Legislature(2021 - 2022)BARNES 124
03/29/2021 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB117 | |
| HB111 | |
| HB117 | |
| HB151 | |
| HB117 | |
| Alcoholic Beverage Control Board | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 117 | TELECONFERENCED | |
| *+ | HB 111 | TELECONFERENCED | |
| *+ | HB 151 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 111-DENTAL HYGIENIST ADVANCED PRAC PERMIT
3:21:10 PM
CO-CHAIR FIELDS announced that the next order of business would
be HOUSE BILL NO. 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."
3:21:24 PM
CO-CHAIR SPOHNHOLZ, as prime sponsor, introduced HB 111. She
explained that the advanced practice permit created under HB 111
would allow experienced, licensed dental hygienists to provide
preventative oral care to underserved populations at senior
centers, healthcare facilities, daycares, and schools, as well
as to those who are eligible for public assistance, are
homebound, or who live in an underserved community. Pointing
out that 62 percent of Alaska's elementary-aged children have
tooth decay, and many low income families don't regularly seek
dental care due to cost and difficulty in finding a provider,
she explained that HB 111 would create a permit for dental
hygienists similar to one used by nurse practitioners.
Currently, she said, dental hygienists can either practice in a
dental office or collaboratively with a supervising dentist; HB
111 would allow hygienists who have at least 4,000 hours of
clinical experience and have been approved by the Alaska Board
of Dental Examiners to work independently via a direct care
agreement with a dentist.
CO-CHAIR SPOHNHOLZ noted that the proposed legislation was
developed in consultation with the Alaska Dental Society, the
Board of Dental Examiners, and the Alaska Dental Hygienist
Association. The advanced practice permit holders would have to
maintain malpractice insurance, she said, provide written notice
of their service limitations, and make referrals to dentists for
cases in which treatment is needed. Co-Chair Spohnholz noted
that Colorado, Washington, Montana, Maine, Connecticut, and
California allow dental hygienists to practice under a similar
permit, with 40 other states allowing dental hygienists the
latitude to initiate treatment based on their patients' needs
without prior authorization from, or presence of, a dentist. At
the recommendation of the Board of Dental Examiners and the
Alaska Dental Society, she said, HB 111 includes the requirement
that dental hygienists operating under the advanced practice
permit maintain patient records for at least seven years, as
well as be certified separately by the Board of Dental Examiners
to administer local anesthesia.
3:25:05 PM
PAKAK BOERNER, Staff, Representative Ivy Spohnholz, Alaska State
Legislature, presented a PowerPoint [hard copy included in the
committee packet] titled "HB 111: Dental Hygiene Advanced
Practice Permit," on behalf of Co-Chair Spohnholz, prime
sponsor. She began the presentation on page 2, "Why is HB 111
Important?", which read as follows [original punctuation
provided]:
43% of low-income Alaskans have difficulty biting and
1
chewing.
Low-income families in Alaska don't regularly seek
oral health care due to cost, access, or trouble
1
finding a provider.
62% of Alaskan elementary students have a high tooth
2
decay rate .
Pain is the top oral health problem for young adults
3
and low-income adults in America.
1
American Dental Association Health Policy Institute
2015: "Oral Health and Well-Being in the Alaska"
2
Alaska Department of Health & Social Services 2012-
2016: " Alaska Oral Health Plan"
3
American Dental Association Health Policy Institute
2015: "Oral Health and Well-Being in the United
States"
MR. BOERNER presented slide 3, "Why is HB 111 Important?", which
read as follows [original punctuation provided]:
? Dental diseases disproportionately affect our
state's most vulnerable people.
? Dental hygienists work on the front line for
preventative dental care and education about the
critical link between oral health and overall well-
being.
? HB 111 increases access to oral health care for
underserved populations:
? Children
? Seniors
? Alaskans with disabilities
? Alaskans in correctional facilities
MS. BOERNER presented slide 4, "What Does HB 111 Do?", which
read as follows [original punctuation provided]:
HB 111 creates an advanced practice permit.
? This permit allows experienced, licensed dental
hygienists to work independently without on-site
supervision when providing dental care.
3:26:55 PM
MS. BOERNER paused the PowerPoint to detail the sectional
analysis, which read as follows [original punctuation provided]:
Section 1
Ability of practice of dental hygienists.
(e) Amends AS 08.32.110. to allow a licensed dental
hygienist who holds an advanced practice permit issued
by the board to perform duties allowed by the permit.
Section 2
Advanced practice permits.
Adds a new section under AS 08.32.125. creating the
advanced practice permit and providing requirements as
follows:
(a) The Board of Dental Examiners may issue an
advanced practice permit to a licensed dental
hygienist with a minimum 4,000 documented hours of
clinical experience. This subsection lists what
duties fall under advanced practice permits:
general oral health & cleaning, providing treatment
plans, screenings, taking radiographs, and/or
delegating to dental assistants.
(b) A licensed dental hygienist holding an
advanced practice permit may provide services to a
patient who is not able to receive dental
treatment because of age, infirmity, or
disability. The patient may be a resident of a
senior center, residential health facility, or held in
a local correctional facility. The patient may also
be enrolled in certain schools, receiving benefits
under the Special Supplemental Food Program
(WIC), homebound, or a resident of a community that
has a shortage of dental health professionals.
(c) A licensed dental hygienist holding an
advanced practice permit can provide appropriate
services to a patient without the presence,
authorization, and supervision of a licensed dentist
and without an examination from a licensed
dentist.
(d) Licensed dental hygienists with an advanced
practice permits must maintain professional liability
insurance. They must also give the patient,
parent, or legal guardian written notice that the
treatment provided will be limited to those
allowed by the permit, a written recommendation that
the patient be examined by a licensed dentist for
comprehensive oral care, and assistance in
receiving a referral to a licensed dentist for
further oral treatment.
(e) Licensed dental hygienists with advanced
practice permits may practice as independent
contractors.
(f) An advanced practice permit is valid until
the license of the dental hygienist expires. A
licensed dental hygienist can renew their advanced
practice permit at the same time they renew their
license.
Section 3
Grounds for discipline, suspension, or revocation of
license.
Amends AS 08.32.160 to exempt a licensed dental
hygienist as permitted under an advanced practice
permit from supervision requirements for clinical
procedures. Licenses may be revoked if a licensee
allows a dental assistant to perform a prohibited
procedure, or if the licensee falsified, destroyed, or
failed to maintain a patient or facility record for
the last seven years.
Section 4
Allows a dental hygienist holding an advance practice
permit to delegate to a dental assistant the
exposure/development of radiographs, the application
of preventative agents, and other tasks as specified
by the board in regulations.
Section 5
Prohibits insurance providers from discriminating
against dental hygienists holding advanced practice
permits.
Section 6
This section is amended to include dental hygienist
services in the optional services 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. The regulations may not take effect
before the effective date of this bill.
Section 8
Section 7 on regulations takes effective immediately.
Section 9
Effective date for sections 1-6 is July 1, 2022.
3:32:13 PM
MS. BOERNER resumed the PowerPoint presentation with slide 5,
"Dental Health Professional Shortage Areas (DHPSA) in Alaska,"
which read as follows [original punctuation provided]:
In 2021 there are 679 licensed dental hygienists in
Alaska
Geographic DHPSAs (e.g. Aleutians East Borough, North
Slope Borough, Yukon-Koyukuk Census Area)
Alaskan Native Tribal Populations (e.g. SEARHC/Mt.
Edgecumbe Hospital, Norton Sound Health Corporation
Outpatient Primary Care, Kana Clinic Native Village of
Karluk, . Chief Andrew Isaac Health Center, Eklutna
Health Clinic, Upper Tanana Health Center,Dena' Nena'
Henash)
Correctional Facilities (e.g. Lemon Creek Correctional
Facility, Yukon Kuskokwim Correctional Facility, Anvil
Mountain Correctional Facility )
Federally Qualified Health Centers (e.g. Bethel Family
Clinic, Mat-Su Health Services, Southeast Alaska
Region Health Consortium)
Full index of all Dental Health Professional Shortage
Areas here: https://data.hrsa.gov/tools/shortage-
area/hpsa-find
3:32:37 PM
CO-CHAIR SPOHNHOLZ noted that in attendance via teleconference
were representatives of the Alaska Dental Hygienists'
Association, Alaska Primary Care Association, and HyLife Oral
Health Alliance. Also in attendance via teleconference, she
said, is a former state senator from Minnesota who worked on
similar statutes.
3:33:06 PM
CO-CHAIR FIELDS referred to the language of HB 111, page 3, line
31 through page 4, line 1, which read, "(e) A licensed dental
hygienist holding an advanced practice permit may practice as an
independent contractor." He then asked for explanation of that
subsection.
CO-CHAIR SPOHNHOLZ responded that a dental hygienist holding an
advanced practice permit ("advanced practice dental hygienist"),
and who is in a collaborative agreement with a dentist, would be
able to have an independent practice similar to that of a
physician's assistant (PA). She said that many of the urgent
care centers in Southcentral Alaska are owned and operated by
PAs who have direct care agreements with doctors; under HB 111,
dental hygienists with an advanced practice permit may operate
in a similar manner.
CO-CHAIR FIELDS said that the term "independent contractor"
usually has other implications in terms of labor law, workers'
compensation, and minimum wage. He expressed that he did not
want to unintentionally exclude someone from workers'
compensation coverage through the language of the bill, and
asked for testimony from Legislative Legal Services at the next
meeting.
CO-CHAIR SPOHNHOLZ said that she would follow up.
CO-CHAIR FIELDS pointed out that pediatrics is an area in which
advanced practice dental hygienist could practice, and he asked
whether there is data on accessibility for pediatric dentistry
in Anchorage, and how pediatric dentistry would be addressed by
HB 111. He said, "My sense is there are lots of pediatric
dentists, so the supply is there in terms of the practitioners,
but what are the barriers in terms of kids who don't actually
have pediatric care?"
CO-CHAIR SPOHNHOLZ replied that the populations proposed to be
served by the creation of the advanced practice permit are
underserved populations, such as low income families and those
who lack access to adequate dental health care. She explained
that underserved populations also include those who receive
services through federally-qualified health centers (FQHCs) like
Anchorage Neighborhood Health, which could hire an advanced
practice dental hygienist to provide dental care for the
population it serves.
CO-CHAIR FIELDS asked Ms. Menkens what percentage of kids are
not receiving adequate dental care and, should HB 111 pass, how
she envisions care reaching the kids.
3:36:06 PM
JESSIE MENKENS, Policy & Partnerships Manager, Alaska Primary
Care Association, replied that she doesn't have data on
pediatric dental care accessibility but that she would be happy
to follow up. She referred to Co-Chair Spohnholz's description
of the FQHCs and said that those facilities have a mandate to
provide "safety net" care regardless of an individual's ability
to pay. Within the FQHCs, she said, families rely on pediatric
dental health care. She stated the Alaska Primary Care
Association's support of HB 111 and said that its provisions are
becoming a national "best practice" with positive impact.
3:37:21 PM
REPRESENTATIVE MCCARTY referred to page 2, lines 5-8, of HB 111,
which read as follows:
Sec. 08.32.125. Advanced practice permits. (a) The
board may issue an advanced practice permit to a
licensed dental hygienist with a minimum of 4,000
documented hours of clinical experience. A licensed
dental hygienist holding an advanced practice permit
may
REPRESENTATIVE MCCARTY asked whether there is a definition for
"hours of clinical experience."
CO-CHAIR SPOHNHOLZ deferred to Ms. Bryant.
3:37:58 PM
LISA BRYANT, Legislative Co-Chair, Alaska Dental Hygienists'
Association, explained that 4,000 hours of clinical experience
equates to approximately two to three years' experience, which
is the same amount of time required by the state to have a
collaborative agreement with a dentist.
REPRESENTATIVE MCCARTY asked whether there is a difference
between hours providing direct patient care versus hours working
on notes or reviewing charts.
MS. BRYANT responded that there is no differentiation between
those tasks because every time care is provided to a patient,
the dental hygienist is performing tasks such as reviewing the
patient's health history, assessing patient needs, or reviewing
radiographs.
REPRESENTATIVE MCCARTY asked whether other states differentiate
between hours providing direct patient care versus hours
reviewing patient charts or notes.
MS. BRYANT replied that she has not experienced any such
differentiation.
3:39:46 PM
CO-CHAIR SPOHNHOLZ interjected that Ms. Reetz, who has earned
the equivalent of the advanced practice permit in Oregon, may be
able to provide more details.
3:40:04 PM
LORI REETZ, President, Alaska Dental Hygienists' Association,
clarified that she has only practiced dental hygiene in Alaska;
however, she graduated with a bachelor's degree in dental
hygiene in Oregon, where the curriculum includes practice to
obtain an Oregon license similar to the advanced practice permit
as proposed under HB 111.
3:41:35 PM
REPRESENTATIVE MCCARTY stated that one of his concerns is
ensuring that a practitioner has experience with patient care
instead of only paperwork experience.
CO-CHAIR SPOHNHOLZ said that the intention of the proposed
legislation is to make the licensure available only to a
practicing dental hygienist who has 4,000 hours of experience
prior to seeking licensure.
REPRESENTATIVE MCCARTY stated his understanding that in order to
receive the advanced practice permit, one must be a dental
hygienist with 4,000 hours of practice.
CO-CHAIR SPOHNHOLZ replied, "Yes, sir."
REPRESENTATIVE MCCARTY referred to the text of HB 111, page 4,
lines 2-4, which read as follows:
(f) An advanced practice permit is valid until the
expiration of the dental hygienist's license to
practice. A licensed dental hygienist may renew an
advanced practice permit at the time of license
renewal under AS 08.32.071.
REPRESENTATIVE MCCARTY said, "Did I overhear that a person, as
an advanced practitioner, has to have two licenses, not just
one?"
CO-CHAIR SPOHNHOLZ replied that one must have received approval
and licensure in order to become a dental hygienist, and
subsequently seek the additional licensure in order to become an
advanced practice dental hygienist.
REPRESENTATIVE MCCARTY asked whether the same process is
followed for a nurse practitioner.
CO-CHAIR SPOHNHOLZ explained that a nurse practitioner may go
all the way through school to achieve that licensure without
independent practice, with clinical hours as part of the
training; for example, a biology degree, followed by a master's
or doctoral degree, would include clinical experience, with
independent practice thereafter. She said that this licensure
is different because one would do clinical training to become a
dental hygienist, followed by additional training to get the
advanced practice permit.
REPRESENTATIVE MCCARTY stated his understanding that a dental
hygienist with an advanced practice permit would, under HB 111,
have to have two licenses: a dental hygienist license, and an
advanced practice permit. He asked why two licenses are
necessary for a dental hygienist to operate under an advanced
practice permit, when the same thing is not required for nurse
practitioners.
CO-CHAIR SPOHNHOLZ responded that the advanced practice permit
is designed to build onto a dental hygienist license after
they've gotten the requisite clinical experience. She explained
that a nurse practitioner can proceed forward through their
training and, after graduating with a master's degree or
doctorate, go directly into practice. She pointed out that a
nurse practitioner has a much wider scope of practice and isn't
required to have a direct care agreement with a doctor. She
said that a better comparison in training and licensure would be
the process of becoming a physician's assistant: a medical
professional who has practiced in their field, returns to school
to receive additional training, and then practices in
partnership with a direct care agreement under a supervising
physician.
REPRESENTATIVE MCCARTY referenced Co-Chair Fields' earlier
questions about page 3, line 31 through page 4, line 1, of the
proposed legislation, which read, "(e) A licensed dental
hygienist holding an advanced practice permit may practice as an
independent contractor." He stated the understanding that this
subsection would give the advanced dental hygienist the ability
to have their own practice. Co-Chair Spohnholz stated her
agreement, and he said, "So they would not be under a dentist,
if that's the case." He then surmised that in the scenario
described by Co-Chair Spohnholz, advanced practice dental
hygienists "would actually have their own practice, and they'd
have people working for them, even potentially a dental
hygienist under the advanced [practice permit]."
CO-CHAIR SPOHNHOLZ responded, "Both of those things are sort of
true." A physician's assistant, she explained, has a direct
care agreement with a physician, yet can still have an
independent practice. An advanced dental hygienist would have a
direct care agreement with a dentist but would be able to
operate their own practice.
3:47:17 PM
CO-CHAIR FIELDS asked for input from Legislative Legal Services.
3:47:26 PM
REPRESENTATIVE KAUFMAN asked whether the proposed legislation
includes provisions for radiography such as what would be found
in a dental office.
CO-CHAIR SPOHNHOLZ deferred to Ms. Bryant.
3:48:03 PM
MS. BRYANT explained that dental hygienists are highly trained
in radiography and, as advanced dental hygienists, could use
portable radiography units in their treatment plans and
assessments. She offered clarification on the collaborative
agreements and said that the advanced practice permit would
allow a dental hygienist to work without a dentist's
authorization.
REPRESENTATIVE KAUFMAN asked how an advanced practice hygienist
would manage radiation safety. He said that he wants to ensure
that radiation safety requirements would match what is required
of a dentist office.
MS. BRYANT responded that radiation safety devices such as lead
aprons and thyroid collars are employed. She said that dental
hygienists practice the radiation safety training given during
their education.
3:50:45 PM
CO-CHAIR SPOHNHOLZ interjected to point out that it was an
earlier version of HB 111 that included the direct care
agreement; the current version does not include that provision.
She then pointed out that the issue of all regulations
associated with radiography are determined by the Board of
Dental Examiners, and that an advanced practice hygienist would
be required to follow all rules and regulations set forth by the
board.
CO-CHAIR FIELDS asked to hear testimony from representatives of
the Board of Dental Examiners and the Alaska Dental Association
during the next meeting.
3:51:26 PM
REPRESENTATIVE KAUFMAN asked whether professional liability
would be commensurate with that faced by dentists.
MS. BRYANT responded that professional liability would be
covering practices performed as dental hygienists.
CO-CHAIR SPOHNHOLZ explained that a dental hygienist's scope of
practice is much narrower than that of a dentist. She also
noted that a representative from the Board of Dental Examiners
is expected to provide testimony at the next hearing.
REPRESENTATIVE KAUFMAN said, "I appreciate that their scope is
different, but there's a little bit of convergence with the
expanded scope." He then asked whether the intent of HB 111 is
to limit services provided by an advanced dental hygienist to
underserved populations, or to make care available to anyone.
CO-CHAIR SPOHNHOLZ clarified that the advanced practice permit
would not expand the scope of practice for dental hygienists, it
would simply allow them to practice independently. She said,
"What dental hygienists do will not change, and I think that's a
very important distinction." She described HB 111 as a
"carefully crafted compromise" between dental hygienists and
dentists, and she expressed the belief that, if HB 111 proposed
expanding the dental hygienists' scope of practice, the dental
society might not be supportive of the proposed legislation.
She said that the intention is to increase access to dental
health care for underserved communities. She noted that there
are many communities throughout the state with economies that
don't support dental health care; there are also people who live
in facilities that don't get access to regular dental health
care. Communities to which dentists won't travel could benefit
from the dental health care provided by advanced dental
hygienists. She stressed that the dental society has been
supportive of the proposed legislation for the past three years.
REPRESENTATIVE KAUFMAN asked whether Anchorage, with its
adequate level of dental health care access, could expect to see
businesses opening to practice the scope of work as described in
the proposed legislation.
CO-CHAIR SPOHNHOLZ replied that nothing in the proposed
legislation prohibits an advanced dental hygienist from opening
a business in Anchorage, given that the hygienist operate within
their limited scope of training and authorization by the Board
of Dental Examiners.
3:55:12 PM
CO-CHAIR FIELDS asked whether a dental company could lay off all
of their dentists and hire dental hygienists instead.
CO-CHAIR SPOHNHOLZ responded that dentists do not provide the
preventative care that dental hygienists do. Typically, she
said, when one goes to the dentist's office, it's only the
dental hygienist providing the care. A dentist may do a brief
exam, but it's the dental hygienist taking any x-rays, cleaning,
and doing the screening. She said that HB 111 wouldn't
necessarily change that practice.
3:56:26 PM
REPRESENTATIVE NELSON asked whether there is a rough estimate of
how many people are in the underserved categories described in
the proposed legislation.
CO-CHAIR SPOHNHOLZ replied that she doesn't have an immediate
answer to that question. "What we do know," she said, "is that
there is a shortage of dental health care access in correctional
facilities, federally-qualified health centers for low income
folks, and in many parts of rural Alaska where dental hygienists
would be able to practice using this advanced practice permit."
She stressed that HB 111 would increase access to dental health
care in underserved communities.
REPRESENTATIVE NELSON said that he wanted to know the number of
people in the "underserved" category.
CO-CHAIR SPOHNHOLZ said that Ms. Menkens, who works with
federally-qualified health centers, may be able to address the
question.
3:57:37 PM
REPRESENTATIVE NELSON noted that the fiscal note is calculated
with a 75 percent federal match. He asked for further
explanation of the 25 percent for which the state is
responsible.
CO-CHAIR SPOHNHOLZ responded that the amount in question is the
state's contribution for the increased amount of dental health
care that could be provided if a certain percentage of dental
hygienists were to become advanced practice providers.
REPRESENTATIVE NELSON asked, "And what's that percentage?"
CO-CHAIR SPOHNHOLZ replied that she doesn't have the number
immediately accessible.
3:58:31 PM
CO-CHAIR FIELDS opened invited testimony on HB 111.
3:58:42 PM
MS. MENKENS, having previously provided answers to committee
questions, now gave her testimony in support of HB 111. She
read a letter from Joe Zasada, Policy Integration Director of
the Alaska Primary Care Association, which read as follows
[original punctuation provided]:
The Alaska Primary Care Association (APCA) supports
the operations and development of Alaska's 29
Federally Qualified Health Centers (FQHCs and Look
Alikes). Alaska Health Centers voted to support health
workforce development initiatives that introduce new
provider types to the market and increase access to
care in their 2021 Policy Priorities.
All of Alaska's Community Health Centers are required
to provide oral health services as a component of the
comprehensive medical, dental, behavioral, pharmacy
and care coordination services they offer. Dental
services and overall oral health are vital components
in the whole person care that Community Health Centers
provide their patients. Many Health Centers offer on-
site dental services provided by staff or contracted
dental health professionals. Other more rural and
smaller sites rely on sending patients to larger hub
health facilities or neighboring urban Health Centers
for dental care. One frequently cited reason for the
shortage of dental services is the lack of providers.
In 2019, almost one third of Alaska Health Centers'
113,000 patients received dental care at their
Community Health Center through over 96,796 visits
provided by 77 full-time equivalent dentists,
hygienists, and dental therapists. Persistent
shortages of providers at all levels in Community
Health Center dental clinics result in providers not
working at their highest level of licensure; creating
inefficiencies, decreased provider satisfaction, and
barriers to patient care. The addition of Advanced
Hygienists to practices would add an additional
valuable layer of staffing between dentists and other
hygienists and dental therapists to provide
comprehensive services and support integration with
other Health Center services, including chronic
disease management, and behavioral health/substance
use disorder services.
Community Health Centers have been pioneers in the
past in supporting and incorporating expansion of
health professional provider types into their care
settings. Community Health Centers are ready to
embrace this new provider type as they continue to
grow and expand the increasing need of integrated
dental care in primary care settings.
We urge passage of House Bill 111.
4:00:52 PM
CO-CHAIR FIELDS asked Ms. Menkens what percentage of children
are served under Medicaid versus private insurance.
MS. MENKENS responded that she would follow up with that
information.
CO-CHAIR FIELDS opined that there seems to be an oversupply of
dentists and an undersupply of affordable care in Anchorage. He
wondered whether parents know where to get dental health care
for their children, or whether pediatric dentists don't accept
Medicaid. He then asked whether schools have dental screenings
and how families can access services.
4:02:28 PM
CO-CHAIR SPOHNHOLZ pointed out that Co-Chair Fields identified
that while there are many dentists in Anchorage, that is not the
situation for the entire state of Alaska. She said that she
mentioned Anchorage Neighborhood Health because Anchorage is the
home community of the majority of committee members; however,
rural Alaska does not have the supply of dentists that Anchorage
has. She stressed that it's not only the tribal communities but
also communities on the road system with shortages in dental
health care providers. She recalled the inception of the Dental
Health Aide Therapist program, intended to help communities in
rural Alaska, and said that the belief among dentists was that
those therapists may not provide adequate care; however, those
dentists weren't travelling to rural Alaska to provide that
care. She said, "[In] urban Alaska, particularly in Anchorage,
we don't have an access problem when it comes to dental health
care. But we're not the rest of the state, we're just 40
percent of the population."
CO-CHAIR FIELDS said he wants to understand what percentage of
kids in Anchorage don't have adequate dental care, and why.
4:04:31 PM
MS. BRYANT, having previously responded to committee questions,
now gave testimony in support of HB 111. She stated that she is
a registered dental hygienist (RDH), as well as a U.S. Air Force
veteran. She said that as of March 8, 2021, there are
approximately 679 RDHs in Alaska, with only a few with a
collaborative agreement with a dentist. The factor limiting
collaborative agreements, she said, is believed to be the number
of licensed dentists in Alaska interested in entering into such
an agreement. A collaborative agreement allows an RDH with
4,000 hours of experience to work under the authorization of a
licensed dentist without the dentist being onsite, in an area
other than the usual place of practice of the licensed dentist,
and without the dentist's diagnosis and treatment plan, unless
otherwise specified in the collaborative agreement. The
provisions under HB 111 would break down barriers and bridge the
gap in access to dental health care. Based on feedback from
RDHs in meetings pertaining to this bill, approximately 5
percent have expressed interest in seeking an advanced practice
permit. Advanced practice for dental hygienists is not a new
concept, she said; many states have implemented legislation for
RDHs to provide varying degrees of direct patient care since
1995, with many states advancing legislation as lawmakers,
dental associations, and medical professionals recognize the
benefits of utilizing RDHs to safely provide services while
increasing access to oral health care and education.
MS. BRYANT pointed out that there are no legal cases regarding
treatment issues, and RDHs in Alaska have had a longstanding
safety record. She explained that care provided by RDHs
includes oral cancer screenings, blood pressure assessment,
providing tobacco cessation information, and educating the
public about oral health and its systemic connection. Routine
dental health care, she said, correlates to decreased emergency
dental care, thereby decreasing medical costs. She expressed
witnessing the suffering caused by oral diseases among those who
live remotely and have experienced challenges accessing dental
health care services. She implored the committee members to not
let Alaska be known as the "Last Frontier" for passing
legislation that could help increase access to care, and urged
them to support HB 111. She stressed that the Alaska Dental
Hygienists' Association, American Dental Hygienists'
Association, Alaska Dental Society, and the Alaska Board of
Dental Examiners support HB 111.
4:08:52 PM
CO-CHAIR FIELDS asked Ms. Bryant what being an independent
contractor means.
MS. BRYANT replied that it means a dental hygienist would
practice on their own, creating their own assessment and
treatment plans for the patient, and if necessary, referring the
patient to a licensed dentist for further care.
CO-CHAIR FIELDS interjected and asked Mr. Fisher why language
allowing advanced practice dental hygienists to be classified as
independent contractors is in the proposed legislation.
4:10:10 PM
SANDON FISHER, Legislative Counsel, Legislative Legal Services,
Legislative Affairs Agency, explained that the term "independent
contractor" is a commonly used term in the employment context,
with ramifications for the relationship between the party
contracting for the services and the independent contractor
themselves. A person or business using an independent
contractor would generally not withhold employment taxes or
cover the contractor by workers' compensation insurance.
CO-CHAIR FIELDS thanked Mr. Fisher for the explanation.
4:11:39 PM
LORI REETZ, President, Alaska Dental Hygienists' Association,
testified in support of HB 111 on behalf of the Alaska Dental
Hygienists' Association. She said that she obtained her
associate degree in dental hygiene from the University of Alaska
Anchorage in 1997, and has been practicing as an RDH in Alaska
for 24 years. In 2015 she obtained her bachelor's degree in
dental hygiene from the Oregon Institute of Technology where,
she explained, part of the curriculum is training to
successfully become Oregon's version of an advanced practice
dental hygienist. She described learning how to provide care to
people in limited access populations, and to those with limited
mobility, without the supervision of a dentist. She expressed
concern about her aging parents' ability to access dental health
care if they're not able to leave their house, and said that
with an expanded practice permit she could provide care to those
with limited mobility.
4:15:13 PM
ANGIE STONE, Founder and CEO, HyLife Oral Health Alliance,
testified in support of HB 111. She said that she first became
aware of the problems faced by the elder population in accessing
dental health care when a family member entered a nursing home
which had no dental health care. She said, "As a Wisconsin
dental hygienist, I was not allowed to provide dental hygiene
treatment without the involvement of a dentist, which is
currently the situation in Alaska." With no dentist wanting to
provide care at the facility, she said, her family member was
left with no treatment for periodontal disease and subsequently
had recurrent lung infections. Ms. Stone told of another family
member who, within two years of entering a nursing home, lost 60
percent of the teeth that she had kept for 90 years. She said
that the surgeon general has reported that elderly nursing home
residents have extensive oral disease, poor oral hygiene, and
suffer the worst oral health of any population. She said that
nursing home oral health surveys around the country reflect
this, reporting that 42 percent of residents have untreated
tooth decay, 31 percent have root tips in their mouths, 35
percent have substantial oral debris, 22 percent have severe
inflammation of the gum tissues, and 20 percent have a need for
periodontal care. All of the observed conditions, she said, are
things that dental hygienists are trained to prevent. On March
30, 2017, Wisconsin passed a law allowing dental hygienists to
practice without the presence of a dentist. She asked the
committee to ensure vulnerable nursing home residents in Alaska
have access to dental health care.
4:19:50 PM
CO-CHAIR FIELDS asked whether dental hygienists in Alaska could
sign up as independent contractors with HyLife Oral Health
Alliance. He also asked what the business model is.
MS. STONE responded that clinical services had ceased due to the
COVID-19 restrictions, with the dental hygienists not able to
enter nursing homes. She said that dental hygienists in Alaska
could register through HyLife Oral Health Alliance, allowing the
company to handle billing. She said that in Wisconsin she is
able to bill Medicaid, but she doesn't know how billing would
work in Alaska. She said that she was of the opinion that the
language of HB 111 would be most beneficial if the hygienist
could be either an employee or an independent contractor, as
there are several different models with varying levels of
appropriateness for situations.
4:22:04 PM
ANN LYNCH, Director of Advocacy and Education, American Dental
Hygienists' Association, testified in support of HB 111 on
behalf of the American Dental Hygienists' Association (ADHA).
She read excerpts from her written testimony, which read as
follows [original punctuation provided]:
ADHA advocates that dental hygiene and/or dental
practice acts be amended so that the services of
dental hygienists can be fully utilized in all
settings. Furthermore, ADHA supports oral health care
workforce models that culminate in graduation from an
accredited institution; professional licensure; and
direct access to patient care. ADHA defines direct
access as the ability of a dental hygienist to
initiate treatment based on their assessment of a
patient's needs without the specific authorization of
a dentist, treat the patient without the presence of a
dentist, and maintain a provider-patient relationship.
In 1995, five states allowed direct access. Currently,
42 states, including Alaska, have policies that allow
dental hygienists to work in community-based settings
to provide preventive oral health services without the
presence or direct supervision of a dentist. Allowing
dental hygienists to practice under an advanced
practice permit will further improve upon Alaska's
direct access and provide additional opportunities for
the safe and effective care provided by dental
hygienists in order to reach patients in need.
MS. LYNCH explained that HB 111 would further the impact of
dental hygienists by allowing them to work to the full extent of
their education and license. She expressed gratitude to Co-
Chair Spohnholz for carrying the bill, as well as to the
committee for hearing it. She continued reading excerpts from
her written testimony, which read as follows [original
punctuation provided]:
The policies cited above are further supported by
research demonstrating the impact dental hygienists
have on access to care and public policy
recommendations supporting dental hygienists providing
care in direct access settings, including:
? In December 2018, the U.S. Departments of Health and
Human Services (HHS), Treasury, and Labor in
collaboration with the U.S. Federal Trade Commission
(FTC) and White House offices, made policy
recommendations on state and federal policies to
improve choice and competition in the health care
markets. The report says dental hygienists can safely
and effectively provide some services offered by
dentists, as well as complementary services. It goes
on to recommend states should consider changes to
their scope-of-practice statutes to allow all
healthcare providers to practice to the top of their
license, utilizing their full skill set. It also
recommends that States eliminate requirements for
rigid collaborative practice and supervision
agreements between dentists and hygienists that are
not justified by legitimate health and safety
concerns.
? The National Governor's Association specifically
says, "the rationale that state dental boards most
commonly used for restricting hygienists from
practicing in unsupervised settings focuses on
concerns about quality and safety, even though no
clear evidence exists to support such restrictions.
? The FTC previously wrote to the Georgia Board of
Dentistry regarding regulation of dental hygiene
supervision. In the letter, FTC staff stated "sound
competition policy calls for competition to be
restricted only when necessary to protect the public
from significant harm. Here, we are aware of no
evidence of past or future harm from current
practices."
? The Oral Health Workforce Research Center concluded
in 2016 that "Scopes of practice which allow dental
hygienists to provide services to patients in public
health settings without burdensome supervision or
prescriptive requirements appear to increase access to
educational and preventive care."
MS. LYNCH said, "Simply put, House Bill 111 is good public
policy."
4:28:37 PM
CO-CHAIR FIELDS opened public testimony on HB 111. There being
no one who wished to testify, he closed public testimony.
[HB 111 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 111 FN - DCCED, 3.26.21.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 111 v. A.PDF |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 111 FN - DHSS, 3.26.21.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 111 Presentation 3.27.2020.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 111 Supporting Document - Oral Health and Well-being in the U.S..pdf |
HL&C 3/29/2021 3:15:00 PM SFIN 4/21/2022 9:00:00 AM |
HB 111 |
| HB 111 FAQ Document.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 111 v. A Sponsor Statement.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 111 v. A Sectional Analysis.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| HB 151 v. B.PDF |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |
| HB 151 Sponsor Statement.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |
| HB 151 Sectional Analysis.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |
| HB 151 FN, DOLWD 3.26.21.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |
| Supporting Document - UI General Information Brochure.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |
| Supporting Document - Wage Replacement Data, DOLWD.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |
| HB 111 Letters of Support Received as of 3.27.21.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 111 |
| Supporting Document - UI Claims, DOLWD.pdf |
HL&C 3/29/2021 3:15:00 PM |
HB 151 |