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 American Dental Association's
1-12     parameters of care for dentistry and within the quality assurance
1-13     criteria of the American Academy of Pediatric Dentistry, as
1-14     applicable, would provide the service or product to a patient to
1-15     diagnose, prevent, or treat orofacial pain, infection, disease,
1-16     dysfunction, or 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)  set the reimbursement rate for a stainless steel
2-23     crown at an amount equal to the reimbursement rate for an amalgam
2-24     or resin filling;
2-25                 (2)  reduce the amount of the hospitalization fee in
2-26     effect on December 1, 2000, and redistribute amounts made available
 3-1     through reduction of that fee to other commonly billed dental
 3-2     services for which adequate accountability measures exist;
 3-3                 (3)  eliminate the nutritional consultation fee and
 3-4     redistribute amounts made available through elimination of that fee
 3-5     to other commonly billed dental services for which adequate
 3-6     accountability measures exist;
 3-7                 (4)  provide for reimbursement of a behavior management
 3-8     fee only if:
 3-9                       (A)  the patient receiving dental treatment has
3-10     been previously diagnosed with mental retardation or a mental
3-11     disability or disorder, and extraordinary behavior management
3-12     techniques are necessary for therapeutic dental treatment because
3-13     of the patient's uncooperative behavior; and
3-14                       (B)  the dentist includes in the patient's
3-15     records and on the claim form for reimbursement a narrative
3-16     description of:
3-17                             (i)  the specific behavior problem
3-18     demonstrated by the patient that required the use of behavior
3-19     management techniques;
3-20                             (ii)  the dentist's initial efforts to
3-21     manage the patient's behavior through routine behavior management
3-22     techniques; and
3-23                             (iii)  the dentist's extraordinary behavior
3-24     management techniques subsequently required to manage the patient's
3-25     behavior; and
3-26                 (5)  redistribute amounts made available through
 4-1     limitation of the behavior management fee under Subdivision (4) to
 4-2     other commonly billed dental services for which adequate
 4-3     accountability measures exist.
 4-4           (e)  The department shall develop the minimum standard
 4-5     described by Subsection (c)(3) in cooperation with the State Board
 4-6     of Dental Examiners.
 4-7           SECTION 2.  If before implementing any provision of this Act
 4-8     a state agency determines that a waiver or authorization from a
 4-9     federal agency is necessary for implementation of that provision,
4-10     the agency affected by the provision shall request the waiver or
4-11     authorization and may delay implementing that provision until the
4-12     waiver or authorization is granted.
4-13           SECTION 3.  This Act takes effect immediately if it receives
4-14     a vote of two-thirds of all the members elected to each house, as
4-15     provided by Section 39, Article III, Texas Constitution.  If this
4-16     Act does not receive the vote necessary for immediate effect, this
4-17     Act takes effect September 1, 2001.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I hereby certify that S.B. No. 1411 passed the Senate on
         April 20, 2001, by the following vote:  Yeas 30, Nays 0, one
         present not voting; and that the Senate concurred in House
         amendments on May 26, 2001, by a viva-voce vote.
                                             _______________________________
                                                 Secretary of the Senate
               I hereby certify that S.B. No. 1411 passed the House, with
         amendments, on May 23, 2001, by a non-record vote.
                                             _______________________________
                                                Chief Clerk of the House
         Approved:
         _______________________________
                      Date
         _______________________________
                    Governor