dental therapy in arizona - arizona v. inter tribal...
TRANSCRIPT
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