HBA-TBM H.B. 3507 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 3507 By: Maxey Public Health 4/4/2001 Introduced 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. Unfortunately, Texas is currently suffering a severe shortage of dentists and dental hygienists (dental professionals). The Texas Senate Committee reports 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. Expanding student loan repayment programs as incentives for newly licensed dental professionals who practice in medically underserved communities may help alleviate the burden on rural dental professionals. Also, 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 may decrease the amount of time a dentist needs 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, and teledentistry and implements the recommendations of the 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 SECTION 2.03 (Section 531.02171, Government Code) of this bill. ANALYSIS House Bill 3507 amends the Human Resources Code to require the Health and Human Services Commission (HHSC), in providing dental services under the medical assistance program (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 medical 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 medical necessity for hospitalization and general anesthesia with a more objective and comprehensive system developed by HHSC; _take all necessary action to eliminate fraud in the provision of dental services; and _reduce the hospitalization fee and eliminate the behavior management and nutritional consultation fees and redistribute amounts made available by such actions to other commonly billed dental services for which adequate accountability measures exist (Sec. 32.053). H.B. 3507 amends the Occupations Code to authorize a licensed dentist to use telecommunications technology to examine a patient and to then delegate an assignment through telecommunications technology to a dental hygienist who is under the supervision and responsibility of the dentist (Sec. 262.151). The bill provides that a person in another state practices dentistry in this state if the person through any medium including an electronic medium performs an act that constitutes the practice of dentistry on a patient in this state (Sec. 251.003). The bill authorizes a licensed dentist who is a Medicaid provider to delegate to a qualified and trained dental assistant acting under the dentist's direct supervision the application of a pit and fissure sealant and root planing or the smoothing and polishing of exposed teeth (Secs. 258.001 and 258.002). The bill authorizes a licensed dentist to delegate a service, task, or procedure, including the application of a pit and fissure sealant, 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 facility serving an underserved population. The patient must be referred to a licensed dentist after the completion of a service, task, or procedure performed by a hygienist (Sec. 262.1515). The bill authorizes a dental assistant who is not professionally licensed to apply a pit and fissure sealant only if the assistant has at least two years of experience as an assistant, and is certified by the State Board of Dental Examiners (board) for application of a sealant, and is certified by the board to perform the act (Sec. 265.003). The bill requires the board to issue a license to practice dentistry to a reputable dentist or a license to practice dental hygiene to a reputable dental hygienist who meets the other eligibility criteria and has practiced as a dental educator at a dental school or dental hygiene school accredited by the Commission on Dental Accreditation of the American Dental Association for at least the five years preceding the date of application for a license provided the dentist or dental hygienist will practice dentistry or dental hygiene in this state in a medically underserved area (Sec. 256.101). H.B. 3507 amends the Government Code to require HHSC to require, by rule, each health and human services agency that administers a part of the Medicaid program to provide Medicaid reimbursement for a teledental consultation provided by a licensed dentist in this state at the same rate as the Medicaid program reimburses for a comparable in-person consultation. The bill prohibits the denial of a request for reimbursement solely because an in-person consultation between a dentist and a patient did not occur (Sec. 531.02171). 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. 5.01). The bill repeals the provision that limits repayment assistance grants for dentists to five years (SECTION 5.02). EFFECTIVE DATE September 1, 2001.