Modifies the law governing investigations and hearings conducted by the State Dental Board and licensure of audiologists and speech-language pathologists, and makes other changes related to administrative adjudication, and Medicaid claims for Medicare cost-sharing expenses
State Fiscal Highlights
· The State Dental Board may experience an increase in costs to comply with certain provisions of the bill as they relate to changes in the Board's investigation and hearing processes and license renewal procedures. The Board may experience a gain in revenue generated from several sources: the license renewal late fee, the increased license reinstatement fee, and allowable charges for copies of investigative materials when an individual has been notified of an opportunity for a hearing.
· The Board of Speech-Language Pathology and Audiology may experience an increase in costs to license those persons who do not hold a doctor of audiology degree, to process applications to inactivate a license, and to adopt rules regarding inactive licenses. Costs may be partially offset if the Board experiences a gain in revenue from charging a fee for classifying a license as inactive.
Local Fiscal Highlights
· No direct fiscal effect on political subdivisions.
Detailed Fiscal Analysis
State Dental Board investigatory and disciplinary changes
Vice-secretary of the State Dental Board
The bill creates the position of vice-secretary, requiring the Board to elect a secretary and vice-secretary from among its members who are dentists. Current law provides for the secretary to be reimbursed for necessary expenses incurred in the discharge of official duties and the bill applies this provision to the vice-secretary as well. The only costs to the Board would be if the vice-secretary receives reimbursement above what the person already receives as a board member due to being elected to the newly created position.
Supervisory investigative panels
The bill requires the State Dental Board to create a supervisory investigative panel, consisting solely of the Board's secretary and vice-secretary, to oversee all investigations conducted by the Board. The panel is responsible for making recommendations pertaining to the disposition of each investigation within a specified time frame if the alleged violation involves a license or certificate holder providing, or allowing subordinate dental professionals to provide, dental care that does not meet accepted standards for the profession. The bill prohibits the investigatory panel members from participating in any deliberations of the case after a recommendation has been made.
According to the Executive Director of the Dental Board, investigation oversight is currently managed by a board member who spends about 20 hours a week performing this duty and is assisted by another board member, both of whom are paid an hourly rate to perform this function. The Board may experience a minimal increase in administrative costs to create and manage the panel.
The bill requires the Board to appoint three referees or examiners who are attorneys at law who have been admitted to the practice of law in this state who are not Board members and do not otherwise represent the Board. The bill specifies that appointments are for one year and sets term limits for appointees. The referees or examiners are to oversee all of the Board's disciplinary hearings and deliberations. The bill requires that the referees or examiners be assigned to hearings at random without regard to experience or background. Currently, the Board contracts with two hearing examiners for oversight of all disciplinary hearings and deliberations. At the beginning of each fiscal year, the Board enters into personal service contracts for up to $5,000 with each of the hearing examiners, to be paid at a rate of $75 per hour. To comply with this provision of the bill, the Board will likely enter into a contract with an additional hearing examiner. The total costs paid by the Board for hearing examiners is unlikely to change; costs will be divided among the three appointees required under the bill instead of between the two hearing examiners currently under contract.
Currently, board proceedings relative to an investigation or the determination of whether reasonable grounds exist to believe that a violation has occurred are confidential and not subject to discovery. If the Board has notified an individual of an opportunity for a hearing, the bill requires the Board to provide one copy of each item that the Board procures or creates in the course of an investigation of an individual, to the individual at a reasonable cost. These items may include, but are not limited to, complaints filed with the Board; correspondence, reports, and statements; deposition transcripts; and patient dental records. The bill further requires the Board to redact any personal identifying information that may be contained within such documents prior to disclosure.
According to the Board's Executive Director, there are between 75 and 100 charges filed each year and each person who is charged with a violation is notified of an opportunity for a hearing. The Board currently provides individuals who have been charged with a violation a copy of any information in the investigative file that specifically pertains to the charge against them. The Board will likely experience a minimal increase in costs to prepare documents by redacting personal information and to provide the entire patient record or file to each individual as required by the bill. However, these costs may be partially offset by a minimal gain in revenue if the Board charges individuals for copies of the investigative materials, as allowed under the bill.
Current law permits the Board to issue subpoenas for the purposes of an investigation. The bill modifies the Board's subpoena authority by requiring all subpoenas to be authorized by the supervisory investigatory panel. Prior to authorizing a subpoena, the bill requires the panel to first consult with the Office of the Attorney General to determine whether there is probable cause to believe that the complaint filed alleges a violation of state law or administrative rules governing the practice of dentistry and that the information sought pursuant to the subpoena is relevant to the alleged violation and material to the investigation. The Board already utilizes the Office of the Attorney General for legal representation services, including reviewing each case to determine whether probable cause exists to proceed with an investigation. Therefore, this provision is not likely to create additional costs for the Office of the Attorney General or the Board.
Under current law, once a subpoena has been authorized and issued, the Board is required to notify the individual of an opportunity for a hearing prior to issuing an order. After the Board notifies an individual of an opportunity for a hearing, the individual may ask the Board to issue a subpoena for the testimony of witnesses and the production of certain tangible items for purposes of the hearing. On receipt of the request, the Board is required to issue the subpoena. The Board currently issues such subpoenas and should therefore not experience any increase in costs.
Quality Intervention Program
The bill permits, rather than requires as under current law, the Board to develop and implement the Quality Intervention Program. If the Board decides to develop and implement the program, the bill requires that the Board elect, from its members who are dentists, a coordinator to administer the program and requires that educational and assessment service providers for participants be selected by a concurrence of a majority of the Board's members. The bill also limits required participation in the program to 180 days, and limits additional monitoring or other action taken by the Board to a one‑year period following the licensee's agreement to participate in the program. The Board may incur additional costs to have a board member serve as the coordinator and administrator of the program.
The bill removes a provision requiring the automatic suspension of a dentist's license for failing to renew registration or submit evidence of completed continuing education credits and instead requires the Board to create a notification process whereby dentists would be notified, by certified mail, and given a four-month grace period prior to any disciplinary action. During the grace period, licensees would be considered to be in good standing, provided the dentist or hygienist remains in compliance with all other applicable rules and provisions. When filing a late renewal application, the dentist must pay the biennial registration fee and a $100 fee to cover the cost of late renewal.
If a dentist fails to renew within the four-month grace period, the Board may initiate disciplinary action, including license suspension. Under continuing law, if a dentist's license is suspended, it may be reinstated with payment of the biennial registration fee and an additional fee to cover the cost of reinstatement. The bill increases the additional fee for reinstatement of a suspended license from $81 to $300.
The Board could incur additional costs with the creation
and implementation of the notification process for licensees and certificate
holders that do not renew a license or certificate prior to disciplinary
action. However, these costs may be partially offset by a reduction in
administrative costs for not having to automatically suspend and then reinstate
a license and by the gain in late fee and reinstatement fee revenue. The Board
may also incur additional administrative costs to insure compliance with the
increased continuing education requirement among dental hygienists.
Audiologists and speech-language pathologists
The bill reauthorizes certain persons to obtain an audiologist license without holding a doctor of audiology degree. The bill also permits a licensed speech-language pathologist or audiologist to apply to the Board of Speech-Language Pathology and Audiology to have their license classified as inactive. The Board may charge a fee for classifying a license as inactive. The bill authorizes the Board to adopt rules as necessary for classifying a license inactive.
These provisions may increase costs to the Board to license those persons who do not hold a doctor of audiology degree, to process applications to place a license on inactive status, and to adopt rules regarding inactive licenses. Costs may be partially offset if the Board experiences a gain in revenue from charging a fee for classifying a license as inactive.
Appeal of an administrative adjudication order
Currently, an individual desiring to appeal an administrative adjudication order must file a notice of appeal with the agency that issued the order and the appropriate county court of common pleas that states the grounds of the individual's appeal. The bill modifies the requirement that the notice contain the specific grounds of appeal and instead requires only that the notice state that the agency's order is not supported by reliable, probative, and substantial evidence and is not in accordance with the law. The bill states that this provision is to be applied retrospectively to all applicable appeals filed before the bill's effective date but not earlier than May 7, 2009. This provision modifies the content that an appellant must include in a notice of appeal and is therefore unlikely to affect costs for county courts of common pleas or state agencies that issue administrative adjudication orders.
The bill provides that a nursing facility provider is not required to bill Medicaid for the Medicare cost-sharing expenses of a resident of the nursing facility who is eligible to have the Medicaid Program pay for a part of the expenses if the provider determines that the nursing facility would not receive a Medicaid payment for any part of the expenses. In such a situation, the claim for the Medicare cost-sharing expenses is to be considered to have been adjudicated at no payment. This provision could reduce the state Medicaid Program's and nursing facilities' administration workloads by simplifying the billing process.
 The provision requiring that the secretary be a dentist does not apply to the current secretary of the Board. The current secretary will be permitted to serve out the term.
 This is the date the Supreme Court of Ohio released its opinion and judgment in Medcorp, Inc. v. Ohio Dep't of Job and Family Servs. (2009), 121 Ohio St.3d 622.