Brief Summary of Substitute Bill

Expands the circumstances under which a dental hygienist may practice without the direct supervision of a dentist.
Removes the expiration date from provisions relating to the unsupervised practice of dentistry in senior centers and the authorization of dental hygienists to remove deposits and stains from the surfaces of teeth in community-based sealant programs.
Provides an expiration date for reporting requirements relating to the practice of dental hygiene in senior centers and community-based sealant programs.
Requires the Secretary of Health to report information on patients receiving dental hygiene services in senior centers at community-based sealant programs.

Background:

Unsupervised Practice of Dental Hygiene.

A licensed dental hygienist is authorized to remove deposits and stains from the surfaces of teeth, apply topical preventative or prophylactic agents, polish and smooth restorations, perform root planning and soft-tissue curettage, and other dental operations and services delegated by a dentist. Generally speaking, a dental hygienist must be supervised by a dentist when performing these services.

One exception to this general rule is that a dental hygienist with two years of practical clinical experience within the last five years may provide dental hygiene operations and services without the supervision of a dentist when employed or retained by a health care facility, including a hospital, a nursing home, and a home health agency. Such a hygienist may only remove deposits and stains from the surfaces of teeth, apply topical preventative or prophylactic agents, polish and smooth restorations, and perform root planning and soft-tissue curettage.

Senior Centers.

In 2007 the definition of "health care facilities" for purposes of allowing the unsupervised practice of dental hygiene was temporarily expanded to include senior centers. For purposes of this expansion, "senior center" was defined as a multi-purpose community facility operated and maintained by a nonprofit organization or local government for the organization and provision of a broad spectrum of health, social, nutritional, and educational services and recreational activities for persons 60 years of age or older. When providing services in a senior center, the dental hygienist must:

enter into a written practice arrangement plan with a dentist who will provide off-site supervision;
obtain relevant information about the patient's health from the patient's primary care provider; and
collect data on the patients treated and provide the data to the Department of Health (DOH) each quarter.

The provisions authorizing a dental hygienist to provide dental hygiene without supervision in a senior center expire on July 1, 2009.

Community-Based Sealant Programs.

A licensed dental hygienist is authorized to assess for and apply sealants and fluoride varnishes for low-income, rural, and other at-risk populations in community-based sealant programs carried out in schools. A dental hygienist participating in a community-based sealant program must either have been licensed prior to April 19, 2001, or be school-sealant endorsed under the DOH's School Sealant Endorsement Program. In 2007 the services a dental hygienist is authorized to carry out in these programs were expanded to include removing stains from the surfaces of teeth. This expansion expires on July 1, 2009.

A dental hygienist providing services in a community-based sealant program must collect data on the patients treated under the program and provide the data to the DOH each quarter.

Summary of Substitute Bill:

Unsupervised Practice of Dental Hygiene.

The circumstances under which a dental hygienist with two years practical experience in the preceding five years may practice without the supervision of a dentist are expanded to include:

when a dental hygienist is contracted by a health care facility to provide dental hygiene operations and services; and
when a dental hygienist provides dental hygiene operations and services under a lease agreement with a health care facility.

Senior Centers.

The definition of "senior center" for purposes of allowing the unsupervised practice of dental hygiene is changed. Instead of a "broad spectrum" of health, social, nutritional, and educational services and recreational activities, the center must only provide a combination of some of these services.

The requirement of reporting patient data to the Department of Health (DOH) is terminated effective October 1, 2013.

The provisions that allow the unsupervised practice of dental hygiene in senior centers are made permanent; i.e., the expiration date is eliminated.

Community-Based Sealant Programs.

The requirement of reporting patient data to the DOH is terminated effective October 1, 2013.

The provisions that allow dental hygienists to remove deposits and stains from the surfaces of teeth in community-based sealant programs are made permanent; i.e., the expiration date is eliminated.

Department of Health Reporting.

The Secretary of Health must report to the Legislature information on patients receiving dental hygiene services in senior centers and community-based sealant programs by December 1, 2013.

Staff Summary of Public Testimony:

(In support) There is a great need for dental hygiene services in senior centers and in schools. Many seniors and children do not have access to regular dental care because of factors such as lack of insurance or finances. These programs increase access to dental hygiene services among underserved populations and do not cost the state any money. These programs help seniors get their smiles back and help children get the preventative services they need. Grant funding is available to fund these programs, but they are contingent upon the sunset being removed.

(Opposed) This program was acceptable when it was just a pilot, had reporting requirements, and was limited to a structured environment. This bill removes the sunset, removes the reporting requirements, broadens the program beyond seniors, and broadens the program beyond a structured environment.