By Maxey H.B. No. 3507
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of dentistry and the provision of dental
1-3 services.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 ARTICLE 1. DENTAL SERVICES PROVIDED UNDER MEDICAL ASSISTANCE
1-6 PROGRAM
1-7 SECTION 1.01. Subchapter B, Chapter 32, Human Resources Code,
1-8 is amended by adding Section 32.053 to read as follows:
1-9 Sec. 32.053. DENTAL SERVICES. (a) In providing dental
1-10 services under the medical assistance program, the department
1-11 shall:
1-12 (1) ensure that a stainless steel crown is used only
1-13 when medically necessary and not as a preventive measure;
1-14 (2) require a dentist participating in the medical
1-15 assistance program to document, through x-rays or other methods
1-16 established by department rule, the medical necessity for a
1-17 stainless steel crown before the crown is applied;
1-18 (3) require a dentist participating in the medical
1-19 assistance program to comply with a minimum standard of
1-20 documentation and record-keeping for each of the dentist's
1-21 patients, regardless of whether the patient's costs are paid
1-22 privately or through the medical assistance program;
1-23 (4) replace the 15-point system used for determining
2-1 the medical necessity for hospitalization and general anesthesia
2-2 with a more objective and comprehensive system developed by the
2-3 department; and
2-4 (5) take all necessary action to eliminate fraud in
2-5 the provision of dental services under the medical assistance
2-6 program, including:
2-7 (A) adopting a zero tolerance policy toward
2-8 fraud;
2-9 (B) aggressively investigating and prosecuting
2-10 any dentist who abuses the system for reimbursement under the
2-11 medical assistance program; and
2-12 (C) randomly auditing all dentists participating
2-13 in the medical assistance program and conducting targeted audits of
2-14 dentists whose billing activities under the medical assistance
2-15 program are excessive or otherwise inconsistent with the billing
2-16 activities of other similarly situated dentists.
2-17 (b) In setting reimbursement rates for dental services under
2-18 the medical assistance program, the department shall:
2-19 (1) reduce the amount of the hospitalization fee in
2-20 effect on December 1, 2000, and redistribute amounts made available
2-21 through reduction of that fee to other commonly billed dental
2-22 services for which adequate accountability measures exist; and
2-23 (2) eliminate the behavior management fee and the
2-24 nutritional consultation fee and redistribute amounts made
2-25 available through elimination of those fees to other commonly
2-26 billed dental services for which adequate accountability measures
3-1 exist.
3-2 (c) The department shall develop the minimum standard
3-3 described by Subsection (a)(3) in cooperation with the State Board
3-4 of Dental Examiners.
3-5 SECTION 1.02. If before implementing any provision of this
3-6 article a state agency determines that a waiver or authorization
3-7 from a federal agency is necessary for implementation of that
3-8 provision, the agency affected by the provision shall request the
3-9 waiver or authorization and may delay implementing that provision
3-10 until the waiver or authorization is granted.
3-11 ARTICLE 2. REGULATION OF TELEDENTISTRY
3-12 SECTION 2.01. Section 251.003, Occupations Code, is amended
3-13 by adding Subsection (d) to read as follows:
3-14 (d) A person located in another state practices dentistry in
3-15 this state if the person through the use of any medium, including
3-16 an electronic medium, performs an act that constitutes the practice
3-17 of dentistry on a patient in this state.
3-18 SECTION 2.02. Section 262.151(a), Occupations Code, is
3-19 amended to read as follows:
3-20 (a) A licensed dentist may delegate orally, [or] in writing,
3-21 or through advanced audio and video telecommunications services a
3-22 service, task, or procedure to a dental hygienist who is under the
3-23 supervision and responsibility of the dentist, if:
3-24 (1) the dental hygienist is licensed to perform the
3-25 service, task, or procedure;
3-26 (2) the supervising dentist examines the patient
4-1 either in person or through advanced audio and video
4-2 telecommunications services:
4-3 (A) at the time the service, task, or procedure
4-4 is performed by the dental hygienist; or
4-5 (B) during the 12 calendar months preceding the
4-6 date of performance of the service, task, or procedure by the
4-7 dental hygienist; and
4-8 (3) the dental hygienist does not:
4-9 (A) diagnose a dental disease or ailment;
4-10 (B) prescribe a treatment or a regimen;
4-11 (C) prescribe, order, or dispense medication; or
4-12 (D) perform any procedure that is irreversible
4-13 or involves the intentional cutting of soft or hard tissue by any
4-14 means.
4-15 SECTION 2.03. Subchapter B, Chapter 531, Government Code, is
4-16 amended by adding Section 531.02171 to read as follows:
4-17 Sec. 531.02171. REIMBURSEMENT FOR CERTAIN DENTAL
4-18 CONSULTATIONS. (a) In this section:
4-19 (1) "Dental professional" means a:
4-20 (A) dentist licensed under Subtitle D, Title 3,
4-21 Occupations Code; or
4-22 (B) dental hygienist licensed under Chapter 262,
4-23 Occupations Code, practicing under the supervision of a dentist.
4-24 (2) "Teledental consultation" means a dental
4-25 consultation between dental professionals for purposes of patient
4-26 diagnosis or treatment that requires the use of advanced
5-1 telecommunications technology, including:
5-2 (A) compressed digital interactive video, audio,
5-3 or data transmission;
5-4 (B) clinical data transmission via computer
5-5 imaging for teleradiology or telepathology; and
5-6 (C) other technology that facilitates access in
5-7 rural and underserved counties to dental services or dental
5-8 specialty expertise.
5-9 (b) The commission by rule shall require each health and
5-10 human services agency that administers a part of the Medicaid
5-11 program to provide Medicaid reimbursement for a teledental
5-12 consultation provided by a licensed dentist in this state. The
5-13 commission shall require reimbursement for a teledental
5-14 consultation at the same rate as the Medicaid program reimburses
5-15 for a comparable in-person consultation. A request for
5-16 reimbursement may not be denied solely because an in-person
5-17 consultation between a dentist and a patient did not occur.
5-18 ARTICLE 3. DELEGATION OF CERTAIN ACTS BY DENTISTS
5-19 SECTION 3.01. Section 258.001, Occupations Code, is amended
5-20 to read as follows:
5-21 Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not
5-22 delegate:
5-23 (1) an act to an individual who, by board order, is
5-24 prohibited from performing the act;
5-25 (2) any of the following acts to a person not licensed
5-26 as a dentist or dental hygienist:
6-1 (A) the removal of calculus, deposits, or
6-2 accretions from the natural and restored surfaces of exposed human
6-3 teeth and restorations in the human mouth;
6-4 (B) root planing or the smoothing and polishing
6-5 of roughened root surfaces [or exposed human teeth]; or
6-6 (C) any other act the delegation of which is
6-7 prohibited by board rule;
6-8 (3) any of the following acts to a person not licensed
6-9 as a dentist:
6-10 (A) comprehensive examination or diagnosis and
6-11 treatment planning;
6-12 (B) a surgical or cutting procedure on hard or
6-13 soft tissue;
6-14 (C) the prescription of a drug, medication, or
6-15 work authorization;
6-16 (D) the taking of an impression for a final
6-17 restoration, appliance, or prosthesis;
6-18 (E) the making of an intraoral occlusal
6-19 adjustment;
6-20 (F) direct pulp capping, pulpotomy, or any other
6-21 endodontic procedure;
6-22 (G) the final placement and intraoral adjustment
6-23 of a fixed or removable appliance; or
6-24 (H) the placement of any final restoration; or
6-25 (4) the authority to an individual to administer a
6-26 local anesthetic agent, inhalation sedative agent, parenteral
7-1 sedative agent, or general anesthetic agent if the individual is
7-2 not licensed as:
7-3 (A) a dentist with a permit issued by the board
7-4 for the procedure being performed, if a permit is required;
7-5 (B) a certified registered nurse anesthetist
7-6 licensed by the Board of Nurse Examiners, only if the delegating
7-7 dentist holds a permit issued by the board for the procedure being
7-8 performed, if a permit is required; or
7-9 (C) a physician anesthesiologist licensed by the
7-10 Texas State Board of Medical Examiners.
7-11 SECTION 3.02. Section 258.002, Occupations Code, is amended
7-12 by amending Subsection (b) and adding Subsection (c) to read as
7-13 follows:
7-14 (b) A licensed dentist who is a Medicaid provider may
7-15 delegate, under Subsection (a), the application of a pit and
7-16 fissure sealant.
7-17 (c) The board by rule shall establish guidelines regarding
7-18 the types of dental acts that may be properly or safely delegated
7-19 by a dentist, including a determination of which delegated dental
7-20 acts, if any, require competency testing before a person may
7-21 perform the act.
7-22 SECTION 3.03. Subchapter D, Chapter 262, Occupations Code, is
7-23 amended by adding Section 262.1515 to read as follows:
7-24 Sec. 262.1515. DELEGATION OF DUTIES TO DENTAL HYGIENIST
7-25 PRACTICING IN FACILITY SERVING UNDERSERVED POPULATION. (a) In this
7-26 section, "facility serving an underserved population" means:
8-1 (1) a health center as defined by 42 U.S.C. Section
8-2 254b;
8-3 (2) a group home as defined by Section 591.003, Health
8-4 and Safety Code;
8-5 (3) a public school as defined by Section 821.001,
8-6 Government Code; or
8-7 (4) a nursing facility as defined by Section 242.301,
8-8 Health and Safety Code.
8-9 (b) A licensed dentist may delegate a service, task, or
8-10 procedure, including the application of a pit and fissure sealant,
8-11 to a dental hygienist without complying with Section 262.151(a)(2)
8-12 if:
8-13 (1) the dental hygienist has at least two years'
8-14 experience in the practice of dental hygiene; and
8-15 (2) the service, task, or procedure is performed in a
8-16 facility serving an underserved population.
8-17 (c) The patient must be referred to a licensed dentist after
8-18 the completion of a service, task, or procedure performed under
8-19 Subsection (b).
8-20 SECTION 3.04. Section 265.003, Occupations Code, is amended
8-21 to read as follows:
8-22 Sec. 265.003. PERMITTED DUTIES. (a) A dental assistant who
8-23 is not professionally licensed may:
8-24 (1) be employed by and work in the office of a
8-25 licensed and practicing dentist; and
8-26 (2) perform one or more delegated dental acts under
9-1 the direct supervision, direction, and responsibility of the
9-2 dentist, including the application of a pit and fissure sealant.
9-3 (b) A dental assistant may apply a pit and fissure sealant
9-4 under Subsection (a) only if the assistant:
9-5 (1) has at least two years' experience as an
9-6 assistant;
9-7 (2) has completed any training required by the board
9-8 for application of a sealant under this section; and
9-9 (3) is certified by the board to perform the act.
9-10 ARTICLE 4. RECIPROCITY OF LICENSES
9-11 SECTION 4.01. Section 256.101(a), Occupations Code, is
9-12 amended to read as follows:
9-13 (a) The board shall issue a license to practice dentistry to
9-14 a reputable dentist or a license to practice dental hygiene to a
9-15 reputable dental hygienist who:
9-16 (1) pays the fee set by the board;
9-17 (2) is licensed in good standing as a dentist or
9-18 dental hygienist in another state that has licensing requirements
9-19 substantially equivalent to the requirements of this subtitle;
9-20 (3) has not been the subject of a final disciplinary
9-21 action and is not the subject of a pending disciplinary action in
9-22 any jurisdiction in which the dentist or dental hygienist is or has
9-23 been licensed;
9-24 (4) has graduated from a dental or dental hygiene
9-25 school accredited by the Commission on Dental Accreditation of the
9-26 American Dental Association and approved by the board under board
10-1 rule;
10-2 (5) has passed a national or other examination
10-3 relating to dentistry or dental hygiene and recognized by the
10-4 board;
10-5 (6) has passed the board's jurisprudence examination;
10-6 (7) has submitted documentation of current
10-7 cardiopulmonary resuscitation certification;
10-8 (8) has practiced dentistry or dental hygiene[:]
10-9 [(A)] for at least the five years preceding the
10-10 date of application for a license under this section[;] or has
10-11 practiced
10-12 [(B)] as a dental educator at a dental school or
10-13 dental hygiene school accredited by the Commission on Dental
10-14 Accreditation of the American Dental Association for at least the
10-15 five years preceding the date of application for a license under
10-16 this section[;] and the dentist or dental hygienist will practice
10-17 dentistry or dental hygiene in this state in a medically
10-18 underserved area;
10-19 (9) has been endorsed by the board of dentistry in the
10-20 jurisdiction in which the applicant practices at the time of
10-21 application; and
10-22 (10) meets any additional criteria established by
10-23 board rule.
10-24 SECTION 4.02. (a) In accordance with Section 311.031(c),
10-25 Government Code, which gives effect to a substantive amendment
10-26 enacted by the same legislature that codifies the amended statute,
11-1 the text of Section 256.101(a), Occupations Code, as set out in
11-2 Section 4.01 of this Act, gives effect to changes made by Section
11-3 4, Chapter 627, Acts of the 76th Legislature, Regular Session,
11-4 1999.
11-5 (b) To the extent of any conflict, this Act prevails over
11-6 another Act of the 77th Legislature, Regular Session, 2001,
11-7 relating to nonsubstantive additions and corrections in enacted
11-8 codes.
11-9 ARTICLE 5. REPAYMENT OF DENTAL LOANS
11-10 SECTION 5.01. Section 61.904(a), Education Code, is amended
11-11 to read as follows:
11-12 (a) The board may provide repayment assistance for the
11-13 repayment of any student loan for education at a public or private
11-14 institution of higher education [in this state], including loans
11-15 for undergraduate education, received by a dentist through any
11-16 lender.
11-17 SECTION 5.02. Section 61.903, Education Code, is repealed.
11-18 ARTICLE 6. EFFECTIVE DATE
11-19 SECTION 6.01. This Act takes effect September 1, 2001.