Agenda Item 7.2Katherine A. ThomasApril 22, 2021Health Professions Council Annual ReportSummary:The Health Professions Council (HPC) was established by the Legislature in 1993 to achieve thepotentially desirable outcomes of consolidation of small independent health licensing agencieswithout sacrificing the quality, independence, accessibility and accountability of individual boards.The Council has 14 agencies that represent 34 professional licensing boards, certificationprograms and the Governor’s Office. The Council elects a presiding officer and assistant presidingofficer to conduct the business of the Council. The presiding officer (Chair) is Ralph Harper,Executive Director of the Texas PT/OT Council. While member agencies license and regulatehealth professionals, the HPC provides support services to member health care professionallicensing boards. The Council meets at least four times a year. Meetings are open to the publicand posted with the Office of the Secretary of State. HPC is required to submit an annual reportto State leadership. The FY 2019 and 2020 reports are attached.
Health Professions CouncilAnnual ReportTo theGovernorLieutenant GovernorSpeaker of the House of RepresentativesFebruary 1, 2020Board of NursingBoard of PharmacyTexas Medical BoardOffice of the GovernorTexas Optometry BoardBoard of Dental ExaminersHealth and Human ServicesFuneral Service CommissionBoard of Chiropractic ExaminersBoard of Examiners of PsychologistsBoard of Physical Therapy ExaminersBoard of Veterinary Medical ExaminersBoard of Occupational Therapy Examiners
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationMembersKatherine ThomasBoard of NursingAllison Vordenbaumen BenzTexas State Board of PharmacyBrint CarltonTexas Medical BoardW. Boyd BushTexas State Board of DentalExaminersJohn HelenbergTexas State Board of VeterinaryMedical ExaminersDarrel SpinksTexas State Board of Examiners ofPsychologistsRalph Harper,Executive Council of PhysicalTherapy and OccupationalTherapy ExaminersPatrick FortnerTexas Board of ChiropracticExaminersChris KloerisTexas Optometry BoardKyle SmithTexas Funeral Service CommissionTimothy SpeerHealth and Human ServicesKara HolsingerOffice of the Attorney GeneralChris SmithGovernor’s OfficeStaffJohn Monk, Administrative OfficerRita Ybarra, Administrative AsstHieu Nguyen, Website AdminAngie Berumen, Database AdminJames Kocurek, Database AdminRichard White, Systems AnalystPat Harris, Systems Analyst.The Texas Health Professions Council (HPC) provides a uniquesolution for the multiple challenges of state regulation of healthprofessions. The State of Texas created HPC to achieve thebenefits of consolidation without sacrificing, the quality,independence, accessibility and accountability of independenthealth licensing and regulatory agencies. Originally, established in1993, the Council has a membership of 13 agencies that representover 45 professional licensing boards, certification programs,documentation programs, permit programs or registrationprograms; the Office of the Attorney General and the Office of theGovernor. Executive Directors of each of the member agenciesactively participate. Through this collaborative effort, the HPC hasrealized economies of scales in the areas of InformationTechnology, human resources and staff training. The HPC fostersa spirit of cooperation between agencies striving to achieveregulatory best practices and better serve their respectiveconstituencies.
Table of ContentsThe Framework for the Health Professions Council .1Economies of Scale . . 3Regulatory Best Practices . .7Responsiveness . . .9Future Opportunities . .10Health Professions Council Administrative Office Budget .11AppendicesAppendix A – Regulatory Cost Comparison California and FloridaAppendix B – Agency Statutory Reports
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationFrameworkMEMBERSFor over twenty-five years, the Texas Health Professions Council (HPC) has provided a unique solutionfor the multiple challenges of state regulation of health professions. The State of Texas in 1993 createdthe Health Professions Council to achieve the potentially desirable outcomes of consolidation of smallindependent health licensing and regulatory agencies without sacrificing the quality, independence,accessibility and accountability of individual boards.Members: The Council consists of one representative from each of the 13)(14)the Texas Board of Chiropractic Examiners;the State Board of Dental Examiners;the Texas Optometry Board;the State Board of Pharmacy;the State Board of Veterinary Medical Examiners;the Texas Medical Board;the Texas Board of Nursing;the Texas State Board of Examiners of Psychologists;the Texas Funeral Service Commission;the Texas State Board of Physical Therapy Examiners;the Texas State Board of Occupational Therapy Examiners;the Health and Human Services Licensing and Certification Unitthe Governor’s office.the Office of the Attorney GeneralThe Council elects from its members a presiding officer and an assistant presiding officer to conduct thebusiness of the Council. Continuing in their leadership roles, the presiding officer (Chair) is Chris Kloeris,Executive Director from the Texas Optometry Board The assistant presiding officer (Vice-Chair) is DarrelSpinks, Executive Director for the Texas State Board of Examiners of Psychology. Council officers servetwo-year terms ending August 31 of odd numbered years.1
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationSTATUTORY REQUIREMENTSThe Health Professions Council was created on the recommendation of the Texas Sunset Commission toachieve the efficiency and effectiveness goals of consolidation while avoiding the creation of a newmulti-tiered bureaucracy. Repeated efforts to consolidate boards under one agency had received variedsupport while generating heated opposition from the professional associations. Experience in otherstates had shown that large umbrella agencies sometimes failed to meet the perceived benefits anddesired objectives of improved consumer service and decreased costs (Appendix B). Problems ofconsolidation included increased response time for services, decreased quality of services, lack ofexpertise in regulated professions, and decreased disciplinary actions against licensees. This cooperationhas achieved the results of consolidation without the associated costs and upheaval.The Council has mitigated problems of competition and conflict among the licensed professions byfostering an atmosphere of communication and cooperation. It has provided a forum for discussion ofissues and allowed a coordinated response to legislative issues when requested by elected officials. TheCouncil has no authority over member agencies.STAFFING/FUNDINGThe Health Professions Council employs a small staff (currently only 7 FTEs are assigned to the agency),to coordinate and or complete the tasks of the Council. The HPC staff is organized as a separate stateagency (#364). Its staff report to the Council directly through supervision of its manager, theAdministrative Officer, by the Council Chair. The Council utilizes its staff, along with committeesconsisting of staff from member agencies to carry out its activities. The Council is funded entirely bytransfer of funds from member agencies. A rider in the biennial appropriations bill specifies proratedamounts. .Agencies continue to offer written support for the Council in their individual LegislativeAppropriations Requests.Statutory language provides for the participating agencies to be collocated in the William P. HobbyBuilding at 333 Guadalupe St. to facilitate resource sharing. The other remaining agencies are housed attheir agency headquarters.Economies of Scale2
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationINFORMATION TECHNOLOGY SHARINGThe Council has developed areas to realize cost savings across agencies. These economies of scale havebeen found primarily in the area of information technology. Other areas that undergo regular review toensure best practices are incorporated in all of the regulatory agencies that the Council supports includeHuman Resources, accounting and finance, and employee training.Employees benefit through increased training opportunities, access to employee assistance programs,and opportunities to refine job skills as administrative sharing allows greater staff specialization. TheCouncil network provides opportunities for communication, shared expertise and joint problem-solving.Web Administrator Position: The Web Administrator position has been used as designed to update theweb infrastructure, design and security for all of the participating agencies. The position was filled inSeptember of 2013 and work began in earnest. The Council continues to see improvement in theagency websites both from a security and content standpoint. Agencies that have recently completedSunset Reviews that included website updates have been prioritized to ensure compliance with therecent recommendations. During Fiscal Year 18, the Council completed an audit (18-034) with the StateAuditor’s Office. Since then, the position has continued to serve the participating agencies effectivelyand provided a safe and secure web environment for those participants.Security Project: Late in Fiscal Year 18 the Council volunteered for an additional Security Assessmentthrough AT&T a Department of Information Resources contractor. That audit concluded and to theextent possible the Council has implemented process changes in order to ensure a safe and securetechnology environment.Shared Database System: The database system has been up and running since May 31, 2011 althoughwork began in 2009. With any large scale system start up, the agencies participating in the SharedSolution experienced many challenges. The Council continues to work with the vendor to resolve issuesthat arise.In Fiscal Year 2013 the agencies began the process of adding the Texas Funeral Service Commission tothe database. That implementation is complete and the Texas Funeral Service Commission is online.This implementation another example of HPC responding to the changing environment of governmentregulation. Serving the needs of the State of Texas is at the core of our mission. The Council sawminimal interference with the agencies that are currently on the database system.In Fiscal Year 2016 a complete update of the database software and infrastructure was completed. Thisupgrade added much needed improvements to various aspects of the system. First, the upgrade wascompleted in the cloud using Amazon Web Based Services. This allows for virtually no downtime related3
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and Regulationto system overloads, maintenance or other power outages. Further, it allows for a level of redundancythat had been steadily deprecated as various vendors took over the previous system in the state datacenter. Last, it allows the proprietors of the system to manage maintenance and repair and eliminatesan additional level of bureaucracy that existed within the state datacenter. By having staff that areversed in the proprietary system, the Council will be able to manage any other agencies that needdatabase services in the future. A database user group consisting of other agencies that utilize the sameor similar software meets on an as needed basis. Below is a table of agencies that use a version of thesame software along with their number of respective licensees. With software, changes occur rapidly.Because this system is a vital component of the participating agencies, HPC regularly reviewsopportunities and needs for improvement. As a result, HPC is currently reviewing options for an upgradeduring the next biennium. Any request for appropriations will be detailed in the upcoming LegislativeAppropriations Request and staff of both the House Appropriations and Senate Finance will be e Version188.8.131.52.112.6Host LocationDIR-DCSAmazon Web ServicesAmazon Web ServicesAmazon Web ServicesIn HouseNumber of Licensees 98,000 330,000 823,186 84,415 190,000Information Technology Sharing: The Council regularly studies the resources and needs of memberagencies for Information Technology support.The Council created a Shared Services Committee and assigned that committee to investigate models toprovide member agencies the most efficient IT support possible. The Committee developed a programthat facilitates sharing of information technology knowledge and resources among all of the memberagencies in the Hobby building through its Technology Committee. In addition to the RegulatoryDatabase Program, this program also utilizes staff, our own and one from the Texas Optometry Board toprovide direct ongoing support services to twelve (12) of the smaller member agencies in the HobbyBuilding. The staff positions are funded through contributions from the agencies. This program hasbeen operating since November 1, 2003.For the Eighty Fourth Legislative Session (84th Reg), the Council requested additional funding for anadditional Systems Support Analyst. The goal of this shared position is to address the recommendationsfrom previous Security Assessments. In today’s technological environment, infrastructure and websitesare under constant attack. Therefore, being able to respond to those attacks are critical. Based on the4
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationCouncil’s success with the ITSS program, agencies are confident that their website upgrades will be asuccess.HUMAN RESOURCES PROGRAMThe Human Resources Committee studied the needs of member agencies to determine what, if any,assistance the Council staff could provide in the area of Human Resources. The Council has developed aprogram to take a role in the HR functions of member agencies. The recommended program includesthe basic job tasks of a Human Resource Specialist I. Specifically, it allows for the coordinating andprocessing of newly hired and terminating employees. It also includes the administration ofemployment screenings, evaluation of candidates and background checks. Until a time that the Councildetermines a need for a full time FTE to fulfill the position, the Council continues to provide variousservices. As Human Resources issues become more complex, the agencies will review the needs for HRprofessionals at the Council.TRAINING OPPORTUNITIESThe member agencies share training opportunities for member agencies. One member agency staffmember from the Board of Nursing offers new employee EEO training. HPC staff handle thecoordination and documentation of the training. HPC provides a regular forum for the Employee’sRetirement System staff to give presentations to member agency employees on investments throughthe Citistreet program.HPC also works with the National Certified Investigator/Inspector Training (NCIT) program of the Councilon Licensure, Enforcement, and Regulation (CLEAR) to provide training locally approximately once ayear, providing the highest quality training at the lowest possible cost for HPC members and other stateagencies employing investigators. Periodically, throughout the year CLEAR provides remote accesstraining through the use of webinars. HPC has regularly provided access to these webinars on behalf ofthe members. The training is part of the Council’s performance measures.OTHER OPPORTUNITIES FOR SHARING5
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationCourier Services: The Texas Medical Board (TMB) coordinates the sharing of a courier service with all ofthe member agencies in the Hobby building to facilitate movement of priority communication, anddeposits, etc. with the Comptroller’s office. TMB coordinates the contract, pays the vendor, and billsagencies based on use. Other non-HPC member small state agencies located in the Hobby buildingparticipate in this sharing as well.Legislative Tracking: HPC member agencies have worked together to improve member agencies’Legislative Tracking. Smaller agencies that could not afford to purchase the services of LegislativeTracking Services, such as Texas Legislative Service or Gallery Watch, have gained access to that serviceat a much lower cost by sharing the service.6
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationRegulatory Best PracticesAREAS OF SHARED INTERESTThe Council regularly brings new topics for members to discuss and review. This allows new ideas andpractices to be thoroughly vetted prior to implementation. This saves both time and money. Byallowing all agencies access to the expertise of both large and small agencies, ideas are reviewed with adepth of knowledge not often found in a single umbrella agency structure. This cooperation requireslittle, if any, additional appropriations or significant time commitments from any single agency and theresults are available to all of the member agencies. The Council meetings serve further as a forum formember agency Executive Directors to identify common issues faced in licensing and regulation, shareperspectives, and often move toward consistent policy stances.Below are examples where agencies have found opportunities to implement regulatory best practices.Improved Customer Service: The Council has also created a resource list of member agency staff thatcan communicate in languages other than English. Member agencies have agreed to share staff when itis needed to communicate effectively with customers.Board Member Training Program: The Council has established a training program for the governingbodies (boards) of member agencies. The training has been compiled into a training manual. Eachagency must customize the basic training program to include agency/board specific information. Thetraining manual is updated every two years, following the Regular Legislative session.Policy and Procedure Development: In the past the Council, through its committees has developedmodel policies and procedures for risk management, disaster recovery, and workforcepolicy/procedures. When new reporting requirements are mandated member agency staff meet on anad hoc basis to review the requirements and instructions. As a group, they clarify expectations and seekfurther clarification to facilitate quality reporting.Minimum Data Set: The Statewide Health Coordinating Council’s recommends that the licensing boardsfor those professions named should change their licensing forms and data systems to include thecollection of the minimum data set on an annual or biennial basis. During the 80th Regular Sessionsignificant progress was made in this direction. Council staff is worked diligently with the HPRC and DIRto implement the provisions of the Minimum Data Set. After the planned Regulatory Database Systembecomes operational only one agency will rely significantly on DIR to retain MDS information.7
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationPeer-to-Peer Sharing/General Sharing: Member agencies back up each other in administrative functionssuch as accounting, purchasing, and payroll. These back up arrangements are typically short term innature, such as for occasions when employees are out on illnesses, vacations or other short terms.However, in some cases, agencies may provide these services to one another for longer periods of time(such as for an extended vacancy) with or without compensation through interagency contract.Agencies with certified purchasers assist agencies that are too small to have staff on board with suchexpertise through a “purchasing pool.” Member agency employees consult with one another, peer topeer, throughout the administrative and regulatory departments and divisions. There is a cost savingsto member agencies when their staff share their efforts that cannot be specifically calculated. Forexample, agency financial staff routinely consult each other when preparing major financial reports suchas the Annual Financial Report and the Legislative Appropriations Request. As a result of thisrelationship between member agency staff, reports are completed quicker, procedures are developedmore efficiently, and other state agencies enjoy a reduction in inquiries and clarifications on requiredreports and procedures. HPC member agencies embrace the spirit of cooperation within the HealthProfessions Council. The larger member agencies often allow their staff to assist smaller agencies withtasks that the larger agencies are better equipped to handle. Although it cannot be quantified, it isexpected that the assistance provided by larger agencies has prevented smaller agencies from having torequest additional funding for staff to handle the routine administrative requirements of being a stateagency.8
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationResponsivenessThe Health Professions Council serves a wide variety of constituents. First and foremost it serves thecitizens of Texas. The shared toll-free complaint line directly benefits consumers who can place one tollfree call to obtain information or initiate a complaint against any licensed health professional. Manyconsumers lack information necessary to determine which board to go to with their complaint. Thegreatest benefit to consumers is preservation of independent boards with specific expertise ininvestigation and resolution of consumer problems. Consumers and taxpayers benefit indirectly fromimproved efficiency and from cooperation among agencies, which produces cooperative rulemaking andless reliance on the administrative law system to resolve conflicts. Licensees benefit from retention ofindependent boards, which are more responsive and accessible to licensees, and from increasedefficiency of the agencies. As more administrative tasks are shared, staff with specific expertise aremore available to respond to needs of licensees and consumers. The Council goes to great lengths toensure that all of their customers are served.TOLL FREE COMPLAINT LINEThe Council operates a complaint system, which allows consumers to file complaints against any statelicensed health professional by calling one toll-free number. The shared complaint line improveseffectiveness and efficiency by providing easy “one-stop” access for consumers and significant costsavings for individual agencies. The 1-800 line receives an average of 2,250 calls per month, of thosecalls approximately 500 are routed to HPC staff. HPC receives a variety of inquiries. Many times thepublic is referred to one of our boards or to other state agencies. The cost of the system is shared bymember agencies, which split the cost of equipment and lines and pay for long distance charges basedon the percentage of calls assigned to each agency each month.STATEWIDE FORUMSThe Council has assigned the Administrative Officer to represent HPC member agencies at meetingsinvolving statewide forums. The Administrative Officer represents the views of member agencies intheir licensing/regulatory role, generally. The Administrative Officer communicates back to the memberagencies. Member agencies may increase their own participation in these forums, depending on thenature of the issues. The Council, through the HPC Chair also assigns member agencies to “outside”committees, as appropriate. Examples of the forums include the Department of Information ResourcesOccupational Licensing Steering Committee, and other workgroups and task forces. This approachallows member agencies to achieve representation and input into these processes.9
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationFuture OpportunitiesThe Health Professions Council’s activities are mandated legislatively, identified by the Council toprovide means for member regulatory agencies to coordinate administrative and regulatory efforts; orrequested by various legislative entities or oversight bodies, such as the Governor’s office, individualmembers of the Texas Senate or House of Representatives, the LBB, Comptroller’s office, etc.As agencies continue to align solutions with their own business processes there is a strong desire withinthe Council to anticipate future opportunities. As mentioned before the Council regularly reviews areaswhere agencies could improve services while still focusing on their core missions. In addition toexpanding the Human Resources Pilot Program, the Council will work closely with the Governor’s Officeand the Legislative Budget Board to realize streamlined and consistent practices on behalf of themember agencies. Texas is growing rapidly, which indicates that the agencies will see increasedworkloads in the near future. Meeting the challenges of that increased workload is an opportunity theCouncil looks forward to in 2020.10
TEXAS HEALTH PROFESSIONS COUNCILAnnual Report for Fiscal Year 2019An Efficient Model for Licensing and RegulationHealth Professions Council - Administrative Office BudgetFY 2019 BudgetedAs mentioned above, the Council works diligently to streamline programs toprovide the most cost effective service delivery to the participating agencies. Thenumber one area of savings is related to the Regulatory Database Program. Sevenagencies participate in the program at a cost determined by their size and numberof licensees. This allows smaller agencies to use a robust database system thatthey would not otherwise be unable to afford. This is just one example of manywhere the Council has provided significant savings to agencies.Board of Chiropractic Examiners 18,718Board of Dental Examiners 270,555Texas Medical Board 28,846Board of Nursing 68,805Executive Council of Occupational Therapyand Physical Therapy Examiners 28,828Texas Optometry Board 24,866 342,748Board of PharmacyTexas Health and Human Services: 11,599Board of Examiners of Psychologists 47,028Board of Veterinary Medical Examiners 27,575Texas Funeral Service Commission 37,314 188,352Texas Board of Plumbing Examiners 13,800Texas Board of Land SurveyingBoard of Professional Geoscientists 7,752Office of Public Insurance Counsel 5,958TOTAL MEMBER AGENCY TRANSFERS 1,083,23011
Appendix A - Reports on State to StateComparison of Licensee and Costs Per Licensee1. Texas Costs compared with California Department of Consumer Affairs2. Texas Costs compared with Florida Department of Health
TEXASProfessionChiropracticDentalMedical (1)Nurse & LVNOptometryPT/OT Estimated 717,254.85 3,829,226.84 14,052,705.58 17,134,091.00 492,118.12 1,463,563.43 14,841,346.67 938,805.31 1,294,098.85 54,763,210.65Comparison ofCalifornia to TexasCALIFORNIA ***Number **of LicenseesCost perLicenseeFY2018ExpendituresNumber ofLicenseesCost perLicenseeExpenditures DifferenceNumber ofLicensees****Cost ,3989,87611,262 116.99 49.36 90.76 36.25 114.63 31.62 129.73 95.06 114.91 3,666,000 15,328,000 67,685,000 57,572,000 2,382,000 6,689,000 23,979,000 4,791,000 9,47320,18641,618 255.56 82.41 363.21 99.98 156.17 115.56 171.93 237.34 115.60 2,948,745 11,498,773 53,632,294 40,437,909 1,889,882 5,225,437 9,137,653 3,852,195 7510,31030,356 138.57 33.06 272.45 63.73 41.53 83.94 42.19 142.28 0.69897,384 61.03 186,903,0001,236,951 151.10 132,139,789339,567 90.07(1) For the purpose of comparison, the expenditures and number of licensees for California Acupuncture, Medicine, Osteopathic, and Physician Assistants are combined since they are combined inTexas.(2) For the purpose of comparison, the expenditures and number of licensees for the California Physical and Occupational Therapy Boards are combined since they are combined in Texas.* Source: Texas Comptroller Online Agency Expenditure Tool for FY 2019** Source: Health Professions Council Annual Report, February 1, 2019*** Source: 2019 California Department of Consumer Affairs Annual Report
FLORIDA ***TEXASProfessionChiropracticDentalMedical (1)Nurse & LVNOptometryPT/OT (2)PharmacyPsychologistsTotalsFY2019*Estimated 717,254 3,829,226 14,052,705 17,134,091 492,118 1,463,563 14,841,346 938,805 53,469,108Number **of 989,876886,122Cost perLicenseeFY2018Expenditures 116.99 49.36 90.76 36.25 114.63 31.62 129.73 95.06Number ofLicenseesComparison of Florida to TexasCost perLicenseeExpendituresDifferenceNumber ofLicensees****Cost perLicensee 1,648,779 3,381,540 20,594,685 19,519,078 607,098 2,138,329 7,418,131 6,260 146.74 54.95 186.03 44.82 160.27 43.17 75.08 149.94 931,525 (447,686) 6,541,980 2,384,987 114,980 674,766 (7,423,215) 9)(3,616) 29.75 5.59 95.28 8.57 45.64 11.56 (54.65) 54.88 60.34 56,246,246777,403 72.35 2,777,138(108,719) 12.01(1) For the purpose of comparison, the expenditures and number of licensees for Florida Acupuncture, Medicine, Osteopathic, and Physician Assistants are combined since they arecombined in Texas.(2) For the purpose of comparison, the expenditures and number of licensees for the Florida Physical and Occupa
Apr 07, 2021 · Texas State Board of Pharmacy Brint Carlton Texas Medical Board W. Boyd Bush Texas State Board of Dental Examiners John Helenberg Texas State Board of Veterinary Medical Examiners Darrel Spinks Texas State Board of Examiners of Psychologists Ralph Harper, Executive Council of Physical Ther
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