Michigan Office of Administrative Hearings and Rules

MOAHR-Rules@michigan.gov

AGENCY REPORT TO THE

JOINT COMMITEE ON ADMNINISTRATIVE RULES (JCAR)

1. Agency Information

Agency name:

Licensing and Regulatory Affairs

Division/Bureau/Office:

Bureau of Professional Licensing

Name of person completing this form:

Andria Ditschman

Phone number of person completing this form:

517-290-3361

E-mail of person completing this form:

DitschmanA@michigan.gov

Name of Department Regulatory Affairs Officer reviewing this form:

Elizabeth Arasim

2. Rule Set Information

MOAHR assigned rule set number:

2021-40 LR

Title of proposed rule set:

Dentistry - General Rules

3. Purpose for the proposed rules and background:

The purpose of the Dentistry – General Rules is to regulate the prelicensure education, licensure,

licensure renewal, relicensure, and continuing education, for dentists, dental therapists, registered

dental assistants, and registered dental hygienists; delegation and assignment of dental procedures;

dental specialties; anesthesia; intravenous conscious sedation, and enteral sedation training

requirements; and, requirements for disposal of dental amalgam. The proposed rules will modify the

requirements for licensure as a dental therapist consistent with Public Act 298 of 2020, and will

modify any other provisions necessary for consistency with the Public Health Code.

4. Summary of proposed rules:

MCL 24.242 and 24.245

Agency Report to JCAR-Page 2

The proposed rules require licensees to meet the requirements in the Public Health Code-General

Rules, R 338.7001 through R 338.7005, including complying with a minimum English language

requirement and an implicit bias training requirement; applicants for endorsement and relicensure

will disclose all licenses with other entities, report current discipline or sanctions on a license, and

meet the human trafficking training requirement, English language requirement, and implicit bias

training; dental professionals will be trained in basic cardiac life support or advanced cardiac life

support for healthcare providers with a hands-on component prior to being licensed; limited licensees

will be trained in infection control before being licensed; unlicensed assistants will be referred to as

an unregistered dental auxiliary (UDA); applicants licensed in Canada, other countries, and other

states, who meet certain educational and examination requirements will have a pathway for licensure;

dentists from other states may supervise dental therapy program clinical hours; dentists will meet

with a patient in-person at least once in 24 months if duties will be delegated or assigned; a UDA will

obtain additional training; the licensure requirements for dental specialists in dental anesthesiology,

dental public health, oral and maxillofacial radiology, oral medicine, and orofacial pain will be added

to the rules; dentists who administer or collaboratively provide general anesthesia, deep, moderate, or

minimal sedation with a physician, anesthesiologist, dentist, or nurse anesthetist will obtain additional

training; and dental professionals who use telehealth will meet consent and prescribing requirements.

5. List names of newspapers in which the notice of public hearing was published and

publication dates:

Marquette Mining Journal – August 4, 2022; Flint Journal – July 28, 2022; Grand Rapids Press – July

28, 2022.

6. Date of publication of rules and notice of public hearing in Michigan Register:

8/15/2022

7. Date, time, and location of public hearing:

8/22/2022 09:00 AM at Location: G. Mennen Williams Building Auditorium 525 W. Ottawa Street,

Lansing, Michigan , 525 W. Ottawa Street, Lansing, Michigan

8. Provide the link the agency used to post the regulatory impact statement and cost-benefit

analysis on its website:

https://ARS.apps.lara.state.mi.us/Transaction/RFRTransaction?TransactionID=1298

9. List of the name and title of agency representative(s) who attended the public hearing:

Andria Ditschman, Senior Policy Analyst; and Stephanie Wysack, Board Support Technician.

10. Persons submitting comments of support:

Nathan Mick and Nathan Thomas, American Association of Orthodontists (AAO) and Michigan

Association of Orthodontists (MAO) submitted comments in support.

11. Persons submitting comments of opposition:

MCL 24.242 and 24.245

Agency Report to JCAR-Page 3

Marc Bernard Ackerman, American TeleDentistry Association (ATDA); Vincent Benivegna,

Michigan Dental Association (MDA); Richael Cobler, Central Regional Dental Testing Service, Inc.

(CRDTS); Tyler Diers; TechNet; Heather Gietzen; Peter Horkan, Governmental Affairs,

SmileDirectClub; Representative Bronna Kahle, 57th District; Shirley Kim, Byte; Kathryn Swan;

Senator Curtis VanderWall, 35th District; and Representative; Angela Witwer, 71st District submitted

comments in opposition.

12. Persons submitting other comments:

Brent Accurso, Heather Beavers, Michigan Oral Health Program, Department of Health and Human

Services (DHHS); Misty Davis, Michigan Primary Care Association (MPCA); Kim Hoppes,

Michigan Dental Assistants Association, (MDAA); Ellen Sugrue Hyman, Michigan Oral Health

Coalition (MOHC); J. David Johnson, American Association of Oral and Maxillofacial Surgeons

(AAOMS); Mark Johnston, DDS; Nathan Mick and Nathan Thomas, American Association of

Orthodontists (AAO) and Michigan Association of Orthodontists (MAO); Richard Small and Frank

Farbod, Michigan Society of Oral and Maxillofacial Surgeons (MSOMS); Craig Spangler; Kathryn

Swan; Irene Tseng, DDS; Katie Whitman-Herzer, Council of Michigan Dental Specialties, Inc.; and

Amy Zaagman, Michigan Council for Maternal and Child Health (MCMCH) submitted other

comments.

The following 50 individuals sent the same letter regarding R 338.11411 (delegation of duties):

Katherine Beard, Marsha Beattie, Jashleen Bedi, Michael Behnan, Sara Bergsma, Mark Bieszki,

Steven Bowman, George Bork, Rick Bruno, Jason Charnley, Te Chen, David Copus, Spencer Crouch,

Andrew DeHaan, Richard Friedman, Kevin Hallgren, Renee Geran, Cameron George, Heather

Gietzen, Sindy Goodman, Christian Groth, Eric Hannapel, Travis Harshman, Gregory Hummon, Amy

Isenberg, Ludia Kim, Maureen Kuhta, Michel Lanzetta, Kathryn Marks, Laurie McClatchey, Lathe

Miller, John Monticello, Mark Powell, Nicholas Rafaill, Tracie Resler, Jamie Sage, Dina Salman,

Scott Schulz, Thomas Shannon, Lainie Shapiro, Brandon Shoukri, Nicole Siara-Olds, Ritu Singh,

Kathryn Swan, Lauren Sytek, Nathan Thomas, Nicole Teifer, James Williams, and Gabrielle Zuzo.

13. Identify any changes made to the proposed rules based on comments received during the

public comment period:

MCL 24.242 and 24.245

Agency Report to JCAR-Page 4

Name &

Organization public hearing

Comments made at Written

Agency Rationale Rule number

for Rule Change & citation

and Description changed

of Change(s)

Comments

Made

1

Beavers/

DHHS

Change all

pronouns to they pronouns in the

Modify the

R 338.11101

(1)(ll)

or their to be

gender neutral.

document as

allowed by the

rule making

R 338.11103

(a)

R 338.11201

(a)

requirements.

R 338.11202

(b),(c)(i),

(c)(ii),(c)(iii)

R 338.11218

(2)

R 338.11233

(1),(2)

R 338.11240

(1),(2)

R 338.11247

(1)(d),(g),(h),

(i),(2)(g),(3),

(3)(g),(h),(i)

R 338.11255

(2),(2)(a)(i),

(2)(a)(ii)(A),

(2)(a)(ii)(B)

R 338.11256

R 338.11257

(2)

R 338.11259

(2)

R 338.11261

(2),(3)

R 338.11263

(1),(1)(b),

(i),(k),(1)(k)

(ii),(l),

(1)(l)(ii)

MCL 24.242 and 24.245

Agency Report to JCAR-Page 5

Change all

2

Beavers/

DHHS

Modify the

R 338.11265

(1),(1)(b),(j),

(1)(j)(ii),(1)

(k)

R 338.11267

(1),(1)(b),(i),

(j)

pronouns to they pronouns in the

or their to be

gender neutral.

document as

allowed by the

rule making

requirements.

R 338.11269

(1), (1)(b),(i),

(1)(i)(ii),(1)(j)

R 338.11501

(4)

R 338.11611

(c)

R 338.11613

(1)(a)(b),

(4)(a),(4)(c)

R 338.11615,

(b),(d)

R 338.11701

(3)

R 338.11811

(1)

MCL 24.242 and 24.245

Agency Report to JCAR-Page 6

3

Beavers/

DHHS

Regarding the

new infection

control

The most up to

date version of the (q)

Centers for

R 338.11101

requirement, we Disease Control

suggest adding

“the current

and Prevention’s

infection control

version” before guidelines should

the Centers for be referenced in

Disease Control the rules. The

and Prevention’s definitions in R

infection control 338.11101 will be

guidelines.

modified as

follows:

“CDC infection

control guidelines”

means the Centers

for Disease

Control and

Prevention

infection control

guidelines

established by the

CDC in effect on

the effective date

of the rules and

any amendments

adopted by the

CDC.”

MCL 24.242 and 24.245

Agency Report to JCAR-Page 7

Accept an

4

Davis/MPCA

Zaagman/

Modify for the

R 338.11209

examination that following reasons: (b)

MCMCH

is substantially

similar to the

ADEX

as the profession is

new; the need to

address access to

oral care in

examination.

Michigan; limited

or no dental

therapist

educational

training in

Michigan; desire

to encourage

dental therapists

from outside of

Michigan who

have taken another

examination that is

substantially

equivalent to the

ADEX to obtain

licensure and

practice in

Michigan.

5

Cobler/

CRDTS

Modify the rule Accept

R 338.11257

(4)

to accept

substantially

equivalent

examinations for

examinations for licensure by

licensure by

endorsement.

Portability for

candidates

endorsement,

which requires

modifications to

(4). This will

seeking licensure allow more

is an important

matter.

Restricting

acceptance of

licensure

applicants by

endorsement to

seek licensure in

Michigan.

examinations to

one agency

creates an undue

burden for

candidates.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 8

6

Cobler/

CRDTS

Modify the rule Accept

R 338.11259

(2), (c), (3),

and (4)

to accept

substantially

equivalent

substantially

equivalent

examinations for

examinations for licensure by

licensure by

endorsement.

Portability for

candidates

endorsement,

which requires

modifications to

(2)(c), (3), and (4).

seeking licensure This will allow

is an important

matter.

Restricting

acceptance of

licensure

more applicants by

endorsement to

seek licensure in

Michigan.

examinations to

one agency

creates an undue

burden for

candidates.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 9

7

Hoppes/

MDAA

Require

unlicensed

It is in the best

interest of the

R 338.11411

(2)

individuals in the public if all dental

dental office to be personnel know

required to

review the

delegation of

the requirements

of delegation,

assignment, and

duties chart and supervision.

levels of

Before functions

supervision.

Specifically

are delegated to an

unlicensed

require that the individual, the

dentist must

provide and

dentist shall

provide the

explain the duties individual with a

chart. Add (c)

“The employer

dentist must

provide the

copy of the

delegation and

assignment duties

in Table 1 and

shall explain the

unregistered

dental auxiliary levels of

with a current

copy of the

supervision.

delegation of

duties chart and

the dentist must

explain the levels

of supervision.”

MCL 24.242 and 24.245

Agency Report to JCAR-Page 10

8

Mick/Thomas-

AAO/MAO

Michigan dentists Modify the table R 338.11411

are feeling the

effects of a

as follows:

- Allow

(3)(h),(i), (j),

(k),(n) and (y)

shortage of

workforce, and

unregistered dental

auxiliary to handle

specifically, are the functions in

having a difficult (h), (i), (j), (k), (n),

time finding and and (y) with direct

hiring dental

supervision.

assistants, and

- Functions (i), (j),

more specifically, (k), (n) and (y)

orthodontic will require

assistants. RDAs training prior to

would need to

complete

additional

handling any of

these functions.

The in-person or

specialty training virtual training

to understand must include

how to work for performance

an orthodontist, evaluations.

and there are not - This training will

enough RDAs

be added to the

available to serve bottom of the

as orthodontic

assistants in

Michigan.

Table and noted

with **.

The existing

Request that

unregistered

designations of **

and *** will be

dental auxiliaries modified to ***

perform the tasks and ****.

listed in (h), (i), - The *

(j), (k) and (y)

under direct

designation will be

modified to

supervision, and include the UDA.

the task in (n)

under

assignment.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 11

9

Swan

Request that

unregistered

dental auxiliaries * Allow

Modify the table R 338.11411

as follows:

(3)(p),(r) and

(v)

perform the tasks unregistered dental

listed in (p), (r), auxiliary to handle

and (v) under

supervision.

the functions in

(p), (r) and (v)

with direct

supervision.

* Function (r)

shall further state

that UDA’s may

not place sealants.

* Functions (p), (r)

and (v) will

require training

prior to handling

any of these

functions. The in-

person or virtual

training must

include

performance

evaluations.

10

11

Mick/Thomas-

AAO/MAO

Modify item (v) Delete “sizing”, as R 338.11411

as it is redundant it is redundant to (3)(v)

to item (e).

(e).

Benivegna/

MDA

Requiring

dentists to be

qualified to

administer

anesthesia or

sedation to

provide dental

treatment to an

anesthetized or

sedated patient

The rules will

clarify when a

R 338.11601

(1), (2), and

dentist must have (3)

additional training

regarding general

anesthesia and

deep sedation. The

rules will be

modified as

follows:

will significantly • Separate the

limit access to

care. Dentists

rules regarding a

general dentist

frequently work providing general

with qualified

professionals,

such as oral

anesthesia or deep

sedation versus a

general dentist

who

surgeons and

anesthesiologists, collaboratively

MCL 24.242 and 24.245

Agency Report to JCAR-Page 12

to safely

provides general

administer

anesthesia or deep

anesthesia while sedation.

the dentist

delivers the

• If a physician

anesthesiologist,

necessary dental oral surgeon, or

care. The current nurse anesthetist is

proposal by the providing general

Board of

Dentistry will

anesthesia or deep

sedation in the

cause confusion dental office, the

among dentists as general dentist

to when and how providing the

they are able to

dental treatment, a

treat their patients dental therapist,

who require

sedation or

and allied dental

personnel only

anesthesia, which needs BLS

will hurt the training.

delivery of dental • The term

care to patients. “dentist” should

The MDA

be modified to

strongly believes “general dentist

clarifying this

language will

achieve the

who does not hold

a specialty license

in dental

desired result of anesthesiology or

protecting

oral and

patients, while

providing clear

guidelines for

maxillofacial

surgery.”

• Delete the term

dentists to follow. “treatment.”

Add AAOMS to Add training

12

Small/Farbod

MSOMS

R 338.11601

(1)(a)(i), (1)

(a)(ii)(A), (1)

(b)(i)

Rule 1601 and

1602 as a

provided by

AAOMS.

recognized

provider of

courses on

managing

medical

emergencies

associated with

office-based

anesthesia, plus

monitoring

guidelines.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 13

13

Benivegna/

MDA

Requiring

The rules will

clarify when a

dentist must have (3)

additional training

regarding

R 338.11602

(1), (2), and

dentists to be

qualified to

administer

sedation to

provide dental

treatment to a

sedated patient

sedation. The rules

will be modified

as follows:

will significantly • Separate the

limit access to

care. Dentists

rules regarding a

general dentist

frequently work providing sedation

with qualified

professionals,

such as oral

versus a general

dentist who

collaboratively

provides sedation.

surgeons and

anesthesiologists, • If a physician

to safely

anesthesiologist,

oral surgeon, or

nurse anesthetist is

providing sedation

in the dental

administer

sedation while

the dentist

delivers the

necessary dental office, the general

care. The current dentist providing

proposal by the the dental

Board of

Dentistry will

treatment, a dental

therapist, and

cause confusion allied dental

among dentists as personnel only

to when and how needs BLS

they are able to

training.

treat their patients • The term

who require

“dentist” should

sedation, which be modified to

will hurt the

“general dentist

delivery of dental who does not hold

care to patients. a specialty license

The MDA

in dental

strongly believes anesthesiology or

clarifying this

language will

achieve the

oral and

maxillofacial

surgery.”

desired result of • Delete

protecting

"treatment"

patients, while

providing clear

MCL 24.242 and 24.245

Agency Report to JCAR-Page 14

guidelines for

dentists to follow.

14

Small/Farbod

MSOMS

Add AAOMS to Add training

R 338.11602

(1)(a)(iii)(A)

and (1)(b)(i)

Rule 1601 and

1602 as a

provided by

AAOMS.

recognized

provider of

courses on

managing

medical

emergencies

associated with

office-based

anesthesia, plus

monitoring

guidelines.

15

Hyman/

MOHC

We want to

ensure that an

individual does

The following

language will be (b)

added to the

R 338.11611

not need to be a definition of

patient of record telehealth services

of the provider to to clarify when the

have a

“in-person

teledentistry

appointment.

requirement in the

patient of record

Often, individuals definition applies

in an emergency in telehealth: The

dental situation

(injury to or

requirement in R

338.11401 to have

an “in-person”

contact with the

dentist or dental

therapist once

infection of a

tooth) do not

have a dental

home and may

need to be seen

by a dental

every 24 months

does not apply to

professional who telehealth services

has not yet seen unless the dentist

them in person. or dental therapist

delegates or

assigns duties,

other than

radiographic

images, to allied

dental personnel.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 15

16

Hoppes/

MDAA

The word

“approved” is

Automatically

approved CE in (a) (1)(a)

R 338.11704a

misleading when should be relevant

it is widely

to healthcare and

known that there advancement of

are courses

the licensee’s

provided by

dental education.

organizations that

do not meet the

states standard

for acceptable

continuing

education. The

word “approved”

makes it sound as

if anything would

be accepted by

the department if

a dental

professional was

audited for CE

compliance. The

statement used in

R 338.11704 (3)

(c) would also be

appropriate in

section (1)(a) in

the chart:

“(c) A course or

program must

substantially meet

the standards and

criteria for an

acceptable

category of

continuing

education under

this rule and must

be relevant to

health care and

advancement of

the licensee’s

dental

education.”

MCL 24.242 and 24.245

Agency Report to JCAR-Page 16

Anyone who is

17

Beavers/

DHHS

It would benefit

R 338.11704a

(1)(n)

part of the dental the public to

team, has a

license with

LARA, and

works at an

underserved

encourage

licensees to work

with underserved

populations and

that offering

clinic (ex. FQHC) continuing

should receive a education for this

determined

number of CEs

work would be an

incentive for

for working with licensees. The rule

the underserved will be modified to

population.

allow 1 hour

continuing

education for

every 120 hours of

patient care or

supportive dental

services with

underserved

populations, for a

maximum of 1/3

of the total hours

required.

18

Whitman-

Herzer/

Update from

"Oral

For consistency, R 338.11811

oral pathologists (2)(c)

Council of

Michigan

Dental

pathologists" to will be modified to

"Oral &

oral and

maxillofacial

Specialties, Inc.

pathologists" for pathologists.

consistency

throughout the

rules.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 17

19

Department

A pediatric

dentistry

The Department

has withdrawn the (2)(c)

R 338.11521

specialty license Dentistry-General

must provide

Rules from JCAR

verification of a pursuant to

passing score on Section 45a(10)(b)

the American

Board of

of the APA, to

work with the

Pediatric

Dentistry

qualifying

Board of Dentistry

and stakeholders

to clarify that to

examination. The obtain a pediatric

proposed rule dentistry specialty

includes passing license the

the oral clinical applicant must

examination

provide

which should be verification of

deleted. In

only the qualifying

addition the word examination.

“both” should be

deleted.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 18

CDCA-WREB

20

Department

The Department

R 338.11101

has modified its has withdrawn the (1)(g)

name to CDCA- Dentistry-General R 338.11101

WREB-CITA due Rules from JCAR (1)(r)

to a merger.

pursuant to

R 338.11201

Section 45a(10)(b) (c)

of the APA, to

work with the

R 338.11202

(e)

Board of Dentistry R 338.11203

and stakeholders (2)

to clarify that

R 338.11209

CDCA-WREB has (b)

become CDCA-

WREB-CITA.

R 338. 11213

(1)

R 338.11221

(c)

R 338.11223

(2)

R 338.11255

(2)(c)

R 338.11256

(c)(ii)

R 338.11257

(2)(b)

R 338.11257

(4)

R 338.11259

(2)(c)

R 338.11259

(5)(ii)

R 338.11263

(1)(k)

R 338.11263

(1)(l)(iv)

R 338.11267

(1)(i)(i)

R 338.11267

(1)(j)(iv)

MCL 24.242 and 24.245

Agency Report to JCAR-Page 19

Delete

21

Department

The Department

R 338.11101

“advanced” in the has withdrawn the (1)(n)

definition of

“BLS” which

means basic

cardiac life

support.

Dentistry-General

Rules from JCAR

pursuant to

Section 45a(10)(b)

of the APA, to

work with the

Board of Dentistry

and stakeholders

to clarify that BLS

means basic

cardiac life

support not basic

advanced cardiac

life support.

22

Department

CDCA-WREB

The Department

R 338.11101

has modified its has withdrawn the (1)(r)

name to CDCA- Dentistry-General

WREB-CITA

after a merger

Rules from JCAR

pursuant to

and therefore the Section 45a(10)(b)

definition of

CDCA-WREB

should be

of the APA, to

work with the

Board of Dentistry

and stakeholders

changed to

CDCA-WREB- to clarify that the

CITA, or definition of

Commission on CDCA-WREB

Dental

should be

Competency

Assessments

modified to

CDCA-WREB-

Western Regional CITA as the

Examining Board organization has

Council of

changed its name

Interstate Testing after a merger.

Agencies.

23

Department

Change the

The Department

R 338.11101

acronym from

BSL to BLS.

has withdrawn the (1)

Dentistry-General R 338.11202

Rules from JCAR (f)

pursuant to

R 338.11247

Section 45a(10)(b) (1)(e)

of the APA, to

work with the

R 338.11247

(2)(e)

Board of Dentistry R 338.11247

MCL 24.242 and 24.245

Agency Report to JCAR-Page 20

and stakeholders (3)(e)

to clarify that the R 338.11255

acronym for basic (2)(g)

cardiac life

support is BLS not (g)

BSL. R 338.11257

R 338.11256

(2)(g)

R 338.11259

(2)(g)

R 338.11259

(5)(h)

R 338.11261

(2)(c)

R 338.11261

(3)(e)

R 338.11263

(1)(d)

R 338.11265

(1)(d)

R 338.11267

(1)(d)

R 338.11269

(1)(d)

R 338.11411

(1)(a)

R 338.11411

(4)(uu)(v)

R 338.11601

(1)(a)(iii)

R 338.11602

(1)(a)(ii)

R 338.11603

(2)

R 338.11701

(5)

R 338.11703

(4)

R 338.11704

(5)

R 338.11705

(4)

MCL 24.242 and 24.245

Agency Report to JCAR-Page 21

Unregistered

24

Department

The Department

R 338.11411

dental auxiliary has withdrawn the (1)

should be Dentistry-General

replaced with its Rules from JCAR

acronym UDA. pursuant to

Section 45a(10)(b)

of the APA, to

work with the

Board of Dentistry

and stakeholders

to clarify that the

acronym UDA

should replace

unregistered dental

auxiliary.

25

Department

The provision

requires that a

dentist only

delegate a

The Department

R 338.11411

has withdrawn the (1)(a)

Dentistry-General

Rules from JCAR

pursuant to

function to a

UDA after proof Section 45a(10)(b)

the UDA has

current

of the APA, to

work with the

certification in

BSL or ACLS

Board of Dentistry

and stakeholders

within two years to clarify that the

before being reference to a

licensed. Since a UDA being

UDA does not

licensed should be

receive a license modified as a

the section must UDA does not

be modified to

receive a license

two years before from the

the UDA receives Department.

the delegated or

assigned

function.

MCL 24.242 and 24.245

Agency Report to JCAR-Page 22

26

Small/Farbod

MSOMS

Add AAOMS to Since training by R 11101(1)(a)

Rule 1601 and

1602 as a

AAOMS is being

added to the rules

the definition of

AAOMS will also

be added to R

recognized

provider of

courses on

managing

338.11101.

medical

emergencies

associated with

office-based

anesthesia, plus

monitoring

guidelines which

requires that the

definition of

AAOMS be

added.

14.Date report completed:

6/1/2023

MCL 24.242 and 24.245