ADOPTED RULES An agency may take final action on a section 30 days after a proposal has been published in the Texas Register. The section becomes effective 20 days after the agency files the correct document with the Texas Register, unless a later date is specified or unless a federal statute or regulation requires implementation of the action on shorter notice. If an agency adopts the section without any changes to the proposed text, only the preamble of the notice and statement of legal authority will be published. If an agency adopts the section with changes to the proposed text, the proposal will be republished with the changes. TITLE 25. HEALTH SERVICES Part II. Texas Department of Mental Health and Mental Retardation Chapter 409. Medicaid Programs Subchapter F. Case Management Program Requirements 25 TAC sec.sec.409.202-409.205 The Texas Department of Mental Health and Mental Retardation (TDMHMR) adopts amendments to sec.409.202 and sec.409.203 of Chapter 409, Subchapter F, concerning case management for persons with mental retardation without changes to the proposed text as published in the May, 16, 1995, issue of the Texas Register (20 TexReg 3627). Technical changes to reflect the wording of updated statutes are reflected in sec.409.204 and sec.409.205. The purpose of the amendments to sec.sec.409.202-409.205 is to streamline service definitions to facilitate accurate and reliable documentation of case management activities and increase the numbers of persons who can provide Medicaid reimbursed case management activities. A public hearing was held in Austin on May 26, 1995, to accept oral and written testimony concerning the amendments to sec. sec.409.251-409.254. No testimony was provided concerning these amendments. Written comments were received from Mental Health and Mental Retardation Authority of Harris County, Houston; Anderson County Mental Health Services, Palestine; Spencer Bayles, M. D., Houston; and the Helen Farabee Center, Wichita Falls. A commenter requested that the rule be amended to clarify that the case manager functions as an advocate and service broker as a part of a treatment team, not as an autonomous decision-maker. The department responds that sec.409. 205(b)(5) requires case management to be conducted in compliance with the TDMHMR Community Standards for Mental Retardation Services. These standards require that each individual receives services according to an individual treatment plan. The plan is developed by an interdisciplinary team which would include the case manager as one of several members. A commenter requested that the philosophy of case management reflected in sec.409.203 retain a reference to "the optimal functioning of the individual" as a goal of case management services. The department responds that the principles and philosophy of case management have shifted so that the consumer directs service delivery to the greatest possible degree. The role of the case manager is to assist and support persons to achieve their goals. The intent of the department is to incorporate this person-centered language and philosophy into policy and procedure. A second commenter suggested that language in the same section reflect that case management services are provided by a single accountable staff person assigned to that person. The department responds that intensive case management services, as provided within a case management unit, will continue to be provided by a single accountable individual as required in the operating instructions for case management (OI 401-2). Case management activities such as service coordination and monitoring which are provided outside of an existing case management unit will continue to be potentially provided by several staff persons. TDMHMR Community Standards for Mental Retardation Services require that an individual program coordinator be designated for each person served. Persons entering services will continue to be screened for their need for case management services. Those persons determined to be in need of intensive case management services will continue to be referred to these services. The intent of the amendments to the subchapter is to recognize that persons determined not to be in need of intensive case management do receive case management services, and to allow the local mental retardation authority to seek reimbursement for those services. A commenter suggested that the designation of a single case management unit be retained as a requirement of the rule. The department responds that a case management unit is not precluded by the amended rule. The intent of the amendment is to recognize those case management activities which are performed by persons outside the single case management unit. A commenter suggested that the minimum requirements for screening and assessment and service planning formerly referenced in sec.409.203(3) be retained as a part of the rule. The department responds that these requirements will continue to be specified within the operating instructions for the delivery of case management services (OI 401-2). Persons providing case management activities are required to comply with the TDMHMR Community Standards for Mental Retardation Services which delineate requirements for these activities. These amendments are adopted under the Texas Health and Safety Code, sec.532. 015, which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority, and under the provisions of Texas Civil Statutes, Article 4413(502), sec.16, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds. sec.409.204. Service Limitations. (a) Case management services will not be reimbursable as a Medicaid service for which another payor is liable. Case management activities associated with the following are not reimbursable as an optional targeted case management service: (1) Medicaid eligibility determinations and redeterminations; (2) Medicaid eligibility intake processing; (3) Medicaid preadmission screening; (4) prior authorization for Medicaid services; (5) required Medicaid utilization review; (6) EPSDT administration; and (7) Medicaid "lock-in" provided for under sec.1915(a) of the Omnibus Reconciliation Act of 1987. (b) Specifically, reimbursement will not be made for the following: (1) Outreach activities that are designed to locate individuals who are potential Medicaid eligible. This exclusion does not include Medicaid eligible requiring services outlined in sec.409.203(a)(1) of this title (relating to Case Management Intake). (2) Any medical evaluation, examination or treatment billable as a distinct Medicaid covered benefit. However, referral arrangements and staff consultation for such services are reimbursable as a case management service. (3) Services provided under the home and community-based services waiver for mentally retarded individuals (HCS). (4) Services provided under the home and community-based services waiver for persons with mental retardation or related conditions (HCS-OBRA). sec.409.205. Provider Qualifications. (a) Section 4118(i) of Public Law 100-203, Omnibus Reconciliation Act of 1987, is invoked to limit the provider of case management services to the state mental retardation authority, the Texas Department of Mental Health and Mental Retardation (TDMHMR) or its designated providers authorized under sec.534.054 of the Texas Health and Safety Code, who offer a service delivery system for required as outlined in sec.534.053 of the Texas Health and Safety Code. (b) TDMHMR has implemented rules, standards and procedures to ensure that case management activities are: (1) available on a statewide basis with procedures to ensure continuity of services and avoidance of duplication; (2) provided by persons who meet the requirements specified by TDMHMR; (3) made available to all persons with mental retardation or a related condition, regardless of their ability to pay; (4) provided in compliance with federal, state and local laws, including directives, settlements and resolutions applicable to the target population; (5) provided in accordance with the TDMHMR Community Standards for Mental Retardation; and (6) provided in compliance with the TDMHMR Guidelines for Annual Financial and Compliance Audits of Community MHMR Centers. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on June 27, 1995. TRD-9507541 Ann Utley Chair, Texas MHMR Board Texas Department of Mental Health and Mental Retardation Effective date: July 12, 1995 Proposal publication date: May 16, 1995 For further information, please call: (512) 206-4516 Subchapter G. Case Management for Persons with Severe and Persistent Mental Illness 25 TAC sec.sec.409.251-409.254 The Texas Department of Mental Health and Mental Retardation (TDMHMR) adopts amendments to sec.sec.409.251-409.254 of Chapter 409, Subchapter G, concerning case management for persons with severe and persistent mental illness. Section 409.253 is adopted without changes to the proposed text as published in the May, 16, 1995, issue of the Texas Register (20 TexReg 3629) and will not be republished. Technical changes to reflect the wording of updated statutes are reflected in sec.409.254. The phrase "chronic mental illness" has been replaced with the phrase "severe and persistent mental illness" throughout the subchapter to reflect language preferred by consumers. The purpose of the amendments to sec.sec.409.251-409.254 is to streamline service definitions to facilitate accurate and reliable documentation of case management activities and increase the numbers of persons who can provide Medicaid reimbursed case management activities. A public hearing was held in Austin on May 26, 1995, to accept oral and written testimony concerning the amendments to sec. sec.409.251-409.254. No testimony was provided concerning these amendments. Written comments were received from the Texas Mental Health Association; Advocacy Inc., Austin; Mental Health and Mental Retardation Authority of Harris County, Houston; Anderson County Mental Health Services, Palestine; Spencer Bayles, M.D., Houston; and the Helen Farabee Center, Wichita Falls. A commenter requested that the phrase "severe and persistent mental illness" be used in place of the phrase "chronic mental illness". The title of the subchapter and other references to chronic mental illness have been changed to reflect the language preferred by consumers. A commenter requested that the rule be amended to clarify that the case manager functions as an advocate and service broker as a part of a treatment team, not as an autonomous decision-maker. The department responds that sec.409. 254(b)(6) requires case management to be conducted in compliance with the TDMHMR Community Standards for Mental Health Services. These standards require that all assessments are performed or approved by a qualified mental health professional, and that an individual service plan be developed which reflects the collaboration of the individual and those persons providing services. These standards presume a multi-disciplinary model of treatment which requires the case manager to function as a part of a cohesive team. A commenter requested that the philosophy of case management reflected in sec.409.252(a) retain a reference to "the optimal functioning of the individual" as a goal of case management services. The department responds that the principles and philosophy of case management have shifted so that the consumer directs service delivery to the greatest possible degree. The role of the case manager is to assist and support persons to achieve their goals. The intent of the department is to incorporate this person-centered language and philosophy into policy and procedure. A second commenter suggested that language in the same section reflects that case management services are provided by a single accountable staff person assigned to that person. The department responds that intensive case management services, as provided within a case management unit, will continue to be provided by a single accountable individual as required in the operating instructions for case management (OI 401-2). Case management activities such as service coordination and monitoring which are provided outside of an existing case management unit will continue to be potentially provided by several staff persons. Persons entering services will continue to be screened for their need for case management services. Those persons determined to be in need of intensive case management services will continue to be referred to these services. The intent of the amendments to the subchapter is to recognize that persons determined not to be in need of intensive case management do receive case management services, and to allow the local mental health authority to seek reimbursement for those services. A commenter suggested that the designation of a single case management unit be retained as a requirement of the rule. The department responds that a case management unit is not precluded by the amended rule. The intent of the amendment is to recognize those case management activities which are performed by persons outside the single case management unit. A commenter suggested that the minimum requirements for screening and assessment and service planning formerly referenced in sec.409.252(d) be retained as a part of the rule. The department responds that these requirements will continue to be specified within the operating instructions for the delivery of case management services (OI 401-2). Persons providing case management activities are required to comply with the TDMHMR Community Standards for Mental Health Services which delineate requirements for these activities. These sections are adopted under the Texas Health and Safety Code, sec.532. 015(a), which provides the Texas Mental Health and Mental Retardation Board with broad rulemaking authority, and under the provisions of Texas Civil Statutes, Article 4413(502), sec.16, which provides the Texas Health and Human Services Commission with the authority to administer federal medical assistance funds. sec.409.251. Target Population. (a) (No change.) (b) Case management activities may be provided to persons, regardless of age, who have a single severe and persistent mental disorder, excluding mental retardation, or a combination of chronic mental disorders as defined in the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, and are at risk of institutionalization. Those at risk of institutionalization include individuals who, without community-based support services, would require long-term psychiatric care in a hospital. Individuals with severe and persistent mental illness will not be required to receive case management services. (c) Persons most in need of case management and service coordination must be identified and provided such services as a first priority. Persons will be screened to identify and establish the level of intensity of case management needed by the individual. sec.409.252. Services. (a) Case management services are provided to assist individuals with severe and persistent mental illness in gaining access to medical, social, educational and other appropriate services that will help them achieve a quality of life and community participation acceptable to each individual. The role of persons who provide case management activities is to support and assist the person in achieving personal goals. Case management activities are provided regardless of age. (b) Case management activities may include: (1) screening and assessment: obtaining client-identifying information and identifying the nature of the presenting problem and the service and support needs of the individual. (2) crisis intervention: locating and coordinating emergency services. (3) service planning and coordination: identifying and arranging for the delivery of services and supports that address the individual's needs. (4) monitoring: evaluating the effectiveness of the services and the need for additional or different services. sec.409.254. Provider Qualifications. (a) Section 4118(i) of Public Law 100-203, Omnibus Reconciliation Act of 1987, is invoked to limit the provider of case management services to the State Mental Health Authority, which is the Texas Department of Mental Health and Mental Retardation (TDMHMR) or providers authorized under sec.534.054 of the Texas Health and Safety Code, who offer a service delivery system for required services as outlined in sec.534.053 of the Texas Health and Safety Code. (b) TDMHMR has implemented standards and procedures to ensure that case management services are: (1) (No change.) (2) provided by persons who meet the requirements specified by TDMHMR; (3) administered through a community-based center or a facility outreach center that is governed by the operating procedures and program standards established by the TDMHMR; (4) in compliance with federal, state and local laws, including directives, settlements, and resolutions applicable to the target population; (5) provided regardless of an individual's ability to pay; (6) provided in accordance the TDMHMR Community Mental Health Standards; and (7) in compliance with the TDMHMR Guidelines for Annual Financial and Compliance Audits of Community MHMR Centers. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on June 27, 1995. TRD-9507542 Ann Utley Chair, Texas MHMR Board Texas Department of Mental Health and Mental Retardation Effective date: July 12, 1995 Proposal publication date: May 16, 1995 For further information, please call: (512) 206-4516 Part V. Center for Rural Health Initiatives Chapter 500. Executive Committee for the Center for Rural Health Initiatives Subchapter B. Texas Outstanding Rural Scholar Recognition Program 25 TAC sec.sec.500.21-500.42 The Center for Rural Health Initiatives (CRHI) adopts the repeal of sec.sec.500.21-500.42, concerning the outstanding rural scholar recognition program, without changes to the proposed text as published in the January 24, 1995, issue of the Texas Register (20 TexReg 320). The justification for these repeals is to replace them with the new sections which will streamline administrative procedures and increase the efficiency and effectiveness of the program. No comments were received regarding adoption of the repeals. The repeals are adopted pursuant to the Health and Safety Code, Chapter 106, Subchapter C, which authorizes the Executive Committee of the Center for Rural Health Initiatives to adopt rules to administer the Center's program. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on June 9, 1995 TRD-9507478 Laura M. Jordon Executive Director Center for Rural Health Initiatives Effective date: July 11, 1995 Proposal publication date: January 24, 1995 For further information, please call: (512) 479-8891 25 TAC sec.sec.500.21-500.30 The Center for Rural Health Initiatives adopts new sec. sec.500.21-500.30, concerning the outstanding rural scholar recognition program which provides forgiveness loans to students pursuing health care professions. Sections 500. 22-500.26 are adopted with changes to the proposed text as published in the January 24, 1995, issue of the Texas Register (20 TexReg 320). Section 500.21 and sec. sec.500.27-500.30 are adopted without changes and will not be republished. These new sections are adopted to streamline administrative procedures and increase the efficiency and effectiveness of the outstanding rural scholar recognition program. In sec.500.22, changes were made to the definition of "health care profession" and "health care professional" by adding "podiatry", since it is a recognized profession under Texas state law. Changes were made in sec.500.23 and sec.500.24 to clarify the responsibility of the outstanding rural scholar advisory committee. Changes were made in sec.500. 25 and sec.500.26 which addressed the requirement that medical students pursue a residency program in a primary-care related field. These new sections are adopted to streamline administrative procedures and to increase the efficiency and effectiveness of the program, and to ensure consistency with the law governing the program. Comments received addressed the definitions of "health care profession" and "health care professional", and the requirement that medical students pursue a residency program in a primary-care related field. No comments were received regarding adoption of the new sections. The new sections are adopted under the Health and Safety Code, Chapter 106, Subchapter C, which authorizes the Executive Committee of the Center for Rural Health Initiatives to adopt rules to administer the Center's program. sec.500.22. Definitions. The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. Academic term-Is equal to one of the following: (A) a semester; (B) a trimester; and (C) a quarter. Advisory committee -The Outstanding Rural Scholar Advisory Committee. Allied health professional-A provider of health care or health related services, including services relating to: the identification, evaluation, and prevention of diseases and disorders; diet and nutrition; health promotion; rehabilitation; or health systems management. Allied health professions-Fields relating to the delivery of health care or health related services responsible for the identification, evaluation and prevention of diseases and disorders; dietary and nutritional services; health promotion, rehabilitation; or health systems management. Center-The Center for Rural Health Initiatives. Cost of attendance -Allowable costs as determined to be necessary by the financial aid office of the academic institution a student attends which includes costs for tuition, fees, books, supplies, room and board, transportation and personal expenses. Executive committee -The executive committee of the Center for Rural Health Initiatives. Executive director -The executive director of the Center for Rural Health Initiatives. Family member-An individual related to the student by kinship, adoption, or marriage, as well as foster children certified by the Texas Department of Protective and Regulatory Services. Forgiveness loan -A loan made through the Outstanding Rural Scholar Recognition Program. Fund-The Outstanding Rural Scholar Loan Fund administered by the executive committee. Health care professional-Any provider of health care or health related services in the fields of medicine, dentistry, optometry, pharmacy, chiropractic, podiatry, psychology, nursing or allied health. Health care professions-The fields of medicine, dentistry, optometry, pharmacy, chiropractic, podiatry, psychology, nursing and or allied health. Resident of Texas-As described in Education Code, Chapter 54, Subchapter B. Rural community -An incorporated or unincorporated municipality in a nonmetropolitan county in Texas as defined by the United States Census Bureau in its most recent census. Satisfactory academic progress-Maintenance of satisfactory and course load to qualify the student for placement in planned subsequent years of the degree plan. sec.500.23. Advisory Committee. (a) Appointments to the advisory committee by the executive committee shall be made with consideration to geographical areas of the state. (b) The composition of the advisory committee shall be: (1) one rural practicing family practice physician; (2) one rural hospital administrator; (3) one rural practicing registered professional nurse; (4) one rural practicing allied health professional; (5) one dean of a medical school; (6) one dean of a nursing school; (7) one dean of a school of allied health science; (8) one head of a vocational/technical institution; (9) one community college administrator; (10) one individual knowledgeable in student financial assistance programs; (11) one rural public school superintendent; and (12) one rural resident. (c) The committee members serve terms of six years with the terms of one-third of the members expiring on August 31 of each odd-numbered year. All committee members are eligible for reappointment to consecutive terms. (d) A member of the advisory committee shall be reimbursed for expenses incurred in performing duties pertaining to the Outstanding Rural Scholar Recognition Program. Reimbursement may not exceed the amount specified in the General Appropriations Act for travel and per diem allowances for state employees. (e) The advisory committee may elect a chairman, vice-chairman and secretary from among its members and may adopt rules for the conduct of its activities. (f) Vacancies on the advisory committee shall be filled by the executive committee in the same manner as indicated in subsections (a), (b) and (c) of this section. (g) The advisory committee advises the executive committee on the progress of the Outstanding Rural Scholar Recognition Program and shall: (1) select students to be recognized as outstanding rural scholars; (2) recommend guidelines for sponsors to nominate students; (3) recommend guidelines for awarding forgiveness loans; (4) recommend the amount of the loan to be awarded to the student; (5) review cases and make recommendations concerning exceptions regarding the community in which a student may fulfill the obligated service period; and (6) review cases and make recommendations concerning student academic progress. sec.500.24. Requirements for Recognition. (a) Eligibility Requirements for Recognition. (1) Eligible Sponsor. To nominate a student for recognition, a sponsor shall: (A) be located in a rural community in Texas; (B) be an entity with a council, board of trustees or commissioners which is responsible to the rural community in which it is located, and is legally authorized to raise funds, or accept grants, financial gifts, scholarship funds, or private foundation funds; (C) agree to provide 50% of the cost of attendance, if the nominee is selected to receive a forgiveness loan; and (D) be in good standing with the Outstanding Rural Scholar Recognition Program. (2) Eligible Student. To be nominated for recognition, a student shall: (A) be a Texas resident, who is sponsored by and has financial support committed from a rural community sponsor; (B) be enrolled or intend to enroll in an eligible academic institution of higher education to become a health care professional; (i) be a high school student who is in the upper 25% of the high school's class, if such class numbers 48 or greater, or have an overall B average; or (ii) be a college student who has a cumulative 3.00 on a 4.00 scale; or (iii) be an individual who has a high school diploma or equivalent and demonstrates to the satisfaction of the rural community sponsor the motivation, qualities, and abilities that lead to success in the chosen health care profession. (3) Eligible Academic Institution. (A) An eligible academic institution shall be a Texas institution of higher education which may be any public institution as defined in Texas Education Code, sec.61.003(8) or any nonprofit, independent institution as defined in Texas Education Code, sec.61. 222 or any other nonprofit health-related school or program. (B) Any health related schools or programs within eligible academic institutions must be accredited by the Commission on Colleges of the Southern Association of Colleges and Schools, the Liaison Committee on Medical Education, the American Osteopathic Association, the Texas State Board of Nurse Examiners for Registered Nurses, the Texas Board of Vocational Nurse Examiners, or, in the case of allied health, an accrediting body recognized by the U.S. Department of Education. (C) An eligible academic institution must follow the Civil Rights Act of 1964 (Public Law 88-353) Title VI to prevent discrimination in admissions. (b) Application Requirements for Recognition. (1) The application shall be coordinated and submitted by the sponsor. The application shall be in a form prescribed by the Center and may include but is not limited to: (A) the student's name, social security number, home address, and phone number; (B) academic credentials; (C) the results of one or more sponsor interviews with the student; (D) a typed essay of no more than 500 words stating the following: (i) the reasons for entering the competition; (ii) a description of the chosen health care profession; (iii) the reasons for entering the chosen health care profession; (iv) the reasons for wanting to provide health care to rural Texans; (E) no more than three letters of recommendation from the professional staff of the high school or college, or from employers or community leaders who have known the student for at least one year; and (F) evidence of sponsor eligibility. (2) The advisory committee may request additional information or interviews from the sponsor or the student as needed. (c) Criteria for Recognition. (1) A student shall be selected for recognition as an outstanding rural scholar by the advisory committee based on the student's: (A) academic credentials; (B) one or more interviews with the sponsor; (C) a statement written by the student of the student's reasons for entering the competition and a health care profession and the student's reasons for wanting to provide health care to rural Texans; (D) financial support committed by the sponsoring rural community; and (E) standardized tests, but in no event shall the student's performance on a standardized test be used as the sole criterion to determine selection. (2) The advisory committee shall select and rank the students and inform the executive committee of its selections. The executive committee shall notify each sponsor of the results and provide the sponsor with a certificate of award signed by the executive director and the executive committee chairman for each student recognized as an outstanding rural scholar. sec.500.25. Requirements for Forgiveness Loan. (a) Eligibility Criteria for Forgiveness Loan. (1) Initial Loan. To be eligible to apply for a forgiveness loan under this program, the student shall: (A) meet the eligibility requirements and be recognized as an outstanding rural scholar; (B) receive public recognition of the student's selection as an outstanding rural scholar. Each sponsor shall send the Center proof of public recognition of the student. Such recognition may include an announcement in local newspapers of the student's selection and public recognition of the student at civic gatherings or school assemblies; (C) have the sponsor's commitment to provide 50% of the student's costs of education; (D) not have defaulted on nor owe a refund on any state or federal aid; (2) Subsequent Loan. A student who has received an initial loan shall have priority for subsequent loans provided the following requirements are satisfied: (A) the student maintains satisfactory academic progress in the educational program in accordance with the prescribed degree plan; (B) the student files a degree plan complete with graduation date; (C) the student files a course plan, financial aid disclosure statement and grade report each academic term; (D) the student completes the same number of credit hours for which the student enrolled at the beginning of the academic term each academic term, unless circumstances outside the student's control such as severe illness suffered by the student or a family member, or death of a family member have necessitated the student to reduce the credit load. The student shall present to the Center verification of the reason for dropping below the initial number of credit hours for which initially enrolled at the beginning of the academic term. Such verification may include a sworn affidavit from a qualified physician as to the student's or family member's health status, or a death certificate in the case of a death in the student's family. If the student repeatedly drops below the initial number of credit hours during the course of the academic program, the Center in concurrence with the sponsor shall determine whether the student is in breach of contract and whether the student should be discontinued from the program. However, the advisory committee may unilaterally recommend removal of a student from the program should the advisory committee determine that the student is not maintaining satisfactory academic progress to attain the prescribed degree; and (E) state funds are available for subsequent loans. (b) Application for Forgiveness Loan. The student shall submit the completed forgiveness loan application. The forgiveness loan application shall be in a form prescribed by the Center and may include but is not limited to: (1) student personal information; (2) health care professional education program the student is pursuing; (3) name and relation of a cosigner for forgiveness loan; (4) name of the academic institution the student shall attend; (5) cost of attendance at the academic institution; (6) other financial aid the student will receive; (7) length of academic year; (8) estimated graduation date; (9) signature of financial aid officer; (10) name and address of sponsoring rural community organization; and (11) signature of sponsor representative. (c) Conditions for Forgiveness Loan. (1) The student shall use the proceeds of the forgiveness loan only for educational expenses at the agreed upon academic institution. (2) The annual forgiveness loan shall not exceed the annual cost of attendance at the eligible academic institution the student attends. (3) The cost of attendance shall be determined by the academic institution's financial aid office. A student may receive other financial aid in the form of grants, scholarships and loans for which the student may be eligible. However, it is recommended that the student decline any loans other than the forgiveness loan. The Center shall reduce the amount of the forgiveness loan by the amount of other financial aid a student receives in order that the total financial aid a student receives does not exceed the allowable cost of attendance as determined by the financial aid office. (4) The executive director may authorize forgiveness loans to be awarded to eligible students provided the: (A) student has submitted a forgiveness loan application; (B) sponsor has executed a Memorandum of Understanding with the Center in which the sponsor agrees to provide 50% of the student's costs of attendance for the academic year; (C) sponsor and the student have executed a contract with the Center in which the: (i) sponsor agrees to provide 50% of the student's cost of attendance for the duration of the student's academic program as determined by the eligible academic institution; (ii) sponsor agrees to provide a practice or employment opportunity for the student upon certification or licensure in the prescribed health care profession; (iii) student agrees to provide a course plan, grade report or transcript and financial aid disclosure statement each academic term; (iv) student agrees to complete the prescribed health care professional education program within the time period determined by the eligible academic institution for the specified degree; (v) student agrees to attain certification or licensure in the prescribed health care profession; (vi) in the case of medical students, the student agrees to complete a residency program in family practice, emergency medicine, general internal medicine, general pediatrics, general surgery, or general obstetrics and gynecology. (vii) student agrees to return to the sponsoring rural community within 60 days of attaining certification or licensure or completing the prescribed residency program in the case of medical students; (viii) student agrees to provide health care on a full-time basis in the sponsoring rural community for a period of obligated service equal to the same number of years loan support was provided; (ix) Center agrees to provide 50% of the student's cost of attendance for the duration of the student's academic program; and (x) Center agrees to report the student's status to the sponsor at least once a year. (d) Disbursement of Forgiveness Loan Funds. Disbursements shall be made according to a schedule determined by the Center. Before a disbursement is made: (1) the student shall execute a promissory note with the Center to pay the forgiveness loan in the event of breach of contract. The promissory note must be cosigned: (A) a cosigner of a promissory note executed under these rules shall be a person signing a note, other than the student, who is a citizen or permanent resident of the United States over 21 years of age and who is gainfully employed or otherwise demonstrates financial responsibility; (B) a cosigner may be a relative other than the student's spouse and may not be a student; (C) a cosigner is jointly and severally responsible for the promissory note in the event of breach of contract; (2) the sponsor shall remit to the Center an amount equal to 50% of the disbursement; and (3) a state warrant for the prescribed disbursement will be made payable to the student at the academic institution the student attends, and shall be sent to the financial aid office of the academic institution. Disbursements shall not be sent directly to the student. (e) Refunds. (1) A student shall be responsible for refunding the Center an amount equal to: (A) the cost of attendance paid for courses not completed; and (B) any amount of financial aid received from other sources. (2) The Center may: (A) deduct the refund from the student's next scheduled loan disbursement; (B) request the financial aid office of the academic institution the student attends to remit an institutional check for the amount of the refund; or (C) require the student to remit a personal check for the amount of the refund in the event the student will not receive any more loan disbursements. (f) Loan Forgiveness. (1) A student who receives a forgiveness loan under this program shall be forgiven the total forgiveness loan by providing full-time health care practice for an obligated period of service equal to 12 months for each year loan support is provided. If employment is on less than a full-time basis, forgiveness shall be prorated. (2) The obligated period of service shall begin on the date full-time employment or practice begins in the sponsoring rural community after the student has become certified or licensed in the health care profession for which sponsored. (3) Only outstanding principal and interest remaining unpaid shall be eligible for forgiveness. sec.500.26. Breach of Contract. A contract executed under this subchapter between the Center, the sponsor and the student is a binding contract. (1) Sponsor. (A) A sponsor shall be in breach of contract on the date the sponsor failed to meet the conditions of this subchapter. (B) A sponsor shall notify the Center in writing within two weeks of any change in status. (C) A sponsor shall be in breach of contract if the sponsor: (i) fails to provide 50% of the student's costs of attendance as determined by the academic institution for the duration of the student's agreed upon health care academic program; or (ii) fails to provide a full-time employment or practice opportunity for the student as a health care professional for which sponsored upon the student's certification or licensure. (D) If the sponsor is found to be in breach of contract, the Center may require any or all of the following: (i) forfeiture of all claim to funds forwarded to the student; (ii) cancellation of the student's obligated period of service; and (iii) forfeiture of opportunity to sponsor a student in the future. (E) In the event of a sponsor breach of contract, the Center may assist the student in obtaining alternative sponsorship, employment or practice opportunity in another rural community where loan forgiveness may be granted. In such an event, the original sponsor may not seek reimbursement from either the student, another rural community sponsor nor the Center. (2) Student. (A) The student shall be in breach of contract on the date the student failed to meet the conditions of this subchapter. (B) The Center shall hold the student who breaches a contract liable for liquidated damages equal to one time the total forgiveness loan amount plus all applicable costs, fees and interest at the highest rate allowed by law. (C) The student shall be considered in breach of contract and shall not be eligible to receive forgiveness loan funds if the student fails to meet any of the conditions of this subchapter. The student shall notify the Center in writing within two weeks of any change in status. The student shall be in breach of contract if the student: (i) fails to maintain satisfactory academic progress according to the academic institution the student attends except that one academic term of grace will be extended to the student if the student is placed on scholastic probation during which time the student may receive a loan disbursement; (ii) fails to attain satisfactory academic progress following an academic term of scholastic probation; (iii) voluntarily withdraws from the Outstanding Rural Scholar Recognition Program forgiveness loan; (iv) fails to accept payment or instructs the academic institution not to accept payment, in whole or in part, of a forgiveness loan under contract as described in this subsection; (v) voluntarily withdraws from or terminates enrollment in the agreed upon academic program or institution before completion of the agreed upon academic program; (vi) fails to complete the academic program according to the degree plan; (vii) ceases to be enrolled full-time in an academic program which requires full-time enrollment; (viii) is dismissed for disciplinary reasons from the agreed upon academic program or institution; (ix) fails to begin or complete the required practicum, internship or residency; (x) fails to begin or complete a residency program in family practice, emergency medicine, general internal medicine, general pediatrics, general surgery, or general obstetrics and gynecology, in the case of medical students; (xi) fails to begin the obligated period of service within 60 days of attaining certification or licensure, or within 60 days of completing a residency program in the case of medical students; or (xii) fails to complete the obligated period of service. (D) A student shall sit for the first certification or licensure examination for which eligible upon completion of the prescribed academic program. If certification or licensure is delayed because of failure to pass the examination, the student shall retake it the next time the student is eligible to do so. If the student fails to become certified or licensed after the second attempt, the student shall be in breach of contract. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on June 9, 1995. TRD-9507479 Laura M. Jordan Executive Director Center for Rural Health Initiatives Effective date: July 11, 1995 Proposal publication date: January 24, 1995 For further information, please call: (512) 479-8891 Part VIII. Interagency Council on Early Childhood Intervention Services Chapter 621. Early Childhood Intervention Program Early Childhood Intervention Service Delivery 25 TAC sec.621.24 The Interagency Council on Early Childhood Intervention Services (Council) adopts an amendment to sec.621.24 with one change to the proposed text as published in the April 7, 1995, issue of the Texas Register (20 TexReg 2606). The justification for the amendment is to have a consistent state-wide standard which will ensure a consistent quality of service for all eligible Early Childhood Intervention children and families. The amendment will function by establishing a competency-based personnel standard for Early Intervention Specialist Professionals employed in Early Childhood Intervention Programs. During the comment period, the Interagency Council on Early Childhood Intervention Services invited additional comments to the rule establishing a personnel standard for Early Intervention Specialist Professionals and the policy which would implement the new standard. Five comments were received from individuals; two comments concerned the amendment to sec.621.24. The remaining three addressed the proposed policy to implement the new standard. Only the comments which addressed the rule are summarized below: Comment: An Early Childhood Intervention (ECI) program director expressed concern that local program staff currently employed as program supervisors and managers who do not meet the professional qualifications for other professional categories would be excluded from being recognized as Fully Qualified Early Intervention Specialist (EIS) Professionals since they were not "...employed as EIS Professionals on September 1, 1995." Council Response: No changes to the rule are necessary. The term "EIS Professional" is used to designate an occupational category as well as a job title. The wording of sec.621.24(b)(5)(D)(iv)(I) does not prohibit persons who are employed by ECI programs on September 1, 1995, as administrative staff or coordinators and who met the required qualifications of EIS Professionals from applying for professional recognition as Fully Qualified EIS Professionals. Council directed staff to clarify in policy the professional recognition of Fully Qualified EIS Professionals who are employed by ECI programs on September 1, 1995, in positions which have job titles other than "EIS Professional." Regardless of job titles, the same requirements and application procedures will be used for all EIS Professionals. The requirements are that applicants must: 1) be employed by an ECI program as EIS Professionals on September 1, 1995; 2) meet the educational qualifications for Fully Qualified EIS Professionals; and 3) have been employed by ECI programs with satisfactory performance evaluations for a minimum of one calendar year. Comment: An ECI program director reported the comments of her staff who are EIS Professionals and hold master's degrees. They felt that different professional titles should be created to differentiate between EIS Professionals holding master's and bachelor's degrees. Council Response: No changes to the rule are necessary. While the Council recognizes and commends staff for pursuing advanced training, the purpose of the new EIS Professional standard is to insure a consistent, statewide entry-level personnel standard. The standard defines a minimum educational requirement of a bachelor's degree for EIS Professionals which is consistent with educational requirements for certified teachers. Although the Council is establishing minimum personnel standards, local ECI programs may: 1) require additional or advanced training of the EIS Professionals they recruit and hire (e.g., master's degrees, years of ECI experience, etc.) and 2) differentiate among EIS Professional staff through the use of locally used job titles and pay grades. At a Council member's request the definition of professional title of Provisional Early Intervention Specialist Professional was removed from sec.621. 24(b)(D)(iv)(II), since it is no longer in use. The amendment is adopted under the Human Resources Code, sec.sec.73.003, which authorizes the Interagency Council on Early Childhood Intervention Services to establish rules regarding services provided for children with developmental delays. The amendment implements the Human Resources Code, sec. sec.73.001-73.021. sec.621.24. Program Administration for Comprehensive Services. (a) (No change.) (b) Program requirements. (1)-(4) (No change.) (5) Staff composition and qualifications. (A) -(B) (No change.) (C) For the occupational category Early Intervention Specialist Professionals (EIS Professionals), the Interagency Council on Early Childhood Intervention Services will establish the standards for education and experience and the nature and amount of required supervision. (D) As of September 1, 1995, the following qualifications and responsibilities for EIS Professionals are effective. (i) Definitions of Early Intervention Specialist Professional levels. EIS Professional is an occupational title and occupational category specific to service providers employed by Early Childhood Intervention (ECI) programs. These service providers have demonstrated through their education and experience the knowledge and skills required in early intervention service delivery. There are two classes of EIS Professionals: (I) Entry level-Persons with bachelor's degrees in disciplines related to early intervention services or bachelor's degrees in unrelated fields which include a minimum of 18 hours of college credit related to the provision of early intervention services are eligible to apply for Entry Level status. An Entry Level EIS Professional will have a maximum of two years from the initial date of hiring to complete the requirements to be approved as a Fully Qualified EIS Professional. Failure to complete the required process within two years will result in the loss of professional status and privileges. Exceptions to this provision may be approved by the state ECI office on an individual basis for extreme circumstances. Requests for exceptions must be in writing. (II) Fully qualified-Persons meeting the conditions and requirements for Professional Recognition as Fully Qualified EIS Professionals. (ii) Scope of responsibilities. Early Intervention Specialist Professionals (Entry Level and Fully Qualified EIS Professionals) may represent the discipline of early intervention and may be one of the two required professionals on an Interdisciplinary Team (IDT). EIS Professionals may conduct developmental screenings and assessments, participate in the development and implementation of Individualized Family Service Plans, and provide service coordination, special instruction, and family education services. (iii) Supervision. The Entry Level EIS Professionals must receive a minimum of one hour per week of direct supervision from a fully qualified professional until they have successfully completed the requirements to be Fully Qualified EIS Professionals. The supervising professionals may be from any of the disciplines related to early intervention and must meet the highest state standards for their profession. (iv) Professional recognition for EIS Professionals employed on September 1, 1995. (I) Persons employed by ECI programs as Fully Qualified EIS Professionals on September 1, 1995, must: (-a-) meet entry level requirements as defined in clause (i)(I) of this subparagraph; (-b-) submit a written application for continued recognition as a Fully Qualified EIS Professional to the Texas Interagency Council on Early Childhood Intervention by September 1, 1996; and (-c-) have been employed a minimum of one calendar year as an EIS Professional with a satisfactory performance evaluation(s) in an ECI-funded program. (II) Persons employed by ECI programs as Provisional EIS Professionals on September 1, 1995, must either meet the qualifications as fully qualified EIS Professionals or apply in writing by September 1, 1995, to complete the required demonstrations of knowledge and skills in early intervention service provision by September 1, 1997. (III) EIS Professionals and Provisional EIS Professionals who were hired before September 1, 1995, and are currently employed in ECI-funded programs, who fail to complete the required application process within the specified time frames will not be considered EIS Professionals. They will no longer be able to independently perform the scope of responsibilities of EIS Professionals as defined in clause (ii) of this subparagraph. To obtain status as Fully Qualified EIS Professionals, they must enter the system as Entry Level EIS Professionals and complete the conditions defined in clause (v) of this subparagraph. (v) Professional recognition for EIS Professionals hired after September 1, 1995. Persons hired as EIS Professionals after September 1, 1995, who are not Fully Qualified EIS Professionals are identified as Entry Level EIS Professionals and to be recognized as Fully Qualified EIS Professionals must: (I) meet the educational requirements of a bachelor's degree in a discipline related to early intervention or a bachelor's degree which includes a minimum of 18 hours of course credit relevant to early intervention service provision and submit a statement of intent to complete the required demonstrations of early intervention knowledge and skills and apply for full professional recognition; (II) within six months of their hiring date, complete a self assessment of early intervention knowledge and skills with their ECI program director or supervisor; (III) within two years of their hiring date, complete the required demonstrations of early intervention knowledge and skills and submit documentation for recognition as a Fully Qualified EIS Professional; and (IV) complete the required processes or lose professional status and privileges. They will no longer be able to independently perform the scope of responsibilities of EIS Professionals as defined in clause (ii) of this subparagraph. (vi) Other ECI employees. ECI employees employed in positions other than EIS Professionals who, by the completion of educational requirements and approval of the ECI program director, are eligible to enter the system as Entry Level EIS Professionals may complete the conditions defined in clause (v) of this subparagraph and be recognized as Fully Qualified EIS Professionals. (vii) Continuing professional education requirements. EIS Professionals must meet annual continuing professional education requirements to maintain their status. Continuing professional education consists of the planned individual learning experiences as described in the EIS Professional's annual Individual Professional Development Plan (IPDP) which shall include completion of a minimum of ten contact hours of approved continuing professional development education experiences. (viii) Registry. The Texas Interagency Council on Early Childhood Intervention shall issue certificates of recognition to and maintain a registry of individuals who successfully complete the requirements to be Fully Qualified EIS Professionals. (ix) Grievance process. Each local agency shall have a procedure for local resolution of personnel grievances. A party who has a disagreement with the local decision regarding his qualifications or status as an EIS Professional shall have an opportunity for dispute resolution at the local level. Agencies may use existing personnel grievance procedures to resolve disagreements and will inform their staff of their existence. (x) Complaints. Any individual or organization may file a complaint with the Council alleging that a requirement of the applicable federal and/or state regulations has been violated as provided in sec.621.43 of this title (relating to Confidentiality). (E) The director of the local ECI program must provide and document the amounts of supervision appropriate for all ECI contract staff and program staff to ensure the philosophy and intent of these regulations are met as adopted by the Interagency Council on Early Childhood Intervention Services. (F) Local programs must establish a procedure to ensure that employees have not been convicted of any felony or a misdemeanor related to child abuse or sexual abuse or any other offense against a person or family. (6)-(14) (No change.) This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on June 19, 1995. TRD-9507449 Nancy Murphy Section Manager, Media and Policy Services Interagency Council on Early Childhood Intervention Services Effective date: July 10, 1995 Proposal publication date: April 7, 1995 For further information, please call: (512) 450-3765 TITLE 30. ENVIRONMENTAL QUALITY Part I. Texas Natural Resource Conservation Commission Chapter 335. Industrial Solid Waste and Municipal Hazardous Waste Subchapter Q. Pollution Prevention: Source Reduction and Waste Minimization 30 TAC sec.335.476 The Texas Natural Resource Conservation Commission (TNRCC) adopts amendments to sec.335.476, concerning Pollution Prevention: Source Reduction and Waste Minimization, Reporting and Recordkeeping. The amendments are adopted with changes to the proposed text as published in the May 5, 1995, issue of the Texas Register (20 TexReg 3320). Section 335.476(4)(A)-(E) is amended by changing the words "March 1" to "July 1" in each subparagraph. The changes align the annual due date of March 1 for the Source Reduction and Waste Minimization (SR/WM) Annual Report with the Toxics Release Inventory (TRI) Form R reporting due date of July 1. This change will improve data quality and will reduce the potential for reporting errors on the SR/WM Annual Report Form, which, in turn, will decrease administrative burden to the regulated community. The comment period was open from May 5, 1995 to June 5, 1995. One commenter, Red Star Yeast and Products, supported the rule amendments. The other commenter, ARCO Chemical Company, supported the amendments but found that the language requires facilities under sec.335.476(4)(A) to continue the March 1 report submissions. This was not intended and a sentence has been added to clarify that all facilities affected by this section have July 1 reporting dates. The amendments are adopted under Texas Water Code, sec. sec.5.103, 5.105, and 26. 011, which provides the TNRCC the authority to adopt rules necessary to carry out its powers, duties, and policies and to protect water quality in the state. These changes are also adopted under the Health and Safety Code, sec.361.024, which provides the TNRCC the authority to adopt rules necessary to manage solid waste, and under sec.361.504(b), which provides the TNRCC the authority to establish schedules for Source Reduction and Waste Minimization reports. sec.335.476. Reports and Recordkeeping. All persons required to develop a source reduction and waste minimization plan for a facility under this subchapter shall submit to the commission and the board, concurrent with implementation of the plan under sec.335.475 of this title (relating to Implementation Dates), an initial executive summary of such plan and a copy of the certification of completeness and correctness in sec.335.474(1)(H) of this title (relating to Source Reduction and Waste Minimization Plans). Within 30 days of any revision of such plan, a revised executive summary shall be submitted. All owners and operators required to develop a plan shall also submit an annual report according to the schedule outlined in paragraph (4) of this section. (1)-(3) (No change.) (4) The report and the executive summary of the plan shall be submitted according to the following schedule and annually thereafter. (A) For all facilities meeting the specifications of sec.335.475(1) of this title (relating to Implementation Dates), the first report will be due on or before March 1, 1994. The report will cover calendar year 1993. Subsequent annual reports will be submitted on or before July 1 of each year. (B) For all facilities meeting the specifications of sec.335.475(2), the first report will be due on or before July 1, 1995. The report will cover calendar year 1994. (C) For all facilities meeting the specifications of sec.335.475(3), the first report will be due on or before July 1, 1996. The report will cover calendar year 1995. (D) For all facilities meeting the specifications of sec.335.475(4), the first report will be due on or before July 1, 1997. The report will cover calendar year 1996. (E) For all facilities meeting the specifications of sec.335.475(5), the first report will be due on or before July 1, 1998. The report will cover calendar year 1997. (5)-(6) (No change.) This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Issued in Austin, Texas, on June 19, 1995. TRD-9507474 Lydia Gonzalez Gromatzky Acting Director, Leal Services Division Texas Natural Resource Conservation Commission Effective date: July 11, 1995 Proposal publication date: May 5, 1995 For further information, please call: (512) 239-6087 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 notices of actions taken by the Department of Insurance pursuant to Chapter 5, Subchapter L, of the Code. Board action taken under these articles is not subject to the Administrative procedure Act. These actions become effective 15 days after the date of publication or on a later specified date. The text of the material being adopted will not be published, but may be examined in the offices of the Department of Insurance, 333 Guadalupe, Austin.) The Commissioner of Insurance, at a public hearing under Docket Number 2146 held at 1:30 p.m., June 14, 1995 in Room 100 of the Texas Department of Insurance Building, 333 Guadalupe Street in Austin, Texas, adopted amendments proposed by staff to the Texas Automobile Rules and Rating Manual (the Manual), Symbol and Identification Section. Staff's petition (Reference Number A-0495-08- I) was published in the May 5, 1995, issue of the Texas Register (20 TexReg 3322). Subject to certain exceptions, in the past the Department has adopted the Insurance Services Office's (ISO) physical damage rating symbols and adjustments. Symbols and adjustments to them are based on vehicle cost, damageability, repairability, and other relevant loss factors. Without timely symbol adjustments, some consumers pay higher or lower premiums than suitable. The Department currently requires the rating of a multi-purpose or utility vehicle by application of a rating table to the vehicle's Original Cost New. ISO instead assigns a symbol to such a vehicle in the same manner as for private passenger autos. ISO's approach more accurately reflects the true physical damage rating symbol for the multi-purpose and utility type vehicle, and for that reason the Manual is amended to conform to the methodology that assigns a specific symbol to 1995 and later models of multi-purpose and utility type vehicles, as shown in an exhibit attached to staff's petition. However, symbols for customized vehicles of this type will continue to be rated by application of a rating table to the vehicle's Original Cost New. This Order also adopts new and/or adjusted 1993, 1994, and 1995 Model Rating Symbols for Automobile Physical Damage Coverage, as shown in exhibits attached to the petition. The amendments as adopted by the Commissioner of Insurance are shown in exhibits on file with the Chief Clerk under Reference Number A-0495-08-I, which is incorporated by reference into Commissioner's Order Number 95-0607. The Commissioner of Insurance has jurisdiction over this matter pursuant to the Insurance Code, Articles 5.10, 5.96, 5.98 and 5.101. This notification is made pursuant to the Insurance Code, Article 5.96, which exempts it from the requirements of the Government Code. Consistent with the Insurance Code, Article 5.96(h), the Department will notify all insurers writing automobile insurance of this adoption by letter summarizing the Commissioner's action. This agency hereby certifies that the rule as adopted has been reviewed by legal counsel and found to be a valid exercise of the agency's authority to adopt. Issued in Austin, Texas, on June 21, 1995. TRD-9507530 Alicia M. Fechtel General Counsel and Chief Clerk Texas Department of Insurance Effective date: September 1, 1995 Proposal date: May 5, 1995 For further information, please call: (512) 463-6327