Titles of Regulations: 18VAC60-21. Regulations Governing the Practice of Dentistry (amending 18VAC60-21-40, 18VAC60-21-240).

18VAC60-25. Regulations Governing the Practice of Dental Hygiene (amending 18VAC60-25-30, 18VAC60-25-180).

18VAC60-30. Regulations Governing the Practice of Dental Assistants (amending 18VAC60-30-30, 18VAC60-30-150).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

October 18, 2019 - 9:05 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, 2nd Floor, Board Room 3, Henrico, VA 23233.

Public Comment Deadline: November 15, 2019.

Agency Contact: Sandra Reen, Executive Director, Board of Dentistry, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4437, FAX (804) 527-4428, or email sandra.reen@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Dentistry the authority to levy fees sufficient to cover all expenses and to promulgate regulations to administer the regulatory system. In addition, the board is obligated by § 54.1-113 of the Code of Virginia to reduce fees if projections indicate that the board is continuing to collect fees in excess of expenditures.

Purpose: The proposed regulatory action may make it easier for licensees to remember to renew licensure because renewal will coincide with each person's birth month and avoid late fees or practicing without a valid license. The birth month renewal schedule has been adopted by the Boards of Medicine and Nursing for many years. It alleviates the compressed workload associated with renewals and allows staff to be more responsive to other concerns. Renewal of licensure is essential to protect public health and safety. As a non-general-fund agency, the Board of Dentistry depends on a steady stream of revenue to offset expenditures associated with the regulation and discipline of these professions.

Substance: Sections in each chapter setting out the renewal of licensure for dentists, dental hygienists, and dental assistants II is amended to become effective in 2020. The revised renewal schedule by birth month would take effect in 2021, so in March of 2020, all persons with active licenses or registrations will renew with a proportionally reduced fee depending on each person's birth month. For example, a dentist with a January birth month would renew in March of 2020, and his license would expire in January of 2021. Therefore, he would pay a prorated renewal fee for 10 months of licensure. A dentist with a September birth month would pay a prorated renewal fee for 18 months.

Issues: There are no advantages or disadvantages to the public. The advantage to the board and the department is spreading the workload associated with licensure renewal throughout the year rather than having all renewals on a single date. There are no disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Dentistry (Board) proposes to change the renewal date for dentist, dental hygienist, and registered dental assistant II licenses from a set date of March 31st to the licensee's birth month, and to also reduce the license fees temporarily.

Result of Analysis. The benefits likely exceed the costs for all proposed changes. A slightly different design would likely yield greater benefits at about same the cost for at least one proposed change.

Estimated Economic Impact. Currently, the renewal date for annual dentist, dental hygienist, and registered dental assistant II licenses is March 31st of each year. The Board proposes to change the renewal date to the licensee's birthday, in order to distribute the Board's administrative workload more evenly throughout the year. This change is expected to result in the ongoing issuance of approximately 1,125 licenses in any given month rather than simultaneously issuing 13,499 licenses in March of each year. Under the proposal, the license renewals that occur in March 2020 would cover the period from March 31, 2020 to the licensee's birth month the following year at a prorated fee schedule. In other words, when a license is renewed in 2020, the expiration date will be set at the licensee's birth month in 2021.

The main economic effect of this change would accrue to the Board as it would have a more evenly distributed license renewal workload. According to the Board staff, the birth month renewal schedule has been used by the Boards of Medicine and Nursing for many years. The proposed approach alleviates the compressed workload associated with renewals and allows staff to be more responsive to other concerns. The proposed regulatory action may also make it easier for licensees to remember to renew if it coincides with their birth month and thus avoid late fees or practicing without a valid license.

The Board also has an excess cash balance it wishes to reduce in conjunction with the renewal date change. To accomplish that goal, the Board proposes a prorated renewal fee schedule at a discounted rate. For example, the current renewal fee for an active dental license is $285 payable by March 31st each year, which equals $23.75 for 12 months of licensure. The proposed fee would temporarily be $15 per month for renewal. To illustrate: in 2020, a dentist with a January birth date would pay $150 ($15 X 10 months); a dentist with a December birth date would pay $315 ($15 X 21 months). For renewals in 2021, the fee would revert to the current amount of $285 payable in one's birth month. Essentially, the prorated transition fee schedule would provide $8.75 (i.e., $23.75 - $15) savings per month. Similarly, the prorated monthly fee for dental hygienists would be $4 per month as opposed to current $6.25 monthly rate, and for dental assistant IIs it would be $3 instead of current $4.16. The prorated transition fee schedule would benefit licensees in that they would experience a temporary relief in the amount of fees they pay to the Board. Assuming a uniform distribution of birth months, dentists, dental hygienists, and dental assistant IIs would realize $1,012,169, $209,598, and $467 respectively from this total one-time fee relief.

This one time relief, however, would be uneven among the licensees depending on their birth month. Those who have a birth month in the early part of the year would receive a smaller savings compared to those with a birth month in the later part of the year. For example, a dentist with a January birth date would realize $87.50 in savings ($8.75 X 10) while a dentist with a December birth date would benefit $183.75 ($8.75 X 21). Similarly, the one time savings range for dental hygienists would be between $22.50 ($2.25 X 10) for January birth month and $47.25 Economic impact of 18 VAC 60-21 3 ($2.25 X 21) for December birth month, and for dental assistant IIs it would be between $11.16 ($1.16 X 10) and $24.36 ($1.16 X 21). While it would be possible to devise a prorated fee schedule that would more evenly distribute the excess fee revenues among the licensees, such a mechanism would likely not be as administratively efficient as the scheme proposed.

Another unintended consequence of this regulatory change is the possible administrative inconvenience that would be imposed on some dental practices. As raised in public comments, group practices that manage renewals for their members simultaneously on March 31 would no longer have the ability to do so. Such practices would have to manage renewals on a monthly basis depending on the birth months of their member practitioners. This will require tracking all member birth months and the associated renewal schedules individually, and then cutting multiple checks instead of just one check. Though they will also avoid a large cash outlay at one time. According to a Virginia Dental Association executive, the number of group practices in Virginia is in the "hundreds" which suggests the impact of this change could be significant. Similarly and in addition to the group practices, the proposed renewal in the birth month could be inconvenient for single practitioners if their birth month happens to fall in a month they are particularly busy or have limited time. For example, someone with a birth month during holidays or tax filing season might have less time to renew their license simply because there are fewer business days or more things to do. The Board acknowledges that the change would require adjustment but believes birth month would be eventually be easier for dental practices rather than an arbitrary date. However, the ongoing nature of this particular unintended consequence and its likely prevalence demands consideration.

Businesses and Entities Affected. There are 7,463 licensed dentists, 6,010 dental hygienists, and 26 dental assistant IIs in Virginia.

Localities Particularly Affected. The proposed regulation would not affect any particular locality more than others.

Projected Impact on Employment. The proposed changes should not have a significant impact on employment.

Effects on the Use and Value of Private Property. No significant effect on the use and value of private property is expected.

Real Estate Development Costs. No impact on real estate development costs is expected.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The vast majority of dental practices are small businesses. As described, the proposed changes to license renewal dates would increase administrative costs for some dental practices.

Alternative Method that Minimizes Adverse Impact. As raised in public comments and discussed, the proposed regulation would likely have the unintended consequence of introducing an administrative inconvenience for a number of group practices and individual practitioners. Once the transition to birth month renewal is completed and the Board's administrative workload is spread more evenly throughout the year, the Board could eliminate this unintended consequence by

allowing the licensees to request a renewal month that better accommodates their busy schedules.

Adverse Impacts:

Businesses: As described, the proposed changes to license renewal dates would increase administrative costs for some dental practices.

Localities: The proposed amendments would not adversely affect localities.

Other Entities: The proposed amendments would not adversely affect other entities.

____________________________

¹Adverse impact is indicated if there is any increase in net cost for any entity, even if the benefits exceed the costs for all entities combined.

Agency's Response to Economic Impact Analysis: The Board of Dentistry does not concur with some of the assertions of the economic impact analysis (EIA) on the proposed change in renewal schedule. The EIA asserts that the "one-time relief, however, would be uneven among the licensees depending on their birth month." The agency does not agree. A licensee pays the renewal fee prospectively. In the proposed action, the fee paid in March of 2020 will be based on the number of months a licensee will have before the next renewal date in 2021. Every licensee will pay exactly the same fee ($15 per month for a dentist). The amount is prorated for the number of months of licensure (10 months X $15 = $150; 21 months X $15 = $315), so no licensee is disadvantaged. A person with a January birth month will only get 10 months of licensure before the person has to renew in January of 2021. However, a person with a December birth month will get 21 months of licensure before having to renew in 2021. The prorated fee treats every licensee the same.

The agency considered a variety of methods for converting to birth month renewal. Board members concluded that this proration based on the number of months renewal was the most equitable. The agency does not concur that another prorated fee schedule would more evenly distribute the excess revenue because some licensees would be disadvantaged by fewer months of licensure.

While the agency understands that the change will necessitate some adjustment for administrative in some dental practices, it notes that the two boards (Board of Medicine and Board of Nursing) with the largest number of licensees have had renewal by birth month for many years. Medical practices that employ large numbers of doctors and nurses have not had difficulty with birth month renewals. Additionally, the agency would note the relatively small number of comments in opposition to the change. Out of 7,463 dentists and 6,010 dental hygienists licensed in Virginia, only 10 dentists and five hygienists commented in opposition. The decision to amend regulations was made by the board, which is comprised of seven dentists and two hygienists, all of whom voted in favor of the change to birth month.

The EIA commented that a person with a birth date during holidays or tax filing season would have less time to renew. Renewal notices are sent 45 to 60 days in advance of the renewal month, so there is ample time for electronic renewal of one's license.

Finally, the EIA noted that "the board could eliminate this unintended consequence by allowing licenses to request a renewal month that better accommodates their busy schedules." The agency explained to the Department of Planning and Budget (DPB) that such a scheme would be chaotic, not only for board staff, but for the finance and IT divisions of the department, and ultimately for licensees themselves. To allow more than 300,000 licensees of the department to choose their own renewal date is not a viable option. To the board's knowledge, there is no licensing agency in Virginia or elsewhere that has adopted such a renewal schedule, and DPB provided no feasibility study or plan for implementation and impact.

Summary:

The proposed amendments change the license renewal schedule for a dentist or dental hygienist or registration renewal for a dental assistant II from a set date of March 31 to renewal in the birth month of the dentist, dental hygienist, or dental assistant II.

18VAC60-21-40. Required fees.

A. Application/registration fees.

1. Dental license by examination	$400
2. Dental license by credentials	$500
3. Dental restricted teaching license	$285
4. Dental faculty license	$400
5. Dental temporary resident's license	$60
6. Restricted volunteer license	$25
7. Volunteer exemption registration	$10
8. Oral maxillofacial surgeon registration	$175
9. Cosmetic procedures certification	$225
10. Mobile clinic/portable operation	$250
11. Moderate sedation permit	$100
12. Deep sedation/general anesthesia permit	$100

B. Renewal fees.

1. Dental license - active	$285
2. Dental license - inactive		$145
3. Dental temporary resident's license		$35
4. Restricted volunteer license		$15
5. Oral maxillofacial surgeon registration		$175
6. Cosmetic procedures certification		$100
7. Moderate sedation permit		$100
8. Deep sedation/general anesthesia permit		$100

C. Late fees.

1. Dental license - active	$100
2. Dental license - inactive	$50
3. Dental temporary resident's license	$15
4. Oral maxillofacial surgeon registration	$55
5. Cosmetic procedures certification	$35
6. Moderate sedation permit	$35
7. Deep sedation/general anesthesia permit	$35

D. Reinstatement fees.

1. Dental license - expired	$500
2. Dental license - suspended	$750
3. Dental license - revoked	$1000
4. Oral maxillofacial surgeon registration	$350
5. Cosmetic procedures certification	$225

E. Document fees.

1. Duplicate wall certificate	$60
2. Duplicate license	$20
3. License certification	$35

F. Other fees.

1. Returned check fee	$35
2. Practice inspection fee	$350

G. No fee will be refunded or applied for any purpose other than the purpose for which the fee is submitted.

H. For the renewal of licenses, registrations, certifications, and permits an active dental license in 2018 2020, the following fees shall be in effect fees shall be prorated according to a licensee's birth month as follows:

1. Dentist - active	$142
2. Dentist - inactive	$72
3. Dental full-time faculty	$142
4. Temporary resident	$17
5. Dental restricted volunteer	$7
6. Oral/maxillofacial surgeon registration	$87
7. Cosmetic procedure certification	$50
8. Moderate sedation certification	$50
9. Deep sedation/general anesthesia	$50
10. Mobile clinic/portable operation January birth month February birth month March birth month April birth month May birth month June birth month July birth month August birth month September birth month October birth month November birth month December birth month	$75 $150 $165 $180 $195 $210 $225 $240 $255 $270 $285 $300 $315

Part V
Licensure Renewal

18VAC60-21-240. License renewal and reinstatement.

A. The license or permit of any person who does not return the completed renewal form and fees by the deadline shall automatically expire and become invalid, and his practice of dentistry shall be illegal. With the exception of practice with a current, restricted volunteer license as provided in § 54.1-2712.1 of the Code practicing in Virginia with an expired license or permit may subject the licensee to disciplinary action by the board.

B. Every Prior to 2021, every person holding an active or inactive license and those holding a permit to administer moderate sedation, deep sedation, or general anesthesia shall annually, on or before March 31, renew his license or permit. Beginning in January 2021, every person holding an active or inactive license and those holding a permit to administer moderate sedation, deep sedation, or general anesthesia shall annually renew his license or permit in his birth month in accordance with fees set forth 18VAC60-21-40.

C. Every person holding a faculty license, temporary resident's license, a restricted volunteer license, or a temporary permit shall, on or before June 30, request renewal of his license.

C. D. Any person who does not return the completed form and fee by the deadline required in subsection B of this section shall be required to pay an additional late fee.

D. E. The board shall renew a license or permit if the renewal form, renewal fee, and late fee are received within one year of the deadline required in subsection B of this section provided that no grounds exist to deny said renewal pursuant to § 54.1-2706 of the Code and Part II (18VAC60-21-50 et seq.) of this chapter.

E. F. Reinstatement procedures.

1. Any person whose license or permit has expired for more than one year or whose license or permit has been revoked or suspended and who wishes to reinstate such license or permit shall submit a reinstatement application and the reinstatement fee. The application must include evidence of continuing competence.

2. To evaluate continuing competence, the board shall consider (i) hours of continuing education that meet the requirements of subsection H of 18VAC60-21-250; (ii) evidence of active practice in another state or in federal service; (iii) current specialty board certification; (iv) recent passage of a clinical competency examination accepted by the board; or (v) a refresher program offered by a program accredited by the Commission on Dental Accreditation of the American Dental Association.

3. The executive director may reinstate such expired license or permit provided that the applicant can demonstrate continuing competence, the applicant has paid the reinstatement fee and any fines or assessments, and no grounds exist to deny said reinstatement pursuant to § 54.1-2706 of the Code and Part II (18VAC60-21-50 et seq.) of this chapter.

18VAC60-25-30. Required fees.

A. Application fees.

1. License by examination	$175
2. License by credentials	$275
3. License to teach dental hygiene pursuant to § 54.1-2725 of the Code	$175
4. Temporary permit pursuant to § 54.1-2726 of the Code	$175
5. Restricted volunteer license	$25
6. Volunteer exemption registration	$10

B. Renewal fees.

1. Active license	$75
2. Inactive license	$40
3. License to teach dental hygiene pursuant to § 54.1-2725	$75
4. Temporary permit pursuant to § 54.1-2726	$75

C. Late fees.

1. Active license	$25
2. Inactive license	$15
3. License to teach dental hygiene pursuant to § 54.1-2725	$25
4. Temporary permit pursuant to § 54.1-2726	$25

D. Reinstatement fees.

1. Expired license	$200
2. Suspended license	$400
3. Revoked license	$500

E. Administrative fees.

1. Duplicate wall certificate	$60
2. Duplicate license	$20
3. Certification of licensure	$35
4. Returned check	$35

F. No fee shall be refunded or applied for any purpose other than the purpose for which the fee was submitted.

G. For the renewal of licenses an active dental hygienist license in 2018 2020, the following fees shall be in effect fees shall be prorated according to a licensee's birth month as follows:

1. Dental hygienist - active	$37
2. Dental hygienist - inactive	$20
3. Dental hygienist restricted volunteer January birth month February birth month March birth month April birth month May birth month June birth month July birth month August birth month September birth month October birth month November birth month December birth month	$7 $40 $44 $48 $52 $56 $60 $64 $68 $72 $76 $80 $84

Part V
Licensure Renewal and Reinstatement

18VAC60-25-180. Requirements for licensure renewal.

A. An Prior to 2021, an active or inactive dental hygiene license shall be renewed on or before March 31 each year. Beginning in January 2021, an active or inactive dental hygiene license shall be renewed in the licensee's birth month each year.

B. A faculty license, a restricted volunteer license, or a temporary permit shall be renewed on or before June 30 each year.

B. C. The license of any person who does not return the completed renewal form and fees by the deadline required in subsection A of this section shall automatically expire and become invalid and his practice of dental hygiene shall be illegal. With the exception of practice with a current, restricted volunteer license as provided in § 54.1-2726.1 of the Code, practicing in Virginia with an expired license may subject the licensee to disciplinary action by the board.

C. D. Any person who does not return the completed form and fee by the deadline required in subsection A of this section shall be required to pay an additional late fee. The board may renew a license if the renewal form, renewal fee, and late fee are received within one year of the deadline required in subsection A of this section.

18VAC60-30-30. Required fees.

A. Initial registration fee.	$100
B. Renewal fees.
1. Dental assistant II registration - active	$50
2. Dental assistant II registration - inactive	$25
C. Late fees.
1. Dental assistant II registration - active	$20
2. Dental assistant II registration - inactive	$10
D. Reinstatement fees.
1. Expired registration	$125
2. Suspended registration	$250
3. Revoked registration	$300
E. Administrative fees.
1. Duplicate wall certificate	$60
2. Duplicate registration	$20
3. Registration verification	$35
4. Returned check fee	$35

F. No fee will be refunded or applied for any purpose other than the purpose for which the fee is submitted.

G. For the renewal of an active dental assistant II registration in 2018 2020, the fee shall be $25. For the renewal of an inactive dental assistant II registration in 2018, the fee shall be $13. fees for renewal of an active dental assistant II registration shall be prorated according to the registrant's birth month as follows:

January birth month February birth month March birth month April birth month May birth month June birth month July birth month August birth month September birth month October birth month November birth month December birth month

$30 $33 $36 $39 $42 $45 $48 $51 $54 $57 $60 $63

Part V
Requirements for Renewal and Reinstatement

18VAC60-30-150. Registration renewal requirements.

A. Every Prior to 2021, every person holding an active or inactive registration shall annually, on or before March 31, renew his registration. Beginning in January of 2021, every person holding an active or inactive registration shall annually renew his registration in his birth month. Any person who does not return the completed form and fee by the deadline shall be required to pay an additional late fee.

B. The registration of any person who does not return the completed renewal form and fees by the deadline shall automatically expire and become invalid and his practice as a dental assistant II shall be illegal. Practicing in Virginia with an expired registration may subject the registrant to disciplinary action by the board.

C. In order to renew registration, a dental assistant II shall be required to maintain and attest to current certification from the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association.

D. A dental assistant II shall also be required to maintain evidence of successful completion of training in basic cardiopulmonary resuscitation.

E. Following the renewal period, the board may conduct an audit of registrants to verify compliance. Registrants selected for audit shall provide original documents certifying current certification.