September 27, 2012, Introduced by Rep. MacGregor and referred to the Committee on Health Policy.
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 prediagnostic service of
limited or focused inspection that is completed to identify signs
of oral or systemic disease, malformation, or injury, and the
potential need for referral of a patient to a dentist for diagnosis
and treatment planning.
(c) "Board of dentistry" means the board created under part
166.
(d) "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 proper diagnosis and treatment planning
to determine the treatment needs of an individual patient.
(e) "Comprehensive dental services" means the clinical
evaluation, including diagnosis and treatment planning, imagery
services, and providing indicated treatment that may include
preventative, restorative, and surgical procedures that are
considered necessary for an individual patient.
(f) "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.
(g) "Dentally underserved population" means a population that
meets 1 of the following criteria:
(i) Fifty percent or more of the prospective patients are
medicaid-eligible or enrolled in medicaid.
(ii) There is an identifiable subpopulation of prospective
patients located in an area designated as a dental health
profession shortage area by the department of community health.
(iii) Twenty-five percent or more of the prospective patients
are eligible for a federal free or reduced-priced lunch subsidy.
(h) "Memorandum of agreement" means a document written between
parties to cooperatively work together 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) Any facility where dental services are rendered using
portable equipment.
(j) "Operator" means either of the following:
(i) An individual licensed to practice dentistry in this state
who utilizes and holds a permit under this part for a mobile dental
facility and is a licensed dentist, in good standing and possessing
a valid and current license under this act.
(ii) A Michigan nonprofit corporation or any governmental
agency contracting with individuals licensed to practice dentistry
in this state or dental hygienists licensed in this state, who
utilize and hold 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 a prediagnostic service to
determine a patient's need to be seen by a dentist for diagnosis.
Screening of a patient includes a state- or federally mandated
screening.
(2) In addition, article 1 contains general definitions and
principles of construction applicable to all articles in this code.
Sec. 21603. (1) Every mobile dental facility must obtain a
permit under this part.
(2) Every mobile dental facility must have an operator in
charge at all times.
(3) An owner of a mobile dental facility or an owner of an
entity providing contractual management services to an operator is
subject to the requirements of this part.
(4) An operator may contract or employ other dentists, dental
hygienists, or dental assistants to work in a mobile dental
facility.
(5) One operator may hold permits for more than 1 mobile
dental facility.
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 of licensing and regulatory
affairs.
(2) At the time of application, the individual or entity
seeking a permit shall pay a registration fee to the department of
licensing and regulatory affairs in an amount determined by the
department of licensing and regulatory affairs.
(3) A permit is valid for 2 years and may be renewed not later
than the last day of the month in which the permit was issued upon
submission of proof to the department of licensing and regulatory
affairs of compliance with the requirements of this part. Permits
not renewed on time are subject to a late fee as prescribed by the
department of licensing and regulatory affairs.
(4) A permit shall not be issued unless the applying
individual or entity complies with all of the requirements of this
part.
(5) If ownership of the mobile dental facility changes, the
permit is rendered invalid and a new permit application must be
submitted within 30 days after the transfer of ownership.
Sec. 21607. (1) An operator shall provide as part of the
application for a permit, and after an application has been
submitted, within 10 days after a request from the department of
licensing and regulatory affairs, all of the following information,
as applicable:
(a) A list of each dentist, dental hygienist, and dental
assistant who will be providing care at or within the mobile dental
facility, providing, 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 all patients treated at the mobile dental
facility.
(c) A signed memorandum of agreement between the operator and
at least 1 dentist located within a 100-mile radius in the Upper
Peninsula or a 50-mile radius in the Lower Peninsula of any
location where the operator provides service to a patient, that
states the contracting dentist will accept patients treated at the
mobile dental facility for any follow-up dental services, if the
operator does not provide for follow-up services at a permanent
location located within a 100-mile radius in the Upper Peninsula or
a 50-mile radius in the Lower Peninsula of where the operator
provided service to the patient.
(d) To the extent the operator only provides preventative
dental services, a signed memorandum of agreement for referral for
comprehensive dental services between the operator and a dentist
located within a 100-mile radius in the Upper Peninsula or a 50-
mile radius in the Lower Peninsula of the location where the
operator provides services to a patient.
(e) A written plan that shows compliance with the guidelines
established by the department of community health and Michigan
dental association for school-based oral health programs.
(f) A copy of the driver license and official motor vehicle
driving record from the secretary of state of every person that
will be driving or transporting the mobile dental facility.
(g) Proof of general liability insurance covering the mobile
dental facility 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 applicable federal, state, and local laws,
regulations, and ordinances, 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 a constantly available communication device for
making and receiving telephone calls and summoning emergency
services at the mobile dental facility.
(c) Have immediately available, upon request, a copy of the
license of each dentist, dental hygienist, or dental assistant
working within the mobile dental facility.
(d) Have immediately available, upon request, a copy of the
permit required under this part in the mobile dental facility.
(3) A mobile dental facility shall comply with all federal,
state, and local laws, regulations, and ordinances applicable to
providing preventative dental services or comprehensive dental
services at the mobile dental facility, including, but not limited
to, those concerning the operation of sanitation, infectious waste
management and disposal, occupational safety, disease prevention,
and administrative code rules pertaining to the practice of
dentistry.
(4) A mobile dental facility shall have ready access to all of
the following functional equipment:
(a) Instrument sterilization system.
(b) Potable hot and cold water, hand sanitizer, or both.
(c) Toilet facilities.
(d) A ramp or lift.
(e) Smoke and carbon monoxide detectors, as applicable.
(f) Radiographic equipment properly registered and inspected
by the state.
(g) Communication devices constantly available for making and
receiving telephone calls and summoning emergency services.
(5) A mobile dental facility shall have ready access to the
following dental equipment:
(a) Proper lighting.
(b) Portable suction.
(c) Hand pieces.
(d) Dental instruments.
(e) Supplies.
(6) A dentist licensed under this act shall be present in a
mobile dental facility at any time comprehensive dental services
are being performed on a patient.
Sec. 21609. (1) The operator or his or her designee shall
establish and provide a written treatment plan to all patients
receiving dental services at a mobile dental facility.
(2) The written treatment plan required under subsection (1)
shall address providing comprehensive dental services either by the
mobile dental facility or through an affiliated dentist or dental
office providing those services under a memorandum of agreement
with the mobile dental facility.
(3) If the written treatment plan required under subsection
(1) cannot be completed during the patient's initial visit to the
mobile dental facility, the operator or his or her designee shall
make a reasonable attempt to schedule additional appointments to
complete dental services either at the mobile dental facility or
with an affiliated dentist or dental office providing those dental
services under a memorandum of agreement with the mobile dental
facility, at intervals not to exceed 90 days, until the treatment
plan is completed or the patient ceases treatment. If the operator
or his or her designee is unable to make arrangements for continued
treatment, written documentation of the attempts must be part of
the patient record and be available upon request. A copy of this
documentation must be sent to the patient. Failure of the operator
or his or her designee to comply with the provisions of this
subsection shall be considered unprofessional conduct by patient
abandonment and is subject to disciplinary action by the board of
dentistry.
(4) The operator shall obtain the patient's written consent
before providing any dental services to a patient at a mobile
dental facility.
(5) A parent or guardian must authorize providing dental
services to a minor child or incapacitated person at a mobile
dental facility.
(6) The written consent form required under subsection (4)
shall include, at a minimum, all of the following:
(a) The name of the mobile dental facility providing dental
services.
(b) The permanent address of the mobile dental facility.
(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 treatment may be provided at the patient's
dental home rather than at a mobile dental facility.
(7) If the patient is a minor or incapacitated person, the
written consent required under subsection (4) must also include
both of the following:
(a) If the minor or incapacitated person has had dental
services in the past 12 months, the name and address of the dentist
or dental office where the dental services were provided.
(b) A statement indicating that the minor or incapacitated
person may have any or all dental treatment at the dental home and
that duplication of treatment of the minor or incapacitated person
at a mobile dental facility may impact benefits that he or she
receives from private insurance, a state or federal program, or
other third-party provider of dental benefits.
(8) Each person receiving dental services at a mobile dental
facility shall receive all of the following printed information:
(a) The name of the dentist, dental hygienist, or dental
assistant who provided the dental services to the patient.
(b) The telephone number or emergency contact number to reach
the mobile dental facility or operator, or both, in case of
emergency.
(c) A list of the treatment rendered, including dental
procedure code, fee, and tooth numbers.
(d) A description of any further treatment that is advisable
or that has been scheduled.
(e) A referral to a specialist or other dentist if the mobile
dental facility is unable to provide the necessary comprehensive
dental services.
(f) A copy of the consent form required under this section for
additional treatment.
(9) An operation may operate at authorized facilities serving
dentally underserved populations.
(10) An operator who fails to comply with applicable federal,
state, or local laws and rules governing the practice of dentistry,
dental hygiene, or any of the requirements of this article is
subject to disciplinary action for unethical or unprofessional
conduct and may be subject to disciplinary action by the department
of licensing and regulatory affairs or board of dentistry, as
applicable.
Sec. 21611. (1) Not later than 1 year after the application
approval date under this part, the operator shall submit an annual
report of the activities of the mobile dental facility to the
department of licensing and regulatory affairs, department of
community health, and the board of dentistry.
(2) The annual report required under subsection (1) shall
include all of the following information:
(a) A list of all locations, including street address, city,
and state, where any level of dental service was provided.
(b) The dates when dental services were provided.
(c) The total number of patients treated at each location
during the calendar year.
(d) The types of dental services provided, reported in a
manner consistent with center for medicare and medicaid services
(CMS) Form 416, using appropriate diagnostic, preventative, and
restorative coding for each dentist, dental hygienist, or dental
assistant providing dental services.
(e) A list of the changes in the dentist, dental hygienist, or
dental assistant providing dental services at the mobile dental
facility.
Sec. 21613. (1) The operator, or his or her designee, shall
notify the department of licensing and regulatory affairs and the
board of dentistry not later than 30 days after 1 or more of the
following occurrences:
(a) A change in ownership of the mobile dental facility.
(b) A change in the memorandum of agreement required under
section 21607.
(c) A change in the address or telephone number of the mobile
dental facility.
(d) Cessation of operation of the mobile dental facility.
(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 that written notice to the board of
dentistry.
(b) At the request of an active patient or the active
patient's parent or guardian, transfer that active patient's dental
records to another dentist or to the active patient, for a period
of not less 180 days following the cessation of operations of the
mobile dental facility.
(c) Provide written notice to active patients or the active
patients' parents or guardians stating where records are stored and
may be retrieved.
Sec. 21615. The following entities or organizations are exempt
from the requirements of this part:
(a) A federal, state, or local government agency performing or
facilitating dental services.
(b) Any other public health agency created or appointed under
section 2413, 2415, or 2421 or federally qualified health center
performing dental services.
(c) Any student, faculty, or volunteer affiliated with a
dental school or dental hygiene school accredited by the commission
on dental accreditation or similar accrediting body.