84R1424 EES-D
 
  By: Rodríguez, Eltife S.B. No. 787
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the improvement of oral health care access through the
  regulation of dental hygiene practitioners, dental hygienists, and
  dentists in this state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Chapter 256, Occupations Code, is
  amended to read as follows:
  CHAPTER 256. LICENSING OF DENTISTS, [AND] DENTAL HYGIENISTS, AND
  DENTAL HYGIENE PRACTITIONERS
         SECTION 2.  Chapter 256, Occupations Code, is amended by
  adding Subchapter B-1 to read as follows:
  SUBCHAPTER B-1. ISSUANCE OF LICENSE TO DENTAL HYGIENE PRACTITIONER
         Sec. 256.081.  DEFINITION. In this chapter, "dental hygiene
  practitioner" means a person who practices dental hygiene therapy
  under a license issued under this chapter.
         Sec. 256.082.  LICENSE REQUIRED. A person may not practice
  or offer to practice dental hygiene therapy in this state unless the
  person is licensed under this chapter.
         Sec. 256.083.  ELIGIBILITY FOR LICENSE. An applicant for a
  license to practice dental hygiene therapy in this state must:
               (1)  be at least 18 years of age;
               (2)  be of good moral character;
               (3)  be a licensed dental hygienist;
               (4)  have obtained an associate's or bachelor's degree
  in dental hygiene from a public or private institution of higher
  education or other postsecondary institution accredited by:
                     (A)  an accrediting agency recognized by the Texas
  Higher Education Coordinating Board; and
                     (B)  the Commission on Dental Accreditation of the
  American Dental Association or a successor organization;
               (5)  after having obtained an associate's degree in
  dental hygiene or having completed coursework equivalent to an
  associate's degree in dental hygiene as part of a bachelor's degree
  in dental hygiene, have successfully completed a dental hygiene
  practitioner program that:
                     (A)  is accredited by the Commission on Dental
  Accreditation of the American Dental Association or a successor
  organization;
                     (B)  consists of a minimum of four semesters;
                     (C)  has a curriculum that:
                           (i)  is consistent with the model curriculum
  for dental hygiene practitioner programs adopted by the American
  Association of Public Health Dentistry or a successor organization;
                           (ii)  is consistent with the curriculum
  followed by dental hygiene practitioner programs in other states;
  and
                           (iii)  has been approved by the board; and
                     (D)  meets the requirements for dental hygiene
  practitioner programs adopted by the board; and
               (6)  have passed the examination required by Section
  256.085.
         Sec. 256.084.  APPLICATION FOR EXAMINATION. To take the
  examination under Section 256.085, an applicant for a license must:
               (1)  submit an application on a form prescribed by the
  board;
               (2)  pay the application fee set by the board;
               (3)  include with the application:
                     (A)  proof of current certification in
  cardiopulmonary resuscitation approved by the American Heart
  Association or American Red Cross; or
                     (B)  if the applicant is not physically able to
  comply with the certification requirement of Paragraph (A), a
  written statement describing the person's physical incapacity
  executed by a physician or an instructor in cardiopulmonary
  resuscitation approved by the American Heart Association or
  American Red Cross; and
               (4)  provide any other information the board requires
  to determine the applicant's qualifications.
         Sec. 256.085.  LICENSE EXAMINATION. (a) The board shall
  provide for the examination of an applicant for a dental hygiene
  practitioner license.
         (b)  The examination must include subjects and operations
  relating to dentistry and dental hygiene therapy, including
  subjects regularly taught in schools of dentistry and in dental
  hygiene practitioner programs accredited by an accrediting agency
  recognized by the Texas Higher Education Coordinating Board.
         (c)  The board shall contract with one or more independent or
  regional testing services for any required clinical examination. If
  the board uses one or more regional testing services, the board may
  contract for or otherwise use licensed dental hygiene practitioners
  to provide assistance to the regional testing service or services.
         (d)  The board shall have the written portion of the board's
  jurisprudence examination validated by an independent testing
  professional.
         Sec. 256.086.  EXAMINATION RESULTS. (a) The board shall
  notify each examinee of the results of the examination within a
  reasonable time after the date of the examination.
         (b)  If the board contracts with an independent or regional
  testing service, the contract with the service must provide for the
  notification of results.
         Sec. 256.087.  REEXAMINATION. (a) The board by rule shall
  establish the conditions under which and the number of times an
  applicant may retake an examination.
         (b)  The board may require an applicant who fails the
  examination to meet additional education requirements set by the
  board.
         Sec. 256.088.  ISSUANCE OF LICENSE. The board shall issue a
  license to practice dental hygiene therapy to an applicant who
  meets the eligibility requirements of Section 256.083.
         Sec. 256.089.  MAINTENANCE OF DENTAL HYGIENE LICENSE NOT
  REQUIRED. A dental hygiene practitioner is not required to
  maintain an active license to practice dental hygiene.
         SECTION 3.  Sections 256.101(a) and (a-1), Occupations Code,
  are amended to read as follows:
         (a)  The board shall issue a license to practice dentistry to
  a qualified [reputable] dentist, a license to practice dental
  hygiene therapy to a qualified dental hygiene practitioner, or a
  license to practice dental hygiene to a qualified [reputable]
  dental hygienist who:
               (1)  pays the fee set by the board;
               (2)  is licensed in good standing as a dentist, dental
  hygiene practitioner, or dental hygienist in another state that has
  licensing requirements substantially equivalent to the
  requirements of this subtitle;
               (3)  has not been the subject of a final disciplinary
  action and is not the subject of a pending disciplinary action in
  any jurisdiction in which the dentist, dental hygiene practitioner,
  or dental hygienist is or has been licensed;
               (4)  has graduated from a dental or dental hygiene
  school or a dental hygiene practitioner program accredited by the
  Commission on Dental Accreditation of the American Dental
  Association and approved by the board under board rule;
               (5)  has passed a national or other examination
  relating to dentistry, dental hygiene therapy, or dental hygiene
  and recognized by the board;
               (6)  has passed the board's jurisprudence examination;
               (7)  has submitted documentation of current
  cardiopulmonary resuscitation certification;
               (8)  has practiced dentistry, dental hygiene therapy,
  or dental hygiene:
                     (A)  for at least the three years preceding the
  date of application for a license under this section; or
                     (B)  as a dental educator at a dental school or
  dental hygiene school or in a dental hygiene practitioner program 
  accredited by the Commission on Dental Accreditation of the
  American Dental Association for at least the five years preceding
  the date of application for a license under this section;
               (9)  has been endorsed by the board of dentistry in the
  jurisdiction in which the applicant practices at the time of
  application; and
               (10)  meets any additional criteria established by
  board rule.
         (a-1)  The board by rule shall specify the circumstances
  under which the board may waive the requirement under Subsection
  (a)(8) that an applicant for a license under this section has been
  continuously engaged in the practice of dentistry, dental hygiene
  therapy, or dental hygiene during the period required by that
  subsection if the applicant has engaged in the practice of
  dentistry, dental hygiene therapy, or dental hygiene for a
  cumulative total of at least three years before the date of
  application for a license under this section.
         SECTION 4.  Sections 256.1013(a) and (c), Occupations Code,
  are amended to read as follows:
         (a)  The board may issue a provisional license to an
  applicant currently licensed in another jurisdiction who seeks a
  license in this state and who:
               (1)  has been licensed in good standing as a dentist,
  dental hygiene practitioner, or dental hygienist for at least two
  years in another jurisdiction that has licensing requirements
  substantially equivalent to the requirements of this subtitle;
               (2)  is a graduate of a recognized school of dentistry
  or dental hygiene or a dental hygiene practitioner program 
  accredited by the Commission on Dental Accreditation of the
  American Dental Association and approved by the board;
               (3)  has passed a national or other examination
  recognized by the board relating to the practice of dentistry,
  dental hygiene therapy, or dental hygiene, as appropriate; and
               (4)  is sponsored by a person who holds an appropriate
  license under this subtitle and with whom the provisional license
  holder will practice during the time the person holds a provisional
  license.
         (c)  A provisional license is valid until the date the board
  approves or denies the provisional license holder's application for
  a license. The board shall issue a license under this subtitle to
  the provisional license holder if:
               (1)  the provisional license holder is eligible to be
  licensed under Section 256.101; or
               (2)  the provisional license holder passes the part of
  the examination under Section 256.003, [or] 256.055, or 256.085
  that relates to the applicant's knowledge and understanding of the
  laws and rules relating to the practice of dentistry, dental
  hygiene therapy, or dental hygiene, as appropriate, in this state
  and:
                     (A)  the board verifies that the provisional
  license holder meets the academic and experience requirements for a
  license under this subtitle; and
                     (B)  the provisional license holder satisfies any
  other licensing requirements under this subtitle.
         SECTION 5.  Section 256.1015(a), Occupations Code, is
  amended to read as follows:
         (a)  The board, upon payment by the applicant of a fee set by
  the board, shall grant a temporary license to practice dentistry to
  any qualified [reputable] dentist, a temporary license to practice
  dental hygiene therapy to any qualified dental hygiene
  practitioner, or a temporary license to practice dental hygiene to
  any qualified [reputable] dental hygienist who:
               (1)  meets all requirements of Section 256.101 except
  those of Subsection (a)(8); and
               (2)  is employed by a nonprofit corporation that
  accepts Medicaid reimbursement.
         SECTION 6.  Section 256.103(a), Occupations Code, is amended
  to read as follows:
         (a)  A licensed dentist, dental hygiene practitioner, or
  dental hygienist shall display the person's current registration
  certificate in each office in which the person provides dental
  services.  If the dentist, dental hygiene practitioner, or dental
  hygienist provides dental services at more than one location, the
  person may display a duplicate of the original registration
  certificate obtained from the board on payment of a duplicate
  certificate fee set by the board.
         SECTION 7.  Section 256.105(a), Occupations Code, is amended
  to read as follows:
         (a)  Each dentist, dental hygiene practitioner, dental
  hygienist, and owner or manager of a dental laboratory licensed or
  registered with the board shall timely notify the board of:
               (1)  any change of address of the person's place of
  business;
               (2)  any change of employers for the dentist, dental
  hygiene practitioner, or dental hygienist and any change of owners
  or managers for the dental laboratory; and
               (3)  any change of the person's mailing address.
         SECTION 8.  Section 257.004, Occupations Code, is amended to
  read as follows:
         Sec. 257.004.  CARDIOPULMONARY RESUSCITATION REQUIREMENTS.
  (a) A person holding a dental, [or] dental hygienist, or dental
  hygiene practitioner license must submit at the time the person
  applies for renewal of the license:
               (1)  a written statement executed by the person stating
  that the person has successfully completed a current program or
  course in cardiopulmonary resuscitation that includes a
  demonstration of skills and a written evaluation; or
               (2)  if the person is not physically able to comply with
  the requirements of Subdivision (1), a written statement describing
  the person's physical incapacity executed by a licensed physician.
         (b) [(c)]  A dentist, [or] dental hygienist, or dental
  hygiene practitioner licensed by the board who resides in a country
  other than the United States on the renewal date of the person's
  license and has not practiced dentistry, [or] dental hygiene, or
  dental hygiene therapy in the United States during the year
  preceding the renewal date is exempt from the requirements of
  Subsection (a) if the person submits proof of foreign residence
  with the person's renewal application.
         SECTION 9.  The heading to Section 257.005, Occupations
  Code, is amended to read as follows:
         Sec. 257.005.  CONTINUING EDUCATION FOR DENTIST, DENTAL
  HYGIENE PRACTITIONER, AND DENTAL HYGIENIST.
         SECTION 10.  Section 257.005(a), Occupations Code, is
  amended to read as follows:
         (a)  The board shall develop a mandatory continuing
  education program for licensed dentists, dental hygiene
  practitioners, and dental hygienists. The board by rule shall
  require a license holder to complete at least 12 hours of continuing
  education for each annual registration period to renew the license
  for a subsequent annual period.
         SECTION 11.  Section 258.001, Occupations Code, is amended
  to read as follows:
         Sec. 258.001.  [IMPERMISSIBLE] DELEGATIONS.  A dentist may
  not delegate:
               (1)  an act to an individual who, by board order, is
  prohibited from performing the act;
               (2)  any of the following acts to a person not licensed
  as a dentist, dental hygiene practitioner, or dental hygienist:
                     (A)  the removal of calculus, deposits, or
  accretions from the natural and restored surfaces of exposed human
  teeth and restorations in the human mouth;
                     (B)  root planing or the smoothing and polishing
  of roughened root surfaces or exposed human teeth; or
                     (C)  any other act the delegation of which is
  prohibited by board rule;
               (3)  any of the following acts to a person not licensed
  as a dentist or dental hygiene practitioner:
                     (A)  initial assessment or [comprehensive]
  examination or diagnosis and treatment planning;
                     (B)  [a surgical or cutting procedure on hard or
  soft tissue;
                     [(C)]  the prescription of a drug, medication, or
  work authorization;
                     (C) [(D)]  the taking of an impression for a final
  restoration, appliance, or prosthesis; or
                     (D) [(E)]  the making of an intraoral occlusal
  adjustment; or
               (4)  any of the following acts to a person not licensed
  as a dentist:
                     (A)  a surgical or cutting procedure on hard or
  soft tissue;
                     (B)  direct pulp capping, pulpotomy, or any other
  endodontic procedure;
                     (C)  the final placement and intraoral adjustment
  of a fixed or removable appliance; or
                     (D)  the placement of any final restoration
                     [(F)     direct pulp capping, pulpotomy, or any other
  endodontic procedure;
                     [(G)     the final placement and intraoral
  adjustment of a fixed or removable appliance; or
                     [(H)  the placement of any final restoration; or
               [(4)     the authority to an individual to administer a
  local anesthetic agent, inhalation sedative agent, parenteral
  sedative agent, or general anesthetic agent if the individual is
  not licensed as:
                     [(A)     a dentist with a permit issued by the board
  for the procedure being performed, if a permit is required;
                     [(B)     a certified registered nurse anesthetist
  licensed by the Texas Board of Nursing, only if the delegating
  dentist holds a permit issued by the board for the procedure being
  performed, if a permit is required; or
                     [(C)     a physician anesthesiologist licensed by
  the Texas Medical Board].
         SECTION 12.  Subchapter A, Chapter 258, Occupations Code, is
  amended by adding Section 258.004 to read as follows:
         Sec. 258.004.  COLLABORATIVE PRACTICE WITH DENTAL HYGIENIST
  OR DENTAL HYGIENE PRACTITIONER.  (a)  In this section,
  "collaborative practice agreement" means a written practice
  agreement and protocols for the practice of dental hygiene or
  dental hygiene therapy.
         (b)  A dental hygienist may practice dental hygiene or a
  dental hygiene practitioner may practice dental hygiene therapy
  under a collaborative practice agreement with a dentist if the
  dental hygienist or dental hygiene practitioner:
               (1)  has been engaged in the practice of dental hygiene
  or dental hygiene therapy, as applicable, for at least one year with
  a minimum of 2,000 practice hours;
               (2)  completes annually an eight-hour continuing
  education program that includes instruction in medical emergency
  procedures, risk management, and professional ethics;
               (3)  completes a jurisprudence class every three years;
  and
               (4)  pays the required fee.
         (c)  A dental hygienist may enter into a collaborative
  practice agreement to practice dental hygiene in any setting
  authorized by law for the practice of dental hygiene.  A dental
  hygiene practitioner may enter into a collaborative practice
  agreement to practice dental hygiene therapy in any setting
  authorized by law for the practice of dental hygiene therapy.
         (d)  A collaborative practice agreement must include
  protocols:
               (1)  describing the practice of dental hygiene or
  dental hygiene therapy for:
                     (A)  medically compromised patients;
                     (B)  specific medical conditions;
                     (C)  patients with needs related to age; and
                     (D)  patients with complex medical histories;
               (2)  prescribing standards for specific dental hygiene
  or dental hygiene therapy procedures, including intervals for the
  performance of those procedures;
               (3)  prescribing intervals at which a supervising
  dentist must examine a patient;
               (4)  describing the services that the dental hygienist
  or dental hygiene practitioner may provide, the procedures that the
  dental hygienist or dental hygiene practitioner may perform, the
  practice settings in which the services may be provided and the
  procedures may be performed, and any limitations on the services
  and procedures;
               (5)  describing case selection criteria, assessment
  guidelines, and imaging frequency guidelines for patients by age
  and in relation to specific procedures;
               (6)  prescribing procedures for obtaining informed
  consent from patients and for creating and maintaining patient
  records;
               (7)  establishing a plan for the dentist to review
  patient records created and maintained by the dental hygienist or
  dental hygiene practitioner;
               (8)  establishing a plan for the management of medical
  emergencies in each setting in which the dental hygienist or dental
  hygiene practitioner practices;
               (9)  establishing a quality assurance plan for the
  dentist to monitor care provided by the dental hygienist or dental
  hygiene practitioner, including review of patient care, referrals,
  and charts; 
               (10)  describing the medications that may be
  administered and dispensed by the dental hygienist or dental
  hygiene practitioner and the specific circumstances under which the
  medications may be administered and dispensed;
               (11)  describing any requirements for consultation
  with the dentist before providing care to patients with specific
  medical conditions or complex medical histories; and
               (12)  establishing a plan, which includes clinical
  resources and referrals, for situations in which a patient requires
  treatment that exceeds the capabilities or scope of practice of the
  dental hygienist or dental hygiene practitioner.
         (e)  A collaborative practice agreement may include
  provisions to allow the practice of dental hygiene or dental
  hygiene therapy without:
               (1)  prior examination of the patient by a dentist; and
               (2)  the presence of a supervising dentist.
         (f)  A collaborative practice agreement must be:
               (1)  signed by the dentist, the dental hygienist or the
  dental hygiene practitioner, and, if applicable, a representative
  of the facility, program, or organization in which the practice of
  dental hygiene or dental hygiene therapy takes place;
               (2)  reviewed annually by the dentist and the dental
  hygienist or the dental hygiene practitioner who are parties to the
  collaborative practice agreement; and
               (3)  made available to the board and other interested
  parties on request.
         (g)  Not more than two collaborative practice agreements
  between a dentist and a dental hygienist or a dental hygiene
  practitioner may be in effect at a time.
         (h)  A dentist may have a collaborative practice agreement
  with not more than six dental hygienists or dental hygiene
  practitioners at the same time. The board may grant an exception to
  the requirements of this subsection for the practice of dental
  hygiene or dental hygiene therapy in a public health setting.
         (i)  Before providing any service authorized by a
  collaborative practice agreement, the dental hygienist or dental
  hygiene practitioner must provide the patient with a written
  statement advising the patient that the dental hygiene or dental
  hygiene therapy services performed are not a substitute for
  examination by a dentist.
         (j)  If a dental hygienist or dental hygiene practitioner
  operating under a collaborative practice agreement makes a referral
  for further dental procedures, the dental hygienist or dental
  hygiene practitioner must complete a referral form approved by the
  board and provide a copy of the form to the dentist who is a party to
  the collaborative practice agreement.
         SECTION 13.  Section 262.002, Occupations Code, is amended
  by amending Subsection (a) and adding Subsection (c) to read as
  follows:
         (a)  A person practices dental hygiene if the person:
               (1)  removes accumulated matter, tartar, deposits,
  accretions, or stains, other than mottled enamel stains, from the
  natural and restored surface of exposed human teeth and
  restorations in the human mouth;
               (2)  smoothes roughened root surfaces;
               (3)  polishes exposed human teeth, restorations in the
  human mouth, or roughened root surfaces;
               (4)  topically applies drugs to the surface tissues of
  the human mouth or the exposed surface of human teeth;
               (5)  makes dental x-rays; [and]
               (6)  administers intraoral, block, or infiltration
  anesthesia or inhalation sedations in the form of nitrous oxide
  under the authorization and supervision of a dentist; and
               (7)  performs any other service, task, or procedure
  prescribed by board rule.
         (c)  A dental hygienist may not establish an independent
  practice to provide services authorized by this subtitle.
         SECTION 14.  Section 262.151(a), Occupations Code, is
  amended to read as follows:
         (a)  A licensed dentist may delegate orally or in writing a
  service, task, or procedure to a dental hygienist who is under the
  supervision and responsibility of the dentist, if:
               (1)  the dental hygienist is licensed to perform the
  service, task, or procedure;
               (2)  [the supervising dentist examines the patient:
                     [(A)     at the time the service, task, or procedure
  is performed by the dental hygienist; or
                     [(B)     during the 12 calendar months preceding the
  date of performance of the service, task, or procedure by the dental
  hygienist; and
               [(3)]  the dental hygienist does not:
                     (A)  diagnose a dental disease or ailment;
                     (B)  prescribe a treatment or a regimen;
                     (C)  prescribe, order, or dispense medication; or
                     (D)  perform any procedure that is irreversible or
  involves the intentional cutting of soft or hard tissue by any
  means; and
               (3)  the supervising dentist has determined that the
  patient presents no evidence of tooth decay.
         SECTION 15.  Sections 262.1515(a) and (c), Occupations Code,
  are amended to read as follows:
         (a)  A licensed dentist may delegate a service, task, or
  procedure, pursuant to this section, to a dental hygienist[,
  without complying with Section 262.151(a)(2)] if:
               (1)  the dental hygienist has at least two years'
  experience in the practice of dental hygiene; and
               (2)  the service, task, or procedure is performed in
  one of the following locations:
                     (A)  a nursing facility as defined in Section
  242.301, Health and Safety Code;
                     (B)  a primary or secondary school [school-based
  health center established under Subchapter B, Chapter 38, Education
  Code]; [or]
                     (C)  a community health center as defined by
  Section 136.002, Human Resources Code;
                     (D)  a Head Start program facility;
                     (E)  a hospital;
                     (F)  a charitable clinic;
                     (G)  a correctional facility;
                     (H)  a state-operated facility;
                     (I)  a military or veterans clinic;
                     (J)  an adult day care facility licensed under
  Chapter 103, Human Resources Code;
                     (K)  a clinic located on land recognized as tribal
  land by the federal government and maintained or operated by a
  federally recognized Indian tribe or tribal organization as listed
  by the United States secretary of the interior under 25 U.S.C.
  Section 479a-1 or as listed under a successor federal statute or
  regulation; or
                     (L)  the residence of a patient who is homebound
  or who is receiving or is eligible to receive:
                           (i)  home and community-based waiver
  services under the Medicaid program;
                           (ii)  hospice services; or
                           (iii)  other home care services.
         (c)  A dental hygienist may [only] perform delegated tasks or
  procedures with respect to a patient for not more than 12 [six]
  months unless:
               (1)  the patient has been examined by a dentist;
               (2)  a dentist has reviewed the patient's dental
  records and determined that the dental hygienist may continue to
  provide services to the patient; or
               (3)  a dentist has used telemedicine as defined by
  Section 262.154(a) to determine that the dental hygienist may
  continue to provide services to the patient [in compliance with
  Section 262.151(a)(2)].
         SECTION 16.  Subchapter D, Chapter 262, Occupations Code, is
  amended by adding Section 262.154 to read as follows:
         Sec. 262.154.  TELEMEDICINE. (a) In this section,
  "telemedicine" means the use of technology that allows a health
  care service provider located at a site other than the site where
  the patient is located to deliver health care services and
  information, either in real time or after a delay.
         (b)  To the extent otherwise provided by law, a dental
  hygienist may use telemedicine to practice dental hygiene in any
  setting authorized by law for the practice of dental hygiene.
         SECTION 17.  Subtitle D, Title 3, Occupations Code, is
  amended by adding Chapter 268 to read as follows:
  CHAPTER 268. REGULATION OF DENTAL HYGIENE PRACTITIONERS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 268.001.  DEFINITIONS. In this chapter, "dental
  hygiene practitioner" means a person who practices dental hygiene
  therapy under a license issued by the board under Chapter 256.
         Sec. 268.002.  PRACTICE OF DENTAL HYGIENE THERAPY. (a)  A
  person practices dental hygiene therapy if the person:
               (1)  provides:
                     (A)  oral health and nutrition education; and
                     (B)  assessment and treatment planning as
  authorized by a dentist;
               (2)  places sealant on exposed human teeth;
               (3)  places or removes:
                     (A)  preformed or temporary crowns on exposed
  human teeth; and
                     (B)  space maintainers in the human mouth;
               (4)  applies coronal polishing of exposed human teeth;
               (5)  performs:
                     (A)  oral cancer screening;
                     (B)  tooth decay risk assessment;
                     (C)  provisional restorations of primary and
  permanent teeth;
                     (D)  nonsurgical removal of primary teeth;
                     (E)  nonsurgical removal of periodontally
  diseased permanent teeth, if authorized in advance by the
  supervising dentist;
                     (F)  atraumatic restorative therapy; and
                     (G)  stabilization of reimplanted teeth;
               (6)  makes and assesses dental radiographs;
               (7)  administers and monitors inhalation sedations in
  the form of nitrous oxide;
               (8)  administers intraoral, block, or infiltration
  anesthesia under the authorization and supervision of a dentist;
               (9)  prescribes, dispenses, and administers, with the
  authorization of the supervising dentist, analgesics,
  anti-inflammatories, antibiotics, antimicrobials, and anticaries;
               (10)  repairs defective prosthetic devices for the
  human mouth; and
               (11)  performs other related services and functions
  authorized by the supervising dentist and for which the dental
  hygiene practitioner is trained.
         (b)  A person legally practicing dental hygiene therapy does
  not violate state law regulating the practice of dentistry.
         (c)  A dental hygiene practitioner may not establish an
  independent practice to provide services authorized by this
  subtitle.
         (d)  A dental hygiene practitioner may supervise dental
  hygienists and dental assistants but may not supervise more than
  two dental hygienists and three dental assistants in a practice
  setting.
         Sec. 268.003.  EXEMPTIONS. This chapter does not apply to:
               (1)  a dentist practicing dentistry in this state,
  except as provided by Subchapter C;
               (2)  a physician authorized to practice medicine in
  this state; or
               (3)  an employee of a dentist practicing dentistry in
  this state who makes dental x-rays in the office of and under the
  supervision of the dentist.
  SUBCHAPTER B. POWERS AND DUTIES OF BOARD RELATING TO DENTAL HYGIENE
  PRACTITIONERS
         Sec. 268.051.  BOARD POWERS AND DUTIES. The board shall:
               (1)  administer this chapter; and
               (2)  regulate all matters concerning dental hygiene
  practitioners and the practice of dental hygiene therapy.
         Sec. 268.052.  RULEMAKING AUTHORITY OF BOARD. (a) The board
  shall adopt and enforce rules that are necessary and advisable to
  carry out the purposes of and to enforce this chapter, including
  rules relating to professional conduct for dental hygiene
  practitioners.
         (b)  As necessary to protect public health and safety, the
  board may adopt and enforce a rule to establish the number of dental
  hygiene practitioners a dentist may employ.
  SUBCHAPTER C. PRACTICE BY LICENSE HOLDER
         Sec. 268.101.  DELEGATION OF DUTIES BY DENTIST. (a) A
  dentist may delegate orally or in writing a service, task, or
  procedure to a dental hygiene practitioner who is under the
  supervision and responsibility of the dentist, if:
               (1)  the dental hygiene practitioner is licensed to
  perform the service, task, or procedure; and
               (2)  the dental hygiene practitioner does not:
                     (A)  diagnose a dental disease or ailment without
  consulting with the supervising dentist;
                     (B)  prescribe a treatment or a regimen without
  consulting with the supervising dentist; or
                     (C)  prescribe, order, or dispense medication,
  other than as authorized by the dentist.
         (b)  A dentist may delegate to a dental hygiene practitioner
  any act that a dentist may delegate to a dental hygienist or a
  dental assistant.
         (c)  A dentist is not required to be on the premises when the
  dental hygiene practitioner performs a delegated act.
         (d)  This chapter does not prevent a dentist from authorizing
  a dental hygiene practitioner employed by the dentist to:
               (1)  instruct and educate a patient in proper oral
  hygiene; or
               (2)  provide to a patient a medication ordered by the
  dentist.
         Sec. 268.102.  PERFORMANCE OF DELEGATED DUTIES. A dental
  hygiene practitioner shall practice dental hygiene therapy:
               (1)  in the dental office of a supervising dentist; or
               (2)  in an alternate setting, including a location
  described by Section 268.103(2).
         Sec. 268.103.  DELEGATION OF DUTIES TO DENTAL HYGIENE
  PRACTITIONER PRACTICING IN CERTAIN FACILITIES. A licensed dentist
  may delegate a service, task, or procedure, pursuant to this
  section, to a dental hygiene practitioner if:
               (1)  the dental hygiene practitioner has at least two
  years' experience in the practice of dental hygiene therapy; and
               (2)  the service, task, or procedure is performed in
  one of the following locations:
                     (A)  a nursing facility as defined in Section
  242.301, Health and Safety Code;
                     (B)  a primary or secondary school;
                     (C)  a community health center as defined by
  Section 136.002, Human Resources Code;
                     (D)  a Head Start program facility;
                     (E)  a hospital;
                     (F)  a charitable clinic;
                     (G)  a correctional facility;
                     (H)  a state-operated facility;
                     (I)  a military or veterans clinic;
                     (J)  an adult day care facility licensed under
  Chapter 103, Human Resources Code; 
                     (K)  a clinic located on land recognized as tribal
  land by the federal government and maintained or operated by a
  federally recognized Indian tribe or tribal organization as listed
  by the United States secretary of the interior under 25 U.S.C.
  Section 479a-1 or as listed under a successor federal statute or
  regulation; or
                     (L)  the residence of a patient who is homebound
  or who is receiving or is eligible to receive:
                           (i)  home and community-based waiver
  services under the Medicaid program;
                           (ii)  hospice services; or
                           (iii)  other home care services.
         Sec. 268.104.  TELEMEDICINE. (a) In this section,
  "telemedicine" means the use of technology that allows a health
  care service provider located at a site other than the site where
  the patient is located to deliver health care services and
  information, either in real time or after a delay.
         (b)  To the extent otherwise provided by law, a dental
  hygiene practitioner may use telemedicine to practice dental
  hygiene therapy in any setting authorized by law for the practice of
  dental hygiene therapy.
  SUBCHAPTER D. PROHIBITED PRACTICES; CIVIL LIABILITIES
         Sec. 268.151.  PROHIBITED PRACTICE. A dental hygiene
  practitioner may not practice or offer to practice dental hygiene
  therapy under a name other than the name appearing on the person's
  license.
         Sec. 268.152.  CIVIL LIABILITY. A dental hygiene
  practitioner who administers to a person cardiopulmonary
  resuscitation or other emergency care in an emergency situation is
  not liable to the person for damages unless the emergency care is
  performed in a wilfully or wantonly negligent manner.
         SECTION 18.  Section 32.024, Human Resources Code, is
  amended by adding Subsection (ll) to read as follows:
         (ll) The department shall establish separate provider types
  for dental hygienists and dental hygiene practitioners for purposes
  of enrollment as providers of and reimbursement under the medical
  assistance program. 
         SECTION 19.  Section 843.002(24), Insurance Code, is amended
  to read as follows:
               (24)  "Provider" means:
                     (A)  a person, other than a physician, who is
  licensed or otherwise authorized to provide a health care service
  in this state, including:
                           (i)  a chiropractor, registered nurse,
  pharmacist, optometrist, registered optician, [or] acupuncturist,
  dental hygienist, or dental hygiene practitioner; or
                           (ii)  a pharmacy, hospital, or other
  institution or organization;
                     (B)  a person who is wholly owned or controlled by
  a provider or by a group of providers who are licensed or otherwise
  authorized to provide the same health care service; or
                     (C)  a person who is wholly owned or controlled by
  one or more hospitals and physicians, including a
  physician-hospital organization.
         SECTION 20.  Section 1301.001(1-a), Insurance Code, is
  amended to read as follows:
               (1-a)  "Health care provider" means a practitioner,
  institutional provider, or other person or organization that
  furnishes health care services and that is licensed or otherwise
  authorized to practice in this state. [The term includes a
  pharmacist and a pharmacy.] The term does not include a physician.
  The term includes:
                     (A)  a pharmacist;
                     (B)  a pharmacy;
                     (C)  a dental hygienist; and
                     (D)  a dental hygiene practitioner.
         SECTION 21.  Section 1451.101, Insurance Code, is amended by
  amending Subdivision (1) and adding Subdivisions (1-a) and (1-b) to
  read as follows:
               (1)  "Dental hygiene practitioner" has the meaning
  assigned by Section 256.081, Occupations Code.
               (1-a)  "Dental hygienist" has the meaning assigned by
  Section 256.051, Occupations Code.
               (1-b)  "Health insurance policy" means a policy,
  contract, or agreement described by Section 1451.102.
         SECTION 22.  Subchapter C, Chapter 1451, Insurance Code, is
  amended by adding Sections 1451.128 and 1451.129 to read as
  follows:
         Sec. 1451.128.  SELECTION OF DENTAL HYGIENIST. An insured
  may select a dental hygienist to provide the services scheduled in
  the health insurance policy that are within the scope of the dental
  hygienist's license.
         Sec. 1451.129.  SELECTION OF DENTAL HYGIENE PRACTITIONER.
  An insured may select a dental hygiene practitioner to provide the
  services scheduled in the health insurance policy that are within
  the scope of the dental hygiene practitioner's license.
         SECTION 23.  The State Board of Dental Examiners shall, not
  later than June 30, 2016, adopt rules under Chapter 256,
  Occupations Code, as amended by this Act, and Chapter 268,
  Occupations Code, as added by this Act.
         SECTION 24.  As soon as practicable after the effective date
  of this Act, the Health and Human Services Commission shall
  establish and implement separate provider types for dental
  hygienists and dental hygiene practitioners as required by Section
  32.024(ll), Human Resources Code, as added by this Act.
         SECTION 25.  If before implementing any provision of this
  Act a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 26.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2015.