June 20, 2013, Introduced by Reps. MacGregor, Shirkey, Lyons, Pscholka, Haines, Hooker, Schmidt, Darany, Genetski, Callton, Yonker, Foster, Cotter, Stallworth, Jacobsen, Tlaib, Zorn and Switalski and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
(MCL 333.1101 to 333.25211) by adding part 216.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
MOBILE DENTAL FACILITY
Sec. 21601. (1) As used in this part:
(a) "Active patient" means a person who has received any type
of dental care in a mobile dental facility in the preceding 24
(b) "Assessment of a patient" means a limited clinical
inspection that is performed to identify possible signs of oral or
systemic disease, malformation, or injury, and the potential need
for referral for diagnosis and treatment.
(c) "Board of dentistry" means the board created under part
(d) "Clinical evaluation" means a diagnostic service provided
by a dentist that includes a complete intra- and extra-oral
inspection, may include other modalities of examination to identify
signs of oral or systemic disease, malformation, or injury, and may
include the completion of diagnosis and treatment planning to
determine the treatment needs of an individual patient.
(e) "Comprehensive dental services" means clinical evaluation,
including diagnosis and treatment planning; imagery services; and
indicated treatment that may include preventative, restorative, and
surgical procedures that are considered necessary for an individual
(f) "Dental home" means a network of individualized care based
on risk assessment, that includes oral health education, dental
screenings, preventative dental services, diagnostic services,
comprehensive dental services, and emergency services.
(g) "Imagery" means visualization of oral and facial
structures using specialized instruments and techniques for
(h) "Memorandum of agreement" means written documentation of
an agreement between parties to work together cooperatively on an
agreed-upon project or meet an agreed-upon objective. The purpose
of a memorandum of agreement is to have a written understanding of
the agreement between the parties. A memorandum of agreement serves
as a legal document that is binding and holds the parties
responsible to their commitment along with describing the terms and
details of the cooperative agreement. A memorandum of agreement may
be used between agencies, the public, the federal or state
government, communities, and individuals.
(i) "Mobile dental facility" means either of the following:
(i) A self-contained, intact facility in which dentistry or
dental hygiene is practiced that may be transported from 1 location
(ii) Any facility where dental services are rendered using
(j) "Operator" means either of the following:
(i) An individual with a valid, current license to practice
dentistry in this state who utilizes and holds a permit under this
part for a mobile dental facility.
(ii) A Michigan nonprofit corporation or any governmental
agency contracting with individuals licensed to practice dentistry
in this state or dental hygienists licensed in this state, who
utilizes and holds a permit under this part for a mobile dental
(k) "Preventative dental services" means dental services that
include, but are not limited to, screening of a patient, assessment
of a patient, prophylaxis, fluoride treatments, and application of
sealants. Imagery studies are not preventative dental services.
(l) "Screening of a patient" means screening, including state-
or federally mandated screening, to determine an individual's need
to be seen by a dentist for diagnosis.
(2) In addition, article 1 contains general definitions and
principles of construction applicable to this part.
Sec. 21603. (1) An operator shall obtain a permit under this
part for a mobile dental facility before offering dental services
at the facility.
(2) A mobile dental facility shall have an operator in charge
at all times.
(3) An operator may contract or employ other dentists, dental
hygienists, or dental assistants to work in a mobile dental
(4) An operator may hold a permit for 1 or more mobile dental
Sec. 21605. (1) An individual or entity seeking a permit to
operate a mobile dental facility shall submit an application on a
form provided by the department.
(2) An application submitted to the department under
subsection (1) shall include a registration fee in an amount
determined by the department but not more than the cost of
(3) A permit is valid for 2 years and an application for
renewal may be submitted not later than the last day of the month
in which the permit expires upon submission of proof to the
department of compliance with the requirements of this part. A
permit application that is not timely filed is subject to a late
fee in an amount determined by the department as the additional
cost of processing the late renewal.
(4) A permit shall not be issued unless the applying
individual or entity is in compliance with all applicable
requirements of this part.
(5) A permit issued under this part is not transferrable. If
the operator of the mobile dental facility changes, the permit is
no longer valid. However, if an application for a new permit to
continue operating the mobile dental facility is submitted not
later than 30 days after the change of operator, the former permit
is valid as an interim permit until the application is approved or
denied, but not longer than 90 days.
(6) The department of licensing and regulatory affairs shall
either approve or deny an application for a permit under this part
not later than 60 days after receiving the application.
Sec. 21607. (1) An applicant shall provide with the
application for a permit under this part, and subsequently, within
10 days after a request from the department, all of the following
information, as applicable:
(a) A list of each dentist, dental hygienist, and dental
assistant who will provide care at or within the mobile dental
facility, including, at a minimum, each individual's name, address,
telephone number, and state occupational license number.
(b) A written plan and procedure for providing emergency
follow-up care to each patient treated at the mobile dental
(c) A signed memorandum of agreement between the operator and
at least 1 dentist or party who can arrange for or provide follow-
up services at a site within a reasonable distance of the location
where the operator provides dental services to a patient. The
memorandum of agreement shall state that the contracting dentist or
party will accept patients treated at the mobile dental facility
for follow-up dental services, if the operator does not provide for
follow-up services at a permanent location within a reasonable
distance of the location where the operator provided dental
services to the patient.
(d) If the operator provides only preventative dental
services, a signed memorandum of agreement for referral for
comprehensive dental services between the operator and a dentist or
party who can arrange for or provide comprehensive dental services
at a site within a reasonable distance of the location where the
operator provides preventative dental services to a patient.
(e) For a school-based or school-linked setting, a written
plan that shows compliance with the guidelines jointly developed by
the department of community health and the Michigan dental
association for a school-based oral health program.
(f) A copy of the driver license and official motor vehicle
driving record from the secretary of state of every individual who
drives or transports the mobile dental facility or the mobile
dental facility's portable equipment.
(g) Proof of general liability insurance covering the mobile
dental facility that is issued by a licensed insurance carrier
authorized to do business in this state.
(2) An operator shall meet all of the following requirements:
(a) Comply with all applicable federal, state, and local laws,
regulations, and ordinances, including, but not limited to, those
concerning radiographic equipment, flammability, sanitation,
zoning, and construction standards, including standards relating to
required access for persons with disabilities.
(b) Maintain continuously available at the mobile dental
facility a communication device for making and receiving telephone
calls and summoning emergency services.
(c) Make immediately available, upon request from any person,
a copy of the license of each dentist, dental hygienist, or dental
assistant working at the mobile dental facility.
(d) Make immediately available, at the mobile dental facility,
upon request from any person, a copy of the permit required under
(3) The operator of a mobile dental facility and the
operator's agents and employees shall comply with all federal,
state, and local laws, administrative rules, regulations, and
ordinances applicable to the mobile dental facility and to the
individuals and entities that provide the preventative dental
services or comprehensive dental services at the mobile dental
facility, including, but not limited to, those concerning
sanitation, infectious waste management and disposal, occupational
safety, and disease prevention.
(4) A mobile dental facility shall have ready access to all of
the following functional equipment:
(a) An instrument sterilization system.
(b) Potable hot and cold water, hand sanitizer, or both.
(c) Toilet facilities.
(d) A ramp or lift if necessary for access by individuals with
(e) Smoke and carbon monoxide detectors, as applicable.
(f) Radiographic equipment properly registered and inspected,
as applicable, by the state.
(g) A communication device continuously available for making
and receiving telephone calls and summoning emergency services.
(5) A mobile dental facility shall have ready access to the
following dental equipment:
(a) Proper lighting.
(b) Portable suction.
(c) Hand pieces.
(d) Dental instruments.
(6) A dentist licensed under this act shall be present in a
mobile dental facility at any time comprehensive dental services
are performed on a patient. A dentist need not be present while
only preventative dental services are performed.
(7) If the mobile dental facility is part of a program that
provides comprehensive dental services and is established under a
memorandum of agreement, the mobile dental facility may provide
Sec. 21609. (1) The operator or his or her designee shall
establish a written treatment plan for, and provide a copy to, each
patient who receives dental services at a mobile dental facility.
(2) The written treatment plan required under subsection (1)
shall address comprehensive dental services to be provided either
by the mobile dental facility or through an affiliated dentist,
dental office, or party who can arrange for or provide those
services under a memorandum of agreement with the operator of the
mobile dental facility.
(3) If the written treatment plan required under subsection
(1) cannot be completed during the patient's initial visit to the
mobile dental facility, the operator or his or her designee shall
make a reasonable attempt to schedule additional appointments to
complete dental services either at the mobile dental facility or
with an affiliated dentist, dental office, or party who can arrange
for or provide those dental services under a memorandum of
agreement with the mobile dental facility, at intervals not to
exceed 90 days, until the treatment plan is completed or the
patient ceases treatment. If the operator or his or her designee is
unable to make arrangements for continued treatment, he or she
shall place written documentation of the attempts in the patient
record and make the documentation available upon the request of the
department. A copy of the documentation shall be sent to the
patient. Failure of the operator or his or her designee to comply
with the provisions of this subsection is unprofessional conduct by
patient abandonment and is cause for disciplinary action by the
board of dentistry.
(4) The operator shall obtain the patient's written consent,
or the consent of a parent or guardian of a patient who is a minor
or legally incapable of consent, before providing any dental
services to a patient at a mobile dental facility.
(5) The form for the written consent required under subsection
(4) shall include, at a minimum, all of the following:
(a) The name of the mobile dental facility providing dental
(b) The permanent address of the mobile dental facility.
(c) The telephone number that a patient may call 24 hours a
day for emergency calls.
(d) A list of the services to be provided.
(e) A statement indicating that the patient, parent, or
guardian understands that treatment may be obtained at the
patient's dental home rather than at a mobile dental facility.
(6) If the patient is a minor or incapacitated person, the
written consent required under subsection (4) shall also include
both of the following:
(a) If the minor or incapacitated person has had dental
services in the past 12 months, the name and address of the dentist
or dental office that provided the dental services.
(b) A statement indicating that the minor or incapacitated
person may obtain any or all dental services at his or her dental
home, and that obtaining duplicate services at a mobile dental
facility may affect benefits that he or she receives from private
insurance, a state or federal program, or other third-party
provider of dental benefits.
(7) Each person receiving dental services at a mobile dental
facility shall receive all of the following information in writing:
(a) The name of the dentist, dental hygienist, or dental
assistant who provided the dental services to the patient.
(b) The telephone number or emergency contact number to reach
the mobile dental facility or operator, or both, in case of
(c) A list of the dental services rendered, including dental
procedure code, fee, and tooth numbers.
(d) A description of any further dental services that are
advisable or that have been scheduled.
(e) A referral to a specialist, dentist, or party who can
arrange for or provide comprehensive dental services if the mobile
dental facility is unable to provide the necessary comprehensive
dental services. The referral shall include all imagery records the
mobile dental facility obtained for the patient.
(f) A copy of the consent form required under this section
authorizing additional treatment.
(8) An operator who fails to comply with applicable federal,
state, or local laws and rules governing the practice of dentistry,
dental hygiene, or any of the requirements of this article is
subject to disciplinary action for unethical or unprofessional
conduct and may be subject to disciplinary action by the department
or board of dentistry, as applicable.
Sec. 21611. (1) The operator shall submit an annual report on
activities performed at the mobile dental facility during the 1-
year period following approval of the application under this part
and for each 1-year period thereafter. The report shall be
submitted to the department, the department of community health,
and the board of dentistry not later than 60 days after the
expiration of each 1-year period.
(2) An annual report required under subsection (1) shall
include all of the following information:
(a) A list of all locations, including street address, city,
and state, where any level of dental service was provided.
(b) The dates when dental services were provided.
(c) The total number of patients treated at each location.
(d) The types of dental services provided, reported in a
manner consistent with center for medicare and medicaid services
(CMS) Form 416, using appropriate diagnostic, preventative, and
restorative coding for each dentist, dental hygienist, or dental
assistant providing dental services.
(e) A list of the changes in the dentists, dental hygienists,
or dental assistants providing dental services at the mobile dental
Sec. 21613. (1) The operator or his or her designee shall
notify the department and the board of dentistry not later than 30
days after any of the following occurrences:
(a) A change in ownership of the mobile dental facility.
(b) A change in a memorandum of agreement required under
(c) A change in the address or telephone number of the mobile
(d) Cessation of operation of the mobile dental facility.
(2) Upon cessation of operation of a mobile dental facility,
the operator shall do all of the following:
(a) Provide written notice to all treatment venues and, upon
request, provide evidence of the written notice to the board of
(b) Provide for availability of each active patient's dental
records by 1 of the following methods:
(i) Make the dental records available to the patient or the
patient's parent or guardian from the mobile dental facility for
180 days after the mobile dental facility ceases operation and,
upon his or her request, transfer the records to the active
patient, the patient's parent or guardian, or another dentist.
(ii) Transfer the records to another dentist.
(c) Notify each active patient or the patient's parent or
guardian that the dental records are available as required under
subdivision (b), including the name and contact information for the
dentist if the records have been transferred.
(d) Upon request from the department, provide documentation
that a reasonable attempt was made to contact each active patient
or the active patient's parent or guardian to provide information
concerning storage and retrieval of the patient's records.