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H. B. No. 188 As IntroducedAs Introduced
127th General Assembly | Regular Session | 2007-2008 |
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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 4715.64 and to enact sections 4715.221, 4715.222, 4715.223, 4715.224, 4715.225, 4715.226, 4715.227, 4715.228, 4715.229, and 4715.2210 of the Revised Code to permit dental hygienists to enter into collaboration agreements with dentists.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 4715.22, 4715.23, 4715.39, and 4715.64 be amended and sections 4715.221, 4715.222, 4715.223, 4715.224, 4715.225, 4715.226, 4715.227, 4715.228, 4715.229, and 4715.2210 of the Revised Code be enacted to read as follows:
Sec. 4715.22. (A) As This section applies only when a licensed dental hygienist is not providing services under a collaboration agreement entered into under section 4715.222 of the Revised Code.
As used in this section, "health
care facility" means either of the following:
(1) A hospital registered under section 3701.07 of the Revised
Code;
(2) A "home" as defined in section 3721.01 of the Revised
Code.
(B) A licensed dental hygienist shall
practice under the supervision, order, control, and full responsibility of
a dentist licensed under this chapter. A dental hygienist may practice in
a dental office, public or private school, health care
facility, dispensary, or public institution. Except as provided in
division
(C) or (D) of this section, a dental
hygienist may not provide dental hygiene services to a patient
when the supervising dentist is not physically present at the
location where the dental hygienist is practicing.
(C) A dental hygienist
may provide, for not more than fifteen consecutive business
days, dental hygiene services to a patient when the supervising
dentist is not physically present at the location
at which the services are provided if all of the following
requirements are met:
(1) The dental hygienist has at least two years and a minimum of three
thousand hours of experience in the practice of
dental hygiene.
(2) The dental hygienist has successfully completed a
course approved by the
state dental board in the
identification and prevention of potential medical
emergencies.
(3) The dental hygienist complies with written protocols
for emergencies the supervising dentist establishes.
(4) The dental hygienist does not perform, while the
supervising dentist is absent from the location, procedures while the patient
is anesthetized, definitive root planing, definitive
subgingival curettage, or other procedures identified in rules
the state dental board adopts.
(5) The supervising dentist has evaluated the dental
hygienist's skills.
(6) The supervising dentist examined the patient not more
than seven months prior to the date the dental hygienist
provides the dental hygiene services to the patient.
(7) The dental hygienist complies with written protocols or written
standing orders that the supervising dentist establishes.
(8) The supervising dentist completed and evaluated a
medical and dental history of the patient not more than one year
prior to the date the dental hygienist provides dental hygiene
services to the patient and, except when the dental hygiene services
are provided in a health care facility, the supervising dentist
determines that the patient is in a medically stable
condition.
(9) If the dental hygiene services are provided in a
health care facility, a doctor of medicine and
surgery or osteopathic medicine and surgery who holds a current
certificate issued under
Chapter 4731. of the
Revised
Code or a registered nurse
licensed under Chapter 4723. of
the Revised
Code is present in the health care facility when the services are
provided.
(10) In advance of the
appointment for dental hygiene services, the patient is notified that the
supervising dentist will be absent from the
location and that the dental hygienist cannot diagnose the patient's
dental health care status.
(11) The dental hygienist is employed by, or under
contract with, one of the following:
(a) The supervising dentist;
(b) A dentist licensed under this chapter who is
one of the following:
(i) The employer of the supervising
dentist;
(ii) A shareholder in a professional association
formed under Chapter
1785. of the Revised
Code of which the supervising
dentist is a shareholder;
(iii) A member or manager of a limited liability
company formed under
Chapter 1705. of the
Revised
Code of which the supervising
dentist is a member or manager;
(iv) A shareholder in a corporation formed
under division (B) of
section 1701.03 of the Revised
Code of which the supervising
dentist is a shareholder;
(v) A partner or employee of a partnership or a
limited liability partnership formed under
Chapter 1775. of the
Revised
Code of which the supervising
dentist is a partner or employee.
(c) A government entity that employs the dental hygienist
to provide dental hygiene services in a public school or in
connection with other programs the government entity
administers.
(D) A dental hygienist may provide dental hygiene services to a
patient
when the supervising dentist is not physically present at the location at
which
the services are provided if
the services are provided as part of a dental hygiene program that is
approved by the state dental board and all of the following requirements are
met:
(1) The program is operated through a school district
board
of education or the governing board of an educational service center; the
board
of health of a city or general health district or the authority having the
duties of a board of health under section 3709.05 of the Revised
Code; a national, state, district, or local dental association; or
any
other public or private entity recognized by the state dental board.
(2) The supervising dentist is employed by or a volunteer for, and the
patients
are referred by, the entity through which the program is operated.
(3) The services are performed after examination and diagnosis by the dentist
and in accordance with the dentist's written treatment plan.
(E) No person shall do
either of the following:
(1) Practice dental hygiene in a manner that is separate
or otherwise independent from the dental practice of a
supervising dentist;
(2) Establish or maintain an office or practice that is
primarily devoted to the provision of dental hygiene services.
(F) The state dental
board shall adopt rules under division
(C) of section 4715.03 of the
Revised
Code identifying procedures a
dental hygienist may not perform when practicing in the absence
of the supervising dentist pursuant to division
(C) or (D) of this section.
Sec. 4715.221. As used in this section and sections 4715.222 to 4715.2210 of the Revised Code:
(A) "Collaboration agreement" means an agreement entered into by a dentist and a dental hygienist under section 4715.222 of the Revised Code.
(B) "Dentist" means an individual licensed under this chapter to practice dentistry.
(C) "Dental hygienist" means an individual licensed under this chapter to practice as a dental hygienist.
(D) "Facility" means any of the following:
(2) A "public school" or "nonpublic school" as defined in section 3701.93 of the Revised Code;
(3) A "health care facility" as defined in section 4715.22 of the Revised Code;
(4) A "home health agency" as defined in section 5101.61 of the Revised Code;
(6) A "state correctional institution" as defined in section 2967.01 of the Revised Code;
(7) A clinic or shelter financed with public or private funds;
(8) A mobile dental unit;
(9) A community health fair;
(10) A comprehensive child development program that receives funds distributed under the "Head Start Act," 95 Stat. 499 (1981), 42 U.S.C. 9831, as amended, and is licensed as a child day-care center;
(11) A corporation, association, group, institution, society, or other organization that is exempt from federal taxation under section 501(c)(3) of the "Internal Revenue Code of 1986," 100 Stat. 2085, 26 U.S.C. 501(c)(3), as amended, and serves individuals who are uninsured or enrolled in the medicaid program established under Chapter 5111. of the Revised Code or the disability medical assistance program established under Chapter 5115. of the Revised Code;
(12) A special needs program;
(13) A residential facility licensed under section 5123.19 of the Revised Code;
(14) Any other location specified by the state dental board in rules adopted under section 4715.2210 of the Revised Code.
(E) "Patient" means an individual who receives dental hygiene services at a facility, a student enrolled in the facility at which the services are provided, or a resident of a facility at which the services are provided.
(F) "Special needs program" means a program operated by any of the following:
(1) A school district board of education or the governing board of an educational service center;
(2) The board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code;
(3) A national, state, district, or local dental association.
Sec. 4715.222. (A) A dental hygienist who has provided the evidence required by section 4715.223 of the Revised Code may enter into a collaboration agreement with a dentist under which the dentist authorizes all of the following:
(1) The dental hygienist to provide the services described in section 4715.224 of the Revised Code to patients at any facility without the dentist being physically present at the facility where the services are provided;
(2) The dental hygienist to provide the services described in section 4715.224 of the Revised Code to patients without prior examination of the patients by the dentist or diagnosis or treatment plans approved by the dentist, unless otherwise specified in the collaboration agreement;
(3) The dental hygienist to work with dental assistants certified by the dental assisting national board or the Ohio commission on dental assistant certification who may perform only the duties they are authorized to provide without the direct supervision of a dentist.
(B) A collaboration agreement must meet the requirements of section 4715.225 of the Revised Code.
Sec. 4715.223. Prior to entering into a collaboration agreement, a dental hygienist shall do both of the following:
(A) Submit written evidence of all of the following to the dentist who is to be the collaborating dentist under the agreement:
(1) The dental hygienist has at least two years and a minimum of three thousand hours of experience in the practice of dental hygiene.
(2) The dental hygienist has successfully completed a course approved by the state dental board in the identification and prevention of potential medical emergencies and infection control.
(3) The dental hygienist holds current certification to perform basic life-support procedures as required under section 4715.251 of the Revised Code.
(4) The dental hygienist holds professional liability insurance.
(B) Permit the dentist who is to be the collaborating dentist under the agreement to personally observe the dental hygienist provide to patients the services described in section 4715.224 of the Revised Code.
Sec. 4715.224. A dental hygienist may provide the following services to a patient under a collaboration agreement:
(A) Oral health promotion and disease prevention education, including information gathering, screening, and assessment;
(B) Removal of calcareous deposits or accretions from the crowns and roots of teeth;
(C) Sulcular placement of prescribed materials;
(D) Polishing of the clinical crowns of teeth, including restorations;
(E) Standard diagnostic and radiological procedures for the purpose of contributing to the provision of dental services;
(F) Fluoride applications;
(G) Placement of sealants;
(H) Any other basic remediable intraoral dental task or procedure designated by the state dental board in rules adopted under section 4715.2210 of the Revised Code.
Sec. 4715.225. A collaboration agreement shall be in writing and do all of the following at a minimum:
(A) Contain the following terms:
(1) A procedure the dental hygienist must follow in securing the dentist's review of the patient's record and medical history if the dental hygienist believes the patient's condition is medically compromised;
(2) A procedure the dental hygienist must follow if the dental hygienist believes the patient's condition presents an emergency dental condition;
(3) Practice protocols for the dental hygienist to follow in providing services to patients who are different ages and who require different procedures, including recommended intervals for the performance of dental hygiene services and a period of time in which an examination by a dentist should occur;
(4) Specific protocols for the placement of pit and fissure sealants and requirements for follow-up care to assure the efficacy of the sealants after application;
(5) A procedure for creating and maintaining dental records for patients that are treated by the dental hygienist. The procedure must specify where the records are to be located.
(6) Services specified under section 4715.224 of the Revised Code, if any, for which the dentist requires either or both of the following:
(a) The patient be examined by the dentist prior to the dental hygienist providing the services;
(b) The dentist to approve a patient-specific diagnosis or treatment plan.
(7) The number of patient visits for dental hygiene services, if any, that the dentist requires the dental hygienist to provide, on an annual basis, to patients in special needs programs for a charge determined according to the sliding fee scale established by the state dental board in rules adopted under section 4715.2210 of the Revised Code.
(8) A statement that the dentist and dental hygienist agree that the dental hygienist's provision of services under a collaboration agreement is neither of the following:
(a) The practice of dental hygiene in a manner that is separate or otherwise independent from the dental practice of a collaborating dentist;
(b) The establishment or maintenance of an office or practice that is primarily devoted to the provision of dental hygiene services.
(B) Contain a blank copy of a consent to treatment form that the dental hygienist can use for purposes of complying with the requirement of section 4715.227 of the Revised Code;
(C) Be signed and dated by both the dentist and dental hygienist.
Sec. 4715.226. (A) A copy of a collaboration agreement must be maintained by the dentist and the dental hygienist who are parties to the agreement. The dental hygienist shall ensure that each facility where the dental hygienist provides services under a collaboration agreement has a copy of the agreement that the dental hygienist works under at that facility.
(B) Except as provided under division (C) of this section, prior approval of a collaboration agreement by the state dental board is not required before a dental hygienist provides services under an agreement, but the dentist or dental hygienist who is a party to the agreement must provide the board with a copy of the agreement on the board's request.
(C) A dentist shall not at any one time be a party to more than three collaboration agreements unless the state dental board determines that the dentist meets the criteria, established by the board in rules adopted under section 4715.2210 of the Revised Code, to be a party to more than three agreements.
Sec. 4715.227. Before performing any services on a patient under a collaboration agreement, a dental hygienist must provide the patient or patient's representative with a consent to treatment form and secure the signature or mark of the patient or representative on it. The signature or mark may be provided through reasonable accommodation, including the use of assistive technology or augmentative devices.
The form must include a statement advising the patient that the dental hygiene services provided are not a substitute for a dental examination by a dentist, that a dentist will not be present during the provision of dental hygiene services, and that the dental hygienist cannot diagnose the patient's dental health care status.
Sec. 4715.228. Following the provision of services to a patient under a collaboration agreement, the dental hygienist shall refer the patient to the dentist who is the collaborating dentist under the agreement the dental hygienist is working under at the facility where the patient was treated. The dental hygienist shall give the patient or patient's representative a completed referral form that lists the name, office address, and office telephone of the collaborating dentist and the date the dental hygienist provided the services to the patient. The dental hygienist shall provide a copy of each completed referral form and the patient's record to the collaborating dentist.
Sec. 4715.229. A collaboration agreement entered into under section 4715.222 of the Revised Code may be terminated by the dentist or dental hygienist who entered into the agreement. A dentist or dental hygienist who terminates a collaboration agreement shall provide written notice to the opposite party. The dental hygienist shall not provide services under the agreement once notice of the termination has been given or sent to the dentist.
Sec. 4715.2210. The state dental board shall adopt rules to do all of the following:
(A) For purposes of division (D)(14) of section 4715.221 of the Revised Code, specify the locations other than those listed in divisions (D)(1) to (13) of section 4715.221 of the Revised Code that are to be considered facilities under sections 4715.222 to 4715.229 of the Revised Code.
(B) For purposes of division (H) of section 4715.224 of the Revised Code, designate the basic remediable intraoral dental tasks or procedures, in addition to the services listed in divisions (A) to (G) of section 4715.224 of the Revised Code, that a dental hygienist may provide under a collaboration agreement.
(C) For purposes of division (A)(7) of section 4715.225 of the Revised Code, establish a sliding fee scale that determines the fee a patient in a special needs program is charged for dental hygiene services provided by a dental hygienist under a collaboration agreement.
(D) For purposes of division (C) of section 4715.226 of the Revised Code, establish the criteria the board must use in determining whether a dentist can be a party to more than three collaboration agreements at one time.
Sec. 4715.23. Except when a dental hygienist is providing services under a collaboration agreement entered into under section 4715.222 of the Revised Code, all of the following apply with respect to the practice of a dental hygienist:
(A) The practice of a dental hygienist shall
consist of those prophylactic, preventive, and other procedures
that licensed dentists are authorized by this chapter and rules
of the dental board to assign only to licensed dental hygienists
or to qualified personnel under section 4715.39 of the Revised
Code.
(B) Licensed dentists may assign to dental hygienists intraoral
tasks that do not require the professional competence or skill of
the licensed dentist and that are authorized by board rule. Such
performance of intraoral tasks by dental hygienists shall be
under supervision and full responsibility of the licensed
dentist, and at no time shall more than three dental hygienists
be practicing clinical hygiene under the supervision of the same
dentist. The foregoing shall not be construed as authorizing the
assignment of diagnosis, treatment planning and prescription
(including prescriptions for drugs and medicaments or
authorizations for restorative, prosthodontic, or orthodontic
appliances); or, except when done in conjunction with the removal
of calcarious deposits, dental cement, or accretions on the crowns and roots of
teeth, surgical procedures on hard and soft tissues within the
oral cavity or any other intraoral procedure that contributes to
or results in an irremediable alteration of the oral anatomy; or
the making of final impressions from which casts are made to
construct any dental restoration.
(C) The state dental board shall issue rules defining the
procedures that may be performed by licensed dental hygienists
engaged in school health activities or employed by public
agencies.
Sec. 4715.39. (A) The state dental board
may
define
the
duties
that may be performed by dental assistants and other
individuals designated by the board as qualified personnel.
If
defined, the
duties shall be defined in
rules adopted in
accordance with Chapter 119. of the Revised
Code. The rules
may
include training and practice standards for
dental
assistants and
other qualified
personnel. The standards
may
include examination
and issuance of
a certificate. If the board
issues a certificate,
the recipient shall
display the certificate
in a conspicuous
location in any office in which the
recipient is
employed to
perform the duties authorized by the certificate.
(B) A dental assistant may
polish the
clinical crowns of teeth if all of the following
requirements are met:
(1) The dental assistant's polishing activities are limited
to the use of
a rubber cup attached to a slow-speed rotary dental
hand piece to remove soft deposits that build up over time on the crowns of teeth.
(2) The polishing is performed only after a dentist has evaluated the patient and any calculus detected on the teeth to be polished has been removed by a dentist or dental hygienist.
(3) The dentist supervising the assistant supervises not
more than two
dental assistants engaging in polishing activities
at any given time.
(4) The dental assistant is certified by the dental
assisting national
board or the Ohio commission on dental
assistant certification.
(5) The dental assistant receives a certificate from the
board authorizing
the assistant to engage in the polishing
activities. The board
shall issue the
certificate if the
individual has successfully
completed training in the polishing of
clinical crowns through a program
accredited by the American dental association commission on
dental accreditation or equivalent training
approved by the board.
The training shall
include courses in basic dental anatomy and
infection
control, followed by a course in coronal polishing that
includes didactic,
preclinical, and clinical
training; any other
training
required by the board; and a skills assessment that
includes successful
completion of standardized testing. The board shall adopt rules pursuant to division (A) of this section establishing standards for approval of this training.
(C) A dental assistant may apply pit and fissure sealants if all of the following requirements are met:
(1) A dentist evaluates the patient and designates the teeth and surfaces that will benefit from the application of sealant on the day the application is to be performed.
(2) The dental assistant is certified by the dental assisting national board or the Ohio commission on dental assistant certification.
(3) The dental assistant has successfully completed a course in the application of sealants consisting of at least two hours of didactic instruction and six hours of clinical instruction through a program provided by an institution accredited by the American dental association commission on dental accreditation or a program provided by a sponsor of continuing education approved by the board.
(4) The dentist supervising the assistant has observed the assistant successfully apply at least six sealants.
(5) The dentist supervising the assistant checks and approves the application of all sealants placed by the assistant before the patient leaves the location where the sealant application procedure is performed.
(D) Subject to this section and the applicable rules of the board, licensed dentists may
assign to dental assistants and other qualified personnel dental
procedures that do not
require the professional competence or
skill of the licensed
dentist, a dental hygienist, or an expanded function dental auxiliary as this section or the board by
rule authorizes
dental assistants and other qualified
personnel to
perform. The performance of dental procedures by
dental
assistants and other qualified personnel shall be under direct
supervision and full
responsibility of the licensed dentist.
(E) Nothing in this section shall be construed by rule of
the
state dental board or otherwise to do the following:
(1) Authorize dental assistants or other qualified
personnel
to engage in the
practice of dental hygiene as defined by sections
4715.22 and
4715.23 of the Revised Code, to enter into a collaboration agreement under section 4715.222 of the Revised Code, or to perform the duties
of a dental
hygienist, including the removal of calcarious
deposits, dental cement, or
accretions on the crowns and roots of teeth other than as authorized pursuant to this section;
(2) Authorize dental assistants or other qualified personnel to engage in the practice of an expanded function dental auxiliary as specified in section 4715.64 of the Revised Code or to perform the duties of an expanded function dental auxiliary other than as authorized pursuant to this section.
(3) Authorize
the assignment of any of the following:
(b) Treatment planning and prescription,
including
prescription for drugs and medicaments or
authorization for
restorative, prosthodontic, or orthodontic
appliances;
(c) Surgical procedures on hard or soft tissue of the
oral
cavity, or any other intraoral procedure that contributes to
or
results in an irremediable alteration of the oral anatomy;
(d) The making of final impressions from which casts are
made
to
construct any dental restoration.
(F) No dentist shall assign any dental assistant or other
individual acting in the capacity of qualified personnel to
perform
any dental procedure that the assistant or other
individual is not authorized by this section or by board
rule to perform. No dental
assistant or other individual acting in the
capacity of qualified
personnel shall perform any dental
procedure other than in
accordance with this section and any applicable board rule or any dental
procedure that the
assistant or other individual is not authorized
by this section or by board rule to
perform.
Sec. 4715.64. (A) The practice of an expanded function dental auxiliary shall consist of the following:
(1) The procedures involved in the placement of restorative materials limited to amalgam restorative materials and non-metallic nonmetallic restorative materials, including direct-bonded restorative materials;
(2) The procedures involved in the placement of sealants;
(3) Any additional procedures authorized by the state dental board in rules adopted under section 4715.66 of the Revised Code.
(B) An expanded function dental auxiliary shall practice under the direct supervision, order, control, and full responsibility of a dentist licensed under this chapter. At no time shall more than two expanded function dental auxiliaries be practicing as expanded function dental auxiliaries under the direct supervision of the same dentist. An expanded function dental auxiliary shall not practice as an expanded function dental auxiliary when the supervising dentist is not physically present at the location where the expanded function dental auxiliary is practicing.
(C) Nothing in this section shall be construed by rule of the board or otherwise to authorize an expanded function dental auxiliary to engage in the practice of dental hygiene as defined by sections 4715.22 and 4715.23 of the Revised Code or to enter into a collaboration agreement under section 4715.222 of the Revised Code.
Section 2. That existing sections 4715.22, 4715.23, 4715.39, and 4715.64 of the Revised Code are hereby repealed.
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