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A BILL TO BE ENTITLED
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AN ACT
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relating to the practice of dentistry, including the regulation of |
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dental service organizations; providing an administrative penalty. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle D, Title 3, Occupations Code, is |
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amended by adding Chapter 268 to read as follows: |
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CHAPTER 268. REGULATION OF DENTAL SERVICE ORGANIZATIONS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 268.001. DEFINITIONS. In this chapter: |
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(1) "Dental service agreement" means an agreement |
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between a dental service organization and a dentist under which the |
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dental service organization will: |
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(A) provide services related to the nonclinical |
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business aspects of a dental practice, including arranging or |
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providing financing, performing billing or payroll tasks, |
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processing patient insurance claims, scheduling or otherwise |
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interacting with patients, and performing other administrative |
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tasks; |
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(B) supervise or manage the employees or |
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contractors of the dentist; or |
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(C) employ or otherwise contract with a dentist |
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in the dentist's capacity as a dentist. |
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(2) "Dental service organization" means an entity |
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that: |
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(A) is owned wholly or partly by a person who is |
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not a dentist; and |
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(B) under a dental service agreement, provides or |
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offers to provide services to a dentist or employs or otherwise |
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contracts with a dentist in the dentist's capacity as a dentist. |
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(3) "Dentist" means a person licensed to practice |
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dentistry under this subtitle. |
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Sec. 268.002. APPLICATION TO CERTAIN BUSINESS ENTITIES. |
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For purposes of this chapter, an entity is considered to be owned by |
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a person if the entity is the person's sole proprietorship, or if |
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the entity is a partnership, corporation, limited liability |
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company, or other business entity in which the person is a partner, |
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shareholder, director, member, manager, or officer. |
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Sec. 268.003. EXEMPTION FROM REGISTRATION. An entity is |
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not required to obtain a certificate of registration under this |
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chapter if the services provided by the entity to a dentist consist |
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only of: |
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(1) leasing of office space; |
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(2) financing, either through a loan, lease-purchase, |
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or other financing arrangement, of an office or equipment used in a |
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dental practice; |
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(3) utility, security, or janitorial services; |
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(4) providing or administering insurance coverage of |
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any type; |
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(5) offering or providing a direct or indirect prepaid |
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dental plan; |
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(6) serving as administrator or executor of the estate |
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of a dentist or acting for a dentist adjudicated to be mentally |
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incompetent as provided by Section 260.001; or |
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(7) other services provided under a type of agreement |
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that has been exempted by board rule. |
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Sec. 268.004. EFFECT OF CHAPTER. This chapter does not |
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affect or change the practice of dentistry as described by Section |
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251.003, authorize a person to practice dentistry who is not |
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licensed to practice dentistry under Section 256.001, or authorize |
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a person not licensed to practice dentistry under Section 256.001 |
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to employ, contract with, or otherwise control another in the |
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practice of dentistry. |
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[Sections 268.005-268.050 reserved for expansion] |
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SUBCHAPTER B. POWERS AND DUTIES OF BOARD |
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Sec. 268.051. GENERAL POWERS AND DUTIES OF BOARD. The board |
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shall: |
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(1) administer this chapter; and |
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(2) adopt rules the board determines are necessary or |
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advisable to administer this chapter. |
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Sec. 268.052. FEES. (a) The board shall set the fees for |
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the issuance or renewal of a certificate of registration under this |
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chapter in amounts reasonable and necessary to cover the costs of |
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administering this chapter, except that the amount of the |
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application or renewal fee must equal or exceed the amount of the |
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dental application or renewal fee set by the board under Section |
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254.004. |
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(b) A holder of a certificate of registration that provides |
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services at more than one location shall annually pay a separate fee |
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for each location at which it provides services. The amount of the |
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fee under this subsection must be equal to the amount of the fee |
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paid by the certificate holder under Subsection (a). |
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[Sections 268.053-268.100 reserved for expansion] |
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SUBCHAPTER C. REGISTRATION AND RENEWAL REQUIREMENTS |
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Sec. 268.101. CERTIFICATE OF REGISTRATION REQUIRED. A |
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person may not act as a dental service organization unless the |
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person holds a certificate of registration issued under this |
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chapter. |
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Sec. 268.102. APPLICATION; APPLICATION FEE. (a) An |
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applicant for a certificate of registration under this chapter |
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must: |
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(1) apply to the board on a form and under rules |
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adopted by the board; and |
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(2) submit with the application a nonrefundable |
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application fee in an amount set by the board. |
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(b) The board by rule shall specify the information that |
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must be included on an application submitted to the board. The |
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rules must require each application to include: |
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(1) a written statement that the dental service |
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organization will comply with, and will not violate, Chapters 251, |
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258, 259, 262, 265, and 266 and board rules adopted under those |
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chapters; |
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(2) a list of each dental office or clinic within this |
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state at which the dental service organization will provide |
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services; |
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(3) a copy of each dental service agreement into which |
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the dental service organization has entered; |
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(4) a financial statement showing the dental service |
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organization's assets and liabilities for the preceding fiscal |
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year; and |
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(5) the name and address of each person who owns at |
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least 10 percent of the dental service organization and, if an owner |
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is not an individual, the name and address of each individual owning |
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at least 10 percent of that owner. |
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(c) The chief executive officer of the dental service |
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organization or an individual holding an equivalent position must |
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sign the application. |
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Sec. 268.103. TERM OF CERTIFICATE OF REGISTRATION. A |
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certificate of registration expires on the first anniversary of the |
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date of issuance. |
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Sec. 268.104. RENEWAL OF CERTIFICATE OF REGISTRATION. (a) |
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The holder of a certificate of registration who is otherwise |
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eligible to renew the certificate may renew an unexpired |
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certificate by paying the required renewal fee to the board before |
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the expiration date of the certificate. |
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(b) If a person's certificate of registration has been |
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expired for 90 days or less, the person may renew the certificate by |
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paying to the board a fee in an amount equal to one and one-half |
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times the required renewal fee. |
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(c) If the person's certificate of registration has been |
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expired for longer than 90 days but less than one year, the person |
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may renew the certificate by paying to the board a fee in an amount |
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equal to two times the required registration renewal fee. |
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(d) If the person's certificate of registration has been |
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expired for one year or longer, the person may not renew the |
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certificate. The person may obtain a new certificate of |
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registration by complying with the requirements and procedures for |
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obtaining an original certificate of registration. |
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(e) The board by rule may establish additional renewal |
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requirements. |
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[Sections 268.105-268.150 reserved for expansion] |
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SUBCHAPTER D. PROVISION OF SERVICES BY REGISTRATION HOLDER |
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Sec. 268.151. LIMITATIONS ON DENTAL SERVICE AGREEMENTS. |
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(a) A dental service organization may not enter into a dental |
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service agreement if the agreement: |
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(1) places limitations on communications between a |
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dentist and a patient concerning matters that are clinical in |
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nature and relate to the patient's care; |
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(2) establishes any standards, protocols, or practice |
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guidelines that conflict with generally accepted standards of care |
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within the dental profession; or |
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(3) authorizes the dental service organization to: |
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(A) select or influence the selection of specific |
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diagnostic examinations, treatments, or practices provided to a |
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patient; |
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(B) penalize or in any way discipline a dentist |
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for reporting a violation of a law regulating the practice of |
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dentistry or a board rule; |
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(C) limit or restrict access to or control of |
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supplies, instruments, or equipment considered reasonably |
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necessary by a dentist to provide diagnosis and treatment to a |
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patient; or |
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(D) impose a maximum or other standardized time |
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for the performance of a specific dental procedure or establish a |
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quota for a certain number of dental procedures to be performed |
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within a specified period. |
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(b) Each dental service agreement that a dental service |
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organization enters into with a dentist must state the limitations |
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set forth in Subsection (a) and that: |
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(1) the dentist is entitled to exercise the dentist's |
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independent professional judgment over all qualitative and |
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quantitative aspects of the delivery of dental care to a patient; |
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(2) the records of a diagnosis made and treatment |
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performed for and on a patient are the property of the dentist |
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performing the dental service and the records may only be |
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transferred in compliance with Subchapter C, Chapter 258, and board |
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rules; and |
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(3) each patient will be assigned to an individual |
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dentist to ensure continuity of treatment. |
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Sec. 268.152. EFFECT ON DENTIST RESPONSIBLE FOR TRAINING. |
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This chapter does not limit the ability of a dentist who is |
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responsible for training or supervising another dentist to |
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reasonably limit treatments or practices as a part of the training |
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or supervision of the dentist based on the competency to perform the |
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specific treatments or practices of the dentist being trained. |
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Sec. 268.153. NOTIFICATION OF CHANGE OF INFORMATION. (a) |
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The holder of a certificate of registration shall timely notify the |
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board of: |
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(1) any change of address of the person's place of |
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business; |
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(2) any change in the locations of the dental offices |
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or clinics at which the dental service organization provides |
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services; |
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(3) any change of owners or managers of the dental |
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service organization; and |
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(4) any change of the person's mailing address. |
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(b) Notification under Subsection (a) is timely if the board |
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receives the notice not later than the 60th day after the date the |
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change occurs. |
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[Sections 268.154-268.200 reserved for expansion] |
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SUBCHAPTER E. DISCIPLINARY ACTIONS; ENFORCEMENT |
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Sec. 268.201. GROUNDS FOR DISCIPLINARY ACTION. The board |
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may refuse to issue a certificate of registration, impose an |
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administrative penalty on a person who holds a certificate of |
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registration, suspend or revoke a person's certificate of |
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registration, or probate any portion of the suspension if, after a |
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hearing, the board determines that the applicant or certificate of |
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registration holder: |
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(1) has violated, aided another person in violating, |
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or required or allowed a person under the direction or control of |
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the person to violate: |
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(A) this chapter or a board rule adopted under |
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this chapter; or |
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(B) a law regulating the practice of dentistry, |
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including a law that regulates: |
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(i) a plan to provide, arrange for, pay for, |
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or reimburse any part of the cost of dental care services; or |
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(ii) the business of insurance; |
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(2) has committed fraud, been deceptive or dishonest, |
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or made a misrepresentation in: |
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(A) operating a dental service organization, |
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including in making patient referrals; or |
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(B) obtaining or seeking to obtain a certificate |
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of registration under this chapter; |
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(3) has employed or permitted a person not licensed to |
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practice dentistry to practice dentistry in an office that is |
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subject to the person's control or management; or |
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(4) holds a license or certificate to practice |
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dentistry or provide dental services under a dental service |
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agreement in another state and that state, based on an act by the |
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person that is the same as an act described in this section: |
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(A) reprimands the person; or |
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(B) suspends or revokes the person's license or |
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certificate or places the person on probation. |
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Sec. 268.202. PROCEDURES FOR DISCIPLINARY ACTION. The |
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board shall follow the procedures under Chapter 263 in a complaint |
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or disciplinary action under this chapter. |
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Sec. 268.203. INJUNCTION. The board may apply for a |
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restraining order or injunction to enforce this chapter or a board |
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rule adopted under this chapter. |
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SECTION 2. Chapter 254, Occupations Code, is amended by |
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adding Section 254.0091 to read as follows: |
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Sec. 254.0091. ASSISTANCE BY STATE AND LOCAL OFFICIALS. At |
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the board's request, the attorney general or the district attorney |
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or county attorney of the county in which a violation of state law |
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regulating the practice of dentistry is alleged to have occurred |
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shall take appropriate action to enforce this subtitle. |
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SECTION 3. Section 256.002(a), Occupations Code, is amended |
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to read as follows: |
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(a) An applicant for a license to practice dentistry must: |
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(1) be an individual who is at least 21 years of age; |
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(2) be of good moral character; and |
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(3) present proof of: |
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(A) graduation from a dental school accredited by |
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the Commission on Dental Accreditation of the American Dental |
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Association; or |
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(B) graduation from a dental school that is not |
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accredited by the commission and successful completion of training |
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in an American Dental Association approved specialty in an |
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education program accredited by the commission that consists of at |
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least two years of training as specified by the Council on Dental |
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Education. |
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SECTION 4. Subchapter B, Chapter 258, Occupations Code, is |
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amended by adding Section 258.055 to read as follows: |
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Sec. 258.055. PRACTICE OF DENTISTRY ON CERTAIN CHILDREN. |
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(a) Before performing a dental treatment or procedure on a child |
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younger than 18 years of age, a dentist must inform the child's |
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parent or guardian that the parent or guardian may be present in the |
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treatment room during the treatment or procedure. |
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(b) If a parent or guardian of a child younger than 18 years |
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of age has informed the dentist that the parent or guardian desires |
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to be present in the treatment room during the child's treatment or |
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procedure, the dentist may not perform the treatment or procedure |
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without the parent or guardian present unless the dentist |
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determines in the dentist's professional judgment that the presence |
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of the parent or guardian in the treatment room is likely to have an |
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adverse effect on the treatment or the child. |
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(c) In this section, "parent or guardian" includes a person |
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authorized by law to consent for the medical or dental treatment of |
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a child younger than 18 years of age. |
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SECTION 5. Not later than December 1, 2013, the State Board |
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of Dental Examiners shall adopt rules necessary to implement |
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Chapter 268, Occupations Code, as added by this Act. |
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SECTION 6. (a) Except as provided by Subsection (b) of this |
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section, this Act takes effect September 1, 2013. |
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(b) Section 268.101, Occupations Code, as added by this Act, |
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takes effect February 1, 2014. |