Current through Register Vol. 49, No. 2, February 2024
Article
XIX
DENTAL HYGIENIST COLLABORATIVE CARE PROGRAM
Pursuant to ACA
17-82-701
-
17-82-707
the Arkansas State Board of Dental Examiners herby promulgates these rules to
implement the dental hygienist collaborative care program.
A. DEFINITIONS
1. Collaborative Agreement
A written plan that identifies a dentist licensed by the Arkansas
State Board of Dental Examiners who agrees to collaborate with a dental
hygienist licensed by the Arkansas State Board of Dental Examiners in the joint
provision of dental hygiene services to patients and outlines procedures for
consultation with or referral to the collaborating dentist or other dentists as
indicated by a patient's dental care needs. Under a collaborative agreement,
the dental hygienist may provide any services within the current scope of
practice of a dental hygienist to children, senior citizens, and persons with
developmental disabilities in a public setting without the presence of the
dentist and without a prior examination of the patient by the dentist
2. Collaborative Dental Hygienist
A dental hygienist who holds a Collaborative Care Permit I or a
Collaborative Care Permit II from the Arkansas State Board of Dental Examiners
and who has entered into a collaborative agreement with no more than one (1)
consulting dentist regarding the provision of services under this rule.
3. Consulting Dentist
A dentist who holds a Collaborative Dental Care Permit from the
Arkansas State Board of Dental Examiners and:
a. If engaged in the private practice of
dentistry, has entered into a collaborative agreement with no more than three
(3) collaborative dental hygienists regarding the provision of services under
this rule; or
b. Is employed by the
Department of Health
4.
Dental Home
A licensed primary dental care provider who has an ongoing
relationship with a patient where comprehensive oral health care is
continuously accessible, coordinated, family-centered and provided in
compliance with policies of the American Dental Association beginning no later
than one year of age.
5.
Informed Consent
A document informing the patient of all proposed dental hygiene
treatments, risks involved and alternative treatments available which must be
signed by the patient or parent/guardian of any minor or incapacitated person
before dental hygiene services can be provided. This form must meet all the
elements described in Section E. (Consent Forms) of this rule.
6. Medicaid
The medical assistance program established under §
20-77-101
et seq.
7. Public Settings
a. Adult long-term care facilities
b. Charitable health clinics that provide
free or reduced-fee services to low-income patients
c. County incarceration facilities
d. Facilities that primarily serve
developmentally disabled persons;
e. Head Start programs
f. Homes of homebound patients who qualify
for in-home medical assistance
g.
Hospital long-term care units
h.
Local health units
i.
Schools
j. Community health
centers
k. State correctional
institutions
8. Senior
Citizen
A person sixty-five (65) years of age or older.
B. PERMIT REQUIREMENTS AND FEES
1. Collaborative Care Permit I
a. A dentist must be licensed by the Arkansas
State Board of Dental Examiners.
b.
A dental hygienist must be licensed by the Arkansas State Board of Dental
Examiners; and
i. Have practiced as a dental
hygienist for one thousand two hundred (1,200) clinical hours (documentation
provided to ASBDE); or
ii. Taught
for two (2) academic years over the course of the immediately preceding three
(3) academic years of courses in which a person enrolls to obtain necessary
academic credentials for a dental hygienist license.
iii. Show proof of liability
insurance
2.
Collaborative Care Permit II
a. A dentist must
be licensed by the Arkansas State Board of Dental Examiners.
b. A dental Hygienist must be licensed by the
Arkansas State Board of Dental Examiners; and
i. Have practiced as a dental hygienist for
one thousand eight hundred (1,800) clinical hours (documentation provided to
ASBDE); or
ii. Taught for two (2)
academic years over the course of the immediately preceding three (3) academic
years of courses in which a person enrolls to obtain necessary academic
credentials for a dental hygienist license.
iii. Completed a six (6) hour continuing
education course approved by the Arkansas State Board of Dental Examiners. The
educational course must be related to senior care and/or patients with
developmental disabilities.
iv.
Show proof of liability insurance
3. Obtaining a permit
Complete required application forms provided by the Board.
a. Pay fee of $500.00 for Collaborative Care
Permit I and II for dentist as set by Arkansas Code
17-82-702.
b. Pay fee of $100.00 for Collaborative Care
Permit I for dental hygienists as set by Arkansas Code
17-82-702;
or
c. Pay fee of $150.00 for
Collaborative Care Permit II for dental hygienists as set by Arkansas Code
17-82-702
d. Show proof of liability
insurance
C.
SERVICES PROVIDED BY COLLABORATIVE DENTAL HYGIENISTS
1. A collaborative dental hygienist who
obtains a Collaborative Care Permit I may provide dental hygiene services
within the scope of practice of a dental hygienist in the State of Arkansas
(Article XI) and delegated by the consulting dentist to children in a public
setting without the presence of a dentist and without a prior examination of
the patient by the consulting dentist.
2. A collaborative dental hygienist who holds
a Collaborative Care Permit II may provide dental hygiene services within the
scope of practice of a dental hygienist in the State of Arkansas (Article XI)
and delegated by the consulting dentist to children, senior citizens, and
persons with developmental disabilities in public settings without the presence
of a dentist and without a prior examination of the patient by the consulting
dentist.
3. Prohibited services
provided by a Collaborative Dental Hygienist.
a. Scaling and Root Planing
b. Administration of local
anesthesia
c.
Administration/monitoring of nitrous oxide
D. COLLABORATIVE PRACTICE AGREEMENT PROTOCOL
1. A written protocol to be used by the
collaborative care dental hygienist to treat patients must be established by
the consulting dentist and dental hygienist prior to the delivery of patient
care.
The written agreement must include the following elements:
a. Be signed and dated by both the consulting
dentist and the dental hygienist
b.
Address, telephone number and license number of both the consulting dentist and
the dental hygienist
c. Contain the
dental and dental hygiene license numbers
d. The date on which the agreement becomes
effective
e. A provision addressing
the availability of the consulting dentist for emergency situations,
consultation and referral
f. The
name, address, telephone number, and license number of a designee for the
dental hygienist to contact in cases where the consulting dentist is not
available
g. Location(s) where the
dental hygiene services will be provided. The agreement must be updated when
new locations are added or listed locations are discontinued.
h. Plan for retrospective chart reviews
conducted within seven days of the most recent hygiene service date by the
consulting dentist. Reviews must include the patient's health history,
documentation, type and appropriateness of services rendered, review of patient
consent forms, review of release of information forms, if applicable, and
evaluation of the quality and appropriateness of radiographs.
The protocol must include but is not limited to medical history,
record keeping, criteria for the provision of prophylaxis, sealants, fluoride
therapies, radiographs, and other services within the scope of practice of the
dental hygienist, and infection control procedures.
2. In accordance with this
protocol a consulting dentists must:
a. Be
available to provide emergency communication and consultation with the dental
hygienist or appoint another dentist as a designee for those times when the
consulting dentist cannot be reached.
b. Maintain records of patients treated. If
another dentist provides follow-up treatment, the consulting dentist is
responsible for the transfer of records.
c. Maintain a copy of the Collaborative
Agreement and the Protocol on file.
d. Notify the Board if the collaborative
agreement between dentist and hygienist dissolves or contact information
changes.
3. In
accordance with this protocol a collaborative care dental hygienist must:
a. Maintain contact capabilities with the
consulting dentist.
b. Secure
informed consent from all patients or the parent/guardian of the patient before
providing services.
c. Provide to
the patient, parent, or guardian a written plan for referral to a dentist for
assessment of further dental treatment needs.
d. Provide copy of collaborative care record
of services to the institutional facility responsible for patient's care, when
applicable.
e. Secure release of
information forms from the patient or parent/guardian of the patient if the
care is provided in an institutional facility allowing the dental hygienist to
access the patient's medical and dental records.
f. Create and maintain all patient records
and forward all records and radiographs or duplicates, to the consulting
dentist within 7 days of services rendered.
g. Maintain a copy of the Collaborative
Agreement and the protocol on file.
h. Notify the Board if the collaborative
agreement between dentist and hygienist dissolves or contact information
changes,
i. Maintain a malpractice
liability policy for the provision of services.
j. The collaborative care dental hygienist
may use or supervise a dental assistant but shall not permit assistants to
provide direct clinical services to patients.
4. A copy of the protocol must be sent to the
ASBDE office to have on file with the corresponding permit.
E. CONSENT FORMS
A consent form must be obtained prior to the provision of any
collaborative care dental hygiene services. The form must be signed by the
patient or by a parent or guardian if the patient is a minor or an
incapacitated person.
A consent form must include at a minimum:
1. Name, address, telephone number and
license number of collaborative care hygienist and consulting dentist under
which services are provided.
2.
Services to be provided
3. If the
patient is a minor, the consent form must also contain the following questions
and statement:
a. Has the child had dental
care in the past twelve months? Yes__ No__
b. Does the child have an appointment
scheduled at the dental home where care is normally provided? Yes__ No__
i. If Yes, please list the name and address
of the dentist or dental home where the care was provided.
ii. If Yes, we recommend maintaining your
relationship within a dental home and not receive services in a public
setting.
c. "I
understand that I can choose to have dental hygiene services provided at the
dental home where care is normally provided rather than a public setting. I
understand that all dental hygiene care provided by the dental home I have used
in the past or a collaborative care dental hygienist will reduce future
benefits that the child may receive from private insurance, Medicaid (ARKids)
or other third party provider of dental hygiene benefits for the remaining
benefit period."
4. If
the patient is an adult, the consent form must be signed by the patient and
contain the following statement:
a. Have you
received dental care in the past twelve months?
Yes_ No__
b.
Do you have an appointment scheduled at the dental home where care is normally
provided? Yes___No___
i. If Yes, please list
the name and address of the dentist or dental home where the care was
provided.
ii. If Yes, we recommend
maintaining your relationship within a dental home and not receive services in
a public setting.
c. "I
understand that I can choose to have dental hygiene services provided at the
dental home where care is normally provided rather than a public setting. I
understand that all dental hygiene care proved by the dental home I have used
in the past or a collaborative care dental hygienist will reduce future
benefits that the I may receive from private insurance, or other third party
provider of dental hygiene benefits for the remaining benefit period"
5. If the patient is an
incapacitated person, the form must be signed by the patient's legal guardian
and contain the following statement:
a. Has
the patient received dental care in the past twelve months? Yes__No__
b. Does the patient have an appointment
scheduled at the dental home where care is normally provided? Yes___No___
i. If Yes, please list the name and address
of the dentist or dental home where the care was provided.
ii. If Yes, we recommend maintaining your
relationship within a dental home and not receive services in a public
setting.
c. "I
understand that I can choose to have dental hygiene services provided at the
dental home where care is normally provided rather than a public setting. I
understand that all dental hygiene care proved by the dental home I have used
in the past or a collaborative care dental hygienist will reduce future
benefits that the patient may receive from private insurance, or other third
party provider of dental hygiene benefits for the remaining benefit
period"
F.
POST CARE INFORMATION TO PATIENTS
Each person receiving collaborative care dental hygiene services
must receive an information sheet at the completion of services. The
information sheet must contain:
1.
Name of collaborative care dental hygienist who provided the service and the
consulting dentist.
2. Telephone
number and/or other emergency contact number of the dental hygienist and
consulting dentist.
3. Listing of
treatment rendered including, when applicable, billing codes, fees, and tooth
numbers.
4. Description of further
treatment that is needed or recommended. The dental hygienist will advise the
patient and/or legal guardian that dental hygiene services are preventive in
nature and do not constitute a comprehensive dental diagnosis. The dental
hygienist will recommend that patients see the consulting dentist or give a
list of dentists within a 50 mile radius for comprehensive care.
5. The collaborative dentist is ultimately
responsible for the care of the patient.
G. REIMBURSEMENT
1. For the purposes of reimbursement the
Collaborative Dental Hygienist is deemed to be an employee of the consulting
dentist.
2. A health insurance
company, Medicaid, or other person that pays a fee for service performed by a
collaborative dental hygienist under this rule shall submit the payment
directly to the consulting dentist.
3. If a health insurance company, Medicaid,
or other person pays a fee for service performed by a dental hygienist under
this rule to the collaborative dental hygienist, the collaborative dental
hygienist shall deliver the payment to the consulting dentist.
4. For the limited purposes of Medicaid
reimbursement under this rule, the collaborative dental hygienist is deemed to
be an employee of the consulting dentist and the collaborative dental hygienist
as a condition of employment under this rule shall submit the Medicaid payment
for services performed under this rule to the consulting dentist.
5. If, however, language in the collaborative
agreement required under this rule conflicts with a federal law, a federal
rule, or a federal regulation, the federal law, federal rule, or federal
regulation shall control, and the conflicting language of the agreement shall
be disregarded.
H.
MALPRACTICE INSURANCE.
A collaborative dental hygienist who provides services permitted
under this rule shall be insured under a malpractice liability policy for the
provision of the services.
I. REPORTING
Reports from the collaborating dental hygienist and consulting
dentist must be submitted to the ASBDE office. An annual report is due by
January 31st of each calendar year, which must
include:
1. List of all locations
where collaborative care services were provided
2. Dates when services were
provided
3. Number of patients
treated during the year
4. The
types of services provided and quantity of each type of service
5. The number of patients who had dental care
within the previous 12 months
6.
The number of patients who had an appointment scheduled at the dental office
where care is normally provided.
Within two business days of services provided, the collaborating
dental hygienist and consulting dentist must report to the ASBDE office:
1. The location(s) where the dental hygiene
services were provided. The agreement must be updated when new locations are
added or listed locations are discontinued.
J. CESSATION OF OPERATION
1. The Board must be notified within thirty
(30) days of the cessation of operation of any collaborative care
agreement.
2. Arrangements must be
made for the transfer of records of all patients including radiographs or
copies thereof to succeeding practitioners or at the written request of the
patient.
