HOUSE BILL No. 2724

      An Act concerning the dental practices act; relating to the practice of dental hygiene;
      concerning dental services for dentally indigent persons; amending K.S.A. 65-1462 and
      K.S.A. 1997 Supp. 65-1423, 65-1456, 65-1466 and 74-1404 and repealing the existing
      sections.

Be it enacted by the Legislature of the State of Kansas:

    Section 1. K.S.A. 1997 Supp. 65-1423 is hereby amended to read as
follows: 65-1423. Nothing in this act shall apply to the following practices,
acts and operations:

    (a) To the practice of a person licensed to practice medicine and
surgery under the laws of this state, unless such person practices dentistry
as a specialty; or

    (b) to the performance by a licensed nurse of a task as part of the
administration of an anaesthetic for a dental operation under the direct
supervision of a licensed dentist or person licensed to practice medicine
and surgery so long as the anaesthetic given under the direct supervision
of a licensed dentist is consistent with the anaesthetic the dentist is au-
thorized to administer under K.S.A. 65-1444 and amendments thereto
and consistent with subsection (a) of K.S.A. 65-1162 and amendments
thereto and subsection (e) of K.S.A. 65-1163 and amendments thereto;

    (c) to the giving by a registered nurse anesthetist of an anaesthetic
for a dental operation in an interdependent role as a member of a phy-
sician or dentist directed health care team;

    (d) the practice of dentistry in the discharge of their official duties
by graduate dentists or dental surgeons in the United States army, navy,
air force, marines, public health service, coast guard or veterans' bureau
administration;

    (e) the practice of dentistry by a licensed dentist of other states or
countries at meetings of the Kansas state dental association or compo-
nents thereof, or other like dental organizations approved by the board,
while appearing as clinicians;

    (f) to the filling of prescriptions of a licensed and registered dentist
as hereinafter provided by any person or persons, association, corporation
or other entity, for the construction, reproduction or repair of prosthetic
dentures, bridges, plates or appliances to be used or worn as substitutes
for natural teeth, provided that such person or persons, associations, cor-
poration or other entity, shall not solicit or advertise, directly or indirectly
by mail, card, newspaper, pamphlet, radio or otherwise, to the general
public to construct, reproduce or repair prosthetic dentures, bridges,
plates or other appliances to be used or worn as substitutes for natural
teeth;

    (g) to the use of roentgen or x-ray machines or other rays for making
radiograms or similar records, of dental or oral tissues under the super-
vision of a licensed dentist or physician except that such service shall not
be advertised by any name whatever as an aid or inducement to secure
dental patronage, and no person shall advertise that such person has,
leases, owns or operates a roentgen or x-ray machine for the purpose of
making dental radiograms of the human teeth or tissues or the oral cavity,
or administering treatment thereto for any disease thereof;

    (h) except as hereinafter limited to the performance of any dental
service of any kind by any person who is not licensed under this act, if
such service is performed under the supervision of a dentist licensed
under this act at the office of such licensed dentist except that such non-
licensed person shall not be allowed to perform or attempt to perform
the following dental operations or services:

    (1) Any and all removal of or addition to the hard or soft tissue of the
oral cavity;

    (2) any and all diagnosis of or prescription for treatment for disease,
pain, deformity, deficiency, injury or physical condition of the human
teeth or jaws, or adjacent structure;

    (3) any and all correction of malformation of teeth or of the jaws;

    (4) any and all administration of general or local anaesthesia of any
nature in connection with a dental operation; or

    (5) a prophylaxis, except that individuals who are not licensed but
who are operating under the direct supervision of a dentist may (A) cor-
onal polish teeth as defined by rules and regulations of the board and (B)
coronal scale teeth above the gum line as long as such procedure is not
performed on a patient who has undergone local or general anesthesia at
the time of the procedure, is undertaken by a nonlicensed person who has
successfully completed necessary training for performing such dental pro-
cedure in a course of study approved by the board, which course of study
is consistent with American dental association accreditation standards
and includes but is not limited to adequate instruction on scaling the teeth
and recognition of periodontal disease, is undertaken by a person who
has met the experience requirements for performing such procedures as
established by the board and such procedure is performed prior to July
1, 2001. The provisions of this part (B) of subsection (h)(5) shall expire
on July 1, 2001.

    (i) As used in this section:

    (1) ``Removal of or addition to the hard or soft tissue of the oral
cavity'' means: (A) A surgical or cutting procedure on hard or soft tissues;
(B) the grafting of hard or soft tissues; (C) the final placement or intraoral
adjustment of a fixed crown or fixed bridge; and (D) root planing or the
smoothing of roughened root surfaces.

    (2) ``Diagnosis of or prescription for treatment for disease, pain, de-
formity, deficiency, injury or physical condition of the human teeth or
jaws or adjacent structure'' means: (A) A comprehensive examination; (B)
diagnosis and treatment planning; and (C) the prescription of a drug,
medication or work authorization.

    (3) ``Correction of malformation of teeth or the jaws'' means surgery,
cutting or any other irreversible procedure.

    (4) ``General or local anesthesia of any nature in connection with a
dental operation'' means any general anaesthetic and any local anaesthetic
whether block or infiltration but shall not include the administration and
monitoring of the analgesic use of nitrous oxide or oxygen, or both.

    Sec. 2. K.S.A. 1997 Supp. 65-1456 is hereby amended to read as
follows: 65-1456. (a) The board may suspend or revoke the license, license
certificate and renewal certificate of any registered and licensed dentist
who shall permit any dental hygienist operating under such dentist's su-
pervision to perform any operation other than that permitted under the
provisions of article 14 of chapter 65 of the Kansas Statutes Annotated,
or acts amendatory thereof, and may suspend or revoke the license of any
hygienist found guilty of performing any operation other than those per-
mitted under article 14 of chapter 65 of the Kansas Statutes Annotated,
or acts amendatory thereof. No license or certificate of any dentist or
dental hygienist shall be suspended or revoked in any administrative pro-
ceedings without first complying with the notice and hearing require-
ments of the Kansas administrative procedure act.

    (b) The practice of dental hygiene shall include those educational,
preventive, and therapeutic procedures which result in the removal of
extraneous deposits, stains and debris from the teeth and the rendering
of smooth surfaces of the teeth to the depths of the gingival sulci. In-
cluded among those educational, preventive and therapeutic procedures
are the instruction of the patient as to daily personal care, protecting the
teeth from dental caries, the scaling and polishing of the crown surfaces
and the planing of the root surfaces, in addition to the curettage of those
soft tissues lining the free gingiva to the depth of the gingival sulcus and
such additional educational, preventive and therapeutic procedures as the
board may establish by rules and regulations.

    (c) Subject to such prohibitions, limitations and conditions as the
board may prescribe by rules and regulations, any licensed dental hy-
gienist may practice dental hygiene and may also perform such dental
service as may be performed by a dental assistant under the provisions of
K.S.A. 65-1423 and amendments thereto.

    (d) Except as otherwise provided in this section, the practice of dental
hygiene shall be performed under the direct or indirect or general su-
pervision of a licensed dentist at the office of such licensed dentist. The
board may designate by rules and regulations the procedures which may
be performed by a dental hygienist under direct supervision and the pro-
cedures which may be performed under the indirect supervision of a
licensed dentist. The board shall designate by rules and regulations the
procedures which may be performed by a dental hygienist under direct
supervision and the procedures which may be performed under general
supervision of a licensed dentist. As used in this section,: (1) ``Indirect
supervision'' means that the dentist is in the dental office, authorizes the
procedures and remains in the dental office while the procedures are
being performed and ``Direct supervision'' means that the dentist is in
the dental office, personally diagnoses the condition to be treated, per-
sonally authorizes the procedure and before dismissal of the patient eval-
uates the performance; and (2) ``general supervision'' means a Kansas
licensed dentist may delegate verbally or by written authorization the
performance of a service, task or procedure to a licensed dental hygienist
under the supervision and responsibility of the dentist, if the dental hy-
gienist is licensed to perform the function, and the supervising dentist
examines the patient at the time the dental hygiene procedure is per-
formed, or during the 12 calendar months preceding the performance of
the procedure, except that the licensed hygienist shall not be permitted to
diagnose a dental disease or ailment, prescribe any treatment or a regimen
thereof, prescribe, order or dispense medication or perform any procedure
which is irreversible or which involves the intentional cutting of the soft
or hard tissue by any means. A dentist is not required to be on the prem-
ises at the time a hygienist performs a function delegated under part (2)
of this subsection.

    (e) The practice of dental hygiene may be performed at an adult care
home, hospital long-term care unit, state institution, local health depart-
ment or indigent health care clinic on a resident of a facility, client or
patient thereof so long as:

    (1) A licensed dentist has delegated the performance of the service,
task or procedure;

    (2) the dental hygienist is under the supervision and responsibility of
the dentist;

    (3) either the supervising dentist is personally present or the services,
tasks and procedures are limited to the cleaning of teeth, education and
preventive care;

    (4) the supervising dentist examines the patient at the time the dental
hygiene procedure is performed or has examined the patient during the
12 calendar months preceding performance of the procedure; and

    (5) nothing in this subsection (e) shall be construed to prevent a den-
tal hygienist from providing dental education in a school setting; and

    (6) the provisions of this subsection (e) shall expire on July 1, 1998.

    (f) The board may issue a permit to a licensed dental hygienist to
provide dental screening as an employee of the state of Kansas, or any
subdivision thereof, at any public institution or facility under the super-
vision of the governing body of such public institution or facility under
such terms and conditions as the board may reasonably establish in such
permit. Such permit shall be for a period of one year and shall be subject
to renewal annually at the time the license for dental hygiene is renewed.

    (g) In addition to the duties specifically mentioned in subsection (b)
of K.S.A. 65-1456, and amendments thereto, any duly licensed and reg-
istered dental hygienist may:

    (1) Give fluoride treatments as a prophylactic measure, as defined by
the United States public health service and as recommended for use in
dentistry;

    (2) remove overhanging restoration margins and periodontal surgery
materials by hand scaling instruments; and

    (3) administer local block and infiltration anaesthesia and nitrous ox-
ide. (A) The administration of local anaesthesia shall be performed only
under the direct supervision of a licensed dentist at the office of the
licensed dentist. (B) Each dental hygienist who administers local anaes-
thesia shall have completed courses of instruction in local anaesthesia and
nitrous oxide which have been approved by the board.

    (h) (1) The courses of instruction required in subsection (g)(3)(B) of
K.S.A. 65-1456, and amendments thereto, shall provide a minimum of 12
hours of instruction at a teaching institution accredited by the American
dental association.

    (2) The courses of instruction shall include courses which provide
both didactic and clinical instruction in: (A) Theory of pain control; (B)
anatomy; (C) medical history; (D) pharmacology; and (E) emergencies
and complications.

    (3) Certification in cardiac pulmonary resuscitation shall be required
in all cases.

    New Sec. 3. The state board of education, the state board of regents
and the Kansas dental board shall report to the legislature on or before
January 11, 1999, on plans for increasing the number of persons in this
state being trained as dental hygienists.

    Sec. 4. K.S.A. 1997 Supp. 65-1466 is hereby amended to read as
follows: 65-1466. (a) Notwithstanding any other provision of the dental
practices act, a not-for-profit corporation having the status of an organi-
zation under 26 United States Code Annotated 501(c)(3) which is also a
facility qualified under subsection (b) of K.S.A. 65-431 and amendments
thereto to select and employ professional personnel, an indigent health
care clinic as defined by the rules and regulations of the secretary of
health and environment, a federally qualified health center, or a local
health department may employ or otherwise contract with a person li-
censed under the dental practices act to provide dental services to dentally
indigent persons.

    (b) Dentally indigent persons are those persons who are: (1) Deter-
mined to be a member of a family unit earning at or below 200% of
poverty income guidelines based on the annual update of ``poverty income
guidelines'' published in the federal register by the United States de-
partment of health and human services and are not indemnified against
costs arising from medical and hospital care or dental care by a policy of
accident and sickness insurance or an employee health benefits plan; or
(2) eligible for medicaid; or (3) qualified for Indian health services. This
subsection shall not be construed to prohibit an entity under subsection
(a) which enters into an arrangement with a licensee under the dental
practices act for purposes of providing services to dentally indigent per-
sons pursuant to subsection (a) from defining ``dentally indigent persons''
more restrictively than such term is defined under this subsection.

    (c) A licensee under the dental practices act who enters into an ar-
rangement with an entity under subsection (a) to provide dental services
pursuant to subsection (a): (1) Shall not be subject to having the licensee's
license certificate suspended or revoked by the board solely as a result of
such arrangement; and (2) may not permit another person who is not
licensed in Kansas as a dentist, and is not otherwise competent, to engage
in the clinical practice of dentistry. No entity under subsection (a) or any
other person may direct or interfere or attempt to direct or interfere with
a licensed dentist's professional judgment and competent practice of den-
tistry.

    (d) A dentist who is classified as ``retired'' by the Kansas dental board
is not required to pay the annual renewal fee or comply with the dental
continuing education requirements if the dentist elects to provide dental
services to the indigent through one of the entities specified in subsection
(a). A ``retired'' dentist providing such services shall be required to comply
with the annual renewal requirements of the Kansas dental board.

    (e) The Kansas dental board may adopt rules and regulations as nec-
essary to carry out the provisions of this section.

    (e) (f) This section shall be part of and supplemental to the dental
practices act. The provisions of this section shall expire on July 1, 1998.

    Sec. 5. K.S.A. 1997 Supp. 74-1404 is hereby amended to read as
follows: 74-1404. (a) In order to accomplish the purpose and to provide
for the enforcement of this act, there is hereby created the Kansas dental
board. The board shall be vested with authority to carry out the purposes
and enforce the provisions of this act. The board shall consist of the
following: (1) Three Six licensed and qualified resident dentists; (2) one
two licensed and qualified resident dental hygienist hygienists; and (3)
one representative of the general public. At least 30 days before the ex-
piration of any term, other than that of the member appointed from the
general public or a member who is a dental hygienist, the Kansas dental
association or its successor shall submit to the governor a list of three
names of persons of recognized ability who have the qualifications pre-
scribed for the dentist board members. At least 30 days before the ex-
piration of the term of the dental hygienist member of the board, the
Kansas dental hygiene association shall submit to the governor a list of
three names of persons of recognized ability who have the qualifications
prescribed for the dental hygienist member. For the four new members
to be appointed under this act, such names shall be submitted within 10
days after the effective date of this act. The governor shall consider such
list of persons in making the appointment to the board.

    (b) The members shall be appointed by the governor in the manner
hereinafter prescribed for terms of four years and until their successors
are appointed and qualified. Of the six licensed dentists on the board, one
shall be appointed from each congressional district and two shall be ap-
pointed from the state at large. On and after the effective date of this act,
no person shall be appointed for more than two consecutive four-year
terms. No person in any way connected with a dental supply or dental
laboratory business shall be eligible for appointment to the board. No
person shall be eligible for appointment to the board who has been con-
victed of a violation of any of the provisions of this or any other prior
dental practice act or who has been convicted of a felony. A dentist who
is an officer of the Kansas dental association shall not be eligible for ap-
pointment to the Kansas dental board. A dental hygienist who is an officer
of the Kansas dental hygienists association shall not be eligible for ap-
pointment to the Kansas dental board. No dentist or dental hygienist shall
be appointed to the board who has not been engaged in the active practice
of dentistry or dental hygiene in the state of Kansas for at least five years
next preceding appointment. Whenever a vacancy occurs it shall be filled
by appointment for the remainder of the unexpired term in the same
manner as an original appointment is made.

    (b) (c) Upon the effective date of this act, in order to expand the
membership to the prescribed six dentists and two dental hygienists, the
governor shall appoint three additional dentists and one additional hy-
gienist to the board in the manner described in this section. Of the three
new dental members, one shall serve until April 30, 2000, one shall serve
until April 30, 2001 and one shall serve until April 30, 2002, as designated
by the governor. Thereafter, all terms shall be four-year terms beginning
May 1 of the appointment year and expiring April 30 four years later.
When the terms of the existing dentist members which expire May 1, 2000,
and May 1, 2001 conclude, then successors shall be appointed for four
year terms beginning May 1 and expiring April 30 four years later. The
additional dental hygienist appointed upon the effective date of this act
shall serve until April 30, 2002, and thereafter the successor shall serve a
four-year term beginning May 1 and expiring April 30 four years later.
Upon the expiration of terms of office of members, successors shall be
appointed in the same manner as original appointments for terms of four
years.

    Sec. 6. K.S.A. 65-1462 is hereby amended to read as follows: 65-
1462. (a) No person reporting to the Kansas dental board under oath and
in good faith any information such person may have relating to alleged
incidents of malpractice or the qualifications, fitness or character of a
person licensed to practice dentistry shall be subject to a civil action for
damages as a result of reporting such information.

    (b) Any state, regional or local association of licensed dentists or li-
censed dental hygienists, and the individual members of any committee
thereof, which in good faith investigates or communicates information
pertaining to the alleged incidents of malpractice or the qualifications,
fitness or character of any licensee to the Kansas dental board or to any
committee or agent thereof, shall be immune from liability in any civil
action, that is based upon such investigation or transmittal of information
if the investigation and communication was made in good faith and did
not represent as true any matter not reasonably believed to be true.

    Sec. 7. K.S.A. 65-1462 and K.S.A. 1997 Supp. 65-1423, 65-1456, 65-
1466 and 74-1404 are hereby repealed.

    Sec. 8. This act shall take effect and be in force from and after its
publication in the statute book.

I hereby certify that the above Bill originated in the
House, and passed that body

__________________________________

House adopted
Conference Committee Report __________________________

__________________________________

Speaker of the House.

__________________________________

Chief Clerk of the House.

Passed the Senate
as amended __________________________

Senate adopted
Conference Committe Report __________________________

__________________________________

President of the Senate

__________________________________

Secretary of the Senate.

Approved__________________________

__________________________________

Governor.