TITLE 22.EXAMINING BOARDS

Part 9. TEXAS MEDICAL BOARD

Chapter 175. FEES, PENALTIES AND FORMS

22 TAC §175.2

The Texas Medical Board proposes an amendment to §175.2, concerning Registration and Renewal Fees.

The amendment to §175.2 increases PA Registration Fees.

Michele Shackelford, General Counsel, Texas Medical Board, has determined that for the first five-year period the amendment is in effect there will be no fiscal implications to state or local government as a result of enforcing the amendment as proposed. The effect to individuals required to comply with the amendment as proposed will be an increase in registration fees by $69 per year for licensees of the agency.

Ms. Shackelford also has determined that for each year of the first five years the amendment as proposed is in effect the public benefit anticipated as a result of enforcing the amended section will be to adjust fees to apportion costs of administration of agency equally among licensees. The effect on small or micro businesses will be to the extent small or micro businesses pay the licensing fees of physician assistants, there will be an increased cost of $69 per year.

Comments on the proposal may be submitted to Sally Durocher, 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 Texas Occupations Code Annotated, §204.103, which provides the Texas Medical Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

No other statutes, articles or codes are affected by this proposal.

§175.2.Registration and Renewal Fees.

The board shall charge the following fees to continue licenses and permits in effect:

(1) (No change.)

(2) Physician Assistant Registration Permits:

(A) Initial annual permit (includes surcharges of $10)-- $229 [ $160 ].

(B) Subsequent annual permit (includes surcharges of $6)-- $225 [ $156 ].

(3) - (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 February 13, 2006.

TRD-200600706

Donald W. Patrick, MD, JD

Executive Director

Texas Medical Board

Earliest possible date of adoption: March 26, 2006

For further information, please call: (512) 305-7016


Chapter 183. ACUPUNCTURE

22 TAC §§183.1 - 183.4, 183.6, 183.12, 183.14, 183.16, 183.23

The Texas State Board of Acupuncture Examiners (Acupuncture board), with the approval of the Texas Medical Board proposes amendments to §§183.1 - 183.4, 183.6, 183.12, 183.14 and 183.16 and new §183.23, concerning Acupuncture.

The amendment to §183.1 adds a more extensive list of functions of the Acupuncture board. The amendment to §183.2 updates the citation to the board rule regarding licensure; deletes references to provision of §183.4(g) that is being deleted; updates names of agencies; and provides the requirement to take the Biomedicine Module of the NCCAM, in accordance with statutory changes. The amendment to §183.3 revises functions of the licensure committee in accordance with statutory changes authorizing the acupuncture board to issue licenses. The amendment to §183.4 provides requirements for applicants to pass jurisprudence examination, in accordance with statutory changes; and revises the time period for expiration of an application from two years to one year. The amendment to §183.6 provides that Chapter 187 and Chapter 190 apply to acupuncturists; and adds "criminal convictions" to list of subjects relating to Chapter 190. Section 183.12 is amended to provide for adoption of rules by the acupuncture board with approval of the medical board. The amendment to §183.14 provides for advice by the acupuncture board to the medical board for Acudetox Specialist training programs. The amendment to §183.16 updates the name of the Texas Medical Board. New §183.23 is proposed in order to reference Chapter 196, regarding voluntary surrender of a license, to Acupuncturists.

Michele Shackelford, General Counsel, Texas State Board of Acupuncture Examiners and Texas Medical Board, has determined that for the first five-year period the amendments and new section are in effect there will be no fiscal implications to state or local government as a result of enforcing the amendments and new section as proposed. There will be no effect to individuals required to comply with the amendments and new section as proposed.

Ms. Shackelford also has determined that for each year of the first five years the amendments and new section as proposed are in effect the public benefit anticipated as a result of enforcing the amended and new sections will be to provide the public with more information regarding the functions of the acupuncture board; update rules in accordance with statutory changes; incorporate revisions to Chapter 187 and Chapter 190, which have been amended in conformity with legislative changes, so that the same changes apply to the acupuncture board; require the Medical Board to obtain advice from the Acupuncture Board regarding training programs for Acudetox Specialists; and provide implementation of legislative change authorizing voluntary surrender of acupuncture licenses. There will be no effect on small or micro businesses.

Comments on the proposal may be submitted to Sally Durocher, P.O. Box 2018, Austin, Texas 78768-2018. A public hearing will be held at a later date.

The amendments and new section are proposed under the authority of the Texas Occupations Code Annotated, §205.101 which provides the Texas State Board of Acupuncture Examiners, with the approval of the Texas Medical Board, to adopt rules and bylaws as necessary to administer and enforce Chapter 205, Texas Occupations Code.

The following statutes, articles or codes are affected by this proposal: Texas Occupations Code, §§205.001(6-8), 205.203, 205.206, 205.1521, 205.3522.

§183.1.Purpose.

(a) These rules are promulgated under the authority of the Medical Practice Act, Title 3 Subtitle B Tex. Occ. Code and the Acupuncture Act, Chapter 205 Tex. Occ. Code, to establish procedures and standards for the training, education, licensing, and discipline of persons performing acupuncture in this State so as to establish an orderly system of regulating the practice of acupuncture in a manner which protects the health, safety, and welfare of the public.

(b) The Acupuncture board's functions include but are not limited to the following:

(1) Establish standards for the practice of acupuncture.

(2) Regulate the practice of acupuncture through the licensure and discipline of acupuncturists.

(3) Interpret the Acupuncture Act and the Acupuncture board Rules acupuncturists and the public to ensure informed professionals, allied health professionals, and consumers.

(4) Receive complaints and investigate possible violations of the Acupuncture Act and the Acupuncture board Rules.

(5) Discipline violators through appropriate legal action to enforce the Acupuncture Act and the Acupuncture board Rules.

(6) Provide a mechanism for public comment with regard to the Acupuncture Act and the Acupuncture board Rules.

(7) Review and modify the Acupuncture board rules when necessary and appropriate, subject to approval of the Medical Board.

(8) Examine and license qualified applicants to practice acupuncture in Texas in a manner that ensures that applicable standards are maintained.

(9) Provide recommendations to the legislature concerning appropriate changes to the Acupuncture Act to ensure that the acts are current and applicable to changing needs and practices.

(10) Provide informal public information on licensees.

(11) Maintain data concerning the practice of acupuncture.

§183.2.Definitions.

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

(1) Ability to communicate in the English language--An applicant who has met the requirements set out in §183.4(a) (8) [ (7) ] of this title (relating to Licensure).

(2) Acceptable approved acupuncture school--Effective January 1, 1996, and in addition to and consistent with the requirements of §205.206 of the Tex. Occ. Code : [ and with the exception of the provisions outlined in §183.4(h) of this title (relating to Exceptions), ]

(A) - (C) (No change.)

(3) - (6) (No change.)

(7) Agency--The divisions, departments, and employees of the Texas [ State Board of ] Medical Board [ Examiners ], the Texas [ State Board of ] Physician Assistant Board [ Examiners ], and the Texas State Board of Acupuncture Examiners.

(8) - (18) (No change.)

(19) Full NCCAOM examination--The National Certification Commission for Acupuncture and Oriental Medicine examination, consisting of the following:

(A) (No change.)

(B) if taken on or after June 1, 2004 and before January 1, 2007 : the NCCAOM Foundation of Oriental Medicine Module, Acupuncture Module, Point Location Module, and the Chinese Herbology Module.

(C) if taken on or after January 1, 2007, the NCCAOM Foundation of Oriental Medicine Module, Acupuncture Module, Point Locations Module, the Chinese Herbology Module, and the Biomedicine Module.

(20) - (23) (No change.)

(24) Medical board--The Texas [ State Board of ] Medical Board [ Examiners ].

(25) - (34) (No change.)

§183.3.Meetings.

(a) - (f) (No change.)

(g) The following are standing and permanent committees of the acupuncture board. Each committee, with the exception of the Executive Committee, shall consist of at least one board member who is a licensed physician, one board member who is a licensed acupuncturist, and one public board member. In the event that a committee does not have a representative of one or more of these groups, the presiding officer shall appoint additional members as necessary to maintain this composition. The Executive Committee shall include the presiding officer, the assistant presiding officer, and the secretary-treasurer, plus additional members so that the committee consists of a minimum of two board members who are licensed acupuncturists, one board member who is a licensed physician, and one public board member. The responsibilities and authority of these committees shall include those duties and powers as set forth below and such other responsibilities and authority which the acupuncture board may from time to time delegate to these committees.

(1) Licensure Committee:

(A) - (D) (No change.)

(E) make determinations of eligibility, present the results of reviews of applications for licensure and make recommendations to the acupuncture board regarding licensure of applicants;

(F) oversee and make recommendations to the acupuncture board regarding any aspect of the examination process including the approval of an appropriate licensure examination and the administration of such an examination and documentation and verification of records from all applicants for licensure ;

(G) (No change.)

(H) maintain communication with Texas acupuncture schools;

(I) [ (H) ] make recommendations to the acupuncture board regarding matters brought to the attention of the Licensure Committee.

(2) - (4) (No change.)

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

§183.4.Licensure.

(a) Qualifications. An applicant must present satisfactory proof to the acupuncture board that the applicant:

(1) - (5) (No change.)

(6) has taken and passed the CCAOM (Council of Colleges of Acupuncture and Oriental Medicine) Clean Needle Technique (CNT) course and practical examination; [ and ]

(7) for applicants who apply for a license on or after September 1, 2007, passes a jurisprudence examination ("JP exam"), which shall be conducted on the licensing requirements and other laws, rules, or regulations applicable to the acupuncture profession in this state. The jurisprudence examination shall be developed and administered as follows:

(A) Question for the JP Exam shall be prepared by agency staff with input from the Acupuncture board and the agency staff shall make arrangements for a facility by which applicants can take the examination.

(B) Applicants must pass the JP exam with a score of 75 or better within three attempts.

(C) An examinee shall not be permitted to bring medical books, compends, notes, medical journals, calculators or other help into the examination room, nor be allowed to communicate by word or sign with another examinee while the examination is in progress without permission of the presiding examiner, nor be allowed to leave the examination room except when so permitted by the presiding examiner.

(D) Irregularities during an examination such as giving or obtaining unauthorized information or aid as evidenced by observation or subsequent statistical analysis of answer sheets, shall be sufficient cause to terminate an applicant's participation in an examination, invalidate the applicant's examination results, or take other appropriate action.

(E) An applicant who is unable to pass the JP exam within three attempts must appear before a committee of the board to address the applicant's inability to pass the examination and to re-evaluate the applicant's eligibility for licensure. It is at the discretion of the committee to allow an applicant additional attempts to take the JP exam; and

(8) [ (7) ] is able to communicate in English as demonstrated by one of the following:

(A) passage of the NCCAOM examination taken in English;

(B) passage of the TOEFL (Test of English as a Foreign Language) with a score of 550 or higher on the paper based test or with a score of 213 or higher on the computer based test;

(C) passage of the TSE (Test of Spoken English) with a score of 45 or higher;

(D) passage of the TOEIC (Test of English for International Communication) with a score of 500 or higher; or

(E) at the discretion of the acupuncture board, passage of any other similar, validated exam testing English competency given by a testing service with results reported directly to the acupuncture board or with results otherwise subject to verification by direct contact between the testing service and the acupuncture board.

(b) Procedural rules for licensure applicants. The following provisions shall apply to all licensure applicants.

(1) Applicants for licensure:

(A) (No change.)

(B) whose application for licensure which has been filed with the board office and which is in excess of one year [ two years ] old from the date of receipt shall be considered inactive. Any fee previously submitted with that application shall be forfeited. Any further application procedure for licensure will require submission of a new application and inclusion of the current licensure fee.

(C) - (G) (No change.)

(2) - (4) (No change.)

(c) - (d) (No change.)

(e) Distinguished professor temporary license.

(1) Issuance. The acupuncture board may issue a distinguished professor temporary license to an acupuncturist who:

(A) - (D) (No change.)

(E) passes the JP Exam, as provided in subsection (a)(7) of this section.

(2) (No change.)

(3) Disciplinary action. A distinguished professor temporary license or renewal may be denied, terminated, canceled [ cancelled ], suspended, or revoked for any violation of acupuncture board rules or the Act, Subchapter H.

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

[(h) Exceptions. Before January 1, 2004, the acupuncture board may not adopt a rule under §205.101 of the Act, that requires a school of acupuncture operating in Texas on or before September 1, 1993, be accredited by, or a candidate for accreditation by, the ACAOM.]

§183.6.Denial of License; Discipline of Licensee.

(a) - (b) (No change.)

(c) The denial of licensure or the imposition of disciplinary action by the acupuncture board pursuant to §205.351 of the Act shall be in accordance with the Act, the procedures set forth in Chapters [ Chapter ] 187 and 190 of this title (relating to Procedural Rules and Disciplinary Guidelines ), the Administrative Procedure Act, and the rules of the State Office of Administrative Hearings. Chapters 187 and 190 of this title (relating to Procedural Rules and Disciplinary Guidelines) shall be applied to acupuncturists to the extent applicable. If the provisions of Chapter 187 or Chapter 190 conflict with the Act or rules under this chapter, the Act and provisions of this chapter shall control.

(d) Disciplinary guidelines.

(1) Chapter 190 of this title (relating to Disciplinary Guidelines) shall apply to acupuncturists regulated under this chapter and be used as guidelines for the following areas as they relate to the denial of licensure or disciplinary action of a licensee:

(A) - (C) (No change.)

(D) repeated and recurring meritorious health care liability claims; [ and ]

(E) aggravating and mitigating factors ; and [ . ]

(F) criminal convictions.

(2) (No change.)

§183.12.Medical Board Review and Approval.

(a) Pursuant to §205.202 of the Act, [ after consulting ] the acupuncture board[ , the medical board ] shall issue a license to practice acupuncture in this state to a person who meets the requirements of the Act and the rules adopted pursuant to the Act without approval of the Medical Board .

(b) Pursuant to §205.352 of the Act, the acupuncture board shall take disciplinary action against a license holder without approval of the Medical Board [ The issuance, renewal, surrender, or cancellation of a license to practice acupuncture in this state shall be subject to final approval by the medical board after consultation with the acupuncture board ].

[(c) The acupuncture board recommendations of the revocation, suspension, restriction, probation, cancellation, or surrender of a license to practice acupuncture, as well as all recommended disciplinary actions, dismissals of allegations of violations of the Act, and agreed dispositions, shall be subject to medical board review and final approval by the medical board.]

(c) [ (d) ] Pursuant to §205.101(b) of the Act, a rule adopted by the acupuncture board is subject to Medical board approval , which [ of acupuncture board actions under this section ] shall be memorialized in the minutes of the medical board, the minutes of a committee of the medical board, or in a writing signed by the medical board's presiding officer, secretary-treasurer, or authorized committee chairman after consideration of the recommendations of the acupuncture board.

§183.14.Acudetox Specialist.

(a) (No change.)

(b) Any person who does not possess a Texas acupuncture license or is not otherwise authorized to practice acupuncture under Tex. Occ. Code Ann. Title 3, Subtitle C, Chapter 205, may practice as an acudetox specialist for the sole purpose of the treatment of alcoholism, substance abuse, or chemical dependency upon obtaining certification as an acudetox specialist only under the following conditions listed in paragraphs (1) - (4) of this subsection:

(1) (No change.)

(2) after successful completion of a training program in acupuncture for the treatment of alcoholism, substance abuse, or chemical dependency, which has been approved by the Medical Board with advice from the acupuncture board . Such program in auricular acupuncture shall be 70 hours in length, and shall include a clean needle technique course or equivalent universal infection control precaution procedures course approved by the Medical Board;

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

(c) - (k) (No change.)

§183.16.Texas Acupuncture Schools.

(a) (No change.)

(b) Compliance with the provisions of subsection (a) of this section shall be accomplished by providing students and applicants with a copy of Subchapter H of the Act, a copy of Chapter 183 (Acupuncture) contained in the Rules of the Texas [ State Board of ] Medical Board [ Examiners ], and the following typed statement:

Figure: 22 TAC §183.16(b)

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

§183.23.Voluntary Surrender of Acupuncture License.

Pursuant to Section 205.3522 of the Act, the Board may accept the voluntary surrender of an acupuncture license. Chapter 196 of this title (relating to Voluntary Surrender of a Medical License) shall govern the voluntary surrender of an acupuncture license in a similar manner as that chapter applies to a medical license. Section 183.4 of this title (relating to Licensure) shall govern reapplication after a voluntary surrender.

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 February 13, 2006.

TRD-200600707

Donald W. Patrick, MD, JD

Executive Director

Texas Medical Board

Earliest possible date of adoption: March 26, 2006

For further information, please call: (512) 305-7016