The Executive Commissioner of the Health and Human Services Commission (commission), on behalf of the Department of State Health Services (department), adopts the repeal of §§157.14, 157.33, 157.34, and 157.40 and new §§157.14, 157.33, 157.34, and 157.40, concerning the requirements for first responder organizations, certification, recertification and paramedic licensure. New §157.14 and §157.34 are adopted with changes to the proposed text as published in the April 14, 2006, issue of the Texas Register (31 TexReg 3160). The repeal of §§157.14, 157.33, 157.34, 157.40 and new §157.33 and §157.40 are adopted without changes and, therefore, the sections will not be republished.

BACKGROUND AND PURPOSE

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 Procedure Act). Sections 157.14, 157.33, 157.34 and 157.40 have been reviewed and the department has determined that reasons for adopting the sections continue to exist because rules on this subject are needed.

Revisions of these sections were necessary to comply with the mandatory four-year rule review. Additionally, the repealed and new sections reflect consensus achieved by the stakeholder group (Governor's EMS and Trauma Advisory Council) and department staff. These sections also reflect organizational changes in the department mandated by House Bill 2292 of the 78th Texas Legislature, Regular Session, 2003.

SECTION-BY-SECTION SUMMARY

The decision to repeal §§157.14, 157.33, 157.34 and 157.40 and adopt new §§157.14, 157.33, 157.34 and 157.40 was due to extensive formatting changes and changes within the rules to make these sections more uniform.

New §157.14 strengthens regulation of First Responder Organizations using certified or licensed Emergency Medical Services (EMS) personnel to provide prehospital emergency medical care. Under new §157.14, the organizations will be required to be licensed, have medical direction, and work cooperatively with the EMS Providers who transport the patients.

New §157.33 provides clarification to the rules, allows more flexibility to candidates for EMS certification, including those coming from other states or other health care disciplines, and parallels requirements that candidates must meet to be eligible for taking the credentialing exam with the National Testing Service.

New §157.34 provides clarification to the rules, allows more flexibility to candidates completing EMS recertification requirements, and provides an option for candidates with inactive certifications or certifications that have lapsed for more than one year.

New §157.40 provides clarification to the rules, allows more flexibility to candidates for EMS paramedic licensure, parallels requirements that candidates must meet to be eligible for taking the credentialing exam with the National Testing Service, and provides an option for candidates with inactive licensure or a license that has lapsed for more than one year.

COMMENTS

The department, on behalf of the commission, has reviewed and prepared responses to comments received regarding the proposed rules during the comment period, which the commission has reviewed and accepts. The commenter was an individual representing the City of Arlington, Texas. The commenter was not against the rules; however, suggested recommendations for changes to new §157.14 as discussed in the summary of comments. The department, on behalf of the commission, did not receive any public comments regarding the other proposed rules during the comment period.

Comment: Concerning §157.14(c)(3) and §157.14(d)(4), the commenter recommended changing "who" to "that". The result is "Applicants that meet all the requirements shall be issued an FRO license". The word "that" should be used because "applicants" refers to organizations rather than persons.

Response: The commission agrees and has revised the sentence to read: "Applicants that meet all the requirements shall be issued an FRO license".

Comment: Concerning §157.14(e)(9)(B), the commenter recommended changing "condition upon arrival at the scene" to "...patient's condition when first contacted by FRO personnel..." The language published in the Texas Register requires the patient report to include the patient's condition upon the patient's arrival at the scene rather than upon the FRO's arrival at the scene. Further, because all patients cannot always be immediately located as soon as the first FRO personnel arrive, the requirement should be to report the patient's condition when contact is first made with the patient.

The commenter also recommended changing "EMS staff" to "FRO personnel who provided care to the patient". "EMS staff is vague and could refer to FRO or ambulance personnel". With these changes, the following sentence results: "the report shall document, at a minimum, the patient's name, the patient's condition when first contacted by FRO personnel; the prehospital care provided, the dispatch time; scene arrival time; and the identification of the FRO personnel who provided care to the patient".

Response: The commission agrees and has revised the sentence to read: "the report shall document, at a minimum, the patient's name, the patient's condition when first contacted by FRO personnel; the prehospital care provided, the dispatch time; scene arrival time; and the identification of the FRO personnel who provided care to the patient".

The following changes were made as a result of staff comments:

Change: Concerning §157.14, a correction to the reference of "paragraph" and "subsection" for proper Texas Register formatting was made to subsections (c)(1)(F) and (d)(2)(F) and (G) of the section.

Change: Concerning §157.34(b)(4)(B), a title "Recertification Course" was added to the top of the chart; §157.34(d)(3), the word "the" was added in the last sentence to read "a total of two times the fee shall be necessary"; §157.34(e)(2), second sentence, added the words "times the" after the number "1-1/2" to state "a total of 1-1/2 times the fee shall be necessary"; and §157.34(e)(3), second sentence, the word "the" was added after the word "times" to read "a total of two times the fee shall be necessary".

LEGAL CERTIFICATION

The Department of State Health Services, General Counsel, Cathy Campbell, certifies that the rules, as adopted, have been reviewed by legal counsel and found to be a valid exercise of the agencies' legal authority.

STATUTORY AUTHORITY

The adopted new sections are authorized by Health and Safety Code, §12.0111, which requires the department to charge fees for issuing or renewing a license; §773.050(e) which authorizes the department to adopt minimum standards of first responder organizations; §773.050(b) and §773.0495 which authorize the department to adopt minimum standards for certified and licensed EMS personnel; and Government Code, §531.0055, and Health and Safety Code, §1001.075, which authorize the Executive Commissioner of the Health and Human Services Commission to adopt rules and policies necessary for the operation and provision of health and human services by the department and for the administration of Health and Safety Code, Chapter 1001. The review of the sections implements Government Code, §2001.039.