H.B. 285

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DOCTOR-RELATED COMMUNICATIONS
2 1997 GENERAL SESSION
3 STATE OF UTAH
4 Sponsor: Robert H. M. Killpack
5 AN ACT RELATING TO HEALTH; CLARIFYING THOSE ACTIONS THAT ARE
6 UNLAWFUL INVOLVEMENT IN A DENTIST'S EXERCISE OF INDEPENDENT
7 JUDGMENT IN HIS PRACTICE; AND PROVIDING PARALLEL LANGUAGE IN THE
8 INSURANCE CODE.
9 This act affects sections of Utah Code Annotated 1953 as follows:
10 AMENDS:
11 31A-4-106, as last amended by Chapter 20, Laws of Utah 1995
12 58-69-102, as enacted by Chapter 116, Laws of Utah 1996
13 58-69-501, as enacted by Chapter 116, Laws of Utah 1996
14 Be it enacted by the Legislature of the state of Utah:
15 Section 1. Section 31A-4-106 is amended to read:
16 31A-4-106. Provision of health care.
17 (1) As used in this section, "health care provider" has the same definition as in Section
18 78-14-3.
19 [(1)] (2) Except under Subsection [(2)] (3) or [(3)] (4), no person may directly or indirectly
20 provide health care, or arrange for, manage, or administer the provision or arrangement of, collect
21 advance payments for, or compensate providers of health care unless authorized to do so or
22 employed by someone authorized to do so under Chapter 5, 7, 8, 9, or 14.
23 [(2)] (3) Subsection [(1)] (2) does not apply to:
24 (a) a natural person or professional corporation that alone or with others professionally
25 associated with him or it, and without receiving consideration for services in advance of the need
26 for a particular service, provides the service personally with the aid of nonprofessional assistants;
27 (b) a health care facility as defined in Section 26-21-2 which is licensed or exempt from

1 licensing under Title 26, Chapter 21, and which does not engage in health care insurance as
2 defined under Subsection 31A-1-301(35);
3 (c) a person who files with the commissioner under Section 31A-1-105 a certificate from
4 the United States Department of Labor, or other evidence satisfactory to the commissioner,
5 showing that the laws of Utah are preempted under Section 514 of the Employee Retirement
6 Income Security Act of 1974 or other federal law;
7 (d) a person licensed under Chapter 23 who has arranged for the insurance of all services
8 under Subsection [(1)] (2) by an insurer authorized to do business in Utah, or under Section
9 31A-15-103, or who works for an uninsured employer that complies with Chapter 13; or
10 (e) an employer that self-funds its obligations to provide health care services or indemnity
11 for its employees, provided the employer complies with Chapter 13.
12 [(3) No] (4) A person may not provide administrative or management services for any
13 other person subject to Subsection [(1)] (2) and not exempt under Subsection [(2)] (3) unless the
14 person is an authorized insurer under Chapter 5, 7, 8, 9, or 14, or complies with Chapter 25.
15 (5) It is unlawful for any insurer or person providing, administering, or managing health
16 care insurance under Chapter 5, 7, 8, 9, or 14 to enter into a contract that limits a health care
17 provider's ability to advise the health care provider's patients or clients fully about treatment
18 options or other issues that affect the health care of the health care provider's patients or clients.
19 Section 2. Section 58-69-102 is amended to read:
20 58-69-102. Definitions.
21 In addition to the definitions in Section 58-1-102, as used in this chapter:
22 (1) "Board" means the Dentist and Dental Hygienist Licensing Board created in Section
23 58-69-201.
24 (2) "Dental assistant" means an unlicensed individual who engages in, directly or
25 indirectly, supervised acts and duties as defined by division rule made in collaboration with the
26 board.
27 (3) "Direct supervision" means the supervising dentist is present and available for
28 face-to-face communication with the person being supervised when and where professional
29 services are being provided.
30 (4) "General supervision" means that the supervising dentist is available for consultation
31 regarding work the supervising dentist has authorized, without regard as to whether the supervising

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1 dentist is located on the same premises as the person being supervised.
2 (5) "Indirect supervision" means that the supervising dentist is present within the facility
3 in which the person being supervised is providing services and is available to provide immediate
4 face-to-face communication with the person being supervised.
5 (6) "Practice of dentistry" means the following, regarding humans:
6 (a) to offer, undertake, or represent that a person will undertake by any means or method
7 to:
8 (i) examine, evaluate, diagnose, treat, operate, or prescribe therapy for any disease, pain,
9 injury, deficiency, deformity, or any other condition of the human teeth, alveolar process, gums,
10 jaws, or adjacent hard and soft tissues and structures in the maxillofacial region;
11 (ii) take an appropriate history and physical consistent with the level of professional
12 service to be provided and the available resources in the facility in which the service is to be
13 provided;
14 (iii) take impressions or registrations;
15 (iv) supply artificial teeth as substitutes for natural teeth;
16 (v) remove deposits, accumulations, calculus, and concretions from the surfaces of teeth;
17 and
18 (vi) correct or attempt to correct malposition of teeth;
19 (b) to administer anesthetics necessary or proper in the practice of dentistry only as
20 allowed by an anesthesia permit obtained from the division;
21 (c) to administer and prescribe drugs related to and appropriate in the practice of dentistry;
22 (d) to supervise the practice of a dental hygienist or dental assistant as established by
23 division rule made in collaboration with the board; [or]
24 (e) to represent oneself by any title, degree, or in any other way that one is a dentist; or
25 (f) when a person not licensed as a dentist directs a licensee under this chapter to withhold
26 or alter the health care services that the licensee has ordered, but practice of dentistry does not
27 include any conduct under Subsection 58-69-501(2).
28 (7) "Practice of dental hygiene" means, regarding humans:
29 (a) under the general supervision of a dentist to:
30 (i) perform preliminary clinical examination of human teeth and gums;
31 (ii) make preliminary instrumental examination of patients' teeth;

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1 (iii) expose dental radiographs;
2 (iv) assess dental hygiene status and collaborate with the supervising dentist regarding a
3 dental hygiene treatment plan for a patient;
4 (v) remove deposits, accumulations, calculus, and concretions from the surfaces of human
5 teeth;
6 (vi) remove toxins and debris from subgingival surfaces;
7 (vii) provide dental hygiene care in accordance with a dentist's treatment plan for a patient;
8 (viii) take impressions of teeth or jaws except for impressions or registrations to supply
9 artificial teeth as substitutes for natural teeth; or
10 (ix) engage in other practices of dental hygiene as defined by division rule;
11 (b) under the indirect supervision of a dentist to administer in accordance with standards
12 and ethics of the professions of dentistry and dental hygiene:
13 (i) local anesthesia; or
14 (ii) nitrous oxide analgesia;
15 (c) to represent oneself by any title, degree, or in any other way as being a dental hygienist;
16 or
17 (d) to direct a dental assistant when the supervising dentist is not on the premises.
18 (8) "Supervising dentist" means a licensed dentist who has agreed to provide supervision
19 of a dental hygienist or unlicensed individual in accordance with the provisions of this chapter.
20 (9) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-69-501.
21 (10) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-69-502 and as
22 may be further defined by rule.
23 Section 3. Section 58-69-501 is amended to read:
24 58-69-501. Unlawful conduct.
25 (1) "Unlawful conduct" includes, in addition to the definition in Section 58-1-501:
26 [(1)] (a) administering anesthesia or analgesia in the practice of dentistry or dental hygiene
27 if the individual does not hold a current permit issued by the division authorizing that individual
28 to administer the type of anesthesia or analgesia used;
29 [(2)] (b) practice of dental hygiene by a licensed dental hygienist when not under the
30 supervision of a dentist in accordance with the provisions of this chapter; [or]
31 [(3)] (c) directing or interfering with a licensed dentist's judgment and competent practice

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1 of dentistry[.];
2 (d) substantially interfering with a licensee's lawful and competent practice of dentistry
3 in accordance with this chapter by:
4 (i) any person or entity that manages, owns, operates, or conducts a business having a
5 direct or indirect financial interest in the licensee's professional practice; or
6 (ii) anyone other than another dentist licensed under this title, who is engaged in direct
7 clinical care or consultation with the licensee in accordance with the standards and ethics of the
8 profession of dentistry; or
9 (e) entering into a contract that limits a licensee's ability to advise the licensee's patients
10 fully about treatment options or other issues that affect the health care of the licensee's patients.
11 (2) "Unlawful conduct" does not include:
12 (a) establishing, administering, or enforcing the provisions of a policy of disability
13 insurance by an insurer doing business in this state in accordance with Title 31A, Insurance Code;
14 (b) adopting, implementing, or enforcing utilization management standards related to
15 payment for a licensee's services, provided that;
16 (i) utilization management standards adopted, implemented, and enforced by the payer
17 have been approved by a dentist or by a committee that contains one or more dentists; and
18 (ii) the utilization management standards do not preclude a licensee from exercising
19 independent professional judgment on behalf of the licensee's patients in a manner that is
20 independent of payment considerations;
21 (c) developing and implementing clinical practice standards that are intended to reduce
22 morbidity and mortality or developing and implementing other dental practice standards related
23 to the standardization of effective health care practices, provided that:
24 (i) the practice standards and recommendations have been approved by a dentist or by a
25 committee that contains one or more dentists; and
26 (ii) the practice standards do not preclude a licensee from exercising independent
27 professional judgment on behalf of the licensee's patients in a manner that is independent of
28 payment considerations;
29 (d) requesting or recommending that a patient obtain a second opinion from a licensee;
30 (e) conducting peer review, quality evaluation, quality improvement, risk management,
31 or similar activities designed to identify and address practice deficiencies with health care

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1 providers, health care facilities, or the delivery of health care;
2 (f) providing employment supervision or adopting employment requirements that do not
3 interfere with the licensee's ability to exercise independent professional judgment on behalf of the
4 licensee's patients, provided that employment requirements that may not be considered to interfere
5 with an employed licensee's exercise of independent professional judgment include:
6 (i) an employment requirement that restricts the licensee's access to patients with whom
7 the licensee's employer does not have a contractual relationship, either directly or through contracts
8 with one or more third-party payers; or
9 (ii) providing compensation incentives that are not related to the treatment of any
10 particular patient;
11 (g) providing benefit coverage information, giving advice, or expressing opinions to a
12 patient or to a family member of a patient to assist the patient or family member in making a
13 decision about health care that has been recommended by a licensee; or
14 (h) any otherwise lawful conduct that does not substantially interfere with the licensee's
15 ability to exercise independent professional judgment on behalf of the licensee's patients and that
16 does not constitute the practice of dentistry as defined in this chapter.




Legislative Review Note
as of 1-28-97 5:01 PM

A limited legal review of this bill raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel

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