An Act To Conform Maine Law to the Requirements of the American Dental Association Commission on Dental Accreditation
Maine Legislature, Session 127, LD 1514
Committee Amendment CA_B-SA_B_S516 (Senate)
Amends: 22 MRSA §3174-X, 24-A MRSA §2765-A, 24-A MRSA §2847-U, 32 MRSA §18302, 32 MRSA §18345, 32 MRSA §18371, 32 MRSA §18377

SENATE AMENDMENT "13,, to COMMITTEE AMENDMENT "B" to H.P. 
1037, L.D. 1514, Bill, "An Act To Conform Maine Law to the Requirements of the 
American Dental Association Commission on Dental Accreditation" 
Amend the amendment by striking out everything after the title and before the 
summary and inserting the following: 
'Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. 1. 22 MRSA §3174-XX, sub-§1, as amended by PL 2015, c. 429, §5, is 
further amended to read: 
1. Reimbursement. By October 1, 2015, the department shall provide for the 
reimbursement under the MaineCare program of dental hygiene therapists and advanced 
dental therapists practicing as authorized under Title 32, section 183 77 for the procedures 
identified in their scope of practice. Reimbursement must be provided to dental hygiene 
therapists and advanced dental therapists directly or to a federally qualified health center 
pursuant to section 3174-V when a dental hygiene therapist or an advanced dental 
therapist is employed as a core provider at the center. 
Sec. 2. 24-A MRSA §2765-A, sub-§1, as amended by PL 2015, c. 429, §12, is 
further amended to read: 
1. Services provided by dental therapists and advanced dental therapists. 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 or an advanced dental therapist licensed under Title 32, chapter 143 
when those services are covered services under the contract and when they are within the 
lawful scope of practice of the dental hygiene therapist or advanced dental therapist. 
Sec. 3. 24-A MRSA §2847-U, sub-§1, as amended by PL 2015, c. 429, §14, is 
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further amended to read: 
1. Services provided by dental therapists and advanced dental therapists An 
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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 
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therapist or an advanced dental therapist licensed under Title 32, chapter 143 when those 
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services are covered services under the contract and when they are within the lawful 
scope of practice of the dental hygiene therapist or advanced dental therapist. 
Sec. 4. 32 MRSA §18302, sub-§§1-A and 1-B are enacted to read: 
1-A. Advanced dental therapist. "Advanced dental therapist" means a person who 
holds a valid license as a dental hygienist issued by the board and is authorized to practice 
advanced dental therapy under this chapter. 
1-B. Advanced dental therapy. "Advanced dental therapy" means the delivery of 
dental hygiene services, including performance of certain dental procedures under the 
general supervision of a dentist in accordance with this chapter. 
Sec. 5. 32 MRSA §18302, sub-§5, as enacted by PL 2015, c. 429, §21, is 
amended to read: 
· 
5. Dental auxiliary. "Dental auxiliary" means a dental radiographer, expanded 
function dental assistant, dental hygienist, independent practice dental hygienist, public 
health dental hygienist, dental hygiene therapist, advanced dental therapist or denturist. 
Sec. 6. 32 MRSA §18345, sub-§2, ,re, as enacted by PL 2015, c. 429, §21, is 
amended to read: 
C. For dental hygiene therapist authority: 
( 1) Verification of having successfully completed a bachelor's degree or higher 
in dental h;rgiene therapy from an educational program that: 
(a) ls accredited by the American Dental Association Commission on Dental 
Accreditation or a successor organization approved by the board; or 
(b) ls a m.in:imHm. of 4 semesters: 
(o) ls oonsistent w:ith the model 01:1rrio1:1l1:1m fer edl:leating dental hJrgiene 
therapists adopted by the American Assoeiation of Pl:lblio Health Dentistry or 
a s1:1eeessor oreani2atlon: 
(d) 
ls consistent 1uith eristing dental hveiene theranv nroerams in other 
states anoroved bv the boaFEl: aiid 
(e) Meets the requirements for dental hJ'giene therapy education programs 
adopted by board rule; 
(2) 
Verification of a bachelor's degree or higher in dental hygiene, dental 
hygiene therapy or dental therapy from a school accredited by the American 
Dental Association Commission on Dental Acereditation or a s1:1ecessor 
orgaiiization; 
(3) Verification of passing a clinical examination and all other examinations 
required by board rule. The clinical examination must be a comprehensive, 
competency-based clinical examination approved by the board and administered 
independently of an institution providing dental hygiene therapy education; 
( 4) Verification of having engaged in 2,000 hours of supervised clinical practice 
under the supervision of a dentist and in conformity with rules adopted by the 
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SENATE AMENDMENT "6 "to COMMITTEE AMENDMENT "B" to H.P. 1037, L.D. 1514 
board, during which supervised clinical practice the applicant is authorized to 
practice pursuant to paragraph F. 
For purposes of meeting the clinical requirements of this subparagraph, an 
applicant's hours of supervised clinical experience while enrolled in the dental 
hygiene therapy program under subparagraph ( 1) may be included as well as 
hours completed under the supervision of a dentist licensed in another state or a 
Canadian province, provided that as long as the applicant was operating lawfully 
under the laws and rules of that state or province; and 
( 5) A copy of the written practice agreement and standing orders required by 
sec ti on 1 8 3 77, subsection 3; 
Sec. 7. 32 MRSA §18345, sub-§2, ,c-1 is enacted to read: 
C-1. For advanced dental therapist authority: 
(1) Verification of having successfully completed a master of science degree or 
higher in dental therapy from an educational program that: 
(a) Is accredited by the American Dental Association Commission on Dental 
Accreditation or a successor organization approved by the board; or 
(b) Meets the requirements for dental therapy education programs adopted 
by board rule; 
(2) Verification of passing a clinical examination and all other examinations 
required by board rule. The clinical examination must be a comprehensive, 
competency-based clinical examination approved by the board and administered 
independently of an institution providing dental therapy education; 
(3) Verification of having engaged in 2,000 hours of supervised clinical practice 
under the supervision of a dentist and in conformity with rules adopted by the 
board, during which supervised clinical practice the applicant is authorized to 
practice pursuant to paragraph F. 
For purposes of meeting the clinical requirements of this subparagraph, an 
applicant's hours of supervised clinical experience while enrolled in the dental 
therapy program under subparagraph (l) may be included as well as hours 
completed under the supervision of a dentist licensed in another state or a 
Canadian province, as long as the applicant was operating lawfully under the 
laws and rules of that state or province; and 
( 4) A copy of the written practice agreement and standing orders required by 
section 18377, subsection 3; 
Sec. 8. 32 MRSA §18345, sub-§2, ,rF, as enacted by PL 2015, c. 429, §21, is 
amended to read: 
F. For provisional dental hygiene therapist or advanced dental therapist authority: 
(1) Verification of meeting the requirements of paragraph C, subparagraphs (1) 
to (3) or paragraph C-1, subparagraphs (1) and (2); and 
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(2) A copy of the written agreement between the applicant and a dentist who will 
provide levels of supervision consistent with the scope of practice outlined in 
section 183 77 and in conformity with rules adopted by the board. 
During the period of provisional authority the applicant may be compensated for 
services performed as a dental hygiene therapist or advanced dental therapist. The 
period of provisional authority may not exceed 3 years. 
Sec. 9. 
MRSA §18371, sub-§5, as enacted by PL 2015, c. 429, §21, is 
amended to read: 
5. Supervision of dental therapists and advanced dental therapists. A dentist, 
referred to in this section as the "supervising dentist," who employs or supervises a dental 
hyeene therapist or advanced dental therapist shall comply with this subsection. 
A. A supervising dentist shall arrange for another dentist or specialist to provide any 
services needed by a patient of a dental hygiene therapist or an advanced dental 
therapist supervised by that dentist that are beyond the scope of practice of the dental 
hygiene therapist or advanced dental therapist and that the supervising dentist is 
unable to provide. 
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B. The supervising dentist is responsible for all authorized services and procedures 
performed by the dental hygiene therapist or advanced dental therapist pursuant to a 
written practice agreement executed by the dentist pursuant to section 183 77. 
C. Revisions to a written practice agreement must be documented in a new written 
practice agreement signed by the supervising dentist and the dental hygiene therapist 
or advanced dental therapist. 
D. A supervising dentist who signs a written practice agreement shall file a copy of 
the agreement with the board, keep a copy for the dentist's own records and make a 
copy available to patients of the dental hygiene therapist or advanced dental therapist 
upon request. 
E. A dentist may not supervise more than a total of 5 dental therapists and advanced 
dental therapists at one time. 
Sec. 10. 32 MRSA §18377, as enacted by PL 2015, c. 429, §21, is amended to 
read: 
§18377. Dental therapist; advanced dental therapist 
1. Scope of practice; dental therapist. A dental hygiene therapist may perform the 
following procedures in limited practice settings, if authorized by a written practice 
agreement with a dentist licensed in this State pursuant to subsection 3. 
A. To the extent permitted in a written practice agreement, a dental hygiene therapist 
may provide the care and services listed in this paragraph only under the direct 
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supervision of the supervising dentist: 
(1) Perform oral health assessments, pulpal disease assessments for primary and 
young teeth, simple cavity preparations and restorations and simple extractions; 
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(2) Prepare and place stainless steel crowns and aesthetic anterior crowns for 
primary incisors and prepare, place and remove space maintainers; 
(3) Provide referrals; 
( 4) Administer local anesthesia and nitrous oxide analgesia; 
(5) Perform pr~ventive services; 
( 6) 
Conduct urgent management of dental trauma, perform suturing, extract 
primary teeth and perform nonsurgical extractions of periodontally diseased 
permanent teeth if authorized in advance by the supervising dentist; 
(7) 
Provide, dispense and administer anti-inflammatories, nonprescription 
analgesics, antimicrobials, antibiotics and anticaries materials; 
(8) Administer radiographs; and 
(9) Perform other related services and functions authorized by the supervising 
dentist and for which the dental hye;ieae therapist is trained. 
B. To the extent permitted in a written practice agreement, a dental hygieae therapist 
may provide the care and services listed in section 183 7 4, subsections I and 2 under 
the general supervision of the supervising dentist. 
1-A. Scope of practice; advanced dental therapist. An advanced dental therapist 
may perform the procedures listed in subsection 1, paragraphs A and B in limited practice 
settings, if authorized by a written practice agreement with a dentist licensed in this State 
pursuant to subsection 3. To the extent permitted in the written practice agreement, the 
advanced dental therapist may perform these procedures under the general supervision of 
the supervising dentist. 
2. Supervision responsibilities. A dental hygieae therapist or an advanced dental 
therapist may be delegated a dentist's responsibility to supervise up to 2 dental hygienists 
and 3 unlicensed persons in any one practice setting through a written practice agreement 
pursuant to subsection 3. 
3. 
Practice requirements. A dental hygieae therapist and an advanced dental 
therapist must comply with the following practice limitations. 
A. A dental hygieae therapist and an advanced dental therapist may provide services 
only in 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 
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and Human Services, Centers for Medicare and Medicaid Services to meet the 
requirements 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 in 
which at least 50% of the patients who are provided services by that dental J:n·i;riene 
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therapist or advanced dental therapist are covered by the MaineCare program under 
Title 22 or are underserved adults. 
B. A dental h.ygiene therapist and ari advanced dental therapist may practice only 
under the ffif8St supervision of a dentist through a written practice agreement signed 
by both parties. A written practice agreement is a signed document that outlines the 
functions that the dental hygiene therapist or advanced dental therapist is authorized 
to perform, which may not exceed the scopes of practice specified in subsections 1.,. 
1-A and 2. A dental hygiene therapist or advanced dental therapist may practice only 
under the standing order of the supervising dentist, may provide only care that 
follows written protocols and may provide only services that the dental hygieae 
therapist or advanced dental therapist is authorized to provide by the written practice 
agreement. 
C. A written practice agreement between a supervising dentist and a dental hygiene 
therapist or an advanced dental therapist must include the following elements: 
( 1) The services and procedures and the practice settings for those services and 
procedures that the dental hygiene therapist or advanced dental therapist may 
provide, together with any limitations on those services and procedures; 
(2) Any age-specific and procedure-specific practice protocols, including case 
selection criteria, assessment guidelines and imaging frequency; 
(3) Procedures to be used with patients treated by the dental hygiene therapist or 
advanced dental therapist for obtaining informed consent and for creating and 
maintaining dental records; 
( 4) A plan for review of patient records by the supervising dentist and the dental 
J,11,i:,ir11'1r1 therapist or advanced dental therapist; 
(5) A plan for managing medical emergencies in each practice setting in which 
the dental h-ygieae therapist or advanced dental therapist provides care; 
(6) A quality assurance plan for monitoring care, including patient care review, 
referral follow-up and a quality assurance chart review; 
(7) 
Protocols for administering and dispensing medications, including the 
specific circumstances under which medications may be administered and 
dispensed; 
(8) Criteria for providing care to patients with specific medical conditions or 
complex medical histories, including requirements for consultation prior to 
initiating care; and 
(9) 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 h-ygieae therapist or 
advanced dental therapist. 
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SENATE AMENDMENT" B 
"to COMMITTEE AMENDMENT "B" to H.P. 1037, L.D. 1514 
D. Revisions to a written practice agreement must be documented in a new written 
practice agreement signed by the supervising dentist and the dental hygiene therapist 
or advanced dental therapist. 
E. A dental hygiene therapist or an advanced dental therapist shall file a copy of a 
written practice agreement with the board, keep a copy for the dental hygiene 
therapist's own records and make a copy available to patients of the dental hygiene 
therapist upon request. 
F. A dental hygiene therapist or an advanced dental therapist shall refer patients in 
accordance with a written practice agreement to another qualified dental or health 
care professional to receive needed services that exceed the scope of practice of the 
deRtal hvi;rieRe therapist. 
G. A dental hygiene therapist or an advanced dental therapist who provides services 
or procedures beyond those authorized in a written agreement engages in 
unprofessional conduct and is subject to discipline pursuant to section 18325. 
4. 
Dental coverage and reimbursement. 
Notwithstanding 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 or an advanced dental therapist authorized to practice under this chapter. 
Sec. 11. Maine Revised Statutes amended; revision clause. Wherever in the 
Maine Revised Statutes the words "dental hygiene therapist" appear or reference is made 
to those words, they are amended to read or mean, as appropriate, "dental therapist," and 
the Revisor of Statutes shall implement this revision when updating, publishing or 
republishing the statutes. 
Sec. 12. Maine Revised Statutes amended; revision clause. Wherever in the 
Maine Revised Statutes the words "dental hygiene therapy" appear or reference is made 
to those words, they are amended to read or mean, as appropriate, "dental therapy," and 
the Revisor of Statutes shall implement this revision when updating, publishing or 
republishing the statutes.' ' 
SUMMARY 
This amendment makes the following changes to the Dental Practice Act enacted in 
Public Law 2015, chapter 429: 
1. It changes the term "dental hygiene therapist" to "dental therapist"; 
2. It changes the term "dental hygiene therapy" to "dental therapy"; 
3. 
It specifies that a dental hygienist seeking authority to practice as a dental 
therapist must have received at least a bachelor's degree from a dental therapy education 
program that is accredited by either the Board of Dental Practice or the American Dental 
Association Commission on Dental Accreditation or a successor organization approved 
by the board; 
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4. 
It creates a new category of dental hygienist authority, the advanced dental 
therapist; 
5. It specifies that a dental hygienist seeking authority to practice as an advanced 
dental therapist must have received at least a master of science degree from a dental 
therapy education program that is accredited by either the Board of Dental Practice or the 
American Dental Association Commission on Dental Accreditation or a successor 
organization approved by the board; 
6. 
It retains the requirement that a dental therapist practice under the direct 
supervision of a dentist licensed in the State; 
7. It authorizes an advanced dental therapist to practice under the general supervision 
of a dentist licensed in the State; and 
8. It limits to 5 the total number of dental therapists and advanced dental therapists 
that a single dentist may supervise at one time. 
The amendment also requires reimbursement under the MaineCare program, 
individual and group dental insurance policies and individual and group health insurance 
policies .that include coverage for dental services for dental services provided by 
advanced dental therapists. 
FISCAL NOTE REQUIRED 
SPONSORED BY: 
(Senator VOLK) 
COUNTY: Cumberland 
(S~attacy~ 
SENA TE.AMENDMENT 
Approved: 04/12/16 
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LD 1514 
LR 2414(08) 
An Act To Conform Maine Law to the Requirements of the American Dental Association Commission 
on Dental Accreditation 
Fiscal Note for Senate Amendment 'tf to Committee Amendment "B" 
Fiscal Detail and Notes 
Sponsor: Sen. Volk of Cumberland 
Fiscal Note Required: Yes 
Fiscal Note 
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Potential future biennium cost increase - General Fund 
Potential future biennium cost increase - Other Special Revenue Funds 
While the bill requires MaineCare reimburse for advancded dental therapist services, 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 advanced dental 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, affiliated with the Department of Professional and Financial Regulation, may incur 
additional costs to implement the process of creating a new category of dental hygienist authority, the advanced dental 
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. 
LR2414(08) - Fiscal Note - Page 1 of 1