Part 9.
TEXAS STATE BOARD OF MEDICAL EXAMINERS
Chapter 163.
LICENSURE
22 TAC §163.14
The Texas State Board of Medical Examiners proposes new §163.14,
concerning Licensure to Practice Medicine Across State Lines. The new rule
is created in order to implement requirements for practicing medicine across
state lines.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rule is in effect there
will be no fiscal implications to state or local government as a result of
enforcing the rule as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rule as proposed is in effect the public benefit anticipated as
a result of enforcing the section will be an updated rule regarding qualifications,
registration requirements, and limits and exemptions relating to special purpose
telemedicine licenses. There will be no effect on small or micro businesses.
There will be no effect to individuals required to comply with the section
as proposed.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed new rule: Texas Occupations
Code Annotated, §151.002 and §151.056.
§163.14.Licensure to Practice Medicine Across State Lines.
(a)
Qualifications. A person may not engage in the practice
of medicine across state lines in this State, hold oneself as qualified to
do the same, or use any title, word, or abbreviation to indicate or induce
others to believe that one is licensed to practice across state lines in this
state unless the person is actually so licensed. For a person to eligible
for a special purpose telemedicine license to practice medicine across state
lines under the Medical Practice Act, §151.056, and §163.1 of this
chapter (relating to Definitions), the person must:
(1)
be 21 years of age or older;
(2)
be actively licensed to practice medicine in another state
which is recognized by the Texas State Board of Medical Examiners for purposes
of licensure, and not the recipient of a previous disciplinary action by any
other state or jurisdiction;
(3)
not be the subject of a pending investigation by a state
medical board or another state or federal agency;
(4)
be certified in a medical specialty pursuant to the standards
of and approved by the American Board of Medical Specialties or the Bureau
of Osteopathic Specialists and Boards of Certification;
(5)
have passed the Texas Medical Jurisprudence Examination;
(6)
complete a board-approved application for a special purpose
telemedicine license for the practice of medicine across state lines and submit
the requisite initial fee; and
(7)
not be determined ineligible for licensure under subsection
(b) of this section.
(b)
Denial of Special Purpose Telemedicine License. An application
for a special purpose telemedicine license to practice medicine across state
lines may be denied based on failure to demonstrate the requisite qualifications
for issuance of a special purpose license, any grounds for denial of an application
for a full license, failure to submit the required fee, and any grounds for
disciplinary action of a licensee under the Medical Practice Act, §164.051
(relating to Grounds for Denial or Disciplinary Action).
(c)
Limits on Special Purpose Telemedicine License. A special
purpose telemedicine license to practice medicine across state lines shall
be limited exclusively to the practice of medicine as defined by §163.1
of this chapter and limited to the specialty or specialization upon which
the license was granted under subsection (a)(3) of this section, and the license
holder shall practice medicine in a manner so as to comply with all other
statutes and laws governing the practice of medicine in the state of Texas.
Unless a person holds a current full license to practice medicine in this
state pursuant to this chapter and the provisions of the Medical Practice
Act, Chapter 155 (relating to License to Practice Medicine), a person holding
a special purpose telemedicine license shall not be authorized to physically
practice medicine in the state of Texas.
(d)
Registration Requirements. All special purpose telemedicine
licenses to practice medicine across state lines licenses must be renewed
and maintained according to registration requirements of §166.1 of this
title (relating to Physician Registration).
(e)
Disciplinary Action. The issuance by the board of a special
purpose telemedicine license subjects the licensee to the jurisdiction of
the board in all matters set forth in the Medical Practice Act and all rules
and regulations, including all matters related to discipline.
(f)
Exemptions. The following activities shall be exempt from
the requirements of a special purpose telemedicine license and this chapter:
(1)
episodic consultation by a medical specialist located in
another jurisdiction who provides such consultation services on request to
a person licensed in this state;
(2)
consultation services provided by a physician located in
another jurisdiction to a medical school as defined in the Education Code, §61.501;
(3)
consultation services provided by a physician located in
another jurisdiction to an institution defined in either Subchapter C, Chapter
73, or Subchapter K, Chapter 74 of the Education Code;
(4)
informal consultation performed outside the context of
a contractual relationship and on an irregular or infrequent basis without
the expectation or exchange of direct or indirect compensation;
(5)
furnishing of medical assistance in case of an emergency
or disaster if no charge is made for the medical assistance; and
(6)
a physician located in another jurisdiction of a state
having borders contiguous with the borders of this state who is the treating
physician of a patient and orders home health or hospice services for a resident
of this state to be delivered by a home and community support services agency
licensed in this state.
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 April 12, 2004.
TRD-200402444
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
The Texas State Board of Medical Examiners proposes the repeal of §§174.1
- 174.17 and new §§174.1 - 174.5, concerning Telemedicine. The new
rules relate to standards for provision of telemedicine medical services and
use of the Internet in transmission of information.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rules are in effect
there may be fiscal implications to physicians not already participating in
Medicaid/Medicare. There will be no fiscal implications to state or local
government as a result of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rules as proposed are in effect the public benefit anticipated as
a result of enforcing the sections will be updated rules to be consistent
with standards established by other government agencies. There will be no
effect on small or micro businesses.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
22 TAC §§174.1 - 174.17
(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 State Board of Medical Examiners or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the authority of the
Occupations Code Annotated, §153.001, which provides the Texas State
Board of Medical Examiners to adopt rules and bylaws as necessary to: govern
its own proceedings; perform its duties; regulate the practice of medicine
in this state; and enforce this subtitle.
The following are affected by the proposed repeals: Article 21.53F of the
Insurance Code; Government Code §531.0217(i) and Texas Occupations Code
Annotated, §153.004.
§174.1.Purpose.
§174.2.Definitions.
§174.3.Qualifications for Special Purpose License for Practice of Medicine Across State Lines.
§174.4.Limits on Special Purpose License to Practice Medicine Across State Lines.
§174.5.Denial of Application for Special Purpose License to Practice Medicine Across State Lines.
§174.6.Revocation and Limitation of Special Purpose License.
§174.7.Cooperation.
§174.8.Appearances.
§174.9.Patient Medical Records.
§174.10.Informed Consent.
§174.11.Address Changes.
§174.12.Delegation and Supervision.
§174.13.Exemptions.
§174.14.Temporary Suspension of Special Purpose License.
§174.15.Fees and Failure To Submit Fees.
§174.16.Registration Requirements.
§174.17.Use of the Internet in Medical Practice.
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 April 12, 2004.
TRD-200402445
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §§174.1 - 174.5
The new sections are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed new rules: Article 21.53F of
the Insurance Code; Government Code §531.0217(i) and Texas Occupations
Code Annotated, §153.004.
§174.1.Purpose.
This chapter is promulgated to establish standards for the use of the
Internet and provision of telemedicine medical services by physicians who
are licensed to practice medicine in this State.
§174.2.Definitions.
The following words and terms, when used in this chapter shall have
the following meanings unless the context indicates otherwise.
(1)
Medical practice site--A patient-specific Internet site,
access to which is limited to licensed physicians, associated medical personnel
and patients. It is an interactive site and thus qualifies as a practice location.
It requires a defined physician-patient relationship.
(2)
Medium--Any mechanism of information transfer including
electronic means.
(3)
Person--An individual unless otherwise expressly made applicable
to a partnership, association, or corporation.
(4)
Physician-patient e-mail--A computer-based communication
between physician (or their medical personnel) and patients within a professional
relationship in which the physician has taken on an explicit measure of responsibility
for the patient's care.
(5)
Telemedicine medical service--A health care service initiated
by a physician or provided by a health professional acting under physician
delegation and supervision, for purposes of assessment by a health professional,
diagnosis or consultation by a physician, treatment, or the transfer of medical
data, that requires the use of advanced telecommunications other than by telephone
or facsimile as described in §57.042 of the Utilities Code.
§174.3.Telemedicine Medical Services.
(a)
All physicians that use telemedicine medical services in
their practices shall adopt protocols to prevent fraud and abuse through the
use of telemedicine medical services. These standards must be consistent with
those established by the Telecommunications Infrastructure Fund Board and
Health and Human Services Commission pursuant to §531.02161 of the Government
Code.
(b)
In order to establish that a physician has made a good
faith effort in the physician's practice to prevent fraud and abuse through
the use of telemedicine medical services, the physician must implement written
protocols that address the following:
(1)
authentication and authorization of users;
(2)
authentication of the origin of information;
(3)
the prevention of unauthorized access to the system or
information;
(4)
system security, including the integrity of information
that is collected, program integrity, and system integrity;
(5)
maintenance of documentation about system and information
usage;
(6)
information storage, maintenance, and transmission; and
(7)
synchronization and verification of patient profile data.
§174.4.Use of the Internet in Medical Practice.
(a)
Evaluation of the Patient. Physicians who utilize the Internet
must ensure a proper physician-patient relationship is established that at
a minimum includes:
(1)
establishing that the person requesting the treatment is
in fact who the person claims to be;
(2)
establishing a diagnosis through the use of acceptable
medical practices such as patient history, mental status examination, physical
examination, and appropriate diagnostic and laboratory testing to establish
diagnoses and identify underlying conditions and/or contra-indications to
treatment recommended/provided;
(3)
discussing with the patient the diagnosis and the evidence
for it, the risks and benefits of various treatment options; and
(4)
ensuring the availability of the physician or coverage
of the patient for appropriate follow-up care.
(b)
Treatment. Treatment and consultation recommendations made
in an online setting, including issuing a prescription via electronic means,
will be held to the same standards of appropriate practice as those in traditional
(face-to-face) settings. An online or telephonic evaluation by questionnaire
does not constitute an acceptable standard of care.
(c)
State Licensure. Physicians who treat and prescribe through
the Internet are practicing medicine and must possess appropriate licensure
in all jurisdictions where patients reside.
(d)
Electronic Communications.
(1)
Written policies and procedures must be maintained when
using electronic mail for physician-patient communications. Policies must
be evaluated periodically for currency. Such policies and procedures must
address:
(A)
privacy to assure confidentiality and integrity of patient-identifiable
information;
(B)
health care personnel, in addition to the physician, who
will process messages;
(C)
hours of operation and availability;
(D)
types of transactions that will be permitted electronically;
(E)
required patient information to be included in the communication,
such as patient name, identification number and type of transaction;
(F)
archival and retrieval; and
(G)
quality oversight mechanisms.
(2)
All patient-physician e-mail, as well as other patient-related
electronic communications, must be stored and filed in the patient's medical
record.
(3)
Patients must be informed of alternative forms of communication
for urgent matters.
(e)
Medical Records.
(1)
Medical records must include copies of all patient-related
electronic communications, including patient-physician e-mail, prescriptions,
laboratory and test results, evaluations and consultations, records of past
care and instructions.
(2)
Notice of privacy practices related to the use of e-mail
must be filed in the medical record.
(f)
Disclosure. Physician medical practice sites must clearly
disclose:
(1)
ownership of the website;
(2)
specific services provided;
(3)
office address and contact information;
(4)
licensure and qualifications of physician(s) and associated
health care providers;
(5)
fees for online consultation and services and how payment
is to be made;
(6)
financial interest in any information, products, or services;
(7)
appropriate uses and limitations of the site, including
providing health advice and emergency health situations;
(8)
uses and response times for e-mails, electronic messages,
and other communications transmitted via the site;
(9)
to whom patient health information may be disclosed and
for what purpose;
(10)
rights of patients with respect to patient health information;
and
(11)
information collected and any passive tracking mechanisms
utilized.
(g)
Accountability. Medical practice sites must provide patients
with a clear mechanism to:
(1)
access, supplement, and amend patient-provided personal
health information;
(2)
provide feedback regarding the site and the quality of
information and services; and
(3)
register complaints, including information regarding filing
a complaint with the Texas State Board of Medical Examiners as provided for
in Chapter 178 of this title (relating to Complaints).
(h)
Advertising/Promotion of Goods or Products. Advertising
or promotion of goods or products from which the physician receives direct
remuneration or incentives is prohibited.
§174.5.Notice of Privacy Practices.
(a)
Physicians that communicate with patients by e-mail or
other electronic means other than telephone or facsimile must make a good
faith effort to notify patients in writing of the physicians' privacy practices.
(b)
The notice of privacy practices shall include language
that is consistent with federal standards under 45 CFR Parts 160 and 164 relating
to privacy of individually identifiable health information.
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 April 12, 2004.
TRD-200402446
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
The Texas State Board of Medical Examiners proposes amendments to §§177.1
- 177.8, the repeal of §§177.9 - 177.16 and new §§177.9
- 177.13, concerning Certification of Non-Profit Health Organizations. The
amendments, repeals and new rules are necessary for general cleanup of the
chapter.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
of Chapter 177.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rules are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rules as proposed are in effect the public benefit anticipated as
a result of enforcing the sections will be to make reference to other sections
of the rules rather than to repeat the entire text. In addition, the rules
clarify that Board of Directors must hold unrestricted licenses and that all
corporations must be Texas-based. There will be no effect on small or micro
businesses. There will be no effect to individuals required to comply with
the sections as proposed.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
22 TAC §§177.1 - 177.8
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments: Texas Occupations
Code Annotated, §§162.001 - 162.003.
§177.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the contents clearly indicate otherwise.
(1)
Act--The Texas Medical Practice Act, Texas Occupations
Code Annotated,
Title 3
Subtitle B.
(2)
Actively engaged in the practice of medicine--The physician
on a full-time basis
is engaged in diagnosing, treating or offering
to treat any mental or physical disease or disorder or any physical deformity
or injury or performing such actions with respect to individual patients for
compensation and shall include clinical medical research, the practice of
clinical investigative medicine, the supervision and training of medical students
or residents in a teaching facility or program approved by the Liaison Committee
on Medical Education of the American Medical Association, the American Osteopathic
Association or the Accreditation Council for Graduate Medical Education, and
professional managerial, administrative, or supervisory activities related
to the practice of medicine or the delivery of health care services.
The term "full-time basis," for purposes of this section, shall mean at least
20 hours per week for 40 weeks duration during a given year.
(3)
Board--Texas State Board of Medical Examiners.
(4)
Board of Directors--The board of the
health organization
[
(5)
Certification by the Board--In accordance with Chapter
162, Texas Occupations Code Annotated, the Board shall certify a health organization
as a non-profit health organization; as a migrant, community, or homeless
health center; or as a federally qualified health center.
(6)
Chief Executive Officer--The officer of the
health
organization
[
(7)
Director--A member of
a health organization's board
of directors
[
(8)
Member--A member of the
health organization
[
(9)
Health Organization--An applicant for or holder of certification
from the Texas State Board of Medical Examiners under the Act, §162.001(b)
and (c)
.
(10)
Rules--The rules
, 22 Texas Administrative Code Chapters
161-200,
promulgated by the Texas State Board of Medical Examiners pursuant
to the Act.
(11)
Supplier--
(A)
A physician retained to provide medical services to or
on behalf of the
health organization
[
(B)
any other person providing or anticipated to provide services
or supplies to or on behalf of the
health organization
[
§177.2.Initial Certification of 162.001(b) Health Organizations .
Any
health organization
[
§177.3.Qualifications for Certification as a 162.001(b) Health Organization .
A
162.001(b) health organization
[
(1)
the
health organization
[
(2)
the
health organization
[
(3)
the
board of directors
[
(4)
the
health organization
[
(5)
the
health organization
[
§177.4.Applications for Certification as a 162.001(b) Health Organization .
A
health organization
[
(1)
Initial Identification Statement. A statement signed and
verified by the chief executive officer:
(A)
indicating the name and mailing address of the
health
organization
[
(B)
indicating the names and mailing addresses of all
members
[
(C)
indicating the names and mailing addresses of all
officers
[
(D)
indicating the names and mailing addresses of all
directors
[
(2)
Initial Document Statement. A statement signed and verified
by the chief executive officer attaching a copy of the current certificate
of incorporation of the
health organization
[
(A)
the
health organization
[
(i)
the carrying out of scientific research and research projects
in the public interest in the fields of medical sciences, medical economics,
public health, sociology, or related areas;
(ii)
the supporting of medical education in medical schools
through grants and scholarships;
(iii)
the improving and developing of the abilities of individuals
and institutions studying, teaching, and practicing medicine;
(iv)
the delivery of health care to the public
;
or[
(v)
the engaging in the instruction of the general public in
the area of medical science, public health, and hygiene and related instruction
useful to the individual and beneficial to the community.
(B)
the physician(s) organizing and incorporating the
health organization
[
(C)
the by-laws of the
health organization
[
(D)
each
director
[
(E)
each
director
[
(F)
the termination of the retention of any physician to provide
medical services on behalf of the
health organization
[
(3)
Initial Director Statements. Statements signed and verified
by each current
director
[
(A)
such
director
[
(B)
such
director
[
(C)
such
director
[
(D)
such
director
[
(E)
such
director
[
(F)
such
director
[
(4)
Initial Compliance Statement. A statement signed and verified
by the chief executive officer indicating that the
health organization
[
(5)
Initial Fee Payment. A fee in the amount and form specified
by the Rules.
§177.5.Special Requirements for 162.001(b) Health Organizations .
In addition to the general by-law requirements set forth herein for
health organizations
[
(1)
All credentialing, quality assurance, utilization review
and peer review policies shall be made exclusively by the
board of directors
[
(2)
Subsequent to the appointment of the initial
board
of directors
[
(3)
Without the approval of at least a majority of the
board of directors
[
§177.6.Biennial Reports for 162.001(b) Health Organizations [
Each
health organization
[
(1)
Biennial Identification Statement. A statement signed and
verified by the chief executive officer:
(A)
indicating the name and mailing address of the
health
organization
[
(B)
indicating the names and mailing addresses of all
members
[
(C)
indicating the names and mailing addresses of all
officers
[
(D)
indicating the names and mailing addresses of all
directors
[
(E)
disclosing any changes in the composition of the
board of directors
[
(2)
Biennial Document Statement. A statement signed and verified
by the chief executive officer attaching a copy of the current certificate
of incorporation and by-laws of the
health organization
[
(A)
whether or not the by-laws or articles of incorporation
of the
health organization
[
(B)
whether or not such revisions, if any, were recommended
or approved by the
board of directors
[
(C)
a concise explanation of such revisions, if any.
(3)
Biennial Director Statements. Statements signed and verified
by each current
director
[
(A)
such
director
[
(B)
such
director
[
(C)
such
director
[
(D)
such
director
[
(E)
such
director
[
(F)
such
director
[
(4)
Biennial Compliance Statement. A statement signed and verified
by the chief executive officer indicating that the Health Organization is
in compliance with the requirements for certification and continued certification
as required by the provisions of the Act and the Rules.
(5)
Biennial Fee Payment. A fee in the amount and form specified
by the Rules.
§177.7.Establishment of Fees.
(a)
Fees established pursuant to §153.011
and §153.051 of the Act relating to initial certification, recertification,
and late applications for recertification are set forth under Chapter 175
of this title (relating to Fees, Penalties, and Applications).
[
[(1)
Initial Fee. In addition to all other
requirements for certification under the Act, §162.001(b), and the Rules,
to obtain certification, the Health Organization shall submit a fee of $2,500
in the form of a check or money order payable to the Texas State Board of
Medical Examiners.]
[(2)
Biennial Fee. In addition to all other
requirements for continued certification under the Act, §162.001(b),
and the Rules, to maintain certification, at the time of submission of the
Biennial Report, the Health Organization shall submit a fee of $1,000 in the
form of a check or money order payable to the Texas State Board of Medical
Examiners.]
(b)
[
(c)
[
§177.8.Failure to Submit Reports or Fees for 162.001(b) Health Organizations .
(a)
The failure of a
health organization
[
(b)
The failure of a
health organization
[
(c)
If a
health organization
[
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 April 12, 2004.
TRD-200402447
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §§177.9 - 177.16
(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 State Board of Medical Examiners or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the authority of the
Occupations Code Annotated, §153.001, which provides the Texas State
Board of Medical Examiners to adopt rules and bylaws as necessary to: govern
its own proceedings; perform its duties; regulate the practice of medicine
in this state; and enforce this subtitle.
The following are affected by the proposed repeals: Texas Occupations Code
Annotated, §§162.001 - 162.003.
§177.9.Denial of Certification.
§177.10.Revocation of Certification
§177.11.Review of Applications and Reports.
§177.12.Procedure for Denial of Certification or Decertification.
§177.13.Approved Form.
§177.14.Compliance Date.
§177.15.Migrant, Community or Homeless Health Centers.
§177.16.Complaint Procedure Notification.
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 April 12, 2004.
TRD-200402448
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §§177.9 - 177.13
The new rules are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed new rules: Texas Occupations
Code Annotated, §§162.001 - 162.003.
§177.9.Migrant, Community or Homeless Health Centers.
(a)
Section 162.001(c), non-profit health organizations. Migrant,
community, or homeless health centers organized and operated under the authority
of and in compliance with 42 U.S.C. §254b or §254c, or federally
qualified health centers under 42 U.S.C. §1396(d)(1)(2)(B), that are
non-profit corporations under the Texas Non-Profit Corporation Act, Article
1396-1.01, Texas Civil Statutes, and the Internal Revenue Code, §501(c)(3),
and who wish to obtain approval and certification to contract with and employ
physicians pursuant to the Medical Practice Act, §162.001(c), Texas Occupations
Code Annotated, Title 3 Subtitle B, may do so by submitting an application
on a form approved by the board to the permits department of the board with
the following attached documentation:
(1)
a copy of the certificate of incorporation under the Texas
Non-Profit Corporation Act;
(2)
a copy of documentation verifying that a determination
has been made that the organization is tax exempt under the Internal Revenue
Code pursuant to §501(c)(3); and,
(3)
a copy of documentation verifying that the organization
is organized and operated as a migrant, community, or homeless health center
under the authority of and in compliance with 42 U.S.C. §254b or §254c,
or is a federally qualified health center under 42 U.S.C. §1396(d)(1)(2)(B).
(b)
Initial Fee Payment. A fee in the amount and form specified
by board rules.
(c)
Biennial reports. Each organization approved and certified
under the Act, §162.001(c), shall file with the board a completed biennial
report on a board-approved form that contains updated and current information
which would otherwise be required for initial approval and certification to
contract with and employ physicians. The biennial report shall be submitted
in September of each odd numbered year if certified in an odd numbered year,
and in September of each even numbered year if certified in an even numbered
year. Failure to timely submit a required biennial report shall be grounds
for denial of recertification to contract with and employ physicians pursuant
to §177.10(e) of this chapter (relating to Review of Applications and
Reports).
(d)
Biennial Fee Payment. There is no biennial fee for health
organizations certified pursuant to §162.001(c) of the Act.
§177.10.Review of Applications and Reports.
(a)
Applications for certification and biennial reports under
this section shall be initially reviewed by the permits and legal staffs of
the board or other designees of the board to determine compliance with the
requirements for certification.
(b)
If an application for certification is insufficient or
there is any other basis for denial, the health organization will be notified
in writing that unless it takes corrective action or remedies the insufficiency,
the health organization's application will be denied. The health organization
shall have 60 days from the date of the mailing by the board to submit the
corrected application.
(c)
If a biennial report is insufficient or there is any other
basis for decertification, the health organization will be notified in writing
that unless it takes corrective action, the health organization will be recommended
for decertification at the next meeting of the board. The health organization
shall have 60 days from the date of the mailing by the board to submit the
corrected biennial report.
(d)
If upon review of the application or biennial report and
any supporting documentation, the applying or reporting appears to be in compliance
for certification or continued certification, such certification or recertification
shall be made upon approval of the board or a committee of the board.
(e)
In the event that such compliance cannot be determined
or is otherwise in question for any reason including complaints of actions
by the health organization in contravention of this section or the Act, including
but not limited to failure to provide due process or evidence of undue influence
on the practice of medicine, the application or statement and any supporting
documentation shall be submitted to the board or a committee of the board
for further review, investigation, approval, denial, or decertification.
§177.11.Denial of Certification.
Subject to due process procedures, the board may refuse to certify
any health organization making application to the board if in the board's
determination the applying health organization is established or organized
or operated in contravention to or with the intent to circumvent any of the
provisions of the Act.
§177.12.Revocation of Certification.
(a)
In the event that the Board receives information about
a health organization including complaints of actions by the Health Organization
in contravention of this chapter or the Act, including but not limited to
failure to provide due process or evidence of undue influence on the practice
of medicine information, such information shall be referred to the board's
investigation department.
(b)
Subject to due process procedures, the board shall revoke
a certification if in the board's determination the health organization is
established, organized, or operated in contravention of or with the intent
to circumvent any of the provisions of the Act or the board's rules.
(c)
Chapter 187 of this title (relating to Procedural Rules)
shall govern procedures relating to revocation of certification where applicable.
If the provisions of Chapter 187 of this title conflict with the Act or rules
under this chapter, the Act and provisions of this chapter shall control.
§177.13.Complaint Procedure Notification.
(a)
Method of Notification. For the purpose of directing complaints
to the board regarding health-care delivery by licensees of the board practicing
through non-profit health organizations certified pursuant to the Medical
Practice Act, §162.001, the non-profit health organizations which are
certified or otherwise approved pursuant to the Medical Practice Act, §162.001(b)
and (c), shall provide notification to the public of the name, mailing address,
and telephone number of the board by displaying in a prominent location at
each site of health-care delivery and readily visible to patients or potential
patients, signs in English and Spanish of no less than 8 1/2 inches by 11
inches in size with the board-approved notification statement printed alone
and in its entirety in black on white background in type no smaller than standard
24-point Times Roman print with no alterations, deletions, or additions to
the language of the board-approved statement.
(b) Approved English Notification Statement. The following
notification statement in English is approved by the board for purposes of
these rules:
(c) Approved Spanish Notification Statement. The following
notification statement in Spanish is approved by the board for purposes of
these rules:
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 April 12, 2004.
TRD-200402449
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §184.14
The Texas State Board of Medical Examiners proposes an amendment
to §184.14, concerning qualifications of supervising physicians. The
amendment clarifies that a supervising physician's license must be unrestricted
and active.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rule is in effect there
will be no fiscal implications to state or local government as a result of
enforcing the rule as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rule as proposed is in effect the public benefit anticipated as
a result of enforcing the section will be clarification that a supervising
physician's license must be unrestricted and active. There will be no effect
on small or micro businesses. There will be no effect to individuals required
to comply with the section as proposed.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendment: Texas Occupations
Code Annotated, §206.251.
§184.14.Supervising Physician.
To be authorized to supervise a surgical assistant, a physician must
be currently licensed as a physician in this state by the medical board. The
license must be unrestricted and active [
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 April 12, 2004.
TRD-200402450
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §§185.8, 185.16, 185.20
The Texas State Board of Medical Examiners proposes amendments
to §§185.8, 185.16 and 185.20, concerning Physician Assistants.
The amendments regard inactive status, supervising physicians, employment
guidelines, and complaints.
Elsewhere in this issue of the
Texas Register
, the Texas State Board of Medical Examiners proposes the rule review
of Chapter 185.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rules are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rules as proposed are in effect the public benefit anticipated as
a result of enforcing the sections will be clarification of rules to ensure
that doctors who delegate any act to a physician assistant requires on-site
presence of doctor at that site 20% of site's business hours when PA works.
There will be no effect on small or micro businesses. There will be no effect
to individuals required to comply with the section as proposed.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendments are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendments:
185.8 - Texas Occupations Code Annotated, §204.157.
185.16 - Texas Occupations Code Annotated, §§157.001-.0542, 204.204-.205.
185.20 - Texas Occupations Code Annotated, §204.251-.252
§185.8.Inactive License.
(a)
A license holder may have the license holder's license
placed on inactive status by applying to the board. A physician assistant
with an inactive license is excused from paying renewal fees on the license
and may not practice as a physician assistant in Texas.
(b)
In order for a license holder to be placed on inactive
status, the license holder must have a current annual registration permit
and have a license in good standing
.
(c)
A license holder who practices as a physician assistant
while on inactive status is considered to be practicing without a license.
(d)
A physician assistant may return to active status by applying
to the board, paying the license renewal fee, complying with the requirements
for license renewal under the Physician Assistant Licensing Act and complying
with subsection (e) of this section.
(e)
A physician assistant applicant applying to return to active
status shall provide sufficient documentation to the board that the applicant
has, on a full-time basis as defined in §185.4(d) of this chapter, actively
practiced as a physician assistant or has been on the active teaching faculty
of an acceptable approved physician assistant program, within either of the
two years preceding receipt of an application for reactivation. Applicants
who do not meet this requirement may, in the discretion of the board, be eligible
for the reactivation of a license subject to one or more of the following
conditions or restrictions as set forth in paragraphs (1)-(5) of this subsection:
(1)
current certification by the National Commission on the
Certification of Physician Assistants;
(2)
completion of specified continuing medical education hours
approved for Category 1 credits by a CME sponsor approved by the American
Academy of Physician Assistants;
(3)
limitation and/or exclusion of the practice of the applicant
to specified activities of the practice as a physician assistant;
(4)
remedial education; and
(5)
such other remedial or restrictive conditions or requirements
which, in the discretion of the board are necessary to ensure protection of
the public and minimal competency of the applicant to safely practice as a
physician assistant.
§185.16.Employment Guidelines.
(a)
Except as otherwise provided in this section, a physician
may supervise up to five physician assistants, or their full-time equivalents.
"Full time" shall mean no more than 50 hours per week.
(b)
A physician assistant may not independently bill patients
for the services provided by the physician assistant except where provided
by law.
(c)
Except at a site serving medically underserved populations
as defined by Sec. 157.052 of the Tex. Occ. Code
, a physician assistant
shall not practice at a site where that physician assistant's supervising
physician is not present at least 20 percent of the site's listed business
hours
. This provision shall not be interpreted to prevent a physician
who has delegated prescriptive authority to a PA or APN pursuant to Chapter
157 of the Tex. Occ. Code from applying for a waiver in accordance with Sec.
157.0542 of the Tex. Occ. Code and
[
(d)
A physician who provides medical services in preventive
medicine, disease management, health and wellness education, or similar services
in an accredited academic/teaching institution listed in paragraphs (1)-(10)
of this subsection, or its affiliates, may be denoted as the supervising physician
for more than five physician assistants in that institution or its affiliates,
provided the supervising physician determines that the physician assistants
are properly trained to deliver the services, that the services are of such
a nature that they may be safely and competently delivered by the supervised
physician assistants, and the proper paperwork has been filed with the Texas
State Board of Medical Examiners. The supervision of physician assistants
must comply with all institutional rules and there must be accurate and timely
internal institutional records, which are available upon request within 24
hours to the Texas State Board of Medical Examiners, which list the name and
license number of the physician who is specifically assigned to actively supervise
each physician assistant at one of the following institutions:
(1)
University of Texas Medical Branch at Galveston;
(2)
University of Texas Southwestern Medical Center at Dallas;
(3)
University of Texas Health Science Center at Houston;
(4)
University of Texas Health Science Center at San Antonio;
(5)
University of Texas Health Center at Tyler;
(6)
University of Texas M.D. Anderson Cancer Center;
(7)
Texas A&M University College of Medicine;
(8)
Texas Tech University School of Medicine;
(9)
Baylor College of Medicine; or
(10)
University of North Texas Health Science Center at Fort
Worth.
(e)
A physician who holds the position of Medical Director,
Chief of Staff, or Emergency Room Department Chair at a licensed hospital
may be denoted as the supervising physician for more than five physician assistants
for the purpose of staffing a hospital emergency room. This physician may
then delegate the direct supervision of the physician assistant to staff physicians
providing medical services within the emergency room, provided that the supervising
physician determines that the physician assistants are properly trained to
deliver the services, that the services are of such a nature that they may
be safely and competently delivered by the supervised physician assistants,
and that the proper paperwork has been filed with the Texas State Board of
Medical Examiners. The supervision of physician assistants must comply with
all institutional rules and there must be accurate and timely internal institutional
records, which are available upon request within 24 hours to the Texas State
Board of Medical Examiners, which list the name and license number of the
physician who is specifically assigned to actively supervise each physician
assistant.
(f)
The provisions of subsections (a), (d), and (e) of this
section relating to the number of physician assistants authorized to be supervised
shall not be interpreted to change or modify rules or statutes relating to
the number of physician assistants to whom prescriptive authority may be delegated.
§185.20. Complaints [
Chapter
178
[
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 April 12, 2004.
TRD-200402451
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
The Texas State Board of Medical Examiners proposes an amendment to §187.2
and §187.31, the repeal of §§187.26-187.28 and new §187.26
and §187.27, concerning Procedural Rules. The amendments, repeals and
new rules regard default judgments by the Board in SOAH administrative proceedings.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rules are in effect
there will be no fiscal implications to state or local government as a result
of enforcing the rules as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rules as proposed are in effect the public benefit anticipated as
a result of enforcing the sections will be clarification of the procedures
to be followed regarding service in SOAH proceedings and peer review proceedings.
There will be no effect on small or micro businesses. There will be no effect
to individuals required to comply with the section as proposed.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
Subchapter A. GENERAL PROVISIONS AND DEFINITIONS
22 TAC §187.2
The amendment is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendment: Texas Occupations
Code Annotated, §§164.002 and 164.007 and 164.004-.006 and Govt
Code 2001.056 and 2001.051 and 2001.141 and 2001.052.
§187.2.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
Act--Tex. Occ. Code Ann, Title 3 Subtitle B, for physicians;
Tex. Occ. Code Ann. Chapter 204 for physician assistants; Tex. Occ. Code Ann.
Chapter 205 for acupuncturists; and Tex. Occ. Code Ann. Chapter 206 for surgical
assistants.
(2)
Address of record--The mailing address of each licensee
or applicant as provided to the agency pursuant to the Act.
(3)
Administrative law judge (ALJ)--An individual appointed
to preside over administrative hearings pursuant to the APA.
(4)
Agency--The divisions, departments, and employees of the
Texas State Board of Medical Examiners, the Texas State Board of Physician
Assistant Examiners, and the Texas State Board of Acupuncture Examiners.
(5)
APA--The Administrative Procedure Act, Texas Government
Code, Chapter 2001 as amended.
(6)
Applicant--A person seeking a license from the board.
(7)
Attorney of record--A person licensed to practice law in
Texas who has provided staff with written notice of representation.
(8)
Authorized representative--An attorney of record or any
other person who has been designated in writing by a party to represent the
party at a board proceeding.
(9)
Board--The Texas State Board of Medical Examiners for physicians
and surgical assistants, the Texas State Board of Acupuncture Examiners for
acupuncturists, and the Texas State Board of Physician Assistant Examiners
for physician assistants.
(10)
Board member--One of the members of the board appointed
pursuant to the Act.
(11)
Board proceeding--Any proceeding before the board or at
which the board is a party to an action, including a hearing before SOAH.
(12)
Board representative--a board member or district review
committee member who sits on a panel at an informal proceeding.
(13)
Complaint--Pleading filed at SOAH by the board alleging
a violation of the Act.
(14)
Contested case--A proceeding, including but not restricted
to licensing, in which the legal rights, duties, or privileges of a party
are to be determined by the board after an opportunity for an administrative
hearing to be held at SOAH.
(15)
Default judgment--The issuance of a proposal for decision
or board order in which the factual allegations against a party are deemed
admitted as true upon the party's failure to appear at a properly noticed
SOAH hearing or ISC.
(16)
Default Order--A board order
in which the factual allegations against a party are deemed admitted as true
upon the party's failure to file a timely answer to a Complaint or to appear
at a properly noticed SOAH hearing.
(17)
[
(18)
[
(19)
[
(20)
[
(21)
[
(22)
[
(23)
[
(24)
[
(25)
[
(26)
[
(27)
[
(28)
[
(29)
[
(30)
[
(31)
[
(32)
[
(33)
[
(34)
[
(35)
[
(36)
[
(37)
[
(38)
[
(39)
[
(40)
[
(41)
[
(42)
[
(43)
[
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 April 12, 2004.
TRD-200402452
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §§187.26 - 187.28
(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 State Board of Medical Examiners or in the Texas Register office,
Room 245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the authority of the
Occupations Code Annotated, §153.001, which provides the Texas State
Board of Medical Examiners to adopt rules and bylaws as necessary to: govern
its own proceedings; perform its duties; regulate the practice of medicine
in this state; and enforce this subtitle.
The following are affected by the proposed repeals: Texas Occupations Code
Annotated, §§164.002 and 164.007 and 164.004-.006 and Govt Code
2001.056 and 2001.051 and 2001.141 and 2001.052.
§187.26.Service in SOAH Proceedings.
§187.27.Written Answers in SOAH Proceedings and Default Judgments.
§187.28.Discovery.
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 April 12, 2004.
TRD-200402453
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §187.26, §187.27
The new rules are proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed new rules: Texas Occupations
Code Annotated, §§164.002 and 164.007 and 164.004-.006 and Govt
Code 2001.056 and 2001.051 and 2001.141 and 2001.052.
§187.26.Service in SOAH Proceedings.
(a)
Service of a notice of adjudicative hearing and complaint
shall be made by hand delivery, regular, registered or certified mail, courier
service, or otherwise in accordance with the APA and the Rules of SOAH. The
notice shall be delivered to the respondent at the address of record on file
with the board. A certificate of service indicating service in the manner
provided for in this subsection shall be prima facie evidence of proper service
of notice of adjudicative hearing.
(1)
Service by hand delivery shall be complete upon hand delivery
to the respondent or respondent's agent at the respondent's address of record.
(2)
Service by mail shall be complete upon deposit of the paper,
enclosed in a postpaid, properly addressed wrapper, in a post office or official
depository under the care and custody of the United States Postal Service.
(3)
Service by courier service shall be complete upon deposit
of the paper, enclosed in a properly addressed wrapper, in a depository under
the care and custody of a courier service, with payment under a contract with
the board.
(b)
Service by publication. If service of notice as prescribed
by subsection (a) of this section is impossible or cannot be accomplished,
then notice may be made through publication of a notice of hearing once a
week for two successive weeks in a newspaper published in the county of the
last known place of practice of the person entitled to notice if the county
is known. If the person is not currently practicing in Texas as evidenced
by information in the agency files, or if the last county of practice is unknown,
publication shall be in a newspaper in Travis County. When publication of
notice is used, the date of hearing may not be less than ten days after the
date of the last required publication of notice. Proof of publication may
be accomplished by affidavit of a representative or record custodian of the
publisher indicating the required publication or by introduction and admission
into evidence of copies of the required notices published for purposes of
service.
(c)
Service of documents in contested cases pending before
SOAH shall be governed by the rules of SOAH.
§187.27.Written Answers in SOAH Proceedings and Default Orders.
(a)
Written Answers in SOAH Proceedings.
(1)
Within 20 days after the date that service of a notice
of adjudicative proceeding and complaint is complete, as provided in §187.26
of this title (related to Service in SOAH Proceedings), the respondent shall
file a written answer with the State Office of Administrative Hearings and
with the Hearings Coordinator of the board.
(2)
The written answer shall specifically admit or deny each
factual and legal allegation made against the respondent. As to any allegation,
the answer may admit in part and deny in part, clearly stating the parts that
are admitted and the parts that are denied. Any unreasonable denial of any
allegation or part of an allegation shall constitute unprofessional and dishonorable
conduct and shall be considered as an aggravating factor if a violation of
the Act is found.
(3)
The notice of hearing shall include the following language
in at least 10-point bold type: If you do not file a written answer to this
notice with the State Office of Administrative Hearings within 20 days of
the date notice of service was mailed, a default judgment may be entered against
you, which may include the denial of licensure or any or all of the requested
sanctions including the revocation of your license. If you file a written
answer, but then fail to attend the hearing, a default judgment may be entered
against you, which may include the denial of licensure or any or all of the
requested sanctions including the revocation of your license. A copy of any
response you file with the State Office of Administrative Hearings shall also
be provided to the hearings coordinator of the Texas State Board of Medical
Examiners.
(4)
Upon the filing of a notice of adjudicatory hearing, the
Hearings Coordinator for the board shall calculate the date that a written
answer must be filed.
(b)
Default Orders.
(1)
Upon the filing of a written answer or upon the expiration
of the time that a written answer must be filed, the Hearings Coordinator
shall present the administrative record of the case to the Hearings Counsel
for the board, including the complaint, the notice of adjudicative hearing,
and the written answer, if any. The Hearings Counsel shall determine whether
the notice was properly served and whether the written answer reasonably complies
with subsection (a)(2) of this section.
(2)
In the event the Hearings Counsel determines that the notice
of adjudicative hearing was properly served and that respondent has failed
to timely file a written answer, as required by subsections (a)(1) and (a)(2)
of this section, the Hearings Counsel shall issue a Determination of Default,
which shall be served on respondent and filed at SOAH. The Determination of
Default shall specifically state the facts on which the Hearings Counsel has
based the Determination of Default, request that the matter be abated or continued
at SOAH pending informal disposition by the board, and summarize the requirements
by which a Determination of Default may be set aside, as provided in paragraph
(6) of this subsection.
(3)
The failure to file an answer that reasonably complies
with subsection (a)(2) of this section shall be considered the failure to
timely file a written answer.
(4)
The board shall consider the complaint and the Determination
of Default at a meeting of the board not less than twenty days after the date
of the Determination of Default. If the board concurs with the findings in
the Determination of Default, the board may deem the allegations in the Complaint
as true and enter a Default Order.
(5)
An answer received after a Determination of Default has
been issued shall not be filed.
(6)
In the event that the respondent wishes to file an answer
after a Determination of Default has been issued, but before a Default Order
has been adopted by the board, the respondent must file a Motion to Set Aside
the Determination of Default, which shall show the board that
(A)
the failure to timely file a written answer was not intentional
or the result of conscious indifference but was due to a mistake or accident;
(B)
respondent has a meritorious defense;
(C)
the setting aside of the Determination of Default will
not cause any delay or injury to the board; and
(D)
respondent is prepared to file an answer that fully complies
with subsection (a)(2) of this section if the board sets aside the Determination
of Default.
(7)
In the event that the respondent wishes to file an answer
after a Default Order has been entered by the board, but before the time for
filing a Motion for Rehearing has expired, the respondent must file a Motion
for Rehearing to Set Aside Default Order, which shall show that:
(A)
the failure to timely file a written answer was caused
by fraud, accident, or wrongful act or official mistake of the board;
(B)
the failure to timely file a written answer was not the
result of respondent's fault or negligence;
(C)
the respondent has a meritorious defense; and
(D)
respondent is prepared to file an answer that fully complies
with subsection (a)(2) of this section if the board grants the Motion for
Rehearing. The Motion for Rehearing shall be supported by affidavits and documentary
evidence that present a prima facie case for a meritorious defense.
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 April 12, 2004.
TRD-200402454
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
22 TAC §187.31
The amendment is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendment: Texas Occupations
Code Annotated, §§164.002 and 164.007 and 164.004-.006 and Govt
Code 2001.056 and 2001.051 and 2001.141 and 2001.052.
§187.31.Evidence.
(a)
Rules. The rules of evidence as applied in nonjury civil
cases in the district courts of this state shall be followed, except that
evidence inadmissible under those rules may be admitted if it meets the standards
set out in the APA §2001.081, as discussed in this section. In all cases,
irrelevant, immaterial, or unduly repetitious evidence shall be excluded.
When necessary to ascertain facts not reasonably susceptible of proof under
those rules, evidence not admissible thereunder may be admitted, except where
precluded by statute, if it is of a type commonly relied upon by reasonably
prudent men in the conduct of their affairs. The ALJ shall give effect to
the rules of privilege recognized by law. Opportunity must be afforded all
parties to respond and present evidence and argument of all issues involved.
(b)
Objections. Objections to evidentiary offers shall be made
and shall be noted in the record. Formal exceptions to rulings of the ALJ
during a hearing shall be unnecessary. It shall be sufficient that the party
at the time any ruling is made or sought shall have made known to the ALJ
the action which he or she desires.
(c)
Offer of proof. If evidence is excluded from the record
by an exclusionary ruling of the ALJ the evidence may be included in the record
by an offer of proof by the sponsoring party by dictating into the record
or submitting in writing the substance of the evidence. An offer of proof
shall be sufficient to preserve the evidence for review.
(d)
Physician's office records. When subpoenaed by the board,
unless stipulated by the parties, the office records of each patient shall
have stapled thereto an affidavit in the form approved and furnished by the
board which contains the requisite elements to comply with the Texas Rules
of Evidence, 902 (10)(b), relating to form of affidavits.
(e)
Peer review proceedings.
(1)
Pursuant to Section 160.006 of the Act, a record,
report, or other information that has been submitted to the board in accordance
with Chapter 160 of the Act
[
(2)
In accordance with [
(f)
Deferred adjudications. In accordance with §2001.081
of the APA and consistent with §§164.053(a)(1) and 164.053(b) of
the Act, deferred adjudications are admissible as evidence that the respondent
violated the law with which the respondent was charged and pled to, which
gave rise to the deferred adjudication.
(g)
Documents. Subject to these requirements, if a hearing
will be expedited and the interests of the parties will not be substantially
prejudiced, any part of the evidence may be received in written form.
(1)
Copies. Documentary evidence may be received in the form
of copies or excerpts if the original is not readily available. On request,
parties shall be given an opportunity to compare the copy with the original.
When numerous documents are offered, the ALJ may limit those admitted to a
number which are typical and representative and may, in his or her discretion,
require the abstracting of the relevant data from the documents and the presentation
of the abstracts in the form of an exhibit; provided, however, that before
making such requirement the ALJ shall require that all parties of record or
their representatives be given the right to examine the documents from which
such abstracts were made.
(2)
Prepared testimony. In all contested proceedings, prepared
testimony of a witness upon direct examination, either in narrative or question
and answer form, may be incorporated in the record as if read or received
as an exhibit, upon the witness's being sworn and identifying the same. Such
witness shall be subject to cross-examination and the prepared testimony shall
be subject to a motion to strike in whole or in part. A party may not be required
over objection to submit written testimony. The board relies upon physicians
who receive minimal compensation to act as consultants to the board and provide
testimony as needed at SOAH hearings. Requiring the board's consultants to
spend additional time to reduce their testimony to writing would dissuade
and deter physicians from continuing to volunteer to act as board consultants
and experts. Accordingly, it is not in the interest of the board and would
be substantially prejudicial to the board to require testimony to be reduced
to writing.
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 April 12, 2004.
TRD-200402455
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
Subchapter B. VIOLATION GUIDELINES
22 TAC §190.8
The Texas State Board of Medical Examiners proposes an amendment
to §190.8, concerning Disciplinary Guidelines. The amendment will clarify
the definition of a proper physician/patient relationship for hospice patients.
Michele Shackelford, General Counsel, Texas State Board of Medical Examiners,
has determined that for the first five-year period the rule is in effect there
will be no fiscal implications to state or local government as a result of
enforcing the rule as proposed.
Ms. Shackelford also has determined that for each year of the first five
years the rule as proposed is in effect the public benefit anticipated as
a result of enforcing the section will be to clarify the definition of a proper
physician/patient relationship for hospice patients. There will be no effect
on small or micro businesses. There will be no effect to individuals required
to comply with the section as proposed.
Comments on the proposal may be submitted to Colleen Klein, P.O. Box 2018,
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The amendment is proposed under the authority of the Occupations
Code Annotated, §153.001, which provides the Texas State Board of Medical
Examiners to adopt rules and bylaws as necessary to: govern its own proceedings;
perform its duties; regulate the practice of medicine in this state; and enforce
this subtitle.
The following are affected by the proposed amendment: Texas Occupations
Code Annotated, §164.001, §164.051(a)(6).
§190.8.Violation Guidelines.
When substantiated by credible evidence, the following acts, practices,
and conduct are considered to be violations of the Act. The following shall
not be considered an exhaustive or exclusive listing.
(1)
Practice Inconsistent with Public Health and Welfare. Failure
to practice in an acceptable professional manner consistent with public health
and welfare within the meaning of the Act includes, but is not limited to:
(A) - (K)
(No change.)
(L)
prescription of any dangerous drug or controlled substance
without first establishing a proper professional relationship with the patient.
(i)
A proper relationship, at a minimum requires:
(I)
[
(II)
[
(III)
[
(IV)
[
(ii)
A proper professional relationship
is also considered to exist between a patient certified as having a terminal
illness and who is enrolled in a hospice program, or another similar formal
program which meets the requirements of subclauses (I) through (IV) of this
clause, and the physician supporting the program. To have a terminal condition
for the purposes of this rule, the patient must be certified as having a terminal
illness under the requirements of 40 TAC §97.403 and 42 CFR 418.22.
(M)
(No change.)
(2) - (6)
(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 April 12, 2004.
TRD-200402456
Donald W. Patrick, MD, JD
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: May 23, 2004
For further information, please call: (512) 305-7016
Chapter 346.
PRACTICE SETTINGS FOR PHYSICAL THERAPY
Chapter 174.
TELEMEDICINE
Chapter 177.
CERTIFICATION OF NON-PROFIT HEALTH ORGANIZATIONS
Health Organization
] whether referred to as the board of
directors, the board of trustees or other title.
Health Organization
] authorized in the articles
of incorporation, the bylaws, or otherwise, to perform the functions of the
principal executive officer, irrespective of the name by which such officer
may be designated by the
health organization
[
Health Organization
].
the Board of Directors
] whether referred to
as a director, trustee or other title.
Health Organization
].
Health Organization
]; and
Health
Organization
] in excess of $10,000 during a twelve-month period.
Health Organization
]
meeting the qualifications specified in §177.3 of this title (relating
to Qualifications for Certification
as a 162.001(b) Health Organization
) may seek certification by the
board
[
Texas State Board
of Medical Examiners
] under the Act, §162.001(b), by the submission
of an application as provided in §177.4 of this title (relating to Applications
for Certification
as a 162.001(b) Health Organization
).
Health Organization
] meeting the following qualifications shall be certified by the
board
[
Texas State Board of Medical Examiners
]:
Health Organization
] is formed solely by persons licensed by the
board
[
Texas State Board of Medical Examiners
];
Health Organization
] is a non-profit corporation
registered in Texas as a domestic
corporation
under the provisions of the Texas Non-
Profit
[
profit
] Corporation Act;
Board of Directors
] of the
health organization
[
Health Organization
]
consists solely of persons licensed by the
board
[
Texas State
Board of Medical Examiners
] and actively engaged in the practice of
medicine
without restrictions on their Texas medical licenses
;
Health Organization
] is not established or organized or operated in contravention to or
with the intent to circumvent any of the provisions of the Act; and
Health Organization
] makes application, submits reports, pays fees and otherwise complies
with the provisions of this chapter.
Health Organization
] seeking
certification
under §162.001(b) of the Act
shall submit an
application to the
board
[
Texas State Board of Medical Examiners
],
to the
attention
of the Non-Profits
[
permits
] department, on a form approved by the
board. The
[
Texas State Board of Medical Examiners, which
] application shall include:
Health Organization
];
Member(s)
] or that there are no
members
[
Member(s)
];
Officers
]; and
Directors
].
Health Organization
] and attaching a copy of the current by-laws of the
health organization
[
Health Organization
] including
provisions
[
provision
] that:
Health Organization
] is organized for any or all of the following purposes:
;
]
Health Organization
] shall select the
initial
board of directors
[
Board of Directors
] consistent
with the mission, goals, and purposes of the
health organization
[
Health Organization
];
Health Organization
] shall be interpreted in a manner that reserves
to the
health organization
[
Health Organization
] through
its retained physicians the sole authority to engage in the practice of medicine
and reserves to the
health organization
[
Health Organization
] through its
board of directors
[
Board of Directors
] the sole authority to direct the medical, professional, and ethical
aspects of the practice of medicine;
Director
] is required
to immediately report to the
board
[
Texas State Board of Medical
Examiners
] any action or event which such
director
[
Director
] reasonably and in good faith believes constitutes a violation
or attempted violation of the Act or the Rules;
Director
] is required
to individually disclose to the
member(s)
[
Member(s)
],
if any, and to the
board of directors
[
Board of Directors
] (at the times of nomination and appointment) and to the
board
[
Texas State Board of Medical Examiners
] (at the times of
initial application and biennial reports) the identity of each financial relationship
known to such
director
[
Director
], if any, which such
director
[
Director
] has with any
member
[
Member
], any other
director
[
Director
], any
supplier
[
Supplier
] of the
health organization
[
Health Organization
] or any affiliate of any
member
[
Member
], other
director
[
Director
], or
supplier
[
Supplier
] of the
health organization
[
Health Organization
], and to provide a concise explanation of the nature
of each such financial relationship;
and
Health
Organization
] during such physician's term of retention may be accomplished
only by the
board of directors
[
Board of Directors
]
or its physician designee(s) and such termination shall be subject to due
process procedures adopted by the
board of directors
[
Board
of Directors
] or its physician designee(s) or provided by the retention
agreement between the
health organization
[
Health Organization
] and the subject physician unless the physician is terminated.
Director
] indicating that:
Director
] is licensed
by the
board
[
Texas State Board of Medical Examiners
];
Director
] is actively
engaged in the practice of medicine
and has no restrictions on his or
her Texas medical license
;
Director
] will, as
a
director
[
Director
], exercise independent judgment
in all matters and, specifically, matters relating to credentialing, quality
assurance, utilization review, peer review, and the practice of medicine;
Director
] will, as
a
director
[
Director
], exercise best efforts to cause
the
health organization
[
Health Organization
] to comply
with all relevant provisions of the Act and the Rules;
Director
] will, as
a
director
[
Director
], immediately report to the
board
[
Texas State Board of Medical Examiners
] any action
or event which such
director
[
Director
] reasonably and
in good faith believes constitutes a violation or attempted violation of the
Act or the Rules; and
Director
] has disclosed
within such
director's
[
Director's
] statement the identity
of all of such
director's
[
Director's
] financial relationships,
if any, of the type described in paragraph (2)(E) of this
subsection
[
section
] and provided a concise explanation of the nature
of each such financial relationship within such
director's
[
Director's
] statement.
Health Organization
] is in compliance with the requirements
for certification and continued certification as required by the provisions
of the Act and the Rules.
Health Organizations
] seeking certification
under §162.001(b) of the Act
, any
health organization
[
Health Organization
] in which a
member
[
Member
]
is either a person who is not a physician actively engaged in the practice
of medicine or an entity or organization that is not wholly owned and controlled
by physicians actively engaged in the practice of medicine must comply with
the following requirement:
Board of Directors
]; however, following consultation with
the
board of directors
[
Board of Directors
], the
member(s)
[
Member(s)
] may retain the right to approve, or
in the case of a
health organization
[
Health Organization
] seeking to obtain or maintain tax exempt status the right to make,
any financial decision of the
health organization
[
Health
Organization
] including, but not limited to, decisions regarding capital
and operating budgets, physician compensation and benefits, expenditures of
monies, and managed care contracts in which the
health organization
[
Health Organization
] is at financial risk, the substance of which requirements
shall be provided for in the by-laws of the
health organization
[
Health Organization
].
Board of Directors
], a
member
[
Member
] may not appoint or elect any
director
[
Director
] without the approval of at least a majority of the
board of directors
[
Board of Directors
] unless required by law including requirements
to obtain or maintain tax exemption.
Board of Directors
], the
member
[
Member
] may not unilaterally amend the bylaws of the
health organization
[
Health Organization
] unless required
by law including requirements to obtain or maintain tax exemption.
Report ].
Health Organization
]
certified under the Act, §162.001(b), shall file with the
board
[
Texas State Board of Medical Examiners
] a
biennial
report
[
Biennial Report
] in September of each odd numbered
year if certified in an odd numbered year, and in September of each even numbered
year if certified in an even numbered year, and the
biennial report
[
Biennial Report
] shall include:
Health Organization
];
Member(s)
] or that there are no
members
[
Member(s)
];
Officers
];
Directors
]; and
Board of Directors
] since the last biennial
report.
Health Organization
] if not already on file with the
board
[
Texas State Board of Medical Examiners
] and indicating:
Health Organization
] have
been revised since the last biennial report;
Board of Directors
]; and
Director
] indicating that:
Director
] is licensed
by the
board
[
Texas State Board of Medical Examiners
];
Director
] is actively
engaged in the practice of medicine
and has no restrictions on his or
her Texas medical license
;
Director
] will, as
a
director
[
Director
], exercise independent judgment
in all matters and, specifically, matters relating to credentialing, quality
assurance, utilization review, peer review, and the practice of medicine;
Director
] will, as
a
director
[
Director
], exercise best efforts to cause
the
health organization
[
Health Organization
] to comply
with all relevant provisions of the Act and the Rules;
Director
] will, as
a
director
[
Director
], immediately report to the
board
[
Texas State Board of Medical Examiners
] any action
or event which such
director
[
Director
] reasonably and
in good faith believes constitutes a violation or attempted violation of such
Act or the Rules; and
Director
] has disclosed
within such
director's
[
Director's
] statement the identity
of all of such
director's
[
Director's
] financial relationships,
if any, of the type described in §177.4(2)(E) of this title (relating
to Applications for Certification
as a 162.001(b) Health Organization)
and provided a concise explanation of the nature of each such financial
relationship within such
director's
[
Director's
] statement.
The fees established pursuant to the Act, §153.011 and §153.051
and the Rules for certification and continued certification shall be as follows.
]
(3)
] [
Late Fee.
] In addition
to all other requirements for continued certification under the Act, §162.001(b),
if the
health organization
[
Health Organization
] is
more than 30 days late in submitting their completed
biennial report
[
Biennial Report
] and
biennial fee
[
Biennial
Fee
] as specified in
§177.6
[
§177.7(2)
]
of this title (relating to
Biennial Reports for 162.001(b) Health Organizations
[
Initial Certification
]), the
health organization
[
Health Organization
] will be required to pay a
late fee
penalty
[
amount of $1,000
] at the time of submission of their late
biennial report
[
Biennial Report
] in addition to the biennial
fee in the form of a check or money order payable to the
board
[
Texas State Board of Medical Examiners
].
(4)
] [
Refunds.
] Fees
shall not be refundable.
Health Organization
] seeking certification under the Act, §162.001(b),
and the Rules to submit any required fee shall be grounds for the
board
[
Texas State Board of Medical Examiners
] to stop the processing
of the application for certification and to deny the application.
Health Organization
] which is certified under the Act, §162.001(b),
and the Rules to timely submit an accurate
biennial report
[
Biennial Report
] along with any required fee within 90 days of its due
date may result in decertification at the next
board
[
Board
] meeting of the
board
[
Texas State Board of Medical
Examiners
].
Health Organization
] has been decertified, it will be required to submit a new application
for certification as a nonprofit health organization under §162.001(b)
of the Act and
applicable
[
a
] fee [
of $2,500
]
with the application for certification [
in the form of a check or money
order payable to the Texas State Board of Medical Examiners
].
Chapter 177.
CERTIFICATION OF NON-PROFIT ORGANIZATIONS
Chapter 177.
CERTIFICATION OF NON-PROFIT HEALTH ORGANIZATIONS
Chapter 184.
SURGICAL ASSISTANTS
, and not under an order of
the board
].
Chapter 185.
PHYSICIAN ASSISTANTS
unless the supervising physician
has obtained a waiver under
] §193.6(i) of this title (relating
to Waivers).
Complaint Procedure Notification ].
188
] of this title (relating to
Complaints
[
Complaint Procedure Notification
]) shall govern
physician assistants with regard to
procedures for the initiation, filing
and appeals of complaints and
methods of notification for filing complaints
with the agency. If the provisions of Chapter
178
[
188
]
conflict with the Act or rules under this chapter, the Act and provisions
of this chapter shall control.
Chapter 187.
PROCEDURAL RULES
(16)
] Documents--Applications,
petitions, complaints, motions, protests, replies, exceptions, answers, notices,
or other written instruments filed with the board in a board proceeding.
(17)
] Executive director--The executive
director of the agency, the authorized designee of the executive director,
or the secretary of the board if and whenever the executive director and authorized
designee are unavailable.
(18)
] Formal board proceeding--any
proceeding requiring action by the board, including a temporary suspension
hearing.
(19)
] Group practice--Any business
entity, including a partnership, professional association, or corporation,
organized under Texas law and established for the purpose of practicing medicine
in which two or more physicians licensed in Texas are members of the practice.
(20)
] Informal board proceeding--Any
proceeding involving matters before the board prior to the filing of a pleading
at SOAH, to include, but not limited to show compliance proceedings, eligibility
determinations, and informal resolution conferences.
(21)
] Informal show compliance
proceeding--a board proceeding that provides a licensee the opportunity to
demonstrate compliance with all requirements of the Act and board rules either
in writing as set out in §187.17 of this title (relating to Informal
Show Compliance Proceeding Based on Written Information) or through a personal
appearance with one or more representatives of the board as set out in §187.18
of this title (relating to Informal Show Compliance Proceeding and Settlement
Conference Based on Personal Appearance ("ISC")) and an opportunity to enter
into an informal settlement.
(22)
] ISC--Informal Show Compliance
Proceeding and Settlement Conference Based on Personal Appearance.
(23)
] License--Includes the whole
or part of any board permit, certificate, approval, registration or similar
form of permission authorized by law.
(24)
] Licensee--Any person to whom
the agency has issued a license, permit, certificate, approval, registration
or similar form of permission authorized by law.
(25)
] Licensing--The agency process
relating to the granting, denial, renewal, revocation, cancellation, suspension,
limitation, reinstatement or reissuance of a license.
(26)
] National Practitioner Data
Bank (NPDB) reportable action--In accordance with the Health Care Quality
Improvement Act, 42 U.S.C. §11132, a public board action subject to reporting
to the NPDB, includes a revocation, suspension, restriction or limitation
of a physician's license or public reprimand. An administrative penalty or
a requirement that a physician obtain additional education or training are
not considered reportable actions for the purpose of reporting to the NPDB,
however, all disciplinary actions are public as set out in the Act.
(27)
] Party--The board and each
person named or admitted as a party in a SOAH hearing or contested case before
the board.
(28)
] Person--Any individual, partnership,
corporation, association, governmental subdivision, or public or private organization.
(29)
] Petition--Pleading filed
at SOAH by the board alleging the reasons for the denial of a license.
(30)
] Pleading--A written document
submitted by the board, which requests procedural or substantive relief, makes
claims, alleges facts, makes legal arguments, or otherwise addresses matters
involved in a board proceeding.
(31)
] Presiding officer--The president
of the board or the duly qualified successor of the president or other person
presiding over a board proceeding.
(32)
] Probationer--A licensee who
is under a board order.
(33)
] Probationer show compliance
proceeding--A board proceeding that provides a probationer the opportunity
to demonstrate compliance with the Act, board rules, and board order prior
to the board finding that a probationer is in noncompliance with the probationer's
order.
(34)
] Register--The Texas Register.
(35)
] Respondent--in a contested
case, the licensee or applicant who either formally contests or defaults on
an action rendered in a board proceeding.
(36)
] Rule--Any agency statement
of general applicability that implements, interprets, or prescribes law or
policy, or describes the procedures or practice requirements of this board.
The term includes the amendment or repeal of a prior section but does not
include statements concerning only the internal management or organization
of any agency and not affecting private rights or procedures. This definition
includes substantive regulations.
(37)
] Secretary--The secretary-treasurer
of the board.
(38)
] SOAH--The State Office of
Administrative Hearings.
(39)
] SOAH hearing--A public adjudication
proceeding at SOAH.
(40)
] SOAH rules--1 Texas Administrative
Code §155.1 et seq.
(41)
] Texas Public Information
Act--Texas Government Code, Chapter 552.
(42)
] Witness--Any person offering
testimony or evidence at a board proceeding who is not board staff, the respondent,
or an authorized representative of the respondent.
Subchapter C. FORMAL BOARD PROCEEDINGS AT SOAH
Findings
] by a [
"
]medical
peer review committee [
"
], [
"
]professional review body[
"
] or any [
"
]health care entity[
"
]
may be
disclosed by Board Staff and shall be admitted into evidence for all purposes
in a disciplinary hearing before the board or at SOAH. The authorization to
disclose such records in a disciplinary hearing, provided in Section 160.006(a)(1),
creates a statutory exception to the hearsay rule, as stated in Article VIII,
Texas Rules of Evidence. Furthermore, such peer review records should be excepted
from the hearsay rule in accordance with Rule 803(1), (6), and (8), Texas
Rules of Evidence
[
as those terms are defined in the Act are admissible
in accordance with §2001.081 of the APA
].
the exceptions to the confidentiality
of peer review proceedings cited in
] §§160[
.008-
].009
of the Act, parties and witnesses can be required to produce documents and
testify
in a hearing or a deposition
regarding medical peer review
proceedings otherwise privileged pursuant to §160.007 of the Act.
Chapter 190.
DISCIPLINARY GUIDELINES
(i)
] establishing that the person
requesting the medication is in fact who the person claims to be;
(ii)
] establishing a diagnosis
through the use of acceptable medical practices such as patient history, mental
status examination, physical examination, and appropriate diagnostic and laboratory
testing. An online or telephonic evaluation by questionnaire is inadequate;
(iii)
] discussing with the patient
the diagnosis and the evidence for it, the risks and benefits of various treatment
options; and
(iv)
] ensuring the availability
of the licensee or coverage of the patient for appropriate follow-up care
.
[
; and
]
Part 16.
TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS