SB181: Bill Text

SB181,16,10 6. “Medical Assistance patient” means a patient who is a recipient of services under the Medical Assistance program under subch. IV of ch. 49.

SB181,16,12 7. “Qualifying dentist” means a dentist who is licensed in this state and who is actively practicing in this state.

SB181,16,16 8. “Uninsured patient” means a patient who lacks dental health coverage, either through a public health care program or private insurance, and has an annual gross family income equal to or less than 200 percent of the federal poverty guidelines.

SB181,16,19 (b) The scope of practice of a dental therapist shall, subject to the terms of a collaborative management agreement, be limited to providing the following services, treatments, and procedures:

SB181,16,21 1. Oral evaluation and assessment of dental disease and formulation of an individualized treatment plan.

SB181,16,24 2. Identification of oral and systemic conditions requiring evaluation or treatment by dentists, physicians, or other health care providers and managing referrals.

SB181,16,25 3. Comprehensive charting of the oral cavity.

SB181,17,2 4. Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis.

SB181,17,3 5. Exposure and evaluation of radiographic images.

SB181,17,4 6. Dental prophylaxis, including subgingival scaling and polishing procedures.

SB181,17,7 7. Dispensing and administration via the oral or topical route of nonnarcotic analgesic, anti-inflammatory, and antibiotic medications as prescribed by a licensed health care provider.

SB181,17,10 8. Application of topical preventive or prophylactic agents, including fluoride varnish, antimicrobial agents, caries arresting medicaments, and pit and fissure sealants.

SB181,17,11 9. Pulp vitality testing.

SB181,17,12 10. Application of desensitizing medications or resins.

SB181,17,13 11. Fabrication of athletic mouth guards and soft occlusal guards.

SB181,17,14 12. Changing of periodontal dressings.

SB181,17,15 13. Administration of local anesthetic and nitrous oxide.

SB181,17,16 14. Simple extraction of erupted primary teeth.

SB181,17,20 15. Nonsurgical extraction of periodontally diseased permanent teeth with tooth mobility of +3 to +4 to the extent authorized in the dental therapist's collaborative management agreement, except for the extraction of a tooth that is unerupted, impacted, or fractured or that needs to be sectioned for removal.

SB181,17,22 16. Emergency palliative treatment of dental pain limited to the procedures in this paragraph.

SB181,17,24 17. Preparation and placement of direct restoration in primary and permanent teeth.

SB181,17,25 18. Fabrication and placement of single-tooth temporary crowns.

SB181,18,1 19. Preparation and placement of preformed crowns on primary teeth.

SB181,18,2 20. Indirect and direct pulp capping on permanent teeth.

SB181,18,3 21. Indirect pulp capping on primary teeth.

SB181,18,4 22. Intraoral suture placement and removal.

SB181,18,5 23. Minor adjustment and repair of removable prostheses.

SB181,18,6 24. Placement and removal of space maintainers.

SB181,18,7 25. Pulpotomy on primary teeth.

SB181,18,8 26. Tooth reimplantation and stabilization.

SB181,18,9 27. Recementing of a permanent crown.

SB181,18,11 28. Any additional services, treatments, or procedures specified in the rules promulgated under s. 447.02 (1) (g).

SB181,18,15 (bm) 1. Notwithstanding par. (b) 1. to 28., a dental therapist shall, except as provided in subd. 2., limit his or her practice of dental therapy to providing the services, treatments, and procedures covered by his or her dental therapy education program.

SB181,18,20 2. If any service, treatment, or procedure under par. (b) 1. to 28. was not covered by a dental therapist's dental therapy education program, the dental therapist may provide that service, treatment, or procedure if the dental therapist has subsequently received additional dental therapy educational training to provide that service, treatment, or procedure.

SB181,18,24 (c) 1. Except as provided in subd. 2., a dental therapist licensed under this chapter may provide dental therapy services in this state only under the direct supervision or indirect supervision of a qualifying dentist with whom the dental therapist has entered into a collaborative management agreement.

SB181,19,5 2. a. Once a dental therapist licensed under this chapter has provided dental therapy services for at least 2,000 hours under direct supervision or indirect supervision, the dental therapist may provide dental therapy services in this state under the general supervision of a qualifying dentist with whom the dental therapist has entered into a collaborative management agreement.

SB181,19,12 b. For purposes of the 2,000 hours requirement under subd. 2. a., hours may include hours of providing dental therapy services in this state under direct supervision or indirect supervision of a qualifying dentist as described in subd. 1. or hours of providing dental therapy services under direct supervision or indirect supervision while licensed as a dental therapist outside this state, but may not include any hours completed prior to graduating from the dental therapy education program.

SB181,19,15 3. Notwithstanding subds. 1. and 2., the level of supervision for a dental therapist may be further limited under the terms of a collaborative management agreement under par. (d) 1. b.

SB181,19,22 4. A supervising dentist shall accept responsibility for all services performed by a dental therapist pursuant to a collaborative management agreement. If services needed by a patient are beyond the dental therapist's scope of practice or authorization under the collaborative management agreement, the dental therapist shall, to the extent required under the collaborative management agreement, consult with the supervising dentist as needed to arrange for those services to be provided by a dentist or another qualified health care provider.

SB181,20,2 (d) 1. Prior to providing any dental therapy services, a dental therapist shall enter into a written collaborative management agreement with a qualifying dentist who will serve as a supervising dentist under par. (c). The agreement must be signed by the dental therapist and the qualifying dentist and address all of the following:

SB181,20,4 a. The practice settings where services may be provided and the patient populations that may be served.

SB181,20,8 b. Consistent with and subject to pars. (bm) and (c), any conditions or limitations on the services that may be provided by the dental therapist, the level of supervision required, and any circumstances requiring consultation prior to performing services.

SB181,20,9 c. Age-specific and procedure-specific practice protocols.

SB181,20,10 d. Dental record-keeping procedures.

SB181,20,11 e. Plans for managing dental or medical emergencies.

SB181,20,13 f. A quality assurance plan for monitoring care provided by the dental therapist.

SB181,20,14 g. Protocols for administering and dispensing medications.

SB181,20,16 h. Criteria or protocols relating to the provision of care to patients with specific medical conditions, treatments, or medications.

SB181,20,17 i. Policies relating to supervision of dental hygienists and other staff.

SB181,20,20 j. A plan for the referral of patients to other dental or health care providers or clinics when services needed are beyond the scope of practice or authorization of the dental therapist.

SB181,20,22 k. Whether and to what extent the dental therapist may perform services described in par. (b) 15.

SB181,20,24 2. a. A collaborative management agreement shall be limited to covering one qualifying dentist and one dental therapist.

SB181,21,2 b. A dental therapist may enter into multiple collaborative management agreements.

SB181,21,4 c. No dentist may have collaborative management agreements with more than 4 dental therapists at any time.

SB181,21,5 (e) A dental therapist shall at all times comply with at least one of the following:

SB181,21,11 1. Limit his or her practice to practicing in one or more dental health shortage areas. If a dental therapist begins practicing in a dental health shortage area, and that area loses its designation as a dental health shortage area while the dental therapist continues to practice in that area, the dental therapist is considered to satisfy this subdivision as long as the dental therapist continues to practice in that area.

SB181,21,13 2. Practice in one or more settings in which at least 50 percent of the total patient base of the dental therapist consists of patients who are any of the following:

SB181,21,14 a. Medical Assistance patients.

SB181,21,15 b. Uninsured patients.

SB181,21,16 c. Patients receiving dental care at free and charitable clinics.

SB181,21,17 d. Patients receiving dental care at federally qualified health centers.

SB181,21,18 e. Patients who reside in long-term care facilities.

SB181,21,19 f. Veterans.

SB181,21,20 g. Patients who are members of a federally recognized Indian tribe or band.

SB181,21,21 h. Patients receiving dental care at clinics or facilities located on tribal lands.

SB181,21,23 i. Patients with medical disabilities or chronic conditions that create barriers of access to dental care.

SB181,44 Section 44. 447.063 of the statutes is amended to read:

SB181,22,6 447.063 Preservation and transfer of patient health care records. (1) A person who manages or controls a business that offers dental, dental therapy, or dental hygiene services, including management or control of a business through which the person allows another person to offer dental, dental therapy, or dental hygiene services, shall preserve patient health care records, as defined in s. 146.81 (4), for an amount of time determined by the examining board by rule.

SB181,22,13 (2) A person who manages or controls a business that offers dental, dental therapy, or dental hygiene services, including management or control of a business through which the person allows another person to offer dental, dental therapy, or dental hygiene services, shall, upon request of a patient or person authorized by the patient, as defined in s. 146.81 (5), transfer the patient health care records, as defined in s. 146.81 (4), of the patient to another person that the patient or person authorized by the patient specifies to receive the patient health care records.

SB181,45 Section 45 . 447.065 of the statutes is amended to read:

SB181,22,19 447.065 Delegation of remediable procedures and dental practices. (1) A dentist or dental therapist who is licensed to practice dentistry under this chapter may delegate to an individual who is not licensed under this chapter only the performance of remediable procedures, and only if all of the following conditions are met:

SB181,22,21 (a) The unlicensed individual performs the remediable procedures in accordance with a treatment plan approved by the dentist or dental therapist.

SB181,22,23 (b) The dentist or dental therapist is on the premises when the unlicensed individual performs the remediable procedures.

SB181,22,25 (c) The unlicensed individual's performance of the remediable procedures is subject to inspection by the dentist or dental therapist.

SB181,23,7 (2) Subject to the requirements under s. 447.06 (2), a dentist or dental therapist who is licensed to practice dentistry under this chapter may delegate to a dental hygienist who is licensed to practice dental hygiene under this chapter the performance of remediable procedures and the administration of oral systemic premedications, local anesthesia, nitrous oxide inhalation analgesia, and subgingival sustained release chemotherapeutic agents, to the extent the dentist or dental therapist has the authority to perform the activity personally.

SB181,23,10 (3) A dentist or dental therapist who delegates to another individual the performance of any practice or remediable procedure is responsible for that individual's performance of that delegated practice or procedure.

SB181,46 Section 46 . 447.07 (1) of the statutes is amended to read:

SB181,23,17 447.07 (1) The examining board may, without further notice or process, limit, suspend, or revoke the license or certificate of any dentist, dental therapist, or dental hygienist, or the registration of a mobile dentistry program registrant, who fails, within 60 days after the mailing of written notice to the dentist's, dental therapist's, dental hygienist's, or registrant's last-known address, to renew the license, certificate, or registration.

SB181,47 Section 47 . 447.07 (3) (intro.) of the statutes is amended to read:

SB181,24,5 447.07 (3) (intro.) Subject to the rules promulgated under s. 440.03 (1), the examining board may make investigations and conduct hearings in regard to any alleged action of any dentist, dental therapist, or dental hygienist, of a mobile dentistry program registrant, or of any other person it has reason to believe is engaged in or has engaged in the practice of dentistry, dental therapy, or dental hygiene, or the operation of a mobile dentistry program, in this state, and may, on its own motion, or upon complaint in writing, reprimand any dentist , dental therapist, or dental hygienist who is licensed or certified under this chapter, or any mobile dentistry program registrant, or deny, limit, suspend, or revoke his or her license or certificate, or the registration of the mobile dentistry program registrant, if it finds that the dentist, dental therapist, dental hygienist, or mobile dentistry program registrant has done any of the following:

SB181,48 Section 48 . 447.07 (3) (e) to (h) of the statutes are amended to read:

SB181,24,9 447.07 (3) (e) Subject to ss. 111.321, 111.322, and 111.335, been convicted of a crime, the circumstances of which substantially relate to the practice of dentistry, dental therapy, or dental hygiene or the operation of a mobile dentistry program.

SB181,24,12 (f) Violated this chapter or any federal or state statute or rule that relates to the practice of dentistry, dental therapy, or dental hygiene, or the operation of a mobile dentistry program.

SB181,24,15 (g) Subject to ss. 111.321, 111.322 and 111.34, practiced dentistry , dental therapy, or dental hygiene while his or her ability was impaired by alcohol or other drugs.

SB181,24,18 (h) Engaged in conduct that indicates a lack of knowledge of, an inability to apply or the negligent application of, principles or skills of dentistry , dental therapy, or dental hygiene.

SB181,49 Section 49 . 447.40 (intro.) of the statutes is amended to read:

SB181,25,2 447.40 Informed consent. (intro.) Any dentist or dental therapist who treats a patient shall inform the patient about the availability of reasonable alternate modes of treatment and about the benefits and risks of these treatments. The reasonable dentist standard is the standard for informing a patient under this section. The reasonable dentist standard requires disclosure only of information that a reasonable dentist would know and disclose under the circumstances. The dentist's or dental therapist's duty to inform the patient under this section does not require disclosure of any of the following:

SB181,50 Section 50 . 447.40 (6) of the statutes is amended to read:

SB181,25,6 447.40 (6) Information about alternate modes of treatment for any condition the dentist or dental therapist has not included in his or her diagnosis, assessment, or treatment plan at the time the dentist or dental therapist informs the patient.