Chapter 192
2015 -- S 0683 SUBSTITUTE A
Enacted 07/09/2015

A N   A C T
RELATING TO BUSINESSES AND PROFESSIONS -- DENTISTS AND DENTAL HYGIENISTS

Introduced By: Senators Nesselbush, Crowley, Pichardo, Miller, and P Fogarty
Date Introduced: March 12, 2015

It is enacted by the General Assembly as follows:
     SECTION 1. Chapter 5-31.1 of the General Laws entitled "Dentists and Dental
Hygienists" is hereby amended by adding thereto the following section:
     5-31.1-39. Public health hygienists. – (a) Any public health dental hygienist, which for
purposes of this chapter means any practicing registered dental hygienist who may perform dental
hygiene procedures in a public health setting subject to conditions adopted by the Rhode Island
board of examiners in dentistry, may perform in a public health setting, without the immediate or
direct supervision or direction of a dentist, any procedure or provide any service that is within the
dental hygiene scope of practice that has been authorized and adopted by the Rhode Island board
of examiners in dentistry as a delegable procedure for a dental hygienist under general
supervision in a private practice setting.
     (b) Public health settings shall, for purposes of this section, include, but are not limited
to, residences of the homebound, schools, nursing home and long-term care facilities, clinics,
hospitals, medical facilities, community health centers licensed or certified by the department of
health, mobile and portable dental health programs licensed or certified by the department of
health and operated by a local or state agency, head start programs and any other facilities or
programs deemed appropriate by the department of health.
     (c) Any public health hygienist shall enter into a written, collaborative agreement with a
local or state government agency or institution or with a licensed dentist who states that he or she
shall be able to provide the appropriate level of communication and consultation with the dental
hygienist to ensure patient health and safety prior to performing any procedure or providing any
service under this section. The written, collaborative agreement will follow the appropriate
guidelines as determined and established by the Rhode Island board of examiners in dentistry.
     (d) Any public health dental hygienist shall provide to the patient, or to the patient's legal
guardian, a consent form to be signed by the patient or legal guardian. The consent form shall be
consistent with current department of health policies that describes services to be rendered and
explains that services rendered are not a substitute for a dental examination by a dentist. The
consent form shall also inform the patient or legal guardian that the patient should obtain a dental
examination by a dentist within ninety (90) days after undergoing a procedure authorized
pursuant to this section. The patient or legal guardian shall also obtain written referral to a dentist
and an assessment of further dental needs.
     (e) The public health dental hygienist shall be directly reimbursed for services
administered in a public health setting by Medicaid or the state health care insurance program
except as required by federal Medicaid law, but shall not seek reimbursement from any other
insurance or third-party payor. A public health dental hygienist shall not operate independently of
a dentist, except for a dental hygienist working for a local or state government agency or
institution or practicing in a mobile or portable prevention program licensed or certified by the
department of health. In such cases, the local or state government agency or institution or mobile
or portable prevention program licensed or certified by the department of health may seek
reimbursement from any other third-party payor.
     SECTION 2. Section 16-21-9 of the General Laws in Chapter 16-21 entitled "Health and
Safety of Pupils" is hereby amended to read as follows:
     16-21-9. Health examinations and dental screenings -- Reports -- Records. -- (a) Each
community as defined in § 16-7-16 shall provide for the appointment of a physician to make
examinations of the health of the school children, who shall report any deviation from the normal,
and for the preservation of records of the examinations of the children. Each community shall
further provide for dental screenings by a licensed dentist or licensed dental hygienist or a
licensed public health dental hygienist, with at least three (3) years of clinical experience, who
shall report any suspected deviation from the normal normal, and for the preservation of records
of the screenings of the children. Each community shall notify the parents or custodians of
children of conditions requiring professional or skilled treatment. The state commissioner of
elementary and secondary education shall provide blank forms and record books that he or she
may deem necessary for the purposes of this section.
      (b) Each community as defined in § 16-7-16 shall only contract with a licensed dentist,
dentist and/or a licensed public health dental hygienist, for the provision of the dental screenings
services required by this section. Dental hygienists performing the dental screenings pursuant to
the provisions of this section shall do so under the general supervision of the dentist liable and
responsible under the contract with the community or within the collaborative agreement
guidelines between a licensed public health hygienist and licensed dentist.
      (c) Except in emergency circumstances, referral by a dentist, or dental hygienist, and/or
public health dental hygienist of children screened pursuant to the provisions of this section to a
dental practice by which the dentist or dental hygienist is employed and/or which the dentist owns
shall be strictly prohibited. In the event that a referral has been made in violation of this
provision, the community shall terminate its contract with the dentist. In the case of an egregious
violation of the referral prohibition contained in this section, that conduct shall be reported to the
board of dental examiners.
      (d) Each community shall provide to parents or custodians of children who require
professional or skilled treatment a list of both dental practices in the community which that
accept patients insured by Medical Assistance medical assistance and/or RIte Care and dental
practices which that provide services on a sliding scale basis to uninsured individuals. The
department of human services shall provide each community with a list containing the addresses
and telephone numbers of both dental practices which that accept patients insured by Medical
Assistance medical assistance and/or RIte Care and dental practices which that provide services
on a sliding scale basis to uninsured individuals.
      (e) Dental screenings for children in kindergarten, third, and ninth grade shall only be
performed by a licensed dentist.
      (f) All dentists, or dental hygienists, and/or public health dental hygienists, performing
dental screenings pursuant to the provisions of this section, shall meet with the oral health
director of the department of health on a regular basis, as determined by the chief.
     SECTION 3. This act shall take effect upon passage.
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LC001791/SUB A/2
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