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Jan. 29, 2013
TOPEKA A bill that would authorize the licensure of mid-level dental providers in Kansas was introduced today in the House Health and Human Services Committee.
Rep. Brian Weber, a Dodge City Republican, said registering mid-level technicians was among the proposals he'd found when searching for solutions to the dental provider shortage in Kansas.
"Kids and people in nursing homes — but mostly kids — are going untreated. We can't mandate that dentists treat Medicaid patients, because they'll go out of business," Weber said. "But the reimbursement rate is the same whether it's a dentist or a hygienist doing a procedure."
Weber is a member of the committee and also chairs the House Social Services Budget Committee.
The bill would expand the scope of practice for hygienists who receive an additional 18 months of training so that they would be authorized, among other things, to:
• permanently fill teeth,
• extract teeth,
• repair dentures, and
• temporarily crown teeth.
The proposal would allow for two levels of supervision by a dentist, said Suzanne Wikle of Kansas Action for Children, one of several advocacy organizations here and nationwide pushing to license mid-level practitioners in more states. Alaska was the first state to sanction licensing in 2006, and only Minnesota has done so since.
"This is a very Kansas solution — we can increase access to care by creating jobs for Kansans, helping business grow and operate as they would like, while increasing the efficiency of our state safety net system. And all of this can be done at no cost to the state," Wikle said.
In Kansas, at least 57,000 people live in so-called dental deserts, where there are no dental services and where the closest dental office is at least a half-hour drive from the resident's home, according to a 2011 report.
Many more Kansans lack dental insurance and cannot afford routine preventive care, leading to 17,500 hospital emergency room visits for dental care each year, Wikle said.
Supporters of the bill said more Kansans could receive oral health care at safety net clinics with the use of mid-level providers — including those who, as of Jan. 1, can receive preventive dental care under KanCare.
"Medical clinics are able to stretch their funding to serve the most people by utilizing not only physicians, but also physician assistants and nurse practitioners. If they had a similar workforce option for dental services, their resources — including state dollars — would be able to serve more Kansans," Wikle said.
Kevin Robertson, chief executive of the Kansas Dental Association, also spoke before the committee and said there were better options available to legislators for expanding access to oral health care.
One option would be to offer scholarships and loan forgiveness programs to dental students, akin to the dental association's Kansas Initiative for New Dentists (KIND). He said that next week the first four KIND beneficiaries would be announced — up to $50,000 is awarded to each in exchange for agreeing to serve in a dental desert for two years.
"In place of a state-funded loan forgiveness program, we have created our own, perhaps funding it as robustly as the state would," Robertson said. "This is not a problem that requires a ton of new dentists. Fourteen dentists can serve a population of 57,000 people," he said referring to the number of people thought to be living in dental deserts.
Another option would be to purchase additional training slots at a neighboring state's dental school. Currently Kansas purchases up to 22 seats per year from the University of Missouri-Kansas City. About two-thirds of those graduates stay in Kansas to practice, Robertson said, although many do so in urban areas.
He said it would cost $25,000 per student to buy additional seats at the University of Nebraska or Creighton, which have seats available.
"For $1 million four years down the line you could have 40 Kansan dentists," Robertson said.
Kansas does not have its own dental school.
Buying more seats was among the recommendations made to the Kansas Board of Regents earlier this year. The regents' budget recommendation did not include funding for additional seats.
Rep. Jim Ward, a Wichita Democrat, said he thought licensing mid-level practitioners was a more expedient option than trying to lure more dentists to underserved areas.
"The ideas you present here to bring in one or two or three new dentists are all laudable, but we're talking five or six or seven years before that would really start to have an impact. But what the mid-level practitioners (proposal) does, it addresses people who aren't getting care. It's not taking patients away from dentists — these folks aren't getting care," Ward said.
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