1-1           By:  Patterson                                   S.B. No. 291

 1-2           (In the Senate - Filed January 23, 1997; January 28, 1997,

 1-3     read first time and referred to Committee on State Affairs;

 1-4     February 25, 1997, reported adversely, with favorable Committee

 1-5     Substitute by the following vote:  Yeas 11, Nays 0;

 1-6     February 25, 1997, sent to printer.)

 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 291                  By:  Shapiro

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to the regulation of orthotists and prosthetists;

1-11     providing a civil penalty.

1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

1-13           SECTION 1.  Title 132, Revised Statutes, is amended by adding

1-14     Article 8920 to read as follows:

1-15           Art. 8920.  REGULATION OF ORTHOTISTS AND PROSTHETISTS

1-16           Sec. 1.  SHORT TITLE.  This article may be cited as the

1-17     Orthotics and Prosthetics Act.

1-18           Sec. 2.  DEFINITIONS.  In this Act:

1-19                 (1)  "Board" means the Texas Board of Orthotics and

1-20     Prosthetics.

1-21                 (2)  "Commissioner" means the commissioner of public

1-22     health.

1-23                 (3)  "Custom-fabricated" means an orthosis or

1-24     prosthesis has been designed, prescribed, fabricated, fitted, and

1-25     aligned specifically for an individual in accordance with sound

1-26     biomechanical principles.

1-27                 (4)  "Custom-fitted" means an orthosis or prosthesis

1-28     that has been adjusted, prescribed, fitted, and aligned for a

1-29     specific individual according to sound biomechanical principles.

1-30                 (5)  "Department" means the Texas Department of Health.

1-31                 (6)  "License" includes a license, registration,

1-32     certificate, accreditation, or other authorization issued under

1-33     this Act to engage in an activity regulated under this Act.

1-34                 (7)  "Licensed orthotist" or "LO" means a person

1-35     licensed under this Act who practices orthotics and represents the

1-36     person to the public by a title or description of services that

1-37     includes the term "orthotics," "orthotist," "brace," "orthoses,"

1-38     "orthotic," or a similar title or description of services.

1-39                 (8)  "Licensed orthotist assistant" or "LOA" means a

1-40     person licensed under this Act who assists and is under the

1-41     supervision at an orthotic or prosthetic facility of a licensed

1-42     orthotist responsible for the acts of the assistant.

1-43                 (9)  "Licensed prosthetist" or "LP" means a person

1-44     licensed under this Act who practices prosthetics and represents

1-45     the person to the public by a title or description of services that

1-46     includes the term "prosthetics," "prosthetist," "prostheses,"

1-47     "prosthetic," "artificial limb," or a similar title or description

1-48     of services.

1-49                 (10)  "Licensed prosthetist assistant" or "LPA" means a

1-50     person licensed under this Act who assists and is under the

1-51     supervision at an orthotic or prosthetic facility of a licensed

1-52     prosthetist responsible for the acts of the assistant.

1-53                 (11)  "Licensed prosthetist orthotist" or "LPO" means a

1-54     person licensed under this Act who practices both prosthetics and

1-55     orthotics and represents the person to the public by a title or

1-56     description of services that includes the terms "prosthetics

1-57     orthotics," "prosthetist orthotist," "prosthetic orthotic,"

1-58     "artificial limb," "brace," or a similar title or description of

1-59     services.

1-60                 (12)  "Licensed prosthetist orthotist assistant" or

1-61     "LPOA" means a person licensed under this Act who assists and is

1-62     under the supervision at an orthotic or prosthetic facility of a

1-63     licensed prosthetist orthotist or a licensed prosthetist and

1-64     licensed orthotist responsible for the acts of the assistant.

 2-1                 (13)  "Orthosis" means a custom-fabricated or

 2-2     custom-fitted medical device designed to provide for the support,

 2-3     alignment, prevention, or correction of neuromuscular or

 2-4     musculoskeletal disease, injury, or deformity.  The term does not

 2-5     include a fabric or elastic support, corset, arch support,

 2-6     low-temperature plastic splint, truss, elastic hose, cane, crutch,

 2-7     soft cervical collar, orthosis for diagnostic or evaluation

 2-8     purposes, dental appliance, or any other similar device carried in

 2-9     stock and sold by a drugstore, department store, or corset shop.

2-10                 (14)  "Orthotic or prosthetic facility" means a

2-11     physical site, including a building or office, where the profession

2-12     and practice of orthotics or prosthetics normally takes place.

2-13                 (15)  "Orthotics" means the science and practice of

2-14     measuring, designing, fabricating, assembling, fitting, adjusting,

2-15     or servicing an orthosis under an order from a licensed physician,

2-16     chiropractor, or podiatrist for the correction or alleviation of

2-17     neuromuscular or musculoskeletal dysfunction, disease, injury, or

2-18     deformity.

2-19                 (16)  "Person" means an individual, corporation,

2-20     partnership, association, or other organization.

2-21                 (17)  "Profession of orthotics or prosthetics" means

2-22     allied health care medical services used to identify, prevent,

2-23     correct, or alleviate acute or chronic neuromuscular or

2-24     musculoskeletal dysfunctions of the human body that support and

2-25     provide rehabilitative health care services concerned with the

2-26     restoration of function, prevention, or progression of disabilities

2-27     resulting from disease, injury, or congenital anomalies.  Orthotic

2-28     and prosthetic services include direct patient care, including

2-29     consultation, evaluation, treatment, education, and advice to

2-30     maximize the rehabilitation potential of disabled individuals.

2-31                 (18)  "Prosthesis" means a custom-fabricated or fitted

2-32     medical device that is not surgically implanted and is used to

2-33     replace a missing limb, appendage, or other external human body

2-34     part, including an artificial limb, hand, or foot.  The term does

2-35     not include an artificial eye, ear, finger, or toe, a dental

2-36     appliance, a cosmetic device, including an artificial breast,

2-37     eyelash, or wig, or other device that does not have a significant

2-38     impact on the musculoskeletal functions of the body.

2-39                 (19)  "Prosthetics" means the science and practice of

2-40     measuring, designing, fabricating, assembling, fitting, adjusting,

2-41     or servicing a prosthesis under an order from a licensed physician,

2-42     chiropractor, or podiatrist.

2-43                 (20)  "Registered orthotic technician" means a person

2-44     registered under this Act who fabricates, assembles, and services

2-45     orthoses under the direction of a licensed orthotist or licensed

2-46     orthotist assistant responsible for the acts of the technician.

2-47                 (21)  "Registered prosthetic orthotic technician" means

2-48     a person registered under this Act who fabricates, assembles, or

2-49     services prostheses and orthoses under the direction of a licensed

2-50     orthotist and licensed prosthetist, a licensed prosthetist

2-51     orthotist, or a licensed orthotist assistant, licensed prosthetist

2-52     assistant, or licensed prosthetist orthotist assistant responsible

2-53     for the acts of the technician.

2-54                 (22)  "Registered prosthetic technician" means a person

2-55     registered under this Act who fabricates, assembles, or services

2-56     prostheses under the direction of a licensed prosthetist or

2-57     licensed prosthetist assistant responsible for the acts of the

2-58     technician.

2-59           Sec. 3.  BOARD.  (a)  The Texas Board of Orthotics and

2-60     Prosthetics is established as a part of the department and shall

2-61     perform its duties as a board with the department.

2-62           (b)  The board consists of six members appointed by the

2-63     governor with the advice and consent of the senate.  Appointments

2-64     to the board shall be made without regard to the race, color,

2-65     disability, sex, religion, age, or national origin of the

2-66     appointees.

2-67           (c)  Members of the board are appointed for staggered

2-68     six-year terms, with two members' terms expiring on February 1 of

2-69     each odd-numbered year.

 3-1           (d)  One member of the board must be a licensed orthotist, be

 3-2     a resident of this state, and have practiced orthotics for the five

 3-3     years preceding the date of appointment.  One member of the board

 3-4     must be a licensed prosthetist, be a resident of this state, and

 3-5     have practiced prosthetics for the five years preceding the date of

 3-6     appointment.  One member of the board must be a licensed

 3-7     prosthetist orthotist, be a resident of this state, and have

 3-8     practiced prosthetics and orthotics for the five years preceding

 3-9     the date of appointment.  One member of the board must be a

3-10     representative of the public who uses an orthosis.  One member of

3-11     the board must be a representative of the public who uses a

3-12     prosthesis.  One member of the board must be a representative of

3-13     the public who does not use an orthosis or prosthesis.

3-14           (e)  A vacancy on the board shall be filled by appointment by

3-15     the governor of an individual who has the appropriate

3-16     qualifications.  The appointed person serves for the remainder of

3-17     the term.

3-18           (f)  A member of the board is not liable for damages in a

3-19     civil action for any act performed in good faith in the execution

3-20     of the member's duties.

3-21           (g)  The board is subject to Chapter 325, Government Code

3-22     (Texas Sunset Act).  Unless continued in existence as provided by

3-23     that chapter, the board is abolished and this Act expires September

3-24     1, 2009.

3-25           Sec. 4.  REMOVAL FROM BOARD.  (a)  It is a ground for removal

3-26     from the board if a member:

3-27                 (1)  does not have at the time of appointment the

3-28     qualifications required for appointment to the board;

3-29                 (2)  does not maintain during service on the board the

3-30     qualifications required for appointment to the board;

3-31                 (3)  violates a prohibition established by this Act;

3-32                 (4)  cannot discharge the member's duties for a

3-33     substantial part of the term for which the member is appointed

3-34     because of illness or disability; or

3-35                 (5)  is absent from more than half of the regularly

3-36     scheduled board meetings that the member is eligible to attend

3-37     during a calendar year unless the absence is excused by majority

3-38     vote of the board.

3-39           (b)  The validity of an action of the board is not affected

3-40     by the fact that the action was taken when a ground for removal of

3-41     a member of the board existed.

3-42           (c)  If the executive director has knowledge that a potential

3-43     ground for removal exists, the executive director shall notify the

3-44     presiding officer of the board of the ground.  The presiding

3-45     officer shall then notify the governor that a potential ground for

3-46     removal exists.

3-47           Sec. 5.  BOARD POWERS AND DUTIES.  (a)  The board shall

3-48     review applications for a license at least once each year at

3-49     reasonable times and places designated by the board.

3-50           (b)  The board may collect license application fees, renewal

3-51     fees, examination fees, and other fees for other administrative

3-52     expenses.  If the General Appropriations Act does not set the

3-53     amount of those fees, the board shall set the fees in amounts

3-54     reasonable and necessary for the administration and implementation

3-55     of this Act.

3-56           (c)  The board shall approve any examination required for a

3-57     license under this Act.  Each examination shall be offered at least

3-58     once each year.

3-59           (d)  The board may:

3-60                 (1)  investigate complaints;

3-61                 (2)  issue, suspend, deny, and revoke licenses;

3-62                 (3)  reprimand license holders and place license

3-63     holders on probation;

3-64                 (4)  issue subpoenas; and

3-65                 (5)  hold hearings.

3-66           (e)  The board shall keep an information file about each

3-67     complaint that is filed with the board relating to a person or

3-68     entity regulated by the board.  If a written complaint that the

3-69     board has authority to resolve is filed with the board, the board,

 4-1     at least as frequently as quarterly and until the final disposition

 4-2     of the complaint, shall notify the parties to the complaint of the

 4-3     status of the complaint unless the notice would jeopardize an

 4-4     undercover investigation.

 4-5           (f)  The board shall propose rules consistent with this Act

 4-6     to carry out its duties in administering this Act and submit the

 4-7     proposed rules to the attorney general for review.  The board shall

 4-8     adopt rules consistent with the advice of the attorney general.  In

 4-9     adopting rules, the board shall consider the applicable policies

4-10     and procedures of the department.

4-11           (g)  The commissioner, with the advice of the board, shall

4-12     appoint an executive director to administer this Act.  The board

4-13     may use personnel, facilities, furniture, equipment, and other

4-14     items supplied by the department to administer this Act.

4-15           (h)  The executive director or the executive director's

4-16     designee shall develop an intra-agency career ladder program.  The

4-17     program shall require intra-agency posting of all nonentry level

4-18     positions concurrently with any public posting.

4-19           (i)  The executive director or the executive director's

4-20     designee shall develop a system of annual performance evaluations

4-21     based on measurable job tasks.  All merit pay for board employees

4-22     shall be based on the system established under this subsection.

4-23           (j)  The board shall prepare information of consumer interest

4-24     describing the regulatory functions of the board and legal rights

4-25     of consumers as provided by this Act.

4-26           (k)  The board shall assist legal authorities in the

4-27     prosecution of any person violating this Act.

4-28           (l)  The board shall prepare or approve continuing education

4-29     programs for license holders and shall adopt rules that require a

4-30     license holder to participate in an approved continuing education

4-31     program to renew a license issued under this Act.

4-32           (m)  The board shall develop and implement policies that

4-33     clearly define the respective responsibilities of the governing

4-34     body of the board and the staff of the board.

4-35           Sec. 6.  PUBLIC INFORMATION.  (a)  The board shall prepare

4-36     information of public interest describing the functions of the

4-37     board and describing the procedures by which complaints are filed

4-38     with and resolved by the board.  The board shall make the

4-39     information available to the general public and appropriate state

4-40     agencies.

4-41           (b)  The board by rule shall establish methods by which

4-42     consumers and service recipients are notified of the name, mailing

4-43     address, and telephone number of the board for the purpose of

4-44     directing complaints to the board.  The board may provide for that

4-45     notification:

4-46                 (1)  on each registration form, application, or written

4-47     contract for services of an individual or entity regulated by the

4-48     board;

4-49                 (2)  on a sign prominently displayed in the place of

4-50     business of each individual or entity regulated by the board; or

4-51                 (3)  in a bill for service provided by an individual or

4-52     entity regulated by the board.

4-53           (c)  The board shall list along with its regular telephone

4-54     number the toll-free telephone number that may be called to present

4-55     a complaint about a person regulated or required to be regulated

4-56     under this Act if the toll-free number is established under other

4-57     state law.

4-58           Sec. 7.  PUBLIC PARTICIPATION IN BOARD MEETINGS.  The board

4-59     shall develop and implement policies that provide the public with a

4-60     reasonable opportunity to appear before the board and to speak on

4-61     any issue under the jurisdiction of the board.

4-62           Sec. 8.  PROGRAM ACCESSIBILITY.  The board shall prepare and

4-63     maintain a written plan that describes how a person who does not

4-64     speak English can be provided reasonable access to the board's

4-65     programs.  The board shall also comply with federal and state laws

4-66     for program and facility accessibility.

4-67           Sec. 9.  TRAINING; STANDARDS OF CONDUCT INFORMATION.  Each

4-68     board member shall comply with the board member training

4-69     requirements established by any other state agency that is given

 5-1     authority to establish the requirements for the board.

 5-2           Sec. 10.  OPEN MEETINGS AND ADMINISTRATIVE PROCEDURE

 5-3     REQUIREMENTS.  The board is subject to Chapters 551 and 2001,

 5-4     Government Code.

 5-5           Sec. 11.  ORGANIZATION OF BOARD.  (a)  The members of the

 5-6     board shall elect from the membership of the board a presiding

 5-7     officer, a secretary, and other officers required for the conduct

 5-8     of business.  Special meetings of the board shall be called by the

 5-9     presiding officer or on the written request of any three members.

5-10     The board may adopt rules necessary to govern its proceedings.

5-11           (b)  The executive director shall keep a record of each

5-12     meeting of the board and maintain a register containing the names

5-13     of all persons holding a license under this Act.  The record and

5-14     register shall be open at all times to public inspection.  On March

5-15     1 of each year, the executive director shall send an official copy

5-16     of the register of license holders to the secretary of state for

5-17     permanent record.  A certified copy of the register is admissible

5-18     as evidence in any court of this state.

5-19           Sec. 12.  COMPENSATION.  A member of the board is entitled to

5-20     compensation and reimbursement of the member's travel expenses as

5-21     provided by the General Appropriations Act.

5-22           Sec. 13.  EFFECT OF LOBBYING ACTIVITY.  A person may not

5-23     serve as a member of the board or act as the general counsel to the

5-24     board if the person is required to register as a lobbyist under

5-25     Chapter 305, Government Code, because of the person's activities

5-26     for compensation on behalf of a profession related to the operation

5-27     of the board.

5-28           Sec. 14.  PUBLIC MEMBERSHIP RESTRICTION.  A person is not

5-29     eligible for appointment by the governor as a public member of the

5-30     board if the person or person's spouse:

5-31                 (1)  is registered, certified, or licensed by an

5-32     occupational regulatory agency in the field of health care;

5-33                 (2)  is employed by or participates in the management

5-34     of a business entity or other organization regulated by the board

5-35     or receiving funds from the board;

5-36                 (3)  owns or controls, directly or indirectly, more

5-37     than a 10 percent interest in a business entity or other

5-38     organization regulated by the board or receiving funds from the

5-39     board; or

5-40                 (4)  uses or receives a substantial amount of tangible

5-41     goods, services, or funds from the board, other than compensation

5-42     or reimbursement authorized by law for board membership,

5-43     attendance, or expenses.

5-44           Sec. 15.  CONFLICT OF INTEREST RESTRICTIONS.  (a)  An

5-45     officer, employee, or paid consultant of a Texas trade association

5-46     in the field of health care may not be a member or employee of the

5-47     board who is exempt from the state's position classification plan

5-48     or is compensated at or above the amount prescribed by the General

5-49     Appropriations Act for step 1, salary group 17, of the position

5-50     classification salary schedule.

5-51           (b)  A person who is the spouse of an officer, manager, or

5-52     paid consultant of a Texas trade association in the field of health

5-53     care may not be a member of the board and may not be an employee of

5-54     the board who is exempt from the state's position classification

5-55     plan or is compensated at or above the amount prescribed by the

5-56     General Appropriations Act for step 1, salary group 17, of the

5-57     position classification salary schedule.

5-58           (c)  For the purposes of this section, a Texas trade

5-59     association is a nonprofit, cooperative, and voluntarily joined

5-60     association of business or professional competitors in this state

5-61     designed to assist its members and its industry or profession in

5-62     dealing with mutual business or professional problems and in

5-63     promoting their common interest.

5-64           Sec. 16.  AUDIT.  The financial transactions of the board are

5-65     subject to audit by the state auditor in accordance with Chapter

5-66     321, Government Code.

5-67           Sec. 17.  REPORT TO GOVERNOR AND LEGISLATURE.  During January

5-68     of each year, the board shall file with the governor and the

5-69     presiding officer of each house of the legislature a complete and

 6-1     detailed written report accounting for all funds received and

 6-2     disbursed by the board during the preceding year.

 6-3           Sec. 18.  EQUAL EMPLOYMENT OPPORTUNITY POLICIES.  (a)  The

 6-4     executive director or the executive director's designee shall

 6-5     prepare and maintain a written policy statement to ensure

 6-6     implementation of a program of equal employment opportunity under

 6-7     which all personnel transactions are made without regard to race,

 6-8     color, disability, sex, religion, age, or national origin.  The

 6-9     policy statement must include:

6-10                 (1)  personnel policies, including policies relating to

6-11     recruitment, evaluation, selection, application, training, and

6-12     promotion of personnel, that are in compliance with Chapter 21,

6-13     Labor Code;

6-14                 (2)  a comprehensive analysis of the board workforce

6-15     that meets federal and state guidelines;

6-16                 (3)  procedures by which a determination can be made of

6-17     significant underutilization in the board workforce of all persons

6-18     for whom federal or state guidelines encourage a more equitable

6-19     balance; and

6-20                 (4)  reasonable methods to appropriately address those

6-21     areas of underutilization.

6-22           (b)  A policy statement prepared under Subsection (a) of this

6-23     section must cover an annual period, be updated annually, be

6-24     reviewed by the Commission on Human Rights for compliance with

6-25     Subsection (a)(1) of this section, and be filed with the governor's

6-26     office.

6-27           (c)  The governor's office shall deliver a biennial report to

6-28     the legislature based on the information received under Subsection

6-29     (b) of this section.  The report may be made separately or as part

6-30     of other biennial reports to the legislature.

6-31           Sec. 19.  NOTICE OF STANDARDS OF CONDUCT.  The board shall

6-32     provide to its members and employees, as often as necessary,

6-33     information regarding their qualifications for office or employment

6-34     under this Act and their responsibilities under applicable laws

6-35     relating to standards of conduct for state officers or employees.

6-36           Sec. 20.  APPROPRIATIONS TO TEXAS DEPARTMENT OF HEALTH.  The

6-37     department shall receive and account for funds derived under this

6-38     Act.  The department shall deposit all funds collected under this

6-39     Act to the credit of the general revenue fund.

6-40           Sec. 21.  EXEMPTIONS.  (a)  This Act does not restrict a

6-41     license holder of another state agency from performing health care

6-42     services within the scope of the license holder's applicable

6-43     licensing act if:

6-44                 (1)  the license holder:

6-45                       (A)  does not represent to others that the

6-46     license holder practices the profession of orthotics or

6-47     prosthetics; or

6-48                       (B)  does not use the terms "prosthetist,"

6-49     "prosthesis," "prosthetic," "artificial limb," "orthotist,"

6-50     "orthosis," "orthotic," or "brace" or the letters "LP," "LPA,"

6-51     "LO," "LOA," "LPO," or "LPOA" or any derivative of those terms or

6-52     letters in connection with the license holder's name or practice;

6-53     and

6-54                 (2)  the license holder practices in conformance with

6-55     the applicable laws and rules relating to the person's license and

6-56     does not violate Section 22 of this Act.

6-57           (b)  This Act does not apply to the activities and services

6-58     of a person acting as a student in orthotics or prosthetics who is

6-59     pursuing a course of study in a prosthetic or orthotic program at a

6-60     college or university recognized and accredited by the Commission

6-61     on Accreditation of Allied Health Education Programs or an orthotic

6-62     or prosthetic educational program having educational standards that

6-63     are equivalent to or exceed the standards adopted by the Commission

6-64     on Accreditation of Allied Health Education Programs or who is

6-65     working in a recognized training center or research facility, if

6-66     those activities and services constitute a part of the person's

6-67     course of study in the discipline in which the person's supervisor

6-68     is licensed under this Act.

6-69           (c)  This Act does not apply to a:

 7-1                 (1)  podiatrist practicing under the law regulating

 7-2     podiatry (Article 4567 et seq., Revised Statutes); or

 7-3                 (2)  doctor of chiropractic practicing under the law

 7-4     regulating chiropractic (Chapter 94, Acts of the 51st Legislature,

 7-5     Regular Session, 1949 (Article 4512b, Vernon's Texas Civil

 7-6     Statutes)).

 7-7           (d)  This Act does not apply to a pedorthist certified by the

 7-8     Board for Certification in Pedorthics.  For the purposes of this

 7-9     subsection, a certified pedorthist is a person certified by the

7-10     Board for Certification in Pedorthics, or its successor entity, in

7-11     the design, manufacture, fit, and modification of shoes and related

7-12     foot orthoses below the anatomical ankle joint as prescribed by a

7-13     licensed doctor of medicine or a doctor of podiatry for the

7-14     amelioration of a painful or disabling condition of the foot.

7-15     "Foot orthosis" includes prosthetic toe fillers or orthoses for use

7-16     below the ankle.

7-17           (e)  This Act does not apply to a certified fitter or

7-18     certified master orthotist who holds a credential issued by the

7-19     National Community Pharmacists Association if the fitter or master

7-20     orthotist:

7-21                 (1)  is working within the person's scope of practice

7-22     as defined by the board; or

7-23                 (2)  provides the following services or devices

7-24     described by the Health Care Financing Administration's Common

7-25     Procedure Coding System:

7-26                       (A)  foam cervical collar;

7-27                       (B)  thermoplastic foam cervical collar;

7-28                       (C)  plastic cervical collar;

7-29                       (D)  rib belt;

7-30                       (E)  thoracic-lumbar support;

7-31                       (F)  lumbar-sacral support;

7-32                       (G)  sacroiliac support;

7-33                       (H)  ptosis support;

7-34                       (I)  pendulous abdomen support;

7-35                       (J)  torso support;

7-36                       (K)  knee orthosis;

7-37                       (L)  knee orthosis with stays;

7-38                       (M)  knee orthosis with joints;

7-39                       (N)  knee orthosis with condylar pads;

7-40                       (O)  knee orthosis with joints and condylar pads;

7-41                       (P)  knee immobilizer;

7-42                       (Q)  multiligamentus ankle support;

7-43                       (R)  figure eight shoulder restrainer;

7-44                       (S)  acromioclavicular support;

7-45                       (T)  elbow orthosis with stays;

7-46                       (U)  elbow orthosis with joints;

7-47                       (V)  wrist splint;

7-48                       (W)  pneumatic ankle splint;

7-49                       (X)  pneumatic walking splint;

7-50                       (Y)  pneumatic full leg splint;

7-51                       (Z)  pneumatic knee splint;

7-52                       (AA)  mastectomy bra;

7-53                       (BB)  mastectomy sleeve;

7-54                       (CC)  mastectomy form;

7-55                       (DD)  silicone breast prosthesis;

7-56                       (EE)  medium weight calf-length stocking;

7-57                       (FF)  heavy weight calf-length stocking;

7-58                       (GG)  surgical weight calf-length stocking;

7-59                       (HH)  medium weight thigh-length stocking;

7-60                       (II)  heavy weight thigh-length stocking;

7-61                       (JJ)  surgical weight thigh-length stocking;

7-62                       (KK)  medium weight full-length stocking;

7-63                       (LL)  heavy weight full-length stocking;

7-64                       (MM)  surgical weight full-length stocking;

7-65                       (NN)  medium weight leotard;

7-66                       (OO)  surgical weight leotard;

7-67                       (PP)  custom made compression stocking;

7-68                       (QQ)  lymphedema sleeve;

7-69                       (RR)  garter belt;

 8-1                       (SS)  single truss with standard pad;

 8-2                       (TT)  double truss with standard pad;

 8-3                       (UU)  water pad addition to truss; and

 8-4                       (VV)  scrotal pad addition to truss.

 8-5           Sec. 22.  PROHIBITED ACTS.  (a)  A person may not practice,

 8-6     attempt to practice, or offer to practice prosthetics or orthotics,

 8-7     act as an assistant to a person who practices prosthetics or

 8-8     orthotics, or in any way hold the person out as being able to

 8-9     practice prosthetics or orthotics unless the person holds a license

8-10     issued by the board under this Act.

8-11           (b)  A person or the person's employees, agents, or

8-12     representatives may not use in connection with the person's name or

8-13     business activities the terms or a combination of the terms or

8-14     letters described in Section 21(a)(1), indicate orally or in

8-15     writing, directly or by implication, that a prosthetic or orthotic

8-16     service is provided or supplied, or extend or provide prosthetic or

8-17     orthotic services unless the person is a prosthetist or orthotist

8-18     or an assistant to a prosthetist or orthotist licensed under this

8-19     Act.

8-20           (c)  A person licensed under this Act violates this Act if

8-21     the person violates Section 161.091, Health and Safety Code.

8-22           Sec. 23.  PROSTHETIST AND ORTHOTIST LICENSE REQUIREMENTS.

8-23     (a)  To obtain a license to practice prosthetics or orthotics in

8-24     this state, an individual must file a written application with the

8-25     board on the form provided by the board, pay the nonrefundable

8-26     application fee prescribed by the board, and:

8-27                 (1)  be a resident of this state;

8-28                 (2)  have completed the formal training, including the

8-29     required hours of classroom education and clinical practice, in an

8-30     area of study the board by rule determines to be necessary and

8-31     appropriate;

8-32                 (3)  have completed a clinical residency in the

8-33     professional area for which licensure is sought that complies with

8-34     the standards, guidelines, or procedures established by the board

8-35     for a clinical residency offered in this state or in another state;

8-36     and

8-37                 (4)  have completed and passed all written and

8-38     practical examinations approved and required by the board.

8-39           (b)  The requirements for a license established by board rule

8-40     must include:

8-41                 (1)  either:

8-42                       (A)  a bachelor's degree in orthotics and

8-43     prosthetics from a college or university educational program

8-44     recognized and accredited by the Commission on Accreditation of

8-45     Allied Health Education Programs or from a practitioner educational

8-46     program having educational standards that are equivalent to or

8-47     exceed the standards adopted by the Commission on Accreditation of

8-48     Allied Health Education Programs; or

8-49                       (B)  a bachelor's degree and a prosthetic or

8-50     orthotic certificate from a practitioner educational program

8-51     recognized and accredited by the Commission on Accreditation of

8-52     Allied Health Education Programs or from a practitioner educational

8-53     program having educational standards that are equivalent to or

8-54     exceed the standards adopted by the Commission on Accreditation of

8-55     Allied Health Education Programs; and

8-56                 (2)  not less than 1,900 hours of professional clinical

8-57     residency completed under the direct supervision of a licensed

8-58     orthotist, licensed prosthetist, or a licensed prosthetist

8-59     orthotist in the discipline for which licensure is sought.

8-60           (c)  The board's rules providing requirements for a license

8-61     must include as an alternative to the requirement under Subsection

8-62     (b) of this section that an applicant have an associate's degree,

8-63     including courses in the anatomical, biological, and physical

8-64     sciences and not less than 4,500 hours of postgraduate clinical

8-65     experience under the direct supervision of a licensed orthotist,

8-66     licensed prosthetist, or licensed prosthetist orthotist in the

8-67     discipline for which licensure is sought.  This subsection expires

8-68     January 1, 2005.

8-69           (d)  A person may apply for an exemption from the license

 9-1     requirements adopted by the board under this section if the person

 9-2     applies not later than the 181st day after the date the board's

 9-3     initial rules under this Act are finally adopted and published and

 9-4     the person:

 9-5                 (1)  is a resident of this state; and

 9-6                 (2)  preceding the date of the application:

 9-7                       (A)  provided comprehensive prosthetic or

 9-8     orthotic care for not less than three years, including practicing

 9-9     orthotics or prosthetics in this state for the one-year period

9-10     preceding the application date; or

9-11                       (B)  provided comprehensive prosthetic and

9-12     orthotic care for not less than six years, including practicing

9-13     orthotics and prosthetics in this state for the one-year period

9-14     preceding the application date.

9-15           (e)  A person may apply for an exemption from the license

9-16     requirements adopted by the board under this section if the person

9-17     is a resident of this state who presents evidence satisfactory to

9-18     the board that the person possesses unique qualifications to

9-19     practice orthotics, prosthetics, or orthotics and prosthetics.

9-20           (f)  A person may obtain a license to practice in this state

9-21     by completing and passing all written and practical examinations

9-22     approved and required by the board if the person:

9-23                 (1)  applies for the examinations on a form provided by

9-24     the board not later than the 181st day after the date the board's

9-25     initial rules under this Act are finally adopted and published;

9-26                 (2)  pays the nonrefundable application fee prescribed

9-27     by the board; and

9-28                 (3)  provided comprehensive orthotic, prosthetic, or

9-29     orthotic and prosthetic care in this state for less than the number

9-30     of years required by Subsection (d) of this section.

9-31           (g)  The board shall issue a license to a person who is

9-32     determined to be exempt from the license requirements under

9-33     Subsection (d) or (e) of this section or who obtains a license

9-34     under Subsection (f) of this section.  Such a license holder is

9-35     entitled to the same license privileges as if the person met the

9-36     educational and vocational requirements under Subsection (a) or (b)

9-37     of this section.  The person is subject to the license renewal

9-38     requirements adopted by the board, except for the academic,

9-39     clinical training, and examination requirements, which may not be

9-40     imposed as a condition of the person's license.

9-41           Sec. 24.  PHARMACISTS.  The board shall issue a license to a

9-42     person who applies for a license and is licensed by the State Board

9-43     of Pharmacy and is certified by the National Community Pharmacists

9-44     Association as a certified fitter or master orthotist.

9-45           Sec. 25.  PROSTHETIST OR ORTHOTIST ASSISTANT LICENSE.

9-46     (a)  An applicant for a license as a prosthetist assistant or

9-47     orthotist assistant must file a written application with the board

9-48     on a form provided by the board and pay the nonrefundable

9-49     application fee prescribed by the board.

9-50           (b)  An applicant under this section must present evidence

9-51     satisfactory to the board that the applicant has completed an

9-52     educational program, including courses in the anatomical,

9-53     biological, and physical sciences, and a clinical residency as

9-54     prescribed and adopted by the board.

9-55           (c)  An assistant licensed under this section may provide

9-56     only ancillary patient care services, as defined by the board, in

9-57     the discipline in which the assistant's supervisor is licensed

9-58     under this Act.

9-59           (d)  A person may apply for an exemption from the license

9-60     requirements adopted by the board under this section if the person

9-61     applies not later than the 181st day after the date the board's

9-62     initial rules under this Act are finally adopted and published and

9-63     if the person is a resident of this state who has practiced within

9-64     the scope of practice of an assistant, as defined by the board, for

9-65     five consecutive years in this state.

9-66           Sec. 26.  PROSTHETIC OR ORTHOTIC TECHNICIAN REGISTRATION.

9-67     (a)  An applicant for registration as a registered prosthetic

9-68     technician or registered orthotic technician must file a written

9-69     application with the board on a form provided by the board and pay

 10-1    the nonrefundable application fee prescribed by the board.

 10-2          (b)  An applicant under this section must present evidence

 10-3    satisfactory to the board that the applicant has completed an

 10-4    educational program and laboratory experience as prescribed and

 10-5    adopted by the board.

 10-6          (c)  A person may apply for an exemption from the

 10-7    registration requirements adopted by the board under this section

 10-8    if the person applies not later than the 181st day after the date

 10-9    the board's initial rules under this Act are finally adopted and

10-10    published and if the person is a resident of this state who has

10-11    practiced as an orthotic or prosthetic technician for five

10-12    consecutive years in this state.

10-13          Sec. 27.  ACCREDITATION OF FACILITIES.  (a)  The board by

10-14    rule shall adopt requirements for the accreditation and the renewal

10-15    of an accreditation of an orthotic or prosthetic facility in which

10-16    the profession and practice of orthotics or prosthetics is

10-17    conducted.

10-18          (b)  If one or more facilities are owned by a person, the

10-19    board may require only one application for the accreditation of all

10-20    the person's facilities.  Each orthotic or prosthetic facility must

10-21    meet the requirements prescribed by the board.

10-22          (c)  An orthotic or prosthetic facility must be under the

10-23    on-site direction of an orthotist or prosthetist licensed by the

10-24    board in the discipline for which accreditation is sought.

10-25          (d)  The rules adopted under this section may not prohibit a

10-26    licensed individual from practicing in an orthotic or prosthetic

10-27    facility within the scope of the individual's license.

10-28          (e)  This section does not apply to a facility licensed under

10-29    Subtitle B, Title 4, Health and Safety Code.

10-30          Sec. 28.  ISSUANCE OF LICENSE.  (a)  The board shall issue a

10-31    license in prosthetics or orthotics to an applicant who meets the

10-32    qualifications established under this Act and the requirements

10-33    adopted by the board as provided by this Act.  A license is valid

10-34    for two years from the date issued and may be renewed before

10-35    expiration.

10-36          (b)  The board may issue a license or registration under this

10-37    Act only to an individual.  The board may issue an accreditation

10-38    only to an orthotic or prosthetic facility.

10-39          (c)  A license may be granted in either orthotics or

10-40    prosthetics, or in both, if the person meets the requirements

10-41    established by the board.

10-42          Sec. 29.  PROVISIONAL LICENSE.  (a)  A person practicing

10-43    comprehensive prosthetic or orthotic patient management who does

10-44    not meet the requirements of this Act for licensing as a

10-45    prosthetist or orthotist by October 1, 1998, and is not exempt

10-46    under this Act, must comply with the requirements of Sections 23(a)

10-47    and (b) of this Act on or before January 1, 2005.

10-48          (b)  A person subject to this section may apply for a

10-49    prosthetist or orthotist provisional license by filing a written

10-50    application with the board on a form provided by the board and

10-51    paying a nonrefundable application fee prescribed by the board.

10-52          (c)  A provisional license may only be issued to an

10-53    individual who is actively engaged in complying with the

10-54    educational and clinical licensing requirements of Sections 23(a)

10-55    and (b) of this Act.

10-56          (d)  A provisional license may be revoked by the board if the

10-57    board determines that the provisional license holder is not in

10-58    compliance with this section.

10-59          (e)  The educational and clinical training requirements

10-60    established by board rule for a provisional license must include:

10-61                (1)  an associate degree, including course work in the

10-62    anatomical, biological, and physical sciences; and

10-63                (2)  not less than 4,500 hours of postgraduate clinical

10-64    residency completed under the direct supervision of a licensed

10-65    orthotist or a licensed prosthetist in the discipline for which a

10-66    provisional license is sought.

10-67          (f)  A provisional license is valid for two years from the

10-68    date issued and may be renewed with documentation as required by

10-69    board rule.

 11-1          (g)  This section expires January 1, 2005.

 11-2          Sec. 30.  TEMPORARY LICENSE.  (a)  The board may issue a

 11-3    temporary license to an individual who:

 11-4                (1)  has recently become a resident of this state;

 11-5                (2)  has applied for licensing as an orthotist,

 11-6    prosthetist, or both; and

 11-7                (3)  has:

 11-8                      (A)  practiced the profession of orthotics

 11-9    regularly since January 1, 1996; or

11-10                      (B)  been licensed by the state in which the

11-11    person formerly resided that has licensing requirements that are

11-12    equal to or exceed the requirements of this Act.

11-13          (b)  A temporary license is valid for one year from the date

11-14    issued.  A temporary license may be renewed for not more than one

11-15    additional year if the applicant presents to the board sufficient

11-16    evidence of good cause for renewal.

11-17          Sec. 31.  STUDENT REGISTRATION.  (a)  The board may issue a

11-18    student registration certificate to an individual who:

11-19                (1)  holds either:

11-20                      (A)  a bachelor's degree in orthotics and

11-21    prosthetics conferred by a college or university educational

11-22    program recognized and accredited by the Commission on

11-23    Accreditation of Allied Health Education Programs or from a

11-24    practitioner educational program having educational standards that

11-25    are equivalent to or exceed the standards adopted by the Commission

11-26    on Accreditation of Allied Health Education Programs; or

11-27                      (B)  a bachelor's degree and a prosthetic or

11-28    orthotic certificate from a practitioner educational program

11-29    recognized and accredited by the Commission on Accreditation of

11-30    Allied Health Education Programs or from an educational program

11-31    having educational standards that are equivalent to or exceed the

11-32    standards adopted by the Commission on Accreditation of Allied

11-33    Health Education Programs; and

11-34                (2)  is working toward fulfillment of the requirements

11-35    for licensing as a prosthetist, orthotist, or prosthetist

11-36    orthotist.

11-37          (b)  The board may issue a student registration certificate

11-38    to an individual who holds, as an alternative to the qualifications

11-39    required by Subsection (a)(1)(B) of this section, an associate's

11-40    degree, including course work in the anatomical, biological, and

11-41    physical sciences.  This subsection expires January 1, 2005.

11-42          (c)  A student registrant may work only under the direct

11-43    supervision of a licensed orthotist, licensed prosthetist, or

11-44    licensed prosthetist orthotist who is responsible for the acts of

11-45    the student registrant and is licensed in the discipline of the

11-46    clinical residency.

11-47          (d)  A student registration certificate is valid for two

11-48    years from the date issued and may be renewed once for an

11-49    additional two years.

11-50          Sec. 32.  EXAMINATION EXEMPTION.  The board may accept as a

11-51    substitute for the examination requirement proof that the applicant

11-52    for the exemption holds a current license in a state that has

11-53    licensing requirements that are equal to or exceed the requirements

11-54    of this Act.

11-55          Sec. 33.  CONTINUING EDUCATION.  (a)  An applicant for

11-56    renewal of a license shall submit to the board evidence of

11-57    satisfactory completion of the continuing education requirements

11-58    required by the board.

11-59          (b)  The board shall notify each license holder of the

11-60    holder's failure to comply with the board's continuing education

11-61    requirements and shall notify the license holder that if the holder

11-62    does not obtain the required continuing education before the

11-63    expiration of three months after the date the notice was given, the

11-64    board may take any action authorized by this Act concerning the

11-65    suspension or revocation of the holder's license.

11-66          Sec. 34.  DISCIPLINARY PROVISIONS.  (a)  After notice and

11-67    opportunity for a hearing, the board may revoke, suspend, or refuse

11-68    to renew a license issued under this Act on a finding that:

11-69                (1)  the license was obtained by fraud,

 12-1    misrepresentation, or concealment of a material fact;

 12-2                (2)  the person engaged in fraud or deceit in

 12-3    connection with services provided by the person;

 12-4                (3)  the person engaged in unprofessional or unethical

 12-5    conduct;

 12-6                (4)  the person engaged in gross negligence or

 12-7    malpractice; or

 12-8                (5)  the person violated this Act or a rule adopted

 12-9    under this Act.

12-10          (b)  A license revoked under Subsection (a) of this section

12-11    may be reinstated after the first anniversary of the date of the

12-12    revocation by the board on terms the board determines to be

12-13    necessary.

12-14          Sec. 35.  CIVIL PENALTY.  (a)  A person who violates this Act

12-15    is subject to a civil penalty of $200 for the first violation and

12-16    $500 for each subsequent violation.  At the request of the board,

12-17    the attorney general shall bring an action in the name of the state

12-18    to collect a civil penalty under this section.

12-19          (b)  Each day a violation of Section 22 of this Act continues

12-20    is a separate violation for the purpose of this section.

12-21          SECTION 2.  (a)  In making the initial appointments to the

12-22    Texas Board of Orthotics and Prosthetics, the governor shall, not

12-23    later than October 1, 1997, appoint:

12-24                (1)  two members for terms expiring February 1, 1999;

12-25                (2)  two members for terms expiring February 1, 2001;

12-26    and

12-27                (3)  two members for terms expiring February 1, 2003.

12-28          (b)  The initial members of the board appointed under

12-29    Subsection (a) of this section shall have the qualifications

12-30    required by this subsection.  One member must be an orthotist

12-31    certified by the American Board for Certification in Orthotics and

12-32    Prosthetics, Inc., be a resident of this state, and have practiced

12-33    orthotics for the five years preceding the date of appointment.

12-34    Two members must be orthotists who hold a credential issued by the

12-35    Board for Orthotist Certification, are residents of this state, and

12-36    have practiced orthotics for the five years preceding the date of

12-37    appointment.  One member must be a prosthetist orthotist or

12-38    prosthetist certified by the American Board for Certification in

12-39    Orthotics and Prosthetics, Inc., be a resident of this state, and

12-40    have practiced prosthetics or orthotics for the five years

12-41    preceding the date of appointment.  One member must be a

12-42    representative of the public who uses an orthosis.  One member must

12-43    be a representative of the public who uses a prosthesis.

12-44          (c)  A member appointed under this section to a place on the

12-45    board required to be held by a person licensed under Article 8920,

12-46    Revised Statutes, as added by this Act, may continue to serve

12-47    without having the appropriate license until February 1, 1999, by

12-48    which date the person must obtain the required license.

12-49          (d)  The board shall adopt rules under Article 8920, Revised

12-50    Statutes, as added by this Act, not later than October 1, 1998.

12-51          SECTION 3.  (a)  Except as provided by Subsection (b) of this

12-52    section, this Act takes effect September 1, 1997.

12-53          (b)  Sections 22 and 35, Article 8920, Revised Statutes, as

12-54    added by this Act, take effect October 1, 1998.

12-55          SECTION 4.  The importance of this legislation and the

12-56    crowded condition of the calendars in both houses create an

12-57    emergency and an imperative public necessity that the

12-58    constitutional rule requiring bills to be read on three several

12-59    days in each house be suspended, and this rule is hereby suspended.

12-60                                 * * * * *