SB89: Bill Text

MED:amn

2019 - 2020 LEGISLATURE

2019 Senate BILL 89

March 7, 2019 - Introduced by Senators Craig, Darling, L. Taylor, Kapenga, Tiffany, Kooyenga, Bernier, Hansen, Stroebel and Schachtner, cosponsored by Representatives Felzkowski, Nygren, Kolste, Mursau, Neylon, Pronschinske, Skowronski, Snyder, Stafsholt, Tauchen, Quinn, Dittrich, Emerson, Gundrum, Hutton, Katsma, Kulp, Magnafici, Myers, Plumer, Ramthun, Schraa, Tusler, Wittke and Zimmerman. Referred to Committee on Health and Human Services.

SB89,2,2 An Act to amend 36.61 (1) (b), 36.61 (3) (a), 36.61 (5) (b) 1., 36.61 (8) (c) 3., 146.81 (1) (c), 146.89 (1) (r) 1., 146.89 (1) (r) 5., 146.89 (3) (b) 8., 146.89 (3m) (intro.), 146.997 (1) (d) 3., 155.01 (7), 252.14 (1) (ar) 3., 257.01 (5) (a), 257.01 (5) (b), 447.02 (1) (a), 447.02 (1) (b), 447.02 (2) (a), 447.02 (3) (a) (intro.), 447.02 (3) (a) 2., 447.02 (3) (b), 447.02 (5), 447.03 (3) (c), 447.05, 447.06 (1), 447.06 (2) (a) 3., 447.06 (2) (b), 447.06 (2) (c) (intro.), 447.06 (2) (c) 2. (intro.), 447.065, 447.07 (1), 447.07 (3) (intro.), 447.07 (3) (e) to (h), 447.40 (intro.), 447.40 (6), 448.03 (2) (a), 448.21 (1) (a), 450.03 (1) (e), 450.10 (3) (a) 4., 462.02 (2) (d), 462.04, 463.10 (5), 463.12 (5), 632.87 (4), 895.48 (1m) (a) (intro.), 895.48 (1m) (a) 2. and 941.315 (5); and to create 15.405 (6) (am), 36.61 (1) (ak), 440.03 (13) (b) 20m., 440.08 (2) (a) 25m., 447.01 (6g), 447.01 (6r), 447.02 (1) (g), 447.03 (1m), 447.03 (3) (am), 447.04 (1m), 447.057, 447.06 (1m) and 447.06 (3) of the statutes; relating to: licensure of dental therapists; extending the time limit for emergency rule procedures; providing an exemption from emergency rule procedures; providing an exemption from rule-making procedures; and granting rule-making authority.

Analysis by the Legislative Reference Bureau

This bill provides for the licensure of dental therapists, who are health care practitioners who may engage in the limited practice of dentistry.

Under current law, dentists and dental hygienists are licensed by the Dentistry Examining Board to practice dentistry and dental hygiene, respectively. This bill provides for the licensure of a third type of dental practitioner, dental therapists. Under the bill, the board must grant a dental therapist license to an individual who satisfies certain criteria, including completion of a dental therapy program and passage of required examinations.

Dental therapists may provide dental therapy services only under the general supervision of a dentist with whom the dental therapist has a collaborative management agreement that addresses various aspects of the dental therapist's practice. Supervision by a dentist requires the dentist's prior knowledge and consent, but does not require the presence of the dentist at the time a task or procedure is being performed or prior examination or diagnosis of a patient by a dentist prior to the provision of dental therapy services by a dental therapist. Dental therapists are, subject to the terms of a collaborative management agreement, limited to providing services, treatments, and procedures that are specified in the bill, as well as additional services, treatments, or procedures specified by the board by rule. Dental therapists must complete 12 hours of continuing education each biennium.

The bill subjects dental therapists to, or covers dental therapists under, various other laws, including the health care records law, the volunteer health care provider program, the health care worker protection law, and the emergency volunteer health care practitioner law. The bill also provides for loan forgiveness for dental therapists under the health care provider loan assistance program.

Finally, the bill requires, effective when the first individual becomes licensed as a dental therapist in this state, that two dental therapists be added to the board.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB89,1 Section 1 . 15.405 (6) (am) of the statutes is created to read:

SB89,2,4 15.405 (6) (am) Two dental therapists who are licensed under ch. 447.

SB89,2 Section 2 . 36.61 (1) (ak) of the statutes is created to read:

SB89,3,2 36.61 (1) (ak) “Dental therapist” means an individual licensed under s. 447.04 (1m).

SB89,3 Section 3 . 36.61 (1) (b) of the statutes is amended to read:

SB89,3,5 36.61 (1) (b) “Health care provider" means a dental therapist, dental hygienist, physician assistant, nurse-midwife, or nurse practitioner.

SB89,4 Section 4 . 36.61 (3) (a) of the statutes is amended to read:

SB89,3,13 36.61 (3) (a) The board shall enter into a written agreement with the health care provider. In the agreement, the health care provider shall agree to practice at least 32 clinic hours per week for 3 years in one or more eligible practice areas in this state or in a rural area, except that a health care provider in the expanded loan assistance program under sub. (8) who is not a dental therapist or dental hygienist may only agree to practice at a public or private nonprofit entity in a health professional shortage area.

SB89,5 Section 5 . 36.61 (5) (b) 1. of the statutes is amended to read:

SB89,3,20 36.61 (5) (b) 1. The degree to which there is an extremely high need for medical care in the eligible practice area, health professional shortage area, or rural area in which an eligible applicant who is not a dental therapist or dental hygienist desires to practice and the degree to which there is an extremely high need for dental care in the dental health shortage area or rural area in which an eligible applicant who is a dental therapist or dental hygienist desires to practice.

SB89,6 Section 6 . 36.61 (8) (c) 3. of the statutes is amended to read:

SB89,3,25 36.61 (8) (c) 3. Practice at a public or private nonprofit entity in a health professional shortage area, if the health care provider is not a dental therapist or dental hygienist, or in a dental health shortage area, if the health care provider is a dental therapist or dental hygienist.

SB89,7 Section 7. 146.81 (1) (c) of the statutes is amended to read:

SB89,4,2 146.81 (1) (c) A dentist or dental therapist licensed under ch. 447.

SB89,8 Section 8 . 146.89 (1) (r) 1. of the statutes is amended to read:

SB89,4,8 146.89 (1) (r) 1. Licensed as a physician under ch. 448, a dentist, dental therapist, or dental hygienist under ch. 447, a registered nurse, practical nurse, or nurse-midwife under ch. 441, an optometrist under ch. 449, a physician assistant under ch. 448, a pharmacist under ch. 450, a chiropractor under ch. 446, a podiatrist under subch. IV of ch. 448, or a physical therapist under subch. III of ch. 448.

SB89,9 Section 9 . 146.89 (1) (r) 5. of the statutes is amended to read:

SB89,4,15 146.89 (1) (r) 5. An individual who holds a valid, unexpired license, certification, or registration issued by another state or territory that authorizes or qualifies the individual to perform acts that are substantially the same as those acts that an individual who is described in subds. 1. to 4., except a dentist , dental therapist, or dental hygienist, is licensed or certified to perform and who performs acts that are within the scope of that license, certification, or registration.

SB89,10 Section 10 . 146.89 (3) (b) 8. of the statutes is amended to read:

SB89,4,21 146.89 (3) (b) 8. Dental services, including tooth extractions and other procedures done under local anesthesia only and any necessary suturing related to the extractions, performed by a dentist or dental therapist who is a volunteer health provider; and dental hygiene services, performed by a dental hygienist who is a volunteer health provider.

SB89,11 Section 11 . 146.89 (3m) (intro.) of the statutes is amended to read:

SB89,5,2 146.89 (3m) (intro.) A volunteer health care provider who is a dentist or dental therapist may provide dental services or a volunteer health care provider who is a dental hygienist may provide dental hygiene services, to persons who are recipients of Medical Assistance, if all of the following apply:

SB89,12 Section 12 . 146.997 (1) (d) 3. of the statutes is amended to read:

SB89,5,4 146.997 (1) (d) 3. A dentist or dental therapist licensed under ch. 447.

SB89,13 Section 13 . 155.01 (7) of the statutes is amended to read:

SB89,5,15 155.01 (7) “Health care provider" means a nurse licensed or permitted under ch. 441, a chiropractor licensed under ch. 446, a dentist or dental therapist licensed under ch. 447, a physician, physician assistant, perfusionist, podiatrist, physical therapist, physical therapist assistant, occupational therapist, or occupational therapy assistant licensed under ch. 448, a person practicing Christian Science treatment, an optometrist licensed under ch. 449, a psychologist licensed under ch. 455, a partnership thereof, a corporation or limited liability company thereof that provides health care services, a cooperative health care association organized under s. 185.981 that directly provides services through salaried employees in its own facility, or a home health agency, as defined in s. 50.49 (1) (a).

SB89,14 Section 14 . 252.14 (1) (ar) 3. of the statutes is amended to read:

SB89,5,17 252.14 (1) (ar) 3. A dentist or dental therapist licensed under ch. 447.

SB89,15 Section 15 . 257.01 (5) (a) of the statutes is amended to read:

SB89,5,24 257.01 (5) (a) An individual who is licensed as a physician, a physician assistant, or a podiatrist under ch. 448, licensed as a registered nurse, licensed practical nurse, or nurse-midwife under ch. 441, licensed as a dentist or dental therapist under ch. 447, licensed as a pharmacist under ch. 450, licensed as a veterinarian or certified as a veterinary technician under ch. 89, or certified as a respiratory care practitioner under ch. 448.

SB89,16 Section 16 . 257.01 (5) (b) of the statutes is amended to read:

SB89,6,8 257.01 (5) (b) An individual who was at any time within the previous 10 years, but is not currently, licensed as a physician, a physician assistant, or a podiatrist under ch. 448, licensed as a registered nurse, licensed practical nurse or nurse-midwife, under ch. 441, licensed as a dentist or dental therapist under ch. 447, licensed as a pharmacist under ch. 450, licensed as a veterinarian or certified as a veterinary technician under ch. 89, or certified as a respiratory care practitioner under ch. 448, if the individual's license or certification was never revoked, limited, suspended, or denied renewal.

SB89,17 Section 17 . 440.03 (13) (b) 20m. of the statutes is created to read:

SB89,6,10 440.03 (13) (b) 20m. Dental therapist.

SB89,18 Section 18 . 440.08 (2) (a) 25m. of the statutes is created to read:

SB89,6,12 440.08 (2) (a) 25m. Dental therapist: October 1 of each odd-numbered year.

SB89,19 Section 19 . 447.01 (6g) of the statutes is created to read:

SB89,6,15 447.01 (6g) “Dental therapist” means an individual who practices dental therapy.

SB89,20 Section 20 . 447.01 (6r) of the statutes is created to read:

SB89,6,18 447.01 (6r) “Dental therapy” means the limited practice of dentistry, consisting of the services, treatments, and procedures specified in s. 447.06 (3) (b).

SB89,21 Section 21 . 447.02 (1) (a) of the statutes is amended to read:

SB89,6,23 447.02 (1) (a) Governing the reexamination of an applicant who fails an examination specified in s. 447.04 (1) (a) 5., (1m) (a) 5., or (2) (a) 5. The rules may specify additional educational requirements for those applicants and may specify the number of times an applicant may be examined.

SB89,22 Section 22 . 447.02 (1) (b) of the statutes is amended to read:

SB89,7,2 447.02 (1) (b) Governing the standards and conditions for the use of radiation and ionizing equipment in the practice of dentistry or dental therapy.

SB89,23 Section 23 . 447.02 (1) (g) of the statutes is created to read:

SB89,7,6 447.02 (1) (g) Specifying services, treatments, or procedures, in addition to those specified under s. 447.06 (3) (b) 1. to 28., that are included within the practice of dental therapy.

SB89,24 Section 24 . 447.02 (2) (a) of the statutes is amended to read:

SB89,7,9 447.02 (2) (a) The conditions for supervision and the degree of supervision required under ss. 447.03 (3) (a), (am), (b) and (d) 2. and 447.065.

SB89,25 Section 25 . 447.02 (3) (a) (intro.) of the statutes is amended to read:

SB89,7,14 447.02 (3) (a) (intro.) The examining board may issue a permit authorizing the practice in this state, without compensation, of dentistry, dental therapy, or dental hygiene to an applicant who is licensed to practice dentistry, dental therapy, or dental hygiene in another state, if all of the following apply:

SB89,26 Section 26 . 447.02 (3) (a) 2. of the statutes is amended to read:

SB89,7,19 447.02 (3) (a) 2. The examining board determines that the applicant is qualified and satisfies the criteria specified under s. 447.04 (1) (b) 1. to 3., except that the examining board may not require the applicant to pass an examination of state statutes and rules relating to dentistry, dental therapy, or dental hygiene.

SB89,27 Section 27 . 447.02 (3) (b) of the statutes is amended to read:

SB89,7,25 447.02 (3) (b) A permit under this subsection shall authorize the practice of dentistry, dental therapy, or dental hygiene in a specified area of the state for a period of time not more than 10 days in a year and may be renewed by the examining board. The examining board may not require an applicant to pay a fee for the issuance or renewal of a permit under this subsection.

SB89,28 Section 28. 447.02 (5) of the statutes is amended to read:

SB89,8,6 447.02 (5) Except as provided in ss. 447.058 and 447.063, nothing in this chapter may be construed as authorizing the examining board to regulate business or administrative support functions or services, that do not constitute the practice of dentistry, dental therapy, or dental hygiene, provided to a business that provides dental or dental hygiene services.

SB89,29 Section 29 . 447.03 (1m) of the statutes is created to read:

SB89,8,10 447.03 (1m) Dental therapists. Except as provided under sub. (3) and s. 447.02 (3), no person may do any of the following unless he or she is licensed to practice dental therapy under this chapter:

SB89,8,11 (a) Practice or offer to practice dental therapy.

SB89,8,14 (b) Represent himself or herself to the public as a dental therapist or use, in connection with his or her name, any title or description that may convey the impression that he or she is a dental therapist.

SB89,30 Section 30 . 447.03 (3) (am) of the statutes is created to read:

SB89,8,19 447.03 (3) (am) A dental therapy student who practices dental therapy under the supervision of a dentist in an infirmary, clinic, hospital or other institution connected or associated for training purposes with an accredited dental therapy school.

SB89,31 Section 31 . 447.03 (3) (c) of the statutes is amended to read:

SB89,9,2 447.03 (3) (c) An individual licensed to practice dentistry, dental therapy, or dental hygiene in another state or country who practices dentistry , dental therapy, or dental hygiene in a program of dental education or research at the invitation of a group of dentists or practices dentistry, dental therapy, or dental hygiene under the jurisdiction of the army, navy, air force, U.S. public health service, or veterans bureau.

SB89,32 Section 32 . 447.04 (1m) of the statutes is created to read:

SB89,9,5 447.04 (1m) Dental therapists. (a) The examining board shall grant a license to practice dental therapy to an individual who does all of the following: