Welcome to the 13^th edition of the TDLR Health Monitor, our quarterly newsletter for TDLR’s medical and health professionals. This edition marks our fourth newsletter produced during the COVID-19 pandemic. While the promise of vaccines brings us all some much needed hope, continued vigilance is necessary before this pandemic is safely behind us.

I want to thank each of you for the essential care you have provided and continue to provide to Texans. I also want to thank you for your continued patience over the past few months as we at TDLR have experienced delays in our application processing and new challenges with working from home. Please know my staff are trying their best every day to get your questions answered and your renewals and new applications processed as quickly as possible.

As we continue to work through the COVID-19 pandemic, I wanted to hear from some of our advisory board chairs to get their perspective on how COVID-19 has affected their professional practices, and how those changes may impact their future practices. I am pleased to share their experiences with you:

Sherry Sancibrian, Presiding Officer - Speech-Language Pathologists & Audiologists Advisory Board

As the director of the Speech-Language Pathology graduate program at a health-related institution, I have found that the impact of the COVID-19 virus evolves daily. Last March, the biggest issue was transforming our university clinic services from face-to-face to remote so our patients continued to receive the treatment they needed and our students acquired the experiences required to graduate. 

Ten months later, my worries center around maintaining an adequate supply of PPE, convincing third party payers to continue reimbursing for teletherapy, and getting our students and patients immunized. Despite the challenges, I must acknowledge that the pandemic has caused some positive, transformative changes in our policies and practices.

Travis Motley, D.P.M., Presiding Officer - Podiatric Medical Examiners Advisory Board

Trying to maintain clinics and OR schedules even with cancellation of elective cases has been a significant challenge with required quarantines of nurses and other team members. This seems to be a significant challenge with the current volume of inpatient hospitalizations due to COVID and the required increase in staffing in those particular units.

In addition to this increase in staffing for COVID units, we also have dedicated staff to administer COVID vaccines (as well as dedicated staff for the monitoring areas after vaccine). It takes a well-trained team that is willing to provide care in areas outside of their “normal."

Laurie Fremgen, Presiding Officer, Midwives Advisory Board

The experience of the COVID-19 pandemic in 2020 has been an interesting one for midwives. In the initial months of the pandemic, my phone was ringing off the hook. I was getting ten calls a day for people wanting to switch out of medical care into midwifery care for their births. Hospitals were limiting who could be present at births, so I initially began taking extra people into my care, wanting to do my part in what was needed in this unprecedented time.

My schedule filled up very quickly and I ended up having double the number of clients I normally have in one year. Given that the end to this pandemic is nowhere in sight, working that hard is not sustainable. So, 2021 will be back to my normal pace.

This year also introduced telehealth visits into my care. Generally, I like to see people in person, but this has added a new dimension for busy or working moms who need to check in, but their pregnancy is medically uneventful. All in all, COVID has had some positive impact by raising awareness and bringing people to midwifery who would have opted for the medical care most people experience and expect. 

The 87^th Texas Legislature’s regular session runs from January 12 to May 31, 2021. 

Many bills have already been filed that may impact health professions programs, if passed. To find the latest information on filed bills, visit Texas Legislature Online.

Key dates:

• November 9, 2020: Bill prefiling began
• January 12, 2021: (1st day) 87th Legislature convened at noon
• March 12, 2021 (60th day): Deadline for the unrestricted filing of bills and joint resolutions other than local bills, emergency appropriations, and emergency matters submitted by the governor
• May 31, 2021 (140th day): Last day of 87th Legislature (sine die)
• June 20, 2021 (20th day following final adjournment of 87th Legislature, Regular Session): Last day the governor may sign, or veto bills passed during the regular session
• August 30, 2021 (91st day following final adjournment of 87th Legislature, Regular Session): Date that bills without specific effective dates become law

TDLR tracks legislation that impacts your programs and provides a list of those bills on our website. Visit TDLR’s 87^th Legislature webpage to view the list of bills that we are tracking as we move through the session.

Due to the COVID-19 pandemic, TDLR faced a monumental challenge with processing paper renewals and applications. TDLR has taken action to combat delays in processing applications; however, we strongly encourage everyone who can renew online to take advantage of this option.

On November 23, 2020, the Texas Commission of Licensing and Regulation passed an emergency rule related to the pandemic. Under this rule, all TDLR licensees with a renewable license that expired between August 1, 2020 and January 31, 2021 automatically hold an emergency license that is valid for 120 days after the original license expiration date.

This extra time is to allow those who are waiting for their license to be renewed by TDLR to continue working with a valid license as TDLR navigates workflow challenges brought on by COVID-19. 

TDLR will not issue printed emergency licenses, and licensees are not required to post or display proof of an emergency license. An online database of all emergency licenses is available at https://www.tdlr.texas.gov/emergency-licenses.htm. This database only consists of licensees who have been given extensions, and it is not a complete database of all current licensees. Anyone needing verification or authorization for an emergency license should search the emergency extension database.

Please note:

• The TDLR License Search database information will not reflect the emergency license, and your original license expiration date will not change.
• Under this emergency authorization, if your license expired between August 1, 2020 and January 31, 2021, you will still be able to work for up to 120 days after your expiration date while your renewal is being processed. If TDLR makes a final determination that your renewal application is denied, you will no longer be able to work under the emergency license.
• Please renew online instead of mailing in a paper renewal application. TDLR’s online renewal portal accepts all major credit cards, including MasterCard and Visa branded gift cards.

Athletic Trainers

At its meeting held December 8, 2020, the Texas Commission of Licensing and Regulation (Commission) adopted amendments to the Athletic Trainers program rules. These amendments implement House Bill 2059, 86th Legislature, Regular Session (2019), which requires certain health care practitioners to complete a human trafficking prevention training course in order to renew their license. The amendments also allow licensed athletic trainers to claim one clock-hour of continuing education credit for each clock-hour spent attending the training course. The rule amendments were effective January 15, 2021.  

Dyslexia Therapy

The Commission also readopted the rules at 16 Administrative Code, Chapter 120, regarding Licensed Dyslexia Therapists and Licensed Dyslexia Practitioners, as a result of the rule review process. This review was conducted pursuant to Texas Government Code §2001.039, which requires state agencies to review their rules every four years to determine if the reasons for initially adopting the rules continue to exist. The rules were re-adopted in their current form. You can find out more about this rule review adoption in the review justification.

Podiatry

The Texas Department of Licensing and Regulation proposed amendments to an existing rule for the Podiatry program at 16 Texas Administrative Code, Chapter 130, Subchapter E, §130.59; and proposed repeal of an existing rule at Subchapter G, §130.74. The proposed rules implement House Bill 2174, 86th Legislature, Regular Session (2019), by establishing a procedure for the Department to issue waivers of the requirement for controlled substance prescriptions to be issued electronically, and repeal the rule adopting a penalty matrix.

Electronic prescriptions are now required for all controlled substances in Texas. Centers for Medicare and Medicaid (CMS) also now require electronic prescribing for policies using Medicare Part D and Medicare Advantage. However, electronic prescribing is not always possible for a variety of reasons. Recognizing this, TDLR, in cooperation with the Texas State Board of Pharmacy and other medical agencies, has passed rules in the last year that outline the requirements for e-prescribing and the options for waivers, but specific waiver language was still needed.

The proposed rules were published in the December 25, 2020, issue of the Texas Register (45 TexReg 9381). 

TDLR Waives Part II CSPE Exam Requirement for Class of 2021 Podiatric Residency License Applicants

In response to the ongoing COVID pandemic, TDLR, in consultation with the Podiatric Medical Examiners Advisory Board, waived the Clinical Skills Patient Encounter (CSPE) exam for the class of 2021 podiatry school graduates who apply for a temporary residency license in Texas. Temporary residency applicants must still take Part I and the written Part II examinations administered by the National Board of Podiatric Medical Examiners. Part III is required for full licensure after residency.

In-Person CPR Course Waiver

In response to COVID-19, podiatry applicants may now take a virtual CPR course in order to qualify for licensure. Applicants must still provide proof of successful course completion.

TDLR is seeking subject matter experts (SMEs) to assist our Enforcement Division with complaint case reviews. SMEs review complaint cases, generally involving standard of care issues, during the investigation stage of the enforcement process.

We currently have a shortage of Behavior Analyst, Podiatrist, and Speech-Language Pathologist SMEs.

If you are interested in becoming a SME, please complete the Expert Witness Application. Once the application is submitted, you will receive a questionnaire to complete and return. Documents are screened and contracts are issued to approved SMEs.

All SMEs receive training on their role in reviewing complaint cases. Tasks may include the following:

• Reviewing documents and statements collected by investigators.
• Writing a report stating an opinion as to whether the respondent violated a rule or law in the provision of care to a client.
• Answering specific questions from the prosecutor about the case.
• Testifying as a witness for TDLR at hearings.

Our mission is to protect the citizens of Texas and the hard-working members of your profession. We cannot do that without your specialized knowledge of the complexities of your profession. Please consider becoming a SME today. 

Do you need to contact TDLR or send us a document or file? You may have noticed that program-specific email addresses have been removed from forms and webpages. We have replaced our program-specific email addresses with a more secure method of communication.

Contacting TDLR via the new webform communication method will better protect personal information. Documents and other files may be attached to the webform.

More information on how to contact TDLR may be found on our Contact Information webpage.

Is your license due for renewal? If so, please be sure to submit your renewal application timely. TDLR encourages all licensees to renew online when possible. You can attach all required documents to your online renewal. It’s safe, secure and fast!

The following documents must be included with your renewal:

• Proof of 20 hours of continuing education;
• Copy of current Cardiopulmonary Resuscitation (CPR) card (both sides) as proof of current certification for health care providers by the American Heart Association, professional rescuer from the Red Cross or EMS Safety Services, or healthcare and professional rescuer from the National Safety Council;
• Copy of current Neonatal Resuscitation card (both sides) from American Academy of Pediatrics/American Heart Association; and
• Copy of Jurisprudence Examination certificate – this exam is required for renewal every four (4) years, not at each renewal.

You are also required to complete a human trafficking prevention training course approved by the Health and Human Services Commission (HHSC) in order to renew your license. The course completion certificate is not required to be submitted with your renewal. However, TDLR may request proof of the training at any time, so be sure to retain a copy for your records.

To find out more information on the human trafficking training requirement, please visit TDLR’s Human Trafficking Prevention Training for Health Care Practitioners webpage. To view a list of HHSC approved courses, please visit HHSC’s Health Care Practitioner Human Trafficking Training webpage.

Due to the COVID-19 pandemic, TDLR is facing an enormous challenge with processing paper applications and renewals. If you choose to submit your application by mail, please be aware that processing time will be delayed. 

Many of TDLR’s medical and health professions licensees are now required to complete a Health and Human Services Commission (HHSC)-approved human trafficking prevention training course in order to renew their license. This requirement went into effect on September 1, 2020, as a result of House Bill 2059, 86^th Legislative Session (Regular Session, 2019).

HHSC has recently approved several additional training courses. You can find a list of currently approved courses here. Licensees required to take the training may complete any of the training courses on this list. Please be sure to look at the course length and cost, if any, to determine if the course is right for you.

For more information on the training requirement, visit TDLR’s Human Trafficking Prevention Training for Health Care Practitioners webpage.

The fourth TDLR Midwives Educational Summit was held virtually on November 6, 2020 and it was our most attended summit to date. Licensed midwives who attended the conference earned five credit hours of continuing education. Topics covered during the summit included Managing Postpartum Hemorrhage in the Community Birth Setting; the Importance of Early Diagnosis and Treatment of Infant Ear Deformities and Malformations; Midwifery in at Risk Communities; TDLR Updates 2020; and The Millennial Midwife: Her Practice and Business Model. 

TDLR would like to thank our presenters for their participation: Roxanne Anderson, LM, CPM; H. Steve Byrd, MD; Paige Jackson, LM, CPM; Jennifer Mozeke, LM, CPM; and Mary Hoffman. TDLR’s Katie Brice did an excellent job facilitating the summit. 

The next Midwives Educational Summit will be held after the conclusion of the 87^th Texas legislative session. You may sign up to receive emails or check the Midwives Educational Summit webpage often for updates regarding future summit dates, registration process, and agenda topics. The webpage also has links to previous summit presentations and videos.