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PROPOSED RULEMAKING

STATE BOARD OF DENTISTRY

[ 49 PA. CODE CH. 33 ]

Public Health Dental Hygiene Practitioner Practice Sites

[49 Pa.B. 1396]
[Saturday, March 23, 2019]

 The State Board of Dentistry (Board) proposes to amend § 33.205b (relating to practice as a public health dental hygiene practitioner) to read as set forth in Annex A.

Effective Date

 This proposed rulemaking will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.

Statutory Authority

 Section 3(o) of the Dental Law (act) (63 P.S. § 122(o)) authorizes the Board to adopt, promulgate and enforce these rules and regulations as may be deemed necessary by the Board to carry out the provisions of the act. Section 11.9(b)(10) of the act (63 P.S. § 130j(b)(10)) authorizes the Board to determine other locations at which public health dental hygiene practitioners may practice.

Background and Purpose

 On January 4, 2016, the act of November 4, 2015 (P.L. 225, No. 60) (Act 60 of 2015) became effective, amending § 11.9 of the act to allow the Board to add other ''locations'' it deems appropriate for practice by public health dental hygiene practitioners in addition to those enumerated by the General Assembly. Prior to this amendment, subsection (b)(10) permitted the Board to add other ''institutions'' it deemed appropriate. After the amendment became effective, the Board undertook a review of the existing locations at which a public health dental hygiene practitioner may practice and found them to be acceptable. The enumerated locations limited the practice of a public health dental hygiene practitioner to nine types of locations. The common thread between these locations is that they are all licensed, operated or otherwise regulated by State or Federal agencies. At that time, the Board did not believe the change from the term ''institutions'' to the term ''locations'' necessitated a revision to the regulations.

 On March 3, 2016, the Pennsylvania Dental Hygienists' Association (PDHA) petitioned the Board seeking amendments to the regulations to include additional practice sites for public health dental hygiene practitioners. Specifically, the PDHA asked the Board to consider adding the following locations: private settings of hospice and home-bound patients; primary care settings, especially pediatric settings; and childcare settings. The PDHA pointed out that the intent of the change in language in the act was to provide an opportunity for those home-bound or in hospice care to be able to receive preventive dental hygiene care in their homes or hospice settings. The PDHA also pointed out that as this Commonwealth moves to shift more care from institutional to community settings, the need for home-bound patients to receive services will significantly increase and that transportation for home-bound patients is difficult to arrange and expensive. They argue that allowing public health dental hygiene practitioners with portable equipment to serve home-bound patients will provide a more affordable option and help to improve their oral health outcomes. Finally, the PDHA pointed out that inter-professional care is now becoming a standard. Pediatric medical offices and other primary care settings see populations that need the most preventive oral health care on a regular basis for well-child visits. The PDHA argues that medical offices are ''a perfect setting to deliver safe and effective oral hygiene education and services,'' and that day care centers that provide child care to low-income individuals are taking care of the neediest populations. The PDHA believes the inclusion of these locations would improve access to oral health care in this Commonwealth and would improve the oral health of citizens of this Commonwealth. For all of these reasons, the PDHA requested the Board consider the expansion of locations at which public health dental hygiene practitioners may practice.

 The Board discussed the PDHA's proposal at meetings throughout 2016, and ultimately assigned the issue to the Board's Legislative/Regulatory Review Committee (Committee), which met on January 20, 2017, with the PDHA and other interested parties. The Committee developed this proposed rulemaking which was presented to the Board at its meeting on May 19, 2017. At that meeting, the Board authorized the release of the proposal as an ''exposure draft'' to interested parties and stakeholders. The exposure draft was sent out to over 140 individuals and entities on June 7, 2017. The Board received numerous comments both in support and in opposition to the proposal, which were discussed at meetings on July 28, 2017, and September 15, 2017. Ultimately, at the September 15, 2017, meeting, the Board voted to proceed with promulgating this proposed rulemaking as drafted.

 The purpose of this proposed rulemaking is threefold: (1) to clarify, by way of example, some of the acceptable practice sites included within the definition of ''health care facility'' under section 802.1 of the Health Care Facilities Act (35 P.S. § 448.802a); (2) to expand the locations at which a public health dental hygiene practitioner may practice beyond just ''personal care homes'' to include other ''facilities'' regulated by the Department of Human Services as defined in section 1001 of the Human Services Code (62 P.S. § 1001); and (3) to add ''an office or clinic of a physician who is licensed by the State Board of Medicine or the State Board of Osteopathic Medicine'' as an acceptable location for the practice of public health dental hygiene practitioners. These additional sites are meant to expand access to dental hygiene services, oral health education and referrals to dentists.

Description of the Proposed Amendments

 The Board proposes to amend § 33.205b(c)(3) to clarify, by way of example, those types of health care facilities that are regulated by the Department of Health under the Health Care Facilities Act (35 P.S. §§ 448.101—448.904b). It appeared to the Board that there had been some confusion among the regulated community on this issue. Further, the Board proposes to add a provision which would allow public health dental hygiene practitioners employed by health care facilities to provide services to patients of the health care facility in their place of residence or other independent living environment. Permitting the provision of services in these locations is consistent with the language provided in the definitions of ''home care agency,'' ''home health care agency'' and ''hospice'' in section 802.1 of the Health Care Facilities Act, which include services provided by these health care facilities to patients in their homes or other independent living environments.

 The Board also proposes to amend § 33.205b(c)(4) by deleting the term ''personal care homes'' and replacing it with ''a facility'' as defined in section 1001 of the Human Services Code. The Board intends this replacement to expand access to the services provided by public health dental hygiene practitioners to additional facilities that are regulated by the Department of Human Services, not only personal care homes. The Board is adding, by way of example, adult day care centers; child day care centers; family child care homes; boarding homes for children; mental health establishments; assisted living residences; nursing homes; hospitals; maternity homes and any other facility licensed and regulated by the Department of Human Services or a successor agency.

 The Board is also proposing an amendment to § 33.205b(c)(6) to correct the citation to section 2 of the Older Adults Daily Living Centers Licensing Act (62 P.S. § 1511.2).

 Finally, the Board proposes to add a new paragraph (c)(11) to add an additional acceptable location for public health dental hygiene practitioners to provide dental hygiene services to include ''an office or clinic of a physician licensed by the State Board of Medicine or the State Board of Osteopathic Medicine.'' The Board believes that this additional site will expand access to oral health care and education by public health dental hygiene practitioners and will assist patients, particularly pediatric patients, find a ''dental home'' by way of the annual referral to a dentist as required by § 33.205b(b).

Fiscal Impact and Paperwork Requirements

 The Board does not anticipate any fiscal impact relating to these amendments. Because public health dental hygiene practitioners will not be required to submit any additional paperwork based on their practice locations, these amendments will not require any further paperwork.

Sunset Date

 The Board continuously monitors the effectiveness of its regulations on a fiscal year and biennial basis. Therefore, no sunset date has been assigned.

Regulatory Review

 Under Section 5(a) of the Regulatory Review Act (71 P.S. § 745.5(a)), on March 12, 2019, the Board submitted a copy of this proposed rulemaking and a copy of a regulatory analysis form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.

 Under section 5(g) of the Regulatory Review Act, IRRC may convey any comments, recommendations or objections to this proposed rulemaking within 30 days of the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria that have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly, and the Governor of comments, recommendations or objections raised.

Public Comment

 Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Regulatory Counsel, Department of State, P.O. Box 69523, Harrisburg, PA 17106-9523, RA-STRegulatoryCounsel@pa.gov within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Comments should be identified as pertaining to rulemaking 16A-4633 (Public Health Dental Hygiene Practitioner Practice Sites).

JOHN F. ERHARD, III, DDS, 
Chairperson

Fiscal Note: 16A-4633. No fiscal impact; (8) recommends adoption.

Annex A

TITLE 49. PROFESSIONAL AND
VOCATIONAL STANDARDS

PART I. DEPARTMENT OF STATE

Subpart A. PROFESSIONAL AND
OCCUPATIONAL AFFAIRS

CHAPTER 33. STATE BOARD OF DENTISTRY

Subchapter C. MINIMUM STANDARDS OF CONDUCT AND PRACTICE

§ 33.205b. Practice as a public health dental hygiene practitioner.

 (a) Scope of professional practice. A public health dental hygiene practitioner may perform the dental hygiene services set forth in § 33.205(a)(2)—(6) (relating to practice as a dental hygienist) in the practice settings identified in subsection (c) without the authorization, assignment or examination by a dentist. A public health dental hygiene practitioner may perform the dental hygiene services set forth in § 33.205(a)(1) and (7) in accordance with § 33.205(d).

 (b) Requirement of referral. A public health dental hygiene practitioner shall refer each patient to a licensed dentist on an annual basis. Documentation of the referral must be maintained in the patient's dental record. The failure of the patient to see a dentist as referred will not prevent the public health dental hygiene practitioner from continuing to provide dental hygiene services to the patient within the scope of professional practice set forth in subsection (a).

 (c) Practice settings. A public health dental hygiene practitioner may perform dental hygiene services without the supervision of a dentist in the following practice settings:

 (1) Public and private educational institutions that provide elementary and secondary instruction to school aged children under the jurisdiction of the State Board of Education, and in accordance with all applicable provisions of the Public School Code of 1949 (24 P.S. §§ 1-101—27-2702), the regulations relating to the certification of professional personnel in 22 Pa. Code Chapter 49 (relating to certification of professional personnel), and the regulations of the Department of Health in 28 Pa. Code § 23.35 (relating to dental hygienists).

 (2) Correctional facilities. For purposes of this section, correctional facilities include Federal prisons and other institutions under the jurisdiction of the United States Department of Justice, Bureau of Prisons which are located within this Commonwealth; institutions, motivational boot camps and community corrections centers operated or contracted by the Department of Corrections; and jails, prisons, detention facilities or correctional institutions operated or contracted by local, county or regional prison authorities within this Commonwealth.

[(3)] (3)(i) Health care facilities, as defined in section 802.1 of the Health Care Facilities Act (35 P.S. § 448.802a).

(ii) By way of example, a health care facility includes, but is not limited to, a general, chronic disease or other type of hospital; a home health care agency; a home care agency; a hospice; a long-term care nursing facility; a cancer treatment center; an ambulatory surgical facility or any other facility licensed and regulated by the Department of Health or a successor agency.

(iii) For purposes of this section, services provided by a health care facility to patients in their places of residence or other independent living environment are included as acceptable practice locations for public health dental hygiene practitioners.

[(4) Personal care homes] (4)(i) A ''facility,'' as defined in section 1001 of the [Public Welfare] Human Services Code (62 P.S. § 1001).

(ii) By way of example, a facility includes, but is not limited to, an adult day care center; child day care center; family child care home; boarding home for children; mental health establishment; personal care home; assisted living residence; nursing home, hospital or maternity home or any other facility licensed and regulated by the Department of Human Services or a successor agency.

 (5) Domiciliary care facilities, as defined in section 2202-A of The Administrative Code of 1929 (71 P.S. § 581-2).

 (6) Older adult daily living centers, as defined in section 2 of the Older Adult Daily Living Centers Licensing Act [(62 P.S. § 10225.102)] (62 P.S. § 1511.2).

 (7) Continuing-care provider facilities, as defined in section 3 of the Continuing-Care Provider Registration and Disclosure Act (40 P.S. § 3203).

 (8) Federally-qualified health centers, as defined in section 1905(1)(2)(B) of the Social Security Act (42 U.S.C.A. § 1369(1)(2)(B)). For purposes of this section, the term includes Federally-qualified health center lookalikes that do not receive grant funds under section 330 of the Public Health Service Act (42 U.S.C.A. § 254b).

 (9)  Public or private institutions under the jurisdiction of a Federal, State or local agency.

 (10) Free and reduced-fee nonprofit health clinics.

(11) An office or clinic of a physician who is licensed by the State Board of Medicine or the State Board of Osteopathic Medicine.

 (d) Recordkeeping. A public health dental hygiene practitioner shall maintain a dental record which accurately, legibly and completely reflects the dental hygiene services provided to the patient. The dental record must be retained for at least 5 years from the date of the last treatment entry. The dental record must include, at a minimum, the following:

 (1) The name and address of the patient and, if the patient is a minor, the name of the patient's parents or legal guardian.

 (2) The date dental hygiene services are provided.

 (3) A description of the treatment or services rendered at each visit.

 (4) The date and type of radiographs taken, if any, and documentation demonstrating the necessity or justification for taking radiographs, as well as the radiographs themselves.

 (5) Documentation of the annual referral to a dentist.

[Pa.B. Doc. No. 19-428. Filed for public inspection March 22, 2019, 9:00 a.m.]



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