PART 3. TEXAS BOARD OF CHIROPRACTIC EXAMINERS
CHAPTER 72. BOARD FEES, LICENSE APPLICATIONS, AND RENEWALS
The Texas Board of Chiropractic Examiners (Board) adopts the repeal of 22 TAC §72.21 (Requirements for Military Spouses), without changes as published in the December 1, 2023, issue of the Texas Register (48 TexReg 6991). The repeal will not be republished. The Board will adopt a new §72.21 in a separate rulemaking action.
The Board received no public comments on this rulemaking.
This repeal is adopted under Texas Occupations Code §201.152 (which authorizes the Board to adopt rules necessary to perform the Board's duties and to regulate the practice of chiropractic), and §§55.002 - 55.006, and 55.009 (which require the Board to adopt rules relating to alternative licensing methods for military members, veterans, and military spouses).
No other statutes or rules are affected by this repeal.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400922
Christopher Burnett
General Counsel
Texas Board of Chiropractic Examiners
Effective date: March 21, 2024
Proposal publication date: December 1, 2023
For further information, please call: (512) 305-6700
The Texas Board of Chiropractic Examiners (Board) adopts new 22 TAC §72.21 (Requirements for Military Spouses), with changes to the text as published in the December 1, 2023, issue of the Texas Register (48 TexReg 6992). Changes include corrections to title, paragraph, and subparagraph reference locations. The rule will be republished. The current §72.21 is being repealed in a separate rulemaking action.
Recent changes to Texas Occupations Code Chapter 55 (Licensing of Military Service Members, Military Veterans, and Military Spouses) have expanded the methods by which the spouse of an active duty military member may obtain a license to practice chiropractic in Texas or have a license from another jurisdiction recognized by the Board. The adopted new §72.21 reflects those changes and delineates the four methods.
In general, the requirements are: First, a military spouse who is licensed in good standing in another jurisdiction may obtain a Board license within 30 days by providing written notice to the Board along with proof of residency.
Second, a military spouse who previously held a now-expired Texas license but currently has a license from another jurisdiction may be issued a new license by following the application requirements of 22 TAC §77.2 (License Application).
Third, a military spouse who has never held a license in Texas or in any other jurisdiction may nonetheless be issued a license if the spouse can demonstrate professional competency through other means that are satisfactory to the Board's executive director; the spouse will still be required to pass professional examinations.
And fourth, a military spouse may practice chiropractic in Texas without obtaining a Board license if the spouse holds a license in good standing in another jurisdiction, notifies the Board, provides proof of residency, and submits a copy of the military member's military identification card.
The new rule also provides an administrative process for appealing a denial of a license or authority to practice under these four methods and for waiving of Board application fees.
The Board received no public comment on this rule.
The rule is adopted under Texas Occupations Code §201.152 (which authorizes the Board to adopt rules necessary to perform the Board's duties and to regulate the practice of chiropractic), and §§55.002 - 55.006, 55.009 (which require the Board to adopt rules relating to alternative licensing methods for military members, veterans, and military spouses).
No other statutes or rules are affected by this new rule.
§72.21.Requirements for Military Spouses.
(a) This section applies to an individual who is the spouse of an active duty member of the United States armed forces (military member).
(b) This section states licensing requirements established under Texas Occupations Code Chapter 55 (Licensing of Military Service Members, Military Veterans, and Military Spouses); this section does not modify any rights provided under federal law.
(c) The spouse of a military member may obtain a Texas license from the Board by other than the process required by §72.2 of this title (relating to License Application) or have a license from another jurisdiction recognized by the Board in one of four ways:
(1) The spouse of a military member may be issued a license to practice chiropractic in Texas if the spouse is currently licensed in good standing in a jurisdiction with licensing requirements substantially similar to Texas Occupations Code Chapter 201.
(A) Before issuing a license to practice chiropractic under paragraph (1) of this subsection, the spouse of a military member shall provide to the Board:
(i) written notification of the intent to practice chiropractic in Texas; and
(ii) proof of residency in Texas, including the military member's permanent change of duty station orders.
(B) Not later than the 10th day after the spouse of a military member provides the Board with the information required under subparagraph (A) of this paragraph, the Board shall verify if the spouse is licensed in good standing in another jurisdiction.
(C) Not later than the 30th day after the spouse of a military member provides the Board with the information required under subparagraph (A) of this paragraph, the Board shall issue a license if the information satisfies the Board.
(D) If the Board approves a license under subparagraph (A) of this paragraph, the license shall be valid for a period the same as any biennial license or 12 months from the date of issuance, whichever is longer.
(2) The Board may issue a license to the spouse of a military member who previously held a Texas license that expired while the spouse and the military member lived in another state within the five years preceding the new application date, and who currently holds a license in good standing in a jurisdiction with substantially similar licensing requirements to Texas Occupations Code Chapter 201. The spouse of a military member seeking a license under this subsection shall comply with the application requirements of §77.2.
(3) The spouse of a military member who has never held a license in Texas or any other jurisdiction may apply for a license by showing professional competency by other means (other than examination results), to the satisfaction of the executive director, through verified military service, training, or education.
(4) The spouse of a military member may practice chiropractic in Texas without obtaining a license from the Board if the spouse currently holds a license in good standing from another jurisdiction with licensing requirements substantially similar to those in Texas Occupations Code Chapter 201.
(A) The spouse of a military member seeking to practice chiropractic in Texas under paragraph (4) of this subsection shall provide the Board with:
(i) written notification of the intent to practice chiropractic in Texas; and
(ii) proof of residency in Texas, including the military member's permanent change of duty station orders; and
(iii) a copy of the military member's current military identification card.
(B) Not later than the 30th day after the spouse of a military member provides the Board with the information required under subparagraph (A) of this paragraph, the Board shall notify the spouse of the spouse's authority to practice chiropractic in Texas.
(C) The spouse of a military member who practices chiropractic under subparagraph (A) of this paragraph may do so only for the time the military member is permanently stationed in Texas but not to exceed three years.
(D) In the event of a divorce or a similar event, the spouse may continue to practice chiropractic in Texas under subparagraph (A) of this paragraph until the third anniversary of the date the spouse received the confirmation described in subparagraph (B) of this paragraph.
(d) The Board shall notify in writing all holders of licenses issued under this section of the requirements to renew the license with the Board.
(e) The spouse of a military member practicing in Texas under this section shall comply with all statutes and Board rules relating to chiropractic practice and are subject to disciplinary action by the Board.
(f) The Board shall exempt the spouse of a military member eligible for a license or the authority to practice under this section from application and exam fees.
(g) The spouse of a military member seeking a license or the authority to practice under this section shall undergo a criminal history background check.
(h) The Board shall maintain and update a list of jurisdictions with substantially similar licensing requirements as Texas Occupations Code Chapter 201.
(i) If the Board administratively denies an application for a license or the authority to practice under this section, an applicant may appeal the decision to the full Board.
(j) If the full Board denies an application for a license or the authority to practice under this section, the applicant may request a hearing at the State Office of Administrative Hearings.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400923
Christopher Burnett
General Counsel
Texas Board of Chiropractic Examiners
Effective date: March 21, 2024
Proposal publication date: December 1, 2023
For further information, please call: (512) 305-6700
The Texas Board of Chiropractic Examiners (Board) adopts the repeal of 22 TAC §72.22 (Requirements for Military Members and Veterans), without changes as published in the December 1, 2023, issue of the Texas Register (48 TexReg 6994). The repeal will not be republished. The Board will adopt a new §72.22 in a separate rulemaking action.
The Board received no public comment on this rulemaking.
The repeal is adopted under Texas Occupations Code §201.152 (which authorizes the Board to adopt rules necessary to perform the Board's duties and to regulate the practice of chiropractic), and §§55.002 - 55.006, and 55.009 (which require the Board to adopt rules relating to alternative licensing methods for military members, veterans, and military spouses).
No other statutes or rules are affected by this repeal.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400924
Christopher Burnett
General Counsel
Texas Board of Chiropractic Examiners
Effective date: March 21, 2024
Proposal publication date: December 1, 2023
For further information, please call: (512) 305-6700
The Texas Board of Chiropractic Examiners (Board) adopts new 22 TAC §72.22 (Requirements for Military Members and Veterans), with changes to the text as published in the December 1, 2023, issue of the Texas Register (48 TexReg 6994). Changes include corrections to the location reference for an outside section. The rule will be republished. The current §72.22 is being repealed in a separate rulemaking action.
Recent changes to Texas Occupations Code Chapter 55 (Licensing of Military Service Members, Military Veterans, and Military Spouses) have expanded the methods by which an active duty military member or veteran may obtain a license to practice chiropractic in Texas or have a license from another jurisdiction recognized by the Board. This adopted new §72.22 reflects those changes and delineates the four methods.
In general, the requirements are: First, a military member or veteran who is licensed in good standing in another jurisdiction may obtain a Board license within 30 days by providing written notice to the Board along with proof of residency.
Second, a military member or veteran who previously held a now-expired Texas license but currently has a license from another jurisdiction may be issued a new license by following the application requirements of 22 TAC §77.2 (License Application).
Third, a military member or veteran spouse who has never held a license in Texas or in any other jurisdiction may nonetheless be issued a license if the military member or veteran spouse can demonstrate professional competency through other means that are satisfactory to the Board's executive director; the military member or veteran will still be required to pass professional examinations.
And fourth, a military member only may practice chiropractic in Texas without obtaining a Board license if the military member holds a license in good standing in another jurisdiction, notifies the Board, provides proof of residency, and submits a copy of the military member's military identification card.
The new rule also provides an administrative process for appealing a denial of a license or authority to practice under these four methods, and for waiving of Board application fees.
The Board received no public comment about this rulemaking.
The rule is adopted under Texas Occupations Code §201.152 (which authorizes the Board to adopt rules necessary to perform the Board's duties and to regulate the practice of chiropractic), and §§55.002 - 55.006, and 55.009 (which require the Board to adopt rules relating to alternative licensing methods for military members, veterans, and military spouses).
No other statutes or rules are affected by this proposed rule.
§72.22.Requirements for Military Members and Veterans.
(a) This section applies to an individual who is an active duty member of the United States armed forces (military member) or a veteran.
(b) This section states licensing requirements established under Texas Occupations Code Chapter 55 (Licensing of Military Service Members, Military Veterans, and Military Spouses); this section does not modify any rights provided under federal law.
(c) A military member may obtain a Texas license from the Board by other than the process required by §72.2 of this title (relating to License Application) or have a license from another jurisdiction recognized by the Board in one of four ways.
(1) A military member or veteran may be issued a license to practice chiropractic in Texas if the military member or veteran is currently licensed in good standing in a jurisdiction with licensing requirements substantially similar to Texas Occupations Code Chapter 201.
(A) Before practicing chiropractic under paragraph (1) of this subsection, a military member or veteran shall provide to the Board:
(i) written notification of the intent to practice chiropractic in Texas; and
(ii) proof of residency in Texas, including the member's permanent change of duty station orders.
(B) Not later than the 10th day after a military member or veteran provides the Board with the information required under subparagraph (A) of this paragraph, the Board shall verify if the military member or veteran is licensed in good standing in another jurisdiction.
(C) Not later than the 30th day after a military member or veteran provides the Board with the information required under subparagraph (A) of this paragraph, the Board shall issue a license if the information satisfies the Board.
(D) If the Board approves a license under subsection (c) of this section, the license shall be valid for a period the same as any biennial license or 12 months from the date of issuance, whichever is longer.
(2) The Board may issue a license to a military member or veteran who previously held a Texas license that expired while the military member or veteran lived in another state for at least six months within the five years preceding the application date and the military. A military member or veteran seeking a license under this subsection shall comply with the application requirements of §77.2.
(3) A military member or veteran who has never held a license in Texas or any other jurisdiction may apply for a license by showing professional competency by other means (other than examination results), to the satisfaction of the executive director, through verified military service, training, or education.
(4) A military member only may practice chiropractic in Texas without obtaining a license from the Board if the military member currently holds a license in good standing from another jurisdiction with licensing requirements substantially similar to those in Texas Occupations Code Chapter 201.
(A) A military member seeking the authority to practice chiropractic in Texas under paragraph (4) of this subsection shall provide the Board with:
(i) written notification of the intent to practice chiropractic in Texas; and
(ii) proof of residency in Texas, including the member's permanent change of duty station orders; and
(iii) a copy of the military member's current active duty military identification card.
(B) Not later than the 30th day after a military member provides the Board with the information required under subparagraph (A) of this paragraph, the Board shall notify the military member that the member has the authority to practice chiropractic in Texas.
(d) The Board shall notify in writing all holders of licenses issued under this section of the requirements to renew the license with the Board.
(e) The Board shall maintain and update a list of jurisdictions with substantially similar licensing requirements as Texas Occupations Code Chapter 201.
(f) The Board shall exempt a military member or veteran eligible for a license under this section from application and exam fees.
(g) The Board shall exempt a military member or veteran from any fee or penalty for failing to timely renew a license if the failure was due to active duty military service.
(h) A military member or veteran seeking a license or authority to practice under this section shall undergo a criminal history background check.
(i) A military member or veteran practicing in Texas under this section shall comply with all statutes and Board rules relating to chiropractic practice and is subject to disciplinary action by the Board.
(j) If the Board administratively denies an application for a license under subsection (c) of this section, an applicant may appeal the decision to the full Board.
(k) If the full Board denies an application for a license under subsection (c) of this section, the applicant may request a hearing at the State Office of Administrative Hearings.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400925
Christopher Burnett
General Counsel
Texas Board of Chiropractic Examiners
Effective date: March 21, 2024
Proposal publication date: December 1, 2023
For further information, please call: (512) 305-6700
CHAPTER 213. PRACTICE AND PROCEDURE
Introduction. The Texas Board of Nursing (Board) adopts new 22 Texas Administrative Code §213.36 and §213.37. The Board simultaneously proposed both new sections in the December 22, 2023, issue of the Texas Register (48 TexReg 7740). The adopted rule text of 22 Texas Administrative Code §213.36 contains a change that will result in the republication of this section. There are no changes to the proposed text of 22 Texas Administrative Code §213.37, which will not be republished.
Reasoned Justification. During the 88th Legislative Session, the Texas Legislature enacted SB 1343 which requires that complaints alleging a standard-of-care violation by an Advanced Practice Registered Nurse (APRN) be reviewed by an expert reviewer, appointed by the Board, who is an APRN practicing in the same advanced practice role and with the same population focus as the APRN who is the subject of the complaint. The bill further requires that the appointed expert reviewer determine whether the APRN violated the standard-of-care applicable to the circumstances of the allegation, record the expert reviewer's conclusions in a report, and submit the report to the Board. Before initiating informal proceedings involving the APRN, the Board must provide notice of the proceedings along with a deidentified copy of the expert reviewer's report. These new sections are adopted under the authority of the Occupations Code § 301.151 and are necessary for compliance with the statutory mandates found in Texas Occupations Code §§ 301.457, 301.4575, and 301.464.
Section by Section Overview. 22 Texas Administrative Code §213.36 sets forth the process the Board must follow when investigating an alleged standard of care violation by an APRN. 22 Texas Administrative Code §213.36(a) implements Texas Occupations Code § 301.457(h) by establishing that the Board shall appoint an APRN reviewer to assist in the investigation in the same practice role with the same population focus if the Board determines that an act of the APRN likely falls below an applicable standard of care. 22 Texas Administrative Code §213.36(b) implements Texas Occupations Code § 301.457(i), mirroring the statutory language regarding when the Board may not refer a complaint to against an APRN to an APRN reviewer. 22 Texas Administrative Code §213.36(c) implements Texas Occupations Code § 301.4575(1)&(2), mirroring the statutory language regarding the procedures for an advanced practice registered nurse review. 22 Texas Administrative Code §213.36(d) implements Texas Occupations Code § 301.4575 by providing guidance as to the contents of the preliminary report to be submitted by the reviewer.
22 Texas Administrative Code §213.37 sets forth the procedure for the disclosure of the expert reviewer's report. This new section implements Texas Occupations Code § 301.464(b) by providing that the notice of any informal proceeding include a copy of the expert report with any identifying information other than the role and population focus of the expert reviewer redacted.
Summary of Comments and Agency Response
Summary of Comment 1: The Board received a comment from the APRN Alliance. This organization is a partnership of Advanced Practice Registered Nurse organizations, including the Consortium of Texas Certified Nurse-Midwives (CTCNM), Texas Association of Nurse Anesthetists (TxANA), Texas Clinical Nurse Specialists (TxCNS), Texas Nurse Practitioners (TNP), and the Texas Nurses Association (TNA). The APRN Alliance commented in support of the language as drafted.
Agency Response: The Board appreciates the comment from the APRN Alliance in support of the proposed language.
Summary of Comment 2: The Board received a comment from the Texas Medical Association (TMA). TMA is a private, voluntary, non-profit association of more than 57,000 physicians and medical student members. TMA expressed concerns that the use of the term "medical care" in the proposed rule could be interpreted either to expand the scope of the rule to include physicians or to expand the scope of practice for advanced practice registered nurses (APRNs).
Agency Response: The Board agrees that due to the various definitions in existing law of the term "medical care," as cited in the comment, the term "nursing care" is the more appropriate term in this rule section. The intention of the Board is to ensure that the expert report includes all relevant facts related to the APRN's care, including the medical aspects of care that are performed by APRNs. As TMA acknowledges, and the Board agrees, the existing statutory framework allows certain medical acts to be performed by an APRN under physician delegation. The Board further agrees that these medical aspects of care, when performed by an APRN, constitute the practice of nursing. As such, the Board agrees that the language of the rule should be adopted with the term "nursing care" substituted for the term "medical care."
Statutory Authority. The amendments are adopted under the authority of the Occupations Code, §301.151. Texas Occupations Code § 301.151 addresses the general rulemaking authority of the Board to adopt and enforce rules consistent with Chapter 301 to perform its duties and conduct proceedings before the Board, regulate the practice of professional nursing and vocational nursing, establish standards of professional conduct for license holders under Chapter 301, and determine whether an act constitutes the act of professional nursing or vocational nursing. Further, the adoption of these sections is necessary to comply with rulemaking requirements in Texas Occupations Code §§ 301.457, 301.4575, and 301.464.
§213.36.Alleged Standard of Care Violations by Advanced Practice Registered Nurses.
(a) If, during the course of investigating a complaint made against an APRN, the board determines that an act of the APRN likely falls below an acceptable standard of care, the board shall appoint another APRN as an expert reviewer to assist in the investigation. An APRN appointed as an expert reviewer under this section must practice in the same advanced practice role with the same population focus as the APRN who is the subject of the complaint.
(b) The board may not refer a complaint against an APRN to an expert reviewer appointed under this section if the act alleged is:
(1) within the scope of practice applicable to a nurse who is not an advanced practice registered nurse; or
(2) considered unprofessional conduct, as described by Occupations Code, § 301.452(b)(10).
(c) An expert reviewer appointed under this section to review allegations against an APRN shall:
(1) determine whether the APRN violated the standard of care applicable to the circumstances of the allegation; and
(2) issue to the board a preliminary written report of the expert reviewer's conclusions.
(d) A report issued by an expert reviewer under this section must include:
(1) relevant facts concerning the nursing care rendered;
(2) the applicable standard of care;
(3) application of the standard of care to the relevant facts;
(4) a determination of whether the standard of care has been violated; and
(5) a summation of the expert reviewer's opinion.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400915
James W. Johnston
General Counsel
Texas Board of Nursing
Effective date: March 21, 2024
Proposal publication date: December 22, 2023
For further information, please call: (512) 305-6879
Introduction. The Texas Board of Nursing (Board) adopts new 22 Texas Administrative Code §214.14, relating to Standardized Examination Prepared by Private Entity, without changes to the proposed text published in the December 22, 2023, issue of the Texas Register (48 TexReg 7742) and will not be republished.
Reasoned Justification. During the 88th Legislative Session, the Texas Legislature enacted S.B. 1429, which required the Board to adopt rules related to the use of a standardized examination prepared by a private entity. The rules must be applicable to all schools of nursing regulated by the Board. S.B. 1429 requires that the rules prohibit the use of a standardized examination as a graduation requirement or to deny students an affidavit of graduation. The required rules authorize the use of standardized examination only to familiarize students with computerized testing and for the enumerated and limited purposes in Texas Occupations Code § 301.1571(a)(2)&(3). S.B. 1429 further requires that a standardized examination, prepared by a private entity, may not account for more than ten (10) percent of a course grade. Additionally, S.B. 1429 requires that the adopted rules prohibit the regulated school from requiring a student to attend a course offered by the private entity which provides the standardized examination. The rules adopted by the Board are necessary to implement this legislation.
Section by Section Overview. 22 Texas Administrative Code §214.14(a) prohibits a vocational nursing education program from using a student's score on a standardized examination as a graduation requirement; or as the basis for denying the student an affidavit of graduation.
22 Texas Administrative Code §214.14(b) prohibits the vocational nursing education program from using a student's score to account for more than 10 (ten) percent of the student's final grade in any course provided under the program.
22 Texas Administrative Code §214.14(c) lists the only permissible manner in which vocational nursing education programs may use a standardized examination prepared by a private entity. These include letting students familiarize themselves with computerized testing, using scores as a component of program admissions criteria, evaluating a student's strengths and weaknesses for remediation purposes; and identifying students who are experiencing academic difficulties and require early remediation. The rule also allows use of standardized test scores in assessing the effectiveness of the program by providing trend data, comparisons with nationwide averages, assessment of student knowledge of program content, assessment of success in curriculum revisions or changes, and as a measure of student mastery of program content.
22 Texas Administrative Code §214.14(d) prohibits the vocational nursing education program from requiring the student, based on the student's score, to attend any course offered by the private entity that created the standardize exam.
22 Texas Administrative Code §214.14(e) clarifies that failure to comply with the requirements of this section will subject a vocational nursing education program to board disciplinary action, including a change in the program's approval status.
Public Comment. The Board did not receive any written comments on the proposal's rule language. However, Staff of the Board met with Career Colleges and Schools of Texas (CCST) informally regarding the wording of the preamble published in the Texas Register, relating to whether this section applies to all nursing programs in Texas. The Board takes this opportunity to clarify that the rule language applies to all nursing programs regulated by the Board of Nursing in Texas.
Statutory Authority. This new section is adopted under the authority of the Occupations Code §§ 301.151, 301.157, and 301.1571. Texas Occupations Code § 301.151 addresses the general rulemaking authority of the Board to adopt and enforce rules consistent with Chapter 301 to perform its duties and conduct proceedings before the Board, regulate the practice of professional nursing and vocational nursing, establish standards of professional conduct for license holders under Chapter 301, and determine whether an act constitutes the act of professional nursing or vocational nursing. Texas Occupations Code § 301.157 authorizes the Board to prescribe and publish the minimum requirements and standards for a course of study in each program that prepares registered nurses or vocational nurses and to prescribe other rules as necessary to conduct approved schools of nursing and educational programs for the preparation of registered nurses or vocational nurses. Texas Occupations Code § 301.1571 requires the Board to adopt rules related to the use of standardized examinations prepared by a private entity.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400917
James W. Johnston
General Counsel
Texas Board of Nursing
Effective date: March 21, 2024
Proposal publication date: December 22, 2023
For further information, please call: (512) 305-6879
Introduction. The Texas Board of Nursing (Board) adopts new 22 Texas Administrative Code §215.14, relating to Standardized Examination Prepared by Private Entity, without changes to the proposed text published in the December 22, 2023, issue of the Texas Register (48 TexReg 7743) and will not be republished.
Reasoned Justification. During the 88th Legislative Session, the Texas Legislature enacted S.B. 1429, which required the Board to adopt rules related to the use of a standardized examination prepared by a private entity. The rules must be applicable to all schools of nursing regulated by the Board. S.B. 1429 requires that the rules prohibit the use of a standardized examination as a graduation requirement or to deny students an affidavit of graduation. The required rules authorize the use of standardized examination only to familiarize students with computerized testing and for the enumerated and limited purposes in Texas Occupations Code § 301.1571(a)(2)&(3). S.B. 1429 further requires that a standardized examination, prepared by a private entity, may not account for more than ten (10) percent of a course grade. Additionally, S.B. 1429 requires that the adopted rules prohibit the regulated school from requiring a student to attend a course offered by the private entity which provides the standardized examination. The rules adopted by the Board are necessary to implement this legislation.
Section by Section Overview. 22 Texas Administrative Code §215.14(a) prohibits a professional nursing education program from using a student's score on a standardized examination as a graduation requirement or as the basis for denying the student an affidavit of graduation.
22 Texas Administrative Code §215.14(b) prohibits the professional nursing education program from using a student's score to account for more than ten (10) percent of the student's final grade in any course provided under the program.
22 Texas Administrative Code §215.14(c) lists the only permissible ways professional nursing education programs may use a standardized examination prepared by a private entity. These include letting students familiarize themselves with computerized testing, using scores as a component of program admissions criteria, evaluating a student's strengths and weaknesses for remediation purposes; and identifying students who are experiencing academic difficulties and require early remediation. The rule also allows use of standardized test scores in assessing the effectiveness of the program by providing trend data, comparisons with nationwide averages, assessment of student knowledge of program content, assessment of success in curriculum revisions or changes, and as a measure of student mastery of program content.
22 Texas Administrative Code §215.14(d) prohibits the professional nursing education program from requiring the student, based on the student's score, to attend any course offered by the private entity that created the standardized exam.
22 Texas Administrative Code §215.14(e) clarifies that failure to comply with the requirements of this section will subject a professional nursing education program to board disciplinary action, including a change in the program's approval status.
Public Comment. The Board did not receive any written comments on the proposal's rule language. However, Staff of the Board met with Career Colleges and Schools of Texas (CCST) informally regarding the wording of the preamble published in the Texas Register, relating to whether this section applies to all nursing programs in Texas. The Board takes this opportunity to clarify that the rule language applies to all nursing programs regulated by the Board of Nursing in Texas.
Statutory Authority. This new section is adopted under the authority of the Occupations Code §§ 301.151, 301.157, and 301.1571. Texas Occupations Code § 301.151 addresses the general rulemaking authority of the Board to adopt and enforce rules consistent with Chapter 301 to perform its duties and conduct proceedings before the Board, regulate the practice of professional nursing and vocational nursing, establish standards of professional conduct for license holders under Chapter 301, and determine whether an act constitutes the act of professional nursing or vocational nursing. Texas Occupations Code § 301.157 authorizes the Board to prescribe and publish the minimum requirements and standards for a course of study in each program that prepares registered nurses or vocational nurses and to prescribe other rules as necessary to conduct approved schools of nursing and educational programs for the preparation of registered nurses or vocational nurses. Texas Occupations Code § 301.1571 requires the Board to adopt rules related to the use of standardized examinations prepared by a private entity.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400918
James W. Johnston
General Counsel
Texas Board of Nursing
Effective date: March 21, 2024
Proposal publication date: December 22, 2023
For further information, please call: (512) 305-6879
Introduction. The Texas Board of Nursing (Board) adopts amendments to 22 Texas Administrative Code §217.5, relating to Temporary License and Endorsement, with changes to the proposed text published in the December 15, 2023, issue of the Texas Register (48 TexReg 7286). The rule will be republished.
Reasoned Justification. In 2019, the Texas Legislature enacted S.B. 1200 which created Texas Occupations Code § 55.0041, to recognize out-of-state occupational licenses for a spouse of a military service member. This allows the portability of a license for the spouse of a service member, so the spouse does not have to redo any curriculum and testing from one state to another when the service member changes duty station. In 2021, during the 87th Regular Legislative Session, the Legislature enacted H.B. 139 that further amended Texas Occupations Code § 55.0041, requiring a state agency that issues a license with a residency requirement for license eligibility to adopt rules regarding the documentation necessary for a military spouse applicant to establish residency; allowing the provision to the agency a copy of the permanent change of station order for the military service member to whom the spouse is married.
During the 88th Legislative Session, S.B. 422 was enacted, which amending Texas Occupations Code § 55.0041 extending this occupational licensing reciprocity to military members themselves who often must station in states outside of their original license was issued, but who still wish to provide valuable services, such as nursing, that are experiencing workforce shortages. Under the new bill, a state agency that issues business or occupational license must determine within a thirty-day period whether the original jurisdiction of licensure for a military service member or military spouse is in good standing. Upon confirmation, a military service member can retain the Texas license for three years. The revised law also provides that a military spouse licensed pursuant to Texas Occupations Code § 55.0041, may retain the license for the full three-year period notwithstanding a divorce or similar event affecting the license holder's status as a spouse. The adopted amendments are necessary to comply with these statutory changes.
Section by Section Overview. 22 Texas Administrative Code §217.5(h) relates to out-of-state licensure of military spouse applicants. The proposed amendment to §217.5(h) adds "service member" as an eligible applicant along with the previously covered military spouse. Further, 22 Texas Administrative Code §217.5(h) is amended to add provisions that a license application under this rule will not be charged a fee, a licensure determination will be made within 30 days upon showing of residency and licensure in good standing in the out of state jurisdiction, and that a license issued under Texas Occupations Code § 54.0041 may continue until the third anniversary of issuance regardless of divorce or similar event.
Public Comment. The Board received a comment from the APRN Alliance. This organization is a partnership of Advanced Practice Registered Nurse organizations, including the Consortium of Texas Certified Nurse-Midwives (CTCNM), Texas Association of Nurse Anesthetists (TxANA), Texas Clinical Nurse Specialists (TxCNS), Texas Nurse Practitioners (TNP), and the Texas Nurses Association (TNA).
First, the commenter states that in subdivision (h)(4)(B) of the proposal, the Texas Board of Nursing would be required to determine if the service member or spouse is licensed and in good standing in another state within 30 days of receipt of an application. They note however that S.B. 422 requires the license to be issued within 30 days of "receipt." They state that it appears that the proposed rule is applying the standards for reciprocity in S.B. 422, at Texas Occupations Code § 55.0041(e)(2), rather than the standards for applications, at Texas Occupations Code § 55.005(a). The commenter believes that the agency would issue a license within 30 days regardless of the rule. The commenter stated that they wanted the Board to clarify these sections of the rule to ensure the proposal is consistent with statute.
Second, the organization comments that, throughout proposed Subsection (h), the Board is adding language to the rule to read "military service member or military spouse, but the title stem in Subsection (h) was not amended to include reference to "military service member." The organization suggests the title be amended to read "Out-of-State Licensure of Military Service Member or Military Spouse" to provide clarity.
Agency Response: The Board declines to amend the proposed rule language to include the thirty (30) day deadline in Texas Occupations Code § 55.005(a) as this change is unnecessary for consistency with the statute. Texas Occupations Code § 55.005(a), which relates to expedited license procedure for military service members, military veterans, and military spouses, addresses the timeline for an agency to process an application and issue a license to an applicant who qualifies for licensure under Texas Occupations Code § 55.004. Unlike Texas Occupations Code § 55.0041, which this adoption implements, there is no rulemaking directive associated with this § 55.005. Given the lack of any rulemaking directive and the explicit requirements of the section, the Board finds that there is no rulemaking necessary to implement this legislation. Any rulemaking action related to this section would be superfluous in that it would simply restate the existing law. The Board affirms the commenter's stated belief that the agency would comply with all statutory deadlines after the filing of a complete, qualifying application.
The Board agrees with the commenter's recommendation to amend the title of 22 Texas Administrative Code §217.5(h), which currently reads "Out-of-State Licensure of Military Spouse." The commenter recommends amending the title of the subsection to "Out-of-State Licensure of Military Service Member or Military Spouse" to provide clarity. The Board agrees that the title shall be amended to "Out-of-State Licensure of Military Service Member or Military Spouse" in the adopted rule.
Statutory Authority. This new section is adopted under the authority of the Texas Occupations Code § 301.151. Texas Occupations Code § 301.151 addresses the general rulemaking authority of the Board to adopt and enforce rules consistent with Chapter 301 to perform its duties and conduct proceedings before the Board, regulate the practice of professional nursing and vocational nursing, establish standards of professional conduct for license holders under Chapter 301, and determine whether an act constitutes the act of professional nursing or vocational nursing. These amendments are necessary for compliance with rulemaking requirements found in Texas Occupations Code § 55.0041.
§217.5.Temporary License and Endorsement.
(a) A nurse who has practiced nursing in another state within the four years immediately preceding a request for temporary licensure and/or permanent licensure by endorsement may obtain a non-renewable temporary license, which is valid for 120 days, and/or a permanent license for endorsement by meeting the following requirements:
(1) Graduation from an approved Texas nursing education program or a program with substantially equivalent education standards to a Texas approved nursing program as defined below.
(A) A professional nursing education program operated in another state may be determined to have substantially equivalent education standards to a Texas approved nursing program if:
(i) the program is approved by a state board of nursing or other governmental entity to offer a pre-licensure professional nursing program of study that awards a nursing diploma or degree upon completion;
(ii) the program includes general education courses providing a sound foundation for nursing education for the level of preparation;
(iii) the program's nursing courses include didactic content and supervised clinical learning experiences in medical-surgical, maternal/child health, pediatrics, geriatrics, and mental health nursing that teach students to use a systematic approach to clinical decision-making and safe patient care across the life span; and
(iv) for baccalaureate degree nursing programs, nursing courses must also include didactic content and supervised clinical learning experiences, as appropriate, in community, research, and leadership.
(B) A vocational nursing education program operated in another state may be determined to have substantially equivalent education standards to a Texas approved nursing program if:
(i) the program is approved by a state board of nursing or other governmental entity to offer a pre-licensure vocational/practical nursing program of study that awards a vocational/practical nursing certificate, diploma, or degree upon completion;
(ii) the program's nursing courses include didactic and supervised clinical learning experiences in medical-surgical, maternal/child health, pediatrics, geriatrics, and mental health nursing that teach students to use a systematic approach to clinical decision-making and safe patient care across the life span; and
(iii) the program includes support courses providing a sound foundation for nursing education for the level of preparation.
(C) A clinical competency assessment program shall be deemed substantially equivalent to a Texas approved nursing program while compliant with Tex. Occ. Code §301.157(d-8) and (d-9). A clinical competency assessment program will be deemed to not be substantially equivalent to a Texas approved nursing program if the program fails to meet applicable requirements of Tex. Occ. Code §301.157(d-11) and (d-12).
(D) If an applicant does not have substantially equivalent education under subparagraph (A) or (B), the applicant may become eligible for licensure if the applicant enrolls in an approved Texas program and completes the necessary educational requirements.
(E) If an applicant for licensure as a registered nurse has completed a clinical competency assessment program which is deemed not to be substantially equivalent to Board standards for Texas programs under subparagraph (C), the Board may issue a provisional license to the applicant once the applicant has passed the National Council Licensure Examination for Registered Nurses (NCLEX-RN® Examination). The applicant will be eligible for full licensure if the applicant completes the requirements of clause (i) or (ii) of this subparagraph:
(i) The applicant completes 500 hours of clinical practice under the direct supervision of an approved preceptor. The applicant, prior to beginning practice, must submit the name and license number of a potential preceptor for Board approval. After completion of 500 hours of clinical practice under direct supervision of the approved preceptor and the preceptor's signature that the applicant is competent and safe to practice nursing, the applicant may be eligible for full licensure.
(ii) The applicant completes an educational program at an approved Texas program which is designed to assess and improve clinical skills for applicants who have not completed supervised clinical experiences in their prior educational program. The applicant must seek and receive the Board's approval prior to entering into the program to ensure that the program will allow the applicant may be eligible for full licensure. The applicant must provide the Board evidence of completion of the approved program.
(F) If an applicant for licensure as a registered nurse has completed a clinical competency assessment program which is deemed not to be substantially equivalent to Board standards for Texas programs under subparagraph (C), in lieu of completing the requirements of subparagraph (E), an applicant may be eligible for full licensure by submitting proof, for Board review and approval, of at least 500 hours of clinical practice as a nurse in a single employment setting that is verified by a licensed nursing supervisor. The licensed nursing supervisor's signature shall evidence that the applicant is competent and safe to practice nursing;
(2) Satisfactory completion of the licensure examination according to Board established minimum passing scores:
(A) Vocational Nurse Licensure Examination:
(i) Prior to April 1982--a score of 350 on the SBTPE;
(ii) Beginning October 1982 to September 1988--a score of 350 on the NCLEX-PN; and
(iii) October 1988 and after, must have achieved a passing report on the NCLEX-PN; and
(B) Registered Nurse Licensure Examination:
(i) Prior to July 1982--a score of 350 on each of the five parts of the SBTPE;
(ii) Prior to February 1989--a minimum score of 1600 on the NCLEX-RN;
(iii) February 1989 and after, must have achieved a passing report on the NCLEX-RN; and
(iv) January 2015 and after, for applicants taking the Canadian NCLEX-RN, must have achieved a passing report on the Canadian NCLEX-RN;
(3) Licensure by another U.S. jurisdiction or licensure from a Canadian province by NCLEX-RN;
(4) For an applicant who has graduated from a nursing education program outside of the United States or National Council jurisdictions--verification of LVN licensure as required in §217.4(a)(1) of this chapter or verification of RN licensure must be submitted from the country of education or as evidenced in a credential evaluation service full education course by course report from a credential evaluation service approved by the Board, as well as meeting all other requirements in paragraphs (2) and (3) of this subsection;
(5) Filing a completed "Application for Temporary License/Endorsement" containing:
(A) personal identification and verification of required information in paragraphs (1) - (3) of this subsection; and
(B) attestation that the applicant meets current Texas licensure requirements and has never had disciplinary action taken by any licensing authority or jurisdiction in which the applicant holds, or has held licensure and attestation that all information contained in, or referenced by, the application is complete and accurate and is not false or misleading;
(6) the required application processing licensure fee, which is not refundable;
(7) submitting fingerprints for a complete criminal background check; and
(8) a passing score on the jurisprudence exam approved by the Board, effective September 1, 2008.
(b) Credential evaluation service (CES).
(1) A CES wishing to be approved by the Board must meet the following requirements:
(A) The CES must be a member of a national credentialing organization that sets performance standards for the industry. The CES must adhere to the prevailing standards for the industry.
(B) The CES must specialize in the evaluation of international nursing education and licensure.
(C) The CES must be able to demonstrate its ability to accurately analyze academic and licensure credentials for purposes of United States comparison, with course-by-course analysis of nursing academic records.
(D) The CES must be able to manage the translation of original documents into English.
(E) The CES must inform the Board in the event applicant documents are found to be fraudulent.
(F) The CES must have been in the business of evaluating nursing education for a minimum of five years.
(G) The CES must cite all references used in its evaluation in its credentials report.
(H) The CES report must identify the language of nursing instruction and the language of textbooks for nursing education.
(I) The CES must use only original source documentation in evaluating nursing education.
(J) The CES report must describe the comparability of the foreign education to United States standards.
(K) The CES report must detail course clock hours for theory and clinical components of nursing education.
(L) The CES must be able to issue an evaluation report within a reasonable time period, not to exceed six weeks.
(M) The CES must have an efficient and accessible process for answering customer queries.
(N) The CES must be able to provide client references/reviews upon request.
(O) The CES must have an established record retention policy.
(P) The CES must be able to provide testimony for Board hearings, if required.
(2) The CES must complete the form(s) and affidavit required by the Board, submit all required documentation, and receive approval from the Board before providing a report for Board consideration. The Board will maintain a list of approved CES providers.
(c) A nurse who has not practiced nursing in another state within the four years immediately preceding a request for temporary licensure and/or permanent licensure by endorsement will be required to:
(1) complete a refresher course, extensive orientation to the practice of nursing, or a nursing program of study that meets the requirements prescribed by the Board. The nurse must submit an Application for Six Month Temporary Permit (RN) or an Application for Six Month Temporary Permit (LVN), as applicable, to the Board for the limited purpose of completing a refresher course, extensive orientation to the practice of nursing, or a nursing program of study;
(2) submit to the Board evidence of the successful completion of the requirements of paragraph (1) of this subsection;
(3) after completing the requirements of paragraphs (1) - (2) of this subsection, submit to the Board verification of the completion of the requirements of subsection (a)(1) - (8) of this section.
(d) The Board adopts by reference the following forms, which comprise the instructions and requirements for a refresher course, extensive orientation to the practice of nursing, and a nursing program of study required by this section, and which are available at http://www.bon.state.tx.us/olv/forms.html:
(1) Application for Six Month Temporary Permit (RN); and
(2) Application for Six Month Temporary Permit (LVN).
(e) A nurse who has had disciplinary action at any time by any licensing authority is not eligible for temporary licensure until completion of the eligibility determination.
(f) Upon initial licensure by endorsement, the license is issued for a period ranging from six months to 29 months depending on the birth month. Licensees born in even-numbered years shall renew their licenses in even-numbered years; licensees born in odd-numbered years shall renew their licenses in odd-numbered years.
(g) Should it be ascertained from the application filed, or from other sources, that the applicant should have had an eligibility issue determined by way of a petition for declaratory order pursuant to the Occupations Code §301.257, then the application will be treated and processed as a petition for declaratory order under §213.30 of this title (relating to Declaratory Order of Eligibility for Licensure), and the applicant will be treated as a petitioner under that section and will be required to pay the non-refundable fee required by that section.
(h) Out-of-State Licensure of Military Service Member or Military Spouse.
(1) Pursuant to Texas Occupations Code §55.0041, a military service member or military spouse is eligible to practice nursing in Texas if the member or spouse:
(A) holds an active, current license to practice nursing in another state or territory:
(i) that has licensing requirements, including education requirements, that are determined by the Board to be substantially equivalent to the requirements for nursing licensure in Texas; and
(ii) is not subject to any current restriction, eligibility order, disciplinary order, probation, suspension, or other encumbrance;
(B) submits a copy of the member's or spouse's military identification card;
(C) notifies the Board of the member's or spouse's intent to practice nursing in Texas on a form prescribed by the Board; and
(D) meets the Board's fitness to practice and eligibility criteria set forth in §213.27 (relating to Good Professional Character), §213.28 (relating to Licensure of Individuals with Criminal History), and §213.29 (relating to Fitness to Practice) of this title.
(2) If a military service member or military spouse meets the criteria set forth in this subsection, the Board will issue a license to the member or spouse to practice nursing in Texas. The member or spouse will not be charged a fee for the issuance of the license. A license issued under this subsection is valid through the third anniversary of the date of the issuance of the license; thereafter, the license is subject to the Board's standard renewal cycle.
(3) A military service member or military spouse who is unable to meet the criteria set forth in this subsection remains eligible to seek licensure in Texas, as set forth in §217.2 (relating to Licensure by Examination for Graduates of Nursing Education Programs Within the United States, its Territories, or Possessions), §217.4 (relating to Requirements for Initial Licensure by Examination for Nurses Who Graduate from Nursing Education Programs Outside of United States' Jurisdiction), §221.3 (relating to APRN Education Requirements for Licensure), §221.4 (relating to Licensure as an APRN), §213.30 (relating to Declaratory Order of Eligibility for Licensure), or the other remaining subsections of this section.
(4) For a military service member or military spouse applying for licensure under this subsection, the Board will:
(A) determine whether the jurisdiction in which the member or spouse is licensed has licensure requirements substantially equivalent to the requirements for the type of license in this state; and
(B) not later than 30 days after the date the member or spouse provides notice of intent to practice in this state and a copy of the military identification card, verify whether the member or spouse is licensed in good standing in the jurisdiction in which the member or spouse is licensed.
(5) While practicing nursing in Texas, the military service member or spouse must comply with all laws and regulations applicable to the practice of nursing in Texas.
(6) A military spouse issued a license under this section may continue to practice under the license until the third anniversary of its issuance regardless of the occurrence before that date of divorce or a similar event affecting the license holder's status as a military spouse.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on March 1, 2024.
TRD-202400919
James W. Johnston
General Counsel
Texas Board of Nursing
Effective date: March 21, 2024
Proposal publication date: December 15, 2023
For further information, please call: (512) 305-6879