WSR 18-12-036 PROPOSED RULES DEPARTMENT OF HEALTH [Filed May 29, 2018, 1:34 p.m.] Original Notice. Preproposal statement of inquiry was filed as WSR 15-21-046. Title of Rule and Other Identifying Information: Chapter 246-814 WAC, Access to dental care for children, the department of health (department) proposes rule revisions that will clarify and modernize standards regarding the provision of dental cleaning and sealants to at-risk children in school-based and school-linked settings by dental hygienists and assistants. Hearing Location(s): On July 13, 2018, at 1:00 p.m, at the Department of Health, Town Center Two, Room 158, 111 Israel Road S.E., Tumwater, WA 98501. Date of Intended Adoption: August 13, 2018. Submit Written Comments to: Bruce Bronoske, Jr., Washington State Department of Health, P.O. Box 47852, Olympia, WA 98504-7852, email https://fortress.wa.gov/doh/policyreview, fax 360-236-4901, by July 13, 2018. Assistance for Persons with Disabilities: Contact Bruce Bronoske, Jr., phone 360-236-4843, fax 360-236-4901, TTY 360-833-6388 or 711, email bruce.bronoske@doh.wa.gov, by July 6, 2018. Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed changes will update and clarify the types of sites where sealant/varnish care is provided by dental hygienists and dental assistants to increase access to dental care for at-risk, rural, and low-income children in Washington. These sites include school-based settings and clinical settings associated with a school. The changes will bring the present language up-to-date with current dental hygiene techniques and will delete obsolete or unnecessary language. Reasons Supporting Proposal: The department opened chapter 246-814 WAC to revise the rules so they are clear, concise, and reflect current dental hygiene practices. This revision is part of [a] five year rule review conducted consistent with RCW 43.70.041. Specifically, the department is proposing changes to rules that regulate the department sealant/varnish guidelines which will increase access to dental cleanings and sealants for at-risk children in school-based and school-linked settings through the Access to Dental Care for Children Act. Rule is not necessitated by federal law, federal or state court decision. Name of Proponent: Department of health, governmental. Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Bruce Bronoske, Jr., 111 Israel Road S.E., Tumwater, WA 98501, 360-236-4843. A school district fiscal impact statement is not required under RCW 28A.305.135. A cost-benefit analysis is not required under RCW 34.05.328. The agency did not complete a cost-benefit analysis under RCW 34.05.328. RCW 34.05.328 (5)(b)(iv) exempts rules that only correct typographical errors, make address or name changes or clarify the language of a rule without changing its effect. This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal: Is exempt under RCW 19.85.025(3) as the rules only correct typographical errors, make address or name changes, or clarify language of a rule without changing its effect. May 29, 2018 John Wiesman, DrPH, MPH Secretary
AMENDATORY SECTION (Amending WSR 02-21-128, filed 10/23/02, effective 11/23/02)
WAC 246-814-010 Purpose.
The purpose of this chapter is to implement RCW 18.29.220 and 18.32.226. These laws are intended to improve access to dental care for low-income, rural, and other at-risk children by enhancing the authority of dental hygienists and dental assistants to provide dental sealant and fluoride varnish treatments in school-based and school-linked programs. The department ((of health)) encourages partnerships within geographical regions and among participants in the oral health care community in implementing this law.
NEW SECTION
WAC 246-814-015 Definitions.
The definitions of this section apply throughout this chapter unless the context clearly indicates otherwise:
(1) "Department" means the Washington state department of health.
(2) "School-based program" means a program that is conducted entirely in the school setting.
(3) "School-linked program" means a program that may be conducted in both the school and clinical settings associated with the school.
AMENDATORY SECTION (Amending WSR 02-21-128, filed 10/23/02, effective 11/23/02)
WAC 246-814-020 Practices authorized.
(1) Dental hygienists. Solely for purposes of providing services under this chapter, dental hygienists holding endorsements under this chapter may assess by determining the need for (i.e., the absence of gross carious lesions and sealants) and acceptability of dental sealant ((and/or)) or fluoride varnish treatment for children in school-based and school-linked programs ((and)). Dental hygienists may apply dental sealants and fluoride varnish treatments and may remove deposits and stains from the surfaces of teeth, without the supervision of a licensed dentist. This determination does not include or involve diagnosing conditions or constitute a dental examination.
(2) Dental assistants. A dental assistant is currently defined ((by the Dental Quality Assurance Commission in WAC 246-817-510 as an unlicensed person working under the close supervision of a licensed dentist)) in RCW 18.260.010 as a person who is registered by the dental quality assurance commission to provide supportive services to a licensed dentist to the extent provided in chapter 18.260 RCW and under the close supervision of a dentist. Solely for purposes of this chapter, authorized dental assistants may apply dental sealants and fluoride varnish treatments to children in school-based and school-linked programs under the general supervision of a Washington state licensed dentist, as described in this chapter.
(a) Close supervision requires the ((licensed)) supervising dentist to first determine the need for and acceptability of dental sealant and fluoride varnish treatments, refer the treatment and the dentist ((must be)) is continuously on-site and physically present in the treatment facility when the treatment is provided.
(b) General supervision requires the ((licensed)) supervising dentist to first determine the need for and acceptability of dental sealant and fluoride varnish treatments, refer the treatment and the dentist does not have to be in the treatment facility when the treatment is provided.
AMENDATORY SECTION (Amending WSR 02-21-128, filed 10/23/02, effective 11/23/02)
WAC 246-814-030 Application process and documentation of training required to qualify for endorsement.
(1) The department ((of health)) has issued endorsements to all dental hygienists holding valid licenses on or before April 19, 2001, the effective date of RCW 18.29.220.
(2) Dental hygienists licensed after April 19, 2001, must obtain an endorsement to provide services under this chapter. Applicants must meet the additional requirements in RCW 18.29.220 and must submit the following to the department:
(a) Application for endorsement;
(b) Fee;
(c) Information of having a valid Washington state dental hygiene license for reference; and
(d) Proof of the completion of training that has incorporated the Washington state department of health sealant/fluoride varnish program guidelines as described in WAC 246-814-040(3).
(3) Dental assistants employed by a Washington state licensed dentist on or before April 19, 2001, are not required to obtain an endorsement but may voluntarily do so without having to meet the additional requirements in RCW 18.32.226.
(4) Dental assistants employed by a Washington state licensed dentist for two hundred hours after April 19, 2001, must obtain an endorsement to provide services under this chapter. Applicants must meet the additional requirements in RCW 18.32.226 and must submit the following to the department:
(a) Application for endorsement;
(b) Fee;
(c) Proof of two hundred hours of employment as a dental assistant by a Washington state licensed dentist that has included theoretical and clinical training in the application of dental sealants and fluoride varnish treatments, verified by a declaration provided by the licensed dentist who provided the training; and
(d) Proof of completion of training that has incorporated the Washington state department of health sealant/fluoride varnish program guidelines as described in WAC 246-814-040(3).
(5) Dental assistants and their supervising dentists, as well as dental hygienists should use the Washington state department of health sealant/fluoride varnish guidelines described in WAC 246-814-040 and other protocols that may be in place for the geographic region when coordinating with local public health jurisdictions. ((To assist the local public health jurisdictions and the practitioners in coordinating these services, a "letter of understanding" is recommended and would provide a means to address mutual concerns. It may include, but is not limited to:
(a) Data collection requirements;
(b) Delineation of responsibilities of the treatment providers and the local public health jurisdictions;
(c) Quality assurance mechanisms; and
(d) Communication with schools being served.))
(6) Dental assistants and their supervising dentists, as well as dental hygienists shall coordinate with ((the)) established local oral health coalitions by participating in oral health coalition meetings that may be held in the geographical region.
AMENDATORY SECTION (Amending WSR 02-21-128, filed 10/23/02, effective 11/23/02)
WAC 246-814-040 Training and the provision of services.
(1) The "Washington state department of health sealant/fluoride varnish program guidelines" (sealant/fluoride varnish program guidelines) have been developed, maintained and distributed by the department ((of health)) in partnership with the oral health community and health care practitioners. To obtain copies of the (("guidelines")) sealant/fluoride varnish program guidelines contact the department ((of health)).
(2) The ((Washington state department of health)) sealant/fluoride varnish program guidelines are designed to assist the local public health jurisdictions and oral health care communities in the planning, implementation, and evaluation of school-based dental sealant and fluoride varnish programs. Every school-based dental sealant and fluoride varnish program should design their program to provide, at minimum, for the following:
(a) Assessing and targeting the population.
(b) Establishing community capacity and infrastructure.
(c) Determining staffing needs and training.
(d) Securing equipment and supplies.
(e) Developing policies, procedures and data collection forms.
(f) Scheduling schools/sites.
(g) Preparing sites for implementation.
(h) Providing services.
(i) Evaluating the process and outcomes.
(3) The ((Washington state department of health)) sealant/fluoride varnish program guidelines also provides the training required for dental hygienists and dental assistants providing services under this chapter. Applicants for endorsement must obtain training as contained in these specific guidelines, which can be met through any one of the following methods:
(a) Graduation from a dental assisting, dental hygiene or dental educational program, accredited by the ((American Dental Association)) commission on dental accreditation (CODA), which has incorporated the ((Washington state department of health)) sealant/fluoride varnish program guidelines.
(b) Continuing education courses which teach the ((Washington state department of health)) sealant/fluoride varnish program guidelines.
(c) Individual training provided by a Washington licensed dentist, which has incorporated the ((Washington state department of health)) sealant/fluoride varnish program guidelines.
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