State Update

H.B. 1061 was signed into law on March 24 by Gov. Mike Pence (R-IN). Under the new law, dental hygienists may practice under the prescriptive supervision of a licensed dentist in the following locations: dental offices, clinical settings, health facilities or other locations approved by the State Board of Dentistry.

The U.S. Preventive Services Task Force (USPSTF) released a final recommendation statement on the prevention of dental caries in children from birth through five years of age. The USPSTF recommended the following: (1) that primary care clinicians prescribe oral fluoride supplementation starting at six months of age for children whose water supply is deficient in fluoride, and (2) that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.

Introduced in 2013, the ADEA United States Interactive Legislative Tracking Map provides access to the most up-to-date information on state legislation of interest to academic dentistry.

In a meeting held January 23, the California Health Benefit Exchange Board voted unanimously to offer embedded pediatric dental benefits beginning in 2015. Covered California staff told the board members that during the first three months of open enrollment, slightly more than 500,000 people enrolled in Covered California. 

On March 11, Gov. Susana Martinez (R-NM) approved S.B. 313, the state budget (FY15 appropriations). The approved budget allocates sufficient funding to add six additional New Mexico dental slots to the Western Interstate Commission for Higher Education (WICHE).   In 2013, New Mexico had 21 WICHE certified applicants with offers, but only 12 received support. The approved FY15 state budget will increase the number of New Mexico dental slots to 18.  Sen. Mark Moores (R-NM), WICHE Commissioner and New Mexico Dental Association Executive Director played an integral role in ensuring that funding for additional dental slots remained on the forefront during budget negotiations.  According to information provided by the Department of Health (DOH), New Mexico is experiencing a dental healthcare professional shortage. All New Mexico counties, except one, are federally designated as Health Professional Shortage Areas and Medically Underserved Areas/Populations. Additionally, New Mexico ranks 49th among the 50 states in per-capita income for dentists. Access to dental healthcare and preventive services is challenging in many communities throughout New Mexico, thus increasing the number of dental students will have a significant impact on the state. 92% of dentistry graduates supported by WICHE return to New Mexico and serve.

Rep. Jeffrey C. Smith (R-MS), Chair of the House Ways and Means Committee, sponsored H.B. 787. The bill as introduced would have authorized the issuance of bonds, up to $31 million, to be used for the construction of a new School of Medicine building at the University of Mississippi Medical Center. However, after successfully passing through the House as is, the Senate Finance Committee adopted new bill text similar to S.B. 2975. S.B. 2975, as introduced, authorized the issuance of bonds for the purpose of making capital improvements for state institutions of higher education. The bill initially included $62.9 million in bonds to state universities, and an additional $1 million in bonds to be used for the construction of a new School of Medicine building at the University of Mississippi Medical Center. However, as S.B. 2975 was making its way through the legislative process in the House, the bill was laden with amendments unrelated to capital improvements for state institutions of higher education. Both H.B. 787 and S.B. 2975 went to conference committee. The conference report for H.B. 787 was adopted by both chambers on March 31 and currently authorizes $92.8 million in bonds to its state universities, including $30.5 million to be used for the construction of a new School of Medicine building at the University of Mississippi Medical Center. To view the conference report for H.B. 787 click here.   The conference report for S.B. 2975 was adopted by both chambers and is unrelated to capital improvements for state institutions of higher education.

On February 27, Gov. John Hickenlooper (D-CO) signed S.B. 4. The new law permits the State Board for Community Colleges and Occupational Education (SBCCOE) to establish technical, career and workforce development bachelor of applied science degree programs at state-supported community colleges. The new law provides that the SBCCOE may not establish bachelor of arts or bachelor of science degree programs. Additionally, all new bachelor of applied science degree programs must be approved by the Colorado Commission on Higher Education (CCHE). Prior to approving new degree programs, the CCHE must consider whether:   The SBCCOE can provide data demonstrating workforce and student demand for the degree; The accreditation requirements for the new program can be met by the college; The new degree program is cost-effective for the student and the community college system; andThe new degree program can be provided through an existing statewide transfer agreement with an accredited four-year institution in the community college’s geographical service area, or with a four-year institution that has a statewide service area.   In addition, the CCHE must determine if the degree program requested by the SBCCOE is sufficiently distinguishable from: An existing degree program at a state four-year institution of higher education, or A degree program that has been successfully offered previously in conjunction with a state four-year university and which will be reinstated sooner than the newly proposed degree program can be offered by the community college. Dental hygiene and culinary arts are the two programs farthest along in the development process, according to a senior official at the Colorado Community College System (CCCS). CCCS hopes that, within the next two or three years, a four-year dental hygiene program will be established. Under current Colorado law, a dental hygienist licensed to practice in the state may be the proprietor of a dental hygiene practice. CCCS staff believes that S.B. 4 will allow more dental hygienists to practice independently in the state. Offering bachelor of applied science degrees in high-demand fields is important to meeting local economic development needs and critical to reducing the educational attainment gap between urban and rural areas, according to the legislative declaration linked to the new law. Additionally, the new degrees will provide an opportunity for underserved and first-generation students to continue their educational pathways in a familiar community college setting, thus making it more likely these students will persist and complete their degrees.

A few states have been considering offering free tuition at community colleges, as the cost of higher education continues to rise across the country. Below are examples of what some states are doing to tackle the high cost of higher education. Mississippi H.B. 424, called the “2014 Mississippi Promise Community College Tuition Gap Pilot Program,” passed the House but failed to pass out of a Senate committee. The bill would have made tuition free at all 15 Mississippi community colleges for students who graduated from high school within 12 months of enrolling in college. According to the bill text, Mississippi would pick up the tuition costs only after all other federal, state, institutional and private aid resources had been exhausted. Tennessee During his State of the State address before the Tennessee General Assembly, Gov. Bill Haslam (R-TN) introduced the “Tennessee Promise.” The proposal commits to providing on a continuing basis two years of community college or a college of applied technology (TCAT) free of tuition and fees to graduating high school seniors.  “Through the Tennessee Promise, we are fighting the rising cost of higher education, and we are raising our expectations as a state,” Gov. Haslam said during his State of the State address. “We are committed to making a clear statement to families that education beyond high school is a priority in the state of Tennessee.” It is estimated that the cost of the program will be $34 million annually. In order to make the Tennessee Promise sustainable, the governor hopes to transfer approximately $300 million in excess lottery reserve funds and join it with a $47 million endowment created by the General Assembly to fund the program in perpetuity. H.B. 2491 and S.B. 2471 were filed on behalf of the governor and would enact the Tennessee Promise Scholarship (TPS) Act of 2014. The TPS is for Tennessee residents who are seeking an associate degree, certificate or diploma from an eligible postsecondary program. To be eligible for the TPS, a student must be admitted and enrolled as a full-time student for the fall term following graduation or obtaining a GED. The TPS amount shall be the cost of tuition and mandatory fees at the eligible postsecondary institution attended, once all other gift aid is subtracted from the total cost. The amount of a TPS for students who seek a two-year degree at an eligible four-year public or private postsecondary institution shall be the average cost of tuition and mandatory fees at a public two-year postsecondary institution. Gov. Haslam is actively advocating for the legislation as a way to fuel his "Drive to 55,” a plan to bring the percentage of Tennesseans with college degrees or certifications to 55% by the year 2025; currently only 32% of Tennesseans have college degrees or certifications. Both H.B. 2491 and S.B. 2471 are pending in committee. Oregon On March 11, Gov. John Kitzhaber (D-OR) signed S.B. 1524. The new law directs the Higher Education Coordinating Commission to examine the viability of allowing students who graduated from high school in the state, or completed grade 12, to attend community college for a specified period without paying tuition and fees.  

On March 3, the U.S. Supreme Court agreed to hear North Carolina Board of Dental Examiners v. FTC during its October 2014 term. In this case, the North Carolina Board of Dental Examiners is challenging a lower court ruling and an order by the Federal Trade Commission (FTC), which said that the board engaged in unfair competition in the market for teeth-whitening services by excluding individuals not licensed to practice dentistry from the market for teeth-whitening services. According to court documents, beginning in the 1990s, dentists began providing teeth-whitening services in North Carolina. In about 2003, non-dentists also began offering the services, often at a reduced price. The board became aware of the performance of teeth whitening services by persons not licensed to practice dentistry, and also began receiving complaints from dentists. Several consumers suffered from adverse side effects, including bleeding or “chemically burned” gums, after receiving teeth whitening from non-dentists. In addition, consumers complained that the non-licensed individuals performing services were doing so without gloves or masks, thereby increasing the risk of side effects. As a result of the board receiving a number of complaints, an investigation was conducted and more than 40 cease-and-desist letters to non-dentist teeth-whitening providers were issued.  The FTC’s original complaint against the board was issued on June 17, 2010, alleging that the board was harming competition by preventing non-dentists from providing teeth-whitening services in North Carolina.  The board appealed, arguing that the FTC overstepped its authority. Specifically, the board argued that it is exempt from the federal antitrust laws under the “state action” doctrine. Under this doctrine, the antitrust laws “do not apply to anticompetitive restraints imposed by the states ‘as an act of government.’”   The board has lost several appeals of the FTC’s decision, including a 2013 ruling by the U.S. Court of Appeals for the Fourth Circuit, which upheld the right of non-dentists to offer teeth-whitening products and services in the state. Click here to view documents associated with the board’s appeals to the FTC. Justice Barbara Keenan, of the U.S. Court of Appeals for the Fourth Circuit, stated in her concurring opinion, that “the fact that the board is comprised of private dentists elected by other private dentists, along with North Carolina’s lack of active supervision of the board’s activities, leaves us [the court] with little confidence that the state itself, rather than a private consortium of dentists, chose to regulate dental health in this manner at the expense of robust competition for teeth whitening services. Accordingly, the board’s actions are those of a private actor and are not immune from the antitrust laws under the state action doctrine.” The question before the U.S. Supreme Court is whether, for purposes of the state-action exemption from federal antitrust law, an official state regulatory board created by state law may properly be treated as a “private” actor simply because, pursuant to state law, a majority of the board’s members are also market participants who are elected to their official positions by other market participants. According to an April 2013 report by the Institute for Justice, since 2005, at least 14 states have changed their laws or regulations to exclude all but licensed dentists, dental hygienists or dental assistants from offering teeth-whitening services. As a result, the U.S. Supreme Court’s decision could have far-reaching implications. 

S.B. 648 has been introduced by Sen. John Moolenaar (R-MI) and is tie-barred with S.B. 649, which was introduced by Sen. Jim Marleau (R-MI). Each bill has twelve co-sponsors. S.B. 648 would expand the Michigan Essential Health Provider program to include loan repayment for dentists who chose to work in health resource shortage areas.