TITLE 22. EXAMINING BOARDS

PART 3. TEXAS BOARD OF CHIROPRACTIC EXAMINERS

CHAPTER 73. CONTINUING EDUCATION

22 TAC §73.1

The Texas Board of Chiropractic Examiners (Board) proposes repealing 22 TAC §73.1 (Continuing Education). The purpose of repealing this section is to remove it and then replace it at the same time with an updated new rule regarding continuing education.

The Board's Executive Director, Patrick Fortner, has determined that for the first five-year period the proposed repeal is in effect there will be no fiscal implications for state or local government. There will be no adverse effect on small businesses or rural communities, micro-businesses, or local or state employment. There will be no additional economic costs to persons required to comply with the repeal as proposed. An Economic Impact Statement and Regulatory Flexibility Analysis is not required because the proposed repeal will not have an adverse economic effect on small businesses or rural communities as defined in Texas Government Code §2006.001(1-a) and (2).

Mr. Fortner has determined for each year of the first five years that the proposed repeal will be in effect, the public benefit is to update and streamline the Board's rules regarding continuing education requirements for chiropractors without lessening the Board's ability to protect the public.

The Board provides this Government Growth Impact Statement, pursuant to Texas Government Code §2001.0221, for the proposed repeal of 22 TAC §73.1. For each year of the first five years the proposed repeal is in effect, Mr. Fortner has determined:

(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 Board.

(4) The proposed repeal does not increase or decrease fees paid to the Board.

(5) The proposed repeal does not create a new regulation.

(6) The proposal repeals existing Board rules for an administrative process.

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

(8) The proposed repeal does not positively or adversely affect the state economy.

Comments on the proposed repeal or a request for a public hearing may be submitted to Christopher Burnett, General Counsel, Texas Board of Chiropractic Examiners, 333 Guadalupe, Suite 3-825, Austin, Texas 78701, via email: rules@tbce.state.tx.us; or fax: (512) 305-6705, no later than 30 days from the date that this proposed repeal is published in the Texas Register.

The repeal is proposed 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.

The proposed repeal does not affect any other statutes or rules.

§73.1.Continuing Education.

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 November 8, 2018.

TRD-201804835

Christopher Burnett

General Counsel

Texas Board of Chiropractic Examiners

Earliest possible date of adoption: December 23, 2018

For further information, please call: (512) 305-6700


22 TAC §73.1

The Texas Board of Chiropractic Examiners (Board) proposes new §73.1, Continuing Education, to replace the existing §73.1 to update and streamline the Board's continuing education requirements for chiropractors. Accordingly, current §73.1 is being repealed elsewhere in this issue of the Texas Register.

The Board's Executive Director, Patrick Fortner, has determined that for the first five-year period the proposed new rule is in effect, there will be no fiscal implications for state or local government as a result of enforcing or administering the proposed rule.

Mr. Fortner has determined that for the first five-year period the proposed rule is in effect, the expected public benefit will be clarity and guidance for the public and stakeholders regarding the Board's continuing education requirements.

Mr. Fortner has also determined that the proposed new rule will not have an adverse economic effect on small businesses, rural communities or individuals because it does not impose any duties or obligations upon small businesses, rural communities or individuals.

GOVERNMENT GROWTH IMPACT: Mr. Fortner has determined that the proposed rule does not have a government growth impact pursuant to Texas Government Code, §2001.0221.

Comments on the proposed new rule or to a request for a public hearing may be submitted to Christopher Burnett, General Counsel, Texas Board of Chiropractic Examiners, 333 Guadalupe Street, Tower III, Suite 825, Austin, Texas 78701, via email rules@tbce.state.tx.us; or fax: (512) 305-6705, no later than 30 days from the date that this proposed new rule is published in the Texas Register.

The new rule is proposed under Texas Occupations Code §201.152, which authorizes the Board to adopt rules necessary to regulate the practice of chiropractic to protect the public health and safety. The Board is further authorized to adopt rules based upon the relevant portions of the Administrative Procedure Act, Government Code §2001.

No other statutes, articles or codes are affected by the new rule.

§73.1.Continuing Education.

(a) Condition of Renewal. A licensee is required to attend continuing education courses as a condition of renewal of a license.

(b) Definitions:

(1) Live format--any educational course that is not pre-recorded and is presented in real time through an interactive medium such as a live webinar or at an in-person training event.

(2) Online course--any pre-recorded or live format educational course that is delivered through an internet-based platform. All online courses shall have the means to verify attendance through testing on the material presented or other approved format.

(c) Requirements.

(1) Every licensee shall complete 16 hours of continuing education each year unless a licensee is exempted under subsection (e) of this section. Each licensee's reporting year shall begin on the first day of the month in which his or her birthday occurs.

(2) The 16 hours of continuing education may be completed through any course or seminar elected by the licensee that has been approved by the Board.

(A) A licensee must attend any course designated as a "TBCE Required Course" in a live format, and the course may be counted as part of the 16 hour requirement. A minimum of four of the 16 annual required hours of continuing education shall include topics designated by the Board.

(i) A minimum of three hours of the total required continuing education shall consist of a course specifically related to the Board's rules including the Board's code of ethics, recordkeeping, documentation, and coding.

(ii) A minimum of one hour of the total required continuing education shall relate to risk management in chiropractic practice. Risk management means the identification, investigation, and evaluation of risks and methods to correct and eliminate those risks.

(iv) This may be taken online through a course offered by the Board or in any live format course approved by the Board. An instructor for this continuing education must meet one of the following criteria:

(I) hold a doctorate degree and hold an active license to practice chiropractic or law;

(II) is part of the full-time faculty of a chiropractic college accredited by the Council of Chiropractic Education;

(III) is some other qualified health care provider; or

(IV) is an individual with substantial knowledge, skill, and ability in chiropractic practice.

(v) Licensees who were initially licensed on or after September 1, 2012, must complete at least eight hours of continuing education in coding and documentation for Medicare claims no later than their second renewal period unless they are exempted under subsection (e) of this section. The eight hours in coding and documentation for Medicare claims may be counted as part of the total 16 continuing education hours required during the year in which the eight hours were completed.

(iv) The Board may issue public memoranda on urgent public health issues. The Board will publish these on the Board's website and distribute them to the major continuing education providers.

(B) A licensee who serves as an examiner for the National Board of Chiropractic Examiners' Part IV Examination may receive credit for this activity, not to exceed eight hours each year.

(C) A licensee is only allowed to take up to ten hours of online courses that are not live format.

(3) A list of approved courses, including "TBCE Required Courses", will be available on the Board's website. The Board will also post notice of TBCE courses in its newsletter.

(4) A licensee who is unable to travel to attend a continuing education course due to an illness or disability may satisfy the Board's requirements by completing 16 hours of approved courses online. If a licensee is unable to take an online course, the licensee must submit a request for special accommodations to complete their requirements.

(d) Verification.

(1) At the Board's request, a licensee shall submit written verification from each sponsor of the licensee's completion of each continuing education course hour used to fulfill the required hours for all years requested.

(2) A licensee submitting hours as a National Boards examiner must submit written verification of the licensee's participation from the National Boards, on National Boards letterhead. The verification must include the licensee's name, board license number, and the date, time, and place of each examination attended by the licensee as an examiner.

(3) Failure to submit verification as required by paragraph (1) of this subsection shall be considered the same as failing to meet the continuing education requirements of subsection (c) of this section.

(e) Exemption. The following are exempt from the requirements of subsection (c) of this section:

(1) a licensee who holds an inactive license. If an individual wishes to resume the practice of chiropractic during the reporting year for which this exemption applies, the individual cannot begin to practice until first obtaining all required continuing education hours;

(2) a licensee who is a military member, veteran, or military spouse during part of the 12 months immediately preceding the annual license renewal date;

(3) a licensee who submits proof satisfactory to the Board that the licensee suffered an illness or disability which prevented the licensee from complying with the requirements of this section during the 12 months immediately preceding the annual license renewal date; or

(4) a licensee who is in their first renewal period.

(f) A military member who holds a license is entitled to two years of additional time to complete:

(1) any continuing education requirements; and

(2) any other requirement related to the renewal of the military member's license.

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 November 8, 2018.

TRD-201804836

Christopher Burnett

General Counsel

Texas Board of Chiropractic Examiners

Earliest possible date of adoption: December 23, 2018

For further information, please call: (512) 305-6700


PART 9. TEXAS MEDICAL BOARD

CHAPTER 186. RESPIRATORY CARE PRACTITIONERS

22 TAC §186.10

The Texas Medical Board (Board) proposes amendments to §186.10, concerning Continuing Education Requirements.

The amendment to §186.10 clarifies when continuing education (CE) credit is granted to Respiratory Care Practitioners for completion of an academic semester unit or hour. Previously, the rule did not specify what kind of coursework qualified for this continuing education credit. The amendment makes clear that the academic semester unit or hour must be part of the curriculum of a respiratory care education program or a similar education program in another health-care related field offered by an accredited institution. Additionally, the amendment specifies that the 15 contact hour credit will be granted in non-traditional CE.

Scott Freshour, General Counsel for the Board, has determined that for each year of the first five years this section as proposed is in effect the public benefit anticipated as a result of enforcing this proposal will be to clarify CE credit and ensure that credit is given for coursework relating to the practice of respiratory care.

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

Mr. Freshour has also determined that for the first five-year period the sections are in effect there will be no probable economic cost to individuals required to comply with these rules as proposed.

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

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

(1) The proposed rules do not create or eliminate a government program.

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

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

(4) The proposed rules do not require an increase or decrease in fees paid to the agency.

(5) The proposed rules do not create new regulations.

(6) The proposed rules do not expand existing regulations. The proposed rules do limit existing regulations, as described above.

(7) The proposed rules do not increase or decrease the number of individuals subject to the rules' applicability.

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

Comments on the proposal may be submitted to Rita Chapin, P.O. Box 2018, Austin, Texas 78768-2018, or email 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 §604.052, which provides authority for the Board to recommend rules necessary to administer and enforce Chapter 604 of the Texas Occupations Code. The amendments are also proposed under the authority of the Texas Occupations Code Annotated §604.154, which provides authority for the Board to establish continuing education requirements.

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

§186.10.Continuing Education Requirements.

(a) General. Each respiratory care practitioner is required to complete 24 contact hours of approved continuing education (CE) every two (2) years as a condition of renewal of a certificate. At least 12 contact hours must be in traditional courses. The remainder of contact hours may be in non-traditional courses or from passage of examinations detailed in subsection (b)(3) of this section. At least 2 contact hours must be in ethics. These ethics hours may be completed via traditional courses or non-traditional courses.

(1) A contact hour shall be 60 minutes of attendance and participation in an acceptable continuing education experience.

(2) A retired respiratory care practitioner providing only voluntary charity care who is approved by the advisory board for renewal may complete reduced CE requirements equal to half of the number of CE hours required for renewal for a certified respiratory care practitioner.

(3) Notwithstanding paragraph (1) of this subsection, completion of one academic semester unit or hour that is a part of the curriculum of a respiratory care education program or a similar education program in another health-care related field offered by an accredited institution shall be credited 15 contact hours of non-traditional CE.

(4) No CE hours may be carried over from one renewal period to another renewal period.

(b) Types of acceptable continuing education. Continuing education must be in skills relevant to the practice of respiratory care and must have a direct benefit to patients and clients and shall be acceptable if the experience falls in one or more of the following categories:

(1) Traditional CE. Provider-directed educational activities directly related to the profession of respiratory care that require the learner and provider to interact in real time, including, but not limited to, live lectures, courses, seminars, workshops, review sessions, or distance learning activities such as webcasts, videoconferences, and audio conferences in which the learner can interact with the provider. Traditional CE must be approved, recognized, accepted, or assigned CE credit by a professional organization or association (such as TSRC, NBRC or AARC) or offered by a federal, state, or local government entity.

(2) Non-traditional CE.

(A) Self-directed study directly related to the profession of respiratory care that does not include interaction between the learner and the instructor. A test at the conclusion of the self-directed study is required. Non-traditional CE must be approved, recognized, accepted, or assigned CE credit by a professional organization or association (such as TSRC, NBRC or AARC) or offered by a federal, state, or local government entity.

(B) A respiratory care practitioner who teaches or instructs a CE course shall be credited one (1) contact hour in non-traditional CE for each contact hour actually taught. CE credit will be given only once for teaching a particular course.

(C) A respiratory care practitioner who teaches or instructs a course in a respiratory care educational program accredited by the Commission on Accreditation for Respiratory Care or other accrediting body approved by the board shall be credited one (1) contact hour in non-traditional CE for each contact hour actually taught. CE credit will be given only once per renewal period for teaching a particular course.

(3) Passage of an official credentialing or proctored self-evaluation examination, as follows:

(A) NBRC Therapist Multiple Choice (TMC) credentialing or re-credentialing examination - 10 contact hours;

(B) NBRC Clinical Simulation Examination (credentialing or re-credentialing) - 10 contact hours;

(C) NBRC Neonatal/Pediatric Respiratory Care Specialist (NPS) examination (credentialing or re-credentialing) - 10 contact hours;

(D) NBRC Adult Critical Care Specialist (ACCS) examination (credentialing or re-credentialing) - 10 contact hours;

(E) NBRC Sleep Disorder Specialist (SDS) examination (credentialing or re-credentialing) - 10 contact hours;

(F) NBRC Certified Pulmonary Function Technologist (CPFT) examination or NBRC Registered Pulmonary Function Technologist (RPFT) examination (credentialing or re-credentialing) - 10 contact hours;

(G) Board of Registered Polysomnographic Technologists (BRPT) registration examination (credentialing or re-credentialing) - 10 contact hours;

(H) National Asthma Educator Certification Board (NAECB) Certified Asthma Educator (AE-C) examination (credentialing or re-credentialing) - 10 contact hours;

(I) Advanced cardiac life-support (ACLS), pediatric advanced life-support (PALS), neonatal advanced life-support (NALS) or neonatal resuscitation program (NRP), basic trauma life-support, or pre-hospital trauma life-support (credentialing or re-credentialing) - 8 contact hours;

(J) Examinations listed in subparagraphs (A) - (I) of this paragraph may be counted only once for credit. If an initial credentialing examination is counted towards fulfillment of CE requirements, the same examination taken later for re-credentialing purposes may only be applied towards fulfillment of CE requirements once every three (3) renewal periods.

(c) Verification of continuing education. The advisory board may conduct random audits of CE reported to be completed by respiratory care practitioners to determine compliance with this section. The advisory board may require written verification of CE hours from a respiratory care practitioner within 30 days of request. Failure to provide such verification may result in disciplinary action by the advisory board.

(d) Exemptions.

(1) A respiratory care practitioner may request in writing an exemption from the CE requirement for the following reasons:

(A) documented catastrophic illness;

(B) military service of longer than one year's duration outside the United States;

(C) residence of longer than one year's duration outside the United States; or

(D) good cause shown on written application of the respiratory care practitioner that gives satisfactory evidence to the advisory board that he or she is unable to comply with the CE requirement.

(2) Exemptions are subject to the approval of the Executive Director of the Medical Board and must be requested in writing at least 30 days prior to the expiration date of the certificate.

(3) An approved exemption may not exceed one renewal period but may be requested biennially, subject to the approval of the Executive Director of the Medical Board.

(e) CE hours that are obtained to comply with the CE requirements for the preceding renewal period as a prerequisite for obtaining the renewal of a certificate shall first be credited to meet the CE requirements for the previous renewal period. Once the previous renewal period's CE requirement is satisfied, any additional hours obtained shall be credited to meet the CE requirements for the current renewal period.

(f) A false report or statement to the advisory board by a respiratory care practitioner regarding CE hours reportedly obtained shall be a basis for disciplinary action by the board pursuant to §604.201 of the Act. A respiratory care practitioner who is disciplined by the advisory board for such a violation may be subject to the full range of actions authorized by the Act including suspension or revocation of the practitioner's certificate.

(g) A respiratory care practitioner who is a military service member may request an extension of time, not to exceed two years, to complete any CE requirements. A request for such extension is subject to the approval of the Executive Director of the Medical Board.

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 November 9, 2018.

TRD-201804843

Scott Freshour

General Counsel

Texas Medical Board

Earliest possible date of adoption: December 23, 2018

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