SF 2895

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health occupations; establishing an advanced dental hygiene
practitioner level of practice; amending Minnesota Statutes 2006, sections
150A.01, by adding a subdivision; 150A.05, subdivisions 1, 2, by adding a
subdivision; 150A.08, by adding a subdivision; 150A.10, subdivisions 1, 1a, 2,
4, by adding a subdivision; 151.01, subdivision 23; Minnesota Statutes 2007
Supplement, section 151.37, subdivision 2; proposing coding for new law in
Minnesota Statutes, chapter 150A.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2006, section 150A.01, is amended by adding a
subdivision to read:

new text begin Subd. 4a. new text end

new text begin Advanced dental hygiene practitioner. new text end

new text begin "Advanced dental hygiene
practitioner" means a licensed dental hygienist who meets the requirements described
under section 150A.061 and is authorized to perform the services under section 150A.10,
subdivisions 1, 1a, 1b, and 4, or any other services authorized under this chapter.
new text end

Sec. 2.

Minnesota Statutes 2006, section 150A.05, subdivision 1, is amended to read:

Subdivision 1.

Practice of dentistry.

new text begin (a) new text end A person shall be deemed to be practicing
dentistry within the meaning of sections 150A.01 to 150A.12:

(1) who uses a dental degree, or designation, or card, device, directory, sign, or other
media whereby the person represents an ability to diagnose, treat, prescribe, or operate for
any disease, pain, deformity, deficiency, injury, or physical condition of the human tooth,
teeth, alveolar process, gums or jaw, or adjacent or associated structures;

(2) who is a manager, proprietor, operator or conductor of a place where dental
operations are performed;

(3) who performs dental operations of any kind gratuitously, or for a fee, gift,
compensation or reward, paid or to be paid, to any person or agency;

(4) who uses a roentgen or X-ray machine for dental treatment, roentgenograms or
for dental diagnostic purposes;

(5) who extracts a human tooth or teeth, or corrects or attempts to correct
malpositions of the human teeth or jaws;

(6) who offers and undertakes, by any means or method, to diagnose, treat or remove
stains or accretions from human teeth or jaws;

(7) who takes impressions of the human tooth, teeth, or jaws or performs any phase
of any operation incident to the replacement of a part of a tooth, a tooth, teeth or associated
tissues by means of a filling, a crown, a bridge, a denture or other appliance;

(8) who furnishes, supplies, constructs, reproduces, repairs, or offers to furnish,
supply, construct, reproduce or repair prosthetic dentures or plates, bridges or other
substitutes for natural teeth, to the user or prospective user thereof; or

(9) who performs any clinical operation included in the curricula of recognized
dental schools and colleges.

new text begin (b) An advanced dental hygiene practitioner shall not be deemed as practicing
dentistry to the extent the services provided are authorized by this chapter or the Board of
Dentistry.
new text end

Sec. 3.

Minnesota Statutes 2006, section 150A.05, is amended by adding a subdivision
to read:

new text begin Subd. 1b. new text end

new text begin Practice of advanced dental hygiene. new text end

new text begin A person shall be deemed to be
practicing advanced dental hygiene within the meaning of this chapter:
new text end

new text begin (1) who works under the collaborative management of a licensed dentist authorized
under this chapter;
new text end

new text begin (2) who formulates individualized care plans, in collaboration with the patient,
based on evidence-based standards of care and practice guidelines within the context of
the collaborative management agreement;
new text end

new text begin (3) who provides primary oral health care services including diagnostic, educational,
prescriptive, palliative, therapeutic, and restorative services as authorized under section
150A.10, subdivision 1b; and
new text end

new text begin (4) who works cooperatively as part of an oral health care team as well as with other
health care professionals to provide the most effective evidence-based dental care.
new text end

Sec. 4.

Minnesota Statutes 2006, section 150A.05, subdivision 2, is amended to read:

Subd. 2.

Exemptions and exceptions of certain practices and operations.

Sections 150A.01 to 150A.12 do not apply to:

(1) the practice of dentistry or dental hygiene in any branch of the armed services of
the United States, the United States Public Health Service, or the United States Veterans
Administration;

(2) the practice of dentistry, dental hygiene, or dental assisting by undergraduate
new text begin or graduate new text end dental students, dental hygiene students, and dental assisting students of
the University of Minnesota, schools of dental hygiene, or schools of dental assisting
approved by the board, when acting under the direction and supervision of a licensed
dentist or a licensed dental hygienist acting as an instructor;

(3) the practice of dentistry by licensed dentists of other states or countries while
appearing as clinicians under the auspices of a duly approved dental school or college, or a
reputable dental society, or a reputable dental study club composed of dentists;

(4) the actions of persons while they are taking examinations for licensure or
registration administered or approved by the board pursuant to sections 150A.03,
subdivision 1, and 150A.06, subdivisions 1, 2, and 2a;

(5) the practice of dentistry by dentists and dental hygienists licensed by other states
during their functioning as examiners responsible for conducting licensure or registration
examinations administered by regional and national testing agencies with whom the
board is authorized to affiliate and participate under section 150A.03, subdivision 1,
and the practice of dentistry by the regional and national testing agencies during their
administering examinations pursuant to section 150A.03, subdivision 1;

(6) the use of X-rays or other diagnostic imaging modalities for making radiographs
or other similar records in a hospital under the supervision of a physician or dentist or
by a person who is credentialed to use diagnostic imaging modalities or X-ray machines
for dental treatment, roentgenograms, or dental diagnostic purposes by a credentialing
agency other than the Board of Dentistry; or

(7) the service, other than service performed directly upon the person of a patient, of
constructing, altering, repairing, or duplicating any denture, partial denture, crown, bridge,
splint, orthodontic, prosthetic, or other dental appliance, when performed according
to a written work order from a licensed dentist in accordance with section 150A.10,
subdivision 3.

Sec. 5.

new text begin [150A.061] ADVANCED DENTAL HYGIENE PRACTITIONER.
new text end

new text begin Subdivision 1. new text end

new text begin Requirements. new text end

new text begin Any dental hygienist licensed under this chapter may
practice as an advanced dental hygiene practitioner upon the following:
new text end

new text begin (1) successful completion of a master's degree program in advanced dental hygiene
practice from a program that meets the requirements in subdivision 4. The advanced
dental hygiene practitioner program curriculum must include, at a minimum:
new text end

new text begin (i) management of oral health care delivery;
new text end

new text begin (ii) provision of primary oral health care, including health assessment and oral
diagnostic reasoning;
new text end

new text begin (iii) promotion of health care policy and consumer advocacy;
new text end

new text begin (iv) use of scientific methods and evidence-based information; and
new text end

new text begin (v) management of urgent care and emergencies;
new text end

new text begin (2) passes a comprehensive competency-based clinical examination developed
in consultation with and approved by the board. This examination must be part of the
master's degree program graduation requirements;
new text end

new text begin (3) meets the requirements described in section 150A.10, subdivision 1a, paragraph
(a), clauses (1), (3), and (4);
new text end

new text begin (4) enters into a collaborative management agreement with a licensed dentist that
meets the requirements described in subdivision 2; and
new text end

new text begin (5) provides the board with evidence of completing clauses (1), (2), and (3).
new text end

new text begin Subd. 2. new text end

new text begin Collaborative management agreement. new text end

new text begin (a) Prior to performing the
services authorized under this chapter or by the board, an advanced dental hygiene
practitioner shall enter into a written collaborative management agreement with a dentist
licensed under this chapter and who practices in Minnesota. The agreement must include:
new text end

new text begin (1) age- and procedure-specific practice protocols;
new text end

new text begin (2) a procedure for creating and maintaining dental records for the patients that are
treated by the advanced dental hygiene practitioner;
new text end

new text begin (3) a description of the parameters of the management relationship between the
licensed dentist and advanced dental hygiene practitioner that includes patient care review,
referral follow-up, and a quality assurance system;
new text end

new text begin (4) specific protocols for prescribing, administering, and dispensing medications,
including the conditions and circumstances under which medications are to be prescribed,
dispensed, and administered; and
new text end

new text begin (5) an emergency plan. The plan must describe guidelines and the conditions under
which the following must occur:
new text end

new text begin (i) consultation with a licensed dentist;
new text end

new text begin (ii) the transfer of care to a licensed dentist; and
new text end

new text begin (iii) the implementation of emergency care.
new text end

new text begin (b) The collaborative management agreement must be signed and maintained by
the licensed dentist and the advanced dental hygiene practitioner and must be available to
the board upon request.
new text end

new text begin (c) Agreements must be reviewed and updated on an annual basis.
new text end

new text begin (d) A collaborating dentist may enter into a collaborative management agreement
with no more than four advanced dental hygiene practitioners, unless otherwise authorized
by the board. The board shall develop parameters and a process for obtaining authorization
to collaborate with more than four advanced dental hygiene practitioners.
new text end

new text begin Subd. 3. new text end

new text begin Delegation authority. new text end

new text begin The collaborating dentist shall delegate to an
advanced dental hygiene practitioner the authority to prescribe, dispense, and administer
medications for anti-infective therapies, nonnarcotic pain management, and prevention.
This authority to prescribe, dispense, and administer extends only to the categories of
drugs described in the written agreement developed under this section. The authority to
dispense includes the authority to receive and dispense sample drugs.
new text end

new text begin Subd. 4. new text end

new text begin Program accreditation. new text end

new text begin In order to offer a master's degree in advanced
dental hygiene practice, a Minnesota public university must meet the following conditions:
new text end

new text begin (1) be institutionally accredited by the Higher Learning Commission of the North
Central Association of Colleges and Schools;
new text end

new text begin (2) be affiliated with or in partnership with a dental hygiene program accredited by
the Commission on Dental Accreditation; and
new text end

new text begin (3) pursue national programmatic accreditation when it becomes available.
new text end

Sec. 6.

Minnesota Statutes 2006, section 150A.08, is amended by adding a subdivision
to read:

new text begin Subd. 10. new text end

new text begin Professional liability insurance. new text end

new text begin In addition to the grounds provided
in subdivision 1, and notwithstanding subdivision 3, the board may not issue or renew
a license to practice dentistry or dental hygiene for advanced dental hygiene practice
unless the applicant or licensee provides evidence to the board of applicable professional
liability insurance.
new text end

Sec. 7.

Minnesota Statutes 2006, section 150A.10, subdivision 1, is amended to read:

Subdivision 1.

Dental hygienists.

Any licensed dentist, public institution, or
school authority may obtain services from a licensed dental hygienist deleted text begin . Such licensed
dental hygienist deleted text end new text begin who new text end may provide those services defined in section 150A.05, subdivision
1a. Such services shall not include the establishment of a final diagnosis or treatment
plan for a dental patient deleted text begin . Such services deleted text end new text begin and new text end shall be provided under supervision of a
licensed dentist new text begin , unless the dental hygienist is practicing as an advanced dental hygiene
practitioner new text end . Any licensed dentist who shall permit any dental service by a dental hygienist
other than those authorized new text begin under this chapter or authorized new text end by the Board of Dentistry,
shall be deemed to be violating the provisions of sections 150A.01 to 150A.12, and any
deleted text begin such deleted text end unauthorized dental service by a dental hygienist new text begin that exceeds the authority granted
under this chapter or the board new text end shall constitute a violation of sections 150A.01 to 150A.12.

Sec. 8.

Minnesota Statutes 2006, section 150A.10, subdivision 1a, is amended to read:

Subd. 1a.

Limited authorization for dental hygienists.

(a) Notwithstanding
subdivision 1, a dental hygienist licensed under this chapter may be employed or retained
by a health care facility, program, or nonprofit organization to perform dental hygiene
services described under paragraph (b) without the patient first being examined by a
licensed dentist if the dental hygienist:

(1) has been engaged in the active practice of clinical dental hygiene for not less than
2,400 hours in the past 18 months or a career total of 3,000 hours, including a minimum of
200 hours of clinical practice in two of the past three years;

(2) has entered into a collaborative agreement with a licensed dentist that designates
authorization for the services provided by the dental hygienist;

(3) has documented participation in courses in infection control and medical
emergencies within each continuing education cycle; and

(4) maintains current certification in advanced or basic cardiac life support as
recognized by the American Heart Association, the American Red Cross, or another
agency that is equivalent to the American Heart Association or the American Red Cross.

(b) The dental hygiene services authorized to be performed by a dental hygienist
under this subdivision are limited to:

(1) oral health promotion and disease prevention education;

(2) removal of deposits and stains from the surfaces of the teeth;

(3) application of topical preventive or prophylactic agents, including fluoride
varnishes and pit and fissure sealants;

(4) polishing and smoothing restorations;

(5) removal of marginal overhangs;

(6) performance of preliminary charting;

(7) taking of radiographs; and

(8) performance of scaling and root planing.

The dental hygienist may administer injections of local anesthetic agents or nitrous
oxide inhalation analgesia as specifically delegated in the collaborative agreement with a
licensed dentist. The dentist need not first examine the patient or be present. If the patient
is considered medically compromised, the collaborative dentist shall review the patient
record, including the medical history, prior to the provision of these services. Collaborating
dental hygienists new text begin who are authorized to perform services under this subdivision new text end may work
with unregistered and registered dental assistants who may only perform duties for which
registration is not required. The performance of dental hygiene services in a health care
facility, program, or nonprofit organization as authorized under this subdivision is limited
to patients, students, and residents of the facility, program, or organization.

(c) A collaborating dentist must be licensed under this chapter and may enter into
a collaborative agreement with no more than four dental hygienists unless otherwise
authorized by the board. The board shall develop parameters and a process for obtaining
authorization to collaborate with more than four dental hygienists. The collaborative
agreement must include:

(1) consideration for medically compromised patients and medical conditions for
which a dental evaluation and treatment plan must occur prior to the provision of dental
hygiene services;

(2) age- and procedure-specific standard collaborative practice protocols, including
recommended intervals for the performance of dental hygiene services and a period of
time in which an examination by a dentist should occur;

(3) copies of consent to treatment form provided to the patient by the dental
hygienist;

(4) specific protocols for the placement of pit and fissure sealants and requirements
for follow-up care to assure the efficacy of the sealants after application; and

(5) a procedure for creating and maintaining dental records for the patients that are
treated by the dental hygienist. This procedure must specify where these records are
to be located.

The collaborative agreement must be signed and maintained by the dentist, the dental
hygienist, and the facility, program, or organization; must be reviewed annually by the
collaborating dentist and dental hygienist; and must be made available to the board
upon request.

(d) Before performing any services authorized under this subdivision, a dental
hygienist must provide the patient with a consent to treatment form which must include a
statement advising the patient that the dental hygiene services provided are not a substitute
for a dental examination by a licensed dentist. If the dental hygienist makes any referrals
to the patient for further dental procedures, the dental hygienist must fill out a referral form
and provide a copy of the form to the collaborating dentist.

(e) For the purposes of this subdivision, a "health care facility, program, or
nonprofit organization" is limited to a hospital; nursing home; home health agency; group
home serving the elderly, disabled, or juveniles; state-operated facility licensed by the
commissioner of human services or the commissioner of corrections; and federal, state, or
local public health facility, community clinic, tribal clinic, school authority, Head Start
program, or nonprofit organization that serves individuals who are uninsured or who are
Minnesota health care public program recipients.

(f) For purposes of this subdivision, a "collaborative agreement" means a written
agreement with a licensed dentist who authorizes and accepts responsibility for the
services performed by the dental hygienist. The services authorized under this subdivision
and the collaborative agreement may be performed without the presence of a licensed
dentist and may be performed at a location other than the usual place of practice of the
dentist or dental hygienist and without a dentist's diagnosis and treatment plan, unless
specified in the collaborative agreement.

new text begin (g) Nothing in this subdivision shall limit an advanced dental hygiene practitioner
from practicing advanced dental hygiene as authorized under this chapter.
new text end

Sec. 9.

Minnesota Statutes 2006, section 150A.10, is amended by adding a subdivision
to read:

new text begin Subd. 1b. new text end

new text begin Advanced dental hygiene practitioners. new text end

new text begin (a) An advanced dental
hygiene practitioner may perform the services authorized within the scope provided in the
collaborative management agreement under this subdivision.
new text end

new text begin (b) The oral health services authorized to be performed by an advanced dental
hygiene practitioner under this subdivision include:
new text end

new text begin (1) all services authorized to be performed by a licensed dental hygienist under
subdivisions 1, 1a, and 4;
new text end

new text begin (2) formulating a diagnosis and individualized care plan based on evidence-based
standards of care and practice guidelines in collaboration with the patient and members of
an oral health care team;
new text end

new text begin (3) providing primary diagnostic, educational, palliative, therapeutic, prescriptive,
and restorative oral health services, including:
new text end

new text begin (i) evidence-based diagnostic services to identify oral diseases and conditions;
new text end

new text begin (ii) preparation of cavities and restoration of primary and permanent teeth using
direct placement of appropriate dental materials;
new text end

new text begin (iii) temporary placement of crowns and restorations;
new text end

new text begin (iv) placement of preformed crowns;
new text end

new text begin (v) pulpotomies on primary teeth; and
new text end

new text begin (vi) direct and indirect pulp capping in primary and permanent teeth;
new text end

new text begin (4) prescribing, administering, and dispensing medications for anti-infective
therapies, nonnarcotic pain management, and prevention pursuant to and subject to the
limitations of the collaborative management agreement and chapter 151;
new text end

new text begin (5) performing nonsurgical extractions of primary and permanent teeth;
new text end

new text begin (6) placing and removing sutures;
new text end

new text begin (7) preventing or intercepting potential orthodontic problems and parafunctional
habits by early identification and appropriate referral;
new text end

new text begin (8) providing reparative services to patients with defective prosthetic appliances;
new text end

new text begin (9) consulting, collaborating, and coordinating care with other health care
professionals in the provision of evidence-based care as a member of an oral health care
team; and
new text end

new text begin (10) providing referrals as needed to patients for further dental procedures or other
health care needs.
new text end

new text begin (c) An advanced dental hygiene practitioner may supervise registered and
unregistered dental assistants. A registered and unregistered dental assistant may perform
all services authorized in this chapter or by the board.
new text end

new text begin (d) The services authorized under this subdivision and the agreement may be
performed:
new text end

new text begin (1) without the patient first being examined by a licensed dentist;
new text end

new text begin (2) without the presence of a licensed dentist;
new text end

new text begin (3) without a dentist's diagnosis and treatment plan; and
new text end

new text begin (4) at a location other than the usual place of practice of the dentist or advanced
dental hygiene practitioner.
new text end

Sec. 10.

Minnesota Statutes 2006, section 150A.10, subdivision 2, is amended to read:

Subd. 2.

Dental assistants.

Every licensed dentist new text begin or advanced dental hygiene
practitioner new text end who uses the services of any unlicensed person for the purpose of assistance
in the practice of dentistry new text begin or advanced dental hygiene new text end shall be responsible for the acts of
such unlicensed person while engaged in such assistance. Such dentist new text begin or advanced dental
hygiene practitioner new text end shall permit such unlicensed assistant to perform only those acts
which are authorized to be delegated to unlicensed assistants by the Board of Dentistry.
Such acts shall be performed under supervision of a licensed dentist new text begin or advanced dental
hygiene practitioner new text end . The board may permit differing levels of dental assistance based
upon recognized educational standards, approved by the board, for the training of dental
assistants. The board may also define by rule the scope of practice of registered and
nonregistered dental assistants. The board by rule may require continuing education
for differing levels of dental assistants, as a condition to their registration or authority
to perform their authorized duties. Any licensed dentist new text begin or advanced dental hygiene
practitioner new text end who shall permit such unlicensed assistant to perform any dental service other
than that authorized by the board shall be deemed to be enabling an unlicensed person
to practice dentistry, and commission of such an act by such unlicensed assistant shall
constitute a violation of sections 150A.01 to 150A.12.

Sec. 11.

Minnesota Statutes 2006, section 150A.10, subdivision 4, is amended to read:

Subd. 4.

Restorative procedures.

(a) Notwithstanding subdivisions 1, 1a, and 2,
a licensed dental hygienist or a registered dental assistant may perform the following
restorative procedures:

(1) place, contour, and adjust amalgam restorations;

(2) place, contour, and adjust glass ionomer;

(3) adapt and cement stainless steel crowns; and

(4) place, contour, and adjust class I and class V supragingival composite restorations
where the margins are entirely within the enamel.

(b) The restorative procedures described in paragraph (a) may be performed only if:

(1) the licensed dental hygienist or the registered dental assistant has completed a
board-approved course on the specific procedures;

(2) the board-approved course includes a component that sufficiently prepares the
dental hygienist or registered dental assistant to adjust the occlusion on the newly placed
restoration;

(3) a licensed dentist has authorized the procedure to be performed; and

(4) a licensed dentist new text begin or advanced dental hygiene practitioner new text end is available in the
clinic while the procedure is being performed.

(c) The dental faculty who teaches the educators of the board-approved courses
specified in paragraph (b) must have prior experience teaching these procedures in an
accredited dental education program.

Sec. 12.

Minnesota Statutes 2006, section 151.01, subdivision 23, is amended to read:

Subd. 23.

Practitioner.

"Practitioner" means a licensed doctor of medicine,
licensed doctor of osteopathy duly licensed to practice medicine, licensed doctor of
dentistry, licensed doctor of optometry, licensed podiatrist, or licensed veterinarian.
For purposes of sections 151.15, subdivision 4, 151.37, subdivision 2, paragraph (b),
and 151.461, "practitioner" also means a physician assistant authorized to prescribe,
dispense, and administer under chapter 147A, deleted text begin or deleted text end an advanced practice nurse authorized to
prescribe, dispense, and administer under section 148.235 new text begin , or an advanced dental hygiene
practitioner authorized to prescribe, dispense, and administer under chapter 150A new text end .

Sec. 13.

Minnesota Statutes 2007 Supplement, section 151.37, subdivision 2, is
amended to read:

Subd. 2.

Prescribing and filing.

(a) A licensed practitioner in the course of
professional practice only, may prescribe, administer, and dispense a legend drug, and may
cause the same to be administered by a nurse, a physician assistant, new text begin an advanced dental
hygiene practitioner, new text end or medical student or resident under the practitioner's direction and
supervision, and may cause a person who is an appropriately certified, registered, or
licensed health care professional to prescribe, dispense, and administer the same within
the expressed legal scope of the person's practice as defined in Minnesota Statutes. A
licensed practitioner may prescribe a legend drug, without reference to a specific patient,
by directing a nurse, pursuant to section 148.235, subdivisions 8 and 9, new text begin an advanced
dental hygiene practitioner pursuant to chapter 150A, a new text end physician assistant, or new text begin a new text end medical
student or resident to adhere to a particular practice guideline or protocol when treating
patients whose condition falls within such guideline or protocol, and when such guideline
or protocol specifies the circumstances under which the legend drug is to be prescribed
and administered. An individual who verbally, electronically, or otherwise transmits a
written, oral, or electronic order, as an agent of a prescriber, shall not be deemed to have
prescribed the legend drug. This paragraph applies to a physician assistant only if the
physician assistant meets the requirements of section 147A.18.

(b) A licensed practitioner that dispenses for profit a legend drug that is to be
administered orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must
file with the practitioner's licensing board a statement indicating that the practitioner
dispenses legend drugs for profit, the general circumstances under which the practitioner
dispenses for profit, and the types of legend drugs generally dispensed. It is unlawful to
dispense legend drugs for profit after July 31, 1990, unless the statement has been filed
with the appropriate licensing board. For purposes of this paragraph, "profit" means (1)
any amount received by the practitioner in excess of the acquisition cost of a legend drug
for legend drugs that are purchased in prepackaged form, or (2) any amount received
by the practitioner in excess of the acquisition cost of a legend drug plus the cost of
making the drug available if the legend drug requires compounding, packaging, or other
treatment. The statement filed under this paragraph is public data under section 13.03.
This paragraph does not apply to a licensed doctor of veterinary medicine or a registered
pharmacist. Any person other than a licensed practitioner with the authority to prescribe,
dispense, and administer a legend drug under paragraph (a) shall not dispense for profit.
To dispense for profit does not include dispensing by a community health clinic when the
profit from dispensing is used to meet operating expenses.

(c) A prescription or drug order for a legend drug is not valid if it is based solely
on an online questionnaire, unless it can be established that the prescription or order was
based on a documented patient evaluation adequate to establish a diagnosis and identify
underlying conditions and contraindications to treatment.