Bill Text: MI HB5374 | 2015-2016 | 98th Legislature | Introduced

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Bill Title: Health occupations; health care professionals; limited prescriptive authority for dental hygienists; establish. Amends sec. 16611 of 1978 PA 368 (MCL 333.16611).

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2016-02-17 - Bill Electronically Reproduced 02/16/2016 [HB5374 Detail]

Download: Michigan-2015-HB5374-Introduced.html

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HOUSE BILL No. 5374

February 16, 2016, Introduced by Rep. Chatfield and referred to the Committee on Health Policy.

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending section 16611 (MCL 333.16611), as amended by 2004 PA

 

30.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 16611. (1) An individual shall not engage in the practice

 

of dentistry, the practice as a dental hygienist, or the practice

 

as a dental assistant unless he or she is licensed or otherwise

 

authorized by this article.

 

     (2) Deep scaling, root planing, and the removal of calcareous

 

deposits may only be performed by an individual who is licensed or

 

otherwise authorized by this article as a dental hygienist or a

 

dentist.

 

     (3) The department shall not issue a dental hygienist's

 

license to an individual unless the individual has graduated from a

 

school or college for dental hygienists whose dental hygiene

 

program is accredited by the commission on dental accreditation

 

Commission on Dental Accreditation of the American dental

 

association Dental Association and approved by the department. The

 

school or college must be accredited by a regional accrediting

 

agency for colleges, universities, or institutions of higher

 

education that is recognized by the United States department of

 

education Department of Education and approved by the department

 

and must conduct a curriculum consisting of not less than 2

 

academic years for dental hygiene graduation with courses at the

 

appropriate level to enable matriculation into a more advanced

 

academic degree program.

 

     (4) Upon delegation by a dentist under section 16215 and under

 

the direct supervision of a dentist, a dental hygienist may

 

administer intraoral block and infiltration anesthesia or nitrous

 

oxide analgesia, or both, to a patient 18 years of age or older, if

 

the following criteria are met:

 

     (a) The dental hygienist has successfully completed a course

 

in the administration of local anesthesia or nitrous oxide

 

analgesia, or both, as applicable, offered by a dental or dental

 

hygiene program accredited by the commission on dental

 

accreditation Commission on Dental Accreditation of the American

 

dental association Dental Association and approved by the

 

department. A course described in this subdivision involving local

 

anesthesia administration must contain a minimum of 15 hours

 

didactic instruction and 14 hours of clinical experience. A course

 

described in this subdivision involving nitrous oxide analgesia

 

administration must contain a minimum of 4 hours of didactic

 

instruction and 4 hours of clinical experience. The courses of

 

instruction shall include content in all of the following:

 

     (i) In the case of local anesthesia, the following:

 

     (A) Theory of pain control.

 

     (B) Selection of pain control modalities.

 

     (C) Anatomy.

 

     (D) Neurophysiology.

 

     (E) Pharmacology of local anesthetics.

 

     (F) Pharmacology of vasoconstrictors.

 

     (G) Psychological aspects of pain control.

 

     (H) Systemic complications.

 

     (I) Techniques of maxillary anesthesia.

 

     (J) Techniques of mandibular anesthesia.

 

     (K) Infection control.

 

     (L) Local anesthesia medical emergencies.

 

     (ii) In the case of nitrous oxide analgesia, the following:

 

     (A) Nitrous oxide analgesia medical emergency techniques.

 

     (B) Pharmacology of nitrous oxide.

 

     (C) Nitrous oxide techniques.

 

     (D) If such a course is available, selection of pain control

 

modalities.

 

     (b) The dental hygienist has successfully completed a state or

 

regional board-administered written examination on either or both

 

of the following within 18 months of completion of the course work

 

required under subdivision (a):

 

     (i) Local anesthesia.

 

     (ii) Nitrous oxide analgesia, if such an examination is

 

available and approved by the department.

 

     (c) The dental hygienist maintains and can show evidence of

 

current certification in basic or advanced cardiac life support in

 

compliance with R 338.11701 of the Michigan administrative code.

 

     (5) Application for certification in the administration of

 

local anesthesia and nitrous oxide under subsection (4) is at the

 

discretion of each individual dental hygienist. The department or

 

its designee shall issue a certificate to a dental hygienist who

 

meets the criteria in subsection (4) following the initial

 

completion of the requirements to administer local anesthesia or

 

nitrous oxide, or both. The certificate is not subject to renewal

 

but is part of the dental hygienist's permanent record and must be

 

prominently displayed in the dental hygienist's principal place of

 

employment. The fee for the person seeking certification for

 

completion of the requirements of subsection (4) is $10.00.

 

     (6) Monitoring and assisting the administration of nitrous

 

oxide analgesia is at the discretion of each individual registered

 

dental assistant who fulfills the applicable conditions imposed in

 

subsection (7).

 

     (7) In addition to the rules promulgated by the department

 

under this part, upon delegation by a dentist under section 16215

 

and under the direct supervision of a dentist, a registered dental

 

assistant may assist and monitor the administration of nitrous

 

oxide analgesia by the dentist or dental hygienist if the

 

registered dental assistant has successfully completed a course in

 

the assisting and monitoring of the administration of nitrous oxide

 

analgesia offered by a dental or dental assisting program

 

accredited by the commission on dental accreditation Commission on

 

Dental Accreditation of the American dental association Dental

 

Association and approved by the department. The course must contain

 

a minimum of 5 hours of didactic instruction and include content in

 

all of the following:

 

     (a) Nitrous oxide analgesia medical emergencies techniques.

 

     (b) Pharmacology of nitrous oxide.

 

     (c) Nitrous oxide techniques.

 

     (8) The ability of a dental hygienist to administer nitrous

 

oxide analgesia under this section is limited to circumstances in

 

which the dental hygienist may administer not more than 50% nitrous

 

oxide.

 

     (9) In the assisting by a registered dental assistant

 

otherwise qualified under this section in the administration of

 

nitrous oxide analgesia, the nitrous oxide levels must be preset by

 

the dentist or dental hygienist and shall not be adjusted by the

 

registered dental assistant except in the case of an emergency, in

 

which circumstances the registered dental assistant may turn off

 

the nitrous oxide and administer 100% oxygen.

 

     (10) Upon assignment by a dentist, a dental hygienist may take

 

an impression for orthodontic appliances, mouth guards, bite

 

splints, and bleaching trays.

 

     (11) In addition to the rules promulgated by the department

 

under this part, upon delegation by a dentist under section 16215

 

and under the direct supervision of a dentist, a registered dental

 

assistant may place, condense, and carve amalgam restorations and

 

take final impressions for indirect restorations if the registered

 

dental assistant has successfully completed a course offered by a

 

dental or dental assisting program accredited by the commission on

 

dental accreditation Commission on Dental Accreditation of the

 

American dental association Dental Association and approved by the

 

department. For taking final impressions and placing, condensing,

 

and carving amalgam restorations, the registered dental assistant

 

shall have completed a course with a minimum of 20 hours' didactic

 

instruction followed by a comprehensive clinical experience of

 

sufficient duration that validates clinical competence through a

 

criterion based assessment instrument.

 

     (12) In addition to the rules promulgated by the department

 

under this part, upon delegation by a dentist under section 16215

 

and under the general supervision of a dentist, a registered dental

 

assistant may perform the following intraoral dental procedures if

 

the registered dental assistant has successfully completed a course

 

meeting the standards described in subsection (13) offered by a

 

dental or dental assisting program accredited by the commission on

 

dental accreditation Commission on Dental Accreditation of the

 

American dental association Dental Association and approved by the

 

department:

 

     (a) Performing pulp vitality testing.

 

     (b) Placing and removing matrices and wedges.

 

     (c) Applying cavity liners and bases.

 

     (d) Placing and packing nonepinephrine retraction cords.

 

     (e) Applying desensitizing agents.

 

     (f) Taking an impression for orthodontic appliances, mouth

 

guards, bite splints, and bleaching trays.

 

     (g) Drying endodontic canals with absorbent points.

 

     (h) Etching and placing adhesives prior to placement of

 

orthodontic brackets.

 

     (13) The course in subsection (12) that involves those

 

intraoral procedures described in subsection (12) must contain a

 

minimum of 10 hours of didactic and clinical instruction.

 

     (14) In addition to any prescriptive authority granted by

 

rules promulgated by the department under this part, upon

 

assignment by a dentist, and following practice guidelines that are

 

consistent with national recommendations, a dental hygienist may

 

prescribe any of the following for a patient:

 

     (a) Any fluoride supplement in the form of a tablet, lozenge,

 

drop, or similar method of oral dosing.

 

     (b) Any topical sodium fluoride or stannous fluoride anti-

 

caries treatment in the form of a toothpaste, gel, rinse, varnish,

 

prophy paste, or similar method of application.

 

     (c) Any topical or subgingival anti-infective.

 

     (15) (14) This section does not require new or additional

 

third party reimbursement or mandated worker's compensation

 

benefits for services rendered by an individual licensed as a

 

dental assistant or as a dental hygienist under this article.

 

     (16) (15) Within 30 days after the effective date of the

 

amendatory act that added this subsection, By April 21, 2004, the

 

board shall develop patient safety and equipment practice

 

guidelines for dentists delegating to dental hygienists and dental

 

assistants the administration of nitrous oxide analgesia under this

 

part. The practice guidelines shall be consistent with national

 

recommendations.

 

     (17) (16) As used in this section:

 

     (a) "Assisting" means setting up equipment and placing the

 

face mask. Assisting does not include titrating and turning on or

 

off equipment.

 

     (b) "Direct supervision" means that a dentist complies with

 

all of the following:

 

     (i) Designates a patient of record upon whom the procedures

 

are to be performed and describes the procedures to be performed.

 

     (ii) Examines the patient before prescribing the procedures to

 

be performed and upon completion of the procedures.

 

     (iii) Is physically present in the office at the time the

 

procedures are being performed.

 

     (c) "General supervision" means that a dentist complies with

 

all of the following:

 

     (i) Designates a patient of record upon whom services are to

 

be performed.

 

     (ii) Is physically present in the office at the time the

 

procedures are being performed.

 

     (d) "Monitoring" means observing levels and reporting to the

 

dentist or dental hygienist.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.