Adopted Sections An agency may take final action on a section 30 days after a proposal has been published in the Texas Register. The section becomes effective 20 days after the agency files the correct document with the Texas Register, unless a later date is specified or unless a federal statute or regulation requires implementation of the action on shorter notice. If an agency adopts the section without any changes to the proposed text, only the preamble of the notice and statement of legal authority will be published. If an agency adopts the section with changes to the proposed text, the proposal will be republished with the changes. TITLE 16. ECONOMIC REGULATION Part I. Railroad Commission of Texas Chapter 3. Oil and Gas Division Conservation Rules and Regulations 16 TAC sec.3.68 The Railroad Commission of Texas adopts an amendment to sec.3.68, concerning conservation rules and regulations, with changes to the proposed text as published in the October 29, 1991, issue of the Texas Register (16 TexReg 6117). The amendments shall take effect on March 1, 1992. Adoption of the amendment will both increase the efficiency of enforcement by the commission of its statutory authority regarding the regulation operations under its jurisdiction, and help ensure that operations connected with the production of oil, gas, and geothermal resources do not pose a threat of harm to natural resources. In addition, the commission finds that the provisions of Senate Bill 1103, 72nd Legislature, 1991, which took effect September 1, 1991, require adoption of some of the amendment. The amendment outlines procedures for shutting in and sealing wells, and cancelling certificates of compliance. Several commenters stated that the 10-day compliance period set out in subsection (b) is too short. The commission disagrees. The 10-day period is a minimum compliance period. A 10-day period is necessary when there is a threat of pollution or other harm to natural resources. Longer compliance periods may be set out in the notification letter in cases where there is not a threat of pollution or other harm to natural resources. One commenter suggested that the rule should be modified to focus on violations associated with wells and bringing wells into compliance. The commission disagrees. The obligation of the operator to comply with statutes and commission permits, rules, and orders is not confined to wells. One commenter stated that "may" in subsection (b) should be changed to "shall" to conform with the provisions of Texas Natural Resources Code, sec.85. 164 (Vernon Supplement 1992). The commission agrees. One commenter stated that the rule should establish the availability of a hearing before action is taken by the commission or its delegate. The commission disagrees. The availability of a hearing is already prescribed by the commission's general rules of practice and procedure and the Administrative Procedure and Texas Register Act. One commenter suggested that the rule should not provide for the delegation of the commission's authority under the rule. The commission disagrees. It is necessary for the commission to have the option to delegate its authority because of the large number of cases that may require action under this rule. The following commenters opposed adoption of the amendment as originally proposed: Texas Independent Producers & Royalty Owners Association, Texas Mid- Continent Oil & Gas Association, and Permian Basin Petroleum Association. The amendment is adopted under the Texas Natural Resources Code, sec.sec.81.051, 81.052, 85.042, 85.202, 86.041, and 86.042, which provides the commission with the authority to adopt rules to govern and regulate persons and their operations under the jurisdiction of the commission. sec.3.68. Pipeline Connection; Cancellation of Certificate of Compliance; Severance. (a) (No change.) (b) The commission may shut in and seal any well, and cancel any certificate of compliance if it appears that the operator of a well has violated or is violating, in connection with the operation of the well, any of the oil, gas, or geothermal resource conservation laws or any of the permits, rules, or orders of the commission made thereunder. Upon receipt of information that indicates operations are being conducted in violation of a state statute or a commission permit, rule, or order, the commission shall send a notice letter to the operator directing the operator to remedy the violation. The letter shall state the facts or conduct alleged to warrant the shut in and sealing of the well, and cancellation of the certificate of compliance. The letter shall give the operator an opportunity to show compliance with state statutes and commission permits, rules, and orders. The letter shall be sent by registered or certified mail, and shall indicate the time within which compliance must be demonstrated or achieved. The time period allowed for the operator to achieve compliance shall not be less than 10 days from the date the notice letter, or any extension thereto, is sent. (c) Within the time period set out in the notice letter, the operator shall either demonstrate compliance or remedy the violation, and notify the commission of its action. (d) If the violation is not remedied within the time period set out in the notice letter, the commission, or the commission's delegate, may direct the appropriate commission personnel to shut in and seal the well, and cancel the certificate of compliance. (e) If a certificate of compliance has been cancelled, the commission may not issue a new certificate of compliance until the owner or operator of the property covered by the certificate of compliance submits to the commission a reissuance fee as required by sec.3.76 of this title (relating to Fees, Performance Bonds, and Alternate Forms of Financial Security Required to be Filed) (Statewide Rule 78); and (1) the property covered by the certificate is brought into compliance with all oil, gas, and geothermal resource conservation laws, and the permits, rules, and orders of the commission made thereunder; or (2) the commission determines that there are just and equitable grounds for reissuing the certificate. (f) Upon notice from the commission to any pipeline or other carrier connected to any oil, gas, or geothermal resource well that the certificate of compliance applicable to the well has been cancelled by the commission, the pipeline or other carrier shall disconnect from the well, and it shall be unlawful for the pipeline or other carrier to transport any oil or gas produced therefrom until a new certificate of compliance has been issued by the commission. (g) Upon notice from the commission that a certificate of compliance as to any oil, gas, or geothermal resource well has been cancelled by it as provided in this section, it shall be unlawful for the operator of such well to produce oil, gas, or geothermal resources therefrom until a new certificate of compliance with respect to the well has been issued by the commission as provided in this section. (h) The provisions of this section are cumulative of other commission actions and procedures relating to violations of state statutes or commission permits, rules, and orders, including the authority of the commission or the commission's delegate to immediately shut in a well or lease, or to direct the operator to shut in a well or lease, when an emergency exists due to pollution or an imminent threat of harm to people or property. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201352 Nolan Ward Hearings Examiner, General Law, Legal Division Railroad Commission of Texas Effective date: March 1, 1992 Proposal publication date: October 29, 1991 For further information, please call: (512) 463-6864 5. Transportation Division Rules and Regulations 16 TAC sec.sec.5.534, 5.535, 5.537 The Railroad Commission of Texas adopts the repeal of sec. sec.5.534, 5.535, and 5.537, new sec.5.534 and sec.5.535, and amendments to sec.5.536 and sec.5.538, concerning scope of exemption under House Bill 593, definitions of key terms relating to agricultural commodities exemptions, and grace period for holders of seasonal agricultural permits; scope of exemption and definitions of key terms relating to agricultural commodities exemption; and procedures for obtaining agricultural permits and enforcement of regulations under an agricultural permit. The repeals, new sections, and amendments are adopted without changes to the proposed text as published in the November 5, 1991, issue of the Texas Register (16 TexReg 6253). The repeals, new sections, and amendments harmonize the rules with the Motor Carrier Act as amended, and recodify the agricultural permit rules to make them more clear and simple. The changes broaden the agricultural permit exemption in accordance with recent legislative actions, and facilitate enforcement and interpretation of the rules. No comments were received in support of the proposed rules. Comments in opposition were received from nine carriers. All of the carrier comments are against the proposed changes as they relate to peanuts, cottonseed hulls, and cottonseed meal. The argument is that the thrust of the new legislation is to ensure that cattle moving from feedlots to slaughtering houses are within the agricultural permit regulations. The rule should not, therefore, apply to the commodities they transport. The Texas Cottonseed Crushers Association also commented in opposition to the proposed rules. It requests the addition of cottonseed oil mills to the list of persons entitled to the benefit of the exemption. The commission disagrees with the commenters in opposition to the proposed rules. The rules have been drafted in accordance with legislative action. There is no basis to infer that the changes should affect some agricultural commodities and not others. Adding cottonseed oil mills to the list of persons entitled to the benefit of the exemption requires additional legislative action. The repeals are adopted under the Texas Motor Carrier Act, Texas Civil Statutes, Article 911b, sec.5b, which authorizes the commission to issue agricultural permits for the transportation of eligible agricultural commodities. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201309 Nolan Ward Hearings Examiner, General Law, Legal Division Railroad Commission of Texas Effective date: November 5, 1991 Proposal publication date: February 18, 1992 For further information, please call: (512) 463-7096 16 TAC sec.sec.5.534, 5.535, 5.536, 5.538 The new sections and amendments are adopted under the Texas Motor Carrier Act, Texas Civil Statutes, Article 911b, sec.5b, which authorizes the commission to issue agricultural permits for the transportation of eligible agricultural commodities. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201310 Nolan Ward Hearings Examiner, General Law, Legal Division Railroad Commission of Texas Effective date: February 18, 1992 Proposal publication date: November 5, 1991 For further information, please call: (512) 463-7096 Part VIII. Texas Racing Commission Chapter 313. Officials and Rule of Horse Racing Subchapter B. Entries, Declarations, and Allowances Entries 16 TAC sec.313.112 The Texas Racing Commission adopts an amendment to sec.313.112, concerning official workouts, without changes to the proposed text as published in the November 8, 1991, issue of the Texas Register (16 TexReg 6354). The amendment is adopted to ensure that pari-mutuel racetracks are operated with utmost integrity. The amendment limits the number of workouts a horse may receive on any one day. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 179e, sec.3. 02, which authorize the commission to adopt rules for conducting racing with pari- mutuel wagering and for administering the Texas Racing Act and sec.3. 021, which authorize the commission to adopt rules relating to the regulation of workouts. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 17, 1992. TRD-9201237 Paula Cochran Carter General Counsel Texas Racing Commission Effective date: February 17, 1992 Proposal publication date: November 8, 1991 For further information, please call: (512) 794-8461 TITLE 22. EXAMINING BOARDS Part XVI. Texas State Board of Physical Therapy Examiners Chapter 337. Display of License 22 TAC sec.337.2 The Texas State Board of Physical Therapy Examiners adopts an amendment sec.337.2 concerning the consumer information sign, without changes to the proposed text as published in the December 24, 1991, issue of the Texas Register (16 TexReg 7622). The amendment is necessary because the agency has moved to a new location. This rule change will necessitate licensees to change the signs in their offices which indicate to what address compliants may be forwarded. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 4512e, sec.3(e) which provide the Texas State Board of Physical Therapy with the authority to adopt rules consistent with the Texas Physical Therapy Practice Act to carry out its duties in administering the Act. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1991. TRD-9201265 Sherry L. Lee Executive Director Texas State Board of Physical Therapy Examiners Effective date: February 18, 1992 Proposal publication date: December 24, 1992 For further information, please call: (512) 443-8202 Part XXI. Texas State Board of Examiners of Psychologists Chapter 473. Fees. 22 TAC sec.473.3 The Texas State Board of Examiners of Psychologists adopts an amendment to sec.473.3 concerning fees, without changes to the proposed text as published in the November 29, 1991, issue of the Texas Register (16 TexReg 6900). The 72nd Legislature required the board to raise an additional $17,756 during each year of the biennium in order for the agency to use the monies appropriated to them. Since doctoral level persons' renewals are being assessed the additional $200 professional fee required by the legislature, the board felt each psychological associate's renewal fee should be increased by $20 to meet this need. The amendment will collect fees necessary to provide credentials review and monitoring of those persons wanting to be certified as a psychological associate. The increase in psychological associate renewal fees at this time may detrimentally affect the board's membership and receivable fees in the long run. If psychological associates do not perceive that they are being supported during the Sunset period they may seek to follow other alternatives. Commenting against the amendment were the Psychological Associates Division and the Texas Psychological Association. The agency regrets having to impose an additional fee on anyone during these difficult economic times. However, the agency feel that the doctoral level persons have already been asked to pay an additional $200 professional fee and should not be assessed more. The earning power of licensed psychologists is recognized as being greater than that of psychological associates. However, the board did not feel it was 10 times greater than that of a psychological associate ($200 for doctoral level versus $20 for masters level). The amendment is adopted under Texas Civil Statutes, Article 4512c which provide the Texas State Board of Examiners of Psychologists with the authority to make all rules not inconsistent with the Constitution and laws of this state, which are reasonably necessary for the proper performance of its duties and regulations of proceedings before it. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201321 Patricia S. Bizzell Tweedy Executive Director Texas State Board of Examiners of Psychologists Effective date: February 18, 1992 Proposal publication date: November 29, 1991 For further information, please call: (512) 835-2036 Part XXII. Texas State Board of Public Accountancy Chapter 515. Licenses 22 TAC sec.515.10 The Texas State Board of Public Accountancy adopts new sec.515.10, concerning licenses for certificate holders who default on student loans, without changes to the proposed text as published in the October 18, 1991, issue of the Texas Register (16 TexReg 5813). The rule is necessary in order to ensure that professionals make payments on their student loan obligations. Certificate and registration holders in default must demonstrate compliance with the rule in order to renew their licenses. No comments were received regarding adoption of the new section. The new section is adopted under Texas Civil Statutes, Article 41a-1, sec.6(a), which provide the Texas State Board of Public Accountancy with the authority to promulgate rules relating to licensing, and is proposed pursuant to the Texas Education Code, sec.57.491. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201294 William Treacy Executive Director Texas State Board of Public Accountancy Effective date: February 18, 1992 Proposal publication date: October 18, 1991 For further information, please call: (512) 450-7066 Chapter 519. Practice and Procedures 22 TAC sec.519.27 The Texas State Board of Public Accountancy adopts an amendment to sec.519. 27, concerning hearings in disciplinary actions, without changes to the proposed text as published in the October 25, 1991, issue of the Texas Register (16 TexReg 6025). The amendment is necessary in order to ensure that administrative costs will be paid by the individuals and firms that incur the costs. The amendment will allow the agency to recover administrative costs. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 41a-1, sec.6(a) which provide the Texas State Board of Public Accountancy with the authority to promulgate rules regarding hearings in disciplinary actions. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201295 William Treacy Executive Director Texas State Board of Public Accountancy Effective date: February 18, 1992 Proposal publication date: October 25, 1991 For further information, please call: (512) 450-7066 22 TAC sec.519.29 The Texas State Board of Public Accountancy adopts amendments to sec.519.29, concerning publication of disciplinary/administrative sanctions, without changes to the proposed text as published in the October 25, 1991, issue of the Texas Register (16 TexReg 6025). The rule is necessary in order to ensure that certificate and registration holders will be deterred from committing violations of the Act and the rules of professional conduct. The rule will define the circumstances in which the names of the violators will be published. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 41a-1, sec.6(a) which provide the Texas State Board of Public Accountancy with the authority to promulgate rules relating to publication of disciplinary/administrative sanctions. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201296 William Treacy Executive Director Texas State Board of Public Accountancy Effective date: February 18, 1992 Proposal publication date: October 25, 1991 For further information, please call: (512) 450-7066 Chapter 521. Fee Schedule 22 TAC sec.521.1 The Texas State Board of Public Accountancy adopts an amendment to sec.521.1, concerning license fee, without changes to the proposed text as published in the October 29, 1991, issue of the Texas Register (16 TexReg 6122). The amendment is necessary to ensure that the persons benefiting from licensure will bear the costs associated with their licenses. This amendment will increase license fees and will institute the collection of fees on a biennial schedule. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 41a-1, sec.6(a), which provide the Texas State Board of Public Accountancy with the authority to promulgate rules relating to fee schedule. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201297 William Treacy Executive Director Texas State Board of Public Accountancy Effective date: February 18, 1992 Proposal publication date: October 29, 1991 For further information, please call: (512) 450-7066 Chapter 527. Quality Review 22 TAC sec.527.7 The Texas State Board of Public Accountancy adopts an amendment to sec.527.7, concerning retention of documents relating to quality reviews, without changes to the proposed text as published in the October 29, 1991, issue of the Texas Register (16 TexReg 6123). The rule is necessary in order to ensure that the board will be able to review records so that quality review standards are met. The rule will establish guidelines for the retention of records relating to quality reviews. No comments were received regarding adoption of the amendment. The amendment is adopted under Texas Civil Statutes, Article 41a-1, sec.6(a) which provide the Texas State Board of Public Accountancy with the authority to promulgate rules relating to quality review. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201298 William Treacy Executive Director Texas State Board of Public Accountancy Effective date: February 18, 1992 Proposal publication date: October 25, 1991 For further information, please call: (512) 450-7066 22 TAC sec.527.8 The Texas State Board of Public Accountancy adopts new sec.527.8, concerning oversight procedures to be followed by the Quality Review Oversight Board, without changes to the proposed text as published in the November 5, 1991, issue of the Texas Register (16 TexReg 6256). The rule is necessary in order to ensure that the responsibilities of the Quality Review Oversight Board will be clarified. The proposed rule will set forth the responsibilities of the Quality Review Oversight Board. No comments were received regarding adoption of the new section. The new section is adopted under Texas Civil Statutes, Article 41a-1, sec.6(a), which provide the Texas State Board of Public Accountancy with the authority to promulgate rules relating to the Quality Review Program. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201299 William Treacy Executive Director Texas State Board of Public Accountancy Effective date: February 18, 1992 Proposal publication date: November 5, 1991 For further information, please call: (512) 450-7066 TITLE 25. HEALTH SERVICES Part I. Texas Department of Health Chapter 97. Communicable Diseases Consent for Immunization 25 TAC sec.97.91, sec.97.92 The Texas Department of Health adopts new sec.97.91 and sec.97.92, concerning consent for immunization, without changes to the proposed text as published in the July 26, 1991, issue of the Texas Register (16 TexReg 4054). The new sections implement the provisions of Senate Bill 345, 72nd Legislature, 1991, concerning the delegation of consent for immunization. Section 97.91 covers the delegation of authority to give informed consent for immunizations of a minor. Section 97.92 covers recommendations for documentation of the reason or reasons a parent or guardian could not be contacted. Several comments were received concerning implementation of and procedures related to the new sections. No comments were received concerning the text of the sections themselves. No agencies, groups, or associations commented on the proposed sections. The commenters were individuals (public health nurses and immunization program administrators). The new sections are adopted under Senate Bill 345, sec.2, 72nd Legislature, 1991, which provides the Board of Health with authority to adopt rules covering the information contained in the written delegation of authority to consent for immunization of a minor; Health and Safety Code, sec.12.001, which provides the board with authority to adopt rules for the performance of every duty imposed by law on the board, the Texas Department of Health, and the commissioner of health. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201219 Robert A. MacLean, M.D. Deputy Commissioner Texas Department of Health Effective date: February 17, 1992 Proposal publication date: July 26, 1991 For further information, please call: (512) 458-7455 Chapter 157. Emergency Medical Care Emergency Medical Services-Part A 25 TAC sec.157.2 The Texas Department of Health (department) adopts the amendment to sec.157. 2 and new rules sec.sec.157.121-157.129. The amendment to sec.157.2 and new sec.sec.157.121, 157.123-157.125 are adopted with changes to the proposed text as published in the September 10, 1991 issue of the Texas Register (16 TexReg 4921). Section 157.122 and sec. sec.157.126-157.129 are adopted without changes and will not be republished. The amendment and new sections implement the provisions of the Health and Safety Code, Chapter 773, Subchapter D, concerning emergency medical services (EMS) and trauma care systems. The amendment adds definitions concerning EMS trauma systems and the new sections establish the procedures and standards for the implementation of a statewide EMS trauma system. Comments received concerning the proposed sections and the department's responses are as follows. Concerning sec.157.2, a commenter said that the definitions of "basic trauma facility" and "general trauma facility" refer to transfer of patients to a higher level trauma facility. The commenter recommended that the department formulate a standard plan for patient transfers for individual hospitals. The department disagrees because the federal government and the department's hospital licensing program already have established standards for patient transfers. Concerning sec.157.2, as regards the definition of "bypass," a commenter requested that "direct" medical control be changed to "on-line" medical control because the language would be more appropriate. The department agrees only in part because "direct" is the term used in the rules of the Texas State Board of Medical Examiners (BME) in Title 22, Texas Administrative Code, sec.197.2. The department will add "on-line" after "direct" to avoid confusion. Concerning sec.157.2, a commenter requested that the definition of "facility triage" be changed to read, "The process of assigning patients to an appropriate trauma facility based on injury severity and trauma facility availability." The department agrees and has changed the language as recommended. Concerning sec.157.2, a commenter requested that the last sentence in the definition of "lead trauma facility", which refers to shared responsibilities, be deleted so that the position of those hospitals willing to take the extra effort will not be weakened. Another commenter supports the concept of shared responsibilities. The department disagrees with the first comment that sharing educational and outreach programs will weaken a hospital's position in its community. Concerning sec.157.2, a commenter requested that the definition of "medical control" be changed to follow the definition of "direct medical control" which has been adopted by the BME in its rules in Title 22, Texas Administrative Code, sec.197.2. The department disagrees because not all health care facilities will have access to the BME rules. Concerning sec.157.2, as regards the definition of "pediatric trauma facility, " a commenter wanted to add the phrase "or other" after the word "pediatric" as used in the definition. The department agrees and has changed the language accordingly. Concerning sec.157.2, as regards the definition of "Regional medical control," two commenters stated that it was unclear if regional medical control would supersede the medical control physician for the various pre-hospital care providers in a trauma service area (TSA). In response, the department has clarified that on-line medical control supersedes off-line medical policies and procedures. Concerning sec.157.2, a commenter questioned why the definition of "trauma" includes the category of burn injuries but omits the additional categories of poisoning, near drowning, and suffocations, other than those due to external forces. The department disagrees with changing the definition to include additional categories because the language used in the definition is nationally accepted. Concerning sec.157.2, as regards the definition of "Trauma facility," a commenter asked for clarification of the term "comprehensive." The commenter stated that a basic trauma facility will not qualify as a trauma facility using this definition. The department disagrees because the definition comes directly from legislation and cannot be changed in the rules. Concerning the publication titled, "Texas Trauma Facility Criteria," which is adopted by reference in sec.157.121(b), the following comments were received regarding the publication. 1. Concerning the criteria marked "E" (essential), one commenter asked if hospitals are only responsible for (the criteria marked "E" (essential)), for developing their trauma program. Another commenter asked who would the hospital notify if Level II status could not be maintained and how much advance notice would be required. The department's response to the first comment is that hospitals are only required to meet the criteria marked "E". The department's response to the second comment is addressed in sec.157.125. 2. Concerning paragraph (4)(A), as regards surgical specialties availability, one commenter requested that the orthopedic surgery requirement in footnote #5 be changed to permit only an orthopedic surgeon or senior level orthopedic resident to fulfill this speciality requirement. The department disagrees because it believes that the current requirement is sufficient. 3. Concerning subsection (b)(1)(a)(3), as regards nurse staffing, one commenter asked if reimbursement is available to hospitals for nursing staff who complete the advanced cardiac life support course (ACLS) and the pediatric advanced life support course (PALS) training, and for hospitals that become trauma nurse core course (TNCC) verified providers. The department's response is that such reimbursement is not available at this time. 4. Concerning paragraph (10)(B), as regards rehabilitative medicine, one commenter said there is confusion with the subsection (a) or (b) requirement for rehabilitation medicine for Level I facilities and suggested that either subsection (a) or (b) be acceptable to meet the criteria. In response, the department has clarified the requirement by stating that Level I trauma facilities must meet the requirement listed in subsection (a) while Level II and Level III trauma facilities must meet the requirement listed in subsection (b). 5. Concerning paragraph (3)(C), as regards morbidity and mortality review, one commenter asked who would be responsible for the criteria used in the morbidity and mortality review. The department's response is that whoever the hospital selects is responsible. 6. Concerning paragraph (5)(C), as regards medical nursing auditutilization reviewtissue review, one commenter requested that "tissue review" be defined and its relevance to the proposed requirements explained. The department's response is that the the tissue committee of each hospital should define what types of tissue it will review. 7. Concerning paragraph (6)(C), as regards the trauma registry, one commenter asked if reimbursement is available for hospitals to support the trauma registry. The department's response is that there is no such reimbursement available. 8. Concerning paragraph (8)(C), as regards the published on-call schedule, one commenter asked where the on-call schedule is expected to be published. In response, the department has clarified this requirement by saying that the on- call schedule should be readily available to those who need the information. 9. Concerning paragraph (10)(C), as regards quality management personnel, one commenter requested that the phrase, "dedicated quality management personnel for the trauma program" be defined and asked what resources the hospitals are expected to provide. The department's response is that the hospital should decide who meets the requirement before assigning them to the trauma program. Also, the hospitals should provide all resources necessary to provide trauma care at the designation level it desires. Concerning the publication titled, "Pediatric Trauma Care," which is adopted by reference in sec.157.121(b), one commenter suggested that footnote #2 in Table 1 (Adult Trauma Facility with Pediatric Commitment) be changed to the pediatric surgeon requirement of "being available at all times in the adult trauma facility" to being "on-call." The department agrees in part and will make a footnote change for Level I trauma facilities with pediatric commitment to read: "A pediatric surgeon must be available at the hospital on short notice. Local criteria may be established that allow the pediatric surgeon to take call from outside of the hospital, but with the clear commitment on the part of the hospital and the surgical staff, that the pediatric surgeon will be present in the emergency department at the time of arrival of the pediatric trauma patient and be available to care for pediatric trauma patients in the ICU. The adult trauma surgeon must have special interest in and commitment to care of the injured child." Concerning the publication titled, "Qualifications of Texas Trauma Care Personnel," which is adopted by reference of sec.157.121(b), one commenter expressed strong opposition concerning a part of the provision on specific qualifications for nonsurgical specialists (emergency physicians). The commenter strongly opposed the use of certificates in short courses, i.e., Advanced Trauma Life Support (ATLS), to determine qualifications relating to emergency medicine. The department's response is that the ATLS requirement for emergency physicians is still being considered by the department. Concerning sec.157.122(b)(2), a commenter said that the phrase, "lead general trauma facility," as used in the paragraph is ambiguous. The department disagrees because a general trauma facility could also be a "lead trauma facility" in its TSA. Concerning sec.157.122(b)(3) and (c)(3), a commenter asked if a TSA could end up with fewer than the three county minimum if counties in a designated TSA aligned with an adjacent TSA. Another commenter supports the multi-county composition. Several commenters asked that changes be made to a currently defined TSA to maintain established patient referral lines. The department's response to the first comment is that the rules will not permit a TSA to have fewer than three counties. The department agrees with the second comment. The department disagrees with the third comment because this rule does not restrict patient referrals and allows for realignment of counties. Concerning sec.157.123, one commenter requested that the regional advisory council's (RAC) authority and responsibilities be defined and detailed. The department's response is that proposed sec.157.124 addresses responsibilities and each RAC is permitted to expand its role as needed for its TSA. Section 157.124 allows for flexibility. Concerning sec.157.123(a), one commenter asked if there is a contingency plan if a RAC is not established. The department's response is that a RAC is totally voluntary. Concerning sec.157.123(b), one commenter said that a RAC would become unmanageable if all participating health care entities were represented and suggested that only participating hospitals be allowed on a RAC while other health care entities be on an advisory group to the RAC. Another commenter suggested that the RAC's role, composition, term length, method of appointment and goals be defined and by-laws approved by the department's Bureau of Emergency Management (bureau) be added to the subsection. The department disagrees with the first commenter on the basis that a trauma system is made up of more than just hospitals and other health care entities, such as EMS, must have input into the planning process. The department disagrees with the second comment because each RAC is given flexibility to make internal decisions on its composition, length of term, etc. Concerning sec.157.123(c), one commenter questioned the need for a RAC if final decisions are left to the bureau. The department disagrees because the RAC, not the bureau, will make the final decisions for trauma system planning and implementation. Concerning sec.157.123(e), two commenters said that a RAC made up of volunteers would need financial support from the state to operate. The department agrees that this might be the case for some RACs; however, funds have not been made available by the legislature. Concerning sec.157.124, one commenter asked who would educate the public about the system and if funds are available for this purpose. Another commenter asked what the bureau's role would be to coordinate each system plan. The department's response is that the department, the RACs, and the trauma facilities would educate the public and that funds are not available at this time. The department said the bureau's role is to recognize official RACs, review all system plans, designate trauma facilities and provide technical assistance. Concerning sec.157.124(a), four commenters asked how the cost will be paid for in establishing a trauma plan in the application phase. The department's response is that trauma system planning is voluntary and those involved will assume their own expenses. Concerning sec.157.124(b), three commenters asked how the application will be structured and if the applications will be uniform for all TSAs. The department's response is that the application structure will be outlined in the "Texas Trauma System Manual" and will be made available when completed. The department assures that the applications will be uniform. Concerning sec.157.124(c), one commenter asked if the participating health care entities would be defining their community's standard of care if not all health care entities participated in system planning. The department agrees that this might be the case; however, this is true with many types of planning and is the reason that all participating entities should participate in the planning process. Concerning sec.157.124(c)(3), several commenters asked the following questions: if the physician responsible for medical oversight would be reimbursed and what procedures are being considered; what is available to ensure transport protocols comply with state and federal laws; who is responsible to identify patients for transfer and what guidelines are available; who would develop a system-wide quality management program; and what rules are in place to guarantee confidentiality for peer review evaluation. The department's response is that physician reimbursement for services to a TSA or RAC would be decided by a RAC and that no state funding is available; EMS providers and agencies must comply with EMS laws for patient transport; the physician is responsible for patient transfers and should use protocols approved by medical-legal authority; and finally, each RAC will develop a system-wide quality management program. Concerning sec.157.124(d), one commenter expressed fear that a hospital may not be deemed eligible for funds if a RAC is not organized or functioning. The department's is that if RAC formation has not begun or has not been organized, a mechanism for the bureau to grant an exception is provided in sec.157.125. Concerning sec.157.125(a), one commenter stated that the American College of Surgeons (ACS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defined the levels of hospitals differently and the proposed trauma level designation would be confusing. A second commenter stated that every 40-bed hospital would qualify for Level III designation; however, no recognition is given to a hospital providing 98% of the Level II criteria. Another commenter wanted to know what would happen if Level I and Level II services were not volunteered in a TSA. The department disagrees with the first comment because the trauma facility designation levels, which are outlined in the Health and Safety Code, Chapter 773, are nationally accepted. The department disagrees with the second comment because many 40-bed hospitals will not be able to meet the requirements and standards for Level III designation. The department's reply to the third comment is that trauma facility designation is a voluntary process and a TSA might not have a designated trauma facility at all or the highest level of designation may be a Level III. TSAs were established to ensure that there is a hospital with the potential to achieve a Level III designation. Concerning sec.157.125(b), one commenter applauded on-site surveys before trauma designation is awarded. The department appreciates this support. Concerning sec.157.125(e), one commenter asked if local assistance for planning and development was considered and will the bureau use its regional staff or hire new staff. The department's response is that local assistance was not considered and money is not available to hire additional staff. Regional staff members cannot be diverted from their primary responsibility. Concerning sec.157.125(g)(1), one commenter suggested that survey physicians be board certified in their respective discipline and that survey nurses have either critical care or certified emergency nurse (CEN) certification. A second commenter would like to add an EMS representative to the survey team. The department disagrees with the first comment stating that the requirements for survey team members are sufficient. The department disagrees with the second comment because the team composition is similar to the survey team composition in other states and larger teams are more costly. Concerning sec.157.126(a), two commenters requested that the hospital's application fee be deleted since the other health care entities don't have to submit a fee and suggested that the department develop a grant program to replace the application cost. The department disagrees because the application fee for trauma designation is defined in accordance with the Health and Safety Code, Chapter 773. Additionally, other health care entities are paying for their licensing and certification. Concerning sec.157.127(a), two commenters said that a RAC should take an active role in handling a complaint or dispute before the state intervenes and not be left out of the process. The department agrees that RACs should be involved in the complaint process and encourages their support in complaint resolution. No change in the language in the subsection is necessary. Concerning sec.157.129, two commenters said there will be additional costs to a hospital for reporting data and revising the existing collection forms. One commenter suggested a grant under House Bill 18, sec.5.02, 71st Legislature, 1989 (House Bill 18), be used to offset the cost. One commenter said the Texas Medical Records Association would like to be included in the body charged with state registry formation. The department agrees with the first comment that there will be additional costs; however, the grant program provided by House Bill 18 has not been funded by the legislature. The department disagrees with the last commenter because it is the bureau's responsibility to develop the trauma registry; however, all interested organizations will be kept apprised of the concerns and direction taken by the registry. Concerning sec.157.129(a)(2), one commenter would like the word "expenditures" changed to "costs" for meaningful comparisons. The department disagrees because "expenditures" is used in House Bill 18 and cannot be changed in the rules. Concerning sec.157.129(b), one commenter requested that data collection be compatible with current methods to defray costs. A second commenter wanted to know the reimbursement procedure, and another commenter suggested that the use of ICD-9-CM E-Codes be consistent between hospital and ambulance reporting. The department agrees with the first comment and will provide the software free of charge to each participating health care entity. In response to the second comment, the department said that there is no money available to defray costs. The department agrees with the third comment and believes that the subsection as written implements this intent. Concerning sec.157.129(c), one commenter wanted to know which health care entity collects and reports the data when more than one entity is owned by a hospital. Another commenter wanted a reasonable time frame for submitting the quarterly report, recommended that 60-90 days after the close of each quarter be allowed, and that the trauma registry be delayed until data collection is uniform, consistent, accurate, and meaningful. Concerning the first comment, the department's response is that each hospital can decide which of their entities will collect and report data to the bureau. Concerning the second comment, the department's response is that data, including incomplete data, be reported at the specified time and follow-up data submitted the following quarter. The department disagrees with the third comment because the Health and Safety Code, Chapter 773 requires the bureau to collect and report data. Concerning sec.157.129(e), one commenter asked what rules or requirements, other than the provisions in the Texas Open Records Act, are used to maintain the confidentiality of records. Another commenter was concerned that blood alcohol levels could become public information under the Open Records Act. The department's response to the first comment is that the records will be held confidential to the extent authorized by the Health and Safety Code, Chapter 773, Subchapter D, relating to confidential communications. The department's response to the second comment is that Chapter 773, Subchapter C also applies since laboratory reports are included in a patient's medical record. In addition to changes made as a a result of comments received, the department made editorial changes to sec.157.121, sec.157.123, sec.157.124, and sec.157.125 for the purpose of clarification. General comments received by the department, including the department's responses, are as follows. One commenter thought that the purpose of the trauma legislation in the Health and Safety Code, Chapter 773, was only to create enabling legislation to fund uncompensated trauma care from EMS to rehabilitation services. The department disagrees because Chapter 773 contains very specific language regarding the duties of the Bureau (sec.773.083) and rules for the Texas Board of Health to adopt (sec.773.082). The proposed sections were written according to the mandates in Chapter 773. One commenter stated that, "the act calls for all providers in a catchment area to participate in evaluating their services and coordinate delivery through a regional plan. In essence, the act favors grassroots decision-making in a "bottom-up" rather than "top down" approach." The department agrees, but believes that the rules as written implement this intent. One commenter stated that, "The one caveat was that this was Texas and not Maryland; the size and diversity of Texas warranted slight modification of ACS guidelines to include even the smallest of the rural hospital into the trauma system. The trauma system was to be inclusive rather than exclusive." The department agrees, but believes that the rules as written implement this intent. One commenter stated that, "The major problem faced in 1987 was the lack of credible data to support the development of trauma systems. Here, in 1991, over two years after the legislation became law, there is still no trauma registry. I suggest that the committee recommend that the registry be implemented to accumulate the mortality and morbidity data essential to prove that trauma systems will save lives in Texas." The department's response is that it intends to implement a trauma registry. Funding was obtained in support of a Texas trauma study by legislative mandate; however, funding for a full registry has not been made available by the legislature. One commenter stated that, "the legislative intent was to establish the advisory committee to advise the Texas Board of Health on technical medical matters only; the committee was not a general advisory committee that would recommend policy." The department's response is that the language in the Health and Safety Code, Chapter 773, seems to give the advisory committee some responsibility to recommend policy in addition to being advisory. Section 773. 082 provides that the Board of Health shall adopt rules on trauma system policies that reflect advisory committee recommendations. Also, sec.773.088 authorizes the advisory committee to review and comment on hospital administrative and operational considerations related to rules adopted under Chapter 773. The amendment is adopted under Health and Safety Code, Chapter 773, as amended by Senate Bill 18, 71st Legislature, 1989, which provides the Texas Board of Health (board) with the authority to adopt rules covering minimum standards and objectives for EMStrauma systems; and Health and Safety Code, sec.12.001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the commissioner of health. sec.157.2. Definitions. The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise. Basic trauma facility-A hospital designated by the department as having met the criteria for a Level IV trauma facility as described in the publication titled "Texas Trauma Facility Criteria" which is adopted by reference in sec.157.121 of this title (relating to Purpose). Basic trauma facilities provide resuscitation, stabilization, and arrange for appropriate transfer of all major and severe trauma patients to a higher level trauma facility. Bypass-Direction given to a prehospital emergency medical services unit, by directon-line medical control or predetermined triage criteria, to pass the nearest hospital. Comprehensive trauma facility-A hospital designated by the department as having met the criteria for a Level I trauma facility as described in the publication titled "Texas Trauma Facility Criteria" which is adopted by reference in sec.157.121. Comprehensive trauma facilities manage major and severe trauma patients, provide educational opportunities in trauma related topics for health care professionals, and conduct trauma research. Critically injured person-A person suffering major or severe trauma, with severe multisystem injuries or major unisystem injury; the extent of the injury may be difficult to ascertain, but which has the potential of producing mortality or major disability. Designation-A formal recognition by the department of a hospital's trauma care capabilities and commitment. Diversion-A procedure put into effect by a trauma facility to insure appropriate patient care when that facility is unable to provide the level of care demanded by a trauma patient's injuries or when the facility has temporarily exhausted its resources. Emergency medical services and trauma care system-An arrangement of available resources that are coordinated for the effective delivery of emergency health care services in geographical regions consistent with planning and management standards. Facility triage -The process of assigning patients to an appropriate trauma facility based on injury severity and facility availability. General trauma facility-A hospital designated by the department as having met the criteria for a Level III trauma facility as described in the publication titled "Texas Trauma Facility Criteria" which is adopted by reference in sec.157.121. General trauma facilities provide resuscitation, stabilization, and assessment of injury victims and either provide treatment or arrange for appropriate transfer to a higher level trauma facility. Health care entity-A prehospital provider, physician, nurse, hospital, designated trauma facility or a rehabilitation program. Health care facility-A licensed hospital. Lead trauma facility-A trauma facility that has made an additional commitment to its trauma service area. This commitment, which usually is offered by the highest level of trauma facility in a given trauma service area, includes outreach and increased educational activities. The responsibilities may be shared by trauma facilities. Major trauma facility-A hospital designated by the department as having met the criteria for a Level II trauma facility as described in the "Texas Trauma Facility Criteria" which is adopted by reference in sec.157.121. Major trauma facilities provide similar services to the Level I trauma facility although research and some medical specialty areas are not required for Level II facilities. Major trauma injury victimpatient-A person with injuries severe enough to benefit from treatment at a trauma facility, whose revised trauma score (RTS) is less than 11, andor whose injury severity score (ISS) is nine or above. Medical control -The supervision of prehospital emergency medical service providers by a licensed physician through voice communication. Medical control is also referred to as on-line medical supervision. Medical oversight -The assistance given to the Regional Advisory Council (RAC) andor regional health care entities in system planning by a physician or group of physicians designated by the RAC to provide technical assistance. Pediatric trauma facility-A pediatric or other hospital designated by the department as having met the criteria as described in the publication titled "Pediatric Trauma Care," which is adopted by reference in sec.157.121. Prehospital triage -The process of identifying injury severity so that the appropriate care level can be readily accessed according to patient care guidelines. Quality management -Quality assurance and quality improvement activities. Regional EMStrauma system-An emergency medical services and trauma care system that has been developed by a RAC in a multi-county area and has been recognized by the bureau. Regional medical control-Direct on-line physician communication for prehospital providers in a given trauma service area. Regional medical control is usually based at the lead trauma facility. Severe trauma injury victimpatient-A person with injuries severe enough to require care at a comprehensive or major trauma facility, whose RTS is less than 11, and whose ISS is 16 or above. Site survey-An on-site review of a trauma facility applicant to determine if it meets the criteria for a particular level of designation. Specialty centers -Entities that care for specific types of trauma patients such as pediatric hospitals and burn units. Trauma-An injury or wound to a living body caused by the application of an external force or violence. Burn injuries are to be included in this definition, and poisonings, near-drownings and suffocations, other than those due to external forces, are to be excluded from this definition. Trauma facility -A health care facility that is capable of comprehensive treatment of seriously injured persons and is part of an emergency medical services (EMS)trauma system. Trauma nurse-A registered nurse with demonstrated interest and experience in trauma care. Trauma patient -Any critically injured person who has been evaluated by a physician, a registered nurse, or emergency medical services personnel; and found to require medical care in a trauma facility. Trauma registry -A statewide database which documents and integrates medical and system information related to the provision of trauma care by health care entities. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201241 Robert A. MacLean, M.D. Deputy Commissioner Texas Department of Health Effective date: February 17, 1992 Proposal publication date: September 10, 1991 For further information, please call: (512) 458-7550 Emergency Medical Services Trauma Systems 25 TAC sec.sec.157.121-157.129 The new sections are adopted under the Health and Safety Code, Chapter 773, as amended by Senate Bill 18, 71st Legislature, 1989, which provides the Texas Board of Health (board) with the authority to adopt rules covering minimum standards and objectives for EMStrauma systems; and Health and Safety Code, sec.12.001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the commissioner of health. sec.157.121. Purpose. (a) The purpose of these sections is to establish the procedures and standards for the implementation of a comprehensive statewide emergency medical services (EMS)trauma system (system) as mandated in the Health and Safety Code, Chapter 773, sec. sec.773.081-773.090, in order to decrease morbidity and mortality which results from trauma. (b) The Texas Department of Health adopts by reference the following publications developed by the Trauma Technical Advisory Committee (TTAC) titled: "Texas Trauma Facility Criteria," "Pediatric Trauma Care," "Qualifications of Texas Trauma Care Personnel," "Prehospital Triage Protocol," "Facility Triage Criteria and Decision Guidelines for Transfer," "Facility Diversion," "Facility Bypass," "Medical Control Within EMSTrauma Systems Development," "Prehospital Standard Data Set" and "Hospital Standard Data Set." (1) The publications are based on documents titled "Resources for Optimal Care of the Injured Patient" published by the American College of Surgeons in 1990 and "Guidelines for Trauma Care Systems" published by the American College of Emergency Physicians in 1987. (2) Copies of the publications may be viewed during normal business hours at the Texas Department of Health, Bureau of Emergency Management, Room M-528, 1100 West 49th Street, Austin, Texas 78756-3199. (c) The Bureau of Emergency Management and the TTAC shall review these sections every three years. sec.157.123. Regional Advisory Councils. (a) A regional advisory council (RAC) shall be established if a trauma service area (TSA) is to reach regional emergency medical services (EMS)trauma system (system) status. (b) All participating health care entities should have representation on the RAC. (1) Membership status for hospitals for the first six months shall be provisional. (2) Continuing or renewed membership status for hospitals will be dependent upon a commitment to trauma care, as demonstrated by trauma facility designation or involvement in the designation process as described in sec.157.125 of this title (relating to Requirements for Trauma Facility Designation). (c) The bureau shall recognize only one official RAC for a TSA or a group of TSAs. (d) The RAC shall develop a system plan based on standard guidelines for comprehensive system development. The system plan is subject to approval by the Bureau of Emergency Management (bureau). (e) The RAC is a voluntary entity which functions without the expectation of state funding. (f) RACs may request technical assistance from the bureau at any time. sec.157.124. Regional EMSTrauma Systems. (a) The Bureau of Emergency Management (bureau) shall recognize the establishment of a regional emergency medical services (EMS)trauma system (system) within a trauma service area (TSA) as described in sec.157.122 of this title (relating to Trauma Service Areas). (b) For a TSA to be recognized as a system, a RAC, organized as described in sec.157.123 of this title (relating to Regional Advisory Councils), shall submit a system plan (plan) to the bureau, which includes the organizational structure of the RAC. (c) The bureau shall review the plan to assure that: (1) all counties within the TSA have been included unless a specific county, or portion thereof, has been named within an adjacent system; (2) all health care entities and interested specialty centers have been given an opportunity to participate in the planning process; and (3) the following have been addressed: (A) access to the system; (B) communications; (C) medical oversight; (D) prehospital triage criteria; (E) diversion policies; (F) bypass protocols; (G) regional medical control; (H) facility triage criteria; (I) inter-hospital transfers; (J) planning for the designation of trauma facilities, including the identification of the lead facility(ies); and (K) a quality management program that evaluates outcome from a system perspective. (d) Bureau approval of the completed plan shall qualify health care entities participating in the system to receive state funding for trauma care when funding is made available. (e) Annually, on a form provided by the bureau, the RAC shall file a report with the bureau which describes progress toward system development and includes evidence that members of the RAC are currently involved in trauma care. sec.157.125. Requirements for Trauma Facility Designation. (a) The Bureau of Emergency Management (bureau) shall recommend to the commissioner of health (commissioner) the designation of trauma facilities by levels of care capability as defined by the publications titled "Texas Trauma Facility Criteria" (criteria), "Qualifications of Texas Trauma Care Personnel" andor "Pediatric Trauma Care" which the Texas Department of Health (department) adopts by reference in sec.157.121 of this title (relating to Purpose). The levels are as follows: (1) Level I-comprehensive trauma facility; (2) Level II-major trauma facility; (3) Level III-general trauma facility; and (4) Level IV-basic trauma facility. (b) The designation process shall consist of three phases. (1) The first phase is the application phase which begins with completing and submitting to the bureau an application and non-refundable fee as described in sec.157.126 (relating to Fees) for designation as a trauma facility and ends when the bureau recommends a site survey (survey); (2) The second phase is the review phase which begins with the survey and ends with a bureau recommendation to the commissioner to designate the hospital; (3) The third phase is the final phase which begins with the commissioner reviewing the recommendation and ends with hisher final decision. This phase also includes an appeal procedure for the denial of a designation application in accordance with the department formal hearing procedures as described in Chapter 1 of this title (relating to Texas Board of Health). (c) A secondary review shall be utilized in the event the bureau recommendation (of whether or not) to designate differs from the findings of the survey team. A secondary review shall also be used when a hospital does not agree with a bureau request for specific corrective action prior to recommending designation. (d) The bureau may provide technical assistance to all hospitals throughout the three phases of the designation process for the purpose of answering questions and clarifying the process. (e) The bureau's analysis of submitted application materials, which may result in recommendations for corrective action when deficiencies are noted, shall include a review of: (1) the evidence of participation in system planning; (2) the completeness of the application materials submitted; and (3) the hospital's self-study for comparison with the criteria. (f) When the application phase results in a bureau recommendation for a survey, the bureau shall notify the hospital to contract for the survey, as follows. (1) A hospital may choose to request a survey by an American College of Surgeons survey team, may request the bureau to approve an alternate survey team assembled by a bureau-approved organization, or may request the bureau to select individual survey team members. (2) The hospital shall notify the bureau of the date of the planned survey and the composition of the survey team. (3) The hospital shall be responsible for any costs associated with the survey. (4) The bureau may appoint an observer to accompany the survey team. In this event, the cost for the observer shall be borne by the bureau. (g) The survey team composition shall be as follows. (1) A survey team for a comprehensive, major, or lead general trauma facility applicant, shall be multidisciplinary and include at a minimum: a general surgeon, an emergency physician, and a trauma nurse all active in the management of trauma patients. The inclusion of a neurosurgeon on the survey team for a potential comprehensive or major trauma facility is recommended. (2) Other general trauma facility applicants shall be surveyed by a survey team consisting of a nurse and a surgeon both active in the management of trauma patients and a bureau representative. (3) Basic trauma facility applicants shall be surveyed by a bureau representative or a bureau approved consultant. (4) It is recommended that a pediatric trauma surgeon andor pediatric trauma nurse be a member of the survey team for review of a pediatric trauma facility applicant. (5) Any member of the survey team should come from a public health region outside the hospital's location and at least 100 miles from the applicant hospital. (h) When an applicant hospital is notified of the survey team composition, it has 15 postmark days to alert the bureau of potential conflict of interest concerns. (i) From the date the survey team is selected and prior to the survey, the applicant's administration, faculty, medical staff, employees, and representatives are prohibited from having any discussions regarding the upcoming survey with any survey team member except as directed by the bureau. A violation of this provision may be grounds for delaying the survey and reorganizing the composition of the survey team. (j) The survey team shall evaluate the quality of each hospital's compliance with the requirements set forth in the criteria, by: (1) reviewing medical records, staff rosters and schedules, quality management committee meeting minutes, and other documents relevant to trauma care; (2) reviewing equipment and the physical plant; and (3) conducting interviews with hospital personnel. (k) Findings of the survey team shall be forwarded to the bureau within 90 days. (1) The bureau shall review the findings for compliance with the criteria. If a hospital does not meet the criteria for the level of designation for which it applied, the bureau may discuss designation at a lower level with the hospital. (2) A recommendation for designation shall be made to the commissioner based on compliance with the criteria. (3) In the event there is a problem area in which a hospital does not comply with the criteria, the bureau shall notify the hospital of deficiencies and recommend corrective action. (A) The hospital shall submit a report to the bureau which outlines the corrective action taken. If the report substantiates action that brings the hospital into compliance with the criteria, the bureau shall recommend designation to the commissioner. (B) If the hospital disagrees that there is need for corrective action, the bureau shall refer the complete file to the trauma technical advisory committee (TTAC) for review. (C) If TTAC disagrees with the bureau recommendation for corrective action, the records shall be referred to the deputy commissioner of health for review. (l) The bureau shall provide a copy of the survey report and results to the applicant hospital. (m) At the end of the secondary review and final phases of the designation process, if a hospital disagrees with the bureau recommendations, opportunity for an appeal in accordance with the department formal hearing procedures as described in Chapter 1 shall be offered. (n) The bureau may grant an exception to this section if it finds that compliance with this section would not be in the best interests of the persons served in the affected local system. (o) The applicant hospital shall have the right to withdraw its application at any time prior to being awarded trauma facility designation by the bureau. (p) If the commissioner concurs with the bureau recommendation, a letter of notification shall be forwarded to the hospital. If the decision is to designate, the hospital shall receive a certificate of designation for three years. (q) When a facility has been designated for a period of three years, it shall be necessary to repeat the designation process as described in this section. (r) A designated trauma facility shall: (1) notify the bureau and the regional advisory council (RAC) within five days if temporarily unable to comply with designation standards; (2) notify the bureau and the RAC if it chooses to no longer provide trauma services commensurate with its designation level, as follows. (A) If the trauma facility chooses to apply for a lower level of designation, it may do so at any time; however, it shall be necessary to repeat the designation process as described in subsections (b)-(e) of this section. There shall be a paper review by the bureau to determine if a full survey shall be required. (B) If the trauma facility chooses to permanently relinquish its designation, it shall provide at least 30 days' notice to the RAC and the bureau. (3) comply with the provisions within these sections, all current state and system standards as described in this chapter, and all policies, protocols, and procedures as set forth in the system plan; (4) continue its commitment to provide the resources, personnel, equipment, and response as required by its designation level; and (5) participate in the state trauma registry as described in sec.157.129 of this title (relating to State Trauma Registry). (s) After September 1, 1993, a hospital may not use the terms "trauma facility," "trauma hospital," "trauma center" or similar terminology in its signs or advertisements or in the printed materials and information it provides to the public unless the hospital has been designated as a trauma facility according to the process described in this section. This subsection also applies to hospitals whose designation has lapsed. (t) A trauma facility shall not advertise or publicly assert in any manner that its trauma facility designation affects its care capabilities for non-trauma patients or that its trauma facility designation should influence the referral of non-trauma patients. (u) The bureau shall have the right to review, inspect, evaluate, and audit all trauma patient records, trauma quality management committee minutes, and other documents relevant to trauma care in any designated trauma facility at any time to verify compliance with criteria. The bureau shall maintain confidentiality of such records to the extent authorized by the Open Records Act, Texas Civil Statutes, Article 6252-17a. Such inspections shall be scheduled by the bureau when appropriate. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201242 Robert A. MacLean, M.D. Deputy Commissioner Texas Department of Health Effective date: February 17, 1992 Proposal publication date: September 10, 1991 For further information, please call: (512) 458-7550 TITLE 28. INSURANCE Part II. Texas Workers' Compensation Commission Chapter 142. Dispute Resolution-Benefit Contested Case Hearing 28 TAC sec.142.13 The Texas Workers' Compensation Commission adopts an amendment to sec.142.13, concerning discovery prior to a benefit contested case hearing, without changes to the proposed text as published in the November 5, 1991, issue of the Texas Register (16 TexReg 6270). The amendment adds a new subsection (g), providing that the notice setting an expedited hearing, or a hearing held without a prior benefit review conference, shall include time limits for conducting prehearing discovery. The amendment is necessary to inform parties of this exception to the usual time limits for prehearing discovery set out in the Texas Workers' Compensation Act and this section. No comments were received regarding adoption of the amendment. The amended section is adopted under Texas Civil Statutes, Article 8308-66. 31(d), which requires the commission to adopt rules governing procedures under which contested case hearings are conducted, and Article 8308-2.09(a), which authorized the commission to adopt rules necessary to implement and enforce the Texas Workers' Compensation Act. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 28, 1992. TRD-9201287 Ernest Boardman Acting General Counsel Texas Workers' Compensation Commission Effective date: February 18, 1992 Proposal publication date: November 5, 1991 For further information, please call: (512) 440-3971 TITLE 37. PUBLIC SAFETY AND CORRECTIONS Part III. Texas Youth Commission Chapter 119. Agreements With Other Agency Memorandums of Understanding 37 TAC sec.119.5 The Texas Youth Commission (TYC) adopts amendments to sec.119.5 concerning service contract for dysfunctional families, without changes to the proposed text as published in the December 27, 1991, issue of the Texas Register (16 TexReg 7721). The amendment to the section ensures dysfunctional families that they will continue receiving coordinated services when the agencies have sufficient funding to enter into joint contracts. The amendment will require TYC, the Texas Department of Human Services (DHS), and the Texas Juvenile Probation Commission (TJPC) to continue complying with the Human Resources Code, (HRC), sec.71.011(A), as passed by the 71st Texas Legislature. The agencies initially complies with the law by adopting sec.72.901 in 1990. The amendment also allows the agencies to continue applying the section without having to amend it every year. Finally, the amendment clarifies that the MOU is operative only in those years when the stat appropriations are sufficient for the agencies to allocate funds for joint contracts for services dysfunctional families. No comments were received regarding adoption of the amendment. The amendment is adopted under the Human Resources Code, sec.71.011(a), which provides Texas Youth Commission with the authority to enter into a memorandum of understanding with the DHS and TJPC regarding service delivery to dysfunctional families. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 27, 1992. TRD-9201212 Ron Jackson General Counsel Texas Youth Commission Effective date: February 17, 1992 Proposal publication date: December 27, 1991 For further information, please call: (512) 483-5244 Part VI. Texas Department of Criminal Justice Chapter 195. Parole Terms and Conditions of Parole 37 TAC sec.195.61 The Texas Department of Criminal Justice adopts an amendment to 37 TAC sec.195.61 concerning terms and conditions of paroles, without changes to the proposed text as published in the December 13, 1991, issue of the Texas Register (16 TexReg 7167). Notice of the extension of these emergency rules was published in the January 14, 1992, issue of the Texas Register (17 TexReg 293). The amendment is being adopted to comply with the mandate of Texas Civil Statutes, Article 6252-13c, as amended by the 72nd Legislature. The amendment requires that all sex offenders register with appropriate law enforcement authorities within seven days of their arrival in any municipality or county. This requirement will be added to the required terms and conditions of parole of all such offenders. No comments were received regarding adoption of the amendment. The amendment is adopted under the Texas Code of Criminal Procedure, Article 42.18, sec.8(g), which authorizes the Texas Department of Criminal Justice to adopt reasonable rules with respect to terms and conditions of parole. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 29, 1992. TRD-9201357 Jackee Cox General Counsel Texas Department of Criminal Justice Effective date: February 19, 1992 Proposal publication date: December 13, 1991 For further information, please call: (512) 463-9988 Chapter 197. Mandatory Supervision Rules and Conditions of Mandatory Supervision 37 TAC sec.197.21 The Texas Department of Criminal Justice adopts an amendment to 37 TAC sec.197.21 concerning mandatory supervision, without changes to the proposed text as published in the December 13, 1991, issue of the Texas Register (16 TexReg 7167). Notice of the extension of these emergency rules was published in the January 14, 1992, issue of the Texas Register (17 TexReg 293). The amendment is being adopted to comply with the mandate of Texas Civil Statutes, Article 6252-13c, as amended by the 72nd Legislature. The amendment requires that all sex offenders register with appropriate law enforcement authorities within seven days of their arrival in any municipality or county. This requirement will be added to the required terms and conditions of mandatory supervision for all such offenders. No comments were received regarding adoption of the amendment. The amendment is adopted under the Texas Code of Criminal Procedure, Article 42.18, sec.8(g), which authorizes the Texas Department of Criminal Justice to adopt reasonable rules with respect to terms and conditions of parole. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 29, 1992. TRD-9201355 Jackee Cox General Counsel Texas Department of Criminal Justice Effective date: February 19, 1992 Proposal publication date: December 13, 1991 For further information, please call: (512) 463-9988 TITLE 40. SOCIAL SERVICES AND ASSISTANCE Part I. Texas Department of Human Services Chapter 3. Income Assistance Services Subchapter G. Resources The Texas Department of Human Services (DHS) adopts amendments to sec.3.704 and sec.3.902, concerning resources. Section 3.704 is adopted with changes to the proposed text as published in the December 27, 1991, issue of the Texas Register (16 TexReg 7722). Section 3.902 is adopted without changes and will not be republished. The justification for the amendments is to comply with federal regulations that specify income and resources that are exempted by federal law for Native Americans who receive aid to families with dependent children (AFDC) and/or Food Stamp Program benefits. The amendments will function by stating food stamp policy that is in compliance with federal regulations. No comments were received regarding adoption of the amendments. DHS is, however, adopting sec.3.704(b)(10)(D) with a change to correct the spelling of the name Maliseet. 40 TAC sec.3.704 The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 and 31, which provides the department with the authority to administer public assistance and financial assistance programs. sec.3.704. Types. (a) (No change.) (b) Aid to families with dependent children. Exclusions from resources in AFDC are: (1)-(9) (No change.) (10) resources exempted by federal law. DHS exempts government payments by the Individual and Family Grant Program or the Small Business Administration provided to rebuild a home or replace personal possessions damaged in a disaster, if the household is subject to legal sanction if the funds are not used as intended. DHS exempts payments made under the following acts: (A)-(C) (No change.) (D) Passamaquoddy Tribe, the Penobscot Nation, and the Houlton Band of Maliseet Indians received according to the Maine Indian Claims Settlement Act of 1980; (E)-(I) (No change.) (11)-(12) (No change.) (c)-(d) (No change.) This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 28, 1992. TRD-9201311 Nancy Murphy Agency liaison, Policy and Document Support Texas Department of Human Services Effective date: April 1, 1992 Proposal publication date: December 27, 1991 For further information, please call: (512) 450-3765 Subchapter I. Income 40 TAC sec.3.902 The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 and 31, which provides the department with the authority to administer public assistance and financial assistance programs. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 28, 1992. TRD-9201312 Nancy Murphy Agency liaison, Policy and Document Support Texas Department of Human Services Effective date: April 1, 1992 Proposal publication date: December 27, 1991 For further information, please call: (512) 450-3765 Chapter 15. Medicaid Eligibility Subchapter D. Resources 40 TAC sec.15.430 The Texas Department of Human Services adopts new sec.15.430, concerning client participation in transfers, in its Medicaid Eligibility chapter. The amendment is adopted without changes to the proposed text as published in the December 17, 1991, issue of the Texas Register (16 TexReg 7325). The new section is justified because it provides for a uniform, state-wide application of the transfer policy. The new section will function by clarifying the effects of client knowledge and consent in the transfer of resources policy and by identifying cases of possible financial exploitation for referral to adult protective services staff. No comments were received regarding adoption of the new section. The new section is adopted under the Human Resources Code, Title 2, Chapter 22, which authorizes the department to administer public assistance programs, and Chapter 32, which authorizes the department to administer medical assistance programs. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on January 28, 1992. TRD-9201284 Nancy Murphy Agency liaison, Policy and Document Support Texas Department of Human Services Effective date: March 1, 1992 Proposal publication date: December 17, 1991 For further information, please call: (512) 450-3765 State Board of Insurance Exempt Filing Notification Pursuant to the Insurance Code, Chapter 5, Subchapter L (Editor's note: As required by the Insurance Code, Article 5.96 and Article 5.97, the Register publishes notices of actions taken by the State Board of Insurance pursuant to Chapter 5, Subchapter L, of the Code. Board action taken under these articles is not subject to the Administrative Procedure and Texas Register Act. These actions become effective 15 days after the date of publication or on a later specified date. The text of the material being adopted will not be published, but may be examined in the offices of the State Board of Insurance, 333 Guadalupe, Austin.) The State Board of Insurance adopted amendments to the Texas Automobile Rules and Rating Manual (the Manual) and the Standard Provisions for Automobile Insurance Policies (the Standard Provisions) in regard to installments for premium payments for personal auto policies. In order to make auto insurance more affordable, the board has required the addition of Rule 14 to the Manual, which rule will read as set forth follow. 14. INSTALLMENTS FOR PREMIUM PAYMENTS A. All insurers writing personal auto insurance policies shall make available to the applicant or policyholder, at his or her option, an installment payment plan. The insurer may make the installment payment plan available either itself, through an affiliate or through an entity approved to make loans for insurance premiums, including but not limited to lending institutions and premium finance companies. The installment payment plan must meet the following requirements: 1. A down payment may be required if the down payment is no greater than 25% of the total premium for twelve-month policies and no greater than 40% of the total premium for six-month policies. 2. For twelve-month policies, the remaining balance must be payable in no less than eight equal monthly installments beginning with the second month of coverage; provided, however, that the equal monthly installments may include an amount such that at the end of the policy term there would remain a specified advanced minimum deposit of no greater than 25% of the total premium for such a policy if the plan permits a minimum of eleven equal monthly installment payments. 3. For six-month policies, the remaining balance must be payable in no less than three equal monthly installments beginning with the second month of coverage; provided, however, that the equal monthly installments may include an amount such that at the end of the policy term there would remain a specified advanced minimum deposit of no greater than 40% of the total premium for such a policy if the plan permits a minimum of five equal monthly installment payments. 4. An insurer who provides the installment plan itself or through an affiliate may charge a monthly service charge of no more than three dollars for providing the installment payment plan. The monthly service fee may be increased by $.50 for each $250 or fraction thereof by which the annual premium exceeds $500. B. Whatever payment options an insurer offers, it shall not offer or refuse to offer a particular payment option on any basis, including whether the customer did or did not have previous automobile insurance; except that insurers shall not be required to make available an installment payment plan to those insureds who, within the last two years, have defaulted in the payment of premiums to an insurer and caused a lapse in the policy. C. Nothing in this rule shall prohibit an insurer from offering other payment options to an applicant in addition to those described above. The Board has amended the Standard Provisions by requiring that the Special Instructions for the Personal Auto Policy be expanded to include a new instruction, titled "Installment Payments" and numbered "12", and reading: "Each insurance company must either print on, stamp on, or attach to the declarations page the following statement: 'We agree to make available to you an installment plan as described in Rule 14 of the Texas Automobile Rules and Rating Manual.' " The amendments to the Manual and Standard Provisions have been adopted for policies that become effective on and after 12:01 a.m., March 1, 1992. This notification is made pursuant to the Texas Insurance Code, Article 5.96, which exempts it from the requirements of the Administrative Procedure and Texas Register Act. This notification is made pursuant to the Insurance Code, Article 5.97, which exempts it from the requirements of the Administrative Procedure and Texas Register Act. Issued in Austin, Texas, on January 29, 1992. TRD-9201350 Linda K. von Quintus-Dorn Chief Clerk Texas Department of Insurance Filed: January 29, 1992 For further information, please call: (512) 463-6327