NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A488A Revised 2/7/24
TITLE OF BILL:
An act to amend the education law, in relation to registered dental
hygienists working without supervision but within a collaborative prac-
tice agreement with a licensed dentist
To create the category of registered dental hygienist, collaborative
practice, which authorizes dental hygienists to practice without super-
vision but within a collaborative practice agreement with a licensed
SUMMARY OF PROVISIONS:
Section one amends section 6606 of the education law to create and
define the practice of collaborative practice dental hygiene. This
section provides that the practice of dental hygiene may be performed
in. collaboration with a licensed dentist provided such services are
performed in accordance with a written practice. agreement and written
practice protocols. This section also establishes the required content
and procedures pertaining to the written collaborative practice agree-
ment and collaborative practice arrangements.
Section one of this bill also requires dental hygienists to provide a
patient with a written statement advising the patient that dental
hygiene services are not a substitute for a dental examination by a
licensed dentist, and to make referrals for further dental procedures as
Section two provides for the immediate enactment of this bill.
According to the Department of Health's Oral Health Plan for New York
State (2014), approximately 44% of children in New York experience tooth
decay by the third grade and about 17% of New Yorkers 65 years and older
have lost all their teeth. Because of current disparities that exist in
oral health, these numbers are even higher among low-income and minority
populations. Increasing access to dental hygiene services will help to
ensure that all New Yorkers are able to receive quality oral healthcare.
Dental hygienists fulfill a critical role in the provision of dental
care, both in private practice and public health settings. In fact, a
2010 report issued by the Pew Center on the States found that adding
dental hygienists to a practice. enables most private-practice dentists
to serve more patients while increasing profitability and productivity.
The enactment of the federal Affordable Care Act, which mandates insur-
ance coverage for pediatric dental care, continues to increase patient
demand for dental care. Thus, it is imperative that dental hygienists'
skills and training are fully utilized, freeing-'up dentists to treat
The Medicaid Redesign Team (MRT) supported this action as one of its top
five priorities of their twelve final recommendations. According to the
2011 published recommendations from MRT, this bill will allow for the
maximum utilization of the dental hygienists in New York State, in keep-
ing with their education, training, and expertise as oral health
prevention specialists. Collaborative Practice will serve to improve the
oral health status of New Yorkers and promote the prevention of disease
and oral health.
Collaborative practice is another way to increase access to dental
hygiene care and disease prevention. Collaborative practice dental
hygienists would be able to practice, pursuant to the terms of the
collaborative practice agreement, without the supervision of the
dentist. This makes it much easier for dental hygienists to practice in
under-served communities, where there is a great need for prophylactic
treatments and oral health counseling.- Collaborative practice dental
hygienists would also screen patients for disease and refer them to the
collaborating dentist for dental examinations and other treatments..
This creates more opportunities for New Yorkers to receive dental
hygiene care, and decreases their risk of developing oral disease and
Moreover this bill requires registered dental hygienists to apply for a
new certification with the New York State Education Department for
Collaborative Practice (RDH-CP). Three years of experience and continu-
ing education requirements are required for the certification.
A.3934, 2021 and 2022, referred to higher education.
A.335, 2019 and 2020, referred to higher education.
A.2553, 2017 and 2018, referred to higher education.
Same as S.743, 2017 and 2018, referred to higher education.
A.1959, 2015 and 2016, referred to higher education.
Same as S.3308, 2015 and 2016, referred to higher education.
A.5096, 2013 and 2014, referred to higher education.
Same as 5.1944, 2013 and 2014, referred to higher education.
A.111-A, 2011 and 2012, referred to higher education. Same as 5.7353,
2012, referred to higher education.
This act shall take effect immediately.
STATE OF NEW YORK
2023-2024 Regular Sessions
January 9, 2023
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Higher Education -- recommitted to the Committee on Higher Educa-
tion in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the education law, in relation to registered dental
hygienists working without supervision but within a collaborative
practice agreement with a licensed dentist
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 6606 of the education law, as amended by chapter
2 244 of the laws of 1973, subdivision 1 as amended by chapter 239 of the
3 laws of 2013, is amended to read as follows:
4 § 6606. Definition of practice of dental hygiene. 1. The practice of
5 the profession of dental hygiene is defined as the performance of dental
6 services which shall include removing calcareous deposits, accretions
7 and stains from the exposed surfaces of the teeth which begin at the
8 epithelial attachment and applying topical agents indicated for a
9 complete dental prophylaxis, removing cement, placing or removing rubber
10 dam, removing sutures, placing matrix band, providing patient education,
11 applying topical medication, placing and exposing diagnostic dental
12 X-ray films, performing topical fluoride applications and topical anes-
13 thetic applications, polishing teeth, taking medical history, charting
14 caries, taking impressions for study casts, placing and removing tempo-
15 rary restorations, administering and monitoring nitrous oxide analgesia
16 and administering and monitoring local infiltration anesthesia, subject
17 to certification in accordance with section sixty-six hundred five-b of
18 this article, and any other function in the definition of the practice
19 of dentistry as may be delegated by a licensed dentist in accordance
20 with regulations promulgated by the commissioner. The practice of dental
21 hygiene may be conducted in the office of any licensed dentist or in any
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 is old law to be omitted.
A. 488--A 2
1 appropriately equipped school or public institution but must be done
2 either under the supervision of a licensed dentist or[, in the case of a
3 registered dental hygienist working for a hospital as defined in article
4 twenty-eight of the public health law, pursuant to a collaborative
5 arrangement with a licensed and registered dentist who has a formal
6 relationship with the same hospital in accordance with regulations
7 promulgated by the department in consultation with the department of
8 health] may be performed by a registered dental hygienist designated as
9 a registered dental hygienist, collaborative practice (RDH-CP) in
10 collaboration with a licensed dentist provided such services are
11 performed in accordance with a written practice agreement and written
12 practice protocols to be known as a collaborative practice agreement.
13 Under a collaborative practice agreement, dental hygienists may perform
14 all services which are designated in regulation under general super-
15 vision without prior evaluation of a dentist or medical professional and
16 may be performed without supervision in a collaborative practice
17 setting. Such collaborative arrangement shall not obviate or supersede
18 any law or regulation which requires identified services to be performed
19 under the personal supervision of a dentist. [When dental hygiene
20 services are provided pursuant to a collaborative agreement, such dental
21 hygienist shall instruct individuals to visit a licensed dentist for
22 comprehensive examination or treatment.]
23 2. (a) The collaborative practice agreement shall include consider-
24 ation for medically compromised patients, specific medical conditions,
25 and age- and procedure-specific practice protocols, including, but not
26 limited to recommended intervals for the performance of dental hygiene
27 services and a periodicity in which an examination by a dentist should
29 (b) The collaborative practice agreement shall be:
30 (i) signed and maintained by the dentist, the dental hygienist and the
31 facility, program or organization; and
32 (ii) reviewed annually by the collaborating dentist and dental hygien-
33 ist; and
34 (iii) made available to the department and other interested parties
35 upon request.
36 (c) A registered dental hygienist, collaborative practice (RDH-CP)
37 shall have no more than one collaborative practice agreement with a
38 collaborative dentist at one time.
39 3. Before performing services authorized under this section, a dental
40 hygienist must provide the patient with a written statement advising the
41 patient that the dental hygiene services provided are not a substitute
42 for a dental examination by a licensed dentist. If the dental hygienist
43 makes any referrals to the patient for further procedures, the dental
44 hygienist must fill out a referral form and provide a copy of the form
45 to the collaborating dentist.
46 4. A contractual arrangement under this section may be made by either
47 a New York state licensed and registered dentist or a registered dental
48 hygienist, collaborative practice (RDH-CP) in the following settings: a
49 hospital as defined in article twenty-eight of the public health law,
50 any appropriately equipped school, federally qualified health centers,
51 long-term care facilities, group homes servicing the intellectually and
52 developmentally disabled population, facilities serving veterans,
53 facilities servicing the homeless, prisons, drug treatment facilities,
54 domestic violence shelters, and appropriate settings in which homebound
55 residents are unable to be relocated for necessary treatment.
A. 488--A 3
1 5. A collaborating dentist shall have collaborative agreements with no
2 more than six RDH-CPs. The department may grant exceptions to these
3 limitations for public health settings on a case-by-case basis.
4 6. A dental hygienist must make application to the department to prac-
5 tice as an RDH-CP and pay a fee set by the department. As a condition of
6 collaborative practice, the dental hygienist must have been engaged in
7 practice for three years with a minimum of four thousand five hundred
8 practice hours and shall complete an eight-hour continuing education
9 program that includes instruction in medical emergency procedures, risk
10 management, dental hygiene jurisprudence and professional ethics.
11 7. The commissioner shall promulgate regulations defining the func-
12 tions a dental hygienist may perform that are consistent with the train-
13 ing and qualifications for a license as a dental hygienist.
14 § 2. This act shall take effect immediately.