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Minnesota Legislature

Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

                              CHAPTER 5-S.F.No. 13 
                  An act relating to health; modifying dental practice 
                  provisions; requiring a study; amending Minnesota 
                  Statutes 2002, sections 150A.06, subdivisions 1a, 3, 
                  by adding a subdivision; 150A.10, subdivision 1a, by 
                  adding a subdivision; 256B.55, subdivisions 3, 4, 5. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 2002, section 150A.06, 
        subdivision 1a, is amended to read: 
           Subd. 1a.  [FACULTY DENTISTS.] (a) Faculty members of a 
        school of dentistry must be licensed or registered in order to 
        practice dentistry as defined in section 150A.05.  The board may 
        issue to members of the faculty of a school of dentistry a 
        license designated as either a "limited faculty license" or a 
        "full faculty license" entitling the holder to practice 
        dentistry within the school and its affiliated teaching 
        facilities, but only for the purposes of instructing or 
        conducting research.  The practice of dentistry at a school 
        facility for purposes other than instruction or research is not 
        allowed unless the faculty member is licensed under subdivision 
        1 or is a faculty member on August 1, 1993 terms described in 
        paragraph (b) or (c).  The dean of the school of dentistry and 
        program directors of accredited Minnesota dental hygiene or 
        dental assisting schools shall certify to the board those 
        members of the school's faculty who practice dentistry but are 
        not licensed to practice dentistry in Minnesota.  A faculty 
        member who practices dentistry as defined in section 150A.05, 
        before beginning duties in the school of dentistry, shall apply 
        to the board for a limited or full faculty license.  The license 
        expires the next July 1 and may, at the discretion of the board, 
        be renewed on a yearly basis.  The faculty applicant shall pay a 
        nonrefundable fee set by the board for issuing and renewing the 
        faculty license.  The faculty license is valid during the time 
        the holder remains a member of the faculty of a school of 
        dentistry and subjects the holder to this chapter.  This 
        subdivision takes effect on September 1 following the date that 
        the rules adopted under this subdivision become effective.  
           (b) The board may issue to dentist members of the faculty 
        of an accredited Minnesota school of dentistry, dental hygiene, 
        or dental assisting a license designated as a limited faculty 
        license entitling the holder to practice dentistry within the 
        school and its affiliated teaching facilities, but only for the 
        purposes of instructing or conducting research.  The practice of 
        dentistry at a school facility for purposes other than 
        instruction or research is not allowed unless the faculty member 
        is licensed under subdivision 1 or is a faculty member on August 
        1, 1993.  
           (c) The board may issue to dentist members of the faculty 
        of an accredited Minnesota school of dentistry, dental hygiene, 
        or dental assisting a license designated as a full faculty 
        license entitling the holder to practice dentistry within the 
        school and its affiliated teaching facilities and elsewhere if 
        the holder of the license is employed 50 percent time or more by 
        the school in the practice of teaching or research, and upon 
        successful review by the board of the applicant's qualifications 
        as described in subdivisions 1c and 4.  The board, at its 
        discretion, may waive specific licensing prerequisites. 
           Sec. 2.  Minnesota Statutes 2002, section 150A.06, is 
        amended by adding a subdivision to read: 
           Subd. 2d.  [VOLUNTEER AND RETIRED DENTISTS, DENTAL 
        HYGIENISTS, AND REGISTERED DENTAL ASSISTANTS.] (a) The board 
        shall grant a waiver to the continuing education requirements 
        under this chapter for a dentist, dental hygienist, or 
        registered dental assistant who documents to the satisfaction of 
        the board that the dentist, dental hygienist, or registered 
        dental assistant has retired from active practice in the state 
        and limits the provision of dental care services to those 
        offered without compensation in a public health, community, or 
        tribal clinic or a nonprofit organization that provides services 
        to the indigent or to recipients of medical assistance, general 
        assistance medical care, or MinnesotaCare programs. 
           (b) The board may require written documentation from the 
        volunteer and retired dentist, dental hygienist, or registered 
        dental assistant prior to granting this waiver. 
           (c) The board shall require the volunteer and retired 
        dentist, dental hygienist, or registered dental assistant to 
        meet the following requirements: 
           (1) a licensee or registrant seeking a waiver under this 
        subdivision must complete at least five hours of approved 
        courses in infection control, medical emergencies, and medical 
        management for the continuing education cycle; and 
           (2) provide documentation of certification in advanced or 
        basic cardiac life support recognized by the American Heart 
        Association, the American Red Cross, or an equivalent entity. 
           Sec. 3.  Minnesota Statutes 2002, section 150A.06, 
        subdivision 3, is amended to read: 
           Subd. 3.  [WAIVER OF EXAMINATION.] (a) All or any part of 
        the examination for dentists or dental hygienists, except that 
        pertaining to the law of Minnesota relating to dentistry and the 
        rules of the board, may, at the discretion of the board, be 
        waived for an applicant who presents a certificate of 
        qualification from the national board of dental examiners or 
        evidence of having maintained an adequate scholastic standing as 
        determined by the board, in dental school as to dentists, or 
        dental hygiene school as to dental hygienists. 
           (b) Effective January 1, 2004, the board shall waive the 
        clinical examination required for licensure for any applicant 
        who is a graduate of a dental school accredited by the 
        commission on dental accreditation of the American Dental 
        Association or an equivalent organization as determined by the 
        board, who has successfully completed Parts I and II of National 
        Boards, and who has satisfactorily completed a Minnesota-based 
        postdoctoral general dentistry residency program accredited by 
        the commission on dental accreditation of the American Dental 
        Association if the program is of at least one year's duration 
        and includes an outcome assessment evaluation assessing the 
        resident's competence to practice dentistry.  The board may 
        require the applicant to submit any information deemed necessary 
        by the board to determine whether the waiver is applicable.  The 
        board may waive the clinical examination for an applicant who 
        meets the requirements of this paragraph and has satisfactorily 
        completed an accredited postdoctoral general dentistry residency 
        program located outside of Minnesota. 
           Sec. 4.  Minnesota Statutes 2002, 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 two years practical clinical experience with a 
        licensed dentist within the preceding five years 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; and 
           (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 and soft-tissue 
        curettage.  The dental hygienist shall not place pit and fissure 
        sealants, unless the patient has been recently examined and the 
        treatment planned by a licensed dentist.  
        The dental hygienist shall not perform injections of anesthetic 
        agents or the administration of nitrous oxide unless under the 
        indirect supervision of a licensed dentist.  Collaborating 
        dental hygienists 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; and 
           (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 and, 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, or 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.  
           (e) (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. 
           Sec. 5.  Minnesota Statutes 2002, section 150A.10, is 
        amended by adding a subdivision 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 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. 6.  Minnesota Statutes 2002, section 256B.55, 
        subdivision 3, is amended to read: 
           Subd. 3.  [DUTIES.] The advisory committee shall provide 
        recommendations on the following: 
           (1) how to reduce the administrative burden governing 
        dental care coverage policies in order to promote administrative 
        simplification, including prior authorization, coverage limits, 
        and co-payment collections developing a new model for 
        purchasing, administering, and delivering dental care services 
        to public program recipients based on public health principles; 
           (2) developing and implementing an action plan to improve 
        the oral health of children and persons with special needs in 
        the state exploring innovative ways to develop workforce 
        solutions to ensure access to dental care statewide; and 
           (3) exploring alternative ways of purchasing and improving 
        access to dental services; 
           (4) developing ways to foster greater responsibility among 
        health care program recipients in seeking and obtaining dental 
        care, including initiatives to keep dental appointments and 
        comply with dental care plans; 
           (5) exploring innovative ways for dental providers to 
        schedule public program patients in order to reduce or minimize 
        the effect of appointment no shows; 
           (6) exploring ways to meet the barriers that may be present 
        in providing dental services to health care program recipients 
        such as language, culture, disability, and lack of 
        transportation; and 
           (7) exploring the possibility of pediatricians, family 
        physicians, and nurse practitioners providing basic oral health 
        screenings and basic preventive dental services identifying data 
        needed to effectively evaluate the dental care needs of the 
        state.  
           Sec. 7.  Minnesota Statutes 2002, section 256B.55, 
        subdivision 4, is amended to read: 
           Subd. 4.  [REPORT.] The commissioner shall submit a report 
        by February 1, 2002, and by each February 1, 2003 thereafter, 
        summarizing the activities and recommendations of the advisory 
        committee. 
           Sec. 8.  Minnesota Statutes 2002, section 256B.55, 
        subdivision 5, is amended to read: 
           Subd. 5.  [SUNSET.] Notwithstanding section 15.059, 
        subdivision 5, this section expires June 30, 2003 2007.  
           Sec. 9.  [URGENT CARE DENTAL CLINIC.] 
           The commissioner of human services, in consultation with 
        the dental access advisory committee, is requested to report on 
        the feasibility of developing one or more urgent care dental 
        clinics.  The primary purpose of an urgent care dental clinic is 
        to provide recipients of medical assistance, general assistance 
        medical care, and MinnesotaCare with an alternative to receiving 
        dental care services in hospital emergency rooms.  The 
        commissioner shall determine if savings from the reduction in 
        dental care provided in emergency rooms would warrant the 
        construction of urgent care facilities.  The commissioner may 
        seek funding for the construction and operation of a dental 
        urgent care clinic from the federal government as authorized by 
        Congress under the dental health improvement provisions of the 
        Health Care Safety Net Improvement Act of 2002. 
           Sec. 10.  [DENTAL ASSISTANT STUDY.] 
           The board of dentistry, in consultation with the Minnesota 
        Dental Association, the Minnesota Dental Assistants Association, 
        and the Minnesota Dental Hygienists' Association, shall make 
        recommendations on the appropriate level of regulation for 
        dental assistants and the appropriate terminology used to 
        distinguish the different levels of training and education.  The 
        recommendations must include:  
           (1) whether registered dental assistants should be 
        licensed; and 
           (2) whether the term "nonregistered dental assistants" 
        should be changed to a term that better describes this position. 
           In making these recommendations, the board must consult 
        with representatives of registered and nonregistered dental 
        assistants and must review the issues in terms of the 
        requirements of Minnesota Statutes, section 214.001, subdivision 
        2, and consumer safety and awareness.  The board must report the 
        recommendations to the chairs and ranking minority members of 
        the house and senate health and human services policy committees 
        by January 15, 2004.  
           Sec. 11.  [EXPIRATION.] 
           Minnesota Statutes 2002, section 150A.06, subdivision 3, 
        paragraph (b), expires on August 1, 2008. 
           Presented to the governor May 27, 2003 
           Signed by the governor May 30, 2003, 4:03 p.m.