Analysis by the Legislative Reference Bureau
This bill is explained in the Notes provided by the joint legislative council in
the bill.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
Prefatory note: This bill was prepared for the joint legislative council's special
committee on dental care access. The bill contains the following provisions:
Regional Dental Examinations
Under current law, the dentistry examining board is required to grant a dentist
license to a person who does all of the following: (1) submits an application for licensure;
(2) pays the specified fee; (3) submits evidence of graduation from an accredited dental
school; (4) submits evidence that he or she has passed the national dental examination
and the examination of a dental testing service approved by the board; (5) passes an
examination administered by the board on the statutes and rules relating to dentistry;
and (6) completes any other requirements established by the board by rule.
The bill modifies the fourth requirement above. Under the bill, the applicant will
have to submit evidence that he or she has passed the national dental examination, as
required under current law. However, the bill provides that the applicant may pass an
examination of either a dental testing service approved by the board or a regional dental
testing service in the United States.
Licensure of Dentists from Other Jurisdictions
Current law specifies that the board may grant a license to practice dentistry to a
person who is licensed in good standing in another state or U.S. territory or another
country if the applicant meets the requirements for licensure established by the board by
rule and presents the license and pays the specified fee.
The bill requires the board to grant a license to practice dentistry to an applicant
who is licensed in good standing to practice dentistry in another state or territory of the
United States or in Canada upon presentation of the license, payment of the required fee,
and submission of evidence satisfactory to the board that he or she has met the seven
conditions specified in the bill. The board would be permitted to refuse to grant a license
to an applicant following an interview if the board determines that discipline that was
imposed against the applicant in another jurisdiction demonstrates that the applicant is
unfit to practice dentistry.
Educational Dentist's License
The bill requires the board to grant a license to practice dentistry to an applicant
who is a faculty member at a school of dentistry in Wisconsin if specified conditions are
met. Marquette University School of Dentistry is the only school of dentistry in this state.
The person must present his or her license to the board, pay the required fee and submit
evidence satisfactory to the board that he or she has met the seven conditions specified
in the bill, one of which is that he or she is a faculty member at a school of dentistry in
this state. The board would be permitted to refuse to grant a license to an applicant
following an interview if the board determines that discipline that was imposed against
the applicant in another jurisdiction demonstrates that the applicant is unfit to practice
dentistry. In addition, an educational dentist's license granted under the bill is no longer
in effect if the licensee ceases to be a full-time faculty member at a school of dentistry in
this state.
Dental Hygienist's Scope of Practice
Current law allows a dental hygienist to practice dental hygiene or perform
remediable procedures only as an employee or as an independent contractor and only in
one of eight specified settings or circumstances. In five of those settings or circumstances,
the dental hygienist may practice only if there is a dentist present in the facility or if the
practice is being performed pursuant to a dentist's written or oral prescription that meets
specified requirements.
The bill retains the eight settings and circumstances in which a dental hygienist
may practice. The bill specifies that a dental hygienist may practice dental hygiene only
if a dentist is present in the facility or pursuant to a dentist's oral or written prescription
that meets the requirements set forth in current law, with two exceptions.
The first exception is that a dental hygienist may practice at a school for the
education of dental hygienists without a dentist present in the facility and without a
written or oral prescription. A dental hygienist may apply sealants on a patient at a
school for the education of dental hygienists without a diagnosis or treatment plan by a
dentist if the dental hygienist has performed an oral risk assessment, as defined by the
bill.
The second exception to the requirement that a dentist be present in the facility
or an oral or written prescription be used is set forth in the bill for dental hygienists who
meet specified education and experience requirements and practice specified procedures.
The dental hygienist will be allowed to perform those practices only in the following
settings or circumstances: (1) for a school board or a governing body of a private school;
(2) for a facility, as defined in current law, a hospital, or a facility established to provide
care for terminally ill patients; (3) for a local health department; (4) for a charitable
institution open to the general public or to members of a religious sect or order; (5) for a
nonprofit home health care agency; and (6) for a nonprofit dental care program serving
primarily indigent, economically disadvantaged, or migrant worker populations.
Under this second exception, the dental hygienist would be permitted to practice
as specified in the bill if he or she meets the education and experience requirements under
the bill to obtain a separate certificate. To obtain such a certificate, the person must have
two years experience as a dental hygienist and meet one of four educational
requirements.
Delegation of Dentistry Practices
Current law allows a dentist to delegate to an unlicensed person the performance
of remediable procedures if certain conditions are met. In addition, a dentist may
delegate to a dental hygienist the performance of remediable procedures and the
administration of oral systemic premedications, local anesthesia, and subgingival
sustained release chemotherapeutic agents if certain requirements are met.
The bill modifies the statute on delegation of practices by a dentist to a dental
hygienist. The bill allows any dentistry practice not included in dental hygiene to be
delegated to a dental hygienist, except for those practices that are prohibited practices
by a dental hygienist under current law. In order for the delegation to occur, the delegated
acts 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.
In addition, the dental hygienist's performance of the practice must be inspected by a
dentist.
The bill also modifies the statute dealing with delegation of remediable procedures
to unlicensed persons. In addition to delegation of remediable procedures, the bill
permits a dentist to delegate dentistry practices if certain requirements are met. First,
the practice must be one that is not one of several prohibitions on delegation enumerated
in the bill. Second, the person must have graduated from an accredited dental assisting
program or have worked at least 1,000 hours during the preceding 12 months in a clinical
dentistry setting. Third, the dentist making the delegation must document in his or her
records that the person has been trained or educated to do the dental practice by one of
several specified entities. Fourth, the delegated practices must be 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.
Loan Assistance Programs
Under current law, the department of commerce administers a physician loan
assistance program and a health care provider loan assistance program. Current law also
has established a rural health development council, which advises the department on
operation of the two programs. The physician loan assistance program provides loan
assistance to physicians who practice in specified eligible practice areas, and the health
care provider loan assistance program provides such assistance to physician assistants,
nurse-midwives, and nurse practitioners who practice in specified eligible practice areas.
The amount of the assistance is $50,000 under the physician loan assistance program and
$25,000 under the health care provider loan assistance program, both repaid by the
department over a three-year period.
The bill expands the physician loan assistance program to include dentists and
renames it the physician and dentist loan assistance program. In addition, the bill
expands the health care provider loan assistance program to include dental hygienists.
Finally, the bill adds a dentist and a dental hygienist to the rural health development
council.
Community Dental Health Education Report
The bill requires the Wisconsin technical college system board to report on the
feasibility and cost of increasing the number of sites in the system that offer community
dental health education for dentists and dental hygienists. The report must be submitted
to the governor and the legislature by the first day of the sixth month after publication
of the act.
Dental Work Force Report
The bill requires the dentistry examining board and the department of health and
family services to prepare a joint report every five years on the ability of the dental work
force to meet the oral health care needs of individuals in Wisconsin. The report must be
submitted to the governor and the legislature. The first report is due January 1, 2003.
Oral Health Data Collection Plan
The bill requires the department of health and family services to prepare a plan
for development of a comprehensive oral health data collection system. The plan must
be submitted to the governor and the legislature by September 1, 2002.
Prior Authorization Report
The bill requires the department of health and family services to prepare a report
on its efforts to reduce the requirement for prior authorization for dental services under
medical assistance and to simplify the prior authorization process for those services. The
report must be submitted to the governor and the legislature by the first day of the sixth
month beginning after publication of the act.
Access to Services Report
The bill requires the department of health and family services and the department
of regulation and licensing jointly to prepare reports on whether the provisions of the bill
relating to a dental hygienist's scope of practice and delegation of dentistry practices have
improved access to dental services and dental hygiene services. The reports, which would
be submitted to the governor and the legislature, would be done two years and four years
after enactment of the bill.
AB367, s. 1
1Section
1. 15.157 (8) (intro.) and (g) of the statutes are amended to read:
AB367,5,72
15.157
(8) Rural health development council. (intro.) There is created in the
3department of commerce a rural health development council consisting of
11 13 4members nominated by the governor, and with the advice and consent of the senate
5appointed, for 5-year terms, and the secretaries of commerce and health and family
6services, or their designees. The appointed members shall include all of the
7following:
AB367,6,3
1(g) A physician licensed under ch. 448
and, a nurse licensed under ch. 441,
both 2a dentist licensed under ch. 447, and a dental hygienist licensed under ch. 447, all 3of whom practice in a rural area, and a representative of public health services.
Note: This Section adds a dentist and a dental hygienist to the rural health
development council. The council is advisory to the department of commerce, which
administers the current physician loan assistance program and the health care provider
loan assistance program. The first program is being expanded to include dentists and the
second program is being expanded to include dental hygienists.
AB367, s. 2
4Section
2. 20.143 (1) (jc) (title), (jm) (title), and (kr) (title) of the statutes are
5amended to read:
AB367,6,76
20.143
(1) (jc) (title)
Physician and dentist and health care provider loan
7assistance programs repayments; penalties.
AB367,6,88
(jm) (title)
Physician and dentist loan assistance program; local contributions.
AB367,6,109
(kr) (title)
Physician and dentist and health care provider loan assistance
10programs, repayments and contract.
Note: This Section modifies the name of the physician loan assistance program
to be the physician and dentist loan assistance program.
AB367, s. 3
11Section
3
. 46.03 (44) of the statutes is created to read:
AB367,6,1712
46.03
(44) Dental work force report. By January 1, 2003, and every 5 years
13thereafter, submit jointly with the dentistry examining board a report to the
14legislature in the manner provided under s. 13.172 (2) and to the governor on the
15ability of the dental work force to meet the oral health care needs of individuals in
16this state. The report shall include findings and any recommendations of the
17department and the examining board.
Note: Sections 3 and 9 require the department of health and family services and
the dentistry examining board to submit a periodic report on the ability of the dental work
force to meet the oral health care needs of individuals in Wisconsin. The first report is
due January 1, 2003, and subsequent reports would be due every five years thereafter.
AB367, s. 4
18Section
4. 447.01 (10) of the statutes is created to read:
AB367,7,3
1447.01
(10) "Oral risk assessment" means a review of the patient's caries
2experience, dental care utilization, use of preventive services, and medical history.
3"Oral risk assessment" does not include a dental diagnosis.
Note: This Section creates a definition of "oral risk assessment." The term is used
in provisions of the bill dealing with the scope of practice of dental hygienists.
AB367, s. 5
4Section
5. 447.01 (12) of the statutes is amended to read:
AB367,7,85
447.01
(12) "Remediable procedures" means patient procedures that create
6changes within the oral cavity or surrounding structures that are reversible
without
7professional intervention and do not involve any increased health risks to the
8patient.
Note: This Section modifies the current definition of "remediable procedures."
The bill specifies that the procedures must be reversible without professional
intervention.
AB367, s. 6
9Section
6
. 447.02 (1) (c) of the statutes is amended to read:
AB367,7,1110
447.02
(1) (c) Subject to ch. 553 and s.
447.06 (1) 447.055, governing dental
11franchising.
AB367, s. 7
12Section
7. 447.02 (2) (d) of the statutes is amended to read:
AB367,7,1513
447.02
(2) (d) The oral systemic premedications and subgingival sustained
14release chemotherapeutic agents that may be administered by a dental hygienist
15licensed under this chapter under s. 447.06
(2) (e) 1. and 3 (6) (a) and (c).
AB367, s. 8
16Section
8
. 447.02 (2) (e) of the statutes is amended to read:
AB367,7,1917
447.02
(2) (e) The educational requirements for administration of local
18anesthesia by a dental hygienist licensed under this chapter under s. 447.06
(2) (e)
192 (6) (b).
Note: Sections 6 to 8 modify current cross-references to reflect changes made by
the bill.
AB367, s. 9
20Section
9
. 447.02 (3) of the statutes is created to read:
AB367,8,6
1447.02
(3) By January 1, 2003, and every 5 years thereafter, the examining
2board shall submit jointly with the department of health and family services a report
3to the legislature under s. 13.172 (2) and to the governor on the ability of the dental
4work force to meet the oral health care needs of individuals in this state. The report
5shall include findings and any recommendations of the examining board and the
6department.
AB367, s. 10
7Section
10
. 447.03 (2) (intro.), (a) and (b) of the statutes are renumbered
8447.03 (2) (a) (intro.), 1. and 2.
AB367, s. 11
9Section
11
. 447.03 (2) (b) of the statutes is created to read:
AB367,8,1210
447.03
(2) (b) Any individual who is licensed as a dental hygienist under this
11chapter is not required to be licensed as a dentist to perform acts delegated by a
12dentist under s. 447.06.
AB367, s. 12
13Section
12
. 447.03 (3) (g) of the statutes is amended to read:
AB367,8,1514
447.03
(3) (g) Any individual who provides remediable procedures
or other
15dentistry practices that are delegated under s. 447.065 (1)
or (2).
Note: Sections 10 to 12 modify current statutes dealing with unauthorized
practice of dentistry to allow individuals who are delegated dentistry practices by a
dentist under the bill to do so without having to be licensed as a dentist.
AB367, s. 13
16Section
13. 447.04 (1) (a) 4. of the statutes is amended to read:
AB367,8,2017
447.04
(1) (a) 4. Submits evidence satisfactory to the examining board that he
18or she has passed the national dental examination and
either the examination of a
19dental testing service approved by the examining board
or an examination of a
20regional dental testing service in the United States.
Note: This Section modifies one of the requirements for licensure as a dentist.
Under the current requirement, the applicant must submit evidence satisfactory to the
dentistry examining board that he or she has passed the national dental examination and
the examination of a dental testing service approved by the examining board. This
Section modifies the latter requirement so that the individual would have to pass either
the examination of a dental testing service approved by the examining board or an
examination of a regional dental testing service in the United States. There are four such
regional dental testing services in the United States, two of which are currently
recognized by the examining board.
AB367, s. 14
1Section
14. 447.04 (1) (b) of the statutes is amended to read:
AB367,9,72
447.04
(1) (b)
The Except as provided in pars. (c) and (d), the examining board
3may grant a license to practice dentistry to an individual who is licensed in good
4standing to practice dentistry in another state or territory of the United States or in
5another country if the applicant meets the requirements for licensure established by
6the examining board by rule and upon presentation of the license and payment of the
7fee specified under s. 440.05 (2).
Note: This Section amends the current statute allowing the dentistry examining
board to grant a license to practice dentistry to an individual who is licensed in another
state, territory, or country. The statute is amended to reference the two provisions in the
bill under which the examining board would be required to grant a license to practice
dentistry, as specified in Sections 15 and 16.
AB367, s. 15
8Section
15
. 447.04 (1) (c) of the statutes is created to read:
AB367,9,139
447.04
(1) (c) 1. The examining board shall grant a license to practice dentistry
10to an applicant who is licensed in good standing to practice dentistry in another state
11or territory of the United States or in Canada upon presentation of the license,
12payment of the fee specified under s. 440.05 (2), and submission of evidence
13satisfactory to the examining board that all of the following conditions are met:
AB367,9,1514
a. The applicant has graduated from a school of dentistry accredited by the
15American Dental Association's commission on dental accreditation.
AB367,9,1916
b. The applicant submits a certificate from each jurisdiction in which the
17applicant is or has ever been licensed stating that no disciplinary action is pending
18against the applicant or the license, and detailing all discipline, if any, that has ever
19been imposed against the applicant or the license.
AB367,10,4
1c. The applicant has been engaged in the active practice of dentistry, as defined
2in s. DE 1.02 (2), Wis. Adm. Code, in one or more jurisdictions in which the applicant
3has a current license in good standing, for at least 48 of the 60 months preceding the
4application for licensure in this state.
AB367,10,75
d. The applicant has successfully completed a jurisprudence examination on
6the provisions of Wisconsin statutes and administrative rules relating to dentistry
7and dental hygiene.
AB367,10,98
e. The applicant possesses a current certificate of proficiency in
9cardiopulmonary resuscitation.
AB367,10,1210
f. The applicant has disclosed all discipline that has ever been taken against
11the applicant in any jurisdiction shown in reports from the national practitioner data
12bank and the American association of dental examiners.
AB367,10,1613
g. The applicant has presented satisfactory responses during any personal
14interview with the board that the board may require to resolve conflicts between the
15licensing standards and the applicant's application or to inquire into any discipline
16that was imposed against the applicant or the license in another jurisdiction.
AB367,10,2017
2. Notwithstanding subd. 1., the examining board may refuse to grant a license
18to an applicant following an interview under subd. 1. g. if the examining board
19determines that discipline that was imposed against the applicant or the license in
20another jurisdiction demonstrates that the applicant is unfit to practice dentistry.
Note: This Section requires the dentistry examining board to grant a license to
practice dentistry to an applicant who is licensed in good standing to practice dentistry
in another state or territory of the United States or in Canada upon satisfying conditions
specified in the bill. Licensure of persons who have practiced in another jurisdiction is
commonly referred to as "licensure by endorsement."
AB367, s. 16
21Section
16
. 447.04 (1) (d) of the statutes is created to read:
AB367,11,5
1447.04
(1) (d) 1. The examining board shall grant a license to practice dentistry
2to an applicant who is licensed in good standing to practice dentistry in another state
3or territory of the United States or in another country upon presentation of the
4license, payment of the fee specified under s. 440.05 (2), and submission of evidence
5satisfactory to the examining board that all of the following conditions are met: