PAGD Keystone Explorer Winter 2019 20

18 www.pagd.org Regulations Subcommittee The regularly scheduled board meeting was proceeded by a meeting of the State Board of Dentistry (SBOD) Regulations Subcommittee. The discussion topic was expanded independent practice sites for Public Health Dental Hygiene Practitioners (PHDHPs). Board counsel noted that the board was still formulating its response to many of the comments that were made during the public comment period. Based on previous discussions by the board, some changes were included in the draft response: » Birth centers were added. » Satellite locations of physician’s offices were added. » Facilities licensed by the Department of Drug and Alcohol Programs were added. » Language regarding in-home and residential care were removed, with a plan to address these in the future with additional safety measures. Several board members requested to address physician’s offices as an independent practice site. Dr. Casey noted that many states require collaborative practice agreements with a dentist as a consideration and suggested that this board do the same. Dr. Cindy Olewine from St. Luke’s was recognized in the audience. She oversees a team of PHDHPs that offers services in a community setting and refers to St. Luke’s as a dental home, primarily for the Medical Assistance (MA) population. She indicated that many locations were easier to include a collaborative practice agreement than others, as some locations that they serve in rural Pennsylvania have few to no dentists participating in MA, making a collaborative agreement difficult. Morgan Plant, lobbyist for the Pennsylvania Dental Hygienists Association (PDHA), noted that there is currently no requirement for a collaborative agreement in the empowering statute for PHDHPs. When asked about collaborative agreements specifically, Morgan indicated that nurse practitioners, many of which are required to have collaborative practice agreements, consider them a barrier to access in the medical field. She also indicated that there won’t be many PHDHPs practicing independently, most will be working for or partnering with managed care organizations and health systems. Dr. Lugo asked about sterilization procedures by PHDHPs in mobile settings. He cited a child from Tamaqua that was infected with HIV while living in Florida due to inadequate infection control in a dental van. His concern is that PHDHPs practicing independently and remotely may not have the capability to sterilize properly. Several of the hygienists present noted that all regulated practitioners are required to follow CDC guidelines in regulation, regardless of the setting. Several board members continued objections about the lack of follow-through on the required referral and noted a newsletter article that indicated only seven percent of patients seen by a PHDHP or independently practicing hygienist follow through with an appointment at a dental home. Ms. Fowler responded that this argument is brought up frequently, and that the provider is only responsible for their own behavior, not their patient’s. Several board members suggested that as a potential compromise for those with concerns about physicians’ offices, that independent practice in a physician’s office be limited to Dental Health Professional Shortage Areas (DHPSAs), a ratio of provider to population defined by the Department of Health. An informal straw poll of board members indicated that many of the board would be in favor of this. Board counsel will research the legal ramifications of adding language to the draft regulations tying in DHPSAs to PHDHP practice in physicians’ offices. The scheduled vote on the subject was not held and the board will consider this further at its January meeting. State Board of Dentistry Meeting The board introduced incoming board counsel Jackie Lutz. Ms. Lutz has been an attorney for over 30 years and has State Board of Dentistry Report Meeting Summary November 15, 2019 \ advocacy