TITLE 22. EXAMINING BOARDS

PART 9. TEXAS MEDICAL BOARD

CHAPTER 186. MEDICAL RADIOLOGIC TECHNOLOGY

SUBCHAPTER C. NON-CERTIFIED TECHNICIAN REGISTRATION AND PRACTICE REQUIREMENTS

The Texas Medical Board (Board) proposes an amendment concerning Chapter 186, Medical Radiologic Technology, Subchapter C, concerning Non-Certified Technician Registration and Practice Requirements, §186.26.

The proposed amendment to rule §186.26 corrects the minimum number of hours required for the completion of an NCT educational program. Specifically, the amendment clarifies that only one (or more) of an anatomy unit must be completed within that program, but not all.

The proposed amendment to §186.26, relating to Non-Certified Technician Registration and Practice Requirements, clarifies that the rule does not require 120 classroom hours, but rather, the educational standard is met upon completion of the minimum hours required by an approved program within each topic area. The proposed amendment further clarifies that, within an approved program, a non-certified technician is required to complete one or more of the units of applied human anatomy on the list.

Scott Freshour, General Counsel for the Texas Medical Board, has determined that, for each year of the first five years the proposed amendment is in effect, the public benefit anticipated as a result of enforcing the proposed amendment will be to clarify the requirements for education standards for non-certified technicians.

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

Mr. Freshour has also determined that for the first five-year period the proposed amendment rule is in effect there will be no probable economic cost to individuals required to comply with the proposed amendment rule.

Pursuant to Texas Government Code §2006.002, the agency provides the following economic impact statement for the proposed amendment rule and determined that for each year of the first five years the proposed amendment rule will be in effect there will be no effect on small businesses, micro businesses, or rural communities. The agency has considered alternative methods of achieving the purpose of the proposed amendment 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 the proposed amendment rule is in effect:

(1) there is no additional estimated cost to the state or to local governments expected as a result of enforcing or administering the proposed amendment rule;

(2) there are no estimated reductions in costs to the state or to local governments as a result of enforcing or administering the proposed amendment rule;

(3) there is no estimated loss or increase in revenue to the state or to local governments as a result of enforcing or administering the proposed amendment rule; 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 proposed amendment rule.

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

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

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

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

(3) Implementation of the proposed amendment rule does not require an increase or decrease in future legislative appropriations to the agency.

(4) The proposed amendment rule does not require an increase or decrease in fees paid to the agency.

(5) The proposed amendment rule does not create new regulations.

(6) The proposed amendment rule does not repeal existing regulations as described above. The proposed amendment rule does not expand or limit an existing regulation.

(7) The proposed amendment rule does not increase the number of individuals subject to the rules' applicability.

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

Comments on the proposals may be submitted using this link: https://forms.cloud.microsoft/g/Y9emrgjADA or e-mail comments to: rules.development@tmb.state.tx.us. A public hearing will be held at a later date.

The proposed amendment rule is proposed under the authority of Texas Occupations Code §§153.001 and §601.052 and §601.0522, which provides authority for the Board to adopt rules necessary to administer and enforce the Medical Radiologic Technologist Certification Act and to adopt rules necessary to regulate and license non-certified technicians.

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

§186.26. Education Standards for Non-Certified Technician [(NCT)].

(a) Placement on the Non-Certified Technician [(NCT)] registry requires successful completion of an approved program that meets [of 120 total classroom hours with] the following minimum requirements:

(1) radiation safety and protection for the patient, self and others--22 classroom hours;

(2) image production and evaluation--24 classroom hours; and

(3) radiographic equipment maintenance and operation--16 classroom hours including at least 6 hours of quality control, darkroom, processing, and Texas for Control of Radiation; and

(4) one or more of the following units of applied human anatomy and radiologic procedures of the:

(A) skull (5 views: Caldwell, Townes, Waters, AP/PA, and lateral)--10 classroom hours;

(B) chest--8 classroom hours;

(C) spine--8 classroom hours;

(D) abdomen, not including any procedures utilizing contrast media--4 classroom hours;

(E) upper extremities--14 classroom hours; and/or

(F) lower extremities--14 classroom hours.

(b) The training program hours must be live, in-person, and directed by an approved instructor.

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 March 3, 2026.

TRD-202601083

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: April 19, 2026

For further information, please call: (512) 305-7059

PART 11. TEXAS BOARD OF NURSING

CHAPTER 216. CONTINUING COMPETENCY

BACKGROUND. The Texas Board of Nursing (Board) proposes amendments to Board Rules §§216.1, 216.5, 216.7 - 216.9 and 216.11 to implement the requirements of Senate Bill 912, which added Texas Occupations Code §§112.101-112.106. This bill requires the Board to establish a continuing education tracking system to verify that licensees have complied with continuing competency requirements prior to renewal of a license. The proposed amendments to 22 Texas Administrative Code Chapter 216, relating to Continuing Competency, are intended to implement Senate Bill 912 by establishing and integrating a continuing education tracking system for verifying licensee compliance.

SECTION-BY-SECTION SUMMARY OVERVIEW.

Section 216.1 contains definitions for Chapter 216. The Board proposes to revise the definition of "Audit" to clarify that audits may involve a general review of licensees and monitoring of the continuing education tracking system vendor, rather than being limited to a random sampling conducted during a biennial licensing period. The amendments also add a new definition for "Continuing education tracking system," defined as an electronic system established by the Board in accordance with Texas Occupations Code §§112.104 and 112.105. Existing definitions in the section are renumbered as necessary to accommodate the addition of the new term.

Section 216.5 establishes additional methods by which a licensee may demonstrate compliance with continuing competency requirements, other than by submitting evidence of completed continuing nursing education (CNE) hours or an approved national nursing certification. The proposed amendments to §216.5 transition documentation requirements for these alternative methods from the current reactive, audit-based submission process to a proactive requirement that licensees upload sufficient documentation and information to the continuing education tracking system. Under the proposed amendments, licensees are required to upload documentation verifying completion of qualifying academic courses, development or presentation of approved programs, and publication of eligible manuscripts, rather than submitting documentation only upon audit.

Section 216.7 establishes the responsibilities of individual licensees with respect to recordkeeping and verification of continuing competency activities. The proposed amendments to §216.7 clarify these responsibilities by maintaining the requirement that licensees retain records of general continuing nursing education activities for a minimum of three consecutive licensing periods, while proposing removal of language specifying forms of documentation to be submitted upon audit. The proposed amendments also add a provision requiring licensees to upload all documentation and information necessary to verify completion of continuing competency requirements to the continuing education tracking system prior to license renewal or reactivation.

Section 216.8 establishes the process for renewal, reactivation, and other forms of relicensure. The proposed amendments to §216.8 incorporate use of the continuing education tracking system into the relicensure framework by proposing that licensees attest, upon renewal, that they have complied with the requirement to upload verification documentation to the tracking system. The proposed amendments further require that licensees seeking renewal of a delinquent license or reactivation of an inactive license upload sufficient documentation to the tracking system to verify completion of required continuing education or maintenance of approved national nursing certification. Additional conforming amendments align the renewal, delinquency, and reactivation processes with the proposed verification framework.

Section 216.9 establishes the Board's audit process for verifying compliance with continuing competency requirements. The proposed amendments to §216.9 align the audit process with the continuing education tracking system by proposing that the Board review documentation and information previously uploaded to the system and request additional materials as necessary to verify compliance. The proposed amendments also remove obsolete provisions describing prior random sampling procedures and specific submission formats in order to comport with the proposed continuing education tracking system procedures.

Section 216.11 establishes the consequences of noncompliance with continuing competency requirements. The proposed amendments to §216.11 clarify that failure to demonstrate compliance upon audit, falsely attesting to completion of continuing competency requirements, or falsification of records would constitute unprofessional conduct and grounds for disciplinary action, in addition to denial of license renewal.

FISCAL NOTE. Dr. Kristin Benton, RN, DNP, Executive Director, has determined that for each year of the first five years the proposed new sections will be in effect, there will be no anticipated change in the revenue to state or local government as a result of the enforcement or administration of the proposal.

PUBLIC BENEFIT/COST NOTE. Dr. Benton has determined that, for each year of the first five years the proposed amendments are in effect, the anticipated public benefit will be the adoption of amendments that implement a statutorily required continuing education tracking system and provide clear notice to licensees and the public regarding requirements for establishing compliance with continuing competency standards.

There are no anticipated costs of compliance associated with the proposed amendments. The proposed amendments do not impose new fees, requirements, or conditions that would result in additional expenditures by licensees or other regulated entities.

ECONOMIC IMPACT STATEMENT AND REGULATORY FLEXIBILITY ANALYSIS FOR SMALL BUSINESSES, MICRO-BUSINESSES, AND RURAL COMMUNITIES. The Government Code §2006.002(c) and (f) require that if a proposed rule may have an economic impact on small businesses, micro-businesses, or rural communities, state agencies must prepare, as part of the rulemaking process, an economic impact statement that assesses the potential impact of the proposed rule on these businesses and communities and a regulatory flexibility analysis that considers alternative methods of achieving the purpose of the rule.

These proposed amendments cannot reasonably be expected to result in adverse economic effects on small businesses, micro-businesses, or rural communities. Because the agency has determined that the proposed rule will have no adverse economic effect on small businesses, micro-businesses, or rural communities, preparation of an Economic Impact Statement and a Regulatory Flexibility Analysis, as detailed under Texas Government Code §2006.002, is not required.

GOVERNMENT GROWTH IMPACT STATEMENT. The Board is required, pursuant to Texas Government Code §2001.0221 and 34 Texas Administrative Code §11.1, to prepare a government growth impact statement. The Board has determined for each year of the first five years the proposed amendments will be in effect: (i) the proposal does not create or eliminate a government program; (ii) implementation of the proposal does not require the creation of new employee positions or the elimination of existing employee positions; (iii) implementation of the proposal does not require an increase or decrease in future legislative appropriations to the Board, as the Board intends to shift necessary resources to comply with the statutory mandate; (iv) the proposal does not require an increase or decrease in fees paid to the Board; (v) the proposal does not create a new regulation; (vi) the proposal does not expand or repeal an existing regulation; (vii) the proposed rule does not increase or decrease the number of individuals subject to the rule's applicability; and (viii) the proposal does not have an effect on the state's economy.

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

REQUEST FOR PUBLIC COMMENT. Comments on this proposal may be submitted to James W. Johnston, General Counsel, Texas Board of Nursing, 1801 Congress Avenue, Suite 10-200, Austin, Texas 78701, or by e-mail to dusty.johnston@bon.texas.gov. Comments must be received no later than thirty (30) days from the date of publication of this proposal. If a hearing is held, written and oral comments presented at the hearing will be considered.

STATUTORY AUTHORITY. These amendments are proposed under the authority of Texas Occupations Code §§301.151, 301.303, 112.104 & 112.106.

CROSS REFERENCE TO STATUTE. The following statutes are affected by this proposal: Texas Occupations Code §§301.151, 301.303 & 112.101-112.106.

§216.1. Definitions.

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

(1) - (4) (No change.)

(5) Audit--A review of licensees [A random sample of licensees selected] to verify satisfactory completion of the Board's requirements for continuing competency and to monitor the performance of the Board's continuing education tracking system vendor. [during a biennial licensing period.]

(6) - (12) (No change.)

(14) [(13)] Credentialing agency--An organization recognized by the Board as having met nationally predetermined criteria to approve programs and providers of CNE.

(15) [(14)] Licensing period--Period of time in which nursing licensure status is current; determined by the licensee's birth month and year, usually beginning on the first day of the month after the birth month and ending on the last day of the birth month. The specific time frame for initial licensure and for the immediate licensing period following renewal of a delinquent license or license reactivation may vary from six months to 29 months, as determined by Board policies; subsequent licensing periods will be two years in length.

(16) [(15)] Prescriptive authority--Authorization granted to an APRN who meets the requirements to prescribe or order a drug or device, as set forth in Chapter 222 of this title (relating to Advanced Practice Registered Nurses with Prescriptive Authority).

(17) [(16)] Program development and/or presentation--Formulation of the purpose statement, objectives and associated content and/or presentation of an approved CNE activity.

(18) [(17)] Program number--A unique number assigned to a continuing education offering upon approval which shall identify it regardless of the number of times it is presented.

(19) [(18)] Provider--An individual, partnership, organization, agency or institution approved by an organization recognized by the Board which offers continuing education programs and activities.

(20) [(19)] Provider number--A unique number assigned to the provider of continuing education upon approval by the credentialing agency or organization.

(21) [(20)] Shall, will, and must--Mandatory requirements.

(22) [(21)] Targeted continuing education--Continuing education offerings beyond the basic scholastic preparation which are designed to promote and enrich knowledge, improve skills, and develop attitudes for the enhancement of nursing practice that are directed by statute and Board rules at specific levels of licensure and/or areas of practice.

§216.5. Additional Methods for Meeting Continuing Competency Requirements.

(a) Academic Courses. A licensee may receive CNE credit for attendance and completion of an academic course within the framework of a curriculum that leads to an academic degree in nursing or any academic course directly relevant to the licensee's area of nursing practice.

(1) The [Upon audit by the Board, the] licensee must upload to the continuing education tracking system sufficient documentation and/or information to verify [submit to the Board an official transcript indicating] completion of the course with a grade of "C" or better, or a "Pass" on a Pass/Fail grading system. For example, the licensee may provide a copy of their transcript.

(2) (No change.)

(b) Program Development and/or Presentation.

(1) (No change.)

(2) The [Upon audit by the Board, the] licensee must upload to the continuing education tracking system sufficient documentation and/or information to verify the licensee's program development and/or presentation. For example, the licensee may provide, [submit to the Board] on one page: the title of the program, program objectives, brief outline of content, name of credentialing agency that approved the program for contact hours, provider number, program number, dates and locations of the presentation, and number of contact hours.

(3) (No change.)

(c) Authorship.

(1) (No change.)

(2) The [Upon audit by the Board, the] licensee must upload to the continuing education tracking system sufficient documentation and/or information to verify publication. For example, a licensee may provide [submit to the Board] a letter from the publisher indicating acceptance of the manuscript for publication or a copy of the published work.

(3) (No change.)

§216.7. Responsibilities of Individual Licensee.

(a) (No change.)

(b) The licensee shall be responsible to maintain a record of CNE activities for a minimum of three consecutive licensing periods or six years, unless otherwise specified in this chapter. These records shall document completion as described by §216.4 and §216.5 of this chapter (relating to Criteria for Acceptable Continuing Education Offerings and Additional Methods for Meeting Continuing Competency Requirements). [evidenced by original certificates of completion, contact hour certificates, or official academic transcripts. Copies of these shall be submitted to the Board upon audit.]

§216.8. Relicensure Process.

(a) Renewal of license.

(1) Upon renewal of the license, the licensee shall sign a statement attesting that they have complied with the requirements of §216.7(c) of this chapter. [the CNE contact hours or approved national nursing certification requirement has been met.]

(2) (No change.)

(b) - (c) (No change.)

(d) Delinquent license.

(1) A license that has been delinquent for less than four years may be renewed by the licensee uploading to the continuing education tracking system sufficient documentation and/or information to verify that the licensee [submitting proof of having] completed 20 contact hours of acceptable CNE or a current approved national nursing certification in his or her prior area of practice within the two years immediately preceding application for relicensure and by meeting all other Board requirements. A licensee shall be exempt from the continuing competency requirements for the immediate licensing period following renewal of the delinquent license with the exception of applicable targeted continuing competency requirements in §216.3 of this chapter (relating to Continuing Competency Requirements).

(2) (No change.)

(e) Reactivation of a license.

(1) A license that has been inactive for less than four years may be reactivated by the licensee uploading to the continuing education tracking system sufficient documentation and/or information to verify that the licensee [submitting proof of having] completed 20 contact hours of acceptable CNE or a current approved national nursing certification in his or her prior area of practice within the two years immediately preceding application for reactivation and by meeting all other Board requirements. A licensee shall be exempt from the continuing competency requirements for the immediate licensing period following reactivation of the license with the exception of applicable targeted continuing competency requirements in §216.3 of this chapter (relating to Continuing Competency Requirements).

(2) (No change.)

(f) (No change.)

§216.9. Audit Process.

The Board shall select a random sample of licensees 90 days prior to each renewal month. Notification shall be sent to selected licensees to substantiate compliance with the continuing competency requirements.

(2) (No change.)

§216.11. Consequences of Noncompliance.

(a) Failure to comply with the Board's continuing competency requirements will result in the denial of license renewal.

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 March 9, 2026.

TRD-202601124

James W. Johnston

General Counsel

Texas Board of Nursing

Earliest possible date of adoption: April 19, 2026

For further information, please call: (512) 305-6879