HB 295-DENTIST SPEC. LICENSE/RADIOLOGIC EQUIP 4:58:05 PM CO-CHAIR FIELDS announced that the second order of business would be HOUSE BILL NO. 295, "An Act relating to the practice of dentistry; relating to dental radiological equipment; and providing for an effective date." 4:58:17 PM REPRESENTATIVE DAN ORTIZ, Alaska State Legislature, as prime sponsor of HB 295, introduced the bill. He spoke as follows: House Bill 295 works to solve two problems facing Alaskan dentists and helps them do their jobs safely, efficiently, and honestly. Firstly, this bill transfers the oversight of dental radiological equipment from the Alaska Board of Dental Examiners to the Department of Health and [Social] Services (DHHS). Alaskan dentists have had great difficulty finding private radiological inspectors for their x-ray equipment and as DHSS already oversees medical radiological equipment and employs inspectors, this is a way to ensure that dental equipment is being inspected at the right intervals by the people qualified to do the job. Secondly, ? this bill establishes truth in advertising for dental specialists. Alaska currently doesn't have a legal definition of dental specialist, which means that a dentist can advertise as an ? endodontist specialist without having an endodontist training. I ? certainly would want the dentist performing my root canals to know what they're doing, and I think everyone in this room would want that as well. Alaskans seeking dental specialists should be confident that their dentist has the specialized training to give them the best care possible, and HB 295 does just that. These concerns were brought to us by dentists who recognized obstacles in doing the best job they can for their patients, and these concerns are worth considering by passing HB 295. 5:00:42 PM ABIGAIL SWEETMAN, Staff, Representative Dan Ortiz, Alaska State Legislature, presented the sectional analysis for HB 295 on behalf of Representative Ortiz, prime sponsor. She paraphrased from a written sectional analysis, which read as follows [original punctuation provided with some formatting changes]: Section 1: Conforming language in AS 08.01.065(c). Section 2: Adds a new section (k) to AS 08.01.065 (Title 8. Business and Professions, Chapter 1. Centralized Licensing, Section 065. Establishment of fees) Requires the Board of Dental Examiners to establish and collect fees on behalf of the Department of Health and Social Services for the inspection of dental radiological equipment. Section 3: Adds new sections to AS 08.36 (Title 8. Business and Professions, Chapter 36. Dentistry) AS 08.36.242. License to practice as a specialist  required.  Establishes that a dentist may not advertise using the term "specialist," the name of a specialty, or other phrases that suggest they are a specialist unless they have a specialist license as established. AS 08.36.243. Qualification for specialist; scope  of practice.  (a)Establishes that in order to qualify for a specialist licenses a person must (1)Hold a dental license issued by the board and (2)Meet the qualifications of a specialist as established by the board in regulation. (b) In creating the qualifications for a specialist license, the board shall consider the standards of a nationally recognized certifying entity approved by the board. (c) Establishes that a dental specialist can only claim to be a specialist in the specialty they hold a license in. Sec. 08.36.245. Suspension or revocation of  specialist license. Establishes that a board may suspend or revoke a specialist license as set by AS 08.36.315. Section 4: Adds a new section (d) to AS 44.29.020 (Title 44. State Government, Chapter 29. Department of Health and Human Services, Section 020. Duties of the Department) Requires DHSS to establish standards of registration, use, record keeping, and inspection of dental radiological equipment in compliance with federal law. Section 5: Conforming language in AS 44.46.029 Section 6: Conforming language in AS 46.03.022 Section 7: Repeals: AS 08.36.075: Section of law requiring the Board of Dental Examiners to set standards for inspection of dental radiological equipment. Placed under DHSS by section 4. AS 18.05.065, AS 18.60.525(e), and AS 44.29.027: Sections of law prohibiting DHSS from regulating dental radiological equipment. Section 8: Allows the Board of Dental Examiners, the Department of Commerce, Community, and Economic Development, and the Department of Health and Social Services to adopt regulations in line with this act. Section 9: Allows the departments and board to immediately begin setting regulations. Section 10: Set a delayed effective date for the rest of the act to July 1, 2023. 5:03:01 PM CO-CHAIR FIELDS opened invited testimony on HB 295. 5:03:11 PM DAVID LOGAN, DDS, Executive Director, Alaska Dental Society, provided invited testimony in support of HB 295. He explained that currently there isn't an avenue for dentists to get the necessary inspections of their x-ray equipment. Dentists must use state certified inspectors, but for several years there have been no certified inspectors that dentists can use. DR. LOGAN said there have been a couple false starts at legislation, but this year is coming to a deadline as dentists are going to start falling out of compliance at year's end. Without action of some sort, dentists will be in the situation at year's end of their x-ray machines becoming out of compliance with the necessary inspections. Consequently, dentists will have to use machines that are no longer compliant or not be able to use their machines at all neither of which is a great option. These machines need to be inspected periodically, not doing so doesn't help things from a public health standpoint. Dentists would like to get those machines inspected. 5:05:03 PM DAVID NIELSON, DDS, Chair, Board of Dental Examiners, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community, and Economic Development (DCCED), provided invited testimony in support of HB 295. He said he agrees with Dr. Logan's testimony. Regarding Section 3 of the bill, he explained that the Dental Practice Act repealed specialty license categories in 2012 for reasons he is not aware of because he was not on the Board of Dental Examiners at that time. Since then, the board has shied away from investigating false and misleading advertising complaints that tend to crop up. For the board to address this, specialty license categories are needed that can hold up under legal scrutiny. The board needs the ability to reduce public confusion over deceptive or false advertising brought by dentists using the term specialist for specializing in an area of dentistry that is professionally recognized to require significantly more training than they have received. Typically, an accredited post-graduate specialty program demands two years minimum of training beyond dental school. DR. NIELSON related that the board has had to deny a few license applications to specialists trying to come work in Alaska because the board didn't have a way to approve their applications. That is because, without having a license type that's limited to the specialty area of dentistry that they've been practicing in for years or that they have a specific training in, the board had to deny licenses to dentists who have graduated from an accredited specialty program. If [the board] can limit the scope of practice of the specific branch of dentistry covered by the specialty license, it will open the doors a little wider to more qualified specialists to come to Alaska. 5:08:07 PM REPRESENTATIVE MCCARTY offered his understanding that currently there is not someone to inspect the machines used in dentistry. He asked whether there are dentists under investigation because they cannot comply with this. He further asked whether this means every dentist is going to have to shut down if this is not implemented fast enough. 5:09:02 PM SARA CHAMBERS, Director, Division of Corporations, Business, and Professional Licensing, Department of Commerce, Community, and Economic Development (DCCED), replied that the division is not currently investigating these potentially out of compliance dentists because there is no program with which to comply. The division does not want to put them in a "catch 22." If this bill passes, the plan would be to assist the Department of Health and Social Services (DHSS) in getting this up and running quickly and then move toward compliance rather than an enforcement right out of the gate. The division would want to make sure dentists were aware of how to comply and that there was a program that allowed compliance. DR. NIELSON agreed with Ms. Chambers. He pointed out that realistically there isn't a process in place for one dental examiner to figure out which of the approximately 2,400 devices being used are out of compliance. Dentists have had nobody qualified to do their inspections for years. Everyone wants to get caught up and get this program going again and DHSS has the people to do it. REPRESENTATIVE MCCARTY asked how viable it is that DHSS will be able to find people to do the inspections given dentistry hasn't been able to find inspectors. MS. CHAMBERS responded that it would be a different model. The board, she explained, has typically utilized a private sector model that would rely on a supply of people who are performing this type of service for other healthcare devices, but the board hasn't been able to identify anyone in the last several years who is qualified or willing to do that. The DHSS model, which is reflected in the fiscal notes of both departments, would be to employ someone who would be able to do this. A fee would be collected by DCCED from the dentist to pay for this service, which would then be sent over to DHSS through a reimbursable service agreement (RSA) to pay for the person on staff, thereby ensuring that someone is available to perform these inspections. REPRESENTATIVE MCCARTY asked whether this is kicking the can from one department to another - previously dentists were paying for the inspections until they couldn't find any inspectors in the state. He further asked whether a grace period for dentists is planned since it will take a while into the future to find an inspector given the current labor shortage. MS. CHAMBERS answered that everyone is in support of moving this program. Radiological physicists are required to perform these inspections, but since DCCED doesn't specialize in that, it is looking to its partner sister agency for an assist to do something that is currently under dental board statute. To not reinvent the wheel, DCCED often works that way with other departments for efficiency measures as well as expertise. The grace period would extend to a length of time that it would take for this program to be up and running, DCCED is not in the business of enforcing impossible-to-comply-with laws. So, DCCED would be working closely with DHSS to make sure that the program is functional, fully staffed, and available, and to clearly communicate a rollout of that inspection series to the dentists involved so, compliance rather than enforcement. 5:13:50 PM JAYME PARKER, MD, Chief, Alaska State Public Health Laboratory Fairbanks, Division of Public Health, Department of Health and Social Services (DHSS), responded to Representative McCarty's questions. She explained that her laboratory houses the radiological health program, which currently has a single radiological health physicist who inspects and registers over 1,000 non-dental devices every year. For this to be successful [the laboratory] would need to hire another radiological health care physicist to take on this additional capacity. While this isn't easy to come by, it isn't impossible. REPRESENTATIVE MCCARTY asked whether the effective date of 7/1/23 is a doable timeframe. MS. CHAMBERS replied that [DCCED] has been in communication with DHSS and this effective date seems to work best for most people and is a realistic start date. The original start date was 3/1/23 and July is a more reasonable date. DR. PARKER added that [DHSS] would not investigate if the program was not able to be complied with. Investigations would not be initiated for people who could not comply with a program that was not fully up and running. 5:15:52 PM REPRESENTATIVE NELSON recalled Ms. Chambers' statement that impossible laws would not be enforced. He asked what the future looks like if this doesn't get through in time. MS. CHAMBERS responded that DCCED will have to work closely with the industry to determine. The first step would be for dentists to not utilize equipment that wasn't properly inspected or where they were not complying with the laws that are attainable. This means that if a dentist has a piece of radiological equipment that hasn't been inspected within that six years the dentist would need to make a professional call as to whether he or she wants to run the risk of damage happening to staff or patients. [The departments] aren't going to seek investigations because dentists didn't comply with a date that is on the books. That is different than professionals making a call as to whether they feel comfortable using equipment that is out of compliance but that they believe is safe. The departments will link arms and plow forward if the bill passes and gives DHSS the tools to do that, along with communicating with dentists because neither one is an outcome that anybody wants. REPRESENTATIVE NELSON asked if the fees would be enough to cover the bill's attached fiscal notes [totaling about $500,000]. MS. CHAMBERS answered that this would be completely receipt supported, as indicated in the fiscal notes. One way to look at it is that this program is currently theoretically on the books and [DCCED] should have been collecting these fees or dentists should have been paying a private contractor these fees these last several years. Dentists are aware of going to a model of a state employee at DHSS because this has been discussed with the board on the record, and that the fees for all licensing programs and each sector's group payment will be set through an annual fee analysis. If the final model is [an inspection] every sixth year, then that amount would be paid every six years, so it would not be an annual amount to every dentist. [The departments] will have to work through the cost, which was previously paid through the private sector and now will be paid through the public sector. REPRESENTATIVE NELSON said he has heard about struggles with recruiting people for public jobs compared to private jobs that pay much better. He asked what the relationship would be of having this on the books, but no one could be hired before the deadline for this position had passed. MS. CHAMBERS deferred to the writer of the DHSS fiscal note to answer the question. 5:20:17 PM IRENE CASARES, Radiological Health Physicist, Alaska State Public Health Laboratory Fairbanks, Division of Public Health, Department of Health and Social Services (DHSS), responded that the situation of the inspections would be once the program is attainable and a person is hired. She related that people currently in Alaska have asked her about the salary and duties of this position, and said they are willing to take this position of getting the program in alignment, inspecting the equipment, and getting the dentists in compliance. It is just a fact of who, when, where, and how does this get started. REPRESENTATIVE NELSON asked whether Ms. Casares is confident that within a few months of passing HB 295, someone could be hired and already out inspecting equipment. MS. CASARES replied yes. 5:21:51 PM REPRESENTATIVE KAUFMAN inquired about how the risk is managed to prevent specialists from being locked out of what they are qualified to do because of categorization. He further asked whether the state has good definitions with enough latitude for specializing along with doing general dentistry. DR. NIELSON answered that certain specialties have more cross training in general dentistry procedures than others, and each specialty must be looked at individually to see what they routinely do. It's a bit of a gray area, he said, but he wouldn't suspect it would be a problem if an endodontist put in a small filling. It would be on a case-by-case basis, so he can't give the scope of practice for each specialty down to the letter. It's just more appropriate, he advised, to allow a specialist to work in their specialty area and keep it at that. DR. LOGAN pointed out that, in general, most specialists are not interested in performing general dentistry. Some specialists, like a root canal specialist (endodontist), may routinely throw in a filling. A periodontist (gum specialist) would have no interest in putting in a filling because that is not what they deal with, it is a completely different piece of the anatomy. Therefore, this would not take away something. MS. CHAMBERS added that these will be some of the things that the board will need to work through in regulation. It would typically fall to the education and training that the person is presenting, so [DCCED] would not intentionally prevent someone from practicing something they were qualified to do and want to do. If they wished to pursue both pathways there is a method in the law to do that, and the board will just need to narrow that down through the regulatory process. DR. NIELSON agreed with Ms. Chambers. He explained that the intent of this is really the other way around which is to allow someone who has had training in a specialty area to come to Alaska even though they haven't done "general dentistry" for a long time. The intent is to open this up for specialists who are highly trained in their area, [the board] is not going to focus a lot of time on not allowing a specialist to put in a little filling once in a while if they feel qualified to do it. REPRESENTATIVE KAUFMAN cautioned against creating a catch-22 situation where there is a little piece of work, and someone is afraid to do it even though they are competent to do so but it isn't per the regulations. In general, he continued, he is seeing that everything is going in a good direction. 5:27:19 PM REPRESENTATIVE MCCARTY concurred with Representative Kaufman about micro-managing, but said he isn't hearing that from the invited testimony. He stated he is confused about where the problem is in recognizing specialists trying to get into the state given specialists are already in Alaska. DR. LOGAN confirmed there are about 150 specialists in Alaska. He explained that by not having a specialty license they cannot differentiate themselves from somebody else as a specialist; or they can but the reverse is also unfortunately true in that a general dentist can list himself or herself as a specialist even without the requisite training, and the board is powerless to prevent them from doing that because the board doesn't have the statutory authority with the specialty license. [HB 295 was held over.]