Legislature(2021 - 2022)SENATE FINANCE 532
04/22/2022 01:00 PM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB99 | |
| HB111 | |
| HB168 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 99 | TELECONFERENCED | |
| + | HB 111 | TELECONFERENCED | |
| + | HB 168 | TELECONFERENCED | |
| + | TELECONFERENCED |
CS FOR HOUSE BILL NO. 111(FIN)
"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."
1:19:01 PM
CHELSEA WARD-WALLER, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
introduced herself. She believed Representative Spohnholz
was available online to introduce the legislation.
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, ANCHORAGE (via
teleconference), introduced the legislation with prepared
remarks:
House Bill 111 creates an advanced practice permit,
which would allow experienced and licensed dental
hygienists to provide preventative oral healthcare to
underserved populations at senior centers, healthcare
facilities, daycares, and schools for Alaskans who are
eligible for public assistance, are homebound, or who
live in a rural underserved community. We know that
oral health plays a really critical role in the
overall health and well-being of Alaskans and poor
oral health contributes to poor health. In fact, bad
oral health is linked to cardiovascular disease,
Alzheimer's, osteoporosis, as well as poor nutrition
and other serious health issues and this is more acute
for low income individuals and those who are
physically immobile.
Currently, dental hygienists can practice in a dentist
office or they can practice semi-independently if they
have a collaborative agreement with a dentist, which
is similar to what physician's assistants do already.
An advance practice permit that's proposed by House
Bill 111 would allow dental hygienists to care for
these underserved populations at senior centers,
healthcare facilities, daycare, schools, and those
that are eligible for public assistance, are
homebound, or live in underserved communities if they
have a minimum of 4,000 hours of clinical experience
and are approved by the board of dental examiners,
which includes both dentists and dental hygienists.
The bill lays out specific services allowed under the
permit and specific populations that a licensed dental
hygienist can provide those services to without the
supervision and physical presence of a licensed
dentist. Unlike some licensing bills in the past where
there was competing license types that had different
perspectives, this bill has been developed in
consultation with the Alaska Dental Society, the Board
of Dental Examiners, and the Alaska Dental Hygienists
Association. The advanced practice permit holder will
have to maintain malpractice insurance, provide
written notice of their service limitations, and make
a referral to a licensed dentist if further treatment
is necessary.
This bill would allow dental hygienists who are
experienced to practice to the full scope of their
training credentials and professional experience.
Importantly, Alaska won't be the first state to make
these changes. Dental hygienists are able to practice
under advance practice permits or similar permits in
six other states and 40 other states are considered
direct access states for dental hygienists, which
means that dental hygienists can initiate treatment
based on their assessment of a patient's needs without
the authorization or presence of a dentist.
Finally, I will note that we have made important
changes to this bill at the recommendation of the
Board of Dental Examiners and the Alaska Dental
Society including requiring permit holders to maintain
patient records for at least seven years, making sure
that the Board of Dental Examiners has a separately
certified hygienist to administer local anesthesia,
and then empowering the Department of Health and
Social Services (DHSS) to make regulations related to
this bill. We may need to update the DHSS language to
confirm with the recent split of the Department of
Health and Social Services.
Representative Spohnholz listed individuals available to
speak to the bill.
1:23:31 PM
Senator Olson asked if the bill allowed prescriptive
authority to the advanced dental hygienists.
Representative Spohnholz replied there was very narrow
prescriptive authority regarding topical, preventative, and
prophylactic agents that dental hygienists were already
allowed to provide. She deferred the question to Royann
Royer [with the Alaska Dental Hygiene Association] for
further detail.
Senator Olson asked if advanced dental hygienists had to
participate in the Prescription Drug Monitoring Program
(PDMP) that other prescriptive practitioners were required
to abide by.
Representative Sponholz answered that dental hygienists did
not prescribe controlled substances and therefore, did not
have DEA [Drug Enforcement Administration] certification
and did not have to participate in the PDMP.
Senator Olson asked if the permit enabled advanced dental
hygienists to perform advanced dental procedures.
Representative Sponholz responded that the bill did not
allow dental hygienists to practice beyond the scope of
their current practice in any way. The bill simply enabled
dental hygienists to do what they had already been doing
safely for a very long time and without the supervision of
a dentist if they had 4,000 hours of experience in addition
to a previous dental hygienist license and were approved by
the Board of Dental Examiners.
1:25:27 PM
Ms. Ward-Waller discussed the Sectional Analysis (copy on
file):
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) A licensed dental hygienist with an advanced
practice permit 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) 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.
1:29:31 PM
ROYANN ROYER, ALASKA DENTAL HYGIENE ASSOCIATION, ANCHORAGE
(via teleconference), spoke in support of the legislation.
She shared information about her work in dentistry for many
years in Alaska. She shared that approximately six years
back she had seen a significant need that was not being
addressed in Alaska. She had started a nonprofit
organization that served residents in long-term care
facilities. She spoke to the importance of the legislation.
She currently practiced under a collaborative practice
agreement, which allowed dental hygienists to provide
treatment under the general supervision of a dentist. She
was able to see a patient prior to the dentist. She was
lucky to have several dentists to collaborate with on the
project and would continue as long as possible. However, if
the bill went through, it would provide another option to
continue the program if needed. For example, if she did not
have a dentist to work with, she would be able to continue
seeing the long-term residents and provide assessments,
radiographs, preventative services, and oral health
education. The patients could then see a dentist either in
or outside the facility as needed.
Ms. Royer relayed that many hygienists wanted to work in
underserved areas, but they could not find a dentist who
would work in a collaborative agreement. The legislation
had been brought forward by a hygienist in Fairbanks who
wanted to find a way to provide services. She shared that
assessment and treatment done routinely were less expensive
than waiting for a person to notice problems, which
necessitated more extensive and expensive procedures. She
highlighted that preventative treatment helped to prevent
systemic conditions such as pneumonia, diabetes
complications, and heart disease. She stated that Alaska
needed more providers in underserved areas and the
registered dental hygienist advanced practitioner would
help decrease the disparity.
1:32:54 PM
DAVID NIELSON, CHAIR, ALASKA BOARD OF DENTAL EXAMINERS,
ANCHORAGE (via teleconference), shared that discussion
about the advanced dental hygiene permit had come up
several times over the past couple of years and the support
had always been good. He shared that the bill sponsor had
been receptive to board comments and had made a couple of
changes to the original bill. He relayed that the board
supported the bill in its current form. He highlighted that
Section 4 specified that the dental board would draft
regulations to clarify what additional tasks, if any, would
be delegated dental assistants by the advanced hygiene
permit holder and under what level of supervision.
Co-Chair Bishop looked at Section 2 (a) and wondered how
the 4,000 hours was documented. He asked if students or
individuals had a logbook.
Mr. Nielson replied that there was typically an affidavit
where someone attested to the fact that a person had 4,000
hours of practice. He stated that it would likely be a
person's employer.
1:35:24 PM
JOHN ZASADA, POLICY DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION, ANCHORAGE (via teleconference), spoke in
support of the legislation. He detailed that the
association supported the operations and development of
Alaska's 29 non-tribal and tribal federally qualified
health centers. He provided detail about the association.
He stressed that dental services and oral health were vital
components of the whole person care that community health
centers provided patients. He detailed that many health
centers offered on-site dental services provided by staff
or contracts with other dental health professionals.
Smaller sites relied on sending patients to larger hub
facilities or neighboring urban health centers for dental
care. One frequently cited reason for the shortage of
dental services was the lack of providers. He stated that
persistent provider shortages at all levels in the
community healthcare dental system resulted in providers
not working at their highest level of licensure, which
created inefficiencies, decreased provider satisfaction,
and barriers to patient care. The bill would add a valuable
layer of staffing between dentists and other hygienists to
provide comprehensive services. He spoke to further
attributes of the program. The new provider type would lead
to an adjustment of the overall health spend, potentially
lessening the reliance on higher cost dentists to lower
cost hygiene. He urged the passage of the bill.
1:37:44 PM
Co-Chair Bishop OPENED and CLOSED public testimony.
1:38:03 PM
AT EASE
1:38:43 PM
RECONVENED
CSHB 111(FIN) was HEARD and HELD in committee for further
consideration.
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