97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1920

 

Introduced , by Rep. Brandon W. Phelps

 

SYNOPSIS AS INTRODUCED:
 
225 ILCS 25/4  from Ch. 111, par. 2304
225 ILCS 25/18  from Ch. 111, par. 2318

    Amends the Illinois Dental Practice Act. Provides that a dental hygienist may be employed or engaged by a licensed physician. Provides that a dental hygienist may be employed or retained by a health care facility, program, or nonprofit organization to perform dental hygiene services without the patient first being examined by a licensed dentist if the dental hygienist (i) has engaged in active practice of clinical dental hygiene for a minimum of 2,400 hours in the past 18 months or a career total of 3,000 hours, (ii) has entered into a collaborative agreement with a licensed dentist, (iii) had documented participation in course in infection control and medical emergencies, and (iv) maintains current CPR certification. Authorizes the dental hygienist to perform limited specified services. Provides that a licensed dentist may not have a collaborative agreement with more than 4 dental hygienist unless otherwise authorized by the Board. Provides that the collaborative agreement must (i) include certain provisions and it must be signed and maintained by the dentist, the dental hygienist, and the facility, program, or organization, (ii) be reviewed yearly, and (iii) be made available to the Board upon request. Effective immediately.


LRB097 06078 CEL 46151 b

 

 

A BILL FOR

 

HB1920LRB097 06078 CEL 46151 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Dental Practice Act is amended by
5changing Sections 4 and 18 as follows:
 
6    (225 ILCS 25/4)   (from Ch. 111, par. 2304)
7    (Section scheduled to be repealed on January 1, 2016)
8    Sec. 4. Definitions. As used in this Act:
9    (a) "Department" means the Illinois Department of
10Professional Regulation.
11    (b) "Director" means the Director of Professional
12Regulation.
13    (c) "Board" means the Board of Dentistry established by
14Section 6 of this Act.
15    (d) "Dentist" means a person who has received a general
16license pursuant to paragraph (a) of Section 11 of this Act and
17who may perform any intraoral and extraoral procedure required
18in the practice of dentistry and to whom is reserved the
19responsibilities specified in Section 17.
20    (e) "Dental hygienist" means a person who holds a license
21under this Act to perform dental services as authorized by
22Section 18.
23    (f) "Dental assistant" means an appropriately trained

 

 

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1person who, under the supervision of a dentist, provides dental
2services as authorized by Section 17.
3    (g) "Dental laboratory" means a person, firm or corporation
4which:
5        (i) engages in making, providing, repairing or
6    altering dental prosthetic appliances and other artificial
7    materials and devices which are returned to a dentist for
8    insertion into the human oral cavity or which come in
9    contact with its adjacent structures and tissues; and
10        (ii) utilizes or employs a dental technician to provide
11    such services; and
12        (iii) performs such functions only for a dentist or
13    dentists.
14    (h) "Supervision" means supervision of a dental hygienist
15or a dental assistant requiring that a dentist authorize the
16procedure, remain in the dental facility while the procedure is
17performed, and approve the work performed by the dental
18hygienist or dental assistant before dismissal of the patient,
19but does not mean that the dentist must be present at all times
20in the treatment room.
21    (i) "General supervision" means supervision of a dental
22hygienist requiring that the patient be a patient of record,
23that the dentist examine the patient in accordance with Section
2418 prior to treatment by the dental hygienist, and that the
25dentist authorize the procedures which are being carried out by
26a notation in the patient's record, but not requiring that a

 

 

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1dentist be present when the authorized procedures are being
2performed. The issuance of a prescription to a dental
3laboratory by a dentist does not constitute general
4supervision.
5    (j) "Collaborative agreement" means a written agreement
6between a licensed dental hygienist and a collaborating
7licensed dentist.
8    (k) (j) "Public member" means a person who is not a health
9professional. For purposes of board membership, any person with
10a significant financial interest in a health service or
11profession is not a public member.
12    (l) (k) "Dentistry" means the healing art which is
13concerned with the examination, diagnosis, treatment planning
14and care of conditions within the human oral cavity and its
15adjacent tissues and structures, as further specified in
16Section 17.
17    (m) (l) "Branches of dentistry" means the various
18specialties of dentistry which, for purposes of this Act, shall
19be limited to the following: endodontics, oral and
20maxillofacial surgery, orthodontics and dentofacial
21orthopedics, pediatric dentistry, periodontics,
22prosthodontics, and oral and maxillofacial radiology.
23    (n) (m) "Specialist" means a dentist who has received a
24specialty license pursuant to Section 11(b).
25    (o) (n) "Dental technician" means a person who owns,
26operates or is employed by a dental laboratory and engages in

 

 

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1making, providing, repairing or altering dental prosthetic
2appliances and other artificial materials and devices which are
3returned to a dentist for insertion into the human oral cavity
4or which come in contact with its adjacent structures and
5tissues.
6    (p) (o) "Impaired dentist" or "impaired dental hygienist"
7means a dentist or dental hygienist who is unable to practice
8with reasonable skill and safety because of a physical or
9mental disability as evidenced by a written determination or
10written consent based on clinical evidence, including
11deterioration through the aging process, loss of motor skills,
12abuse of drugs or alcohol, or a psychiatric disorder, of
13sufficient degree to diminish the person's ability to deliver
14competent patient care.
15    (q) (p) "Nurse" means a registered professional nurse, a
16certified registered nurse anesthetist licensed as an advanced
17practice nurse, or a licensed practical nurse licensed under
18the Nurse Practice Act.
19    (r) (q) "Patient of record" means a patient for whom the
20patient's most recent dentist has obtained a relevant medical
21and dental history and on whom the dentist has performed an
22examination and evaluated the condition to be treated.
23    (s) (r) "Dental emergency responder" means a dentist or
24dental hygienist who is appropriately certified in emergency
25medical response, as defined by the Department of Public
26Health.

 

 

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1    (t) "Public health setting" means a hospital; nursing home;
2home health agency; group home serving the elderly, disabled or
3juveniles; State-operated facility licensed by the
4Commissioner of Human Services or the Commissioner of
5Corrections; federal, State, or local public health facility;
6community clinic; school authority; Head start program;
7Maternal and Child Health WIC program; or a program operated by
8a non-profit organization that services individuals who are
9uninsured or who are Illinois health care public program
10recipients.
11(Source: P.A. 94-409, eff. 12-31-05; 95-639, eff. 10-5-07.)
 
12    (225 ILCS 25/18)   (from Ch. 111, par. 2318)
13    (Section scheduled to be repealed on January 1, 2016)
14    Sec. 18. Acts constituting the practice of dental hygiene;
15limitations.
16    (a) A person practices dental hygiene within the meaning of
17this Act when he or she performs the following acts under the
18supervision of a dentist:
19            (i) the operative procedure of dental hygiene,
20        consisting of oral prophylactic procedures;
21            (ii) the exposure and processing of X-Ray films of
22        the teeth and surrounding structures;
23            (iii) the application to the surfaces of the teeth
24        or gums of chemical compounds designed to be
25        desensitizing agents or effective agents in the

 

 

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1        prevention of dental caries or periodontal disease;
2            (iv) all services which may be performed by a
3        dental assistant as specified by rule pursuant to
4        Section 17;
5            (v) administration and monitoring of nitrous oxide
6        upon successful completion of a training program
7        approved by the Department;
8            (vi) administration of local anesthetics upon
9        successful completion of a training program approved
10        by the Department; and
11            (vii) such other procedures and acts as shall be
12        prescribed by rule or regulation of the Department.
13    (b) A dental hygienist may be employed or engaged only:
14        (1) by a dentist;
15        (2) by a federal, State, county, or municipal agency or
16    institution;
17        (3) by a public or private school; or
18        (4) by a public clinic operating under the direction of
19    a hospital or federal, State, county, municipal, or other
20    public agency or institution; or .
21        (5) by a physician.
22    (c) When employed or engaged in the office of a dentist, a
23dental hygienist may perform, under general supervision, those
24procedures found in items (i) through (iv) of subsection (a) of
25this Section, provided the patient has been examined by the
26dentist within one year of the provision of dental hygiene

 

 

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1services, the dentist has approved the dental hygiene services
2by a notation in the patient's record and the patient has been
3notified that the dentist may be out of the office during the
4provision of dental hygiene services.
5    (d) If a patient of record is unable to travel to a dental
6office because of illness, infirmity, or imprisonment, a dental
7hygienist may perform, under the general supervision of a
8dentist, those procedures found in items (i) through (iv) of
9subsection (a) of this Section, provided the patient is located
10in a long-term care facility licensed by the State of Illinois,
11a mental health or developmental disability facility, or a
12State or federal prison. The dentist shall personally examine
13and diagnose the patient and determine which services are
14necessary to be performed, which shall be contained in an order
15to the hygienist and a notation in the patient's record. Such
16order must be implemented within 120 days of its issuance, and
17an updated medical history and observation of oral conditions
18must be performed by the hygienist immediately prior to
19beginning the procedures to ensure that the patient's health
20has not changed in any manner to warrant a reexamination by the
21dentist.
22    (e) School-based oral health care, consisting of and
23limited to oral prophylactic procedures, sealants, and
24fluoride treatments, may be provided by a dental hygienist
25under the general supervision of a dentist. A dental hygienist
26may not provide other dental hygiene treatment in a

 

 

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1school-based setting, including but not limited to
2administration or monitoring of nitrous oxide or
3administration of local anesthetics. The school-based
4procedures may be performed provided the patient is located at
5a public or private school and the program is being conducted
6by a State, county or local public health department initiative
7or in conjunction with a dental school or dental hygiene
8program. The dentist shall personally examine and diagnose the
9patient and determine which services are necessary to be
10performed, which shall be contained in an order to the
11hygienist and a notation in the patient's record. Any such
12order for sealants must be implemented within 120 days after
13its issuance. Any such order for oral prophylactic procedures
14or fluoride treatments must be implemented within 180 days
15after its issuance. An updated medical history and observation
16of oral conditions must be performed by the hygienist
17immediately prior to beginning the procedures to ensure that
18the patient's health has not changed in any manner to warrant a
19reexamination by the dentist.
20    (f) Without the supervision of a dentist, a dental
21hygienist may perform dental health education functions and may
22record case histories and oral conditions observed.
23    (g) The number of dental hygienists practicing in a dental
24office shall not exceed, at any one time, 4 times the number of
25dentists practicing in the office at the time.
26    (h) Notwithstanding subsections (c), (d), (e), or (f) of

 

 

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1Section 18, a dental hygienist licensed under this Act may be
2employed or retained by a health care facility, program, or
3nonprofit organization to perform dental hygiene services
4described under subsection (i) of this Section without the
5patient first being examined by a licensed dentist if the
6dental hygienist:
7        (1) has been engaged in the active practice of clinical
8    dental hygiene for not less than 2,400 hours in the past 18
9    months or a career total of 3,000 hours, including a
10    minimum of 200 hours of clinical practice in 2 of the past
11    3 years;
12        (2) has entered into a collaborative agreement with a
13    licensed dentist that designates authorization for the
14    services provided by the dental hygienist;
15        (3) has documented participation in courses in
16    infection control and medical emergencies within each
17    continuing education cycle; and
18        (4) maintains current CPR certification from
19    completion of the American Heart Association healthcare
20    provider course, the American Red Cross professional
21    rescuer course, or an equivalent entity.
22    (i) The dental hygiene services authorized to be performed
23by a dental hygienist under this subsection are limited to:
24        (1) screen and assess oral health conditions;
25        (2) preliminary charting of the oral cavity and
26    surrounding structures to include case histories, perform

 

 

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1    initial and periodic examinations and assessments to
2    determine periodontal status, and formulate a dental
3    hygiene treatment plan in coordination with a dentist's
4    treatment plan;
5        (3) removal of deposits and stains from the surfaces of
6    the teeth;
7        (4) prescribe, administer, and dispense fluoride,
8    fluoride varnish, antimicrobial solutions, or resorbable
9    antimicrobial agents;
10        (5) apply sealants;
11        (6) polishing and smoothing restorations;
12        (7) removal of marginal overhangs;
13        (8) performance of preliminary charting;
14        (9) taking of radiographs; and
15        (10) performance of scaling and root planing.
16    (j) A collaborating dentist must be licensed under this Act
17and may enter into a collaborative agreement with no more than
184 dental hygienists unless otherwise authorized by the Board.
19The Board shall develop parameters and a process for obtaining
20authorization to collaborate with more than 4 dental
21hygienists. The collaborative agreement must include:
22        (1) consideration for medically compromised patients
23    and medical conditions for which a dental evaluation and
24    treatment plan must occur prior to the provision of dental
25    hygiene services;
26        (2) age-and procedure-specific standard collaborative

 

 

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1    practice protocols, including recommended intervals for
2    the performance of dental hygiene services and a period of
3    time that an examination by a dentist should occur;
4        (3) copies of consent to treatment form provided to the
5    patient by the dental hygienist;
6        (4) specific protocols for the placement of pit and
7    fissure sealants and requirements for follow-up care to
8    assure the efficacy of the sealants after application; and
9        (5) a procedure for creating and maintaining dental
10    records for the patients that are treated by the dental
11    hygienist; this procedure must specify where these records
12    are to be located.
13    (k) The collaborative agreement must be (i) signed and
14maintained by the dentist, the dental hygienist, and the
15facility, program, or organization, (ii) reviewed annually by
16the collaborating dentist and dental hygienist, and (iii) made
17available to the Board upon request.
18    (l) Before performing any services authorized under this
19subsection, a dental hygienist must provide the patient with a
20consent to treatment form that must include a statement
21advising the patient that the dental hygiene services provided
22are not a substitute for a dental examination by a licensed
23dentist. If the dental hygienist makes any referrals to the
24patient for further dental procedures, the dental hygienist
25must fill out a referral form and provide a copy of the form to
26the collaborating dentist.

 

 

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1    (m) The dental hygienist working under a collaborative
2agreement and the collaborating dentist must agree to maintain
3communication and consultation with each other.
4    (n) The dental hygienist working under a collaborative
5agreement must provide the collaborating dentist opportunities
6to review patient records as requested.
7(Source: P.A. 93-113, eff. 1-1-04; 93-821, eff. 7-28-04.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.