Part 1.
TEXAS DEPARTMENT OF HEALTH
Chapter 61.
CHRONIC DISEASES
Subchapter C. BREAST AND CERVICAL CANCER CONTROL PROGRAM
25 TAC §§61.31 - 61.42
The Texas Department of Health (department) adopts amendments
to §§61.31 - 61.42 concerning the operation of the Texas Breast
and Cervical Cancer Control Program (program). Sections 61.32, 61.34 - 61.35,
61.37, and 61.41 are adopted with changes to the proposed text as published
in the November 9, 2001 issue of the
Texas Register
(26 TexReg 9012). Sections 61.31, 61.33, 61.36, 61.38 - 61.40 and
61.42 are adopted without changes, and therefore the sections will not be
republished.
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). The sections have been
reviewed and the department has determined that reasons exist for readopting
the sections continue to exist.
Specifically, the sections concern purpose and scope; federal authorization
and requirements; eligible applicants; target population; selection process;
program requirements; financial eligibility and screening guidelines; quality
assurance standards; follow-up; maintenance of current services; reimbursement
of costs; and client charges.
Section 61.31 is adopted to update the purpose and scope of the program.
An amendment to §61.32 is adopted to incorporate references to the re-authorization
of the enabling federal legislation and to clarify the department's role in
managing the program. Section 61.33 is adopted to clarify the program's income
eligibility requirements and the types of organizations eligible to apply
for program funds. Adoption of §61.34 clarifies eligibility for program
services. Adoption of amendment to §61.35 clarifies the criteria for
selection of program service providers. Section 61.36 is adopted to clarify
the requirements that applicant organizations must meet to qualify for program
funding, including the addition of requirements for matching contributions.
Adoption of §61.37 clarifies program financial eligibility and updates
requirements for screening and diagnostic services. Section 61.38 concerning
Quality Assurance Standards is adopted to repeal reference to publications
in §61.32. Adoption of §61.39 adds requirements for follow-up and
case management. Adoption of §61.40 updates the intent of the program
to provide diagnostic services, client education, professional education,
and case management. Adoption of §61.41 revises the reimbursement method
used by the program and updates the method for determining reimbursement rates.
Additionally, the amendment describes the conditions under which administrative
and other costs are reimbursed. Adoption of §61.42 clarifies the program
policy prohibiting the charging of fees to program clients.
The department is making the following minor changes due to staff comments
to clarify the intent and improve the accuracy of the sections.
Change: Concerning §61.32, the phrase "prevention and control of"
was deleted and replaced with "early detection of and prevention of mortality
from" to clarify the program's intent and the department's authorization from
the federal government.
Change: Concerning §61.34 in general, the department has stated specific
eligibility criteria for breast cancer and for cervical cancer services, and
deleted the references to the program's "target population" and "priority
populations" to clarify that any woman who meets the age and income eligibility
criteria will be served. The duty to designate "priority populations" in their
respective service areas and to affirm that they will make a priority outreach
effort to contact and to serve those populations applies only to applicants
for program funding and will be addressed through the application process.
Change: Concerning §61.34(a), the phrase "and who do not have access
to third-party payment for breast and cervical cancer screening or diagnostic
services" was deleted for clarity because the same language already exists
in §61.37(1).
Change: Concerning §61.35, the phrase "using criteria in §61.34
of this title (relating to Target and Priority Populations)" has been deleted
for clarity because §61.34 has been amended to delete references to target
and priority populations.
Change: Concerning §61.41(c), the phrase "and support services" has
been added and the phrase "administrative costs include costs" has been deleted
to clarify the definition of "reimbursable services".
Change: Concerning §61.41(d), the phrase "and support services" has
been added to clarify the definition of reimbursable services.
The following comments were received concerning the proposed sections.
Following each comment is the department's response and any resulting changes.
Comment: Concerning §61.34(a), one commenter asked if women 65 and
over who do not have Medicare, even if eligible to apply but do not due to
lack of funding, would be eligible for the BCCCP.
Response: Women eligible for Medicare but who do not have Part B coverage
would not be eligible for Medicare reimbursement for outpatient physician
services. Therefore, women age 65 who have access to no other third-party
payment for breast and cervical cancer screening or diagnostic services would
be eligible for BCCCP services. No changes were made as a result of this comment.
Comment: Concerning §61.37(5), one commenter stated that the section
is unclear because it does not does not clearly state that women under age
18 are ineligible for cervical cancer services. The commenter compared §61.37(5)
with §61.37(3), which states that women under age 40 are eligible for
diagnostic services only.
Response: The department agrees that the section as proposed does not specifically
deny eligibility for cervical cancer services to women under age 18, and has
amended the section accordingly.
The commenter was the San Antonio Metropolitan Health District, expressing
concerns and asking questions.
The amendments are adopted under the Health and Safety Code, §12.001,
which provides the Texas Board of Health (board) with authority to adopt rules
for the performance of every duty imposed by law on the board, the department,
and the commissioner of health.
§61.32.Federal Authorization and Requirements.
The Breast and Cervical Cancer Mortality Prevention Act of 1990 (Act),
Public Law 101-354, and its re-authorization, the Women's Health Research
and Prevention Amendments of 1998, Public Law 105-340, establish a program
of grants to states, territories, and tribal organizations for early detection
of and prevention of mortality from breast and cervical cancer. The Texas
Department of Health, through a cooperative agreement with the Centers for
Disease Control and Prevention and in compliance with the Act and its reauthorization,
manages the statewide Breast and Cervical Cancer Control Program (program).
§61.34.Eligibility For Program Services.
(a)
Women eligible for Breast and Cervical Cancer Control Program
(program) services must have incomes at or below 200% of the federal poverty
level.
(b)
Women age 40 or older with incomes at or below 200% of
the federal poverty level are eligible for breast cancer screening services.
Women under age 40 with incomes at or below 200% of the federal poverty level
are eligible for diagnostic services only.
(c)
Women age 18 or older with incomes at or below 200% of
the federal poverty level are eligible for cervical cancer screening services.
§61.35.Selection Process.
Selection of applicants eligible to provide program services, as defined
in §61.33 of this title (relating to Eligible Applicants), will be based
on previous performance as service providers, and/or the merits of proposals
submitted by eligible applicants.
§61.37.Program Eligibility Requirements.
Service providers shall demonstrate their ability to apply the following
financial eligibility and screening services requirements:
(1)
Only women with incomes at or below 200% of the federal
poverty level and who have no access to third-party payment for screening
and/or diagnostic services are eligible to receive Breast and Cervical Cancer
Control Program (program) services. The program must be the payer of last
resort.
(2)
Breast cancer screening shall include a clinical breast
examination and a mammogram.
(3)
Only women age 40 or older are eligible for program-funded
breast cancer screening services. Women under age 40 are eligible for diagnostic
services only.
(4)
Cervical cancer screening shall include a clinical breast
examination, pelvic examination, and a Pap test.
(5)
Only women age 18 or older are eligible for program-funded
cervical cancer screening and diagnostic services.
(6)
Participating providers may subcontract with other providers
for clinical services.
§61.41.Reimbursement for Services.
(a)
Reimbursement for clinical screening and diagnostic services
shall be on a fee-for-service basis.
(b)
Reimbursement will be subject to audit by the department.
The Breast and Cervical Cancer Control Program (program) shall approve all
covered procedures and reimbursement rates, which shall not exceed the maximum
state Medicare rate for that procedure. A list of procedures approved for
reimbursement shall be included in all program requests for proposals, contracts,
and the program Manual of Operations.
(c)
The program shall reimburse providers for administrative
and support services costs associated with the following activities:
(1)
eligibility determination;
(2)
outreach;
(3)
client education;
(4)
data collection and reporting; and
(5)
other activities authorized in advance.
(d)
In order to be reimbursed for administrative and support
services costs, a provider must request such reimbursement in its annual proposed
budget. Administrative and support services cost reimbursement shall not exceed
10% of a service provider's budget for clinical services.
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 May 3, 2002.
TRD-200202775
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: May 23, 2002
Proposal publication date: November 9, 2001
For further information, please call: (512) 458-7236
25 TAC §99.1
The Texas Department of Health (department) adopts an amendment
to §99.1 concerning Occupational Conditions with a change to the proposed
text as published in the February 1, 2002, issue of the
Texas Register
(27 TexReg 676).
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). The section
has been reviewed and the department has determined that reasons for adopting
the section continue to exist; however changes were necessary as described
in this preamble.
The department published a Notice of Intention to Review the section as
required by Government Code §2001.039 in the
Texas Register
on April 13, 2001 (26 TexReg 2855). No comments were
received due to the publication of this notice.
The amendment changes the current name of the division responsible to receive
reports of reportable occupational conditions. The division name has changed
from Noncommunicable Disease Epidemiology and Toxicology Division to Environmental
Epidemiology and Toxicology Division. Minor editorial changes were made to
improve the accuracy of the section.
No comments were received during the comment period; however, a change
was made due to a staff comment to correct punctuation in §99.1(c).
The amendment is adopted under Health and Safety Code, §84.003,
which authorizes the board of health (board) to adopt rules relating to the
reporting of occupational diseases and Health and Safety Code, §12.001,
which provides the board with the authority to adopt rules for its procedure
and for the performance of each duty imposed by law on the board, the department,
or the commissioner of health.
§99.1.General Provisions.
(a)
Purpose. This section implements the Texas Occupational
Conditions Reporting Act, Health and Safety Code, Chapter 84, House Bill 2091,
69th Legislature, 1985, which authorizes the Texas Board of Health to adopt
rules concerning the reporting and control of occupational conditions.
(b)
Definitions. The following words and terms, when used in
these sections, shall have the following meanings unless the context clearly
indicates otherwise.
(1)
Case--A person in whom an occupational condition is diagnosed
by a physician based upon clinical evaluation, interpretation of laboratory
and/or roentgenographic findings, and an appropriate occupational history.
(2)
Commissioner--The commissioner of health.
(3)
Department--The Texas Department of Health, 1100 West 49th
Street, Austin, Texas 78756.
(4)
Local health authority--The chief administrative officer
of a public health district or a local health department, or the physician
who is to administer state and local laws relating to public health.
(5)
Occupational conditions--Those diseases, abnormal health
conditions or laboratory findings that are caused by or are related to exposures
in the workplace.
(6)
Reportable occupational condition--Any occupational disease,
condition or laboratory finding for which an official report is required.
See subsection (d) of this section.
(7)
Report of occupational condition--The notification to the
appropriate authority of the occurrence of a specific occupational disease
in a human, including all information required by the procedures established
by the Board of Health.
(8)
Suspected case--A case in which an occupational condition
is suspected, but the final diagnosis is not yet made.
(c)
Reporting requirements.
(1)
It is the duty of every physician holding a license to
practice in the State of Texas to report promptly to the local health authority
each patient she or he shall examine and who has or is suspected of having
any reportable occupational condition. The local health authority may authorize
a staff member to transmit reports.
(2)
It is the duty of every person who is in charge of a clinical
or hospital laboratory, blood bank, mobile unit, or other facility in which
a laboratory examination of any specimen derived from a human body yields
microscopical, cultural, serological, chemical, or other evidence suggestive
of a reportable condition to report promptly that information to the local
health authority.
(3)
The reporting physician or laboratory director shall make
the report in writing. A local health authority may authorize one or more
employees under his or her supervision to receive the report from the physician
or laboratory director by telephone; use of this alternative, if authorized,
is at the option of the reporter. The local health authority shall implement
a method for verifying the identity of the telephone caller when that person
is unfamiliar to the employee.
(4)
The local health authority shall collect the reports and
transmit the information at weekly intervals to the Environmental Epidemiology
and Toxicology Division, Bureau of Epidemiology, Texas Department of Health,
1100 West 49th Street, Austin, Texas 78756. Transmission may be made by mail,
courier, or electronic transfer.
(A)
If by mail or courier, the reports shall be placed in a
sealed envelope addressed to the attention of the Environmental Epidemiology
and Toxicology Division, Bureau of Epidemiology, Texas Department of Health,
1100 West 49th Street, Austin, Texas, 78756, and marked "Confidential Medical
Records."
(B)
If by electronic transmission, including facsimile transmission
by telephone, it shall be in a manner and form authorized by the commissioner
or his or her designee in each instance. Any electronic transmission of the
reports must provide at least the same degree of protection against unauthorized
disclosure as those of mail or courier transmission. The commissioner or his
or her designee shall, before authorizing such transmission, establish guidelines
for establishing and conducting such transmission.
(5)
When an occupational condition is reported to a local health
authority, and the person diagnosed as having the condition resides outside
his or her area of local health jurisdiction, the local health authority receiving
the report shall notify the appropriate local health authority where the person
or persons reside. The department shall assist the local health authority
in providing such notifications if requested.
(d)
List of reportable occupational conditions. Occupational
conditions reportable by name, address, age, sex, race/ethnicity, method of
diagnosis, and relevant occupation(s) and employer(s) of the case, and identity
of the reporter, are: asbestosis, silicosis, blood lead levels at or above
25 micrograms lead/100 milliliters of blood in persons 15 years of age or
older, and acute occupational pesticide poisoning.
(e)
General control measures for reportable occupational conditions.
The commissioner or his or her duly authorized representative shall, as circumstances
may require, proceed as follows:
(1)
investigation shall be made for the purpose of verifying
the diagnosis, ascertaining the source of the causative agent, obtaining an
occupational and employment history and discovering unreported cases;
(2)
collection of specimens of the body tissues, fluids, or
discharges and of materials directly or indirectly associated with the case,
as may be necessary in confirmation of the diagnosis, and their submission
to a laboratory for examination;
(3)
obtaining samples of air or materials from the current
or former business or place of employment of a case, as may be necessary to
ascertain if a public health hazard exists. If a hazard is found the commissioner
or his/her designee shall make appropriate recommendations concerning the
hazard.
(f)
Confidential nature of case reporting.
(1)
All case reports received by the local health authority
or the Texas Department of Health are confidential records and not public
records. These records will be held in a secure location and accessed only
by authorized personnel.
(2)
The department may use information obtained from reports
or health records for statistical and epidemiological studies which may be
public information as long as an individual is not identifiable.
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 May 3, 2002.
TRD-200202773
Susan K. Steeg
General Counsel
Texas Department of Health
Effective date: May 23, 2002
Proposal publication date: February 1, 2002
For further information, please call: (512) 458-7236
Subchapter T. LICENSURE OF TANNING FACILITIES
Chapter 99.
OCCUPATIONAL DISEASES
Chapter 229.
FOOD AND DRUG