The Texas Department of Health (department) adopts amendments to §§157.1, 157.11, 157.14, 157.32 - 157.34, 157.38, 157.40, 157.43 - 157.44, 157.49, 157.122, and 157.125, concerning regulation of EMS certificants, licensees, providers, training institutions, educators and EMS/Trauma systems, the repeal of §157.4 concerning request for EMS training at the local level, the repeal of §157.31 concerning automated external defibrillator training course, §157.123 concerning regional emergency medical services/trauma systems, and §157.129 concerning state trauma registry, new §157.4 concerning regulatory audit activities by the Bureau of Emergency Management and new §157.123 concerning regional emergency medical services/trauma systems. Section 157.11 is adopted with changes to the proposed text as published in the January 30, 2004, issue of the Texas Register (29 TexReg 785), as a result of comments received during the 30-day comment period. The amendments to §§157.1, 157.14, 157.32 - 157.34, 157.38, 157.40, 157.43 - 157.44, 157.49, 157.122, 157.125, repeal of 157.4, 157.31, 157.123, 157.129, and new §§157.4 and 157.123 are adopted without changes and will not be republished.

Specifically, the sections cover purpose; audits; provider licenses; disciplinary actions; training and course approval; personnel certification, Regional/EMS trauma systems, trauma facility designation and the trauma care system fund.

Rule amendments regarding licensing fees are required as a result of revisions to Chapter 12 of the Texas Health and Safety Code, §§12.0111 and 12.0112, pursuant to House Bill 2292 of the 78th Regular Session of the Texas Legislature. Rule amendments for the clarification of standards for regional advisory councils are required as a result of revisions to Chapter 773 of the Texas Health and Safety Code, §773.113, pursuant to Senate Bill 530 of the 78th Regular Session of the Texas Legislature. Rule amendments for clarification of standards for emergency care attendants are required as a result of revisions to Chapter 773 of the Texas Health and Safety Code, §773.046, pursuant to House Bill 861 of the 78th Regular Session of the Texas Legislature.

Government Code, §2001.039, requires that each state agency review and consider for readoption each rule adopted by that agency pursuant to the Government Code, Chapter 2001 (Administrative Procedures Act). The sections have been reviewed and the department has determined that reasons for adopting the sections continue to exist; however, revisions to the sections are necessary and described in this preamble. Authority for the board to propose and adopt rules in this section is found in the Health and Safety Code, Chapter 773.

The department published a Notice of Intention to review and consider for readoption, revision, or repeal Chapter 157, Emergency Medical Care, Subchapter A, Emergency Medical Services--Part A, §§157.1 - 157.4; Subchapter B, Emergency Medical Services Provider Licenses, §§157.11 - 157.14, 157.16, and 157.25; Subchapter C, Emergency Medical Services Training and Course Approval, §§157.31 - 157.34, 157.36 - 157.38, 157.40, and 157.41; Subchapter D, Emergency Medical Services Personnel Certification, §§157.43, 157.44, and 157.49; and Subchapter G, Emergency Medical Services Trauma Systems, §§157.122, 157.123, 157.125, and 157.128 - 157.130 in the September 12, 2003, issue of the Texas Register (28 TexReg 8013). There were no comments received due to the publication of notice.

The department received four public comments during the comment period.

Comment: Concerning §157.11(a)(2), a total of three commenters generally opposed the fee increases for provider licensing. Two of the commenters opposed the non-refundable application fee of $500.

Response: The department disagrees with the commenters. The fee increases were authorized by HB 2292 in the 78th Regular Session of the Texas Legislature. This bill directed each state fee program to raise its fees to cover 100% of the costs of the regulating the industry/profession. EMS, which currently covers about 50% of its regulatory program costs and had not raised fees in a number of years, was exempted from full cost recovery. The main reason was that Volunteer Providers are exempt from fees under §773.0581 of the Health and Safety Code. However, the expectation is that EMS will raise its cost recovery percentage up to 70-75% through raising fees approximately 20% overall and continuing to cut program costs. Additionally, EMS has historically charged a vehicle inspection fee, but not a provider application fee. There is a significant amount of staff time and resources to process a provider license application and a fee is necessary to partially cover those costs. There were no changes to the rule text due to the comments.

Comment: Concerning §157.11(a)(2), one commenter requested insertion of language that more clearly details the fee structure.

Response: The department agrees with the commenter. Wording has been added to subsections (a)(2) and (a)(4) to clarify that the $500 application fee applies to the EMS Provider and not to each vehicle and that the fees are required every 2 years rather than annually.

The following change was made due to a staff comment.

Change: Concerning §157.11(a)(2), the fee requirement for initial applicants will be implemented on "June 1, 2004" instead of "20 days following adoption of the rule" because this will implement the fee increases from these rules at the same time new fees are imposed by the Texas Online Authority. The original proposed language of "20 days following adoption of the rule" would result in two separate fee increases within a few days.

Three commenters were not in favor of the rules due to the fee increases. One commenter was neither for nor against the rules in their entirety, but suggested changes for clarification.

The amendments are adopted under the Texas Health and Safety Code, Chapter 773, which provides the department with the authority to adopt rules concerning certification and licensing of EMS certificants, providers, training institutions and educators; and §12.001, which provides the board with the authority to adopt rules for its procedure and for the performance of each duty imposed by law on the board, the department or the commissioner of health. The review of the rules implements Government Code, §2001.039.