CS FOR HOUSE BILL NO. 319(L&C) "An Act relating to the practice of dentistry, to dental assistants, and to dental hygienists." REPRESENTATIVE JAY RAMRAS, Sponsor, explained that HB 319 continues the responsible exporting of dentistry across Alaska, particularly in the rural areas. Oral hygiene is critical and contributes to the health and nutritional benefits of an individual. JANE PIERSON, STAFF, REPRESENTATIVE JAY RAMRAS, related the details of the bill: · Oral health plays a key role in overall health. Unfortunately not all Alaskan's enjoy good dental health due to geographical barriers, cost of dental care and limitations on dental personnel. · HB 319 follows the provisions allowing for expanded duties of dental hygienist and dental assistants improving access to dental care and reducing costs for dental care. · With expanded duties, dental hygienist, dental assistants and dentists can provide greater access and more costs effective care. · This bill specifically lays the framework for expanding dental assistant's duties for two specific procedures. It would allow a certified dental assistant, under a dentist's direct supervision to place fillings into a cavity prepared by a licensed dentist. And allows a certified dental assistant, under a dentist's direct supervision, to polish teeth that are already clean of tarter. These expanded duties are already permitted in 36 other states. · Includes under a dental hygienists' scope of practice the ability to obtain a restorative function endorsement permitting placement of a filling into a cavity prepared by a licensed dentist and perform the activities authorized under a collaborative agreement with licensed dentist. · Authorizes a licensed dental hygienist to administer local anesthetic agents under the general supervision of a licensed dentist. Sixteen other states have variations of these provisions in place. · Authorizes the Dental Board to approve a collaborative agreement between a licensed dentist and a licensed dental hygienist and specifies the services and procedures allowed under a collaborative agreement. · Applies supervision requirements to a dental hygienist operation in conjunction with a licensed dentist under a collaborative agreement. · Dental assistants who perform expanded duties of packing cavities or polishing teeth will have to pass a training program and an exam prior to becoming eligible for certification by the Alaska Dental Board. Furthermore, the supervising dentist must personally authorize the procedure and examine the patient afterwards. · This bill is supported by the Alaska Dental Society, Alaska Board of Dental Examiners, Alaska State Dental Hygienist Association, Alaska Dental Outreach Consortium and the Alaska Native Tribal Health Consortium. · Oral health plays a key role in overall health. Untreated dental problems can cause pain, effect nutrition, and influence quality of life. This bill will increase the efficiency of delivering dental while upholding the quality of that care. 9:29:40 AM Co-Chair Stedman summarized that the bill would improve the lack of dental services in rural areas. Ms. Pierson said it would have a positive effect in both rural and urban Alaska because it would expand the practices done by both assistants and hygienists. Co-Chair Stedman asked if any groups oppose the bill. Ms. Pierson said none that she knew of. Senator Thomas praised the combining of two bills into one and suggested that the bill would also provide a career track for dental assistants. He reported that there was not opposition to the bill in previous committees. Senator Huggins pointed out that the bill talks about "direct supervision" and "indirect supervision", but not about "general supervision". Ms. Pierson explained that general supervision would be supervision where a dentist would not have to be present to directly oversee the procedure. 9:31:20 AM Senator Olson asked how many dental hygienists there are in rural Alaska. Ms. Pierson deferred to the Alaska Dental Society to answer. Co-Chair Stedman said he had a list that shows that information. Senator Olson questioned if "direct supervision" means that the dentist is present and supervising injections. Ms. Pierson said that is correct. Senator Olson asked if there had been any problems with local anesthesia in the past. Ms. Pierson deferred to others to answer. 9:33:11 AM PETE HIGGINS, PRESIDENT, ALASKA DENTAL SOCIETY, testified in support of HB 319. He pointed out that the legislation would help dentists in urban areas take on more Medicaid patients. He addressed the question about hygienists administering anesthetics. He said they are currently able to if they pass the test, but dental assistants would not be able to. The purpose of the bill is to ensure that more patients receive dental services. Other states already have this in place. 9:35:26 AM ROYANN ROYER, CHUGIAK, testified in support of HB 319. She listed her vast experience in the dental field. She advocated for the legislation based on personal experience delivering dental care in rural areas. She maintained that the legislation would lead to more people being treated. She noted this service is practiced in many other states. 9:37:28 AM GAIL WALDEN, DENTAL HYGIENIST, WASILLA, testified in support of HB 319. She pointed out that hygienists have been administering anesthesia in Alaska since 1981. She reported that there have never been any disciplinary actions against the hygienists. 9:39:06 AM DAVID LOGAN, DENTIST, LEGISLATIVE CHAIR, ALASKA DENTAL SOCIETY, spoke in support of HB 319. It will help provide more services in rural and underserved areas of Alaska. He clarified the three different types of supervision. "Direct" means that the dentist is in the facility and sees the patient before and after the procedure. "Indirect" means the dentist has seen the patient before the procedure, but does not necessarily see them afterwards. "General" means that dentist has diagnosed the condition and is not in the facility at the time. Co-Chair Stedman noted one fiscal note by the Department of Commerce, Community and Economic Development. Representative Ramras reported that the intent of the bill is to do no harm. The work would be done under appropriate supervision. Senator Olson MOVED to REPORT SCS CSHB 319(HES) out of Committee with individual recommendations and the accompanying fiscal note. There being NO OBJECTION, it was so ordered. SCS CSHB 319(HES) was REPORTED out of Committee with a "do pass" recommendation and with indeterminate fiscal note #2 by the Department of Commerce, Community and Economic Development. 9:42:41 AM