BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1202|
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THIRD READING
Bill No: SB 1202
Author: Leno (D)
Amended: 5/29/12
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP COMM : 9-0, 4/09/12
AYES: Price, Emmerson, Corbett, Correa, Hernandez, Negrete
McLeod, Strickland, Vargas, Wyland
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/24/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
SUBJECT : Dental hygienists
SOURCE : California Dental Hygienists Association
DIGEST : This bill makes a number of clean up changes
regarding the licensure and regulation of registered dental
hygienists by the Dental Hygiene Committee of California;
and increases various regulatory fee ceilings.
ANALYSIS : Existing law:
1. Licenses and regulates registered dental hygienists
(RDH), registered dental hygienists in alternative
practice (RDHAP), and registered dental hygienists in
extended functions by the Dental Hygiene Committee of
California (DHCC) under the Dental Board of California
(DBC) within the Department of Consumer Affairs.
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2. Requires the DHCC to perform specified functions,
including, the evaluation of all RDH, RDHAP, and
registered dental hygienists in extended functions
educational programs that apply for approval. Provides
that, any dental hygiene program accredited by and in
good standing with the Commission on Dental
Accreditation is required to be approved by the DHCC.
3. Authorizes the DHCC to employ employees and examiners
necessary to carry out the functions of the DHCC.
4. Establishes the requirements which an applicant must
meet to be issued an RDH license, including completion
of specified educational and examination requirements.
5. Authorizes the DHCC to issue a RDH license to an
applicant who has not taken the specified clinical
examination, if the applicant submits certain
information including proof that he or she has been in
clinical practice as an RDH or has been a full-time
faculty member of an accredited RDH education program
for at least 5 years preceding the application date, and
proof that the applicant has not been subject to
disciplinary action by another state where he or she was
previously licensed as an RDH.
6. Under a general provision, prohibits a Department of
Consumer Affairs licensing board, including the DHCC,
from imposing limitations or additional requirements on
an applicant to take an examination when the applicant
has failed a prior examination.
7. Authorizes a licensed RDHAP to perform specified
functions and procedures in residences of the homebound,
schools, residential facilities, and dental health
professional shortage areas.
8. Specifies that an RDHAP may not provide services
without a written prescription for dental hygiene
services from a dentist or physician and specifies that
failure to comply with the requirement shall be
considered unprofessional conduct.
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9. Authorizes the DHCC, as a condition of license renewal,
to require licensees to complete up 7.5 hours of
continuing education per renewal period, as specified.
10.Requires continuing education course providers to be
approved by the DHCC and specifies that providers
approved by the Dental Board of California shall be
deemed approved by the DHCC.
11.Requires the DHCC to establish by resolution the amount
of the fees, subject to specified maximum fee amounts,
that relate to the licensed under its jurisdiction.
This bill:
1. Authorizes the DHCC to issue a special permit to a RDH
licensed in another state authorizing him or her to
teach in a dental hygiene program in California without
holding a California license upon meeting certain
requirements, including the completion of educational
and examination requirements and the payment of an
application fee, subject to biennial renewal fee, for
the special permit.
2. Recasts the provision requiring the DHCC to approve an
educational program accredited by the Commission on
Dental Accreditation to instead make it permissive, that
the DHCC may approve such an educational program.
3. Requires an applicant for a RDH license to complete a
Committee-approved instruction in gingival soft tissue
curettage, nitrous oxide-oxygen analgesia, and local
anesthesia.
4. Revises the requirements for issuing a California
license to a RDH licensed in another state to require:
A. The out-of-state experience to have been obtained
in the five years immediately preceding the
application date.
B. Expands the information relating to
disciplinary action to include any other state where
the applicant was previously issued any professional
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or vocational license.
C. Proof that the applicant has not, more than
one time in the prior 5 years, failed the DHCC's
clinical examination, the examination given by the
Western Regional Examining Board, or any other
clinical dental hygiene examination approved by the
DHCC.
1. Prohibits an applicant for a RDH license who has failed
the clinical examination three times, or who has failed
the examination because he or she has imposed gross
trauma on a patient from being eligible to take the
examination again until the applicant completes remedial
education approved by the DHCC.
2. Authorizes a RDHAP to operate a mobile dental hygiene
clinic, as specified, and establishes a fee not to
exceed $250.
3. Requires a RDHAP to register his or her place or places
of practice, within 30 days with the DHCC.
4. Authorizes a RDHAP to apply for approval of the DHCC to
have an additional place of practice, and establishes a
biennial renewal fee.
5. Authorizes the DHCC to seek an injunction against a
violation by a RDHAP of the requirement to obtain a
prescription prior to rendering services
6. Specifies that providing services without a written
prescription on the part of a RDHAP shall constitute
unprofessional practice and a cause revocation of
suspension of the license.
7. Increases the mandatory continuing education course
requirement to not exceed 10 hours per renewal period,
and specifies that providers approved by the Dental
Board of California may be deemed approved by the DHCC.
8. Authorizes the DHCC to adopt by regulation a measure of
continued competency as a condition of license renewal.
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9. Requires the Committee to grant or renew approval of
only those educational programs that meet their
standards and, where appropriate, meet the minimum
standards set by the commission or an equivalent body,
as determined by the committee.
10.Requires a new educational program for registered
dental hygienists, as defined, to also submit a
feasibility study demonstrating a need for a new
educational program and requires a new educational
program to apply to the committee for specified approval
prior to seeking initial accreditation from the
commission or an equivalent body, as determined by the
committee.
11.Defines "extramural dental facility" to mean any
clinical facility that has contracted with an approved
dental hygiene educational program for instruction in
dental hygiene which exists outside or beyond the walls,
boundaries, or precincts of the primary campus of the
approved program and in which dental hygiene services
are rendered. Requires a dental hygiene educational
program shall register an extramural dental facility
with the DHCC as specified.
12.Increases the maximum fee amounts for various fees as
follows:
A. Application for an original license, and the fee
for issuance of an original license, from $50 to
$250.
B. Biennial license renewal fee from $80 to
$250.
C. Curriculum review and site evaluation for
dental hygiene educational programs fee from $1,400
to $2,100.
1. Establishes new maximum fees as follows:
A. The fee for registration of an extramural dental
facility shall not exceed $250.
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B. The fee for registration of a mobile dental
hygiene unit shall not exceed $150.
C. The biennial renewal fee for a mobile dental
hygiene unit shall not exceed $250.
D. The fee for an additional office permit shall not
exceed $250.
E. The biennial renewal fee for an additional
office shall not exceed $250.
F. The initial application and biennial special
permit fee is equal to the biennial license renewal
fee.
1. Makes technical, nonsubstantive and conforming changes.
Background
The following is background and reasons for the specific
provisions of the bill as indicated by the author:
1.Special Permits . The bill creates a special permit that
allows a RDH licensed in another state to teach in a
California dental hygiene program without a license
provided that he or she obtains a special permit form the
DHCC. Similar language and a special permit already
exists for dentistry.
Educational programs such as dentistry often hire subject
experts to teach in their programs. If a dental school
wants to hire a DDS from another state, who is a dental
expert in his or her field, to lecture for a semester,
they may do so with a special permit. Currently, dental
hygiene programs cannot invite out-of-state dental
hygienists because no special permit exists for RDHs.
Establishing a special permit for RDHs will allow dental
hygiene programs to contract with subject experts from
outside of California to teach in the programs.
2.DHCC Dental Hygiene Program Approval Authority . The bill
gives the DHCC the authority to approve or not approve
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accredited dental hygiene programs. The sponsor states
that in addition to deleting obsolete sections, this
provision clarifies that the DHCC makes recommendations
to the DBC regarding dental hygiene; adds consultants to
the list of people the DHCC may employ; allows the DHCC
to create an advisory board to review clinical
examinations.
The Commission on Dental Accreditation (CODA) accredits
all dental hygiene programs. Current law states that if
CODA accredits a program, the DHCC must accept CODA's
approval. CODA grants dental hygiene programs
preliminary accreditation even though programs do not
meet the standards necessary for full accreditation.
With preliminary accreditation, programs are able to
operate and accept students, but they cannot graduate
students or provide proper channels for licensure without
full accreditation. In other words, the program must
later apply to CODA for full accreditation, but students
are allowed to enroll, pay high tuition costs and begin
classes without the guarantee that the program will be
accredited. Recently, a program with preliminary
accreditation closed leaving students, who were one month
from graduating, with no recourse, no way to graduate and
no options to pursue licensure. Allowing the DHCC
oversight and authority for approval or non-approval of
programs will prevent schools that do not meet the
accreditation standards from being approved in the first
place and protect future students from entering into a
program that will not lead them to become a licensed
registered dental hygienist.
3.Completion of Course in Expanded Functions for Initial
Licensure . The bill clarifies that all RDHs seeking
licensure must all meet the same level of education. All
graduates of California dental hygiene programs have
education in expanded functions as that is a requirement
of licensure. Many out of state dental hygienists do not
have the training or education in expanded functions
because these functions are not allowed in their states.
By standardizing the educational requirements for all
RDHs seeking California licensure, consumers are ensured
that all applicants have met the same standards and
training for expanded functions.
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4.Out-of-State License Applicant Requirements . The bill
requires that program hours to be used towards licensure
must be in the immediately preceding five years. The
bill requires proof that the applicant has not been
subject to any professional disciplinary action or
monitoring in another state. The bill clarifies that the
applicant must prove he or she has not previously failed
the DHCC's or another clinical examination.
The Western Regional Examination Board (WREB) provides
the national test recognized by DHCC. The bill clarifies
that the applicant must prove he or she has not failed
WREB. Additionally, consumers are protected by requiring
clearer licensure requirements for out-of-state RDHs.
Out-of-state licensees who have not practiced for more
than five years are required to pass a clinical
competence exam in order to obtain California licensure.
Furthermore, out-of-state applicants are responsible for
providing proof that they have not been subject to
disciplinary action or monitoring in another state.
These changes will ensure that out-of-state RDHs are not
coming to California to escape disciplinary actions in
another state. With the current process of licensure by
credential and/or allowing graduates from other states to
take WREB for initial licensure, it is critical that the
DHCC ensures that the applicant has not failed the
clinical examination. All California dental hygiene
students must pass a clinical licensure examination to be
licensed. This language will ensure that dental hygiene
students from other states must also pass a clinical
licensure examination.
5.Remediation Requirements . The bill requires applicants
failing the clinical examination three times, or
applicants causing gross trauma, to provide proof of
remediation prior to re-taking the examination.
If a dental hygiene student is unable to pass the
examination after three attempts, remediation is required
before they are allowed to re-take the examination.
Remediation is also required for students retaking the
examination if the student, in a previous clinical
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examination (which uses public patients), caused gross
trauma that required intervention by a doctor or dentist
as well as follow-up by a medical or dental professional.
Consumers need assurance that a student who has
previously caused gross trauma during an examination will
not do the same in a subsequent examination.
6.Mobile Clinics . The bill authorizes RDHAPs to establish
mobile clinics. The DHCC also licenses RDHAPs to work
with patients outside the current traditional dental care
delivery system. RDHAPs are homebound, in residential
care facilities, schools, rural areas and/or
institutions. Allowing RDHAPs to have a mobile clinic
will further increase their ability to bring crucial
services to individuals who require additional attention
and increased access to care.
7.Requires RDHAPs to Register Additional Sites . Currently,
all dentists must register their practice location sites
with the CDB in order to maintain oversight of the
additional sites. Similarly, the bill requires RDHAPs,
who own their own practices, to report all of their
registered sights to the DHCC.
8.Continuing Education . The bill increases the maximum
number of continuing education hours that the DHCC may
require for biennial renewal of a license from 7.5 hours
to 10 hours. The bill further requires courses to
measure continued competency. Providers of continuing
education courses who are approved by the DBC may be
approved by the DHCC for dental hygienists.
This language allows the DHCC to set standards for
continued competency, a huge consumer protection issue in
health care. Providers of dental hygiene services would
be required to take clinical courses that would assist
them in maintaining clinical competence, so that patients
would be assured of receiving quality dental hygiene
services.
9.Increase Statutory Maximum Fee Levels . Sought by and
supported by the California Dental Hygienists
Association, the increase in the cap will give the DHCC
flexibility to keep the fund solvent and would be
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comparable to fee structures in other states. Any actual
fee increase would be required to go through the
regulatory process, according to the Sponsor.
In a January 31, 2012 letter, the DHCC requests that the
current fee ceiling be increased to give DHCC more
flexibility to maintain necessary funds for the functions
of the DHCC. The DHCC states that the proposal is not an
actual fee increase, just an increase to the fee ceiling
that the the DHCC may charge for a biennial license
renewal. The fee ceiling has not been modified for over
two decades (1990) and was increased from $30 to $80 at
that time. Some examples of other biennial license
renewal fees in other states are: New York = $128; Maine
= $175; and Nevada = $600.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Minor costs, one time to the State Dental Hygiene Fund to
adopt continued competency regulations.
Cost of new program functions offset by new fees to the
State Dental Hygiene Fund.
SUPPORT : (Verified 5/24/12)
California Dental Hygienists Association (source)
Dental Hygiene Committee of California
JJA:nl 5/29/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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