Bill Text: HI HB1806 | 2020 | Regular Session | Introduced

Hawaii House Bill 1806 (Prior Session Legislation)

Introduced

Bill Title: Relating To Dentistry.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced - Dead) 2020-01-21 - Referred to HLT/IAC, CPC, FIN, referral sheet 2 [HB1806 Detail]

Download: Hawaii-2020-HB1806-Introduced.html

HOUSE OF REPRESENTATIVES	H.B. NO.	1806
THIRTIETH LEGISLATURE, 2020
STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO DENTISTRY.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:

"Chapter

DENTAL THERAPISTS

§ -1 Definitions. As used in this chapter:

"Board" means the board of dentistry.

"Dental therapist" means an individual licensed under this chapter to provide the dental therapy services set forth in section -7(b) pursuant to a collaborative agreement.

"Dentist" means an individual holding a certificate of license to practice dentistry pursuant to chapter 448; provided that the individual is not a holder of a community service license or a temporary license.

§ -2 Licensure; investigations and hearings; certificates of licensure. (a) An applicant shall be eligible for licensure as a dental therapist if the applicant is eighteen years of age or more, and:

(1) Submits an application and fee in the manner prescribed by the board in rules adopted pursuant to chapter 91;

(2) Is a graduate of a dental therapy education program that is accredited by the American Dental Association Commission on Dental Accreditation or any other dental accrediting entity recognized by the United States Department of Education. A graduate of a non-accredited education program is also eligible for licensure if the applicant's education and training is comparable to an accredited program considering both the applicant's education program and any additional education, training, or supervised practice that was completed by the applicant after graduation, as determined by the board;

(3) Has demonstrated clinical competency to provide dental therapy services through at least one of the following methods:

(A) Graduation from an accredited, competency-based dental therapy education program that includes supervised clinical practice and requires demonstration of clinical competency prior to graduation, as determined by the board;

(B) Completion of a total of four hundred hours of clinical practice under the direct or indirect supervision of a dentist licensed in any state, which may be completed during or after the applicant's dental therapy education or a combination of both; or

(C) Passing a clinical licensing examination administered by a board-approved regional or national dental testing service or another examination approved by the board; and

(4) Has successfully completed a written examination on the laws and rules of the State relating to the practice of dental therapy.

(b) The board, or its duly authorized representative, may inquire of any applicant for examination concerning the applicant's character, qualifications, or experience and may conduct investigations and hearings in order to secure further information concerning the character, qualifications, or experience of any such applicant.

(c) Upon the board's determination that an applicant has successfully met the requirements of subsection (a) and after any investigations or hearings pursuant to subsection (b), the board shall issue a certificate of licensure to the applicant. The original or a copy of the certificate of licensure shall be prominently displayed at all times in the workplace where the dental therapist is employed or practices.

§ -3 Fees. Every individual holding a license to practice as a dental therapist in the State pursuant to this chapter shall pay to the board on or before December 31 of each odd-numbered year, a biennial registration fee as determined by the board through rules adopted pursuant to chapter 91. The failure, neglect, or refusal of any duly licensed dental therapist to pay the biennial fee during the time the license remains in force shall constitute a forfeiture of the license; provided that the license may be restored upon written application and payment to the board of the biennial registration fee and a restoration fee.

§ -4 Supervision by a dentist. A licensed dental therapist may perform the dental therapy services in section -7(b) under the general supervision of a dentist to the extent authorized by the supervising dentist and provided that the services are consistent with the terms of a written collaboration agreement that meets the requirements of section -5. The supervising dentist may restrict or limit the dental therapist's practice to be less than the full set of dental therapy services set forth in section -7(b). A supervising dentist may authorize a dental therapist to provide dental therapy services without a prior examination or diagnosis by a dentist.

§ -5 Collaborative agreement. Prior to performing any of the services authorized under this chapter, a dental therapist shall enter into a written collaboration agreement with a supervising dentist. The agreement shall be signed by the dental therapist and the supervising dentist, updated whenever changes are made in the supervisory or collaborative relationship, and maintained on file. A dentist may enter into a collaborative agreement with more than one dental therapist and a dental therapist may enter into a collaborative agreement with more than one dentist. The collaborative agreement shall include:

(1) Methods of dentist supervision, consultation, and approval;

(2) Services the dental therapist is authorized to provide, including any limits or conditions set by the supervising dentist on the provision of any of the services set forth in section -7(b);

(3) Settings in which the supervising dentist authorizes dental therapy services to be provided and the circumstances or conditions under which services may be provided in particular settings;

(4) Protocols for informed consent, recordkeeping, quality assurance, and dispensing or administering medications;

(5) Policies for handling referrals when a patient needs services the dental therapist is not authorized or qualified to provide;

(6) Policies for handling medical emergencies;

(7) Circumstances or conditions when dental therapy services may be provided without a prior examination or diagnosis by the supervising dentist; and

(8) Policies for supervision of dental assistants and working with dental hygienists and other dental practitioners and staff.

§ -6 Supervision of dental assistants. A dental therapist may supervise one or more dental assistants.

§ -7 Scope of practice; dental therapy services. (a) The practice of dental therapy shall be defined as the competent provision of the following oral health care services under the general supervision of a dentist:

(1) Identifying oral and systemic conditions requiring evaluation or treatment by dentists, physicians, or other healthcare providers, and manage referrals;

(2) Comprehensive charting of the oral cavity;

(3) Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis;

(4) Exposing radiographic analysis;

(5) Dental prophylaxis including sub-gingival scaling or polishing procedures;

(6) Dispensing and administering via the oral or topical route non-narcotic analgesics, anti-inflammatory, and antibiotic medications as prescribed by a licensed healthcare provider;

(7) Providing topical preventative or prophylactic agents, including fluoride varnish, antimicrobial agents, and pit and fissure sealants;

(8) Pulp vitality testing;

(9) Applying desensitizing medication or resin;

(10) Fabricating athletic mouthguards;

(11) Changing periodontal dressings;

(12) Administering local anesthetic;

(13) Simple extraction of erupted primary teeth;

(14) Emergency palliative treatment of dental pain limited to the procedures in this subsection;

(15) Preparation and placement of direct restoration in primary and permanent teeth;

(16) Fabrication and placement of single-tooth temporary crowns;

(17) Preparation and placement of preformed crowns on primary teeth;

(18) Indirect and direct pulp capping on permanent teeth;

(19) Indirect pulp capping on primary teeth;

(20) Suture removal;

(21) Minor adjustments and repairs on removable prostheses; and

(22) Removal of space maintainers.

(b) A licensed dental therapist may provide the following dental therapy services to the extent authorized in the written collaboration agreement:

(1) All the services for which education is provided by accredited dental therapy education programs under the American Dental Association Commission on Dental Accreditation's accreditation standards for dental therapy education programs;

(2) Oral examination, evaluation, diagnosis, and treatment planning for conditions and services that are within the practice of dental therapy and the dental therapist's education;

(3) Any of the following services if a dental therapist's education program or post-graduation education included education on the provision of the service:

(A) Evaluation of radiographic images;

(B) Administration of nitrous oxide;

(D) Pulpotomy on primary teeth;

(E) Fabrication of soft occlusal guards;

(F) Tooth reimplantation and stabilization;

(G) Recementing permanent crowns; or

(H) Simple extractions of periodontally diseased permanent teeth with mobility of +3 or +4;

(4) Other services and functions related to those services within paragraphs (1), (2), or (3) for which the dental therapist has education and training; and

(5) Other services authorized by the board by rule adopted pursuant to chapter 91.

§ -8 Continuing education requirements. The board shall adopt a program of continuing education for dental therapists. After January 1, 2022, at the time of reregistration of license as a dental therapist, each licensee shall present to the board evidence of compliance with the program of continuing education. Failure to reregister and present evidence of compliance shall constitute a forfeiture of license, which may be restored only upon written application therefor and payment to the board of the biennial registration fee and a restoration fee.

§ -9 Revocation of dentist's license. The board of dentistry may revoke the license of any dentist who permits any dental therapist employed by or working under the dentist's supervision to perform any dental operation other than that permitted under this chapter.

§ -10 Summary suspension. (a) The board may summarily suspend any license issued under this chapter upon a specific determination that the failure to take such an action may result in an immediate and unreasonable threat to personal safety or of fraud that jeopardizes or endangers the health or safety of patients as determined by the professional standards of care upon consumers, and that, for the protection of the public from the possible consequences of such practices, the license should be immediately suspended or restricted.

(b) The order of summary suspension shall include a brief statement of findings of fact and conclusions of law and shall be served upon the licensee as required by chapter 91. The order of summary suspension shall be effective upon service.

(c) A licensee served with an order of summary suspension shall have the right to request a hearing to show cause why the order of summary suspension should be terminated. Any request for a hearing shall be made in writing and filed with the board within five business days of service of the order. The board shall hold a hearing within seven business days of receipt of the licensee's request for the hearing to show cause.

(d) Notwithstanding any law to the contrary, an order summarily suspending a license issued under this chapter shall remain in effect until the effective date of a final decision and order issued by the board in a disciplinary action or the effective date of an order issued by the board terminating the summary suspension following a hearing to show cause, whichever occurs first, but in either case shall not exceed thirty business days.

(e) The board shall conduct a hearing for disciplinary action against a licensee whose license has been summarily suspended under this section within twenty business days from the effective date of the order of summary suspension.

(f) Any attempt by the licensee to continue the practice of dental therapy or the practice of dental therapy by the licensee while the license has been summarily suspended shall be grounds for revocation of the license.

§ -11 Filing of false information; revocation of licenses. The board shall refuse to grant a license to any applicant or shall revoke the license of any person who knowingly records, registers, or files, or offers for recordation, registration, or filing with the department of commerce and consumer affairs, any written statement which has been falsely made, completed, or altered, or in which a false entry has been made, or which contains a false statement or false information.

§ -12 Prohibited acts; discipline; penalty. (a) In addition to any other actions authorized by law, the board may suspend or revoke any license issued under this chapter or fine a licensee for any cause authorized by law, including but not limited to the following:

(1) Professional misbehavior; or

(2) Any other violation of this chapter or rules adopted pursuant thereto.

(b) Any person who violates any of the provisions of this chapter or any other law, or who fails to comply with any of the requirements or provisions of this chapter or any other law, a penalty for which is not otherwise provided, shall be fined not less than $50, nor more than $250, and each day's violation or failure to comply shall be deemed a separate violation and shall result in a separate fine.

§ -13 Remedies or penalties cumulative. Unless otherwise expressly provided, the remedies provided by this chapter are cumulative to each other and to the remedies or penalties available under all other laws of this State."

SECTION 2. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§346- Dental therapy coverage under medical assistance programs. For purposes of medical assistance programs that offer dental services, services provided by a dental therapist who is licensed pursuant to chapter and under the supervision of a licensed dentist who is enrolled as a state medicaid dental provider shall be covered; provided that the dental therapist is enrolled as a medicaid provider and is designated as the rendering provider on claims submitted by an enrolled and authorized medicaid billing provider."

SECTION 3. Section 92-28, Hawaii Revised Statutes, is amended to read as follows:

"§92-28 State service fees; increase or decrease of. Any law to the contrary notwithstanding, the fees or other nontax revenues assessed or charged by any board, commission, or other governmental agency may be increased or decreased by the body in an amount not to exceed fifty per cent of the statutorily assessed fee or nontax revenue, to maintain a reasonable relation between the revenues derived from such fee or nontax revenue and the cost or value of services rendered, comparability among fees imposed by the State, or any other purpose which it may deem necessary and reasonable; provided that:

(1) The authority to increase or decrease fees or nontax revenues shall be subject to the approval of the governor and extend only to the following: chapters 36, 92, 94, 142, 144, 145, 147, 150, 171, 188, 189, 231, 269, 271, 321, 338, 373, 412, 414, 414D, 415A, 417E, 419, 421, 421C, 421H, 421I, 425, 425E, 428, 431, 436E, 436H, 437, 437B, 438, 439, 440, 440E, 441, 442, 443B, 444, 447, 448, 448E, 448F, 448H, 451A, 451J, 452, 453, 453D, 455, 456, 457, 457A, 457B, 457G, 458, 459, 460J, 461, 461J, 462A, 463, 463E, 464, 465, 465D, 466, 466D, 466K, 467, 467E, 468E, 468L, 468M, 469, 471, 472, 482, 482E, 484, 485A, 501, 502, 505, 514B, 514E, 572, 574, [~~and~~] 846 (part II), and and any board, commission, program, or entity created pursuant to title 25 and assigned to the department of commerce and consumer affairs or placed within the department for administrative purposes;

(2) The authority to increase or decrease fees or nontax revenues under the chapters listed in paragraph (1) that are established by the department of commerce and consumer affairs shall apply to fees or nontax revenues established by statute or rule;

(3) The authority to increase or decrease fees or nontax revenues established by the University of Hawaii under chapter 304A shall be subject to the approval of the board of regents; provided that the board's approval of any increase or decrease in tuition for regular credit courses shall be preceded by an open public meeting held during or prior to the semester preceding the semester to which the tuition applies;

(4) This section shall not apply to judicial fees as may be set by any chapter cited in this section;

(5) The authority to increase or decrease fees or nontax revenues pursuant to this section shall be exempt from the public notice and public hearing requirements of chapter 91; and

(6) Fees for copies of proposed and final rules and public notices of proposed rulemaking actions under chapter 91 shall not exceed 10 cents a page, as required by section 91-2.5."

SECTION 4. Section 448-5, Hawaii Revised Statutes, is amended to read as follows:

"§448-5 Board of dentistry; appointment. The board of dentistry shall consist of [~~twelve~~] thirteen members, eight of whom shall be practicing dentists who have been engaged in the practice of dentistry for a period of five years preceding their several appointments, two of whom shall be practicing dental hygienists, duly licensed under section 447-1, who have been engaged in the practice of dental hygiene in the State for a period of five years preceding appointment, one of whom shall be a practicing dental therapist duly licensed under chapter , and two of whom shall be public members. No member shall be in any way connected with, or interested financially in, any dental supply company. One member in the practice of dentistry shall be appointed from each of the counties of Hawaii, Maui, and Kauai and five members in the practice of dentistry shall be appointed from the city and county of Honolulu. As used in this chapter, "board" means the board of dentistry."

SECTION 5. Section 466J-6, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Any provision in this chapter to the contrary notwithstanding, a license shall not be required for:

(1) A licensed medical practitioner in radiology;

(2) A licensed practitioner of nuclear medicine;

(3) A licensed physician assistant;

(4) A licensed doctor of dentistry;

(5) A licensed dental therapist;

[~~(5)~~] (6) A licensed dental technician;

[~~(6)~~] (7) A licensed dental hygienist;

[~~(7)~~] (8) A student in an approved school for radiographers, radiation therapists, or nuclear medicine technologists, or in a school of medicine, podiatry, dentistry, or a chiropractic school; provided that the student is operating x-ray machines under the direct supervision of a licensed radiographer, licensed radiation therapist, licensed nuclear medicine technologist, or a qualified person pursuant to this chapter; and

[~~(8)~~] (9) A radiologist duly licensed to practice medicine and radiology services in another state who uses telehealth while located in this State to provide radiology services to a patient who is located in the state in which the radiologist is licensed; provided that services provided by telehealth pursuant to this paragraph shall be consistent with all federal and state privacy, security, and confidentiality laws. For the purposes of this paragraph:

"Distant site" means the location of the radiologist delivering services through telehealth at the time the services are provided.

"Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a radiologist through telehealth, including but not limited to a radiologist's or health care provider's office, hospital, health care facility, a patient's home, and other non-medical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"Radiologist" means a doctor of medicine or a doctor of osteopathy certified in radiology by the American Board of Radiology or the American Board of Osteopathy.

"Telehealth" means the use of telecommunications, as that term is defined in section 269-1, to encompass four modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the radiologist is at a distant site. Standard telephone contacts, facsimile transmissions, or e-mail texts, in combination or by themselves, do not constitute a telehealth service for the purposes of this paragraph."

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect on July 1, 2020; provided that section 4 of this Act shall take effect on July 1, 2025.

INTRODUCED BY:	_____________________________

Report Title:

Dental Therapists; Licensure; Board of Dentistry

Description:

Establishes the licensure and regulation of dental therapists.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.