TITLE 22. EXAMINING BOARDS

PART 9. TEXAS MEDICAL BOARD

CHAPTER 185. PHYSICIAN ASSISTANTS

22 TAC §185.32

The Texas Medical Board (Board) proposes new rule §185.32, concerning Training and Registration Requirements for Physician Assistants Performing Radiologic Procedures.

The proposed rule is related to the training requirements for a physician assistant in order to perform radiological procedures.

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 ensure patient safety through health care provider training and education.

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

There will be no effect to individuals required to comply with the rules as proposed. There will be no effect on small or micro businesses or rural communities.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed new rule and determined that for each year of the first five years the proposed new rule 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 new rule 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 this new rule, as proposed, is 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 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 new rule 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 create a new regulation.

(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 new rule is proposed under the authority of the Texas Occupations Code Annotated, §601.254.

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

§185.32.Training and Registration Requirements for Physician Assistants Performing Radiologic Procedures.

Pursuant to Texas Occupations Code §601.254, prior to delegating to a physician assistant the performance of a radiologic procedure, including a dangerous or hazardous procedure (as defined under §194.17 of this title), the delegating physician must comply with requirements of Texas Occupations Code §157.001. The delegating physician remains responsible for the physician assistant's performance of the radiologic procedure as set out in Texas Occupations Code §157.001.

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 9, 2019.

TRD-201900085

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: February 24, 2019

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


CHAPTER 193. STANDING DELEGATION ORDERS

22 TAC §193.5, §193.21

The Texas Medical Board (Board) proposes amendments to §193.5 and new §193.21 of Chapter 193, relating to Standing Delegation Orders.

The amendment to §193.5, relating to Physician Liability for Delegated Acts and Enforcement, clarifies that supervising and delegating physicians must report to Board any disciplinary action taken against a healthcare provider not regulated or licensed by the state.

New rule §193.21, relating to Delegation Related to Radiological Services, proposes new language clearly delineating that the interpretation of radiological studies and imaging is the practice of medicine and cannot be delegated.

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 clearly define the obligations of physicians as it relates to reporting certain actions and defines the parameters surrounding the delegation of interpreting radiological studies and diagnosis based on such studies.

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

Pursuant to Government Code §2006.002, the agency provides the following economic impact statement for the proposed amendments and new rule, and determined that for each year of the first five years the proposed amendments and new rule 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 amendments and new rule, and found none.

Pursuant to Government Code §2001.024(a)(4), Mr. Freshour certifies that this proposal has been reviewed and the agency has determined that for each of the first five years the amendments and new rule, 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 and new rule 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 rule. For each year of the first five years the proposed amendments and new rule 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 create new regulations.

(6) The proposed rules do not expand existing regulations.

(7) The proposed rules do not increase or decrease the number of individuals subject to the rules' 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 and new rule are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to recommend adopt rules and bylaws as necessary to: govern its own proceedings; perform its duties; regulate the practice of medicine; and enforce this subtitle.

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

§193.5.Physician Liability for Delegated Acts and Enforcement.

(a) A physician shall not be liable for the act or acts of a physician assistant or advanced practice registered nurse solely on the basis of having signed an order, a standing medical order, a standing delegation order, a prescriptive authority agreement, or other order or protocol, authorizing a physician assistant or advanced practice registered nurse to administer, provide, prescribe or order a drug or device, unless the physician has reason to believe the physician assistant or advanced practice registered nurse lacked the competency to perform the act or acts.

(b) Notwithstanding subsection (a) of this section, delegating physicians remain responsible to the Board and to their patients for acts performed under the physician's delegated authority. This responsibility to the Board includes reporting those healthcare providers not otherwise licensed, certified or regulated by the state. Such healthcare providers include those sponsored by a physician for credentialing at a facility or subject to physician oversight by means of supervision, delegation, standing orders, protocols or other method to provide healthcare. The physician shall report to the board any termination or discipline of the healthcare provider within 30 days of such discipline or termination.

(c) Any physician authorizing standing delegation orders or standing medical orders which authorize the exercise of independent medical judgment or treatment shall be subject to having his or her license to practice medicine in the State of Texas revoked or suspended under §§164.001, 164.052, and 164.053 of the Act. §193.21.Delegation Related to Radiological Services.

(a) A physician may delegate the performance of radiological procedures to properly trained midlevel providers, certified radiological technologists (MRT and LMRT), or non-certified radiological technologists (NCT).

(b) The delegation under this section must be under a physician's order, medical order, standing delegation order, prescriptive authority agreement, or protocol.

(c) The administering or providing of radiological services under this section shall comply with other applicable laws.

(d) The following acts have been determined to be the practice of medicine under the authority of the Act, §157.001(b)(1), and cannot be delegated to a midlevel provider, certified radiological technologist (MRT and LMRT), or non-certified radiological technologist (NCT):

(1) the reading and interpretation of the radiological studies; and

(2) rendering a diagnosis based on the radiological studies.

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 10, 2019.

TRD-201900093

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: February 24, 2019

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