PROPOSED RULES
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 action is 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 action, 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 1. ADMINISTRATION
PART XII. Advisory Commission on State Emergency Communications 
CHAPTER 251.Regional Plans-Standards
1 TAC sec.251.2, sec.251.6
The Advisory Commission on State Emergency Communications proposes new 
sec.251.2, concerning guidelines for changing or extending 9-1-1 service 
arrangements and an amendment to sec.251.6, concerning guidelines for Strategic 
Plans, Amendments, and Equalization Surcharge Allocation. These sections provide 
guidelines for changing or extending 9-1-1 service arrangements in the new 
competitive and fast-changing telecommunications environment. The new section 
provides guidelines to ensure that changing or extending service arrangements 
does not degrade the provision of the highest level of 9-1-1 service or fail to 
address technical or cost issues that may result from the new telecommunications 
environment. The amended section incorporates the new section into the existing 
guidelines for strategic plans, amendments, and equalization surcharge 
allocation. 
James D. Goerke, Executive Director, has determined that for each year of the 
first five years the new and amended sections are in effect any fiscal impact to 
state or local governments will be covered by emergency service fees and/or 
equalization surcharges. 
James D. Goerke, Executive Director, has determined that for each year of the 
first five years the new and amended sections are in effect the public benefit 
as a result of the section will be the better and more orderly implementation of 
changes and extensions of service arrangements in the new telecommunications 
environment. There are no economic costs to persons (e.g. service providers) 
required to comply with these sections. Furthermore, these sections will better 
inform service providers wanting to make proposals that change or extend service 
arrangement of the criteria for such proposals. 
Comments may be submitted within 30 days after publication in the Texas Register 
and reply comments within 15 days thereafter to James D. Goerke, Executive 
Director, Advisory Commission on State Emergency Communications, 333 Guadalupe 
Street, Suite 2-212, Austin, Texas 78701, (512) 305-6911. 
The sections are proposed under Health and Safety Code, Chapter 771, 
sec.sec.771.051, 771.055, 771.056, 771.059, which provide the Advisory 
Commission on State Emergency Communications with the authority to administer 
the implementation of statewide 9-1-1 service, to develop minimum performance 
standards for 9-1-1 service to be followed in developing regional plans, and to 
allocate money for the operation of 9-1-1 service. 
Health and Safety Code, Chapter 771 is affected by these proposed sections. 

sec.251.2.Guidelines for Changing or Extending 9-1-1 Service Arrangements.
(a) Definitions. When used in this rule, the following words and terms shall 
have the meanings identified in paragraphs (1)-(5) of this subsection, unless 
the context of the word or term clearly indicates otherwise.
(1) Automatic Number Identification (ANI) -- A system which permits the 
identification of the caller's telephone number. For purposes of this rule, the 
term has the same meaning as in 47 C.F.R sec.20.18. 
(2) Emergency Communications District -- A public agency or group of public 
agencies acting jointly that provided 9-1-1 service before September 1, 1987, or 
that had voted or contracted before that date to provide that service; or a 
district created under Texas Health and Safety Code, Chapter 772, Subchapters B, 
C, D, or E. 
(3) Pseudo Automatic Number Identification (Pseudo ANI) -- A system which 
identifies the location of the base station or cell site through which a mobile 
call originates. For purposes of this rule, the term has the same meaning as in 
47 C.F.R sec.20.18. 
(4) Regional Plan -- A plan for the establishment and operation of 9-1-1 service 
throughout the region that regional planning commissions serves. The plan must 
meet the standards established by and be amended in accordance with the 
standards established by the Advisory Commission on State Emergency 
Communications. 
(5) Regional Planning Commission -- A commission established under Local 
Government Code, Chapter 391, also referred to as a regional council of 
governments (COG). 
(b) Policy and Procedures. As authorized by Health and Safety Code, Chapter 771, 
the Advisory Commission on State Emergency Communications (ACSEC) may impose 9-
1-1 emergency service fees and equalization surcharges to support the planning, 
development, and provision of 9-1-1 service throughout the State of Texas. ACSEC 
is responsible for administering the implementation of statewide 9-1-1 service. 
ACSEC is also responsible for minimum performance standards for the operation of 
9-1-1 service to be followed in developing regional plans. One of the most 
fundamental components of any 9-1-1 service operation and any regional plan is 
how the 9-1-1 service will be provided by the service provider(s) directly 
connecting to the Public Safety Answering Point (PSAP). Changing the tandem 
and/or database service arrangements for direct connection to the PSAP, adding 
additional tandem and/or database service providers, or extending current 
service arrangements for a fixed period may potentially adversely effect the 
level, quality, and costs of 9-1-1 service. Changing the tandem and/or database 
service arrangements for direct connection to the PSAP, adding additional tandem 
and/or database service providers, or extending current service arrangements for 
a fixed period may also potentially adversely effect other service providers 
that rely on another service provider for interconnection to the PSAP (e.g., 
other service providers need to know which provider to send Automatic Number 
Identification (ANI) information and Automatic Location Information (ALI) 
records, the format for ALI records, the procedures for modifying 9-1-1 database 
information, and how 9-1-1 service will be provided to their end-user 
customers). It is the policy of ACSEC that the highest level of 9-1-1 emergency 
service continue to be provided notwithstanding the new competitive 
telecommunications environment. Therefore, any agreement by a regional planning 
commission with a service provider to change or to extend 9-1-1 service 
arrangements for a fixed period must be made contingent upon final approval of a 
regional plan amendment. For emergency communication districts requesting 9-1-1 
funds in accordance with established rules and procedures for 9-1-1 service 
arrangements, the extent to which the guidelines below are satisfied may be 
considered in allocating equalization surcharges. 
(c) Guidelines. 
(1) Changes or extensions of 9-1-1 service arrangements must include the 
following: 
(A) The service provider making the proposal to the regional planning commission 
or emergency communications district verifies in writing, as part of the 
proposed agreement, that: 
(i) Reasonable notice of the proposal (i.e., at least ten days before a joint 
planning meeting) has been provided to the current service provider (if a change 
in service providers is involved) and to other potentially affected service 
providers. The service provider also verifies that at least one joint planning 
meeting occurred with at least ten days notice to all affected service providers 
that they may participate in the joint planning meeting. 
(ii) As a result of the joint planning meeting either each technical issue, or 
objection by other service providers has fully been resolved or an impartial 
statement of each unresolved issue or objection has been provided. (A joint 
planning meeting is open to evaluate all alternatives and is not limited to a 
discussion of one service provider's proposal.) 
(iii) An inventory of each affected exchange, central office, and tandem has 
been provided to all affected service providers involved.
(iv) An itemization of all costs under the proposal and an itemized comparison 
with all costs under current rates (e.g., itemized list and comparison of all 
charges for each level of service, for all database service, etc.). 
(v) Any and all changes in E9-1-1 or 9-1-1 service features (i.e., all 
additional service features or reductions in service features that may result 
from the proposal) must be clearly specified. The service provider must also 
explain the justifications for any and all changes and why those changes do not 
degrade the level of 9-1-1 service and are consistent with providing the highest 
level of 9-1-1 service to all customers. 
(vi) The service provider takes full responsibility to professionally and timely 
coordinate all 9-1-1 service changes and modifications with all service 
providers and private switch providers involved in the geographic area, and that 
any necessary new or modified interconnection agreements relating to 9-1-1 
service will be approved by the Public Utility Commission of Texas before the 
effective date of the proposed agreement and as necessary thereafter.
(vii) The proposal includes a statement of work to be performed that includes: 
(I) an implementation schedule; 
(II) diagrams of all proposed changes; 
(III) how testing will occur and be coordinated; 
(IV) how interfaces with other service providers will be accomplished and 
coordinated; 
(V) an explanation of everything necessary for implementation;
(VI) a schedule of everything necessary for database service implementation, 
including Emergency Service Number (ESNs) assignments and Master Street Address 
Guide (MSAG) revisions and distribution to other service providers; and 
(VII) an explanation of any potential Customer Premises Equipment (CPE) impacts. 
(viii) The proposal provides for service providers that are wireless carriers to 
be able to pass ANI and Pseudo ANI or that on request any modifications 
necessary to pass ANI and Pseudo ANI by the Federal Communications Commission's 
eighteen month deadline in 47 C.F.R sec.20.18(d) will not require additional 
rates or charges to any PSAP, 9-1-1 entity, or any wireless carrier. 
(ix) The proposal provides for and enables long-term number portability or that 
any modifications necessary for long-term number portability will not require 
additional rates or charges to any PSAP or 9-1-1 entity.
(x) The proposal provides that there will be no additional costs to any PSAP or 
9-1-1 entity for any modifications necessary during the period of the agreement 
because of Number Plan Area (NPA) splits and/or existing tandem or other network 
limitations. 
(xi) The proposal provides that there will be no additional costs to any PSAP or 
9-1-1 entity to maintain the current level of E9-1-1 service, except as 
specifically set forth in an itemized list that is part of the proposed 
agreement. 
(xii) No further agreement by the regional planning commission is necessary to 
implement the proposal (e.g., the service provider and not the regional planning 
commission is responsible for any and all coordination with other parties or 
service providers that may be necessary to implement the proposal). 
(xiii) A most favored nation provision (i.e. a provision that requires the best 
price provided to any other entity in Texas for comparable service) is included 
in the agreement and the service provider will automatically reduce the rates 
and charges in the agreement if comparable service is offered in Texas at a 
lower rate or charge by that service provider to any other PSAP or 9-1-1 entity. 
(xiv) The service provider will comply with all ACSEC and Public Utility 
Commission of Texas rules or regulations relating to 9-1-1 service.
(B) The regional planning commission requesting the plan amendment verifies in 
writing, as part of the proposed plan amendment, that: 
(i) Competitive procurement procedures were used or an explanation of the 
applicability of an exception to competitive procurement requirements.
(ii) All neighboring or adjacent 9-1-1 entities that could potentially be 
affected by the requested plan amendment have been provided a copy of the plan 
amendment either before or concurrently with the filing of the plan amendment 
with the ACSEC. 
(2) Emergency communication districts requesting 9-1-1 funds in accordance with 
established rules and procedures for 9-1-1 service arrangements shall ensure 
that any changes or extensions of service arrangements meet or exceed the 
guidelines for regional planning commissions in this section. 
(3) Annual budgeted costs associated with 9-1-1 service arrangements shall be 
monitored by the ACSEC staff for consistency with this section. Such costs that 
are determined by the ACSEC staff to not be consistent with this section shall 
be reviewed by the commission. 

sec.251.6.Guidelines for Strategic Plans, Amendments, and Equalization Surcharge 
Allocation .
(a)-(e) (No change.) 
(f) Funding Parameters. The Commission will look favorably on plan amendments 
for <nl> tandem and/or database service arrangements and <ol> ancillary 
equipment that will improve the effectiveness and reliability of 9-1-1 call 
delivery systems. This will include the following when the equipment is for 9-1-
1 call delivery: surge protection devices, uninterrupted power source (UPS), 
power backup, voice recorders, paging systems for 9-1-1 call delivery, security 
devices, and other backup communication services. 
(1)-(2) (No change.) 
(g)-(h) (No change.) 
This agency hereby certifies that the proposal has been reviewed by legal 
counsel and found to be within the agency's legal authority to adopt. 
Issued in Austin, Texas, on December 27, 1996.
TRD-9618661
James D. Goerke
Executive Director
Advisory Commission on State Emergency Communications
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-6911

TITLE 22. EXAMINING BOARDS
PART IX. Texas State Board of Medical Examiners
CHAPTER 163.Licensure
22 TAC sec.163.6, sec.163.10
The Texas State Board of Medical Examiners proposes amendments to sec.163.6 and 
sec.163.10, concerning procedural rules for licensure of physicians. The 
amendments will correct a typographical error and outline examinations or formal 
evaluations required for relicensure of physicians. Tony Cobos, general counsel, 
has determined that for the first five-year period the sections are in effect 
there will be no fiscal implications as a result of enforcing or administering 
the section as proposed. 
Mr. Cobos also has determined that for each year of the first five years the 
sections as proposed are in effect the public benefit anticipated as a result of 
enforcing the section will be to require that all licensure applicants pass an 
examination or formal evaluation within ten years prior to licensure as outlined 
in sec.163.6 and to correct a typographical error in sec.163.10. There will be 
no effect on small businesses. The economic cost to persons who are required to 
comply with the section as proposed will vary depending on the type of 
examination the applicant is required to take. 
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, 
Austin, Texas 78768-2018. A public hearing will be held at a later date. The 
amendments are proposed under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provides the Texas State Board of Medical 
Examiners with the authority to make rules, regulations and bylaws not 
inconsistent with this Act as may be necessary for the governing of its own 
proceedings, the performance of its duties, the regulation of the practice of 
medicine in this state, and the enforcement of this Act. 
Article 4495b, Texas Civil Statutes, sec.3.05, is affected by this amendment. 

sec.163.6.Procedural Rules for Licensure Applicants. 
(a)-(b) (No change.) 
(c) Applicants for licensure by endorsement: 
(1) (No change.) 
(2) who have not been examined for licensure in a ten-year period prior to the 
filing date of the application must pass Day III or Component II of the FLEX 
prior to June 1988, or SPEX, with a grade of 75 or higher, unless the applicant 
has [obtained]: 
(A) <nl>passed a<ol> specialty certification <nl>examination or formal 
evaluation<ol>, recertification <nl>examination or formal evaluation,<ol> or an 
examination of continued demonstration of qualifications by a board that is a 
member of the American Board of Medical Specialties or the Advisory Board for 
Osteopathic Specialists within the preceding ten years; or 
(B) <nl>obtained<ol> through extraordinary circumstances, unique training equal 
to the training required for specialty certification as determined by a 
committee of the board and approved by the board. 

sec.163.10.Distinguished Professors Temporary License. 
(a) The executive director of the board may issue a distinguished professors 
temporary license to an endorsement applicant: 
(1)-(2) (No change.) 
(3) whose application has been filed, processed, and found to be in order. The 
application shall be complete in every detail except that the applicant will not 
be required to have taken and passed the SPEX examination as set forth in 
sec.<nl>163.6<ol> [163.1] of this title (relating to <nl>Procedural Rules for 
Licensure Applicants <ol> [Licensure Definitions]); 
(4) (No change.) 
(b)-(e) (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 December 23, 1996.
TRD-9618634
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 165.Medical Records
22 TAC sec.165.2
The Texas State Board of Medical Examiners proposes new sec.165.2, regarding 
patient access to diagnostic imaging studies in the physician's office. This 
section is promulgated to ensure that patients have reasonable access to films 
and other static diagnostic imaging studies maintained in the physician's office 
and that the practice of medicine by individual licensees and the delivery of 
health care to the public shall not be unduly hindered or interrupted by 
allowing for such access. 
Tony Cobos, general counsel, has determined that for the first five-year period 
the section is in effect there will be no fiscal implications as a result of 
enforcing or administering the section as proposed. 
Mr. Cobos also has determined that for each year of the first five years the 
section as proposed is in effect the public benefit anticipated as a result of 
enforcing the section will be to outline the charges and procedures for 
providing copies of x-rays and other static diagnostic imaging studies. There 
may be an effect on small businesses which cannot be determined at this time. 
There is anticipated economic cost to persons who are required to comply with 
the section as proposed; however, the extent of the cost cannot be determined at 
this time. 
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, 
Austin, Texas 78768-2018. A public hearing will be held at a later date. The new 
section is proposed under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provides the Texas State Board of Medical 
Examiners with the authority to make rules, regulations and bylaws not 
inconsistent with this Act as may be necessary for the governing of its own 
proceedings, the performance of its duties, the regulation of the practice of 
medicine in this state, and the enforcement of this Act. 
Article 4495b, Texas Civil Statutes, sec.5.08 is affected by this new section.

sec.165.2.Patient Access to Diagnostic Imaging Studies in Physician's Office.
(a) Purpose. This section is promulgated to ensure that patients have reasonable 
access to films and other static diagnostic imaging studies maintained in the 
physician's office and that the practice of medicine by individual licensees and 
the delivery of health care to the public shall not be unduly hindered or 
interrupted by allowing for such access. 
(b) Request and release. 
(1) Upon receiving a written request and release of information as provided for 
in the Medical Practice Act, sec.5.08(j), as required for the release of medical 
records, a physician in possession or control of films or other static 
diagnostic imaging studies of a patient shall allow access to the films or other 
diagnostic imaging studies through one or more of the following means: 
(A) providing copies of the films or other static diagnostic imaging studies to 
the patient or recipient as designated in the request; or, 
(B) releasing the original films or other static diagnostic imaging studies to 
the patient or recipient as designated in the request.
(2) Release and transfer of original films or other static diagnostic imaging 
studies may be evidenced by a signed and dated receipt from a recipient of the 
original films or other diagnostic imaging studies, or from their authorized 
representative, acknowledging receipt of and responsibility for the original 
studies. 
(c) Exceptions. as provided for under the Medical Practice Act, sec.5.08(j) 
(relating to release of confidential patient information), a physician is not 
required to release films or other static diagnostic imaging studies directly to 
a patient if the physician determines that access to the films or static 
diagnostic imaging studies would be harmful to the physical, mental, or 
emotional health of the patient. If a physician makes a determination that 
access would be harmful to the physical, mental, or emotional health of the 
patient, the physician shall, within the time allowed after receipt of a proper 
request, provide access to the requested films or static diagnostic imaging 
studies to an authorized representative of the patient as provided for in 
subsection (b) of this section (relating to request and release).
(d) Time for release and denial. The requested copies or access to films or 
other static diagnostic imaging studies shall be provided by the physician 
within 30 days after the date of receipt of the request. If the physician denies 
the request, in whole or in part, the physician shall furnish the patient a 
written statement, signed and dated, stating the reason for the denial. A copy 
of the statement denying the request shall be placed in the patient's medical 
records. 
(e) Fees. The physician responding to a request for copies of films or other 
static diagnostic imaging studies shall be entitled to a reasonable fee for 
providing the copies. A reasonable fee shall be no more than $8.00 per copy. In 
addition, a reasonable fee may include actual costs for mailing, shipping, or 
delivery. 
(f) Emergency Request. The physician providing copies of requested films or 
other static diagnostic imaging studies shall be entitled to a reasonable fee 
prior to release of the copies unless the copies are requested by a licensed 
Texas health care provider or a physician licensed by any state, territory, or 
insular possession of the United States or any state or province of Canada if 
requested for purposes of emergency or acute medical care. In the event that the 
physician receives a proper request for copies of films or other static 
diagnostic imaging studies for purposes other than for emergency or acute 
medical care, the physician may retain the requested information until payment 
is received. In the event that payment is not routed with such a request, within 
ten calendar days from receiving a request for copies of films or other static 
diagnostic imaging studies for purposes other than emergency or acute medical 
care, the physician shall notify the requesting party in writing of the need for 
payment and may withhold the copies until payment of a reasonable fee is 
received. A copy of the letter regarding the need for payment shall be made part 
of the patient's medical record. Access to or copies of films or other static 
diagnostic imaging studies requested pursuant to a proper request for release 
may not be withheld from the patient, the patient's authorized agent, or the 
patient's designated recipient for such copies based on a past due account for 
medical care or treatment previously rendered to the patient. 
(g) Subpoena. A subpoena shall not be required for access to or the release of 
originals or copies of static diagnostic imaging studies requested pursuant to 
the provisions of this section. 
(h) Maximum charges. The allowable charges set forth in this section shall be 
maximum amounts, and this section shall be construed and applied so as to be 
consistent with lower fees or the prohibition or absence of such fees as 
required by prevailing state or federal law.
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 December 23, 1996.
TRD-9618633
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 174.Telemedicine
22 TAC sec.174.3
The Texas State Board of Medical Examiners proposes an amendment to sec.174.3, 
relating to the practice of telemedicine in Texas. The amendment will require 
passage of the Texas Medical Jurisprudence Examination for physicians applying 
for a special license to practice telemedicine. 
Tony Cobos, general counsel, has determined that for the first five-year period 
the section is in effect there will be fiscal implications as a result of 
enforcing or administering the section as proposed which the agency anticipates 
will be offset by the revenue generated through the cost of the examination. Mr. 
Cobos also has determined that for each year of the first five years the section 
as proposed is in effect the public benefit anticipated as a result of enforcing 
the section will be to require passage of the medical jurisprudence examination 
as a prerequisite for obtaining a special license to practice telemedicine. This 
will ensure that physicians practicing telemedicine will be knowledgeable 
regarding Texas laws governing the practice of medicine. There is currently no 
anticipated significant effect on small businesses. There is an anticipated cost 
of the examination already calculated in the licensure processing fee, as well 
as individual expenses for travel to Austin, Texas, to take the examination, to 
persons who are required to comply with the section as proposed. 
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, 
Austin, Texas 78768-2018. A public hearing will be held at a later date. The 
amendment is proposed under the Medical Practice Act, Texas Civil Statutes, 
Article 4495b, sec.2.09(a), which provides the Texas State Board of Medical 
Examiners with the authority to make rules, regulations and bylaws not 
inconsistent with this Act as may be necessary for the governing of its own 
proceedings, the performance of its duties, the regulation of the practice of 
medicine in this state, and the enforcement of this Act. 
Article 4495b, Texas Civil Statutes, sec.3.06, is affected by this amendment.

sec.174.3.Qualifications for Special Purpose License for Practice of Medicine 
Across State Lines.
For a person to engage in the practice of medicine in Texas as defined under the 
Medical Practice Act, sec.3.06(i), and sec.174.2 of this chapter (relating to 
Definitions), the person must: 
(1)-(2) (No change.) 
(3) be certified in a medical specialty pursuant to the standards of and 
approved by the American Board of Medical Specialties or the Bureau of 
Osteopathic Specialists and Boards of Certification; [and]
<nl>(4)<ol> <nl> have passed the Texas Medical Jurisprudence Examination; and 
<ol>
<nl>(5)<ol>[(4)] be in possession of a special purpose license issued pursuant 
to the terms of this chapter after submission of a completed board-approved 
application for a special purpose license for the practice of medicine across 
state lines and any requisite initial fee and subsequent annual renewal fees. 
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 December 23, 1996.
TRD-9618632
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 183.Acupuncture
22 TAC sec.183.4
(Editor's note: The text of the following section proposed for repeal will not 
be published. The section may be examined in the offices of the Texas State 
Board of Medical Examiners or in the Texas Register office, Room 245, James Earl 
Rudder Building, 1019 Brazos Street, Austin.)
The Texas State Board of Medical Examiners proposes repeal of sec.183.4, 
relating to licensure requirements for acupuncturists. Extensive rewrite of the 
section is necessary; therefore, repeal of existing rule is proposed with 
simultaneous new section. 
Tony Cobos, general counsel, has determined that for the first five-year period 
the repeal is in effect there will be no fiscal implications as a result of 
enforcing or administering the section as proposed. 
Mr. Cobos also has determined that for each year of the first five years the 
repeal as proposed is in effect the public benefit anticipated as a result of 
enforcing the section will be clarification by omission of outdated information. 
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.
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, 
Austin, Texas 78768-2018. A public hearing will be held at a later date. The 
repeal is proposed under the Medical Practice Act, Texas Civil Statutes, Article 
4495b, sec.2.09(a), which provides the Texas State Board of Medical Examiners 
with the authority to make rules, regulations and bylaws not inconsistent with 
this Act as may be necessary for the governing of its own proceedings, the 
performance of its duties, the regulation of the practice of medicine in this 
state, and the enforcement of this Act.
Article 4495b, Texas Civil Statutes, Subchapter F, is affected by this proposal. 
sec.183.4.Licensure. 
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 December 23, 1996.
TRD-9618631
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016

22 TAC sec.sec.183.4, 183.20, 183.22
The Texas State Board of Medical Examiners proposes amendments to sec.183.20 and 
new sec.183.4 and 183.22 relating to the practice of acupuncture. Extensive 
rewrite of sec.183.4 regarding licensure requirements for acupuncturists was 
necessary; therefore the new section is proposed with simultaneous repeal of 
existing rule. Amendments to sec.183.20 concern the issuance of masters of 
acupuncture and of oriental medicine degrees. New sec.183.22 outlines the 
requirements for continuing medical education. 
Tony Cobos, general counsel, has determined that for the first five-year period 
the sections are in effect there will be no fiscal implications as a result of 
enforcing or administering the sections as proposed. 
Mr. Cobos also has determined that for each year of the first five years the 
sections as proposed are in effect the public benefit anticipated as a result of 
enforcing the sections will be to clarify the licensure rules and ensure that 
proper patient care is maintained through participation in continuing education. 
There may be some effect on small businesses which offer continuing acupuncture 
education courses. There is anticipated economic cost to persons who are 
required to comply with the sections as proposed, but the exact amount will vary 
between educational courses. 
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, 
Austin, Texas 78768-2018. A public hearing will be held at a later date. The 
amendments and new sections are proposed under the Medical Practice Act, Texas 
Civil Statutes, Article 4495b, sec.2.09(a), which provides the Texas State Board 
of Medical Examiners with the authority to make rules, regulations and bylaws 
not inconsistent with this Act as may be necessary for the governing of its own 
proceedings, the performance of its duties, the regulation of the practice of 
medicine in this state, and the enforcement of this Act. 
Article 4495b, Texas Civil Statutes, Subchapter F, is affected by this proposal. 

sec.183.4.Licensure.
(a) Qualifications. An applicant must present satisfactory proof to the 
acupuncture board that the applicant: 
(1) is at least 21 years of age; 
(2) is of good professional character as defined in section 183.2 of this title 
(relating to Definitions); 
(3) has successfully completed 60 semester hours of general academic college 
level courses, other than in acupuncture school, that are not remedial and would 
be acceptable at the time they were completed for credit on an academic degree 
at a two or four year institution of higher education within the United States 
accredited by an agency recognized by the Higher Education Coordinating Board or 
its equivalent in other states as a regional accrediting body. Coursework 
completed as a part of a degree program in acupuncture or Oriental medicine may 
be accepted by the acupuncture board if, in the opinion of the acupuncture 
board, such coursework is substantially equivalent to the required hours of 
general academic college level coursework; 
(4) is a graduate of an acceptable acupuncture school that was a candidate for 
accreditation or had accreditation through the National Accreditation Commission 
for Schools and Colleges of Acupuncture and Oriental Medicine (NACSCAOM) at the 
time of applicant's graduation, or received and completed training which, in the 
opinion of the acupuncture board, was substantially equivalent to training 
provided by such a school; 
(5) has taken and passed, within three attempts, the full NCCA examination; 
(6) has taken and passed the CCAOM (Council of Colleges of Acupuncture and 
Oriental Medicine) Clean Needle Technique (CNT) course and practical 
examination; and 
(7) is able to communicate in English as demonstrated by one of the following: 
(A) passage of the NCCA examination taken in English; or 
(B) passage of the TOEFL (Test of English as a Foreign Language) with a score of 
550 or higher; or 
(C) passage of the TSE (Test of Spoken English) with a score of 45 or higher; or 
(D) passage of the TOEIC (Test of English for International Communication) with 
a score of 500 or higher; or 
(E) at the discretion of the acupuncture board, passage of any other similar, 
validated exam testing English competency given by a testing service with 
results reported directly to the acupuncture board or with results otherwise 
subject to verification by direct contact between the testing service and the 
acupuncture board; or 
(F) an interview conducted in English with the acupuncture board, a committee of 
the acupuncture board, or the executive director of the acupuncture board. 
(b) Procedural rules for licensure applicants. The following provisions shall 
apply to all licensure applicants. 
(1) Applicants for licensure: 
(A) whose documentation indicates any name other than the name under which the 
applicant has applied must furnish proof of the name change; 
(B) whose application for licensure which has been filed with the board office 
and which is in excess of two years old from the date of receipt shall be 
considered inactive. Any fee previously submitted with that application shall be 
forfeited. Any further application procedure for licensure will require 
submission of a new application and inclusion of the current licensure fee. 
(C) will be allowed to sit for the NCCA examination only three times. After the 
third failure of the examination, and after each subsequent failure, an 
applicant for licensure shall be required to appear before a committee of the 
acupuncture board to address the applicant's inability to pass the examination 
and to re-evaluate the applicant's eligibility for licensure;
(D) who in any way falsify the application may be required to appear before the 
acupuncture board. It will be at the discretion of the acupuncture board whether 
or not the applicant will be issued a Texas acupuncture license; 
(E) on whom adverse information is received by the acupuncture board may be 
required to appear before the acupuncture board. It will be at the discretion of 
the acupuncture board whether or not the applicant will be issued a Texas 
license; 
(F) shall be required to comply with the acupuncture board's rules and 
regulations which are in effect at the time the completed application form and 
fee are filed with the board; 
(G) may be required to sit for additional oral, written, or practical 
examinations or demonstrations that, in the opinion of the acupuncture board, 
are necessary to determine competency of the applicant; 
(H) must have the application for licensure completed and legible in every 
detail 60 days prior to the acupuncture board meeting in which they are to be 
considered for licensure unless otherwise determined by the acupuncture board 
based on good cause. 
(2) Applicants for licensure by examination who wish to request reasonable 
accommodation due to a disability must submit the request at the time of filing 
the application. 
(3) Applicants who have been licensed in any other state, province, or country 
shall complete a notarized oath or other verified sworn statement in regard to 
the following: 
(A) whether the license, certificate, or authority has been the subject of 
proceedings against the applicant for the restriction, cancellation, suspension, 
or revocation of the license, certificate, or authority to practice in the 
state, province, or country, and if so, the status of such proceedings and any 
resulting action; and, 
(B) whether an investigation in regard to the applicant is pending in any 
jurisdiction or a prosecution is pending against the applicant in any state, 
federal, national, local, or provincial court for any offense that under the 
laws of the state of Texas is a felony, and if so, the status of such 
prosecution or investigation. 
(c) Licensure documentation. 
(1) Original documents/interview. An applicant must appear for a personal 
interview at the board offices and present original documents to a 
representative of the board for inspection. Original documents may include, but 
are not limited to, those listed in paragraph (2) of this subsection.
(2) Required documentation. Documentation required of all applicants for 
licensure shall include the following: 
(A) Birth certificate/proof of age. Each applicant for licensure must provide a 
copy of either a birth certificate and translation, if necessary, to prove that 
the applicant is at least 21 years of age. In instances where a birth 
certificate is not available, the applicant must provide copies of a passport or 
other suitable alternate documentation. 
(B) Name change. Any applicant who submits documentation showing a name other 
than the name under which the applicant has applied must present copies of 
marriage licenses, divorce decrees, or court orders stating the name change. In 
cases where the applicant's name has been changed by naturalization the 
applicant must submit the original naturalization certificate by hand delivery 
or by certified mail to the board office for inspection. 
(C) Examination scores. Each applicant for licensure must have a certified 
transcript of grades submitted directly from the appropriate testing service to 
the acupuncture board for all examinations used in Texas for purposes of 
licensure in Texas. 
(D) Dean's certification. Each applicant for licensure must have a certificate 
of graduation submitted directly from the school of acupuncture on a form 
provided by the acupuncture board. The applicant shall attach to the form a 
recent photograph, meeting United States Government passport standards, before 
submitting it to the school of acupuncture. The school shall have the Dean or 
the designated appointee sign the form attesting to the information on the form 
and placing the school seal over the photograph. 
(E) Diploma or certificate. All applicants for licensure must submit a copy of 
their diploma or certificate of graduation. 
(F) Evaluations. All applicants must provide, on a form furnished by the 
acupuncture board, evaluations of their professional affiliations for the past 
ten years or since graduation from acupuncture school, whichever is the shorter 
period. 
(G) Preacupuncture school transcript. Each applicant must have the appropriate 
school or schools submit a copy of the record of their undergraduate education 
directly to the acupuncture board. Transcripts must show courses taken and 
grades obtained. If determined that the documentation submitted by the applicant 
is not sufficient to show proof of the completion of 60 semester hours of 
college courses other than in acupuncture school, which courses would be 
acceptable, at the time of completion, to The University of Texas at Austin for 
credit on a bachelor of arts degree or a bachelor of science degree, the 
applicant may be requested to contact the Office of Admissions at The University 
of Texas at Austin for course work verification or otherwise submit such 
documentation to the acupuncture board for a determination as to the adequacy of 
such education. 
(H) School of acupuncture transcript. Each applicant must have his or her 
acupuncture school submit a transcript of courses taken and grades obtained 
directly to the acupuncture board. 
(I) Fingerprint card. Each applicant must complete a fingerprint card for the 
Texas Department of Public Safety and return it to the acupuncture board as part 
of the application. 
(J) Other verification. For good cause shown, with the approval of the 
acupuncture board, verification of any information required by this subsection 
may be made by a means not otherwise provided for in this subsection.
(3) Additional documentation. Applicants may be required to submit other 
documentation, including but not limited to the following:
(A) Translations. An accurate certified translation of any document that is in a 
language other than the English language along with the original document or a 
certified copy of the original document which has been. 
(B) Arrest Records. If an applicant has ever been arrested, a copy of the arrest 
and arrest disposition from the arresting authority and submitted by that 
authority directly to the acupuncture board. 
(C) Malpractice. If an applicant has ever been named in a malpractice claim 
filed with any liability carrier or if an applicant has ever been named in a 
malpractice suit, the applicant shall submit the following: 
(i) a completed liability carrier form furnished by the acupuncture board 
regarding each claim filed against the applicant's insurance; 
(ii) for each claim that becomes a malpractice suit, a letter from the attorney 
representing the applicant directly to this board explaining the allegation, 
dates of the allegation, and current status of the suit. If the suit has been 
closed, the attorney must state the disposition of the suit, and if any money 
was paid, the amount of the settlement, unless release of such information is 
prohibited by law or an order of a court with competent jurisdiction. If such 
letter is not available, the applicant will be required to furnish a notarized 
affidavit explaining why this letter cannot be provided; and 
(iii) a statement, composed by the applicant, explaining the circumstances 
pertaining to patient care in defense of the allegations. 
(D) Inpatient treatment for alcohol/substance abuse or mental illness. Each 
applicant that has been admitted to an inpatient facility within the last ten 
years for the treatment of alcohol/substance abuse or mental illness must submit 
the following: 
(i) an applicant's statement explaining the circumstances of the 
hospitalization; 
(ii) an admitting summary and discharge summary, submitted directly from the 
inpatient facility; 
(iii) a statement from the applicant's treating physician/psychotherapist as to 
diagnosis, prognosis, medications prescribed, and follow-up treatment 
recommended; and 
(iv) a copy of any contracts or agreements signed with any licensing authority. 
(E) Outpatient treatment for alcohol/substance abuse or mental illness. Each 
applicant that has been treated on an outpatient basis within the last ten years 
for alcohol/substance abuse or mental illness must submit the following: 
(i) an applicant's statement explaining the circumstances of the outpatient 
treatment; 
(ii) a statement from the applicant's treating physician/psychotherapist as to 
diagnosis, prognosis, medications prescribed, and follow-up treatment 
recommended; and 
(iii) a copy of any contracts or agreements signed with any licensing authority. 
(F) Additional documentation. Additional documentation as is deemed necessary to 
facilitate the investigation of any application for licensure.
(G) DD214. A copy of the DD214 indicating separation from any branch of the 
United States military. 
(H) Other verification. For good cause shown, with the approval of the 
acupuncture board, verification of any information required by this subsection 
may be made by a means not otherwise provided for in this subsection.
(I) False documentation. Falsification of any affidavit or submission of false 
information to obtain a license by examination or endorsement shall subject an 
acupuncturist to denial of a license or to discipline pursuant to the Act, 
sec.6.11. 
(4) Substitute documents/proof. The acupuncture board may, at its discretion, 
allow substitute documents where proof of exhaustive efforts on the applicant's 
part to secure the required documents is presented. These exceptions are 
reviewed by the acupuncture board, a board committee, or the board's executive 
director on an individual case-by-case basis. 
(d) Temporary license. 
(1) Issuance. The Texas State Board of Acupuncture Examiners may, through the 
executive director of the Texas State Board of Medical Examiners, issue a 
temporary license to a licensure applicant who appears to meet all the 
qualifications for an acupuncture license under the Act, but is waiting for the 
next scheduled meeting of the Texas State Board of Acupuncture Examiners for the 
license to be issued. 
(2) Duration/renewal. A temporary license shall be valid for 100 days from the 
date issued and may be extended only for another 30 days after the date the 
initial temporary license expires. Issuance of a temporary license may be 
subject to restrictions at the discretion of the executive director and shall 
not be deemed dispositive in regard to the decision by the Texas State Board of 
Acupuncture Examiners to grant or deny an application for a permanent license. 
(e) Distinguished professor temporary license. 
(1) Issuance. The acupuncture board may issue a distinguished professor 
temporary license to an acupuncturist who: 
(A) holds a substantially equivalent license, certificate, or authority to 
practice acupuncture in another state, province, or country; and 
(B) agrees to and limits any acupuncture practice in this state to acupuncture 
practice for demonstration or teaching purposes for acupuncture students and/or 
instructors, and in direct affiliation with an acupuncture school that is a 
candidate for accreditation or has accreditation through the National 
Accreditation Commission for Schools and Colleges of Acupuncture and Oriental 
Medicine (NACSCAOM) at which the students are trained and/or the instructors 
teach; and 
(C) agrees to and limits practice to demonstrations or instruction under the 
direct supervision of a licensed Texas acupuncturist who holds an unrestricted 
license to practice acupuncture in this state; and 
(D) pays any required fees for issuance or renewal of the distinguished 
professor temporary license. 
(2) Duration/renewal. Any such distinguished professor temporary license shall 
have a duration of no longer than 60 days and may be renewed no more than three 
consecutive times for a total of an additional 180 days. 
(3) Termination. A distinguished professor temporary license shall automatically 
expire at the end of 60 days from issuance or 60 days from date of renewal 
unless otherwise renewed. a distinguished professor temporary license or renewal 
may be denied, terminated, cancelled, suspended, or revoked for any violation of 
acupuncture board rules or the Act, Subchapter F. 
(f) Relicensure. 
(1) If an acupuncturist's license has been expired for one year, it is 
considered to have been canceled, and the acupuncturist may not renew the 
license. The acupuncturist may obtain a new license by submitting to 
reexamination and complying with the requirements and procedures for obtaining 
an original license. The examination required by this section is the full NCCA 
examination. 
(2) A person may qualify for renewal of his or her original license without 
reexamination if that person: 
(A) held a license previously in this state; 
(B) moved to another state, province, or country; 
(C) legally practiced in the other state, province, or country for not more than 
two years since the expiration of his or her Texas license; and 
(D) files an application for relicensure under subsections (a)-(c) of this 
section. 
(g) Approved schools. A NACSCAOM approved acupuncture school may use the word 
college as a means of representation to the public as long as it maintains 
NACSCAOM accreditation. An approved school may not represent itself as a 
university. 

sec.183.20.Texas Acupuncture Schools.
(a)-(d) (No change.) 
<nl>(e)<ol> <nl>For purposes of licensure and regulation of acupuncturists 
practicing in Texas, NACSCAOM approved acupuncture schools in Texas meeting the 
criteria set forth in sec.183.2 of this title (relating to Definitions) may 
issue masters of acupuncture and of oriental medicine degrees in a manner 
consistent with the laws of the State of Texas. The Texas State Board of 
Acupuncture Examiners shall recognize any such lawfully issued degrees. For 
purposes of licensure and regulation of acupuncturists practicing in Texas, 
acupuncture schools in Texas which are NACSCAOM candidates for masters level 
programs in acupuncture and oriental medicine and who have issued diplomas or 
degrees during the period of candidacy, may upgrade such degrees to masters 
degrees upon obtaining full NACSCAOM accreditation. The Texas State Board of 
Acupuncture Examiners shall recognize any such lawfully upgraded degrees. <ol>

sec.183.22.Continuing Acupuncture Education.
(a) Purpose. This section is promulgated to promote the health, safety, and 
welfare of the people of Texas through the establishment of minimum requirements 
for continuing acupuncture education (CAE) for licensed Texas acupuncturists so 
as to further enhance their professional skills and knowledge.
(b) Minimum Continuing Acupuncture Education. As a prerequisite to the annual 
registration of the license of an acupuncturist, the acupuncturist shall 
complete 15 hours of continuing acupuncture education (CAE) each year in the 
following categories: 
(1) The required hours shall be from courses that are designated or otherwise 
approved for credit by the Texas State Board of Acupuncture Examiners at the 
time the course was taken based on a review and recommendation of the Education 
Committee of the Board. 
(2) At least five of the required hours from courses shall be herbology. 
(c) Reporting Continuing Acupuncture Education. An acupuncturist must report on 
the licensee's annual registration form the number of hours and type of 
continuing acupuncture education completed during the previous year. 
(d) Grounds for Exemption from Continuing Acupuncture Education. An 
acupuncturist may request in writing and may be exempt from the annual minimum 
continuing acupuncture education requirements for one or more of the following 
reasons: 
(1) catastrophic illness; 
(2) military service of longer than one year in duration;
(3) acupuncture practice and residence of longer than one year in duration 
outside the United States; and/or 
(4) good cause shown on written application of the licensee which gives 
satisfactory evidence to the board that the licensee is unable to comply with 
the requirements of continuing acupuncture education. 
(e) Exemption Requests. Exemption requests shall be subject to the approval of 
the executive director of the board, and shall be submitted in writing at least 
30 days prior to the expiration of the license. 
(f) Exemption Duration and Renewal. An exemption granted under subsection (d) 
and (e) of this section may not exceed one year, but may be renewed annually 
upon written request submitted at least 30 days prior to the expiration of the 
current exemption. 
(g) Verification of Credits. The board may require written verification of both 
formal and informal continuing acupuncture education hours from any licensee and 
the licensee shall provide the requested verification within 30 calendar days of 
the date of the request. Failure to timely provide the requested verification 
may result in disciplinary action by the Board.
(h) Nonrenewal for Insufficient Continuing Acupuncture Education. Unless 
exempted under the terms of this section, the apparent failure of an 
acupuncturist to obtain and timely report the 15 hours of continuing education 
hours as required and provided for in this section shall result in nonrenewal of 
the license until such time as the acupuncturist obtains and reports the 
required hours; however, the executive director of the board may issue to such 
an acupuncturist a temporary license numbered so as to correspond to the 
nonrenewed license. Such a temporary license issued pursuant to this subsection 
may be issued to allow the board to verify the accuracy of information related 
to the continuing acupuncture education hours of the acupuncturist and to allow 
the acupuncturist who has not obtained or timely reported the required number of 
hours an opportunity to correct any deficiency so as not to require termination 
of ongoing patient care. 
(i) Fee for Issuance of Temporary License. The fee for issuance of a temporary 
license pursuant to the provisions of this section shall be in the amount 
specified under section 183.6 of this title (relating to Schedule of Fees); 
however, the fee need not be paid prior to the issuance of the temporary 
license, but shall be paid prior to the renewal of a permanent license. 
(j) Application of Additional Hours. Continuing acupuncture education hours 
which are obtained to comply with the requirements for the preceding year as a 
prerequisite for licensure renewal, shall first be credited to meet the 
requirements for that previous year. Once the requirements of the previous year 
are satisfied, any additional hours obtained shall be credited to meet the 
continuing acupuncture education requirements of the current year. 
(k) False Reports/Statements. An intentionally false report or intentionally 
false statement to the board by a licensee regarding continuing acupuncture 
education hours reportedly obtained shall be a basis for disciplinary action by 
the board pursuant to the Act, sec.6.11(a)(2), sec.6.11(a)(4), and 
sec.6.11(a)(5). 
(l) Monetary Penalty. Failure to obtain and timely report the continuing 
acupuncture education hours for renewal of a license shall subject the licensee 
to a monetary penalty for late registration in the amount set forth in sec. 
183.5 of this title (relating to Annual Renewal of License).
(m) Disciplinary Action, Conditional Licensure, and Construction. This section 
shall be construed to allow the board to impose requirements for completion of 
additional continuing acupuncture education hours for purposes of disciplinary 
action and conditional licensure. 
(n) Effective Date. This section shall become effective on December 1, 1998. 
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 December 23, 1996.
TRD-9618630
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 185.Physician Assistants
22 TAC sec.sec.185.4, 185.6, 185.9, 185.15, 185.25, 185.26
The Texas State Board of Medical Examiners proposes amendments to sec.185.4, 
185.6, 185.9, 185.15, 185.25, and 185.26, relating to the physician assistants. 
The proposal will address the penalties for practicing without a current annual 
registration permit, clarify procedures for inactive status, and amend hearing 
procedures. 
Tony Cobos, general counsel, has determined that for the first five-year period 
the sections are in effect there will be no fiscal implications as a result of 
enforcing or administering the section as proposed. 
Mr. Cobos also has determined that for each year of the first five years the 
sections as proposed are in effect the public benefit anticipated as a result of 
enforcing the section will be ensuring that physician assistants are practicing 
with a valid annual registration permit and clarifying hearing procedures. 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. Comments on the 
proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, Austin, Texas 
78768-2018. 
The amendments are proposed under the Medical Practice Act, Texas Civil 
Statutes, Article 4495b, sec.2.09(a), which provides the Texas State Board of 
Medical Examiners with the authority to make rules, regulations and bylaws not 
inconsistent with this Act as may be necessary for the governing of its own 
proceedings, the performance of its duties, the regulation of the practice of 
medicine in this state, and the enforcement of this Act, and the Physician 
Assistant Licensing Act, Texas Civil Statutes, Article 4495b-1, sec.23 which 
authorizes the Texas State Board of Physician Assistant Examiners to adopt 
reasonable and necessary rules for the performance of its duties. 
Article 4495b-1, Physician Assistant Licensing Act, sec.sec.9, 10, 13, and 18 
are affected by these amendments.

sec.185.4.Licensure. 
(a) (No change.) 
(b) The following documentation shall be submitted as a part of the licensure 
process: 
(1) Name change. Any applicant who submits documentation showing a name other 
than the name under which the applicant has applied must present 
<nl>certified<ol> copies of marriage licenses, divorce decrees, or court orders 
stating the name change. In cases where the applicant's name has been changed by 
naturalization the applicant should send the original naturalization certificate 
by certified mail to the board for inspection.
(2)-(8) (No change.) 
(c) (No change.) 

sec.185.6.Annual Renewal of License. 
(a)-(f) (No change.) 
<nl>(g)<ol> <nl>Practicing as a physician assistant as defined in the Physician 
Assistant Licensing Act without an annual registration permit for the current 
year as provided for in the board rules has the same force and effect as and is 
subject to all penalties of practicing as a physician assistant without a 
license. <ol>

sec.185.9.Inactive License. 
(a) (No change.) 
<nl>(b)<ol> <nl>In order for a license holder to be placed on inactive status, 
the license holder must have a current annual registration permit. <ol>
<nl>(c)<ol>[(b)] A license holder who practices as a physician assistant while 
on inactive status is considered to be practicing without a license.
<nl>(d)<ol>[(c)] A physician assistant may return to active status by applying 
to the board, paying the license renewal fee, <nl>penalty fees,<ol> and 
complying with the requirements for license renewal under the Physician 
Assistant Licensing Act.

sec.185.15.Physician Supervision. 
(a) (No change.) 
(b) It is the obligation of each team of physician(s) and physician assistant(s) 
to ensure that: 
(1)-(3) (No change.) 
(4) [and] a process for evaluation of the physician assistant's performance is 
established<nl>; and<ol> [.] 
<nl>(5)<ol> <nl> the physician assistant's annual registration permit is 
current. <ol>

sec.185.25.Procedure - Prehearing. 
(a) Discovery. After the initiation and filing of a formal complaint, or upon 
the filing of the board's initial pleading in any other contested matter, the 
following discovery rules shall apply: 
(1)-(3) (No change.) 
(4) Depositions. The taking and use of depositions shall be governed by the 
Administrative Procedure Act or by an agreement between the parties either on 
the record or in a writing signed by the parties or their representatives. 
Except by an agreement between the parties either on the record or in a writing 
signed by the parties or their representatives, <nl>or upon an order by the 
Administrative Law Judge,<ol> depositions shall be conducted and completed no 
later than five days prior to the scheduled hearing date. Failure of a properly 
noticed witness who is a party to the case to attend a deposition for the 
purpose of taking the testimony of that party witness, or the failure of such a 
witness to attend such a deposition as agreed to by the parties on the record or 
in a writing signed by the parties or their representatives, may result in the 
imposition of the sanctions and remedies set forth in paragraph (5) of this 
subsection. 
(5)-(13) (No change.) 
(b)-(h) (No change.) 

sec.185.26.Procedure - Hearing. 
(a)-(f) (No change.) 
<nl>(g)<ol> <nl>Default. If the respondent (applicant) fails to appear in person 
or by legal representation on the day and at the time set for hearing in a 
contested case, regardless of whether an appearance has been entered, the 
administrative law judge, upon motion by board staff shall enter a default 
judgment in the matter adverse to the respondent (applicant) who failed to 
attend the hearing, provided that accompanying the motion will be an affidavit 
of board staff averring that in the opinion of board staff, there is legally 
admissible credible evidence reasonably available to support the factual 
allegations against the respondent (applicant).<ol>
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 December 23, 1996.
TRD-9618635
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016

CHAPTER 193.Standing Delegation Orders
22 TAC sec.193.9
The Texas State Board of Medical Examiners proposes new sec.193.9, concerning 
delegated drug therapy management. The new section will allow properly qualified 
and trained pharmacists to perform specific acts of drug therapy management 
under the supervision and delegation of licensed physicians. 
Tony Cobos, general counsel, has determined that for the first five-year period 
the section is in effect there will be no fiscal implications as a result of 
enforcing or administering the section as proposed. 
Mr. Cobos also has determined that for each year of the first five years the 
section as proposed is in effect the public benefit anticipated as a result of 
enforcing the section will be to promote efficient administration and regulation 
of delegated drug therapy management. There will be no effect on small 
businesses. There will be no anticipated economic cost to persons who are 
required to comply with the section as proposed. 
Comments on the proposal may be submitted to Pat Wood, P.O. Box 2018, MC-901, 
Austin, Texas 78768-2018. A public hearing will be held at a later date.
The new section is proposed under the Medical Practice Act, Texas Civil 
Statutes, Article 4495b, sec.2.09(a), which provide the Texas State Board of 
Medical Examiners with the authority to make rules, regulations and bylaws not 
inconsistent with this Act as may be necessary for the governing of its own 
proceedings, the performance of its duties, the regulation of the practice of 
medicine in this state, and the enforcement of this Act.
Article 4495b, Texas Civil Statutes, sec.3.061 is affected by this new section. 

sec.193.9.Delegated Drug Therapy Management.
(a) Purpose. This section is promulgated to promote the efficient administration 
and regulation of the delegation by physicians to pharmacists of drug therapy 
management pursuant to the Medical Practice Act, sec.3.061 (related to 
Delegation of Certain Functions). 
(b) Delegation. A physician licensed to practice medicine in Texas may delegate 
to a properly qualified and trained pharmacist acting under adequate supervision 
the performance of specific acts of drug therapy management authorized by the 
physician through the physician's order, standing medical order, standing 
delegation order, or other order or protocol as provided for in this section. 
(c) Drug therapy management. Drug therapy management is the performance of 
specific acts by pharmacists as authorized by a physician through written 
protocol. Drug therapy management does not include the selection of drug 
products not prescribed by the physician unless the drug product is named in the 
physician initiated protocol or the physician initiated record of deviation from 
a standing protocol. Drug therapy management may include the following: 
(1) collecting and reviewing patient drug use histories; 
(2) ordering or performing routine drug therapy related patient assessment 
procedures including temperature, pulse, and respiration;
(3) ordering drug therapy related laboratory tests; 
(4) implementing or modifying drug therapy following diagnosis, initial patient 
assessment, and ordering of drug therapy by a physician, as detailed in the 
protocol; 
(5) generically equivalent drug selection if the physician's signature does not 
clearly indicate that the prescription must be dispensed as written, with the 
exception of Narrow Therapeutic Index Drugs which shall require specific written 
authorization by the prescribing physician for interchange of this class of 
drugs. For purposes of this section, Narrow Therapeutic Index Drugs shall 
include digoxin, phenytoin, warfarin sodium, theophylline, levothryroxine, 
carbamazine, valproic acid, and lithium; or 
(6) any other drug therapy related act delegated by a physician. 
(d) Supervision. Physician supervision shall be considered adequate for purposes 
of this section if the delegating physician is in compliance with this section 
and the physician: 
(1) is responsible for the formulation or approval of the written protocol and 
any patient-specific deviation from the protocol and review of the written 
protocol and any patient-specific deviations from the protocol at least annually 
and the services provided to a patient under the protocol on a schedule defined 
in the written protocol; 
(2) has established and maintains a physician-patient relationship with each 
patient provided drug therapy management by a delegated pharmacist and informed 
the patient that drug therapy will be managed by a pharmacist under written 
protocol; 
(3) is geographically located so as to be able to be physically present daily to 
provide medical care and supervision; 
(4) receives, on a schedule defined in the written protocol, a periodic status 
report on the patient, including any problem or complication encountered; 
(5) is available through direct telecommunication for consultation, assistance, 
and direction. 
(e) Written protocol. Written protocols for purposes of this section shall mean 
a physician's order, standing medical order, standing delegation order, or other 
written order. 
(1) A written protocol must contain at a minimum the following:
(A) a statement identifying the individual physician authorized to prescribe 
drugs and responsible for the delegation of drug therapy management;
(B) a statement identifying the individual pharmacist authorized to dispense 
drugs and to engage in drug therapy management as delegated by the physician; 
(C) a statement identifying the types of drug therapy management decisions that 
the pharmacist is authorized to make which shall include:
(i) a statement of the ailments or diseases, drugs, and type of drug therapy 
management authorized; and 
(ii) a specific statement of the procedures, decision criteria, or plan the 
pharmacist shall follow when exercising drug therapy management authority; 
(D) a statement of the activities the pharmacist shall follow in the course of 
exercising drug therapy management authority, including the method for 
documenting decisions made and a plan for communication or feedback to the 
authorizing physician concerning specific decisions made. Documentation shall be 
recorded within a reasonable time of each intervention and may be performed on 
the patient medication record, patient medical chart, or in a separate log book; 
and 
(E) a statement that describes appropriate mechanisms and time schedule for the 
pharmacist to report to the physician monitoring the pharmacist's exercise of 
delegated drug therapy management and the results of the drug therapy 
management. 
(2) A standard protocol may be used, or the attending physician may develop a 
drug therapy management protocol for the individual patient. If a standard 
protocol is used, the physician shall record, what deviations if any, from the 
standard protocol are ordered for that patient.
(f) Review and revision of protocols. 
(1) At least annually, written protocols shall be reviewed by the physician and, 
if necessary, revised. 
(2) Documentation of all services provided to the patient by the pharmacist 
shall be reviewed by the physician on the schedule established in the protocol. 
(g) Construction and interpretation. This section shall not be construed or 
interpreted to restrict the use of a pre-established health care program or 
restrict a physician from authorizing the provision of patient care by use of a 
pre-established health care program if the patient is institutionalized and the 
care is to be delivered in a licensed hospital with an organized medical staff 
that has authorized standing delegation orders, standing medical orders, or 
protocols. This section may not be construed to limit, expand, or change any 
provision of law concerning or relating to therapeutic drug substitution or 
administration of medication, including the Texas Pharmacy Act, Article 4542a-1, 
Vernon's Texas Civil Statutes, sec.17(a)(5). 
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 December 23, 1996.
TRD-9618637
Bruce A. Levy, M.D., J.D.
Executive Director
Texas State Board of Medical Examiners
Earliest possible date of adoption: February 7, 1997
For further information, please call: (512) 305-7016