Texas Register, Volume 28, Number 14, Pages 2821-2988, April 4, 2003 Page: 2,868
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under Acts 1991, 72nd Legislature, First Called Session, Chap-
ters 15, 1.07.
The proposed repeals affect the Human Resources Code, Chap-
ter 32.33.305.
33.306.
33.307.
33.308.
ticipation.Emergency Dental Services.
Allowable Services and Limitations.
Eligibility for Texas Health Steps Dental Services.
Requirements for Provider Enrollment and Continuing Par-33.309. Termination of a Provider Agreement.
33.312. Charges to Recipients.
33.313. Payment of Claims.
33.314. Claims--Time Limits, Submission, and Denial.
33.315. Change to Another Provider
33.316. Standards of Care.
33.317. Management of Complaints.
33.318. Performance of Dental Services.
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-200301892
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
SUBCHAPTER H. DENTAL UTILIZATION
REVIEW
25 TAC 33.331 - 33.333
(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will not be published.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 authorized
under Acts 1991, 72nd Legislature, First Called Session, Chap-
ters 15, 1.07.
The proposed repeals affect the Human Resources Code, Chap-
ter 32.
33.331. Orthodontic Services Limitations.33.332. Eligibility for Orthodontic Services.
33.333. Payment Limitations for Orthodontic Services.
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-200301893
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 33.331, 33.334, 33.351 - 33.358
The new section and amendments 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 new section and amendments affect the Human
Resources Code, Chapter 32.
33.331. Purpose.
The purpose of the Dental Utilization Review process is to ensure
program fiscal integrity and to respond to the federal mandate requir-
ing that program dollars be spent only on services as allowed under
THSteps and that the services be appropriately provided to eligible
recipients.
33.334. Post-payment Orthodontic Utilization Review.
(a) (No change.)
(b) As part of an orthodontic utilization review, a provider may
be required to submit study models, [and] diagnostic work-up informa-
tion and records at the provider's expense.
33.351. Types of TDH [Department] Utilization Reviews.
(a) TDH, HHSC or its designee [The department er its claims
processing contractor] may conduct utilization reviews through auto-
mated analysis of a provider's pattern(s) of practice, including peer
group analysis. Such analysis may result in the subsequent conduct of
an on-site utilization review. Utilization reviews may also be conducted
[The department er its claims processing contractor may eenduet uti-
lization reviews] at the direction of OIE, according to HHSC rules.
(b) The TDH [department] may conduct dental utilization re-
views which:
(1)-(2) (No change.)
(c) Dental utilization reviews shall be based on written pro-
cedures and screening criteria which are evaluated and updated peri-
odically with input from practicing dentists, the OHSAC, and/or the
SBDE. Criteria shall be objective, clinically valid, and compatible with28 TexReg 2868 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/m1/47/: accessed May 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.