An Act To Align the Laws Governing Dental Therapy with Standards Established by the American Dental Association Commission on Dental Accreditation
Maine Legislature, Session 129, LD 1441
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MASTRACCIO, JACKSON, BABINE, CAIAZZO, CRAVEN, DENK, FARNSWORTH, FECTEAU, GROHOSKI, JORGENSEN
Amends: 22 MRSA §3174-X, 24 MRSA §2317-B, 24-A MRSA §2765-A, 24-A MRSA §2847-U, 32 MRSA §18302, 32 MRSA §18345, 32 MRSA §18351, 32 MRSA §18371, 32 MRSA §18377

Legislative Document
No. 1441
H.P. 1053
House of Representatives, April 2, 2019
An Act To Align the Laws Governing Dental Therapy with 
Standards Established by the American Dental Association 
Commission on Dental Accreditation
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MASTRACCIO of Sanford.
Cosponsored by President JACKSON of Aroostook and
Representatives: BABINE of Scarborough, CAIAZZO of Scarborough, CRAVEN of Lewiston, 
DENK of Kennebunk, FARNSWORTH of Portland, FECTEAU of Biddeford, GROHOSKI of 
Ellsworth, JORGENSEN of Portland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §3174-XX, as amended by PL 2015, c. 429, §5, is further 
amended to read:
§3174-XX.  Dental 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, section 18377 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-§21, as enacted by PL 2013, c. 575, §4 and 
affected by §10, is amended to read:
21.  Title 24-A, sections 2765-A and 2847-U.  The practice of dental hygiene 
therapy by a dental hygiene therapist, Title 24-A, sections 2765-A and 2847-U.
Sec. 3.  24-A MRSA §2765-A, as amended by PL 2015, c. 429, §12, is further 
amended to read:
§2765-A.  Coverage for services provided by dental therapist
1.  Services provided by dental 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 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.
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. 4.  24-A MRSA §2847-U, as amended by PL 2015, c. 429, §14, is further 
amended to read:
§2847-U.  Coverage for services provided by dental therapist
1.  Services provided by dental 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 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.
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. 5.  32 MRSA §18302, sub-§§5, 7 and 8, as enacted by PL 2015, c. 429, 
§21, are further 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 or denturist.
7.  Dental therapist.  "Dental hygiene therapist" means a person who holds a valid 
license as a dental hygienist issued by the board and is authorized to practice dental 
hygiene therapy under this chapter.
8.  Dental therapy.  "Dental hygiene therapy" means the delivery of dental hygiene 
services, including performance of certain dental procedures in accordance with this 
chapter.
Sec. 6.  32 MRSA §18302, sub-§29, as enacted by PL 2015, c. 429, §21, is 
amended to read:
29.  Provisional dental therapist.  "Provisional dental hygiene therapist" means a 
person who holds a valid license as a dental hygienist issued by the board and who is 
authorized to practice dental hygiene therapy under the supervision of a dentist in 
accordance with this chapter.
Sec. 7.  32 MRSA §18345, sub-§2, ¶¶C and F, as enacted by PL 2015, c. 429, 
§21, are amended to read:
C.  For dental hygiene therapist authority:
(1)  Verification of having successfully completed a of a master's degree in dental 
hygiene therapy from a program that: accredited by the American Dental 
Association Commission on Dental Accreditation or its successor organization;
(a)  Is accredited by the American Dental Association Commission on Dental 
Accreditation or a successor organization;
(b)  Is a minimum of 4 semesters;
(c)  Is consistent with the model curriculum for educating dental hygiene 
therapists adopted by the American Association of Public Health Dentistry or 
a successor organization;
(d)  Is consistent with existing dental hygiene therapy programs in other 
states approved by the board; and
(e)  Meets the requirements for dental hygiene therapy education programs 
adopted by board rule;
(2)  Verification of a bachelor's degree or higher in dental hygiene, master's 
degree in dental hygiene therapy or dental therapy from a school accredited from 
a program that meets the requirements by board rule consistent with the 
accreditation standards identified by the American Dental Association 
Commission on Dental Accreditation or a its successor organization;
(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 
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 
section 18377, subsection 3; and
(6)  Verification of a current advanced cardiac life support certification;
F.  For provisional dental hygiene therapist authority:
(1)  Verification of meeting the requirements of paragraph C, subparagraphs (1) 
to (3) and (6); and
(2)  A copy of the written agreement in conformity with rules adopted by the 
board between the applicant and a dentist who will provide levels of supervision 
consistent direct supervision with the scope of practice outlined in section 18377 
and in conformity with rules adopted by the board, subsection 1, paragraph A and 
levels of supervision consistent with the scope of practice outlined in section 
18374, subsections 1 and 2.
During the period of provisional authority the applicant may be compensated for 
services performed as a dental hygiene therapist.  The period of provisional authority 
may not exceed 3 years.
Sec. 8.  32 MRSA §18351, last ¶, as amended by PL 2017, c. 388, §12, is further 
amended to read:
An individual who practices under a resident dentist license or as a provisional dental 
hygiene therapist may not apply for inactive status.
Sec. 9.  32 MRSA §18371, sub-§5, as enacted by PL 2015, c. 429, §21, is 
amended to read:
5.  Supervision of dental  therapists.  A dentist, referred to in this section as the 
"supervising dentist," who employs a dental hygiene 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 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.
B.  The supervising dentist is responsible for all authorized services and procedures 
performed by the dental hygiene therapist pursuant to a written practice agreement 
executed by the dentist pursuant to section 18377.
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.
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 upon request.
Sec. 10.  32 MRSA §18377, as enacted by PL 2015, c. 429, §21, is amended to 
read:
§18377.  Dental therapist
1.  Scope of practice.  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 and in section 18374, 
subsections 1 and 2 under the direct general 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;
(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 preventive 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 hygiene therapist is trained.
B.  To the extent permitted in a written practice agreement, a dental hygiene therapist 
may provide the care and services listed in section 18374, subsections 1 and 2 under 
the general supervision of the supervising dentist.
2.  Supervision responsibilities.  A dental hygiene 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 hygiene therapist must comply with the 
following practice limitations.
A.  A dental hygiene 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 and Human Services, Centers for 
Medicare and Medicaid Services to meet the requirements for funding under Section 
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 hygiene therapist are covered by the 
MaineCare program under Title 22 or are underserved adults.
B.  A dental hygiene therapist may practice only under the direct levels of supervision 
of a dentist through identified in 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 is authorized to perform, which may not exceed the scopes of 
practice specified in subsections 1 and 2.  A dental hygiene 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 hygiene 
therapist is authorized to provide by the written practice agreement.
C.  A written practice agreement between a supervising dentist and a dental hygiene 
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 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 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 
hygiene therapist;
(5)  A plan for managing medical emergencies in each practice setting in which 
the dental hygiene 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 hygiene therapist.
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.
E.  A dental hygiene 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 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 dental hygiene therapist.
G.  A dental hygiene 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 authorized to practice under this chapter.
SUMMARY
This bill makes the following changes to the laws affecting dental therapists.
1.  It changes the name of the occupation licensed from "dental hygiene therapist" to 
"dental therapist" to conform to the name used by other state licensing boards and the 
American Dental Association Commission on Dental Accreditation.
2.  It identifies the educational requirement as a master's degree in dental therapy.  It 
also clarifies that a dental therapy program must either be accredited by the American 
Dental Association Commission on Dental Education or approved by the Board of Dental 
Practice by rulemaking consistent with the curriculum standards of a dental therapy 
program as adopted by the American Dental Association Commission on Dental 
Education.
3.  It requires a provisional dental therapist and a dental therapist to maintain a 
current certification in advanced cardiac life support.
4.  It clarifies the level of supervision of a provisional dental therapist to require both 
direct and general supervision as identified in a written practice agreement with a 
supervising dentist.  It authorizes a dental therapist to practice under the general 
supervision instead of direct supervision of a dentist pursuant to a written practice 
agreement.
5.  It removes the practice setting requirements.