BILL ANALYSIS Ó ----------------------------------------------------------------------- |Hearing Date:May 2, 2011 |Bill No:SB | | |540 | ----------------------------------------------------------------------- SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT Senator Curren D. Price, Jr., Chair Bill No: SB 540Author:Price As Amended:April 25, 2011 Fiscal:Yes SUBJECT: Dentistry. SUMMARY: Extends the sunset date of the Dental Board of California to January 1, 2018, and makes other programmatic changes. Existing law: 1) Establishes the Dental Board of California (DBC) to license and regulate the practice of dentistry. 2) Specifies that the DBC shall consist of eight practicing dentists, one registered dental hygienist, one registered dental assistant, and four public members. States that this provision shall remain in effect only until January 1, 2012, and after that date, is repealed unless a later enacted statute, that is enacted before January 1, 2012, deletes or extends that date. (Business & Professions Code (BPC) § 1601.1) 3) Provides that every board within the Department of Consumer Affairs, as specified, shall initiate the process of adopting regulations on or before January 1, 1999, to require its licentiates, as defined, to provide notice to their clients or customers that the practitioner is licensed by this state. (BPC § 138) 4) States that for purposes of advertising, a dentist may not hold himself or herself out as a specialist, as specified, unless the dentist satisfies specific specialization requirements. (BPC § 651(h)(5)(A)(i) et seq) SB 540 Page 2 5) Allows DBC to issue a probationary license to an applicant for licensure as a dentist or dental auxiliary. Allows the DBC to require a licensee, as a term or condition of issuing a probationary license, to comply with certain requirements, as specified. (BPC § 1628.7) 6) Requires licensees of the DBC to fulfill continuing education requirements. 7) Specifies the intent of the Legislature to seek ways and means to identify and rehabilitate licenciates whose competency may be impaired due to abuse of dangerous drugs or alcohol, so that licentiate so afflicted may be treated and returned to the practice of dentistry in a manner which will not endanger the public health and safety. (BPC § 1695) 8) Requires the DBC to establish criteria for the acceptance denial or termination of licentiates in a diversion program. States that licentiates shall sign an agreement of understanding that withdrawal or termination from the diversion program at a time when a diversion evaluation committee determines the licentiate presents a threat to the public's health and safety shall result in the utilization of the DBC of diversion treatment records in disciplinary or criminal proceedings. (BPC § 1695.5) 9) States that the amount of fees that relate to the licensing and permitting of dental assistants shall be established by DBC resolution. (BPC § 1725) 10)Finds and declares that dental assistants provide a dental care services that is vital to good health. It is the intent of the Legislature that the DBC create and implement an effective forum where dental assistant services and regulatory oversight of dental assistants can be heard and discussed in full and where all matters relating to dental assistants in this state can be discussed, as specified. 11)Establishes the Dental Corps Loan Repayment Program of 2002 to provide loan repayment assistance to dentists who commit to a minimum of three years of services in a dentally underserved area, as defined. (BPC § 1970 et.seq.) This bill: 1) Deletes existing law requirements relating to advertising by a dentist of specialization or accreditation in a specialty area of SB 540 Page 3 practice unless certain requirements are met. 2) Extends the sunset date of the DBC comprised of eight practicing dentists, one registered dental hygienist, one registered dental assistant and five public members to January 1, 2016. 3) Establishes, on and after January 1, 2016, a DBC which shall consist of eight practicing dentists and seven public members. States that this provision shall remain in effect only until January 1, 2018, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2018, deletes or extends that date. States that this repeal renders the DBC subject to review by the appropriate policy committees of the Legislature. States that members of the DBC shall be appointed for a term of four years, and that the Governor appoints the 8 dentists and five of the public members, and the Senate Rules Committee and the Speaker of the Assembly each appoint a public member. 4) States that on and after January 1, 2016, all members of the DBC, except the public members, shall have been actively and legally engaged in the practice of dentistry, as specified. Provides that the public members shall not be licentiates of the DBC or any other board, as specified. 5) Requires the DBC, by January 1, 2013, to comply with existing statute that requires boards within DCA, including the DBC, to adopt regulations to require licensees to provide notice to clients or customers that the licensee is licensed by the state. Requires the notice to include a provision indicating that the DBC is the entity that regulates dentists and provide the telephone number and Internet address of the DBC. States that the DBC should require the notice to be posted in a conspicuous location accessible to public view. 6) Extends the sunset date of the appointment of the executive officer to January 1, 2018. 7) Requires the DBC to adopt written guidelines on how to make probation assignments, and to ensure that probationary and evaluation reports are conducted consistently and regularly. 8) Requires the DBC to ensure that the law and ethics examination reflect current law and regulations, and to ensure that the examinations are randomized. 9) Provides that if requested by the Legislature through the Joint SB 540 Page 4 Legislative Audit Committee in 2012, the Bureau of State Audits shall conduct a thorough performance audit of the DBC's diversion program to evaluate the effectiveness and efficiency of the program, and make recommendations regarding the continuation of the program and any changes or reforms required to ensure that licensees participating in the program are appropriately monitored and that the public is protected from licensees who are impaired due to alcohol or drug abuse or mental or physical illness. Requires this audit to be paid for with moneys from the State Dentistry Fund. 10)Deletes existing law provision requiring a licentiate to sign an agreement of understanding that the withdrawal or termination from the diversion program at a time when a diversion evaluation committee determines the licentiate presents a threat to the public's health and safety shall result in the utilization by the DBC of diversion treatment records in disciplinary or criminal proceedings. 11)Requires that if a licentiate withdraws or is terminated from the diversion program for failure to comply or is determined to be a threat to the public or their own health and safety, all diversion records for that licentiate shall be provided to the DBC's enforcement program and may be used in any disciplinary proceeding. States that if a licentiate in a diversion program tests positive for any banned substance, the board's diversion program manager shall immediately notify the DBC's enforcement program and provide the documentation evidencing the positive test result to the enforcement program. Provides that this documentation may be used in a disciplinary proceeding. 12)Deletes the requirement that dental assisting fees that relate to licensing and permitting be established by DBC resolution and instead requires these fees to be established by regulation. 13)Deletes existing intent language for the DBC to create and implement an effective forum for dental assisting matters, as specified. 14)Creates a Dental Assisting Council (Council) of the DBC, which shall consider all matters relating to dental assistants in this state, including matters that relate to standards for approval of dental assisting educational programs and courses, and make appropriate recommendations to the DBC, as specified. 15)Requires that members of the Council to be appointed by the DBC SB 540 Page 5 president, and shall consist of two members of DBC, and five members who are either registered dental assistants or registered dental assistants in extended functions. Requires the Council to meet in conjunction with other DBC Committees, and at other times as deemed necessary. 16)Provides that the Council members shall serve a term of four years, except that, of the initial appointments of the nonboard members, one of the members shall serve a term of one year, two members shall serve a term of two years, and two members shall serve a term of three years. 17)Requires the Council to be the sole entity of the DBC that will provide recommendations on dental assisting matters. 18)Extends the California Dental Corps Loan Repayment Program of 2002 until all the moneys in the account are expended. 19)Makes other technical, non-substantive, and conforming changes. FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by Legislative Counsel. COMMENTS: 1. Purpose. The Author is the Sponsor of this measure. According to the Author, in 2011, this Committee conducted oversight hearings to review 7 boards: the Board of Registered Nursing, the Board of Vocational Nursing and Psychiatric Technicians, the Dental Board of California, the Board of Accountancy, the Contractors State License Board, the Board for Professional Engineers, Land Surveyors and Geologists, the California Architects Board (and the Landscape Architects Committee). The Committee also reviewed the Athletic Commission and the Professional Fiduciaries Bureau and conducted oversight hearings of the Department of Real Estate and the Office of Real Estate Appraisers. The Committee began its review of these licensing agencies in March and conducted three days of hearings. This bill, and the accompanying sunset bills, is intended to implement legislative changes as recommended in the Committee's Background/Issue Papers for all of the agencies reviewed by the Committee this year. This bill is one of the seven "sunset bills" authored by the Chair of this Committee. According to the Author, this bill is necessary to extend the sunset date of the DBC and continue the regulation of dentists and other dental practitioners in California and continue SB 540 Page 6 with the DBC's mission to protect the public. Additionally, the Author points out that there is a need to increase the public membership within the DBC to assure the public that the professions' interests do not outweigh what is in the best interest of the public. Additionally, there is a need to ensure the programs administered by the DBC, including its Diversion Program, continue to protect the public while rehabilitating licensees. 2. Background. The DBC was created by the California Legislature in 1885, and was originally established to regulate dentists. Today, the DBC is responsible for regulating the practice of approximately 71,000 licensed dental health professionals in California, including 35,500 dentists, 34,300 registered dental assistants (RDAs), and 1,300 registered dental assistants in extended functions (RDAEFs). In addition, DBC is responsible for setting the duties and functions of approximately 50,000 unlicensed dental assistants. The Dental Practice Act provides that the "Ýp]rotection of the public shall be the highest priority of the Dental Board of California in exercising its licensing, regulatory and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount." DBC implements regulatory programs and performs a variety of functions to protect consumers. These programs and activities include setting licensure requirements for dentists, and dental assistants, including examination requirements, issue and renew licenses, issue special permits, monitor probationer dentists and RDAs and manage a Diversion Program for dentists and RDAs whose practice may be impaired due to chemical dependency or mental illness. DBC is composed of 14 members; 8 practicing dentists, 2 dental auxiliaries (RDH and RDA), and 4 public members. The 8 licensed dentists, the registered dental hygienist, the RDA, and 2 public members are appointed by the Governor. The Speaker of the Assembly and the Senate Rules Committee each get a public member appointment. According to DBC, public membership is 29% of the Board's composition. Existing law allows the Legislature to conduct policy review of regulatory boards within DCA. This review includes an evaluation of a board's regulatory programs, including staffing, enforcement, budgetary, examination, and practice issues to ensure that consumer protection remains the priority of these boards. This year, the DBC was reviewed by this Committee and an oversight hearing was held on March 14, 2011. As part of this hearing, Committee staff prepared an extensive background paper detailing various issues and recommendations for the DBC. SB 540 Page 7 3. Former Sunset Review of the DBC. DBC was last reviewed by the former Joint Legislative Sunset Review Committee (JLSRC) in 2002. At that time, the JLSRC issued five recommendations. Additionally, prior to this last review, SB 26 (Figueroa), Chapter 615, Statutes of 2001 required the Director of the DCA to appoint an Enforcement Monitor (Monitor) to evaluate DBC's disciplinary system and procedures with specific focus on the quality and consistency of complaint processing and investigation, timeframes needed for complaint handling and investigation, complaint backlogs, and other related managerial, organizational, and operational problems, issues, and concerns. The Monitor submitted his initial report to the Legislature in 2002, and made 40 specific recommendations for improvements. In this initial report, the Monitor indicated that there are numerous significant inconsistencies in the way complaints are processed and investigated, it was taking much too long to resolve or investigate complaints, and as a result of staff turnover and the state's hiring freeze, backlogs have begun to accumulate. On October 1, 2010, DBC submitted its required Sunset Report to this Committee. In this report, DBC described actions it has taken since its last sunset review and to address the recommendations of the Monitor. The following are some of the changes and enhancements that DBC had undertaken: Augmentation of enforcement unit staff and restructuring of its Complaint Unit has allowed DBC to respond to consumer complaints in a timely manner and has reduced the processing times of complaints. In response to concerns raised that DBC is unable to administer an adequate amount of examinations, DBC sponsored AB 1524 (Hayashi), Chapter 446, Statutes of 2010 which repeals the previous clinical and written examination administered by DBC and replaced it with a portfolio examination of an applicant's competence to practice dentistry to be administered while the applicant is enrolled in a dental school program. DBC converted limited term peace officer positions to permanent full time positions. New licensure, examination and permit requirements were established. To address issues raised by the Monitor on the lack of a case tracking system, DBC will be one of the Boards that will benefit from a new, integrated, enterprise-wide enforcement and licensing system, called BreEZe that will support applicant tracking, SB 540 Page 8 licensing, renewal, enforcement, monitoring, cashiering, and data management. According to DCA, BreEZe will replace the existing CAS, ATS, and multiple "workaround" systems with an integrated system for use by all DCA organizations. The BreEZe project was approved by the Office of the State Chief Information Officer (OCIO) in November 2009, and the Request For Proposal (RFP) for a solution vendor is currently under development. To address the need for tracking investigative case activity, in 2003, DBC tested a version of the Investigation Activity Reporting (IAR) program used by the Medical Board of California (MBC). According to DBC, although this demonstration version of MBC's database was intended to provide a method for managers to track casework on all cases, the system was not established in protocol and was only used sporadically. DBC's enforcement program has partnered with the MBC to utilize MBC's newest version of the IAR to track casework. This format is intended to provide information for cost recovery purposes and allow managers to better track staff performance and productivity. Transition to the new IAR was anticipated to be completed by the end of 2010. The Expert Reviewer rate was increased from $75 to $100. However, DBC indicates it continues to struggle to recruit experts. Effective August 1, 2010, a new consumer survey procedure has been adopted. The Disciplinary Guidelines of DBC were revised and approved by the Office of Administrative Law on December 14, 2010. The regulations became effective January 13, 2011. DBC's regulatory authority and responsibility was extended to all dental assisting functions. The duties and functions of unlicensed dental assistants, RDAs, RDAEFs, Dental Sedation Assistants, and Orthodontic Assistants were revised in statute. The Board updated its dental assisting educational requirements relating to RDA programs, infection control courses, Orthodontic Assistant Permit Courses, Dental Sedation Assistant Courses, and RDAEF programs, and is moving forward with finalizing the rulemaking process. The DBC updated the regulations for the minimum standards for infection control applicable to all DBC licensees and is moving SB 540 Page 9 forward with finalizing the rulemaking process. 1. This Measure Includes the Following Statutory Changes as Identified by This Committee During Its Oversight Hearings of March, 2011: a) Increases Public Membership of the DBC. DBC's current composition of 8 professionals and 4 public members may not be in the best interest of consumer protection. DBC currently has 14 members: 8 dentists, 1 RDA, 1 RDH and 4 public members. The 8 licensed dentists, 1 RDH, 1 RDA, and 2 public members are appointed by the Governor. The Senate Rules Committee and the Speaker of the Assembly each get 1 public member appointment. According to DBC, public membership is 29% of DBC's composition. Generally, a public member majority for occupational regulatory boards or greater representation of the public where current board membership is heavily weighted in favor of the profession is preferred for consumer protection. Since any regulatory program's (including DBC) primary purpose is to protect the public, increasing the public's representation on DBC assures the public that the professions' interests do not outweigh what is in the best interest of the public. Requiring closer parity between public and professional members is also consistent with both this Committee's and the DCA's recommendations regarding other boards that have undergone sunset review over the past 8 years. Additionally, all other health related consumer boards have no more than a simple majority of professional members or a public majority. This bill, effective January 1, 2012, would increase the membership of the DBC to 15 by adding one public member. Effective January 1, 2016, the registered dental hygienist and registered dental assistant would be replaced by public members, changing the composition of the DBC to 8 dentists and 7 public members. b) Deletes Existing Law Requirements on Advertising of Specialty Education and Accreditation Requirements for Specialized Areas of Dentistry. Existing law prohibits a dentist from holding himself or herself out as a specialist, or advertising in a specialty recognition by an accredited organization, unless the practitioner completed specialty education programs approved by the American Dental Association, as specified. Additionally, existing law prohibits a dentist from representing or advertising himself or herself as accredited in a specialty area of practice unless the dentist is a member of, or credentialed by, an accredited organization recognized by DBC as a bona fide organization for an area of dental practice. This law was SB 540 Page 10 recently the subject of litigation in the case of Potts v. Hamilton, 334 F.Supp.2d 1206, and was ruled by a federal court as an unconstitutional restriction on commercial speech. According to the DBC, to prevent future litigation in this area and to mitigate costs associated with the Potts litigation (over $1.1 million), DBC is recommending that Section 651(h)(5)(A)(i) through 651(h)(5)(A)(iii) of the B&P Code be deleted from statute. DBC does not believe this is an area in which DBC needs to be involved. c) Requires Dentist to Post a Notice Accessible to Patients to Indicate that Dentists are Regulated by DBC. Section 138 of the Business & Professions Code requires that DCA board and bureaus, including healing arts boards such as DBC, initiate the process of adopting regulations on or before June 30, 1999, to require its licentiates, to provide notice to their clients or customers that the practitioner is licensed by this state. A board is exempt from the requirement to adopt regulations if the board has in place, in statute or regulation, a requirement that provides for consumer notice of a practitioner's status as a licensee of this state. The purpose of this statute is to inform consumers the appropriate regulatory body that regulates a particular licensee or practitioner. Recently, the MBC promulgated regulations pursuant to Section 138 to require physicians and surgeons to inform their patients that they are licensed by the MBC, and includes the board's contact information. In the same manner, DBC should implement Section 138 and adopt regulations to require dentists to inform their patients that they are licensed by the Board. d) Requires Written Guidelines for Probation Assignments. Probation cases within DBC are assigned to inspectors or investigators after taking into consideration the variety of circumstances necessitating probation, combined with the known behavior of certain licensees. RDAs are generally assigned to inspectors, and difficult or questionable probation subjects are assigned to sworn investigative staff. According to a recent Enforcement Assessment of the DBC, there are no written guidelines on how to make probation assignments, and that probationary reports and evaluation reports have not been conducted with regularity. e) Ensures that the Law and Ethics Examination for Dentists Reflects Current Law and Regulation. As part of the licensure process, a dentist must pass a California Law and Ethics examination that is developed and administered by DBC. DBC SB 540 Page 11 contracts with the DCA's Office of Professional Examination Services (OPES) for its examination development services. According to DBC, in FY 2006/2007 and 2007/2008, the pass rate for the Dental Law and Ethics examination was 96%, and for fiscal years 2008/2009 and 2009/2010, the pass rate increased to 98%. This pass rate is extremely high. To ensure that examination questions reflect current law and regulations, DBC should require that OPES randomize (scramble) California law and ethics examinations for dentists. f) Requires an Audit of DBC's Diversion Program. DBC administers a Diversion Program intended to identify and rehabilitate dentists whose competence may be impaired due to abuse of dangerous drugs or alcohol, so that licentiates may be treated and returned to the practice of dentistry in a manner that will not endanger the public health and safety. Entry into the diversion program may be through self-referral but most participants enter the diversion program because they are under investigation by DBC and were referred by a program manager. Since 1983, the clinical management of the diversion program has been done by MAXIMUS, Inc. MAXIMUS provides the following services: medical advisors, compliance monitors, case managers, urine testing system, reporting, and record maintenance. In 2007 and 2008, this Committee held informational hearings on the Physician Diversion Program (PDP) after an audit of MBC's diversion program revealed that the MBC's program was not sufficiently protecting the public. Although the MBC voted unanimously to end the PDP on June 30, 2008, this Committee recognized the need to strengthen the diversion programs of boards that continue to administer them. As such, in 2008, SB 1441 (Ridley-Thomas, Chapter 548, Statutes of 2008) became law and required the DCA to establish a Substance Abuse Coordination Committee (SACC) to adopt uniform guidelines on sixteen specific standards that would apply to substance abusing health care licensees, regardless of whether a board has a diversion program. The intent of SB 1441 was to establish common and uniform standards to govern the different health care licensing boards' diversion programs so as to maintain public confidence that these programs are truly monitoring and rehabilitating substance abusing licensees. In 2010, MAXIMUS was audited by the DCA and it was indicated that they were complying with all of the requirements of their contract; however, Committee staff had serious concerns about the completeness of this audit and the serious deficiencies which may still exist with this program. This came to light when it was found that MAXIMUS was recently testing those participants in the health boards' Diversion SB 540 Page 12 Programs and using inexact standards (i.e., participants were tested at a higher standard and tested negative when they should have been tested at a lower standard and may have potentially tested positive). The DCA took immediate steps to rectify this problem, but it still raises questions about the effectiveness and efficiency of MAXIMUS and those diversion programs which rely on this contractor. The DBC's Diversion Program has never been audited in its entirety since its inception. The intent of this audit is to assure that the Diversion Program is appropriately monitoring and treating participants, and determine whether it is effective in preventing further substance abuse, and ensure that the uniform standards that were adopted pursuant to SB 1441 are being implemented. g) Requires all Diversion Records to be Provided to the DBC's Enforcement Program if a Licentiate Withdraws, is Terminated from the Diversion Program for Failure to Comply, or is Determined to be a Threat. Section 1698 of the Dental Practice Act specifies that except where the licentiate presents a threat to the public's health and safety, all DBC and diversion evaluation committee records and records of proceedings pertaining to the treatment of a licentiate in a diversion program is kept confidential and are not subject to discovery or subpoena. According to DBC, current law does not allow DBC's diversion program to notify its own enforcement program when a licensee participating in diversion is not in substantial compliance. The diversion program can only provide the name of the terminated licensee and not any specifics as to why the individual was terminated from the program. This notification, DBC argues, is necessary as the information obtained in the diversion program could be used for subsequent disciplinary action by DBC. h) Requires Licensing and Permitting Fees of Dental Assistants to be Established by Regulation. Current law allows the DBC to increase the fees for RDAs by board resolution. However, most licensing fees, including those of dentists, are generally increased through regulation, if the increase is within the statutory maximum. i) Establishes a Dental Assisting Council Provide Recommendations on Dental Assisting Matters. Current law states legislative intent for the DBC to create and implement an effective forum where dental assistant services and regulatory oversight of dental assistants can be heard and discussed in full and where all matters relating to dental assistants can be discussed, including matters related to licensure and renewal, duties, SB 540 Page 13 standards or conduct and enforcement. In 2009, DBC established two groups to deal with dental assisting issues: The Dental Assisting Committee (DAC) composed of DBC members and chaired by the RDA appointee to DBC; and the Dental Assisting Forum (DAF), composed of RDAs and RDAEFs. The DAC meets at every board meeting and the DAF held short meetings in January and April 2010, and met again in January 2011. Advocates for dental assistants have indicated to Committee staff that many items that DAF members have requested be included on agendas but have been removed, requests that meetings be held in conjunction with DBC so that there can be open lines of communication and establish greater efficiency have been denied, and dental assisting issues are placed on the agenda for DBC's DAC, instead of on the DAF agenda. Additionally, it is unclear what is the DBC's policy for referring issues to the DAF and DAC, how recommendations are referred from the DAF and DAC to DBC and what kind of discretion DBC has over deciding dental assisting issues; how often are issues referred to DAF and DAC and how often are they taken up by DBC, and how often are DAF and DAC recommendations accepted. Essentially, the establishment of two groups to deal with dental assisting issues has resulted in very inefficient and ineffective process. It is also unclear why DBC established a bifurcated process for hearing dental assisting issues. j) Extend the Dental Corps Loan Repayment Program. The California Dental Corps Loan Repayment Program, administered by DBC, was created in 2002 (AB 982, Chapter 1131, Statutes of 2002) to increase the number of dentists who practice in historically underserved areas by providing grants to help pay for the high cost of attending dental school. DBC selects participants to practice in underserved areas, in practice settings with a majority of underserved patients, and gives priority consideration to applicants who are best suited to the cultural and linguistic needs of those populations and meet other related criteria. After each consecutive year of service completed, participants will receive money for loan repayment ($25,000 for the 1st year, $35,000 for the 2nd year, and $45,000 for the 3rd year) for up to three years. The law states each participant may receive no more than $105,000 over three years. The program was extended until July 1, 2012 and authorized DBC to distribute funds remaining in the account. However, due to limited participation, DBC points out that the program should be extended until DBC distributes all the remaining money in the fund. aa) Extends the Sunset Date of the DBC. The health and safety of consumers are protected by a well-regulated dental SB 540 Page 14 profession. DBC should be continued with a six-year extension of its sunset date so that this Committee may review it once again. 2. Related Legislation. Other sunset review bills to be presented before the Senate Business and Professions Committee include: a) SB 538 which deals with the Board of Registered Nursing b) SB 539 which deals with the Board of Vocational Nurses and Psychiatric Technicians. c) SB 541 which deal with the DCA and the contracting for expert consultants by the boards. d) SB 542 which deals with California Board of Accountancy and the Professional Fiduciaries Bureau. e) SB 543 which deals with the California Architects Board , Contractors State License Board, Landscape Architects Technical Committee, Board for Professional Engineers, Land Surveyors, and Geologists, State Board of Guide Dogs for the Blind, State Athletic Commission. f) SB 706 which deals with the Department of Real Estate and the Office of Real Estate Appraisers. 3. Arguments in Support. The Dental Assisting Alliance (Alliance) states that it supports replacing the Dental Assisting Forum with a Dental Assisting Council that meets in conjunction with other Board committees, and establishes the Council as the sole entity making dental assisting recommendations to the DBC. As a result, the Alliance points out, dental assisting matters will be much more efficiently and effectively integrated into the DBC's deliberations. The Alliance states that it also supports requiring dental assisting fees to be set by regulation rather than DBC resolution, so that the fee levels will be fully scrutinized during a regulatory process. The Alliance only supports these provisions. SUPPORT AND OPPOSITION: Support: None on file as of April 27, 2011 Opposition: None on file as of April 27, 2011 Consultant:Rosielyn Pulmano SB 540 Page 15