Bill Text: NH SB193 | 2013 | Regular Session | Introduced
Bill Title: Relative to dental therapists and access to oral health care.
Spectrum: Slight Partisan Bill (Democrat 5-2)
Status: (Introduced - Dead) 2013-03-28 - Rereferred to Committee, Motion Adopted, Voice Vote; [SB193 Detail]
Download: New_Hampshire-2013-SB193-Introduced.html
SB 193-FN – AS INTRODUCED
2013 SESSION
01/10
SENATE BILL 193-FN
AN ACT relative to dental therapists and access to oral health care.
SPONSORS: Sen. Gilmour, Dist 12; Sen. Woodburn, Dist 1; Sen. D'Allesandro, Dist 20; Sen. Reagan, Dist 17; Rep. Rosenwald, Hills 30; Rep. M. Nelson, Hills 35; Rep. Emerson, Ches 11
COMMITTEE: Health, Education and Human Services
This bill authorizes licensure of dental therapists who may perform dental services under the supervision of a currently licensed dentist.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
13-0859
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to dental therapists and access to oral health care.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Statement of Purpose. The general court recognizes that access to oral health care services for New Hampshire’s children, elderly, minority populations, low income adults, and people with developmental disabilities and special medical needs remains sporadic and unreliable, particularly in sparsely populated areas of our state. In New Hampshire, the distribution of dentists and the current dental workforce lacks the capacity to meet the needs of the underserved, resulting in inadequate access to care for those who need it most. Numerous independent studies have determined that dental therapists are a pragmatic, cost-effective workforce model that safely provides quality oral health care services to otherwise underserved populations and regions. Dental therapists have been providing such care and services in more than 50 countries for nearly 90 years. Under the supervision of a dentist, dental therapists are an extension of the dental team, reaching populations not served by the existing dental delivery system. Dental therapists are a vital, best practice workforce approach to addressing oral health access challenges for underserved populations and regions in New Hampshire.
2 Dental Hygienists and Dental Therapists. Amend the subdivision heading preceding RSA 317-A:21 to read as follows:
Dental [Hygienist] Hygienists and Dental Therapists
3 New Sections; Dental Therapists. Amend RSA 317-A by inserting after section 22 the following new sections:
317-A:22-a Practice of Dental Therapy.
I. In this section and RSA 317-A:22-b through RSA 317-A:22-d, “dental therapist” means a person licensed under this chapter to perform the services authorized in this section under the dental therapy supervision of a licensed dentist as provided in RSA 317-A:22-b.
II. A licensed dental therapist, under the supervision of a licensed dentist and subject to a written practice agreement under RSA 317-A:22-b, may perform the following dental services:
(a) Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis.
(b) Dental charting, including periodontal screening exam, provided, that the dental therapist shall not perform a full periodontal charting.
(c) Taking and developing radiographs.
(d) Dental prophylaxis, including removal of visible calculus.
(e) Mechanical polishing.
(f) Application of topical preventive or prophylactic agents, including fluoride varnishes, antimicrobial agents, and pit and fissure sealants.
(g) Pulp vitality testing.
(h) Application of desensitizing medication or resin.
(i) Fabrication of athletic mouthguards.
(j) Placement of temporary restorations.
(k) Fabrication of soft occlusal guards.
(l) Tissue conditioning and soft reline.
(m) Placement of interim therapeutic restorations.
(n) Periodontal dressing changes.
(o) Tooth reimplantation and stabilization.
(p) Administration of local anesthetic.
(q) Administration of nitrous oxide analgesia.
(r) Oral evaluation and assessment of dental disease.
(s) Formulation of an individualized treatment plan, including services within the dental therapist scope of practice and referral for services outside of the dental therapist scope of practice.
(t) Extractions of primary teeth.
(u) Nonsurgical extractions of permanent teeth, provided that, the dental therapist shall not extract a tooth for any patient if the tooth is unerupted, impacted, fractured, or needs to be sectioned for removal.
(v) Emergency palliative treatment of dental pain.
(w) Placement and removal of space maintainers.
(x) Cavity preparation.
(y) Restoration of primary and permanent teeth with amalgam and composite filling materials.
(z) Placement of temporary crowns.
(aa) Preparation and placement of preformed crowns.
(bb) Pulpotomies on primary teeth.
(cc) Indirect and direct pulp capping on primary and permanent teeth.
(dd) Suture removal.
(ee) Brush biopsies.
(ff) Repair of defective prosthetic devices.
(gg) Recementing of permanent crowns.
III. A dental therapist shall only provide dental hygiene services under paragraph II if, in addition to completing a qualified dental therapy program, the dental therapist has completed one year of dental hygiene education and training from an accredited dental hygiene educational program.
317-A:22-b Dental Therapy Supervision.
I. A dental therapist shall practice under the supervision of a dentist currently licensed under this chapter through a written practice agreement. A written practice agreement is a signed document that outlines the functions, agreed upon by the supervising dentist and dental therapist, that the dental therapist is authorized to provide within the scope of RSA 317-A:22-a. The dental therapist shall provide care that follows written protocols and services that the dental therapist is authorized to provide by the dentist.
II. Under dental therapy supervision, dental therapy services may be provided to an individual patient without the patient first seeing a dentist for an examination, diagnosis, or treatment plan if the supervising dentist has provided the dental therapist with written authorization and standing protocols for the services and reviews the dental therapist patient records at least once in a 12-month period, as provided in the written practice agreement. The supervising dentist shall personally examine the patient, face to face or via teledentistry, for all cases that the standing protocols require.
III. The written practice agreement between a supervising dentist and dental therapist shall, at a minimum, contain the following elements:
(a) Services and procedures the dental therapist may provide.
(b) Any limitations on the services or procedures the dental therapist may provide.
(c) Practice settings where services and procedures may be provided.
(d) Age and procedure-specific practice protocols, including case selection criteria, assessment guidelines, and imaging frequency.
(e) A procedure for obtaining informed consent, and for creating and maintaining dental records, for patients treated by the dental therapist.
(f) A plan for review by the supervising dentist of dental therapist patient records.
(g) A plan to manage medical emergencies in each practice setting where the dental therapist provides care.
(h) A quality assurance plan for monitoring care provided by the dental therapist, including patient care review, referral follow-up, and a quality assurance chart review.
(i) Protocols for administering and dispensing medications, including the specific circumstances under which the medications may be dispensed and administered.
(j) Criteria relating to the provision of care to patients with specific medical conditions or complex medical histories, including requirements for consultation prior to the initiation of care.
(k) Specific written protocols, including a plan for the provision of clinical resources and/or referrals, governing situations where the dental therapist encounters a patient requiring treatment that exceeds the dental therapist’s scope of practice or capabilities.
IV. The supervising dentist shall accept responsibility for all authorized services and procedures performed by the dental therapist pursuant to the written practice agreement. A supervising dentist who knowingly permits a dental therapist to provide a service or procedure that is not authorized in the written practice agreement, or a dental therapist who provides a service or procedure which is not authorized in the written practice agreement, shall constitute unprofessional conduct for the purposes of RSA 317-A:17.
V. New and revised written practice agreements shall be signed and maintained by the supervising dentist and by the dental therapist. All new and revised written practice agreements between supervising dentists and dental therapists shall be filed with the board of dental examiners, and shall be made available to the public upon request. The agreements shall also be made available at the practice of the supervising dentist and dental therapist, and provided to patients of the dental therapist upon request.
317-A:22-c Licensure. The board of dental examiners shall issue a license to practice as a dental therapist to any applicant who:
I. Pays any applicable fees established by the board under RSA 317-A:12, VII;
II. Submits, on forms provided by the board, the applicant’s name, address, and other applicable information as determined by the board under RSA 317-A:12, I and II; and
III.(a) Demonstrates that the following requirements have been met:
(1) Successful completion of a dental therapy education program that provides a minimum of 2 academic years of dental therapy curriculum administered by an institution accredited to train dentists or dental hygienists; and
(2) As part of that education program, passage of a comprehensive examination to demonstrate competency under the dental therapy scope of practice and completion of at least 100 hours of dental therapy clinical practice under the direct or indirect supervision of a licensed dentist.
(b) A licensed dental hygienist may be licensed as a dental therapist after completion of at least one year of dental therapy education specific in this paragraph and passage of the examination and completion of the clinical practice specified in this paragraph.
317-A:22-d Dental Coverage and Reimbursement. Any service performed by a dentist licensed under this chapter, dental assistant, or dental hygienist that is covered and reimbursed by private insurance, a dental service corporation, Medicaid, or the Children’s Health Insurance Program shall also be covered and reimbursed when performed by a licensed dental therapist.
4 Dental Therapists; Rulemaking. Amend RSA 317-A:12, I to read as follows:
I. The application procedure for a dental [or], dental hygiene, or dental therapy license and for public health dental hygienist certification;
5 Dental Therapists; Rulemaking. Amend RSA 317-A:12, VI to read as follows:
VI. Ethical standards required to be met by each holder of a dental [or], dental hygiene, or dental therapy license and how such licenses may be revoked for violation of these standards;
6 New Paragraph; Non-Practice; Public Health Dental Therapist. Amend RSA 317-A:23 by inserting after paragraph II the following new paragraph:
III. Under the dental therapy supervision of a dentist currently licensed under this chapter and in accordance with a written practice agreement, a licensed dental therapist may provide services under RSA 317-A:22-a for which dental therapists have been trained and which have been authorized by a supervising dentist in writing under RSA 317-A:22-b. Services may be provided to an individual patient without the patient first seeing a dentist for an examination, diagnosis, and treatment planning if the supervising dentist has provided written general authorization and standing protocols for the licensed dental therapist.
7 Effective Date. This act shall take effect 60 days after its passage.
LBAO
13-0859
Revised 02/14/13
SB 193 FISCAL NOTE
AN ACT relative to dental therapists and access to oral health care.
FISCAL IMPACT:
The New Hampshire Board of Dental Examiners and the Department of Health and Human Services state this bill, as introduced, would increase state revenue and expenditures by an indeterminable amount in FY 2014 and each year thereafter. There will be no fiscal impact on county and local revenue or expenditures.
METHODOLOGY:
The Board of Dental Examiners states the Board would be involved in developing: the dental therapy program, testing and licensing requirements, supervision and monitoring requirements, and, reviewing and approving practice agreements. The Board assumes the New Hampshire Technical Institute would develop a dental therapy program that would require an additional year of training for hygienists and three years of training for students without a dental hygiene degree. The Board assumes a class size of ten students consisting of one-half hygienists and one-half students without a dental hygiene degree. The Board assumes the license and registration fees for therapists would be similar to current fees for hygienists and there would be no additional revenue associated with the hygienists choosing to become therapists since they already pay licensure and renewal fees. Based on these assumptions the Board projects the following revenue and expenditures:
Revenue
FY 2014
FY 2015
FY 2016
FY 2017
Dental Therapy Licenses (5 @ $100)
$0
$0
$500
$500
Dental Therapy Registration (5@ $160)
$0
$0
$800
$800
Total Revenue:
$0
$0
$1,300
$1,300
Expenditures:
Additional costs for testing, licensure, rulemaking, supervision and monitoring:
$2,000
$2,000
$2,305
$2,315
Software for E-licensing :
$5,000
$300
$330
$363
Increase in Telecommunications costs:
$250
$263
$276
$290
Additional 5 hours/ week for Administrator I:
$8,470
$8,470
$8,470
$8,470
Associated Benefits @ 7.65%
$648
$648
$648
$693
Total Expenditures:
$16,368
$11,681
$12,029
$12,131
The Department of Health and Human Services states this bill creates a coverage mandate for oral health services provided by dental therapists if those services would otherwise be covered by the Medicaid program if performed by a dentist or hygienist. The Department states the Medicaid program covers preventative and restorative services for children under the age of 21 and very limited emergency services for those over the age of 21. The Department is not able to determine when the first dental therapists would be licensed, if they would enroll in the Medicaid program, how many Medicaid recipients would visit a dental therapist for care, or what the dental therapy rates would be. The Department indicates, to the extent more Medicaid recipients would receive oral health services under this bill, there may be additional costs to the Medicaid program, however, due to the uncertainties listed, the Department cannot project the fiscal impact of the bill.
