85R2773 TSR-D     By: Burkett H.B. No. 2990       A BILL TO BE ENTITLED   AN ACT   relating to the continuation and functions of the State Board of   Dental Examiners; imposing fees.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 251.005, Occupations Code, is amended to   read as follows:          Sec. 251.005.  APPLICATION OF SUNSET ACT.  The State Board   of Dental Examiners is subject to Chapter 325, Government Code   (Texas Sunset Act).  Unless continued in existence as provided by   that chapter, the board is abolished September 1, 2029 [2017].          SECTION 2.  Section 252.001(a), Occupations Code, is amended   to read as follows:          (a)  The State Board of Dental Examiners consists of 11 [15]   members appointed by the governor with the advice and consent of the   senate as follows:                (1)  six [eight] reputable dentist members who reside   in this state and have been actively engaged in the practice of   dentistry for at least the five years preceding appointment;                (2)  three [two] reputable dental hygienist members who   reside in this state and have been actively engaged in the practice   of dental hygiene for at least the five years preceding   appointment; and                (3)  two [five] members who represent the public.          SECTION 3.  Section 252.003, Occupations Code, is amended to   read as follows:          Sec. 252.003.  MEMBERSHIP AND EMPLOYEE RESTRICTIONS. (a)   In this section, "Texas trade association" means a [nonprofit,]   cooperative[,] and voluntarily joined statewide association of   business or professional competitors in this state designed to   assist its members and its industry or profession in dealing with   mutual business or professional problems and in promoting their   common interest.          (b)  A person may not be a member of the board and may not be a   board employee employed in a "bona fide executive, administrative,   or professional capacity," as that phrase is used for purposes of   establishing an exemption to the overtime provisions of the federal   Fair Labor Standards Act of 1938 (29 U.S.C. Section 201 et seq.) if:                (1)  the person is an [An] officer, employee, or paid   consultant of a Texas trade association in the field of health care;   or                (2)  the person's [may not be a member or employee of   the board who is exempt from the state's position classification   plan or is compensated at or above the amount prescribed by the   General Appropriations Act for B9 of the position classification   salary schedule.          [(c)  A person who is the] spouse is [of] an officer,   manager, or paid consultant of a Texas trade association in the   field of health care [may not be a board member and may not be a   board employee who is exempt from the state's position   classification plan or is compensated at or above the amount   prescribed by the General Appropriations Act for B9 of the position   classification salary schedule].          (c) [(d)]  A person may not serve as a member of the board or   act as the general counsel to the board if the person is required to   register as a lobbyist under Chapter 305, Government Code, because   of the person's activities for compensation on behalf of a   profession related to the operation of the board.          SECTION 4.  Section 252.010, Occupations Code, is amended by   amending Subsection (b) and adding Subsection (d) to read as   follows:          (b)  The training program must provide the person with   information regarding:                (1)  the law governing board operations [this   subtitle];                (2)  the programs, [operated by the board;                [(3)  the role and] functions, [of the board;                [(4)  the] rules, and [of the board, with an emphasis on   the rules that relate to disciplinary and investigatory authority;                [(5)  the current] budget of [for] the board;                (3)  the scope of and limitations on the rulemaking   authority of the board;                (4) [(6)]  the results of the most recent formal audit   of the board;                (5) [(7)]  the requirements of:                      (A)  laws relating to [the] open meetings [law],   [Chapter 551, Government Code;                      [(B)  the] public information [law], [Chapter   552, Government Code;                      [(C)  the] administrative procedure [law],   [Chapter 2001, Government Code;] and disclosing conflicts                      [(D)     other laws relating to public officials,   including conflict] of interest [laws]; and                      (B)  other laws applicable to members of the board   in performing their duties; and                (6) [(8)]  any applicable ethics policies adopted by   the board or the Texas Ethics Commission.          (d)  The executive director shall create a training manual   that includes the information required by Subsection (b). The   executive director shall distribute a copy of the training manual   annually to each board member. On receipt of the training manual,   each board member shall sign and submit to the executive director a   statement acknowledging receipt of the training manual.          SECTION 5.  Chapter 254, Occupations Code, is amended by   adding Section 254.0065 to read as follows:          Sec. 254.0065.  CONFIDENTIALITY OF CERTAIN INFORMATION   REGARDING LICENSE HOLDER.  (a)  Except as provided by Subsection   (b), all information, records, and proceedings of the board or an   authorized agent of the board relating to the participation of a   license holder in a peer assistance program or the evaluation of a   license holder under Section 263.0025 are confidential and not   subject to disclosure under Chapter 552, Government Code.          (b)  The board may disclose a disciplinary action taken   against a license holder in the enforcement of Section   263.002(a)(1), (7), or (11). The board may not disclose the nature   of the impairment or condition that resulted in the board's action.          SECTION 6.  Section 254.010(b), Occupations Code, is amended   to read as follows:          (b)  Rules adopted under this section must include   procedures to:                (1)  monitor for compliance a license holder who is   ordered by the board to perform a certain act; [and]                (2)  identify and monitor each license holder who   represents a risk to the public; and                (3)  periodically review reports filed with the   National Practitioner Data Bank for any report of disciplinary   action taken against a license holder by another state that would   constitute grounds for disciplinary action under Section 263.002.          SECTION 7.  Chapter 254, Occupations Code, is amended by   adding Section 254.0105 to read as follows:          Sec. 254.0105.  MONITORING HARMFUL PRESCRIBING PATTERNS.   (a) The board shall periodically check the prescribing information   submitted to the Texas State Board of Pharmacy as authorized by   Section 481.076(a)(1), Health and Safety Code, to determine whether   a dentist licensed under this subtitle is engaging in potentially   harmful prescribing patterns or practices.          (b)  The board, in coordination with the Texas State Board of   Pharmacy, shall determine the conduct that constitutes a   potentially harmful prescribing pattern or practice for purposes of   Subsection (a). In determining the conduct that constitutes a   potentially harmful prescribing pattern or practice, the board   shall consider:                (1)  the number of times a dentist licensed under this   subtitle prescribes a drug listed in Section 258.0535(b); and                (2)  for prescriptions described by Subdivision (1),   patterns of prescribing combinations of those drugs and other   dangerous combinations of drugs identified by the board.          (c)  If the board suspects that a dentist licensed under this   subtitle may be engaging in potentially harmful prescribing   patterns or practices, the board may notify the dentist of the   potentially harmful prescribing pattern or practice.          (d)  The board may initiate a complaint against a dentist   based on information obtained under this section.          SECTION 8.  Section 256.002(a), Occupations Code, is amended   to read as follows:          (a)  An applicant for a license to practice dentistry must:                (1)  be at least 21 years of age; and                (2)  [be of good moral character; and                [(3)]  present proof of:                      (A)  graduation from a dental school accredited by   the Commission on Dental Accreditation of the American Dental   Association; or                      (B)  graduation from a dental school that is not   accredited by the commission and successful completion of training   in an American Dental Association approved specialty in an   education program accredited by the commission that consists of at   least two years of training as specified by the Council on Dental   Education.          SECTION 9.  Section 256.053, Occupations Code, is amended to   read as follows:          Sec. 256.053.  ELIGIBILITY FOR LICENSE.  (a)  An applicant   for a license to practice dental hygiene in this state must be:                (1)  at least 18 years of age;                (2)  [of good moral character;                [(3)]  a graduate of an accredited high school or hold a   certificate of high school equivalency; and                (3) [(4)]  a graduate of a recognized school of   dentistry or dental hygiene accredited by the Commission on Dental   Accreditation of the American Dental Association and approved by   the board or an alternative dental hygiene training program.          (b)  A school of dentistry or dental hygiene described by   Subsection (a)(3) [(a)(4)] must include at least two full academic   years of instruction or its equivalent at the postsecondary level.          SECTION 10.  Chapter 257, Occupations Code, is amended by   adding Section 257.003 to read as follows:          Sec. 257.003.  REFUSAL FOR VIOLATION OF BOARD ORDER. The   board may refuse to renew a license issued under this subtitle if   the license holder is in violation of a board order.          SECTION 11.  Section 258.002(a), Occupations Code, is   amended to read as follows:          (a)  A licensed dentist may delegate to a qualified and   trained dental assistant acting under the dentist's general or   direct supervision any dental act that a reasonable and prudent   dentist would find is within the scope of sound dental judgment to   delegate if:                (1)  in the opinion of the delegating dentist, the act:                      (A)  can be properly and safely performed by the   person to whom the dental act is delegated; and                      (B)  is performed in a customary manner and is not   in violation of this subtitle or any other statute;                (2)  the person to whom the dental act is delegated does   not represent to the public that the person is authorized to   practice dentistry; and                (3)  the person to whom the dental act is delegated is   registered under Chapter 265 [holds the appropriate certificate],   if registration [a certificate] is required to perform the act.          SECTION 12.  Subchapter B, Chapter 258, Occupations Code, is   amended by adding Section 258.0535 to read as follows:          Sec. 258.0535.  DUTIES RELATED TO CERTAIN PRESCRIPTIONS.   (a) A dentist may not prescribe a drug listed in Subsection (b) to a   patient unless the dentist has reviewed the patient's prescription   history by accessing the prescription information submitted to the   Texas State Board of Pharmacy as authorized by Section   481.076(a)(5), Health and Safety Code.          (b)  Subsection (a) applies only to the prescribing of:                (1)  opioids;                (2)  benzodiazepines;                (3)  barbiturates; or                (4)  carisoprodol.          (c)  Failure by a dentist to comply with the requirements of   this section is grounds for disciplinary action under Section   263.002.          SECTION 13.  Section 258.054(c), Occupations Code, is   amended to read as follows:          (c)  A dentist may not authorize a dental assistant to make a   dental x-ray unless the dental assistant is registered [holds an   x-ray certificate issued] under Chapter 265 [Section 265.005].          SECTION 14.  The heading to Subchapter D, Chapter 258,   Occupations Code, is amended to read as follows:   SUBCHAPTER D. [ENTERAL] ADMINISTRATION OF ANESTHESIA          SECTION 15.  Section 258.151, Occupations Code, is amended   to read as follows:          Sec. 258.151.  DEFINITIONS [DEFINITION]. In this   subchapter:                (1)  "High-risk patient" means a patient who:                      (A) is older than 75 years of age; or                      (B)  has a level 3 or 4 classification according   to the American Society of Anesthesiologists Physical Status   Classification System.                (2)  "Pediatric patient" means a patient 12 years of   age or younger[, "enteral" means any technique of administering   anesthesia in which the anesthetic is absorbed through the   gastrointestinal tract or oral mucosa. Examples of enterally   administering anesthesia include administering an anesthetic   orally, rectally, sublingually, or intranasally].          SECTION 16.  Subchapter D, Chapter 258, Occupations Code, is   amended by adding Section 258.1521 to read as follows:          Sec. 258.1521.  ADVISORY COMMITTEE ON DENTAL ANESTHESIA.   (a) The board shall establish an advisory committee to advise the   board regarding the adoption and amendment of rules related to   dental anesthesia. The advisory committee consists of nine members   appointed by the presiding officer of the board and must include:                (1)  a dentist;                (2)  a dentist anesthesiologist;                (3)  an oral and maxillofacial surgeon;                (4)  a pediatric dentist; and                (5)  a physician anesthesiologist.          (b)  The board shall designate an attorney employed by the   board to:                (1)  act as counsel and provide legal advice to the   advisory committee; and                (2)  be present during the committee's meetings and   deliberations.          (c)  The advisory committee shall report to the board at   least annually regarding the committee's recommendations or other   findings related to dental anesthesia.  The board shall post on the   board's Internet website any recommendations or findings reported   by the committee.          (d)  A board member may not serve as a member of the advisory   committee.          (e)  Chapter 2110, Government Code, does not apply to the   size, composition, or duration of the advisory committee.          SECTION 17.  Sections 258.153, 258.154, and 258.155,   Occupations Code, are amended to read as follows:          Sec. 258.153.  RULES. (a) The board shall adopt rules to   administer this subchapter, including rules to establish [by rule]   the minimum standards for the [enteral] administration of   anesthesia by a dentist.          (b)  The rules must be designed to protect the health,   safety, and welfare of the public and must include requirements   relating to:                (1)  for each level of permit held, the methods that may   be used to [enterally] administer an anesthetic and the anesthetic   agents that may be used;                (2)  dental patient evaluation, diagnosis, counseling,   and preparation;                (3)  dental patient monitoring to be performed and   equipment to be used during a procedure and during postprocedure   monitoring;                (4)  emergency procedures, drugs, and equipment,   including education, training, and certification of personnel, as   appropriate, and including protocols for transfers to a hospital;                (5)  the documentation necessary to demonstrate   compliance with this subchapter; and                (6)  the period in which protocols or procedures   covered by rules of the board shall be reviewed, updated, or   amended.          Sec. 258.154.  COMPLIANCE WITH ANESTHESIA RULES. (a) A [On   and after August 31, 2002, a] dentist who practices dentistry in   this state and who [enterally] administers anesthesia or performs a   procedure for which anesthesia is [enterally] administered shall   comply with the rules adopted under this subchapter.          (b)  The board may require a dentist to submit and comply   with a corrective action plan to remedy or address any current or   potential deficiencies with the dentist's [enteral] administration   of anesthesia in accordance with this subtitle or rules of the   board.          Sec. 258.155.  ANNUAL PERMIT REQUIRED. (a)  The board shall   issue permits to administer anesthesia in the following four   categories based on the extent to which the intended procedure will   alter the patient's mental status and the method of anesthetic   delivery:                (1)  level 1: minimal sedation;                (2)  level 2: moderate sedation (enteral   administration);                (3)  level 3: moderate sedation (parenteral   administration); and                (4)  level 4: deep sedation or general anesthesia.          (b)  A [Not later than September 1, 2002, the board shall   require each] dentist may not administer [who enterally   administers] anesthesia or perform [performs] a procedure for which   anesthesia is [enterally] administered unless the dentist [to]   annually obtains the appropriate [obtain a] permit issued under   this section [from the board by completing a form prescribed by the   board].          (c)  The board shall set and impose a fee for issuance of a   [the] permit in an amount designed to recover the costs of   regulating a permit holder under this subchapter.          (d) [(b)]  The board shall coordinate the times at which a   permit must be renewed with the times at which a dentist's license   must be renewed under Chapter 257 so that the times of registration,   payment, notice, and imposition of penalties for late payment are   similar and provide a minimum of administrative burden to the board   and to dentists.          SECTION 18.  Subchapter D, Chapter 258, Occupations Code, is   amended by adding Sections 258.1551, 258.1552, 258.1553, and   258.1554 to read as follows:          Sec. 258.1551.  PERMIT QUALIFICATIONS.  (a)  The board by   rule shall establish the qualifications to obtain each level of   permit described by Section 258.155, including the education and   training required to obtain the permit.          (b)  The rules adopted under Subsection (a) must require an   applicant for a level 2, level 3, or level 4 permit to complete   training on:                (1)  pre-procedural patient evaluation, including the   evaluation of a patient's airway and physical status as classified   by the American Society of Anesthesiologists;                (2)  the continuous monitoring of a patient's level of   sedation during the administration of anesthesia; and                (3)  the management of emergency situations.          Sec. 258.1552.  PORTABILITY OF ANESTHESIA SERVICES. (a) A   dentist who holds a permit issued under this subchapter may not   provide a permitted anesthesia service in a location other than a   facility or satellite facility unless the dentist obtains   authorization from the board under this section.          (b)  The board shall adopt rules establishing procedures and   other requirements for a permit holder to apply for and obtain an   authorization described by Subsection (a).          (c)  Rules adopted under Subsection (b) must require an   applicant to complete advanced didactic and clinical training and   may require additional training of, or establish additional   qualifications for, an applicant who will administer anesthesia to   pediatric or high-risk patients.          Sec. 258.1553.  ADMINISTRATION OF ANESTHESIA TO CERTAIN   PATIENTS.  (a)  A permit holder under this subchapter may not   administer anesthesia under a level 2, level 3, or level 4 permit to   a pediatric or high-risk patient unless the permit holder has:                (1)  demonstrated to the satisfaction of the board that   the permit holder has advanced didactic and clinical training; and                (2)  obtained authorization from the board under this   section.          (b)  The board by rule may establish limitations on the   administration of anesthesia by a permit holder to a pediatric or   high-risk patient.          Sec. 258.1554.  MINIMUM EMERGENCY PREPAREDNESS STANDARDS.   (a)  The board shall adopt rules to establish minimum emergency   preparedness standards and requirements for the administration of   anesthesia under a permit issued under this subchapter. The rules   must require a permit holder to:                (1)  have available at any location at which the permit   holder administers anesthesia:                      (A)  an adequate and unexpired supply of drugs and   anesthetic agents necessary for the safe administration of   anesthesia; and                      (B)  an automated external defibrillator, as   defined by Section 779.001, Health and Safety Code;                (2)  conduct periodic inspections of the permit   holder's equipment in the manner and on the schedule determined by   the board;                (3)  maintain and make available to the board on   request an equipment readiness log; and                (4)  develop and annually update written policies,   procedures, and training requirements, specific to the permit   holder's equipment and drugs, for responding to emergency   situations involving anesthesia.          (b)  Rules adopted under Subsection (a)(4) must require a   holder of a level 2, level 3, or level 4 permit to develop policies   and procedures that include:                (1)  advanced cardiac life support rescue protocols;                (2)  advanced airway management techniques; and                (3)  if the permit holder is authorized to administer   anesthesia to pediatric patients, pediatric advanced life support   rescue protocols.          SECTION 19.  Section 258.156, Occupations Code, is amended   to read as follows:          Sec. 258.156.  INSPECTIONS. (a) Except as provided by   Subsection (g), the [The] board may conduct inspections of a   dentist who applies for or holds a permit issued under this   subchapter as necessary to enforce this subchapter, including   inspections of an office site, equipment, a facility, and any   document of the [documents of a] dentist [dentist's practice that   relate to the enteral administration of anesthesia].          (b)  The board shall conduct an inspection with respect to a   dentist who holds a level 2, level 3, or level 4 permit not less than   once every five years. The board shall adopt a risk-based   inspection schedule for inspections required by this subsection.          (c)  The board may contract with another state agency or   qualified person to conduct these inspections.          (d)  The [(b) Unless it would jeopardize an ongoing   investigation, the] board is not required to give [shall provide at   least five business days'] notice before conducting an [on-site]   inspection under this section.          (e)  The board shall maintain records of inspections   conducted under this section.          (f)  The board by rule may establish education and training   requirements for inspectors who conduct inspections under this   section.          (g)  The board may not conduct an inspection under this   section with respect to a dentist who administers anesthesia   exclusively in a state-licensed hospital or state-licensed   ambulatory surgical center. The board may by rule except from   inspection under this section a dentist who administers anesthesia   exclusively in any other facility that is subject to inspection by   the Department of State Health Services or an accrediting body   under state law. The board retains all other authority provided by   this subtitle over a dentist described by this subsection    [(c)     This section does not require the board to make an on-site   inspection of a dentist's office].          SECTION 20.  Chapter 263, Occupations Code, is amended by   adding Section 263.0025 to read as follows:          Sec. 263.0025.  SUBMISSION TO MENTAL OR PHYSICAL EVALUATION.   (a) In enforcing Section 263.002(a)(1), (7), or (11), the board or   an authorized agent of the board, on probable cause, as determined   by the board or agent, may request a license holder to submit to a   mental or physical evaluation by a physician or other health care   professional designated by the board.          (b)  If the license holder refuses to submit to the   evaluation under Subsection (a), the board shall issue an order   requiring the license holder to show cause why the license holder   will not submit to the evaluation.  The board shall schedule a   hearing on the order not later than the 30th day after the date   notice is served on the license holder. The board shall notify the   license holder of the order and hearing by personal service or   certified mail, return receipt requested.          (c)  At the hearing, the license holder and the license   holder's attorney are entitled to present testimony or other   evidence to show why the license holder should not be required to   submit to the evaluation. The license holder has the burden of   proof to show why the license holder should not be required to   submit to the evaluation.          (d)  After the hearing, the board by order shall require the   license holder to submit to the evaluation not later than the 60th   day after the date of the order or withdraw the request for an   evaluation, as applicable.          SECTION 21.  Section 263.0065(c), Occupations Code, is   amended to read as follows:          (c)  A complaint delegated under this section shall be   referred for informal proceedings under Section 263.007 [263.0075]   if:                (1)  the committee of employees determines that the   complaint should not be dismissed or settled;                (2)  the committee is unable to reach an agreed   settlement; or                (3)  the affected license holder requests that the   complaint be referred for informal proceedings.          SECTION 22.  Section 263.007, Occupations Code, is amended   by amending Subsection (b) and adding Subsections (c) through (k)   to read as follows:          (b)  Rules adopted under this section must require that:                (1)  not later than the 180th day after the date the   board's official investigation of a complaint is commenced, the   board schedule an informal settlement conference unless good cause   is shown by the board for not scheduling the conference by that   date;                (2)  the board give notice to the license holder of the   time and place of the conference not later than the 45th day before   the date the conference is held;                (3)  the complainant and the license holder be provided   an opportunity to be heard;                (4)  the board's legal counsel or a representative of   the attorney general be present to advise the board or the board's   staff; and                (5)  a member of the board's staff be at the conference   to present the facts the staff reasonably believes the board could   prove at a hearing by competent evidence or qualified witnesses   [provide the complainant, if applicable and permitted by law, an   opportunity to be heard;                [(2)     provide the license holder an opportunity to be   heard; and                [(3)     require the presence of a member of the board's   legal staff, if the board has a legal staff, or, if the board does   not have a legal staff, an attorney from the attorney general's   office to advise the board or the board's employees].          (c)  The license holder is entitled at the conference to:                (1)  reply to the staff's presentation; and                (2)  present the facts the license holder reasonably   believes the license holder could prove at a hearing by competent   evidence or qualified witnesses.          (d)  After ample time is given for the presentations, the   informal settlement conference panel shall recommend that the   investigation be closed or make a recommendation regarding the   disposition of the case in the absence of a hearing under applicable   law concerning contested cases.          (e)  If the license holder has previously been the subject of   disciplinary action by the board, the board shall schedule the   informal settlement conference as soon as practicable but not later   than the 180th day after the date the board's official   investigation of the complaint is commenced.          (f)  A notice under Subsection (b)(2) must be accompanied by   a written statement of the nature of the allegations and the   information the board intends to use at the informal settlement   conference.  If the board does not provide the statement or   information at that time, the license holder may use that failure as   grounds for rescheduling the conference.  If the complaint includes   an allegation that the license holder has violated the standard of   care in the practice of dentistry or dental hygiene, the notice must   include a copy of the report by the expert reviewer.  The license   holder must provide to the board the license holder's rebuttal not   later than the 15th day before the date of the conference in order   for that information to be considered at the conference.          (g)  The board by rule shall define circumstances   constituting good cause for purposes of Subsection (b)(1),   including an expert reviewer's delinquency in reviewing and   submitting a report to the board under Section 255.0067.          (h)  The board by rule shall define circumstances   constituting good cause to grant a request by a license holder for a   continuance of the informal settlement conference.          (i)  Information presented by the board or board staff in an   informal settlement conference is confidential and not subject to   disclosure under Chapter 552, Government Code.          (j)  On request by the license holder under review, the board   shall make a recording of the informal settlement conference   proceeding.  The recording is a part of the investigative file and   may not be released to a third party unless authorized under this   subtitle. The board may charge the license holder a fee to cover   the cost of recording the proceeding.          (k)  The board shall provide a copy of the recording to the   license holder on the license holder's request.          SECTION 23.  Chapter 263, Occupations Code, is amended by   adding Sections 263.0071, 263.0072, and 263.0073 to read as   follows:          Sec. 263.0071.  DENTAL REVIEW COMMITTEE. (a) The dental   review committee consists of nine members appointed by the governor   as follows:                (1)  six dentist members; and                (2)  three dental hygienist members.          (b)  A member of the committee serves a six-year term.          (c)  If a vacancy occurs during a member's term, the governor   shall appoint a replacement to fill the unexpired term.          (d)  A member of the committee is entitled to receive a per   diem for actual duty in the same manner provided for board members.          (e)  A member of the committee is subject to law and the rules   of the board, including Sections 252.003, 252.007, and 252.010, as   if the committee member were a member of the board, except that a   committee member is not subject to Chapter 572, Government   Code.  The training program a committee member must complete under   Section 252.010 must be an abbreviated version of the program under   that section that is limited to training relevant to serving on a   committee.          Sec. 263.0072.  INFORMAL SETTLEMENT CONFERENCE PANEL. (a)   The board shall appoint members of the board and the dental review   committee to serve, on a rotating basis, as panelists on an informal   settlement conference panel for purposes of this section.          (b)  In an informal settlement conference under Section   263.007, the board shall appoint at least two panelists to   determine whether an informal disposition is appropriate. At least   one of the panelists must be a dentist.          (c)  The board by rule shall require that at least one   panelist be physically present at the informal settlement   conference and may authorize another panelist to appear by video   conference.          (d)  Notwithstanding Subsection (b), an informal settlement   conference may be conducted by one panelist if the license holder   who is the subject of the complaint waives the requirement that at   least two panelists conduct the conference. If the license holder   waives that requirement, the panelist may be a dentist, a dental   hygienist, or a member who represents the public.          (e)  Notwithstanding Subsections (b) and (d), an informal   settlement conference conducted under Section 263.007 to show   compliance with an order or remedial plan of the board may be   conducted by one panelist.          Sec. 263.0073.  ROLES AND RESPONSIBILITIES OF PARTICIPANTS   IN INFORMAL SETTLEMENT CONFERENCE. (a) At an informal settlement   conference under Section 263.007, the panel shall make   recommendations for the disposition of the complaint or allegation.   The panel may request the assistance of a board employee at any   time.          (b)  Board employees shall present a summary of the   allegations against the license holder and of the facts pertaining   to the allegation that the employees reasonably believe may be   proven by competent evidence at a formal hearing.          (c)  An attorney for the board shall act as counsel to the   panel and shall be present during the informal settlement   conference and the panel's deliberations to advise the panel on   legal issues that arise during the proceeding.  The attorney may ask   questions of participants in the conference to clarify any   statement made by the participant.  The attorney shall provide to   the panel a historical perspective on comparable cases that have   appeared before the board, keep the proceedings focused on the case   being discussed, and ensure that the board's employees and the   license holder have an opportunity to present information related   to the case.  During the panel's deliberations, the attorney may be   present only to advise the panel on legal issues and to provide   information on comparable cases that have appeared before the   board.          (d)  The panel and board employees shall provide an   opportunity for the license holder and the license holder's   authorized representative to reply to the board employees'   presentation and to present oral and written statements and facts   that the license holder and representative reasonably believe could   be proven by competent evidence at a formal hearing.          (e)  An employee of the board who participated in the   presentation of the allegation or information gathered in the   investigation of the complaint, the license holder, the license   holder's authorized representative, the complainant, the   witnesses, and members of the public may not be present during the   deliberations of the panel.  Only the members of the panel and the   attorney serving as counsel to the panel may be present during the   deliberations.          (f)  During the deliberations, the panel may not reconsider   an expert panel's determinations that are included in a final   written report issued under Section 255.0067.          (g)  The panel shall recommend the dismissal of the complaint   or allegations or, if the panel determines that the license holder   has violated a statute or board rule, may recommend board action and   terms for an informal settlement of the case.          (h)  The panel's recommendations under Subsection (g) must   be made in writing and presented to the license holder and the   license holder's authorized representative.  The license holder may   accept the proposed settlement within the time established by the   panel at the informal settlement conference.  If the license holder   rejects the proposed settlement or does not act within the required   time, the board may proceed with the filing of a formal complaint   with the State Office of Administrative Hearings.          SECTION 24.  Section 264.011, Occupations Code, is amended   to read as follows:          Sec. 264.011.  INFORMAL ASSESSMENT OF ADMINISTRATIVE   PENALTY. This subchapter does not prevent the board from assessing   an administrative penalty using an informal proceeding under   Section 263.007 [263.003].          SECTION 25.  Section 265.001, Occupations Code, is amended   to read as follows:          Sec. 265.001.  REGISTRATION. (a) The board may adopt and   enforce rules requiring the registration of dental assistants as   necessary to protect the public health and safety.          (b)  This section expires September 1, 2018.          SECTION 26.  Chapter 265, Occupations Code, is amended by   adding Sections 265.0015, 265.0016, 265.0017, and 265.0018 to read   as follows:          Sec. 265.0015.  REGISTRATION REQUIRED FOR CERTAIN DENTAL   ACTS. Unless a dental assistant is registered under this chapter, a   dental assistant may not:                (1)  apply a pit and fissure sealant;                (2)  make a dental x-ray;                (3)  perform coronal polishing; or                (4)  monitor the administration of nitrous oxide.          Sec. 265.0016.  ELIGIBILITY REQUIREMENTS FOR REGISTRATION.   (a) The board by rule shall establish the requirements for   registration under this chapter, including requiring a dental   assistant to:                (1)  hold a high school diploma or its equivalent;                (2)  complete an educational program approved by the   board that includes courses of instruction on:                      (A)  the dental acts described by Section   265.0015;                      (B)  basic life support;                      (C)  infection control; and                      (D)  jurisprudence;                (3)  pass an examination approved or administered by   the board; and                (4)  meet any additional qualifications established by   the board.          (b)  The board may approve courses of instruction and   examinations that are provided by private entities for the purposes   of this section.          Sec. 265.0017.  FEES. The board shall set and collect fees   in amounts that are reasonable and necessary to cover the costs of   administering this chapter, including registration and renewal   fees.          Sec. 265.0018.  REGISTRATION EXPIRATION AND RENEWAL. (a)  A   registration under this chapter is valid for two years.          (b)  A dental assistant may renew a registration by paying   the required renewal fee and complying with any other renewal   requirements established by the board.          (c)  A dental assistant whose registration has expired may   not engage in an activity that requires registration until the   registration has been renewed.          (d)  The board by rule may adopt a system under which   registrations expire on various dates during the year.  For the year   in which the expiration date is changed, the board shall prorate   registration fees on a monthly basis so that each registration   holder pays only that portion of the registration fee that is   allocable to the number of months during which the registration is   valid. On renewal of the registration on the new expiration date,   the total renewal fee is payable.          SECTION 27.  Section 265.003, Occupations Code, is amended   by amending Subsections (a) and (a-1) and adding Subsections (c)   and (d) to read as follows:          (a)  A dental assistant who is not registered under this   chapter [professionally licensed] may be employed by and work in   the office of a licensed and practicing dentist and perform one or   more delegated dental acts under:                (1)  the direct supervision, direction, and   responsibility of the dentist, including[:                      [(A)     the application of a pit and fissure   sealant;                      [(B)     coronal polishing, if the dental assistant   holds a certificate under Section 265.006; and                      [(C)]  the application of fluoride varnish; or                (2)  the general supervision, direction, and   responsibility of the dentist, limited to[:                      [(A)     the making of dental x-rays in compliance   with Section 265.005; and                      [(B)]  the provision of interim treatment of a   minor emergency dental condition to an existing patient of the   treating dentist.          (a-1)  A treating dentist who delegates the provision of   interim treatment of a minor emergency dental condition to a dental   assistant under Subsection (a)(2) [(a)(2)(B)] shall:                (1)  delegate the procedure orally or in writing before   the dental assistant performs the procedure;                (2)  retain responsibility for the procedure; and                (3)  schedule a follow-up appointment with the patient   within a reasonable time.          (c)  A delegating dentist remains responsible for the dental   acts of a registered or nonregistered dental assistant performing   the delegated dental acts.          (d)  A dental assistant to whom a delegation is made may not   represent to the public that the dental assistant is authorized to   practice dentistry or dental hygiene.          SECTION 28.  Section 265.004, Occupations Code, is amended   by adding Subsection (f) to read as follows:          (f)  This section expires September 1, 2018.          SECTION 29.  Section 265.005, Occupations Code, is amended   by adding Subsection (p) to read as follows:          (p)  This section expires September 1, 2018.          SECTION 30.  Section 265.006, Occupations Code, is amended   by adding Subsection (c) to read as follows:          (c)  This section expires September 1, 2018.          SECTION 31.  Section 265.007, Occupations Code, is amended   by adding Subsection (d) to read as follows:          (d)  This section expires September 1, 2018.          SECTION 32.  Chapter 265, Occupations Code, is amended by   adding Sections 265.008 and 265.009 to read as follows:          Sec. 265.008.  CONTINUING EDUCATION REQUIRED FOR   REGISTRATION RENEWAL. The board by rule shall establish continuing   education requirements for dental assistants registered under this   chapter, including a minimum number of hours of continuing   education required to renew a registration.          Sec. 265.009.  GROUNDS FOR DISCIPLINARY ACTION. (a) The   board, after notice and hearing, may reprimand a person registered   under this chapter, issue a warning letter to a person registered   under this chapter, impose a fine on a person registered under this   chapter, impose an administrative penalty under Subchapter A,   Chapter 264, on a person registered under this chapter, place on   probation with conditions a person whose registration has been   suspended, or revoke or suspend a person's registration issued   under this chapter.          (b)  The board by rule shall establish the grounds and   procedures for disciplinary action under this chapter.          (c)  A proceeding under this section is subject to Chapter   2001, Government Code.          SECTION 33.  The heading to Subchapter C, Chapter 266,   Occupations Code, is amended to read as follows:   SUBCHAPTER C. BOARD POWERS AND DUTIES [OF COUNCIL AND BOARD]          SECTION 34.  The following provisions of the Occupations   Code are repealed:                (1)  Sections 256.0531(h), (i), and (j);                (2)  Section 262.001(1);                (3)  Subchapter B, Chapter 262;                (4)  Section 262.102(c);                (5)  Section 262.1025;                (6)  Section 262.103;                (7)  Section 263.0075;                (8)  Section 263.0076;                (9)  Section 266.001(1);                (10)  Subchapter B, Chapter 266;                (11)  Section 266.101; and                (12)  Sections 266.102(a) and (d).          SECTION 35.  Not later than March 1, 2018, the State Board of   Dental Examiners shall:                (1)  adopt rules and fees necessary to implement   Chapters 258 and 265, Occupations Code, as amended by this Act; and                (2)  adopt rules necessary to implement Chapter 263,   Occupations Code, as amended by this Act.          SECTION 36.  (a)  The term of a member of the State Board of   Dental Examiners serving on September 1, 2017, expires on that   date.          (b)  Not later than December 1, 2017, the governor shall   appoint 11 members to the State Board of Dental Examiners in   accordance with Section 252.001(a), Occupations Code, as amended by   this Act. The governor shall appoint:                (1)  two dentist members and one dental hygienist   member to terms expiring February 1, 2019;                (2)  two dentist members, one dental hygienist member,   and one public member to terms expiring February 1, 2021; and                (3)  two dentist members, one dental hygienist member,   and one public member to terms expiring February 1, 2023.          (c)  Notwithstanding Section 252.001, Occupations Code, as   amended by this Act, the members whose terms expire under   Subsection (a) of this section shall continue to perform the duties   of office as a 15-member board until six members are appointed under   Subsection (b) of this section and qualified.          (d)  The governor may appoint to the board under Subsection   (b) of this section a member whose term expires under Subsection (a)   of this section.  The expired term of a member described by this   subsection does not constitute a full term for purposes of Section   252.004(b), Occupations Code.          SECTION 37.  Not later than December 1, 2017, the presiding   officer of the State Board of Dental Examiners shall appoint the   members of the advisory committee established under Section   258.1521, Occupations Code, as added by this Act.          SECTION 38.  Not later than December 1, 2017, the governor   shall appoint the members of the dental review committee in   accordance with Section 263.0071, Occupations Code, as added by   this Act. In making the appointments, the governor shall appoint:                (1)  three members to terms expiring February 1, 2019;                (2)  three members to terms expiring February 1, 2021;   and                (3)  three members to terms expiring February 1, 2023.          SECTION 39.  (a) Except as provided by Subsection (b) of this   section, Section 252.010, Occupations Code, as amended by this Act,   applies to a member of the State Board of Dental Examiners appointed   before, on, or after the effective date of this Act.          (b)  A member of the board appointed after the effective date   of this Act who, before the effective date of this Act, completed   the training program required by Section 252.010, Occupations Code,   as that law existed before the effective date of this Act, is   required to complete additional training only on the subjects added   by this Act to the training program as required by Section 252.010,   Occupations Code. A board member described by this subsection may   not vote, deliberate, or be counted as a member in attendance at a   meeting of the board held on or after December 1, 2017, until the   member completes the additional training.          SECTION 40.  Section 258.0535, Occupations Code, as added by   this Act, applies only to a prescription issued on or after   September 1, 2018. A prescription issued before September 1, 2018,   is governed by the law in effect on the date the prescription was   issued, and the former law is continued in effect for that purpose.          SECTION 41.  Section 265.008, Occupations Code, as added by   this Act, applies only to the renewal of a registration on or after   September 1, 2018.          SECTION 42.  (a) On September 1, 2018, a registration or   certificate issued under former Section 265.001, 265.004, 265.005,   or 265.006, Occupations Code, expires.          (b)  As soon as practicable after September 1, 2018, the   State Board of Dental Examiners shall issue a prorated refund of any   fees paid by a holder of a registration or certificate that expires   under Subsection (a) of this section.          SECTION 43.  (a)  Chapter 263, Occupations Code, as amended   by this Act, applies only to the investigation or disposition of a   complaint filed with the State Board of Dental Examiners on or after   March 1, 2018. A complaint filed before that date is governed by   the law in effect on the date the complaint was filed, and the   former law is continued in effect for that purpose.          (b)  The changes in law made by this Act do not affect the   validity of a disciplinary action or other proceeding that was   initiated before the effective date of this Act and that is pending   before a court or other governmental entity on that date.          SECTION 44.  (a)  A violation of a law that is repealed by   this Act is governed by the law in effect on the date the violation   was committed, and the former law is continued in effect for that   purpose.          (b)  For purposes of this section, a violation was committed   before the effective date of this Act if any element of the   violation occurred before that date.          SECTION 45.  (a)  Except as provided by Subsections (b) and   (c) of this section, this Act takes effect September 1, 2017.          (b)  Section 258.155, Occupations Code, as amended by this   Act, and Sections 258.1552 and 258.1553, Occupations Code, as added   by this Act, take effect March 1, 2018.          (c)  Sections 258.002 and 258.054, Occupations Code, as   amended by this Act, and Section 265.0015, Occupations Code, as   added by this Act, take effect September 1, 2018.