Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,863
2821-2988 p. ; 28 cm.View a full description of this periodical.
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The department also proposes new 33.319-33.320 that covers
management of complaints and performance of dental services.
The proposed amendments to 33.301 add new definitions;
the proposed amendments to 33.302 exclude non-applicable
language to the section while clarifying service limitations; the
proposed amendments to 33.303-33.304 ensure consistency
in service standards; new 33.305 is renamed Orthodontic
Services Limitations and incorporates language from pro-
posed repealed 33.333 while excluding language concerning
emergency dental services. Proposed new 33.306 is reti-
tled Eligibility for Orthodontic Services, excludes language
concerning allowable services and limitations and includes
language from the proposed repeal of 33.332. Proposed
new 33.307 is renamed Payment Limitations for Orthodontic
Services, excludes language concerning eligibility and adds
language regarding payment limitations for orthodontic ser-
vices. Proposed new 33.308, renamed Emergency Dental
Services, excludes language regarding provider enrollment and
continuing participation requirements while adding language
concerning emergency dental services. Proposed repeal
of 33.309 excludes language concerning termination of a
provider agreement, as the department no longer maintains the
authority to enforce those provisions. Proposed new 33.309
adds language relating to allowable services and limitations.
Proposed new 33.310, renamed as Eligibility for THSteps Den-
tal Services, excludes language pertaining to maximum payment
and adds language concerning eligibility for THSteps dental ser-
vices. Proposed new 33.311 is renamed as Requirements for
Provider Enrollment and Continuing Participation, and appropri-
ate language pertinent to the new title is added. The proposed
repeal of 33.312 excludes language that covered charges to re-
cipients.
Language relating to payment of claims is excluded from the
repeal of 33.313. Proposed new 33.314 adds a new title,
Charges to Recipients, as well as language appropriate to the
new title. The previous title, Claims - Time Limits, Submission
and Denial is deleted in the repeal of 33.316; the repeal also
excludes language pertaining to this title as the department is
not authorized to set time limits on claim submission and denial.
Proposed new 33.315 renames this section as Payment of
Claims and adds appropriate language to this section. The prior
title of this section, Changes to Another Provider, is deleted and
moved to proposed new 33.317. Pertinent language relating
to change to another provider is also moved to proposed new
33.317.
Language relating to Standards of Care is excluded in the repeal
of 33.316 and moved to proposed new 33.318.
Proposed new 33.317 is renamed as Change to Another
Provider and adds language pertinent to the new title. The
former title of this section, Management of Complaints and
accompanying language is moved to proposed new 33.319.
Proposed new 33.318 is renamed as Standards of Care and
incorporates language pertinent to the new title. The prior name
of this section, Performance of Dental Services and relevant lan-
guage, is moved to proposed new 33.320.
Proposed new 33.331 is renamed as Purpose and explains the
purpose of the dental utilization review process. The prior name
of this section, Orthodontic Services Limitation, and accompa-
nying language is moved to proposed amended 33.305.Proposed amended 33.334 restructures pertinent portions for
clarity. Proposed amended 33.351 clarifies the responsibility
of the department and HHSC related to utilization reviews. Pro-
posed amended 33.352 adds stricter standards and designates
the proper entity to which complaints should be made.
Proposed amended 33.353 requires that providers be notified
in writing of a utilization review.
Proposed amended 33.354 restructures the section for clarity;
proposed amended 33.355 adds a new standard concerning
review results and also reflects changes in the entity that may
forward utilization results to the Office of Investigations and En-
forcement at the Health and Human Services Commission.
Government Code, 2001.039, requires that each state agency
review and consider for readoption each rule adopted by that
agency pursuant to the Government Code, Chapter 2001
(Administrative Procedure Act). The department has reviewed
33.301-33.309, 33.312-33.318 and 33.331-33.334, and
33.351-33.358 and has determined that reasons for adopting
these sections continue to exist. However, the rules need
revision as described in this preamble.
The department published a Notice of Intention to Review
33.301-33.318 in the May 12, 2000 issue of the Texas
Register (25 TexReg 4358). No comments were received.
The department published a Notice of Intention to Review
33.331-33.334, and 33.351-33.358 in the November 22, 2002
issue of the Texas Register (27 TexReg 10957). No comments
were received.
Lee Johnson, Financial Management Division Director, has de-
termined that for each year of the first five-year period the revised
sections are in effect, there will be no fiscal implications to state
or local government as a result of enforcing or administering the
sections as proposed.
Jerry W. Felkner, State Dental Director, Division of Oral Health,
has determined that for each year of the first five years these
sections are in effect, the public benefit anticipated as a result
of enforcing the sections will be a more effective and efficient
provision of Texas Health Steps dental services to eligible recip-
ients. Additionally, the proposed sections will provide more spe-
cific guidance to providers and recipients. The rules will have no
adverse economic effect on micro-businesses and/or small busi-
nesses because the sections do not add any new or additional
requirements on either eligible providers or recipients. There are
no anticipated economic costs to persons who are required to
comply with the sections as proposed. There is no anticipated
impact on local employment.
Comments on the proposal may be submitted to Mike McAnally,
Program Policy Analyst, Division of Oral Health, Texas Depart-
ment of Health, 1100 West 49th Street, Austin, Texas 78756,
(512) 458-7323. Comments will be accepted for 30 days follow-
ing publication of this proposal in the Texas Register.
The department's Board of Health (board) voted on the pro-
posed repeal of 33.310 - 33.311 concerning reimbursement
rates. Subsequent to the board's approval on February 28, 2003,
and prior to this publication, the Health and Human Services
Commission transferred 25 TAC 33.310 - 33.311 to 1 TAC
355.8443 and 355.8445. The transfer was filed by the Health
and Human Services Commission with the Office of the Secre-
tary of State on March 4, 2003, and was published in the MarchPROPOSED RULES April 4, 2003 28 TexReg 2863
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Texas. Secretary of State. Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003, periodical, April 4, 2003; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth101027/m1/42/: accessed May 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.