(a) As a prerequisite to the registration of a physician's permit a physician must complete 48 credits of continuing medical education (CME) every 24 months. CME credits must be completed in the following categories and topics:
  (1) At least 24 credits every 24 months are to be from formal courses that are:
    (A) designated for AMA/PRA Category 1 credit by a CME sponsor accredited by the Accreditation Council for Continuing Medical Education or a state medical society recognized by the Committee for Review and Recognition of the Accreditation Council for Continuing Medical Education;
    (B) approved for prescribed credit by the American Academy of Family Physicians;
    (C) designated for AOA Category 1-A credit required for osteopathic physicians by an accredited CME sponsor approved by the American Osteopathic Association;
    (D) approved by the Texas Medical Association based on standards established by the AMA for its Physician's Recognition Award; or
    (E) approved by the board for medical ethics and/or professional responsibility courses only.
  (2) At least two of the 24 formal credits of CME which are required by paragraph (1) of this subsection must involve the study of medical ethics and/or professional responsibility. Whether a particular credit of CME involves the study of medical ethics and/or professional responsibility shall be determined by the organizations which are enumerated in paragraph (1) of this subsection as part of their course planning.
  (3) At least two of the 24 formal credits of CME which are required by paragraph (1) of this subsection must involve the study of the following topics:
    (A) best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical therapy, psychotherapy, and other treatments;
    (B) safe and effective pain management related to the prescription of opioids and other controlled substances, including education regarding:
      (i) standards of care;
      (ii) identification of drug-seeking behavior in patients; and
      (iii) effectively communicating with patients regarding the prescription of an opioid or other controlled substances; and
    (C) prescribing and monitoring of controlled substances.
    (D) For physicians practicing in pain clinics, the hours required under this subparagraph shall be credited towards the 10 hours of required continuing medical education related to pain management required under 22 TAC Chapter 195.4(e), relating to Operation of Pain Management Clinics.
    (E) The hours required under this subparagraph may be designated for medical ethics or professional responsibility credit for purposes of compliance with paragraph (2) of this subsection.
  (4) As part of the 24 formal credits of CME required under paragraph (1) of this subsection, a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission must be completed. The course shall be designated by the board for medical ethics or professional responsibility credit for the purposes of compliance with paragraph (2) of this subsection.
  (5) The remaining 24 credits for the 24-month period may be composed of informal self-study, attendance at hospital lectures, grand rounds, or case conferences not approved for formal CME, and shall be recorded in a manner that can be easily transmitted to the board upon request.
  (6) A physician who performs sexual assault forensic examinations must have basic forensic evidence collection training or the equivalent education. A physician who completes a CME course in forensic evidence collection that:
    (A) meet the requirements described in paragraph (1)(A) - (C) of this subsection; or
    (B) is approved or recognized by the Texas Board of Nursing, is considered to have the basic forensic evidence training required by the Health and Safety Code, §323.0045.
  (7) A physician may complete one credit of formal continuing medical education, as required by paragraph (1) of this subsection, for each hour of time spent up to 12 hours, based on participation in a program sponsored by the board and approved for CME credit for the evaluation of a physician competency or practice monitoring.
  (8) A physician whose practice includes the treatment of tick-borne diseases should complete CME in the treatment of tick-borne diseases that meet the requirements described in paragraph (1)(A) - (E) of this subsection.
(b) A physician must report on the registration permit application if she or he has completed the required CME during the previous 2 years.
  (1) A physician may carry forward CME credits earned prior to a registration report which are in excess of the 48-credit biennial requirement and such excess credits may be applied to the following years' requirements, except that excess credits may not be applied to requirements set forth under paragraphs (2) and (3) of subsection (a).
  (2) A maximum of 48 total excess credits may be carried forward and shall be reported according to the categories set out in subsection (a) of this section, subject to the limitations established under paragraph (1) of this subsection.
  (3) Excess CME credits of any type may not be carried forward or applied to a report of CME more than two years beyond the date of the registration following the period during which the credits were earned.
(c) A physician shall be presumed to have complied with this section if in the preceding 36 months the physician becomes board certified or recertified by a specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association Bureau of Osteopathic Specialists (AOA). This provision exempts the physician from all CME requirements, including the requirement for two credits involving the study of medical ethics and/or professional responsibility, as outlined in subsection (a)(2) of this section. This exemption is valid for one registration period only.
(d) Maintenance of Certification, Presumption of Compliance.
  (1) Except as otherwise provided in this subsection, a physician shall be presumed to have complied with subsection (a)(1) and (5) of this section if the physician is meeting the Maintenance of Certification (MOC) program requirements set forth by a specialty or subspecialty member board of the ABMS or the Osteopathic Continuous Certification (OCC) program requirements set forth by the AOA, and the member board's MOC or OCC program mandates completion of CME credits that meet the minimum criteria set forth under subsection (a)(1) of this section.
  (2) Notwithstanding paragraph (1) of this subsection, a physician's compliance with an MOC program will not be credited toward the requirements set forth under paragraphs (2), (3), and (4) of subsection (a).
(e) A physician may request in writing an exemption for the following reasons:
  (1) the physician's catastrophic illness;
  (2) the physician's military service of longer than one year's duration outside the state;
  (3) the physician's medical practice and residence of longer than one year's duration outside the United States; or
  (4) good cause shown submitted in writing by the physician, which provides satisfactory evidence to the board that the physician is unable to comply with the requirement for CME.
(f) Exemptions are subject to the approval of the executive director or medical director and must be requested in writing at least 30 days prior to the expiration date of the permit.
(g) A temporary exemption under subsection (d) of this section may not exceed one year but may be renewed, subject to the approval of the board.
(h) Subsection (a) of this section does not apply to a physician who is retired and has been exempted from paying the registration fee under §166.3 of this title (relating to Retired Physician Exception).
(i) This section does not prevent the board from taking board action with respect to a physician or an applicant for a license by requiring additional credits of CME or of specific course subjects.
(j) The board may require written verification of both formal and informal credits from any physician within 30 days of request. Failure to provide such verification may result in disciplinary action by the board.
(k) Residency or Fellowship Training Completion, Presumption of Compliance.
  (1) Except as otherwise provided in this subsection, physicians in residency/fellowship training or who have completed such training within six months prior to the registration expiration date will satisfy the requirements of subsection (a)(1) and (2) of this section by their residency or fellowship program.
Cont'd...
(2) Notwithstanding paragraph (1) of this subsection, completion of training in a residency or fellowship within six months prior to the registration expiration date will not be credited toward requirements set forth under paragraphs (3) and (4) of subsection (a).
(l) CME credits which are obtained during the 30-day grace period after the expiration of the physician's permit to comply with the CME requirements for the preceding two years, shall first be credited to meet the CME requirements for the previous registration period and then any additional credits obtained shall be credited to meet the CME requirements for the current registration period.
(m) A false report or false statement to the board by a physician regarding CME credits reportedly obtained shall be a basis for disciplinary action by the board pursuant to the Medical Practice Act (the "Act"), Tex. Occ. Code Ann. §§164.051 - 164.053. A physician who is disciplined by the board for such a violation may be subject to the full range of actions authorized by the Act including suspension or revocation of the physician's medical license, but in no event shall such action be less than an administrative penalty of $500.
(n) Administrative penalties for failure to timely obtain and report required CME credits may be assessed in accordance with §§187.75 - 187.82 of this title (relating to Imposition of Administrative Penalty) and §190.14 of this title (relating to Disciplinary Sanction Guidelines).
(o) Unless exempted under the terms of this section, failure to obtain and timely report the CME credits on a registration permit application shall subject the physician to a monetary penalty for late registration in the amount set forth in §175.3 of this title (relating to Penalties). Any administrative penalty imposed for failure to obtain and timely report the 48 credits of CME required for a registration permit application shall be in addition to the applicable penalties for late registration as set forth in §175.3 of this title.
(p) A physician, who is a military service member, may request an extension of time, not to exceed two years, to complete any continuing medical education requirements.

Source Note: The provisions of this §166.2 adopted to be effective December 24, 1993, 18 TexReg 9189; amended to be effective August 2, 1995, 20 TexReg 5240; amended to be effective January 12, 1996, 21 TexReg 106; amended to be effective December 12, 1996, 21 TexReg 11785; amended to be effective December 23, 1997, 22 TexReg 12490; amended to be effective March 4, 1998, 23 TexReg 1949; amended to be effective May 9, 1999, 24 TexReg 3346; amended to be effective May 21, 2000, 25 TexReg 4349; amended to be effective September 21, 2000, 25 TexReg 9217; amended to be effective October 17, 2001, 26 TexReg 8069; amended to be effective January 6, 2002, 26 TexReg 10865; amended to be effectiveSeptember 19, 2002, 27 TexReg 8769; amended to be effective November 30, 2003, 28 TexReg 10483; amended to be effective June 29, 2006, 31 TexReg 5099; amended to be effective August 10, 2008, 33 TexReg 6133; amended to be effective January 20, 2009, 34 TexReg 337; amended to be effective May 6, 2009, 34 TexReg 2675; amended to be effective November 29, 2009, 34 TexReg 8531; amended to be effective May 13, 2012, 37 TexReg 3408; amended to be effective January 20, 2014, 39 TexReg 278; amended to be effective March 16, 2015, 40 TexReg 1379; amended to be effective July 9, 2015, 40 TexReg 4353; amended to be effective January 24, 2016, 41 TexReg 620; amended to be effective July 12, 2020, 45 TexReg 4520