By: Moncrief S.B. No. 1411
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,
1-6 is amended by adding Section 32.053 to read as follows:
1-7 Sec. 32.053. DENTAL SERVICES. (a) For purposes of this
1-8 section, the "dental necessity" for a dental service or product is
1-9 defined as the circumstances under which a prudent dentist, acting
1-10 in accordance with generally accepted practices of the professional
1-11 dental community and within the parameters of care of the American
1-12 Dental Association and within the quality assurance criteria of the
1-13 American Academy of Pediatric Dentistry, as applicable, would
1-14 provide the service or product to a patient to diagnose, prevent,
1-15 or treat orofacial pain, infection, disease, dysfunction, or
1-16 disfiguration.
1-17 (b) A dental service or product may not be provided under
1-18 the medical assistance program unless there is a dental necessity
1-19 for the service or product.
1-20 (c) In providing dental services under the medical
1-21 assistance program, the department shall:
1-22 (1) ensure that a stainless steel crown is not used as
1-23 a preventive measure;
1-24 (2) require a dentist participating in the medical
1-25 assistance program to document, through x-rays or other methods
2-1 established by department rule, the dental necessity for a
2-2 stainless steel crown before the crown is applied;
2-3 (3) require a dentist participating in the medical
2-4 assistance program to comply with a minimum standard of
2-5 documentation and recordkeeping for each of the dentist's patients;
2-6 (4) replace the 15-point system used for determining
2-7 the dental necessity for hospitalization and general anesthesia
2-8 with a more objective and comprehensive system developed by the
2-9 department; and
2-10 (5) take all necessary action to eliminate unlawful
2-11 acts described by Section 36.002 in the provision of dental
2-12 services under the medical assistance program, including:
2-13 (A) aggressively investigating and prosecuting
2-14 any dentist who abuses the system for reimbursement under the
2-15 medical assistance program; and
2-16 (B) conducting targeted audits of dentists whose
2-17 billing activities under the medical assistance program are
2-18 excessive or otherwise inconsistent with the billing activities of
2-19 other similarly situated dentists.
2-20 (d) In setting reimbursement rates for dental services under
2-21 the medical assistance program, the department shall:
2-22 (1) reduce the amount of the hospitalization fee in
2-23 effect on December 1, 2000, and redistribute amounts made available
2-24 through reduction of that fee to other commonly billed dental
2-25 services for which adequate accountability measures exist;
2-26 (2) eliminate the nutritional consultation fee and
3-1 redistribute amounts made available through elimination of that fee
3-2 to other commonly billed dental services for which adequate
3-3 accountability measures exist;
3-4 (3) provide for reimbursement of a behavior management
3-5 fee only if:
3-6 (A) the patient receiving dental treatment has
3-7 been previously diagnosed with mental retardation or a mental
3-8 disability or disorder, and extraordinary behavior management
3-9 techniques are necessary for therapeutic dental treatment because
3-10 of the patient's uncooperative behavior; and
3-11 (B) the dentist includes in the patient's
3-12 records and on the claim form for reimbursement a narrative
3-13 description of:
3-14 (i) the specific behavior problem
3-15 demonstrated by the patient that required the use of behavior
3-16 management techniques;
3-17 (ii) the dentist's initial efforts to
3-18 manage the patient's behavior through routine behavior management
3-19 techniques; and
3-20 (iii) the dentist's extraordinary behavior
3-21 management techniques subsequently required to manage the patient's
3-22 behavior; and
3-23 (4) redistribute amounts made available through
3-24 limitation of the behavior management fee under Subdivision (3) to
3-25 other commonly billed dental services for which adequate
3-26 accountability measures exist.
4-1 (e) The department shall develop the minimum standard
4-2 described by Subsection (c)(3) in cooperation with the State Board
4-3 of Dental Examiners.
4-4 SECTION 2. If before implementing any provision of this Act
4-5 a state agency determines that a waiver or authorization from a
4-6 federal agency is necessary for implementation of that provision,
4-7 the agency affected by the provision shall request the waiver or
4-8 authorization and may delay implementing that provision until the
4-9 waiver or authorization is granted.
4-10 SECTION 3. This Act takes effect immediately if it receives
4-11 a vote of two-thirds of all the members elected to each house, as
4-12 provided by Section 39, Article III, Texas Constitution. If this
4-13 Act does not receive the vote necessary for immediate effect, this
4-14 Act takes effect September 1, 2001.