The Executive Commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendments to §157.33, concerning Certification, §157.34, concerning Recertification, and §157.125, concerning Requirements for Trauma Facility Designation.

BACKGROUND AND PURPOSE

The proposal is necessary to comply with House Bill (H.B.) 871 and H.B. 1418, 86th Legislature, Regular Session, 2019, which requires the adoption of rules to implement the legislation.

H.B. 871, 86th Legislature, Regular Session, 2019, amended Texas Health and Safety Code, §773.1151, which authorizes a hospital located in a county with a population of less than 30,000 to utilize telemedicine medical services to comply with the physician requirement for Level IV Trauma Designation. DSHS is directed to adopt rules not later than December 1, 2019.

H.B. 1418, 86th Legislature, Regular Session, 2019, amended Texas Health and Safety Code, §773.0551, which requires emergency services personnel receive their immunization status during certification or recertification. H.B. 1418 also requires that emergency personnel be provided information about certain risks of exposure to serious or deadly communicable disease when responding to an emergency that an immunization may prevent.

During Hurricane Harvey, lack of clarity for first responders concerning their vaccine history caused certain individuals to either duplicate previous vaccinations or be required to wait for vaccinations due to high demand for the vaccines in the disaster-declared region. DSHS is directed to adopt rules as soon as practicable.

SECTION-BY-SECTION SUMMARY

The proposed amendments to §157.33(l) and §157.34(d) add the applicant's immunization history, which require DSHS to provide the emergency services personnel their immunization status during certification or recertification. The proposed amendments add that DSHS will provide information about certain vaccine preventable diseases when responding to an emergency that an immunization may prevent. The rule references in §157.33 and §157.34 are also revised to reflect the addition of new text.

The proposed amendment to §157.125 adds text for a hospital located in a county with a population of less than 30,000 to utilize telemedicine medical services to comply with the physician requirement for a Level IV trauma facility designation. The new text is added to the basic Level IV trauma facility criteria in the Figure for §157.125(y).

FISCAL NOTE

Donna Sheppard, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules do not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

DSHS has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of DSHS employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to DSHS;

(5) the proposed rules will not create a new rule;

(6) the proposed rules will not expand existing rules;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) the proposed rules will not affect the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Donna Sheppard, has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. The rules do not impose any additional costs on small businesses, micro-businesses, or rural communities that are required to comply with the rules.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas; do not impose a cost on regulated persons; and are necessary to implement legislation that does not specifically state that §2001.0045 applies to the rules. Sections 157.33 and 157.34 are being adopted in response to a natural disaster.

PUBLIC BENEFIT AND COSTS

Stephen Pahl, Associate Commissioner, Consumer Protection Division, has determined that for each year of the first five years that the amended §157.33 and §157.34 are in effect, the public benefit will be the opportunity for emergency medical service personnel to know their immunization status at certification and recertification and also information about certain risks posed when responding to an emergency. For each year of the first five years that the amended §157.125 is in effect, the public benefits by continuing to receive quality trauma patient care directed by a physician who has special competence in the care of critically injured patients in the rural areas of Texas. The rural hospitals may seek or maintain trauma designation and participate in the trauma system to improve patient care and outcomes.

Donna Sheppard, has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. The amendments to §157.33 and §157.34 require DSHS to provide the emergency services personnel their immunization status during certification or recertification and the cost of certification or recertification is not impacted by these amendments. There also would not be any additional costs based on the amendment to §157.125, as participation in trauma facility designation is voluntary and is not required or mandated.

REGULATORY ANALYSIS

DSHS has determined this proposal is not a "major environmental rule" as defined by Texas Government Code §2001.0225. "Major environmental rule" is defined to mean a rule the specific intent of which is to protect the environment or reduce risk to human health from environmental exposure and that may adversely affect, in a material way, the economy, a sector of the economy, productivity, competition, jobs, the environment or the public health and safety of a state or a sector of the state. This proposal is not specifically intended to protect the environment or reduce risks to human health from environmental exposure.

TAKINGS IMPACT ASSESSMENT

DSHS has determined the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to Christina Coleman, Program Specialist, Mail Code 1876, P.O. Box 149347, Austin, Texas 78714-9347, by fax to (512) 834-6736 or by email to EMSInfo@dshs.texas.gov.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be: (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period to the Exchange Building, EMS/Trauma Systems, 8407 Wall Street, Austin, Texas 78754; or (3) faxed or emailed before midnight on the last day of the comment period. If last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When faxing or emailing comments, please indicate "Comments on Proposed Rules 19R056" in the subject line.

STATUTORY AUTHORITY

The amendments are authorized by Texas Health and Safety Code, Chapter 773; and Texas Government Code §531.0055, which provides that the Executive Commissioner of HHSC shall adopt rules for the operation and provision of services by the health and human services system, including by DSHS. Under Texas Health and Safety Code, Chapter 1001, the DSHS Commissioner is authorized to assist the Executive Commissioner in the development of rules relating to the matters within DSHS jurisdiction.

The amendments implement Texas Health and Safety Code, Chapter 773.