By: John Langley
Navigating the TMB Website
In my practice representing physicians, both in liability cases and in disciplinary matters before the Texas Medical Board, I have found that often the practitioner is unaware of where to find the statutes and rules (and other important information) by which he or she is governed. By this article, I hope to assist the practitioner in locating this vital information, with a focus on one resource that is frankly critical to be aware of and familiar with: the TMB web site.
The TMB website address is www.tmb.state.tx.us. The site is large and, in this writing, I cannot cover everything there is to know and where to find information on the site. However, there are a few key places to be aware of for physicians in Texas.
On the main/home page, one finds a number of tabs across the top, similar to a bookmarks bar in a browser. These tabs are really the starting point for folks looking for information. The home page (marked by a house symbol on the bar) contains a number of splash screens, each sending the reader to a specific area if clicked on.
For instance, the tabs include “Look up a License,” “Board action Search,” “Latest Updates,” and, on the far right side of the screen, a box that contains “Quick Links” that provide frequent sources of information. If you have recently moved, for instance, and need to update the TMB on your address (did you know that failure to do so can be a rules violation?) you simply click on “Change Address” and you are taken to a screen where you can do it online! Convenient!
Note the TMB has an advisory on that page stating: “Now that there is an online option for licensees to update their mailing and practice addresses, the hard copy Change of Address forms will be accepted only in limitied circumstances.” This follows a trend by the TMB of moving to electronic, and away from paper, methods of record-keeping. Note also that this page is cross-linked under “Licensee Resources,” which is the fifth tab on the booksmark bar.
As of this writing, the second tab on the bar is “COVID-19” and leads to a running list of announcements that relate to emergency rules dating back to the beginning of the crisis. www.tmb.state.tx.us/page/coronavirus. This information has been historically important, especially for those seeking guidance on what procedures (including surgical) are permitted and what are not. For the most part, the driving policy decision behind the rules is the preservation of medical and surgical resources, including ICU beds and ventilators. At the height of the crisis, all elective surgical procedures were paused to save these resources for patients who needed admission to ICU and ventilator assistance. Some of the emergency rules have now been converted into permanent rules, such as those for telemedicine:
This latter link takes the reader to amendments to telemedicine rules pertaining to prescription of medications under Title 22 of the Texas Administrative Code, section 174.5, Issuance of Prescriptions. On the main COVID-19 page there are also FAQ links, Emergency Rules links, Licensing links, Information links, and Up to Date Health Related COVID-19 Information links.
The next tab on the bar (no pun intended) is entitled “Licensing.” This is a very important link for all things licensure for physicians and also for all of the licensees governed by TMB sub-boards, such as PAs, Acupuncturists, Medical Radiologic Technologists, Respiratory Care Practitioners, and others. The far left column is for physicians. It contains links for various physician types and stages of licensure, such as full medical license, interstate medical license, physicians in training, and out of state telemedicine licenses, to name a few. Clicking on each type will take the reader to the respective page for that type of license. If one clicks on full Texas medical license for instance, you are taken to an overview page which contains vital information on how to apply for a medical license, a link to an eligibility checklist, exam requirements, and even a sample application.
Also located here is an explanation of the Licensure Inquiry System of Texas (LIST) which serves as an online communication system for messages to and from the Board and physician applicants regarding application requirements. This is a great way to communicate with the Licensure division at the TMB. Understand, they are frequently backed up so be patient.
Also under Licensure is a link to the Texas Medical Jurisprudence Exam, which is required for all physicians in Texas:
You can now take the exam online and there is even a study guide! It is available for all applicants with active, pending applications through their “My TMB” account.
The next tab is “Renewals” and of course this is an important resource for when it comes time to renew your license. It is broken down by license type.
There is a wealth of information for physicians who need to renew, and online forms. There is information regarding fees, delinquent fees, and electronic licenses.
Under the Renewal tab is also a link for Supervision and Prescriptive Delegation Registration:
Here, one can review eligibility requirements for PAs (physician assistants) and APNs (advanced practice nurses) and a FAQ section is there as well. This is an extremely important and useful feature of the web site for physicians who supervise midlevels, whether in the clinic environment or who are in facility based practices, such as hospitals.
The next main tab on the bar is “Licensee Resources.” Here, one finds a wealth of information on CME, Licensee Forms (change of address!), Special Topics (such as practice resources, the Texas Physician Health Program, Electronic Death Certificate Registration, and other areas), and Outreach Information:
Next tab is “Forms.” Here is the library of forms for Consumers, Licensees, Licensing Forms, and Renewal Forms for the various license types:
If one clicks on the form categories in the left box, there are links to numerous forms relevant to each category. Under Licensee Resource Forms alone there are more than 25 links to forms.
The next category tab on the bar is one that is near and dear to my heart: “Laws and Rules.” Here is the all important location for the Medical Practice Act and the Board Rules for each type of license that falls under the jurisdiction/regulatory authority of the TMB.
Under this umbrella are check boxes for the laws and Board rules, Processes, General Counsel, Required Notices, and Position Statements. To the far right of this page is a box that has links to General Counsel, Forms, Board Rules, the Texas Administrative Code (which governs administrative hearings at SOAH and appeals, among other things), TMB Bulletins, and Newsroom. TMB bulletins are a useful source of information.
Clicking on Board Rules takes you to a page with links to Current Board Rules and Adopted Rule Changes. Here is where you find your rules! Clicking will take you to the Secretary of State website with the table of contents to the TMB rules.
Some of the topics include, discipline, supervision of midlevels, medical records, prescription of controlled substances, telemedicine, investigations, complaints, and physician advertising. You will find separate board rules for other types of licenses such as physician assistants and perfusionists and a separate section governing pain management clinics. There really is too much information to even begin to outline in this paper, so please investigate this section carefully.
The next tab is “Publications.” Here is where the mintues of each board can be found, as well as changes to the laws and rules for each year going back to 1998. The Newsroom link takes you to the press releases, statistics, and the TMB Bulletin. Clicking on Medical Board Minutes takes you to several years’ of Board minutes. For 2021, clicking will take you to each quarterly meeting and includes the minutes of the Executive Committee, Finance Committee, Licensure Committee, and Full Board Minutes.
The “Newsroom” tab is fairly self-explanatory, and takes you to the page for links to the TMB Bulletin and press releases. So far, there have been 28 press releases for 2021. There were 56 in 2020.
The “Public” tab is where information for the general public can be found, and it serves as the consumer/public resources page. It contains information on how to look up a licensee, how to file a complaint, calendar and agendas of the Boards, Open Records requests, and other areas. There is also a FAQ list at the bottom of that page, including for medical records.
The “Agency” tab contains agency information for the various sub-boards and the TMB, for each license type. It also contains the Board member biographies and lists the members of the Board and various committees. It also contains the calendar and agendas, and meeting minutes.
Finally, there is the “FAQ” tab. This is a very important link and takes you to several pages of Frequently Asked Questions that are very helpful, and in some cases, state Board policy on a number of topics, such as physician supervision of midlevels. For instance, under Laws and Rules FAQs, there is a link to Prescriptive Authority Agreements that contains 15 separate FAQs! Questions such as:
As you can see, there is a lot of important, specific, technical information from the TMB on its FAQ page. You owe it to yourself and your practice to be familiar with it.
Based on my experience in years of representing physicians, even highly skilled practitioners often are unaware of all of the information available to them on the TMB website. Yet, the TMB holds the physician licensee responsible for being familiar with its laws and rules, and even the material on the website. If there is one source of information that I would point physicians to in answering questions, it is this site. Go there, explore, and go back often!