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

CHAPTER 30--H.F.No. 1712

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 Limiteddeleted text end new text begin Collaborative practicenew text end authorization for dental hygienistsnew text begin in community settingsnew 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 andnew 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 anddeleted text end new text begin completion of a course onnew text end medical emergencies within each continuing education cycledeleted text begin ; anddeleted 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 hygienistdeleted 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 todeleted text end new text begin includesnew 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.

Presented to the governor May 8, 2017

Signed by the governor May 11, 2017, 10:43 a.m.

Official Publication of the State of Minnesota
Revisor of Statutes