Ohio Dental Hygienists’ Association

Changes to House Bill 463-As introduced

April 16, 2014

ORC 3333.61 No issue

ORC 4715.10 No issue

ORC 4715.13 No issue, (Amendment, see below)

Seek creation of a Dental Hygienist Loan Repayment Program, established with a $10 per biennium per license fee.

ORC 4715.22

Remove lines 173-175 and 303-305

Rationale: Hygienists are degreed professionals and should be able to practice to the highest level of their training. It should be noted that Michigan does not have this restriction in its practice act. We believe that it may cause more degreed graduates to be hired in offices as supervising dentists would be able to utilize personnel instead of waiting for a minimum of two year period. This change will create flexibility and create greater access to care.

Line 189 Support (Amendment, see below)

ODHA agrees with the language in line 189, but suggests that for services that are provided to patients that the time period be extended to 15 months. Under current service provisions, adult Medicaid patients are limited to one dental visit per year. If for some reason they cancel due to weather, lack of transportation, etc. the window to take advantage of this flexibility is lost. In an effort to not create a two-tiered system, all parties should explore raising the review standard to 15 months.

Line 264-265 Support (amendment, see below)

  • The line would be re-written to state: “The board shall not identify the re-cementation of temporary crowns or the re-cementation of crowns with temporary cement as one of those procedures.”

Amendment -Items not currently in the bill.

  • Allow an RDH to apply fluoride varnish without a prior examination of the dentist and under general supervision. Primary Care providers (Pediatricians) and staff as well as social workers are trained to apply fluoride varnish prior to a dental examination.
  • Allow RDHs to apply sealants in the office without a prior dental examination and under general supervision. RDHs can seal over decay and can effectively communicate to the patient about further oral health prevention techniques.
  • In line 161 add after “chapter” “or a physician who holds a valid certificate to practice medicine and surgery or osteopathic medicine or surgery issued under Chapter 4731. of the Revised Code.”

In line 163 add after “institution.” “A dental hygienist practicing under a supervising physician may not provide dental hygiene services to a patient when the supervising physician is not physically present at the location where the dental hygienist is practicing.”

In line 164 after “hygienist” insert “practicing under a supervising dentist”

Rationale: These changes in lines 161,163, and 164in 4715.22 allow for the direct employment of a dental hygienist with a physician and makesit possible for hygienists to work in hospitals and health care facilities, like nursing homes.The independent practice prohibition is to remain unchanged in this bill, but rather allows for alternative employers such as a hospital. The dentist,or physician in collaboration with a dentist,also employed by the facility,wouldbe the supervisor. In this drafting of new direct employment in such placements it is not intended to seek any expanded scope of practice. We believe this change will increase oral health care access in settings, lead to a reduction in the amount of emergency room utilization and create employment opportunities. In House Bill 463, as introduced, supervision of EFDAs and CDAs by physicians and registered nurses is proposed.

ORC 4715.23 No issue.

OHASP REVISIONS

ODHA believes that the OHASP has not been as successful as it could be and has significant issues that must be addressed to make it more workable. ODHA proposes that the program continue but revisions need to be made for greater impact. To our knowledge there have been no patients seen under the OHASP since its inception in 2010. In order to make the program more attractive to hygienists, we suggest a few revisions to the OHASP.

The current standard to allow a hygienist to obtain a permit is a completion of at least 2 years and a minimum of three thousand hours of experience. More hygienists at the beginning of their careers may be more open to this type of practice setting, but would not be able to participate for a significant amount of time after obtaining their degree because of the current restriction.

Recommendation

  • We suggest that the standard be revised to require only 1 year or 1500 hours of practice experience.

Additionally, if we are seeking to create maximum flexibility, a patient seen under the OHASP can only obtain one dental hygiene appointment under the current law. Treatment is provided and a required referral is made to any dentist (changed under the bill) to occur within 6 months (increased from 90 days in the bill) of the hygiene appointment. ODHA suggests that an OHASP patient be permitted two hygiene appointments without a dentist examination. Currently, Medicaid patients are only permitted one visit a year. In a dental office, it is proposed under the bill that a patient could theoretically be seen twice before having to be seen by a dentist. We believe a similar accommodation is appropriate for the Medicaid population.

Recommendation

  • In an effort to provide the greatest amount of services a patient should be able to obtain two hygiene care appointments before services are prohibited. Additionally, we suggest removing language on a timeline for referral as the requirement to refer back to an authorizing dentist is being eliminated and it would be nearly impossible for a hygienist not from the area to be able to cause an appointment to be scheduled.

ORC 4715.363No issue (amendment, see below)

In line 300 after “check.” add, “or credit card”.

ORC 4715.366 No issue (technical amendment, see below)

In line 337 change the second “the” to “a”

ORC 4715.371No issue

ORC 4715.39 Delete lines 416-504, lines 511-512, and technical changes in lines 516, 539

Many of the duties that are identified in the bill for certified dental assistants are significant expansions for the supervision of practice and the duties sought are not currently covered in the education of certified dental assistants. ODHA believes it is inappropriate to make these changes.

ORC 4715.421 Support (amendment, see below)

In line 560 after “from” add “a anaccredited”, in line 561 after “school” insert “or program.”

Rationale: If a dental hygienist received a degree from a school in the State of Alabama and came to Ohio to obtain employment as an RDH, the Ohio State Dental Board would not be able to offer licensure reciprocity as that school is not accredited. Additionally, the Armed Services do not have the same accreditation standards as it applies to licensure reciprocity. ODHA encourages the use of active duty or retired military personnel in these volunteer programs, but the state must ensure that only the highest quality dentists and hygienists are permitted to provide these limited time services.

Additionally, the dental residency program added in ORC 4715. 10 must be accredited.

ORC 4715.64 ODHA Compromise amendments (EFDAs)

Line 612 re-written to state: “The re-cementation of temporary crowns or the re-cementation of crowns with temporary cement as one of those procedures.”

Delete line 613 “The application of topical fluoride;”

Rationale: Training for this work is inconsistent.

Delete line 616 “The application of desensitizing agents;”

Rationale for deletion: EFDAs do not receive any training in oral hygiene procedures. Given the fact that a goal of dental health care in the US is now going towards prevention, handing these tasks to untrained personnel is going to be detrimental to the population that needs these instructions the most. Most of the EFDAs trained have no knowledge of proper oral hygiene procedures. As far as the implementation of this skill set into the EFDA curriculum, there is not time allotted for extra course objectives.

Technical amendment Line 617 “Carries” should be “Caries”

No objection to item.

Line 618 delete “procedures” and insert “instructions”

Amend line 620 to read “The discussion of basic nutrition related to oral health;”

Rationale: Dental hygienists spend an entire semester, 3 credit hours, learning nutrition as it applies to dental health and also overall health. Again, EFDAs & CDAs at no point in their education are given such thorough instruction, or any at all, in nutrition. Given the fact that the population that needs nutritional counseling the most is probably the population that has the least access to good nutrition. Giving away this responsibility to untrained individuals, or dentist trained individuals, is very disturbing. This would be a disservice to our overall population.

Amendment -Item not currently in the bill.

ODHA believes that EFDAs should be required to complete a State Tested Nursing Assistant (STNA) Course if allowed to work under the supervision of a physician or a registered nurse.

Line 661 delete the balance of the line after “and,”

Line 662 delete “health care facility,”

Delete lines 664-669.

Rationale: EFDAs should work under the supervision of a dentist only.

Line 683-684 delete “prior to a dentist examining the patient and rendering a diagnosis” and insert “after a dentist examines the patient and renders a diagnosis.”

Temporary Law sections 3 and 4 No issue