Legislature(2019 - 2020)ADAMS 519
03/02/2020 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB127 | |
| HB159 | |
| HB182 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 127 | TELECONFERENCED | |
| *+ | HB 159 | TELECONFERENCED | |
| + | HB 182 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 127
"An Act relating to the practice of dental hygiene;
establishing an advanced practice permit; 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."
2:38:59 PM
Co-Chair Johnston invited the testifiers to the table.
2:39:18 PM
REPRESENTATIVE IVY SPOHNHOLZ, BILL SPONSOR, introduced
herself. She thanked the committee for hearing her bill
which would establish advanced practice permits for dental
hygienists. She explained that oral health was an important
part to an individual's overall health and wellbeing. Poor
oral health attributed to poor physical health. It was a
problem amongst some of the state's most vulnerable
populations. She reported that 62 percent of elementary
students had tooth decay. Low income individuals and
families that did not regularly seek oral health care due
to cost, apprehension of dental care, access, and trouble
finding a provider contributed to bad health outcomes. She
noted several negative health outcomes including heart
disease, Alzheimer's, osteoporosis, and poor nutrition.
Representative Spohnholz continued that HB 127 aimed to
increase access to oral healthcare to underserved
populations, specifically children, seniors, and
individuals with disabilities. The legislation created an
advanced practice permit for dental hygienists similar to
the certificate advanced nurse practitioners had which was
created in 1981 and implemented in 1984. Currently, dental
hygienists were able to practice in a dentist's practice or
semi-independently if they had a collaborative agreement
with a dentist similar to what physician's assistants did.
House Bill 127 created an advanced practice permit which
allowed dental hygienists to care for underserved
populations in senior centers, healthcare facilities,
daycares, schools, and for Alaskans who were eligible for
public assistance, homebound, or lived in an underserved
community. Dental hygienists who had a minimum of 4000
hours of clinical experience and who were approved by the
Alaska Board of Dental Examiners could be advanced practice
dental hygienists.
Representative Spohnholz indicated the bill laid out very
specific services that could be provided by permit holders
and the specific populations that licensed dental
hygienists could serve without supervision or the physical
presence of a licensed dentist. The permit was not a cart
blanch permit for practicing independently. The list of
services had been developed in consultation with the Alaska
Dental Society, the Board of Dental Examiners, and the
Alaska Dental Hygienists Association. Advanced practice
dental hygienists would have to maintain malpractice
insurance, provide a written notice of their service
limitations, and make a referral to a licensed dentist
nearby for a patient's dental treatment. The permit would
allow dental hygienists to practice to the full scope of
their training, credentials, and professional experience.
She noted that Alaska would not be the first state to make
such changes. Dental Hygienists were able to practice under
advanced practice permits or similar permits in six other
states: Colorado, Montana, Maine, Connecticut, and
California. She indicated 40 other states were considered
direct access states. The bill would mean that dental
hygienists could initiate treatment based on their
assessment of a patient's need without authorization or the
presence of a dentist. Alaska would not be breaking new
trail; it was something done in many other states. She
noted that since the prior year she had made some important
changes to the bill at the recommendation of the Board of
Dental Examiners and the Alaska Dental Association
including requiring permit holders to maintain patient
records for at least 7 years. It would ensure that the
Board of Dental Examiners had separately certified a dental
hygienist to administer anesthesia, and empowering DHSS to
make regulations related to the bill. She reported that her
aide had a PowerPoint Presentation and relayed the names of
available testifiers.
Co-Chair Johnston indicated Co-Chair Foster and
Representative Knopp had joined the meeting.
2:43:28 PM
KASEY CASORT, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
introduced the PowerPoint: HB 127: Dental Hygiene Advance
Practice Permit. She began with slide 2 to review the
importance of the bill. She spoke of there being many
unique barriers to accessing health care including dental
care in Alaska. She noted that 62 percent of Alaskan
elementary students had a high rate of tooth decay and, 43
percent of low-income Alaskans had trouble biting or
chewing. Both young adults and low-income adults across
American cited pain as their top oral health problem and,
low-income families in Alaska did not regularly seek oral
health care due to cost, access, or trouble finding a
provider. She asserted that Alaska needed all of its
qualified health professionals operating to the full scope
of their training, especially when it came to caring for
Alaskans with the greatest need.
2:44:27 PM
Ms. Casort continued to explain the importance of HB 127
turning to slide 3. Dental hygienists were state-
licensed health professionals who were trained to
provide education and care that focused on preventing
and treating oral diseases. However, under current
statute, dental hygienists were required to work under
the direct supervision of a licensed dentist or enter a
collaborative agreement where they remained under
general supervision. The requirements limited where and
when dental hygienists could practice and was a barrier
to preventative dental care for Alaskas seniors,
children, and adults living with disabilities.
Ms. Casort relayed with slide 4 that HB 127 created an
advanced practice permit that would allow experienced,
licensed dental hygienists to work independently to the
full scope of their credentials and professional experience
when they were caring for underserved populations.
Ms. Casort turned to slide 5. She indicated that
underserved populations were defined in U.S. Code under
the term "dental health shortage areas," which were
"geographic areas, populations, and facilities with too
few dental providers and services." In Alaska, it meant
an area with more than 5000 patients per 1 provider.
Ms. Casort continued that dental health shortage areas
in Alaska where an advanced practice permit-holder
could serve included geographic areas like the North
Slope Borough; facilities which primarily serve tribal
populations like Mt. Edgecumbe Hospital or Chief Andrew
Isaac Health Center; correctional centers like Goose
Creek Correctional Center; and federally qualified
health centers like the Bethel Family Clinic or Mat-Su
Health Services. House Bill 127 would allow hygienists
to care for Alaskans in need like elders living in
senior centers, underserved children in schools,
Alaskans who were eligible for public assistance, and
Alaskans with disabilities for whom oral care could be
a scary, uncomfortable experience. Increasing the
number of underserved Alaskans receiving preventative
care also meant that dental hygienists could catch more
acute problems earlier on when care was less costly,
painful, and inconvenient.
Ms. Casort concluded that HB 127 was the next step in
allowing dental hygienists to provide preventative care
to patients with the greatest need. Should would be
walking through the bill section-by-section.
2:46:35 PM
Ms. Casort presented a sectional analysis in a prepared
statement:
Section 1 amends the dental hygienists' scope of
practice to allow advanced practice permit holders to
provide specific services independently.
Section 2(a) allows the State of Alaska Board of
Dental Examiners to issue advanced practice permits to
hygienists with at least 4000 hours of clinical
experience.
Section 2(b) enumerates the services an advanced
practice permit-holder can perform without the
presence, authorization, supervision, or prior
examination of a licensed dentist (section 2(c)),
including
• providing oral health education,
• removing stains and deposits from the surface of
the teeth,
• applying preventative agents and sealants,
• taking and developing x-rays,
• screening for oral cancer,
• using local anesthesia if separately licensed to
do so by the Board,
• and performing preliminary charting and triage to
formulate a dental hygiene assessment and dental
hygiene treatment plan.
Section 2(d) requires an advanced practice permit-
holder to maintain liability insurance and provide
their patients or the patient's parent or legal
guardian with a written notice of the services the
permit allows them to perform. They must also help the
patient with referrals to see licensed dentists in the
area for more comprehensive dental care.
Section 2(e) allows an advanced practice permit-holder
to practice as an independent contractor.
Section 2(f) establishes that the advanced practice
permit is valid until the dental hygienist's license
expires and allows the permit to be renewed at the
same time as the license.
Section 3 amends the grounds for discipline,
suspension, or revocation of a dental hygienist's
license to allow them to provide the services listed
in section 2 independently without being punished.
Section 3 also empowers the Board to discipline
permit-holders who
• allow a dental assistant under their supervision
to perform procedures outside their scope of
practice,
• falsify or destroy a patient or facility record,
• or fail to maintain a patient or facility record
for at least 7 years, which is similar to the
requirement for dentists.
o This was added into the bill in House Labor
& Commerce, at the request of the Alaska
Board of Dental Examiners and the Alaska
Dental Society.
Section 4 amends Alaska Statue 08.36.346, Delegation
to dental assistants, to allow permit-holders to
delegate x-rays, application of topical preventative
agents or sealants, and other tasks specified by the
Board of Dental Examiners in regulation to dental
assistants under their supervision. The Board is also
tasked with specifying in regulation the level of
supervision required over the dental assistants.
Section 5 adds dental hygienists holding an advanced
practice permit to the list of providers who may not
be discriminated against. This prevents an insurer
from refusing to reimburse the appropriately licensed
provider on the basis of cost or on the basis of race,
religion, gender, etc.
Section 6 adds dental hygiene services to the list of
services which may be provided by the Department of
Health and Social Services.
Section 7 allows the Department of Commerce,
Community, and Economic Development, the Department of
Health and Social Services, and the Board of Dental
Examiners to adopt regulations necessary to implement
the changes made in this bill.
Finally, Sections 8 and 9 set an effective date of
July 1, 2020.
Ms. Casort indicated Katrina Virgin, President of the
Alaska Dental Hygienists' Association, was online as well
as others to answer any questions.
2:50:02 PM
Representative Sullivan-Leonard asked for information
regarding the educational requirements for dental
hygienists. She was seeing a correlation between a nurse
practitioner and an advanced dental hygienist.
Representative Spohnholz deferred to Ms. Virgin to answer
the question about education.
2:50:52 PM
KATRINA VIRGIN, PRESIDENT, ALASKA DENTAL HYGIENISTS
ASSOCIATION (via teleconference), responded that the
requirements for a dental hygienist to become licensed in
any state within the lower 48 and Alaska were that they
must graduate from an accredited dental hygiene school that
was a CODA [Commission on Dental Accreditation]
accreditation. School was typically 4 years. There were
some programs that were still in existence that were 2
years. However, even the University of Alaska Anchorage had
moved to a 4-year baccalaureate type program. It would take
about 3 to 4 years working consecutively under the
supervision of a dentist for a dental hygienist to meet the
4000 clinical hours requirement.
Representative Sullivan-Leonard asked for a comparison of
the requirements for an advanced nurse practitioner versus
an advanced dental hygienist.
Representative Spohnholz responded that a nurse
practitioner had more training than a dental hygienist.
However, a nurse practitioner had more authority. Nurse
practitioners in Alaska had full prescriptive authority
whereas, a dental hygienist would not. The training for a
dental hygienist was in line with the services they would
be providing.
Representative Sullivan-Leonard asked for the number of
years of training for an advanced nurse practitioner versus
an advanced practice dental hygienist.
Representative Spohnholz responded that a nurse
practitioner would have a 4-year undergraduate degree and
either a 2-year or 4-year graduate degree.
2:52:50 PM
Representative Tilton asked if the services could be billed
through Medicaid and whether a new category would be
created in Medicaid. She also asked if there would be an
increase or decrease in Medicaid services, overall.
Representative Spohnholz responded that a dental hygienist
would be able to bill Medicaid. Currently, they already did
under the supervision of a dentist or through a
collaborative agreement with a dentist. The legislation
would allow dental hygienists to practice independently.
Theoretically, there might be an increase in the number of
people receiving services. However, it was unclear because
eligibility or the number of services available would not
change. There was a finite number of people eligible for
Medicaid in the State of Alaska and a finite number of
services that could be provided. House Bill 127 would make
it easier and more cost effective for people to receive the
preventative care that dental hygienists provided as
opposed to the treatment options that dentists provided.
Frequently, people stated they were going to the dentist
when they were really going to a dental hygienist for a
routine cleaning or other prophylactic treatments used for
cavity prevention and the prevention of other more
expensive care.
2:54:25 PM
Representative Tilton asked if the bill sponsor thought
there was confidence in allowing a new category of advanced
practice hygienists. She wondered if people would be more
comfortable about getting preventative dental care. She
noted there were existing challenges in getting people to
receive preventative dental care.
Representative Spohnholz responded that the proposal was
structured to allow people to receive care where they
lived. They might be able to avoid going to an office to
receive dental care. They might be able to have a dental
hygienist go onsite to places such as nursing homes, day
care centers, elementary schools, and senior centers. She
thought some of the barriers would be reduced to getting
needed preventative care. She also thought the legislation
would increase access for people who were physically
challenged in going to the dentist's office.
2:55:49 PM
Co-Chair Foster asked if the bill sponsor had reached out
to any of the hospitals in rural areas. He wondered if she
had received any feedback from any folks from the rural
areas of Alaska.
Representative Spohnholz responded that she had not
received any feedback from providers or hospitals in the
rural areas. She surmised that the bill would be viewed
very favorably by the people in the rural areas, as the
bill would increase access to care. She was aware of huge
challenges in getting access to dental care in rural Alaska
which precipitated the creation of the dental health aide
therapist. They did amazing work in rural Alaska and
dramatically increased access to dental care. The bill
before the committee would be adding another level of
possible provider care in rural Alaska. Dental hygienists
would also be more affordable than would dentists, as they
had few university bills to pay off.
2:56:56 PM
Vice-Chair Ortiz referred to slide 4 and noted that in
order for a dental hygienist to receive an advance practice
permit they could only do so in underserved areas. He asked
how extensive the list was that was mentioned on the slide.
Ms. Casort noted she could provide the extensive list which
included many facilities across Alaska, but specifically
underserved areas. She could also provide how the
information was calculated which factored in the
patient-to-provider ratio, whether water was fluoridated,
and how long it took to access a dentist. She had outlined
the factors which were considered in scoring between 0 and
26. She would provide more detail to the committee.
2:58:15 PM
Representative Tilton asked if it was an appropriate time
to discuss the fiscal note.
Co-Chair Johnston indicated there would be another time
available for fiscal note questions.
Representative Wool had a couple of questions related to
the list of underserved populations. He had a letter from
Mary Cerney from Fairbanks which mentioned that the bill
would eliminate barriers to accessing care desperately
needed by many people. He thought one of the barriers to
care was that some people could not afford it. He wondered
if, by approving an advanced practice certificate for
dental hygienists, low-income people would have more access
just on the basis of being low-income as opposed to being
in a geographical area where the ratio was not as high as
in urban centers.
Representative Spohnholz responded that a person would have
to be low-income and receiving services in a dental
professional shortage area or in one of the facilities
listed on page 3 starting on line 2. The list included a
senior center, a hospital long-term care facility, an adult
foster home, and a residential care facility. The list was
long. The list continued to page 3, line 12 of the bill.
She informed the committee that the word "and" was
stipulated. A person had to meet the first 3 criteria and
receive services in one of the centers or live in a dental
health professional shortage area. The bill was not
designed to allow a dramatic expansion of those people that
would be providing services. The bill targeted a very,
specific, and under-served population.
Representative Wool noted that there were 703 dental
hygienists in Alaska. He supposed there were shortages in
some areas around the state. He asked if the bill sponsor
envisioned dental hygienists leaving their current
workplace to become an advanced dental hygienist and
exacerbating any shortages.
Representative Spohnholz reported that there was a shortage
of dental healthcare in Alaska, particularly in the
underserved populations. She did not believe creating the
advanced practice license would exacerbate the shortage.
She thought it would help redistribute access to dental
hygiene care, which was really important. Many of the
places where advanced practice dental hygienists would
practice would be in locations currently without
appropriate care. She reported that the Alaska Dental
Hygiene Association estimated that of the 703 dental
hygienists, approximately 5 percent would explore an
advanced practice license in order to practice
independently, which was on par with nurses. She indicated
there were about 5.5 percent of nurses in the State of
Alaska that were advanced practice nurses. She did not
think the legislation would change the total number. Rather
she thought it would help reallocate the resource to get it
to the people that needed it most.
Representative Wool suggested that 5 percent of hygienists
would equal about 3500 hygienists. The current population
of hygienists would go into advanced practice. He suspected
the model would be such that a practitioner would leave the
office they were currently in to go to an undeserved area.
He wondered about the potential for a practitioner to
continue working in their current office a couple of days
and on their own another couple of days per week.
Ms. Virgin offered that it was common for dental hygienists
to work in several facilities in a week. The goal would not
be to work in one location. The bill would allow for a
practitioner to work at multiple facilities and would open
up what services hygienists could provide.
Representative Wool asked if there was a dental hygienist
program currently in Alaska.
Representative Spohnholz responded affirmatively.
Ms. Virgin added that there was a degree program for dental
hygienists through the University of Alaska Anchorage. The
University offered a 4-year degree, a CODA approved dental
program. The University focused on public health
initiatives and going out to different rural areas to
provide treatment. The University wanted to see equal
access to care.
Co-Chair Johnston set the bill aside.
HB 127 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 159 Sponsor Statement 1.31.20.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 159 |
| HB 127 v. M Sponsor Statement 2.28.2020.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 127 |
| HB 127 v. M Sectional Analysis 2.28.2020.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 127 |
| HB 127 v. M Explanation of Changes 2.28.2020.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 127 |
| HB 182 Sponsor Statement 2.28.20.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 182 |
| HB 182 DNA arrest KTVA 11 9.6.19.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 182 |
| HB 182 Explanation of Changes v. U 2.12.20.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 182 |
| HB 127 v. M Index of Letters of Support 3.1.2020.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 127 |
| HB 127 Slideshow 3.1.2020.pdf |
HFIN 3/2/2020 1:30:00 PM |
HB 127 |