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 10. COMMUNITY DEVELOPMENT PART V. Texas Department of Economic Development CHAPTER 190.Procedures of the Board 10 TAC sec.sec.190.1-190.8 The Texas Department of Economic Development (Department) adopts the repeal of sec.sec.190.1-190.8, concerning the Procedures of the Board, without changes to the proposed text, as published in the December 26, 1997, issue of the Texas Register (22 TexReg 12643). The repeal is necessary to accurately reflect current law and to allow the adoption of new rules. Senate Bill 932 of the 75th Legislature, which abolished the Texas Department of Commerce and created the Texas Department of Economic Development, also abolished the Texas Department of Commerce policy board and created a new governing board for the Department. Chapter 190 applies to procedures of the board for the Texas Department of Commerce policy board that no longer exists. No comments were received regarding the repeal. The rules are repealed under the authority of sec.481.0044(a) of the Texas Government Code, which authorizes the Department to promulgate rules necessary for the administration of department programs and may adopt rules for its internal management and control, and the Administrative Procedure Act, Texas Government Code, Chapter 2001, which prescribes the standards for agency rulemaking. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 17, 1998. TRD-9802128 W. Lane Lanford Chief Administrative Officer Texas Department of Economic Development Effective date: February 4, 1998 Proposal publication date: December 26, 1997 For further information, please call: (512) 936-0181 10 TAC sec.sec.190.1-190.7 The Texas Department of Economic Development (Department) adopts new sec.sec.190.1-190.7, concerning setting forth procedures for the Department's governing board. Sections 190.2, 190.3, and 190.6 are adopted with changes to the proposed text as published in the December 26, 1997, issue of the Texas Register (22 TexReg 12645). Sections 190.1, 190.4, 190.5, and 190.7, are adopted without changes and will not be republished. The new rules are being adopted because Senate Bill 932, which abolished the Texas Department of Commerce and established the Department, also abolished the Texas Department of Commerce policy board and established a new governing board for the Department. Rules of procedure previously adopted for the policy board needed to be replaced by rules for the new governing board. The changes made to sec.sec.190.2, 190.3, and 190.6 in the final rules are primarily minor word changes made for accuracy and clarity. Section 190.3(2) was rewritten to more accurately reflect the process used to appoint the board of directors and elect the officers of the TEXCAP Financing Corporation. No comments were received regarding the adoption of the new sections. Section 190.1, Definitions, sets forth definitions of terms used throughout the proposed rules. Section 190.2, Officers and sec.190.3, Ex Officio Duties; Officers, identify the officers of the governing board, their ex officio director duties on other Department boards, and the officers to be elected to those boards. Section 190.4, Committees, sets forth procedures for establishing standing, advisory, and special committees to assist the governing board. Section 190.5, Personnel, provides for delegation of duties and provision of administrative and professional support to the governing board. Section 190.6, Meetings, sets forth the process for persons who desire to make public appearances and public comments before the governing board. In addition, the section provides a contact for meeting accessibility accommodations. Section 190.7, Communication and complaints; access to Department programs, sets forth the process for registering complaints with the governing board and additional access provisions. The new rules are adopted pursuant to Government Code, sec.481.0044(a), which authorizes the board to adopt rules for administration of the department and for its internal management and control, and the Administrative Procedure Act, Government Code, Chapter 2001, Subchapter B, Rulemaking, which sets forth the agency rulemaking process. sec.190.2.Officers. (a) Chairman. The presiding officer as designated by the governor serves as the chairman of the Board. The chairman will preside at all meetings of the board. The chairman shall have the duty to generally direct, supervise, or control the business of the board and shall exercise such supervisory duties as may be required or given to him by the board from time to time. (b) Vice chairman. The vice chairman of the board shall have such powers and duties as may be assigned to him by the chairman and shall exercise the powers of the chairman during any time that the chairman is absent or unable to act. (c) Secretary. The secretary or his designee shall keep, or cause to be kept, the minutes of all meetings and a record of all actions of the governing board, and he or she shall attend to the giving and serving of all notices. sec.190.3.Ex Officio Duties; Officers. (a) The members of the board shall serve ex officio as the directors of the following nonprofit corporations: (1) The members of the board serve ex officio as the board of directors of the Texas Small Business Industrial Development Corporation. (A) The board of directors shall appoint the officers of TSBIDC by majority vote. (B) The officers shall consist of a president, vice president, secretary, and treasurer. (C) One person may serve as both secretary and treasurer. (D) Members of the board, employees of the department, or any other individuals deemed qualified by the board may be appointed as officers of TSBIDC. (2) The board of directors of TSBIDC shall appoint the board of directors of TEXCAP by majority vote. (A) The board of directors of TEXCAP shall elect officers by majority vote. (B) The officers shall consist of a president, vice president, secretary, and treasurer, in accordance with the by-laws of the corporation. (C) Members of the board, employees of the department, or any other individuals deemed qualified by the board may be appointed as officers of TEXCAP. (3) The members of the board shall serve ex officio as the Board of Directors of the Texas Economic Development Corporation. (A) The board shall appoint the officers of TEDC by majority vote. (B) The officers shall consist of a president, vice president, secretary, and treasurer. (C) The president of the board shall serve as the president of TEDC. (D) The vice chair of the board shall serve as the vice president of TEDC. (E) The secretary of the board shall serve as the secretary of TEDC. (F) The treasurer of TEDC shall be elected from the remaining board members. (b) The corporations' directors and officers shall receive no compensation for their services. They may receive reimbursement for actual and necessary travel expenses, subject to any applicable limitation on reimbursement provided by the General Appropriations Act or other law, if and when deemed advisable and feasible by the board. sec.190.6.Meetings. (a) Public appearances at board meetings. Members of the public may appear before the board regarding any issue under the board's jurisdiction. (1) Any person or organization wishing to be placed on the board meeting agenda must provide a written statement of such request. The request must identify the name of the presenter(s)and the topic of discussion desired to be discussed, and must be delivered to the chairman at the department's headquarters, 1700 N. Congress Avenue, Suite 130, Austin, Texas 78701, or mailed to the department at P.O. Box 12728, Austin, Texas 78711-2728, or faxed to the department at (512) 936-0303. The request must include a contact person's name, mailing address, telephone number, and fax number, if available. (2) Within 30 days after receipt of the request, the requestor will be notified of the time and place of the next board meeting for which the requestor can be placed on the agenda and the amount of time scheduled for the requestor's presentation. (b) Public comment on scheduled agenda items. Member of the public may comment on scheduled agenda items as determined by the board, consistent with the Texas Open Meetings Act. (1) The board agenda shall consist of agenda items prepared by department staff and approved by the chairman. Agenda items shall be filed with the Secretary of State's Office prior to board meetings in accordance with the Act. (2) The board agenda shall include time for public comments whenever possible. Members of the public who wish to speak on a scheduled board agenda item must complete a comment sheet, identifying the presenter and the item to be addressed, prior to board discussion on the item. Comment sheets will be available to members of the public prior to and during board meetings. (3) The chairman will recognize the presenter at the point in the agenda where the comments are most relevant and may determine an appropriate amount of time for the presentation. The board may further limit presentations at any time in accordance with the Act. (c) Meeting accessibility. Any disabled or non-English speaking person who requires assistance in order to attend a board meeting will be reasonably accommodated whenever possible. Any person requiring an accommodation must contact the Board Coordinator at department headquarters as set out in subsection (a)(1) of this section. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 17, 1998. TRD-9802127 W. Lane Lanford Chief Administrative Officer Texas Department of Economic Development Effective date: February 4, 1998 Proposal publication date: December 26, 1997 For further information, please call: (512) 936-0181 TITLE 16. ECONOMIC REGULATION PART I. Railroad Commission of Texas CHAPTER 9.Liquefied Petroleum Gas Division SUBCHAPTER A.General Applicability and Requirements 16 TAC sec.9.2, sec.9.15 The Railroad Commission of Texas adopts amendments to sec.9.2 and sec.9.15, relating to definitions, and registration and transfer of LP-gas transports or container delivery units, without changes to the versions published in the December 19, 1997, issue of the Texas Register (22 TexReg 12372). The amendments clarify the fees required to be paid to the commission and other requirements to initially register or to transfer registration of LP-gas transports or other described vehicles for use in Texas. Specifically, the adopted amendments to sec.9.2 add definitions for the terms "container delivery unit," "operator," "register" (or "registration"), and "transfer;" the adopted definitions clarify some terms which are used in the Commission's rules. Adopted amendments to sec.9.15(c) clarify the requirements of the table in subsection (e) by adding more explanation in new paragraphs (1) through (4) of the requirements for the various types of units, and explain how the registration fee will be calculated. The adopted transfer fee (previously called a reregistration fee) in sec.9.15(d) is changed from a prorated amount based on $156 or $108, depending on the size of the unit, to a flat fee of $50. This fee is being changed because it will no longer be prorated, and will still comply with the commission's statutory authority in Texas Natural Resources Code, sec.113.131. The substantive adopted amendments to the table in subsection (e) increase the registration fee for LP-gas transports with 3,500 gallons or less aggregate water capacity, commonly known as bobtails, from $96 to $108. The fee increase is necessary to comply with the commission's statutory authority in Texas Natural Resources Code, sec.113.131, regarding registration of LP-gas transports, which requires the registration fee be at least $100. The amount of $108 was chosen to keep the increase at a minimum and because it is divisible by 12, which is necessary for easy administration of the commission's staggered license and registration renewal system. In addition, the aggregate water capacity which identifies transports and bobtails has been changed from the current split at 5,000 gallons aggregate water capacity to 3,500. This change is being adopted to make Commission rules consistent with 49 Code of Federal Regulations, Parts 171 - 180, which are being adopted for adoption by the Commission in a separate rulemaking. The lowering of this gallonage will require a few more transports to pay the higher fee ($156 versus $108); however, commission records show only about 13 such units will be affected. Adopted amendments in sec.9.15(g) change the commission's inspection schedule from once every four fiscal years to once every five years to more accurately reflect the commission's practices and to correspond with the time period required for testing of containers, as specified in sec.9.1753 of this title (relating to testing requirements). Other adopted nonsubstantive amendments include changes in wording, punctuation, or organization to provide clarity. The Commission received no comments regarding the adopted amendments. The amendments are adopted under Texas Natural Resources Code, sec.113.051, which authorizes the commission to adopt rules relating to any and all aspects or phases of the LP-gas industry that will protect or tend to protect the health, welfare, and safety of the general public, and sec.113.131, which authorizes the commission to establish registration and transfer fees for LP-gas transports and other described vehicles. The Texas Natural Resources Code, sec.113.051 and sec.113.131, are affected by the adopted amendments. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10 1998. TRD-9801968 Mary Ross McDonald Deputy General Counsel, Office of General Counsel Railroad Commission of Texas Effective date: March 2, 1998 Proposal publication date: December 19, 1997 For further information, please call: (512) 463-7008 16 TAC sec.sec.9.20-9.22, 9.29 The Railroad Commission of Texas adopts amendments to sec.sec.9.20, 9.21, 9.22, and 9.29, relating to filings required for stationary LP-gas installations; notice of stationary LP-gas installations; objections to proposed stationary LP- gas installations; and application for an exception to a safety rule, without changes to the versions published in the November 21, 1997, issue of the Texas Register (22 TexReg 11197). The commission adopts these amendments to clarify the requirements for plats or drawings filed with plans and specifications, to specify a cap on the aggregate water capacity an LP-gas installation may reach without further notice to property owners, and to clarify deadlines for filing objections to proposed LP- gas installations. Specifically, adopted amendments to sec.9.20(a)(1) add the new explanation for plats or drawings, and a reference to these is added to subsection (e)(1). The addition of the 250-foot diameter in subsection (a)(1)(B) will ensure that the commission receives plats or drawings that accurately represent the proposed LP-gas installation. The adopted amendments to sec.9.21 add a cap of 120,000 gallons aggregate water capacity for existing LP-gas installations before notice must be provided to real property owners. An existing LP- gas installation may increase its aggregate water capacity up to 120,000 gallons without having to provide notice to real property owners. Additions to existing installations which will result in an aggregate water capacity of more than 120,000 gallons will require notice as specified in sec.9.21(a). Other adopted amendments in sec.9.22 regard the time period for mailing objections. The current rule requires objections to be mailed to the commission within 18 days of receipt of the notice of the proposed installation; the adopted amendment specifies the objection period to be 18 calendar days from the postmark of the mailed notice. This change should allow the commission to proceed with its review and approval process of a proposed installation more expeditiously, while still providing adequate time for real property owners to respond. In addition, new subsections (b), (c), and (d) explain the commission's responsibilities in reviewing objections. Subsection (d) also contains a limit on the number and type of objections that real property owners may file. This will assist in the submission of valid objections and prevent LP-gas applications from being suspended indefinitely while repeated and possibly invalid objections are filed. A similar amendment in sec.9.29(d)(1) concerns objections to an application for an exception to a safety rule. Again, the commission adopts changing the time period for objections from 18 days from receipt to 18 calendar days from the postmark date. Other nonsubstantive amendments include changes in wording, punctuation, or organization to provide better clarity. The Commission received no comments regarding the adopted amendments. The amendments are adopted under the Texas Natural Resources Code, sec.113.051, which authorizes the commission to adopt rules relating to any and all aspects or phases of the LP-gas industry that will protect or tend to protect the health, welfare, and safety of the general public. The Texas Natural Resources Code, sec.113.051, is affected by the adopted amendments. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10 1998. TRD-9801969 Mary Ross McDonald Deputy General Counsel, Office of General Counsel Railroad Commission of Texas Effective date: March 2, 1998 Proposal publication date: November 21, 1997 For further information, please call: (512) 463-7008 PART IX. Texas Lottery Commission CHAPTER 401.Administration of the State Lottery Act SUBCHAPTER D.Lottery Game Rules 16 TAC sec.401.311 The Texas Lottery Commission adopts new sec.401.311, concerning on-line game rules relating to a new on-line game, "Texas Million", with changes to the proposed text as published in the January 2, 1998 issue of the Texas Register (23 Tex Reg 37). The new section is adopted to provide specific game details and requirements for the new on-line game "Texas Million". The introduction of a new on-line game will generate interest and excitement for lottery players as well as attract new lottery players. As a result, "Texas Million" will generate additional revenue to the State of Texas through increased ticket sales. Staff has recommended some changes to clarify and facilitate the game. The changes are minimal and listed as follows: Subsection (b)(1) is changed to reflect the numbers 0 through 99 inclusive as opposed to 00 through 99 inclusive. Subsection (b)(4) is changed to reflect the numbers 0 through 99 instead of 00 through 99. Subsection (d)(1) is changed to reflect the numbers 0 through 99 instead of 00 through 99. Staff recommends these changes because the numbers 0 through 9 are easier to read as single digit numbers. Subsection (h)(1) is changed to reflect a drawing time between 9:58 p.m. Central Time and 10:00 p.m. Central Time instead of a 9:58 p.m. Central Time drawing time. Staff recommends this change to allow flexibility to aid staff in consolidating all game drawings to one minute and thereby receive more press coverage of the drawings. No oral or written comments were received regarding adoption of the new section. The new section is adopted under Texas Government Code, sec.466.016, which provides the Texas Lottery Commission with the authority to adopt rules governing the type of lottery games to be conducted and pursuant to the Administrative Procedure Act, Texas Government Code, sec.2001.004 sec.401.311."Texas Million" On-Line Game Rule. (a) Texas Million. A Texas Lottery on-line game to be known as 'Texas Million' is authorized to be conducted by the executive director under the following rules and under such further instructions and directives that may issue in furtherance thereof. If a conflict arises between this section and sec.401.301 of this title (relating to Lottery Game Rules (General Definitions)) or between this section and sec.401.304 of this title (relating to On-Line Game Rules (General)), this section shall have precedence. (b) Definitions. In addition to the definitions provided in sec.401.301 and sec.401.304 of this title, and unless the context in this section otherwise requires, the following definitions listed in paragraphs (1)-(6) of this subsection apply. (1) Number - Any play integer from 0 through 99 inclusive. (2) Play - The seven sets of four numbers printed on the ticket. The player can select only the first set of the seven sets of four numbers for the 'million dollar prize'. The terminal will randomly select the remaining six sets of four numbers. The player can also have the terminal randomly select all seven sets of four numbers. (3) Multi Draw - A player may purchase a Texas Million ticket for up to ten consecutive drawings beginning with the current draw period. (4) Play Board - A field of numbers from 0 through 99 found on the playslip. Each playslip has three play boards on it. (5) Playslip- An optically readable card issued by the Texas Lottery used by players of Texas Million to select plays. There shall be three play boards on each playslip identified as Game 1, Game 2, and Game 3. (6) A playslip has no pecuniary value and shall not constitute evidence of ticket purchase or of numbers selected. (c) Price of ticket. The price of each Texas Million play shall be $2.00. A player may purchase up to three plays on one playslip. A player may also select the Multi Draw feature. (d) Play for Texas Million. (1) Type of play. A Texas Million player must select one set of four numbers from 0 through 99 for the million dollar cash prize, or select the Quick Pick option. The on-line terminal will randomly select the other six sets of four numbers for other cash prizes. The seven sets of four numbers are divided into three groups. The first group has one set of four numbers, the second group of numbers has two sets of four numbers, and the third group has four sets of four numbers. A winning play is achieved only when two, three or four numbers in one or more of the seven sets of four numbers selected by the player match, in any order, with the four winning numbers drawn by the Texas Lottery. Each set of four numbers is a separate set which must match with the four winning numbers drawn by the Texas Lottery. (2) Method of play. The player will use playslips to make number selections for the first set of four numbers. The other six sets of four numbers will be selected by a random number generator operated by the computer, referred to as Quick Pick. The on-line terminal will read the playslip and issue ticket(s) with corresponding plays. If a playslip is not available, the on-line retailer may enter the selected numbers via the keyboard. However, the retailer shall not accept telephone or mail-in requests to manually enter selected numbers. If offered by the lottery, the player may also choose the Quick Pick feature and have the random number generator operated by the on-line terminal randomly select all seven sets of four numbers. (3) Multiple prizes. The total number of prizes that can be won from one play is seven. The holder of a winning ticket may win only one prize for each set of four numbers and shall only be entitled to the highest prize category won by the set of four numbers. (e) Prizes for Texas Million. (1) Prize amounts. At the discretion of the executive director, a prize amount may be altered temporarily for marketing or promotional purposes. This temporary alteration of the prize amount will be announced in advance of ticket sales for the affected draw. Prize amounts are a guaranteed amount except in the situation where more than ten prizes are won in the first prize group in a single drawing wherein the prize in the first prize group becomes pari-mutuel for a total prize value of $10,000,000. Otherwise, each Texas Million player who matches two, three or four numbers in any one set of four numbers per play will be guaranteed a set prize amount as follows: Figure 1: 16 TAC sec.401.311(e)(1) (2) Prize pool. The prize pool for Texas Million prizes shall be 50% of Texas Million sales for each drawing. The amount of actual prizes won may vary since most prize amounts are guaranteed. (3) Prize categories. (A) First Prize consists of matching all four numbers in the first group of numbers with the winning numbers. This prize must be claimed at the Austin claim center. (B) Second Prize consists of matching all four numbers in either one of the two sets of four numbers in the second group of numbers with the winning numbers. (C) Third Prize consists of matching all four numbers in any one of the four sets of four numbers in the third group of numbers with the winning numbers. (D) Fourth Prize consists of matching any three numbers in any one of the seven sets of four numbers on the ticket with the winning numbers, excluding any situation where a First, Second or Third prize has already been won for that set of four numbers. (E) Fifth Prize consists of matching any two numbers in any one of the seven sets of four numbers on the ticket with the winning numbers, excluding any situation where a First, Second, Third or Fourth prize has already been won for that set of four numbers. (4) Prize reserve fund. The prize reserve fund may be increased or decreased depending on amounts won by winners as compared to the appropriate percentage of the prize pool. The prize reserve fund may be decreased by any amounts won by winners, due to the guaranteed prize amounts. For example, money may be allocated from the prize reserve fund to the Texas Million prize pool if the prize liability is greater than the 50% prize pool for that drawing. The prize reserve fund will also increase or decrease depending upon the number of times the First Prize is won. If the First Prize of a guaranteed $1,000,000 is not won after each drawing, the amount of money in that prize pool will be designated to the prize reserve fund. If multiple winners claim the First Prize of a guaranteed $1,000,000, the additional million dollar prize money will come from the prize reserve fund, up to ten First Prizes, where upon the First Prize becomes pari-mutuel on a value of $10,000,000. The pari-mutuel prize amount shall be calculated by dividing the prize category contributions of the First Prize pool for that drawing, plus prize reserve monies up to $10,000,000, by the number of shares for the prize category. (5) Unclaimed prize fund. In the event any player who has a valid winning ticket does not claim the prize within 180 days after the drawing in which the prize was won, the prize amount shall be added to the unclaimed prize fund and all rights to the prize shall terminate. (f) Odds of winning. The following table shown in this subsection sets forth the odds of winning and guaranteed prizes in each prize category, based upon the total number of possible combinations of matching 2, 3 or 4 numbers in one set of four numbers per play. The overall odds of winning are 1:20. Figure 2: 16 TAC sec.401.311(f) (g) Ticket purchases. (1) Texas Million tickets may be purchased only at a licensed location from a lottery retailer authorized by the director to sell on-line tickets. (2) Texas Million tickets shall show the player's selection of numbers and numbers selected by Quick Pick, play amount, drawing date(s), validation and reference numbers. (3) It shall be the exclusive responsibility of the player to verify the accuracy of the player's selection(s), draw date(s) and other data printed on the ticket. A ticket is a bearer instrument until signed. (4) Except as provided in subsection (d)(2) of this section, Texas Million tickets must be purchased using official Texas Million playslips. Playslips which have been mechanically completed are not valid. Texas Million tickets must be printed on official Texas Lottery on-line game paper stock and purchased at a licensed location through an authorized Texas Lottery retailer's on-line terminal. (h) Drawings. (1) The Texas Million drawing shall be held every Friday evening between 9:58 p.m. Central Time and 10:00 p.m. Central Time except that the drawing schedule may be changed by the executive director, if necessary. (2) Texas Million tickets will not be sold from 9:45 p.m. Central Time to 10:00 p.m. Central Time on drawing days. (3) The drawings will be conducted by Texas Lottery officials. (4) Each drawing shall determine, at random, four winning numbers in accordance with Texas Million drawing procedures. Any numbers drawn are not declared winning numbers until the drawing is certified by the lottery in accordance with the drawing procedures. The winning numbers shall be used in determining all Texas Million winners for that drawing. (5) Each drawing shall be witnessed by an independent certified public accountant. All drawing equipment used shall be examined by at least one lottery security representative, the drawing supervisor, and the independent certified public accountant immediately prior to a drawing and immediately after a drawing. (6) A drawing will not be invalidated based on the financial liability of the lottery. (i) Announcement of retailer incentive or bonus program. The director shall announce each retailer incentive or bonus program prior to its commencement. The announcement shall specify the beginning and ending time, if applicable, of the incentive or bonus program and the value of the award(s). This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 13, 1998. TRD-9802219 Kimberly L. Kiplin General Counsel Texas Lottery Commission Effective date: March 5, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 344-5113 CHAPTER 402.Bingo Regulation and Tax 16 TAC 402.544, 402.550, 402.552, 402.553, 402.557, 402.560-402.562, 402.564, 402.566 The Texas Lottery Commission adopts the repeal of sec.sec.402.544, 402.550, 402.552, 402.553, 402.557, 402.560-402.562, 402.564, and 402.566, concerning bingo regulation and tax without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 38) and will not be republished. The repeal of these sections is necessary to remove these sections from the Texas Administrative Code since the sections have expired by operation of law on April 1, 1995. No oral or written comments were received regarding adoption of the repeals. The repeals are adopted under authority of Texas Revised Civil Statutes, Article 179d, sec.sec.16(a) and (d), and under Texas Government Code, sec.467.102, which provide the Texas Lottery Commission with the authority to adopt rules for the enforcement and administration of the Bingo Enabling Act and pursuant to the Administrative Procedure Act, Texas Government Code, sec.2001.004. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 13, 1998. TRD-9802220 Kimberly L. Kiplin General Counsel Texas Lottery Commission Effective date: March 5, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 344-5113 TITLE 19. EDUCATION PART I. Texas Higher Education Coordinating Board CHAPTER 13.Financial Planning SUBCHAPTER F.Tuition Rebates for Certain Undergradutes 19 TAC sec.sec.13.91-13.98 The Texas Higher Education Coordinating Board adopts Chapter 13, new Subchapter F, sec.sec.13.91-13.98, concerning Tuition Rebates For Certain Undergraduates with changes to the proposed text as published in the December 5, 1997 issue of the Texas Register (22 TexReg 11919). Changes were made to sec.sec.13.91, 13.93, 13.94, 13.96, and 13.97(d). The amendments are being adopted to provide rebates to undergraduate students who complete their studies with a minimum of "excess" courses. The purpose of the change is to encourage students to complete their studies in a timely, efficient manner. Comments were received from the University of Texas-Health Science Center at Houston. They asked that we clarify the fact that students earning baccalaureate degrees at the health science center would not be eligible for these rebates. As a result of that comment, changes were made to indicate that "general academic institutions" are required to offer the rebates rather than the previous wording that referred to universities. In addition, members of a committee of the Texas Association of Collegiate Registrars and Admissions Officers assembled to provide advice related to the transcript rule made two verbal suggestions: Some community colleges may not be able to offer students 12 credits in a given semester because they do not offer that many courses that would apply to a university degree; and some universities do not make graduation effective until 30 days after the formal graduation ceremony in order to allow time for all graduation checks. Changes were made accordingly from these comments. The new rules are adopted under Texas Education Code, sec.54.0065 which provides the Texas Higher Education Coordinating Board with the authority to adopt rules concerning Tuition Rebates For Certain Undergraduates. sec.13.91.Purpose. The purpose of this program is to provide tuition rebates that will provide a financial incentive for students to prepare for university studies while completing their high school work, avail themselves of academic counseling, make early career decisions, and complete their baccalaureate studies with as few courses outside the degree plan as possible. Minimizing the number of courses taken by students results in financial savings to students, parents, and the state. sec.13.93. Eligible Students. To be eligible for rebates under this program, students must meet all of the following conditions: (1) they must have enrolled for the first time in an institution of higher education in the fall 1997 semester or later, (2) they must be requesting a rebate for work related to a first baccalaureate degree received from a Texas public university, (3) they must have been a resident of Texas, must have attempted all coursework at a Texas public institution of higher education, and have been entitled to pay resident tuition at all times while pursuing the degree, and (4) they must have attempted no more than three hours in excess of the minimum number of semester credit hours required to complete the degree under the catalog under which they were graduated. Hours attempted include transfer credits, course credit earned exclusively by examination, courses that are dropped after the official census date, for-credit developmental courses, optional internship and cooperative education courses, and repeated exclusively by examination, courses that are dropped after the official census date, for- credit developmental courses, optional internship and cooperative education courses, and repeated courses. Courses dropped for reasons that are determined by the institution to be totally beyond the control of the student shall not be counted. sec.13.94.Affected Institutions. (a) All Texas public baccalaureate-granting general academic universities are required to offer rebates to eligible students. (b) All Texas public institutions of higher education are required to notify students of the existence of the tuition rebate program and provide course enrollment opportunities (see sec.13.96 of this title) (relating to Tuition Rebates for Certain Undergraduates). sec.13.96.Responsibilities of Institutions. Affected institutions have the following responsibilities associated with this program: (1) All Texas public institutions of higher education, including community and technical colleges, shall notify first-time freshman students of the tuition rebate program. A notice in the institution's official catalog is one acceptable form of notice. (2) If requested by potentially eligible students, public institutions of higher education are required to provide these students opportunities to enroll during each fall and spring semester in the equivalent of at least 12 semester credit hours that apply toward their degrees. Institutions are not required to provide students with the opportunity to enroll in specific courses or specific sections. Community and Technical Colleges will comply to the extent that courses for the current semester are being offered that apply to the student's university degree program. The requirement may be met by allowing substitutions for required courses or by allowing concurrent enrollment in courses from another institution, so long as the courses are taught on the students' home campus and the student incurs no financial penalty. (3) Texas public universities are required to provide students with appropriate forms and instructions for requesting tuition reimbursement at the time that students apply for baccalaureate degrees. (4) Institutions are required to provide tuition rebates to students who apply for them within 60 days after graduation or provide the student with a statement explaining the reason the student is ineligible for the rebate. (5) Institutions are required to provide a dispute resolution process to resolve disputes related to local administration of the program. (6) Disputes related to lower division credit transfer should be resolved in accordance with Coordinating Board rules, Chapter 5, sec.5.393 of this title (relating to Transfer of Lower Division Course Credit). (7) Institutions may adopt rules and regulations for administering the program. For example, institutions may require students to declare their intent to qualify for a tuition rebate early in their careers or register prior to the beginning of the semester. sec.13.97.Responsibilities of Students. (a) Students desiring to qualify for tuition rebates are responsible for complying with all university rules and regulations related to administration of the program. (b) Students desiring to qualify for tuition rebates are solely responsible for enrolling only in courses that will qualify them for the rebates. (c) A student who has transferred from another institution of higher education is responsible for providing to the institution awarding the degree official transcripts from all institutions attended by the student. (d) Students must apply for rebates prior to receiving their baccalaureate degrees on forms provided by the institution and must keep the institution apprized of their addresses for at least 60 days after their graduation date. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 13, 1998. TRD-9802162 James McWhorter Assistant Commissioner for Administration Texas Higher Education Coordinating Board Effective date: March 5, 1998 Proposal publication date: December 5, 1997 For further information, please call: (512) 483-6162 CHAPTER 17.Campus Planning SUBCHAPTER A.Criteria for Approval of New Construction and Major Repair and Rehabilitation 19 TAC sec.17.32 The Texas Higher Education Coordinating Board adopts an amendment to Chapter 17, Subchapter A, sec.17.32, concerning Criteria for Approval of New Construction and Major Repair and Rehabilitation (Assessment of Needs for Instructional and Research Equipment) without changes to the proposed text as published in the December 5, 1997, issue of the Texas Register (22 TexReg 11921). The amendment is being adopted to reflect the change in university formula funding allocations whereby appropriations for operation and maintenance of facilities are based on the Coordinating Board Space Projection Model rather than actual square feet in buildings. No comments were received concerning the adoption of the amendment. The amendment is adopted under Texas Education Code, sec.61.058 which provides the Texas Higher Education Coordinating Board with the authority to adopt rules concerning Criteria for Approval of New Construction and Major Repair and Rehabilitation (Assessment of Needs for Instructional and Research Equipment). This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 13, 1998. TRD-9801974 James McWhorter Assistant Commissioner for Administration Texas Higher Education Coordinating Board Effective date: March 5, 1998 Proposal publication date: December 5, 1997 For further information, please call: (512) 483-6162 SUBCHAPTER B.Applications for Approval of New Construction and Major Repair and Rehabilitation 19 TAC sec.17.42 The Texas Higher Education Coordinating Board adopts an amendment to Chapter 17, Subchapter B, sec.17.42, concerning Application for Approval of new Construction and Major Repair and Rehabilitation (Application for Project Approval) without changes to the proposed text as published in the December 5, 1997, issue of the Texas Register (22 TexReg 11921). The amendments are being adopted to reflect the change in university formula funding allocations whereby appropriations for operation and maintenance of facilities are based on the Coordinating Board Space Projection Model rather than actual square feet in buildings. No comments were received concerning the adoption of the amendment. The amendment is adopted under Texas Education Code, sec.61.058, which provides the Texas Higher Education Coordinating Board with the authority to adopt rules concerning Application for Approval of new Construction and Major Repair and Rehabilitation (Application for Project Approval). This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 11, 1998. TRD-9801975 James McWhorter Assistant Commissioner for Administration Texas Higher Education Coordinating Board Effective date: March 3, 1998 Proposal publication date: December 5, 1997 For further information, please call: (512) 483-6162 SUBCHAPTER C.Requesting Coordinating Board Endorsement of Real Property Acquisitions 19 TAC sec.17.66, sec.17.68 The Texas Higher Education Coordinating Board adopts amendments to Chapter 17, Subchapter C, sec.17.66 and sec.17.68, concerning Requesting Coordinating Board Endorsement of Real Property Acquisitions with changes to the proposed text as published in the December 5, 1997, issue of the Texas Register (22 TexReg 11922). Changes were made to sec.17.68. The amendments are being adopted to reflect the change in university formula funding allocations whereby appropriations for operation and maintenance of facilities are based on the Coordinating Board Space Projection Model rather than actual square feet in buildings. Comments were received from University of Texas Southwestern Medical Center at Dallas, University of Texas Health Science Center at Houston, and Texas State Technical College at Waco regarding leased or rented real property, that the rule should be amended to exclude clinical and research space from requiring Board approval. The agency agreed with the comments from UT-Southwestern Medical Center and UT Health Science Center at Houston and changes were made accordingly. The comments from TSTC-Waco did not specifically refer to the rule change. The concern was for the legislative change to fund public university appropriations based on the Space Projection Model, and the effect that might have if applied to Texas State Technical Colleges. The staff believed that the proposed rule change would, in the long run, affect appropriations to TSTC only to a small degree. The amendments are adopted under Texas Education Code, sec.61.058, which provides the Texas Higher Education Coordinating Board with the authority to adopt rules concerning Requesting Coordinating Board Endorsement of Real Property Acquisitions. sec.17.68.Leased or Rented Real Property. The Coordinating Board shall review for approval any improved real property whose use is obtained by rental or lease whenever an institution seeks to place the property on its educational and general facilities inventory, if the property contains at least 3,000 square feet of educational and general space. The application for approval shall be submitted at least 60 days prior to the meeting at which the request is to be considered. The Board's authority does not apply to leased or rented real property acquisitions for clinical or research facilities. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 11, 1998. TRD-9801976 James McWhorter Assistant Commissioner for Administration Texas Higher Education Coordinating Board Effective date: March 3, 1998 Proposal publication date: December 5, 1997 For further information, please call: (512) 483-6162 TITLE 22. EXAMINING BOARDS PART IV. Texas Cosmetology Commission CHAPTER 89.General Rules and Regulations 22 TAC sec.89.8, sec.89.13 The Texas Cosmetology Commission adopts new section sec.89.8, concerning student registration without changes to the proposed text as published in the October 31, 1997, issue of the Texas Register (22 TexReg 10611), and adopts amendments to section sec.89.13, concerning reducing, increasing or withholding of hours without changes to the proposed text as published in the October 24, 1997, issue of the Texas Register (22 TexReg 10491). The new section is adopted to require schools to send in student registrations within 10 days of enrollment and the amendment is adopted to allow schools authority to clock students out for disciplinary reasons. No comments were received regarding the adoption of the new and amended sections. The amendment and new sections are adopted under Texas Civil Statutes, Article 8451a, sec.22, which provides the commission with the authority to issue rules consistent with this Act after a public hearing and to protect the public's health and safety. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9801928 Delores Alspaugh Interim Executive Director Texas Cosmetology Commission Effective date: March 2, 1998 Proposal publication date: October 31, 1997 For further information, please call: (512) 454-4674 PART IX. Texas State Board of Medical Examiners CHAPTER 163.Licensure 22 TAC sec.163.1, sec.163.8 The Texas State Board of Medical Examiners adopts amendments to sec.163.1 and sec.163.8, concerning definitions and administration of examinations, without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 41) and will not be republished. The amendments are adopted to ensure that all examination requirements are consistent and equal. One comment was received from the American Osteopathic Association. The comment was not specifically related to the amendment that was proposed because it dealt with the name of an organization which had changed its name. This change will be handled in a future amendment. The amendments are adopted 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9802100 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 CHAPTER 166.Physician Registration 22 TAC sec.166.2 The Texas State Board of Medical Examiners adopts an amendment to sec.166.2, concerning continuing medical education, without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 44) and will not be republished. The amendment will clarify that continuing medical education courses recognized by the Committee for Review and Recognition of the Accreditation Council for Continuing Medical Education and sponsored by state medical societies, meet the Texas State Board of Medical Examiners' requirements for continuing medical education for license renewal. No comments were received regarding adoption of the amendment. The amendment is adopted 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9802099 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 CHAPTER 171.Institutional Permits 22 TAC sec.171.9 The Texas State Board of Medical Examiners adopts an amendment to sec.171.9, concerning faculty temporary license, without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 44) and will not be republished. The amendment will ensure that medical school faculty who would not be eligible for an unrestricted physician license, as outlined in Chapter 163 of this title (relating to Licensure) would also not be eligible for a faculty temporary license. No comments were received regarding adoption of the amendment. The amendment is adopted 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9802101 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 CHAPTER 175.Schedule of Fees and Penalties 22 TAC sec.175.1, sec.175.2 The Texas State Board of Medical Examiners adopts amendments to sec.175.1 and sec.175.2, concerning fees and penalties, without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 45) and will not be republished. The amendments to sec.175.1 outline fees for processing an application for acudetox specialists and annual renewal of acudetox specialists; fees for approval of continuing acupuncture and acudetox acupuncture education courses. The amendments to sec.175.2 outline penalty fees for renewal of non-certified radiologic technician's registration expired for 1- 90 days. No comments were received regarding adoption of the amendments. The amendments are adopted under the Medical Practice Act, Texas Civil Statutes, Article 4495(b), 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9802102 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 CHAPTER 181.Contact Lens Prescriptions 22 LTALC sec.sec.181.1-181.7 The Texas State Board of Medical Examiners adopts new sec.sec.181.1-181.7, concerning contact lens prescriptions, without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 45) The new rules were also adopted on an emergency basis in the January 2, 1998, issue of the Texas Register (23 TexReg 15). The rules will not be republished. New chapter 181 is mandated by the 75th Legislature through the Texas Contact Lens Prescription Act, Chapter 1345. The new chapter is adopted in order to set forth the criteria under which a patient may request and receive a contact lens prescription and under which a physician shall provide such prescription. No comments were received regarding adoption of the new rules. The new sections are adopted 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9802103 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 CHAPTER 183.Acupuncture 22 TAC sec.183.17 The Texas State Board of Medical Examiners adopts the repeal of sec.183.17 and new sec.183.17 and sec.183.23, concerning acupuncture, without changes to the proposed text as published in the January 2, 1998, issue of the Texas Register (23 TexReg 46). The repeal and new sections were also adopted on an emergency basis in the January 2, 1998, issue of the Texas Register (23 TexReg 17). The rules will not be republished. The repeal and new sections are as a result of Senate Bill 1765, 75th Legislature, which requires the Board of Medical Examiners to certify acudetox specialists, annually renew certification, and monitor continuing education for these registrants. No comments were received regarding adoption of the repeal and new sections. The repeal is adopted 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 12, 1998. TRD-9802104 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 22 TAC sec.183.17, sec.183.23 The new sections are adopted 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. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9802105 Bruce A. Levy, M.D., J.D. Executive Director Texas State Board of Medical Examiners Effective date: March 4, 1998 Proposal publication date: January 2, 1998 For further information, please call: (512) 305-7016 PART XXX. State Board of Examiners of Professional Counselors CHAPTER 681.Professional Counselors The Texas State Board of Examiners of Professional Counselors (the board), by majority vote of the board on December 13, 1997, enters this order finally adopting sec.sec.681.64, 681.81, 681.82, 681.92, and 681.94 concerning the licensing and regulation of professional counselors. Sections 681.81, 681.82, 681.92 and 681.94 are adopted with changes to the proposed text as published in the October 31, 1997, issue of the Texas Register (22 TexReg 10613). Section 681.64 is adopted without changes, and therefore this section will not be republished. The amendments cover academic course content, temporary license requirements, experience requirements (internship), requirements for examination and examination failures. The amendments are necessary to implement legislative amendments to Texas Civil Statutes, Article 4512g (the Licensed Professional Counselor Act) which increased the supervised experience requirements from 24 months or 2,000 clock hours to 36 months or 3,000 clock hours and to delete the language relating to an application for examination. No comments were received, however the staff made the following changes due to staff comments for clarification to board rules. Change: Concerning sec.681.81(g)(2), the word "an" was deleted and "The Texas State Professional Counselor" was inserted in its place. Change: Concerning sec.681.82(k)(2), the section number and section title referenced was incorrect, and "sec.681.64(c) of this title (relating to Academic Course Content)" was deleted and "sec.681.63(c) of this title (Academic Requirements)" was inserted. Change: Concerning sec.681.82(g), "September 1, 1992" was deleted and "October 2, 1996" was inserted. The required semester hours were changed from "45" to "48" to accommodate changes in the Act. Also "before beginning the supervised experience" was deleted and the phrase "and hold a temporary license from the board" was inserted. Change: Concerning sec.681.82(i), the subsection was proposed as one sentence, and has now been divided into two sentences for clarification. Change: Concerning sec.681.92(b), "Required Application Material" was deleted and "General" was was inserted to reflect the correct section title for sec.681.51. Change: Concerning sec.681.94(c) and (d), the order of (c) and (d) were reversed for a more sequential flow. Also the word "apply" was deleted and "reapply" was inserted in its place. SUBCHAPTER E.Academic Requirements for Examination and Licensure 22 TAC sec.681.64 The amendment is adopted under the Licensed Professional Counselor Act, Texas Civil Statutes, Article 4512g, sec.6, which provides the Texas State Board of Examiners of Professional Counselors with the authority to adopt and revise rules that are necessary to administer the Licensed Professional Counselor Act and sec.14(p) relating to rules concerning temporary licenses. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9801963 Anthony P. Picchioni, Ph.D. Chairperson State Board of Examiners of Professional Counselors Effective date: March 2, 1998 Proposal publication date: October 31, 1997 For further information, please call: (512) 458-7236 SUBCHAPTER F.Experience Requirements for Examination and Licensure 22 TAC sec.sec.681.81, 681.82 The amendments are adopted under the Licensed Professional Counselor Act, Texas Civil Statutes, Article 4512g, sec.6, which provides the Texas State Board of Examiners of Professional Counselors with the authority to adopt and revise rules that are necessary to administer the Licensed Professional Counselor Act and sec.14(p) relating to rules concerning temporary licenses. sec.681.81. Temporary License. (a)-(f) (No change.) (g) An LPC intern who holds a temporary license may obtain a regular license by: (1) submitting a supervised experience documentation form documenting successful completion of the required hours of supervised experience in accordance with sec.681.52(c) of this title (relating to Required Application Materials) and sec.681.82 of this title (relating to Experience Requirements (Internship)); and (2) successfully completing The Texas State Professional Counselor examination for licensure in accordance with Subchapter G of this chapter (relating to Licensure Examinations). sec.681.82. Experience Requirements (Internship). (a) Applicants for licensure must have completed a supervised experience acceptable to the Texas State Board of Examiners of Professional Counselors (board) based on the following: (1) persons who were admitted to a counselor preparation program designed to obtain a graduate degree in counseling or related fields prior to September 1, 1997, must complete 24 months or 2,000 clock-hours of supervised counseling experience; or (2) persons who are admitted to a counselor preparation program designed to obtain a graduate degree in counseling or related fields after September 1, 1997, must complete 36 months or 3,000 clock hours of supervised counseling experience. (b) The supervised experience must include at least 1,000 hours of direct client counseling contact for persons accumulating 2,000 hours and 1,500 hours of direct client counseling contact for persons accumulating 3,000 hours. (c) An applicant must complete: (1) the required 2,000 clock-hours of supervised experience in a time period of no fewer than 12 months; or (2) the required 3,000 clock-hours of supervised experience in a time period of no fewer than 18 months. (d) The 12 or 18 month time period shall not be decreased by excess practicum hours that are applied toward the supervised experience hours. (e) If applying under the 24-month requirement or the 36 month requirement, the applicant must average at least 20 clock-hours per week of practice. (f) The internship must have been after completion of a: (1) graduate degree in counseling or a related field; and (2) a planned graduate program in counseling or its substantial equivalent of at least 48 semester hours. (g) The applicant who began to accumulate supervised experience on or after October 2, 1996, must have completed at least 48 graduate semester hours in counseling or a related field and hold a temporary license from the board. (h) The experience must have consisted primarily of the provision of direct counseling services within a professional relationship to individuals or groups by using a combination of mental health and human development principles, methods, and techniques to achieve the mental, emotional, physical, social, moral, educational, spiritual, or career-related development and adjustment of the client throughout the client's life. (i) The applicant must have received direct supervision consisting of a minimum of one hour a week of face-to-face supervision in individual or group settings. No more than one half of the total hours of supervision having been received in group supervision. (j) The experience must have been under the direction of a board approved supervisor. (k) The board may count excess practicum hours toward the experience requirements of this subchapter if: (1) the hours were part of the applicant's academic practicum or internship accumulated after the commencement of the applicant's planned graduate program; (2) the hours are in excess of the 300-hour practicum required by sec.681.63(c) of this title (relating to Academic Requirements); and (3) the hours to be counted are not more than 400 hours. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9801964 Anthony P. Picchioni, Ph. D. Chairperson State Board of Examiners of Professional Counselors Effective date: March 2, 1998 Proposal publication date: October 31, 1997 For further information, please call: (512) 458-7236 SUBCHAPTER G.Licensure Examinations 22 TAC sec.sec.681.92, 681.94 The amendments are adopted under the Licensed Professional Counselor Act, Texas Civil Statutes, Article 4512g, sec.6, which provides the Texas State Board of Examiners of Professional Counselors with the authority to adopt and revise rules that are necessary to administer the Licensed Professional Counselor Act and sec.14(p) relating to rules concerning temporary licenses. sec.681.92. Requirements for Licensure Examination. (a) LPC interns must submit a supervised experience documentation form documenting successful completion of the required supervised experience in accordance with sec.681.52(c) of this title (relating to Required Application Materials). (b) Applicants for a regular license that do not hold a temporary license must apply for licensure in accordance with sec.681.51 of this title (relating to General) and sec.681.52 of this title. (c) The Texas State Board of Examiners of Professional Counselors (board) shall provide written notification to persons who meet all requirements for examination. sec.681.94. Failures. (a)-(b) (No change.) (c) The temporary license of a person who fails any two successive examinations shall be voided. (d) A person who fails any two successive examinations may not reapply for a regular license until two years have elapsed from the date of the last examination or until the person has completed nine graduate semester-hours in the applicant's weakest portions of the examination. An application for licensure must be submitted in accordance with sec.681.51 of this title (relating to General) and sec.681.52 of this title (relating to Required Application Materials). This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 10, 1998. TRD-9801965 Anthony P. Picchionnni, Ph.D. Chairperson State Board of Examiners of Professional Counselors Effective date: March 2, 1998 Proposal publication date: October 31, 1997 For further information, please call: (512) 458-7236 TITLE 25. HEALTH SERVICES PART I. Texas Department of Health CHAPTER 29.Purchased Health Services SUBCHAPTER D.Medicaid Home Health Services 25 TAC sec.29.302 On behalf of the State Medicaid Director, the Texas Department of Health (department) submits by federal mandate an adopted amendment to sec.29.302, concerning provider participation requirements for home health services providers. This amendment is a federal mandate required by sec.4724, Title IV of the Balanced Budget Act of 1997. The section as amended adds surety bond requirements to the home health services provider participation requirements. Home health agencies and durable medical equipment providers must provide the department a surety bond in the same form specified by the Secretary of Health and Human Services for Medicare home health services. The amendment complies with the federal mandate contained in sec.4724, Title IV of the Balanced Budget Act of 1997, to be effective January 1, 1998. Although this amendment will be effective January 1, 1998, it will not be implemented until the Health Care Financing Administration finalizes its federal regulations requiring surety bonds for home health services providers. The amendment is adopted under the Human Resources Code, sec.32.021 and Government Code, sec.531.021, which provide the Health and Human Services Commission with the authority to adopt rules to administer the state's medical assistance program and is submitted by the Texas Department of Health under its agreement with the Health and Human Services Commission to operate the purchased health services program and as authorized under Chapter 15, sec.1.07, Acts of the 72nd Legislature, First Called Session (1991). sec.29.302. Provider Participation Requirements. (a) - (b) (No change.) (c) Surety bond requirements. To participate in the Texas Medicaid Program's home health services, providers must provide the department with a surety bond in the form specified by the Secretary of the Department of Health and Human Services (Secretary). The amount of the surety bond must be no less than $50,000 or an amount comparable to that specified by the Secretary for home health services providers in the Medicare program. This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 9, 1998. TRD-9801857 Susan K. Steeg General Counsel Texas Department of Health Effective date: January 1, 1998 Proposal publication date: N/A For further information, please call: (512) 458-7236 CHAPTER 97.Communicable Diseases Control of Communicable Diseases 25 TAC sec.sec.97.1-97.5 The Texas Department of Health (department), by majority vote of the Texas Board of Health (board) on February 8, 1998, enters this order finally adopting amendments to sec.sec.97.1-97.5, concerning control of communicable diseases. Sections 97.1, 97.3, 97.4, and 97.5, are adopted with changes to the proposed text as published in the September 26, 1997, issue of the Texas Register (22 TexReg 9595) as a result of comments received during the 30 day comment period. Section 97.2 is adopted without changes to the proposed text and will not be republished. Specifically, the sections clarify definitions, what to report, when to report, who shall report, and where to report. The amendments add and delete diseases to the list of reportable diseases. Significant amendments to sec.97.1 through sec.97.5 concern the reporting of antibiotic resistant bacteria. The optimism of the antibiotic era that began 50 years ago is waning. Even before the widespread use of penicillin in the late 1940s, resistance was detected in both gram-positive and gram-negative organisms. Within one year of methicillin's introduction in 1960, methicillin resistant strains of Staphylococcus aureus emerged. In recent years Streptococcus pneumoniae, which accounts for 3,000 cases of meningitis and 7,000,000 cases of otitis media nationwide annually, has developed resistant strains. With the recent emergence of vancomycin resistant Enterococcus species and the potential for vancomycin resistant Staphylococcus aureus, an event which would make all current antibiotics ineffective for these diseases, the need to determine the intrastate distribution of resistant isolates of Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus species has become urgent. A first step toward curtailing the pernicious progression of antibiotic resistance involves increasing the medical community's awareness of the problem. This is best accomplished by providing health care providers with timely surveillance data detailing the incidence of resistant organisms in their communities. In parts of the United States, resistance rates have recently risen dramatically. Because antibiotic resistant organisms significantly affect antibiotic use and health care costs, data are needed to assess the problem, plan appropriate intervention strategies, and alleviate the clinical and economic burden of these diseases. Additional revisions address other emerging disease threats. For instance, an increased incidence of Creutzfeldt-Jakob Disease (CJD) has been noted in northeast Texas. This fatal disease, characterized by a rapidly progressive dementia accompanied by severe muscle spasms and incoordination is now thought to be caused by a transmissible agent. The revised list also includes yersiniosis, an emerging bacterial disease which can cause serious gastrointestinal illness and may sometimes lead to unnecessary surgery. Making these conditions reportable will result in better case ascertainment, allowing the department to identify risk factors and possible control measures. It has recently been recognized that several closely related organisms can cause the same disease. Rocky Mountain spotted fever (RMSF) needs to be changed to "spotted fever group rickettsioses" because several different microorganisms (rickettsia) can cause RMSF-like illnesses. Invasive group A streptococcal disease needs to be changed to "invasive streptococcal disease" since more than one Streptococcus species, and not just group A, can cause invasive disease. Because it has not contributed to a public health response, reporting of tuberculosis infection in persons less than 15 years of age is being deleted. Tuberculosis disease which is active and potentially infectious remains reportable for all age groups. Changes have been made to the proposed text in response to comments received during the comment period. The details of the changes are described in the summary of comments that follow. Other minor editorial changes were made for clarification. The following comments were received concerning the proposed sections. Following each comment is the department's response and any resulting changes(s). Comment: Ten commenters were concerned about sec.97.3(c)(6) and asked that the department drop reporting of quarterly numeric totals for "all Enterococcus species, all Streptococcus pneumoniae, all Haemophilus influenzae..." Response: The department agrees with the reviewers' request to have the reporting of Haemophilus influenzae isolates dropped from these proposed rules. However, individual cases of invasive Haemophilus influenzae type b, a vaccine preventable disease, will still remain reportable as listed in sec.97.3(b)(1). The department disagrees with the reviewers' request to drop reporting of quarterly numeric totals for Enterococcus species and Streptococcus pneumoniae. Resistant strains of both of these pathogens are important causes of morbidity; quarterly numeric totals are needed to calculate resistance rates for these pathogens. Comment: Ten commenters were concerned that sec.97.3(c)(6) would not "secure a risk-stratified denominator to provide multiple resistant organism rates for comparison in Texas." Various commenters suggested that the rate generated "as proposed" would be inaccurate, possibly misleading, greatly skewed, and would not provide useful rates. Response: The department agrees with the commenters that the data the department wishes to collect cannot be used to calculate a "risk-stratified denominator." The department's goal is to calculate antibiotic resistance rates for specific pathogens by geographic area. No change was made as a result of this comment. Comment: Regarding sec.97.3(c)(6) ten commenters suggested that the department "...concentrate on accurate numerator reporting to create reports based on patient days." Another commenter suggested that "...the denominator which is commonly used for other reportable diseases could be used to calculate incidence of each multiple resistant organism per 100,000 population." Response: The department disagrees with the suggestions to concentrate on the numerator and to calculate rates based on census data (population) or patient days. Traditionally numerator data alone are regarded as being of little value. Numerator and denominator data that are used to calculate rates should come from the same group. Having a denominator based on the population in a geographic area would not be appropriate. In this case, the numerator and denominator used to calculate the rates should be numbers of bacterial isolates, not patients. The department also wishes to point out that laboratories do not normally have easy access to information about patient days. No change was made as a result of this comment. Comment: Concerning sec.97.3(c)(6), fourteen commenters stated that collecting denominator data would be "labor intensive" for laboratories and that this activity would detract from accurate reporting of true multiple resistant organism occurrences. Several commenters suggested that this requirement would draw resources away from other activities. Response: The department agrees with the commenters that reporting, in general, requires time and additional work for the individuals reporting. The department believes that monitoring trends of resistant organisms is critical to the health of Texas citizens. One large laboratory in central Texas used a popular laboratory information system to obtain the proposed data for a two month period this effort required five minutes. While the department understands that other laboratories may have less efficient computer systems, based on information from a large teaching hospital, it should take large laboratories less than one hour per month to collect the data. Although some small laboratories may need to hand tabulate the data, they should have far fewer isolates to review and report. No change was made as a result of this comment. Comment: Concerning sec.97.3(c)(6), eight commenters were concerned that the cost to collect denominator data was underestimated. They suggested the department "...weigh the cost of this reporting against the value to be gained from this nonspecific data collection." One commenter estimated the cost of manual recording at "...15-30 minutes per day at a salary of $12.00 per hour." Another commenter concerned about unfunded mandates suggested the department provide their own personnel to visit facilities and collect this data." Response: The department disagrees. As explained above we believe the time required to report should not exceed one hour per month. Many commenters thought that they were being asked to identify and delete duplicates, further speciate isolates, or perform additional antibiotic susceptibility testing. It is not the department's intention to impose any of these additional costs/duties on laboratories. In parts of the United States in which resistance rates have been longitudinally monitored, these rates have recently risen dramatically. The department feels that one hour of laboratory time per month will be necessary to evaluate the impact of emerging antibiotic resistance in Texas. Because antibiotic resistant organisms significantly affect antibiotic use and health care costs, data are needed to assess the problem and plan appropriate intervention strategies. No change was made as a result of this comment. Comment: Two commenters were concerned that there is no differentiation between infection or colonization. This comment was concerning the rules regarding reporting of antibiotic resistant organisms in general. Response: The department agrees that the rules do not differentiate between infection and colonization. These rates are intended to be a measure of incidence of antibiotic resistance in isolates not a measure of infection or colonization. No change was made as a result of this comment. Comment: Five commenters were concerned that in sec.97.3(c)(6) there is no control for duplicates. Response: The department agrees that duplicates are likely to be reported. However, asking laboratory staff to delete duplicates would impose an excessive burden on laboratories. The department will use its own staff to remove duplicates of resistant organisms from the numerator and the denominator. The department understands that the denominator data will be less than perfect and will have some duplication of nonresistant organisms. Nevertheless the data should be adequate for following temporal and geographic trends in antibiotic resistance. No change was made as a result of this comment. Comment: Concerning sec.97.4(a) one commenter pointed out that submission of pure cultures of vancomycin resistant coagulase negative Staphylococcus species was required "as they become available"; however, reports of this antibiotic resistant organism were only required quarterly. Response: The department agrees and is grateful to the commenter for pointing out this oversight; sec.sec.97.4(a) and 97.5(b)(3) have been changed to reflect the necessity of immediate reporting of vancomycin resistant coagulase negative Staphylococcus species. Comment: One commenter stated that speciation of all vancomycin resistant Enterococcus would result in an additional 5-10 identifications per month at a cost of $3.00 - $5.00 per panel. Response: The department agrees with the commenter that further speciation would impose an additional cost. However, the department is not requesting additional speciation of antibiotic resistant organisms. The definition in sec.97.1 has been changed to "Vancomycin resistant Enterococcus - Enterococcus species with a vancomycin minimum inhibitory concentration (MIC) greater than 16 µg/mL or a disk diffusion of 14 milliliters or less." Comment: Three commenters were concerned about the confidentiality of the statistics. "The prevalence of the antibiotic resistant organisms need to be published by communities not individual hospital or laboratories." This comment was concerning the rules regarding reporting of antibiotic resistant organisms in general. Response: The department agrees that confidentiality is a concern. All data with patient identifiers that are reported to the department are well protected by law. Data that are gathered for denominator purposes (eg, all Enterococcus species) will be stored and tabulated so as to prevent identification of particular hospitals. Comment: Two commenters had concerns about sec.sec.97.4(a) and 97.5(b)(3). "It is unclear whether reports of this antibiotic resistant bacteria are to go directly to TDH or to the local health department." Response: The department agrees that clarification of these sections is needed. Because of the confidentiality concerns, reports of antibiotic resistant isolates and numeric totals of Enterococcus species and Streptococcus pneumoniae should be reported directly to the state health department. The data will be compiled and reported back to the local health departments at least quarterly. Minor editorial changes were made in sec.sec.97.4(a) and 97.5(b)(3) to clarify this point. Comment: One commenter requested that "...the reports of the antibiotic resistant bacteria come through the local health department as do other reportable conditions. Bypassing the local health department serves to undermine their authority." Response: The department disagrees. The purpose of this reporting is to provide feedback of geographic antibiotic resistance patterns to providers on a quarterly basis, not to initiate a public health response. The reporting of antibiotic resistant organisms directly to the state health department will expedite data cleanup and analysis and timely reporting of these data back to health care providers. Any identification of vancomycin resistant Staphylococcus will be considered a public health emergency. The local health department will be notified by the department the same day any such report is received. No change was made as a result of this comment. Comment: Two commenters were concerned that in sec.97.1 there is no MIC for ampicillin resistant Haemophilus influenzae and requested clarification regarding the reporting of Haemophilus influenzae. Another commenter was concerned about increased laboratory costs related to beta lactamase testing of all Haemophilus influenzae; currently their laboratory only tests ampicillin resistant strains. Response: The department agrees. Ampicillin resistant Haemophilus influenzae reporting has been deleted from sec.97.1, sec.97.3(b)(3), sec.97.3(c)(6), sec.97.3(c)(7), sec.97.4(g), and sec.97.5(b)(3). Comment: Regarding sec.97.3(c)(6), two commenters asked whether the department wanted reporting of "all isolates" or of isolates by patient. Response: The department agrees that this section needed some clarification. Numerator data (i.e., resistant isolates), must be reported by name, city of submitter, date of birth or age, sex, anatomic site of culture, and date of culture; denominator data need only be reported by numeric totals. Minor editorial changes have been made in sec.97.3(c)(6) to clarify what to report. Comment: One commenter was concerned that some systems used for identification and antibiotic sensitivity testing have a vancomycin MIC cut-off of 16 µg/mL or greater. "All Enterococcus that have this value will then have to be further manually tested to determine if it is to be considered resistant by the state reporting standard." Response: The department agrees. The definition for vancomycin resistant Enterococcus has been changed to an MIC greater than 16 µg/mL instead of an MIC greater than or equal to 32 µg/mL. This change will eliminate the reporting of organisms which have a vancomycin MIC of 8 µg/mL - 16 µg/mL. The department recognizes that this could exclude occasional isolates with inducible van B resistance in which MICs may be 8 µg/mL - 16 µg/mL. The changes have been made in the definitions included in sec.97.1. Comment: One commenter had concerns regarding Enterococcus casseliflavis and Enterococcus gallinarum. "The automated systems that many medical centers use for identification and antibiotic sensitivity testing of organisms do not identify by species. To eliminate these two species of Enterococcus from the totals, further labor intensive manual testing will have to be done." Response: The department agrees. sec.97.1 defining vancomycin resistant Enterococcus has been changed to eliminate the need for additional manual testing. The department is not requiring that laboratories do additional speciation. Twenty-two commenters from 13 different associations or hospitals made comments regarding the proposed rules. Three commenters stated that they appreciate the need to conduct surveillance, provide data regarding antibiotic resistant bacteria, and aspire to impact the medical community's practices regarding antibiotics, but they felt there were some weak points in the proposed rules. The commenters were the University of Texas MD Anderson Cancer Center, Northwest Texas Healthcare System, and Baylor University Medical Center. The commenters were individuals from associations and hospitals who were generally not in favor of sec.97.3(c)(6) rules requiring reporting of numeric totals for Enterococcusspecies, Haemophilus influenzae, and Streptococcus pneumoniae. The commenters main concerns were the increase in costs and time spent to tabulate and report these data. Furthermore, the commenters felt the data collected would not give accurate antibiotic resistant rates. In addition, commenters were concerned about sec.97.1 regarding reporting of ampicillin resistant Haemophilus influenzae, and the minimum inhibitory concentration (MIC) of 32 µg/mL as the cut-off for reporting of vancomycin resistant Enterococcus. These comments on the proposed rules received by the department during the comment period were submitted by three board members of the Texas Society of Infection Control Practitioners, the Texas Hospital Association, the Dallas-Fort Worth Regional Chapter of Association for Professionals in Infection Control and Epidemiology, and from the Assistant Director of Communicable Disease at the City of Houston Health and Human Services Department. Comments were also received from individuals from nine different hospitals in Texas. The hospitals include; MD Anderson Cancer Center, Metropolitan Methodist Hospital, Northwest Texas Healthcare System, Victoria Regional Medical Center, RHD Memorial Medical Center/Trinity Medical Center, Parkland Memorial Hospital, Mercy Regional Medical Center, Baylor University Medical Center, and Methodist Hospital. The amendments are adopted under the Health and Safety Code, Chapter 81, which provides the Board of Health (board) with the authority to prevent and control communicable disease; and sec.12.001, which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health. sec.97.1.Definitions. The following words and terms, when used in these sections, shall have the following meanings, unless the context clearly indicates otherwise. Penicillin resistant Streptococcus pneumoniae - Streptococcus pneumoniae with a penicillin minimum inhibitory concentration (MIC) of 2 µg/mL or greater (high level), and an intermediate level resistance of 0.1- 1 µg/mL. Reportable disease - Any disease or condition that is required to be reported under the Act or by these sections. See sec.97.3 of this title (relating to What Condition To Report and What Isolates To Report or Submit). Any outbreak, exotic disease, or unusual group expression of illness which may be of public health concern, whether or not the disease involved is listed in sec.97.3 of this title, shall be considered a "reportable disease." Specimen Submission Form G-1 - A multipurpose specimen submission form available from the Texas Department of Health, Bureau of Laboratories, 1100 West 49th Street, Austin, Texas, 78756-3199. Vancomycin resistant Enterococcus species - Enterococcus species with a vancomycin MIC greater than 16 micrograms per milliliter (µg/mL) or a disk diffusion zone of 14 millimeters or less. Vancomycin intermediate Enterococcus (eg, Enterococcus casseliflavis and Enterococcus gallinarum) with a vancomycin MIC of 8 µg/mL - 16 µg/mL do not need to be reported. Vancomycin resistant Staphylococcus aureus and vancomycin resistant coagulase negative Staphylococcus species - For the purposes of reporting, Staphylococcus aureus or a coagulase negative Staphylococcus species with a vancomycin MIC of 8 µg/mL or greater. sec.97.3.What Condition To Report and What Isolates To Report or Submit. (a) (No change.) (b) Reportable conditions or isolates. (1) Confirmed and suspected cases of the following diseases are reportable: acquired immune deficiency syndrome (AIDS); amebiasis; anthrax; botulism - adult and infant; brucellosis; campylobacteriosis; chancroid; chickenpox; Chlamydia trachomatis infection; cholera; Creutzfeldt-Jakob disease (CJD); cryptosporidiosis; dengue; diphtheria; ehrlichiosis; encephalitis (specify etiology); Escherichia coli O157:H7 infection; gonorrhea; Hansen's disease (leprosy); Haemophilus influenzae type b infection, invasive; hantavirus infection; hemolytic uremic syndrome (HUS); hepatitis, acute viral (specify type); human immunodeficiency virus (HIV) infection; legionellosis; listeriosis; Lyme disease; malaria; measles (rubeola); meningitis (specify type); meningococcal infection, invasive; mumps; pertussis; plague; poliomyelitis, acute paralytic; rabies in man; relapsing fever; rubella (including congenital); salmonellosis, including typhoid fever; shigellosis; spotted fever group rickettsioses (such as Rocky Mountain spotted fever); streptococcal disease, invasive; syphilis; tetanus; trichinosis; tuberculosis; typhus; Vibrio infection (specify species); viral hemorrhagic fevers; yellow fever; and yersiniosis. (2) (No change.) (3) The following organisms shall be reported: Enterococcus species; vancomycin resistant Enterococcus species; vancomycin resistant Staphylococcus aureus; vancomycin resistant coagulase negative Staphylococcus species; Streptococcus pneumoniae; and penicillin - resistant Streptococcus pneumoniae. (c) Minimal reportable information requirements. The minimal information that shall be reported for each disease is as follows: (1)-(3) (No change.) (4) for tuberculosis - name, present address, present telephone number, age, date of birth, sex, race and ethnicity, physician, disease, type of diagnosis, date of onset, antibiotic susceptibility results, initial antibiotic therapy, and any change in antibiotic therapy; (5) for all other reportable conditions listed in subsection (b)(1) of this section - name, present address, present telephone number, age, date of birth, sex, race and ethnicity, physician, disease, type of diagnosis, date of onset, address, and telephone number; (6) for all isolates of Enterococcus species and all isolates of Streptococcus pneumoniae regardless of resistance patterns - numeric totals at least quarterly; and (7) for vancomycin resistant Enterococcus species; penicillin resistant Streptococcus pneumoniae; vancomycin resistant Staphylococcus aureus; vancomycin resistant coagulase negative Staphylococcus species, - name, city of submitter, date of birth or age, sex, anatomic site of culture, and date of culture. (d) Diseases requiring submission of cultures. For all Neisseria meningitidis from normally sterile sites, all vancomycin resistant Staphylococcus aureus, and vancomycin resistant coagulase negative Staphylococcus species - pure cultures shall be submitted accompanied by a Specimen Submission Form G-1. sec.97.4.When to Report a Condition or Isolate; When to Submit an Isolate. (a) The following reportable diseases are public health emergencies and suspect cases shall be reported immediately by phone to the local health authority or the regional director of the Texas Department of Health (department): botulism, foodborne; cholera; diphtheria; Haemophilus influenzae type b infection, invasive; measles (rubeola); meningococcal infection, invasive; pertussis; poliomyelitis, acute paralytic; plague; rabies in man; viral hemorrhagic fevers; yellow fever. Vancomycin resistant Staphylococcus aureus and vancomycin resistant coagulase negative Staphylococcus species shall be reported immediately by phone or fax to the Infectious Disease Epidemiology and Surveillance Division, Texas Department of Health, Austin. (b)-(f) (No change.) (g) For Enterococcus species; vancomycin resistant Enterococcus species; Streptococcus pneumoniae; and penicillin - resistant Streptococcus pneumoniae - reports shall be made no later than the last working day of March, June, September, and December. (h) All Neisseria meningitidis from normally sterile sites, all vancomycin resistant Staphylococcus aureus, and all vancomycin resistant coagulase negative Staphylococcus species shall be submitted as pure cultures to the Texas Department of Health, Bureau of Laboratories, 1100 West 49th Street, Austin, Texas 78756-3199 as they become available. sec.97.5.Where to Report a Condition or Isolate; Where to Submit an Isolate. (a) (No change.) (b) The administrative officer of a clinical laboratory, blood bank, mobile unit, or other facility shall report a condition or submit an isolate as follows. (1)-(2) (No change.) (3) For vancomycin resistant Staphylococcus aureus and vancomycin resistant coagulase negative Staphylococcus species immediately report by phone to the Infectious Disease Epidemiology and Surveillance Division at 1-800-252-8239. For Enterococcusspecies; vancomycin resistant Enterococcus species; Streptococcus pneumoniae; and penicillin - resistant Streptococcus pneumoniae; reports shall be mailed to the Infectious Disease Epidemiology and Surveillance Division, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756-3199, or faxed to the Infectious Disease Epidemiology and Surveillance Division at 512- 458-7616. (4) All Neisseria meningitidis from normally sterile sites, all vancomycin resistant Staphylococcus aureus, and all vancomycin resistant coagulase negative Staphylococcus species shall be submitted as pure cultures to the Texas Department of Health, Bureau of Laboratories, 1100 West 49th Street, Austin, Texas, 78756-3199. (c) (No change.) This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority. Filed with the Office of the Secretary of State on February 9, 1998. TRD-9802187 Susan K. Steeg General Counsel Texas Department of Health Effective date: March 5, 1998 Proposal publication date: September 26, 1997 For further information, please call: (512) 458-7236 CHAPTER 115.Home and Community Support Services Agencies The Texas Department of Health (department), by majority vote of the Texas Board of Health (board) on February 8, 1998, enters this final order adopting amendments to sec.sec.115.1, 115.11, 115.12, 115.21, 115.25, 115.27, 115.28, 115.51, and 115.52 concerning the licensing of home and community support services agencies (HCSSAs). Sections 115.12, 115.21, and 115.52 are adopted with changes to the proposed text published in the December 5, 1997, issue of the type-name="italic">Texas Register (22 TexReg 11941). Sections 115.1, 115.11, 115.25, 115.27, 115.28, and 115.51 are adopted without changes to proposed text and will not be republished. The amended sections cover purpose; application and issuance of initial license; issuance and renewal of license; licensure requirements and standards for agencies providing licensed home health, licensed and certified home health or hospice services; standards for hospice services; standards for branch offices; standards for alternate delivery sites; survey procedures; and enforcement action. The most significant amendments to the rules implement changes to the Health and Safety Code, Chapter 142 as added by Acts of the 75th Legislature, 1997. Specifically, Senate Bill (SB) 1247 added new statutory requirements under sec.142.004(c) relating to an HCSSA's provision of certain documentation when applying for a license and sec.sec.142.017-142.0175 relating to the assessment of administrative penalties against an HCSSA. House Bill (HB) 3075 added new Health and Safety Code, sec.sec.142.061-142.063 relating to an HCSSA's possession of sterile water or saline, possession of certain vaccines or tuberculin, and possession of certain dangerous drugs. House Bill 3100 amended the Human Resources Code, Chapter 102 relating to rights of the elderly, requiring the department to amend the current rule reference to this statute. The administrative penalty requirements mandated by SB 1247 are unique from other licensing statutes authorizing the department to assess penalties (e.g., hospitals). The unique requirements are that the department may only assess an administrative penalty under rules adopted by the board: 1) for any number of days a violation occurred before the day on which an HCSSA receives notice of the violation counting as one violation; 2) for each day of a continuing violation occurring after the day the HCSSA receives notice of the violation counting as a separate violation; 3) according to a list of each violation for which a penalty may be assessed; 4) if the department has considered the seriousness of the violation (including the nature, circumstances, extent, and gravity of the violation and the hazard or safety of clients), the history of previous violations, and whether the HCSSA had identified the violation through its quality assurance process, and had made appropriate progress on correction; 5) if the department has provided an HCSSA with a reasonable time to correct the violation prior to assessing a penalty; 6) for minor violations, if these violations are of a continuing nature or not corrected; 7) if the violation is a hazard to the health or safety of an HCSSA client; and 8) according to a schedule of appropriate and graduated penalties. The proposed amendments to each of the affected sections are outlined as follows. The amendment to sec.115.1 (relating to purpose) corrects the rule's reference to the Medicare program from Title XIII to Title XVIII. The amendment to sec.115.11(g)(2)(D) implements new Health and Safety Code, sec.142.004(c)(5) which requires the department to request during the license application process identifying information on the HCSSA owner, administrator, and chief financial officer for the purpose of conducting a criminal background check on those persons. The amendment to sec.115.11(g)(2)(E) changes the percentage ownership reporting from 10% to 5% and adds the words, "and entities," to be clear that the department expects not only names of individuals but also business entities owning at least 5% interest in the applicant. The amendment to sec.115.11(g)(2)(J) changes the percentage ownership reporting from 10% to 5% to be consistent with the change in sec.115.11(g)(2)(E). The amendment to sec.115.11(j) adds new paragraph (6) to clarify that by applying for or holding an HCSSA license, an HCSSA consents to entry to the HCSSA and access to documents by the department to verify compliance with the provisions of the licensing statute and the licensing rules. The amendments to sec.115.12 implement changes to the Health and Safety Code, sec.142.004(c)(5) for the same reason described for sec.115.11(g)(2)(D) and require an HCSSA to provide an updated description of its service area at time of license renewal. The amendment to sec.115.21(a)(5) requires an HCSSA to notify the department of a change in the HCSSA administrator or chief financial officer within 15 calendar days after the change. The amendment to sec.115.21(b)(3)(B)(ii) changes the prohibition relating to an agency administrator from five years to one year and clarifies the term "enforcement action" as used in that clause. The amendment to sec.115.21(c)(2) corrects an incorrect cross reference to rule language concerning physician delegation. The amendment to sec.115.21(b)(3)(B)(iii) was made to conform to the reformatting of sec.115.52. The amendment to sec.115.21(b)(3)(D) provides that an HCSSA which only provides physical, occupational, speech, or respiratory therapy; medical social services; or nutritional counseling is not required to have a supervising nurse. The amendments to sec.sec.115.21(b)(4)(D) and (H), 115.27(e)(3), and 115.28(e)(3) clarify and make consistent rule language regarding client record storage. The amendment to sec.115.21(b)(4)(I) deletes the age reference to an elderly individual due to changes to the Human Resources Code, Chapter 102. The amendment to sec.115.21(c) adds a requirement that an HCSSA develop, implement, and enforce policies relating to qualifications of a registered nurse providing or supervising pediatric services (if offered) and relating to the possession of sterile water or saline, certain vaccines or tuberculin, and certain dangerous drugs. The amendment in sec.115.21(g)(3)(E) provides clarification as to an agency's responsibilities and a pharmacist's responsibilities in response to public comment. The existing language in sec.115.21(g) was deleted because it no longer applies; new subsection (g) describes the protocols and conditions under which an HCSSA may possess sterile water or saline, certain vaccines or tuberculin, and certain dangerous drugs and mirrors statutory language in the Health and Safety Code, sec.sec.142.061 - 142.063 (HB 3075). The amendment to sec.115.25(e)(1) clarifies that the medical director may be an independent contractor. This change eliminates concern that the existing language created a conflict for physicians with state law prohibiting the corporate practice of medicine. The amendment to sec.115.51(a) adds new paragraphs (5) and (6) for the same reasons as previously described for the amendment to sec.115.11(j). The amendment to sec.115.51(g) requires a department surveyor to review a sample of pediatric client records if pediatric clients are served by the HCSSA. Other changes to sec.115.51 were made for clarification purposes. Section 115.52 has been reformatted to provided needed clarification. Existing subsections (a) and (b) were combined under a common catch title called, "License denial, suspension or revocation." New language was added to new subsection (a)(1)(I) and (1)(J) to authorize the department to deny, suspend, suspend on an emergency basis, or revoke an HCSSA license if the HCSSA fails to comply with the Human Resources Code, Chapter 102 (relating to Rights of the Elderly) or knowingly employs as an administrator or chief financial officer an individual convicted of certain felonies or misdemeanors. New language was added to subsection (a)(2)(B)(vii) - (xx) to specify convictions under the Texas Penal Code which would bar a person from receiving an HCSSA license or would bar an individual from working in an HCSSA as an administrator or chief financial officer. The new language in sec.115.52(a)(3) clarifies that the notice giving due process to an HCSSA against which enforcement action is proposed by the department may be published in a newspaper of general circulation under certain conditions. In addition, the 15-day time period in which an HCSSA may request a hearing when enforcement action is proposed was changed to a 20-day time period in new sec.115.52(a)(3)(A) and (D). The amendment to sec.115.52(a)(5) and (6)(C) adds new clarifying language concerning the prohibition for applying for a license when enforcement action is taken against an HCSSA. Section 115.52(b) contains new language relating to the department's assessment of administrative penalties in accordance with the Health and Safety Code, sec.sec.142.017 - 142.0175. The new language describes the conditions under which the department may assess an administrative penalty, establishes a schedule of appropriate and graduated penalties based upon certain criteria, describes time frames in which an HCSSA must correct a violation, lists the violations which may effect an administrative penalty, and describes the due process provided to an HCSSA against which an administrative penalty is proposed. The change to sec.115.52(b)(3)(C) was made for clarification purposes in response to public comment. Section 115.52(c) contains existing language moved from deleted sec.sec.115.52(e) and (f) concerning court action. Section 115.52(d) contains existing language moved from deleted sec.115.52(k) relating to the surrender or expiration of a license. Other changes to the rules were for editorial purposes. The department received several comments on the proposal; a majority of the comments were submitted in writing and one was provided at a public hearing on the proposal held on December 19, 1997. The Home and Community Support Services Advisory Committee (committee) reviewed and approved the final rules on January 12, 1998. The comments, the department's responses, and the resulting changes(s) are summarized as follows: Comment: Concerning the proposed rules in general, one commenter expressed appreciation for the opportunity to comment and supported efforts to "...stamp out fraud and unscrupulous providers that might jeopardize the fate of this industry." Response: The department appreciates the support. No changes were made as a result of the comment. Comment: Concerning sec.115.11(g)(2)(D), one commenter stated that the rule limits the criminal background checks of corporations to the corporate entity, and added that the rule should allow the department to conduct criminal background checks on each officer, director, and shareholder of the corporation. The commenter suggested that without such criminal background checks, the department will not be able to verify compliance with other disclosure requirements. Response: The department understands the commenter's concern, but believes that it is not necessary to conduct criminal background checks on each officer, director, and shareholder of a corporate owner. The department has chosen to use its existing resources to focus on conducting background checks on individuals who have direct influence or oversight on the care delivered to HCSSA clients (e.g., administrator) and who are responsible for directly overseeing the day- to-day operations of an HCSSA (e.g., owner and individual acting in the capacity of chief financial officer). The department will continue to monitor the issue for problems and make changes to the rules in the future as necessary. No change was made. Comment: Concerning sec.115.11(g)(2)(E) and (J), three commenters stated that the percentage ownership conflicts with the percentage ownership specified in the definition of the term "affiliate" (sec.115.2(C)(iii)) and suggested the definition be changed to 5% instead of 10% for consistency. One of the commenters suggested the change would also provide more adequate disclosure of the information required in sec.115.11(g)(2)(R) and (S). This commenter concluded by asking if all officers and directors are required to provide the information described in sec.115.11(g)(2)(R) and (S) regardless of the amount of ownership interest, and suggested requiring the same information concerning the administrator be disclosed on the license application. Response: The department agrees that all disclosure requirements should be consistent. However, the department is unable to submit the change as a final rule at this time because a change to sec.115.2 was not duly afforded public comment. The change to sec.115.2 will be presented as a proposal to the board in the near future. In response to the commenter's other suggestion, the department disagrees that the same information concerning the administrator should also be submitted and made no change. The department believes that the new language in sec.115.11(g)(2)(D) allowing the department to conduct a criminal background check on the administrator is sufficient. Comment: Concerning sec.115.11(g)(2)(K) which was proposed as "(No change.)," one commenter suggested amending the language to seek information regarding bankruptcy or insolvency information from not only the corporate entity making an application, but also all affiliates. The commenter indicated that this would allow the department to better determine financial competency of a corporation which reorganizes under a different name. Response: The department agrees that a bankrupt corporation could dissolve, its former officers or directors reorganize to form a new corporation with no history of bankruptcy or insolvency. The requirement that such a corporation attest to having the financial resources to meet its proposed budget and provide services, and the disclosure of ownership information relating to the officers or directors should address the commenter's concern. After receiving a license, an applicant is also required to comply with sec.115.21(b)(5) relating to financial solvency. No change was made. Comment: Concerning sec.115.11(g)(2)(R) which was proposed as "(No change.)," one commenter indicated that the disclosure requirement does not specify a time limit and suggested that the department's application form does not fully implement this requirement. The commenter added that the language should be clarified to indicate that the applicant, all officers, all directors, all persons owning 5% or more of the stock, all other controlling persons, and the administrator are required to disclose the information listed. Response: The department agrees that the existing language in sec.115.11(g)(2)(R) does not specify a time limit and did not intend to limit the time period for the information listed under subparagraph (R). The department believes that disclosure of the information specified in sec.115.11(g)(2)(R) is important regardless of how long before application is made. Unless the administrator is an applicant, affiliate, or manager, disclosure of the information is not necessary. Further, the new language in sec.115.11(g)(2)(D) is adequate to address concerns relating to the administrator's criminal background. No change to sec.115.11(g)(2)(R) was made. Comment: Concerning sec.115.11(g)(2)(S) which was proposed as "(No change.)," one commenter suggested extending the time period for disclosing certain information regarding the applicant, the applicant's affiliates, and the applicant's managers from two years to five years. Response: The department disagrees that the information required for disclosure described in sec.115.11(g)(2)(S) should be for a five-year period prior to application and believes that the two-year period is sufficient for the disclosure of the information described in the subparagraph. No change was made. Comment: Concerning sec.115.12(b)(2)(A), one commenter stated that the affidavit of financial solvency and resources is excluded from the requirements for license renewal and that additional specificity should be added to the language in sec.115.11(g)(2)(K) relating to financial resources. The commenter added that such a lack of specificity coupled with the confidentiality statement in the Health and Safety Code, sec.142.004(d) fails "to project public confidence into the industry as a whole" and that the public "deserves to place their trust in those home health agencies that can demonstrate financial solvency, and dependability in accordance with exacting regulatory standards." Response: The department disagrees that the affidavit for financial solvency should be required upon renewal. Upon issuance of a license, the HCSSA is required to comply with many standards which would demand it to maintain the financial ability to fulfill its responsibilities to provide quality care to its clients. The department believes that existing sec.115.21(b)(5) relating to financial solvency contains the requirement intended by the commenter and is more effective than an affidavit requirement. No change was made. Comment: Concerning sec.115.13(a)(3), one commenter suggested that a change of ownership occurs when 50% or more controlling interest in the corporation changes. The commenter added that the department should add a requirement that all new officers, directors, shareholders, and HCSSA administrators must reapply for a license 15 days in advance of the change. Response: The department understands the commenter's concern. However, amendments to sec.115.13 were not proposed. State law in sec.142.002(e) provides that a license may not be transferred to another person. "Person" refers to the legal entity in whose name the license would be held. If 40% or more controlling interest in the corporation changes, there is no change in the legal entity which holds the license. The same corporation continues to hold the license. If there is a question as to whether a change of ownership occurs due to a reorganization of a corporation, partnership, or other business entity, department staff will continue to request a review of the transaction by the department's Office of General Counsel for a legal opinion as to whether a change of ownership has occurred under the appropriate licensing statute. Regarding the commenter's suggestion that the department require 15 days of advance notice of a change of control, such a change does not change the legal entity which holds the license. The department cannot require relicensure if there is a change of control. Since a license is not transferrable nor assignable, a new owner who does not apply for a license in accordance with sec.115.13 would be operating an HCSSA without a license. In such a scenario, the owner is subject to injunctive action, and civil and administrative penalties. The department will continue to monitor change of ownership transactions for problems and will propose amendments to the section as necessary. No change was made. Comment: Concerning sec.115.21(b)(2)(G)(i) and sec.115.21(b)(4)(I)(ix), one commenter stated that requiring HCSSAs to provide a copy of the entire Human Resources Code, Chapter 102 (relating to Rights of the Elderly) is not necessary since the intent of the law is to let clients know about their rights under the law. The commenter requested amending the language to allow an HCSSA to provide only the list of rights included in the law (sec.102.003). Response: The department disagrees that the law relating to rights of the elderly should not be provided to a client. All five sections of the Human Resources Code, Chapter 102 contain important information for a client. Section 102.001 defines terms used in the following sections; sec.102.002 informs the client that a provider may not deny them a right listed in the law and violation of the law is grounds for suspension or revocation of the license; sec.102.003 describes the client's rights; sec.102.004 requires a provider to provide a client with the written list of the rights and to inform the client of changes in the list; and sec.102.005 informs the client that the list of rights is in addition to other rights or remedies to which an elderly individual is entitled. Since sec.sec.102.001, 102.002, 102.004, and 102.005 combined contain less text than sec.102.003 alone and the statute is readily available on the Internet and in public libraries, the department believes it will not be burdensome to HCSSAs to reproduce the additional text and provide it to their clients. No change was made. Comment: Concerning in sec.115.21(b)(3)(B)(ii), one commenter stated that the department's proposal to change the employment prohibition for administrators from five years to one year and to exclude administrative or civil penalties from the term "enforcement action" diminishes the already inadequate requirements in sec.115.21(b)(3)(B)(i)(III). The commenter stated that existing sec.115.21(b)(3)B)(i)(III) is inadequate to protect the health and safety of the public and suggested the development of more stringent standards of training and experience for HCSSA administrators. Response: The department disagrees with the commenter. The department believes that the one-year employment prohibition for administrators is adequate and that the new rule language adopted by the board effective October 1, 1997, increases accountability of an HCSSA to provide quality care to its clients. The department further believes that the new rules prescribing administrative penalties for violations of a continuing nature or of health or safety significance will provide a new protection to the public not previously in place. The department agrees with the commenter that the new enforcement activities (administrative penalties) is in its "infancy." The department has benefited from the experiences of other state agencies implementing enforcement strategies and has chosen to implement the enforcement tools in a manner which will promote and protect patient care through working with industry and consumers to effect positive changes toward that goal. The department believes that the new requirements are a beginning to seek a balance between the department's mandate to regulate the HCSSA industry while affording the industry due process. The department will continue to review the training and experience issue as it relates to enforcement activities and will make changes in the future as necessary. The department also notes that the training and experience requirement referred to by the commenter does not "grandfather" an administrator hired prior to October 1, 1997. No change was made. Comment: Concerning sec.115.21(b)(3)(B)(ii), one commenter expressed support for the reduction from a five-year to a one-year exclusion of an individual in the administrator position. The commenter indicated the change was "...more appropriate and reasonable." The same commenter expressed concern that an administrator hired by an HCSSA to replace the administrator employed at the time violations were cited would be held accountable for the violations which occurred prior to his or her employment. The commenter suggested adding language to clarify that the administrator would have to have been employed by the HCSSA for at least six months prior to the enforcement action in order for the rule to apply; that the administrator will have the opportunity for review by the department's Enforcement Action Committee (EAC) of the circumstances and the appropriateness of excluding the administrator before the exclusion is applied; and that the EAC make a separate determination relating to the administrator's exclusion and the HCSSAs exclusion. The commenter expressed similar concerns in the case of a new owner taking control of an HCSSA which was cited with violations resulting in enforcement action. Response: The department agrees that the proposed language is more appropriate and has retained the language. The department disagrees that the rule language infers the possible scenarios described by the commenter and that additional language is necessary. The rule is clear that the employment prohibition for an administrator is relevant only to the administrator who was employed "at the time the agency was cited with violations of the statute" or the licensing rules "which resulted in enforcement action taken against the agency." If the new administrator was not employed at the time the violations were cited, then the new administrator is not prohibited from being employed by another HCSSA owned by the same or different owner. If the violations were cited after the new administrator was hired to correct problems identified by the HCSSA, and improvements were effected after the new administrator's arrival, the department takes this as well as the seriousness of the violations into consideration when reviewing a case for enforcement action. The department further notes that the enforcement actions effecting the exclusion include revocation or suspension of a license (administrative penalties would not effect the exclusion), which reflects that very serious health and safety issues exist. The commenter's concern that a new owner could be held responsible for violations found under previous ownership is irrelevant to the rule requirement in sec.115.21(b)(3)(B)(ii). An enforcement action against a licensee is against the owner of the HCSSA at the time violations were cited; enforcement action relating to a previous owner cannot be made against the new owner. No change was made. Comment: Concerning sec.115.21(b)(3)(D), one commenter stated that the rule was not clear as to how the overall plan of care is coordinated, especially in situations where the staff is contracted and the HCSSA offers only the one therapy service. The commenter added that under the rule, children with complex medical situations and the isolated elderly are placed at increased risk with less coordination of services and appropriate oversight when served by an HCSSA that offers one therapy service or contracts for services. Response: The department disagrees that clients will be at risk and that less coordination of services will occur when a client is served by an HCSSA offering one therapy service or contracts for services. For example, an HCSSA which provides only physical therapy services must enter into an agreement with the client who is receiving the service. The HCSSA and client must agree that only physical therapy services will be provided. The HCSSA is then not responsible for other needs the client develops while receiving the one service from the HCSSA. In this scenario, the coordination of other needs is the responsibility of the client, client's family, and the client's physician. No further clarification is necessary and no change was made. Comment: Concerning sec.115.21(c)(37), one commenter requested a definition for pediatric services as the term is used in the rule and indicated that the rule requires only nursing to have pediatric qualifications. The commenter included sec.115.21(c)(38) relating to a policy concerning the possession of sterile water or saline, certain vaccines or tuberculin, and certain dangerous drugs in the comment regarding the need to define pediatric services. The commenter further suggested requiring all staff to be required to have pediatric qualifications (not just nursing staff) and that those qualifications be clarified and added that the rule be amended to read "...supervises direct nursing care staff...." Response: The department disagrees that the term "pediatric services" requires definition. The term is clear to mean services provided to a pediatric client. The department further disagrees that the rule should require all staff caring for a pediatric client to have "pediatric qualifications." The services provided to a client under sec.115.21(c)(37) must be supervised by a registered nurse (supervising nurse). The department believes that the requirement that the supervising nurse overseeing the care of the pediatric client or the nurse actually providing the care have pediatric qualifications is sufficient. It is each HCSSA's responsibility to determine how extensive such qualifications should be based upon the skill level appropriate to c