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“... .us.
Applicants who appear at the agency’s office will be asked to submit their inquiry in writing on the form provided and they will be contacted in 3 business days by agency staff.
Registration/Renewal questions:
For questions or information related to the registration/renewal ... ”
“... re the items we expect you to submit or complete, based on your application.
Use LIST to track receipt of the items.
In most cases, additional items will be required later. Don’t worry! That’s expected. We just want to make sure you have the basics first.
During pre-licensure the docume ... ”
“... ard by an administrative law judge from the State Office of Administrative Hearings. The complainant is also invited to this conference. If, as a result of an agreement or hearing, the licensee is found to have violated the Texas Occupations Code, there are several options available to the Boar ... ”
“...
The initial registration fee includes a $5 Office of Patient Protection fee for the first year, with an additional $1 charged for any subsequent year. This fees are required by statute and cannot be pro-rated. The remaining amount is required by the TMB and prorated for each permit length.
&n ... ”
“... n updated.
Sometimes more items will be required based on information obtained from the new documentation. Licensing Analysts will add these items to the Application Requirements list and post messages to the message center when any new items are required.
Once all items have been receive ... ”
“... 5 for the Physician Health Program (PHP) and a $2 Office of Patient Protection fee. These fees are required by statute. The remaining $555 is the fee required by the TMB.
These fees are explained in more detail in the chart below.
Subsequent Registration
Length of Permit
Agency F ... ”
“... limited and temporary licenses. Requirements vary based on license type.
The Board collects and verifies applicant credentials, as required by statute and Board Rule.
An applicant is not granted licensure until all required documents are furnished to the board and are verified.
The Licensure Departm ... ”
“... individual application processing time will vary based on the complexity of the application. The processing time clock begins when the applicant has submitted all initial documents and has moved to the second step. Factors that increase the processing time are answering “yes” to a ... ”
“... nbsp;
Applicants who appear at the agency’s office will be asked to submit their inquiry in writing on the form provided and they will be contacted in 3 business days by agency staff. ”
“... individual application processing time will vary based on the complexity of the application. The processing time clock begins when the applicant has submitted all the supplemental information.
Eligibility
To qualify, an applicant:
Must have filed an application for physician licensure in Tex ... ”
“... individual application processing time will vary based on the complexity of the application. The processing time clock begins when the applicant has submitted all initial documents and has moved to the second step. Factors that increase the processing time are answering “yes” to a ... ”
“... include input from a wide variety of stakeholders based on periodic stakeholder meetings.
The frequency of rulemaking in any given year varies depending on the volume of newly passed legislation, the number of rule chapters open for review and comment based on state requirements for rule revie ... ”
“... s described above.
FORMAL RESOLUTION AT THE STATE OFFICE OF ADMINISTRATIVE HEARINGS
If a solution cannot be reached through an agreed order or a remedial plan, the case is assigned to a TMB staff attorney who will handle the case at the State Office of Administrative Hearings (SOAH). A TMB cas ... ”
“... o keep medical records?
My physician closed his office. How do I get my medical records?
My physician died. How do I get my medical records?
”
“... e made.
Because this form must be received by our office before the expiration date of the current certificate, completed and bearing original signatures, as well as bearing an original seal of notary public, it cannot be faxed back to our office.
RCP Inactive Request Form - click here
... ”
Description: TMB Bulletin Fall 2000
Document: ... ly a regulatory authority in an evenhanded manner based on the facts of the specific license or disciplinary action. We are sometimes limited by legislated statutes and we use Board rules for clarification of procedures and conduct. We are bound by certain legislative mandates, such as physician pro ...
Description: TMB Bulletin Fall 2006
Document: ... for Optometric Issues, Ad Hoc Committee to Study Office-Based Anesthesia, and the Non-Profit Health Organizations Committee. The board is also grateful to Dr. Canterbury for her service since September 15, 2003. During her time on the board, Dr. Canterbury served on the Disciplinary Process Review ...
Description: TMB Bulletin Fall 2002
Document: ... k Perry appropriated $200,000 from the Governor's Office for State Agency Grant Assistance. The intent of the grant was to allow TMB to hire additional investigations staff to look at medical malpractice claims. Along with the reorganization of the enforcement functions of the agency (see the Medica ...
Description: TMB Bulletin Fall 2001
Document: ... Mandatory September 1 Update on Opinions from the Office of the Attorney General Summary of Significant Legislation from 77th Session Physician Assistant Board News Former Board Member Dies Acupuncture Board News Rule Changes Non-Profit Reminder Reportable Illness Information on TDH Web Site Formal ...
Description: TMB Bulletin Fall 2004
Document: ... eed order or file a formal complaint at the State Office of Administrative Hearings. Complaints opened under the new requirements are moving through the system from investigations into litigation. At the close of FY 04, there were approximately 300 well-qualified physicians representing a wide varie ...
Description: TMB Bulletin Fall 2009
Document: ... unication for consultation,
emergency.
Facility-based practice state, such as a licensed
hospital or long-term care facility. A physician
may delegate if the physician is the medical
director, chair of the facility’s credentialing
Docs, PAs Need To Know New Rx Delegation Rules
PA and Acup ...
Description: TMB Bulletin Fall 2007
Document: ... er negotiation, the case is referred to the State Office of Administrative Hearings for a formal hearing with the elements of a civil court trial, with sworn witnesses, rules of evidence, depositions and a formal record by a court reporter. The administrative law judge who hears the case deliberates ...
Description: TMB Bulletin Fall 2010
Document: ... ized distributors to the pharmacy
or physician’s office.
Providing patients with non-FDA
approved drugs and devices originating
from foreign sources raises concerns
about patient informed consent. Likewise,
important English language labeling
information may be lacking in non-FDA
approv ...
Description: TMB Bulletin Fall 2008
Document: ... she worked in a law firm as well as for the Texas Office of the Attorney General. She is active in the Austin Young Lawyers Association and other civic and professional organizations. Dr. Moore graduated with honors from U.T. Austin and received his medical degree from the University of Texas Southw ...
Description: TMB Bulletin Fall 1997
Document: ... with the environmental protection division of the Office of the Attorney General. She is a graduate of Vanderbilt University and earned her law degree from the University of Houston Law Center. Mrs. Turner was reappointed to the Board.
Legal and Ethical Issues of HIV in Medical Practice by Mary An ...
Description: TMB Bulletin Fall 1998
Document: ... owing Formal Complaints were filed with the State Office of Administrative Hearings since the last publication of the Medical Board Report regarding the licensees listed below: Physicians Robert J. Byrnes, D.O. Rafael M. Cappiello, M.D. Joye M. Carter, M.D. Arthur B. Conde, M.D. Bernard J. Dolenz, M ...
Description: TMB Bulletin Fall 1999
Document: ... owing Formal Complaints were filed with the State Office of Administrative Hearings since the last publication of the Medical Board Report regarding the licensees listed below: Physicians Robert J. Byrnes, D.O. Rafael M. Cappiello, M.D. Joye M. Carter, M.D. Arthur B. Conde, M.D. Bernard J. Dolenz, M ...
Description: TMB Bulletin Fall 2005
Document: ... , physicians responsible for the management of an office that provides ongoing medical care to elderly persons are required by TMB to offer, to the extent possible as determined by the physician, the opportunity to receive the pneumococcal and influenza vaccines to each elderly person who receives o ...
Description: TMB Bulletin June-July 2003
Document: ... Projects for the Bexar County District Attorney's Office, as well as a part-time faculty member of San Antonio College, Palo Alto College and St. Philip's College. He earned a bachelor's degree from North Carolina A&T State University and master's degrees from Troy State University, the University o ...
Description: TMB Bulletin March 2013
Document: ... prac ce enhancement or management, or business or office administra on. Courses can be taken from coursework approved by the Acupuncture Board; from an Acupuncture Board approved provider; courses approved for CAE credit by another state for at least three years; courses approved by the Na onal Cer ...
“... Formal complaints filed by the Board at the State Office of Administrative Hearings are public documents. ”
Are complaints public information?
Complaints and investigational information received and maintained are not public information, by state law. Any resulting disciplinary orders are public and can be viewed on the physician’s profile. Formal complaints filed by the Board at the State Office of Administrative Hearings are public documents.
“... uest is related to a benefits or assistance claim based on the patient's disability. A reasonable fee for copies of imaging studies shall be no more than $8 per copy of an imaging study. ”
What are reasonable fees for medical records?
Board rules define a reasonable fee for providing paper copies of medical records as no more than $25 for the first twenty pages and $.50 per page for every copy thereafter. A reasonable fee for providing copies of medical records in electronic format is a charge of no more than: $25 for 500 pages or less and $50 for more than 500 pages. Also, a reasonable fee of up to $15 may be charged for executing an affidavit, if requested.
A physician may not charge a fee for a medical or mental health record if the request is related to a benefits or assistance claim based on the patient's disability.
A reasonable fee for copies of imaging studies shall be no more than $8 per copy of an imaging study.
“Put your request in writing and send it to the physician’s address listed on the physician’s Profile on the TMB website. You can also contact the TMB to determine if a custodian of records has been reported. If another physician has taken over the practice, the records may also be availa ... ”
My physician closed his office. How do I get my medical records?
Put your request in writing and send it to the physician’s address listed on the physician’s Profile on the TMB website. You can also contact the TMB to determine if a custodian of records has been reported. If another physician has taken over the practice, the records may also be available there.
“... dividual health plan or employer’s benefits office. Plans will have a listing of providers who accept your insurance and can offer further guidance. For physicians who accept Medicare payments, visit the Centers for Medicare and Medicaid Services' Physician Compare: https://www.medicare.gov/ph ... ”
How do I find a new physician?
The TMB does not provide a referral service or make recommendations to patient consumers regarding specific health care providers. Here are some tips on locating a new physician:
For physicians who accept Medicare payments, visit the Centers for Medicare and Medicaid Services' Physician Compare: https://www.medicare.gov/physiciancompare/.
For Medicaid and the Children's Health Insurance Program (CHIP), visit https://hhs.texas.gov/services/health/medicaid-chip.
“... rtunities in rural Texas please contact the State Office of Rural Health or the Southern Rural Access Program ”
How do I find out about career opportunities for physicians in rural Texas?
For information concerning practice opportunities in rural Texas please contact the State Office of Rural Health or the Southern Rural Access Program
“... ing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Pr ... ”
What are the general rules related to AAs/CRNAs?
The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:
1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.
It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”
Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.
One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.
As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.
While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.
Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.
“... a medically underserved population or in facility based practice. ”
How many physician assistants can a physician supervise?
There is no limitation to the number of PAs or APNs a physician may supervise. However, a physician may only delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent. The only exception relates to supervision and prescriptive delegation to a medically underserved population or in facility based practice.
“... a medically underserved population or in facility based practice. Refer to Board rule 193. ”
How many PAs can a physician delegate prescriptive authority to?
A physician may delegate prescriptive authority to a maximum of seven PA's or APN's, or their full-time equivalent. There are some statutory exceptions for prescriptive delegation to a medically underserved population or in facility based practice. Refer to Board rule 193.
“... tatute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple phys ... ”
I am an anesthesiologist. I contract out my services to other physicians to provide anesthesia for procedures in their offices. Since the anesthesia is not done in my office and I am only a contractor, do I need to register for Office Based Anesthesia (OBA)?
Yes, both the anesthesiologist and the physician performing the procedure should be registered for OBA. Statute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple physicians is not required to register each location where they perform OBA, but only the highest level of OBA services that they provide.
“The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the i ... ”
How much does OBA registration cost?
The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.
For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process. You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us.
“... be subject to disciplinary action. Action may be based on unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the physician engages in the compensated practice of medicine, provides medical services to members of the physician's family, or self-prescribes cont ... ”
Is there an exemption for retired physicians providing voluntary charity care?
Yes. A retired physician whose only clinical practice is the provision of voluntary charity care to indigent populations shall be exempt from the registration fee but must register the license as well as report CME. The physician's practice of medicine must not include the provision of medical services for either direct or indirect compensation which has monetary value of any kind and the physician's practice is limited to voluntary charity care to indigent populations and receives no direct or indirect compensation of any kind for medical services rendered. Also, the physician's practice cannot include the provision of medical services to family members or the self-prescribing of controlled substances or dangerous drugs. A physician who violates the provisions of this exemption may be subject to disciplinary action. Action may be based on unprofessional or dishonorable conduct likely to deceive, defraud, or injure the public if the physician engages in the compensated practice of medicine, provides medical services to members of the physician's family, or self-prescribes controlled substances or dangerous drugs. Additionally, a physician who attempts to obtain this exemption by submitting false or misleading statements shall be subject to disciplinary action pursuant to the Medical Practice Act, in addition to any civil or criminal actions provided for by the state or federal law.
“... PAs, x-ray techs, phlebotomists, RNs, MAs, etc.). Office staff, such as managers, janitors, etc. who do not provide medical services, would not be required to meet the CME requirement, but would need to be listed in response to a pain clinic audit which requires listing all clinic personnel for that ... ”
What are the continuing education requirements for pain management clinics?
Per Board Rule 195.4(e), the medical director or owner/operator of the pain management clinic, must on annual basis, ensure all personnel are properly licensed and, if applicable, have the requisite training to include 10 hours of continuing medical education (CME) annually in the area of pain management. This CME requirement applies to all personnel providing medical services to the patients (including, but not limited to: PAs, x-ray techs, phlebotomists, RNs, MAs, etc.). Office staff, such as managers, janitors, etc. who do not provide medical services, would not be required to meet the CME requirement, but would need to be listed in response to a pain clinic audit which requires listing all clinic personnel for that clinic. Documentation of the completed CME course shall be required to be made available upon request by Board Staff, including, but not limited to, during an on-site audit of the clinic, or during the certificate renewal process. The Board does have the authority to conduct audits and inspections at clinics to ensure compliance with all requirements and regulations pertaining to registered pain clinics, including audits of CME training as required.
“... epends on the practice setting. In facility-based hospital practices and in practices that serve medically underserved populations, there are no limitations. In all other practice settings, one physician may delegate to no more than seven full time equivalent APRNs and PAs (1:7 FTEs).&nb ... ”
Is there still a ratio for the number of APRNs or PAs to whom a physician may delegate prescriptive authority?
The answer to the question depends on the practice setting. In facility-based hospital practices and in practices that serve medically underserved populations, there are no limitations. In all other practice settings, one physician may delegate to no more than seven full time equivalent APRNs and PAs (1:7 FTEs).
“... en full time equivalent APRNs and PAs in facility based hospital practices and in practices that serve medically underserved populations. In all other settings and practice scenarios, the 1:7 FTE ratios applies. ”
Is there a waiver if a physician wants to delegate prescriptive authority to more than seven full time equivalent APRNs and PAs?
No, the waiver process no longer exists. A physician may only delegate prescriptive authority to more than seven full time equivalent APRNs and PAs in facility based hospital practices and in practices that serve medically underserved populations. In all other settings and practice scenarios, the 1:7 FTE ratios applies.
“No. The old site-based prescriptive authority system is no longer in effect. ”
Do the requirements for types of practice sites still apply?
No. The old site-based prescriptive authority system is no longer in effect.