As you may know, under current Colorado law, a dental hygienist licensed to practice in the state may be the proprietor of a dental hygiene practice. In addition, a licensed dental hygienist may practice unsupervised in the state. Specifically, Colorado is one of 36 states which permit registered dental hygienists to have direct access. Direct access allows a dental hygienist the right to initiate treatment based on his/her assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist and maintain a provider-patient relationship. Colorado is also one of 14 states which permit registered dental hygienists to bill Medicaid directly for reimbursement (2).
In December 2008, a 5-year Colocation Project began in Denver, Colorado. Specifically, beginning in December 2008, five registered dental hygienists were colocated into five medical practices identified for their service to high-risk, low-income children. Dual-function exam rooms were built in each office. The five medical practices included two private, non-profit health care clinics; one federally qualified health center; and two private medical clinics. The majority of the children served were enrolled in either Medicaid or the Children’s Health Insurance Program (CHIP). During the five years of Phase I of the Colocation Project, the five participating dental hygienists served 2,071 children, primarily young children. The project was funded by a $500,000 grant from the Delta Dental of Colorado Foundation. The funding provided a monthly stipend to the registered dental hygienists and participating practices, care for children who did not have any dental insurance and an evaluation of the colocation project.
The five registered dental hygienists who participated in the Colocation Project provided the following services: caries risk assessment, prophylaxis, fluoride varnish application, oral health instruction, scaling and root planning for older children, assessment for caries, and referral to a dentist and care coordination when restorative needs were identified. All the registered dental hygienists independently billed Medicaid and CHIP for rendered services with the exception of one who was hired by the practice; in this case, the practice, a federally qualified health center, billed for the services.
According to a published report evaluating the project, colocating dental hygienists into medical practices is a feasible and innovative way to provide primary preventive dental services to children at high risk for early childhood caries.
Phase II of the Colocation Project will begin in 2014. The project plans to expand the program to additional sites located in schools, federally qualified health centers, and medical foster care clinics.
(2) Information on direct access and direct Medicaid reimbursement for registered dental hygienists was taken from the American Dental Hygienists Association Direct Access States Chart last updated on October 2013.