TITLE 22. EXAMINING BOARDS

PART 6. TEXAS BOARD OF PROFESSIONAL ENGINEERS

CHAPTER 133. LICENSING

SUBCHAPTER G. EXAMINATIONS

22 TAC §133.69

The Texas Board of Professional Engineers (Board) proposes an amendment to §133.69, concerning waiver of examinations.

The examination on the Fundamentals of Engineering (FE exam) is considered a foundational qualification in the licensure of an engineer. The Board has the authority to waive the exam for applicants who possess sufficient education and experience credentials. Section 133.69(d) currently states that an applicant is not eligible to request a waiver of the FE exam if the applicant has taken and failed any FE exam in any jurisdiction within the previous two years. The proposed amendment limits an applicant from applying for an FE exam waiver if the applicant has failed the exam three or more times in any jurisdiction. This amendment does not prohibit an applicant from retaking the exam to achieve a passing score.

FISCAL NOTE ON STATE AND LOCAL GOVERNMENTS. David Howell, P.E., Deputy Executive Director for the Board, has determined that for the first five-year period the proposed amendments are in effect, there are no foreseeable implications relating to cost or revenues of state or local governments under Government Code §2001.024(a)(4) as a result of enforcing or administering these amendments as proposed. The proposed change is related to individuals and not government, businesses or local economies.

PUBLIC BENEFIT/COST NOTE. Mr. Howell has determined under Government Code §2001.024(a)(5) that for the first five-year period the amended rules are in effect, there are no foreseeable negative implications relating to the public benefit. The rule change would result in fewer deviations from the standard, expected licensure process. He further has determined there will be no probable economic cost to persons required to comply with the rule since it adds no new fees or requirements.

IMPACT ON LOCAL EMPLOYMENT OR ECONOMY. There is no effect on local economy for the first five years that the proposed amendments are in effect because it adds no new fees or requirements. Therefore, no economic impact statement, local employment impact statement, nor regulatory flexibility analysis is required under Texas Government Code §§2001.022 or 2001.024(a)(6).

COST TO REGULATED PERSONS (COST-IN/COST-OUT). This rule proposal is not subject to Texas Government Code §2001.0045 concerning increasing costs to regulated persons because this agency is a Self-Directed Semi-Independent (SDSI) agency and is exempt from that statute, but also because, as described above in the public benefit and cost note, the proposed amendments do not impose a cost on regulated persons under Government Code §2001.024, including another state agency, a special district, or a local government.

ECONOMIC IMPACT STATEMENT AND REGULATORY FLEXIBILITY ANALYSIS FOR SMALL BUSINESSES, MICROBUSINESSES, AND RURAL COMMUNITIES. Mr. Howell has also determined there will be no impact on rural communities, small businesses, or micro-businesses as a result of implementing these amendments and, therefore, no regulatory flexibility analysis, as specified in Texas Government Code §2006.002 is required. The proposed change is related to individuals and not government, businesses or local economies.

GOVERNMENT GROWTH IMPACT STATEMENT. In compliance with Texas Government Code §2001.0221, the Board has prepared a government growth impact statement. During the first five years the proposed rule is in effect, this proposed amendment: (1) will not create or eliminate a government program; (2) will not result in an increase or decrease in the number of agency employees; (3) will not require an increase or decrease in future legislative appropriations to the agency because the agency, which is a self-directed, semi-independent agency, receives no legislative appropriations; (4) will not lead to an increase or decrease in fees paid to a state agency because the affected rule does not require any fees to be paid to the agency; (5) will not create a new regulation; (6) will not repeal an existing regulation; (7) will not result in an increase or decrease in the number of individuals subject to the rule because the proposed change would only result in fewer deviations from the standard, expected licensure process; and (8) the proposed amendment will not positively or adversely affect the state's economy. The proposed change is related to individuals and not government, businesses or local economies.

TAKINGS IMPACT ASSESSMENT: The Board has determined that no private real property interests are affected by this proposal and the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

REQUEST FOR PUBLIC COMMENT. Any comments or request for a public hearing may be submitted no later than 30 days after the publication of this notice to Lance Kinney, Ph.D., P.E., Executive Director, Texas Board of Professional Engineers, 1917 S. Interstate 35, Austin, Texas 78741, faxed to his attention at (512) 440-0417 or sent by email to rules@engineers.texas.gov.

STATUTORY AUTHORITY. The amendments are proposed pursuant to the Texas Engineering Practice Act, Occupations Code §1001.202, which authorizes the Board to make and enforce all rules and regulations and bylaws consistent with the Act as necessary for the performance of its duties, the governance of its own proceedings, and the regulation of the practice of engineering in this state, and Occupations Code §1001.305, which authorizes the Board to by rule waive all or part of examination requirements for licensure.

No other statutes, articles or codes are affected by the proposed amendments.

§133.69.Waiver of Examinations.

(a) - (c) (No change.)

(d) An applicant is not eligible to request a waiver of the examination on the fundamentals of engineering if the applicant has taken and failed any examination on the fundamentals of engineering in any jurisdiction within the previous two years. An applicant is not eligible to request a waiver of the examination on the fundamentals of engineering if the applicant has taken and failed any examination on the fundamentals of engineering in any jurisdiction three or more times.

(e) - (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 June 21, 2019.

TRD-201901952

Lance Kinney, Ph.D., P.E.

Executive Director

Texas Board of Professional Engineers

Earliest possible date of adoption: August 4, 2019

For further information, please call: (512) 440-0417


PART 9. TEXAS MEDICAL BOARD

CHAPTER 165. MEDICAL RECORDS

22 TAC §165.5

The Texas Medical Board (Board) proposes amendments to 22 TAC §165.5, relating to Transfer and Disposal of Medical Records.

The amendments to §165.5 update and modernize the notice requirements when a physician leaves from or relocates a practice. The rule as amended will allow for use of electronic communications for notice to patients. The rule also provides exceptions from notice provisions for certain types of medical practices, including locum tenens and hospital-based practitioners.

The public benefit anticipated as a result of enforcing this section will be to provide additional methods for practitioners providing adequate notice to patients regarding the closing of their practice or leaving a practice and how to obtain their medical records and continuity of care.

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

Mr. Freshour has determined that, for the first five-year period this rule is in effect, the effect to individuals required to comply with these rules as proposed will be None. The effect on small businesses, micro businesses, or rural communities will be None.

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 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 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, 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 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.

§165.5.Transfer and Disposal of Medical Records.

(a) Required Notification of Discontinuance of Practice. Except as provided for in subsection (f) of this section, when a physician retires, terminates employment, or otherwise leaves a medical practice, he or she is responsible for:

(1) ensuring that patients receive reasonable notification and are given the opportunity to obtain copies of their records or arrange for the transfer of their medical records to another physician; and

(2) notifying the board when they are terminating practice, retiring, or relocating, and therefore no longer available to patients, specifying who has custodianship of the records, and how the medical records may be obtained.

(3) Employers of the departing physician as described in §165.1(b)(6) of this chapter are not required to provide notification, however, the departing physician remains responsible[,] for providing notification consistent with this section.

(b) Method of Notification.

(1) Except as provided for in subsection (f) of this section, when a physician retires, terminates employment, or otherwise leaves a medical practice, he or she shall provide notice to patients of when the physician intends to terminate the practice, retire or relocate, and will no longer be available to patients, and offer patients the opportunity to obtain a copy of their medical records or have their records transferred.

(2) Notification shall be accomplished by:

(A) either:

(i) posting such notice on the physician's or practice website; or

(ii) publishing notice in the newspaper of greatest general circulation in each county in which the physician practices or practiced and in a local newspaper that serves the immediate practice area; and

(B) placing written notice in the physician's office; and

(C) [sending letters to patients seen in the last two years] notifying [them]patients seen in the last two years of the physician's discontinuance of practice by either:[.]

(i) sending a letter to each patient; or

(ii) sending an email to each patient.

(3) A copy of the posted notices [notice] shall be submitted to the Board within 30 days from the date of termination, sale, or relocation of the practice.

(4) Notices placed in the physician's office shall be placed in a conspicuous location in or on the facade of the physician's office, a sign, announcing the termination, sale, or relocation of the practice. The sign shall be placed at least thirty days prior to the termination, sale or relocation of practice and shall remain until the date of termination, sale or relocation.

(c) Prohibition Against Interference.

(1) Other licensed physicians remaining in the practice may not prevent the departing physician from posting notice and the sign, unless the departing physician is excepted from providing notice of his or her departure under subsection (f) of this section.

(2) A physician, physician group, or organization described in §165.1(b)(6) of this title (relating to Medical Records) may not withhold information from a departing physician that is necessary for notification of patients, unless the departing physician is excepted from providing notice of his or her departure under subsection (f) of this section.

(d) Voluntary Surrender or Revocation of Physician's License.

(1) Except as provided for in subsection (f) of this section, physicians who have voluntarily surrendered their licenses or have had their licenses revoked by the board must notify their patients, consistent with subsection (b) of this section, within 30 days of the effective date of the voluntary surrender or revocation.

(2) Physicians who have voluntarily surrendered their licenses or have had their licenses revoked by the board must obtain a custodian for their medical records to be approved by the board within 30 days of the effective date of the voluntary surrender or revocation.

(e) Criminal Violation. A person who violates any provision of this chapter is subject to criminal penalties pursuant to §165.151 of the Act.

(f) Exceptions to Required Notification of Discontinuance of Practice. A physician is not required to provide notice of his or her discontinuation of practice to patients as required in subsection (b) of this section if the physician:

(1) [A physician is not required to provide notice of his or her discontinuation of practice to patients] treated the patient while in [pursuant to] a locum tenens position at a practice location[, if the physician was treating such patients during] for a period of no longer than six months at that location. For the purpose of this section, "locum tenens" is defined as a position in which a physician is employed or contracted on a temporary or substitute basis to provide physician services;

(2) only treated the patient in the following settings:

(A) a hospital, as defined under Texas Occupations Code Section 157.051(6);

(B) an emergency room;

(C) a birthing center; or

(D) an ambulatory surgery center; or

(3) only provided the following:

(A) anesthesia services in a setting described in paragraph (2) of this subsection; or

(B) radiology services based on an order by a treating physician or in a setting described in paragraph (2) of this subsection.

[(2) For the purpose of this section, "locum tenens" is defined as a position in which a physician is employed or contracted on a temporary or substitute basis to provide physician services.]

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 June 21, 2019.

TRD-201901923

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: August 4, 2019

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


CHAPTER 193. STANDING DELEGATION ORDERS

22 TAC §193.8

The Texas Medical Board (Board) proposes to repeal Chapter 193, relating to Standing Delegation Orders, §193.8.

Section 193.8, relating to Prescriptive Authority Agreements: Minimum Requirements, is being repealed in its entirety.

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

Mr. Freshour has determined that for the first five-year period this repeal is in effect, the effect to individuals required to comply with the proposal will be none. The effect on small businesses, micro businesses, or rural communities will be none.

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

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

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

(3) the estimated loss or increase in revenue to the state or to local governments as a result of repealing 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 repealing the rule.

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

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

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

(3) Implementation of the proposed repeal does not require an 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 or limit 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 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 repeal is 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.

§193.8.Prescriptive Authority Agreements: Minimum Requirements.

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 June 21, 2019.

TRD-201901924

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: August 4, 2019

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


22 TAC §193.17

The Texas Medical Board (Board) proposes amendments to Chapter 193, relating to Standing Delegation Orders, §193.17.

The amendment to §193.17, relating to Nonsurgical Medical Cosmetic Procedures, requires providing notice to patients of the identity and license number of the physician supervisor at a facility providing nonsurgical cosmetic procedures. It also requires posting notice of how and where to file a complaint against a physician or physician assistant involved at one of these facilities.

The public benefit anticipated as a result of repeal is the elimination of an unnecessary rule §193.8 related to Prescriptive Authority Agreements. The rules for §193.17 enhance patient safety and awareness through increased transparency concerning provider information and accountability of the medical professionals involved in these types of medical procedures.

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

Mr. Freshour has determined that for the first five-year period this rule is in effect, the effect to individuals required to comply with these rules as proposed will be None. The effect on small businesses, micro businesses, or rural communities will be None.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed rule and determined that for each year of the first five years the proposed 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 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 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 not 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 amendments are proposed under the authority of the Texas Occupations Code Annotated, §153.001, which provides authority for the Board to recommend and 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.

§193.17.Nonsurgical Medical Cosmetic Procedures.

(a) Purpose. The purpose of this section is to establish the duties and responsibilities of a physician who performs or who delegates the performance of a nonsurgical medical cosmetic procedure (hereafter referred to as "Procedure"). These procedures can result in complications and the performance of these procedures is the practice of medicine. This rule shall not be interpreted to allow individuals to perform procedures without either a physician or midlevel practitioner being onsite, or a physician being available for emergency consultation or appointment in the event of an adverse outcome.

(b) Definitions.

(1) (1) Midlevel practitioner--A physician assistant or advanced practice registered nurse.

(2) Prescription medical device--A device that the federal Food and Drug Administration has designated as a prescription medical device, and can be sold only to persons with prescriptive authority in the state in which they reside.

(3) Procedure--A nonsurgical medical cosmetic procedure, including but not limited to the injection of medication or substances for cosmetic purposes, the administration of colonic irrigations, and the use of a prescription medical device for cosmetic purposes.

(c) Applicability. This section does not apply to:

(1) surgery as defined under Texas Occupations Code, §151.002(a)(14);

(2) the practice of a profession by a licensed health care professional under methods or means within the scope of practice permitted by such license;

(3) the use of nonprescription devices;

(4) intravenous therapy;

(5) procedures performed at a physician's practice by the physician or midlevel practitioners acting under the physicians supervision; or

(6) laser hair removal procedures performed in accordance with Texas Health and Safety Code, Chapter 401, Subchapter M.

(d) Physician Responsibilities.

(1) A physician must be appropriately trained, including hands-on training, in a Procedure prior to performing the Procedure or delegating the performance of a Procedure. The physician must keep a record of his or her training in the office and have it available for review upon request by a patient or a representative of the board.

(2) Prior to authorizing a Procedure, a physician, or a midlevel practitioner acting under the delegation of a physician, must:

(A) take a history;

(B) perform an appropriate physical examination;

(C) make an appropriate diagnosis;

(D) recommend appropriate treatment;

(E) develop a detailed and written treatment plan;

(F) obtain the patient's informed consent;

(G) provide instructions for emergency and follow-up care;

(H) prepare and maintain an appropriate medical record;

(I) have signed and dated written protocols as described in paragraph (7) of this subsection that are detailed to a level of specificity that the person performing the Procedure may readily follow; and

(J) have signed and dated written standing orders.

(K) The performance of the items listed in subparagraphs (A) - (J) of this paragraph must be documented in the patient's medical record.

(3) After a patient has been evaluated and diagnosed, as described in paragraph (2) of this subsection, qualified unlicensed personnel may perform a procedure only if:

(A) a physician or midlevel practitioner is onsite during the procedure; or

(B) a delegating physician is available for emergency consultation in the event of an adverse outcome, and if the physician considers it necessary, be able to conduct an emergency appointment with the patient.

(4) Regardless of who performs the Procedure, the physician is ultimately responsible for the safety of the patient and all aspects of the Procedure.

(5) Regardless of who performs the Procedure, the physician is responsible for ensuring that each Procedure is documented in the patient's medical record. A Procedure performed by unlicensed personnel must be timely co-signed by a supervising physician.

(6) The physician must ensure that the facility at which Procedures are performed, there is a quality assurance program pertaining to Procedures that includes the following:

(A) a mechanism to identify complications and adverse effects of treatment and to determine their cause;

(B) a mechanism to review the adherence to written protocols by all health care personnel;

(C) a mechanism to monitor the quality of treatments;

(D) a mechanism by which the findings of the quality assurance program are reviewed and incorporated into future protocols; and

(E) ongoing training to maintain and improve the quality of treatment and performance of Procedures by health care personnel.

(7) A physician may delegate Procedures only at a facility at which the physician has either:

(A) approved in writing the facility's written protocols pertaining to the Procedures; or

(B) developed his own protocols for the Procedures as described in paragraph (2)(I) of this subsection.

(8) The physician must ensure that a person performing a Procedure has appropriate training in, at a minimum:

(A) techniques for each Procedure;

(B) cosmetic or cutaneous medicine;

(C) indications and contraindications for each Procedure;

(D) pre-procedural and post-procedural care;

(E) recognition and acute management of potential complications that may result from the Procedure; and

(F) infectious disease control involved with each treatment.

(9) The physician has a written office protocol for the person performing the Procedure to follow in performing Procedure delegated. A written office protocol must include, at a minimum, the following:

(A) the identity of the physician responsible for the delegation of the Procedure;

(B) selection criteria to screen patients by the physician or midlevel practitioner for the appropriateness of treatment;

(C) a description of appropriate care and follow-up for common complications, serious injury, or emergencies;

(D) a statement of the activities, decision criteria, and plan the physician, or midlevel practitioner, shall follow when performing or delegating the performance of a Procedure, including the method for documenting decisions made and a plan for communication or feedback to the authorizing physician or midlevel practitioner concerning specific decisions made; and

(E)a description of what information must be documented by the person performing the Procedure.

(10) The physician ensures that each person performs each Procedure in accordance with the written office protocol.

(11) Each patient signs a consent form prior to treatment that lists potential side effects and complications, and the identity and titles of the individual who will perform the Procedure.

(12) Each person performing a Procedure must be readily identified by a name tag or similar means that clearly delineates the identity and credentials of the person.

(13) Any time a Procedure is performed, at least one person trained in basic life support must be onsite.

(e) Notice Provisions.

(1) Each facility providing Nonsurgical Medical Cosmetic Procedures must post a Notice Concerning Complaints in compliance with 22 TAC Chapter 178.

(2) Each facility providing Nonsurgical Medical Cosmetic Procedures must post in each public area and treatment room or area a Notice in the format found in Rule §178.3 of this title (relating to Complaint Notification), including the name(s) of the delegating physician(s) for that facility including their Texas Medical License Number.

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 June 21, 2019.

TRD-201901925

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: August 4, 2019

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


PART 15. PHARMACISTS

CHAPTER 295. TEXAS STATE BOARD OF PHARMACY

22 TAC §295.5

The Texas State Board of Pharmacy proposes amendments to §295.5, concerning Pharmacist License or Renewal Fees. The amendments, if adopted, will increase pharmacist license fees based on expected expenses.

Allison Vordenbaumen Benz, R.Ph., M.S., Executive Director/Secretary, has determined that, for the first five-year period the rule is in effect, there will be fiscal implications for state government as a result of enforcing or administering the amended rule as follows:

Revenue Increase

FY2020 = $955,980

FY2021 = $982,300

FY2022 = $1,007,680

FY2023 = $1,033,060

FY2024 = $1,058,440

There are no anticipated fiscal implications for local government.

Ms. Benz has determined that, for each year of the first five-year period the rule will be in effect, the public benefit anticipated as a result of enforcing the amendments will be to assure that the Texas State Board of Pharmacy is adequately funded to carry out its mission. The economic cost to large, small or micro-businesses (pharmacies) will be the same as the economic cost to an individual, if the pharmacy chooses to pay the fee for the individual. The economic cost to individuals who are required to comply with the amended rule will be an increase of $44 for an initial license and an increase of $47 for the renewal of a license. An economic impact statement and regulatory flexibility analysis are not required because the proposed rule will have a de minimis economic effect on Texas small businesses or rural communities.

For each year of the first five years the proposed amendment will be in effect, Ms. Benz 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 the future legislative appropriations to the agency;

(4) The proposed rule does require an increase in fees paid to the agency;

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

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

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

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

Written comments on the amendments may be submitted to Megan G. Holloway, Assistant General Counsel, Texas State Board of Pharmacy, 333 Guadalupe Street, Suite 3-500, Austin, Texas, 78701, FAX (512) 305-8061. Comments must be received by 5:00 p.m., August 4, 2019.

The amendments are proposed under §§551.002 and 554.051 of the Texas Pharmacy Act (Chapters 551 - 569, Texas Occupations Code). The Board interprets §551.002 as authorizing the agency to protect the public through the effective control and regulation of the practice of pharmacy. The Board interprets §554.051(a) as authorizing the agency to adopt rules for the proper administration and enforcement of the Act.

The statutes affected by these amendments: Texas Pharmacy Act, Chapters 551 - 569, Texas Occupations Code.

§295.5.Pharmacist License or Renewal Fees.

(a) Biennial Registration. The Texas State Board of Pharmacy shall require biennial renewal of all pharmacist licenses provided under the Pharmacy Act, §559.002.

(b) Initial License Fee.

(1) The fee for the initial license shall be $328 [$284] for a two-year [two year] registration.

(2) New pharmacist licenses shall be assigned an expiration date and initial fee shall be prorated based on the assigned expiration date.

(c) Renewal Fee. The fee for biennial renewal of a pharmacist license shall be $328 [$281] for a two-year [two year] registration.

(d) Exemption from fee. The license of a pharmacist who has been licensed by the Texas State Board of Pharmacy for at least 50 years or who is at least 72 years old shall be renewed without payment of a fee provided such pharmacist is not actively practicing pharmacy. The renewal certificate of such pharmacist issued by the board shall reflect an inactive status. A person whose license is renewed pursuant to this subsection may not engage in the active practice of pharmacy without first paying the renewal fee as set out in subsection (c) of this section.

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 June 21, 2019.

TRD-201901922

Allison Vordenbaumen Benz, R.Ph., M.S.

Executive Director

Texas State Board of Pharmacy

Earliest possible date of adoption: August 4, 2019

For further information, please call: (512) 305-8010