130th Ohio General Assembly
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Sub. H. B. No. 463  As Passed by the House
As Passed by the House

130th General Assembly
Regular Session
2013-2014
Sub. H. B. No. 463


Representative Johnson 

Cosponsors: Representatives Duffey, Roegner, Scherer, Milkovich, Blessing, Schuring, Bishoff, Young, Hackett, Stinziano, Smith, Stebelton, Rosenberger, Adams, R., Grossman, Celebrezze, Sears, Barnes, Hill, Amstutz, Perales, Terhar, Thompson, Retherford, Lundy, Barborak, Wachtmann, Sprague, Antonio, Baker, Beck, Boose, Brown, Buchy, Budish, Burkley, Butler, Cera, DeVitis, Dovilla, Driehaus, Green, Hagan, C., Hall, Hayes, Landis, Letson, Mallory, McClain, O'Brien, Patterson, Rogers, Romanchuk, Ruhl, Sheehy, Slaby, Strahorn, Sykes, Winburn Speaker Batchelder 



A BILL
To amend sections 3333.61, 4715.031, 4715.037, 4715.10, 4715.13, 4715.22, 4715.23, 4715.24, 4715.363, 4715.366, 4715.371, 4715.373, 4715.39, 4715.56, 4715.64, and 4715.66 and to enact sections 3702.96, 3702.961, 3702.962, 3702.963, 3702.964, 3702.965, 3702.966, 3702.967, 3702.968, 3702.969, and 4715.421 of the Revised Code to make changes to the laws governing dental professionals.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 3333.61, 4715.031, 4715.037, 4715.10, 4715.13, 4715.22, 4715.23, 4715.24, 4715.363, 4715.366, 4715.371, 4715.373, 4715.39, 4715.56, 4715.64, and 4715.66 be amended and sections 3702.96, 3702.961, 3702.962, 3702.963, 3702.964, 3702.965, 3702.966, 3702.967, 3702.968, 3702.969, and 4715.421 of the Revised Code be enacted to read as follows:
Sec. 3333.61.  The chancellor of the Ohio board of regents shall establish and administer the Ohio innovation partnership, which shall consist of the choose Ohio first scholarship program and the Ohio research scholars program. Under the programs, the chancellor, subject to approval by the controlling board, shall make awards to state universities or colleges for programs and initiatives that recruit students and scientists in the fields of science, technology, engineering, mathematics, and medicine, and dentistry to state universities or colleges, in order to enhance regional educational and economic strengths and meet the needs of the state's regional economies. Awards may be granted for programs and initiatives to be implemented by a state university or college alone or in collaboration with other state institutions of higher education, nonpublic Ohio universities and colleges, or other public or private Ohio entities. If the chancellor makes an award to a program or initiative that is intended to be implemented by a state university or college in collaboration with other state institutions of higher education or nonpublic Ohio universities or colleges, the chancellor may provide that some portion of the award be received directly by the collaborating universities or colleges consistent with all terms of the Ohio innovation partnership.
The choose Ohio first scholarship program shall assign a number of scholarships to state universities and colleges to recruit Ohio residents as undergraduate, or as provided in section 3333.66 of the Revised Code graduate, students in the fields of science, technology, engineering, mathematics, and medicine, and dentistry, or in science, technology, engineering, mathematics, or medical, or dental education. Choose Ohio first scholarships shall be awarded to each participating eligible student as a grant to the state university or college the student is attending and shall be reflected on the student's tuition bill. Choose Ohio first scholarships are student-centered grants from the state to students to use to attend a university or college and are not grants from the state to universities or colleges.
Notwithstanding any other provision of this section or sections 3333.62 to 3333.69 of the Revised Code, a nonpublic four-year Ohio institution of higher education may submit a proposal for choose Ohio first scholarships or Ohio research scholars grants. If the chancellor awards a nonpublic institution scholarships or grants, the nonpublic institution shall comply with all requirements of this section, sections 3333.62 to 3333.69 of the Revised Code, and the rules adopted under this section that apply to state universities or colleges awarded choose Ohio first scholarships or Ohio research scholars grants.
The Ohio research scholars program shall award grants to use in recruiting scientists to the faculties of state universities or colleges.
The chancellor shall adopt rules in accordance with Chapter 119. of the Revised Code to administer the programs.
Sec. 3702.96.  There is hereby created the dental hygienist loan repayment program, which shall be administered by the department of health in cooperation with the dental hygienist loan repayment advisory board. The program shall provide loan repayment on behalf of individuals who agree to provide dental hygiene services in areas designated as dental health resource shortage areas by the director of health pursuant to section 3702.87 of the Revised Code.
Under the program, the department, by means of a contract entered into under section 3702.965 of the Revised Code, may agree to repay all or part of the principal and interest of a government or other educational loan taken by an individual for the following expenses incurred while the individual was enrolled in an accredited dental hygiene school that meets the standards described in section 4715.21 of the Revised Code:
(A) Tuition;
(B) Other educational expenses, such as fees, books, and laboratory expenses that are for purposes and in amounts determined reasonable by the director;
(C) Room and board, in an amount determined reasonable by the director.
Sec. 3702.961.  The director of health, in accordance with Chapter 119. of the Revised Code, shall adopt rules as necessary to implement and administer sections 3702.96 to 3702.969 of the Revised Code. In preparing rules, the director shall consult with the dental hygienist loan repayment advisory board.
Sec. 3702.962.  The director of health, by rule, shall establish priorities among dental health resource shortage areas for use in recruiting dental hygienists to sites within particular areas under the dental hygienist loan repayment program. In establishing priorities, the director shall consider the ratio of dental hygienists to the population in the dental health resource shortage area, the distance to dental hygienists outside the area, dental health status indicators of the target population in the area, presence of dental health care provider sites in the area with vacancies for dental hygienists, availability of an eligible candidate interested in being recruited to a particular site within an area, and the distribution of dental health care provider sites in urban and rural regions. The director shall give greatest priority to dental health resource shortage areas having a high ratio of population to dental hygienists.
The director, by rule, shall establish priorities for use in determining eligibility among applicants for participation in the dental hygienist loan repayment program. The priorities may include consideration of an applicant's background and career goals, the length of time the applicant is willing to provide dental hygiene services in a dental health care resource shortage area, and the amount of the educational expenses for which reimbursement is being sought through the program.
Sec. 3702.963.  (A) An individual who will not have an outstanding obligation for dental hygiene service to the federal government, a state, or other entity at the time of participation in the dental hygienist loan repayment program and meets either of the following requirements may apply for participation in the dental hygienist loan repayment program:
(1) The applicant is a dental hygiene student enrolled in the final year of dental hygiene school.
(2) The applicant holds a valid license to practice dental hygiene issued under Chapter 4715. of the Revised Code.
(B) An application for participation in the dental hygienist loan repayment program shall be submitted to the director of health on a form the director shall prescribe. The following information shall be included or supplied:
(1) The applicant's name, permanent address or address at which the applicant is currently residing if different from the permanent address, and telephone number;
(2) The dental hygiene school the applicant attended or is attending, dates of attendance, and verification of attendance;
(3) A summary and verification of the educational expenses for which the applicant seeks reimbursement under the program;
(4) If the applicant is a licensed dental hygienist, verification of the applicant's license issued under Chapter 4715. of the Revised Code to practice dental hygiene and proof of good standing;
(5) Verification of the applicant's United States citizenship or status as a legal alien.
Sec. 3702.964.  If funds are available in the dental hygienist loan repayment fund created under section 3702.969 of the Revised Code and the general assembly has appropriated the funds for the program, the director of health shall approve an applicant for participation in the program on finding in accordance with the priorities established under section 3702.962 of the Revised Code that the applicant is eligible for participation and is needed in a dental health resource shortage area.
On approving an application, the director shall notify and enter into discussions with the applicant. The object of the discussions is to facilitate recruitment of the applicant to a site within a dental health resource shortage area where, according to the priorities established under section 3702.962 of the Revised Code, the applicant is needed.
If the director and applicant agree on the applicant's placement at a particular site within a dental health resource shortage area, the applicant shall sign and deliver to the director a letter of intent agreeing to that placement.
Sec. 3702.965.  (A) An individual who has signed a letter of intent under section 3702.964 of the Revised Code may enter into a contract with the director of health for participation in the dental hygienist loan repayment program. The dental hygienist's employer or other funding source may also be a party to the contract.
(B) The contract shall include all of the following obligations:
(1) The individual agrees to provide dental hygiene services in the dental health resource shortage area identified in the letter of intent for at least two years.
(2) When providing dental hygiene services in the dental hygiene health resource shortage area, the individual agrees to do all of the following:
(a) Provide dental hygiene services for a minimum of forty hours per week;
(b) Provide dental hygiene services without regard to a patient's ability to pay;
(c) Meet the requirements for a medicaid provider agreement and enter into the agreement with the department of medicaid to provide dental hygiene services to medicaid recipients.
(3) The department of health agrees, as provided in section 3702.96 of the Revised Code, to repay, so long as the individual performs the service obligation agreed to under division (B)(1) of this section, all or part of the principal and interest of a government or other educational loan taken by the individual for expenses described in section 3702.96 of the Revised Code.
(4) The individual agrees to pay the department of health an amount established by rules adopted under section 3702.961 of the Revised Code, if the individual fails to complete the service obligation agreed to under division (B)(1) of this section.
(C) The contract may include any other terms agreed upon by the parties.
(D) Not later than the thirty-first day of January of each year, the department of health shall mail to each individual to whom or on whose behalf repayment is made under the dental hygienist loan repayment program a statement showing the amount of principal and interest repaid by the department pursuant to the contract in the preceding year. The statement shall be sent by ordinary mail with address correction and forwarding requested in the manner prescribed by the United States postal service.
Sec. 3702.966. There is hereby created the dental hygienist loan repayment advisory board. The board shall consist of the following members:
(A) As ex officio members, the members of the dentist loan repayment advisory board appointed under divisions (A) to (D) of section 3702.92 of the Revised Code;
(B) Four representatives of the dental hygiene profession, appointed by the governor from persons nominated by the Ohio dental hygienists' association.
Terms of office of the members appointed under division (B) of this section shall be two years. Each member shall hold office from the date of appointment until the end of the term for which the member was appointed. No person shall be appointed to the board for more than two consecutive terms.
Vacancies shall be filled in the manner prescribed for the original appointment. A member appointed to fill a vacancy occurring prior to the expiration of the term for which the member's predecessor was appointed shall hold office for the remainder of that term. A member shall continue in office subsequent to the expiration of the member's term until a successor takes office or until sixty days have elapsed, whichever occurs first.
The governor may remove a member for whom the governor was the appointing authority, for misfeasance, malfeasance, or willful neglect of duty.
The board shall designate a member to serve as chairperson of the board.
The board shall meet at least once annually. The chairperson shall call special meetings as needed or upon the request of four members.
Six members of the board constitute a quorum to transact and vote on all business coming before the board.
Members of the board shall serve without compensation.
The department of health shall provide the board with staff assistance as requested by the board.
Sec. 3702.967. The dental hygienist loan repayment advisory board shall determine the amounts that will be paid as loan repayments on behalf of participants in the dental hygienist loan repayment program. In the first and second years, no repayment shall exceed twenty-five thousand dollars in each year. In the third and fourth years, no repayment shall exceed thirty-five thousand dollars in each year. If, however, a repayment results in an increase in the participant's federal, state, or local income tax liability, the department of health, at the participant's request and with the approval of the director of health, may reimburse the participant for the increased tax liability, regardless of the amount of the repayment in that year.
Sec. 3702.968.  The dental hygienist loan repayment advisory board, annually on or before the first day of March, shall submit a report to the governor and general assembly describing the operations of the dental hygienist loan repayment program during the previous calendar year. The report shall include information about all of the following:
(A) The number of requests received by the director of health that a particular area be designated as a dental health resource shortage area;
(B) The areas that have been designated as dental health resource shortage areas and the priorities that have been assigned to them;
(C) The number of applicants for participation in the dental hygienist loan repayment program;
(D) The number of dental hygienists assigned to dental health resource shortage areas and the payments made on behalf of those dental hygienists under the dental hygienist loan repayment program;
(E) The dental health resource shortage areas that have not been matched with all of the dental hygienists they need;
(F) The number of dental hygienists failing to complete their service obligations, the amount of damages owed, and the amount of damages collected.
Sec. 3702.969.  The director of health may accept gifts of money from any source for the implementation and administration of sections 3702.96 to 3702.967 of the Revised Code.
The director shall pay all gifts accepted under this section into the state treasury, to the credit of the dental hygiene resource shortage area fund, which is hereby created, and all damages collected under division (B)(4) of section 3702.965 of the Revised Code, into the state treasury, to the credit of the dental hygienist loan repayment fund, which is hereby created.
The director shall use the dental hygiene resource shortage area and dental hygienist loan repayment funds for the implementation and administration of sections 3702.96 to 3702.969 of the Revised Code.
Sec. 4715.031.  (A) The state dental board may develop and implement a quality intervention program. The board may propose that the holder of a license issued by the board participate in the program if the board determines pursuant to an investigation conducted under section 4715.03 of the Revised Code that there are reasonable grounds to believe the license holder has violated a provision of this chapter due to a clinical or communication problem that could be improved through participation in the program and determines that the license holder's participation in the program is appropriate. The board shall refer a license holder who agrees to participate in the program to an educational and assessment service provider selected by the board.
(B) If the board develops and implements a quality intervention program, all of the following apply:
(1) The board shall select, by a concurrence of a majority of the board's members, educational and assessment service providers, which may include quality intervention program panels of case reviewers. A provider selected by the board to provide services to a license holder shall recommend to the board the educational and assessment services the license holder should receive under the program. The license holder may begin participation in the program if the board approves the services the provider recommends. The license holder shall not be required to participate in the program beyond one hundred eighty days from the date the license holder agrees to participate in the program under this division. The license holder shall pay the amounts charged by the provider for the services.
(2) The board shall monitor a license holder's progress in the program and determine whether the license holder has successfully completed the program. If the board determines that the license holder has successfully completed the program, it may continue to monitor the license holder, take other action it considers appropriate, or both. The additional monitoring, other action taken by the board, or both, shall not continue beyond one year from the date the license holder agrees to participate in the program under this division. If the board determines that the license holder has not successfully completed the program, it shall, as soon as possible thereafter, commence disciplinary proceedings against the license holder under section 4715.03 of the Revised Code.
(3) The board shall elect, from the board's members who are dentists, a coordinator to administer and provide oversight of the quality intervention program. The coordinator may delegate to the board's members or employees those duties that the coordinator considers appropriate.
(C) The board may adopt rules in accordance with Chapter 119. of the Revised Code to further implement the quality intervention program.
Sec. 4715.037.  (A) Notwithstanding the permissive nature of hearing referee or examiner appointments under section 119.09 of the Revised Code, the state dental board shall appoint, by a concurrence of a majority of its members, three referees or examiners to conduct the hearings the board is required to hold pursuant to sections 119.01 to 119.13 of the Revised Code. Referees or examiners appointed under this section shall be attorneys who have been admitted to the practice of law in this state. In making the appointments, the board shall not appoint an attorney who is a board employee or represents the board in any other manner.
(B)(1) Referees or examiners appointed under this section shall serve not more than the following number of consecutive one-year terms:
(a) In the case of the first initial appointee, three six;
(b) In the case of the second initial appointee, four seven;
(c) In the case of the third initial appointee and all successor appointees, five eight.
(2) The board may not refuse to reappoint a referee or examiner before the referee or examiner has served the maximum number of terms applicable to the referee or examiner unless the referee or examiner does not seek to serve the maximum number of terms or the board, by a concurrence of a majority of its members, determines there is cause not to reappoint the referee or examiner.
(C) The board shall assign one referee or examiner appointed under this section to conduct each hearing. Assignments shall be made in the order the board receives requests for hearings without regard to the experience or background of a particular referee or examiner or the consideration of any factor other than whether the referee or examiner is available at the appropriate time.
Sec. 4715.10. (A) As used in this section, "accredited dental college" means a dental college accredited by the commission on dental accreditation or a dental college that has educational standards recognized by the commission on dental accreditation and is approved by the state dental board.
(B) Each person who desires to practice dentistry in this state shall file a written application for a license with the secretary of the state dental board. The application shall be on a form prescribed by the board and verified by oath. Each applicant shall furnish satisfactory proof to the board that the applicant has met the requirements of divisions (C) and (D) of this section, and if the applicant is a graduate of an unaccredited dental college located outside the United States, division (E) of this section.
(C) To be granted a license to practice dentistry, an applicant must meet all of the following requirements:
(1) Be at least eighteen years of age;
(2) Be of good moral character;
(3) Be a graduate of an accredited dental college or of a dental college located outside the United States who meets the standards adopted under section 4715.11 of the Revised Code;
(4) Have passed parts I and II of the examination given by the national board of dental examiners;
(5) Have passed a written jurisprudence examination administered by the state dental board under division (E)(2) of section 4715.03 of the Revised Code;
(6) Pay the fee required by division (A)(1) of section 4715.13 of the Revised Code.
(D) To be granted a license to practice dentistry, an applicant must meet any one of the following requirements:
(1) Have taken an examination administered by any of the following regional testing agencies and received on each component of the examination a passing score as specified in division (A) of section 4715.11 of the Revised Code: the central regional dental testing service, inc., northeast regional board of dental examiners, inc., the southern regional dental testing agency, inc., or the western regional examining board;
(2) Have taken an examination administered by the state dental board and received a passing score as established by the board;
(3) Possess a license in good standing from another state and have actively engaged in the legal and reputable practice of dentistry in another state or in the armed forces of the United States, the United States public health service, or the United States department of veterans' affairs for five years immediately preceding application;
(4) Have completed a dental residency program accredited or approved by the commission on dental accreditation and administered by an accredited dental college or hospital.
(E) To be granted a license to practice dentistry, a graduate of an unaccredited dental college located outside the United States must meet both of the following requirements:
(1) Have taken a basic science and laboratory examination consistent with rules adopted under section 4715.11 of the Revised Code and received a passing score as established by the board;
(2) Have had sufficient clinical training in an accredited institution to reasonably assure a level of competency equal to that of graduates of accredited dental colleges, as determined by the board.
Sec. 4715.13. (A) Applicants for licenses to practice dentistry or for a general anesthesia permit or a conscious intravenous sedation permit shall pay to the secretary of the state dental board the following fees:
(1) For license to practice dentistry, two hundred ten dollars if issued in an odd-numbered year or three hundred thirty-seven fifty-seven dollars if issued in an even-numbered year;
(2) For duplicate license, to be granted upon proof of loss of the original, twenty dollars;
(3) For a general anesthesia permit, one hundred twenty-seven dollars;
(4) For a conscious intravenous sedation permit, one hundred twenty-seven dollars.
(B) Twenty Forty dollars of each fee collected under division (A)(1) of this section for a license issued in an even-numbered year and ten twenty dollars of each fee collected under division (A)(1) of this section in an odd-numbered year shall be paid to the dentist loan repayment fund established under section 3702.95 of the Revised Code.
(C) In the case of a person who applies for a license to practice dentistry by taking an examination administered by the state dental board, both of the following apply:
(1) The fee in division (A)(1) of this section may be refunded to an applicant who is unavoidably prevented from attending the examination, or the applicant may be examined at the next regular or special meeting of the board without an additional fee.
(2) An applicant who fails the first examination may be re-examined at the next regular or special meeting of the board without an additional fee.
Sec. 4715.22.  (A)(1) This section applies only when a licensed dental hygienist is not practicing under a permit issued pursuant to section 4715.363 of the Revised Code authorizing practice under the oral health access supervision of a dentist.
(2) As used in this section, "health care facility" means either of the following:
(a) A hospital registered under section 3701.07 of the Revised Code;
(b) 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 divisions (C) or (D) to (E) 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 where the services are provided if all of the following requirements are met:
(1) The dental hygienist has at least two years one year and a minimum of three one thousand five hundred 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 for emergencies.
(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 one year 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. or 1776. 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 where 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)(a) Except as provided in division (D)(3)(b) of this section, the services are performed after examination and diagnosis by the dentist and in accordance with the dentist's written treatment plan.
(b) The requirement in division (D)(3)(a) of this section does not apply when the only service to be provided by the dental hygienist is the placement of pit and fissure sealants.
(E) A dental hygienist may apply fluoride varnish and discuss proper nutrition for the purpose of maintaining good oral health when the supervising dentist is not physically present at the location where the services are provided if the dental hygienist is employed by, or under contract with, the supervising dentist or another person or government entity specified in division (C)(11)(b) or (c) of this section.
(F) 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)(G) 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. The board shall not identify the re-cementation of temporary crowns or the re-cementation of crowns with temporary cement as such procedures.
Sec. 4715.23.  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.
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 four 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.
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. 4715.24.  (A) Each person who is licensed to practice as a dental hygienist in Ohio shall, on or before the first day of January of each even-numbered year, register with the state dental board, unless the person is temporarily retired pursuant to section 4715.241 of the Revised Code. The registration shall be made on a form prescribed by the board and furnished by the secretary, shall include the licensee's name, address, license number, and such other reasonable information as the board may consider necessary, and shall include payment of a biennial registration fee of one hundred five fifteen dollars. This fee shall be paid to the treasurer of state. All such registrations shall be in effect for the two-year period beginning on the first day of January of each even-numbered year and ending on the last day of December of the following odd-numbered year, and shall be renewed in accordance with the standard renewal procedure of sections 4745.01 to 4745.03 of the Revised Code. The failure of a licensee to renew registration in accordance with this section shall result in the automatic suspension of the licensee's license to practice as a dental hygienist, unless the licensee is temporarily retired pursuant to section 4715.241 of the Revised Code.
(B) Any dental hygienist whose license has been automatically suspended under this section may be reinstated on application to the board on a form prescribed by the board for licensure reinstatement and payment of the biennial registration fee and in addition thereto thirty-one dollars to cover the costs of reinstatement.
(C) The license of a dental hygienist shall be exhibited in a conspicuous place in the room in which the dental hygienist practices. Each dental hygienist licensed to practice, whether a resident or not, shall notify the secretary in writing or electronically of any change in the dental hygienist's office address or employment within ten days after the change takes place.
(D) Ten dollars of each biennial registration fee collected under division (A) or (B) of this section shall be paid to the dental hygienist loan repayment fund established under section 3702.969 of the Revised Code.
Sec. 4715.363. (A) A dental hygienist who desires to participate in the oral health access supervision program shall apply to the state dental board for a permit to practice under the oral health access supervision of a dentist. The application shall be under oath, on a form prescribed by the board in rules adopted under section 4715.372 of the Revised Code, and accompanied by an application fee of twenty dollars, which may be paid by personal check or credit card.
(B) The applicant shall provide evidence satisfactory to the board that the applicant has done all of the following:
(1) Completed at least two years one year and attained a minimum of three one thousand five hundred hours of experience in the practice of dental hygiene;
(2) Completed at least twenty-four hours of continuing dental hygiene education during the two years prior to submission of the application;
(3) Completed a course pertaining to the practice of dental hygiene under the oral health access supervision of a dentist that meets standards established in rules adopted under section 4715.372 of the Revised Code;
(4) Completed, during the two years prior to submission of the application, a course pertaining to the identification and prevention of potential medical emergencies that is the same as the course described in division (C)(2) of section 4715.22 of the Revised Code.
(C) The state dental board shall issue a permit to practice under the oral health access supervision of a dentist to a dental hygienist who is in good standing with the board and meets all of the requirements of divisions (A) and (B) of this section.
Sec. 4715.366. (A) A dental hygienist providing dental hygiene services under a permit issued under section 4715.363 of the Revised Code to practice under the oral health access supervision of a dentist shall do both of the following:
(1) Comply with written protocols established by the authorizing dentist who authorizes the dental hygienist's provision of services and standing orders established by the authorizing dentist, including protocols and standing orders regarding emergencies and, for the purpose of section 4715.365 of the Revised Code, protocols regarding what constitutes a medically significant change to a patient's medical or dental history;
(2) Immediately following the completion of the dental hygiene services and subject to division (B) of this section, direct the patient to the authorizing a dentist for a clinical evaluation and schedule or cause to be scheduled an appointment for the patient with the authorizing a dentist.
(B) For purposes of division (A)(2) of this section, the dental hygienist shall make every attempt to schedule the patient's appointment with the authorizing dentist not later than ninety days six months after the completion of the dental hygiene services. The dental hygienist shall provide the patient with a written notice of the appointment that includes, at a minimum, the authorizing dentist's name, address, and telephone number; the date and time of the appointment; and a statement of the dental hygiene services performed by the hygienist. The notice shall be given to the patient or the patient's representative and one copy shall be given to the authorizing dentist.
Sec. 4715.371. The state dental board shall develop and publish on its internet web site a directory containing the names and contact information, including electronic mail addresses, of dentists and dental hygienists who hold current, valid permits issued under sections 4715.362 and 4715.363 of the Revised Code.
Sec. 4715.373. Nothing in sections 4715.36 to 4715.372 of the Revised Code authorizes any activity prohibited by this chapter or prohibited by a rule adopted under this chapter by the state dental board, including the activities prohibited by division (E)(F) of section 4715.22 of the Revised Code and the activities prohibited or not authorized by section 4715.23 of the Revised Code.
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 Except as provided in division (D) or (E) of this section, 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)(1) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification may provide, for not more than fifteen consecutive business days, all of the following services to a patient when the supervising dentist is not physically present at the location where the services are provided if the conditions specified in division (D)(2) of this section have been satisfied:
(a) The re-cementation of temporary crowns or the re-cementation of crowns with temporary cement;
(b) The application of fluoride varnish;
(c) The application of disclosing solutions;
(d) Carries susceptibility testing;
(e) Instruction on of oral hygiene practices, including the use of toothbrushes and dental floss;
(f) The discussion of proper nutrition for the purpose of maintaining good oral health.
(2) The conditions that must be satisfied before a dental assistant may provide the services specified in division (D)(1) of this section are all of the following:
(a) The dental assistant has at least two years and a minimum of three thousand hours of experience practicing as a dental assistant.
(b) The dental assistant has successfully completed a course approved by the state dental board in the identification and prevention of potential medical emergencies.
(c) The supervising dentist has evaluated the dental assistant's skills.
(d) The supervising dentist examined the patient not more than one year prior to the date that the dental assistant provides the services to the patient.
(e) The supervising dentist has established written protocols or written standing orders for the dental assistant to follow during and in the absence of an emergency.
(f) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date that the dental assistant provides services to the patient and, except when the services are provided in a health care facility, the supervising dentist determines that the patient is in a medically stable condition.
(g) If the 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.
(h) The patient is notified, in advance of the appointment for services, that the supervising dentist will be absent from the location and that the dental assistant cannot diagnose the patient's dental health care status.
(i) The dental assistant is employed by, or under contract with, the supervising dentist, a dentist licensed under this chapter who meets one of the criteria specified in division (C)(11)(b) of section 4715.22 of the Revised Code, or a government entity that employs the dental assistant to provide services in a public school or in connection with other programs the government entity administers.
(3) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification may apply, for not more than fifteen business days, pit and fissure sealants when the supervising dentist is not physically present at the location where the sealants are to be applied if the dental assistant meets the requirements in divisions (C)(3) and (4) of this section and all of the conditions specified in division (D)(2) of this section have been satisfied.
(E) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, and when a dentist is not physically present at the location where the service is provided, if all of the following are the case:
(1) The dental assistant meets the requirements in divisions (C)(3) and (4) of this section.
(2) All of the conditions specified in division (D)(2) of this section have been satisfied.
(3) The dental assistant is providing the service as part of a program operated through any of the following: 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.
(4) A supervising dentist for the program described in division (E)(3) of this section meets both of the following conditions:
(a) Is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated;
(b) Is available for consultation by telephone, videoconferencing, or other means of electronic communication.
(5) The application of pit and fissure sealants is limited to erupted permanent posterior teeth without suspicion of cavitation.
(6) If the patient is a minor, a parent, guardian, or other person responsible for the patient has been notified that a dentist will not be present at the location and that the dental assistant is not trained to diagnose or treat other serious dental concerns that could exist.
(F) 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 Except as provided in division (D) or (E) of this section, 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)(G) 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 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)(H) 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. 4715.421. (A) As used in this section:
(1) "Accredited dental college" has the same meaning as in section 4715.10 of the Revised Code.
(2) "Accredited dental hygiene school" has the same meaning as in section 4715.36 of the Revised Code.
(3) "Operation" has the same meaning as in section 2305.234 of the Revised Code.
(B) Within thirty days after receiving an application for a temporary volunteer's certificate that includes all of the items listed in divisions (C)(1) and (2) of this section, the state dental board shall issue, without examination, a temporary volunteer's certificate to a person not licensed under this chapter so that the person may provide dental services in this state as a volunteer.
(C) An application for a temporary volunteer's certificate shall include both of the following:
(1) A copy of the applicant's degree from an accredited dental college or accredited dental hygiene school;
(2) One of the following, as applicable:
(a) Evidence satisfactory to the board that the applicant holds a valid, unrestricted license to practice dentistry or dental hygiene issued by a jurisdiction in the United States that licenses persons to practice dentistry or dental hygiene;
(b) Evidence satisfactory to the board that the applicant is practicing dentistry or dental hygiene in one or more branches of the United States armed services.
(D) The holder of a temporary volunteer's certificate shall not accept any form of remuneration for providing dental services pursuant to the certificate. Except in a dental emergency, the holder shall not perform any operation. The board may revoke a temporary volunteer's certificate on receiving proof satisfactory to the board that the holder has engaged in practice in this state outside the scope of the holder's certificate or that there are grounds for action against the person under section 4715.30 of the Revised Code.
(E)(1) A temporary volunteer's certificate shall be valid for a period of seven days, and may be renewed upon the application of the holder, unless the certificate was previously revoked under division (D) of this section. The board shall maintain a register of all persons who hold a temporary volunteer's certificate. The board may charge a fee not to exceed twenty-five dollars for issuing or renewing a certificate pursuant to this section.
(2) The board shall issue to each person who qualifies under this section for a temporary volunteer's certificate a wallet certificate that states that the certificate holder is authorized to provide dental services pursuant to the laws of this state. The holder shall keep the wallet certificate on the holder's person while providing dental services.
(3) The holder of a temporary volunteer's certificate issued pursuant to this section is subject to the immunity provisions in section 2305.234 of the Revised Code.
(F) The board shall adopt rules in accordance with Chapter 119. of the Revised Code to administer and enforce this section.
(G) Not later than ninety days after the effective date of this section, the state dental board shall make available through the board's internet web site the application form for a temporary volunteer's certificate under this section, a description of the application process, and a list of all items that are required by division (C) of this section to be submitted with the application.
Sec. 4715.56.  A (A) Except as provided in division (B) of this section, a dental x-ray machine operator may perform radiologic procedures only if a dentist is providing direct supervision. Direct supervision does not require the dentist to observe each radiologic procedure performed by the operator, but does require that he the dentist be present at the location where the operator is performing radiologic procedures for purposes of consulting with and directing the operator while performing the procedures.
(B) A dental x-ray machine operator may perform radiologic procedures for a patient when the supervising dentist is not physically present at the location where the radiologic procedures are performed if the supervising dentist examined the patient not more than one year prior to the date the dental x-ray machine operator performs the radiologic procedures.
Sec. 4715.64. (A) The Subject to divisions (B), (C), and (D) of this section, 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 application of pit and fissure sealants;
(3) The re-cementation of temporary crowns or the re-cementation of crowns with temporary cement;
(4) The application of topical fluoride;
(5) The application of fluoride varnish;
(6) The application of disclosing solutions;
(7) The application of desensitizing agents;
(8) Carries susceptibility testing;
(9) Instruction on oral hygiene practices, including the use of toothbrushes and dental floss;
(10) The discussion of proper nutrition for the purpose of maintaining good oral health;
(11) 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 perform the services specified in divisions (A)(1) and (11) of this section only 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 Except as provided in divisions (C) and (D) of this section, 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) An expanded function dental auxiliary may perform, for not more than fifteen consecutive business days, the services specified in divisions (A)(2) to (10) of this section when the supervising dentist is not physically present at the location where the expanded function dental auxiliary is practicing if all of the following conditions have been satisfied:
(1) The expanded function dental auxiliary has at least two years and a minimum of three thousand hours of experience practicing as an expanded function dental auxiliary.
(2) The expanded function dental auxiliary has successfully completed a course approved by the board in the identification and prevention of potential medical emergencies.
(3) The supervising dentist has evaluated the expanded function dental auxiliary's skills.
(4) The supervising dentist examined the patient not more than one year prior to the date that the expanded function dental auxiliary provides services to the patient.
(5) The supervising dentist has established written protocols or written standing orders for the expanded function dental auxiliary to follow during and in the absence of an emergency.
(6) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date that the expanded function dental auxiliary provides services to the patient and, except when the services are provided in a health care facility, the supervising dentist determines that the patient is in a medically stable condition.
(7) In advance of the appointment for services, the patient is notified that the supervising dentist will be absent from the location and that the expanded function dental auxiliary cannot diagnose the patient's dental health care status.
(8) The expanded function dental auxiliary is employed by, or under contract with, the supervising dentist, a dentist licensed under this chapter who meets one of the criteria specified in division (C)(11)(b) of section 4715.22 of the Revised Code, or a government entity that employs the expanded function dental auxiliary to provide services in a public school or in connection with other programs the government entity administers.
(D) An expanded function dental auxiliary may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, and when a dentist is not physically present at the location where the service is provided, if all of the following are the case:
(1) All of the conditions specified in division (C) of this section have been satisfied.
(2) The expanded function dental auxiliary is providing the service as part of a program operated through any of the following: 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.
(3) A supervising dentist for the program described in division (D)(2) of this section meets both of the following conditions:
(a) Is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated;
(b) Is available for consultation by telephone, videoconferencing, or other means of electronic communication.
(4) The application of pit and fissure sealants is limited to erupted permanent posterior teeth without suspicion of cavitation.
(5) If the patient is a minor, a parent, guardian, or other person responsible for the patient has been notified that a dentist will not be present at the location and that the expanded function dental auxiliary is not trained to diagnose or treat other serious dental concerns that could exist.
(E) 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.
Sec. 4715.66. (A) The state dental board shall adopt rules as the board considers necessary to implement and administer sections 4715.61 to 4715.64 of the Revised Code. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.
(B) In adopting rules under this section, all of the following apply:
(1) The board shall adopt rules specifying the education or training necessary for an individual to register as an expanded function dental auxiliary under this chapter.
(2) The board shall adopt rules specifying the standards that must be met for an examination to be accepted by the board as an examination of competency to practice as an expanded function dental auxiliary. In specifying the standards, the board shall provide that an examination will be accepted only if the entity that administered the examination required an individual to be one of the following as a condition of admission to the examination:
(a) An unlicensed dentist who has graduated from an accredited dental college, as specified in section 4715.10 of the Revised Code, and does not have a dental license under suspension or revocation by the board;
(b) A dental student who is enrolled in an accredited dental college, as specified in section 4715.10 of the Revised Code, and is considered by the dean of the college to be in good standing as a dental student;
(c) A graduate of a dental college located outside of the United States;
(d) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification;
(e) A dental hygienist licensed under this chapter whose license is in good standing;
(f) An unlicensed dental hygienist who has graduated from an accredited dental hygiene school, as specified in section 4715.21 of the Revised Code, and does not have a dental hygienist license under suspension or revocation by the board.
(3) The board may adopt rules specifying procedures an expanded function dental auxiliary may perform that are in addition to the procedures specified in divisions (A)(1) and (2) to (10) of section 4715.64 of the Revised Code.
Section 2.  That existing sections 3333.61, 4715.031, 4715.037, 4715.10, 4715.13, 4715.22, 4715.23, 4715.24, 4715.363, 4715.366, 4715.371, 4715.373, 4715.39, 4715.56, 4715.64, and 4715.66 of the Revised Code are hereby repealed.
Section 3. (A) There is hereby created the Medicaid Payment Rates for Dental Services Workgroup. The Workgroup shall consist of all of the following:
(1) The Medicaid Director or the Director's designee;
(2) The Director of Health or the Director's designee;
(3) Two members of the Senate, one from the majority party and the other from the minority party, appointed by the President of the Senate;
(4) Two members of the House of Representatives, one from the majority party and the other from the minority party, appointed by the Speaker of the House of Representatives;
(5) Four dentists who have valid Medicaid provider agreements and practice in different geographic areas of the state, appointed by the executive director of the Ohio Dental Association.
(B) Appointments to the Workgroup shall be made not later than thirty days after the effective date of this section. Except to the extent that serving on the Workgroup is part of a member's regular employment duties, a member of the Workgroup shall not be paid for the member's service on the Workgroup. Members of the Workgroup shall not be reimbursed for their expenses incurred in serving on the Workgroup.
(C) The Medicaid Director or Director's designee shall serve as the Workgroup's chairperson. The Workgroup shall meet at the call of the chairperson.
(D) The Department of Medicaid shall provide staff and other support services for the Workgroup.
(E) The Workgroup shall study the issue of Medicaid payment rates for dental services. Not later than December 31, 2014, the Workgroup shall submit a report of its study to the Governor and, in accordance with section 101.68 of the Revised Code, the General Assembly. The report shall include recommendations regarding Medicaid payment rates for dental services. The Workgroup shall cease to exist on submission of its report.
Section 4. Not later than July 1, 2015, the Development Services Agency shall enter into a contract with JobsOhio. This contract shall specify that JobsOhio shall use $250,000 in the fiscal year ending June 30, 2016, to provide no-interest loans for the purchase of dental equipment to be used for the treatment of underserved populations in dental health resource shortage areas designated by the Director of Health under section 3702.87 of the Revised Code. The Development Services Agency shall coordinate duties with JobsOhio through this contract.
Section 5. The amendment by this act to division (B)(1) of section 4715.037 of the Revised Code establishing new limits on the number of consecutive terms that a referee or examiner may serve shall apply to a referee or examiner serving in such capacity on the effective date of this section.
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