(a) Except as otherwise provided in this section, an individual applying for a respiratory care practitioner certificate issued by the advisory board must:
  (1) submit an application on forms approved by the advisory board;
  (2) pay the appropriate application fee as prescribed by the advisory board and as set forth in §175.1 of this title (relating to Application and Administrative Fees);
  (3) successfully complete an approved four-year high school course of study or the equivalent as determined by the appropriate educational agency;
  (4) successfully complete an educational program for respiratory care practitioners accredited by the Commission on Accreditation for Respiratory Care (CoARC) or other accrediting body approved by the advisory board, and hold a valid and current certification issued by the NBRC;
  (5) certify that the applicant is mentally and physically able to function safely as a respiratory care practitioner;
  (6) not have a license, certification, or registration as a respiratory care practitioner in this state or from any other licensing or certifying authority that is currently revoked or on suspension or the applicant is not subject to probation or other disciplinary action for cause;
  (7) not have any proceeding that has been instituted against the applicant for the restriction, cancellation, suspension, or revocation of a certificate, permit, license, or other authority to practice respiratory care in any state, territory, Canadian province, country, or uniformed service of the United States in which it was issued;
  (8) not have pending any prosecution against applicant in any state, federal, or international court for any offense that under the laws of this state is a felony, a misdemeanor that involves the practice of respiratory care, or a misdemeanor that involves a crime of moral turpitude;
  (9) be of good professional character as defined under §186.2(15) of this chapter (relating to Definitions);
  (10) submit a complete and legible set of fingerprints, on a form prescribed by the Medical Board, for the purpose of obtaining criminal history record information, as required by §604.1031 of the Act;
  (11) submit to the board any other information the board considers necessary to evaluate the applicant's qualifications;
  (12) meet any other requirement established by rules adopted by the advisory board;
  (13) pass an independently evaluated respiratory care practitioner examination prepared by the NBRC; and
  (14) pass the jurisprudence examination ("JP exam"), which shall be conducted on the certification requirements and other laws, rules, or regulations applicable to the respiratory care practitioner profession in this state. The jurisprudence examination shall be developed and administered as follows:
    (A) the staff of the Medical Board shall prepare questions for the JP exam and provide a facility by which applicants can take the examination;
    (B) applicants must pass the JP exam with a score of 75 or better;
    (C) an examinee shall not be permitted to bring books, compends, notes, journals, calculators, "smart phones," cellular phones, or other devices or materials designed to assist examinee pass the exam into the examination room, nor be allowed to communicate by word or sign with another examinee while the examination is in progress without permission of the presiding examiner, nor be allowed to leave the examination room except when so permitted by the presiding examiner;
    (D) irregularities during an examination such as giving or obtaining unauthorized information or aid as evidenced by observation or subsequent statistical analysis of answer sheets, shall be sufficient cause to terminate an applicant's participation in an examination, invalidate the applicant's examination results, or take other appropriate action; and
    (E) a person who has passed the JP Exam shall not be required to retake the Exam for recertification, except as a specific requirement of the advisory board as part of an agreed order.
(b) The following documentation shall be submitted as a part of the certificate application process:
  (1) Birth Certificate/Proof of Age. Each applicant for a certificate must provide a copy of a birth certificate and translation if necessary to prove that the applicant is at least 18 years of age. In instances where a birth certificate is not available the applicant must provide copies of a passport or other suitable alternate documentation.
  (2) Name Change. Any applicant who submits documentation showing a name other than the name under which the applicant has applied must present certified copies of marriage licenses, divorce decrees, or court orders stating the name change. In cases where the applicant's name has been changed by naturalization, the applicant should send the original naturalization certificate by certified mail to the advisory board for inspection.
  (3) Certification. Each applicant for a respiratory care practitioner certificate issued by the advisory board must submit:
    (A) a letter of verification of current certification acceptable to the advisory board, sent directly from the certifying body; and
    (B) a certificate of successful completion of an educational program submitted directly from the program on a form provided by the advisory board.
  (4) Examination Scores. Each applicant for a respiratory care practitioner certificate issued by the advisory board must have a certified transcript of grades submitted directly from the appropriate testing service to the advisory board for all examinations accepted by the advisory board for issuance of a certificate. The advisory board must notify the applicant of the results of the examination in accordance with §604.1042 of the Act.
  (5) Evaluations.
    (A) All applicants must provide evaluations, on forms provided by the board, of their professional affiliations for the past three years or since graduation from an educational program described by subsection (a)(4) of this section, whichever is the shorter period.
    (B) The evaluations must come from at least three supervisors or instructors who are either Texas state-certified respiratory care practitioners or licensed physicians and have each supervised the applicant's work experience.
    (C) An exception to subparagraph (B) of this paragraph may be made for those applicants who provide adequate documentation that they have not been supervised by at least three licensed physicians or Texas state-certified respiratory care practitioners for the three years preceding the board's receipt of application or since graduation, whichever is the shorter period.
  (6) Verification from Other States. On request of Medical Board staff, an applicant must have any state, in which he or she has ever been certified or otherwise licensed as a respiratory care practitioner regardless of the current status of the certification or license, submit to the advisory board a letter verifying the status of the certificate or license and a description of any sanctions or pending disciplinary matters. The information must be sent directly from the state certifying or licensing entities. Such information may be considered in accordance with §604.106 of the Act.
  (7) Arrest Records. If an applicant has ever been arrested, a copy of the arrest and arrest disposition must be requested from the arresting authority and that authority must submit copies of such records directly to the advisory board.
  (8) Malpractice. If an applicant has ever been named in a malpractice claim filed with any liability carrier or if an applicant has ever been named in a malpractice suit, the applicant must:
    (A) have each liability carrier complete a form furnished by this advisory board regarding each claim filed against the applicant's insurance;
    (B) for each claim that becomes a malpractice suit, have the attorney representing the applicant in each suit submit a letter directly to the advisory board explaining the allegation, dates of the allegation, and current status of the suit. If the suit has been closed, the attorney must state the disposition of the suit, and if any money was paid, the amount of the settlement. The letter shall be accompanied by supporting documentation including court records if applicable. If such letter is not available, the applicant will be required to furnish a notarized affidavit explaining why this letter cannot be provided; and
    (C) provide a statement, composed by the applicant, explaining the circumstances pertaining to patient care in defense of the allegations.
(c) Review and Recommendations by the Executive Director.
Cont'd...
(1) The executive director or designee shall review each application for a respiratory care practitioner certificate and may determine whether an applicant is eligible for a certificate or refer an application to a committee of the advisory board for review.
  (2) If the executive director or designee determines that the applicant clearly meets all requirements for a certificate, the executive director or designee may issue a certificate to the applicant, to be effective on the date issued without formal board approval, as authorized by §604.110 of the Act.
  (3) If the executive director determines that the applicant does not clearly meet all requirements for a certificate as prescribed by the Act and this chapter, a certificate may be issued only upon action by the advisory board following a recommendation by the Practice Authorization Committee, in accordance with §604.110 and §604.209 of the Act and §187.13 of this title (relating to Informal Board Proceedings Relating to Licensure Eligibility). Not later than the 20th day after the date the applicant receives notice of the executive director's determination the applicant shall:
    (A) request a review of the executive director's recommendation by a committee of the board conducted in accordance with §187.13 of this title; or
    (B) withdraw his or her application.
    (C) If an applicant fails to take timely action, as provided under this subsection, such inaction shall be deemed a withdrawal of his or her application.
  (4) To promote the expeditious resolution of any certificate issuance matter, the executive director, with the approval of the board, may recommend that an applicant be eligible for a certificate, but only under certain terms and conditions, and may present a proposed agreed order or remedial plan to the applicant. Not later than the 20th day after the date the applicant receives notice of the executive director's recommendation, the applicant shall do one of the following:
    (A) sign the order/remedial plan and the order/remedial plan shall be presented to the board for consideration and acceptance without initiating a disciplinary licensure investigation (as defined in §187.13 of this title) or appearing before a committee of the board concerning issues relating to certificate eligibility; or
    (B) request a review of the executive director's recommendation by a committee of the board conducted in accordance with §187.13 of this title; or
    (C) withdraw his or her application.
    (D) If the applicant fails to take timely action, as provided under this subsection, such inaction shall be deemed a withdrawal of his or her application.
(d) Committee Referrals. An applicant who has either requested to appear before the Practice Authorization Committee of the advisory board or has elected to be referred to the Practice Authorization Committee of the board due to a determination of ineligibility by the executive director in accordance with this section, in lieu of withdrawing the application for a certificate, may be subject to a Disciplinary Licensure Investigation as defined by §187.13 of this chapter. Review of the executive director's determination by a committee of the board shall be conducted in accordance with §187.13 of this chapter.
(e) All respiratory care practitioner applicants shall provide sufficient documentation to the advisory board that the applicant has, on a full-time basis, actively practiced as a respiratory care practitioner, has been a student at an acceptable approved respiratory care practitioner program, or has been on the active teaching faculty of an acceptable approved respiratory care practitioner program, within either of the last two years preceding receipt of an application for a respiratory care practitioner certificate. The term "full-time basis," for purposes of this section, shall mean at least 20 hours per week for 40 weeks duration during a given year. Applicants who are unable to demonstrate active practice on a full time basis may, in the discretion of the advisory board, be eligible for an unrestricted certificate or a restricted certificate subject to one or more of the following conditions or restrictions as set forth in paragraphs (1) - (4) of this subsection:
  (1) completion of approved continuing education in those topics specified by the advisory board;
  (2) limitation and/or exclusion of the practice of the applicant to specified activities of the practice as a respiratory care practitioner;
  (3) remedial education; and
  (4) such other remedial or restrictive conditions or requirements which, in the discretion of the advisory board, are necessary to ensure protection of the public and minimal competency of the applicant to safely practice as a respiratory care practitioner.
(f) Applicants for a respiratory care practitioner certificate:
  (1) whose applications have been filed with the advisory board in excess of one year will be considered expired. Any fee previously submitted with that application shall be forfeited unless otherwise provided by §175.5 of this title (relating to Payment of Fees or Penalties). Any further request for issuance of a certificate will require submission of a new application and inclusion of the current fee. An extension to an application may be granted under certain circumstances, including:
    (A) delay by advisory board staff in processing an application;
    (B) application requires Practice Authorization Committee review after completion of all other processing and will expire prior to the next scheduled meeting;
    (C) Practice Authorization Committee requires an applicant to meet specific additional requirements for certification and the application will expire prior to deadline established by the Committee;
    (D) applicant requires a reasonable, limited additional period of time to obtain documentation after completing all other requirements and demonstrating diligence in attempting to provide the required documentation;
    (E) applicant is delayed due to unanticipated military assignments, medical reasons, or catastrophic events;
  (2) who in any way falsify the application may be required to appear before the advisory board;
  (3) on whom adverse information is received by the advisory board may be required to appear before the advisory board;
  (4) shall be required to comply with the advisory board's rules and regulations which are in effect at the time the completed application form and fee are filed with the advisory board;
  (5) may be required to sit for additional oral or written examinations that, in the opinion of the advisory board, are necessary to determine competency of the applicant;
  (6) must have the application for a certificate complete in every detail 20 days prior to the advisory board meeting in which they are considered for approval. Applicants may qualify for a Temporary Permit prior to being considered by the advisory board for issuance of a certificate, as required by §186.7 of this chapter (relating to Temporary Permit);
  (7) who previously held a Texas health care provider license, certificate, permit, or registration may be required to complete additional forms as required.
(g) Alternative Certification Procedure for Military Service Members, Military Veterans, and Military Spouses:
  (1) An applicant who is a military service member, military veteran, or military spouse, as defined in §186.2 of this chapter (relating to Definitions), may be eligible for alternative demonstrations of competency for certain Texas state-certification requirements. Unless specifically allowed in this subsection, an applicant must meet the requirements for certification as specified in this chapter.
  (2) To be eligible, an applicant must be a military service member, military veteran, or military spouse and meet one of the following requirements:
    (A) holds an active unrestricted respiratory care practitioner certificate or license issued by another state that has certification or licensure requirements that are substantially equivalent to the requirements for a Texas respiratory care practitioner certificate; or
    (B) within the five years preceding the application date, applicant must have held a respiratory care practitioner certificate in this state that expired and was cancelled for nonpayment while the applicant lived in another state for at least six months.
  (3) Applications for a respiratory care practitioner certificate from applicants qualifying under paragraphs (1) and (2) of this subsection shall be expedited by the Medical Board's licensure division.
  (4) Alternative Demonstrations of Competency Allowed. Applicants qualifying under paragraphs (1) and (2) of this subsection:
Cont'd...
(A) in demonstrating compliance with subsection (e) of this section must only provide sufficient documentation to the advisory board that the applicant has, on a full-time basis, actively practiced as a respiratory care practitioner, has been a student at an acceptable approved respiratory care practitioner program, or has been on the active teaching faculty of an acceptable approved respiratory care practitioner program, within one of the last three years preceding receipt of an application for a respiratory care practitioner certificate;
    (B) notwithstanding the one year expiration in subsection (f)(1) of this section, are allowed an additional 6 months to complete the application prior to it becoming inactive; and
    (C) notwithstanding the 20 day deadline in subsection (f)(6) of this section, may be considered for a certificate up to 5 days prior to the advisory board meeting.
(h) Applicants with Military Experience.
  (1) For applications filed on or after March 1, 2014, the advisory board shall, with respect to an applicant who is a military service member or military veteran as defined in §186.2 of this chapter (relating to Definitions), credit verified military service, training, or education toward the certification requirements, other than an examination requirement, for a respiratory care practitioner certificate issued by the advisory board.
  (2) This section does not apply to an applicant who:
    (A) has had a respiratory care practitioner certificate or license suspended or revoked by another state or a Canadian province;
    (B) holds a respiratory care practitioner certificate or license issued by another state or a Canadian province that is subject to a restriction, disciplinary order, or probationary order; or
    (C) has an unacceptable criminal history.
(i) Re-Application for Certificate Prohibited. A person who has been determined ineligible for a respiratory care practitioner certificate by the Practice Authorization Committee may not reapply for a certificate prior to the expiration of one year from the date of the advisory board's ratification of the Practice Authorization Committee's determination of ineligibility and denial of a certificate.

Source Note: The provisions of this §186.4 adopted to be effective April 3, 2017, 42 TexReg 1758; amended to be effective April 15, 2018, 43 TexReg 2147; amended to be effective March 31, 2019, 44 TexReg 1528