LegislationLegislation

2010 Legislation

 

Senate Bill - SB719 Health Occupations—Dental Hygienists—Practice in Long-Term Care Facilities, sponsored by Senator Middleton. 

House Bill – HB1302 Health Occupations—Dental Hygienists—Practice in Long-Term Care Facilities, sponsored by Delegates Kipkie, Kach, Kullen & Montgomery.

 

Synopsis:

Authorizing a dental hygienist to practice dental hygiene under the general supervision of a dentist in long-term care facilities under specified circumstances; requiring specified dental hygienists to have a specified written agreement; requiring specified dental hygienists to consult with the supervising dentist or a treating physician under specified circumstances; requiring specified dental hygienists to assess the appropriate recall interval for a patient in a specified manner; etc.

 

The intent of this bill is to allow the Hygienist in private practice to go into long-term facilities under general supervision.

 

 

Legislative Update 12/3/09:

The State Board of Dental Examiners (SBODE) met yesterday for a final vote on the Rules and Regulations concerning local anesthesia administration in Maryland.  The final outcome was favorable.  Here is the final result: 

·         We do NOT have to report incidents related to the administration of Local Anesthesia

·         You will pay a onetime fee of $50. for anesthesia certification, with NO renewal.

·         Out of state hygienists must certify that they have completed a minimum of 25 (NOT 40) injections within the 2 years prior to Maryland application. 

·         After taking an accredited course and examination of that course you will have to take a NERB exam which includes Block.  While the legislative committee wanted this aspect removed, it will stand.  The NERB Exam will consist of 55 questions and does NOT include a clinical exam.    

Now, these Rules & Regulation will go back to the legislature for a final look, and then they will be available for public viewing and comments.    Legal counsel said the process should be finalized by February, 2010.   We will continue to keep you posted.

 

Legislative Update 11/29/09: 

I promised I would keep you all informed of the progress being made on  local anesthesia by infiltration.  After the bill was passed, Rules and Regulations had to be written and passed by the Maryland State Board of Dental Examiners.  This process has taken several months with much time and effort put forth by your Legislative committee.  We are trying to have fair rules and regulation that will be affordable to the hygienists in our state.  The Dental Hygiene Committee of the Board has worked diligently to  achieve the same goal.  Right now we need your help.  After the  DH Committee made their recommendations the Rules and Regulations were sent to the Rules and Regulations Committee for their input and approval.  Then they are sent  to the entire board for approval.  The Rules and Regulations Committee  added back recommendations that had already  been deleted by the Dental Hygiene Committee. We are asking that you contact: Laurie Sheffield-James Executive Director of the Board Sheffiel@DHMH.state.md.us and address your concerns to Jane Casper, President of the Board  and  Gerri Seager, Chair person of the DH committee. 

 

The issues you want removed from these Rules and Regulations are:

 

Having to report incidents related to the administration of Local Anesthesia, should be removed

 

After taking an accredited course and examination of that course you will have to take a NERB exam which includes Block.  Not all Maryland schools may offer a program that includes block, the University of Md will.  The NERB should be removed.             

 

$40 renewal fee every 2 years for anesthesia renewal.  We felt an initial fee would be sufficient.

 

Out of state hygienists must certify that they have completed a minimum of 40 injections within the 2 years prior to Maryland application.  (DH committee recommended 25)

 

As of this date the entire Board will be discussing and voting on these Rules and Regulations on December 2nd .   Please contact these people immediately. 

Thank you for your support,

Carol Caiazzo, RDH 

Chair of MDHA  Legislative Committee

 

Legislative Chair, Carol Caiazzo, RDH

The Maryland Dental Hygienists Association (MDHA) Legislative Committee addresses all legislative issues concerning the profession of Dental Hygiene. Our goal is to represent all Hygienists in the state of Maryland. We endeavor to do this by having representation from all nine components of MDHA. We are open to your concerns and “wish list” for the future of Dental Hygiene. Anyone, who is interested in serving on the committee, is welcome to attend our meetings. We try to meet at least every other month when our State Legislature is not in session and more frequently when needed. The decisions that affect our profession are not taken lightly. We try to serve everyone!

Every year the last Friday of January is reserved for the MDHA Legislative Luncheon. We gather in Annapolis in the morning to visit our Legislators offices to distribute Oral Healthcare care packages with information concerning dental hygiene. This is followed by our Luncheon at Noon. All Legislators are sent personal invitations to this event. This is our opportunity to personally discuss Dental Hygiene concerns and upcoming legislation with our representatives in Annopolis. All members are welcome to attend.

We have a new Lobbyist representing us in Annapolis, she is Sandy Schrader. Sandy has served as a Maryland Senator and is one of the five Senior Consultants at The Artemis Group, LLC.. Artemis has three Partners and everyone in the firm is a consulting and government affairs professional that has expertise in state and federal politics and policies.

Through our efforts in representing you in Annapolis we have helped to achieve the Public Health Hygienist bill passing into law and the Dental Hygienists – Expanded Functions bill. With the passing of the Expanded Functions bill, Dental Hygienists in the state of Maryland will be permitted to administer local anesthesia by infiltration. Dental Hygienists will also be permitted to perform manual curettage in conjunction with scaling and root planning. The State Board of Dental Examiners will be setting the dental hygiene guide lines for the education, training, evaluation, and examination for administering local anesthesia and manual curettage. This bill also had an impact on General Supervision. The number of hours that a Hygienist may practice unsupervised has changed. The number of unsupervised clinical hours worked by a supervised dental hygienist in any given 3 month period is less than 60 percent of the dental hygienists total hours worked during that 3-month period. This bill also addressed Nitrous Oxide. Unfortunately there was a last minute concern in the House of Delegates about the safety of women and nitrous oxide and consequently the monitoring of nitrous oxide was amended out of the bill.

The Board of Dental Examiners has now made it mandatory for Dental Hygienists and Dentist to have completed a Board approved two hours course in “Abuse and Neglect “ for license renewal starting 2011 and thereafter. This Board approved course has to be completed every other renewal cycle. This course has to be related to Maryland law and will count toward the 30 full hours of required CE. To date Mid-Atlantic P.A.N.D.A. is the only approved course.



2009 Licensure renewal guidelines

04 Requirements

A. A licensee shall maintain cardiopulmonary resuscitation certification from one of the following programs:

  1. The American Heart Association's Basic Life Support for Healthcare Providers;
  2. The American Red Cross's Cardiopulmonary Resuscitation for Professional Rescuers; or
  3. An equivalent program approved by the Board.

B. A licensee seeking renewal shall complete not less than 30 full hours of continuing education, including 2 hours of infection control. (Please note:  only 15 of the required 30 continuing education hours needed for licensure can be home study/online courses). 
C. A licensee seeking renewal in 2011 and thereafter shall complete a Board-approved course of 2 hours in abuse and neglect.
D. The 2-hour, board-approved course in abuse and neglect required by §C of this regulation shall:

  1. Be completed by each licensee every other renewal cycle;
  2. Relate to Maryland law on the subject of abuse and neglect; and
  3. Count toward the 30 full hours of required continuing education.

E. A licensee who has received a license within 6 months of graduation from an approved dental or dental hygiene school is not required to fulfill the continuing education requirements of the Board for the first renewal following initial licensure.
F. A licensee who is on inactive status shall provide evidence of compliance with the continuing education requirements of the Board for the 2-year period preceding application for reactivation of the licensee's license.
G. A licensee who fails to obtain the required continuing education due to disability or retirement shall comply with this regulation within 6 months of the licensee's return to practice.

2009 General Supervision Rules & Regulations

Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 44 BOARD OF DENTAL EXAMINERS
Chapter 21 Practice of Dental Hygiene Under General Supervision in a Facility
Authority: Health Occupations Article, §4-308, Annotated Code of Maryland; Ch. 221, Acts of 2003; Ch. 164 and 165, Acts of 2007

.01 Scope.
  This chapter governs the practice of dental hygiene in a facility. The practice of dental hygiene in a private dental office is governed by COMAR 10.44.27.

.02 Definitions.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.

  1. "Contractual employee" means a dental hygienist who has an annual contract to practice dental hygiene an average of at least 8 hours per week in a facility identified in Regulation .09A of this chapter.
  2. "Facility" as used in Regulation .09 of this chapter includes a program operated within a facility that is specified under Regulation .09 of this chapter.
  3. "Federally qualified health center" has the meaning stated in 42 U.S.C. §254b(a).
  4. "Federally qualified health center look-alike" has the meaning stated in 42 U.S.C. §1396d(l)(2)(B).
  5. "General supervision" means the supervision of a dental hygienist by a dentist where the dentist may or may not be present when the dental hygienist performs the dental hygiene procedures.
  6. "On-site supervision" means the supervision of a dental hygienist by a dentist who is physically present on the premises and may or may not be present in the operatory when the dental hygiene services are provided.
  7. "Waiver of on-site supervision" means that a facility has been approved by the Board to enable a licensed dental hygienist to provide dental hygiene services under general supervision.

.03 Supervision Requirements in a Facility.

  Unless a facility is operating pursuant to this chapter, a general license to practice dental hygiene in a facility authorizes the licensee to practice dental hygiene only under the on-site supervision of a licensed dentist.

.04 Qualification for Practice Under General Supervision by Report to the Board.

A. With the exception of those facilities identified in Regulation .09A of this chapter, a facility is qualified to permit a dental hygienist to practice under general supervision if the facility has filed a report with the Board and the facility is owned or operated by:

  1. The federal government;
  2. The State government;
  3. A county or local government; or
  4. A public health department of the federal, State, or local government.

B. A facility shall include in the report to the Board:

  1. The name of the federal, State, or local government agency which owns or operates the facility;
  2. The location of the facility and all other sites where dental hygiene services will be provided;
  3. The name of the supervising dentist affiliated with the facility who will be responsible for carrying out the requirements necessary for the facility to operate under general supervision; and
  4. The names of the dental hygienists who will provide dental hygiene services under general supervision.

C. A facility which is qualified for practice under general supervision by report to the Board may do so on receipt of the report by the Board.

.05 Waiver of On-Site Supervision by Application to the Board.

A. With the exception of those facilities identified in Regulation .09A of this chapter, the Board may grant on a case-by-case basis a waiver of on-site supervision qualifying a facility to permit the practice of dental hygiene under general supervision, after the facility has made application to the Board, if the facility is a health facility that is licensed by the Department of Health and Mental Hygiene and:

  1. Provides medical care to the poor, elderly, or handicapped;
  2. Is owned or operated by a charitable institution;
  3. Is a federal-qualified or State-qualified community health care program; or
  4. Is a setting otherwise authorized by the Board to provide dental hygiene services.

B. The facility shall include in the application for a waiver of on-site supervision the following:

  1. The name of the facility;
  2. The location of the facility;
  3. The name and signature of each supervising dentist responsible for carrying out the requirements necessary for the facility to operate under a waiver of on-site supervision affirming that the dentist understands and accepts those responsibilities;
  4. The name and signature of each dental hygienist who will provide dental hygiene services at the facility under a waiver of on-site supervision affirming that the dental hygienist understands and accepts the terms of the waiver of on-site supervision;
  5. The supervisory responsibilities of the supervising dentist or dentists;
  6. A description of the program and how the program will operate and be administered;
  7. A description of a medical emergency plan of action; and
  8. A description of the facility that demonstrates that it has adequate equipment for the delivery of dental hygiene services, unless the dental hygiene services that are provided are limited to fluoride rinse programs.

C. The Board shall grant or deny an application for waiver of on-site supervision:

  1. Within 60 calendar days after receipt of the application by the Board; or
  2. Within 90 calendar days after receipt of the application by the Board, if the Board notifies the applicant that extraordinary circumstances exist.

D. If the Board fails to grant or deny an application within the appropriate time, the Board shall consider the application granted.
E. The Board may, on written request or its own motion, conduct a public informational hearing on the granting or denial of a waiver of on-site supervision.

.06 Term and Renewal of Qualification of a Facility To Operate Under General Supervision.

A. A report or waiver issued by the Board under this chapter is effective for a 5-year term.
B. At least 90 days before the expiration of the 5-year term, the Board shall notify the facility of the expiration of the report or waiver and send to the facility an application for renewal of the waiver.
C. A facility seeking to renew a report to qualify for practice under general supervision shall file a new report with the Board not later than 60 days before the expiration of the existing 5-year term.
D. A facility seeking to renew a waiver of on-site supervision shall file the application with the Board not later than 60 days before the expiration of the existing waiver.

.07 Requirements for Dentists and Dental Hygienists to Operate Under General Supervision in a Facility.

A. Each supervising dentist responsible for carrying out the requirements necessary for the facility to operate under general supervision shall:

  1. Hold an active license to practice dentistry in this State;
  2. Hold a current certificate of Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; and
  3. Have at least 2 years experience in providing direct patient care in the active clinical practice of dentistry.

B. Each dental hygienist providing dental hygiene services under general supervision shall:

  1. Hold an active license to practice dental hygiene in this State;
  2. Hold a current certificate of Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; and
  3. Have at least 2 years experience in direct patient care in the active clinical practice of dental hygiene.

C. Within 30 days after there has been a change in either the supervising dentist or the dental hygienist, a facility shall notify the Board in writing of the following:

  1. The name of the new supervising dentist or the new dental hygienist;
  2. The date of the change in personnel; and
  3. A statement affirming that all personnel meet the criteria established in this regulation for practice under general supervision.


.08 Guidelines for Operating Under General Supervision in a Facility.

A. A facility shall provide adequate facilities and equipment for the delivery of dental hygiene services;
B. Each time a patient receives dental hygiene services under general supervision, the dental hygienist shall determine, before initiation of treatment, that there has been no change in the patient's medical history;
C. If there is a change in the medical history of the patient, the dental hygienist shall consult with the supervising dentist, the patient's own dentist, the facility's dental consultant, or the patient's treating physician before providing dental hygiene services; and
D. All recall patients seen by a dental hygienist working under general supervision shall be scheduled for an oral examination with a dentist every 6 months or as otherwise recommended by the supervising dentist.

.09 Exceptions.

A. This regulation applies to the following facilities:

  1. A dental facility owned and operated by:
    (a) The federal government;
    (b) The State government; or
    (c) A county or local government;
  2. A pubic health department of:
    (a) The State; or
    (b) A county or local government;
  3. A public school of:
    (a) The State; or
    (b) A county or local government;
  4. A facility in which a program licensed by the Department of Health and Mental Hygiene is operating;
  5. A facility owned and operated by the Department of Juvenile Services;
  6. A facility owned and operated by the State, county, or local government that provides medical care to the poor, elderly, or handicapped;
  7. A facility in which a federally qualified health center or a federally qualified health center look-alike is located; or
  8. A facility in which a State-licensed Head Start Program or Early Head Start Program operates.

B. A general license to practice dental hygiene authorizes the licensee to practice dental hygiene under general supervision in a facility identified in §A of this regulation and apply:

  1. Sealants;
  2. Fluoride agents, such as professional topical fluoride agents;
  3. Mouth wash; or
  4. Varnish.

C. The Board may not require a facility identified in §A of this regulation to obtain a waiver in order to practice in accordance with §B of this regulation.
D. Before a facility may allow a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation, the facility shall report to the Board:

  1. That the facility is operating under general supervision;
  2. The identity of each hygienist employed by the facility; and
  3. The identity of each supervising dentist.

E. A facility that authorizes a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation shall insure that the supervising dentist for the facility:

  1. Holds an active general license to practice dentistry in the State;
  2. Holds a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; and
  3. Has at least 2 years of active clinical practice in direct patient care.

F. A facility that authorizes a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation shall insure that the dental hygienist:

  1. Holds an active general license to practice dental hygiene in the State;
  2. Holds a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation;
  3. Has at least 2 years of active clinical practice in direct patient care; and
  4. Is a permanent or contractual employee of:
    (a) The federal government;
    (b) A state government;
    (c) A county or local government; or
    (d) A federally qualified health center.

G. A facility that authorizes a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation shall insure that:

  1. The facility has a medical emergency plan;
  2. Adequate equipment, including portable equipment where appropriate and appropriate armamentarium, is available for the appropriate delivery of dental hygiene services; and
  3. Adequate safeguards are present to protect the patient's health and safety.


.10 Penalties.

A. A violation of this chapter by a dentist or dental hygienist shall constitute unprofessional conduct.
B. A violation of this chapter may result in revocation of the facility's right to operate under a waiver of on-site supervision.

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