BILL NUMBER: S6532
SPONSOR: FAHY
 
TITLE OF BILL:
An act to amend the education law, in relation to licensing of a dental
therapist and an advanced dental therapist; and to amend the social
services law, in relation to Medicaid reimbursement for dental therapy
services
 
PURPOSE OR GENERAL IDEA OF BILL::
To expand dental care to underserved communities by allowing for the
licensure of dental therapists.
 
SUMMARY OF SPECIFIC PROVISIONS::
Section 1: amends the heading of article 133 of the education law to
include dental therapy and advanced dental therapy.
Section 2: amends section 6600 of the education law to include dental
therapy and advanced dental therapy.
Section 3: adds sections 6614, 6614-a, 6614-b, 6614-c, 6615, 6615-a,
6615-b, and 6615-c to article 133 of the education law to define the
practice of dental therapy, add licensure requirements, delineate the
authorized use of the title of dental therapist and mandate continuing
education for dental therapists, plus add licensure requirements for
advanced dental therapists, delineate the authorized use of the title of
advanced dental therapist and mandate continuing education for advanced
dental therapists.
Section 4: adds new paragraph (nn) to subdivision 2 of section 365-a of
the social services law to require that Medicaid covers care and
services provided by a licensed dental therapist who is enrolled as a
Medicaid managed care provider.
Section 5: authorizes the commissioner of health to promulgate or adopt
rules and authorizes the commissioner of health and superintendent of
financial services and any appropriate council to adopt, amend or
promulgate on an emergency basis any regulation deemed necessary.
Section 6: sets forth the effective date.
 
JUSTIFICATION:
As fewer dentists continue to own their own dental practices and hospi-
tal clinics close, millions of New Yorkers cannot access the dental
services they desperately need. As a result, many patients are compelled
to seek treatment in a hospital Emergency Department where, instead of
receiving restorative dental services, they often receive pain manage-
ment and a dentist referral, or simply have their tooth pulled.
Federal and state statistics confirm the breakdown of the pipeline to
care. The U.S. Department of Health & Human Services lists New York
State as having 161 dental Health Practitioner Shortage Areas (HPSAs),
including 117 designated HPSA facilities and 44 designated HPSA popu-
lation groups (mostly Medicaid eligible populations). Facilities and
population groups that qualify for dental HPSA designation have a popu-
lation-to-dentist ratio of 4000+ people for every 1 dentist. As a
result, NYS currently meets only 16.15% of the documented need, leading
HRSA to estimate that New York needs an additional 588 dentists.
This situation has worsened over time and arises from a perfect storm of
circumstances, including the COVID-19 pandemic, the end of federal fund-
ing for dental schools since 1981, and a recent wave of dentist retire-
ments. New York State's existing dental care delivery system does not
sufficiently address the many barriers to delivering timely, quality
care to low-income, rural and developmentally disabled individuals. Some
of the largest barriers include:
*High operating costs - Dentists have high education debt and establish-
ing and maintaining a dental practice is significantly more expensive
than operating a medical practice.
*Insufficient insurance reimbursement rates - High operating expenses
are more difficult to overcome in a Medicaid-dense locality with fewer
private pay patients or in small rural practices with fewer patients
and/or fewer private pay patients. Medicaid reimbursement rates do not
cover the cost of providing care, and private insurance reimbursement
rates are not incrementally high enough to overcome that deficit.
Such challenges discourage dentists from practicing in their small
and/or low-income hometown communities and hinder those communities from
attracting new dentists.
To alleviate these challenges, New York must enable dentists to add
highly-specialized, lower-cost paraprofessionals, known as "dental ther-
apists," to their existing oral healthcare team of dental hygienists and
dental assistants. Dental therapists work exclusively under the general
supervision of a dentist and provide preventative and basic restorative
treatments such as cavity screening, cavity fillings, fluoride treat-
ments and sealants. Dental therapists receive training to perform proce-
dures to the same standard of care as dentists, however their training
focuses on far fewer procedures, i.e., 60-70 procedures vs. approximate-
ly 500 procedures performed by dentists. Dental therapy is an estab-
lished profession around the world, and dental therapists began practic-
ing in the U.S. in Alaska in 2005 and in Minnesota in 2009.
The use of dental therapists in Alaska and Minnesota has enabled
dentists in those states to financially sustain dental practices that
serve Medicaid populations and/or are located in rural and remote
locations. Because they have lower student debt and are dental practice
employees who do not practice independently from their supervising
dentist, dental therapists often practice in the small-town or rural
communities from which they came and are more likely to remain in those
communities. Unlike associate dentists immediately hired by a dental
practice upon their licensure, dental therapists do not (and cannot)
aspire to leave to run their own practice.
 
PRIOR LEGISLATIVE HISTORY::
2023-24: A.5373 - referred to Higher Education S.4428 - referred to
Higher Education
2021-22: A.1749 - referred to Higher Education S.0819 - referred to
Higher Education
2019-20: A.11033 - referred to Higher Education S.07935 - referred to
Higher Education
 
FISCAL IMPLICATIONS::
To be determined.
 
EFFECTIVE DATE::
This act shall take effect on the one hundred and eightieth day after it
shall have become a law.

Statutes affected:
S6532: 6600 education law, 365-a social services law, 365-a(2) social services law