Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 1364

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.

Brief Description: Establishing the practice of dental therapy.

Sponsors: Representatives Cody, Macri, Clibborn, Pettigrew, Farrell, Stonier, Jinkins, Kagi, Fitzgibbon, Gregerson, Tharinger, Robinson, Appleton and Kloba.

Brief Summary of Bill

  • Creates a new licensed health profession: dental therapists.

  • Authorizes the use of dental health aide therapists.

Hearing Date: 1/27/17

Staff: Jim Morishima (786-7191).

Background:

Dental Personnel in Washington.

Washington has a variety of credentialed providers who provide assistance to licensed dentists. For example:

Dental Health Aide Therapists.

The federal Community Health Aide Program (CHAP):

As part of the CHAP, dental health aide therapists (DHATs) are authorized to provide a variety of services pursuant to an agreement with a supervising dentist, including fillings and preventive services. A DHAT may only perform pulpal therapy (not including pulpotomies on deciduous teeth) or extractions of adult teeth after consultation with a dentist who determines that the procedure is a medical emergency that cannot be resolved with palliative treatment. A DHAT may not otherwise perform oral or jaw surgeries other than uncomplicated extractions. A dental health aide therapist must have a high school education, complete a two-year educational/clinical program, and complete a perceptorship of at least 400 hours with a supervising dentist.

The federal government is authorized to expand the CHAP nationally; the expansion authority does not generally include the DHAT program. The DHAT program may, however, be expanded upon the election of an Indian tribe or tribal organization located in a state where "the use of [DHAT] services or midlevel dental health provider services is authorized under [s]tate law to supply such services in accordance with [s]tate law."

Summary of Bill:

Dental Therapists.

A person may not practice dental therapy or represent himself or herself as a dental therapist without being licensed by the Dental Quality Assurance Commission. A dental therapist must meet the following qualifications for licensure:

A dental therapist may perform the following services and procedures:

A dental therapist must practice pursuant to a written practice plan contract with a dentist. The contract must be signed and maintained by both the contracting dentist and the dental therapist, be submitted to the Department of Health (DOH) annually, and be made available at the practice of the dental therapist. The contract must specify:

A contracting dentist must make arrangements for the provision of advanced procedures and services needed by the patient or any treatment that exceeds the dental therapist's scope of practice or capabilities. The contracting dentist must also ensure that he or she, or another dentist, is available for instant communication during treatment. A dentist may enter into a practice plan contract with no more than five dental therapists at any one time.

A dental therapist may only provide services and procedures under the off-site supervision of the contracting dentist, who must accept responsibility for all of the services and procedures provided by the dental therapist. A contracting dentist who knowingly allows a dental therapist to perform services or procedures that are not authorized in the collaborative agreement, or any dental therapist who performs such service or procedures, commits unprofessional conduct for purposes of the Uniform Disciplinary Act.

A dental therapist may practice only in:

Dental Health Aide Therapists.

A federally recognized Indian tribe, tribal organization, or urban Indian organization is authorized to train, employ, or contract with a dental health aide therapist (DHAT). A dentist employed or contracted by a federally recognized Indian tribe, tribal organization, or urban Indian organization may supervise a DHAT. The DHAT must be certified by a federal Community Health Aide Program (CHAP) or an Indian tribe that has adopted equivalent or higher standards than the CHAP with respect to curriculum, training, scope of practice, continuing education, and supervision.

A DHAT may only perform procedures allowed by a CHAP or an Indian tribe with equivalent or higher standards. The DHAT's practice is further limited by federal law and any limitations in his or her practice agreement. A DHAT may only practice in settings operated by an Indian health program or an urban Indian organization.

The DOH must convene a DHAT work group consisting of:

The work group must develop and recommend criteria for establishing a pathway for DHATs licensed by tribes or tribal organizations, or certified by a CHAP, to become a licensed dental therapist in Washington. The work group must also evaluate the accreditation standards and competencies of existing tribes' or tribal organizations' DHAT certification programs and make recommendations for any additional education, clinical experiences, and evaluation and examination processes necessary to meet Washington's dental therapist licensure standards.

The work group must be convened by July 1, 2017, and must report its findings to the Legislature by December 1, 2017.

Appropriation: None.

Fiscal Note: Available.

Effective Date: This bill takes effect 90 days after adjournment of the session in which the bill is passed, except for section 10, relating to dental health aide therapists, which takes effect immediately, and sections 1 through 9, 11 through 20, and 22, relating to licensing dental therapists, which take effect January 1, 2018..