HB 111: "An Act relating to the practice of dental hygiene; relating to advanced practice permits for dental hygienists; relating to dental assistants; 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 HOUSE BILL NO. 111 01 "An Act relating to the practice of dental hygiene; relating to advanced practice permits 02 for dental hygienists; relating to dental assistants; prohibiting unfair discrimination 03 under group health insurance against a dental hygienist who holds an advanced practice 04 permit; relating to medical assistance for dental hygiene services; and providing for an 05 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 by the board 12 under AS 08.32.125 or has entered into a collaborative agreement approved by the 13 board under AS 08.32.115 from performing the activities authorized under the permit

01 or 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 is amended by adding a new section to read: 05 Sec. 08.32.125. Advanced practice permits. (a) The board may issue an 06 advanced practice permit to a licensed dental hygienist with a minimum of 4,000 07 documented hours of clinical experience. A licensed dental hygienist holding an 08 advanced practice permit may 09 (1) promote oral health and provide disease prevention education and 10 oral systemic health education; 11 (2) remove calcareous deposits, accretions, and stains from the 12 surfaces of teeth; 13 (3) apply topical preventive or prophylactic agents, including silver 14 diamine fluoride, fluoride varnishes, and pit and fissure sealants; 15 (4) polish and smooth restorations; 16 (5) remove marginal overhangs; 17 (6) perform preliminary charting and triage to formulate a dental 18 hygiene assessment and dental hygiene treatment plan; 19 (7) expose and develop radiographs; 20 (8) use local periodontal therapeutic agents; 21 (9) perform nonsurgical periodontal therapy, with or without the 22 administration of local anesthesia; 23 (10) screen for oral cancer; 24 (11) if certified by the board, administer local anesthesia; 25 (12) prescribe 26 (A) fluoride that is applied or provided to a patient; and 27 (B) chlorhexidine or a similar antibacterial rinse; and 28 (13) delegate dental operations and services to a dental assistant as 29 provided in AS 08.36.346. 30 (b) A licensed dental hygienist holding an advanced practice permit may 31 provide the services described in (a) of this section to a patient who is unable to

01 receive dental treatment because of age, infirmity, or disability and is 02 (1) a resident in a senior center, including a hospital, long-term care 03 facility, adult foster home, residential care facility, or adult congregate living facility; 04 (2) a resident in a health care facility, including a mental health 05 residential program or facility for individuals with developmental or other disabilities; 06 (3) held in a local correctional facility for juveniles or adults; 07 (4) enrolled in a nursery school, day care program, vocational training 08 facility, primary school, secondary school, private school, or public charter school; 09 (5) entitled to benefits under 42 U.S.C. 1786 (Special Supplemental 10 Nutrition Program for Women, Infants, and Children); 11 (6) homebound; or 12 (7) a resident of a dental health professional shortage area designated 13 under 42 U.S.C. 254e. 14 (c) A licensed dental hygienist holding an advanced practice permit may 15 provide the services described in (a) of this section to a patient described in (b) of this 16 section without 17 (1) the physical presence, authorization, or supervision of a licensed 18 dentist; 19 (2) a licensed dentist's examination of the patient. 20 (d) A licensed dental hygienist who provides services under an advanced 21 practice permit shall maintain professional liability insurance and provide the patient, 22 or the parent or legal guardian of the patient, with 23 (1) a written notice that the treatment provided will be limited to 24 services permitted under (a) of this section; 25 (2) a written recommendation that the patient be examined by a 26 licensed dentist for comprehensive oral health care services; and 27 (3) assistance in obtaining a referral to a licensed dentist for further 28 dental planning and treatment, including a written description of methods for 29 obtaining a referral and a list of licensed dentists in the patient's community or other 30 resources for finding a licensed dentist. 31 (e) A licensed dental hygienist holding an advanced practice permit may

01 practice as an independent contractor. 02 (f) An advanced practice permit is valid until the expiration of the dental 03 hygienist's license to practice. A licensed dental hygienist may renew an advanced 04 practice permit at the time of license renewal under AS 08.32.071. 05 * Sec. 3. AS 08.32.160 is amended to read: 06 Sec. 08.32.160. Grounds for discipline, suspension, or revocation of license. 07 The board may revoke or suspend the license of a dental hygienist, or may reprimand, 08 censure, or discipline a licensee, if, after a hearing, the board finds that the licensee 09 (1) used or knowingly cooperated in deceit, fraud, or intentional 10 misrepresentation to obtain a license, certificate, or endorsement; 11 (2) engaged in deceit, fraud, or intentional misrepresentation in the 12 course of providing or billing for professional services or engaging in professional 13 activities; 14 (3) advertised professional services in a false or misleading manner; 15 (4) has been convicted of a felony or other crime that affects the 16 licensee's ability to continue to practice competently and safely; 17 (5) failed to comply with this chapter, with a regulation adopted under 18 this chapter or under AS 08.36, or with an order of the board; 19 (6) continued to practice after becoming unfit due to 20 (A) professional incompetence; 21 (B) addiction or dependence on alcohol or other drugs that 22 impairs the licensee's ability to practice safely; 23 (C) physical or mental disability; 24 (7) engaged in lewd or immoral conduct in connection with the 25 delivery of professional service to patients; 26 (8) except as permitted under an advanced practice permit under 27 AS 08.32.125, performed clinical procedures without being under the supervision of a 28 licensed dentist; 29 (9) did not conform to professional standards in delivering dental 30 hygiene services to patients regardless of whether actual injury to the patient occurred; 31 (10) permitted a dental assistant employed by a dental hygienist or

01 working under the supervision of a dental hygienist to perform a dental 02 procedure in violation of AS 08.32.110 or AS 08.36.346; 03 (11) falsified or destroyed a patient or facility record, or failed to 04 maintain a patient or facility record for at least seven years after the date the 05 record was created. 06 * Sec. 4. AS 08.36.346 is amended by adding a new subsection to read: 07 (c) A dental hygienist holding an advanced practice permit issued under 08 AS 08.32.125 may delegate to a dental assistant under a level of supervision specified 09 by the board in regulations 10 (1) the exposure and development of radiographs; 11 (2) application of topical preventive agents or pit and fissure sealants; 12 (3) other tasks specified by the board in regulations. 13 * Sec. 5. AS 21.36.090(d) is amended to read: 14 (d) Except to the extent necessary to comply with AS 21.42.365 and 15 AS 21.56, a person may not practice or permit unfair discrimination against a person 16 who provides a service covered under a group health insurance policy that extends 17 coverage on an expense incurred basis, or under a group service or indemnity type 18 contract issued by a health maintenance organization or a nonprofit corporation, if the 19 service is within the scope of the provider's occupational license. In this subsection, 20 "provider" means a state licensed physician, physician assistant, dentist, osteopath, 21 optometrist, chiropractor, advanced practice registered nurse, naturopath, physical 22 therapist, occupational therapist, marital and family therapist, psychologist, 23 psychological associate, licensed clinical social worker, licensed professional 24 counselor, [OR] certified direct-entry midwife, or dental hygienist holding an 25 advanced practice permit. 26 * Sec. 6. AS 47.07.030(b) is amended to read: 27 (b) In addition to the mandatory services specified in (a) of this section and the 28 services provided under (d) of this section, the department may offer only the 29 following optional services: case management services for traumatic or acquired brain 30 injury; case management and nutrition services for pregnant women; personal care 31 services in a recipient's home; emergency hospital services; long-term care

01 noninstitutional services; medical supplies and equipment; advanced practice 02 registered nurse services; clinic services; rehabilitative services for children eligible 03 for services under AS 47.07.063, substance abusers, and emotionally disturbed or 04 chronically mentally ill adults; targeted case management services; inpatient 05 psychiatric facility services for individuals 65 years of age or older and individuals 06 under 21 years of age; psychologists' services; clinical social workers' services; marital 07 and family therapy services; midwife services; prescribed drugs; physical therapy; 08 occupational therapy; chiropractic services; low-dose mammography screening, as 09 defined in AS 21.42.375(e); hospice care; treatment of speech, hearing, and language 10 disorders; adult dental and dental hygiene services; prosthetic devices and 11 eyeglasses; optometrists' services; intermediate care facility services, including 12 intermediate care facility services for persons with intellectual and developmental 13 disabilities; skilled nursing facility services for individuals under 21 years of age; and 14 reasonable transportation to and from the point of medical care. 15 * Sec. 7. The uncodified law of the State of Alaska is amended by adding a new section to 16 read: 17 REGULATIONS. The Department of Commerce, Community, and Economic 18 Development, the Department of Health and Social Services, and the Board of Dental 19 Examiners may adopt regulations necessary to implement the changes made by this Act. The 20 regulations take effect under AS 44.62 (Administrative Procedure Act), but not before the 21 effective date of the law implemented by the regulations. 22 * Sec. 8. Section 7 of this Act takes effect immediately under AS 01.10.070(c). 23 * Sec. 9. Except as provided in sec. 8 of this Act, this Act takes effect January 1, 2022.