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. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 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.