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.

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:

(1) A dental office;

(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;

(5) A dispensary;

(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:

(a) Diagnosis;

(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.