TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 37. MATERNAL AND INFANT HEALTH SERVICES

The Texas Department of Health (department) proposes the repeal of §§37.231-37.244, concerning the Maternal and Infant Health Improvement Program; §§37.261-37.270, concerning the State Maternal and Infant Health Care Program Advisory Committee; and §37.281, concerning the Maternal and Child Health Advisory Committee.

Specifically, §§37.231-37.244 cover purpose and scope; definitions; program; contract and written agreements; selection of providers; eligibility for prenatal care services; eligibility for high-risk patient services; services provided to patients; coordination of benefits and recovery of costs; denial/modification/suspension/termination of services; development and improvement of guidelines and services; appeals, confidentiality, gifts, and nondiscrimination; items adopted by reference; and memorandum of understanding. Sections 37.261-37.270 cover authorization; purpose; membership; officers; meetings; quorum; subcommittees; parliamentary procedure; minutes; and public participation. Section 37.281 covers procedures of the Maternal and Child Health Advisory Committee.

Government Code, §2001.039, requires that each state agency review and consider for readoption each rule adopted by that agency pursuant to Government Code, Chapter 2001 (Administrative Procedure Act). Sections 37.231-37.244, 37.261-37.270, and 37.281 have been reviewed, and the department has determined that reasons for adopting the sections do not exist. Since the maternal and infant health improvement program and both advisory committees are no longer operational, the rules are not needed.

The department published a Notice of Intention to Review for §§37.231-37.244, 37.261-37.270, and 37.281 as required by Government Code, §2001.039, in the Texas Register on April 28, 2000, (25 TexReg 3799). No comments were received as a result of the publication of the notice.

Chan McDermott, Perinatal Health Program Coordinator, has determined that for each year of the first five years the repeal of the sections is in effect, there will be no fiscal implications as a result of enforcing or administering the repeal of the sections for state or local government. Neither the program nor the two advisory committees are operational, and no funds have been or will be expended for their administration.

Ms. McDermott has also determined that for each year of the first five years the repeal of the sections is in effect, the public benefit anticipated as a result of enforcing the repeal will be increased clarity and more efficient use of the department's rules by elimination of sections that are no longer necessary. There will be no costs to small businesses or micro-businesses since none of these entities has ever been required to comply with the sections. There are no anticipated costs to persons who are required to comply with the sections as proposed. No impact on local employment is anticipated.

Comments on the proposal may be submitted to Chan McDermott, Perinatal Health Program Coordinator, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3139, (512) 458-7796. Comments will be accepted for 30 days following publication of this proposal in the Texas Register .

Subchapter L. MATERNAL AND INFANT HEALTH IMPROVEMENT PROGRAM

25 TAC §§37.231 - 37.244

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

The repeals are proposed under Health and Safety Code, §32.006, which directs the Board of Health (board) to adopt rules necessary to administer Chapter 32; and Health and Safety Code, §12.001, which provides the 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.

The repeal of the sections affects Health and Safety Code, Chapter 32; and implements Government Code, §2001.039.

§37.231.Purpose and Scope.

§37.232.Definitions.

§37.233.Program.

§37.234.Contract and Written Agreements.

§37.235.Selection of Providers.

§37.236.Eligibility for Prenatal Care Services.

§37.237.Eligibility for High-Risk Patient Services.

§37.238.Services Provided to Patients.

§37.239.Coordination of Benefits and Recovery of Costs.

§37.240.Denial/Modification/Suspension/Termination of Services.

§37.241.Development and Improvement of Guidelines and Services.

§37.242.Appeals, Confidentiality, Gifts, and Nondiscrimination.

§37.243.Items Adopted by Reference.

§37.244.Memorandum of Understanding.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303562

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Subchapter N. STATE MATERNAL AND INFANT HEALTH CARE PROGRAM ADVISORY COMMITTEE

25 TAC §§37.261 - 37.270

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

The repeals are proposed under Health and Safety Code, §32.006, which directs the Board of Health (board) to adopt rules necessary to administer Chapter 32; and Health and Safety Code, §12.001, which provides the 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.

The repeal of the sections affects Health and Safety Code, Chapter 32; and implements Government Code, §2001.039.

§37.261.Authorization.

§37.262.Purpose.

§37.263.Membership.

§37.264.Officers.

§37.265.Meetings.

§37.266.Quorum.

§37.267.Subcommittees.

§37.268.Parliamentary Procedure.

§37.269.Minutes.

§37.270.Public Participation.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303563

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Subchapter O. MATERNAL AND CHILD HEALTH ADVISORY COMMITTEE

25 TAC §37.281

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

The repeal is proposed under Health and Safety Code, §32.006, which directs the Board of Health (board) to adopt rules necessary to administer Chapter 32; and Health and Safety Code, §12.001, which provides the 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.

The repeal of the section affects Health and Safety Code, Chapter 32; and implements Government Code, §2001.039.

§37.281.Procedures of the Maternal and Child Health Advisory Committee.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303564

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Chapter 109. TEXAS DEPARTMENT OF HEALTH HOSPITALS

The Texas Department of Health (department) proposes the repeal of §§109.1-109.7, 109.15, and 109.25-109.31, concerning the department's hospitals, which consist of Texas Center for Infectious Disease (TCID) and South Texas Health Care System (STHCS). The sections affect matters related to internal management and operation of TCID and STHCS, and management of certain tuberculosis patient affairs.

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 the reasons for adopting the sections do not continue to exist due to organizational changes in facility management and operation, as statutorily mandated by Acts, 76th Legislature, 1999, Chapter 264 (House Bill 1748) and Chapter 1106 (House Bill 3504); and Acts, 77th Legislature, 2001, Article II, page II-45, §68, and Article IX, page IX-107, §10.87. Changes in the management of tuberculosis patient affairs have been maintained to conform with hospital standards published by private accreditation manuals and considered best practice. Also, written policies supersede the sections. The current rules are obsolete.

The department published a Notice of Intention to Review the sections as required by Government Code, §2001.039, in the January 7, 2000, issue of the Texas Register (25 TexReg 219). No comments were received as a result of this publication.

Each section was analyzed for current applicability and for need to delete obsolete, unenforceable, and unnecessary language. The proposed repeal of the rules will more accurately reflect the manner in which each facility is currently managed and operated and will improve the flexibility of written policies in place at each facility, including written policies that relate to tuberculosis patient management. Flexibility is needed in the changing legal environment related to operation and management of the facilities.

Jim Elkins, Hospital Director for TCID, and Maria Diaz, Director of STHCS, have each determined that for each year of the first five-years the sections are in effect, there will not be any fiscal implication to state or local government as a result of enforcing or administering the repeal of the sections as proposed.

Mr. Elkins and Dr. Diaz have also determined that for each year of the first five years the sections are in effect, the public benefits anticipated as a result of enforcing or administering the rules will be to maintain greater flexibility in the operation and management of each facility in order to continue the provision of public health care services by each facility.

There will be no costs to micro-businesses or small businesses to comply with the sections as proposed, because the sections that affect third parties have been superceded by written policies, and the sections as proposed do not change the management or operation of TCID or STHCS and do not change the management of tuberculosis patient affairs. The sections as proposed eliminate obsolete provisions that have been replaced by written policies applicable to each facility. There are no anticipated economic costs to persons who are required to comply with the sections as proposed. There is no anticipated impact on local employment.

Comments on the proposal may be submitted to Sharon Alexander, Assistant General Counsel, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3183, (512) 458-7236. Comments will be accepted for 30 days following publication of this proposal in the Texas Register .

Subchapter A. HOSPITAL AND MEDICAL STAFF BYLAWS

25 TAC §§109.1 - 109.7, 109.15

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

The repeal of these sections is proposed under the Texas Health and Safety Code, §12.001, which provides the Board of Health (board) with the authority to adopt rules and to implement every duty imposed by law on the board, the department, and the commissioner of health; and, under Texas Health and Safety Code, Chapter 13, which provides the board with authority to operate the department hospitals.

The sections proposed for repeal affect the Texas Health and Safety Code, Chapters 12 and 13, concerning operation and management of the facilities and management of tuberculosis patient affairs; and also affect Texas Health and Safety Code, Chapter 81, concerning prevention and control of communicable diseases, including tuberculosis patient quarantine procedures. The sections proposed for repeal also implement Government Code, §2001.039.

§109.1.Purpose.

§109.2.Definitions.

§109.3.Governance.

§109.4.Hospital Bylaws.

§109.5.Hospital Committees.

§109.6.Medical Staff.

§109.7.Auxillary Organizations.

§109.15.Medical Staff Bylaws.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303560

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Subchapter B. TUBERCULOSIS

25 TAC §§109.25 - 109.31

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

The repeal of these sections is proposed under the Texas Health and Safety Code, §12.001, which provides the Board of Health (board) with the authority to adopt rules and to implement every duty imposed by law on the board, the department, and the commissioner of health; and, under Texas Health and Safety Code, Chapter 13, which provides the board with authority to operate the department hospitals.

The sections proposed for repeal affect the Texas Health and Safety Code, Chapters 12 and 13, concerning operation and management of the facilities and management of tuberculosis patient affairs; and also affect Texas Health and Safety Code, Chapter 81, concerning prevention and control of communicable diseases, including tuberculosis patient quarantine procedures. The sections proposed for repeal also implement Government Code, §2001.039.

§109.25.Patient Transfers.

§109.26.Funeral Service Contracts.

§109.27.Gifts, Grants, and Donations.

§109.28.Clothing Needs of Patients.

§109.29.Marking of Indigent Patients' Graves.

§109.30.Admission of Quarantine Patients.

§109.31.Disposition of Patients' Trust Funds and Miscellaneous Personal Property.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303561

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Chapter 123. RESPIRATORY CARE PRACTITIONER CERTIFICATION

25 TAC §123.3

The Texas Department of Health (department) proposes an amendment to §123.3, concerning the Respiratory Care Practitioners Advisory Committee (committee). The committee has provided advice to the Texas Board of Health (board) and the department related to rules and examinations for the certification of respiratory care practitioners. The committee is established under the Health and Safety Code, §11.016, which allows the board to establish advisory committees. 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 §123.3 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 for §123.3 in the Texas Register on May 30, 2003 (28 TexReg 4325). 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 2001, the board established a rule relating to the Respiratory Care Practitioners Advisory Committee. The rule states that the committee will automatically be abolished on November 1, 2003. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until November 1, 2007.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to: continue the committee until November 1, 2007; specify that the committee appoints its presiding and assistant presiding officers; include additional requirements regarding statements by members; and clarify the components that the committee must include in an annual report to the board.

Jacquelyn McDonald, Director of the Office of the Board of Health, has determined that for each year of the first five years the section is in effect, there will be no fiscal implications for state and local government as a result of administering the section as proposed.

Ms. McDonald has also determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of amending the section will be to provide a continuance of the committee and continued advice to the department on this important issue. There will be no costs to small business or micro-business resulting from compliance with this section, as this section addresses only continuance of the committee; terms of office; statements by members; and information to be included in the annual report. There are no anticipated economic costs to persons who are required to comply with the section as proposed. There is no anticipated impact on local employment.

Comments may be submitted to Jacquelyn McDonald, Director, Office of the Board of Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-7484. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The amendment is 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.

The proposed amendment affects the Health and Safety Code, Chapters 11 and 12; the Government Code, Chapter 2110; and implements Government Code, §2001.039.

§123.3.Respiratory Care Practitioners Advisory Committee.

(a)-(d) (No change.)

(e) Review and duration. By November 1, 2007 [ 2003 ], the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee, or abolished. If the committee is not continued or consolidated, the committee shall be abolished on that date.

(f)-(g) (No change.)

(h) Officers. The committee [ chairman of the board ] shall select from its members the [ appoint a ] presiding officer and an assistant presiding officer to begin serving on November 1 of each odd-numbered year.

(1) Each officer shall serve until October 31 of each odd-numbered year. Each officer may holdover until his or her replacement is elected. [ the next regular appointment of officers. ]

(2) (No change.)

(3) The assistant presiding officer shall perform the duties of the presiding officer in case of the absence or disability of the presiding officer. In case the office of presiding officer becomes vacant, the assistant presiding officer will [ serve until a successor is appointed to ] complete the unexpired portion of the term of the office of presiding officer.

(4) If the office of assistant presiding officer becomes vacant, it may be filled [ temporarily ] by vote of the committee [ until a successor is appointed by the chairman of the board ].

(5)-(6) (No change.)

[(7) The presiding officer and assistant presiding officer serving on October 1, 1999, will continue to serve until the chairman of the board appoints their successors.]

(i)-(m) (No change.)

(n) Statement by members.

(1)-(2) (No change.)

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

(5) A committee 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 committee 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 committee shall file an annual written report with the board.

(1) (No change.)

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

(3) (No change.)

(p) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303565

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Chapter 129. OPTICIANS' REGISTRY

The Texas Department of Health (department) proposes amendments to §§129.1 - 129.2 and the repeal of §129.3, concerning the Opticians' Registry Advisory Committee (committee). The committee has provided advice to the Texas Board of Health (board) and the department in the area of opticianry and the regulation of dispensing opticians.

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 2001, the board established a rule relating to the Opticians' Registry Advisory Committee. The rule states that the committee will automatically be abolished on November 1, 2003, and the board has determined that the committee should be abolished on that date. Issues relating to the type of advice previously provided by the committee are better addressed through the establishment of ad hoc workgroups.

The amendments to §§129.1 and 129.2 and the repeal of §129.3 are necessary to eliminate language referencing the committee.

Jacquelyn McDonald, Director, Office of the Board of Health, has determined that for each year of the first five years the sections are in effect, there will be no fiscal implications for state or local governments as a result of enforcing or administering these sections.

Ms. McDonald has also determined that for each year of the first five years the sections are in effect, the public benefit anticipated will be increased flexibility and breadth in obtaining specific input on issues related to opticianry and the regulation of dispensing opticians. There will be no effect on micro-businesses or small businesses. The proposed rules will not require small businesses and micro-businesses to alter their business practices. There is no economic costs to persons as a result of the elimination of all references to the committee. There will be no effect on local employment.

Comments may be submitted to Jacquelyn McDonald, Director, Office of the Board of Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, 512-458-7484. Comments on the proposed sections will be accepted for 30 days following publication in the Texas Register .

25 TAC §129.1, §129.2

The amendments are proposed 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.

The proposed amendments affect the Health and Safety Code, Chapter 11; and the Government Code, Chapter 2110.

§129.1.Purpose and Construction.

(a) (No change.)

(b) Construction. These sections cover definitions; [ organization, administration and operation of the committee; ] fees; application procedures and requirements; applicant eligibility and registration; examination; renewal of registration certificates; requirements for continuing education; name or address changes; procedures for violations, complaints, investigation of complaints, and disciplinary actions; registration of applicants with criminal backgrounds; and professional and ethical standards.

§129.2.Definitions.

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

(1)-(8) (No change.)

[ (9) Committee--The eleven member Opticians' Registry Advisory Committee.]

(9) [ (10) ] Department--The Texas Department of Health.

(10) [ (11) ] Dispensing optician--A person who provides or offers to provide spectacle or contact lens dispensing services or products to the public.

(11) [ (12) ] Dual application--An application by one person as both a registered spectacle dispensing optician and a registered contact lens dispenser.

(12) [ (13) ] Examination--A qualifying test administered to eligible applicants by the department or its designee.

(13) [ (14) ] Registered contact lens dispenser--A person properly registered under the Act as a contact lens dispenser.

(14) [ (15) ] Registered spectacle dispensing optician--A person properly registered under the Act as a spectacle dispensing optician.

(15) [ (16) ] Registration certificate--A document issued by the department to a qualified person authorizing that person to represent that he or she is registered under the Act.

(16) [ (17) ] Spectacle dispensing--The design, verification, fitting, adjustment, sale, and delivery to the consumer of fabricated and finished spectacle lenses, frames, or other ophthalmic devices, other than contact lenses, prescribed by and dispensed in accordance with a prescription from a licensed physician or optometrist. The term includes:

(A) prescription analysis and interpretation;

(B) the taking of measurements of the face, including interpupillary distances, to determine the size, shape, and specification of the spectacle lenses or frames best suited to the wearer's needs;

(C) the preparation and delivery of work orders to laboratory technicians engaged in grinding lenses and fabricating spectacles;

(D) the verification of the quality of finished spectacle lenses;

(E) the adjustment of spectacle lenses or frames to the intended wearer's face; and

(F) the adjustment, repair, replacement, reproduction, or duplication of previously prepared spectacle lenses, frames, or other specially fabricated optical devices, other than contact lenses.

(17) [ (18) ] Spectacle prescription--A written specification by a licensed physician or optometrist for therapeutic or corrective lenses that states the refractive power of the product and other information as required by the physician or optometrist.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303559

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


25 TAC §129.3

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

The repeal is proposed 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. The proposed repeal affects the Health and Safety Code, Chapter 11; and the Government Code, Chapter 2110.

§129.3.Opticians' Registry Advisory Committee.

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303558

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Chapter 143. MEDICAL RADIOLOGIC TECHNOLOGISTS

25 TAC §143.3

The Texas Department of Health (department) proposes an amendment to §143.3, concerning the Medical Radiologic Technologist Advisory Committee (committee). The committee has provided advice to the Texas Board of Health (board) and the department related to rules and examinations for the certification of medical radiologic technologists. The committee is established under the Health and Safety Code, §11.016, which allows the board to establish advisory committees. 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 §143.3 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 for §143.3 in the Texas Register on May 30, 2003 (28 TexReg 4325). 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 2001, the board established a rule relating to the Medical Radiologic Technologist Advisory Committee. The rule states that the committee will automatically be abolished on November 1, 2003. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until November 1, 2007.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to: continue the committee until November 1, 2007; specify that the committee appoints its presiding and assistant presiding officers; indicate the terms of office; include additional requirements regarding statements by members; and clarify the components that the committee must include in an annual report to the board.

Jacquelyn McDonald, Director of the Office of the Board of Health, has determined that for each year of the first five years the section is in effect, there will be no fiscal implications for state and local government as a result of administering the section as proposed.

Ms. McDonald has also determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of amending the section will be to provide a continuance of the committee and continued advice to the department on this important issue. There will be no costs to small business or micro-business resulting from compliance with this section, as this section addresses only continuance of the committee; the terms of office; and statements and/or actions by members. There are no anticipated economic costs to persons who are required to comply with the section as proposed. There is no anticipated impact on local employment.

Comments may be submitted to Jacquelyn McDonald, Director, Office of the Board of Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-7484. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The amendment is 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.

The proposed amendment affects the Health and Safety Code, Chapters 11 and 12; the Government Code, Chapter 2110; and implements Government Code, §2001.039.

§143.3.Medical Radiologic Technologist Advisory Committee.

(a)-(d) (No change.)

(e) Review and duration. By November 1, 2007 [ 2003 ], the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee , or abolished. If the committee is not continued or consolidated, the committee shall [ will ] be abolished on that date.

(f)-(g) (No change.)

(h) Officers. The committee [ chairman of the board ] shall select from its members the [ appoint a ] presiding officer and an assistant presiding officer to begin serving on November 1 of each odd-numbered year.

(1) Each officer shall serve until October 31 of each odd-numbered year. Each officer may holdover until his or her replacement is elected. [ the next regular appointment of officers. ]

(2) (No change.)

(3) The assistant presiding officer shall perform the duties of the presiding officer in case of the absence or disability of the presiding officer. In case the office of presiding officer becomes vacant, the assistant presiding officer will [ serve until a successor is appointed to ] complete the unexpired portion of the term of the office of presiding officer.

(4) If the office of assistant presiding officer becomes vacant, it may be filled [ temporarily ] by vote of the committee [ until a successor is appointed by the chairman of the board ].

(5)-(6) (No change.)

[ (7) The presiding officer and assistant presiding officer serving on October 1, 1999, will continue to serve until the chairman of the board appoints their successors.]

(i)-(m) (No change.)

(n) Statements by members.

(1)-(2) (No change.)

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

(5) A committee 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 committee 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 committee shall file an annual written report with the board.

(1) (No change.)

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

(3) (No change.)

(p) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303557

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Chapter 146. TRAINING AND REGULATION OF PROMOTORAS

25 TAC §146.2

The Texas Department of Health (department) proposes an amendment to §146.2, concerning the Promotor(a) or Community Health Worker Training and Certification Advisory Committee (committee). The committee has provided advice to the Texas Board of Health (board) and the department related to the review of applications and the recommendation of qualifying applicants as sponsoring institutions, training instructors or as promotores(as) or community health workers. The committee also recommends new or amended rules for the approval of the board. The committee is established under the Health and Safety Code, §11.016, which allows the board to establish advisory committees. 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 §146.2 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 for §146.2 in the Texas Register on May 2, 2003 (28 TexReg 3741). 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 2001, the board established a rule relating to the Promotor(a) or Community Health Worker Training and Certification Advisory Committee. The rule states that the committee will automatically be abolished on November 1, 2003. The board has now reviewed and evaluated the committee and has determined that the committee should continue in existence until November 1, 2007.

This section amends provisions relating to the operation of the committee. Specifically, language is revised to: continue the committee until November 1, 2007; change the terms of committee membership from four years to six years; include additional requirements regarding statements by members; add requirements related to travel reimbursement; and clarify the components that the committee must include in an annual report to the board.

Jacquelyn McDonald, Director of the Office of the Board of Health, has determined that for each year of the first five years the section is in effect, there will be no fiscal implications for state and local government as a result of amending the section as proposed.

Ms. McDonald has also determined that for each year of the first five years the section is in effect, the public benefit anticipated as a result of amending the section will be to provide a continuance of the committee and continued advice to the department on this important issue.

There will be no costs to small business or micro-business resulting from compliance with this section, as this section addresses only continuance of the committee; terms of office; statements by members; adds requirements related to travel reimbursement; and the information to be included in an annual report. There are no anticipated economic costs to persons who are required to comply with the section as proposed. There is no anticipated impact on local employment.

Comments may be submitted to Jacquelyn McDonald, Director, Office of the Board of Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, (512) 458-7484. Comments on the proposed section will be accepted for 30 days following publication in the Texas Register .

The amendment is 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.

The proposed amendment affects the Health and Safety Code, Chapters 11 and 12; the Government Code, Chapter 2110; and implements Government Code, §2001.039.

§146.2.Promotor(a) or Community Health Worker Training and Certification Advisory Committee.

(a)-(d) (No change.)

(e) Review and duration. By November 1, 2007 [ 2003 ], the board will initiate and complete a review of the committee to determine whether the committee should be continued, consolidated with another committee, or abolished. If the committee is not continued or consolidated, the committee shall be abolished on that date.

(f) Composition. The committee shall be composed of nine members appointed by the board. The composition of committee shall include:

(1)-(2) (No change.)

(3) one member from the Texas Higher Education Coordinating Board, or a higher education faculty member who has teaching experience in community health, public health or adult education and has trained promotores(as) or community health workers; and

(4) two professionals who work with promotores(as) or community health workers in a community setting . [ ; ]

(g) Terms of office. The term of office of each member shall be six [ four ] years, and the member may be reappointed.

(1)-(2) (No change.)

(h)-(m) (No change.)

(n) Statement by members. [ The board, the department, and the committee shall not be bound in any way by any statement or action on the part of any committee member except what a statement or action is in pursuit of specific instructions from the board, department, or committee. ]

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

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

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

(5) A committee 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 committee 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 committee shall file an annual written report with the board.

(1) (No change.)

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

(3) (No change.)

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

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

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

(3) A nonmember of the committee who is appointed to serve on a subcommittee may not receive reimbursement for expenses from the department.

(4) Each member who is to be reimbursed for expenses shall submit to staff the member's receipts for expenses and any required official forms not later than 14 days after each committee meeting.

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

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 13, 2003.

TRD-200303556

Susan K. Steeg

General Counsel

Texas Department of Health

Earliest possible date of adoption: July 27, 2003

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


Part 2. TEXAS DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Chapter 419. MEDICAID STATE OPERATING AGENCY RESPONSIBILITIES

Subchapter D. HOME AND COMMUNITY-BASED SERVICES (HCS) PROGRAM

25 TAC §§419.153, 419.155, 419.159, 419.166

The Texas Department of Mental Health and Mental Retardation (department) proposes amendments to §419.153, concerning definitions; §419.155, concerning eligibility criteria; §419.159, concerning level of care (LOC) determination; and §419.166 concerning revisions and renewals of individual plans of care (IPCs), levels of care (LOCs) and levels of need (LONs) for enrolled individuals.

The proposed amendments are in response to new Texas Health and Safety Code, §533.0355, added by House Bill 2292 of the 78th Legislature, which redefines the responsibilities of a mental retardation authority, a program provider, and the department under the Mental Retardation Local Authority (MRLA) Program, a Medicaid waiver program under §1915(c) of the Social Security Act operated by the department. New §533.0355 requires the department to redesign the program model underlying the MRLA Program. Until the department can redesign the MRLA Program to conform to the new statutory requirements, the proposed amendments will allow the department to continue services to all current MRLA Program consumers under the existing Home and Community-based Services (HCS) Program. In addition, the department will consolidate services provided through the Home and Community-Based--OBRA (HCS-O) Program with the HCS Program. The department intends to retract its proposed repeal of Chapter 419, Subchapter D, concerning the Home and Community-Based Service Program, which was published in the June 13, 2003, issue of the Texas Register (28 TexReg 4520).

The amendments to §419.155 revise the HCS Program eligibility criteria to include individuals who are currently enrolled in the MRLA or HCS-O Programs. The section is also revised to include individuals who have been determined by the department to have an Intermediate Care Facility for Persons with Mental Retardation (ICF/MR) I or VIII level of care (LOC) and have been determined by the Texas Department of Human Services to have mental retardation or a related condition, to need specialized services, and to be inappropriately placed in a Medicaid certified nursing facility based on an annual resident review conducted in accordance with Texas Administrative Code, Title 40, §19.2500.

The amendments to §419.153 and §419.166(a) assure the continued application of the principles of person-directed planning and permanency planning during the development of individual service plans. These planning principles are an important part of a consumer-focused service system that the department wants to ensure are incorporated into all service planning activities. In addition, the rule reference is corrected in the definition of program provider in §419.153.

The amendments to §419.159(b) require the department to make a determination of LOC based on the ICF/MR LOC I or LOC VIII criteria. The reference to the ICF/MR rules regarding level of care assignment has been changed to clarify the applicable sections.

Cindy Brown, Chief Financial Officer, has determined that, for each year of the first five year period that the proposed amendments are in effect, there are foreseeable implications relating to costs or revenues of state government. The result will be a minimal cost savings of general revenue and loss of federal funding. The department does not anticipate that the amendments will have an adverse effect on small or micro-businesses. The department does not anticipate that there will be any additional economic cost to persons required to comply with the amendments. The department does not anticipate that the amendments will affect a local economy.

Barry Waller, Director, Long Term Services and Supports, has determined that, for each year of the first five-year period the proposed amendments are in effect, the public benefit expected is that, until the department can redesign the MRLA Program consistent with new statutory requirements, Medicaid waiver services and supports will continue to be provided to consumers through one program, the HCS Program, rather than multiple programs.

Comments concerning the proposed amendments must be submitted in writing to Linda Logan, Director, Policy Development, by mail to P.O. Box 12668, Austin, Texas 78711, by fax to (512) 206-4744, or by e-mail to policy.co@mhmr.state.tx.us within 30 days of publication of this notice.

A hearing to accept oral and written testimony from members of the public concerning the proposal has been scheduled for 1:30 p.m., Friday, July 18, 2003, in the department's Central Office Auditorium in Building 2 at 909 West 45th Street, in Austin, Texas. Persons requiring an interpreter for the deaf or hearing impaired should contact the department's Central Office operator at least 72 hours prior to the hearing at TDD (512) 206-5330. Persons requiring other accommodations for a disability should notify Long Term Services and Supports at least 72 hours prior to the hearing at (512) 206-4706 or at the TDY phone number of Texas Relay, 1-800-735-2988.

The amendments are proposed under the Texas Health and Safety Code (THSC), §532.015(a), which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority; the Texas Government Code (TGC), §531.021(a), and the Texas Human Resources Code (THSC), §32.021(a), which provide the Texas Health and Human Services Commission (THHSC) with the authority to administer the federal medical assistance (Medicaid) program in Texas; Acts 1995, 74th Texas Legislature, Chapter 6, §1, (Senate Bill 509), which clarifies the authority of THHSC to delegate the operation of all or part of a Medicaid program to a health and human services agency; and the THSC, §32.021(c), which provides an agency operating part of the Medicaid program with the authority to adopt necessary rules for the proper and efficient operation of the program. THHSC has delegated to the department the authority to operate the HCS Program.

The proposed amendments affect TGC, §531.021(a), and THRC, §32.021(a) and (c).

§419.153.Definitions.

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

(1) - (14) (No change.)

(15) ISP (individual service plan)--A written plan, from which the IPC is derived, [ document ] developed by the IDT using person-directed planning and, if appropriate, permanency planning. The ISP [ , from which the IPC is derived, which ] describes the assessments, recommendations, deliberations, conclusions, justifications and outcomes regarding the specific services provided to the individual by the program provider.

(16) - (23) (No change.)

(24) Person-directed planning--A process that empowers the individual (and the LAR on the individual's behalf) to direct the development of a plan for supports and services that meet the individual's personal outcomes. The process:

(A) identifies existing supports and services necessary to achieve the individual's outcomes;

(B) identifies natural supports available to the individual and negotiates needed services system supports;

(C) occurs with the support of a group of people chosen by the individual (and the LAR on the individual's behalf); and

(D) accommodates the individual's style of interaction and preferences regarding time and setting.

(25) [ (24) ] Permanency Planning--A philosophy and planning process that focuses on the outcome of family support for an individual under 22 years of age by facilitating a permanent living arrangement in which the primary feature is an enduring and nurturing parental relationship.

(26) [ (25) ] Permanency Planning Review Screen--A screen in CARE that, when completed by an MRA or program provider, identifies community supports needed to achieve an individual's permanency planning outcomes and provides information necessary for approval to provide supervised living or residential support to the individual.

(27) [ (26) ] Program provider--An entity that provides HCS Program services under a waiver program provider agreement with the department as defined in Chapter 419, Subchapter Q [ O ] of this title (relating to Enrollment of Medicaid Waiver Program Providers).

(28) [ (27) ] Service coordinator--An employee of an MRA responsible for assisting an individual or the individual's LAR on behalf of the individual in accessing medical, social, educational, and other appropriate services including HCS Program services

(29) [ (28) ] Service planning team--A planning team constituted by an MRA consisting of an applicant, the applicant's LAR, service coordinator, and other persons chosen by the applicant or the LAR on behalf of the applicant.

§419.155.Eligibility Criteria.

(a) An applicant or individual is eligible for HCS program services if he or she:

(1) meets the financial eligibility criteria as defined in subsection (b) of this section;

(2) meets one of the following criteria:

(A) is enrolled in the MRLA or HCS-O Program immediately prior to enrollment in the HCS Program;

(B) qualifies for the ICF/MR I level of care (LOC) as defined in §419.238 of this title (relating to Level of Care Criteria I), as determined by the department according to §419.159 of this title (relating to Level of Care Determination); and

(i) has had a determination of mental retardation performed in accordance with state law (Texas Health and Safety Code, Chapter 593, Admission and Commitment to Mental Retardation Services, Subchapter A); or

(ii) has been diagnosed by a licensed physician as having a related condition as defined in §419.203 of this title (relating to Definitions) prior to enrollment in the HCS Program; or

(C) qualifies for the ICF/MR I LOC as defined in §419.238 of this title (relating to Level of Care Criteria I) or ICF/MR VIII LOC as defined in §419.239 of this title (relating to Level of Care Criteria VIII), as determined by the department according to §419.159 of this title (relating to Level of Care Determination), and has been determined by TDMHMR or TDHS:

(i) to have mental retardation or a related condition;

(ii) to need specialized services; and

(iii) to be inappropriately placed in a Medicaid certified nursing facility based on an annual resident review conducted in accordance with the requirements of Texas Administrative Code, Title 40, §19.2500; and

[(2) meets the ICF/MR I level of care criteria (LOC) as determined by the department according to §419.159 of this title (relating to Level of Care (LOC) Determination);]

[(3) has had a determination of mental retardation performed in accordance with state law (Texas Health and Safety Code, Chapter 593, Admission and Commitment to Mental Retardation Services, Subchapter A) or has been diagnosed by a licensed physician as having a related condition as defined in §419.203 of this title (relating to Definitions) prior to enrollment in the HCS Program; and]

(3) [ (4) ] has an approved IPC for which the IPC cost does not exceed 125% of the annual ICF/MR reimbursement rate paid to a small ICF/MR, as defined in 1 TAC §355.456 (relating to Rate Setting Methodology) for the individual's level of need as it would be assigned under §419.240 of this title (relating to Level of Need) or 125% of the estimated annualized per capita cost for ICF/MR services, whichever is greater.

(b) - (c) (No change.)

§419.159.Level of Care (LOC) Determination.

(a) (No change.)

(b) The department will make an LOC determination in accordance with §419.238 of this title (relating to ICF/MR LOC I Criteria) and §419.239 of this title (relating to ICF/MR LOC VIII) based on the department's review of information reported on the applicant's or individual's MR/RC Assessment. [ A LOC determination will be made by the department in accordance with §419.237 of this title (relating to Level of Care). ]

(c) - (e) (No change.)

§419.166.Revisions and Renewals of Individual Plans of Care (IPCs), Levels of Care (LOCs) and Levels of Need (LONs) for Enrolled Individuals.

(a) At least annually, and prior to the expiration of an individual's IPC, the individual's IDT must review the ISP and IPC to determine whether individual outcomes and services previously identified remain relevant.

(1) The IDT must initiate revisions to the IPC in response to changes in the individual's personal outcomes or needs as documented in the current ISP.

(2) At minimum, the ISP must include the following:

(A) a description of the outcomes to be achieved for the individual through the HCS Program;

(B) for an individual under 22 years of age receiving supervised living or residential support, permanency planning outcomes as described in §419.174 (14) of this title (relating to Certification Principles: Service Delivery);

(C) written justification for each service component to be included in the IPC; and

(D) documentation that the type and amount of each service component included in the individual's IPC:

(i) are necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services; and

(ii) do not replace existing natural supports or other non-program sources for the service components; and

(E) when the proposed IPC includes residential support, the reasons that the team concluded that supervision and assistance from awake service providers during normal sleeping hours are required to assure the individual's health and welfare including but not limited to the individual's demonstrated needs for staff intervention to respond to:

(i) the individual's medical condition;

(ii) a behavior displayed by the individual that poses a danger to the individual or to others; or

(iii) the individual's need for assistance with activities of daily living during normal sleeping hours.

[(2) The ISP must include documentation that the type and amount of each service component included in the individual's IPC:]

[(A) are necessary for the individual to live in the community, to ensure the individual's health and welfare in the community, and to prevent the need for institutional services;]

[(B) do not replace existing natural supports or other non-program sources for the service components; and]

[(C) when the proposed IPC includes residential support, the reasons that the team concluded that supervision and assistance from awake service providers during normal sleeping hours are required to assure the individual's health and welfare including but not limited to the individual's demonstrated needs for staff intervention to respond to:]

[(i) the individual's medical condition;]

[(ii) a behavior displayed by the individual that poses a danger to the individual or to others; or]

[(iii) the individual's need for assistance with activities of daily living during normal sleeping hours.]

(3) - (4) (No change.)

(b) (No change.)

This agency hereby certifies that the proposal has been reviewed by legal counsel and found to be within the agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 16, 2003.

TRD-200303691

Rodolfo Arredondo

Chair, Texas MHMR Board

Texas Department of Mental Health and Mental Retardation

Earliest possible date of adoption: July 27, 2003

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