Part 1.
DEPARTMENT OF STATE HEALTH SERVICES
Chapter 123.
RESPIRATORY CARE PRACTITIONER CERTIFICATION
25 TAC §§123.1 - 123.16
The Executive Commissioner of the Health and Human Services
Commission, on behalf of the Department of State Health Services (department),
proposes amendments to §§123.1-123.16, concerning the certification
and regulation of respiratory care practitioners.
BACKGROUND AND PURPOSE
The amendments implement House Bill (HB) 2680, 79th Legislature, Regular
Session (2005), located in Occupations Code, Chapter 112, relating to reduced
fees and continuing education requirements for retired health professionals,
including respiratory care practitioners, engaged in the provision of voluntary
charity care; and HB 102, 79th Legislature, Regular Session (2005), which
amended Occupations Code, Chapter 604, relating to the renewal requirements
for a respiratory care practitioner certificate. In addition, the proposed
amendments reflect the name change of the "Texas Department of Health" to
the "Department of State Health Services"; clarify the amount of time a person
can hold a temporary permit and renew a temporary permit; and remove obsolete
language regarding one-year renewals.
Government Code, §2001.039, requires that each state agency review
and consider for readoption each rule adopted by that agency pursuant to the
Government Code, Chapter 2001 (Administrative Procedure Act). Sections 123.1-123.16
have been reviewed and the need for the rules continues to exist; however,
revisions are necessary to implement recent legislation and to update and
clarify the rules.
SECTION-BY-SECTION SUMMARY
An amendment to §123.1 updates language to include references for
advisory committee. Sections 123.2, 123.3, 123.4, 123.5, 123.6, 123.8, 123.11,
123.13, 123.14, and 123.15 to replace terms made obsolete by statutory change
such as "Texas Department of Health," to "Department of State Health Services"
and accompanying references to the abolished "Texas Board of Health", "board",
and "administrator", and "replace them with the "Department of State Health
Services", "department", or "Executive Commissioner of the Health and Human
Services Commission," as appropriate. Amendments to §123.4 remove obsolete
language regarding the one-year application fee and temporary extension fee.
Section 123.5 is amended to change 45 days of graduation to 30 days of graduation
to apply for a temporary permit. Amendments to §123.6 remove language
on requiring a photo with the application for certification, and the medical
director's signature on the application to reflect changes necessary to facilitate
online application for certification, change the deadline from 180 days for
denial of certification to 90 days, and remove temporary extension language.
Section 123.7 is amended to remove obsolete language related to issuing a
license for a one-year term, and remove language regarding the temporary permit
extension. Amendments to §123.9 remove the required signature of the
supervising physician on the renewal form, remove language regarding temporary
permit extension, clarify renewal of a temporary permit, and add new language
regarding respiratory care practitioners performing voluntary charity care.
Section 123.10 is amended to remove obsolete language regarding one-year renewal,
and add standards for renewal for respiratory care practitioners performing
voluntary charity care. Amendments to §123.12 update the standards in
the practice of respiratory care regarding patient records and substandard
care. Section 123.14 is amended to set out the department's options for enforcement
if a licensee violates an order issued by the department. An amendment to §123.16
removes language related to renewal of a temporary permit.
FISCAL NOTE
Kathy Perkins, Director, Health Care Quality Section, has determined that
for each year of the first five years the sections are in effect, there will
be fiscal implications to state or local government as a result of enforcing
or administering the sections as proposed. The impact of the possible decrease
in renewal fees collected due to the implementation of reduced renewal fees
for retired respiratory care practitioners over the age of 55 providing voluntary
charity care is estimated to be $9,200 each fiscal year. Approximately 368
respiratory care practitioners are estimated to provide retired voluntary
charity care services at a reduced renewal fee of $25 biennially.
SMALL AND MICRO-BUSINESS IMPACT ANALYSIS
Ms. Perkins has also determined that there will be no effect on small businesses
or micro-businesses required to comply with the sections as proposed. This
was determined by interpretation of the rules that small businesses and micro-businesses
will not be required to alter their business practices in order to comply
with the sections. There are no anticipated economic costs to persons who
are required to comply with the sections as proposed. There is no anticipated
negative impact on local employment.
PUBLIC BENEFIT
In addition, Ms. Perkins has also determined that for each year of the
first five years the sections are in effect, the public will benefit from
adoption of the sections. The public benefit anticipated as a result of enforcing
or administering the sections is to continue to ensure public health and safety
through the certification and regulation of respiratory care practitioners.
REGULATORY ANALYSIS
The department has determined that this proposal is not a "major environmental
rule" as defined by Government Code, §2001.0225. "Major environmental
rule" is defined to mean a rule the specific intent of which is to protect
the environment or reduce risk to human health from environmental exposure
and that may adversely affect, in a material way, the economy, a sector of
the economy, productivity, competition, jobs, the environment or the pubic
health and safety of a state or a sector of the state. This proposal is not
specifically intended to protect the environment or reduce risks to human
health from environmental exposure.
TAKINGS IMPACT ASSESSMENT
The department has determined that the proposed rules do not restrict or
limit an owner's right to his or her property that would otherwise exist in
the absence of government action and, therefore, do not constitute a taking
under Government Code, §2007.043.
PUBLIC COMMENT
Comments on the proposal may be submitted to Pam K. Kaderka, Professional
Licensing and Certification Unit, Division for Regulatory Services, Department
of State Health Services, 1100 West 49th Street, Austin, Texas 78756, 512/834-6628
or by email to Pam.Kaderka@dshs.state.tx.us. Comments will be accepted for
30 days following publication of the proposal in the
Texas Register
.
LEGAL CERTIFICATION
The Department of State Health Services General Counsel, Cathy Campbell,
certifies that the proposed rules have been reviewed by legal counsel and
found to be within the state agencies' authority to adopt.
STATUTORY AUTHORITY
The proposed amendments are authorized by Occupations Code, Chapters 112
and 604; and Government Code, §531.0055, and Health and Safety Code, §1001.075,
which authorize the Executive Commissioner of the Health and Human Services
Commission to adopt rules and policies necessary for the operation and provision
of health and human services by the department and for the administration
of Health and Safety Code, Chapter 1001.
The proposed amendments affect the Occupations Code, Chapters 112 and 604;
Health and Safety Code, Chapter 1001; and Government Code, Chapter 531.
§123.1.Context.
These sections cover definitions; the advisory
committee
[
§123.2.Definitions.
The following words and terms when used in these sections, shall have
the following meanings, unless the context clearly indicates otherwise:
(1) - (2)
(No change.)
[
(3)
[
(4)
[
(5)
[
(6)
[
(7)
[
[
(8)
[
(9)
[
(10)
[
(11)
[
(12)
[
(13)
[
(14)
[
(15)
[
(A)
includes supervised and directed instruction specific to
the respiratory care procedures to be performed by the individual;
(B)
includes specific objectives, activities, and an evaluation
of competency; and
(C)
is supervised and directed by another individual qualified
to provide the training and supervision.
(16)
[
(17)
[
(18)
[
(19)
[
(20)
[
(21)
[
(A)
a program in respiratory care approved by the educational
accrediting body;
(B)
a program approved by an appropriate education agency and
working toward becoming an approved program in respiratory care. A program
will qualify as a respiratory care education program under this subparagraph
only for a period of one year from the date of the first class offered by
the program; after that one year, the program must be an approved program
in respiratory care; or
(C)
a program accredited by the Canadian Medical Association
and whose graduates are eligible to take the national registry exam given
by the Canadian Board of Respiratory Care.
(22)
[
(23)
[
(A)
administration of medical gases - such as nitric oxide,
helium and carbon dioxide;
(B)
providing ventilatory assistance and ventilatory control
- including high frequency oscillatory ventilation and high frequency jet
ventilation;
(C)
providing artificial airways - including insertion, maintenance
and removal;
(D)
performing pulmonary function testing - including neonatal
and pediatric studies;
(E)
hyperbaric oxygen therapy;
(F)
monitoring - including pulse oximeter, end-tidal carbon
dioxide and apnea monitoring;
(G)
extracorporeal membrane oxygenation (ECMO);
(H)
patient assessment, respiratory patient care planning;
and
(I)
implementation of respiratory care protocols.
(24)
[
(25)
[
(26)
[
(27)
[
§123.3.Respiratory Care Practitioners Advisory Committee.
(a)
The committee. An advisory committee shall be appointed
under and governed by this section.
(1)
(No change.)
(2)
The committee is established under
Government Code, §531.012,
[
(b)
(No change.)
(c)
Purpose. The purpose of the committee is to recommend rules
and examinations for the approval of the
Executive Commissioner of the
Health and Human Services Commission
[
(d)
Tasks.
(1)
The committee shall advise the
Executive Commissioner
of the Health and Human Services Commission
[
(2)
The committee shall carry out any other tasks given to
the committee by the
Executive Commissioner of the Health and Human Services
Commission
[
(e)
Review and duration. By November 1, 2007, the
Executive
Commissioner of the Health and Human Services Commission
[
(f)
Composition. The committee shall be composed of nine members
appointed by the
Executive Commissioner of the Health and Human Services
Commission
[
(1) - (3)
(No change.)
(g)
(No change.)
(h)
Officers. The committee shall select from its members the
presiding officer and an assistant presiding officer to begin serving on November
1 of each odd-numbered year.
(1)
(No change.)
(2)
The presiding officer shall preside at all committee meetings
at which he or she is in attendance, call meetings in accordance with this
section, appoint subcommittees of the committee as necessary, and cause proper
reports to be made to the
Executive Commissioner of the Health and Human
Services Commission
[
(3) - (6)
(No change.)
(i)
Meetings. The committee shall meet only as necessary to
conduct committee business.
(1)
A meeting may be called by agreement of
the Department
of State Health Services
[
(2) - (7)
(No change.)
(j) - (k)
(No change.)
(l)
Procedures. Roberts Rules of Order, Newly Revised, shall
be the basis of parliamentary decisions except where otherwise provided by
law or rule.
(1) - (4)
(No change.)
(5)
Minutes of each committee meeting shall be taken by department
staff.
(A)
A summary of the meeting shall be provided to the
Executive Commissioner of the Health and Human Services Commission
[
(B)
(No change.)
(m)
(No change.)
(n)
Statement by members.
(1)
The
Executive Commissioner of the Health and Human
Services Commission,
[
(2)
The committee and its members may not participate in legislative
activity in the name of the
Executive Commissioner of the Health and
Human Services Commission,
[
(3) - (6)
(No change.)
(o)
Reports to
Executive Commissioner of the Health and
Human Services Commission
[
(1)
The report shall list the meeting dates of the committee
and any subcommittees, the attendance records of its members, a brief description
of actions taken by the committee, a description of how the committee has
accomplished the tasks given to the committee by the
Executive Commissioner
of the Health and Human Services Commission,
[
(2)
(No change.)
(3)
The report shall cover the meetings and activities in the
immediate preceding 12 months and shall be filed with the
Executive Commissioner
of the Health and Human Services Commission
[
(p)
Reimbursement for expenses. In accordance with the requirements
set forth in the Government Code,
§2110.004
[
(1) - (5)
(No change.)
(q)
(No change.)
§123.4.Fees.
The following fees are required to be paid to the department before
any certificate or permit is issued. All fees shall be submitted in the form
of a check or money order and are nonrefundable. The department may direct
examination applicants to submit examination fees to the National Board for
Respiratory Care, Inc. (NBRC).
(1)
Schedule of fees for certification as a respiratory care
practitioner:
(A)
application (includes initial certificate) fee
-- $120
[
[
(B)
[
(C)
[
(D)
renewal fee for a license issued
to a retired respiratory care practitioner performing voluntary charity care
for a two-year term is $50;
(E) - (M)
(No change.)
(N)
for all applications and renewal applications, the department
[
(O)
for all applications and renewal applications, the department
[
(2)
Schedule of fees for a temporary permit as a respiratory
care practitioner:
(A)
(No change.)
(B)
temporary permit
renewal
[
(C) - (E)
(No change.)
(3) - (4)
(No change.)
(5)
The
department
[
§123.5.Exemptions.
(a) - (b)
(No change.)
(c)
Student status.
(1) - (4)
(No change.)
(5)
Students who are within
30
[
(d)
(No change.)
§123.6.Application Requirements and Procedures.
(a)
(No change.)
(b)
Required application materials.
(1)
Application form. The application form shall contain:
(A) - (H)
(No change.)
(I)
the signature of the applicant which has been dated
.
[
[
(2)
Educational record for regular certification. The department
shall issue a regular certificate to an applicant who is currently credentialed
by the National Board for Respiratory Care (NBRC) and nationally certified
as a Certified Respiratory
Therapist
[
(3)
(No change.)
(4)
Examination results.
(A)
If the applicant is making application for a temporary
permit, an examination score release form shall be signed allowing the department
to obtain the applicant's examination results from the NBRC, or other agency
administering the examination prescribed by the
department
[
(B)
(No change.)
(5)
(No change.)
[
(c)
(No change.)
(d)
Application processing.
(1)
Time periods. The department shall comply with the following
procedures in processing applications for a permit or certificate.
(A)
The following periods of time shall apply from the date
of receipt of an application until the date of issuance of a written notice
that the application is complete and accepted for filing or that the application
is deficient and additional specific information is required. A written notice
stating that the application has been approved may be sent in lieu of the
notice of acceptance of a complete application. The time periods are as follows:
(i)
letter of acceptance of application for permit or certification--14
working days. The notice of acceptance may include a statement that an application
for temporary permit received more than
30
[
(ii)
(No change.)
(B)
The following periods of time shall apply from the receipt
of the last item necessary to complete the application until the date of issuance
of written notice approving or denying the application. The time periods for
denial include notification of the proposed decision and of the opportunity,
if required, to show compliance with the law, and of the opportunity for a
formal hearing. The time periods are as follows:
(i)
(No change.)
(ii)
letter of denial of permit or certificate--
90
[
(2)
Reimbursement of fees.
(A)
In the event an application is not processed in the time
periods stated in paragraph (1) of this subsection, the applicant has the
right to request reimbursement of all fees paid in that particular application
process. Requests for reimbursement shall be made to the
department
[
(B)
(No change.)
[
(3)
[
(e)
(No change.)
(f)
Disapproved applications.
(1)
The department shall disapprove the application if the
person:
(A)
(No change.)
(B)
has failed to pass the examination [
(C) - (I)
(No change.)
(2)
If after review the
department
[
(3)
An applicant whose application has been disapproved under
paragraph (1)(E) and (F) of this subsection shall be permitted to reapply
after a period of not less than one year from the date of the disapproval
and shall submit with the reapplication proof satisfactory to the department
of compliance with all rules of the
department
[
§123.7.Types of Certificates and Temporary Permits and Applicant Eligibility.
(a)
(No change.)
(b)
Issuance of certificates and permits.
(1)
(No change.)
(2)
[
(c)
(No change.)
(d)
Applicant eligibility.
(1)
Temporary permit.
Temporary permits are valid for
a six-month period.
The department shall issue a temporary permit to
practice respiratory care to:
(A)
an applicant who:
(i) - (iii)
(No change.)
(iv)
meets all qualifications for a certificate except taking
the written examination prescribed by the department for certification. An
applicant may file an application if he or she is within
30
[
(B)
(No change.)
[
(2) - (3)
(No change.)
§123.8.Examination.
(a) - (d)
(No change.)
(e)
Results.
(1)
Results of an examination prescribed by the
department
[
(2) - (5)
(No change.)
(f)
Refunds. Examination fee refunds to persons who fail to
appear for the examination will be in accordance with policies and procedures
of the NBRC, or other agency approved by the
department
[
§123.9.Certificate Renewal.
(a) - (b)
(No change.)
(c)
Certificate renewal.
(1)
(No change.)
(2)
The renewal form for all practitioners shall require the
provision of the preferred mailing address, primary employment address and
telephone number, and category of employment, misdemeanor and felony convictions,
statement concerning status with The National Board for Respiratory Care,
Inc., and continuing education completed. [
(3) - (4)
(No change.)
(5)
A temporary permit may be renewed
once for an additional six-month period.
(d)
Late renewal or reapplication.
(1)
A person whose certificate has expired may renew the certificate
by submitting to the department the renewal form, continuing education as
set out in §123.10 of this title (relating to Continuing Education Requirements)
completed since the last renewal, and if respiratory care procedures were
performed after the certificate expired, a statement indicating how the person
complied with the Act, §604.003.
(A) - (B)
(No change.)
[
(C)
[
[
(2)
[
(3)
[
(4)
[
(A)
pays a fee that is equal to two times the renewal fee;
(B)
is currently certified as a respiratory care practitioner
in another state;
(C)
has been practicing respiratory care in the state where
the certification is held for the two years preceding the date of application
for renewal; and
(D)
submits proof of completion of the continuing education
requirements as set out in §123.10 of this title within the
24-month
[
(e) - (f)
(No change.)
(g)
Inactive status. A respiratory care practitioner who holds
a certificate under the Act and who is not actively engaged in the practice
of respiratory care may make application to the department in writing on a
form prescribed by the department to be placed on an inactive status list
maintained by the department. The application for inactive status and the
inactive fee must be postmarked prior to the expiration of the respiratory
practitioner's annual certificate. No refund will be made of any fees paid
prior to application for inactive status.
(1) - (7)
(No change.)
(8)
If a person on inactive status desires to reenter active
practice, the person shall:
(A) - (B)
(No change.)
(C)
pay a renewal fee for the current renewal period [
(D)
submit to the department proof of successful completion,
within
24-month
[
(9)
(No change.)
(h)
(No change.)
(i)
Renewal for retired respiratory
care practitioners performing voluntary charity care.
(1)
A "retired respiratory care practitioner" is
defined as a person who is:
(A)
above the age of 55;
(B)
is not employed for compensation in the practice
of respiratory care; and
(C)
has notified the department in writing of his
or her intention to retire and provide only voluntary charity care.
(2)
"Voluntary charity care" for the purposes of
this subsection is defined as the practice of respiratory care by a retired
respiratory care practitioner without compensation or expectation of compensation.
(3)
A retired respiratory care practitioner providing
only voluntary charity care may renew his or her license by submitting a renewal
form; the retired respiratory care practitioner renewal fee required by §123.4
of this title (relating to Fees); and the continuing education hours required
by §123.10 of this title (relating to Continuing Education Requirements).
§123.10.Continuing Education Requirements.
(a)
General. Continuing education requirements for renewal
shall be fulfilled each renewal
period
[
(1)
The initial period shall begin with the date the department
issues the certificate and end on the last day of the birth month at the time
of [
[
(2)
[
(3)
[
(4)
A respiratory care practitioner
who is approved by the department for renewal in accordance with §123.9
of this title (relating to Certificate Renewal) may complete reduced continuing
education requirements equal to half of the number of continuing education
hours required for renewal for a certified respiratory care practitioner.
(b) - (g)
(No change.)
§123.11.Changes of Name or Address.
(a)
(No change.)
(b)
Notification of address changes shall be made in writing,
including the name, mailing address, and zip code and be mailed to the
department
[
(c) - (d)
(No change.)
§123.12.Professional and Ethical Standards.
The purpose of this section shall be to establish the standards of
professional and ethical conduct required of a
respiratory
practitioner
pursuant to the Act, §604.201(b)(4).
(1)
Professional representation and responsibilities.
(A) - (L)
(No change.)
(M)
A practitioner shall conform to medically accepted principles
and standards of respiratory care which are those generally recognized by
the profession as appropriate for the situation presented, including those
promulgated or interpreted by or under the American Association for Respiratory
Care, the National Board for Respiratory Care, the Texas Society for Respiratory
Therapy, [
(N) - (Q)
(No change.)
(R)
A respiratory care practitioner
shall not falsify or make grossly incorrect, grossly inconsistent, or unintelligible
entries in any patient's, hospital or other record.
(S)
A respiratory care practitioner
shall not exhibit a pattern of substandard care in the performance of duties
related to the practice of respiratory care.
(T)
A respiratory care practitioner
shall not change the prescription of a physician or falsify verbal or written
orders for treatment diagnostic regimen received, whether or not that actions
resulted in actual patient harm.
(2) - (6)
(No change.)
§123.13.Certifying or Permitting Persons with Criminal Backgrounds To Be Respiratory Care Practitioners.
(a)
(No change.)
(b)
Procedures for revoking, suspending, suspending on an emergency
basis, or denying a certificate or temporary permit to persons with criminal
backgrounds.
(1)
The
department
[
(2)
If the department denies, suspends, suspends on an emergency
basis, or revokes a certificate or temporary permit under these sections after
hearing, the
department
[
(A) - (D)
(No change.)
§123.14.Violations, Complaints, and Subsequent Actions.
(a)
General. This section establishes standards relating to:
(1) - (3)
(No change.)
(4)
the department's investigation of complaints and the department's
and commissioner's actions, on behalf of the
department
[
(b)
(No change.)
(c)
Filing of complaints.
(1)
(No change.)
(2)
A person wishing to complain about an offense, prohibited
action, or alleged violation against a practitioner or other person shall
notify the
department
[
(3)
Upon receipt of a complaint the
department
[
(4)
Anonymous complaints shall be investigated by the
department
[
(d)
Investigation of complaints.
(1)
The [
(2)
The
department
[
(e)
The department's action.
(1) - (2)
(No change.)
(3)
The department may determine that a practitioner has violated
the Act or a
department
[
(4)
(No change.)
(f)
Disciplinary actions.
(1) - (4)
(No change.)
(5)
The department may take action
for violation of the Act or this chapter, an order of the department previously
entered in a disciplinary proceeding, or an order to comply with a subpoena
issued by the department.
(g)
Formal hearing.
(1)
(No change.)
(2)
Prior to institution of formal proceedings to revoke or
suspend a permit or certificate, the
department
[
(3)
To initiate formal hearing procedures, the
department
[
(A) - (B)
(No change.)
(h)
Final action.
(1)
If the department suspends a certificate or permit, the
suspension remains in effect until the [
(2)
(No change.)
(3)
If a suspension overlaps a certificate renewal period,
the former certificate holder shall comply with the normal renewal procedures
in these sections; however, the department may not renew the certificate until
the [
[
(4)
[
(5)
[
§123.15.Informal Disposition.
(a)
(No change.)
(b)
If the
department
[
(c)
(No change.)
(d)
The
department
[
(1) - (2)
(No change.)
(e) - (g)
(No change.)
(h)
The program's legal counsel will be requested to attend
each settlement conference. The
department
[
(i) - (l)
(No change.)
(m)
At the conclusion of the settlement conference, the
department
[
(n)
(No change.)
(o)
If the temporary permit or certificate holder or applicant
rejects the proposed settlement, the matter shall be referred to the
department
[
(p)
If the temporary permit or certificate holder or applicant
signs and accepts the recommendations, the agreed order shall be submitted
to the
department
[
(q)
The
department
[
(r)
If the
department
[
(s)
A temporary permit or certificate holder or applicant's
opportunity for an informal conference under this section shall satisfy the
requirement of the APA, §2001.054(c).
(1)
If the
department
[
(2)
The complainant shall be sent a copy of the written notice
described in paragraph (1) of this subsection. The complainant shall be informed
that he or she may also submit a written statement to the
department
[
§123.16.Suspension of License Relating to Child Support and Child Custody.
(a) - (d)
(No change.)
(e)
If a suspension overlaps a license renewal period, an individual
with a license suspended under this section shall comply with the standard
renewal procedures in the Respiratory Care Practitioner Certification Act,
Texas Occupations Code, §604.153, and §604.157,
concerning
the issuance of renewal certificates
[
(f) - (h)
(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 March 10, 2006.
TRD-200601578
Cathy Campbell
General Counsel
Department of State Health Services
Earliest possible date of adoption: April 23, 2006
For further information, please call: (512) 458-7111 x6972
committee's operation
]; fees; exceptions to certification; application
requirements and procedures; types of certificates, temporary permits, and
applicant eligibility; examination; certificate renewal; continuing education
requirements; changes of name or address; professional and ethical standards;
certifying or permitting persons with criminal background to be respiratory
care practitioners; violations, complaints and subsequent actions.
(3)
Administrator--The department
employee designated as the administrator of certification activities authorized
by the Act.]
(4)
] Advisory committee--The Respiratory
Care Practitioners Advisory Committee.
(5)
] Aides/orderlies--Health care
workers who perform routine tasks under the direct supervision of a
respiratory care
practitioner such as transporting patients, assembling
treatment equipment, preparing work areas, and other assigned duties. Aides/orderlies
may not perform respiratory care procedures.
(6)
] AMA--The American Medical Association.
(7)
] Applicant--A person who applies
to the [
Texas
] Department of
State
Health
Services
for a certificate or temporary permit.
(8)
] Appropriate educational agency--The
Texas Education Agency or other governmental agency authorized by law or statute
to approve educational institutions and curriculum, or an educational accrediting
body of a professional organization, such as the Committee on
Accreditation
for
Respiratory Care (COARC) and its predecessor or successor organization.
(9)
Board--The Texas Board of
Health]
(10)
] BME--Texas State Board of
Medical Examiners.
(11)
] Certificate--A respiratory
care practitioner certificate issued by the [
Texas
] Department
of
State
Health
Services
.
(12)
] Commissioner--The commissioner
of the [
Texas
] Department of
State
Health
Services
.
(13)
] Delegated authority--As defined
in the Texas Medical Practice Act, Texas Occupations Code, Chapter 157 and
the rules pertaining thereto adopted by the BME.
(14)
] Department--The [
Texas
] Department of
State
Health
Services
.
(15)
] Diagnostic--Of or relating
to or used in the art or act of identifying a disease or disorder.
(16)
] Educational accrediting body--The
Committee on Allied Health Education and Accreditation of the American Medical
Association, or its successor organization which approves respiratory care
education programs.
(17)
] Formally trained--Completion
of an organized educational activity which:
(18)
] NBRC--The National Board
for Respiratory Care, Inc., and its predecessor or successor organizations.
(19)
] Palliative--Serving to moderate
the intensity of pain or other disease process.
(20)
] Practice--Engaging in respiratory
care as a clinician, educator, or consultant.
(21)
] Qualified medical director--A
physician licensed and in good standing with the BME, and who has special
interest and knowledge in the diagnosis and treatment of respiratory care
problems who is actively engaged in the practice of medicine. This physician
must be a member of the active medical staff of a health care facility, agency
or organization who supervises the provision of respiratory care.
(22)
] Respiratory care--The treatment,
management, control, diagnostic evaluation, and care of inpatients or outpatients
who have deficiencies and abnormalities associated with the cardiorespiratory
system. Respiratory care does not include the delivery, assembly, set up,
testing, and demonstration of respiratory care equipment upon the order of
a licensed physician. Demonstration is not to be interpreted here as the actual
patient assessment and education, administration, or performance of the respiratory
care procedure(s).
(23)
] Respiratory care education
program--
(24)
] Respiratory care practitioner
(RCP)--A person permitted or certified under the Act to practice respiratory
care.
(25)
] Respiratory care procedure--Respiratory
care provided by the therapeutic and diagnostic use of medical gases,
the delivery of humidification and aerosols
[
humidifiers, and aerosols
], the administration of drugs and medications to the cardiorespiratory
system, ventilatory assistance and ventilatory control, postural drainage,
chest drainage, chest percussion or vibration, breathing exercises, respiratory
rehabilitation, cardiopulmonary resuscitation, maintenance of natural airways,
and the insertion and maintenance of artificial airways. The term includes
a technique employed to assist in diagnosis, monitoring, treatment, and research,
including the measurement of ventilatory volumes, pressures and flows, the
specimen collection of blood and other materials, pulmonary function testing,
and hemodynamic and other related physiological forms of monitoring or treating,
as ordered by the patient's physician, the cardiorespiratory system. These
procedures include:
(26)
] Respiratory therapist--A
person permitted or certified under the Act to practice respiratory care.
(27)
] Temporary permit--A permit
issued in accordance with §123.7(d) of this title (relating to Types
of Certificates, Temporary Permits, and Applicant Eligibility) for a period
of six months.
(28)
] Therapeutic--Of or relating
to the treatment of disorders by remedial agents or methods.
(29)
] Under the direction--Assuring
that established policies are carried out; monitoring and evaluating the quality,
safety, and appropriateness of respiratory care services and taking action
based on findings; and providing consultation whenever required, particularly
on patients receiving continuous ventilatory or oxygenation support.
the Health and Safety Code, §11.016,
] which allows
the
Executive Commissioner of the Health and Human Services Commission
[
Texas Board of Health (board)
] to
appoint
[
establish
] advisory committees
as needed
.
board
].
board
] concerning
rules relating to the certification of respiratory care practitioners.
board
].
board
] will initiate and complete a review of the committee to determine
whether the committee should be continued, consolidated with another committee,
or abolished. If the committee is not continued or consolidated, the committee
shall be abolished on that date.
board
]. The composition of the committee shall
include:
board
]. The presiding officer may serve
as an ex-officio member of any subcommittee of the committee.
Texas Department of Health
] (department)
staff and either the presiding officer or at least three members of the committee.
board
] and each member of the committee within 30 days of each meeting.
board, the
] department, and the committee
shall not be bound in any way by any statement or action on the part of any
committee member except when a statement or action is in pursuit of specific
instructions from the
Executive Commissioner of the Health and Human
Services Commission,
[
board,
] department, or committee.
board, the
] department or the
committee except with approval through the department's legislative process.
Committee members are not prohibited from representing themselves or other
entities in the legislative process.
board
]. The committee shall file
an annual written report with the
Executive Commissioner of the Health
and Human Services Commission
[
board
].
board
], the
status of any rules which were recommended by the committee to the
Executive
Commissioner of the Health and Human Services Commission,
[
board
], and anticipated activities of the committee for the next year.
board
] each
November. It shall be signed by the presiding officer and appropriate department
staff.
Chapter
2110
], a committee member may receive reimbursement for the member's
expenses incurred for each day the member engages in official committee business
if authorized by the General Appropriations Act or budget execution process.
for applications filed on or before December 31, 2004--$60
];
(B)
application (includes initial
certificate) fee for applications filed on or after January 1, 2005--$120;]
(C)
] renewal fee for a license issued
for a
one-year
[
one year
] term is $50;
(D)
] renewal fee for a license issued
for a
two-year
[
two year
] term is $100;
(or board)
] is authorized to collect subscription and convenience
fees, in amounts determined by the Texas Online Authority, to recover costs
associated with application and renewal application processing through Texas
Online; and
(or board)
] is authorized to collect fees to fund the Office of
Patient Protection, Health Professions Council, as mandated by law.
extension
]
fee--$20;
administrator, on behalf
of the board,
] shall make periodic reviews of the fee schedule and recommend
any adjustments necessary to provide sufficient funds to meet the expenses
of the respiratory care practitioner certification program without creating
an unnecessary surplus. Such adjustments shall be made through rule amendments
approved by the
Executive Commissioner of the Health and Human Services
Commission
[
board
].
45
] days
of graduation may apply to the department for a temporary permit in accordance
with §123.6 of this title (relating to Application Requirements and Procedures).
A person who holds a temporary permit may perform any and all respiratory
care procedures which he or she has been trained to perform.
;
]
(J)
A full face color photograph
signed on the reverse side with the applicant's signature as it appears on
the application. The photograph must have been taken within the two year period
prior to application to the department and the minimum size is one and one-half
inches by one and one-half inches.]
Practitioner
]
(CRT), [
a Certified Respiratory Therapy Technician (CRTT),
] or
a Registered Respiratory Therapist (RRT), upon payment of the application
fee, submission of the application forms and approval by the department, the
department shall issue a regular certificate to a person which is currently
credentialed by the National Board for Respiratory Care (NBRC).
board
].
(6)
Medical direction requirement.
If the applicant is practicing respiratory care in Texas at the time of application
to the department, the applicant shall provide on the application form the
signature and license number of the qualified medical director as defined
in §123.2 of this title (relating to Definitions) or other Texas licensed
physicians directing the provision of respiratory care services.]
45
] days
from the date of the applicant's graduation will be held pending until the
applicant is within
30
[
45
] days of graduation; and
180
] working days.
program administrator
]. If the
department
[
program administrator
] does not agree that the time period has been
violated or finds that good cause existed for exceeding the time period, the
request will be denied.
(3)
Appeal. If a request reimbursement
under paragraph (2) of this subsection is denied by the program administrator,
the applicant may appeal to the commissioner of health for a timely, resolution
of any dispute arising from a violation of the time periods. The applicant
shall give written notice to the commissioner of health at the address of
the department that he or she requests full reimbursement of all fees paid
because his or her application was not processed within the applicable time
period. The program administrator shall submit a written report of the facts
related to the processing of the application and of any good cause for exceeding
the applicable time period. The commissioner of health shall provide written
notice of the decision to the applicant and the program administrator. An
appeal shall be decided in favor of the applicant if the applicable time period
was exceeded and good cause was not established. If the appeal is decided
in favor of the applicant, full reimbursement of all fees paid in that particular
application process shall be made.]
(4)
] Contested cases. The time periods
for contested cases related to the denial of licensure renewals are not included
with the time periods stated in paragraph (1) of this subsection. The time
period for conducting a contested case hearing runs from the date the department
receives a written request for a hearing and ends when the decision of the
department is final and appealable. [
a hearing may be completed within
one to four months, but may extend for a longer period of time depending on
the particular circumstances of the hearing.
]
prescribed by
the board
] as set out in §123.8 of this title (relating to Examination)
during the period for which the temporary certificate, or temporary permit
[
or temporary permit extension,
] was valid, if applicable;
administrator
] determines that the application should not be approved, the
department
[
administrator
] shall give the applicant written
notice of the reason for the proposed decision and of the opportunity for
a formal hearing. The formal hearing shall be conducted according to the Administrative
Procedure Act, Texas Government Code 2001, et seq. Within 10 days after receipt
of the written notice, the applicant shall give written notice to the
department
[
administrator
] that the applicant either waives
the hearing, or wants the hearing. Receipt of the written notice is deemed
to occur on the tenth day after the notice is mailed unless another date of
receipt is reflected on a United States Postal Service return receipt. If
the applicant fails to respond within 10 days after receipt of the notice
of opportunity, or if the applicant notifies the
department
[
administrator
] that the hearing be waived, the applicant is deemed to
have waived the hearing. If the hearing has been waived, the department shall
disapprove the application.
board
]
and the provisions of the Act in effect at the time of reapplication. The
date of disapproval is the effective date of a disapproval order signed by
the commissioner of health or the commissioner's designee.
Certificates issued within three months of the practitioner's
birth month shall be issued for the next full renewal period.
] Certificates
shall expire on the last day of the practitioner's birth month.
45
] days prior to graduation. A temporary permit is valid for six months
from date of issuance by the department. After the applicant passes the examination,
as set out in §123.8 of this title (relating to Examination), and pays
the prescribed fee, a regular certificate shall be issued and the temporary
permit shall become null and void;
(C)
an applicant who holds a valid
temporary permit pending reexamination who has applied for an extension of
the temporary permit on the form prescribed by the department and who has
paid the additional prescribed fee. This temporary permit shall expire not
more than 12 months from the date of issuance of the original permit. A temporary
permit holder is not entitled to an extension if the person has not submitted
a certificate of completion from a respiratory care education program in accordance
with §123.6(b)(2)(C) of this title (relating to Application Requirements
and Procedures). After the applicant passes the examination as set out in §123.8
of this title (relating to Examination) and has paid the prescribed fee, a
regular certificate shall be issued and the temporary permit shall become
null and void.]
board
] but administered under the auspices of another agency
will be communicated to the applicant by the department, unless the contract
between the department and that agency provides otherwise.
board
] to administer an examination prescribed in this section.
If the applicant is practicing
as a respiratory care practitioner at the time of renewal the name, signature
and license number of the physician directing the provision of respiratory
care and the physician's institutional affiliations(s), if any, shall be provided
on the renewal form if requested by the department.
]
(C)
If the person received a 90-day
extension of the person's certificate pursuant to §123.10(f) of this
title (relating to Continuing Education Requirements), the expiration date
under subparagraphs (A)-(B) of this paragraph is the expiration date of the
person's last annual certificate.]
(D)
] After the certificate is renewed,
the next continuing education reporting period starts on the date the certificate
is renewed and continues until the next expiration date.
(2)
The department shall inform
a person who has not renewed a certificate by the expiration date of the amount
of the fee required for renewal, the continuing education required for renewal,
and the date the certificate expired.]
(3)
] A person whose certificate
has been expired for one year or more may apply for a new certificate by complying
with the then-current requirements for obtaining a certificate.
(4)
] After a certificate is expired
and until a person has renewed the certificate, a person may not practice
respiratory care in violation of the Act.
(5)
] A person who fails to renew
a certificate within one year may obtain a new certificate without examination
if the person:
12 month
] period preceding the date of
the renewal
application [
for a new certificate
].
plus a reinstatement fee equal to one-half the renewal fee
]; and
12-month
] period prior to reentering
active status, of the continuing education hours as set out in §123.10
of this title.
year
].
the second
] renewal.
(2)
At the time the certificate
is mailed, each practitioner shall be notified of the beginning and ending
dates of the continuing education period.]
(3)
] A
respiratory care
practitioner
must complete
24
[
12
] hours of continuing education
acceptable to the department during each renewal
period
[
year
].
(4)
] A clock hour shall be 50 minutes
of attendance and participation in an acceptable continuing education experience.
administrator
].
the board,
] the department, and other professional or
governmental bodies.
administrator
] shall
give written notice to the person that the department intends to deny, suspend,
or revoke the certificate or temporary permit after hearing in accordance
with the provisions of the Administrative Procedure Act,
Chapter 2001
[
§2001
], Texas Government Code, Texas Occupations Code,
Chapter 53.
administrator
] shall give the
person written notice:
board
], when offenses and prohibited actions and violations have occurred.
administrator
]. The initial notification
of a complaint may be in writing, by telephone, or by personal visit to the
department
[
administrator's office
]. (Mailing address: 1100
West 49th Street, Austin, Texas 78756-3183, Phone: 512-834-6632.
administrator
] or the
department's
[
administrator's
] designee shall send an acknowledgment letter to the complainant and
the department's complaint form which the complainant must complete and return
to the
department
[
administrator
] or the
department's
[
administrator's
] designee before action can be taken. If
the complaint is made by a visit to the
department
[
administrator's
office
], the form may be given to the complainant at that time; however,
it must be completed and returned to the
department
[
administrator
] or the
department's
[
administrator's
] designee
before further action may be taken. Copies of the complaint form may be obtained
from the
Department of State Health Services
[
Texas Department
of Health, 1100 West 49th Street, Austin, Texas 78756-3183
].
administrator or the administrator's designee
],
provided sufficient information is submitted.
administrator and the
] department
is
[
are
] responsible for handling complaints.
administrator, or his or
her designee,
] shall make the initial investigation and report the findings
to the
manager
[
director
] of Professional Licensing
and Certification
Unit
[
Division
] or his or her designee,
or the
manager
[
director
] or designee of its successor.
board
] rule and may institute
disciplinary action in accordance with subsection (f) of this section.
program administrator
] shall give written notice to the permit or certificate holder by certified
mail, return receipt requested, of the facts or conduct alleged to warrant
revocation or suspension, and the person shall be given the opportunity, as
described in the notice, to show compliance with all requirements of the Act
and this chapter.
administrator
] shall give the practitioner written notice
for the opportunity for hearing. The notice shall state the basis for the
proposed action. Within 10 days after receipt of the notice, the practitioner
must give written notice to the
department
[
administrator
] that he or she either waives the hearing or wants the hearing. Receipt
of the notice is deemed to occur on the 10th day after the notice is mailed
unless another date of receipt is reflected on a United States Postal Service
return receipt.
administrator or the
] department
determines that the reasons for suspension no longer exist. The
respiratory
practitioner whose certificate or permit has been suspended is responsible
for securing and providing to the department such evidence, as may be required
by the department that the reasons for the suspension no longer exist. The
[
administrator or the
] department shall investigate prior to making
a determination.
administrator or the
] department determines that the reasons
for suspension have been removed.
(4)
If the department suspends
a temporary permit and the suspension is in effect at the time of the expiration
of the temporary permit, the former temporary permit holder must reapply in
order to obtain a new temporary permit. The department may not issue a new
temporary permit until the administrator or the department determines that
the reasons for suspension have been removed.]
(5)
] A person whose application
is denied or whose temporary permit or certificate is revoked or surrendered
is ineligible for a temporary permit or certificate under this Act for one
year from the date of the denial or revocation or surrender.
(6)
] Upon revocation or nonrenewal,
the former certificate or permit holder shall return the certificate or permit
and any identification card(s) to the department.
program administrator
] determines that the public interest might be served by attempting
to resolve a complaint or contested case by an agreed order in lieu of a formal
hearing, the provisions of this section shall apply. A temporary permit
or certificate holder,
or applicant may request an informal settlement
conference; however, the decision to hold a conference shall be made by the
department
[
program administrator
].
program administrator
]
shall decide upon the time, date, and place of the settlement conference and
provide written notice to the temporary permit or certificate holder or applicant
of the same. Notice shall be provided no less than ten days prior to the date
of the conference by certified mail, return receipt requested to the last
known address of the temporary permit or certificate holder or applicant or
by personal delivery. The ten days shall begin on the date of mailing or personal
delivery. The temporary permit or certificate
holder
or applicant
may waive the ten-day notice requirement.
program administrator
] may call upon the program's attorney at any time for assistance in
the settlement conference.
program administrator
] may make recommendations
for informal disposition of the complaint or contested case. The recommendations
may include any disciplinary action authorized by the Act. They may also conclude
that the department lacks jurisdiction, conclude that a violation of the Act
or this chapter has not been established, or refer the matter for further
investigation.
program administrator
] for appropriate action.
program administrator
] for its approval.
program administrator
]
shall enter an agreed order approving the accepted settlement recommendations.
The
department
[
program administrator
] may not change
the terms of a proposed order but may only approve or disapprove an agreed
order unless the temporary permit or certificate holder or applicant agrees
to other terms proposed by the
department
[
program administrator
].
program administrator
] does not approve a proposed agreed order, the temporary permit or
certificate holder or applicant and the complainant shall be so informed.
program administrator
] determines that an informal conference shall not be held, the
department
[
program administrator
] shall give written notice
to the temporary permit or certificate holder or applicant of the facts or
conduct alleged to warrant the intended disciplinary action and the temporary
permit or certificate holder or applicant shall be given the opportunity to
show, in writing and as described in the notice, compliance with all requirements
of the Act and this chapter.
program administrator
].
of this title (relating to
Issuance of Renewal Certificate and Renewal of Temporary Permit)
]. However,
the license will not be renewed until the requirements of subsections (g)
and (h) of this section are met.
Chapter 143.
MEDICAL RADIOLOGIC TECHNOLOGISTS