HOUSE BILL No. 4865

 

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:

 

PART 216

 

                        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

 

months.

 

     (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

 

166.

 

     (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

 

patient.

 

     (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

 

diagnostic purposes.

 

     (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

 

to another.

 

     (ii) Any facility where dental services are rendered using

 

portable equipment.

 

     (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

 

facility.

 

     (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

 

facility.

 

     (4) An operator may hold a permit for 1 or more mobile dental

 

facilities.

 

     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

 

regulation.

 

     (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

 

facility.

 

     (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

 

this part.

 

     (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

 

limited mobility.

 

     (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.

 

     (e) Supplies.

 

     (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

 

imagery services.

 

     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

 

services.

 

     (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

 

emergency.

 

     (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

 

facility.

 

     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

 

section 21607.

 

     (c) A change in the address or telephone number of the mobile

 

dental facility.

 

     (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

 

dentistry.

 

     (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.