HOUSE BILL 367

51st legislature - STATE OF NEW MEXICO - first session, 2013

INTRODUCED BY

Edward C. Sandoval

AN ACT

RELATING TO HEALTH CARE; ENACTING THE DENTAL THERAPIST ACT TO ESTABLISH A DENTAL THERAPY DEMONSTRATION PROJECT; PROVIDING FOR REGULATION, CERTIFICATION AND SCOPE OF SERVICES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. SHORT TITLE.--This act may be cited as the "Dental Therapists Act".

     SECTION 2. DEFINITIONS.--As used in the Dental Therapists Act:

          A. "board" means the New Mexico board of dental health care;

          B. "community" means a county, municipality, tribe or similar jurisdictional entity that exists in a dental workforce shortage area;

          C. "community dental health coordinator" means a dental assistant, dental hygienist or other trained personnel certified by the board as a community dental health coordinator pursuant to the Dental Health Care Act;

          D. "demonstration project" means a temporary study of the provision of dental services by dental therapists in a limited number of communities with the oversight of the board and department;

          E. "dental hygienist" means an individual who holds a license to practice dental hygiene pursuant to the Dental Health Care Act;

          F. "dental therapist" means an individual who has completed a board-approved dental therapist educational program and has been certified to participate in the demonstration project established pursuant to the Dental Therapists Act;

          G. "dental work force shortage area" means a geographic area of the state that the department has identified as having significantly limited access to dental care;

          H. "dentist" means an individual who holds a license to practice dentistry pursuant to the Dental Health Care Act;

          I. "department" means the department of health;

          J. "general supervision" means the authorization by a dentist of the procedures to be used by a dental therapist, dental hygienist, dental assistant or dental student and the execution of the procedures in accordance with a dentist's diagnosis and treatment plan at a time the dentist is not physically present and in facilities as designated by rule of the board;

          K. "indirect supervision" means that a dentist is present in the treatment facility while authorized treatments are being performed by a dental therapist, dental hygienist, dental assistant or dental student;

          L. "palliative procedure" means a nonsurgical, reversible procedure that is intended to alleviate pain and stabilize acute or emergent problems;

          M. "resident" means an individual who has resided in or been a documented member of a community for at least two years immediately preceding commencement of the demonstration project established pursuant to Section 3 of the Dental Therapists Act;

          N. "secretary" means the secretary of health;

          O. "supervising dentist" means an individual who has:

                (1) an active license to practice general dentistry in the state;

                (2) employed or supervised dental auxiliary personnel for at least five years immediately preceding the demonstration project;

                (3) undergone a minimum of fifty hours of formal training in teledentistry techniques; and

                (4) spent four hundred hours providing indirect supervision to a candidate for a dental therapist certificate; and

          P. "teledentistry" means a dentist's use of health information technology in real time to provide limited diagnostic and treatment planning services in cooperation with another dentist, a dental therapist, a dental hygienist, a community dental health coordinator or a student enrolled in a program of study to become a dental assistant, dental therapist, dental hygienist or dentist.

     SECTION 3. DENTAL THERAPY DEMONSTRATION PROJECT.--

          A. The department shall identify and approve a maximum of five communities as demonstration project sites for the provision of services by dental therapists working under the provisions of the Dental Therapists Act.

          B. The department shall select communities to serve as demonstration project sites from applications the communities provide pursuant to department rules on the basis of the applications' adherence to the following criteria:

                (1) documented jurisdictional authority of the applying entity;

                (2) location within an area that the department has identified as a dental work force shortage area;

                (3) a service population of not less than one thousand five hundred individuals within a fifteen-mile radius of the demonstration project site, of which twenty-five percent or more are eligible for medicaid; and

                (4) an operational plan that includes the ability of the community to recruit a supervising dentist and a resident to undergo training as a dental therapist and includes adequate assistance with educational and living expenses, compensation commensurate with the dental therapist's educational level and a fully equipped dental clinical facility with staff support to act as a demonstration project site.

          C. The secretary shall appoint a "project oversight committee" to include:

                (1) five dentists, two of whom are members of the board;

                (2) two dental hygienists, one of whom is a member of the board's New Mexico dental hygienists committee; and

                (3) two public members, one of whom is a member of the board.

          D. The project oversight committee shall establish a schedule and criteria for regular review of the project in the various phases and determine appropriate levels of informed consent for participating patients receiving services by dental therapists.

          E. The board shall identify and designate an educational program for dental therapists that is affiliated with a school of dentistry located in the United States, that is accredited by the commission on dental accreditation and that provides a minimum of three thousand hours of dental therapy curriculum.

          F. Before dental therapists begin providing services within a community selected as a demonstration project site, the department shall perform a survey of the oral health of that community. The survey shall use widely accepted indicators for such an assessment.

     SECTION 4. CERTIFICATION--DENTAL THERAPISTS--SUPERVISING DENTISTS.--

          A. The board shall certify dental therapists for participation in the demonstration project established pursuant to the Dental Therapists Act who have:

                (1) successfully completed the educational program designated by the board under Section 3 of that act;

                (2) practiced under the indirect supervision of a supervising dentist for a minimum of four hundred documented hours; and

                (3) demonstrated competency by successfully completing an examination administered by a nationally recognized regional testing agency or a comparable examination approved by the board.

          B. The board shall certify dentists to act as supervising dentists based on applications that shall include documentation:

                (1) that demonstrates that the dentist has completed advanced education in teledentistry;

                (2) that the dentist has the appropriate liability insurance for participation in the project; and

                (3) of a proposed supervisory protocol for both indirect and general supervision of a dental therapist based on criteria determined by the project oversight committee.

     SECTION 5. SCOPE OF SERVICES.--The board shall determine the scope of services allowed to be performed by dental therapists under the general supervision of a dentist based upon the curriculum used by the designated educational program and demonstrated competencies. The scope of services may include:

          A. acquisition of diagnostic data for teledentistry;

          B. preventive and educational services;

          C. limited direct restorative services;

          D. limited palliative endodontic services;

          E. limited periodontal services;

          F. uncomplicated extractions and post-care;

          G. administration of local anesthetics and inhalation anxiolysis;

          H. provisional cementation of indirect restoratives and prosthetics; and

          I. impressing for or delivery of provisional removable prosthetics that replace four or fewer teeth.

     SECTION 6. CONDUCT.--

          A. A dental therapy student that has successfully completed three thousand hours in a designated educational program may provide clinical services through participation in the demonstration project under the indirect supervision of a supervising dentist, following protocols to be determined by the oversight committee.

          B. A dental therapist that has been certified to participate in the demonstration project established pursuant to Section 3 of the Dental Therapists Act may provide those dental services that are within the dental therapist's scope of services as designated by the board and that are also within the scope of practice of dentistry as designated in Section 61-5A-4 NMSA 1978.

          C. A dental therapist shall not perform any dental services outside of a demonstration project site.

          D. A dental therapist and the dental therapist's supervising dentist shall submit a detailed list of protocols for the approval of the board before the dental therapist is allowed to deliver any services. The protocols shall include supervision parameters and mechanisms, guidelines for the administration and dispensing of medication, referral protocols, time frames for chart and case reviews and billing mechanisms. The dental therapist shall strictly follow the protocols.

          E. Any participating dentist or dental therapist shall be subject to all provisions of Section 61-5A-21 NMSA 1978 and the corresponding rules with regard to professional conduct and discipline by the board, including revocation of certification to participate in the demonstration project.

          F. The project oversight committee may require a community serving as a demonstration project site to provide regular reports regarding the progress of the demonstration project's implementation, demographics of those receiving services through the project, costs and revenues associated with providing services, surveys from those receiving services and other information as the oversight committee determines.

          G. A supervising dentist shall not supervise or attempt to supervise more than two dental therapists at any time.

     SECTION 7. DELAYED REPEAL.--Sections 1 through 6 of this act are repealed effective June 30, 2019.

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