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SB-653 Dental hygienists: registered dental hygienist in alternative practice: scope of practice.(2019-2020)



Current Version: 04/25/19 - Amended Senate         Compare Versions information image


SB653:v96#DOCUMENT

Amended  IN  Senate  April 25, 2019
Amended  IN  Senate  April 22, 2019
Amended  IN  Senate  March 27, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill
No. 653


Introduced by Senator Chang

February 22, 2019


An act to amend Sections 1911, 1925, 1926, and 1926.05 of, and to add Sections 1911.5, 1926.01, and 1926.5 to, the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


SB 653, as amended, Chang. Dental hygienists: registered dental hygienist in alternative practice: scope of practice.
Existing law, the Dental Practice Act, provides for the licensure and regulation of the practice of registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice by the Dental Hygiene Board of California within the Department of Consumer Affairs. Existing law makes certain violations of specific provisions relating to healing arts by a licensee a crime.
Existing law specifies the scope of practice of a registered dental hygienist and requires any procedure performed by a registered dental hygienist that does not specifically require direct supervision of a dentist to be performed under the general supervision of a dentist. Existing law authorizes a registered dental hygienist to provide, without supervision, dental hygiene preventive services in addition to oral screenings in a specified federal, state, or local public health program.
This bill would authorize a registered dental hygienist to provide, without supervision, fluoride varnish to a patient. The bill would additionally authorize a registered dental hygienist to provide dental hygiene preventive services and oral screenings at specified sponsored events and nonprofit organizations.
Existing law authorizes a registered dental hygienist in alternative practice to perform any of the duties or functions authorized to be performed by a registered dental hygienist as an employee of a dentist, as an employee of another registered dental hygienist in alternative practice, as an employee of specified clinics, or as an employee of a professional corporation. Existing law authorizes a registered dental hygienist in alternative practice to perform additional duties and functions in residences of the homebound, schools, residential facilities and other institutions, and dental health professional shortage areas, as provided, and requires the duties and functions performed in these settings to be under the general supervision of a dentist when specified.
This bill would authorize a registered dental hygienist in alternative practice to practice in specified clinics or in a professional corporation without being an employee of that clinic or professional corporation. The bill would additionally authorize a registered dental hygienist in alternative practice to perform specified functions and duties of a registered dental hygienist in dental or medical settings. The bill would authorize a registered dental hygienist in alternative practice to perform soft-tissue curettage, administration of local anesthesia, and administration of nitrous oxide and oxygen with emergency protocols and under the direct supervision of a dentist in residences of the homebound, residential facilities and other institutions, dental health professional shortage areas, and dental or medical settings. The bill would remove the general supervision requirement and instead require prior authorization by a collaborating dentist for specified duties in those settings. The bill would also authorize a registered dental hygienist in alternative practice to continue to practice in a former dental health professional shortage area if the registered dental hygienist in alternative practice established the practice prior to the designation being removed. certain conditions are met.
Because a violation of certain provisions of the bill would be a crime, the bill would create a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1911 of the Business and Professions Code is amended to read:

1911.
 (a) A registered dental hygienist may provide, without supervision, educational services, oral health training programs, and oral health screenings.
(b) A registered dental hygienist shall refer any screened patients with possible oral abnormalities to a dentist for a comprehensive examination, diagnosis, and treatment plan.
(c) In any public health program created by federal, state, or local law or administered by a federal, state, county, or local governmental entity, at a sponsored event by a sponsoring entity, or at a nonprofit organization, a registered dental hygienist may provide, without supervision, dental hygiene preventive services in addition to oral screenings, including, but not limited to, the application of fluorides and pit and fissure sealants. A registered dental hygienist employed as described in this subdivision may submit, or allow to be submitted, any insurance or third-party claims for patient services performed as authorized in this article.
(d) For purposes of this section, the following shall apply:
(1) “Nonprofit organization” means a tax-exempt nonprofit corporation supported and maintained in whole or in substantial part by donations, bequests, gifts, grants, government funds, or contributions, in the form of money, goods, or services, where dental hygiene services are performed. A nonprofit organization shall not be construed to be engaging in the unlicensed practice of dentistry if all of the following apply:
(A) The nonprofit organization obtains the dental hygiene board’s approval to offer dental hygiene services pursuant to regulations adopted by the dental hygiene board.
(B) The nonprofit organization does nothing to interfere with, control, or otherwise direct the professional judgment of, or the services performed by, a registered dental hygienist acting within their scope of practice pursuant to this chapter.
(C) The licensees providing services for or at the nonprofit organization are in compliance with all applicable provisions of this chapter.
(D) The nonprofit organization operating is in compliance with this chapter and all other applicable provisions of state and federal law.
(2) “Sponsored event” shall be defined as in paragraph (4) of subdivision (b) of Section 1626.6.
(3) “Sponsoring entity” shall be defined as in paragraph (6) of subdivision (b) of Section 1626.6.

SEC. 2.

 Section 1911.5 is added to the Business and Professions Code, to read:

1911.5.
 Notwithstanding Section 1912, a registered dental hygienist may provide, without supervision, fluoride varnish to a patient.

SEC. 3.

 Section 1925 of the Business and Professions Code is amended to read:

1925.
 A registered dental hygienist in alternative practice may practice, pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, subdivisions (a) and (b) of Section 1910, Section 1910.5, and Section 1926.05 as an employee of a dentist or of another registered dental hygienist in alternative practice, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, in a primary care clinic or specialty clinic that is licensed pursuant to Section 1204 of the Health and Safety Code, in a primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code, in a clinic owned or operated by a public hospital or health system, in a clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the county’s role under Section 17000 of the Welfare and Institutions Code, or in a professional corporation under the Moscone-Knox Professional Corporation Act (commencing with Section 13400) of Part 4 of Division 3 of Title 1 of the Corporations Code.

SEC. 4.

 Section 1926 of the Business and Professions Code is amended to read:

1926.
 In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
(a) Residences of the homebound.
(b) Schools.
(c) Residential facilities and other institutions.
(d) Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines.

SEC. 5.

 Section 1926.01 is added to the Business and Professions Code, to read:

1926.01.
 In addition to practices authorized in Section 1925, a registered dental hygienist in alternative practice may perform the duties authorized pursuant to subdivisions (a) and (b) of Section 1909 with emergency protocols in the following settings:
(a) Residences of the homebound.
(b) Residential facilities and other institutions.
(c) Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines.
(d) Dental or medical settings.

SEC. 6.

 Section 1926.05 of the Business and Professions Code is amended to read:

1926.05.
 (a) In addition to the duties specified in Section 1926, a registered dental hygienist in alternative practice is authorized to perform the duties pursuant to Section 1910.5, in the following settings:
(1) Residences of the homebound.
(2) Schools.
(3) Residential facilities and other institutions.
(4) Dental or medical settings.
(5) Dental health professional shortage areas, as certified by the Office of Statewide Health Planning and Development in accordance with existing office guidelines.
(b) A registered dental hygienist in alternative practice is authorized to perform the duties pursuant to paragraph (2) of subdivision (a) of Section 1910.5 in the settings specified in this section with prior authorization of a collaborating dentist.

SEC. 7.

 Section 1926.5 is added to the Business and Professions Code, to read:

1926.5.
 A registered dental hygienist in alternative practice may continue to practice in a former dental health professional shortage area after the designation is removed if the registered dental hygienist in alternative practice established the practice prior to removal of the designation. area, if both of the following conditions are met:
(a) The registered dental hygienist in alternative practice established their practice in a certified dental health professional shortage area.
(b) The registered dental hygienist in alternative practice continues to practice within the dental health professional shortage area after the date the dental health professional shortage area designation was lifted, if a minimum of 15 percent of the annual visits at their practice are for persons with Medi-Cal benefits.

SEC. 8.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.