Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the Governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the Governor to remove any member of the board, as specified. Existing law repeals those provisions on January 1, 2024, at which time the board is subject to review by the appropriate policy committees of the Legislature.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified. This bill would also extend the repeal date of the board and related appointment provisions to January 1, 2028.

Existing law requires the board to license as a registered dental hygienist a person who satisfies specified requirements, including completion of a prescribed education program, satisfactory completion of an examination in California law and ethics, and satisfactory performance, within the preceding 3 years, of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the board.

Under this bill, graduation from a California accredited dental hygiene college approved by the board within the preceding 3 years satisfies the requirement for satisfactory performance of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the board. This bill would additionally require an applicant for licensure as a registered dental hygienist to maintain a current, valid certification in basic life support, as prescribed.

Under existing law, the board, as a condition of license renewal, shall require a licensee to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. Under existing law, the mandatory coursework prescribed by the board shall not exceed 7 ¹/₂ hours per renewal period.

This bill would authorize the board to increase the prescribed mandatory coursework to 10 hours per renewal period.

Existing law requires the State Department of Public Health to license and regulate health facilities. Existing law requires the board to license and regulate registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice, who have varying levels of education and training requirements and varying privileges within the scope of their respective practice. Existing law authorizes a person licensed as a registered dental hygienist in alternative practice to provide oral health inservice training to staff in a long-term health care facility.

This bill would instead authorize a person licensed as a registered dental hygienist to provide the above-described training.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the Governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the Governor to remove any member of the board, as specified. Existing law repeals those provisions on January 1, 2024, at which time the board is subject to review by the appropriate policy committees of the Legislature.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified. This bill would also extend the repeal date of the board and related appointment provisions to January 1, 2028.

Existing law requires the board to license as a registered dental hygienist a person who satisfies specified requirements, including completion of a prescribed education program, satisfactory completion of an examination in California law and ethics, and satisfactory performance, within the preceding 3 years, of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the board.

Under this bill, graduation from a California accredited dental hygiene college approved by the board within the preceding 3 years satisfies the requirement for satisfactory performance of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the board. This bill would additionally require an applicant for licensure as a registered dental hygienist to maintain a current, valid certification in basic life support, as prescribed.

Under existing law, the board, as a condition of license renewal, shall require a licensee to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the board. Under existing law, the mandatory coursework prescribed by the board shall not exceed 7 ¹/₂ hours per renewal period.

This bill would authorize the board to increase the prescribed mandatory coursework to 10 hours per renewal period.

Existing law requires the State Department of Public Health to license and regulate health facilities. Existing law requires the board to license and regulate registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice, who have varying levels of education and training requirements and varying privileges within the scope of their respective practice. Existing law authorizes a person licensed as a registered dental hygienist in alternative practice to provide oral health inservice training to staff in a long-term health care facility.

This bill would instead authorize a person licensed as a registered dental hygienist to provide the above-described training.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the Governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the Governor to remove any member of the board, as specified. Existing law repeals those provisions on January 1, 2024, at which time the board is subject to review by the appropriate policy committees of the Legislature.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified. This bill would also extend the repeal date of the board and related appointment provisions to January 1, 2028.

Existing law requires the committee to license as a registered dental hygienist a person who satisfies specified requirements, including completion of a prescribed education program, satisfactory completion of an examination in California law and ethics, and satisfactory performance, within the preceding 3 years, of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the dental hygiene board.

Under this bill, graduation from a California accredited dental hygiene college approved by the dental hygiene board within the preceding 3 years satisfies the requirement for satisfactory performance of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the dental hygiene board. This bill would additionally require an applicant for licensure as a registered dental hygienist to maintain a current, valid certification in basic life support, as prescribed.

Under existing law, the board, as a condition of license renewal, shall require a licensee to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the dental hygiene board. Under existing law, the mandatory coursework prescribed by the board shall not exceed 7 ¹/₂ hours per renewal period.

This bill would authorize the board to increase the prescribed mandatory coursework to 10 hours per renewal period.

Existing law requires the State Department of Public Health to license and regulate health facilities. Existing law requires the Dental Hygiene Board within the Department of Consumer Affairs to license and regulate registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice, who have varying levels of education and training requirements and varying privileges within the scope of their respective practice. Existing law authorizes a person licensed as a registered dental hygienist in alternative practice to provide oral health inservice training to staff in a long-term health care facility.

This bill would instead authorize a person licensed as a registered dental hygienist to provide the above-described training.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the Governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the Governor to remove any member of the board, as specified. Existing law repeals those provisions on January 1, 2024, at which time the board is subject to review by the appropriate policy committees of the Legislature.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified. This bill would also extend the repeal date of the board and related appointment provisions to January 1, 2028.

Existing law requires the committee to license as a registered dental hygienist a person who satisfies specified requirements, including completion of a prescribed education program, satisfactory completion of an examination in California law and ethics, and satisfactory performance, within the preceding 3 years, of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the dental hygiene board.

Under this bill, graduation from a California accredited dental hygiene college approved by the dental hygiene board within the preceding 3 years satisfies the requirement for satisfactory performance of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the dental hygiene board. This bill would additionally require an applicant for licensure as a registered dental hygienist to maintain a current, valid certification in basic life support, as prescribed.

Under existing law, the board, as a condition of license renewal, shall require a licensee to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the dental hygiene board. Under existing law, the mandatory coursework prescribed by the board shall not exceed 7 ¹/₂ hours per renewal period.

This bill would authorize the board to increase the prescribed mandatory coursework to 10 hours per renewal period.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the Governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the Governor to remove any member of the board, as specified. Existing law repeals those provisions on January 1, 2024, at which time the board is subject to review by the appropriate policy committees of the Legislature.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified. This bill would also extend the repeal date of the board and related appointment provisions to January 1, 2026. 2028.

Existing law requires the committee to license as a registered dental hygienist a person who satisfies specified requirements, including completion of a prescribed education program, satisfactory completion of an examination in California law and ethics, and satisfactory performance, within the preceding 3 years, of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the dental hygiene board.

Under this bill, graduation from a California accredited dental hygiene college approved by the dental hygiene board within the preceding 3 years satisfies the requirement for satisfactory performance of the dental hygiene examination given by the Western Regional Examining Board or any other clinical or dental hygiene examination approved by the dental hygiene board. This bill would additionally require an applicant for licensure as a registered dental hygienist to maintain a current, valid certification in basic life support, as prescribed.

Under existing law, the board, as a condition of license renewal, shall require a licensee to successfully complete a portion of the required continuing education hours in specific areas adopted in regulations by the dental hygiene board. Under existing law, the mandatory coursework prescribed by the board shall not exceed 7 ¹/₂ hours per renewal period.

This bill would authorize the board to increase the prescribed mandatory coursework to 10 hours per renewal period.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the governor, Governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the governor Governor to remove any member of the board, as specified. Existing law repeals those provisions on January 1, 2024, at which time the board is subject to review by the appropriate policy committees of the Legislature.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified. This bill would also extend the repeal date of the board and related appointment provisions to January 1, 2026.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dental hygienists by the Dental Hygiene Board of California. Existing law requires the board to consist of 9 members, and requires 7 members to be appointed by the governor, one to be appointed by the Senate Committee on Rules, and one to be appointed by the Speaker of the Assembly. Existing law authorizes the governor to remove any member of the board, as specified.

This bill would instead authorize an appointing authority to remove a member of the board appointed by that appointing authority, as specified.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1257

Author:(Berman)

As Amended Ver:September 1, 2023

Majority vote

SUMMARY

Extends the sunset date for the Dental Hygiene Board of California (DHBC) until January 1, 2028, and makes additional technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC's sunset review oversight process.

Senate Amendments

1. Authorize any category of registered dental hygienist to provide oral health inservice training to staff in a licensed long-term health care facility.
2. Make additional technical and nonsubstantive changes.

COMMENTS

Sunset review. In order to ensure that California's myriad professional boards and bureaus are meeting the state's public protection priorities, authorizing statutes for these regulatory bodies are subject to statutory dates of repeal, at which point the entity "sunsets" unless the date is extended by the Legislature. The sunset process provides a regular forum for discussion around the successes and challenges of various programs and the consideration of proposed changes to laws governing the regulation of professionals. Currently, the sunset review process applies to approximately three dozen different boards and bureaus under the Department of Consumer Affairs, as well as the Department of Real Estate and three nongovernmental nonprofit councils.

On a schedule averaging every four years, each entity is required to present a report to the Legislature's policy committees, which in return prepare a comprehensive background paper on the efficacy and efficiency of their licensing and enforcement programs. Both the Administration and regulated professional stakeholders actively engage in this process. Legislation is then subsequently introduced extending the repeal date for the entity along with any reforms identified during the sunset review process.

Dental Hygiene Board of California. The Dental Hygiene Board of California (DHBC) regulates three categories of mid-level dental professionals. These categories include registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). The DHBC maintains authority over all aspects of licensure, enforcement, and investigation of California dental hygienists. The DHBC is also responsible for approving the state's dental hygiene educational programs (DHEPs). In all, there are 29 educational programs in California. The DHBC provides prospective dental hygienists and dental professionals with the state's education and training standards to become California-licensed dental hygienists. The DHBC also dedicates time toward outreach efforts to support new professionals entering the dental hygiene community.

The following issues were discussed in the DHBC's sunset review hearing background paper, which resulted in language included in this bill.

Prior Issue #1 – additional revisions to prior changes from prior DHCB prior sunset legislation (SB 1482, Hill, 2018): Should the composition of the Dental Hygiene Board of California (DHBC) authorize any appointee the ability to remove a member of the DHBC? The DHBC consists of nine members, which is comprised as four dental hygienists, four public members, and one practicing general or public health dentist. Seven members are appointed by the Governor, one public member appointed by the Assembly Speaker, and one public member appointed by the Senate Rules Committee. Prior to 2019, the entire composition of the DHBC were members that were appointed solely by the Governor. The function of the Board is to discuss, deliberate, address, hear public comment, and act upon any programmatic, legislative, regulatory, or other issue or policy that may affect the professional population, interested stakeholders, and the consumers of California. However, the DHBC and stakeholders support additional revision relating to the DHBC's appointees and removal of a member of the DHBC. Specifically, AB 1257 proposes changes to the current statute relating to the DHBC’s appointees. Specifically, this proposed change in law would authorize any appointing authority the power to remove any member of the DHBC from office.

ISSUE #6: Should the DHBC eliminate the clinical examination requirement for licensure for graduates of California dental hygiene programs if they apply for license within three years of graduation?

In its 2023 DHBC Sunset Review Report, the Board requested revisions to current law to eliminate the clinical examination requirement for licensure for graduates of California dental hygiene educational programs if they apply for the license within three years of graduation. California schools teach and train their students to complete proficiencies that prepare them adequately for licensure where the need for a one-day examination is no longer required. Out-of-state applicants for licensure would still be required to complete an approved dental hygiene clinical examination due to the variances in dental hygiene education across the United States.

This bill includes language to eliminate the clinical examination requirements for licensure for graduates of California dental hygiene educational programs if they apply for the license within three years of graduation.

ISSUE #6: Should the DHBC require Basic Life Support (BLS) certification for all initial licensure applicants?

Additionally, the DHBC and stakeholders requested changes to current law to add a Basic Life Support (BLS) certification requirement for initial licensure applicants. BLS is already completed as a requirement while students are enrolled in the dental hygiene educational program and is a requirement to renew the license at its expiration. Typically, the BLS certification carries over from the graduating student to the licensee applicant. However, this certification is not listed in California law as a requirement for the license. The DHBC and stakeholders agree requiring BLS certification for a new applicant's licensure as well as for renewals of a license is logical and in the best interest of the profession and general public safety. DHBC concluded that BLS certification requirements would greatly benefit consumer's understanding of the licensee's training and would enhance consumer protection.

This bill contains language that would revise current statute and implement a new requirement of BS certification for initial applicants for licensure as well as for any license renewals.

ISSUE #7: Should there be a change in current law to Increase the number of Board mandated continuing education (CE) hours ceiling from 7.5 to 10 to expand the number of mandated CE hours to renew the license if necessary?

The Board is currently at its maximum mandated CE hours of 7.5 per license renewal cycle, and therefore, has no room to add or expand any additional CE requirements should the need arise. This does not mean the DHBC will increase the CE requirement, but has room and option to expand in the future should the need arise to increase the CE requirement for license renewal.

AB 1257 includes provisions that would increase the mandatory course work ceiling from 7.5 hours to 10 hours.

According to the Author

"AB 1257 is the sunset review vehicle for the Dental Hygiene Board of California (DHBC). The measure extends the sunset date for the DHBC and enacts technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC's 2023 Sunset Review Report."

Arguments in Support

The California Dental Hygienists' Association (CDHA) writes the following in support of this measure: "We support allowing board appointees to be removed by the appointing authority. Additionally, CDHA supports the 2028 sunset extension of the DHBC. The association looks forward to working with the legislature to address outstanding issues outlined in the DHBC's most recent sunset review report."

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Senate Appropriations Committee, the 2023-24 Budget Act provides approximately $2.90 million to support the continued operation of the DHBC’s licensing and enforcement activities, with no meaningful new fiscal impacts resulting from this bill.

VOTES:

ASM BUSINESS AND PROFESSIONS: 16-0-2

YES: Berman, Flora, Alanis, Alvarez, Bonta, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting

ABS, ABST OR NV: Chen, McCarty

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

ASSEMBLY FLOOR: 77-0-3

YES: Addis, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

ABS, ABST OR NV: Aguiar-Curry, Mathis, Papan

SENATE FLOOR: 39-0-1

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Caballero

UPDATED

VERSION: September 1, 2023

CONSULTANT: Robert Sumner / B. & P. / (916) 319-3301 FN: 0002245

 THIRD READING  

Bill No: AB 1257

Author: Berman (D), et al.

Amended: 9/1/23 in Senate

Vote: 21

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 13-0, 7/10/23

AYES: Roth, Nguyen, Alvarado-Gil, Archuleta, Ashby, Becker, Dodd, Eggman, Glazer, Niello, Smallwood-Cuevas, Wahab, Wilk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 9/1/23

AYES: Portantino, Jones, Ashby, Bradford, Seyarto, Wahab, Wiener

ASSEMBLY FLOOR: 77-0, 5/25/23 - See last page for vote

SUBJECT: Dentistry: Dental Hygiene Board of California: Dental hygienists: Examinations and licensure

SOURCE: Author

DIGEST:

This bill makes various changes to provisions of law regulating the practice of dental hygiene stemming from the joint sunset review oversight of the Dental Hygiene Board of California (DHBC) and extends the DHBC’s operations until 2028.

ANALYSIS:

Existing law:

1. Establishes DHBC, until January 1, 2024, tasked with oversight of registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). (Business and Professions Code (BPC) § 1900 - 1966.6)
2. Provides for the licensure of RDHs who meet specified education and examination standards. (BPC § 1917)
3. Provides for the licensure of RDHAPs, who must meet the same requirements as RDHs in addition to either meeting minimum experience and higher education requirements, or possessing a letter of acceptance into the employment utilization phase of the Health Workforce Pilot Project. (BPC § 1922)
4. States that in establishing the DHB, the intent of the Legislature was to permit the full utilization of RDHs, RDHAPs, and registered dental hygienists in extended functions (RDHEFs) in order to meet the dental care needs of all of the state’s citizens. (BPC § 1900)
5. Authorizes an RDH to perform the functions of a registered dental assistant. (BPC § 1907)
6. Authorizes an RDHAP to perform all the functions that may be performed by a registered dental assistant, as specified, in the following settings: residences of the homebound; schools; residential facilities and other institutions; and, shortage areas, as certified by the Office of Statewide Health Planning and Development (OSHPD). (BPC § 1926)
7. Defines “direct supervision” as requiring a licensed dentist to be physically present in the treatment facility during the performance of a procedure, and “general supervision” as allowing for a licensed dentist to not be physically present in the treatment facility during the performance of a procedure, provided the procedure is provided based on instructions given by the licensed dentist. (BPC § 1902)
8. States that any procedure performed or service provided by an RDH that does not specifically require direct supervision shall require general supervision, so long as it does not give rise to a situation in the dentist’s office requiring immediate services for alleviation of severe pain, or immediate diagnosis and treatment of unforeseeable dental conditions that, if not immediately diagnosed and treated, would lead to serious disability or death. (BPC § 1912)
9. Authorizes a RDHAP, a RDH who has been engaged in the practice of dental hygiene and in practice as a RDH for a minimum of 2,000 hours during the immediately preceding 36 months and holds a bachelor’s degree from an accredited institution of higher education, to practice in various specified settings and engage in specified activities in residences of the homebound, schools, residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services, dental health professional shortage areas (DHPSA), as certified by the Department of Health Care Access and Information in accordance with existing office guidelines, and dental offices. Authorizes a RDHAP to operate a mobile dental hygiene clinic if the clinic is registered with DHBC and authorizes a RDHAP to operate one mobile dental hygiene clinic as a dental hygiene office or facility. (BPC §§ 1925, 1926, 1926.1, and 1926.2)

This bill:

1. Extends DHBC’s operations until 2028 and specifies that each appointing authority has the power to remove any member of DHBC appointed by the appointing authority.
2. Adds graduation from a California accredited dental hygiene college approved by DHBC within the preceding three years to the pathway for RDH licensure and adds certification in basic life support to the requirements for RDH licensure.
3. Updates mandatory continuing education hours to specify that coursework prescribed by DHBC shall not exceed 10 hours, updated from 7.5 under current law.
4. Clarifies that a RDH, and not only a RDHAP can provide oral health inservice training to staff in a long-term health care facility.

Background

In early 2023, the Senate Business, Professions and Economic Development Committee and the Assembly Committee on Business and Professions (Committees) began their comprehensive sunset review oversight of 8 regulatory entities including the Board. The Committees conducted two oversight hearings in March of this year. This bill and the accompanying sunset bills are intended to implement legislative changes as recommended by staff of the Committees and which are reflected in the Background Papers prepared by Committee staff for each agency and program reviewed this year.

The dental hygiene profession was originally regulated by the Committee on Dental Auxiliaries (COMDA), a body established by the Legislature in 1974 and placed under the jurisdiction of the Dental Board of California. In 2008, COMDA became an independent committee with authority to regulate dental hygienist licensing and enforcement, and was renamed the Dental Hygiene Committee of California (DHCC). In 2018, DHCC transitioned to an independent board under the umbrella of the Department of Consumer affairs and was renamed DHBC. Today, the Board regulates three categories of dental professionals: Registered Dental Hygienists, Registered Dental Hygienists in Alternative Practice, and Registered Dental Hygienists with Extended Functions:

• A RDH is a dental professional authorized to perform all duties assigned to dental assistants (DA) and registered dental assistants (RDA), and those additionally enumerated in statute and regulation, under the supervision of a licensed dentist.

• A RDHAP may perform all the functions of a DA, RDA, and RDH under general supervision, and certain RDH duties independently, if prescribed by a dentist or physician and under other qualifying conditions.
• A RDHEF may perform all the functions of a DA, RDA, and RDH under general supervision, and other procedures specified in regulation under the direct supervision of a dentist.

Broadly, the practice of dental hygiene includes dental hygiene assessment and development, planning, implementation of a dental hygiene care plan, health education, counseling, and health screenings. Dental hygiene does not include diagnosis or comprehensive treatment planning, placing or removal of permanent restorations, surgery, prescribing medication, or administering anesthesia or conscious sedation. DHBC is also responsible for approving and overseeing RDH, RDHAP, and RDHEF educational programs.

As policymakers have explored opportunities to expand access to oral health care, it has continued to be argued that dental hygienists are underutilized and could play a larger role in delivering dental services to vulnerable communities. Because RDHs and RDHAPs possess meaningful education and training and are already entrusted to perform a range of procedures with varying degrees of dentist supervision, access to dental care could be responsibly expanded by continuing to empowering these professionals to provide additional services in more settings and with less supervision.

The DHBC requested amendments to BPC Section 1917 to eliminate the clinical examination requirement for licensure for graduates of California dental hygiene educational programs if they apply for the license within three years of graduation.

California schools teach and train their students to complete proficiencies that prepare them adequately for licensure where the need for a one-day examination is no longer required. Out-of-state applicants for licensure would still be required to complete an approved dental hygiene clinical examination due to the variances in dental hygiene education across the United States. Additionally, the DHBC has requested to amend BPC Section 1917 to add a Basic Life Support (BLS) certification requirement for initial licensure applicants. BLS is already completed as a requirement while students are enrolled in the dental hygiene educational program and is also a requirement to renew the license at its expiration. This bill makes various changes as requested by DHBC.

DHBC requires licensees to complete a certain number of continuing education (CE) hours to renew the dental hygiene license and to assist with continued competency for the practitioner in the profession. This bill adjusts the maximum amount of hours DHBC could require licensees to complete prior to renewal.

Comments

The issue of barriers to practice have been longstanding for RDHs, and particularly RDHAPs who are trained and authorized to provide unsupervised dental hygiene services in specified limited practice settings, settings that most likely result in a vulnerable and challenging patient populations - children, individuals with limited access to healthcare (and therefore likely with more advanced oral health conditions), and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings. Currently, an RDHAP may establish a practice in a dental health professional shortage area, but once that shortage is deemed to no longer exist, the RDHAP must relocate his or her practice.  AB 502 (Chau, Chapter 516, Statutes of 2015) originally contained provisions that would have allowed a RDHAP to continue practicing.  This language was later removed, but not before the California Health Benefits Review Program (CHBRP) performed an independent, evidence-based analysis of the legislation.  It determined that the services RDHAPs provide are largely effective in improving oral health and that “The reductions in administrative barriers associated with RDHAP practice may result in increasing numbers of RDHAP licensees. Thus, the long-term effects would likely increase access to dental health services and improve dental health for patient populations in RDHAP practice settings.    Essentially, CHBRP stated that RDHAPs improve oral health where they practice, and if there were fewer barriers to expanded practice, more people would benefit from their care. 

The Federal Trade Commission (FTC) commented on a similar situation in Georgia, in which the FTC was asked to comment on a bill proposing to relax supervision requirements on dental hygienists providing care in certain settings. In stating its support for the legislation, the FTC wrote, “Various authorities have concluded that direct supervision of dental hygienists is not necessary for them to provide preventive services safely. According to the National Governors Association, there is no clear evidence to support state dental boards’ concerns about quality and safety, which boards sometimes raise to justify restrictions on hygienists’ practicing without supervision in settings where dentists are not available. The Institute of Medicine has likewise concluded that restrictive scope of practice and supervision laws and regulations governing dental hygienists ‘are often unrelated to competence, education and training, or the safety’ of the services they provide. The IOM recommends that state legislatures increase access to basic oral health care by amending dental practice acts to allow allied dental professionals such as hygienists to work to the full extent of their education and training ‘in a variety of settings under evidence-supported supervision levels[.]’” FTC also noted that relaxing supervision standards could improve access and improve cost-effective care, since hygienists generally cost less than dentists. 

One reason the RDHAP license category was created was to serve areas of the state where dental hygiene services are scarce. Licensees are rightfully wary of opening a dental hygiene practice with the risk that they could lose the business if the DHPSA designation is lifted, however just by virtue of removing formal population based data, that does not imply that the needs of those same communities and areas will also go away. The designation can be removed if more providers are successful in treating patients in the DHPSA and in theory, additional oral health providers have opted to serve in the shortage area.

However, notable concerns remain that prohibiting a RDHAP from continuing to offer safe and effective services without supervision, as they can when a DHPSA designation is in place, once the designation is removed does not appear to benefit patients and the public. There is no change in the training, education, and skills the RDHAP receives and no adjustment to the fact that they still have to comply with scope of practice and standard of care laws – the only result of continued prohibition that these trained professionals serve patients once a designation is removed is further exacerbation of access to care challenges.

According to the DHBC, with the ability to maintain their practice should the DHPSA designation be lifted, more RDHAPs would potentially be willing to open new practices in these communities where their dental services are vitally needed the most. It is important to determine the necessity of limiting the ability of trained oral health professionals to safely serve California’s patient population and may wish to consider striking language in the law that says a RDHAP cannot serve in the same manner in the same area once a DHPSA designation is removed.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Committee on Appropriations, the 2023-24 Budget Act provides approximately $2.90 million and 15.0 positions to support the continued operation of the DHBC’s licensing and enforcement activities. The DHBC does not anticipate additional fiscal impacts from the provisions of this bill other than the annually approved expenses of its operations through January 1, 2028.

SUPPORT: (Verified 9/1/23)

California Dental Hygienists Association

Dental Hygiene Board of California

Foundation for Allied Dental Education

OPPOSITION: (Verified 9/1/23)

None received

ARGUMENTS IN SUPPORT: The California Dental Hygienist’ Association notes that “Generally, hygienists’ education and training track focuses on preventive care and therapies to bring health, healing and wellness to the patient by arresting disease and decay. This care is vital – especially in elderly and a disabled patients – to stop illness or infection in the mouth from exacerbating disease throughout the rest of the body. Hygienists educate skilled nursing facility staff and patients regarding best self‐care for patients and their children and provide care coordination ‐ connecting patients with a dentist who is available to treat them.”

According to the Foundation for Allied Dental Education, “By supporting the continuation of the Dental Hygiene Board and its oversight of educational programs, the programs are held to a greater level of accountability to ensure that graduates have completed comprehensive examinations. Competency is demonstrated over a portfolio of learning, assessment, and evaluation that best validates the clinical competency of a graduate far more effectively than a singular day at a singular examination administered by a state or regional entity. We commend the Dental Hygiene Board for its exemplary oversight of their licensees, their educational programs, and their direct responsibilities to both student and licensed allied dental healthcare personnel while ensuring public protection is centric to their mission. Their willingness to work with all stakeholders using a comprehensive approach to reform while addressing the complexities of the issues surrounding dental hygiene at every level is deserving of our recognition and appreciation.”

ASSEMBLY FLOOR: 77-0, 5/25/23

AYES: Addis, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Aguiar-Curry, Mathis, Papan

Prepared by: Sarah Mason / B., P. & E.D. /

9/2/23 12:11:12

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1257 (Berman) - Dentistry: Dental Hygiene Board of California: Dental hygienists: Examinations and licensure

Bill Summary:

AB 1257 extends the operation of the Dental Hygiene Board of California (DHBC) to January 1, 2028 and makes changes recommended during the joint sunset review of the DHBC, as specified.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on September 1, 2023

Fiscal Impact:

• The 2023-24 Budget Act provides approximately $2.90 million (State Dental Hygiene Fund) and 15.0 positions to support the continued operation of the DHBC’s licensing and enforcement activities.
• The DHBC does not anticipate additional fiscal impacts from the provisions of this bill other than the annually approved expenses of its operations through January 1, 2028.

Author Amendments:

Make conforming changes to authorize registered dental hygienists in extended functions and registered dental hygienists in alternative practice to provide oral health in-service training to staff in long-term health care facilities.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1257 (Berman) - Dentistry: Dental Hygiene Board of California: Dental hygienists: Examinations and licensure

Bill Summary:

AB 1257 extends the operation of the Dental Hygiene Board of California (DHBC) to January 1, 2028 and makes changes recommended during the joint sunset review of the DHBC, as specified.

Fiscal Impact:

The 2023-24 Budget Act provides approximately $2.90 million (State Dental Hygiene Fund) and 15.0 positions to support the continued operation of the DHBC’s licensing and enforcement activities.

The DHBC does not anticipate additional fiscal impacts from the provisions of this bill other than the annually approved expenses of its operations through January 1, 2028.

Background:

The dental hygiene profession was originally regulated by the Committee on Dental Auxiliaries (COMDA), a body established by the Legislature in 1974 and placed under the jurisdiction of the Dental Board of California. In 2008, COMDA became an independent committee with authority to regulate dental hygienist licensing and enforcement, and was renamed the Dental Hygiene Committee of California (DHCC). In 2018, DHCC transitioned to an independent board under the umbrella of the Department of Consumer Affairs (DCA) and was renamed DHBC. Today, the DHBC regulates three categories of dental professionals: Registered Dental Hygienists (RDH), Registered Dental Hygienists in Alternative Practice (RDHAP), and Registered Dental Hygienists with Extended Functions (RDHEF):

• A RDH is a dental professional authorized to perform all duties assigned to dental assistants (DA) and registered dental assistants (RDA), and those additionally enumerated in statute and regulation, under the supervision of a licensed dentist.
• A RDHAP may perform all the functions of a DA, RDA, and RDH under general supervision, and certain RDH duties independently, if prescribed by a dentist or physician and under other qualifying conditions.
• A RDHEF may perform all the functions of a DA, RDA, and RDH under general supervision, and other procedures specified in regulation under the direct supervision of a dentist.

Broadly, the practice of dental hygiene includes dental hygiene assessment and development, planning, implementation of a dental hygiene care plan, health education, counseling, and health screenings. Dental hygiene does not include diagnosis or comprehensive treatment planning, placing or removal of permanent restorations, surgery, prescribing medication, or administering anesthesia or conscious sedation. DHBC is also responsible for approving and overseeing RDH, RDHAP, and RDHEF educational programs.

Proposed Law:

• Extends DHBC’s operations until 2028.
• Specifies that each appointing authority has the power to remove any member of DHBC appointed by the appointing authority.
• Adds graduation from a California accredited dental hygiene college approved by DHBC within the preceding three years to the pathway for RDH licensure and adds certification in basic life support to the requirements for RDH licensure.
• Updates mandatory continuing education hours to specify that coursework prescribed by DHBC shall not exceed 10 hours, updated from 7.5 under current law.
• Clarifies that a RDH, and not only a RDHAP can provide oral health inservice training to staff in a long-term health care facility.

Related Legislation:

SB 812 (Roth, 2023) is the California Tax Education Council sunset bill. SB 812 is pending in Assembly Appropriations Committee.

SB 813 (Roth, 2023) is the Structural Pest Control Board sunset bill. SB 813 is pending in Assembly Appropriations Committee.

SB 814 (Roth, 2023) is the Bureau of Household Goods and Services sunset bill. SB 814 is pending in Assembly Appropriations Committee.

SB 815 (Roth, 2023) is the Medical Board of California sunset bill. SB 815 is pending in Assembly Appropriations Committee.

AB 1262 (Berman, 2023) is the Professional Fiduciaries Bureau sunset bill. AB 1262 is pending in this committee.

AB 1263 (Berman, 2023) is the Bureau of Automotive Repair sunset bill. AB 1263 is pending in this committee.

AB 1264 (Berman, 2023) is the California Acupuncture Board sunset bill. AB 1264 is pending in this committee.

Staff Comments:

The boards and bureaus within the DCA are special fund agencies whose activities are funded by regulatory and license fees and generally receive no support from the General Fund. New legislative mandates, even those modest in scope, may in totality create new cost pressures and impact the entity’s operating costs, future budget requests, or license fees.

-- END --

SENATE COMMITTEE ON

Senator Anthony Portantino, Chair

2023 - 2024 Regular Session

AB 1257 (Berman) - Dentistry: Dental Hygiene Board of California: Dental hygienists: Examinations and licensure

Bill Summary:

AB 1257 extends the operation of the Dental Hygiene Board of California (DHBC) to January 1, 2028 and makes changes recommended during the joint sunset review of the DHBC, as specified.

Fiscal Impact:

The 2023-24 Budget Act provides approximately $2.90 million (Professional Fiduciaries Fund) and 15.0 positions to support the continued operation of the DHBC’s licensing and enforcement activities.

The DHBC does not anticipate additional fiscal impacts from the provisions of this bill other than the annually approved expenses of its operations through January 1, 2028.

Background:

The dental hygiene profession was originally regulated by the Committee on Dental Auxiliaries (COMDA), a body established by the Legislature in 1974 and placed under the jurisdiction of the Dental Board of California. In 2008, COMDA became an independent committee with authority to regulate dental hygienist licensing and enforcement, and was renamed the Dental Hygiene Committee of California (DHCC). In 2018, DHCC transitioned to an independent board under the umbrella of the Department of Consumer Affairs (DCA) and was renamed DHBC. Today, the DHBC regulates three categories of dental professionals: Registered Dental Hygienists (RDH), Registered Dental Hygienists in Alternative Practice (RDHAP), and Registered Dental Hygienists with Extended Functions (RDHEF):

• A RDH is a dental professional authorized to perform all duties assigned to dental assistants (DA) and registered dental assistants (RDA), and those additionally enumerated in statute and regulation, under the supervision of a licensed dentist.
• A RDHAP may perform all the functions of a DA, RDA, and RDH under general supervision, and certain RDH duties independently, if prescribed by a dentist or physician and under other qualifying conditions.
• A RDHEF may perform all the functions of a DA, RDA, and RDH under general supervision, and other procedures specified in regulation under the direct supervision of a dentist.

Broadly, the practice of dental hygiene includes dental hygiene assessment and development, planning, implementation of a dental hygiene care plan, health education, counseling, and health screenings. Dental hygiene does not include diagnosis or comprehensive treatment planning, placing or removal of permanent restorations, surgery, prescribing medication, or administering anesthesia or conscious sedation. DHBC is also responsible for approving and overseeing RDH, RDHAP, and RDHEF educational programs.

Proposed Law:

• Extends DHBC’s operations until 2028.
• Specifies that each appointing authority has the power to remove any member of DHBC appointed by the appointing authority.
• Adds graduation from a California accredited dental hygiene college approved by DHBC within the preceding three years to the pathway for RDH licensure and adds certification in basic life support to the requirements for RDH licensure.
• Updates mandatory continuing education hours to specify that coursework prescribed by DHBC shall not exceed 10 hours, updated from 7.5 under current law.
• Clarifies that a RDH, and not only a RDHAP can provide oral health inservice training to staff in a long-term health care facility.

Related Legislation:

SB 812 (Roth, 2023) is the California Tax Education Council sunset bill. SB 812 is pending in Assembly Appropriations Committee.

SB 813 (Roth, 2023) is the Structural Pest Control Board sunset bill. SB 813 is pending in Assembly Appropriations Committee.

SB 814 (Roth, 2023) is the Bureau of Household Goods and Services sunset bill. SB 814 is pending in Assembly Appropriations Committee.

SB 815 (Roth, 2023) is the Medical Board of California sunset bill. SB 815 is pending in Assembly Appropriations Committee.

AB 1262 (Berman, 2023) is the Professional Fiduciaries Bureau sunset bill. AB 1262 is pending in this committee.

AB 1263 (Berman, 2023) is the Bureau of Automotive Repair sunset bill. AB 1263 is pending in this committee.

AB 1264 (Berman, 2023) is the California Acupuncture Board sunset bill. AB 1264 is pending in this committee.

Staff Comments:

The boards and bureaus within the DCA are special fund agencies whose activities are funded by regulatory and license fees and generally receive no support from the General Fund. New legislative mandates, even those modest in scope, may in totality create new cost pressures and impact the entity’s operating costs, future budget requests, or license fees.

-- END --

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Richard Roth, Chair

2023 - 2024 Regular

Bill No: Hearing Date: July 10, 2023

Subject:

SUMMARY:

Makes various changes to provisions of law regulating the practice of dental hygiene stemming from the joint sunset review oversight of the Dental Hygiene Board of California (DHBC) and extends the DHBC’s operations until 2028.

Existing law:

1. Establishes DHBC, until January 1, 2024, tasked with oversight of registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). (Business and Professions Code (BPC) § 1900 - 1966.6)
2. Provides for the licensure of RDHs who meet specified education and examination standards. (BPC § 1917)
3. Provides for the licensure of RDHAPs, who must meet the same requirements as RDHs in addition to either meeting minimum experience and higher education requirements, or possessing a letter of acceptance into the employment utilization phase of the Health Workforce Pilot Project. (BPC § 1922)
4. States that in establishing the DHB, the intent of the Legislature was to permit the full utilization of RDHs, RDHAPs, and registered dental hygienists in extended functions (RDHEFs) in order to meet the dental care needs of all of the state’s citizens. (BPC § 1900)
5. Authorizes an RDH to perform the functions of a registered dental assistant. (BPC § 1907)
6. Provides that the practice of dental hygiene includes dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan, in addition to oral health education, counseling, and health screenings; expressly excludes diagnosis and treatment, permanent restoration procedures, surgery, prescribing medication, and administration of anesthesia from the practice. (BPC § 1908)
7. Authorizes an RDHAP to perform all the functions that may be performed by a registered dental assistant, as specified, in the following settings: residences of the homebound; schools; residential facilities and other institutions; and, shortage areas, as certified by the Office of Statewide Health Planning and Development (OSHPD). (BPC § 1926)
8. Defines “direct supervision” as requiring a licensed dentist to be physically present in the treatment facility during the performance of a procedure, and “general supervision” as allowing for a licensed dentist to not be physically present in the treatment facility during the performance of a procedure, provided the procedure is provided based on instructions given by the licensed dentist. (BPC § 1902)
9. States that any procedure performed or service provided by an RDH that does not specifically require direct supervision shall require general supervision, so long as it does not give rise to a situation in the dentist’s office requiring immediate services for alleviation of severe pain, or immediate diagnosis and treatment of unforeseeable dental conditions that, if not immediately diagnosed and treated, would lead to serious disability or death. (BPC § 1912)
10. Authorizes an RDH to perform soft-tissue curettage and administer local anesthesia under the direct supervision of a licensed dentist, after submitting to the DHB evidence of satisfactory completion of an approved course of instruction in the procedures. (BPC § 1909)
11. Authorizes an RDH to perform preventive and therapeutic interventions, applications of agents used for the control of caries and periodontal disease, and the taking of impressions for bleaching trays and whitening devices under general supervision. (BPC § 1910)
12. Authorizes any person to apply topical fluoride, including fluoride varnish, to the teeth of individuals who are being served in a public health setting or a public health program that is created or administered by a federal, state, or local governmental entity, according to the prescription and protocol issued and established by a physician or dentist. (Health and Safety Code § 104762)
13. Authorizes a RDH to provide educational services, oral health training programs, and oral health screenings without supervision and other specified duties in a public health program or sponsored event providing free services. (BPC § 1911)
14. Authorizes a RDHAP, a RDH who has been engaged in the practice of dental hygiene and in practice as a RDH for a minimum of 2,000 hours during the immediately preceding 36 months and holds a bachelor’s degree from an accredited institution of higher education, to practice in various specified settings and engage in specified activities in residences of the homebound, schools, residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services, dental health professional shortage areas (DHPSA), as certified by the Department of Health Care Access and Information in accordance with existing office guidelines, and dental offices. Authorizes a RDHAP to operate a mobile dental hygiene clinic if the clinic is registered with DHBC and authorizes a RDHAP to operate one mobile dental hygiene clinic as a dental hygiene office or facility. (BPC §§ 1925, 1926, 1926.1, and 1926.2)

This bill:

1. Extends DHBC’s operations until 2028 and specifies that each appointing authority has the power to remove any member of DHBC appointed by the appointing authority.
2. Adds graduation from a California accredited dental hygiene college approved by DHBC within the preceding three years to the pathway for RDH licensure and adds certification in basic life support to the requirements for RDH licensure.
3. Updates mandatory continuing education hours to specify that coursework prescribed by DHBC shall not exceed 10 hours, updated from 7.5 under current law.
4. Clarifies that a RDH, and not only a RDHAP can provide oral health inservice training to staff in a long-term health care facility.

FISCAL EFFECT:

This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations, the bill will result in annual, ongoing costs of approximately $2 million to extend the sunset date of DHBC until January 1, 2028, supported by licensee fee revenue.

COMMENTS:

1. Purpose. This bill is sponsored by the Author, and is one of a number of sunset bills the Author is advancing this year. This bill is necessary to make changes to DHBC operations in order to improve oversight of licensees.
2. Oversight Hearings and Sunset Review of Licensing Boards and Programs. In early 2023, the Senate Business, Professions and Economic Development Committee and the Assembly Committee on Business and Professions (Committees) began their comprehensive sunset review oversight of 8 regulatory entities including the Board. The Committees conducted two oversight hearings in March of this year. This bill and the accompanying sunset bills are intended to implement legislative changes as recommended by staff of the Committees and which are reflected in the Background Papers prepared by Committee staff for each agency and program reviewed this year.
3. DHBC. The dental hygiene profession was originally regulated by the Committee on Dental Auxiliaries (COMDA), a body established by the Legislature in 1974 and placed under the jurisdiction of the Dental Board of California. In 2008, COMDA became an independent committee with authority to regulate dental hygienist licensing and enforcement, and was renamed the Dental Hygiene Committee of California (DHCC). In 2018, DHCC transitioned to an independent board under the umbrella of the Department of Consumer affairs and was renamed DHBC. Today, the Board regulates three categories of dental professionals: Registered Dental Hygienists, Registered Dental Hygienists in Alternative Practice, and Registered Dental Hygienists with Extended Functions:

• A RDH is a dental professional authorized to perform all duties assigned to dental assistants (DA) and registered dental assistants (RDA), and those additionally enumerated in statute and regulation, under the supervision of a licensed dentist.

• A RDHAP may perform all the functions of a DA, RDA, and RDH under general supervision, and certain RDH duties independently, if prescribed by a dentist or physician and under other qualifying conditions.
• A RDHEF may perform all the functions of a DA, RDA, and RDH under general supervision, and other procedures specified in regulation under the direct supervision of a dentist.

Broadly, the practice of dental hygiene includes dental hygiene assessment and development, planning, implementation of a dental hygiene care plan, health education, counseling, and health screenings. Dental hygiene does not include diagnosis or comprehensive treatment planning, placing or removal of permanent restorations, surgery, prescribing medication, or administering anesthesia or conscious sedation. DHBC is also responsible for approving and overseeing RDH, RDHAP, and RDHEF educational programs.

As policymakers have explored opportunities to expand access to oral health care, it has continued to be argued that dental hygienists are underutilized and could play a larger role in delivering dental services to vulnerable communities. A report published by the Legislative Analyst’s Office (LAO) in September 2018 recommended expanding RDHAP scope of practice as a solution for improving access to dental care, particularly for the developmentally disabled. Specifically, the LAO argued that “given the valuable role that RDHAPs can play in increasing access to dental care for consumers (particularly among those who are homebound or have anxiety about going to the dentist),” the Department of Health Care Services should work with stakeholders and the Legislature to propose statutory scope of practice changes for consideration.

Similar issues were discussed during the 2018 joint sunset review oversight of DHBC in 2018. At the time, the committees discussed “whether it would be in the best interest of public health and safety to expand the unsupervised hygiene practices of an RDH.” The committees also considered whether limiting the areas in which RDHAPs are authorized to provide unsupervised dental hygiene services creates unnecessary barriers to practice in other dental health care settings.

Because RDHs and RDHAPs possess meaningful education and training and are already entrusted to perform a range of procedures with varying degrees of dentist supervision, access to dental care could be responsibly expanded by continuing to empowering these professionals to provide additional services in more settings and with less supervision.

1. Review of the DHBC, Issues Identified and Recommended Changes. The following are some of the issues pertaining to DHBC that may require statutory changes, along with background information concerning the particular issue. Recommendations were made by Committee staff regarding the particular issue areas which needed to be addressed.
2. Issue 6: Licensure Requirements.

Background. The DHBC requested amendments to BPC Section 1917 to eliminate the clinical examination requirement for licensure for graduates of California dental hygiene educational programs if they apply for the license within three years of graduation.

California schools teach and train their students to complete proficiencies that prepare them adequately for licensure where the need for a one-day examination is no longer required. Out-of-state applicants for licensure would still be required to complete an approved dental hygiene clinical examination due to the variances in dental hygiene education across the United States.

Additionally, the DHBC has requested to amend BPC Section 1917 to add a Basic Life Support (BLS) certification requirement for initial licensure applicants. BLS is already completed as a requirement while students are enrolled in the dental hygiene educational program and is also a requirement to renew the license at its expiration. The BLS certification normally carries over from the graduating student to the licensee applicant. However, it’s not listed in the law as a requirement for the license so the DHBC requests to add BLS language for clarity and consumer protection.

Recommendation and Proposed Statutory Change. Staff recommended additional discussion on this subject within DHBC and the Board’s relevant Committee. This bill makes various changes as requested by DHBC.

1. Issue 7: Continuing Education.

Background. The DHBC requires licensees to complete a certain number of continuing education (CE) hours to renew the dental hygiene license and to assist with continued competency for the practitioner in the profession.

The DHBC is seeking to increase the number of Board mandated CE hours ceiling from 7.5 to 10 to expand the number of mandated CE hours to renew the license if necessary. The DHBC is currently at its maximum mandated CE hours of 7.5 per license renewal cycle, and therefore, has no room to add or expand any additional CE requirements should the need arise. This does not mean the DHBC will increase the CE requirement, but has room to expand in the future should the need arise to increase the CE requirement for license renewal.

Recommendation and Proposed Statutory Change. DHBC was advised to continue internal discussions with its appropriate committee. This bill adjusts the maximum amount of hours DHBC could require licensees to complete prior to renewal.

1. Issue 9: Continued Regulation.

Background. Patients and the public are best protected by strong regulatory boards with oversight of licensed professions. The DHBC has proven to be a competent entity providing important oversight of licensed dental hygienists and California dental hygiene educational programs.

Recommendation and Proposed Statutory Change. It was noted that the licensing and regulation of the dental hygiene profession should continue to be regulated by the current members of the DHBC and DHBC should be reviewed again on a future date to be determined. This bill extends DHBC operations for 4 years.

1. Arguments in Support. The California Dental Hygienist’ Association (CDHA) supports this bill and the extension of the DHBC. According to CDHA, it represents hygienists are licensed and regulated by the DHBC to bring preventive and therapeutic dental hygiene care to our communities in traditional dental offices, in Skilled Nursing Facilities, in public health at county health departments and healthcare clinics, in schools and to the homebound elderly and disabled in their homes. APs receive additional education and training to provide care without supervision to special needs patients using gentle techniques and abundant time in order to meet patients’ needs and provide care in ways patients can accept. The legislature created the AP to increase access to preventive and therapeutic dental hygiene care and serve patients in areas of the state that lack access to dental care, like Dental Health Professional Shortage Areas (DHPSAs). To dates, APs are all women who contract directly with MediCal and own businesses providing dental hygiene care directly to patients throughout the state in a variety of settings.”

CDHA notes that “Generally, hygienists’ education and training track focuses on preventive care and therapies to bring health, healing and wellness to the patient by arresting disease and decay. This care is vital – especially in elderly and a disabled patients – to stop illness or infection in the mouth from exacerbating disease throughout the rest of the body. Hygienists educate skilled nursing facility staff and patients regarding best self‐care for patients and their children and provide care coordination ‐ connecting patients with a dentist who is available to treat them.”

DHBC supports this bill, noting that it is “a consumer protection agency, and our responsibilities include the oversight of three categories of dental hygienists – Registered Dental Hygienists, Registered Dental Hygienist in Alternative Practice, and Registered Dental Hygienist in Extended Functions including licensing, enforcement, and regulation. We are also authorized to oversee all of the dental hygiene educational programs (DHEPs) in California where we review their program requirements, conduct school site visits, educate them on the laws that govern their dental hygiene programs, and enact progressive action should a DHEP be noncompliant of the law or a risk to consumer protection.”

According to the Foundation for Allied Dental Education, “By supporting the continuation of the Dental Hygiene Board and its oversight of educational programs, the programs are held to a greater level of accountability to ensure that graduates have completed comprehensive examinations. Competency is demonstrated over a portfolio of learning, assessment, and evaluation that best validates the clinical competency of a graduate far more effectively than a singular day at a singular examination administered by a state or regional entity. We commend the Dental Hygiene Board for its exemplary oversight of their licensees, their educational programs, and their direct responsibilities to both student and licensed allied dental healthcare personnel while ensuring public protection is centric to their mission. Their willingness to work with all stakeholders using a comprehensive approach to reform while addressing the complexities of the issues surrounding dental hygiene at every level is deserving of our recognition and appreciation.”

1. Remaining sunset issue that should be addressed in order to ensure greater access to oral health care. The issue of barriers to practice have been longstanding for RDHs, and particularly RDHAPs who are trained and authorized to provide unsupervised dental hygiene services in specified limited practice settings, settings that most likely result in a vulnerable and challenging patient populations - children, individuals with limited access to healthcare (and therefore likely with more advanced oral health conditions), and patients with compromised mobility or other health concerns that impede their ability to get dental care in more traditional settings. If an RDHAP chooses to practice in more traditional settings, like a dentist office, clinic, or hospital, he or she must perform those same services under general supervision licensed as an RDH. This does not align with the statutory authority of an RDHAP to be employed by a dentist, community clinic, free clinic, surgical clinic, chronic dialysis clinic, rehabilitation clinic, alternative birth center, specialty care clinic, clinic owned and operated by a federally recognized Indian tribe or tribal organization, or various iterations of a public hospital. Essentially, an RDHAP may not practice in many of the same settings as his or her employer.

Currently, an RDHAP may establish a practice in a dental health professional shortage area, but once that shortage is deemed to no longer exist, the RDHAP must relocate his or her practice. AB 502 (Chau, Chapter 516, Statutes of 2015) originally contained provisions that would have allowed a RDHAP to continue practicing. This language was later removed, but not before the California Health Benefits Review Program (CHBRP) performed an independent, evidence-based analysis of the legislation. It determined that the services RDHAPs provide are largely effective in improving oral health and that “The reductions in administrative barriers associated with RDHAP practice may result in increasing numbers of RDHAP licensees. Thus, the long-term effects would likely increase access to dental health services and improve dental health for patient populations in RDHAP practice settings. Essentially, CHBRP stated that RDHAPs improve oral health where they practice, and if there were fewer barriers to expanded practice, more people would benefit from their care.

The Federal Trade Commission (FTC) commented on a similar situation in Georgia, in which the FTC was asked to comment on a bill proposing to relax supervision requirements on dental hygienists providing care in certain settings. In stating its support for the legislation, the FTC wrote, “Various authorities have concluded that direct supervision of dental hygienists is not necessary for them to provide preventive services safely. According to the National Governors Association, there is no clear evidence to support state dental boards’ concerns about quality and safety, which boards sometimes raise to justify restrictions on hygienists’ practicing without supervision in settings where dentists are not available. The Institute of Medicine has likewise concluded that restrictive scope of practice and supervision laws and regulations governing dental hygienists ‘are often unrelated to competence, education and training, or the safety’ of the services they provide. The IOM recommends that state legislatures increase access to basic oral health care by amending dental practice acts to allow allied dental professionals such as hygienists to work to the full extent of their education and training ‘in a variety of settings under evidence-supported supervision levels[.]’” FTC also noted that relaxing supervision standards could improve access and improve cost-effective care, since hygienists generally cost less than dentists.

Further, any concern about any dentist involvement should be obviated by the existing requirements that a RDHAP is required to have a dentist of record with whom he or she consults, and the requirement that a RDHAP patient receive a prescription from a dentist or physician to continue receiving services after a certain period of time.

One reason the RDHAP license category was created was to serve areas of the state where dental hygiene services are scarce. Licensees are rightfully wary of opening a dental hygiene practice with the risk that they could lose the business if the DHPSA designation is lifted, however just by virtue of removing formal population based data, that does not imply that the needs of those same communities and areas will also go away. The designation can be removed if more providers are successful in treating patients in the DHPSA and in theory, additional oral health providers have opted to serve in the shortage area.

However, notable concerns remain that prohibiting a RDHAP from continuing to offer safe and effective services without supervision, as they can when a DHPSA designation is in place, once the designation is removed does not appear to benefit patients and the public. There is no change in the training, education, and skills the RDHAP receives and no adjustment to the fact that they still have to comply with scope of practice and standard of care laws – the only result of continued prohibition that these trained professionals serve patients once a designation is removed is further exacerbation of access to care challenges.

According to the DHBC, with the ability to maintain their practice should the DHPSA designation be lifted, more RDHAPs would potentially be willing to open new practices in these communities where their dental services are vitally needed the most. Moving forward, the Author should continue to work with stakeholders to determine the necessity of limiting the ability of trained oral health professionals to safely serve California’s patient population and may wish to consider striking language in the law that says a RDHAP cannot serve in the same manner in the same area once a DHPSA designation is removed.

SUPPORT AND OPPOSITION:

Support:

California Dental Hygienists’ Association

Dental Hygiene Board of California

Foundation for Allied Dental Education

Numerous RDHs

Opposition:

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 1257

Author:(Committee on Business and Professions)

As Amended Ver:April 24, 2023

Majority vote

SUMMARY

Extends the sunset date for the Dental Hygiene Board of California (DHBC) until January 1, 2028, and makes additional technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC's sunset review oversight process.

Major Provisions

1. Extends the sunset date of the DHBC and related appointment provisions to January 1, 2028.
2. Authorizes graduation from a California-accredited dental hygiene college approved by the DHBC within three years of application to qualify for initial licensure as a registered dental hygienist.
3. Requires a Basic Life Support (BLS) certification requirement for initial licensure applicants.
4. Revises the number of DHBC mandated continuing education (CE) hours ceiling from 7.5 to 10.
5. Makes a clarifying change regarding the removal of board members by their appointing authority.

COMMENTS

Sunset review. In order to ensure that California's myriad professional boards and bureaus are meeting the state's public protection priorities, authorizing statutes for these regulatory bodies are subject to statutory dates of repeal, at which point the entity "sunsets" unless the date is extended by the Legislature. The sunset process provides a regular forum for discussion around the successes and challenges of various programs and the consideration of proposed changes to laws governing the regulation of professionals. Currently, the sunset review process applies to approximately three dozen different boards and bureaus under the Department of Consumer Affairs, as well as the Department of Real Estate and three nongovernmental nonprofit councils.

On a schedule averaging every four years, each entity is required to present a report to the Legislature's policy committees, which in return prepare a comprehensive background paper on the efficacy and efficiency of their licensing and enforcement programs. Both the Administration and regulated professional stakeholders actively engage in this process. Legislation is then subsequently introduced extending the repeal date for the entity along with any reforms identified during the sunset review process.

Dental Hygiene Board of California. The Dental Hygiene Board of California (DHBC) regulates three categories of mid-level dental professionals. These categories include registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). The DHBC maintains authority over all aspects of licensure, enforcement, and investigation of California dental hygienists. The DHBC is also responsible for approving the state's dental hygiene educational programs (DHEPs). In all, there are 29 educational programs in California. The DHBC provides prospective dental hygienists and dental professionals with the state's education and training standards to become California-licensed dental hygienists. The DHBC also dedicates time toward outreach efforts to support new professionals entering the dental hygiene community.

The following issues were discussed in the DHBC's sunset review hearing background paper, which resulted in language included in this bill.

Prior Issue #1 – additional revisions to prior changes from prior DHCB prior sunset legislation (SB 1482 (Hill), Chapter 858, Statutes of 2018): Should the composition of the Dental Hygiene Board of California (DHBC) authorize any appointee the ability to remove a member of the DHBC? The DHBC consists of nine members, which is comprised as four dental hygienists, four public members, and one practicing general or public health dentist. Seven members are appointed by the Governor, one public member appointed by the Assembly Speaker, and one public member appointed by the Senate Rules Committee. Prior to 2019, the entire composition of the DHBC were members that were appointed solely by the Governor. The function of the Board is to discuss, deliberate, address, hear public comment, and act upon any programmatic, legislative, regulatory, or other issue or policy that may affect the professional population, interested stakeholders, and the consumers of California. However, the DHBC and stakeholders support additional revision relating to the DHBC's appointees and removal of a member of the DHBC. Specifically, AB 1257 proposes changes to the current statute relating to the DHBC's appointees. Specifically, this proposed change in law would authorize any appointing authority the power to remove any member of the DHBC from office.

ISSUE #6: Should the DHBC eliminate the clinical examination requirement for licensure for graduates of California dental hygiene programs if they apply for license within three years of graduation?

In its 2023 DHBC Sunset Review Report, the Board requested revisions to current law to eliminate the clinical examination requirement for licensure for graduates of California dental hygiene educational programs if they apply for the license within three years of graduation. California schools teach and train their students to complete proficiencies that prepare them adequately for licensure where the need for a one-day examination is no longer required. Out-of-state applicants for licensure would still be required to complete an approved dental hygiene clinical examination due to the variances in dental hygiene education across the United States.

This bill includes language to eliminate the clinical examination requirements for licensure for graduates of California dental hygiene educational programs if they apply for the license within three years of graduation.

ISSUE #6: Should the DHBC require Basic Life Support (BLS) certification for all initial licensure applicants?

Additionally, the DHBC and stakeholders requested changes to current law to add a Basic Life Support (BLS) certification requirement for initial licensure applicants. BLS is already completed as a requirement while students are enrolled in the dental hygiene educational program and is a requirement to renew the license at its expiration. Typically, the BLS certification carries over from the graduating student to the licensee applicant. However, this certification is not listed in California law as a requirement for the license. The DHBC and stakeholders agree requiring BLS certification for a new applicant's licensure as well as for renewals of a license is logical and in the best interest of the profession and general public safety. DHBC concluded that BLS certification requirements would greatly benefit consumer's understanding of the licensee's training and would enhance consumer protection.

This bill contains language that would revise current statute and implement a new requirement of BLS certification for initial applicants for licensure as well as for any license renewals.

ISSUE #7: Should there be a change in current law to Increase the number of Board mandated continuing education (CE) hours ceiling from 7.5 to 10 to expand the number of mandated CE hours to renew the license if necessary?

The Board is currently at its maximum mandated CE hours of 7.5 per license renewal cycle, and therefore, has no room to add or expand any additional CE requirements should the need arise. This does not mean the DHBC will increase the CE requirement, but has room and option to expand in the future should the need arise to increase the CE requirement for license renewal.

This bill includes provisions that would increase the mandatory course work ceiling from 7.5 hours to 10 hours.

According to the Author

AB 1257 is the sunset review vehicle for the Dental Hygiene Board of California (DHBC). The measure extends the sunset date for the DHBC and enacts technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC's 2023 Sunset Review Report.

Arguments in Support

The CA Dental Hygienists' Association (CDHA) writes the following in support of this measure: "We support allowing board appointees to be removed by the appointing authority. Additionally, CDHA supports the 2028 sunset extension of the DHBC. The association looks forward to working with the legislature to address outstanding issues outlined in the DHBC's most recent sunset review report."

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Appropriations Committee, this measure would create annual, ongoing costs of approximately $2 million to extend the sunset date of DHBC until January 1, 2028 (State Dental Hygiene Fund). The State Dental Hygiene Fund is fully self-supporting with fee revenue.

VOTES

ASM BUSINESS AND PROFESSIONS: 16-0-2

YES: Berman, Flora, Alanis, Alvarez, Bonta, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McKinnor, Stephanie Nguyen, Joe Patterson, Ting

ABS, ABST OR NV: Chen, McCarty

ASM APPROPRIATIONS: 15-0-1

YES: Holden, Megan Dahle, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Hart, Lowenthal, Mathis, Papan, Pellerin, Sanchez, Weber, Ortega

ABS, ABST OR NV: Robert Rivas

UPDATED

VERSION: April 24, 2023

CONSULTANT: Annabel Smith / B. & P. / (916) 319-3301 FN: 0000484

Date of Hearing: May 17, 2023

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Chris Holden, Chair

ABPCA Bill Id:AB 1257

Author:(Committee on Business and Professions) – As Amended Ver:April 24, 2023

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill extends the sunset date for the Dental Hygiene Board of California (DHBC) until January 1, 2028, and makes additional technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC’s sunset review oversight process. This bill also increases the mandatory coursework ceiling from 7.5 hours to 10 hours and adds to the requirements of initial licensure that the applicant graduate from a California-accredited dental hygiene college approved by DHBC and have current, valid certification in basic life support, as specified.

FISCAL EFFECT:

Annual, ongoing costs of approximately $2 million to extend the sunset date of DHBC until January 1, 2028 (State Dental Hygiene Fund). The State Dental Hygiene Fund is fully self-supporting with fee revenue.

COMMENTS:

1. Purpose. This bill is the sunset review vehicle for DHBC. The measure extends the sunset date for the DHBC and enacts technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC’s 2023 Sunset Review Report.
   
2. Background.
   
   Sunset review. To ensure California’s professional boards and bureaus are meeting the state’s public protection priorities, the authorizing statutes for these regulatory bodies are subject to statutory dates of repeal. Unless the date is extended by the Legislature, the entity “sunsets” and its enacting statute is repealed. The sunset process allows for a consistent forum to facilitate constructive discussions regarding the successes and challenges of various programs and provides the Legislature with an opportunity to consider proposed changes to laws governing the regulation of professionals.
   
   DHBC. DHBC regulates three categories of mid-level dental professionals: registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). The DHBC maintains authority over all aspects of licensure, enforcement, and investigation of California dental hygienists.
   
   The DHBC is also responsible for approving the state’s 29 dental hygiene educational programs. The DHBC provides prospective dental hygienists and other dental professionals with the state’s education and training standards to become California-licensed dental hygienists. The DHBC also conducts outreach to support new professionals entering the dental hygiene community.
   
   The DHBC has the authority to regulate the dental hygiene profession under the direction of statutes in the Business and Professions Code, as well as sections of the California Code of Regulations. DHBC has the responsibility to pursue legislation; author and enforce regulations; grant, renew, review, and withdraw approval of dental hygiene programs; conduct site visits, cite and fine, and place dental hygiene educational programs on probation; conduct feasibility standards for new dental hygiene educational programs; issue, suspend, and revoke dental hygiene licenses and permits; and investigate licensing violations; among other duties.
   
   Workforce Development. The DHBC has also been seeking pathways to implement Business and Professions Code Section 1900, which states the intent of the Legislature to permit the full utilization of RDHs, RDHAPs, and RDHEFs to meet the dental care needs of all of the state's citizens. According to the DHBC’s 2023 sunset review, barriers to full utilization of all categories of dental hygienists is restrictive supervision levels, scope of practice restrictions limiting the services that dental hygienists are allowed to provide independently, and the inability for dental hygiene practitioners such as RDHAPs to obtain full payment for services rendered. DHBC also points to current law that states which dental hygiene services are completed under the direct supervision of a licensed dentist, in other words, the dentist employer must be physically present in the office when the service is performed, and which may be performed under general supervision, in other words, the dentist employer need not be present when the services are performed.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Marc Berman, Chair

ABPCA Bill Id:AB 1257

Author:(Committee on Business and Professions) – As Amended Ver:April 24, 2023

SUBJECT: Dentistry: Dental Hygiene Board of California: Dental hygienists: Examinations and licensure.

SUMMARY: Extends the sunset date for the Dental Hygiene Board of California (DHBC) until January 1, 2028, and makes additional technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC’s sunset review oversight process.

EXISTING LAW:

1. Establishes the Dental Hygiene Board of California (DHBC) under the Department of Consumer Affairs (DCA) with the authority to grant and regulate licensure of various types of dental hygienists. (Business and Professions Code (BPC) § 1902)
2. Specifies the DHBC to consist of nine members. The Governor appoints seven members and specifies two of those members must be public members and one member must be a practicing general or public health dentist who holds a current license in California. Requires four members to be registered dental hygienists who hold current licenses in California. Of the registered dental hygienist members, one shall be licensed either in alternative practice or in extended functions, one shall be a dental hygiene educator, and two shall be registered dental hygienists. No public member shall have been licensed under this chapter within five years of the date of his or her appointment or have any current financial interest in a dental-related business. Requires one public member to be appointed by the Senate Committee on Rules. Requires one public member to be appointed by the Speaker of the Assembly. (BPC § 1903)
3. Authorizes a registered dental hygienist (RDH) to perform all functions that may be performed by a registered dental assistant (RDA). (BPC § 1907(a))
4. Specifies the practice of dental hygiene includes dental hygiene assessment and development, planning, and implementation of a dental hygiene care plan. The practice also includes oral health education, counseling, and health screenings. (BPC § 1908(a))
5. Specifies the practice of dental hygiene does not include diagnosis and comprehensive treatment planning, placing, condensing, carving, or removal of permanent restorations, surgery or cutting on hard and soft tissue including, but not limited to, the removal of teeth and the cutting and suturing of soft tissue, prescribing medication, and administering local or general anesthesia or oral or parenteral conscious sedation, except for the administration of nitrous oxide and oxygen, whether administered alone or in combination with each other, or local anesthesia. (BPC § 1908)
6. Authorizes an RDH to perform the following procedures under direct supervision of a licensed dentist, after submitting to the dental hygiene board evidence of satisfactory completion of a course of instruction, approved by the dental hygiene board, in the procedures:
   1. Soft-tissue curettage.
   2. Administration of local anesthesia.

Administration of nitrous oxide and oxygen, whether administered alone or in combination with each other.(BPC § 1909 (a)(b)(c))

1. Authorizes an RDH to perform, under general supervision the following procedures: preventive and therapeutic interventions, including oral prophylaxis, scaling, and root planning, application of topical, therapeutic, and subgingival agents used for the control of caries and periodontal disease, taking of impressions for bleaching trays and application and activation of agents with nonlaser, light-curing devices, and taking of impressions for bleaching trays and placements of in-office, tooth-whitening devices. (BPC § 1910 (a)(b)(c)(d))
2. Authorizes an RDH to place interim therapeutic restorations. (BPC § 1910.5(a)(2))
3. Permits an RDHAP to practice as an employee of a dentist or of another RDHAP, as an independent contractor, as a sole proprietor of an alternative dental hygiene practice, in a primary care clinic or specialty clinic licensed by CDPH, in a clinic exempt from licensure, as specified, in clinics owned or operated by a public hospital or health system, or in a professional corporation. (BPC § 1925)
4. Authorizes a registered dental hygienist in alternative practice (RDHAP) may perform the duties authorized pursuant to subdivision (a) of Section 1907, subdivision (a) of Section 1908, and subdivisions (a) and (b) of Section 1910 in the following settings:
   1. Residences of the homebound.
   2. Schools.
   3. Residential facilities and other institutions and medical settings that a residential facility patient has been transferred to for outpatient services.
   4. Dental health professional shortage areas, as certified by the Department of Health Care Access and Information in accordance with existing office guidelines.
   5. Dental offices.

(BPC § 1926)

THIS BILL:

1. Extends the sunset date of the DHBC and related appointment provisions to January 1, 2028.
2. Authorizes graduation from a California-accredited dental hygiene college approved by the DHBC within three years of application to qualify for initial licensure as a registered dental hygienist.
3. Requires a Basic Life Support (BLS) certification requirement for initial licensure applicants.
4. Revises the number of DHBC mandated continuing education (CE) hours ceiling from 7.5 to 10.
5. Makes a clarifying change regarding the removal of board members by their appointing authority.

FISCAL EFFECT: Unknown. This bill has been keyed fiscal by Legislative Counsel.

COMMENTS:

Purpose. This bill is the sunset review vehicle for the Dental Hygiene Board of California (DHBC). The measure extends the sunset date for the DHBC and enacts technical changes, statutory improvements, and policy reforms in response to issues raised during the DHBC’s 2023 Sunset Review Report.

Background.

Sunset review. In order to ensure California’s professional boards and bureaus are meeting the state’s public protection priorities, authorizing statutes for these regulatory bodies are subject to statutory dates of repeal. Unless the date is extended by the Legislature, the entity “sunsets” and its enacting statute is repealed from law. The sunset process allows for a consistent forum to facilitate constructive discussions regarding the successes and challenges of various programs. The process also provides the Legislature with thoughtful consideration of proposed changes to laws governing the regulation of professionals. On a schedule averaging every four years, each entity is required to present a report to the Legislature’s policy committees, which in return prepare a comprehensive background paper on the efficacies and efficiencies of their licensing and enforcement programs. Both the Administration and regulated professional stakeholders actively engage in this process. Legislation is then subsequently introduced extending the repeal date for the entity along with any reforms identified during the sunset review process.

Dental Hygiene Board of California. The Dental Hygiene Board of California (DHBC) regulates three categories of mid-level dental professionals. These categories include registered dental hygienists (RDH), registered dental hygienists in alternative practice (RDHAP), and registered dental hygienists in extended functions (RDHEF). The DHBC maintains authority over all aspects of licensure, enforcement, and investigation of California dental hygienists.

The DHBC is also responsible for approving the state’s dental hygiene educational programs (DHEPs). In all, there are 29 educational programs in California. The DHBC provides prospective dental hygienists and dental professionals with the state’s education and training standards to become California-licensed dental hygienists. The DHBC also dedicates time toward outreach efforts to support new professionals entering the dental hygiene community.

The DHBC has the authority to regulate the dental hygiene profession under the direction of statutes contained in the Business and Professions Code (BPC) Sections 1900-1967.4 as well as sections of the California Code of Regulations (CCR). Current law grants the DHBC with the responsibility to do all of the following:

• Pursue legislation;
• Author and enforce regulations;
• Grant, renew, review, and withdraw approval of dental hygiene programs;
• Periodically conduct site visits, cite and fine, and place dental hygiene educational programs on probation;
• Conduct feasibility standards for new dental hygiene educational programs;
• Develop and maintain the dental hygiene Law of Ethics Examination in conjunction with the Office of Professional Examination Services;
• Review and approve RDHAP applications for mobile dental hygiene clinics to enhance access to care in underserved areas of the state.
• Issue, suspend, and revoke dental hygiene licenses and permits;
• Conduct random continuing education audits of licensees for compliance of license renewal laws;
• Oversee licenses placed on probation;
• Conduct investigation of and administer enforcement for licensing violations; and
• Participate in outreach and support of the dental and dental hygiene community.

History of the Board. The practice of dental hygiene includes dental hygiene assessment and development, planning, implementation of a dental hygiene care plan, health education, counseling, and health screenings. Dental hygiene does not include diagnosis or comprehensive treatment planning, placing or removal of permanent restorations, surgery, prescribing medication, or administering anesthesia or conscious sedation.

More than twenty years ago in 2002, the Joint Legislative Sunset Review Committee (JLSRC) reached a consensus that dental hygienists had attained a status where the profession’s roles and responsibilities justified granting dental hygienists an independent regulatory body separate from the Dental Board of California (DBC). Prior to this decision, dental hygienists and dental assisting professions were co-regulated under the DBC through its Committee on Dental Auxiliaries (COMDA), which was established by the Legislature in 1974. Beginning in 2001, COMDA was repeatedly criticized by the JLSRC because of its consistent failure to implement and “permit the full utilization of dental auxiliaries in order to meet the dental care needs of all the state’s citizens.”

One of the perceived flaws of COMDA was that it did not have the independent authority to regulate dental auxiliaries, which included dental assistants, registered dental hygienists, registered dental hygienists in extended functions, and registered dental hygienists in alternative practice; it could merely provide recommendations to DBC. The recommendations provided were regularly rejected by the DBC, with a majority of its members consisting of practicing dentists. With allegations of bias and conflict between COMDA and DBC, it was determined that COMDA needed significant reform and restructuring. The JLSRC, believing that the DBC advocated only for dentists, urged the Legislature to move COMDA into its own independent licensing agency for dental auxiliaries.

The Legislature responded to the JLSRC’s recommendation and introduced Senate Bill (SB) 853 (Chapter 31, Statutes of 2008) to address the JLSRC’s ongoing concerns. One provision of SB 853 eliminated COMDA and authorized the Committee on Dental Auxiliaries (CODA) to operate as its own independent licensing agency for dental auxiliaries. In 2008, Governor Schwarzenegger signed SB 853 into law. The Dental Hygiene Committee of California (DHCC) was officially established in Fiscal Year (FY) 2009-10, nominally still within the jurisdiction of the DBC. Ten years after the dental hygiene profession successfully advocated and established a separate committee, the Legislature revisited whether its name should be changed to reflect its status as a truly independent regulatory body. In 2018, the Legislature granted the DHCC approval to change its name to the DHBC. The official name change from “Committee” to “Board” was accomplished through the DHBC’s sunset bill, SB 1482 (Chapter 858, Statutes of 2018). The changes in SB 1482 were considered significant for a variety of reasons. The name change was viewed as legitimizing the DHBC as an independent, semiautonomous state agency and not a subdivision of another entity, and operating within the Department of Consumer Affairs (DCA). Although the DHBC’s revised name could be seen as purely technical, the change was considered notable as it conveyed the regulator’s independence from the DBC, and focus on the dental hygienist profession. Although the DHCC was never meaningfully under the purview of the DBC, it was perceived to be under the DBC because the majority of dental hygiene licensing entities are structured this way.

It is worth noting that the DHBC is the only self-regulating dental hygiene oversight government agency with the mission of consumer protection in the United States. Other states are watching what the DHBC does in regulating the profession to possibly initiate an autonomous dental hygiene oversight agency themselves. During the DHBC/DHCC’s early years and under its former name, it functioned as an independent committee that acted as the sole authority for regulating every aspect of the dental hygiene profession. The DHCC maintained authority of dental hygiene profession for licensing, enforcement, and approval of dental hygiene education programs. Since its last sunset review, the DHBC has continued that mission with a name that is more reflective of its status and autonomy.

Workforce Development: The DHBC has made efforts in seeking pathways to implement BPC Section 1900 which states: “It is the intent of the Legislature by enactment of this article to permit the full utilization of registered dental hygienists, registered dental hygienists in alternative practice, and registered dental hygienists in extended functions in order to meet the dental care needs of all of the state's citizens.”

According to the DHBC’s 2023 sunset review, one primary reason that restrict full utilization of all categories of dental hygienists and decreases their ability to provide care for all of the state's citizens are restrictive supervision levels, scope of practice restrictions limiting the services that dental hygienists are allowed to provide independently, and the inability for dental hygiene practitioners such as the RDHAP to obtain full reimbursement payment for the services rendered. DHBC also points to current law that states which dental hygiene services are completed under the direct supervision of a licensed dentist – the dentist employer must be physically present in the office when the service is performed – and general supervision – the dentist employer need not be present when the services are performed.

Current laws allow the dentist employer to determine the level of supervision necessary for the performance of the services that dental assistants are legally allowed to provide. This same provision should be extended to dental hygienists where the supervising dentist should be able to determine the level of supervision required for a dental hygienist working in the dental office rather than the law dictating the required level of supervision. Although BPC Sections 1912 through 1914 allow for general supervision for most services performed by dental hygienists, some services are still authorized under direct supervision (soft tissue curettage, local anesthesia administration, and nitrous oxide-oxygen analgesia) which, according to the DHBC, limits the full utilization of the dental hygienist services. The DHBC has approved to seek legislation to remove the direct supervision restrictions in the current law for soft tissue curettage and administration of local anesthesia and amend it for the supervising dentist to indicate the level of supervision needed for these procedures.

Regarding DHBC’s efforts to address workforce issues, the DHBC collects workforce information data for the California Department of Healthcare Access and Information (HCAI) through surveys required to be completed at the time of the license renewal. This data is forwarded to HCAI annually for its use, however, is not shared with the DHBC. Unfortunately, many dental hygienists could be considered “nomads,” an individual constantly moving for a variety of reasons. Many dental hygienists work in several dental locations and do not have typical fulltime jobs at one single office. There is also a consensus in communications with the educational programs and licensees that they prefer to work in the heavier populated areas of the state rather than seeking work in the more rural and underserved areas. Better employment opportunities and higher wages play the largest role in determining where licensees choose to work.

The DHBC has requested amendments to BPC Section 1909 for clarification and authorize local anesthesia administration under the direct or general supervision as determined by the supervising licensed dentist and maintain the nitrous oxide-oxygen analgesia and soft tissue curettage under the direct supervision of a licensed dentist. The DHBC and segments of the dental profession state this revision allows registered dental hygienists that are confident in these functions to provide the care under standing orders or with more oversight depending on the how the specific dental office chooses to operate. This change in supervision would allow more flexibility for the dental team to meet the needs of patients more efficiently.

Question of the Direct Supervision Requirements: Dental hygienists work under the general and direct supervision of a licensed dentist unless they are employed by a public health agency. The definition of general supervision is the supervision of dental procedures based on instructions given by a licensed dentist who is not required to be physically present in the treatment facility during the performance of these procedures. Direct supervision is defined as the dentist is required to be physically present in the treatment facility during the performance of these procedures.

There are only three dental procedures where direct supervision is required: Soft Tissue Curettage, Local Anesthesia administration, and Nitrous Oxide-Oxygen Analgesia administration. All other dental hygiene procedures may be completed under the general supervision of a licensed dentist. If the patient is a patient of record of the dentist and a comprehensive treatment plan has been previously established, the majority of dental hygienists may perform general supervision services with authorization from a licensed dentist through online means such as telehealth or tele-dentistry.

DHPSA Designation: In the DHBC’s 2023 Sunset Review Report, the Board recommends new statutory language that will allow an RDHAP who has opened a stand-alone dental hygiene practice site in a Dental Health Professional Shortage Area (DHPSA) to maintain their practice if in the future, the DHPSA designation is removed. According to the DHBC, one reason the RDHAP license category was created was to serve the designated shortage areas of the state where dental hygiene services are scarce. The DHBC states that licensees are wary of opening a dental hygiene practice with the risk that they could lose the business if the DHPSA designation is lifted by the Federal Government due to the dental hygiene services they are providing to the population. According to the DHBC, with the ability to maintain their practice should the DHPSA designation be lifted, more RDHAPs would be willing to open new practices in these communities where their dental services are vitally needed the most

Prior Related Legislation.

AB 560 (Perata) Chapter 753, Statutes of 1997, authorized RDHAPs to perform certain duties in “residential facilities and other institutions,” among other settings.

SB 853 (Perata) Chapter 31, Statutes of 2008, eliminated the Committee on Dental Auxiliaries within the Dental Board of California, transfers the regulation of dental hygienists to a newly created Dental Hygiene Committee, and transfers the regulation of a Registered Dental Assistants (RDA) to the Dental Board of California.

SB 1482 (Hill) Chapter 858, Statutes of 2018, reestablished the Dental Hygiene Committee of California (DHCC) as the Dental Hygiene Board of California (DHBC), an independent board within the Department of Consumer Affairs (DCA). This measure authorizes the DHBC to review and discipline educational programs. The bill also continued DHBC’s operations until January 1, 2023 and made other technical, non-substantive changes and updates to the Dental Hygiene Practice Act (Act). Finally, the measure reduced the time to attain licensure following successful completion of the dental hygiene exam from five to two years.

SB 786 (Committee on Business, Professions and Economic Development) Chapter 456, Statutes of 2020, implemented changes related to the DHBC. Specifically, this bill added "Dental" before “hygiene board” throughout the Act and clarified that restoration materials used in interim therapeutic restorations are "interim.”

SB 1495 (Committee on Business, Professions and Economic Development) Chapter 511, Statutes of 2022, clarifies licensees complete a specific number of continuing education (CE) hours in order to be eligible for licensure renewal. Specifically, this measure made it clear CE requirements must be completed in the preceding two-year period prior to the license’s expiration.

AB 2145 (Davies) Chapter 157, Statutes of 2022, clarifies that a registered dental hygienist in alternative practice (RDHAP) may provide dental services to patients in long term health care health (LTC) facilities. Also permits a RDHAP to provide oral health in-service training to staff in LTC facilities.

ARGUMENTS IN SUPPORT:

The CA Dental Hygienists’ Association (CDHA) supports this bill and allowing board appointees to be removed by the appointing authority. Additionally, the CDHA states that it understands this bill will be the vehicle for the sunset extension of the DHBC. CDHA supports extending the sunset of the DHBC and the board appointee provision. CDHA would like to work with the legislature to address outstanding issues in the sunset review report.

ARGUMENTS IN OPPOSITION:

The California Dental Association (CDA) is opposed to possible inclusion of specific language in this sunset bill. CDA writes, “to express a position of ‘oppose unless amended’ to the anticipated language to be amended in [this bill], which serves as the legislative vehicle for the Dental Hygiene Board of California’s (DHBC) sunset review. While supporting the continuation of DHBC and the role it maintains in protecting the public, CDA respectfully opposes sections of the DHBC Legislative Sunset Review Report regarding the expansion of the registered dental hygienist (RDH) scope of practice to include the unsupervised administration of local anesthesia and the continuation of brick-and-mortar practices of registered dental hygienists in alternative practice (RDHAP) in previously designated Dental Health Professional Shortage Areas (DHPSA). Information is unclear about the current problems these proposals aim to solve and whether sunset review is the most appropriate venue in which to make these changes.”

REGISTERED SUPPORT:

The California Dental Hygienists’ Association (CDHA)

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Annabel Smith / B. & P. / (916) 319-3301