BILL REQ. #:  H-0585.1 

Read first time 01/29/13.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to advanced function dental auxiliaries; amending RCW 18.32.030, 18.32.0351, and 18.260.070; reenacting and amending RCW 18.120.020, 18.120.020, 18.130.040, and 18.130.040; adding a new chapter to Title 18 RCW; providing effective dates; and providing an expiration date.

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

NEW SECTION.  Sec. 1   The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Advanced function dental auxiliary" means a person licensed by the commission under this chapter who performs the limited services provided in section 5 of this act.
     (2) "Close supervision" means that a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervising dentist is continuously on-site and physically present in the treatment facility while the procedures are performed by the assistive personnel and capable of responding immediately in the event of an emergency. The term does not require a supervising dentist to be physically present in the operatory.
     (3) "Commission" means the Washington state dental quality assurance commission created in chapter 18.32 RCW.
     (4) "Dentist" means a person licensed to practice dentistry under chapter 18.32 RCW.
     (5) "Department" means the department of health.
     (6) "Expanded function dental auxiliary" means a person who is licensed to practice as an expanded function dental auxiliary under chapter 18.260 RCW.
     (7) "General supervision" means that a supervising dentist has examined and diagnosed the patient and provided subsequent instructions to be performed by the assistive personnel, but does not require that the dentist be physically present in the treatment facility.
     (8) "Secretary" means the secretary of the department of health.
     (9) "Supervising dentist" means a dentist licensed under chapter 18.32 RCW that is responsible for providing the appropriate level of supervision for advanced function dental auxiliaries.

NEW SECTION.  Sec. 2   No person may practice as an advanced function dental auxiliary, or represent himself or herself as an advanced function dental auxiliary, by use of any title or description or other means, unless he or she is licensed by the commission under this chapter.

NEW SECTION.  Sec. 3   The commission shall issue a license to practice as an advanced function dental auxiliary to any applicant who:
     (1) Pays all applicable fees established by the secretary in accordance with RCW 43.70.110 and 43.70.250;
     (2) Submits, on forms provided by the secretary, the applicant's name, address, and other applicable information as determined by the secretary; and
     (3) Demonstrates that the following requirements have been met:
     (a) Successful completion of one of the following:
     (i) An expanded function dental auxiliary education program approved by the commission; or
     (ii) A dental hygiene education program approved by the secretary;
     (b) Successful completion of minimum work experience in a dental operatory, prior to commencement of the advanced function dental auxiliary program, as established by rule by the commission;
     (c) Successful completion of an advanced function dental auxiliary program approved by the commission. The commission must establish criteria of the program, including a requirement that the program be at least two years;
     (d) Successful completion of a preceptorship of at least four hundred hours and under the close supervision and control of a dentist approved by the commission;
     (e) Successful completion of both a written examination and a clinical examination approved by the commission in accordance with section 4 of this act;
     (f) Each applicant shall furnish proof satisfactory to the commission of the following:
     (i) That the applicant is of good moral character; and
     (ii) That the applicant is physically and mentally capable of practicing as an advanced function dental auxiliary with reasonable skill and safety; and
     (g) Other requirements determined by the commission including, if necessary, an examination to determine an applicant's physical or mental capability, or both, to safely practice as an advanced function dental auxiliary.

NEW SECTION.  Sec. 4   (1) The commission may approve a written examination prepared or administered by a private testing agency or association of licensing agencies for use by an applicant in meeting the licensing requirements under section 3 of this act. The requirement that the examination be written does not exclude the use of computerized test administration.
     (2) The commission may approve a clinical examination prepared or administered by a private testing agency or association of licensing agencies for use by an applicant in meeting the licensing requirements under section 3 of this act.

NEW SECTION.  Sec. 5   (1) The commission shall adopt rules relating to the scope of advanced function dental auxiliary services related to patient care and laboratory duties that may be performed by advanced function dental auxiliaries. All dental services provided by an advanced function dental auxiliary must be as directed by his or her supervising dentist. The supervising dentist shall examine the patient and make the diagnosis of the patient's dental condition and determine the treatment to be provided.
     (2) Advanced function dental auxiliaries may not diagnose the dental condition of a patient, nor independently determine the treatment to be provided. All services of the advanced function dental auxiliary are subject to the direction and control of the supervising dentist, to applicable protocols established by the dentist, and must comply with commission rules.
     (a) An advanced function dental auxiliary may perform the following services under the general supervision of a dentist:
     (i) Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis;
     (ii) Preliminary charting of the oral cavity;
     (iii) Making radiographs;
     (iv) Mechanical polishing of restorations;
     (v) Application of topical preventative or prophylactic agents, including fluoride varnishes and pit and fissure sealants;
     (vi) Pulp vitality testing;
     (vii) Application of temporary restorations;
     (viii) Dressing changes;
     (ix) Placement of temporary crowns;
     (x) Temporary recementing of crowns;
     (xi) Suture removal;
     (xii) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth;
     (xiii) Scaling; and
     (xiv) Gross debridement.
     (b) An advanced function dental auxiliary may perform the following services under the close supervision of a dentist:
     (i) Tissue conditioning;
     (ii) Administration of local anesthetic;
     (iii) Administration of nitrous oxide;
     (iv) The placement and removal of space maintainers;
     (v) Cavity preparation;
     (vi) Direct restoration of primary and permanent teeth;
     (vii) Preparation and placement of preformed crowns;
     (viii) Pulpotomies of primary teeth;
     (ix) Indirect and direct pulp capping on permanent teeth;
     (x) Indirect pulp capping on primary teeth and direct pulp capping on primary teeth in cases of traumatic pulpal exposure or mechanical pulpal exposure;
     (xi) Extractions of primary teeth with class III mobility;
     (xii) Brush biopsies;
     (xiii) Permanent recementing of permanent crowns;
     (xiv) Nonsurgical extractions of periodontally diseased permanent teeth with class III mobility if the teeth are erupted, are not impacted, are not fractured, and do not need to be sectioned for removal;
     (xv) Taking final impressions; and
     (xvi) Authority to dispense and orally administer medications as provided in section 6 of this act.

NEW SECTION.  Sec. 6   (1) Advanced function dental auxiliaries may dispense and orally administer the following drugs within the parameters of the practice protocols established by a supervising dentist and an advanced function dental auxiliary: Nonnarcotic analgesics, anti-inflammatories, preventive agents, and antibiotics.
     (2) The authority to dispense and administer extends only to the categories of drugs identified in this section and may be further limited by practice protocols established by a supervising dentist.
     (3) The authority to dispense includes the authority to dispense sample drugs within the categories identified in this section if dispensing is permitted by the practice protocols established by a supervising dentist.
     (4) Advanced function dental auxiliaries may not dispense and administer narcotic drugs as defined in chapter 69.50 RCW.

NEW SECTION.  Sec. 7   (1) An advanced function dental auxiliary may only work within the parameters of a written practice agreement entered into between the dentist and the advanced function dental auxiliary. If the supervisory relationship terminates, the advanced function dental auxiliary must discontinue practice until a practice agreement is established with another supervising dentist.
     (2) The practice agreement must include the delegated functions the advanced function dental auxiliary is permitted to perform and practice protocols established by a supervising dentist. The practice protocols must, at a minimum, contain the following:
     (a) Protocols determining how the dentist delegates treatment after diagnosis;
     (b) Any limitations on the services or procedures the advanced function dental auxiliary may provide;
     (c) A plan to manage medical emergencies and specific written protocols governing situations within the advanced function dental auxiliary's scope of practice; and
     (d) Protocols for allowing dental assistants and expanded function dental auxiliaries to assist advanced function dental auxiliaries.
     (3) Practice agreements must be submitted to the commission when created and when modified. Practice agreements must be made available to the public upon request.

NEW SECTION.  Sec. 8   (1) Advanced function dental auxiliaries may only practice in federally qualified health centers. All practice locations must be approved by the commission.
     (2) A dentist may supervise no more than two advanced function dental auxiliaries.
     (3) By November 15, 2022, the commission must submit a recommendation to the legislature on maintaining, modifying, or removing the practice restrictions of this section.

NEW SECTION.  Sec. 9   (1) An advanced function dental auxiliary, at all times when meeting or treating patients, must wear a badge identifying him or her as an advanced function dental auxiliary. No advanced function dental auxiliary may be presented in any manner which would tend to mislead the patients or the public as to his or her title.
     (2) Patient consents related to services provided by an advanced function dental auxiliary must include specific disclosure of the services that will be provided by an advanced function dental auxiliary and not by a dentist. For the purposes of this subsection, "patients" includes parents of minors and guardians.

NEW SECTION.  Sec. 10   The commission may adopt rules to implement this chapter including rules relating to:
     (1) License renewals and the circumstances under which a license may be suspended, denied, or withdrawn, such as a finding of unprofessional conduct under chapter 18.130 RCW; and
     (2) Continuing education requirements.

NEW SECTION.  Sec. 11   Nothing in this chapter prohibits or restricts:
     (1) The practice of dental therapy in the discharge of official duties by government employees on behalf of the United States government, including the armed forces, coast guard, public health service, veteran's bureau, or bureau of Indian affairs;
     (2) Advanced function dental auxiliary education programs and preceptorships approved by the commission and the practice as an advanced function dental auxiliary by students in advanced function dental auxiliary education programs and preceptorships approved by the commission, when acting under the direction and supervision of a dentist.

NEW SECTION.  Sec. 12   Chapter 18.130 RCW governs the unlicensed practice, the issuance and denial of licenses, and the discipline of those credentialed under this chapter. The commission is the disciplinary authority under this chapter.

Sec. 13   RCW 18.32.030 and 2012 c 23 s 7 are each amended to read as follows:
     The following practices, acts, and operations are excepted from the operation of the provisions of this chapter:
     (1) The rendering of dental relief in emergency cases in the practice of his or her profession by a physician or surgeon, licensed as such and registered under the laws of this state, unless the physician or surgeon undertakes to or does reproduce lost parts of the human teeth in the mouth or to restore or to replace in the human mouth lost or missing teeth;
     (2) The practice of dentistry in the discharge of official duties by dentists in the United States federal services on federal reservations, including but not limited to the armed services, coast guard, public health service, veterans' bureau, or bureau of Indian affairs;
     (3) Dental schools or colleges approved under RCW 18.32.040, and the practice of dentistry by students in accredited dental schools or colleges approved by the commission, when acting under the direction and supervision of Washington state-licensed dental school faculty;
     (4) The practice of dentistry by licensed dentists of other states or countries while appearing as clinicians at meetings of the Washington state dental association, or component parts thereof, or at meetings sanctioned by them, or other groups approved by the commission;
     (5) The use of roentgen and other rays for making radiographs or similar records of dental or oral tissues, under the supervision of a licensed dentist or physician;
     (6) The making, repairing, altering, or supplying of artificial restorations, substitutions, appliances, or materials for the correction of disease, loss, deformity, malposition, dislocation, fracture, injury to the jaws, teeth, lips, gums, cheeks, palate, or associated tissues or parts; providing the same are made, repaired, altered, or supplied pursuant to the written instructions and order of a licensed dentist which may be accompanied by casts, models, or impressions furnished by the dentist, and the prescriptions shall be retained and filed for a period of not less than three years and shall be available to and subject to the examination of the secretary or the secretary's authorized representatives;
     (7) The removal of deposits and stains from the surfaces of the teeth, the application of topical preventative or prophylactic agents, and the polishing and smoothing of restorations, when performed or prescribed by a dental hygienist licensed under the laws of this state;
     (8) A qualified and licensed physician and surgeon or osteopathic physician and surgeon extracting teeth or performing oral surgery pursuant to the scope of practice under chapter 18.71 or 18.57 RCW;
     (9) The performing of dental operations or services by registered dental assistants and licensed expanded function dental auxiliaries holding a credential issued under chapter 18.260 RCW and advanced function dental auxiliaries licensed under chapter 18.--- RCW (the new chapter created in section 20 of this act) when performed under the supervision of a licensed dentist, or by other persons not licensed under this chapter if the person is licensed pursuant to chapter 18.29, 18.57, 18.71, or 18.79 RCW as it applies to registered nurses and advanced registered nurse practitioners, each while acting within the scope of the person's permitted practice under the person's license: PROVIDED HOWEVER, That such persons shall in no event perform the following dental operations or services unless permitted to be performed by the person under this chapter or chapters 18.29, 18.57, 18.71, 18.79 as it applies to registered nurses and advanced registered nurse practitioners, ((and)) 18.260 ((RCW)), and 18.--- RCW (the new chapter created in section 20 of this act):
     (a) Any removal of or addition to the hard or soft tissue of the oral cavity;
     (b) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure;
     (c) Any administration of general or injected local anaesthetic of any nature in connection with a dental operation, including intravenous sedation;
     (d) Any oral prophylaxis;
     (e) The taking of any impressions of the teeth or jaw or the relationships of the teeth or jaws, for the purpose of fabricating any intra-oral restoration, appliance, or prosthesis; and
     (10) The performing of dental services described in RCW 18.350.040 by dental anesthesia assistants certified under chapter 18.350 RCW when working under the supervision and direction of an oral and maxillofacial surgeon or dental anesthesiologist.

Sec. 14   RCW 18.32.0351 and 2007 c 269 s 16 are each amended to read as follows:
     The Washington state dental quality assurance commission is established, consisting of ((sixteen)) seventeen members each appointed by the governor to a four-year term. No member may serve more than two consecutive full terms. ((In appointing the initial members of the commission, it is the intent of the legislature that, to the extent possible, members of the previous boards and committees regulating these professions be appointed to the commission.)) Members of the commission hold office until their successors are appointed. ((The governor may appoint members of the initial commission to staggered terms of from one to four years. Thereafter, all)) Members shall be appointed to ((full)) staggered four-year terms. Twelve members of the commission must be dentists, ((two members must be expanded function dental auxiliaries licensed under chapter 18.260 RCW, and)) two members must be public members, and three members must be dental auxiliaries licensed under either chapter 18.260 or 18.--- RCW (the new chapter created in section 20 of this act). Of the three dental auxiliary members, one member must be an expanded function dental auxiliary, one member must be an advanced function dental auxiliary, and the third member must be either an expanded function dental auxiliary or an advanced function dental auxiliary.

Sec. 15   RCW 18.120.020 and 2012 c 153 s 14, 2012 c 137 s 18, and 2012 c 23 s 8 are each reenacted and amended to read as follows:
     The definitions in this section 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: Podiatric medicine and surgery under chapter 18.22 RCW; chiropractic under chapter 18.25 RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; denturism under chapter 18.30 RCW; dental anesthesia assistants under chapter 18.350 RCW; dispensing opticians under chapter 18.34 RCW; hearing instruments 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; 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 and 18.71A RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.79 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.79 RCW; occupational therapists licensed under chapter 18.59 RCW; respiratory care practitioners licensed under chapter 18.89 RCW; veterinarians and veterinary technicians under chapter 18.92 RCW; health care assistants under chapter 18.135 RCW; massage practitioners under chapter 18.108 RCW; East Asian medicine practitioners licensed under chapter 18.06 RCW; persons registered under chapter 18.19 RCW; persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW; dietitians and nutritionists certified by chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW; nursing assistants registered or certified under chapter 18.88A RCW; ((and)) reflexologists certified under chapter 18.108 RCW; ((and)) medical assistants-certified, medical assistants-hemodialysis technician, medical assistants-phlebotomist, and medical assistants-registered certified and registered under chapter 18.360 RCW; and advanced function dental auxiliaries licensed under chapter 18.--- RCW (the new chapter created in section 20 of this act).
     (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. 16   RCW 18.120.020 and 2012 c 153 s 15, 2012 c 137 s 18, and 2012 c 23 s 8 are each reenacted and amended to read as follows:
     The definitions in this section 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: Podiatric medicine and surgery under chapter 18.22 RCW; chiropractic under chapter 18.25 RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; denturism under chapter 18.30 RCW; dental anesthesia assistants under chapter 18.350 RCW; dispensing opticians under chapter 18.34 RCW; hearing instruments 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; 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 and 18.71A RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.79 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.79 RCW; occupational therapists licensed under chapter 18.59 RCW; respiratory care practitioners licensed under chapter 18.89 RCW; veterinarians and veterinary technicians under chapter 18.92 RCW; massage practitioners under chapter 18.108 RCW; East Asian medicine practitioners licensed under chapter 18.06 RCW; persons registered under chapter 18.19 RCW; persons licensed as mental health counselors, marriage and family therapists, and social workers under chapter 18.225 RCW; dietitians and nutritionists certified by chapter 18.138 RCW; radiologic technicians under chapter 18.84 RCW; nursing assistants registered or certified under chapter 18.88A RCW; ((and)) reflexologists certified under chapter 18.108 RCW; ((and)) medical assistants-certified, medical assistants-hemodialysis technician, medical assistants-phlebotomist, and medical assistants-registered certified and registered under chapter 18.360 RCW; and advanced function dental auxiliaries licenced under chapter 18.--- RCW (the new chapter created in section 20 of this act).
     (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. 17   RCW 18.130.040 and 2012 c 208 s 10, 2012 c 153 s 16, 2012 c 137 s 19, and 2012 c 23 s 6 are each reenacted and amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions 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 secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Midwives licensed under chapter 18.50 RCW;
     (iii) Ocularists licensed under chapter 18.55 RCW;
     (iv) Massage practitioners and businesses licensed under chapter 18.108 RCW;
     (v) Dental hygienists licensed under chapter 18.29 RCW;
     (vi) East Asian medicine practitioners licensed under chapter 18.06 RCW;
     (vii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (viii) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (ix) Hypnotherapists and agency affiliated counselors registered and advisors and counselors certified under chapter 18.19 RCW;
     (x) Persons licensed as mental health counselors, mental health counselor associates, marriage and family therapists, marriage and family therapist associates, social workers, social work associates--advanced, and social work associates -- independent clinical under chapter 18.225 RCW;
     (xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xii) Nursing assistants registered or certified or medication assistants endorsed under chapter 18.88A RCW;
     (xiii) Health care assistants certified under chapter 18.135 RCW;
     (xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xv) Chemical dependency professionals and chemical dependency professional trainees certified under chapter 18.205 RCW;
     (xvi) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xvii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xviii) Denturists licensed under chapter 18.30 RCW;
     (xix) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xx) Surgical technologists registered under chapter 18.215 RCW;
     (xxi) Recreational therapists under chapter 18.230 RCW;
     (xxii) Animal massage practitioners certified under chapter 18.240 RCW;
     (xxiii) Athletic trainers licensed under chapter 18.250 RCW;
     (xxiv) Home care aides certified under chapter 18.88B RCW;
     (xxv) Genetic counselors licensed under chapter 18.290 RCW; ((and))
     (xxvi) Reflexologists certified under chapter 18.108 RCW; and
     (xxvii) Medical assistants-certified, medical assistants-hemodialysis technician, medical assistants-phlebotomist, and medical assistants-registered certified and registered under chapter 18.360 RCW.
     (b) The boards and commissions having authority under this chapter are as follows:
     (i) The podiatric medical board as established in chapter 18.22 RCW;
     (ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW, licenses and registrations issued under chapter 18.260 RCW, licenses issued under chapter 18.--- RCW (the new chapter created in section 20 of this act), and certifications issued under chapter 18.350 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) 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;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) The medical quality assurance commission as established in chapter 18.71 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 nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW; and
     (xv) The board of naturopathy established in chapter 18.36A RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses. The disciplining authority may also grant a license subject to conditions.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the uniform disciplinary act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 18   RCW 18.130.040 and 2012 c 208 s 10, 2012 c 153 s 17, 2012 c 137 s 19, and 2012 c 23 s 6 are each reenacted and amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions 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 secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Midwives licensed under chapter 18.50 RCW;
     (iii) Ocularists licensed under chapter 18.55 RCW;
     (iv) Massage practitioners and businesses licensed under chapter 18.108 RCW;
     (v) Dental hygienists licensed under chapter 18.29 RCW;
     (vi) East Asian medicine practitioners licensed under chapter 18.06 RCW;
     (vii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (viii) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (ix) Hypnotherapists and agency affiliated counselors registered and advisors and counselors certified under chapter 18.19 RCW;
     (x) Persons licensed as mental health counselors, mental health counselor associates, marriage and family therapists, marriage and family therapist associates, social workers, social work associates--advanced, and social work associates -- independent clinical under chapter 18.225 RCW;
     (xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xii) Nursing assistants registered or certified or medication assistants endorsed under chapter 18.88A RCW;
     (xiii) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xiv) Chemical dependency professionals and chemical dependency professional trainees certified under chapter 18.205 RCW;
     (xv) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xvi) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xvii) Denturists licensed under chapter 18.30 RCW;
     (xviii) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xix) Surgical technologists registered under chapter 18.215 RCW;
     (xx) Recreational therapists under chapter 18.230 RCW;
     (xxi) Animal massage practitioners certified under chapter 18.240 RCW;
     (xxii) Athletic trainers licensed under chapter 18.250 RCW;
     (xxiii) Home care aides certified under chapter 18.88B RCW;
     (xxiv) Genetic counselors licensed under chapter 18.290 RCW; ((and))
     (xxv) Reflexolgists certified under chapter 18.108 RCW; and
     (xxvi) Medical assistants-certified, medical assistants-hemodialysis technician, medical assistants-phlebotomist, and medical assistants-registered certified and registered under chapter 18.360 RCW.
     (b) The boards and commissions having authority under this chapter are as follows:
     (i) The podiatric medical board as established in chapter 18.22 RCW;
     (ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW, licenses and registrations issued under chapter 18.260 RCW, licenses issued under chapter 18.--- RCW (the new chapter created in section 20 of this act), and certifications issued under chapter 18.350 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) 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;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) The medical quality assurance commission as established in chapter 18.71 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 nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW; and
     (xv) The board of naturopathy established in chapter 18.36A RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses. The disciplining authority may also grant a license subject to conditions.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the uniform disciplinary act, among the disciplining authorities listed in subsection (2) of this section.

Sec. 19   RCW 18.260.070 and 2007 c 269 s 6 are each amended to read as follows:
     (1) The commission shall adopt rules relating to the scope of expanded function dental auxiliary services related to patient care and laboratory duties that may be performed by expanded function dental auxiliaries.
     (2) The scope of expanded function dental auxiliary services that the commission identifies in subsection (1) of this section includes:
     (a) In addition to the dental assisting services that a dental assistant may perform under the close supervision of a supervising dentist, the performance of the following services under the general supervision of a supervising dentist as the dentist may allow:
     (i) Performing coronal polishing;
     (ii) Giving fluoride treatments;
     (iii) Applying sealants;
     (iv) Placing dental x-ray film and exposing and developing the films;
     (v) Giving patient oral health instruction; ((and))
     (vi) Dressing changes;
     (vii) Suture removal;
     (viii) Placement of temporary restorations; and
     (ix) Placement of temporary crowns;
     (b) Notwithstanding any prohibitions in RCW 18.260.040, the performance of the following services under the close supervision of a supervising dentist as the dentist may allow:
     (i) Placing and carving direct restorations; ((and))
     (ii) Taking final impressions;
     (iii) Administration of local anesthesia;
     (iv) Supragingival scaling;
     (v) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth; and
     (vi) Gross debridement.
     (3) A dentist may not assign an expanded function dental auxiliary to perform services until the expanded function dental auxiliary has demonstrated skills necessary to perform competently all assigned duties and responsibilities.

NEW SECTION.  Sec. 20   Sections 1 through 12 of this act constitute a new chapter in Title 18 RCW.

NEW SECTION.  Sec. 21   (1) Section 14 of this act takes effect July 1, 2018.
     (2) Sections 16 and 18 of this act take effect July 1, 2016.

NEW SECTION.  Sec. 22   Sections 15 and 17 of this act expire July 1, 2016.