SB1464 99TH GENERAL ASSEMBLY

LRB099 07277 HAF 27381 b

99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB1464

Introduced 2/20/2015, by Sen. Donne E. Trotter

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 (rather than employed) in specified settings, including in a public health setting (and defines "public health setting"). Provides that certain orders by dentists to dental hygienists must be completed within 12 months (rather than 120 or 180 days). Allows a dental hygienist to perform certain dental hygiene services in a public health setting if the dental hygienist has entered into a written collaborative agreement with a licensed dentist. Sets requirements for the written collaborative agreements and limits the services that may be authorized. 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(Section scheduled to be repealed on January 1, 2016)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 has obtained a relevant medical and dental history and on whom the dentist has performed an examination and evaluated the condition to be treated or for whom a dental hygienist with whom the dentist has a written collaborative agreement has performed a dental hygiene assessment and screening.

"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.

"Written collaborative agreement" means a written agreement between a licensed dental hygienist and a collaborating licensed dentist to authorize the licensed dental hygienist to perform services under subsection (i) of Section 18 of this Act.

"Consultation" means the process whereby a dental hygienist seeks the advice, opinion, or direction of a dentist.

"Public health setting" means a hospital; a nursing home; a home health agency; a group home serving the elderly, the disabled, or juveniles; a State-operated facility or facility licensed by the State of Illinois; a State or federal prison; a federal, State, or local public health facility; a community clinic; a school-based program; a school authority; Head Start; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; or a program operated by a non-profit organization or any other entity that serves individuals who are uninsured or who are Illinois Medical Assistance 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) in a public health setting by a public clinic operating under the direction of a hospital or federal, State, county, municipal, or other public agency or institution.

(c) When employed or retained engaged in the office of a dentist, 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 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. Such order must be completed 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. 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 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 completed implemented within 12 months 120 days after its issuance. Any such order for oral prophylactic procedures or fluoride treatments must be completed 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.

(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 this Section, a dental hygienist licensed under this Act may perform dental hygiene services described under subsection (i) of this Section in a public health setting if the dental hygienist has entered into a written collaborative agreement with a licensed dentist.

(i) The dental hygiene services authorized to be performed by a dental hygienist under a written collaborative agreement are limited to:

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

(2) preliminary charting of the oral cavity and surrounding structures to include case histories in order to formulate a dental hygiene care 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; and

(11) performance of scaling and root planing.

(j) A collaborating dentist must be licensed under this Act and may enter into a written 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.

(k) The written collaborative agreement must:

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

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

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

(4) include 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;

(5) include a procedure for creating and maintaining dental records for the patients that are treated by the dental hygienist; this procedure must specify the notations to be made in the patient's record regarding procedures authorized by the collaborating dentist and performed by the dental hygienist pursuant to the written collaborative agreement and specify where these records are to be located;

(6) include a provision that requires the dental hygienist working under a written collaborative agreement and the collaborating dentist to maintain communication and consultation with each other;

(7) include a provision that requires the dental hygienist working under a written collaborative agreement to provide the collaborating dentist opportunities to review patient records as requested;

(8) include provisions detailing notice for termination or change of status involving a written collaborative agreement, except when such notice is given for just cause;

(9) include a provision that requires the dental hygienist to inform each collaborating dentist of all written collaborative agreements he or she has signed and provide a copy of these to any collaborating dentist upon request;

(10) require that the dental hygienist refer each of his or her patients to a licensed dentist for a comprehensive dental examination; and

(l1) be (i) signed and maintained by the dentist, the dental hygienist, and the authorized representative of the facility, program, or organization, (ii) reviewed annually by the collaborating dentist and dental hygienist, and (iii) made available to the Board upon request.

The collaborative relationship under a written collaborative agreement shall not be construed to require that a dentist examine a patient prior to treatment by the dental hygienist or to require the personal presence of a dentist at the place where services are rendered. Methods of communication shall be available for consultation with the collaborating dentist in person or by telecommunications in accordance with established written guidelines as set forth in the written collaborative agreement.

(l) Before performing any services authorized under a written collaborative agreement, a dental hygienist must provide the patient or guardian with a consent to treatment form that must include a statement advising the patient or guardian 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) Nothing in this Act shall be construed to limit the delegation of tasks or duties by a dentist to a dental hygienist, dental technician, or other persons in accordance with Section 17 of this Act. Nothing in this Act shall be construed to limit the method of delegation that may be authorized by any means, including, but not limited to, oral, written, electronic, standing orders, protocols, guidelines, or verbal orders.

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

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