Texas 2019 - 86th Regular

Texas Senate Bill SB792 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	By: Perry, Flores S.B. No. 792
2		-	(In the Senate - Filed February 12, 2019; March 1, 2019,
3		-	read first time and referred to Committee on Health & Human
4		-	Services; April 26, 2019, reported adversely, with favorable
5		-	Committee Substitute by the following vote: Yeas 9, Nays 0;
6		-	April 26, 2019, sent to printer.)
7		-	Click here to see the committee vote
8		-	COMMITTEE SUBSTITUTE FOR S.B. No. 792 By: Perry
	1	+	86R6259 JCG-D
	2	+	By: Perry S.B. No. 792
9	3
10	4
11	5		A BILL TO BE ENTITLED
12	6		AN ACT
13	7		relating to the practice of dentistry and the provision of
14	8		teledentistry dental services.
15	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	10		SECTION 1. The heading to Chapter 111, Occupations Code, is
17	11		amended to read as follows:
18	12		CHAPTER 111. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
19	13		SECTION 2. Section 111.001, Occupations Code, is amended by
20	14		amending Subdivisions (1) and (3) and adding Subdivision (2-a) to
21	15		read as follows:
22	16		(1) "Dentist," "health [Health] professional," and
23	17		"physician" have the meanings assigned by Section 1455.001,
24	18		Insurance Code.
25	19		(2-a) "Teledentistry dental service" means a health
26	20		care service delivered by a dentist, or a health professional
27	21		acting under the delegation and supervision of a dentist, acting
28	22		within the scope of the dentist's or health professional's license
29	23		or certification to a patient at a different physical location than
30	24		the dentist or health professional using telecommunications or
31	25		information technology.
32	26		(3) "Telehealth service" means a health service, other
33	27		than a telemedicine medical service or a teledentistry dental
34	28		service, delivered by a health professional licensed, certified, or
35	29		otherwise entitled to practice in this state and acting within the
36	30		scope of the health professional's license, certification, or
37	31		entitlement to a patient at a different physical location than the
38	32		health professional using telecommunications or information
39	33		technology.
40	34		SECTION 3. Section 111.002, Occupations Code, is amended to
41	35		read as follows:
42		-	Sec. 111.002. INFORMED CONSENT. ~~(a)~~ A treating physician,
	36	+	Sec. 111.002. INFORMED CONSENT. A treating physician,
43	37		dentist, or health professional who provides or facilitates the use
44	38		of telemedicine medical services, teledentistry dental services,
45	39		or telehealth services shall ensure that the informed consent of
46	40		the patient, or another appropriate individual authorized to make
47	41		health care treatment decisions for the patient, is obtained before
48	42		telemedicine medical services, teledentistry dental services, or
49	43		telehealth services are provided.
50		-	(b) A dentist who delegates a teledentistry dental service
51		-	shall ensure that the informed consent of the patient includes
52		-	disclosure to the patient that the dentist has delegated the
53		-	service.
54	44		SECTION 4. Section 111.003, Occupations Code, is amended to
55	45		read as follows:
56	46		Sec. 111.003. CONFIDENTIALITY. A treating physician,
57	47		dentist, or health professional who provides or facilitates the use
58	48		of telemedicine medical services, teledentistry dental services,
59	49		or telehealth services shall ensure that the confidentiality of the
60	50		patient's clinical [medical] information is maintained as required
61	51		by Chapter 159, by Subchapter C, Chapter 258, or by other applicable
62	52		law.
63	53		SECTION 5. Section 111.004, Occupations Code, is amended
64	54		to read as follows:
65	55		Sec. 111.004. RULES. (a) The Texas Medical Board, in
66	56		consultation with the commissioner of insurance, as appropriate,
67	57		may adopt rules necessary to:
68	58		(1) ensure that patients using telemedicine medical
69	59		services receive appropriate, quality care;
70	60		(2) prevent abuse and fraud in the use of telemedicine
71	61		medical services, including rules relating to the filing of claims
72	62		and records required to be maintained in connection with
73	63		telemedicine medical services;
74	64		(3) ensure adequate supervision of health
75	65		professionals who are not physicians and who provide telemedicine
76	66		medical services; and
77	67		(4) establish the maximum number of health
78	68		professionals who are not physicians that a physician may supervise
79	69		through a telemedicine medical service.
80	70		(b) The State Board of Dental Examiners, in consultation
81	71		with the commissioner of insurance, as appropriate, may adopt rules
82	72		necessary to:
83	73		(1) ensure that patients using teledentistry dental
84	74		services receive appropriate, quality care;
85	75		(2) prevent abuse and fraud in the use of
86	76		teledentistry dental services, including rules relating to the
87	77		filing of claims and records required to be maintained in
88	78		connection with teledentistry dental services;
89	79		(3) ensure adequate supervision of health
90	80		professionals who are not dentists and who provide teledentistry
91		-	dental services under the delegation and supervision of a dentist;
92		-	and
93		-	(4) establish that a dentist may delegate to and
94		-	supervise through a teledentistry dental service not more than two
95		-	health professionals who are not dentists.
	81	+	dental services; and
	82	+	(4) establish the maximum number of health
	83	+	professionals who are not dentists that a dentist may supervise
	84	+	through a teledentistry dental service.
96	85		SECTION 6. The heading to Section 111.005, Occupations
97	86		Code, is amended to read as follows:
98	87		Sec. 111.005. PRACTITIONER-PATIENT RELATIONSHIP FOR
99	88		TELEMEDICINE MEDICAL SERVICES OR TELEDENTISTRY DENTAL SERVICES.
100		-	SECTION 7. Section 111.005, Occupations Code, is amended by
101		-	amending Subsections (a) and (b) and adding Subsection (d) to read
102		-	as follows:
	89	+	SECTION 7. Sections 111.005(a) and (b), Occupations Code,
	90	+	are amended to read as follows:
103	91		(a) For purposes of Section 562.056, a valid
104	92		practitioner-patient relationship is present between a
105	93		practitioner providing a telemedicine medical service or a
106	94		teledentistry dental service and a patient receiving the
107	95		[telemedicine medical] service as long as the practitioner complies
108	96		with the standard of care described in Section 111.007 and the
109	97		practitioner:
110	98		(1) has a preexisting practitioner-patient
111	99		relationship with the patient established in accordance with rules
112	100		adopted under Section 111.006;
113	101		(2) communicates, regardless of the method of
114	102		communication, with the patient pursuant to a call coverage
115	103		agreement established in accordance with:
116	104		(A) Texas Medical Board rules with a physician
117	105		requesting coverage of medical care for the patient; or
118	106		(B) State Board of Dental Examiners rules with a
119	107		dentist requesting coverage of dental care for the patient; or
120	108		(3) provides the telemedicine medical services or
121	109		teledentistry dental services through the use of one of the
122	110		following methods, as long as the practitioner complies with the
123	111		follow-up requirements in Subsection (b), and the method allows the
124	112		practitioner to have access to, and the practitioner uses, the
125	113		relevant clinical information that would be required in accordance
126	114		with the standard of care described in Section 111.007:
127	115		(A) synchronous audiovisual interaction between
128	116		the practitioner and the patient in another location;
129	117		(B) asynchronous store and forward technology,
130	118		including asynchronous store and forward technology in conjunction
131	119		with synchronous audio interaction between the practitioner and the
132	120		patient in another location, as long as the practitioner uses
133	121		clinical information from:
134	122		(i) clinically relevant photographic or
135	123		video images, including diagnostic images; or
136	124		(ii) the patient's relevant clinical
137	125		[medical] records, such as the relevant medical or dental history,
138	126		laboratory and pathology results, and prescriptive histories; or
139	127		(C) another form of audiovisual
140	128		telecommunication technology that allows the practitioner to
141	129		comply with the standard of care described in Section 111.007.
142	130		(b) A practitioner who provides telemedicine medical
143	131		services or teledentistry dental services to a patient as described
144	132		in Subsection (a)(3) shall:
145	133		(1) provide the patient with guidance on appropriate
146	134		follow-up care; and
147		-	(2) ~~subject to Subsection (d),~~ if the patient consents
148		-	~~and the patient has a~~ primary care physician or a regular dentist,
149		-	~~provide to the~~ patient's primary care physician or regular dentist,
150		-	as appropriate, within 72 hours after the practitioner provides the
	135	+	(2) if the patient consents and the patient has a
	136	+	primary care physician or a regular dentist, provide to the
	137	+	patient's primary care physician or regular dentist, as
	138	+	appropriate, within 72 hours after the practitioner provides the
151	139		services to the patient, a clinical [medical] record or other
152		-	report containing an explanation of:
153		-	(A) the treatment provided by the practitioner to
154		-	the patient; and
155		-	(B) as authorized by the law under which the
156		-	practitioner is licensed, certified, or otherwise permitted to
157		-	provide the service, the practitioner's evaluation, analysis, or
158		-	diagnosis[, as appropriate,] of the patient's condition.
159		-	(d) A practitioner who provides teledentistry dental
160		-	services to a patient as described in Subsection (a)(3):
161		-	(1) on the date the practitioner first provides the
162		-	teledentistry dental services, shall inform the patient of the
163		-	limitation provided by Subdivision (2); and
164		-	(2) may only provide teledentistry dental services
165		-	with respect to the patient for 12 months unless:
166		-	(A) a dentist performs an in-person tactile and
167		-	visual examination of the hard and soft tissues of the patient's
168		-	oral cavity; and
169		-	(B) the practitioner receives notice of the
170		-	examination described by Paragraph (A).
	140	+	report containing an explanation of the treatment provided by the
	141	+	practitioner to the patient and the practitioner's evaluation,
	142	+	analysis, or diagnosis, as appropriate, of the patient's condition.
171	143		SECTION 8. Section 111.006, Occupations Code, is amended by
172	144		adding Subsection (c) to read as follows:
173	145		(c) The State Board of Dental Examiners and the Texas State
174	146		Board of Pharmacy shall jointly adopt rules that establish the
175	147		determination of a valid prescription in accordance with Section
176		-	111.005. Rules adopted under this subsection must allow for the
	148	+	111.005, as that section applies to teledentistry dental services.
	149	+	Rules adopted under this subsection must allow for the
177	150		establishment of a practitioner-patient relationship by a
178		-	teledentistry dental service provided by a ~~dentist~~ to a ~~patient in a~~
179		-	manner that complies with Section 111.005(a)(3). The ~~State Board~~
180		-	of Dental Examiners and the Texas State Board of ~~Pharmacy shall~~
181		-	jointly develop and publish on each respective ~~board's Internet~~
182		-	website responses to frequently asked questions ~~relating to the~~
183		-	determination of a valid prescription issued in the ~~course of the~~
184		-	provision of teledentistry dental services.
	151	+	teledentistry dental service provided by a practitioner to a
	152	+	patient in a manner that complies with Section 111.005(a)(3). The
	153	+	State Board of Dental Examiners and the Texas State Board of
	154	+	Pharmacy shall jointly develop and publish on each respective
	155	+	board's Internet website responses to frequently asked questions
	156	+	relating to the determination of a valid prescription issued in the
	157	+	course of the provision of teledentistry dental services.
185	158		SECTION 9. Section 111.007, Occupations Code, is amended to
186	159		read as follows:
187	160		Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL
188	161		SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES.
189	162		(a) A health professional providing a health care service or
190	163		procedure as a telemedicine medical service, a teledentistry dental
191	164		service, or a telehealth service is subject to the standard of care
192	165		that would apply to the provision of the same health care service or
193	166		procedure in an in-person setting.
194	167		(b) An agency with regulatory authority over a health
195	168		professional may not adopt rules pertaining to telemedicine medical
196	169		services, teledentistry dental services, or telehealth services
197	170		that would impose a higher standard of care than the standard
198	171		described in Subsection (a).
199	172		SECTION 10. Chapter 111, Occupations Code, is amended by
200		-	adding Section 111.0075 to read as follows:
201		-	Sec. 111.0075. LICENSING FOR TELEDENTISTRY DENTAL
202		-	SERVICES. A health professional providing a health care service or
203		-	procedure as a teledentistry dental service is subject to the
204		-	licensing requirements that would apply to the provision of the
205		-	same health care service or procedure in an in-person setting.
206		-	SECTION 11. Chapter 111, Occupations Code, is amended by
207	173		adding Section 111.009 to read as follows:
208	174		Sec. 111.009. CERTAIN PRESCRIPTIONS PROHIBITED. (a) In
209	175		this section, "controlled substance" and "prescribe" have the
210	176		meanings assigned by Section 481.002, Health and Safety Code.
211	177		(b) A dentist may not prescribe a controlled substance to a
212	178		patient as a teledentistry dental service.
213		-	SECTION 12. Section 251.003, Occupations Code, is amended
	179	+	SECTION 11. Section 251.003, Occupations Code, is amended
214	180		by adding Subsection (d) to read as follows:
215	181		(d) For purposes of this subtitle, a person located in
216		-	another state practices dentistry in this state and is required to
217		-	hold a license to practice dentistry in this state if the person
	182	+	another state practices dentistry in this state if the person
218	183		through the use of any medium, including an electronic medium,
219	184		performs an act that constitutes the practice of dentistry on a
220	185		patient in this state.
221		-	SECTION 13. Chapter 254, Occupations Code, is amended by
	186	+	SECTION 12. Chapter 254, Occupations Code, is amended by
222	187		adding Section 254.0035 to read as follows:
223	188		Sec. 254.0035. RULES REGARDING CALL COVERAGE AGREEMENTS.
224	189		The board shall adopt rules governing a call coverage agreement
225	190		between dentists.
226		-	SECTION 14. Section 258.001, Occupations Code, is amended
	191	+	SECTION 13. Section 258.001, Occupations Code, is amended
227	192		to read as follows:
228	193		Sec. 258.001. IMPERMISSIBLE DELEGATIONS. A dentist may not
229	194		delegate:
230	195		(1) an act to an individual who, by board order, is
231	196		prohibited from performing the act;
232	197		(2) any of the following acts to a person not licensed
233	198		as a dentist or dental hygienist:
234	199		(A) the removal of calculus, deposits, or
235	200		accretions from the natural and restored surfaces of exposed human
236	201		teeth and restorations in the human mouth;
237	202		(B) root planing or the smoothing and polishing
238	203		of roughened root surfaces or exposed human teeth; or
239	204		(C) any other act the delegation of which is
240	205		prohibited by board rule;
241	206		(3) any of the following acts to a person not licensed
242	207		as a dentist:
243	208		(A) comprehensive examination or diagnosis and
244	209		treatment planning;
245	210		(B) a surgical or cutting procedure on hard or
246	211		soft tissue;
247	212		(C) the prescription of a drug, medication, or
248	213		work authorization;
249	214		(D) the taking of an impression for a final
250	215		restoration, appliance, or prosthesis;
251	216		(E) the making of an intraoral occlusal
252	217		adjustment;
253	218		(F) direct pulp capping, pulpotomy, or any other
254	219		endodontic procedure;
255	220		(G) the final placement and intraoral adjustment
256	221		of a fixed or removable appliance; or
257	222		(H) the placement of any final restoration; or
258	223		(4) the authority to an individual to administer a
259	224		local anesthetic agent, inhalation sedative agent, parenteral
260		-	sedative agent, or general anesthetic agent, including as a
	225	+	sedative agent, or general anesthetic agent, including the
	226	+	authority to administer an anesthetic or sedative agent as a
261	227		teledentistry dental service as that term is defined by Section
262	228		111.001, if the individual is not licensed as:
263	229		(A) a dentist with a permit issued by the board
264	230		for the procedure being performed, if a permit is required;
265	231		(B) a certified registered nurse anesthetist
266	232		licensed by the Texas Board of Nursing, only if the delegating
267	233		dentist holds a permit issued by the board for the procedure being
268	234		performed, if a permit is required; or
269	235		(C) a physician anesthesiologist licensed by the
270	236		Texas Medical Board.
271		-	SECTION 15. Section 262.152, Occupations Code, is amended
272		-	to read as follows:
273		-	Sec. 262.152. PERFORMANCE OF DELEGATED DUTIES. (a) Except
274		-	as provided by Section 262.1515, a dental hygienist shall practice
275		-	dental hygiene:
276		-	(1) in the dental office of a supervising dentist
277		-	licensed by the board; or
278		-	(2) in an alternate setting, including a nursing home,
279		-	the patient's home, a school, a hospital, a state institution, a
280		-	public health clinic, or another institution, under the supervision
281		-	of a supervising dentist.
282		-	(b) For purposes of this section, a dental hygienist who
283		-	practices dental hygiene as a teledentistry dental service, as
284		-	defined by Section 111.001, is practicing in an alternate setting
285		-	in compliance with Subsection (a)(2).
286		-	SECTION 16. Section 562.056(c), Occupations Code, is
	237	+	SECTION 14. Subchapter A, Chapter 258, Occupations Code, is
	238	+	amended by adding Section 258.004 to read as follows:
	239	+	Sec. 258.004. COLLABORATIVE PRACTICE WITH DENTAL
	240	+	HYGIENIST. (a) In this section, "collaborative practice
	241	+	agreement" means a written practice agreement and protocols for the
	242	+	practice of dental hygiene.
	243	+	(b) A dental hygienist may practice dental hygiene under a
	244	+	collaborative practice agreement with a dentist if the dental
	245	+	hygienist has been engaged in the practice of dental hygiene for at
	246	+	least one year with a minimum of 2,000 practice hours.
	247	+	(c) A dental hygienist may enter into a collaborative
	248	+	practice agreement to practice dental hygiene in any setting
	249	+	authorized by law for the practice of dental hygiene.
	250	+	(d) A collaborative practice agreement must include
	251	+	protocols:
	252	+	(1) describing the practice of dental hygiene for:
	253	+	(A) medically compromised patients;
	254	+	(B) specific medical conditions;
	255	+	(C) patients with needs related to age; and
	256	+	(D) patients with complex medical histories;
	257	+	(2) prescribing standards for specific dental hygiene
	258	+	procedures, including intervals for the performance of those
	259	+	procedures;
	260	+	(3) prescribing intervals at which a supervising
	261	+	dentist must examine a patient;
	262	+	(4) describing the services that the dental hygienist
	263	+	may provide, the procedures that the dental hygienist may perform,
	264	+	the practice settings in which the services may be provided and the
	265	+	procedures may be performed, and any limitations on the services
	266	+	and procedures;
	267	+	(5) describing case selection criteria, assessment
	268	+	guidelines, and imaging frequency guidelines for patients by age
	269	+	and in relation to specific procedures;
	270	+	(6) prescribing procedures for obtaining informed
	271	+	consent from patients and for creating and maintaining patient
	272	+	records;
	273	+	(7) establishing a plan for the dentist to review
	274	+	patient records created and maintained by the dental hygienist;
	275	+	(8) establishing a plan for the management of medical
	276	+	emergencies in each setting in which the dental hygienist
	277	+	practices;
	278	+	(9) establishing a quality assurance plan for the
	279	+	dentist to monitor care provided by the dental hygienist, including
	280	+	review of patient care, referrals, and charts;
	281	+	(10) describing the medications that may be
	282	+	administered and dispensed by the dental hygienist and the specific
	283	+	circumstances under which the medications may be administered and
	284	+	dispensed;
	285	+	(11) describing any requirements for consultation
	286	+	with the dentist before providing care to patients with specific
	287	+	medical conditions or complex medical histories; and
	288	+	(12) establishing a plan, which includes clinical
	289	+	resources and referrals, for situations in which a patient requires
	290	+	treatment that exceeds the capabilities or scope of practice of the
	291	+	dental hygienist.
	292	+	(e) A collaborative practice agreement may include
	293	+	provisions to allow the practice of dental hygiene without:
	294	+	(1) prior examination of the patient by a dentist; and
	295	+	(2) the presence of a supervising dentist.
	296	+	(f) A collaborative practice agreement must be:
	297	+	(1) signed by the dentist, the dental hygienist, and,
	298	+	if applicable, a representative of the facility, program, or
	299	+	organization in which the practice of dental hygiene takes place;
	300	+	(2) reviewed annually by the dentist and the dental
	301	+	hygienist who are parties to the collaborative practice agreement;
	302	+	and
	303	+	(3) made available to the board and other interested
	304	+	parties on request.
	305	+	(g) Not more than two collaborative practice agreements
	306	+	between a dentist and a dental hygienist may be in effect at a time.
	307	+	(h) Notwithstanding any rule adopted under Section
	308	+	111.004(b)(4), a dentist may have a collaborative practice
	309	+	agreement with not more than six dental hygienists at the same time.
	310	+	The board may grant an exception to the requirements of this
	311	+	subsection for the practice of dental hygiene in a public health
	312	+	setting.
	313	+	(i) Before providing any service authorized by a
	314	+	collaborative practice agreement, the dental hygienist must
	315	+	provide the patient with a written statement advising the patient
	316	+	that the dental hygiene services performed are not a substitute for
	317	+	examination by a dentist.
	318	+	(j) If a dental hygienist operating under a collaborative
	319	+	practice agreement makes a referral for further dental procedures,
	320	+	the dental hygienist must complete a referral form approved by the
	321	+	board and provide a copy of the form to the dentist who is a party to
	322	+	the collaborative practice agreement.
	323	+	SECTION 15. Section 262.001, Occupations Code, is amended
	324	+	by adding Subdivision (3) to read as follows:
	325	+	(3) "Teledentistry dental service" has the meaning
	326	+	assigned by Section 111.001.
	327	+	SECTION 16. Section 262.151(a), Occupations Code, is
	328	+	amended to read as follows:
	329	+	(a) A licensed dentist may delegate orally or in writing a
	330	+	service, task, or procedure to a dental hygienist who is under the
	331	+	supervision and responsibility of the dentist, if:
	332	+	(1) the dental hygienist is licensed to perform the
	333	+	service, task, or procedure;
	334	+	(2) the supervising dentist:
	335	+	(A) examines the patient, including an
	336	+	examination performed as a teledentistry dental service:
	337	+	(i) [(A)] at the time the service, task, or
	338	+	procedure is performed by the dental hygienist; or
	339	+	(ii) [(B)] during the 12 calendar months
	340	+	preceding the date of performance of the service, task, or
	341	+	procedure by the dental hygienist; or
	342	+	(B) enters into a collaborative practice
	343	+	agreement with the dental hygienist, as described by Section
	344	+	258.004, that includes a provision allowing the dental hygienist to
	345	+	practice dental hygiene without prior examination of the patient by
	346	+	the dentist; and
	347	+	(3) the dental hygienist does not:
	348	+	(A) diagnose a dental disease or ailment;
	349	+	(B) prescribe a treatment or a regimen;
	350	+	(C) prescribe or[,] order[, or dispense]
	351	+	medication; [or]
	352	+	(D) except as authorized by the supervising
	353	+	dentist in a collaborative practice agreement described by Section
	354	+	258.004, administer or dispense medication; or
	355	+	(E) perform any procedure that is irreversible or
	356	+	involves the intentional cutting of soft or hard tissue by any
	357	+	means.
	358	+	SECTION 17. Sections 262.1515(a), (b), and (c), Occupations
	359	+	Code, are amended to read as follows:
	360	+	(a) A licensed dentist may delegate a service, task, or
	361	+	procedure, pursuant to this section, to a dental hygienist, without
	362	+	complying with Section 262.151(a)(2) if:
	363	+	(1) the dental hygienist has at least two years'
	364	+	experience in the practice of dental hygiene; and
	365	+	(2) the service, task, or procedure is performed in
	366	+	one of the following locations:
	367	+	(A) a medical facility, including:
	368	+	(i) a public health clinic conducted by a
	369	+	local health unit, health department, or public health district
	370	+	organized and recognized under Chapter 121, Health and Safety Code;
	371	+	(ii) a general hospital or special
	372	+	hospital, as those terms are defined by Section 241.003, Health and
	373	+	Safety Code, including a hospital maintained or operated by this
	374	+	state;
	375	+	(iii) a nursing facility as defined in
	376	+	Section 242.301, Health and Safety Code;
	377	+	(iv) an ambulatory surgical center licensed
	378	+	under Chapter 243, Health and Safety Code;
	379	+	(v) a birthing center licensed under
	380	+	Chapter 244, Health and Safety Code;
	381	+	(vi) a mental hospital licensed under
	382	+	Chapter 577, Health and Safety Code;
	383	+	(vii) a community health center as defined
	384	+	by Section 136.002, Human Resources Code;
	385	+	(viii) a mobile dental facility operating
	386	+	under a permit issued by the board; and
	387	+	(ix) an outpatient clinic;
	388	+	(B) a primary or secondary school [school-based
	389	+	health center established under Subchapter B, Chapter 38, Education
	390	+	Code]; [or]
	391	+	(C) a Head Start program facility;
	392	+	(D) a secure correctional facility as defined by
	393	+	Section 1.07, Penal Code;
	394	+	(E) the residence of a patient who is homebound
	395	+	or who is receiving or is eligible to receive:
	396	+	(i) home and community-based waiver
	397	+	services under the Medicaid program;
	398	+	(ii) hospice services; or
	399	+	(iii) other home care services; or
	400	+	(F) any other facility approved by board rule [a
	401	+	community health center as defined by Section 136.002, Human
	402	+	Resources Code].
	403	+	(b) The patient may [must] be referred as needed to a
	404	+	licensed dentist after the completion of a service, task, or
	405	+	procedure performed under Subsection (a).
	406	+	(c) A dental hygienist may [only] perform delegated tasks or
	407	+	procedures with respect to a patient for not more than 12 [six]
	408	+	months unless:
	409	+	(1) the patient has been examined by a dentist in
	410	+	compliance with Section 262.151(a)(2)(A);
	411	+	(2) a dentist reviews the patient's dental records,
	412	+	including a review performed as a teledentistry dental service, and
	413	+	determines that the dental hygienist may continue to provide
	414	+	services to the patient; or
	415	+	(3) a dentist otherwise provides teledentistry dental
	416	+	services to the patient and determines that the dental hygienist
	417	+	may continue to provide services to the patient [262.151(a)(2)].
	418	+	SECTION 18. Section 562.056(c), Occupations Code, is
287	419		amended to read as follows:
288	420		(c) For purposes of this section and Section 562.112, a
289	421		valid practitioner-patient relationship is present between a
290	422		practitioner providing telemedicine medical services or
291	423		teledentistry dental services and the patient receiving the
292	424		[telemedicine medical] services if the practitioner has complied
293	425		with the requirements for establishing such a relationship in
294	426		accordance with Section 111.005.
295		-	SECTION 17. Section 531.001, Government Code, is amended by
	427	+	SECTION 19. Section 531.001, Government Code, is amended by
296	428		adding Subdivision (6-a) to read as follows:
297	429		(6-a) "Teledentistry dental service" has the meaning
298	430		assigned by Section 111.001, Occupations Code.
299		-	SECTION 18. Section 531.0216, Government ~~Code, is amended~~
300		-	to read as follows:
	431	+	SECTION 20. The heading to Section 531.0216, Government
	432	+	Code, is amended to read as follows:
301	433		Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
302	434		TELEMEDICINE MEDICAL SERVICE PROVIDERS, TELEDENTISTRY DENTAL
303	435		SERVICE PROVIDERS, AND TELEHEALTH SERVICE PROVIDERS UNDER
304		-	MEDICAID. (a) The executive commissioner by rule shall develop
305		-	and implement a system to reimburse providers of services under
	436	+	MEDICAID.
	437	+	SECTION 21. Sections 531.0216(a), (b), (c), (d), (e), and
	438	+	(f), Government Code, are amended to read as follows:
	439	+	(a) The executive commissioner by rule shall develop and
	440	+	implement a system to reimburse providers of services under
306	441		Medicaid for services performed using telemedicine medical
307	442		services, teledentistry dental services, or telehealth services.
308	443		(b) In developing the system, the executive commissioner by
309	444		rule shall:
310	445		(1) review programs and pilot projects in other states
311	446		to determine the most effective method for reimbursement;
312	447		(2) establish billing codes and a fee schedule for
313	448		services;
314	449		(3) consult with the Department of State Health
315	450		Services to establish procedures to:
316	451		(A) identify clinical evidence supporting
317	452		delivery of health care services using a telecommunications system;
318	453		and
319	454		(B) annually review health care services,
320	455		considering new clinical findings, to determine whether
321	456		reimbursement for particular services should be denied or
322	457		authorized;
323	458		(4) establish a separate provider identifier for
324	459		telemedicine medical services providers, teledentistry dental
325	460		services providers, telehealth services providers, and home
326	461		telemonitoring services providers; and
327	462		(5) establish a separate modifier for telemedicine
328	463		medical services, teledentistry dental services, telehealth
329	464		services, and home telemonitoring services eligible for
330	465		reimbursement.
331	466		(c) The commission shall encourage health care providers
332	467		and health care facilities to participate as telemedicine medical
333	468		service providers, teledentistry dental service providers, or
334	469		telehealth service providers in the health care delivery system.
335	470		The commission may not require that a service be provided to a
336	471		patient through telemedicine medical services, teledentistry
337	472		dental services, or telehealth services when the service can
338		-	reasonably be provided by a physician or a dentist ~~through a~~
339		-	face-to-face consultation with the patient in the ~~community in~~
340		-	which the patient resides or works. This subsection ~~does not~~
341		-	prohibit the authorization of the provision of any service ~~to a~~
342		-	patient through telemedicine medical services, teledentistry
	473	+	reasonably be provided by a physician or a dentist, if appropriate,
	474	+	through a face-to-face consultation with the patient in the
	475	+	community in which the patient resides or works. This subsection
	476	+	does not prohibit the authorization of the provision of any service
	477	+	to a patient through telemedicine medical services, teledentistry
343	478		dental services, or telehealth services at the patient's request.
344		-	(c-1) Subsection (c) does not prohibit the authorization of
345		-	the provision of any service to a patient through teledentistry
346		-	dental services if:
347		-	(1) the patient requests the service; and
348		-	(2) the provision of the service through teledentistry
349		-	does not violate the standard of care applicable to the service.
350		-	(c-2) The commission shall:
351		-	(1) explore opportunities to increase STAR Health
352		-	program providers' use of telemedicine medical services in
353		-	medically underserved areas of this state; and
354		-	(2) encourage STAR Health program providers to use
355		-	telemedicine medical services as appropriate.
356	479		(d) Subject to Sections 111.004 and [Section] 153.004,
357	480		Occupations Code, the executive commissioner may adopt rules as
358	481		necessary to implement this section. In the rules adopted under
359	482		this section, the executive commissioner shall:
360	483		(1) refer to the site where the patient is physically
361	484		located as the patient site; and
362	485		(2) refer to the site where the physician, dentist, or
363	486		health professional providing the telemedicine medical service,
364	487		teledentistry dental service, or telehealth service is physically
365	488		located as the distant site.
366	489		(e) The commission may not reimburse a health care facility
367	490		for telemedicine medical services, teledentistry dental services,
368	491		or telehealth services provided to a Medicaid recipient unless the
369	492		facility complies with the minimum standards adopted under Section
370	493		531.02161.
371	494		(f) Not later than December 1 of each even-numbered year,
372	495		the commission shall report to the speaker of the house of
373	496		representatives and the lieutenant governor on the effects of
374	497		telemedicine medical services, teledentistry dental services,
375	498		telehealth services, and home telemonitoring services on Medicaid
376	499		in the state, including the number of physicians, dentists, health
377	500		professionals, and licensed health care facilities using
378	501		telemedicine medical services, teledentistry dental services,
379	502		telehealth services, or home telemonitoring services, the
380	503		geographic and demographic disposition of the physicians,
381	504		dentists, and health professionals, the number of patients
382	505		receiving telemedicine medical services, teledentistry dental
383	506		services, telehealth services, and home telemonitoring services,
384	507		the types of services being provided, and the cost of utilization of
385	508		telemedicine medical services, teledentistry dental services,
386	509		telehealth services, and home telemonitoring services to Medicaid.
387		-	SECTION 19. The heading to Section 531.02161, Government
	510	+	SECTION 22. The heading to Section 531.02161, Government
388	511		Code, is amended to read as follows:
389	512		Sec. 531.02161. TELEMEDICINE, TELEDENTISTRY, TELEHEALTH,
390	513		AND HOME TELEMONITORING TECHNOLOGY STANDARDS.
391		-	SECTION 20. Section 531.02161(b), Government Code, is
	514	+	SECTION 23. Section 531.02161(b), Government Code, is
392	515		amended to read as follows:
393	516		(b) The executive commissioner by rule shall establish and
394	517		adopt minimum standards for an operating system used in the
395	518		provision of telemedicine medical services, teledentistry dental
396	519		services, telehealth services, or home telemonitoring services by a
397	520		health care facility participating in Medicaid, including
398	521		standards for electronic transmission, software, and hardware.
399		-	SECTION 21. The heading to Section 531.02162, Government
	522	+	SECTION 24. The heading to Section 531.02162, Government
400	523		Code, is amended to read as follows:
401	524		Sec. 531.02162. MEDICAID SERVICES PROVIDED THROUGH
402	525		TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND
403	526		TELEHEALTH SERVICES TO CHILDREN WITH SPECIAL HEALTH CARE NEEDS.
404		-	SECTION 22. Section 531.02162, Government Code, is amended
405		-	by amending Subsections (b) and (c) and adding Subsection (d) to
406		-	read as follows:
	527	+	SECTION 25. Sections 531.02162(b) and (c), Government Code,
	528	+	are amended to read as follows:
407	529		(b) The executive commissioner by rule shall establish
408	530		policies that permit reimbursement under Medicaid and the child
409	531		health plan program for services provided through telemedicine
410	532		medical services, teledentistry dental services, and telehealth
411	533		services to children with special health care needs.
412	534		(c) The policies required under this section must:
413	535		(1) be designed to:
414	536		(A) prevent unnecessary travel and encourage
415	537		efficient use of telemedicine medical services, teledentistry
416	538		dental services, and telehealth services for children with special
417	539		health care needs in all suitable circumstances; and
418	540		(B) ensure in a cost-effective manner the
419	541		availability to a child with special health care needs of services
420	542		appropriately performed using telemedicine medical services,
421	543		teledentistry dental services, and telehealth services that are
422	544		comparable to the same types of services available to that child
423	545		without the use of telemedicine medical services, teledentistry
424	546		dental services, and telehealth services; and
425	547		(2) provide for reimbursement of multiple providers of
426	548		different services who participate in a single session of
427	549		telemedicine medical services, teledentistry dental services,
428	550		[and] telehealth services, or any combination of those services,
429	551		[session] for a child with special health care needs, if the
430	552		commission determines that reimbursing each provider for the
431	553		session is cost-effective in comparison to the costs that would be
432	554		involved in obtaining the services from providers without the use
433	555		of telemedicine medical services, teledentistry dental services,
434	556		and telehealth services, including the costs of transportation and
435	557		lodging and other direct costs.
436		-	(d) The policies established under Subsection (c)(1) may
437		-	authorize the provision of a service as a teledentistry dental
438		-	service only if the provision of the service through teledentistry
439		-	does not violate the standard of care applicable to the service.
440		-	SECTION 23. Subchapter B, Chapter 531, Government Code, is
	558	+	SECTION 26. Subchapter B, Chapter 531, Government Code, is
441	559		amended by adding Section 531.02172 to read as follows:
442	560		Sec. 531.02172. REIMBURSEMENT FOR TELEDENTISTRY DENTAL
443		-	SERVICES. ~~(a)~~ The commission by rule shall require each health
444		-	~~and~~ human services agency that administers a part of the Medicaid
	561	+	SERVICES. The commission by rule shall require each health and
	562	+	human services agency that administers a part of the Medicaid
445	563		program to provide Medicaid reimbursement for teledentistry dental
446	564		services provided by a dentist licensed to practice dentistry in
447		-	this state.
448		-	~~(b)~~ The commission shall require reimbursement ~~for a~~
449		-	teledentistry dental service at the same rate as the Medicaid
	565	+	this state or a dental hygienist licensed to practice dental
	566	+	hygiene in this state. The commission shall require reimbursement
	567	+	for a teledentistry dental service at the same rate as the Medicaid
450	568		program reimburses for a comparable in-person dental service. A
451	569		request for reimbursement may not be denied solely because an
452	570		in-person dental service between a dentist and a patient did not
453		-	occur. A service provided as a teledentistry dental service may
454		-	only be reimbursed if provision of the service through
455		-	teledentistry does not violate the standard of care applicable to
456		-	the service.
457		-	(c) The State Board of Dental Examiners, in consultation
458		-	with the commission and the commission's office of inspector
459		-	general, as appropriate, may adopt rules as necessary to:
460		-	(1) ensure that appropriate care, including quality of
461		-	care, is provided to patients who receive teledentistry dental
462		-	services; and
463		-	(2) prevent abuse and fraud through the use of
464		-	teledentistry dental services, including rules relating to filing
465		-	claims and the records required to be maintained in connection with
466		-	teledentistry dental services.
467		-	SECTION 24. The heading to Section 62.157, Health and
	571	+	occur.
	572	+	SECTION 27. The heading to Section 62.157, Health and
468	573		Safety Code, is amended to read as follows:
469	574		Sec. 62.157. TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY
470	575		DENTAL SERVICES, AND TELEHEALTH SERVICES FOR CHILDREN WITH SPECIAL
471	576		HEALTH CARE NEEDS.
472		-	SECTION 25. Sections 62.157(a) and (b), Health and Safety
	577	+	SECTION 28. Sections 62.157(a) and (b), Health and Safety
473	578		Code, are amended to read as follows:
474	579		(a) In providing covered benefits to a child with special
475	580		health care needs, a health plan provider must permit benefits to be
476	581		provided through telemedicine medical services, teledentistry
477	582		dental services, and telehealth services in accordance with
478	583		policies developed by the commission.
479	584		(b) The policies must provide for:
480	585		(1) the availability of covered benefits
481	586		appropriately provided through telemedicine medical services,
482	587		teledentistry dental services, and telehealth services that are
483	588		comparable to the same types of covered benefits provided without
484	589		the use of telemedicine medical services, teledentistry dental
485	590		services, and telehealth services; and
486	591		(2) the availability of covered benefits for different
487	592		services performed by multiple health care providers during a
488	593		single [telemedicine medical services and telehealth services]
489	594		session of telemedicine medical services, teledentistry dental
490	595		services, telehealth services, or any combination of those
491	596		services, if the executive commissioner determines that delivery of
492	597		the covered benefits in that manner is cost-effective in comparison
493	598		to the costs that would be involved in obtaining the services from
494	599		providers without the use of telemedicine medical services,
495	600		teledentistry dental services, and telehealth services, including
496	601		the costs of transportation and lodging and other direct costs.
497		-	SECTION 26. Section 62.1571, Health and Safety Code, is
	602	+	SECTION 29. Section 62.1571, Health and Safety Code, is
498	603		amended to read as follows:
499	604		Sec. 62.1571. TELEMEDICINE MEDICAL SERVICES AND
500	605		TELEDENTISTRY DENTAL SERVICES. (a) In providing covered benefits
501	606		to a child, a health plan provider must permit benefits to be
502	607		provided through telemedicine medical services and teledentistry
503	608		dental services in accordance with policies developed by the
504	609		commission.
505	610		(b) The policies must provide for:
506	611		(1) the availability of covered benefits
507	612		appropriately provided through telemedicine medical services and
508	613		teledentistry dental services that are comparable to the same types
509	614		of covered benefits provided without the use of telemedicine
510	615		medical services and teledentistry dental services; and
511	616		(2) the availability of covered benefits for different
512	617		services performed by multiple health care providers during a
513	618		single session of telemedicine medical services, teledentistry
514	619		dental services, or both services, if the executive commissioner
515	620		determines that delivery of the covered benefits in that manner is
516	621		cost-effective in comparison to the costs that would be involved in
517	622		obtaining the services from providers without the use of
518	623		telemedicine medical services or teledentistry dental services,
519	624		including the costs of transportation and lodging and other direct
520	625		costs.
521	626		(c) [(d)] In this section, "teledentistry dental service"
522	627		and "telemedicine medical service" have [has] the meanings
523	628		[meaning] assigned by Section 531.001, Government Code.
524		-	SECTION 27. The heading to Chapter 1455, Insurance Code, is
	629	+	SECTION 30. Section 32.024, Human Resources Code, is
	630	+	amended by adding Subsection (ll) to read as follows:
	631	+	(ll) The executive commissioner shall establish a separate
	632	+	provider type for dental hygienists for purposes of enrollment as a
	633	+	provider of and reimbursement under the medical assistance program.
	634	+	SECTION 31. Section 843.002(24), Insurance Code, is amended
	635	+	to read as follows:
	636	+	(24) "Provider" means:
	637	+	(A) a person, other than a physician, who is
	638	+	licensed or otherwise authorized to provide a health care service
	639	+	in this state, including:
	640	+	(i) a chiropractor, registered nurse,
	641	+	pharmacist, optometrist, [or] acupuncturist, or dental hygienist;
	642	+	or
	643	+	(ii) a pharmacy, hospital, or other
	644	+	institution or organization;
	645	+	(B) a person who is wholly owned or controlled by
	646	+	a provider or by a group of providers who are licensed or otherwise
	647	+	authorized to provide the same health care service; or
	648	+	(C) a person who is wholly owned or controlled by
	649	+	one or more hospitals and physicians, including a
	650	+	physician-hospital organization.
	651	+	SECTION 32. Section 1301.001(1-a), Insurance Code, is
	652	+	amended to read as follows:
	653	+	(1-a) "Health care provider" means a practitioner,
	654	+	institutional provider, or other person or organization that
	655	+	furnishes health care services and that is licensed or otherwise
	656	+	authorized to practice in this state. [The term includes a
	657	+	pharmacist and a pharmacy.] The term does not include a physician.
	658	+	The term includes:
	659	+	(A) a pharmacist;
	660	+	(B) a pharmacy; and
	661	+	(C) a dental hygienist.
	662	+	SECTION 33. Section 1451.101, Insurance Code, is amended by
	663	+	amending Subdivision (1) and adding Subdivision (1-a) to read as
	664	+	follows:
	665	+	(1) "Dental hygienist" has the meaning assigned by
	666	+	Section 256.051, Occupations Code.
	667	+	(1-a) "Health insurance policy" means a policy,
	668	+	contract, or agreement described by Section 1451.102.
	669	+	SECTION 34. Subchapter C, Chapter 1451, Insurance Code, is
	670	+	amended by adding Section 1451.128 to read as follows:
	671	+	Sec. 1451.128. SELECTION OF DENTAL HYGIENIST. An insured
	672	+	may select a dental hygienist to provide the services scheduled in
	673	+	the health insurance policy that are within the scope of the dental
	674	+	hygienist's license.
	675	+	SECTION 35. The heading to Chapter 1455, Insurance Code, is
525	676		amended to read as follows:
526	677		CHAPTER 1455. TELEMEDICINE, TELEDENTISTRY, AND TELEHEALTH
527		-	SECTION 28. Section 1455.001, Insurance Code, is amended by
	678	+	SECTION 36. Section 1455.001, Insurance Code, is amended by
528	679		amending Subdivisions (1) and (3) and adding Subdivision (1-a) to
529	680		read as follows:
530	681		(1) "Dentist" means a person licensed to practice
531	682		dentistry in this state under Subtitle D, Title 3, Occupations
532	683		Code.
533	684		(1-a) "Health professional" means:
534	685		(A) a physician;
535	686		(B) an individual who is:
536	687		(i) licensed or certified in this state to
537	688		perform health care services; and
538	689		(ii) authorized to assist:
539	690		(a) a physician in providing
540	691		telemedicine medical services that are delegated and supervised by
541	692		the physician; or
542	693		(b) a dentist in providing
543	694		teledentistry dental services that are delegated and supervised by
544	695		the dentist;
545	696		(C) a licensed or certified health professional
546	697		acting within the scope of the license or certification who does not
547		-	perform a telemedicine medical service or a teledentistry dental
548		-	service; or
	698	+	perform a telemedicine medical service; or
549	699		(D) a dentist.
550	700		(3) "Teledentistry dental service," "telehealth
551	701		["Telehealth] service," and "telemedicine medical service" have
552	702		the meanings assigned by Section 111.001, Occupations Code.
553		-	SECTION 29. Section 1455.004, Insurance Code, is amended to
	703	+	SECTION 37. Section 1455.004, Insurance Code, is amended to
554	704		read as follows:
555	705		Sec. 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES,
556	706		TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A
557	707		health benefit plan may not exclude from coverage a covered health
558	708		care service or procedure delivered by a preferred or contracted
559	709		health professional to a covered patient as a telemedicine medical
560	710		service, a teledentistry dental service, or a telehealth service
561	711		solely because the covered health care service or procedure is not
562	712		provided through an in-person consultation.
563	713		(b) A health benefit plan may require a deductible, a
564	714		copayment, or coinsurance for a covered health care service or
565	715		procedure delivered by a preferred or contracted health
566	716		professional to a covered patient as a telemedicine medical
567	717		service, a teledentistry dental service, or a telehealth service.
568	718		The amount of the deductible, copayment, or coinsurance may not
569	719		exceed the amount of the deductible, copayment, or coinsurance
570	720		required for the covered health care service or procedure provided
571	721		through an in-person consultation.
572	722		(c) Notwithstanding Subsection (a), a health benefit plan
573	723		is not required to provide coverage for a telemedicine medical
574	724		service, a teledentistry dental service, or a telehealth service
575	725		provided by only synchronous or asynchronous audio interaction,
576	726		including:
577	727		(1) an audio-only telephone consultation;
578	728		(2) a text-only e-mail message; or
579	729		(3) a facsimile transmission.
580		-	SECTION 30. Section 1455.006, Insurance Code, is amended to
	730	+	SECTION 38. Section 1455.006, Insurance Code, is amended to
581	731		read as follows:
582	732		Sec. 1455.006. TELEMEDICINE MEDICAL SERVICES,
583	733		TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES STATEMENT.
584	734		(a) Each issuer of a health benefit plan shall adopt and display in
585	735		a conspicuous manner on the health benefit plan issuer's Internet
586	736		website the issuer's policies and payment practices for
587	737		telemedicine medical services, teledentistry dental services, and
588	738		telehealth services.
589	739		(b) This section does not require an issuer of a health
590	740		benefit plan to display negotiated contract payment rates for
591	741		health professionals who contract with the issuer to provide
592	742		telemedicine medical services, teledentistry dental services, or
593	743		telehealth services.
594		-	SECTION 31. Not later than March 1, 2020:
595		-	(1) the State Board of Dental Examiners and the Texas
596		-	State Board of Pharmacy shall jointly adopt rules as required by
597		-	Section 111.006(c), Occupations Code, as added by this Act;
598		-	(2) the State Board of Dental Examiners shall adopt:
599		-	(A) rules necessary to implement Chapter 111,
600		-	Occupations Code, as amended by this Act; and
601		-	(B) rules as required by Section 254.0035,
602		-	Occupations Code, as added by this Act; and
603		-	(3) the Health and Human Services Commission shall
604		-	adopt rules as required by Section 531.02172, Government Code, as
605		-	added by this Act.
606		-	SECTION 32. If before implementing any provision of this
	744	+	SECTION 39. (a) Not later than March 1, 2020, the State
	745	+	Board of Dental Examiners and the Texas State Board of Pharmacy
	746	+	shall jointly adopt rules as required by Section 111.006(c),
	747	+	Occupations Code, as added by this Act.
	748	+	(b) Not later than March 1, 2020, the State Board of Dental
	749	+	Examiners shall adopt:
	750	+	(1) rules necessary to implement Chapter 111,
	751	+	Occupations Code, as amended by this Act;
	752	+	(2) rules as required by Section 254.0035, Occupations
	753	+	Code, as added by this Act; and
	754	+	(3) rules necessary to implement Section 258.004,
	755	+	Occupations Code, as added by this Act.
	756	+	SECTION 40. As soon as practicable after the effective date
	757	+	of this Act, the Health and Human Services Commission shall
	758	+	establish and implement a separate provider type for dental
	759	+	hygienists as required by Section 32.024(ll), Human Resources Code,
	760	+	as added by this Act.
	761	+	SECTION 41. If before implementing any provision of this
607	762		Act a state agency determines that a waiver or authorization from a
608	763		federal agency is necessary for implementation of that provision,
609	764		the agency affected by the provision shall request the waiver or
610	765		authorization and may delay implementing that provision until the
611	766		waiver or authorization is granted.
612		-	SECTION 33. (a) Except as provided by Subsection (b) of
	767	+	SECTION 42. (a) Except as provided by Subsection (b) of
613	768		this section, this Act takes effect September 1, 2019.
614	769		(b) Sections 1455.004 and 1455.006, Insurance Code, as
615	770		amended by this Act, take effect January 1, 2020.
616		-	* * * * *