Volume 5, No. 6, June 2016 South Dakota Capitol Building IN THIS ISSUE Vermont Governor Signs Dental Therapy Bill Tennessee Governor Signs Bill Establishing a Scope of Practice Task Force Alabama Governor Signs Bill Establishing Alabama Dental Service Program Massachusetts Adopts Amendment to Establish Dental Hygiene Practitioner Role National Governors Association Issues Statement on Zika Virus Funding and Impact on States Community Water Fluoridation Update Reports of Interest State Resources ADEA Fellowship Opportunity
Vermont Governor Signs Dental Therapy Bill On June 2, Gov. Peter Shumlin (D-VT) signed into law S. 20, establishing and regulating a new oral health practitioner category in the State of Vermont, a dental therapist. Below is an overview of the new law. Education and Licensure An individual can be licensed in Vermont as a dental therapist, one of two ways, either by examination (Sec. 611 of S. 20) or endorsement (Sec. 612 of S. 20). In sum, to be licensed by examination you must: Currently be a licensed dental hygienist in Vermont who has graduated from a dental therapist educational program administered by an institution accredited by the Commission on Dental Accreditation (CODA) to train dental therapists. Have passed a comprehensive, competency-based clinical examination approved by the Board of Dental Examiners and administered independently of an institution providing dental therapist education. Scope of Practice The new law provides that a person who provides dental care services, including prevention, evaluation and assessment; education; palliative therapy; and restoration under the general supervision of a dentist within the parameters of a collaborative agreement shall be regarded as practicing as a dental therapist. 1 A complete listing of procedures allowed under scope of practice is in Sec. 613 of S. 20. Collaborative Practice Agreement Prior to entering into a collaborative agreement, a dental therapist must: Complete 1,000 hours of direct patient care using dental therapy procedures under the direct supervision of a dentist, and Receive a certificate of completion signed by the supervising dentist. To practice as a dental therapist, a dental therapist must enter into a written collaborative agreement with a dentist licensed and practicing in Vermont. A dentist may not enter into a collaborative agreement with more than two dental therapists. Specifications of a collaborative agreement is in Sec. 614 of S. 20. 1 S. 20 defines general supervision as the direct or indirect oversight of a dental therapist by a dentist, which need not be on-site; or the oversight of a dental hygienist by a dentist as prescribed by the Board of Dental Examiners. ADEA State Update Volume 5, No. 6, June 2016 Page 2
Supervision of Dental Hygienists and Dental Assistants A dental therapist may supervise dental assistants and dental hygienists directly to the extent permitted in the collaborative agreement. However, a dental therapist may directly supervise no more than a total of two assistants or hygienists or a combination thereof at any one practice setting. Referrals The law provides that the supervising dentist must refer patients to another dentist or specialist to provide any necessary services needed by a patient that are beyond the scope of practice of the dental therapist and which the supervising dentist is unable to provide. Additionally, a dental therapist, in accordance with the collaborative agreement, must refer patients to another qualified dental or health care professional to receive any needed services that exceed the scope of practice of the dental therapist. Reporting Requirement The law requires a report to be generated and forwarded to the state legislature. Specifically, two years after graduation of the first class of dental therapists from a Vermont accredited program, the Department of Health, in consultation with the Board of Dental Examiners, must report to certain committees in the state legislature on the following: The geographic distribution of licensed dental therapists practicing in Vermont. The geographic areas of Vermont that are underserved by licensed dental therapists. Recommended strategies to promote the practice of licensed dental therapists in underserved areas of Vermont, particularly rural areas that have high numbers of people living in poverty. Required Rulemaking The Vermont Board of Dental Examiners is directed to adopt rules and perform all other acts necessary to implement the provisions of the new law. Tennessee Governor Signs Bill Establishing a Scope of Practice Task Force Gov. Bill Haslam (R-TN) signed S.B. 1979 on April 28, and the law took effect immediately. The new law creates a scope of practice task force to make recommendations to the Tennessee General Assembly on improving the health of Tennessee residents by providing access to quality and costeffective care. The task force will consist of approximately 20 members. Members will represent nursing programs, medical school programs and local and state government. Although practicing ADEA State Update Volume 5, No. 6, June 2016 Page 3
dentists and dental hygienists and dental education programs are not specifically mentioned, members of the task force will come from public health clinics and community health centers. The task force is charged with the following: Developing a plan to educate the public and health care professionals about the advantages and methods for a transformed health care delivery system that addresses the need for accessible, equitable and affordable care provided by the appropriate health care professional. Making recommendations on the implementation of a plan to allow health care providers to work to the full extent of their education, training, experience and certification. Identifying the barriers to adoption of best practices and potential public policy options to address such barriers, including, but not limited to, unnecessary regulation and lack of access to primary care providers. Additionally, the task force is required to submit a report of its findings and recommendations, including any proposed legislation, to the Tennessee General Assembly no later than Jan. 15, 2017. Alabama Governor Signs Bill Establishing Alabama Dental Service Program On May 3, Gov. Robert Bentley (R-AL), a physician, signed S.B. 203. The new law establishes the Dental Service Program. The program will be run by the Board of Dental Scholarship Awards. The Board will receive and review all applications for scholarship loans and awards and for loans awarded under the program. Loans awarded under the program are based on economic need and scholastic ability. The Board may award each participant in the program, for as many as four years, an annual loan worth up to the annual cost of in-state tuition and required fees at the University of Alabama at Birmingham School of Dentistry. The program will be funded by direct appropriation from the Education Trust Fund. Each applicant to the program must enter into a written contract agreeing to work in full-time clinical practice as a licensed dentist in an area of critical need approved by the Board for either 18 months, 15 months if the dentist demonstrated to the Board s satisfaction that an average of at least 20% of his or her active patients were indigent or covered by Medicaid during that time, or 12 months if the dentist demonstrated to the Board s satisfaction that an average of at least 30% of his or her active patients were indigent or covered by Medicaid during that time. ADEA State Update Volume 5, No. 6, June 2016 Page 4
Massachusetts Adopts Amendment to Establish Dental Hygiene Practitioner Role Senate Majority Leader Harriette L. Chandler, along with 21 co-sponsors, introduced an amendment during the FY17 budget discussion to establish the role of dental hygiene practitioner. The amendment (amendment #479) was unanimously approved 39-0. The amendment language is very similar to S. 2076, sponsored by the Massachusetts Joint Committee on Public Health last December. The amendment outlines education, supervision and scope of practice requirements for the new role. Education Requirements A dental hygiene practitioner must complete and adhere to the following: Currently be a dental hygienist who is a graduate of a dental therapist education program and dental practitioner education program accredited by the Commission on Dental Accreditation (CODA) and provided by a postsecondary institution accredited by the New England Association of Schools and Colleges; or is certified by the Federal Indian Health Service pursuant to the Indian Health Care Improvement Act. 2 Pass a comprehensive, competency-based clinical examination that is approved by the Board of Registration in Dentistry (board) and administered independently of an institution providing registered dental practitioner education. Obtain a policy of professional liability insurance and shows proof of such insurance as required by rules and regulations. Register as a dental hygiene practitioner and has a certificate allowing the therapist to practice in this capacity. Have practiced under the direct supervision of a supervising dentist for at least 500 hours or completed one year of residency before practicing under general supervision. Written Collaborative Agreement and Supervision A dental hygiene practitioner must enter into a written collaborative agreement with a local, state or federal government agency or institution or with a licensed dentist prior to performing a procedure or providing a service. The agreement must address such items as (this list is not exhaustive): practice settings, any limitation on services established by the supervising dentists, the 2 The Senate amendment, as does S. 2076, contains conflicting language in the definition of a dental hygiene practitioner: Section 35B requires the dental hygiene practitioner to be a dental hygienist who is a graduate of a dental therapist education program accredited by the CODA; and Section 35D requires the dental hygiene practitioner to be a dental hygienist who is a graduate of a dental practitioner education program accredited by the CODA. The final language in the state budget addressing/clarifying this discrepancy will likely be determined during conference committee. ADEA State Update Volume 5, No. 6, June 2016 Page 5
level of supervision required for various services or treatment settings, administering and dispensing medications and supervision of dental assistants and dental hygienists. The collaborative agreement must include specific written protocols to govern situations in which the dental hygiene practitioner encounters a patient requiring treatment that exceeds the authorized scope of practice of the dental hygiene practitioner. A supervising dentist may have a collaborative management agreement with no more than four dental hygiene practitioners at the same time. Scope of Practice A dental hygiene practitioner licensed by the board may perform all acts of a public health dental hygienist, all acts provided for in CODA s dental therapy standards, as well as the following services and procedures pursuant to the written collaborative management agreement without the supervision or direction of a dentist: interpreting radiographs; the placement of space maintainers; pulpotomies on primary teeth; an oral evaluation and assessment of dental disease and the formulation of an individualized treatment plan authorized by the collaborating dentist; and nonsurgical extractions of permanent teeth as limited in the following paragraph. A dental hygiene practitioner may perform nonsurgical extractions of periodontally diseased permanent teeth with tooth mobility of +3 to +4 under general supervision if authorized in advance by the collaborating dentist. The dental hygiene practitioner shall not extract a tooth for any patient if the tooth is unerupted, impacted, fractured or needs to be sectioned for removal. The collaborating dentist is responsible for directly providing or arranging for another dentist or specialist to provide any necessary advanced services needed by the patient. A dental hygiene practitioner in accordance with the written collaborative agreement must refer patients to another qualified dental or health care professional to receive any needed services that exceed the scope of practice of the dental hygiene practitioner. Reimbursement The dental hygiene practitioner shall be reimbursed for services covered by Medicaid and other third-party payers. A dental hygiene practitioner shall not operate independently of a dentist, except for a dental hygiene practitioner working for a local, state or federal government agency or institution or practicing in a mobile or portable prevention program licensed or certified by the department of public health as permitted by law. Evaluation Within seven years of the proposed law taking effect, an evaluation must be conducted by the board in consultation with the Executive Office of Health and Human Services. The evaluation process shall focus on the following outcome measures: 1) number of new patients served, 2) reduction in ADEA State Update Volume 5, No. 6, June 2016 Page 6
waiting times for needed services, 3) decreased travel time for patients, 4) impact on emergency room usage for dental care, and 5) the costs to the public health care system. National Governors Association Issues Statement on Zika Virus Funding and Impact on States On May 9, the National Governors Association (NGA) issued a statement on behalf of the nation s governors asking Congress and the Administration to work together to reach agreement on the appropriate level of funding needed to combat the Zika virus. The NGA states, The nation is on the threshold of a public health emergency, and asks for action to be taken to prevent an eventual outbreak. The statement was read live at the White House press briefing on May 10. In February, the White House requested $1.9 billion to fight the virus. Several weeks ago, the U.S. Senate approved a bill that would provide $1.1 billion in funding, and the U.S. House of Representatives approved reallocating $622 million from existing programs to fight Zika. For the latest information on the Zika virus, visit NGA s Zika in the States: What You Need to Know. Community Water Fluoridation Update Although a dozen states filed bills to regulate community water fluoridation, two state legislatures, Connecticut and Missouri, ultimately passed water fluoridation bills during the 2016 legislative session. Additionally, for the second consecutive fiscal year, New York State has appropriated money to its fluoridation fund. Connecticut On May 2, Gov. Dannel P. Malloy (D-CT) signed into law H.B. 5350. The new law reduces the mandated fluoride content of the public water supply. Specifically, it requires water companies serving at least 20,000 people to add a measured amount of fluoride to the water supply to maintain an average monthly fluoride content that is no more than 0.15 milligrams per liter (mg/l) different from the U.S. Department of Health and Human Services most recent recommendation for optimal fluoride levels in drinking water to prevent tooth decay (currently 0.7 mg/l). This is a change from the current state law, which requires that the public water supply s fluoride content be between 0.8 and 1.2 mg/l. H.B. 5350 becomes effective on Oct. 1. ADEA State Update Volume 5, No. 6, June 2016 Page 7
Missouri On May 25, H.B. 1717, sponsored by Rep. Donna Lichtenegger (R), a dental hygienist, was delivered to the governor for approval or veto. The bill requires public water systems and water supply districts to notify the Department of Health and Senior Services, Department of Natural Resources and its customers at least 90 days prior to any meeting held at which a vote to modify the fluoridation of water in the system or district will occur. If the water system is an investor-owned water supply, the entity calling for the modifications is responsible for the meeting and notice requirements. New York During the 2015 16 Executive Budget, a line item was created establishing a Fluoridation Fund, with $5 million appropriated to the fund during that fiscal year. The fund allows grantees to use monies for such projects as starting up fluoridation systems in their area and repairing, replacing or upgrading fluoridation equipment. However, funds cannot be used toward the cost and expense of operation of the fluoridation system. In the 2016 17 Executive Budget, $5 million was again allocated to the Fluoridation Fund. The grant applications (search for active grants using the term fluoridation ) went live on May 13 and will stay open to applicants on a rolling basis until Aug. 31. Eligible grant applicants include counties, cities, towns or villages that own their public water system and the water supply for such system. The Fluoridation Fund falls under the Medicaid Budget within the Executive Budget. Reports of Interest The New York Joint Senate Task Force on Heroin and Opioid Addiction issued its 2016 Report, making numerous recommendations for the 2016 legislative session and the FY17 budget. Recommendations included the following (this list is not exhaustive): Limiting initial prescriptions of controlled substances to a five-day supply. Ensuring proper opioid education to prescribed patients. Patient counseling prior to issuing a prescription for an opioid. State Resources ADEA Advocacy Website The ADEA Advocacy website is updated daily with information on issues of importance to academic dentistry and dental and craniofacial research. Also, it allows you to communicate with your elected officials by simply entering your zip code or address. ADEA State Update Volume 5, No. 6, June 2016 Page 8
You can navigate the website by clicking through the drop-down menus at the top of the page. While there, please subscribe to ADEA Action Alerts to maximize your ability to send messages to your elected officials. ADEA/AGR on Twitter For the latest information on issues affecting dental education and dental and craniofacial research in the state legislatures, please follow us on Twitter at @ADEAAGR. ADEA Fellowship Opportunity ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship Dental school faculty members or administrators who want to interface with members of Congress on issues of importance to oral health are encouraged to apply for the ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship. The selected fellow spends three months (flexible schedule) in Washington, D.C., working on issues and policies that could make a difference in the life of every American. This public policy fellowship coincides with congressional consideration of the federal budget and other legislative and regulatory activities important to dental education and research. The fellow functions as an ADEA Policy Center staff member who works within the ADEA AGR portfolio on ADEA s specific legislative priorities. The fellow s responsibilities may include drafting policy, legislative language, position papers and testimony; educating members of Congress and other decision-makers on matters of importance to dental education; and participating in gatherings of various national coalitions. The fellow receives a taxable stipend of $15,000 to cover travel and expenses for approximately three months (cumulative) in Washington, D.C. ADEA is flexible in the arrangement of time away from the fellow s institution. The fellow s institution continues to provide salary support for the duration of the experience. Since its inception in 1985, the ADEA/Sunstar Americas, Inc./Harry W. Bruce, Jr. Legislative Fellowship has been generously underwritten by Sunstar Americas, Inc. Interested candidates should apply now. ADEA State Update Volume 5, No. 6, June 2016 Page 9
ADEA publishes the ADEA State Update monthly. Its purpose is to keep ADEA members abreast of state issues and events of interest to the academic dentistry and the dental and research communities. 2016 American Dental Education Association 655 K Street NW, Suite 800, Washington, DC 20001 Telephone: 202-289-7201, Website: ADEA.org Yvonne Knight, J.D. ADEA Chief Advocacy Officer (KnightY@ADEA.org) Jennifer Brown, J.D. ADEA Director of State Relations (BrownJ@ADEA.org) Timothy Leeth, C.P.A. ADEA Senior Director for Federal Relations (LeethT@ADEA.org) Evelyn Lucas-Perry, D.D.S., M.P.H. ADEA Director of Public Policy Research (Lucas-PerryE@ADEA.org) ADEA State Update Volume 5, No. 6, June 2016 Page 10