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SENATE BILL 455 SIGNED INTO
LAW
 PDHA's
President, Judy Ernst, RDH, joined Governor Ed Rendell on the dais
on Friday, July 20, at the University of Pennsylvania School of
Nursing in Philadelphia, as he signed SB 455 into law. This legislation,
introduced by Sen. Pat Vance (R-Cumberland/York) creates a new opportunity
for dental hygienists in Pennsylvania to serve dentally un- and
underserved populations as "Public Health Dental Hygiene Practitioners."
PDHA has long advocated for this legislation, which would allow
hygienists to work in public health settings, (which are defined
in the bill), without dental supervision. Governor Rendell incorporated
this concept into his Prescription for Pennsylvania health care
reform plan and included SB 455 in the package of health care reform
bills which passed the legislature before the summer recess. SB
455 also changes the supervision standard for radiographs for all
hygienists from direct to general and removes the American Society
of Anesthesiology classifications of patient's health for supervision
from the current dental regulations. The State Board of Dentistry
will have to write new regulations to implement the law, which also
requires that hygienists must first work for two years (3600 hours)
under the supervision of a dentist before being eligible to apply
for the Public Health Dental Hygiene Practitioner certificate.
 To
read Governor Rendell’s press release go to: www.governor.state.pa.us/
and click on ‘Prescription for Pennsylvania.’
To read a copy of SB 455 go to: www.legis.state.pa.us
and type in the bill number in the box at the top of the page.
History of Senate Bill
455
ROLLIN’ ROLLIN’
ROLLIN’
Submitted by: Morgan Plant
PDHA Government Relations Consultant
The theme song from Rawhide is running around
my head, which probably means I am older than dirt, but there is
no doubt about it, we are rollin’! Years of work and preparation
are starting to bear fruit and I am very pleased to report on the
progress we have made thus far this legislative session.
Governor’s Health Care Reform Plan Includes
Hygiene
January started out with Governor Rendell
rolling out his Rx for PA, which is the most ambitious health care
reform plan yet seen on the state level. Included in that is the
legislation allowing dental hygienists to work independently in
public health settings; restoration of RDH’s ability to administer
local anesthesia; scrapping the confusing and antiquated ASA classifications
for supervision, which would be replaced by a process where the
dentist AND the hygienist would determine the appropriate level
of supervision, based on the health and history of the patient;
and removal of the requirement for direct supervision for taking
radiographs. In the intervening months we have probably gotten more
press coverage than in the last five years combined. The omnibus
Rx for PA bill is HB 700.
PDHA Legislation Re-introduced in New Session
In February and March we reintroduced our legislation
from last session, allowing RDHs to work in public health settings
without dental supervision. Sen. Pat Vance (R-Cumberland)
continues to lead the way, with Sen. Lisa Boscola
as the lead Democrat on the bill, which is SB 455 this session.
In the House the same duo who introduced it last session, Reps.
Steve Nickol (R-York/Adams) and Louise
Bishop (D-Philadelphia) swapped places as the House is
now in Democratic hands, with Rep. Bishop being the prime sponsor
and Rep. Nickol being the lead Republican. This is HB 914 this session.
(Go to www.legis.state.pa.us
and plug in the bill number to either view online or download.)
Please contact your State Representative and
ask them to co-sponsor and support HB 914.
PDHA Testifies before both House and Senate
Committees
In late March PDHA representatives Judy Gelinas,
RDH, BS, Kathy Schlotthauer, RDH, MEd and Alberta Landis, RDH, BS,
MS testified in back to back hearings, before the House Insurance
Committee on March 26 on the Governor’s Health Care Reform
Plan’s dental hygiene components included in HB 700, and the
next day before the Senate Consumer Protection and Professional
Licensure Committee on SB 455. It was a scramble to prepare for
both of these hearings with less than two weeks notice, but we did
it. We provided lots of supporting information, including copies
of our three white papers on Access to Care, Nursing Homes and Children
to all members of each committee.
Lobby Day April 17 was a Smashing Success
On April 17 we had a magnificent Lobby Day
in the Capitol, with a rally addressed by Sen. Vance and Rep. Bishop,
scores of lobby visits and a legislative reception at the end of
the day. PA Partnerships for Children, which advocates statewide
for children, participated in the rally as well. Special thanks
to the dental hygiene students from Harcum, Community College of
Philadelphia and Harrisburg Area Community College who attended
and brought numbers and enthusiasm to the task.
Meeting with Sen. Vance, PDHA and PDA
Sen. Vance and staff from the Senate Consumer
Protection and Professional Licensure Committee invited both the
PA Dental Association and PDHA to meet to discuss possible compromises
on SB 455 on April 18. Faye Capirano, GR co-chair and I attended,
with Sue Giorgio on the phone. Linda K. Himmelberger, DMD,
current President of PDA attended with Marisa Fenice from the PDA
staff and their contract lobbyist, Mark Singel. PDA said that what
they were proposing should be considered “temporary policy”
as approved by their Board of Trustees, but any final decisions
would have to be ratified by the House of Delegates, which was meeting
the following week.
PDA suggested the following:
- Change the title in the bill from “Independent
Dental Hygiene Practitioner” to “Public Health Dental
Hygienist” (PHDH).
- While PDA wanted dental hygienists to have
to work for three years under dental supervision before being
able to work independently in public health settings, as opposed
to the one year (1800 hours) in SB 455 bill, it appears that we
may settle on two years or 3600 hours. PDA also wanted PHDHs to
have additional education and CEUs, but both Sen. Vance and the
Director of the Senate CP&PL Committee pointed out that we
could work in essentially the same settings now under general
supervision. It was also suggested that of the 20 hours of CEUs
hygienists are now required to take, for those holding the certificate
as a “Public Health Dental Hygienist” five of those
20 hours could be on public health topics. They requested that
the Public Health Dental Hygienist be required to refer the patient
at least annually to a dentist and immediately refer any patient
who has conditions requiring examination and/or care beyond the
PHDH’s experience, training or scope of practice. Sen. Vance
asked whom the hygienist would refer to if there were no dentists
available locally who accepted Medical Assistance patients. PDHA
agrees that a hygienist will always try to refer to a dentist,
but we can’t conjure them up upon request if they are not
available.
- That the current ASA (American Society
of Anesthesiology) Guidelines used to determine level of supervision
be changed to allow the dentist AND the hygienist to determine
the appropriate level of supervision based on the health and history
of the patient. This language is also included in the Governor’s
HB 700 and is not included in SB 455.
- Hygienists would once again be permitted
to administer local anesthesia under the direct supervision of
a dentist.
But then came the kicker – PDA
proposed:
- Allowing dental assistants to provide dental
prophylaxis to those up to 17 years of age under direct supervision.
- Allowing dental assistants to perform fluoride
treatments (including fluoride varnishes) under direct supervision.
- Allowing Expanded Function Dental Assistants
to do supragingival scaling.
Throughout this process Sen. Vance has made
it clear that SB 455 does not expand the dental hygiene scope of
practice and she was not interested in doing so, or in doing it
for anyone else, including dental assistants or EFDAs. The point
was also made that currently dental assistants are not recognized
or regulated in Pennsylvania.
Amendment Drafted to SB 455
As of this writing a draft amendment to SB
455 has been written to include some of the changes discussed above.
PDA is still seeking to have the EFDA scope of practice expanded
to include supragingival scaling. PDHA does not support this. The
ADHA position paper on this (http://www.adha.org/profissues/prophylaxis.htm)
suggests that 10 percent of people are likely to have calculus only
above the gum line and it would not be good hygiene practice to
just do supragingival scaling, even on children, who are less likely
to have calculus below the gum line. More and more children are
presenting with periodontal disease.
Language has also been added that in the event
the patient is not able to find a dentist to provide services after
an annual referral from a hygienist, this would not preclude the
patient from seeing the hygienist again. In the case of dental emergencies
it is expected that the referral of last resort, failing finding
a dentist to accept the patient, would be a hospital emergency department.
It is hoped that the Senate Consumer Protection
and Professional Licensure Committee will take up SB 455 and its
amendments in the next several weeks. It is not possible to predict
the outcome, but we will hope for successful Committee consideration
in the Senate, and a vote by the full Senate before the summer break.
We will likely be battling to keep our changes intact and try to
prevent the expansion of scope of practice for EFDAs, who are not
currently educated to scale.
Please contact your Senator and ask them
to support SB 455 in whatever form is recommended by Sens. Vance
and Boscola.
On the other side of the building
Meanwhile, “back at the ranch,”
on the other side of the Capitol building, the House Democrats are
pulling the professional licensure pieces out of the Governor’s
HB 700 and introducing them as separate legislation. Rep.
Eddie Day Pashinski (D-Luzerne), a freshman from the Wilkes
Barre area, will be introducing the dental hygiene legislation.
It is HB 1257 and a hearing on it has been scheduled before the
House Professional Licensure Committee at Drexel in Philadelphia
on May 30. It is expected to include all the dental hygiene issues
included in HB 700, including working in public health facilities
without dental supervision; local anesthesia under direct supervision;
changing the supervision standard to do away with the outmoded and
confusing ASA classifications and allowing RDHs to take radiographs
under direct supervision. Given the progress in the Senate it is
hoped that some of the positions advocated in the Senate may migrate
to the House bill.
Please contact your House members and ask
them to support HB 1257.
Meeting with Medical Director at OMAP
Sue Giorgio, RDH, PDHA GR co-chair and I met
with David Kelly, MD, Medical Director of the Medical Assistance
Program in the Department of Public Welfare, and Paul Westerberg,
DDS, Chief Dental Officer of the Medical Assistance program in late
April to bring them up to date on our efforts. Dr. Kelly expressed
support and enthusiasm for our legislation and clearly recognized
the benefits of expanding access to preventive dental care with
RDHs.
PDHA Joins Allied Health Working Group
PDHA has also been asked to represent dental
hygienists’ in the PA Center for Health Careers Leadership
Council’s Allied Health Working Group.
Fluoride
PDA has asked Rep. Steve Barrar (R-Delaware)
to re-introduce the Community Fluoridation bill (HB 1588 of last
session). Rep. Barrar is circulating a co-sponsorship memo and PDHA
members are encouraged to contact their legislators asking them
to co-sponsor. If you don’t know who your legislator is go
to www.legis.state.pa.us and plug in your zip code in the box in
the upper right hand corner of your screen.
The Practice of Dental Hygiene in Pennsylvania:
Evolving to Provide Greater Access to
Services
For the past two years, the Pennsylvania
Dental Hygienists’ Association (PDHA) and key members of the
Pennsylvania House and Senate have worked together to develop and
enact legislation intended to significantly
expand access to preventive dental hygiene
services for thousands of Pennsylvania’s most vulnerable residents.
The creation of HB 914 and SB 455 (formerly HB 2200 and SB 1010
last session) was based on reports from the Department of Health,
the Office of Medical Assistance Programs, and the U.S. Department
of Health and Human Services, as well as the reports of dental hygienists
working in the public health arena. It became increasingly clear
that poor families, children, nursing home residents and those living
in group homes for the disabled are suffering the physical consequences
of neglect and disparities in access to preventive dental care.
Pennsylvania’s current system for delivering dental health
care has left them behind.
As an integral part of its mission, the PDHA’s
strong commitment ensued to assuring access to preventive dental
hygiene services and education for all Pennsylvanians. The Senate
Consumer Protection and Professional Licensure Committee held a
hearing on SB 455 on March 27th which revealed how some of our members
working in public health and other institutional settings have been
frustrated by the lack of supervising dentists, growing waiting
lists, cut-backs in their programs, and the progress of preventable
diseases that eventually take their toll.
Personally as a dental hygienist working with
Head Start children, I talk with concerned mothers who struggle
to find a dentist to treat their children’s severely decayed
teeth and at times end up in the emergency room because of the pain.
And, just as troubling was the closing of this Head Start clinic
for six months because there was no supervising dentist resulting
in an expenditure of over $400,000 to transport these children to
another county.
Also volunteering to provide preventive services
at a pregnant women’s clinic, I see patients that haven’t
had their teeth cleaned in many years or ever! Periodontal disease,
as well as severe tooth decay is rampant among these women. The
long waiting list coupled with the inability to receive care elsewhere
leaves many of these women to line up before dawn at the clinic
seeking emergency treatment.
We know that Pennsylvania has a real shortage
of dentists, with 67 federally-designated Dental Health Professional
Shortage Areas. We know that a minute proportion of all dentists
currently licensed to practice in Pennsylvania provide services
to Medicaid patients. This means a small and rapidly dwindling pool
of dentists are available and willing to provide the supervision
required for dental hygienists working in public and private institutions
throughout the Commonwealth. We know that other states have less
restrictive laws and regulations that result in greater access.
And we know that supervision does not define the quality of the
services any dental hygienist provides, that comes from the education
and experience of the practitioner; the enforcement of clear and
meaningful professional standards; and a licensure process that
facilitates the best interests of patients and full utilization
of the knowledge base and skills of those licensed to practice.
The disparities in access to oral health care
are complex. Pennsylvania legislation and regulations requiring
supervision by a dentist block professional hygienists from providing
greater levels of preventive dental care for children, the elderly,
and the working poor. The PDHA believes that increasing the opportunities
for those dental hygienists who wish to provide their professional
services in an institutional setting will go a long way in improving
access to services for Pennsylvanians who are barred by their circumstances
from receiving dental care in a private dental office.
Recently the PDHA and key legislative officials
met with representatives of the Pennsylvania Dental Association
to discuss their proposed amendments. Although we are awaiting actual
language to these amendments, we look forward to continued collaboration
in an effort to provide a team approach to this severe problem of
access to dental care.
This article was researched and developed
by Bonnie Fowler, PDHA Governmental Relations Support Consultant
and Faye Capirano, AS, RDH, PDHA Governmental Relations Co-Chair
and submitted to the PA Academy of General Dentistry for publication
in their newsletter.
 Please
help PA Dental Hygienists' Association Pass SB 455 / HB 914
SB 455 and HB 914 are identical bills
that allow dental hygienists to work in public health settings without
dental supervision. To view copies of this legislation on the web
go to
www.legis.state.pa.us
and type in the bill number in the box at the top of the page. You
can also use this site to find out who your state Representative
and state Senator are. Please contact them to convey your support
for this legislation. Check the legislative area on the PDHA website
at www.pdhaonline.org for
updates.
PDHA's primary job right now is to gather
support and additional co-sponsors for SB 455
introduced in the Senate by Sen. Pat
Vance (R-Cumberland/York) and Sen. Lisa Boscola
(D-Northampton). In the House HB 914 was introduced by Rep. Louise
Williams Bishop (D-Philadelphia) and Rep. Steve Nickol
(R-Adams/York). Introducing bills in both the House and the Senate,
which is called introducing "companion legislation"
provides an opportunity for us to work with each chamber on the
legislation now, rather than waiting for one chamber to pass it
to the other.
PDHA is proposing this legislation solely
to address problems relating to access to care
for children, the elderly, low-income and intellectually disabled
Pennsylvanians. In many cases the lack of supervising dentists
precludes any care being given to these populations. We believe
that at least making hygiene more accessible to them is better
than their having no care at all. Stress access to care and
the value of prevention as often as possible. We don't want to
be dentists and we won't be taking business away from dentists,
we want to provide preventive oral health care to those who currently
have little or no access to dental care.
This legislation will allow a dental hygienist
to work in public or private institutional settings, which are
defined in the bill, without the supervision of a dentist. The
public and private institutional settings include schools, correctional
facilities, health care facilities, personal care homes, older
adult daily living centers and other facilities deemed appropriate
by the Board.
This legislation does not expand the scope
of practice for hygienists. The only change in the area of private
dental offices is that the current direct supervision
requirement for a hygienist to perform radiographs would be changed
to general supervision. The PA Dental Association supports
this part of the bill.
You can say that PDHA would like to work
collaboratively with the PA Dental Association on this legislation
and is open to changes to make it better, but that the bottom
line is access to care, not a turf battle. This isn't about dentists
controlling their hygienists, it is about trying to provide better
access to care for the:
73,000 Pennsylvania children between the
ages of 3 and 5 who were enrolled and eligible for Medicaid dental
services during 2003 but were not able to access those services.
The 23% of adults surveyed
in Pennsylvania making less than $15,000 who have lost
all their teeth.
The thousands of older Pennsylvanians who
are living in long-term care facilities where dental care
is problematic and difficult to access.
The approximately 23% of
65-74 year olds who have severe periodontal disease.
Mouth and throat cancers are primarily diagnosed in the elderly.
PDHA is heartened by recent conversations
with PDA about this legislation and is hopeful that agreement can
be reached on compromises that will allow PDA to withdraw their
opposition to this legislation.
You should also be clear that we know that
this proposal is not going to solve all of the problems people in
Pennsylvania have in getting dental care, but that it might help
make it better for some. Hygienists working in public health settings
will do what they can to get those most in need of care for acute
dental problems to dentists who can treat them.
There is a shortage of dentists in Pennsylvania
now, which is expected to get worse.
Very few dentists accept Medical Assistance
patients.
Severe dental disease has very much become
a disease afflicting mainly low-income people.
While the number of dentists is declining the
number of dental hygienists is going up. There are 11 dental hygiene
schools in Pennsylvania.
> senate/district
contact information (167k Word doc)
The Times They Are
a-Changin'*
*apologies to Bob Dylan from Morgan Plant,
PDHA Governmental Relations Consultant
Come writers and critics
Who prophesize with your pen
And keep your eyes wide
The chance won't come again
And don't speak too soon
For the wheel's still in spin
And there's no tellin' who it is namin'.
For the loser now
Will be later to win
For the times they are a-changin'.
Come senators, congressmen
Please heed the call
Don't stand in the doorway
Don't block up the hall
For he that gets hurt
Will be he who has stalled
There's a battle outside
And it is ragin'.
It'll soon shake your windows
And rattle your walls
For the times they are a-changin'.
About the time Bob Dylan was writing this song
(these are verses two and three) in 1963, dental hygienists had
already developed into the dental care professionals they are today.
Now, over 40 years later, RDHs in Pennsylvania are looking to Governor
Rendell's Prescription for Pennsylvania in hopes that this
will herald another step in surmounting the barriers dental hygienists
frequently encounter from antiquated laws and regulations that more
properly belong in the last century. (I love the internet! I wanted
to use this as the title for this piece and "Googled"
it to see exactly how it was written. There were the lyrics, and
it struck me that they are as appropriate for us today as they were
44 years ago.)
On the first day of his second term, Governor
Rendell unveiled his three pronged plan to provide access to health
care for ALL Pennsylvanians. The Governor's plan specifically includes
dental hygienists, which provides PDHA with an unprecedented opportunity
to open things up and restore practices like administration of local
anesthesia.
The three components of the Governor's plan
focus on the Cover All Pennsylvanians program (CAP), quality of
health services, and accessibility of health care.
Through CAP, small businesses and uninsured
citizens can purchase affordable basic health coverage through the
private insurance market. All uninsured Pennsylvanians, even those
employed in small businesses, will be able to buy health insurance.
The Prescription for Pennsylvania
calls for significant reforms to improve the quality of health care
by increasing the accountability of consumers, hospitals and other
health care providers. The proposal focuses on eliminating hospital-acquired
infections, targeting avoidable medical errors, using a successful
model that manages treatment of common chronic conditions, and providing
consumer incentives that reward healthy lifestyles.
Over the last several weeks there have been
numerous references by the Governor to the need to open things up
for nurse practitioners, midwives AND DENTAL HYGIENISTS, so they
can work up to their full scope of practice. I expect there will
be a great deal of attention focused on RDHs in PA, especially by
"organized dentistry."
In 2005 representatives from the PA Dental
Hygienists' Association met with the staff of the Governor's Office
of Health Care Reform and presented a series of White Papers which
enumerated many of the barriers to access to dental care that many
Pennsylvanians encounter on a regular basis as well as our legislation
to allow hygienists to practice in public health settings without
dental supervision. Copies of the White Papers, which include one
on Access to Care in general, one on nursing homes and one on children,
as well as a "Fast Facts" on supervision are available
on the PDHA website, www.PDHAonline.org,
under the Legislative Link under "papers".
While the Governor has set an ambitious time
table for passage of his plan, the PA legislature must also approve
it and pass a budget that will include funds to implement it. This
is where the devil is in the details and what emerges on the other
end may not be all that we hope it will be. It will be up to us
to work to convince members of the General Assembly of the merit
of our proposed changes. We haven't seen the actual legislative
language yet, but expect it fairly soon.
The Governor, who also endorsed clean indoor
air for all of Pennsylvania, is proposing an additional tax on cigarettes
to help pay for some segments of the plan as well as a tax on non-cigarette
tobacco products. Pennsylvania is currently the ONLY state in the
country that does NOT tax cigars, chew, snuff and other non-cigarette
tobacco products.
Dental hygienists in Pennsylvania are presented
with an opportunity to change antiquated rules and regulations and,
make it easier to provide the kind of health care they have been
educated to provide in public health settings without dental supervision.
Having the Governor on our side will help a lot, but it won't be
a slam dunk and we will likely face very stiff opposition from "organized
dentistry." We must work harder and smarter to make sure that
the kinds of changes we are proposing don't get lost in the shuffle,
or get held up in endless reg changes. We are STILL waiting for
new regulations to restore the administration of local anesthesia
to emerge from the State Board of Dentistry.
Please keep an eye on our website and contact
your legislators about the need to have dental hygienists freed
from the restrictions of a bygone era. We have 50 new House members
and five new Senators in our State legislature as well as four new
Congressmen in Washington. If you live in one of the new members'
districts, please make it a personal project to educate them about
the role of Pennsylvania's dental hygienists in providing preventive
dental care to the unserved and underserved.
For the times they are –changin'!
PDHA-Sponsored Bill
- HB
914
- SB
455
Registered Dental Hygienist in Public
Health Settings Bill
Registered Dental Hygienist in Public
Health Settings Bill
THE STATEWIDE AVERAGE PERCENTAGE OF CHILDREN 6-8 YEARS OLD WITH
UNTREATED DECAY IS 6% BUT THERE ARE AREAS AS HIGH AS 25%.
SCHOOL NURSES REPORT ON AVERAGE, ONE OR TWO
DENTAL EMERGENCIES PER WEEK, BUT CERTAIN SCHOOLS REPORT AS HIGH
AS ONE PER DAY.
57% OF ADULTS OVER 65 YEARS HAVE SEEN A DENTIST
IN THE LAST YEAR, BUT NOT NECESSARILY FOR PREVENTIVE SERVICES.
THERE IS A GROWING POTENTIAL DENTIST SHORTAGE
OVER THE NEXT TEN YEARS BECAUSE THERE ARE MORE DENTISTS RETIRING
THAN COMING INTO THE WORKFORCE.
This is not the data from a third world country
but from the state you live and work in! WHAT is wrong with this
picture? WHO provides oral health preventive services? It is well
documented that oral health education, fluorides, sealants, and
professional cleanings improve health and reduces costs. REGISTERED
DENTAL HYGIENISTS ARE PART OF THE SOLUTION TO PENNSYLVANIA’S
ORAL HEALTH CRISIS! But to be part of the solution the Dental Law
needs to be changed, registered dental hygienists in public health
settings (schools, nursing homes, Head Start programs, long term
care facilities, nurse practitioner centers, etc) should be allowed
to independently provide preventive dental hygiene services. These
dental hygienists will be EXPERIENCED dental hygienists and utilizing
our current practice standards, identified oral health needs will
be referred for appropriate care. The independent designation is
necessary for 2 reasons: 1. Currently in Pennsylvania, there are
about 1,000 more dentists in the 40 to 50 age group as are in the
30 to 40 age group. Given this current age distribution of dentists,
without significant near-term change, expected retirement rates
will certainly exacerbate any ACCESS issues over the next 10-15
years (Oral Health Strategic Plan for Pennsylvania). There is difficulty
now finding “authorizing” dentists for supervision in
these practice sites. It will only get worse! 2. Unless a registered
dental hygienist is recognized as an independent practitioner, reimbursement
from the Dept of Public Welfare and the CHIP program, will not be
possible.
Both bills were introduced in the House and
Senate last fall and are now in the House Professional Licensure
Committee and the Senate Consumer Protection and Professional Licensure
Committee. Please contact your lesgistalitors and ask them to call
for a vote in each committee. YOU ARE THE VOICE OF DENTAL HYGIENE.
SPEAK UP AND BE HEARD. BE PREPARED TO RESPOND QUICKLY TO YOUR LEGISLATORS
TO MAKE THIS LAW CHANGE A REALITY
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