Proposed Rules Title 16

TITLE 16. ECONOMIC REGULATION

PART 4. TEXAS DEPARTMENT OF LICENSING AND REGULATION

CHAPTER 130. PODIATRIC MEDICINE PROGRAM

The Texas Department of Licensing and Regulation (Department) proposes amendments to existing rules at 16 Texas Administrative Code (TAC) Chapter 130, Subchapter A, §130.1 and §130.2; Subchapter B, §§130.20, 130.23,130.27, and 130.28; Subchapter C, §130.30 and §130.32; Subchapter D §§130.40 - 130.42; Subchapter E, §§130.50, 130.51, 130.54, 130.55, and §§130.57 - 130.59; Subchapter F, §130.60; and Subchapter G, §§130.70, 130.72, and 130.73; proposes new rules at Subchapter B, §§130.21. 130.22, and 130.24, Subchapter C, §§130.31, 130.34 - 130.37; and Subchapter D, §§130.43 - 130.48; and proposes the repeal of existing rules at Subchapter B, §§130.21, 130.22, and 130.24, Subchapter C, §130.31, Subchapter D, §§130.43 - 130.49; and Subchapter E, §130.52 and §130.53, regarding the Podiatric Medicine Program. These proposed changes are referred to as "proposed rules."

EXPLANATION OF AND JUSTIFICATION FOR THE RULES

The rules under 16 TAC, Chapter 130, implement Texas Occupations Code, Chapter 202, Podiatrists; and Chapter 51, the enabling statute of the Texas Commission of Licensing and Regulation (Commission) and the Department. Specific provisions within this rule chapter also implement the statutory requirements under Texas Occupations Code, Chapters 53, 108, 112, 116, and 601.

The proposed rules are necessary to implement changes recommended as a result of the required four-year rule review conducted under Texas Government Code §2001.039. The Department's Notice of Intent to Review 16 TAC, Chapter 130, was published in the September 3, 2021, issue of the Texas Register (46 TexReg 5598). At its meeting on October 18, 2022, the Commission readopted the rule chapter in its entirety without changes. The readoption notice was published in the February 25, 2022, issue of the Texas Register (47 TexReg 988).

In response to the Notice of Intent to Review that was published, the Department received one public comment from one interested party regarding Chapter 130. The comment questioned whether there is a fee for an inactive status license. The comment has been addressed in the proposed rules by explaining that there is not a fee for an inactive license.

The proposed rules also include changes recommended by Department staff during the rule review process to reorganize and streamline the entire chapter. These recommendations include changes to consolidate the existing rules, reorganize provisions by subject matter, expand existing Subchapter C, eliminate duplicative provisions, and apply plain language principles to improve clarity.

The proposed rules also change the license terms for the Podiatric Medical Radiological Technician license, the Hyperbaric Oxygen Certificate, and the Nitrous Oxide/Oxygen Inhalation Conscious Sedation Registration. Beginning January 1, 2025, all three license types will change from one-year to two-year terms and application and renewal fees will be updated to reflect this change. Existing licenses renewed by the Department will be valid for one year if renewed before January 1, 2025, or for two years if renewed on or after January 1, 2025.

Advisory Board Recommendations

The proposed rules were presented to and discussed by the Podiatric Medical Examiners Advisory Board at its meeting on May 13, 2024. The Advisory Board did not make any changes to the proposed rules. The Advisory Board voted and recommended that the proposed rules be published in the Texas Register for public comment.

SECTION-BY-SECTION SUMMARY

Subchapter A. General Provisions.

The proposed rules amend §130.1, Authority. The proposed rules change the name of the section from "Authority" to "Authority and Applicability." The proposed rules amend subsection (a) to identify other statutes that are implemented by the rules in Chapter 130. The proposed rules also add new subsection (b) to explain that the Chapters 60 and 100 rules also apply to the Podiatry program.

The proposed rules amend §130.2, Definitions. The proposed rules update the definition of "Podiatric Medical Radiological Technician" to clarify that the term includes a Podiatry X-ray Machine Operator. The proposed rules update the definition of "Practitioner" to clarify that the term includes a podiatrist and a podiatric physician. The proposed rules also remove unnecessary language from the definition of "Act" and add clarifying language to the definition of "License."

Subchapter B. Advisory Board.

The proposed rules amend §130.20, Board Membership. The proposed rules streamline this section by referring to the Occupations Code instead of repeating it verbatim.

The proposed rules repeal existing §130.21, Public Member Eligibility. This section is replaced with new §130.21, Public Member Eligibility.

The proposed rules add new §130.21, Public Member Eligibility. The proposed rules streamline this section by referring to the Occupations Code instead of repeating it verbatim.

The proposed rules repeal existing §130.22, Membership and Employee Restrictions. This section is replaced with new §130.22, Membership and Employee Restrictions.

The proposed rules add new §130.22, Membership and Employee Restrictions. The proposed rules streamline this section by referring to the Occupations Code instead of repeating it verbatim.

The proposed rules amend §130.23, Terms; Vacancies. The proposed rules streamline this section by referring to the Occupations Code instead of repeating it verbatim.

The proposed rules repeal existing §130.24, Grounds for Removal. This section is replaced with new §130.24, Grounds for Removal.

The proposed rules add new §130.24, Grounds for Removal. The proposed rules streamline this section by referring to the Occupations Code instead of repeating it verbatim.

The proposed rules amend §130.27, Advisory Board Meetings and Duties of Department. The proposed rules merge subsection (i) into subsection (g).

The proposed rules amend §130.28, Training. The proposed rules streamline this section by referring to the Occupations Code instead of repeating it verbatim.

Subchapter C. Temporary Residency and Other License Types.

The proposed rules amend Subchapter C, Temporary Residency. The proposed rules rename Subchapter C from "Temporary Residency" to "Temporary Residency and Other License Types," which now includes requirements for a Limited Faculty License, for a Podiatric Medical Radiological Technician Registration, for a Hyperbaric Oxygen Certificate, and for a Nitrous Oxide/Oxygen Inhalation Conscious Sedation Registration.

The proposed rules amend §130.30, Temporary Residency License--General Requirements and Application. The proposed rules remove the word "successfully" and replace the word "shall" with "must."

The proposed rules repeal existing §130.31, Temporary Residency License--Residency Requirements; Program Responsibilities; License Term. This section is replaced with new §130.31, Temporary Residency License--License Term; Residency Requirements; Program Responsibilities.

The proposed rules add new §130.31, Temporary Residency License--License Term; Residency Requirements; Program Responsibilities. The proposed rules rename the section from "Temporary Residency License--Residency Requirements; Program Responsibilities; License Term" to "Temporary Residency License--License Term; Residency Requirements; Program Responsibilities." The proposed rules rearrange the order of the section to increase readability.

The proposed rules amend §130.32, Temporary Residency License--Final Year of Residency. The proposed rules streamline the section to increase readability, rearrange the order of the section, and establish requirements a resident must follow in their final year of residency.

The proposed rules add new §130.34, Limited Faculty License--Requirements; License Term. The proposed rules create a standalone section for a limited faculty license by relocating existing §130.40(b) and §130.42(d) to this section. The proposed rules explain the requirements for procuring a limited faculty license and establish that the term of this license is up to two years. The proposed rules also establish when a limited faculty license will be terminated and that termination does not preclude a podiatrist from applying for or holding another license type issued under this subchapter.

The proposed rules add new §130.35, Podiatric Medical Radiological Technicians. The proposed rules relocate existing §130.53 to this section and update the number of training hours needed for podiatric medical radiological technicians. The proposed rules also change the length of the registration term from one year to two years. A registration is valid for one year if the registration was issued before January 1, 2025, or two years if the registration was issued on or after January 1, 2025. Similarly, the proposed rules establish that a registration renewed by the department is valid for one year if the renewal was issued before January 1, 2025, and must be renewed annually, or two years if the renewal was issued on or after January 1, 2025, and must be renewed every two years. The proposed rules explain the process for completing a renewal application, establish that human trafficking prevention training is required for each renewal, and explain when the department may refuse to issue or renew a registration.

The proposed rules add new §130.36, Hyperbaric Oxygen Certificate--Application Requirements and Guidelines. The proposed rules relocate existing §130.47 to this section and change the length of the certificate term from one year to two years. A certificate is valid for one year if the certificate was issued before January 1, 2025, or two years if the certificate was issued on or after January 1, 2025. Similarly, the proposed rules establish that a certificate renewed by the department is valid for one year if the renewal was issued before January 1, 2025, and must be renewed annually, or two years if the renewal was issued on or after January 1, 2025, and must be renewed every two years.

The proposed rules add new §130.37, Nitrous Oxide/Oxygen Inhalation Conscious Sedation-Registration Requirements, Guidelines, and Direct Supervision. The proposed rules relocate existing §130.48 to this section and change the length of the certificate term from one year to two years. A registration is valid for one year if the registration was issued before January 1, 2025, or two years if the registration was issued on or after January 1, 2025. Similarly, the proposed rules establish that a registration renewed by the department is valid for one year if the renewal was issued before January 1, 2025, and must be renewed annually, or two years if the renewal was issued on or after January 1, 2025, and must be renewed every two years.

Subchapter D. Doctor of Podiatric Medicine.

The proposed rules amend §130.40, Doctor of Podiatric Medicine License--General Requirements and Application; Limited Faculty License. The proposed rules change the name of the section from "Doctor of Podiatric Medicine License--General Requirements and Applications; Limited Faculty License" to "Doctor of Podiatric Medicine License--General Requirements and Application." The proposed rules relocate the limited faculty license language to new §130.34 and streamline the remaining language to make it easier to read.

The proposed rules amend §130.41, Doctor of Podiatric Medicine License--Jurisprudence Exam. The proposed rules replace the word "shall" with "must."

The proposed rules amend §130.42, Doctor of Podiatric Medicine License--Term; Renewal. The proposed rules remove language relating to a limited faculty license and relocate it to new §130.34. The proposed rules also remove outdated language and add clarifying language.

The proposed rules repeal existing §130.43, Doctor of Podiatric Medicine License--Provisional License. This section is replaced with new §130.43, Doctor of Podiatric Medicine License--Provisional License.

The proposed rules add new §130.43, Doctor of Podiatric Medicine License--Provisional License. The proposed rules remove duplicative language located elsewhere in the chapter and streamline the remaining language to make it easier to read.

The proposed rules repeal existing §130.44, Continuing Medical Education--General Requirements. This section is replaced with new §130.44, Continuing Medical Education--General Requirements.

The proposed rules add new §130.44, Continuing Medical Education--General Requirements. The proposed rules streamline the section and relocate the continuing medical education audit process to new §130.45.

The proposed rules repeal §130.45, Continuing Medical Education--Exceptions and Allowances; Approval of Hours. The proposed rules relocate the repealed provisions to new §130.46.

The proposed rules add new §130.45, Continuing Medical Education--Audit Process. The proposed rules relocate audit information from current §130.44 and establish that the Department will select random license holders to ensure compliance with CME hours.

The proposed rules repeal §130.46, Inactive Status. The proposed rules relocate the repealed provisions to new §130.47.

The proposed rules add new §130.46, Continuing Medical Education--Exceptions and Allowances; Approval of Hours. The proposed rules relocate the requirements of existing §130.45 to this new section.

The proposed rules repeal §130.47, Hyperbaric Oxygen Certificate--Application Requirements and Guidelines. The proposed rules relocate the repealed provisions to new §130.36.

The proposed rules add new §130.47, Inactive Status. The proposed rules relocate the requirements of existing §130.46 to this new section and establish that a practitioner may place a license on inactive status at no cost.

The proposed rules repeal §130.48, Nitrous Oxide/Oxygen Inhalation Conscious Sedation--Registration Requirements, Guidelines, and Direct Supervision. The proposed rules relocate the repealed provisions to new §130.37.

The proposed rules add new §130.48, Voluntary Charity Care Status. The proposed rules relocate the requirements of existing §130.49 to this new section.

The proposed rules repeal §130.49, Voluntary Charity Care Status. The proposed rules relocate the repealed provisions to new §130.48.

Subchapter E. Practitioner Responsibilities and Code of Ethics.

The proposed rules amend §130.50, Practitioner Identification; Professional Corporations or Associations. The proposed rules remove language regarding the purpose of this section and streamline the rest of the section to make it easier to read.

The proposed rules amend §130.51, Advertising. The proposed rules streamline the section and remove language relating to certifying boards that are not recognized by the Council of Podiatric Medical Education of the American Podiatric Medical Association.

The proposed rules repeal §130.52, Medical Offices, because the Department does not regulate medical offices, but individual licensees.

The proposed rules repeal §130.53, Podiatric Medical Radiological Technicians. The proposed rules relocate the repealed provisions to new §130.35.

The proposed rules amend §130.54, Records. The proposed rules streamline the section to make it easier to read.

The proposed rules amend §130.55, Practitioner Code of Ethics. The proposed rules add new subsection (g) to establish that treatment must be consistent with best practices and standards observed in the podiatry community.

The proposed rules amend §130.57, Sexual Misconduct. The proposed rules streamline the section to make it easier to read.

The proposed rules amend §130.58, Standards for Prescribing Controlled Substances and Dangerous Drugs. The proposed rules streamline the section to make it easier to read.

The proposed rules amend §130.59, Opioid Prescription Limits and Required Electronic Prescribing. The proposed rules streamline the section to make it easier to read.

Subchapter F. Fees.

The proposed rules amend §130.60, Fees. The proposed rules update the fees for the hyperbaric oxygen certificate, the nitrous oxide registration, and the podiatric medical radiological technician registration, because the certificate and registration terms are changed from one year to two years. The fees are $25 if the certificate or registration is issued or renewed before January 1, 2025, or $50 if the certificate or registration is issued or renewed on or after January 1, 2025. The proposed rules add a $0 fee for an Inactive Status License (Initial and Renewal). The proposed rules also make clean-up changes to the cross-referenced fees under Chapter 60.

Subchapter G. Enforcement.

The proposed rules amend §130.70, Complaints and Claims. The proposed rules replace the word "shall" with "must" and streamline the section to make it easier to read.

The proposed rules amend §130.72, Administrative Penalties and Sanctions. The proposed rules clarify that a person or entity who violates or attempts to violate the Occupations Code, this chapter, or any rule of the commission may face proceedings against them.

The proposed rules amend §130.73, Conditions of Suspension of License. The proposed rules streamline the section to make it easier to read.

FISCAL IMPACT ON STATE AND LOCAL GOVERNMENT

State Government Costs and Revenues

Tony Couvillon, Policy Research and Budget Analyst, has determined that for each year of the first five years the proposed rules are in effect, there are no estimated additional costs or reductions in costs to state government as a result of enforcing or administering the proposed rules. Any activities required to implement the proposed rule changes, if any, are one-time program administration tasks that are routine in nature, such as modifying or revising publications or website information, which will also not result in an increase or decrease in program costs.

Mr. Couvillon has determined that for each year of the first five years the proposed rules are in effect, the only increase in revenue to state government will occur in the latter eight months of the first fiscal year, by approximately $4,200. The revenue in all subsequent fiscal years will be approximately the same as current revenue amounts.

The increase in revenue is a result of the proposed rules doubling the length of the license term for the Registered Podiatric Medical Radiological Technician registration, the Hyperbaric Oxygen certificate, and the Nitrous Oxide/Oxygen Inhalation Conscious Sedation registration. The application fees for these licenses will need to double as well, to keep the amount of revenue for the administration of the program consistent. The increase in revenue will occur when some of the licensee population will pay application fees that are doubled, when, prior to the adoption of the proposed rules, these applicants would not have paid doubled fees.

Mr. Couvillon has determined that for each year of the first five years the proposed rules are in effect, there is no estimated loss in revenue to the state as a result of enforcing or administering the proposed rules. The proposed rules do not create a revenue loss, as they do not eliminate or decrease any fees assessed by the licensing program.

Local Government Costs and Revenues

Mr. Couvillon has determined that for each year of the first five years the proposed rules are in effect, enforcing or administering the proposed rules does not have foreseeable implications relating to costs or revenues of local governments. There is no impact to local government costs or revenues because local governments are not responsible for any regulation of podiatry.

LOCAL EMPLOYMENT IMPACT STATEMENT

Because Mr. Couvillon has determined that the proposed rules will not affect a local economy, the agency is not required to prepare a local employment impact statement under Texas Government Code §2001.022. The proposed rules have no anticipated impact on the local economy because they are not anticipated to increase or decrease employment opportunities for professionals licensed under Texas Occupations Code Chapter 202 in any area of the state or increase or decrease the number of individuals who may choose to become licensed in the podiatry program.

PUBLIC BENEFITS

Mr. Couvillon also has determined that for each year of the first five-year period the proposed rules are in effect, the public benefit will be an effective and efficient regulatory program for podiatry, which protects the health, safety, and welfare of the citizens of Texas. The proposed rules clarify, streamline, and reorganize the rules to make them more user friendly for licensees and the public. The proposed rules also change the license terms for the Registered Podiatric Medical Radiological Technician licenses, the Hyperbaric Oxygen certificates, and the Nitrous Oxide/Oxygen Inhalation Conscious Sedation registrations, thereby allowing these persons to renew their licenses every other year instead of renewing every year.

PROBABLE ECONOMIC COSTS TO PERSONS REQUIRED TO COMPLY WITH PROPOSAL

Mr. Couvillon has determined that for each year of the first five-year period the proposed rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. The proposed rules have no economic costs to persons who are license holders, businesses, or the general public in Texas. The rules do not impose additional fees upon licensees, nor do they create requirements that could cause licensees to expend funds for equipment, technology, staff, supplies or infrastructure.

FISCAL IMPACT ON SMALL BUSINESSES, MICRO-BUSINESSES, AND RURAL COMMUNITIES

There will be no adverse economic effect on small businesses, micro-businesses, or rural communities as a result of the proposed rules. Because the agency has determined that the proposed rules will have no adverse economic effect on small businesses, micro-businesses, or rural communities, preparation of an Economic Impact Statement and a Regulatory Flexibility Analysis, as detailed under Texas Government Code §2006.002, are not required.

The proposed rules have no anticipated adverse economic effect on small businesses or micro-businesses because they do not impose additional fees upon licensees or small or micro-businesses, nor do they create requirements that would cause licensees or those businesses to expend funds for equipment, staff, supplies, or infrastructure. Additionally, the proposed rules have no anticipated adverse economic effect on rural communities because the rules will not decrease the availability of podiatric medical services, nor will the rules increase the cost of those services in rural communities.

ONE-FOR-ONE REQUIREMENT FOR RULES WITH A FISCAL IMPACT

The proposed rules do not have a fiscal note that imposes a cost on regulated persons, including another state agency, a special district, or a local government. Therefore, the agency is not required to take any further action under Texas Government Code §2001.0045.

GOVERNMENT GROWTH IMPACT STATEMENT

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

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

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

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

4. The proposed rules do not require an increase or decrease in fees paid to the agency. The proposed rules change some fee amounts, but also change how often they are paid, so there is no actual increase or decrease in fees paid to the agency.

5. The proposed rules do not create a new regulation.

6. The proposed rules do expand, limit, or repeal an existing regulation. The proposed rules repeal an existing regulation regarding podiatric medical offices.

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

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

TAKINGS IMPACT ASSESSMENT

The Department has determined that no private real property interests are affected by the proposed rules and the proposed rules do not restrict, limit, or impose a burden on an owner's rights to his or her private real property that would otherwise exist in the absence of government action. As a result, the proposed rules do not constitute a taking or require a takings impact assessment under Texas Government Code §2007.043.

PUBLIC COMMENTS

Comments on the proposed rules may be submitted electronically on the Department's website at https://ga.tdlr.texas.gov:1443/form/gcerules ; by facsimile to (512) 475-3032; or by mail to Shamica Mason, Legal Assistant, Texas Department of Licensing and Regulation, P.O. Box 12157, Austin, Texas 78711. The deadline for comments is 30 days after publication in the Texas Register.

SUBCHAPTER A. GENERAL PROVISIONS

16 TAC §130.1, §130.2

STATUTORY AUTHORITY

The proposed rules are proposed under Texas Occupations Code, Chapters 51 and 202, which authorize the Texas Commission of Licensing and Regulation, the Department's governing body, to adopt rules as necessary to implement these chapters and any other law establishing a program regulated by the Department.

The statutory provisions affected by the proposed rules are those set forth in Texas Occupations Code, Chapters 51, 53, 108, 112, 116, 202, and 601. No other statutes, articles, or codes are affected by the proposed rules.

§130.1.Authority and Applicability.

(a) This chapter is promulgated under the authority of the Texas Occupations Code, Chapters 51 and 202. Specific provisions within this chapter also implement the statutory requirements under Texas Occupations Code, Chapters 53, 108, 112, 116, and 601.

(b) In addition to this chapter, the rules under 16 TAC Chapter 60, Procedural Rules of the Commission and the Department, and 16 TAC Chapter 100, General Provisions for Health-Related Programs, are applicable to the Podiatric Medicine Program.

§130.2.Definitions.

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

(1) Act--The Podiatric Medical Practice Act of Texas[~~, Texas Occupations Code, Chapter 202~~].

(2) Advisory Board--The Podiatric Medical Examiners Advisory Board, Texas Occupations Code, Chapter 202.

(3) Commission--The Texas Commission on Licensing and Regulation.

(4) Continuing Medical Education (CME)--Educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a practitioner uses to provide services for patients, the public, or the profession.

(5) Department--The Texas Department of Licensing and Regulation.

(6) Executive Director--The executive director of the department.

(7) Graduate Podiatric Medical Education (GPME)--An accredited graduate podiatric medical education or residency training program.

(8) License--The term includes a license, registration, certificate, or other authorization issued under the Act.

(9) Medical Records--Any records, reports, notes, charts, x-rays, or statements pertaining to the history, diagnosis, evaluation, treatment or prognosis of the patient including copies of medical records of other health care practitioners contained in the records of the practitioner to whom a request for release of records has been made.

(10) Podiatric Medical Radiological Technician--A person who performs only radiological podiatric procedures under the supervision of a practitioner. The term also includes Podiatry X-ray Machine Operator.

(11) Public Communication--Any written, printed, visual, or oral statement or other communication made or distributed, or intended for distribution, to a member of the public.

(12) Practitioner--A person validly licensed by the department to practice podiatric medicine in the State of Texas. The term is used interchangeably with "Podiatrist" and "Podiatric Physician" in this chapter.

(13) Publication--Any and all public communications relating to the practitioner's practice, including but not limited to, advertisements, announcements, invitations, press releases, journal articles, periodical articles, leaflets, news stories, materials distributed by private or by United States mail, and signs or placards placed in public view or electronic submission.

(14) Solicitation--A private communication to a person concerning the performance of a podiatric service for such person.

(15) Supervision--Responsibility for the control of quality, radiation safety and protection, and technical aspects of podiatric radiological procedures utilized in podiatric medicine for diagnostic purposes.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402537

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

SUBCHAPTER B. ADVISORY BOARD

16 TAC §§130.20 - 130.24, 130.27, 130.28

STATUTORY AUTHORITY

§130.20.Board Membership.

[~~(a)~~] The Podiatric Medical Examiners Advisory Board consists of nine members appointed by the governor as prescribed by Occupations Code §202.051. [~~follows:~~]

~~[(1) six members who are licensed in this state to practice podiatry and have been actively engaged in the practice of podiatry for the five years preceding appointment; and]~~

~~[(2) three members who represent the public.]~~

~~[(b) Appointments to the board shall be made without regard to the race, color, disability, sex, religion, age, or national origin of the appointees.]~~

§130.21.Public Member Eligibility.

If a person or the person's spouse meets any of the specifications prescribed by Occupations Code §202.053, the person is not eligible for appointment as a public member of the advisory board.

§130.22.Membership and Employee Restrictions.

If a person meets any of the specifications prescribed by Occupations Code §202.054, the person may not be a member of the advisory board.

§130.23.Terms; Vacancies.

(a) Members of the advisory board serve staggered six-year terms as prescribed by Occupations Code §202.056. [~~, with the term of three members expiring on February 1 of each odd numbered year. At the expiration of the term of each member, the governor shall appoint a successor.~~]

(b) If a vacancy occurs during a term, the governor shall appoint a replacement as prescribed by Occupations Code §202.056. [~~who meets the qualifications of the vacated position to serve for the remainder of the term.~~]

§130.24.Grounds for Removal.

If a member meets any of the specifications prescribed by Occupations Code §202.056, it is a ground for removal from the advisory board.

§130.27.Advisory Board Meetings and Duties of Department.

(a) The advisory board shall meet at the call of the presiding officer of the commission or the executive director.

(b) The department will present the following documents, including any updates or revisions, to the advisory board for its input and recommendation:

(1) The penalty matrix for podiatry to be included in the department's Enforcement Plan; and

(2) Criminal Conviction Guidelines (Guidelines for Applicants with Criminal Convictions) for podiatry.

(c) The department will provide information regarding the general investigative, enforcement, or disciplinary procedures of the department or commission to the advisory board in the following manner:

(1) At advisory board meetings, the department will provide a report on recent enforcement activities, including:

(A) a brief description of final orders entered in enforcement cases; and

(B) statistics on complaints received, disposition of cases, and any sanctions or administrative penalties assessed;

(2) On request of the advisory board, the department will provide additional information:

(A) during the staff report portion of the advisory board meeting; or

(B) by placing a discussion item on the agenda for a future advisory board meeting; or

(3) The department may provide information directly to an individual member of the advisory board in response to a request from that member.

(d) The commission may not adopt a new rule relating to the scope of practice of, a health-related standard of care for, or the ethical practice of the profession of podiatry unless the rule has been proposed by the advisory board.

(e) Under Occupations Code §51.2032(b) and (c), the advisory board may propose a rule described by subsection (d) according to the following procedure:

(1) The advisory board, by a majority vote of the members present and voting at a meeting at which a quorum is present, shall either:

(A) recommend that the rule be published in the Texas Register for public comment; or

(B) if the rule has been published and after considering the public comments, make a recommendation to the commission concerning adoption of the rule;

(2) The rule must be within the commission's legal authority to adopt; and

(3) The department may make non-substantive, editorial changes to the rule as necessary.

(f) The commission shall either adopt the rule as proposed by the advisory board under subsection (e), with any non-substantive, editorial changes made by the department under subsection (e)(3), or return the rule to the advisory board for revision.

(g) The department will establish an advisory board work group to review and make recommendations regarding continuing education requirements. Opinions or recommendations made will be presented to the full advisory board for discussion.

(h) The department may obtain additional expertise from one or more of the following sources:

(1) a former member of the advisory board;

(2) a department staff expert; or

(3) an outside expert with relevant education, training, or experience.

~~[(i) Opinions or recommendations made under subsection (g) will be presented to the full advisory board for discussion.]~~

§130.28.Training.

[~~(a)~~] A person who is appointed to and qualifies for office as a member of the advisory board may not vote, deliberate, or be counted as a member in attendance at a meeting of the advisory board until the person completes a training program that complies with Occupations Code, §202.061 [~~this section~~].

~~[(b) The training program must provide the person with information regarding:]~~

~~[(1) this chapter;]~~

~~[(2) the department's programs, functions, and rules with respect to this chapter;]~~

~~[(3) the results of the most recent formal audit of the department with respect to this chapter;]~~

~~[(4) the scope and limitations on the rulemaking authority of the advisory board;]~~

[(5) the types of rules, interpretations, and enforcement actions that may implicate federal Antitrust law by limiting competition or impacting prices charged by persons engaged in a profession or business regulated under this chapter, including rules, interpretations, and enforcement actions that:]

~~[(A) regulate the scope of practice of persons in a profession or business regulated under this chapter;]~~

~~[(B) restrict advertising by persons in a profession or business regulated under this chapter;]~~

~~[(C) affect the price of goods or services provided by persons in a profession or business regulated under this chapter; and]~~

~~[(D) restrict participation in a profession or business regulated under this chapter;]~~

~~[(6) the requirements of:]~~

~~[(A) laws relating to open meetings, public information, administrative procedure, and disclosing conflicts of interest; and]~~

~~[(B) other laws applicable to members of the advisory board in performing the members' duties; and]~~

~~[(7) any applicable ethics policies adopted by the commission or the Texas Ethics Commission.]~~

[(c) The executive director shall create a training manual that includes the information required by subsection (b). The executive director shall distribute a copy of the training manual annually to each advisory board member. On receipt of the training manual, each advisory board member shall sign and submit to the executive director a statement acknowledging receipt of the training manual.]

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402538

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

16 TAC §§130.21, 130.22, 130.24

STATUTORY AUTHORITY

The proposed repeals are proposed under Texas Occupations Code, Chapters 51 and 202, which authorize the Texas Commission of Licensing and Regulation, the Department’s governing body, to adopt rules as necessary to implement these chapters and any other law establishing a program regulated by the Department.

The statutory provisions affected by the proposed repeals are those set forth in Texas Occupations Code, Chapters 51, 53, 108, 112, 116, 202, and 601. No other statutes, articles, or codes are affected by the proposed repeals.

§130.21.Public Member Eligibility.

§130.22.Membership and Employee Restrictions.

§130.24.Grounds for Removal.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402544

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

SUBCHAPTER C. TEMPORARY RESIDENCY

16 TAC §§130.30 - 130.32, 130.34 - 130.37

STATUTORY AUTHORITY

§130.30.Temporary Residency License--General Requirements and Application.

(a) A person who is enrolled in an accredited graduate podiatric medical education (GPME) program in Texas must hold a temporary residency license.

(b) The GPME program must be accredited by the Council on Podiatric Medical Education of the American Podiatric Medical Association.

(c) An applicant granted a temporary residency license for the purpose of pursuing a GPME program in the State of Texas must [~~shall~~] not engage in the practice of podiatric medicine, whether for compensation or free of charge, outside the scope and limits of the GPME program in which the applicant is enrolled.

(d) A temporary residency license granted by the department for the purpose of pursuing a GPME program in the State of Texas is valid until the licensee leaves or is terminated from said GPME program.

(e) All temporary residency licensees shall be subject to the same fees and penalties as all other licensees as set forth in the Act and this chapter, except that temporary residency licensees are not subject to continuing medical education requirements.

(f) To be eligible for a temporary residency license an applicant must:

(1) be at least 21 years of age;

(2) pass [~~successfully complete~~] at least 90 semester hours of undergraduate college courses acceptable at the time of completion for credit toward a bachelor's degree at an institution of higher education determined by the department to have acceptable standards;

(3) [~~successfully~~] graduate from a reputable college of podiatry approved by the Council on Podiatric Medical Education of the American Podiatric Medical Association, and the college must have been so approved during the entire period of the applicant's course of instruction;

(4) [~~successfully~~] pass all required sections of the American Podiatric Medical Licensing Examination;

(5) pay all applicable fees;

(6) submit a completed application in a form and manner prescribed by the department [~~on a department-approved form~~];

(7) submit all transcripts of relevant college coursework, acceptable to the department;

(8) [~~successfully~~] pass a criminal history background check performed by the department;

(9) provide proof of successful completion of a course in cardiopulmonary resuscitation (CPR);

(10) complete the "Memorandum of Understanding for Approved Residency Program";

(11) complete the "Certificate of Acceptance for Postgraduate Training Program"; and

(12) [~~successfully~~] pass a National Practitioner Data Bank query check performed by the department.

(g) The department approves and adopts by reference the Standards and Requirements for Approval of Residencies in Podiatric Medicine and Surgery and Procedures for Approval of Residencies in Podiatric Medicine and Surgery adopted by the Council on Podiatric Medical Education of the American Podiatric Medical Association.

(h) The department approves and adopts by reference the Standards and Requirements for Accrediting Colleges of Podiatric Medicine and Procedures for Accrediting Colleges of Podiatric Medicine adopted by the Council on Podiatric Medical Education of the American Podiatric Medical Association.

(i) The applicant must [~~shall~~] submit evidence sufficient for the department to determine that the applicant has met all the requirements and any other information reasonably required by the department. Any application, diploma or certification, or other document required to be submitted to the department that is not in the English language must be accompanied by a certified translation into English.

§130.31.Temporary Residency License--License Term; Residency Requirements; Program Responsibilities.

(a) License term. A temporary residency license is valid for one year. The license holder must renew by submitting a completed renewal application in a form and manner prescribed by the department and paying the required fee under §130.60. The annual renewal application notification will be deemed to be written notice of the impending license expiration forwarded to the person at the person's last known address. A temporary residency license to practice podiatric medicine expires on June 30 of each year.

(b) Temporary residency license responsibilities. A temporary residency license holder is not considered to be a fully licensed podiatrist who independently practices podiatric medicine without supervision. A temporary residency license holder is a person in training and is limited by the Graduate Podiatric Medical Education (GPME) program for residency based supervised patient encounters, supervision of which is designed to protect patients and the citizens of Texas.

(1) A person enrolled in a GPME program must hold a temporary residency license at all times and is not considered to be qualified for a Doctor of Podiatric Medicine license until all residency program requirements have been completed and fulfilled as certified by the GPME program residency director, and all other requirements for licensure have been attained.

(2) Residents enrolled in an accredited GPME residency program who hold a temporary residency license (i.e. denoted with the letter "T" followed by numerals) may register with the U.S. Drug Enforcement Administration (DEA) to prescribe controlled substances subject to the supervision of the program and residency director. Under no circumstances are residents allowed to prescribe controlled substances for purposes outside of the approved residency program.

(c) Residency Requirements. All residency programs requesting temporary residency licenses for their enrollees must meet all American Podiatric Medical Association/Council on Podiatric Medical Education (APMA/CPME) requirements for accreditation.

(d) Residency director requirements. Within 30 days after the start date of the program each year, the residency director must report to the department a list of all residents enrolled in the program. The residency director will be held responsible for the entire program, including, but not limited to:

(1) ensuring that the temporary residency licensee is practicing within the scope of the residency program requirements;

(2) ensuring that the temporary residency licensee has read and understood the Act and rules governing the practice of podiatric medicine; and

(3) ensuring that all residency program attendees are properly licensed with the department prior to participation in the program.

§130.32.Temporary Residency License--Final Year of Residency.

(a) A holder of a temporary residency license who has entered the final year of an accredited GPME program, [~~who~~] is in good standing with the GPME program, and [~~who~~] is on course to complete the course in a timely manner, is [~~may be~~] permitted to apply for the Doctor of Podiatric Medicine license in the spring, if [~~provided that~~] the resident has entered and signed the "Memorandum of Understanding for Conditional Issuance of Texas Doctor of Podiatric Medicine License" (MOU).

(b) A holder of a temporary residency license who passes the jurisprudence examination, [~~and who~~] is in compliance with the resident's MOU(s), and [~~who~~] meets all other requirements of the law regarding licensure may be issued a Doctor of Podiatric Medicine license prior to completion of the last year of the residency. The Doctor of Podiatric Medicine license issued under this subsection will be subject to the resident's MOU and to the following conditions and restrictions[~~, in addition to any other provisions in statute and rule applicable to a license to practice podiatry, in general that~~]:

(1) the resident must pass [~~successfully complete~~] and graduate from the resident's accredited GPME program by the date noted in the resident's MOU; [~~with the department, and~~]

(2) the resident must submit [~~to the department~~] proof of passage [~~successful completion~~] and graduation to the department within 30 days after the end date of the residency as noted on the MOU. Failure to timely provide the required proof to the department [~~requires~~] subjects the Doctor of Podiatric Medicine license to automatic revocation; [~~and~~]

(3) [~~(2)~~] the resident must [~~who has received a Doctor of Podiatric Medicine license prior to successful completion and graduation from an accredited GPME program, and for such period of time while still a resident, shall~~] practice podiatry only under the temporary residency license, and subject to the scope and limits of the GPME program, and must [~~shall~~ ] not practice podiatry under the Doctor of Podiatric Medicine license until after passage [~~successful completion~~] and graduation from the GPME program and after providing to the department proof of such completion and graduation; and [.]

(4) the resident must comply with any other provisions in statute and rule applicable to a license to practice podiatry.

§130.34.Limited Faculty License--Requirements; License Term.

(a) Requirements. The department may issue a limited faculty license to practice podiatry only for purposes of instruction in an educational institution to a podiatrist who has not completed the jurisprudence examination required in §130.40(a)(5), if the applicant:

(1) at the time of applying for a limited faculty license has accepted an appointment or is serving as a full-time member of the faculty of an educational institution in this state offering an approved or accredited course of study or training leading to a degree in podiatry;

(2) holds a license to practice podiatry from another state with licensing requirements that are substantially equivalent to the requirements established by this subchapter; and

(3) otherwise satisfies the requirements of this section.

(b) License Term. A limited faculty license to practice podiatry is valid for two years.

(1) The department will terminate a limited faculty license immediately upon receiving notice that the faculty appointment of the podiatrist holding the license is terminated.

(2) The termination of a limited faculty license does not prohibit or otherwise impair the ability of a podiatrist to apply for or hold another license type issued under this subchapter.

§130.35.Podiatric Medical Radiological Technicians.

(a) This section implements Texas Occupations Code, Chapter 601. This section does not apply to persons certified by the Texas Medical Board under the Medical Radiologic Technologist Certification Act who are Non-Certified Technicians (NCTs), Certified Medical Radiologic Technologists (MRTs), or Limited Medical Radiologic Technologists (LMRTs).

(b) It is the practitioner's responsibility to ensure that all individuals wishing to perform podiatric radiological procedures are properly trained and apply for registration with the department as a podiatric medical radiological technician. For the purposes of this section, the term Podiatric X-ray Machine Operator, (PXMO) is synonymous with podiatric medical radiological technicians.

(c) Podiatric equipment training course providers and standards for curricula and instructors must be approved by the department.

(d) A podiatric medical radiological technician applicant must:

(1) be 18 years of age or older;

(2) successfully complete, at a minimum, the following 45 hours of clinical and didactic training requirements and provide proof of completion to the department:

(A) five classroom hours and five out-of-classroom hours of radiation safety and protection for the patient, self, and others;

(B) five classroom hours and five out-of-classroom hours of radiographic equipment used in podiatric medicine, including safety standards, operation, and maintenance;

(C) 10 classroom hours and 10 out-of-classroom hours in podiatric radiologic procedures, imaging production and evaluation; and

(D) three classroom hours and two out-of-classroom hours in methods of patient care and management essential to radiologic procedures, excluding CPR, BCLS, ACLS and similar subjects; and

(3) submit a completed application in a form and manner prescribed by the department; and

(4) pay the required fee under §130.60.

(e) A supervising podiatrist must:

(1) verify the student's out-of-classroom training hours;

(2) require the student to maintain a log demonstrating the successful production of x-rays in the clinical setting;

(3) oversee the student's successful production of at least 90 x-rays in the clinical setting; and

(4) sign the log

(f) A podiatric medical radiological technician must hold a registration and must perform only podiatric radiological procedures.

(g) A podiatric medical radiological technician registrant must perform radiological procedures only under the supervision of a practitioner physically present on the premises.

(h) A podiatric medical radiological technician registrant must not perform any dangerous or hazardous procedures as identified by the Texas Medical Board.

(i) A podiatric medical radiological technician registrant must comply with the safety rules of the Texas Department of State Health Services, Radiation Control Program relating to the control of radiation.

(j) Registration Term and Renewal. A registration is valid for one or two years.

(1) A registration is valid for one year if the registration was issued before January 1, 2025, or two years if the registration was issued on or after January 1, 2025.

(2) A registration renewed by the department is valid for:

(A) one year, if the registration was renewed before January 1, 2025; or

(B) two years, if the registration was renewed on or after January 1, 2025.

(3) A registration renewal is completed by submitting a registration renewal application in a form and manner prescribed by the department and paying the required fee under §130.60.

(4) For each registration renewal, a podiatric medical radiological technician must complete the human trafficking prevention training required under Occupations Code, Chapter 116, and provide proof of completion as prescribed by the department.

(k) A podiatric medical radiological technician registrant must inform the department of any address change or change of supervising podiatric physician within two weeks.

(l) The department may refuse to issue or renew a registration to an applicant or a podiatric medical radiological technician who:

(1) violates or attempts to violate the Podiatric Medical Practice Act of Texas, the rules, an order of the executive director or commission previously entered in a disciplinary proceeding, or an order to comply with a subpoena issued by the department;

(2) violates or attempts to violate the Medical Radiologic Technologist Certification Act, or the rules promulgated by the Texas Medical Board;

(3) violates or attempts to violate the rules of the Texas Department of State Health Services for Control of Radiation, as prescribed by Health and Safety Code, Chapter 401;

(4) obtains, attempts to obtain, or uses a registration by bribery or fraud;

(5) engages in unprofessional conduct, including but not limited to, conviction of a crime or commission of any act that is in violation of the laws of the State of Texas if the act is connected with provision of health care;

(6) develops or has an incapacity that prevents the practice of a podiatric medical radiological technician with reasonable skill, competence, and safety to the public as a result of:

(A) an illness;

(B) drug or alcohol dependency; or habitual use of drug or intoxicating liquors; or

(7) fails to practice in an acceptable manner consistent with public health and welfare;

(8) has disciplinary action taken against a radiological certification, permit, or registration in another state, or by another regulatory agency;

(9) engages in acts requiring registration under these rules without a current registration from the department; or

(10) has had a registration revoked, suspended, or has received disciplinary action.

(m) The commission, executive director, or department, as appropriate, may suspend, revoke, or refuse to issue or renew the registration upon finding that a podiatric medical radiological technician has committed any offense listed in this section.

§130.36.Hyperbaric Oxygen Certificate--Application Requirements and Guidelines.

(a) A certificate to supervise and administer hyperbaric oxygen is available to practitioners. To obtain the certificate, the practitioner must:

(1) submit an application in a form and manner prescribed by the department; and

(2) pay the required fee under §130.60.

(b) A practitioner practicing hyperbaric oxygen must:

(1) follow the published recommendations of the Undersea Hyperbaric Medical Society, Inc. (UHMS);

(2) act within the credentials and bylaws of the hospital that operates the hyperbaric unit;

(3) only practice hyperbaric oxygen in a hospital setting;

(4) show evidence of attendance and successful completion of a hyperbaric medicine team training course that is recognized by the UHMS;

(5) only utilize hyperbaric oxygen in the treatment of the foot as recognized by the Podiatric Medical Practice Act; and

(6) have on file with the department documentation certifying compliance with the above requirements, prior to administering hyperbaric oxygen.

(1) The Hyperbaric Oxygen Certificate is valid for: one year if the certificate was issued before January 1, 2025, or two years if the registration was issued on or after January 1, 2025.

(2) A certificate renewed by the department is valid for one year if the certificate was renewed before January 1, 2025, and must be renewed annually, or two years if the certificate was renewed on or after January 1, 2025, and must be renewed every two years. A certificate renewal is completed by submitting a certificate renewal application in a form and manner prescribed by the department and paying the required fee under §130.60.

(d) A certificate holder must inform the department within 10 business days of any address change or change of hospital setting.

(e) A hyperbaric oxygen certificate must be clearly displayed in the office alongside the original license.

§130.37.Nitrous Oxide/Oxygen Inhalation Conscious Sedation--Registration Requirements, Guidelines, and Direct Supervision.

(a) As used in this section, conscious sedation means the production of an altered level of consciousness in a patient by pharmacological or non-pharmacological methods.

(b) Conscious sedation of a patient by nitrous oxide is the administration by inhalation of a combination of nitrous oxide and oxygen producing a minimally depressed level of consciousness while retaining the patient's ability to maintain a patent airway independently and continuously, and to respond appropriately to physical stimulation and verbal command.

(c) Conscious sedation of a patient by nitrous oxide must be induced, maintained, and continuously supervised only by the practitioner or by the assistant under continuous direct supervision of the practitioner. The nitrous oxide must not be flowing if the practitioner is not present in the room.

(d) To use nitrous oxide/oxygen inhalation conscious sedation on a patient for podiatric medical purposes in the State of Texas, the practitioner must first register with the department and provide the following:

(1) proof that the practitioner has completed a didactic and clinical course which includes aspects of monitoring patients and the hands-on use of the gas machine. The didactic and clinical course must:

(A) be directed by a licensed and certified M.D., D.O., D.D.S., or D.P.M., in the State of Texas with advanced educational and clinical experience with routine administration of nitrous oxide/oxygen inhalation conscious sedation;

(B) include a minimum of four hours didactic work in pharmacodynamics of nitrous oxide/oxygen inhalation conscious sedation; and

(2) proof that the practitioner has completed a CME course in nitrous oxide/oxygen inhalation conscious sedation that includes training in the prevention and management of emergencies in the podiatric medical practice; and

(3) proof that the practitioner has completed a basic and advanced CPR program sponsored by either the American Heart Association or the American Red Cross. Proof of current certification is the responsibility of the podiatric physician. Additionally, the D.P.M. must provide documented training or emergency procedures to office personnel.

(e) The department may, at any time and without prior notification, require an on-site office evaluation to determine that all standards regarding nitrous oxide/oxygen inhalation conscious sedation are being met.

(f) Registration Term and Renewal. A registration is valid for one or two years.

(1) A registration is valid for one year if the registration was issued before January 1, 2025, or two years if the registration was issued on or after January 1, 2025.

(2) A registration renewed by the department is valid for one year if the registration was renewed before January 1, 2025, and must be renewed annually, or two years if the registration was renewed on or after January 1, 2025, and must be renewed every two years. A registration renewal is completed by submitting a registration renewal application in a form and manner prescribed by the department and paying the required fee under §130.60.

(3) A registration will not be renewed if a current certificate of inspection of the gas machine is not filed with the department.

(g) A registrant must inform the department within 10 business days of any address change.

(h) When a registration is issued, it must be clearly displayed in the office.

(i) All office personnel who assist the practitioner in the nitrous oxide/oxygen inhalation conscious sedation procedure must:

(1) be trained in basic life support;

(2) have annual reviews of emergency protocols, contents, and use of emergency equipment; and

(3) have annual reviews of basic CPR.

(j) Documentation verifying these annual reviews must be maintained in the office of the practitioner who employs the personnel and must be provided to the department if requested.

(k) The practitioner must evaluate and document in the patient's medical record, prior to the nitrous oxide/oxygen inhalation conscious sedation procedure, the patient's health and medical status to ensure that nitrous oxide/oxygen inhalation conscious sedation is medically appropriate.

(l) Equipment used must meet the following safety criteria: The gas machine must have:

(1) 30% minimum oxygen flow;

(2) Glass flow tubes;

(3) Nitrous oxide fail-safe (will not flow without oxygen);

(4) Automatic room air intake in the event the bag is empty;

(5) Non-rebreathing check valve;

(6) Oxygen flush; and

(7) Auxiliary oxygen outlet with one demand valve resuscitation assembly per office.

(m) All practitioners administering nitrous oxide must have:

(1) a functioning vacuum system;

(2) a scavenger system;

(3) appropriate emergency drugs and equipment for resuscitation;

(4) a manifold to provide for protection against overpressure. The manifold must be equipped with an audible alarm system. The machine must have a service check on a three-year basis, a copy of which must be filed with the department; and

(5) a method of locking the nitrous oxide tanks after business hours.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402539

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

16 TAC §130.31

STATUTORY AUTHORITY

The proposed repeals are proposed under Texas Occupations Code, Chapters 51 and 202, which authorize the Texas Commission of Licensing and Regulation, the Department's governing body, to adopt rules as necessary to implement these chapters and any other law establishing a program regulated by the Department.

§130.31.Temporary Residency License--Residency Requirements; Program Responsibilities; License Term.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402545

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

SUBCHAPTER D. DOCTOR OF PODIATRIC MEDICINE

16 TAC §§130.40 - 130.48

STATUTORY AUTHORITY

§130.40.Doctor of Podiatric Medicine License--General Requirements and Application[~~; Limited Faculty License~~].

(a) An applicant for a license to practice podiatry in this state must:

(1) be at least 21 years of age;

(3) [~~successfully~~] graduate from a [~~reputable~~ ] college of podiatry approved by the Council on Podiatric Medical Education of the American Podiatric Medical Association, and the college must have been so approved during the entire period of the applicant's course of instruction;

(4) [~~successfully~~] pass all required sections of the American Podiatric Medical Licensing Examination;

(5) [~~successfully~~] pass the jurisprudence examination[~~, except as provided in subsection (b)~~];

(6) successfully complete at least one year of GPME in a program approved by the Council on Podiatric Medical Education of the American Podiatric Medical Association with a hospital, clinic, or institution acceptable to the department (successful completion means the applicant must have finished the entire GPME program in which the applicant matriculated; partial program attendance is not acceptable) [(successful completion means the GPME program which was actually begun/matriculated is completed; the applicant must have successfully completed the entire program; partial program attendance is not acceptable);]

(7) pay all applicable fees;

(8) submit a completed application in a form and manner prescribed by the department [~~on a department-approved form~~];

(9) submit all transcripts of relevant college coursework, acceptable to the department;

(10) [~~successfully~~] pass a criminal history background check performed by the department;

(11) provide proof of passage [~~successful completion~~] of a course in cardiopulmonary resuscitation (CPR); and

(12) [~~successfully~~] pass a National Practitioner Data Bank query check performed by the department.

(b) At the discretion of the executive director, the GPME requirement, which became effective in Texas on July 1, 1995, may be waived if the applicant:

(1) has been licensed and in active podiatric practice for at least five continuous years in another state; and

(2) demonstrates in the application to the department an acceptable record from that state and all other states under which the applicant has ever been licensed.

[(b) The department may issue a limited faculty license to practice podiatry only for purposes of instruction in an educational institution to a podiatrist who has not completed the jurisprudence examination required in subsection (a)(5), if the applicant:]

[(1) at the time of applying for a limited faculty license has accepted an appointment or is serving as a full-time member of the faculty of an educational institution in this state offering an approved or accredited course of study or training leading to a degree in podiatry;]

~~[(2) holds a license to practice podiatry from another state with licensing requirements that are substantially equivalent to the requirements established by this subchapter; and]~~

~~[(3) otherwise satisfies the requirements of this section.]~~

(c) At the discretion of the department, the National Board Part III (formerly known as PM Lexis) requirement, which became effective in Texas on January 29, 1992, may be waived if:

(1) the applicant has been in active licensed practice for at least five continuous years, with an acceptable record;

(2) the applicant has successfully completed any other course of training reasonably required by the executive director relating to the safe care and treatment of patients; and

(3) the executive director determines that the applicant has substantially equivalent experience and was not required to pass a part of an examination related to the testing of clinical skills when licensed in this or another state.

[(c) At the discretion of the executive director, the GPME requirement may be waived if the applicant has been in active podiatric practice for at least five continuous years in another state under license of that state, and upon application to the department demonstrates an acceptable record from that state and from all other states under which the applicant has ever been licensed. The GPME requirement became effective in Texas on July 1, 1995.]

(d) A showing of an acceptable record under this section is defined to include, but is not limited to:

(1) a showing that the applicant has:

(A) no civil or criminal judgement, in state or federal court or other judicial forum, entered against the applicant on a podiatric medical-related cause of action;

(B) no conviction of or deferred adjudication for a felony;

(D) no disciplinary action recorded from any medical institution or agency or organization, including, but not limited to:

(i) any licensing board;

(ii) hospital;

(iii) surgery center;

(iv) clinic;

(v) professional organization;

(vi) governmental health organization; or

(vii) extended-care facility.

(2) If any judgment or disciplinary determination under this subsection, has been on appeal, reversed, reversed and rendered, or remanded and later dismissed, or in any other way concluded in favor of the applicant, it shall be the applicant's responsibility to bring such result to the notice of the department by way of certified mail along with any such explanation of the circumstances as the applicant deems pertinent to the determination of admittance to licensure in this state.

(3) The applicant must obtain and submit to the department a letter directly from all state boards under which they have ever been previously licensed stating that the applicant is a licensee in good standing with each said board or that said prior license or licenses were terminated or expired with the licensee in good standing.

[(d) At the discretion of the executive director, the executive director may excuse an applicant for a license from the National Board Part III (formerly known as PM Lexis) requirement if the executive director determines that an applicant with substantially equivalent experience was not required to pass a part of an examination related to the testing of clinical skills when the applicant was licensed in this or another state with an acceptable record, provided that the applicant has been in active licensed practice for at least five continuous years and has successfully completed any other course of training reasonably required by the executive director relating to the safe care and treatment of patients. The National Board Part III/PM Lexis came into existence in June 1987. Texas began the National Board Part III/PM Lexis requirement for licensure on January 29, 1992.]

~~[(e) A showing of an acceptable record under this section is defined to include, but is not limited to:]~~

[(1) a showing that the applicant has not had entered against them a judgment, civil or criminal, in state or federal court or other judicial forum, on a podiatric medical-related cause of action; no conviction of or deferred adjudication for a felony; no disciplinary action recorded from any medical institution or agency or organization, including, but not limited to, any licensing board, hospital, surgery center, clinic, professional organization, governmental health organization, or extended-care facility; and no dishonorable discharge from military service.]

[(2) If any judgment or disciplinary determination under this subsection, has been on appeal, reversed, reversed and rendered, or remanded and later dismissed, or in any other way concluded in favor of the applicant, it shall be the applicant's responsibility to bring such result to the notice of the department by way of certified letter along with any such explanation of the circumstances as the applicant deems pertinent to the determination of admittance to licensure in this state.]

(e) [~~(f)~~] The department approves and adopts by reference the Standards and Requirements for Approval of Residencies in Podiatric Medicine and Surgery and Procedures for Approval of Residencies in Podiatric Medicine and Surgery adopted by the Council on Podiatric Medical Education of the American Podiatric Medical Association.

(f) [~~(g)~~] The department approves and adopts by reference the Standards and Requirements for Accrediting Colleges of Podiatric Medicine and Procedures for Accrediting Colleges of Podiatric Medicine adopted by the Council on Podiatric Medical Education of the American Podiatric Medical Association.

(g) [~~(h)~~] The department may require additional information from an applicant who has been out of practice for more than two years and require the applicant to complete additional education, examinations, or training before issuing a license to ensure the applicant [~~podiatrist~~] possesses reasonable knowledge, skill and competence for the safe care and treatment of patients.

(h) [~~(i)~~] The applicant must [~~shall~~] submit, in a form and manner prescribed by [~~through a method acceptable to~~] the department, evidence sufficient for the department to determine that the applicant has met all the requirements and any other information reasonably required by the department. Any application, diploma or certification, or other document required to be submitted to the department that is not in the English language must be accompanied by a certified translation into English.

§130.41.Doctor of Podiatric Medicine License--Jurisprudence Exam.

(a) All applicants shall be provided detailed information about the examination process prior to exam administration.

(b) Applicants must [~~shall~~] follow the security procedures required for administration of the exam at each testing facility.

(c) A license shall not be issued to any person who has been detected in a deceptive, dishonest or fraudulent act while taking an examination required by the department.

(d) The passing score for the examination shall be determined by the department.

§130.42.Doctor of Podiatric Medicine License--Term; Renewal.

(a) A Doctor of Podiatric Medicine license is valid for two years.

(b) To renew a Doctor of Podiatric Medicine license, the licensee must:

(1) submit a completed [~~department-approved~~ ] renewal application in a form and manner prescribed by the department;

(2) complete all required continuing medical education hours as required by §130.44; and

(3) pay the required fee under §130.60.

(c) For each license renewal [~~on or after September 1, 2020~~], a Doctor of Podiatric Medicine must complete the human trafficking prevention training required under Occupations Code, Chapter 116, and provide proof of completion as prescribed by the department.

[(d) A limited faculty license to practice podiatry only for purposes of instruction in an educational institution is valid for the term indicated in subsection (a), except that the department shall terminate a limited faculty license immediately upon receiving notice that the faculty appointment of the podiatrist holding the limited faculty license is terminated. The termination of a limited faculty license does not prohibit or otherwise impair the ability of a podiatrist to apply for or hold another license type issued under this subchapter.]

§130.43.Doctor of Podiatric Medicine License--Provisional License.

(a) An applicant for a provisional license must abide by all the provisions of §130.40 except for §130.40(a)(5) and must meet the following requirements:

(1) be licensed in good standing as a podiatric physician in another state, the District of Columbia, or a territory of the United States that has licensing requirements that are substantially equivalent to the requirements of the Act, subsequent amendments, and rules;

(2) furnish proof of such licensure to the department;

(3) not have been revoked or suspended in any jurisdiction; and

(4) pass the jurisprudence exam.

(b) An applicant for provisional licensure must be sponsored by a person currently licensed by the department for at least five years and in good standing under the Act with the following conditions applicable.

(1) that the applicant for provisional licensure will be working within the same office and under the direct supervision of the sponsor licensee; and

(2) that such sponsor licensee is aware of the Act and rules governing provisional licensure and that the sponsorship will cease upon the invalidity of the provisional license.

(d) The sponsor licensee will be held responsible for the unauthorized practice of podiatric medicine should such provisional license expire.

(e) An applicant for a provisional license may be excused from the requirement of sponsorship of this rule if the department determines that compliance with this subsection constitutes a hardship to the applicant.

(f) A provisional license is valid for up to 180 days or until passage or failure of the jurisprudence exam and may be renewed up to three times. It is the responsibility of the applicant and sponsor to return the provisional license to the department upon expiration.

(g) If at any time during the provisional licensure period it is determined that the holder of such provisional license has violated the Act or department rules, such provisional license will be subject to disciplinary action including revocation.

§130.44.Continuing Medical Education--General Requirements.

(a) A licensee must complete 50 hours of department-approved continuing medical education (CME) every two years for the renewal of the license to practice podiatric medicine. One hour of training is equal to one hour of CME. It is the responsibility of the licensee to ensure that all CME hours being claimed meet the standards for CME as set by the commission.

(b) A licensee must complete two CME hours related to approved procedures of prescribing and monitoring controlled substances prior to the first anniversary of the date the license was originally issued.

(c) A licensee must complete at least two CME hours on a course, class, seminar, or workshop in: Ethics in the Delivery of Health Care Services and/or Rules and Regulations pertaining to Podiatric Medicine in Texas.

(1) Acceptable topics for the course, class, seminar, or workshop include:

(A) Human Trafficking Prevention;

(B) Healthcare Fraud;

(D) Practice Risk Management or Podiatric Medicine related Ethics or Jurisprudence courses;

(E) Abuse and Misuse of Controlled Substances;

(F) Opioid Prescription Practices, and/or

(G) Pharmacology, including those sponsored by an entity approved by the CPME, APMA, APMA affiliated organizations, American Medical Association (AMA), AMA affiliated organizations, or governmental entities, or the entities described in subsections (e) and (f).

(2) Any program approved by the CPME of the APMA is acceptable to the department.

(d) A licensee whose practice includes prescription or dispensation of opioids must annually complete at least one hour of CME covering best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical therapy, psychotherapy, and other treatments.

(e) A licensee shall receive credit for each hour of podiatric medical meetings and training sponsored by:

(1) the APMA;

(2) APMA affiliated organizations;

(3) the Texas Podiatric Medical Association (TPMA);

(4) state, county or regional podiatric medical association podiatric medical meetings;

(5) university sponsored podiatric medical meetings;

(6) hospital podiatric medical meetings or hospital podiatric medical grand rounds;

(7) medical meetings sponsored by the Foot & Ankle Society or the orthopedic community relating to foot care; and

(8) others, at the discretion of the Advisory Board. A practitioner may receive credit for giving a lecture, equal to the credit that a podiatrist attending the lecture obtains.

(f) A licensee shall receive credit for each hour of training for non-podiatric medical sponsored meetings that are relative to podiatric medicine and department approved. This includes, but is not limited to;

(1) hospital grand rounds;

(2) hospital CME programs;

(3) corporate sponsored meetings;

(4) meetings sponsored by the American Medical Association, the orthopedic community, the American Diabetes Association, the Nursing Association, the Physical Therapy Association; and

(5) others if approved by the department.

(g) A licensee may obtain up to 20 CME hours per biennium for practice management, home study and self-study programs if the provider is approved by the CPME.

(h) A licensee may receive up to three CME hours for Cardiopulmonary Resuscitation (CPR) certification or up to six hours of CME for Advanced Cardiac Life Support (ACLS) certification, but not both. No on-line CPR certification will be accepted by the department for CME credit.

(i) A licensee may only receive one CME hour for having an article published in a peer review journal, regardless of the number of times or the number of journals in which the article is published.

(j) With the exception of the allowed hours carried forward, the required 50 hours of CME must be obtained in a 24-month period immediately preceding the date in which the license is to be renewed. The 24-month period will begin on the first full day of the month after the practitioner's date of renewal and end two years later. A licensee who completes more than the required 50 hours during the preceding CME period may carry forward a maximum of 10 hours for the next renewal CME period.

(k) Licensees that are deficient in CME hours must complete all deficient CME hours and current biennium CME requirements in order to maintain licensure.

(l) CME obtained as a part of a disciplinary action is not acceptable credit towards the total of 50 hours required every two years.

(m) The CPME updated the CPME 720 - Standards and requirements for approval of providers of continuing education in podiatric medicine, effective July 1, 2020.

(1) The CPME standards define Internet Live Activity as "an online continuing educational activity available at a certain time on a certain date and available only in real-time, just as if it were a continuing educational activity held in an auditorium. Once the event has taken place, learners may no longer participate in that activity."

(2) Some examples of an internet live activity are a webinar, videoconference, or teleconference.

(3) CPME has also released guidance for CME in response to COVID-19 concerns.

(4) Providers of CME, including all organizations listed in the podiatry CME rules, can organize and present an internet live activity for CME credit.

(5) There are no limits on the amount of CME hours that can be obtained through internet live activity.

§130.45.Continuing Medical Education--Audit Process.

(a) The department employs an audit system for CME reporting. The licensee is responsible for maintaining a record of the licensee's CME experiences. The certificates or other documentation verifying earning of CME hours are only to be forwarded to the department if the licensee has been selected for audit.

(b) The audit process shall be as follows:

(1) The department will select for audit a random sample of licensees to ensure compliance with CME hours. The audit may occur before, during, or after the license renewal process.

(2) If selected for an audit, the licensee must submit copies of certificates, transcripts, or other documentation satisfactory to the department, verifying the licensee attendance, participation and completion of the CME.

(3) Failure to timely furnish this information within 30 calendar days after notification of the audit, being deficient in the CME required for the most recent renewal of the license, failure to complete all CME within 90 calendar days after notification of the deficiency, or providing false information during the audit process are grounds for disciplinary action against the licensee.

(4) If selected for CME audit during the renewal period, the licensee may renew and pay renewal fees.

§130.46.Continuing Medical Education--Exceptions and Allowances; Approval of Hours.

(a) Delinquency of CME hours may be allowed in cases of hardship, as determined on an individual basis by the executive director. In cases of such hardship, hours of delinquency must be current at the end of a three-year period.

(b) Any licensee not actively practicing podiatric medicine shall be exempt from these requirements; however, upon resuming practice of podiatric medicine, that licensee must fulfill the requirements of the preceding year from the effective date prior to the resumption of practice.

(c) Hours obtained in colleges or universities while working on a degreed or non-degreed program or an approved residency program by the Council on Podiatric Medical Education shall be considered as having fulfilled the requirements of continuing education hours for the fiscal year, provided that the courses are of a medical nature.

(d) Hours of continuing education submitted to the department for approval, must be certified by the continuing education director of the institution or organization from which the hours were obtained, that the licensee was in actual attendance for the specified period.

§130.47.Inactive Status.

(a) A practitioner may place a license on inactive status, at no cost, by submitting a completed application in a form and manner prescribed by the department.

(b) A person whose license is on inactive status must not practice podiatric medicine in this state. The practice of podiatric medicine by a person whose license is on inactive status constitutes the practice of podiatric medicine without a license.

(c) A practitioner on inactive status must renew the inactive status every two years, at no cost, in a form and manner prescribed by the department.

(d) To change from an inactive status license to an active status license, an applicant must:

(1) submit a completed application in a form and manner prescribed by the department;

(2) pay the required renewal fee as prescribed in §130.60; and

(3) complete the CME that is required for the renewal of an active license during the preceding license period. CME hours used to satisfy the requirement for changing from an inactive status license to an active status license must not also be utilized for a future renewal of an active status license.

§130.48.Voluntary Charity Care Status.

(a) This section implements Texas Occupations Code, Chapter 112. As used in this section:

(1) "Voluntary charity care" means medical care provided for no compensation:

(A) to indigent populations;

(B) in medically underserved areas; or

(2) "Compensation" means direct or indirect payment of anything of monetary value, except payment or reimbursement of reasonable, necessary, and actual travel and related expenses.

(b) A practitioner may place a license on voluntary charity care status, at no cost, by submitting a completed application in a form and manner prescribed by the department.

(1) is limited to voluntary charity care for which the practitioner receives no compensation of any kind for podiatric services rendered;

(2) does not include the provision of podiatric services for compensation which has monetary value of any kind;

(3) does not include the provision of podiatric services to members of the practitioner's family; and

(4) does not include the self-prescribing of controlled substances or dangerous drugs.

(d) A practitioner on voluntary charity care status must:

(1) renew the voluntary charity status every two years, at no cost, in a form and manner prescribed by the department; and

(2) complete 25 hours of CME during each renewal cycle.

(e) A practitioner on voluntary charity care status is subject to disciplinary action for:

(1) a violation of the Act or rule adopted under this chapter;

(2) obtaining, or attempting to obtain, voluntary charity care status by submitting false or misleading information to the department; or

(3) unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the practitioner engages in the compensated practice of podiatric medicine, the provision of podiatric services to members of the practitioner's family, or the self-prescribing of controlled substances or dangerous drugs.

(f) A practitioner on voluntary charity care status must apply with the department before returning to active status by:

(1) submitting a completed application in a form and manner prescribed by the department;

(2) providing a description of the work performed while on voluntary charity care status;

(3) paying the required doctor of podiatric medicine license renewal fee under §130.60; and

(4) completing an additional 25 hours of CME to meet the doctor of podiatric medicine renewal requirements.

(g) The department may require additional information, education, examinations, or training from a podiatrist who has been on voluntary charity care status for more than two years before returning to active status.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402540

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

16 TAC §§130.43 - 130.49

STATUTORY AUTHORITY

§130.43.Doctor of Podiatric Medicine License--Provisional License.

§130.44.Continuing Medical Education--General Requirements.

§130.45.Continuing Medical Education--Exceptions and Allowances; Approval of Hours.

§130.46.Inactive Status.

§130.47.Hyperbaric Oxygen Certificate--Application Requirements and Guidelines.

§130.48.Nitrous Oxide/Oxygen Inhalation Conscious Sedation--Registration Requirements, Guidelines, and Direct Supervision.

§130.49.Voluntary Charity Care Status.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402546

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

SUBCHAPTER E. PRACTITIONER RESPONSIBILITIES AND CODE OF ETHICS

16 TAC §§130.50, 130.51, 130.54, 130.55, 130.57 - 130.59

STATUTORY AUTHORITY

§130.50.Practitioner Identification; Professional Corporations or Associations.

(a) A practitioner must [~~shall~~] use the following professional identifiers in any publication related to the practice of podiatric medicine: Doctor of Podiatric Medicine, D.P.M., Podiatrist, Podiatric Physician.

(b) A practitioner must [~~Practitioners shall~~] include one of the following designations to describe the practitioner's [~~his or her~~] practice in all publications related to the practice of podiatric medicine: Foot Surgeon, Podiatric Surgeon, Foot Specialist, Doctor and Surgeon of the Foot, Injuries and Diseases of the Foot, Podiatric Physician.

[(c) The purpose of this section and of so limiting the professional designations of a practitioner and the practitioner's practice business is to ensure that the public and all prospective patients are reasonably informed of the distinction between a podiatrist and other medical practitioners as is reflected by the difference in training and licensing and the scope of practice.]

(c) [~~(d)~~] A practitioner must [~~shall~~] not use a trade name or assumed name to identify the practitioner's [~~his~~] practice, except as authorized in this section.

(d) [~~(e)~~] A practitioner must provide the department with the practitioner's practice name, corporate name, trade name or assumed name to identify an individual practice, or a group of podiatric physicians with which he/she is practicing and the address, and notify the department of any changes within 10 business days.

(e) [~~(f)~~] The name of a professional corporation created for the practice of podiatric medicine must [~~shall~~] include one of the following suffixes:

(1) (Name), A Professional Corporation;

(2) (Name), A Prof. Corp.;

(3) (Name), P.C.;

(4) (Name), Incorporated;

(5) (Name), Inc.;

(6) (Name), Professional Association;

(7) (Name), P.A.;

(8) (Name), P.L.L.P.;

(9) (Name), Professional Limited Liability Partnership;

(10) (Name), P.L.L.C.;

(11) (Name), Professional Limited Liability Company;

(12) (Name), L.L.C.; or

(13) (Name), Limited Liability Company.

(f) [~~(g)~~] A practitioner practicing in a group composed of practitioners from different branches of the healing arts may practice under a corporate name, trade name or assumed name adopted by the group, provided the name fairly and objectively identifies the practice. In addition, within the group, the practitioner must [~~shall~~] identify themself [~~himself~~] appropriately.

§130.51.Advertising.

(a) A practitioner may advertise. A practitioner must [~~shall~~] not use or participate in the use of any publication, including advertisements, news stories, press releases, and periodical articles, that contains a false, misleading, or deceptive statement.

(b) A practitioner must [~~may~~] not include any of the following types of statements in any advertisements or press releases:

(1) a misrepresentation of fact, or claims as fact something that has not been generally accepted among the podiatric community or by the department as having been proven or established as fact;

(2) a statement that is likely to mislead or deceive or entice or persuade a reasonable person because it fails to make full disclosure of relevant facts whether regarding fees, modes of treatment, conditions or techniques of surgery, post-operative conditions such as degree of pain, length of time of recovery, mobility and strength during recovery, and the like;

(3) a statement that is intended or likely to create in a [~~an ordinary~~] reasonable person false or unjustified expectations of favorable results;

(4) a laudatory statement, or other statement or implication that the practitioner's services are of exceptional quality;

(5) [a] statistical data or information that reflects or is intended to reflect quality or degree of success of past performance, or prediction of future success;

(6) a representation that podiatric services can or will be completely performed for a stated fee amount when this is not the case, or makes representations with respect to fees that do not disclose all variables affecting the fees, or makes representations that might [~~reasonable~~] cause a reasonable [~~an ordinary prudent~~] person to misunderstand or be deceived about the fee amount;

(7) a representation that health care insurance deductibles or co-payments may be waived or are not applicable to health care services to be provided if the deductibles or co-payments are required; or

(8) a representation that the benefits of a health benefit plan will be accepted as full payment when deductibles or co-payments are required.

(1) name, address, telephone numbers, office hours, and telephone-answering hours;

(2) biographical and educational background;

(3) professional memberships and attainments and certifications, subject[~~, however,~~] to the provisions of subsection (e);

(4) description of services offered, subject[~~, however~~] to the provisions of subsection (f);

(5) foreign language ability;

(6) acceptable credit arrangements, subject[~~, however,~~] to the provisions of subsection (b)(2) and (b)(6);

(7) the limitation of practice to certain areas of podiatric medicine;

(8) the opening or change in location of any office and change in personnel;

(9) fees charged for the initial consultation, provided that any limitation on the time for the consultation must [~~shall if the time for the consultation is to be limited, any such limitation on the time~~] be stated;

(10) fixed fees for specific podiatric treatments and services, subject, however, to the provisions of subsection (b)(2) and (b)(6); and

(11) a statement that a schedule of fees or an estimate of fees to be charged for specific treatments or services will be available on request.

(d) All practitioners must [~~shall~~] retain recordings, transcripts, or copies of all public communications by date of publication for a period of at least two years after such communication was made.

(e) A practitioner may advertise or publish the name of any board of certification under which the practitioner has fully and validly become certified, provided that the full name of the certifying board is included in the publication. [: except as provided by this subsection, practitioners may not list in any type of advertisement or public communication any certifying board that is not approved or recognized by the Council on Podiatric Medical Education of the American Podiatric Medical Association.]

(f) A practitioner must not list in any type of advertisement or public communication any certifying board that is not approved or recognized by the Council on Podiatric Medical Education of the American Podiatric Medical Association.

~~[(f) Each certifying board that is not recognized by the Council on Podiatric Medical Education of the American Podiatric Medical Association must meet each of the following requirements:]~~

[(1) the certifying board requires all practitioners who are seeking certification to successfully pass a written or an oral examination or both, which tests the applicant's knowledge and skills in the specialty or subspecialty area of podiatric medicine. All or part of the examination may be delegated to a testing organization. All examinations require a psychometric evaluation for validation;]

~~[(2) the certifying board has written proof of a determination by the Internal Revenue Service that the certifying board is tax exempt under the Internal Revenue Code pursuant to §501(c);]~~

~~[(3) the certifying board has a permanent headquarters and staff;]~~

~~[(4) the certifying board has at least 100 duly licensed certificants from at least one-third of the states; and]~~

[(5) the certifying board requires all practitioners who are seeking certification to have satisfactorily completed identifiable and substantial training in the specialty or subspecialty area of podiatric medicine in which the practitioner is seeking certification, and the certifying organization utilizes appropriate peer review. This identifiable training shall be deemed acceptable unless determined by the department, with the advice of the advisory board, to be inadequate in scope, content, and duration in that specialty or subspecialty area of podiatric medicine in order to protect the public health and safety.]

(g) The terms "board eligible", "board qualified", or any similar words or phrase calculated to convey the same meaning must [~~may~~] not be used in advertising.

(h) If a publication by or for a practitioner mentions [~~includes mention of~~] a particular surgical technique or device, the publication must also include a specific and true statement that reveals [~~to an ordinary reasonable person~~] the limits, [~~and~~] scope, and specific purpose of the technique or device so as not to mislead a [~~an ordinary~~] reasonable person regarding the difficulty, pain or discomfort, length of time for surgery or recuperation, or possibility of complications.

§130.54.Records.

(a) All practitioners must [~~shall~~] make, maintain, and keep accurate records of the diagnosis made and the treatment performed for and upon each of the practitioner's [~~his or her~~] patients for reference and for protection of the patient for at least five years following the completion of treatment.

(b) The records of the identity, diagnosis, evaluation, or treatment of a patient by a practitioner that are created or maintained by a practitioner are the property of the practitioner.

(c) A practitioner must furnish copies, a summary, or a narrative of the medical records pursuant to a written request by:

(1) the patient;

(2) a parent or legal guardian if the patient is aminor;

(3) a legal guardian if the patient has been adjudicated incompetent to manage his or her personal affairs;

(4) an attorney ad litem appointed for the patient; or

(5) a personal representative if the patient is deceased, except if the practitioner determines that access to the information would be harmful to the physical, mental, or emotional health of the patient. The practitioner must delete confidential information about another patient or family member of the patient who has not consented to the release.

[(c) A practitioner shall furnish copies of medical records or a summary or narrative of the medical records pursuant to a written request by the patient or by a parent or legal guardian if the patient is a minor, or a legal guardian if the patient has been adjudicated incompetent to manage his or her personal affairs, or an attorney ad litem appointed for the patient or personal representative if the patient is deceased, except if the practitioner determines that access to the information would be harmful to the physical, mental, or emotional health of the patient. The practitioner may delete confidential information about another patient or family member of the patient who has not consented to the release.]

(d) The requested copies of medical records or [of] a summary or narrative of the records must [~~shall~~ ] be furnished by the practitioner within thirty (30) days after the date of the request and reasonable fees for furnishing the information shall be paid by the patient or someone on behalf of the patient.

(e) As referenced in subsection (c), if the practitioner denies the request for copies of medical records or a summary or narrative of the records, either in whole or in part, the practitioner must [~~shall~~] furnish the patient a written statement, signed and dated, stating the reason for the denial, and a copy of the statement denying the request must [~~shall~~] be placed in the patient's medical records.

(f) The practitioner is entitled to [~~responding to a request for such information shall be entitled to receive~~] a reasonable fee for providing the requested information. In addition, a reasonable fee may include actual costs for mailing, shipping, or delivery of the records and x-rays.

(g) A practitioner is entitled to payment of a reasonable fee prior to releasing a requested copy, summary, or narrative of medical records. A practitioner may retain the requested information until payment is received but must notify the requesting party, in writing and within ten calendar days of receiving the request, of the need for payment.

(1) A copy of the letter regarding the need for payment shall be made part of the patient's medical record. Medical records requested pursuant to a proper request for release may not be withheld from the patient, the patient's authorized agency, or the patient's designated recipient for such records based on a past due account for medical care or treatment previously rendered to the patient.

(2) A practitioner is not entitled to payment of a reasonable fee when the information is requested for purposes of emergency or acute medical care by a health care provider licensed by any state, territory, or insular possession of the United States or any State or Province of Canada.

[(g) The practitioner providing copies of requested medical records or a summary or a narrative of such medical records shall be entitled to payment of a reasonable fee prior to release of the information unless the information is requested by a health care provider licensed in Texas or licensed by any state, territory, or insular possession of the United States or any State or Province of Canada if requested for purposes of emergency or acute medical care. In the event the practitioner receives a proper request for copies of medical records or a summary or narrative of the medical records for purposes other than for emergency or acute medical care, the practitioner may retain the requested information until payment is received. In the event payment is not routed with such a request, within ten calendar days from receiving a request for the release of such medical records for reasons other than emergency or acute medical care, the practitioner shall notify the requesting party in writing of the need for payment and may withhold the information until payment of a reasonable fee is received. A copy of the letter regarding the need for payment shall be made part of the patient's medical record. Medical records requested pursuant to a proper request for release may not be withheld from the patient, the patient's authorized agency, or the patient's designated recipient for such records based on a past due account for medical care or treatment previously rendered to the patient.]

(h) A subpoena is not [~~shall not be~~] required for the release of medical records requested pursuant to a proper release for records under this section made by a patient or by the patient's guardian or other representative duly authorized to obtain such records.

(i) A practitioner is only required to provide copies of billing records pertaining to medical treatment of a patient when specifically requested in a proper request for release of medical records.

[(i) In response to a proper request for release of medical records, a practitioner shall not be required to provide copies of billing records pertaining to medical treatment of a patient unless specifically requested pursuant to the request for release of medical records.]

(j) The allowable charges as set forth in this chapter shall be maximum amounts, and this chapter shall be construed and applied [~~so as~~] to be consistent with lower fees or the prohibition or absence of such fees as required by state statute or prevailing federal law.

§130.55.Practitioner Code of Ethics.

(a) The health and safety of patients shall be the first consideration of the practitioner. The principal objective to the practitioner is to render service to humanity. A practitioner shall continually strive to improve his medical knowledge and skill for the benefit of his patients and colleagues. The practitioner shall administer to patients in a professional manner and to the best of his ability. Secrets and personal information entrusted to him shall be held inviolate unless disclosure is necessary to protect the welfare of the individual or the community. A practitioner shall be temperate in all things in recognition that his knowledge and skill are essential to public health, welfare, and human life.

(b) A practitioner shall conduct his practice on the highest plane of honesty, integrity, and fair dealing and shall not mislead his patients as to the gravity of such patient's podiatric medical needs. A practitioner shall not abandon a patient he has undertaken to treat. The practitioner may discontinue treatment after reasonable notice has been given to the patient by the practitioner of the practitioner's intention to discontinue treatment and the patient has had a reasonable time to secure the services of another practitioner or all podiatric medical services actually begun have been completed and there is no contract or agreement to provide further treatment.

(c) A practitioner shall not aid an unethical practitioner or engage in any subterfuge with any person, business, or organization. The practitioner shall expose any illegal, unethical, or dishonest conduct of other practitioners and cooperate with those invested with the responsibility of enforcement of the law and these rules of conduct.

(d) A person under a practitioner's care or treatment on whom podiatric medical surgery is to be performed in connection with such care or treatment should be informed by the practitioner of the identity of the surgeon before the surgery is performed.

(e) The practitioner has special knowledge which his patient does not have; therefore, to avoid misunderstanding he should advise his patient in advance of beginning treatment of the nature and extent of the treatment needed; the approximate time required to perform the recommended treatment and services; and any further or additional services or return by the patient for treatment, adjustments, or consultation and the time in which this shall occur. A practitioner should inform his patients as to the fees to be charged for services before the services are performed, regardless of whether the fees are charged on a case basis, on the basis of a separate charge for each service, or a combination of these two methods, or some other basis. If an exact fee for a particular service, as in extended care cases, cannot be quoted to a patient, a fair and reasonable estimate of what the fee will be and the basis on which it will be determined should be given the patient.

(f) A practitioner shall not tender or receive a commission for a referral.

(g) A podiatrist's treatment of a patient must be consistent with the best practices and standards observed in the podiatry community and must be performed with the same level of skill required of a reasonably prudent podiatrist practicing under the same or similar circumstances.

§130.57.Sexual Misconduct.

(a) Sexual misconduct is behavior that exploits the physician-patient or physician-staff member relationship in a sexual way. This behavior is non-diagnostic and non-therapeutic, may be verbal or physical, and may include expressions of thoughts and feelings or gestures that are sexual or that reasonably may be construed by a person as sexual.

(b) Sexual misconduct may be the basis for disciplinary action if the behavior was injurious or there is an exploitation of the physician-patient or physician-staff member relationship.

(c) Sexual violation may include physician-patient or physician-staff member sex, whether or not initiated by the patient/staff, and engaging in any conduct with a patient/staff that is sexual or may be reasonably interpreted as sexual, including but not limited to:

(1) sexual intercourse, genital-to-genital contact;

(2) oral to genital contact;

(3) oral to anal contact, genital to anal contact;

(4) kissing in a romantic or sexual manner;

(5) touching breasts, genitals, or any sexualized body part for any purpose other than appropriate examination or treatment, or where the patient/staff has refused or has withdrawn consent;

(6) encouraging the patient/staff to masturbate in the presence of the physician or masturbation by the physician while the patient/staff is present; and

(7) offering to provide practice-related services, such as drugs, in exchange for sexual favors.

(d) Sexual impropriety may comprise behavior, gestures, or expressions that are seductive, sexually suggestive, or sexually demeaning to a patient/staff, including but not limited to:

(1) disrobing or draping practices that reflect a lack of respect for the patient's/staff's privacy, deliberately watching a patient/staff dress or undress, instead of providing privacy for disrobing;

(2) subjecting a patient/staff to an intimate examination in the presence of medical students or other parties without the explicit consent of the patient/staff or when consent has been withdrawn;

(3) examination or touching of genitals without the use of gloves;

(4) inappropriate comments about or to the patient/staff, including but not limited to:

(A) making sexual comments about a person's body or underclothing;

(B) making sexualized or sexually demeaning comments to a patient/staff;

(D) making comments about potential sexual performance during an examination or consultation, except when the examination or consultation is pertinent to the issue of sexual function or disfunction;

(E) requesting details of sexual history, sexual likes, or sexual dislikes when not clinically indicated for the type of consultation;

[(4) inappropriate comments about or to the patient/staff, including but not limited to making sexual comments about a person's body or underclothing, making sexualized or sexually demeaning comments to a patient/staff, criticizing the patient's/staff's sexual orientation (transgender, homosexual, heterosexual, or bisexual), making comments about potential sexual performance during an examination or consultation except when the examination or consultation is pertinent to the issue of sexual function or dysfunction, requesting details of sexual history or sexual likes or dislikes when not clinically indicated for the type of consultation;]

(5) engaging in treatment or examination of a patient/staff for other than bona fide health care purposes or in a manner substantially inconsistent with reasonable health care practices;

(6) using the physician-patient or physician-staff member relationship under the pretext of treatment to solicit a date;

(7) initiation by the physician of conversation regarding the sexual problems, preferences, or fantasies of the physician; and

(8) examining the patient/staff intimately without consent.

(e) Sexual exploitation by a practitioner is the breakdown of the professionalism in the physician/patient/staff relationship constituting sexual abuse. Sexual exploitation may undermine the therapeutic relationship, may exploit the vulnerability of the patient/staff, and ultimately may be detrimental to the patient's/staff's emotional well-being, including but not limited to:

(1) causing emotional dependency of the patient/staff;

(2) causing unnecessary dependence outside the therapeutic relationship;

(3) breach of trust; and

(4) imposing coercive power over the patient/staff.

(f) A third impartial person who is the same sex as the patient must be present in the examining room if a patient is asked to disrobe or if the genitalia are examined.

(g) The practitioner under investigation for sexual misconduct may be required to have a complete medical evaluation, including appropriate mental and physical examination. Laboratory examination should include appropriate urine and blood drug screens.

(h) The psychiatric history and mental status examination is to be performed by a psychiatrist knowledgeable in the evaluation suspected of sexual misconduct. The examination may include neuropsychological testing.

(i) Sexual violation or impropriety may warrant disciplinary action by the department up to and including revocation of license.

(j) In the event a physician applies for license reinstatement, any petition for reinstatement will include the stipulation that additional mental and physical evaluations may be required prior to the department's review for reinstatement to ensure the continuing protection of the public.

§130.58.Standards for Prescribing Controlled Substances and Dangerous Drugs.

(a) A podiatrist must comply with all federal and state laws and regulations relating to the ordering and prescribing of controlled substances in Texas, including, but not limited to, requirements set forth by:

(1) the United States Drug Enforcement Administration;

(2) the United States Food and Drug Administration;

(3) the Texas Health and Human Services Commission;

(4) the Texas Department of Public Safety;

(5) the Texas State Board of Pharmacy; and

(6) the department.

[(a) Podiatrists shall comply with all federal and state laws and regulations relating to the ordering and prescribing of controlled substances in Texas, including but not limited to requirements set forth by the United States Drug Enforcement Administration, United States Food & Drug Administration, Texas Health & Human Services Commission, Texas Department of Public Safety, Texas State Board of Pharmacy, and the department.]

(b) A podiatrist must [~~may~~] not prescribe a controlled substance except for a valid podiatric medical purpose and in the course of podiatric practice.

(c) A podiatrist must [~~may~~] not confer upon and must [~~may~~] not delegate prescriptive authority (the act of prescribing or ordering a drug or device) to any other person.

(d) A podiatrist may designate an agent to communicate a prescription to a pharmacist. The podiatrist remains personally responsible for the actions of the designated agent who communicates a prescription to a pharmacist. A podiatrist who designates an agent must:

(1) on request, provide a pharmacist with a copy of the podiatrist's written authorization for a designated agent to communicate a prescription; and

(2) maintain a list of the designated agents at the podiatrist's usual place of business.

[(d) A podiatrist may designate an agent to communicate a prescription to a pharmacist. A podiatrist who designates an agent shall provide a pharmacist on request with a copy of the podiatrist's written authorization for a designated agent to communicate a prescription and shall maintain at the podiatrist's usual place of business a list of the designated agents. The podiatrist remains personally responsible for the actions of the designated agent who communicates a prescription to a pharmacist.]

(e) Responsible prescribing of controlled substances requires that a podiatrist consider certain elements prior to issuing a prescription, including, but not limited to:

(1) reviewing the patient's Schedule II, III, IV, and V prescription drug history report by accessing the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database;

(2) the patient's date of birth matches with proper identification;

(3) an initial comprehensive history and physical examination is performed;

(4) the Schedule II prescription copy is in the chart or record found for each prescription written; and

(5) alternative therapy (e.g. ultrasound, TENS) discussed and prescribed for the patient.

(f) Prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol, a podiatrist must [~~shall~~] review the patient's Schedule II, III, IV, and V prescription drug history report by accessing the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database. Failure to do so is grounds for disciplinary action by the department.

(g) Prior to prescribing any controlled substance, a podiatrist may review the patient's Schedule II, III, IV, and V prescription drug history report by accessing the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database.

(h) An employee of the podiatrist acting at the direction of the podiatrist may perform the function described in subsection (e) and (f) so long as that employee acts in compliance with HIPAA and only accesses information related to a particular patient of the podiatrist.

(i) A podiatrist or an employee of a podiatrist acting at the direction of the podiatrist may access the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database to inquire about the podiatrist's own Schedule II, III, IV, and V prescription drug activity.

(j) A podiatrist or an employee of a podiatrist acting at the direction of the podiatrist may not access the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database for reasons not directly related to a patient under their care. Unauthorized access is grounds for disciplinary action by the department.

(k) If a podiatrist uses an electronic medical records management system (health information exchange) that integrates a patient's Schedule II, III, IV, and V prescription drug history data from the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database, a review of the electronic medical records management system (health information exchange) with the integrated data must [~~shall~~] be deemed compliant with the review of the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database as required under §481.0764(a) of the Texas Health and Safety Code and these rules.

(l) The duty to access a patient's Schedule II, III, IV, and V prescription drug history report through the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database as described in subsection (e) does not apply in the following circumstances:

(1) it is clearly noted in the patient's medical record that the patient has a diagnosis of cancer or is in hospice care; or

(2) the podiatrist or an employee of the podiatrist makes a good faith attempt to access the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database but is unable to access the information because of circumstances outside the control of the podiatrist or an employee of the podiatrist and the good faith attempt and circumstances are clearly documented in the patient's medical record for prescribing a controlled substance.

(m) Information obtained from the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database may be included in any form in the searched patient's medical record and is subject to any applicable state or federal confidentiality, privacy or security laws.

(n) In accordance with Texas Health and Safety Code Chapter 483, Subchapter E., a podiatrist may prescribe an opioid antagonist to a person at risk of experiencing an opioid-related drug overdose or to a family member, friend, or other person in a position to assist the person who is at risk of experiencing an opioid-related drug overdose. A podiatrist who prescribes an opioid antagonist must [~~shall~~ ] document the basis for the prescription in the medical record of the person who is at risk of experiencing an opioid-related drug overdose.

§130.59.Opioid Prescription Limits and Required Electronic Prescribing.

(a) In this section, "acute pain" means the normal, predicted, physiological response to a stimulus such as trauma, disease, and operative procedures. Acute pain is time limited and the term does not include:

(1) chronic pain;

(2) pain being treated as part of cancer care;

(3) pain being treated as part of hospice or other end-of-life care; or

(4) pain being treated as part of palliative care.

(b) For the treatment of acute pain, a podiatrist must [~~may~~] not:

(1) issue a prescription for an opioid in an amount that exceeds a 10-day supply; or

(2) provide for a refill of an opioid.

(1) in an emergency or in circumstances in which electronic prescribing is not available due to temporary technological or electronic failure, in a manner provided for by the Texas State Board of Pharmacy rules;

(2) by a practitioner to be dispensed by a pharmacy located outside this state, in a manner provided for by the Texas State Board of Pharmacy rules;

(3) when the prescriber and dispenser are in the same location or under the same license;

(4) in circumstances in which necessary elements are not supported by the most recently implemented national data standard that facilitates electronic prescribing;

(5) for a drug for which the United States Food and Drug Administration requires additional information in the prescription that is not possible with electronic prescribing;

(6) for a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency or in other circumstances in which the practitioner may issue a non-patient-specific prescription;

(7) for a drug under a research protocol;

(8) by a practitioner who has received a waiver under Section 481.0756 of the Texas Health and Safety Code from the requirement to use electronic prescribing, as provided by subsections (d) - (e); or

(9) under circumstances in which the practitioner has the present ability to submit an electronic prescription but reasonably determines that it would be impractical for the patient to obtain the drugs prescribed under the electronic prescription in a timely manner and that a delay would adversely impact the patient's medical condition.

(d) To obtain a waiver of the requirement to use electronic prescribing, a practitioner must submit a waiver request on a form approved by the department.

(1) The waiver request form must document sufficient evidence of the circumstances justifying the waiver as outlined in subsection (e).

(2) A waiver granted by the department under this section shall expire one year after the date of approval.

(3) A practitioner must reapply for a subsequent waiver not earlier than the 30th day before the date the waiver expires if the circumstances that necessitated the waiver continue.

[(d) To obtain a waiver of the requirement to use electronic prescribing, a practitioner must submit a waiver request on a form approved by the department. The waiver request form must document sufficient evidence of the circumstances justifying the waiver as outlined in subsection (e). A waiver granted by the department under this section shall expire one year after the date of approval. A practitioner may reapply for a subsequent waiver not earlier than the 30th day before the date the waiver expires if the circumstances that necessitated the waiver continue.]

(e) A practitioner's waiver of electronic prescribing request form must contain sufficient evidence of one or more of the following that, in the judgment of the executive director, justify the issuance of a waiver:

(1) economic hardship, including:

(A) any special situational factors affecting either the cost of compliance or ability to comply;

(B) the likely impact of compliance on profitability or viability; and

(2) technological limitations not reasonably within the control of the practitioner;

(3) issuance of fifty or fewer prescriptions for controlled substances in the year immediately prior to the application for a waiver, as documented by the Texas Prescription Monitoring Program; or

(4) other exceptional circumstances demonstrated by the practitioner.

(f) The department may revoke or refuse to issue a waiver under this section if the practitioner violates or attempts to violate any provision of Texas Occupations Code, Chapters 51 or 202, this chapter, or any rule or order of the executive director or commission.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402541

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

16 TAC §130.52, §130.53

STATUTORY AUTHORITY

§130.52.Medical Offices.

§130.53.Podiatric Medical Radiological Technicians.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402547

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

SUBCHAPTER F. FEES

16 TAC §130.60

STATUTORY AUTHORITY

§130.60.Fees.

(a) Fees paid to the department are non-refundable.

(b) Fees are as follows:

(1) Temporary Residency License (Initial and Renewal)--$125

(2) Extended Temporary License extension--$50

(3) Provisional License--$125

(4) Doctor of Podiatric Medicine Initial License--$750

(5) Doctor of Podiatric Medicine Renewal License--$700

(6) Limited Faculty Initial License--$125

(7) Limited Faculty Renewal License--$60

(8) Voluntary Charity Care Status License (Initial and Renewal)--$0

(9) Inactive Status License (Initial and Renewal)--$0

(10) [~~(9)~~] Active Duty Military Members--$0

(11) [~~(10)~~] Hyperbaric Oxygen Certificate (Initial and Renewal)--$25 if issued or renewed before January 1, 2025; $50 if issued or renewed on or after January 1, 2025

(12) [~~(11)~~] Nitrous Oxide Registration (Initial and Renewal)--$25 if issued or renewed before January 1, 2025; $50 if issued or renewed on or after January 1, 2025

(13) [~~(12)~~] Podiatric Medical Radiological Technician Registration (Initial and Renewal) [~~Technicians~~] --$25 if issued or renewed before January 1, 2025; $50 if issued or renewed on or after January 1, 2025

(14) [~~(13)~~] Duplicate License/replacement license--$25

(15) [~~(14)~~] The fee for a criminal history evaluation letter is the fee prescribed under §60.42 [~~(relating to Criminal History Evaluation Letters)~~].

(16) [~~(15)~~] A dishonored[~~/returned check or~~] payment fee is the fee prescribed under §60.82 [~~(relating to Dishonored Payment Device)~~].

(17) [~~(16)~~] Late renewal fees for licenses issued under this chapter are provided under §60.83 [~~(relating to Late Renewal Fees)~~].

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402542

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750

SUBCHAPTER G. ENFORCEMENT

16 TAC §§130.70, 130.72, 130.73

STATUTORY AUTHORITY

§130.70.Complaints and Claims.

(a) The licensee must display a department-approved sign or provide to all patients and consumers a brochure that notifies consumers or recipients of services of the name, mailing address, website, and telephone number of the department and a statement informing consumers or recipients of services that complaints against a licensee can be directed to the department.

(b) The sign must [~~shall~~] be conspicuously and prominently displayed in a location where it may be seen by all patients. The consumer brochure, if chosen, must be prominently displayed and available to patients and consumers at all times.

(c) Each defendant practitioner against whom a professional liability claim or complaint has been filed must report the claim or complaint to the department. The information is to be reported by insurers or other entities providing medical professional liability insurance for a practitioner. If an insurance carrier does not adequately report, reporting must [~~shall~~] be the responsibility of the practitioner.

(d) One separate report must [~~shall~~] be filed for each defendant insured practitioner.

(e) The information must be provided within 30 days of receipt of the claim or suit. A copy of the claim letter or petition must be attached.

(f) The information reported must contain at least the requested data as follows:

(1) There must be enough identification data available to enable department staff to match the closure report to the original file. The data required to accomplish this include:

(A) name and license number of defendant practitioner(s); and

(B) name of plaintiff; or

(2) A court order or settlement agreement is acceptable and should contain the necessary information to match the closure information to the original file.

(g) Failure by a licensed insurer to report under this section must [~~shall~~] be referred to the Texas Department of Insurance and sanctions under the Texas Insurance Code maybe imposed for failure to report.

(h) For the purposes of this section, a professional liability claim or complaint shall be defined as a cause of action against a practitioner for treatment, or other claimed departure from accepted standards of medical or health care or safety which proximately results in injury to or death of the patient, whether the patient's claim or cause of action sounds in tort or contract to include: [interns, residents, supervising practitioner, on-call practitioner, consulting practitioner, and those practitioner who administer, read, or interpret laboratory tests, x-rays, and other diagnostic studies.]

(1) interns;

(2) residents;

(3) supervising practitioner;

(4) on-call practitioner;

(5) consulting practitioner; and

(6) practitioners who administer, read, or interpret laboratory tests, x-rays, and other diagnostic studies.

(i) Claims that are not required to be reported under this chapter but which may be reported include, but are not limited to, the following:

(1) Product liability claims;

(2) antitrust allegations;

(3) allegations involving improper peer review activities;

(4) civil rights violations;

(5) allegations of liability for injuries occurring on a podiatric physician's property, but not involving a breach of duty in the podiatric physician-patient relationship; or

(6) business disputes.

(j) Claims that are not required to be reported under this chapter may however be voluntarily reported pursuant to the provisions of the Act.

§130.72.Administrative Penalties and Sanctions.

(a) If a person or entity violates or attempts to violate any provision of Texas Occupations Code, Chapters 51 or 202, this chapter, or any rule or order of the executive director or commission, proceedings may be instituted to impose administrative penalties, administrative sanctions, or both in accordance with the provisions of Texas Occupations Code, Chapters 51 and 202, any associated rules, and consistent with the department's enforcement plan.

(b) A person authorized to receive information by accessing the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database must [~~may~~] not disclose or use the information in a manner not authorized by law.

(c) A person authorized to receive information by accessing the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database commits an offense if the person discloses or uses the information in a manner not authorized by law.

(d) A person authorized to receive information by accessing the Texas State Board of Pharmacy's - Texas Prescription Monitoring Program (PMP) database commits an offense if the person makes a material misrepresentation or fails to disclose a material fact in the request for information.

(e) The department shall deny an application for license, and shall revoke the license of a person licensed under Chapter 202, Texas Occupations Code, as required by Chapter 108, Subchapter B, Texas Occupations Code.

(f) A person whose application for licensure has been denied, or whose license has been revoked, pursuant to Texas Occupations Code, Chapter 108, Subchapter B may reapply or seek reinstatement as provided by that subchapter.

§130.73.Conditions of Suspension of License.

(a) Suspension of a license means that the office of the practitioner is to be closed for the purposes of receiving, diagnosing, treating, or consulting with patients.

(1) The suspended practitioner must not participate for income in any professional activity that is directly related to:

(A) the diagnosis of a patient;

(B) the treatment of a patient; or

(2) The suspended practitioner may refer patients to another practitioner for treatment or consultation during the period of the suspension, but the suspended practitioner must not derive any income from such referrals.

(3) The suspended practitioner may allow another practitioner to see the suspended practitioner's patients during the period of the suspension, in the suspended practitioner's office or the other practitioner's office, but the suspended practitioner must not derive income from the other practitioner by way of referral fees, or the like.

[(a) Suspension of a license means that the office of the practitioner is to be closed for the purposes of receiving, diagnosing, treating, or consulting with patients, and the licensee may not participate for income in any professional activity that is directly related to diagnosis or treatment of a patient or activities that involve consultation services related to management of a practice. The practitioner may refer patients to another practitioner for treatment or consultation during the period of the suspension, but the practitioner shall not derive any income from such referrals. The practitioner may allow another practitioner to see the practitioner's patients during the period of the suspension the practitioner's office or other practitioner's office, but the practitioner shall derive no income from the other practitioner by way of referral fees, or the like.]

(b) The practitioner's office may remain open for the purposes of administrative work, including making future appointments, arranging referrals, handling mail, processing accounts, billing, and insurance matters, and other similar matters not directly related to the diagnosis and treatment of patients.

(c) If the suspended practitioner shares offices with another practitioner, the other practitioner shall be allowed to continue to practice. [, but the suspended practitioner shall not share income with the other practitioner, including any income derived in any way from the diagnosis or treatment of patients. The department may, through unannounced visits or by requesting documentation, check on the business arrangement that the suspended practitioner has with the other practitioner(s) regarding the renting of equipment, rental of business facilities, referral fees or any other negotiated arrangement so as to be sure that the suspended practitioner is not deriving any monies from the practice of podiatric medicine.]

(1) The suspended practitioner must not share income with the other practitioner, including any income derived in any way from the diagnosis or treatment of patients.

(2) The department may, through unannounced visits or by requesting documentation, check on the business arrangement that the suspended practitioner has with the other practitioner(s) regarding the renting of equipment, rental of business facilities, referral fees or any other negotiated arrangement so as to be sure that the suspended practitioner is not deriving any monies from the practice of podiatric medicine.

(d) If a license suspension is probated, the commission or executive director may require the licensee to:

(1) report regularly to the department on matters that are the basis of the probation;

(2) limit practice to the areas prescribed by the commission or executive director; or

(3) continue or review continuing professional education until the licensee attains a degree of skill satisfactory to the department in those areas that are the basis of the probation.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on June 7, 2024.

TRD-202402543

Doug Jennings

General Counsel

Texas Department of Licensing and Regulation

Earliest possible date of adoption: July 21, 2024

For further information, please call: (512) 463-7750