G ove r n men t Re lat ions
At its meeting on May 17, 2019, the SBOD discussed
stakeholders’ comments in support of and in opposition to the
proposed regulations. The SBOD will continue to review
comments from stakeholders and other governmental agencies,
and will most likely make changes to the current draft of the
proposed regulations as the regulatory process continues.
The SBOD must first discuss and vote on any proposed changes,
which may take place at future meetings this year.
PDA’s position is that PHDHPs should provide services to
underserved patient populations with the goal of identifying
dental homes for these patients. We believe that standardizing
the referral process between PHDHPs and dentists is essential
to patients benefiting from a continuity of care and achieving
better health outcomes. A standard referral form should
include specific language for patients to understand that they
were not treated by a dentist and that they must follow
through on the referral to a dentist for a thorough examination,
diagnosis and treatment plan. PDA would also like the
regulations to require PHDHPs to apply sealants using current
evidence-based guidelines and manufacturers’ instructions.
A history of PHDHPs in Pennsylvania
Former Sen. Patricia Vance first introduced PHDHP legislation
during the 2005-2006 legislative session. PDA successfully
“killed” the bill in committee and it never received any
consideration. Sen. Vance reintroduced her legislation during
the 2007-2008 session and it quickly became apparent that
leadership in the House of Representatives and Senate
supported the bill and that it had traction.
PDA lobbied aggressively against the bill and testified in
opposition during at least one hearing. At some point in the
process, knowing that a law was going to pass, we worked with
Sen. Vance to amend the bill in order to involve dentists and
provide additional safeguards for patients. PDA successfully
amended the legislation so that PHDHPs must carry malpractice
insurance and make annual referrals to dentists. We also
convinced lawmakers that hygienists need more work experience
before they were allowed to practice in the10 public locations
delineated in the law. After the law passed, the SBOD
promulgated regulations that reflected the provisions passed
in the law.
The law enacted in 2007 does not change a PHDHPs scope
of practice. Hygienists with PHDHPs permits are not allowed to
examine, diagnose or render treatment plans in any setting.
8
JU LY/AU GU ST 2019 | P EN N S YLVA N IA D EN TA L J O UR N A L
That remains with the dentists’ scope of practice, both in the
Dental Practice Act and the regulations. They are allowed to
practice to the full extent of hygienists’ scope of practice outline
in State Board of Dentistry regulations.
In 2016, the Pennsylvania Dental Hygienists’ Association (PDHA)
petitioned the SBOD to amend current regulations and allow
PHDHPs to practice in three additional site locations:
• primary care settings (such as physician offices)
• child care settings
• residences of homebound and hospice patients
In 2016 and 2017, PDA wrote letters to the SBOD opposing this
petition, citing a number of safety and other concerns for
patients. In January 2017, PDA leadership attended a committee
meeting of the SBOD, which first considered PDHA’s petition
and spoke out in opposition to the expansion of PHDHP
practice site locations. We sent action alerts to all members,
requesting that they send letters of opposition to the SBOD. We
asked the SBOD to consider concerns specific to the challenges
dentists face when providing care to the geriatric and pediatric
patient population. Despite our opposition, in September 2017,
the SBOD voted to proceed with drafting regulations allowing
PHDHPs to practice in these three settings. After the SBOD vote,
PDA began to consider how best the regulations should read for
the provider community and for patients.
In March 2019, the formal regulatory process was initiated when
the SBOD published its proposed regulations in the PA Bulletin.
This process involves the Governor’s Office, the Independent
Regulatory Review Commission, the House and Senate
Professional Licensure Committees, and last but not least,
stakeholders. This process is intentionally time consuming and
cumbersome, so that the issue is thoroughly vetted before
regulations are enacted. Stay tuned for more updates as the State
Board of Dentistry continues to deliberate the draft regulations.
New DEP Regulations
Recently, new Department of Environmental Protection (DEP)
regulations regarding radiological health have gone into
effect. While these changes most notably impact dental offices
with Cone Beam- Computed Tomography (CBCT) machines,
there are changes that will impact all dental offices.
Here is an overview of the changes:
Offices with CBCT machines
For offices with CBCT machines, these updated quality control
regulations must be adhered to: