Athletic Trainers Proposed Administrative Rules

Chapter 110. Athletic Trainers
Proposal Filed: February 10, 2020 – Published in the Texas Register: February 21, 2020
Deadline for Public Comment: March 23, 2020

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The Texas Department of Licensing and Regulation (Department) proposes amendments to existing rules at 16 Texas Administrative Code (TAC), Chapter 110, §§110.21, 110.23, 110.30, and 110.70, regarding the Athletic Trainers Program.

EXPLANATION OF AND JUSTIFICATION FOR THE RULES

The rules under 16 TAC, Chapter 110 implement Texas Occupations Code, Chapter 451, Athletic Trainers.

The proposed rules consist of recommendations made by a workgroup of the Advisory Board of Athletic Trainers and recommendations from staff. The advisory board workgroup focused on improving the pass rate on the Texas written examination, and it recommended listing the domains that may be tested on the written exam in order to provide advance notice and guidance to students and education providers. The workgroup also recommended updating the required coursework and apprenticeship topics for applicants qualifying under §451.153(a)(1) of the Texas Occupations Code, as the proposed new educational requirements are essential knowledge areas for athletic trainers and are already being taught in athletic training programs across the state.

The remainder of the proposed rule changes were recommended by staff. These include clarification and clean-up changes, changing the term of a temporary license, removing the prohibition on athletic trainers using testimonials in advertising, and allowing the Department to accept Board of Certification (BOC) test results from applicants who successfully completed the exam at any time, not just on or after January 1, 2004. The proposed new end date of a temporary license closes a loophole that was inadvertently created when the rules were amended to require an applicant to pass the written exam before the applicant is eligible to take the practical exam. The proposed rules ensure that a temporary license is not valid indefinitely until the license holder passes the written exam. Instead, the temporary license is valid only until the results are released from the first practical exam that takes place at least 30 days after the temporary license was issued. The 30 days are a minimum window of time in which a temporary license holder could pass the written exam and register for the practical exam. This change also aligns with the intent of the existing rule, which is for the temporary license to expire when the results are released for the first practical examination for which the license holder could register. The proposed amendment removing the prohibition on testimonials in advertising is based on guidance from Office of the Attorney General opinions. Finally, the proposed amendment to accept BOC exam results from before 2004 would allow applicants who have extensive athletic training experience to gain Texas licensure without having to take the Texas exam. In one instance, the January 1, 2004 cut-off date presented a delay in licensure for an applicant who had been BOC certified for 17 years, had two graduate degrees, and had worked as athletic training faculty at two universities. The proposed amendment would save applicants such as this the time and expense of taking another examination, thereby eliminating an unnecessary burden and impediment to licensure.

The Advisory Board of Athletic Trainers (Advisory Board) discussed the proposed rules on December 2, 2019, and recommended publishing the proposed rules, except for the amendment that would provide an exam waiver for applicants who successfully passed the BOC exam before 2004. The Advisory Board was concerned that before 2004, the BOC required a two-year apprenticeship, whereas the corresponding Texas apprenticeship required three years. The Department respects the professional opinion of the Advisory Board, particularly in matters of scope of practice and standard of care. In this case, however, the one-year difference in the apprenticeship has been outweighed by at least 16 years of professional experience. Therefore, the Department is publishing the proposed amendment and recommending removal of the January 1, 2004 cut-off date. The Department has consistently focused its efforts on removing regulations that tend to place unnecessary burdens on licensure. In addition to the Department’s own initiatives in this regard, in his October 8, 2019, letter Governor Abbott instructed Texas state agencies to remove unnecessary and overbroad regulations. The proposed rule would remove an unnecessary impediment to Texas licensure for out-of-state licensees.

SECTION-BY-SECTION SUMMARY

The proposed rules amend §110.21 by adding human physiology as a required course area for licensure under Texas Occupations Code §451.153(a)(1), clarifying that an affiliated apprenticeship setting may be any setting where athletic training takes place, and adding administrative management and assessment of injuries as required apprenticeship topics. The proposed rules also remove from subsection (c)(3) the description of an affiliated setting as being in a collegiate, secondary school, or professional setting as that description includes every setting where athletic training might take place.

The proposed rules amend §110.23 by adding a non-exclusive list of the domains that may be tested on the Texas written examination. The proposed rules also remove the January 1, 2004, date by which an applicant must have passed the BOC examination, in order for the BOC exam results to be accepted in lieu of passing the Texas examination.

The proposed rules amend §110.30 by changing the term of a temporary license and making clean-up changes to better describe the process for issuing temporary licenses. The provision for voiding a temporary license is not necessary because the license term does not extend past a point at which it would need to be voided.

The proposed rules amend §110.70 by removing a prohibition on athletic trainers including testimonials in their advertising and renumbering the section accordingly.

FISCAL IMPACT ON STATE AND LOCAL GOVERNMENT

Tony Couvillon, Policy Research and Budget Analyst, has determined that for each year of the first five years the proposed rules are in effect, there are no estimated additional costs or reductions in costs to state or local government as a result of enforcing or administering the proposed rules. The proposed rule changes do not impact Department costs. The activities required to implement the changes are routine program administration tasks such as revising publications and websites or tasks included in work already being performed, such as reviewing license applications for specific course content completion and confirmation of passing the BOC exam. These tasks will not result in increased or decreased Department costs. Local governments do not enforce or administer the proposed rules.

Mr. Couvillon has determined that for each year of the first five years the proposed rules are in effect, there is no estimated increase or loss in revenue to the state or local government as a result of enforcing or administering the proposed rules. The proposed rules do not amend or impact the fees assessed by the licensing program, and local governments do not enforce or administer the proposed rules.

LOCAL EMPLOYMENT IMPACT STATEMENT

Mr. Couvillon has determined that the proposed rules will not affect the local economy, so the agency is not required to prepare a local employment impact statement under Government Code §2001.022. The Athletic Trainers program regulates individuals who provide athletic training services across the state. The proposed rules have no anticipated impact on the local economy because they are not anticipated to increase or decrease employment opportunities for athletic trainers in any area of the state.

PUBLIC BENEFITS

Mr. Couvillon also has determined that for each year of the first five-year period the proposed rules are in effect, the public benefit of listing the Texas written exam domains will be providing additional notice to students and educators of topics which may be tested. This may lead to more students being able to pass the written examination and enter the profession earlier. Additionally, the rule changes updating the required coursework and apprenticeship topics may result in improved apprenticeship competency levels and higher exam scores.

The public benefit of the clean-up and clarification changes will be enhanced understanding of the Athletic Trainer rules. In particular, the clarification regarding affiliated apprenticeship settings may lead to more students choosing to gain apprenticeship hours at affiliated settings, and more places partnering with colleges and universities to become affiliated apprenticeship settings. This could, in turn, expand the breadth of experience and knowledge gained by athletic training students.

The public benefit of accepting successful BOC exam results from prior to January 1, 2004, is that applicants who have already demonstrated mastery of athletic training concepts through the BOC exam and who likely have 15 years or more of athletic training experience will not have to re-test. This reduces barriers to entry, making more athletic training services available to the public and allowing applicants to enter the profession in Texas more quickly. Additionally, this change will save these applicants the cost of the Texas exam fee.

The public benefit of limiting the term of a temporary license will be ensuring public health and safety. Specifically, it will ensure that persons who have not yet demonstrated mastery of athletic training through the written exam will not be allowed to practice athletic training indefinitely.

The public benefit of removing the prohibition on athletic trainers using testimonials in advertising will be providing the public with another source of information regarding the services of athletic trainers, and providing athletic trainers with another way to advertise, if they so choose.

PROBABLE ECONOMIC COSTS TO PERSONS REQUIRED TO COMPLY WITH PROPOSAL

Mr. Couvillon has determined that for each year of the first five-year period the proposed rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. The rules do not impose additional fees upon licensees, nor do they create requirements that would cause licensed athletic trainers to expend funds for training, staff, equipment, supplies, infrastructure, etc. Additionally, changes to required coursework and apprenticeship topics merely update the requirements to those already being taught in colleges and university athletic training programs.

FISCAL IMPACT ON SMALL BUSINESSES, MICRO-BUSINESSES, AND RURAL COMMUNITIES

There will be no adverse effect on small businesses, micro-businesses, or rural communities as a result of the proposed rules. Since the agency has determined that the proposed rule will have no adverse economic effect on small businesses, micro-businesses, or rural communities, preparation of an Economic Impact Statement and a Regulatory Flexibility Analysis, as detailed under Texas Government Code §2006.002, is not required.

It is unknown how many licensed athletic trainers can be classified as small or micro-businesses. Most athletic trainers are employed by public and private colleges, universities, high schools, and organized professional or amateur sports teams and leagues. However, athletic trainers classified as small or micro-businesses would not be adversely impacted by the rule changes. The changes are clarifications of existing requirements and prohibitions and do not impose additional fees upon licensees or create requirements that would cause licensees to expend additional funds.

The proposed rules will have no adverse economic effect on rural communities because the proposed rules will not decrease the availability of athletic training services in rural communities, nor will they increase the cost of athletic training services in rural communities.

ONE-FOR-ONE REQUIREMENT FOR RULES WITH A FISCAL IMPACT

The proposed rules do not have a fiscal note that imposes a cost on regulated persons, including another state agency, a special district, or a local government. Therefore, the agency is not required to take any further action under Government Code §2001.0045.

GOVERNMENT GROWTH IMPACT STATEMENT

Pursuant to Government Code §2001.0221, the agency provides the following Government Growth Impact Statement for the proposed rules. For each year of the first five years the proposed rules will be in effect, the agency has determined the following:

1. The proposed rules do not create or eliminate a government program.

2. Implementation of the proposed rules does not require the creation of new employee positions or the elimination of existing employee positions.

3. Implementation of the proposed rules does not require an increase or decrease in future legislative appropriations to the agency.

4. The proposed rules do not require an increase or decrease in fees paid to the agency.

5. The proposed rules do not create a new regulation.

6. The proposed rules do expand or limit an existing regulation. They do not repeal an existing regulation. Specifically, the proposed rules expand coursework and apprenticeship requirements in §110.21 and reduce the amount of time a temporary license may be held according to §110.30. The proposed rules limit requirements related to BOC exam dates in §110.23 and testimonials in advertising in §110.70.

7. The proposed rules do not increase or decrease the number of individuals subject to the rule's applicability.

8. The proposed rules do not positively or adversely affect this state's economy.

TAKINGS IMPACT ASSESSMENT

The Department has determined that no private real property interests are affected by the proposed rules and the proposed rules do not restrict, limit, or impose a burden on an owner’s rights to his or her private real property that would otherwise exist in the absence of government action. As a result, the proposed rules do not constitute a taking or require a takings impact assessment under Government Code §2007.043.

PUBLIC COMMENTS

Comments on the proposed rules may be submitted to Dalma Sotero, Assistant General Counsel, Texas Department of Licensing and Regulation, P.O. Box 12157, Austin, Texas 78711, or facsimile (512) 475-3032, or electronically: erule.comments@tdlr.texas.gov . The deadline for comments is 30 days after publication in the Texas Register.

STATUTORY AUTHORITY

The proposed rules are proposed under Texas Occupations Code, Chapter 51 and Chapter 451, which authorize the Texas Commission of Licensing and Regulation, the Department’s governing body, to adopt rules as necessary to implement these chapters and any other law establishing a program regulated by the Department.

The statutory provisions affected by the proposed rules are those set forth in Texas Occupations Code, Chapters 51 and 451. No other statutes, articles, or codes are affected by the proposed rules.

§110.21. License Requirements.

(a) Applicants qualifying under the Act, §451.153(a)(1), shall have:

(1) a baccalaureate or post-baccalaureate degree, which includes at least 24 hours of combined academic credit from each of the following course areas:

(A) human anatomy and human physiology;

(B) health, disease, nutrition, fitness, wellness, emergency care, first aid, or drug and alcohol education;

(C) kinesiology or biomechanics;

(D) physiology of exercise;

(E) athletic training, sports medicine, or care and prevention of injuries;

(F) advanced athletic training, advanced sports medicine, or assessment of injury; and

(G) therapeutic exercise, therapeutic rehabilitation, or therapeutic modalities; and

(2) an apprenticeship in athletic training meeting the following requirements:

(A) the program shall be under the direct supervision of and on the same campus as a Texas licensed athletic trainer, or if out-of-state, the college or university's certified or state licensed athletic trainer;

(B) the apprenticeship must be a minimum of 1,800 hours. It must be based on the academic calendar and must be completed during at least five fall and/or spring semesters. Hours in the classroom do not count toward apprenticeship hours;

(C) the hours must be completed in college or university intercollegiate sports programs. A maximum of 600 hours of the 1,800 hours may be accepted from an affiliated setting which the college or university's athletic trainer has approved. An affiliated setting may be any setting where athletic training takes place. No more than 300 hours may be earned at one affiliated setting. These hours must be under the direct supervision of a licensed physician, licensed or certified athletic trainer, or licensed physical therapist;

(D) 1,500 hours of the apprenticeship shall be fulfilled while enrolled as a student at a college or university; and

(E) the apprenticeship must offer work experience in a variety of sports. It shall include instruction by a certified or state-licensed athletic trainer in prevention of injuries, emergency care, rehabilitation, [ and ] modality usage , administrative management, and assessment of injuries.

(b) (No change.)

(c) Applicants qualifying under the Act, §451.153(a)(2) or (a)(3), shall have a baccalaureate or post-baccalaureate degree or a state-issued certificate in physical therapy or a baccalaureate or post-baccalaureate degree in corrective therapy with at least a minor in physical education or health. Applicants who hold such degrees must complete three semester hours of a basic athletic training course from an accredited college or university. An applicant shall also complete an apprenticeship in athletic training meeting the following requirements.

(1) The program shall be a minimum of 720 hours. It must be based on the academic calendar and must be completed during at least three fall and/or spring semesters. The hours must be under the direct supervision of a college or university's Texas licensed athletic trainer or if out-of-state, the college or university's certified or state-licensed athletic trainer. The apprenticeship includes a minimum of 360 hours per year. Hours in the classroom do not count toward apprenticeship hours.

(2) Actual working hours shall include a minimum of 20 hours per week during each fall semester. A fall semester includes pre-season practice sessions. The apprenticeship must offer work experience in a variety of sports.

(3) The apprenticeship must be completed in a college or university's intercollegiate sports program. A maximum of 240 hours of the 720 hours may be earned at an [ a collegiate, secondary school, or professional ]affiliated setting which the college or university's athletic trainer has approved. An affiliated setting may be any setting where athletic training takes place. No more than 120 hours may be earned at one affiliated setting.

(d) – (h) (No change.)

§110.23. Examination for Licensure .

(a) (No change.)

(b) The examination required under the Act, §451.156 consists of a written examination, a practical examination, and a jurisprudence examination prescribed by the department.

(1) An applicant must pass the written examination prior to taking the practical examination.

(2) An applicant must complete the jurisprudence examination no more than six months prior to the date of application.

(3) The written examination may test subject areas including, but not limited to:

(A) injury and illness prevention and wellness promotion;

(B) examination and assessment;

(C) immediate and emergency care;

(D) therapeutic intervention; and

(E) healthcare administration and professional responsibility.

(c) - (l) (No change.)

(m) If an applicant has successfully completed the examination administered by the Board of Certification, Inc. (BOC)[ on or after January 1, 2004 ], the applicant shall not be required to complete the state examination described in subsections (a) - (l)[ , unless the applicant has previously held a license issued by the department ]. The applicant must furnish to the department a copy of the test results indicating that the applicant passed the examination.

[ (n) If an applicant has completed the examination administered by the Board of Certification, Inc. (BOC) before January 1, 2004, the applicant shall be required to complete the state examination described in subsections (a) - (l). ]

§110.30. Temporary License.

(a) (No change.)

(b) The temporary license entitles an applicant to perform the activities of an athletic trainer until the results are released from the first practical examination administered at least 30 days after the temporary license is issued. [ results of the first practical examination, which the applicant is eligible to take, are released. ]

(c) Except as provided in subsection (d), an applicant shall not be eligible for another temporary license after the initial temporary license is issued. [ An applicant who failed an examination administered by the department, shall not be eligible for a temporary license. If a temporary license has previously been issued, it shall be voided and the applicant shall not be eligible for another temporary license. ]

(d) (No change.)

§110.70. Standards of Conduct.

(a) - (p) (No change.)

(q) A licensee shall not use advertising that is false, misleading, or deceptive or that is not readily subject to verification. False, misleading, or deceptive advertising or advertising that is not readily subject to verification includes advertising that:

(1) makes a material misrepresentation of fact or omits a fact necessary to make the statement as a whole not materially misleading;

(2) makes a representation likely to create an unjustified expectation about the results of a health care service or procedure;

(3) compares a health care professional's service with another health care professional's service, unless the comparison can be factually substantiated;

[ (4) contains a testimonial; ]

(4) [ (5) ]causes confusion or misunderstanding as to the credentials, education, or licensure of a health care professional;

(5) [ (6) ]advertises or represents that health care insurance deductibles or copayments may be waived or are not applicable to health care services to be provided, if the deductibles or copayments are required;

(6) [ (7) ]advertises or represents that the benefits of a health benefit plan will be accepted as full payment, when deductibles or copayments are required;

(7) [ (8) ]makes a representation that is designed to take advantage of the fears or emotions of a particularly susceptible type of patient; or

(8) [ (9) ] advertises or represents in the use of a professional name, a title or professional identification, that is expressly or commonly reserved to or used by another profession or professional.

(r) - (y) (No change.)

REVIEW BY AGENCY COUNSEL

The agency certifies that the proposed rules have been reviewed by legal counsel and found to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 10, 2020.


Brad Bowman
General Counsel
Texas Department of Licensing and Regulation