Proposed Sections 
 Before an agency may permanently adopt a new or amended section, or repeal an 
existing section, a proposal detailing the action must be published in the Texas 
Register at least 30 days before any action may be taken. The 30-day time period 
gives interested persons an opportunity to review and make oral or written 
comments on the section. Also, in the case of substantive sections, a public 
hearing must be granted if requested by at least 25 persons, a governmental 
subdivision or agency, or an association having at least 25 members. 
 Symbology in proposed amendments. New language added to an existing section is 
indicated by the use of bold text. [Brackets] indicate deletion of existing 
material within a section. 
 
   
  TITLE 25. HEALTH SERVICES 
 Part I. Texas Department of Health 
  Chapter 38. Chronically Ill and Disabled Children's Services 
  
  25 TAC sec.38.11 
 
  The Texas Department of Health (department) proposes an amendment to 
sec.38.11, concerning the Chronically Ill and Disabled Children's (CIDC) 
Services. Section 38.11, covers guidelines for a cardiac center to be approved 
as a CIDC cardiovascular diagnostic and treatment center. The amendment will 
revise the current CIDC guidelines for cardiac centers. 
 Roy Middleton, Chief Accountant III, has determined that for the first five-
year period the section is in effect there will be no fiscal implications for 
state or local government as a result of enforcing or administering the section. 
 Mr. Middleton also has determined that for each year of the first five years 
the section is in effect the public benefit anticipated as a result of enforcing 
the section will be that the CIDC Program will utilize guidelines for the 
approval and review of cardiovascular diagnostic and treatment centers which 
follow the nationally recognized guidelines established by the American Academy 
of Pediatrics. There is no anticipated economic cost to small businesses or 
persons who are required to comply with the section as proposed. There also will 
be no effect on local employment. 
 Oral and written comments on the proposal may be submitted to John E. Evans, 
Chief, Bureau of Chronically Ill and Disabled Children's (CIDC) Services 
Program, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756, 
(512) 458-7355. Public comments will be accepted for 30 days after the 
publication of the section in the Texas Register. 
 The amendment is proposed under Health and Safety Code, Chapter 35, which 
provides the Texas Board of Health with the authority to adopt rules concerning 
Chronically Ill and Disabled Children's (CIDC) Services Program; and sec.12.001, 
which provides the Texas Board of Health with the authority to adopt rules for 
the performance of every duty imposed by law on the Texas Board of Health, the 
Texas Department of Health, and the Commissioner of Health. 
 
 
  sec.38.11. Guidelines for a Cardiac Center to be Approved Through the 
Chronically Ill and Disabled Children's (CIDC) Services Program. 
 
  (a)  Introduction. To assure that eligible children with cardiac conditions 
receive <nl>high<ol> quality comprehensive services, the Texas Board of Health 
(board) adopts the guidelines in this section for cardiac diagnostic and 
treatment centers (center). The guidelines are based on guidelines <nl>developed 
by the American Academy of Pediatrics (AAP) Section on Cardiology<ol> 
[concerning pediatric cardiology diagnostic and treatment centers, which were 
developed by the American Academy of Pediatrics section on cardiology which were 
published in the Academy's publication titled, "Pediatrics", Volume 62, Number 
2, August 1978. The academy's guidelines have been recognized and accepted by 
national maternal and child health/crippled children's services (MCH/CC) 
programs and the board]. 
   
  (b) Approval <nl>process for<ol> [as a] Chronically Ill and Disabled 
Children's (CIDC) Services Program <nl>cardiac <ol> [cardiovascular] diagnostic 
and treatment <nl>centers <ol> [center]. 
 
  [(1) Initial or continuing approval process. ] 
   
  <nl>(1)<ol>[(A)] Centers making <nl>initial<ol> [new] application for approval 
will be reviewed by the Texas Department of Health (department) CIDC Program 
according to the guidelines in this section <nl>.<ol> [, with particular 
attention paid to quantitative data such as number of live births required in 
the center's catchment area, number of staff, number of procedures, caseload 
numbers, number of catheterizations (excluding electrophysiologic studies) that 
go to surgery, etc. Also, the centers must meet the requirements in the 
guidelines in this section concerning administration and facilities. The CIDC 
Program will emphasize geographic need in the approval of new centers. ] 
 
  [(B) Prior to initial approval, all centers are subject to a site visit in 
which the centers and their quality of care are assessed according to the 
guidelines in this section. If a center is approved, the approval will be for a 
period of three years, subject to a review of the quality of care at that center 
based on review of site visit reports and morbidity/mortality data by the CIDC 
Program. Approval periods may be less than three years if specified by the CIDC 
Program and approved by the board. 
   
  [(C) At the time of the review, a written invitation shall be sent to the 
administrator of the center to attend and/or present information required in the 
review process. Recommendations from the CIDC Program for initial approval, 
continuing approval or disapproval shall be sent through the chief, Bureau of 
Chronically Ill and Disabled Children's Services, to the board for its 
consideration.] 
     
  (2) <nl>Following review of the initial application, all centers being 
considered for initial approval will undergo a site visit in which the centers 
and their quality of care are assessed according to the guidelines in this 
section.<ol> [Calculation of the number of statewide centers. It is desirable 
that on the average no more than one center per 24,000 live births for the State 
of Texas be approved at any one time, including those centers with approval 
based on geographic need as provided in paragraph (3) of this subsection. For 
the approximately 300,000 live births in Texas in 1985, this means that only 12 
centers could be approved until there are 312,000 live births in Texas, when a 
13th center could be approved, based on the guidelines in this section.] 
   
  <nl>(3) At the time of the site visit, written notification shall be sent to 
the administrator of the center to attend the site visit and present information 
required in the review process. 
   
  <nl>(4) Recommendations from the CIDC Program for initial approval or 
disapproval shall be sent through the bureau chief of the CIDC Program to the 
board for its consideration and action. 
   
  <nl>(5) The final decision by the board regarding approval shall be made after 
it has carefully reviewed the documentation submitted, and has determined the 
applying center is capable of meeting these standards. 
   
  <nl>(6) If a center is approved, the center will be subject to ongoing 
quality-of-care review by the CIDC Program, based on site visit reports and 
morbidity/mortality data. The approval period will be for three years, unless 
otherwise specified by the board. 
   
  <nl>(7)  Continuing approval will depend upon on the center's demonstrated 
ability to maintain the high standards expected. This ability will be verified 
by periodic site visits (every three years, or more often if so specified) by a 
team made up of CIDC approved physicians, a representative(s) from the CIDC 
Program staff, and other individuals as deemed necessary by CIDC. 
   
  <nl>(8)  The quality of care and services will be determined according to 
qualifications of personnel; adequacy of the facility; quality of 
diagnostic/therapeutic measures; and documentation of results of short and long 
term follow-up, client outcomes, and morbidity/mortality statistics for the 
previous year. 
   
  <nl>(9) The center will be required to generate documentation that its program 
meets the requirements in the guidelines in this section. This information must 
be available for review by the site visit team. 
   
  <nl>(10) If a center is found to be deficient or have problems in certain 
areas, the CIDC Program will make recommendations, which shall include the 
status of the center pending corrective action; the recommended corrective 
action; the time frame for corrective action to occur; and the reevaluation 
process. 
   
  <nl>(11) Recommendations from the CIDC Program for continuing approval or 
disapproval shall be sent through the bureau chief of the CIDC Program to the 
board for its consideration and action. 
     
  <nl>(c)<ol>[(3)] Catchment area criteria/geographic need. 
 
  <nl>(1)<ol>[(A)] As a general rule, in order to be approved, a center should 
meet the overall criteria set out in these guidelines in this section and 
provide pediatric cardiology care to a geographic area with at least 30, 000 
live births per year. 
   
  <nl>(2)<ol>[(B)] An exception to the catchment area criteria may be made if a 
center meets a geographic need. Geographic need for a center shall be defined as 
having greater than 12,000 live births in the proposed catchment area and being 
approximately 75 miles or more from another CIDC Program approved center. 
     
  <nl>(d)<ol>[(c)]  Pediatric cardiology diagnostic and treatment team for a 
CIDC Program approved cardiac center. 
 
  <nl>(1) Criteria and process for approval. The CIDC Program sets the criteria 
and process for approval of cardiac center pediatric cardiologists and 
thoracic/cardiovascular surgeons. Only physicians who meet these approval 
criteria may be reimbursed for invasive cardiac procedures. 
   
  <nl>(2)<ol>[(1)] Pediatric cardiology staff. A center should have a minimum of 
two CIDC Program approved and board certified pediatric cardiologists. The 
suggested ratio for a pediatric cardiologist is 1/50-75 cardiac catheterizations 
or 1/1,000 client visits per year. <nl>Caseload numbers may be smaller, but must 
be sufficient to maintain skills resulting in good quality of care. 
   
  <nl>(3)<ol>[(2)] Pediatric cardiac surgical staff. A center should have <nl>a 
minimum of<ol> [at least] two CIDC Program approved [and] cardiac surgeons who 
are board certified in thoracic surgery. One surgeon should have experience 
<nl>in, <ol> and [a major interest in and the] primary responsibility for the 
surgery of congenital heart disease. The cardiac surgeon should be able to 
direct a surgical team in the performance of all current cardiac surgical 
procedures applicable to <nl>infants and children <ol> [the age group cared 
for], although special procedures in limited volume may be the province of a 
single member of the team. 
   
  <nl>(4)<ol>[(3)] Other pediatric staff. A cardiac center must have available 
[the following] CIDC Program approved [and board eligible/certified] physicians 
<nl>with recognized competence in providing necessary consultative services to 
infants and children.<ol> [in the following specializations for 
consultation:]<nl> It is preferable that these physicians be board certified in 
their subspecialties and/or have certificates of pediatric proficiency, if such 
boards/certificates exist. The required specializations are: pediatric 
anesthesiology; pediatric radiology; pediatric intensive care; pediatric 
hematology; pediatric nephrology; pediatric neurology; neonatology; pediatric 
pulmonology; pediatric endocrinology; pediatric surgery; pediatric infectious 
disease; and pediatric pathology. 
 
  [(A) pediatric hematology; 
   
  [(B) nephrology; 
   
  [(C)  neurology; 
   
  [(D) neonatology; 
   
  [(E) pulmonary; 
   
  [(F)  endocrinology; 
   
  [(G) pediatric surgery; 
   
  [(H) pediatric intensivist; 
   
  [(I) urology; 
   
  [(J) radiology; 
   
  [(K) anesthesiology; and 
   
  [(L) pathology.] 
     
  <nl>(5)<ol>[(4) ] Nursing staff. A center must have nurses who are [specially] 
trained in the management of <nl>infants and children <ol> [specific age groups] 
with heart disease; they include <nl>cardiac nurse specialists and<ol> surgical, 
intensive care, and <nl>general pediatric nurses<ol> [unit floor nurses]. 
Frequent reassignment of nurses outside their area of special training is 
discouraged. [Basic nursing skills must include evaluation of cardiac output, 
blood pressure, pulse volume, pulse rate and rhythm, interpretation of ECG's and 
other monitoring devices, and management under the direct physician supervision 
of preoperative and postoperative complications associated with heart diseases.] 
<nl>Continuing inservice education must be incorporated into the nursing program 
<ol> [A continuing inservice education program for nurses assigned to the center 
is required]. 
   
  <nl>(6)<ol>[(5)] Social work. A center should have [available] a master's 
level social worker for [referrals for] <nl>family support, <ol> family social 
assessments, and coordination of community resources. <nl>The social worker 
should be familiar with state and local programs for financial support, case 
management, and rehabilitation of cardiac clients. 
     
  <nl>(e)<ol>[(d)] Administration/facilities. 
 
  (1)  Administration. A hospital with a CIDC Program approved cardiac center 
must have trustees, an administration system, and a medical board <nl>each 
with<ol> [; each must have] an understanding of the requirements for a high 
quality program. There should be assurance that necessary materials and 
professional resources are available <nl>, and that excellent quality of care 
can be maintained<ol> [and that excellence of performance can be maintained]. 
   
  (2) Professional staff and support system. The center, directed by a CIDC 
Program approved pediatric cardiologist, shall assure that there is adequate in-
hospital professional staff coverage at all times, that [the] hospital support 
systems and services are sufficiently integrated to manage medical and surgical 
emergencies, and that a physician <nl>team<ol> member [of the team] familiar 
with the <nl>child <ol> [client] is available on site until the  <nl>child<ol> 
[client] is stable. 
   
  <nl>(3)<ol>[(A)]  Inpatient services. Comprehensive specialized services for 
<nl>infants and children<ol> [pediatric clients] with heart disease must be 
provided in a children's hospital or in a pediatric cardiology department of a 
category C hospital (designated in accordance with the national hospital 
categorization guidelines of the Joint Commission on Accreditation of Health 
Care Organizations). These hospitals should be capable of providing <nl>quality 
<ol> comprehensive, diagnostic, and therapeutic services, [of optimal quality] 
including cardiac surgery for <nl>infants and<ol> children with all types of 
cardiovascular disease. 
   
  <nl>(4)<ol>[(B)]  <nl>Outpatient services<ol> [Ambulatory services]. There 
should be readily accessible pediatric cardiology <nl>outpatient<ol> 
[ambulatory] services, [available] <nl>including office or clinic services, <ol> 
which are supervised by a pediatric cardiologist [, and emergency service should 
be available on 24-hour call]. 
   
  <nl>(5) Emergency services/equipment. 
 
  <nl>(A) Emergency care appropriate for infants and children must be available 
on a 24-hour basis. 
   
  <nl>(B) Resuscitation equipment and supplies must be available at all times 
for immediate use in the catheterization lab and elsewhere in the facility. The 
equipment must be checked regularly for reliable performance and should include 
the following: a defibrillator capable of delivering energy at low doses and of 
synchronized cardioversion; laryngoscopes and endotracheal tubes appropriate for 
all ages; an oxygen source; equipment for oxygen administration and assisted 
ventilation; a suction device; emergency drugs; facilities for insertion of a 
transvenous pacemaker; a body temperature monitoring device; and a warming 
device for infants. 
     
  <nl>(6)<ol>[(C)] <nl>Cardiac catheterization laboratory. 
 
  <nl>(A) The cardiac catheterization laboratory staff should be headed by a 
CIDC Program approved pediatric cardiologist. In addition to the cardiologist 
<nl>performing the<ol> [present at a] catheterization, there should be 
<nl>present<ol> a [full time] registered nurse with [special] training in 
cardiovascular techniques or in the intensive care of <nl>infants and 
children<ol> [pediatric clients]. Other staff should include two or more 
additional personnel <nl>who<ol> [which] may include nurses, anesthesiologists, 
<nl>or<ol> technicians [, or individuals specially] trained in <nl>the operation 
of radiologic, resuscitation, and monitoring equipment.<ol> [operating 
monitoring and radiologic equipment. The catheterization equipment should meet 
the following requirements.] 
 
  <nl>(i) <nl>Intracardiac electrophysiologic studies are a specialized area of 
cardiac catheterization which require additional medical expertise and technical 
support. In centers without available pediatric expertise in this area, these 
studies may be performed in conjunction with an adult electrophysiologist, or 
patients may be referred to a more specialized center. When performing 
electrophysiologic studies, the catheterization laboratory team should be 
particularly well trained in performing cardioversion and cardiopulmonary 
resuscitation. 
   
  <nl>(ii)  <nl>Interventional catheterization is another specialized area of 
cardiac catheterization which requires additional medical expertise and 
technical and surgical support. Surgical intervention must be immediately 
available in the same facility in the event of a major complication. 
     
  <nl>(B) The equipment necessary for a cardiac catheterization laboratory 
includes the following: 
 
  (i) a multi-channel recording apparatus <nl>for the<ol> [with a] continuous 
display and recording of intracardiac <nl>pressures<ol> [pressure], 
<nl>electrocardiograms<ol> [ecg's], and other selected physiologic 
variables<nl>;<ol> [should be available.] 
   
  (ii)  equipment [should be available] to measure oxygen consumption and to 
determine the cardiac output in <nl>infants, children, and adolescents;<ol> 
[clients of all ages, and densitometers and other equipment to detect shunts 
using indicator dilution or hydrogen electrode techniques should be available.] 
   
  (iii) <nl>equipment to evaluate hemoglobin oxygen saturation, blood pH, and 
blood partial pressures of carbon dioxide and oxygen. Results of these studies 
should be immediately available. Laboratories which serve infants should have 
equipment which uses small samples of blood for analysis. A transcutaneous 
oximeter for continuous monitoring of tissue oxygenation is a necessity when 
performing invasive procedures on high-risk infants and children;<ol> [A 
hemoglobin-oxygen saturation analyzing technique, and equipment for laboratories 
that is periodically checked for accuracy, should be available. In addition, 
measurement of blood gases should be immediately available. The results of 
oxygen determinations should be immediately available while the catheter is in 
place. Laboratories in which infants are studied should be equipped with units 
requiring small samples of blood for analysis.] 
   
  (iv) [Radiologic equipment should include] image intensification 
<nl>roentgenographic<ol> [x-ray] apparatus capable of video and cine 
recording<nl>, biplane<ol> [. Biplane] imaging [,] <nl>equipment, and pressure 
injector<ol> [either cine or serial large frame technique, is essential. 
Equipment] that permits rapid injection of controlled amounts of radiopaque 
contrast <nl>material are essential. Low ionic or recently developed nonionic 
radiopaque contrast <ol> materials should be available<nl>;<ol> [.] 
   
  <nl>(v) <nl>intracardiac electrophysiologic study equipment (for those centers 
performing these specialized studies) should include: a physiological recorder 
capable of displaying and recording at least three simultaneous 
electrocardiograms, six intracardiac signals, and blood pressure; a "freeze" 
oscilloscope; a programmable stimulator capable of delivering three or more 
extra stimuli; and electrophysiologic catheters designed for children. 
   
  <nl>(vi) <nl>interventional catheterization equipment should include 
specialized equipment for angioplasty and catheter or prosthesis retrieval. 
     
  [(D) Resuscitation equipment. Client support devices should include 
resuscitation equipment and supplies available at all times for immediate use in 
the laboratory. The equipment should be periodically checked for reliable 
performance and should include the following: 
 
  [(i) a defibrillator; 
   
  [(ii) laryngoscopes and endotracheal tubes appropriate for all ages; 
   
  [(iii) an oxygen source; 
   
  [(iv) equipment for oxygen administration; 
   
  [(v) an assisted respiratory ventilation; 
   
  [(vi) a suction device; 
   
  [(vii) emergency drugs; 
   
  [(viii)  facilitates for insertion of a transvenous pacemaker; 
   
  [(ix)  a body temperature monitoring device; and 
   
  [(x) a warming device for infants.] 
       
  <nl>(7)<ol>[(E)] Non-invasive procedures/equipment. A center must have 
available electrocardiography, <nl>ambulatory electrocardiographic monitoring, 
exercise testing,<ol> and echocardiography procedures <nl>with interpretation of 
each<ol> [used] under the direction of the pediatric cardiologist. <nl>A center 
dedicated to the care of clients with life threatening arrhythmias should 
provide means for telemetry. Equipment for complete<ol> [High quality] two-
dimensional and M-mode <nl>echocardiography and doppler examinations<ol> [echo 
equipment, preferably with doppler,] should be available and in regular use. A 
technician capable of recording diagnostic quality studies on <nl>neonates, 
infants, and <ol> children [and infants including newborn babies as part of the 
cardiac team is desirable.] <nl>is necessary to the center. Personnel able to 
recognize and treat medical emergencies should be in attendance during these 
studies. Physician staff review of each echocardiographic examination is 
mandatory. 
   
  <nl>(8)<ol>[(F)] Operating room and surgical facilities. The cardiovascular 
operating room should be a part of the general surgical suite. The 
administration of the cardiac surgery operating rooms is assigned to a specialty 
nurse supervisor. Specific recommendations regarding equipment are outlined in 
the report of the "Intersociety Commission for Heart Disease Resources", 
published in "Circulation", Volume 52, November 1975. 
   
  <nl>(9) <ol>[(G)] Records management. A center must maintain a medical records 
system permitting prompt retrieval of information. Medical records must be 
legible, <nl>must show complete and accurate documentation<ol> [accurately 
documented] in a timely manner, and <nl>must be<ol> accessible to the site 
review team. 
   
  <nl>(10)<ol>[(H)] Responsibility to the CIDC Program. A center must agree to 
abide by the CIDC  <nl>Program's<ol> requirements in this section which include, 
but are not limited to, utilizing all third party resources available to clients 
prior to requesting payment; accepting CIDC Program payment as payment in full;  
<nl>and<ol> submitting  <nl>documentation required by the CIDC Program.<ol> 
[CIDC Program required documentation; submitting an annual report due 30 days 
after the end of the state fiscal year (August 31).] 
   
  <nl>(11)<ol>[(I)] Rights of clients. A center must be responsible for assuring 
that all members of the diagnostic and treatment team recognize the rights of 
eligible clients. The responsible physician is expected to inform parents or 
guardians or adult clients of the complete information concerning diagnosis, 
treatment, and prognosis. He or she should provide opportunities for parents or 
guardians or adult clients to participate in discussion involving the client's 
care and provide a written follow up plan for parents or guardians or adult 
clients and referring physicians. When appropriate, a referral to a <nl>primary 
care provider<ol> [CIDC Program approved physician] in the client's home 
community should be made for [the] follow-up care and emergencies.  <nl>Unless 
there are compelling reasons to the contrary, cardiac care should be delivered 
in the cardiac center which is closest to the client's home and which has 
available facilities and expertise. Services should be culturally competent, 
family centered, community based, and coordinated. 
     
  <nl>(f)<ol>[(e)] Caseloads. Although there may be a decline in the number of 
catheterizations being performed, generally, minimum caseloads are essential to 
stimulate and maintain quality of care. <nl>The caseload numbers for 
catheterizations and surgeries should be large enough that the team responsible 
for the delivery of cardiac care to infants and children will maintain their 
technical skills and provide quality care. The relationship between caseload and 
quality of care will be assessed at the time of the site review. A center 
applying for initial approval will be considered if its caseload volume 
approaches that of other CIDC approved cardiac centers and there is an 
established pattern of caseload growth over the last three to five years, which 
is expected to continue. The caseload must reflect a variety of cardiac 
diagnoses and degrees of complexity and must represent various pediatric age 
groups.<ol> [Without these minimum caseloads it is believed that the team that 
is responsible for the delivery of cardiac care to infants and children will not 
maintain their technical skills. CIDC Program approved centers should perform a 
minimum of 100-150 catheterizations per year when catheterizing only infants and 
children, or 350 cardiac catheterizations per year when serving both adults and 
pediatric clients, with at least 100 catheterizations performed on pediatric 
clients. The ratio of invasive studies to total surgical procedures will be 
considered in the overall assessment of the statistics, excluding 
electrophysiological studies. The center should perform at least 100 operations 
per year on pediatric clients, with at least 30% using extra-corporeal 
circulation.] 
   
  [(f) Continuing approval. 
 
  [(1) The guidelines in this section for approval of a center for the cardiac 
care of children are intended to ensure that a very high quality of care is 
delivered. It is expected that a center meet a majority of the criteria set out 
in the guidelines in this section before making application for approval. The 
final decision by the board regarding approval shall be made upon the 
recommendation of the CIDC Program after it has carefully reviewed the 
documentation submitted, and has been convinced that the applying center is 
capable of meeting these standards. Once the center has been approved, its 
ongoing approval will only depend on its demonstrated ability to continue to 
maintain the high standards expected. This ability will be verified by periodic 
site visits by a team made up of approved CIDC physicians. 
   
  [(2)  Continuation of approved centers will be based on a qualitative and 
quantitative assessment. Quality will be assessed by annual reports, if 
possible, and on-site visits will be evaluated on the basis of the CIDC 
Program's expertise. The quality of care and services will be determined 
according to competency of personnel; adequacy of the facility; quality of 
diagnostic/therapeutic measures; and documentation of results of short and long 
term follow-up, client outcomes, and mortality statistics for the previous year. 
   
  [(3) The center will be required to generate documentation that it's program 
meets the statistical requirements in the guidelines in this section. This 
information must be available for review by the onsite review team. 
   
  [(4) The CIDC Program will make site visits every three years to approved 
cardiac centers or more often if so specified. 
   
  [(5) If a center is found to be deficient or have problems in certain areas, 
the CIDC Program will make a recommendation, which shall include the status of 
the center until corrective action is taken; the recommended corrective action; 
the time frame for corrective action to occur; and the re-evaluation process.] 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 25, 1993. 
 TRD-9319524 
  Robert A. MacLean, M.D. 
 Deputy Commissioner 
 Texas Department of Health 
    Proposed date of adoption: June 19, 1993 
 For further information, please call: (512) 458-7355 
         
                   
  TITLE 31. NATURAL RESOURCES AND CONSERVATION 
 Part III. The Texas Air Control Board 
  Chapter 101. General Rules 
  
   31 TAC sec.101.1 
 
  The Texas Air Control Board (TACB) proposes amendments to sec.101.1, 
concerning Definitions. The definition for nonattainment area is reworded to 
avoid using the defined term "nonattainment" within the definition. The 
definitions that apply only to nonattainment area new source review rules will 
be deleted from the General Rules and will be proposed for addition to Chapter 
116 in concurrent action. 
 Lane Hartsock, Deputy Director of Air Quality Planning, has determined that for 
the first five-year period the section is in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the section. 
 Mr. Hartsock also has determined that for each year of the first five years the 
section is in effect the public benefit anticipated as a result of enforcing the 
section will be a clearer understanding of the rules. The nonattainment 
definitions only concern permit applicants affected by nonattainment review, and 
will be relocated within the new Chapter 116. There will be no effect on small 
businesses. There is no anticipated economic cost to persons who are required to 
comply with the section as proposed. 
 A public hearing on this proposal will be held on March 16, 1993, at 10 a.m. in 
the Auditorium, Room 201S of the TACB Central Office, Air Quality Planning Annex 
located at 12118 North IH-35, Park 35 Technology Center, Building A, Austin, 
Texas 78753. The hearing is structured for the receipt of oral or written 
comments by interested persons. Interrogation or cross-examination is not 
permitted; however, a TACB staff member will discuss the proposal and answer 
questions 30 minutes before the hearing. 
 Written comments not presented at the hearing may be submitted to the TACB Air 
Quality Planning Annex located at 12118 North IH-35, Park 35 Technology Center, 
Building A, Austin, Texas 78753 through March 31, 1993. Material received by the 
Regulation Development Division by 4 p.m. on that date will be considered by the 
Board prior to any final action on the proposed sections. Copies of the proposal 
are available at the TACB Air Quality Planning Annex located at 12118 North IH-
35, Park 35 Technology Center, Building A, Austin, Texas 78753, and at all TACB 
Regional offices. For further information, contact Gary McArthur at (512) 908-
1917. 
 Persons with disabilities who have special communication or other accommodation 
needs who are planning to attend the hearing should contact the agency at (512) 
908-1815. Requests should be made as far in advance as possible. 
 The amendment is proposed under the Texas Clean Air Act (TCAA), sec.382.017, 
Texas Health and Safety Code (Vernon 1990), which provides the TACB with the 
authority to adopt rules consistent with the policy and purposes of the TCAA. 
 
 
  sec.101.1. Definitions.  Unless specifically defined in the Texas Clean Air 
Act (TCAA) or in the rules of the Board, the terms used by the Board have the 
meanings commonly ascribed to them in the field of air pollution control. In 
addition to the terms which are defined by the TCAA, the following words and 
terms, when used in this chapter, shall have the following meanings, unless the 
context clearly indicates otherwise. 
   
   [Actual emissions (applies only to nonattainment area, new source review 
rules pursuant to Federal Clean Air Act provisions) -Actual emissions as of a 
particular date shall equal the average rate, in tons per year, at which the 
unit actually emitted the pollutant during a two-year period which precedes the 
particular date and which is representative of normal source operation. The 
Executive Director shall allow the use of a different time period upon a 
determination that it is more representative of normal source operation. Actual 
emissions shall be calculated using the unit's actual operating hours, 
production rates, and types of materials processed, stored, or combusted during 
the selected time period. The Executive Director may presume that the source-
specific allowable emissions for the unit are equivalent to the actual 
emissions, e.g., when the allowable limit is reflective of actual emissions. For 
any emissions unit which has not begun normal operations on the particular date, 
actual emissions shall equal the potential to emit of the unit on that date. 
   
   [Allowable emissions (applies only to nonattainment area, new source review 
rules pursuant to Federal Clean Air Act provisions) -The emissions rate of a 
stationary source, calculated using the maximum rated capacity of the source 
(unless the source is subject to federally enforceable limits which restrict the 
operating rate, or hours of operation, or both), and the most stringent of the 
applicable standards set forth in 40 Code of Federal Regulations, Part 60 or 61, 
any applicable State Implementation Plan emissions limitation including those 
with a future compliance date, or the emissions rate specified as a federally 
enforceable permit condition including those with a future compliance date. 
   
   [Begin actual construction (applies only to nonattainment area, new source 
review rules pursuant to Federal Clean Air Act provisions) -In general, 
initiation of physical on-site construction activities on an emissions unit 
which are of a permanent nature. Such activities include, but are not limited 
to, installation of building supports and foundations, laying of underground 
pipework, and construction of permanent storage structures. With respect to a 
change in method of operation, this term refers to those on-site activities 
other than preparatory activities which mark the initiation of the change. 
   
   [Building, structure, facility, or installation (applies only to 
nonattainment area, new source review rules pursuant to Federal Clean Air Act 
provisions)-All of the pollutant-emitting activities which belong to the same 
industrial grouping are located in one or more contiguous or adjacent 
properties, and are under the control of the same person (or persons under 
common control) except the activities of any vessel. Pollutant-emitting 
activities shall be considered as part of the same industrial grouping if they 
belong to the same "Major Group" (i.e., which have the same two-digit code) as 
described in the Standard Industrial Classification Manual, 1972, as amended by 
the 1977 supplement. 
   
   [Commence (applies only to nonattainment area, new source review rules 
pursuant to Federal Clean Air Act provisions)-As applied to construction of a 
major stationary source or major modification, means that the owner or operator 
has all necessary preconstruction approvals or permits and either has begun, or 
caused to begin, a continuous program of actual on-site construction of the 
source, to be completed within a reasonable time; or has entered into binding 
agreements or contractual obligations, which cannot be canceled or modified 
without substantial loss to the owner or operator, to undertake a program of 
actual construction of the source to be completed within a reasonable time. 
   
   [Construction (applies only to nonattainment area, new source review rules 
pursuant to Federal Clean Air Act provisions)-Any physical change or change in 
the method of operation (including fabrication, erection, installation, 
demolition, or modification of an emissions unit) which would result in a change 
in actual emissions. 
   
   [De minimis threshold-(In regard to any proposed emissions increase in a 
specific nonattainment area), an emissions level, as determined by aggregating 
the proposed increase with all other creditable source emission increases and 
decreases during the previous five calendar years, including the calendar year 
of the proposed change, which equals the major modification level (in tons/year) 
for that specific nonattainment area. Table I, of sec.101.1 of this section, 
specifies the various classifications of nonattainment along with the associated 
emission levels which designate a major modification for those classifications. 
   
   [Lowest achievable emission rate-For any emitting facility, that rate of 
emissions of a contaminant which does not exceed the amount allowable under 
applicable new source performance standards promulgated by the United States 
Environmental Protection Agency under Section 111 of the Federal Clean Air Act 
and which reflects: 
 
  (A) the most stringent emission limitation which is contained in the rules and 
regulations of any approved state implementation plan for a specific class or 
category of facility, unless the owner or operator of the proposed facility 
demonstrates that such limitations are not achievable; or 
   
  (B) the most stringent emission limitation which is achieved in practice by a 
specific class or category of facilities, whichever is more stringent. 
     
   [Major facility/stationary source (applies only to nonattainment area, new 
source review rules pursuant to Federal Clean Air Act provisions)-Any 
facility/stationary source which emits, or has the potential to emit, the amount 
specified in the MAJOR SOURCE column of Table I of this section or more of any 
air contaminant (including volatile organic compounds) for which a National 
Ambient Air Quality Standard has been issued. Any physical change that would 
occur at a stationary source not qualifying as a major stationary source in 
Table I of this section, if the change would constitute a major stationary 
source by itself. A major stationary source that is major for volatile organic 
compounds shall be considered major for ozone. The fugitive emissions of a 
stationary source shall not be included in determining for any of the purposes 
of this definition whether it is a major stationary source, unless the source 
belongs to one of the categories of stationary sources listed in 40 Code of 
Federal Regulations, 51.165(a)(1)(iv) (C). 
   
   [Major modification (applies only to new source review rules pursuant to 
Federal Clean Air Act provisions)-Any physical change, or change in the method 
of operation of a facility/ stationary source that causes a net increase of its 
potential to emit volatile organic compounds (VOC), or any air contaminant for 
which a National Ambient Air Quality Standard has been issued by the amount 
listed in the MAJOR SOURCE column of Table I of this section, or a major 
facility/stationary source that would result in a net increase in its potential 
to emit VOC, or any air contaminant for which a National Ambient Air Quality 
Standard has been issued by an amount equal to or greater than that specified in 
the MAJOR MODIFICATION column of Table I. Any net emissions increase that is 
considered significant for volatile organic compounds shall be considered 
significant for ozone. A physical change or change in the method of operation 
shall not include routine maintenance, repair, and replacement; use of an 
alternative fuel or raw material by reason of an order under the Energy Supply 
and Environmental Coordination Act of 1974, sec.2(a) and (b) (or any superseding 
legislation) or by reason of a natural gas curtailment plan pursuant to the 
Federal Power Act; use of an alternative fuel by reason of an order or rule of 
the FCAA, sec.125; use of an alternative fuel at a steam generating unit to the 
extent that the fuel is generated from municipal solid waste; use of an 
alternative fuel or raw material by a stationary source which the source was 
capable of accommodating before December 21, 1976 (unless such change would be 
prohibited under any federally enforceable permit condition established after 
December 21, 1976) or the source is approved to use under any permit issued 
under regulations approved pursuant to this section; an increase in the hours of 
operation or in the production rate (unless the change is prohibited under any 
federally enforceable permit condition which was established after December 21, 
1976); or any change in ownership at a stationary source. 
 
  
   
  [graphic] 
     
   [Necessary preconstruction approvals or permits (applies only to 
nonattainment area, new source review rules pursuant to Federal Clean Air Act 
provisions)-Those permits or approvals required under federal air quality 
control laws and regulations and those air quality control laws and regulations 
which are part of the applicable State Implementation Plan. 
   
   [Net emissions increase (applies only to nonattainment area, new source 
review rules pursuant to Federal Clean Air Act provisions) -Any emissions 
changes at the building, structure, facility, or installation in which the sum 
of any increase in actual emissions from a particular physical change or change 
in the method of operation at a stationary source, and any other increases and 
decreases in actual emissions at the source that are contemporaneous with the 
particular change and are otherwise creditable, exceeds zero. An increase or 
decrease in actual emissions is contemporaneous with the increase from the 
particular change only if it occurs before the date that the increase from the 
particular change occurs. An increase or decrease in actual emissions is 
creditable only if it occurs within a reasonable period to be specified by the 
reviewing authority, and the reviewing authority has not relied on it in issuing 
a permit for the source (under regulations approved during which the permit is 
in effect) when the increase in actual emissions from the particular change 
occurs. An increase in actual emissions is creditable only to the extent that 
the new level of actual emissions exceeds the old level. A decrease in actual 
emissions is creditable only to the extent that the old level of actual emission 
or the old level of allowable emissions, whichever is lower, exceeds the new 
level of actual emissions; it is federally enforceable at and after the time 
that actual construction on the particular change begins, the reviewing 
authority has not relied on it in issuing any permit, or the state has not 
relied on it in demonstrating attainment or reasonable further progress; it has 
approximately the same qualitative significance for public health and welfare as 
that attributed to the increase from the particular change. An increase that 
results from a physical change at a source occurs when the emissions unit on 
which construction occurred becomes operational and begins to emit a particular 
pollutant. Any replacement unit that requires shakedown becomes operational only 
after a reasonable shakedown period, not to exceed 180 days.] 
   
   Nonattainment area -<nl>A defined region within the State which is designated 
by the United States Environmental Protection Agency (EPA) as failing to meet 
the National Ambient Air Quality Standard for a pollutant for which a standard 
exists. The EPA will designate the area as nonattainment under the provisions of 
the Federal Clean Air Act, sec.107(d) <ol> [An area which is designated 
"nonattainment" with respect to any air pollutant within the meaning of the 
Federal Clean Air Act, sec.107(d)]. 
   
   [Potential to emit (applies only to nonattainment areas, new source rules 
pursuant to Federal Clean Air Act provisions) -The maximum capacity of a 
facility/stationary source to emit a pollutant under its physical and 
operational design. Any physical or enforceable operational limitation on the 
capacity of the facility/stationary source to emit a pollutant, including air 
pollution control equipment and restrictions on hours of operation or on the 
type or amount of material combusted, stored, or processed, shall be treated as 
part of its design only if the limitation or the effect it would have on 
emissions is federally enforceable. Secondary emissions, as defined in 40 Code 
of Federal Regulations, 51.165(viii), do not count in determining the potential 
to emit of a stationary source. 
   
   [Reconstruction (applies only to nonattainment area, new source review rules 
pursuant to Federal Clean Air Act provisions)-Will be presumed to have taken 
place where the fixed capital costs of the new component (as cumulated from 
December 21, 1976) exceeds 50% of the fixed capital cost of a comparable 
entirely new source. 
   
   [Secondary emissions (applies only to nonattainment area, new source review 
rules pursuant to Federal Clean Air Act provisions) -Emissions which would occur 
as a result of the construction or operation of a major stationary source or 
major modification, but do not come from the source or modification itself. 
Secondary emissions must be specific, well defined, quantifiable, and impact the 
same general area as the stationary source or modification which causes the 
secondary emissions. Secondary emissions include emissions from any offsite 
support facility which would not be constructed or increase its emissions, 
except as a result of the construction or operation of the major stationary 
source or major modification. Secondary emissions do not include any emissions 
which come directly from a mobile source such as emissions from the tailpipe of 
a motor vehicle, from a train, or from a vessel. 
   
   [Stationary source (applies only to nonattainment area, new source review 
rules pursuant to Federal Clean Air Act provisions) -Any building, structure, 
facility, or installation which emits or may emit any air pollutant subject to 
regulation under the Federal Clean Air Act.] 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 22, 1993. 
 TRD-9319355 
  Lane Hartsock 
 Deputy Director, Air Quality Planning 
 Texas Air Control Board 
    Proposed date of adoption: May 15, 1993 
 For further information, please call: (512) 908-1451 
         
               
  TITLE 40. SOCIAL SERVICES AND ASSISTANCE 
 Part I. Texas Deptartment of Human Services 
  Chapter 47. Primary Home Care 
  
  General Provisions and Services 
 
  The Texas Department of Human Services (DHS) proposes amendments to 
sec.47.1903 and sec.47.4901, concerning staffing requirements and contracting in 
its Primary Home Care chapter. The purpose of the amendments is to correct the 
hotline telephone number for reporting abuse and neglect and to delete obsolete 
references in the requirements for special attendants. 
 Burton F. Raiford, commissioner, has determined that for the first five-year 
period the proposed sections will be in effect there will be no fiscal 
implications for state or local governments as a result of enforcing or 
administering the sections. 
 Mr. Raiford also has determined that for each year of the first five years the 
sections are in effect the public benefit anticipated as a result of enforcing 
the sections will be public access to correct information. There will be no 
effect on small businesses. There is no anticipated economic cost to persons who 
are required to comply with the proposed sections. 
 Questions about the content of the proposal may be directed to Shirley Muery at 
(512) 450-3854 in DHS's Community Care Section. Comments on the proposal may be 
submitted to Nancy Murphy, Agency Liaison, Policy and Document Support-046, 
Texas Department of Human Services E-503, P.O. Box 149030, Austin, Texas 78714-
9030, within 30 days of publication in the Texas Register. 
   
  40 TAC sec.47.1903 
 
  The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Civil Statutes, Article 
4413(502), sec.16, which provide the Health and Human Services Commission with 
the authority to administer federal medical assistance funds. 
 
 
  sec.47.1903. Staffing Requirements. 
 
  (a)-(b) (No change.) 
   
  (c) The two types of attendants are as follows. 
 
  (1) (No change.) 
   
  (2) Special attendants. Special attendants may be used to initiate services, 
prevent a break in service, or provide ongoing services. Although special 
attendants are required to receive the general orientation specified in 
paragraph (1) of this subsection, they do not have to receive it in the client's 
home as long as they meet the following requirements. 
 
  (A) (No change.) 
   
  (B) The special attendant must either: 
 
  (i) meet the requirements described in sec.115.13(a) [and (c)-(g)] of Title 25 
(relating to Home Health Aides; Training Course; Duties); or 
   
  (ii)-(iii) (No change.) 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on March 1, 1993. 
 TRD-9319625 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: June 15, 1993 
 For further information, please call: (512) 450-3765 
         
                   
  Provider Contracts 
 
  40 TAC sec.47.4901 
 
  The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Civil Statutes, Article 
4413(502), sec.16, which provide the Health and Human Services Commission with 
the authority to administer federal medical assistance funds. 
 
 
  sec.47.4901. Contracting. 
 
  (a) (No change.) 
   
  (b) Provider agencies must: 
 
  (1)-(6) (No change.) 
   
  (7) report suspected cases of client abuse, neglect, and exploitation within 
24 hours of awareness to the local CCAD unit or to the <nl>Texas Department of 
Protective and Regulatory Services <ol>[department] hotline at <nl>1-800-252-
5400 <ol>[1 (800) 262-5400]; 
   
  (8)-(10) (No change.) 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on March 1, 1993. 
 TRD-9319624 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: June 15, 1993 
 For further information, please call: (512) 450-3765 
         
                 Chapter 48. Community Care for the Aged and Disabled 
  
  Medicaid Waiver Program for Persons with Related Conditions 
 
  40 TAC sec.48.2103 
 
  The Texas Department of Human Services (DHS) proposes an amendment to 
sec.48.2103, concerning client eligibility criteria in its Community Care for 
Aged and Disabled (CCAD) chapter. The purpose of the amendment is to revise the 
Community Living Assistance and Support Services (CLASS) program income and 
resource limit, and to specify that CLASS participants cannot receive CLASS and 
other CCAD services at the same time. 
 Burton F. Raiford, commissioner, has determined that for the first five-year 
period the proposed section will be in effect there will be no fiscal 
implications for state or local government as a result of enforcing or 
administering the section. 
 Mr. Raiford also has determined that for each year of the first five years the 
section is in effect the public benefit anticipated as a result of enforcing the 
section will be that more people will have an opportunity to receive CLASS 
services. There will be no effect on small businesses. There is no anticipated 
economic cost to persons who are required to comply with the proposed section. 
 Questions about the content of the proposal may be directed to Barbara Stegall 
at (512) 450-3228 in DHS's Community Care Section. Comments on the proposal may 
be submitted to Nancy Murphy, Agency Liaison, Policy and Document Support-043, 
Texas Department of Human Services E-503, P.O. Box 149030, Austin, Texas 78714-
9030, within 30 days of publication in the Texas Register. 
 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 
and 32, which provides the department with the authority to administer public 
and medical assistance programs and under Texas Civil Statutes, Article 
4413(502), sec.16, which provide the Health and Human Services Commission with 
the authority to administer federal medical assistance funds. 
 
 
  sec.48.2103. Client Eligibility Criteria. 
 
  (a) To be determined eligible by the Texas Department of Human Services (DHS) 
for waiver program services, an applicant must: 
 
  (1)-(2) (No change.) 
   
  (3) be under age 18 and reside with parents or spouses, and: 
 
  (A)-(D) (No change.) 
   
  (E) receive waiver program services for persons with related conditions<nl>; 
or  <ol>[.] 
     
  <nl>(4) be an individual who would be financially eligible for Medicaid if 
residing in a Medicaid-certified institution. For these individuals, the 
policies specified in subparagraphs (A) and (B) of this paragraph apply. 
 
  <nl>(A) Spousal impoverishment provisions. 
 
  <nl>(i) For waiver participants with spouses who live in the community, the 
income and resource eligibility requirements are determined according to the 
spousal impoverishment provisions in the Social Security Act, sec.1924, and as 
specified in the Medicaid State Plan and subsection (a) of this section. 
   
  <nl>(ii) After the participant is determined to be eligible for Medicaid, DHS 
determines the amount of the participant's income applicable to payment. 
   
  <nl>(iii) To determine the amount of the participant's income applicable to 
payment, DHS uses the same methodology as if the participant were residing in an 
institution, except that the personal needs allowance is equal to the 
institutional cap. 
     
  <nl>(B) Calculation of participant copayment. 
 
  <nl>(i) A participant who is financially eligible based on the special 
institutional income limit must share in the cost of waiver services. The method 
for determining the participant copayment is specified in this subparagraph and 
is documented on DHS's Medical Assistance Only Worksheet form. When calculating 
the copayment amount for a participant with income that exceeds the SSI federal 
benefit rate, DHS deducts the following: 
 
  <nl>(I) the cost of the participants maintenance needs, which must equal the 
special institutional income limit for eligibility under the Texas Medicaid 
program; 
   
  <nl>(II) the cost of the maintenance needs of the participant's dependent 
children. This amount is equivalent to the Aid to Families with Dependent 
Children (AFDC) program basic monthly grant for children or for a spouse with 
children, using the recognizable needs amount in the AFDC Budgetary Allowance 
Chart; and 
   
  <nl>(III) the costs incurred for medical or remedial care that are necessary, 
but not covered by Medicare, Medicaid, or any other third party. This includes 
the cost of health insurance premiums, deductibles, and coinsurance. 
     
  <nl>(ii) The copayment amount is the participant's remaining income after all 
allowable expenses have been deducted. The copayment amount is applied only to 
the cost of home and community-based services which are funded through the 
Community Living Assistance and Support Services (CLASS) waiver program and 
specified on the participant's individual plan of care. The copayment amount 
must not exceed the cost of services actually delivered. 
   
  <nl>(iii) Participants must pay the copayment amount to the provider 
contracted to deliver authorized waiver services. 
         
  (b)-(d) (No change.) 
   
  (e) <nl>Participants <ol>[Clients] may be enrolled in only one waiver program 
at a time. <nl>Participants may not receive both CLASS waiver services and other 
DHS community care services at the same time. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on March 1, 1993. 
 TRD-9319624 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: June 1, 1993 
 For further information, please call: (512) 450-3765 
         
             
  In-Home and Family Support Program 
 
  40 TAC sec.48.2707 
 
  The Texas Department of Human Services (DHS) proposes an amendment to 
sec.48.2707, concerning program restrictions, in its Community Care for Aged and 
Disabled chapter. The purpose of the amendment is to prevent individuals from 
receiving Community Living Assistance and Support Services (CLASS) and In-Home 
and Family Support (IH/FSP) services at the same time. 
 Burton F. Raiford, commissioner, has determined that for the first five-year 
period the section is in effect there will be no fiscal implications for state 
or local government as a result of enforcing or administering the section. 
 Mr. Raiford also has determined that for each year of the first five years the 
section is in effect the public benefit anticipated as a result of enforcing the 
section will be to provide IH/FSP services to individuals on the IH/FSP waiting 
list, instead of individuals who are receiving CLASS services. There will be no 
effect on small businesses. There is no anticipated economic cost to persons who 
are required to comply with the proposed section. 
 Questions about the content of the proposal may be directed to Linda Lamb at 
(512) 450-3199 in DHS's Community Care Section. Comments on the proposal may be 
submitted to Nancy Murphy, Agency Liaison, Policy and Document Support-033, 
Texas Department of Human Services E-503, P.O. Box 149030, Austin, Texas 78714-
9030, within 30 days of publication in the Texas Register. 
 The amendment is proposed under the Human Resources Code, Title 2, Chapters 22 
and 35, which provides the department with the authority to administer public 
and support services for persons with disabilities programs. 
 
 
  sec.48.2707. Program Restrictions. 
 
  (a)-(g) (No change.) 
   
  <nl>(h) Individuals eligible to receive benefits in the Community Living 
Assistance and Support Services program are not eligible to receive benefits in 
the IH/FSP. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 25, 1993. 
 TRD-9319527 
  Nancy Murphy 
 Agency Liaison, Policy and Document Support 
 Texas Department of Human Services 
    Proposed date of adoption: June 1, 1993 
 For further information, please call: (512) 450-3765 
         
           
  Part IX. Texas Department on Aging 
 Chapter 255. State Delivery Systems 
 40 TAC sec.255.41 
 
  The Texas Department on Aging proposes new sec.255.41, concerning targeting of 
individuals eligible under the Older Americans Act, as amended, to receive 
services. This chapter establishes definitions, policies, and procedures to 
facilitate and enhance the targeting process for individuals mandated by the OAA 
to be served to more effectively promote the health and independence of the 
elderly of Texas. 
 Ann Ammons, Director of Field Operations, Texas Department on Aging, has 
determined that for the first five year period the rule will be in effect, there 
will not be fiscal implications as a result of enforcing or administering the 
rule. 
 Ms. Ammons also has determined that for each year of the first five years the 
section is in effect, the public benefit anticipated as a result of enforcing 
the section will be greater understanding of the processes required of area 
agencies on aging to assure proper components of this service are included in 
contract stipulations and that monitoring of contracting programs is based on 
clear requirements established by the department. There will be no effect on 
small businesses. 
 The anticipated economic cost to persons who are required to comply with the 
section as be none. 
 Request for public comments on the proposal may be submitted to Ann Ammons, 
Director of Field Operations, Texas Department on Aging, P.O. Box 12786, Austin, 
Texas 78711. 
 The new section is proposed under the Human Resources Code, Chapter 101, which 
provides the Texas Department on Aging with the authority to promulgate rules 
governing the operation of the department. 
 
 
  sec.255.41. Targeting of Services. 
 
  (a) Purpose. The purpose of these targeting standards is to set policies for 
the provision of Title III services to older persons in the targeted population; 
insure that those most in need receive services; and to reduce individual and 
social barriers to economic and personal independence for older persons. 
   
  (b) Scope. These standards shall apply to all area agencies on aging and all 
service providers which provide services funded through the Texas Department on 
Aging and the Older Americans Act of 1992, as amended. These standards shall 
apply to all area agencies on aging and service providers, including those in 
areas whose 60+ minority population constitutes a majority of the total 60+ 
population. Particular attention must be paid to reaching unserved older persons 
within ALL targeted populations. When funding is not sufficient to serve 
everyone seeking services, need shall be the principle criteria for 
prioritization. 
   
  (c) Targeted populations. Preference for services shall be given to the 
targeted populations as listed below: 
 
  (1)  older individuals with greatest economic need (with particular attention 
to low-income minority individuals); 
   
  (2) older individuals who have greatest social need (with particular attention 
to low-income minority individuals); 
   
  (3) older individuals with severe disabilities; 
   
  (4) older individuals with limited English-speaking ability; 
   
  (5) older individuals with Alzheimer's Disease or related disorders with 
neurological and organic brain dysfunction and the caretakers of such 
individuals; and 
   
  (6) older individuals residing in rural areas. 
     
  (d) Definitions. The following words and terms, when used in this section, 
shall have the following meanings, unless the context clearly indicates 
otherwise. 
 
  (1) Targeting-Efforts made to identify, outreach, and serve those populations 
identified by the Older Americans Act and these standards. 
   
  (2) Outreach-A variety of interventions to identify and reach older 
individuals in the targeted population. 
   
  (3)  Minority-A person in one or more of the following four racial/ethnic 
groups: Black, Hispanic, Asian/Pacific Islander, and Native American. 
   
  (4) Black-A person of African-American decent, including those from the 
Caribbean Islands, the Dominican Republic, or Haiti. 
   
  (5)  Hispanic-A person with a heritage originating from Mexico, Spain, Puerto 
Rico, Central America, South America, or any other area where Spanish is the 
native language. 
   
  (6) Asian American and Pacific Islander-Persons having origins in any of the 
original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or 
the Pacific Islands. 
   
  (7) Native American-American Indian, Alaskan Native, and Native Hawaiian. 
   
  (8)  Indian-A person who is a member of an Indian tribe. 
   
  (9)  Native Hawaiian-A person any of whose ancestors were natives of the area 
which consists of the Hawaiian Islands prior to 1778. 
   
  (10) Indian Tribe-Any tribe, band, nation, or other organized group or 
community of Indians which: 
 
  (A) is recognized as eligible for the special programs and services provided 
by the United States to Indians because of their status as Indians; or 
   
  (B) is located on, or in proximity to, a Federal or State reservation or 
rancheria. 
     
  (11) Significant Indian population-At least 50 Indians over the age of 60. 
   
  (12)  Indian Organization-The recognized governing body of any Indian tribe, 
or any legally established organization of Indians which is controlled, 
sanctioned, or chartered by such governing body. 
   
  (13)  Reservation-Any federally recognized Indian tribe's, reservation, 
pueblo, or colony. 
   
  (14) Greatest Economic Need-The need resulting from an income level at or 
below the poverty line. 
   
  (15) Poverty Line-The official poverty live as defined by the federal Office 
of Management and Budget. 
   
  (16) Low-income-A level of income, below which a person or persons is 
considered to be living in poverty. (see Poverty Line). 
   
  (17) Greatest Social Need-The need caused by non-economic factors, which 
include: 
 
  (A) physical and mental disabilities; 
   
  (B) language barriers; and 
   
  (C) cultural, social, or geographical isolation including that caused by 
racial or ethnic status that: 
 
  (i) restricts the ability of the individual to perform normal daily tasks or 
   
  (ii) threatens the capacity of the individual to live independently. 
       
  (18) Frail-An older individual is determined to be functionally impaired 
because the individual: 
 
  (A) is unable to perform at least two activities of daily living without 
substantial human assistance, including verbal reminding, physical cueing, or 
supervision; 
   
  (B)  due to a cognitive or other mental impairment, requires substantial 
supervision because the individual behaves in a manner that poses a serious 
safety hazard to the individual or to another individual. 
     
  (19) Severe Disability-A severe, chronic disability attributable to mental or 
physical impairment, or a combination of mental and physical impairments, that: 
 
  (A) is likely to continue indefinitely; 
   
  (B) results in substantial functional limitation in three or more major life 
activities. 
     
  (20) Disability- 
 
  (A) a physical or mental impairment that substantially limits one or more of 
the major life activities of an individual; 
   
  (B) a record of such an impairment; (which means has a history of, or has been 
misclassified as having, a mental or physical impairment that substantially 
limits one or more major life activities); 
   
  (C)  being regarded as having such an impairment, which means: 
 
  (i)  an individual may have an impairment which is not substantially limiting 
but is perceived as constituting a substantially limiting impairment; 
   
  (ii) the individual may have an impairment which is only substantially 
limiting because of the attitudes of others toward the impairment; or 
   
  (iii) the individual may have no impairment at all but is regarded as having a 
substantially limiting impairment). 
       
  (21) Developmental Disability-A severe, chronic disability attributable to a 
mental or physical impairment, or combination of both: 
 
  (A) that is manifested before age 22; 
   
  (B) is likely to continue indefinitely; 
   
  (C) results in substantial limitations in three or more of the following areas 
of major life activity: self-care, receptive and expressive language, learning, 
mobility, self-direction, capacity for independent living, and economic self-
sufficiency; and results in the need for individually planned and coordinated 
services lifelong or over an extended period of time. 
     
  (22) Alzheimer's Disease-A progressive, degenerative disease that attacks the 
brain and results in impaired memory, thinking, and behavior. 
   
  (23) Related disorders (dementia)-The loss of intellectual functions, not 
caused by Alzheimer's Disease ( such as thinking, remembering, and reasoning) of 
sufficient severity to interfere with an older individual's daily functioning. 
Examples: multi-infarct dementia, Huntington's disease, Pick's disease, 
Creutzfeldt-Jakob disease, and Parkinson's disease. 
   
  (24) Qualified individual with a disability-An 60+ individual with a 
disability who, with or without reasonable modifications to rules, policies, or 
practices, the removal of architectural, communication, or transportation 
barriers, or the provision of auxiliary aids and services, meets the essential 
eligibility requirements for the receipt of services or the participation in 
programs or activities provided by a public entity. 
   
  (25)  Substantially limited- 
 
  (A) unable to perform a major life activity that the average older person in 
the general population can perform; or 
   
  (B) significantly restricted as to the condition, manner or duration under 
which an older individual can perform a particular major life activity as 
compared to the condition, manner, or duration under which the average older 
person in the general population can perform that same major life activity. 
     
  (26) Impairment (Physical or Mental)- 
 
  (A) any physiological disorder, or condition, cosmetic disfigurement, or 
anatomical loss affecting one or more of the following body systems: 
neurological, musculoskeletal, special sense organs, respiratory (including 
speech organs), cardiovascular, reproductive, digestive, genito-urinary, hemic 
and lymphatic, skin, and endocrine; or 
   
  (B) Any mental or psychological disorder, such as mental retardation, organic 
brain syndrome, emotional or mental illness, and specific learning disabilities. 
The phrase physical or mental impairment includes, but is not limited to, such 
contagious and noncontagious diseases and conditions as orthopedic, visual, 
speech and hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, 
multiple sclerosis, cancer, heart disease, diabetes, mental retardation, 
emotional illness, specific learning disabilities, HIV disease (whether 
symptomatic or asymptomatic), tuberculosis, drug addiction, and alcoholism. 
     
  (27) Major Life Activities-Functions such as: 
 
  (A) self-care which are daily activities which enable a person to meet basic 
life needs for food, hygiene and appearance. Examples: able to eat, drink, use 
utensils, use the restroom, bath, keep clothes clean, dress, hair and nail care, 
etc., without the aid of another person; 
   
  (B) receptive and expressive language which is communication involving verbal 
and/or non-verbal behavior enabling the individual both to understand others and 
to express ideas/information to others. Examples: use of oral or sign language 
or other intelligible gestures of sounds, use of letter boards or typewriters, 
voice control, lip reading, understanding through listening, reading, etc; 
   
  (C) learning ability to acquired new behaviors, perceptions and information, 
and to apply experiences in new situations. Examples: memory, knowledge, 
reading, writing, ability to see relationships among pieces of information, etc; 
   
  (D) mobility ability to use fine and gross motor skills. Ability to move one's 
person from one place to another with or without mechanical aids. Examples: 
walking, climbing, use of mobility aids such as crutches, wheelchair, cane or 
walker, balance, precision movements, eye-hand coordination, manual dexterity, 
etc; 
   
  (E) self-direction management and taking control over one's social and 
personal life. Ability to make decisions affecting and protecting one's own 
interests. Examples: social awareness, emotional stability, decision making, and 
awareness and responsiveness to surroundings; 
   
  (F) capacity for independent living ability to live without extraordinary 
assistance from other persons, especially to maintain normal societal roles. 
Examples: cleaning house, cooking, laundering, maintaining relationships, 
budgeting, purchasing, using money, selecting appropriate clothing for the 
weather, recreation, cultural activities, using transportation, telephone, post 
office, etc; 
   
  (G)  economic self-sufficiency and absence of dependence on family or welfare 
for financial support; 
   
  (H) cognitive functioning and general cognitive competence. Examples: 
recognition, ability to understand information, ability to generalize, to 
conceptualize, to use abstract concepts, etc; 
   
  (I) emotional adjustment-self-esteem, self-confidence, emotionally stability, 
etc. 
     
  (28) Adult Child with a Disability-A child who: 
 
  (A) is 18 years of age or older; 
   
  (B) is financially dependent on an older individual who is a parent of the 
child; and 
   
  (C) has a disability. 
     
  (29) Caregiver-An individual who has the responsibility for the care of an 
older individual, either voluntarily, by contract, by receipt of payment; for 
care, or as a result of the operation of law. 
   
  (30) Caretaker-A family member or other individual who provides (on behalf of 
such individual or of a public or private agency, organization, or institution) 
uncompensated care to an older individual who needs supportive services. 
   
  (31) Substantial Number of Limited English-Speaking Participants -one-fourth 
of the total number of participants and/or 25 participants, whichever is lower. 
     
  (e) Outcomes. 
 
  (1)  Groups, organizations, and agencies which deal with persons with 
disabilities, as well as older persons with disabilities, will have been 
consulted for assistance with the identification and outreach of older persons 
with disabilities and their needs. 
   
  (2) Each AAA will have developed a written report on the needs of the targeted 
population(s) in their area. 
   
  (3) Each AAA will have analyzed each service provider's outreach plan, the 
efforts made and reported to TDOA on the results. 
   
  (4) Each AAA will have a written targeting strategy in place which outlines 
how the AAA plans to insure that the targeted groups are reached. 
   
  (5) TDOA will have received information detailing each AAA's outreach and 
targeting strategies, efforts, and results. 
   
  (6) The number of targeted older persons served will increase. 
     
  (f) Service Provider Responsibilities. Each service provider shall be required 
to: 
 
  (1)  Identify the number, location, and needs of targeted older persons in the 
service area and provide that information to the AAA on an annual basis. This 
may be accomplished through a needs assessment process, public hearings, 
contacts with minority and/or disability organizations and groups, a local task 
force on targeting consisting of concerned citizens from the targeted groups or 
other methods. Needs may be: 
 
  (A) self-declared; 
   
  (B) provider observation; or 
   
  (C) reasonable perception. 
     
  (2) Means testing is strictly prohibited. Providers may not require older 
persons to disclose information about income or resources as a condition for 
providing services. 
   
  (3) Set specific written objectives for providing services to low-income 
minority individuals within the service area, based on need. These objectives 
should be established through a dialog with the area agency on aging and should 
be written into the provider contract. 
   
  (4) Describe methods the provider intends to use to outreach those identified 
older targeted persons in greatest need. 
   
  (5) The information identified in subparagraphs (A), (B), and (C) in this 
subsection relating to needs, shall be maintained in the provider and AAA files 
at all times and made available to TDOA upon request. 
   
  (6) Monthly reports shall be provided to the AAA on the extent to which the 
provider has met the objectives of providing services to older individuals in 
the targeted population. 
   
  (7) Each service provider must insure that sites are accessible to persons 
with disabilities, in accordance with the Americans with Disabilities Act. This 
means that when an individual service provider's services are viewed in their 
entirety, persons with disabilities shall have equal access to services. 
Violation of this requirement will result in the withdrawal of TDOA funding. 
   
  (8) Each provider must maintain an accurate record of participants and report 
them to the AAA monthly. 
     
  (g)  Client Application (Intake) Requirements. 
 
  (1) All policies shall be established with the dignity and privacy of all 
participants as a goal. This is especially important for targeted individuals 
who may feel uncomfortable in a new and unfamiliar setting. 
   
  (2) Policies (whether formal or informal) of discrimination or segregation 
shall not be allowed. This includes, for example, the "grouping" together of 
individuals with disabilities or persons who speak a language other than English 
solely for the convenience of the staff or the preference of other participants. 
   
  (3) A policy shall be established that insures confidentiality regarding each 
participant. Staff will not discuss or reveal any personal aspects of a 
participant's life or condition with anyone outside the staff, AAA, or TDOA, and 
only then when necessary for reporting, administrative, or monitoring purposes. 
   
  (4) All activities shall be inclusionary. No participant shall be discouraged 
in any way from participating in any activity in which he or she choose to 
participate. 
   
  (5) There shall be no policies (formal or informal) which allow for assigned 
seating during activities, unless there is a safety reason for doing so. 
   
  (6) As a general rule, self declaration, observation, and/or reasonable 
perception may be used to identify targeted individuals. However, according to 
the Americans with Disabilities Act, the following factors should be considered 
in determining whether an individual is substantially limited in a major life 
activity: 
 
  (A) the nature and severity of the impairment; 
   
  (B) the duration or expected duration of the impairment; and 
   
  (C) the permanent or long term impact, or the expected permanent or long term 
impact of or resulting from the impairment. 
     
  (7)  Participant contributions shall be handled in a confidential manner. No 
pressure shall be put on any participant to contribute and no services shall be 
denied due to the lack of a contribution. All participants shall be treated 
equally whether they have made a contribution or not. 
   
  (8) All signs and brochures should be printed in English and Spanish and/or 
other languages as appropriate. 
     
  (h) Administrative Requirements. 
 
  (1)  These standards apply to all services provided by services providers and 
area agencies on aging which are funded through the Department and the Older 
Americans Act of 1992, as amended. 
   
  (2) Those AAAs which have a significant Native American population in their 
area, or have an Indian Tribe, tribal organization and/or providers in their 
area shall develop and enter into cooperative agreements with those groups. 
     
  (i) Area Agency on Aging Responsibilities. Each AAA shall include in the area 
plan a comprehensive section on identification of need which will include the 
following. 
 
  (A) The extent of need for services and multipurpose senior centers taking 
into consideration the number of older individuals with low incomes residing in 
the area, the number of older individuals who have greatest economic need (with 
particular attention to low-income minority individuals) residing in such area, 
the number of older individuals who have greatest social need (with particular 
attention to low-income minority individuals) residing in such area, and the 
number of older Indians residing in such area shall be documented in the area 
plan. This may be accomplished through a formal needs assessment process, public 
hearings, contacts with minority and/or disability organizations and groups, a 
local task force on targeting consisting of concerned citizens from the targeted 
groups, as well as other methods (formal or informal). 
   
  (B) Whatever method(s) is used, there must be a written document in the AAA 
files supporting the need for services in the PSA by the targeted population as 
stated in the area plan. That document shall include, at a minimum: 
 
  (i) methods used to ascertain need; 
   
  (ii) persons and groups contacted and results; 
   
  (iii) public hearings results; 
   
  (iv)  number persons and needs identified; 
   
  (v)  identification by target group; and, 
   
  (vii)  geographic location of targeted populations. 
     
  (C) Needs may be: 
 
  (i) self-declared; 
   
  (ii) provider observation; or 
   
  (iii) reasonable perception. 
     
  (D)  Documentation of this needs assessment shall be maintained in the AAA 
office and shall be made available to TDOA when requested. 
   
  (2)  Outreach efforts will be specific and shall inform or cause to be 
informed targeted individuals eligible for services and/or their caretakers of 
the availability of AAA services. Examples of outreach efforts may include, but 
are not limited to: public service announcements on television (in Spanish and 
closed captioned); Spanish radio stations; contacts with minority community 
leaders, caregiver support groups and publications, etc.; contacts with local 
disability advocacy groups, public agencies, such as the Texas Rehabilitation 
Commission, as well as hospital personnel. 
   
  (3) Service delivery strategies will be developed. Specific strategies shall 
be included for providing services to targeted persons. This should be placed 
under the State Strategy which "provides a statewide, locally-based system of 
information and assistance which includes advocacy for the removal of barriers 
to service access to all eligible Texans, especially frail, low- income, and 
minority older people." This shall include, but is not limited to: 
 
  (A)  specific objectives for providing services to older individuals with the 
greatest economic or social needs, including specific objectives for services to 
low income minority individuals; 
   
  (B) identification and descriptions of specific program development, advocacy 
and outreach efforts which focus on the needs of targeted populations in the 
service area; 
   
  (C)  descriptions of methods for establishing and maintaining information and 
assistance services. This must indicate that I & A services will be provided in 
such a way to insure that all older persons in the PSA will have reasonably 
convenient access to the services with particular emphasis on linking services 
available to isolated older individuals and older individuals with Alzheimer's 
Disease or related disorders with neurological and organic brain dysfunction 
(and the caretakers of individuals with such disease or disorders). 
     
  (4)  If there is a significant Indian population in the PSA, the AAA shall 
conduct outreach to that population. This can best be done through Indian 
organizations and leaders. 
   
  (5) Participant data shall be monitored by the AAA as part of an ongoing 
assessment of the progress of the provider in meeting objectives. 
   
  (6) Each activity undertaken by the agency, including planning, advocacy, and 
systems development, will include a focus on the needs of low-income minority 
older individuals, and shall be identified as such in the area plan. 
   
  (7) The methods of carrying out the provision of services to those in greatest 
economic and social needs shall be implemented, as described in the area plan. 
   
  (8) The area agency on aging shall require the following in the provider 
Request for Proposals (RFP): 
 
  (A) the number, location, and needs of targeted older persons in the service 
area; 
   
  (B) specific written objectives for providing services to low-income minority 
individuals within the service area, based on need. These objectives should be 
established through a dialog between the AAA and the service provider; 
   
  (C) methods the provider intends to use to outreach those identified older 
targeted persons in greatest need. 
     
  (9)  The provider contract shall stipulate that special emphasis shall be 
given to serving the targeted populations. 
   
  (10) The AAA is to maintain records in the AAA Office of provider reports on 
the extent to which each provider has met the objectives of providing services 
to older individuals in the targeted population and make it available to TDOA 
upon request. 
   
  (11) Each AAA must comply with the provisions of the Americans with 
Disabilities Act and must insure that any entity with which it contracts also 
complies with that Act. 
   
  (12) The location of new services/nutrition sites/senior centers shall be 
established in areas which contain a prominent population of targeted older 
persons. 
   
  (13) The AAA will provide technical assistance to service providers on 
outreach methods and strategies. 
   
  (14) The AAA will analyze the outreach efforts of each service provider on a 
quarterly basis by comparing its objectives against its participation reports. 
   
  (15) The AAA Advisory Council composition will be in accordance with 40 TAC 
sec.255.35(c)(6)(v) of this title (relating to Membership In Area Agency On 
Aging Advisory Councils). 
     
  (j) Legal Requirements. 
 
  (1) All AAAs and service providers must comply with the provisions of The 
Americans with Disabilities Act of 1990 (Public Law 101-336), as amended. 
   
  (2) All AAAs and service providers must comply with the provisions of the 
Older Americans Act of 1992, as amended. 
     
  (k) Reporting Requirements. 
 
  (1) Each service provider shall provide a report to the AAA on targeting 
efforts and the results, with particular attention to unserved older individuals 
with greatest economic need (including low-income minority individuals) and 
unserved older individuals with greatest social need (including low-income 
minority individuals). 
   
  (2) Each AAA shall include in its quarterly report to TDOA, an analysis of the 
effectiveness of its targeting efforts in meeting the needs of older individuals 
with greatest economic need (including low-income minority individuals) and 
older individuals with greatest social need (including low-income minority 
individuals, as well as the other targeted populations in these standards. This 
shall include information on reaching those persons in the targeted population 
which had been previously unserved. 
 
  (A)  This quarterly area plan report should include the following: 
 
  (i) the results of the needs assessment conducted by the AAA, including how it 
was conducted, who was contacted, what agencies assisted, and the results. 
(First quarter only unless changes occur); 
   
  (ii)  methods used to reach the targeted population; 
   
  (iii)  an analysis of the outreach plan, including revisions; 
   
  (iv)  analysis of provider compliance. 
         
  (l) Staff Requirements. 
 
  (1) Documentable efforts should be made to recruit and hire qualified staff 
persons who are bilingual and/or bicultural when there is a significant minority 
population in the area. 
   
  (2) Qualified persons with disabilities should receive equal consideration for 
staff positions and shall have reasonable accommodations made in compliance with 
Title I of the Americans with Disabilities Act. 
   
  (3) AAAs are encouraged to make every effort to work with minority service 
providers. 
     
  (m) Staff In-service Training. 
 
  (1) AAAs should provide the following training to its service providers at a 
minimum of once a year: 
 
  (A) cultural diversity and sensitivity; 
   
  (B) outreach techniques; 
   
  (C)  disability issues and etiquette; 
   
  (D) pertinent laws and implications, such as: 
 
  (i) Older Americans Act, as amended; 
   
  (ii) Americans with Disabilities Act. 
       
  (2) Training should also be provided on United States Census data and its 
implications, when changes occur. 
     
  (n) Monitoring. 
 
  (1) Area Agency on Aging. 
 
  (A) The effectiveness of the targeting and outreach efforts of the AAA and 
their service providers will be an important part of the monitoring process. The 
AAA's monitoring records will be reviewed for compliance. 
   
  (B) The AAA area plan quarterly reports and the participant tracking 
information on targeted populations served will become part of TDOA's monitoring 
report. 
   
  (C) The annual TDOA program review process shall include, but not be limited 
to, a review of the following: 
 
  (i) participant data analysis; 
   
  (ii)  quarterly area plan reports; 
   
  (iii) needs assessments; 
   
  (iv) service provider targeting information and reports; 
   
  (v) an analysis of outreach efforts; 
   
  (vi) AAA monitoring reports; 
   
  (vii) Advisory Council representation; 
   
  (viii) number of minority service providers. 
       
  (2)  Service provider. 
 
  (A) The service provider shall be monitored by the AAA on the provisions of 
the request for proposals and the contract. 
   
  (B) The AAA will conduct periodic on-site visits to providers to insure 
compliance with these standards. 
   
  (C) Participant data shall be monitored by the AAA as part of an ongoing 
assessment of the progress of the provider in meeting objectives. 
   
  (D) The AAA must monitor each service provider to insure that sites are 
accessible to persons with disabilities, in accordance with the Americans with 
Disabilities Act. This means that when an individual service provider's services 
are viewed in their entirety, persons with disabilities shall have equal access 
to services. Violation of this requirement will result in the withdrawal of TDOA 
funding. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 24, 1993. 
 TRD-9319480 
  Mary Sapp 
 Executive Director 
 Texas Department on Aging 
    Earliest possible date of adoption: April 5, 1993 
 For further information, please call: (512) 444-2727 
         
                   Chapter 273. Transportation Service Standards 
  
  40 TAC sec.sec.273.1, 273.3, 273.5 
 
  The Texas Department on Aging proposes the repeal of sec. s273.1, 273.3, and 
273.5 concerning Transportation Service Standards as a result of the development 
of a new chapter pertaining to this service. 
 Ann Ammons, Director of Field Operations, Texas Department on Aging, has 
determined there will not be fiscal implications as a result of enforcing or 
administer this rule. 
 Ms. Ammons, also has determined that for each year of the first five years the 
repeal is in effect, the public benefit anticipated as a result of this repeal 
will be greater understanding of the processes required of area agencies on 
aging as a result of publishing an updated version of these standards. There 
will be no effect on small businesses. 
 The anticipated economic cost to persons who are required to comply with the 
chapter as proposed will be none. 
 Request for public comments on the proposal may be submitted to Ann Ammons, 
Director of Field Operations, Texas Department on Aging, P.O. Box 12786, Austin, 
Texas 78711. 
 The repeals are proposed under the Human Resources Code, Chapter 101, which 
provides the Texas Department on Aging with the authority to promulgate rules 
governing the operation of the department. 
 
 
  sec.273.1. Title III Transportation Service Standards. 
 
   
  sec.273.3. Qualifications of Vehicle Operators. 
 
   
  sec.273.5. Vehicle Operational Consideration. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 24, 1993. 
 TRD-9319479 
  Mary Sapp 
 Executive Director 
 Texas Department on Aging 
    Earliest possible date of adoption: April 5, 1993 
 For further information, please call: (512) 444-2727 
         
    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 5. 97, the 
Texas Register publishes notice of proposed actions by the Texas Board of 
Insurance. Notice of action proposed under Article 5.96 must be published in the 
Texas Register not later than the 30th day before the board adopts the proposal. 
Notice of action proposed under Article 5.97 must be published in the Texas 
Register not later than the 10th day before the Board of Insurance adopts the 
proposal. The Administrative Procedure and Texas Register Act, Texas Civil 
Statutes, Article 6252-13a, does not apply to board action under Articles 5.96 
and 5.97. 
 The complete text of the proposal summarized here may be examined in the 
offices of the Texas Department of Insurance, 333 Guadalupe Street, Austin, 
Texas 78714-9104.) 
   
  The State Board of Insurance, at a Board meeting scheduled for 9 a.m. April 
15, 1993, in Room 100 of the Texas Department of Insurance Building, 333 
Guadalupe Street in Austin, Texas, will consider a proposal filed on behalf of 
the Texas Workers' Compensation Insurance Facility (the Facility). The Facility 
proposed a rule on procedures for redistribution of assessments made on 
insurance carriers that are in liquidation. The rule was proposed in a petition 
(Reference Number W-0293-73), filed by the Facility on February 1, 1993. 
 According to the Facility's petition, the proposed rule would allow for an 
equitable redistribution of the assessment among all members of the Facility. 
The proposal is to apportion the redistributed amount among the members on the 
same basis as their individual member assessments for such year. The proposed 
rule further provides that, in the event the company in liquidation can later 
repay the assessment so distributed, appropriate debits can be made to all 
members who participated in the initial redistribution. If approved by the 
Board, the rule will become a part of the Texas Basic Manual of Rules, 
Classification and Rates for Workers' Compensation and Employers' Liability 
Insurance. 
 A copy of the petition containing the full text of the proposed amendments is 
available for review in the office of the Chief Clerk of the Texas Department of 
Insurance, 333 Guadalupe Street, Austin, Texas 78714-9104. For further 
information or to request copies of the petition, please contact Ms. Angie 
Arizpe (512)322-4147, refer to (Reference Number W-0293-73). 
 This notification is made pursuant to the Insurance Code, Article 5.96, which 
exempts it from the requirements of the Administrative Procedures and Texas 
Register Act. 
 
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 25, 1993. 
 TRD-9319537 
  Linda K. von Quintus-Dorn 
 Chief Clerk 
 Texas Department of Insurance 
    For further information, please call: (512) 463-6327 
         
   
  The State Board of Insurance, of the Texas Department of Insurance, at a Board 
meeting scheduled for April 15, 1993, at 9 a.m., will consider the adoption of 
amendments to the Texas Workers' Compensation Statistical Plan. These amendments 
consist of deleting the requirement that certain serial card numbers be reported 
to the Texas Department of Insurance; requiring that each insured's four-digit 
classification code be reported; deleting the reporting of losses while on 
strike duty; requiring the separate reporting of direct expenditures by an 
insurer to influence public policy and any amounts paid by an insurer as damages 
in a suit against the insurer for malice or bad faith or as fines or penalties; 
reporting of premium credits and negotiated deductible amounts; reporting of 
small employer premium incentive discounts, surcharges and small premium policy 
plan penalties; reporting of maintenance tax surcharges; and other editorial 
changes to ensure the proper gathering of statistical information. 
 Copies of the full text of the Texas Workers' Compensation Statistical Plan are 
available for review in the Office of the Chief Clerk of the State Board of 
Insurance, 333 Guadalupe Street, Austin, Texas, 78714-9104. For further 
information or to request copies of the text, please contact Angie Arizpe, at 
(512) 322-4147, (refer to Reference Number W-0193-74-I). 
 This notification is made pursuant to the Texas Insurance Code, Article 5. 96, 
which exempts it from the requirements of the Administrative Procedure and Texas 
Register Act. 
   
  This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's authority to adopt. 
 Issued in Austin, Texas, on February 25, 1993. 
 TRD-9319536 
  Linda K. von Quintus-Dorn 
 Chief Clerk 
 Texas Department of Insurance 
    For further information, please call: (512) 463-6327