HB4441 98TH GENERAL ASSEMBLY

LRB098 17739 ZMM 52859 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB4441

Introduced , by Rep. William Davis

SYNOPSIS AS INTRODUCED:

225 ILCS 25/4	from Ch. 111, par. 2304
225 ILCS 25/18	from Ch. 111, par. 2318

Amends the Illinois Dental Practice Act. Provides that a dental hygienist may be employed or retained by a nonprofit organization or in a public health setting. Provides that a dental hygienist under remote supervision with a collaborative agreement with a licensed dentist shall provide a dental hygiene examination and screenings and determine which services are necessary to be performed with a referral to a dentist for a dental examination within 12 months. Provides that a dental hygienist may be employed or retained by a health care facility, program, or nonprofit organization to perform dental hygiene services without the patient first being examined by a licensed dentist if the dental hygienist (i) has engaged in active practice of clinical dental hygiene for a minimum of 2,400 hours in the past 18 months or a career total of 3,000 hours, (ii) has entered into a collaborative agreement with a licensed dentist, (iii) had documented participation in courses in infection control and medical emergencies, and (iv) maintains current CPR certification. Provides that a licensed dentist may not have a collaborative agreement with more than 4 dental hygienists, unless otherwise authorized by the Board. Provides that the collaborative agreement must (i) include certain provisions and it must be signed and maintained by the dentist, the dental hygienist, and the facility, program, or organization, (ii) be reviewed yearly, and (iii) be made available to the Board upon request. Makes other changes. Effective immediately.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Dental Practice Act is amended by changing Sections 4 and 18 as follows:

(225 ILCS 25/4) (from Ch. 111, par. 2304)

(Section scheduled to be repealed on January 1, 2016)

Sec. 4. Definitions. As used in this Act:

"Address of record" means the designated address recorded by the Department in the applicant's or licensee's application file or license file as maintained by the Department's licensure maintenance unit. It is the duty of the applicant or licensee to inform the Department of any change of address, and those changes must be made either through the Department's website or by contacting the Department.

"Department" means the Department of Financial and Professional Regulation.

"Secretary" means the Secretary of Financial and Professional Regulation.

"Board" means the Board of Dentistry.

"Dentist" means a person who has received a general license pursuant to paragraph (a) of Section 11 of this Act and who may perform any intraoral and extraoral procedure required in the practice of dentistry and to whom is reserved the responsibilities specified in Section 17.

"Dental hygienist" means a person who holds a license under this Act to perform dental services as authorized by Section 18.

"Dental assistant" means an appropriately trained person who, under the supervision of a dentist, provides dental services as authorized by Section 17.

"Dental laboratory" means a person, firm or corporation which:

(i) engages in making, providing, repairing or altering dental prosthetic appliances and other artificial materials and devices which are returned to a dentist for insertion into the human oral cavity or which come in contact with its adjacent structures and tissues; and

(ii) utilizes or employs a dental technician to provide such services; and

(iii) performs such functions only for a dentist or dentists.

"Supervision" means supervision of a dental hygienist or a dental assistant requiring that a dentist authorize the procedure, remain in the dental facility while the procedure is performed, and approve the work performed by the dental hygienist or dental assistant before dismissal of the patient, but does not mean that the dentist must be present at all times in the treatment room.

"General supervision" means supervision of a dental hygienist requiring that the patient be a patient of record, that the dentist examine the patient in accordance with Section 18 prior to treatment by the dental hygienist, and that the dentist authorize the procedures which are being carried out by a notation in the patient's record, but not requiring that a dentist be present when the authorized procedures are being performed. The issuance of a prescription to a dental laboratory by a dentist does not constitute general supervision.

"Public member" means a person who is not a health professional. For purposes of board membership, any person with a significant financial interest in a health service or profession is not a public member.

"Dentistry" means the healing art which is concerned with the examination, diagnosis, treatment planning and care of conditions within the human oral cavity and its adjacent tissues and structures, as further specified in Section 17.

"Branches of dentistry" means the various specialties of dentistry which, for purposes of this Act, shall be limited to the following: endodontics, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics, and oral and maxillofacial radiology.

"Specialist" means a dentist who has received a specialty license pursuant to Section 11(b).

"Dental technician" means a person who owns, operates or is employed by a dental laboratory and engages in making, providing, repairing or altering dental prosthetic appliances and other artificial materials and devices which are returned to a dentist for insertion into the human oral cavity or which come in contact with its adjacent structures and tissues.

"Impaired dentist" or "impaired dental hygienist" means a dentist or dental hygienist who is unable to practice with reasonable skill and safety because of a physical or mental disability as evidenced by a written determination or written consent based on clinical evidence, including deterioration through the aging process, loss of motor skills, abuse of drugs or alcohol, or a psychiatric disorder, of sufficient degree to diminish the person's ability to deliver competent patient care.

"Nurse" means a registered professional nurse, a certified registered nurse anesthetist licensed as an advanced practice nurse, or a licensed practical nurse licensed under the Nurse Practice Act.

"Patient of record" means a patient for whom the patient's most recent dentist or collaborative dentist has obtained a relevant medical and dental history and on whom the dentist or collaborative dentist has performed an examination or a collaborative dental hygienist has performed a dental hygiene examination and screenings and evaluated the condition to be treated.

"Dental emergency responder" means a dentist or dental hygienist who is appropriately certified in emergency medical response, as defined by the Department of Public Health.

"Mobile dental van or portable dental unit" means any self-contained or portable dental unit in which dentistry is practiced that can be moved, towed, or transported from one location to another in order to establish a location where dental services can be provided.

"Remote supervision" means supervision of a dental hygienist with a collaborative agreement requiring that the registered dental hygienist provide a dental hygiene examination and screenings with an appropriate treatment plan developed and implemented in accordance with supervision provided by a licensed dentist with a written collaborative agreement. Supervision may take place through verbal, written, visual, electronic, or in-person communication, or a combination of those modes of communication, that authorizes the procedures that are being carried out by a notation in the patient's record, but not requiring that a dentist be physically present when the dental hygiene examination and screenings or authorized procedures are being performed, and that a referral to a licensed dentist for a comprehensive dental examination will be made to take place within 12 months.

"Collaborative agreement" means a written agreement between a licensed dental hygienist and a collaborating licensed dentist.

"Public health setting" means a hospital; nursing home; home health agency; group home serving the elderly, the disabled, or juveniles; State-operated facility licensed by the Secretary of Human Services or the Director of Corrections; federal, State, or local public health facility; community clinic; school-based program; school authority; Head Start; Maternal and Child Health Women, Infants, and Children (WIC) program; or a program operated by a non-profit organization that services individuals who are uninsured or who are Illinois health care public program recipients.

(Source: P.A. 97-526, eff. 1-1-12; 97-1013, eff. 8-17-12.)

(225 ILCS 25/18) (from Ch. 111, par. 2318)

(Section scheduled to be repealed on January 1, 2016)

Sec. 18. Acts constituting the practice of dental hygiene; limitations.

(a) A person practices dental hygiene within the meaning of this Act when he or she performs the following acts under the supervision of a dentist:

(i) the operative procedure of dental hygiene, consisting of oral prophylactic procedures;

(ii) the exposure and processing of X-Ray films of the teeth and surrounding structures;

(iii) the application to the surfaces of the teeth or gums of chemical compounds designed to be desensitizing agents or effective agents in the prevention of dental caries or periodontal disease;

(iv) all services which may be performed by a dental assistant as specified by rule pursuant to Section 17, and a dental hygienist may engage in the placing, carving, and finishing of amalgam restorations only after obtaining formal education and certification as determined by the Department;

(v) administration and monitoring of nitrous oxide upon successful completion of a training program approved by the Department;

(vi) administration of local anesthetics upon successful completion of a training program approved by the Department; and

(vii) such other procedures and acts as shall be prescribed by rule or regulation of the Department.

(b) A dental hygienist may be employed or retained engaged only:

(1) by a dentist;

(2) by a federal, State, county, or municipal agency or institution;

(3) by a public or private program school; or

(4) by a nonprofit organization public clinic operating under the direction of a hospital or federal, State, county, municipal, or other public agency or institution ; or .

(5) in a public health setting.

(c) When employed or retained engaged in the office of a dentist, or utilizing remote supervision, a dental hygienist may perform, under general supervision, those procedures found in items (i) through (iv) of subsection (a) of this Section, provided the patient has been examined by the dentist within one year of the provision of dental hygiene services, the dentist has approved the dental hygiene services by a notation in the patient's record and the patient has been notified that the dentist may be out of the office during the provision of dental hygiene services.

(d) If a patient of record is unable to travel to a dental office because of illness, infirmity, or imprisonment, a dental hygienist may perform, under the general supervision of a dentist, those procedures found in items (i) through (iv) of subsection (a) of this Section, provided the patient is located in a long-term care facility licensed by the State of Illinois, a mental health or developmental disability facility, or a State or federal prison. The dental hygienist with a collaborative agreement shall provide a dental hygiene examination and screenings or the dentist shall personally examine and diagnose the patient and determine which services are necessary to be performed, which shall be contained in an order with to the hygienist and a notation in the patient's record. Such order must be implemented within 12 months 120 days of its issuance, and an updated medical history and observation of oral conditions must be performed by the hygienist immediately prior to beginning the procedures to ensure that the patient's health has not changed in any manner to warrant a reexamination by the dentist.

(e) School-based oral health care, consisting of and limited to oral prophylactic procedures, sealants, and fluoride treatments, may be provided by a dental hygienist under the general supervision of a dentist or the remote supervision of a dental hygienist with a collaborative agreement. A dental hygienist may not provide other dental hygiene treatment in a school-based setting, including but not limited to administration or monitoring of nitrous oxide or administration of local anesthetics. The school-based procedures may be performed provided the patient is located at a public or private school and the program is being conducted by a State, county or local public health department initiative or in conjunction with a dental school or dental hygiene program. The dental hygienist under general supervision shall have the The dentist shall personally examine and diagnose the patient and determine which services are necessary to be performed, which shall be contained in an order to the hygienist and a notation in the patient's record. Any such order for sealants must be implemented within 12 months 120 days after its issuance. Any such order for oral prophylactic procedures or fluoride treatments must be implemented within 12 months 180 days after its issuance. An updated medical history and observation of oral conditions must be performed by the hygienist immediately prior to beginning the procedures to ensure that the patient's health has not changed in any manner to warrant a reexamination by the dentist.

The dental hygienist under remote supervision with a collaborative agreement with a licensed dentist shall provide a dental hygiene examination and screenings and determine which services are necessary to be performed with a referral to a dentist within 12 months.

(f) Without the supervision of a dentist, a dental hygienist may perform dental health education functions and may record case histories and oral conditions observed.

(g) The number of dental hygienists practicing in a dental office shall not exceed, at any one time, 4 times the number of dentists practicing in the office at the time.

(h) Notwithstanding subsections (c), (d), (e), or (f) of Section 18, a dental hygienist licensed under this Act may be employed or retained by a health care facility, program, or nonprofit organization to perform dental hygiene services described under subsection (i) of this Section 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 2 of the past 3 years;

(2) has entered into a collaborative agreement with a licensed dentist that designates authorization for the services provided by the dental hygienist and that continues without interruption, provided that the patient is referred to and seen for an annual dental examination by a licensed dentist;

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

(4) maintains current CPR certification from a Basic Life Support (BLS) certification training intended for health care providers at the time of renewal. Basic Life Support certification training taken as a requirement pursuant to this Section shall count for no more than 4 hours during each licensure period toward the continuing education hours.

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

(1) screenings, dental hygiene examinations, and assessing oral health conditions;

(2) preliminary charting of the oral cavity and surrounding structures to include case histories, perform initial and periodic examinations and assessments to determine periodontal status, and formulate a dental hygiene treatment plan in coordination with a dentist's treatment plan;

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

(4) prescribing, administering, and dispensing only fluoride, fluoride varnish, antimicrobial solutions, or resorbable antimicrobial agents;

(5) administering and dispensing home-use oral hygiene aids;

(6) applying sealants;

(7) polishing and smoothing restorations;

(8) removal of marginal overhangs;

(9) performance of preliminary charting;

(10) taking of radiographs;

(11) performance of scaling and root planing; and

(12) administering local anesthesia.

(j) A collaborating dentist must be licensed under this Act and may enter into a collaborative agreement with no more than 4 dental hygienists, unless otherwise authorized by the Board. The Board shall develop parameters and a process for obtaining authorization to collaborate with more than 4 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-specific and procedure-specific standard collaborative practice protocols, including recommended intervals for the performance of dental hygiene services and a period of time that an examination by a dentist should occur;

(3) copies of the 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 ensure 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.

(k) The collaborative agreement must be (i) signed and maintained by the dentist, the dental hygienist, and the facility, program, or organization, (ii) reviewed annually by the collaborating dentist and dental hygienist, and (iii) made available to the Board upon request.

(l) Before performing any services authorized under this Section, a dental hygienist must provide the patient with a consent to treatment form that 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.

(m) The dental hygienist working under a collaborative agreement and the collaborating dentist must agree to maintain communication and consultation with each other.

(n) The dental hygienist working under a collaborative agreement must provide the collaborating dentist opportunities to review patient records as requested.

(Source: P.A. 97-526, eff. 1-1-12.)

Section 99. Effective date. This Act takes effect upon becoming law.