Budget Amendment ID: FY2017-S4-479-R2
2nd Redraft EHS 479
Dental Hygiene Practitioner
Ms. Chandler, Ms. L'Italien, Messrs. Humason and Moore, Ms. Flanagan, Messrs. Lewis and Eldridge, Ms. Forry, Messrs. Rush, McGee and Brownsberger, Ms. Donoghue, Mr. Keenan, Ms. Gobi, Mr. deMacedo, Ms. O'Connor Ives, Messrs. Brady, Boncore and Montigny, Ms. Chang-Diaz, Messrs. Tarr and O'Connor moved that the proposed new text be amended by inserting after section 35 the following 4 sections:-
“SECTION 35A. Section 43A of chapter 112 of the General Laws, as so appearing, is hereby amended by inserting after the definition of “Appropriate supervision” the following 2 definitions:-
“Board”, the board of registration in dentistry or a committee or subcommittee thereof established in the department of public health pursuant to sections 9 and 19 of chapter 13, chapter 30A and sections 43 to 53, inclusive.
“Collaborative management agreement”, a written agreement between a local, state or federal government agency or institution or a licensed dentist and a dental hygiene practitioner outlining the procedures, services, responsibilities and limitations of the practitioner.
SECTION 35B. Said section 43A of said chapter 112, as so appearing, is hereby further amended by inserting after the definition of “Dental assistant” the following definition:-
“Dental hygiene practitioner”, a dental hygienist who: (i) is a graduate of a dental therapist education program that meets the standards of the Commission on Dental Accreditation provided by a post-secondary institution accredited by the New England Association of Schools and Colleges, Inc.; successfully completed a dental therapist education program that meets the standards of the Commission on Dental Accreditation; or is certified by the federal Indian Health Service pursuant to the Indian Health Care Improvement Act, 25 U.S.C. 1601 et seq.; (ii) has been licensed by the board to practice as a dental hygiene practitioner pursuant to section 51B; and (iii) provides oral health care services, including preventive, oral evaluation and assessment, educational, palliative, therapeutic and restorative services as authorized under said section 51B.
SECTION 35C. Said section 43A of said chapter 112, as so appearing, is hereby further amended by adding the following definition:-
“Supervising dentist”, a licensed dentist who enters into a collaborative management agreement with a dental hygiene practitioner.
SECTION 35D. Said chapter 112 is hereby further amended by inserting after section 51A the following section:-
Section 51B. Any licensed dental hygienist of good moral character, who: (i) is a graduate of a dental practitioner education program that meets the standards of the Commission on Dental Accreditation provided by a post-secondary institution accredited by the New England Association of Schools and Colleges, Inc.; successfully completed a dental therapist education program that that meets the standards of the Commission on Dental Accreditation; or is certified by the federal Indian Health Service pursuant to the Indian Health Care Improvement Act, 25 U.S.C. 1601 et seq.; (ii) passes a comprehensive, competency-based clinical examination that is approved by the board and administered independently of an institution providing registered dental practitioner education; and (iii) obtains a policy of professional liability insurance and shows proof of such insurance as required by rules and regulations, shall be registered as a dental hygiene practitioner and be given a certificate allowing the therapist to practice in this capacity. A dental hygiene practitioner shall have practiced under the direct supervision of a supervising dentist for at least 500 hours or completed 1 year of residency before practicing under general supervision.
The educational curriculum for a dental hygiene practitioner educated in the commonwealth shall include training on serving patients with special needs including, but not limited to, people with developmental disabilities including autism spectrum disorders, mental illness, cognitive impairment, complex medical problems, significant physical limitations and the vulnerable elderly.
Before performing a procedure or providing a service under this paragraph, a dental hygiene practitioner shall enter into a written collaborative management agreement with a licensed dentist. The agreement shall address: practice settings, any limitation on services established by the supervising dentist, the level of supervision required for various services or treatment settings, patient populations that may be served, practice protocols, record keeping, managing medical emergencies, quality assurance, administering and dispensing medications and supervision of dental assistants and dental hygienists. A dental hygiene practitioner may provide the services authorized in practice settings where the supervising dentist is not on-site and has not previously examined the patient, to the extent authorized by the supervising dentist in the collaborative management agreement and provided the supervising dentist is available for consultation and supervision by telephone or other means of electronic communication.
The collaborative management agreement shall include specific written protocols to govern situations in which the dental hygiene practitioner encounters a patient who requires treatment that exceeds the authorized scope of practice of the dental hygiene practitioner. A collaborative management agreement shall be signed and maintained by the supervising dentist and the dental hygiene practitioner and shall be submitted upon request by the board. The board shall establish appropriate guidelines for a written collaborative management agreement. The agreement may be updated from time to time. A supervising dentist may have a collaborative management agreement with not more than 4 dental hygiene practitioners at the same time.
A dental hygiene practitioner licensed by the board may perform all acts of a public health dental hygienist, all acts provided for in Commission on Dental Accreditation’s dental therapy standards, as well as the following services and procedures pursuant to the written collaborative management agreement without the supervision or direction of a dentist: (A) interpreting radiographs; (B) the placement of space maintainers; (C) pulpotomies on primary teeth; (D) an oral evaluation and assessment of dental disease and the formulation of an individualized treatment plan authorized by the collaborating dentist; and (E) nonsurgical extractions of permanent teeth as limited in this section.
A dental hygiene practitioner shall not perform any service or procedure described in this section except as authorized by the collaborating dentist. A dental hygiene practitioner may perform nonsurgical extractions of periodontally diseased permanent teeth with tooth mobility of +3 to +4 under general supervision if authorized in advance by the collaborating dentist. The dental hygiene practitioner shall not extract a tooth for a patient if the tooth is unerupted, impacted, fractured or needs to be sectioned for removal. The collaborating dentist is responsible for directly providing or arranging for another dentist or specialist to provide any necessary advanced services needed by the patient. A dental hygiene practitioner in accordance with the written collaborative management agreement shall refer patients to another qualified dental or health care professional to receive any needed services that exceed the scope of practice of the dental hygiene practitioner. The collaborating dentist shall ensure that a dentist is available to the dental hygiene practitioner for timely consultation during treatment if needed and shall either provide or arrange with another dentist or specialist to provide the necessary treatment to a patient who requires more treatment than the dental hygiene practitioner is authorized to provide. A dental hygiene practitioner may dispense and administer the following medications within the parameters of the written collaborative management agreement, within the scope of practice of the dental hygiene practitioner and with the authorization of the collaborating dentist: analgesics, anti-inflammatories and antibiotics. The authority to dispense and administer shall extend only to the categories of drugs identified in this paragraph and may be further limited by the written collaborative management agreement. The authority to dispense includes the authority to dispense sample drugs within the categories identified in this paragraph if dispensing is permitted by the written collaborative management agreement. A dental hygiene practitioner is prohibited from dispensing or administering a narcotic drug.
Dental hygiene practitioners shall be reimbursed for services covered by Medicaid and other third-party payers. A dental hygiene practitioner shall not operate independently of a dentist, except for a dental hygiene practitioner working for a local, state or federal government agency or institution or practicing in a mobile or portable prevention program licensed or certified by the department of public health as permitted by law.
A licensed dental hygiene practitioner may supervise dental assistants to the extent permitted in the collaborative management agreement and according to section 51 ½.”; and
by inserting after section 77 the following section:-
“SECTION 77A. The board of registration in dentistry, in consultation with the executive office of health and human services, shall perform a 5-year evaluation of the impact of dental hygiene practitioners, as established under section 51B of chapter 112 of the General Laws, on patient safety, cost-effectiveness and access to dental services. The board shall ensure effective measurements of the following outcomes and file a report of its findings, which shall include: (i) the number of new patients served; (ii) the reduction in waiting times for needed services; (iii) decreased travel time for patients; (iv) the impact on emergency room usage for dental care; and (v) the costs to the public health care system. The report shall be submitted not later than July 1, 2021 to the joint committee on public heath, the joint committee on health care financing and the senate and house committees on ways and means.”.