Current through Register 1531, September 27, 2024
A public health dental hygienist who holds a valid license to
practice dental hygiene in the Commonwealth issued pursuant to M.G.L. c. 112,
§ 51, and who has completed the appropriate training required by the Board
and has either three years of full-time or an equivalent 4,500 hours of
clinical experience shall practice in accordance with Board statutes and
regulations and shall enter into a written collaborative agreement (WCA) with a
dentist who holds a valid license issued pursuant to M.G.L. c. 112, § 45
or with the appropriate local or state government agency or institution
pursuant to M.G.L. c. 112, § 51, where a dentist licensed pursuant to
M.G.L. c. 112, § 45, is available to provide the appropriate level of
communication and consultation with the dental hygienist to ensure patient
health and safety.
(1) A public health
dental hygienist shall:
(a) Enter into a
written collaborative agreement (CA) which complies with the requirements at
234 CMR 5.08 before rendering treatment, advertising, or soliciting patients to
provide any dental hygiene services in a public health setting pursuant to the
collaborative agreement;
(b)
Maintain contact and document communication with the dentist with whom the
public health dental hygienist has entered into a written collaborative
agreement (WCA);
(c) Practice in
accordance with Board rules and regulations;
(d) Practice in accordance with systems,
policies and procedures established pursuant to Board statute and
regulations;
(e) Obtain written,
signed informed consent of the patient or legal representative which complies
with Board regulations contained in 234 CMR 5.08, informs the patient or legal
representative that the services provided by the public health dental hygienist
are not a substitute for a dental examination by a dentist and informs the
patient that the patient or legal representative that the patient should
obtain, or should have had a dental examination by a dentist within 90
days;
(f) Provide each patient with
a written Information Sheet at the conclusion of the patient's visit. Said
Information Sheet shall, at a minimum, include the following:
1.Results of the dental hygiene
evaluation;
2.The name(s) of the
public health dental hygienists and any licensed dentist and other dental
auxiliaries who provided services;
3.A description of the treatment rendered
including, but not limited to, billed service codes and fees associated with
treatment, and tooth numbers when appropriate;
4.Information on how to contact the public
health dental hygienist, dental health services program director, mobile dental
facility or portable dental operation permit holder (See
234
CMR 7.00: Mobile and Portable Dentistry);
5.If necessary, provide a referral for
emergency assessment by a dentist;
6.When a referral is made, the patient or
legal representative shall be referred to the patient's regular dentist if one
is identified. If none is identified, then the patient or legal representative
must be provided with the names of dentist(s), community health center(s) or
dental school clinic(s) located within a reasonable geographic distance from
the patient's home and with whom the public health dental hygienist or dental
health services program had communicated with regarding the acceptance of
referrals;
7.The name and signature
of the public health dental hygienist; and
8.If the patient or legal representative has
given consent for an institutional facility (e.g. school, nursing home) to
access the patient's dental health records, then the dental hygienist shall
also provide the institution with a copy of the information sheet.
(2) A dentist entering
into a written collaborative agreement (WCA) with a public health dental
hygienist, may, but is not required to, provide subsequent dental treatment to
patients served under said agreement.
(3)
Written Collaborative
Agreement (WCA). A collaborative agreement between a public health
dental hygienist and a municipality or state agency or institution, or with a
licensed dentist who holds a valid license issued pursuant to M.G.L. c. 112,
§ 45 shall, at a minimum, address all of the following:
(a) Identify by name(s) the dentist(s) who
shall be available to provide the appropriate level of communication and
consultation with the public health dental hygienist to ensure patient health
and safety;
(b) Describe, with
specificity, how communication and consultation between the dentist and public
health dental hygienist will be accomplished, including the frequency and
arrangements for back-up coverage when the dentist is not accessible to provide
communication and consultation (e.g., during vacation, illness);
(c) Provide the names, license numbers,
addresses, telephone and facsimile numbers, and emergency contact information
for the dentist(s) and public health dental hygienist;
(d) Include an attestation from the public
health dental hygienist which is signed under the pains and penalties of
perjury that describes the public health dental hygienist's qualifications to
practice as a public health dental hygienist and explicitly states that the
dental hygienist has a minimum of three years of full-time or an equivalent of
4,500 hours of clinical experience as a registered dental hygienist and has
completed all training required by the Board;
(e) Identify entity(ies) and geographic
area(s) where public health dental hygienist services will be provided pursuant
to the collaborative agreement;
(f)
Specify the dental hygiene procedures to be provided and the populations to be
served pursuant to the collaborative agreement;
(g) Specify and describe responsibilities for
creating, maintaining, storing, retrieving and providing for the
confidentiality of patient records;
(h) Specify and describe responsibilities for
establishing systems, policies and procedures to ensure compliance with Board
regulations, including but not limited to requirements of
234 CMR 5.00 and
7.00: Mobile and Portable
Dentistry as may be applicable;
(i)
Specify and describe responsibilities for developing, implementing, and
maintaining emergency medical protocols and for the provision of periodic
review and training on same;
(j)
Include any considerations for age- or procedure-specific protocols as may be
deemed necessary by the dentist or public health dental hygienist;
(k) Include any considerations for
medically-compromised patients as may be deemed necessary by the dentist or
public health dental hygienist;
(l) Outline responsibilities for billing and
reimbursement for services rendered by the dental hygienist in the public
health setting, if indicated;
(m)
Identify a process for the public health dental hygienist to legally obtain
prescription products (e.g. chemotherapeutics, fluoride varnish) pertinent to
the provision of dental hygiene services and which are to be utilized when
rendering services in a public health setting; and
(n) Term of the collaborative agreement, if
applicable.
(4) The
dentist and public health dental hygienist shall review and update the written
collaborative agreement at least annually.
(5) The dentist and public health dental
hygienist shall immediately notify each other and, if applicable, the
municipality, state agency or institution involved in the collaborative
agreement of any disciplinary action imposed by the Board or any other
governmental agency against his or her license to practice dentistry or dental
hygiene in the Commonwealth.
(6) A
copy of the written collaborative agreement shall be maintained by the
municipality, state agency or institution, licensed dentist, and the public
health dental hygienist. Upon written request, said agreement shall be made
available to the Board, or to a patient who received treatment pursuant to the
agreement or his or her legal representative.
(7) Each public health dental hygienist shall
maintain the following data to be reported to the Massachusetts Department of
Public Health's Office of Oral Health on forms and in accordance with
procedures and timelines established by that office:
(a) The dates of each session with name and
address of the site where public health dental hygiene services were provided;
and
(b) The number of patients
served and the type(s) and quantity(ies) of each service provided.
