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 22. EXAMINING BOARDS 
 Part XI. Board of Nurse Examiners 
  Chapter 213. Practice and Procedure 
  
  22 TAC sec.213.20 
 
  The Board of Nurse Examiners adopts an amendment to sec.213.20 concerning 
practice and procedure, without changes to the proposed text as published in the 
April 10, 1992, issue of the Texas Register (17 TexReg 2576). 
 The amendment is being adopted due, in part, to the passage of Texas Civil 
Statutes, Article 4519a during the 72nd Legislative Session and the adoption of 
sec.213.21 regarding declaratory order of eligibility for licensure. These 
recommendations are the result of a task force convened to study the issue of 
mental/physical disability/illness. 
 Detailed procedures will be provided for a candidate/prospective candidate 
requesting verification of eligibility to write the licensure examination who 
has previously been hospitalized or treated for a mental/physical 
disability/illness, or chemical dependency. 
 A comment was received regarding concern in the order of  sec.213.20(c)(1) and 
(2) in that the commenter felt these paragraphs should be reordered. Their 
concern dealt with the issue of mental illness being the main concern, rather 
than the issue of safe practice. 
 The Mental Health Association in Texas was neither for nor against the 
amendment, rather suggesting a reorganization of the paragraphs in sec.213.20(c) 
. 
 The agency did not disagree with the comments, but felt no need to reorder the 
paragraphs as recommended. 
 The amendment is adopted under Texas Civil Statutes, Article 4514, sec.1, which 
provides the Board of Nurse Examiners with the authority to make and enforce all 
rules and regulations necessary for the performance of its duties and conducting 
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 May 22, 1992. 
 TRD-9207112 
  Louise Waddill, Ph.D, R.N. 
 Executive Director 
 Board of Nurse Examiners 
  Effective date: June 12, 1992 
 Proposal publication date: April 20, 1992 
 For further information, please call: (512) 835-8650 
         
  
  TITLE 25. HEALTH SERVICES 
 Part I. Texas Department of Health 
  Chapter 61. Chronic Diseases 
  
  Breast and Cervical Cancer Control Program 
 
  25 TAC sec.sec.61.31-61.42 
 
  The Texas Department of Health (department) adopts new  sec.sec.61.31-61.42, 
concerning breast and cervical cencer control program. Sections 61.32, 61.37, 
61.41 and 62.42 are adopted with changes to the proposed text as published in 
the March 10, 1992, issue of the Texas Register (17 TexReg 1801). Sections 
61.31, 61.33-61. 36, and 61.38-61.40 are adopted without changes and will not be 
republished. 
 The new sections implement a breast and cervical cancer control program. The 
department's Chronic Disease Prevention Program has been awarded a grant by the 
United States Department of Health and Human Services, Centers for Disease 
Control (DHHS/CDC) to develop a statewide breast and cervical cancer early 
detection and control program. The program's goal is to reduce breast and 
cervical cancer mortality by increasing the availability of cancer screening and 
follow-up services among medically underserved women who are below 200% of the 
federal poverty level and who do not have third-party payment for these 
services. Activities to be supported under this program include outreach, 
screening, tracking, referral for diagnosis and treatment, and client education. 
Concerning sec.61.37(a)(1), relating to financial eligibility, a commenter 
suggested that the words "and/or" be replaced with the word "or" for 
clarification. The department agrees and has made the change. Minor changes have 
been made in sec.sec.61.32, 61.41, and 62.42 for the purpose of clarity. The 
only commenter was a department staff member. 
 The new sections are adopted under the Breast and Cervical Cancer Mortality 
Prevention Act of 1990, Public Law 101-354, which establishes a program of 
grants to states for prevention and control of breast and cervical cancer; House 
Bill Number 1 (General Appropriations Act), 72nd Legislature, First Called 
Session, 1991, Article II, pages II-19 and II-24, which authorizes the Board of 
Health to receive and disburse federal funds in accordance with plans acceptable 
to the federal agency providing the federal funds; and Health and Safety Code, 
sec.12.001, which provides the Board of Health with the authority to adopt rules 
to implement its duties and procedures. 
 
 
  sec.61.32. Federal Authorization and Requirements. 
 
  (a) The Breast and Cervical Cancer Mortality Prevention Act of 1990 (Act), 
Public Law 101-354, establishes a program of grants to states for prevention and 
control of breast and cervical cancer. Under authority of the Act, the United 
States Department of Health and Human Services, Centers for Disease Control 
(DHHS/CDC) , has published documents containing the requirements, guidelines, 
and instructions covering the program. The documents are titled, "1991 Early 
Detection and Control of Breast and Cervical Cancer (Announcement Number 121); 
Program Guidance, Application Instructions and Information," "Quality Assurance 
Guidelines for Cervical Cytology Services Under Public Law 101-354 CDC Program 
Announcement Numbers 121, 122," and "Mammography Quality Assurance Guidelines 
for Facilities Participating in Breast and Cervical Prevention and Control 
Programs Supported by the Centers for Disease Control." 
  
  (b)  In order to participate in the program, the Department of Health 
(department) is required to follow the provisions in the Act and in the DHHS/CDC 
document issued under authority of the Act. Accordingly, the department adopts 
by reference the provisions in the Act and the DHHS/CDC documents described in 
subsection (a) of this section. Copies of the Act and the DHHS/CDC document are 
available for public review in the office of the Chronic Disease Prevention 
Program, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, 
during regular business hours. 
 
  
  sec.61.37. Financial Eligibility and Screening Guidelines. 
 
  (a)  Applicants must demonstrate ability to adhere to the following financial 
eligibility and screening services guidelines. 
 
  (1) No person with income at or above 200% of the federal poverty level or who 
has third-party payment for screening services is eligible to receive services. 
  
  (2)  Only women age 40 or older will be eligible for screening mammography. 
  
  (3) Screening will include a clinical breast examination and mammography 
according to American Cancer Society (ACS) guidelines for women age 40 or older. 
  
  (4) All women who are, or have been sexually active, or who have reached the 
age of 18, will be eligible for an annual Pap test and pelvic examination. 
  
  (5) After a woman has had three or more consecutive satisfactory normal annual 
examinations, the Pap test may be performed less frequently at the discretion of 
her physician. 
  
  (b)  Applicants shall provide the breast exam and may subcontract with local 
providers for screening and diagnostic mammography services (repeat mammography; 
diagnostic mammography), including interpretations. Applicants will provide the 
pelvic exam and take the Pap smear, will use state-contracted laboratories for 
interpretation of Pap smears, and will either provide or contract for diagnostic 
services related to Pap smears (i.e., colposcopy; biopsy). 
 
  
  sec.61.41. Reimbursement of Costs. 
 
  (a) Monthly reimbursement for services provided shall be on a unit cost basis. 
Unit costs will be subject to audit by the Texas Department of Health 
(department). The unit cost for the following screening, follow-up, and 
diagnostic procedures will be determined by the applicant and shall not exceed 
the maximum cost as determined by the department: 
 
  (1) breast and cervical cancer screening; 
  
  (2) breast screening only; 
  
  (3) cervical screening only; 
  
  (4) repeat and diagnostic mammograms; 
  
  (5) repeat pap tests; 
  
  (6) colposcopy; and 
  
  (7) colposcopy and biopsy. 
  
  (b) The maximum unit cost for each procedure includes costs for performing 
activities involving: 
 
  (1) outreach; 
  
  (2)  eligibility determination; 
  
  (3) client counseling/education; and 
  
  (4) tracking and follow-up. 
  
  (c) Indirect costs shall be included in the unit cost calculation. 
  
  (d) Applicants may not include the following costs in determining their unit 
cost for each procedure: 
 
  (1) diagnostic procedures, except those specified in this section; 
  
  (2) treatment or treatment services; 
  
  (3) services already being provided; 
  
  (4) building construction, alteration, or renovations; and 
  
  (5) purchased equipment except as justified in relation to conducting the 
screening program, and which has received specific written approval from the 
department. 
 
  
  sec.61.42. Client Charges.  Contractors may not charge fees for services to 
clients who are provided services under the Breast and Cervical Cancer Control 
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 May 26, 1992. 
 TRD-9207173 
  Robert A. MacLean, M.D. 
 Deputy Commissioner 
 Texas Department of Health 
  Effective date: July 1, 1992 
 Proposal publication date: March 26, 1992 
 For further information, please call: (512) 458-7534 
         
  Chapter 115. Home Health Care Agencies 
  
  Licensing and Regulation 
 
  25 TAC sec.sec.115.1, 115.2, 115.5-115.10, 115.12, 115.13, 115.19 
 
  The Texas Department of Health (department) adopts amendments to 
sec.sec.115.1, 115.2, 115.5-115.10, 115.12, 115.13, and 115.19, concerning the 
licensing and regulation of home health care agencies. Sections 115.2, 115.6, 
115.10, and 115.19 are adopted with changes to the proposed text as published in 
the March 20, 1992, issue of the Texas Register  (17 TexReg 2093). Sections 
115.1, 115.5, 115.7-115.9, 115.12, and 115.13 are adopted without changes and 
will not be republished. 
 The amendments clarify the provisions relating to the citing of deficiencies 
during an inspection; require an agency to provide the address in the State of 
Texas of its place of business; clarify the provisions relating to patients' 
clinical records which must be maintained by a home health agency to allow for 
microfilm or certified copies of the records; clarify the tasks a home health 
aide and home health medication aide may perform and may not perform; describe 
the hearing process that the department will follow when an agency requests a 
hearing following the director's disapproval of a training and competency 
evaluation program or competency evaluation program; provide for withdrawal of 
approval of a home health aide training and competency evaluation program or 
competency evaluation program; require the qualification of the registered nurse 
(RN) responsible for home health aide training to conform to the RN 
qualifications in the federal rules; and clarify provisions relating to home 
health medication aide permits including qualification, application, 
reciprocity, application by trainees, examination, permit renewal, and training 
program requirements. 
 The amendments also reflect the recodification of certain sections of Texas 
Civil Statutes into the Health and Safety Code; amendments to Health and Safety 
Code, Chapters 85 and 161; implementation of House Bill 1393, 72nd Legislature, 
1991; and implementation of the Texas Education Code, sec.57.491. The provisions 
added by the amendments concern the prohibition of illegal remuneration and the 
prevention of the transmission of HIV and Hepatitis B virus by infected health 
care workers; the exemption of a licensee from any increased fee or other 
penalty for failure to renew the license in a timely manner if the individual 
was on active duty in the United States armed forces serving outside the State 
of Texas; and the denial of the renewal of a license if the renewal is 
prohibited by the Texas Education Code relating to defaults on guaranteed 
student loans. Further, the department has reorganized the sections for 
clarification; has clarified the definition of "assistance with medication"; and 
has added definitions for "administration of medication" and "association." 
 The following comments were received concerning the proposed amendments. 
 Comment: One commenter stated the adoption preamble should state that the 
qualifications of the RN responsible for the Class B home health aide training 
program shall now conform to the federal rules concerning Class A agencies, 
rather than state that the amendment requires the home health aides to conform 
to the federal rules. 
 Response: The department agrees with the commenter and has entered the language 
in the adoption preamble. 
 Comment: The definition of "Administration of medication" needs clarification. 
 Response: The department agrees and has expanded the definition for 
clarification. 
 Comment: One commenter stated the new language in sec.115.5(b) was redundant 
and implied the business was already operating. 
 Response: The department disagrees. The licensure statute (Health and Safety 
Code, Chapter 142) specifically states a person may not engage in the business 
of providing home health services without a license. Also, sec.115. 3 of the 
rules addresses unregulated agencies providing home health services without a 
license. The department has retained the proposed language. 
 Comment: One commenter stated the language in sec.115.8(d) was prescriptive by 
requiring policies and procedures for the home health agency's implementation of 
the Health and Safety Code, sec.161.091. 
 Response: The department disagrees. The adoption, implementation and 
enforcement of the home health agency's policy for illegal remuneration is the 
most effective means for the department to regulate and evaluate the agency's 
compliance with State law. The Health and Safety Code requires the Board of 
Health to adopt rules that relate to other aspects of home health services as 
necessary to protect the public. The department has retained the proposed 
language. 
 Comment: One commenter requested the language in sec.115.10(c) be changed to 
allow the original record to be maintained at the branch office rather than the 
parent agency. 
 Response: The department agrees in part and has changed the language in new 
sec.115.10(c)(4) to allow for original, microfilmed or certified copies of the 
clinical record to be maintained at the address on the license. Section 115.17 
of the current licensing standards for Class B branch offices still requires 
original medical records and personnel files be maintained at the parent agency. 
 Comment: A commenter requested that the provisions in sec.115.13(c) concerning 
tasks a home health aide may not perform be expanded to include removing 
medications from the package or container. 
 Response: The department agrees and has added the language. 
 Comment: One commenter stated that applicable sections from the department's 
rules relating to the approval of home health medication aide training programs 
and permitting of home health medication aides, administered by the department's 
Professional Licensing and Certification Division, should be incorporated into 
the final rules for purposes of parity. 
 Response: The department agrees and has incorporated the applicable sections 
throughout sec.115.19 of the final rules. 
 Editorial changes for clarification purposes were made in sec.115.6 and 
sec.115.19. 
 The commenters were generally for the adoption; however, they had questions, 
recommendations, and concerns regarding specific provisions in the amendment. 
 Comments received on the proposed rules during the comment period were from the 
Texas Association for Home Care, a Texas Board of Health member and department 
staff. 
 The amendments are adopted under the Health and Safety Code, sec.142.012, which 
provides the Texas Board of Health (board) with the authority to adopt rules to 
establish and enforce minimum standards for the licensing of home health care 
agencies; and sec.12.001, which provides the board with authority to adopt rules 
for the performance of every duty imposed by law upon the board, the department 
and the commissioner of health. 
 
 
  sec.115.2. Definitions.  The following words and terms, when used in these 
sections, shall have the following meanings, unless the context clearly 
indicates otherwise. 
  
     Administration of medication-The direct application of any medication by 
injection, inhalation, ingestion, or any other means to the body of a patient. 
The preparaton of medication is part of the administration of medication and is 
the act or process of making ready a medication for administration, including 
the calculation of a patient's medication dosage; altering the form of the 
medication by crushing, dissolving, or any other method; pouring a quantity of a 
liquid to be ingested; reconstitution of an injectable medication; drawing an 
injectable medication into a syringe; preparing an intravenous admixture; or any 
other act required to render the medication ready for administration. 
  
     Assistance with medication or treatment regimen -Any needed ancillary aid 
provided to a patient in the patient's self-administered medication or treatment 
regimen, such as reminding a patient to take a medication at the prescribed 
time, opening and closing a medication container, returning a medication to the 
proper storage area, and assisting in reordering medications from a pharmacy. 
Such ancillary aid shall not include administration of any medication. 
  
     Association-A partnership, limited liability company, or other business 
entity that is not a corporation. 
  
     Home health medication aide-A person permitted under the Health and Safety 
Code, Chapter 142, Subchapter B. 
  
     Statute-The Health and Safety Code, Chapter 142. 
 
  
  sec.115.6. Inspections. 
 
  (a)-(b) (No change.) 
  
  (c)  After an inspection is completed, the surveyor shall submit a compliance 
record to the department which contains the following: 
 
  (1)-(2) (No change.) 
  
  (3) a plan of correction proposed by the agency and the date(s) by which 
correction(s) must be made if deficiencies are cited and the agency meets 
licensing standards; and 
  
  (4) (No change.) 
  
  (d)  (No change.) 
  
  (e) The surveyor shall prepare a summary report of each inspection and submit 
it to the director for evaluation and decision. If the director determines the 
agency is meeting minimum standards but deficiencies were cited, the director 
shall notify the agency in writing of the standards and request that the agency 
prepare the plan of correction necessary for compliance. If the plan of 
correction is not acceptable, the director will notify the applicant in writing 
within 10 days of receipt of the plan of correction and request that the plan of 
correction be resubmitted within a specified period of time, but no later than 
30 days from the date of the director's letter. 
  
  (f) If a subsequent survey results in evidence of further deficiencies, a plan 
of correction may be requested in accordance with the provisions of this section 
or the director may propose action to deny, suspend or revoke the license. 
 
  
  sec.115.10. Standards for a Class B License. 
 
  (a)-(b) (No change.) 
  
  (c) The agency shall maintain a current roster of patients and have a clinical 
record for each patient which is maintained according to professional standards. 
 
  (1) A clinical record shall contain, as applicable, appropriate identifying 
information; name of practitioner; treatment plan which shall include 
medication, dietary, treatment and activity orders; initial assessment and 
patient care plan; clinical and progress notes (clinical notes are written the 
day service is rendered and incorporated no less often than weekly); medication 
sheet; medication administration records (if applicable); record of patient care 
conference; record of supervisory visits; written statements regarding consumer 
complaints; acknowledgement of receipt of a copy of the Human Resources Code, 
Chapter 102, Rights of the Elderly (as applicable); patient request for and 
acknowledgement of home health medication aides; and discharge summary. All 
entries shall be signed and dated by the person making the entry and/or 
supervisory personnel as is necessary. 
  
  (2) Records shall be retained for five years and safeguarded against loss and 
unofficial use. The agency shall have written procedures governing the use and 
removal of records and the release of information. 
  
  (3) An agency shall provide a copy of the clinical record to a person who has 
obtained the patient's consent for the release of the record. 
  
  (4) The original, microfilmed, or certified copy of the clinical record shall 
be maintained at the address on the license. If the clinical record is 
microfilmed, the microfilm and the equipment needed to read the record must be 
accessible at the time of the on-site inspection of the home health agency. 
  
  (d)-(i) (No change.) 
 
  
  sec.115.19. Home Health Medication Aides. 
 
  (a) General. 
 
  (1)-(2) (No change.) 
  
  (3) Other exemptions shall be as follows. 
 
  (A) A person may administer medication to a patient of an agency without the 
license or permit as required in paragraph (1) of this subsection if the person 
is: 
 
  (i) a graduate nurse holding a temporary permit issued by the Board of Nurse 
Examiners; 
  
  (ii) a student enrolled in an accredited school of nursing or program for the 
education of registered nurses who is administering medications as part of the 
student's clinical experience; 
  
  (iii) a graduate vocational nurse holding a temporary permit issued by the 
Board of Vocational Nurse Examiners; 
  
  (iv) a student enrolled in an accredited school of vocational nursing or 
program for the education of vocational nurses who is administering medications 
as part of the student's clinical experience; or 
  
  (v) a trainee in a medication aide training program approved by the department 
under this chapter who is administering medications as part of the trainee's 
clinical experience. 
  
  (B) An exempt person described in subparagraph (A) of this paragraph shall be 
supervised as follows. 
 
  (i) A person described in: 
 
  (I) subparagraph (A)(i) of this paragraph shall be supervised by a registered 
nurse; 
  
  (II) subparagraph (A)(ii) or (iv) of this paragraph shall be supervised by the 
student's instructor; or 
  
  (III)  subparagraph (A)(iii) of this paragraph shall be supervised by a 
registered nurse or licensed vocational nurse. 
  
  (ii) Supervision must be on-site. 
  
  (C) An exempt person described in this subsection may not be used in a 
supervisory or charge position. 
  
  (b) (No change.) 
  
  (c) Permitted actions. A permit holder is permitted to: 
 
  (1)  observe and report to the agency's registered nurse and document in the 
clinical note reactions and side effects to medication shown by a patient; 
  
  (2) (No change.) 
  
  (3) administer regularly prescribed medication which the permit holder has 
been trained to administer only after personally preparing (setting up) the 
medication to be administered. The medication aide shall document the 
administered medication in the patient's clinical note; 
  
  (4)-(6) (No change.) 
  
  (d) Prohibited actions. Permit holders shall not: 
 
  (1) (No change.) 
  
  (2) administer medication used for intermittent positive pressure breathing 
(IPPB) treatment or any form of medication inhalation treatments; 
  
  (3) administer previously ordered pro re nata (PRN) medication unless 
authorization is obtained from the agency's registered nurse. If authorization 
is obtained the permit holder must: 
 
  (A) document in the patient's clinical notes symptoms indicating the need for 
medication and the time the symptoms occurred; 
  
  (B) document in the patient's clinical notes that the agency's registered 
nurse was contacted, symptoms were described, and permission was granted to 
administer the medication and the time of contact; 
  
  (C)-(D)  (No change.) 
  
  (4)-(9) (No change.) 
  
  (10) apply topical medications that involve the treatment of skin that is 
broken or blistered or when a specified aseptic technique is ordered by the 
attending physician; 
  
  (11) (No change.) 
  
  (12) steal, divert, or otherwise misuse medications; 
  
  (13) violate any provision of the statute or of this chapter; 
  
  (14) fraudulently procure or attempt to procure a permit; 
  
  (15) neglect to administer appropriate medications, as prescribed, in a 
responsible manner; or 
  
  (16) administer medications if the person is unable to do so with reasonable 
skill and safety to patients by reason of drunkenness, excessive use of drugs, 
narcotics, chemicals, or any other type of material. 
  
  (e) Applicant qualifications. Each applicant for a permit issued under the 
statute must complete a training program. Prior to enrollment in a training 
program and prior to application for a permit under this section, all persons: 
 
  (1)-(3) (No change.) 
  
  (4) must be a graduate of a high school or have an equivalent diploma or 
higher degree; and 
  
  (5) (No change.) 
  
  (f) (No change.) 
  
  (g) Nursing graduates. A person who is a graduate of an accredited school of 
nursing and who does not hold a license to practice professional or vocational 
nursing shall meet the training requirements for issuance of a permit under this 
section; provided, however, the date of graduation from the nursing school must 
have been no earlier than January 1 of the year immediately preceding the year 
of application for a permit under this section. 
 
  (1)-(5) (No change.) 
  
  (6) The applicant shall complete the department's written examination. The 
site of the examination shall be determined by the department. Any applicant 
failing to schedule and take the examination within 45 days of the examination 
notice may have his or her application voided. 
  
  (7)-(9)  (No change.) 
  
  (h) Reciprocity. A person who holds a valid license, registration, 
certificate, or permit as a home health medication aide issued by another state 
whose minimum standards or requirements are substantially equivalent to or 
exceed the requirements of this section in effect at the time of application, 
may request a waiver of the training program requirement. 
 
  (1)-(6) (No change.) 
  
  (7) The applicant shall complete the department's written examination. The 
site of the examination shall be determined by the department. Any applicant 
failing to schedule and take the examination within 45 days of the examination 
notice may have his or her application voided. 
  
  (8)-(10) (No change.) 
  
  (i) Application by trainees. An applicant under subsection (e) of this section 
must submit to the department, no later than 30 days after enrollment in a 
training program, all required information and documentation on official 
department forms. 
 
  (1) -(2) (No change.) 
  
  (3) A certified copy or a photocopy which has been notarized as a true and 
exact copy of an unaltered original of the applicant's high school graduation 
diploma or transcript or an equivalent GED diploma or higher degree shall be 
submitted unless the applicant is applying under subsection (g) of this section. 
  
  (4) The department will send a notice listing the additional materials 
required to an applicant who does not complete the application in a timely 
manner. An application not completed within 30 days after the date of the notice 
shall be voided. 
  
  (5)  Notice of application acceptance, disapproval, or deficiency shall be in 
accordance with subsection (q) of this section (relating to Processing 
Procedures). 
  
  (j)-(k) (No change.) 
  
  (l) Permit renewal. Home health medication aides shall comply with the 
following permit renewal requirements. 
 
  (1)-(6) (No change.) 
  
  (7) Home health medication aide permit renewal procedures are as follows. 
 
  (A)-(D) (No change.) 
  
  (E) A permit shall not be renewed if renewal is prohibited by the Texas 
Education Code, sec.57.491. 
  
  (F) If a permit holder fails to timely renew his or her permit, because the 
permit holder is or was on active duty with the armed forces of the United 
States of America serving outside the State of Texas, the permit holder may 
renew the permit pursuant to this subsection. 
 
  (i) Renewal of the permit may be requested by the permit holder, the permit 
holder's spouse, or an individual having power of attorney from the permit 
holder. The renewal form shall include a current address and telephone number 
for the individual requesting the renewal. 
  
  (ii) Renewal may be requested before or after the expiration of the permit. 
  
  (iii) A copy of the official orders or other official military documentation 
showing that the permit holder is or was on active military duty serving outside 
the State of Texas should be filed with the department along with the renewal 
form. 
  
  (iv) A copy of the power of attorney from the permit holder shall be filed 
with the department along with the renewal form if the individual having the 
power of attorney executes any of the documents required in this section. 
  
  (v) A permit holder renewing under this subsection shall pay the applicable 
renewal fee. 
  
  (vi) A permit holder is not authorized to act as a home health medication aide 
after the expiration of the permit unless and until the permit holder actually 
renews the permit. 
  
  (vii) A permit holder renewing under this subsection shall not be required to 
submit any continuing education hours. 
  
  (8)-(9) (No change.) 
  
  (10) Notices of permit renewal approval, disapproval, or deficiency shall be 
in accordance with subsection (q) of this section (relating to Processing 
Procedures). 
  
  (m)-(n) (No change.) 
  
  (o) Training program requirements. 
 
  (1) (No change.) 
  
  (2) The program shall include, but shall not be limited to, the following 
instruction and training: 
 
  (A)-(I) (No change.) 
  
  (J)  drug reactions and side effects of medications commonly administered to 
home health patients; 
  
  (K) instruction on universal precautions; and 
  
  (L) the provisions of this chapter. 
  
  (3) The program shall consist of 140 hours: 100 hours of classroom instruction 
and training, 20 hours of return skills demonstration laboratory, 10 hours of 
clinical experience including clinical observation and skills demonstration 
under the supervision of a registered nurse in a home health agency, and 10 more 
hours in the return skills demonstration laboratory in the preceding order. A 
classroom or laboratory hour shall constitute 50 clock minutes of actual 
classroom or laboratory time. 
 
  (A) Class time shall not exceed four hours in a 24-hour period. 
  
  (B) The completion date of the program shall be a minimum of 60 days and a 
maximum of 180 days from the starting date of the program. 
  
  (C) Each program shall follow the curricula established by the department. 
  
  (4)-(6) (No change.) 
  
  (7) The coordinator shall provide clearly defined and written policies 
regarding each student's clinical experience to the student, the administrator, 
and the director of nursing of the home health agency used for the clinical 
experience. 
 
  (A) The clinical experience shall be counted only when the student is 
observing or involved in functions involving medication administration and under 
the direct, contact supervision of a registered nurse. 
  
  (B) The coordinator shall be responsible for final evaluation of the student's 
clinical experience. 
  
  (8)-(9) (No change.) 
  
  (p)-(q) (No change. ) 
  
  (r) Denial, suspension, or revocation. 
 
  (1)-(3) (No change.) 
  
  (4) If the program administrator for the Home Health Medication Aide Permit 
Program proposes to deny, suspend, or revoke a home health medication aide 
permit or to rescind a home health medication aide program approval, the program 
administrator shall notify the permit holder or home health medication aide 
program by certified mail, return receipt requested, of the reasons for the 
proposed action and offer the permit holder or home health medication aide 
program an opportunity for a hearing. 
 
  (A) The permit holder or home health medication aide program must request a 
hearing within 30 days of receipt of the notice. Receipt of notice is presumed 
to occur on the tenth day after the notice is mailed to the last address known 
to the department unless another date is reflected on a United States Postal 
Service return receipt. 
  
  (B)-(C) (No change.) 
  
  (5) (No change.) 
  
  (6) All hearings shall be conducted pursuant to the Administrative Procedure 
and Texas Register Act, Texas Civil Statutes, Article 6252-13a and the 
department's formal hearing procedures in Chapter 1 of this title (relating to 
the Texas Board of Health). 
  
  (7) If the permit holder or program fails to appear or be represented at the 
scheduled hearing, the permit holder or program has waived the right to a 
hearing and the proposed action shall be taken. 
  
  (8)  If the department suspends a home health medication aide permit, the 
suspension shall remain in effect until the department determines that the 
reason for suspension no longer exists. The department shall investigate prior 
to making a determination. 
 
  (A) During the time of suspension, the suspended permit holder shall return 
his or her permit to the department. 
  
  (B) If a suspension overlaps a renewal date, the suspended permit holder may 
comply with the renewal procedures in this chapter; however, the department may 
not renew the permit until the department determines that the reason for 
suspension no longer exists. 
  
  (9) If the department revokes or does not renew a permit, a person may reapply 
for a permit by complying with the requirements and procedures in this chapter 
at the time of reapplication. 
 
  (A) The department may refuse to issue a permit if the reason for revocation 
or non-renewal continues to exist. 
  
  (B) Upon revocation or non-renewal, a permit holder shall return the license 
or permit to the department. 
 
  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 May 22, 1992. 
 TRD-9207158 
  Robert A. MacLean, M.D. 
 Deputy Commissioner 
 Texas Department of Health 
  Effective date: July 1, 1992 
 Proposal publication date: March 20, 1992 
 For further information, please call: (512) 834-6647 
         
  Chapter 125. Special Care Facilities 
  
  25 TAC sec.sec.125.1-125.7 
 
  The Texas Department of Health (department) adopts amendments to 
sec.sec.125.1-125.7, concerning special care facilities. Sections 125.1 and 
125.6 are adopted with changes to the proposed text as published in the March 
13, 1992, issue of the Texas Register (17 TexReg 1884). Sections 125.2-125.5, 
and sec.125.7 are adopted without changes and will not be republished. 
 Licensure inspections which have been conducted in these facilities have 
revealed areas in the rules which need to be modified or eliminated to 
facilitate the facilities' effectiveness in providing services to the 
individuals which they serve and in the facilities' abilities to provide these 
services. The amendments also reflect the recodification of certain sections of 
Texas Civil Statutes into the Health and Safety Code; amendments to Health and 
Safety Code, Chapters 85 and 161; and the enactment of House Bill 1393, 72nd 
Legislature, 1991. 
 In addition, the provisions added by the amendments concern the prohibition of 
illegal remuneration, the prevention of the transmission of HIV and Hepatitis B 
virus by infected health care workers, and the exemption of a license from any 
increased fee or other penalty for failure to renew the license in a timely 
manner if the individual license holder failed to renew the license in a timely 
manner because the individual was on active duty in the United States armed 
forces serving outside the State of Texas. 
 Finally, the sections have been reorganized for clarification and the 
construction standards have been revised to provide a more appropriate 
application to the facilities which they regulate. Other amendments clarify the 
definitions of "assistance with medication or treatment regimen," "dangerous 
drugs," and "drug;" add definitions of "administration of medication," 
"medication," "occupancy," and "practitioner"; and provide for the increase in 
construction inspection fees and plan review fees in order to offset the 
department's costs in conducting the inspections and plan reviews. 
 The department received one comment concerning the proposed rules. Concerning 
sec.125.1, the commenter stated that the definition of "administration of 
medication" should be clarified. The department agrees and has expanded the 
definition for clarification. 
 Minor editorial changes have been made in sec.125.6(f)(7)(G) and (8)(B) for 
clarification purposes. 
 The amendments are adopted under the Health and Safety Code, sec.248.026, which 
authorizes the Texas Board of Health (board) to adopt rules to establish and 
enforce minimum standards for the licensing of special care facilities; and 
sec.12.001, which provides the board with authority to adopt rules for the 
performance of every duty imposed by law upon the board, the department, and the 
commissioner of health. The amendments affect the Health and Safety Code, 
Chapter 248. 
 
 
  sec.125.1. Definitions.  The following words and terms, when used in this 
chapter, shall have the following meanings, unless the context clearly indicates 
otherwise. 
  
     Act-The Texas Special Care Facility Licensing Act, Health and Safety Code, 
Chapter 248. 
  
     Administration of medication-The direct application of any medication by 
injection, inhalation, ingestion, or any other means to the body of a patient. 
The preparaton of medication is part of the administration of medication and is 
the act or process of making ready a medication for administration, including 
the calculation of a patient's medication dosage; altering the form of the 
medication by crushing, dissolving, or any other method; pouring a quantity of a 
liquid to be ingested; reconstitution of an injectable medication; drawing an 
injectable medication into a syringe; preparing an intravenous admixture; or any 
other act required to render the medication ready for administration. 
  
     Assistance with medication or treatment regimen -Any needed ancillary aid 
provided to a resident in the resident's self-administered medication or 
treatment regimen, such as reminding a resident to take a medication at the 
prescribed time, opening and closing a medication container, returning a 
medication to the proper storage area, and assisting in reordering medications 
from a pharmacy. Such ancillary aid shall not include administration of any 
medication. 
  
     Controlled substance -A drug, controlled substance, or immediate precursor 
as defined in the Texas Controlled Substance Act, Health and Safety Code, 
sec.481.002, or the Federal Controlled Substance Act of 1970, Public Law 91-513. 
  
     Dangerous drugs -Any dangerous drug as defined in the Texas Dangerous Drug 
Act, Health and Safety Code, sec.483.001. 
  
     Drug-A drug is: 
 
  (A) any substance recognized in the official United States Pharmacopoeia 
National Formulary or any supplement to it; 
  
  (B) any substance designed or intended for use in the diagnosis, cure, 
mitigation, treatment, or prevention of disease in man or other animals; 
  
  (C) any substance, other than food, intended to affect the structure of any 
function of the body of man or other animals; or 
  
  (D)  any substance intended for use as a component of any substance specified 
in subparagraphs (A)-(C) of this paragraph. The term does not include devices or 
their components, parts, or accessories. 
  
     Local health authority-The physician having local jurisdiction to 
administer state and local laws or ordinances relating to public health as 
defined in the Health and Safety Code, Chapter 121, Subchapter B. 
  
     Medication-A drug or controlled substance dispensed on prescription or 
obtained over the counter. 
  
     Occupancy-The purpose for which a building or portion thereof is used or 
intended to be used as determined by the local authority having jurisdiction. 
Special care facilities may fall under various occupancies, such as residential, 
residential board and care, custodial care, day care, educational, 
institutional, and one and two family dwellings as determined by the local 
authority having jurisdiction. In the absence of any local authority, the 
occupancy classification will be determined by the definitions of the National 
Fire Protection Association (NFPA 101, Chapter 4). 
  
     Practitioner-A person who is currently licensed in the State of Texas as a 
physician, dentist, or podiatrist. 
 
  
  sec.125.6. Standards. 
 
  (a) Administrative management. 
 
  (1)  General requirements. 
 
  (A) A special care facility shall comply with all applicable state and local 
laws. 
  
  (B) The license will specify the maximum number of residents who can be cared 
for at any one time. 
  
  (C) Copies of this chapter shall be available to the personnel and residents 
of the facility upon request. 
  
  (D) The facility management upon request shall make available to the 
department representatives copies of pertinent facility documents or records 
which in the opinion of the representatives contain evidence of conditions that 
threaten the health and safety of residents. Such documents and records are 
residents' medical records including health care notes, pharmacy records, 
medication records, physicians' orders, and incident/accident reports concerning 
residents. 
  
  (E) Each facility shall conspicuously and prominently post the facility 
license. 
  
  (F) All accidents, whether resulting in injury, and any unusual incidents or 
abnormal events, including allegations of mistreatment of residents by staff, 
personnel, or visitors, shall be described in separate administrative records 
filed in the director's office. Certain procedures regarding accidents, unusual 
incidents, and abnormal events shall be observed as directed by the department. 
  
  (G) Within 72 hours of admission, the facility must prepare a written 
inventory of the personal property a resident brings to the facility. The 
facility does not have to inventory the resident's clothing. If requested by the 
resident or responsible party, the inventory shall be updated. The facility 
should have a mechanism to protect resident clothing. 
  
  (H) Grounds for denial, revocation, or suspension of the license in accordance 
with sec.125.7 of this title (relating to License Denial, Suspension, or 
Revocation and Criminal Penalties) may exist when there is substantiated 
evidence of the owner, director, or any employee willfully inflicting injury, 
physical suffering, or mental anguish on any resident in a facility; the failure 
of management, who is knowledgeable of a substantiated case of physical or 
mental abuse or neglect, to take corrective action; or the failure of 
management, who has cause to believe that a resident's physical or mental health 
or welfare has been or may be adversely affected by abuse or neglect caused by 
another person, to report it to the department. 
  
  (I)  A license may not be transferred or assigned. 
  
  (2) Operating policies and procedures. The facility shall comply with its own 
written policies and procedures. All policies shall be reviewed and updated 
annually. 
 
  (A) The facility shall have a written policy and procedure manual detailing 
the overall operating policies and procedures. The manual shall include 
information on admission and admission agreements, resident care services, 
charges or reimbursement for services, expectations of residents, transfers, 
discharges, complaint procedures, use of volunteers, protection of residents' 
personal property, and resident's rights. 
  
  (B) A facility shall adopt, implement, and enforce a written policy to ensure 
compliance of the agency and its employees, volunteers, and contractors with the 
Health and Safety Code, sec.161.091 relating to the prohibition of illegal 
remuneration for securing or soliciting patients or patronage. 
  
  (C) The facility shall have written personnel policies and procedures. These 
policies and procedures must be explained to employees when first employed and 
be made available to them. 
  
  (D) In accordance with personnel policies, the facility may hire and retain 
employees with certain communicable diseases based on their abilities to perform 
on the job adequately and safely and on their willingness to follow prescribed 
measures to prevent the transmission of infections. Questions of employee 
infectious status and ability to perform duties should be resolved by 
consultation with a physician and/or local health authorities. 
  
  (E) (No change.) 
  
  (F) The facility shall ensure that personnel records are correct and contain 
sufficient information to support placement in the assigned position (including 
a resume of training and experience). Where applicable, a current copy of the 
person's license or permit shall be in the file. If copying of a license is 
prohibited, the file shall include a notation of when the license was verified. 
  
  (G) If the resident or the resident's responsible party entrusts the handling 
of cash to the facility, simple accounting records of receipts and expenditures 
of such cash shall be maintained. These funds must be separate from the 
facility's operating accounts. 
  
  (H) The facility is encouraged to provide assistance to the residents in their 
securing or arranging for transportation to meet the residents' transportation 
needs. 
  
  (I) In the case of an acute episode, a serious change in the resident's 
condition, or death, the resident's responsible party shall be notified as soon 
as possible. 
  
  (J)  If a facility does not employ a person qualified to provide a required or 
needed service, it shall have arrangements with an outside resource that has the 
necessary qualifications to provide the service directly to residents or to act 
as a consultant to the facility. Facility policies shall state the methods used 
to provide required or needed services. The facility may employ personnel or use 
appropriate volunteer services or arrange with outside resources to provide 
services to residents or to act as consultants to the facility. Regardless of 
the method or combinations of methods used, staff performing services must be 
appropriately qualified or supervised. 
  
  (3)  Legal responsibility. There shall be an individual or individuals which 
assume(s) full legal responsibility for the overall conduct of the facility and 
are responsible for compliance with all applicable laws and rules of the 
department. 
  
  (4) Facility director. 
 
  (A) The facility director, who is to be accountable for the overall management 
of the facility, shall be named in writing. 
  
  (B) The director's responsibilities shall be defined in writing. 
  
  (C) If the facility can be successfully managed with less than the director's 
full-time management, the director may be less than full-time. In such 
instances, the director shall assign another responsible individual who can 
perform management tasks so that there is administrative management essentially 
for the usual and customary 40-hours-per-week business operations. 
  
  (D) There shall be a competent individual authorized to be in charge of the 
facility when the director is absent. 
  
  (E) The director shall be at least 18 years of age and shall be physically, 
mentally, and emotionally able to perform the duties of operating the facility. 
  
  (F) The director shall be responsible for coordinating the provision of all 
services. 
  
  (5) Medical care. The facility shall make arrangements for appropriate medical 
care as needed. 
  
  (6) Staff development. Staff and/or volunteers shall be oriented to the basic 
philosophy of the facility and shall be given periodic training to update their 
knowledge and skills in providing care to residents. Training must include the 
facility's policy on confidentiality of patient's medical records. Training may 
be provided by the facility or by another appropriate entity. 
  
  (7) Volunteer services. 
 
  (A) The facility shall provide written guidelines to volunteers concerning 
areas such as confidentiality, infection control and sanitation, and security. 
It is recommended that volunteers sign a confidentiality agreement. 
  
  (B)  Volunteers may be utilized in the following areas and in any other area 
in which they have the necessary qualifications for the assignment such as peer 
counseling, support groups, advocacy, information and referral, assistance with 
activities of daily living, spiritual support, grief work for both resident and 
significant others, recreational programs, errands, transportation, and facility 
housekeeping and maintenance. 
  
  (C) All volunteers will receive documented orientation to the facility which 
will include at a minimum location of fire alarm system; emergency procedures, 
including emergency phone numbers; evacuation plan; availability of counseling 
programs, support groups, and advocacy information; the facility's policy on 
confidentiality of medical records and information pertaining to patient's 
diagnosis, treatment, and identification; and the general mission statement of 
the facility. 
  
  (D) All volunteers will receive documented training on job specifics of all 
assigned tasks. A detailed job description will be developed for each category 
of volunteer and be signed and dated by the volunteer acknowledging that he or 
she has read and understand the requirements and limitations of his or her 
assigned duties, and the facility's policy regarding the confidentiality of 
patient identity and information contained in medical records. 
  
  (E) All volunteers who are performing duties that require licensure, 
certification, or registration must currently be licensed, certified, or 
registered by the appropriate board or agency and a copy of their credentials 
shall be kept on file in the facility. If the copying of a license or 
certification is prohibited, the file shall include a notation of when the 
license or certification was verified. 
  
  (b)  Minimum construction standards. 
 
  (1) A facility that is classified as an institutional occupancy shall comply 
with the requirements found in National Fire Protection Association (NFPA) 101, 
Life Safety Code, Chapter 12 (relating to new construction) and Chapter 13 
(relating to existing facilities) , and building codes applicable to 
institutional use. New construction shall be subject to applicable local codes 
covering construction and electrical and mechanical systems for the occupancy. 
In the absence of, or absence of enforcement of the local codes, the department 
shall require conformance to the fundamentals of the following codes: 
 
  (A) the appropriate sections of NFPA 101, Life Safety Code; 
  
  (B) nationally recognized building codes, such as the Standard Building Code 
(1984) of the Southern Building Code Congress, International, Inc., or the 
Uniform Building Code (1988) of the International Conference of Building 
Officials. The nationally recognized codes used by a single facility shall be 
publications of the same group or organization so as to assure the intended 
continuity; 
  
  (C) the Handbook of Fundamentals of the American Society of Heating, 
Refrigeration, and Air Conditioning Engineers; the NFPA National Electrical Code 
(NFPA 70); 
  
  (D) for handicap provisions, American National Standards Institute, Standard 
A117.1-1980, the applicable requirements of the Texas General Services 
Commission, and the applicable provisions of the Americans with Disabilities Act 
and the regulations promulgated by that law; and 
  
  (E)  the National Standard Plumbing Code (1983) of the National Association of 
Plumbing Heating Cooling Contractors. 
  
  (2) A facility may impose more stringent construction standards than the 
minimum construction standards in this subsection. 
  
  (3) A facility that is classified by an occupancy other than institutional 
shall comply with the applicable requirements found in NFPA 101, Chapter 4, 
relating to classification of occupancy and hazards of contents; and with the 
sections found in NFPA 101 which apply to the occupancy in question and with 
applicable building codes. 
  
  (4) All buildings or structures, new or existing, used as licensed facilities 
shall be in accordance with the standards in this chapter. 
  
  (5) For existing buildings and structures which are converted to facilities, 
the department may modify those requirements, which, if strictly applied, would 
clearly be impractical in the judgment of the department. Any such modifications 
will be allowed only to the extent that reasonable accommodations to protect 
health and safety are provided and maintained. 
  
  (6) Residents may not be admitted until all standards are met and approval for 
occupancy is granted by the department. 
  
  (7) The facility shall conform to all applicable state laws and local codes 
and ordinances. When such laws, codes, and ordinances are more stringent than 
the provisions of this chapter, the more stringent requirements shall govern. 
Should state laws or local codes or ordinances be in conflict with the 
requirements of the standards in this chapter, the department shall be informed 
so that these conflicts may be legally resolved. 
  
  (8) When a common wall exists between a facility and another occupancy, the 
common wall between the facility and the other occupancy shall be not less than 
a two-hour noncombustible fire rated partition as is defined in NFPA 101, Life 
Safety Code, Chapter 6 (relating to features of fire protection), unless 
approved otherwise by the department. A licensed hospital, nursing home, 
custodial care home, or personal care home is not considered another occupancy 
for this purpose. 
  
  (9) Planning, construction, procedures, and approvals shall be done in 
conformance with the following provisions. 
 
  (A) A facility may request the approval of the department of its construction 
plans unless approval is required under subparagraph (B) of this paragraph. 
  
  (B) A facility shall submit construction documents to the director for 
approval if it is anticipated that the facility will fall under the 
institutional occupancy or if 16 or more residents will occupy the facility. The 
plans that are submitted shall be drawn to scale; include a plot plan; and 
indicate the usages of all spaces, sizes of areas and rooms, and the kind and 
location of fixed equipment. 
 
  (i) The plot plan shall show all structures within 20 feet of the facility. If 
the local governmental unit has a building official charged with the enforcement 
of a local code, that authority's review of the drawings and specifications is 
required. 
  
  (ii) The facility shall pay the required fee for plan review and inspection of 
construction at the time the proposed plans are submitted. 
  
  (C) Before licensing, the facility shall be approved by the local fire marshal 
having jurisdiction for compliance with local ordinances or requirements. In the 
absence of a local fire marshal, the state fire marshal shall have jurisdiction. 
These approvals shall be provided to the department at the time of final 
inspection for licensure purposes. 
  
  (10) Facility location shall be determined using the following considerations. 
 
  (A) The facility shall be located so as to promote at all times the health, 
comfort, safety, and well-being of the residents. 
  
  (B) The facility shall be serviced by a paid or volunteer fire fighting unit 
as approved by the department. Water supply for fire fighting purposes shall be 
as required or approved in writing by the fire fighting unit serving the area. 
  
  (C) Any site conditions that can be considered a fire hazard, health hazard, 
or physical hazard shall be corrected by the facility as determined by the 
department. 
  
  (c) Personal safety and comfort. 
 
  (1) Fire alarm systems shall be required only in a facility which is required 
to have a system by local codes or under the applicable NFPA 101 occupancy 
category. 
  
  (2) Approved smoke detectors shall be installed in all habitable areas, such 
as residential bedrooms, public areas, staff areas, and kitchens, except offices 
and workrooms. The primary power source for the smoke detector shall be from a 
commercial electrical source except that a facility which is licensed for six or 
less residents may use approved battery operated smoke detectors. 
  
  (3) The fire alarm smoke detector systems shall be maintained in working 
condition at all times. The system will be tested on a regular basis not to 
exceed quarterly between tests. Documentation of quarterly tests shall be 
maintained. 
  
  (4) Approved portable fire extinguishers shall be provided as required by the 
state or local fire authority having jurisdiction. 
  
  (5)  General fire safety shall be observed at all times. 
 
  (A) Storage items shall be neatly arranged and placed to minimize fire hazard. 
Gasoline, volatile materials, paint, and similar products shall not be stored in 
the building housing the residents. Accumulations of extraneous material and 
refuse shall not be permitted. Storage of items, such as janitor supplies, shall 
be provided in closets or spaces separate from residential use areas. 
  
  (B) The building shall be kept in good repair and electrical, heating, and 
cooling systems shall be maintained in a safe manner. Use of electrical 
appliances, devices, and lamps shall be such as not to overload circuits and not 
to require extension cords. 
  
  (C) All fires shall be reported to the department within 72 hours; however, 
any fire causing injury or death to a resident shall be reported immediately to 
the department and appropriate law enforcement authority. A report of a fire to 
which the local fire authority has responded shall be followed by a copy of the 
local fire authority's report. All reports of fire shall be submitted to the 
department within 30 days on a form supplied by the department. 
  
  (D) All personnel shall be familiar with the locations of fire- fighting 
equipment. There shall be a fire exit drill of personnel at least quarterly. 
Exit drills shall include suitable procedures to make sure that all persons in 
the building or all persons subject to the drill actually participate. In the 
conduct of the drills, emphasis shall be on the orderly evacuation under proper 
discipline rather than upon speed. 
  
  (6) Waste and storage containers shall be used in the appropriate areas. 
 
  (A) Metal wastebaskets of substantial gauge or Underwriters Laboratories, Inc. 
(U.L.) approved plastic trash containers shall be provided for bedrooms, 
offices, staff areas, lounges, and similar locations in a facility. 
  
  (B) Garbage, waste, or trash containers provided for kitchens, janitor 
closets, laundries, general storage, and similar places must meet U.L. 
standards. Disposable plastic liners may be used in these containers for 
sanitation. 
  
  (C) Plastic containers with lids are acceptable for storage of staple foods in 
the pantry. Dishwashing chemicals used in the kitchen may be stored in plastic 
containers provided they are the original containers in which the manufacturer 
packaged the chemicals. 
  
  (D) All infectious waste and waste disposal procedures must comply with the 
department's rules and regulations concerning definition, treatment, and 
disposal of special waste from health-care related facilities, under Chapter 1 
of this title (relating to Texas Board of Health). 
  
  (7) The facility shall comply with the following requirements of safety and 
comfort. 
 
  (A)  All new carpet installed in public corridors and paths of egress shall 
have a maximum flame spread rate of 75 based on the "radiant panel test." Proper 
documentation must be provided on the letterhead of the testing company. 
  
  (B) Only open flame heating devices which have been listed by a testing 
laboratory approved by the National Bureau of Standards shall be used in the 
appropriate locations within the facility. All fuel burning heating devices 
shall be vented. Working fireplaces shall have a glass enclosure that will 
withstand 650 degrees Fahrenheit temperature. 
  
  (C) Smoking regulations and designated smoking areas shall be established. 
Ashtrays of noncombustible material and safe design shall be provided. 
  
  (D) The facility shall develop and conspicuously post throughout the facility 
an emergency evacuation plan approved by the local fire marshal having 
jurisdiction and the department. 
  
  (E) There shall be at least one non-coin operated telephone in the facility 
available to both staff and residents use in case of emergency. Emergency 
telephone numbers shall be posted conspicuously at or near the telephone in a 
place that can be read while using the telephone. 
  
  (F) Storage of hazardous items such as janitor supplies and equipment shall be 
provided in closets or spaces separate from resident-use areas. Closets or 
spaces shall be maintained in a safe and sanitary condition and ventilated in a 
manner commensurate with the use of the closet or space. 
  
  (G) All exterior site conditions shall be designed, constructed, and 
maintained in the interest of resident safety. Guard rails, fences, and hand 
rails shall be provided where needed. Grounds, grass, shrubbery, trees, and 
other site features shall be maintained in a neat and attractive manner. 
  
  (H) Tubs and showers shall have non-slip bottoms or floor surfaces, either 
built-in or applied to the surface. 
  
  (I) All lavatories and bathing units shall be supplied with hot water in 
quantities to meet the needs of the residents. Hot water shall be controlled not 
to exceed 120 degrees Fahrenheit. 
  
  (J) Cooling and heating shall be provided for resident comfort. Conditioning 
systems shall be capable of maintaining the comfort ranges of heating and 
cooling. 
  
  (K) The facility shall be well ventilated through the use of windows, 
mechanical ventilation, or a combination of both. 
  
  (L) Illumination, either natural or artificial, shall be provided to supply 
the needs of the residents and staff without eye strain or glare. Each resident 
bedroom shall have sufficient illumination for reading and general use. 
  
  (M) A passenger elevator shall be provided in the facility for resident 
bedroom and use areas which are on the third floor or higher, the street floor 
being considered the first floor. Applicable codes shall be observed in the 
design and construction of elevators. 
  
  (N)  It is desirable that finish materials, colors, decorations, and 
furnishings contribute to physical and emotional comfort. Furniture shall be 
substantial and stable and of design commensurate with its function and use. 
Loose rugs creating a hazard shall not be permitted. Building features, 
furnishings, and furniture shall be provided and maintained free of hazardous 
conditions and in the interest of continuing resident benefit. 
  
  (O)  There shall be no occupancies or activities undesirable to the health and 
safety of the residents in the buildings or on the premises of the facility. 
  
  (d) Sanitary environment. 
 
  (1)-(7) (No change.) 
  
  (8)  All bathrooms, toilet rooms, and other odor-producing rooms or areas for 
soiled and unsanitary operations shall be ventilated for odor control by means 
of operable windows or powered exhaust. 
  
  (9) (No change.) 
  
  (10)  Floors shall be maintained in good condition and cleaned regularly; 
walls and ceilings shall be structurally maintained, repaired, and repainted or 
cleaned as needed. Storage areas, attics, and cellars shall be free of refuse 
and extraneous materials. 
  
  (11) Clean linen shall be available in a quantity sufficient to meet the needs 
of the residents. Clean linens shall be stored in clean linen storage areas. 
  
  (e) Accommodations. 
 
  (1)  Resident bedrooms. 
 
  (A) (No change.) 
  
  (B) Usable bedroom floor space shall be not less than 80 square feet for a 
one-bed room and not less than 60 square feet (40 square feet where bassinets or 
cribs are used) per bed for a multiple-bed room. Larger rooms are recommended 
for those residents needing nursing care. A bedroom shall be not less than eight 
feet in the smallest dimension, unless specifically approved otherwise by the 
department. 
  
  (C) (No change.) 
  
  (D) In the bedrooms and for each resident there shall be a bed, chair, table, 
dresser, and closet space or wardrobe providing security and privacy for 
clothing and personal belongings. 
  
  (E) (No change.) 
  
  (F) All resident rooms shall open upon a hallway or corridor leading to an 
exterior exit either by stairway or a door opening to the exterior. 
  
  (G) All resident rooms shall be arranged for convenient and sheltered resident 
access to living or public areas, restrooms, and dining facilities. 
  
  (2) Resident toilet and bathing facilities. 
 
  (A) (No change.) 
  
  (B) One water closet and one lavatory shall be provided for each four 
residents or fraction thereof. Where the needs of residents require, the 
facility may supplement this number by using bedside commodes, although water 
closets are preferable. Provisions may be needed for additional toilets and 
handwashing facilities for staff and the general public if the department 
determines the residents' facilities are not conveniently accessible. One tub or 
one shower shall be provided for each six residents or fraction thereof. 
  
  (C) (No change.) 
  
  (D) Soap and towel dispensers or the equivalent shall be provided at all 
handwashing facilities. 
  
  (3) Recreation, living, or day room. 
 
  (A) Recreation, living, or day room space and furniture shall be provided to 
allow seating of residents. Each facility shall have at least one space of not 
less than 144 square feet. A facility with a capacity of nine or more residents 
shall provide a space of 10 square feet more per resident in addition to the 144 
square feet minimum. 
  
  (B) At least one of the recreation, living, or day room areas shall have 
exterior windows providing a view to the outside. 
  
  (4) Parking. The facility shall provide adequate parking accommodations for 
the staff, residents, and visitors. 
  
  (f) Care and services. 
 
  (1) Admission. 
 
  (A) (No change.) 
  
  (B) Upon admission, the resident, responsible party, or facility responsible 
for the placement of the resident shall see that arrangements are made for the 
medical care of the resident by a designated attending physician or alternate 
physician. 
  
  (C) The facility shall secure at the time of admission appropriate identifying 
information, including full name; sex; date of birth; usual occupation; social 
security number; family/friend name, address, and telephone number; and 
physician names and telephone numbers including emergency numbers. 
  
  (D) There shall be in easily understood wording a written admission agreement 
between a facility and a resident. The agreement shall specify such details as 
services to be provided and how services will be reimbursed, and shall be based 
on the operational policies. 
  
  (E) The facility shall maintain a chronological register of all residents 
admitted to and discharged from the facility. The register shall contain at 
least the name of the resident, date of birth, date of admission, date of 
discharge/death, and disposition (where resident went including address). 
  
  (F) The facility shall have a written resident care document detailing the 
services provided. A list of the medications the resident is taking shall be 
included in the document. The resident, if capable, shall participate in the 
care document's preparation and update as needed. The facility is not required 
to obtain copies of records which document the care provided by other providers. 
  
  (2) Staffing. 
 
  (A) The facility shall be staffed with personnel or shall arrange through 
outside resources or volunteers for personnel in the quantity and of the 
disciplines, professions, or types necessary to provide the types and kinds of 
services stated in the policies of the facility. 
  
  (B) For residents requiring nursing care, including the administration of 
injectable or intravenous medications or medications by tube into a body cavity, 
direct care facility personnel shall be registered professional nursing 
personnel, licensed vocational nursing personnel or may be outside resource 
personnel or volunteers with the required qualifications. 
  
  (C) There shall be personnel, as needed to maintain cleanliness, sanitation, 
and safety; to prepare and serve meals; to keep a supply of clean linen; and to 
assure that each resident receives the kind and amount of supervision and care 
required to meet his or her basic needs. These personnel may be employees, be 
arranged for, be volunteers, or, where appropriate, be residents themselves, 
depending on the policies of the facility. In some facilities, these personnel 
may perform these functions on a periodic, as compared to an ongoing, basis. 
  
  (D) At least one or more appropriate staff person(s) as needed shall be on 
duty at all times. Each shift or tour of duty shall have an appropriate staff 
person designated in charge. This person shall be qualified to recognize and 
respond to obvious sudden changes in a resident's condition and obtain necessary 
consultation or direct assistance by others. 
  
  (3) Physician services. 
 
  (A) Each resident shall have a designated attending physician who is in charge 
of the medical care of the resident. 
  
  (B) The facility shall make a reasonable effort to contact the resident's 
physician within 72 hours after admission to obtain any information relating to 
the care of the resident. Any relevant information obtained from the physician 
will be recorded on the resident care document. 
  
  (C) In the event of an acute illness, condition, or accident requiring medical 
and/or nursing care beyond the capabilities of the facility, the resident shall 
be transferred to a hospital or other health care facility as appropriate where 
needed services and facilities are available. 
  
  (4)  Nursing services. 
 
  (A) Licensed nurses shall function consistent with the nursing practices 
recognized and authorized by their licensing boards in Texas. 
  
  (B) When nursing services are provided, nursing personnel shall assure that 
residents requiring nursing care receive treatments, medications, and diets as 
prescribed; receive preventive care to discourage decubiti; are kept 
comfortable, clean, and well-groomed; are protected from accident and injury by 
adoption of indicated safety measures; and are treated with kindness and 
respect. Duties of nursing personnel consist of direct resident care and 
services. 
  
  (C) Nursing or attendant personnel on duty shall be responsible to obtain 
emergency medical care when a resident's condition so requires and shall notify 
the applicable attending physician. 
  
  (5) Infection control. The facility shall have written policies and procedures 
for the control of communicable diseases and infections in personnel, residents, 
volunteers or visitors, and for a safe and sanitary environment. A facility 
shall adopt, implement, and enforce a written policy to ensure compliance of the 
facility and its employees, volunteers, and contractors with the Health and 
Safety Code, Chapter 85, Subchapter I, relating to the prevention of the 
transmission of human immunodeficiency virus and hepatitis B virus. 
  
  (6) Resident file. 
 
  (A) The facility shall maintain for each resident admitted, a separate file 
with all entries kept current, dated, and signed by the recorder. The file shall 
include: 
 
  (i) identification data as identified in paragraph (1)(C) of this subsection; 
  
  (ii) medical history and physical exam reports, if available; 
  
  (iii) any physician orders and progress notes, if available; 
  
  (iv) any documentation of the resident's change in health condition requiring 
emergency procedures and/or health services provided by facility personnel; 
  
  (v) other documents or reports related to the care of the resident as required 
by facility policy; 
  
  (vi)  if appropriate, documentation of nursing services provided and nursing 
staff observation as required by facility policy; and 
  
  (vii) a list of medications the resident is taking. 
  
  (B) The director shall be responsible for the organization and management of 
the resident file. 
  
  (C)  The facility will protect the resident file against loss, damage, 
destruction, and unauthorized use by: 
 
  (i) safeguarding the confidentiality of the resident file and allowing access 
or release only as specifically allowed by federal or state laws; 
  
  (ii) maintaining files in an organized manner, storing them in a protective 
device (manila folder, ring binder, envelope, etc.), and filing them using an 
organized system; 
  
  (iii) recording entries in ink, computer, or typewritten format and keeping 
original reports and records; and 
  
  (iv) storing files in a lockable area during non-use and after resident's 
discharge. 
  
  (D) The following pertains to resident files. 
 
  (i)  Resident files must be retained for at least five years after services 
end. In the case of a minor, the resident file must be retained for at least 
three years after the minor reaches majority under state law. 
  
  (ii)  The facility may not destroy resident files that relate to any matter 
that is involved in litigation if the facility knows the litigation has not been 
finally resolved. 
  
  (iii) Each resident of the facility shall have an opportunity to comply with 
the provisions of the Natural Death Act, Health and Safety Code, Chapter 672, if 
the resident desires to execute a directive under the Act. 
  
  (iv) In the event of change of ownership, the new management shall maintain 
proof of the medical information required for the continuity of services of 
residents. 
  
  (7) Medications. 
 
  (A) Medications shall be provided as required for those residents on a 
physician-ordered medication therapy regimen. 
  
  (B) Upon admission, and as part of the care plan, the admitting physician 
shall determine whether a resident can self-administer his or her medications or 
will require administration by qualified personnel in accordance with 
subparagraph (G) of this paragraph. 
  
  (C) Each resident's health status shall be reviewed at least quarterly, or 
more often if indicated, to determine if any changes are necessary in the 
medication administration procedures. 
 
  (i)  The appropriateness for a resident to self-administer medications shall 
be reviewed by the facility director and attending physician. 
  
  (ii)  A resident's drug regimen review shall be incorporated into the 
individual's plan of care. 
  
  (D) Residents self-administering their medications may: 
 
  (i) keep them in their possession; 
  
  (ii)  secure their medications in a lockable cabinet in their room or within 
the room itself if the room is not shared with others and can be secured. Only 
the resident and authorized facility staff shall have access to the secured 
medications; or 
  
  (iii) allow the facility to keep residents' medications in a central 
medication storage area under control of facility staff. 
  
  (E) The central medication storage shall be lockable and shall be kept locked 
when facility staff are not actually in or at the storage area. 
  
  (F) Residents may be permitted entrance or access to the storage area for the 
purpose of self-administering their medications or treatments or receiving 
assistance with their medication or treatment regimen. A facility staff member 
shall remain in or at the storage area the entire time any resident is in the 
storage area. 
  
  (G) Medications that are administered to a resident shall be administered only 
by a registered professional nurse, licensed vocational nurse, practitioner, or 
individual under direct delegation orders by a physician and in conformance with 
all laws, rules, and recognized professional standards of practice. A home 
health agency who is providing services within a special care facility may use a 
home health medication aide only in accordance with sec.115.19(c) of this title 
(relating to Home Health Medication Aides). 
 
  (i) The person administering medications shall properly record in the 
appropriate record the medications administered. This record will be retained in 
the resident file. 
  
  (ii) Medications may not be taken by or administered to residents unless the 
medication was obtained directly from or under a valid prescription or order of 
a physician. All medications administered to residents shall be upon written 
orders or verbal orders subsequently verified in writing by the treating 
physician. 
  
  (iii) All injectables, intravenous solutions, or medications administered by 
way of a tube inserted in a cavity of the body shall be administered by a 
physician, registered professional nurse, or licensed vocational nurse under 
physician's orders. 
  
  (iv) If administration of medications to residents is performed by a 
registered professional nurse or licensed vocational nurse the following shall 
apply. 
  
  (v) There shall be a specific area designated for medication that is: 
 
  (I) sufficient in size and/or space for the storage of all medications that 
are being administered to residents and for the preparation of medications for 
administration to residents; 
  
  (II) lockable and shall be maintained locked at all times when not occupied; 
  
  (III)  accessible only to persons authorized to administer medications to 
residents; 
  
  (IV) equipped with a sink having hot and cold water available at all times; 
and 
  
  (V) adequately ventilated and temperature controlled. 
  
  (vi) A medication storage cart may be used in addition to the medication room 
for the storage of residents' medications. When not in use, the medication 
storage cart must be kept locked in the locked medication room or in the 
designated locked storage room that shall be used only for the storage of the 
cart. 
  
  (H) When a resident needs assistance with taking oral medication, only those 
individuals approved in writing by the director of the facility may provide that 
assistance. 
 
  (i)  A mechanism will be developed, implemented, and monitored by the facility 
director to insure that the resident is given only those medications that have 
been prescribed by the resident's physician at the intervals detailed on the 
resident's medication container. 
  
  (ii) When assistance with taking oral medication is provided, the facility 
will maintain a medication record which documents the medication, date, and time 
taken. The name of the individual who assisted the resident taking the oral 
medication shall also be documented. 
  
  (iii) The facility director or designee will monitor the medication records 
daily to insure accuracy. 
  
  (I)  Medication service policies and procedures shall be developed and 
maintained current. 
  
  (J) Appropriate documentation shall assure that policies and procedures are 
reviewed at least annually. 
  
  (K)  Medication requiring refrigeration shall be stored in a separate 
designated area within the refrigerator in a manner which prevents contamination 
of the medications. 
  
  (L) Medication under storage control of the facility shall be returned to the 
resident upon dismissal from the facility. 
  
  (M) Medications of a resident shall not be used for another resident. When a 
resident is dismissed from or otherwise leaves the facility for a period of time 
greater than 48 hours, medications which had been under the control of the 
resident and left in the facility shall be secured under locked storage control 
of the facility until reclaimed by the resident and no longer than 90 days. 
Medications of deceased residents shall not remain in the facility for more than 
seven days after the resident's death. Medications of deceased residents and 
medications which have been left unclaimed in the facility for more than 90 days 
shall be handled in one of the following manners. 
 
  (i) Medications may be returned to any licensed pharmacy for destruction in 
accordance with regulations of the Texas Board of Pharmacy governing the 
destruction of dangerous drugs or controlled substances. A record shall be 
maintained by the facility which itemizes the quantity and strength of each 
medication returned to a pharmacy for destruction. Such record shall be signed 
by the director of the facility and the pharmacist accepting the drugs for 
destruction and shall be retained in the resident's file. 
  
  (ii) Medications may be destroyed beyond reclamation on-site by the facility 
director. Drugs should be destroyed by incineration, if possible. Small amounts 
of drugs may be flushed into the sewer system unless prohibited by local 
ordinance. Large quantities of drugs may be destroyed by removing the drugs from 
the prescription containers, placing them in a strong plastic container, and 
adulterating the drugs with water or bleach. 
 
  (I) A record of the destruction shall be maintained by the facility and 
include: 
 
  (-a-) the name, strength, and quantity of the drug; 
  
  (-b-) the method of destruction; and 
  
  (-c-) the signature of the facility director who destroyed the drugs and 
signatures of two other individuals who witnessed the destruction. 
  
  (II) This record shall be retained in the resident's file. 
  
  (N)  Controlled substances and drugs under storage control of the facility 
shall be kept separately locked in a permanently affixed compartment within the 
medicine room or medication storage cart. 
 
  (i) A separate record must be maintained for each controlled substance and 
drug. 
  
  (ii)  The record shall include, but not be limited to, prescription number, 
name and strength of drug, date received by the facility, date and time each 
dose is provided, signature of person providing the dose, name of resident, and 
the original amount received with the balance verifiable by drug inventory at 
least daily. 
  
  (O) All residents' medications shall be properly dispensed and/or labeled in 
accordance with applicable laws and regulations. 
  
  (8) Dietary services. 
 
  (A) A dining room, rooms, or space with appropriate furnishings shall be 
provided. The dining space and furnishings should allow the residents who can 
come to the dining room to dine at one sitting. Where alternate or second meal 
services are employed, those services must be equal in quantity, quality, and 
sanitation to the first serving. 
  
  (B) The facility shall have a kitchen or dietary area to meet the food service 
needs of the residents. It shall include provisions for the storage, 
refrigeration, preparation, and serving of food; for dish and utensil cleaning; 
and for refuse storage and removal in accordance with sec.sec.229.161- 229.173 
of this title (relating to Food Service and Sanitation). 
  
  (C) Meal service at intervals of at least three meals per day, seven days per 
week, shall be provided or arranged to be commensurate with the needs of the 
residents. Meals shall be palatable and meet the nutritional needs of the 
residents. 
  
  (D) Procedures to prevent cross contamination shall be observed in the 
storage, preparation, and distribution of food; in the cleaning of dishes, 
equipment, and work area; and in the storage and disposal of waste. 
  
  (E) All dishes and utensils shall be washed in an automatic dishwasher or by 
the use of manual dishwashing procedures in accordance with sec.229.166 of this 
title (relating to Cleaning, Sanitization, and Storage of Equipment and 
Utensils). 
  
  (F) Sanitary handwashing and drying provisions shall be provided in the 
kitchen area and shall include soap, water, and individual disposable towels. 
  
  (9) Social services/pastoral care. Services to meet identified social, 
spiritual, and emotional needs shall be offered to the resident, the resident's 
family or responsible party, the resident's friend, and significant other 
persons. Acceptance of these services will be at the option of the resident. 
  
  (10) Personal care services. 
 
  (A) The facility shall provide personal care services required of residents to 
assist them in their day-to-day living. 
  
  (B) All residents will need the following basic personal care services: 
 
  (i)  a safe, comfortable, and sanitary environment; 
  
  (ii) a food service which provides wholesome and satisfying meals meeting 
general nutritional needs; and 
  
  (iii) humane treatment, including responsible communication. 
  
  (C) Some residents may need personal care services such as: 
 
  (i) assistance with their medication regimen; 
  
  (ii) assistance with hygiene; 
  
  (iii) assistance with grooming, including clothing; 
  
  (iv) assistance with ambulation; and 
  
  (v) emotional support. 
  
  (D) Some residents may be able to be cared for through personal care services 
without reliance on nursing services. 
  
  (11) Humane treatment and resident rights. 
 
  (A)  As home-like an atmosphere as possible shall be provided. Restrictive 
rules shall be kept to a minimum. While some rules are necessary in group living 
to maintain a balance between individual wishes and group welfare, they shall 
not infringe upon a resident's rights of self-determination, privacy of person 
or thought, and personal dignity. 
  
  (B) Through action and attitudes the facility staff shall help the residents 
develop and maintain self-respect, confidence, self-fulfillment, and meaningful 
relationships with other residents and staff. 
  
  (C) All facility staff, including management staff and volunteers, shall, in 
the course of their tasks, provide emotional support. 
  
  (D) Staff shall provide observation and precautionary measures to promote 
safety and protection from falling, wandering, and harm. 
  
  (E) Abuse or punishment of residents in the facility is prohibited. 
  
  (F) Each resident shall have unlimited freedom to move from the facility. A 
written release from the resident or the resident's responsible party is 
recommended. 
  
  (G) No resident shall be discharged from the facility other than for reasons 
specified in the admission policies and without due notification. 
  
  (H) To the extent practical, each resident shall have the right to keep and 
maintain his or her personal belongings in his or her possession. 
  
  (I) Each resident shall have the right to keep and maintain his or her own 
finances. 
  
  (J) Each resident shall have the right to participate in, or abstain from, 
religious observances. 
  
  (K) Each resident shall have freedom to receive and send mail unopened and 
without undue delay. 
  
  (L) Residents shall have the opportunity to receive visitors at reasonable 
hours but within reasonable limitations, as may be required by the facility in 
its operation policies. 
  
  (M) Residents shall have as much freedom as possible in choice of clothing 
when provisions are available for laundry and dry cleaning at the individual 
resident's expense. Beautician and barber services shall be available for use by 
those desiring such outside service at the individual resident's expense. 
  
  (N) The facility shall provide opportunities for meaningful activities and 
social relationships. 
  
  (O) Use of volunteers from the community to participate and assist in 
meaningful resident activities is encouraged. 
  
  (P) Rights of the elderly specified in the Human Resources Code, Title 6, 
Chapter 102 shall apply to residents 55 years of age or older. 
  
  (g) Waivers, modifications, and variations to provisions of this section. 
 
  (1) On the request of the facility, the department may grant a waiver or 
modification for certain provisions of the physical plant and environment which, 
in the opinion of the department, would be impractical for the facility to meet. 
In granting the waiver or approving the modification, the department shall 
determine that there will be no adverse effect on resident health or safety, and 
the requirement, if not waived or modified, would impose an unreasonable 
hardship on the facility in providing adequate care for the residents. The 
department may require offsetting or equivalent provisions in granting such a 
waiver or approving such a modification. 
  
  (2) On the request of the facility, the department may grant a waiver or 
approve a variation for certain provisions of facility operation which, in the 
opinion of the department, would be impractical or inappropriate for the 
facility to meet. In granting the waiver or approving the variation, the 
department shall determine that there will be no adverse effect on resident 
health or safety, and the requirement, if not waived or varied, would impose an 
unreasonable hardship on the facility in providing adequate care to residents. 
The department may require offsetting or equivalent provisions in granting such 
a waiver or approving such a variation. 
 
  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 May 22, 1992. 
 TRD-9207157 
  Robert A. MacLean, M.D. 
 Deputy Commissioner 
 Texas Department of Health 
  Effective date: July 1, 1992 
 Proposal publication date: March 13, 1992 
 For further information, please call: (512) 834-6650 
         
  Chapter 133. Hospital Licensing 
  
  Permits 
 
  25 TAC sec.133.32 
 
  The Texas Department of Health (department) adopts new  sec.133.32, concerning 
hospital licensing fees with changes to the proposed text as published in the 
March 6, 1992, issue of the Texas Register (17 TexReg 1713). 
 The new section establishes a schedule for hospital license fees at $3.00 per 
bed, with a minimum fee of $100 and a maximum fee of $3,000. The fees are set to 
assure that the department's costs of processing hospital license applications 
are supported by fee collections rather than general revenue. 
 No comments were received regarding adoption of the new section. However, the 
department added subsection (d) denoting the sections's effective date of July 
1, 1992. 
 The new section is adopted under the Health and Safety Code, sec.241.025, which 
provides the Board of Health (board) with the authority to adopt rules relating 
to hospital license fees; and 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 department, and the commissioner of health. 
 
 
  sec.133.32. Hospital Licensing Fees. 
 
  (a) Each hospital shall pay an annual license fee at the time of application 
for an initial license or a license renewal. 
  
  (b) The initial license fee shall be $3.00 per bed in the hospital with a 
minimum fee of $100 and a maximum fee of $3,000. 
  
  (c) The license renewal fee shall be $3.00 per bed in the hospital with a 
minimum fee of $100 and a maximum fee of $3,000. 
  
  (d) This section shall become effective on July 1, 1992. 
 
  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 May 22, 1992. 
 TRD-9207156 
  Robert A. MacLean, M.D. 
 Deputy Commissioner 
 Texas Department of Health 
  Effective date: July 1, 1992 
 Proposal publication date: March 6, 1992 
 For further information, please call: (512) 834-6650 
         
  Part VIII. Interagency Council on Early Childhood Intervention 
  Chapter 621. Early Childhood Intervention Program 
  
  Early Childhood Intervention Service Delivery 
 
  The Interagency Council on Early Childhood Intervention (council) adopts 
amendments to sec.sec.621.22-621.23, 621.27, 621.30-621.33, 621.41, 621.43-621. 
44, 621.46, and 621.48 concerning early childhood intervention service delivery, 
without changes to the proposed text as published in the February 25, 1992, 
issue of the Texas Register (17 TexReg 1503). 
 The sections clarify service delivery requirements and definitions in order to 
comply with federal regulations in Title 34, Code Federal Regulations, Part 303 
for editorial purposes. 
 The sections ensure consistent application of ECI policies which comply with 
federal requirements. 
 No comments were received regarding adoption of the amendments. 
  
  25 TAC sec.sec.621.22-621.23, 621.27, 621.30-621.33 
 
  The amendments are adopted under the Human Resources Code, sec.73.003, which 
provides the Interagency Council on Early Childhood Intervention with the 
authority to establish rules regarding services provided for children with 
developmental delays. 
 
  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 May 27, 1992. 
 TRD-9207252 
  Austin R. Kessler 
 Chairperson 
 Interagency Council on Early Childhood Intervention 
  Effective date: June 17, 1992 
 Proposal publication date: February 25, 1992 
 For further information, please call: (512) 458-7673 
         
  
  Early Childhood Intervention Service Delivery 
 
  25 TAC sec.621.23 
 
  The Interagency Council on Early Childhood Intervention (council) adopts an 
amendment to sec.621.23 concerning service delivery requirements, without 
changes to the proposed text as published in the March 24, 1992, issue of the 
Texas Register  (17 TexReg 2184). 
 The amendments outline the service delivery requirements related to the 
conditions under which parent consent for the use of third party resources is 
required and the policies which apply if parental consent is denied. 
 The rule will ensure consistent application of policies related to parental 
consent and billing third party insurers. 
 No comments were received regarding adoption of the amendment. 
 The amendment is adopted under the Human Resource Code,  sec.73.003, which 
provides the Interagency Council on Early Childhood Intervention with the 
authority to establish rules regarding services provided for children with 
developmental delays. 
 
  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 May 27, 1992. 
 TRD-9207253 
  Austin R. Kessler 
 Chairperson 
 Interagency Council on Early Childhood Intervention 
  Effective date: June 17, 1992 
 Proposal publication date: March 24, 1992 
 For further information, please call: (512) 458-7673 
         
  
  25 TAC sec.sec.621.41-621.43, 621.44, 621.46, 621.48 
 
  The amendments are adopted under the Human Resources Code, sec.73.003, which 
provides the Interagency Council on Early Childhood Intervention with the 
authority to establish rules regarding services provided for children with 
developmental delays. The amendments will affect Chapter 73 of the Health and 
Safety Code. 
 
  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 May 27, 1992. 
 TRD-9207251 
  Austin R. Kessler 
 Chairperson 
 Interagency Council on Early Childhood Intervention 
  Effective date: June 17, 1992 
 Proposal publication date: February 25, 1992 
 For further information, please call: (512) 458-7673 
         
  
  TITLE 31. NATURAL AND RESOURCES AND CONSERVATION 
 Part VII. Texas Water Well Drillers Board 
  Chapter 234. Pump Installers 
  
  The Texas Water Well Drillers Board adopts new 31 TAC Chapter sec.234, 
concerning pump installers. New sec.234.2 is adopted with changes to the 
proposed text as published in the April 10, 1992, issue of the Texas Register  
(17 TexReg 2576). Sections sec.sec.234.1, 234.3-234.6, 234.10-234.16, 234.20-
234.24, and 234.30-234.44 are adopted without changes and will not be 
republished. 
 The justification for the new chapter is the Water Well Pump Installers Act, 
Texas Civil Statutes, Article 8905, Supplementary Pamphlet to Volume 23. 
 The new chapter addresses the licensing, continuing education, and professional 
conduct of water well pump installers. 
 Senator Bill Sims and Representative Layton Black filed comments urging that 
the term "full-time" be deleted from Exclusion (D) of the definition of 
Installer. In addition Senator Sims suggested the following verbiage be added: 
"An employee whose primary duty is pump installation is not exempt under this 
section." American Chrome and Chemical, Inc. recommended the definition of 
"Installer" exclude individuals who install or repair water well pumps and 
equipment used in groundwater sampling or recovery activities associated with 
evaluation or remediation of underground contamination. 
 The Water Well Drillers Board agreed that the term "full-time" should be 
eliminated from Exclusion "D" of the definition of Installer in order that part-
time agricultural employees can work on water well pumps without being licensed. 
However, in order to prevent those persons actively involved in water well pump 
installation avoiding the requirement of a license, the board substitutes the 
following verbiage for the verbiage contained in Exclusion "D" which was printed 
on April 10, 1992, in the Texas Register.  "An individual who is a ranch or farm 
employee that has general duties that include installing or repairing a water 
well pump or equipment on his employer's property for his employer's use, but 
that individual cannot be gainfully employed or in the business of installation 
or repair of water pumps or equipment." 
 The board declines to adopt the suggestion made by American Chrome and 
Chemicals, Inc. because the activities described by American Chrome and 
Chemicals, Inc., are not "exploring for or producing groundwater for human 
consumption, agriculture and livestock, industrial or municipal use." Therefore 
individuals who install or repair water well pumps and equipment used in 
groundwater sampling or recovery activities associated with evaluation or 
remediation of underground contamination are already excluded by the Act itself. 
  
  Subchapter A. General Provisions 
 
  31 TAC sec.sec.234.1-234.7 
 new sections are adopted pursuant to Texas Civil Statutes, Article 8905, 
sec.7(a) Suppplementary Pamphlet to Volume 23, which authorize the Texas Water 
Well Drillers Board to adopt rules as necessary to enforce the Water Well Pump 
Installers Act. 
 
 
  sec.234.2. Definitions.  The following words and terms, when used in this 
chapter, shall have the following meanings, unless the context clearly indicates 
otherwise. 
  
     Act-The Water Well Pump Installers Act, Texas Civil Statutes, Article 8905, 
1992 Supplementary Pamphlet to Volume 23. 
  
     Board-The Texas Water Well Drillers Board. 
  
     Commission-The Texas Water Commission. 
  
     Executive director -The executive director of the Texas Water Commission. 
  
     Installer-A person who installs or repairs water well pumps and equipment 
for hire or compensation. The term excludes the following from testing and 
licensing: 
 
  (A) an individual who installs or repairs water well pumps and equipment on 
his own property for his own use; 
  
  (B) an individual who installs or repairs water well pumps and equipment on 
property that he has leased or rented for his own use; 
  
  (C) an individual who assists in the procedure of pump installation under the 
direct supervision of a licensed installer and who is not primarily responsible 
for the installation; or 
  
  (D) an individual who is a ranch or farm employee that has general duties that 
include installing or repairing a water well pump or equipment on his employer's 
property for his employer's use, but that individual cannot be gainfully 
employed or in the business of installation or repair of water pumps or 
equipment. 
  
     Licensed installer -A person who holds a license issued under this chapter. 
  
     Person-An individual, firm, partnership, association, corporation, or any 
other private legal entity. 
  
     Pollution-The alteration of the physical, thermal, chemical, or biological 
quality of water in a way that makes the water harmful to humans, animals, 
vegetation, property, or that impairs the public enjoyment of water for a 
reasonable purpose. 
  
     Public water system well-A water well supplying water to a number of 
connections or individuals as defined by current rules and regulations of the 
Texas Department of Health. 
  
     Well-Any artificial excavation constructed for the purpose of exploring for 
or producing groundwater for human consumption, agriculture and livestock, 
industrial or municipal use. The term, however, shall not include any test or 
blast holes in quarries or mines, or any well or excavation for the purpose of 
exploring for, or producing oil, gas, or any other minerals unless the holes are 
used to produce groundwater. The term shall not include any injection water 
source well regulated by the Railroad Commission of Texas pursuant to the 
Natural Resources Code, sec.91.101. 
  
     Well pumps and equipment-Equipment and materials used to obtain water from 
a well, including the seals and safeguards necessary to protect the water from 
contamination. 
 
  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 May 22, 1992. 
 TRD-9207162 
  Larry Persky 
 Staff Attorney 
 Texas Water Commission 
  Effective date: June 12, 1992 
 Proposal publication date: April 10, 1992 
 For further information, please call: (512) 463-8069 
         
  
  Subchapter B. Licensing 
 
  31 TAC sec.sec.234.10-234.16 
 
  The new sections are adopted pursuant to Texas Civil Statutes, Article 8905, 
sec.7(a), Supplementary Pamphlet to Volume 23, which authorize the Texas Water 
Well Drillers Board to adopt rules as necessary to enforce the Water Well Pump 
Installers 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 May 22, 1992. 
 TRD-9207164 
  Larry Persky 
 Staff Attorney 
 Texas Water Commission 
  Effective date: June 12, 1992 
 Proposal publication date: April 10, 1992 
 For further information, please call: (512) 463-8069 
         
  
  Subchapter C. Standards and Professional Conduct 
 
  31 TAC sec.sec.234.20-234.24 
 
  The new sections are adopted pursuant to Texas Civil Statutes, Article 8905, 
sec.7(a), Supplementary Pamphlet to Volume 23, which authorize the Texas Water 
Well Drillers Board to adopt rules as necessary to enforce the Water Well Pump 
Installers 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 May 22, 1992. 
 TRD-9207165 
  Larry Persky 
 Staff Attorney 
 Texas Water Commission 
  Effective date: June 12, 1992 
 Proposal publication date: April 10, 1992 
 For further information, please call: (512) 463-8069 
         
  
  Subchapter D. Enforcement 
 
  31 TAC sec.sec.234.30-234.44 
 
  The new sections are adopted pursuant to Texas Civil Statutes, Article 8905, 
sec.7(a), Supplementary Pamphlet to Volume 23, which authorize the Texas Water 
Well Drillers Board to adopt rules as necessary to enforce the Water Well Pump 
Installers 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 May 22, 1992. 
 TRD-9207163 
  Larry Persky 
 Staff Attorney 
 Texas Water Commission 
  Effective date: June 12, 1992 
 Proposal publication date: April 10, 1992 
 For further information, please call: (512) 463-8069 
         
  
  TITLE 37. PUBLIC SAFETY AND CORRECTIONS 
 Part III. Texas Youth Commission 
  Chapter 87. Treatment 
  
  Program Planning 
 
  37 TAC sec.87.13, sec.87.17 
 
  The Texas Youth Commission (TYC) adopts amendments to sec.87.13 and sec.87. 
17, concerning program planning, without changes to the proposed text as 
published in the April 21, 1992, issue of the Texas Register (17 TexReg 2854). 
 The sections concern youth commitment to mental health facilities. The 
amendment to sec.87.13 reflects an expansion of the category of special needs 
youth to include those youth who have offense specific treatment needs. Also, in 
both section sec.87.13 and sec.87.17, the title of the chief of counseling has 
been changed to chief of mental health services. 
 The sections as adopted will bring about more effective mental health services 
for youth committed to TYC. 
 No comments were received regarding adoption of the amendments. 
 The amendments are adopted under the Human Resources Code, sec.61.076, which 
provides the Texas Youth Commission with the authority to provide any 
psychiatric treatment that is necessary as a means of correcting the socially 
harmful tendencies of a child committed to the agency. 
 
  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 May 22, 1992. 
 TRD-9207188 
  Ron Jackson 
 Executive Director 
 Texas Youth Commission 
  Effective date: June 16, 1992 
 Proposal publication date: April 21, 1992 
 For further information, please call: (512) 483-5244 
         
  Chapter 91. Discipline and Control 
  
  Control 
 
  37 TAC sec.91.53 
 
  The Texas Youth Commission (TYC) adopts an amendment to  sec.91.53, with 
changes to the proposed text as published in the April 21, 1992, issue of the 
Texas Register  (17 TexReg 2854). 
 Changes to the proposed version are merely for clarification. 
 The amended section concerns the search of a youth or a youth's room in a TYC 
residential facility. The amendment states that staff must follow precautionary 
guidelines in accordance with workplace guidelines. Also, the definition of body 
cavity is included in relation to search and seizure. The policy will bring 
about a more efficient and safe search and seizure procedures. 
 No comments were received regarding adoption of the amendment. 
 The amendment is adopted under the Human Resources Code,  sec.61.034, which 
provides the Texas Youth Commission with the authority to make rules appropriate 
to the proper accomplishment of its functions. 
 
 
  sec.91.53. Search. 
 
  (a) Policy. Designated staff may conduct a search of a Texas Youth Commission 
(TYC) youth or a youth's room in a residential facility other than the youth's 
home for the purpose of finding and seizing contraband in compliance with 
General Operating Policy (GOP) 6101, sec.89.1 of this title (relating to Basic 
Youth Rights). 
  
  (b) Rules. 
 
  (1) Searches, except body cavities, to detect and deter possession of 
contraband or to protect persons may be conducted with or without probable cause 
so long as searches are conducted at a reasonable time and in a reasonable 
manner. 
  
  (2) Room searches are conducted in accordance with the following rules: 
 
  (A) two staff members must be in attendance for all room searches; 
  
  (B) the presence of the youth whose property is being searched is preferable; 
  
  (C) searches are to be conducted no more frequently than necessary to control 
possession by youth of unauthorized items or to recover missing or stolen 
property; 
  
  (D) staff will follow precautionary guidelines in accordance with Workplace 
Guidelines, HLS-760. 
  
  (3) Searches requiring the removal of clothing shall take place in a private 
setting that aids in the avoidance of unnecessary force, embarrassment, or 
indignity to the youth. Strip searches are conducted by staff of the same sex as 
the youth being searched. Police, other law enforcement officers, detention 
workers, and duly designated agents of the court may assist TYC staff in such a 
search if necessary. 
  
  (4) Body cavity searches are permissable only on probable cause that the youth 
possesses contraband and shall be conducted only by medical personnel. Body 
cavity is defined as the vagina or rectum for purposes of requiring a medical 
staff to perform the exam. 
  
  (5) Room searches, searches of youth being admitted to facilities, and 
searches of youth after visitation which are routinely conducted at facilities 
do not require documentation unless unauthorized items are seized from a youth. 
Searches under any other circumstances shall be documented. Any time 
unauthorized items are seized from a youth, the search and disposition of items 
shall be documented. 
 
  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 May 22, 1992. 
 TRD-9207187 
  Ron Jackson 
 Executive Director 
 Texas Youth Commission 
  Effective date: June 16, 1992 
 Proposal publication date: April 21, 1992 
 For further information, please call: (512) 483-5244 
         
  
  TITLE 40. SOCIAL SERVICES AND ASSISTANCE 
 Part I. Texas Department of Human Services 
  Chapter 47. Primary Home Care 
  
  Service Requirements 
 
  40 TAC sec.47.2904, sec.47.2909 
 
  The Texas Department of Human Services (DHS) adopts amendments to sec.47. 2904 
and sec.47.2909 concerning service requirements, without changes to the proposed 
text as published in the March 31, 1992, issue of the Texas Register (17 TexReg 
2334). Also in this issue of the Texas Register , DHS is adopting related 
amendments in Chapter 48, Community Care for Aged and Disabled, and in Chapter 
50, Day Activity and Health Services. 
 The justification for the amendments is to extend from six months to 12 months 
the period for which physicians' orders may be valid for primary home care 
services. The prescribing physician retains the authority to order the service 
for a period of time shorter than 12 months. 
 The amendments will function by reducing unnecessary paperwork for physicians, 
DHS, and home health agency staff. 
 No comments were received regarding adoption of the amendments. 
 The amendments are adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which authorizes the department to administer public and 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 May 22, 1992. 
 TRD-9207152 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
  Effective date: July 1, 1992 
 Proposal publication date: March 31, 1992 
 For further information, please call: (512) 450-3765 
         
  Chapter 48. Community Care for Aged and Disabled 
  
  Eligibility 
 
  40 TAC sec.48.2918 
 
  The Texas Department of Human Services (DHS) adopts an amendment to sec.48. 
2918 concerning eligibility for primary home care, without changes to the 
proposed text as published in the March 31, 1992, issue of the Texas Register 
(17 TexReg 2334). Also in this issue of the Texas Register , DHS is adopting 
related amendments in Chapter 47, Primary Home Care, and in Chapter 50, Day 
Activity and Health Services. 
 The justification for the amendment is to extend from six months to 12 months 
the period for which physicians' orders may be valid for primary home care 
services. The prescribing physician retains the authority to order the service 
for a period of time shorter than 12 months. 
 The amendment will function by reducing unnecessary paperwork for physicians, 
DHS, and home health agency staff. 
 No comments were received regarding adoption of the amendment. 
 The amendment is adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which authorizes the department to administer public and 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 May 22, 1992. 
 TRD-9207152 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
  Effective date: July 1, 1992 
 Proposal publication date: March 31, 1992 
 For further information, please call: (512) 450-3765 
         
  Chapter 50. Day Activity and Health Services 
  
  Eligibility Requirements 
 
  40 TAC sec.50.1901, sec.50.1902 
 
  The Texas Department of Human Services (DHS) adopts amendments to sec.50. 1901 
and sec.50.1902 concerning eligibility requirements, without changes to the 
proposed text as published in the March 31, 1992, issue of the Texas Register 
(17 TexReg 2335). Also in this issue of the Texas Register , DHS is adopting 
related amendments in Chapter 47, Primary Home Care, and in Chapter 48, 
Community Care for Aged and Disabled. 
 The justification for the amendments is to extend from six months to 12 months 
the period for which physicians' orders may be valid for primary home care 
services. The prescribing physician retains the authority to order the service 
for a period of time shorter than 12 months. 
 The amendments will function by reducing unnecessary paperwork for physicians, 
DHS, and home health agency staff. 
 No comments were received regarding adoption of the amendments. 
 The amendments are adopted under the Human Resources Code, Title 2, Chapters 22 
and 32, which authorizes the department to administer public and 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 May 22, 1992. 
 TRD-9207153 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
  Effective date: July 1, 1992 
 Proposal publication date: March 31, 1992 
 For further information, please call: (512) 450-3765 
         
  Part II. Texas Rehabilitation Commission 
  Chapter 101. General Rules 
  
  40 TAC sec.101.11 
 
  The Texas Rehabilitation Commission adopts an amendment to sec.101.11, 
concerning protest and appeal of grant, contract or award process, without 
changes to the proposed text as published in the April 24, 1992, issue of the 
Texas Register  (17 TexReg 2973) 
 This section makes available to the public the policies and procedures of the 
Texas Rehabilitation Commission concerning protest and appeal of actions on 
grants, contracts, or awards. 
 The section will increase the availability to the public of applicable policies 
and procedures. Concerns relating to grants, contracts, or awards may be 
addressed by use of these policies and procedures. 
 No comments were received regarding adoption of the amendments. 
 The amendment is adopted under the Texas Human Resources Code, Title 7 which 
provides the Texas Rehabilitation Commission with the authority to "... make 
regulations governing personnel standards, the protection of records and 
confidential information, the manner and form of filing applications, 
eligibility, investigation, and determination for hearings, and other 
regulations necessary to carry out the purposes of this chapter." 
 
  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 May 27, 1992. 
 TRD-9207248 
  Charles W. Schiesser 
 Associate Commissioner 
 Texas Rehabilitation Commission 
  Effective date: June 17, 1992 
 Proposal publication date: April 24, 1992 
 For further information, please call: (512) 483-4051 
         
   Texas Department 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 of the Texas Department of Insurance at a Board 
meeting scheduled on April 29, 1992, adopted a filing by Hanover Insurance 
Company of a new endorsement, Include Volunteer Workers Other Than Fund 
Solicitors As Employees 181-1135, for the Business Services Bond (Reference No. 
O-0492-16-I). 
 In accordance with the provisions of Article 5.97, Texas Insurance Code, a text 
of the proposed filing has been filed in the Office of the Chief Clerk of the 
State Board of Insurance. The proposed filing has been available for public 
inspection for 15 days and a public hearing was not requested by any party. 
 The new Include Volunteer Workers Other Than Fund Solicitors As Employees 181-
1135 endorsement broadens the definition of "employee" to include non-
compensated natural persons, other than fund solicitors, such as volunteers, 
while performing services for the obligee which are the usual duties of an 
"employee". 
 There are no rate consequences to this endorsement. 
 This filing becomes effective 15 days after notice of this action is published 
in the Texas Register. 
 This notification is made pursuant to the Insurance Code, Article 5.97, which 
exempts it from the requirements of the Administrative Procedures and Texas 
Register 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 May 26, 1992. 
 TRD-9207169 
  Linda K. von Quintus-Dorn 
 Chief Clerk 
 Texas Department of Insurance 
  Effective date: June 17, 1992 
 For further information, please call: (512) 463-6327 
  
  On May 6, 1992, the State Board of Insurance of the Texas Department of 
Insurance adopted an amended Texas Workers' Compensation Detailed Claim 
Information Statistical Plan (the Plan) (Reference Number W-0592-26-I). 
 The Plan is unchanged from the Plan which was filed with the Chief Clerk's 
office in accordance with the Insurance Code, Article 5.96, with one exception. 
The following language has been deleted from each page of the Plan: This 
Statistical Plan includes material of the National Council on Compensation 
Insurance, copyright 1991. Permission is granted by the National Council on 
Compensation Insurance to use, reproduce, or have reproduced this material 
solely for use in the State of Texas. 
 The Plan is effective 15 days after publication in the  Texas Register for use 
by all insurers or other entities authorized to write workers' compensation 
insurance in Texas. 
 This notification is made pursuant to the Texas Insurance Code, Article 5. 96, 
which exempts it from the Administrative Procedure and Texas Register 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 May 26, 1992. 
 TRD-9207170 
  Linda K. von Quintus-Dorn 
 Chief Clerk 
 Texas Department of Insurance 
  Effective date: June 17, 1992 
 For further information, please call: (512) 463-6327