By: Zerwas H.B. No. 2330
A BILL TO BE ENTITLED
AN ACT
relating to the right of a dentist to contract for certain services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 251, Occupations Code, is amended by
adding Section 251.0041 to read as follows:
Sec. 251.0041. IMPROPER INFLUENCE ON PROFESSIONAL
JUDGMENT. (a) In this section, the term "dentist" includes:
(1) a dentist licensed by the board;
(2) a professional corporation wholly owned by one or
more dentists licensed by the board; and
(3) a professional entity that provides dental
services and is owned solely by one or more dentists licensed by the
board.
(b) A dentist who enters into any contract or other
agreement that allows a person other than a dentist one or more of
the following rights or authorities is presumed to have allowed the
other person to control, influence, or otherwise interfere with the
exercise of the dentist's independent professional judgment
regarding the diagnosis or treatment of a dental disease, disorder,
or physical condition:
(1) controlling, owning, or setting any conditions for
access to or the specific contents of dental records of patients of
a dentist;
(2) setting a maximum or other standardized time for
the performance of specific dental procedures;
(3) placing any limitation or requirement on
treatments, referrals, or consultations except those based on the
professional judgment of the dentist;
(4) limiting or imposing requirements concerning the
type or scope of dental treatment, procedures, or services that may
be recommended, prescribed, directed, or performed, except that a
dentist may limit the dentist's practice, or the practice of a
dentist employed by or contracting with the dentist, to certain
procedures or the treatment of certain dental diseases;
(5) limiting or imposing requirements concerning the
supplies, instruments, or equipment deemed reasonably necessary by
a dentist to provide diagnoses and treatment of the patients of the
dentist, including a restriction on the use of a dentist's money for
the purchase of supplies, instruments, or equipment;
(6) limiting or imposing requirements for the
professional training deemed necessary by the dentist to properly
serve the patients of the dentist;
(7) directing or influencing the selection of specific
diagnostic examinations and treatments or practices regarding
patients without due regard to the recommended diagnostic
examinations and treatment agreed upon by the dentist and the
patient, except that a dentist having the responsibility for
training or supervising another dentist may reasonably limit
treatments or practices as a part of the training or supervision of
a dentist based upon the training and competency of a dentist to
perform certain treatments or practices;
(8) limiting or determining the duties of
professional, clinical, or other personnel employed to assist a
dentist in the practice of dentistry;
(9) establishing professional standards, protocols,
or practice guidelines which, in the professional judgment of the
dentist providing dental service to the dentist's patient, conflict
with generally accepted standards within the dental profession;
(10) encouraging impermissible referrals from
unlicensed persons in consideration of a fee;
(11) placing limitations or conditions upon
communications that are clinical in nature with the dentist's
patients;
(12) precluding or restricting a dentist's ability to
exercise independent professional judgment over all qualitative
and quantitative aspects of the delivery of dental care;
(13) scheduling patients of the dentist in a manner
that may have the effect of discouraging new patients from coming
into the dentist's practice or postponing future appointments or
giving scheduling preference to an individual, class, or group;
(14) penalizing a dentist for reporting violations of
a law regulating the practice of dentistry;
(15) conditioning the payment of fees to a dentist or
the amount of management fees a dentist must pay on the referral of
patients to other health care providers specified by a non-dentist;
or
(16) interfering with a dentist's decision regarding
the refund of any payment made by a patient for dental services.
(c) If a person who is not a dentist enters into any contract
or other agreement with a dentist that allows the person one or more
of the following rights or authorities, the person is presumed not
to have engaged in the practice of dentistry as defined by Section
251.003 without a license or to have been allowed to control,
influence, or otherwise interfere with the exercise of the
dentist's independent professional judgment regarding the
diagnosis or treatment of any dental disease, disorder, or physical
condition:
(1) leases, mortgages, ownership agreements, or other
arrangements regarding use of space for dental offices based on a
fee or amount that is reasonably related to the fair market value of
the office space at the time the lease or other arrangement is
entered into;
(2) the purchase, sale, financing, or lease of dental
equipment, instruments, and supplies as long as the dentist
maintains the complete care, custody, and control of the dental
equipment, instruments, and supplies and the lease does not provide
for a payment or fee based upon a percentage of the revenue received
by the dentist or the dental practice;
(3) accounting, bookkeeping, banking, investment, or
similar financial services, including services related to the
payment of invoices, obligations, and debts of a dentist;
(4) the financing, lease, use, or ownership of
non-dentist business equipment such as telephones, computers,
software, and general office equipment at reasonable,
market-related fees;
(5) services regarding the pledge, collection, or sale
of accounts receivable from patients;
(6) billing and collection services;
(7) advertising and marketing services as long as the
dentist remains solely responsible for the content of any
advertising or marketing services and for ensuring that the
advertising and marketing services conform to all applicable legal
requirements;
(8) consulting and advising regarding professional
development, business practices, and third party payor
arrangements, and the provision of business and other nonclinical
services for the day-to-day operation of a dental office which do
not limit the dentist's ability to use the dentist's independent
professional judgment regarding the diagnosis or treatment of any
dental disease, disorder, or physical condition;
(9) employing or retaining the services of personnel
working in a dental office, other than the dentist; or
(10) providing loans, capital, or funding to a
dentist, including under a secured arrangement.
(d)(1) The presumption established by Subsection (b) may be
rebutted by evidence that the contract or agreement did not result
in a person who is not a dentist controlling, influencing, or
otherwise interfering with the exercise of the dentist's
independent professional judgment regarding the diagnosis or
treatment of any dental disease, disorder, or physical condition.
(2) The presumption established by Subsection (c) may
be rebutted by evidence that the contract or agreement actually
resulted in a person who is not a dentist controlling, influencing,
or otherwise interfering with the dentist's independent
professional judgment regarding the diagnosis or treatment of any
dental disease, disorder, or physical condition. Evidence is not
admissible to rebut the presumption established by Subsection (c)
if the evidence relates to:
(A) the length of the contract or agreement;
(B) whether an unlicensed person provides all,
substantially all, or is the exclusive provider of such
undertakings to a dentist or dental office; or
(C) subject to the limitations of Subsection
(b)(5), whether the dentist has authorized an unlicensed person to
have signature authority over the dentist's accounts.
(e) This rule does not apply to a person or circumstance
described by Section 251.004, 260.001, 260.002, 260.003, or
260.004.
SECTION 2. Section 254.0011, Occupations Code, is amended
to read as follows:
Sec. 254.0011. RULES RELATING TO CONTROL OF DENTAL
PRACTICE. [(a)] The board may not adopt rules [relating to the
practice of dentistry as described by Section 251.003(a)(9)] to
prohibit or otherwise restrict [a dentist from engaging in
contracts that allow a person who is not a dentist to influence or
interfere with the exercise of the dentist's independent
professional judgment.
[(b) Rules adopted by the board under this subtitle may not
preclude] a dentist's right to contract with:
(1) a management service organization; or
(2) a person for the provision of management services.
[Rules affecting contracts for provision of management services
apply the same to dentists contracting with management service
organizations and to dentists otherwise contracting for management
services.]
SECTION 3. This Act takes effect September 1, 2015.