TITLE 22. EXAMINING BOARDS

PART 5. STATE BOARD OF DENTAL EXAMINERS

CHAPTER 101. DENTAL LICENSURE

22 TAC §101.1

The State Board of Dental Examiners (Board) proposes an amendment to rule §101.1, concerning General Qualifications for Licensure. This amendment eliminates the reference to "good moral character" and provides that applicants who are currently in violation of a board order are ineligible. Both changes are in accordance with SB313.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to comply with legislative requirements and to prevent dentists with on-going disciplinary compliance issues from renewing their licenses. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§101.1.General Qualifications for Licensure.

(a) Any person desiring to practice dentistry in the State of Texas must possess a license issued by the State Board of Dental Examiners (Board) as required by the Dental Practice Act and Board rules.

(b) Any applicant for licensure under this chapter must meet the requirements of this section.

(c) To be eligible for licensure, an applicant must present on or accompanying a licensure application form approved by the Board proof satisfactory to the Board that the applicant:

(1) Is at least 21 years of age;

(2) Is professionally fit [of good moral character and professional fitness], which is demonstrated by patterns of personal, academic and occupational behaviors, including final or pending disciplinary action on an occupational license in any jurisdiction, which, in the judgment of the Board, indicate honesty, accountability, trustworthiness, reliability, integrity, and ability;

(3) Has successfully completed a current course in basic life support;

(4) Has taken and passed the jurisprudence assessment administered by the Board or an entity designated by the Board within one year immediately prior to application;

(5) Has paid all application fees required by the Dental Practice Act and Board rules; and

(6) Has submitted fingerprints for the retrieval of criminal history record information.

(d) In conjunction with the application, the applicant must provide any information requested by the Board pursuant to §254.019(b) of the Dental Practice Act. If an applicant fails to comply with this subsection, then the applicant is subject to disciplinary action, which includes administrative fines and public disciplinary sanctions.

(e) Applications for licensure must be delivered to the office of the Board.

(f) An application for licensure is filed with the Board when it is actually received, date-stamped, and logged-in by the Board along with all required documentation and fees. An incomplete application for licensure and fee will be returned to the applicant with an explanation of additional documentation or information needed.

(g) Each applicant must submit to the Board the documents and information required by this chapter and other documents or information requested by the Board to evaluate an application and take appropriate actions.

(h) An applicant for licensure is ineligible if they are in violation of a board order at the time of application.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800810

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §101.5

The State Board of Dental Examiners (Board) proposes an amendment to rule §101.5, concerning Staggered Dental Registrations. This amendment will move all dental license renewals to a two year cycle. Renewals were previously required to be done annually, but SB313 eliminated that requirement and deferred to the Board. The Board believes it will be more efficient for its staff to renew licenses every two years.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to reduce the burdens on our licensing division which will result in faster processing time for all licenses. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§101.5.Staggered Dental Registrations.

(a) The Board, pursuant to the Occupations Code, Chapter 257, §257.001, Texas Civil Statutes has established a staggered license registration system comprised of initial dental license registration periods followed by biennial [annual] registrations (i.e., renewals).

(b) The initial, staggered dental license registration periods will range from 18 [6] months to 30 [17] months. The length of the initial license registration period will be determined by [according to] the licensee's birth month, but will be no less than 18 months. The expiration of the initial license will be based on the licensee's birth month. Initial dental license fees will be prorated according to the number of months of the initial license period.

(c) Prior to the expiration date of the initial dental license registration period, a license renewal notice will be mailed to all dental licensees who have that expiration date.

(d) A license registration expired for one year or more may not be renewed.

(e) An initial license expires on the 30th day after the date the license is issued if the holder of the license fails to pay the required license fee on or before that date.

(f) In conjunction with the license renewal, the licensee must provide any information requested by the Board pursuant to §254.019(b) of the Dental Practice Act. If a licensee fails to comply with this subsection, then the licensee is subject to disciplinary action, which includes administrative fines and public disciplinary sanctions.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800811

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §101.13

The State Board of Dental Examiners (Board) proposes new rule §101.13, concerning Military Limited Volunteer Licenses for dental hygienists. This new rule provides for a volunteer dental hygienist license for current or former military members, as required by HB 2007. There will be no fees associated with the license.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to comply with legislative requirements and to provide a pathway for current or former military practitioners to volunteer their services. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§101.13.Military Limited Volunteer License.

(a) A dentist with a Military Limited Volunteer License may only practice at a clinic that primarily treats indigent patients and may not receive direct or indirect compensation for services rendered at the clinic.

(b) A person is eligible for a Military Limited Volunteer License if they:

(1) Are licensed in good standing or are retired in good standing in another state.

(2) Are or were authorized to treat personnel enlisted in a branch of the United States armed forces or veterans.

(c) A person is ineligible for a Military Limited Volunteer License if they:

(1) Hold a dentist or dental hygienist license in another state that is currently under active investigation or has been subject to a disciplinary order or action;

(2) Hold a license to prescribe, dispense, administer, supply, or sell a controlled substance that is currently under active investigation or has been subject to a disciplinary order or action;

(3) Have been convicted of, is on deferred adjudication community supervision, or deferred disposition for, or is under active investigation for the commission of a felony or a misdemeanor involving moral turpitude.

(d) Except for the limitations described in subsection (a) of this section, a Military Limited Volunteer License holder has the same privileges and responsibilities of any other licensee and is similarly subject to board rules, including rules regarding standard of care, record keeping, disciplinary actions, license registration and renewal, and continuing education, except that there will not be any fees associated with the issuance or renewal of the license.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800816

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


CHAPTER 102. FEES

22 TAC §102.1

The State Board of Dental Examiners (Board) proposes an amendment to rule §102.1, concerning Fees. This amendment will increase fees to provide for the rising costs of running the agency, particularly the Prescription Monitoring Program, updates to the National Practitioner Database, and technological changes necessary to implement biennial license renewals. Increases mandated by the legislature are effective on May 1, 2018 and can found in the two columns marked "85th Leg". Other increases are as follows:

DDS Faculty Annual Renewal +$2

DDS Faculty Annual Renewal- Late 1 to 90 days +$1.50

DDS Faculty Annual Renewal- Late 91 to 365 days +$1

RDH Faculty Annual Renewal- Late 1 to 90 days +$2.50

RDH Faculty Annual Renewal- Late 91 to 365 days +$3

RDA Annual Renewal- Late 1 to 90 days +$2.50

RDA Annual Renewal- Late 91 to 365 +$3

Dental Laboratories Annual Renewal- Late 1 to 90 days +$2.50

Dental Laboratories Annual Renewal- Late 90 to 365 days +$3

Annual Mobile Renewal- 1 to 90 days +$92

Annual Mobile Renewal- 91 to 365 days +$122

Please note the asterisk next to anesthesia permit fees. The numbers reflect a substantial increase in fees that is an estimate necessary to administer the Board's anesthesia permit inspection program. Those fees are not being changed at this time.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to help administer the functions of the agency and to comply with legislative requirements related to the PMP.

Mr. Vance has determined that there may be an adverse economic impact on small business and micro business. Specifically, the Board currently has 59 licensed mobile facilities and 826 licensed dental laboratories. Most, if not all of these licensees are small or micro businesses. The fee increases will have a negative economic effect on these entities, but the Board is legislatively required to raise fees to cover the expenses of operating the Board. In considering alternatives, the Board is only raising fees for renewal applications that are submitted late. Licensees who provide their materials on time are not facing any increases. Also, there were previously no late fees whatsoever for mobile renewal applications that were late. Every other license with the Board has late fees, and it is only fair that mobile facilities do, too.

Mr. Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§102.1.Fee Schedule.

Effective September 1, 2018 [2016], the Board has established the following reasonable and necessary fees for the administration of its function.

Figure: 22 TAC §102.1 (.pdf)

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800824

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


CHAPTER 103. DENTAL HYGIENE LICENSURE

22 TAC §103.1

The State Board of Dental Examiners (Board) proposes an amendment to rule §103.1, concerning General Qualifications for Licensure. This amendment eliminates the reference to "good moral character" and provides that applicants who are currently in violation of a board order are ineligible. Both changes are in accordance with SB313.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to comply with legislative requirements and to prevent dental hygienists with on-going disciplinary compliance issues from renewing their licenses. Mr. Vance has determined that for the first five-year period the proposed rule is in effect, costs to persons or small businesses will be minimal. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§103.1.General Qualifications for Licensure.

(a) Any person desiring to practice dental hygiene in the State of Texas must possess a license issued by the State Board of Dental Examiners (Board) as required by the Dental Practice Act and Board rules.

(b) Any applicant for licensure under this chapter must meet the requirements of this section.

(c) To be eligible for licensure, an applicant must present on or accompanying a licensure application form approved by the Board proof satisfactory to the Board that the applicant:

(1) Is at least 18 years of age;

(2) Is professionally fit [of good moral character and professional fitness], which is demonstrated by patterns of personal, academic and occupational behaviors, including final or pending disciplinary action on an occupational license, which, in the judgment of the Board, indicate honesty, accountability, trustworthiness, reliability, integrity, and ability;

(3) Has graduated from an accredited high school or holds a certificate of high school equivalency, General Equivalency Diploma (GED);

(4) Has graduated from a dental school accredited by the Commission on Dental Accreditation of the American Dental Association (CODA) with a degree in dentistry or a degree or certificate in dental hygiene, or has graduated from a CODA-accredited school or college of dental hygiene with a degree in dental hygiene;

(5) Has taken and passed the examination for dental hygienists given by the American Dental Association Joint Commission on National Dental Examinations;

(6) Has met the requirements of §101.8 of this title (relating to Persons with Criminal Backgrounds);

(7) Has successfully completed a current course in basic life support;

(8) Has taken and passed the jurisprudence assessment administered by the Board or an entity designated by the Board within one year prior to application;

(9) Has paid all application, examination and licensing fees required by the Dental Practice Act and Board rules; and

(10) Has submitted fingerprints for the retrieval of criminal history record information.

(d) Applications for licensure must be delivered to the office of the Board.

(e) An application for licensure is filed with the Board when it is actually received, date-stamped, and logged-in by the Board along with all required documentation and fees. An incomplete application for licensure and fee will be returned to applicant with an explanation of additional documentation or information needed.

(f) Each applicant must submit to the Board the documents and information required by this chapter and other documents or information requested by the Board to evaluate an application and take appropriate actions.

(g) An applicant for licensure is ineligible if they are in violation of a board order at the time of application.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800812

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §103.5

The State Board of Dental Examiners (Board) proposes an amendment to rule §103.5, concerning Staggered Dental Hygiene Registrations. This amendment will move all dental hygiene license renewals to a two year cycle. Renewals were previously required to be done annually, but SB 313 eliminated that requirement and deferred to the Board. The Board believes it will be more efficient for its staff to renew licenses every two years.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to reduce the burdens on our licensing division which will result in faster processing time for all licensees. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§103.5.Staggered Dental Hygiene Registrations.

(a) The Board, pursuant to Occupations Code, Chapter 257, §257.001, Texas Civil Statutes has established a staggered license registration system comprised of initial dental hygiene license registration periods followed by biennial [annual] registrations (i.e., renewals).

(b) The initial dental hygiene license registration periods will range from 18 [6] months to 30 [17] months. The length of the initial license registration period will be determined by the licensee's birth month, but will be no less than 18 months. The expiration of the initial license will be based on the licensee's birth month. Initial dental license fees will be prorated according to the number of months of the initial license period.

(c) Prior to the expiration date of the initial dental hygiene license registration period, a license renewal notice will be mailed to all dental hygiene licensees who have that expiration date.

(d) A license registration expired for one year or more may not be renewed.

(e) An initial license expires on the 30th day after the date the license is issued if the holder of the license fails to pay the required license fee on or before that date.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800813

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §103.9

The State Board of Dental Examiners (Board) proposes new rule §103.9, concerning Military Limited Volunteer Licenses for dentists. This new rule provides for a volunteer dental license for current or former military members, as required by HB 2007. There will be no fees associated with the license.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Mr. Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to comply with legislative requirements and to provide a pathway for current or former military practitioners to volunteer their services. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Mr. Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§103.9.Military Limited Volunteer License.

(a) A dental hygienist with a Military Limited Volunteer License may only practice at a clinic that primarily treats indigent patients and may not receive direct or indirect compensation for services rendered at the clinic.

(b) A person is eligible for a Military Limited Volunteer License if they:

(1) are licensed in good standing or are retired in good standing in another state; and

(2) are or were authorized to treat personnel enlisted in a branch of the United States armed forces or veterans.

(c) A person is ineligible for a Military Limited Volunteer License if they:

(1) hold a dentist or dental hygienist license in another state that is currently under active investigation or has been subject to a disciplinary order or action;

(2) hold a license to prescribe, dispense, administer, supply, or sell a controlled substance that is currently under active investigation or has been subject to a disciplinary order or action; or

(3) have been convicted of, is on deferred adjudication community supervision, or deferred disposition for, or is under active investigation for the commission of a felony or a misdemeanor involving moral turpitude.

(d) Except for the limitations described in subsection (a) of this section, a Military Limited Volunteer License holder has the same privileges and responsibilities of any other licensee and is similarly subject to board rules, including rules regarding standard of care, record keeping, disciplinary actions, license registration and renewal, and continuing education, except that there will not be any fees associated with the issuance or renewal of the license.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800815

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


CHAPTER 104. CONTINUING EDUCATION

22 TAC §104.1

The State Board of Dental Examiners (Board) proposes amended rule §104.1, concerning Continuing Education Requirements. This rule amendment is being made in light of the switch from annual to biennial license renewals. In general, all requirements have been doubled. One exception to that is the jurisprudence exam, which was previously required every three years and will now be required every four years (i.e., one time per two renewal cycles.) Another change worth noting is the carry-over provision. Previously, licensees could carry over up to 24 hours of additional training obtained from up to three years prior to the current annual renewal year. The rule is being amended to allow for carry-over of up to 24 hours of additional training obtained from the one year prior to the current biennial renewal cycle.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to increase efficiency in the licensing division which will result in faster processing times for all applicants. Mr. Vance has determined that for the first five-year period the proposed rule is in effect, costs to persons or small businesses will be minimal. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§104.1.Requirement.

As a prerequisite to the biennial [annual] renewal of a dental or dental hygiene license, proof of completion of 24 [12] hours of acceptable continuing education is required.

(1) Each licensee shall select and participate in the continuing education courses endorsed by the providers identified in §104.2 of this title (relating to Providers). A licensee, other than a licensee who resides outside of the United States, who is unable to meet education course requirements may request that alternative courses or procedures be approved by the Licensing Committee.

(A) Such requests must be in writing and submitted to and approved by the Licensing Committee prior to the expiration of the biennial [annual] period for which the alternative is being requested.

(B) A licensee must provide supporting documentation detailing the reason why the continuing education requirements set forth in this section cannot be met and must submit a proposal for alternative education procedures.

(C) Acceptable causes may include unanticipated financial or medical hardships or other extraordinary circumstances that are documented.

(D) A licensee who resides outside of the United States may, without prior approval of the Licensing Committee, complete all required hours of coursework by self-study.

(i) These self-study hours must be provided by those entities cited in §104.2 of this title (relating to Providers). Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses.

(ii) Upon being audited for continuing education compliance, a licensee who submits self-study hours under this subsection must be able to demonstrate residence outside of the United States for all periods of time for which self-study hours were submitted.

(E) Should a request to the Licensing Committee be denied, the licensee must complete the requirements of this section.

(2) Effective September 1, 2018 [2008], the following conditions and restrictions shall apply to coursework submitted for renewal purposes:

(A) At least 16 [8] hours of coursework must be either technical or scientific as related to clinical care. The terms "technical" and "scientific" as applied to continuing education shall mean that courses have significant intellectual or practical content and are designed to directly enhance the practitioner's knowledge and skill in providing clinical care to the individual patient.

(B) Up to 8 [4] hours of coursework may be in risk-management courses. Acceptable "risk management" courses include courses in risk management, record-keeping, and ethics.

(C) Up to 12 [6] hours of coursework may be self-study. These self-study hours must be provided by those entities cited in §104.2 of this title (relating to Providers). Examples of self-study courses include correspondence courses, video courses, audio courses, and reading courses.

(D) Hours of coursework in the standards of the Occupational Safety and Health Administration (OSHA) annual update course or in cardiopulmonary resuscitation (CPR) basic life support training may not be considered in the 24 [12]-hour requirement.

(E) Hours of coursework in practice finance may not be considered in the 24 [12]-hour requirement.

(3) Each licensee shall complete the jurisprudence assessment every four (4) [three (3)] years. This requirement is in addition to the twenty-four (24) [twelve (12)] hours of continuing education required biennially for the renewal of a license.

(4) A licensee may carry forward continuing education hours earned prior to a renewal period which are in excess of the 24 [12]-hour requirement and such excess hours may be applied to subsequent years' requirements. Excess hours to be carried forward must have been earned in a classroom setting and within the one year [three years] immediately preceding the renewal period. A maximum of 24 total excess credit hours may be carried forward.

(5) Examiners for the Western Regional Examining Board (WREB) and for Central Regional Dental Testing Services Inc. (CRDTS) will be allowed credit for no more than 12 [6] hours biennially [annually], obtained from calibration and standardization exercises associated with the examinations.

(6) Any individual or entity may petition one of the providers listed in §104.2 of this title to offer continuing education.

(7) Providers cited in §104.2 of this title will approve individual courses and/or instructors.

(8) A consultant for the SBDE who is also a licensee of the SBDE is eligible to receive up to 12 [6] hours of continuing education credit biennially [annually ] to apply towards the biennial [annual] renewal continuing education requirement under this section.

(A) Continuing education credit hours shall be awarded for the issuance of an expert opinion based upon the review of SBDE cases and for providing assistance to the SBDE in the investigation and prosecution of cases involving violations of the Dental Practice Act and/or the Rules of the SBDE.

(B) The amount of continuing education credit hours to be granted for each consultant task performed shall be determined by the Executive Director, Division Director or manager that authorizes the consultant task to be performed. The award of continuing education credit shall be confirmed in writing and based upon a reasonable assessment of the time required to complete the task.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800817

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


CHAPTER 107. DENTAL BOARD PROCEDURES

SUBCHAPTER A. PROCEDURES GOVERNING GRIEVANCES, HEARINGS, AND APPEALS

22 TAC §107.52

The State Board of Dental Examiners (Board) proposes an amendment to rule §107.52, concerning Oral Arguments before the board. This amendment will allow respondents with cases before the Board to submit their arguments in writing. The rule also places a time limit on oral arguments and a page limit on written arguments.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to provide for an additional manner in which licensees can respond to the Board in proposed disciplinary cases. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§107.52.Oral and Written Arguments [Argument].

All parties shall be given notice of the scheduling of a proposal for decision (PFD) for consideration by the board. The notice shall include a statement that the parties may attend the meeting of the board and provide up to a 10 minute oral argument or submit up to a 10 page written argument concerning the PFD before the board. Board staff shall send notice by electronic mail or regular mail to the attorneys of record, or if a party is not represented by an attorney, by regular mail to the party's address of record with the board. Notice shall be sent by board staff no later than seven days prior to the meeting of the board at which the PFD is scheduled to be considered by the board.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800825

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


SUBCHAPTER B. COMPLAINTS AND INVESTIGATIONS

22 TAC §107.104

The State Board of Dental Examiners (Board) proposes repeal of rule §107.104, concerning Official Investigation of a Complaint. Rule 107.104 was improperly adopted following the January 12, 2018, Board meeting. This repeal is being done so that an identical rule can be re-proposed and then properly adopted.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule repeal is in effect, there will not be any fiscal implications for state or local government as a result of repealing the rule.

Mr. Vance has also determined that for the first five-year period the proposed rule repeal is in effect, the public benefit anticipated as a result of this repeal is complying with the law. Mr. Vance has determined that the proposed rule repeal will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Mr. Vance has also determined that for the first five-year period the proposed rule repeal is in effect, the following government growth effects apply: the rule repeal does not create or eliminate a government program; implementation of the repealed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule repeal does not require an increase or decrease in future appropriations; the proposed rule repeal does not require an increase or decrease in fees paid to the agency; the proposed rule repeal does not create a new regulation; the proposed rule repeal does not expand an existing regulation; the proposed rule repeal decreases the number of individuals subject to it; the proposed rule repeal does not adversely affect the state's economy.

Comments on the proposed rule repeal may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov, no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule repeal is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§107.104.Official Investigation of a Complaint.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800828

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §107.104

The State Board of Dental Examiners (Board) proposes new rule §107.104, concerning Official Investigation of a Complaint. This rule describes the Board's investigation process and classification of complaints.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to increase safety to patients by ensuring dentists are adequately prepared to perform acts they are legally able to perform. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§107.104.Official Investigation of a Complaint.

(a) Once an official investigation commences, board staff shall notify the complainant and respondent of the filing of the complaint and the commencing of the official investigation. The complainant and the respondent shall receive notice of the complaint's status, at least quarterly, until final disposition of the complaint, unless such notice would jeopardize an investigation.

(b) The official investigation of a complaint may include referral to a panel of experts for review.

(c) As of September 1, 2016, board staff shall classify each filed complaint into one or more of the following allegation categories:

(1) Standard of Care: failure to treat a patient according to the standard of care in the practice of dentistry or dental hygiene.

(2) Sanitation: failure to maintain the dental office in a sanitary condition.

(3) Dishonorable Conduct: unprofessional or dishonorable conduct, including conduct identified in §108.9 of this title (related to Dishonorable Conduct).

(4) Administrative: failure to comply with administrative requirements of the Act or board rules.

(5) Business Promotion: failure to comply with the requirements of the Act or board rules relating to advertising and referral schemes.

(6) Practicing Dentistry without a License.

(7) Non-compliance: failure to comply or timely comply with an Order or Remedial Plan issued by the board.

(d) Board staff shall assign each filed complaint a priority classification, as follows:

(1) Priority 1 includes allegations that require an expedited investigation or consideration of temporary suspension of license of permits.

(2) Priority 2 includes allegations that require an expedited investigation.

(3) Priority 3 includes investigations that require a standard investigation.

(4) A complaint's priority classification may be changed when appropriate.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800829

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


CHAPTER 110. SEDATION AND ANESTHESIA

22 TAC §110.7

The State Board of Dental Examiners (Board) proposes repeal of §110.7, concerning Portability. Section 110.7 was improperly adopted following the January 12, 2018, Board meeting. This repeal is being done so that an identical rule can be re-proposed and then properly adopted.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed repeal is in effect, there will not be any fiscal implications for state or local government as a result of repealing the rule.

Tyler Vance has also determined that for the first five-year period the proposed repeal is in effect, the public benefit anticipated as a result of this repeal is complying with the law. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed repeal is in effect, the following government growth effects apply: the repeal does not create or eliminate a government program; implementation of the repealed does not require the creation or elimination of employee positions; the implementation of the proposed repeal does not require an increase or decrease in future appropriations; the proposed repeal does not require an increase or decrease in fees paid to the agency; the proposed repeal does not create a new regulation; the proposed repeal does not expand an existing regulation; the proposed repeal decreases the number of individuals subject to it; the proposed repeal does not adversely affect the state's economy.

Comments on the proposed repeal may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed is published in the Texas Register.

This repeal is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt s necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed repeal.

§110.7.Portability.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800826

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §110.7

The State Board of Dental Examiners (Board) proposes new rule §110.7, concerning Portability. This new rule will require dentists who provide anesthesia services in multiple locations to attest to that fact on their permit applications. This rule mimics the statutory language added by SB313 and reminds dentists that they are responsible for the services they provide wherever they may provide them.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the agency's compliance with legislative directives. Mr. Vance has determined that for the first five-year period the proposed rule is in effect, costs to persons or small businesses will be minimal. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§110.7.Portability.

(a) A dentist who applies for the issuance or renewal of a sedation/anesthesia permit must include in the application a statement indicating whether the dentist provides or will provide a permitted sedation/anesthesia service in more than one location.

(b) A dentist providing sedation/anesthesia services in more than one location remains responsible for providing these services in strict compliance with all applicable laws and rules. The dentist shall ascertain that the location is supplied, equipped, staffed, and maintained in a condition to support provision of sedation/anesthesia services that meet the standard of care.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800827

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §110.16

The State Board of Dental Examiners (Board) proposes new rule §110.16, concerning Sedation/Anesthesia of High-Risk Patients. This new rule will require dentists to undergo additional didactic and clinical training prior to providing levels 2, 3, or 4 sedation/anesthesia to high-risk patients. This rule is being proposed to comply with the requirements of S.B.313.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the agency's compliance with legislative directives and increased public safety as a result of increased training requirements for dentists.

Tyler Vance has also determined that an economic impact statement and regulatory flexibility analysis for small businesses, micro-businesses, and rural communities is necessary for this rule. The Board has approximately 3,400 permit holders affected by this rule across the State of Texas. Many of these permit holders are considered small or micro-businesses in that they are independent practitioner-business owners employing fewer than 100 employees. Many of them practice in rural communities, defined as municipalities with fewer than 25,000 people. Small businesses, micro-businesses, and rural communities will almost certainly experience an adverse economic effect from this proposed rule. Informal comments presented at stakeholder and committee meetings estimate the cost of the new additional training program will be in the range of $10-20,000. Permit holders will have to take at least 16 hours out of their schedule for the didactic training and obtaining the necessary clinical training will likely require even further time, travel, and expense. As for rural communities, it is an inevitable consequence of this regulation that there will be fewer providers of moderate sedation and above for these patients throughout the State of Texas. There are already fewer of these providers in rural areas than in urban areas and presumably that gap will grow wider due to the costs associated with this regulation. A provider in a rural area who only does these procedures a few times a year likely will not go through the additional training required to continue doing so. As a result, rural patients may have to seek out someone else who is qualified to perform the procedures, likely in a more urban setting that will require additional time and expense. As such, rural communities will likely experience an adverse economic impact from this proposed regulation. That said, this rule is being proposed due to a legislative mandate in Senate Bill 313 (85th Legislature) that requires these practitioners to undergo "additional didactic and clinical training", as defined by the Board. The legislature has mandated further training to protect the health and safety of all Texans. The Board was charged with defining "additional training" and after many discussions about alternatives they arrived at the requirements that are being proposed. The proposed requirements could be higher or lower, but either way, the legislature has mandated "additional training" and any amount of "additional training" is going to have an adverse economic effect on small businesses and rural communities. It would not have been acceptable to the Board of the legislature to have proposed one standard for rural providers and another for urban providers. The Board believes the proposed rule strikes a good balance between protecting the public health and safety and keeping the new regulation economically feasible for those who wish to provide or receive this service.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§110.16.Sedation/Anesthesia of High-Risk Patients.

(a) "High-risk patient" means a patient who has a level 3 or 4 classification according to the American Society of Anesthesiologists Physical Status Classification System (ASA).

(b) For the purposes of this chapter, ASA classifications are defined as follows:

(1) ASA I: a normal healthy patient

(2) ASA II: a patient with mild systemic disease

(3) ASA III: a patient with severe systemic disease.

(4) ASA IV: a patient with severe systemic disease that is a constant threat to life.

(c) A permit holder may not administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a high-risk patient unless the permit holder has:

(1) completed a university or hospital-based residency at least 12 months in length; or

(2) completed a board-approved education program that includes a minimum of sixteen (16) hours of didactic training and instruction in sedation/anesthesia of high-risk patients. Successful completion of the program must include passing an examination covering the course components. Didactic education must include:

(A) pre-anesthetic patient assessment/evaluation for medically compromised and geriatric patients;

(B) physical evaluation and medical history of high-risk patients, including obesity, pregnancy, and obstructive sleep apnea syndrome, cardiovascular disease, metabolic or genetic disorders, hematologic disorders, and other systemic diseases/conditions affecting sedation/anesthesia;

(C) high-risk patient anatomical and physiological differences;

(D) medical consultations;

(E) high-risk respiratory assessment, including airway anatomy, physiology, and management;

(F) informed consent by patient, parent, or guardian;

(G) sedation/anesthesia pharmacology;

(H) sedation/anesthesia management of patients identified with special health care needs;

(I) high-risk patient monitoring;

(J) peri-operative complications and emergencies;

(K) emergency management of high-risk patients, including high-risk anesthesia equipment and resuscitation supplies;

(L) sedation/anesthesia technique;

(M) sedation/anesthesia record keeping;

(N) patient recovery and discharge;

(O) appropriate patient selection; and

(3) completed satisfactory management of sedation/anesthesia in at least ten (10) cases involving high-risk patients sedated/anesthetized at the highest level of permit held. At least five (5) of the cases must involve the hands-on administration of sedation/anesthesia as the primary provider. No more than five (5) cases may be observed. The ten (10) cases must involve either live patients and/or high-fidelity emergency sedation/anesthesia simulations. All of the cases must be performed and documented under the on-site instruction and direct supervision of a licensed dentist authorized to administer sedation/anesthesia to high-risk patients.

(d) A permit holder is authorized to administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a high-risk patient if they have completed the requirements above. The permit holder must attest to their advanced training in high-risk patients on their initial and/or renewal permit application and they will be required to produce proof of completion as part of a permit inspection or an investigation of a complaint involving sedation/anesthesia of a high-risk patient.

(e) The education hours described in subsection (c)(2) of this section can be applied towards the permit holder's continuing education requirement for maintaining a sedation/anesthesia permit.

(f) The didactic and clinical training described in subsection (c)(2) and (3) of this section may not be fulfilled by the same didactic and clinical training used to fulfill the requirements for initial permit issuance.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800808

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


22 TAC §110.17

The State Board of Dental Examiners (Board) proposes new rule §110.17, concerning Sedation/Anesthesia of Pediatric Patients. This new rule will require dentists to undergo additional didactic and clinical training prior to providing levels 2, 3, or 4 sedation/anesthesia to pediatric patients. This rule is being proposed to comply with the requirements of S.B. 313.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of this rule will be the agency's compliance with legislative directives and increased public safety as a result of increased training requirements for dentists.

Tyler Vance has also determined that an economic impact statement and regulatory flexibility analysis for small businesses, micro-businesses, and rural communities is necessary for this rule. The Board has approximately 3,400 permit holders affected by this rule across the State of Texas. Many of these permit holders are considered small or micro-businesses in that they are independent practitioner-business owners employing fewer than 100 employees. Many of them practice in rural communities, defined as municipalities with fewer than 25,000 people. Small businesses, micro-businesses, and rural communities will almost certainly experience an adverse economic effect from this proposed rule. Informal comments presented at stakeholder and committee meetings estimate the cost of the new additional training program will be in the range of $10-20,000. Permit holders will have to take at least 16 hours out of their schedule for the didactic training and obtaining the necessary clinical training will likely require even further time, travel, and expense. As for rural communities, it is an inevitable consequence of this regulation that there will be fewer providers of moderate sedation and above for these patients throughout the State of Texas. There are already fewer of these providers in rural areas than in urban areas and presumably that gap will grow wider due to the costs associated with this regulation. A provider in a rural area who only does these procedures a few times a year likely will not go through the additional training required to continue doing so. As a result, rural patients may have to seek out someone else who is qualified to perform the procedures, likely in a more urban setting that will require additional time and expense. As such, rural communities will likely experience an adverse economic impact from this proposed regulation. That said, this rule is being proposed due to a legislative mandate in Senate Bill 313 (85th Legislature) that requires these practitioners to undergo "additional didactic and clinical training", as defined by the Board. The legislature has mandated further training to protect the health and safety of all Texans. The Board was charged with defining "additional training" and after many discussions about alternatives they arrived at the requirements that are being proposed. The proposed requirements could be higher or lower, but either way, the legislature has mandated "additional training" and any amount of "additional training" is going to have an adverse economic effect on small businesses and rural communities. It would not have been acceptable to the Board or the legislature to have proposed one standard for rural providers and another for urban providers. The Board believes the proposed rule strikes a good balance between protecting the public health and safety and keeping the new regulation economically feasible for those who wish to provide or receive this service.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed new rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§110.17.Sedation/Anesthesia of Pediatric Patients.

(a) "Pediatric patient" means a patient younger than 13 years of age.

(b) A permit holder may not administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a pediatric patient unless the permit holder has:

(1) completed a university or hospital-based residency at least 12 months in length; or

(2) completed a board-approved education program that includes a minimum of sixteen (16) hours of didactic training and instruction in sedation/anesthesia of pediatric patients. Successful completion of the program must include passing an examination covering the course components. Didactic education must include:

(A) pre-anesthetic patient assessment/evaluation for pediatric patients;

(B) physical evaluation and medical history of pediatric patients, including obesity, limited neck mobility, micro/retrognathia, macroglossia, tonsillar obstruction % (Malampatti), and limited oral opening;

(C) pediatric anatomical and physiological differences;

(D) pediatric respiratory assessment, including airway anatomy, physiology, and management;

(E) informed consent by parent, guardian, or care-giver;

(F) sedation/anesthesia pharmacology;

(G) sedation/anesthesia management of pediatric patients;

(H) pediatric patient monitoring;

(I) peri-operative patient assessment;

(J) emergency management of pediatric patients including pediatric anesthesia equipment and resuscitation supplies;

(K) sedation/anesthesia technique;

(L) sedation/anesthesia record keeping;

(M) patient recovery and discharge; and

(N) pediatric case selection and reference behavior scale; and

(3) completed satisfactory management of sedation/anesthesia in at least fifteen (15) cases involving pediatric patients sedated/anesthetized at the highest level of permit held. The cases must include at least three (3) live cases in which the permit holder is the primary sedation/anesthesia provider, no more than seven (7) cases observed on live patients, and no more than five (5) cases performed as part of a hands-on high-fidelity sedation simulation center or program. All of the cases must be performed and documented under the on-site instruction and direct supervision of a licensed dentist authorized to administer sedation/anesthesia to pediatric patients.

(c) A permit holder is authorized to administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a pediatric patient if they have completed the requirements above. The permit holder must attest to their advanced training in pediatric patients on their initial and/or renewal permit application and they will be required to produce proof of completion as part of a permit inspection or an investigation of a complaint involving sedation/anesthesia of a pediatric patient.

(d) The education hours described in subsection (b)(2) of this section can be applied towards the permit holder's continuing education requirement for maintaining a sedation/anesthesia permit.

(e) The requirements described in subsection (b)(2) and (3) of this section may not be fulfilled by the same didactic and clinical training used to fulfill the requirements for initial permit issuance.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800809

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977


CHAPTER 114. EXTENSION OF DUTIES OF AUXILIARY PERSONNEL--DENTAL ASSISTANTS

22 TAC §114.2

The State Board of Dental Examiners (Board) proposes amended rule §114.2, concerning Registration of Dental Assistants. This rule amendment is being made due to changes provided for in SB313. First, dental registrations will be moving to a biennial cycle. Continuing education requirements will remain the same- 6 hours per year depending on which tasks the assistant performs. Applicants will now be required to submit fingerprints and provide proof of completion of high school or a GED program. All new applicants and renewal applicants will be required to take a hands-on basic life support course. Renewal applicants who are currently in violation of a board order will be ineligible. Finally, registered dental assistants will be allowed to carry-over up to six hours of additional continuing education obtained in the year prior to a renewal cycle.

Tyler Vance, Interim Executive Director, has determined that for the first five-year period the proposed rule is in effect, there will not be any fiscal implications for state or local government as a result of enforcing or administering the rule.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the public benefit anticipated as a result of administering this section will be to increase efficiency in the licensing division which will result in faster processing times for all applicants and to increase training requirements on RDAs which will provide better public safety. Mr. Vance has determined that the proposed rule will not have an adverse economic effect on small or micro businesses or rural communities. There is no foreseeable impact on employment in any regional area where the rule is enforced or administered.

Tyler Vance has also determined that for the first five-year period the proposed rule is in effect, the following government growth effects apply: the rule does not create or eliminate a government program; implementation of the proposed rule does not require the creation or elimination of employee positions; the implementation of the proposed rule does not require an increase or decrease in future appropriations; the proposed rule does not require an increase or decrease in fees paid to the agency; the proposed rule creates a new regulation; the proposed rule expands an existing regulation; the proposed rule increases the number of individuals subject to it; the proposed rule does not adversely affect the state's economy.

Comments on the proposed amended rule may be submitted to Tyler Vance, Interim Executive Director, 333 Guadalupe, Suite 3-800, Austin, Texas 78732, Fax (512) 305-9364, tvance@tsbde.texas.gov no later than 30 days from the date that the proposed rule is published in the Texas Register.

This rule is proposed under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety.

No statutes are affected by this proposed rule.

§114.2.Registration of Dental Assistants.

(a) A dental assistant may not position or expose dental x-rays unless the dental assistant holds a dental assistant radiology certificate issued by the State Board of Dental Examiners under this section.

(b) To be eligible for a dental assistant radiology certificate under this section, an applicant must present on or accompanying an application form approved by the State Board of Dental Examiners proof satisfactory to the Board that the applicant has:

(1) Paid all application, examination and licensing fees required by law and Board rules and regulations;

(2) Graduated from an accredited high school or holds a certificate of high school equivalency, General Equivalency Diploma (GED);

(3) Submitted fingerprints for the retrieval of criminal history record information;

(4) [(2)] Successfully completed a current hands-on course in basic life support; and,

(5) [(3)] Either:

(A) taken and passed a course of instruction and an examination administered by the State Board of Dental Examiners or its designated agent, that fulfills the requirements in subsection (h) of this section; or,

(B) if the applicant is certified as a dental assistant by the Dental Assisting National Board, taken and passed a jurisprudence examination administered by the State Board of Dental Examiners or its designated agent.

(c) The State Board of Dental Examiners has established a staggered dental assistant registration system comprised of initial registration periods followed by biennial [annual] registrations (i.e., renewals). The initial, staggered registration periods will range from 18 [6] months to 30 [17] months. The length of the initial registration period will be determined by the registrant's birth month, but will be no less than 18 months. The expiration of the initial registration will be based on the registrants' birth month. [Each dental assistant for whom an initial certificate of registration is issued will be assigned a computer-generated check digit. The length of the initial registration period will be according to the assigned check digit as follows:]

[(1) a dental assistant assigned to check digit 1 will be registered for 6 months;]

[(2) a dental assistant assigned to check digit 2 will be registered for 7 months;]

[(3) a dental assistant assigned to check digit 3 will be registered for 8 months;]

[(4) a dental assistant assigned to check digit 4 will be registered for 9 months;]

[(5) a dental assistant assigned to check digit 5 will be registered for 11 months;]

[(6) a dental assistant assigned to check digit 6 will be registered for 12 months;]

[(7) a dental assistant assigned to check digit 7 will be registered for 13 months;]

[(8) a dental assistant assigned to check digit 8 will be registered for 14 months;]

[(9) a dental assistant assigned to check digit 9 will be registered for 15 months; and]

[(10) a dental assistant assigned to check digit 10 will be registered for 17 months.]

[(11) Initial dental assistant registration fees will be prorated according to the number of months in the initial registration period.]

(d) Subsequent to the initial registration period, a registered dental assistant's biennial [annual] renewal will occur on the first day of the month that follows the last month of the dental assistant initial registration period.

(1) Approximately 60 days prior to the expiration date of the initial dental assistant registration period, renewal notices will be mailed to all registered dental assistants who have that expirationdate.

(2) A dental assistant registered under this section who wishes to renew his or her registration must:

(A) Pay a renewal fee set by Board rule;

(B) Submit proof that the applicant has successfully completed a current hands-on course in basic life support; and,

[(C) For certificates that expire before September 1, 2009, complete at least six (6) hours of continuing education in the previous registration year.]

[(i) The continuing education curriculum must cover dental assistant duties.]

[(ii) The continuing education requirement may be met through self-study, interactive computer courses, or lecture courses as offered or endorsed by continuing education providers listed in §104.2 of this title; or]

(C) [(D)] [For certificates that expire on or after September 1, 2009,] Complete continuing education as required by §114.12 of this chapter.

(3) A registration expired for one year or more may not be renewed.

(4) Up to 6 hours of continuing education may be carried forward from the year preceding the current renewal period.

(e) Applications for registration or for renewal of registration must be submitted to the office of the State Board of Dental Examiners.

(f) An application for registration is filed with the State Board of Dental Examiners when it is actually received, date-stamped, and logged-in by the State Board of Dental Examiners along with all required documentation and fees. An incomplete application for registration and fee will be returned to applicant within three working days with an explanation of additional documentation or information needed.

(g) A dental assistant shall display a current registration certificate in each office where the dental assistant provides services for which registration is required by this chapter. When a dental assistant provides such services at more than one location, a duplicate registration certificate issued by the Board may be displayed. Photocopies are not acceptable. The duplicate may be obtained from the State Board of Dental Examiners for a fee set by the Board.

(h) Radiology. Courses administered to fulfill the requirements of a Dental Assistant Radiology Certificate must cover the following course objectives identified by the Dental Assistant Advisory Committee:

(1) At the end of this course of instruction, the student should be able to:

(A) Apply principles of radiation safety in the operation of radiographic equipment.

(i) Explain factors affecting x-ray production.

(ii) Explain x-ray machine factors that influence radiation safety.

(iii) Identify differences between primary radiation and scattered (secondary) radiation.

(iv) Describe protocol in suspected x-ray machine malfunctions.

(B) Practice safety measures for patient protection.

(i) Explain major cause of unnecessary radiation exposure.

(ii) Identify short and long-term effects of radiation on cells and tissues.

(iii) Identify ways to reduce radiation exposure to patients.

(iv) Explain guidelines to determine frequency of radiation exposure.

(C) Practice safety measures for operator protection.

(i) Explain basic radiation physics and biology related to operator exposure.

(ii) Explain sources of radiation to operators while exposing radiographs.

(iii) Identify safety measures to reduce operator radiation exposure.

(D) Identify and select infection control techniques and barriers to minimize cross-contamination according to ADA/CDC guidelines.

(E) Utilize patient management techniques before, during, and after radiographic exposure.

(i) Address patient concerns regarding radiation exposure.

(ii) Select appropriate patient management techniques for radiographic exposure.

(F) Select appropriate intraoral radiographic technique.

(i) Identify appropriate armamentarium for radiographic techniques.

(ii) Select appropriate film size and film speed.

(iii) Expose radiographs.

(G) Practice infection control procedures for radiographic processing.

(H) Prepare, maintain, and replenish radiographic solutions for manual and automatic processors.

(I) Process exposed intra- and extraoral radiographs manually and with automatic processors.

(i) Identify optimum conditions and procedures for processing radiographs.

(ii) Identify and correct errors related to radiographic processing and improper film handling.

(J) Store film and chemical agents used in radiographic procedures according to regulatory guidelines.

(K) Dispose of all chemical agents and other materials used in dental radiographic procedures.

(L) Mount radiographs using facial view.

(i) Identify anatomical landmarks to aid in correct mounting.

(ii) Match specific tooth views to specified tooth mount windows.

(iii) Utilize optimum viewing techniques.

(iv) Label the radiographic mount appropriately.

(M) Identify anatomical structures, dental materials and patient characteristics observed on radiographs.

(N) Evaluate radiographs for diagnostic value.

(i) Identify diagnostically acceptable radiographs.

(ii) Identify and correct causes of errors on intraoral radiographs.

(O) Understand basic principles of extraoral radiology.

(P) Select the appropriate film and equipment.

(Q) Prepare patient for exposure.

(R) Expose extraoral radiographs.

(S) Identify and correct causes of errors on extraoral radiographs.

(T) Explain the concept of digital radiography.

(U) Select appropriate equipment.

(V) Expose digital radiographs.

(W) Identify and correct causes of errors on digital radiographs.

(X) Utilize quality assurance procedures in the dental office for radiographic procedures.

(Y) Prepare radiographs to comply with legal requirements for viewing and duplication.

(i) Explain methods for duplicating radiographs.

(ii) Explain reasons for exposing and retaining radiographs.

(Z) Comply with HIPAA/Patient Privacy Rules and Regulations.

(2) Infection control. At the end of this course of instruction, the student should be able to:

(A) Follow standards and guidelines of occupational safety for dental office personnel.

(i) Utilize regulations in the OSHA/CDC Bloodborne Pathogens Standard.

(ii) Utilize regulations in the OSHA/CDC Hazard Communication Standard.

(B) Identify infectious diseases in the dental setting and available immunizations.

(C) Prevent cross-contamination and disease transmission in the dental setting.

(i) Perform proper hand washing.

(ii) Use disposable items whenever possible.

(iii) Utilize barrier techniques and personal protective equipment (PPE).

(D) Perform disinfection procedures.

(i) Select appropriate PPE.

(ii) Select, prepare and use chemical agents following manufacturer's directions.

(iii) Prepare surfaces for disinfection.

(iv) Disinfect the treatment room, darkroom, instrument processing area, and all associated equipment.

(E) Perform sterilization procedures.

(i) Select appropriate PPE.

(ii) Prepare dental instruments and equipment for sterilization.

(iii) Apply appropriate method for sterilization of dental instruments, equipment and supplies.

(iv) Label and store all instruments properly.

(v) Monitor effectiveness of sterilization process for dental instruments, equipment and supplies.

(F) Maintain infection control of dental unit and equipment.

(G) Practice safety measures when handling all hazardous materials.

(i) Identify and dispose of biohazardous waste.

(ii) Identify and dispose of non-regulated waste.

(iii) Identify and manage potential chemical and physical hazards in accordance with MSDS sheets.

(H) Practice infection control in handling and transporting dental items.

(i) Select appropriate PPE.

(ii) Identify conditions for potential cross-contamination.

(iii) Select and apply appropriate disinfectant.

(iv) Label biohazardous material.

(I) Utilize and maintain a quality assurance program for infection control throughout the dental setting.

(3) Jurisprudence. At the end of this course of instruction, the student should be able to:

(A) State the mission, philosophy and composition of the State Board of Dental Examiners.

(B) Differentiate between the Texas Occupations Code and the rules of the State Board of Dental Examiners.

(C) Comply with Texas law and the rules of the State Board of Dental Examiners as they relate to dental assistant duties.

(i) This subsection as well as subsections (j) and (k) of this section apply to certificates issued on or after September 1, 2009. A dental assistant who holds a certificate of registration issued under this chapter shall display the person's current certificate of registration in each office in which the person makes dental x-rays. If the person makes dental x-rays 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.

(j) A dental assistant who holds a certificate of registration issued under this chapter shall timely notify the Board of:

(1) any change of address of the registrant's place of business;

(2) any change of the registrant's employer; and

(3) any change of the registrant's mailing address.

[(k) An initial certificate of registration issued under this section expires on the 30th day after the date the certificate is issued if the holder of the certificate fails to pay the required certificate fee on or before that date.]

(k) [(l)] The Board may issue a registration to a dental assistant applicant who is a Military service member, Military veteran, or Military spouse in compliance with §101.6 of this title (relating to Dental Licensing for Military Service Members, Military Veterans and Military Spouses).

(l) An applicant for registration is ineligible if they are in violation of a board order at the time of application.

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on February 26, 2018.

TRD-201800814

Tyler Vance

Interim Executive Director

State Board of Dental Examiners

Earliest possible date of adoption: April 8, 2018

For further information, please call: (512) 475-0977