Minnesota: requested $3,000, the BOT approved $3,000.
Dental care (Laws, regulations and rules)
Dental care (Government finance)
|Publication:||Name: The Dental Assistant Publisher: American Dental Assistants Association Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Science and technology Copyright: COPYRIGHT 2009 American Dental Assistants Association ISSN: 1088-3886|
|Issue:||Date: Sept-Oct, 2009 Source Volume: 78 Source Issue: 5|
|Topic:||Event Code: 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 900 Government expenditures; 970 Government domestic functions Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation|
|Geographic:||Geographic Scope: Minnesota Geographic Name: Minnesota Geographic Code: 1U4MN Minnesota|
Submitted by: Natalie Kaweckyj, CDA, RDARF, CDPMA, COA, COMSA,
MDAA has many things going on involving legislation
Licensure: MN has been pursuing licensure for the past decade. The bill was resubmitted in January 2006 but never heard in committee. The bill was not resubmitted in January 2007 or 2008 due to the loss of the key author and new legislators not willing to discuss anything controversial. Our original author was unable to author this year because of committee chairing duties--we still have his support. We reintroduced our bill in March 2009 with the Board of Dentistry's backing. There are five authors to this bill, SF 1911--now SF12 17. There is no author in the House, but one lined up if needed; House Bill is HF 2377. Go to https://www.revisor.leg.state.mn.us/revisor/pages/search_status/ status_detail.php?b=Senate&f=SF1217&ssn=0&y=2009 for more information.
Testimony was heard on March 27, 2009, in the Senate Health, Housing and Family Security Committee. Bill passed and forwarded to the Senate Finance Committee because of the $15 increase in fee for initial licensure. In a nutshell, DANB certification would be required for initial licensure; grandfathering of the 7000-plus current RDAs would occur. Currently one-third of the RDAs in Minnesota hold certification.
OHP/Dental Therapist: MDAA was present at ali meetings although not invited to participate in the task force by legislator in charge. MDAA is on record for supporting the Dental Therapist bill that is what the University of Minnesota Dental School and MDA proposed. Debate over language defining what has come to be known as a "midlevel" dental provider in Minnesota has continued in separate committees of the state's Senate and House of Representatives. The Minnesota Dental Association and University of Minnesota School of Dentistry are supporting a bill that would provide funding for a program at the School of Dentistry to educate a new member of the dental team, the dental therapist, at the dental school, with the dental therapist's position being an integrated member of the dental team who would practice with a dentist's supervision.
However, a competing bill advanced by the Minnesota State Colleges and Universities system (community colleges and public universities not affiliated with the University of Minnesota), the Hennepin County Safety Net Coalition and Minnesota Dental Hygienists' Association proposes an "oral health practitioner" with the authority to perform surgical and restorative procedures without a dentist being on-site to provide supervision. While the MDA is pleased that the MDA and School of Dentistry proposal was met with little resistance and was enthusiastically supported, they are also frustrated that the legislature appears to be willing to pass both bills and is not inclined to pick one over the other.
The MDA experienced one setback after the Minnesota House Licensing Subcommittee rolled the OHP and Dental Therapist bills into an omnibus licensing bill known as HF 835 for consideration before the full House Health and Human Services Policy and Oversight Committee. On March 25 an amendment to strip the scope of practice and supervision of the OHP and replace it with the Dental Therapist language failed to gain a majority of the full committee. The next step is for HF 535 to be heard by the flail chamber at a date yet to be determined.
On March 26 the Senate Finance Committee passed SF 1106, the bill that includes both the OHP and dental therapist language. The dental therapist bill is attached to language that the MDA does not support, however, they were able to preserve the language that they support and move it forward. Instead of going to the Senate floor directly, SF 1106 has been referred back to the Rules Committee until Senate leaders determine the bill's next action. MDA officials knew the deck was stacked against them when they went into legislative hearings in early March. Supporters of the 0HP bill brought spokespersons from Alaska and Canada and contended that [the OHP proposal] would not cost MNSCU any money and that it was not necessary for a dentist to be supervising with anything more than a written agreement.
The written agreement is referenced in the OHP legislation as the "collaborative management agreement." An OHP could not work without one in place with a collaborating dentist. The dentist would have the authority to authorize a scope of practice for the OHP (within the stated scope of the law), determine when consultation is required and other parameters. However, it does not require any specific periodicity of case reviews, referrals or related activities, so its application in day-to-day practice is an open question.
The Dental Association finds fault with the OHP in two areas: First, the educational element--the University of Minnesota School of Dentistry--is the only institution in the entire state accredited to teach surgical dental procedures, as allowing this position to be trained at any other school in Minnesota does a disservice to the worker's education and to the rural and low-income populations they will eventually serve; second, the OHP plan is unrealistic in its requirements for supervision; specifically, it allows the mid-level dental worker to perform irreversible, surgical procedures without a dentist anywhere in the building.
Oral Surgery Assistants: There is proposed expansion of surgery assistant duties by the Minnesota Society of Oral Maxillofacial Surgeons (MSOMS). Many of their assistants are not DANB-certified. Increased duties would include administration of IVs, administering medications, and removal of IV apparatus, to name a few. This has temporarily been put on the back burner at the BOD because of the OHP/Dental Therapist issue.
MDAA submitted a list of proposed expanded functions that was originally drafted in 2003 for a licensure summit and only heard in the Policy Committee this year at the Board of Dentistry. The composition of the BOD has changed significantly since 2003, and support for MDAA and it's endeavors has weakened. MDAA is represented at every BOD committee meeting and full Board meeting. Some months, those meetings exceed ten in number.
Currently, the MDAA legislative Committee and the MDAA expanded functions committee have merged and have been pursuing in earnest to get additional expanded functions approved for RDAs in Minnesota. The following are the scaled down functions (from the list of 25) that were brought forward for further consideration at the BOD Allied Education Committee meeting, November 1, 2006: (minor education = can be trained in office, added to curriculum; major education = additional coursework). These will be brought forth again, regardless of licensure bill outcome in the next year.
1. Placement of bases (glass ionomer)
for RDA's not pursuing the Restorative Functions course--Direct Supervision. (MDA survey said 67 percent would not delegate this.)
* Major education: MDHA, MDA, PC
* Minor education: MEDA, MDAA
* Undecided: MDHEA
2. Placement of gingival retraction cord--Direct supervision.
* No support: MDHA, MDA, MDHEA, PC
* Major education: MDAA
* Undecided: MEDA
3. Taking final bite registration for partials, full dentures, crowns, bridges, inlays, and onlays--Direct supervision.
* No support: MDA, MDHEA, PC
* Major education: MEDA, MDHA, MDAA
4. Fit trial endodontic filling points--Direct supervision.
* No support: MDA
* Minoreducation: MEDA, MDHA, MDAA, PC
* Undecided: MDHEA
5. Preliminary pulp vitality testing (record findings for dentist to evaluate and diagnose with all modalities)--Indirect supervision.
* Minor education: MEDA, MDHA, MDA, MDAA, MDHEA, PC
6. Move coronal polishing from Indirect to General supervision.
* No additional education: MEDA, MDHA, MDA, MDAA, PC
7. Move application of topical agents from Indirect to General supervision.
* No additional education: MEDA, MDHA, MDA, MDAA, MDHEA, PC
8. Move placement of sealant from Indirect to General supervision.
* No additional education: MEDA, MDHA, MDA, MDAA, MDHEA, PC
9. Administration of local anesthesia--Direct supervision.
* No support: MDA, MDHEA, PC
* Major education: MEDA, MDAA
* Abstain: MDHA
(There has been open discussion with the Dental Association on this one recently.)
The MDAA previously proposed the administration of nitrous oxide analgesia in 1998 and it became a delegated duty in 2003. The Minnesota State Legislature also mandated restorative functions as a way to alleviate access to care issues in 2003 and in 2005, the first restorative assistants and hygienists began to utilize the function. MDAA has since had to defend restorative functions as an expanded duty, with the threat of a moratorium being placed on any additional certificants of the restorative functions course or any additional expanded duties. The composition of the Board Of Dentistry has changed greatly over the last four years and the older dentists are opposed to the "girls" doing any direct patient care. MDAA has supplied supporting documentation on how competent and qualified dental assistants can aid the dental profession.
New on the horizon is the collaborative practice agreement for hygienists and now there is discussion on incorporating assisting duties for qualified assistants. This topic is agreeable with ali organizations.
MDAA recently had to defend the topic of exposing radiographs and dental assistants--language was submitted that omitted the RDA by a nondental organization and a lot of last minute educating and lobbying was needed. The Dental Association keeps requesting that a survey be sent to the 14,000--plus dental professionals in Minnesota requesting feedback on access to care issues and what duties they would like to see each auxiliary be able to perform. Postage alone will be over $5,000. MDAA is planning on polling the dental assisting profession only, which would cut costs in half. MDAA is looking at various avenues to do this. So far lobbying costs have been absorbed by various associations we have worked with. Mileage alone eats most of the funding received.
compiled by Rosana Rodriguez, CDA, CDPMA, FADAA Chair, ADAA Council on Legislation
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