BILL REQ. #:  S-0634.1 

Read first time 01/31/13.   Referred to Committee on Health Care .

     AN ACT Relating to allowing dental hygienists and dental assistants to provide certain services under the supervision of a dentist; amending RCW 18.29.050, 18.29.056, and 18.260.040; and adding a new section to chapter 18.29 RCW.

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

Sec. 1   RCW 18.29.050 and 2003 c 257 s 1 are each amended to read as follows:
     Any person licensed as a dental hygienist in this state may remove deposits and stains from the surfaces of the teeth, may apply topical preventive or prophylactic agents, may polish and smooth restorations, may perform root planing and soft-tissue curettage, and may perform other dental operations and services delegated to them by a licensed dentist. Any person licensed as a dental hygienist in this state may apply topical anesthetic agents under the general supervision, as defined in RCW 18.260.010, of a dentist: PROVIDED HOWEVER, That licensed dental hygienists shall in no event perform the following dental operations or services:
     (1) Any surgical removal of tissue of the oral cavity;
     (2) Any prescription of drugs or medications requiring the written order or prescription of a licensed dentist or physician, except that a hygienist may place antimicrobials pursuant to the order of a licensed dentist and under the dentist's required supervision;
     (3) Any diagnosis for treatment or treatment planning; or
     (4) The taking of any impression 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.
     Such licensed dental hygienists may perform dental operations and services only under the supervision of a licensed dentist, and under such supervision may be employed by hospitals, boards of education of public or private schools, county boards, boards of health, or public or charitable institutions, or in dental offices.

Sec. 2   RCW 18.29.056 and 2009 c 321 s 1 are each amended to read as follows:
     (1)(a) Subject to RCW 18.29.230 and (e) of this subsection, dental hygienists licensed under this chapter with two years' practical clinical experience with a licensed dentist within the preceding five years may be employed, retained, or contracted by health care facilities and senior centers to perform authorized dental hygiene operations and services without dental supervision.
     (b) Subject to RCW 18.29.230 and (e) of this subsection, dental hygienists licensed under this chapter with two years' practical clinical experience with a licensed dentist within the preceding five years may perform authorized dental hygiene operations and services without dental supervision under a lease agreement with a health care facility or senior center.
     (c) Dental hygienists performing operations and services under (a) or (b) of this subsection are limited to removal of deposits and stains from the surfaces of the teeth, application of topical preventive or prophylactic agents, application of topical anesthetic agents, polishing and smoothing restorations, and performance of root planing and soft-tissue curettage, but shall not perform injections of anesthetic agents, administration of nitrous oxide, or diagnosis for dental treatment.
     (d) The performance of dental hygiene operations and services in health care facilities shall be limited to patients, students, and residents of the facilities.
     (e) A dental hygienist employed, retained, or contracted to perform services under this section or otherwise performing services under a lease agreement under this section in a senior center must, before providing services:
     (i) Enter into a written practice arrangement plan, approved by the department, with a dentist licensed in this state, under which the dentist will provide off-site supervision of the dental services provided. This agreement does not create an obligation for the dentist to accept referrals of patients receiving services under the program;
     (ii) Collect data on the patients treated by dental hygienists under the program, including age, treatments rendered, insurance coverage, if any, and patient referral to dentists. This data must be submitted to the department of health at the end of each annual quarter, during the period of time between October 1, 2007, and October 1, 2013; and
     (iii) Obtain information from the patient's primary health care provider about any health conditions of the patient that would be relevant to the provision of preventive dental care. The information may be obtained by the dental hygienist's direct contact with the provider or through a written document from the provider that the patient presents to the dental hygienist.
     (f) For dental planning and dental treatment, dental hygienists shall refer patients to licensed dentists.
     (2) For the purposes of this section:
     (a) "Health care facilities" are limited to hospitals; nursing homes; home health agencies; group homes serving the elderly, individuals with disabilities, and juveniles; state-operated institutions under the jurisdiction of the department of social and health services or the department of corrections; and federal, state, and local public health facilities, state or federally funded community and migrant health centers, and tribal clinics.
     (b) "Senior center" means a multipurpose community facility operated and maintained by a nonprofit organization or local government for the organization and provision of a combination of some of the following: Health, social, nutritional, educational services, and recreational activities for persons sixty years of age or older.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.29 RCW to read as follows:
     (1)(a) Any person licensed in this state as a dental hygienist with two years of practical clinical experience within the preceding five years may perform delegated acts specified in (b) of this subsection on a homebound patient under the general supervision of a dentist licensed under chapter 18.32 RCW if the patient has first been examined by the supervising dentist within a time frame deemed appropriate by the supervising dentist.
     (b) The acts that may be performed under (a) of this subsection are limited to the acts, specified in rule by the dental quality assurance commission, that a dental hygienist is authorized to perform under the general supervision of a dentist.
     (2) Prior to performing acts under this section, the dental hygienist shall:
     (a) Obtain information from the patient's primary health care provider about any health conditions of the patient that would be relevant to the provision of preventive dental care. The dental hygienist shall review and discuss any changes in health condition with the supervising dentist prior to treatment;
     (b) Discuss appropriateness of care with the supervising dentist; and
     (c) Obtain written consent from the supervising dentist.
     (3) For purposes of this section:
     (a) "General supervision" has the same meaning as in RCW 18.260.010; and
     (b) "Homebound patient" means a patient incapable of travel due to age or disability.

Sec. 4   RCW 18.260.040 and 2007 c 269 s 5 are each amended to read as follows:
     (1)(a) The commission shall adopt rules relating to the scope of dental assisting services related to patient care and laboratory duties that may be performed by dental assistants.
     (b) In addition to the services and duties authorized by the rules adopted under (a) of this subsection, a dental assistant may apply topical anesthetic agents.
     (c) All dental services performed by dental assistants under (a) or (b) of this subsection must be performed under the close supervision of a supervising dentist as the dentist may allow.
     (2) In addition to any other limitations established by the commission, dental assistants may not perform the following procedures:
     (a) Any scaling procedure;
     (b) Any oral prophylaxis, except coronal polishing;
     (c) Administration of any general or local anesthetic, including intravenous sedation;
     (d) Any removal of or addition to the hard or soft tissue of the oral cavity;
     (e) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth, jaw, or adjacent structures; and
     (f) 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.
     (3) A dentist may not assign a dental assistant to perform duties until the dental assistant has demonstrated skills necessary to perform competently all assigned duties and responsibilities.