216-40-05 R.I. Code R. § 2.9

Current through June 20, 2024

Section 216-RICR-40-05-2.9 - Public Health Dental Hygiene Practice

2.9.1 Qualifications

A. A public health dental hygienist may provide dental services which are educational, preventive, therapeutic, prophylactic and intra-oral in nature as may be authorized by the Board and may perform all tasks as set forth under the Act and this Part.

B. Educational requirements for the Public Health Dental Hygiene Practitioner

1. Prior to practicing as a public health dental hygienist a dental hygienist shall complete a minimum of twelve (12) hours of continuing education as follows:

a. A minimum of six (6) hours of hands-on experience in a public health setting.

b. Successful completion of the following courses within twenty-four (24) months prior to license issuance:

(1) Public Health Fundamentals:

(AA) CDC Guidelines (Infection Control);

(BB) Risk management for practice in a public health setting; and

(CC) Management of medical emergencies.

(DD) The courses specified by §§ 2.9.1(B)(1)(b) ((1))(AA) through (CC) of this Part must be by an educational institution with a program accredited by the Commission on Dental Accreditation, or by a program approved by the Board.

2. The public health dental hygienist shall permanently retain documentation demonstrating compliance of continuing educational requirement including a signed affidavit that confirms successful completion.

C. A public health dental hygienist practicing in a public health setting may perform those services which are authorized by the Board to be provided in a public health setting, pursuant to a written collaborative agreement (WCA).

D. A registered dental hygienist practicing in a public health setting may provide dental hygiene services including placement of sealants, without first having a dentist examine the patient, pursuant to a written collaborative agreement (WCA).

E. Public health dental hygienists shall maintain current malpractice insurance.

2.9.2Application Process

A. Application for licensure shall be made on forms provided by the Board

B. Rhode Island Registered Dental Hygienists shall provide the following documents with their application:

1. Verification that their license is in good standing in state(s) where licensed [if licensed in another state(s)];

2. Verification that they have worked full time as a Registered Dental Hygienist for at least three (3) years full time or have completed at least 4500 hours of clinical experience;

3. Verification of additional training as set forth in § 2.9 of this Part;

4. The application fee as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title) in accordance with R.I. Gen. Laws § 5-31.1-6.

C. Applicants holding a Dental Hygienist License from another state shall provide the following documents with their application:

1. A state driver's license, a state-issued identification card or such other identification papers acceptable to the Director that include birthdate and a picture;

2. Verification that the licensee is in good standing in state(s) where licensed [if licensed in another state(s)];

3. Verification that they have:

a. Worked full time as a Registered Dental Hygienist for at least three (3) years full time; or

b. Have completed at least four thousand five hundred (4500) hours of clinical experience; or

c. Hold a current license in good standing to practice Public Health Dental Hygiene or equivalent, as determined by the Board, in another state for five (5) years that required the successful completion of a clinical board examination in order to be eligible for licensure.

4. Verification of additional training as set forth in § 2.9.9 of this Part; and the application fee as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title) in accordance with R.I. Gen. Laws § 5-31.1-6.

2.9.3Written Collaborative Agreement (WCA) with a Public Health Dental Hygienist

A. A public health dental hygienist shall:

1. Enter into a written collaborative agreement (WCA) which complies with the requirements of R.I. Gen. Laws § 5-31.1-39(c) and § 2.9.3(C) of this Part before rendering treatment to provide any dental hygiene services in a public health setting pursuant to the collaborative agreement;

2. Maintain contact and document communication with the dentist with whom the public health dental hygienist has entered into a written collaborative agreement (WCA) as set forth within that agreement.

3. Practice in accordance with R.I. Gen. Laws § 5-31.1-39 and this Part;

4. Practice in accordance with systems, policies and procedures established pursuant to the Board, the Act and this Part.

5. Obtain written and signed informed consent from the patient or legal representative which complies with R.I. Gen. Laws § 23-4.6-1 and the Board regulations which informs the patient or legal representative that the services provided by the public health dental hygienist are not a substitute for a dental examination by a dentist and informs the patient that the patient or legal representative should obtain, or should have had a dental examination by a dentist within ninety (90) days.

6. Provide each patient with a written Information Sheet at the conclusion of the patient's visit. Said Information Sheet shall, at a minimum, include the following:

a. Results of the dental hygiene evaluation;

b. The name(s) of the public health dental hygienists and any licensed dentist and other dental auxiliaries who provided services;

c. A description of the treatment rendered including, but not limited to, billable service codes and fees associated with treatment, and tooth numbers, when appropriate;

d. Information on how to contact the public health dental hygienist, public health setting's program director, mobile dental facility or portable dental operation permit holder;

e. If necessary, provide a referral for emergency assessment by a dentist;

f. When a referral is made, the patient or legal representative shall be referred to the patient's regular dentist if one is identified. If none is identified, then the patient or legal representative shall be provided with the names of dentist(s), community health center(s) or dental school clinic(s) located within a reasonable geographic distance from the patient's home and with whom the public health dental hygienist or dental health services program has communicated with regarding the acceptance of referrals;

g. The name and signature of the public health dental hygienist; and

h. If the patient or legal representative has given consent for an institutional facility (e.g. school, nursing home) to access the patient's dental health records, then the dental hygienist shall also provide the institution with a copy of the Information Sheet for each patient.

B. A dentist entering into a written collaborative agreement (WCA) with a public health dental hygienist may, but is not required to, provide subsequent dental treatment to patients served under said agreement.

C. Written Collaborative Agreement (WCA). The collaborative agreement between a public health dental hygienist and a municipality or state agency or institution, or with a licensed dentist who holds a valid Rhode Island dental license shall, at a minimum address all of the following:

1. Identify by name(s) the dentist(s) who shall be available to provide the appropriate level of communications and consultation with the public health dental hygienist to ensure patient health and safety;

2. Describe, with specificity how communication and consultation between the dentist and public health dental hygienist will be accomplished including the frequency and arrangements for back-up coverage when the dentist is not accessible to provide communication and consultation (e.g. during vacation, illness);

3. Provide the names, license numbers, address(es), telephone and facsimile number(s) and emergency contact information for the dentist(s) and public health dental hygienist;

4. Identify entity(ies) and geographic area(s) where public health dental hygienist services will be provided pursuant to the collaborative agreement;

5. Specify the dental hygiene procedures to be provided and the populations to be served pursuant to the collaborative agreement;

6. Specify and describe responsibilities for creating, maintaining, storing, retrieving and providing for the confidentiality of patient records;

7. Specify and describe responsibilities for establishing systems, policies and procedures to ensure compliance with Board regulations, including but not limited to requirements of Mobile and Portable Dentistry as may be applicable;

8. Specify and describe responsibilities for developing, implementing, and maintaining emergency medical protocols and for the provision of periodic review and training on same;

9. Include any considerations for age-related procedure-specific protocols as may be deemed necessary by the dentist or public health dental hygienist;

10. Include any considerations for medically-compromised patients as may be deemed necessary by the dentist or public health dental hygienist;

11. Outline responsibilities for billing and reimbursement for services rendered by the dental hygienist in the public health setting, if indicated;

12. Identify a process for the public health dental hygienist to legally obtain prescription products (e.g. chemotherapeutics, fluoride varnish) pertinent to the provision of dental hygiene services and which are to be utilized when rendering services in a public health setting; and

13. Term of the collaborative agreement, if applicable.

D. The dentist and public health dental hygienist shall review and update the written collaborative agreement on an annual basis, as a minimum frequency.

E. The dentist and public health dental hygienist shall immediately notify each other and, if applicable, the municipality, state agency or institution involved in the collaborative agreement of any disciplinary action imposed by the Board or any other governmental agency against his/her license to practice dentistry or dental hygiene in the State of Rhode Island.

F. A copy of the written collaborative agreement shall be maintained by the municipality, state agency or institution, licensed dentist and the public health dental hygienist. Upon written request, said agreement shall be made available to the Board, or to a patient who received treatment pursuant to the agreement or his/her legal representative.

G. Each public health dental hygienist shall maintain the following data to be reported to the Rhode Island Department of Health Oral Health Program on forms and in accordance with procedures and timelines established by that program:

1. The dates of each session with name and address of the site where public health dental hygiene services were provided; and

2. The number of patients served.

2.9.4Availability of Dental Records

A. Request for Copy of Dental Record. The public health dental hygienist shall provide upon request by a patient or a specifically authorized person, a complete copy of the patient's dental record in accordance with R.I. Gen. Laws § 5-31.1-10(10) A copy of the patient record including radiographs and other images, shall be provided within a reasonable amount of time not to exceed thirty (30) calendar days from the date of the request. The public health dental hygienist may charge a reasonable fee for the expense of providing a patient's dental record, not to exceed the cost of either labor and/or material incurred in the copying of the patient record, radiographs and models. The Public Health Dental Hygienist shall not require payment for dental services rendered as a condition of providing a copy of the dental record.

B. Treatment in a School Setting. Where consent has been granted by the patient or legal representative, a copy of the patient's summary of care or other written summary of the screening, examination, or treatment shall be provided to the official designated by the school.

C. Treatment in a Nursing Home or Residential Treatment Facility. A copy of the patient's summary of care or other written summary of the screening, examination, or treatment shall be provided to the official designated by the facility or institution and shall be made part of the patient record maintained by the nursing home or residential facility

D. Electronic patient records shall comply with the requirements of HIPAA and the Confidentiality of Health Care Communications and Information Act, R.I. Gen. L aws Chapter 5-37.3 and shall be unalterable and producible in paper form upon request.

2.9.5Content of Patient Records

A. The patient record shall be a complete record of all patient contact, including, but not limited to, a general description of the patient's medical and dental history and status at time of examination, assessments and /or diagnosis provided by a dentist, patient education, treatment plan, referral for specialty treatment, medications administered and prescribed, pre- and post-treatment instructions and information conveyed to the patient. Patient records shall be legible and clear in meaning to a subsequent examining or treating dentist, the patient, dental auxiliary or other authorized persons.

B. Public health dental hygienist proprietary forms shall include language as approved by the Board.

2.9.6Required Referrals

Public health dental hygienists will refer patients without a dental provider to a public or private dentist with the goal of establishing a dental home for the patient. When the public health dental hygienist determines at a subsequent appointment that there are conditions present which require evaluation for treatment, and the patient has not seen a dentist as referred, the dental hygienist will make every practical or reasonable effort to schedule the patient with a Rhode Island dentist or local private dentist volunteer for an examination, treatment plan and follow up care, or a community health center if available.

2.9.7Radiograph

Digital radiographs shall be conducted pursuant to the regulations for Radiation (Subchapter 20 of this Chapter). The collaborating and currently licensed Rhode Island dentist shall evaluate the radiographs within thirty (30) days of exposure.

2.9.8Temporary Restorative Procedures

A public health dental hygienist, as defined by this Part may perform reversible procedures including but not limited to temporary restorative procedures without a dentist present under protocols developed by the Board of Dentistry as outlined in § 2.17 of this Part.

2.9.9Continuing Education Requirements

A. Public health dental hygienists; prior to renewal of licensure shall obtain a minimum of six (6) hours of continuing education in courses related to public health. These six (6) hours are included in the required twenty (20) hours of continuing education required every two (2) years following the criteria listed in § 2.16 of this Part. The following public health topics are recommended:

1. Home && Community - Based Care

a. Youth Services

(1) School-based care

(2) Head Start && Early Head Start

(3) Day Care

2. Eldercare Services

3. Community- based settings (e.g. nursing homes, assisted living)

4. Homebound - All Populations (including individuals with disabilities)

B. Third Party Payment Models && Business 101

C. Grant Writing 101

D. Diversity Training && Case Management Concepts

216 R.I. Code R. § 216-RICR-40-05-2.9

Amended effective 4/4/2019