Texas Register November 8, 2019 Volume: 44 Number: 45

Texas Medical Board

 

Proposed Rules

Proposes amendments to 22 TAC §163.13, concerning Expedited Licensure

CHAPTER 163. LICENSURE22 TAC §163.13Section 163.13, relating to Expedited Licensure, is amended to implement a legislative mandate in H.B. 1504 (86th Regular Legislative Session) requiring the Board to develop an expedited licensing process for certain applicants who also hold an out-of-state license in good standing.

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Texas Medical Board

Proposed Rules

Proposes a new rule to 22 TAC 165, relating to Out-of-Network Provider Notice and Disclosure Requirements, §165.7

CHAPTER 165. MEDICAL RECORDS22 TAC §165.7The new rule §165.7 implements a legislative mandate in S.B. 1264 (86th Regular Legislative Session) requiring the Board to develop a notice and disclosure form related to cost estimate for out-of-network providers performing elective medical procedures. The provider must furnish the notice and disclosure form to the patient prior to undergoing such elective procedures.

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Texas Medical Board

Proposed Rules

Proposes amendments to 22 TAC §193.5, concerning Physician Liability for Delegated Acts and Enforcement,; §193.13, concerning Certified Registered Nurse Anesthetists; and §193.17, concerning Nonsurgical Medical Cosmetic Procedures, and a new §193.21, concerning Delegation Related to Radiological Services

CHAPTER 193. STANDING DELEGATION ORDERS22 TAC §§193.5, 193.13, 193.17, 193.21The amendments to §193.5 relating to Physician Liability for Delegated Acts and Enforcement, adds new subsections (c) and (d) in order to clarify that the physician and the delegate relationship applies for providers other than PA and APRN’s.The amendments to §193.13 relating to Delegation to Certified Registered Nurse Anesthetists, adds clarifying language and new subsections (d), (e) and (f) relating to the roles and responsibilities of the delegating physician and CRNAs. The rule clarifies that a CRNA does have not independent practice authority, but significant discretion in performing delegated duties. This clarifying language is a direct result of a recent Attorney General Opinion directly on point.The amendments to §193.17 relating to Nonsurgical Medical Cosmetic Procedures, adds clarifying language addressing the responsibilities of delegating physician and providers while providing non-surgical cosmetic procedures in medspas. New subsection (f) is proposed to ensure that delegating and supervising physicians of medspas are required to report such delegation relationships to the Board. These rule amendments arose out of increasing concerns over relating to non-surgical cosmetic procedures being provided at medspas without physician involvement and without proper delegation and supervision.The proposed new rule §193.21, relating Delegation Related to Radiological Services, adds requirements to ensure proper oversight by delegating physicians involving radiological studies and treatment plans.

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Texas Health and Human Services Commission

Adopted Rules

Adopts an amendment to §354.1707, concerning Performer Valuations, in Texas Administrative Code (TAC) Title 1, Chapter 354, Subchapter D, Division 7 and adopts new Division 8, concerning DSRIP Program Demonstration Years 9-10

CHAPTER 354. MEDICAID HEALTH SERVICESSUBCHAPTER D. TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAMThe Texas Health and Human Services Commission (HHSC) adopts an amendment to §354.1707, concerning Performer Valuations, in Texas Administrative Code (TAC) Title 1, Chapter 354, Subchapter D, Division 7 and adopts new Division 8, concerning DSRIP Program Demonstration Years 9-10, consisting of new §354.1729, concerning Definitions; new §354.1731, concerning Medicaid and Low-income or Uninsured Patient Population by Provider; new §354.1733, concerning Regional Healthcare Partnerships (RHPs); new §354.1735, concerning Participants; new §354.1737, concerning RHP Plan Update for DY9-10; new §354.1739, concerning RHP Plan Update Review; new §354.1741, concerning RHP Plan Update Modifications; new §354.1743, concerning Independent Assessor; new §354.1745, concerning Categories; new §354.1747, concerning Performer Valuations; new §354.1749, concerning Category A Requirements for Performers; new §354.1751, concerning Category B Requirements for Performers; new §354.1753, concerning Category C Requirements for Performers; new §354.1755, concerning Category D Requirements for Performers; and new §354.1757, concerning Disbursement of Funds.New §354.1731 and §354.1747 are adopted with changes to the proposed text as published in the August 2, 2019, issue of the Texas Register (44 TexReg 3977) and are being republished. The remaining sections are adopted without changes to the proposed text as published in the August 2, 2019, issue of the Texas Register (44 TexReg 3977), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONOn December 12, 2011, the Centers for Medicare & Medicaid Services (CMS) approved Texas’ request for a new Medicaid demonstration waiver entitled “Texas Healthcare Transformation and Quality Improvement Program” in accordance with section 1115 of the Social Security Act. This waiver authorized the establishment of the Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program provides incentive payments to hospitals, physician practices, community mental health centers, and local health departments to support their efforts to enhance access to health care, the quality of care, and the health of patients and families served.The initial waiver was approved through September 30, 2016, and an initial extension was granted through December 31, 2017. On December 21, 2017, CMS granted a five-year extension of the waiver through September 30, 2022.The Program Funding and Mechanics (PFM) protocol and Measure Bundle Protocol govern DSRIP for Demonstration Years (DYs) 9-10 (October 1, 2019 – September 30, 2021). HHSC posted the draft PFM protocol proposal for DYs 9-10, along with a survey to solicit stakeholder feedback on the proposal, to the Transformation Waiver website on January 3, 2019. HHSC revised the PFM protocol proposal based on these survey responses and submitted it to CMS on March 29, 2019. The adopted rules closely align with the PFM protocol proposal submitted to CMS. HHSC will update these rules, as necessary, in accordance with CMS guidance.The purpose of the new rules is to specify the DSRIP program requirements for DYs 9-10 consistent with the PFM protocol HHSC proposed to CMS. The purpose of the amendment to §354.1707, relating to Performer Valuations, is to reflect the reduction to the Regional Healthcare Partnership (RHP) 9 private hospital valuation and minimum private hospital valuation per DY for DYs 7-8 due to the closure of a private hospital in that RHP.

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Texas Medical Board

Adopted Rules

Adopts new §160.31, concerning exemption from licensure for certain military spouses for medical physicists

CHAPTER 160. MEDICAL PHYSICISTS22 TAC §160.31The Texas Medical Board (Board) adopts new §160.31, concerning exemption from licensure for certain military spouses for medical physicists. The new rule is being adopted without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4814). The adopted will not be republished.The new rule is mandated by the passage of SB 1200 (86th Regular Legislative Session) and relates to exemption from licensure for certain military spouses. This rule allows qualified military spouses to practice medical physics without obtaining a medical physicist license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas.

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Texas Medical Board

Adopted Rules

Adopts amendments and deletions were necessary to accurately reflect the operations of the board and eliminate obsolete committees and their related functions

CHAPTER 161. GENERAL PROVISIONSThe Texas Medical Board (Board) adopts amendments to 22 TAC §161.1, concerning Introduction, §161.2, concerning Purpose and Functions, §161.3, concerning Organization and Structure, §161.4, concerning Officers of the Board, §161.5, concerning Meetings, §161.6, concerning Committees of the Board and the repeal of §§161.8, 161.9, 161.11 – 161.13, without changes to the proposed text as published in the September 13, 2019, issue of the Texas Register (44 TexReg 4930). The adopted rules will not be republished.The Board determined that the amendments and deletions were necessary to accurately reflect the operations of the board and eliminate obsolete committees and their related functions.The Board has determined that the public benefit anticipated as a result of enforcing this adoption will be to simplify and clarify the functions and operations of the board that are not otherwise clearly set out in statute. This increases public ability to understand the functions and duties of the board.

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Texas Medical Board

Adopted Rules

Adopts new rule §163.3, concerning exemption from licensure for certain military spouses for physicians

CHAPTER 163. LICENSURE22 TAC §163.3The Texas Medical Board (Board) adopts new rule §163.3, concerning exemption from licensure for certain military spouses for physicians. The new rule is being adopted without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4815). The adopted rule will not be republished.The new rule is mandated by the passage of SB 1200 (86th Regular Legislative Session) and relates to exemption from licensure for certain military spouses who are physicians. New rule, §163.3 Exemption from Licensure for Certain Military Spouses regarding Physicians, allows qualified military spouses to practice medicine without obtaining a license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas.

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Texas Medical Board

Adopted Rules

Adopts new rule §183.27, concerning exemption from licensure for certain military spouses for acupuncturists

CHAPTER 183. ACUPUNCTURE22 TAC §183.27The Texas Medical Board (Board) adopts new rule §183.27, concerning exemption from licensure for certain military spouses for acupuncturists. The new rule is being adopted without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4819). The adopted rule will not be republished.The new rule is mandated by the passage of SB 1200 (86th Regular Legislative Session) and relates to exemption from licensure for certain military spouses. New rule §183.27, Exemption from Licensure for Certain Military Spouses regarding acupuncturists, allows qualified military spouses to practice acupuncture without obtaining a license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas.

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Texas Medical Board

Adopted Rules

Adopts new rule §185.33, concerning exemption from licensure for certain military spouses for physician assistants

CHAPTER 185. PHYSICIAN ASSISTANTS22 TAC §185.33The Texas Medical Board (Board) adopts new rule §185.33, concerning exemption from licensure for certain military spouses for physician assistants. The new rule is being adopted without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4821). The adopted rule will not be republished.The new rule is mandated by the passage of SB 1200 (86th Regular Legislative Session) and relates to exemption from licensure for certain military spouses. New rule §185.33, Exemption from Licensure for Certain Military Spouses, allows qualified military spouses to practice as a physician assistant without obtaining a license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas.

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Texas Medical Board

Adopted Rules

Adopts new rule §186.30, concerning exemption from licensure for certain military spouses for respiratory care practitioners

CHAPTER 186. RESPIRATORY CARE PRACTITIONERS22 TAC §186.30The Texas Medical Board (Board) adopts new rule §186.30, concerning exemption from licensure for certain military spouses for respiratory care practitioners. The new rule is being adopted without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4822). The adopted rule will not be republished.The new rule is mandated by the passage of SB 1200 (86th Regular Legislative Session) and relates to exemption from licensure for certain military spouses. New rule §186.30, Exemption from Licensure for Certain Military Spouses regarding respiratory care practitioners, allows qualified military spouses to practice as a respiratory care practitioner without obtaining a license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas.

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Texas Medical Board

Adopted Rules

Adopts new rule §188.30, concerning exemption from licensure for certain military spouses for perfusionists

CHAPTER 188. PERFUSIONISTS22 TAC §188.30The Texas Medical Board (Board) adopts new rule §188.30, concerning exemption from licensure for certain military spouses for perfusionists. The new rule is being adopted without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4823). The adopted rule will not be republished.The adopted new rule is mandated by the passage of SB 1200 (86th Regular Legislative Session) and relates to exemption from licensure for certain military spouses. New rule §188.30, Exemption from Licensure for Certain Military Spouses regarding perfusionists, allows qualified military spouses to practice as a perfusionist without obtaining a license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas.

Texas Medical Board

Adopted Rules

Adopts amendments to Subchapter A, Certificate Holders, Non-Certified Technicians, and Other Authorized Individuals or Entities

CHAPTER 194. MEDICAL RADIOLOGICAL TECHNOLOGYSUBCHAPTER A. CERTIFICATE HOLDERS, NON-CERTIFIED TECHNICIANS, AND OTHER AUTHORIZED INDIVIDUALS OR ENTITIES22 TAC §§194.2, 194.6, 194.7, 194.10, 194.21, 194.34The Texas Medical Board (Board) adopts amendments to Subchapter A, Certificate Holders, Non-Certified Technicians, and Other Authorized Individuals or Entities regarding §194.2, concerning Definitions, §194.6, concerning Procedural Rules and Minimum Eligibility Requirements for Applicants for a Certificate or Placement on the Board’s Non-Certified Technician Registry, §194.7, concerning Biennial Renewal of Certificate or Placement on the Board’s Non-Certified Technician Registry, §194.10, concerning Retired Certificate or NCT Registration, §194.21, concerning Scope of Practice, and new §194.34, Exemption from Licensure for Certain Military Spouses.The amendments to §§194.2, 194.6, 194.7, 194.10, 194.21, and new §194.34, are being adopted with changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4825), incorporating stakeholder feedback. The adopted rules will be republished.The adopted amendment to §194.2, relating to Definitions, is amended with new definitions for “Certification Board for Radiology Practitioner Assistants”, “radiologist”, and “radiologist assistant.” The amended section is adopted with changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4825), amending the definitions for “podiatrist” so that the licensing entity is accurately reflected to be the Texas Department of Licensing and Regulation, and podiatric medical degree accurately described.The adopted amendment to §194.6, relating to Procedural Rules and Minimum Eligibility Requirements for Applicants for a Certificate or Placement on the Board’s Non-Certified Technician General Registry, is adopted with non-substantive changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4825), so that individuals performing radiologic procedures under the supervision of a podiatrist are not required to register with the Texas Board of Medical Radiologic Technology (MRT Board). The language is added in accordance with HB 2847 (86th Legislature), which transferred the authority for registering such individuals from the MRT Board to the Texas Department of Licensure and Regulation. In addition, the adopted new language establishes eligibility requirements that must be met in order for an applicant to obtain a temporary or regular radiologist assistant certificate, pursuant to HB 1504 (86th Legislature). Other amendments delete references to the NCT “general” registry, a distinction no longer required after the passage of SB 674 (85th Regular Session), which eliminated the NCT secondary registry with the Texas Medical Board. Finally, adopted amendments represent changes necessitated by the new language to maintain consistency and clarity throughout the section.The adopted amendments to §194.7, relating to Biennial Renewal of Certificate or Placement on the Board’s General Registry for Non-Certified Technicians Generally, contain new language establishing continuing education requirements that must be met in order for a radiologist assistant certificate holder to renew a certificate, in accordance with HB 1504.The adopted amendments are further added to clarify that certificate holders and NCTs are required to “complete activities” meeting the RCEEM or RCEEM+ designation, as opposed to “attendance and participation in formal activities”, reflecting that web-based courses are formats that comply with the continuing education requirements.The adopted amendments are made to language mandating the denial of an application for renewal of a certificate or NCT registration upon notice of a Texas Guaranteed Student Loan Corporation guaranteed student loan is proposed for repeal, in accordance with SB 37 (86th Legislature).Other adopted amendments delete references to the NCT “general” registry, a distinction no longer required after the passage of SB 674 (85th Regular Session), which eliminated the NCT secondary registry with the Texas Medical Board. Remaining amendments represent changes necessitated by the new language related to radiologist assistant certificates, to maintain consistency and clarity throughout the section.The adopted amendment to §194.10, relating to Retired Certificate or NCT General Registration Permit, is amended so that references to the NCT “general” registry are eliminated throughout, a distinction no longer required after the passage of SB 674 (85th Regular Session). Language is added with a reference to the Certification Board for Radiology Practitioner Assistants (CBRPA) related to possible certification renewal requirements for a radiologist assistant with a retired certificate, who desires to return to active practice and who had initially obtained eligibility for a Texas certificate through CBRPA national certification. The proposed language reflects the new radiologist assistant eligibility requirements established by HB 1504 (86th Legislature).The adopted amendment to §194.21, relating to Scope of Practice, includes proposed changes to more precisely outline the allowed scope of practice for an individual holding a limited certificate.New §194.34, Exemption from Licensure for Certain Military Spouses (regarding Medical Radiologic Technologists), allows qualified military spouses to practice medical radiological technology without obtaining a license during the time the military service member to whom the military spouse is married is stationed at a military installation in Texas. The exemption cannot exceed three years, and practice must be authorized by the Board after verifying that the military spouse holds an active license in good standing in another state with substantially equivalent requirements for licensure as Texas. The adopted new rule is mandated by the passage of SB 1200 (86th Legislature).

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Texas Department of State Health Services

Adopted Rules

Relating to the licensing and regulation of wholesale distribution of nonprescription drugs and prescription drugs

CHAPTER 229. FOOD AND DRUGThe Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), adopts amendments to §229.249, concerning Licensure Fees, and §229.427, concerning Licensure Fees. The amendments are adopted without changes to the proposed text as published in the August 2, 2019, issue of the Texas Register (44 TexReg 4026), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONDSHS adopted rules under the authority of Texas Health and Safety Code, Chapter 431, Subchapters I and N, relating to the licensing and regulation of wholesale distribution of nonprescription drugs and prescription drugs. Title 25, Texas Administrative Code, Chapter 229, Subchapters O and W relate to the licensing and regulation of manufacturers and distributors of nonprescription and prescription drugs. DSHS has legal authority to set fees in amounts that are reasonable and necessary and allow DSHS to recover biennial expenditures under Texas Health and Safety Code, §431.409(b). Currently, the fees for prescription drug manufacturers and nonprescription drug distributors who are manufacturers are divided into three levels. DSHS is proposing a new fee structure which expands the fee structure into five levels. This change aligns the nonprescription drug manufacturer fees with prescription drug manufacturer fees assessed by DSHS. Adding additional levels will result in a reduction of fees for some businesses with gross annual sales ranging from $200,000 to $19,999,999.99.Under the authority of Texas Health and Safety Code, Chapter 431, the Food and Drug Safety program protects Texans from unnecessary morbidity and mortality through its regulation of people and entities that provide products and services that may pose a health threat if manufactured or used in an unapproved manner. The Drug Manufacturing program ensures that drugs are safe to consume and use, are properly labeled, and are not fraudulently presented. The Drug Manufacturing program issues two specific license types: nonprescription and prescription drug manufacturing. The objective of the rules is to create parity between small and large businesses and ensure smaller businesses are not paying a fee that is disproportionate to the amount of their sales.

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Texas Department of State Health Services

Adopted Rules

Relating to the licensing of wholesale distributors of nonprescription drugs–including good manufacturing practices

SUBCHAPTER O. LICENSING OF WHOLESALE DISTRIBUTORS OF NONPRESCRIPTION DRUGS–INCLUDING GOOD MANUFACTURING PRACTICES25 TAC §229.249STATUTORY AUTHORITYThe amendments are adopted under Texas Health and Safety Code, §431.241, which authorizes the Executive Commissioner of HHSC to adopt rules necessary for the implementation and enforcement of Chapter 431 by DSHS; Texas Health and Safety Code, §431.409(b) and §431.204(b) authorizes DSHS to collect fees for licenses; and Texas Government Code, §531.0055, and Texas Health and Safety Code, §1001.075, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of health and human services by DSHS and for the administration of Texas Health and Safety Code, Chapter 1001.

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Texas Department of State Health Services

Adopted Rules

Relating to the licensing of wholesale distributors of prescription drugs–including good manufacturing practices

SUBCHAPTER W. LICENSING OF WHOLESALE DISTRIBUTORS OF PRESCRIPTION DRUGS–INCLUDING GOOD MANUFACTURING PRACTICES25 TAC §229.427STATUTORY AUTHORITYThe amendments are adopted under Texas Health and Safety Code, §431.241, which authorizes the Executive Commissioner of HHSC to adopt rules necessary for the implementation and enforcement of Chapter 431 by DSHS; Texas Health and Safety Code, §431.409(b) and §431.204(b) authorizes DSHS to collect fees for licenses; and Texas Government Code, §531.0055, and Texas Health and Safety Code, §1001.075, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of health and human services by DSHS and for the administration of Texas Health and Safety Code, Chapter 1001.

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Texas Health and Human Services Commission

Adopted Rules

Recognition of certain out-of-state administrator’s licenses for military spouses

CHAPTER 745. LICENSINGSUBCHAPTER N. ADMINISTRATOR’S LICENSINGThe Texas Health and Human Services Commission (HHSC) adopts new §745.8914 and §745.9030 without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4844), and therefore will not be republished.BACKGROUND AND JUSTIFICATIONThe new sections are necessary to comply with Senate Bill (S.B.) 1200, 86th Legislature, Regular Session, 2019, which adds §55.0041 to the Texas Occupations Code to recognize certain out-of-state licenses for military spouses. The rules allow a military spouse to act as an administrator for a general residential operation, child-placing agency, or both without obtaining an administrator’s license from Child Care Licensing (CCL), a division of HHSC. The rules require the military spouse to be currently licensed in good standing by another state that has licensing requirements substantially equivalent to the requirements for a CCL administrator’s license in Texas. CCL regulates administrator’s licenses and promulgates rules related to that regulation under Chapter 43, Texas Human Resources Code.

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Texas Board of Occupational Therapy Examiners

Adopted Rules

Recognition of out-of-state licenses of military spouses

CHAPTER 364. REQUIREMENTS FOR LICENSURE40 TAC §364.5The Texas Board of Occupational Therapy Examiners adopts new rule §364.5, concerning recognition of out-of-state license of military spouse, without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4851). The rule will not be republished.The new rule is adopted to add provisions to the Occupational Therapy Rules concerning the recognition of out-of-state licenses of military spouses as required by SB 1200 of the 86th Regular Legislative Session.New rule §364.5 will add to the Occupational Therapy Rules provisions concerning the information a military spouse seeking recognition of the out-of-state license must submit to the Board and the conditions under which the military spouse may practice in the state once the individual has received confirmation from the Board that the military spouse is authorized to engage in the practice of occupational therapy. The adoption includes further provisions pursuant to SB 1200.

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Texas Board of Occupational Therapy Examiners

Adopted Rules

Removing language concerning restrictions to renewal for a licensee in default of a student loan

CHAPTER 370. LICENSE RENEWAL40 TAC §370.1The Texas Board of Occupational Therapy Examiners adopts amendments to §370.1, concerning license renewal, without changes to the proposed text as published in the September 6, 2019, issue of the Texas Register (44 TexReg 4852). The rule will not be republished.The amendments are adopted to remove language concerning restrictions to renewal for a licensee in default of a student loan pursuant to SB 37 of the 86th Regular Legislative Session and to cleanup and clarify provisions in the section.The adoption includes amendments to reflect law changes, already in effect, made by SB 37, relating to a prohibition on the use of student loan default or breach of a student loan repayment as a ground for refusal to renew a license. Related changes to §370.1 are adopted to remove from the section a provision restricting the renewal of a license for an individual who has defaulted with the Texas Guaranteed Student Loan Corporation.Additional amendments are adopted as cleanups and clarifications. An amendment is adopted to strike a reference in the section to the number of continuing education hours required per renewal period and to replace such with language referencing continuing education requirements as per Chapter 367, concerning Continuing Education, as previously adopted amendments to that chapter changed the number of required hours from thirty to twenty-four hours. Additional amendments are adopted to remove a redundant reference to the address of record, as language concerning such is already located elsewhere in the Occupational Therapy Rules, and to clarify a provision regarding a restriction on renewal for certain child support issues, including to add a reference to related statutory language in Texas Family Code.

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Texas Board of Occupational Therapy Examiners

In Addition

Readopts rules concerning procedures and requirements for nursing licensure in Texas, criteria for the Board’s peer assistance program, and standards for nursing practice and professional conduct

Title 22, Part 11In accordance with Government Code §2001.039, the Texas Board of Nursing (Board) filed a notice of intention to review and consider for re-adoption, re-adoption with amendments, or repeal, 22 Texas Administrative Code Chapters 211 and 217, pursuant to the rule review plan adopted by the Board at its July 2018 quarterly meeting. The notice appeared in the September 13, 2019, edition of the Texas Register, and the comment period ended on October 14, 2019. The Board did not receive any comments on either rule chapter.The Board has completed its review of these chapters and has determined that the reasons for originally adopting the rules continue to exist. Chapter 211 is necessary to organize and structure Board functions and Chapter 217 contains procedures and requirements for nursing licensure in Texas, criteria for the Board’s peer assistance program, and standards for nursing practice and professional conduct. The rules were also reviewed to determine whether they were obsolete, whether they reflected current legal and policy considerations and current procedures and practices of the Board, and whether they were in compliance with Texas Government Code Chapter 2001 (Texas Administrative Procedure Act). The Board finds that the rules are not obsolete, reflect current legal and policy considerations, current procedures and practices of the Board, and that the rules are in compliance with the Texas Administrative Procedure Act.The Board readopts the rules in Chapters 211 and 217 without changes, pursuant to the Texas Government Code §2001.039 and Texas Occupations Code §301.151, which authorizes the Board to adopt, enforce, and repeal rules consistent with its legislative authority under the Nursing Practice Act. This concludes the rule review of Chapter 211 and 217 under the 2019 rule review plan adopted by the Board.

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Advisory Board of Athletic Trainers

In Addition

Amendments to three notices of requests to CMS to amend the Home and Community-based Services (HCS) waiver, the Texas Home Living (TxHmL) waiver program, and the Deaf Blind with Multiple Disabilities (DBMD) waiver

The Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request to amend the Home and Community-based Services (HCS) waiver administered under section 1915(c) of the Social Security Act. CMS has approved this waiver through August 31, 2023. The proposed effective date for the amendment is March 9, 2020.The Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request for an amendment to the Texas Home Living (TxHmL) waiver program, a waiver implemented under the authority of section 1915(c) of the Social Security Act. CMS has approved this waiver through February 28, 2022. The proposed effective date for this amendment is March 9, 2020.The Texas Health and Human Services Commission (HHSC) is submitting to the Centers for Medicare & Medicaid Services (CMS) a request to amend the Deaf Blind with Multiple Disabilities (DBMD) waiver administered under section 1915(c) of the Social Security Act. CMS has approved this waiver through February 28, 2023. The proposed effective date for the amendment is March 9, 2020. This notice was originally published in the November 1, 2019, issue of the Texas Register. The original notice indicated that HHSC was removing performance measure D.E.1, relating to the number and percent of individuals who were afforded choice among waiver providers during enrollment. This measure is not being deleted from the waiver application.

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Advisory Board of Athletic Trainers

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for Indian Health Services

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 18, 2019, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for Indian Health Services.The public hearing will be held in HHSC’s Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Boulevard, Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC also will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for the Indian Health Services are proposed to be effective January 1, 2019.

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Advisory Board of Athletic Trainers

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Review

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 18, 2019, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medicaid Biennial Calendar Fee Review.The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.

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Advisory Board of Athletic Trainers

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medical Policy Review of Continuous Glucose Monitoring

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 18, 2019, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medical Policy Review of Continuous Glucose Monitoring.The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for the Medical Policy Review of Continuous Glucose Monitoring are proposed to be effective January 1, 2020.

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Advisory Board of Athletic Trainers

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medical Policy Review of Fetal Magnetic Resonance Imaging (MRI)

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 18, 2019, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medical Policy Review of Fetal Magnetic Resonance Imaging (MRI).The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for the Medical Policy Review of Fetal Magnetic Resonance Imaging (MRI) are proposed to be effective January 1, 2020.

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Advisory Board of Athletic Trainers

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Medical Policy Review of Vision Services Nonsurgical

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 18, 2019, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Medical Policy Review of Vision Services Nonsurgical.The public hearing will be held in the HHSC Public Hearing Room at the Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for the Medical Policy Review of Vision Services Nonsurgical are proposed to be effective January 1, 2020.

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Advisory Board of Athletic Trainers

In Addition

Notice of Public Hearing on Proposed Medicaid Payment Rates for the Quarterly Healthcare Common Procedure Coding System (HCPCS) Updates

Hearing. The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on November 18, 2019, at 1:30 p.m., to receive comment on proposed Medicaid payment rates for the Quarterly HCPCS Updates.The public hearing will be held in the HHSC Public Hearing Room, Brown-Heatly Building, located at 4900 North Lamar Blvd., Austin, Texas. Entry is through security at the main entrance of the building, which faces Lamar Boulevard. HHSC will broadcast the public hearing; the broadcast can be accessed at https://hhs.texas.gov/about-hhs/communications-events/live-archived-meetings. The broadcast will be archived and can be accessed on demand at the same website. The hearing will be held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.Proposal. The payment rates for the Quarterly HCPCS Updates are proposed to be effective January 1, 2020, for Physician Administered Drugs.

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