Last Updated: Jan 15, 2021
Final-form regulations by the State Board of Dentistry (Board) expanding the practice sites of public health dental hygiene practitioner (PHDHPs) to include certain physician offices were published in the Jan.16, 2021 edition of the Pennsylvania Bulletin. These regulations took effect immediately upon publication.
The final-form regulations can be accessed here.
These regulations implement a law – Act 60 of 2016 – that gave the Board the ability to add other locations it deemed appropriate for these practitioners in addition to those sites enumerated by the General Assembly.
Background Information
In March of 2019, the Board published proposed regulations regarding PHDHP practice sites in the Pennsylvania Bulletin. A public comment period followed this publication.
These proposed regulations add “an office or clinic of a physician who is licensed by the State Board of Medicine or the State Board of Osteopathic Medicine” as an acceptable location for the practice of PHDHPs. The Board believes this additional location will expand access to oral health care and education by PHDHPs and will assist patients, particularly pediatric patients, find a dental home by way of the annual referral to a dentist as required under the regulations. Under existing laws and regulations, PHDHPs can practice certain dental hygiene services without the supervision of dentist only in certain settings/locations. The proposed regulations expand such practice settings/locations.
The final-form regulations clarify that such physician offices must be located in a dental health professional shortage area, as determined by the United States Department of Health and Human Services, Health Resources & Services Administration, and published on the Pennsylvania Department of Health's web site.
PAMED Comments and Dental Board Response
On April 3, 2019, the Pennsylvania Medical Society (PAMED) issued a comment letter to the Board. PAMED is seeking clarification on how these regulations will affect physicians and physician offices that choose to place these practitioners within the office setting. Specifically, PAMED will ask the Board to clarify the following:
- Is physician employment of PHDHPs voluntary?
- What role will the Board play in approving these arrangements or otherwise reviewing the terms or conditions between a physician or physician’s office and a PHDHP?
- What are the responsibilities of the physician or the physician’s office to PHDHPs practicing in their office, i.e. must physicians provide specified oversight and to what extent? If there will be oversight responsibilities, will those responsibilities be specified in the final-form regulations?
- Will the Board oversee issues that could arise in physician offices, including with physicians specifically, or will the Board refer those issues to the State Boards of Medicine and Osteopathic Medicine or another appropriate agency?
The Board reviewed all public comments and questions submitted. In the final-form regulations, the Board responded to these inquiries.
Regarding the relationship between PHDHPs and physicians, the Board commented that while dental hygienists are required to work under the supervision of a dentist, PHDHPs are not. It follows that a PHDHP who is working in a physician's office is not required to work under the supervision of the physician. While the physician may choose to have an employer/employee relationship or an employer/independent contractor relationship with the PHDHP, that is up to the parties to determine independently. Therefore, the Board will not be regulating the relationship between the PHDHP and the physician. It is up to the parties to establish what type of employment relationship, if any, they choose to have. They might not choose to have an employment relationship. A PHDHP might also opt to lease space in a physician's office and work as an independent contractor.
Furthermore, the Board also clarified that it only PHDHPs would be subject to discipline by the Board. Additionally, the Board commented that PHDHPs are required to maintain professional liability insurance. If something were to occur while the PHDHP is treating a patient, the patient would be covered by the PHDHP's professional liability insurance.
The Board’s responses to comments submitted can be accessed here.