Rep Cody Moves ahead: Legislators will see two bills aimed at creating dental therapists. Here they are.
Dental therapist legislation will be a major challenge for dentistry in the 2011 Legislature. Two bills are now promised: a bill for an advanced dental therapist by Rep. Eileen Cody, chair of the House Healthcare and Wellness Committee, and a bill sponsored by the Washington State Dental Hygienists’ Association.
WSDA is adamantly opposed to both bills and urges members to become involved in grassroots efforts to stop them (See sidebar on facing page and Dental Action Day information on page 6).
Rep. Cody’s bill would create a new oral health position called the advanced dental therapist, modeled on Minnesota’s legislation approved in 2009. In some important aspects, however, it is much less restrictive.
• Regulation through DQAC
• Unsupervised, but under a collaborative agreement with a dentist, after 960 hours of supervised practice
• Scope more expanded than other dental mid-level models
• Access to care improvement not assured.
• Economic viability questionable.
Key provisions of the Cody bill:
Under the Dental Quality Assurance Commission, however this is restricted to interpreting terms that are not explicit in legislation, which limits DQAC’s impact on regulation. Some statutory provisions that apply to dentists are not included in this bill draft.
Fundamentally unsupervised, subject to a collaborative agreement between a dentist and the dental therapist. The bill states what must be included in the terms of an agreement, but leaves discretion between the dentist and the dental therapist on the actual practice. The dentist is not required to diagnose and prescribe treatment plans prior to therapist treatment.
Initial dental therapist practice is under supervision in office by the dentist until the therapist has completed 960 hours of practice; unsupervised practice under the collaborative agreement is allowed following that period
Scope of Practice
The bill allows the therapist to perform diagnosis, treatment planning, limited drug prescriptions, and limited restorative, extractions, endodontics, prosthodontics, and periodontics. The provisions for scope would be spelled out in legislation and not subject to revision by DQAC.
Unlike Minnesota’s law, under Rep. Cody’s bill the supervising (collaborating) dentist would not be required to authorize treatment plans and extractions of permanent teeth.
Master’s level dental therapy program approved by DQAC, however, the program would not award a master’s degree.
Clinical and written exams developed and approved by DQAC.
Effect on Access
Minnesota’s legislation requires that 50 percent of the patient base of an advanced dental therapist practice be underserved (income below 200 percent of federal poverty level, home-bound, dental shortage area, etc.). No such restriction is included in the Cody bill and it is uncertain how this model will then improve access for the underserved.
The economics of an independent dental therapist practice is questionable. Initial infrastructure investment and ongoing operating costs may be greater than revenue can sustain, particularly if the intent, as promoted by advocates, is improved access for the underserved. Worldwide and historically, all dental therapy programs have been incorporated into government operated or funded national health systems. Dental therapists in Alaska are funded by a tribal consortium and start-up foundation grants.
There is no state funding proposed for a Washington bill and any would be highly unlikely. Federal funding is authorized in the health care reform at $4 million each for 15 “alternative dental provider” pilot projects. This money will likely not be appropriated.
A draft of Rep. Cody’s bill is available at /alternative-dental-workforce/ as well as an outline of the WSDHA proposal.
The Hygienists Bill
The Dental Hygienists’ Association’s bill calls for creation of an Advanced Dental Hygienist Therapist (ADHT). It is similar to Rep. Cody’s bill, but has some major differences.
- The ADHT will be regulated by and independent Dental Hygiene Examining Committee (DHEC), which may result in conflicts with DQAC in regulating the same dental procedures
- Practice settings may include “any clinic or setting in which at least 50 percent of the total patient base of the ADHT consists of patients on Medicaid, have a medical or chronic condition that creates a significant barrier to receiving dental care, or who are uninsured”.
Advocates for either bill are likely to include the Kellogg Foundation and the Washington Children’s Alliance (Kellogg has granted $1 million to the Alliance for oral health advocacy, which in other states has included lobbying for dental therapists.) Others may include dentists and other associations which supported legislation in Minnesota and the Alaska Dental Health Aide Therapist program.
The WSDA Position
HD-9S-201 passed by the WSDA House of Delegates directs WSDA’s opposition to these bills. The resolution states:
“The Washington State Dental Association considers these parameters to be paramount when evaluating any dental workforce proposal:
The dentist is the sole oral health professional authorized to diagnose and prescribe treatment for patients;
Close on site supervision is required by the dentist for any expanded function;
General supervision may be allowed for procedures that are authorized by statutes when approved by the dentist based on the dentist’s determination of competency;
Regulation of dental workforce will be the responsibility of the Dental Quality Assurance Commission.