Bill Text: MI SB0541 | 2017-2018 | 99th Legislature | Engrossed
Bill Title: Health occupations; health professionals; licensing and regulation of dental therapists; provide for. Amends secs. 16221, 16226, 16323, 16601, 16605, 16621 & 16626 of 1978 PA 368 (MCL 333.16221 et seq.) & adds secs. 16651, 16652, 16653, 16654, 16655, 16656, 16657, 16658, 16659, 16660 & 20189.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Passed) 2018-12-28 - Assigned Pa 0463'18 With Immediate Effect [SB0541 Detail]
Download: Michigan-2017-SB0541-Engrossed.html
SB-0541, As Passed House, December 18, 2018
HOUSE SUBSTITUTE FOR
SENATE BILL NO. 541
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 16221, 16226, 16323, 16601, 16605, 16621,
16626, and 17031 (MCL 333.16221, 333.16226, 333.16323, 333.16601,
333.16605, 333.16621, 333.16626, and 333.17031), sections 16221 and
16226 as amended by 2017 PA 249, section 16323 as amended by 2014
PA 305, section 16605 as added by 2006 PA 429, section 16621 as
amended by 2002 PA 590, section 16626 as added by 2012 PA 289, and
section 17031 as amended by 2002 PA 643, and by adding sections
16651, 16652, 16653, 16654, 16655, 16656, 16657, 16658, 16659, and
20189a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 Sec. 16221. Subject to section 16221b, the department shall
2 investigate any allegation that 1 or more of the grounds for
1 disciplinary subcommittee action under this section exist, and may
2 investigate activities related to the practice of a health
3 profession by a licensee, a registrant, or an applicant for
4 licensure or registration. The department may hold hearings,
5 administer oaths, and order the taking of relevant testimony. After
6 its investigation, the department shall provide a copy of the
7 administrative complaint to the appropriate disciplinary
8 subcommittee. The disciplinary subcommittee shall proceed under
9 section 16226 if it finds that 1 or more of the following grounds
10 exist:
11 (a) Except as otherwise specifically provided in this section,
12 a violation of general duty, consisting of negligence or failure to
13 exercise due care, including negligent delegation to or supervision
14 of employees or other individuals, whether or not injury results,
15 or any conduct, practice, or condition that impairs, or may impair,
16 the ability to safely and skillfully engage in the practice of the
17 health profession.
18 (b) Personal disqualifications, consisting of 1 or more of the
19 following:
20 (i) Incompetence.
21 (ii) Subject to sections 16165 to 16170a, substance use
22 disorder as defined in section 100d of the mental health code, 1974
23 PA 258, MCL 330.1100d.
24 (iii) Mental or physical inability reasonably related to and
25 adversely affecting the licensee's or registrant's ability to
26 practice in a safe and competent manner.
27 (iv) Declaration of mental incompetence by a court of
1 competent jurisdiction.
2 (v) Conviction of a misdemeanor punishable by imprisonment for
3 a maximum term of 2 years; conviction of a misdemeanor involving
4 the illegal delivery, possession, or use of a controlled substance;
5 or conviction of any felony other than a felony listed or described
6 in another subparagraph of this subdivision. A certified copy of
7 the court record is conclusive evidence of the conviction.
8 (vi) Lack of good moral character.
9 (vii) Conviction of a criminal offense under section 520e or
10 520g of the Michigan penal code, 1931 PA 328, MCL 750.520e and
11 750.520g. A certified copy of the court record is conclusive
12 evidence of the conviction.
13 (viii) Conviction of a violation of section 492a of the
14 Michigan penal code, 1931 PA 328, MCL 750.492a. A certified copy of
15 the court record is conclusive evidence of the conviction.
16 (ix) Conviction of a misdemeanor or felony involving fraud in
17 obtaining or attempting to obtain fees related to the practice of a
18 health profession. A certified copy of the court record is
19 conclusive evidence of the conviction.
20 (x) Final adverse administrative action by a licensure,
21 registration, disciplinary, or certification board involving the
22 holder of, or an applicant for, a license or registration regulated
23 by another state or a territory of the United States, by the United
24 States military, by the federal government, or by another country.
25 A certified copy of the record of the board is conclusive evidence
26 of the final action.
27 (xi) Conviction of a misdemeanor that is reasonably related to
1 or that adversely affects the licensee's or registrant's ability to
2 practice in a safe and competent manner. A certified copy of the
3 court record is conclusive evidence of the conviction.
4 (xii) Conviction of a violation of section 430 of the Michigan
5 penal code, 1931 PA 328, MCL 750.430. A certified copy of the court
6 record is conclusive evidence of the conviction.
7 (xiii) Conviction of a criminal offense under section 83, 84,
8 316, 317, 321, 520b, 520c, 520d, or 520f of the Michigan penal
9 code, 1931 PA 328, MCL 750.83, 750.84, 750.316, 750.317, 750.321,
10 750.520b, 750.520c, 750.520d, and 750.520f. A certified copy of the
11 court record is conclusive evidence of the conviction.
12 (xiv) Conviction of a violation of section 136 or 136a of the
13 Michigan penal code, 1931 PA 328, MCL 750.136 and 750.136a. A
14 certified copy of the court record is conclusive evidence of the
15 conviction.
16 (c) Prohibited acts, consisting of 1 or more of the following:
17 (i) Fraud or deceit in obtaining or renewing a license or
18 registration.
19 (ii) Permitting a license or registration to be used by an
20 unauthorized person.
21 (iii) Practice outside the scope of a license.
22 (iv) Obtaining, possessing, or attempting to obtain or possess
23 a controlled substance as defined in section 7104 or a drug as
24 defined in section 7105 without lawful authority; or selling,
25 prescribing, giving away, or administering drugs for other than
26 lawful diagnostic or therapeutic purposes.
27 (d) Except as otherwise specifically provided in this section,
1 unethical business practices, consisting of 1 or more of the
2 following:
3 (i) False or misleading advertising.
4 (ii) Dividing fees for referral of patients or accepting
5 kickbacks on medical or surgical services, appliances, or
6 medications purchased by or in behalf of patients.
7 (iii) Fraud or deceit in obtaining or attempting to obtain
8 third party reimbursement.
9 (e) Except as otherwise specifically provided in this section,
10 unprofessional conduct, consisting of 1 or more of the following:
11 (i) Misrepresentation to a consumer or patient or in obtaining
12 or attempting to obtain third party reimbursement in the course of
13 professional practice.
14 (ii) Betrayal of a professional confidence.
15 (iii) Promotion for personal gain of an unnecessary drug,
16 device, treatment, procedure, or service.
17 (iv) Either of the following:
18 (A) A requirement by a licensee other than a physician or a
19 registrant that an individual purchase or secure a drug, device,
20 treatment, procedure, or service from another person, place,
21 facility, or business in which the licensee or registrant has a
22 financial interest.
23 (B) A referral by a physician for a designated health service
24 that violates 42 USC 1395nn or a regulation promulgated under that
25 section. For purposes of this subdivision, 42 USC 1395nn and the
26 regulations promulgated under that section as they exist on June 3,
27 2002 are incorporated by reference. A disciplinary subcommittee
1 shall apply 42 USC 1395nn and the regulations promulgated under
2 that section regardless of the source of payment for the designated
3 health service referred and rendered. If 42 USC 1395nn or a
4 regulation promulgated under that section is revised after June 3,
5 2002, the department shall officially take notice of the revision.
6 Within 30 days after taking notice of the revision, the department
7 shall decide whether or not the revision pertains to referral by
8 physicians for designated health services and continues to protect
9 the public from inappropriate referrals by physicians. If the
10 department decides that the revision does both of those things, the
11 department may promulgate rules to incorporate the revision by
12 reference. If the department does promulgate rules to incorporate
13 the revision by reference, the department shall not make any
14 changes to the revision. As used in this sub-subparagraph,
15 "designated health service" means that term as defined in 42 USC
16 1395nn and the regulations promulgated under that section and
17 "physician" means that term as defined in sections 17001 and 17501.
18 (v) For a physician who makes referrals under 42 USC 1395nn or
19 a regulation promulgated under that section, refusing to accept a
20 reasonable proportion of patients eligible for Medicaid and
21 refusing to accept payment from Medicaid or Medicare as payment in
22 full for a treatment, procedure, or service for which the physician
23 refers the individual and in which the physician has a financial
24 interest. A physician who owns all or part of a facility in which
25 he or she provides surgical services is not subject to this
26 subparagraph if a referred surgical procedure he or she performs in
27 the facility is not reimbursed at a minimum of the appropriate
1 Medicaid or Medicare outpatient fee schedule, including the
2 combined technical and professional components.
3 (vi) Any conduct by a health professional with a patient while
4 he or she is acting within the health profession for which he or
5 she is licensed or registered, including conduct initiated by a
6 patient or to which the patient consents, that is sexual or may
7 reasonably be interpreted as sexual, including, but not limited to,
8 sexual intercourse, kissing in a sexual manner, or touching of a
9 body part for any purpose other than appropriate examination,
10 treatment, or comfort.
11 (vii) Offering to provide practice-related services, such as
12 drugs, in exchange for sexual favors.
13 (viii) A violation of section 16655(4) by a dental therapist.
14 (f) Failure to notify under section 16222(3) or (4).
15 (g) Failure to report a change of name or mailing address as
16 required in section 16192.
17 (h) A violation, or aiding or abetting in a violation, of this
18 article or of a rule promulgated under this article.
19 (i) Failure to comply with a subpoena issued pursuant to this
20 part, failure to respond to a complaint issued under this article,
21 article 7, or article 8, failure to appear at a compliance
22 conference or an administrative hearing, or failure to report under
23 section 16222(1) or 16223.
24 (j) Failure to pay an installment of an assessment levied
25 under the insurance code of 1956, 1956 PA 218, MCL 500.100 to
26 500.8302, within 60 days after notice by the appropriate board.
27 (k) A violation of section 17013 or 17513.
1 (l) Failure to meet 1 or more of the requirements for
2 licensure or registration under section 16174.
3 (m) A violation of section 17015, 17015a, 17017, 17515, or
4 17517.
5 (n) A violation of section 17016 or 17516.
6 (o) Failure to comply with section 9206(3).
7 (p) A violation of section 5654 or 5655.
8 (q) A violation of section 16274.
9 (r) A violation of section 17020 or 17520.
10 (s) A violation of the medical records access act, 2004 PA 47,
11 MCL 333.26261 to 333.26271.
12 (t) A violation of section 17764(2).
13 (u) Failure to comply with the terms of a practice agreement
14 described in section 17047(2)(a) or (b), 17547(2)(a) or (b), or
15 18047(2)(a) or (b).
16 (v) A violation of section 7303a(2).
17 (w) A violation of section 7303a(4) or (5).
18 (x) A violation of section 7303b.
19 Sec. 16226. (1) After finding the existence of 1 or more of
20 the grounds for disciplinary subcommittee action listed in section
21 16221, a disciplinary subcommittee shall impose 1 or more of the
22 following sanctions for each violation:
|
23 |
Violations of Section 16221 |
Sanctions |
|
24 |
Subdivision (a), (b)(i), |
Probation, limitation, denial, |
|
25 |
(b)(ii), (b)(iii), (b)(iv), |
suspension, revocation, |
|
26 |
(b)(v), (b)(vi), (b)(vii), |
permanent revocation, |
|
27 |
(b)(ix), (b)(x), (b)(xi), |
restitution, or fine. |
|
1 |
or (b)(xii) |
|
|
2 |
||
|
3 |
Subdivision (b)(viii) |
Revocation, permanent revocation, |
|
4 |
or denial. |
|
|
5 |
||
|
6 |
Subdivision (b)(xiii) |
Permanent revocation |
|
7 |
for a violation described in |
|
|
8 |
subsection (5); otherwise, |
|
|
9 |
probation, limitation, denial, |
|
|
10 |
suspension, revocation, |
|
|
11 |
restitution, or fine. |
|
|
12 |
||
|
13 |
Subdivision (b)(xiv) |
Permanent revocation. |
|
14 |
||
|
15 |
Subdivision (c)(i) |
Denial, revocation, suspension, |
|
16 |
probation, limitation, or fine. |
|
|
17 |
||
|
18 |
Subdivision (c)(ii) |
Denial, suspension, revocation, |
|
19 |
restitution, or fine. |
|
|
20 |
||
|
21 |
Subdivision (c)(iii) |
Probation, denial, suspension, |
|
22 |
revocation, restitution, or fine. |
|
|
23 |
||
|
24 |
Subdivision (c)(iv) |
Fine, probation, denial, |
|
25 |
or (d)(iii) |
suspension, revocation, permanent |
|
26 |
revocation, or restitution. |
|
|
27 |
|
1 |
Subdivision (d)(i) |
Reprimand, fine, probation, |
|
2 |
or (d)(ii) |
denial, or restitution. |
|
3 |
||
|
4 |
Subdivision (e)(i), |
Reprimand, fine, probation, |
|
5 |
(e)(iii), (e)(iv), (e)(v), |
limitation, suspension, |
|
6 |
(h), or (s) |
revocation, permanent revocation, |
|
7 |
denial, or restitution. |
|
|
8 |
||
|
9 |
Subdivision (e)(ii) |
Reprimand, probation, suspension, |
|
10 |
or (i) |
revocation, permanent |
|
11 |
revocation, restitution, |
|
|
12 |
denial, or fine. |
|
|
13 |
||
|
14 |
Subdivision (e)(vi), |
Probation, suspension, revocation, |
|
15 |
|
limitation, denial, |
|
16 |
restitution, or fine. |
|
|
17 |
||
|
18 |
Subdivision (f) |
Reprimand, denial, limitation, |
|
19 |
probation, or fine. |
|
|
20 |
||
|
21 |
Subdivision (g) |
Reprimand or fine. |
|
22 |
||
|
23 |
Subdivision (j) |
Suspension or fine. |
|
24 |
||
|
25 |
Subdivision (k), (p), |
Reprimand, probation, suspension, |
|
26 |
or (r) |
revocation, permanent revocation, |
|
27 |
or fine. |
|
1 |
||
|
2 |
Subdivision (l) |
Reprimand, denial, or |
|
3 |
limitation. |
|
|
4 |
||
|
5 |
Subdivision (m) or (o) |
Denial, revocation, restitution, |
|
6 |
probation, suspension, |
|
|
7 |
limitation, reprimand, or fine. |
|
|
8 |
||
|
9 |
Subdivision (n) |
Revocation or denial. |
|
10 |
||
|
11 |
Subdivision (q) |
Revocation. |
|
12 |
||
|
13 |
Subdivision (t) |
Revocation, permanent revocation, |
|
14 |
fine, or restitution. |
|
|
15 |
||
|
16 |
Subdivision (u) |
Denial, revocation, probation, |
|
17 |
suspension, limitation, reprimand, |
|
|
18 |
or fine. |
|
|
19 |
||
|
20 |
Subdivision (v) or (x) |
Probation, limitation, denial, |
|
21 |
fine, suspension, revocation, or |
|
|
22 |
permanent revocation. |
|
|
23 |
||
|
24 |
Subdivision (w) |
Denial, fine, reprimand, |
|
25 |
probation, limitation, |
|
|
26 |
suspension, revocation, or |
|
|
27 |
permanent revocation. |
1 (2) Determination of sanctions for violations under this
2 section shall be made by a disciplinary subcommittee. If, during
3 judicial review, the court of appeals determines that a final
4 decision or order of a disciplinary subcommittee prejudices
5 substantial rights of the petitioner for 1 or more of the grounds
6 listed in section 106 of the administrative procedures act of 1969,
7 1969 PA 306, MCL 24.306, and holds that the final decision or order
8 is unlawful and is to be set aside, the court shall state on the
9 record the reasons for the holding and may remand the case to the
10 disciplinary subcommittee for further consideration.
11 (3) A disciplinary subcommittee may impose a fine in an amount
12 that does not exceed $250,000.00 for a violation of section
13 16221(a) or (b). A disciplinary subcommittee shall impose a fine of
14 at least $25,000.00 if the violation of section 16221(a) or (b)
15 results in the death of 1 or more patients.
16 (4) A disciplinary subcommittee may require a licensee or
17 registrant or an applicant for licensure or registration who has
18 violated this article, article 7, or article 8 or a rule
19 promulgated under this article, article 7, or article 8 to
20 satisfactorily complete an educational program, a training program,
21 or a treatment program, a mental, physical, or professional
22 competence examination, or a combination of those programs and
23 examinations.
24 (5) A disciplinary subcommittee shall impose the sanction of
25 permanent revocation for a violation of section 16221(b)(xiii) if
26 the violation occurred while the licensee or registrant was acting
27 within the health profession for which he or she was licensed or
1 registered.
2 (6) Except as otherwise provided in subsection (5) and this
3 subsection, a disciplinary subcommittee shall not impose the
4 sanction of permanent revocation under this section without a
5 finding that the licensee or registrant engaged in a pattern of
6 intentional acts of fraud or deceit resulting in personal financial
7 gain to the licensee or registrant and harm to the health of
8 patients under the licensee's or registrant's care. This subsection
9 does not apply if a disciplinary subcommittee finds that a licensee
10 or registrant has violated section 16221(b)(xiv).
11 Sec. 16323. (1) Except as otherwise provided in subsection
12 (2), fees for an individual licensed or seeking licensure to
13 practice as a dentist, dental assistant, or dental hygienist, or
14 dental therapist under part 166 are as follows:
|
15 |
(a) |
Application processing fees: |
|
|
16 |
(i) |
Dentist................................. $ 20.00 |
|
|
17 |
(ii) |
Dental assistant........................ 10.00 |
|
|
18 |
(iii) |
Dental hygienist........................ 15.00 |
|
|
19 |
|
(iv) |
Dental therapist........................ 15.00 |
|
20 |
(v) |
Health profession specialty field |
|
|
21 |
license for a dentist................... 20.00 |
||
|
22 |
(b) |
Examination fees: |
|
|
23 |
(i) |
Dental assistant's examination, |
|
|
24 |
complete................................ 70.00 |
||
|
25 |
(ii) |
Dental assistant's examination, |
|
|
26 |
per part................................ 35.00 |
||
|
27 |
|
(iii) |
Dental therapist........................ 300.00 |
|
1 |
(iv) |
Dentist's health profession specialty |
|
|
2 |
field license examination, complete..... 300.00 |
||
|
3 |
(v) |
Dentist's health profession specialty |
|
|
4 |
field license examination, per part..... 100.00 |
||
|
5 |
(c) |
License fees, per year: |
|
|
6 |
(i) |
Dentist................................. 90.00 |
|
|
7 |
(ii) |
Dental assistant........................ 10.00 |
|
|
8 |
(iii) |
Dental hygienist........................ 20.00 |
|
|
9 |
|
(iv) |
Dental therapist........................ 40.00 |
|
10 |
(v) |
Dentist's health profession specialty |
|
|
11 |
field license........................... 15.00 |
||
|
12 |
(d) |
Temporary license fees: |
|
|
13 |
(i) |
Dentist................................. 20.00 |
|
|
14 |
(ii) |
Dental assistant........................ 5.00 |
|
|
15 |
(iii) |
Dental hygienist........................ 10.00 |
|
|
16 |
|
(iv) |
Dental therapist........................ 15.00 |
|
17 |
(e) |
Limited license fee, per year: |
|
|
18 |
(i) |
Dentist................................. 25.00 |
|
|
19 |
(ii) |
Dental assistant........................ 5.00 |
|
|
20 |
(iii) |
Dental hygienist........................ 10.00 |
|
|
21 |
|
(iv) |
Dental therapist........................ 15.00 |
|
22 |
(f) |
Examination review fees: |
|
|
23 |
(i) |
Dental preclinical or dentist's health |
|
|
24 |
profession specialty field license...... 50.00 |
||
|
25 |
(ii) |
Dental assistant........................ 20.00 |
|
|
26 |
|
(iii) |
Dental therapist........................ 50.00 |
27 (2) The department shall waive the application processing and
1 license fees required under subsection (1) for an initial license
2 to engage in practice as a dental assistant if the applicant for
3 initial licensure, while on active duty as a member of the armed
4 forces, served as a military dental specialist and was separated
5 from service with an honorable character of service or under
6 honorable conditions (general) character of service in the armed
7 forces. The applicant shall provide a form DD214, DD215, or any
8 other form that is satisfactory to the department to be eligible
9 for the waiver of fees under this subsection. As used in this
10 subsection, "armed forces" means that term as defined in
section 2
11 of the veteran right to employment services act, 1994 PA 39, MCL
12 35.1092.the United
States Army, Air Force, Navy, Marine Corps, or
13 Coast Guard or other military force designated by Congress as a
14 part of the Armed Forces of the United States.
15 Sec. 16601. (1) As used in this part:
16 (a) "Assignment" means that a dentist has designated a patient
17 of record upon on whom services are to be performed and has
18 described the procedures to be performed. The dentist need not be
19 physically present in the office or in the treatment room at the
20 time the procedures are being performed.
21 (b) "Dental laboratory" means a dental workroom that is
22 operated as a part of a dental office or otherwise, by a person,
23 other than a dentist, who is engaged in, or holds himself, herself,
24 or itself out as being directly or indirectly engaged in,
25 constructing, repairing, or altering prosthetic dentures, bridges,
26 orthodontic or other appliances, or structures to be used as
27 substitutes for or as a part of human teeth or jaws or associated
1 structures, or for the correction of malocclusions or deformities.
2 (c) "Dentist" means an individual who is licensed under this
3 article to engage in the practice of dentistry.
4 (d) "Practice of dentistry" means the diagnosis, treatment,
5 prescription, or operation for a disease, pain, deformity,
6 deficiency, injury, or physical condition of the human tooth,
7 teeth, alveolar process, gums or jaws, or their dependent tissues,
8 or an offer, undertaking, attempt to do, or holding oneself out as
9 able to do any of these acts.
10 (e) "Practice as a dental assistant" means assistance in the
11 clinical practice of dentistry based on formal education,
12 specialized knowledge, and skill at the assignment and under the
13 supervision of a dentist.
14 (f) "Practice as a dental hygienist" means practice at the
15 assignment of a dentist in that specific area of dentistry based on
16 specialized knowledge, formal education, and skill with particular
17 emphasis on preventive services and oral health education.
18 (g) "Practice as a dental therapist" means providing any of
19 the care and services, and performing any of the duties, described
20 in section 16656.
21 (2) In addition, article 1 contains general definitions and
22 principles of construction applicable to all articles in this code
23 and part 161 contains definitions applicable to this part.
24 Sec. 16605. The following words, titles, or letters, or a
25 combination thereof, of
any of those words, titles, or letters,
26 with or without qualifying words or phrases, are restricted in use
27 only to those persons individuals
who are authorized under this
1 part to use the following terms and in a way prescribed in this
2 part: "dentist", "doctor of dental surgery", "oral and
3 maxillofacial surgeon", "orthodontist", "prosthodontist",
4 "periodontist", "endodontist", "oral pathologist", "pediatric
5 dentist", "dental hygienist", "registered dental hygienist",
6 "dental assistant", "registered dental assistant", "dental
7 therapist",
"r.d.a.", "d.d.s.", "d.m.d.", and "r.d.h.", and "d.t.".
8 Sec. 16621. (1) The Michigan board of dentistry is created in
9 the department. Subject to subsection (2), the board consists of
10 the following 19 20
voting members, who
each of whom must meet the
11 requirements of part 161:
12 (a) Eight Nine
dentists. Subject to subsection (3),
(4), 1 or
13 more of the dentists appointed under this subdivision may have a
14 health profession specialty certification issued under section
15 16608.
16 (b) Subject to subsection (3), (4), 2
dentists who have been
17 issued a health profession specialty certification under section
18 16608.
19 (c) Four dental hygienists.
20 (d) Two dental assistants.
21 (e) Three public members.
22 (2) A dentist, dental hygienist, public member, or other
23 individual who is a member of the board on July 14, 2000 may serve
24 out his or her term.Beginning
5 years after the effective date of
25 the 2018 amendatory act that amended this subsection, the board
26 must include 1 dental therapist, bringing the total number of
27 voting members on the board to 21. The dental therapists appointed
1 under this subsection must each meet the requirements of part 161.
2 (3) The board meeting dates and times shall must be
concurred
3 in by a vote of not less than 13 board members.
4 (4) One member of the board shall be a dentist who is a dental
5 school faculty member.
6 (5) (4) A
board member who is licensed to practice as a dental
7 hygienist, or a dental assistant, or a dental therapist votes as an
8 equal member of the board in all matters except those designated in
9 section 16148(1) or (2) that apply only to dentists and not to
10 dental hygienists, or dental assistants, or dental therapists.
11 Sec. 16626. (1) Subject to subsection (2), and notwithstanding
12 section 16601(1)(f) or the rules promulgated under section
13 16625(1), a dental hygienist or dental therapist may utilize a
14 dental assistant to act as his or her second pair of hands.
15 (2) Notwithstanding section 16601(1)(e) or the rules
16 promulgated under section 16625(1), a dental assistant may function
17 as a second pair of hands for a dentist, or dental hygienist, or
18 dental therapist if all of the following are met:
19 (a) The dentist, or dental hygienist, or dental therapist is
20 actively performing services in the mouth of a patient at the time
21 the dental assistant is assisting him or her.
22 (b) If the dental assistant is assisting a dental hygienist, a
23 supervising dentist has assigned the dental assistant to act as the
24 dental hygienist's second pair of hands.
25 (3) This section does not require new or additional third
26 party reimbursement or mandated worker's compensation benefits for
27 services rendered by an individual who is licensed as a dental
1 assistant, or as a dental hygienist, or dental therapist under this
2 article.
3 (4) As used in this section, "second pair of hands" means that
4 term as defined in R 338.11101 of the Michigan administrative
5 code.Administrative
Code.
6 Sec. 16651. (1) An individual who is granted a license under
7 this part as a dental therapist may engage in practice as a dental
8 therapist to the extent permitted under this section and sections
9 16652 to 16658.
10 (2) To qualify for licensure under this part as a dental
11 therapist, an individual shall apply to the department on forms
12 provided by the department, pay the application fee under section
13 16323, and demonstrate to the department that he or she meets all
14 of the following:
15 (a) Has graduated from a dental therapy education program that
16 satisfies all of the following:
17 (i) Meets the standards established under section 16148 for
18 accreditation of a degree-granting program in dental therapy
19 education at an approved postsecondary education institution.
20 (ii) As determined by the department in consultation with the
21 board, meets the accreditation standards for dental therapy
22 education programs established by the Commission on Dental
23 Accreditation.
24 (iii) Is accredited under section 16148.
25 (iv) Meets any other requirements for dental therapy education
26 programs adopted by the board.
27 (b) Has passed a comprehensive, competency-based clinical
1 examination approved by the department that includes an examination
2 of the applicant's knowledge of the laws of this state under this
3 part and rules promulgated under this part.
4 (c) Has completed 500 hours of supervised clinical practice
5 under the direct supervision of a dentist and in conformity with
6 rules adopted by the board. As used in this subdivision, "direct
7 supervision" means that a dentist complies with all of the
8 following:
9 (i) Designates a patient of record upon whom the procedures
10 are to be performed and describes the procedures to be performed.
11 (ii) Examines the patient before prescribing the procedures to
12 be performed and upon completion of the procedures.
13 (iii) Is physically present in the office at the time the
14 procedures are being performed.
15 Sec. 16652. (1) The board shall grant a license to practice as
16 a dental therapist to an applicant for licensure under sections
17 16651 to 16658 who meets the requirements of sections 16651 to
18 16658 and rules adopted under those sections for licensure and pays
19 the application fee under section 16323.
20 (2) A dental therapist shall pay to the board the license fee
21 under section 16323.
22 Sec. 16653. As a condition of renewal of a license to practice
23 under sections 16651 to 16658, a dental therapist shall certify
24 that he or she has successfully completed 35 hours of continuing
25 education in the 2 years before renewal. Continuing education under
26 this section must conform with the requirements of part 161
27 concerning continuing education courses and must include board-
1 approved courses, including, but not limited to, a course in
2 cardiopulmonary resuscitation.
3 Sec. 16654. A dental therapist may provide services described
4 in section 16656 included within the scope of practice as a dental
5 therapist and under the supervision of a dentist in any of the
6 following health settings:
7 (a) A hospital that is licensed under article 17.
8 (b) A health facility or agency, other than a hospital, that
9 is licensed under article 17 and is reimbursed as a federally
10 qualified health center as defined in 42 USC 1395x(aa)(4) or that
11 has been determined by the United States Department of Health and
12 Human Services, Centers for Medicare and Medicaid Services to meet
13 the requirements for funding under section 330 of the public health
14 service act, 42 USC 254b.
15 (c) A federally qualified health center, as defined in 42 USC
16 1395x(aa)(4), that is licensed as a health facility or agency under
17 article 17.
18 (d) An outpatient health program or facility operated by a
19 tribe or tribal organization under the Indian self-determination
20 act, 25 USC 5321 to 5332, or by an urban Indian organization
21 receiving funds under title V of the Indian health care improvement
22 act, 25 USC 1651 to 1660h.
23 (e) A correctional facility. As used in this subdivision,
24 "correctional facility" means a facility or institution that houses
25 a prisoner population under the jurisdiction of the department of
26 corrections.
27 (f) A health setting in a geographic area that is designated
1 as a dental shortage area by the United States Department of Health
2 and Human Services.
3 (g) A school-based health center, as that term is defined in
4 42 USC 280h-5.
5 (h) A local health department.
6 (i) Any other clinic or practice setting, including a mobile
7 dental unit, in which at least 50% of the annual total patient base
8 of the dental therapist will consist of patients who meet any of
9 the following:
10 (i) Are enrolled in a health care program administered by the
11 department of health and human services.
12 (ii) Have a medical disability or chronic condition that
13 creates a significant barrier to receiving dental care.
14 (iii) Do not have dental health coverage, either through a
15 public health care program or private insurance, and have an annual
16 gross family income equal to or less than 200% of the federal
17 poverty level. As used in this subparagraph and subparagraph (iv),
18 "federal poverty level" means the poverty guidelines published
19 annually in the federal register by the United States Department of
20 Health and Human Services under its authority to revise the poverty
21 line under 42 USC 9902.
22 (iv) Do not have dental health coverage, either through a
23 state public health care program or private insurance, and whose
24 family gross income is equal to or less than 200% of the federal
25 poverty level.
26 Sec. 16655. (1) A dental therapist may practice only under the
27 supervision of a dentist and through a written practice agreement
1 signed by the dental therapist and the dentist. A dental therapist
2 may provide only the services that are within his or her scope of
3 practice, are authorized by a supervising dentist, and are provided
4 according to written protocols or orders established by the
5 supervising dentist.
6 (2) A dental therapist may perform an oral evaluation and
7 assessment of dental disease and develop an individualized
8 treatment plan if the supervising dentist has given the dental
9 therapist written authorization to provide the services and reviews
10 the patient records as provided in the written practice agreement.
11 The written practice agreement may require the supervising dentist
12 to personally examine patients either face-to-face or by the use of
13 electronic means.
14 (3) A written practice agreement between a supervising dentist
15 and a dental therapist must include all of the following elements:
16 (a) The services and procedures and the practice settings for
17 those services and procedures that the dental therapist may
18 provide, together with any limitations on those services and
19 procedures.
20 (b) Any age-specific and procedure-specific practice
21 protocols, including case selection criteria, assessment
22 guidelines, and imaging frequency.
23 (c) Procedures to be used with patients treated by the dental
24 therapist for obtaining informed consent and for creating and
25 maintaining dental records.
26 (d) A plan for review of patient records by the supervising
27 dentist and the dental therapist.
1 (e) A plan for managing medical emergencies in each practice
2 setting in which the dental therapist provides care.
3 (f) A quality assurance plan for monitoring care, including
4 patient care review, referral follow-up, and a quality assurance
5 chart review.
6 (g) Protocols for administering and dispensing medications,
7 including the specific circumstances under which medications may be
8 administered and dispensed.
9 (h) Criteria for providing care to patients with specific
10 medical conditions or complex medical histories, including
11 requirements for consultation before initiating care.
12 (i) Specific written protocols, including a plan for providing
13 clinical resources and referrals, governing situations in which the
14 patient requires treatment that exceeds the dental therapist's
15 capabilities or the scope of practice as a dental therapist.
16 (4) A dental therapist who provides services or procedures
17 beyond those authorized in the written practice agreement engages
18 in unprofessional conduct for the purposes of section 16221.
19 (5) A supervising dentist shall not supervise more than 4
20 dental therapists.
21 (6) A supervising dentist shall actively participate in
22 drafting a written practice agreement with a dental therapist. Any
23 revision to the written practice agreement must be documented in a
24 new written practice agreement signed by the supervising dentist
25 and the dental therapist.
26 (7) A written practice agreement is valid for 3 years. A
27 supervising dentist and dental therapist shall each review the
1 practice agreement before renewing the practice agreement.
2 (8) A supervising dentist and a dental therapist who sign a
3 written practice agreement shall keep a copy for the dentist's or
4 dental therapist's own records and make a copy available to
5 patients of the dental therapist, or to the department, on request.
6 (9) As used in this section and sections 16656 and 16657,
7 "written practice agreement" means a document that is signed by a
8 dentist and a dental therapist and that, in conformity with the
9 legal scope of practice as a dental therapist, outlines the
10 functions that the dental therapist is authorized to perform.
11 Sec. 16656. (1) Under the supervision of a dentist, a licensed
12 dental therapist may provide any of the following care or services:
13 (a) Identifying oral and systemic conditions that require
14 evaluation or treatment by dentists, physicians, or other health
15 care professionals and managing referrals.
16 (b) Comprehensive charting of the oral cavity.
17 (c) Providing oral health instruction and disease prevention
18 education, including nutritional counseling and dietary analysis.
19 (d) Administering and exposing radiographic images.
20 (e) Dental prophylaxis including subgingival scaling or
21 polishing procedures.
22 (f) Dispensing and administering via the oral or topical route
23 nonnarcotic analgesics and anti-inflammatory and antibiotic
24 medications as prescribed by a health care professional.
25 (g) Applying topical preventative or prophylactic agents,
26 including fluoride varnish, silver diamine fluoride and other
27 fluoride treatments, antimicrobial agents, and pit and fissure
1 sealants.
2 (h) Pulp vitality testing.
3 (i) Applying desensitizing medication or resin.
4 (j) Fabricating athletic mouth guards.
5 (k) Changing periodontal dressings.
6 (l) Administering local anesthetic and nitrous oxide
7 analgesia.
8 (m) Simple extraction of erupted primary teeth.
9 (n) Emergency palliative treatment of dental pain related to a
10 care or service described in this subsection.
11 (o) Preparation and placement of direct restoration in primary
12 and permanent teeth.
13 (p) Fabrication and placement of single-tooth temporary
14 crowns.
15 (q) Preparation and placement of preformed crowns on primary
16 teeth.
17 (r) Indirect and direct pulp capping on permanent teeth.
18 (s) Indirect pulp capping on primary teeth.
19 (t) Suturing and suture removal.
20 (u) Minor adjustments and repairs on removable prostheses.
21 (v) Placement and removal of space maintainers.
22 (w) Nonsurgical extractions of periodontally diseased
23 permanent teeth with tooth mobility +3. However, a dental therapist
24 shall not extract a tooth for any patient if the tooth is
25 unerupted, impacted, or fractured or needs to be sectioned for
26 removal.
27 (x) Performing other related services and functions authorized
1 by the supervising dentist and for which the dental therapist is
2 trained.
3 (y) Performing any other duties of a dental therapist that are
4 authorized by the board by rule.
5 (2) A dental therapist may supervise dental assistants and
6 dental hygienists to the extent permitted in a written practice
7 agreement. However, a dental therapist shall not supervise more
8 than 3 dental assistants and 2 dental hygienists in any 1 practice
9 setting.
10 (3) A dental therapist shall not prescribe a controlled
11 substance that is included in schedules 2 to 5 of part 72.
12 (4) As used in this section and section 16657, "health care
13 professional" means an individual who is authorized to practice a
14 health profession under this article.
15 Sec. 16657. (1) A supervising dentist shall arrange for
16 another dentist or specialist to provide any services needed by a
17 patient of a dental therapist who is supervised by that dentist
18 that are beyond the scope of practice of the dental therapist and
19 that the supervising dentist is unable to provide.
20 (2) A dental therapist, in accordance with a written practice
21 agreement entered into under section 16655, shall refer patients to
22 another qualified dental professional or health care professional
23 to receive needed services that exceed the scope of practice of the
24 dental therapist.
25 Sec. 16658. (1) Within 12 months after the effective date of
26 the amendatory act that added this section, the department, in
27 consultation with the board, shall promulgate any rules that the
1 department considers necessary to implement this section and
2 sections 16651 to 16657.
3 (2) Within 7 years after the effective date of the amendatory
4 act that added this section, the department of health and human
5 services, in consultation with the department, shall conduct and
6 complete a study concerning the impact of licensing dental
7 therapists on patient safety, cost-effectiveness, and access to
8 dental services in this state. The study shall focus on the
9 following outcome measures:
10 (a) Number of new patients served.
11 (b) Reduction in waiting time for needed services.
12 (c) Decreased travel time for patients.
13 (d) Impact on emergency room usage for dental care.
14 (e) Costs to the health care system.
15 (3) Within 30 days after the completion of the study described
16 in subsection (2), the department of health and human services
17 shall provide a written report concerning the results of the study
18 to the director of the department and the chairs of the standing
19 committees of the senate and house of representatives responsible
20 for health policy.
21 Sec. 16659. Sections 16651 to 16658 do not require new or
22 additional third party reimbursement or mandated worker's
23 compensation benefits for services rendered by an individual who is
24 licensed as a dental therapist under this article.
25 Sec. 17031. (1) Except as provided in subsection (2), an
26 applicant, in addition to completing the requirements for the
27 degree in medicine, shall complete a period of postgraduate
1 education to attain proficiency in the practice of the profession,
2 as prescribed by the board in rules, as a condition for more than
3 limited licensure.
4 (2) The board may grant a full license to practice medicine to
5 an applicant who has completed the requirements for a degree in
6 medicine at a medical school located outside the United States or
7 Canada if, except as provided in subsection (4), the applicant
8 demonstrates to the board all of the following:
9 (a) That the applicant has engaged in the practice of medicine
10 for not less than 10 years after completing the requirements for a
11 degree in medicine.
12 (b) That the applicant has completed not less than 3 years of
13 postgraduate clinical training in an institution that has an
14 affiliation with a medical school that is listed in a directory of
15 medical schools published by the world health organization World
16 Health Organization as approved by the board.
17 (c) That the applicant has achieved a score determined by the
18 board to be a passing score on an initial medical licensure
19 examination approved by the board.
20 (d) That the applicant has safely and competently practiced
21 medicine under a clinical academic limited license granted by the
22 board under this article for 1 or more academic institutions
23 located in this state for not less than the 2 years immediately
24 preceding the date of application for a license under this
25 subsection, during which time the applicant functioned not less
26 than 800 hours per year in the observation and treatment of
27 patients.
1 (3) An applicant under subsection (2) who is required to meet
2 the requirements of subsection (2)(d) shall file with the board a
3 written statement from each academic institution upon which the
4 applicant relies to satisfy that
subsection. (2)(d).
The statement
5 shall indicate, at a minimum, that the applicant functioned for the
6 academic institution in the observation and treatment of patients
7 not less than 800 hours per year and that in so doing the applicant
8 practiced medicine safely and competently. A person who in good
9 faith makes a written statement that is filed under this subsection
10 is not civilly or criminally liable for that statement. There is a
11 rebuttable presumption that a person who makes a written statement
12 that is filed under this subsection has done so in good faith.
13 (4) Subsection (2)(c) and (d) do not apply to an applicant who
14 was granted a clinical academic limited license after January 1,
15 2011 but before January 1, 2017 and who has continuously held a
16 license to practice medicine from the effective date of the
17 amendatory act that added this subsection through the date of
18 application for a full license under subsection (2).
19 Sec. 20189a. A health facility or agency shall not require a
20 dentist to enter into a written practice agreement with a dental
21 therapist as a condition of employment. As used in this section,
22 "written practice agreement" means that term as defined in section
23 16655.
24 Enacting section 1. This amendatory act takes effect 90 days
25 after the date it is enacted into law.
