AB367: Bill Text

AB367,14,17 447.06 (4) Practice circumstances without a dentist present and without a prescription; additional education and experience. (a) A dental hygienist may perform any of the following practices without a dentist present in the facility in which the practices are performed and without a written or oral prescription if the requirements of pars. (am), (b), and (c) are met and if the dental hygienist first reviews the patient's medical history and performs an oral risk assessment:

AB367,14,21 1. Conduct an oral screening and have a plan of what dental hygiene procedures will be performed on the patient. Oral screening that is performed solely for the purpose of data collection does not require an oral risk assessment and does not require certification under par. (c).

AB367,15,2 2. Apply dental sealants. Sealants may be applied under this subdivision without a diagnosis or treatment plan by a dentist.

AB367,15,3 3. Provide fluoride therapies.

AB367,15,4 4. Provide patient education services.

AB367,15,6 5. Expose radiographs if a dentist will be available to read and diagnose the radiographs.

AB367,15,12 6. Perform oral prophylaxis, if a dentist, nurse practitioner, physician or physician assistant has reviewed a current medical history for the patient and has indicated in writing that the patient may receive the service. The dental hygienist may use topical anesthesia under this subdivision only if the anesthesia has been prescribed by a dentist, nurse practitioner, physician, or physician assistant. Local anesthesia may not be administered by a dental hygienist under this subdivision.

AB367,15,21 7. Remove supragingival or subgingival calcareous deposits, subgingival cement, or extrinsic stains from a natural or restored surface of a human tooth or a fixed replacement for a human tooth, perform debridement or deep scaling or root planing of teeth, if a dentist, nurse practitioner, physician, or physician assistant has reviewed a current medical history of the patient and has indicated in writing that the patient may receive the service for the patient. The dental hygienist may use topical anesthesia under this subdivision only if prescribed by a dentist, nurse practitioner, physician, or physician assistant. Local anesthesia may not be administered by a dental hygienist under this subdivision.

AB367,15,24 (am) A dental hygienist shall maintain a written record of and oral risk assessment performed under par. (a) and make appropriate referrals based on the assessment.

AB367,15,25 (b) The practices under par. (a) may be performed only as follows:

AB367,16,1 1. For a school board or a governing body of a private school.

AB367,16,3 2. For a facility, as defined in s. 50.01 (1m), a hospital, as defined in s. 50.33 (2), or a facility established to provide care for terminally ill patients.

AB367,16,4 3. For a local health department, as defined in s. 250.01 (4).

AB367,16,6 4. For a charitable institution open to the general public or to members of a religious sect or order.

AB367,16,7 5. For a nonprofit home health care agency.

AB367,16,9 6. For a nonprofit dental care program serving primarily indigent, economically disadvantaged, or migrant worker populations.

AB367,16,15 (c) A dental hygienist may perform the practices under par. (a) only if certified by the examining board in dental hygiene practice circumstances without a dentist present and without a prescription. The examining board shall issue a certificate in dental hygiene practice circumstances without a dentist present and without a presciption to an individual who documents to the board that he or she has 2 years of experience as a dental hygienist and meets any of the following:

AB367,16,20 1. Has submitted to the examining board proof of course completion issued by an accredited dental school or an accredited dental hygiene school in dental hygiene circumstances without a dentist present and without a prescription. This course may be offered in conjunction with a national or state dental or dental hygiene association.

AB367,16,23 2. Has been certified in community dental health, public health, or public health education from an accredited dental school or an accredited dental hygiene program.

AB367,16,25 3. Has worked for at least 1,000 hours in a public health or community health setting.

AB367,17,1 4. Has received a bachelor's degree from an accredited college or university.

Note: This Section creates an exception to the general rule that in order for a dental hygienist to practice, there must be a dentist in the facility or the practice must be pursuant to a written or oral prescription by a dentist. A dental hygienist who meets specified education and experience requirements would be allowed to perform specified procedures in the six practice settings or circumstances specified in this Section.

AB367, s. 27 Section 27. 447.06 (5) (title) of the statutes is created to read:

AB367,17,3 447.06 (5) (title) Prohibited practices.

Note: This Section creates a new subsection title to reflect a restructuring of s. 447.06, stats.

AB367, s. 28 Section 28. 447.06 (6) (title), (d) and (e) of the statutes are created to read:

AB367,17,5 447.06 (6) (title) Delegation by a dentist to a dental hygienist.

AB367,17,7 (d) Any dentistry practice not included in dental hygiene, except as provided in sub. (5), if all of the following conditions are met:

AB367,17,10 1. The delegated practices are ones that, in the opinion of the dentist and the dental hygienist, the dental hygienist is competent to perform based on his or her education, training, or experience.

AB367,17,11 2. The dental hygienist's performance of the practice is inspected by a dentist.

AB367,17,14 (e) A remediable procedure, except that a dentist need not be present on the premises in which the procedure is performed if it is performed pursuant to a prescription that meets the requirements of sub. (2m) (b).

Note: This Section allows a dentist to delegate to a dental hygienist any dentistry practice not included in dental hygiene, with certain exceptions specified in current law, if two conditions are met. First, the delegated practices must be ones that, in the opinion of the dentist and the dental hygienist, the dental hygienist is competent to perform based on his or her education, training, or experience. Second, the dental hygienist's performance of the practice must be inspected by a dentist.

AB367, s. 29 Section 29 . 447.06 (7) of the statutes is created to read:

AB367,18,2 447.06 (7) Dentist responsible for delegation. A dentist who delegates to a dental hygienist the performance of any practice or remediable procedure under sub. (6) is responsible for that dental hygienist's performance of that delegated practice or procedure.

AB367, s. 30 Section 30 . 447.065 (title) of the statutes is amended to read:

AB367,18,5 447.065 (title) Delegation of remediable procedures and dental dentistry practices to unlicensed individuals.

Note: Since all provisions dealing with delegation by a dentist to a dental hygienist will be in s. 447.06, stats., Section 29 replicates a current law dealing with dental responsibility for delegation and Section 30 modifies the title of s. 447.065, stats., to reflect that that section applies only to delegation to unlicensed individuals.

AB367, s. 31 Section 31 . 447.065 (1) of the statutes is amended to read:

AB367,18,10 447.065 (1) A dentist 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 or other dentistry practices subject to sub. (2), if all of the following conditions are met:

AB367,18,12 (a) The unlicensed individual performs the remediable procedure or dentistry practices in accordance with a treatment plan approved by the dentist.

AB367,18,14 (b) The dentist is on the premises when the unlicensed individual performs the remediable procedures or dentistry practices.

AB367,18,16 (c) The unlicensed individual's performance of the remediable procedures or dentistry practices is subject to inspection inspected by the dentist.

AB367, s. 32 Section 32 . 447.065 (2) of the statutes is repealed and recreated to read:

AB367,18,20 447.065 (2) A dentist may make a delegation under sub. (1) of dentistry practices that are not remediable procedures if all of the following requirements are met:

AB367,19,3 (a) The practice does not involve a practice under s. 447.01 (3) (a), (b), (e), (f), or (g), diagnosis of a dental disease or ailment, determination of any treatment or any regimen of treatment, prescription or ordering of medication, performance of any procedure that involves the intentional cutting of soft or hard tissue of the mouth by any means, or administration of local anesthesia or subgingival sustained release chemotherapeutic agents.

AB367,19,6 (b) The individual has graduated from an accredited dental assisting program or has worked at least 1,000 hours during the preceding 12 months in a clinical dentistry setting.

AB367,19,11 (c) The dentist making the delegation documents in his or her records that the individual has been trained or educated to do the delegated practice by a dental school; dental hygiene program; dental assisting program; a program offered or approved by a national or state dental, dental hygiene, or dental assisting association; or a program approved by the examining board.

AB367,19,14 (d) The delegated practices are ones that, in the opinion of the dentist and the individual to whom the practices are delegated, the individual is competent to perform based on his or her education, training, or experience.

Note: Section 31 modifies the current law regarding delegation of remediable procedures by a dentist to an unlicensed individual to reflect that a dentist may delegate additional dentistry practices to an unlicensed individual. With regard to those other dentistry practices, the three conditions for delegation in current law must be met as well as the four conditions specified in Section 32.

AB367, s. 33 Section 33. 447.065 (3) of the statutes is amended to read:

AB367,19,18 447.065 (3) A dentist who delegates to another an unlicensed individual the performance of any practice or remediable procedure is responsible for that individual's performance of that delegated practice or procedure.

Note: This Section amends the current law on dental responsibility for delegation to make it applicable to delegation to unlicensed individuals. A separate provision dealing with dental responsibility for delegation to a dental hygienist is created in Section 29.

AB367, s. 34 Section 34 . 560.183 (title) of the statutes is amended to read:

AB367,19,20 560.183 (title) Physician and dentist loan assistance program.

Note: Sections 34 to 43 include dentists in the current physician loan assistance program and rename the program to be the physician and dentist loan assistance program. In addition, the bill defines "dental health professional shortage area."

AB367, s. 35 Section 35. 560.183 (1) (ad) of the statutes is created to read:

AB367,20,4 560.183 (1) (ad) "Dental health professional shortage area" means an area that is designated by the federal department of health and human services under 42 CFR part 5, appendix B, as having a shortage of dental professionals.

AB367, s. 36 Section 36. 560.183 (1) (ae) of the statutes is created to read:

AB367,20,6 560.183 (1) (ae) "Dentist" means an individual licensed under s. 447.04 (1).

AB367, s. 37 Section 37. 560.183 (2) (a) and (b) of the statutes are amended to read:

AB367,20,11 560.183 (2) (a) The department may repay, on behalf of a physician or dentist, up to $50,000 in educational loans obtained by the physician or dentist from a public or private lending institution for education in an accredited school of medicine or dentistry or for postgraduate medical training.

AB367,20,15 (b) A physician or dentist who is a participant in the national health service corps scholarship program under 42 USC 254n, or a physician or dentist who was a participant in that program and who failed to carry out his or her obligations under that program, is not eligible for loan repayment under this section.

AB367, s. 38 Section 38. 560.183 (3) (a) of the statutes is amended to read:

AB367,21,3 560.183 (3) (a) The department shall enter into a written agreement with the physician. In the agreement, the physician shall agree , in which the physician agrees to practice at least 32 clinic hours per week for 3 years in one or more eligible practice areas in this state, except that a physician specializing in psychiatry may only agree to practice psychiatry in a mental health shortage area and a physician in the expanded loan assistance program under sub. (9) may only agree to practice at a public or private nonprofit entity in a health professional shortage area. The physician shall also agree to care for patients who are insured or for whom health benefits are payable under medicare, medical assistance, or any other governmental program.

AB367, s. 39 Section 39. 560.183 (3) (am) of the statutes is created to read:

AB367,21,9 560.183 (3) (am) The department shall enter into a written agreement with the dentist, in which the dentist agrees to practice at least 32 clinic hours per week for 3 years in one or more dental health professional shortage areas in this state. The dentist shall also agree to care for patients for whom health benefits are payable under medical assistance.

AB367, s. 40 Section 40. 560.183 (5) (b) 1., 2., 3., 4. and 5. and (d) of the statutes are amended to read:

AB367,21,16 560.183 (5) (b) 1. The degree to which there is an extremely high need for medical care in the eligible practice area or health professional shortage area in which the a physician desires to practice and the degree to which there is an extremely high need for dental care in the dental health professional shortage area in which a dentist desires to practice.

AB367,21,20 2. The likelihood that a physician will remain in the eligible practice area or health professional shortage area, and that a dentist will remain in the dental health professional shortage area, in which he or she desires to practice after the loan repayment period.

AB367,21,23 3. The per capita income of the eligible practice area or health professional shortage area in which a physician desires to practice and of the dental health professional shortage area in which a dentist desires to practice.

AB367,22,4 4. The financial or other support for physician recruitment and retention provided by individuals, organizations, or local governments in the eligible practice area or health professional shortage area in which a physician desires to practice and for dentist recruitment and retention provided by individuals, organizations, or local governments in the dental health professional shortage area in which a dentist desires to practice.

AB367,22,8 5. The geographic distribution of the physicians and dentists who have entered into loan repayment agreements under this section and the geographic distribution of the eligible practice areas or, health professional shortage areas, and dental health professional shortage areas in which the eligible applicants desire to practice.

AB367,22,11 (d) An agreement under sub. (3) does not create a right of action against the state on the part of the physician or the, dentist, or lending institution for failure to make the payments specified in the agreement.

AB367, s. 41 Section 41. 560.183 (6m) (a) (intro.) of the statutes is amended to read:

AB367,22,16 560.183 (6m) (a) (intro.) The department shall, by rule, establish penalties to be assessed by the department against physicians or dentists who breach an agreement agreements entered into under sub. (3) (a). The rules shall do all of the following:

AB367, s. 42 Section 42. 560.183 (8) (b), (d), (e) and (f) of the statutes are amended to read:

AB367,22,21 560.183 (8) (b) Advise the department and rural health development council on the identification of eligible practice areas with an extremely high need for medical care and dental health professional shortage areas with an extremely high need for dental care.

AB367,22,23 (d) Assist the department to publicize the program under this section to physicians, dentists, and eligible communities.

AB367,22,25 (e) Assist physicians and dentists who are interested in applying for the program under this section.

AB367,23,2 (f) Assist communities in obtaining physicians' and dentists' services through the program under this section.

AB367, s. 43 Section 43 . 560.183 (9) of the statutes is amended to read:

AB367,23,10 560.183 (9) Expanded loan assistance program. The department may agree to repay loans as provided under this section on behalf of a physician or dentist under an expanded physician and dentist loan assistance program that is funded through federal funds in addition to state matching funds. To be eligible for loan repayment under the expanded physician and dentist loan assistance program, a physician or dentist must fulfill all of the requirements for loan repayment under this section, as well as all of the following:

AB367,23,11 (a) The physician or dentist must be a U.S. citizen.

AB367,23,13 (b) The physician or dentist may not have a judgment lien against his or her property for a debt to the United States.

AB367,23,14 (c) The physician or dentist must agree to do all of the following:

AB367,23,16 1. Accept If the provider is a physician, accept medicare assignment as payment in full for services or articles provided.

AB367,23,19 2. Use a sliding fee scale or a comparable method of determining payment arrangements for patients who are not eligible for medicare or medical assistance and who are unable to pay the customary fee for the physician's or dentist's services.

AB367,23,22 3. Practice at a public or private nonprofit entity in a health professional shortage area, if the provider is a physician, or in a dental health professional shortage area, if the provider is a dentist.

AB367, s. 44 Section 44 . 560.184 (1) (ag) of the statutes is created to read: