Dental Therapy in Arizona

Kristen Boilini

Pivotal Policy Consulting

Dental Care for Arizona

August 1, 2018

TIMELINE

• COR Hearing: December 2016

• Spring of 2017: Building Support

• COR Hearing: November 2017

• 2018 Legislative Session

• 2018 Success

• General Effective Date: August 3, 2018

Dental Care for Arizona Coalition

• American College of OB-GYNs-AZ Section

• Americans for Prosperity

• Arizona Advisory Council on Indian Health Care

• Arizona Hispanic Chamber of Commerce

• Arizona Dental Hygienists Association

• Arizona Community Action Association

• Arizona Farm Bureau

• Arizona Free Enterprise Club

• Arizona Rural Health Association

• Asian Pacific Community in Action

• Chicanos Por la Causa

• Goldwater Institute

• Inter-Tribal Association of Arizona

• Arizona American Indian Oral Health Initiative

• Native American Connections

• Navajo Nation

• Pew Charitable Trusts

• Southern Arizona Oral Health Coalition

• Tohono O’odham Nation

• Tucson Hispanic Chamber of Commerce

• Valle del Sol (FQHC)

• Community Health Centers Alliance

National momentum

Arizona law

• Broad, flexible, and statewide model

• Focus on underserved populations

• Broad scope; aligns with and goes beyond CODA

licensure

Who must be licensed?

• Anyone practicing as a dental therapist in Arizona, must be licensed through AzBODEX

Exception:

• Persons not required to be licensed (ARS 32-1231) nor regulated by AzBODEX (paraphrased): A dental therapist, whether or not they are licensed by the State, may practice dental therapy without falling under the licensure requirements or practice restrictions contained in Arizona Law, Chapter 296 when practicing under the following conditions:

A. In the discharge of official duties on behalf of the United States government, including the U.S. Department of Veterans Affairs the U.S. Public Health Services, and the Indian Health Service.

B. While employed by tribal health programs authorized pursuant to Public Law 93-638 or Urban Indian Health Programs.

Models for dental therapy practice

1. Under direct supervision of a dentist • Direct supervision means that a licensed dentist is present

in the office and available to provide treatment or care to a patient and observe a dental therapist’s work.

2. Under a Collaborative Practice Agreement (CPA) • Dentists may supervise up to 4 CPA DTs. The dentist

includes standing orders for the DT that include: Where/when the DT can practice The types of patients the DT can see The medications a DT may dispense (antibiotics, anti-

inflammatories, analgesics) and Any restrictions within the scope of practice.

Educational requirements

• Must be licensed as a dental hygienist (no requirements to maintain hygiene license)

• Must graduate from a “Recognized Dental Therapy School” (CODA accredited, includes initial accreditation)

• No degree level specified in statute

Licensure requirements

• Graduation from Recognized School

• Pass Western Regional Examining Board DT Clinical Exam (or equivalent)

• Pass Dental Jurisprudence Exam

• 1,000 hours preceptorship-applies to Collaborative Practice Agreement only

Other states

• See handout

Scope of practice

• CODA (a floor, not a ceiling)

Plus:

• Extractions of certain permanent teeth (Direct supervision only under CPA)

• Suturing

• Space Maintainers

• Fabrication of athletic mouth guards

• *Root planning- full hygiene scope is incorporated into DT scope.

Where can dental therapists practice?

• IHS, Urban Indian Health Programs, Tribal 638’s

• Community Health Centers: FQHCs, Look-A-Likes

• Non-Profit Practices/Clinics that provide care to low income individuals

(e.g. CPLC, St. Vincent de Paul, Brighter Way, CASS)

• Private Practice Dental Offices who treat CHC patients of record

What do we still need to do?

• Immediate Opportunities • The bill passed in May

• The effective date is August 3

• Tribes can immediately begin using dental therapists

• Tribes can begin to consider existing training programs for current or new dental professionals.

What do we still need to do?

• Education • 8 CODA Accredited dental hygiene programs in Arizona:

-Rio Salado Community Colleges

-Phoenix College

-Mesa Community College

-Pima Community Colleges

-Mohave Community College

-Northern Arizona University

-Carrington College

-Fortis College

What do we still need to do?

• Examination & Licensure • No national/regional Dental Therapy exam, yet…

• WREB or equivalent (clinical exam for dental students)

• BODEX licensure requirements • Process

• Documentation of preceptorship

What do we still need to do?

• Reimbursement • Statewide Plan Amendment (AHCCCS)

• Employment • AHCCCS Health Plans

• CHC’s & Non-Profit Clinics

Thank you

Kristen Boilini

kristen@pivotalpolicyconsulting.com