Expanded Function Regulations Update

2019_Expanded_FunctionUpdated September 5, 2019
The Board of Dentistry met last week to review the Public comments to the Regulations.  Specifically, the BOD reviewed two issues of specific concern to the NDA. 1) Included expanded function hygiene as part of standard hygiene curriculum.   The BOD voted to delete text that would have allowed expanded function hygiene as part of standard hygiene curriculum.

2) As part of reinserting the Prohibited Services language into the Regulations, the Board included language that would have included any duty taught in a CODA hygiene program to become a new duty in Nebraska.  After discussion, the BOD voted to remove language that would allow any duty taught in a CODA hygiene program to become a new duty in Nebraska.  

When the draft Regulations following this BOD meeting are available, they will be posted here.

2019 July 12 Summary Public Comments_2

Updated June 25, 2019
During the DHHS Regulations revision process, the Department was given two tasks:1) Completely reorganize the Regulations of all professions and 2) Do not repeat (if possible) any language that appears in the statutes related to that profession.

As a result, the Regulations related to Dentistry have been reorganized to apply to Dentists (Chapter 56), Hygienists (Chapter 57) and Assistants (Chapter 53).  Adding to the confusion, the Department had to incorporate the changes related to the NDA/NDAA legislation LB18 (2017).

Over a two year period, the NDA and NDAA has been tracking each draft of the Regulations coming out from the Department to make sure text from the existing Regulations was not lost and new Regulations and text from LB 18 was properly included.  

There were a few key issues that the Department intentionally kept omitting from the current Regulations, specifically the Prohibited Services section 002.02 and 002.03 172 NAC 53.  This necessitated a meeting with Lauren Kintner of the Governor's Research and Policy Office on August 10, 2018.

After final discussion regarding concerns with the draft Regulations with Board of Dentistry Chair Drs. Dennis Anderson and John Thomas, the Board considered the NDA/NDAA suggested changes during their April 2019 meeting.  The Board voted on reinsertion of the Prohbited Services language, but voted to keep in language that would allow an Expanded Function Restorative procedure to be "part of an accredited dental assisting/hygiene training program"  This language would essentially force ALL hygiene or assisting students to pay for expanded function training that they have no intention of using.  Representatives from Nebraska hygiene programs have indicated that they will implement this into their basic education.  This was NEVER the intention of LB 18.

Public Hearing - July 8th

The following Regulations are set for public hearing at 10 am on July 8th at the State Office Building:
2019 May 172 NAC 57 (Hygienists)- see page 5, Section 008
2019 May 172 NAC 53 (Assistants)
2019 May 172 NAC 56 (Dentists)
2019 May 172 NAC 54 (Advertising)
2019 May 172 NAC 55 (Office Maintenence)
2019 May 172 NAC 58 (faculty licenses) 

The NDA submitted the following Public Hearing Expanded Functions Regulations Letter to the Department.

If you are opposed to forcing new hygiene students to take expanded function education as part of their standard hygiene program, we have drafted a  Public Hearing Expanded Functions Regulations Letter that you can use to write to the Department.  Please submit your comments to the Department by July 8th and email a copy to the NDA.

June 28, 2018
The issue of who could take an impression under the new Regulations governing dental assistants came up during the Spring Board of Dentistry meeting. Because the Board of Dentistry needed guidance on the intent behind the recently enacted NDA/NDAA legislation expanding dental auxiliary duties, the Board of Trustees created
an Ad Hoc Committee to review the draft Regulations for dental auxiliaries’ expanded functions. This Committee met twice in the last two months. The Committee consists of Brett Thomsen (chair), Mark Hinrichs, Scott Morrison, Sam Jacoby, Deb West, Melanie Steckleberg, Crystal Stuhr, Cindy Cronick and David O’Doherty.

The Committee has been charged with drafting language that will address the Regulations of the expanded function dental auxiliary. We have completed our mission and now the document will be transmitted to the Board of Dentistry before their July 13th meeting. We have created reasonable and appropriate language that will help steer our profession into the future concerning the regulation of expanded function dental personnel.

The summary of the changes are as follows:

172 NAC 53 Assistants - NDA May 21 2018 - June 8

1.   A detailed definition of Dental Prosthesis in Section 2.07

2.   Modification of Section 008. Prohibited Services, paragraph (E) and (F) acknowledging the Restorative Permits and excluding non-radiation digital scans that do not require manipulation of soft tissue.

3.   New Section 009, Categories of Practice of Licensed Dental Assistants and Section 010, Categories of Practice for Expanded Function Dental Assistants -  both of which mirror the proposal contained in our 407 Application.

4.   New Section 013 -  Permit and Expanded Function Course Providers also mirrors the proposal contained in our 407 Application.  The direction of the education and testing contained in the February 2018 DHHS draft Regulations was inconsistent with our 407 Application and therefore deleted in place of the new Section 013.

5.   We question why the Regulations governing Coronal Polishing and Dental X-Rays were not pulled in from the existing Regulations.  We have placed the existing Regulations text in Section 011 and recommend that it be used in the new draft.

172 NAC 56 Hygienists - NDA - June 20

1.    A detailed definition of Dental Prosthesis in Section 2.05

2.    Modification of Section 008. Prohibited Services, paragraph (E) and (F) acknowledging the Restorative Permits and excluding non-radiation digital scans that do not require manipulation of soft tissue.

3.   New Section 009, Categories of Practice of Expanded Function Dental Hygienist, which should be identical to the Expanded Function Restorative in Chapter 53 -  also mirroring the proposal contained in our 407 Application.

4.   We just began working on 009 – Additional Duties of Practice for Licensed Dental Hygienist, that would address Minor Denture Adjustments,  Interim Therapeutic Restoration Technique, Writing Prescriptions for Mouth Rinses and Fluoride Products and Administer and Titrate Nitrous Oxide Analgesia.

We believe that these two drafts are much more in line with our 407 Application August 5 2014.

Please reach out to any of the Ad Hoc committee members to express your thoughts regarding the newly drafted regulatory language.