STATE OF NEW YORK ________________________________________________________________________ 5373 2023-2024 Regular Sessions IN ASSEMBLY March 9, 2023 ___________ Introduced by M. of A. WOERNER -- read once and referred to the Commit- tee on Higher Education AN ACT to amend the education law, in relation to licensing of a dental therapist and an advanced dental therapist; and to amend the social services law, in relation to Medicaid reimbursement for dental therapy services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The article heading of article 133 of the education law, as 2 amended by chapter 390 of the laws of 2019, is amended to read as 3 follows: 4 DENTISTRY, DENTAL HYGIENE, DENTAL THERAPY, ADVANCED DENTAL 5 THERAPY AND REGISTERED DENTAL ASSISTING 6 § 2. Section 6600 of the education law, as amended by chapter 390 of 7 the laws of 2019, is amended to read as follows: 8 § 6600. Introduction. This article applies to the professions of 9 dentistry, dental hygiene, dental therapy, advanced dental therapy and 10 registered dental assisting. The general provisions for all professions 11 contained in article one hundred thirty of this title apply to this 12 article. 13 § 3. The education law is amended by adding eight new sections 6614, 14 6614-a, 6614-b, 6614-c, 6615, 6615-a, 6615-b and 6615-c to read as 15 follows: 16 § 6614. Definition of practice of dental therapy. 1. The practice of 17 the profession of dental therapy is defined as the performance of dental 18 services under the general supervision of a dentist within the parame- 19 ters of a collaborative agreement, as provided in subdivision two of 20 this section, which shall include: oral health instruction and disease 21 prevention education, including nutritional counseling and dietary anal- 22 ysis; preliminary charting of the oral cavity; making radiographs; 23 mechanical polishing; application of topical preventive or prophylactic EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07644-01-3A. 5373 2 1 agents, including fluoride varnishes and pit and fissure sealants; pulp 2 vitality testing; application of desensitizing medication or resin; 3 fabrication of athletic mouthguards; placement of temporary restora- 4 tions; fabrication of soft occlusal guards; tissue conditioning and soft 5 reline; atraumatic restorative therapy; dressing changes; tooth reim- 6 plantation; administration of local anesthetic; administration of 7 nitrous oxide. A licensed and registered dental therapist may perform 8 the following services under indirect supervision: emergency palliative 9 treatment of dental pain; the placement and removal of space maintain- 10 ers; cavity preparation; restoration of primary and permanent teeth; 11 placement of temporary crowns; preparation and placement of preformed 12 crowns; pulpotomies on primary teeth; indirect and direct pulp capping 13 on primary and permanent teeth; stabilization of reimplanted teeth; 14 extractions of primary teeth; suture removal; brush biopsies; repair of 15 defective prosthetic devices; and recementing of permanent crowns and 16 any other function in the definition of the practice of dentistry as may 17 be delegated by a licensed dentist in accordance with regulations 18 promulgated by the commissioner. The practice of dental therapy may be 19 conducted in the office of any licensed dentist or in any appropriately 20 equipped school or public institution. 21 2. (a) Prior to performing any of the services authorized under this 22 article, a dental therapist shall enter into a written collaborative 23 management agreement with a licensed and registered dentist. Such colla- 24 borative arrangement shall not obviate or supersede any law or regu- 25 lation which requires identified services to be performed under the 26 personal supervision of a dentist. When dental therapist services are 27 provided pursuant to a collaborative agreement, such dental therapists 28 shall instruct individuals to visit a licensed dentist for comprehensive 29 examination or treatment. 30 (b) A collaborating dentist is limited to entering into a collabora- 31 tive agreement with no more than five dental therapists or advanced 32 dental therapists at any one time. The agreement shall include: practice 33 settings where services may be provided and the populations to be 34 served; any limitations on the services that may be provided by the 35 dental therapist, including the level of supervision required by the 36 collaborating dentist; age and procedure-specific practice protocols, 37 including case selection criteria, assessment guidelines, and imaging 38 frequency; a procedure for creating and maintaining dental records for 39 the patients that are treated by the dental therapist; a plan to manage 40 medical emergencies in each practice setting where the dental therapist 41 provides care; a quality assurance plan for monitoring care provided by 42 the dental therapist, including patient care review, referral follow-up, 43 and a quality assurance chart review; criteria relating to the provision 44 of care to patients with specific medical conditions or complex medica- 45 tion histories, including requirements for consultation prior to the 46 initiation of care; supervision criteria of dental assistants; a plan 47 for the provision of clinical resources and referrals in situations 48 which are beyond the capabilities of the dental therapist; and protocols 49 for administering and dispensing analgesics, anti-inflammatories, and 50 antibiotics, including the specific conditions and circumstances under 51 which these medications are to be dispensed and administered. 52 (c) A collaborating dentist shall be licensed and practicing in New 53 York state. The collaborating dentist shall accept responsibility for 54 all services authorized and performed by the dental therapist pursuant 55 to the management agreement.A. 5373 3 1 (d) Collaborative dentist management agreements shall be signed and 2 maintained by the collaborating dentist and the dental therapist. Agree- 3 ments shall be reviewed, updated, and submitted to the board on an annu- 4 al basis. 5 3. A dental therapist licensed under this article is limited to prima- 6 rily practicing in settings that serve low-income, uninsured, and under- 7 served patients or in a dental health professional shortage area as 8 designated by the commissioner, including a health facility or agency 9 that is reimbursed as a federally qualified health center as defined in 10 42 U.S.C. § 1395x(aa)(4) or a medically-underserved population as 11 defined in 42 U.S.C. § 254b. 12 4. The commissioner shall promulgate regulations defining the func- 13 tions a dental therapist may perform that are consistent with the train- 14 ing and qualifications for a license as a dental therapist. 15 5. As used in this section, "general supervision" shall mean the 16 supervision of tasks or procedures that do not require the presence of a 17 dentist in the office or on the premises at the time the tasks or proce- 18 dures are being performed but require the tasks be performed with the 19 prior knowledge and consent of such dentist. As used in this section, 20 "indirect supervision" shall mean the dentist is in the office, author- 21 izes the procedures and remains in the office while the procedures are 22 being performed by allied dental personnel. 23 § 6614-a. Requirements for a license as a dental therapist. To qualify 24 for a license as a dental therapist, an applicant shall fulfill the 25 following requirements: 26 1. Application: file an application with the department; 27 2. Education: have received an education, including high school gradu- 28 ation and a baccalaureate degree or master's degree from a dental thera- 29 py education program, in accordance with the commissioner's regulations; 30 3. Experience: have experience satisfactory to the board and in 31 accordance with the commissioner's regulations; 32 4. Examination: pass an examination satisfactory to the board and in 33 accordance with the commissioner's regulations; 34 5. Age: be at least eighteen years of age; 35 6. Citizenship or immigration status: be a United States citizen or a 36 noncitizen lawfully admitted for permanent residence in the United 37 States; provided, however, that the board of regents may grant a three 38 year waiver for a noncitizen to practice in an area which has been 39 designated a federal dental health professions shortage area, except 40 that the board of regents may grant an additional extension not to 41 exceed six years to a noncitizen to enable him or her to secure citizen- 42 ship or permanent resident status, provided such status is being active- 43 ly pursued; 44 7. Character: be of good moral character as determined by the depart- 45 ment; and 46 8. Fees: pay a fee of one hundred fifteen dollars to the department 47 for admission to a department conducted examination and for an initial 48 license, a fee of fifty dollars for each reexamination, a fee of seventy 49 dollars for an initial license for persons not requiring admission to a 50 department conducted examination, and a fee of fifty dollars for each 51 triennial registration period. 52 § 6614-b. Practice of dental therapy and use of title "dental thera- 53 pist". Only a person licensed under section sixty-six hundred four- 54 teen-a of this article or exempt shall practice dental therapy or use 55 the title "dental therapist".A. 5373 4 1 § 6614-c. Mandating continuing education for dental therapists. 1. (a) 2 Each dental therapist licensed pursuant to sections sixty-six hundred 3 fourteen and sixty-six hundred fourteen-a of this article and required 4 to register triennially with the department to practice in this state 5 shall comply with the provisions of the mandatory continuing education 6 requirements, except as set forth in paragraphs (b) and (c) of this 7 subdivision. Dental therapists who do not satisfy the mandatory continu- 8 ing education requirements shall not practice until they have met such 9 requirements and have been issued a registration or conditional regis- 10 tration certificate. 11 (b) Dental therapists shall be exempt from the mandatory continuing 12 education requirement for the triennial registration period during which 13 they are first licensed. In accordance with the intent of this section, 14 adjustments to the mandatory continuing education requirement may be 15 granted by the department for reasons of health, certified by a physi- 16 cian, for extended active duty with the Armed Forces of the United 17 States, or for other good cause acceptable to the department which may 18 prevent compliance. 19 (c) A licensed dental therapist not engaged in the practice of dental 20 therapy shall be exempt from the mandatory continuing education require- 21 ment upon the filing of a statement with the department declaring such 22 status. Any licensee who returns to the practice of dental therapy 23 during the triennial registration period shall notify the department 24 prior to reentering the profession and shall meet such mandatory contin- 25 uing education requirements as shall be prescribed by regulation of the 26 commissioner. 27 2. During each triennial registration period an applicant for regis- 28 tration shall complete a minimum of twenty-four hours of acceptable 29 formal continuing education including currently mandated child abuse 30 reporting instruction and infection control training as approved by the 31 department. Of these twenty-four hours a maximum of ten hours may be 32 self-instructional coursework as approved by the department. A licensee 33 who has not satisfied the mandatory continuing education requirements 34 shall not be issued a triennial registration certificate by the depart- 35 ment and shall not practice unless and until a conditional registration 36 certificate is issued as provided in subdivision three of this section. 37 The individual licensee shall determine the selection of courses or 38 programs of study pursuant to subdivision four of this section. 39 3. The department, in its discretion, may issue a conditional regis- 40 tration to a licensee who fails to meet the continuing education 41 requirements established in subdivision two of this section but who 42 agrees to make up any deficiencies and take any additional education 43 which the department may require. The fee for such a conditional regis- 44 tration shall be the same as, and in addition to, the fee for the trien- 45 nial registration. The duration of such conditional registration shall 46 be determined by the department. Any licensee who is notified of the 47 denial of registration for failure to submit evidence, satisfactory to 48 the department, of completion of required continuing education and who 49 practices dental therapy without such registration, may be subject to 50 disciplinary proceedings pursuant to section sixty-five hundred ten of 51 this title. 52 4. As used in this section, "acceptable formal continuing education" 53 shall mean formal programs of learning which contribute to professional 54 practice and which meet the standards prescribed by regulations of the 55 commissioner. To fulfill the mandatory continuing education requirement,A. 5373 5 1 programs shall be taken from sponsors approved by the department, pursu- 2 ant to the regulations of the commissioner. 3 5. The mandatory continuing education fee of thirty dollars shall be 4 payable on or before the first day of each triennial registration period 5 and shall be paid in addition to the triennial registration fee required 6 by section sixty-six hundred fourteen-a of this article. 7 § 6615. Definition of practice of advanced dental therapy. 1. The 8 practice of the profession of advanced dental therapy is defined as the 9 performance of dental services under the general supervision of a 10 dentist within the parameters of a collaborative agreement as provided 11 in subdivision two of this section which shall include: an oral evalu- 12 ation and assessment of dental disease and the formulation of an indi- 13 vidualized treatment plan authorized by the collaborating dentist; 14 nonsurgical extractions of periodontally diseased permanent teeth with 15 tooth mobility of +3 to +4 under general supervision if authorized in 16 advance by the collaborating dentist, but shall not include extracting a 17 tooth for any patient if the tooth is unerupted, impacted, fractured, or 18 needs to be sectioned for removal; and the services and procedures 19 described under subdivision one of section sixty-six hundred fourteen of 20 this article. The practice of advanced dental therapy may be conducted 21 in the office of any licensed dentist or in any appropriately equipped 22 school or public institution. 23 2. Prior to performing any of the services authorized under this arti- 24 cle, an advanced dental therapist shall enter into a written collabora- 25 tive management agreement with a licensed and registered dentist pursu- 26 ant to subdivision two of section sixty-six hundred fourteen. The 27 collaborating dentist shall ensure that a dentist is available to the 28 advanced dental therapist for timely consultation during treatment if 29 needed and shall either provide or arrange with another dentist or 30 specialist to provide the necessary treatment to any patient who 31 requires more treatment than the advanced dental therapist is authorized 32 to provide. 33 3. An advanced dental therapist licensed under this article is limited 34 to primarily practicing in settings that serve low-income, uninsured, 35 and underserved patients or in a dental health professional shortage 36 area as designated by the commissioner. 37 4. The commissioner shall promulgate regulations defining the func- 38 tions an advanced dental therapist may perform that are consistent with 39 the training and qualifications for a license as an advanced dental 40 therapist. 41 § 6615-a. Requirements for a license as an advanced dental therapist. 42 To qualify for a license as an advanced dental therapist, an applicant 43 shall fulfill the following requirements: 44 1. Application: file an application with the department; 45 2. Education: have received an education, including high school gradu- 46 ation and a master's degree from a dental therapy education program, in 47 accordance with the commissioner's regulations; 48 3. Experience: have experience satisfactory to the board and in 49 accordance with the commissioner's regulations; 50 4. Examination: pass an examination satisfactory to the board and in 51 accordance with the commissioner's regulations; 52 5. Age: be at least eighteen years of age; 53 6. Citizenship or immigration status: be a United States citizen or a 54 noncitizen lawfully admitted for permanent residence in the United 55 States; provided, however, that the board of regents may grant a three 56 year waiver for a noncitizen to practice in an area which has beenA. 5373 6 1 designated a federal dental health professions shortage area, except 2 that the board of regents may grant an additional extension not to 3 exceed six years to a noncitizen to enable him or her to secure citizen- 4 ship or permanent resident status, provided such status is being active- 5 ly pursued; 6 7. Character: be of good moral character as determined by the depart- 7 ment; and 8 8. Fees: pay a fee of one hundred fifteen dollars to the department 9 for admission to a department conducted examination and for an initial 10 license, a fee of fifty dollars for each reexamination, a fee of seventy 11 dollars for an initial license for persons not requiring admission to a 12 department conducted examination, and a fee of fifty dollars for each 13 triennial registration period. 14 § 6615-b. Practice of advanced dental therapy and use of the title 15 "advanced dental therapist". Only a person licensed under section 16 sixty-six hundred fifteen-a of this article or exempt shall practice 17 advanced dental therapy or use the title "advanced dental therapist". 18 § 6615-c. Mandatory continuing education for advanced dental thera- 19 pists. 1. (a) Each advanced dental therapist, licensed pursuant to this 20 article and required to register triennially with the department to 21 practice in this state shall comply with the provisions of the mandatory 22 continuing education requirements, except as set forth in paragraphs (b) 23 and (c) of this subdivision. Advanced dental therapists who do not 24 satisfy the mandatory continuing education requirements shall not prac- 25 tice until they have met such requirements and have been issued a regis- 26 tration or conditional registration certificate. 27 (b) Advanced dental therapists shall be exempt from the mandatory 28 continuing education requirement for the triennial registration period 29 during which they are first licensed. In accordance with the intent of 30 this section, adjustments to the mandatory continuing education require- 31 ment may be granted by the department for reasons of health, certified 32 by a physician, for extended active duty with the Armed Forces of the 33 United States, or for other good cause acceptable to the department 34 which may prevent compliance. 35 (c) A licensed advanced dental therapist not engaged in the practice 36 of advanced dental therapy shall be exempt from the mandatory continuing 37 education requirement upon the filing of a statement with the department 38 declaring such status. Any licensee who returns to the practice of 39 dental therapy during the triennial registration period shall notify the 40 department prior to reentering the profession and shall meet such manda- 41 tory continuing education requirements as shall be prescribed by regu- 42 lation of the commissioner. 43 2. During each triennial registration period an applicant for regis- 44 tration shall complete a minimum of twenty-four hours of acceptable 45 formal continuing education including currently mandated child abuse 46 reporting instruction and infection control training as approved by the 47 department. Of these twenty-four hours a maximum of ten hours may be 48 self-instructional coursework as approved by the department. A licensee 49 who has not satisfied the mandatory continuing education requirements 50 shall not be issued a triennial registration certificate by the depart- 51 ment and shall not practice unless and until a conditional registration 52 certificate is issued as provided in subdivision three of this section. 53 The individual licensee shall determine the selection of courses or 54 programs of study pursuant to subdivision four of this section. 55 3. The department, in its discretion, may issue a conditional regis- 56 tration to a licensee who fails to meet the continuing educationA. 5373 7 1 requirements established in subdivision two of this section but who 2 agrees to make up any deficiencies and take any additional education 3 which the department may require. The fee for such a conditional regis- 4 tration shall be the same as, and in addition to, the fee for the trien- 5 nial registration. The duration of such conditional registration shall 6 be determined by the department. Any licensee who is notified of the 7 denial of registration for failure to submit evidence, satisfactory to 8 the department, of completion of required continuing education and who 9 practices advanced dental therapy without such registration, may be 10 subject to disciplinary proceedings pursuant to section sixty-five 11 hundred ten of this title. 12 4. As used in this section, "acceptable formal continuing education" 13 shall mean formal programs of learning which contribute to professional 14 practice and which meet the standards prescribed by regulations of the 15 commissioner. To fulfill the mandatory continuing education requirement, 16 programs shall be taken from sponsors approved by the department, pursu- 17 ant to the regulations of the commissioner. 18 5. The mandatory continuing education fee of thirty dollars shall be 19 payable on or before the first day of each triennial registration period 20 and shall be paid in addition to the triennial registration fee required 21 by section sixty-six hundred fifteen-a of this article. 22 § 4. Subdivision 2 of section 365-a of the social services law is 23 amended by adding a new paragraph (kk) to read as follows: 24 (kk) care and services furnished by a licensed dental therapist pursu- 25 ant to article one hundred thirty-three of the education law who is 26 enrolled as a medicaid managed care provider; 27 § 5. The commissioner of health is authorized to promulgate or adopt 28 any rules or regulations necessary to implement the provisions of this 29 act and any procedures, forms, or instructions necessary for such imple- 30 mentation may be adopted and issued on or after the effective date of 31 this act. Notwithstanding any inconsistent provision of the state admin- 32 istrative procedure act or any other provision of law, rule or regu- 33 lation, the commissioner of health and the superintendent of financial 34 services and any appropriate council is authorized to adopt or amend or 35 promulgate on an emergency basis any regulation he or she or such coun- 36 cil determines necessary to implement any provision of this act on its 37 effective date. 38 § 6. This act shall take effect on the one hundred eightieth day after 39 it shall have become a law.