HBA-TBM H.B. 3507 77(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 3507 By: Maxey Public Health 7/3/2001 Enrolled BACKGROUND AND PURPOSE According to the Centers for Disease Control and Prevention, tooth decay is one of the most infectious diseases among children, and the longer an oral disease is left untreated, the more complex and damaging it can become. When the 77th Legislative session convened, Texas was suffering a severe shortage of dentists and dental hygienists (dental professionals). The Texas Senate Committee reported that in 1998 the population to dentist ratio in urban counties was 2,636:1 while the ratio in rural counties was 4,342:1. The committee report espoused several recommendations that could have improved the situation. It was believed that expanding student loan repayment programs as incentives for newly licensed dental professionals who practice in medically underserved communities would help alleviate the burden on rural dental professionals. Also, the report recommended authorizing a dentist to delegate dental procedures to a dental hygienist or authorizing a dental hygienist to perform preventative oral care procedures and screening outside the office to decrease the amount of time a dentist needed to spend with each patient, and thus expand access to dental care. Teledentistry could also supplement dental care to rural and medically underserved areas. The House Committee on General Investigating found some evidence of fraud in the Texas Health Steps Dental Services Program and recommended various changes to help eliminate abuse of the system. House Bill 3507 sets forth provisions related to student loan repayment, delegation, alternative training for dental hygienists, and teledentistry, and implements the recommendations of the House committee. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 1.01 (Section 32.053, Human Resources Code) and to the State Board of Dental Examiners in SECTION 3.02 (Section 256.0531, Occupations Code) and SECTION 4.04 (Section 265.004, Occupations Code) of this bill. ANALYSIS House Bill 3507 amends the Human Resources Code to prohibit a dental service or product from being provided under Medicaid unless there is a dental necessity for the service or product. The bill requires the Health and Human Services Commission (HHSC), in providing dental services under Medicaid, to: _ensure that a stainless steel crown is used only when medically necessary and not as a preventive measure; _require a dentist participating in Medicaid to document, through x-rays or other methods established by HHSC rule, the dental necessity for a stainless steel crown before it is applied; _require a dentist participating in Medicaid to comply with a minimum standard of documentation and record-keeping for each of the dentists; _establish such a minimum standard in cooperation with the State Board of Dental Examiners; _replace the 15-point system used for determining the dental necessity for hospitalization and general anesthesia with a more objective and comprehensive system developed by HHSC; _take all necessary action to eliminate unlawful acts in the provision of dental services; _reduce the hospitalization fee, limit the behavior management fee, and eliminate the nutritional consultation fee and redistribute amounts made available by such actions to other commonly billed dental services for which adequate accountability measures exist (Sec. 32.053). The bill requires the commissioner of health and human services to appoint a program administrator (administrator) to administer a pilot program that uses teledentistry and other methods of delivering dental services to provide dental services to students in one public school district in the state (SECTION 2.02). For purposes of the pilot program the bill authorizes a licensed dentist to use telecommunications technology to examine a patient and delegate an assignment through telecommunications technology to a dental hygienist who is under the supervision and responsibility of the dentist (SECTION 2.01). The bill requires the administrator to establish an advisory committee to assist the administrator in developing and implementing the pilot program. The bill sets forth provisions regarding the creation and administration of the pilot program, including reimbursement by Medicaid, supervision of a dental hygienist by a dentist, and the appointment of the administrator and the advisory committee. Not later than December 31, 2002, the administrator is required to submit a report to the legislature regarding the program. These provisions expire and the advisory committee is abolished December 31, 2002 (SECTION 2.02). H.B. 3507 amends the Occupations Code to provide that an applicant for a dental hygiene license can be a graduate of an alternative dental hygiene training program that is accredited by the Commission on Dental Accreditation (Sec. 256.053 and SECTION 3.04). The bill sets forth provisions regarding alternative dental hygiene training programs, including requirements such a program must meet, student experience, and training qualification. The State Board of Dental Examiners (board) is required to adopt an alternative dental hygiene training program no later than January 1, 2002, and to appoint an advisory committee to advise the board in developing the hygiene training equivalency program. The bill authorizes the board to adopt rules necessary to implement these provisions (Sec. 256.0531). The program, including the clinical training component, must be accredited by the Commission on Dental Accreditation by December 31, 2004, or the program expires (SECTION 3.03). The bill authorizes a licensed dentist to delegate to a qualified and trained dental assistant acting under the dentist's direct supervision the application of a pit and fissure sealant if the dentist is a Medicaid provider. The bill provides that cleansing of the occlusal and smooth surfaces of the teeth by a dental assistant is allowed immediately prior to and for the sole purpose of preparing the tooth area for the placement of pit and fissure sealants or orthodontic bonding (Sec. 258.002). The bill authorizes a dental assistant who is not professionally licensed to apply a pit and fissure sealant only if the assistant is certified to apply a pit and fissure sealant and the dentist is a Medicaid provider (Sec. 265.003). The bill sets forth provisions regarding certification of a dental assistant to apply a pit and fissure sealant and requires the board, not later than March 1, 2002, to adopt rules as necessary to implement these provisions (Sec. 265.004). The bill authorizes a licensed dentist to delegate a service, task, or procedure to a dental hygienist without complying with supervisory requirements if the hygienist has at least two years of experience in the practice of dental hygiene, and the service, task, or procedure is performed in a nursing facility or a school-based health center. The patient must be referred to a licensed dentist after the completion of a service, task, or procedure performed by a hygienist. The bill prohibits a dental hygienist from performing a second set of delegated tasks or procedures until the patient has been examined by a dentist or from performing a service, task, or procedure without the express authorization of a dentist. The bill requires the nursing facility or school-based health center to note each delegated service, task, or procedure performed by the dental hygienist in the patient's medical records (Sec. 262.1515). The bill requires the board to issue a temporary license to practice dentistry to a reputable dentist or a temporary license to practice dental hygiene to a reputable dental hygienist who meets all eligibility criteria other than the five years of practice requirement and is employed by a nonprofit corporation that accepts Medicaid reimbursement. A license granted under this provision expires immediately when a licensee fails to meet the requirements of this provision (Sec. 256.1015). H.B. 3507 amends the Education Code to remove the condition that an institution of higher education be in this state from the provision authorizing the Texas Higher Education Coordinating Board to provide repayment assistance for the repayment of a student loan for education at a public or private institution of higher education received by a dentist through any lender (Sec. 61.904). The bill repeals the provision that limits repayment assistance grants for dentists to five years (SECTION 6.02). EFFECTIVE DATE September 1, 2001.