MDHA has been instrumental in moving telehealth (teledentisty) forward in Missouri. MDHA first worked to have language added to SB579, the telehealth bill, in 2016 to allow dental hygienists to become providers utilizing telehealth. The collection of data from the site where the hygienist is located can be transferred to another site where the dentist is practicing so that a long-distance diagnosis may be made for the patient. Then, the dental hygienist could be given authori...zation to provide hygiene services under general supervision.
The telehealth rules created by the Missouri Dental Board were requested by MDHA, as dental hygienists were not able to probe (unless the dentist examined the patient first) to get the needed data for the dentist to make a complete dental diagnosis. The MDB promulgated a rule that now will allow dental hygienists to work under telehealth through a change in the “patient of record” definition. The rule was implemented on Dec. 30, 2107. Medicaid payment rules are still in the process of being approved.
The new language states: “Patient of record-one for whom a dentist has performed a relevant history, performed an examination and evaluated the condition to be treated. A supervising dentist may delegate to a licensed dental hygienist the collection of information and measurements necessary for the dentist to perform an examination prior to the dentist performing the examination and evaluation and does not need to be physically present when information and measurements are collected.” The collection of data before the dentist examines the patient first will also be allowed in private dental facilities not just in those locations (usually public health settings) in which telehealth is performed.
This is another way that MDHA has been working for you to provide more jobs for dental hygienists and for providing better access to care for more Missourians!
Additional Information about the Bill
Includes definitions asynchronous store-and-forward transfer, clinical staff, distant site, health care provider, originating site, telehealth/telemedicine (terms which related to telehealth)
Allows for any licensed provider within scope of practice/same standard of care
Fully licensed in state and subject to professional board.
Bill does not apply to consulting providers from other states.
Does not alter current state laws on scope of practice or collaborative practice.
Reimbursement is allowed for dental services which require a diagnosis.
Rules on telehealth will be established by Dept. of Social Services, Mental Health, DHSS for MO HealthNet program and appropriate standards. Rules must contain: Standards for store and forward; certification of agencies offering the technology; timelines for completion of consulting provider’s opinion; timelines to hold records; securing and privacy of records; participant request; payment for services by providers; participant consent; and payment for services provided.
Patient participant consent is needed before initiation of telehealth services.
Telehealth Services Advisory Committee includes a dentist.
Eligible telehealth providers include dentists, oral surgeons and specifically mentions dental hygienists under the supervision of currently registered and licensed dentists. Note that MDHA pushed for language to include dental hygienists as providers in this bill).
Addresses many locations where teledentisty can take place including an office of a physician or health care provider.
Indicates where originating sites can be located 13. State will establish a statewide program for telemonitoring services to include chronic health conditions and two or more health risks such as hospitalizations.
Before prescribing any drug or treatment through telehealth, an MD shall establish a valid physician-patient relationship through a medical history, physical exam, patient dialogue, assessment of treatment outcomes, maintaining electronic prescription records as part of patient records.
A patient-provider relationship will be established through a hospital, hospice program, home health service, collaborative practice agreements; with Pas and an assistant physician or consulting physician.
There are provisions when drugs may be prescribed or prohibited; cannot just prescribe through an internet request.
Establishes the “Utilization of Telehealth by Nurses” committee.
The Missouri Dental Board voted to change language to the patient-of-record definition to create flexibility for telehealth/teledentistry.
At the April 2017 meeting, the Missouri Dental Board has voted to promulgate a rule to allow dental hygienists to probe and collect other data before the dental gives his/her diagnosis via a teledentistry examination. It will also be helpful when not utilizing telehealth. It is rare when dentists want to see patients first, especially when adverse oral conditions cannot be recognized because teeth cannot be seen to perform the exam. Note that the last sentence below was not worth arguing about.
This is the proposed wording:“Patient of record-one for whom the dentist has obtained a relevant history, performed an examination and evaluated the condition to be treated. A supervising dentist may delegate to a licensed dental hygienist the collection of a patient's relevant systemic and oral health data necessary for the dentist to perform an examination and evaluation. The patient shall be made aware prior to the collection of any data that the supervising dentist may not be physically present when that data is collected.”
The current wording is: “Patient of record”—one for whom the dentist has obtained a relevant history, performed an examination and evaluated the condition to be treated.
The Missouri Dental Board Will Be Holding Hearings
The Missouri Dental Board will be holding hearings on the proposed telehealth bill and on other dental rules at the Aug. and Oct. 2017 meetings. Governor Greitens wants the public to identify any rules and regulations that are ineffective, unnecessary or unduly burdensome. MDHA will be commenting on rules that it feels meet those criteria and which prevent access to oral health care. Anyone may attend and anyone may give comments in writing or in person.