Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same as follows:
SECTION 1. Section 19 of chapter 13 of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out, in line 2, the figure “9” and inserting in place thereof the following figure:- 10.
SECTION 2. Said section 19 of said chapter 13, as so appearing, is hereby further amended by inserting after the word “appointment”, in line 11, the following words:- and 1 of whom shall be a dental assistant in the commonwealth for the 5 years next preceding his appointment.
SECTION 3. Chapter 111 of the General Laws is hereby amended by inserting after section 4N the following section:-
Section 4O. (a) Subject to appropriation, the commissioner shall appoint a dental director. The dental director shall serve at the pleasure of the commissioner and shall be a dentist licensed in the commonwealth with public health experience. The department may establish additional qualifications for the position of dental director by regulation. The dental director shall oversee the department of public health dental program to increase access to oral health services, oral health prevention activities and other initiatives to address oral health disparities.
(b) There shall be an office of oral health within the department with responsibilities that shall include, but not be limited to:
(1) providing recommendations and guidance to the department and other individuals or entities as the office determines including, but not limited to, other departments, agencies, community providers and the legislature for preventing oral diseases and for improving, promoting and protecting oral health with a focus on underserved populations and reducing oral health disparities;
(2) monitoring, studying and appraising the commonwealth's oral health needs and resources;
(3) fostering the development, expansion and evaluation of oral health services for residents of the commonwealth in collaboration with key partners including, but not limited to, MassHealth, the department of youth services, the department of children and families, the department of mental retardation, the department of mental health, the executive office of elderly affairs, the board of registration in dentistry, the department of elementary and secondary education and the department of early education and care;
(4) providing information and education concerning oral health to the dental and health community and to the public;
(5) promoting and providing technical assistance, monitoring and evaluating population-based dental programs including, but not limited to, community water fluoridation programs, school prevention programs, mobile and portable dental programs and other programs to improve access to services;
(6) developing policies to promote oral health; and
(7) developing related programs, policies and preventive measures that impact oral health.
SECTION 4. Section 43A of chapter 112 of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out, in lines 15 and 16, the words “qualified by education, training or experience” and inserting in place thereof the following words:- registered by the board or authorized under section 51½.
SECTION 5. Said section 43A of said chapter 112, as so appearing, is hereby further amended by inserting after the word “procedures”, in line 18, the following words:- under the supervision of a licensed dentist as determined by the board.
SECTION 6. Said section 43A of said chapter 112, as so appearing, is hereby further amended by adding the following definition:-
“Public health dental hygienist”, a dental hygienist with at least 3 years of full-time clinical experience who is practicing full or part time in a public health setting pursuant to section 51 and who has received appropriate training as determined by the department of public health.
SECTION 7. Section 51 of said chapter 112, as so appearing, is hereby amended by inserting after the second paragraph the following paragraph:-
A registered dental hygienist practicing as a public health dental hygienist may perform in a public health setting, without the supervision or direction of a dentist, any procedure or provide any service that is within the scope of his practice and that has been authorized and adopted by the board as a delegable procedure for dental hygienists in private practice under general supervision. A public health setting shall include, but not be limited to, the following: residences of the homebound; schools; nursing homes and long-term care facilities; clinics, hospitals, medical facilities, community health centers and mobile and portable dental health programs licensed or certified by the department of public health; Head Start programs; and other facilities or programs deemed appropriate by the department of public health. Before performing a procedure or providing a service under this paragraph, a public health dental hygienist shall enter into a written collaborative agreement with a local or state government agency or institution or with a licensed dentist who states that he shall be able to provide the appropriate level of communication and consultation with the dental hygienist to ensure patient health and safety. The board shall establish appropriate guidelines for this written collaborative agreement. Public health dental hygienists shall provide to the patient or to the patient’s legal guardian a written referral to a dentist and an assessment of further dental needs. Public health dental hygienists shall also provide to each patient or to the patient's legal guardian a consent form to be signed by the patient or legal guardian, which form shall be consistent with current department of public health policies, that describes services to be rendered, explains that the services are not a substitute for a dental examination by a dentist and informs the patient or legal guardian that the patient should obtain a dental examination by a dentist within 90 days. Public health dental hygienists shall be directly reimbursed for services administered in a public health setting by MassHealth or the commonwealth care health insurance program, but shall not seek reimbursement from any other insurance or third party payor. A public health dental hygienist shall not operate independently of a dentist, except for a dental hygienist working for a local or state government agency or institution or practicing in a mobile or portable prevention program licensed or certified by the department of public health. In such cases, the local or state government agency or institution, or mobile or portable prevention program licensed or certified by the department of public health may seek reimbursement from any other insurance or third party payor.
SECTION 8. Said section 51 of said chapter 112, as so appearing, is hereby amended by striking out, in lines 41 and 42, the words “and those delegated procedures performed by a dental assistant”.
SECTION 9. Said chapter 112 is hereby further amended by inserting after section 51 the following section:-
Section 51½. No person shall practice as a dental assistant unless registered with the board. A person who is at least 18 years of age, of good moral character and who meets the applicable qualifications and requirements for registration as a dental assistant as established and adopted by the board shall, upon application and payment of a fee, as determined annually by the secretary of administration under section 3B of chapter 7, be registered as a dental assistant. The board shall furnish to each such person a registration certificate in a form prescribed by the board. A registration certificate issued under this section shall be revoked upon the issuance to the same person of a certificate of registration under section 45 or 51. The board may adopt rules and regulations consistent with sections 43 to 53, inclusive, governing the registration and practice of dental assistants to protect the public health, safety and welfare including, without limitation, rules and regulations that establish and define the acts, services and delegated procedures that may be performed by dental assistants, the level of supervision required by a registered dentist, tiered classes or levels of practice and certification requirements for each established class or level, education and training requirements, registration and registration renewal procedures and requirements for the display of registration certificates. The continuing education requirements set forth in section 51A shall not apply to this section unless adopted by the board. A dental assistant shall not practice dentistry as defined in section 50 or perform acts or services requiring the knowledge and skill of a registered dentist, such as diagnoses, treatment planning, surgical or cutting procedures on hard or soft tissue and the prescription of medications, or perform any acts or services that require the training, knowledge or skill of a registered dental hygienist, unless specifically authorized by regulation of the board and performed under the appropriate supervision of a registered dentist; provided, however, that the board shall not authorize a dental assistant to perform dental screenings, periodontal charting, subgingival and supragingival scaling, root planting and curettage, minor emergency dental adjustments, polishing of amalgam restorations, micro disk identification applications or preliminary examinations for hygienist services. The board may, without examination, register as a dental assistant an applicant who is duly licensed or registered under the laws of a state, territory or commonwealth of the United States or the District of Colombia, where the requirements for licensure or registration are, in the opinion of the board, equivalent to those in the commonwealth. A dental assistant shall register biennially, which shall be in the year not so designated for the registration of dentists, and shall pay a biennial registration fee determined under this section; provided, however, that the board may issue an initial registration for not more than 2 years. Notwithstanding the above registration requirement, a person who is at least 18 years of age may practice as a dental assistant without being registered by the board for on-the-job training or professional education training under the supervision of a registered dentist for a preliminary and 1-time period of up to 6 consecutive months to commence from the beginning of the initial training if the person: (i) has not been previously employed, licensed or registered as a dentist, dental hygienist or dental assistant; (ii) prior to the commencement of the training, provided written notification of such training to the board on a form prescribed by the board and a certification by the supervising dentist confirming that he will supervise the person during the training; and (iii) is not in violation of any rule or regulation adopted by the board. The board may extend the training period for an additional 6 months for a dental assistant who is enrolled in a program of professional educational training for dental assistants offered by a college, university or dental school authorized to confer degrees or by another dental institution or association recognized by the board. All registration applications and training notifications submitted to the board under this section shall be signed under the penalties of perjury by the person certifying the information contained therein. The board shall investigate all complaints relating to the practice of dental assistants. The authority granted to the board in sections 43 to 53, inclusive, shall include disciplining dental assistants who are registered or authorized to practice for training purposes, and the board may exercise such authority by conducting hearings regarding complaints or by suspending, revoking or cancelling any such registration or authorization to practice as a dental assistant to protect the health, safety and welfare of the public, in the same manner as with registered dentists and dental hygienists.
A registered dentist under section 45, a dental faculty member or a dental intern under section 45A subject to a restriction on location of practice or a dental hygienist under section 51 shall not be considered to be practicing as a dental assistant for the purposes of this section.
SECTION 10. Section 52 of said chapter 112, as appearing in the 2006 Official Edition, is hereby amended by inserting after the word “hygiene”, in line 7, the following words:- or as a dental assistant.
SECTION 11. Said section 52 of said chapter 112, as so appearing, is hereby further amended by striking out, in lines 7 and 8, the words “forty-five to fifty-one”, and inserting in place thereof the following figures:- 45 to 51 1/2.
SECTION 12. Chapter 118E of the General Laws is hereby amended by inserting after section 2 the following section:-
Section 2A. (a) In order to improve, promote and protect oral health, there shall be, in the office of Medicaid, a full-time director of dental services who shall work collaboratively with the department of public health to facilitate the integration of programs to improve oral health.
(b) The director of dental services shall be a dentist licensed in the commonwealth who has public health experience and shall oversee the MassHealth dental program and collaborate with the dental director at the department of public health and the office of oral health on dental public health programs for MassHealth recipients to increase access to oral health services, oral health prevention activities and other initiatives to address oral health disparities including, but not limited to, workforce shortages.
SECTION 13. Notwithstanding any general or special law the contrary, the office of oral health in the department of public health shall evaluate programs and develop quality assurance activities, which shall include, but not limited to, updating on the progress made to date on the recommendations of the report of the special commission on oral health filed pursuant to section 42 of chapter 170 of the acts of 1997. The update shall be filed with the joint committee on public health not later than May 1, 2009.
SECTION 14. Notwithstanding any general or special law the contrary, the department of public health shall submit separate reports on public health dental hygienists as defined in section 43A of chapter 112 of the General Laws, which shall include, but not limited to, the current number of registered public health dental hygienists, the public health settings in which they practice and the type of procedures or services most commonly performed under that designation. The report shall also evaluate whether the designation of public health dental hygienists has improved access to safe and effective dental and dental hygiene services. The department shall submit the report, along with any recommendations for legislative or other action, to the clerks of the senate and house of representatives not later than July 1, 2010. The department shall submit a subsequent report, along with any recommendations for legislative or other action, to the clerks of the senate and house of representatives not later than July 1, 2013.
SECTION 15. The department of public health, in consultation with the board of registration in dentistry, shall determine an appropriate level of training for public health dental hygienists pursuant to section 51 of chapter 112 of the General Laws not later than 6 months after the effective date of this act.
SECTION 16. The board of registration in dentistry shall establish guidelines pursuant to section 51 of chapter 112 of the General Laws not later than 6 months after the effective date of this act.
SECTION 17. Sections 4, 5, 8, 9, 10 and 11 shall take effect on July 1, 2009.
Approved January 15, 2009