TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 1. TEXAS BOARD OF HEALTH

Subchapter G. CLINICAL HEALTH SERVICES

25 TAC §1.91

The Texas Department of Health (department) adopts the amendment to §1.91 concerning fees for clinical health services with changes to the proposed text as published in the September 20, 2002, issue of the Texas Register (27 TexReg 8869).

The amendment to §1.91 affects clinics operated by the department's public health regions and department contractors that provide direct health care services to eligible clients. The amendment deletes the current requirement that the department publish in the Texas Register poverty income guidelines distributed annually by the United States Department of Health and Human Services for services provided to clients whose eligibility is based on the poverty guidelines. The amendment also deletes internal operating procedures as well as several provisions of Health and Safety Code, §12.032 that are restated in the section. An operating procedure will be developed to describe the procedures for distribution of the revised poverty guidelines.

The department is making the following clarifying change as a result of a staff comment.

Change: Concerning §1.91(b)(3), the paragraph is effective as an internal operating procedure and is being deleted as unnecessary. Health and Safety Code, §12.035(a) already requires that fees from persons who receive public health services from the department shall be deposited in the public health services fee fund in the state treasury.

No other comments were received concerning the proposal during the comment period.

The amendment is adopted under Health and Safety Code, §12.032, which authorizes the Texas Board of Health (board) by rule to charge fees for public health services provided by the department; and Health and Safety Code, §12.001, which authorizes the board to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department, and the commissioner of health.

§1.91.Fees for Personal Health Services.

(a) Poverty Guidelines. The department provides personal health services directly or through contractors throughout Texas. The commissioner or his designee shall distribute poverty guidelines published annually by the United States Department of Health and Human Services, in coordination with the Texas Medicaid program. Public health regions and the department's contractors shall use these poverty guidelines for determining clients' eligibility for services, unless prohibited from doing so by federal funding requirements. The department's operating procedures contain procedures for implementing the poverty guidelines.

(b) Schedule of fees.

(1) Public health regional clinics shall charge fees for personal health services according to the following schedule.

Figure: 25 TAC §1.91(b)(1)

(2) No recipient or client eligible for Medicaid shall be charged a fee in addition to the amount reimbursable by Medicaid.

(c) Modification, suspension, or termination of services.

(1) The department may modify, suspend, or terminate services to a person determined able to pay for nonpayment of fees after notice to the person and opportunity for hearing. The criteria upon which the department will take such action is when the person fraudulently or deliberately misrepresents a material fact about his or her eligibility, ability to pay, or the application of the schedule of fees to him/her.

(2) The department shall conduct the hearing in accordance with §§1.51-1.55 of this title (relating to Fair Hearing Procedures).

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 January 17, 2003.

TRD-200300301

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: September 20, 2002

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


Subchapter R. STANDARDS FOR CONDUCT GOVERNING THE RELATIONSHIP BETWEEN THE TEXAS DEPARTMENT OF HEALTH AND PRIVATE DONORS AND PRIVATE ORGANIZATIONS

25 TAC §§1.221 - 1.228

The Texas Department of Health (department) adopts amendments to §§1.221-1.228 concerning standards for conduct governing the relationship between the department and private donors and private organizations without changes to the proposed text as published in the September 20, 2002 issue of the Texas Register (27 TexReg 8870), 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 department has reviewed §§1.221-1.228 and has determined that reasons for adopting the sections continue to exist and published amendments to these sections.

The department published a Notice of Intention to Review §§1.221-1.228 in the Texas Register on May 24, 2002 (27 TexReg 4594). No comments were received due to publication of this notice.

Government Code, §2255.001, which addresses the relationship between state agencies and private organizations that are set up to support them, requires these rules. The rules address the issues of donations by private donors, the creation of a private organization that supports the department, the relationship between the department and the private organization, standards of conduct for department employees and private organizations, and miscellaneous topics.

No comments were received during the 30 day comment period on the proposal.

The amendments are adopted under Government Code, §2255.001 which requires the department to adopt rules governing the relationship with private donors or organizations; and Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with authority to adopt rules to implement every duty imposed by law on the board, the department, and the commissioner of health.

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

Filed with the Office of the Secretary of State on January 17, 2003.

TRD-200300306

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: September 20, 2002

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


Subchapter X. POSTING OF FINAL ENFORCEMENT ACTIONS

25 TAC §§1.551 - 1.553

The Texas Department of Health (department) adopts new §§1.551 - 1.553, concerning the posting of final enforcement actions without changes to the proposed text as published in the September 20, 2002, issue of the Texas Register (27 TexReg 8871), and the sections will not be republished.

The new sections cover definitions; purpose of posting; posting procedures; website information; effect of other laws; corrections; annual analysis; and trends. Section 1.551 sets forth the scope of the subchapter, and defines the terms necessary to comply with the Health and Safety Code, Chapter 12. Section 1.552 sets forth the purpose of posting final enforcement actions and the requirements of that posting, information to be made available on program websites, and the effect of other laws or errors in the posting. Section 1.553 sets forth the requirements of analysis of the enforcement actions, and the trends of enforcement from year to year.

There were no comments received during the comment period.

The new sections are adopted under the Health and Safety Code, §12.0145 and §12.0146, which requires the department to publish information about enforcement actions and to analyze trends in enforcement; and §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.

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 January 17, 2003.

TRD-200300278

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: September 20, 2002

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


Chapter 2. EMERGENCY PREPAREDNESS

25 TAC §2.1

The Texas Department of Health (department) adopts the new §2.1 concerning the establishment of the Preparedness Coordinating Council (council). This section is adopted with changes to the proposed text as published in the November 1, 2002 issue of the Texas Register (27 TexReg 10296). Specifically, the rule covers the establishment, structure, and composition of a preparedness coordinating council. The purpose of the council is to provide advice and assistance to the Board of Health (board) and the department in coordinating efforts to prepare the State of Texas for bioterrorism attacks, other infectious disease outbreaks, and additional public health threats and emergencies. This rule is necessary in order to comply with the requirements of Title 42 United States Code, §247d-3a(b).

The council is established under the Health and Safety Code, §11.016, which allows the board to establish advisory committees, and Title 42 United States Code, §247d-3a(b), which requires an advisory committee to provide the department with advice on public health preparedness. The council is governed by the Government Code, Chapter 2110, concerning state agency advisory committees.

The department modified the wording and punctuation of the rule for clarification purposes. The following comments and responses reflect other department modifications.

Change: Staff suggested that the council might discuss security issues in their meetings. If these meetings are open to the general public, sensitive information may be disclosed. The proposed rule allows meetings open to the public. The department agrees that security may be of concern and has amended §2.1(i)(3) so that meetings may be called without public notice. The department shall notify stakeholders of meetings as appropriate.

Change: Staff suggested that since the Hospital Preparedness Planning Committee and the Bioterrorism Preparedness and Response Committee are required by contract, the department should have control over the membership of these two subcommittees. The department agreed with this comment and modified §2.1(m)(1) to reflect this change.

Change: Staff suggested that §2.1(h)(3) and §2.1(h)(4) be amended to include the presiding officer. The department agreed and made this change.

Change: Staff suggested that portions of §2.1(j), §2.1(n), and §2.1(p) be modified to include the members of the subcommittees, as well as council members. The department agreed and made these modifications.

The following comments were received. Following each comment is the department's response.

Comment: The commenter suggested that §2.1(f)(2)(B)(iii) be modified to read, "two representatives from community hospitals and one from other community health providers" to ensure that hospitals are adequately represented.

Response: The department believes that the members of the council should represent a broad range of experienced professionals. Because of this, the department will seek to select council members who are able to "wear two hats," in other words, persons who are members of multiple entities or professional groups. The department will take care to ensure that hospitals have significant representation on the council. No changes were made as a result of this comment.

Comment: The commenter requested that one or more Infection Control Professionals be appointed to the council.

Response: The department will consider this request when appointing council members. No changes were made to the rule as a result of this comment.

The comments on the proposed rule received by the department during the comment period were submitted by: Texas Hospital Association and Texas Society of Infection Control Practitioners. The commenters were generally in favor of the proposed rule.

The new rule is adopted under Health and Safety Code, §11.016, which authorizes the board to establish advisory committees. The new rule was proposed under Health and Safety Code, §12.001 which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner; and Government Code, §2110.005 which requires the department to adopt rules stating the purpose and tasks of its advisory committees.

§2.1.Preparedness Coordinating Council.

(a) The council.

(1) The Preparedness Coordinating Council (council) shall be appointed under and governed by this section.

(2) The council is established under the Health and Safety Code, §11.016, which authorizes the board to establish advisory councils and Title 42 United States Code §247d-3a(b) which requires an advisory committee (or similar mechanism) to obtain input on preparedness planning.

(b) Applicable law. The council is subject to the Government Code, Chapter 2110, concerning state agency advisory councils.

(c) Purpose. The purpose of the council is to provide advice and assistance to the Board of Health (board) and the Department of Health (department) in coordinating efforts to prepare the state of Texas for bioterrorism attacks, other infectious disease outbreaks, and additional public health threats and emergencies.

(d) Tasks.

(1) The council shall advise the board concerning rules relating to major public health preparedness issues.

(2) The council will assist the department and the board in coordinating preparedness and response planning, improving disease surveillance and detection, developing epidemic response capabilities, and addressing other public health emergency activities related to the department.

(3) The council shall carry out any other tasks assigned by the board.

(e) Council abolished. By January 1, 2007, the board will initiate and complete a review of the council to determine whether the council should be continued, consolidated with another council, or abolished. If the council is not continued or consolidated, the council shall be abolished on that date.

(f) Composition. The council shall be composed of 17 members.

(1) The composition of the council shall include 5 consumer representatives, and 12 non-consumer representatives.

(2) The members of the council shall be appointed by the commissioner of health (commissioner) as follows:

(A) 5 consumers representing the interests of the general public;

(B) 12 non-consumer members, including the following:

(i) 3 representatives of local health departments or local governments;

(ii) 3 representatives from emergency management entities;

(iii) 3 representatives from community hospitals or other community health providers; and

(iv) 3 representatives from universities or health science centers.

(g) Terms of office. The term of office of each member shall be 6 years.

(1) Members shall be appointed for staggered terms so that the terms of six members will expire on December 31 of each even-numbered year.

(2) If a vacancy occurs, a person shall be appointed to serve the unexpired portion of that term.

(h) Officers. The council shall select from its members the presiding officer and an assistant presiding officer.

(1) The presiding officer shall serve until December 31 of each even-numbered year. The assistant presiding officer shall serve until December 31 of each odd-numbered year. Both the presiding officer and the assistant presiding officer may holdover until his or her replacement is elected by the council.

(2) The presiding officer shall preside at all council meetings which he or she attends, call meetings in accordance with this section, appoint subcommittees of the council as necessary, and cause proper reports to be made to the board. The presiding officer may serve as an ex-officio member of any subcommittee of the council.

(3) If the office of presiding officer or assistant presiding officer becomes vacant, it may be filled by vote of the council

(4) A member shall serve no more than two consecutive terms as presiding officer or assistant presiding officer.

(5) The council may reference its officers by other terms, such as chairperson and vice-chairperson.

(i) Meetings. The council shall meet only as necessary to conduct council business.

(1) A meeting may be called by agreement of department staff and either the presiding officer or at least three members of the council.

(2) Meeting arrangements shall be made by department staff. Department staff shall contact council members to determine availability for a meeting date and place.

(3) The council is not a "governmental body" as defined in the Open Meetings Act.

(4) Each member of the council shall be informed of a council meeting at least five working days before the meeting.

(5) A simple majority of the members of the council shall constitute a quorum for the purpose of transacting official business.

(6) The council is authorized to transact official business only when in a legally constituted meeting with a quorum present.

(7) The agenda for each council meeting shall include an opportunity for any person to address the council on matters relating to council business. The presiding officer may establish procedures for such public comment, including a time limit on each comment.

(j) Attendance. Members shall attend council meetings as scheduled. Members and subcommittee members shall attend meetings of subcommittees to which the members and subcommittee members are assigned.

(1) A member shall notify the presiding officer or appropriate department staff if he or she is unable to attend a scheduled meeting.

(2) It shall be grounds for removal from the council if a member or subcommittee member cannot discharge the member's duties for a substantial part of the term for which the member is appointed because of illness or disability, absence from more than half of the council and subcommittees meetings during a calendar year, or absence from at least three consecutive council meetings.

(3) The validity of an action of the council is not affected by the fact that it is taken when a ground for removal of a member exists.

(k) Staff. Staff support for the council shall be provided by the department.

(l) Procedures. Roberts Rules of Order, Newly Revised, shall be the basis of parliamentary decisions except where otherwise provided by law or rule.

(1) Any action taken by the council must be approved by a majority vote of the members present once a quorum is established.

(2) Each member shall have one vote.

(3) A member may not authorize another individual to represent the member by proxy.

(4) The council shall make decisions in the discharge of its duties without discrimination based on any person's race, creed, gender, religion, national origin, age, physical condition, or economic status.

(5) Minutes of each council meeting shall be taken by department staff.

(A) A draft of the minutes approved by the presiding officer shall be provided to the board and each member of the council within 30 days of each meeting.

(B) After approval by the council, the minutes shall be signed by the presiding officer.

(m) Subcommittees. The council shall have a Hospital Preparedness Planning Committee (HPPC) and a Bioterrorism Preparedness and Response Committee (BRPC). The council may establish other subcommittees as necessary to assist the council in carrying out its duties.

(1) With the exception of the HPPC and the BPRC, the presiding officer shall appoint members of the council to serve on subcommittees and to act as subcommittee chairpersons. The presiding officer also may appoint nonmembers of the council to serve on subcommittees, subject to the approval of the Commissioner. The HPPC and the BRPC members shall be appointed by the Commissioner.

(2) Subcommittees shall meet when called by the subcommittee chairperson or when so directed by the council.

(3) A subcommittee chairperson shall make regular reports to the advisory council at each council meeting or in interim written reports as needed. The reports shall include an executive summary or minutes of each subcommittee meeting.

(n) Statement by members.

(1) The board, the department, and the council shall not be bound in any way by any statement or action on the part of any council member or subcommittee member except when a statement or action is in pursuit of specific instructions from the board, department, or council.

(2) The council and its members or subcommittee members may not participate in legislative activity in the name of the board, the department, or the council except with approval through the department's legislative process. Council members are not prohibited from representing themselves or other entities in the legislative process.

(3) A council member or subcommittee member should not accept or solicit any benefit that might reasonably tend to influence the member in the discharge of the member's official duties.

(4) A council member or subcommittee member should not disclose confidential information acquired through his or her committee membership.

(5) A council member or subcommittee member should not knowingly solicit, accept, or agree to accept any benefit for having exercised the member's official powers or duties in favor of another person.

(6) A council member or subcommittee member who has a personal or private interest in a matter pending before the committee shall publicly disclose the fact in a committee meeting and may not vote or otherwise participate in the matter. The phrase "personal or private interest" means the committee member has a direct pecuniary interest in the matter but does not include the committee member's engagement in a profession, trade, or occupation when the member's interest is the same as all others similarly engaged in the profession, trade, or occupation.

(o) Reports to board. The council shall file an annual written report with the board.

(1) The report shall list the meeting dates of the council and any subcommittees, the attendance records of its members, a brief description of actions taken by the council, a description of how the council has accomplished the tasks given to the council by the board, the status of any rules which were recommended by the council to the board, and anticipated activities of the council for the next year.

(2) The report shall identify the costs related to the council's existence, including the cost of agency staff time spent in support of the council's activities and the source of funds used to support the council's activities.

(3) The report shall cover the meetings and activities in the immediately preceding fiscal year and shall be filed with the board each January. The report shall be signed by the commissioner.

(p) Reimbursement for expenses. In accordance with the requirements set forth in the Government Code, Chapter 2110, a council member or subcommittee member may receive reimbursement for the member's expenses incurred for each day the member engages in official council business if authorized by the General Appropriations Act or the budget execution process.

(1) No compensatory per diem shall be paid to council members or subcommittee members unless required by law.

(2) A council member or subcommittee member who is an employee of a state agency, other than the department, may not receive reimbursement for expenses from the department.

(3) Each member who is to be reimbursed for expenses shall submit to staff the member's receipts for expenses and any required official forms no later than 14 days after each council meeting.

(4) Requests for reimbursement of expenses shall be made on official state travel vouchers prepared by department staff.

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 January 17, 2003.

TRD-200300307

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: November 1, 2002

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


Chapter 37. MATERNAL AND INFANT HEALTH SERVICES

Subchapter P. SURVEILLANCE AND CONTROL OF BIRTH DEFECTS

25 TAC §37.307

The Texas Department of Health (department) adopts the repeal of §37.307 concerning the Scientific Advisory Committee on Birth Defects in Texas (committee) without changes to the proposed text as published in the November 1, 2002, issue of the Texas Register (27 TexReg 10299). The committee has provided advice to the Texas Board of Health (board) and the department in the area of implementing an effective birth defects registry and related research, referral, and educational activities.

In 1993, the Texas Legislature passed Senate Bill 383 (now codified in the Government Code, Chapter 2110) which requires that each state agency adopt rules on advisory committees. The rules must state the purpose of the committee, describe the tasks of the committee, describe the manner in which the committee will report to the agency, and establish a date on which the committee will be automatically abolished unless the governing body of the agency affirmatively votes to continue the committee's existence.

In 1995, the board established a rule relating to the Scientific Advisory Committee on Birth Defects in Texas. The rule states that the committee will automatically be abolished on March 1, 2003, and the board has determined that the committee should be abolished by that date. Issues relating to the type of advice previously provided by the committee have been implemented and future related issues are better addressed through the establishment of ad hoc workgroups.

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 department has reviewed §37.307 and has determined that reasons for adopting the rule no longer continue to exist.

The department published a Notice of Intention to Review §37.307 in the Texas Register on April 28, 2000 (25 TexReg 3799). No comments were received due to publication of this notice.

There were no comments received concerning the repeal during the 30-day comment period.

The repeal is adopted under the Health and Safety Code, §11.016, which allows the board to establish advisory committees; the Government Code, Chapter 2110, which sets standards for the evaluation of advisory committees by the agencies for which they function; and the Health and Safety Code, §12.001, which provides the board with authority to adopt rules for the performance of every duty imposed by law upon the board, the department, and the commissioner of health.

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

Filed with the Office of the Secretary of State on January 17, 2003.

TRD-200300304

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: November 1, 2002

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


Chapter 61. CHRONIC DISEASES

Subchapter A. KIDNEY HEALTH CARE PROGRAM

25 TAC §61.12

The Texas Department of Health (department) adopts an amendment to §61.12 concerning the Kidney Health Care Advisory Committee (committee). The section is adopted without changes to the proposed text as published in the November 1, 2002 issue of the Texas Register (27 TexReg 10300), and the section will not be republished.

The committee has provided advice to the Texas Board of Health (board) and the department in the area of end-stage renal disease (ESRD) and on current state-of-the-art treatment modalities, medication therapies, and prioritization of the needs of ESRD patients in Texas. The committee is established under the Health and Safety Code, §11.016, which allows the board to establish advisory committees and the Health and Safety Code, §85.066, which allows the board to appoint an advisory committee to assist in the development of procedures and guidelines required by the Kidney Health Care Program. The committee is governed by the Government Code, Chapter 2110, concerning state agency advisory committees.

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 department has reviewed §61.12 and 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 §61.12 in the Texas Register on January 7, 2000 (25 TexReg 218). No comments were received due to publication of this notice.

In 1993, the Texas Legislature passed Senate Bill 383 (now codified in the Government Code, Chapter 2110) which requires that each state agency adopt rules on advisory committees. The rules must state the purpose of the committee, describe the tasks of the committee, describe the manner in which the committee will report to the agency, and establish a date on which the committee will be automatically abolished unless the governing body of the agency affirmatively votes to continue the committee's existence.

In 1997, the board established a rule relating to the Kidney Health Care Advisory Committee. The rule states that the committee will automatically be abolished on March 1, 2003. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until March 1, 2008.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to: continue the committee until March 1, 2008; include additional requirements regarding statements by members; and clarify the components that the committee must include in an annual report to the board.

No public comments were received during the comment period for the rule.

The amendment is adopted under the Health and Safety Code, §12.001 which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner; §85.066 which allows the board to appoint the committee; and the Government Code, §2110.005 which requires the department to adopt rules stating the purpose and tasks of its advisory committees.

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 January 17, 2003.

TRD-200300302

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: November 1, 2002

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


Chapter 98. HIV AND STD PREVENTION

Subchapter C. TEXAS HIV MEDICATION PROGRAM

2. ADVISORY COMMITTEE

25 TAC §98.121

The Texas Department of Health (department) adopts an amendment to §98.121 concerning the Texas HIV Medication Advisory Committee (committee). The section is adopted without changes to the proposed text as published in the November 1, 2002 issue of the Texas Register (27 TexReg 10302), and the section will not be republished.

The committee has provided advice to the Texas Board of Health (board) and the department on strategies in the development of procedures and guidelines for the HIV Medication Program. The committee was established under the Health and Safety Code, §11.016, which allows the board to establish advisory committees and the Health and Safety Code, § 85.066, which allows the board to appoint an advisory committee to assist in the development of procedures and guidelines required by the HIV Medication Program. The committee is governed by the Government Code, Chapter 2110, concerning state agency advisory committees.

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 department has reviewed §98.121 and 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 §98.121 in the Texas Register on April 28, 2000 (25 TexReg 3801). No comments were received due to publication of this notice.

In 1993, the Texas Legislature passed Senate Bill 383 (now codified in the Government Code, Chapter 2110) which requires that each state agency adopt rules on advisory committees. The rules must state the purpose of the committee, describe the tasks of the committee, describe the manner in which the committee will report to the agency, and establish a date on which the committee will be automatically abolished unless the governing body of the agency affirmatively votes to continue the committee's existence.

In 1994, the board established a rule relating to the Texas HIV Medication Advisory Committee. The rule states that the committee will automatically be abolished on March 1, 2003. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until March 1, 2008.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to: continue the committee until March 1, 2008; define committee tasks; include additional requirements regarding statements by members; and clarify the components that the committee must include in an annual report to the board.

No public comments were received during the comment period for the rule.

The amendment is adopted under the Health and Safety Code, §12.001 which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner; §85.066 which allows the board to appoint the committee; and the Government Code, §2110.005 which requires the department to adopt rules stating the purpose and tasks of its advisory committees.

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 January 17, 2003.

TRD-200300303

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: November 1, 2002

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


Chapter 102. DISTRIBUTION OF TOBACCO SETTLEMENT PROCEEDS TO POLITICAL SUBDIVISIONS

25 TAC §102.3

The Texas Department of Health (department) adopts an amendment to §102.3 concerning the distribution of tobacco settlement proceeds to political subdivisions. Section 102.3 is adopted without changes to the proposed text as published in the November 1, 2002, issue of the Texas Register (27 TexReg 10304), and therefore the section will not be republished.

This rule implements a portion of the Government Code, Chapter 12, Subchapter J, which designates the department's responsibilities under the Agreement Regarding Disposition of Tobacco Settlement Proceeds (agreement) filed on July 24, 1998, in United States District Court, Eastern District of Texas, in the case styled The State of Texas v. The American Tobacco Co., et al., No. 5-96CV-91. The department collects information and certifies amounts of the tobacco settlement proceeds for annual distribution to political subdivisions. The term "political subdivision" means a hospital district, another local political subdivision owning or maintaining a public hospital, or a county of the State of Texas responsible for providing indigent health care to the general public. The Health and Safety Code, Chapter 61, defines which entities are responsible for providing indigent health care to the general public.

Specifically, the amendment is needed to clarify the definition of unreimbursed expenditures that may be claimed by a political subdivision that owns a non-hospital district public hospital, as well as the manner in which the political subdivision funds are paid to the hospital and the source of the payment. The amendment is also needed to improve the procedures for submission of the annual expenditure statement by political subdivisions.

No comments were received on the proposal during the comment period.

The amendment is adopted under the Health and Safety Code, Chapter 12, Subchapter J, §§12.138 - 12.139, which requires the department to adopt rules governing the distribution of tobacco settlement proceeds to political subdivisions; and Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with authority to adopt rules to implement every duty imposed by law on the board, the department, and the commissioner of health.

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

Filed with the Office of the Secretary of State on January 17, 2003.

TRD-200300305

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: November 1, 2002

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


Chapter 123. RESPIRATORY CARE PRACTITIONER CERTIFICATION

25 TAC §§123.4, 123.6 - 123.12

The Texas Department of Health (department) adopts amendments to §§123.4, and 123.6 - 123.12 concerning the regulation and certification of respiratory care practitioners. Section 123.6 was adopted with changes to the proposed text as published in the September 20, 2002, issue of the Texas Register (27 TexReg 8888). Sections 123.4 and 123.7 - 123.12 are adopted without changes, and will not be republished.

Specifically, the amendments add an annual inactive status fee; delete language concerning notarization; delete the signature of the commissioner of health on certificates and permits; increase self-study continuing education hours; and add language concerning sexual misconduct.

The following comment was received concerning the proposed section. Following the comment is the department's response and any resulting changes.

Comment: Concerning §123.10(b)(4), the commenter opposed the increase from four to six hours of self-directed Internet-based or computer-based courses. Lack of control on the design and content of self-directed education centers which provide continuing education hours for the respiratory care practitioner was the primary concern.

Response: The department disagrees. The Respiratory Care Practitioner Certification Program recommended that six hours of self-directed Internet-based or study would benefit respiratory care practitioners that practice in rural areas and have difficulty obtaining continuing education hours. The self-directed Internet-based or computer-based studies must still be approved by the department. No change was made as a result of comment.

The following change was made due to a staff comment.

Change: Concerning §123.6(c), "regulated in any profession" was inadvertently deleted in the proposed rule text and has been added to final rule text.

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

§123.6.Application Requirements and Procedures.

(a) General.

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

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

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

(b) Required application materials.

(1) Application form. The application form shall contain:

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

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

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

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

(E) a statement that the applicant understands that fees submitted are nonrefundable;

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

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

(H) a statement that if issued a certificate or permit the practitioner shall keep the department advised of his or her current mailing address; and

(I) the signature of the applicant which has been dated;

(J) a full-face color photograph signed on the reverse side with the applicant's signature as it appears on the application. The photograph must have been taken within the two year period prior to application to the department and the minimum size is one and one-half inches by one and one-half inches.

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

(A) a photocopy which is a true and exact copy of an unaltered:

(i) an official diploma or official transcript indicating graduation from high school;

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

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

(B) a photocopy which is a true and exact copy of an unaltered certificate of completion from a respiratory care education program. The certificate must contain:

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

(ii) name of the graduate;

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

(iv) accreditation statement; and

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

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

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

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

(3) Examination results.

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

(B) If an applicant for a regular certificate is:

(i) recognized as certified respiratory therapist or registered respiratory therapist by the NBRC at the time of application, a photocopy of the certificate issued by NBRC shall be submitted in lieu of examination results; or

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

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

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

(c) Information/Documentation form. Persons applying for any certificate or permit who are licensed, registered, or otherwise regulated in any profession at the time of application to the department must submit with their applications a properly completed information/documentation form signed by an agency official.

(d) Application processing.

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

(A) The following periods of time shall apply from the date of receipt of an application until the date of issuance of a written notice that the application is complete and accepted for filing or that the application is deficient and additional specific information is required. A written notice stating that the application has been approved may be sent in lieu of the notice of acceptance of a complete application. The time periods are as follows:

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

(ii) letter of application deficiency-14 working days.

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

(i) letter of approval-14 working days; and

(ii) letter of denial of permit or certificate-180 working days.

(2) Reimbursement of fees.

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

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

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

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

(e) Application approval.

(1) The administrator shall be responsible for reviewing all applications.

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

(f) Disapproved applications.

(1) The department shall disapprove the application if the person:

(A) has not completed the requirements in subsection (b) of this section;

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

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

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

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

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

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

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

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

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

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

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 January 17, 2003.

TRD-200300308

Susan K. Steeg

General Counsel

Texas Department of Health

Effective date: February 6, 2003

Proposal publication date: September 20, 2002

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


Part 2. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Chapter 411. STATE AUTHORITY RESPONSIBILITIES

Subchapter B. INTERAGENCY AGREEMENTS

25 TAC §411.64

The Texas Department of Mental Health and Mental Retardation (department) adopts new §411.64, governing memorandum of understanding (MOU) on relocation pilot program, without changes to the text as proposed in the August 9, 2002, issue of the Texas Register (27 TexReg 7031.

The new section adopts by reference a new rule of the Texas Department of Human Services (TDHS) at Texas Administrative Code, Title 40, §72.104, governing memorandum of understanding on relocation pilot program, that was published for public review and comment in the July 26, 2002, issue of the Texas Register (27 TexReg 6670).

The TDHS rule contains the text of a new memorandum of understanding (MOU) between the department, TDHS, and the Texas Department of Protective and Regulatory Services (TDPRS). The agencies are required by Texas Human Resources Code (THRC), §22.038, as added by Senate Bill 367 (SB 367) of the 77th Legislature, to develop and adopt the MOU by rule. The MOU will facilitate the coordination and implementation of a pilot program, subject to availability of funds, required by THRC, §22.037, also added by SB 367. The pilot program is intended to provide opportunities for persons with disabilities to move out of nursing facilities into community-based settings. The MOU defines the responsibilities of each agency for implementing the pilot program.

Written comments concerning the text of the MOU contained in the TDHS rule that new §411.64 will adopt by reference were received from the parent/guardian of a resident of a state mental retardation facility (state MR facility), Garland; and the Parent Association for the Retarded of Texas (PART), Austin. The department has shared the comments with TDHS and has collaborated with TDHS in developing responses.

Concerning §72.104(b)(1), (2)(A), and (4), two commenters questioned who will determine what constitutes being "inappropriately placed in an institution". The department responds that federal laws and regulations describe the criteria that permit a person to be admitted to and remain in a nursing facility for Medicaid services. If a person meets the criteria but moves to a community-based alternative care setting, the decision to do so is made by the person, the person's legally authorized representative (LAR), or the person's family, if the person doesn't have an LAR.

Two commenters stated that §72.104(b)(2)(B) should be revised to add the phrase "or legally authorized representative" to specify that either the person or the person's LAR makes a decision regarding a long-term care placement. The department responds that the proposed MOU text follows the text of the statute authorizing the pilot, and declines to make the requested revision.

Concerning references in §72.104(b)(3) and (4) to "community-based organizations," the two commenters stated that the official policy of community-based organizations such as The Arc of Texas, Advocacy, Inc., Texas Council for Developmental Disabilities, and The Disability Policy Consortium is that institutional placement is never appropriate. The commenters stated that a "transition case manager" provided by one of these organizations would have the same perspective. The commenters further stated that a community-based organization to whom a grant is awarded under the terms of the MOU to identify persons who may inappropriately reside in nursing facilities must advocate for a full array of residential services, including state MR facilities. The department responds that the organizations named by the commenters are not the recipients of the grants authorized by THRC, §22.037. The department further explains that the THRC, §22.037, which requires the implementation of the pilot relocation program, specifies that the "transition case manager" will assist a person with a disability who resides in a nursing facility to access a "community-based alternative care setting" if the person or the LAR decides that the transition should occur. Therefore, advocating for admission to a state MR facility would be counter to the statutory directive. The department declines to make the requested revision.

Concerning §72.104(c)(1)(A)(i), the two commenters stated that TDHS must include a requirement that all residential services, including state MR facilities, are included in the full array of services offered to a person with mental retardation or the person's LAR. The department responds, again, that THRC, §22.037, requires that the pilot relocation program address "community-based alternative care settings" for persons residing in nursing facilities, and that state MR facilities do not fit that description. The department does note that subsection (b)(3)(B) specifies that a transition case manager will coordinate with the local mental health or mental retardation authority (MHMRA) when a nursing facility resident who wishes to make a transition from the nursing facility to a community-based alternative care setting requires mental retardation or a mental health services. A person referred to a mental retardation authority will be informed by the MRA of the full array of available services, including state MR facilities, as required by department rules in Texas Administrative Code, Title 25, §415.159(c), concerning assessment of an individual's need for services and supports.

Also concerning §72.104(c)(1)(A)(i), the commenters stated that the phrase "nursing facility residents/their families" should be revised to include a reference to LARs. The department and TDHS agree, and TDHS has revised the language accordingly.

The two commenters expressed their agreement with the reference to "legally authorized representative" in §72.104(c)(1)(A)(ii) and stated that the phrase needs to be used throughout the section. The department acknowledges the commenters' approval, and notes that the phrase is used in the section where appropriate.

The two commenters stated that §72.104(c)(1)(C) must be revised to prohibit TDHS community awareness and relocation contract staff from talking to a nursing facility resident who has an LAR unless the LAR gives permission. The department and TDHS respond that such a requirement is beyond the scope of this rule action and decline to make the requested revision.

The two commenters questioned whether the description that the department is required by §72.104(c)(2)(A) to provide to a TDHS contractor includes a list of names. The department responds that, as specified in the reference subparagraph, the description provided by the department to TDHS contractors is the "priority population" descriptions for mental retardation and mental illness included in the department's performance contracts with local MHMRAs. It does not include names of persons served by department programs.

Concerning §72.104(c)(3), the two commenters stated that before the Texas Department of Protective and Regulatory Services (TDPRS) identifies for TDHS those TDPRS clients residing in nursing facilities who are appropriate for transition into community-based living, TDPRS must first ask the individual or LAR if such transition is desired. The department responds that TDPRS is the LAR for its clients residing in nursing facilities and declines to make the requested revision.

The two commenters stated that the requirement in §72.104(d)(2) that a special staffing be held to resolve disagreements about whether a nursing facility resident should leave the nursing facility or whether the resident should move to a specific placement must be changed. The commenters stated that the individual or LAR will resolve a disagreement by making the decision. The commenters stated that the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), issued a ruling in 1993-1994 against the department that supported the right of the individual or LAR to make this decision. The department and TDHS respond that this provision is included to address those situations when a person residing in a nursing facility wants to leave but family members, nursing facility staff, and other concerned persons believe that the person's health and safety would be compromised in a community-based setting. As written, the provision does not take away decision making authority from a person who has capacity to make decisions or the LAR of that person. The provision provides a forum for the person's family members, nursing facility staff, and other concerned persons to resolve the situation. The HCFA ruling cited by the commenters was specific to the state MR facilities.

The new section is adopted under the Texas Health and Safety Code, §532.015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority, and under THRC, §22.038, which requires the department to adopt the MOU by rule.

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 January 13, 2003.

TRD-200300165

Andrew Hardin

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Effective date: February 2, 2003

Proposal publication date: August 9, 2002

For further information, please call: (512) 206-5232