Legislature(2007 - 2008)CAPITOL 106
02/07/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HCR13 | |
| HB319 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HCR 13 | TELECONFERENCED | |
| *+ | HB 319 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 319-DENTISTS & DENTAL ASSISTANTS 4:27:14 PM CHAIR WILSON announced that the final order of business would be HOUSE BILL NO. 319, "An Act relating to the practice of dentistry and to dental assistants." 4:27:09 PM PATTY KRUEGER, Staff to Representative Jay Ramras, Alaska State Legislature, introduced HB 319 on behalf of Representative Ramras, sponsor. She read from the following prepared statement: Oral health plays a key role in overall health unfortunately not all Alaskan's enjoy good dental health due to geographical barriers, cost of dental care and limitations on dental personnel. House Bill 319 follows the provisions already in place in 36 other states allowing for expanded duties of dental assistants thereby improving access to dental care and reducing costs for dental care. With expanded duties, dental assistants can help community health centers and traveling dental teams provide greater access to care and more cost effective care. This bill specifically will allow certified dental assistants to place "fillings" into a cavity prepared by a licensed dentist and allows a certified dental assistant to do coronal polishing of the teeth. House Bill 319 is beneficial to the citizens of Alaska by improving access to care while still maintaining the oversight to ensure safety and quality of care. This bill is supported by the Alaska Dental Society, Alaska Board of Dental Examiners, Alaska Dental Outreach Consortium and the Alaska Native Tribal Health Consortium. House Bill 319 meets the goals of the preliminary report for the Governor's Health Care Strategies Planning Council. 4:29:44 PM REPRESENTATIVE FAIRCLOUGH asked for the source of the definitions that are found on page 5, line 5 to 15, of the bill. JANE PIERSON, Staff to Representative Jay Ramras, Alaska State Legislature, informed the committee that the definitions in the bill were provided by the Alaska Dental Society, Inc. 4:30:44 PM REPRESENTATIVE FAIRCLOUGH further asked for confirmation that the definitions are consistent with standard dental procedures. 4:31:56 PM DAVID L. EICHLER, D.D.S.; President, Alaska Board of Dental Examiners, affirmed that the definitions are standard in the dental industry. 4:32:07 PM DAVID LOGAN, D.D.S.; Legislative Liaison, Alaska Dental Society, agreed with Dr. Eichler. He added that the definitions for supervision are defined elsewhere in the statute; in fact, the bill creates a new class of supervised entity with the dental assistant. Previously, dental assistants have been a non regulated entity. 4:33:27 PM REPRESENTATIVE FAIRCLOUGH then asked whether these definitions are accepted nationally, or just in Alaska. DR. EICHLER explained that the two definitions related to supervision would be specific with the state of Alaska statute and regulation. The definitions of "calculus" and "coronal polishing" meet the standards of clinical dental practice, and the scope of practice of the "dental assistant" is defined by statute in individual states. 4:34:24 PM REPRESENTATIVE SEATON assumed that the bill creates a more limited scope for a dental assistant when compared to the responsibilities of a physician's assistant. For example, the only time that the dental assistant can perform these procedures is when the dentist is present in the facility. DR. LOGAN said that is correct. A dental assistant can only work in the presence of the dentist, under direct or indirect supervision. 4:35:24 PM REPRESENTATIVE ROSES asked whether a local dental assistant would be allowed to correct the polishing after a traveling dentist has left the community. DR. LOGAN explained that coronal polishing has to do with cleaning the teeth, not the adjustment of fillings. He stressed that a dental assistant cannot make any adjustments to a tooth with a dentist present. 4:36:46 PM REPRESENTATIVE FAIRCLOUGH asked about the repeal of AS 08.32.110(d) that allows dental assistants to apply topical preventive agents and sealants. DR. LOGAN explained that the provision cited by Representative Fairclough was defined under the hygiene statutes and this authority is now found in the bill on page 4, line 21. 4:37:56 PM CHAIR WILSON asked whether there is a national board or agency that certifies dental assistants. DR. EICHLER said yes. He added that national standards are not a part of the regulatory requirements in Alaska. In answer to a question, he further explained that it is difficult to obtain dental office personnel in Alaska, and many are trained on the job by the dentist. 4:39:12 PM CHAIR WILSON asked whether there would be an objection to requiring certification for dental assistants who will be performing the expanded duties. DR LOGAN responded that there is not a national certification process for dental health care providers; however, each state is allowed to credential to their own statute. He said he was not aware of any state that required certification from a national board for all assistants. DR. EICHLER concurred. 4:40:55 PM REPRESENTATIVE ROSES asked whether dental assistants are required to be licensed. DR. EICHLER indicated no. 4:41:07 PM REPRESENTATIVE FAIRCLOUGH referred to page 4, line 23, and asked for further clarification of "other dental operations and services except as provided in AS 08.32.110(c) and this chapter." DR. EICHLER stated that AS 08.32.110(c) is an exception to the delegation powers that could be delegated to a hygienist. These same exceptions would apply to a dental assistant, also. Paragraph (3) of the bill allows the delegation of services, except for those previously cited. 4:43:07 PM REPRESENTATIVE FAIRCLOUGH pointed out that one of the other services delegated to a hygienist is the administration of a local anesthetic, and the bill would also apply this exception to dental assistants. DR. EICHLER disagreed. 4:43:47 PM REPRESENTATIVE FAIRCLOUGH further asked whether this procedure is allowed under paragraph (c). DR. EICHLER clarified that a dental hygienist is allowed to administer a local anesthetic with a separate certification. He stated that there is no provision in this bill to allow that certification for dental assistants. 4:45:04 PM CHAIR WILSON observed that there is time to clear this up before the bill is moved from committee. REPRESENTATIVE SEATON referred to page 4, line [25], [sub] section (b), and asked for clarification of "direct supervision" as compared to "indirect supervision." 4:46:24 PM DR. LOGAN explained that the current definition, under hygiene statute, for "direct supervision" is that the dentist is in the office, but not necessarily in the room, and the dentist is required to see the patient before and after the work is done. 4:47:17 PM CHAIR WILSON asked for further clarification. DR. LOGAN responded that for "indirect supervision" the dentist sees the patient beforehand, and is in the office, but not necessarily in the room, and does not see the patient for evaluation after the work is done. For example, taking a x-ray only requires "indirect supervision." 4:48:10 PM CHAIR WILSON asked for a description of procedures that assistants are allowed to do with both "direct" and "indirect" supervision. DR. LOGAN stated that anything dental assistants do now, they would still be able to do under "indirect supervision." House Bill 319 will allow, with "direct supervision," the packing and carving of filling materials and coronal polishing. 4:49:10 PM CHAIR WILSON expressed a concern about the lack of certification of the assistants who are performing these expanded duties. A certification procedure, independent of the dentists, would assuage this concern. DR. LOGAN emphasized that the function of the dental board is to license dentists and hygienists. He opined that the dental board is in the best qualified position to authorize individuals to perform procedures. 4:50:22 PM CHAIR WILSON asked how the dental board makes this conclusion. DR. EICHLER pointed out that the clause on page 3, line 24, requires that the board will issue a certificate to dental assistants upon completion of a training program. The University of Alaska is willing to develop a training course to ensure competency for the new duties. 4:51:22 PM CHAIR WILSON surmised that dental assistants would attend, and pass, competency classes prior to applying for certification. 4:51:41 PM REPRESENTATIVE SEATON noted that on page 3, line 2, the bill establishes the dentist's responsibility to ensure that an assistant under his or her supervision meets the minimum professional standards. DR. EICHLER concurred. 4:52:43 PM REPRESENTATIVE ROSES stated that the bill requires an assistant to be competent, but does not require licensing. DR. EICHLER agreed that the bill requires a certification course only. 4:53:19 PM REPRESENTATIVE ROSES asked whether a dental assistant would be able to perform these functions without a certificate. DR. EICHLER said no. 4:53:32 PM REPRESENTATIVE ROSES recalled that Dr. Eichler had trained some assistants in his office. He asked whether they had certificates. DR. EICHLER said they did not have certificates for these functions. He added that the functions that a dental assistant currently performs have no certification. 4:53:57 PM REPRESENTATIVE ROSES confirmed that certifications will be required for the expanded functions. DR. EICHLER concurred. 4:54:09 PM CHAIR WILSON asked for the consequences to the dentist of allowing procedures by a noncertified assistant. DR. LOGAN recalled that there was a case about 10 years ago and the dentist was fined $5,000. He noted that the maximum fine is now $25,000. 4:54:57 PM REPRESENTATIVE FAIRCLOUGH opined that this bill would create additional income for dentists. 4:55:21 PM CHAIR WILSON asked whether the bill would allow dentists to collect more money. DR. LOGAN said no. He explained that dental billing is by procedure regardless of how many providers are involved. He added that the bill would allow a more cost effective means to provide treatment for children who qualify for Medicaid. 4:56:41 PM DR. LOGAN, in answer to a question, estimated that there are a very, very low number of dentists who provide cleaning services for Medicaid patients. 4:56:57 PM CHAIR WILSON asked whether the bill would allow dental assistants to perform the cleanings that dentists and hygienists now perform, but at a lower cost. DR. LOGAN said yes. 4:57:16 PM REPRESENTATIVE SEATON observed that, in Homer, there are no dentists that provide Medicaid patients with service. 4:58:08 PM CHAIR WILSON shared that Ketchikan kids fly to Juneau for dental care. 4:58:28 PM REPRESENTATIVE FAIRCLOUGH opined that the owner of a dental office will have the opportunity to provide additional access to care. 4:58:59 PM CHAIR WILSON asked whether the bill would be an incentive for dentists to accept more Medicaid patients. DR. LOGAN expressed his hope that the bill would lower one of the barriers to Medicaid patients. [Although not formally stated, HB 319 was held over.]
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