Legislature(2021 - 2022)BELTZ 105 (TSBldg)
03/21/2022 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB19 | |
| HB111 | |
| SB193 | |
| SB197 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 111 | TELECONFERENCED | |
| += | SB 193 | TELECONFERENCED | |
| *+ | SB 197 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 19 | TELECONFERENCED | |
HB 111-DENTAL HYGIENIST ADVANCED PRAC PERMIT
1:37:56 PM
CHAIR COSTELLO reconvened the meeting and announced the
consideration of 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."
She noted that this was the first hearing and the intention was
to hear the introduction and take invited and public testimony.
1:38:23 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 111, introduced the legislation
paraphrasing the following:
HB 111 creates an Advanced Practice Permit, which will
allow experienced, licensed dental hygienists to
provide preventative oral health care to underserved
populations at senior centers, health care facilities,
day cares, and schools, and for Alaskans who are
eligible for public assistance, are homebound, or who
live in underserved rural communities.
Oral health care plays a crucial role in the overall
health and well-being of Alaskans. Poor oral health
care contributes to poor overall health. This problem
is worst amongst our state's most vulnerable
populations. Many low income individuals and families
in Alaska don't regularly seek oral healthcare due to
cost, apprehension of dental work, access, and trouble
finding a provider. Bad oral health is linked to
cardiovascular disease, Alzheimer's, osteoporosis, as
well as poor nutrition and other serious health
issues. So, increasing access to preventative dental
health care through dental hygienists will save and
improve Alaskan's health and well-being.
Currently, dental hygienists can practice in a
dentist's practice or practice semi-independently if
they have a collaborative agreement with a dentist,
similar to what Physicians Assistants do.
An Advanced Practice Permit will allow dental
hygienists to care for underserved populations at
senior centers, health care facilities, day cares, and
schools, and for Alaskans who are eligible for public
assistance, are homebound, or who live in an
underserved community if they have the following:
1. minimum of 4,000 hours of clinical experience,
and
2. are approved by the Alaska Board of Dental
Examiners.
The bill lays out the specific services allowed under
the permit and the specific populations that a
licensed dental hygienist can provide services to
without the supervision or physical presence of a
licensed dentist. This list has been developed in
consultation with the Alaska Dental Society, Board of
Dental Examiners, and Alaska Dental Hygienists
Association (Section 2 (a) services and Section 2 (b)
populations).
The Advanced Practice Permit-holder will have to
maintain malpractice insurance, provide a written
notice of their service limitations, and make a
referral to a licensed dentist nearby if further
dental treatment is needed (Section 2 (d)). This will
allow dental hygienists to practice to the full scope
of their training, credentials, and professional
experience.
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 (Colorado, Washington, Montana, Maine,
Connecticut, and California) and 40 other states are
considered "direct access" states, meaning that dental
hygienists can initiate treatment based on their
assessment of a patient's needs without the
authorization or presence of a dentist
Lastly, I'll note that we have already 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 7 years,
• making sure that the Board of Dental Examiners has
separately certified a dental hygienist to administer
local anesthesia, and
• empowering DHSS to make regulations related to the
bill.
CHAIR COSTELLO requested the sectional analysis for HB 111.
1:42:49 PM
CHELSEA WARD-WALLER, Staff, Representative Ivy Spohnholz, Alaska
State Legislature, Juneau, Alaska, presented the sectional
analysis for HB 111 on behalf of the sponsor.
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.
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 dental
hygienist 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.
1:45:39 PM
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
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 effect immediately.
Section 9
Effective date for sections 1-6 is January 1, 2023.
1:46:42 PM
CHAIR COSTELLO asked why two departments are involved in
licensing, not just the Department of Commerce, Community and
Economic Development (DCCED).
1:47:04 PM
REPRESENTATIVE SPOHNHOLZ explained that regulations are needed
in both Medicaid and in professional licensing to ensure there
is clear guidance on implementation for dental hygienists who
will provide services to those eligible for public services.
CHAIR COSTELLO noted that Section 6 provides the option to offer
these services through Medicaid.
REPRESENTATIVE SPOHNHOLZ replied the bill does not change the
services that are available through Medicaid, but it does allow
advanced practice dental hygienists (APDN) who practice
independently to offer those services. She clarified that DHSS
regulations would need to be changed to reflect this.
CHAIR COSTELLO asked her to talk about why the provision in
Section 5 that prohibits insurance providers from discriminating
against APDNs is in the bill, and whether she anticipated that
sort of discrimination.
REPRESENTATIVE SPOHNHOLZ explained that in the past insurance
companies have used a change in statute as an opportunity to
compensate a provider at a different rate. HB 111 seeks to
ensure that dental hygienists holding an advanced practice
permit who are practicing autonomously continue to be reimbursed
at the same rate as though they were practicing under a dental
office. The training is the same, but they hold an advanced
practice permit and operate an independent practice.
She added that there is a shortage of both dentists and dental
hygienists in the state. Because most of the problems in dental
health care are associated with preventative work, supporting
the market for APDHs actually will save money in the long term.
1:49:40 PM
SENATOR STEVENS said he assumes the bill will need some changes
to reflect the Governor's Executive Order to divide the
Department of Health and Social Services (DHSS).
REPRESENTATIVE SPOHNHOLZ agreed that changes would be needed
because the bill was drafted prior to that Executive Order.
1:50:13 PM
SENATOR GRAY-JACKSON said she was pleased to see the provision
in Section 5 to prevent discrimination in reimbursement for
APDHs practicing independently. She offered her belief that
insurance companies will need to be educated.
SENATOR STEVENS said he assumes that the eight villages in his
district that do not have dentists will not experience a
reduction in the quality of care they currently receive.
REPRESENTATIVE SPOHNHOLZ replied the expectation is that access
to care will improve dramatically with this advanced practice
permit for dental hygienists. These experienced professionals
have been providing preventative dental care for a very long
time and the bill does not change that standard of care.
SENATOR STEVENS commented on past battles and said he was
pleased that there is continuing progress to help the people in
small communities.
REPRESENTATIVE SPOHNHOLZ relayed that her office had worked
carefully with the Dental Society, the Board of Dental
Examiners, and the Alaska Dental Hygienists' Association to
craft the bill. The bill was changed to accommodate concerns and
she was pleased to see the alignment among all stakeholders.
1:53:32 PM
At ease
1:53:53 PM
CHAIR COSTELLO reconvened the meeting and asked Ms. Wing-Heier
to talk about Section 5 and how the Division of Insurance would
help educate insurance companies to prevent discrimination in
reimbursement practices.
1:54:26 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community, and Economic Development, Anchorage,
Alaska, explained that insurance companies may discriminate, but
not unfairly. For example, it is acceptable for an insurance
company to file to offer homeowners insurance in Kodiak, but not
Barrow. In the case of this bill, insurance companies would be
expected to reimburse advanced practice dental hygienists who
are active under their own license in a separate clinic.
However, it may not be at the same rate as a dentist because
dental hygienists currently are not reimbursed at the same rate
as dentists.
SENATOR GRAY-JACKSON restated her concern that insurance
companies may not know about this new law and reject a claim
that comes from an APDH because it is not from a dentist. She
asked how the division will educate insurance companies so this
issue doesn't arise.
MS. WING-HEIER responded that once the bill is signed and there
is an effective date, the division will notify insurance
companies of this change. Consumers are encouraged to contact
the division if they have a claim that is not paid the way it
should be so the matter can be resolved.
CHAIR COSTELLO turned to invited testimony.
1:56:26 PM
ROAYANN ROYER, CDA, RDH, MPH, Member, Alaska Dental Hygiene
Association, Anchorage, Alaska, testified by invitation in
support of HB 111. She gave her credentials and related that she
currently practices under a collaborative agreement that allows
a hygienist to provide treatment under the general supervision
of a dentist, prior to the dentist seeing a patient.
MS. ROYER clarified that a dental hygienist holding an advanced
practice permit would still provide treatment as a member of a
comprehensive oral health care team. She stressed that allowing
a hygienist to provide services prior to the diagnosis and
treatment planning of a dentist does not compromise the health
and safety of a patient or the quality of service they receive.
HB 111 offers an opportunity to provide efficient, cost-saving
services to the under-served population. Citing her own
situation, she said that if she did not have an agreement with a
dentist, HB 111 would allow her to continue to provide the
current hygienist scope of practice services to the long-term
care residents and refer to a dentist as needed. She said she
intends to continue her collaborative agreement, but HB 111
provides another option. She noted that the bill also addresses
Senator Steven's concern about access to dental care services in
villages. Many hygienists who want to work in under-served
communities cannot find a dentist with whom to collaborate.
Because routine assessment and preventative treatment clearly is
less expensive in the long term, dental professionals throughout
the state support HB 111.
2:00:40 PM
SENATOR STEVENS asked if hygienists who work for Native health
organizations are part of the Alaska Dental Hygiene Association.
MS. ROYER replied many of them are part of ADHA. She noted that
Southcentral Foundation is a member and when she worked for that
organization she went to the villages.
SENATOR STEVENS asked if non-Natives are able to receive care
from Native health care organizations that serve a village.
MS. ROYER answered yes.
2:02:01 PM
DR. DAVID NIELSON, Chair, Board of Dental Examiners, Anchorage,
Alaska, testified by invitation in support of HB 111. Stated
that the Board of Dental Examiners supports HB 111 in its
current form. The board appreciates that the sponsors of the
bill have been receptive to board comments and suggestions for
changes. As stipulated in Section 4, he said the dental board
will draft regulations stating what additional tasks, if any, a
dental hygienist holding an advanced practice permit may
delegate to a dental assistant and under what level of
supervision. He expressed optimism that the extended effective
date would allow time to write those regulations.
2:03:51 PM
JOHN ZASADA, Policy Director, Alaska Primary Care Association,
Anchorage, Alaska, testified by invitation in support of HB 111.
On behalf of APCA, he stated support for the operation and
development of Alaska's 29 tribal and non-tribal federally
qualified health centers. He relayed that APCA partners with the
Alaska Dental Hygiene Association and the Alaska Dental Society.
He stated that overall oral health is a vital component of the
whole person care that community health centers provide their
patients. A frequently cited reason for the shortage of dental
services is the lack of providers. Persistent shortages of
providers results in providers not working at their highest
level of licensure, which creates inefficiencies and decreases
provider satisfaction. APCA believes the advanced practice
permit will be a valuable addition.
2:06:06 PM
CHAIR COSTELLO opened public testimony on HB 111; finding none,
she closed public testimony.
CHAIR COSTELLO held HB 111 in committee for future
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 19 Letters of Support Received as of 3.21.22.pdf |
SL&C 3/21/2022 1:30:00 PM |
HB 19 |
| HB 111 v. I Sponsor Statement 2.10.2022.pdf |
SL&C 3/21/2022 1:30:00 PM |
HB 111 |
| HB 111 v. I Sectional Analysis 2.10.2022.pdf |
SL&C 3/21/2022 1:30:00 PM |
HB 111 |
| HB 111 Supporting Document - FAQs 2.16.22.pdf |
SFIN 4/21/2022 9:00:00 AM SL&C 3/21/2022 1:30:00 PM |
HB 111 |
| SB 193 Version I.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 193 |
| SB 193 Explanation of Changes, version B to I.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 193 |
| SB 197 Sponsor Statement.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |
| SB 197 Sectional Analysis.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |
| SB 197 Fiscal Note 242 - DOH.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |
| SB 197 Supporting Document - Pioneer Health DHCA White Paper.pdf |
SL&C 3/21/2022 1:30:00 PM |
SB 197 |