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AB-733 Dental hygienists: registered dental hygienist in alternative practice: scope of practice.(2021-2022)

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Date Published: 03/18/2021 09:00 PM
AB733:v98#DOCUMENT

Amended  IN  Assembly  March 18, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 733


Introduced by Assembly Member Chiu

February 16, 2021


An act to add Section 1925.5 to the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


AB 733, as amended, Chiu. Dental hygienists: registered dental hygienist in alternative practice. 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 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 or of another registered dental hygienist in alternative practice, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, in specified clinics, or in a professional corporation. Existing law further authorizes a registered dental hygienist in alternative practice to perform certain additional duties and functions in prescribed settings.

This bill would make a statement of legislative intent to enact legislation that would expand access to oral healthcare for children enrolled in Medi-Cal and pregnant people by allowing registered dental hygienists in alternative practice to partner with medical professionals in medical settings to provide fluoride treatments and oral health education and to coordinate care with dental providers and the dental care system.

This bill would authorize a registered dental hygienist in alternative practice to perform specified duties and functions authorized to be performed by a registered dental hygienist as an independent contractor for a physician and surgeon or medical practice on an individual who is under 18 years of age or pregnant, enrolled in the Medi-Cal program, and has not utilized Medi-Cal dental program benefits in the past 12 months. The bill would require a registered dental hygienist in alternative practice to refer a screened patient with possible oral abnormalities or conditions to a dentist for a comprehensive examination, diagnosis, and treatment plan, as provided. The bill would also require a registered dental hygienist in alternative practice to provide a written informed consent to the patient at each visit and to provide to the patient’s established medical provider all relevant patient information, as specified.
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: NOYES   Local Program: NOYES  

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


SECTION 1.

 Section 1925.5 is added to the Business and Professions Code, to read:

1925.5.
 (a) In addition to the settings specified in Section 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 independent contractor for a physician and surgeon or medical practice on an individual who meets the requirements of subdivision (b).
(b) (1) A registered dental hygienist in alternative practice may offer the services identified in subdivision (a) to an individual who meets all of the following requirements:
(A) Is under 18 years of age or pregnant.
(B) Is enrolled in the Medi-Cal program.
(C) Has not utilized Medi-Cal dental program benefits in the past 12 months.
(2) A registered dental hygienist in alternative practice shall confirm individual patient information pursuant to this section in a manner consistent with state and federal law and only upon an executed agreement with the physician or medical practice. The agreement shall state the specific access to patient information the registered dental hygienist in alternative practice is allowed to access and the legal liabilities the hygienist will be responsible for based on violations of state or federal law.
(c) A registered dental hygienist in alternative practice shall refer a screened patient with possible oral abnormalities or conditions to a dentist for a comprehensive examination, diagnosis, and treatment plan. The registered dental hygienist in alternative practice shall utilize a statewide referral system to refer patients to dentists and coordinate care. To the extent that a statewide referral system is not available, the registered dental hygienist in alternative practice shall maintain an established relationship with a dental provider in the community to facilitate referrals and assist in care coordination. This relationship shall be formalized between the providers and available to the board upon request.
(d) The registered dental hygienist in alternative practice shall provide a written informed consent to the patient at each visit stating: “The services received today are limited to dental hygiene services and oral health counseling only. The patient should also receive an examination by a licensed dentist in order to diagnose any potential decay or other oral disease, including cavities. The patient should also receive a written prescription from their dentist in order to continue treatment by a registered dental hygienist in alternative practice.”
(e) To facilitate care coordination between a registered dental hygienist in alternative practice and a dentist, oral surgeon, or other licensed dental provider, and to the extent consistent with state and federal law, the registered dental hygienist in alternative practice shall provide to the patient’s established medical provider all relevant patient information, including, but not limited to, services provided pursuant to subdivision (a), noted medical conditions or other notes, and any referrals to another dental provider.

SEC. 2.

 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.
SECTION 1.Section 1925.5 is added to the Business and Professions Code, to read:
1925.5.

(a)The Legislature finds and declares the following:

(1)An increasing number of studies support integrating dental care and medical care as a means to improve health outcomes and lower the cost of care.

(2)In 2017, the National Association of Dental Plans released an analysis showing that providing a preventive dental service, defined as a prophylaxis, examination, fluoride treatment or sealant, to adult Medicaid recipients was associated with a 36 to 67 percent decrease in medical costs for patients with seven chronic conditions, with savings totaling almost $100 million in 2014.

(3)Tooth decay and disease are associated with pregnancy risks, diabetes, and respiratory and heart disease. Only 42 percent of pregnant individuals seek a dental visit, yet maternal gum disease is a significant factor in preterm birth or low birthweight.

(4)In the calendar year 2019, only 51 percent of children 1 to 20 years of age in the Medi-Cal program received dental care, however 84 percent of the same group visited a physician.

(b)It is the intent of the Legislature to enact in subsequent amendments legislation that would expand access to oral healthcare for children enrolled in Medi-Cal and pregnant people by allowing registered dental hygienists in alternative practice to partner with medical professionals in medical settings to provide fluoride treatments and oral health education and to coordinate care with dental providers and the dental care system.