HF 1712

1st Engrossment - 90th Legislature (2017 - 2018) Posted on 02/20/2018 01:14pm

A bill for an act
relating to health occupations; modifying the requirements for collaborative
community dental hygiene services; establishing requirements for collaborative
community dental assisting services; amending Minnesota Statutes 2016, sections
150A.10, subdivision 1a, by adding a subdivision; 150A.105, subdivision 8.

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

Section 1.

Minnesota Statutes 2016, section 150A.10, subdivision 1a, is amended to read:

Subd. 1a.

deleted text begin Limited deleted text end new text begin Collaborative practice new text end authorization for dental hygienists new text begin in
community settings new text end .

(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 new text begin the new text end dental hygiene services deleted text begin described under paragraph (b) deleted text end new text begin listed in
Minnesota Rules, part 3100.8700, subpart 1, new text end without the patient first being examined by a
licensed dentist if the dental hygienist:

deleted text begin (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;
deleted text end

deleted text begin (2) deleted text end new text begin (1) new text end has entered into a collaborative agreement with a licensed dentist that designates
authorization for the services provided by the dental hygienist; new text begin and
new text end

deleted text begin (3) deleted text end new text begin (2) new text end has documented deleted text begin participation in courses in infection control and deleted text end new text begin completion of
a course on new text end medical emergencies within each continuing education cycle deleted text begin ; and deleted text end new text begin .
new text end

deleted text begin (4) maintains current CPR certification from completion of the American Heart
Association healthcare provider course or the American Red Cross professional rescuer
course.
deleted text end

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

deleted text begin (1) oral health promotion and disease prevention education;
deleted text end

deleted text begin (2) removal of deposits and stains from the surfaces of the teeth;
deleted text end

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

deleted text begin (4) polishing and smoothing restorations;
deleted text end

deleted text begin (5) removal of marginal overhangs;
deleted text end

deleted text begin (6) performance of preliminary charting;
deleted text end

deleted text begin (7) taking of radiographs; and
deleted text end

deleted text begin (8) performance of scaling and root planing.
deleted text end

deleted text begin 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
may work with unlicensed and licensed dental assistants who may only perform duties for
which licensure 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.
deleted text end

deleted text begin (c) deleted text end new text begin (b) new text end 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) deleted text begin 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. deleted text end new text begin the procedure for creating and maintaining dental records for patients who are
treated by the dental hygienist under Minnesota Rules, part 3100.9600, including specifying
where records will be located.
new text end

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 deleted text begin ; deleted text end and must be made available to the board upon
request.

deleted text begin (d) deleted text end new text begin (c) new text end 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. deleted text begin 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. deleted text end new text begin When the patient requires a
referral for additional dental services, the dental hygienist shall complete a referral form
and provide a copy to the patient, the facility, if applicable, the dentist to whom the patient
is being referred, and the collaborating dentist, if specified in the collaborative agreement.
A copy of the referral form shall be maintained in the patient's health care record. The patient
does not become a new patient of record of the dentist to whom the patient was referred
until the dentist accepts the patient for follow-up services after referral from the dental
hygienist.
new text end

deleted text begin (e) deleted text end new text begin (d) new text end For the purposes of this subdivision, a "health care facility, program, or nonprofit
organization" deleted text begin is limited to deleted text end new text begin includes new text end 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.

deleted text begin (f) deleted text end new text begin (e) new text end 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. deleted text begin 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.
deleted text end

Sec. 2.

Minnesota Statutes 2016, section 150A.10, is amended by adding a subdivision to
read:

new text begin Subd. 2a. new text end

new text begin Collaborative practice authorization for dental assistants in community
settings. new text end

new text begin (a) Notwithstanding subdivision 2, a dental assistant licensed under this chapter
may be employed or retained by a health care facility, program, or nonprofit organization
as defined in subdivision 1a to perform the dental assisting services described in paragraph
(b) without the patient first being examined by a licensed dentist, without a dentist's diagnosis
or treatment plan, and without the dentist being present at the location where services are
being performed, if:
new text end

new text begin (1) the dental assistant has entered into a collaborative agreement with a licensed dentist,
which must be part of a collaborative agreement established between a licensed dentist and
a dental hygienist under subdivision 1a, that designates authorization for the services provided
by the dental assistant; and
new text end

new text begin (2) the dental assistant has documented completion of a course on medical emergencies
within each continuing education cycle.
new text end

new text begin (b) A dental assistant operating under general supervision of a collaborating dentist
under this subdivision is authorized to perform the following services:
new text end

new text begin (1) provide oral health promotion and disease prevention education;
new text end

new text begin (2) take vital signs such as pulse rate and blood pressure;
new text end

new text begin (3) obtain informed consent, according to Minnesota Rules, part 3100.9600, subpart 9,
for treatments authorized by the collaborating dentist within the licensed dental assistant's
scope of practice;
new text end

new text begin (4) apply topical preventative agents, including fluoride varnishes and pit and fissure
sealants;
new text end

new text begin (5) perform mechanical polishing to clinical crowns not including instrumentation;
new text end

new text begin (6) complete preliminary charting of the oral cavity and surrounding structures, except
periodontal probing and assessment of the periodontal structure;
new text end

new text begin (7) take photographs extraorally or intraorally; and
new text end

new text begin (8) take radiographs.
new text end

new text begin (c) A collaborating dentist must be licensed under this chapter and may enter into a
collaborative agreement with no more than two licensed dental assistants, unless otherwise
authorized by the board. The board shall develop a process and parameters for obtaining
authorization to collaborate with more than two licensed dental assistants. The collaborative
agreement must include the elements listed in subdivision 1a, paragraph (b).
new text end

Sec. 3.

Minnesota Statutes 2016, section 150A.105, subdivision 8, is amended to read:

Subd. 8.

Definitions.

(a) For the purposes of this section, the following definitions apply.

(b) "Practice settings that serve the low-income and underserved" mean:

(1) critical access dental provider settings as designated by the commissioner of human
services under section 256B.76, subdivision 4;

(2) dental hygiene collaborative practice settings identified in section 150A.10,
subdivision 1a, paragraph deleted text begin (e) deleted text end new text begin (d) new text end , and including medical facilities, assisted living facilities,
federally qualified health centers, and organizations eligible to receive a community clinic
grant under section 145.9268, subdivision 1;

(3) military and veterans administration hospitals, clinics, and care settings;

(4) a patient's residence or home when the patient is home-bound or receiving or eligible
to receive home care services or home and community-based waivered services, regardless
of the patient's income;

(5) oral health educational institutions; or

(6) any other clinic or practice setting, including mobile dental units, in which at least
50 percent of the total patient base of the dental therapist or advanced dental therapist
consists of patients who:

(i) are enrolled in a Minnesota health care program;

(ii) have a medical disability or chronic condition that creates a significant barrier to
receiving dental care;

(iii) do not have dental health coverage, either through a public health care program or
private insurance, and have an annual gross family income equal to or less than 200 percent
of the federal poverty guidelines; or

(iv) do not have dental health coverage, either through a state public health care program
or private insurance, and whose family gross income is equal to or less than 200 percent of
the federal poverty guidelines.

(c) "Dental health professional shortage area" means an area that meets the criteria
established by the secretary of the United States Department of Health and Human Services
and is designated as such under United States Code, title 42, section 254e.