TITLE 22. EXAMINING BOARDS

PART 9. TEXAS MEDICAL BOARD

CHAPTER 172. TEMPORARY AND LIMITED LICENSES

SUBCHAPTER D. DISASTER EMERGENCY RULE

22 TAC §172.20, §172.21

The Texas Medical Board (Board) proposes new Subchapter D, Disaster Emergency Rule §172.20 and §172.21.

New Rule §172.20, relating to Physician Practice and Limited License for Disasters and Emergencies, provides two methods for an out of state physician to be approved to practice in the event of a disaster. One method is hospital-to-hospital credentialing, which will not require the physician to apply for and obtain a license. This method will allow qualified out of state physicians to come to Texas and practice medicine at a Texas licensed hospital at the request of that facility. The second method allows a qualified out of state physician to obtain a limited emergency license if the physician has been requested by a Texas sponsoring physician to assist in the disaster or emergency.

New Rule §172.21, relating to Other Health Care Providers Practice and Limited License for Disasters and Emergencies, provides a method for out of state licensees, permit holders, and certificate holders, other than physicians, who practice in healthcare areas subject to regulation by the Board, to obtain authority to practice in Texas during a disaster. These providers must practice under the supervision and delegation of a physician and the supervising physician must be licensed in Texas.

The public benefit anticipated as a result of enforcing this section will be to have the ability to provide medical services and care to citizens in the event of a natural disaster. The process provides a clearly delineated and expeditious process in place for out of state physicians and other health care providers responding to a disaster. The process delineated by this rule was implemented on an ad-hoc basis during Hurricane Harvey and was extremely successful at providing necessary medical personnel without compromise to patient safety.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that for each year of the first five years the subsection as proposed is in effect the public benefit anticipated as a result of enforcing this proposal will be as stated above.

Mr. Freshour has also determined that for the first five-year period these sections as proposed are in effect there will be no fiscal impact or effect on government growth as a result of enforcing the sections as proposed.

Mr. Freshour has also determined that for the first five-year period the sections are in effect there will be no probable economic cost to individuals required to comply with these rules as proposed.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule amendments and determined that for each year of the first five years the proposed amendments will be in effect:

(1) there will be no effect on small businesses, micro businesses, or rural communities; and

(2) the agency has considered alternative methods of achieving the purpose of the proposed rule amendments and found none.

Pursuant to Texas Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each year of the first five years these rule amendments, as proposed, are in effect:

(1) the additional estimated cost to the state and to local governments expected as a result of enforcing or administering the rule is none;

(2) the estimated reductions in costs to the state and to local governments as a result of enforcing or administering the rule is none;

(3) the estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the rule is none; and

(4) there are no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering the rule.

Pursuant to Texas Government Code §2001.024(a)(6) and §2001.022, the agency has determined that for each year of the first five years the proposed amendments will be in effect, there will be no effect on local economy and no effect on local employment.

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 or decrease in fees paid to the agency.

(5) The proposed rule creates new regulations.

(6) The proposed rule does not expand, limit, or repeal 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 amendments are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to adopt rules necessary to administer and enforce the Medical Practice Act.

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

§172.20.Physician Practice and Limited License for Disasters and Emergencies.

(a) The purpose of this rule to allow the Texas Medical Board, its advisory boards and committees (collectively "Board") to provide a rapid and safe response to health care and medical needs as a result of natural disasters through an emergency licensing process. In the event of an occurrence for which the Governor of the State of Texas has declared a state of emergency, in accordance with the Texas Government Code, the Office of the Governor may temporarily suspend all necessary statutes and rules to allow health care providers to practice medicine, or within the scope of their appropriate licensure, permit, or certification in Texas to assist with disaster response operations.

(b) The Board shall, pursuant to a lawful emergency declaration, waive requirements for licensure except to the extent set forth below and after the Governor of the State of Texas has declared a disaster or state of emergency, or in the event of an occurrence for which a county or municipality has declared a state of emergency, or to protect the public health, safety or welfare of its citizens. There are two ways for physicians to practice under this rule:

(1) Hospital-to-Hospital Credentialing: A physician who holds a full, unlimited and unrestricted license to practice medicine in another U.S. state, territory or district and has unrestricted hospital credentials and privileges in any U.S. state, territory or district may practice medicine at a hospital that is licensed by the Texas Health and Human Services Commission upon the following terms and conditions being met:

(A) the licensed Texas hospital shall verify all physician credentials and privileges;

(B) the licensed Texas hospital shall keep a list of all physicians coming to practice and shall provide this list to the Board within ten (10) days of each physician starting practice at the licensed Texas hospital; and

(C) the licensed Texas hospital shall also provide the Board a list of when each physician has stopped practicing medicine in Texas under this section within ten (10) days after each physician has stopped practicing medicine under this section.

(2) Limited Emergency License: A physician who holds a full, unlimited and unrestricted license to practice medicine in another U.S. state, territory or district may qualify for a limited emergency license upon the following conditions being met:

(A) the applicant must complete a limited emergency license application;

(B) the Board shall verify that the physician holds a full, unlimited and unrestricted license to practice medicine in another U.S. state, territory or district; and

(C) the applicant must present written verification from a Texas sponsoring physician who is requesting the physician to assist in the disaster or emergency.

(c) The Board may limit the sponsored physician's practice locale and scope of practice.

(d) The sponsoring physician shall be considered the supervising physician for the sponsored physician.

(e) The Board shall have jurisdiction over all physicians practicing under this subchapter for all purposes set forth in or related to Texas Occupations Code, and all other applicable state and federal laws, and such jurisdiction shall continue in effect even after any and all physicians have stopped practicing medicine under this section related to providing medical services in Texas during the disaster.

(f) A physician license issued under this subchapter shall be valid for no more than thirty (30) days from the date the physician is licensed or until the emergency or disaster declaration has been withdrawn or ended, whichever is longer.

(g) Physicians holding limited emergency licenses under this subchapter shall not receive any compensation outside of their usual compensation for the provision of medical services during a disaster or emergency.

§172.21.Other Health Care Providers Practice and Limited License for Disasters and Emergencies.

(a) For out of state licensees, permit holders, and certificate holders, other than physicians, who practice in health care areas subject to regulation by the Board, the process for obtaining authority to practice in Texas during a disaster is set out in §172.20(b)(1) and (2), relating to Physician Practice and Limited License for Disasters and Emergencies, including all verification and reporting requirements.

(b) In addition, the following is applicable to these health care providers:

(1) the health care provider must practice under the supervision and delegation of a physician and the supervising physician must be licensed in Texas;

(2) the provisions related to supervision and delegation under §157.001, Texas Occupations Code, apply to both the health care provider and supervising physician; and

(3) the health care provider must also comply with all provisions of the applicable Texas Occupations Code for that occupation.

(c) Physician assistants and physicians practicing under this section are not required to maintain onsite documentation describing supervisory arrangements and instructions for prescriptive authority as otherwise required by Chapter 157, Texas Occupations Code.

(d) The Board shall have jurisdiction over licensees, permit holders, and certificate holders practicing under this subchapter for all purposes set forth in or related to the Texas Occupations Code, and all other applicable state and federal laws, and such jurisdiction shall continue in effect even after the licensee, permit holder, or certificate holder have stopped practicing under this section related to providing medical services in Texas during the disaster.

(e) The authority to practice issued to a licensee, permit holder, or certificate holder under this subchapter shall be valid for no more than thirty (30) days from the date the licensee, permit holder, or certificate holder is authorized to practice or until the emergency or disaster declaration has been withdrawn or ended, whichever is longer.

(f) A licensee, permit holder, and certificate holder holding limited emergency authority under this subchapter shall not receive any compensation outside of their usual compensation for the provision of medical services during a disaster or emergency.

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 April 9, 2019.

TRD-201901051

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: May 26, 2019

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