85(R) - 2017
Senate Health & Human Services
Senate Health & Human Services
Health & Human Services
Relating to the continuation and functions of the State Board of Dental Examiners; imposing fees.
From the LBB: Estimated Two-year Net Impact to
General Revenue Related Funds for SB313, As Introduced: an impact of $0 through
the biennium ending August 31, 2019. Under provisions of the bill, it is
assumed that the licensure of dental assistants under one registration could
result in an impact to revenue in the General Revenue Fund beginning in fiscal
year 2019; however, because the number of dental assistants that would qualify
for this registration and the amount of the registration fee is unknown, an
estimate on revenue cannot be determined.
This bill would extend the sunset date of the State Board of Dental Examiners until 2029, and changes the board to consist of 11 people instead of 15 as under current law. The bill would prohibit a person from being a board member if they or their spouse are employees of a Texas trade association in the field of healthcare, or if they are required to register as a lobbyist. The executive director of the board would be required to create a training manual and distribute it to the members of the board annually. The bill would add the provision that all information, records, and proceedings regarding a license holder or applicant are confidential although the board may disclose disciplinary actions against license holders. This bill would require the board to periodically review reports filed with the National Provider databank to see if any report of disciplinary action against a license holder by another state has been filed that would constitute grounds for disciplinary action under the section.
The bill would require the board to periodically check the prescribing information submitted to the Texas State Board of Pharmacy to make sure dentists are not engaging in potentially harmful prescriptive practices and notify dentists when the board identifies them as engaging in a potentially harmful prescriptive practice. The bill would also require a dentist to check a patient’s prescription history before prescribing them opioids, benzodiazepines, barbiturates, or carisoprodol. The board would also be allowed to deny an applicant a license if they are in violation of a board order. The bill would also establish continuing education requirements for dentists and dental hygienists.
A dentist would be required to purchase an annual permit to administer anesthesia in four categories: minimal sedation, moderate sedation (enteral administration), moderate sedation (parenteral administration), and deep sedation/general anesthesia. A dentist would be prohibited form administering anesthesia without first purchasing a permit. Rules would be established on the training required to be eligible to purchase different kinds of anesthesia permits. A permit holder would be required to establish emergency preparedness protocols regarding anesthesia.
The bill would allow the board to request a license holder to submit to a mental or physical evaluation with probable cause. The bill also establishes requirements regarding a license holder’s rights in relation to complaints made against them. The bill would also establish a dental review committee and an informal settlement conference panel to handle complaints towards license holders.
The bill would prohibit dental assistants from performing certain services without being licensed under the chapter. The bill also would establish rules regarding eligibility requirements to be a registered dental assistant under the chapter, and would allow the board to charge fees for registration.
Vote Recommendation Notes
There are many good parts to this bill, including expanding the scope of practice of dental assistants by allowing them to perform more services after being registered by the board. However, this bill also introduces new regulations for dentists, including requiring them to purchase a permit to administer anesthesia each year. This is in violation of our free market and personal responsibility principles, as well as our limited government principles. The included provisions for monitoring the prescribing patterns of licensees and allowing discipline to be initiated based on what the board believes are "harmful prescribing patterns" is an arbitrary and unnecessary expansion of bureaucratic authority as well.
Unfortunately, in the case of SB 313, the bad outweighs the good. This bill would be a net increase on the regulatory burdens the state would be imposing on applicants and current licensees, therefore we oppose the bill. If the prescription monitoring provision were to be removed, we would withdraw our objection.
For a fuller exposition of our views regarding occupational licensure, click here.
For further reading on this issue we recommend a couple excellent resources:
The Institute for Justice has done yeoman’s work in researching the pervasiveness of the licensing problem. Their 2012 national study, License To Work, which gives an in-depth report on the status of licensure in every state, should be required reading for policymakers working on licensure issues.
Guild-Ridden Labor Markets: The Curious Case of Occupational Licensing by Morris M. Kleiner, which describes in easily readable language the history of occupational licensing in the United States, demonstrates the clear connection between licensure and industry protection.