Texas Register, Volume 23, Number 49, Part III, Pages 12311-12450, December 4, 1998 Page: 12,319
12311-12450 p. ; 28 cm.View a full description of this periodical.
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(C) hospital records, Eft
(D) patient records, including radiographs; or Pr
(E) any other records determined to be necessary to Fo
conduct the review; and
(2) are performed by a dentist licensed by the SBDE.
Review of the work of specialists shall be substantiated by a specialist C
in the same field or by a panel which contains such a specialist when d
issues of patient care are involved.
(c) Dental utilization reviews shall be based on written
procedures and screening criteria which are evaluated and updated T
periodically with input from practicing dentists. Criteria shall be a
objective, clinically valid, and compatible with established principles F
of dental care. The department shall apply review and screening C
criteria with flexibility appropriate to the circumstances of each case.
33.352. Selection o' Dentists f r Departlnt Utilization Review
(a) An individual or group dental provider may be selected
by the department for a utilization review as a result of:
(1) a random selection procedure from the current list of
participating dental providers in a geographic area selected for review;
(2) comparisons of claims submitted or patterns of prac-
tice in relation to other participating dentists: or
(3) information or complaints received by the department,
except those alleging fraud or abuse or concerning the practice of
dentistry as described in 33.317 of this title (relating to Management
of Complaints).
(b) Providers suspected of program fraud or abuse will not
be subject to a utilization review by the department, but will instead
be referred to OIE for disposition.
(c) Complaints regarding the practice of dentistry will be
referred to SBDE.
33.353. Notification to Protider of Departnent On-Site Utilizationl
Review
(a) The department shall give the provider at least 30 days
notice of the time and place of a utilization review, unless such no-
tice would jeopardize an active investigation.
(b) At least seven days prior to a utilization review, the
department shall give the provider a list of the recipients for whom
all records must be provided, unless such notice would jeopardize an
active investigation.
(c) Prior notification requirements to providers do not apply
to utilization reviews conducted under the direction of the OIE.
33.355. Dispositionl of Departent Utilization Review Results.
The results of utilization reviews, either automated or on-site, shall be
forwarded by the department or by its claims processing contractor
to the OIE for evaluation and linal disposition. Results of a review
which reflects no deviation from review standards will be mailed to
the provider in a timely manner upon completion of the review.
This agency hereby certifies that the adoption has been re-
viewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of the Secretary of State on November 18,
1998.
TRD-9817698
Susan K. Steeg
General Counselxas Department of Health
elective date: December 8, 1998
oposal publication date: May 22, 1998
)r further information, please call: (512) 458-7236
:hapter 38. Chronically Ill and Disabled Chil-
ren's Services Programs
5 TAC 38.18
he Texas Department of Health (department) adopts an
amendment to 38.18, concerning the Children with Special
-lealth Care Needs Advisory Committee (committee) with
:hanges to the proposed text as published in the September
>5, 1998, issue of the Texas Register (23 TexReg 9689).
In 1993, the Texas Legislature passed Senate Bill 383 (now
codified in the Government Code, Chapter 2110) which requires
that each state agency adopt rules to establish advisory com-
mittees. The rules must state the purpose of each committee,
state the composition of the committee, describe the tasks of
the committee, describe the manner in which the committee will
report to the agency, and establish a date on which the commit-
tee will be automatically abolished unless the governing body
of the agency affirmatively votes to continue the committee in
existence.
In 1995, the Texas Board of Health (board) established a rule re-
lating to the Children with Special Health Care Needs Advisory
Committee. The committee provides advice to the board and
the department in the area of developing comprehensive sys-
tems of health care for children with special health care needs
and their families. The rule states that the committee will au-
tomatically be abolished on January 1, 1999. The board has
now reviewed and evaluated the committee and has determined
that the committee should continue in existence until January
1,2003.
This section amends provisions relating to the operation of
the committee. Specifically, language is revised to state
the committee is established under the Health and Safety
Code, 11.016 which allows the board to establish advisory
committees; to reference the Government Code; to make it
clear that the purpose of the committee is to provide advice to
the board; to continue the committee until January 1, 2003; to
address changes to the composition of the committee; to require
that the presiding officer and the assistant presiding officer of
the committee will be selected by the chairman of the board for
a term of two years; to allow a temporary vacancy in an office
to be filled by vote of the committee until appointment by the
chairman of the board occurs; to clarify that the committee is
prohibited from holding an executive session (closed meeting)
for any reason; and to clarify that the committee and its
members may not participate in legislative activity in the name
of the board, the department, or the committee except with
certain approval. These changes will clarify procedures for the
committee and emphasize the advisory nature of the committee.
No comments were received on the proposal during the com-
ment period; however, the department is making minor changes
due to staff comments to clarify the intent and improve accuracy
of the section.
Change: Concerning 38.18(f)(3), the language was revised to
acknowledge that the composition of the committee is changingADOPTED RULES December 4, 1998 23 TexReg 12319
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Texas. Secretary of State. Texas Register, Volume 23, Number 49, Part III, Pages 12311-12450, December 4, 1998, periodical, December 4, 1998; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth379980/m1/19/?rotate=90: accessed April 30, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.