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 Amendment CA_A_H503 (House)
Amends: 32 MRSA §18345, 32 MRSA §18377

COMMITTEE AMENDMENT .. f]" to H.P. 1053, L.D. 1441, Bill, "An Act To 
Align the Laws Governing Dental Therapy with Standards Established by the American 
Dental Association Commission on Dental Accreditation" 
Amend the bill by striking out all of section 7 and inserting the following: 
•Sec. 7. 32 MRSA §18345, sub-§2, ,r,rc 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 dental hygiene therapy 
program that: 
(a) Is accredited by the }.merican Dental }.ssociation Commission on Dental 
AAcm:iilHRtinn or R r.HAAl'lt.t.Ar nrmmi7.Rtinn: 
(b) Is a minimlffil of 4 semesters; 
(c) Is consistent 1tvith the model curriculum for educating dsntal hygiene 
therapists adopted by the American Association of Public Health Dentistry or 
a sussessnr ornaHization: 
(d) Is consistent with existing dental hygiene therapy programs in other 
states appmved by the board; and 
(e) Meets the requirements for dental hygiene therapy education programs 
adopted by board rule; 
(2) Verification of a bachelor's master's degree or higher in dental hygiene, 
dsntal hygiene therapy or in dental therapy from a school accredited by the 
American Dental Association Commission on Dental Accreditation or a its 
successor organization or a master's degree in dental therapy from a program that 
meets the requirements adopted by board rule consistent with the accreditation 
standards identified by the American Dental Association Commission on Dental 
Accreditation or its successor organization; 
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COMMITTEEAMENDMENT"A" toH.P.1053,L.D.1441 
(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 •.vell as 
hffi:lfS completed under the supervision of a dentist licensed in another state or a 
Canadian province may be included, provided that as long as the applicant was 
operating lawfully under the laws and rules of that state or province; arui 
(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 fB 
te (61 (3) and (6); and 
(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 18377 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. The period of provisional authority 
may not exceed 3 years.' 
Amend the bill by striking out all of section 10 and inserting the following: 
'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 under the direct 
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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COMMITTEEAMENDMENT"~"toH.P.1053,L.D.1441 
(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. 
l'... 
A dental hygiene therapist may pro11ide services only in a hospital; a public 
school, as defined in Title 20 l' .. , 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 fedsrally qualified health centsr as 
defined in 42 United States Code, S6ction 1395x(aa)(4) (1993) or that has been 
determined by the federal Department of Health and Human Services, Centers for 
Medicai'e and M6dicaid S6rvices to ill66t the requirnmoots for funding under Section 
of the Public Health Service Act, 42 United States Code, Section 254(b); a 
fedsrally qualified health center licensed in this State; a pablic health setting that 
serves und6rS6f\'ed populations as recognized by the federal Depai'tment of Health 
and Human Senrioes; or a private dental practice in v:hich at least 50% of the patients 
1.vho ai'e provided senrices by that dental hygiene therapist ai'e covered by the 
MaineCai'e program. under Title 22 or are undersenred adults. 
B. A dental hygiene therapist may practice only under the direct 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 is authorized to pe1form, which may not exceed the scopes of practice 
specified in subsections 1 and 2. A dental hygien.e therapist may practice only under 
the standing order of the supervising dentist, may provide only care that follows 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. ,4,, to H.P. 1053, L.D. 1441 
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 hvvim1A 
therapist must include the following elements: 
(1) The services and procedures and the practice settings for those services and 
procedures that the dental hygisne 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 
hvgisne 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 hygisne 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 hygisne 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 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" )1,, to H.P. 1053, L.D. 1441 
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 
4-T must also be covered and reimbursed when performed by a dental hv!!iene 
therapist authorized to practice under this chapter. 
Sec. 11. Board of Dental Practice to review dental practice laws and 
recommend changes. The Board of Dental Practice, in consultation with interested 
parties, shall review the Maine Revised Statutes, Title 32, chapter 143 and any rules 
adopted by the board and recommend changes to the statutory definitions of supervision 
and recommend a definition of "teledentistry" for the purpose of aligning current 
supervision practices and reflecting advancements in technology. The Board of Dental 
Practice shall submit its report and recommendations to the Joint Standing Committee on 
Health Coverage, Insurance and Financial Services no later than February 1, 2020. The 
Joint Standing Committee on Health Coverage, Insurance and Financial Services may 
report out a bill to the Second Regular Session of the 129th Legislature based on the 
board's recommendations.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment clarifies the educational requirements for dental therapists. 
The amendment removes language proposing to clarify statutory language related to 
supervision of dental therapists and replaces it with a provision requiring futther study of 
the issues by the Board of Dental Practice. The Board of Dental Practice is directed to 
recommend changes to the statutory definitions of supervision and to recommend a 
definition of "teledentistry" for the purpose of aligning current supervision practices and 
reflecting advancements in technology. The Board of Dental Practice is required to 
submit its recommendations to the Joint Standing Committee on Health Coverage, 
Insurance and Financial Services no later than February 1, 2020. The Joint Standing 
Committee on Health Coverage, Insurance and Financial Services may report out a bill to 
the Second Regular Session of the 129th Legislature based on the board's 
recommendations. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Revised: 06/01/19 ;Wac 
LD 1441 
LR 1201(02) 
An Act To Align the Laws Governing Dental Therapy with Standards Established by the American 
Dental Association Commission on Dental Accreditation 
Fiscal Note for Bill as Amended by Committee Amendment ,{Jr( H- !.>O~ 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
Current biennium cost increase - General Fund 
Current biennium cost increase - Federal Expenditures Fund 
The bill will require a technology change to the Maine Integrated Health Management System in the Office of 
MaineCare Service within the Department of Health and Human Services which is estimated to have a one-time cost 
of$19,841, of which $4,960 is a General Fund cost. This bill provides no new funding. The impact of these new 
unfunded costs on other programs in the DHHS cannot be determined at this time. 
Additional costs to the Board of Dental Practice, affiliated with the Department of Professional and Financial 
Regulation, to implement the requirements of this legislation can be absorbed within existing budgeted resources. 
LR1201(02) - Fiscal Note - Page 1 of 1