As Introduced

127th General Assembly
Regular Session
2007-2008
H. B. No. 188


Representatives Adams, Boyd 

Cosponsors: Representatives McGregor, J., Peterson, Flowers, Aslanides, Fessler, Otterman, Stebelton, Huffman, Raussen, Healy 

A BILL
To amend sections 4715.22, 4715.23, 4715.39, and 1
4715.64 and to enact sections 4715.221, 4715.222, 2
4715.223, 4715.224, 4715.225, 4715.226, 4715.227, 3
4715.228, 4715.229, and 4715.2210 of the Revised 4
Code to permit dental hygienists to enter into 5
collaboration agreements with dentists.6


BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

       Section 1.  That sections 4715.22, 4715.23, 4715.39, and 7
4715.64 be amended and sections 4715.221, 4715.222, 4715.223, 8
4715.224, 4715.225, 4715.226, 4715.227, 4715.228, 4715.229, and 9
4715.2210 of the Revised Code be enacted to read as follows:10

       Sec. 4715.22.  (A) AsThis section applies only when a 11
licensed dental hygienist is not providing services under a 12
collaboration agreement entered into under section 4715.222 of the 13
Revised Code.14

       As used in this section, "health care facility" means either 15
of the following:16

       (1) A hospital registered under section 3701.07 of the 17
Revised Code;18

       (2) A "home" as defined in section 3721.01 of the Revised19
Code.20

       (B) A licensed dental hygienist shall practice under the 21
supervision, order, control, and full responsibility of a dentist 22
licensed under this chapter. A dental hygienist may practice in a 23
dental office, public or private school, health care facility, 24
dispensary, or public institution. Except as provided in division25
(C) or (D) of this section, a dental hygienist may not provide 26
dental hygiene services to a patient when the supervising dentist 27
is not physically present at the location where the dental 28
hygienist is practicing. 29

       (C) A dental hygienist may provide, for not more than fifteen 30
consecutive business days, dental hygiene services to a patient 31
when the supervising dentist is not physically present at the 32
location at which the services are provided if all of the 33
following requirements are met:34

       (1) The dental hygienist has at least two years and a minimum 35
of three thousand hours of experience in the practice of dental 36
hygiene.37

       (2) The dental hygienist has successfully completed a course 38
approved by the state dental board in the identification and 39
prevention of potential medical emergencies.40

       (3) The dental hygienist complies with written protocols for 41
emergencies the supervising dentist establishes.42

       (4) The dental hygienist does not perform, while the43
supervising dentist is absent from the location, procedures while 44
the patient is anesthetized, definitive root planing, definitive45
subgingival curettage, or other procedures identified in rules the 46
state dental board adopts.47

       (5) The supervising dentist has evaluated the dental48
hygienist's skills.49

       (6) The supervising dentist examined the patient not more50
than seven months prior to the date the dental hygienist provides 51
the dental hygiene services to the patient.52

       (7) The dental hygienist complies with written protocols or 53
written standing orders that the supervising dentist establishes.54

       (8) The supervising dentist completed and evaluated a medical 55
and dental history of the patient not more than one year prior to 56
the date the dental hygienist provides dental hygiene services to 57
the patient and, except when the dental hygiene services are 58
provided in a health care facility, the supervising dentist59
determines that the patient is in a medically stable condition.60

       (9) If the dental hygiene services are provided in a health 61
care facility, a doctor of medicine and surgery or osteopathic 62
medicine and surgery who holds a current certificate issued under63
Chapter 4731. of the Revised Code or a registered nurse licensed 64
under Chapter 4723. of the Revised Code is present in the health 65
care facility when the services are provided.66

       (10) In advance of the appointment for dental hygiene 67
services, the patient is notified that the supervising dentist 68
will be absent from the location and that the dental hygienist 69
cannot diagnose the patient's dental health care status.70

       (11) The dental hygienist is employed by, or under contract 71
with, one of the following:72

       (a) The supervising dentist;73

       (b) A dentist licensed under this chapter who is one of the 74
following:75

       (i) The employer of the supervising dentist;76

       (ii) A shareholder in a professional association formed under 77
Chapter 1785. of the Revised Code of which the supervising dentist 78
is a shareholder;79

       (iii) A member or manager of a limited liability company 80
formed under Chapter 1705. of the Revised Code of which the 81
supervising dentist is a member or manager;82

       (iv) A shareholder in a corporation formed under division (B) 83
of section 1701.03 of the Revised Code of which the supervising84
dentist is a shareholder;85

       (v) A partner or employee of a partnership or a limited 86
liability partnership formed under Chapter 1775. of the Revised87
Code of which the supervising dentist is a partner or employee. 88

       (c) A government entity that employs the dental hygienist to 89
provide dental hygiene services in a public school or in90
connection with other programs the government entity administers. 91

       (D) A dental hygienist may provide dental hygiene services to 92
a patient when the supervising dentist is not physically present 93
at the location at which the services are provided if the services 94
are provided as part of a dental hygiene program that is approved 95
by the state dental board and all of the following requirements 96
are met:97

       (1) The program is operated through a school district board98
of education or the governing board of an educational service 99
center; the board of health of a city or general health district 100
or the authority having the duties of a board of health under 101
section 3709.05 of the Revised Code; a national, state, district, 102
or local dental association; or any other public or private entity 103
recognized by the state dental board.104

       (2) The supervising dentist is employed by or a volunteer 105
for, and the patients are referred by, the entity through which 106
the program is operated.107

       (3) The services are performed after examination and 108
diagnosis by the dentist and in accordance with the dentist's 109
written treatment plan.110

       (E) No person shall do either of the following:111

       (1) Practice dental hygiene in a manner that is separate or 112
otherwise independent from the dental practice of a supervising 113
dentist;114

       (2) Establish or maintain an office or practice that is115
primarily devoted to the provision of dental hygiene services. 116

       (F) The state dental board shall adopt rules under division117
(C) of section 4715.03 of the Revised Code identifying procedures 118
a dental hygienist may not perform when practicing in the absence119
of the supervising dentist pursuant to division (C) or (D) of this 120
section.121

       Sec. 4715.221.  As used in this section and sections 4715.222 122
to 4715.2210 of the Revised Code:123

       (A) "Collaboration agreement" means an agreement entered into 124
by a dentist and a dental hygienist under section 4715.222 of the 125
Revised Code.126

       (B) "Dentist" means an individual licensed under this chapter 127
to practice dentistry. 128

       (C) "Dental hygienist" means an individual licensed under 129
this chapter to practice as a dental hygienist.130

       (D) "Facility" means any of the following:131

       (1) A dental office;132

       (2) A "public school" or "nonpublic school" as defined in 133
section 3701.93 of the Revised Code;134

       (3) A "health care facility" as defined in section 4715.22 of 135
the Revised Code;136

       (4) A "home health agency" as defined in section 5101.61 of 137
the Revised Code;138

       (5) A dispensary;139

       (6) A "state correctional institution" as defined in section 140
2967.01 of the Revised Code;141

       (7) A clinic or shelter financed with public or private 142
funds;143

       (8) A mobile dental unit;144

       (9) A community health fair;145

       (10) A comprehensive child development program that receives 146
funds distributed under the "Head Start Act," 95 Stat. 499 (1981), 147
42 U.S.C. 9831, as amended, and is licensed as a child day-care 148
center;149

       (11) A corporation, association, group, institution, society, 150
or other organization that is exempt from federal taxation under 151
section 501(c)(3) of the "Internal Revenue Code of 1986," 100 152
Stat. 2085, 26 U.S.C. 501(c)(3), as amended, and serves 153
individuals who are uninsured or enrolled in the medicaid program 154
established under Chapter 5111. of the Revised Code or the 155
disability medical assistance program established under Chapter 156
5115. of the Revised Code;157

       (12) A special needs program;158

       (13) A residential facility licensed under section 5123.19 of 159
the Revised Code;160

       (14) Any other location specified by the state dental board 161
in rules adopted under section 4715.2210 of the Revised Code.162

       (E) "Patient" means an individual who receives dental hygiene 163
services at a facility, a student enrolled in the facility at 164
which the services are provided, or a resident of a facility at 165
which the services are provided. 166

       (F) "Special needs program" means a program operated by any 167
of the following:168

       (1) A school district board of education or the governing 169
board of an educational service center;170

       (2) The board of health of a city or general health district 171
or the authority having the duties of a board of health under 172
section 3709.05 of the Revised Code;173

       (3) A national, state, district, or local dental association.174

       Sec. 4715.222.  (A) A dental hygienist who has provided the 175
evidence required by section 4715.223 of the Revised Code may 176
enter into a collaboration agreement with a dentist under which 177
the dentist authorizes all of the following:178

       (1) The dental hygienist to provide the services described in 179
section 4715.224 of the Revised Code to patients at any facility 180
without the dentist being physically present at the facility where 181
the services are provided;182

       (2) The dental hygienist to provide the services described in 183
section 4715.224 of the Revised Code to patients without prior 184
examination of the patients by the dentist or diagnosis or 185
treatment plans approved by the dentist, unless otherwise 186
specified in the collaboration agreement;187

       (3) The dental hygienist to work with dental assistants 188
certified by the dental assisting national board or the Ohio 189
commission on dental assistant certification who may perform only 190
the duties they are authorized to provide without the direct 191
supervision of a dentist.192

       (B) A collaboration agreement must meet the requirements of 193
section 4715.225 of the Revised Code. 194

       Sec. 4715.223.  Prior to entering into a collaboration 195
agreement, a dental hygienist shall do both of the following:196

       (A) Submit written evidence of all of the following to the 197
dentist who is to be the collaborating dentist under the 198
agreement: 199

       (1) The dental hygienist has at least two years and a minimum 200
of three thousand hours of experience in the practice of dental 201
hygiene.202

       (2) The dental hygienist has successfully completed a course 203
approved by the state dental board in the identification and 204
prevention of potential medical emergencies and infection control.205

       (3) The dental hygienist holds current certification to 206
perform basic life-support procedures as required under section 207
4715.251 of the Revised Code.208

       (4) The dental hygienist holds professional liability 209
insurance.210

       (B) Permit the dentist who is to be the collaborating dentist 211
under the agreement to personally observe the dental hygienist 212
provide to patients the services described in section 4715.224 of 213
the Revised Code.214

       Sec. 4715.224.  A dental hygienist may provide the following 215
services to a patient under a collaboration agreement:216

       (A) Oral health promotion and disease prevention education, 217
including information gathering, screening, and assessment;218

       (B) Removal of calcareous deposits or accretions from the 219
crowns and roots of teeth;220

       (C) Sulcular placement of prescribed materials;221

       (D) Polishing of the clinical crowns of teeth, including 222
restorations;223

       (E) Standard diagnostic and radiological procedures for the 224
purpose of contributing to the provision of dental services;225

       (F) Fluoride applications;226

       (G) Placement of sealants;227

       (H) Any other basic remediable intraoral dental task or 228
procedure designated by the state dental board in rules adopted 229
under section 4715.2210 of the Revised Code.230

       Sec. 4715.225.  A collaboration agreement shall be in writing 231
and do all of the following at a minimum:232

       (A) Contain the following terms:233

       (1) A procedure the dental hygienist must follow in securing 234
the dentist's review of the patient's record and medical history 235
if the dental hygienist believes the patient's condition is 236
medically compromised;237

       (2) A procedure the dental hygienist must follow if the 238
dental hygienist believes the patient's condition presents an 239
emergency dental condition;240

       (3) Practice protocols for the dental hygienist to follow in 241
providing services to patients who are different ages and who 242
require different procedures, including recommended intervals for 243
the performance of dental hygiene services and a period of time in 244
which an examination by a dentist should occur;245

       (4) Specific protocols for the placement of pit and fissure 246
sealants and requirements for follow-up care to assure the 247
efficacy of the sealants after application;248

       (5) A procedure for creating and maintaining dental records 249
for patients that are treated by the dental hygienist. The 250
procedure must specify where the records are to be located.251

       (6) Services specified under section 4715.224 of the Revised 252
Code, if any, for which the dentist requires either or both of the 253
following:254

       (a) The patient be examined by the dentist prior to the 255
dental hygienist providing the services;256

       (b) The dentist to approve a patient-specific diagnosis or 257
treatment plan.258

       (7) The number of patient visits for dental hygiene services, 259
if any, that the dentist requires the dental hygienist to provide, 260
on an annual basis, to patients in special needs programs for a 261
charge determined according to the sliding fee scale established 262
by the state dental board in rules adopted under section 4715.2210 263
of the Revised Code.264

       (8) A statement that the dentist and dental hygienist agree 265
that the dental hygienist's provision of services under a 266
collaboration agreement is neither of the following:267

        (a) The practice of dental hygiene in a manner that is 268
separate or otherwise independent from the dental practice of a 269
collaborating dentist;270

        (b) The establishment or maintenance of an office or practice 271
that is primarily devoted to the provision of dental hygiene 272
services.273

       (B) Contain a blank copy of a consent to treatment form that 274
the dental hygienist can use for purposes of complying with the 275
requirement of section 4715.227 of the Revised Code;276

       (C) Be signed and dated by both the dentist and dental 277
hygienist.278

       Sec. 4715.226.  (A) A copy of a collaboration agreement must 279
be maintained by the dentist and the dental hygienist who are 280
parties to the agreement. The dental hygienist shall ensure that 281
each facility where the dental hygienist provides services under a 282
collaboration agreement has a copy of the agreement that the 283
dental hygienist works under at that facility. 284

       (B) Except as provided under division (C) of this section, 285
prior approval of a collaboration agreement by the state dental 286
board is not required before a dental hygienist provides services 287
under an agreement, but the dentist or dental hygienist who is a 288
party to the agreement must provide the board with a copy of the 289
agreement on the board's request.290

       (C) A dentist shall not at any one time be a party to more 291
than three collaboration agreements unless the state dental board 292
determines that the dentist meets the criteria, established by the 293
board in rules adopted under section 4715.2210 of the Revised 294
Code, to be a party to more than three agreements. 295

       Sec. 4715.227.  Before performing any services on a patient 296
under a collaboration agreement, a dental hygienist must provide 297
the patient or patient's representative with a consent to 298
treatment form and secure the signature or mark of the patient or 299
representative on it. The signature or mark may be provided 300
through reasonable accommodation, including the use of assistive 301
technology or augmentative devices.302

        The form must include a statement advising the patient that 303
the dental hygiene services provided are not a substitute for a 304
dental examination by a dentist, that a dentist will not be 305
present during the provision of dental hygiene services, and that 306
the dental hygienist cannot diagnose the patient's dental health 307
care status.308

       Sec. 4715.228.  Following the provision of services to a 309
patient under a collaboration agreement, the dental hygienist 310
shall refer the patient to the dentist who is the collaborating 311
dentist under the agreement the dental hygienist is working under 312
at the facility where the patient was treated. The dental 313
hygienist shall give the patient or patient's representative a 314
completed referral form that lists the name, office address, and 315
office telephone of the collaborating dentist and the date the 316
dental hygienist provided the services to the patient. The dental 317
hygienist shall provide a copy of each completed referral form and 318
the patient's record to the collaborating dentist.319

       Sec. 4715.229.  A collaboration agreement entered into under 320
section 4715.222 of the Revised Code may be terminated by the 321
dentist or dental hygienist who entered into the agreement. A 322
dentist or dental hygienist who terminates a collaboration 323
agreement shall provide written notice to the opposite party. The 324
dental hygienist shall not provide services under the agreement 325
once notice of the termination has been given or sent to the 326
dentist.327

       Sec. 4715.2210.  The state dental board shall adopt rules to 328
do all of the following:329

       (A) For purposes of division (D)(14) of section 4715.221 of 330
the Revised Code, specify the locations other than those listed in 331
divisions (D)(1) to (13) of section 4715.221 of the Revised Code 332
that are to be considered facilities under sections 4715.222 to 333
4715.229 of the Revised Code.334

       (B) For purposes of division (H) of section 4715.224 of the 335
Revised Code, designate the basic remediable intraoral dental 336
tasks or procedures, in addition to the services listed in 337
divisions (A) to (G) of section 4715.224 of the Revised Code, that 338
a dental hygienist may provide under a collaboration agreement.339

       (C) For purposes of division (A)(7) of section 4715.225 of 340
the Revised Code, establish a sliding fee scale that determines 341
the fee a patient in a special needs program is charged for dental 342
hygiene services provided by a dental hygienist under a 343
collaboration agreement.344

       (D) For purposes of division (C) of section 4715.226 of the 345
Revised Code, establish the criteria the board must use in 346
determining whether a dentist can be a party to more than three 347
collaboration agreements at one time.348

       Sec. 4715.23. Except when a dental hygienist is providing 349
services under a collaboration agreement entered into under 350
section 4715.222 of the Revised Code, all of the following apply 351
with respect to the practice of a dental hygienist:352

       (A) The practice of a dental hygienist shall consist of those 353
prophylactic, preventive, and other procedures that licensed 354
dentists are authorized by this chapter and rules of the dental 355
board to assign only to licensed dental hygienists or to qualified 356
personnel under section 4715.39 of the Revised Code.357

       (B) Licensed dentists may assign to dental hygienists 358
intraoral tasks that do not require the professional competence or 359
skill of the licensed dentist and that are authorized by board 360
rule. Such performance of intraoral tasks by dental hygienists 361
shall be under supervision and full responsibility of the licensed362
dentist, and at no time shall more than three dental hygienists be 363
practicing clinical hygiene under the supervision of the same364
dentist. The foregoing shall not be construed as authorizing the365
assignment of diagnosis, treatment planning and prescription366
(including prescriptions for drugs and medicaments or367
authorizations for restorative, prosthodontic, or orthodontic368
appliances); or, except when done in conjunction with the removal369
of calcarious deposits, dental cement, or accretions on the crowns 370
and roots of teeth, surgical procedures on hard and soft tissues 371
within the oral cavity or any other intraoral procedure that 372
contributes to or results in an irremediable alteration of the 373
oral anatomy; or the making of final impressions from which casts 374
are made to construct any dental restoration.375

       (C) The state dental board shall issue rules defining the376
procedures that may be performed by licensed dental hygienists377
engaged in school health activities or employed by public378
agencies.379

       Sec. 4715.39.  (A) The state dental board may define the380
duties that may be performed by dental assistants and other381
individuals designated by the board as qualified personnel. If382
defined, the duties shall be defined in rules adopted in383
accordance with Chapter 119. of the Revised Code. The rules may384
include training and practice standards for dental assistants and385
other qualified personnel. The standards may include examination386
and issuance of a certificate. If the board issues a certificate,387
the recipient shall display the certificate in a conspicuous388
location in any office in which the recipient is employed to389
perform the duties authorized by the certificate.390

        (B) A dental assistant may polish the clinical crowns of 391
teeth if all of the following requirements are met:392

       (1) The dental assistant's polishing activities are limited393
to the use of a rubber cup attached to a slow-speed rotary dental394
hand piece to remove soft deposits that build up over time on the 395
crowns of teeth.396

       (2) The polishing is performed only after a dentist has 397
evaluated the patient and any calculus detected on the teeth to be 398
polished has been removed by a dentist or dental hygienist.399

       (3) The dentist supervising the assistant supervises not more 400
than two dental assistants engaging in polishing activities at any 401
given time.402

       (4) The dental assistant is certified by the dental assisting 403
national board or the Ohio commission on dental assistant 404
certification.405

       (5) The dental assistant receives a certificate from the406
board authorizing the assistant to engage in the polishing407
activities. The board shall issue the certificate if the408
individual has successfully completed training in the polishing of409
clinical crowns through a program accredited by the American 410
dental association commission on dental accreditation or 411
equivalent training approved by the board. The training shall412
include courses in basic dental anatomy and infection control, 413
followed by a course in coronal polishing that includes didactic,414
preclinical, and clinical training; any other training required by 415
the board; and a skills assessment that includes successful416
completion of standardized testing. The board shall adopt rules 417
pursuant to division (A) of this section establishing standards 418
for approval of this training.419

       (C) A dental assistant may apply pit and fissure sealants if 420
all of the following requirements are met:421

        (1) A dentist evaluates the patient and designates the teeth 422
and surfaces that will benefit from the application of sealant on 423
the day the application is to be performed.424

        (2) The dental assistant is certified by the dental assisting 425
national board or the Ohio commission on dental assistant 426
certification.427

        (3) The dental assistant has successfully completed a course 428
in the application of sealants consisting of at least two hours of 429
didactic instruction and six hours of clinical instruction through 430
a program provided by an institution accredited by the American 431
dental association commission on dental accreditation or a program 432
provided by a sponsor of continuing education approved by the 433
board.434

        (4) The dentist supervising the assistant has observed the 435
assistant successfully apply at least six sealants.436

       (5) The dentist supervising the assistant checks and approves 437
the application of all sealants placed by the assistant before the 438
patient leaves the location where the sealant application 439
procedure is performed.440

       (D) Subject to this section and the applicable rules of the 441
board, licensed dentists may assign to dental assistants and other 442
qualified personnel dental procedures that do not require the 443
professional competence or skill of the licensed dentist, a dental 444
hygienist, or an expanded function dental auxiliary as this 445
section or the board by rule authorizes dental assistants and 446
other qualified personnel to perform. The performance of dental 447
procedures by dental assistants and other qualified personnel 448
shall be under direct supervision and full responsibility of the 449
licensed dentist.450

       (E) Nothing in this section shall be construed by rule of the451
state dental board or otherwise to do the following:452

       (1) Authorize dental assistants or other qualified personnel453
to engage in the practice of dental hygiene as defined by sections454
4715.22 and 4715.23 of the Revised Code, to enter into a 455
collaboration agreement under section 4715.222 of the Revised 456
Code, or to perform the duties of a dental hygienist, including 457
the removal of calcarious deposits, dental cement, or accretions 458
on the crowns and roots of teeth other than as authorized pursuant 459
to this section;460

       (2) Authorize dental assistants or other qualified personnel 461
to engage in the practice of an expanded function dental auxiliary 462
as specified in section 4715.64 of the Revised Code or to perform 463
the duties of an expanded function dental auxiliary other than as 464
authorized pursuant to this section.465

        (3) Authorize the assignment of any of the following:466

       (a) Diagnosis;467

       (b) Treatment planning and prescription, including468
prescription for drugs and medicaments or authorization for469
restorative, prosthodontic, or orthodontic appliances;470

       (c) Surgical procedures on hard or soft tissue of the oral471
cavity, or any other intraoral procedure that contributes to or472
results in an irremediable alteration of the oral anatomy;473

       (d) The making of final impressions from which casts are made474
to construct any dental restoration.475

       (F) No dentist shall assign any dental assistant or other476
individual acting in the capacity of qualified personnel to477
perform any dental procedure that the assistant or other478
individual is not authorized by this section or by board rule to 479
perform. No dental assistant or other individual acting in the480
capacity of qualified personnel shall perform any dental procedure 481
other than in accordance with this section and any applicable 482
board rule or any dental procedure that the assistant or other 483
individual is not authorized by this section or by board rule to484
perform.485

       Sec. 4715.64. (A) The practice of an expanded function dental 486
auxiliary shall consist of the following:487

       (1) The procedures involved in the placement of restorative 488
materials limited to amalgam restorative materials and 489
non-metallicnonmetallic restorative materials, including 490
direct-bonded restorative materials;491

       (2) The procedures involved in the placement of sealants;492

       (3) Any additional procedures authorized by the state dental 493
board in rules adopted under section 4715.66 of the Revised Code.494

       (B) An expanded function dental auxiliary shall practice 495
under the direct supervision, order, control, and full 496
responsibility of a dentist licensed under this chapter. At no 497
time shall more than two expanded function dental auxiliaries be 498
practicing as expanded function dental auxiliaries under the 499
direct supervision of the same dentist. An expanded function 500
dental auxiliary shall not practice as an expanded function dental 501
auxiliary when the supervising dentist is not physically present 502
at the location where the expanded function dental auxiliary is 503
practicing.504

        (C) Nothing in this section shall be construed by rule of the 505
board or otherwise to authorize an expanded function dental 506
auxiliary to engage in the practice of dental hygiene as defined 507
by sections 4715.22 and 4715.23 of the Revised Code or to enter 508
into a collaboration agreement under section 4715.222 of the 509
Revised Code.510

       Section 2.  That existing sections 4715.22, 4715.23, 4715.39, 511
and 4715.64 of the Revised Code are hereby repealed.512