State Codes and Statutes
Statutes > Texas > Health-and-safety-code > Title-2-health > Chapter-43-oral-health-improvement
HEALTH AND SAFETY CODE
TITLE 2. HEALTH
SUBTITLE B. TEXAS DEPARTMENT OF HEALTH PROGRAMS
CHAPTER 43. ORAL HEALTH IMPROVEMENT
Sec. 43.001. SHORT TITLE. This chapter may be cited as the
Texas Oral Health Improvement Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.002. LIBERAL CONSTRUCTION. It is the intent of the
legislature that this chapter be construed liberally so that
eligible individuals may receive appropriate and adequate oral
health services in a timely manner.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.003. DEFINITIONS. (a) In this chapter:
(1) "Dentist" means an individual licensed by the State Board of
Dental Examiners to practice dentistry in this state.
(2) "Oral health services" means:
(A) preventive or treatment services affecting the structures of
the mouth, including the hard and soft tissues such as teeth,
jaws, gums, vestibule, tongue, cheeks, lips, floor and roof of
the mouth, and adjacent masticatory structures; and
(B) oral health education and promotion activities.
(3) "Other benefit" means a benefit, other than a benefit
provided under this chapter, to which an individual is entitled
for the payment of the costs of oral health treatment services,
including benefits available from:
(A) an insurance policy, group oral health plan, or prepaid oral
care plan;
(B) Title XVIII or Title XIX of the Social Security Act, as
amended (42 U.S.C. Sec. 1395 et seq. and 42 U.S.C. Sec. 1396 et
seq.);
(C) the Veterans Administration;
(D) the Civilian Health and Medical Program of the Uniformed
Services;
(E) workers' compensation or any other compulsory employer's
insurance program;
(F) a public program created by federal law, state law, or the
ordinances or rules of a municipality or other political
subdivision of the state; or
(G) a cause of action for the expenses of dental or oral health
treatment services, or a settlement or judgment based on the
cause of action, if the expenses are related to the need for
treatment services provided under this chapter.
(4) "Provider" means a person who, through a contract with the
department, furnishes oral health treatment services that are
purchased by the department for the purposes of this chapter.
(5) "Support" means to contribute money or services necessary
for a person's maintenance, including food, clothing, shelter,
transportation, and health care.
(b) The board by rule may define a word or term not defined by
Subsection (a) as necessary to administer this chapter. The board
may not define a word or term so that the word or term is
inconsistent or in conflict with the purposes of this chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.004. ORAL HEALTH IMPROVEMENT SERVICES PROGRAM. (a) The
oral health improvement services program is in the department to
provide comprehensive oral health services to eligible
individuals.
(b) The board shall adopt rules to govern the program, to
prescribe the type, amount, and duration of oral health services
to be provided, and, if necessary to conform to budgetary
limitations, to prescribe a system of program priorities
regarding the types of services to be furnished, the geographic
areas to be covered, or the classes of individuals eligible for
services.
(c) Except as limited by Subsection (b), the department shall
develop an integrated framework for the equitable provision of
oral health services throughout the state or designated
geographic areas, using existing public and private health care
resources when possible.
(d) The program may consist of all or any combination of the
following:
(1) treatment services for eligible individuals, including:
(A) emergency care for relief of pain and infection, including
extractions and basic restorative services to prevent premature
loss of teeth;
(B) periodontal therapy for the prevention and treatment of
periodontal disease;
(C) endodontics to maintain aesthetics and occlusion;
(D) orthodontic care only in cases of severely handicapping
malocclusion; and
(E) oral surgery and prosthetics in cases in which health is
impaired;
(2) a program of oral disease prevention, including:
(A) the fluoridation of community water supplies;
(B) fluoride mouth rinse programs in schools;
(C) the promotion and implementation of sealants programs; and
(D) the development of appropriate means for prevention of oral
disease, including the continued use of recognized methods of
primary, secondary, and tertiary prevention;
(3) oral health education and promotion, including:
(A) public health education to promote the prevention of oral
disease through self-help methods, including the initiation and
expansion of preschool, school age, and adult education programs;
(B) organized continuing health education training programs for
health care providers; and
(C) preventive health education information for the public; and
(4) facilitation of access to oral health services, including:
(A) the improvement of the existing oral health services
delivery system for the provision of services to low-income
residents;
(B) outreach activities to inform the public of the type and
availability of oral health services to increase the
accessibility of oral health care for low-income residents; and
(C) assistance and cooperation in promoting better distribution
of dentists and other oral health professionals throughout the
state.
(e) The department may provide services only as prescribed by
board rules.
(f) The services listed in Subsection (d) may be furnished
either directly by the department or through a network of
approved providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.005. ADMINISTRATION. (a) The department shall:
(1) administer the program of oral health services established
by the board; and
(2) adopt the design and content of all forms necessary for the
program.
(b) The department may conduct field research, collect data, and
prepare statistical and other reports relating to the need for
and the availability of oral health services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.006. SERVICE PROVIDERS. (a) The board may adopt
substantive and procedural rules relating to:
(1) the selection of dentists, physicians, facilities, and other
providers to furnish program services, including criteria for the
emergency selection of providers; and
(2) the denial, modification, suspension, or termination of a
provider's program participation.
(b) The department shall approve providers to participate in the
program according to the criteria, rules, and procedures adopted
by the board.
(c) The department may pay only for program services furnished
by approved providers, except in an emergency.
(d) The board shall provide a due process hearing procedure for
the resolution of conflicts between the department and a
provider. Chapter 2001, Government Code, do not apply to conflict
resolution procedures adopted under this section.
(e) The department shall render the final administrative
decision in a due process hearing to modify, suspend, or
terminate the approval of a provider.
(f) The department may not terminate a contract while a due
process hearing is pending under this section. The department may
withhold payments while the hearing is pending, but shall pay the
withheld payments and resume contract payments if the final
determination is favorable to the provider.
(g) Subsections (d)-(f) do not apply if a contract:
(1) is canceled by the department because of the exhaustion of
funds;
(2) expires according to its terms; or
(3) is canceled because program services are restricted to
conform to budgetary limitations as prescribed by Section
43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff.
Sept. 1, 1995.
Sec. 43.007. INDIVIDUAL REFERRAL AND APPLICATION FOR SERVICES.
(a) The board may adopt substantive and procedural rules to
govern the application for admission to the program and the
receipt of treatment services, including the dental, financial,
and other criteria for eligibility to receive treatment services.
(b) An applicant for treatment services must be referred to the
program by a person who knows the individual's economic
condition, such as a school administrator or school nurse, social
worker, municipal or county official, dentist, physician, public
health clinic, community health center, hospital, or any other
source acceptable to the board.
(c) An applicant for treatment services must complete or cause
to be completed an application form prescribed by the department.
(d) The application form must include or be accompanied by:
(1) a statement by the individual, or by the person with a legal
obligation to support the individual, that the individual or the
person is financially unable to pay for all or part of the cost
of the necessary treatment services;
(2) a statement from the referring person that the treatment
services are necessary to prevent or reduce the probability of
pain, infection, or disease; and
(3) any other assurances from the applicant or any other
documentary evidence required by the board to support the
applicant's eligibility.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.008. ELIGIBILITY FOR SERVICES. (a) The department
shall determine an individual's eligibility for treatment
services according to this chapter and the program rules.
(b) An individual is not eligible to receive treatment services
provided under this chapter unless:
(1) the individual is a resident of this state;
(2) the department has determined that neither the individual
nor a person with a legal obligation to support the individual is
financially able to pay for all or part of the treatment services
provided by this chapter;
(3) the individual complies with any other requirements stated
in the program rules; and
(4) at least one licensed dentist or licensed physician has
certified to the department that the dentist or physician has
examined the individual and has found that:
(A) the individual meets the board's dental criteria; and
(B) the dentist or physician has reason to expect that the
treatment services provided by or through the department will
prevent or reduce the probability of the individual's
experiencing pain, infection, or disease.
(c) Except as permitted by program rules, the department may not
provide treatment services before an individual's eligibility
date assigned by the department or authorize payment for
treatment services furnished by a provider before that date.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.009. DENIAL, MODIFICATION, SUSPENSION, OR TERMINATION OF
SERVICES. (a) The department may, for cause, deny an
application for treatment services or modify, suspend, or
terminate a recipient's treatment services after notice to the
applicant or recipient and the opportunity for a due process
hearing.
(b) The board by rule shall provide criteria for action by the
department under this section.
(c) Chapter 2001, Government Code, do not apply to the granting,
denial, modification, suspension, or termination of treatment
services. The department shall conduct hearings in accordance
with the board's due process hearing rules.
(d) The department shall render the final administrative
decision in a due process hearing to deny, modify, suspend, or
terminate the receipt of oral health services.
(e) This section does not apply if oral health services are
restricted to conform to budgetary limitations as prescribed by
Section 43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff.
Sept. 1, 1995.
Sec. 43.010. FINANCIAL ELIGIBILITY; OTHER BENEFITS. (a) The
department shall require an individual receiving treatment
services under this chapter or a person with a legal obligation
to support the individual to pay for or reimburse the department
for that part of the cost of the treatment services that the
individual or person is financially able to pay.
(b) An individual is not eligible to receive treatment services
under this chapter to the extent that the individual or a person
with a legal obligation to support the individual is eligible for
some other benefit that would pay for all or part of the
treatment services.
(c) When the application is made under this chapter or at any
time during eligibility and the receipt of treatment services,
the applicant for or recipient of treatment services shall inform
the department of any other benefit to which the individual or a
person with a legal obligation to support the individual may be
entitled.
(d) An individual who has received treatment services that are
covered by some other benefit, or a person with a legal
obligation to support the individual, shall reimburse the
department to the extent of the treatment services provided when
the other benefit is received.
(e) The commissioner may waive the enforcement of Subsection (b)
as prescribed by board rules in certain individually considered
cases in which enforcement will deny treatment services to a
class of otherwise eligible individuals because of conflicting
federal, state, or local laws or rules.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.011. RECOVERY OF COSTS. (a) The department may recover
the cost of treatment services provided under this chapter from a
person who does not pay or reimburse the department as required
by this chapter or from any third party who has a legal
obligation to pay other benefits and to whom notice of the
department's interest has been given.
(b) At the request of the commissioner, the attorney general may
bring suit in the appropriate court of Travis County on behalf of
the department.
(c) In a judgment in favor of the department, the court may
award attorney's fees, court costs, and interest accruing from
the date on which the department provides the service to the date
on which the department is reimbursed.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.012. FEES. The board may charge fees for the oral
health services provided directly by the department or through
approved providers in accordance with Subchapter D, Chapter 12.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.013. FUNDS. (a) Subject to limitations or conditions
prescribed by the legislature, the board may seek, receive, and
spend funds received from any public or private source for the
purposes of this chapter.
(b) The department is not required to provide oral health
services unless funds are appropriated to the department for that
express purpose.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.014. CONTRACTS. The department may enter into contracts
and agreements necessary to facilitate the efficient and
economical provision of oral health services under this chapter,
including contracts for the purchase of services, equipment, and
supplies from qualified providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
State Codes and Statutes
Statutes > Texas > Health-and-safety-code > Title-2-health > Chapter-43-oral-health-improvement
HEALTH AND SAFETY CODE
TITLE 2. HEALTH
SUBTITLE B. TEXAS DEPARTMENT OF HEALTH PROGRAMS
CHAPTER 43. ORAL HEALTH IMPROVEMENT
Sec. 43.001. SHORT TITLE. This chapter may be cited as the
Texas Oral Health Improvement Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.002. LIBERAL CONSTRUCTION. It is the intent of the
legislature that this chapter be construed liberally so that
eligible individuals may receive appropriate and adequate oral
health services in a timely manner.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.003. DEFINITIONS. (a) In this chapter:
(1) "Dentist" means an individual licensed by the State Board of
Dental Examiners to practice dentistry in this state.
(2) "Oral health services" means:
(A) preventive or treatment services affecting the structures of
the mouth, including the hard and soft tissues such as teeth,
jaws, gums, vestibule, tongue, cheeks, lips, floor and roof of
the mouth, and adjacent masticatory structures; and
(B) oral health education and promotion activities.
(3) "Other benefit" means a benefit, other than a benefit
provided under this chapter, to which an individual is entitled
for the payment of the costs of oral health treatment services,
including benefits available from:
(A) an insurance policy, group oral health plan, or prepaid oral
care plan;
(B) Title XVIII or Title XIX of the Social Security Act, as
amended (42 U.S.C. Sec. 1395 et seq. and 42 U.S.C. Sec. 1396 et
seq.);
(C) the Veterans Administration;
(D) the Civilian Health and Medical Program of the Uniformed
Services;
(E) workers' compensation or any other compulsory employer's
insurance program;
(F) a public program created by federal law, state law, or the
ordinances or rules of a municipality or other political
subdivision of the state; or
(G) a cause of action for the expenses of dental or oral health
treatment services, or a settlement or judgment based on the
cause of action, if the expenses are related to the need for
treatment services provided under this chapter.
(4) "Provider" means a person who, through a contract with the
department, furnishes oral health treatment services that are
purchased by the department for the purposes of this chapter.
(5) "Support" means to contribute money or services necessary
for a person's maintenance, including food, clothing, shelter,
transportation, and health care.
(b) The board by rule may define a word or term not defined by
Subsection (a) as necessary to administer this chapter. The board
may not define a word or term so that the word or term is
inconsistent or in conflict with the purposes of this chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.004. ORAL HEALTH IMPROVEMENT SERVICES PROGRAM. (a) The
oral health improvement services program is in the department to
provide comprehensive oral health services to eligible
individuals.
(b) The board shall adopt rules to govern the program, to
prescribe the type, amount, and duration of oral health services
to be provided, and, if necessary to conform to budgetary
limitations, to prescribe a system of program priorities
regarding the types of services to be furnished, the geographic
areas to be covered, or the classes of individuals eligible for
services.
(c) Except as limited by Subsection (b), the department shall
develop an integrated framework for the equitable provision of
oral health services throughout the state or designated
geographic areas, using existing public and private health care
resources when possible.
(d) The program may consist of all or any combination of the
following:
(1) treatment services for eligible individuals, including:
(A) emergency care for relief of pain and infection, including
extractions and basic restorative services to prevent premature
loss of teeth;
(B) periodontal therapy for the prevention and treatment of
periodontal disease;
(C) endodontics to maintain aesthetics and occlusion;
(D) orthodontic care only in cases of severely handicapping
malocclusion; and
(E) oral surgery and prosthetics in cases in which health is
impaired;
(2) a program of oral disease prevention, including:
(A) the fluoridation of community water supplies;
(B) fluoride mouth rinse programs in schools;
(C) the promotion and implementation of sealants programs; and
(D) the development of appropriate means for prevention of oral
disease, including the continued use of recognized methods of
primary, secondary, and tertiary prevention;
(3) oral health education and promotion, including:
(A) public health education to promote the prevention of oral
disease through self-help methods, including the initiation and
expansion of preschool, school age, and adult education programs;
(B) organized continuing health education training programs for
health care providers; and
(C) preventive health education information for the public; and
(4) facilitation of access to oral health services, including:
(A) the improvement of the existing oral health services
delivery system for the provision of services to low-income
residents;
(B) outreach activities to inform the public of the type and
availability of oral health services to increase the
accessibility of oral health care for low-income residents; and
(C) assistance and cooperation in promoting better distribution
of dentists and other oral health professionals throughout the
state.
(e) The department may provide services only as prescribed by
board rules.
(f) The services listed in Subsection (d) may be furnished
either directly by the department or through a network of
approved providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.005. ADMINISTRATION. (a) The department shall:
(1) administer the program of oral health services established
by the board; and
(2) adopt the design and content of all forms necessary for the
program.
(b) The department may conduct field research, collect data, and
prepare statistical and other reports relating to the need for
and the availability of oral health services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.006. SERVICE PROVIDERS. (a) The board may adopt
substantive and procedural rules relating to:
(1) the selection of dentists, physicians, facilities, and other
providers to furnish program services, including criteria for the
emergency selection of providers; and
(2) the denial, modification, suspension, or termination of a
provider's program participation.
(b) The department shall approve providers to participate in the
program according to the criteria, rules, and procedures adopted
by the board.
(c) The department may pay only for program services furnished
by approved providers, except in an emergency.
(d) The board shall provide a due process hearing procedure for
the resolution of conflicts between the department and a
provider. Chapter 2001, Government Code, do not apply to conflict
resolution procedures adopted under this section.
(e) The department shall render the final administrative
decision in a due process hearing to modify, suspend, or
terminate the approval of a provider.
(f) The department may not terminate a contract while a due
process hearing is pending under this section. The department may
withhold payments while the hearing is pending, but shall pay the
withheld payments and resume contract payments if the final
determination is favorable to the provider.
(g) Subsections (d)-(f) do not apply if a contract:
(1) is canceled by the department because of the exhaustion of
funds;
(2) expires according to its terms; or
(3) is canceled because program services are restricted to
conform to budgetary limitations as prescribed by Section
43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff.
Sept. 1, 1995.
Sec. 43.007. INDIVIDUAL REFERRAL AND APPLICATION FOR SERVICES.
(a) The board may adopt substantive and procedural rules to
govern the application for admission to the program and the
receipt of treatment services, including the dental, financial,
and other criteria for eligibility to receive treatment services.
(b) An applicant for treatment services must be referred to the
program by a person who knows the individual's economic
condition, such as a school administrator or school nurse, social
worker, municipal or county official, dentist, physician, public
health clinic, community health center, hospital, or any other
source acceptable to the board.
(c) An applicant for treatment services must complete or cause
to be completed an application form prescribed by the department.
(d) The application form must include or be accompanied by:
(1) a statement by the individual, or by the person with a legal
obligation to support the individual, that the individual or the
person is financially unable to pay for all or part of the cost
of the necessary treatment services;
(2) a statement from the referring person that the treatment
services are necessary to prevent or reduce the probability of
pain, infection, or disease; and
(3) any other assurances from the applicant or any other
documentary evidence required by the board to support the
applicant's eligibility.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.008. ELIGIBILITY FOR SERVICES. (a) The department
shall determine an individual's eligibility for treatment
services according to this chapter and the program rules.
(b) An individual is not eligible to receive treatment services
provided under this chapter unless:
(1) the individual is a resident of this state;
(2) the department has determined that neither the individual
nor a person with a legal obligation to support the individual is
financially able to pay for all or part of the treatment services
provided by this chapter;
(3) the individual complies with any other requirements stated
in the program rules; and
(4) at least one licensed dentist or licensed physician has
certified to the department that the dentist or physician has
examined the individual and has found that:
(A) the individual meets the board's dental criteria; and
(B) the dentist or physician has reason to expect that the
treatment services provided by or through the department will
prevent or reduce the probability of the individual's
experiencing pain, infection, or disease.
(c) Except as permitted by program rules, the department may not
provide treatment services before an individual's eligibility
date assigned by the department or authorize payment for
treatment services furnished by a provider before that date.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.009. DENIAL, MODIFICATION, SUSPENSION, OR TERMINATION OF
SERVICES. (a) The department may, for cause, deny an
application for treatment services or modify, suspend, or
terminate a recipient's treatment services after notice to the
applicant or recipient and the opportunity for a due process
hearing.
(b) The board by rule shall provide criteria for action by the
department under this section.
(c) Chapter 2001, Government Code, do not apply to the granting,
denial, modification, suspension, or termination of treatment
services. The department shall conduct hearings in accordance
with the board's due process hearing rules.
(d) The department shall render the final administrative
decision in a due process hearing to deny, modify, suspend, or
terminate the receipt of oral health services.
(e) This section does not apply if oral health services are
restricted to conform to budgetary limitations as prescribed by
Section 43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff.
Sept. 1, 1995.
Sec. 43.010. FINANCIAL ELIGIBILITY; OTHER BENEFITS. (a) The
department shall require an individual receiving treatment
services under this chapter or a person with a legal obligation
to support the individual to pay for or reimburse the department
for that part of the cost of the treatment services that the
individual or person is financially able to pay.
(b) An individual is not eligible to receive treatment services
under this chapter to the extent that the individual or a person
with a legal obligation to support the individual is eligible for
some other benefit that would pay for all or part of the
treatment services.
(c) When the application is made under this chapter or at any
time during eligibility and the receipt of treatment services,
the applicant for or recipient of treatment services shall inform
the department of any other benefit to which the individual or a
person with a legal obligation to support the individual may be
entitled.
(d) An individual who has received treatment services that are
covered by some other benefit, or a person with a legal
obligation to support the individual, shall reimburse the
department to the extent of the treatment services provided when
the other benefit is received.
(e) The commissioner may waive the enforcement of Subsection (b)
as prescribed by board rules in certain individually considered
cases in which enforcement will deny treatment services to a
class of otherwise eligible individuals because of conflicting
federal, state, or local laws or rules.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.011. RECOVERY OF COSTS. (a) The department may recover
the cost of treatment services provided under this chapter from a
person who does not pay or reimburse the department as required
by this chapter or from any third party who has a legal
obligation to pay other benefits and to whom notice of the
department's interest has been given.
(b) At the request of the commissioner, the attorney general may
bring suit in the appropriate court of Travis County on behalf of
the department.
(c) In a judgment in favor of the department, the court may
award attorney's fees, court costs, and interest accruing from
the date on which the department provides the service to the date
on which the department is reimbursed.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.012. FEES. The board may charge fees for the oral
health services provided directly by the department or through
approved providers in accordance with Subchapter D, Chapter 12.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.013. FUNDS. (a) Subject to limitations or conditions
prescribed by the legislature, the board may seek, receive, and
spend funds received from any public or private source for the
purposes of this chapter.
(b) The department is not required to provide oral health
services unless funds are appropriated to the department for that
express purpose.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.014. CONTRACTS. The department may enter into contracts
and agreements necessary to facilitate the efficient and
economical provision of oral health services under this chapter,
including contracts for the purchase of services, equipment, and
supplies from qualified providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
State Codes and Statutes
Statutes >
Texas >
Health-and-safety-code >
Title-2-health >
Chapter-43-oral-health-improvement HEALTH AND SAFETY CODE
TITLE 2. HEALTH
SUBTITLE B. TEXAS DEPARTMENT OF HEALTH PROGRAMS
CHAPTER 43. ORAL HEALTH IMPROVEMENT
Sec. 43.001. SHORT TITLE. This chapter may be cited as the
Texas Oral Health Improvement Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.002. LIBERAL CONSTRUCTION. It is the intent of the
legislature that this chapter be construed liberally so that
eligible individuals may receive appropriate and adequate oral
health services in a timely manner.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.003. DEFINITIONS. (a) In this chapter:
(1) "Dentist" means an individual licensed by the State Board of
Dental Examiners to practice dentistry in this state.
(2) "Oral health services" means:
(A) preventive or treatment services affecting the structures of
the mouth, including the hard and soft tissues such as teeth,
jaws, gums, vestibule, tongue, cheeks, lips, floor and roof of
the mouth, and adjacent masticatory structures; and
(B) oral health education and promotion activities.
(3) "Other benefit" means a benefit, other than a benefit
provided under this chapter, to which an individual is entitled
for the payment of the costs of oral health treatment services,
including benefits available from:
(A) an insurance policy, group oral health plan, or prepaid oral
care plan;
(B) Title XVIII or Title XIX of the Social Security Act, as
amended (42 U.S.C. Sec. 1395 et seq. and 42 U.S.C. Sec. 1396 et
seq.);
(C) the Veterans Administration;
(D) the Civilian Health and Medical Program of the Uniformed
Services;
(E) workers' compensation or any other compulsory employer's
insurance program;
(F) a public program created by federal law, state law, or the
ordinances or rules of a municipality or other political
subdivision of the state; or
(G) a cause of action for the expenses of dental or oral health
treatment services, or a settlement or judgment based on the
cause of action, if the expenses are related to the need for
treatment services provided under this chapter.
(4) "Provider" means a person who, through a contract with the
department, furnishes oral health treatment services that are
purchased by the department for the purposes of this chapter.
(5) "Support" means to contribute money or services necessary
for a person's maintenance, including food, clothing, shelter,
transportation, and health care.
(b) The board by rule may define a word or term not defined by
Subsection (a) as necessary to administer this chapter. The board
may not define a word or term so that the word or term is
inconsistent or in conflict with the purposes of this chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.004. ORAL HEALTH IMPROVEMENT SERVICES PROGRAM. (a) The
oral health improvement services program is in the department to
provide comprehensive oral health services to eligible
individuals.
(b) The board shall adopt rules to govern the program, to
prescribe the type, amount, and duration of oral health services
to be provided, and, if necessary to conform to budgetary
limitations, to prescribe a system of program priorities
regarding the types of services to be furnished, the geographic
areas to be covered, or the classes of individuals eligible for
services.
(c) Except as limited by Subsection (b), the department shall
develop an integrated framework for the equitable provision of
oral health services throughout the state or designated
geographic areas, using existing public and private health care
resources when possible.
(d) The program may consist of all or any combination of the
following:
(1) treatment services for eligible individuals, including:
(A) emergency care for relief of pain and infection, including
extractions and basic restorative services to prevent premature
loss of teeth;
(B) periodontal therapy for the prevention and treatment of
periodontal disease;
(C) endodontics to maintain aesthetics and occlusion;
(D) orthodontic care only in cases of severely handicapping
malocclusion; and
(E) oral surgery and prosthetics in cases in which health is
impaired;
(2) a program of oral disease prevention, including:
(A) the fluoridation of community water supplies;
(B) fluoride mouth rinse programs in schools;
(C) the promotion and implementation of sealants programs; and
(D) the development of appropriate means for prevention of oral
disease, including the continued use of recognized methods of
primary, secondary, and tertiary prevention;
(3) oral health education and promotion, including:
(A) public health education to promote the prevention of oral
disease through self-help methods, including the initiation and
expansion of preschool, school age, and adult education programs;
(B) organized continuing health education training programs for
health care providers; and
(C) preventive health education information for the public; and
(4) facilitation of access to oral health services, including:
(A) the improvement of the existing oral health services
delivery system for the provision of services to low-income
residents;
(B) outreach activities to inform the public of the type and
availability of oral health services to increase the
accessibility of oral health care for low-income residents; and
(C) assistance and cooperation in promoting better distribution
of dentists and other oral health professionals throughout the
state.
(e) The department may provide services only as prescribed by
board rules.
(f) The services listed in Subsection (d) may be furnished
either directly by the department or through a network of
approved providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.005. ADMINISTRATION. (a) The department shall:
(1) administer the program of oral health services established
by the board; and
(2) adopt the design and content of all forms necessary for the
program.
(b) The department may conduct field research, collect data, and
prepare statistical and other reports relating to the need for
and the availability of oral health services.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.006. SERVICE PROVIDERS. (a) The board may adopt
substantive and procedural rules relating to:
(1) the selection of dentists, physicians, facilities, and other
providers to furnish program services, including criteria for the
emergency selection of providers; and
(2) the denial, modification, suspension, or termination of a
provider's program participation.
(b) The department shall approve providers to participate in the
program according to the criteria, rules, and procedures adopted
by the board.
(c) The department may pay only for program services furnished
by approved providers, except in an emergency.
(d) The board shall provide a due process hearing procedure for
the resolution of conflicts between the department and a
provider. Chapter 2001, Government Code, do not apply to conflict
resolution procedures adopted under this section.
(e) The department shall render the final administrative
decision in a due process hearing to modify, suspend, or
terminate the approval of a provider.
(f) The department may not terminate a contract while a due
process hearing is pending under this section. The department may
withhold payments while the hearing is pending, but shall pay the
withheld payments and resume contract payments if the final
determination is favorable to the provider.
(g) Subsections (d)-(f) do not apply if a contract:
(1) is canceled by the department because of the exhaustion of
funds;
(2) expires according to its terms; or
(3) is canceled because program services are restricted to
conform to budgetary limitations as prescribed by Section
43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff.
Sept. 1, 1995.
Sec. 43.007. INDIVIDUAL REFERRAL AND APPLICATION FOR SERVICES.
(a) The board may adopt substantive and procedural rules to
govern the application for admission to the program and the
receipt of treatment services, including the dental, financial,
and other criteria for eligibility to receive treatment services.
(b) An applicant for treatment services must be referred to the
program by a person who knows the individual's economic
condition, such as a school administrator or school nurse, social
worker, municipal or county official, dentist, physician, public
health clinic, community health center, hospital, or any other
source acceptable to the board.
(c) An applicant for treatment services must complete or cause
to be completed an application form prescribed by the department.
(d) The application form must include or be accompanied by:
(1) a statement by the individual, or by the person with a legal
obligation to support the individual, that the individual or the
person is financially unable to pay for all or part of the cost
of the necessary treatment services;
(2) a statement from the referring person that the treatment
services are necessary to prevent or reduce the probability of
pain, infection, or disease; and
(3) any other assurances from the applicant or any other
documentary evidence required by the board to support the
applicant's eligibility.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.008. ELIGIBILITY FOR SERVICES. (a) The department
shall determine an individual's eligibility for treatment
services according to this chapter and the program rules.
(b) An individual is not eligible to receive treatment services
provided under this chapter unless:
(1) the individual is a resident of this state;
(2) the department has determined that neither the individual
nor a person with a legal obligation to support the individual is
financially able to pay for all or part of the treatment services
provided by this chapter;
(3) the individual complies with any other requirements stated
in the program rules; and
(4) at least one licensed dentist or licensed physician has
certified to the department that the dentist or physician has
examined the individual and has found that:
(A) the individual meets the board's dental criteria; and
(B) the dentist or physician has reason to expect that the
treatment services provided by or through the department will
prevent or reduce the probability of the individual's
experiencing pain, infection, or disease.
(c) Except as permitted by program rules, the department may not
provide treatment services before an individual's eligibility
date assigned by the department or authorize payment for
treatment services furnished by a provider before that date.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.009. DENIAL, MODIFICATION, SUSPENSION, OR TERMINATION OF
SERVICES. (a) The department may, for cause, deny an
application for treatment services or modify, suspend, or
terminate a recipient's treatment services after notice to the
applicant or recipient and the opportunity for a due process
hearing.
(b) The board by rule shall provide criteria for action by the
department under this section.
(c) Chapter 2001, Government Code, do not apply to the granting,
denial, modification, suspension, or termination of treatment
services. The department shall conduct hearings in accordance
with the board's due process hearing rules.
(d) The department shall render the final administrative
decision in a due process hearing to deny, modify, suspend, or
terminate the receipt of oral health services.
(e) This section does not apply if oral health services are
restricted to conform to budgetary limitations as prescribed by
Section 43.004(b).
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1995, 74th Leg., ch. 76, Sec. 5.95(66), eff.
Sept. 1, 1995.
Sec. 43.010. FINANCIAL ELIGIBILITY; OTHER BENEFITS. (a) The
department shall require an individual receiving treatment
services under this chapter or a person with a legal obligation
to support the individual to pay for or reimburse the department
for that part of the cost of the treatment services that the
individual or person is financially able to pay.
(b) An individual is not eligible to receive treatment services
under this chapter to the extent that the individual or a person
with a legal obligation to support the individual is eligible for
some other benefit that would pay for all or part of the
treatment services.
(c) When the application is made under this chapter or at any
time during eligibility and the receipt of treatment services,
the applicant for or recipient of treatment services shall inform
the department of any other benefit to which the individual or a
person with a legal obligation to support the individual may be
entitled.
(d) An individual who has received treatment services that are
covered by some other benefit, or a person with a legal
obligation to support the individual, shall reimburse the
department to the extent of the treatment services provided when
the other benefit is received.
(e) The commissioner may waive the enforcement of Subsection (b)
as prescribed by board rules in certain individually considered
cases in which enforcement will deny treatment services to a
class of otherwise eligible individuals because of conflicting
federal, state, or local laws or rules.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.011. RECOVERY OF COSTS. (a) The department may recover
the cost of treatment services provided under this chapter from a
person who does not pay or reimburse the department as required
by this chapter or from any third party who has a legal
obligation to pay other benefits and to whom notice of the
department's interest has been given.
(b) At the request of the commissioner, the attorney general may
bring suit in the appropriate court of Travis County on behalf of
the department.
(c) In a judgment in favor of the department, the court may
award attorney's fees, court costs, and interest accruing from
the date on which the department provides the service to the date
on which the department is reimbursed.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.012. FEES. The board may charge fees for the oral
health services provided directly by the department or through
approved providers in accordance with Subchapter D, Chapter 12.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.013. FUNDS. (a) Subject to limitations or conditions
prescribed by the legislature, the board may seek, receive, and
spend funds received from any public or private source for the
purposes of this chapter.
(b) The department is not required to provide oral health
services unless funds are appropriated to the department for that
express purpose.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 43.014. CONTRACTS. The department may enter into contracts
and agreements necessary to facilitate the efficient and
economical provision of oral health services under this chapter,
including contracts for the purchase of services, equipment, and
supplies from qualified providers.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
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