ARIZONA STATE SENATE
RESEARCH STAFF
TO: JOINT LEGISLATIVE AUDIT COMMITTEE HEATHER OWENS
Senator Robert Blendu, Chairman LEGISLATIVE RESEARCH ANALYST
HEALTH COMMITTEE
Re~ resentativeJo hn Nelson. Cochair Televhone: ( 602) 926- 3 171
DATE: December 3,2007
SUBJECT: Sunrise Application of the Arizona Dental Association
Attached is the final report of the sunrise review of the application submitted by the Arizona
Dental Association, which was conducted by the Senate Health and House of Representatives Health
Committee of Reference.
This report has been distributed to the following individuals and agencies:
Governor of the State of Arizona
The Honorable Janet Napolitano
President of the Senate
Senator Tim Bee
Senate Members
Senator Tom OYHalleranC, ochairman
Senator Barbara Leff
Senator Paula Aboud
Senator Thayer Verschoor
Senator Amanda Aguirre
Arizona Dental Association
Arizona State Library, Archives & Public Records
Office of the Auditor General
Senate Majority Staff
Senate Research Staff
Senate Minority Staff
Senate Resource Center
Speaker of the House of Representatives
Representative James Weiers
House Members
Representative Bob Stump, Cochairman
Representative Nancy Barto
Representative Rick Murphy
Representative David Bradley
Representative Linda Lopez
House Majority Staff
House Research Staff
House Minority Staff
Chief Clerk
HOIj as
Attachment
Senate Health and House of Representatives Health
Committee of Reference Report
SUNRISE REQUEST OF THE ARIZONA DENTAL ASSOCIATION
Background
Pursuant to Arizona Revised Statutes ( A. R. S.) 5 32- 3 104, the Joint Legislative Audit Committee
( JLAC) assigned the sunrise review to the Senate Health and House of Representatives Health
Committee of Reference. Attached is a copy of the application submitted by the Arizona Dental
Association ( Association).
Committee of Reference Sunset Review Procedures
The Committee of Reference held one public meeting on November 6, 2007, to review the
Association's sunrise application pursuant to A. R. S. 9 32- 3 104 and to hear public testimony.
Committee of Reference Recommendations
The Committee of Reference recommends that the Legislature amend the statutes of the Arizona
Board of Dental Examiners to create a new certified professional, the Community Oral Health
Representative, to coordinate community- based oral health promotion and provide specified dental care
under the general supervision of a licensed dentist.
Attachments
1. Staff memo.
2. Sunrise request of the Arizona Dental Association.
3. Meeting notice.
4. An excerpt of the minutes of the Committee of Reference meeting relating to the sunrise
application.
ARIZONA STATE SENATE
RESEARCH STAFF
TO: MEMBERS OF THE HOUSE AND SENATE
HEALTH COMMITTEE OF REFERENCE
DATE: October 19,2007
SUBJECT: Sunrise Request of the Arizona Dental Association
HEATHER OWENS
ASSISTANT ANALYST
HEALTH COMMITTEE
Telephone: ( 602) 926- 3 1 7 1
Facsimile: ( 602) 926- 3833
The following memo is background information regarding a request for regulation of
Community Dental Health Coordinators. Also attached is a copy of the sunrise application submitted by
the Arizona Dental Association ( Association). A public meeting is scheduled for November 6,2007, to
review, discuss and make a final recommendation as to the Association's request. If you have any
questions or need additional information, please feel free to contact me.
BACKGROUND
Dental Assistants - A dental assistant is a member of the dental team that is currently
unregulated in Arizona. Statute defines a dental assistant as a person who renders personal services to a
patient within close proximity while the patient is under treatment or observation or undergoing
diagnostic procedures. There are no oral health educational or training requirements for dental
assistants, unless the dental assistant takes x- rays for diagnostic purposes or polishes teeth under the
general supervision of a dentist. A dental assistant who wishes to perform these two procedures must
pass an examination approved by the Arizona Board of Dental Examiners ( Board).
Dental Hygienists - A person who practices as a dental hygienist must be licensed by the Board
and meet Board- approved educational requirements. It is a class 2 misdemeanor to practice dental
hygiene in Arizona without a license. Dental hygienists may perform all of the functions authorized for
dental assistants as well as additional specific procedures under the general supervision of a dentist,
such as conducting periodontal examinations and placing periodontal sutures. Dental hygienists may
also administer local anesthetics and nitrous oxide when under the direct supervision of a dentist.
Community Dental Health Coordinators - The American Dental Association ( ADA) is
developing a model of a new dental auxiliary position called the Community Dental Health Coordinator
( CDHC). ADA's stated purpose for creating the CDHC is to extend dental care to rural areas that
otherwise do not have access to oral health care. According to the ADA, the CDHC is part social
worker and part dental assistant who works as part of a dental team within an underserved community to
provide teeth cleanings, apply dental sealants and fluoride treatments and help educate people on the
importance of preventative oral health care. The CDHC would triage severe cases until a dentist could
provide treatment.
MEMORANDUM
October 19,2007
Page 2
SUNRISE REQUEST FOR REGULATION
The Association requests regulation of a new dental auxiliary position, the CDHC. The CDHC
would practice outside of the dental office and conduct procedures such as x- rays, fluoride treatments,
sealants and stabilizing decayed teeth until a dentist could treat the patient. The CDHC would be
employed by an Arizona licensed dentist and work under the general supervision of a dentist, which
means that the dentist is available for consultation but does not have to be physically present on
location. The Association states that a CDHC could be supervised remotely using the " Tele- Dentistry"
model that is being developed by the Department of Health Services Office of Oral Health.
The Association envisions certification of CDHCs by the Board. Rio Salado Community
College is in the process of developing a curriculum for a CDHC program. The Association proposes
that this program would provide the necessary training for anyone wishing to become a CDHC and
suggests that similar training programs could be added to the curriculum for current dental assisting or
dental hygiene programs for those who wished to receive CDHC certification.
According to the Association, the introduction of the CDHC would decrease the cost of
delivering dental care to the uninsured and underinsured. The Association does not estimate the
Board's costs associated with CDHC certification or the number of potential CDHCs who would apply
for certification. Therefore, it is unclear at this time the exact revenue and expenditures the Board could
anticipate as a result of a new certification.
OTHER STATES
No other states currently regulate the CDHC profession.
HOIjas
Attachment
Arizona
Dental
Association
3193 N. Drinkwater Blvd.
Scottsdale, Arizona 85251- 6491
1- 800- 866- 2732
Phone ( 480) 344- 5777
F ~( x48 0) 344- 1442
http:// www.. azda. org
August 29, 2007
Joint Legislative Audit Committee
1700 W. Washington
Phoenix, AZ. 85007
RE: Sunrise Application To Create A New Program To Increase Access To
Dental Care in Rural Arizona
Dear Sen. Blendu and Rep. Nelson:
Enclosed you will find a Sunrise Application for a new program aimed at getting
dental care to Arizona citizens living in remote areas of the state. The Community
Dental Health Coordinator ( CDHC) is a departure from the traditional dental team
model in that it allows competently trained and certified individuals to treat patients
outside of the dental office.
The target populations for treatment are those individuals who normally have
difficulty obtaining treatment whether it is for financial or geographic reasons.
While the primary goal of the CDHC is education of the patient on oral health care,
it also includes a certain degree of assessment and treatment that would normally
be done in a dental office; treatment such as dental cleanings and the placement of
temporary fillings in teeth with cavities until permanent restorations can be
obtained.
The CDHC trained auxiliary utilizes an " Integrated Dental Team" approach to
expand the functions and settings in which dental auxiliaries ( hygienists, dental
assistants, Public Health workers, and others), with the proper training, can provide
a significant level of preventive and emergency care without " direct" dentist
supervision. The CDHC is essentially a facilitator of traditional dental care. The
CDHC trained auxiliaries will be employed and supervised by an Arizona
licensed dentist, practicing in Arizona. Modern technology will allow dentist
oversight and input to the CDHC trained auxiliary remotely by means such as the
computerized ' Tele- Dentistry" model currently being developed and evaluated by
the Arizona Department of Oral Health.
The Arizona Dental Association is developing training modules with the assistance
of Rio Salado Community College. Because of the varied needs of underserved
populations, we have developed a flexible training program for the CDHC. An
individual can take one or all the modules depending on prior education and
experience. All are independent and provide a minimum of oral prevention and
education. Arizona is a prime state to allow properly trained dental auxiliaries to
practice under the general supervision of a dentist, utilizing the elasticity of the
dental office, because of the advanced nature of on- line dental training programs
and dental technology that currently exists here.
Existing Community Health Centers could use a CDHC trained auxiliary to provide
oral health screening at the same time that a medical screening is performed.
School nurses and teachers could be the front- line. CDHC1s would be able provide
radiographs ( x- rays), fluoride treatment, sealants, and stabilize decayed teeth until
treatment can be obtained from a dentist. This will reduce the burden on dentists
in underserved, remote, and tribal areas. This " triage" process will help make
dental care much more efficient, allowing for many more patients to be seen by the
dentist when major treatment can be delivered.
Community connections are essential for the success of a program. Ideally the
CDHC trained auxiliary will come from the community in which they work. This will
provide the most successful model as the level of trust and understanding of
culture is an important part of improving self care and obtaining necessary follow
up dental treatment. Becoming a CDHC trained auxiliary is a way to ' give back' to
their community as well as a good economic development tool.
The Arizona Dental Association has been meeting with stakeholders since October
2006 to educate and gain support for the CDHC concept. This has included several
Tribal representatives, the Indian Health Service, the Rural Health Association,
Community Health Centers, the Office of Oral Health, the Governor's Advisory
Council on Indian Health Care, First Things First of Arizona, Arizona School Boards
Association, Arizona School Nurses Association, Arizona Public Health Association
and the Arizona Department of Human Services, Department oforal Health. This
process has taken a great deal of time and effort.
We believe the CDHC is another step in the right direction in dealing with the
access to care issue. It is a long- term solution for an age- old problem. I look
forward to speaking with you further about our Sunrise Application.
Rick Murra @+ Executive Director
CC: Bill Boyd, Senate Research Analyst
Beth Kohler Lazare, Senate Research Analyst
Carolyn Atwater, House Research Analyst
Dan Brown, House Research Analyst
Sunrise Report
August 30,2007
To Create A New
Program To
Increase Access
To Dental Care
in Rural Arizona
Arizona Dental Association
Rick M urray, Executive Director
3193 North Drinkwater Blvd.
Scottsdale, Arizona 85251
480- 344- 5777
480- 344- 1442 ( fax)
rick@ azda. org
1. A definition of the problem and why a change in scope of practice is
necessary including the extent to which consumers need and will benefit
from practitioners with this scope of practice.
Arizona's public policy supports broad access by residents of this state to dental
care fiom properly educated, qualified and competent providers. In turn, access
to quality dental care is dependent upon the availability of key members of the
dental team to perform needed services in many places around the state.
The purpose of this sunrise application is to seek changes to the dental practice
act to permit a dental auxiliary or other properly certified individual, acting
under the general supervision of a licensed dentist, to perform specific duties
outside of the dental office, in Arizona. This change to the dental practice act
would accomplish the following significant goals:
Improved access to dental care
Increased availability of preventive measures to reduce dental decay and
suffering
Enhanced efficiency in the delivery of dental care and related services to the
public
As such, the challenge addressed by this sunrise application concerns the need
to clearly modifl existing rules of practice to explicitly permit certified
practitioners to perform specified procedures rather than restricting this
practice only to licensed dentists and dental hygienists within the traditional
dental office.
CDHC's would be able to perform important functions such as screening for
oral health problems and developing and implementing community based oral
health promotion programs under the amendment that would be proposed.
CDHC's will be key to responding to the needs of the underserved
populations, using a community- based approach, focused on preventing and
controlling disease as well as assisting with emergencies.
The limits contained in the dental practice act on the performance of these
duties means that only a dentist may perform the service although the service
may be performed equally well by other members of the dental team acting
under the general supervision of a licensed dentist. Existing training programs
can be expanded to prepare CDHC's in the specified procedures outlined
below.
The dental practice act clearly permits dental hygienists and dental assistants
to perform duties that require the same or greater skill level than that required
of the CDHC.
This program has the potential to decrease the cost to deliver dental care for
insured, under- insured, uninsured and those receiving care through
governmental programs. By taking advantage of the elasticity of the dental
team, this will allow more people to receive dental care. Further, by
permitting certified CDHC practitioners to perform certain specific procedures
increases the efficiency of a traditional dental office.
The target populations for treatment are those individuals who normally have
difficulty obtaining treatment whether it is for financial or geographic reasons.
While the primary goal of the CDHC is education of the patient on oral health
care, it also includes a certain degree of assessment and treatment that would
normally be done in a dental ofice; treatment such as dental cleanings and the
placement of temporary fillings in teeth with cavities until permanent
restorations can be obtained.
The CDHC trained auxiliary utilizes an " Integrated Dental Team" approach to
expand the fimctions and settings in which dental auxiliaries ( hygienists,
dental assistants, Public Health workers, and others), with the proper training,
can provide a significant level of preventive and emergency care without
" direct" dentist supervision. The CDHC is essentially a facilitator of
traditional dental care. The CDHC trained auxiliaries will be employed and
supervised by an Arizona licensed dentist, practicing in Arizona. Modern
technology will allow dentist oversight and input to the CDHC trained
auxiliary remotely by means such as the computerized " Tele- Dentistry" model
currently being developed and evaluated by the Arizona Department of Oral
Health.
By allowing auxiliary personnel to perform these procedures, the dentist ( and
other members of the dental team) would be able to see more patients. The
expanded duties that the CDHC explicitly may perform would advance the
important public policy position of increasing access to quality dental care by
Arizona residents. Thus, dentists would be able to increase levels of patient
care while permitting certified auxiliaries to deliver care to the hllest extent
allowed by law and supported by proper training.
CDHC allowed procedures:
Screen and manage care prescribed by a dentist ( includes temporary fillings
in teeth with cavities);
Collaborate and provide programs to promote community oral health;
Provide individual preventive care ( includes fluoride treatments, sealants,
cleanings and scaling teeth [ above the gum line]); and
Assist in the management of medical and dental emergencies.
2. The extent to which the public can be confident that qualified
practitioners are competent including:
( a) Evidence that the profession's regulatory board has functioned
adequately in protecting the public.
The State Board of Dental Examiners has an excellent reputation and record
for protecting the public, as noted by the auditor general in its most recent
performance audit of the Board. Accordingly, when the acting to continue the
existence of the state board of dental examiners, the Legislature found that the
purpose of the state board of dental examiners is " to protect the public health
and safety by regulating the practice of dentistry." Laws 2000 ( 2nd Reg. Sess.)
Ch. 87 $ 5.
( b) Whether effective quality assurance standards exist in the health
profession, such as legal requirements associated with specific programs
that define or endorse standards or a code of ethics.
In Arizona, ARS 32- 1 202 of the Dental Practice Act makes all care of the
patient the responsibility of the supervising dentist. The American Dental
Association's policy is that ultimate legal and ethical responsibility for patient
care lies with the dentist. This policy further provides that all functions
performed must be rendered in accordance with the needs of the patient as
determined by a diagnosis and treatment plan by the dentist.
In general, dentists delegate hctions to dental hygienists and dental
assistants to increase the capacity of the profession to provide patient care. At
the same time, the dentist retains ultimate responsibility for the quality of the
care delivered. This responsibility includes the dentist's identification,
establishment and implementation of appropriate controls on the patient care
services as well as the education, training and practice limitations that govern
the fimctions of hygienists and assistants.
( c) Evidence that state approved educational programs provide or are
willing to provide core curriculum adequate to prepare practitioners at
the proposed level.
At present, programs exist at several Arizona educational institutions that train
dental hygienists. Most of the programs also train dental assistants. These
programs can be found at Northern Arizona University, Pima Community
College, Rio Salado Community College, Phoenix College and several
proprietary educational institutions. These programs focus on both Dental
Assisting and Dental Hygiene programs. Rio Salado has an on- line
educational platform that is particularly suited for this program. Currently,
students in several states including rural parts of Arizona and as far as Oregon
and Washington are enrolled in Rio Salado dental assisting programs. Rio
Salado is in the process of developing curriculum for the CDHC program and
has offered to share it other institutions, including Tribal colleges.
The costs associated with the additional training for the Community Dental
Health Coordinator would be negligible. For dental assisting programs ( other
than Rio Salado Community College) that are not associated with a hygiene
program, those schools would simply add the necessary components as part of
their offered curriculum, with the training made available to any dental
assistant or dental hygienist who wished to undertake a broadened practice
scope. Indeed, any dental auxiliary curriculum could be adapted easily to
include currently practicing Dental Assistants and Dental Hygienists as well
as those in training.
Accordingly, this approach would serve to ensure equal access to all interested
in obtaining CDHC instruction. This in turn would assist in the effort to
broaden the services that can be performed by all members of the dental team,
which in turn would support more ready access to care by the residents of this
state.
3. The extent to which an increase in the scope of practice may harm the
public including the extent to which an increased scope of practice will
restrict entry in to practice and whether the proposed legislation requires
registered, certified or licensed practitioners in other jurisdictions who
migrate to this state to qualify in the same manner as state applicants for
registration, certification and licensure if the other jurisdiction has
substantially equivalent requirements for registration, certification or
licensure as those in this state.
The Dental Association anticipates benefits flowing from this proposed
practice expansion and anticipates no harm. In turn, patients would enjoy
broadened access to care under a framework that permitted the care to be
delivered safely by qualified practitioners.
Likewise, no likelihood exists that the legislation will restrict entry into
practice. Dental auxiliaries will not be required to obtain CDHC certification
as a condition of practice or licensure in Arizona. Accordingly, the proposal
will not restrict entry or limit practice but may instead promote entry into the
profession, as only those people who wish to assume broader duties will have
to submit to the training program. All others would be permitted to secure a
license from the Board in accordance with the present rules.
Finally, the law would apply equally to all, regardless of state of initial
licensure.
4. The cost to this state and to the general public of implementing the
proposed increase in scope of practice.
Educational costs would be borne by dental auxiliaries or their employers.
Interim agendas can be obtained via the Internet at http: llwww. azleg. state. az. usllnterimCommittees. asp
ARIZONA STATE SENATE
INTERIM MEETING NOTICE
OPEN TO THE PUBLIC
SENATE HEALTH AND HOUSE HEALTH COMMITTEE OF REFERENCE
Date: Tuesday, November 6,2007
Time: 9: 30 A. M.
Place: SHR I
AGENDA
1. Call to Order
2. Opening Remarks
3. Sunset Review of the Board of Homeopathic Medical Examiners
Presentation by Auditor General
Response by Board of Homeopathic Medical Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
4. Sunset Review of the Regulatory Board of Physician Assistants
Presentation by Regulatory Board of Physician Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
5. Sunset Review of the Board of Behavioral Health Examiners
Presentation by Board of Behavioral Health Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
6. Sunset Review of the Acupuncture Board of Examiners
Presentation by Acupuncture Board of Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
7. Sunset Review of the Board of Occupational Therapy Examiners
Presentation by Board of Occupational Therapy Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
Page 1 of 2
8. Sunrise application of the Arizona Alliance of Non- Physician Surgical Assistants
Presentation by Arizona Alliance of Non- Physician Surgical Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
9. Sunrise application of the Southern Arizona Behavioral Health Coalition
Presentation by Southern Arizona Behavioral Health Coalition
Public Testimony
Discussion
Recommendations by the Committee of Reference
10. Sunrise application of the Arizona Dental Association
Presentation by Arizona Dental Association
Public Testimony
Discussion
Recommendations by the Committee of Reference
1 1. Sunrise application of Radiology Practitioner Assistants
Presentation by Radiology Practitioner Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
12. Adjourn
Members:
Senator Tom O'Halleran, Co- Chair
Senator Paula Aboud
Senator Amanda Aguirre
Senator Barbara Leff
Senator Thayer Verschoor
Representative Bob Stump, Co- Chair
Representative Nancy Barto
Representative David Bradley
Representative Linda Lopez
Representative Rick Murphy
Persons with a disability may request a reasonable accommodation such as a sign language interpreter, by contacting the
Senate Secretary's Office: ( 602) 926- 4231 ( voice). Requests should be made as early as possible to allow time to arrange the accommodation.
Page 2 of 2
ARIZONA STATE LEGISLATURE
Forty- eighth Legislature - First Regular Session
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
Minutes of Interim Meeting
Tuesday, November 6,2007
Senate Hearing Room 1 - 9: 30 a. m.
Chairman OYHalleran called the meeting to order at 9: 32 a. m. and attendance was noted by the
secretary.
Members Present
Senator Tom O'Halleran, Co- Chair Representative Bob Stump, Co- Chair
Senator Amanda Aguirre Representative Nancy Barto
Senator Barbara Leff Representative David Bradley
Senator Thayer Verschoor Representative Linda Lopez
Representative Rick Murphy
Members Absent
Senator Paula Aboud
Speakers Present
Kim Hildebrand, Performance Audit Manager, Office of the Auditor General
Todd Rowe, Board of Homeopathic Medical Examiners
Christine Springer, Board of Homeopathic Medical Examiners
Jerry Weinsheink, representing himself
Marianne Cherney, representing herself
Neil Garfield, Association for Public Access to Medicine
Barney Nugent, representing himself
Linda Heming, CHOICE
Iris Bell, Doctor, Arizona Homeopathic and Integrative Medical Association
Cliff Heinrich, Doctor, representing himself
Kathleen Fry, Doctor, representing herself
Denise Nugent, representing herself
Lee Bakunin, Attorney, representing herself
Bruce Shelton, Doctor, Arizona Homeopathic and Integrative Medical Association
Amanya Jacobs, Director of Evolution of Self School of Homeopathy
Cindy Zukerman, representing herself
Shelly Malone, representing herself
Stan Klusky, representing himself
Gladys Conroy, representing herself
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
Joan Reynolds, Regulatory Board of Physician Assistants
Debra Rinaudo, Board of Behavioral Health Examiners
Stuart Goodman, Board of Behavioral Health Examiners
Bev Hermon, BH Consulting
Richard Poppy, Therapeutic Practitioners Alliance of Arizona ( The Alliance)
Rachael Hopkins, representing herself
Ronald Anton, representing himself
Josephine Sbrocca, representing herself
Cedric Davis, Board of Behavioral Health Examiners
Della Estrada, Arizona Acupuncture Board of Examiners
Kathryn Babits, Arizona State Board of Occupational Therapy Examiners
Eugene Smith, Arizona Alliance of Non- Physician Surgical Assistants
Susie Cannata, Arizona Alliance of Non- Physician Surgical Assistants
Rory Hays, Arizona Nurses' Association
Scott Lecltie, Radiology Practitioner Assistants
Jane Van Valkenburg, Certification Board for Radiology Practitioner Assistants ( CBRPA)
Mary Connell, M. D., representing herself
Christine Lung, American Society of Radiologic Technologists ( ASRT)
John Gray, Grand Canyon University
Joyce Geyser, Arizona Radiological Society
James Abraham, National Society of Radiology Practitioner Assistants
Heather Owens, Senate Health Analyst
Aubrey Godwin, Medical Radiologic Technology Board of Examiners ( MRTBE)
Teresa Rodgers, Behavioral Health Coalition of Southern Arizona
David Giles, Behavioral Health Coalition of Southern Arizona
Holly Bawnann, Southwest Autism Research and Resource Center
John MacDonald, Arizona Dental Association ( ADA)
Rick Murray, Arizona Dental Association
Anita Elliott, Arizona Dental Association
Nicole Laslavic, Arizona State Dental Hygienists' Association
Janet Midkiff, Arizona State Dental Hygienists' Association
Nicole Albo, Arizona Dental Assistants' Association
Alisa Feugate, Arizona Dental Hygienists' Association
OPENING REMARKS
Chairman O'Halleran welcomed everyone and requested that the speakers keep their comments
as brief as possible, as the committee members are well- versed in the issues to be discussed
today.
SUNSET REVIEW OF THE BOARD OF HOMEOPATHIC MEDICAL EXAMINERS
Presentation by Auditor General
, gave a
he history
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
2 November 6,2007
Discussion
Chairman O'Halleran asked for clarification about the motion; M ens explained the
interaction with other Boards.
Ms. Renaudo explained that for her agency the conce 1 number of behavioral health
professionals eligible for licensure, and that it would to regulate it because it will
not be self- funding.
Representative Bradley stated that the stagnant because these professionals have no
place to go, and that with licensure e drawn to Arizona. Senator Leff stated her
agreement.
Recommendations by the Hmmittee of Reference
ump moved that the Senate and House Health Committee of
ove the sunrise application of the Southern Arizona Behavioral
he motion carried by a voice vote.
SUNRISE APPLICATION OF THE ARIZONA DENTAL ASSOCIATION
Presentation by Arizona Dental Association
John MacDonald, Arizona Dental Association ( ADA), addressed the group to explain the sunrise
application concerning access to care. He described the history of this issue, including the
community needs assessments that have been performed, and the meetings with stakeholders
( Attachment 14).
Rick Murray, Arizona Dental Association, stated that this program proposes the creation of a
position called the Community Oral Health Representative ( COHR), designed to be an extender
of the dental office and to serve out in the community under the general supervision of a dentist.
The goal is to help bring quality dental care to children and families across Arizona.
Anita Elliott, Arizona Dental Association, explained that the primary role of a COHR will be as
community coordinator who provides education and oral health promotion and prevention, as
well as collecting diagnostic information which is sent to the dental office prior to being seen by
the dentist.
Mr. Murray added that the intent is to hire people from within the community, who may then
move into other positions in the dental profession.
Public Testimony
Nicole Laslavic, Arizona State Dental Hygienists' Association, stated that her organization does
not support the position but will not oppose this sunrise application.
Senator Leff asked for clarification of that position.
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
Janet Midkiff, Arizona State Dental Hygienists' Association, stated that they support the concept
of training community people to be dental health representatives, and that the definition of the
COHR does make sense to them. She stated concerns about the education, licensing, or
certification of the people who fill the COHR positions. She said that her organization would
like to work with the ADA and to be a part of the access to care issue.
Nicole Albo. Arizona Dental Assistants' Association, stated her support for the COHR program
provided that the positions will be filled by certified dental assistants with additional training
components. She stated that she has been working with the ADA to develop a curriculum for
expanded COHR training.
Representative Murphy asked if the committee could approve the concept but not specify the
details, letting the Legislative process do that. Mr. Murray stated that the supervision issue is the
biggest concern.
Alisa Feugate, Arizona Dental Hygienists' Association, stated that she supports the concept of
the COHR but is neutral on the application at this time due to concerns about supervision and
scope of practice.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of
Reference recommend that the Legislature amend the statutes of the Arizona Board
of Dental Examiners to create a new certified professional, the Community Oral
Health Representative, to coordinate community- based oral health promotion and
provide specified dental care under the general supervision of a licensed dentist.
The motion carried by a voice vote.
Without objection, the meeting adjourned at 4: 15 p. m.
Jane Dooley, Committee Secretary
November 6,2007
( Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives
- ahvailable at
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
