2015 -- H 5953

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LC001789

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- DENTISTS AND DENTAL

HYGIENISTS

     

     Introduced By: Representatives Azzinaro, Carnevale, Craven, Kennedy, and McNamara

     Date Introduced: March 20, 2015

     Referred To: House Health, Education & Welfare

     (Health)

It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 5-31.1 of the General Laws entitled "Dentists and Dental

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Hygienists" is hereby amended by adding thereto the following section:

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     5-31.1-39. Public health hygienists. – (a) Any public health dental hygienist which for

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purposes of this chapter means any practicing registered dental hygienist who may perform dental

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hygiene procedures in a public health setting subject to conditions adopted by the Rhode Island

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board of examiners in dentistry, may perform in a public health setting, without the immediate or

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direct supervision or direction of a dentist, any procedure or provide any service that is within the

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dental hygiene scope of practice that has been authorized and adopted by the Rhode Island board

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of examiners in dentistry as a delegable procedure for a dental hygienist under general

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supervision in a private practice setting.

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     (b) Public health settings shall for purposes of this section, include, but are not limited to,

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residences of the homebound, schools, nursing home and long-term care facilities, clinics,

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hospitals, medical facilities, community health centers licensed or certified by the department of

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health, mobile and portable dental health programs licensed or certified by the department of

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health and operated by a local or state agency, head start programs and any other facilities or

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programs deemed appropriate by the department of health.

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     (c) Any public health hygienist shall enter into a written collaborative agreement with a

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local or state government agency or institution or with a licensed dentist who states that he or she

 

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shall be able to provide the appropriate level of communication and consultation with the dental

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hygienist to ensure patient health and safety prior to performing any procedure or providing any

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service under this section. The written collaborative agreement will follow the appropriate

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guidelines as determined and established by the Rhode Island board of examiners in dentistry.

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     (d) Any public health dental hygienist shall provide to the patient or to the patient's legal

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guardian a consent form to be signed by the patient or legal guardian. The consent form shall be

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consistent with current department of health policies that describes services to be rendered and

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explains that services rendered are not a substitute for a dental examination by a dentist. The

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consent form shall also inform the patient or legal guardian that the patient should obtain a dental

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examination by a dentist within ninety (90) days after undergoing a procedure authorized

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pursuant to this section. The patient or legal guardian shall also obtain written referral to a dentist

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and an assessment of further dental needs.

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     (e) The public health dental hygienist shall be directly reimbursed for services

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administered in a public health setting by Medicaid or the state health care insurance program

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except as required by federal Medicaid law, but shall not seek reimbursement from any other

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insurance or third-party payor. A public health dental hygienist shall not operate independently of

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a dentist, except for a dental hygienist working for a local or state government agency or

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institution or practicing in a mobile or portable prevention program licensed or certified by the

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department of health. In such cases the local or state government agency or institution or mobile

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or portable prevention program licensed or certified by the department of health may seek

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reimbursement from any other third-party payor.

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     SECTION 2. Section 5-31.1-1 of the General Laws in Chapter 5-31.1 entitled "Dentists

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and Dental Hygienists" is hereby amended to read as follows:

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     5-31.1-1. Definitions. -- As used in this chapter:

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      (1) "Board" means the Rhode Island board of examiners in dentistry or any committee or

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subcommittee of the board.

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      (2) "Chief of the division of oral health" means, the chief of the division of oral health of

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the Rhode Island department of health who is a licensed dentist possessing a masters degree in

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public health or a certificate in public health from an accredited program.

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      (3) "Dental administrator" means the administrator of the Rhode Island board of

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examiners in dentistry.

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      (4) "Dental hygienist" means a person with a license to practice dental hygiene in this

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state under the provisions of this chapter.

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      (5) "Dentist" means a person with a license to practice dentistry in this state under the

 

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provisions of this chapter.

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      (6) "Dentistry" is defined as the evaluation, diagnosis, prevention, and/or treatment (non-

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surgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral

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cavity, cranio-maxillofacial area, and/or the adjacent and associated structures and their impact on

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the human body, provided by a dentist, within the scope of his or her education, training, and

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experience, in accordance with the ethics of the profession and applicable law.

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      (7) "Department" means the Rhode Island department of health.

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      (7.1) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon

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(with a permit to administer deep sedation and general anesthesia) by verbal command and under

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direct line of sight.

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      (8) "Director" means the director of the Rhode Island department of health.

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      (9) "Health care facility" means any institutional health service provider licensed

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pursuant to the provisions of chapter 17 of title 23.

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      (10) "Health maintenance organization" means a public or private organization licensed

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pursuant to the provisions of chapter 17 of title 23 or chapter 41 of title 27.

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      (11) "Limited registrant" means a person holding a limited registration certificate

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pursuant to the provisions of this chapter.

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      (12) "Nonprofit medical services corporation" or "nonprofit hospital service corporation"

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or "nonprofit dental service corporation" means any corporation organized pursuant to chapter 19

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or 20 of title 27 for the purpose of establishing, maintaining and operating a nonprofit medical,

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hospital, or dental service plan.

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      (13) "Peer review board" means any committee of a state, local, dental or dental hygiene,

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association or society, or a committee of any licensed health care facility, or the dental staff of the

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committee, or any committee of a dental care foundation or health maintenance organization, or

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any staff committee or consultant of a hospital, medical, or dental service corporation, the

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function of which, or one of the functions of which, is to evaluate and improve the quality of

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dental care rendered by providers of dental care service or to determine that dental care services

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rendered were professionally indicated or were performed in compliance with the applicable

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standard of care or that the cost for dental care rendered was considered reasonable by the

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providers of professional dental care services in the area and includes a committee functioning as

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a utilization review committee under the provisions of P.L. 89-97, 42 U.S.C. § 1395 et. seq.,

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(Medicare law) or as a professional standards review organization or statewide professional

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standards review council under the provisions of P.L. 92-603, 42 U.S.C. § 1301 et seq.,

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(professional standards review organizations) or a similar committee or a committee of similar

 

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purpose, to evaluate or review the diagnosis or treatment of the performance or rendition of dental

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services performed under public dental programs of either state or federal design.

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      (14) "Person" means any individual, partnership, firm, corporation, association, trust or

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estate, state or political subdivision, or instrumentality of a state.

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      (15) "Practice of dental hygiene." Any person is practicing dental hygiene within the

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meaning of this chapter who performs those services and procedures that a dental hygienist has

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been educated to perform and which services and procedures are, from time to time, specifically

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authorized by rules and regulations adopted by the board of examiners in dentistry. Nothing in

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this section is construed to authorize a licensed dental hygienist to perform the following:

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diagnosis and treatment planning, surgical procedures on hard or soft tissue, prescribe medication

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or administer general anesthesia or injectables other than oral local anesthesia. A dental hygienist

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is only permitted to practice dental hygiene under the general supervision of a dentist licensed

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and registered in this state under the provisions of this chapter.

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      (A) Provided, that in order to administer local injectable anesthesia to dental patients,

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dental hygienists must be under the supervision of a dentist and meet the requirements established

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by regulation of the board of examiners in dentistry including payment of a permit fee.

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      (16) (i) (A) "Practice of dentistry." Any person is practicing dentistry within the meaning

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of this chapter who:

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      (I) Uses or permits to be used, directly or indirectly, for profit or otherwise, for himself,

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herself, or for any other person, in connection with his or her name, the word "dentist" or "dental

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surgeon", or the title "D.D.S." or "D.M.D.", or any other words, letters, titles, or descriptive

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matter, personal or not, that directly or indirectly implies the practice of dentistry;

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      (II) Owns, leases, maintains, operates a dental business in any office or other room or

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rooms where dental operations are performed, or directly or indirectly is manager, proprietor or

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conductor of this business;

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      (III) Directly or indirectly informs the public in any language, orally, in writing, or in

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printing, or by drawings, demonstrations, specimens, signs, or pictures that he or she can perform

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or will attempt to perform, dental operations of any kind;

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      (IV) Undertakes, by any means or method, gratuitously, or for a salary, fee, money, or

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other reward paid or granted directly or indirectly to himself or herself, or to any other person, to

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diagnose or profess to diagnose, or to treat or profess to treat, or to prescribe for, or profess to

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prescribe for, any of the lesions, diseases, disorders, or deficiencies of the human oral cavity,

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teeth, gums, maxilla or mandible, and/or adjacent associated structures;

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      (V) Extracts human teeth, corrects malpositions of the teeth or of the jaws;

 

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      (VI) Except on the written prescription of a licensed dentist and by the use of

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impressions or casts made by a licensed and practicing dentist, directly or indirectly by mail,

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carrier, personal agent, or by any other method, furnishes, supplies, constructs, reproduces, or

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repairs prosthetic dentures, bridges, appliances, or other structures to be used and worn as

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substitutes for natural teeth;

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      (VII) Places those substitutes in the mouth and/or adjusts them;

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      (VIII) Administers an anesthetic, either general or local, in the course of any of the

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previously stated dental procedures; or

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      (IX) Engages in any of the practices included in the curricula of recognized dental

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colleges;

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      (B) Provided, that in order to administer any form of anesthesia, other than local, dentists

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must meet the requirements established by regulation of the board of examiners in dentistry,

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including training in advanced cardiac life support and pediatric advanced life support, and

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payment of a permit fee.

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      (ii) The board shall promulgate regulations relating to anesthesia. Those regulations shall

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be consistent with the American Dental Association guidelines for the use of conscious sedation,

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deep sedation, and general anesthesia in dentistry. Neither the board, nor any regulation

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promulgated by the board, shall require additional licensing fees for the use of nitrous oxide by

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dentists. Prior to the adoption of those regulations, dentists shall be permitted to administer

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anesthesia without restriction. From the proceeds of any fees collected pursuant to the provisions

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of this chapter, there is created a restricted receipts account that is used solely to pay for the

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administrative expenses incurred for expenses of administrating this chapter.

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      (iii) No non-dentist who operates a dental facility in the form of a licensed outpatient

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health care center or management service organization may interfere with the professional

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judgment of a dentist in the practice.

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      (17) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon

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(with a permit to administer deep sedation and general anesthesia) by verbal command and under

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direct line of sight.

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     SECTION 3. This act shall take effect upon passage.

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LC001789

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- DENTISTS AND DENTAL

HYGIENISTS

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     This act would remove the requirement that the chief of the division of oral health

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possess a master's degree in public health. This act would also allow public health dental

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hygienists to perform certain dental hygiene procedures in a public setting without the immediate

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supervision of a dentist.

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     This act would take effect upon passage.

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LC001789

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