ARIZONA
HOUSE OF REPRESENTATIVES
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HB 2235: dental therapy; regulation; licensure |
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PRIME SPONSOR: Representative Thorpe, LD 6 BILL STATUS: Senate Engrossed |
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Relating to Dental Therapists
and dentistry.
Provisions
1. Creates a new dental provider known as a dental therapist. (Sec. 1-15)
2. Includes dental therapists in all relevant Board statutes. (Sec. 1-8, 11)
3. Permits a dental therapist to practice under the direct supervision of a dentist or pursuant to an Agreement for services.
a. Caps the number of Agreements a dentist may enter at four. (Sec. 9)
4. Specifies that providing services or procedures that exceed the scope of practice or the terms of an Agreement is considered unprofessional conduct. (Sec. 2)
5. States that engaging in a practice by which a dental hygienist, dental therapist or dental assistant exceeds the terms of an Agreement is considered unethical conduct. (Sec. 6)
6. Exempts dental therapists working for the federal government, tribal health programs or urban Indian health programs from licensure requirements. (Sec. 4)
7. Requires an individual applying for licensure as a dental therapist to:
a. Apply to the Board;
b. Verify the truthfulness of the application; and
c. Submit a photo and pay an application fee as established in rule. (Sec. 9)
8. Permits the Board to issue a dental therapy license to an applicant who:
a. Is a licensed dental hygienist;
b. Graduates from a CODA accredited program;
c. Successfully passes specified examinations within five years preceding a licensure application;
d. Is not subject to any grounds for application denial;
e. Obtains a fingerprint clearance card; and
f. Meets licensure requirements established by Board rule. (Sec. 9)
9. Stipulates that a dental therapist must complete 1,000 hours of dental therapy clinical practice under direct supervision of a licensed dentist to be able to enter into an Agreement.
a. Requires documentation of completed training hours to be submitted to the Board. (Sec. 9)
10. Allows the Board to deny an initial or renewal license if an applicant:
a. Has committed an act that would be cause for Board discipline;
b. Performs dental therapy while unlicensed;
c. Makes false statements in a license application;
d. Has had a dental therapy license revoked in another jurisdiction;
e. Is currently suspended or restricted in another jurisdiction due to unprofessional conduct; or
f. Has surrendered or given up a dental therapy license in another jurisdiction in lieu of disciplinary action in another jurisdiction. (Sec. 9)
11. Requires the Board to suspend a license application if the applicant is under investigation by a dental board in another jurisdiction.
a. Prohibits the Board from issuing a license or denying an application until the investigation is complete. (Sec. 9)
12. Specifies that a dental therapist license expires on June 30th of every third year. (Sec. 9)
13. Requires a dental therapist to submit a renewal application and pay a renewal fee on or before June 30th of every third year.
a. Specifies that renewal fees are established by a formal vote of the Board. (Sec. 9)
14. Requires the Board to:
a. Review the amount of a renewal fee at a public meeting at least once every three years before establishing the fee; and
b. Prospectively apply any change in the fee amount to a licensee at the time of renewal. (Sec. 9)
15. Specifies that renewal fees do not apply to a retired or disabled dental therapist. (Sec. 9)
16. Requires a dental therapist to submit an affidavit with the renewal application that affirms compliance with CME Board rules. (Sec. 9)
17. States that a written affidavit is not required if:
a. An individual received an initial license in the year preceding the license expiration date; or
b. The licensee is in disabled status. (Sec. 9)
18. Stipulates that the Board may provide an extension to comply with CME requirements if a licensee:
a. Includes an extension request with the renewal application; and
b. Submits a renewal application on or before June 30th of the expiration year.
i. Requires the Board to consider an extension based on criteria established in rule.
ii. Specifies that a license expires on August 30th of the expiration year if an extension is denied. (Sec. 9)
19. Requires an individual applying for licensure for the first time to pay a prorated fee for the remaining time until June 30th.
a. Prohibits the fee from exceeding 1/3 of the licensure fee and requires subsequent applications to be done pursuant to statute. (Sec. 9)
20. Allows an expired license to be reinstated if an individual:
a. Submits a renewal application within 24 months after the expiration date; and
b. Pays the renewal fee and a $100 penalty.
i. Stipulates that an individual must apply for licensure pursuant to statute if their license is not reinstated according to the requirements listed. (Sec. 9)
21. Specifies that a reinstated license begins on the date of the application is valid only for the remainder of the three-year licensing cycle. (Sec. 9)
22. Requires a licensee to notify the Board within 10 days of a change in their mailing address.
a. Prescribes the following penalties if the Board is not notified:
i. $50 if the Board is not notified within the allotted timeframe.
ii. $100 if the Board is not notified within 30 days. (Sec. 9)
23. Permits licensees who are at least 65 years old and fully retired or permanently disabled to provide services to a charitable institution and still retain that classification for registration purposes if a reduced renewal fee established in rule is paid. (Sec. 9)
24. States that a licensee is not required to maintain a dental hygienist license. (Sec. 9)
25. Includes the following acts and procedures in the scope of practice of a dental therapist if either under the direct supervision of a dentist or performed pursuant to an Agreement:
a. Performing oral evaluations and assessments;
b. Performing charting of the oral cavity;
c. Providing oral health instruction and disease prevention education;
d. Exposing and processing radiographic images;
e. Performing dental prophylaxis, including subgingival scaling and polishing procedures, not including root planning;
f. Dispensing and administering specified medications as prescribed by a licensed health care provider;
g. Applying topical preventive and prophylactic agents;
h. Performing pulp vitality testing;
i. Applying desensitizing medicaments or resins;
j. Fabricating mouth guards and soft occlusal guards;
k. Changing periodontal dressings;
l. Administering analgesics and local anesthetics;
m. Performing simple extractions of erupted primary teeth;
n. Performing nonsurgical extractions of diseased permanent teeth that meet specified criteria;
o. Performing emergency palliative treatments of dental pain;
p. Preparing and placing direct restorations in specified teeth;
q. Fabricating and placing single-tooth temporary crowns;
r. Preparing and placing preformed crowns on primary teeth;
s. Performing indirect and direct pulp capping on specified teeth;
t. Performing suturing and suture removal;
u. Providing minor repairs and adjustments on movable prostheses;
v. Placing and removing space maintainers;
w. Performing functions of a dental assistant and expanded function dental assistant;
x. Performing services and functions as authorized by a supervising dentist within the dental therapist's scope of practice and training;
y. Providing referrals; and
z. Performing any other duties that are authorized by Board rule. (Sec. 9)
26. Prohibits a dental therapist from:
a. Dispensing or administering a narcotic drug; or
b. Independently billing for services to any individual or third-party payor. (Sec. 9)
27. Specifies that an individual may not claim to be a dental therapist unless properly licensed. (Sec. 9)
28. Asserts that a dental therapist may only practice in the following practice settings, including mobile dental units:
a. A federally qualified community health center;
b. A health center program with a federal look-alike designation;
c. A community health center;
d. A nonprofit dental practice or organization that serves low-income and underserved people; and
e. A private dental practice that serves patients referred by a community health center. (Sec. 9)
29. Prohibits a dental therapist from providing services without an Agreement with a supervising dentist. (sec. 9)
30. Requires a dentist to provide or arrange for any service for a patient that is beyond the scope of practice of a dental therapist. (Sec. 9)
31. Requires an Agreement to:
a. Address any limitations on services, procedures or practice settings of a dental therapist;
b. Establish practice and quality assurance protocols;
c. Include protocols for when a patient needs services that are beyond a dental therapist's scope of practice or the limits imposed by an Agreement; and
d. Specify that the extraction of permanent teeth must be performed under the direct supervision of a dentist and be consistent with a dental therapist's scope of practice. (Sec. 9)
32. Permits a dental therapist to perform procedures in a practice setting in which the supervising dentist is not on-site and has not examined a patient or given a diagnosis. (Sec. 9)
33. Requires an Agreement to be signed and maintained by both parties.
a. Allows Agreements to be updated and changed by both parties.
b. Requires a copy of an Agreement or Agreement amendment to be submitted to the Board. (Sec. 9)
34. Requires a dental practice to disclose to a patient if they are seeing a dentist or dental therapist. (Sec. 9)
35. Requires a dentist who enters into an Agreement to:
a. Be available to provide support to the dental therapist;
b. Adopt procedures regarding patient referral; and
c. Be geographically available to see a patient. (Sec. 9)
36. Requires a dental therapist who enters into an Agreement to:
a. Perform only the duties outlined in an Agreement; and
b. Maintain an appropriate level of contact with the supervising dentist. (Sec. 9)
37. Requires a supervising dentist and dental therapist to:
a. Notify the Board about the beginning of a collaborative practice relationship;
b. Give the Board a copy of the Agreement and any amendments within 30 days of the Agreement or amendment effective date; and
c. Notify the Board within 30 days of an Agreement's termination, if the date is different than specified in the Agreement. (Sec. 9)
38. Specifies that a dentist's presence, examination, diagnosis and treatment plan are not required unless directed by the Agreement. (Sec. 9)
39. Prescribes a Class 6 felony (1 year/Up to $150,000 plus surcharges) for practicing dental therapy without a license. (Sec. 9)
40. Permits the Board to waive examination requirements and license a dental therapist by credential if:
a. An applicant passes another state's clinical examination more than five years preceding an application; and
b. The other state's licensure requirements are substantially equivalent to Board requirements. (Sec. 9)
41. States that the Board must adopt rules which require:
a. A minimum number of active practice hours within a designated time prior to submission of an application; and
b. An attestation that the applicant has completed CME requirements of the jurisdiction in which a dental therapist is licensed or certified.
i. Requires the Board to prescribe what constitutes active practice. (Sec. 9)
42. Requires an applicant to pay a licensure by credential fee as established in rule. (Sec. 9)
43. Stipulates that an applicant for licensure by credential is not required to obtain a license as a dental hygienist if the Board determines that an applicant otherwise meets dental therapist licensure requirements. (Sec. 9)
44. Allows a recognized dental therapy school to grant advanced standing for prior learning to an individual who has prior experience or coursework that is determined to be equivalent to didactic and clinical education in its program. (Sec. 9)
45. Permits a dental assistant to perform expanded functions if they provide evidence of currently holding or having held, within the last 10 years of holding a license, registration, permit or certificate in expanded functions in restorative procedures issued by another jurisdiction or state in the United States. (Sec. 10)
46. Requires ADHS, in conjunction with the Board, to study the impact of licensing dental therapists within three years after the Board begins licensing dental therapists.
a. Outlines which outcome measures must be in the study.
b. Requires ADHS to report findings to the Chairs of the House Health and Senate Health and Human Services Committee.
c. Repeals reporting requirement on July 1, 2024. (Sec. 15)
47. Defines applicant, direct supervision and licensee. (Sec. 9)
48. Makes technical and conforming changes. (Sec. 1-8, 10-14)
Current Law
The Board regulates a variety of dental practitioners, including dentists, expanded function dental assistants, dental hygienists and denturists. The Board's duties include overseeing educational requirements, licensure requirements, investigations and complaint resolution and the collection of fees to administer the Board.
The Board may issue a license to an individual who meets educational and training requirements. A Board license is valid for three years and may be renewed if an individual submits an application and pays an applicable fee to the Board (Title 32, Chapter 11).
Additional Information
Dental Care for Arizona submitted a sunrise application for consideration by the Senate Health and Human Services and House Health COR. The COR met on November 27, 2017 and approved the application.
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Fifty-third Legislature HB 2235
Second Regular Session Version 4: Senate Engrossed
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