    OCCUPATIONS CODE
    TITLE 3. HEALTH PROFESSIONS
    SUBTITLE D. DENTISTRY
    CHAPTER 256. LICENSING OF DENTISTS AND DENTAL HYGIENISTS
    SUBCHAPTER A. ISSUANCE OF LICENSE TO PRACTICE DENTISTRY
    Sec. 256.001.  LICENSE REQUIRED.  A person may not practice or offer to practice dentistry or dental surgery or represent that the person practices dentistry unless the person holds a license issued by the board.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    Sec. 256.002.  MINIMUM QUALIFICATIONS OF DENTAL APPLICANT.(a)  An applicant for a license to practice dentistry must:(1)  be at least 21 years of age; and(2)  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.(b)  The board shall grant a dental license to an applicant who:(1)  meets the qualifications of this section;(2)  pays an application fee set by the board;  and(3)  satisfactorily passes the examination required by the board.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.079(a), eff. Sept. 1, 2001.Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 9, eff. September 1, 2017.

    Sec. 256.003.  EXAMINATION.  (a)  The board shall provide for the examination of an applicant for a dental license.(b)  The examination must consist of subjects and operations relating to dentistry, including:(1)  anatomy;(2)  physiology;(3)  anaesthesia;(4)  biochemistry;(5)  dental materials;(6)  diagnosis;(7)  treatment planning;(8)  ethics;(9)  jurisprudence;(10)  hygiene;(11)  pharmacology;(12)  operative dentistry;(13)  oral surgery;(14)  orthodontia;(15)  periodontia;(16)  prosthetic dentistry;(17)  pathology;(18)  microbiology;  and(19)  any other subject regularly taught in reputable dental schools that the board may require.(c)  The board shall contract with one or more independent or regional testing services for any required clinical examination.  If the board uses one or more regional testing services, the board may contract for or otherwise use licensed dentists to provide assistance to the regional testing service or services.(d)  The board shall have the written portion of the board's jurisprudence examination validated by an independent testing professional.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1249, Sec. 2, eff. Sept. 1, 2001;  Acts 2001, 77th Leg., ch. 1420, Sec. 14.079(b), eff. Sept. 1, 2001.

    Sec. 256.005.  EXAMINATION RESULTS.  (a)  The board shall notify each examinee of the results of the examination not later than the 30th day after the date the examination is administered.  If an examination is graded or reviewed by a national testing service, the board shall notify examinees of the results of the examination not later than the 14th day after the date the board receives the results from the testing service.(b)  If the notice of the examination results graded or reviewed by a national testing service will be delayed for longer than 90 days after the examination date, the board shall notify the examinee of the reason for the delay before the 90th day.(c)  If requested in writing by a person who fails the examination, the board shall provide to the person an analysis of the person's performance on the examination as prescribed by board rule.(d)  If the board contracts with an independent or regional testing service, this section does not apply.  The contract with the testing service must provide for the notification of results as provided by Subsection (a).
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.079(c), eff. Sept. 1, 2001.

    Sec. 256.006.  REEXAMINATION.  (a)  The board by rule shall establish the conditions under which and the number of times an applicant may retake an examination.(b)  The board may require an applicant who fails the examination to meet additional education requirements.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    SUBCHAPTER B. ISSUANCE OF LICENSE TO DENTAL HYGIENIST
    Sec. 256.051.  DEFINITION.  In this chapter, "dental hygienist" means a person who practices dental hygiene under a license issued under this chapter.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    Sec. 256.052.  LICENSE REQUIRED.  A person may not practice or offer to practice dental hygiene in this state unless the person is licensed under this chapter.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    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)  a graduate of an accredited high school or hold a certificate of high school equivalency; and(3)  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) must include at least two full academic years of instruction or its equivalent at the postsecondary level.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.080(a), eff. Sept. 1, 2001;  Acts 2001, 77th Leg., ch. 1470, Sec. 3.01, eff. Sept. 1, 2001.Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 10, eff. September 1, 2017.

    Sec. 256.0531.  ALTERNATIVE DENTAL HYGIENE TRAINING PROGRAMS.  (a)  It is the intent of the legislature that programs approved by the board under this section provide hygiene training that is substantially equivalent to training provided under traditional programs.(b)  An alternative dental hygiene training program must meet the following requirements:(1)  the program must be determined to be eligible for accreditation by the Commission on Dental Accreditation of the American Dental Association before students can enroll in the program;(2)  the program must require hygiene students to complete four semesters of didactic education from a school of dentistry, dental hygiene school, or other educational institution approved by the board;(3)  didactic education shall be provided by instruction in the classroom or by distance learning, remote coursework, or similar modes of instruction offered by an institution accredited by the Commission on Dental Accreditation of the American Dental Association;(4)  didactic education shall include instruction in anatomy, pharmacology, x-ray, ethics, jurisprudence, hygiene, and any other subject regularly taught in reputable schools of dentistry and dental hygiene that the board may require;(5)  the program must require hygiene students to complete not less than 1,000 hours of clinical training under the direct supervision of a dentist qualified under Subsection (d) or a dental hygienist qualified under Subsection (f) during a 12-month period.  Students must satisfactorily complete 75 full-mouth prophylaxes and demonstrate the ability to accurately record the location and extent of dental restorations, chart mobility, furcations, gingival recession, keratinized gingiva, and pocket depth on six aspects of each tooth;  and(6)  clinical training may occur simultaneously with didactic education.(c)  Prior to commencing training, a hygiene student must have completed no less than two years of full-time employment in a position involving clinical duties with dental patients.(d)  To be qualified to train a hygiene student under this section, a dentist must:(1)  be licensed in Texas and have practiced in Texas for at least five years;(2)  have completed a certification or calibration course approved by the board for purposes of this section;(3)  meet recertification requirements at intervals of no more than three years;(4)  also practice in a dental office located outside a standard metropolitan statistical area, as defined by the United States Census Bureau, or practice in an area that the Texas Department of Health has determined is underserved or an area that has been designated by the United States as having a shortage of dental professionals;  and(5)  have posted a notice visible to patients stating:  "This practice has been approved as an alternative dental hygiene training program.  Students in the program may be performing services."(e)  A hygiene student who completes the requirements of a program under this section must satisfactorily pass the examination required for all hygiene license applicants under this chapter.(f)  A dental hygienist may train hygiene students under this section if:(1)  the dental hygienist is employed by a dentist who provides training under this section and the hygienist works under the direct supervision of the dentist in the same office as the dentist;(2)  the dental hygienist has practiced full-time dental hygiene for the five years immediately preceding the time the training is provided;  and(3)  the dental hygienist has completed a certification or calibration course approved by the board and meets recertification requirements at intervals of no more than five years.(g)  A dentist who supervises a dental hygienist trained under this section has the same liability for acts performed by the hygienist as if the hygienist were trained in a different manner.(h)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(1), eff. September 1, 2017.(i)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(1), eff. September 1, 2017.(j)  Repealed by Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(1), eff. September 1, 2017.(k)  A student in an alternative dental hygiene training program is not considered to be practicing dentistry as described by Section 251.003.(l)  The board shall adopt rules requiring the dentist to give written notice to patients, where applicable, that services will be performed by a student in an alternative dental hygiene training program, and requiring the dentist or the dentist's staff to give oral notice to patients, where applicable, at the time the patient's hygiene appointment is made or confirmed, that services will be performed by a student in an alternative dental hygiene training program.(m)  The board may adopt rules necessary to implement this section.  The board shall adopt a rule requiring notification to dental hygiene students that accreditation of the alternative dental hygiene training program is a requirement for obtaining a license under this chapter.
    Added by Acts 2001, 77th Leg., ch. 1470, Sec. 3.02, eff. Sept. 1, 2001.Amended by: Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(1), eff. September 1, 2017.

    Sec. 256.054.  APPLICATION FOR EXAMINATION.  To take the examination under Section 256.055, an applicant for a license must:(1)  submit an application on a form prescribed by the board;(2)  pay the application fee set by the board;(3)  attach to the application:(A)  proof of current certification in cardiopulmonary resuscitation approved by the American Heart Association or American Red Cross;  or(B)  if the applicant is not physically able to comply with the certification requirements of Paragraph (A), a written statement describing the person's physical incapacity executed by a licensed physician or an instructor in cardiopulmonary resuscitation approved by the American Heart Association or American Red Cross;  and(4)  provide any other information the board requires to determine the applicant's qualifications.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.081(a), eff. Sept. 1, 2001.

    Sec. 256.055.  LICENSE EXAMINATION.  (a)  The board shall provide for the examination of an applicant for a dental hygienist license.(b)  The examination must include subjects and operations relating to dentistry and dental hygiene, including:(1)  anatomy;(2)  pharmacology;(3)  x-ray;(4)  ethics;(5)  jurisprudence;(6)  hygiene;(7)  dental hygiene treatment planning;(8)  dental materials;(9)  physiology;(10)  pathology;(11)  microbiology;  and(12)  any other subject regularly taught in reputable schools of dentistry and dental hygiene that the board may require.(c)  The board shall contract with one or more independent or regional testing services for any required clinical examination.  If the board uses one or more regional testing services, the board may contract for or otherwise use licensed dental hygienists to provide assistance to the regional testing service or services.(d)  The board shall have the written portion of the board's jurisprudence examination validated by an independent testing professional.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1249, Sec. 3, eff. Sept. 1, 2001;  Acts 2001, 77th Leg., ch. 1420, Sec. 14.081(b), eff. Sept. 1, 2001.

    Sec. 256.056.  EXAMINATION RESULTS.  (a)  The board shall notify each examinee of the results of the examination within a reasonable time after the date of the examination.(b)  If the board contracts with an independent or regional testing service, the contract with the service must provide for the notification of results.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.081(c), eff. Sept. 1, 2001.

    Sec. 256.057.  REEXAMINATION.  (a)  The board by rule shall establish the conditions under which and the number of times an applicant may retake an examination.(b)  The board may require an applicant who fails the examination to meet additional education requirements set by the board.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    Sec. 256.058.  ISSUANCE OF LICENSE.  The board shall issue a license to practice dental hygiene to an applicant who has passed all phases of the examination.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    SUBCHAPTER C. GENERAL LICENSE PROVISIONS
    Sec. 256.101.  ISSUANCE OF LICENSE TO CERTAIN OUT-OF-STATE APPLICANTS.  (a)  The board shall issue a license to practice dentistry to a reputable dentist or a license to practice dental hygiene to a reputable dental hygienist who:(1)  pays the fee set by the board;(2)  is licensed in good standing as a dentist or dental hygienist in another state that has licensing requirements substantially equivalent to the requirements of this subtitle;(3)  has not been the subject of a final disciplinary action and is not the subject of a pending disciplinary action in any jurisdiction in which the dentist or dental hygienist is or has been licensed;(4)  has graduated from a dental or dental hygiene school accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the board under board rule;(5)  has passed a national or other examination relating to dentistry or dental hygiene and recognized by the board;(6)  has passed the board's jurisprudence examination;(7)  has submitted documentation of current cardiopulmonary resuscitation certification;(8)  has practiced dentistry or dental hygiene:(A)  for at least the three years preceding the date of application for a license under this section;  or(B)  as a dental educator at a dental school or dental hygiene school accredited by the Commission on Dental Accreditation of the American Dental Association for at least the five years preceding the date of application for a license under this section;(9)  has been endorsed by the board of dentistry in the jurisdiction in which the applicant practices at the time of application;  and(10)  meets any additional criteria established by board rule.(a-1)  The board by rule shall specify the circumstances under which the board may waive the requirement under Subsection (a)(8) that an applicant for a license under this section has been continuously engaged in the practice of dentistry or dental hygiene during the period required by that subsection if the applicant has engaged in the practice of dentistry or dental hygiene for a cumulative total of at least three years before the date of application for a license under this section.(b)  If the board does not complete the processing of an application under this section before the 181st day after the date all documentation and examination results required by this section have been received, the board shall issue a license to the applicant.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1249, Sec. 4, 5, eff. Sept. 1, 2001;  Acts 2003, 78th Leg., ch. 17, Sec. 13, eff. Sept. 1, 2003.

    Sec. 256.1013.  PROVISIONAL LICENSE.  (a)  The board may issue a provisional license to an applicant currently licensed in another jurisdiction who seeks a license in this state and who:(1)  has been licensed in good standing as a dentist or dental hygienist for at least two years in another jurisdiction that has licensing requirements substantially equivalent to the requirements of this subtitle;(2)  is 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;(3)  has passed a national or other examination recognized by the board relating to the practice of dentistry or dental hygiene, as appropriate;  and(4)  is sponsored by a person who holds an appropriate license under this subtitle and with whom the provisional license holder will practice during the time the person holds a provisional license.(b)  The board may waive the requirement of Subsection (a)(4) for an applicant if the board determines that compliance with that subdivision would be a hardship to the applicant.(c)  A provisional license is valid until the date the board approves or denies the provisional license holder's application for a license.  The board shall issue a license under this subtitle to the provisional license holder if:(1)  the provisional license holder is eligible to be licensed under Section 256.101;  or(2)  the provisional license holder passes the part of the examination under Section 256.003 or 256.055 that relates to the applicant's knowledge and understanding of the laws and rules relating to the practice of dentistry or dental hygiene, as appropriate, in this state and:(A)  the board verifies that the provisional license holder meets the academic and experience requirements for a license under this subtitle;  and(B)  the provisional license holder satisfies any other licensing requirements under this subtitle.(d)  The board must approve or deny a provisional license holder's application for a license not later than the 180th day after the date the provisional license is issued.  The board may extend the 180-day period if the results of an examination have not been received by the board before the end of that period.(e)  The board may establish a fee for provisional licenses in an amount reasonable and necessary to cover the cost of issuing the license.
    Added by Acts 2003, 78th Leg., ch. 17, Sec. 14, eff. Sept. 1, 2003.

    Sec. 256.1015.  TEMPORARY LICENSE.  (a)  The board, upon payment by the applicant of a fee set by the board, shall grant a temporary license to practice dentistry to any reputable dentist or a temporary license to practice dental hygiene to any reputable dental hygienist who:(1)  meets all requirements of Section 256.101 except those of Subsection (a)(8);  and(2)  is employed by a nonprofit corporation that accepts Medicaid reimbursement.(b)  A license granted under this section expires immediately when a licensee fails to meet the requirements of this section.
    Added by Acts 2001, 77th Leg., ch. 1470, Sec. 5.01, eff. Sept. 1, 2001.

    Sec. 256.1016.  TEMPORARY LICENSE FOR CHARITABLE PURPOSE.  (a) In this section, "voluntary charity care" has the meaning assigned by board rule under Section 256.102.(b)  The board shall grant a temporary license for a dentist whose practice consists only of voluntary charity care to a reputable dentist who meets the requirements of Sections 256.101(a)(3), (4), and (5) and who:(1)  ceased practicing dentistry in another state that the board has determined has licensing requirements that are substantially similar to the requirements of this state not more than two years before the date the dentist applies for a license under this section and was licensed in good standing at the time the dentist ceased practicing dentistry; or(2)  is currently licensed in another state that the board has determined has licensing requirements that are substantially similar to the requirements of this state.(c)  A dentist issued a license under this section shall:(1)  confine the dentist's practice to voluntary charity care;(2)  practice only in a geographic area specified by the license; and(3)  practice only for the period specified by the license.(d)  The board shall adopt rules as necessary to implement this section.(e)  The board shall take disciplinary action against a dentist licensed under this section for a violation of this subtitle or board rules in the same manner as against a dentist licensed under Subchapter A.
    Added by Acts 2013, 83rd Leg., R.S., Ch. 306 (H.B. 1491), Sec. 1, eff. June 14, 2013.

    Sec. 256.1017.  MILITARY LIMITED VOLUNTEER LICENSE.  (a)  The board shall adopt rules relating to the issuance of a military limited volunteer license under this section.(b)  The board may issue a military limited volunteer license to practice dentistry to a dentist or a military limited volunteer license to practice dental hygiene to a dental hygienist who:(1)  is licensed and in good standing, or was licensed and retired in good standing, as a dentist or dental hygienist in another state;(2)  is or was authorized as a dentist or dental hygienist to treat personnel enlisted in a branch of the United States armed forces or veterans; and(3)  meets any other requirement prescribed by board rule.(c)  The board may not issue a license under this section to an applicant who:(1)  holds a dental or dental hygienist license that:(A)  is currently under active investigation; or(B)  is or was subject to a disciplinary order or action or to denial by another jurisdiction;(2)  holds a license to prescribe, dispense, administer, supply, or sell a controlled substance that:(A)  is currently under active investigation; or(B)  is or was subject to a disciplinary order or action or to denial by another jurisdiction; or(3)  has been convicted of, is on deferred adjudication community supervision or deferred disposition for, or is under active investigation for the commission of:(A)  a felony; or(B)  a misdemeanor involving moral turpitude.(d)  A dentist or dental hygienist may practice dentistry or dental hygiene under a license issued under this section only at a clinic that primarily treats indigent patients.  The dentist or dental hygienist may not receive compensation for dental or dental hygiene services rendered at the clinic.(e)  A military limited volunteer license holder is subject to board rules, including rules regarding disciplinary action, license registration and renewal, and continuing education.
    Added by Acts 2017, 85th Leg., R.S., Ch. 270 (H.B. 2007), Sec. 1, eff. September 1, 2017.

    Sec. 256.102.  RETIRED STATUS.  (a)  The board by rule may allow a license holder to place the person's license on retired status.  A license holder must apply to the board for retired status, on a form prescribed by the board, before the expiration date of the person's license.(b)  In determining whether to grant retired status, the board shall consider the age, years of practice, and the status of the license holder at the time of the application.(c)  A license holder on retired status:(1)  is not required to pay license renewal fees; and(2)  except as provided by Subsection (f), may not perform any activity regulated under this subtitle.(d)  To reinstate a license placed on retired status, the license holder must submit a written request for reinstatement to the board.  The board may return the license to active status and issue a renewal license if the license holder complies with any education or other requirement established by board rule and pays the renewal fee in effect at the time of the requested reinstatement.(e)  The board may charge a reasonable administrative fee to cover the cost of research and the preparation of documentation for the board's consideration of a request for reinstatement of a license on retired status.(f)  A dentist on retired status may perform an activity regulated under this subtitle if the dentist's practice consists only of voluntary charity care, as defined by board rule.  The board's rules under this subsection must prescribe the scope of practice permitted for the retired dentist, the retired dentist's authority to prescribe and administer drugs, and any continuing education requirements applicable to the retired dentist.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.Amended by: Acts 2005, 79th Leg., Ch. 810 (S.B. 610), Sec. 3, eff. September 1, 2005.

    Sec. 256.103.  DISPLAY OF REGISTRATION CERTIFICATE.  (a)  A licensed dentist or dental hygienist shall display the person's current registration certificate in each office in which the person provides dental services. If the dentist or dental hygienist provides dental services 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.(b)  A licensed dentist may not operate on a patient's mouth or treat lesions of the mouth or teeth unless the dentist displays the dentist's registration certificate.(c)  A person may practice without displaying the person's current registration certificate as required by Subsection (a) for not more than 30 days after the date the person receives from the board written confirmation that the person's original license was issued.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1420, Sec. 14.083(a), eff. Sept. 1, 2001.Amended by: Acts 2005, 79th Leg., Ch. 810 (S.B. 610), Sec. 4, eff. September 1, 2005.Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 11, eff. September 1, 2017.

    Sec. 256.104.  DUPLICATE LICENSE.  (a)  The board may issue a duplicate license to a person whose license is lost or destroyed if the person:(1)  pays a reasonable fee;  and(2)  presents to the board an application for a duplicate license, including an affidavit explaining the loss or destruction and stating that the person is the same person originally granted the license.(b)  If board records do not show that the person was previously licensed, the board may refuse to issue a duplicate license.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.

    Sec. 256.105.  NOTIFICATION OF CHANGE OF INFORMATION.  (a)  Each dentist, dental hygienist, and owner or manager of a dental laboratory licensed or registered with the board shall timely notify the board of:(1)  any change of address of the person's place of business;(2)  any change of employers for the dentist or dental hygienist and any change of owners or managers for the dental laboratory; and(3)  any change of the person's mailing address.(b)  Notification under Subsection (a) is timely if the board receives the notice not later than the 60th day after the date the change occurs.
    Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1249, Sec. 6, eff. Sept. 1, 2001.Amended by: Acts 2009, 81st Leg., R.S., Ch. 772 (S.B. 887), Sec. 3, eff. September 1, 2009.

    Sec. 256.106.  DELEGATED AUTHORITY TO ISSUE LICENSES.  The board may delegate authority to board employees to issue licenses under this subtitle to applicants who clearly meet all licensing requirements.  If the board employees determine that the applicant does not clearly meet all licensing requirements, the application shall be returned to the board.  A license issued under this section does not require formal board approval.
    Added by Acts 2013, 83rd Leg., R.S., Ch. 709 (H.B. 3201), Sec. 7, eff. January 1, 2014.