Welcome to the tenth edition of your TDLR Health Monitor. In these challenging times brought on by the novel coronavirus, COVID-19, it's more important than ever for us to stay connected. We here at TDLR are continuing our work in spite of these extraordinary circumstances, and I hope this email showing up in your inbox will help bring a small sense of normalcy, serving as a reminder that not everything has come to a complete stop. As always, my hope is that you find this information useful and informative. 

As I write this, most of my staff and leadership team are working safely from home, trying to continue as best we can the important work we do each day to serve our licensed professionals and fellow Texans. We are still issuing licenses, answering our phones remotely, and learning to do our jobs in a whole new way. 

Many of you in the medical and health professions have shifted your work as well in response to COVID-19: the athletic trainers who are assisting with drive-thru testing and sewing masks; the midwives ramping up their work and taking extra precautions to help mother and baby; and the speech-language pathologists, behavior analysts, hearing instrument fitters, and others who, thanks to the Governor's recent action, can now help their clients through telehealth platforms. We're all learning new ways to work better, smarter, and safer.

I know this has been a trying time for all of us. Our lives, and our livelihoods, have been disrupted in a way that few if any of us have ever experienced before. As we go throughout our day working, helping, and teaching, let's all remember that we are all going through this together. And we will get to a better place soon, together. 

One quick reminder: our Customer Satisfaction Survey is on our website and will be available for you to complete until Friday, April 24 at 5 p.m. This survey is a key piece of our upcoming strategic plan for fiscal years 2021-2025. Please take a few minutes to fill out the survey and let us know how we're doing. 

Yours in Service,

Brian Francis

Executive Director

To help combat the spread of the Coronavirus, TDLR requested and received authority from Governor Greg Abbott to suspend certain regulatory requirements, to the extent necessary, to allow licensees of Medical and Health Professions programs to provide more services to clients through telehealth and to ease other licensing restrictions.

These suspensions are in effect until terminated by the Office of the Governor or until the March 13, 2020 disaster declaration is lifted or expires. In accordance with Section 418.016 of the Texas Government Code, the Office of the Governor has granted TDLR’s request to suspend the following provisions:

Behavior Analysts

• Supervision of a behavior analyst student, intern, or fellow by a licensed behavior analyst or an instructor in a course sequence approved by the certifying entity may now be done through telehealth if approved by the university and/or certifying entity.
• Additionally, telehealth may now be used for direct observation and measurement of behavior and environment, as allowed by the certifying entity.

Dyslexia Practitioners and Dyslexia Therapists

• A licensed dyslexia practitioner may practice and provide services outside of an educational setting.
• Licensed dyslexia therapists continue to be allowed to practice outside of an educational setting.
• Licensed dyslexia practitioners and dyslexia therapists may provide dyslexia services solely through a smart phone or any audio-visual, real-time, or two-way interactive communication system that can be used to provide telehealth services.
• Under the suspension, an initial in-person meeting with a client is not required for either a dyslexia practitioner or therapist.

Hearing Instrument Fitters and Dispensers

• A supervisor of a temporary training permit holder is no longer required to be working in an established place of business.
• A smart phone, or any audio-visual, real-time, or two-way interactive communication system, qualifies as telecommunications technology and may now be used to provide telehealth services, as well as telehealth services related to fitting and dispensing hearing instruments.
• Hearing instrument fitters and dispensers are no longer required to conduct an initial professional contact in person at the same physical location as the client, but services provided through telehealth must be performed at the same standard of care as in-person health care and within the licensee’s scope of practice and competence, and the equipment used must be appropriate for the situation and properly working as required under 16 TAC112.150(j) and (k).
• If a facilitator assists with the provision of telehealth services, no prior training is necessary if the provider determines that the facilitator has the competence needed to assist with the services given.

Orthotist and Prosthetist

• A licensed orthotist and/or prosthetist is not required to provide on-site direction at an accredited facility.

The State Operations Center (SOC) is operated by the Texas Division of Emergency Management (TDEM). The SOC coordinates state assistance to local governments for emergency incidents that include fires, localized weather events, special events and larger incidents, like hurricanes and the current coronavirus pandemic. It’s estimated that they coordinate 3,000 - 4,000 incidents a year. 

When the SOC elevated its activation level on March 17 for their COVID-19 response, TDLR, as a member agency of TDEM’s Emergency Management Council, was asked to provide staff to support their operations. TDLR employee, Stewart Myrick, was sent to represent the agency and serve as the resource and subject matter expert for the medical and health professions regulated by TDLR. Stewart also serves as the liaison between TDLR and TDEM if a request is submitted to TDLR that must be fulfilled. In most cases, Stewart would physically be at the SOC, which he was for three days; however, as the call for social distancing and working remotely increased, the SOC asked that Stewart continue his role from home.

TDLR wants to thank Stewart for his diligent work during the COVID-19 pandemic, and we want to assure our licensees that we will continue to work closely with the SOC and monitor this situation as it evolves. For additional information on the agency’s response to COVID-19, visit our COVID-19 Response webpage.

The U.S. Drug Enforcement Administration (DEA) reports that health professionals have been targeted by criminals posing as DEA agents. This has been an ongoing, changing scam for several years now but usually share the same characteristics:

• The tone of calls is urgent and aggressive; callers refuse to speak or leave a message with anyone other than the person for whom they are calling.
• Callers threaten arrest, prosecution and imprisonment, and in the case of medical practitioners, revocation of their DEA numbers.
• Callers mask the number on caller ID to appear as a legitimate DEA phone number.
• Callers often reference National Provider Identifier numbers and/or state license numbers.
• They also might claim that patients are making accusations against the practitioner.

In some instances, callers may claim to be employees of a regulatory licensing agency, DEA, FBI or other law enforcement entity. They may send documents on official-looking letterhead demanding DEA registration numbers and/ or money.

TDLR will never call and make such requests for sensitive information over the phone or send demand letters for money to reinstate licenses or threaten the arrest of licensees.

The DEA has issued notices to registrants and has provided the following advisory information:

The United States Drug Enforcement Administration (DEA) is aware that registrants are receiving telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel. The criminals mask their telephone number on caller ID by showing the DEA Registration Support 800 number.

Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.

If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information on the DEA Diversion Control Division website www.DEADiversion.usdoj.gov and select the link for “Extortion Scam Online Reporting.”

For more information, contact your local DEA Field Office.

You may also contact the Registration Service Center: 1-800-882-9539 or DEA.Registration.Help@usdoj.gov.

The Texas Commission of Licensing and Regulation adopted new penalty matrices for the Behavior Analysts and Dyslexia Therapists programs at its meeting on February 18, 2020. 

These matrices describe the specific ranges of penalties and license sanctions that apply to alleged violations of the statutes and rules enforced by TDLR. These matrices also present the criteria that are considered by TDLR’s Enforcement staff in determining the amount of an administrative penalty or the magnitude of a sanction to be pursued.

For more information on how these guidelines are established, visit TDLR’s Enforcement webpage. 

Senate Bill (SB) 1264, also known as the “balance billing” or “surprise billing” act, was passed last year by the 86th Texas Legislature. The bill protects patients from surprise billing, with certain exceptions. The provisions of the bill are now effective and being enforced.

TDLR is a member of an interagency workgroup led by the Texas Department of Insurance (TDI) that includes members of the Texas Medical Board, Board of Nursing, Texas State Board of Pharmacy, and the Health and Human Service Commission. The group is working to address and facilitate the specific requirements of the bill so that its implementation is uniform across all agencies.   

The new law applies to:

• State-regulated insurance plans. These TDI-regulated programs cover roughly 1.1 million Texans. Insurance cards for state-regulated plans have either “DOI” (for Department of Insurance) or “TDI” (Texas Department of Insurance) printed on them. Samples of the cards can be viewed at: https://www.tdi.texas.gov/consumer/insurance-card-examples.html;
• Coverage through the Employees Retirement System of Texas (Health Select or certain HMOs); and
• Coverage through the Teacher Retirement System of Texas (TRS ActiveCare).

Who is Impacted?

Providers who work in diagnostic imaging, emergency care, facilities, and laboratories and bill the health plans above. Facilities are defined as hospitals, ambulatory surgical centers, birthing centers, and standalone emergency rooms. 

What do TDLR Licensed Providers Need to do? 

If you work in a facility and provide care to covered enrollees, you should fully understand your responsibilities. Contact TDI with any questions or email IDR@tdi.texas.gov.

The third TDLR Midwives Educational Summit was held at the Embassy Suites Hotel Conference Center in San Marcos on January 31, 2020. Licensed midwives who attended the entire conference earned six credit hours of continuing education.

Topics covered during the summit included Anatomy of a TDLR Enforcement Case; Creating and Sustaining Successful Partnerships Between Preceptors and Apprentices; Beyond the GTT: A Holistic Approach to Assessing and Treating Glucose Intolerance in Pregnancy; and Safe Breech Birth: Practice, Rules and Stats. 

TDLR would like to thank our presenters for their participation: Roxanne Anderson, LM, CPM; Brielle Epstein, LM, CPM; Laurie Fremgen, LM, CPM; and Karen Cox, JD, Enforcement Senior Prosecutor.

TDLR is currently planning to host the next Midwives Educational Summit later this year. Please check the Midwives Educational Summit webpage for information about the date, location, and agenda as those details are confirmed, and to view archived presentation slides and videos from previous Midwives Educational Summits. 

For information on future Midwives Educational Summits, please sign up to receive midwives program email updates. 

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 via LRNET Live Video Streaming and archived on the Meeting Videos page. If you are outside the TDLR network, view live broadcasts or archived meetings on TDLR's YouTube channel. Meeting notices, agendas, and staff reports are posted on the TDLR Meetings page