73R9634 JMM-D By Hirschi H.B. No. 2168 Substitute the following for H.B. No. 2168: By Maxey C.S.H.B. No. 2168 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to dental care pilot programs for certain underserved 1-3 areas. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Chapter 9, Title 71, Revised Statutes, is amended 1-6 by adding Article 4551n to read as follows: 1-7 Art. 4551n. DENTAL CARE FOR UNDERSERVED AREAS 1-8 Sec. 1. DESIGNATION OF UNDERSERVED COUNTIES. The State 1-9 Board of Dental Examiners shall designate counties that are 1-10 underserved with regard to dental care by compiling 1-11 county-by-county statistics on the per capita number of dentists in 1-12 each county. The board shall designate a county as underserved if: 1-13 (1) the county does not have a dentist practicing in 1-14 the county; 1-15 (2) the ratio of dentists to the county population is 1-16 50 percent below the statewide norm based on the statistics 1-17 compiled under this section; or 1-18 (3) special circumstances determined by the board 1-19 exist for designating the county as underserved. 1-20 Sec. 2. PILOT PROGRAM. (a) An accredited dental hygiene or 1-21 dental education program that applies to the board and meets the 1-22 requirements of this article may establish a five-year oral health 1-23 access pilot program for an area not to exceed 15 underserved 1-24 counties. The board by rule may adopt standards for the extension 2-1 of a program under this section beyond five years. 2-2 (b) A school that establishes a pilot program under this 2-3 section shall adopt strategic goals for the program, describe the 2-4 activities necessary to accomplish these goals, and specify the 2-5 quantitative methods for measuring the effectiveness of the 2-6 program. The information required under this subsection shall be 2-7 provided to the board. 2-8 (c) A school that establishes a pilot program under this 2-9 section shall attempt to earn the support and participation of 2-10 dentists and dental hygienists who are already practicing in the 2-11 program area. 2-12 Sec. 3. PRACTICE REQUIREMENTS FOR PILOT PROGRAM. (a) The 2-13 board by rule shall ease the practice restrictions for license 2-14 holders who participate in a pilot program under this article. The 2-15 board shall also ease practice restrictions on participating 2-16 students at a school that establishes a pilot program. 2-17 (b) A dentist or dental hygienist practicing in a designated 2-18 underserved county who participates in a pilot program under this 2-19 article shall comply with the reporting requirements adopted by the 2-20 board for program participants and shall be subject to evaluation 2-21 by the coordinators of the pilot program. 2-22 (c) A dentist who participates in a pilot program under this 2-23 article may use mobile vans or satellite clinics without 2-24 restrictions imposed by the board or elsewhere under law. A mobile 2-25 van or satellite clinic is subject to the same requirements as the 2-26 dentist's main office practice setting. 2-27 Sec. 4. PRACTICE BY DENTAL HYGIENIST IN PILOT PROGRAM. (a) 3-1 A licensed dental hygienist who participates in a pilot program 3-2 under this article may provide limited services outside of the 3-3 hygienist's dental office if the hygienist acts with the authority 3-4 and permission of the hygienist's employing dentist. 3-5 (b) A dental hygienist participating in a pilot program 3-6 under this section may provide a patient the following services, 3-7 without the requirement that the patient first be seen by a dentist 3-8 or without having the patient being a patient of record of the 3-9 hygienist's practice before the treatment is provided: 3-10 (1) individual nondiagnostic referral screenings; 3-11 (2) fluoride treatments; 3-12 (3) sealant applications; and 3-13 (4) patient education. 3-14 (c) A dental hygienist who participates in a pilot program 3-15 under this section shall establish the required patient records but 3-16 may not perform any diagnostic activities. 3-17 (d) A person who receives a fluoride treatment or a sealant 3-18 treatment from a hygienist under Subsection (b) of this section 3-19 shall be referred for a follow-up examination with the hygienist's 3-20 authorizing dentist. 3-21 (e) A dental hygienist who participates in a pilot program 3-22 under this section may provide prophylaxis treatments with the 3-23 permission of the hygienist's employing dentist for homebound 3-24 patients, disabled patients, elderly patients, mobility impaired 3-25 patients, and nursing home patients without the requirement that 3-26 these patients first be seen by a dentist. 3-27 Sec. 5. ADDITIONAL DENTAL CARE PROGRAMS. (a) A pilot 4-1 program under this section may provide for additional dental care 4-2 to be provided in the area served by the program through 4-3 internships, special care programs provided by dental and dental 4-4 hygienist students, patient education programs, and sealant, 4-5 fluoridation, and referral screening projects. 4-6 (b) Quantitative records for additional programs offered by 4-7 a pilot program under this section shall be maintained separately 4-8 from other records for services provided by practicing dentists and 4-9 dental hygienists in the pilot program. 4-10 Sec. 6. ANNUAL REPORT. (a) A school operating a pilot 4-11 program shall file an annual report providing information required 4-12 by the board. 4-13 (b) A report required under this section shall be filed with 4-14 the board, any advisory committee that advises the Texas Department 4-15 of Health about technical dental issues, the Texas Department of 4-16 Human Services, the senate health and human services committee, the 4-17 house of representatives public health committee, and members of 4-18 the legislature who represent a county that is served by the pilot 4-19 program. 4-20 SECTION 2. This Act takes effect September 1, 1993. 4-21 SECTION 3. The importance of this legislation and the 4-22 crowded condition of the calendars in both houses create an 4-23 emergency and an imperative public necessity that the 4-24 constitutional rule requiring bills to be read on three several 4-25 days in each house be suspended, and this rule is hereby suspended.