BILL ANALYSIS                                                                                                                                                                                                    







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          |Hearing Date:  April 8, 2002   |Bill No:SB                |
          |                               |1589                      |
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                    SENATE COMMITTEE ON BUSINESS AND PROFESSIONS
                             Senator Liz Figueroa, Chair

                        Bill No:        SB 1589Author:Perata
                            As Introduced      Fiscal:No

          
          SUBJECT:  Dentistry: dental hygienists.
          
          SUMMARY:  Authorizes a registered dental hygienist in  
          alternative practice (RDHAP) to be an employee of specified  
          clinics or public health entities.

          Existing law:

          1)Provides for the licensing and regulation of dentists,  
            Registered Dental Hygienists (RDHs) and Registered Dental  
            Hygienists in Alternative Practice (RDHAPs) by the Dental  
            Board of California.

          2)Provides that an RDHAP is a RDH with additional specified  
            education and training who may perform specified dental  
            hygiene services independent of supervision by a licensed  
            dentist, in specified practice settings, on a patient who  
            presents a written prescription for those services from a  
            licensed dentist.

          3)Specifies that a RDHAP is authorized to practice:  as an  
            employee of a dentist or of another RDHAP, as an  
            independent contractor, or as a sole proprietor of an  
            alternative dental hygiene practice.  Also specifies that  
            a RDHAP may perform specified dental hygiene services in  
            the following settings:  residences of the homebound,  
            schools, residential facilities and other institutions,  
            and dental health professional shortage areas.

          4)Specifies that a RDHAP may perform dental hygiene  
            services (without supervision by a dentist) on patients  
            who present a written prescription for those services,  





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            from a licensed dentist or physician who has previously  
            performed a physical examination and diagnosis of the  
            patient.  

          This bill:

          Authorizes a RDHAP to be an employee of a primary care  
          clinic exempt from licensure as a clinic operated by a  
          recognized Indian tribe on tribal land, or as an employee  
          of a clinic owned and operated by a public hospital or  
          health system, or as an employee of a clinic owned and  
          operated by a hospital that maintains a primary contract  
          with county government, to fulfill it's statutory  
          responsibility to provide health care to indigent persons.

          FISCAL EFFECT:  None. 

          COMMENTS:
          
          1.Purpose.  This bill is sponsored by the California Dental  
            Hygienists' Association to allow RDHAPs to be employed by  
            "safety net" organizations and public health entities. 

          2.Background.  The statutory scheme that created so-called  
            independent practice for registered dental hygienists  
            with advanced training - referred to as RDHAPs - was  
            enacted by AB 560 (Perata, Chapter 753 - Statutes of  
            1997).  That law specifies only certain limited settings  
            in which the RDHAP may perform his or her dental hygiene  
            services without the supervision of a licensed dentist.   
            Those settings currently do not include settings where  
            organizations and public health entities are providing  
            basic dental health care to indigent or underserved  
            populations - populations for which access to dental  
            hygiene services were sought to be increased via the  
            creation of the RDHAP license classification.

          3.Arguments in Support.  RDHAPs work with populations  
            outside of the "traditional" dental office setting - i.e.  
            those who cannot afford to and who do not have ready  
            access to a traditional private dental office setting.   
            Safety net organizations and public health entities, who  
            do serve these populations, cannot directly employ RDHAPs  
            to provide their independent dental hygiene services to  
            patients who have a diagnosed need for those services.   
            These entities are among those who could utilize the  





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            services of RDHAPs the most, and are the type of  
            organizations and settings that fit in with the type of  
            practice and access that was envisioned and enacted for  
            RDHAPs.

          
          SUPPORT AND OPPOSITION:
          
          Support: California Dental Hygienists' Association (CDHA -  
                  sponsor)

           Opposition:None received











          Consultant:Jay J. DeFuria