HOUSE OF REPRESENTATIVES

H.B. NO.

257

TWENTY-EIGHTH LEGISLATURE, 2015

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to dental therapists.

 

 

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

 


     SECTION 1.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

Dental therapists

Part I.  General provisions

     §   -1  Definitions.  As used in this chapter:

     "Advanced practice dental therapist" means a person licensed as a dental therapist under this chapter and who has been certified by the board to practice as an advanced practice dental therapist under part III.

     "Board" means the board of dental examiners.

     "Dental health professional shortage area" means an area that meets the criteria established by the secretary of the United States Department of Health and Human Services and is designated as such under United States Code, title 42, section 254e.

     "Dental therapist" means a person licensed under this chapter to perform the services authorized under part II or any other services authorized under this chapter.

     "General supervision" means the supervision of tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time the tasks or procedures are being performed but require the tasks be performed with the prior knowledge and consent of the dentist.

     "Indirect supervision" means the dentist is in the office, authorizes the procedures, and remains in the office while the procedures are being performed by the allied dental personnel.

     "Practice of dental therapy" means:

     (1)  Working under the supervision of a licensed dentist under a collaborative management agreement as specified under part II;

     (2)  Practicing in settings that serve low-income, uninsured, and underserved patients or are located in dental health professional shortage areas; and

     (3)  Providing oral health care services, including preventive, oral evaluation and assessment, educational, palliative, therapeutic, and restorative services as authorized under parts II and III and within the context of a collaborative management agreement.

     "Practice settings that serve the low-income and underserved" mean:

     (1)  Critical access dental provider settings as determined by the director of human services;

     (2)  Military and veterans administration hospitals, clinics, and care settings;

     (3)  A patient's residence or home when the patient is home-bound or receiving or eligible to receive home care services or home and community-based waivered services, regardless of the patient's income;

     (4)  Oral health educational institutions; or

     (5)  Any other clinic or practice setting, including mobile dental units, in which at least fifty percent of the total patient base of the dental therapist or advanced practice dental therapist consists of patients who:

         (A)  Are enrolled in a health care program in the State;

         (B)  Have a medical disability or chronic condition that creates a significant barrier to receiving dental care;

         (C)  Do not have dental health coverage, either through a public health care program or private insurance, and have an annual gross family income equal to or less than two hundred per cent of the federal poverty guidelines; or

         (D)  Do not have dental health coverage either through a state public health care program or private insurance, and whose family gross income is equal to or less than two hundred per cent of the federal poverty guidelines.

PART II.  DENTAL THERAPISTS

     §   -2  Dental therapists.  (a)  A person of good moral character may apply for licensure if the person has graduated with a baccalaureate degree or a master's degree from a dental therapy education program that has been approved by the board or accredited by the Commission on Dental Accreditation or another board-approved national accreditation organization.

     (b)  The applicant shall submit an application and fee as prescribed by the board and a diploma or certificate from a dental therapy education program.  Prior to being licensed, the applicant shall pass a comprehensive, competency-based clinical examination that is approved by the board and administered independently of an institution providing dental therapy education.  The applicant shall also pass an examination testing the applicant's knowledge of the state laws and rules relating to the practice of dentistry.  An applicant who has failed the clinical examination twice shall not be eligible to retake the clinical examination until further education and training are obtained as specified by the board.  A separate, nonrefundable fee may be charged for each application.  An applicant who passes both examinations, abides by professional ethical conduct requirements, and meets all the other requirements of the board shall be licensed as a dental therapist.

     §   -3  General.  A dental therapist licensed under this chapter shall practice under the supervision of a dentist licensed pursuant to chapter 448 and pursuant to the requirements of this chapter.

     §   -4  Limited practice settings.  A dental therapist licensed under this chapter shall be limited to primarily practicing in practice settings that serve the low-income and underserved or in a dental health professional shortage area.

     §   -5  Collaborative management agreement.  (a) Prior to performing any of the services authorized under this chapter, a dental therapist shall enter into a written collaborative management agreement with a licensed dentist.  A collaborating dentist shall be limited to entering into a collaborative agreement with no more than five dental therapists or advanced practice dental therapists at any one time.  The agreement shall include:

     (1)  Practice settings where services may be provided and the populations to be served;

     (2)  Any limitations on the services that may be provided by the dental therapist, including the level of supervision required by the collaborating dentist;

     (3)  Age and procedure-specific practice protocols, including case selection criteria, assessment guidelines, and imaging frequency;

     (4)  A procedure for creating and maintaining dental records for the patients that are treated by the dental therapist;

     (5)  A plan to manage medical emergencies in each practice setting where the dental therapist provides care;

     (6)  A quality assurance plan for monitoring care provided by the dental therapist, including patient care review, referral follow-up, and a quality assurance chart review;

     (7)  Protocols for administering and dispensing medications authorized under section    -7, and part III, including the specific conditions and circumstances under which these medications may be dispensed and administered;

     (8)  Criteria relating to the provision of care to patients with specific medical conditions or complex medication histories, including requirements for consultation prior to the initiation of care;

     (9)  Supervision criteria of dental assistants; and

    (10)  A plan for the provision of clinical resources and referrals in situations that exceed the capabilities of the dental therapist.

     (b)  A collaborating dentist shall be licensed pursuant to chapter 448 and practicing in the State.  The collaborating dentist shall accept responsibility for all services authorized and performed by the dental therapist pursuant to the management agreement.  It shall be a violation of this chapter for any licensed dentist to permit a dental therapist to perform a dental service other than those authorized under this section or by the board, or for any dental therapist to perform an unauthorized service.

     (c)  Collaborative management agreements shall be signed and maintained by the collaborating dentist and the dental therapist.  Agreements shall be reviewed, updated, and filed with the board on an annual basis.

     §   -6  Scope of practice.  (a)  A licensed dental therapist may perform dental services as authorized under this section within the parameters of the collaborative management agreement.

     (b)  A licensed dental therapist may provide the oral health services specified in subsections (c) and (d) and within the parameters of the collaborative management agreement.

     (c)  A licensed dental therapist may perform the following services under general supervision, unless restricted or prohibited in the collaborative management agreement:

     (1)  Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis;

     (2)  Preliminary charting of the oral cavity;

     (3)  Making radiographs;

     (4)  Mechanical polishing;

     (5)  Application of topical preventive or prophylactic agents, including fluoride varnishes and pit and fissure sealants;

     (6)  Pulp vitality testing;

     (7)  Application of desensitizing medication or resin;

     (8)  Fabrication of athletic mouthguards;

     (9)  Placement of temporary restorations;

    (10)  Fabrication of soft occlusal guards;

    (11)  Tissue conditioning and soft reline;

    (12)  Atraumatic restorative therapy;

    (13)  Dressing changes;

    (14)  Tooth reimplantation;

    (15)  Administration of local anesthetic; and

    (16)  Administration of nitrous oxide.

     (d)  A licensed dental therapist may perform the following services under indirect supervision:

     (1)  Emergency palliative treatment of dental pain;

     (2)  The placement and removal of space maintainers;

     (3)  Cavity preparation;

     (4)  Restoration of primary and permanent teeth;

     (5)  Placement of temporary crowns;

     (6)  Preparation and placement of preformed crowns;

     (7)  Pulpotomies on primary teeth;

     (8)  Indirect and direct pulp capping on primary and permanent teeth;

     (9)  Stabilization of reimplanted teeth;

    (10)  Extractions of primary teeth;

    (11)  Suture removal;

    (12)  Brush biopsies;

    (13)  Repair of defective prosthetic devices; and

    (14)  Recementing of permanent crowns.

     §   -7  Dispensing authority.  (a)  A licensed dental therapist may dispense and administer the following drugs within the parameters of the collaborative management agreement and within the scope of practice of the dental therapist:

     (1)  Analgesics;

     (2)  Anti-inflammatories; and

     (3)  Antibiotics.

     (b)  The authority to dispense and administer drugs shall extend only to the categories of drugs identified in this section, and may be further limited by the collaborative management agreement.

     (c)  The authority to dispense drugs includes the authority to dispense sample drugs within the categories identified in this section if dispensing is permitted by the collaborative management agreement.

     (d)  A licensed dental therapist shall be prohibited from dispensing or administering a narcotic drug as defined in section 329-1.

     §   -8  Application of other laws.  A licensed dental therapist authorized to practice under this chapter shall not be in violation of this part as it relates to the unauthorized practice of dentistry if the practice is authorized under this chapter and is permitted by the terms of the collaborative management agreement.

     §   -9  Use of dental assistants.  (a)  A licensed dental therapist may supervise dental assistants to the extent permitted in the collaborative management agreement.

     (b)  Notwithstanding subsection (a), a licensed dental therapist shall not supervise more than four dental assistants at any one practice setting.

PART III.  ADVANCED PRACTICE DENTAL THERAPISTS

     §   -10  Advanced practice dental therapist.  The board shall grant recognition as an advanced practice dental therapist to a dental therapist who has:

     (1)  A current unencumbered license as a dental therapist in this State;

     (2)  Completed a dental therapy education program;

     (3)  Passed an examination to demonstrate competency under the dental therapy scope of practice;

     (4)  Completed two thousand hours of dental therapy clinical practice under direct or indirect supervision;

     (5)  Graduated from a master's advanced dental therapy education program;

     (6)  Passed a board-approved certification examination to demonstrate competency under the advanced scope of practice; and

     (7)  Submitted an application for certification as prescribed by the board.

     §   -11  Scope of practice; advanced practice dental therapist.  (a)  An advanced practice dental therapist certified by the board may perform the following services and procedures pursuant to the written collaborative management agreement:

     (1)  An oral evaluation and assessment of dental disease and the formulation of an individualized treatment plan authorized by the collaborating dentist;

     (2)  The services and procedures described under section    -6(c) and (d); and

     (3)  Nonsurgical extractions of permanent teeth as limited in section    -12(b).

     (b)  The services and procedures described under this section may be performed under the general supervision of a licensed dentist.

     §   -12  Practice limitation; advanced practice dental therapist.  (a)  An advanced practice dental therapist shall not perform any service or procedure described in section    -11 except as authorized by the collaborating dentist.

     (b)  An advanced practice dental therapist 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 advanced practice dental therapist shall not extract a tooth for any patient if the tooth is unerupted, impacted, fractured, or needs to be sectioned for removal.

     (c)  The collaborating dentist shall be responsible for directly providing or arranging for another dentist or specialist to provide any necessary advanced services needed by the patient.

     (d)  In accordance with the collaborative management agreement, an advanced practice dental therapist shall refer patients to another qualified dental or health care professional to receive any needed services that exceed the scope of practice of the advanced practice dental therapist.

     (e)  In addition to the collaborative management agreement requirements described in part II, a collaborative management agreement entered into with an advanced practice dental therapist shall include specific written protocols to govern situations in which the advanced practice dental therapist encounters a patient who requires treatment that exceeds the authorized scope of practice of the advanced practice dental therapist.  The collaborating dentist shall ensure that a dentist shall be available to the advanced practice dental therapist for timely consultation during treatment if needed and shall either provide or arrange with another dentist or specialist to provide the necessary treatment to any patient who requires more treatment than the advanced practice dental therapist is authorized to provide.

     §   -13  Medications; advanced practice dental therapist.  (a)  An advanced practice dental therapist may provide, dispense, and administer the following drugs within the parameters of the collaborative management agreement, within the scope of practice of the advanced practice dental therapist, and with the authorization of the collaborating dentist:

     (1)  Analgesics;

     (2)  Anti-inflammatories; and

     (3)  Antibiotics.

     (b)  The authority to provide, dispense, and administer drugs shall extend only to the categories of drugs identified in this section, and may be further limited by the collaborative management agreement.

     (c)  The authority to dispense drugs shall include the authority to dispense sample drugs within the categories identified in this section if dispensing is permitted by the collaborative management agreement.

     (d)  Notwithstanding subsection (a), an advanced practice dental therapist shall be prohibited from providing, dispensing, or administering a narcotic drug as defined in section 329-1."

     SECTION 2.  Section 466J-6, Hawaii Revised Statutes, is amended to read by amending subsection (a) to read as follows:

     "(a)  Any provision in this chapter to the contrary notwithstanding, a license shall not be required for:

     (1)  A licensed medical practitioner in radiology;

     (2)  A licensed practitioner of nuclear medicine;

     (3)  A licensed physician assistant;

     (4)  A licensed doctor of dentistry[;] or a licensed dental therapist;

     (5)  A licensed dental technician;

     (6)  A licensed dental hygienist;

     (7)  A student in an approved school for radiographers, radiation therapists, or nuclear medicine technologists, or in a school of medicine, podiatry, dentistry, or a chiropractic school; provided that the student is operating x-ray machines under the direct supervision of a licensed radiographer, licensed radiation therapist, licensed nuclear medicine technologist, or a qualified person pursuant to this chapter; and

     (8)  A radiologist duly licensed to practice medicine and radiology services in another state who uses telemedicine while located in this State to provide radiology services to a patient who is located in the state in which the radiologist is licensed.  For the purposes of this paragraph:

              "Radiologist" means a doctor of medicine or a doctor of osteopathy certified in radiology by the American Board of Radiology or the American Board of Osteopathy.

              "Telehealth" means the use of telecommunications, as that term is defined in section 269-1, including but not limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information to parties separated by distance.  Standard telephone contacts, facsimile transmissions, or email texts, in combination or by themselves, do not constitute a telehealth service for the purposes of this paragraph."

     SECTION 3.  Section 448-8.5, Hawaii Revised Statutes, is amended to read as follows:

     "[[[§448-8.5[]]  Continuing education requirements.  The board shall adopt [a program of continuing education for dentists and a program of continuing education for dental hygienists.] programs of continuing education for dentists, dental hygienists, and dental therapists.  After January 1, 2002, at the time of reregistration of license as a dentist or dental hygienist, and after January 1, 2018, at the time of registration of a license as a dental therapist, each licensee shall present to the board evidence of compliance with the program of continuing education applicable to their profession.  Failure to reregister and present evidence of compliance shall constitute a forfeiture of license, which may be restored only upon written application therefor and payment to the board of a restoration fee."

     SECTION 4.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 5.  This Act shall take effect upon its approval.

 

INTRODUCED BY:

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Report Title:

Dental Therapists; Licensure; Certification

 

Description:

Requires the licensure of dental therapists and the certification of advanced practice dental therapists.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.