Happy New Year! Welcome to Volume Nine of your TDLR Health Monitor. I’m Brian Francis, Executive Director of TDLR. Once again, our program staff and communications team have created a wealth of information to share with you, keeping you informed and up to date on what's happening around the agency, with your program, and within your profession.

Since the last issue in September, our agency has been working closely with staff from the Sunset Advisory Commission. The Texas Sunset Act requires the Sunset Commission to periodically review all state agencies, and recommend whether to continue the agency and change state law to improve the agency’s efficiency and effectiveness.

Sunset staff are reviewing the mission and performance of TDLR’s overall operations, program administration, and structure. However, state law specifies that programs transferred to TDLR on or after September 1, 2016 are not subject to review at this time, which includes all of our current medical and health-related programs, except the Behavior Analyst program. Twenty-four other TDLR programs make up this current review, and Sunset will follow up with the medical and health-related programs that are not included in the current review beginning in 2021.

The Sunset process has three stages. First, Sunset staff will evaluate TDLR, seek public input, and issue a report recommending solutions to problems found. Second, the Sunset Commission will hold two public meetings: a hearing on the staff report and the agency, and a decision meeting to adopt recommendations to the Legislature based on the report and public comments. Third, the Legislature will convene in January 2021 and will consider Sunset’s statutory recommendations in a Sunset bill for TDLR.

The Legislature ultimately will decide whether to continue TDLR and adopt Sunset’s other statutory recommendations. While a majority of the medical and health-related programs are not included in this current review, and Sunset staff will not evaluate their professional standards or requirements, the Sunset Commission may adopt management directives for TDLR that do not require statutory changes. 

We value your input in charting the course for TDLR’s future. Before the Sunset staff review is completed, we will have a chance to meet with each of you during our biennial strategic planning sessions.

In April 2018, TDLR held five strategic planning sessions across the state and asked participants to tell us how we were doing and how we could improve. We made process improvements and rule changes based on this feedback, and ideas from these sessions were incorporated into our 2019-2023 Strategic Plan and shared with lawmakers during the 86th Legislative Session. Your ideas create real change for Texas. 

Look for announcements in early 2020 about dates and locations for TDLR's 2020 strategic planning sessions. We will be reaching out to all our licensees by email, on our website, and through TDLR's social media channels, and for those who can't participate in person, there will be opportunities to give us feedback via surveys and email. I hope you will participate and make your voice heard. 

Thank you for reading the TDLR Health Monitor, and I hope that you find it helpful and informative. I look forward to visiting with you in 2020!

Yours in Service,

Brian Francis

TDLR Executive Director

In December, the Texas Department of Insurance (TDI) adopted emergency rules interpreting Senate Bill (SB) 1264’s prohibitions related to “surprise billing” (or “balance billing”). In response to TDI's emergency rules, TDLR issued a Guidance Statement to provide clear information concerning SB 1264 to Texas patients, clients, and health care providers under TDLR's regulatory authority.

SB 1264 prohibits surprise billing, with certain exceptions. Health care providers under TDLR’s regulatory authority who seek to exercise the exceptions to SB 1264’s prohibitions against balance billing must comply with all provisions of SB 1264, including as interpreted by TDI rules. See the TDI SB 1264 webpage for additional information. SB 1264 applies to a health care or medical service or supply provided on or after January 1, 2020.

TDLR will be responsible for investigating complaints and taking disciplinary action against TDLR licensees for violations of SB 1264, including as interpreted by TDI rules. Any person who believes that a TDLR-licensed health care provider has committed a balance billing-related violation may file a complaint online with TDLR. Additionally, TDLR and TDI will work together to ensure that any complaints filed with TDI regarding TDLR licensees will be referred to TDLR and investigated.

TDLR will be working on the development of enforcement rules consistent with SB 1264 and TDI’s rules interpreting the statute. As rulemaking moves ahead, we look forward to a transparent process and engaging the public and stakeholders for their input on this important issue.

Senate Bill 202, 84^th Regular Session (2015), transferred 13 occupational and health-related licensing programs from the Department of State Health Services to the Texas Department of Licensing and Regulation (TDLR). The regulation of athletic trainers, dietitians, dyslexia therapists and practitioners, fitters and dispensers of hearing instruments, midwives, orthotists and prosthetists, and speech-language pathologists and audiologists transferred in October 2016. 

The regulation of code enforcement officers, laser hair removal, massage therapy, mold assessors and remediators, offender education providers, and sanitarians transferred in November 2017. 

In an effort to ensure the effective and transparent transition of the programs, TDLR was required to provide an annual implementation report to the Legislature, Sunset Advisory Commission, and each regulatory board/committee of the transferred programs. The report details the status of the transition, including delays or challenges; advisory board and committee appointments; and the establishment and operation of the programs. You can view the December 2019 Implementation Report here. This is the final implementation report on SB 202.

On October 1, 2019, the Texas Commission of Licensing and Regulation voted to approve proposed changes to 16 Texas Administrative Code, Chapter 112, Subchapter C, §112.25, which amended the eligibility requirements for serving as a proctor on the Hearing Instrument Fitters and Dispensers Practical State Licensing Test.  

As of November 1, 2019, to be eligible to serve as a proctor, a licensee must:

• be licensed in good standing;
• have held the license for at least two years;
• observe three full practical test sessions; and
• not have any disciplinary actions or other actions that may disqualify a licensee from serving as a proctor.

There are many benefits to becoming an examination proctor. The biggest benefit is contributing to your profession. Additionally, a proctor trainee receives a compensation of $50/day to observe the test administration. Once a trainee becomes a qualified proctor, they are paid $100/day for proctoring the tests. Trainees and proctors are allowed breaks in-between tests and are given time for lunch. If a proctor travels out-of-town to a test site, they may be reimbursed for their mileage. 

Interested in becoming a proctor? The first step is to sign up to be a trainee. Please send an email to Education@tdlr.texas.gov to get started.

In November 2019, TDLR implemented the provision of House Bill 1865 requiring persons who apply for an initial license and individuals who renew their license to go through a fingerprinting process for the purposes of obtaining criminal history information.

This requirement applies to an individual applying for a massage therapy license and an owner(s) of a massage therapy school or massage therapy establishment. The fingerprinting requirement is a one-time process, which once confirmed and cleared, would not be required if applying for another massage therapy license type.

Overview of the fingerprinting process:

• TDLR receives and processes an application.
• Instructions are mailed or emailed to the applicant on how to set an appointment to get their fingerprints.
• Applicant obtains their fingerprints and receives a receipt as proof of getting their fingerprints.
• Applicant mails or emails a copy of the receipt to TDLR per instructions.
• TDLR confirms and clears applicant’s fingerprints, normally a 72-hour process after TDLR receives a copy of the applicant’s receipt.
• Once confirmed and cleared, TDLR will issue the license, if all other requirements have been met.

On November 5, 2019, the Texas Commission on Licensing and Regulation adopted rules to implement the provisions of Senate Bill 1200, which was passed by the 86^th Texas Legislature. This bill allows spouses of active duty military members to engage in a business or occupation without a formal Texas license. Military spouses may apply for, and be granted, authorization to engage in a business or occupation regulated by TDLR for up to three years. There is also an option to be issued a special three-year license.

To qualify for either option, a military spouse must be licensed in good standing by another state or jurisdiction, and that state/jurisdiction’s licensing requirements must be substantially equivalent to the requirements for licensure in Texas. 

To find out more information on how to apply, visit the Military Outreach webpage.

TDLR is pleased to announce that we will host our third Midwives Educational Summit on Friday, January 31, 2020 at Embassy Suites by Hilton, San Marcos Hotel Conference Center, in San Marcos, Texas.

The summit is a one-day educational conference designed to provide an opportunity to discuss and learn about emerging topics and best practices in midwifery.

A certificate of attendance will be provided to each attendee. Continuing education credit will be awarded to all licensed midwives who attend the entire day of sessions. There is no charge to attend the summit or to receive continuing education credit.

For additional information and updates on the summit, be sure to sign up for email updates and keep an eye on the Midwives Educational Summit webpage.  

The Early Hearing Detection and Intervention program was established to ensure newborns and young children who are deaf or hard of hearing are identified as early as possible. All 50 states have Early Hearing Detection and Intervention programs, and the program in Texas, Texas Early Hearing Detection and Intervention (TEHDI) has been administered by the Texas Department of State Health Services (DSHS) since 1999. Early intervention services may prevent delays in vocabulary, communication, and cognitive skills development.

The national standards for the program are:

• all newborns screened for potential hearing loss by 1 month of age;
• newborns with potential hearing loss should be professionally diagnosed by 3 months of age; and
• infants diagnosed as deaf and hard of hearing should be receiving early intervention services by 6 months of age.

Texas law requires professionals who screen, diagnose, and provide early intervention to utilize TEHDI’s statewide management information system. Preliminary 2018 TEHDI outcome data, developed with the Center for Disease Control and Prevention, document hearing screening data for 97.3%, or 377,112, children born in Texas. Out of all newborns screened, 4,367 did not pass their initial screening and needed a follow-up diagnostic assessment before 3 months of age. Of these newborns with potential hearing loss, 2,593, or 59.4%, were either lost to follow-up or documentation. There were 395 who were identified as deaf or hard of hearing, and 285, or 72.2%, of those hard of hearing children have not been documented as receiving Early Intervention services.

Texas’ outcomes rank last of all 50 states with the largest percentage and greatest number of infants lost to follow-up or documentation. Several factors influence Texas’ 59% loss to follow up and/or diagnosis of infants with potential hearing loss. A large percentage of these 2,593 indicated as “lost” are not documented in the DSHS system, despite the legal requirement for professionals who screen, diagnose, and provide early intervention to utilize the statewide tracking system. There is also a growing number of primary care providers who are now providing audiological diagnostics at their facilities, and frequently these providers are unaware of reporting requirements.

If you are an audiologist, please do your part to correctly report and track Texas children with potential hearing loss to ensure these children are not falling through cracks in the system or going undiagnosed. For more information on the TEHDI program, please go to the DSHS website or click here.

Katie Brice, Senior Program Specialist in TDLR's Medical and Health Professions Section, will conduct school presentations in March and April 2020 for colleges and universities with communicative sciences or disorders programs. The presentations will guide students through the licensure process by reviewing the application and required supporting documents. The presentations will also provide information on supervision requirements and scope of practice.

Presentations are for:

• seniors who are graduating with a bachelor’s degree and applying for a speech-language pathology assistant license or an audiology assistant license;
• graduate students who are getting their master’s degree and applying for a speech-language pathology intern license; and
• graduate students who are getting their doctoral degree in audiology and applying for an audiology intern license. 

Last spring, Katie presented to over 500 students and held 16 sessions at 12 universities. Program directors can contact Katie at Katie.Brice@tdlr.texas.gov to schedule a presentation. Presentations usually last an hour.

Regulatory Program Management staff are available to come out to your school/class to provide a presentation for any profession that we regulate. If you would like to have one of our staff provide a presentation to your students, please send an email to RPM.Health.Professions@tdlr.texas.gov.

To find disciplinary actions taken on complaints filed with TDLR, click here. 

You can search by name, license number, location, or by program. All disciplinary actions posted on the TDLR website are final actions taken by TDLR. No actions taken by previous licensing boards or agencies are included.

For information on why specific violations of the law or rules might fall into a certain penalty range, please see TDLR's Enforcement Plan.

What about license denials?

License denials and revocations are included. If an application denial is based on criminal history, you can find information on why that criminal history was relevant in the program’s Criminal Conviction Guidelines.

Can’t find the Enforcement Plan and/or Criminal Conviction Guidelines for your program?

If no Enforcement Plan or Criminal Conviction Guidelines are posted, that may be because the Texas Commission of Licensing and Regulation has not yet voted to approve these documents for your program. 

Click here to subscribe to TDLR’s Email Updates to receive important information about programs of interest and upcoming Commission and board meetings, including meeting agendas.  

This article takes a closer look at a program-specific topic that may be useful to that program’s licensees. The topic is based on questions received by our customer service representatives and by TDLR staff while conducting outreach activities. This edition focuses on laser hair removal. 

Question:  I hold a current Laser Hair Removal certificate. Am I permitted to perform laser hair removal outside of a licensed laser hair removal facility?

Answer: No. Unless working under the delegation of a physician in an exempt facility, individuals who hold a laser hair removal certificate issued by TDLR may only perform laser hair removal services in a facility that holds a current laser hair removal facility certificate of registration. A business location that provides laser hair removal is required to hold a laser hair removal facility certificate of registration issued by TDLR, unless the facility meets one of the following exemptions:

• the facility is owned or operated by a physician for the practice of medicine;
• the facility is a licensed hospital; or
• the facility is a clinic owned or operated by a licensed hospital.

For more information, visit the Laser Hair Removal program page.

At their December 2nd meeting, TDLR’s Advisory Board of Athletic Trainers honored the legacy of Paul Zeek, who passed away June 11, 2019 at the age of 79. Mr. Zeek helped build the foundation for licensure of athletic trainers in Texas. In 1971, he was issued the first license to practice in this state, which was also the first athletic trainer license to be issued in the United States. He served on the Advisory Board of Athletic Trainers in the late 1970s and again from 1994-1999.

During his distinguished career, Zeek was named National Athletic Trainers’ Association (NATA) National Trainer of the Year (1981) and was inducted into the NATA Hall of Fame in 1989. He was also a member of the Texas State Athletic Trainers’ Association Hall of Honor and the Southwest Athletic Trainers’ Association Hall of Fame. 

The family of Mr. Zeek, represented by his daughters Karen Hartzler and Leanne Zeek Jackson, received a certificate from TDLR Executive Director Brian Francis and Advisory Board Presiding Officer David Weir to honor Zeek’s accomplishments. The family also received Zeek’s original 1974 athletic trainer license, which he had loaned to the state for display purposes at various conferences and workshops.

The advisory board also honored the lifesaving skills of licensed athletic trainers Chris Hall, Matthew Herrill, and Antse Woods with the TDLR Courage Under Pressure Award.

Mr. Hall and Mr. Herrill received the award for their efforts in saving the life of former TCU basketball player Johnny Pate, who had collapsed during an alumni game on August 25, 2019. Hall and Merrill immediately began life-saving measures and continued until first responders arrived.

Antse Woods received the award for her efforts in saving the life of an 8^th grade football payer who collapsed on the field.

Texas is fortunate to have these quick-thinking and skilled athletic trainers!

In the coming months, TDLR Medical and Health Professions staff will be available at a number of conferences and meetings across Texas to provide licensing and program information to attendees.

We hope to see you at one of these upcoming events!

• Greater Houston Athletic Trainers Society Workshop: January 11, 2020 at Shadow Creek High School in Pearland.
• Texas Speech-Language Hearing Association 64^th Annual Convention: February 20-22, 2020 at George R. Brown Convention Center in Houston.

TDLR is available to provide informational presentations and/or staff booths at your next conference or meeting. If you would like a TDLR representative at your next conference or meeting, contact us at: RPM.Health.Professions@tdlr.texas.gov.

Do you want to be more involved in the regulation of your profession? Ever wonder what you can do to get connected and stay informed? TDLR's Advisory Board and Committee meetings are a great way to do both.

All meetings are open to the public and allow attendees to directly address the board on important issues. If you can’t attend in person, you can watch live broadcasts on the TDLR Meetings page, or watch the uploaded video at your convenience on the program home page. A list of upcoming meetings can be found below.

Unless otherwise noted, Commission meetings and all advisory board meetings are held at TDLR's North Campus in the 1st Floor Public Meeting Room. TDLR public meetings are broadcast live and archived on TDLR's YouTube channel. Meeting notices, agendas, and staff reports are posted on the TDLR Meetings page. Meetings are subject to change or cancellation; please be sure to check the TDLR Meetings page before you travel to attend a meeting in person.

TDLR has had some recent personnel changes that we want to make sure you know about.

Mike Arismendez, former Chairman of the Texas Commission of Licensing and Regulation, accepted a position as Deputy Executive Director in March of this year. Additionally, the recent retirement of former Deputy Executive Director, Carla James, has added a few familiar faces to TDLR’s Executive team. Christina Kaiser, former Director of Enforcement, and David Gonzales, former Director of Regulatory Program Management, were both promoted to Deputy Executive Directors effective Dec. 1, 2019.

Mr. Arismendez will oversee the Strategic Response, Financial Services, and Information Technology divisions.

Ms. Kaiser will oversee the Field Inspections, Regulatory Program Management, and Enforcement divisions.

Mr. Gonzales will oversee the Licensing, Education and Examination, and Customer Service divisions.

Charlotte Melder, former Regulatory Program Management Section Manager and Ron Foster, former Chief Prosecutor of Enforcement, have accepted new roles as Regulatory Program Management Division Director and Enforcement Division Director, respectively.

Congratulations to all, and we are excited to see where this great new leadership team will take us in the coming year.

If you need to contact TDLR staff, you can find our contact information here.