Texas Register April 14, 2023 Volume: 48 Number: 15

Texas Register Table of Contents

1 Governor
- - 1.0.1 Appointments Re:
    - 1.0.1.1 The Governor appointed three individuals to the Dental Review Committee.
2 Texas Health and Human Services Commission
- - 2.0.1 Proposed Rules Re:
    - 2.0.1.1 Amending 1 TAC §355.8065, §355.8066, to update reimbursement rates and payment methodology for certain health services.
    - 2.0.1.2 Amending 1 TAC §355.8212, to modify definitions and remove certain payment requirements for purchased health services.
  - 2.0.2 In Addition Re:
3 Texas Department of Licensing and Regulation
- - 3.0.1 Proposed Rules Re:
    - 3.0.1.1 Amending 16 TAC §§115.1, 115.4, 115.5, 115.13, 115.114, 115.115, 115.120, 115.20, 115.21, 115.23, 115.125, 115.70, 115.80, 115.100, 115.120, new 16 TAC §§115.112, 115.22, and repealing 16 TAC §§115.2, 115.16, 115.121, concerning definitions and licensing requirements for midwives.

Governor

Appointments Re:

The Governor appointed three individuals to the Dental Review Committee.

Appointed to the Dental Review Committee for a term to expire February 1, 2029:

Chris L. Cramer, D.D.S. of Coppell, Texas (replacing Jesse Teng, D.D.S of El Paso whose term expired);
Nancy A. Evans, D.D.S of Denton, Texas (Dr. Evans is being reappointed); and
Amanda M. Richardson of Tyler, Texas (Ms. Richardson is being reappointed).

Texas Health and Human Services Commission

Proposed Rules Re:

Amending 1 TAC §355.8065, §355.8066, to update reimbursement rates and payment methodology for certain health services.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8065, §355.8066

OVERVIEW

The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology, §355.8066, concerning Hospital-Specific Limit Methodology, and §355.8212, concerning Waiver Payments to Hospitals for Uncompensated Charity Care.

BACKGROUND AND JUSTIFICATION

HHSC has operated portions of the Medicaid program under the authority of an 1115 Healthcare Transformation and Quality Improvement Demonstration Waiver (1115 Waiver) since 2011. When the 1115 Waiver began, Texas received authority for Medicaid-managed care for several populations of existing Medicaid beneficiaries as well as expenditure authority for two supplemental funding pools – the Delivery System Reform Incentive Payment (DSRIP) Program and the Uncompensated Care (UC) Program. The non-federal share of the payments was funded using primarily local funds matched with federal Medicaid funds. Payments were valued based on allocations that were made early in the waiver development process and were based upon projects, and then achievement, not the utilization of Medicaid services. When the waiver was renewed in 2017, the Special Terms and Conditions of the 1115 Waiver required Texas to reduce expenditures through DSRIP before ultimately ending the DSRIP program on September 30, 2021.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.8065(b) adds the definition for “inflation update factor” as it was erroneously deleted. The definition for “non-rural hospital” is added, which is any hospital that does not meet the definition of rural hospital in the inpatient rule definition from §355.8052. The definition for “Public Health Hospital” is added. The definition for “State-owned teaching hospital,” is added, which refers to the definition in the inpatient hospital rule §355.8052. The definition for “Tax Revenue” is added to define a term that has been used in the program but has not been in the Texas Administrative Code.
The definition for “rural public-financed hospital” is deleted; it has been combined with rural public hospital. The definition for “state chest hospital,” “urban public hospital,” and “urban public hospital – Class two” is deleted.
The proposed amendment to §355.8065(b) updates the definition for “Children’s hospital” to refer to the inpatient rule definition from §355.8052. The definition for “institution for mental disease (IMD)” is updated to refer to the Social Security Act and freestanding psychiatric facility rule §355.8060. The definition for “non-urban public hospital” is updated. The definition for “Ratio of cost-to-charges” is updated to include inpatient and outpatient data.
The proposed amendment to §355.8065(b) updates the definition for “Rural public hospital” to match the inpatient rule definition of rural from §355.8052, defines public hospital in subparagraph (A), and defines public-financed in subparagraph (B). The definition for “State Institution for mental diseases” is updated to reference the Social Security Act and freestanding psychiatric rule §355.761. The definition for “State-owned hospital” is updated to refer to the definitions of “state IMD,” “state-owned teaching hospital,” and “public health hospital.”
The proposed amendment to §355.8065(b) updates the term “Total state and local payments” to “Total state and local subsidies” to match the federal terminology. The amendment adds inpatient and outpatient data and includes tax revenue within the term. The definition for “urban public hospital–Class one” is updated to “transferring public hospital.”
The proposed amendment to §355.8065(c)(3)(E) adds clarification that for mergers, data will be merged if liabilities are assumed through the merger agreement.
The proposed amendment to §355.8065(d)(2) updates the low-income utilization rate calculation to match the federal LIUR calculation. The proposed amendment to §355.8065(d)(4) deletes the term “Children’s hospitals” from being deemed to qualify as this ownership type is not federally deemed and deletes state chest hospitals and state IMDs as these are already included in the definition of state-owned hospitals. The proposed amendment to §355.8065(d)(5) adds clarification that merged hospitals must meet the requirements of subsection (c)(3)(E).
The proposed amendment to §355.8065(e)(3)(C) adds Public Health Hospitals as exempt from the trauma condition of participation to align with current practice. Section 355.8065(e)(8) updates the “Rate Analysis Department” to “Provider Finance Department.” New paragraph (9) is added to §355.8065 to add a new condition of participation: Participation in all voluntary Medicaid programs. This will be a new requirement for all non-rural DSH participants except for state-owned hospitals starting in FFY 2024.
The proposed amendment to §355.8065(g)(1) renames the paragraph “state-owned hospitals” and revises state chest hospitals to public health hospitals. Section 355.8065(g)(2) is revised to establish a set aside amount for rural public providers. Paragraph (g)(3) is updated to rename the paragraph from “other hospitals” to “non-state hospitals.” This update aligns the rule text with the calculation file tabs. Clarification is also added that rural public hospitals are eligible for this amount, and in subparagraph (A), that the non-state allocation is after both (1), the state, and (2), the rural public distribution.
The proposed amendment to §355.8065(h) adds an additional data verification criterion in paragraph (1)(A), data sources, to give providers approved data sources for the application submission. Subsection (h)(2) is updated to include “for non-state hospitals.” Subsection (h)(2)(B)(ii) updates “urban public hospital” to “transferring public hospital,” adds the term “or non-urban” and deletes the word “rural,” and “rural public financed hospital.” The proposed amendment to §355.8065 deletes (h)(2)(C)(iii)(I) urban public hospitals -class two since this class is no longer included in the rule. Subsection (h)(2)(C)(iii)(I) non-urban public hospitals updates the language to not include pool two pass one and pass two, since the second pass will not be necessary with a percentage of cost covered methodology, and the conditions of general revenue shortage was removed. The proposed amendment to §355.8065 (h)(2)(C)(iii)(II) updates “urban public hospitals–class one” to “transferring public hospitals,” and eliminates pool two pass two, since the second pass will not be necessary with a percentage of cost covered methodology.
The proposed amendment to §355.8065(h) replaces paragraph (3), weighting factors, with new paragraph (3), Calculation of percentage of cost covered. Subsection (h)(4) is renamed from “Pass One distribution and payment calculation for Pools One and Two” to “Distribution and payment calculation for Pools One and Two.” The amendment also updates the methodology throughout the paragraph to explain how the percentage of cost covered will be applied to the Pool One and Two calculation. Paragraph (5), Pass Two for Pool One and Two, is deleted since the second pass will not be necessary with a percentage of cost covered methodology. Paragraph (6) is renumbered to paragraph (5) and several updates are made including updating the hospital classes and removing references to pool one and pool two pass two. New paragraph (7), Rural public hospital pool distribution and calculation. This paragraph describes how to distribute the rural public allocation among the rural public hospitals based on remaining percentage of cost covered. Paragraph (8) updates the Pass Three to include, “Pass Three – if any portion non-federal share of the available DSH funds is not fully funded, the remaining allocation will be available to non-urban public hospitals that met the funding requirements described in paragraph (2)(C) of this subsection.” It also updates rural public and rural public-financed to the term non-urban public. Paragraph (9), Reallocating funds if hospital closes, loses its license or eligibility, or files bankruptcy, is updated to note that state hospitals receive reallocated funds first, followed by all other DSH hospitals. This was updated to align with current practice. Paragraph (11) is revised to describe the procedure of first reducing non-state IMDs by a pro-rata reduction in the event that the sum of the annual payment amounts for state owned and non-state owned IMDs exceed the annual Federal IMD limit.
The proposed amendment to §355.8065 (i) adds state natural disaster area to the subsection.
The proposed amendment to §355.8065(k)(5) revises the department name from “Rate Analysis Department” to “Provider Finance Department” and updates “Director of Hospital Rate Analysis” to “Director of Hospital Finance.”
The proposed amendment to §355.8065 adds subsection (p) Redistribution of recouped funds in order to document and align the rule with current practice.
The proposed amendment to §355.8066 renames the section “State Payment Cap and Hospital-Specific Limit Methodology.” Subsection (a), Introduction, is updated to include reference to §355.8212, Waiver Payments to Hospitals for Uncompensated Charity Care.
The proposed amendment to §355.8066(b) adds a definition for “Demonstration Year,” “DSH and UC Application Request Form,” “Federal Fiscal Year (FFY),” “Full-Offset Payment Ceiling,” “Medicaid payor type,” “Recoupment Prevention Payment Ceiling,” and “Uncompensated Care Hospital.”
The proposed amendment to §355.8066(b) deletes the definition for “Non-DSH survey” and “Ratio of cost-to-charges.”
The term “DSH survey” is replaced with “DSH and Uncompensated Care (UC) Application” to match the terminology used and the definition is updated. The proposed amendment updates subsection (b)(12), Hospital-specific limit, to include reference to Section 1923(g) of the Social Security Act, add clarifying language, and remove the mention of “Delivery System Reform Incentive Payment” as the program no longer exists. The definition for “Institution for mental diseases (IMD)” is updated. The definition for Outpatient charges is updated to change language for “hospital specific limit” to “a payment cap or limit.”
The proposed amendment to §355.8066(b) updates the definition for “State payment cap” to remove the mention of “Delivery System Reform Incentive Payment” as the program no longer exists and to clarify language. The term “Total state and local payments” is updated to “Total state and local subsides” to align with the definition in §355.8065.
The proposed amendment to §355.8066(c), Calculating a state payment cap, updates the subsection by removing the words “hospital-specific limit,” replacing the term “DSH or non-DSH survey” with “DSH and UC Application,” and clarifying paragraph references and language.
The proposed amendment to §355.8066(c)(1) replaces the phrase “State Payment Cap” with “Calculation of uninsured and Medicaid costs and payments,” the term “survey” is replaced with “application”, and state and local “payments” with “subsidies.” The proposed amendment to §355.8066(c)(1) adds directed payments as an adjustment factor that can be applied to Medicaid payment data to align with current practice. The paragraph has been reorganized for clarity.
The proposed amendment to §355.8066(c)(1)(D) replaces “calculation of the state payment cap” with “calculation of the full-offset payment ceiling” to clearly explain the payments, costs, and inflator used for this payment ceiling. The amendment to §355.8066(c)(2), which is renumbered as (c)(3), replaces “Hospital-specific limit” with “Calculation of the Recoupment Prevention Payment Ceiling” to explain the methodology for the new recoupment prevention payment ceiling used in Federal Fiscal Year 2023 and forward to prevent recoupments. New subparagraph (c)(4), State Payment Cap, explains the new state payment cap for Federal Fiscal Year 2023 and forward and to preserve the previous definitions of state payment cap used in years before Federal Fiscal Year 2023. New subparagraph (d), Hospital-Specific Limit, updates references and adds a procedure for requesting a federally authorized exception to the HSL calculation.
The proposed amendment to §355.8066(d) replaces the phrase “Due date for DSH or non-DSH survey” with “Due date for DSH and UC Application,” the term “Rate Analysis” with “Provider Finance Department,” and the term “survey” with “application.”
The proposed amendment to §355.8066(e) updates the term “DSH or non-DSH survey” to “DSH and UC Application,” adds “unless it is related to exceptions permitted by Section 1923(g) of the Social Security Act” as an applicable category of data that providers can request a review for, and adds the uncompensated care payment amounts in §355.8212 as a category that HHSC will not consider for a review request.

Amending 1 TAC §355.8212, to modify definitions and remove certain payment requirements for purchased health services.

CHAPTER 355. REIMBURSEMENT RATES
SUBCHAPTER J. PURCHASED HEALTH SERVICES
1 TAC §355.8212

OVERVIEW

BACKGROUND AND JUSTIFICATION

SECTION-BY-SECTION SUMMARY

The proposed amendment to §355.8212(b) deletes the definition for “Affiliation Agreement,” “Anchor,” “Delivery System Reform Incentive Payments (DSRIP),” “Large public hospital,” “Regional Healthcare Partnership (RHP),” and “RHP plan.”
The proposed amendment to §355.8112(b) adds definitions for “Impecunious charge ratio,” “Medicaid cost report,” “Non-public hospital,” “Public Health Hospital (PHH),” “State institution for mental diseases (State IMD),” “State-owned hospital,” “State-owned teaching hospital,” “State Payment Cap,” and “Transferring public hospital.”
The proposed amendment to §355.8212(b) updates the definition for “Disproportionate Share Hospital (DSH)” to add a reference to §355.8065 and the definition for “Institution for mental diseases (IMD)” to add a reference to §1905(i) of the Social Security Act, §355.8060, and §355.761.
The proposed amendment to §355.8212(b) updates the definition for “Uncompensated-care payments” to remove reference to paragraph (5) of the subsection to improve clarity of the definition.
The proposed amendment to §355.8212(c) deletes paragraph (1)(B) to remove language relating to affiliation agreements, anchors, and certification requirements that are no longer applicable and adds new language to describe the UC application fee for non-public providers and to describe the requirement for all non-rural hospitals, except for state hospitals, to enroll, participate and comply with requirements for all voluntary supplemental Medicaid or directed Medicaid programs in order to participate in the UC program.
The proposed amendment to §355.8212 updates subsection (c)(2) to remove subparagraph (B), the RHP eligibility requirement and the content in subsection (c)(2)(A) is combined into paragraph (c)(2).
The proposed amendment to §355.8212(c)(3) removes the RHP eligibility requirement, reference to affiliation, and adds subparagraph (C) to provide details and requirements for merging data in the UC program.
The proposed amendment to §355.8212(f)(2)(A) describes UC pools in each demonstration year and establishes a high impecunious charge hospital (HICH) pool effective Demonstration Year 12 and forward. The amendment to paragraph (2)(B)(i) makes a reference to the new state-owned hospital definition in subsection (b). The amendment to subsection (f)(2)(D) defines eligible hospitals for the high impecunious charge hospital (HICH) pool and describes the calculation methodology for the pool amount. Subsection (f)(2)(E) is updated to accurately reflect reference to subparagraphs “(B)-(D) of this paragraph” following rule text changes.
The proposed amendment to §355.8212(g)(2)(A)(iv) updates “large hospital” to “transferring hospitals” and removes reference to “affiliation agreement” that is no longer valid. Subsections (g)(3)(A) and (g)(3)(B) are updated to change “CMS 2552-10” cost report to “Medicaid” cost report for clarity and consistency across rules. Subsection (g)(6)(B)(i) is updated to clarify that the payment data point includes the advance payments described in paragraph (9) of the subsection.
The proposed amendment to §355.8212 updates subsections (h)(1)(A) to add the word “maximum” to payment amount to clarify language. Subsection (h)(2) is updated to remove reference to “affiliation” which is no longer valid.
Along with these edits, editorial revisions are made to update numbering, references, and punctuation.

In Addition Re:

Notice of Public Hearing on Proposed Updates to Medicaid Payment Rates

OVERVIEW

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on April 24, 2023, at 9:00 a.m., to receive public comments on proposed updates to Medicaid payment rates resulting from Medical Policy Reviews and Special Review.

Public Hearing – Proposed Medicaid Payment Rates for Biennial Calendar Fee Reviews

OVERVIEW

Notice of Public Hearing on proposed payment rates for Nurse Aide Training and Competency Evaluation Program (NATCEP); STAR Kids Community First Choice Personal Attendant and Habilitation (CFC PAS/HAB) Consumer Directed Services Option (CDS); and STAR Kids/STAR Health Prescribed Pediatric Extended Care Centers (PPECC).

Public Notice – Texas State Plan Amendment, which waives the counseling signature requirements at the dispensing of drugs during the Public Health Emergency.

OVERVIEW

The Texas Health and Human Services Commission (HHSC) announces its intent to submit an amendment, transmittal number 23-0010, to the Texas State Plan for Medical Assistance under Title XIX of the Social Security Act.

The proposed amendment waives the counseling signature requirements at the dispensing of drugs during the Public Health Emergency. The requested effective date for the proposed amendment is March 1, 2020.

Texas Department of Licensing and Regulation

Proposed Rules Re:

Amending 16 TAC §§115.1, 115.4, 115.5, 115.13, 115.114, 115.115, 115.120, 115.20, 115.21, 115.23, 115.125, 115.70, 115.80, 115.100, 115.120, new 16 TAC §§115.112, 115.22, and repealing 16 TAC §§115.2, 115.16, 115.121, concerning definitions and licensing requirements for midwives.

CHAPTER 115. MIDWIVES
16 TAC §§115.1, 115.2, 115.4, 115.5, 115.12 – 115.16, 115.20 – 115.23, 115.25, 115.70, 115.80, 115.100, 115.120, 115.121

OVERVIEW

The Texas Department of Licensing and Regulation (Department) proposes amendments to existing rules at 16 Texas Administrative Code (TAC) at Chapter 115, §§115.1, 115.4, 115.5, 115.13 – 115.15, 115.20, 115.21, 115.23, 115.25, 115.70, 115.80, 115.100, and 115.120, the repeal of §§115.2, 115.16 and 115.121 and new rules §§115.2, 115.12, 115.16, 115.22, and 115.121; regarding the Midwives program. These proposed changes are referred to as “proposed rules.”

BACKGROUND AND JUSTIFICATION

The rules under 16 TAC Chapter 115 implement Texas Occupations Code, Chapter 203, Midwives.

The proposed rules implement changes recommended by Department staff as a result of the four-year rule review conducted under Texas Government Code §2001.039. The proposed rules update requirements relating to approval of basic midwifery education courses, preceptor supervision of student clinical experience, informed client choice and disclosure statements, and retired midwife licenses. The proposed rules also make updates to reflect current Department procedures and remove obsolete or unnecessary language.

The Notice of Intent to Review for Chapter 115 was published in the October 9, 2020, issue of the Texas Register (45 TexReg 7281). The public comment period closed on November 9, 2020. At its meeting on March 3, 2021, the Texas Commission of Licensing and Regulation (Commission) readopted Chapter 115 in its entirety without changes. The readoption notice was published in the March 26, 2021, issue of the Texas Register (46 TexReg 2050). In response to the Notice of Intent to Review for Chapter 115 that was published, the Department received comments from one interested party requesting rule changes that would not be possible without statutory changes. Therefore, the proposed rules do not include any changes in response to public comments, and all the changes are based on recommendations by Department staff.

The proposed rules were presented to and discussed by the Midwives Advisory Board at its meeting on March 29, 2023. The Advisory Board made a change to proposed §115.13(a)(3)(B) by adding “and passing” to clarify that the course and exam must be passed. The Advisory Board voted and recommended that the proposed rules with changes be published in the Texas Register for public comment.

SECTION-BY-SECTION SUMMARY

The proposed rules amend §115.1, Definitions, by changing the term “approved midwifery education courses” to “basic midwifery education course” and updating its definition to provide clarity and consistency with Occupations Code §203.151; removing the definition for “Code” because the term is not used elsewhere in the rule chapter; adding a definition for “compensation” to provide clarity; adding a definition for “CPR certification” to streamline multiple references throughout the chapter; adding a definition for “direct supervision” to provide clarity; adding a definition for the acronym “MANA” to streamline multiple references to the Midwives Alliance of North America; adding a definition for the acronym “MEAC” to streamline multiple references to the Midwifery Education Accreditation Council; adding a definition for the acronym “NARM” to streamline multiple references to the North American Registry of Midwives; adding a definition for “preceptor” to provide clarity; removing the definition of “Program” because the term is not used elsewhere in the rule chapter; updating the definition of “retired midwife” to provide clarity and remove the age requirement; correcting a rule reference in the definition of “standing delegation orders”; adding a definition for “student” to provide clarity; and renumbering the remaining definitions accordingly.
The proposed rules repeal current §115.2 and replace it with new §115.2, License Required, to prohibit the unlicensed practice of midwifery.
The proposed rules amend §115.4, Advisory Board Membership, by amending paragraph (1) to provide consistency with Occupations Code §203.052.
The proposed rules amend §115.5, “Terms; Vacancies”, by amending subsections (a) and (b) to provide consistency with Occupations Code §203.055.
The proposed rules add new §115.12, General Application Requirements, to streamline requirements for all applications submitted to the Department; add new subsection (a) consisting of language relocated from current §115.13(a) and (a)(1); and add new subsection (b) to require that original or certified copies of documents must be provided upon request by the Department.
The proposed rules amend §115.13, Initial Application for Licensure, by relocating language from subsections (a) and (a)(1) to proposed new §115.12(a); removing subsections (a)(1)(A) through (a)(1)(E), which consist of application details that can instead be addressed in the application forms approved by the Department; updating subsection (a)(2) to provide clarity and correct grammar; relocating and reorganizing the language in current subsection (a)(2) to become new subsection (a)(3); relabeling current subsection (a)(3) to become new subsection (a)(4) and removing the language that repeats the proposed new definition for “CPR certification” in §115.1; relabeling current subsection (a)(4) to become new subsection (a)(5) and adding language to allow the Department to approve a certification that is equivalent to the certification in neonatal resuscitation from the American Academy of Pediatrics; relabeling current subsection (a)(5) to become new subsection (a)(6) and reorganizing its language for clarity; relabeling current subsection (a)(6) to become new subsection (a)(7) and removing unnecessary language; relabeling current subsection (a)(7) to become new subsection (a)(8) and rephrasing its language for clarity and consistency; rephrasing subsection (b) for clarity and consistency; and creating new subsection (f) consisting of language relocated from current §115.2(b). The Advisory Board made a change to subsection (a)(3)(B) by adding “and passing” to clarify that the course and exam must be passed.
The proposed rules amend §115.14, License Renewal, by adding to subsection (a) the word “midwife” to clarify the section’s applicability to renewal of a midwife license; removing from subsection (a)(3) language that repeats the proposed new definition for “CPR certification” in §115.1; and adding new subsection (e) to provide that each applicant for renewal of a midwife license must successfully pass a criminal history background check.
The proposed rules amend §115.15, Late Renewal, by rephrasing for clarity and adding references to other Department rules applicable to late renewals.
The proposed rules repeal current §115.16 and replace it with new §115.16, Retired Voluntary Charity Care Status License, consisting of subsection (a) to explain the applicability of the section; subsection (b) to provide the eligibility requirements for a retired voluntary charity care status license; subsection (c) to provide the requirements for an initial application for a voluntary charity care status license; subsection (d) to provide the limitations on the practice of a person holding a retired voluntary charity care status license; subsection (e) to detail the actions for which a person holding a retired voluntary charity care status license will be subject to disciplinary action; subsection (f) to provide for the two-year license term of a retired voluntary charity care status license; subsection (g) to provide the renewal application requirements, the procedures for late renewal, and the prohibition on unlicensed activity for a voluntary charity care status license; and subsection (h) to provide the requirements for a person who holds a retired voluntary charity care status license and wants to return to active status.
The proposed rules amend §115.20, Basic Midwifery Education, by amending the section title for clarity; rephrasing and restructuring the rule language to remove the need for subsection labels; relocating from current subsection (a) to new paragraph (1) the requirement for a course to have a course administrator and site in Texas; relabeling current subsection (b)(2) to become new paragraph (2) and rephrasing its language for clarity; relabeling current subsection (b)(3) to become new paragraph (3) and replacing the names of entities with their corresponding acronyms defined in §115.1; relabeling current subsection (b)(4) to become new paragraph (4) and rephrasing its language for clarity; relabeling current subsection (b)(5) to become new paragraph (5) and rephrasing its language for clarity; relabeling current subsection (b)(6) to become new paragraph (6) and amending its language to provide consistency with the clinical experience requirements for certification by the North American Registry of Midwives (NARM); relabeling current subsection (b)(7) to become new paragraph (7) and removing unnecessary language that repeats the new definition for “preceptor” in §115.1; relabeling current subsection (c) to become new paragraph (8), rephrasing its language for clarity, and removing the language that repeats the new definition for “CPR certification” in §115.1.
The proposed rules amend §115.21, Education Course Approval, by amending the section title for clarity and consistency; rephrasing subsection (a)(1) for clarity and consistency; modifying subsection (a)(1)(D) to require that the financial statement or balance sheet must demonstrate the ability to provide refunds to any students who enroll and removing the requirement to disclose any bankruptcy within the last five years; in subsection (a)(1)(E), adding the requirement for written policies to include entrance requirements, a list of all fees, and the notice required by Occupations Code §53.152 and removing requirements for language and accessibility covered by other state and federal laws; in subsection (a)(2), changing the time period for retention of student files from five years to “three years after the student is no longer enrolled in the course” to provide a more definite time period, clarifying that student files must include CPR certification and progression of course work; amending subsection (a)(3) to clarify the process for initial course approval; rephrasing subsections (a)(4) through (a)(6) for clarity; amending subsection (b) to clarify the approval of courses accredited by MEAC; amending subsection (c) to clarify the duration of course approval and the process for obtaining a new approval period; amending subsection (d) to require a substantive change in a course to be approved before the change is implemented; and adding new subsection (e) to allow courses to accept transfer hours from other courses and clinical hours earned under a NARM-certified preceptor.
The proposed rules add new §115.22, Preceptor Supervisory Responsibilities, consisting of new subsection (a) to provide the requirements relating to clinical experience activities performed by a student, including direct supervision by a preceptor and informed consent by the client; new subsection (b) to clarify that the student is not practicing midwifery; and new subsection (c) to provide that a licensed midwife acting as a preceptor is responsible for the actions of the student.
The proposed rules amend §115.23, Jurisprudence Examination, by adding new subsection (d) to address administration of the examination, examination fees, reexamination, and notice of examination results, as required by Occupations Code §203.2555(b).
The proposed rules amend §115.25, Continuing Education, by rephrasing and reorganizing for clarity and removing accessibility requirements covered by other state and federal laws.
The proposed rules amend §115.70, Standards of Conduct, by removing the language in current paragraph (1)(L), which authorizes administrative action due to “a lack of personal or professional character in the practice of midwifery” because the standard is vague and subjective; renumbering the remaining provisions in paragraph (1) accordingly; and updating paragraph (3) to clarify that course approval may be suspended or revoked, add loss of MEAC accreditation as a reason for course suspension or revocation, and make cleanup changes for clarity.
The proposed rules amend §115.80, Fees, by updating the names of fees for clarity and consistency and reducing the retired voluntary charity care status license fees in paragraphs (4) and (5) from $275 to $0.
The proposed rules amend §115.100, Standards for the Practice of Midwifery in Texas, by making cleanup changes to subsections (a) and (c) for clarity and consistency.
The proposed rules amend §115.120, Newborn Screening, to clarify the requirements relating to a midwife who chooses to collect blood specimens for newborn screening tests, including the required training and submission of the appropriate form to the Department, and removing unnecessary language.
The proposed rules repeal current §115.121 and replace with new §115.121, Informed Choice and Disclosure Statement, by removing unnecessary language that merely repeats Occupations Code §203.351; adding new subsection (a) to require a midwife to use the form prescribed by the Department; adding new subsection (b) to require a midwife to provide the content of the form to a prospective client in both oral and written form before providing any midwifery service; and adding new subsection (c) to require a student performing clinical experience activities to first obtain the informed consent required by proposed new §115.22.