Legislature(2019 - 2020)BELTZ 105 (TSBldg)
03/10/2020 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB182 | |
| SB195 | |
| SB68 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 182 | TELECONFERENCED | |
| *+ | SB 68 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 195 | TELECONFERENCED | |
SB 68-DENTAL HYGIENIST ADVANCED PRAC PERMIT
2:03:32 PM
CHAIR BISHOP reconvened the meeting and announced the
consideration of SPONSOR SUBSTITUTE FOR SENATE BILL NO. 68, "An
Act relating to the practice of dental hygiene; establishing an
advanced practice permit; prohibiting unfair discrimination
under group health insurance against a dental hygienist who
holds an advanced practice permit; and relating to medical
assistance for dental hygiene services."
He said this is the first hearing, but the companion has made
significant progress in the other body. He noted there was a
proposed committee substitute that would be addressed after the
sponsor makes opening remarks.
2:03:57 PM
SENATOR CATHY GIESSEL, Alaska State Legislature, Juneau, Alaska,
sponsor of SB 68, stated that this bill will create a dental
hygienist advanced practice permit. She explained that some
dental conditions can predispose a person to heart disease and
if they are missing teeth, their nutritional status falls
significantly, which affects their health. In Alaska, the most
vulnerable populations are children, seniors and those with
disabilities. She said the state has an enormous unmet need for
dental care in Alaska and dental costs are high. Many states
allow dental hygienists to hold advanced practice permits that
allow them to provide dental services to underserved populations
who are at risk. These patients may not have access to a dental
office, there may not be a dental office in their community, or
the patients may have transportation issues getting to a
dentist.
She explained that SB 68 would establish an advanced practice
permit for Alaska-licensed dental hygienists to expand access to
dental care. She highlighted that in 2019 there were 703
licensed dental hygienists in Alaska. These are skilled dental
health professionals whose focus is preventing and treating oral
diseases.
SENATOR GIESSEL said the lack of access to dental care in Alaska
has created enormous need in populations and communities that
are underserved by the traditional system of care and the cost
of obtaining treatment is high. Many states have addressed
similar challenges by allowing non-dentist oral healthcare
practitioners the freedom and flexibility to reach out to
patients in new and creative ways to help improve access to
basic oral care. Alaska would benefit from replicating such
innovative oral health care delivery models.
SENATOR GIESSEL related that dental hygienists have graduated
from nationally accredited dental hygiene education programs and
have successfully passed a national written and state clinical
examination. Given their comprehensive education and clinical
preparation, dental hygienists are well prepared to deliver
preventative oral health care and other services to the public,
safely and effectively, she said.
She listed the identified underserved areas in Alaska, which
includes nursing homes, K-12 schools, senior centers,
residential treatment centers, assisted living centers, nursing
homes, nursery schools, and day care centers.
SENATOR GIESSEL stated that licensed dental hygienists holding
advanced practice permits could provide early preventive
treatment thus reducing the number of acute dental care visits,
which can be very costly. Additionally, these advanced practice
dental hygienists could identify more acute dental issues early
on and refer patients needing definitive restorative treatment
to dentists. She pointed out that 62 percent of Alaska's
children have higher than normal tooth decay rates, so having
access to care at a day care center, nursery school, or K-12
school could help to reduce dental issues. SB 68 would create
new consumer choices for preventive oral health, and help to
educate individuals, families, caregivers, and health providers
on the basics of oral health and dental hygiene. It has support
from the Alaska Board of Dental Examiners, the Alaska Dental
Hygienists Association, the American Dental Hygienists
Association, the Alaska Dental Society, and dental hygienists.
2:07:37 PM
SENATOR STEVENS asked for an estimate of the cost savings if the
underserved dental care is met.
SENATOR GIESSEL replied it is difficult to estimate preventative
dental care savings, but the dental health aides that Alaska now
has have had a significant positive impact.
She added that the advanced practice dental hygienists could
help seniors with dementia some of the disruptive and
disorienting experiences of going to a dentist. An advanced
practice dental hygienist could go into the Pioneer Home, for
example, and meet the needs of many of those seniors.
CHAIR BISHOP noted that he and the sponsor recently heard an
overview on the Medicaid costs for dental care. He suggested
that this bill could help drive down those costs.
2:10:01 PM
SENATOR STEVENS moved to adopt the proposed committee substitute
(CS) for SSSB 68, work order 31-LS0224\R, as the working
document.
CHAIR BISHOP found no objection and Version R was adopted.
2:10:23 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, provided the following sectional
analysis for the CS for SSSB 68, Version R:
Section 1 AS 08.32.110. Scope of practice of dental
hygienists Amends section (e) of dental hygienists'
scope of practice to allow a licensed dental hygienist
who holds an advanced practice permit issued by the
board to perform the duties allowed by the permit.
Section 2
Adds a new section to AS 08.32:
AS 08.32.125. Advanced practice permits.
Outlines the advanced practice permit requirements and
privileges.
(a) The Board of Dental Examiners 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 with
an advanced practice permit may perform the specific
services listed in this section (1) (12)
(b) Describes patients a licensed dental hygienist who
holds an advanced practice permit may provide services
to, including:
• A patient not able to receive dental treatment
due to age, infirmity, or disability, and is
• A resident of a senior center, hospital, long-
term care, residential care facility, adult
foster home, adult congregate living facility, an
inmate in a local correctional facility a
healthcare facility, residential treatment center
or facility for those with disabilities, nursery
school, day care, vocational training program,
secondary school, private school, or charter
school
• A patient receiving benefits under the Special
Supplemental Food Program (WIC), homebound, or a
resident where there's a shortage of dental
health professionals. (1) (7) (c) A licensed
dental hygienist holding an advanced practice
permit can provide services listed in subsection
(a) to a patient described in subsection (b)
without the presence, authorization, or
supervision of a licensed dentist and without an
examination from a licensed dentist. (d) A
licensed dental hygienist with an advanced
practice permit who provides services must do the
following:
~ maintain professional liability insurance.
~ give the patient, parent, or legal
guardian written notice that the treatment
provided will be limited to services listed
under subsection (a)
~ provide a written recommendation that the
patient be examined by a licensed dentist
for comprehensive oral care
~ provide assistance for a referral to a
licensed dentist for further oral treatment.
(e) A licensed dental hygienist with an advanced
practice permit may practice as an independent
contractor.
(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.
2:14:24 PM
CHAIR BISHOP noted that a dental hygienist with an advanced
practice permit who provides services must maintain professional
liability insurance. He asked if she agreed that these
individuals could work in a practice or set up their own shop.
MS. CONWAY answered that is correct but the expectation is that
most of these dental hygienists will work for a dentist and also
go out to underserved areas to provide services.
CHAIR BISHOP asked if the dental office as the primary employer
would maintain the professional liability insurance for these
dental hygienists who also go out on their own to provide
services in other settings.
2:15:29 PM
SENATOR GIESSEL answered that in her experience with advanced
practice nurses, employers will offer liability insurance as a
benefit, but it is typically up to the clinician to maintain
that liability insurance and pay the premiums.
2:16:01 PM
MS. CONWAY continued the sectional analysis for CSSSSB 68:
Section 3 Amends 08.32.160 Grounds for discipline,
suspension or revocation of license. Outlines and
amends grounds for discipline; allows the Board of
Dental Examiners to discipline, suspend, or revoke the
license of an advanced practice permit-holder who:
o Knowingly commits fraud or misrepresentation
to obtain a license
o Knowingly commits fraud/misrepresentation in
providing services or billing procedures o False
advertises or misleads
o Been convicted of a felony or other crime
that would affect ability to practice competently
o Failed to comply to statute or regulations
or board order
o Practices if unfit due to incompetence,
addiction or dependence on drugs or alcohol, is
physically or mentally disabled, engaged in
immoral conduct while in practice
o performs procedures outside scope of
practice or without supervision of a dentist
o allows a dental assistant to perform duties
outside their scope
o Falsifies or destroys a patient or facility
record or fails to maintain a patient or facility
record for at least seven years after the date
the record was created.
MS. CONWAY emphasized that when a dental hygienist with an
advanced practice permit is supervising a dental assistant, it
is mandatory that they make sure that the dental assistant only
operates within the advanced practice permit holder's scope of
practice. The provision related to falsifying or maintaining a
patient or facility record is the same requirement as for
dentists, she said.
SENATOR STEVENS asked what types of procedures would fall
outside the scope of practice.
MS. CONWAY answered that a dental hygienist would not do
invasive procedures such as pulling teeth. Those patients would
be referred to a dentist.
2:18:06 PM
MS. CONWAY continued the sectional analysis for CSSSSB 68:
Section 4 Adds a new subsection to AS 08.36.346.
(Delegation to dental assistant.) Allows delegation of
the following tasks to a dental assistant:
a. The exposure and development of radiographs,
b. Application of topical preventative agents or pit
and fissure sealants, and
c. Other tasks specified by the board in regulations.
The dental assistant must be supervised at a level
specified by Board of Dental Examiners in regulation.
Section 5 AS 21.36.090. Unfair discrimination. Adds
"dental hygienist holding an advanced practice permit"
to the list of providers who may not be discriminated
against in subsection (d).
Section 6 AS 47.07.030. Medical services to be
provided. (Medicaid) Adds dental hygiene services to
the list of services which may be provided by the
Department of Health & Social Services.
Section 7 This new section allows the Department of
Commerce, Community, and Economic Development (DCCED),
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 takes effect immediately.
Section 9 The effective date of this bill (not
including Section 7) is July 1, 2021.
2:19:38 PM
CHAIR BISHOP noted who was available to answer questions.
2:20:45 PM
KATRINA VIRGIN, President, Alaska Dental Hygienist Association,
Kodiak, Alaska, stated support for SB 68 and offered to answer
questions.
2:21:31 PM
DOMINIC WENZELL, DMD, Member, Alaska Board of Dental Examiners,
Girdwood, Alaska, stated support for Version R of SB 68 and
offered to answer questions.
2:22:02 PM
SENATOR REVAK asked Dr. Wenzell if he was back practicing
dentistry.
DR. WENZELL answered that the orthopedic surgeon just released
him to work one-half day per week.
2:22:35 PM
ANN LYNCH, Director of Advocacy and Education, American Dental
Hygienists Association (ADHA), Chicago, Illinois, spoke in
support of SB 68. She stated that she has been with ADHA for
eight years. Before that she served as a state senator in
Minnesota. She said ADHA is the largest national organization
representing dental hygienists in the nation. She related that
in 1995, only five states allowed dental hygienists to practice
without the presence and authorization of a dentist. Now there
are 42 states, including Alaska, that permit dental hygienists
to work in communities to provide preventive oral health
services without the presence or direct supervision of a
dentist. This will further utilize the dental hygienist
workforce in Alaska. She said there are national standards for
dental hygienist education programs that are accredited
throughout the country, including Alaska and this advanced
practice permit will allow dental hygienists to meet clients
where they live and receive service. As a former lawmaker, she
said SB 68 provides an opportunity to provide leadership and
support a change that will make a difference in the lives of
many people across Alaska for years to come. She thanked members
for their service and the leadership members provide.
2:26:27 PM
CHAIR BISHOP asked if there was any data on the number of
hygienists who go on to become dentists.
MS. LYNCH answered that it is far more common for dental
hygienists to seek the ability to practice at the top of their
scope of practice based on their education.
SENATOR REVAK asked about the scope of the practice and whether
advance practice dental hygienists can administer local
anesthesia.
MS. LYNCH directed attention to page 2, lines [9-29] of SB 68,
Version R, which lays out the scope of practice for an advanced
practice dental hygienist. The question about administering
local anesthesia is addressed on page 2, lines 24-27.
SENATOR REVAK asked for a description of nonsurgical periodontal
therapy, with or without local anesthesia.
MS. LYNCH answered that she is not a dental hygienist. She
suggested the question be posed to the dental hygienist online.
CHAIR BISHOP said he'd hold the question.
2:29:56 PM
SENATOR STEVENS referenced her earlier statement that in some
settings dental hygienists can work without a dentist being
present. He asked what that setting would be.
MS. LYNCH responded that 42 states have direct access, such that
in at least in one setting in each of those states, dental
hygienists can provide those services to patients without the
presence or authorization of a dentist. She said most commonly
that occurs in schools and that is the case in Alaska. Since
2008, dental hygienists in Alaska have been able to provide
services under a collaborative practice agreement. SB 68 creates
the advanced practice permit system, which will allow increased
access for dental hygienists to work in more settings.
2:32:18 PM
At ease
2:32:37 PM
CHAIR BISHOP reconvened the meeting and asked Senator Revak to
pose his earlier question to Dr. Wenzell.
SENATOR REVAK asked for help understanding the scope of practice
that includes nonsurgical periodontal surgery, with or without
anesthesia.
DR. WENZELL referred to page 2, lines 21-22 of SB 68, Version R.
He explained that if a patient has [gumline] probings that are
deeper than four millimeters and tenacious sublingual calculus,
the dental hygienist is not able to scale the root plane without
numbing the area so the patient is comfortable. Dental
hygienists currently are able to administer local anesthetic
under the general supervision of a dentist and the dental board
supports allowing dental hygienists to administer local
anesthetic in settings like a nursing home.
2:34:22 PM
CHAIR BISHOP opened public testimony on SB 68.
2:34:34 PM
VIVIAN STIVER, representing self, Fairbanks, Alaska, spoke in
support of SB 68. She said she has worked with the senior
population for nine years and has witnessed the oral health
problems low-income seniors experience due to cost and
transportation barriers. She said having bad teeth can be
painful, cause eating difficulty, and affect a person's overall
health. Sometimes seniors will opt for tooth extractions because
they cannot afford the other types of services. She said SB 68
will help with this situation by allowing dental hygienists to
screen, clean, and encourage seniors to address problems as they
crop up. This has the potential to improve the quality of life
for seniors. She summarized that she was pleased to see the
advanced practice permit system since it can help provide
services to those communities that are currently underserved.
2:36:46 PM
CHAIR BISHOP closed public testimony on SB 68 and held the bill
for future consideration.