MISSISSIPPI LEGISLATURE
2018 Regular Session
To: Public Health and Human Services
By: Representative Brown
AN ACT TO CREATE THE DENTAL THERAPIST LICENSURE ACT; TO PROVIDE THE DEFINITIONS FOR THE ACT; TO PROVIDE THAT A LICENSED DENTAL THERAPIST IS LIMITED TO PRIMARILY PRACTICING IN SETTINGS THAT SERVICE LOW-INCOME, UNINSURED AND UNDERSERVED PATIENTS OR IN A DENTAL HEALTH PROFESSIONAL SHORTAGE AREA; TO PROVIDE THAT A DENTAL THERAPIST MUST ENTER INTO A WRITTEN COLLABORATIVE MANAGEMENT AGREEMENT WITH A MISSISSIPPI-LICENSED DENTIST IN ORDER TO BE LICENSED UNDER THE DENTAL THERAPIST LICENSURE ACT; TO PROVIDE THE SCOPE OF PRACTICE FOR LICENSED DENTAL THERAPISTS; TO BRING FORWARD SECTIONS 73-9-13, 73-9-41, 73-9-57, 73-9-59 AND 73-9-61, MISSISSIPPI CODE OF 1972, WHICH RELATE TO THE LICENSING REQUIREMENTS FOR DENTISTS IN THE STATE OF MISSISSIPPI, FOR THE PURPOSE OF POSSIBLE AMENDMENT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. General. (1) Sections 1 through 8 of this act shall be known and may be cited as the "Dental Therapist Licensure Act."
(2) A dental therapist licensed under Sections 1 through 8 of this act shall practice under the supervision of a Mississippi-licensed dentist and under the requirements of Sections 1 through 8 of this act.
SECTION 2. Definitions. The following words and phrases shall have the meanings as defined in this section unless the context clearly indicates otherwise:
(a) "Practice settings that serve the low-income and underserved" means:
(i) Critical access dental provider settings as designated by the Mississippi State Board of Dental Examiners;
(ii) Dental hygiene collaborative practice settings, including medical facilities, assisted living facilities, federally qualified health centers and organizations eligible to receive a community clinic grant;
(iii) Military and veterans administration hospitals, clinics and care settings;
(iv) A patient's residence or home when the patient is home-bound or receiving or eligible to receive home care services or home- and community-based waivered services, regardless of the patient's income;
(v) Oral health educational institutions; or
(vi) Any other clinic or practice setting, including mobile dental units, in which at least fifty percent (50%) of the total patient base of the dental therapist or advanced dental therapist consists of patients who:
1. Are enrolled in a Mississippi health care program;
2. Have a medical disability or chronic condition that creates a significant barrier to receiving dental care;
3. Do not have dental health coverage, either through a public health care program or private insurance, and have an annual gross family income equal to or less than two hundred percent (200%) of the federal poverty guidelines; or
4. Do not have dental health coverage, either through a state public health care program or private insurance, and whose family gross income is equal to or less than two hundred percent (200%) of the federal poverty guidelines.
(b) "Dental health professional shortage area" means an area that meets the criteria established by the secretary of the United States Department of Health and Human Services and is designated as such under United States Code, Title 42, Section 254e.
(c) "Board" means the Mississippi State Board of Dental Examiners.
SECTION 3. Limited practice settings. A dental therapist licensed under Sections 1 through 8 of this act is limited to primarily practicing in settings that serve low-income, uninsured and underserved patients or in a dental health professional shortage area.
SECTION 4. Collaborative management agreement. (1) Before performing any of the services authorized in Sections 1 through 8 of this act, a dental therapist must enter into a written collaborative management agreement with a Mississippi-licensed dentist. A collaborating dentist is limited to entering into a collaborative agreement with no more than five (5) dental therapists or advanced dental therapists at any one time. The agreement must include:
(a) Practice settings where services may be provided and the populations to be served;
(b) Any limitations on the services that may be provided by the dental therapist, including the level of supervision required by the collaborating dentist;
(c) Age- and procedure-specific practice protocols, including case selection criteria, assessment guidelines, and imaging frequency;
(d) A procedure for creating and maintaining dental records for the patients that are treated by the dental therapist;
(e) A plan to manage medical emergencies in each practice setting where the dental therapist provides care;
(f) A quality assurance plan for monitoring care provided by the dental therapist, including patient care review, referral follow-up, and a quality assurance chart review;
(g) Protocols for administering and dispensing medications authorized under Section 6 of this act, including the specific conditions and circumstance under which these medications are to be dispensed and administered;
(h) Criteria relating to the provision of care to patients with specific medical conditions or complex medication histories, including requirements for consultation before the initiation of care;
(i) Supervision criteria of dental assistants; and
(j) A plan for the provision of clinical resources and referrals in situations which are beyond the capabilities of the dental therapist.
(2) A collaborating dentist must be licensed and practicing in Mississippi. The collaborating dentist shall accept responsibility for all services authorized and performed by the dental therapist pursuant to the management agreement. Any licensed dentist who permits a dental therapist to perform a dental service other than those authorized under this section or by the board, or any dental therapist who performs an unauthorized service, violates Sections 1 through 8 of this act and Sections 73-9-1 through 73-9-65.
(3) Collaborative management agreements must be signed and maintained by the collaborating dentist and the dental therapist. Agreements must be reviewed, updated and submitted to the board on an annual basis.
SECTION 5. Scope of practice. (1) A licensed dental therapist may perform dental services as authorized under this section within the parameters of the collaborative management agreement.
(2) The services authorized to be performed by a licensed dental therapist include the oral health services, as specified in subsections (3) and (4), and services within the parameters of the collaborative management agreement.
(3) A licensed dental therapist may perform the following services under general supervision, unless restricted or prohibited in the collaborative management agreement:
(a) Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis;
(b) Preliminary charting of the oral cavity;
(c) Making radiographs;
(d) Mechanical polishing;
(e) Application of topical preventive or prophylactic agents, including fluoride varnishes and pit and fissure sealants;
(f) Pulp vitality testing;
(g) Application of desensitizing medication or resin;
(h) Fabrication of athletic mouthguards;
(i) Placement of temporary restorations;
(j) Fabrication of soft occlusal guards;
(k) Tissue conditioning and soft reline;
(l) Atraumatic restorative therapy;
(m) Dressing changes;
(n) Tooth reimplantation;
(o) Administration of local anesthetic; and
(p) Administration of nitrous oxide.
(4) A licensed dental therapist may perform the following services under indirect supervision:
(a) Emergency palliative treatment of dental pain;
(b) The placement and removal of space maintainers;
(c) Cavity preparation;
(d) Restoration of primary and permanent teeth;
(e) Placement of temporary crowns;
(f) Preparation and placement of preformed crowns;
(g) Pulpotomies on primary teeth;
(h) Indirect and direct pulp capping on primary and permanent teeth;
(i) Stabilization of reimplanted teeth;
(j) Extractions of primary teeth;
(k) Suture removal;
(l) Brush biopsies;
(m) Repair of defective prosthetic devices; and
(n) Recementing of permanent crowns.
(5) For purposes of this section, "general supervision" means the supervision of tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time the tasks or procedures are being performed but require the tasks be performed with the prior knowledge and consent of the dentist, and "indirect supervision" means the dentist is in the office, authorizes the procedures, and remains in the office while the procedures are being performed by the allied dental personnel.
SECTION 6. Dispensing authority. (1) A licensed dental therapist may dispense and administer the following drugs within the parameters of the collaborative management agreement and within the scope of practice of the dental therapist as prescribed in Section 5 of this act: analgesics, anti-inflammatories, and antibiotics.
(2) The authority to dispense and administer shall extend only to the categories of drugs identified in this section, and may be further limited by the collaborative management agreement.
(3) The authority to dispense includes the authority to dispense sample drugs within the categories identified in this section if dispensing is permitted by the collaborative management agreement.
(4) A licensed dental therapist is prohibited from dispensing or administering a narcotic drug.
SECTION 7. Application of other laws. A licensed dental therapist authorized to practice under Sections 1 through 8 of this act is not in violation of Section 73-9-41 as it relates to the unauthorized practice of dentistry if the practice is authorized under Sections 1 through 8 of this act and is within the parameters of the collaborative management agreement.
SECTION 8. Use of dental assistants. (1) A licensed dental therapist may supervise dental assistants to the extent permitted in the collaborative management agreement.
(2) Except as otherwise provided in subsection (1) of this section, a licensed dental therapist is limited to supervising no more than four (4) licensed dental assistants or nonlicensed dental assistants at any one (1) practice setting.
SECTION 9. Section 73-9-13, Mississippi Code of 1972, is brought forward as follows:
73-9-13. The State Board of Dental Examiners shall each year elect from their number a president, vice president and secretary-treasurer to serve for the coming year and until their successors are qualified. Only dentist members of the board may hold the offices of president and vice president. The board shall have a seal with appropriate wording to be kept at the offices of the board. The secretary and the executive director of the board shall be required to make bond in such sum and with such surety as the board may determine. It shall be the duty of the executive director to keep a complete record of the acts and proceedings of the board and to preserve all papers, documents and correspondence received by the board relating to its duties and office.
The board shall have the following powers and duties:
(a) To carry out the purposes and provisions of the state laws pertaining to dentistry and dental hygiene, and the practice thereof and matters related thereto, particularly Sections 73-9-1 through 73-9-117, together with all amendments and additions thereto.
(b) To regulate the practice of dentistry and dental hygiene and to promulgate reasonable regulations as are necessary or convenient for the protection of the public; however, the board shall not adopt any rule or regulation or impose any requirement regarding the licensing of dentists that conflicts with the prohibitions in Section 73-49-3.
(c) To make rules and regulations by which clinical facilities within institutions, schools, colleges, universities and other agencies may be recognized and approved for the practice of dentistry or of dental hygiene by unlicensed persons therein, as a precondition to their being excepted from the dental practice act and authorized in accordance with Section 73-9-3(g) and (h).
(d) To provide for the enforcement of and to enforce the laws of the State of Mississippi and the rules and regulations of the State Board of Dental Examiners.
(e) To compile at least once each calendar year and to maintain an adequate list of prospective dentist and dental hygienist appointees for approval by the Governor as provided for elsewhere by law.
(f) To issue licenses and permits to applicants when found to be qualified.
(g) To provide for reregistration of all licenses and permits duly issued by the board.
(h) To maintain an up-to-date list of all licensees and permit holders in the state, together with their addresses.
(i) To examine applicants for the practice of dentistry or dental hygiene at least annually.
(j) To issue licenses or duplicates and reregistration/renewal certificates, and to collect and account for fees for same.
(k) To maintain an office adequately staffed insofar as funds are available for the purposes of carrying out the powers and duties of the board.
(l) To provide by appropriate rules and regulations, within the provisions of the state laws, for revoking or suspending licenses and permits and a system of fines for lesser penalties.
(m) To prosecute, investigate or initiate prosecution for violations of the laws of the state pertaining to practice of dentistry or dental hygiene, or matters affecting the rights and duties, or related thereto.
(n) To provide by rules for the conduct of as much board business as practicable by mail, which, when so done, shall be and have the same force and effect as if done in a regular meeting duly organized.
(o) To adopt rules and regulations providing for the reasonable regulation of advertising by dentists and dental hygienists.
(p) To employ, in its discretion, a duly licensed attorney to represent the board in individual cases.
(q) To employ, in its discretion, technical and professional personnel to conduct dental office sedation site visits, administer and monitor state board examinations and carry out the powers and duties of the board.
SECTION 10. Section 73-9-41, Mississippi Code of 1972, is brought forward as follows:
73-9-41. (1) No person shall practice, attempt to practice or offer to practice dentistry or dental hygiene within the state without first having been authorized and issued a license by the board; nor shall any person practice, attempt to practice, or offer to practice dentistry or dental hygiene within the state during any period of suspension of his or her license by the board or after revocation or being voided for failure to reregister by the board of any license previously issued to the offending person.
(2) A person who has never been issued a license to practice dentistry or dental hygiene or whose license has been suspended, voided or revoked by action of the board, shall not perform any act that would constitute the practice of dentistry or dental hygiene as defined in Sections 73-9-3 and 73-9-5, including, but not limited to, the following:
(a) Making impressions or casts of the human mouth or teeth;
(b) Constructing or supplying dentures without the work authorization or prescription of a person licensed under the laws of this state to practice dentistry; and
(c) Constructing or supplying dentures from impressions or casts without the work authorization or prescription of a person licensed under the laws of this state to practice dentistry.
(3) The fact that any person engages in or performs or offers to engage in or performs any of the practices, acts or operations set forth in Section 73-9-3 or Section 73-9-5 is prima facie evidence that the person is engaged in the practice of dentistry or dental hygiene.
(4) In addition to any other civil remedy or criminal penalty provided for by law, the executive director or the secretary of the board may issue a summons to appear before the board to any person or persons who the executive director or any member of the board has probable cause to believe has violated this section by practicing, attempting to practice, or offering to practice dentistry or dental hygiene without a current, valid license or permit and any necessary witnesses. The summons issued by the board shall command each person to whom it is directed to attend and give testimony at a time and place specified in the summons. The summons shall be served upon the individual personally or by any type of mailing requiring a return receipt and shall include a statement of the charges and an explanation of the manner in which the unlicensed person shall be required to respond to the board.
(5) In proceedings conducted pursuant to subsection (4) of this section, the board may levy for each and every violation a civil penalty upon any unlicensed person who after a hearing is found to have practiced dentistry or dental hygiene without the benefit of a current, valid license having been issued by the board under the provisions of this chapter, as follows:
(a) For the first violation, a monetary penalty of not more than Five Hundred Dollars ($500.00).
(b) For the second violation, a monetary penalty of not more than One Thousand Dollars ($1,000.00).
(c) For the third and any subsequent violations, a monetary penalty of not more than Five Thousand Dollars ($5,000.00).
(d) For any violation, the board may assess those reasonable costs that are expended by the board in the investigation and conduct of the hearing as provided in subsection (4) of this section, including, but not limited to, the cost of process service, court reporters, expert witnesses and other witness expenses paid by the board, and investigators. Appeals from the board's decision may be taken as provided in Section 73-9-65. Any monetary penalty or assessment levied under this section shall be paid to the board by the illegal practitioner upon the expiration of the period allowed for appealing those penalties or may be paid sooner if the illegal practitioner elects. Monetary penalties collected by the board under this section shall be deposited to the credit of the General Fund of the State Treasury. Any monies collected for assessment of costs by the board shall be deposited into the special fund of the board.
(6) No person practicing dentistry or dental hygiene without a current valid license shall have the right to receive any compensation for services so rendered. In addition to any other penalties imposed under this section, any person who practices dentistry or dental hygiene without a license shall return any fees collected for practicing dentistry or dental hygiene and shall be liable for any damages resulting from negligent conduct. The board or any patient shall have the right to enforce the obligation provided in this section.
SECTION 11. Section 73-9-57, Mississippi Code of 1972, is brought forward as follows:
73-9-57. If any person for any reason whatsoever, shall practice, attempt, or offer to practice dentistry or dental hygiene illegally within the meaning of this chapter, he or she shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than Two Thousand Dollars ($2.000.00) nor more than Five Thousand Dollars ($5,000.00) or be imprisoned in the county jail not less than two (2) months nor more than six (6) months.
SECTION 12. Section 73-9-59, Mississippi Code of 1972, is brought forward as follows:
73-9-59. It shall be the duty of the several prosecuting officers of this state on notice from a member of the board or other persons having knowledge of violations of this chapter to institute prosecutions in the same manner as for other misdemeanors.
SECTION 13. Section 73-9-61, Mississippi Code of 1972, is brought forward as follows:
73-9-61. (1) Upon satisfactory proof, and in accordance with statutory provisions elsewhere set out for such hearings and protecting the rights of the accused as well as the public, the State Board of Dental Examiners may deny the issuance or renewal of a license or may revoke or suspend the license of any licensed dentist or dental hygienist practicing in the State of Mississippi, or take any other action in relation to the license as the board may deem proper under the circumstances, for any of the following reasons:
(a) Misrepresentation in obtaining a license, or attempting to obtain, obtaining, attempting to renew or renewing a license or professional credential by making any material misrepresentation, including the signing in his or her professional capacity any certificate that is known to be false at the time he or she makes or signs the certificate.
(b) Willful violation of any of the rules or regulations duly promulgated by the board, or of any of the rules or regulations duly promulgated by the appropriate dental licensure agency of another state or jurisdiction.
(c) Being impaired in the ability to practice dentistry or dental hygiene with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other type of material or as a result of any mental or physical condition.
(d) Administering, dispensing or prescribing any prescriptive medication or drug outside the course of legitimate professional dental practice.
(e) Being convicted or found guilty of or entering a plea of nolo contendere to, regardless of adjudication, a violation of any federal or state law regulating the possession, distribution or use of any narcotic drug or any drug considered a controlled substance under state or federal law, a certified copy of the conviction order or judgment rendered by the trial court being prima facie evidence thereof, notwithstanding the pendency of any appeal.
(f) Practicing incompetently or negligently, regardless of whether there is actual harm to the patient.
(g) Being convicted or found guilty of or entering a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction that relates to the practice of dentistry or dental hygiene, a certified copy of the conviction order or judgment rendered by the trial court being prima facie evidence thereof, notwithstanding the pendency of any appeal.
(h) Being convicted or found guilty of or entering a plea of nolo contendere to, regardless of adjudication, a felony in any jurisdiction, a certified copy of the conviction order or judgment rendered by the trial court being prima facie evidence thereof, notwithstanding the pendency of any appeal.
(i) Delegating professional responsibilities to a person who is not qualified by training, experience or licensure to perform them.
(j) The refusal of a licensing authority of another state or jurisdiction to issue or renew a license, permit or certificate to practice dentistry or dental hygiene in that jurisdiction or the revocation, suspension or other restriction imposed on a license, permit or certificate issued by the licensing authority that prevents or restricts practice in that jurisdiction, a certified copy of the disciplinary order or action taken by the other state or jurisdiction being prima facie evidence thereof, notwithstanding the pendency of any appeal.
(k) Surrender of a license or authorization to practice dentistry or dental hygiene in another state or jurisdiction when the board has reasonable cause to believe that the surrender is made to avoid or in anticipation of a disciplinary action.
(l) Any unprofessional conduct to be determined by the board on a case-by-case basis, which shall include, but not be restricted to, the following:
(i) Committing any crime involving moral turpitude.
(ii) Practicing deceit or other fraud upon the public.
(iii) Practicing dentistry or dental hygiene under a false or assumed name.
(iv) Advertising that is false, deceptive or misleading.
(v) Announcing a specialized practice shall be considered advertising that tends to deceive or mislead the public unless the dentist announcing as a specialist conforms to other statutory provisions and the duly promulgated rules or regulations of the board pertaining to practice of dentistry in the State of Mississippi.
(m) Failure to provide and maintain reasonable sanitary facilities and conditions or failure to follow board rules regarding infection control.
(n) Committing any act which would constitute sexual misconduct upon a patient or upon ancillary staff. For purposes of this subsection, the term sexual misconduct means:
(i) Use of the licensee-patient relationship to engage or attempt to engage the patient in sexual activity; or
(ii) Conduct of a licensee that is intended to intimidate, coerce, influence or trick any person employed by or for the licensee in a dental practice or educational setting for the purpose of engaging in sexual activity or activity intended for the sexual gratification of the licensee.
(o) Violation of a lawful order of the board previously entered in a disciplinary or licensure hearing; failure to cooperate with any lawful request or investigation by the board; or failure to comply with a lawfully issued subpoena of the board.
(p) Willful, obstinate and continuing refusal to cooperate with the board in observing its rules and regulations in promptly paying all legal license or other fees required by law.
(q) Practicing dentistry or dental hygiene while the person's license is suspended.
(r) Violation(s) of the provisions of Sections 41-121-1 through 41-121-9 relating to deceptive advertisement by health care practitioners. This paragraph shall stand repealed on July 1, 2020.
(2) In lieu of revocation of a license as provided for above, the board may suspend the license of the offending dentist or dental hygienist, suspend the sedation permit of the offending dentist, or take any other action in relation to his or her license as the board may deem proper under the circumstances.
(3) When a license to practice dentistry or dental hygiene is revoked or suspended by the board, the board may, in its discretion, stay the revocation or suspension and simultaneously place the licensee on probation upon the condition that the licensee shall not violate the laws of the State of Mississippi pertaining to the practice of dentistry or dental hygiene and shall not violate the rules and regulations of the board and shall not violate any terms in relation to his or her license as may be set by the board.
(4) In a proceeding conducted under this section by the board for the denial, revocation or suspension of a license to practice dentistry or dental hygiene, the board shall have the power and authority for the grounds stated for that denial, revocation or suspension, and in addition thereto or in lieu of that denial, revocation or suspension may assess and levy upon any person licensed to practice dentistry or dental hygiene in the State of Mississippi, a monetary penalty, as follows:
(a) For the first violation of any of subparagraph (a), (b), (c), (d), (f), (i), (l), (m), (n), (o) or (q) of subsection (1) of this section, a monetary penalty of not less than Fifty Dollars ($50.00) nor more than Five Hundred Dollars ($500.00).
(b) For the second violation of any of subparagraph (a), (b), (c), (d), (f), (i), (l), (m), (n), (o) or (q) of subsection (1) of this section, a monetary penalty of not less than One Hundred Dollars ($100.00) nor more than One Thousand Dollars ($1,000.00).
(c) For the third and any subsequent violation of any of subparagraph (a), (b), (c), (d), (f), (i), (l), (m), (n), (o) or (q) of subsection (1) of this section, a monetary penalty of not less than Five Hundred Dollars ($500.00) and not more than Five Thousand Dollars ($5,000.00).
(d) For any violation of any of subparagraphs (a) through (q) of subsection (1) of this section, those reasonable costs that are expended by the board in the investigation and conduct of a proceeding for licensure revocation or suspension, including, but not limited to, the cost of process service, court reporters, expert witnesses and investigators.
(5) The power and authority of the board to assess and levy monetary penalties under this section shall not be affected or diminished by any other proceeding, civil or criminal, concerning the same violation or violations except as provided in this section.
(6) A licensee shall have the right of appeal from the assessment and levy of a monetary penalty as provided in this section under the same conditions as a right of appeal is provided elsewhere for appeals from an adverse ruling, order or decision of the board.
(7) Any monetary penalty assessed and levied under this section shall not take effect until after the time for appeal has expired. In the event of an appeal, the appeal shall act as a supersedeas.
(8) A monetary penalty assessed and levied under this section shall be paid to the board by the licensee upon the expiration of the period allowed for appeal of those penalties under this section or may be paid sooner if the licensee elects. With the exception of subsection (4)(d) of this section, monetary penalties collected by the board under this section shall be deposited to the credit of the General Fund of the State Treasury. Any monies collected by the board under subsection (4)(d) of this section shall be deposited into the special fund operating account of the board.
(9) When payment of a monetary penalty assessed and levied by the board against a licensee in accordance with this section is not paid by the licensee when due under this section, the board shall have power to institute and maintain proceedings in its name for enforcement of payment in the chancery court of the county and judicial district of residence of the licensee, and if the licensee is a nonresident of the State of Mississippi, the proceedings shall be in the Chancery Court of the First Judicial District of Hinds County, Mississippi.
(10) In addition to the reasons specified in subsection (1) of this section, the board shall be authorized to suspend the license of any licensee for being out of compliance with an order for support, as defined in Section 93-11-153. The procedure for suspension of a license for being out of compliance with an order for support, and the procedure for the reissuance or reinstatement of a license suspended for that purpose, and the payment of any fees for the reissuance or reinstatement of a license suspended for that purpose, shall be governed by Section 93-11-157 or 93-11-163, as the case may be. If there is any conflict between any provision of Section 93-11-157 or 93-11-163 and any provision of this chapter, the provisions of Section 93-11-157 or 93-11-163, as the case may be, shall control.
(11) All grounds for disciplinary action, including imposition of fines and assessment of costs as enumerated above, shall also apply to any other license or permit issued by the board under this chapter or regulations duly adopted by the board.
SECTION 14. Sections 1 through 8 of this act shall be codified as new sections in Chapter 9, Title 73, Mississippi Code of 1972.
SECTION 15. This act shall take effect and be in force from and after July 1, 2018.