STATE OF IOWA IOWA DENTAL BOARD KIM REYNOLDS, GOVERNOR JILL STUECKER ADAM GREGG, LT. GOVERNOR EXECUTIVE DIRECTOR IOWA DENTAL HYGIENE COMMITTEE MEETING AGENDA January 25, 2019 8:15 AM *Updated 1/23/2019* The mission of the Iowa Dental Board is to ensure that all Iowans receive professional, competent, and safe dental care of the highest quality. Location: Iowa Dental Board, 400 SW 8th St., Suite D, Des Moines, Iowa Members: Mary Kelly, R.D.H., Chair; Nancy Slach, R.D.H., Michael Davidson, D.D.S. OPEN SESSION: 8:15 AM I. CALL MEETING TO ORDER – ROLL CALL II. 1st OPPORTUNITY FOR PUBLIC COMMENT III. APPROVAL OF OPEN SESSION MINUTES a. November 16, 2018 IV. EXECUTIVE DIRECTOR’S REPORT V. ADMINISTRATIVE RULES/ADMINISTRATIVE RULE WAIVERS a. Review of 2018-2019 Regulatory Plan b. Vote on Proposed Notice of Intended Action: Amendments to Iowa Administrative Code 650 - Chapter 27, “Standards of Practice and Principles of Professional Ethics” VI. LEGISLATIVE UPDATE a. Discussion on Board Legislation VII. OTHER BUSINESS a. Discussion on Hygiene Workforce i. Oral Health Workforce Research Center: Variation in Dental Hygiene Scope of Practice by State 400 SW 8th STREET, SUITE D, DES MOINES, IA 50309-4687 PHONE:515-281-5157 FAX:515-281-7969 http://www.dentalboard.iowa.gov ii. Reforming America’s Healthcare System Through Choice and Competition VIII. 2nd OPPORTUNITY FOR PUBLIC COMMENT CLOSED SESSION: Motion to go into closed session pursuant to Iowa Code section 21.5(1)(a), to review or discuss records which are required or authorized by state or federal law to be kept confidential; pursuant to Iowa Code section 21.5(1)(d), to discuss whether to initiate licensee disciplinary investigations or proceedings and pursuant to Iowa Code section 21.5(1)(f), to discuss the decision to be rendered in a contested case conducted according to the provisions of chapter 17A. I. ITEMS FOR REVIEW AND DISCUSSION a. Closed Session Minutes, November 16, 2018 (21.5(1)(a)) b. Complaints and Investigative Reports (21.5(1)(d)) c. Combined Statement of Charges, Settlement Agreement and Final Order (21.5(1)(d) & 21.5(1)(f)) OPEN SESSION II. ACTION, IF ANY, ON CLOSED SESSION ITEMS a. Closed Session Minutes: November 16, 2018 b. Complaints and Investigative Reports c. Combined Statement of Charges, Settlement Agreement and Final Order III. ADJOURN NEXT REGULARLY SCHEDULED MEETING: April 5, 2019 Please Note: At the discretion of the chairperson, agenda items may be taken out of order to accommodate scheduling requests of committee members, presenters or attendees; or to facilitate meeting efficiency. If you require the assistance of auxiliary aids or services to participate in or attend the meeting because of a disability, please call the office of the Board at 515/281-5157. 2 STATE OF IOWA IOWA DENTAL BOARD KIM REYNOLDS, GOVERNOR JILL STUECKER ADAM GREGG, LT. GOVERNOR EXECUTIVE DIRECTOR DENTAL HYGIENE COMMITTEE MINUTES November 16, 2018 Conference Room 400 SW 8th St. Suite D Des Moines, Iowa Committee Members November 16, 2018 Mary C. Kelly, R.D.H. Present Nancy A. Slach, R.D.H. Present Michael Davidson, D.D.S. Present Staff Members Jill Stuecker, Christel Braness, Dee Ann Argo, Steven Garrison, David Schultz, Phil McCollum Attorney General’s Office Laura Steffensmeier, Assistant Attorney General I. CALL TO ORDER FOR NOVEMBER 16, 2018 Ms. Kelly called the meeting of the Dental Hygiene Committee to order at 8:30 a.m., Friday, November 16, 2018. Roll Call: Member: Kelly Slach Davidson Present x x x Absent A quorum was established with all members present. II. 1st OPPORTUNITY FOR PUBLIC COMMENT Ms. Kelly asked everyone to introduce themselves, and allowed the opportunity for public comment. DRAFT Mr. Cope, Iowa Dental Hygienists' Association (IDHA), expressed concerns regarding one of the proposals in the expanded functions rules. The concerns related to the proposal to allow Level 1 expanded functions dental assistants to recement provisional crowns and bridges under general supervision. The IDHA does not believe that there is sufficient training to allow this under general supervision. The IDHA requests that the Board give serious reconsideration to this proposal. 400 SW 8th STREET, SUITE D, DES MOINES, IA 50309-4687 PHONE:515-281-5157 FAX:515-281-7969 http://www.dentalboard.iowa.gov III. APPROVAL OF OPEN SESSION MINUTES . September 28, 2018 – Quarterly Meeting MOVED by SLACH, SECONDED by DAVIDSON, to APPROVE the open session minutes of the September 28, 2018 meeting as submitted. Motion APPROVED unanimously. IV. EXECUTIVE DIRECTOR’S REPORT Ms. Stuecker did not have a report. V. ADMINISTRATIVE RULES/ADMINISTRATIVE RULE WAIVERS . Review of 2018-2019 Regulatory Plan Mr. Garrison provided an overview of the current plan. Vote on Proposed Notice of Intended Action: Addition to Iowa Administrative Code 650 - Chapter 23, “Expanded Functions”, Amendments to Iowa Administrative Code 650 - Chapter 10 “General Requirements”, Iowa Administrative Code 650 - Chapter 20, “Dental Assistants” and Iowa Administrative Code 650 - Chapter 15, “Fees” The committee was provided with the proposed Notice of Intended Action of the expanded functions rules. The most recent changes were in blue for easier review. Ms. Kelly expressed concern with the recommendation to allow Level 1 expanded functions dental assistants to recement provisional restorations under general supervision. The current rules defining general supervision of a dental assistant would be in conflict with this proposal. Ms. Braness asked Ms. Steffensmeier if this could still be addressed administratively before the filing, or if this would be a sufficient enough change to delay a vote on the Notice of Intended Action. Ms. Steffensmeier stated that if a change in language was agreed upon, it could still proceed as a vote. Ms. Stuecker noted that Iowa Administrative Code 650-Chapter 1 was not included in this draft. Ms. Slach expressed concerns with placing expanded functions into a single chapter. Ms. Slach believed that it would be better to have the scopes of practice for dental hygienists and dental assistants addressed separately. The committee discussedDRAFT the concerns related to the proposal to allow recementation of provisional restorations under general supervision. Dr. Davidson stated that there was minimal concern, particularly when compared to a patient trying to recement the provisional restoration him or herself. Dental Hygiene Committee Meeting – OPEN SESSION – Subject to final approval November 16, 2018 (Draft: 11/28/2018) 2 Ms. Stuecker asked Ms. Steffensmeier to further address the issue of the definitions for “general supervision of a dental assistant” in Iowa Administrative Code 650-Chapters 1 and 23. Ms. Steffensmeier noted that there were differences. The definition provided in Iowa Administrative 650-Chapter 1 applies, generally, to the entirety of Iowa Administrative 650; whereas, the definition in chapter 23 applies only to the requirements in that specific chapter. Ms. Kelly stated that she was concerned about public safety; otherwise, she was in favor of the rules as drafted. Ms. Steffensmeier summarized the options available to the committee. After further discussion, the committee decided against making a recommendation to the Board regarding the proposed Notice of Intended Action due to a lack of consensus. The matter would be discussed further at the Board meeting. Discussion on Teledentistry Rules Mr. Garrison provided an overview of the proposed rules. The current draft was more concise than previous versions. The intention would be to have a Notice of Intended Action drafted for a vote in January 2019. Ms. Kelly referenced the proposed subrule Iowa Administrative Code 27.12(9), and recommended adding an item “c” to specifically include public health supervision among the types of supervision allowed within teledentistry. The language was proposed follows: “When public health supervision is utilized, the supervising dentist may authorize the use of teledentistry technologies for consultative purposes.” Ms. Kelly recommended removing “for consultative purposes” from the additional language as she believed that this was inherently understood within the context of the rule. The committee members agreed. Mr. McCollum asked if teledentistry would make these patients of record for the dentist. Ms. Stuecker stated that the teledentistry rules would not change other already-established rules. Ms. Kelly asked if a provision could be added to require that the dental licensee be physically present within in the state of Iowa. Ms. Steffensmeier stated that this type of limitation could not be included. Even if the treatment occurs via teledentistry, the treatment location would be based on the location of the patient. Out-of-state licensees could not be treated differently than licensees physically located within the state of Iowa. MOVED by KELLY, SECONDED by DAVIDSON, to DIRECT staff to draft a Notice of Intended ActionDRAFT for January 2019 with the changes as discussed. Motion APPROVED unanimously. VI. OTHER BUSINESS . Discussion on Settings for Services Provided as Outlined in Iowa Code 153.15 Dental Hygiene Committee Meeting – OPEN SESSION – Subject to final approval November 16, 2018 (Draft: 11/28/2018) 3 Ms. Stuecker asked Mr. Cope to summarize the discussions the IDHA had with the Iowa Dental Association (IDA) about this item. The IDHA believed that the most important focus should be the issue supervision. Identifying locations becomes restrictive, particularly in light of the development of new technologies. The IDHA was in favor of removing references to approved locations and focus on the required levels of supervision in the practice of dental hygiene. The IDA appeared to simply be in favor of adding nursing facilities to the list of approved facilities within the Iowa Code. Ms. Stuecker noted that this was listed as a discussion on the agenda, and was not scheduled as a vote; however, the deadline to file legislative proposals was November 30, 2018. Dr. Davidson agreed with removing the restrictions to location in the Iowa Code and allowing greater flexibility within Iowa Administrative Code 650.