Key provision of CDA-opposed scope bill rejected

Legislation sponsored by the California Dental Hygienists’ Association (CDHA) that would eliminate an important safeguard for patients served by registered dental hygienists in alternative practice (RDHAPs) was substantially amended by a legislative committee in April to address problematic provisions opposed by CDA.

Most notably, the Assembly Business and Professions Committee rejected a provision in Assembly Bill 502, authored by Assemblyman Ed Chau (D-Monterey Park), that would eliminate the current requirement for a dentist’s or physician’s prescription in order for an RDHAP to continue providing services to patients after 18 months. This prescription requirement safeguards the necessary opportunity for a dentist to develop a treatment plan for the full range of needed care and encourages patients to seek any critical services from a dentist. CDA supports, and in fact promotes, the benefits of RDHAPs and dentists working together to improve access, but also supports the prescription requirement that protects patients from possible neglect of undiagnosed or untreated dental disease.

The author accepted the committee’s request to remove this provision of the bill, and the committee approved the amended bill on a 10-4 vote. 

“We are very pleased that the Legislature recognizes the value of the prescription requirement in encouraging access to comprehensive dental care for vulnerable populations,” said CDA President Walt Weber, DDS. “CDA supports expanding access to care through innovative ways that keep the comprehensive care provided by dental teams intact, such as the Virtual Dental Home.”  

The Virtual Dental Home model was enacted on a permanent basis through AB 1174 last year and improves access to comprehensive dental care by connecting specially trained dental hygienists  or extended function dental assistants located in community settings (such as preschools and nursing homes) with a dentist located in an office or clinic via telehealth technology. The allied dental team member collects diagnostic records and sends it electronically via a secure Web-based system (called store-and-forward telehealth) to the supervising dentist to establish a diagnosis and create a dental treatment plan for the hygienist or assistant to carry out. The hygienists and assistants provide basic dental care to patients and make referrals to dental offices for procedures that require the skills of a dentist. 

The committee also obtained a commitment from the author to develop criteria around another provision in the bill that would allow RDHAPs to continue practicing in communities designated as dental health professional shortage areas (DHPSAs) even if the area’s designation changes (current law allows RDHAPs to establish their own practices in DHPSAs). CDA and committee members questioned the need for this given the absence of any DHPSA designation changes. To address these concerns, the committee recommended consideration of language prior to the bill’s hearing by the Assembly Health Committee, anticipated by May 1, that would ensure RDHAPs are providing care for underserved populations, given that this is the purpose of the RDHAP classification. CDA remains opposed to the bill until there is an opportunity to consider such amendments.

The RDHAP license was created through legislation in 1998 and allows RDHAPs to deliver hygiene services in alternative settings, such as schools and skilled nursing facilities, for patients who face difficulties in accessing care in a traditional dental office. There are now more than 500 RDHAPs who provide preventive and periodontal care in settings and locations throughout California, often serving as a patient’s initial point of contact and essential support for his or her entry into the dental care delivery system.  

Read an article highlighting an RDHAP and dentist who have worked together for many years to provide dental care in a California rural community.