HB-4865, As Passed Senate, March 27, 2014

 

 

 

 

 

 

 

 

 

 

 

 

 

SENATE SUBSTITUTE FOR

 

HOUSE BILL NO. 4865

 

 

 

 

 

 

 

 

 

 

 

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

(MCL 333.1101 to 333.25211) by adding part 216.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

PART 216

 

MOBILE DENTAL FACILITY

 

     Sec. 21601. (1) As used in this part:

 

     (a) "Active patient" means a person who has received any type

 

of dental care in a mobile dental facility in the preceding 24

 

months.

 

     (b) "Assessment of a patient" means a limited clinical

 

inspection that is performed to identify possible signs of oral or

 

systemic disease, malformation, or injury, and the potential need

 

for referral for diagnosis and treatment.

 

     (c) "Clinical evaluation" means a diagnostic service provided

 

by a dentist that includes a complete intra- and extra-oral

 

inspection, may include other modalities of examination to identify

 

signs of oral or systemic disease, malformation, or injury, and may

 

include the completion of diagnosis and treatment planning to

 

determine the treatment needs of an individual patient.

 

     (d) "Comprehensive dental services" means clinical evaluation,

 

including diagnosis and treatment planning; imagery services; and

 

indicated treatment that may include preventative, restorative, and

 

surgical procedures that are considered necessary for an individual

 

patient.

 

     (e) "Dental home" means a network of individualized care based

 

on risk assessment, that includes oral health education, dental

 

screenings, preventative dental services, diagnostic services,

 

comprehensive dental services, and emergency services.

 

     (f) "Department" means the department of community health.

 

     (g) "Imagery" means visualization of oral and facial

 

structures using specialized instruments and techniques for

 

diagnostic purposes.

 

     (h) "Memorandum of agreement" means written documentation of

 

an agreement between parties to work together cooperatively on an

 

agreed-upon project or meet an agreed-upon objective. The purpose

 

of a memorandum of agreement is to have a written understanding of

 

the agreement between the parties. A memorandum of agreement serves

 

as a legal document that is binding and holds the parties

 

responsible to their commitment along with describing the terms and

 

details of the cooperative agreement. A memorandum of agreement may

 

be used between agencies, the public, the federal or state

 

government, communities, and individuals.

 

     (i) "Mobile dental facility" means either of the following:

 

     (i) A self-contained, intact facility in which dentistry or

 

dental hygiene is practiced that may be transported from 1 location

 

to another.

 

     (ii) A site used on a temporary basis to provide dental

 

services using portable equipment.

 

     (j) "Operator" means either of the following:

 

     (i) An individual with a valid, current license to practice

 

dentistry or dental hygiene in this state who utilizes and holds a

 

permit under this part for a mobile dental facility.

 

     (ii) A corporation, limited liability company, partnership, or

 

any governmental agency contracting with individuals licensed to

 

practice dentistry in this state or dental hygienists licensed in

 

this state, that utilizes and holds a permit under this part for a

 

mobile dental facility.

 

     (k) "Preventative dental services" means dental services that

 

include, but are not limited to, screening of a patient, assessment

 

of a patient, prophylaxis, fluoride treatments, and application of

 

sealants. Imagery studies are not preventative dental services.

 

     (l) "Screening of a patient" means screening, including state-

 

or federally mandated screening, to determine an individual's need

 

to be seen by a dentist for diagnosis.

 

     (2) In addition, article 1 contains general definitions and

 

principles of construction applicable to this part.

 

     Sec. 21603. (1) An operator shall obtain a permit under this

 

part for a mobile dental facility before offering dental services

 

at the facility.

 

     (2) A mobile dental facility shall have an operator in charge

 

at all times.

 

     (3) An operator may contract or employ other dentists, dental

 

hygienists, or dental assistants to work in a mobile dental

 

facility.

 

     (4) An operator may hold a permit for 1 or more mobile dental

 

facilities.

 

     Sec. 21605. (1) An individual or entity seeking a permit to

 

operate a mobile dental facility shall submit an application on a

 

form provided by the department.

 

     (2) An application submitted to the department under

 

subsection (1) shall include a registration fee in an amount

 

determined by the department but not more than the cost of a dental

 

license renewal fee.

 

     (3) A permit is valid for 3 years and an application for

 

renewal may be submitted not later than the last day of the month

 

in which the permit expires upon submission of proof to the

 

department of compliance with the requirements of this part. A

 

permit application that is not timely filed is subject to a late

 

fee in an amount determined by the department as the additional

 

cost of processing the late renewal, but not more than a dental

 

license late renewal fee.

 

     (4) A permit shall not be issued unless the applying

 

individual or entity is in compliance with all applicable

 

requirements of this part.

 

     (5) A permit issued under this part is not transferrable. If

 

the operator of the mobile dental facility changes, the permit is

 

no longer valid. However, if an application for a new permit to

 

continue operating the mobile dental facility is submitted not

 

later than 30 days after the change of operator, the former permit

 

is valid as an interim permit until the application is approved or

 

denied, but not longer than 90 days.

 

     (6) The department shall either approve or deny an application

 

for a permit under this part not later than 60 days after receiving

 

the application.

 

     Sec. 21607. (1) An applicant shall provide with the

 

application for a permit under this part, and subsequently, within

 

10 days after a request from the department, all of the following

 

information, as applicable:

 

     (a) A list of each dentist, dental hygienist, and dental

 

assistant who will provide care at or within the mobile dental

 

facility, including, at a minimum, each individual's name, address,

 

telephone number, and state occupational license number.

 

     (b) A written plan and procedure for providing emergency

 

follow-up care to each patient treated at the mobile dental

 

facility.

 

     (c) If the operator does not provide for follow-up services at

 

a site within a reasonable distance for the patient and is not

 

exempt under section 21611, a signed memorandum of agreement

 

between the operator and at least 1 dentist or party who can

 

arrange for or provide follow-up services at a site within a

 

reasonable distance for the patient. The memorandum of agreement

 

shall state that the contracting dentist or party will accept

 

referrals of patients treated at the mobile dental facility. The

 

agreement to accept a referral does not require the dentist or

 

party to treat the patient.

 

     (d) If the operator provides only preventative dental services

 

and is not exempt under section 21611, a signed memorandum of

 

agreement for referral for comprehensive dental services between

 

the operator and at least 1 dentist or party who can arrange for or

 

provide comprehensive dental services to the patient within a

 

reasonable distance for the patient.

 

     (e) Proof of general liability insurance covering the mobile

 

dental facility that is issued by a licensed insurance carrier

 

authorized to do business in this state.

 

     (2) An operator shall meet all of the following requirements:

 

     (a) Comply with all federal, state, and local laws,

 

regulations, and ordinances applicable to the operation of a mobile

 

dental facility, including, but not limited to, those concerning

 

radiographic equipment, flammability, sanitation, zoning, and

 

construction standards, including standards relating to required

 

access for persons with disabilities.

 

     (b) Maintain continuously available at the mobile dental

 

facility a communication device for making and receiving telephone

 

calls and summoning emergency services.

 

     (c) Make immediately available, upon request from any person,

 

a copy of the license of each dentist, dental hygienist, or dental

 

assistant working at the mobile dental facility.

 

     (d) Make immediately available, at the mobile dental facility,

 

upon request from any person, a copy of the permit required under

 

this part.

 

     (3) The operator of a mobile dental facility and the

 

operator's agents and employees shall comply with all federal,

 

state, and local laws, administrative rules, regulations, and

 

ordinances applicable to the mobile dental facility and to the

 

individuals and entities that provide the preventative dental

 

services or comprehensive dental services at the mobile dental

 

facility, including, but not limited to, those concerning

 

sanitation, infectious waste management and disposal, occupational

 

safety, and disease prevention.

 

     (4) An operator shall not provide dental services at a mobile

 

dental facility unless it is equipped with, or there is appropriate

 

access to, all of the following functional equipment:

 

     (a) An instrument sterilization system.

 

     (b) Potable hot and cold water or hand sanitizer.

 

     (c) Toilet facilities.

 

     (d) Smoke and carbon monoxide detectors, as applicable.

 

     (e) Radiographic equipment properly registered and inspected,

 

as applicable, by the state.

 

     (f) A communication device continuously available for making

 

and receiving telephone calls and summoning emergency services.

 

     (5) An operator shall not provide dental services at a mobile

 

dental facility unless it is equipped with, or there is appropriate

 

access to, all of the following:

 

     (a) Proper lighting.

 

     (b) Portable suction.

 

     (c) Hand pieces.

 

     (d) Dental instruments.

 

     (e) Supplies.

 

     (6) Except as provided in subsection (7) or (8), a dentist

 

licensed under this act shall be present in the mobile dental

 

facility at any time comprehensive dental services that are not

 

preventative dental services are performed on a patient. A dentist

 

licensed under this act need not be present at a mobile dental

 

facility when only preventative dental services are being provided.

 

     (7) If a mobile dental facility is part of a program that

 

provides comprehensive dental services or is established under a

 

memorandum of agreement that provides for referral for

 

comprehensive dental services, imagery services may be provided at

 

the mobile dental facility without a dentist present.

 

     (8) If a mobile dental facility is part of a program that

 

provides preventative dental services to a nursing home, assisted

 

living center, or other similar setting, imagery services may be

 

provided without a dentist present if the person taking the images

 

obtains permission from the supervising dentist.

 

     Sec. 21609. (1) The operator or his or her designee shall

 

establish a written treatment plan for, and provide a copy to, each

 

patient who receives dental services at a mobile dental facility.

 

If a patient receives dental services in a nursing home, a written

 

treatment plan shall be given to the nursing home for inclusion in

 

the patient's health chart.

 

     (2) The written treatment plan required under subsection (1)

House Bill No. 4865 as amended March 27, 2014

 

shall address comprehensive dental services to be provided either

 

at the mobile dental facility or through an affiliated dentist,

 

dental office, or party who can arrange for or provide those

 

services under a memorandum of agreement with the operator of the

 

mobile dental facility.

 

     (3) If the written treatment plan required under subsection

 

(1) will not be completed at the mobile dental facility, the

 

operator or his or her designee shall make a reasonable attempt to

 

refer the patient to a dentist or party who can arrange for or

 

provide services under a memorandum of agreement until the

 

treatment plan is completed or the patient ceases treatment. If the

 

patient is a minor or incapacitated person, the operator or his or

 

her designee shall also attempt to contact a parent or guardian and

 

inform him or her of the referral. If the operator or his or her

 

designee is unable to make arrangements for continued treatment, he

 

or she shall place written documentation of the attempts in the

 

patient record and make the documentation available to the

 

department upon request. A copy of the documentation shall be sent

 

to the patient. If a patient received dental services in a nursing

 

home, a copy of the documentation shall be sent to the nursing home

 

for inclusion in the patient's health chart. Failure of the

 

operator or his or her designee to comply with this subsection is

 

cause for disciplinary action by the department.

 

     (4) The operator shall obtain the patient's written consent,

 

or the consent of a parent or guardian of a patient who is a minor

 

or legally incapable of consent, before providing any dental

 

services to a patient at a mobile dental facility. <<HOWEVER, IF>>

a patient

House Bill No. 4865 as amended March 27, 2014

 

receives dental services in a nursing home, the operator <<MaY>>

 

obtain a doctor's order from the patient's attending physician or

 

the medical director of the nursing home <<IN LIEU OF ANY OTHER

REQUIRED CONSENT>> before providing any

 

dental services to a patient at a mobile dental facility.

 

     (5) The form for the written consent required under subsection

 

(4) shall include, at a minimum, all of the following:

 

     (a) The name of the operator.

 

     (b) The permanent address of the operator.

 

     (c) The telephone number that a patient may call 24 hours a

 

day for emergency calls.

 

     (d) A list of the services to be provided.

 

     (e) A statement indicating that the patient, parent, or

 

guardian understands that treatment may be obtained at the

 

patient's dental home rather than at a mobile dental facility and

 

that obtaining duplicate services at a mobile dental facility may

 

affect benefits that he or she receives from private insurance, a

 

state or federal program, or other third-party provider of dental

 

benefits.

 

     (6) If the patient is a minor or incapacitated person, the

 

written consent form required under subsection (4) shall also

 

include a request for the name or contact information for the

 

dentist or dental office that provided dental services in the past

 

12 months.

 

     (7) Each person receiving dental services at a mobile dental

 

facility shall receive all of the following information:

 

     (a) The name of the dentist, dental hygienist, dental

 

assistant, or party who arranged for or provided the dental

 

services to the patient.

 

     (b) The telephone number or emergency contact number to reach

 

the mobile dental facility or operator in case of emergency.

 

     (c) A list of the dental services rendered.

 

     (d) A description of any further dental services that are

 

advisable or that have been scheduled.

 

     (e) A referral to a specialist, dentist, or party who can

 

arrange for or provide comprehensive dental services if dental

 

services cannot be provided at the mobile dental facility. Upon

 

request of the dentist or party who accepts the referral, the

 

operator shall transmit all imagery records taken of the patient at

 

the mobile dental facility.

 

     (f) A copy of the consent form required under this section

 

authorizing additional treatment.

 

     (8) An operator who fails to comply with federal, state, or

 

local laws and rules applicable to the mobile dental facility or

 

any of the requirements of this part is subject to disciplinary

 

action by the department.

 

     Sec. 21611. If the operator has a memorandum of agreement due

 

to its status as a state of Michigan designated or funded oral

 

health prevention program with oversight from the department, the

 

operator is exempt from any requirement concerning a memorandum of

 

agreement under this part.

 

     Sec. 21613. (1) The operator or his or her designee shall

 

notify the department not later than 30 days after any of the

 

following occurrences:

 

     (a) A change in the mobile dental facility operator.

 

     (b) A change in a memorandum of agreement required under

 

section 21607.

 

     (c) A change in the address or telephone number of the mobile

 

dental facility operator.

 

     (d) Cessation of operation of a mobile dental facility.

 

     (e) Any memorandum of agreement entered into after obtaining a

 

permit under this part.

 

     (2) Upon cessation of operation of a mobile dental facility,

 

the operator shall do all of the following:

 

     (a) Provide written notice to all treatment venues and, upon

 

request, provide evidence of the written notice to the department.

 

     (b) Provide for availability of each active patient's dental

 

records by 1 of the following methods:

 

     (i) Make the dental records available to the patient or the

 

patient's parent or guardian for 180 days after the mobile dental

 

facility ceases operation and, upon his or her request, transfer

 

the records to the active patient, the patient's parent or

 

guardian, or another dentist.

 

     (ii) Transfer the records to another dentist.

 

     (c) Notify each active patient or the patient's parent or

 

guardian that the dental records are available as required under

 

subdivision (b), including the name and contact information for the

 

dentist if the records have been transferred.

 

     (d) Upon request from the department, provide documentation

 

that a reasonable attempt was made to contact each active patient

 

or the active patient's parent or guardian to provide information

 

concerning storage and retrieval of the patient's records.

 

     Sec. 21615. (1) Any individual or entity owning, operating, or

 

providing services at a mobile dental facility is exempt from this

 

part if the mobile dental facility is used solely to provide

 

services that are rendered without compensation.

 

     (2) If a provision in this part conflicts with a federal law

 

regulating nursing homes, the federal law prevails.

 

     (3) The department may promulgate rules to implement this

 

part.

 

     Sec. 21617. This part does not require new or additional

 

third-party reimbursement or mandated worker's compensation

 

benefits for services rendered at a mobile dental facility.

 

     Enacting section 1. This amendatory act takes effect on April

 

1, 2015.