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SB 68: "An Act relating to the practice of dental hygiene; establishing an advanced practice permit and eliminating collaborative agreements for dental hygienists; prohibiting unfair discrimination under group health insurance against a dental hygienist who holds an advanced practice permit; relating to medical assistance for dental hygiene services; and providing for an effective date."

00                             SENATE BILL NO. 68                                                                          
01 "An Act relating to the practice of dental hygiene; establishing an advanced practice                                   
02 permit and eliminating collaborative agreements for dental hygienists; prohibiting                                      
03 unfair discrimination under group health insurance against a dental hygienist who holds                                 
04 an advanced practice permit; relating to medical assistance for dental hygiene services;                                
05 and providing for an effective date."                                                                                   
06 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
07    * Section 1. AS 08.32.110(e) is amended to read:                                                                   
08            (e)  This section does not prohibit a licensed dental hygienist                                              
09                 (1)  with an endorsement issued under AS 08.32.085 from performing                                      
10       the activities authorized under AS 08.32.085;                                                                     
11 (2)  who holds an advanced practice permit issued [HAS ENTERED                                                      
12 INTO A COLLABORATIVE AGREEMENT APPROVED] by the board under                                                             
13 AS 08.32.115 from performing the activities authorized under the permit                                             
01       [COLLABORATIVE AGREEMENT]; or                                                                                     
02                 (3)  from performing a dental operation, procedure, or service a dentist                                
03       may delegate to a dental assistant under AS 08.36.346.                                                            
04    * Sec. 2. AS 08.32.115(a) is amended to read:                                                                      
05 (a)  The board may issue an advanced practice permit to [IF THE                                                     
06 COLLABORATIVE AGREEMENT IS APPROVED BY THE BOARD UNDER (d)                                                              
07 OF THIS SECTION,] a licensed dental hygienist with a minimum of 4,000                                                   
08 documented hours of clinical experience. A licensed dental hygienist holding an                                     
09 advanced practice permit may [WITHIN THE FIVE YEARS PRECEDING                                                       
10 APPLICATION FOR THE BOARD'S APPROVAL MAY ENTER INTO A                                                                   
11 COLLABORATIVE AGREEMENT WITH A LICENSED DENTIST IN WHICH                                                                
12 THE LICENSED DENTIST AUTHORIZES THE LICENSED DENTAL                                                                     
13       HYGIENIST TO] perform one or more of the following:                                                               
14 (1)  oral health promotion, [AND] disease prevention education, and                                             
15       oral systemic health education;                                                                               
16 (2)  removal of calcareous deposits, accretions, and stains from the                                                    
17       surfaces of teeth;                                                                                                
18 (3)  application of topical preventive or prophylactic agents, including                                                
19       silver diamine fluoride, fluoride varnishes, and pit and fissure sealants;                                
20                 (4)  polishing and smoothing restorations;                                                              
21                 (5)  removal of marginal overhangs;                                                                     
22 (6)  preliminary charting and triage to formulate a dental hygiene                                                      
23       assessment and dental hygiene treatment plan;                                                                     
24                 (7)  the exposure and development of radiographs;                                                       
25                 (8)  use of local periodontal therapeutic agents; [AND]                                                 
26 (9)  [PERFORMANCE OF] nonsurgical periodontal therapy, with or                                                          
27       without the administration of local anesthesia;                                                               
28                 (10)  screening for oral cancer;                                                                    
29                 (11)  atraumatic restorative technique; and                                                         
30                 (12)  writing prescriptions for                                                                     
31                      (A)  fluoride that is applied or provided to a patient; and                                    
01 (B)  chlorhexidine or a similar antibacterial rinse [,                                                              
02 SUBSEQUENT TO A LICENSED DENTIST'S AUTHORIZATION OR                                                                     
03 DIAGNOSIS AS SPECIFIED IN THE LICENSED HYGIENIST'S                                                                      
04            COLLABORATIVE AGREEMENT].                                                                                    
05    * Sec. 3. AS 08.32.115(b) is repealed and reenacted to read:                                                       
06            (b)  A licensed dental hygienist holding an advanced practice permit may                                     
07       provide the services described in (a) of this section to a patient who is unable to                               
08       receive dental treatment because of age, infirmity, or disability and is                                          
09                 (1)  a resident in a senior center, including a hospital, long-term care                                
10       facility, adult foster home, residential care facility, or adult congregate living facility;                      
11 (2)  a resident in a health care facility, including a mental health                                                    
12       residential program or facility for individuals with developmental or other disabilities;                         
13                 (3)  held in a local correctional facility for juveniles or adults;                                     
14 (4)  enrolled in a nursery school, day care program, vocational training                                                
15       facility, primary school, secondary school, private school, or public charter school;                             
16 (5)  entitled to benefits under 42 U.S.C. 1786 (Special Supplemental                                                    
17       Food Program for Women, Infants, and Children);                                                                   
18                 (6)  homebound; or                                                                                      
19 (7)  a member of a population that the board determines is underserved                                                  
20       by the dental health profession.                                                                                  
21    * Sec. 4. AS 08.32.115(c) is repealed and reenacted to read:                                                       
22 (c)  A licensed dental hygienist holding an advanced practice permit may                                                
23 provide the services described in (a) of this section to a patient described in (b) of this                             
24       section without                                                                                                   
25 (1)  the physical presence, authorization, or supervision of a licensed                                                 
26       dentist;                                                                                                          
27                 (2)  a licensed dentist's examination of the patient.                                                   
28    * Sec. 5. AS 08.32.115(d) is repealed and reenacted to read:                                                       
29 (d)  A licensed dental hygienist who provides services under an advanced                                              
30 practice permit shall maintain professional liability insurance and provide the patient,                                
31       or the parent or legal guardian of the patient, with                                                              
01                 (1)  a written notice that the treatment provided will be limited to                                    
02       preventive services and will not include comprehensive oral health care services;                                 
03                 (2)  a written recommendation that the patient be examined by a                                         
04       licensed dentist for comprehensive oral health care services; and                                                 
05 (3)  assistance in obtaining a referral to a licensed dentist for further                                               
06 dental planning and treatment, including a written description of methods for                                           
07 obtaining a referral and a list of licensed dentists in the patient's community or other                                
08       resources for finding a licensed dentist.                                                                         
09    * Sec. 6. AS 08.32.115 is amended by adding new subsections to read:                                               
10 (e)  A licensed dental hygienist holding an advanced practice permit may                                                
11       practice as an independent contractor.                                                                            
12 (f)  An advanced practice permit is valid until the expiration of the dental                                            
13 hygienist's license to practice. A licensed dental hygienist may renew an advanced                                      
14       practice permit at the time of license renewal under AS 08.32.071.                                              
15    * Sec. 7. AS 21.36.090(d) is amended to read:                                                                      
16 (d)  Except to the extent necessary to comply with AS 21.42.365 and                                                     
17 AS 21.56, a person may not practice or permit unfair discrimination against a person                                    
18 who provides a service covered under a group health insurance policy that extends                                       
19 coverage on an expense incurred basis, or under a group service or indemnity type                                       
20 contract issued by a health maintenance organization or a nonprofit corporation, if the                                 
21 service is within the scope of the provider's occupational license. In this subsection,                                 
22 "provider" means a state licensed physician, physician assistant, dentist, osteopath,                                   
23 optometrist, chiropractor, advanced practice registered nurse, naturopath, physical                                     
24 therapist, occupational therapist, marital and family therapist, psychologist,                                          
25 psychological associate, licensed clinical social worker, licensed professional                                         
26 counselor, [OR] certified direct-entry midwife, or dental hygienist holding an                                      
27       advanced practice permit.                                                                                     
28    * Sec. 8. AS 47.07.030(b) is amended to read:                                                                      
29 (b)  In addition to the mandatory services specified in (a) of this section and the                                     
30 services provided under (d) of this section, the department may offer only the                                          
31 following optional services: case management services for traumatic or acquired brain                                   
01 injury; case management and nutrition services for pregnant women; personal care                                        
02 services in a recipient's home; emergency hospital services; long-term care                                             
03 noninstitutional services; medical supplies and equipment; advanced practice                                            
04 registered nurse services; clinic services; rehabilitative services for children eligible                               
05 for services under AS 47.07.063, substance abusers, and emotionally disturbed or                                        
06 chronically mentally ill adults; targeted case management services; inpatient                                           
07 psychiatric facility services for individuals 65 years of age or older and individuals                                  
08 under 21 years of age; psychologists' services; clinical social workers' services; marital                              
09 and family therapy services; midwife services; prescribed drugs; physical therapy;                                      
10 occupational therapy; chiropractic services; low-dose mammography screening, as                                         
11 defined in AS 21.42.375(e); hospice care; treatment of speech, hearing, and language                                    
12 disorders; adult dental and dental hygiene services; prosthetic devices and                                         
13 eyeglasses; optometrists' services; intermediate care facility services, including                                      
14 intermediate care facility services for persons with intellectual and developmental                                     
15 disabilities; skilled nursing facility services for individuals under 21 years of age; and                              
16       reasonable transportation to and from the point of medical care.                                                  
17    * Sec. 9. The uncodified law of the State of Alaska is amended by adding a new section to                          
18 read:                                                                                                                   
19 TRANSITION: COLLABORATIVE AGREEMENTS. Notwithstanding the                                                               
20 amendment to AS 08.32.110(e)(2) by sec. 1 of this Act, the repeal and reenactment of                                    
21 AS 08.32.115(b) - (d) by secs. 3 - 5 of this Act, and the enactment of AS 08.32.115(e) and (f)                          
22 by sec. 6 of this Act, a collaborative agreement approved by the board under AS 08.32.115                               
23 before the effective date of secs. 1 - 6 of this Act is valid until the agreement expires under                         
24 AS 08.32.115 as that section read before the effective date of secs. 1 - 6 of this Act.                                 
25    * Sec. 10. The uncodified law of the State of Alaska is amended by adding a new section to                         
26 read:                                                                                                                   
27 REGULATIONS. The Department of Commerce, Community, and Economic                                                        
28 Development and the Board of Dental Examiners may adopt regulations necessary to                                        
29 implement the changes made by this Act. The regulations take effect under AS 44.62                                      
30 (Administrative Procedure Act), but not before the effective date of the law implemented by                             
31 the regulation.                                                                                                         
01    * Sec. 11. The uncodified law of the State of Alaska is amended by adding a new section to                         
02 read:                                                                                                                   
03       REVISOR'S INSTRUCTION. The revisor of statutes is requested to change the catch                                   
04 line for AS 08.32.115 from "Collaborative agreements" to "Advanced practice permits."                                   
05    * Sec. 12. Section 10 of this Act takes effect immediately under AS 01.10.070(c).