Title of Regulation: 18VAC60-20. Regulations Governing Dental Practice (amending 18VAC60-20-50).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 11, 2013.

Effective Date: September 26, 2013.

Agency Contact: Sandra Reen, Executive Director, Board of Dentistry, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4538, FAX (804) 527-4428, or email sandra.reen@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides the Board of Dentistry the authority to promulgate regulations to administer the regulatory system, and § 54.1-2729 of the Code of Virginia stipulates that the board shall promulgate regulations requiring continuing education for dental hygienist license renewal or reinstatement.

Purpose: The purpose of the amended regulation is to expand the listing of approved continuing education providers to include the American Academy of Dental Hygiene (Academy) in order to give licensees more options for meeting continuing education requirements for license renewal. The Academy has developed standards for continuing education courses that are evaluated for content, depth, accuracy, and outcome. Courses must relate to current dental hygiene practice and patient care and are intended to enhance the licensee's knowledge, skills, and competence in the provision of safe, effective services to patients.

Rationale for Using Fast-Track Process: The amendment is in response to a petition for rulemaking; there was no comment on the petition, and the amendment was recommended by dental hygienists on the board and by the professional association representatives. It is not expected to be controversial.

Substance: 18VAC60-20-50 is amended to add the American Academy of Dental Hygiene to the listing of organizations and entities that can approve continuing education courses for dentists and dental hygienists in Virginia.

Issues: There are no advantages or disadvantages to the public. The public continues to benefit from continuing education that is appropriately evaluated for content and outcome. There are no advantages or 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 add the American Academy of Dental Hygiene and its constituent and component/branch associations to the listing of organizations and entities that can approve continuing education courses for dentists and dental hygienists in Virginia.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. Dentists and dental hygienists are required to complete a minimum of 15 hours of approved continuing education for each annual renewal of licensure. These regulations provide a list of approved continuing education sponsors. The Board proposes to add the American Academy of Dental Hygiene and its constituent and component/branch associations (Academy) to the list.

Adding the Academy to the list of approved sponsors will give dental hygienists additional options for meeting their continuing education requirement for renewal. The additional options may provide some cost savings, be more convenient, or be more applicable for the needs of some licensees. Thus the additional option should produce a benefit. The Department of Health Professions has determined that the Academy has developed standards for continuing education courses, which are evaluated for content, depth, accuracy and outcome. Courses must relate to current dental hygiene practice and patient care and are intended to enhance the licensees knowledge, skills and competence in the provision of safe, effective services to patients. Thus, the additional approved courses should be of sufficient quality to help ensure the competence of the licensees. Given the potential cost savings, increased convenience, increased applicability, and assurance of quality, the proposed amendment should provide a net benefit.

Businesses and Entities Affected. The proposed amendment potentially affects the 5403 dental hygienists currently licensed in Virginia, as well as the 3049 dental offices in the Commonwealth.

Localities Particularly Affected. The proposed amendment does not disproportionately affect particular localities.

Projected Impact on Employment. The proposed amendment is unlikely to significantly affect employment.

Effects on the Use and Value of Private Property. The proposed amendment may result in some dental hygienists taking one or more courses from the Academy of Dental Hygiene or its constituent and component/branch associations rather than from other sponsors currently listed as approved in these regulations.

Small Businesses: Costs and Other Effects. If dental practices reimburse their dental hygienists for their continuing education courses, the proposed amendment may produce some small cost savings for these practices.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendment is unlikely to provide a net adverse impact on small businesses.

Real Estate Development Costs. The proposed amendments are unlikely to significantly affect real estate development costs.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Dentistry concurs with the analysis of the Department of Planning and Budget for the proposed regulation, 18VAC60-20, Regulations Governing Dental Practice, relating to the addition of the American Academy of Dental Hygiene to the list of approved continuing education providers.

Summary:

The amendment to 18VAC60-20-50 adds the American Academy of Dental Hygiene to the listing of organizations and entities that can approve continuing education courses for dentists and dental hygienists in Virginia.

18VAC60-20-50. Requirements for continuing education.

A. A dentist or a dental hygienist shall be required to have completed a minimum of 15 hours of approved continuing education for each annual renewal of licensure. A dental assistant II shall be required to maintain current certification from the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association.

1. A dentist, a dental hygienist, or a dental assistant II shall be required to maintain evidence of successful completion of training in basic cardiopulmonary resuscitation.

2. A dentist who administers or a dental hygienist who monitors patients under general anesthesia, deep sedation or conscious sedation shall complete four hours every two years of approved continuing education directly related to administration or monitoring of such anesthesia or sedation as part of the hours required for licensure renewal.

3. Continuing education hours in excess of the number required for renewal may be transferred or credited to the next renewal year for a total of not more than 15 hours.

B. An approved continuing dental education program shall be relevant to the treatment and care of patients and shall be:

1. Clinical courses in dental practice; or

2. Nonclinical subjects that relate to the skills necessary to provide dental or dental hygiene services and are supportive of clinical services (i.e., patient management, legal and ethical responsibilities, stress management). Courses not acceptable for the purpose of this subsection include, but are not limited to, estate planning, financial planning, investments, and personal health.

C. Continuing education credit may be earned for verifiable attendance at or participation in any courses, to include audio and video presentations, which meet the requirements in subdivision B 1 of this section and which are given by one of the following sponsors:

1. American Dental Association and National Dental Association, their constituent and component/branch associations;

2. American Dental Hygienists' Association and National Dental Hygienists Association, their constituent and component/branch associations;

3. American Dental Assisting Association, its constituent and component/branch associations;

4. American Dental Association specialty organizations, their constituent and component/branch associations;

5. American Medical Association and National Medical Association, their specialty organizations, constituent, and component/branch associations;

6. Academy of General Dentistry, its constituent and component/branch associations;

7. American Academy of Dental Hygiene, its constituent and component/branch associations;

7. 8. Community colleges with an accredited dental hygiene program if offered under the auspices of the dental hygienist program;

8. 9. A college or university that is accredited by an accrediting agency approved by the U.S. Department of Education or a hospital or health care institution accredited by the Joint Commission on Accreditation of Health Care Organizations;

9. 10. The American Heart Association, the American Red Cross, the American Safety and Health Institute and the American Cancer Society;

10. 11. A medical school which is accredited by the American Medical Association's Liaison Committee for Medical Education or a dental school or dental specialty residency program accredited by the Commission on Dental Accreditation of the American Dental Association;

11. 12. State or federal government agencies (i.e., military dental division, Veteran's Administration, etc.);

12. 13. The Commonwealth Dental Hygienists' Society;

13. 14. The MCV Orthodontic and Research Foundation;

14. 15. The Dental Assisting National Board; or

15. 16. A regional testing agency (i.e., Central Regional Dental Testing Service, Northeast Regional Board of Dental Examiners, Southern Regional Testing Agency, or Western Regional Examining Board) when serving as an examiner.

D. A licensee is exempt from completing continuing education requirements and considered in compliance on the first renewal date following the licensee's initial licensure.

E. The board may grant an exemption for all or part of the continuing education requirements due to circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

F. A licensee is required to provide information on compliance with continuing education requirements in his annual license renewal. A dental assistant II is required to attest to current certification by the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association. Following the renewal period, the board may conduct an audit of licensees or registrants to verify compliance. Licensees or registrants selected for audit must provide original documents certifying that they have fulfilled their continuing education requirements by the deadline date as specified by the board.

G. All licensees or registrants are required to maintain original documents verifying the date and subject of the program or activity. Documentation must be maintained for a period of four years following renewal.

H. A licensee who has allowed his license to lapse, or who has had his license suspended or revoked, must submit evidence of completion of continuing education equal to the requirements for the number of years in which his license has not been active, not to exceed a total of 45 hours. Of the required hours, at least 15 must be earned in the most recent 12 months and the remainder within the 36 months preceding an application for reinstatement. A dental assistant II who has allowed his registration to lapse or who has had his registration suspended or revoked must submit evidence of current certification from a credentialing organization recognized by the American Dental Association to reinstate his registration.

I. Continuing education hours required by board order shall not be used to satisfy the continuing education requirement for license or registration renewal or reinstatement.

J. Failure to comply with continuing education requirements or current certification requirements may subject the licensee or registrant to disciplinary action by the board.