S-1041

AN ACT Relating to denturitry; amending RCW 18.120.020; reenacting and amending RCW 18.130.040; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; adding a new chapter to Title 18 RCW; prescribing penalties; making an appropriation; providing an effective date; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that it is necessary to regulate the practice of denturitry to protect the public health, safety, and welfare. It is the legislature's intent that only individuals who meet and maintain minimum standards of competency and professional conduct may provide denturist service to the public.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Committee" means the state denturist advisory committee.

(2) "Denture" means any removable full or partial upper or lower prosthetic dental appliance to be worn in the mouth.

(3) "Denturist" means a person certified under this chapter to engage in the practice of denturitry.

(4) "Department" means the department of health.

(5) "Practice of denturitry" means the taking of impressions of needed x-rays, making, fitting, constructing, altering, reproducing, or repairing of a denture and furnishing or supplying of a denture directly to a person or advising the use of a denture, and maintaining a facility for the same: PROVIDED, That dentists or other persons may perform these services as authorized by law pursuant to section 6 of this act.

(6) "Secretary" means the secretary of health or the secretary's designee.

NEW SECTION. Sec. 3. (1) A denturist certified under this chapter may not:

(a) Extract or attempt to extract natural teeth;

(b) Initially insert immediate dentures after extraction in the mouth of the intended wearer;

(d) Recommend any prescription drugs for any oral or medical diseases;

(e) Construct or fit orthodontic appliances; or

(f) Surgically modify or attempt to surgically modify any natural tissue or teeth.

(2) The practice of denturitry under this chapter requires that all laboratory work except cast partial framework be performed at the address shown on the denturist's certificate. Violation of this section is punishable as a misdemeanor.

NEW SECTION. Sec. 4. (1) Prior to making and fitting a partial denture, a denturist shall:

(a) Refer the patient to dentist, with or without x-rays and study models, for exam of existing teeth, tooth cleaning and mouth preparation; and

(b) If tissue or tooth modification is needed, send a study model, clearly marked with needed modification, with patient to the dentist.

(2) A denturist who makes or fits a partial denture in a manner not consistent with this section is subject to the sanctions provided in chapter 18.130 RCW, the uniform disciplinary act.

NEW SECTION. Sec. 5. (1) Except as provided in section 6 of this act, a person shall hold a certificate for the practice of denturitry under this chapter in order to:

(a) Engage or offer to engage in the practice of denturitry; or

(b) Use in connection with his or her name the word "denturist" or any other words, letter, abbreviations, or insignia implying that the person is engaged in the practice of denturitry.

(2) No person, firm, or corporation may represent or hold himself or herself out to the public as a denturist or as practicing denturitry unless certified under this chapter.

NEW SECTION. Sec. 6. Nothing in this chapter may be construed to prohibit or restrict:

(1) The practice of a profession by individuals who are licensed, certified, or registered under other laws of this state and who are performing services within their authorized scope of practice;

(2) The practice of denturitry by an individual employed by the government of the United States while the individual is engaged in the performance of duties prescribed for him or her by the laws and regulations of the United States; or

(3) The practice of denturitry by students enrolled in a school approved by the department. The performance of services shall be pursuant to a course of instruction or assignment from an instructor and under the supervision of an instructor.

NEW SECTION. Sec. 7. (1) The state denturist advisory committee is created. The committee shall consist of five members appointed by the secretary as follows:

(a) Two members of the committee must have at least five years' experience preceding their appointment in the manufacture, fitting, installation, and repair of dentures in this state or in another state, or both, and shall be certified under this chapter, except initial denturist appointees, who shall have five years' experience, and have completed certain courses approved by the secretary.

(b) Two members shall be selected from persons who are not affiliated with any health care profession or facility, at least one of whom shall be over sixty-five years of age representing the elderly.

(2) The members of the committee shall serve for terms of three years. The terms of the initial members shall be staggered with the members appointed under subsection (1)(a) of this section serving two and three-year terms initially and the members appointed under subsection (1) (b) and (c) of this section serving one, two, and three-year terms initially. Vacancies shall be filled in the same manner as the original appointments, but appointments to fill vacancies shall be for the remainder of the unexpired term of the vacancies.

(3) No appointee may serve more than two consecutive terms.

(4) Members of the committee shall be reimbursed for travel expenses under RCW 43.03.050 and 43.03.060.

(5) A member may be removed for just cause by the secretary.

NEW SECTION. Sec. 8. (1) The committee shall elect a chairperson of the committee annually. The same person may not hold the office of chairperson for more than three years in succession.

(2) The committee shall advise the secretary concerning the administration of this chapter. The committee may meet at such times as designated by the secretary.

(3) A majority of the committee constitutes a quorum for all purposes, and the majority vote of the members voting governs the decisions of the committee.

NEW SECTION. Sec. 9. The secretary shall have the following powers and duties:

(1) To determine the qualifications of persons applying for certification under this chapter;

(2) To prescribe, administer, and determine the requirements for examinations pursuant to this chapter and a passing grade for certification under this chapter;

(3) To issue certificates for the practice of denturitry under this chapter;

(4) To administer oaths and subpoena witnesses for the purpose of carrying out the activities authorized under this chapter;

(5) To adopt rules pursuant to chapter 34.05 RCW to carry out the provisions of this chapter;

(6) Set all certification, examination, and renewal fees in accordance with RCW 43.70.250;

(7) Establish forms and procedures necessary to administer this chapter;

(8) Hire clerical, administrative, investigative, and other staff as needed to implement this chapter and act on behalf of the committee;

(9) To issue licenses of endorsement for applicants from states that maintain standards of practice substantially equivalent to this state;

(10) To evaluate and designate those schools from which graduation will be accepted as proof of an applicant's completion of course work requirements for certification; and

(11) To act as the disciplining authority under this chapter. The uniform disciplinary act, chapter 18.130 RCW, governs uncertified practice, the issuance and denial of certificates, and the disciplining of certificate holders under this chapter.

NEW SECTION. Sec. 10. The secretary shall issue a certificate to practice denturitry to applicants who submit completed applications, pay the appropriate fees, and meet the following requirements:

(1) Persons currently certified to practice denturitry under statutory provisions of other states or federal enclave that maintain standards of practice substantially equivalent to this chapter shall be certified without examination upon providing the department with the following:

(a) Proof of successfully passing a written and clinical examination for denturitry in a state which the department has determined has substantially equivalent standards as those in this chapter in both the written and clinical examinations; and

(b) An affidavit from the state agency where the person is licensed or certified attesting to the fact of the person's licensure or certification; or

(2) Persons graduating from a formal denturitry program shall be certified if they:

(a) Document successful completion of formal training with a major course of study in denturitry of not less than two years in duration at an educational institution accredited by an agency recognized by the secretary; and

(b) Pass a written and clinical examination approved by the department; or

(3) Applicants who do not otherwise qualify under subsection (1) or (2) of this section shall be certified if they:

(a) Provide to the department three affidavits by persons other than family members attesting to the applicant's employment in denture technology for at least five years;

(b) Provide documentation of successful completion of courses approved by the secretary; and

NEW SECTION. Sec. 11. The secretary shall administer the examinations for certification, subject to the following requirements:

(1) Examinations shall determine the qualifications, fitness, and ability of the applicant to practice denturitry. The form of the test must include a written examination and a practical demonstration of skills.

(2) Examinations shall be held at least annually.

(3) The written examination shall cover, but shall not be limited to, the following subjects: (a) Head and oral anatomy and physiology; (b) oral pathology; (c) partial denture construction and design; (d) microbiology; (e) clinical dental technology; (f) dental laboratory technology; (g) clinical jurisprudence; (h) x-ray technology; (i) asepsis; (j) medical emergencies; and (k) cardiopulmonary resuscitation.

(4) Applicants who fail either the written or practical examinations may have, upon payment of the appropriate fee, additional opportunities to retake the portion of the examination that they failed. The secretary may hire trained persons certified under this chapter to administer and grade the examinations or may contract with regional examiners who meet qualifications adopted by the committee.

NEW SECTION. Sec. 12. The department shall charge and collect the fees established by the secretary under RCW 43.70.250. Fees collected shall be placed in the health professions account under RCW 43.70.320 to pay for the cost of administering this chapter.

NEW SECTION. Sec. 13. (1) A certificate is valid for two years. A certificate may be renewed by paying the renewal fee.

(2) If a certificate issued is effective on a date other than July 1, it shall be valid until the following June 30.

(3) The certificate shall contain, on its face, the address or addresses where the certificate holder will perform the denturist services.

NEW SECTION. Sec. 14. The secretary shall establish by rule the requirements for renewal of certificates. The secretary shall establish a renewal and late renewal penalty as provided for in RCW 43.70.250. Failure to renew shall invalidate the certificate and all privileges granted by the certificate. The secretary shall determine by rule whether a certificate shall be canceled for failure to renew and shall establish procedures and prerequisites for recertification.

NEW SECTION. Sec. 15. (1) An individual may place his or her certificate on inactive status. The holder of an inactive certificate shall not practice denturitry in this state without first activating the certificate.

(2) The inactive renewal fee shall be established by the secretary pursuant to RCW 43.70.250. Failure to renew an inactive certificate shall result in cancellation in the same manner as an active certificate.

(3) An inactive certificate may be placed in an active status upon compliance with the rules established by the committee.

(4) The provisions relating to denial, suspension, and revocation of a certificate shall be applicable to an inactive certificate, except that when proceedings to suspend or revoke an inactive certificate have been initiated, the certificate shall remain inactive until the proceedings have been completed.

NEW SECTION. Sec. 16. A certified denturist may enter into any lawful agreement with a dentist regarding fees, compensation, or business association.

NEW SECTION. Sec. 17. The secretary, members of the committee, or individuals acting on their behalf are immune from suit in any civil action based on any certification or disciplinary proceedings or other official acts performed in the course of their duties.

NEW SECTION. Sec. 18. This chapter may be known and cited as the Washington state denturist act.

Sec. 19. RCW 18.120.020 and 1989 c 300 s 14 are each amended to read as follows:

The definitions contained in this section shall apply throughout this chapter unless the context clearly requires otherwise.

(1) "Applicant group" includes any health professional group or organization, any individual, or any other interested party which proposes that any health professional group not presently regulated be regulated or which proposes to substantially increase the scope of practice of the profession.

(2) "Certificate" and "certification" mean a voluntary process by which a statutory regulatory entity grants recognition to an individual who (a) has met certain prerequisite qualifications specified by that regulatory entity, and (b) may assume or use "certified" in the title or designation to perform prescribed health professional tasks.

(3) "Grandfather clause" means a provision in a regulatory statute applicable to practitioners actively engaged in the regulated health profession prior to the effective date of the regulatory statute which exempts the practitioners from meeting the prerequisite qualifications set forth in the regulatory statute to perform prescribed occupational tasks.

(4) "Health professions" means and includes the following health and health-related licensed or regulated professions and occupations: Podiatry under chapter 18.22 RCW; chiropractic under chapters 18.25 and 18.26 RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; denturitry under chapter 18.-- RCW (sections 1 through 18 of this act); dispensing opticians under chapter 18.34 RCW; hearing aids under chapter 18.35 RCW; naturopaths under chapter 18.36A RCW; embalming and funeral directing under chapter 18.39 RCW; midwifery under chapter 18.50 RCW; nursing home administration under chapter 18.52 RCW; optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter 18.55 RCW; osteopathy and osteopathic medicine and surgery under chapters 18.57 and 18.57A RCW; pharmacy under chapters 18.64 and 18.64A RCW; medicine under chapters 18.71, 18.71A, and 18.72 RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.78 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.88 RCW; occupational therapists licensed pursuant to chapter 18.59 RCW; respiratory care practitioners certified under chapter 18.89 RCW; veterinarians and animal technicians under chapter 18.92 RCW; health care assistants under chapter 18.135 RCW; massage practitioners under chapter 18.108 RCW; acupuncturists certified under chapter 18.06 RCW; persons registered or certified under chapter 18.19 RCW; dietitians and nutritionists certified by chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW; and nursing assistants registered or certified under chapter 18.88A

RCW.

(5) "Inspection" means the periodic examination of practitioners by a state agency in order to ascertain whether the practitioners' occupation is being carried out in a fashion consistent with the public health, safety, and welfare.

(6) "Legislative committees of reference" means the standing legislative committees designated by the respective rules committees of the senate and house of representatives to consider proposed legislation to regulate health professions not previously regulated.

(7) "License," "licensing," and "licensure" mean permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission. A license is granted to those individuals who meet prerequisite qualifications to perform prescribed health professional tasks and for the use of a particular title.

(8) "Professional license" means an individual, nontransferable authorization to carry on a health activity based on qualifications which include: (a) Graduation from an accredited or approved program, and (b) acceptable performance on a qualifying examination or series of examinations.

(9) "Practitioner" means an individual who (a) has achieved knowledge and skill by practice, and (b) is actively engaged in a specified health profession.

(10) "Public member" means an individual who is not, and never was, a member of the health profession being regulated or the spouse of a member, or an individual who does not have and never has had a material financial interest in either the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.

(11) "Registration" means the formal notification which, prior to rendering services, a practitioner shall submit to a state agency setting forth the name and address of the practitioner; the location, nature and operation of the health activity to be practiced; and, if required by the regulatory entity, a description of the service to be provided.

(12) "Regulatory entity" means any board, commission, agency, division, or other unit or subunit of state government which regulates one or more professions, occupations, industries, businesses, or other endeavors in this state.

(13) "State agency" includes every state office, department, board, commission, regulatory entity, and agency of the state, and, where provided by law, programs and activities involving less than the full responsibility of a state agency.

Sec. 20. RCW 18.130.040 and 1988 c 243 s 7, 1988 c 267 s 22, and 1988 c 277 s 13 are each reenacted and amended to read as follows:

(1) This chapter applies only to the ((~~director~~)) secretary and the boards having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.

(2) (a) The ((~~director~~)) secretary has authority under this chapter in relation to the following professions:

(i) Dispensing opticians licensed under chapter 18.34 RCW;

(ii) Naturopaths licensed under chapter 18.36A RCW;

(iii) Midwives licensed under chapter 18.50 RCW;

(iv) Ocularists licensed under chapter 18.55 RCW;

(v) Massage operators and businesses licensed under chapter 18.108 RCW;

(vi) Dental hygienists licensed under chapter 18.29 RCW;

(vii) Acupuncturists certified under chapter 18.06 RCW;

(viii) Radiologic technologists certified under chapter 18.84 RCW;

(ix) Respiratory care practitioners certified under chapter 18.89 RCW;

(x) Persons registered or certified under chapter 18.19 RCW;

(xi) Persons registered as nursing pool operators;

(xii) Nursing assistants registered or certified under chapter 18.52B RCW; ((~~and~~))

(xiii) Dietitians and nutritionists certified under chapter 18.138 RCW; and

(xiv) Denturists certified under chapter 18.-- RCW (sections 1 through 18 of this act).

(b) The boards having authority under this chapter are as follows:

(i) The podiatry board as established in chapter 18.22 RCW;

(ii) The chiropractic disciplinary board as established in chapter 18.26 RCW governing licenses issued under chapter 18.25 RCW;

(iii) The dental disciplinary board as established in chapter 18.32 RCW;

(iv) The council on hearing aids as established in chapter 18.35 RCW;

(v) The board of funeral directors and embalmers as established in chapter 18.39 RCW;

(vi) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;

(vii) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;

(viii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;

(ix) The medical disciplinary board as established in chapter 18.72 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;

(x) The board of physical therapy as established in chapter 18.74 RCW;

(xi) The board of occupational therapy practice as established in chapter 18.59 RCW;

(xii) The board of practical nursing as established in chapter 18.78 RCW;

(xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;

(xiv) The board of nursing as established in chapter 18.88 RCW; and

(xv) The veterinary board of governors as established in chapter 18.92 RCW.

(3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. However, the board of chiropractic examiners has authority over issuance and denial of licenses provided for in chapter 18.25 RCW, the board of dental examiners has authority over issuance and denial of licenses provided for in RCW 18.32.040, and the board of medical examiners has authority over issuance and denial of licenses and registrations provided for in chapters 18.71 and 18.71A RCW. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.

NEW SECTION. Sec. 21. A new section is added to chapter 48.20 RCW to read as follows:

To ensure freedom of choice in the denture delivery system, coverage may not be denied under a disability insurance contract for services performed by a denturist certified under chapter 18.-- RCW (sections 1 through 18 of this act) if:

(1) The services performed were within the lawful scope of the person's certificate;

(2) The contract would have covered the services if the services had been performed by a person licensed to practice dentistry under chapter 18.32 RCW; and

(3) The reimbursement does not exceed the "usual and customary fee" paid under the contract to persons licensed to practice dentistry under chapter 18.32 RCW.

NEW SECTION. Sec. 22. A new section is added to chapter 48.21 RCW to read as follows:

To ensure freedom of choice in the denture delivery system, coverage may not be denied under a group or blanket disability insurance contract for services performed by a denturist certified under chapter 18.-- RCW (sections 1 through 18 of this act) if:

(1) The services performed were within the lawful scope of the person's certificate;

(2) The contract would have covered the services if the services had been performed by a person licensed to practice dentistry under chapter 18.32 RCW; and

(3) The reimbursement does not exceed the "usual and customary fee" paid under the contract to persons licensed to practice dentistry under chapter 18.32 RCW.

NEW SECTION. Sec. 23. A new section is added to chapter 48.44 RCW to read as follows:

To ensure freedom of choice in the denture delivery system, coverage may not be denied under a health care service contract for services performed by a denturist certified under chapter 18.-- RCW (sections 1 through 18 of this act) if:

(1) The services performed were within the lawful scope of the person's certificate;

(2) The contract would have covered the services if the services had been performed by a person licensed to practice dentistry under chapter 18.32 RCW; and

(3) The reimbursement does not exceed the "usual and customary fee" paid under the contract to persons licensed to practice dentistry under chapter 18.32 RCW.

NEW SECTION. Sec. 24. A new section is added to chapter 48.46 RCW to read as follows:

To ensure freedom of choice in the denture delivery system, coverage may not be denied under a health maintenance agreement for services performed by a denturist certified under chapter 18.-- RCW (sections 1 through 18 of this act) if:

(1) The services performed were within the lawful scope of the person's certificate;

(2) The agreement would have covered the services if the services had been performed by a person licensed to practice dentistry under chapter 18.32 RCW; and

(3) The reimbursement does not exceed the "usual and customary fee" paid under the agreement to persons licensed to practice dentistry under chapter 18.32 RCW.

NEW SECTION. Sec. 25. Sections 1 through 18 of this act shall constitute a new chapter in Title 18 RCW.

NEW SECTION. Sec. 26. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect thirty days after it is signed into law by the governor.

NEW SECTION. Sec. 27. The sum of .......... dollars, or as much thereof as may be necessary, is appropriated for the biennium ending June 30, 1993, from the health professions account under RCW 43.70.320 to the department of health for the purposes of this act.

NEW SECTION. Sec. 28. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.