Dental Client Rights and Complaint Management System

Loading...

Dental Client Rights

Dental providers enrolled in Texas Medicaid enter into a written contract with the Texas Department of State Health Services (DSHS) to uphold the following rights of the Medicaid client:

  • The right to receive dental services which meet or exceed the standards of care established by the laws relating to the practice of dentistry and the rules and regulations of the Texas State Board of Dental Examiners (TSBDE).
  • The right to receive information following a dental examination regarding the dental diagnosis; scope of proposed treatment, including alternatives and risks; anticipated results; and the need for administration of sedation or anesthesia, including risks.
  • The right to full participation in the development of the treatment plan and the process of giving informed consent.
  • The right to freedom from physical, mental, emotional, sexual, or verbal abuse or harm from the provider or his/her staff.
  • The right to freedom from overly aggressive treatment in excess of that required to address documented medical necessity.

A provider's failure to assure any of the client rights may result in termination of the provider agreement or contract, and other civil or criminal remedies.

Complaint Management System

Any Medicaid client or provider with a complaint about dental services is encouraged to contact the Medicaid Ombudsman with the Health and Human Services Commission (HHSC). Complaints from any source regarding services, providers (including office staff), clients, or program/administrative staff received by the Texas Health Steps Oral Health program are reviewed by the Oral Health program staff and referred, if necessary, to the appropriate agencies for investigation/disposition, i.e., the Texas State Board of Dental Examiners (TSBDE), the Office of Inspector General at the Health and Human Services Commission (HHSC), Provider Relations staff at the Medicaid fiscal agent, Texas Health Steps regional staff, and/or the DSHS Regional Dentists. Program staff do not investigate nor resolve complaints unless there are exceptional circumstances involved.

The complainant is notified in writing that their complaint has been received, and if appropriate, has been referred for further action. The complaints are documented and tracked via a database to monitor frequency, volume, and trends of complaints regarding each provider.

Last updated September 21, 2012