Yesterday, the Connecticut House of Representatives unanimously passed a bill that would allow dental hygienists to provide dental care to patients in their homes. The bill intends to increase access to dental care to those, such as the elderly or the disabled, who may have trouble getting to the dentist’s office for appointments.
“What this bill does, is it provides a truly innovative solution to a critical hole in our health care system, and that is as it relates to home-bound patients” said Rep. Jane Garibay (D-Windsor). “By providing this preventive service on site, we make an absolute, wonderful and innovative breakthrough in the provision of not just dental health, but overall health in the state of Connecticut.”
The bill would allow dental hygienists with at least two years of experience to provide home services, such as cleanings, sealings and hygienic assessments, without a dentist’s supervision. As several lawmakers highlighted, current state law already allows dental hygienists to provide care to patients without a dentist’s supervision at public facilities such as hospitals or nursing homes. Dental hygienists would be required to refer patients to a dentist if their needs exceed the hygienist’s capabilities. The services provided by at-home hygienists would still follow the same statutory limitations, meaning they would not be allowed to prescribe dental procedures, cut or remove teeth or soft tissue, prescribe medication, take dental moulds, or perform or adjust tooth replacements.
The bill originally came before the House Aging Committee in February and was then sent to the House’s Public Health Committee on March 31. At its public hearing, the bill was supported by the state’s Long Term Care Ombudsman and Department of Social Services, as well as the Homecare Association of America, CT Dental Hygienists’ Association, and the Connecticut Oral Health Initiative (COHI).
“In Connecticut, we successfully send nurses and physical therapists into the home,” wrote Sandra Ferreira-Molina, COHI’s Policy and Advocacy Director. “We do not require a surgeon to be in the driveway for a nurse to provide care. Oral health should be no different.”
Dentists served as the bill’s primary opponents, as members of the CT State Dental Association (CTSDA) and CT State Dental Commission (CTSDC), as well as a handful of individual dentists, submitted opposing testimony.
“Dental hygiene procedures are not merely cosmetic cleanings,” wrote Dr. David Fried, a Connecticut dentist and Co-Chair of CTSDA’s Council on Government Affairs. “Under indirect supervision, hygienists provide services within a coordinated diagnostic and treatment framework. Separating hygiene services from diagnostic oversight raises patient safety concerns, particularly for medically compromised elderly individuals — the very population this bill seeks to help.”
Fried argued that the bill leaves “significant unanswered questions regarding standards of care, emergency preparedness, infection control in residential environments, documentation protocols, continuity of care, and liability coverage.” He also argued that the bill would bypass the Department of Public Health’s (DPH) process for modifying changes to a healthcare provider’s “scope of practice,” and said that the bill fails to address the biggest hurdle to home dental care currently, that being the Medicaid reimbursement rate.
“Dentists may already provide care in private residences, nursing facilities, and other community settings when clinically appropriate,” Fried wrote. “The limiting factor is not statutory authority — it is economic feasibility. Increasing Medicaid reimbursement would do far more to expand access than altering supervision or scope requirements.”
Written testimony submitted by Ferreira-Molina addressed some of these concerns directly in her own testimony. Ferreira-Molina disagreed with the notion that the bill would change hygienists’ scope of practice, as the bill “does not change what a hygienist does; it simply changes where they do it.” She agreed with Fried’s assertion that insufficient Medicaid reimbursement remains an issue, but argued it shouldn’t be “a reason to maintain a legal barrier that prevents willing providers from reaching the homebound.”
“For a senior living with dementia who cannot be transported to an office, the ‘economic feasibility’ of a dentist’s travel is irrelevant if no dentist is currently coming,” wrote Ferreira-Molina. “By removing this barrier, we allow licensed professionals to create a viable pathway for care that simply does not exist today.”
She acknowledged that effective dentistry requires more than what a hygienist can perform in a home setting, and argued that the bill does not intend for hygienists to usurp the role of dentists, but rather act as a “bridge back to the network.”
“Right now, the population we are discussing has gone years without seeing a dental professional,” wrote Ferreira-Molina. “They are currently receiving zero diagnostic oversight. This bill removes that arbitrary barrier. It ensures that a hygienist can act as a “sentinel,” identifying infections and oral cancers before they become terminal, and coordinating referrals back to a dentist’s office.
Fried said that the current Medicaid reimbursement for preventative dental care appointments is $41, while the average hygienist in Connecticut makes more than $53 an hour. Fried said that this equation does not take into account the costs associated with travel, liability coverage, and equipment transport, but that all make mobile dental services “financially impractical.”
Rep. Nicole Klarides-Ditria (R-Seymour), Ranking Member of the Public Health Committee, said the committee “did not act” on the bill due to “some concerns,” but that the bill has since been altered to alleviate them. A section has been added to the bill that requires the DPH Commissioner to establish “safeguards the commissioner deems necessary to ensure patient safety,” such as emergency protocols for complications, and standards for infection control, equipment and safety.
“I’m happy that they address those changes,” said Klarides-Ditria. “As you know, it increases access to dental care, which is very important for vulnerable populations — people that may not be able to drive, senior citizens that just aren’t as mobile as they used to be, so, Madam Speaker, I want to thank the good chair of Aging and the good Ranking Member for your work on this very important bill, and I urge adoption.”
The House ultimately passed the bill unanimously, voting 144-0 in its favor, with seven abstentions. The bill must now pass the State Senate and be signed by the Governor to be made law.
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