TITLE 22. EXAMINING BOARDS

PART 9. TEXAS MEDICAL BOARD

CHAPTER 163. LICENSURE

22 TAC §163.11

The Texas Medical Board (Board) proposes an amendment to §163.11, concerning Active Practice of Medicine.

Senate Bill 1148, adopted by the 85th Legislature, prohibits the Board from requiring maintenance of certification by an applicant to be eligible for a medical license. While the Board has never required compliance with specialty certification board maintenance of certification programs as a condition of licensure, proposed amendments are made to §163.11 to clarify that fact.

Scott Freshour, General Counsel for the Board, has determined that for each year of the first five years the section as proposed is in effect the public benefit anticipated as a result of enforcing this proposal will be will be to have rules that are clear and comport with applicable statutes.

Mr. Freshour has also determined that for the first five-year period the section is in effect there will be no effect to individuals required to comply with the rule as proposed. There will be no effect on small businesses, micro businesses, and rural communities.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rule. For each year of the first five years the proposed amendment will be in effect, Mr. Freshour has determined the following:

(1) The proposed rule does not create or eliminate a government program.

(2) Implementation of the proposed rule does not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed rule does not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed rule does not require an increase or decrease in fees paid to the agency.

(5) The proposed rule does not create a new regulation.

(6) The proposed rule does not expand or limit an existing regulation.

(7) The proposed rule does not increase or decrease the number of individuals subject to the rule's applicability.

(8) The proposed rule does not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendment is proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure. The amendments are further proposed under the authority of Texas Occupations Code Annotated, Chapter 155, as amended by Senate Bill 1148 (85th Leg., R.S. 2017).

No other statutes, articles or codes are affected by this proposal.

§163.11.Active Practice of Medicine.

(a) All applicants for licensure shall provide sufficient documentation to the board that the applicant has, on a full-time basis, actively diagnosed or treated persons or has been on the active teaching faculty of an acceptable approved medical school, within either of the last two years preceding receipt of an application [Application] for licensure.

(b) The term "full-time basis," for purposes of this section, shall mean at least 20 hours per week for 40 weeks' [weeks] duration during a given year.

(c) Applicants who do not meet the requirements of subsections (a) and (b) of this section may, in the discretion of the executive director or board, be eligible for:

(1) an unrestricted license if the applicant:

(A) completes remedial education, including but not limited to a mini-residency, fellowship or other structured program;

(B) presents evidence from a member board of the American Board of Medical Specialties, American Osteopathic Association Bureau of Osteopathic Specialists, American Board of Oral and Maxillofacial Surgery, the Royal College of Physicians and Surgeons of Canada, or any other certifying board that is recognized by the Texas Medical Board, of passage, within the two years prior to date of applying for licensure, of a monitored examination; or

(C) completes other remedial measures that, in the discretion of the board, are necessary to ensure protection of the public and minimal competency of the applicant to safely practice medicine.

[(A) presents evidence from a member board of the American Board of Medical Specialties, Bureau of Osteopathic Specialists, American Board of Oral and Maxillofacial Surgery, or by the Royal College of Physicians and Surgeons of Canada of passage, within the two years prior to date of applying for licensure, of a monitored:]

[(i) initial specialty certification examination (passage of all parts required); or]

[(ii) subsequent specialty written certification examination.]

[(B) completion of remedial education, including but not limited to a mini-residency, fellowship or other structured program; or]

[(C) such other remedial measures that, in the discretion of the board, are necessary to ensure protection of the public and minimal competency of the applicant to safely practice medicine.]

(2) a license subject to one or [of] more of the following conditions:

(A) limitation of the practice of the applicant to specified activities of medicine and/or exclusion of specified activities of medicine; or

(B) such other restrictive or remedial conditions that, in the discretion of the executive director or board, are necessary to ensure protection of the public and establish minimal competency of the applicant to safely practice medicine.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 8, 2018.

TRD-201800053

Scott Freshour

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: February 18, 2018

For further information, please call: (512) 305-7016


CHAPTER 166. PHYSICIAN REGISTRATION

22 TAC §166.3, §166.6

The Texas Medical Board (Board) proposes amendments to §166.3, concerning Retired Physician Exception; and §166.6, concerning Exemption From Registration Fee for Retired Physician Providing Voluntary Charity Care.

Senate Bill 1148, adopted by the 85th Legislature, prohibits the Board from requiring maintenance of certification by an applicant to be eligible for initial or renewal registration permit for a medical license. While the Board has never required compliance with specialty certification board maintenance of certification programs as a condition of registration renewal, proposed amendments are made to §166.3 and §166.6 to clarify that fact.

Scott Freshour, General Counsel for the Board, has determined that for each year of the first five years the sections as proposed are in effect the public benefit anticipated as a result of enforcing the proposal will be to have rules that are clear and comport with applicable statutes.

Mr. Freshour has also determined that for the first five-year period the sections are in effect there will be no effect to individuals required to comply with the rule as proposed. There will be no effect on small businesses, micro businesses, and rural communities.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rule. For each year of the first five years the proposed amendment will be in effect, Mr. Freshour has determined the following:

(1) The proposed rules do not create or eliminate a government program.

(2) Implementation of the proposed rules does not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed rules does not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed rules do not require an increase or decrease in fees paid to the agency.

(5) The proposed rules do not create a new regulation.

(6) The proposed rules do not expand or limit an existing regulation.

(7) The proposed rules do not increase or decrease the number of individuals subject to the rule's applicability.

(8) The proposed rules do not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure. The amendments are further proposed under the authority of Texas Occupations Code Annotated, Chapter 156, as amended by Senate Bill 1148 (85th Leg., R.S.)(2017).

No other statutes, articles or codes are affected by this proposal.

§166.3.Retired Physician Exception.

The registration fee shall apply to all physicians licensed by the board, whether or not they are practicing within the borders of this state, except retired physicians.

(1) - (3) (No change.)

(4) The request of a physician seeking a return to active status whose license has been placed on official retired status for two years or longer shall be submitted to the Licensure Committee of the board for consideration and a recommendation to the full board for approval or denial of the request. After consideration of the request and the recommendation of the Licensure Committee, the board shall grant or deny the request. If the request is granted, it may be granted without conditions or subject to such conditions which the board determines are necessary to adequately protect the public. [including but not limited to:]

[(A) current certification by a member board of the American Board of Medical Specialties, Bureau of Osteopathic Specialists, or the American Board of Oral and Maxillofacial Surgery obtained by passing within the two years prior to date request to return to active status, a monitored:]

[(i) specialty certification examination;]

[(ii) maintenance of certification examination; or]

[(iii) continuous certification examination;]

[(B) limitation of the practice of the requestor to specified activities of medicine and/or exclusion of specified activities of medicine;]

[(C) passage of the Special Purpose Examination (SPEX);]

[(D) remedial education, including but not limited to a mini-residency, fellowship or other structured program;]

[(E) passage of the Medical Jurisprudence Examination; and/or]

[(F) such other remedial or restrictive conditions or requirements which, in the discretion of the board, are necessary to ensure protection of the public and minimal competency of the applicant to safely practice medicine.]

(5) The request of a physician seeking a return to active status whose license has been placed on official retired status for less than two years may be approved by the executive director of the board or submitted by the executive director to the Licensure Committee for consideration and a recommendation to the full board for approval or denial of the request. In those instances in which the executive director submits the request to the Licensure Committee of the board, the Licensure Committee shall make a recommendation to the full board for approval or denial. After consideration of the request and the recommendation of the Licensure Committee, the board shall grant or deny the request subject to such conditions which the board determines are necessary to adequately protect the public. [including but not limited to those options provided in paragraph (4)(A) - (F) of this section.]

(6) - (7) (No change.)

§166.6.Exemption From Registration Fee for Retired Physician Providing Voluntary Charity Care.

(a) - (g) (No change.)

(h) The request of a physician seeking a return to active status whose license has been placed on retired status providing voluntary charity care for two years or longer shall be submitted to the Licensure Committee of the board for consideration and a recommendation to the full board for approval or denial of the request. After consideration of the request and the recommendation of the Licensure Committee, the board shall grant or deny the request. If the request is granted, it may be granted without conditions or subject to such conditions which the board determines are necessary to adequately protect the public. [including but not limited to:]

[(1) current certification by a member board of the American Board of Medical Specialties, Bureau of Osteopathic Specialists, or the American Board of Oral and Maxillofacial Surgery obtained by passing within the two years prior to date request to return to active status, a monitored:]

[(A) specialty certification examination;]

[(B) maintenance of certification examination; or]

[(C) continuous certification examination;]

[(2) limitation of the practice of the requestor to specified activities of medicine and/or exclusion of specified activities of medicine;]

[(3) passage of the Special Purpose Examination (SPEX);]

[(4) remedial education, including but not limited to a mini-residency, fellowship or other structured program;]

[(5) passage of the Medical Jurisprudence Examination; and/or]

[(6) such other remedial or restrictive conditions or requirements which, in the discretion of the board are necessary to ensure protection of the public and minimal competency of the applicant to safely practice medicine.]

(i) The request of a physician seeking a return to active status whose license has been placed on retired status providing voluntary charity care for less than two years may be approved by the executive director of the board or submitted by the executive director to the Licensure Committee for consideration and a recommendation to the full board for approval or denial of the request. In those instances in which the executive director submits the request to the Licensure Committee of the board, the Licensure Committee shall make a recommendation to the full board for approval or denial. After consideration of the request and the recommendation of the Licensure Committee, the board shall grant or deny the request subject to such conditions which the board determines are necessary to adequately protect the public. [including, but not limited to, those options provided in subsection (h)(1) - (6) of this section.]

(j) (No change.)

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 8, 2018.

TRD-201800054

Scott Freshour

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: February 18, 2018

For further information, please call: (512) 305-7016


CHAPTER 172. TEMPORARY AND LIMITED LICENSES

SUBCHAPTER C. LIMITED LICENSES

22 TAC §172.12

The Texas Medical Board (Board) proposes an amendment to §172.12, concerning Out-of-State Telemedicine License.

Senate Bill 1148, adopted by the 85th Legislature, prohibits the Board from requiring maintenance of certification by an applicant to be eligible for a medical license. While the Board has never required compliance with specialty certification board maintenance of certification programs as a condition of licensure, proposed amendments are made to §172.12 to clarify that fact.

Scott Freshour, General Counsel for the Board, has determined that for each year of the first five years the section as proposed is in effect the public benefit anticipated as a result of enforcing this proposal will be to have rules that are clear and comport with applicable statutes.

Mr. Freshour has also determined that for the first five-year period the section is in effect there will be no effect to individuals required to comply with the rule as proposed. There will be no effect on small businesses, micro businesses, and rural communities.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rule. For each year of the first five years the proposed amendment will be in effect, Mr. Freshour has determined the following:

(1) The proposed rule does not create or eliminate a government program.

(2) Implementation of the proposed rule does not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed rule does not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed rule does not require an increase or decrease in fees paid to the agency.

(5) The proposed rule does not create a new regulation.

(6) The proposed rule does not expand or limit an existing regulation.

(7) The proposed rule does not increase or decrease the number of individuals subject to the rule's applicability.

(8) The proposed rule does not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendment is proposed under the authority of the Texas Occupations Code Annotated, Section 153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure. The amendments are further proposed under the authority of Senate Bill 1148 (85th Leg., R.S. 2017).

No other statutes, articles or codes are affected by this proposal.

§172.12.Out-of-State Telemedicine License.

(a) Qualifications. A person may not engage in the practice of medicine across state lines in this State, hold oneself as qualified to do the same, or use any title, word, or abbreviation to indicate or induce others to believe that one is licensed to practice across state lines in this state unless the person is actually so licensed. For a person to be eligible for an out-of-state telemedicine license to practice medicine across state lines under the Medical Practice Act, §151.056, and §163.1 of this title (relating to Definitions), the person must:

(1) be 21 years of age or older;

(2) be actively licensed to practice medicine in another state which is recognized by the board for purposes of licensure, and not the recipient of a previous disciplinary action by any other state or jurisdiction;

(3) not be the subject of a pending investigation by a state medical board or another state or federal agency;

[(4) be currently certified by a member board of the American Board of Medical Specialties or Bureau of Osteopathic Specialists, or by the American Board of Oral and Maxillofacial Surgery, obtained by passing, within the ten years prior to date of applying for licensure, a monitored:]

[(A) specialty certification examination;]

[(B) maintenance of certification examination; or]

[(C) continuous certification examination;]

(4) [(5)] have passed the Texas Medical Jurisprudence Examination;

(5) [(6)] complete a board-approved application for an out-of-state telemedicine license for the practice of medicine across state lines and submit the requisite initial fee; and

(6) [(7)] not be determined ineligible for licensure under subsection (b) of this section.

(b) - (f) (No change.)

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 8, 2018.

TRD-201800055

Scott Freshour

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: February 18, 2018

For further information, please call: (512) 305-7016


CHAPTER 175. FEES AND PENALTIES

22 TAC §§175.1 - 175.3, 175.5

The Texas Medical Board (Board) proposes amendments to §§175.1, 175.2, 175.3 and 175.5, concerning Fees and Penalties.

The amendment to §175.1, concerning Application and Administrative Fees, corrects language in paragraph (1)(H)(i) so that fees related to physician-in-training permits are lowered to $200. Further language is added outlining application and administrative fees for processing licenses for medical physicists, medical radiologic technologists, non-certified technicians, perfusionists, and respiratory care practitioners.

The amendment to §175.2, concerning Registration and Renewal Fees, adds language outlining renewal fees for continuing licenses, permits, and certificates for medical physicists, medical radiologic technologists, non-certified technicians, perfusionists, and respiratory care practitioners.

The amendment to §175.3, concerning Penalties, moves language providing an exemption for individuals serving as military members to new paragraph (11). The amendments further add language outlining penalty amounts for late renewals of licenses for perfusionists, respiratory care practitioners, medical physicists, and medical radiologic technologists.

The amendment to §175.5, concerning Payment of Fees or Penalties, amends language clarifying the rule's allowance for fee refunds applies to applicants who timely withdraw applications, in addition to other requirements. Further language is added clarifying that refunds of fees may be granted to licensees who retire or request cancellation of their licenses within 90 days of paying a renewal fee.

Scott Freshour, Executive Director for the Board, has determined that for each year of the first five years the sections as proposed are in effect the public benefit anticipated as a result of enforcing this proposal will be to have updated and correct fees, penalties, and exemptions reflected in the rules.

Mr. Freshour has also determined that for the first five-year period the sections are in effect there will be no effect to individuals required to comply with the rules as proposed. There will be no effect on small businesses, micro businesses, or rural communities.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rules. For each year of the first five years the proposed amendments will be in effect, Mr. Freshour has determined the following:

(1) The proposed rules do not create or eliminate a government program.

(2) Implementation of the proposed rules does not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed rules does not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed rules do not require an increase in fees paid to the agency. The proposed rules require a decrease in fees paid to the agency for physician-in-training permit holders.

(5) The proposed rules create a new regulation outlining specific fee amounts for certain license holders.

(6) The proposed rules do not expand, limit, or repeal an existing regulation.

(7) The proposed rules do not increase or decrease the number of individuals subject to the rule's applicability.

(8) The proposed rules do not positively or adversely affect this state's economy.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The amendments are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

No other statutes, articles or codes are affected by this proposal.

§175.1.Application and Administrative Fees.

The board shall charge the following fees for processing an application for a license or permit:

(1) Physician Licenses:

(A) Full physician license--$817.

(B) Out-of-State Telemedicine license--$817.

(C) Administrative medicine license--$817.

(D) Distinguished Professor Temporary License--$817.

(E) Conceded Eminence--$817.

(F) Reissuance of license following revocation--$817.

(G) Temporary license:

(i) State health agency--$50.

(ii) Visiting physician--$-0-.

(iii) Visiting professor--$167.

(iv) National Health Service Corps--$-0-.

(v) Faculty temporary license--$552.

(vi) Postgraduate Research Temporary License--$-0-.

(vii) Provisional license--$107.

(H) Licenses and Permits relating to Graduate Medical Education:

(i) Initial physician in training permit--$200 [$212].

(ii) Physician in training permit for program transfer--$141.

(iii) Evaluation or re-evaluation of postgraduate training program--$250.

(iv) Physician in training permit for applicants performing rotations in Texas--$131.

(I) In accordance with §554.006 of the Texas Occupations Code, for those physician license types that confer the authority to prescribe controlled substances and access the Prescription Drug Monitoring Program described by §§481.075, 481.076, and 481.0761 of the Texas Health and Safety Code, the Board shall charge an additional reasonable and necessary fee sufficient to cover the Board's responsible portion for costs related to the Texas Pharmacy Board's establishment and implementation of the drug monitoring program. The fee amount will be calculated in accordance with the Texas General Appropriations Act.

(2) Physician Assistants:

(A) Physician assistant license--$220.

(B) Reissuance of license following revocation--$220.

(C) Temporary license--$107.

(D) In accordance with §554.006 of the Texas Occupations Code, the Board shall charge an additional reasonable and necessary fee sufficient to cover the Board's responsible portion for costs related to the Texas Pharmacy Board's establishment and implementation of the Prescription Drug Monitoring Program described by §§481.075, 481.076, and 481.0761 of the Texas Health and Safety Code. The fee amount will be calculated in accordance with the Texas General Appropriations Act.

(3) Acupuncturists/AcudetoxSpecialists/Continuing Education Providers:

(A) Acupuncture licensure--$320.

(B) Temporary license for an acupuncturist--$107.

(C) Acupuncturist distinguished professor temporary license--$50.

(D) Acudetox specialist certification--$52.

(E) Continuing acupuncture education provider--$50.

(F) Review of a continuing acupuncture education course--$25.

(G) Review of continuing acudetox acupuncture education courses--$50.

(4) Non-Certified Radiologic Technician permit--$130.50.

(5) Non-Profit Health Organization initial certification--$2,500.

(6) Surgical Assistants:

(A) Surgical assistant licensure--$315.

(B) Temporary license--$50.

(7) Criminal History Evaluation Letter--$100.

(8) Certifying board evaluation--$200.

(9) Physician/Physician Assistant Jointly-Owned Entity Annual Report--$18.

(10) Perfusionists:

(A) Application and full license--$180;

(B) Application and provisional license--$180.

(11) Respiratory Care Practitioners:

(A) Application and certificate--$125;

(B) Application and temporary permit--$55.

(12) Medical Radiologic Technologist:

(A) Application and general or limited certificate--$80;

(B) Application and temporary general or limited certificate--$30.

(13) Non-Certified Radiologic Technicians: Application and placement on the General Registry--$60.

(14) Medical Physicists:

(A) Application and initial licensing fee:

(i) first specialty on initial application--$130;

(ii) additional specialties on application--$50;

(B) Temporary license application and temporary licensing fee:

(i) first specialty on application--$130;

(ii) additional specialties on application--$50 each.

§175.2.Registration and Renewal Fees.

The board shall charge the following fees to continue licenses and permits in effect:

(1) Physician Registration Permits:

(A) Initial biennial permit--$456.

(B) Subsequent biennial permit--$452.

(C) Additional biennial registration fee for office-based anesthesia--$210.

(D) In accordance with §554.006 of the Texas Occupations Code, for those physician license types that confer the authority to prescribe controlled substances and access the Prescription Drug Monitoring Program described by §§481.075, 481.076, and 481.0761 of the Texas Health and Safety Code, the Board shall charge an additional reasonable and necessary fee sufficient to cover the Board's responsible portion for costs related to the Texas Pharmacy Board's establishment and implementation of the drug monitoring program. The fee amount will be calculated in accordance with the Texas General Appropriations Act.

(2) Physician Assistant Registration Permits:

(A) Initial annual permit--$272.50.

(B) Subsequent annual permit--$268.50.

(C) In accordance with §554.006 of the Texas Occupations Code, the Board shall charge an additional reasonable and necessary fee sufficient to cover the Board's responsible portion for costs related to the Texas Pharmacy Board's establishment and implementation of the Prescription Drug Monitoring Program described by §§481.075, 481.076, and 481.0761 of the Texas Health and Safety Code. The fee amount will be calculated in accordance with the Texas General Appropriations Act.

(3) Acupuncturists/Acudetox Specialists Registration Permits:

(A) Initial annual permit for acupuncturist--$337.50.

(B) Subsequent annual permit for acupuncturist--$333.50.

(C) Annual renewal for acudetox specialist certification--$87.50.

(4) Non-Certified Radiologic Technician permit annual renewal--$130.50.

(5) Non-Profit Health Organization biennial recertification--$1,125.

(6) Surgical Assistants registration permits:

(A) Initial biennial permit--$561.

(B) Subsequent biennial permit--$557.

(7) Certifying board evaluation renewal--$200.

(8) Perfusionists - License biennial renewal--$362.

(9) Respiratory Care Practitioners - Certificate renewal--$106.

(10) Medical Radiologic Technologist - General or limited certificate biennial renewal--$66.00.

(11) Non-Certified Radiologic Technician - Registry biennial renewal--56.00.

(12) Medical Physicists: License biennial renewal:

(A) First specialty--$260;

(B) Additional specialties--$50 each.

§175.3.Penalties.

In addition to any other application, registration, or renewal fees, the board shall charge the following late fee penalties:

(1) Physicians:

(A) Physician's registration permit expired for 31 - 90 days--$75.

(B) Physician's registration permit expired for longer than 90 days but less than one year--$150.

(2) Physician Assistants:

(A) Physician assistant's registration permit expired for 90 days or less--half the registration fee.

(B) Physician assistant's registration permit expired for longer than 90 days but less than one year--full registration fee.

(3) Acupuncturists/Acudetox Specialists:

(A) Acupuncturist's registration permit expired for 90 days or less--half the registration fee.

(B) Acupuncturist's registration permit expired for longer than 90 days but less than one year--full registration fee.

(C) Renewal of acudetox specialist certification expired for less than one year--$25.

(4) Non-Certified Radiologic Technicians. Renewal of non-certified radiologic technician's registration expired for 1 - 90 days--$50 [$25].

(5) Certification as a Non-Profit Health Organization fee for a late application for biennial recertification--$1,000.

(6) Surgical Assistants:

(A) Surgical Assistant's registration permit expired for 90 days or less--half the registration fee.

(B) Surgical Assistant - registration permit expired for longer than 90 days but less than one year--full registration fee.

(7) Perfusionists:

(A) Perfusionists license, full or provisional, expired for 90 days or less--one-fourth the renewal fee;

(B) Perfusionists license, full or provisional, expired for longer than 90 days but less than one year--one-half the renewal fee.

(8) Respiratory Care Practitioners:

(A) Certificate renewal, if expired for 90 days or less--one-half the renewal fee;

(B) Certificate renewal, if expired for longer than 90 days but less than one year--full renewal fee.

(9) Medical Physicists:

(A) Medical Physicist license expired for 90 days or less--one-half of the renewal fee;

(B) Medical Physicist license expired for 91 days but less than on year--full renewal fee;

(10) Medical Radiologic Technologists:

(A) Certificate renewal, if expired for 90 days or less--one-half the renewal fee;

(B) Certificate renewal, if expired for longer than 90 days but less than one year--full renewal fee.

(11) An individual who holds a license issued by the board is exempt from any penalty for failing to renew the license in a timely manner if the individual establishes, to the satisfaction of the board, that the individual failed to renew the license in a timely manner because the individual was serving as a military service member.

[(7) An individual who holds a license issued by the board is exempt from any penalty for failing to renew the license in a timely manner if the individual establishes, to the satisfaction of the board, that the individual failed to renew the license in a timely manner because the individual was serving as a military service member.]

§175.5.Payment of Fees or Penalties.

(a) Method of Payment. Fees paid online must be submitted by credit card, electronic check, or debit card, as required by the online application. All other licensure fees or penalties must be submitted in the form of a money order, personal check, or cashier's check payable on or through a United States bank. Fees and penalties cannot be refunded except as provided in subsection (c) of this section. If a single payment is made for more than one individual permit, it must be made for the same class of permit and a detailed listing, on a form prescribed by the board, must be included with each payment.

(b) Additional Fees Based on Method of Payment.

(1) Online payments. Applicants and licensees who submit payments online may be subject to convenience fees set by the Department of Information Resources, that are in addition to the fees listed in §§175.1 - 175.3 of this title (relating to Application and Administrative Fees, Registration and Renewal Fees and Penalties).

(2) Payments submitted for hard-copy registration. Licensees who choose to register on paper if online processing is available will be subject to an additional fee of $50 collected by the board, in addition to the fees listed in §§175.1 - 175.3 of this title.

(c) Refunds. Refunds of fees may be granted under the following circumstances:

(1) Administrative error by the Board;

(2) Licensure applicants who timely withdraw their applications and do not appear before the Licensure Committee [and who withdraw their applications] and request a refund within 30 days of being notified by board staff that they are ineligible for licensure;

(3) Applicants who withdraw a licensure application after applying for multiple types of licensure at the same time but then either elect to pursue only one type of license or the Board approves one type of license before completing the review of the other applications;

(4) Applicants who apply for temporary licenses but do not receive a temporary license due to the issuance of full licensure;

(5) Licensees who retire or request cancellation of their licenses within 90 days of paying the renewal/registration fee;

(6) Applicants or licensees who die within 90 days of having paid a fee;

(7) If the applicant or licensee has died more than 90 days after having paid a fee and a spouse or personal representative has submitted a written request for a refund demonstrating good cause for a pro-rated refund; or

(8) Applicants who withdraw their applications within 45 days of initial application.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 8, 2018.

TRD-201800043

Scott Freshour

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: February 18, 2018

For further information, please call: (512) 305-7016


CHAPTER 177. BUSINESS ORGANIZATIONS AND AGREEMENTS

SUBCHAPTER E. PHYSICIAN CALL COVERAGE MEDICAL SERVICES

The Texas Medical Board (Board) proposes amendments to Chapter 177, Subchapter E, Physician Call Coverage Medical Services §177.18 and §177.20 and proposes the repeal of §177.19.

The amendments are proposed to provide a more flexible framework for call coverage agreements between physicians practicing in Texas so as to provide continuity of care to patients during a regular treating physician's absence, while ensuring the covering physician's accountability for meeting the standard of care and documenting the care provided during the call coverage period. The amendments propose to eliminate the two-model approach under §177.20(b), allow all call coverage agreements to be contracted orally or in writing, and eliminate the requirement that certain agreements require real-time access to a patient's medical records at the time of the call coverage period.

Section 177.18, Purpose and Scope - Proposed "clean up" revisions are made to the section in order to simplify the text.

Section 177.19, Definitions - §177.19 is proposed for repeal, as the definitions are found in §177.1, of this title (relating to Definitions).

Section 177.20, Call Coverage Minimum Requirements - Proposed amendments to subsection (a) proposes to delete language stating that the covering physician is responsible for meeting the standard of care. The language proposed for deletion is unnecessary, as it is well-established that a physician providing care to a patient is liable for meeting the standard of care, regardless of whether the treatment is provided during a period of call coverage. However, the regular treating physician (who is a party to a call coverage agreement with the covering physician and requested coverage, or is part of a group practice which is a party to such a call coverage agreement) will not be liable for the covering physician's care provided during the call coverage period and the proposed deletion is not intended to change that fact. Other language concerning a required report about care provided during the period of call coverage is proposed for deletion and is added to new subsection (b). Language stating that the duty to provide the report is the sole duty of the covering physician is deleted, as such language is redundant.

New proposed subsection (b) provides that the covering physician must provide to the patients' primary physician(s) who is a party to the CCA a report about the medical intervention or advice provided. Further language is added providing that parties to the CCA can determine the timing and method in which the report is provided and who should receive the report.

The proposed amendments will allow greater flexibility for the parties to the call coverage agreement to determine the appropriate reporting methods and timing.

Other language requiring that a report be made part of the patient's medical records is proposed for deletion as it will be redundant in light of the new language proposed.

Current subsection (b), which sets out the call coverage models and related requirements, is proposed for deletion. The language proposed for deletion includes requirements that real-time access be provided to a regular treating physician's electronic medical record if the agreement is made between physicians practicing in different specialties or lacks reciprocal arrangements between the parties. The deletion of such requirements will especially assist those physicians practicing in rural areas who may not be able to easily arrange call coverage with physicians in the same or similar specialties or provide reciprocity, and who also may lack the ability to have real-time access to another physician's medical record system.

The board's intent in repealing this language is to provide a more flexible rule that will allow expanded call coverage arrangements, including those for rural physicians, while continuing to maintain important minimum requirements necessary to ensure that the covering physician remains accountable for taking important steps in relaying certain information to the patient and the regular treating physician at the end of the call coverage period. This will better ensure continuity of care and the arrangement of timely follow up care. The regular treating physician remains responsible for ensuring that the covering physician's reports and information about such call coverage encounters are made a part of the patient's medical record.

Scott Freshour, General Counsel for the Board, has determined that for each year of the first five years the sections as proposed are in effect, the public benefit anticipated as a result of enforcing this proposal will be to continue to expand call coverage arrangements in Texas, allowing increased options for providing safe and quality medical care to Texas citizens during a treating physician's temporary absence. The public benefit further anticipated as a result of enforcing the sections will be to provide improved guidance to all physicians regarding minimum requirements for all physician call coverage being provided in Texas, which will improve patient safety and quality of medical care.

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rules. For each year of the first five years the proposed amendments will be in effect, the agency has determined the following:

(1) The proposed rules do not create or eliminate a government program.

(2) Implementation of the proposed rules does not require the creation of new employee positions or the elimination of existing employee positions.

(3) Implementation of the proposed rules does not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed rules do not require an increase or decrease in fees paid to the agency.

(5) The proposed rules do not create a new regulation.

(6) The proposed rules limit and repeal an existing regulation. The proposed rules limit and repeal existing regulation requiring (A) real-time access to medical records for certain call coverage agreements; (B) written, formal agreements containing certain minimum terms for call coverage between physicians who are not in the same or similar specialty, or who do not have a reciprocal arrangements.

(7) The proposed rules do not increase or decrease the number of individuals subject to the rule's applicability.

(8) The proposed rules do not positively or adversely affect this state's economy.

Mr. Freshour has also determined that for the first five-year period the sections are in effect, there will be no fiscal implication to state or local government as a result of enforcing the sections as proposed. The effect to individuals required to comply with the rules as proposed will be costs associated with preparing a call coverage arrangement. The effect on small or micro businesses or rural communities will include costs associated with preparing a call coverage agreement. However, because the rules would eliminate formal written agreements, real-time access to a patient's medical records, and other requirements for certain arrangements lacking reciprocity or similar practice area between the parties, the overall costs faced through the enforcement of the proposed rules are expected to decrease.

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

22 TAC §177.18, §177.20

The amendments are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

No other statutes, articles or codes are affected by this proposal.

§177.18.Purpose and Scope.

(a) Purpose. [Pursuant to §153.001 of the Act, the Board is authorized to adopt rules relating to the practice of medicine.] The purpose of this subchapter is to set forth minimum requirements relating to a physician's provision of call coverage services for another physician's established patients. [Advances in technology have enabled a more expansive model of call coverage, requiring that minimum standards be adopted so as to better protect and promote the health and safety of the public while accounting for such technological advances.] In setting forth these rules, the board recognizes that a call coverage model outside of the traditional office setting between physicians who are not of the same specialty and do not provide reciprocal call coverage for each other can provide effective and safe patient care.[, contingent upon the physician meeting the standard of care for the treatment provided under an agreement, and minimum standards being in place that correspond to the level of care being provided. Such standards will allow increased access to healthcare, while maintaining accountability for communication between physicians, in order to provide continuity and coordination of care, thereby protecting patient safety and health.]

(b) Scope. This chapter applies to all physicians providing call coverage in Texas, regardless of the nature and scope of technology being used to provide care to patients through the call coverage relationship.

§177.20.Call Coverage Minimum Requirements.

[(a) Generally.]

(a) [(1)] Physicians may provide medical services through a call coverage agreement (CCA) to established patients of another [a] physician [who requests the coverage]. The CCA may be oral or written. [A covering physician who enters into a CCA is responsible for meeting the standard of care for patient care provided during such call coverage.]

(b) [(2)] The covering physician must provide to the patients' primary physician(s) who are parties to the CCA a report about the medical intervention or advice provided. The parties to the CCA can determine the timing and method in which the report is provided and who should receive the report. [is required to relay a report to the physician who requested the coverage regarding the care provided. The covering physician may satisfy the report requirement described in this subsection by updating the patient's medical record, sending a written report, or providing the information to the physician who requested the coverage through other methods. The duty to provide the report is the sole, exclusive obligation of the covering physician, and cannot be delegated to or satisfied by the patient or patient representative providing a report or otherwise recounting the encounter to the physician who requested coverage. The physician who requested the call coverage must make the report provided by the covering physician a part of the patient's medical record.]

[(b) Call Coverage Models.]

[(1) Non-Reciprocal Call Coverage Model. For physicians who enter into a CCA and are not of the same specialty or similar specialties, or do not require reciprocal medical call coverage services for the covering physician's patients through the CCA, the CCA must be in writing and at a minimum include terms that:]

[(A) establish a covering physician's responsibility for meeting the standard of care in providing call coverage for the patients of the physician requesting coverage;]

[(B) provide a list of all of the physicians that may provide the call coverage under the CCA;]

[(C) require that at the time of the service provided, the covering physician have access to the necessary medical records related to the patient who is being treated under the CCA;]

[(D) for non-emergency care provided for a diagnosis previously made by the physician who requested call coverage, require the covering physician to furnish a report to the physician requesting the call coverage within 7 days from the end of each call coverage period;]

[(E) for non-emergency care provided for an injury, illness, or disease not previously diagnosed by the physician who requested call coverage, require the covering physician to furnish a report to the physician who requested the call coverage within 72 hours from the end of each call coverage period; and]

[(F) for emergency care provided, require the covering physician to furnish a report to the physician who requested call coverage within an appropriate time period according to the circumstances of the emergency situation.]

[(2) Reciprocal Call Coverage Model.]

[(A) For physicians who enter a CCA and are of the same specialty or similar specialties and require reciprocal medical call coverage services for the covering physician's patients, the CCA may be oral or written.]

[(B) Terms of the CCA at a minimum must establish the covering physician's responsibility for meeting the standard of care for patient care provided during such call coverage and relaying a report to the physician who requested the coverage regarding such patient care provided within an appropriate amount of time from the conclusion of each call coverage period.]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 8, 2018.

TRD-201800048

Scott Freshour

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: February 18, 2018

For further information, please call: (512) 305-7016


22 TAC §177.19

The repeal is proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine in this state; enforce this subtitle; and establish rules related to licensure.

No other statutes, articles or codes are affected by this proposal.

§177.19.Definitions.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on January 8, 2018.

TRD-201800049

Scott Freshour

Interim Executive Director

Texas Medical Board

Earliest possible date of adoption: February 18, 2018

For further information, please call: (512) 305-7016