1-1 By: Maxey, et al. (Senate Sponsor - Moncrief) H.B. No. 3507
1-2 (In the Senate - Received from the House May 4, 2001;
1-3 May 7, 2001, read first time and referred to Committee on Health
1-4 and Human Services; May 11, 2001, reported favorably by the
1-5 following vote: Yeas 7, Nays 0; May 11, 2001, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the regulation of dentistry and the provision of dental
1-9 services.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 ARTICLE 1. DENTAL SERVICES UNDER THE MEDICAL
1-12 ASSISTANCE PROGRAM
1-13 SECTION 1.01. Subchapter B, Chapter 32, Human Resources Code,
1-14 is amended by adding Section 32.053 to read as follows:
1-15 Sec. 32.053. DENTAL SERVICES. (a) For purposes of this
1-16 section, the "dental necessity" for a dental service or product is
1-17 based on whether a prudent dentist, acting in accordance with
1-18 generally accepted practices of the professional dental community
1-19 and within the parameters of care of the American Dental
1-20 Association and within the quality assurance criteria of the
1-21 American Academy of Pediatric Dentistry, as applicable, would
1-22 provide the service or product to a patient to diagnose, prevent,
1-23 or treat orofacial pain, infection, disease, dysfunction, or
1-24 disfiguration.
1-25 (b) A dental service or product may not be provided under
1-26 the medical assistance program unless there is a dental necessity
1-27 for the service or product.
1-28 (c) In providing dental services under the medical
1-29 assistance program, the department shall:
1-30 (1) ensure that a stainless steel crown is not used as
1-31 a preventive measure;
1-32 (2) require a dentist participating in the medical
1-33 assistance program to document, through x-rays or other methods
1-34 established by department rule, the dental necessity for a
1-35 stainless steel crown before the crown is applied;
1-36 (3) require a dentist participating in the medical
1-37 assistance program to comply with a minimum standard of
1-38 documentation and recordkeeping for each of the dentist's patients,
1-39 regardless of whether the patient's costs are paid privately or
1-40 through the medical assistance program;
1-41 (4) replace the 15-point system used for determining
1-42 the dental necessity for hospitalization and general anesthesia
1-43 with a more objective and comprehensive system developed by the
1-44 department; and
1-45 (5) take all necessary action to eliminate fraud in
1-46 the provision of dental services under the medical assistance
1-47 program, including:
1-48 (A) adopting a zero-tolerance policy toward
1-49 fraud;
1-50 (B) aggressively investigating and prosecuting
1-51 any dentist who abuses the system for reimbursement under the
1-52 medical assistance program; and
1-53 (C) randomly auditing all dentists participating
1-54 in the medical assistance program and conducting targeted audits of
1-55 dentists whose billing activities under the medical assistance
1-56 program are excessive or otherwise inconsistent with the billing
1-57 activities of other similarly situated dentists.
1-58 (d) In setting reimbursement rates for dental services under
1-59 the medical assistance program, the department shall:
1-60 (1) set the reimbursement rate for a stainless steel
1-61 crown at an amount equal to the reimbursement rate for an amalgam
1-62 or resin filling;
1-63 (2) reduce the amount of the hospitalization fee in
1-64 effect on December 1, 2000, and redistribute amounts made available
2-1 through reduction of that fee to other dental services for which
2-2 adequate accountability measures exist; and
2-3 (3) eliminate the behavior management fee, except for
2-4 patients diagnosed with a mental or physical disability, and the
2-5 nutritional consultation fee and redistribute amounts made
2-6 available through elimination of those fees to other commonly
2-7 billed dental services for which adequate accountability measures
2-8 exist.
2-9 (e) The department shall develop the minimum standard
2-10 described by Subsection (c)(3) in cooperation with the State Board
2-11 of Dental Examiners.
2-12 SECTION 1.02. If before implementing any provision of this
2-13 article a state agency determines that a waiver or authorization
2-14 from a federal agency is necessary for implementation of that
2-15 provision, the agency affected by the provision shall request the
2-16 waiver or authorization and may delay implementing that provision
2-17 until the waiver or authorization is granted.
2-18 ARTICLE 2. REGULATION OF TELEDENTISTRY
2-19 SECTION 2.01. For purposes of this article, a licensed
2-20 dentist may delegate orally, in writing, or through advanced audio
2-21 and video telecommunications services a service, task, or procedure
2-22 to a dental hygienist who is under the supervision and
2-23 responsibility of the dentist, if:
2-24 (1) the dental hygienist is licensed to perform the
2-25 service, task, or procedure;
2-26 (2) the supervising dentist examines the patient
2-27 either in person or through advanced audio and video
2-28 telecommunications services:
2-29 (A) at the time the service, task, or procedure
2-30 is performed by the dental hygienist; or
2-31 (B) during the 12 calendar months preceding the
2-32 date of performance of the service, task, or procedure by the
2-33 dental hygienist; and
2-34 (3) the dental hygienist does not:
2-35 (A) diagnose a dental disease or ailment;
2-36 (B) prescribe a treatment or a regimen;
2-37 (C) prescribe, order, or dispense medication; or
2-38 (D) perform any procedure that is irreversible
2-39 or involves the intentional cutting of soft or hard tissue by any
2-40 means.
2-41 SECTION 2.02. (a) In this section:
2-42 (1) "Dental professional" means:
2-43 (A) a dentist licensed under Subtitle D, Title
2-44 3, Occupations Code; or
2-45 (B) a dental hygienist licensed under Chapter
2-46 262, Occupations Code, practicing under the supervision of a
2-47 dentist.
2-48 (2) "Student" means a person who is under 19 years of
2-49 age, is enrolled in a public school, and receives dental services
2-50 under Chapter 32, Human Resources Code.
2-51 (3) "Teledentistry dental services" means a dental
2-52 service that utilizes, in whole or in part, advanced
2-53 telecommunications technology including:
2-54 (A) compressed digital interactive video, audio,
2-55 or data transmission;
2-56 (B) clinical data transmission via computer
2-57 imaging for teleradiology or telepathology; and
2-58 (C) other technology that facilitates access in
2-59 rural and underserved counties to dental services or dental
2-60 specialty expertise.
2-61 (b) The commissioner of human services shall appoint a
2-62 program administrator to administer a pilot program that uses
2-63 teledentistry and other methods of delivering dental services to
2-64 provide dental services to students in one public school district
2-65 in the state.
2-66 (c) The program administrator shall establish an advisory
2-67 committee to assist the program administrator in developing and
2-68 implementing the pilot program.
2-69 (d) In developing the pilot program, the program
3-1 administrator shall design the program in a manner that:
3-2 (1) increases access to dental services and enhances
3-3 the delivery of dental services to students;
3-4 (2) ensures the provision of oral health education
3-5 services;
3-6 (3) provides for effective and appropriate supervision
3-7 by a dentist of other dental professionals providing care under the
3-8 program; and
3-9 (4) enables the state to determine whether extension
3-10 of the use of teledentistry would improve the delivery of dental
3-11 services.
3-12 (e) The program administrator shall adopt procedures as
3-13 necessary to:
3-14 (1) ensure that appropriate care, including quality of
3-15 care, is provided to students who receive teledentistry dental
3-16 services;
3-17 (2) ensure adequate supervision of dental
3-18 professionals who are not dentists and who provide teledentistry
3-19 dental services;
3-20 (3) establish the maximum number of dental
3-21 professionals who are not dentists that a dentist may supervise;
3-22 and
3-23 (4) require a face-to-face consultation with a dentist
3-24 within a certain number of days following a teledentistry dental
3-25 service.
3-26 (f) Only a teledentistry dental service initiated or
3-27 provided by a licensed dentist in this state may be reimbursed
3-28 under the Medicaid program. Medicaid reimbursement for a
3-29 teledentistry dental service shall be at the same rate as the
3-30 Medicaid program reimburses for a comparable in-person dental
3-31 service. A request for reimbursement may not be denied solely
3-32 because an in-person consultation between a dentist or other dental
3-33 professional and a patient did not occur. Reimbursement for a
3-34 dental hygienist for service shall be made through the supervising
3-35 dentist.
3-36 (g) A dental hygienist must act under the remote supervision
3-37 of a local dentist. Both the dentist and the hygienist must be
3-38 located within the boundaries of the school district served by the
3-39 pilot program.
3-40 (h) Images and assessment information shall be sent by the
3-41 dental hygienist to a supervising dentist either live or by means
3-42 of store and forward technology. After a dentist has reviewed the
3-43 required information, the dentist may authorize the provision of
3-44 preventive services by the dental hygienist located at the school.
3-45 (i) A dental hygienist participating in the pilot program
3-46 may initiate screening and assessment services and, under the
3-47 supervision of a dentist, may perform any procedure the hygienist
3-48 is authorized to perform under law.
3-49 (j) A teledentistry dental service may not be provided if an
3-50 in-person consultation with a dentist is reasonably available to a
3-51 student. Dentists and other dental professionals participating in
3-52 the pilot program shall make a good faith effort to identify and
3-53 coordinate with existing providers to preserve and protect existing
3-54 dental care systems and dental relationships.
3-55 (k) The program administrator shall establish a control
3-56 group not to exceed 1,000 students to provide a benchmark for
3-57 measuring the performance of the pilot program. Each student in
3-58 the control group shall be examined by a dentist, in person, at the
3-59 end of the program to evaluate the effectiveness of teledentistry
3-60 dental services provided during the program. The examining dentist
3-61 must practice in a dental office located outside the boundaries of
3-62 the school district served by the pilot program.
3-63 (l) The program administrator shall use the results of the
3-64 pilot program to:
3-65 (1) determine the efficacy of teledentistry; and
3-66 (2) determine the effectiveness of teledentistry in
3-67 increasing access to dental services and improving oral health of
3-68 students.
3-69 (m) A dental professional who provides teledentistry dental
4-1 services shall ensure that the informed consent of the student or a
4-2 person authorized to provide consent for the student is obtained
4-3 before teledentistry dental services are provided.
4-4 (n) Students participating in the pilot program must be
4-5 referred to local dentists for restorative care and monitored to
4-6 ensure that restorative services are provided.
4-7 (o) Not later than December 31, 2002, the program
4-8 administrator shall submit a report to the legislature containing
4-9 the following:
4-10 (1) the number of students who received teledentistry
4-11 dental services;
4-12 (2) the types of teledentistry dental services
4-13 provided;
4-14 (3) the cost and level of utilization of teledentistry
4-15 dental services;
4-16 (4) the effect of the pilot program on school
4-17 absenteeism of students in the control group;
4-18 (5) a description of improvements in the oral health
4-19 of students in the pilot program; and
4-20 (6) recommendations for changes in or the expansion of
4-21 the pilot program.
4-22 (p) This article expires and the advisory committee is
4-23 abolished December 31, 2002.
4-24 SECTION 2.03. (a) The commissioner of human services shall
4-25 appoint a program administrator for the teledentistry pilot program
4-26 not later than the 30th day after the effective date of this
4-27 article.
4-28 (b) The program administrator shall appoint an advisory
4-29 committee and shall begin implementing the teledentistry pilot
4-30 program not later than the 30th day after the date the program
4-31 administrator is appointed.
4-32 ARTICLE 3. ALTERNATIVE TRAINING OF DENTAL HYGIENISTS
4-33 SECTION 3.01. Section 256.053, Occupations Code, is amended
4-34 to read as follows:
4-35 Sec. 256.053. ELIGIBILITY FOR LICENSE. To qualify for a
4-36 license, an applicant must be:
4-37 (1) at least 18 years of age;
4-38 (2) a graduate of an accredited high school or hold a
4-39 certificate of high school equivalency; and
4-40 (3) a graduate of a recognized school of dentistry or
4-41 dental hygiene accredited by the Commission on Dental Accreditation
4-42 of the American Dental Association and approved by the board, or
4-43 have provided evidence satisfactory to the board that the applicant
4-44 has completed an alternative dental hygiene training program
4-45 approved by the board that meets the requirements of Section
4-46 256.0531.
4-47 SECTION 3.02. Subchapter B, Chapter 256, Occupations Code, is
4-48 amended by adding Section 256.0531 to read as follows:
4-49 Sec. 256.0531. ALTERNATIVE DENTAL HYGIENE TRAINING PROGRAMS.
4-50 (a) It is the intent of the legislature that programs approved by
4-51 the board under this section provide hygiene training that is
4-52 substantially equivalent to training provided under traditional
4-53 programs.
4-54 (b) An alternative dental hygiene training program must meet
4-55 the following requirements:
4-56 (1) the program must require hygiene students to
4-57 complete four semesters of didactic education from a school of
4-58 dentistry, dental hygiene school, or other educational institution
4-59 approved by the board;
4-60 (2) didactic education shall be provided by
4-61 instruction in the classroom or by distance learning, remote
4-62 coursework, or similar modes of instruction offered by an
4-63 institution accredited by the Commission on Dental Accreditation of
4-64 the American Dental Association;
4-65 (3) didactic education shall include instruction in
4-66 anatomy, pharmacology, x-ray, ethics, jurisprudence, hygiene, and
4-67 any other subject regularly taught in reputable schools of
4-68 dentistry and dental hygiene that the board may require;
4-69 (4) the program must require hygiene students to
5-1 complete not less than 1,000 hours of clinical training under the
5-2 direct supervision of a dentist qualified under Subsection (d) or a
5-3 dental hygienist qualified under Subsection (f) during a 12-month
5-4 period. Students must satisfactorily complete 75 full-mouth
5-5 prophylaxes and demonstrate the ability to accurately record the
5-6 location and extent of dental restorations, chart mobility,
5-7 furcations, gingival recession, keratinized gingiva, and pocket
5-8 depth on six aspects of each tooth; and
5-9 (5) clinical training may occur simultaneously with
5-10 didactic education.
5-11 (c) Prior to commencing clinical training, a hygiene student
5-12 must have completed no less than two years of full-time employment
5-13 in a position involving clinical duties with dental patients.
5-14 (d) To be qualified to train a hygiene student under this
5-15 section, a dentist must:
5-16 (1) be licensed in Texas and have practiced in Texas
5-17 for at least five years;
5-18 (2) have completed a certification or calibration
5-19 course approved by the board for purposes of this section; and
5-20 (3) meet recertification requirements at intervals of
5-21 no more than three years.
5-22 (e) A hygiene student who completes the requirements of a
5-23 program under this section must satisfactorily pass the examination
5-24 required for all hygiene license applicants under this chapter.
5-25 (f) A dental hygienist may train hygiene students under this
5-26 section if:
5-27 (1) the dental hygienist is employed by a dentist who
5-28 provides training under this section and the hygienist works under
5-29 the direct supervision of the dentist in the same office as the
5-30 dentist;
5-31 (2) the dental hygienist has practiced full-time
5-32 dental hygiene for the five years immediately preceding the time
5-33 the training is provided; and
5-34 (3) the dental hygienist has completed a certification
5-35 or calibration course approved by the board and meets
5-36 recertification requirements at intervals of no more than five
5-37 years.
5-38 (g) A dentist who supervises a dental hygienist trained
5-39 under this section has the same liability for acts performed by the
5-40 hygienist as if the hygienist were trained in a different manner.
5-41 (h) The board shall implement an alternative dental hygiene
5-42 training program no later than January 1, 2002.
5-43 (i) The board shall appoint an advisory committee to advise
5-44 the board in developing the alternative dental hygiene training
5-45 program. The advisory committee consists of the following members
5-46 appointed by the board:
5-47 (1) three dental hygienists nominated by a statewide
5-48 association of dental hygienists;
5-49 (2) three dentists nominated by a statewide
5-50 association of dentists;
5-51 (3) one dental educator nominated by the State Board
5-52 of Dental Examiners; and
5-53 (4) one dental hygienist educator nominated by the
5-54 Hygiene Advisory Committee to the State Board of Dental Examiners.
5-55 (j) In developing the program, the advisory committee board
5-56 shall consider the standards adopted by the Commission on Dental
5-57 Accreditation.
5-58 SECTION 3.03. The program, including the clinical training
5-59 component, must be accredited by the Commission on Dental
5-60 Accreditation by December 31, 2004, or the program expires.
5-61 SECTION 3.04. The board may not issue a license to a graduate
5-62 of an alternative training program under Section 256.0531,
5-63 Occupations Code, unless the program is accredited by the
5-64 Commission on Dental Accreditation.
5-65 ARTICLE 4. DELEGATION OF CERTAIN ACTS BY DENTISTS
5-66 SECTION 4.01. Section 258.002, Occupations Code, is amended
5-67 by amending Subsection (b) and adding Subsection (c) to read as
5-68 follows:
5-69 (b) A licensed dentist may delegate, under Subsection (a),
6-1 the application of a pit and fissure sealant to a dental assistant
6-2 if the dentist is a Medicaid provider. Cleansing of the occlusal
6-3 and smooth surfaces of the teeth by a dental assistant is allowed
6-4 immediately prior to and for the sole purpose of preparing the
6-5 tooth area for the placement of pit and fissure sealants or
6-6 orthodontic bonding resin, and shall not be billed as a
6-7 prophylaxis.
6-8 (c) The board by rule shall establish guidelines regarding
6-9 the types of dental acts that may be properly or safely delegated
6-10 by a dentist, including a determination of which delegated dental
6-11 acts, if any, require competency testing before a person may
6-12 perform the act.
6-13 SECTION 4.02. Subchapter D, Chapter 262, Occupations Code, is
6-14 amended by adding Section 262.1515 to read as follows:
6-15 Sec. 262.1515. DELEGATION OF DUTIES TO DENTAL HYGIENIST
6-16 PRACTICING IN CERTAIN LONG-TERM CARE FACILITIES AND SCHOOL-BASED
6-17 HEALTH CENTERS. (a) A licensed dentist may delegate a service,
6-18 task, or procedure, pursuant to this section, to a dental
6-19 hygienist, without complying with Section 262.151(a)(2) if:
6-20 (1) the dental hygienist has at least two years'
6-21 experience in the practice of dental hygiene; and
6-22 (2) the service, task, or procedure is performed in
6-23 one of the following locations:
6-24 (A) a nursing facility as defined in Section
6-25 242.301, Health and Safety Code; or
6-26 (B) a school-based health center established
6-27 under Section 38.011, Education Code, as added by Chapter 1418,
6-28 Acts of the 76th Legislature, Regular Session, 1999.
6-29 (b) The patient must be referred to a licensed dentist after
6-30 the completion of a service, task, or procedure performed under
6-31 Subsection (a).
6-32 (c) A dental hygienist may not perform a second set of
6-33 delegated tasks or procedures until the patient has been examined
6-34 by a dentist in compliance with Section 262.151(a)(2).
6-35 (d) A dental hygienist may not perform any service, task, or
6-36 procedure under this section without the express authorization of a
6-37 dentist.
6-38 (e) The nursing facility or school-based health center shall
6-39 note each delegated service, task, or procedure performed by the
6-40 dental hygienist under this section in the patient's medical
6-41 records.
6-42 SECTION 4.03. Section 265.003, Occupations Code, is amended
6-43 to read as follows:
6-44 Sec. 265.003. PERMITTED DUTIES. (a) A dental assistant who
6-45 is not professionally licensed may:
6-46 (1) be employed by and work in the office of a
6-47 licensed and practicing dentist; and
6-48 (2) perform one or more delegated dental acts under
6-49 the direct supervision, direction, and responsibility of the
6-50 dentist, including the application of a pit and fissure sealant.
6-51 (b) A dental assistant may apply a pit and fissure sealant
6-52 under Subsection (a) only if the assistant is certified to apply a
6-53 pit and fissure sealant under Section 265.004.
6-54 SECTION 4.04. Chapter 265, Occupations Code, is amended by
6-55 adding Section 265.004 to read as follows:
6-56 Sec. 265.004. PIT AND FISSURE SEALANT CERTIFICATE. (a) The
6-57 board shall issue a pit and fissure sealant certificate to a dental
6-58 assistant who qualifies under this section.
6-59 (b) To qualify for a certificate, an applicant must:
6-60 (1) have at least two years' experience as a dental
6-61 assistant; and
6-62 (2) have successfully completed a minimum of 16 hours
6-63 of clinical and didactic education in pit and fissure sealants
6-64 taken through an accredited dental hygiene program approved by the
6-65 board.
6-66 (c) The educational program under Subsection (b) must
6-67 include courses on:
6-68 (1) infection control;
6-69 (2) cardiopulmonary resuscitation;
7-1 (3) treatment of medical emergencies;
7-2 (4) microbiology;
7-3 (5) chemistry;
7-4 (6) dental anatomy;
7-5 (7) ethics related to pit and fissure sealant
7-6 application;
7-7 (8) jurisprudence related to pit and fissure sealant
7-8 application; and
7-9 (9) the correct application of sealants, including the
7-10 actual clinical application of sealants.
7-11 (d) To maintain a certificate under this section, the dental
7-12 assistant must complete at least six hours of continuing education
7-13 in technical and scientific coursework each year.
7-14 (e) The board shall adopt rules as necessary to implement
7-15 this section, including rules regarding renewal requirements for a
7-16 certificate issued under this section.
7-17 SECTION 4.05. Not later than March 1, 2002, the State Board
7-18 of Dental Examiners shall adopt the rules required by Section
7-19 265.004, Occupations Code, as added by this Act.
7-20 ARTICLE 5. TEMPORARY RECIPROCAL LICENSE
7-21 SECTION 5.01. Subchapter C, Chapter 262, Occupations Code, is
7-22 amended by adding Section 262.1015 to read as follows:
7-23 Sec. 262.1015. TEMPORARY RECIPROCAL LICENSE. (a) The State
7-24 Board of Dental Examiners, upon payment by the applicant of a fee
7-25 set by the board, shall grant a temporary license to practice
7-26 dentistry to any reputable dentist or a temporary license to
7-27 practice dental hygiene to any reputable dental hygienist who:
7-28 (1) meets all requirements of Section 256.101 except
7-29 those of Subsection (a)(8); and
7-30 (2) is employed by a nonprofit corporation that
7-31 accepts Medicaid reimbursement.
7-32 (b) A license granted under this section expires immediately
7-33 when a licensee fails to meet the requirements of this section.
7-34 ARTICLE 6. REPAYMENT OF DENTAL LOANS
7-35 SECTION 6.01. Section 61.904(a), Education Code, is amended
7-36 to read as follows:
7-37 (a) The board may provide repayment assistance for the
7-38 repayment of any student loan for education at a public or private
7-39 institution of higher education [in this state], including loans
7-40 for undergraduate education, received by a dentist through any
7-41 lender.
7-42 SECTION 6.02. Section 61.903, Education Code, is repealed.
7-43 ARTICLE 7. EFFECTIVE DATE
7-44 SECTION 7.01. This Act takes effect September 1, 2001.
7-45 * * * * *