NY State Senate Bill 2023-S9308A

Senate Bill S9308A

2023-2024 Legislative Session

Relates to the application of topical fluoride varnish by dental assistants and licensed practical nurses

download bill text pdf

Current Bill Status Via A7402 - Passed Senate

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 05, 2024	returned to assembly passed senate 3rd reading cal.1785 substituted for s9308a
Jun 05, 2024	substituted by a7402b ordered to third reading cal.1785 committee discharged and committed to rules
May 22, 2024	print number 9308a
May 22, 2024	amend and recommit to higher education
May 10, 2024	referred to higher education

Bill Amendments

Original

A (Active)

2023-S9308 - Details

See Assembly Version of this Bill:: A7402
Law Section:: Education Law
Laws Affected:: Amd §§6608 & 6902, Ed L

2023-S9308 - Summary

Permits dental assistants and licensed practical nurses to perform the application of topical fluoride varnish.

2023-S9308 - Sponsor Memo

                                 
BILL NUMBER: S9308

SPONSOR: FERNANDEZ
 
TITLE OF BILL:

An act to amend the education law, in relation to permitting certain
persons to perform the application of topical fluoride varnish

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to improve children's dental health outcomes
by allowing additional persons to apply fluoride varnish to teeth when
there is a prescription and under protocols of an authorized provider.

 
SUMMARY OF PROVISIONS:

Section 1 amends section 6608 of the education law related to registered
dental assisting to allow for the application of topical fluoride
varnish.

Section 2 amends subdivision 2 of section 6902 of the education law
related to the practice of nursing as a licensed practical nurse to

allow for the application of topical fluoride varnish.

Section 3 amends section 6610 of the education law to allow for the
application of topical fluoride varnish to a child's teeth by a parent
or legal guardian under the direction and supervision of a licensed
practitioner authorized to apply such varnish.

Section 4 provides for an effective date.

 
JUSTIFICATION:

Applying fluoride varnish to the teeth of young children is proven to
reduce dental disease, but too few children in New York are receiving
treatments. Fluoride varnish application is a standard of care for
pediatric offices and for New York Medicaid.

Allowing additional persons to perform this service would bring New York
in line with other states and create more access points at which chil-
dren and adolescents enrolled in Medicaid can receive this preventive
service.

Dental disease in children has been called a "hidden epidemic." Hidden
because dental disease is not always apparent until the pain becomes
unendurable or until it creates an inability to eat, sleep, or concen-
trate in school. It is also hidden by poverty. Most children won't expe-
rience severe dental disease. Instead, the effects are felt primarily by
low-income children because it relates to many of the same social and
economic factors that drive other health disparities.

In 2021, more than 14% of children in New York reported one or more oral
health problems. In 2021, more than 14% of children in New York reported
one or more oral health problems. In 2020, only one in every three New
York children enrolled in Medicaid (32.8%) received a preventive dental
visit (national median 41.5%) which includes fluoride varnish applica-
tion. Persistent oral health disparities remain, with children who are
Black and Hispanic/Latino and children experiencing poverty most
affected by poor-dental health.  Fluoride varnish is a topical solution
used to prevent tooth decay.  Like fluoridated toothpaste, fluoride
varnish is used on the surface of teeth and helps prevent cavities by
making the tooth hard and helps prevent cavities when they are just
starting or barely visible.  Fluoride varnish is painted onto the front
and back, top and bottom of the teeth with a tiny brush where it hard-
ens. as soon as it is touched by saliva in the mouth. It takes less than
two minutes to apply and requires no special equipment or extensive
training to master the technique.

There is high-quality evidence that fluoride varnish is effective in
preventing tooth decay in children at moderate to high risk for decay.
Studies show that children who receive fluoride varnish every three
months have fewer cavities than those who get it less often or not at
all. Fluoride varnish should be started early, even in infancy, when the
first tooth erupts, because it is most effective when applied before
tooth decay develops. New York Medicaid reimburses for up to four appli-
cations per child per year: dental providers can bill from birth up to
age 21 and medical providers from birth to age 6.

Providers currently authorized to apply fluoride varnish in New York
include dentists, dental hygienists, physicians, nurse practitioners,
registered nurses, and physician assistants. Allowing additional members
of care teams to apply the varnish would increase flexibility in offices
and provide more opportunities to incorporate the service into visits.
Similarly, allowing parents to apply the varnish under the direction and
supervision of a licensed practitioner would provide families with much
needed flexibility, as it reduces common barriers such as travel and
time off from school or work.

 
PRIOR LEGISLATIVE HISTORY:

This is a new bill.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
Immediate, provided that Section 3 shall take effect 18 months after
enactment.

2023-S9308 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9308
 
                             I N  S E N A T E
 
                               May 10, 2024
                                ___________
 
 Introduced by Sen. FERNANDEZ -- read twice and ordered printed, and when
   printed to be committed to the Committee on Higher Education
 
 AN  ACT  to  amend  the education law, in relation to permitting certain
   persons to perform the application of topical fluoride varnish
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Section  6608 of the education law, as amended by chapter
 512 of the laws of 2022, is amended to read as follows:
   § 6608. Definition of practice of  registered  dental  assisting.  The
 practice of registered dental assisting is defined as providing support-
 ive  services  to a dentist in his or her performance of dental services
 authorized under this article.  Such  support  shall  include  providing
 patient  education, taking preliminary medical histories and vital signs
 to be reviewed by the dentist, placing and removing rubber dams, select-
 ing and prefitting provisional crowns, selecting and  prefitting  ortho-
 dontic bands, removing orthodontic arch wires and ligature ties, placing
 and  removing  matrix bands, taking impressions for study casts or diag-
 nostic casts,  removing  periodontal  dressings,  placing  and  removing
 temporary  restorations,  APPLICATION  OF  TOPICAL FLUORIDE VARNISH, and
 such other dental supportive services authorized by the dentist consist-
 ent with regulations promulgated by the commissioner, provided that such
 functions are performed under  the  direct  personal  supervision  of  a
 licensed  dentist  in  the course of the performance of dental services.
 Such services shall not include diagnosing  and/or  performing  surgical
 procedures,  irreversible  procedures or procedures that would alter the
 hard or soft tissue of the oral and  maxillofacial  area  or  any  other
 procedures  determined  by  the  department.  The practice of registered
 dental assisting may be conducted in the office of any licensed  dentist
 or  in  any appropriately equipped school or public institution but must
 be done under the direct personal supervision  of  a  licensed  dentist.
 Direct  personal supervision, for purposes of this section, means super-
 vision of dental procedures based on instructions given  by  a  licensed
 dentist  in  the  course of a procedure who remains in the dental office
 where the supportive services are being performed, personally  diagnoses
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD11382-05-4
 S. 9308                             2
 
 the  condition  to be treated, personally authorizes the procedures, and
 before dismissal of the patient, who remains the responsibility  of  the
 licensed  dentist,  evaluates  the  services performed by the registered
 dental  assistant. Nothing herein authorizes a registered dental assist-
 ant to perform any of the services or functions defined as part  of  the
 practice of dental hygiene in accordance with the provisions of subdivi-
 sion  one of section sixty-six hundred six of this article, except those
 functions authorized pursuant to this  section.  All  dental  supportive
 services  provided  in this section may be performed by currently regis-
 tered dental hygienists either under a dentist's supervision, as defined
 in regulations of the commissioner, or, in  the  case  of  a  registered
 dental  hygienist  working  for a hospital as defined in article twenty-
 eight of the public health law, pursuant to a collaborative  arrangement
 with  a  licensed  dentist in accordance with subdivision one of section
 sixty-six hundred six of this article.  Such  collaborative  arrangement
 shall  not  obviate  or  supersede  any law or regulation which requires
 identified services to be performed under the personal supervision of  a
 dentist.
   § 2. Subdivision 2 of section 6902 of the education law, as amended by
 chapter 781 of the laws of 1990, is amended to read as follows:
   2. The practice of nursing as a licensed practical nurse is defined as
 performing  tasks and responsibilities within the framework of casefind-
 ing, health teaching, health  counseling,  THE  APPLICATION  OF  TOPICAL
 FLUORIDE VARNISH, and provision of supportive and restorative care under
 the  direction of a registered professional nurse or licensed physician,
 dentist or other licensed health care provider legally authorized  under
 this title and in accordance with the commissioner's regulations.
   §  3.  Section  6610  of  the education law is amended by adding a new
 subdivision 9 to read as follows:
   9. THE APPLICATION OF TOPICAL FLUORIDE VARNISH TO A CHILD'S  TEETH  BY
 SUCH CHILD'S PARENT OR LEGAL GUARDIAN, PROVIDED THAT SUCH APPLICATION IS
 DONE  UNDER  THE  DIRECTION  AND  SUPERVISION OF A LICENSED PRACTITIONER
 AUTHORIZED TO APPLY TOPICAL FLUORIDE VARNISH.  A  LICENSED  PRACTITIONER
 ACTING  WITHIN  THEIR  SCOPE  OF PRACTICE MAY PRESCRIBE TOPICAL FLUORIDE
 VARNISH FOR THE PURPOSES OF THIS SUBDIVISION PROVIDED THAT SUCH  PRACTI-
 TIONER  DISPENSES  WRITTEN  SAFETY  INSTRUCTIONS  TO THE PARENT OR LEGAL
 GUARDIAN.
   § 4. This act shall take effect immediately;  provided,  however  that
 section  three  of  this  act shall take effect eighteen months after it
 shall have become a law. Effective immediately, the addition,  amendment
 and/or repeal of any rule or regulation necessary for the implementation
 of  this  act  on  its  effective  date  are  authorized  to be made and
 completed on or before such date.

co-Sponsors

2023-S9308A (ACTIVE) - Details

See Assembly Version of this Bill:: A7402
Law Section:: Education Law
Laws Affected:: Amd §§6608 & 6902, Ed L

2023-S9308A (ACTIVE) - Summary

Permits dental assistants and licensed practical nurses to perform the application of topical fluoride varnish.

2023-S9308A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S9308A

SPONSOR: FERNANDEZ
 
TITLE OF BILL:

An act to amend the education law, in relation to permitting dental
assistants and licensed practical nurses to perform the application of
topical fluoride varnish

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to improve children's dental health outcomes
by allowing additional persons to apply fluoride varnish to teeth when
there is a prescription and under protocols of an authorized provider.

 
SUMMARY PROVISIONS:

Section 1 amends section 6608 of the education law related to registered
dental assisting to allow for the application of topical fluoride
varnish.

Section 2 amends subdivision 2 of section 6902 of the education law

related to the practice of nursing as a licensed practical nurse to
allow for the application of topical fluoride varnish.

Section 3 amends section 6610 of the education law to allow for the
application of topical fluoride varnish to a child's teeth by a parent
or legal guardian under the direction and supervision of a licensed
practitioner authorized to apply such varnish.

Section 4 provides for an effective date.

 
JUSTIFICATION:

Applying fluoride varnish to the teeth of young children is proven to
reduce dental disease, but too few children in New York are receiving
treatments. Fluoride varnish application is a standard of care for
pediatric offices and for New York Medicaid.

Allowing additional persons to perform this service would bring New York
in line with other states and create more access points at which chil-
dren and adolescents enrolled in Medicaid can receive this preventive
service.

Dental disease in children has been called a "hidden epidemic." Hidden
because dental disease is not always apparent until the pain becomes
unendurable or until it creates an inability to eat, sleep, or concen-
trate in school. It is also hidden by poverty. Most children won't expe-
rience severe dental disease. Instead, the effects are felt primarily by
low-income children because it relates to many of the same social and
economic factors that drive other health disparities.

In 2021, more than 14% of children in New York reported one or more oral
health problems. In 2021, more than 14% of children in New York reported
one or more oral health problems. In 2020, only one in every three New
York children enrolled in Medicaid (32.8%) received a preventive dental
visit (national median 41.5%) which includes fluoride varnish applica-
tion. Persistent oral health disparities remain, with children who are
Black and Hispanic/Latino and children experiencing poverty most
affected by poor-dental health.  Fluoride varnish is a topical solution
used to prevent tooth decay.  Like fluoridated toothpaste, fluoride
varnish is used on the surface of teeth and helps prevent cavities by
making the tooth hard and helps prevent cavities when they are just
starting or barely visible.  Fluoride varnish is painted onto the front
and back, top and bottom of the teeth with a tiny brush where it hard-
ens. as soon as it is touched by saliva in the mouth. It takes less than
two minutes to apply and requires no special equipment or extensive
training to master the technique.

There is high-quality evidence that fluoride varnish is effective in
preventing tooth decay in children at moderate to high risk for decay.
Studies show that children who receive fluoride varnish every three
months have fewer cavities than those who get it less often or not at
all. Fluoride varnish should be started early, even in infancy, when the
first tooth erupts, because it is most effective when applied before
tooth decay develops. New York Medicaid reimburses for up to four appli-
cations per child per year: dental providers can bill from birth up to
age 21 and medical providers from birth to age 6.

Providers currently authorized to apply fluoride varnish in New York
include dentists, dental hygienists, physicians, nurse practitioners,
registered nurses, and physician assistants. Allowing additional members
of care teams to apply the varnish would increase flexibility in offices
and provide more opportunities to incorporate the service into visits.
Similarly, allowing parents to apply the varnish under the direction and
supervision of a licensed practitioner would provide families with much
needed flexibility, as it reduces common barriers such as travel and
time off from school or work.

 
PRIOR LEGISLATIVE HISTORY:

This is a new bill.

 
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:

None.

 
EFFECTIVE DATE:
Immediate, provided that Section 3 shall take effect 18 months after
enactment.

2023-S9308A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  9308--A
 
                             I N  S E N A T E
 
                               May 10, 2024
                                ___________
 
 Introduced by Sen. FERNANDEZ -- read twice and ordered printed, and when
   printed  to  be  committed  to  the  Committee  on Higher Education --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to said committee
 
 AN  ACT  to  amend  the  education law, in relation to permitting dental
   assistants and licensed practical nurses to perform the application of
   topical fluoride varnish
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  6608 of the education law, as amended by chapter
 512 of the laws of 2022, is amended to read as follows:
   § 6608. Definition of practice of  registered  dental  assisting.  The
 practice of registered dental assisting is defined as providing support-
 ive  services to a dentist in [his or her] SUCH DENTIST'S performance of
 dental services  authorized  under  this  article.  Such  support  shall
 include  providing  patient education, taking preliminary medical histo-
 ries and vital signs to be reviewed by the dentist, placing and removing
 rubber dams, selecting and prefitting provisional crowns, selecting  and
 prefitting  orthodontic bands, removing orthodontic arch wires and liga-
 ture ties, placing and removing matrix  bands,  taking  impressions  for
 study casts or diagnostic casts, removing periodontal dressings, placing
 and  removing  temporary  restorations,  APPLICATION OF TOPICAL FLUORIDE
 VARNISH, and such other dental supportive  services  authorized  by  the
 dentist  consistent  with  regulations  promulgated by the commissioner,
 provided that such functions are performed  under  the  direct  personal
 supervision  of  a  licensed dentist in the course of the performance of
 dental services. Such  services  shall  not  include  diagnosing  and/or
 performing  surgical  procedures,  irreversible procedures or procedures
 that would alter the hard or soft tissue of the oral  and  maxillofacial
 area  or any other procedures determined by the department. The practice
 of registered dental assisting may be conducted in  the  office  of  any
 licensed  dentist  or  in  any  appropriately  equipped school or public
 institution but must be done under the direct personal supervision of  a
 licensed  dentist.  Direct  personal  supervision,  for purposes of this
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD11382-07-4
 S. 9308--A                          2
 
 section, means supervision of dental procedures  based  on  instructions
 given  by a licensed dentist in the course of a procedure who remains in
 the dental office where the supportive  services  are  being  performed,
 personally  diagnoses the condition to be treated, personally authorizes
 the procedures, and before dismissal of the  patient,  who  remains  the
 responsibility of the licensed dentist, evaluates the services performed
 by  the  registered dental assistant. Nothing herein authorizes a regis-
 tered dental assistant to perform  any  of  the  services  or  functions
 defined as part of the practice of dental hygiene in accordance with the
 provisions  of  subdivision one of section sixty-six hundred six of this
 article, except those functions authorized pursuant to this section. All
 dental supportive services provided in this section may be performed  by
 currently  registered  dental hygienists either under a dentist's super-
 vision, as defined in regulations of the commissioner, or, in  the  case
 of  a  registered  dental hygienist working for a hospital as defined in
 article twenty-eight of the public health law, pursuant to a  collabora-
 tive  arrangement with a licensed dentist in accordance with subdivision
 one of section sixty-six hundred six of this article. Such collaborative
 arrangement shall not obviate or supersede any law or  regulation  which
 requires  identified  services to be performed under the personal super-
 vision of a dentist.
   § 2. Subdivision 2 of section 6902 of the education law, as amended by
 chapter 781 of the laws of 1990, is amended to read as follows:
   2. The practice of nursing as a licensed practical nurse is defined as
 performing tasks and responsibilities within the framework of  casefind-
 ing,  health  teaching,  health  counseling,  THE APPLICATION OF TOPICAL
 FLUORIDE VARNISH, and provision of supportive and restorative care under
 the direction of a registered professional nurse or licensed  physician,
 dentist  or other licensed health care provider legally authorized under
 this title and in accordance with the commissioner's regulations.
   § 3. This act shall take effect immediately.

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