CHAPTER 125 HOUSE BILL No. 2161 An Act regarding dentists and dentistry; relating to dental hygienists; amending K.S.A. 65-1456 and repealing the existing section. Be it enacted by the Legislature of the State of Kansas:

      Section  1. K.S.A. 65-1456 is hereby amended to read as follows: 65-
1456. (a) The board may suspend or revoke the license of any dentist who
shall permit any dental hygienist operating under such dentist's supervi-
sion to perform any operation other than that permitted under the pro-
visions 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 of any dentist or dental hygienist
shall be suspended or revoked in any administrative proceedings without
first complying with the notice and hearing requirements 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 general supervision of a
licensed dentist at the office of such licensed dentist. The board shall
designate by rules and regulations the procedures which may be per-
formed 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) ``Direct supervision'' means that the dentist is
in the dental office, personally diagnoses the condition to be treated,
personally authorizes the procedure and before dismissal of the patient
evaluates 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 premises 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 or community
based setting.

      (f) The board may issue a permit to a licensed dental hygienist to
provide dental screening under such terms and conditions as the board
may reasonably establish in such permit. Such permit shall be subject to
renewal at the time the license for dental hygiene is renewed.

      (g) (f) The practice of dental hygiene may be performed at a public
school or accredited non public school, as defined in K.S.A. 72-89b02, and
amendments thereto, and any head start program with consent of the
parent or legal guardian, state correctional institution, local health de-
partment or indigent health care clinic, as defined in K.S.A. 65-1466, and
amendments thereto, on a person who meets the requirements of medi-
caid, healthwave or the federal free and reduced lunch program, an in-
mate, client or patient thereof so long as:

      (1) The dental hygienist has received an ``extended care permit'' from
the Kansas dental board specifying that the dental hygienist has per-
formed 1,800 hours of dental hygiene care or has been an instructor at
an accredited dental hygiene program for four semesters during the three
years prior;

      (2) the dental hygienist shows proof of professional liability insur-
ance;

      (3) the dental hygienist is sponsored by a dentist licensed in the state
of Kansas, including a signed agreement stating that the dentist shall mon-
itor the dental hygienist's activities, except such dentist shall not monitor
more than five dental hygienists with an extended care permit;

      (4) the tasks and procedures are limited to: (A) 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; (B) the application
of fluoride; (C) dental hygiene instruction; (D) assessment of the patient's
apparent need for further evaluation by a dentist to diagnose the presence
of dental caries and other abnormalities; and (E) other duties as may be
delegated verbally or in writing by the sponsoring dentists consistent with
this act;

      (5) the dental hygienist advises the patient and legal guardian that
the services are preventive in nature and do not constitute a comprehen-
sive dental diagnosis and care;

      (6) the dental hygienist provides a copy of the findings and the report
of treatment to the sponsoring dentist and any other dental or medical
supervisor at a participating organization found in this subsection; and

      (7) any payment to the dental hygienist for dental hygiene services is
received from the sponsoring dentist or the participating organization
found in this subsection.

      (g) The practice of dental hygiene may be performed at an adult care
home, hospital long-term care unit, state institution or at the home of a
homebound person who qualifies for the federal home and community
based service (HCBS) waiver on a resident of a facility, client or patient
thereof so long as:

      (1) The dental hygienist has received an ``extended care permit II''
from the Kansas dental board specifying that the dental hygienist has: (A)
performed 1,800 hours of dental hygiene care or has been an instructor
at an accredited dental hygiene program for four semesters during the
three years prior; and  (B)  completed six hours of training on the care of
special needs patients or other training as may be accepted by the board;

      (2) the dental hygienist shows proof of professional liability insur-
ance;

      (3) the dental hygienist is sponsored by a dentist licensed in the state
of Kansas, including a signed agreement stating that the dentist shall mon-
itor the dental hygienist's activities, except such dentist shall not monitor
more than five dental hygienists with an extended care permit II;

      (4) the tasks and procedures are limited to: (A) 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; (B) the application
of fluoride; (C) dental hygiene instruction; (D) assessment of the patient's
apparent need for further evaluation by a dentist to diagnose the presence
of dental caries and other abnormalities; and (E) other duties as may
be delegated verbally or in writing by the sponsoring dentist consistent
with this act;

      (5) the dental hygienist advises the patient and legal guardian that
the services are preventive in nature and do not constitute comprehensive
dental diagnosis and care;

      (6) the dental hygienist provides a copy of the findings and the report
of treatment to the sponsoring dentist and any other dental or medical
supervisor at a participating organization found in this subsection;

      (7) any payment to the dental hygienist for dental hygiene services is
received from the sponsoring dentist or the participating organization
found in this subsection; and

      (8) the dental hygienist completes a minimum of six hours of educa-
tion in the area of special needs care within the board's continuing dental
education requirements for relicensure.

      (h) In addition to the duties specifically mentioned in subsection (b)
of K.S.A. 65-1456, and amendments thereto, any duly licensed 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 under
the direct supervision of a licensed dentist. (B) Each dental hygienist who
administers local anaesthesia shall have completed courses of instruction
in local anaesthesia and nitrous oxide which have been approved by the
board.

      (h) (i)  (1) The courses of instruction required in subsection (g)
(h)(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.

      (j) The board is authorized to issue to a qualified dental hygienist an
extended care permit or extended care permit II as provided in subsections
(f) and (g) of this section.

      (k) Nothing in this section shall be construed to prevent a dental hy-
gienist from providing dental hygiene instruction or visual oral health
care screenings in a school or community based setting.

 Sec.  2. K.S.A. 65-1456 is hereby repealed.

 Sec.  3. This act shall take effect and be in force from and after its
publication in the statute book.

Approved April 21, 2003.
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