HB 127-DENTAL HYGIENIST ADVANCED PRAC PERMIT  5:15:35 PM CO-CHAIR WOOL announced that the final order of business would be HOUSE BILL NO. 127, "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; relating to medical assistance for dental hygiene services; and providing for an effective date." 5:15:45 PM REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, as prime sponsor, introduced HB 127. She paraphrased parts of the sponsor statement [included in the committee packet], which read in its entirety as follows [original punctuation provided]: Oral health plays a crucial role in the overall health and well-being of Alaskans. The lack of access to dental care in Alaska has created enormous need in communities that are underserved by the traditional system of care. Dental diseases disproportionately affect our state's most vulnerable populations and rural areas where the access to treatment is limited. We need all dental health care providers practicing to the full scope of their training to address this issue. Alaska would benefit from implementing an innovative oral health care delivery model. House Bill 127 would establish an Advanced Practice Permit for Alaska-licensed dental hygienists while continuing the collaborative agreement between licensed dentists and dental hygienists. Dental hygienists are skilled, licensed oral healthcare professionals who focus on preventing and treating oral diseases. HB 127 would allow dental hygienists who meet the necessary advanced education, experience and licensure requirements of the Advanced Practice Permit to work independently within their scope of practice across a variety of institutional and organizational settings, including nursing homes, schools, hospitals and clinics. The creation of Advanced Practice Permits would allow access to individuals who need oral care but cat get to a dental office because of illness or disability, create new consumer choices for preventive treatments and services, educate individuals, families, and caregivers on the basics of dental hygiene, and oral health's connection to overall health and well-being. Additionally, licensed dental hygienists would identify more acute dental issues early on before they become serious and provide referrals for patients needing restorative treatment. HB 127 removes barriers by allowing qualified, licensed dental hygienists to practice to the full extent of their professional training, experience and scope of practice to help promote and restore oral health to Alaska's underserved communities. 5:18:36 PM CO-CHAIR WOOL suggested foregoing the sectional because of time constraints. 5:18:51 PM KATRINA VIRGIN, Alaska Dental Hygienists Association, stated that dental hygienists would like the ability to use their scope of practice to visit areas in Alaska that are underserved. The 4,000 clinical hours that they complete under a dentist's supervision makes them more than competent to provide this care she said. 5:20:22 PM REPRESENTATIVE FIELDS requested additional information on the areas that Ms. Virgin anticipates providing service to currently underserved populations. 5:20:54 PM MS. Virgin said would like to provide services in nursing care facilities, where the oral systemic link has been greatly associated with pneumonia. Another target population, she said, would be schools, especially providing sealants to those with underserved children. Correctional facilities and Homebound as well, as both have individuals that cannot get into a dental facility. She said their goal is to help asses oral health and do as many preventative measures as possible, keep the bacteria in the oral environment down to help decrease inflammation in the overall body. 5:22:03 PM REPRESENTATIVE SPOHNHOLZ referenced a list of dental health professional shortage areas [provided in the bill packet], which includes a list of geographic areas - healthcare communities that are served by FQHCs as well as the Alaska Native Tribal Healthcare Continuum. She noted that there is also a list in the bill of the centers and facilities in which dental hygienists would like the opportunity to have an advanced practice in. 5:22:38 PM REPRESENTATIVE HANNAN questioned whether dental hygienists are allowed prescriptive authority in Alaska and what additional training it takes. 5:23:19 PM MS. VIRGIN explained that currently. there is no prescriptive authority for dental hygienists in this state; however, eight other states provide limited prescriptive authority. She added that they are limited to fluoride prescriptions and anti- microbial mouthwash, which would be the extent of the prescriptive authority being asked for in this bill. 5:24:03 PM REPRESENTATIVE SPOHNHOLZ noted that on page 2, lines 24-25, it clearly defines the prescriptive authority that is being outlined in the bill. REPRESENTATIVE HANNAN sought clarification on whether limited prescriptive authority is being granted in HB 127. REPRESENTATIVE SPONHOLZ acknowledged that the bill grants dental hygienists the authority to prescribe fluoride and anti- microbial mouthwash. REPRESENTATIVE SPOHNHOLZ, responding to a follow-up question from Representative Hannan, said that a business license and billing structure would be needed to practice independently, adding that this bill creates the opportunity for independent self-employment of advanced practice dental hygienists to set up their own practice with their own Medicaid billing, which is currently impossible without a collaborative agreement. 5:25:47 PM REPRESENTATIVE REVAK asked what the fiscal note is for. MS. VIRGIN said that was a base estimate due to the time it took to collaborate with the ADS and the state Board of Dental Examiners. She noted that it would be for the Medicaid system portal that would be built for providing reimbursements. REPRESENTATIVE REVAK asked if this would allow for billing Medicaid for reimbursement. 5:27:14 PM REPRESENTATIVE SPOHNHOLZ explained that HB 127 would allow dental hygienists to bill Medicaid. She noted that currently they are already paid for through Medicaid, so the bill is not adding a new population of providers, just a new class within the preexisting population. She said the fiscal note is to update the MMIS system that processes and tracks the payments. 5:29:01 PM REPRESENTATIVE STUTES pointed out that this will be helpful for communities, like her own, with many rural villages. She sought clarification if this bill would allow someone to set up own their own business. 5:29:35 PM MS. VIRGIN said she answered the question incorrectly yesterday, adding that she should have said it would be very difficult to set up shop in a rural area. She said the intention of the bill is to provide underserved communities that do not have oral healthcare, not to open individual practices. She continued by saying that they are providing dental hygiene services because the scope of practice is very limited. 5:31:44 PM REPRESENTATIVE FIELDS commented that this bill has potential for cost-savings if it's allows to identify dental problems earlier instead of manifesting later at the ER, adding that it will be interesting to see how the cost-savings materialize. 5:32:20 PM REPRESENTATIVE REVAK sought clarification on what HB 127 solves, regarding helping underserved communities. REPRESENTATIVE SPOHNHOLZ said it's much like a physician's assistant collaborative agreement that defines the scope of practice; this would allow for them to provide work without a collaborative agreement set up and increases access to dental care. 5:34:35 PM CO-CHAIR WOOL announced that HB 127 was held over. 5:36:38 PM ADJOURNMENT  There being no further business before the committee, the House Labor and Commerce Standing Committee meeting was adjourned at 5:36 p.m.