SB689: Bill Text

SB689,,1 2023 SENATE BILL 689

November 15, 2023 - Introduced by Senators Felzkowski, Hutton, James, Marklein, Roys, Spreitzer, Testin and Ballweg, cosponsored by Representatives Plumer, Behnke, Binsfeld, Callahan, Dittrich, Emerson, Goeben, Jacobson, Joers, Mursau, Ohnstad, Oldenburg, Ortiz-Velez, Rozar, Snyder and Tusler. Referred to Committee on Health.

SB689,,2 An Act to amend 15.405 (6) (b), 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), 440.094 (1) (c) 3., 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), 447.06 (1), 447.06 (2) (a) 3., 447.06 (2) (b), 447.06 (2) (c) (intro.), 447.06 (2) (c) 2. (intro.), 447.063, 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), 448.975 (2) (c) 1., 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 36.61 (1) (ak), 440.03 (13) (b) 20m., 440.08 (2) (a) 25m., 447.01 (6g), 447.01 (6r), 447.02 (1) (g), 447.02 (3) (a) 3., 447.02 (6), 447.03 (1m), 447.03 (3) (am), 447.04 (1m), 447.05 (2m), 447.057, 447.06 (1m), 447.06 (3) and 447.07 (6) 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.

SB689,,3 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 qualifying dental therapy education program and passage of required examinations.

Under the bill, a dental therapy education program qualifies if the program 1) is accredited by the American Dental Association’s Commission on Dental Accreditation (CODA); 2) is a program approved by the Minnesota Board of Dentistry on or before the bill’s effective date that has, as of the time of application, become CODA-accredited; or 3) is a program offered in Wisconsin that has received initial CODA accreditation but is not yet fully CODA-accredited. With respect to the third category of dental therapy education programs (programs offered in Wisconsin), the bill allows applicants to obtain a license on the basis of graduation from such a program only for four years after the program’s inception, and if the program is not fully CODA-accredited by the time that four-year period has elapsed, the bill requires the licenses of dental therapists who graduated from the program to be revoked.

Under the bill, dental therapists may provide dental therapy services only as an employee of specified employers and only under the supervision of a dentist who is either similarly employed or who directly employs the dental therapist. The dental therapist must also have a collaborative management agreement with a dentist that addresses various aspects of the dental therapist’s practice and supervision. Dental therapists are, subject to the terms of a collaborative management agreement and what was covered in their dental therapy education program, 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 may initially provide dental therapy services only under the direct or indirect supervision of a qualifying dentist. Once a dental therapist licensed has provided dental therapy services for at least 2,000 hours, the dental therapist may provide services under the general supervision of a qualifying dentist. However, the level of supervision for a dental therapist may be further limited under the terms of a collaborative management agreement. Dental therapists must also, under the bill, either 1) limit their practice to federally defined dental shortage areas or 2) practice in settings where at least 50 percent of their patient base consists of certain specified populations. 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 50 individuals become licensed as a dental therapist in this state or five years after the bill is enacted, that, to the extent possible, one of the dental hygienist members on the board also be licensed as a dental therapist.

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

SB689,,4 The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB689,1 Section 1. 15.405 (6) (b) of the statutes is amended to read:

SB689,,6 15.405 (6) (b) Three dental hygienists who are licensed under ch. 447. The governor shall, to the extent possible, appoint members under this paragraph so that at least one of the members under this paragraph is an individual who is also a dental therapist licensed under ch. 447. Notwithstanding s. 15.08 (1m) (a), the dental hygienist members under this paragraph may participate in the preparation and grading of licensing examinations for dental hygienists.

SB689,2 Section 2. 36.61 (1) (ak) of the statutes is created to read:

SB689,,8 36.61 (1) (ak) “Dental therapist” means an individual licensed under s. 447.04 (1m).

SB689,3 Section 3. 36.61 (1) (b) of the statutes is amended to read:

SB689,,10 36.61 (1) (b) “Health care provider” means a dental therapist, dental hygienist, physician assistant, nurse-midwife, or nurse practitioner.

SB689,4 Section 4. 36.61 (3) (a) of the statutes is amended to read:

SB689,,12 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.

SB689,5 Section 5. 36.61 (5) (b) 1. of the statutes is amended to read:

SB689,,14 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.

SB689,6 Section 6. 36.61 (8) (c) 3. of the statutes is amended to read:

SB689,,16 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.

SB689,7 Section 7. 146.81 (1) (c) of the statutes is amended to read:

SB689,,18 146.81 (1) (c) A dentist or dental therapist licensed under ch. 447.

SB689,8 Section 8. 146.89 (1) (r) 1. of the statutes is amended to read:

SB689,,20 146.89 (1) (r) 1. Licensed as a physician under ch. 448, naturopathic doctor under ch. 466, 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 subch. IX of 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.

SB689,9 Section 9. 146.89 (1) (r) 5. of the statutes is amended to read:

SB689,,22 146.89 (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.

SB689,10 Section 10. 146.89 (3) (b) 8. of the statutes is amended to read:

SB689,,24 146.89 (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.

SB689,11 Section 11. 146.89 (3m) (intro.) of the statutes is amended to read:

SB689,,26 146.89 (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:

SB689,12 Section 12. 146.997 (1) (d) 3. of the statutes is amended to read:

SB689,,28 146.997 (1) (d) 3. A dentist or dental therapist licensed under ch. 447.

SB689,13 Section 13. 155.01 (7) of the statutes, as affected by 2021 Wisconsin Act 251, is amended to read:

SB689,,30 155.01 (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, occupational therapy assistant, or genetic counselor licensed under ch. 448, a naturopathic doctor licensed under ch. 466, a person practicing Christian Science treatment, an optometrist licensed under ch. 449, a psychologist who is licensed under ch. 455, who is exercising the temporary authorization to practice, as defined in s. 455.50 (2) (o), in this state, or who is practicing under the authority to practice interjurisdictional telepsychology, as defined in s. 455.50 (2) (b), a physical therapist or physical therapist assistant who holds a compact privilege under subch. XI of ch. 448, an occupational therapist or occupational therapy assistant who holds a compact privilege under subch. XII of ch. 448, 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).

SB689,14 Section 14. 252.14 (1) (ar) 3. of the statutes is amended to read:

SB689,,32 252.14 (1) (ar) 3. A dentist or dental therapist licensed under ch. 447.

SB689,15 Section 15. 257.01 (5) (a) of the statutes is amended to read:

SB689,,34 257.01 (5) (a) An individual who is licensed as a physician, a physician assistant, or a podiatrist under ch. 448, licensed as a naturopathic doctor under ch. 466, 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.

SB689,16 Section 16. 257.01 (5) (b) of the statutes is amended to read:

SB689,,36 257.01 (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 naturopathic doctor under ch. 466, 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.

SB689,17 Section 17. 440.03 (13) (b) 20m. of the statutes is created to read:

SB689,,38 440.03 (13) (b) 20m. Dental therapist.

SB689,18 Section 18. 440.08 (2) (a) 25m. of the statutes is created to read:

SB689,,40 440.08 (2) (a) 25m. Dental therapist: October 1 of each odd-numbered year.

SB689,19 Section 19. 440.094 (1) (c) 3. of the statutes is amended to read:

SB689,,42 440.094 (1) (c) 3. A dentist or dental therapist licensed under ch. 447.

SB689,20 Section 20. 447.01 (6g) of the statutes is created to read:

SB689,,44 447.01 (6g) “Dental therapist” means an individual who practices dental therapy.

SB689,21 Section 21. 447.01 (6r) of the statutes is created to read:

SB689,,46 447.01 (6r) “Dental therapy” means the limited practice of dentistry, consisting of the services, treatments, and procedures specified in s. 447.06 (3) (b).

SB689,22 Section 22. 447.02 (1) (a) of the statutes is amended to read:

SB689,,48 447.02 (1) (a) Governing the reexamination of an applicant who fails an examination specified in s. 447.04 (1) (a) 5., (1m) (e), 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.

SB689,23 Section 23. 447.02 (1) (b) of the statutes is amended to read:

SB689,,50 447.02 (1) (b) Governing the standards and conditions for the use of radiation and ionizing equipment in the practice of dentistry or dental therapy.

SB689,24 Section 24. 447.02 (1) (g) of the statutes is created to read:

SB689,,52 447.02 (1) (g) Specifying services, treatments, or procedures, in addition to those specified under s. 447.06 (3) (b) 1. to 27., that are included within the practice of dental therapy.

SB689,25 Section 25. 447.02 (2) (a) of the statutes is amended to read:

SB689,,54 447.02 (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.

SB689,26 Section 26. 447.02 (3) (a) (intro.) of the statutes is amended to read:

SB689,,56 447.02 (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:

SB689,27 Section 27. 447.02 (3) (a) 2. of the statutes is amended to read:

SB689,,58 447.02 (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.

SB689,28 Section 28. 447.02 (3) (a) 3. of the statutes is created to read:

SB689,,60 447.02 (3) (a) 3. If the applicant is applying for a permit to practice dental therapy, the applicant graduated from a dental therapy education program approved under s. 447.04 (1m) (c) 1. to 3.

SB689,29 Section 29. 447.02 (3) (b) of the statutes is amended to read:

SB689,,62 447.02 (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.

SB689,30 Section 30. 447.02 (5) of the statutes is amended to read:

SB689,,64 447.02 (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.

SB689,31 Section 31. 447.02 (6) of the statutes is created to read:

SB689,,66 447.02 (6) The examining board shall send a notice to the legislative reference bureau for publication in the Wisconsin Administrative Register when the board determines that 50 or more individuals are currently licensed as dental therapists in this state under s. 447.04 (1m). This subsection does not apply on or after the first day of the 6th year beginning after publication of this act .... [LRB inserts date].

SB689,32 Section 32. 447.03 (1m) of the statutes is created to read: