Title of Regulation: 18VAC60-25. Regulations Governing the Practice of Dental Hygiene (amending 18VAC60-25-190).

Statutory Authority: §§ 54.1-2400 and 54.1-2722 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 5, 2018.

Effective Date: September 20, 2018.

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 promulgate regulations to administer the regulatory system, and §§ 54.1-2722 and 54.1-2729 of the Code of Virginia, which provide authority for the board to regulate the practice of dental hygiene, including continuing education.

Purpose: The purpose of the regulatory action is to specify the content and duration of a continuing education course designed to develop the competencies needed to provide care under remote supervision. The goal is an adequate measure of competency and consistency in the course content and in its duration.

Since a dental hygienist working under remote supervision is practicing without a dentist present, it is essential that the hygienist be competent to provide services to the patient and to know the extent and limitation of those services allowed under the law. While the dental care for many citizens, such as persons in long-term care facilities, federally qualified health centers, charitable safety net facilities, free clinics, and schools, may greatly benefit from the practice of a hygienist working under remote supervision, it is as important to protect those citizens' health and safety as it is to increase access to care. This regulation, combined with provisions of § 54.1-2722 of the Code of Virginia, balances safety and access.

Rationale for Using Fast-Track Rulemaking Process: All parties are in agreement on this regulatory action. The only comment in response to the NOIRA published to replace the emergency regulation was support from the Virginia Dental Hygienist Association.

Substance: In accordance with subsection F of § 54.1-2722 of the Code of Virginia, a dental hygienist practicing under remote supervision is required to complete a continuing education course as specified in regulation. The course set out in regulation must be no less than two hours in duration, must be offered by an accredited dental education program or a sponsor, and must include specific course content.

Issues: The primary advantage to the public is the possibility of an increase in the number of dental hygienists who are qualified and competent to provide dental services under remote supervision. There are no disadvantages to the public. 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 establish continuing education requirements for dental hygienists to practice under remote supervision.

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

Estimated Economic Impact. Chapter 497 of the 2016 Acts of Assembly¹ authorized dental hygienists to practice, with certain requirements and restrictions, under the remote supervision of a licensed dentist. One of the requirements was that the dental hygienist complete a continuing education course with specific content to cover issues related to remote supervision. Chapter 410 of the 2017 Acts of Assembly² further clarified the continuing education requirement. Effective November 2017 the Board established a two-hour continuing education requirement related to remote supervision and its specified content in an emergency regulation.³ The Board now proposes to make the emergency regulation permanent.

The proposed required two-hour remote supervision continuing education course will be counted toward the currently required 15 hours of annual continuing education required for renewal of a license. Thus, there should not be any significant additional costs beyond meeting the 15 hours of continuing education currently required. The main difference will be what is covered in two of the 15 hours. The proposed regulation prescribes two hours of education with specific content to cover issues related to remote supervision. Because the specific education content will help address issues that may arise in a remote supervision setting without any discernible costs, the proposed regulation should produce net benefits.

Businesses and Entities Affected. There are 6,889 dental hygienists licensed in Virginia. It is unknown how many may practice under remote supervision.

Localities Particularly Affected. The proposed amendment does not affect any particular locality more than others.

Projected Impact on Employment. The proposed regulation establishes only the duration and content of the statutorily required continuing education and not the remote supervision itself. Thus, it is not expected to have any significant impact on employment.

Effects on the Use and Value of Private Property. No 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 proposed amendment should not significantly affect small businesses.

Alternative Method that Minimizes Adverse Impact. The proposed amendment does not have costs and other significant effects on small businesses.

Adverse Impacts:

Businesses. The proposed amendment does not have adverse impacts on businesses.

Localities. The proposed amendment will not adversely affect localities.

Other Entities. The proposed amendment will not adversely affect other entities.

________________________________________________

¹http://lis.virginia.gov/cgi-bin/legp604.exe?161+sum+SB712.

²http://lis.virginia.gov/cgi-bin/legp604.exe?171+sum+HB1474.

³http://townhall.virginia.gov/l/ViewStage.cfm?stageid=8070.

Agency's Response to Economic Impact Analysis: The Board of Dentistry concurs with the economic impact analysis of the Department of Planning and Budget.

Summary:

The amendment (i) requires a dental hygienist practicing under supervision to complete a continuing education course of at least two hours that is offered by an accredited dental education program or a sponsor and (ii) outlines the content required to be covered in the continuing education course.

18VAC60-25-190. Requirements for continuing education.

A. In order to renew an active license, a dental hygienist shall complete a minimum of 15 hours of approved continuing education. 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.

1. A dental hygienist shall be required to maintain evidence of successful completion of a current hands-on course in basic cardiopulmonary resuscitation for health care providers.

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

3. Up to two hours of the 15 hours required for annual renewal may be satisfied through delivery of dental hygiene services, without compensation, to low-income individuals receiving health services through a local health department or a free clinic organized in whole or primarily for the delivery of those services. One hour of continuing education may be credited for three hours of providing such volunteer services, as documented by the health department or free clinic.

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

1. Clinical courses in dental or dental hygiene practice; or

2. Nonclinical subjects that relate to the skills necessary to provide dental hygiene services and are supportive of clinical services (i.e., patient management, legal and ethical responsibilities, risk management, and recordkeeping). 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 course, to include audio and video presentations, that meets the requirements in subdivision B 1 of this section and is given by one of the following sponsors:

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

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

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

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

5. A provider accredited by the Accreditation Council for Continuing Medical Education for Category 1 credits;

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

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

8. 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 Healthcare Organizations;

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

10. A medical school 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. State or federal government agencies (i.e., military dental division, Veteran's Administration, etc.);

12. The Commonwealth Dental Hygienists' Society;

13. The MCV Orthodontic Education and Research Foundation;

14. The Dental Assisting National Board and its affiliate, the Dental Auxiliary Learning and Education Foundation;

15. The American Academy of Dental Hygiene, its constituent and component/branch associations; or

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

D. Verification of compliance.

1. All licensees are required to verify compliance with continuing education requirements at the time of annual license renewal.

2. Following the renewal period, the board may conduct an audit of licensees to verify compliance.

3. Licensees selected for audit shall provide original documents certifying that they have fulfilled their continuing education requirements by the deadline date as specified by the board.

4. Licensees are required to maintain original documents verifying the date and the subject of the program or activity, the sponsor, and the amount of time earned. Documentation shall be maintained for a period of four years following renewal.

5. Failure to comply with continuing education requirements may subject the licensee to disciplinary action by the board.

E. Exemptions.

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

2. 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. A written request with supporting documents must be submitted at least 30 days prior to the deadline for renewal.

F. The board may grant an extension for up to one year for completion of continuing education upon written request with an explanation to the board prior to the renewal date.

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

H. In order to practice under remote supervision in accordance with subsection F of § 54.1-2722 of the Code of Virginia, a dental hygienist shall complete a continuing education course of no less than two hours in duration that is offered by an accredited dental education program or a sponsor listed in subsection C of this section and that includes the following course content:

1. Intent and definitions of remote supervision;

2. Review of dental hygiene scope of practice and delegation of services;

3. Administration of controlled substances;

4. Patient records, documentation, and risk management;

5. Remote supervision laws for dental hygienists and dentists;

6. Written practice protocols; and

7. Settings allowed for remote supervision.