Dental Hygiene Collaborative Practice Mary Ellen Yankosky, B.S., R.D.H. Director of Policy and Advocacy, DHASNY www.dhasny.org MEYankosky@comcast.net New York State Oral Health Coalition November 13, 2014

Session Outcomes By the end of the session, you will have heard about: Statutory Changes in the Practice of Dental Hygiene Regulatory Process Promulgating Rules to Implement the Law Role of DHASNY in preparing RDHs for collaborative practice

Dental Hygiene: 11th oldest profession in NYS Photo compliments of U of Rochester Library

Changes in Practice………….. General Supervision 1970’s New York Codes, Rules and Regulations, Title 10 – Nursing Homes Practice 1990’s Increased Dental Hygiene Representation, State Board for Dentistry 1990’s Mandatory Continuing Education 1995 Local Anesthesia and Nitrous Oxide Administration and Monitoring 2005 Expanded Scope of Practice to include any/all duties allowed by law for NY Licensed Dental Assistants 1995 Limited License 2000’s Limited Permit 2000’s Children’s Dental Health Certificate 2009 Elimination of Citizenship for Licensure 2013 Collaborative Practice 2013

A bill becomes law………….. A7866/S5757 – Glick/Hannon This amendment to the Education Law allows dental hygienists to provide dental services in facilities organized under Article 28 of PHL, pursuant to a collaborative agreement with a licensed and registered dentist who has a formal agreement with facility Passed both Houses June 2013 Signed into law August 1, 2013

1. The Dental Hygiene Practice Act states that "[the] practice of dental hygiene ... must be done under supervision of a licensed dentist” or effective January 1, 2015, pursuant to a collaborative arrangement as defined in regulations of the Commissioner of Education approved by the Board of Regents. 2. Personal supervision shall mean that the dentist in the dental office or facility, personally diagnoses the condition to be treated, personally authorizes the procedure and, before dismissal of the patient, personally examines the condition after treatment is completed. 3. General supervision shall mean that a supervising dentist is available for consultation, diagnosis and evaluation, has authorized the dental hygienist to perform the services, and exercises that degree of supervision appropriate to the circumstances. http://www.op.nysed.gov/prof/dent/article133.htm#dhdef; § 6606. Definition of practice of dental hygiene http://www.op.nysed.gov/prof/dent/part61.htm#dhpract; §61.9 Practice of dental hygiene http://www.op.nysed.gov/prof/dent/dentpracticeguide.htm; Supervision.

The Law: The practice of dental hygiene, in accordance with section 6606 of the Education Law, shall be performed either under the supervision of a licensed dentist or pursuant to a collaborative arrangement as defined in subdivision (f) of this section. Instruct patients to visit a license dentist for comprehensive examination or treatment Requires certified in CPR and maintain certification as part of mandatory continuing education hours

Scope of Practice Dental Hygiene procedures allowable within Collaborative Practice includes those currently provided under general supervision http://www.op.nysed.gov/prof/dent/part61.htm#dhpract

The Regulations – Key Updates Taking and assessing medical history including the measuring and recording of vital signs as an aid to diagnosis by the dentist and to assist the dental hygienist in providing dental hygiene services; Charting caries and periodontal conditions as an aid to diagnosis by the dentist Performing dental and/or periodontal assessments as an aid to diagnosis by the dentist and to assist the dental hygienist in providing dental hygiene services; Assessments of the oral and maxillofacial area as an aid to diagnosis by the dentist;

Key Updates con’t…………. Providing dental health care case management and care coordination services, which shall include, but not be limited to: (i) Community outreach; (ii) Improving oral outcomes; (iii)Improving access to dental care by assisting people in establishing an ongoing relationship with a dentist, in order to promote the comprehensive, continuous and coordinated delivery of all aspects of oral health care; and (iv) Assisting people to obtain dental health care.

Who made this happen? NYS Medicaid Redesign Team New York State Dental Association NYSDOH, Bureau of Dental Health NYS Assembly and Senate NYS Governor NYS Education Department, State Board for Dentistry Dental Hygienists’ Association of the State of NY

Collaborative Practice “The fundamental feature of collaborative practice is always the commitment by the collaborating providers to work in concert to provide the best comprehensive care for their patients while respecting, recognizing, and building on each other’s strengths and talents.” Elizabeth Mertz, PhD, MA; Vanessa Lindler, MA; and Catherine Dower, JD. January, 2011. “Collaborative Practice in American Dentistry: Practice and Potential.” UCSF Center for the Health Professions