Texas Register December 25, 2020 Volume: 45 Number: 52

State Board of Dental Examiners

 

Emergency Rule

Renewing the emergency amendment to 22 TAC §108.7, establishing minimum standards of care for dental practice during COVID-19

CHAPTER 108. PROFESSIONAL CONDUCTSUBCHAPTER A. PROFESSIONAL RESPONSIBILITY22 TAC §108.7OVERVIEWThe State Board of Dental Examiners is renewing the effectiveness of emergency amended §108.7 for a 60-day period. The text of the emergency rule was originally published in the September 4, 2020, issue of the Texas Register (45 TexReg 6172).The emergency rule amends 22 TAC §108.7 by adding §108.7(16), which dictates protocol for dental practice during the COVID-19 disaster. The new provision is included in its entirety in this week’s edition of the Texas Register (45 Tex Reg 6171). BACKGROUND AND JUSTIFICATION This rule is adopted on an emergency basis due to the imminent peril to the public health, safety and welfare caused by failure to adhere to the minimum standards for safe practice during the COVID-19 pandemic.The amended definitions are applicable only for purposes of the COVID-19 disaster declaration and shall only remain effective until the COVID-19 disaster declaration is terminated.

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Texas Department of State Health Services

Emergency Rule

Renewing the emergency amendment to 25 TAC §417.47, requiring infection control training within state hospitals in response to COVID-19

CHAPTER 417. AGENCY AND FACILITY RESPONSIBILITIESSUBCHAPTER A. STANDARD OPERATING PROCEDURES25 TAC §417.47OVERVIEWThe Department of State Health Services is renewing the effectiveness of emergency amended §417.47 for a 60-day period. The text of the emergency rule was originally published in the August 28, 2020, issue of the Texas Register (45 TexReg 6003).HHSC previously adopted emergency rules concerning staff training in order to efficiently and effectively deploy staff to meet basic needs during the COVID-19 pandemic, without posing risk to the individuals served. As the COVID-19 pandemic and the Governor’s proclamation of disaster have continued, so has the need for training requirements that ensure adequate training and staffing levels at state hospitals. This emergency rule updates those training requirements to require training of infection control specific to COVID-19, including prevention, screening, isolation, and the use of personal protective equipment.BACKGROUND AND JUSTIFICATION As authorized by Texas Government Code §2001.034, the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.The purpose of the emergency rulemaking is to support the Governor’s March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this standard operating procedures.

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Texas Health and Human Services Commission

Emergency Rule

Renewing emergency rule 26 TAC §551.46, establishing requirements for Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions to mitigate and contain the spread of COVID-19

CHAPTER 551. INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH AN INTELLECTUAL DISABILITY OR RELATED CONDITIONSSUBCHAPTER C. STANDARDS FOR LICENSURE26 TAC §551.46OVERVIEWThe Health and Human Services Commission is renewing the effectiveness of emergency new §551.46 for a 60-day period. The text of the emergency rule was originally published in the August 28, 2020, issue of the Texas Register (45 TexReg 6004).To protect individuals receiving ICF/IID services and the public health, safety, and welfare of the state during the COVID-19 pandemic, HHSC is adopting this emergency rule to require ICF/IID actions to mitigate and contain COVID-19. The purpose of the new rule is to describe these requirements.BACKGROUND AND JUSTIFICATION As authorized by Government Code,§2001.034, the Commission may adopt an emergency rule without prior notice or hearing if it finds that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Government Code, §2001.034,may be effective for not longer than 120 days and may be renewed for not longer than 60 days.The purpose of the emergency rulemaking is to support the Governor’s March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of this emergency rule for ICF/IID COVID-19 Response.

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Texas Department on Aging and Disability Services

Emergency Rule

Renewing the emergency amendments to 40 TAC §§3.401 – 3.403, requiring infection control training within state facilities in response to COVID-19

CHAPTER 3. RESPONSIBILITIES OF STATE FACILITIESSUBCHAPTER D. TRAINING40 TAC §§3.401 – 3.403OVERVIEWThe Department of Aging and Disability Services is renewing the effectiveness of emergency amended §§3.401 – 3.403 for a 60-day period. The text of the emergency rule was originally published in the August 28, 2020, issue of the Texas Register (45 TexReg 6008).HHSC previously adopted emergency rules concerning staff training in order to efficiently and effectively deploy staff to meet basic needs during the COVID-19 pandemic, without posing risk to the individuals served. As the COVID-19 pandemic and the Governor’s proclamation of disaster have continued, so has the need for training requirements that ensure adequate training and staffing levels at state supported living centers. This emergency rule updates those training requirements to require training of infection control specific to COVID-19, including prevention, screening, isolation, and the use of personal protective equipment.BACKGROUND AND JUSTIFICATION As authorized by Texas Government Code §2001.034, the Commission may adopt an emergency rule without prior notice or hearing upon finding that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30 days’ notice. Emergency rules adopted under Texas Government Code §2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.March 13, 2020, proclamation certifying that the COVID-19 virus poses an imminent threat of disaster in the state and declaring a state of disaster for all counties in Texas. In this proclamation, the Governor authorized the use of all available resources of state government and of political subdivisions that are reasonably necessary to cope with this disaster and directed that government entities and businesses would continue providing essential services. The Commission accordingly finds that an imminent peril to the public health, safety, and welfare of the state requires immediate adoption of these training rules.

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Texas Department of Licensing and Regulation

Proposed Rules

Amending 16 TAC §130.59 to establish procedures for waiving the electronic prescribing requirements for podiatrists issuing controlled substances

CHAPTER 130. PODIATRIC MEDICINE PROGRAMSUBCHAPTER E. PRACTITIONER RESPONSIBILITIES AND CODE OF ETHICS16 TAC §130.59OVERVIEWThe Texas Department of Licensing and Regulation (Department) proposes amendments to an existing rule at 16 Texas Administrative Code (TAC), Chapter 130, Subchapter E, §130.59.BACKGROUND AND JUSTIFICATIONThe proposed rules amend 16 TAC §130.59, Opioid Prescription Limits and Required Electronic Prescribing. The proposed rules establish a procedure and specify criteria for the Department to apply when granting a waiver from the electronic prescribing requirements for controlled substances. New subsection (d) establishes the Department’s authority to require a form, the one-year time period for a waiver, and the renewal application timeline. New subsection (e) establishes the criteria that a waiver request must satisfy for the Department to grant a waiver. New subsection (f) establishes the Department’s authority to revoke or refuse to grant a waiver.

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Texas Department of Licensing and Regulation

Proposed Rules

Repealing 16 TAC §130.74, which currently contains the penalty matrix for podiatrists

CHAPTER 130. PODIATRIC MEDICINE PROGRAMSUBCHAPTER G. ENFORCEMENT16 TAC §130.74OVERVIEWThe Texas Department of Licensing and Regulation (Department) proposes the repeal of an existing rule at Subchapter G, §130.74, regarding the Podiatry program. BACKGROUND AND JUSTIFICATIONThe proposed rules repeal 16 TAC §130.74, Penalty Matrix. The repeal of this rule reduces redundancy and increases efficiency by harmonizing the program with other Department programs which do not maintain a penalty matrix in rule. Texas Occupations Code §51.302(c) requires the Texas Commission of Licensing and Regulation (Commission), the Department’s governing body, to establish a written enforcement plan that provides specific ranges of penalties for specific violations and the criteria by which the Department determines the amount of the penalty. The Department’s enforcement plan contains a schedule of penalties for each program known as a “penalty matrix.” The podiatry penalty matrix was incorporated into the Department’s enforcement plan when it was created and it will continue to serve its purpose there after 16 TAC §130.74 is repealed. A public notice of revisions to the enforcement plan is published in the Texas Register as required by Texas Occupations Code §51.302(c) each time a program’s penalty matrix is revised.

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Texas Board of Chiropractic Examiners

Proposed Rules

New 22 TAC §74.1, establishing procedures for substance abuse testing of certain applicants

CHAPTER 74. SUBSTANCE ABUSE TESTING AND MONITORING22 TAC §74.1The Texas Board of Chiropractic Examiners (Board) proposes new 22 TAC §74.1 (Substance Abuse Testing and Monitoring of Applicants). The Board proposes this rule to formally state the Board’s procedures when certain applicants for a chiropractic license may be subject to substance abuse testing in order to obtain a probationary license.

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Texas Board of Chiropractic Examiners

Proposed Rules

New 22 TAC §74.2, establishing procedures for substance abuse testing of certain licensees

CHAPTER 74. SUBSTANCE ABUSE TESTING AND MONITORING22 TAC §74.2The Texas Board of Chiropractic Examiners (Board) proposes new 22 TAC §74.2, (Substance Abuse Testing and Monitoring of Licensees). The Board proposes this rule to comply with Texas Occupations Code §201.602, which requires the Board to adopt by rule a system for monitoring a licensee’s compliance with conditions imposed by the Board in disciplinary actions. The purpose of the rule is to permit licensees with substance abuse problems an opportunity to retain their license while still being subject to oversight by the Board.Under the proposed rule, which formalizes the Board’s current practice, a licensee who agrees to undergo substance abuse testing and monitoring as part of an agreed order in a disciplinary action shall bear the cost; the Board shall make reasonable efforts to minimize that cost.

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Texas Health and Human Services Commission

Adopted Rules

New 1 TAC §355.205, establishing rules for temporary Medicaid reimbursement rate increases and limitations on emergency fund use in response to COVID-19

CHAPTER 355. REIMBURSEMENT RATESSUBCHAPTER B. ESTABLISHMENT AND ADJUSTMENT OF REIMBURSEMENT RATES FOR MEDICAID1 TAC §355.205OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts in Texas Administrative Code (TAC) Title 1, Part 15, Chapter 355, Subchapter B, new §355.205, concerning Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID-19). Section 355.205 is adopted without changes to the proposed text as published in the October 23, 2020, issue of the Texas Register (45 TexReg 7513). Therefore, the rule will not be republished.BACKGROUND AND JUSTIFICATION The new rule outlines the process by which HHSC will restrict eligible Medicaid providers from using temporarily increased reimbursement rates to increase hourly wages paid to direct care staff on an ongoing basis. In accordance with the contingencies placed upon use of the funds, use of the funds for staff compensation is limited to overtime payments, lump sum bonuses, bonuses for hazard pay, or other types of compensation that will not result in future reductions to hourly wages when the emergency temporary reimbursement rate increase is discontinued. Reimbursement rates were increased effective April 1, 2020, to ensure that these providers are able to purchase personal protective equipment, ensure adequate staff-to-client ratios, and take other necessary steps to serve clients individually rather than in congregate settings to protect the health and safety of the clients in their care.This new rule is based on an existing emergency rule adopted in response to the COVID-19 pandemic: §355.205, Emergency Rule for Emergency Temporary Reimbursement Rate Increases and Limitations on Use of Emergency Temporary Funds for Medicaid in Response to Novel Coronavirus (COVID-19). The provisions of this new rule are the same as the emergency rule. Except for a minor edit in the title of the rule and a clarifying edit in the text, there are no changes.

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Texas Health and Human Services Commission

Adopted Rules

Amending 1 TAC §355.8201 to update and clarify the secondary reconciliation process and subsequent repayment to hospitals for Uncompensated Care

CHAPTER 355. REIMBURSEMENT RATESSUBCHAPTER J. PURCHASED HEALTH SERVICESDIVISION 11. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT1 TAC §355.8201OVERVIEWThe Texas Health and Human Services Commission (HHSC) adopts an amendment to §355.8201, concerning Waiver Payments to Hospitals for Uncompensated Care. The amendment to §355.8201 is adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7812). The rule will not be republished.SECTION-BY-SECTION SUMMARYThe proposed amendment to §355.8201(i)(3) revises the secondary reconciliation process applied to hospitals that requested an adjustment to their interim HSL in demonstration years 6 through 8. The proposed amendment also includes other clarifying changes to indicate which demonstration years are subject to the secondary reconciliation process.The proposed amendment to §355.8201(k) adds new language to describe the methodology HHSC will use to redistribute recouped funds. The previous language contained in subsection (k) is moved to new §355.8201(l).BACKGROUND AND JUSTIFICATIONThe purpose of the proposal is to revise the secondary reconciliation process applied to hospitals that requested an adjustment to their interim hospital-specific limit (HSL) for purposes of calculating uncompensated care (UC) payments in demonstration years 6 through 8 (October 1, 2016 to September 30, 2019), and to describe the methodology HHSC will use to redistribute recouped funds. The amendment to the secondary reconciliation process is in response to a petition for rulemaking.Further explanation regarding secondary reconciliation and redistribution of recouped funds is included in this week’s edition of the Texas Register (45 Tex Reg 7812).  

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State Board of Dental Examiners

Adopted Rules

Amending 22 TAC §104.1 to require human trafficking prevention training as a condition of license renewal for dentists

CHAPTER 104. CONTINUING EDUCATION22 TAC §104.1The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §104.1, concerning continuing education. The amended rule is necessary to implement the requirements of House Bill 2059 of the 86th Texas Legislature, Regular Session (2019), and the Texas Occupations Code Chapter 116, requiring human trafficking prevention training for health care practitioners prior to the renewal of a license. This amended rule is adopted with no changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7934), and will not be republished.

State Board of Dental Examiners

Adopted Rules

New 22 TAC §111.5, establishing procedures for waiving electronic prescribing requirements for controlled substances

CHAPTER 111. STANDARDS FOR PRESCRIBING CONTROLLED SUBSTANCES AND DANGEROUS DRUGS22 TAC §111.5The State Board of Dental Examiners (Board) adopts new rule 22 TAC §111.5 concerning Electronic Prescribing Waivers. The new rule is adopted to comply with the requirements of HB 2174 (86th Regular Legislative Session), which requires practitioners to electronically prescribe all controlled substances. The law allows for prescriber waivers which may be renewed annually, if the prescriber is experiencing: 1) economic hardship; 2) technological limitations not reasonably within the control of the prescriber; or 3) other exceptional circumstances demonstrated by the prescriber. This new rule is adopted with no changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7936). This rule will not be republished.

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State Board of Dental Examiners

Adopted Rules

Amending 22 TAC §114.12 to require human trafficking prevention training as a condition of license renewal for dental assistants

CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS22 TAC §114.12The State Board of Dental Examiners (Board) adopts this amendment to 22 TAC §114.12, concerning continuing education for certificate holders. The amended rule is necessary to implement the requirements of House Bill 2059 of the 86th Texas Legislature, Regular Session (2019), and the Texas Occupations Code Chapter 116, requiring human trafficking prevention training for health care practitioners prior to the renewal of a license. This amended rule is adopted with no changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7937), and will not be republished.

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Texas Medical Board

Adopted Rules

New 22 TAC §161.11, establishing a Memorandum of Understanding between Texas Medical Board (TMB) and Texas Physician Health Program (TXPHP)

CHAPTER 161. GENERAL PROVISIONS22 TAC §161.11OVERVIEWThe Texas Medical Board (Board) adopts new §161.11, Memorandum of Understanding between Texas Medical Board (TMB) and Texas Physician Health Program (TXPHP), concerning physicians. The new rule section is being adopted as published in the November 6, 2020 issue of the Texas Register (45 TexReg 7938). The adopted new rule section will not be republished.DETAILED EXPLANATION New §161.11, Memorandum of Understanding between Texas Medical Board (TMB) and Texas Physician Health Program (TXPHP), was adopted pursuant to H.B. 1504 (86th Legislature TMB Sunset Bill (2019)). H.B. 1504 added provision Texas Occupations Code §167.012 directing the TMB and TXPHP to enter into a memorandum of understanding to establish performance measures for the TXPHP, include a list of services provided by TMB to TXPHP, and require an internal audit of TXPHP to be completed once every three years.

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Texas Medical Board

Adopted Rules

New 22 TAC §170.10, requiring electronic prescribing of controlled substances

CHAPTER 170. PRESCRIPTION OF CONTROLLED SUBSTANCESSUBCHAPTER D. ELECTRONIC PRESCRIBING OF CONTROLLED SUBSTANCES22 TAC §170.10OVERVIEWThe Texas Medical Board (Board) adopts new Subchapter D, 22 TAC Chapter 170, titled Electronic Prescribing of Controlled Substances, and new §170.10, titled Electronic Prescribing of Controlled Substances. The new subchapter and rule are being adopted with non-substantive changes to the proposed text as published in the November 13, 2020, issue of the Texas Register (45 TexReg 8096). The rule will be republished. Changes in the adopted rule respond to public comments or otherwise reflect non-substantive variations from the proposed amendments. The changes affect no new persons, entities, or subjects other than those given notice, and compliance with the adopted sections will not be more burdensome than under the proposed sections.DETAILED EXPLANATIONNew §170.10 sets forth requirements and exceptions related to electronic prescribing of controlled substances, and the process and circumstances in which a physician may obtain a waiver from such requirements.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §180.4 to remove an erroneous fee provision related to the Texas Physician Health Program

CHAPTER 180. TEXAS PHYSICIAN HEALTH PROGRAM22 TAC §180.4OVERVIEWThe Texas Medical Board (Board) adopts amendment to rule §180.4, concerning Operation of Program, concerning physicians. The amendment to rule §180.4 is being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7939). The adopted amendment to rule §180.4 will not be republished.DETAILED EXPLANATIONSection 180.4, relating to Operation of Program, was adopted to correct an error in the rule and to ensure that the rules are consistent with Texas Occupations Code Section 153.051(d)(10). The erroneous fee increase was implemented for a period of two weeks only and all fees received in excess of the statutory cap have been reimbursed or prorated.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §183.20 to require acupuncturists to complete human trafficking prevention training

CHAPTER 183. ACUPUNCTURE22 TAC §183.20OVERVIEWThe Texas Medical Board (Board) adopts amendments to §183.20, concerning Continuing Acupuncture Education regarding Acupuncturists. The amendments are being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7941). The adopted amendments to rule will not be republished.DETAILED EXPLANATIONAmendments to §183.20, relating to Continuing Acupuncture Education were adopted to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that acupuncturists complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Carry forward hours will not apply to the new course. Other changes proposed to 183.20 are made to reorganize and format the rule.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §184.4 to require surgical assistants to complete human trafficking prevention training

CHAPTER 184. SURGICAL ASSISTANTS22 TAC §184.4OVERVIEWThe Texas Medical Board (Board) adopts amendments to rule §184.4, concerning Qualifications for Licensure. The amendments to rules are being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7945). The adopted amendments to rules will not be republished.DETAILED EXPLANATIONAmendments to §184.4, relating to Qualifications for Licensure, was adopted to implement new continuing education requirements set forth by H.B. 2059 (86th Leg.). The new language requires that licensed surgical assistants complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Carry forward hours will not apply to the new course requirement.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §184.25 to clarify the requirement that surgical assistants complete human trafficking prevention training

CHAPTER 184. SURGICAL ASSISTANTS22 TAC §184.25OVERVIEWThe Texas Medical Board (Board) adopts amendments to rule §184.25, concerning Continuing Education, concerning surgical assistants.The amendments to rules are being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7945). The adopted amendments to rules will not be republished.DETAILED EXPLANATIONAmendments to §184.25, relating to Continuing Education, was adopted to remove references to annual requirements, as the hours are required on a biennial basis. Remaining changes reorganize and format the rule.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §185.6 to require physician assistants to complete human trafficking prevention training

CHAPTER 185. PHYSICIAN ASSISTANTS22 TAC §185.6OVERVIEWThe Texas Medical Board (Board) adopts amendments to §185.6, concerning Biennial Renewal of License concerning physician assistants. The amendments to the rule are being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7948). The adopted amendments to the rule will not be republished.DETAILED EXPLANATIONSection 185.6, relating to Biennial Renewal of License, was amended to implement new continuing education requirements set forth by H.B. 2059 passed by the 86th Legislature, Regular Session (2019). The new language requires that physician assistants complete a course in the topic of human trafficking prevention. The new courses are to be completed as part of the formal course hours required each biennial registration period. Carry forwards will not be allowed toward the new requirements. Other changes are proposed to §185.6 are made to reorganize and format the rule.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §186.10 to require respiratory care practitioners to complete human trafficking prevention training

CHAPTER 186. RESPIRATORY CARE PRACTITIONERS22 TAC §186.10OVERVIEWThe Texas Medical Board (Board) adopts amendments to §186.10, concerning Continuing Education Requirements concerning respiratory care practitioners. The amendments to the rule are being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7950). The adopted amendments to the rule will not be republished.DETAILED EXPLANATIONSection 186.10, relating to Continuing Education Requirements, was amended to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that respiratory care practitioners complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Other changes proposed to §186.10 are made to reorganize and format the rule.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §187.9 to allow the Board to issue multiple remedial plans in response to complaints against licensees

CHAPTER 187. PROCEDURAL RULESSUBCHAPTER A. GENERAL PROVISIONS AND DEFINITIONS22 TAC §187.9OVERVIEW The Texas Medical Board (Board) adopts amendments to Subchapter A: General Provisions and Definitions, §187.9, concerning Board Actions. DETAILED EXPLANATION Section 187.9, relating to Board Actions, was amended to proposes to repeal language limiting the board’s authority to issue more than one remedial plan to resolve complaints of violations of laws by licensees, pursuant to H.B. 1504 (86th Legislature TMB Sunset Bill (2019)). H.B. 1504 changed Texas Occupations Code §164.0015 so that the board is permitted to issue remedial plans to address minor law violations if the licensee has not received a remedial plan in the preceding five years. Remaining amendments delete language related to non-disciplinary orders, a type of order that the board has had no authority to issue since approximately 2009. Finally, the amendments delete an unnecessary reference to chapter 175 of the board rules. 

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Texas Medical Board

Adopted Rules

Amending 22 TAC §187.35 to update requirements for proposal presentation during a formal Board proceeding

CHAPTER 187. PROCEDURAL RULESSUBCHAPTER D. FORMAL BOARD PROCEEDINGS22 TAC §187.35OVERVIEW The Texas Medical Board (Board) adopts amendments to Subchapter D: Formal Board Proceedings, §187.35, concerning Presentation of Proposal for Decision. DETAILED EXPLANATION Section 187.35, relating to Presentation of Proposal for Decision, pursuant to Texas Occupations Code Section 164.0072, added by H.B. 1504 (86th Legislature TMB Sunset Bill (2019)).

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Texas Medical Board

Adopted Rules

Amending 22 TAC §187.37 to update procedure for the issuance of final decisions and orders in formal Board proceedings

CHAPTER 187. PROCEDURAL RULESSUBCHAPTER D. FORMAL BOARD PROCEEDINGS22 TAC §187.37OVERVIEW The Texas Medical Board (Board) adopts amendments to §187.37, concerning Final Decisions and Orders. DETAILED EXPLANATION Section 187.37, relating to Final Decisions and Orders, pursuant to Texas Occupations Code Section 164.0072, added by H.B. 1504 (86th Legislature TMB Sunset Bill (2019)).

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Texas Medical Board

Adopted Rules

Repealing 22 TAC §187.38 to eliminate duplicative language regarding motions for rehearing in formal Board proceedings

CHAPTER 187. PROCEDURAL RULESSUBCHAPTER D. FORMAL BOARD PROCEEDINGS22 TAC §187.38OVERVIEW The Texas Medical Board (Board) adopts the repeal of §187.38, concerning Motions for Rehearing with regard to physicians.DETAILED EXPLANATION Section 187.38, relating to Motions for Rehearing, was repealed to eliminate language due to Texas Government Code Chapter 2001 which provides for a specific and clear process requiring no regulatory clarification.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §188.24 to require perfusionists to complete human trafficking prevention training

CHAPTER 188. PERFUSIONISTS22 TAC §188.24OVERVIEWThe Texas Medical Board (Board) adopts amendments to rule §188.24, concerning Continuing Education concerning perfusionists. The amendments to rule are being adopted without changes to the proposed text as published in the November 6, 2020 issue of the Texas Register (45 TexReg 7955). The adopted amendments to rule will not be republished.DETAILED EXPLANATION Section 188.24, relating to Continuing Education, was amended to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that perfusionists complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Other changes proposed to §188.24 are made to make language consistent with requirements being on a biennial basis, remove outdated language, and otherwise to reorganize and format the rule.

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Texas Medical Board

Adopted Rules

Amending 22 TAC §194.7 to require radiology technicians to complete human trafficking prevention training

CHAPTER 194. MEDICAL RADIOLOGIC TECHNOLOGYSUBCHAPTER A. CERTIFICATE HOLDERS, NON-CERTIFIED TECHNICIANS, AND OTHER AUTHORIZED INDIVIDUALS OR ENTITIES22 TAC §194.7OVERVIEWThe Texas Medical Board (Board) adopts amendments to §194.7, concerning Biennial Renewal of Certificate or Placement on the Board’s Non-Certified Technician Registry, concerning medical radiological technicians. The amendments to §194.7 are being adopted without changes to the proposed text as published in the November 6, 2020, issue of the Texas Register (45 TexReg 7958). The adopted amendments to §194.7 will not be republished.DETAILED EXPLANATION Section 194.7, relating to Biennial Renewal of Certificate or Placement on the Board’s Non-Certified Technician Registry, was amended to implement new continuing education requirements set forth by H.B. 2059, passed by the 86th Legislature, Regular Session (2019). The new language requires that radiologist assistants, medical radiologic technologists, and non-certified technicians complete a course in the topic of human trafficking prevention, as part of the course hours required each biennial registration period. Carry forward hours will not apply to the new course requirement. For radiologist assistants, the course will be required in addition to the formal course hours. Other changes proposed to 194.7 reorganize and format the rule.

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Texas Department of Insurance

Adopted Rules

Amending 28 TAC §3.9901 to update the valuation manual for life, accident, and health insurance and annuities

CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIESSUBCHAPTER RR. VALUATION MANUAL28 TAC §3.9901OVERVIEWThe Commissioner of Insurance adopts amended 28 TAC §3.9901, relating to the adoption of changes to the valuation manual for reserving and related requirements. The amendment is adopted without changes to the proposed text published in the November 6, 2020, issue of the Texas Register (45 TexReg 7979).SUMMARY OF CHANGESIn addition to clarifying existing provisions, the 2021 valuation manual includes changes to:directly reference the interest rate used in the definition of life insurance under the Tax Code as the floor for the life nonforfeiture interest rate;allow for a transition from using the London Inter-bank Offered Rate because that rate standard is being eliminated;allow companies to use different credibility methods for different blocks of the life principle-based reserving business; andprovide that reserving must reflect risks due to policy conversions and be included in reporting requirements.BACKGROUND AND JUSTIFICATION Insurance Code §425.073 requires the Commissioner to adopt a valuation manual that is substantially similar to the valuation manual adopted by the National Association of Insurance Commissioners (NAIC). The valuation manual adopted by the NAIC may be viewed at the following website: content.naic.org/sites/default/files/pbr_data_valuation_manual_future_edition.pdf.TDI amends §3.9901 by striking the date on which the NAIC adopted its previous valuation manual and inserting the date on which the NAIC adopted its current valuation manual, changing it from August 6, 2019, to August 14, 2020.This proposal includes provisions related to NAIC rules, regulations, directives, or standards. Under Insurance Code §36.004, TDI must consider whether authority exists to enforce or adopt it. Additionally, under Insurance Code §36.007, an agreement that infringes on the authority of this state to regulate the business of insurance in this state has no effect unless the agreement is approved by the Texas Legislature. TDI has determined that neither §36.004 nor §36.007 prohibit the proposed rule, because Insurance Code §425.073 requires TDI to adopt a valuation manual that is substantially similar to the valuation manual approved by NAIC, and §425.073(c) expressly requires TDI to adopt changes to the valuation manual that are substantially similar to changes adopted by the NAIC.

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Texas Health and Human Services Commission

In Addition

HHSC plans to submit an amendment to the Texas Healthcare Transformation Quality Improvement Program (THTQIP) Waiver

OVERVIEWThe Health and Human Services Commission (HHSC) plans to submit a request to the Centers for Medicare & Medicaid Services (CMS) for an amendment to the Texas Healthcare Transformation Quality Improvement Program (THTQIP) waiver under section 1115 of the Social Security Act. CMS has approved this waiver through September 30, 2022.BACKGROUND AND JUSTIFICATION This amendment is in response to House Bill (H.B.) 4533, SECTION 32, 86th Legislature, Regular Session, 2019 which requires HHSC to pursue a benefit for medically fragile individuals.While the population served by the amendment is not new to managed care and will not receive new services, the new process as outlined in this amendment for serving this very medically fragile population will improve the coordination of their care and improve health outcomes for them while containing cost growth. Further details are provided in this week’s edition of the Texas Register (45 Tex Reg 9636). PUBLIC COMMENT An individual may obtain a free copy of the proposed waiver amendment, ask questions, obtain additional information, or submit comments regarding this amendment by contacting Amanda Sablan by U.S. mail, telephone, or email. Addresses are listed in this week’s edition of the Texas Register (45 Tex Reg 9636). 

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Texas Health and Human Services Commission

In Addition

HHSC plans to submit amendment to the Texas State Plan for Medical Assistance Amendments (effective January 1, 2021)

OVERVIEWThe Texas Health and Human Services Commission (HHSC) announces its intent to submit amendments to the Texas State Plan for Medical Assistance, under Title XIX of the Social Security Act. The proposed amendments are effective January 1, 2021.The purpose of the amendments is to update the fee schedules in the current state plan by adjusting fees, rates, or charges for the following services:2021 Annual Healthcare Common Procedure Coding System (HCPCS) Updates:Ambulance Services;Birthing Center Facility Services;Case Management Services;Certified Pediatric Nurse Practitioners and Certified Family Nurse Practitioners;Certified Registered Nurse Anesthetists and Anesthesiologist Assistants;Clinical Diagnostic Laboratory Services;Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS);Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT);Family Planning Services;Hearing Aids and Audiometric Evaluations;Home Health Services;Indian Health Services;Licensed Clinical Social Worker Services;Licensed Professional Counselor Services;Licensed Marriage and Family Therapist Services;Physicians and Other Practitioners;Physician Assistants;Rehabilitative Chemical Dependency Treatment Facility Services; andVision Care Services.ADDITIONAL INFORMATION A rate hearing will be held online on January 28, 2021, to address the 2021 Annual Healthcare Common Procedures Coding System (HCPCS) Updates. Once available, information about the proposed rate changes and the hearing will be published in a subsequent issue of the Texas Register at http://www.sos.state.tx.us/texreg/index.shtml.Interested parties may obtain additional information and/or a free copy of the proposed amendments by contacting Cynthia Henderson, State Plan Policy Advisor, by mail at the Health and Human Services Commission, P.O. Box 13247, Mail Code H-600, Austin, TX 78711; by telephone at (512) 487-3349; by facsimile at (512) 730-7472; or by e-mail at Medicaid_Chip_SPA_Inquiries@hhsc.state.tx.us. Copies of the proposed amendments will be available for review at the local county offices of HHSC, (which were formerly the local offices of the Texas Department of Aging and Disability Services).PUBLIC COMMENT Written comments about the proposed amendments and/or requests to review comments may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or email. Addresses are listed in this week’s edition of the Texas Register (45 Tex Reg 9637). 

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Texas Department of Licensing and Regulation

In Addition

Notice of Vacancies on Advisory Board of Athletic Trainers

NOTICE OF VACANCY The Texas Department of Licensing and Regulation (Department) announces two vacancies on the Advisory Board of Athletic Trainers (Board) established by Texas Occupations Code, Chapter 451. The pertinent rules may be found in 16 Texas Administrative Code §110.14. The purpose of the Advisory Board of Athletic Trainers is to provide advice and recommendations to the Texas Commission of Licensing and Regulation (Commission) and the Department on technical matters relevant to the administration of this chapter. Service as a Board member is voluntary, and compensation is not authorized by law.INTERESTED PARTIES This announcement is for: two athletic trainers.Interested persons should submit an application on the Department website at: https://www.tdlr.texas.gov/AdvisoryBoard/login.aspx. Applicants can also request an application from the Department by telephone (800) 803-9202 or e-mail advisory.boards@tdlr.texas.gov.

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Texas Department of Licensing and Regulation

In Addition

Notice of Vacancies on Behavior Analyst Advisory Board

NOTICE OF VACANCYThe Texas Department of Licensing and Regulation (Department) announces four vacancies on the Behavior Analyst Advisory Board (Board) established by Texas Occupations Code, Chapter 506. The Board provides advice and recommendations to the Texas Commission of Licensing and Regulation (Commission) in adopting rules, administering and enforcing the Occupations Code covering Behavior Analysts, and setting fees. The Board meets at the call of the presiding officer of the Commission or the executive director of the Department. INTERESTED PARTIES This announcement is for: one physician experienced in mental or behavioral health services; one licensed assistant behavior analyst; one licensed behavior analyst; and one public member.Interested persons should submit an application on the Department website at: https://www.tdlr.texas.gov/AdvisoryBoard/login.aspx. Applicants can also request an application from the Department by telephone (800) 803-9202 or by e-mail advisory.boards@tdlr.texas.gov.

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Texas Department of Licensing and Regulation

In Addition

Notice of Vacancies on Hearing Instrument Fitters and Dispensers Advisory Board

NOTICE OF VACANCY The Texas Department of Licensing and Regulation (Department) announces two vacancies on the Hearing Instrument Fitters and Dispensers Advisory Board (Board) established by 16 Texas Administrative Code §112.10. The purpose of the Hearing Instrument Fitters and Dispensers Advisory Board is to provide advice and recommendations to the Department on technical matters relevant to the administration of this chapter. INTERESTED PARTIES This announcement is for: one member licensed under this chapter who has been engaged in fitting and dispensing hearing instruments for at least five years preceding appointment; one member who is actively practicing as a physician licensed by the Texas Medical Board and who: (A) is a citizen of the United States; and (B) specializes in the practice of otolaryngology.Interested persons should submit an application on the Department website at: https://www.tdlr.texas.gov/AdvisoryBoard/login.aspx. Applicants can also request an application from the Department by telephone (800) 803-9202 or e-mail advisory.boards@tdlr.texas.gov.

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Texas Department of Licensing and Regulation

In Addition

Notice of Vacancies on Midwives Advisory Board

In Addition

Notice of Vacancies on Orthotists and Prosthetists Advisory Board

NOTICE OF VACANCY The Texas Department of Licensing and Regulation (Department) announces two vacancies on the Orthotists and Prosthetists Advisory Board (Board) established by Texas Occupations Code, Chapter 605. The purpose of the Orthotists and Prosthetists Advisory Board is to provide advice and recommendations to the Department on technical matters relevant to the administration of this chapter. INTERESTED PARTIES This announcement is for: one member who is a representative of the public who uses an orthosis; and one member who is a licensed prosthetist who has practiced for the five years preceding the date of appointment.Interested persons should submit an application on the Department website at: https://www.tdlr.texas.gov/AdvisoryBoard/login.aspx. Applicants can also request an application from the Department by telephone (800) 803-9202 or e-mail advisory.boards@tdlr.texas.gov.

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Texas Department of Licensing and Regulation

In Addition

Notice of Vacancies on the Dietitians Advisory Board

NOTICE OF VACANCY The Texas Department of Licensing and Regulation (Department) announces two vacancies on the Dietitians Advisory Board (Board) established by Texas Occupations Code, Chapter 701. The purpose of the Dietitians Advisory Board is to provide advice and recommendations to the Department on technical matters relevant to the administration of this chapter. INTERESTED PARTIES This announcement is for: two members who represent the public.Interested persons should complete an application on the Department website at: https://www.tdlr.texas.gov/AdvisoryBoard/login.aspx. Applicants can also request an application from the Department by telephone (800) 803-9202 or e-mail advisory.boards@tdlr.texas.gov.

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Texas Department of Licensing and Regulation

In Addition

Notice of Vacancy on Massage Therapy Advisory Board

NOTICE OF VACANCY The Texas Department of Licensing and Regulation (Department) announces one vacancy on the Massage Therapy Advisory Board (Board) established by Texas Occupations Code, Chapter 455. The purpose of the Board is to provide advice and recommendations to the Texas Commission of Licensing and Regulation (Commission) and the Department on technical matters relevant to the administration of this chapter. INTERESTED PARTIES This announcement is for: one member of the public.Interested persons should submit an application on the Department website at: https://www.tdlr.texas.gov/AdvisoryBoard/login.aspx. Applicants can also request an application from the Department by telephone (800) 803-9202 or e-mail advisory.boards@tdlr.texas.gov.

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