Proposed Rules of Practice – Scope of Practice The Texas Board of Chiropractic Examiners (Board) proposes an amendment to §75.17(c)(3), to add a new subparagraph (C) this amendment with an increased requirement that, in order to administer this test, a licensee must have received a diplomate in chiropractic neurology and successfully completed an additional 150-hour post-graduate specialty course in vestibular rehabilitation.

Adopted Rules Applications and Applicants – Approved Chiropractic Schools and Colleges The Texas Board of Chiropractic Examiners (Board) adopts an amendment to §71.5,

The adopted amendment clarifies that bona fide reputable chiropractic schools are those accredited not only by the Council on Chiropractic Education (CCE), but also by other chiropractic educational accrediting bodies that are members in good standing with the Councils on Chiropractic Education International (CCEI). CCE is the American component of CCEI, so American schools currently considered to be “bona fide reputable chiropractic schools” will not be affected by this amendment. The Board has determined applicants from foreign chiropractic schools accredited by CCEI member accrediting bodies should be allowed to be licensed if the applicants meet all other licensing criteria in the state of Texas. Section 201.302 states that an applicant must be either a graduate or a final semester student of a bona fide reputable doctor of chiropractic degree program. Section 201.303 sets forth parameters for determining what qualifies as a bona fide reputable doctor of chiropractic degree program 35 TexReg 5557-58

 Adopted Rules Licenses and Renewals – Renewal of License The Texas Board of Chiropractic Examiners (Board) adopts an amendment to §73.2,

§73.2 The adopted amendment adds subsection (j), which deals with information required to be furnished by licensees to the Board pursuant to license renewal applications. language MOVED FROM 80.3(G)

 Adopted Rules of Practice – Spinal Screening The Texas Board of Chiropractic Examiners (Board) adopts new §75.23, concerning spinal screening, to set forth the minimal standards for conducting out-of-facility spinal screenings, such as at a health fair or other community event. The new rule provides standards for the training required of persons conducting out-of-facility spinal screenings and for the information that must be provided to the public at such screenings. School spinal screenings would still need to be conducted in compliance with DSHS rules and guidelines.

 Adopted Rules of Practice – Impaired Licensees and Applicants Texas Board of Chiropractic Examiners (Board) adopt new §75.25, establishes criteria for when the Board can require an impaired licensee or applicant to undergo mental and/or physical examination. Previously, this information was contained in §80.3, which deals with requests for information and records from licensees. The Board determined that information regarding impaired licensees and applicants would be more appropriate in new §75.25.

 Adopted Rules Formal SOAH Proceedings –amendment to §76.3, concerning Commencement of Enforcement Proceedings corrects an incorrect citation to the Administrative Procedure Act (APA). Previously, subsection (b) cited §2001.052 of the APA in declaring that a respondent is entitled to reasonable notice of a hearing of not less than then days prior to the hearing. However, the correct reference to the APA should be §2001.051, as reflected in this adopted amendment.

  Adopted Rules Formal SOAH Proceedings – Default Judgments amendment to §76.11, concerning Default Judgments, changes the font size of the required default judgment disclosure in notices of hearing. Previously, subsection (b) read that the default judgment disclosure in a notice of hearing was required to be 10-point font Therefore, the adopted amendment changes the required font size for a default judgment disclosure in a notice of hearing to 12-point font.

 Adopted Rules Professional Conduct – Request for Information and Records from Licensees amendment to §80.3, the adopted amendment removes subsections (g) and (h). Previously, §80.3(g) dealt with licensees providing information to the Board about answers to questions on an application for license renewal. The Board determined that §73.2(j) is a more appropriate place for this information. Additionally, §80.3(h) dealt with impaired licensees.

SECTION-BY-SECTION SUMMARY LPC Rule Changes

Section 681.14(a)(10) has been added to authorize the board to charge a fee of $50 for pre-evaluation of a criminal history for eligibility for future licensure.

New §681.17 authorizes the board to pre-evaluate a criminal history by request of future licensees.

Section 681.41(e)(6) is amended to require LPC Interns to provide their supervisor’s name on all documentation.

Section 681.41(j) is amended to allow LPCs to promote and sell products to clients as long as it is for a therapeutic purpose and does not hamper the counseling relationship.

Section 681.41(l) is amended to clarify a dual relationship. REMOVES LANGUAGE REGARDING DUAL RELATIONSHIP AND SIMPLY STATES NON-THERAPUETIC RELATIONSHIPS WITH CLIENTS ARE PROHIBITED UNLESS THEY OCCUR TWO YEARS AFTER THERAPY TERMINATED OR IN THE CASE OF SEXUAL RELATIONSHIPS—FIVE YEARS AFTER THERAPY TERMINATED.

Section 681.42(e)(2) is amended to clarify language. REMOVED THE WORD “Inappropriate” regarding seductive, sexual behavior and sexual comments.

Section 681.48(a) is amended to require LPC Interns to provide their supervisor’s name on all documentation. In addition, §681.48(e) is added to require LPC Interns to inform clients of their supervisor’s name, telephone number, and address.

Section 681.49(d) is amended to ensure the understanding that all degrees must be accepted and reported by American Association of Collegiate Registrars and Admissions Officers. THIS REFERS TO ADVERTISING AND THAT A DEGREE MUST BE RECOGNIZED BY AACR

Section 681.52(e) is amended to require LPC Interns to provide their supervisor’s name on all documentation.

Section 681.72(d) is amended to require the supervisor’s renewal card to be submitted with the supervisor agreement form.

Section 681.83(a) is amended to clarify that an applicant must take at least one course in each of the core areas. REMOVES LANGUAGE:  “obtain academic course work”

Section 681.92(g) is amended to allow supervision over the Internet using live Internet webcam.

Section 681.93(e)(2), (4), and (6) is amended with minor editorial revisions in grammar, renumbering within the section, and removing unnecessary existing language.

Section 681.93(k) is amended to clarify the requirement for repayment of supervision fees.

Section 681.111(g) is amended to ensure the understanding that all degrees must be accepted and reported by American Association of Collegiate Registrars and Admissions Officers.

Section 681.125(e) is amended to remove repetitive language.

Section 681.142(b) is deleted to disallow carry over of continuing education credit.

Section 681.164(d)(6) is amended to clarify the rule. Removes the words “insurance claim” and leaves the word” fraud.”

GENERAL PROVISIONS

22 TAC §100.10

DENTAL HYGIENE LICENSURE

22 TAC §103.5

DENTAL BOARD PROCEDURES

22 TAC §§107.11, 107.15, 107.17, 107.21 – 107.25, 107.47, 107.48, 107.50, 107.54, 107.55, 107.63
22 TAC §107.59
22 TAC §107.102
22 TAC §107.203

PROFESSIONAL CONDUCT

22 TAC §§108.7 – 108.9

EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS

22 TAC §114.10

EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL HYGIENE

22 TAC §115.9

§108.9.Dishonorable Conduct.

The dishonorable conduct section is intended to protect the public from dangerous, unethical, and illegal conduct of licensees. The purpose of this section is to identify unprofessional or dishonorable behaviors of a licensee which the Board believes are likely to pose a threat to the public. Actual injury to a patient need not be established for a licensee to be in violation of this section. Behavior constituting dishonorable conduct includes, but is not limited to [A licensee is in violation of this rule if he or she]:

(1) Criminal conduct–including but not limited to conviction of a misdemeanor involving fraud or a felony under federal law or the law of any state as outlined in Chapter 101 of this title.

[(1) Aids or abets in the violation of a criminal statute or participates in a conspiracy to procure (by corruption, fraud, misrepresentation, or bribery, or both) a dental license for an unqualified person.]

(2) Deception or misrepresentation–engages in deception or misrepresentation:

(A) in soliciting or obtaining patronage; or

(B) in obtaining a fee.

(3) Fraud in obtaining a license–obtains a license by fraud or misrepresentation or participates in a conspiracy to procure a license, registration, or certification for an unqualified person.

(4) Misconduct involving drugs or alcohol–actions or conduct that include, but are not limited to:

(A) [(2)] providing [Provides ] dental services to a patient while the licensee is impaired through the use of drugs, narcotics, or alcohol ;[.]

(B) addicted to or habitually intemperate in the use of alcoholic beverages or drugs;

(C) improperly obtained, possessed, or used habit-forming drugs or narcotics including self-prescription of drugs;

(D) [(3)] grossly [Grossly ] over prescribes, dispenses, or administers narcotic drugs, dangerous drugs, or controlled substances;[.]

(E) [(4)] prescribes [Prescribes ], dispenses, or administers narcotic drugs, dangerous drugs, or controlled substances to or for a person who is not his or her dental patient;[,] or [not for a dental purpose.]

(F) prescribes, dispenses, or administers narcotic drugs, dangerous drugs, or controlled substances to a person for a non-dental purpose, whether or not the person is a dental patient.

(5) Assisting another in engaging in the unauthorized practice of dentistry or dental hygiene–holds a dental license and employs, permits, or has employed or permitted a person not licensed to practice dentistry to practice dentistry in an office of the dentist that is under the dentist’s control or management.

(6) Failure to comply with applicable laws, rules, regulations, and orders–violates or refuses to comply with a law relating to the regulation of dentists, dental hygienists, or dental assistants; fails to cooperate with a Board investigation; or fails to comply with the terms of a Board Order.

(7) Inability to practice safely–is physically or mentally incapable of practicing in a manner that is safe for the person’s dental patients.

(8) Discipline of a licensee by another state board–holds a license or certificate to practice dentistry or dental hygiene in another state and the examining board of that state:

(A) reprimands the person;

(B) suspends or revokes the person’s license or certificate or places the person on probation; or

(C) imposes another restriction on the person’s practice.

(9) Failure to comply with Medicaid, insurance, or other regulatory laws–knowingly provides or agrees to provide dental care in a manner that violates a federal or state law that:

(A) regulates a plan to provide, arrange for, pay for, or reimburse any part of the cost of dental care services; or

(B) regulates the business of insurance.

(10) Improper delegation–improperly delegates any task to any individual who is not permitted to perform the task by law, this chapter, or practice restrictions imposed by Board Order.

[(5) Indicates a fee for dental services on an insurance or other third party reimbursement claim form which is other than the fee which the dentist expects to collect for services rendered.]

(11) [(6)] Unprofessional conduct engages–[Engages] in conduct that has become established through professional experience as likely to disgrace, degrade, or bring discredit upon the licensee or the dental profession.

New §185.27, relating to Duty to Report Certain Conduct to the Board, sets out requirements for physician assistants to report certain events to the PA Board within 30 days of their occurrence.
Rule 185.27 requires reporting within 30 days of:
A) address change,
B) incarceration in a state or federal penitentiary,
C) Any activity concerning a felony offense,
D) Misdemeanors relating to
a. PA responsibilities,
b. morale turpitude,
c. assaultive offenses (except fine only offenses),
d. registering as a sex offender,
e. violating a protective order, including offenses involving bias or prejudice.
f. Being found guilty of offenses involving
i. controlled substances & dangerous drugs
ii. inhalant paraphernalia
iii. guilty of felony under Drug Abuse Prevention & Control Act

If you support or oppose this rule change, you may voice your opinion to the Board as these rules currently are in its comment period.

Over the weekend, the Governor, Lt. Governor and the Speaker of the House asked all agencies to find 10% cuts from its 2012-2013 Budget. Again, most of these cuts will have to come from employees. This means customer service will suffer, licensure will likely take a little longer, investigations will further slow down its resolution time, and prosecutions will take longer.

I also would not be surprised if all renewal fees were increased.

 (1) The mid-level providers can obtain there own certification with the DEA and DPS.  Their individual certification number must appear on their prescription pad and they are required to have a supervisor relationship with a licensed physician.  This person is viewed as a “sponsor.”

 (2) There must be a standing protocol for the mid-level provider to prescribe using the physician’s prescription pad for the listed symptoms and only prescribe medications that are listed in the protocol for the symptoms. 

 The parties meet to discuss creating a field on the Texas Medical Board’s Physician Profile that will list all of the mid-level providers under the physician’s sponsorship who have prescriptive authority.

 The Texas Medical Board’s Standing Delegation Committee voted to create a sub-committee with the Physician Assistant Board and the Nursing Board to look into the guidelines for supervising physicians over PA’s and APN’s who have prescriptive authority under the physician’s supervision.   Their goal is to have everyone on the same page as to what the rules are and the risks involved in prescriptive delegation.

 My Take: First, physicians and mid-levels need to be sure they are in full compliance with current level and the correct paper work is in the Board denoting the supervisor relationship.  Second, look for the rules to be changed in the future.  If you have three boards get together, I can assure you the rules will change.  Given the current regulatory climate, I suspect that rules will tighten-up.  I just hope that before the Boards publish any rule changes, they talk and meet with “stake holders” in this area as any changes to mid-level prescriptive authority will have significant affect over thousands of providers.  Please continue to monitor this blog for changes.