PART 11. TEXAS BOARD OF NURSING

CHAPTER 217. LICENSURE, PEER ASSISTANCE AND PRACTICE

22 TAC §217.6, §217.9

INTRODUCTION. The Texas Board of Nursing (Board) proposes amendments to §217.6 (relating to Failure to Renew License) and §217.9 (relating to Inactive Status). The proposed amendments are authorized under the Occupations Code §§53.021(b), 301.261, 301.301, 301.302, 301.303, 301.4535, and 301.151 and are necessary to: (i) clarify the existing requirements that apply to the reactivation of an expired (delinquent) or inactive nursing license; (ii) specify the new requirements that will apply to the reactivation of an expired (delinquent) or inactive nursing license; (iii) provide additional guidance regarding the content requirements of a refresher course, extensive orientation to the practice of nursing, and nursing program of study (refresher course/s); (iv) ensure consistency among the requirements of §217.6 and §217.9; and (v) prevent individuals with serious and potentially disqualifying histories from renewing delinquent licenses until the Board has had a full opportunity to investigate and take appropriate action.

Background

At its October, 2008, meeting, the Board considered a license reinstatement request from an individual who had been away from patient care for approximately 18 years. The individual sought either: (i) a temporary permit in order to complete a competency evaluation; (ii) a limited license; or (iii) permission to retake the National Counsel Licensure Examination (NCLEX). The Board denied the individual's request due to the extensive amount of time that the nurse had been away from patient care. At that time, the Board also charged Board staff with reviewing its authority under the Occupations Code §301.301 and developing a rule that addressed situations beyond which an expired (delinquent) license could not be renewed. Board Staff presented its findings and recommendations to the Board at its January, 2009, meeting. Board Staff presented the results of a survey from 23 other state boards of nursing, including Alabama, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Indiana, Kansas, Michigan, Missouri, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, South Dakota, Vermont, Washington, DC, and West Virginia, regarding their treatment of the renewal of an expired license. Although there was no uniform standard among the surveyed states, 16 of the 23 states surveyed required the completion of a re-entry program or a comprehensive refresher course after a nursing license had been expired for a certain period of time. The majority of these states required a nursing license to have been expired for at least a five year period. These states included Arkansas, Connecticut, Delaware, Georgia, Hawaii, Kansas, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Vermont, Washington, DC, and West Virginia. Further, 5 of the 23 states required a nurse to complete formal nursing re-education or to retake the NCLEX after a nursing license had been expired for a certain period of time. The majority of these states required at least a five year period. These states included Connecticut, Georgia, Hawaii, Michigan, and Oklahoma. After its consideration of this information, the Board determined that additional information was still needed and charged the Advisory Committee on Education and the Nursing Practice Advisory Committee (Committees) with the development of a rule related to failing to renew a license after a significant passage of time.

The Committees first convened via teleconference on June 4, 2009, to consider the Board's charge. The Committees discussed its concerns related to a nurse's return to active nursing practice after being away for an extended period of time. The Committees also reviewed the Occupations Code §301.301(d), which authorizes the Board to set a length of time beyond which an expired license may not be renewed and to establish additional requirements that apply to the renewal of a license that has been expired for more than one year, but less than the time limit set by the Board beyond which a license may not be renewed. The Committees also considered the results from the Board's survey of other state boards of nursing regarding their treatment of the renewal of an expired license. The Committees discussed the Board's existing requirements related to refresher courses and whether those requirements sufficiently ensured a nurse's competency to re-enter active nursing practice. Several committee members suggested strengthening the Board's refresher course requirements in order to better ensure public safety when nurses seek to re-enter active nursing practice. Some committee members suggested requiring nurses to demonstrate their knowledge in combination with an exam to establish their competency to practice upon re-entry. The Committees also discussed adding a Jurisprudence Exam to the Board's refresher course requirements. Some committee members advocated specialized refresher courses for individuals desiring to work in practice specific areas, such as pediatrics, case management, school nursing, or public health, while other committee members stressed the importance of more generalized refresher courses. The Committees also discussed whether formal nursing re-education should be required if a nurse had been away from active practice for a very lengthy period of time, such as ten or fifteen years. Following its discussions, however, the Committees were unable to reach any final recommendations regarding a nurse's failure to renew a license after a significant passage of time and determined that they needed to discuss the issues further.

The Committees re-convened on May 17, 2010, to again consider the Board's charge. Because there was general agreement at the June, 2009, meeting that the Board's refresher course requirements should be strengthened to better ensure a nurse's competency to re-enter active nursing practice after an extended period of time, the Committees focused their discussions on amendments to the Board's existing requirements for refresher courses. Specifically, the Committees discussed requiring all nurses seeking to re-enter active nursing practice to complete the Board's online Nursing Jurisprudence Prep Course, the Board's Jurisprudence and Ethics Workshop, or a Board approved Nursing Jurisprudence and Ethics Course, as well the Board's Nursing Jurisprudence Exam. The Committees felt that these additional requirements were necessary to test a nurse's competency to re-enter active nursing practice. The Committees also discussed recommendations related to the required course content of refresher courses, such as the amount of time that a nurse should spend reviewing and mastering each refresher course topic, as well as the kinds of issues that should be addressed during each phase of a refresher course. Committee members felt that additional Board guidance in this area would be helpful to nurses completing refresher courses, as well as to preceptors teaching refresher courses. Some committee members suggested that certain portions of the existing rules should be clarified, and one committee member suggested that the language of §217.6 and §217.9 should be made more consistent. Following its discussions, the Committees voted to recommend the adoption of the proposed amendments to §217.6(a) - (h) and §217.9 to the Board.

Expired (Delinquent) Licenses

The proposed amendments to §217.6 are necessary to clarify the existing requirements that apply to the reactivation of an expired (delinquent) nursing license and to specify the new requirements that will apply to the reactivation of an expired (delinquent) nursing license. Proposed amended §217.6 addresses three situations in which an expired (delinquent) nursing license may be reactivated: (i) first, where a nurse has failed to maintain a current Texas license for a period of less than four years; (ii) second, where a nurse has failed to maintain a nursing license from any licensing authority for four or more years; and (iii) third, where a nurse has failed to maintain a current Texas license for a period of four or more years, but has maintained a nursing license from another licensing authority and has practiced nursing during that time period.

Proposed amended §217.6(a) clarifies the existing requirements that apply to the reactivation of an expired (delinquent) nursing license where a nurse has failed to maintain a current Texas license for a period of less than four years, regardless of whether the nurse maintained a nursing license from another licensing authority or practiced nursing during that time period. In such situations, a nurse wishing to reactivate his or her license must file a reactivation application with the Board, pay the applicable licensure fees, including any fines and late fees, and provide evidence of having completed 20 contact hours of continuing education. Proposed amended §217.6(a) also clarifies that the continuing education hours must meet the requirements of Chapter 216 (relating to Continuing Competency).

Proposed amended §217.6(b) is necessary to address situations in which a nurse seeks to reactivate his or her nursing license after failing to maintain a current nursing license from any licensing authority, including Texas, for four or more years. Because the ever evolving landscape of medical care requires nurses to stay abreast of the most current changes in medical techniques, treatments, and technology, such situations raise questions about the nurse's competency to safely reenter nursing practice after being away from practice for an extended period of time. As a result, the Board has historically required such nurses to complete a refresher course before being able to reactivate his or her permanent Texas nursing license. While proposed amended §217.6(b) does not change this existing requirement, it does provide additional guidance to nurses completing refresher courses and to preceptors teaching refresher courses. Although the Board has established general parameters for refresher courses over time, individual refresher courses have historically varied from one another based upon a nurse's individual deficiencies, a preceptor's preferences, and the availability of clinical experiences. In an effort to ensure that a refresher course provides at least a minimally comprehensive review of nursing practice, the Board is proposing new requirements for refresher courses. The new requirements are designed to establish minimum standards for refresher courses without eliminating a preceptor's flexibility to customize certain portions of a refresher course to address a particular nurse's individual deficiencies. A nurse completing a refresher course under the proposed new requirements should receive a more comprehensive review of nursing practice, as well as an opportunity to review and test his or her clinical skills.

First, the proposed new requirements specify the recommended amount of time that a nurse and preceptor should spend on each required refresher course topic. For example, the Board is recommending that 20% of a refresher course be spent on a pharmacology review, while only 15% of a refresher course be spent on the review of the Nursing Practice Act, rules, and position statements. By identifying the amount of time that a nurse and preceptor should spend on each area, the proposed new requirements prioritize the importance of each area of nursing practice, thereby creating a more uniform structure for refresher courses. Second, the proposed new requirements specify the types of information that should be reviewed as part of each refresher course topic. For example, the new requirements specify several documents that should be reviewed as part of a scope of practice discussion, including documents and reference materials that are published on the Board's website. This proposed new requirement helps ensures that a refresher course includes a review of the appropriate reference material applicable to each refresher course topic. In this way, the proposed new requirements are intended to strengthen the quality and value of refresher courses, which should enhance the competency of nurses completing the courses. Third, the proposed new requirements specify that a nurse must provide documentation of his or her current cardiopulmonary resuscitation (CPR) certification prior to beginning any precepted clinical experience. Nurses are required to provide supervised, direct patient care as part of a refresher course. As such, this proposed requirement is necessary to ensure the safety of patients during a nurse's precepted clinical experiences.

In addition to the completion of a refresher course, proposed amended §217.6(b) continues to require the completion of a reactivation application, the submission of all applicable licensure fees, including any late fees or fines, and the completion of 20 contact hours of continuing education. Proposed amended §217.6(b) also clarifies that the continuing education hours must meet the requirements of Chapter 216.

Based upon the Committees' recommendations and the Board's own concerns regarding the safety and competency of nurses reentering nursing practice after being away for an extended period of time, proposed amended §217.6(b) also contains two new requirements. These proposed new requirements are intended to refresh and test a nurse's knowledge of acceptable practices and procedures, which should better ensure the nurse's competency to reenter active nursing practice. First, proposed amended §217.6(b) requires a nurse seeking to reactivate his or her expired (delinquent) nursing license to complete one of the following courses: the online Board Jurisprudence Prep Course; the Board Jurisprudence and Ethics Workshop; or a Board approved Nursing Jurisprudence and Ethics course. Not only do these courses provide information related to the Nursing Practice Act and the Board's rules and regulations, but they also address patient safety and advocacy, scope of practice issues, systems issues, and safe harbor. The information contained in these courses is designed to support a nurse's transition back into active nursing practice. Proposed amended §217.6(b) also requires a nurse seeking to reactivate his or her expired (delinquent) nursing license to complete the Board's Nursing Jurisprudence Exam. This proposed requirement is important because it allows the Board to objectively measure a nurse's requisite nursing knowledge. Each of these proposed new requirements is designed to test a nurse's competency upon reentry to practice.

Existing §217.6(b) requires a nurse seeking to reactivate his or her expired (delinquent) nursing license to apply for, and receive, a temporary permit in order to complete a refresher course. The proposal does not alter this requirement. Under proposed amended §217.6(b), a nurse must still apply for, and receive, a temporary permit in order to complete a refresher course. Because a nurse must first apply for, and receive, a temporary permit before being permitted to complete a refresher course, the Board has historically placed all the requirements and instructions for a refresher course in the same instruction and application packet as temporary permit requirements and instructions. For purposes of better internal organization and readability, the instruction and application packets for both temporary permits and refresher courses are being proposed for adoption by reference in proposed new §217.6(c). Further, for purposes of clarity, the forms are divided among vocational nursing instruction and application packets and professional registered nursing instruction and application packets and are designated accordingly.

Proposed new §217.6(d) addresses situations in which a nurse: (i) has failed to maintain a current Texas nursing license for a period of four or more years; (ii) has practiced in another state during this period of time; and (iii) seeks to reactivate an expired (delinquent) license. Because a nurse seeking reactivation under proposed new §217.6(d) has actively practiced nursing in another state during the preceding four year time period, there is less concern about the nurse's competency to reenter practice in Texas. Further, because a nurse seeking reactivation under proposed new §217.6(d) will have maintained an active nursing license in another jurisdiction during the preceding four year time period, another state licensing board will have overseen the nurse's practice for that period of time, including monitoring and investigating any complaints that may have been filed against the nurse. Because the nurse's general competency to practice is of less concern in this situation, proposed new §217.6(d) does not require the nurse to complete a comprehensive refresher course. However, the nurse still must be knowledgeable of issues that may be unique to Texas. As such, proposed new §217.6(d) requires the nurse to complete the online Board Jurisprudence Prep Course, the Board Jurisprudence and Ethics Workshop, or a Board approved Nursing Jurisprudence and Ethics course and the Board Nursing Jurisprudence Exam. These courses are designed to familiarize the nurse with issues that he or she may encounter in his or her practice in Texas and should supplement and enhance the nurse's existing knowledge and skill set. Further, the Board Nursing Jurisprudence Exam is designed to objectively measure the nurse's competency to practice in Texas. Additionally, proposed new §217.6(d) requires the nurse to complete a reactivation application, pay the applicable licensure fees, including any fines or late fees, and submit evidence of the completion of 20 contact hours of acceptable continuing education that meet the requirements of Chapter 216.

The remaining proposed amendments to §217.6 are necessary to re-designate the existing subsections of §217.6 and to increase the overall organization and readability of the section. Proposed new §217.6(e) - (h) specify the situations in which a license reactivation application may be refused by the Board, a nurse's options after being refused a license reactivation, and special reactivation provisions applicable to actively deployed nurses. Each of the provisions in proposed new §217.6(e) - (h), however, already exist within the current text of §217.6. The Board is not proposing to substantively alter or eliminate any of these existing requirements or procedures. Further, the mere rearrangement of these provisions within the section will not alter the Board's historical interpretation or application of these provisions or affect the Board's interpretation or application of these requirements in the future.

Proposed new §217.6(i) is necessary to prevent individuals with serious and potentially disqualifying histories from renewing expired (delinquent) licenses and practicing nursing in Texas while the Board investigates and initiates actions against their licenses. This proposed new subsection applies only in situations where a statute, such as the Occupations Code §301.4535(a) and §53.021(b), requires the revocation or denial of a license or renewal or where the Board's policies would normally dictate the revocation or denial of a license or renewal. For example, the Occupations Code §301.4535(a) specifies certain criminal offenses for which the Board is required to suspend, refuse to renew, refuse to issue, or revoke a nursing license. Further, the Occupations Code §53.021(b) requires the Board to revoke a nurse's license following the nurse's imprisonment for a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision. Additionally, the Board is a member of the Nurse Licensure Compact (Compact), which is authorized by the Occupations Code Chapter 304. As part of the Compact, the Board shares disciplinary information concerning Texas licensees with other compact members. Further, when a disciplinary action is taken against a licensee by another compact state, the Board is notified. In this way, the various compact states work together to ensure that unsafe, incompetent, or dangerous licensees are monitored and appropriately disciplined, regardless of the state in which they choose to practice. Further, when the Board is notified that a nurse has been disciplined in another compact state, the Board begins its investigation of the matter and, if appropriate, seeks a similar action against the nurse's license or privilege in Texas.

Proposed new §217.6(i) prevents nurses from being able to renew an expired (delinquent) license under certain circumstances. First, the nurse's license must have been expired (delinquent) for at least a one year period. Second, the nurse must fall into one of the following three categories: (i) the nurse must have been initially or finally convicted of, or have entered a plea of guilty or nolo contendere to, an offense specified in the Occupations Code §301.4535(a); (ii) the nurse must have been imprisoned following a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision; or (iii) the nurse must have had a nursing license or privilege in another state revoked, suspended, or denied. If a nurse falls into one of these three categories and seeks to renew a Texas nursing license that has been expired (delinquent) for at least one year, proposed new §217.6(i) will prevent the nurse from being able to renew the license until the Board has had an opportunity to complete its investigation and reach a final resolution of the matter. Proposed new §217.6(i) protects the public health, safety, and welfare. Currently, a nurse who falls into one of the aforementioned categories may seek the renewal of an expired (delinquent) license, regardless of whether the Board is simultaneously conducting an investigation of the matter or not. The nurse may then practice under the renewed license while the Board continues its investigation. As a result, nurses who have pled guilty to murder, indecency with a child, or aggravated sexual assault, for example, could continue unmonitored, daily contact with patients until the Board is able to complete its own disciplinary proceedings against the nurse. Likewise, a nurse whose license was revoked or suspended in another state may also seek to renew his or her Texas nursing license while the Board conducts an investigation of the matter. Again, the nurse may practice under the renewed license and have unmonitored, daily contact with patients until the Board is able to complete its own disciplinary proceedings against the nurse. This period of unsupervised and unmonitored practice poses a direct risk to the public health, safety, and welfare. Proposed new §217.6(i) seeks to minimize this risk by preventing these nurses from practicing in Texas until the Board is able to determine if the nurse is safe and competent to practice, and, if so, whether the nurse's practice should be monitored by the Board. Once the Board concludes its investigation and is able to completely resolve the matter, the nurse may then renew the expired (delinquent) license and comply with the terms prescribed by the Board, as applicable.

Inactive Licenses

The proposed amendments to §217.9 are necessary to clarify the existing requirements that apply to the reactivation of an inactive nursing license; to specify the new requirements that will apply to the reactivation of an inactive nursing license; and to promote consistency between §217.6 and §217.9. Proposed amended §217.9 addresses three situations in which an inactive nursing license may be reactivated: (i) first, where a nurse has not practiced nursing in Texas and his or her license has been in an inactive status for a period of less than four years; (ii) second, where a nurse has not practiced nursing in any jurisdiction and his or her license has been in an inactive status for four or more years; and (iii) third, where a nurse's license has been in an inactive status for a period of four or more years, but the nurse has maintained a nursing license from another jurisdiction and has practiced nursing during that time period. Because these circumstances closely resemble the circumstances outlined in proposed amended §217.6(a), (b), and (d), the proposed amendments to §217.9(e), (f), and (h) mirror the proposed requirements in §217.6(a), (b), and (d). Consistency among these two sections promotes a fair and balanced process for all nurses seeking reactivation of an expired (delinquent) or inactive nursing license and ensures that all similarly situated individuals are treated equally by the Board.

Proposed amended §217.9(e) clarifies the existing requirements that apply to the reactivation of an inactive nursing license where a nurse has not practiced nursing in Texas and his or her license has been in an inactive status for a period of less than four years, regardless of whether the nurse has practiced in another jurisdiction during that time period. In such situations, a nurse wishing to reactivate his or her license must file a reactivation application with the Board, pay the applicable fees, and submit verification of the completion of 20 contact hours of continuing education. Proposed amended §217.9(e) also clarifies that the continuing education hours must meet the requirements of Chapter 216 and must have been completed within the two years immediately preceding the reactivation application. These proposed amendments are consistent with the proposed amendments to §217.6(a).

Proposed amended §217.9(f) prescribes the requirements that apply to the reactivation of an inactive nursing license where a nurse's license has been in an inactive status for four or more years and the nurse has not practiced nursing in any jurisdiction during that time period. When a nurse who has not actively practiced nursing for four years or more seeks to reactivate his or her license, concerns arise regarding the nurse's competency to practice. This is true regardless of whether the nurse chose to place his or her license in an inactive status or whether the nurse failed to maintain his or her license. As a result, the proposed requirements to §217.9(f) closely mirror the proposed amendments to §217.6(b). Proposed amended §217.9(f) requires a nurse whose license has been in an inactive status for four or more years, but who has not practiced nursing during that time, to complete a refresher course. This is not a departure from current Board policy. However, proposed amended §217.9(f) does prescribe new requirements for refresher courses. These requirements are the same requirements that are also being proposed for adoption in proposed amended §217.6(b). These proposed requirements have been previously discussed in the foregoing paragraphs of this proposal and apply equally to a refresher course under proposed amended §217.6(b) and proposed amended §217.9(f). In addition to the completion of a refresher course, proposed amended §217.9(f) continues to require the completion of a reactivation application, the submission of all applicable licensure fees, and the completion of 20 contact hours of continuing education. Proposed amended §217.9(f) also clarifies that the continuing education hours must meet the requirements of Chapter 216.

Like proposed amended §217.6(b), proposed amended §217.9(f) also contains two new requirements. First, proposed amended §217.9(f) requires a nurse seeking to reactivate an inactive nursing license to complete one of the following courses: the online Board Jurisprudence Prep Course; the Board Jurisprudence and Ethics Workshop; or a Board approved Nursing Jurisprudence and Ethics course. Proposed amended §217.9(f) also requires a nurse seeking to reactivate an inactive nursing license to complete the Board's Nursing Jurisprudence Exam. These proposed requirements have also been previously discussed in the foregoing paragraphs of this proposal and are consistent with the proposed amendments to §217.6(b).

The Board has historically required a nurse seeking to reactivate an inactive nursing license to apply for, and receive, a temporary permit in order to complete a refresher course. The proposal does not alter this requirement. Historically, the Board has placed all the requirements and instructions for a refresher course in the same instruction and application packet as temporary permit requirements and instructions. The instruction and application packets for both temporary permits and refresher courses are being proposed for adoption by reference in proposed new §217.6(c) and proposed new §217.9(g). For purposes of consistency, these forms will be utilized by nurses seeking reactivation of an expired (delinquent) license under proposed amended §217.6(b) and reactivation of an inactive license under proposed amended §217.9(f).

Proposed new §217.9(h) addresses situations in which: (i) a nurse's license has been in inactive status for four years or more; (ii) the nurse seeks to reactivate the inactive license; and (iii) the nurse has maintained a license and has practiced in another jurisdiction during the preceding four years. Much like a nurse seeking reactivation under proposed new §217.6(d), a nurse's general competency to practice is of less concern in this situation. As such, proposed new §217.9(h) does not require a nurse in this situation to complete a refresher course. However, the nurse still needs to be knowledgeable of issues that may be unique to Texas. As such, proposed new §217.9(h) requires the nurse to complete the online Board Jurisprudence Prep Course, the Board Jurisprudence and Ethics Workshop, or a Board approved Nursing Jurisprudence and Ethics course and the Board Nursing Jurisprudence Exam. These proposed requirements have been previously discussed in this proposal and are consistent with the proposed amendments to §217.6(d). Additionally, proposed new §217.9(h) requires a nurse to complete a reactivation application, pay the applicable licensure fees, and submit evidence of the completion of 20 contact hours of acceptable continuing education that meet the requirements of Chapter 216. These proposed requirements are also consistent with the proposed amendments to §217.6(d).

Section-by-Section Overview. The following is a section-by-section overview of the proposal.

Proposed amended §217.6(a) provides that a nurse who is not practicing nursing in Texas and who fails to maintain a current Texas license for a period of time less than four years may bring his or her license up-to-date by filing such forms as the Board may require, showing evidence of having completed 20 contact hours of acceptable continuing education that meets the requirements of Chapter 216 (relating to Continuing Competency) within the two years immediately preceding the application for reactivation, and paying the current licensure fee plus a late fee and any applicable fines, which are not refundable.

Proposed amended §217.6(b) provides that a nurse who is not practicing nursing and who fails to maintain a current license from any licensing authority for four or more years will be required to: (i) complete a refresher course, extensive orientation to the practice of nursing, or a nursing program of study that meets the requirements prescribed by the Board. The applicant must submit an application to the Board for a temporary permit for the limited purpose of completing a refresher course, extensive orientation to the practice of nursing, or a nursing program of study; (ii) submit to the Board evidence of the successful completion of the requirements of §217.6(b)(1); (iii) submit to the Board a course completion form from the online Texas Board of Nursing Jurisprudence Prep Course, the Texas Board of Nursing Jurisprudence and Ethics Workshop, or a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course; (iv) submit to the Board a certificate of completion from the Texas Nursing Jurisprudence Exam; (v) submit to the Board a completed reactivation application; (vi) submit to the Board the current, non-refundable licensure fee, plus a late fee and any applicable fines which are not refundable; and (vii) submit to the Board evidence of completion of 20 contact hours of acceptable continuing education for the two years immediately preceding the application for reactivation that meets the requirements of Chapter 216.

Proposed amended §217.6(c) adopts by reference the following forms, which comprise the instructions and requirements for a refresher course, extensive orientation to the practice of nursing, and a nursing program of study required by §217.6, and which are available at http://www.bon.state.tx.us/olv/forms.html: (i) Application for Six Month Temporary Permit (RN); and (ii) Application for Six Month Temporary Permit (LVN).

Proposed amended §217.6(d) provides that a nurse who fails to maintain a current Texas license for four years or more and who is licensed and has practiced in another state during the previous four years preceding the application for reactivation in Texas must comply with the requirements of §217.6(b)(3) - (7).

Proposed amended §217.6(e) provides that the issuance of a license reactivation may be refused to an individual who fails to submit an application for reactivation or submits an application which is incomplete, does not show evidence that the person meets the requirements for reactivation, or is not accompanied by the correct fee(s).

Proposed amended §217.6(f) provides that the Board's refusal to reactivate a license for the reasons specified in §217.6(e) does not entitle an individual to a hearing at the State Office of Administrative Hearings.

Proposed amended §217.6(g) provides that an individual who is refused a license reactivation and who wishes to reactivate his or her license will be required to: (i) correctly complete the reactivation application; (ii) show evidence of meeting all the requirements for reactivation, including completion of 20 contact hours of continuing education that meet the requirements of Chapter 216; and (iii) submit payment of the correct, non-refundable reactivation fee as follows: (A) if the license has been delinquent less than 90 days, the required fee will equal the renewal fee plus one-half the examination fee (see §223.1 (relating to Fees)), plus any applicable fines; or (B) if the license has been delinquent for more than 90 days, the required fee will equal the renewal fee plus the full examination fee (see §223.1), plus any applicable fines.

Proposed amended §217.6(h) sets forth special reactivation provisions for actively deployed nurses. Proposed amended §217.6(h)(1) provides that, if a nurse's license lapses and becomes delinquent while serving in the military whenever the United States is engaged in active military operations against any foreign power, the license may be reactivated without penalty or payment of the late renewal fee(s) under the following conditions: (i) the license was active at the time of deployment; (ii) the application for reactivation is made while still in the armed services or no later than three months after discharge from active service or return to inactive military status; (iii) a copy of the military activation orders or other proof of active military service accompanies the application; (iv) the renewal fee is paid; and (v) if the required continuing education contact hours were not earned for reactivation during the earning period, the nurse shall be required to complete the required continuing education hours needed for reactivation no later than three months after discharge from active service, return to inactive military status, or return to the United States from an active war zone. Proposed amended §217.6(h)(1) provides that the continuing education contact hours used for reactivation may not be used for the next license renewal. Proposed amended §217.6(h)(3) provides that the continuing education contact hours for the next license renewal following reactivation may not be prorated.

Proposed amended §217.6(i) provides that a nurse whose license has been expired for more than one year and who has been initially or finally convicted of, or has entered a plea of guilty or nolo contendere for, an offense specified in the Occupations Code §301.4535(a); surrendered a license or a privilege in another state or had a license or privilege revoked, suspended, or denied in another state; or been imprisoned following a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision may not renew the license until the Board has completed an investigation and reached a final resolution of the matter.

Proposed amended §217.9(a) provides that a nurse who elects to change from active licensure status to inactive status must submit a written request to the Board prior to the expiration of his or her license or designate "inactive" on the renewal form if at the time of renewal.

Proposed amended §217.9(e) provides that a nurse who has not practiced nursing in Texas and whose license has been in an inactive status for less than four years may reactivate the license by completing the reactivation application form, paying the required reactivation fee and the current licensure fee which are non-refundable, and submitting verification of completion of 20 contact hours of continuing education that meets the requirements of Chapter 216 (relating to Continuing Competency) within the two years immediately preceding the application for reactivation.

Proposed amended §217.9(f) provides that a nurse who has not practiced nursing and whose license has been in an inactive status for four or more years must submit to the Board: (i) a completed reactivation application; (ii) verification of completion of a refresher course, extensive orientation to the practice of nursing, or a nursing program of study that meets the requirements prescribed by the Board. The nurse must submit an application to the Board for a temporary permit for the limited purpose of completing a refresher course, extensive orientation to the practice of nursing, or a nursing program of study; (iii) evidence of completion of 20 contact hours of acceptable continuing education for the two years immediately preceding the application for reactivation that meets the requirements of Chapter 216 of this title; (iv) a course completion form from the online Texas Board of Nursing Jurisprudence Prep Course, the Texas Board of Nursing Jurisprudence and Ethics Workshop, or a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course; (v) a certificate of completion from the Texas Nursing Jurisprudence Exam; and (vi) the required reactivation fee, plus the current licensure fee, which are non-refundable.

Proposed amended §217.9(g) adopts by reference the following forms, which comprise the instructions and requirements for a refresher course, extensive orientation to the practice of nursing, and a nursing program of study required by this section, and which are available at http://www.bon.state.tx.us/olv/forms.html: (i) Application for Six Month Temporary Permit (RN); and (ii) Application for Six Month Temporary Permit (LVN).

Proposed amended §217.9(h) provides that a nurse whose license has been in an inactive status for four years or more and who is licensed and has practiced in another state during the previous four years preceding the application for reactivation in Texas must comply with the requirements of §217.9(f)(1) and (3) - (6).

FISCAL NOTE. Katherine Thomas, Executive Director, has determined that for each year of the first five years the proposed amendments are in effect, there will be no additional fiscal implications for state or local government as a result of implementing the proposed amendments.

PUBLIC BENEFIT/COST NOTE. Ms. Thomas has also determined that for each year of the first five years the proposed amendments are in effect, there will be public benefits, and there will be potential costs for individuals required to comply with the proposal.

Anticipated Public Benefits. The anticipated public benefits will be the adoption of requirements that: (i) clarify the existing requirements that apply to the reactivation of an expired (delinquent) or inactive nursing license; (ii) specify the new requirements that will apply to the reactivation of an expired (delinquent) or inactive nursing license; (iii) provide additional guidance regarding the content requirements of a refresher course; (iv) ensure consistency among the requirements of §217.6 and §217.9; (v) ensure the competency of nurses seeking to reenter active nursing practice after an extended period of time; and (v) prevent individuals with serious and potentially disqualifying histories from renewing delinquent licenses until the Board has had a full opportunity to investigate the matter and take the appropriate action.

The Board's mission is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely. When a nurse has been out of active nursing practice for an extended period of time, concerns regarding the nurse's competency to practice arise when the nurse seeks to reactivate his or her nursing license. Nurses may be out of active nursing practice for a variety of reasons and for varying lengths of time. Upon reentry to practice, however, the Board must be assured that each nurse is capable of delivering safe nursing care to the public. The proposed amendments are designed to ensure that a nurse's competency to practice is sufficiently tested prior to the reactivation of an expired (delinquent) or inactive license. The proposed amendments are also intended to ensure the consistent and equal treatment of similarly situated nurses seeking the reactivation of a nursing license. For purposes of establishing competency to practice, a nurse with an expired (delinquent) license is treated the same as a nurse with a license in an inactive status.

There are differences, however, between the proposed requirements. For example, a nurse whose license has been expired (delinquent) or in an inactive status for less than four years must meet different requirements than a nurse whose license has been expired (delinquent) or in an inactive status for four years or more. Further, a nurse who has not practiced nursing and whose license has been expired (delinquent) or in an inactive status for more than four years must meet different requirements than a nurse whose license has been expired (delinquent) or in an inactive status for four years or more, but has practiced nursing in another jurisdiction during that time period. These distinctions serve an important purpose. A nurse who has been away from active nursing practice for a short period of time or who has recently practiced in another jurisdiction is more likely to have retained his or her nursing competencies than a nurse who has been away from active nursing practice for a longer period of time. As such, a nurse who has been away from active nursing practice for a longer period of time is more likely to need additional competency activities designed to refresh the nurse's knowledge and clinical skills. The Board has historically approached the reactivation of expired (delinquent) and inactive nursing licenses in this manner, and the proposed amendments do not substantively change this approach. While the competency threshold is somewhat lessened for those nurses whose license has been expired (delinquent) or in an inactive status for less than four years, these nurses are still required to complete 20 contact hours of acceptable continuing education before reactivating their licenses. Because these nurses have been away from active nursing practice for a relatively short amount of time, the Board has determined that the completion of continuing education courses should be adequate to ensure the nurse's competency to reenter active nursing practice. For those nurses whose license has been expired (delinquent) or in an inactive status for four years or longer, however, the Board has determined that additional competency activities are necessary to adequately ensure the nurse's competency to reenter practice. Thus, the proposal prescribes two new requirements that are designed to more comprehensively test a nurse's competency to reenter practice.

First, in situations where a nurse's license has been expired (delinquent) or in an inactive status for four or more years, the proposal requires the nurse to complete one of three specified courses and to take a Nursing Jurisprudence Exam. The specified courses address a wide array of topics, including the Nursing Practice Act, the Board's rules and regulations, patient safety and advocacy, scope of practice issues, systems issues, and safe harbor. Further, the information in these courses is designed to support a nurse's transition back into active nursing practice. These courses are also designed to familiarize a nurse with issues that he or she may encounter in his or her practice in Texas and should supplement and enhance the nurse's existing knowledge and skill set. Additionally, the Nursing Jurisprudence Exam is designed to objectively measure a nurse's competency to practice in Texas. These proposed new requirements are designed to ensure that each nurse who reenters nursing practice is safe and able to provide competent nursing care, which results in better protection of the public's health, safety, and welfare.

The proposed amendments also provide additional guidance to nurses completing refresher courses and to preceptors teaching refresher courses by specifying the amount of time that should be spent on each refresher course topic and by specifying the types of documents and information that should be reviewed during each phase of the course. These proposed requirements are designed to ensure that all refresher courses provide a minimally comprehensive review of nursing practice for nurses seeking reactivation of their license. Thus, a nurse completing a refresher course under the proposed requirements should receive a more comprehensive review of nursing practice and procedures, which should better ensure the nurse's competency to reenter active nursing practice.

Finally, the proposal is intended to prevent individuals with serious and potentially disqualifying histories from renewing expired (delinquent) licenses and practicing nursing in Texas while the Board investigates the individual's conduct and initiates an action against their licenses, if necessary. The Board is required to suspend, refuse to renew, refuse to issue, or revoke a nurse's license for certain, specified criminal offenses. Further, the Board is required to revoke a nurse's license following the nurse's imprisonment for a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision. There are also instances when the Board becomes aware that a nurse's license has been seriously disciplined by another state nursing board. Oftentimes, these nurses will attempt to reactivate their Texas nursing license before the Board becomes aware of their criminal or disciplinary history. These nurses are not currently prohibited from practicing while the Board investigates and initiates action against their licenses. The proposed amendments are designed to protect the public from these potentially unsafe, incompetent, or dangerous nurses during the time period that the Board investigates their prior criminal or disciplinary history. Under the proposed amendments, these nurses would not be able to practice in Texas until the Board completed its investigation of the matter and reached a determination regarding the nurse's ability to safely provide patient care. In this way, the proposed requirements better ensure the protection of the public health, safety, and welfare.

Potential Costs for Individuals Required to Comply with the Proposal.

Not all nurses will be required to comply with the proposed amendments to §217.6 and §217.9. Only those nurses who seek reactivation of an expired (delinquent) or inactive license will be required to comply with the proposed amendments. For those nurses who choose to reactivate an expired (delinquent) or inactive license, there may be new associated costs of compliance with proposed amended §217.6(b) and (d) and §217.9(f) and (h).

Proposed amended §217.6 addresses the reactivation of an expired (delinquent) license. Proposed amended §217.9 addresses the reactivation of a license in an inactive status. Proposed amended §217.6(a) addresses those nurses who seek reactivation after failing to maintain a current Texas license for a period of less than four years. Proposed amended §217.6(b) addresses those nurses who seek reactivation after failing to maintain a current license from any licensing authority for four or more years. Proposed amended §217.6(d) addresses those nurses who seek reactivation after failing to maintain a current Texas license for four years of more, but who have maintained a license in another jurisdiction and have practiced in that jurisdiction during the preceding four years. Proposed amended §217.9(e) addresses those nurses who have not practiced in Texas and whose license has been in an inactive status for less than four years. Proposed amended §217.9(f) addresses those nurses who have not practiced nursing in any jurisdiction and whose license has been in an inactive status for four or more years. Proposed amended §217.9(h) addresses those nurses whose licenses have been in an inactive status for four years or more, but who have practiced in another jurisdiction during the preceding four year time period. The Board's existing rules require nurses seeking reactivation of a nursing license in these situations to complete a reactivation application, submit all required fees and fines, submit evidence of the completion of 20 contact hours of acceptable continuing education, and, in some instances, complete a refresher course. The proposed amendments to §217.6 and §217.9 do not substantively alter these existing requirements. Although the proposal provides additional guidance regarding the content requirements for refresher courses, the Board does not anticipate that this guidance or any proposed new requirements regarding refresher courses will substantively change a nurse's current manner of compliance with these requirements or alter the current associated cost of compliance with these requirements. Further, the Board does not anticipate altering its historical interpretation or application of any of these requirements nor does it anticipate that a nurse's method of compliance with any of these existing requirements will be altered due to the proposed amendments. As such, the Board does not anticipate that there will be any new compliance costs associated with these proposed requirements.

The proposal does prescribe two new requirements which may carry associated costs of compliance. Proposed amended §217.6(b) and (d) and proposed amended §217.9(f) and (h) require a nurse seeking reactivation of a nursing license to complete one of the three following courses: (i) the online Board Jurisprudence Prep Course; (ii) the Board Jurisprudence and Ethics Workshop; or (iii) a Board approved Nursing Jurisprudence and Ethics Course. Proposed amended §217.6(b) and (d) and proposed amended §217.9(f) and (h) also require a nurse seeking reactivation of a nursing license to complete the Nursing Jurisprudence Exam. The probable economic costs of compliance with proposed amended §217.6(b) and (d) and proposed amended §217.9(f) and (h) are estimated to range between $25 and $350. These estimated costs are based upon the following considerations. First, the cost of the online Board Jurisprudence Prep Course is $25. The cost of the Board Jurisprudence and Ethics Workshop is $109. The cost of the online Board Jurisprudence and Ethics Course is $25. Because the proposed amendments permit a nurse to choose among the three specified courses, a nurse may also opt to complete a Nursing Jurisprudence and Ethics Course offered by a Board approved provider. The costs of a Board approved Nursing Jurisprudence and Ethics Course may vary substantially among approved providers based upon the following factors: (i) the specific provider offering the course; (ii) whether the course if offered online; (iii) the geographic location of the course; (iv) the availability of the course; and (iv) the travel costs associated with attending a particular course. The Board sampled several approved providers to determine the range of costs of a Board approved Jurisprudence and Ethics Course. The costs of the sampled courses ranged from $225 - $350, with the mode being $225. Each nurse, however, is free to choose the most economical means of complying with the proposed requirements. Further, each nurse has the information necessary to determine his or her own compliance costs. Proposed amended §217.6(b) and (d) and proposed amended §217.9(f) and (h) also require a nurse seeking reactivation of a nursing license to complete the Nursing Jurisprudence Exam. There is no fee for the completion of this exam. As such, there are no estimated costs of compliance with this proposed requirement. Any other costs to comply with the proposed amendments result from the enactment of the Occupations Code Chapter 301 and are not a result of the adoption, enforcement, or administration of the proposal.

ECONOMIC IMPACT STATEMENT AND REGULATORY FLEXIBILITY ANALYSIS FOR SMALL AND MICRO BUSINESSES. As required by the Government Code §2006.002(c) and (f), the Board has determined that the proposed amendments will not have an adverse economic effect on any individual, Board regulated entity, or other entity required to comply with the proposed amendments because no individual, Board regulated entity, or other entity required to comply with the proposed amendments meets the definition of a small or micro business under the Government Code §2006.001(1) or §2006.001(2). The Government Code §2006.001(1) defines a micro business as a legal entity, including a corporation, partnership, or sole proprietorship that: (i) is formed for the purpose of making a profit; (ii) is independently owned and operated; and (iii) has not more than 20 employees. The Government Code §2006.001(2) defines a small business as a legal entity, including a corporation, partnership, or sole proprietorship, that: (i) is formed for the purpose of making a profit; (ii) is independently owned and operated; and (iii) has fewer than 100 employees or less than $6 million in annual gross receipts. Each of the elements in §2006.001(1) and §2006.001(2) must be met in order for an entity to qualify as a micro business or small business. The only entities subject to the proposed amendments are individual nurses. Because individual nurses are not independently owned and operated legal entities that are formed for the purpose of making a profit, no individual nurse qualifies as a micro business or small business under the Government Code §2006.001(1) or §2006.001(2). Therefore, in accordance with the Government Code §2006.002(c) and (f), the Board is not required to prepare a regulatory flexibility analysis.

TAKINGS IMPACT ASSESSMENT. The Board has determined that no private real property interests are affected by this proposal and that this proposal does not restrict or limit an owner's right to property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking or require a takings impact assessment under the Government Code §2007.043.

REQUEST FOR PUBLIC COMMENT. To be considered, written comments on the proposal or any request for a public hearing must be submitted no later than 5:00 p.m. on September 19, 2010, to James W. Johnston, General Counsel, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, or by e-mail to dusty.johnston@bon.state.tx.us, or faxed to (512) 305-8101. An additional copy of the comments on the proposal or any request for a public hearing must be simultaneously submitted to Melinda Hester, Nursing Practice Consultant, Texas Board of Nursing, 333 Guadalupe, Suite 3-460, Austin, Texas 78701, or by e-mail to melinda.hester@bon.state.tx.us, or faxed to (512) 305-8101. If a hearing is held, written and oral comments presented at the hearing will be considered.

STATUTORY AUTHORITY. The amendments are proposed under the Occupations Code §§53.021(b), 301.261, 301.301, 301.302, 301.303, 301.4535, and 301.151. Section 53.021(b) provides that a license holder's license shall be revoked on the license holder's imprisonment following a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision.

Section 301.261(a) provides that the Board may place on inactive status the license of a person under Chapter 301 who is not actively engaged in the practice of professional nursing or vocational nursing if the person submits a written request to the Board in the form and manner determined by the Board. The inactive status begins on the expiration date of the person's license. Section 301.261(b) provides that the Board shall maintain a list of each person whose license is on inactive status. Section 301.261(c) provides that a person whose license is on inactive status may not perform any professional nursing or vocational nursing service or work. Section 301.261(d) provides that the Board shall remove a person's license from inactive status if the person requests that the Board remove the person's license from inactive status; pays each appropriate fee; and meets the requirements determined by the Board. Section 301.261(e) provides that the Board by rule shall permit a person whose license is on inactive status and who is 65 years or older to use, as applicable, the title "Registered Nurse Retired," "R.N. Retired," "Licensed Vocational Nurse Retired," "Vocational Nurse Retired," "L.V.N. Retired," or "V.N. Retired."

Section 301.301(a) provides that the Board by rule may adopt a system under which licenses expire on various dates during the year. Section 301.301(b) provides that a person may renew an unexpired license issued under Chapter 301 on payment to the Board of the required renewal fee before the expiration date of the license, payment to the Board of any costs assessed under §301.461, and compliance with any other renewal requirements adopted by the Board. Further, a person whose license has expired may not engage in activities that require a license until the license has been renewed. Section 301.301(c) provides that a person whose license has been expired for 90 days or less may renew the license by paying to the Board the required renewal fee and a late fee in the amount considered appropriate by the Board to encourage timely renewal. Section 301.301(c-1) provides that a person whose license has been expired for more than 90 days but less than one year may renew the license by paying to the Board all unpaid renewal fees and a late fee that is equal to twice the amount of a late fee under §301.301(c). Section 301.301(d) provides that the Board by rule shall set a length of time beyond which an expired license may not be renewed. Further, the Board by rule may establish additional requirements that apply to the renewal of a license that has been expired for more than one year but less than the time limit set by the Board beyond which a license may not be renewed. The person may obtain a new license by submitting to reexamination and complying with the requirements and procedures for obtaining an original license. Section 301.301(e) provides that at least 30 days before the expiration of the person's license, the Board shall send written notice of the impending license expiration to the person at the person's last known address according to the records of the Board. Section 301.301(f) provides that a registered nurse who practices professional nursing or a vocational nurse who practices vocational nursing after the expiration of the nurse's license is an illegal practitioner whose license may be revoked or suspended.

Section 301.302(a) provides that a person who was licensed to practice professional nursing or vocational nursing in this state, moved to another state, and is currently licensed and has been in practice in the other state for the two years preceding application may obtain a new license without examination. Section 301.302(b) provides that the person must pay to the Board a fee that is equal to the amount of the initial fee for the license and the renewal fee.

Section 301.303(a) provides that the Board may recognize, prepare, or implement continuing competency programs for license holders under Chapter 301 and may require participation in continuing competency programs as a condition of renewal of a license. The programs may allow a license holder to demonstrate competency through various methods, including completion of targeted continuing education programs and consideration of a license holder's professional portfolio, including certifications held by the license holder. Section 301.303(b) provides that the Board may not require participation in more than a total of 20 hours of continuing education in a two-year licensing period. Section 301.303(c) provides that, if the Board requires participation in continuing education programs as a condition of license renewal, the Board by rule shall establish a system for the approval of programs and providers of continuing education. Section 301.303(e) provides that the Board may adopt other rules as necessary to implement §301.303. Section 301.303(f) provides that the Board may assess each program and provider under §301.303 a fee in an amount that is reasonable and necessary to defray the costs incurred in approving programs and providers. Section 301.303(g) provides that the Board by rule may establish guidelines for targeted continuing education required under Chapter 301. The rules adopted under §301.303(g) must address: (i) the nurses who are required to complete the targeted continuing education program; (ii) the type of courses that satisfy the targeted continuing education requirement; (iii) the time in which a nurse is required to complete the targeted continuing education; (iv) the frequency with which a nurse is required to meet the targeted continuing education requirement; and (v) any other requirement considered necessary by the Board.

Section 301.4535(a) requires the Board to suspend a nurse's license or refuse to issue a license to an applicant on proof that the nurse or applicant has been initially convicted of: (i) murder under §19.02, the Penal Code, capital murder under §19.03, Penal Code, or manslaughter under §19.04, Penal Code; (ii) kidnapping or unlawful restraint under Chapter 20, Penal Code, and the offense was punished as a felony or state jail felony; (iii) sexual assault under §22.011, Penal Code; (iv) aggravated sexual assault under §22.021, Penal Code; (v) continuous sexual abuse of young child or children under §21.02, Penal Code, or indecency with a child under §21.11, Penal Code; (vi) aggravated assault under §22.02, Penal Code; (vii) intentionally, knowingly, or recklessly injuring a child, elderly individual, or disabled individual under §22.04, Penal Code; (viii) intentionally, knowingly, or recklessly abandoning or endangering a child under §22.041, Penal Code; (ix) aiding suicide under §22.08, Penal Code, and the offense was punished as a state jail felony; (x) an offense under §25.07, Penal Code, punished as a felony; (xi) an offense under §25.071, Penal Code, punished as a felony; (xii) an agreement to abduct a child from custody under §25.031, Penal Code; (xiii) the sale or purchase of a child under §25.08, Penal Code; (xiv) robbery under §29.02, Penal Code; (xv) aggravated robbery under §29.03, Penal Code; (xvi) an offense for which a defendant is required to register as a sex offender under Chapter 62, Code of Criminal Procedure; or (xvii) an offense under the law of another state, federal law, or the Uniform Code of Military Justice that contains elements that are substantially similar to the elements of an offense listed in §301.4535(a). Section 301.4535(b) provides that an applicant or nurse who is refused an initial license or renewal of a license or whose license is suspended under §301.4535(a) is not eligible for a probationary, stipulated, or otherwise encumbered license unless the Board establishes by rule criteria that would permit the issuance or renewal of the license. Section 301.4535(b) provides that, on final conviction or a plea of guilty or nolo contendere for an offense listed in §301.4535(a), the Board, as appropriate, may not issue a license to an applicant, shall refuse to renew a license, or shall revoke a license. Section 301.4535(c) provides that a person is not eligible for an initial license or for reinstatement or endorsement of a license to practice nursing in this state before the fifth anniversary of the date the person successfully completed and was dismissed from community supervision or parole for an offense described by §301.4535(a).

Section 301.151 provides that the Board may adopt and enforce rules consistent with Chapter 301 and necessary to: (i) perform its duties and conduct proceedings before the Board; (ii) regulate the practice of professional nursing and vocational nursing; (iii) establish standards of professional conduct for license holders under Chapter 301; and (iv) determine whether an act constitutes the practice of professional nursing or vocational nursing.

CROSS REFERENCE TO STATUTE. The following statutes are affected by this proposal: Rule: §217.6 and §217.9 - Statute: §§53.021(b), 301.261, 301.301, 301.302, 301.303, 301.4535, and 301.151

§217.6.Failure to Renew License.

(a) A nurse who is not practicing nursing in Texas and who fails to maintain a current Texas license for a period of time less than four years may bring his or her license up-to-date by filing such forms as the Board [board] may require, showing evidence of having completed 20 contact hours of acceptable continuing education that meets the requirements of Chapter 216 of this title (relating to Continuing Competency) within the two years immediately preceding the application for reactivation [relicensure ], and paying the current licensure fee plus a late fee and any applicable fines, which are not refundable.

(b) A nurse who is not practicing nursing and who fails to maintain a current license from any licensing authority for four or more years will be required to:

(1) complete a refresher course, [or] extensive orientation to the practice of nursing, or [completion of] a nursing program of study that meets the requirements prescribed by the Board. The applicant must [will] submit an application to the Board for a temporary permit for the limited purpose of completing a refresher course, extensive orientation to the practice of nursing, or a nursing program of study;

(2) submit to the Board evidence of the successful completion of the requirements of paragraph (1) of this subsection;

(3) submit to the Board a course completion form from one of the following:

(A) the online Texas Board of Nursing Jurisprudence Prep Course;

(B) the Texas Board of Nursing Jurisprudence and Ethics Workshop; or

(C) a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course;

[(3) submit a completed reactivation application;]

(4) submit to the Board a certificate of completion from the Texas Nursing Jurisprudence Exam;

[(4) submit the current non-refundable licensure fee, plus a late fee and any applicable fines which are not refundable; and]

(5) submit to the Board a completed reactivation application;

[(5) submit evidence of completion of 20 contact hours of acceptable continuing education for the two years immediately preceding the application for relicensure.]

(6) submit to the Board the current, non-refundable licensure fee, plus a late fee and any applicable fines which are not refundable; and

(7) submit to the Board evidence of completion of 20 contact hours of acceptable continuing education for the two years immediately preceding the application for reactivation that meets the requirements of Chapter 216 of this title.

(c) The Board adopts by reference the following forms, which comprise the instructions and requirements for a refresher course, extensive orientation to the practice of nursing, and a nursing program of study required by this section, and which are available at http://www.bon.state.tx.us/olv/forms.html:

(1) Application for Six Month Temporary Permit (RN); and

(2) Application for Six Month Temporary Permit (LVN).

[(c) A nurse who fails to maintain a current Texas license for four years or more and who is licensed and has practiced in another state during the previous four years preceding the application for relicensure in Texas, shall be exempt from requirements of subsection (b)(1) and (2) of this section.]

(d) A nurse who fails to maintain a current Texas license for four years or more and who is licensed and has practiced in another state during the previous four years preceding the application for reactivation in Texas must comply with the requirements of subsection (b)(3) - (7) of this section.

[(d) The issuance of a license renewal may be refused to an individual who:]

[(1) fails to submit an application for renewal; or]

[(2) submits an application which:]

[(A) is incomplete;]

[(B) does not show that the person meets the requirements for renewal; or]

[(C) is not accompanied by the correct fee(s).]

(e) The issuance of a license reactivation may be refused to an individual who:

(1) fails to submit an application for reactivation; or

(2) submits an application which:

(A) is incomplete;

(B) does not show evidence that the person meets the requirements for reactivation; or

(C) is not accompanied by the correct fee(s).

[(e) The refusal to renew the license for reasons in subsection (d)(1) and (2) of this section does not entitle the individual to a hearing.]

(f) The Board's refusal to reactivate a license for the reasons specified in subsection (e) of this section does not entitle an individual to a hearing at the State Office of Administrative Hearings.

[(f) The individual refused a license renewal who wishes to reactivate his or her license will be required to:]

[(1) correctly complete the reactivation application form;]

[(2) show evidence of meeting all current requirements for licensure, including 20 contact hours of continuing education according to requirements in Chapter 216 of this title (relating to Continuing Education); and]

[(3) submit payment of the correct non-refundable reactivation fee as follows:]

[(A) if the license has been delinquent less than 90 days, the required fee will equal the renewal fee plus one-half the examination fee (see §223.1), plus any applicable fines; or]

[(B) if the license has been delinquent for more than 90 days, the required fee will equal the renewal fee plus the full examination fee (see §223.1), plus any applicable fines.]

(g) An individual who is refused a license reactivation and who wishes to reactivate his or her license will be required to:

(1) correctly complete the reactivation application;

(2) show evidence of meeting all the requirements for reactivation, including completion of 20 contact hours of continuing education that meets the requirements of Chapter 216 of this title; and

(3) submit payment of the correct, non-refundable reactivation fee as follows:

(A) if the license has been delinquent less than 90 days, the required fee will equal the renewal fee plus one-half the examination fee (see §223.1 of this title (relating to Fees)), plus any applicable fines; or

(B) if the license has been delinquent for more than 90 days, the required fee will equal the renewal fee plus the full examination fee (see §223.1 of this title), plus any applicable fines.

[(g) Special Reactivation Provisions for Actively Deployed Nurses.

[(1) If a nurse's license lapses and becomes delinquent while serving in the military whenever the United States is engaged in active military operations against any foreign power, the license may be reactivated without penalty or payment of the reactivation late renewal fee(s) under the following conditions:

[(A) The license was active at the time of deployment.

[(B) The application for reactivation is made while still in the armed services or no later than three months after discharge from active service or return to inactive military status.]

[(C) A copy of the military activation orders or other proof of active military service accompanies the application;]

[(D) The renewal fee is paid; and]

[(E) If the required continuing education contact hours were not earned for renewal during the earning period, the nurse shall be required to complete the required continuing education hours needed for renewal no later than three months after discharge from active service, return to inactive military status, or return to the United States from an active war zone.]

[(2) The continuing education contact hours used for reactivation may not be used for the next license renewal.]

[(3) The continuing education contact hours for the next license renewal following reactivation may not be prorated.]

(h) Special Reactivation Provisions for Actively Deployed Nurses.

(1) If a nurse's license lapses and becomes delinquent while serving in the military whenever the United States is engaged in active military operations against any foreign power, the license may be reactivated without penalty or payment of the late renewal fee(s) under the following conditions:

(A) The license was active at the time of deployment;

(B) The application for reactivation is made while still in the armed services or no later than three months after discharge from active service or return to inactive military status;

(C) A copy of the military activation orders or other proof of active military service accompanies the application;

(D) The renewal fee is paid; and

(E) If the required continuing education contact hours were not earned for reactivation during the earning period, the nurse shall be required to complete the required continuing education hours needed for reactivation no later than three months after discharge from active service, return to inactive military status, or return to the United States from an active war zone.

(2) The continuing education contact hours used for reactivation may not be used for the next license renewal.

(3) The continuing education contact hours for the next license renewal following reactivation may not be prorated.

(i) A nurse whose license has been expired for more than one year and who has been initially or finally convicted of, or has entered a plea of guilty or nolo contendere for, an offense specified in the Occupations Code §301.4535(a); surrendered a license or a privilege in another state or had a license or privilege revoked, suspended, or denied in another state; or been imprisoned following a felony conviction, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision may not renew the license until the Board has completed an investigation and reached a final resolution of the matter.

§217.9.Inactive Status.

(a) A nurse who elects to change from active licensure status to inactive status must:

(1) submit a written request to the Board [board ] prior to the expiration of his/her license; or

(2) designate "inactive" on the renewal form if at the time of renewal.

(b) - (d) (No change.)

(e) A nurse who has not practiced nursing in Texas and whose license has been in an inactive status for less than four years may reactivate the license by completing the reactivation application form, paying the required reactivation fee and the current licensure fee which are non-refundable, and submitting verification of completion of 20 contact hours of continuing education that meets the requirements of [in compliance with] Chapter 216 of this title (relating to Continuing Competency) within the two years immediately preceding the application for reactivation.

(f) A nurse who has not practiced [professional] nursing [in Texas ] and whose license has been in an inactive status for four or more [than four] years must submit to the Board:

(1) a completed reactivation application [form];

(2) verification of completion of a refresher course, extensive orientation to the practice of nursing, or a nursing program of study that [which] meets the [board's] requirements prescribed by the Board. The nurse must submit an application to the Board for a temporary permit for the limited purpose of completing a refresher course, extensive orientation to the practice of nursing, or a nursing program of study [and was completed within the last year];

(3) evidence of completion of 20 contact hours of acceptable continuing education for the two years immediately preceding the application for reactivation that meets the requirements of Chapter 216 of this title [CE in compliance with Chapter 216];

(4) a course completion form from one of the following:

(A) the online Texas Board of Nursing Jurisprudence Prep Course;

(B) the Texas Board of Nursing Jurisprudence and Ethics Workshop; or

(C) a Texas Board of Nursing approved Nursing Jurisprudence and Ethics course;

[(4) the required reactivation fee plus the current licensure fee, which are non-refundable.]

(5) a certificate of completion from the Texas Nursing Jurisprudence Exam; and

(6) the required reactivation fee, plus the current licensure fee, which are non-refundable.

(g) The Board adopts by reference the following forms, which comprise the instructions and requirements for a refresher course, extensive orientation to the practice of nursing, and a nursing program of study required by this section, and which are available at http://www.bon.state.tx.us/olv/forms.html:

(1) Application for Six Month Temporary Permit (RN); and

(2) Application for Six Month Temporary Permit (LVN).

[(g) A nurse who has not practiced nursing in Texas or another jurisdiction within the last four years and has not participated in a refresher course within the last year must submit:]

[(1) an application for a six month temporary permit to be used only for completion of a refresher course, extensive orientation to the practice of nursing or program of study which meets the board's requirements; and]

[(2) the required six-month temporary permit fee which is non-refundable.]

(h) A nurse whose license has been in an inactive status for four years or more and who is licensed and has practiced in another state during the previous four years preceding the application for reactivation in Texas must comply with the requirements of subsection (f)(1) and (3) - (6) of this section.

[(h) A nurse completing refresher course requirements in another jurisdiction is exempt from requirements of subsection (g)(1) and (2) of this section.]

[(i) Upon completion of the refresher course, extensive orientation to the practice of nursing, or program of study which meets the board's requirements, the nurse shall then comply with subsection (f) of this section.]

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 August 5, 2010.

TRD-201004521

Jena Abel

Assistant General Counsel

Texas Board of Nursing

Earliest possible date of adoption: September 19, 2010

For further information, please call: (512) 305-8101

CHAPTER 651. FEES

22 TAC §651.1, §651.2

The Executive Council of Physical Therapy and Occupational Therapy Examiners (Executive Council) proposes amendments to §651.1 and §651.2, which specify the fees charged by the Executive Council, including fees for Physical Therapy and Occupational Therapy license applications and renewals.

The proposed amendments to §651.1 and §651.2, relating to fee changes to Physical Therapy and Occupational Therapy licensees' applications and renewals, are necessary for the Executive Council to utilize revenue, as provided in Article VIII and Article IX of the General Appropriations Act (Senate Bill 1, 81st Legislature, Regular Session). The revenue is contingent upon the Executive Council assessing fees sufficient to generate $129,185 in additional revenue during the 2010-2011 biennium in excess of $7,625,000 contained in the Comptroller of Public Accounts' Biennial Revenue Estimate for fiscal years 2010 and 2011. Under the current fee structure, the Executive Council will not generate enough revenue during the 2010-2011 biennium to meet the amount necessary to access the contingent revenue, and so must increase fees. This is the first increase of these fees since 2005.

John Maline, Executive Director of the Executive Council, has determined that for the first five-year period these amendments are in effect there will be no additional costs to state or local governments as a result of enforcing or administering the amendments.

Mr. Maline has also determined that for each year of the first five years the amendments are in effect the public benefit anticipated as a result of these amendments will be the Executive Council's ability to better protect the heath, safety and welfare of the citizens by utilizing additional funding for administration and enforcement of the Physical Therapy and Occupational Therapy Practice Acts and rules. The administration and enforcement of the applicable laws includes the investigation of consumer complaints, on-site compliance checks, and pursuing action against persons who choose to endanger the health, safety and welfare of the citizens by violating the two boards' practice acts and rules.

Mr. Maline has determined that, as a result of the amendments, there will be a fiscal impact to potential and current licensees of the Physical Therapy Board or Occupational Therapy Board through increased costs of varied amounts depending on profession.

The 80th Texas Legislature (2007) adopted House Bill 3430, which amended Chapter 2006 of the Texas Government Code. As amended, Texas Government Code, §2006.002, relating to Adoption of Rules with Adverse Economic Effect, requires that as part of the rulemaking process, a state agency prepare an Economic Impact Statement that assesses the potential impact of a proposed rule on small businesses and a Regulatory Flexibility Analysis that considers alternative methods of achieving the purpose of the rule if the proposed rule will have an adverse economic effect on small businesses or micro-businesses.

Mr. Maline has determined that there will be no costs or adverse economic effects to small or micro businesses by the amendments to §651.1 and §651.2, as these fees apply to individuals and not businesses. Therefore an economic impact statement or regulatory flexibility analysis is not required for these amendments.

Comments on the proposed amendments may be submitted to Jennifer Jones, Executive Assistant, Executive Council of Physical Therapy and Occupational Therapy Examiners, 333 Guadalupe Street, Suite 2-510, Austin, Texas 78701; email: jennifer.jones@mail.capnet.state.tx.us. Comments must be received no later than 30 days from the date this proposed amendments are published in the Texas Register.

The amendments are proposed under the Executive Council of Physical Therapy and Occupational Therapy Examiners Practice Act, Title 3, Subtitle H, Chapter 452, Texas Occupations Code, which provides the Executive Council with the authority to adopt rules consistent with this Act to carry out its duties in administering this Act.

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

§651.1.Occupational Therapy Board Fees.

(a) Application Regular License.

(1) Occupational Therapist--$140 [$120].

(2) Occupational Therapy Assistant--$100 [$93].

(3) Application to retake the [certification] exam, OT--$25.

(4) Application to retake the [certification] exam, OTA--$25.

(b) - (e) (No change.)

(f) Renewal.

(1) Active.

(A) Occupational Therapist--$242 [$217].

(B) Occupational Therapy Assistant--$180 [$167].

(2) (No change.)

(g) - (m) (No change.)

§651.2.Physical Therapy Board Fees.

(a) Application/Permanent License.

(1) PT--$190 [$170].

(2) PTA--$125 [$116].

(b) - (e) (No change.)

(f) License Renewal.

(1) Active license.

(A) PT--$242 [$217].

(B) PTA--$180 [$167].

(2) (No change.)

(g) - (n) (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 August 9, 2010.

TRD-201004542

John Maline

Executive Director

Executive Council of Physical Therapy and Occupational Therapy Examiners

Earliest possible date of adoption: September 19, 2010

For further information, please call: (512) 305-6962