Agency Relocation, Telehealth, Glaucoma Rules Update

TEXAS OPTOMETRY BOARD August 2022

Volume 1, Issue 1

Newsletter

A YEAR IN REVIEW

Inside this Issue Agency Relocation

Rules Update ........................ 2 

Practice Reminders .............. 3

 Complaint Information ......... 4

Licensing Update .................. 5 

Special points of interest

 Practice Reminders--Initial Patient

Exams.  Glaucoma Complaints & Investigations. The Texas Optometry Board has relocated to its new office in the brand new George H.W. Bush Building, at 1801 Congress Avenue in Austin, Texas. The 14-story, George H. W.  Disciplinary Actions & The National Bush State Office Building , includes 603,000 SF of office and 1,665 parking spaces above Practitioner Data Bank ground and below ground stands at the gateway to the reimagined Texas Capitol Com-

 88th Legislative Session--January 2023. plex. The new location is also home to other health occupation regulatory boards along with the Racing and Lottery Commissions. Complaints Resulting From Glaucoma After months and months of long meetings, including some special meetings, collabora- tion with the Texas Medical Board and many discussions with stakeholders related to SB993 of the 87th Regular Legislative Session, rules concerning complaints resulting from glaucoma treatment were effectively final and implemented as of May 31, 2022. Specifically, new Board Rules 277.13 Complaints Resulting From Glaucoma Treatment-- Investigation Process and 277.14 Complaints Resulting From Glaucoma Treatment--Use of Case Review Consultants and Expert Panel outline and define the new investigation process for complaints resulting from glaucoma treatment and/or failure to refer cases for glaucoma treatment. The Board is mandated to work with physicians, specializing in ophthalmology, and therapeutic optometrists certified as Optometric Glaucoma Special- ists to carry out the established process.

Telehealth

Telehealth remains a hot topic in the community and at the Texas Optometry Board. The Board supports the use of telehealth so long as the laws and rules of Optometry Act are met in the best interest of public protection. The Board has opined that though telehealth is a way for licensees to provide services it may not be appropriate for every type of pa- tient or visit. If you are a licensee rendering telehealth services especially to new pa- tients, make sure you are familiar with Texas laws and rules that require certain care components.

ARE YOU READY FOR RENEWAL SEASON?

Pursuant to Rule 275.3, all licensees are will not authorize renewal of a license required to use the CE Broker digital unless you are 100% compliant with CE platform for CE reporting and compli- hours in CE Broker. ance in conjunction with license renew- Finally, please note, the Board is aware als. Rule 275.3 further states that licen- of misinformation being posted on other sees are responsible for the accuracy of public platforms regarding the agency's the account. The TOB only requires a transition to CE Broker. Licensees are free, basic, account for license renewal encouraged to contact the agency or CE purposes. Broker's Customer Service for accurate CE Broker provides a comprehensive information related to the Board's re- course search, allows you to track and quirement for reporting and tracking monitor completed hours and has cus- CE requirements. tomer service available to assist you

Monday through Friday, 7:00 a.m. to 7:00 p.m. via email, chat or telephone. Do not wait to sign up for your CE Bro- ker account! The license renewal system

The 2022 renewal season will open on Monday, October 17, 2022. Refer to Board Rule 275.2 for continuing education requirements. Remember--the professional responsibility course is an annual requirement! Rules Update

BOARD MEETING RECAP Amended 22 TAC 275.1 General Requirements - Amended Rule 275.1 modernizes Since September 2021, the TOB the way the TOB approves continuing education course providers and courses. The has held four regular board Board continues to reserve the right to review and approve providers that are not meetings and one special meet- automatically granted approval through the amended rule. The Board also continues ing. Board meeting agendas and to reserve the right to reject any course meeting minutes can be found at : https://tob.texas.gov/board- Amended 22 TAC 273.5 Clinical Instruction and Practice - Limited License for Clini-meetings/ cal Faculty.--Amended Rule §273.5 replaced "Council on Optometric Education of the American Optometric Association (COEAOA)" with "Accreditation Council on EMAIL ADDRESSES Optometric Education (ACOE)". Amended §273.5(g)(1)-(2) removed the "in-state" college of optometry requirement. If you are not receiving the quar- terly email updates or other New 22 TAC 277.13 Complaints Resulting From Glaucoma Treatment - Investiga- notices, you may need to update tion Process. your email address. Updates This new rule was adopted pursuant to SB993 of the 87th Regular Legislative Ses-may be submitted to in- sion. This new rule established the investigation process for all complaints received fo@tob.texas.gov. Note, do not by the agency resulting from the treatment of glaucoma after September 1, 2021. use a general office email for all SB993 required collaboration with the Texas Medical Board for this rulemaking pro-staff cess. 2023--CPR or BLS REQUIRED New 22 TAC 277.14 Complaints Resulting From Glaucoma Treatment - Use of Case . Review Consultant and Expert Panel. After January 1, 2023, all appli- This rule was adopted pursuant to SB993 of the 87th Regular Legislative Session. cants and licensees will be re- This new rule established the selection process for the Case Review Consultant and quired to show proof of a CPR or Expert Panel as required by SB993 of the 87th Regular Legislative Session. SB993 BLS certification for initial or renewal of licensure. required collaboration with the Texas Medical Board for this rulemaking process.  New 22 TAC 273.17 Emergency Management.--Effective January 1, 2023, all initial applicants for licensure shall provide proof of successful completion of CPR or BLS course prior to receiving a license. Also, effective, January 1, 2023, proof of comple- tion of CPR or BLS is required for renewal of licensure. 2

FRAUD ALERT! As early as May 2020, AG Pax- ton warned "all Texans should be aware of unsolicited calls and emails from scammers imperson- ating leaders in their govern- ment. " Currently, licensees still randomly experience this issue. TOB urges you to be on the look- out for unexpected scam phone calls from anyone claiming to be from of our office.

TOB staff will NEVER:

 Threaten to bring in local

police, FBI, immigration officers or other law- enforcement to have you arrested for not paying.

 Pressure you to make a

payment. PRACTICE REMINDERS

INITIAL PATIENT EXAMINATIONS

 Ask for personal infor-Texas licensees are required to abide by the laws and rules of the Texas Optometry Act when mation not directly related treating Texas patients regardless of the type of visit (in-person or telehealth). Here are a few to an agency transaction.

practice reminders when dealing with initial patient exams according to the laws and rules of the state:

 Ask for money outside of Sec. 351.353 INITIAL EXAMINATION OF PATIENT - To ensure adequate examination of a routine transactions made patient for whom a prescription is issued, the components of this section are required when through Texas.gov or our issuing a prescription to a new patient. secure vendors.

 Ask for bank account infor-Sec. 351.453 EXAMINATION REQUIRED FOR PRESCRIPTION. An optometrist or therapeu-

tic optometrist may not sign, or cause to be signed, an ophthalmic lens prescription without mation. first personally examining the eyes of the person for whom the prescription is made. Report suspected fraud to the Sec. 351.360. PROFESSIONAL STANDARD OF THERAPEUTIC OPTOMETRIST. A therapeu- Texas Attorney General's Con- tic optometrist, including an optometric glaucoma specialist, is subject to the same standard of sumer Protection Division by calling toll-free 1-800-621-0508 professional care and judgment as a person practicing as an ophthalmologist. or by filing an online complaint Board Rule 279.1 CONTACT LENS EXAMINATION. This rule specifies what a licensee must at hps:// personally do and what tasks can be delegated during a contact lens examination. Note, pursu- www.texasaorneygeneral.gov/

consumer‐protecon/file‐consumer‐ant to this rule, if a licensee cannot complete requirements of 351.353, it must be noted in the

complaint.chart.

Board Rule 279.3 SPECTACLE EXAMINATION. This rule specifies what a licensee must per- sonally do and what tasks can be delegated during a spectacle examination. Note, pursuant to this rule, if a licensee cannot complete requirements of 351.353, it must be noted in the chart. Board Rule 277.7 PATIENT RECORDS. This rule requires that each patient chart shall con- tain specific information. Remember, if it is not in the chart--it did not happen! Board Rule 279.16 TELEHEALTH SERVICES. This rule requires informed telehealth consent. Optometrists or therapeutic optometrists that use telehealth services must provide notice to patients regarding how they may file a complaint prior to rendering telehealth services. This rule states a telehealth service is subject to the same standard of care that would apply to the provision of the same health care service or procedures in an in-person setting.

Glaucoma Complaints & Investigations Attorney General Opinions

Since September 1, 2021, pursuant to Sec- The licensee in Case Number 2022-00025 On March 30, 2020, the Office of tion 351.3581(f)(1), the TOB has been re- has entered an Agreed Settlement Order the Attorney General issued quired to maintain a publicly available list (Order) with the Board as of August 9, Opinion KP-0297 regarding the regarding the number of complaints filed 2022. The Order revoked the glaucoma authority of the TOB under with the Board regarding the treatment of certification of the licensee and also set section 351.005 of the Occupa-patients for glaucoma by therapeutic op- other conditions in order to maintain a tions Code over activities of tometrists and the disposition of those therapeutic license. A fine was also as-licensed optometrists employed complaints. The list is updated quarterly sessed. by physicians and retailers of after each board meeting. ophthalmic goods leasing space Case Number 2022-00042 is pending an to physicians. In KP-0297, At-As of the date of this Newsletter publica- informal settlement conference with the torney General Paxton pointed Investigation-Enforcement Committee of tion and since September 1, 2021, the out that 351.005 is not a blanket agency has investigated two cases directly the Board. A final disposition is expected exception from the Texas Optom-resulting from the treatment of glaucoma. in or about September 2022. etry Act in its entirety. Both cases were agency initiated-- meaning, the agency became aware of At the May 2022 meeting, the issues and investigated without a patient Board voted unanimously to and/or consumer complaint. Both cases seek a subsequent AG opinion underwent the investigation process out-due to an increased trend in the lined in new rules 277.13 and 277.14 types of complaints being re-which requires a physician ophthalmolo-ceived at the agency and in the gist and expert panel reviews. best interest of public protection. The request was filed on May 31,

1. Most opinions are is- Disciplinary Actions & The National Practitioner Data sued within 180 days of the Bank request, but the amount of time required may vary depending on the volume of research required and the number and length of Disciplinary actions are displayed with a li- even constitute a reason for emergency action commentaries and briefs re- cense when an online verification search is against a license. ceived. performed. The Board is federally mandated The agency conducts an annual check of licen- to report all disciplinary actions to the Nation- sees in the NPDB database. All initial appli- al Practitioner Data Bank (NPDB). Professional Recovery Network cants are also required to provide a self-query The NPDB is an online repository of reports report for initial Texas licensure. The TOB continues to contract containing information on medical malpractice with the Professional Recovery Network to offer impaired op- payments and certain adverse actions related tometrists and optometry stu- to health care practitioners, providers, and dents a pathway to confidential suppliers. It was originally established by recovery as long as treatment Congress in 1986 to prevent practitioners from progresses in a satisfactory man- moving state to state without disclosure or ner. Impairment includes sub- discovery of previous damaging performance. stance abuse as well as mental If the TOB receives a report from the NPDB, it health issues. may trigger an official investigation or may Colleagues of impaired optome- trists may also use this service to assist in finding help for the impaired professional. Information is available on the Board's website or the impaired professional or student may all the Program directly at 1-800-

4727-5152.

Complaints, Investigations & Inspections

The Board takes seriously its core duty to protect the public billing statements, lab coats, and signage. Check it out-- through licensing qualified individuals, regulation of licensees https://statutes.capitol.texas.gov/Docs/OC/htm/ and enforcement of the Optometry Act. Annually the agency OC.104.htm. investigates approximately more than 100 complaints regard-

 Some applicants undergo a criminal background check ing licensees, conducts at least 63 annual compliance inspec-

investigation based on fingerprint results. However, we tions, performs a variety of applicant investigations and also have recently experienced issues with applicants publicly handles reports of substance abuse or mental impairment. The displaying information on websites like "LinkedIn" where-following are a few examples of agency actions over the last in they assert they have passed the Texas law exam and year: are a "licensed optometrist" prior to receiving a license;

 The agency investigated a patient's complaint involving and, we are actively investigating a matter in which an

telehealth services and concerns over an inaccurate exam applicant was practicing optometry prior to being li- which led to an issue with a prescription. The licensee censed. entered an Agreed Settlement Order which imposed a

 Since September 1, 2021, the Board ordered two licensees probated suspension for a period of six months, a standard

to the Professional Recovery Network and required partici-of care chart review, retaking of the Texas Jurisprudence pation in the program to maintain licensure. exam and a fine.

 Since September 2021, the Board has filed five complaints  The Board Investigator conducted inspections that re-

at the Southern Office of Administrative Hearings. These vealed violations of the Healing Arts Identification Act. matters were all related to standard of care issues and Specifically, the Healing Arts Identification Act mandates could not be settled. Therefore, the Board pursued litiga-how an optometrist or therapeutic optometrist shall pro- tion. fessionally designate a name on things like business cards,

HOW DO YOU LIKE THE NEW TOB WEBSITE? The website was updated to be more intuitive and user friendly. Don't see something?- Contact info@tob.texas.gov Update from the Licensing Division

Monthly Jurisprudence Exams National Practitioner Data Bank self-query report--both issues delay the agency's ability to process a file for licen-In July 2021, the Board began offering monthly Jurispru- sure. Agency staff work with applicants to resolve the is-dence examinations. In previous years, the Board only of- sues as timely as possible. fered the Jurisprudence exam six times per year. While this has increased the availability of the exam, it has creat- Current Licensing Statistics (as of July 2022) ed additional work for the Licensing Division. As always, Total Licensees: 5,155 (4,714 active; 438 inactive; 3 retired) we will strive to continue to process licensing information

consistently and timely. Total OGS: 3,876 ((3,755 active; 120 inactive, 1 retired)

Updated Applications  Licensure applications, including glaucoma applications, were updated in July 2022. The new forms are required as of August 1, 2022. Checklists Provided to Applicants Did you know that the Licensing Division provides check- lists to applicants for their use throughout the process? The checklists are customized based on the applicant and de- tails what is needed along with what is missing. Applicants also receive a "missing items" email or letter as well. Licensure Delays Sometimes Happen The agency continues to experience issues that cause licen- sure delays when working with some applicant files that are outside of our control. For instance, applicants often do not send the required documentation needed for the process such as an official transcript with proof of degree or the 5

88th Legislative Session--January 2023 Contact Info:

The 88th Legislative Session is set to begin on January 10, 2023 and end on May 29, info@tob.texas.gov

1. Every two years, in advance of the legislative session, Texas agencies are re- quired to file a Legislative Appropriations Request that includes specific requests for licensinginfo@tob.texas.gov funding from the Legislature. The agency recently filed its request but it should be noted that it may be amended throughout the process. The agency specifically re-www.tob.texas.gov quested additional funding for the following:

512-305-8500  Funds to increase staff salaries;

 Funds to create a budget for staff development;  Funds related to the enhancement of the enforcement program (funds requested

for expert witnesses related to glaucoma cases and SOAH witnesses for general standard of care cases); and,

 Funds related to IT advancements and technology.