22 Tex. Admin. Code § 108.70 - Improper Influence on Professional Judgment
(a) For the purposes of this rule, the term
dentist shall include the following:
(1) a
dentist licensed by the State Board of Dental Examiners;
(2) a professional corporation wholly owned
by one or more dentists;
(3) other
entities that provide dental services and are owned by one or more
dentists.
(b) Any
dentist entering into any contract, partnership or other agreement or
arrangement which allows any person other than a dentist any one or more of the
following rights, powers or authorities shall be presumed to have violated the
provisions of the Dental Practice Act, Section 251.003 regarding controlling,
attempting to control, influencing, attempting to influence or otherwise
interfering with the exercise of a dentist's independent professional judgment
regarding the diagnosis or treatment of any dental disease, disorder or
physical condition:
(1) Controlling, owning
or setting any conditions for access to or the specific contents of dental
records of patients of a dentist.
(2) Setting a maximum or other standardized
time for the performance of specific dental procedures.
(3) Placing any limitations or requirements
on treatments, referrals, or consultations except those based on the
professional judgment of the dentist.
(4) Limiting or imposing requirements
concerning the type or scope of dental treatment, procedures or services which
may be recommended, prescribed, directed or performed, except that a dentist
may limit the dentist's practice or the practice of a dentist employed by or
contracting with the dentist to certain procedures or the treatment of certain
dental diseases.
(5) Limiting or
imposing requirements concerning the supplies, instruments or equipment deemed
reasonably necessary by a dentist to provide diagnoses and treatment of the
patients of the dentist.
(6)
Limiting or imposing requirements for the professional training deemed
necessary by the dentist to property serve the patients of the
dentist.
(7) Directing or
influencing the selection of specific diagnostic examinations and treatment or
practices regarding patients without due regard to the recommended diagnostic
examinations and treatment agreed upon by the dentist and the patient, except
that a dentist having the responsibility for training or supervising another
dentist may reasonably limit treatment or practices as a part of the training
or supervision of a dentist based upon the training and competency of a dentist
to perform certain treatment or practices
(8) Limiting or determining the duties of
professional, clinical or other personnel employed to assist a dentist in the
practice of dentistry.
(9)
Establishing professional standards, protocols or practice guidelines which in
the professional judgment of the dentist providing dental service to the
dentist's patient, conflict with generally accepted standards within the dental
profession.
(10) Entering into any
agreement or arrangement for management services that:
(A) interferes with a dentist's exercise of
his/her independent professional judgment;
(B) encourages improper overtreatment or
undertreatment by dentists; or
(C)
encourages impermissible referrals from unlicensed persons in consideration of
a fee.
(11) Placing
limitations or conditions upon communications that are clinical in nature with
the dentist's patients.
(12)
Precluding or restricting a dentist's ability to exercise independent
professional judgment over all qualitative and quantitative aspects of the
delivery of dental care.
(13)
Scheduling patients of the dentist in a manner that may have the effect of
discouraging new patients from coming into the dentist's practice, or
postponing future appointments or that give scheduling preference to an
individual, class or group.
(14)
Penalizing a dentist for reporting violations of a law regulating the practice
of dentistry.
(15) Conditioning the
payment of fees to a dentist or the amount of management fees a dentist must
pay, on the referral of patients to other health care providers specified by a
non-dentist.
(c) The
entry into one or more of the following agreements by a dentist shall not be
presumed to have violated the Texas Dental Practice Act, Section 251.003.
(1) Leases, mortgages, ownership agreements
or other arrangements regarding use of space for dental offices, based on a
set, non percentage fee reasonably related to the fair market value of the
office space provided at the time the lease or other arrangement is entered
into.
(2) Agreements regarding the
purchase, sale, financing or lease of dental equipment, instruments and
supplies so long as the dentist maintains the complete care, custody, and
control of the dental instruments and supplies and the lease does not provide
for a payment or fee based upon a percentage of the revenue received by the
dentist, or the dental practice.
(3) Agreements providing for accounting,
bookkeeping, investment or similar financial services.
(4) The financing, lease, use or ownership of
non-dentist business equipment such as telephones, computers, software, and
general office equipment at reasonable, market related fees.
(5) Services regarding the pledge, collection
or sale of accounts receivable from patients.
(6) Agreements regarding billing and
collection services.
(7)
Advertising and marketing services so long as the dentist remains solely
responsible for the content of any advertising or marketing services and for
ensuring that such conform to all applicable legal requirements.
(8) Agreements regarding consulting,
professional development, business practices and other advisory agreements
which do not limit the dentist's ability to use the dentist's independent
professional judgment regarding the diagnosis or treatment of any dental
disease, disorder or physical condition.
(9) Employment agreements which specify that
the dentist shall continue to have the right to use the dentist's independent
professional judgment regarding the diagnosis or treatment of any dental
disease, disorder or physical condition, provided that in practice the dentist
is allowed to use the dentist's professional judgment.
(d) The provisions of subsection (c) of this
section herein may be rebutted and the entry into these agreements or other
undertakings may be found to be in violation of the Dental Practice Act if it
can be shown that the agreements or other undertakings result in the control,
attempt to control, influence, attempt to influence or otherwise interfere with
the exercise of a dentist's independent professional judgment regarding the
diagnosis or treatment of any dental disease, disorder or physical
condition.
(e) This rule shall not
be applicable to dentists or others covered by the Dental Practice Act, Section
251.004, entitled Exceptions, Section 260.001, regarding administration of an
estate and continuation of practice nor Sections 260.002 through 260.004,
regarding employment of dentists.
Notes
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