CSHB 111(L&C): "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 CS FOR HOUSE BILL NO. 111(L&C) 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 or that a licensed dental 04 hygienist who holds an advanced practice permit issued by the board under 05 AS 08.32.125 may delegate to a dental assistant under AS 08.36.346(c). 06 * Sec. 2. AS 08.32 is amended by adding a new section to read: 07 Sec. 08.32.125. Advanced practice permits. (a) The board may issue an 08 advanced practice permit to a licensed dental hygienist with a minimum of 4,000 09 documented hours of clinical experience. A licensed dental hygienist holding an 10 advanced practice permit may 11 (1) promote oral health and provide disease prevention education and 12 oral systemic health education; 13 (2) remove calcareous deposits, accretions, and stains from the 14 surfaces of the teeth beginning at the epithelial attachment by scaling and polishing 15 techniques; 16 (3) apply topical preventive or prophylactic agents, including silver 17 diamine fluoride, fluoride varnishes, and pit and fissure sealants; 18 (4) remove marginal overhangs; 19 (5) perform preliminary charting and triage to formulate a dental 20 hygiene assessment and dental hygiene treatment plan; 21 (6) expose and develop radiographs and maintain and register dental 22 radiological equipment under AS 08.36.075; 23 (7) use local periodontal therapeutic agents; 24 (8) perform nonsurgical periodontal therapy; 25 (9) screen for oral cancer; 26 (10) if certified by the board, administer local anesthetic agents; 27 (11) prescribe 28 (A) fluoride that is applied or provided to a patient; and 29 (B) chlorhexidine or a similar antibacterial rinse; and 30 (12) delegate dental operations and services to a dental assistant as 31 provided in AS 08.36.346.

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

01 resources for finding a licensed dentist. 02 (e) 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 an advanced

01 practice dental hygienist or working under the supervision of a dental hygienist 02 to perform a dental 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.