Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,867
2821-2988 p. ; 28 cm.View a full description of this periodical.
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(b) A recipient may select another provider if he or she so de-
sires.
(c) The TDH may refer a recipient to another provider as a
result of information obtained during a utilization review or resolution
of a complaint from either the recipient or the provider or upon the
provider's or recipient's documented request.
33.318. Standards of Care.
(a) THSteps recipients or their parents or guardians who can
give informed consent shall:
(1) receive information following an oral evaluation
regarding:
(A) the dental diagnosis;and risks;
(B) scope of proposed treatment, including alternatives
(C) anticipated results; and
(D) need for administration of sedation or anesthesia,including risks.
(2) receive a full explanation of the treatment plan and give
informed consent prior to its implementation.
(b) THSteps recipients shall:
(1) receive dental services specified in the treatment plan
which meet the standards of care established by the laws relating to the
practice of dentistry and the rules and regulations of the SBDE;
(2) receive dental services free from abuse or harm from
the provider or the provider's staff; and
(3) receive only that treatment required to address docu-
mented dental necessity and which meets professionally recognized
standards of health care as recognized by the SBDE.
(c) If the recipient is younger than 15 years of age and services
are not provided by an exempt entity, the THSteps dental provider shall
require that the recipient be accompanied by a parent, guardian, or an-
other adult authorized by the parent or guardian to a THSteps dental
appointment. If services are provided by an exempt entity, the exempt
entity must, as a condition for reimbursement:
(1) obtain written consent to the services, which has not
been revoked, from the child's parent or guardian, within the one-year
period prior to the date services are provided; and
(2) encourage parental involvement in the management of
the oral health care of the children receiving services from the clinic,
program, or facility.
33.319. Management of Complaints.
(a) The division administration has responsibility for the man-
agement of complaints and payments regarding dental providers and
recipients. Complaints may be received in either written or verbal form
and may originate from any source. In accordance with each agency's
guidelines for referrals of complaints, the TDH shall refer a provider or
recipient to the OIE, the SBDE, the TDH Office of Criminal Investiga-
tion, or the Texas Department of Human Services. The referral shall be
in writing. If discrepancies or irregularities are reported to the TDH or
found during a utilization review, the appropriate agency may take one
or more administrative actions. The provider will be notified in writing
of the review findings and of any proposed administrative action. This
notification may occur before or after other action is taken by profes-
sional dental or governmental organizations.
(b) Referrals to other state agencies.(1) The TDH shall refer to OIE based on OIE criteria. OIE
criteria for referrals by the TDH include, but are not limited to, com-
plaints or allegations of provider fraud or abuse, including program
abuse; abuse or harm to a recipient; lack of medical or dental neces-
sity; overbilling; soliciting or collecting unauthorized payments from
recipients; or failure to refund payments to recipients. Such complaints
or allegations shall be made in writing and forwarded to the OIE. The
OIE may utilize staff from the TDH to assist in determining the validity
of any complaints or allegations received. A TDH employee acting as
an agent of OIE is governed by the parameters of authority and inves-
tigation for OIE.
(2) Complaints about the practice of dentistry as described
in the Texas Dental Practice Act or the rules and regulations of the
SBDE shall be made in writing to the SBDE.
(3) Allegations of fraud or program abuse committed by
a THSteps recipient shall be reported to the appropriate authority for
review of the allegations and determination of the appropriate action as
defined in TDH policy.
33.320. Performance of Dental Services.
All THSteps dental services shall be performed by the enrolled provider
except for that work authorized to be done by a licensed dental hygien-
ist, dental assistant, or dental technician in a dental laboratory on the
premises where the dentist practices or in a commercial laboratory reg-
istered with the SBDE. The Texas Dental Practice Act and the rules and
regulations of the SBDE define the scope of work that dental auxiliary
personnel may perform. Any deviations from these practice limitations
shall be reported to the SBDE and could result in sanctions or other ac-
tions being taken against the provider.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.
Filed with the Office of the Secretary of State on March 24, 2003.
TRD-200301891
Susan K. Steeg
General Counsel
Texas Department of Health
Earliest possible date of adoption: May 4, 2003
For further information, please call: (512) 458-7236
25 TAC 33.305 - 33.309, 33.312 - 33.318
(Editor's note: The text of the following sections proposed for repeal
will not be published. The sections may be examined in the offices of
the Texas Department of Health or in the Texas Register office, Room
245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The repeals are proposed under the Health and Safety Code,
32.021, which allows the Texas Department of Health to es-
tablish 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 de-
partment 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 un-
der its agreement with the Health and Human Services Com-
mission to operate the Early and Periodic Screening, Diagnosis,
and Treatment program, also known as THSteps, as authorizedPROPOSED RULES April 4, 2003 28 TexReg 2867
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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/m1/46/: accessed May 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.