87,40Section 40. 447.06 (2) (a) 3. of the statutes is amended to read: 447.06 (2) (a) 3. For a school for the education of dentists, dental therapists, or dental hygienists.
87,41Section 41. 447.06 (2) (b) of the statutes is amended to read: 447.06 (2) (b) A dental hygienist may practice dental hygiene or perform remediable procedures under par. (a) 1. only as authorized by a dentist or dental therapist who is licensed to practice dentistry or dental therapy under this chapter and who is present in the facility in which those practices or procedures are performed, except as provided in par. (c).
87,42Section 42. 447.06 (2) (c) (intro.) of the statutes is amended to read: 447.06 (2) (c) (intro.) A dental hygienist may practice dental hygiene or perform remediable procedures under par. (a) 1. if a dentist or dental therapist who is licensed to practice dentistry or dental therapy under this chapter is not present in the facility in which those practices or procedures are performed only if all of the following conditions are met:
87,43Section 43. 447.06 (2) (c) 2. (intro.) of the statutes is amended to read: 447.06 (2) (c) 2. (intro.) The dentist or dental therapist who made the written or oral prescription has examined the patient at least once during the 12-month period immediately preceding:
87,44Section 44. 447.06 (3) of the statutes is created to read: 447.06 (3) (a) In this subsection:
1. “Collaborative management agreement” means an agreement under par. (d).
2. “Dental health shortage area” has the meaning given in s. 36.60 (1) (ad).
3. “Direct supervision” means that the dentist is present in the dental office or other practice setting, personally diagnoses the condition to be treated, personally authorizes each procedure, and before dismissal of the patient, evaluates the performance of the allied dental personnel.
4. “General supervision” means that the dentist is not present in the dental office or other practice setting or on the premises at the time tasks or procedures are being performed by the dental therapist, but that the tasks or procedures performed by the dental therapist are being performed with the prior knowledge and consent of the dentist.
5. “Indirect supervision” means that the dentist is present in the dental office or other practice setting, authorizes each procedure, and remains in the office while the procedures are being performed by the allied dental personnel.
6. “Medical Assistance patient” means a patient who is a recipient of services under the Medical Assistance program under subch. IV of ch. 49.
7. “Qualifying dentist” means a dentist who is licensed in this state, who is actively practicing in this state, and who satisfies the requirement under par. (dr).
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.
(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:
1. Oral evaluation and assessment of dental disease and formulation of an individualized treatment plan.
2. Identification of oral and systemic conditions requiring evaluation or treatment by dentists, physicians, or other health care providers and managing referrals.
3. Comprehensive charting of the oral cavity.
4. Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis.
5. Exposure and evaluation of radiographic images.
6. Dental prophylaxis, including subgingival scaling and polishing procedures.
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.
8. Application of topical preventive or prophylactic agents, including fluoride varnish, antimicrobial agents, caries arresting medicaments, and pit and fissure sealants.
9. Pulp vitality testing.
10. Application of desensitizing medications or resins.
11. Fabrication of athletic mouth guards and soft occlusal guards.
12. Changing of periodontal dressings.
13. Administration of local anesthetic and nitrous oxide.
14. Simple extraction of erupted primary teeth.
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.
16. Emergency palliative treatment of dental pain limited to the procedures in this paragraph.
17. Preparation and placement of direct restoration in primary and permanent teeth.
18. Fabrication and placement of single-tooth temporary crowns.
19. Preparation and placement of preformed crowns on primary teeth.
20. Indirect and direct pulp capping on permanent teeth.
21. Indirect pulp capping on primary teeth.
22. Intraoral suture placement and removal.
23. Minor adjustment and repair of removable prostheses.
24. Placement and removal of space maintainers.
25. Pulpotomy on primary teeth.
26. Tooth reimplantation and stabilization.
27. Recementing of a permanent crown.
28. Any additional services, treatments, or procedures specified in the rules promulgated under s. 447.02 (1) (g).
(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.
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.
(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.
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.
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.
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.
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.
(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:
a. The practice settings where services may be provided and the patient populations that may be served.
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.
c. Age-specific and procedure-specific practice protocols.
d. Dental record-keeping procedures.
e. Plans for managing dental or medical emergencies.
f. A quality assurance plan for monitoring care provided by the dental therapist.
g. Protocols for administering and dispensing medications.
h. Criteria or protocols relating to the provision of care to patients with specific medical conditions, treatments, or medications.
i. Policies relating to supervision of dental hygienists and other staff.
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.
k. Whether and to what extent the dental therapist may perform services described in par. (b) 15.
2. a. A collaborative management agreement shall be limited to covering one qualifying dentist and one dental therapist.
b. A dental therapist may enter into multiple collaborative management agreements.
c. No dentist may have collaborative management agreements with more than 4 dental therapists at any time.
(dm) A dental therapist may, subject to par. (e), provide dental therapy services only as an employee of one or more of the following that satisfies par. (dr):
1. A dentist with whom the dental therapist has entered into a collaborative management agreement.
2. A dental practice.
3. A school district or the operator of a private school, as defined in s. 115.001 (3r), or a tribal school, as defined in s. 115.001 (15m).
4. The operator of a school for the education of dentists or dental hygienists.
5. A state or federal prison, a county jail, or other federal, state, county, or municipal correctional or detention facility, or a facility established to provide care for terminally ill patients.
6. A local health department, as defined in s. 250.01 (4).
7. A charitable institution open to the general public or to members of a religious sect or order.
8. A nonprofit home health care agency.
9. The operator of a nonprofit dental care program serving primarily indigent, economically disadvantaged, or migrant worker populations.
10. A health care employer, as defined in s. 440.094 (1) (b).
(dr) A dentist may not enter into a collaborative management agreement with a dental therapist unless the dentist directly employs the dental therapist as provided in par. (dm) 1. or the dentist is employed by or contracts with the dental therapist’s employer described in par. (dm) 2. to 10.
(e) A dental therapist shall at all times comply with at least one of the following:
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.
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:
a. Medical Assistance patients.
b. Uninsured patients.
c. Patients receiving dental care at free and charitable clinics.
d. Patients receiving dental care at federally qualified health centers.
e. Patients who reside in long-term care facilities.
