99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB1464

 

Introduced 2/20/2015, by Sen. Donne E. Trotter

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 25/4  from Ch. 111, par. 2304
225 ILCS 25/18  from Ch. 111, par. 2318

    Amends the Illinois Dental Practice Act. Provides that a dental hygienist may be employed or retained (rather than employed) in specified settings, including in a public health setting (and defines "public health setting"). Provides that certain orders by dentists to dental hygienists must be completed within 12 months (rather than 120 or 180 days). Allows a dental hygienist to perform certain dental hygiene services in a public health setting if the dental hygienist has entered into a written collaborative agreement with a licensed dentist. Sets requirements for the written collaborative agreements and limits the services that may be authorized. Makes other changes. Effective immediately.


LRB099 07277 HAF 27381 b

 

 

A BILL FOR

 

SB1464LRB099 07277 HAF 27381 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Dental Practice Act is amended by
5changing Sections 4 and 18 as follows:
 
6    (225 ILCS 25/4)   (from Ch. 111, par. 2304)
7    (Section scheduled to be repealed on January 1, 2016)
8    Sec. 4. Definitions. As used in this Act:
9    "Address of record" means the designated address recorded
10by the Department in the applicant's or licensee's application
11file or license file as maintained by the Department's
12licensure maintenance unit. It is the duty of the applicant or
13licensee to inform the Department of any change of address, and
14those changes must be made either through the Department's
15website or by contacting the Department.
16    "Department" means the Department of Financial and
17Professional Regulation.
18    "Secretary" means the Secretary of Financial and
19Professional Regulation.
20    "Board" means the Board of Dentistry.
21    "Dentist" means a person who has received a general license
22pursuant to paragraph (a) of Section 11 of this Act and who may
23perform any intraoral and extraoral procedure required in the

 

 

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1practice of dentistry and to whom is reserved the
2responsibilities specified in Section 17.
3    "Dental hygienist" means a person who holds a license under
4this Act to perform dental services as authorized by Section
518.
6    "Dental assistant" means an appropriately trained person
7who, under the supervision of a dentist, provides dental
8services as authorized by Section 17.
9    "Dental laboratory" means a person, firm or corporation
10which:
11        (i) engages in making, providing, repairing or
12    altering dental prosthetic appliances and other artificial
13    materials and devices which are returned to a dentist for
14    insertion into the human oral cavity or which come in
15    contact with its adjacent structures and tissues; and
16        (ii) utilizes or employs a dental technician to provide
17    such services; and
18        (iii) performs such functions only for a dentist or
19    dentists.
20    "Supervision" means supervision of a dental hygienist or a
21dental assistant requiring that a dentist authorize the
22procedure, remain in the dental facility while the procedure is
23performed, and approve the work performed by the dental
24hygienist or dental assistant before dismissal of the patient,
25but does not mean that the dentist must be present at all times
26in the treatment room.

 

 

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1    "General supervision" means supervision of a dental
2hygienist requiring that the patient be a patient of record,
3that the dentist examine the patient in accordance with Section
418 prior to treatment by the dental hygienist, and that the
5dentist authorize the procedures which are being carried out by
6a notation in the patient's record, but not requiring that a
7dentist be present when the authorized procedures are being
8performed. The issuance of a prescription to a dental
9laboratory by a dentist does not constitute general
10supervision.
11    "Public member" means a person who is not a health
12professional. For purposes of board membership, any person with
13a significant financial interest in a health service or
14profession is not a public member.
15    "Dentistry" means the healing art which is concerned with
16the examination, diagnosis, treatment planning and care of
17conditions within the human oral cavity and its adjacent
18tissues and structures, as further specified in Section 17.
19    "Branches of dentistry" means the various specialties of
20dentistry which, for purposes of this Act, shall be limited to
21the following: endodontics, oral and maxillofacial surgery,
22orthodontics and dentofacial orthopedics, pediatric dentistry,
23periodontics, prosthodontics, and oral and maxillofacial
24radiology.
25    "Specialist" means a dentist who has received a specialty
26license pursuant to Section 11(b).

 

 

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1    "Dental technician" means a person who owns, operates or is
2employed by a dental laboratory and engages in making,
3providing, repairing or altering dental prosthetic appliances
4and other artificial materials and devices which are returned
5to a dentist for insertion into the human oral cavity or which
6come in contact with its adjacent structures and tissues.
7    "Impaired dentist" or "impaired dental hygienist" means a
8dentist or dental hygienist who is unable to practice with
9reasonable skill and safety because of a physical or mental
10disability as evidenced by a written determination or written
11consent based on clinical evidence, including deterioration
12through the aging process, loss of motor skills, abuse of drugs
13or alcohol, or a psychiatric disorder, of sufficient degree to
14diminish the person's ability to deliver competent patient
15care.
16    "Nurse" means a registered professional nurse, a certified
17registered nurse anesthetist licensed as an advanced practice
18nurse, or a licensed practical nurse licensed under the Nurse
19Practice Act.
20    "Patient of record" means a patient for whom the patient's
21most recent dentist has obtained a relevant medical and dental
22history and on whom the dentist has performed an examination
23and evaluated the condition to be treated or for whom a dental
24hygienist with whom the dentist has a written collaborative
25agreement has performed a dental hygiene assessment and
26screening.

 

 

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1    "Dental emergency responder" means a dentist or dental
2hygienist who is appropriately certified in emergency medical
3response, as defined by the Department of Public Health.
4    "Mobile dental van or portable dental unit" means any
5self-contained or portable dental unit in which dentistry is
6practiced that can be moved, towed, or transported from one
7location to another in order to establish a location where
8dental services can be provided.
9    "Written collaborative agreement" means a written
10agreement between a licensed dental hygienist and a
11collaborating licensed dentist to authorize the licensed
12dental hygienist to perform services under subsection (i) of
13Section 18 of this Act.
14    "Consultation" means the process whereby a dental
15hygienist seeks the advice, opinion, or direction of a dentist.
16    "Public health setting" means a hospital; a nursing home; a
17home health agency; a group home serving the elderly, the
18disabled, or juveniles; a State-operated facility or facility
19licensed by the State of Illinois; a State or federal prison; a
20federal, State, or local public health facility; a community
21clinic; a school-based program; a school authority; Head Start;
22the Special Supplemental Nutrition Program for Women, Infants,
23and Children (WIC) program; or a program operated by a
24non-profit organization or any other entity that serves
25individuals who are uninsured or who are Illinois Medical
26Assistance Program recipients.

 

 

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1(Source: P.A. 97-526, eff. 1-1-12; 97-1013, eff. 8-17-12.)
 
2    (225 ILCS 25/18)   (from Ch. 111, par. 2318)
3    (Section scheduled to be repealed on January 1, 2016)
4    Sec. 18. Acts constituting the practice of dental hygiene;
5limitations.
6    (a) A person practices dental hygiene within the meaning of
7this Act when he or she performs the following acts under the
8supervision of a dentist:
9            (i) the operative procedure of dental hygiene,
10        consisting of oral prophylactic procedures;
11            (ii) the exposure and processing of X-Ray films of
12        the teeth and surrounding structures;
13            (iii) the application to the surfaces of the teeth
14        or gums of chemical compounds designed to be
15        desensitizing agents or effective agents in the
16        prevention of dental caries or periodontal disease;
17            (iv) all services which may be performed by a
18        dental assistant as specified by rule pursuant to
19        Section 17, and a dental hygienist may engage in the
20        placing, carving, and finishing of amalgam
21        restorations only after obtaining formal education and
22        certification as determined by the Department;
23            (v) administration and monitoring of nitrous oxide
24        upon successful completion of a training program
25        approved by the Department;

 

 

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1            (vi) administration of local anesthetics upon
2        successful completion of a training program approved
3        by the Department; and
4            (vii) such other procedures and acts as shall be
5        prescribed by rule or regulation of the Department.
6    (b) A dental hygienist may be employed or retained engaged
7only:
8        (1) by a dentist;
9        (2) by a federal, State, county, or municipal agency or
10    institution;
11        (3) by a public or private program school; or
12        (4) in a public health setting by a public clinic
13    operating under the direction of a hospital or federal,
14    State, county, municipal, or other public agency or
15    institution.
16    (c) When employed or retained engaged in the office of a
17dentist, a dental hygienist may perform, under general
18supervision, those procedures found in items (i) through (iv)
19of subsection (a) of this Section, provided the patient has
20been examined by the dentist within one year of the provision
21of dental hygiene services, the dentist has approved the dental
22hygiene services by a notation in the patient's record and the
23patient has been notified that the dentist may be out of the
24office during the provision of dental hygiene services.
25    (d) If a patient of record is unable to travel to a dental
26office because of illness, infirmity, or imprisonment, a dental

 

 

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1hygienist may perform, under the general supervision of a
2dentist, those procedures found in items (i) through (iv) of
3subsection (a) of this Section, provided the patient is located
4in a long-term care facility licensed by the State of Illinois,
5a mental health or developmental disability facility, or a
6State or federal prison. The dentist shall personally examine
7and diagnose the patient and determine which services are
8necessary to be performed, which shall be contained in an order
9to the hygienist and a notation in the patient's record. Such
10order must be completed implemented within 12 months 120 days
11of its issuance, and an updated medical history and observation
12of oral conditions must be performed by the hygienist
13immediately prior to beginning the procedures to ensure that
14the patient's health has not changed in any manner to warrant a
15reexamination by the dentist.
16    (e) School-based oral health care, consisting of and
17limited to oral prophylactic procedures, sealants, and
18fluoride treatments, may be provided by a dental hygienist
19under the general supervision of a dentist. A dental hygienist
20may not provide other dental hygiene treatment in a
21school-based setting, including but not limited to
22administration or monitoring of nitrous oxide or
23administration of local anesthetics. The school-based
24procedures may be performed provided the patient is located at
25a public or private school and the program is being conducted
26by a State, county or local public health department initiative

 

 

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1or in conjunction with a dental school or dental hygiene
2program. The dentist shall personally examine and diagnose the
3patient and determine which services are necessary to be
4performed, which shall be contained in an order to the
5hygienist and a notation in the patient's record. Any such
6order for sealants must be completed implemented within 12
7months 120 days after its issuance. Any such order for oral
8prophylactic procedures or fluoride treatments must be
9completed implemented within 12 months 180 days after its
10issuance. An updated medical history and observation of oral
11conditions must be performed by the hygienist immediately prior
12to beginning the procedures to ensure that the patient's health
13has not changed in any manner to warrant a reexamination by the
14dentist.
15    (f) Without the supervision of a dentist, a dental
16hygienist may perform dental health education functions and may
17record case histories and oral conditions observed.
18    (g) The number of dental hygienists practicing in a dental
19office shall not exceed, at any one time, 4 times the number of
20dentists practicing in the office at the time.
21    (h) Notwithstanding subsections (c), (d), (e), or (f) of
22this Section, a dental hygienist licensed under this Act may
23perform dental hygiene services described under subsection (i)
24of this Section in a public health setting if the dental
25hygienist has entered into a written collaborative agreement
26with a licensed dentist.

 

 

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1    (i) The dental hygiene services authorized to be performed
2by a dental hygienist under a written collaborative agreement
3are limited to:
4        (1) screenings, dental hygiene assessments, and
5    assessing oral health conditions;
6        (2) preliminary charting of the oral cavity and
7    surrounding structures to include case histories in order
8    to formulate a dental hygiene care plan in coordination
9    with a dentist's treatment plan;
10        (3) removal of deposits and stains from the surfaces of
11    the teeth;
12        (4) prescribing, administering, and dispensing only
13    fluoride, fluoride varnish, antimicrobial solutions, or
14    resorbable antimicrobial agents;
15        (5) administering and dispensing home-use oral hygiene
16    aids;
17        (6) applying sealants;
18        (7) polishing and smoothing restorations;
19        (8) removal of marginal overhangs;
20        (9) performance of preliminary charting;
21        (10) taking of radiographs; and
22        (11) performance of scaling and root planing.
23    (j) A collaborating dentist must be licensed under this Act
24and may enter into a written collaborative agreement with no
25more than 4 dental hygienists, unless otherwise authorized by
26the Board. The Board shall develop parameters and a process for

 

 

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1obtaining authorization to collaborate with more than 4 dental
2hygienists.
3    (k) The written collaborative agreement must:
4        (1) include consideration for medically compromised
5    patients and medical conditions for which a dental
6    evaluation and care plan must occur prior to the provision
7    of dental hygiene services;
8        (2) include age-specific and procedure-specific
9    standard collaborative practice protocols, including
10    recommended intervals for the performance of dental
11    hygiene services and a period of time within which an
12    examination by a dentist should occur;
13        (3) include copies of the consent to treatment form
14    provided to the patient by the dental hygienist;
15        (4) include specific protocols for the placement of pit
16    and fissure sealants and requirements for follow-up care to
17    ensure the efficacy of the sealants after application;
18        (5) include a procedure for creating and maintaining
19    dental records for the patients that are treated by the
20    dental hygienist; this procedure must specify the
21    notations to be made in the patient's record regarding
22    procedures authorized by the collaborating dentist and
23    performed by the dental hygienist pursuant to the written
24    collaborative agreement and specify where these records
25    are to be located;
26        (6) include a provision that requires the dental

 

 

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1    hygienist working under a written collaborative agreement
2    and the collaborating dentist to maintain communication
3    and consultation with each other;
4        (7) include a provision that requires the dental
5    hygienist working under a written collaborative agreement
6    to provide the collaborating dentist opportunities to
7    review patient records as requested;
8        (8) include provisions detailing notice for
9    termination or change of status involving a written
10    collaborative agreement, except when such notice is given
11    for just cause;
12        (9) include a provision that requires the dental
13    hygienist to inform each collaborating dentist of all
14    written collaborative agreements he or she has signed and
15    provide a copy of these to any collaborating dentist upon
16    request;
17        (10) require that the dental hygienist refer each of
18    his or her patients to a licensed dentist for a
19    comprehensive dental examination; and
20        (l1) be (i) signed and maintained by the dentist, the
21    dental hygienist, and the authorized representative of the
22    facility, program, or organization, (ii) reviewed annually
23    by the collaborating dentist and dental hygienist, and
24    (iii) made available to the Board upon request.
25    The collaborative relationship under a written
26collaborative agreement shall not be construed to require that

 

 

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1a dentist examine a patient prior to treatment by the dental
2hygienist or to require the personal presence of a dentist at
3the place where services are rendered. Methods of communication
4shall be available for consultation with the collaborating
5dentist in person or by telecommunications in accordance with
6established written guidelines as set forth in the written
7collaborative agreement.
8    (l) Before performing any services authorized under a
9written collaborative agreement, a dental hygienist must
10provide the patient or guardian with a consent to treatment
11form that must include a statement advising the patient or
12guardian that the dental hygiene services provided are not a
13substitute for a dental examination by a licensed dentist. If
14the dental hygienist makes any referrals to the patient for
15further dental procedures, the dental hygienist must fill out a
16referral form and provide a copy of the form to the
17collaborating dentist.
18    (m) Nothing in this Act shall be construed to limit the
19delegation of tasks or duties by a dentist to a dental
20hygienist, dental technician, or other persons in accordance
21with Section 17 of this Act. Nothing in this Act shall be
22construed to limit the method of delegation that may be
23authorized by any means, including, but not limited to, oral,
24written, electronic, standing orders, protocols, guidelines,
25or verbal orders.
26(Source: P.A. 97-526, eff. 1-1-12.)
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.