An Act To Improve Access to Oral Health Care
Maine Legislature, Session 126, LD 1230
Committee Amendment CA_C_H589 (House)
Amends: 24 MRSA §2317-B, 24-A MRSA §2847-U

COMMITTEE AMENDMENT "C" to H.P. 870, L.D. 1230, Bill, "An Act To 
Improve Access to Oral Health Care" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRS A §3174-XX is enacted to read: 
§3174-XX. Dental hygiene therapy reimbursement 
1. Reimbursement. By October 1, 2015, the department shall provide for the 
reimbursement under the MaineCare program of dental hygiene therapists practicing as 
authorized under Title 32, chapter 16, subchapter 3-C for the procedures identified in 
their scope of practice. Reimbursement must be provided to dental hygiene therapists 
directly or to a federally qualified health center pursuant to section 3174-V when a dental 
hygiene therapist is employed as a core provider at the center. 
2. Rulemaking. The department shall adopt rules to implement this section. Rules 
adopted pursuant to this subsection are routine technical rules as defined by Title 5, 
chapter 375, subchapter 2-A. 
Sec. 2. 24 MRSA §2317-B, sub-§19, as enacted by PL 1999, c. 256, Pt. M, §10, 
is amended to read: 
19. Title 24-A, chapter 67. Medicare supplement insurance policies, Title 24-A, 
chapter 67; aBEl 
Sec. 3. 24 MRSA §2317-B, sub-§20, as amended by PL 2003, c. 428, Pt. G, §1, 
is further amended to read: 
20. Title 24-A, chapters 68 and 68-A. Long-term care insurance, nursing home 
care insurance and home health care insurance, Title 24-A, chapters 68 and 68-A7: and 
Sec. 4. 24 MRSA §2317-B, s~b-§21 is enacted to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT'~ "to H.P. 870, L.D. 1230 
21. Title 24-A, sections 2765-A and 2847-U. The practice of dental hygiene by a 
dental hygiene therapist, Title 24-A, sections 2765-A and 2847-U. 
Sec. 5. 24-A MRS A §2765-A is enacted to read: 
§2765-A. Coverage for services provided by dental hygiene therapist 
1. Services provided by dental hygiene therapist. An insurer that issues individual 
dental insurance or health insurance that includes coverage for dental services shall 
provide coverage for dental services performed by a dental hygiene therapist licensed 
under Title 32, chapter 16, subchapter 3-C when those services are covered services 
under the contract and when they are within the lawful scope of practice of the dental 
hygiene therapist. 
2. Limits; coinsurance; deductibles. A contract that provides coverage for the 
services required by this section may contain provisions for maximum benefits and 
coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 
provisions are not inconsistent with the requirements of this section. 
3. Coordination of benefits with dental insurance. If an enrollee eligible for 
coverage under this section is eligible for coverage under a dental insurance policy or 
contract and a health insurance policy or contract, the insurer providing dental insurance 
is the primary payer responsible for charges under subsection 1 and the insurer providing 
individual health insurance is the secondary payer. 
4. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered. issued for delivery, continued or renewed in this State. 
For purposes of this section, all contracts are deemed to be renewed no later than the next 
yearly anniversary of the contract date. 
Sec. 6. 24-A MRSA §2847-U is enacted to read: 
§2847-U. Coverage for services provided by dental hygiene therapist 
1. Services provided by dental hygiene therapist. An insurer that issues grOUP 
dental insurance or health insurance that includes coverage for dental services shall 
provide coverage for dental services performed by a dental hygiene therapist licensed 
. under Title 32, chapter 16, subchapter 3-C when those services are covered services 
under the contract and when they are within the lawful scope of practice of the dental 
hygiene therapist. 
2. Limits; coinsurance; deductibles. A contract that provides coverage for the 
services required by this section may contain provisions for maximum benefits and 
coinsurance and reasonable limitations, deductibles and exclusions to the extent that these 
provisions are not inconsistent with the requirements of this section. 
3. Coordination of benefits with dental insurance. If an enrollee eligible for 
coverage under this section is eligible for coverage under a dental insurance policy or 
contract and a health insurance policy or contract, the insurer providing dental insurance 
is the primary payer responsible for charges under subsection 1 and the insurer providing 
group health insurance is the secondary payer. 
Sec. 7. 32 MRSA c. 16, sub-c. 3-C is enacted to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT -ti" to H.P. 870, L.D. 1230 
SUBCHAPTER 3-C 
DENTAL HYGIENE THERAPIST 
§1094-AA. Dental hygiene therapist 
A dental hygienist or independent practice dental hygienist licensed by the board 
pursuant to this chapter may practice as a licensed dental hygiene therapist to the extent 
permitted by this subchapter. To qualify for licensure under this subchapter as a dental 
hygiene therapist, a person shall apply to the board on forms provided by the board, pay 
the application fee under section 1094-DD and demonstrate to the board that the 
applicant: 
1. Licensure. Possesses a valid license to practice dental hygiene or independent 
practice dental hygiene pursuant to this chapter or qualifies for licensure to practice by 
endorsement pursuant to section 1094-L; 
2. 
Education and experience. 
Has graduated from a dental hygiene therapy 
education program that: 
A. Meets the standards adopted in this State for the certification of a degree-granting 
program in dental hygiene therapy at an accredited postsecondary institution; 
B. Is consistent with the model curriculum for educating dental hygiene therapists 
adopted by the American Association of Public Health Dentistry, or a successor 
organization, is consistent with existing dental hygiene therapy programs in other 
states and is approved by the Commissioner of Health and Human Services and the 
Commissioner of Professional and Financial Regulation; and 
C. Meets the requirements for dental hygiene therapy education programs adopted by 
the board; 
3. 
Examination. 
Has passed a comprehensive, competency-based clinical 
examination approved by the board and administered independently of an institution 
providing dental hygiene therapy education and has passed an examination of the 
applicant's knowledge of Maine laws and rules relating to the practice of dentistry; and 
4. Supervised clinical practice. Has completed 1,000 hours of supervised clinical 
practice under the supervision of a dentist licensed under this chapter and in conformity 
with rules adopted by the board, during which supervised clinical practice the applicant 
holds a provisional dental hygiene therapy license pursuant to section 1094-BB. 
§1094-BB. Provisional dental hygiene therapy license 
The board shall issue a provisional dental hygiene therapy license to an applicant for 
licensure under this subchapter who has met the requirements of section 1094-AA, 
subsections 1 to 3 and rules adopted by the board and who has paid a fee established by 
the board of not more than $175. During the period of provisional licensure, which may 
not exceed 3 years, the applicant shall maintain in good standing the applicant's license to 
practice as a dental hygienist or an independent practice dental hygienist. During the 
period of provisional licensure the applicant may be compensated for services performed 
as a dental hygiene therapist. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "e to H.P. 870, L.D. 1230 
§1094-CC. Dental coverage and reimbursement 
Notwithstanding the requirements of Title 24-A, section 2752, any service performed 
by a dentist, dental assistant or dental hygienist licensed in this State that is reimbursed by 
private insurance, a dental service corporation, the MaineCare program under Title 22 or 
the Cub Care program under Title 22, section 3174-T must also be covered and 
reimbursed when performed by a dental hygiene therapist authorized to practice under 
this subchapter. 
§1094-DD. License; fees; discontinuation of license 
The board shall issue a license to practice as a dental hygiene therapist to an applicant 
for licensure under this subchapter who has met the requirements of this subchapter and 
rules adopted pursuant to the subchapter for licensure and has paid the application fee of 
not more than $175. A dental hygiene therapist shall publicly exhibit the license at the 
therapist's place of business or employment. The initial date of expiration of the license 
must be the original expiration date of the dental hygiene therapist's dental hygienist 
license issued by the board pursuant to subchapter 4 or, for an independent practice dental 
hygienist licensed by endorsement, January 1 st of the first odd-numbered year following 
initial licensure. On or before January 1st of each odd-numbered year, a dental hygiene 
therapist shall pay to the board a license renewal fee. The board may renew the license of 
a dental hygiene therapist who meets the requirements for continued licensure and pays a 
renewal fee and a late fee by February 1st in the year in which renewal is due. The board 
shall suspend the license of a dental hygiene therapist who does not renew a license by 
February 1st in the year that renewal is due. The board may renew the license of a dental 
hygiene therapist who pays a renewal fee and a reinstatement fee as required by the 
board. 
§1094-EE. Continuing education 
As a condition of renewal of a license to practice under this subchapter, a dental 
hygiene therapist shall submit evidence of successful completion of 35 hours of 
continuing education in the 2 years prior to renewal. Continuing education under this 
section must be in conformity with the provisions of section 1084-A and must include 
board-approved courses, including but not limited to a course in cardiopulmonary 
resuscitation. The board may refuse renewal to an applicant who has not satisfied the 
requirements of this section or may renew a license on terms and conditions set by the 
board. 
§1094-FF. Limitation of practice 
Upon completion of 1,000 hours of supervised clinical practice under section 
1094-AA, subsection 4 a dental hygiene therapist may provide services within the scope 
of practice provided in section 1094-HH and under the general supervision of a dentist in 
the following health settings: a hospital; a public school, as defined in Title 20-A, section 
1, subsection 24; a nursing facility licensed under Title 22, chapter 405; a residential care 
facility licensed under Title 22, chapter 1663; a clinic; a health center reimbursed as a 
federally qualified health center as defined in 42 United States Code, Section 
1395x(aa)(4) (1993) or that has been determined by the federal Department of Health and 
Human Services, Centers for Medicare and Medicaid Services to meet the requirements 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT 'fJ "to H.P. 870, L.D. 1230 
I 
for funding under Section 330 of the Public Health Service Act, 42 United States Code, 
Section 254(b); a federally qualified health center licensed in this State; a public health 
setting that serves underserved populations as recognized by the federal Department of 
Health and Human Services; or a private dental practice that serves a population that is at 
least 50% patients who are covered by the MaineCare program under Title 22 or are 
underserved adults. 
§1094-GG. Written practice agreement; standing orders 
A dental hygiene therapist may practice only under the supervision of a dentist who is 
licensed in this State and through a written practice agreement signed by both parties. 
For the purposes of this section, a written practice agreement is a signed document that, 
in conformity with the legal scope of practice provided in section 1094-HH, outlines the 
functions that the dental hygiene therapist is authorized to perform. A dental hygiene 
therapist may practice only under the standing order of a dentist, may provide only care 
that follows written protocols and may provide only services that the dental hygiene 
therapist is authorized to provide by that dentist. 
1. Limitation. A dental hygiene therapist may provide services to a patient who has 
not first seen a dentist for an examination if the supervising dentist has given the dental 
hygiene therapist written authorization and standing protocols for the services and 
reviews the patient records at least once in a 12-month period, as provided in the written 
practice agreement. 
The standing protocols may require the supervising dentist to 
personally examine patients either face-to-face or by the use of electronic means. 
2. 
Minimum written practice agreement requirements. 
A written practice 
agreement between a supervising dentist and a dental hygiene therapist must include the 
following elements: 
A. 
The services and procedures and the practice settings for those services and 
procedures that the dental hygiene therapist may provide, together with any 
limitations on those services and procedures; 
B. 
Any age-specific and procedure-specific practice protocols, including case 
selection criteria, assessment guidelines and imaging frequency; 
C. Procedures to be used with patients treated by the dental hygiene therapist for 
obtaining informed consent and for creating and maintaining dental records; 
D. A plan for review of patient records by the supervising dentist and the dental 
hygiene therapist; 
E. A plan for managing medical emergencies in each practice setting in which the 
dental hygiene therapist provides care; 
F. 
A quality assurance plan for monitoring care, including patient care review, 
referral follow-up and a quality assurance chart review; 
G. Protocols for administering and dispensing medications, including the specific 
circumstances under which medications may be administered and dispensed; 
H. Criteria for providing care to patients with specific medical conditions or complex 
medical histories, including requirements for consultation prior to initiating care; and 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT"e,,, to H.P. 870, L.D. 1230 
I. Specific written protocols, including a plan for providing clinical resources and 
referrals, governing situations in which the patient requires treatment that exceeds the 
scope of practice or capabilities of the dental hygiene therapist. 
3. 
Responsibility. 
The supervising dentist shall accept responsibility for all 
authorized services and procedures performed by the dental hygiene therapist pursuant to 
the written agreement. A dental hygiene therapist who provides services or procedures 
beyond those authorized in the written agreement engages in unprofessional conduct for 
the purposes of this chapter. 
4. Revision. Revisions to the written practice agreement must be documented in a 
new written practice agreement signed by the supervising dentist and the dental hygiene 
therapist. 
5. Requirements. A supervising dentist and a dental hygiene therapist who sign a 
written practice agreement shall each file a copy of the agreement with the board, keep a 
copy for the dentist's or dental hygiene therapist's own records and make a copy available 
to patients of the dental hygiene therapist upon request. The copy of the written practice 
agreement in the records of the board must be made available to the public upon request. 
§1094-HH. Scope of practice 
A dental hygiene therapist may provide the care and services listed in this section and 
may provide them only under the general supervision of a dentist. A dental hygiene 
therapist practicing under general supervision of a dentist may perform all duties of a 
dental hygiene therapist listed in rules adopted by the board. A dental hygiene therapist 
who is licensed as a dental hygienist may perform all of the duties of a dental hygienist 
under this chapter. A dental hygiene therapist who is licensed as an independent practice 
dental hygienist may perform all of the duties of an independent practice dental hygienist. 
A dental hygiene therapist may: 
1. Assessments and treatments; preparations; restorations. Perform oral health 
assessments, pulpal disease assessments for primary and young teeth, simple cavity 
preparations and restorations and simple extractions; 
2. 
Crowns; space maintainers. 
Prepare and place stainless steel crowns and 
aesthetic anterior crowns for primary incisors and prepare, place and remove space 
maintainers; 
3. Referrals. Provide referrals; 
4. Anesthesia. Administer local anesthesia and nitrous oxide analgesia; 
5. Preventive services. Perform preventive services; 
6. Management of dental trauma and suturing; extractions. Conduct urgent 
management of dental trauma, perform suturing and extract primary teeth and perform 
nonsurgical extractions of periodontally diseased permanent teeth if authorized in 
advance by the supervising dentist; 
7. Medications. Provide, dispense and administer, within the parameters of the 
written practice agreement entered into under section 1094-GG and with the authorization 
of 
the 
supervIsmg 
dentist, 
anti-inflammatories, 
nonprescription 
analgesics, 
antimicrobials, antibiotics and antic aries materials; 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT' C to H.P. 870, L.D. 1230 
8. Radiographs. Administer radiographs; and 
9. 
Other related services and functions. 
Perform other related services and 
functions authorized by the supervising dentist and for which the dental hygiene therapist 
is trained. 
§1094-II. Supervision of dental hygienists and dental assistants 
A dental hygiene therapist may supervise dental assistants and dental hygienists to 
the extent permitted in the written practice agreement entered into under section 
1094-GG. A dental hygiene therapist may not supervise more than 3 dental assistants and 
dental hygienists in anyone practice setting. 
§1094-JJ. Referrals 
A supervising dentist shall arrange for another dentist or specialist to provide any 
services needed by a patient of a dental hygiene therapist supervised by that dentist that 
are beyond the scope of practice of the dental hygiene therapist and that the supervising 
dentist is unable to provide. A dental hygiene therapist. in accordance with a written 
practice agreement entered into under section 1094-GG, shall refer patients to another 
qualified dental or health care professional to receive needed services that exceed the 
scope of practice of the dental hygiene therapist. 
§1094-KK. Rulemaking 
The board shall adopt rules to implement this chapter. Rules adopted pursuant to this 
section are major substantive rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 8. Board of Dental Examiners. By January 1, 2015, the Department of 
Professional and Financial Regulation, Board of Dental Examiners shall adopt rules 
setting requirements for dental hygiene therapy education programs. 
Rules adopted 
pursuant to this section are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
Sec. 9. Exemption from review. Notwithstanding the Maine Revised Statutes, 
Title 24-A, section 2752, this Act is enacted without review and evaluation by the 
Department of Professional and Financial Regulation, Bureau ofInsurance. 
Sec. 10. Application. Those sections of this Act that enact the Maine Revised 
Statutes, Title 22, section 3174-XX; Title 24, section 2317 -B, subsection 21; and Title 
24-A, sections 2765-A and 2847-U apply to all policies, contracts and certificates 
executed, delivered, issued for delivery, continued or renewed on or after January 1, 2015 
in this State. For purposes ofthis section, all contracts are deemed to be renewed no later 
than the next yearly anniversary of the contract date. I 
SUMMARY 
This amendment is the majority report of the committee. It makes the following 
changes to the bill. 
1. It amends the laws governing MaineCare coverage, health insurance contracts and 
group and blanket health insurance to provide for dental coverage and reimbursement for 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,}G" to H.P. 870, L.D. 1230 
services performed by dental hygiene therapists authorized to practice under the 
provisions of the bill. 
2. It limits the time frame for a provisional dental hygiene therapy license to 3 years. 
3. It increases the number of supervised clinical practice hours required in order to 
obtain a dental hygiene therapy license from 500 to 1,000. 
4. 
It adds language to allow for the provisions regarding dental coverage and 
reimbursement to be enacted without review by the Department of Professional and 
Financial Regulation, Bureau of Insurance. 
5. It adds an application section to provide that the requirements of the bill relating to 
insurance reimbursement apply to all policies, contracts and certificates executed, 
delivered, issued for delivery, continued or renewed on or after January 1, 2015 in this 
State. 
6. It makes changes to the sections of the bill relating to scope of practice of dental 
hygiene therapists by removing minor surgical care, replacing the authority to prescribe 
medication with authority to provide, dispense and administer certain medications within 
the parameters of the written practice agreement and adding the authority to perform 
nonsurgical extractions of diseased permanent teeth if authorized in advance by the 
supervising dentist. 
7. It adds public schools, residential care facilities and nursing facilities to the list of 
health settings where dental hygiene therapists may provide services within their scope of 
practice. 
8. The bill allows a dental hygiene therapist to provide certain services while under 
the general supervision of a dentist in certain health settings, including a setting in a 
county designated as a dental shortage area by the federal Department of Health and 
Human Services and in a private dental practice that serves a population that is at least 
25% patients who are covered by the MaineCare program or are underserved adults. This 
amendment removes a designated dental shortage area as an eligible setting and increases 
the threshold for eligibility for private dental practices to those serving a population that 
is at least 50% patients who are covered by the MaineCare program or are underserved 
adults. 
9. The bill allows a dental hygiene therapist to provide, dispense and administer 
certain medications, including analgesics. This amendment specifies that the analgesics 
are limited to nonprescription analgesics. 
FISCAL ~OTE REQt;IRED. 
{~e~_I1.ttach.~~>-
COMMITTEE AMENDMENT 
Approved: 01127114 ;tvac:. 
LD 1230 
LR 1022(09) 
An Act To Improve Access to Oral Health Care 
Fiscal Note for Bill as Amended by Committee Amendment'fC "U1-589 ') 
Committee: Labor, Commerce, Research and Economic Development 
Fiscal Detail and Notes 
Fiscal Note Required : Yes 
Fiscal Note 
Potential future biennium cost increase - General Fund 
Potential future biennium cost increase - Other Special Revenue Funds 
While the bill requires MaineCare reimburse for dental hygiene therapist services beginning October 1, 2014, any 
increase in MaineCare costs would not likely occur until the following biennium. The fiscal impact on MaineCare 
will ultimately depend on the timing and number of dental hygiene therapists licensed in Maine, the type and volume 
of services provided and the extent to which these services replace existing dental services provided. 
The Board of Dental Examiners will incur additional costs to implement and administer a licensure process for dental 
hygiene therapists. However, these costs are not expected to be incurred until future biennia as it is anticipated that it 
will take several years before potential candidates become qualified to apply for and receive licensure. Additional 
costs to the Board of Dental Examiners, affiliated with the Department of Professional and Financial Regulation, for 
the rulemaking process can be absorbed within existing budgeted resources. 
LRI022(09) - Fiscal Note - Page 1 of 1