SB 5322

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by Senate Committee On:

Health Care, February 16, 2017

Title: An act relating to patient safeguards in agreements between dentists and third parties that provide support services to dentists.

Brief Description: Concerning agreements between dentists and third parties that provide supportive services to dentists.

Sponsors: Senators King, Frockt, Miloscia, Conway, Hobbs and Becker.

Brief History:

Committee Activity: Health Care: 1/30/17, 2/16/17 [DPS].

Brief Summary of Substitute Bill

  • Authorizes persons not licensed to practice dentistry in Washington to own or lease assets of a dental practice, employ or contract for the services of non-dental professionals, provide business support services to a dental practice, and receive associated fees.

  • Reinforces that persons not licensed to practice dentistry are subject to enforcement under the Uniform Disciplinary Act for practicing dentistry without a license.


Majority Report: That Substitute Senate Bill No. 5322 be substituted therefor, and the substitute bill do pass.

Signed by Senators Rivers, Chair; Becker, Vice Chair; Cleveland, Ranking Minority Member; Kuderer, Assistant Ranking Minority Member; Bailey, Baumgartner, Conway, Fain, Keiser, Miloscia, Mullet, O'Ban and Walsh.

Staff: Evan Klein (786-7483)

Background: Practice of Dentistry. Dentists are licensed and regulated in Washington by the Dental Quality Assurance Commission (DQAC). The practice of dentistry is defined as:

Corporations are prohibited from practicing dentistry or soliciting dental patronage for dentists employed by a corporation. This restriction does not apply to corporations or associations that furnish information or clerical services to a licensed dentist, so long as the information or services can be furnished by unlicensed persons and the dentist assumes full responsibility for the information and services.

Summary of Bill (First Substitute): Persons not licensed to practice dentistry may:

Persons not licensed to practice dentistry are subject to enforcement under the Uniform Disciplinary Act, if they are found to be practicing dentistry without a license.

Communications of complaints or information to a state agency relating to a violation of the Dental Practice Act are covered by whistleblower protections.


Appropriation: None.

Fiscal Note: Available.

Creates Committee/Commission/Task Force that includes Legislative members: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony on Original Bill: The committee recommended a different version of the bill than what was heard. PRO: This bill does allow dentists to contract with DSOs, but includes necessary patient safeguards. It is the role of government to protect its citizens. This bill will prevent large DSO settlements that have entered into in many other states. This bill requires a DSO agreement to be set in two parts to protect the patients of Washington, by allowing dentists to leave a services agreement while maintaining the office space to see their patients. This bill is the least restrictive option brought forward while still protecting patient safety. The dental quality assurance commission has opposed the alternative DSO measure, but does not oppose this bill. This bill protects patients from overzealous practices. The DSO model hides from state authorities the fact that a dentist may be the owner in name only, with no control over the dental practice. A federal report in 2013 stated that profits were coming before patient care in the DSO model. This bill does not keep DSOs out of the state, but allows them to operate in Washington with patient safety in mind. This bill is a collaborative compromise to seek clarity in the dental statutes.

CON: This bill does not modernize the dental practice act. This bill will increase costs, impose inappropriate regulatory requirements, and hurt current models operating in Washington. Current law still requires a dentist and only a dentist to provide dental services and does not allow interference in a dentist's judgement. This bill stands for the notion that corporations can influence and overwhelm dentists. The DQAC currently has broad authority to hold dentists accountable under the dental practice act. This bill is not about patient protections, it is about controlling contractual relationships between business entities. The DSO agreements are no different from other contracts entered into by health care providers. Why does the bill cap agreements at five years? The prohibition of having a lease for equipment and service agreement with the same party effectively shuts down the DSO model. Patient safety should be foremost and there should be no influence over a dentist's clinical judgement through quotas or payment models. However, these concerns should be addressed across all practice settings and all practice models, not just with DSOs.

Persons Testifying: PRO: Senator Curtis King, Prime Sponsor; Trent House, Washington State Dental Association; Debra Enneking, dentist; Emily Studebaker, Hall Render; Brady McDonald, dentist. CON: Melissa Johnson, Willamette Dental Group; Cliff Webster, Association of Dental Support Organizations; Lisa Thatcher, Association of Dental Support Organizations.

Persons Signed In To Testify But Not Testifying: No one.