Legislature(2021 - 2022)ADAMS 519
05/15/2021 10:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB111 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | HB 111 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
May 15, 2021
10:24 a.m.
10:24:56 AM
CALL TO ORDER
Co-Chair Merrick called the House Finance Committee meeting
to order at 10:24 a.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Kelly Merrick, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative DeLena Johnson
Representative Andy Josephson
Representative Bart LeBon
Representative Steve Thompson
Representative Adam Wool
MEMBERS ABSENT
Representative Ben Carpenter
Representative Bryce Edgmon
Representative Sara Rasmussen
ALSO PRESENT
Representative Ivy Spohnholz, Sponsor; Pakak Sophie
Boerner, Staff, Representative Ivy Spohnholz.
PRESENT VIA TELECONFERENCE
Royann Royer, Certified Dental Assistant, Anchorage; Sara
Chambers, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community
and Economic Development; Greg Johnson, Member, Board of
Dental Examiners, Fairbanks.
SUMMARY
HB 111 DENTAL HYGIENIST ADVANCED PRAC PERMIT
HB 111 was HEARD and HELD in committee for
further consideration.
Co-Chair Merrick reviewed the meeting agenda.
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."
10:25:39 AM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR, introduced the bill
with a prepared statement as follows:
House Bill 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 is 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
healthcare will save and improve Alaskan's
health.
• HB 111 aims to increase access to oral healthcare
to underserved populations, specifically
children, seniors, and individuals with
disabilities.
• By expanding access, HB 111 creates an advanced
practice permit for dental hygienists.
• Currently, dental hygienists can practice in a
dentist's practice or practice semi-independently
if they have a collaborative agreement with a
dentistsimilar to what Physicians Assistants do.
HB 111 creates an Advanced Practice Permit which 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.
• 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 the Department of Health and
Social Services to make regulations related
to the bill.
10:28:58 AM
Representative Spohnholz listed individuals available to
testify.
Representative Thompson asked how many advanced hygiene
practice permits were expected to be issued at the start.
Representative Spohnholz answered that there were currently
659 registered dental hygienists in the state and roughly
10 percent of dental hygienists in Alaska would be
eligible. She reiterated that the candidates needed 4,000
hours of experience and would have to be approved by the
Board of Dental Examiners. Therefore, roughly 65 dental
hygienists would be eligible.
Representative Wool asked for verification that the bill
did not expand the scope of practice and that hygienist
were currently allowed to give local anesthesia.
Representative Spohnholz answered affirmatively. She
elaborated that hygienist were currently allowed to give
local anesthesia on a limited basis. She determined that if
the bill did expand the scope of practice, dentists would
oppose the legislation. She related that dentists were in
full support of the bill.
10:31:22 AM
Vice-Chair Ortiz spoke to the issuance of an advanced
practice permit and wondered whether it would allow the
hygienist to practice independently and open a clinic
anywhere, if they felt the market would be supportive.
Representative Spohnholz answered that the intent of the
bill was to increase access to preventative dental care,
not to increase competition with dentists. She furthered
that the intent of the bill was that hygienists would meet
the needs of underserved populations.
PAKAK SOPHIE BOERNER, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
interjected and directed members attention to a document in
the members files titled Frequently Asked Questions
(FAQs) (copy on file). She noted that in the document
Vice-Chair Ortizs question was addressed. She relayed that
in other states the advanced practitioners worked part-time
in dental shortage areas as well as continuing to work
part-time in traditional private or public health dental
offices.
10:33:56 AM
Representative Josephson asked if a dental hygienist
sometimes worked less than 40 hours per week due to the
strenuous work. He wondered whether the advanced practice
work would be supplemental in nature. Representative
Spohnholz deferred the answer.
ROYANN ROYER, CERTIFIED DENTAL ASSISTANT, ANCHORAGE (via
teleconference), shared that she worked in the field as a
practitioner and educator for 35 years. She answered that
she expected most people to engage in the advanced license
as a primary practice. She thought that others may do the
work as an extra job. Representative Josephson wondered how
the practitioner's typical day would change. Ms. Royer
answered that the individuals would be doing the work in
underserved areas without a dentist as their primary
practice and it may be supplemental or not. Representative
Josephson asked for verification that the individuals would
remain connected to a dental practice. Ms. Royer answered
that the practitioner would not necessarily have to be
associated with a specific private practice.
Representative Spohnholz clarified that the bill would
create a new standard of licensure for dental hygienists
that would allow them to practice independently without a
dentists supervision to practice in a very narrow scope,
in communities without access to dental care like senior
centers and nursing homes. She furthered that the advanced
practitioner could still practice under a dentist, but it
was anticipated that it would become a specialty of certain
practitioners. She reminded the committee that the
licensing process was very rigorous. She concluded that
there would be a very high bar set for the licensee and the
individuals would be providing services to a small
population of underserved individuals. She characterized
the service as niche.
10:38:46 AM
Ms. Royer interjected that currently she was working under
a Collaborative Practice Agreement that allowed a hygienist
to work independently under the general supervision of a
dentist. She currently worked at Prestige Rehabilitation
Center Long-Term Care, and the Alaska Pioneer Homes. She
furthered that the bill would allow an advanced hygienist
to work independently and refer a patient to a dentist in
the area.
Ms. Boerner provided a PowerPoint presentation titled "HB
111: Dental Hygiene Advanced Practice Permit" (copy on
file). She began with slide 2 titled Why is HB 111
Important? She relayed that according to the American
Dental Association Health Policy Institute 2015 document
titled "Oral Health and Well-Being in the Alaska, 62
percent of Alaskan elementary students have a high rate of
tooth decay rate. In addition, 43 percent of low-income
Alaskans have difficulty biting and chewing. Pain is the
top oral health problem for young adults and low-income
adults in America. Low-income families in Alaska don't
regularly seek oral health care due to cost, access, or
trouble finding a provider.
10:40:37 AM
Ms. Boerner moved to slide 3 titled titled "Why is HB 111
Important?
Dental diseases disproportionately affect our state's
most vulnerable people.
Dental hygienists are the front line for preventative
dental care and education about the critical link
between oral health and overall, wellbeing.
HB 111 increases access to oral health care for
underserved populations:
? Children
? Seniors
? Alaskans with disabilities
? Alaskans in correctional facilities
10:41:40 AM
Ms. Boerner reviewed the sectional analysis of the bill in
lieu of slide 4 (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) 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) 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.
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.
10:45:44 AM
Ms. Boerner turned to slide 5 that listed the Dental Health
Professional Shortage Areas (DHPSA) in Alaska and concluded
her presentation. She noted that the shortage areas were in
geographic DHPSAs, Alaskan Native Tribal populations, state
provided situations such as correctional facilities, and
federally qualified health centers.
Representative Spohnholz suggested that the invited
testifiers be heard.
Ms. Royer provided further invited testimony. She
emphasized that she worked under a Collaborative Practice
Agreement, which she currently practiced under at two long-
term care facilities. She began the non-profit organization
5 years ago and hoped to expand beyond the two facilities.
The agreement allowed a hygienist to practice independently
under the general supervision of a dentist. The legislation
would expand access to dental care by allowing hygienists
to work independently to provide services, be able to bill
for services provided, and refer to a dentist when needed.
The collaborative practice had improved access to care.
However, many hygienists who want to work in underserved
areas cannot find a dentist who will work in a
collaborative agreement. She reported that a dental
hygienist in Fairbanks initiated the legislation due to
that scenario. She believed that new ways of bringing oral
health care to underserved populations were needed and was
the reason dental practitioners supported HB 111. The
legislation would foster an opportunity to revise
efficiency and cost-saving methods to assist the
underserved populations. She emphasized that routine exams
and cleanings were less expensive than waiting for the
patient to notice problems or experience pain before
seeking out a dentist. A hygienist could assess minor
issues and refer the patient to the dentist prior to it
turning into a larger more costly problem. She pointed out
the many correlations recognized between oral health,
overall health, and systemic conditions such as pneumonia,
heart disease, and diabetes.
10:48:30 AM
Vice-Chair Ortiz appreciated the intent of the bill. He was
unclear whether someone who received the advanced practice
permit was responsible for deciding where they could open a
clinic to offer services or were limited to the DHPSAs. Ms.
Royer replied that the bill specified that the practice
could only be in underserved areas and the hygienist could
decide which underserved area she would prefer to work in.
She ascertained that it would likely be in consultation
with a dentist working in the underserved area and would
still work collaboratively with the dentists in the area.
Vice-Chair Ortiz asked for clarification that the
underserved areas were clearly defined. Ms. Royer answered
in the affirmative.
Representative Spohnholz directed attention to the areas in
the bill where the permitted hygienist could practice;
Section 2, subsection (b) on page 3, line 1. She stressed
that the bill clearly lists the underserved areas of the
state.
10:51:17 AM
Representative Wool noted that Ms. Royer had stated she had
a collaborative agreement allowing her to work in
underserved areas. He asked if her job would change much if
she received the advanced licensure. Ms. Royer stated that
she personally would not change licensure and her
collaborative agreement was working well. She viewed the
collaborative agreement, and the advanced practice permits
separately. She would continue working under the
collaborative agreement with a dentist. She provided a
scenario where dentists in the area did not want to work
with a collaborative agreement; the advanced practice
permits would fill the gap. Representative Wool asked if
there was an advantage to a collaborative agreement versus
an advanced practice permit. He asked what she would be
required to do if she chose to become an advanced
practitioner. Ms. Royer answered that she would need to
fill out an application and appear before the board.
Representative Spohnholz noted there was a member of the
Board of Dental examiners on the invited testifier list.
Representative Wool restated his question regarding an
advantage to remain in a collaborative agreement versus
holding an advanced permit.
10:54:05 AM
Ms. Royer answered that it was an advantage to her to have
a collaborative agreement because she worked with the same
dentists that provided care at the facilities, she provided
care in. Representative Wool asked if it was a common
agreement. Ms. Royer answered there had only been
collaborative agreements for about 10 years and it was
working well. She did not know the number of hygienists
working under a collaborative agreement.
Representative Spohnholz interjected that there were five
hygienists in the state that practiced under collaborative
agreements. She asked to hear from the Department of
Commerce, Community and Economic Development (DCCED).
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT (via teleconference),
agreed with Representative Spohnholz. She responded that
there were 5 hygienists working under a collaborative
agreement.
Representative Thompson thought the permit would allow a
dental hygienist to practice independently. He asked if
there would be an additional fee for the permit. Ms.
Chambers replied in the affirmative. The hygienist was
required to be registered as a hygienist before applying
for the advanced permit. The certification would likely be
an endorsement to a dental hygiene license. She related
that she worked with the board and discussed the fee
setting process. It was currently difficult to assess the
amount of an additional fee since the number of applicants
were unknown.
10:57:02 AM
Representative Thompson asked if the advanced practitioner
did anything out of their scope of practice would it
warrant an investigation. Ms. Chambers responded that the
advanced practice permit would fall under the Board of
Dental Examiners authority to review and revoke permits.
The permit would be exactly like all other types of
licenses issued - a fee would be paid to practice and
hopefully they would practice lawfully. In the event of a
complaint or some other triggering event, investigators
would investigate an individual and the board would
ultimately decide if a violation took place and how to
remediate it. She reminded the committee that by statute
the license had to be self-funding; if there were
investigations the increased fees would be covered by all
the dental licensees.
Representative Thompson asked about a scenario where there
were extensive investigations of advanced practice permit
holders. He wondered whether all licensees under the
licensure would be liable for the investigative costs or
only the advanced practice permit holders. Ms. Chambers
answered that she did not anticipate many and likely not
any additional investigations. She elucidated that statute
required each license program to pay for itself. The
division considered investigative fees the same as
administrative fees therefore, the program was required to
cover the costs via discussions with the dental board.
Investigations were not linked by license type so it was
possible all license holders would be liable.
11:01:23 AM
Co-Chair Merrick asked to hear from the additional invited
testimony.
GREG JOHNSON, MEMBER, BOARD OF DENTAL EXAMINERS, FAIRBANKS
(via teleconference), shared that he practiced pediatric
dentistry in Alaska since 1987. He noted that the questions
being asked by the committee were spot on. He reported
that during the prior legislative session, the board had
contemplated the introduction of the bill. The board was in
unanimous support of the advanced practice permit. He
elaborated that the advanced practice and the collaborative
agreement were similar. He estimated that that the number
of advance practice permit holders would be less than 10.
He indicated that the permit holders would be able to
practice independently and there would be a bit more skin
in the game in terms of carrying liability insurance,
paying staff, and overhead. The board would watch the
advanced practitioners very carefully over the next few
years. He was reassured that there were some guard rails in
the bill. He suggested that preventative and maintenance
care was essential for positive outcomes. The board
endorsed the bill because it put the right people with the
right training with the right oversight in the right
places. He was available for questions.
Co-Chair Merrick appreciated the doctor calling in.
11:06:18 AM
Representative Josephson referenced subsection (b) on page
3 of the bill. He wondered if the practice would be
Medicaid eligible. Representative Spohnholz answered in the
affirmative and indicated it was a critical element of the
bill. Representative Josephson asked whether patients with
private insurance and were not Medicaid eligible would have
the service covered. Representative Spohnholz responded
that the bill applied only to underserved areas, if someone
was in the underserved population private insurers were
required to cover the services. She did not expect a large
utilization in the private insurance market because the
bill targeted an underserved population that was typically
in a rural community and covered by tribal health or
economically underserved and would be covered by Medicaid.
She did not expect a large amount of insurance pay.
11:08:23 AM
Representative LeBon thanked Dr. Johnson for calling in on
a Saturday and recognized that he was recently confirmed by
the legislature for his board appointment. Mr. Johnson
affirmed that he was recently named to the Board of Dental
Examiners.
Representative Wool echoed Representative LeBon's comments
to Dr. Johnson. He provided a scenario where a hygienist
was under collaborative agreement, and it was determined
that a patient needed medication. He guessed that it would
be filled by the collaborating dentist. He assumed
hygienists did not have prescription power. He asked if the
advanced hygienist would refer the patient to a dentist.
11:10:54 AM
Representative Spohnholz replied that if a dental hygienist
identified something out of the scope of their training and
practice, they were required to refer patients to a
dentist. She pointed to page 3, line 29, Section 2,
Subsection (d) in the bill, requiring a referral to a
dentist for anything outside the scope of their licensure.
She voiced that an advanced practitioner would uphold the
statute. Representative Wool concluded that the advanced
permit holder could not prescribe drugs. Representative
Spohnholz affirmed the statement.
HB 111 was HEARD and HELD in committee for further
consideration.
Co-Chair Merrick announced that amendments were due by
Tuesday at noon. She reviewed the schedule for the
following meeting.
ADJOURNMENT
11:13:08 AM
The meeting was adjourned at 11:13 a.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 111 Fin FAQ VB 051521.pdf |
HFIN 5/15/2021 10:00:00 AM |
HB 111 |