BILL ANALYSIS �
SB 1202
Page 1
Date of Hearing: June 19, 2012
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
SB 1202 (Leno) - As Amended: May 29, 2012
SENATE VOTE : 38-0
SUBJECT : Dental hygienists.
SUMMARY : Makes a number of changes regarding the licensure and
regulation of registered dental hygienists (RDHs), RDHs in
alternative practice (RDHAPs), and RDH's in extended functions
by the Dental Hygiene Committee of California (DHCC).
Specifically, this bill :
1)Allows an RDH licensed in another state to teach in a dental
hygiene college without being licensed in California if the
RDH holds a special permit, and authorizes the DHCC to issue a
special permit if the RDH has a contract to teach, has
completed specified education and examination requirements,
and pays an application fee subject to a biennial renewal fee,
as specified.
2)Allows, rather than requires, the DHCC to approve educational
programs accredited by the Commission on Dental Accreditation
(CODA) of the American Dental Association (ADA) and deletes
language specifying that the programs be in good standing with
CODA.
3)Deletes language allowing DHCC to withdraw or revoke a dental
hygiene program approval if CODA has placed the program on
probationary status, and instead allows DHCC to withdraw or
revoke approval if CODA has indicated intent to withdraw
approval or has withdrawn approval.
4)Requires an applicant for an RDH license to complete
DHCC-approved instruction in gingival soft tissue curettage,
nitrous oxide-oxygen analgesia, and local anesthesia.
5)Revises the requirements for issuing a California license to
an RDH licensed in another state by:
a) Requiring out-of-state experience to have been obtained
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in the five years immediately preceding the application
date;
b) Expanding information relating to prior disciplinary
action, to include any previously issued professional or
vocational license (not just a dental hygiene or dental
license); and,
c) Expanding the types of exams for which an applicant must
provide proof of completion and of not failing more than
once, to include the examination given by the Western
Regional Examining Board (WREB) or any other clinical
dental hygiene examination approved DHCC.
6)Prohibits an applicant for an RDH license who fails the
clinical examination three times, or who fails the examination
as a result of a single incidence of imposing gross trauma on
a patient, from being eligible to take the examination again
until the applicant completes remedial education approved by
DHCC.
7)Authorizes an RDHAP to operate a mobile dental hygiene clinic,
as specified, and establishes an initial registration fee of
up to $150 and a biennial renewal fee of up to $250.
8)Requires an RDHAP to register his or her place or places of
practice with the DHCC within 30 days of licensure, and
requires an RDHAP who wishes to have more than one place of
practice to apply for DHCC permission and pay an initial fee
of up to $250 and a biennial renewal fee of up to $250.
9)Allows, rather than requires, DHCC to seek an injunction
against an RDHAP who violates a requirement to obtain a
prescription prior to rendering services, as specified.
10)Increases the mandatory continuing education (CE) course
requirement to a maximum of 10 hours per renewal period,
allows DHCC to adopt by regulation a measure of continued
competency as a condition of license renewal, and allows,
rather than requires, CE providers approved by the Dental
Board of California (DBC) to be deemed approved by DHCC.
11)Requires, rather than states legislative intent, that DHCC
grant or renew approval of educational programs that maintain
high-quality instructional standards and requires approval,
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where appropriate, of programs that meet the minimum standards
set by CODA or an equivalent body, as determined by DHCC.
12)Requires a new educational program for RDHs to submit a
feasibility study demonstrating a need for a new educational
program, and apply for approval from DHCC prior to seeking
approval for initial accreditation from CODA or an equivalent
body, as determined by DHCC. DHCC may approve, provisionally
approve, or deny approval of any such new educational program.
13)Defines a new educational program for RDHs to mean a program
provided by a college or institution of higher education that
is accredited by a regional accrediting agency recognized by
the United States Department of Education and that has as its
primary purpose providing college level courses leading to an
associate or higher degree, that is either affiliated with or
conducted by a dental school approved by the DBC, or that is
accredited to offer college level or college parallel programs
by the CODA or an equivalent body, as determined by DHCC.
14)Requires an approved dental hygiene educational program to
register an extramural dental facility with DHCC, as
specified, and defines extramural dental facility to mean any
clinical facility that has contracted with an approved dental
hygiene educational program for instruction in dental hygiene,
that 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.
15)Increases maximum fee amounts as follows:
a) Application for an original license, up to $250 (from
$50);
b) Biennial license renewal, up to $250 (from $80); and,
c) Curriculum review and site evaluation for dental hygiene
educational programs, up to $2,100 (from $1,400).
16)Establishes new maximum fees as follows:
a) Issuance of an original license, up to $250;
b) Registration of an extramural dental facility, up to
$250;
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c) Registration of a mobile dental hygiene unit, up to
$150;
d) Biennial renewal for a mobile dental hygiene unit, up to
$250;
e) Additional office permit, up to $250;
f) Biennial renewal for an additional office, up to $250;
and,
g) Initial application and biennial renewal for a special
permit, equal to the biennial license renewal fee (up to
$250).
17)Makes technical and conforming changes.
EXISTING LAW
1)Licenses and regulates RDHs, RDHAPs, and RDHs in extended
functions by DHCC under DBC within the Department of Consumer
Affairs (DCA).
2)Requires DHCC to perform specified functions, including the
evaluation of all dental hygiene educational programs that
apply for approval. Any dental hygiene program accredited by
and in good standing with CODA is deemed approved by DHCC.
3)Establishes requirements an applicant must meet to be issued
an RDH license, including completion of specified educational
and examination requirements.
4)Authorizes DHCC to issue a RDH license to an applicant who has
not taken a 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 five 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.
5)Authorizes a licensed RDHAP to perform specified functions and
procedures in residences of the homebound, schools,
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residential facilities, and dental health professional
shortage areas.
6)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, as
specified.
7)Authorizes DHCC, as a condition of license renewal, to require
licensees to complete up to 7.5 hours of CE per renewal
period, as specified.
8)Requires CE course providers to be approved by DHCC and
specifies that providers approved by DBC shall be deemed
approved by DHCC.
9)Requires DHCC to establish by resolution the amount of fees,
subject to specified maximum fee amounts, that relate to the
licensees under its jurisdiction.
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author, "Prior to 2008,
the dental hygiene profession was overseen by the DBC. SB 853
(Perata) of 2008 created DHCC to be a stand-alone entity to
regulate the profession. Over the last several years, DHCC and
the California Dental Hygienists' Association have discovered
areas in need of change so that DHCC is best able to oversee the
profession. This is important to consumers so that there is
assurance that their dental hygienists are properly trained and
licensed. The bill outlines many key changes and well as
opportunities to increase access to care and improve consumer
protection."
Background . This bill is a follow-up measure to legislation
from 2008, which created the DHCC and shifted oversight of
dental hygiene from DBC to DHCC. It provides a number of
changes and updates to the statutes governing the DHCC and its
regulatory authority.
According to the author, educational programs such as dentistry
often hire subject experts to teach in their programs. If a
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dental school wants to hire a dentist from another state who is
a dental expert in the field to lecture for a semester, they may
do so with a special permit. Currently, dental hygiene programs
cannot do the same with out-of-state RDHs because no special
permit exists for RDH's. Establishing a special permit for
RDH's will allow dental hygiene programs to contract with
subject experts from outside of California to teach in the
programs.
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. The program must later
apply to CODA for full accreditation, but students are allowed
to enroll, pay high tuition costs and begin classes without any
guarantee that the program will be accredited. Recently, a
preliminary accreditation program closed, leaving students who
were one month from graduating with no recourse, no way to
graduate and no options to pursue licensure. Allowing 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 RDH.
All graduates of California dental hygiene programs have
education in extended functions, as it 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 RDH's seeking California
licensure, consumers are ensured that all RDH's have met the
same standards and training for extended functions.
WREB provides the national test recognized by DHCC. This 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 RDH's.
Out-of-state RDH's 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
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applicants are responsible for providing proof that they have
not been subject to disciplinary action or monitoring in another
state. This bill also requires that program hours to be used
towards licensure must be in the immediately preceding five
years.
These changes will ensure that out-of-state RDH's 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 DHCC ensures that the applicant
has not failed the licensure exam. All California dental
hygiene students must pass a clinical licensure exam to be
licensed. This language will ensure that dental hygiene
students from other states must also pass a clinical licensure
exam.
This bill requires applicants failing the clinical exam, in
which public patients are used, three times or applicants
causing gross trauma to provide proof of remediation prior to
re-taking the exam. Consumers need assurance that a student who
has previously caused gross trauma during an exam will not do
the same in a subsequent exam.
DHCC 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.
Currently, all dentists must register their practice location
sites with DBC in order to maintain oversight of the additional
sites. Similarly, this bill requires RDHAP's who own their own
practices to report all of their registered sights with DHCC.
This bill increases limit on mandatory CE hours from 7.5 hours
to 10 hours and requires courses to measure continued
competency. It also specifies that providers of CE courses who
are approved by DBC may be approved by DHCC for dental
hygienists. This language allows DHCC to set standards for
continued competency. Providers of dental hygiene services will
be required to take clinical courses that assist them in
maintaining clinical competence, so that patients are assured of
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receiving quality dental hygiene services.
This bill also increases the caps on fees DHCC can charge in
statute. These increases give DHCC flexibility to keep its fund
solvent and are comparable to fee structures in other states.
Any actual fee increase must go through the regulatory process.
Support . The California Dental Hygienists' Association states,
"This is a pro-consumer measure that will strengthen the
profession as well as provide appropriate oversight. The bill
has no costs to the state and does not increase current fees.
SB 1202 increases the fee ceiling that the DHCC may charge for
fees in order to fund its activities. Any actual fee increase
must go through the DHCC's public hearing process, of which
dental hygienists are full participants. Any fees that are
adjusted would be done so to keep the fund solvent."
The Dental Hygiene Committee of California writes, "It is
critical for DHCC, as well as consumers and licensees, that DHCC
have the ability to do its work. This can be done by continuing
its mandate of licensing qualified dental hygienists and
allowing the enforcement program to actively protect California
consumers."
Related Legislation . SB 1575 (Business, Professions and
Economic Development Committee) makes several technical cleanup
changes to the RDH law, in addition to numerous other provisions
pertaining to the health care boards within DCA. This bill is
pending in Assembly Business, Professions and Consumer
Protection Committee.
Previous legislation . SB 853 (Perata), Chapter 31, Statutes of
2008, creates the DHCC as a separate body within DBC to oversee
the practice of dental hygiene.
REGISTERED SUPPORT / OPPOSITION :
Support
California Dental Hygienists' Association (sponsor)
Dental Hygiene Committee of California
Opposition
None on file.
SB 1202
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Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301