) of this subsection; and

(iii) whether the person received services pending resolution as described in paragraph (2)(D)(ii) of this subsection.

(d) Social Security work incentive provisions. A person who identified payment for specific needed services in his/her approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ) is determined as having an ability to pay for the specific services. 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. After a financial assessment is conducted, the local authority must provide written notification 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 family members);

(3) the amount of the maximum monthly fee;

(4) the name and phone number of at least one local authority staff who the person (or parent) may contact during office hours to discuss 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.

§412.108.Billing Procedures.

(a) Monthly account.

(1) The local authority will maintain a monthly account for each person that lists all services provided to the person during the month and the standard charges for the services. Each service listed will indicate whether the service is:

(A) covered by Medicare third-party coverage;

(B) covered by non-Medicare third-party coverage;

(C) not covered by third-party coverage; or

(D) identified for payment in the person's approved plan utilizing Social Security work incentive provisions.

(2) If a person has exceeded the maximum third-party coverage benefit of a particular covered service, then that service is indicated as not covered by third-party coverage.

(b) Accessing funding sources. The local authority must access all available funding sources before using TDMHMR funds to pay for a person's services. Funding sources may include third-party coverage, state and/or local governmental agency funds (e.g., crime victims fund), Qualified Medicare Beneficiary (QMB) Program, indigent pharmaceutical programs, or a trust that provides for the person's healthcare and rehabilitative needs.

(c) Billing third-party coverage. The local authority will bill the person's third-party coverage the monthly account amount for covered services. If the local authority has negotiated a reimbursement amount with the third-party coverage that is different from the monthly account amount, then the local authority may bill the third-party coverage the negotiated reimbursement amount for covered services.

(d) Billing the person (or parents).

(1) No third-party coverage. If the monthly account amount for services not covered by third-party coverage:

(A) exceeds the person's maximum monthly fee (MMF), then the amount is reduced to equal the MMF and the local authority bills person (or parent) the MMF; or

(B) is less than the person's MMF, then the local authority bills the person (or parent) the monthly account amount for services not covered by third-party coverage.

(2) Medicare third-party coverage. Nothing in this paragraph is intended to conflict with any applicable law, rule, or regulation with which a local authority must comply.

(A) The following amounts are added to equal the total amount applied toward the person's MMF:

(i) the amount of all applicable co-payments and co-insurance for services listed in the monthly account as covered by Medicare third-party coverage;

(ii) the amount Medicare third-party coverage was billed but did not pay because the deductible hasn't been met; and

(iii) the monthly account amount for services not covered by third-party coverage.

(B) If the total amount applied toward the person's MMF as described in paragraph (2)(A) of this subsection:

(i) exceeds the person's MMF, then the amount is reduced to equal the MMF and the local authority bills person (or parent) the MMF; or

(ii) is less than the person's MMF, then the local authority bills the person (or parent) the total amount applied toward the MMF.

(3) Non-Medicare third-party coverage.

(A) Cost-sharing exceeds MMF. If the amount of all applicable co-payments, co-insurance, and deductibles for services listed in the monthly account as covered by non-Medicare third-party coverage exceeds the person's MMF, then the local authority bills the person (or parent) all applicable co-payments, co-insurance, and deductibles.

(B) Cost-sharing does not exceed MMF.

(i) If the amount of all applicable co-payments, co-insurance, and deductibles for services listed in the monthly account as covered by non-Medicare third-party coverage does not exceed the person's MMF, then the following amounts are added to equal the total amount applied toward the person's MMF:

(I) the amount of all applicable co-payments, co-insurance, and deductibles; and

(II) the monthly account amount for services not covered by third-party coverage.

(ii) If the total amount applied toward the person's MMF as described in paragraph (3)(B) of this subsection:

(I) exceeds the person's MMF, then the amount is reduced to equal the MMF and the local authority bills person (or parent) the MMF; or

(II) is less than the person's MMF, then the local authority bills the person (or parent) the total amount applied toward the MMF.

(C) Annual cost-sharing limit. If the person (or parent) has reached his/her annual cost-sharing limit (i.e., maximum out-of-pocket expense) as verified by the non-Medicare third-party coverage, then the local authority will not bill the person (or parent) any co-payments, co-insurance, or deductibles, as applicable to the annual cost-sharing limit, for services covered by the non-Medicare third-party coverage for the remainder of the policy-year.

(4) Social Security work incentive provisions.

(A) If the person identified a payment amount for specific services in his/her approved plan utilizing Social Security work incentive provisions (i.e., Plan to Achieve Self-Sufficiency; Impairment Related Work Expense ), then the local authority bills the person the monthly account amount for the specific services up to the identified payment amount. If the monthly account amount for the specific services is greater than the identified payment amount, then the remaining balance is applied toward the person's MMF.

(B) The following amounts are added to equal the total amount applied toward the person's MMF:

(i) any remaining balance as described in paragraph (4)(A) of this subsection; and

(ii) the monthly account amount for services not covered by third-party coverage.

(C) If the total amount applied toward the person's MMF as described in paragraph (4)(B) of this subsection:

(i) exceeds the person's MMF, then the amount is reduced to equal the MMF and the local authority bills person (or parent) the MMF; or

(ii) is less than the person's MMF, then the local authority bills the person (or parent) the total amount applied toward the MMF.

(e) Statements.

(1) The local authority will send to persons (and parents) who have been determined as having the ability to pay monthly or quarterly statements that include:

(A) an itemized list, at least by date and by type, of all services provided during the period;

(B) the standard charge for each service;

(C) the total charge for the period;

(D) the amount paid (or to be paid) by each funding source; and

(E) the amount to be paid by the person (or parent).

(2) Unless requested otherwise, the local authority does not send statements to persons (or parents) who have an ability to pay if they maintain a zero balance (i.e., the person (or parent) does not currently owe any money).

(3) Unless requested otherwise, the local authority does not send statements to persons (or parents) who have an inability to pay.

§412.109.Payments, Collections, and Non-payment.

(a) Payment and collection.

(1) Persons (and parents) are responsible for promptly paying all charges owed to the local authority.

(2) Local authorities are responsible for making reasonable efforts to collect payments from all available funding sources before accessing TDMHMR funds to pay for persons' services.

(b) Financial hardship. If a person (or parent) claims financial hardship as provided in this subsection, then the local authority must determine whether a significant financial change (as defined) has occurred. If a significant financial change has occurred, then the local authority must immediately update the person's (or parent's) financial assessment as required in 412.106(a) of the title (relating to Determination of Ability to Pay).

(1) 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.

(2) If a person (or parent) claims that financial hardship prevents prompt payment of all charges owed, then the local authority must arrange for the person (or parent) to pay a lesser amount each month only if the person has third-party coverage that is neither income-based public insurance nor Medicare and the person's cost-sharing exceeds his/her MMF. The lesser amount:

(A) will be no more than the person's MMF, if the person's MMF is greater than zero; or

(B) will be no more than $5.00, if the person's MMF is zero.

(3) Although the person (or parent) may 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.

(c) Discontinuing charges to persons (or parents) for services. If the local authority makes a decision, based on a clinical determination that is documented and includes input from the person's team, that being charged for services and receiving statements will result in a reduction in the functioning level of the person or the person's (or parent's) refusal or rejection of the needed services, then the local authority will discontinue charging the person (or parent) for services and stop sending statements. The clinical determination must be reassessed at least every three months. If the local authority decides to discontinue charging the person (or parent) for services, then the local authority must develop and implement a plan to address the issues related to the person's functioning level or the person's (or parent's) refusal or rejection of the needed services.

(d) Involuntary reduction or termination of services for non-payment by person (or parent).

(1) The local authority will address the past-due account of a person (or parent) who is not making payments to ensure reasonable efforts to secure payments are initiated with the person (or parent). For example, if the local authority determines that non-payment is related to financial hardship, then the local authority may assist the person (or parent) in making arrangements to pay a lesser amount each month in accordance with subsection (a)(2) of this section or if the local authority makes a decision, based on a clinical determination that is documented and includes input from the person's team, that non-payment is related to the person's mental illness or mental retardation, then the person's treatment/service plan may be modified to address the non-payment.

(2) If the local authority makes a decision, based on a clinical determination that is documented and includes input from the person's team, that non-payment is not related to the person's mental illness or mental retardation and, despite reasonable efforts to secure payment, the person (or parent) does not pay, then the local authority may propose to involuntarily reduce or terminate the person's services. The local authority may not propose to involuntarily reduce or terminate the person's services if the proposed action would cause the person's mental or physical health to be at imminent risk of serious deterioration or the local authority is identified as being responsible for providing court-ordered outpatient services to the person.

(3) If the local authority proposes to involuntarily reduce or terminate the person's services, then the local authority must:

(A) maintain clinical documentation that the proposed action would not cause the person's mental or physical health to be at imminent risk of serious deterioration; and

(B) provide written notification to the person (or parent) in accordance with subsection (e)(1) of this section and comply with subsection (e)(2)-(3) as initiated by the person (or parent).

(e) Notification, Appeal, and Review.

(1) Notification. The local authority will notify the person (or parent) in writing of the proposed action (i.e., to involuntarily reduce or terminate the person's services or refer the person to his/her third-party coverage) and the right to appeal the proposed action in accordance with §401.464 of this title (relating to Notification and Appeals Process). The notification will describe 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 local authority may not take the proposed action while the appeal is pending. The local authority may take the proposed action if the person (or parent) does not request a review within the prescribed time frame.

(2) Appeal and appeal decision. The appeal is conducted in accordance with §401.464(g) of this title (relating to Notification and Appeals Process). The local authority will notify the person (or parent) in writing of the appeal decision in accordance with §401.464(h) and the right to have the appeal decision reviewed by the Office of Consumer Services and Rights Protection - Ombudsman (1-800-252-8154) at TDMHMR Central Office if the person (or parent) is dissatisfied with the appeal decision. The notification must describe the time frames and process for requesting a review.

(3) Review of appeal decision. If the person (or parent) is dissatisfied with the appeal decision, then the person (or parent) may request a review by the Office of Consumer Services and Rights Protection - Ombudsman at TDMHMR Central Office. A request for review must be submitted to the Office of Consumer Services and Rights Protection - Ombudsman, TDMHMR, P.O. Box 12668, Austin, TX 78751, within 10 working days of receipt of the appeal decision. If the person (or parent) requests a review within the prescribed time frame, then the local authority may not take the proposed action while the review is pending. The local authority may take the proposed action if the person (or parent) does not request a review within the prescribed time frame and the appeal decision upholds the decision to take the proposed action.

(A) A person (or parent) who requests a review may choose to have the reviewer conduct the review:

(i) 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) 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.

(B) 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 review unless an extension is granted by the director of the Office of Consumer Services and Rights Protection - Ombudsman;

(ii) will include an examination of the pertinent information concerning the proposed action and may include consultation with TDMHMR clinical staff and staff who are responsible for the policy contained in this subchapter;

(iii) will result in a final decision which will uphold, reverse, or modify the original decision to take the proposed action; and

(iv) is the final step of the appeal process for involuntarily reducing or terminating the person's services for non-payment and for referring the person to his/her third-party coverage.

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

(D) The local authority will take appropriate action consistent with the final decision.

(f) Prohibition of financial penalties. The local authority may not impose financial penalties on a person (or parent).

(g) 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.

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

Filed with the Office of the Secretary of State on February 28, 2002.

TRD-200201255

Andrew Hardin

Chairman, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: September 1, 2002

Proposal publication date: December 28, 2001

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