1:34:04 PM SB 92-DENTISTS/DENTAL HYGIENISTS/ASSISTANTS  CHAIR EGAN announced SB 92 to be next up for consideration. DANA OWEN, Staff to Senator Egan, presented the committee substitute (CS) for SB 92. He said this CS came from the Dental Board and contains highly technical issues that have accumulated over a number of years. The bill was divided into two pieces; one that extends the dental board for eight years and that had passed, and SB 92 which contains the issues left over. 1:36:31 PM SENATOR MENARD joined the committee. SENATOR DAVIS moved to adopt CSSB 92(L&C), labeled 27-LS0403\I, Bullard, as the working draft. SENATOR MENARD objected for discussion purposes. SENATOR DAVIS asked for a walk-through and then a sectional analysis. 1:38:24 PM DAVID LOGAN, Legislative Chair, Alaska Dental Society, said SB 92 had input from all major stakeholders (the Hygienist Association, the Dental Association, and both a dentist and a hygiene member from their boards). The overarching legislation is what controls the day-to-day activities, the limits and licensure of the dentists and dental hygienists in Alaska; it also provides the basis for how the Board of Dentistry conducts its business. It has been about 20 years since any substantial review of dental statutes has taken place. The language in those 20 years has become antiquated and the materials, methods, and terminology have changed - as one would expect in a vibrant profession. The changes aren't substantial, mostly language updates. New features are: -Moved from having a part-time to a full-time investigator. -Inserted clarifying language so that students undergoing training in Alaska can do so legally. -Redefined what ownership of a dental practice means and who can own one. They hadn't had a mechanism over the years for a surviving spouse to actually own a dental practice during a transitional period and now they have one. SENATOR GIESSEL said she was curious about section 22, which states the department shall employ a person as an investigator. She thought it was a responsibility of the division to assign investigators. MR. LOGAN responded that they really want to have a full time investigator for the board. The reason is because cases are starting to back up, and he thought several other boards would be making the same request. Somebody has to do the triage when you have a limited number of investigators and in this case the board is self funded through licensing fees and is more than happy to make those payments. What they are not happy about is the length of time it takes to bring a case to conclusion. SENATOR MENARD asked if the board would have to raise their dues to cover a full-time investigator. MR. LOGAN answered yes. SENATOR MENARD said she also appreciated giving the spouse 24 months to get a licensed dentist should there be a death. This was a considerable problem in her area when there was a terrible plane accident. The dentist left, then the spouse came in and she did not live in Alaska. It took many years to resolve. She asked him if board members were okay with a non-dentist being president. MR. LOGAN answered under current statute anyone on the board can serve as president: a dentist, a hygienist or a public member. SENATOR MENARD asked if other states do it differently. MR. LOGAN answered that most states have an open quorum; anyone who serves on the board can serve as an officer there. Two states restrict serving as president to dentists. SENATOR GIESSEL asked if requiring the president to be a licensed dentist or hygienist is what language in section 20 on page 10 means. SENATOR MENARD stated that got changed. MR. LOGAN said he strongly supported that language. 1:49:09 PM GAIL WALDEN, member and officer, Alaska State Dental Hygienists' Association, Wasilla, supported SB 92. Several statutes are inaccurate and don't represent existing practice or terminology. Ultimately one of their goals is to maintain the highest standards for excellent care to Alaskans. 1:52:03 PM DAVID EICHLER, President, Alaska State Board of Dental Examiners, North Pole, explained that the Dental Practice Act was in great need of reform and SB 92 is the collaborative product before them today. He said their investigations take way too long, but hopefully the new director will get that cleaned up with the tools provided in this statute. Currently he has cases as much as seven years old that have not had an accusation filed yet, and letting a case get that stale has the potential of allowing someone to practice who shouldn't. 1:54:12 PM ALPHEUS BULLARD, Legislative Legal Services, Legislative Affairs Agency, Alaska State Legislature, said he was available for questions. MR. OWEN moved on to the sectional analysis. Section 1: removes a requirement that a person practicing dental hygiene or who is offering to practice dental hygiene must have a current certificate of registration. Section 2: establishes the qualifications necessary for licensure as a dental hygienist. Section 3: amends the qualifications necessary for a dental hygienist to be licensed by credentials. Section 4: edits the dental hygiene licensing provisions to provide that successful applicants for licensure will no longer be registered by the Board of Dental Examiners. Sections 5-6: conform the "renewal of license" and "lapse and reinstatement of license" provisions to the bill's removal of the registration requirement for dental hygienists. Section 7: allows a dental hygienist who has completed a course offered by or under the auspices of a program accredited by the Commission on Dental Accreditation of the American Dental Association or other equivalent course or program to receive a restorative function endorsement from the board. Section 8: changes the levels of supervision required for a dental hygiene student performing dental hygiene procedures. Makes the section applicable to all students enrolled in dental hygiene programs. Sections 9-11: changes the permitted scope of practice for a dental hygienist and clarifies what practices and procedures may not be delegated to a dental hygienist by a dentist. Section 12: clarifies what practices and procedures a dental hygienist who has entered into a collaborative agreement with a dentist may be authorized by the dentist to perform. Section 13: makes stylistic changes. Section 14: permits the board to sanction a dental hygienist who used or knowingly cooperated in deceit, fraud, or intentional misrepresentation to obtain a certificate of endorsement and amends the other grounds for discipline, suspension, or revocation of a dental hygienist's license. Section 15: gives the board the authority to impose a civil fine of up to $25,000 for a violation of AS 08.32 or a regulation adopted under the chapter. 1:58:17 PM Section 16: amends the list of dental hygienists to whom the provisions of AS 08.32 do not apply. Section 17: provides new definitions applicable to AS 08.32 for "licensed dental hygienist" and licensed dentist." Section 18: adds a qualification for the public member of the board. Section 21: amends the powers of the board. Section 22: requires the Department of Commerce, Community and Economic Development to employ an investigator for the board. Section 23: requires the board to establish standards for dental radiological equipment that comply with applicable federal law. Permits the board to charge a fee for equipment registered under the section. Removes a requirement that inspections of radiologic equipment be performed by a person with certain qualifications. Section 24: requires the board to maintain a registry of persons licensed as dentists or dental hygienists and persons certified as dental assistants, and a registry of licenses, certificates, and endorsements revoked by the board. Section 25: edits the dentist licensing provision to provide that successful applicants for a license will no longer be registered by the board (see sec. 4 for a parallel provision applicable to dental hygienists). Section 26: amends the qualifications for a license to practice dentistry in the state. Section 27: requires that an applicant for licensure as a dentist must be interviewed in person by the board. Sections 28-29: amends what is necessary for a dental hygienist to be licensed by credentials. Section 30: permits all persons enrolled as students in an accredited school of dentistry to perform dental procedures without a license if certain conditions are met. Section 31: conforms the "renewal of registration" provisions to the bill's removal of the registration requirements for dentists. 2:00:32 PM Section 32: provides that a dentist who does not pay the license renewal fee forfeits the dentist's license. Permits the board to reinstate a license upon certain conditions. Section 33: amends the grounds for discipline, suspension, or revocation of a license to practice dentistry. Section 34: permits a dental assistant who has completed a course offered by or under the auspices of a program accredited by the Commission on Dental Accreditation of the American Dental Association or other equivalent course or program to receive a restorative function endorsement from the board. Section 35: adds a new provision allowing persons enrolled in a program or course of study to perform dental assisting procedures as part of that course of study or program without a certificate if certain conditions are met. Section 36: adds a new section that provides who may own, operate, or maintain a dental practice, office, or clinic. Section 37: provides new definitions applicable to AS 08.36 for "certified dental assistant," "licensed dental hygienist," and "licensed dentist." Section 38: repealers AS 08.32.020, 08.32.035, 08.32.040, 08.32.060, 08.32.097, 08.32.100, 08.32.120, 08.32.130, 08.32.190(2); AS 08.36.075(b), 08.36.075(c), 08.36.075(d), 08.36.075(e), 08.36.114. 08.36.230, 08.36.244, 08.36.246, 08.36.247, 08.36.248, 08.36.260, 08.36.271, 08.36.290, 08.36.350(a)(3), and 08.36.350(a)(4). Section 39: instructs the revisor of statutes to change the catch line of AS 08.36.250. 2:02:22 PM SENATOR MENARD said in the past a dental hygienist could work in the building without the dentist actually being present after consulting with him first. Does that still exist? MR. LOGAN replied yes; the levels of supervision are relatively unchanged. As long as the dentist provided the original diagnosis the hygienist would be able to work. SENATOR MENARD asked if the Dental Board had any concern about a procedure turning out bad while a dentist was not in the office and it becomes an insurance risk management issue. Some periodontal work can cause heart attacks. MR. LOGAN answered he couldn't speak for the current board, but in general thought has been given to that and it was felt that the overall ability to provide additional services to the public outweighed what they considered a relatively minor risk. SENATOR MENARD said that the Palmer Dental Center and one other office chose to have the dentist, because often it is a heart attack issue. She thought that should be looked at sometime down the road. 2:05:23 PM DON HABEGAR, Director, Division of Corporations, Business and Professional Licensing, Department of Commerce, Community and Economic Development (DCCED), went to section 3 on page 4 (SB 92 version M). He said the concept saying, "Pays the fees established by the board under AS 08.01. 065" actually gives the department authority to set the fees. So this is somewhat of a divergent track to what is normally established in most other boards. The reason he thought the department sets the fees is that it keeps track of the costs and tries to then set fees based on an annual analysis (according to statute). Then they ask the professions to reimburse the department for their costs. He said he had a brief conversation with Dr. Logan about this issue prior to the committee meeting, and he didn't seem to indicate that was a huge issue for them either. 2:07:23 PM The other mostly informational piece in section 5 is about the renewal of licenses. As written, it indicates the department will send out a form and the applicant will fill it out and return it with a fee. This is what has been done traditionally, but as the division moves into the "modern age" they are trying to get to where a person can fill out their forms on an interactive website. And for renewal of business licenses they are trying to send out a postcard reminding people to go to their website. It's cheaper and the savings are passed on to the clientele. 2:08:46 PM MR. HABEGAR said section 21 in version M (section 23 in version I) has to do with investigations. Currently the profession has an investigator that shares his responsibilities with other practices. He said the fiscal note was zero, but that is because he didn't understand that the position is entirely brand new as well as full-time. So, there will be a new fiscal note. 2:10:19 PM SENATOR GIESSEL asked Dr. Logan his thoughts on the fees established by the board in section 3 on page 4. MR. LOGAN replied that he is a little sketchy on the fees, but the overall intent was to conform to existing statute. They have no interest in trying to micro-manage the fees. SENATOR GIESSEL said the license renewal notification on a postcard in section 5 was crafted by the Board of Nursing several years ago and it has worked really well. Is the board okay with that? MR. LOGAN said he couldn't speak for the Dental Board because he was no longer a member, but for the Dental Society, yes; they are perfectly fine with the idea of a postcard reminder to go to the website. Finding no further questions, Chair Egan said he would hold SB 92. 2:13:12 PM