Dental Therapists Act

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Summary

This act supports the licensure of dental therapists. Under this act, the board must grant a dental therapist license to an individual who satisfies the provided criteria and grant them the ability to perform procedures that require the patient to be under local anesthesia.

Dental Therapists Act

SECTION 1.  Definitions

(1) “Dental therapist” means an individual licensed by the State Board of Dentistry who engage in the limited practice of dentistry.

(2) “Dental Therapy” means the limited practice of dentistry, consisting of the services, treatments, and procedures specified under state law.

(3) “Health care provider” means a dental therapist, dental hygienist,physician assistant, nurse-midwife, or nurse practitioner.

(4) “Collaborative management agreement” means an agreement under par. (d).

(5) “Dental health shortage area” has the meaning given in [insert subsection number] (ad).

(6) “Direct supervision” means that the dentist is present in the dental office or other practice setting, personally diagnoses the condition to be treated, personally authorizes each procedure, and before dismissal of the patient, evaluates the performance of the allied dental personnel.

(7) “General supervision” means that the dentist is not present in the dental office or other practice setting or on the premises at the time tasks or procedures are being performed by the dental therapist, but that the tasks or procedures performed by the dental therapist are being performed with the prior knowledge and consent of the dentist.

(8) “Indirect supervision” means that the dentist is present in the dental office or other practice setting, authorizes each procedure, and remains in the office while the procedures are being performed by the allied dental personnel.

(9) “Medical Assistance patient” means a patient who is a recipient of services under the Medical Assistance program.

(10) “Qualifying dentist” means a dentist who is licensed in this state, who is actively practicing in this state.

(11) “Uninsured patient” means a patient who lacks dental health coverage, either through a public health care program or private insurance, and has an annual gross family income equal to or less than 200 percent of the federal poverty guidelines.

 

SECTION 2. Education and Licensing Criteria

I. The examining board shall grant a license to practice dental therapy to an individual who does all of the following:

(a) Submits an application for the license to the department on a form provided by the department.

(b) Pays the fee specified in state laws.

(c) Submits evidence satisfactory to the examining board that he or she has done one of the following:

(1) Graduated from an accredited dental therapy education program.

(2) Graduated from a dental therapy education program that was not accredited at the time of graduation, but that satisfies all of the following:

(a) The program was approved by the [insert state] Board of Dentistry on or before the effective date.

(b) The program was accredited as of the date the individual applies for a license under this subsection.

(3) Graduated from a dental therapy education program located in this state that, at the time of graduation, was not fully accredited but had received initial accreditation. This subdivision applies to a dental therapy education program only during the 4-year period beginning after the program’s inception. After those 4 years has elapsed, an individual may not qualify for a license under this subsection on the basis of graduation from that program unless the program has subsequently become accredited. The examining board shall maintain a register of individuals granted a license on the basis of graduation from a program described in this subdivision.

(d) Submits evidence satisfactory to the examining board that he or she has passed a national board dental therapy examination and a dental therapy clinical examination administered by a regional testing service that has been approved by the examining board to administer clinical examinations for dental professionals. If a national board examination or a regional testing service examination for dental therapy does not exist, the examining board shall accept evidence of passing an alternative examination administered by another entity or testing service that is approved by the examining board.

(e) Passes an examination administered by the examining board on the statutes and rules relating to dental therapy.

(f) Submits evidence satisfactory to the examining board that he or she has current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved by the state to provide such instruction.

(g) If the individual was licensed or is currently licensed in another state or territory of the United States or in another country, the individual submits information related to his or her licensure in other jurisdictions as required by the examining board.

(h) Completes any other requirements established by the examining board by rule that are comparable to and no more restrictive than the requirements established by the board for dentists and dental hygienists.

II. The examining board may not renew a license to practice dental therapy unless the applicant for renewal attests that he or she has complied with state laws and regulations, that he or she has current proficiency in cardiopulmonary resuscitation, and that he or she has current proficiency in the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved by the state to provide such instruction.

III. Except as provided in subs. (3) and (4), a person is not eligible for renewal of a license to practice dental therapy unless the person has taught, prepared, attended, or otherwise completed, during the 2-year period immediately preceding the renewal date specified, 12 credit hours of continuing education relating to the clinical practice of dental therapy that is sponsored or recognized by a local, state, regional, national, or international dental, dental therapy, dental hygiene, dental assisting, or medical-related professional organization.

IV. Continuing education required under par. (a) may include training in all of the following:

(1) Basic life support or cardiopulmonary resuscitation. Not more than 2 of the credit hours required under par. (a) may be satisfied by such training.

(2) Infection control. Not less than 2 of the credit hours required under par. (a) must be satisfied by such training.

V. After consultation with the department of health services, the examining board may promulgate rules requiring that continuing education credit hours include courses in specific clinical subjects.

(1) The credit hours required may be satisfied by independent study, correspondence, or Internet programs or courses.

(2) Does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the examining board initially granted the license.

(3) A person may substitute credit hours of college level courses related to the practice of dental therapy for the credit hours required. For purposes of this subsection, one credit hour of a college level course is equivalent to 6 credit hours of continuing education.

(4) One hour of teaching or preparing a continuing education program is equivalent to one credit hour of continuing education, but a person who teaches or prepares a continuing education program may obtain credit for the program only once.

(5) The examining board may require applicants for renewal of a license to practice dental therapy to submit proof of compliance with the requirements of this section.

 

SECTION 3. Dental Therapists

I. Dental therapists may provide dental therapy services only as an employee of specified employers and only under the supervision of a dentist who is either similarly employed or who directly employs the dental therapist. The dental therapist must also have a collaborative management agreement with a dentist that addresses various aspects of the dental therapist’s practice and supervision. Dental therapists are, subject to the terms of a collaborative management agreement and what was covered in their dental therapy education program, limited to providing services, treatments, and specified procedures as well as additional services, treatments, or procedures specified by the board by rule.

II. Dental therapists may initially provide dental therapy services only under the direct or indirect supervision of a qualifying dentist. Once a dental therapist licensed has provided dental therapy services for at least 2,000 hours, the dental therapist may provide services under the general supervision of a qualifying dentist.

III. The level of supervision for a dental therapist may be further limited under the terms of a collaborative management agreement.

IV. Dental therapists must also either:

(a) limit their practice to federally defined dental shortage areas or,

(b) practice in settings where at least 50 percent of their patient base consists of certain specified populations.

V. Dental therapists must complete 12 hours of continuing education each biennium.

VI. Dental therapists are subject to and/or covered under, various other laws, including the health care records law, the volunteer health care provider program, the health care worker protection law, and the emergency volunteer health care practitioner law.

VII. No contract of employment entered into between a dentist or dental therapist and any other party under which the dentist or dental therapist renders dental services may require the dentist or dental therapist to act in a manner which that violates the professional standards for dentistry or dental therapy set forth in this chapter. Nothing in this subsection limits the ability of the other party to control the operation of the dental practice in a manner in accordance with the professional standards for dentistry or dental therapy set forth in this chapter.

VIII.  No contract of employment entered into between a dental therapist and any other party under which the dental therapist is employed to practice dental therapy may require a dental therapist to meet a minimum quota for the number of patients seen or the number of procedures performed.

 

SECTION 4. Practice Requirements

I. A dental hygienist may practice dental hygiene or perform remediable procedures only as authorized by a dentist or dental therapist who is licensed to practice dentistry or dental therapy under this chapter and who is present in the facility in which those practices or procedures are performed.

II. A dental hygienist may practice dental hygiene or perform remediable procedures under par. (a) 1. if a dentist or dental therapist who is licensed to practice dentistry or dental therapy under this chapter is not present in the facility in which those practices or procedures are performed only if all of the required conditions are met.

 

SECTION 5. SCOPE OF PRACTICE

The scope of practice of a dental therapist shall, subject to the terms of a collaborative management agreement, be limited to providing the following services, treatments, and procedures:

(1) Oral evaluation and assessment of dental disease and formulation of an individualized treatment plan.

(2) Identification of oral and systemic conditions requiring evaluation or treatment by dentists, physicians, or other health care providers and managing referrals.

(3) Comprehensive charting of the oral cavity.

(4) Oral health instruction and disease prevention education, including nutritional counseling and dietary analysis.

(5) Exposure and evaluation of radiographic images.

(6) Dental prophylaxis, including subgingival scaling and polishing procedures.

(7) Dispensing and administration via the oral or topical route of nonnarcotic analgesic, anti-inflammatory, and antibiotic medications as prescribed by a licensed health care provider.

(8) Application of topical preventive or prophylactic agents, including fluoride varnish, antimicrobial agents, caries arresting medicaments, and pit and fissure sealants.

(9) Pulp vitality testing.

(10) Application of desensitizing medications or resins.

(11) Fabrication of athletic mouth guards and soft occlusal guards.

(12) Changing of periodontal dressings.

(13) Administration of local anesthetic and nitrous oxide.

(14) Simple extraction of erupted primary teeth.

(15) Nonsurgical extraction of periodontally diseased permanent teeth with tooth mobility of +3 to +4 to the extent authorized in the dental therapist’s collaborative management agreement, except for the extraction of a tooth that is unerupted, impacted, or fractured or that needs to be sectioned for removal.

(16) Emergency palliative treatment of dental pain limited to the procedures in this paragraph.

(17) Preparation and placement of direct restoration in primary and permanent teeth.

(18) Fabrication and placement of single-tooth temporary crowns.

(19) Preparation and placement of preformed crowns on primary teeth.

(20) Indirect and direct pulp capping on permanent teeth.

(21) Indirect pulp capping on primary teeth.

(22) Intraoral suture placement and removal.

(23) Minor adjustment and repair of removable prostheses.

(24) Placement and removal of space maintainers.

(25) Pulpotomy on primary teeth.

(26) Tooth reimplantation and stabilization.

(27) Recementing of a permanent crown.

(28) Any additional services, treatments, or procedures specified in state law.

II. A dental therapist shall, except as otherwise provided, limit his or her practice of dental therapy to providing the services, treatments, and procedures covered by his or her dental therapy education program.

(1) If any service, treatment, or procedure. was not covered by a dental therapist’s dental therapy education program, the dental therapist may provide that service, treatment, or procedure if the dental therapist has subsequently received additional dental therapy educational training to provide that service, treatment, or procedure.

III. Except as otherwise provided, a dental therapist licensed under this chapter may provide dental therapy services in this state only under the direct supervision or indirect supervision of a qualifying dentist with whom the dental therapist has entered into a collaborative management agreement.

IV. Once a dental therapist licensed under this chapter has provided dental therapy services for at least 2,000 hours under direct supervision or indirect supervision, the dental therapist may provide dental therapy services in this state under the general supervision of a qualifying dentist with whom the dental therapist has entered into a collaborative management agreement.

V. For purposes of the 2,000 hours requirement under subd. 2. a., hours may include hours of providing dental therapy services in this state under direct supervision or indirect supervision of a qualifying dentist as described in subd. 1. or hours of providing dental therapy services under direct supervision or indirect supervision while licensed as a dental therapist outside this state, but may not include any hours completed prior to graduating from the dental therapy education program.

VI. The level of supervision for a dental therapist may be further limited under the terms of a collaborative management agreement.

VII. A supervising dentist shall accept responsibility for all services performed by a dental therapist pursuant to a collaborative management agreement.  If services needed by a patient are beyond the dental therapist’s scope of practice or authorization under the collaborative management agreement, the dental therapist shall, to the extent required under the collaborative management agreement, consult with the supervising dentist as needed to arrange for those services to be provided by a dentist or another qualified health care provider.

VIII. Prior to providing any dental therapy services, a dental therapist shall enter into a written collaborative management agreement with a qualifying dentist who will serve as a supervising dentist under par. (c).  The agreement must be signed by the dental therapist and the qualifying dentist and address all of the following:

(a) The practice settings where services may be provided and the patient populations that may be served.

(b) Consistent with and subject to state law, any conditions or limitations on the services that may be provided by the dental therapist, the level of supervision required, and any circumstances requiring consultation prior to performing services.

(c) Age-specific and procedure-specific practice protocols.

(d) Dental record-keeping procedures.

(e) Plans for managing dental or medical emergencies.

(f) A quality assurance plan for monitoring care provided by the dental therapist.

(g) Protocols for administering and dispensing medications.

(h) Criteria or protocols relating to the provision of care to patients with specific medical conditions, treatments, or medications.

(i) Policies relating to supervision of dental hygienists and other staff.

(j) A plan for the referral of patients to other dental or health care providers or clinics when services needed are beyond the scope of practice or authorization of the dental therapist.

(k) Whether and to what extent the dental therapist may perform services described in [state code].

VIII. A collaborative management agreement shall be limited to covering one qualifying dentist and one dental therapist.

IX. A dental therapist may enter into multiple collaborative management agreements. No dentist may have collaborative management agreements with more than 4 dental therapists at any time. A dental therapist may, subject to state law, provide dental therapy services only as an employee of one or more of the following:

(1) A dentist with whom the dental therapist has entered into a collaborative management agreement.

(2) A dental practice.

(3) A school district or the operator of a private school, or a tribal school.

(4) The operator of a school for the education of dentists or dental hygienists.

(5) A state or federal prison, a county jail, or other federal, state, county, or municipal correctional or detention facility, or a facility established to provide care for terminally ill patients.

(6) A local health department.

(7) A charitable institution open to the general public or to members of a religious sect or order.

(8) A nonprofit home health care agency.

(9) The operator of a nonprofit dental care program serving primarily indigent, economically disadvantaged, or migrant worker populations.

(10) A health care employer, as defined in state law.

X. A dentist may not enter into a collaborative management agreement with  a dental therapist unless the dentist directly employs the dental therapist as provided in par. (dm) 1. or the dentist is employed by or contracts with the dental therapist’s employer described in par. (dm) 2. to 10.

(a)  A dental therapist shall at all times comply with at least one of the following:

(1) Limit his or her practice to practicing in one or more dental health shortage areas.  If a dental therapist begins practicing in a dental health shortage area, and that area loses its designation as a dental health shortage area while the dental therapist continues to practice in that area, the dental therapist is considered to satisfy this subdivision as long as the dental therapist continues to practice in that area.

(2) Practice in one or more settings in which at least 50 percent of the total patient base of the dental therapist consists of patients who are any of the following:

(a) Medical Assistance patients.

(b) Uninsured patients.

(c) Patients receiving dental care at free and charitable clinics.

(d) Patients receiving dental care at federally qualified health centers.

(e) Patients who reside in long-term care facilities.

(f) Veterans.

(g) Patients who are members of a federally recognized Indian tribe or band.

(h) Patients receiving dental care at clinics or facilities located on tribal lands.

(i) Patients with medical disabilities or chronic conditions that create barriersof access to dental care.

 

SECTION 6. Preservation and transfer of patient health care records.

I. A person who manages or controls a business that offers dental, dental therapy, or dental hygiene services, including management or control of a business through which the person allows another person to offer dental, dental therapy, or dental hygiene services, shall preserve patient health care records, as defined in state code, for an amount of time determined by the examining board by rule.

II. A person who manages or controls a business that offers dental, dental therapy, or dental hygiene services, including management or control of a business through which the person allows another person to offer dental, dental therapy, or dental hygiene services, shall, upon request of a patient or person authorized by the patient, transfer the patient health care records of the patient to another person that the patient or person authorized by the patient specifies to receive the patient health care records.

 

SECTION 7. Delegation of remediable procedures and dental practices. 

I. A dentist or dental therapist who is licensed to practice dentistry under this chapter may delegate to an individual who is not licensed under this chapter only the performance of remediable procedures, and only if all of the following conditions are met:

(a)  The unlicensed individual performs the remediable procedures in accordance with a treatment plan approved by the dentist or dental therapist.

(b)  The dentist or dental therapist is on the premises when the unlicensed individual performs the remediable procedures.

(c)  The unlicensed individual’s performance of the remediable procedures is subject to inspection by the dentist or dental therapist.

II. Subject to the requirements of state law, a dentist or dental therapist who is licensed to practice dentistry under this chapter may delegate to a dental hygienist who is licensed to practice dental hygiene under this chapter the performance of remediable procedures and the administration of oral systemic premedications, local anesthesia, nitrous oxide inhalation analgesia, and subgingival sustained release chemotherapeutic agents, to the extent the dentist or dental therapist has the authority to perform the activity personally.

III. A dentist or dental therapist who delegates to another individual the performance of any practice or remediable procedure is responsible for that individual’s performance of that delegated practice or procedure.

IV. The examining board may, without further notice or process, limit, suspend, or revoke the license or certificate of any dentist, dental therapist, or dental hygienist, or the registration of a mobile dentistry program registrant, who fails, within 60 days after the mailing of written notice to the dentist’s, dental therapist’s, dental hygienist’s, or registrant’s last-known address, to renew the license, certificate, or registration.

V. Subject to the rules promulgated under state code, the examining board may make investigations and conduct hearings in regard to any alleged action of any dentist, dental therapist, dental hygienist, or expanded function dental auxiliary, of a mobile dentistry program registrant, or of any other person it has reason to believe is engaged in or has engaged in the practice of dentistry, dental therapy, or dental hygiene, or the operation of a mobile dentistry program, in this state, and may, on its own motion, or upon complaint in writing, reprimand any dentist, dental therapist, dental hygienist, or expanded function dental auxiliary who is licensed or certified under this chapter, or any mobile dentistry program registrant, or deny, limit, suspend, or revoke his or her license or certificate, or the registration of the mobile dentistry program registrant, if it finds that the dentist, dental therapist, dental hygienist, expanded function dental auxiliary, or mobile dentistry program registrant has done any of the following:

(a) The health care provider having been convicted of a crime, the circumstances of which substantially relate to the practice of dentistry, dental therapy, or dental hygiene, the practice of an expanded function dental auxiliary, or the operation of a mobile dentistry program.

(b) Violated this chapter or any federal or state statute or rule that relates to the practice of dentistry, dental therapy, dental hygiene, or an expanded function dental auxiliary, or the operation of a mobile dentistry program.

(c) Subject to state law, practiced dentistry, dental therapy, or dental hygiene or as an expanded function dental auxiliary while his or her ability was impaired by alcohol or other drugs.

(d)  Engaged in conduct that indicates a lack of knowledge of, an inability to apply or the negligent application of, principles or skills of dentistry, dental therapy, or dental hygiene or the practice of an expanded function dental auxiliary. The examining board shall immediately revoke the license to practice dental therapy granted under [insert state code number] of an individual who qualified for the license on the basis of graduation from a dental therapy education program if, upon the conclusion of the 4-year period the program is not accredited.

If the program subsequently becomes accredited, the examining board may allow reinstatement of a revoked license described in this subsection.

Informed consent.  (intro.)  Any dentist or dental therapist who treats a patient shall inform the patient about the availability of reasonable alternate modes of treatment and about the benefits and risks of these treatments.  The reasonable dentist standard is the standard for informing a patient under this section.  The reasonable dentist standard requires disclosure only of information that a reasonable dentist would know and disclose under the circumstances.  The dentist’s or dental therapist’s duty to inform the patient under this section does not require disclosure of any of the following:

SECTION [insert state section number] [insert subsection number] of the statutes is amended to read:

[insert subsection number] Information about alternate modes of treatment for any condition the dentist or dental therapist has not included in his or her diagnosis, assessment, or treatment plan at the time the dentist or dental therapist informs the patient.

SECTION [insert state section number]. [insert subsection number] (a) of the statutes is amended to read:

[insert subsection number] (a)  Any person lawfully practicing within the scope of a license, permit, registration, certificate, or certification granted to practice midwifery under

[insert states chapter number], to practice professional or practical nursing or nurse-midwifery under [insert chapter], to practice chiropractic under [insert chapter], to practice dentistry, dental therapy, or dental hygiene or as an expanded function dental auxiliary under [insert chapter], to practice optometry under [insert chapter], to practice as a physician assistant under [insert state subsection number], to practice acupuncture under [insert chapter] or under any other statutory provision, to practice naturopathic medicine under [insert chapter], or as otherwise provided by statute.

SECTION [insert state section number]. [insert subsection number] 1. of the statutes is amended to read:

[insert subsection number] The practice of dentistry, dental therapy, or dental hygiene within the meaning of [insert chapter].

SECTION [insert state section number]. [insert subsection number] of the statutes is amended to read:

[insert subsection number] Any person lawfully practicing within the scope of a license, permit, registration, certificate, or certification granted to practice as a pharmacy technician under [insert subsection number]to provide home medical oxygen under [insert subsection number], to practice professional or practical nursing or nurse-midwifery under [insert chapter], to practice dentistry, dental therapy, or dental hygiene or as an expanded function dental auxiliary under [insert chapter], to practice medicine and surgery under [insert chapter], to practice optometry under [insert chapter], to practice naturopathic medicine under [insert chapter], or to practice veterinary medicine under [insert chapter], or as otherwise provided by statute.

SECTION [insert state section number]. [insert subsection number] of the statutes is amended to read:

[insert subsection number] A dentist or dental therapist licensed under [insert chapter] SECTION [insert state section number]. [insert subsection number] of the statutes is amended to read:

[insert subsection number] A dentist licensed under [insert subsection number], a dental therapist licensed under [insert subsection number], a dental hygienist licensed under [insert subsection number], a person certified as an expanded function dental auxiliary under [insert subsection number] (3), or a person under the direct supervision of a dentist.

SECTION [insert state section number]. [insert subsection number] of the statutes, as affected by [insert state act], is amended to read:

[insert subsection number] Prescription or order required.  A person who holds a license or limited X-ray machine operator permit under this chapter may not use diagnostic

X-ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under [insert subsection number], a naturopathic doctor licensed under [insert subsection number], a dentist licensed under [insert subsection number], a dental therapist licensed under [insert subsection number], a podiatrist licensed under [insert subsection number], a chiropractor licensed under [insert subsection number], an advanced practice nurse certified under [insert subsection number], a physician assistant licensed under [insert subsection number], or, subject to [insert subsection number], a physical therapist who is licensed under [insert subsection number] or who holds a compact privilege under [insert subchapter] of [insert chapter].

SECTION [insert state section number]. [insert subsection number] of the statutes is amended to read:

[insert subsection number]

EXCEPTION.  Subsections [insert subsection range] do not apply to a dentist who is licensed under [insert subsection number] (1) or to a , dental therapist, or physician who tattoos or offers to tattoo a person in the course of the dentist’s, dental therapist’s, or physician’s professional practice.

SECTION [insert state section number]. [insert subsection number] (5) of the statutes is amended to read: [insert subsection number] (5)

EXCEPTION.  Subsections [insert subsection range] do not apply to a dentist who is licensed under [insert subsection number] (1) or to a, dental therapist, or physician who pierces the body of or offers to pierce the body of a person in the course of the dentist’s, dental therapist’s, or physician’s professional practice.

SECTION [insert state section number]. [insert subsection number] (4) of the statutes is amended to read:

[insert subsection number] (4)  No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed dentist or dental therapist within the scope of the dentist’s or dental therapist’s license, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by another health care provider, as defined in [insert subsection number] (1) (a) to (p).

SECTION [insert state section number]. [insert subsection number] (1m) (a) (intro.) of the statutes is amended to read:

[insert subsection number] (1m) (a) (intro.)  Except as provided in par. (b), any physician, naturopathic doctor, physician assistant, podiatrist, or athletic trainer licensed under [insert chapter], chiropractor licensed under [insert chapter], dentist or dental therapist licensed under [insert chapter], emergency medical services practitioner licensed under [insert subsection number], emergency medical responder certified under [insert subsection number], registered nurse licensed under [insert chapter], or a massage therapist or bodywork therapist licensed under [insert chapter] who renders voluntary health care to a participant in an athletic event or contest sponsored by a nonprofit corporation, as defined in [insert subsection number] (6) (b), a private school, as defined in [insert subsection number](3r), a tribal school, as defined in [insert subsection number] (15m), a public agency, as defined in [insert subsection number] (1) (b), or a school, as defined in [insert subsection number] (1) (c), is immune from civil liability for his or her acts or omissions in rendering that care if all of the following conditions exist:

SECTION [insert state section number]. [insert subsection number] (1m) (a) 2. of the statutes is amended to read:

[insert subsection number] (1m) (a) 2.  The physician, naturopathic doctor, podiatrist, athletic trainer, chiropractor, dentist, dental therapist, emergency medical services practitioner, as defined in [insert subsection number], emergency medical responder, as defined in [insert subsection number] (4p), physician assistant, registered nurse, massage therapist or bodywork therapist does not receive compensation for the health care, other than reimbursement for expenses.

SECTION [insert state section number]. [insert subsection number] (5) of the statutes is amended to read:

[insert subsection number] (5) (a)  Subsection (2) does not apply to a person to whom nitrous oxide is administered for the purpose of providing medical or dental care, if the nitrous oxide is administered by a physician or, dentist, or dental therapist or at the direction or under the supervision of a physician or, dentist, or dental therapist. (b)  Subsection (3) does not apply to the administration of nitrous oxide by a physician or, dentist, or dental therapist, or by another person at the direction or under the supervision of a physician or, dentist, or dental therapist, for the purpose of providing medical or dental care. (c)  Subsection (3) (c) does not apply to the sale to a hospital, health care clinic or other health care organization or to a physician or, dentist, or dental therapist of any object used, designed for use or primarily intended for use in administering nitrous oxide for the purpose of providing medical or dental care.

SECTION [insert state section number]. Nonstatutory provisions.

(1)  The dentistry examining board shall send a notice to the legislative reference bureau for publication in the [insert state publication] when the board determines that 50 or more individuals are currently licensed as dental therapists in this state under [insert subsection number] (1m). (2) (a)  The dentistry examining board shall promulgate emergency rules under[insert subsection number] that are necessary to implement this act.  Notwithstanding [insert subsection number](1) (c) and (2), emergency rules promulgated under this paragraph remain in effect for 2 years, or until the date on which permanent rules take effect, whichever is sooner. Notwithstanding [insert subsection number] (1) (a) and (3), the board is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph. (b)  The dentistry examining board shall present a statement of scope for permanent and emergency rules required to implement this act to the department of administration under [insert subsection number] (2) no later than the 30th day after the effective date of this paragraph.  Notwithstanding [insert subsection number] (2), if the governor does not disapprove the statement of scope by the 30th day after the statement is presented to the department of administration, the statement is considered to be approved by the governor. (c)  The dentistry examining board shall submit a proposed emergency rule required to implement this act to the governor for approval under [insert subsection number] (1) (e) 1g. no later than the 150th day after the effective date of this paragraph. Notwithstanding [insert subsection number] (1) (e) 1g., if the governor does not reject the proposed emergency rule by the 14th day after the rule is submitted to the governor in final draft form, the rule is considered to be approved by the governor. (d)  The dentistry examining board shall submit a proposed permanent rule required to implement this act to the governor for approval under [insert subsection number] no later than the 365th day after the effective date of this paragraph.  Notwithstanding [insert subsection number], if the governor does not reject that proposed permanent rule by the 30th day after the rule is submitted to the governor in final draft form, the rule is considered to be approved by the governor.

SECTION [insert state section number].0Effective dates. This act takes effect on the day after publication, except as follows:

(1)  The treatment of [insert subsection number] (6) (b) takes effect on the date the notice under [insert subsection number] (6) is published in the [insert state publication] or on the first day of the 6th year beginning after publication, whichever occurs first.