98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB4441

 

Introduced , by Rep. William Davis

 

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 by a nonprofit organization or in a public health setting. Provides that a dental hygienist under remote supervision with a collaborative agreement with a licensed dentist shall provide a dental hygiene examination and screenings and determine which services are necessary to be performed with a referral to a dentist for a dental examination within 12 months. Provides that a dental hygienist may be employed or retained by a health care facility, program, or nonprofit organization to perform dental hygiene services without the patient first being examined by a licensed dentist if the dental hygienist (i) has engaged in active practice of clinical dental hygiene for a minimum of 2,400 hours in the past 18 months or a career total of 3,000 hours, (ii) has entered into a collaborative agreement with a licensed dentist, (iii) had documented participation in courses in infection control and medical emergencies, and (iv) maintains current CPR certification. Provides that a licensed dentist may not have a collaborative agreement with more than 4 dental hygienists, unless otherwise authorized by the Board. Provides that the collaborative agreement must (i) include certain provisions and it must be signed and maintained by the dentist, the dental hygienist, and the facility, program, or organization, (ii) be reviewed yearly, and (iii) be made available to the Board upon request. Makes other changes. Effective immediately.


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A BILL FOR

 

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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7    (Section scheduled to be repealed on January 1, 2016)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 or collaborative dentist has obtained a
22relevant medical and dental history and on whom the dentist or
23collaborative dentist has performed an examination or a
24collaborative dental hygienist has performed a dental hygiene
25examination and screenings and evaluated the condition to be
26treated.

 

 

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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    "Remote supervision" means supervision of a dental
10hygienist with a collaborative agreement requiring that the
11registered dental hygienist provide a dental hygiene
12examination and screenings with an appropriate treatment plan
13developed and implemented in accordance with supervision
14provided by a licensed dentist with a written collaborative
15agreement. Supervision may take place through verbal, written,
16visual, electronic, or in-person communication, or a
17combination of those modes of communication, that authorizes
18the procedures that are being carried out by a notation in the
19patient's record, but not requiring that a dentist be
20physically present when the dental hygiene examination and
21screenings or authorized procedures are being performed, and
22that a referral to a licensed dentist for a comprehensive
23dental examination will be made to take place within 12 months.
24    "Collaborative agreement" means a written agreement
25between a licensed dental hygienist and a collaborating
26licensed dentist.

 

 

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1    "Public health setting" means a hospital; nursing home;
2home health agency; group home serving the elderly, the
3disabled, or juveniles; State-operated facility licensed by
4the Secretary of Human Services or the Director of Corrections;
5federal, State, or local public health facility; community
6clinic; school-based program; school authority; Head Start;
7Maternal and Child Health Women, Infants, and Children (WIC)
8program; or a program operated by a non-profit organization
9that services individuals who are uninsured or who are Illinois
10health care public program recipients.
11(Source: P.A. 97-526, eff. 1-1-12; 97-1013, eff. 8-17-12.)
 
12    (225 ILCS 25/18)   (from Ch. 111, par. 2318)
13    (Section scheduled to be repealed on January 1, 2016)
14    Sec. 18. Acts constituting the practice of dental hygiene;
15limitations.
16    (a) A person practices dental hygiene within the meaning of
17this Act when he or she performs the following acts under the
18supervision of a dentist:
19            (i) the operative procedure of dental hygiene,
20        consisting of oral prophylactic procedures;
21            (ii) the exposure and processing of X-Ray films of
22        the teeth and surrounding structures;
23            (iii) the application to the surfaces of the teeth
24        or gums of chemical compounds designed to be
25        desensitizing agents or effective agents in the

 

 

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1        prevention of dental caries or periodontal disease;
2            (iv) all services which may be performed by a
3        dental assistant as specified by rule pursuant to
4        Section 17, and a dental hygienist may engage in the
5        placing, carving, and finishing of amalgam
6        restorations only after obtaining formal education and
7        certification as determined by the Department;
8            (v) administration and monitoring of nitrous oxide
9        upon successful completion of a training program
10        approved by the Department;
11            (vi) administration of local anesthetics upon
12        successful completion of a training program approved
13        by the Department; and
14            (vii) such other procedures and acts as shall be
15        prescribed by rule or regulation of the Department.
16    (b) A dental hygienist may be employed or retained engaged
17only:
18        (1) by a dentist;
19        (2) by a federal, State, county, or municipal agency or
20    institution;
21        (3) by a public or private program school; or
22        (4) by a nonprofit organization public clinic
23    operating under the direction of a hospital or federal,
24    State, county, municipal, or other public agency or
25    institution ; or .
26        (5) in a public health setting.

 

 

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1    (c) When employed or retained engaged in the office of a
2dentist, or utilizing remote supervision, a dental hygienist
3may perform, under general supervision, those procedures found
4in items (i) through (iv) of subsection (a) of this Section,
5provided the patient has been examined by the dentist within
6one year of the provision of dental hygiene services, the
7dentist has approved the dental hygiene services by a notation
8in the patient's record and the patient has been notified that
9the dentist may be out of the office during the provision of
10dental hygiene services.
11    (d) If a patient of record is unable to travel to a dental
12office because of illness, infirmity, or imprisonment, a dental
13hygienist may perform, under the general supervision of a
14dentist, those procedures found in items (i) through (iv) of
15subsection (a) of this Section, provided the patient is located
16in a long-term care facility licensed by the State of Illinois,
17a mental health or developmental disability facility, or a
18State or federal prison. The dental hygienist with a
19collaborative agreement shall provide a dental hygiene
20examination and screenings or the dentist shall personally
21examine and diagnose the patient and determine which services
22are necessary to be performed, which shall be contained in an
23order with to the hygienist and a notation in the patient's
24record. Such order must be implemented within 12 months 120
25days of its issuance, and an updated medical history and
26observation of oral conditions must be performed by the

 

 

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1hygienist immediately prior to beginning the procedures to
2ensure that the patient's health has not changed in any manner
3to warrant a reexamination by the dentist.
4    (e) School-based oral health care, consisting of and
5limited to oral prophylactic procedures, sealants, and
6fluoride treatments, may be provided by a dental hygienist
7under the general supervision of a dentist or the remote
8supervision of a dental hygienist with a collaborative
9agreement. A dental hygienist may not provide other dental
10hygiene treatment in a school-based setting, including but not
11limited to administration or monitoring of nitrous oxide or
12administration of local anesthetics. The school-based
13procedures may be performed provided the patient is located at
14a public or private school and the program is being conducted
15by a State, county or local public health department initiative
16or in conjunction with a dental school or dental hygiene
17program. The dental hygienist under general supervision shall
18have the The dentist shall personally examine and diagnose the
19patient and determine which services are necessary to be
20performed, which shall be contained in an order to the
21hygienist and a notation in the patient's record. Any such
22order for sealants must be implemented within 12 months 120
23days after its issuance. Any such order for oral prophylactic
24procedures or fluoride treatments must be implemented within 12
25months 180 days after its issuance. An updated medical history
26and observation of oral conditions must be performed by the

 

 

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1hygienist immediately prior to beginning the procedures to
2ensure that the patient's health has not changed in any manner
3to warrant a reexamination by the dentist.
4    The dental hygienist under remote supervision with a
5collaborative agreement with a licensed dentist shall provide a
6dental hygiene examination and screenings and determine which
7services are necessary to be performed with a referral to a
8dentist within 12 months.
9    (f) Without the supervision of a dentist, a dental
10hygienist may perform dental health education functions and may
11record case histories and oral conditions observed.
12    (g) The number of dental hygienists practicing in a dental
13office shall not exceed, at any one time, 4 times the number of
14dentists practicing in the office at the time.
15    (h) Notwithstanding subsections (c), (d), (e), or (f) of
16Section 18, a dental hygienist licensed under this Act may be
17employed or retained by a health care facility, program, or
18nonprofit organization to perform dental hygiene services
19described under subsection (i) of this Section without the
20patient first being examined by a licensed dentist if the
21dental hygienist:
22        (1) has been engaged in the active practice of clinical
23    dental hygiene for not less than 2,400 hours in the past 18
24    months or a career total of 3,000 hours, including a
25    minimum of 200 hours of clinical practice in 2 of the past
26    3 years;

 

 

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1        (2) has entered into a collaborative agreement with a
2    licensed dentist that designates authorization for the
3    services provided by the dental hygienist and that
4    continues without interruption, provided that the patient
5    is referred to and seen for an annual dental examination by
6    a licensed dentist;
7        (3) has documented participation in courses in
8    infection control and medical emergencies within each
9    continuing education cycle; and
10        (4) maintains current CPR certification from a Basic
11    Life Support (BLS) certification training intended for
12    health care providers at the time of renewal. Basic Life
13    Support certification training taken as a requirement
14    pursuant to this Section shall count for no more than 4
15    hours during each licensure period toward the continuing
16    education hours.
17    (i) The dental hygiene services authorized to be performed
18by a dental hygienist under this Section are limited to:
19        (1) screenings, dental hygiene examinations, and
20    assessing oral health conditions;
21        (2) preliminary charting of the oral cavity and
22    surrounding structures to include case histories, perform
23    initial and periodic examinations and assessments to
24    determine periodontal status, and formulate a dental
25    hygiene treatment plan in coordination with a dentist's
26    treatment plan;

 

 

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1        (3) removal of deposits and stains from the surfaces of
2    the teeth;
3        (4) prescribing, administering, and dispensing only
4    fluoride, fluoride varnish, antimicrobial solutions, or
5    resorbable antimicrobial agents;
6        (5) administering and dispensing home-use oral hygiene
7    aids;
8        (6) applying sealants;
9        (7) polishing and smoothing restorations;
10        (8) removal of marginal overhangs;
11        (9) performance of preliminary charting;
12        (10) taking of radiographs;
13        (11) performance of scaling and root planing; and
14        (12) administering local anesthesia.
15    (j) A collaborating dentist must be licensed under this Act
16and may enter into a collaborative agreement with no more than
174 dental hygienists, unless otherwise authorized by the Board.
18The Board shall develop parameters and a process for obtaining
19authorization to collaborate with more than 4 dental
20hygienists. The collaborative agreement must include:
21        (1) consideration for medically compromised patients
22    and medical conditions for which a dental evaluation and
23    treatment plan must occur prior to the provision of dental
24    hygiene services;
25        (2) age-specific and procedure-specific standard
26    collaborative practice protocols, including recommended

 

 

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1    intervals for the performance of dental hygiene services
2    and a period of time that an examination by a dentist
3    should occur;
4        (3) copies of the consent to treatment form provided to
5    the patient by the dental hygienist;
6        (4) specific protocols for the placement of pit and
7    fissure sealants and requirements for follow-up care to
8    ensure the efficacy of the sealants after application; and
9        (5) a procedure for creating and maintaining dental
10    records for the patients that are treated by the dental
11    hygienist; this procedure must specify where these records
12    are to be located.
13    (k) The collaborative agreement must be (i) signed and
14maintained by the dentist, the dental hygienist, and the
15facility, program, or organization, (ii) reviewed annually by
16the collaborating dentist and dental hygienist, and (iii) made
17available to the Board upon request.
18    (l) Before performing any services authorized under this
19Section, a dental hygienist must provide the patient with a
20consent to treatment form that must include a statement
21advising the patient that the dental hygiene services provided
22are not a substitute for a dental examination by a licensed
23dentist. If the dental hygienist makes any referrals to the
24patient for further dental procedures, the dental hygienist
25must fill out a referral form and provide a copy of the form to
26the collaborating dentist.

 

 

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1    (m) The dental hygienist working under a collaborative
2agreement and the collaborating dentist must agree to maintain
3communication and consultation with each other.
4    (n) The dental hygienist working under a collaborative
5agreement must provide the collaborating dentist opportunities
6to review patient records as requested.
7(Source: P.A. 97-526, eff. 1-1-12.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.