Legislature(2007 - 2008)CAPITOL 106
02/12/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB319 | |
| HB276|| HB279 | |
| HB279 | |
| Presentation on Alzheimer's Disease | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 319 | TELECONFERENCED | |
| *+ | HB 276 | TELECONFERENCED | |
| *+ | HB 279 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 319-DENTISTS & DENTAL ASSISTANTS 3:11:00 PM CHAIR WILSON announced that the first order of business would be HOUSE BILL NO. 319, "An Act relating to the practice of dentistry and to dental assistants." REPRESENTATIVE GARDNER moved to adopt CSHB 319, Version 25- LS1281\K, Bullard, 2/11/08, as a working document. Hearing no objection, Version K was before the committee. 3:12:02 PM PATTY KRUEGER, Staff to Representative Jay Ramras, Alaska State Legislature, presented the changes to HB 319 that are reflected in Version K. She explained that the Alaska Dental Society recommended that this part of the statute remain unchanged; therefore, Sections 1, 2, and 3, were deleted. The next change was suggested by the committee; that the definition of the duties of a dental assistant, versus those of a dental hygienist, should be more narrowly defined. This was done by changes to the language in AS 08.36.346. She further explained that on page 3, line 30, of Version [E], the word "subgingival" was deleted to correct a drafting error. 3:13:41 PM REPRESENTATIVE FAIRCLOUGH asked for the location of the reference to "subgingival" in Version K. MS. KRUEGER responded that the deletion of "subgingival", in Version K, is on page 2, line 28. 3:14:53 PM REPRESENTATIVE GARDNER asked why Sections 1, 2, and 3 were deleted. MS. KRUEGER explained that dental hygienists function under general supervision by dentists and Version [E] specified "direct" and "indirect" supervision; if the sections were not deleted, the kind of direction under which hygienists function would be limited. 3:15:23 PM CHAIR WILSON asked for public testimony. 3:15:37 PM PAUL SILVEIRA, DMD, informed the committee that he is representing the Alaska Dental Society and himself. His practice is located in Valdez, which is a very rural area even though it is located on the road system. He stated his support for HB 319 and explained that this bill will affect his practice and his patients in a positive way. Dr. Silveira's office has been without a dental hygienist for three months; this means he must do the work of a hygienist. He pointed out that a dental office is a health care facility, but is also a small business that must be profitable for his employees and himself. Not having a hygienist means that he must spend time doing this service and the fee for a "prophy" just covers his overhead. In fact, the Medicaid reimbursement for this service does not cover his cost. This bill will allow a dental assistant to do coronal polishing and free the dentist's time for other procedures. Dr. Silveira stressed that the passage of this bill will allow him to better serve the needs of his patients and maintain his practice. Furthermore, it is hard to attract hygienists to Valdez and to other rural areas. He stated that he does not have a problem with having his assistants certified in some manner; however, a national certification course would put undue restrictions on those working in rural areas due to the travel required. He suggested that certification by a correspondence, or a distance education, program would be best. Dr. Silveira emphasized that he can not operate his practice at a loss for very long. 3:22:25 PM REPRESENTATIVE FAIRCLOUGH expressed her appreciation of Dr. Silveira's testimony that, through this bill, additional care can be provided to those individuals on Medicaid. She asked whether he would support the addition of a sunset clause to the bill in order to measure the amount of the increase in care to Medicaid patients. DR. SILVEIRA said that he would not be opposed; however, the problems with Medicaid are a big subject to discuss. 3:23:52 PM CHAIR WILSON stated that both Medicare and Medicaid would "fit in." At this time, the committee is looking for ways to have more access to care for constituents. 3:24:11 PM DR. SILVEIRA told the committee that he accepts Medicaid for kids only. This is because Medicaid rules are too arduous and the penalties are big; these are problems in addition to the ridiculously small reimbursement amount. The bill will help with this problem, but he opined that he would not add Medicaid patients simply because of the bill. 3:25:25 PM REPRESENTATIVE FAIRCLOUGH stated that committee members have heard previous testimony that HB 319 will allow dentists to provide additional care to Medicaid patients. She reluctantly questioned the sincerity of those who support this bill and wondered whether their support was in order to make more money or in order to increase service for Medicaid and Medicare patients. DR. SILVEIRA confirmed that he could see more patients in his community. 3:27:34 PM CHAIR WILSON asked whether a dentist can have other patients waiting in case a Medicaid patient does not show up for the next appointment. DR. SILVEIRA explained that he does not treat his Medicaid patients differently than others. 3:28:47 PM CHAIR WILSON said that her suggestion was for more efficiency. 3:28:57 PM DR. SILVEIRA stressed that this bill will allow him to offer more hygiene services when his practice is without a hygienist. When he has a hygienist, the hygienist, not the dental assistant, would probably do the coronal polishing. 3:29:59 PM PETE HIGGINS, DDS, Acting President, Alaska Dental Society, informed the committee that he is in favor of the bill; in fact, he has been working for the last few years to increase access to care in the rural areas of the state. He said that there is a shortage of dental hygienists in rural areas throughout the state and coronal polishing and the placing of dental materials by dental assistants will certainly help the dentists working in rural areas. Dr. Higgins told the committee that the Alaska Native corporations and the federal government have been doing this program for years. The Alaska Dental Society is also working with Medicaid to try to get more dentists involved in the Medicaid program and bring access to this group of patients. House Bill 319 will make serving Medicaid patients more economically feasible. He opined that many other states have already adopted this program; Alaska is always behind the times. He concluded that the approval of expanded duties for assistants is needed and is a program that should go through. In fact, his assistant is certified, but can not be used in this category due to the lack of legislation. 3:33:20 PM CHAIR WILSON noted that the results of a study done by the Department of Health and Social Services (DHSS) on the reimbursement of Medicaid costs will be released soon. 3:34:03 PM DR. HIGGINS said that Alaska is unique due to the lack of an extensive road system. This program will help to involve local dental assistants that are already living and working in rural areas. 3:35:07 PM CHAIR WILSON closed testimony. 3:35:16 PM REPRESENTATIVE ROSES asked whether "direct supervision", as defined on page 3 of Version K, means that the dentist is in the office where the patient is, or just in the building somewhere. He requested that "dental office" be defined as opposed to the "dental facility" described under "indirect supervision." He expressed his difficulty in understanding the difference between "dental office" and "dental facility". 3:36:52 PM DAVID LOGAN, DDS, and Chair, Alaska Dental Society Legislative Committee, explained that, in the bill "dental office" and "dental facility" are the same. The definitions were borrowed from the dental hygienists statutes and that is the only reason for this distinction. 3:37:36 PM REPRESENTATIVE ROSES remarked: So, for the record, ... the intent of the sponsor of this bill, and for our purposes, that the two are interchangeable, and that one can not later come and say 'Well, I was in the building even though it was five stories, I was on the fifth floor.' As opposed to somebody that at least is in auditory contact with somebody that may need assistance. Because, I see this as a huge difference and it's maybe something that we need to address. 3:38:18 PM DR. LOGAN said: Yes, dental office and dental facility are meant, the, the containment of the dental office and any common areas it shares with adjacent, generally, other dental offices; but, I guess, conceivably, they have a break room or something like that, that is shared with a non-dental office. But, yes. REPRESENTATIVE ROSES said he would be offering an amendment. 3:38:29 PM CHAIR WILSON moved that the committee adopt Amendment 1 that read [original punctuation provided]: Conceptual amendment to require all Dental Assistants that wish to become certified to perform coronal polishing or to perform restorative functions must be Certified Dental Assistants (CDA). Certified Dental Assistant - CDA means a dental assistant that has registered with the board, passed the Dental Assisting National Board Exam (DANB), and maintains the credential (CDA) by meeting DANB recertification requirements. 3:39:34 PM REPRESENTATIVE FAIRCLOUGH objected. 3:39:40 PM CHAIR WILSON explained that the DANB offers three ways to become a CDA. In addition to having a cardiopulmonary resuscitation (CPR) certification the candidate must: graduate from a dental assisting program; or, graduate from a high school and have two years experience in a dental office; or, have current or former certification. She noted that much of the continuing education can be done online by those who have work experience. 3:41:14 PM REPRESENTATIVE GARDNER expressed her understanding that Alaska has working dental assistants that are not certified. The bill proposes to allow assistants to get a certification to do two functions: coronal polishing and restorative placement. She opined that this amendment will require additional certification to become a CDA. 3:42:06 PM CHAIR WILSON explained the three different pathways to CDA certification. 3:42:49 PM REPRESENTATIVE GARDNER clarified that there is a second level of achievement, the CDA certification would be first and then the coronal polishing certification. 3:43:03 PM CHAIR WILSON read the following: This conceptual amendment would make it a requirement for a dental assistant to be certified by the Dental Assisting National Board before they become certified for coronal polishing and the restorative function as defined in the bill. It will just make sure that every dental assistant that is going to provide these additional services will have met the same qualifications. CHAIR WILSON stated that her intent was that the certification would require an "extra step." 3:43:59 PM REPRESENTATIVE GARDNER asked whether the conceptual amendment would require an overreaching CDA certification for a dental assistant's other functions, and then, in addition, the bill requires that they get the two specific certifications. CHAIR WILSON said, " ... that's true." 3:44:20 PM REPRESENTATIVE GARDNER observed that if the committee does not know exactly what is certified now, it is doubling the requirements. 3:44:40 PM CHAIR WILSON explained that dental assistants do not have to be certified now, and if they want to stay uncertified, that will not be a problem. However, they will have to be certified to do the extra functions. 3:44:56 PM REPRESENTATIVE GARDNER advised that is what the bill does without the CDA requirements. 3:45:06 PM REPRESENTATIVE ROSES questioned the need for Amendment 1. He pointed out that the original bill in Section 3, AS 08.36.315, talks about the revocation of a license, reading: The board may revoke or suspend the license of a dentist or may reprimand, censure or discipline a dentist, or both, if the board finds that, after hearing, the dentist engaged in the performance of patient care or permitted the performance of patient care by persons under the dentist's supervision that does not conform to the minimum professional standards of dentistry regardless, of whether actual injury to the patient occurred. REPRESENTATIVE ROSES asked for the need of the certification when the dentist is not allowed to have someone perform a duty for which they are not qualified to perform. He opined that the purpose of the amendment is taken care of in existing statute. 3:46:22 PM REPRESENTATIVE FAIRCLOUGH asked for a brief at-ease. 3:48:22 PM The committee took an at-ease from 3:46 p.m. to 3:48 p.m. CHAIR WILSON withdrew Amendment 1. 3:48:38 PM REPRESENTATIVE FAIRCLOUGH warned that there is a reason to have caution when the Medical Board receives a financial benefit. She recalled the previous testimony regarding the difficulty of having a successful dental practice in a rural area. She opined that the three requirements for CDA accreditation are good standards. 3:49:43 PM CHAIR WILSON cautioned that there is a need to very careful when there will be a monetary gain. She advised that she would contact the chair of the next committee of referral. 3:50:18 PM CHAIR WILSON offered Amendment 2, as follows [original punctuation provided]: After board insert "that do not require the professional skill of a licensed dentist or licensed dental hygienist, including those provided in AS 08.32.110(c) and this chapter." CHAIR WILSON said that this amendment is offered to tighten up the language in the bill. Hearing no objection, Amendment 2 was adopted. 3:51:20 PM REPRESENTATIVE ROSES moved that the committee adopt Conceptual Amendment 3, as follows: Page 3, line 11; Delete "dental facility" Insert "dental office" 3:51:49 PM REPRESENTATIVE GARDNER objected, and then removed her objection. Hearing no further objection, Conceptual Amendment 3 was adopted. 3:52:23 PM REPRESENTATIVE FAIRCLOUGH observed that the next committee of referral is the author of the bill. Therefore, she said that she will not offer her amendment on a sunset and measurable goals, but will talk with the sponsor to confirm whether the intent of the bill is to provide additional services to Medicare and Medicaid recipients. If so, a sunset is needed; however, if this bill is to address business practice measures, a sunset is not needed. 3:54:02 PM CHAIR WILSON indicated that she will also talk with the sponsor. 3:54:28 PM REPRESENTATIVE KELLER observed that the bill will expand the scope of the responsibilities of the lowest paid professionals and allow dentists to compete economically. 3:55:06 PM REPRESENTATIVE FAIRCLOUGH surmised that the holders of the lowest paid positions can qualify for a certificate and elevate their value. 3:55:31 PM3:56:05 PM CHAIR WILSON opined that dentists in urban areas will also use this capability, as well. 3:56:05 PM REPRESENTATIVE ROSES expressed his hope that the bill accomplishes its objective. The intent was to allow dentists to see more patients and, thereby, extend care to Medicaid recipients. However; the testimony was that the bill will not change the issues with Medicaid. He advised that if the sunset amendment is not offered in committee, he will offer it on the floor. Representative Roses opined that the responsibility of the legislature is to increase care and access to dental care for everyone, not necessarily to increase the profitability of the dental practices. 3:58:04 PM REPRESENTATIVE FAIRCLOUGH clarified that the committee's support of good business practices will result in an increase of accessibility to care in rural communities. 3:58:23 PM REPRESENTATIVE FAIRCLOUGH moved to report HB 319, Version 25- LS1281\K, Bullard, 2/11/08, as amended, out of committee with individual recommendations and the accompanying fiscal notes. Hearing no objection, CSHB 319(HES) was reported out of the House Health, Education and Social Services Standing Committee.
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