By Maxey                                              H.B. No. 1228
         77R2349 KKA-D                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to dental services provided under the medical assistance
 1-3     program.
 1-5           SECTION 1. Subchapter B, Chapter 32, Human Resources Code, is
 1-6     amended by adding Section 32.053 to read as follows:
 1-7           Sec. 32.053.  DENTAL SERVICES. (a)  In providing dental
 1-8     services under the medical assistance program, the department
 1-9     shall:
1-10                 (1)  ensure that a stainless steel crown is used only
1-11     when medically necessary and not as a preventive measure;
1-12                 (2)  require a dentist participating in the medical
1-13     assistance program to document, through x-rays or other methods
1-14     established by department rule, the medical necessity for a
1-15     stainless steel crown before the crown is applied;
1-16                 (3)  require a dentist participating in the medical
1-17     assistance program to comply with a minimum standard of
1-18     documentation and record-keeping for each of the dentist's
1-19     patients, regardless of whether the patient's costs are paid
1-20     privately or through the medical assistance program;
1-21                 (4)  replace the 15-point system used for determining
1-22     the medical necessity for hospitalization and general anesthesia
1-23     with a more objective and comprehensive system developed by the
1-24     department; and
 2-1                 (5)  take all necessary action to eliminate fraud in
 2-2     the provision of dental services under the medical assistance
 2-3     program, including:
 2-4                       (A)  adopting a zero tolerance policy toward
 2-5     fraud;
 2-6                       (B)  aggressively investigating and prosecuting
 2-7     any dentist who abuses the system for reimbursement under the
 2-8     medical assistance program; and
 2-9                       (C)  randomly auditing all dentists participating
2-10     in the medical assistance program and conducting targeted audits of
2-11     dentists whose billing activities under the medical assistance
2-12     program are excessive or otherwise inconsistent with the billing
2-13     activities of other similarly situated dentists.
2-14           (b)  In setting reimbursement rates for dental services under
2-15     the medical assistance program, the department shall:
2-16                 (1)  reduce the amount of the hospitalization fee in
2-17     effect on December 1, 2000, and redistribute amounts made available
2-18     through reduction of that fee to other commonly billed dental
2-19     services for which adequate accountability measures exist; and
2-20                 (2)  eliminate the behavior management fee and the
2-21     nutritional consultation fee and redistribute amounts made
2-22     available through elimination of those fees to other commonly
2-23     billed dental services for which adequate accountability measures
2-24     exist.
2-25           (c)  The department shall develop the minimum standard
2-26     described by Subsection (a)(3) in cooperation with the State Board
2-27     of Dental Examiners.
 3-1           SECTION 2. If before implementing any provision of this Act a
 3-2     state agency determines that a waiver or authorization from a
 3-3     federal agency is necessary for implementation of that provision,
 3-4     the agency affected by the provision shall request the waiver or
 3-5     authorization and may delay implementing that provision until the
 3-6     waiver or authorization is granted.
 3-7           SECTION 3.  This Act takes effect immediately if it receives
 3-8     a vote of two-thirds of all the members elected to each house, as
 3-9     provided by Section 39, Article III, Texas Constitution.  If this
3-10     Act does not receive the vote necessary for immediate effect, this
3-11     Act takes effect September 1, 2001.