LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
April 3, 2001
TO: Honorable Patricia Gray, Chair, House Committee on Public
Health
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB3507 by Maxey (Relating to the regulation of dentistry
and the provision of dental services.), As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB3507, As Introduced: negative impact of $(8,040,044) through *
* the biennium ending August 31, 2003. *
* *
* The bill would make no appropriation but could provide the legal *
* basis for an appropriation of funds to implement the provisions of *
* the bill. *
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General Revenue-Related Funds, Five-Year Net Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2002 $(4,055,967) *
* 2003 (3,984,077) *
* 2004 (3,985,045) *
* 2005 (3,985,045) *
* 2006 (3,985,045) *
****************************************************
All Funds, Five-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Revenue Revenue Savings/ Number of *
* (Cost) from Gain/(Loss) Gain/(Loss) (Cost) from State *
* General from from GR Match Employees *
* Revenue General General for from FY 2001 *
* Fund Revenue Revenue Medicaid *
* 0001 Fund Fund 0758 *
* 0001 0001 *
* 2002 $(39,128) $39,128 $(121,825) 1.0 *
* $(3,934,142) *
* 2003 (24,953) 24,953 (121,825) (3,862,252) 1.0 *
* 2004 (24,953) 24,953 (121,825) (3,863,220) 1.0 *
* 2005 (24,953) 24,953 (121,825) (3,863,220) 1.0 *
* 2006 (24,953) 24,953 (121,825) (3,863,220) 1.0 *
***********************************************************************
*****************************************************
* Fiscal Year Probable Savings/(Cost) from *
* Federal Funds - Federal *
* 0555 *
* 2002 $(5,907,838) *
* 2003 (5,812,728) *
* 2004 (5,811,761) *
* 2005 (5,811,761) *
* 2006 (5,811,761) *
*****************************************************
Fiscal Analysis
The bill would make a number of changes regarding the regulation of
dentistry and the provision of dental services. Article I would reduce
or eliminate Medicaid fees for certain dental procedures and redistribute
freed-up funding to other commonly billed dental services for which
adequate accountability measures exist. Consequently, Article I would
not have a significant fiscal impact.
Article II would require the Health and Human Services Commission by rule
to require each Medicaid-operating agency to provide Medicaid
reimbursement for a teledental consultation provided by a licensed
dentist.
Article III would allow dentists to delegate the application of a pit and
fissure sealant and require the State Board of Dental Examiners (SBDE)
to provide a certification to allow dental assistants meeting certain
eligibility requirements to apply a pit and fissure sealant under the
delegation authority of a dentist. Article III would also allow a
dentist to delegate the application of a pit and fissure sealant to a
dental hygienist apart from the dentist's supervision under certain
conditions and authorize a dentist who is a Medicaid provider to delegate
the application of a pit and fissure sealant.
Article IV would revise reciprocity licensing, establishing a new
requirement that the individual practice in a medically underserved area
of the state.
Article V would remove the in-state institution limit on educational
repayment assistance provided by SBDE for dentists.
Methodology
Article II
The Department of Health (TDH) estimates the provision of teledentistry
in the Medicaid program would result in 77,836 additional services per
year at a cost of $95.35 per service. The federal share of client
services expenses would total 60.2 percent in FY 2002, 60.08 percent in
FY 2003, and 60.07 percent in each subsequent year.
Article III
SBDE estimates the bill would require $9,575 in system upgrades to create
a database and an application program to track and verify specific
information for each dental assistant applying for certification. SBDE
also estimates that approximately 2,000 dental assistants will seek
certification each year, and one FTE would be required to verify the
training and experience for each applicant and enter all necessary
information into the new database. The estimated salary and fringe
benefit cost associated with the FTE is $24,953 per year, with a one-time
start up cost of $4,601 in FY 2002. It is assumed that SBDE would
adjust fees to increase revenue, thereby offsetting costs.
TDH estimates allowing dental assistants to perform the application of a
pit and fissure sealant would result in 77,836 additional services per
year at a cost of $24.38 per service. TDH estimates allowing hygienists
to act independently would result in 7,025 additional services per year
at a cost of $50.63 per service. The federal share of client services
expenses would total 60.20% in FY 2002, 60.08% in FY 2003, and 60.07% in
each subsequent year. TDH also estimates a one-time automation cost to
establish hygienists as a new provider type and to accomplish related
claims processing changes, totaling $167,000 in FY 2002. This
administrative expense would be equally shared by the federal government
and the State.
Article IV
SBDE estimates the provision would reduce the number of applicants and
result in a loss in General Revenue, totaling $121,825 per year.
Article V
SBDE indicates the provision would not have a significant fiscal impact.
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies: 529 Health and Human Services Commission, 504
State Board of Dental Examiners, 324 Texas
Department of Human Services, 501 Texas Department
of Health
LBB Staff: JK, HD, PP