TITLE 22. EXAMINING BOARDS
PART 9. TEXAS MEDICAL BOARD
CHAPTER 173. OFFICE-BASED ANESTHESIA SERVICES
SUBCHAPTER
B.
The Texas Medical Board (Board) proposes new rule concerning Chapter 173, Office-Based Anesthesia Services, Subchapter B, concerning Parenteral Ketamine Therapy, §§173.6 - 173.15.
The proposed new sections are as follows:
New §173.6, Definitions, set forth definitions for ketamine administration and psychotropic ketamine therapy.
New §173.7, Exception for Licensed Hospice Provider, provides an exception to the application of the rules under the subchapter for patients enrolled in a hospice program licensed by Texas Health and Human Services.
New §173.8, Mandatory Registration, proposes to require registration for practice settings providing psychotropic ketamine therapy and provides exceptions to registration for certain practice settings.
New §173.9, Operation of PKT Clinics, proposes to limit the provision of psychotropic ketamine therapy to physicians, midlevel providers, or RNs. The new section further specifies training, certification, and delegation requirements for the provision of psychotropic ketamine therapy.
New §173.10, Physician Requirements, sets forth requirements for physicians ordering PKT for psychiatric indications.
New §173.11, Minimum Standards When Administering PKT, proposes to set forth minimum standards related to medical record documentation, patient evaluation, diagnosis, informed consent, and monitoring, and equipment standards when providing psychotropic ketamine therapy.
New §173.12, Prohibited PKT Uses, prohibits any home use, prescribing, or administration of parenteral ketamine.
New §173.13, Complaints and Investigations, proposes to clarify that the medical director and physician owner(s) are responsible for the clinic's operations and regulatory compliance.
New §173.14, Renewal of PKT Clinic Registration, proposes to set forth a registration term of two years and registration renewal requirements.
New §173.15, Audits, Inspections, and Investigations, proposes that psychotropic ketamine therapy clinics will be subject to audits, inspection and investigations as outlined in Chapter 172 of the Board rules related to pain management clinics.
Mr. Scott Freshour, General Counsel for the Texas Medical Board, has determined that, for each year of the first five years the proposed new rules are in effect, the public benefit anticipated as a result of enforcing these proposed new rules will be to enhance the safety of the public health and welfare through the establishment of minimum standards for the provision of psychotropic ketamine therapy.
Mr. Freshour has also determined that for the first five-year period these proposed new rules are in effect, there will be no fiscal impact or effect on government growth as a result of enforcing the proposed sections.
Mr. Freshour has also determined that for the first five-year period these proposed new sections are in effect there will be a probable minimal economic cost to individuals required to comply with these proposed sections.
Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for these proposed new sections and determined that for each year of the first five years these proposed new sections will be in effect there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of these proposed new sections 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 proposed new sections are in effect:
(1) there is no additional estimated cost to the state or to local governments expected as a result of enforcing or administering these proposed new sections;
(2) there are no estimated reductions in costs to the state or to local governments as a result of enforcing or administering these proposed new sections;
(3) there is no estimated loss and no increase in revenue to the state or to local governments as a result of enforcing or administering these proposed new sections; and
(4) there are no foreseeable implications relating to cost or revenues of the state or local governments with regard to enforcing or administering these proposed new sections.
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 these proposed amendments will be in effect, there will be no effect on local economy and local employment.
Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for these proposed new sections. For each year of the first five years these proposed new sections 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;
(5) the proposed rules do create a new regulation;
(6) the proposed rules do not expand, limit, or repeal an existing regulation;
(7) the proposed rules do not increase the number of individuals subject to the rule's applicability; and
(8) the proposed rules do not positively or adversely affect this state's economy.
Comments on the proposal may be submitted using this link https://forms.cloud.microsoft/g/WrgW5yPyKm or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.
The proposed new rule(s) are proposed pursuant to Texas Occupations Code Section 153.001.
No other statutes, articles or codes are affected by this proposal.
§173.6.
The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise.
(1) Ketamine Administration--The administration of parenteral ketamine (IV, subcutaneous and IM) is the practice of medicine under §157.002 of the Act and is subject to regulation by the Texas Medical Board, including required registration under this Chapter.
(2) Psychotropic Ketamine Therapy (PKT)--The administration of parenteral ketamine in a low-dose for psychiatric indications that have been evaluated and diagnosed by a physician such as PTSD, treatment-resistant depression and suicidal ideation.
§173.7.
The rules promulgated under this subchapter do not apply to ketamine administration for patients enrolled in a hospice program licensed by Texas Health and Human Services.
§173.8.
(a) Any medical practice, clinic or facility providing PKT must be registered with the Board, except the following:
(1) a medical school or an outpatient clinic associated with a medical school;
(2) a hospital, including any outpatient facility or clinic of a hospital;
(3) a facility maintained or operated by this state;
(4) a medical clinic maintained or operated by the United States; or
(5) a health organization certified by the board under Section 162.001 of the Act.
(b) Registration requires completion of a board-approved application filed by a physician owner or medical director of the clinic including providing all required information and documentation.
(c) Applications are valid for 180 days from the date of submission. If the applicant fails to provide all required information and documentation the application will be deemed withdrawn.
(d) If the application is approved, the registration is good for two years from the date of approval.
§173.9.
(a) The provision of PKT must comply with all applicable federal and state laws.
(b) The physician prescribing PKT for psychiatric indications must have successfully completed:
(1) training in mental health treatment; or
(2) a course on the use of ketamine for psychiatric conditions.
(c) The physician ordering the PKT must have a properly established physician/patient relationship and have properly documented and diagnosed psychiatric indication supporting PKT.
(d) PKT may be administered only by a physician, advanced practice registered nurse (APRN), physician assistant (PA), or registered nurse (RN) acting under appropriate delegation by a licensed physician for psychiatric indication as identified in the definition of PKT.
(e) A physician, APRN, PA, or RN working under physician delegation must have formal airway management education or must have completed a course on airway management for moderate sedation.
(f) There must be an APRN, PA, or RN present at all times when administering PKT, and the delegating physician must be immediately available onsite for in-person consultation and emergency management throughout the PKT administration.
(g) Any location administering PKT must keep and maintain an adverse event reporting log, organized by year. Each log must be maintained for a period of at least three years. The log must list any event involving airway intervention, EMS transport, hospitalization, or death. The log must include the following information:
(1) patient name;
(2) date of adverse event;
(3) type of adverse event; and
(4) outcome, if known.
§173.10.
(a) The physician ordering PKT for psychiatric indications must have successfully completed:
(1) training in mental health treatment; or
(2) a course on the use of ketamine for psychiatric conditions.
(b) The physician ordering the PKT must have a properly established physician/patient relationship and have properly documented and diagnosed psychiatric indication supporting PKT.
(c) The physician ordering PKT must review the Prescription Monitoring Program when establishing a physician/patient relationship and on at least a quarterly basis for existing patients.
(d) If the physician ordering the PKT delegates the administration of PKT, they need to have protocols or standing delegation orders issued and maintained at the location where the PKT is being administered.
§173.11.
(a) The physician, APRN, PA or RN administering PKT must:
(1) verify the PKT order from the delegating physician, if applicable;
(2) follow the standard of care;
(3) obtain informed consent including:
(A) a discussion of known risks of PKT; and
(B) the identity and licensure credentials of the person administering the PKT;
(4) implement a time out period immediately prior to beginning administration of PKT;
(5) maintain complete, contemporaneous, and legible medical records regarding patient monitoring and status throughout the administration of PKT.
(b) Patient monitoring and status must include continuous appropriate physiologic monitoring of the patient, both during and post procedure until ready for discharge.
(c) Continuous monitoring of the following:
(1) blood pressure;
(2) pulse;
(3) respiration;
(4) O2 saturation;
(5) cardiovascular status; and
(6) appropriate responsiveness to verbal stimuli.
(d) Discharge assessment requires:
(1) A minimum 30-minute observation period upon completion of PKT;
(2) at least two blood pressure readings 10 minutes apart; and
(3) a full cognitive assessment (including an Aldrete score).
(e) Minimum Equipment Requirements. The following equipment must be utilized for continuous cardiorespiratory monitoring of the patient during and after administration of PKT:
(1) pulse oximetry;
(2) incremental blood pressure checks; and
(3) an end-tidal carbon dioxide (CO2) analyzer.
(f) The following items must be on-site at all times and readily available, in case of an emergency:
(1) Supplemental oxygen,
(2) a bag-valve mask, and
(3) an AED (or defibrillator).
§173.12.
Any home use, prescribing, or administration of parenteral ketamine is prohibited.
§173.13.
The Medical Director and physician owner(s) are responsible for the clinic's operations and patient care and ensuring compliance with all applicable regulations.
§173.14.
(a) Registration is effective for two years following the date of initial registration. At least 60 days prior to the expiration of the PKT registration, a physician, clinic or facility seeking renewal must submit:
(1) a board-approved application; and
(2) an attestation stating that the requirements, standards and equipment comply with all applicable laws and board rules.
(b) Upon expiration of the current registration, the clinic must cease PKT operations until the registration is renewed.
§173.15.
PKT clinics are subject to audits, inspection and investigations as outlined in Chapter 172 of the Board rules related to pain management clinics.
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 December 18, 2025.
TRD-202504730
Scott Freshour
General Counsel
Texas Medical Board
Earliest possible date of adoption: February 1, 2026
For further information, please call: (512) 305-7059
PART 14. TEXAS OPTOMETRY BOARD
CHAPTER 271. EXAMINATIONS
22 TAC §271.4The Texas Optometry Board (Board) proposes 22 TAC Title 14 Chapter 271 - Examinations, new §271.4 - Licensing for Military Service Member, Military Veteran, and Military Spouse to incorporate legislation passed by the 89th Texas Legislature. The current rule relating to military licensing (§273.14 - License Applications for Military Service Member, Military Veteran, and Military Spouse) is being repealed in a separate Texas Register submission.
EXPLANATION OF AND JUSTIFICATION FOR THE RULE
HB 5629 and SB 1818, adopted by the 89th Legislature, Regular Session, established new criteria for licensing agencies to consider upon receipt of an application by a member of the military, veteran or a military spouse. Both bills took effect on September 1, 2025.
The purpose of this new rule is to incorporate the updated statutory provisions into language of the current rule (found at TAC §273.14). Additionally, the agency is moving the language related to military licensing from Chapter 273 to Chapter 271 to consolidate agency rules related to licensing into the same chapter for ease of use by applicants and interested parties.
HB 5629 changes the threshold of military licensing from those that have licensing requirements that are substantially equivalent to instead require the Board to consider licenses that are similar in scope of practice and that are in good standing. HB 1818 requires the Board to immediately issue a 180-day provisional license to military applicants while an application for full licensure is pending.
SECTION-BY-SECTION SUMMARY
Section (a) incorporates definitions as found in Chapter 55 of the Texas Occupations Code.
Section (b) outlines how the agency will identify states with similar scope.
Section (c) outlines that the Executive Director can waive licensing requirements except for requiring graduation from optometry school and passage of nationally accepted exams.
Section (d) requires applicants to complete a criminal background check.
Section (e) outlines what it means for a person to be in good standing with another state's licensing board.
Section (f) outlines the procedure the agency will use to license military members, spouses and veterans. It includes language to provide for a 180-day provisional license to be issued while the application is being processed.
Section (g) provides for the recognition of out of state licenses if certain conditions are met. Individuals whose out of state licenses are recognized would not be licensed in Texas and will not be issued an active Texas license number. No verification from Texas will be provided for these recognized licenses.
Section (h) outlines which fees an applicant under this section would be required to pay.
FISCAL IMPACT ON STATE AND LOCAL GOVERNMENT
Janice McCoy, Executive Director, has determined that for each year of the first five years that the proposed rule is in effect, there are no estimated additional costs or reductions in costs to state or local government as a result of enforcing or administering the proposed rules. Additionally, Mrs. McCoy has determined that for each year of the first five years the proposed rules are in effect, there is no estimated increase or loss in revenue to the state or local government as a result of enforcing or administering the proposed rules.
LOCAL EMPLOYMENT IMPACT STATEMENT
Because Mrs. McCoy has determined that the proposed rule will not affect a local economy, the agency is not required to prepare a local employment impact statement under Texas Government Code §2001.022.
PUBLIC BENEFIT
Ms. McCoy has determined for the first five-year period the proposed rule is in effect, the intended public benefit will be a reduction of the complexity of the administrative rules related to the licensing of members of the military, veterans, and military spouses.
PROBABLE ECONOMIC COSTS TO PERSONS REQUIRED TO COMPLY WITH PROPOSAL
Mrs. McCoy has determined that for each year of the first five-year period the proposed rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules.
FISCAL IMPACT ON SMALL BUSINESSES, MICRO-BUSINESSES, AND RURAL COMMUNITIIES
The proposed new rules will have no direct adverse economic impact on small businesses, micro-businesses, or rural communities. Accordingly, the preparation of an economic impact statement and a regulatory flexibility analysis, as specified in Texas Government Code §2006.002, is not required.
ONE-FOR-ONE REQUIREMENT FOR RULES WITH A FISCAL IMPACT
The proposed rules do not have a fiscal note that imposes a cost on regulated persons, including another state agency, a special district, or a local government. Therefore, the agency is not required to take any further action under Texas Government Code §2001.0045.
GOVERNMENT GROWTH IMPACT STATEMENT
Pursuant to Texas Government Code §2001.0221, for the first five-year period the proposed rules are in effect Ms. McCoy has determined the following:
The proposed rule does not create or eliminate a government program.
The proposed rule does not require the creation or elimination of employee positions.
The proposed rule does not require the increase or decrease in future legislative appropriations to the agency.
The proposed rule does not require an increase or decrease in fees paid to the agency.
The proposed rule does not create a new regulation.
The proposed rule does not expand, limit, or repeal an existing regulation.
The proposed rule does not increase or decrease the number of individuals subject to the rule's applicability.
The proposed rule does not positively or adversely affect the state's economy.
TAKINGS IMPACT ASSESSMENT
Ms. McCoy has determined that there are no private real property interests affected by the proposed rules. Thus, the Board is not required to prepare a takings impact assessment pursuant to §2007.043 of the Tex. Gov't Code.
PUBLIC COMMENTS
Comments on the amended rules may be submitted electronically to: janice.mccoy@tob.texas.gov or in writing to Janice McCoy, Executive Director, Texas Optometry Board, 1801 N. Congress, Suite 9.300, Austin, Texas 78701. The deadline for furnishing comments is thirty days after publication in the Texas Register.
STATUTORY AUTHORITY
The Board proposes this rule pursuant to the authority found in §351.151 of the Tex. Occ. Code which vests the Board with the authority to adopt rules necessary to perform its duties. The statutory provisions affected by the proposed rules are those set forth in Chapter 55 of the Tex. Occ. Code.
No other sections are affected by the rulemaking.
§271.4.
(a) The Board adopts by reference the definitions set forth in Chapter 55 of the Occupations Code.
(b) The Board has sole discretion in determining whether an applicant's out-of-state license is similar in scope to a license issued by the Board. Applicants may only practice optometry to the extent allowed by Texas law.
(c) To protect the health and safety of the citizens of this state, a license to practice optometry or therapeutic optometry requires a doctorate degree in optometry and passing scores on nationally accepted examinations. An alternative method to demonstrate competency is not available.
(d) An applicant under this section must pass a criminal-background check. The Board may deny an application is the applicant has a disqualifying criminal history.
(e) A person is in good standing with another state's licensing authority if the person:
(1) holds a license that is current, has not been suspended or revoked, and has not been voluntarily surrendered during an investigation for unprofessional conduct;
(2) has not been disciplined by the licensing authority with respect to the person's practice of optometry or therapeutic optometry; and
(3) is not currently under investigation by the licensing authority for unprofessional conduct related to the practice of optometry or therapeutic optometry.
(f) Alternate licensing procedure for military service member, military spouse, or military veteran authorized by Texas Occupations Code §55.004.
(1) A license shall be issued to a military service member, military veteran, or military spouse upon proof of one of the following:
(A) the applicant holds a current license in another state that is similar in scope of practice to Texas scope of practice and is in good standing with the other state's licensing authority; or
(B) within the five years preceding the application date, the applicant held the license sought in this state.
(2) As part of the application process, the Executive Director may waive any prerequisite for obtaining a license, other than the requirements listed in subsection (c) and (d) of this rule, if it is determined that the applicant's education, training, and experience provide reasonable assurance that the applicant has the knowledge and skills necessary for entry-level practice under the license sought. No waiver may be granted where a military service member or military veteran holds a license issued by another jurisdiction that has been restricted.
(3) While a license application is being processed, the applicant shall be issued a provisional license to practice. The provisional license shall expire on the earlier of the date the agency approves or denies the license application or the 180th day after the date the provisional license is issued.
(4) Not later than 10 days after receipt of a complete application including required supplemental documents and fingerprint criminal history background check, the agency shall process the application.
(5) An applicant applying as a military spouse must submit proof of marriage to a military service member.
(6) The initial renewal date for a license issued pursuant to this rule shall be set in accordance with the agency's rule governing initial renewal dates.
(g) Recognition of out-of-state license of military service member or military spouse authorized by Texas Occupations Code §55.0041
(1) Notwithstanding any other law a military service member or military spouse may engage in the practice of optometry or therapeutic optometry without obtaining a Texas license if the applicant currently holds a license similar in scope of practice to Texas issued by the licensing authority of another state and is in good standing with that licensing authority.
(2) In order for an out-of-state license to be recognized, a military service member or military spouse must submit an application on a form prescribed by the Board that includes:
(A) a copy of the member's military orders showing relocation to Texas;
(B) if the applicant is a military spouse, a copy of the military spouse's marriage license and spouse's order showing relocation to Texas; and
(C) a notarized affidavit affirming under penalty of perjury that:
(i) the applicant is the person described and identified in the application;
(ii) all statements in the application are true, correct, and complete;
(iii) the applicant understands the scope of practice for the applicable license in this state and will not perform outside of that scope of practice; and
(D) the applicant is in good standing in each state in which the applicant holds or has held an applicable license.
(3) Not later than 10 days after receipt of an application for recognition of an out-of-state license, the agency shall notify the applicant:
(A) the agency recognizes the applicant's out-of-state license;
(B) the application is incomplete; or
(C) the agency is unable to recognize the applicant's out-of-state license because the agency does not issue a license similar in scope of practice to the applicant's license in another state or the applicant has a disqualifying criminal history.
(4) In order to ensure the public can verify if a person is recognized to practice optometry or therapeutic optometry in Texas, the Board will post the person's name and out of state license number on its website. The person is not considered licensed by the Board and no license verifications will be issued.
(5) A service member or military spouse authorized to practice with a recognized out of state license is subject to the enforcement authority granted under the Texas Optometry Act, and the laws and regulations applicable to a licensed provider.
(6) A service member or military spouse may practice under this recognized status only while the service member is stationed at a military installation in this state.
(7) In the event of a divorce or similar event (e.g., annulment, death of spouse) affecting a military spouse's marital status, a former spouse who relied upon this rule to obtain authorization to practice may continue to practice under the authority of this rule until the third anniversary of the date of confirmation referenced in paragraph (3)(A) of this subsection.
(8) In order to obtain and maintain the privilege to practice without a license in this state, a service member or military spouse must remain in good standing with every licensing authority that has issued a license to the service member or military spouse at a similar scope of practice and in the discipline applied for in this state.
(h) Pursuant to Texas Occupations Code §55.002, application fees are waived for military service members, military veterans, and military spouses. The applicant is responsible for paying any examination fees that are charged by a third-party examination vendor.
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 December 17, 2025.
TRD-202504679
Janice McCoy
Executive Director
Texas Optometry Board
Earliest possible date of adoption: February 1, 2026
For further information, please call: (512) 305-8500
CHAPTER 273. GENERAL RULES
22 TAC §273.14The Texas Optometry Board (Board) proposes to repeal to §273.14 -- License Applications for Military Service Member, Military Veteran, and Military Spouse. The rule is being re-proposed under Chapter 271-Examinations with changes to incorporate legislation passed by the 89th Texas Legislature in a separate Texas Register submission.
EXPLANATION OF AND JUSTIFICATION FOR THE REPEAL
HB 5629 and SB 1818, adopted by the 89th Legislature, Regular Session, established new criteria for licensing agencies to consider upon receipt of an application by a member of the military, veteran or a military spouse. Both bills take effect on September 1, 2025. In the scope of incorporating the new provisions of the legislation, the Board has determined it makes sense to move the current rule regarding licensing military related optometrist to the Chapter of its rules related to licensing.
The substance of the language will be proposed for amendment to Chapter 271 in a separate rule submission with the Texas Register.
FISCAL IMPACT ON STATE AND LOCAL GOVERNMENT
Janice McCoy, Executive Director, has determined that for each year of the first five years that the proposed repeal is in effect, there are no estimated additional costs or reductions in costs to state or local government as a result of enforcing or administering the proposed rules. Additionally, Mrs. McCoy has determined that for each year of the first five years the proposed repeal is in effect, there is no estimated increase or loss in revenue to the state or local government as a result of enforcing or administering the proposed rules.
LOCAL EMPLOYMENT IMPACT STATEMENT
Because Mrs. McCoy has determined that the proposed repeal will not affect a local economy, the agency is not required to prepare a local employment impact statement under Texas Government Code §2001.022.
PUBLIC BENEFIT
Ms. McCoy has determined for the first five-year period the proposed repeal is in effect, the intended public benefit will be a reduction of the complexity of the administrative rules related to the licensing of members of the military, veterans, and military spouses.
PROBABLE ECONOMIC COSTS TO PERSONS REQUIRED TO COMPLY WITH PROPOSAL
Mrs. McCoy has determined that for each year of the first five-year period the proposed repeal is in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules.
FISCAL IMPACT ON SMALL BUSINESSES, MICRO-BUSINESSES, AND RURAL COMMUNITIES
The proposed new repeal will have no direct adverse economic impact on small businesses, micro-businesses, or rural communities. Accordingly, the preparation of an economic impact statement and a regulatory flexibility analysis, as specified in Texas Government Code §2006.002, is not required.
ONE-FOR-ONE REQUIREMENT FOR RULES WITH A FISCAL IMPACT
The proposed repeal does not have a fiscal note that imposes a cost on regulated persons, including another state agency, a special district, or a local government. Therefore, the agency is not required to take any further action under Texas Government Code §2001.0045.
GOVERNMENT GROWTH IMPACT STATEMENT
Pursuant to Texas Government Code §2001.0221, for the first five-year period the proposed repeal is in effect Ms. McCoy has determined the following:
1. The proposed repeal does not create or eliminate a government program.
2. The proposed repeal does not require the creation or elimination of employee positions.
3. The proposed repeal does not require the increase or decrease in future legislative appropriations to the agency.
4. The proposed repeal does not require an increase or decrease in fees paid to the agency.
5. The proposed repeal does not create a new regulation.
6. The proposed repeal does not expand, limit, or repeal an existing regulation.
7. The proposed repeal does not increase or decrease the number of individuals subject to the rule's applicability.
8. The proposed repeal does not positively or adversely affect the state's economy.
TAKINGS IMPACT ASSESSMENT
Ms. McCoy has determined that there are no private real property interests affected by the proposed repeal. Thus, the Board is not required to prepare a takings impact assessment pursuant to §2007.043 of the Tex. Gov't Code.
PUBLIC COMMENTS
Comments on the proposed repeal may be submitted electronically to: janice.mccoy@tob.texas.gov or in writing to Janice McCoy, Executive Director, Texas Optometry Board, 1801 N. Congress, Suite 9.300, Austin, Texas 78701. The deadline for furnishing comments is thirty days after publication in the Texas Register.
STATUTORY AUTHORITY
The Board proposes this repeal pursuant to the authority found in §351.151 of the Tex. Occ. Code which vests the Board with the authority to adopt rules necessary to perform its duties. No other sections are affected by the repeal.
§273.14.
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 December 17, 2025.
TRD-202504681
Janice McCoy
Executive Director
Texas Optometry Board
Earliest possible date of adoption: February 1, 2026
For further information, please call: (512) 305-8500
CHAPTER 279. INTERPRETATIONS
22 TAC §279.16The Texas Optometry Board (Board) proposes amendments to 22 TAC Title 14 Chapter 279 - Interpretations §279.16 - Telehealth Services.
EXPLANATION OF AND JUSTIFICATION FOR THE RULE
The proposed rule specifies the informed consent documentation that is required when licensees perform telehealth services for optometry. The Board proposes this rule in accordance with House Bill 1700 of the 89th Texas Legislature, Regular Session (2025), and Chapter 111, Texas Occupations Code.
SECTION-BY-SECTION SUMMARY
The amendment adds language that informed consent for the provision of telehealth services shall be in writing and must be maintained in the patient record. However, it does provide that if the informed consent was obtained in an audio-only format, the licensee shall document in the patient record the time and date that the consent was granted.
It goes to list minimum requirements for the written informed consent to include: (1) the patient's consent to treatment by the optometrist or therapeutic optometrist via telehealth services; (2) the patient's acknowledgement that patient's health data is being collected and shared using electronic and digital communication; and (3) the patient's acknowledgement of a potential for breach of confidentiality, or inadvertent access, of protected health information using electronic and digital communication in the provision of care.
FISCAL IMPACT ON STATE AND LOCAL GOVERNMENT
Janice McCoy, Executive Director, has determined that for each year of the first five years that the proposed rule is in effect, there are no estimated additional costs or reductions in costs to state or local government as a result of enforcing or administering the proposed rules. Additionally, Mrs. McCoy has determined that for each year of the first five years the proposed rules are in effect, there is no estimated increase or loss in revenue to the state or local government as a result of enforcing or administering the proposed rules.
LOCAL EMPLOYMENT IMPACT STATEMENT
Because Mrs. McCoy has determined that the proposed rule will not affect a local economy, the agency is not required to prepare a local employment impact statement under Texas Government Code §2001.022.
PUBLIC BENEFIT
Ms. McCoy has determined for the first five-year period the proposed rule is in effect, the intended public benefit will be clarity for patients and optometrists to know when and how the requirements of an initial visit must be met.
PROBABLE ECONOMIC COSTS TO PERSONS REQUIRED TO COMPLY WITH PROPOSAL
Mrs. McCoy has determined that for each year of the first five-year period the proposed rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules.
FISCAL IMPACT ON SMALL BUSINESSES, MICRO-BUSINESSES, AND RURAL COMMUNITIIES
The proposed new rules will have no direct adverse economic impact on small businesses, micro-businesses, or rural communities. Accordingly, the preparation of an economic impact statement and a regulatory flexibility analysis, as specified in Texas Government Code §2006.002, is not required.
ONE-FOR-ONE REQUIREMENT FOR RULES WITH A FISCAL IMPACT
The proposed rules do not have a fiscal note that imposes a cost on regulated persons, including another state agency, a special district, or a local government. Therefore, the agency is not required to take any further action under Texas Government Code §2001.0045.
GOVERNMENT GROWTH IMPACT STATEMENT
Pursuant to Texas Government Code §2001.0221, for the first five-year period the proposed rules are in effect Ms. McCoy has determined the following:
The proposed rule does not create or eliminate a government program.
The proposed rule does not require the creation or elimination of employee positions.
The proposed rule does not require the increase or decrease in future legislative appropriations to the agency.
The proposed rule does not require an increase or decrease in fees paid to the agency.
The proposed rule does not create a new regulation.
The proposed rule does not expand, limit, or repeal an existing regulation.
The proposed rule does not increase or decrease the number of individuals subject to the rule's applicability.
The proposed rule does not positively or adversely affect the state's economy.
TAKINGS IMPACT ASSESSMENT
Ms. McCoy has determined that there are no private real property interests affected by the proposed rules. Thus, the Board is not required to prepare a takings impact assessment pursuant to §2007.043 of the Tex. Gov't Code.
PUBLIC COMMENTS
Comments on the amended rules may be submitted electronically to: janice.mccoy@tob.texas.gov or in writing to Janice McCoy, Executive Director, Texas Optometry Board, 1801 N. Congress, Suite 9.300, Austin, Texas 78701. The deadline for furnishing comments is thirty days after publication in the Texas Register.
STATUTORY AUTHORITY
The Board proposes this rule pursuant to the authority found in §351.151 of the Tex. Occ. Code which vests the Board with the authority to adopt rules necessary to perform its duties. The statutory provisions affected by the proposed rules are those set forth in §111.004 of the Tex. Occ. Code.
No other sections are affected by the amendments.
§279.16.
(a) - (c) (No change.)
(d) Notice.
(1) Privacy Practices and Informed Consent.
(A) Unless previously provided, optometrists or therapeutic optometrists that communicate with patients by electronic communications other than telephone or facsimile must provide patients with written notification of the optometrists' or therapeutic optometrists' privacy practices prior to evaluation or treatment, with a good faith effort to obtain the patient's written acknowledgement, including by e-mail, of the notice.
(B) The notice of privacy practices shall include language that is consistent with federal standards under 45 C.F.R. Parts 160 and 164 relating to privacy of individually identifiable health information.
(2) The optometrist or therapeutic optometrist providing or facilitating the use of telehealth services shall ensure that the informed consent of the patient, or another appropriate individual authorized to make health care treatment decisions for the patient, is obtained before telehealth services are provided.
(A) A licensee shall maintain a patient's informed consent in the patient record and, whenever possible, shall be in writing. If the licensee must obtain the informed consent in an audio-only format, the licensee must document in the patient record the time and date that the patient granted the consent.
(B) At a minimum, the informed consent must include:
(i) the patient's consent to treatment by the optometrist or therapeutic optometrist via telehealth services;
(ii) the patient's acknowledgement that patient's health data is being collected and shared using electronic and digital communication; and
(iii) the patient's acknowledgement of a potential for breach of confidentiality, or inadvertent access, of protected health information using electronic and digital communication in the provision of care.
(3) Complaints to the Board. Optometrists or therapeutic optometrists that use telehealth services must provide notice of how patients may file a complaint with the Board on the optometrist's or therapeutic optometrist's website or with informed consent materials provided to patients prior to rendering telehealth services.
(e) - (g) (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 December 18, 2025.
TRD-202504708
Janice McCoy
Executive Director
Texas Optometry Board
Earliest possible date of adoption: February 1, 2026
For further information, please call: (512) 305-8502