Several states have introduced or passed legislation to improve access to oral health services for underserved populations. We encourage you to use this model legislation to spearhead similar efforts in your state:

AZ HB 2214 Signed by the Governor 4/12/2006 The bill specifically authorizes any dental hygienist to work under contract for schools, public health settings and institutions and to provide unsupervised screening and application of fluorides in those settings.

CT The Connecticut Dental Hygienists' Association (CDHA) actively supported House Bill 5790, to increase the rate of reimbursement for oral health services administered to children under the age of 19 covered by Medicaid to the 70th percentile of fees charged customarily by private providers. Dental hygienists in Connecticut who work in public health settings can be directly reimbursed by Medicaid. The bill would have also required the state commissioner of social services to submit a report on whether the fee change increases access to oral health care. HB 5790 was killed in committee in early April, but CDHA has continued advocating for increased reimbursement rates by taking the fight directly to the governor. CDHA is requesting Governor Rell include a provision to raise Medicaid reimbursement rates for oral health services provided to patients aged 19 and younger to the 70th percentile of customary provider fees.

CT SB317 Signed by the Governor 6/7/2006: The bill amends Connecticut's public health statutes as they relate to health care professionals, health care facilities, programs, and activities. Specifically, the bill establishes a committee to improve health care access by increasing the availability of school-based health centers. The committee would focus on increasing access to care for citizens who are underinsured, uninsured, or on Medicaid.

DC LB 420 Signed by the Governor 3/8/2006 The bill establishes a program to recruit and retain qualified health professionals, including dentists, physicians, registered nurses and physician assistants, to work in underserved areas of the District. The bill also includes loan repayment for needed health professionals in exchange for service obligation at nonprofit or District of Columbia facilities in designated Health Professional Shortage Areas and Medically Underserved Areas.

FL HB 1157 Signed by the Governor 6/9/2006 The bill permits dental hygienists to screen without supervision in a variety of public settings.

GA The Georgia Senate Committee on Health and Human Services may have opened a window to dental hygiene care for the disabled who cannot travel to a dental office when it passed Senate Bill 78 on for further senate action. This bill would authorize dental hygienists with five years' experience to enter into a form of collaborative practice with a "monitoring" dentist, allowing treatment of patients in facilities for the physically or mentally disabled, hospitals and personal care homes, and through home health agencies, provided that the patient had a prescription for services from a dentist. Currently, dental hygienists may only provide clinical services in the office of a dentist under direct supervision.

IA In 2005, Iowa passed a law (HF 841) to reformulate how the state funds its share of Medicaid expenditures. A particular feature of the new law is a requirement to provide "dental homes" for all children 12 years old or younger who receive Medicaid, as well as the dental screenings and preventive care identified in the oral health standards under the early and periodic screening, diagnostic, and treatment program (EPSDT)."Recently, the Oral Health Bureau of the Iowa Department of Public Health, following meetings with dental hygienists, dentists and other interested parties issued a draft document to identify strategies for compliance-"I Smile-The Iowa Dental Home Proposal." Noting insufficient numbers of dentists in Iowa (especially in the rural and lower income areas) and limited Medicaid participation among dentists, the document suggests a number of strategies to increase care using nontraditional providers and alternative ways to deliver services. For example, it discusses a special dental screening code for the reimbursement of physicians, as well as reimbursement of nurses and certain other nondental providers for specific preventive procedures. Another strategy is increased utilization of dental hygienists working at Title V Child Health agencies as dental hygienist/oral health coordinators. These dental hygienists would provide basic preventive services and also perform an initial screening and risk assessment to determine which children needed immediate care and which would be scheduled for annual prevention and dental examination.

IL SB 2395 Signed by Governor 7/7/2006 The bill amends the Illinois Dental Practice Act to allow dentists and dental hygienists licensed in other states who come to Illinois as a result of a catastrophic event to obtain a temporary license to practice. The bill also calls for the Department of Professional Regulation to undertake a census of all licensed dentists to obtain information related to the availability of dental services in the state.

MO SB 828 Signed by the Governor 6/29/2006 The bill repeals a 2006 expiration date so that the program for unsupervised dental hygienists to provide services in certain public health settings to Medicaid-eligible children continues indefinitely.

NY AB 6640-B Signed by Governor 7/14/2006 The bill requires public school students in the state to furnish a dental health certificate in addition to the previously required health certificate. A dental health certificate is to describe the dental health condition of the student at his or her last dental exam, which must be undertaken within 12 months prior to the commencement of the school year. Each dental health certificate must be signed by a dentist licensed to practice in New York.

OH The Ohio Dental Hygienists' Association (ODHA) crafted House Bill 518, to allow dental hygienists in the state to provide some dental hygiene services to patients in public health settings who have not been previously examined by a dentist, without the presence of a dentist, but with a dentist's authorization. Dental hygienists interested in administering services as provided for in H.B. 518 would be required to have at least two years of experience and comply with written protocols related to emergency management and standing orders established by the authorizing dentist. The legislation expands the types of public health settings dental hygienists are able to operate in to include public and private clinics, Head Start programs, and mobile dental units. ODHA President Anne Stephens noted, "HB 518 will enable dental hygienists to act as a first responder in any practice setting under the authority of a dentist." The bill is currently pending in the Ohio House Committee on Health.

OH HB 143 Signed by the Governor 2/10/2006: The bill amends the state dental practice act to allow dental hygienists to administer local anesthesia to patients while under the direct supervision of a dentist. The bill states that hygienists who administer local anesthesia must successfully complete a training course and pass a state or regional written examination approved by the board.
For an overview of public policy recommendations made by Ohio’s Force on Access to Dental Care, see the 2004 Report of the Ohio Dental Workforce Roundtable.

OK SB 1509 Signed by the Governor 4/7/2006 The bill adds mobile dental unit to the types of facilities where hygienists may practice.

RI HB 7772/SB 2384 Signed by Governor 7/7/2006 The bill allows dental hygienists, working under the general supervision of a dentist, to initiate oral health screening assessments and other services, including prophylaxis, on patients in nursing homes regardless of whether or not the patient is a patient of record. Dental hygienists working in nursing homes will provide documentation of initial assessments and make referrals for any necessary follow-up treatment.

SC South Carolina dental hygienists have asked the legislature for a new practice act separate from the dental practice act. The legislation (House Bill 4838/Senate Bill 1251) would transfer all regulatory responsibilities from the dental board to a new Dental Hygiene Advisory/Disciplinary Board under the Department of Labor, Licensing and Regulation. Four dental hygienists, three of whom would represent specific regions of the state, and one public member would make up the new board. In addition, practitioners with at least 3,000 hours of supervised practice would be able to practice in collaboration with, rather than under the supervision of, a dentist.

SD HCR 1009 Signed by the Governor 2/24/2006: The resolution urges Congress to restore funding for the Urban Indian Health Program.

SD SCR 4 signed by the Governor 2/1/2006: The resolution requests the South Dakota congressional delegation and Congress to address deficiencies in the dental care provided to American Indians.

WV The West Virginia Dental Hygiene Association (WVDHA) has also introduced legislation, House Bill 4691, to allow dental hygienists to provide their full scope of services in a variety of public health settings without the direct supervision of a dentist. Currently, the state practice act restricts dental hygienists to providing services in dental offices only, and makes no allowance for general supervision in any setting for any services. The bill is currently pending in the House Health and Human Resources Committee.

WY Wyoming is considering House Bill 184 to license denturists and require the dental board to regulate them. Three neighboring states—Colorado, Idaho and Montana—already license denturists, as do the states of Oregon, Washington, Maine and Arizona.The proposal calls for graduation from a formal denturism program at least two years long at an institution approved by the board, followed by completion of a written and clinical examinations approved by the board. In addition, the board would prescribe special training in oral pathology. Denturists would need to examine patients before providing services and refer any with suspicious oral conditions to a dentist before proceeding

WI Clearinghouse Rule 05-033 - Final on 7/14/2006 Rule designates dental hygienists as providers who can be directly reimbursed under the state's Medicaid program for a specific set of dental hygiene services, including: prophylaxis, fluoride treatments, sealants, and oral health evaluations