Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,864
2821-2988 p. ; 28 cm.View a full description of this periodical.
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21, 2003, issue of the Texas Register (28 TexReg 2523). There-
fore, the repeal of 33.310 - 33.311 is not included in this pro-
posal.
SUBCHAPTER G. DENTAL SERVICES
25 TAC 33.301 - 33.311, 33.314, 33.315, 33.317 - 33.320
The amendments and new sections are proposed under the
Health and Safety Code, 32.021, which allows the Texas
Department of Health to establish rules governing the Medicaid
program; the Health and Safety Code, 12.001, which provides
the Texas Board of Health (board) with authority to adopt rules
for its procedures and the performance of each duty imposed
by law on the board, the department and the commissioner of
health; and the Government Code, 531.021, which provides
the Health and Human Services Commission with the authority
to administer the state's medical assistance program and are
submitted by the department under its agreement with the
Health and Human Services Commission to operate the Early
and Periodic Screening, Diagnosis, and Treatment program,
also known as THSteps, as authorized under Acts 1991, 72nd
Legislature, First Called Session, Chapters 15, 1.07.
The proposed amendments and new sections affect the Human
Resources Code, Chapter 32.
33.301. Definitions.
The following words and terms, when used in Subchapters G and H
of this chapter, shall have the following meanings, unless the context
clearly indicates otherwise.
(1) Accompanied--A parent, guardian or authorized
adult who presents a recipient under age 15 at a Texas Health Steps
(THSteps) [an EPSDT] medical or dental check-up, checkupp] or
treatment visit and continues to wait for the child while the check-up
checkupp] or treatment takes place. It is a requirement of 33.318 of
this title (relating to Standards of Care) that a recipient under the age
of 15 be accompanied as a condition of reimbursement, unless services
are provided by an exempt entity.
(2) Authorized adult--A person, including an adult related
to the child, who is authorized by a child's parent or guardian to ac-
company a child to a THSteps [Texas Health Steps] medical or dental
check-up or treatment visit checkupp].
(3) Adjusted Fee--The fee which results from action taken
by the HHSC or its designee in some instances in order to reduce the
fee billed by the provider to below the maximum amount which can be
billed.
(4) [(3)] Dental necessity--For [for] dental services or
products provided, whether a prudent dentist would provide the
service or product to a patient to diagnose, prevent, or treat orofacial
pain, infection, disease, dysfunction, or disfiguration in accordance
with generally accepted practices:
(A) of the professional dental community;
(B) within the American Dental Association's Dental
Practice Parameters, published by the American Dental Association,
Revised 1997; and/or
(C) within the Quality Assurance Criteria of the Amer-
ican Academy of Pediatric Dentistry, as applicable, published in Pe-
diatric Dentistry, Journal of the American Academy of Pediatric Den-
tistry, Reference Manual, 2000-2001, Volume 22, Number 7.
R 4) Department--The Texas Department of Health(5) Division--The Division of Oral Health of the Texas De-
partment of Health.
(6) EOB--Explanation of Benefits.
(7) [{5)] EPSDT--Early and Periodic Screening, Diagno-
sis, and Treatment [t(P DT) ] is a service of the Medicaid program.
EPSDT provides medical and dental check-ups, diagnosis and treat-
ment to Medicaid eligible recipients younger than 21 years of age.
EPSDT is known in Texas as Texas Health Steps. [A component of
th e Medicaid program also known as Texas Health Steps (THeps
which provides medical eheek-up and dental services to Medicaid and
Texas Health Steps clients under age 24 years.]
(8) Exempt entity--A child-care facility (as defined in Hu-
man Resources Code 42.002(3)), school health clinic, and Head Start
programs which are exempt from the parental accompaniment require-
ment under 33.318 of this title (relating to Standards of Care).
(9) FFP--Federal financial participation is the federal gov-
ernment' s share of a State's expenditures under the Medicaid program.
(10) [(6)] HHSC--The Health and Human Services Com-
mission.
(11) [(7-)] Manual--The Texas Medicaid Provider Proce-
dures Manual, including all updates published in the Texas Medicaid
Bulletin.
(12) [(8)] Medicaid--The medical assistance program im-
plemented by the State of Texas under the provisions of Title XIX of
the Social Security Act, as amended (42 U.S.C. 1396-1396v). [A
medical and dental program provided under Title XIX of the federal
Social Scuriy Act and the Human Resourees CdeA Chapter 32].
(13) OHSAC--The Oral Health Services Advisory Com-
mittee is the official body which assists the TDH Division of Oral
Health by providing review, advice, and recommendations regarding
a variety of subjects related to the operations and policy of the Divi-
sion.
(14) [(9)] OIE--The Office of Investigations and Enforce-
ment at the Health and Human Services Commission.
(15) [(40)] Parental involvement--The encouragement and
involvement in and management of the health care of children receiv-
ing services from an exempt entity as defined in paragraph (8) of this
section. Parental involvement includes the exempt entity [this term ap-
pies only to ooheel health ~lii4e, Head Start programs, and ch4le are
facilities which are exempt from the parental accompaniment requoe-
ment under 22.321t6( of this title (relating to Standards4of Care
The term means exempt entities shall encourage parental involvement
in and management of the health care of children receiviAng services
from the iic program or facility by] notifying the child's parent,
guardian, or other authorized adult before each visit for a THSteps [an
EPSDT] medical or dental check-up checkupp] of the time and place of
the child's appointment and encouraging the parent, guardian, or other
authorized adult to attend. Notification shall be done by [The parent,
.ar4-an~o ,or other a theorized adult shall be notified in a timely man-
-ner by] the means of communication determined by the exempt entity
clinicc, programor facility] to be the most effective. Such communica-
tion must be documented and may include, but is not limited to, one or
more of the following options: a home visit from an outreach worker,
written or printed correspondence or telephone contact.
(16) [(4)] Recipient--An individual who has been deter-
mined eligible for Medicaid [A Medicaid enrolled client].
(17) R & S--A Remittance and Status report which pro-
vides information on pending, paid, denied, and adjusted claims.28 TexReg 2864 April 4, 2003 Texas Register
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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/m1/43/: accessed June 6, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.