[L]egislation that would make Vermont the third state to license mid-level dental providers cleared another hurdle this week, passing the Senate Government Operations Committee on a 4-1 vote on Tuesday.
S.20 would allow people already licensed as hygienists to enter a graduate program and become licensed to perform many of the same services as a dentist. The new class of provider, a dental therapist or dental practitioner, would practice under the direction of a dentist. Alaska and Minnesota license dental therapists and a handful of other states are considering similar legislation.
Hygienists must complete a three-year program. The certification for a dental therapist requires an additional year of classes. The bill originally called for 400 hours of clinical training, but the Government Operations Committee increased that to 1,000 hours.
Advocates say there is a shortage of dentists in the state making it difficult for many people, especially Medicaid patients and residents of rural areas, to access oral health services. Licensed dental therapists would make it possible for dental practices to accept more patients.
Thirty percent of dentists refused to accept new Medicaid patients in 2011, according to a Green Mountain Care Board report, and the number of dentists who continue to take Medicaid patients was unevenly distributed throughout the state. That report predates the Affordable Care Act’s expansion of Medicaid, which has greatly increased the number of beneficiaries in the program.
The legislation is opposed by the Vermont Dental Society because dentists are concerned about the adequacy of training for the proposed license. It could also take years for Vermont Technical College, which has agreed to offer the curriculum for the new license, to implement its new program. Instead, the society would prefer to focus on recruiting more dentists to the state. They also want the state to step up investments in existing programs at schools and nursing homes.
Medicaid pays for roughly half the cost of dental services. The society says the rates must be increased in order for dentists to accept more Medicaid patients.
The governor has said he wants to increase Medicaid reimbursement rates, but his plan but does not include dental services.
Dr. Patrick Rowe, a dentist with a nonprofit practice in Bristol, said he would like to be able to hire a dental therapist to expand his practice and treat more Medicaid patients. Fifty percent of his patients have Medicaid currently, and he can’t take more patients in Addison County without increasing that ratio, he said.
Currently, his private practice is open only three days a week. If he were able to hire a dental therapist, he could “triage” patients by the complexity of their needs, and treat more of them by passing some cases off to another team member — something he’s unable to do with only hygienists in his office. A dental therapist would command a lower salary than if a new dentist were to join his practice, and that would allow him to take more patients.
The Dental Society says, while dental therapists would be cheaper for the practice, they would still bill as a dentist, meaning savings won’t accrue to patients.
Rowe said it’s fine if not all dentists feel similarly, but there’s no reason the Dental Society, of which he is a member, should be attempting to block him from being able to run his practice as he sees fit.
S.20 still faces a long road to passage. The bill missed the crossover deadline last week, but Sen. Jeanette White, chair of the Government Operations Committee, was able to secure an exemption from the Senate Rules Committee.
The bill is now before the Senate Finance Committee, where it stalled last session. The bill must pass through Finance in order to approve fees associated with the new license.
This year, Sen. Tim Ashe, D/P-Chittenden, said he needs to gauge support on his committee before deciding what to do with the legislation.
“If the votes are there for it to pass, then we’ll take it up,” Ashe said.
