Bill Text: MI HB5374 | 2015-2016 | 98th Legislature | Introduced
Bill Title: Health occupations; health care professionals; limited prescriptive authority for dental hygienists; establish. Amends sec. 16611 of 1978 PA 368 (MCL 333.16611).
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2016-02-17 - Bill Electronically Reproduced 02/16/2016 [HB5374 Detail]
Download: Michigan-2015-HB5374-Introduced.html
HOUSE BILL No. 5374
February 16, 2016, Introduced by Rep. Chatfield and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending section 16611 (MCL 333.16611), as amended by 2004 PA
30.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 16611. (1) An individual shall not engage in the practice
of dentistry, the practice as a dental hygienist, or the practice
as a dental assistant unless he or she is licensed or otherwise
authorized by this article.
(2) Deep scaling, root planing, and the removal of calcareous
deposits may only be performed by an individual who is licensed or
otherwise authorized by this article as a dental hygienist or a
dentist.
(3) The department shall not issue a dental hygienist's
license to an individual unless the individual has graduated from a
school or college for dental hygienists whose dental hygiene
program
is accredited by the commission on dental accreditation
Commission
on Dental Accreditation of the American
dental
association
Dental Association and approved by the department. The
school or college must be accredited by a regional accrediting
agency for colleges, universities, or institutions of higher
education
that is recognized by the United States department of
education
Department of Education and approved by the department
and must conduct a curriculum consisting of not less than 2
academic years for dental hygiene graduation with courses at the
appropriate level to enable matriculation into a more advanced
academic degree program.
(4) Upon delegation by a dentist under section 16215 and under
the direct supervision of a dentist, a dental hygienist may
administer intraoral block and infiltration anesthesia or nitrous
oxide analgesia, or both, to a patient 18 years of age or older, if
the following criteria are met:
(a) The dental hygienist has successfully completed a course
in the administration of local anesthesia or nitrous oxide
analgesia, or both, as applicable, offered by a dental or dental
hygiene
program accredited by the commission on dental
accreditation
Commission on Dental
Accreditation of the American
dental
association Dental
Association and approved by the
department. A course described in this subdivision involving local
anesthesia administration must contain a minimum of 15 hours
didactic instruction and 14 hours of clinical experience. A course
described in this subdivision involving nitrous oxide analgesia
administration must contain a minimum of 4 hours of didactic
instruction and 4 hours of clinical experience. The courses of
instruction shall include content in all of the following:
(i) In the case of local anesthesia, the following:
(A) Theory of pain control.
(B) Selection of pain control modalities.
(C) Anatomy.
(D) Neurophysiology.
(E) Pharmacology of local anesthetics.
(F) Pharmacology of vasoconstrictors.
(G) Psychological aspects of pain control.
(H) Systemic complications.
(I) Techniques of maxillary anesthesia.
(J) Techniques of mandibular anesthesia.
(K) Infection control.
(L) Local anesthesia medical emergencies.
(ii) In the case of nitrous oxide analgesia, the following:
(A) Nitrous oxide analgesia medical emergency techniques.
(B) Pharmacology of nitrous oxide.
(C) Nitrous oxide techniques.
(D) If such a course is available, selection of pain control
modalities.
(b) The dental hygienist has successfully completed a state or
regional board-administered written examination on either or both
of the following within 18 months of completion of the course work
required under subdivision (a):
(i) Local anesthesia.
(ii) Nitrous oxide analgesia, if such an examination is
available and approved by the department.
(c) The dental hygienist maintains and can show evidence of
current certification in basic or advanced cardiac life support in
compliance with R 338.11701 of the Michigan administrative code.
(5) Application for certification in the administration of
local anesthesia and nitrous oxide under subsection (4) is at the
discretion of each individual dental hygienist. The department or
its designee shall issue a certificate to a dental hygienist who
meets the criteria in subsection (4) following the initial
completion of the requirements to administer local anesthesia or
nitrous oxide, or both. The certificate is not subject to renewal
but is part of the dental hygienist's permanent record and must be
prominently displayed in the dental hygienist's principal place of
employment. The fee for the person seeking certification for
completion of the requirements of subsection (4) is $10.00.
(6) Monitoring and assisting the administration of nitrous
oxide
analgesia is at the discretion of each individual registered
dental assistant who fulfills the applicable conditions imposed in
subsection (7).
(7) In addition to the rules promulgated by the department
under this part, upon delegation by a dentist under section 16215
and
under the direct supervision of a dentist, a registered dental
assistant may assist and monitor the administration of nitrous
oxide analgesia by the dentist or dental hygienist if the
registered
dental assistant has successfully
completed a course in
the assisting and monitoring of the administration of nitrous oxide
analgesia offered by a dental or dental assisting program
accredited
by the commission on dental accreditation Commission on
Dental
Accreditation of the American dental
association Dental
Association and approved by the department. The course must contain
a minimum of 5 hours of didactic instruction and include content in
all of the following:
(a) Nitrous oxide analgesia medical emergencies techniques.
(b) Pharmacology of nitrous oxide.
(c) Nitrous oxide techniques.
(8) The ability of a dental hygienist to administer nitrous
oxide analgesia under this section is limited to circumstances in
which the dental hygienist may administer not more than 50% nitrous
oxide.
(9)
In the assisting by a registered dental assistant
otherwise qualified under this section in the administration of
nitrous oxide analgesia, the nitrous oxide levels must be preset by
the dentist or dental hygienist and shall not be adjusted by the
registered
dental assistant except in the case
of an emergency, in
which
circumstances the registered dental assistant may turn off
the nitrous oxide and administer 100% oxygen.
(10) Upon assignment by a dentist, a dental hygienist may take
an impression for orthodontic appliances, mouth guards, bite
splints, and bleaching trays.
(11) In addition to the rules promulgated by the department
under this part, upon delegation by a dentist under section 16215
and
under the direct supervision of a dentist, a registered dental
assistant may place, condense, and carve amalgam restorations and
take
final impressions for indirect restorations if the registered
dental assistant has successfully completed a course offered by a
dental
or dental assisting program accredited by the commission on
dental
accreditation Commission on
Dental Accreditation of the
American
dental association Dental
Association and approved by the
department. For taking final impressions and placing, condensing,
and
carving amalgam restorations, the registered dental assistant
shall have completed a course with a minimum of 20 hours' didactic
instruction followed by a comprehensive clinical experience of
sufficient duration that validates clinical competence through a
criterion based assessment instrument.
(12) In addition to the rules promulgated by the department
under this part, upon delegation by a dentist under section 16215
and
under the general supervision of a dentist, a registered dental
assistant may perform the following intraoral dental procedures if
the
registered dental assistant has successfully completed a course
meeting the standards described in subsection (13) offered by a
dental
or dental assisting program accredited by the commission on
dental
accreditation Commission on
Dental Accreditation of the
American
dental association Dental
Association and approved by the
department:
(a) Performing pulp vitality testing.
(b) Placing and removing matrices and wedges.
(c) Applying cavity liners and bases.
(d) Placing and packing nonepinephrine retraction cords.
(e) Applying desensitizing agents.
(f) Taking an impression for orthodontic appliances, mouth
guards, bite splints, and bleaching trays.
(g) Drying endodontic canals with absorbent points.
(h) Etching and placing adhesives prior to placement of
orthodontic brackets.
(13) The course in subsection (12) that involves those
intraoral procedures described in subsection (12) must contain a
minimum of 10 hours of didactic and clinical instruction.
(14) In addition to any prescriptive authority granted by
rules promulgated by the department under this part, upon
assignment by a dentist, and following practice guidelines that are
consistent with national recommendations, a dental hygienist may
prescribe any of the following for a patient:
(a) Any fluoride supplement in the form of a tablet, lozenge,
drop, or similar method of oral dosing.
(b) Any topical sodium fluoride or stannous fluoride anti-
caries treatment in the form of a toothpaste, gel, rinse, varnish,
prophy paste, or similar method of application.
(c) Any topical or subgingival anti-infective.
(15) (14)
This section does not require new
or additional
third party reimbursement or mandated worker's compensation
benefits for services rendered by an individual licensed as a
dental assistant or as a dental hygienist under this article.
(16) (15)
Within 30 days after the effective date of the
amendatory
act that added this subsection, By
April 21, 2004, the
board shall develop patient safety and equipment practice
guidelines for dentists delegating to dental hygienists and dental
assistants the administration of nitrous oxide analgesia under this
part. The practice guidelines shall be consistent with national
recommendations.
(17) (16)
As used in this section:
(a) "Assisting" means setting up equipment and placing the
face mask. Assisting does not include titrating and turning on or
off equipment.
(b) "Direct supervision" means that a dentist complies with
all of the following:
(i) Designates a patient of record upon whom the procedures
are to be performed and describes the procedures to be performed.
(ii) Examines the patient before prescribing the procedures to
be performed and upon completion of the procedures.
(iii) Is physically present in the office at the time the
procedures are being performed.
(c) "General supervision" means that a dentist complies with
all of the following:
(i) Designates a patient of record upon whom services are to
be performed.
(ii) Is physically present in the office at the time the
procedures are being performed.
(d) "Monitoring" means observing levels and reporting to the
dentist or dental hygienist.
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.
