1.1                          A bill for an act 
  1.2             relating to health; modifying dental practice 
  1.3             provisions; requiring a study; amending Minnesota 
  1.4             Statutes 2002, sections 150A.06, subdivisions 1a, 3, 
  1.5             by adding a subdivision; 150A.10, subdivision 1a, by 
  1.6             adding a subdivision; 256B.55, subdivisions 3, 4, 5. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 2002, section 150A.06, 
  1.9   subdivision 1a, is amended to read: 
  1.10     Subd. 1a.  [FACULTY DENTISTS.] (a) Faculty members of a 
  1.11  school of dentistry must be licensed or registered in order to 
  1.12  practice dentistry as defined in section 150A.05.  The board may 
  1.13  issue to members of the faculty of a school of dentistry a 
  1.14  license designated as either a "limited faculty license" or a 
  1.15  "full faculty license" entitling the holder to practice 
  1.16  dentistry within the school and its affiliated teaching 
  1.17  facilities, but only for the purposes of instructing or 
  1.18  conducting research.  The practice of dentistry at a school 
  1.19  facility for purposes other than instruction or research is not 
  1.20  allowed unless the faculty member is licensed under subdivision 
  1.21  1 or is a faculty member on August 1, 1993 terms described in 
  1.22  paragraph (b) or (c).  The dean of the school of dentistry and 
  1.23  program directors of accredited Minnesota dental hygiene or 
  1.24  dental assisting schools shall certify to the board those 
  1.25  members of the school's faculty who practice dentistry but are 
  1.26  not licensed to practice dentistry in Minnesota.  A faculty 
  2.1   member who practices dentistry as defined in section 150A.05, 
  2.2   before beginning duties in the school of dentistry, shall apply 
  2.3   to the board for a limited or full faculty license.  The license 
  2.4   expires the next July 1 and may, at the discretion of the board, 
  2.5   be renewed on a yearly basis.  The faculty applicant shall pay a 
  2.6   nonrefundable fee set by the board for issuing and renewing the 
  2.7   faculty license.  The faculty license is valid during the time 
  2.8   the holder remains a member of the faculty of a school of 
  2.9   dentistry and subjects the holder to this chapter.  This 
  2.10  subdivision takes effect on September 1 following the date that 
  2.11  the rules adopted under this subdivision become effective.  
  2.12     (b) The board may issue to dentist members of the faculty 
  2.13  of an accredited Minnesota school of dentistry, dental hygiene, 
  2.14  or dental assisting a license designated as a limited faculty 
  2.15  license entitling the holder to practice dentistry within the 
  2.16  school and its affiliated teaching facilities, but only for the 
  2.17  purposes of instructing or conducting research.  The practice of 
  2.18  dentistry at a school facility for purposes other than 
  2.19  instruction or research is not allowed unless the faculty member 
  2.20  is licensed under subdivision 1 or is a faculty member on August 
  2.21  1, 1993.  
  2.22     (c) The board may issue to dentist members of the faculty 
  2.23  of an accredited Minnesota school of dentistry, dental hygiene, 
  2.24  or dental assisting a license designated as a full faculty 
  2.25  license entitling the holder to practice dentistry within the 
  2.26  school and its affiliated teaching facilities and elsewhere if 
  2.27  the holder of the license is employed 50 percent time or more by 
  2.28  the school in the practice of teaching or research, and upon 
  2.29  successful review by the board of the applicant's qualifications 
  2.30  as described in subdivisions 1c and 4.  The board, at its 
  2.31  discretion, may waive specific licensing prerequisites. 
  2.32     Sec. 2.  Minnesota Statutes 2002, section 150A.06, is 
  2.33  amended by adding a subdivision to read: 
  2.34     Subd. 2d.  [VOLUNTEER AND RETIRED DENTISTS, DENTAL 
  2.35  HYGIENISTS, AND REGISTERED DENTAL ASSISTANTS.] (a) The board 
  2.36  shall grant a waiver to the continuing education requirements 
  3.1   under this chapter for a dentist, dental hygienist, or 
  3.2   registered dental assistant who documents to the satisfaction of 
  3.3   the board that the dentist, dental hygienist, or registered 
  3.4   dental assistant has retired from active practice in the state 
  3.5   and limits the provision of dental care services to those 
  3.6   offered without compensation in a public health, community, or 
  3.7   tribal clinic or a nonprofit organization that provides services 
  3.8   to the indigent or to recipients of medical assistance, general 
  3.9   assistance medical care, or MinnesotaCare programs. 
  3.10     (b) The board may require written documentation from the 
  3.11  volunteer and retired dentist, dental hygienist, or registered 
  3.12  dental assistant prior to granting this waiver. 
  3.13     (c) The board shall require the volunteer and retired 
  3.14  dentist, dental hygienist, or registered dental assistant to 
  3.15  meet the following requirements: 
  3.16     (1) a licensee or registrant seeking a waiver under this 
  3.17  subdivision must complete at least five hours of approved 
  3.18  courses in infection control, medical emergencies, and medical 
  3.19  management for the continuing education cycle; and 
  3.20     (2) provide documentation of certification in advanced or 
  3.21  basic cardiac life support recognized by the American Heart 
  3.22  Association, the American Red Cross, or an equivalent entity. 
  3.23     Sec. 3.  Minnesota Statutes 2002, section 150A.06, 
  3.24  subdivision 3, is amended to read: 
  3.25     Subd. 3.  [WAIVER OF EXAMINATION.] (a) All or any part of 
  3.26  the examination for dentists or dental hygienists, except that 
  3.27  pertaining to the law of Minnesota relating to dentistry and the 
  3.28  rules of the board, may, at the discretion of the board, be 
  3.29  waived for an applicant who presents a certificate of 
  3.30  qualification from the national board of dental examiners or 
  3.31  evidence of having maintained an adequate scholastic standing as 
  3.32  determined by the board, in dental school as to dentists, or 
  3.33  dental hygiene school as to dental hygienists. 
  3.34     (b) Effective January 1, 2004, the board shall waive the 
  3.35  clinical examination required for licensure for any applicant 
  3.36  who is a graduate of a dental school accredited by the 
  4.1   commission on dental accreditation of the American Dental 
  4.2   Association or an equivalent organization as determined by the 
  4.3   board, who has successfully completed Parts I and II of National 
  4.4   Boards, and who has satisfactorily completed a Minnesota-based 
  4.5   postdoctoral general dentistry residency program accredited by 
  4.6   the commission on dental accreditation of the American Dental 
  4.7   Association if the program is of at least one year's duration 
  4.8   and includes an outcome assessment evaluation assessing the 
  4.9   resident's competence to practice dentistry.  The board may 
  4.10  require the applicant to submit any information deemed necessary 
  4.11  by the board to determine whether the waiver is applicable.  The 
  4.12  board may waive the clinical examination for an applicant who 
  4.13  meets the requirements of this paragraph and has satisfactorily 
  4.14  completed an accredited postdoctoral general dentistry residency 
  4.15  program located outside of Minnesota. 
  4.16     Sec. 4.  Minnesota Statutes 2002, section 150A.10, 
  4.17  subdivision 1a, is amended to read: 
  4.18     Subd. 1a.  [LIMITED AUTHORIZATION FOR DENTAL HYGIENISTS.] 
  4.19  (a) Notwithstanding subdivision 1, a dental hygienist licensed 
  4.20  under this chapter may be employed or retained by a health care 
  4.21  facility, program, or nonprofit organization to perform dental 
  4.22  hygiene services described under paragraph (b) without the 
  4.23  patient first being examined by a licensed dentist if the dental 
  4.24  hygienist: 
  4.25     (1) has two years practical clinical experience with a 
  4.26  licensed dentist within the preceding five years has been 
  4.27  engaged in the active practice of clinical dental hygiene for 
  4.28  not less than 2,400 hours in the past 18 months or a career 
  4.29  total of 3,000 hours, including a minimum of 200 hours of 
  4.30  clinical practice in two of the past three years; and 
  4.31     (2) has entered into a collaborative agreement with a 
  4.32  licensed dentist that designates authorization for the services 
  4.33  provided by the dental hygienist; 
  4.34     (3) has documented participation in courses in infection 
  4.35  control and medical emergencies within each continuing education 
  4.36  cycle; and 
  5.1      (4) maintains current certification in advanced or basic 
  5.2   cardiac life support as recognized by the American Heart 
  5.3   Association, the American Red Cross, or another agency that is 
  5.4   equivalent to the American Heart Association or the American Red 
  5.5   Cross. 
  5.6      (b) The dental hygiene services authorized to be performed 
  5.7   by a dental hygienist under this subdivision are limited to: 
  5.8      (1) oral health promotion and disease prevention education; 
  5.9      (2) removal of deposits and stains from the surfaces of the 
  5.10  teeth,; 
  5.11     (3) application of topical preventive or prophylactic 
  5.12  agents, including fluoride varnishes and pit and fissure 
  5.13  sealants; 
  5.14     (4) polishing and smoothing restorations,; 
  5.15     (5) removal of marginal overhangs,; 
  5.16     (6) performance of preliminary charting,; 
  5.17     (7) taking of radiographs,; and 
  5.18     (8) performance of scaling and root planing and soft-tissue 
  5.19  curettage.  The dental hygienist shall not place pit and fissure 
  5.20  sealants, unless the patient has been recently examined and the 
  5.21  treatment planned by a licensed dentist.  
  5.22  The dental hygienist shall not perform injections of anesthetic 
  5.23  agents or the administration of nitrous oxide unless under the 
  5.24  indirect supervision of a licensed dentist.  Collaborating 
  5.25  dental hygienists may work with unregistered and registered 
  5.26  dental assistants who may only perform duties for which 
  5.27  registration is not required.  The performance of dental hygiene 
  5.28  services in a health care facility, program, or nonprofit 
  5.29  organization as authorized under this subdivision is limited to 
  5.30  patients, students, and residents of the facility, program, or 
  5.31  organization. 
  5.32     (c) A collaborating dentist must be licensed under this 
  5.33  chapter and may enter into a collaborative agreement with no 
  5.34  more than four dental hygienists unless otherwise authorized by 
  5.35  the board.  The board shall develop parameters and a process for 
  5.36  obtaining authorization to collaborate with more than four 
  6.1   dental hygienists.  The collaborative agreement must include: 
  6.2      (1) consideration for medically compromised patients and 
  6.3   medical conditions for which a dental evaluation and treatment 
  6.4   plan must occur prior to the provision of dental hygiene 
  6.5   services; and 
  6.6      (2) age- and procedure-specific standard collaborative 
  6.7   practice protocols, including recommended intervals for the 
  6.8   performance of dental hygiene services and a period of time in 
  6.9   which an examination by a dentist should occur; 
  6.10     (3) copies of consent to treatment form provided to the 
  6.11  patient by the dental hygienist; 
  6.12     (4) specific protocols for the placement of pit and fissure 
  6.13  sealants and requirements for follow-up care to assure the 
  6.14  efficacy of the sealants after application; and 
  6.15     (5) a procedure for creating and maintaining dental records 
  6.16  for the patients that are treated by the dental hygienist.  This 
  6.17  procedure must specify where these records are to be located. 
  6.18  The collaborative agreement must be signed and maintained by the 
  6.19  dentist and, the dental hygienist, and the facility, program, or 
  6.20  organization; must be reviewed annually by the collaborating 
  6.21  dentist and dental hygienist; and must be made available to the 
  6.22  board upon request.  
  6.23     (d) Before performing any services authorized under this 
  6.24  subdivision, a dental hygienist must provide the patient with a 
  6.25  consent to treatment form which must include a statement 
  6.26  advising the patient that the dental hygiene services provided 
  6.27  are not a substitute for a dental examination by a licensed 
  6.28  dentist.  If the dental hygienist makes any referrals to the 
  6.29  patient for further dental procedures, the dental hygienist must 
  6.30  fill out a referral form and provide a copy of the form to the 
  6.31  collaborating dentist.  
  6.32     (e) For the purposes of this subdivision, a "health care 
  6.33  facility, program, or nonprofit organization" is limited to a 
  6.34  hospital; nursing home; home health agency; group home serving 
  6.35  the elderly, disabled, or juveniles; state-operated facility 
  6.36  licensed by the commissioner of human services or the 
  7.1   commissioner of corrections; and federal, state, or local public 
  7.2   health facility, community clinic, or tribal clinic, school 
  7.3   authority, Head Start program, or nonprofit organization that 
  7.4   serves individuals who are uninsured or who are Minnesota health 
  7.5   care public program recipients.  
  7.6      (e) (f) For purposes of this subdivision, a "collaborative 
  7.7   agreement" means a written agreement with a licensed dentist who 
  7.8   authorizes and accepts responsibility for the services performed 
  7.9   by the dental hygienist.  The services authorized under this 
  7.10  subdivision and the collaborative agreement may be performed 
  7.11  without the presence of a licensed dentist and may be performed 
  7.12  at a location other than the usual place of practice of the 
  7.13  dentist or dental hygienist and without a dentist's diagnosis 
  7.14  and treatment plan, unless specified in the collaborative 
  7.15  agreement. 
  7.16     Sec. 5.  Minnesota Statutes 2002, section 150A.10, is 
  7.17  amended by adding a subdivision to read: 
  7.18     Subd. 4.  [RESTORATIVE PROCEDURES.] (a) Notwithstanding 
  7.19  subdivisions 1, 1a, and 2, a licensed dental hygienist or a 
  7.20  registered dental assistant may perform the following 
  7.21  restorative procedures: 
  7.22     (1) place, contour, and adjust amalgam restorations; 
  7.23     (2) place, contour, and adjust glass ionomer; 
  7.24     (3) adapt and cement stainless steel crowns; and 
  7.25     (4) place, contour, and adjust class I and class V 
  7.26  supragingival composite restorations where the margins are 
  7.27  entirely within the enamel. 
  7.28     (b) The restorative procedures described in paragraph (a) 
  7.29  may be performed only if: 
  7.30     (1) the licensed dental hygienist or the registered dental 
  7.31  assistant has completed a board-approved course on the specific 
  7.32  procedures; 
  7.33     (2) the board-approved course includes a component that 
  7.34  sufficiently prepares the dental hygienist or registered dental 
  7.35  assistant to adjust the occlusion on the newly placed 
  7.36  restoration; 
  8.1      (3) a licensed dentist has authorized the procedure to be 
  8.2   performed; and 
  8.3      (4) a licensed dentist is available in the clinic while the 
  8.4   procedure is being performed. 
  8.5      (c) The dental faculty who teaches the educators of the 
  8.6   board-approved courses specified in paragraph (b) must have 
  8.7   prior experience teaching these procedures in an accredited 
  8.8   dental education program. 
  8.9      Sec. 6.  Minnesota Statutes 2002, section 256B.55, 
  8.10  subdivision 3, is amended to read: 
  8.11     Subd. 3.  [DUTIES.] The advisory committee shall provide 
  8.12  recommendations on the following: 
  8.13     (1) how to reduce the administrative burden governing 
  8.14  dental care coverage policies in order to promote administrative 
  8.15  simplification, including prior authorization, coverage limits, 
  8.16  and co-payment collections developing a new model for 
  8.17  purchasing, administering, and delivering dental care services 
  8.18  to public program recipients based on public health principles; 
  8.19     (2) developing and implementing an action plan to improve 
  8.20  the oral health of children and persons with special needs in 
  8.21  the state exploring innovative ways to develop workforce 
  8.22  solutions to ensure access to dental care statewide; and 
  8.23     (3) exploring alternative ways of purchasing and improving 
  8.24  access to dental services; 
  8.25     (4) developing ways to foster greater responsibility among 
  8.26  health care program recipients in seeking and obtaining dental 
  8.27  care, including initiatives to keep dental appointments and 
  8.28  comply with dental care plans; 
  8.29     (5) exploring innovative ways for dental providers to 
  8.30  schedule public program patients in order to reduce or minimize 
  8.31  the effect of appointment no shows; 
  8.32     (6) exploring ways to meet the barriers that may be present 
  8.33  in providing dental services to health care program recipients 
  8.34  such as language, culture, disability, and lack of 
  8.35  transportation; and 
  8.36     (7) exploring the possibility of pediatricians, family 
  9.1   physicians, and nurse practitioners providing basic oral health 
  9.2   screenings and basic preventive dental services identifying data 
  9.3   needed to effectively evaluate the dental care needs of the 
  9.4   state.  
  9.5      Sec. 7.  Minnesota Statutes 2002, section 256B.55, 
  9.6   subdivision 4, is amended to read: 
  9.7      Subd. 4.  [REPORT.] The commissioner shall submit a report 
  9.8   by February 1, 2002, and by each February 1, 2003 thereafter, 
  9.9   summarizing the activities and recommendations of the advisory 
  9.10  committee. 
  9.11     Sec. 8.  Minnesota Statutes 2002, section 256B.55, 
  9.12  subdivision 5, is amended to read: 
  9.13     Subd. 5.  [SUNSET.] Notwithstanding section 15.059, 
  9.14  subdivision 5, this section expires June 30, 2003 2007.  
  9.15     Sec. 9.  [URGENT CARE DENTAL CLINIC.] 
  9.16     The commissioner of human services, in consultation with 
  9.17  the dental access advisory committee, is requested to report on 
  9.18  the feasibility of developing one or more urgent care dental 
  9.19  clinics.  The primary purpose of an urgent care dental clinic is 
  9.20  to provide recipients of medical assistance, general assistance 
  9.21  medical care, and MinnesotaCare with an alternative to receiving 
  9.22  dental care services in hospital emergency rooms.  The 
  9.23  commissioner shall determine if savings from the reduction in 
  9.24  dental care provided in emergency rooms would warrant the 
  9.25  construction of urgent care facilities.  The commissioner may 
  9.26  seek funding for the construction and operation of a dental 
  9.27  urgent care clinic from the federal government as authorized by 
  9.28  Congress under the dental health improvement provisions of the 
  9.29  Health Care Safety Net Improvement Act of 2002. 
  9.30     Sec. 10.  [DENTAL ASSISTANT STUDY.] 
  9.31     The board of dentistry, in consultation with the Minnesota 
  9.32  Dental Association, the Minnesota Dental Assistants Association, 
  9.33  and the Minnesota Dental Hygienists' Association, shall make 
  9.34  recommendations on the appropriate level of regulation for 
  9.35  dental assistants and the appropriate terminology used to 
  9.36  distinguish the different levels of training and education.  The 
 10.1   recommendations must include:  
 10.2      (1) whether registered dental assistants should be 
 10.3   licensed; and 
 10.4      (2) whether the term "nonregistered dental assistants" 
 10.5   should be changed to a term that better describes this position. 
 10.6      In making these recommendations, the board must consult 
 10.7   with representatives of registered and nonregistered dental 
 10.8   assistants and must review the issues in terms of the 
 10.9   requirements of Minnesota Statutes, section 214.001, subdivision 
 10.10  2, and consumer safety and awareness.  The board must report the 
 10.11  recommendations to the chairs and ranking minority members of 
 10.12  the house and senate health and human services policy committees 
 10.13  by January 15, 2004.  
 10.14     Sec. 11.  [EXPIRATION.] 
 10.15     Minnesota Statutes 2002, section 150A.06, subdivision 3, 
 10.16  paragraph (b), expires on August 1, 2008.