Public Act 463 - Dental Therapists Licensed in Michigan

SB 541 was enacted with Governor Rick Snyder's signature on December 27, 2018--establishing PA 463--a little more than a week after the legislation passed the House. You can download the press release on passage of the bill below. 

 

UPDATE 8-31-20: The official notice of public hearing for the draft dental therapist licensing rules has been posted and comments to the rules are now being accepted.
 
Comments on the proposed rules (incorporated into proposed General Dentistry rule changes) may be presented in person at the public hearing or submitted in writing until 5:00 p.m. on September 18.

Written comments should be sent to:
Attention: Policy Analyst, Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing - Boards and Committees Section
P.O. Box 30670, Lansing, MI 48909-8170
Email: BPL_BoardSupport@michigan.gov  
 
For those who wish to speak, the public hearing is set for 1 p.m. EST on Friday, September 18 and will be held virtually via Zoom.
Web Link: 
 https://zoom.us/j/91037626554?pwd=U2hCenFlWnhJZEV1dmV4bmZlSVUzUT09 
Password:658403
Phone number: 877-336-1831; Conference Code for audio connection: 486917
Please note: There is no requirement that Board of Dentistry members be present to hear comments during the hearing. 
 
The draft rules are available via a link here.
 
After leading the work of the MI Dental Access coalition on PA 463 of 2018, MCMCH has continued to follow the rules process and we will be submitting comments IN SUPPORT of the rules as presented.   
 
We believe the rules as presented are substantially in keeping whttps://www.infinityhr.com/extranet/JobSearch.aspx?id=135210&aid=14812ith the legislative intent of the statute and that, if promulgated, will create a regulatory structure that ensures only qualified individuals educated at institutions which meet the Commission on Dental Accreditation standards will be licensed as dental therapists in Michigan. The rules in their current form also do not create any unnecessary burdens to entering the profession or practicing the scope of practice as defined in statute. 
 
As we discussed in our last update, we worked with Rep. Jason Sheppard (R-Temperance) to address one issue that cannot be clarified through rule language. House Bill 5827 amends the Public Health Code to allow the required hours of clinical practice to be supervised by a dentist licensed in the state where the educational program is located, not limiting it to a Michigan dentist.
 
The bill passed the House of Representatives in June and is awaiting action in the Senate Health Policy Committee. We're very grateful to Rep. Sheppard for advancing this bill in a such a timely manner and we look forward to its progression through the Senate in tandem with completion of the rule promulgation process.  
 
Job Opportunity: Help Promote Dental Therapists
Want to help advance dental therapy in Michigan?  It could be your next job!
 
We are happy to share a position posted with the Michigan Primary Care Association for an Oral Health Program Specialist. This new position would be primarily responsible for advancing and promoting dental therapists in Michigan and providing support to member FQHCs and other organizations that are interested in educating and employing dental therapists.  
 
Click here for the position posting and the link to apply but don't delay - the posting is closing soon! 
 

 

Public Act 463 press release
PA 463 press release.pdf
Adobe Acrobat document [349.4 KB]

 

These infographics look at different aspects of the legislation and dental therapists

 

 

 

 

 

 

 

The Minnesota Experience
A September 2019 report on Minnesota's dental therapy workforce from the Minnesota Department of Health is available for download here.
 
The Minnesota Legislature authorized licensing of dental therapists in 2009, and they began practicing in Minnesota in 2011. As is outlined in Michigan's statute as well, dental therapists are required to practice in settings that primarily serve low-income, uninsured, and underserved patients, or in areas designated as dental Health Professional Shortage areas.
 
Currently, two Minnesota schools train dental therapists. Metropolitan State University requires a bachelor's degree in dental hygiene at entrance. Students graduate with a Master of Science Degree in Advanced dental therapy. The University of Minnesota Dental School educates students in both dental hygiene and dental therapy. When the program first began, students graduated with a bachelor's or master's degree in dental therapy, and were not dental hygienists. Starting in 2016, the university began offering a Bachelor of Dental Hygiene and a Master of Dental Therapy degree.
 
According to the Minnesota Board of Dentistry, there were 92 dental therapists (including Advanced Dental Therapists) with active licenses as of December 2018. 

 

Video Available: What is a Dental Therapist? Our partners at the Pew Charitable Trusts produced a fun video that provides a quick overall look at the work of dental therapists. In the video, viewers can see how dental therapists are making a difference when it comes to dental health and why more U.S. states are authorizing dental therapists. Access the video here.

Sen. Mike Shirkey (R- Clarklake) introduced Senate Bill 541 to address significant gaps in access to oral health services across the state by licensing dental therapists to practice in Michigan. SB 541 would allow dentists to treat more patients by hiring dental therapists, similar to a physician assistant on a medical team, to provide preventive and routine restorative care such as filling cavities. 

 

Michigan has an uneven distribution of dentists, resulting in a shortage of dental providers in many rural and urban communities.  77 out of Michigan’s 83 counties have at least one dental shortage area, leaving millions of residents without access to necessary oral care. SB 541 will expand oral health care especially to vulnerable people, including seniors, pregnant women, children and people living in rural areas. 

 

“Expanding the dental team to include a dental therapist could improve overall access to oral health care for underserved patients while allowing dentists to increase their revenues and modernize and expand their practices,” said Sen. Shirkey. “When people cannot get dental care, they often resort to emergency rooms for relief which costs Michigan taxpayers money. Relying on emergency rooms doesn’t alleviate patients’ underlying problems and places an unfair burden on taxpayers.”

 

Access to dental care is limited or nonexistent for millions of Michigan residents:

•      More than one-third of all Michigan seniors have lost six or more natural teeth due to tooth decay or gum disease. 

•      Half of new mothers in 2014 did not receive a preventative dental visit during their pregnancy. Research shows gum disease can increase the risk of preterm birth.

•      Approximately half of the kids covered by Medicaid or Healthy Kids Dental did not receive dental services in 2016.

 

Currently under state law, only dentists are allowed to perform routine procedures like filling cavities. By creating a new dental provider, the law would increase the number of highly trained professionals able to perform these basic procedures under the supervision of a dentist and allow dentists to focus their time and skills on more complicated procedures.

 

Minnesota, Maine, Vermont and tribal governments in Alaska, Washington, and Oregon allow dentists to hire these midlevel providers. More than a dozen other states are considering similar bills.

 

Arizona Approves Dental Therapy Bill

Arizona became the latest state to license dental therapists in May when Gov. Doug Ducey signed legislation that was passed by the Arizona House of Representatives 47-13 and passed unanimously in the Senate. Including Arizona, seven states now authorize dental therapists in some capacity. 
Tribal leaders, in particular, supported the measure, which they argued would help address disparities in care, according to news reports. Native American adults have more than double the average rate of untreated tooth decay. The rural location of many tribes in Arizona makes it difficult to attract and retain dentists.
Dental therapists can practice in urban Indian clinics or tribal health centers, community health centers, non-profit dental practices, federally qualified health centers and other locations under the new law. 

New Minnesota Case Study Highlights Progress With Dental Therapists at Work

In 2011, Apple Tree Dental began deploying an advanced dental therapist, as part of its care team at the Madelia Center for Dental Health, a dental clinic located within the Madelia Community Hospital and Clinic in rural southwestern Minnesota. In 2016, the population of Madelia was 2,239, and both the hospital and Apple Tree served patients from surrounding south-central rural counties.

 

This case study, covering the dental therapist's work from 2014 through 2016, provides an analysis of the productivity and cost effectiveness of an Advanced Dental Therapist (ADT) and the findings strongly suggest that other rural dental practices could benefit from adding dental therapists to their dental care teams. You can read the full case study here.

Study: Dental Therapists Mean Better Outcomes for Alaska Native Communities

Children and adults had lower rates of tooth extractions and more preventive care in Alaska Native communities served frequently by dental health aide therapists than residents in communities not receiving these services, according to a new study released by the University of Washington.

 

Led by Donald Chi, DDS, PhD, and funded by The Pew Charitable Trusts, the Rasmuson Foundation and the WK Kellogg Foundation, the study presents an analysis of patients in the Yukon-Kuskokwim Health Corporation (YKHC) from 2006 to 2015. The YKHC, which is a part of the Alaska Tribal Health System, serves 25,000 Alaska Natives representing 58 federally recognized tribes. Read more here.

Dental Therapy Helps Increase Revenue, Access to Oral Health Care

Two recent case studies show that the addition of dental therapists at two private, for-profit clinics in Minnesota helped increase access to oral health services for low-income and underserved residents while providing quality care and significantly increased cost-efficiency. In 2009, Minnesota approved legislation authorizing the statewide use of dental therapy. State dental therapists must work in practice settings that serve low-income and underserved people or in areas designated by the federal government as a "dental health professional shortage area" (DHPSA).

 

The case studies assessed the contribution of dental therapists at Midwest Dental and Grand Marais Family Dentistry. These two private, for-profit clinics are located in rural areas of Minneosta that are designated as DHPSAs. The results show that the clinics were able to serve more patients with public insurance after hiring dental therapists. Read more here.

The MI Dental Access Coalition: How We Got Here

The need to improve access to oral health care in Michigan is not a new issue.  Despite efforts, the lack of access persists for many populations in our state.  We must follow up on past recommendations and look for new solutions as numerous populations in our state—children, the elderly, the disabled and pregnant women to name a few—remain underserved.

 

The Michigan Council for Maternal and Child Health (MCMCH) and its partners are working to further evidence-based, cost effective policy solutions to improve access to oral health services. One solution is to expand the dental team by licensing a midlevel provider called a dental therapist. This will allow dentists to hire dental therapists, leading to better oral health in areas where state data shows routine dental care is limited or nonexistent.

 

Sen. Mike Shirkey (R-Clarklake) has introduced Senate Bill 541. This common-sense, cost-effective legislation would enable dentists to delegate routine procedures to dental therapists working under their supervision, and allow dentists to focus their time and skills on more complicated procedures. Dental therapists are similar to physician assistants on medical teams, and are well trained to perform routine dental procedures currently only performed by dentists, such as filling cavities.

 

Michigan now has the opportunity to be a national leader in addressing its oral health needs through this innovative, cost-effective solution. We opened the conversation about how a new workforce model incorporating dental therapists in the dental team could be part of a long-term solution.

Current Research

Visit our Research page to learn more about oral health and dental care access in Michigan. 

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The MI Dental Access Mission

For decades, disparities in oral health have existed due to barriers to access, including a misdistribution of dental providers, a shortage of dentists in Michigan who accept Medicaid and a lack of dentists who specialize in populations such as children, special needs adults and senior citizens. Other barriers to oral health care include lack of transportation, delays in getting appointments during a dental emergency, and lack of awareness of parents and caregivers about the importance of oral health care.
 
MCMCH and its partners are working to develop evidence-based, cost-effective policy solutions to improve oral health access in Michigan. To learn more about our work, visit the About page

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