Welcome to the sixteenth edition of the TDLR Health Monitor, our newsletter for our medical and health professionals.

A new year always brings new challenges and opportunities, and 2022 will be no different: I will be retiring from TDLR as of January 31, 2022. It has been my honor to serve this agency and our licensees for nearly 22 years, first as a deputy executive director and these past five years as your executive director.

Thank you for the feedback and insight you have provided to me over the years. Your perspective on how TDLR can best serve our licensees has helped me do my job, and made us a better agency. I sincerely hope you will continue reaching out to my successor, who will be named by the Texas Commission of Licensing and Regulation. I know that anyone they choose will bring great energy and focus to this position. You will be in good hands.

I wish each of you a safe and happy holiday season, and a successful new year in 2022.

Yours in Service,

Brian E. Francis, Executive Director

Massage Therapy

Proposed amendments to existing rules at 16 Texas Administrative Code (TAC), Chapter 117, Subchapter A, §117.2, Subchapter F, §§117.50, 117.55, 117.58, 117.59, 117.62, 117.66, 117.67, and 117.68, Subchapter G, §117.82, and Subchapter H, §§117.91 and 117.92, regarding the Massage Therapy Program were adopted. The amendments implement Senate Bill 1130, 87th Legislature, Regular Session (2021), pertaining to distance learning, and House Bill 1540, 87th Legislature, Regular Session (2021), which amended the definition of “sexual contact” in the Massage Therapy statute. The amendments also include clarification and clean-up changes and make amendments in response to violence and other misconduct against massage therapists.

Speech-Language Pathologists and Audiologists

Proposed amendments to existing rules at 16 Texas Administrative Code (TAC), Chapter 111, Subchapter A, §111.2; Subchapter E, §111.41; Subchapter F, §111.50 and §111.51; Subchapter J, §111.91 and §111.92; Subchapter V, §111.210 and §111.211; the proposed new rule at Subchapter V, §111.212; and the proposed repeal of existing rules at Subchapter V, §§111.212-111.216, and Subchapter X, §§111.230-111.232, regarding the Speech-Language Pathologists and Audiologists Program were adopted. The amendments implement the telehealth emergency rules on a permanent basis; implement Senate Bill 40, 87th Legislature, Regular Session (2021); and include changes as a result of the four-year rule review related to telehealth and remote supervision (tele-supervision). The amendments also reorganize the current provisions and eliminate duplicative provisions.

Hearing Instrument Fitters and Dispensers

Proposed amendments to an existing rule at 16 Texas Administrative Code (TAC), Chapter 112, Subchapter A, §112.2; the proposed new rules at Subchapter N, §112.130 and §112.132; and the proposed repeal of an existing rule at Subchapter P, §112.150, regarding the Hearing Instrument Fitters and Dispensers Program were adopted. The amendments implement the telehealth emergency rules on a permanent basis; implement Senate Bill 40, 87th Legislature, Regular Session (2021); and include changes as a result of the four-year rule review related to telehealth. The proposed rules also reorganize the current provisions.

Midwives

Proposed amendments to existing rules at 16 Texas Administrative Code (TAC), Chapter 115, §115.14 and §115.115, regarding the Midwives Program were adopted. The amendments update the list of conditions during labor or delivery that require immediate emergency transfer; provide standards for assessing fetal heart rates; require continuing education covering fetal heart rates for license renewal; and create an audit system for reporting completion of continuing education.

Chapter 60 Procedural Rules of the Commission and the Department

Proposed amendments to an existing rule at 16 Texas Administrative Code (TAC), Chapter 60, Subchapter B, §60.24, regarding the Procedural Rules of the Commission and the Department were adopted. The amendments update the list of the Department’s advisory boards and their abolishment dates, as applicable.

The following programs have proposed rule amendments that will be considered by the Commission at a future Commission meeting:

Orthotists and Prosthetists

The department has proposed amendments to the Orthotists and Prosthetists Program rules, at 16 Texas Administrative Code, Chapter 114. The proposed rules implement changes identified by the Department as a result of the four-year rule review process conducted under Texas Government Code §2001.39. The proposed rules update rule provisions to reflect current Department procedures, amend outdated rule language, and eliminate unnecessary fees.

The proposed rules were published in the November 5, 2021, issue of the Texas Register (46 TexReg 7485). The Department accepted comments on the proposal until December 6, 2021.

Laser Hair Removal

The Laser Hair Removal Program rules, 16 Texas Administrative Code, Chapter 118, are currently under four-year rule review. During the review, the Department will assess whether the reasons for adopting or readopting the rules continue to exist. The Department will review the rule to determine whether it is obsolete, whether the rule reflects current legal and policy considerations, and whether the rule reflects current Department procedures. This review is required every four years in accordance with Texas Government Code §2001.39. The public comment period closed on October 4, 2021. Rule amendments will be considered by the Commission at a future meeting.

Hearing instruments (hearing aids) are regulated at the federal level as medical devices by the U.S. Food and Drug Administration (FDA). Changes are being made at the federal level regarding hearing instruments that will affect two of TDLR’s programs, the Hearing Instrument Fitters and Dispensers program and the Speech-Language Pathologists and Audiologists program. These two programs regulate the fitting and dispensing of hearing instruments by Texas licensees.

In August 2017, the U.S. Congress passed the FDA Reauthorization Act of 2017 (FDARA) | FDA, which in part defined “over-the-counter hearing aid,” required the FDA to establish a category of over-the-counter (OTC) hearing aids, and specified certain requirements that must be included in the FDA regulations. On October 20, 2021, the FDA published proposed regulations for public comment. These proposed regulations establish the OTC category and realign other regulations for hearing aids. The FDA will eventually publish final regulations, taking public comments into account.

You will find the proposed regulations published in the Federal Register, 86 FR 58150. Electronic or written comments on the proposed regulations must be submitted to the FDA by January 18, 2022. The Federal Register notice includes all the details about submitting public comments.

The FDA has issued a letter clarifying that the over-the-counter category of hearing aids does not exist until the effective date of published final regulations. Licensed Hearing Instrument Fitters and Dispensers and licensed Audiologists may wish to visit the FDA’s website on hearing aids for additional information. 

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.

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 law or rule in the provision of care to a client;
• answering specific questions from the prosecutor about the case; and/or
• 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.

In each edition of the Health Monitor, we take a closer look at a program-specific topic that may be useful to that program’s licensees, using questions received by our customer service representatives and by TDLR staff while conducting outreach activities. This edition, we're focusing on laser hair removal. 

Question: A Laser Hair Removal (LHR) apprentice-in-training is required to perform 100 LHR procedures in order to upgrade their license to a LHR technician. When performing those 100 LHR procedures, can the body areas be split or divided between more than one student?

Answer: No, the body areas may not currently be split or divided between more than one student when performing the required 100 LHR procedures. The student must perform the LHR procedure for the entire body area to count as one LHR procedure.

A laser hair removal procedure is each separate treatment with a client involving the removal of hair from one of the following areas:

• head and neck areas: forehead, glabella, cheeks, nose, upper lip, chin, ears, front of neck and back of neck;
• upper extremity areas: hands, fingers, upper arms, lower arms, armpits, shoulders;
• torso, pelvis, and buttocks areas: areolas, chest, abdomen, bikini or Brazilian, upper back, lower back, buttocks, midline; and
• lower extremity areas: knees, lower legs, upper legs, feet, toes.

TDLR hosted the fifth Midwives Educational Summit, virtually, on December 10, 2021. Although we had a few technical issues early on, the summit had the highest number of attendees to date.

TDLR would like to give a special thanks to the speakers for their participation and very informative presentations: Laurie Fremgen, LM, CPM; Anissa Sartini, LM, CPM; Charleta Guillory, MD; Michael Nix, MD; Derek Burkhalter, TDLR Assistant General Counsel; and Sabrina Elliott, LM, CPM. TDLR’s Katie Brice did another excellent job facilitating the summit.

A certificate for six hours of continuing education (CE) credit, will be emailed to licensed midwives who:

• registered for the summit,
• attended the summit, and
• complete the Midwives Educational Summit 5 Survey by December 17, 2021.

A certificate of attendance will be issued to individuals who meet the requirements above but are not licensed.

Certificates will be sent to the email address provided when registering for the summit.

If you missed the summit, you can watch the archived video on the Midwives Education Summit webpage. The webpage also has links to previous summit presentations and videos. Signup here to receive information on future summits and other midwives program information.

In early 2020, TDLR enacted temporary distance education provisions in response to the COVID-19 pandemic and state and local restrictions on in-person activities. These temporary provisions allowed licensed massage schools to offer all required massage therapy studies, except the 50-hour internship, via distance education. The temporary distance education provisions will expire on December 15, 2021.

On May 28, 2021, Governor Greg Abbott signed Senate Bill 1130 into law. The bill amended the Massage Therapy statute to allow licensed massage therapy schools to offer 250 hours of distance learning education, in specific, non-hands-on massage therapy studies, to their students. However, the statute still requires the 200 hours of instruction on massage therapy techniques and the 50-hour internship to be taught in-person by a licensed massage therapy instructor.

TDLR will not accept any distance learning hours after December 15, 2021, unless the massage school has applied for and received approval to offer distance learning hours. TDLR is currently developing an application for this process. Please check the Massage Therapy webpage in the near future for more information.

Katie Brice, Senior Program Specialist in TDLR's Medical and Health Professions Section, will conduct school presentations between February to April 2022 for colleges and universities with communicative sciences or disorders programs. The presentation guides students through the licensure process by reviewing the application and required supporting documents. The presentations will also provide information on supervision requirements, scope of practice, and maintaining your license.

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. 

Program directors can contact Katie at Katie.Brice@tdlr.texas.gov to schedule a presentation, whether it’s in-person or virtual. 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.

The Texas Department of State Health Services (DSHS) is collaborating with the Center for Disease Control and Prevention (CDC) to promote infection control training called Project Firstline for all frontline workers across various healthcare settings. Due to the high rate of infections and increased need for infection prevention, the CDC is currently offering quick, easy, and free online training to frontline workers. 

DSHS recommends that all frontline workers in Texas are provided with information on CDC Firstline training modules. Many of the infection prevention training videos can be incorporated into annual infection prevention trainings (most videos are only about 3 minutes long).

As an added incentive, healthcare facilities and public health jurisdictions with the most healthcare worker participation (based on training completion rates) will be invited to send an individual to one of these free DSHS-sponsored infection prevention trainings:

• An Introduction to Infection Prevention course geared toward new Infection Preventionists, February 10-11, 2022
• a CIC Preparatory course with CIC exam scholarship geared toward experienced Infection Preventionists, offered March 10-11, 2022.

One of these classes will be offered to those individuals who have completed the most trainings OR one spot will be awarded to facilities who have the most healthcare workers complete at least one training.

Email your completed Training Tracker to participate.

To find disciplinary actions taken on complaints filed with TDLR, visit the TDLR Administrative Orders Search page.

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.

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.

You can file a complaint online for most TDLR programs. 

You will be asked to choose whether you are filing a complaint against a licensed or an unlicensed person or business. If you are unsure about whether the person or business holds a TDLR license, use the unlicensed link.

Some medical or health-related programs require you to submit a complaint form by fax or mail, due to the risk of electronically transmitting confidential health information. The online system will direct you to print out a complaint form in .pdf format if one is required.

If your complaint does not allege a violation of the law or rules or does not include sufficient information for TDLR to investigate the allegations, TDLR will not open a complaint.

Read more about TDLR's complaint investigation and resolution process.

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.

Whether it’s virtual or in-person, TDLR is excited to see you at an upcoming event.

• Greater Houston Athletic Trainers’ Society Student Workshop in Houston: January 15, 2022
• Texas Speech-Language Hearing Association (TSHA) 66^th Annual Convention and Exhibition in Fort Worth: February 24-26, 2022

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.