AzDA supported this bill. The Arizona Dental Association filed a Sunrise Application late last year to make a change in the Scope of Practice to permit Dentists to administer botulinum toxin Type A (aka Botox®) and dermal fillers for both therapeutic and cosmetic purposes in the head and neck area.
AzDA opposed this bill. It did not pass. However, it’s important to note as a legislative victory for AzDA’s Advocacy Team. If it had passed, this bill would have allowed a dental hygienist to perform a dental hygiene diagnosis, develop a dental hygiene treatment plan, and give limited prescriptive authority for fluorides (either ingestible or topically applied) and topically applied rinses containing anti-microbial agents. SB1112 was the result of a Sunrise Application filed by the Arizona Dental Hygiene Association.
AzDA supported this bill. Insurance claim forms contain a provision that allows a patient to instruct the insurer to direct payment to the health care provider directly, particularly when a patient is seeing a provider who is “out of network.” Health care providers complained that despite this instruction, insurers were directing payment to the patients, who in turn, kept the check and did not send payment to the provider. This then presented a collection problem for the health care industry.
To address this, 2021 session legislation (HB2119 – Bollick) was passed to, among other provisions, now requires insurers to honor an assignment of benefits designation by a patient and make payment directly to a health care provider when the provider is out of network.
However, despite the new requirement, some insurers, when acting as a third-party benefits administrator, were not honoring this requirement. HB2698 clarified that the assignment of benefits designations must be honored in all cases.
The following was contributed by the State Board of Dental Examiners Executive Director Ryan Edmonson:
This bill did not originally start out with so many layers for the Legislature to review and vote on.
Originally, it was one bill addressing one matter—licensees to provide the Board with patient records when subpoenaed and provide them free of charge. It became apparent that the other four matters could be wrapped up into one bill and voted on altogether.
Of the four other matters, only the requirement that all dental practices must have at least one AED machine in the dental office was removed because some legislative members did not like that it was a mandate.
The other three matters include cleaning up the renewal date(s) and expiration date(s) for licensees, and the establishment of an investigation committee, which also addressed removing the executive director terminations.
The last matter amends the initial application requirements regarding the clinical exam. In the last hour, another matter was added to SB1240, but was not reviewed, nor approved by the Board. Initially, that matter, although still poorly written, attempts to make it known that “practicing” dentists in a school setting is not regulated by the Board.
As was reported in this publication, the long-standing expiration date was June 30 every three years. However, in an effort to be more efficient and to spread the renewal workload throughout the entire calendar year, the Legislature, in 2021, amended the expiration date from June 30 to 30 days from the licensees’ birthdates.
That became effective January 1, 2022. It did not take long for the Board and its staff to quickly recognize that although it spread out the workload, the Board ended up with potentially 365 expiration dates every year, which is as challenging, if not more challenging, than the previous arrangement of having to manage a very high volume of renewals by June 30. Therefore, in 2022, SB1240 memorializes how the Board interpreted the previous year’s legislation. Now, the expiration dates are 12, and is the last day of the month following the licensees’ birth month.
For example, if your birth month is any date in April, then your expiration date will be May 31.
The establishment of an investigation committee formalizes the complaint process and makes the investigation process more transparent to the public, the complainants, and the licensees.
The Board established an 11-member committee made up of 10 dentists and one hygienist who meet about 9-10 times per year to review, discuss and make advisory recommendations to the Board on completed investigations conducted by the Board’s investigators.
On average, the Board receives about 375 complaints per calendar year. Once received, a copy of the complaint is sent to the licensee for their response, along with a subpoena for a copy of the patient records. During that period of time, the staff assigns the complaint to one of five contract investigators, or to a contract consultant, depending on the allegations.
Once the licensee’s response is received, along with the patient records, the investigator/consultant reviews the material and writes a report to be reviewed. Prior to this new legislation, that report, and all the records, were reviewed by the Board’s executive director and investigative staff. That group was called the Internal Investigative Review Committee (“IIRC”). The review was behind closed doors, not extremely transparent, and not open to public meetings. Adding the newly formed Investigative Committee fixes that and allows for a more peer-reviewed process. If you are ever interested in serving the Board and the community in this capacity, please reach out to the Board for more information.
For some of you, it’s been a long time since you received your initial license, and you can probably guess that things have come a long way. The Board’s hope is that it’s easier to accomplish receiving an initial license nowadays, but one matter that needed to be addressed was the requirement for applicants to take and pass the Western Regional Examining Board’s (“WREB”) clinical examination.
As you might have already concluded, it’s never a good idea to have a very specifically named examination written into a statute. You would be correct.
A little over a year ago, WREB merged with the Commission on Dental Competency Assessments (“CDCA,” formerly NERB). That merger nullified, in some regard, the clinical test that the Board required. The only saving grace was that the rest of the statute reads, “...or a clinical examination administered by another state or regional testing agency.
SB1240 removed WREB and now the statute just reads that the applicant takes and passes a clinical examination by a state or regional testing agency.
AzDA, the Board, the Governor’s office, the Ombudsman’s office, and some of the State’s Legislators receive complaints about the Board’s processes and some of its current and ongoing inefficiencies.
My hope in contributing this is not to offer an excuse for those inefficiencies, but to share with you my labors to correct those inefficiencies.
Many licensees know that the Board has an operating budget and that the fund balance, as well as the operating budget comes from licensees’/ applicants’ fees. Many of you also likely know that the Board’s fund balance hovered over five-million dollars about four years ago and dating back more than eight years ago.
So, the question is why are the process timeframes still slow? Why doesn’t the Board spend its money to hire more staff, hire an IT team/person, purchase better technology, expand its modernization, create a more robust and automated service(s), create a larger online presence, retain quality staff with pay increases, track and report performance measurements, etc?
The short answer is that although the Board had (no longer has) a five-milliondollar balance, the Board has to “seek permission” from the legislative body and governor to receive an appropriated amount of the $5M to spend on the aforementioned. This sounds easy, but it’s an arduous task, with multiple layers and for years the Board’s budget operated on the same budget despite an increase of over 35% growth in the dental profession in Arizona.
The challenge now is to show and prove to the many layers that the Board cannot continue to sustain its operations amongst this growth and managing over 375 complaints per year without adding some of the aforementioned supporting efficiencies.
My goal, along with AzDA’s Executive Director Dr. Regina Cobb’s, was to increase the Board’s operating budget when I took this role in 2019. We were not successful in our first two budget cycles, but in 2021, the Board’s operating budget increased by $600K. That was a huge step in the right direction! However, there is still more work to be done. In the 2023 statewide budget process, the BODEX budget increased by $130k to cover a legislature-approved and long overdue employee pay increases and other statewide technical adjustments.
The Board needs to add more staff to also manage the workload, especially since the Board will be introducing a new mid-level dental profession (dental therapists) later this year or at the beginning of 2023.
Why doesn’t the Board just use some of the $600K to hire more staff?
The answer is just as loaded as the previous one—regarding the budget increase. Along with making a budget request to the many layers, the Board also must make a request to increase its staff size. Currently, this is set at 11 employees and to date, the Board has not been granted the approval to hire more staff.
The Board estimates that they need to hire about four more employees to be more successful and efficient. Now that we’ve shared our warts, please contact your State Senator and House Representatives and encourage them to support the Board’s fiscal year 2024 budget request.