SB1362 - 531R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 32-1201, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1201. Definitions

In this chapter, unless the context otherwise requires:

1. "Affiliated practice dental hygienist" means any licensed dental hygienist who is able, pursuant to section 32‑1289.01, to initiate treatment based on the dental hygienist's assessment of a patient's needs according to the terms of a written affiliated practice agreement with a dentist, to treat the patient without the presence of a dentist and to maintain a provider‑patient relationship.

1. 2. "Auxiliary personnel" means all dental assistants, dental technicians, dental x‑ray technicians and other persons employed by dentists or firms and businesses providing dental services to dentists.

2. 3. "Board" means the state board of dental examiners.

3. 4. "Business entity" means a business organization that has an ownership that includes any persons who are not licensed or certified to provide dental services in this state, that offers to the public professional services regulated by the board and that is established pursuant to the laws of any state or foreign country.

4. 5. "Dental assistant" means any person who acts as an assistant to a dentist or a dental hygienist by rendering personal services to a patient that involve close proximity to the patient while the patient is under treatment or observation or undergoing diagnostic procedures.

5. 6. "Dental hygienist" means any person licensed and engaged in the general practice of dental hygiene and all related and associated duties, including educational, clinical and therapeutic dental hygiene procedures.

6. 7. "Dental incompetence" means lacking in sufficient dentistry knowledge or skills, or both, in that field of dentistry in which the dentist, denturist or dental hygienist concerned engages, to a degree likely to endanger the health of that person's patients.

7. 8. "Dental laboratory technician" means any person, other than a licensed dentist, who, pursuant to a written work order of a dentist, fabricates artificial teeth, prosthetic appliances or other mechanical and artificial contrivances designed to correct or alleviate injuries or defects, both developmental and acquired, disorders or deficiencies of the human oral cavity, teeth, investing tissues, maxilla or mandible or adjacent associated structures.

8. 9. "Dental x‑ray laboratory technician" means any person, other than a licensed dentist, who, pursuant to a written work order of a dentist, performs dental and maxillofacial radiography, including cephalometrics, panoramic and maxillofacial tomography and other dental related non‑fluoroscopic diagnostic imaging modalities.

9. 10. "Dentistry", "dentist" and "dental" means the general practice of dentistry and all specialties or restricted practices of dentistry.

10. 11. "Denturist" means a person practicing denture technology pursuant to article 5 of this chapter.

11. 12. "Disciplinary action" means regulatory sanctions that are imposed by the board in combination with, or as an alternative to, revocation or suspension of a license and that may include:

(a) Imposition of an administrative penalty in an amount not to exceed two thousand dollars for each violation of this chapter or rules adopted under this chapter.

(b) Imposition of restrictions on the scope of practice.

(d) Imposition of censure or probation requirements best adapted to protect the public welfare, which may include a requirement for restitution to the patient resulting from violations of this chapter or rules adopted under this chapter.

12. 13. "Irregularities in billing" means submitting any claim, bill or government assistance claim to any patient, responsible party or third‑party payor for dental services rendered that is materially false with the intent to receive unearned income as evidenced by any of the following:

(a) Charges for services not rendered.

(b) Any treatment date that does not accurately reflect the date when the service and procedures were actually completed.

(d) Any charge for a service or procedure that cannot be clinically justified or determined to be necessary.

(e) Any statement that is material to the claim and that the licensee knows is false or misleading.

(f) An abrogation of the copayment provisions of a dental insurance contract by a waiver of all or a part of the copayment from the patient if this results in an excessive or fraudulent charge to a third party or if the waiver is used as an enticement to receive dental services from that provider. This subdivision does not interfere with a contractual relationship between a third‑party payor and a licensee or business entity registered with the board.

(g) Any other practice in billing that results in excessive or fraudulent charges to the patient.

13. 14. "Letter of concern" means an advisory letter to notify a licensee or a registered business entity that, while the evidence does not warrant disciplinary action, the board believes that the licensee or registered business entity should modify or eliminate certain practices and that continuation of the activities that led to the information being submitted to the board may result in board action against the practitioner's license or the business entity's registration. A letter of concern is not a disciplinary action. A letter of concern is a public document and may be used in a future disciplinary action.

14. 15. "Licensed" means licensed pursuant to this chapter.

15. 16. "Place of practice" means each physical location at which a person licensed pursuant to this chapter performs services subject to this chapter.

16. 17. "Primary mailing address" means the address on file with the board and to which official board correspondence, notices or documents are delivered in a manner determined by the board.

17. 18. "Recognized dental hygiene school" means a school that has a dental hygiene program with a minimum two academic year curriculum, or the equivalent of four semesters, and that is approved by the board and accredited by the American dental association commission on dental accreditation.

18. 19. "Recognized dental school" means a dental school accredited by the American dental association commission on dental accreditation.

19. 20. "Recognized denturist school" means a denturist school that maintains standards of entrance, study and graduation and that is accredited by the United States department of education or the council on higher education accreditation.

20. 21. "Supervised personnel" means all dental hygienists, dental assistants, dental laboratory technicians, denturists, dental x‑ray laboratory technicians and other persons supervised by licensed dentists.

21. 22. "Teledentistry" means the use of data transmitted through interactive audio, video or data communications for the purposes of examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by dentists and dental providers in settings permissible under this chapter or specified in rules adopted by the board. END_STATUTE

Sec. 2. Repeal

Section 32-1211, Arizona Revised Statutes, is repealed.

Sec. 3. Section 32-1233, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1233. Applicants for licensure; examination requirements

An applicant for licensure shall have passed all of the following:

1. The written national dental board examinations.

2. The western regional examining board examination or a clinical examination administered by another state or regional testing agency in the United States within five years preceding filing the application.

3. The Arizona dental jurisprudence examination. END_STATUTE

Sec. 4. Section 32-1240, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1240. Licensure by credential; examinations; waiver; fee

A. The board by rule may waive the examination requirements of this article on receipt of evidence satisfactory to the board that the applicant has passed the clinical examination of another state or testing agency more than five years before submitting an application for licensure pursuant to this chapter and either:

1. the other state or testing agency maintains a standard of licensure that is substantially equivalent to that of this state as determined by the board. The board by rule shall require:

(a) 1. A minimum number of active practice hours within a specific time period before the applicant submits the application. The board shall define what constitutes active practice.

(b) 2. An affirmation that the applicant has completed the continuing education requirements of the jurisdiction where the applicant is licensed.

2. The applicant has acquired a certificate or other evidence of successful completion of a board approved examination not more than five years before submitting an application for licensure pursuant to this chapter.

B. The applicant shall pay a licensure by credential fee of not more than two thousand dollars as prescribed by the board. END_STATUTE

Sec. 5. Section 32-1281, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1281. Practicing as dental hygienist; supervision requirements; definitions

A. A person is deemed to be practicing as a dental hygienist if the person does any of the acts or performs any of the operations included in the general practice of dental hygienists, dental hygiene and all related and associated duties.

B. A licensed dental hygienist may perform the following:

1. Prophylaxis.

2. Scaling.

3. Closed subgingival curettage.

4. Root planing.

5. Administering local anesthetics and nitrous oxide.

6. Inspecting the oral cavity and surrounding structures for the purposes of gathering clinical data to facilitate a diagnosis.

7. Periodontal screening or assessment.

8. Recording of clinical findings.

9. Compiling case histories.

10. Exposing and processing dental radiographs.

11. All functions authorized and deemed appropriate for dental assistants.

12. Except as provided in paragraph 13 of this subsection, those restorative functions permissible for an expanded function dental assistant if qualified pursuant to section 32‑1291.01.

13. Placing interim therapeutic restorations after successful completion of a course completed at an institution accredited by the commission on dental accreditation of the American dental association.

C. The board by rule shall prescribe the circumstances under which a licensed dental hygienist may:

1. Apply preventive and therapeutic agents, used in relation to dental hygiene procedures, to the hard and soft tissues.

2. Use emerging scientific technology and prescribe the necessary training, experience and supervision to operate newly developed scientific technology. A dentist who supervises a dental hygienist whose duties include the use of emerging scientific technology must have training on the use of the emerging technology that is equal to or greater than the training the dental hygienist is required to obtain.

3. Perform other procedures not specifically authorized by this section.

D. Except as provided in subsections E and G H of this section, a dental hygienist shall practice under the general supervision of a dentist licensed pursuant to this chapter.

E. Dental hygienists shall practice under the direct supervision of a dentist licensed pursuant to this chapter when performing the following procedures and after completing a course of study recognized by the board:

1. Administering local anesthetics. A dental hygienist may administer local anesthetics to a patient of record under general supervision if all of the following are true:

(a) The patient is at least eighteen years of age.

(b) The patient has been examined by a dentist licensed pursuant to this chapter within the previous twelve months.

(c) There has been no change in the patient's medical history since the last examination. If there has been a change in the patient's medical history within that time, the dental hygienist must consult with the dentist before administering local anesthetics.

(d) The supervising dentist who performed the examination has approved the patient for the administration of local anesthetics by a dental hygienist under general supervision and documented this approval in the patient's record.

2. Administering nitrous oxide analgesia.

E. A dental hygienist may perform the following procedures on meeting the following criteria and under the following conditions:

1. The administration of local anesthetics under the direct supervision of a dentist licensed pursuant to this chapter after:

(a) The dental hygienist successfully completes a course in the administration of local anesthetics that includes didactic and clinical components in both block and infiltration techniques offered by a dental or dental hygiene program accredited by the commission on dental accreditation of the American dental association.

(b) The dental hygienist successfully completes an examination in local anesthesia given by the western regional examining board or a written and clinical examination of another state or regional examination that is substantially equivalent to the requirements of this state, as determined by the board.

(c) The board issues to the dental hygienist a local anesthesia certificate on receipt of proof that the requirements of subdivisions (a) and (b) of this paragraph have been met.

2. The administration of local anesthetics under general supervision to a patient of record if all of the following are true:

(a) The dental hygienist holds a local anesthesia certificate issued by the board.

(b) The patient is at least eighteen years of age.

(d) There has been no change in the patient's medical history since the last examination. If there has been a change in the patient's medical history within that time, the dental hygienist must consult with the dentist before administering local anesthetics.

(e) The supervising dentist who performed the examination has approved the patient for the administration of local anesthetics by the dental hygienist under general supervision and has documented this approval in the patient's record.

3. The administration of nitrous oxide analgesia under the direct supervision of a dentist licensed pursuant to this chapter after:

(a) The dental hygienist successfully completes a course in the administration of nitrous oxide analgesia that includes didactic and clinical components offered by a dental or dental hygiene program accredited by the commission on dental accreditation of the American dental association.

(b) The board issues to the dental hygienist a nitrous oxide analgesia certificate on receipt of proof that the requirements of subdivision (a) of this paragraph has been met.

F. The board may issue local anesthesia and nitrous oxide analgesia certificates to a licensed dental hygienist on receipt of evidence satisfactory to the board that the dental hygienist holds a valid certificate or credential in good standing in the respective procedure issued by a licensing board of another jurisdiction of the United States that maintains a standard of certification that is substantially equivalent to that of this state as determined by the board.

F. G. A dental hygienist may perform dental hygiene procedures in the following settings:

1. On a patient of record of a dentist within that dentist's office.

2. Except as prescribed in section 32‑1289 32‑1289.01, in a health care facility, long‑term care facility, public health agency or institution, public or private school or homebound setting on patients who have been examined by a dentist within the previous year.

G. H. A dental hygienist may provide dental hygiene services under an affiliated practice relationship with a dentist as prescribed in section 32‑1289.01.

H. I. For the purposes of this article:

1. "Assessment" means a limited, clinical inspection that is performed to identify possible signs of oral or systemic disease, malformation or injury and the potential need for referral for diagnosis and treatment, and may include the collection of clinical information to facilitate an examination, diagnosis and treatment plan by a dentist.

2. "Direct supervision" means that the dentist is present in the office while the dental hygienist is treating a patient and is available for consultation regarding procedures that the dentist authorizes and for which the dentist is responsible.

3. "General supervision" means that the dentist is available for consultation, whether or not the dentist is in the dentist's office, over procedures that the dentist has authorized and for which the dentist remains responsible.

4. "Screening" means the determination of an individual's need to be seen by a dentist for diagnosis and does not include an examination, diagnosis or treatment planning. END_STATUTE

Sec. 6. Section 32-1285, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1285. Applicants for licensure; examination requirements

An applicant for licensure shall have passed all of the following:

1. The national dental hygiene board examination.

2. A clinical examination that is completed within five years preceding filing the application and that is either of the following:

(a) The western regional examining board examination.

(b) An examination administered by another state or testing agency that is substantially equivalent to the requirements of this state, as determined by the board. For the purposes of this subdivision, a clinical examination administered by another state or testing agency is deemed to meet the requirements of this subdivision if the clinical examination satisfies the requirements of section 32‑1292.01, subsection A, paragraph 1.

3. The Arizona dental jurisprudence examination. END_STATUTE

Sec. 7. Section 32-1289.01, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1289.01. Dental hygienists; affiliated practice relationships; rules; definition

A. A dentist who holds an active license pursuant to this chapter and a dental hygienist who holds an active license pursuant to this article may enter into an affiliated practice relationship for the delivery of dental hygiene services.

B. A dental hygienist shall satisfy all of the following to be eligible to enter into an affiliated practice relationship with a dentist pursuant to this section for the delivery of dental hygiene services in an affiliated practice relationship:

1. Hold an active license in good standing pursuant to this article.

2. Enter into an affiliated practice relationship with a dentist who holds an active license pursuant to this chapter.

3. Meet one of the following:

(a) Have held an active license as a dental hygienist for at least five years and Be actively engaged in dental hygiene practice for at least five hundred hours in each of the two years immediately preceding the affiliated practice relationship.

(b) Hold a bachelor's degree in dental hygiene, have held an active license for at least three years and be actively engaged in dental hygiene practice for at least five hundred hours in each of the two years preceding the affiliated practice relationship.

C. An affiliated practice agreement between a dental hygienist and a dentist shall be in writing and shall include at least the following:

1. An identification of the affiliated practice settings in which the dental hygienist may deliver services pursuant to the affiliated practice relationship.

2. An identification of the services to be provided and any procedures and standing orders the dental hygienist must follow. The standing orders shall include the circumstances in which a patient may be seen by the dental hygienist.

D. The following requirements apply to all dental hygiene services provided through an affiliated practice relationship:

1. Patients who have been assessed by the dental hygienist shall be directed to the affiliated dentist for diagnosis, treatment or planning that is outside the dental hygienist's scope of practice, and the affiliated dentist may make any necessary referrals to other dentists.

2. The affiliated practice dental hygienist shall consult with the affiliated practice dentist if the proposed treatment is outside the scope of the agreement.

3. The affiliated practice dental hygienist shall consult with the affiliated practice dentist before initiating further treatment on patients who have not been seen by a dentist within twelve months of the initial treatment by the dental hygienist.

4. The affiliated practice dental hygienist shall consult with the affiliated practice dentist before initiating treatment on patients presenting with a complex medical history or medication regimen.

5. The patient shall be informed in writing that the dental hygienist providing the care is a licensed dental hygienist and that the care does not take the place of a diagnosis or treatment plan by a dentist.

E. A contract for dental hygiene services with licensees who have entered into an affiliated practice relationship pursuant to this section may be entered into only by:

1. A health care organization or facility.

2. A long-term care facility.

3. A public health agency or institution.

4. A public or private school authority.

5. A government-sponsored program.

6. A private nonprofit or charitable organization.

7. A social service organization or program.

F. An affiliated practice dental hygienist may not provide dental hygiene services in a setting not listed in subsection E of this section.

G. Each dentist in an affiliated practice relationship shall:

1. Be available to provide an appropriate level of contact, communication and consultation with the affiliated dental hygienist during the business hours of the affiliated practice dental hygienist.

2. Adopt standing orders applicable to dental hygiene procedures that may be performed and populations that may be treated by the dental hygienist under the terms of the applicable affiliated practice agreement and to be followed by the dental hygienist in each affiliated practice setting in which the dental hygienist performs dental hygiene services under the affiliated practice relationship.

3. Adopt procedures to provide timely referral of patients referred by the affiliated practice dental hygienist to a licensed dentist for examination and treatment planning. If the examination and treatment planning is to be provided by the dentist, that treatment shall be scheduled in an appropriate time frame. The affiliated practice dentist or the dentist to whom the patient is referred shall be geographically available to see the patient.

4. Not permit the provision of dental hygiene services by more than three affiliated practice dental hygienists at any one time.

H. Each affiliated dental hygienist, when practicing under an affiliated practice relationship:

1. May perform only those duties within the terms of the affiliated practice relationship.

2. Shall maintain an appropriate level of contact, communication and consultation with the affiliated dentist.

3. Is responsible and liable for all services rendered by the dental hygienist under the affiliated practice relationship.

I. The dental hygienist and the affiliated dentist shall notify the board of the beginning of the affiliated practice relationship and provide the board with a copy of the agreement and any amendments to the agreement within thirty days after the effective date of the agreement or amendment. The dental hygienist and the affiliated dentist shall also notify the board within thirty days after the termination date of the affiliated practice relationship if this date is different than the contract termination date.

J. Subject to the terms of the written affiliated practice agreement entered into between a dentist and a dental hygienist, a dental hygienist may perform all dental hygiene procedures authorized by this chapter except for any diagnostic procedures that are required to be performed by a dentist. The dentist's presence and an examination, diagnosis and treatment plan are not required unless specified by the affiliated practice agreement. Procedures identified in section 32-1281, subsection B, paragraphs 4 and 5 are subject to the conditions prescribed in section 32-1281, subsection E, paragraph 1.

K. The board shall adopt rules regarding participation in affiliated practice relationships by dentists and dental hygienists that specify the following:

1. Additional continuing education requirements that must be satisfied by a dental hygienist.

2. Additional standards and conditions that may apply to affiliated practice relationships.

3. Compliance with the dental practice act and rules adopted by the board.

L. For the purposes of this section, "affiliated practice relationship" means the delivery of dental hygiene services, pursuant to an agreement, by a dental hygienist who is licensed pursuant to this article and who refers the patient to a dentist licensed pursuant to this chapter for any necessary further diagnosis, treatment and restorative care. END_STATUTE

Sec. 8. Section 32-1291.01, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1291.01. Expanded function dental assistants; training and examination requirements; duties

A. A dental assistant may perform expanded functions on successful completion of after meeting one of the following:

1. Successfully completing a board‑approved expanded function dental assistant training program completed at an institution accredited by the commission on dental accreditation of the American dental association and on successful completion of an examination successfully completing examinations in dental assistant expanded functions that is approved by the board.

2. Providing both:

(a) Evidence of currently holding or having held within the preceding ten years a license, registration, permit or certificate issued by another state or jurisdiction in the United States authorizing the performance of the expanded functions specified in subsection B of this section.

(b) Proof acceptable to the board of clinical experience in the expanded functions listed in subsection B of this section.

B. Expanded functions include the placement, contouring and finishing of direct restorations or the placement and cementation of prefabricated crowns following the preparation of the tooth by a licensed dentist. The restorative materials used shall be determined by the dentist.

C. An expanded function dental assistant may place interim therapeutic restorations under the general supervision and direction of a licensed dentist following a consultation conducted through teledentistry.

D. An expanded function dental assistant may apply sealants and fluoride varnish under the general supervision and direction of a licensed dentist.

E. A licensed dental hygienist may engage in expanded functions pursuant to section 32‑1281, subsection B, paragraph 12 following a course of study and examination equivalent to that required for an expanded function dental assistant as specified by the board.END_STATUTE

Sec. 9. Section 32-1292.01, Arizona Revised Statutes, is amended to read:

START_STATUTE32-1292.01. Licensure by credential; examinations; waiver; fee

1. the other state or testing agency maintains a standard of licensure that is substantially equivalent to that of this state as determined by the board. The board by rule shall require:

(a) 1. A minimum number of active practice hours within a specific time period before the applicant submits the application. The board shall define what constitutes active practice.

(b) 2. An affirmation that the applicant has completed the continuing education requirements of the jurisdiction where the applicant is licensed.

2. The applicant has acquired a certificate or other evidence of successful completion of a board‑approved examination not more than five years before submitting an application for licensure pursuant to this chapter.

B. The applicant shall pay a licensure by credential fee of not more than one thousand dollars as prescribed by the board. END_STATUTE

Sec. 10. Section 36-3611, Arizona Revised Statutes, is amended to read:

START_STATUTE36-3611. Definitions

In this article, unless the context otherwise requires:

1. "Board" means the state board of dental examiners.

2. "Dental provider" means a dental hygienist, affiliated practice dental hygienist or dental assistant who is licensed pursuant to title 32, chapter 11.

3. "Dentist" means a person who is licensed in the general practice of dentistry pursuant to title 32, chapter 11.

4. "Health care decision maker" has the same meaning prescribed in section 12‑2801.

5. "Teledentistry" means the use of data transmitted through interactive audio, video or data communications for the purposes of examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by dentists and dental providers in settings permissible under title 32, chapter 11 or specified in rules adopted by the board. END_STATUTE

Sec. 11. State board of dental examiners; renewal fee waiver; delayed repeal

A. The state board of dental examiners shall provide a one‑time waiver from license or certificate renewal fees for dentists, denturists and dental hygienists who are licensed in this state before January 1, 2018.

B. The one‑time waiver provided in subsection A of this section is effective for licenses renewing in calendar years 2018, 2019 and 2020.

C. This section is repealed from and after December 31, 2020.