Rep. Michael J. Zalewski

Filed: 4/8/2016

 

 


 

 


 
09900HB5948ham002LRB099 20560 SMS 47232 a

1
AMENDMENT TO HOUSE BILL 5948

2    AMENDMENT NO. ______. Amend House Bill 5948 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Dental Practice Act is amended by
5changing Sections 4, 17, and 18.1 as follows:
 
6    (225 ILCS 25/4)   (from Ch. 111, par. 2304)
7    (Section scheduled to be repealed on January 1, 2026)
8    Sec. 4. Definitions. As used in this Act:
9    "Address of record" means the designated address recorded
10by the Department in the applicant's or licensee's application
11file or license file as maintained by the Department's
12licensure maintenance unit. It is the duty of the applicant or
13licensee to inform the Department of any change of address and
14those changes must be made either through the Department's
15website or by contacting the Department.
16    "Department" means the Department of Financial and

 

 

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1Professional Regulation.
2    "Secretary" means the Secretary of Financial and
3Professional Regulation.
4    "Board" means the Board of Dentistry.
5    "Dentist" means a person who has received a general license
6pursuant to paragraph (a) of Section 11 of this Act and who may
7perform any intraoral and extraoral procedure required in the
8practice of dentistry and to whom is reserved the
9responsibilities specified in Section 17.
10    "Dental hygienist" means a person who holds a license under
11this Act to perform dental services as authorized by Section
1218.
13    "Dental assistant" means an appropriately trained person
14who, under the supervision of a dentist, provides dental
15services as authorized by Section 17.
16    "Dental laboratory" means a person, firm or corporation
17which:
18        (i) engages in making, providing, repairing or
19    altering dental prosthetic appliances and other artificial
20    materials and devices which are returned to a dentist for
21    insertion into the human oral cavity or which come in
22    contact with its adjacent structures and tissues; and
23        (ii) utilizes or employs a dental technician to provide
24    such services; and
25        (iii) performs such functions only for a dentist or
26    dentists.

 

 

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1    "Supervision" means supervision of a dental hygienist or a
2dental assistant requiring that a dentist authorize the
3procedure, remain in the dental facility while the procedure is
4performed, and approve the work performed by the dental
5hygienist or dental assistant before dismissal of the patient,
6but does not mean that the dentist must be present at all times
7in the treatment room.
8    "General supervision" means supervision of a dental
9hygienist requiring that the patient be a patient of record,
10that the dentist examine the patient in accordance with Section
1118 prior to treatment by the dental hygienist, and that the
12dentist authorize the procedures which are being carried out by
13a notation in the patient's record, but not requiring that a
14dentist be present when the authorized procedures are being
15performed. The issuance of a prescription to a dental
16laboratory by a dentist does not constitute general
17supervision.
18    "Public member" means a person who is not a health
19professional. For purposes of board membership, any person with
20a significant financial interest in a health service or
21profession is not a public member.
22    "Dentistry" means the healing art which is concerned with
23the examination, diagnosis, treatment planning and care of
24conditions within the human oral cavity and its adjacent
25tissues and structures, as further specified in Section 17.
26    "Branches of dentistry" means the various specialties of

 

 

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1dentistry which, for purposes of this Act, shall be limited to
2the following: endodontics, oral and maxillofacial surgery,
3orthodontics and dentofacial orthopedics, pediatric dentistry,
4periodontics, prosthodontics, and oral and maxillofacial
5radiology.
6    "Specialist" means a dentist who has received a specialty
7license pursuant to Section 11(b).
8    "Dental technician" means a person who owns, operates or is
9employed by a dental laboratory and engages in making,
10providing, repairing or altering dental prosthetic appliances
11and other artificial materials and devices which are returned
12to a dentist for insertion into the human oral cavity or which
13come in contact with its adjacent structures and tissues.
14    "Impaired dentist" or "impaired dental hygienist" means a
15dentist or dental hygienist who is unable to practice with
16reasonable skill and safety because of a physical or mental
17disability as evidenced by a written determination or written
18consent based on clinical evidence, including deterioration
19through the aging process, loss of motor skills, abuse of drugs
20or alcohol, or a psychiatric disorder, of sufficient degree to
21diminish the person's ability to deliver competent patient
22care.
23    "Nurse" means a registered professional nurse, a certified
24registered nurse anesthetist licensed as an advanced practice
25nurse, or a licensed practical nurse licensed under the Nurse
26Practice Act.

 

 

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1    "Patient of record" means a patient for whom the patient's
2most recent dentist has obtained a relevant medical and dental
3history and on whom the dentist has performed an examination
4and evaluated the condition to be treated.
5    "Dental responder" means a dentist or dental hygienist who
6is appropriately certified in disaster preparedness,
7immunizations, and dental humanitarian medical response
8consistent with the Society of Disaster Medicine and Public
9Health and training certified by the National Incident
10Management System or the National Disaster Life Support
11Foundation.
12    "Mobile dental van or portable dental unit" means any
13self-contained or portable dental unit in which dentistry is
14practiced that can be moved, towed, or transported from one
15location to another in order to establish a location where
16dental services can be provided.
17    "Public health dental hygienist" means a hygienist who
18holds a valid license to practice in the State, has 2 years of
19full-time clinical experience or an equivalent of 4,000 hours
20of clinical experience and has completed 42 clock 72 hours of
21additional course work in areas specific to public health
22dentistry, including, but not limited to, emergency procedures
23for medically compromised patients, pharmacology, medical
24recordkeeping procedures, geriatric dentistry, pediatric
25dentistry, and pathology, and works in a public health setting
26pursuant to a written public health supervision agreement as

 

 

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1defined by rule by the Department with a dentist working in or
2contracted with a local or State government agency or
3institution or who is providing services as part of a certified
4school-based program or school-based oral health program.
5    "Public health setting" means a federally qualified health
6center; a federal, State, or local public health facility; Head
7Start; a special supplemental nutrition program for Women,
8Infants, and Children (WIC) facility; or a certified
9school-based health center or school-based oral health
10program.
11    "Public health supervision" means the supervision of a
12public health dental hygienist by a licensed dentist who has a
13written public health supervision agreement with that public
14health dental hygienist while working in an approved facility
15or program that allows the public health dental hygienist to
16treat patients, without a dentist first examining the patient
17and being present in the facility during treatment, (1) who are
18eligible for Medicaid or (2) who are uninsured and whose
19household income is not greater than 200% of the federal
20poverty level.
21(Source: P.A. 99-25, eff. 1-1-16; 99-492, eff. 12-31-15.)
 
22    (225 ILCS 25/17)  (from Ch. 111, par. 2317)
23    (Section scheduled to be repealed on January 1, 2026)
24    Sec. 17. Acts constituting the practice of dentistry. A
25person practices dentistry, within the meaning of this Act:

 

 

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1        (1) Who represents himself or herself as being able to
2    diagnose or diagnoses, treats, prescribes, or operates for
3    any disease, pain, deformity, deficiency, injury, or
4    physical condition of the human tooth, teeth, alveolar
5    process, gums or jaw; or
6        (2) Who is a manager, proprietor, operator or conductor
7    of a business where dental operations are performed; or
8        (3) Who performs dental operations of any kind; or
9        (4) Who uses an X-Ray machine or X-Ray films for dental
10    diagnostic purposes; or
11        (5) Who extracts a human tooth or teeth, or corrects or
12    attempts to correct malpositions of the human teeth or
13    jaws; or
14        (6) Who offers or undertakes, by any means or method,
15    to diagnose, treat or remove stains, calculus, and bonding
16    materials from human teeth or jaws; or
17        (7) Who uses or administers local or general
18    anesthetics in the treatment of dental or oral diseases or
19    in any preparation incident to a dental operation of any
20    kind or character; or
21        (8) Who takes impressions of the human tooth, teeth, or
22    jaws or performs any phase of any operation incident to the
23    replacement of a part of a tooth, a tooth, teeth or
24    associated tissues by means of a filling, crown, a bridge,
25    a denture or other appliance; or
26        (9) Who offers to furnish, supply, construct,

 

 

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1    reproduce or repair, or who furnishes, supplies,
2    constructs, reproduces or repairs, prosthetic dentures,
3    bridges or other substitutes for natural teeth, to the user
4    or prospective user thereof; or
5        (10) Who instructs students on clinical matters or
6    performs any clinical operation included in the curricula
7    of recognized dental schools and colleges; or
8        (11) Who takes impressions of human teeth or places his
9    or her hands in the mouth of any person for the purpose of
10    applying teeth whitening materials, or who takes
11    impressions of human teeth or places his or her hands in
12    the mouth of any person for the purpose of assisting in the
13    application of teeth whitening materials. A person does not
14    practice dentistry when he or she discloses to the consumer
15    that he or she is not licensed as a dentist under this Act
16    and (i) discusses the use of teeth whitening materials with
17    a consumer purchasing these materials; (ii) provides
18    instruction on the use of teeth whitening materials with a
19    consumer purchasing these materials; or (iii) provides
20    appropriate equipment on-site to the consumer for the
21    consumer to self-apply teeth whitening materials.
22    The fact that any person engages in or performs, or offers
23to engage in or perform, any of the practices, acts, or
24operations set forth in this Section, shall be prima facie
25evidence that such person is engaged in the practice of
26dentistry.

 

 

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1    The following practices, acts, and operations, however,
2are exempt from the operation of this Act:
3        (a) The rendering of dental relief in emergency cases
4    in the practice of his or her profession by a physician or
5    surgeon, licensed as such under the laws of this State,
6    unless he or she undertakes to reproduce or reproduces lost
7    parts of the human teeth in the mouth or to restore or
8    replace lost or missing teeth in the mouth; or
9        (b) The practice of dentistry in the discharge of their
10    official duties by dentists in any branch of the Armed
11    Services of the United States, the United States Public
12    Health Service, or the United States Veterans
13    Administration; or
14        (c) The practice of dentistry by students in their
15    course of study in dental schools or colleges approved by
16    the Department, when acting under the direction and
17    supervision of dentists acting as instructors; or
18        (d) The practice of dentistry by clinical instructors
19    in the course of their teaching duties in dental schools or
20    colleges approved by the Department:
21            (i) when acting under the direction and
22        supervision of dentists, provided that such clinical
23        instructors have instructed continuously in this State
24        since January 1, 1986; or
25            (ii) when holding the rank of full professor at
26        such approved dental school or college and possessing a

 

 

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1        current valid license or authorization to practice
2        dentistry in another country; or
3        (e) The practice of dentistry by licensed dentists of
4    other states or countries at meetings of the Illinois State
5    Dental Society or component parts thereof, alumni meetings
6    of dental colleges, or any other like dental organizations,
7    while appearing as clinicians; or
8        (f) The use of X-Ray machines for exposing X-Ray films
9    of dental or oral tissues by dental hygienists or dental
10    assistants; or
11        (g) The performance of any dental service by a dental
12    assistant, if such service is performed under the
13    supervision and full responsibility of a dentist.
14        For purposes of this paragraph (g), "dental service" is
15    defined to mean any intraoral procedure or act which shall
16    be prescribed by rule or regulation of the Department.
17    Dental service, however, shall not include:
18            (1) Any and all diagnosis of or prescription for
19        treatment of disease, pain, deformity, deficiency,
20        injury or physical condition of the human teeth or
21        jaws, or adjacent structures.
22            (2) Removal of, or restoration of, or addition to
23        the hard or soft tissues of the oral cavity, except for
24        the placing, carving, and finishing of amalgam
25        restorations by dental assistants who have had
26        additional formal education and certification as

 

 

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1        determined by the Department. A dentist utilizing
2        dental assistants shall not supervise more than 4
3        dental assistants at any one time for placing, carving,
4        and finishing of amalgam restorations.
5            (3) Any and all correction of malformation of teeth
6        or of the jaws.
7            (4) Administration of anesthetics, except for
8        monitoring of nitrous oxide, conscious sedation, deep
9        sedation, and general anesthetic as provided in
10        Section 8.1 of this Act, that may be performed only
11        after successful completion of a training program
12        approved by the Department. A dentist utilizing dental
13        assistants shall not supervise more than 4 dental
14        assistants at any one time for the monitoring of
15        nitrous oxide.
16            (5) Removal of calculus from human teeth.
17            (6) Taking of impressions for the fabrication of
18        prosthetic appliances, crowns, bridges, inlays,
19        onlays, or other restorative or replacement dentistry.
20            (7) The operative procedure of dental hygiene
21        consisting of oral prophylactic procedures, except for
22        coronal polishing and pit and fissure sealants, which
23        may be performed by a dental assistant who has
24        successfully completed a training program approved by
25        the Department. Dental assistants may perform coronal
26        polishing under the following circumstances: (i) the

 

 

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1        coronal polishing shall be limited to polishing the
2        clinical crown of the tooth and existing restorations,
3        supragingivally; (ii) the dental assistant performing
4        the coronal polishing shall be limited to the use of
5        rotary instruments using a rubber cup or brush
6        polishing method (air polishing is not permitted); and
7        (iii) the supervising dentist shall not supervise more
8        than 4 dental assistants at any one time for the task
9        of coronal polishing or pit and fissure sealants.
10            In addition to coronal polishing and pit and
11        fissure sealants as described in this item (7), a
12        dental assistant who has at least 2,000 hours of direct
13        clinical patient care experience and who has
14        successfully completed a training program approved by
15        rule by the Department may perform: (A) coronal scaling
16        above the gum line, supragingivally, on the clinical
17        crown of the tooth only on patients 12 years of age or
18        younger who have an absence of periodontal disease and
19        who are not medically compromised or individuals with
20        special needs and (B) intracoronal temporization of a
21        tooth. The training program approved by the Department
22        must: (I) include a minimum of 16 hours of instruction
23        in both didactic and clinical manikin or human subject
24        instruction; all training programs shall include
25        courses in dental anatomy, public health dentistry,
26        medical history, dental emergencies, and managing the

 

 

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1        pediatric patient; (II) include an outcome assessment
2        examination that demonstrates competency; (III)
3        require the supervising dentist to observe and approve
4        the completion of 6 full mouth supragingival scaling
5        procedures; and (IV) issue a certificate of completion
6        of the training program, which must be kept on file at
7        the dental office. A dental assistant must have
8        successfully completed an approved coronal polishing
9        course prior to taking the coronal scaling course. A
10        dental assistant performing these functions shall be
11        limited to the use of hand instruments only. In
12        addition, coronal scaling as described in this
13        paragraph shall only be utilized on patients who are
14        eligible for Medicaid or who are uninsured and whose
15        household income is not greater than 200% of the
16        federal poverty level. A dentist may not supervise more
17        than 2 dental assistants at any one time for the task
18        of coronal scaling. This paragraph is inoperative on
19        and after January 1, 2021.
20        The limitations on the number of dental assistants a
21    dentist may supervise contained in items (2), (4), and (7)
22    of this paragraph (g) mean a limit of 4 total dental
23    assistants or dental hygienists doing expanded functions
24    covered by these Sections being supervised by one dentist.
25        (h) The practice of dentistry by an individual who:
26            (i) has applied in writing to the Department, in

 

 

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1        form and substance satisfactory to the Department, for
2        a general dental license and has complied with all
3        provisions of Section 9 of this Act, except for the
4        passage of the examination specified in subsection (e)
5        of Section 9 of this Act; or
6            (ii) has applied in writing to the Department, in
7        form and substance satisfactory to the Department, for
8        a temporary dental license and has complied with all
9        provisions of subsection (c) of Section 11 of this Act;
10        and
11            (iii) has been accepted or appointed for specialty
12        or residency training by a hospital situated in this
13        State; or
14            (iv) has been accepted or appointed for specialty
15        training in an approved dental program situated in this
16        State; or
17            (v) has been accepted or appointed for specialty
18        training in a dental public health agency situated in
19        this State.
20        The applicant shall be permitted to practice dentistry
21    for a period of 3 months from the starting date of the
22    program, unless authorized in writing by the Department to
23    continue such practice for a period specified in writing by
24    the Department.
25        The applicant shall only be entitled to perform such
26    acts as may be prescribed by and incidental to his or her

 

 

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1    program of residency or specialty training and shall not
2    otherwise engage in the practice of dentistry in this
3    State.
4        The authority to practice shall terminate immediately
5    upon:
6            (1) the decision of the Department that the
7        applicant has failed the examination; or
8            (2) denial of licensure by the Department; or
9            (3) withdrawal of the application.
10(Source: P.A. 98-147, eff. 1-1-14; 98-463, eff. 8-16-13;
1198-756, eff. 7-16-14; 99-492, eff. 12-31-15.)
 
12    (225 ILCS 25/18.1)
13    (Section scheduled to be repealed on January 1, 2021)
14    Sec. 18.1. Public health dental supervision
15responsibilities.
16    (a) When working together in a public health supervision
17relationship, dentists and public health dental hygienists
18shall enter into a public health supervision agreement. The
19dentist providing public health supervision must:
20        (1) be available to provide an appropriate level of
21    contact, communication, collaboration, and consultation
22    with the public health dental hygienist and must meet
23    in-person with the public health dental hygienist at least
24    quarterly for review and consultation;
25        (2) have specific standing orders or policy guidelines

 

 

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1    for procedures that are to be carried out for each location
2    or program, although the dentist need not be present when
3    the procedures are being performed;
4        (3) provide for the patient's additional necessary
5    care in consultation with the public health dental
6    hygienist;
7        (4) file agreements and notifications as required; and
8        (5) include procedures for creating and maintaining
9    dental records, including protocols for transmission of
10    all records between the public health dental hygienist and
11    the dentist following each treatment, which shall include a
12    notation regarding procedures authorized by the dentist
13    and performed by the public health dental hygienist and the
14    location where those records are to be kept.
15    Each dentist and hygienist who enters into a public health
16supervision agreement must document and maintain a copy of any
17change or termination of that agreement.
18    Dental records shall be owned and maintained by the
19supervising dentist for all patients treated under public
20health supervision, unless the supervising dentist is an
21employee of a public health clinic or federally qualified
22health center, in which case the public health clinic or
23federally qualified health center shall maintain the records.
24    If a dentist ceases to be employed or contracted by the
25facility, the dentist shall notify the facility administrator
26that the public health supervision agreement is no longer in

 

 

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1effect. A new public health supervision agreement is required
2for the public health dental hygienist to continue treating
3patients under public health supervision.
4    A dentist entering into an agreement under this Section may
5supervise and enter into agreements for public health
6supervision with 2 public health dental hygienists. This shall
7be in addition to the limit of 4 dental hygienists per dentist
8set forth in subsection (g) of Section 18 of this Act.
9    (b) A public health dental hygienist providing services
10under public health supervision may perform only those duties
11within the accepted scope of practice of dental hygiene, as
12follows:
13        (1) the operative procedures of dental hygiene,
14    consisting of oral prophylactic procedures, including
15    prophylactic cleanings, application of fluoride, and
16    placement of sealants;
17        (2) the exposure and processing of x-ray films of the
18    teeth and surrounding structures; and
19        (3) such other procedures and acts as shall be
20    prescribed by rule of the Department.
21    Any patient treated under this subsection (b) must be
22examined by a dentist before additional services can be
23provided by a public health dental hygienist. However, if the
24supervising dentist, after consultation with the public health
25hygienist, determines that time is needed to complete an
26approved treatment plan on a patient eligible under this

 

 

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1Section, then the dentist may instruct the hygienist to
2complete the remaining services prior to an oral examination by
3the dentist. Such instruction by the dentist to the hygienist
4shall be noted in the patient's records. Any services performed
5under this exception must be scheduled in a timely manner and
6shall not occur more than 30 days after the first appointment
7date.
8    (c) A public health dental hygienist providing services
9under public health supervision must:
10        (1) provide to the patient, parent, or guardian a
11    written plan for referral or an agreement for follow-up
12    that records all conditions observed that should be called
13    to the attention of a dentist for proper diagnosis;
14        (2) have each patient sign a permission slip or consent
15    form that informs them that the service to be received does
16    not take the place of regular dental checkups at a dental
17    office and is meant for people who otherwise would not have
18    access to the service;
19        (3) inform each patient who may require further dental
20    services of that need;
21        (4) maintain an appropriate level of contact and
22    communication with the dentist providing public health
23    supervision; and
24        (5) complete an additional 4 hours of continuing
25    education in areas specific to public health dentistry
26    yearly.

 

 

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1    (d) Each public health dental hygienist who has rendered
2services under subsections (c), (d), and (e) of this Section
3must complete a summary report at the completion of a program
4or, in the case of an ongoing program, at least annually. The
5report must be completed in the manner specified by the
6Division of Oral Health in the Department of Public Health
7including information about each location where the public
8health dental hygienist has rendered these services. The public
9health dental hygienist must submit the form to the dentist
10providing supervision for his or her signature before sending
11it to the Division.
12    (e) Public health dental hygienists providing services
13under public health supervision may be compensated for their
14work by salary, honoraria, and other mechanisms by the
15employing or sponsoring entity. Nothing in this Act shall
16preclude the entity that employs or sponsors a public health
17dental hygienist from seeking payment, reimbursement, or other
18source of funding for the services provided.
19    (f) This Section is repealed on January 1, 2021.
20(Source: P.A. 99-492, eff. 12-31-15.)".