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July 29, 2022 SB 22-219
Legislative Council Staff
Nonpartisan Services for Colorado’s Legislature
Final Fiscal Note
Drafting Number:
Prime Sponsors:
LLS 22-0229
Sen. Moreno; Smallwood
Rep. Duran; McLachlan
Date:
Bill Status:
Fiscal Analyst:
July 29, 2022
Signed into Law
Aaron Carpenter | 303-866-4918
Aaron.Carpenter@state.co.us
Bill Topic: REGULATE DENTAL THERAPISTS
Summary of
Fiscal Impact:
☒ State Revenue
☒ State Expenditure
☐ State Transfer
☒ TABOR Refund
☐ Local Government
☐ Statutory Public Entity
The bill requires the Department of Regulatory Agencies to regulate dental therapists.
The bill increases state revenue and expenditures starting in FY 2022-23.
Appropriation
Summary:
For FY 2022-23, the bill requires and includes an appropriation of $14,786 to the
Department of Regulatory Agencies.
Fiscal Note
Status:
This fiscal note reflects the enacted bill.
Table 1
State Fiscal Impacts Under SB 22-219
Budget Year
FY 2022-23
Out Year
FY 2023-24
Revenue Cash Funds $10,350 $91,573
Total Revenue $10,350 $91,573
Expenditures Cash Funds $14,786 $36,018
Centrally Appropriated - $6,846
Total Expenditures $14,786 $42,864
Total FTE 0.1 FTE 0.3 FTE
Transfers - -
Other Budget Impacts TABOR Refund $10,350 $91,573
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July 29, 2022 SB 22-219
Summary of Legislation
The bill requires dental therapists be licensed by the Colorado Dental Board in the Department of
Regulatory Agencies (DORA) beginning May 1, 2023. The bill outlines requirements for dental
therapists including education, examination, supervision, professional liability insurance, and
mandatory reporting of child abuse requirements. The bill also authorizes certain tasks a dental
therapist can perform, including a task or procedure assigned to them by a licensed dentist that does
not require the professional skill of a dentist but that must still occur under the supervision of a dentist
Dental Board. Beginning July 1, 2031, the bill changes the composition of the Colorado Dental Board
to include dental therapists, and sets parameters for their appointment. The bill applies current
disciplinary actions for dentists or dental hygienists to dental therapists, except that the maximum
fine that may be imposed on a dental therapist cannot exceed $4,000.
Dental therapy training programs. The bill authorizes a state institution of higher education offering
an accredited dental therapy training program to grant advance training toward completion of an
accredited dental therapy program if the student demonstrates past completion of curriculum.
Medicaid reimbursement. The bill allows dental therapists to get reimbursed from Medicaid for
services provided to children.
Background and Assumptions
Based on information from the Minnesota State Dental Board, Minnesota currently licenses 113 dental
therapists. This represents 0.6 percent of total dental licenses in Minnesota. According to DORA,
Colorado currently has 11,433 dental licenses. Assuming a 0.6 percent increase, the fiscal note
estimates that there will be 69 new dental therapy licenses.
Comparable Crime Analysis
Legislative Council Staff is required to include certain information in the fiscal note for any bill that
creates a new crime, changes the classification of an existing crime, or creates a new factual basis for
an existing crime. The following sections outline data on crimes that are comparable to the offense in
this bill and discuss assumptions on future rates of criminal convictions resulting from the bill.
Unauthorized practice. This bill adds practicing dental therapy without a license to the list of
unauthorized practices, a class 2 misdemeanor. From FY 2018-19 to FY 2020-21, 4 individuals have
been convicted and sentenced for this offense. Of the persons convicted, 1 was male and 3 were
female. Demographically, 2 were White, 1 was Hispanic, and 1 was Asian.
Failure to report child abuse. This bill adds dental therapists to list of mandatory reporters. Failure
to report child abuse is a class 2 misdemeanor. From FY 2018-19 to FY 2020-21, 4 individuals have
been convicted and sentenced for this offense. Of the persons convicted, 1 was male and 3 were
female. Demographically, 2 were White, 1 was Black/African American, and 1 was Hispanic.
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July 29, 2022 SB 22-219
Assumptions. Based on the low number of sentences for each offense, this analysis assumes a high
level of compliance. Because the bill is not expected to have a tangible impact on criminal
justice-related expenditures or revenue at the state or local levels, these potential impacts are not
discussed further in this fiscal note. Visit leg.colorado.gov/fiscalnotes for more information about
criminal justice costs in fiscal notes.
State Revenue
State revenue to the Professions and Occupations Cash Fund is estimated to increase by $10,350 in
FY 2022-23 and $91,573 in FY 2023-24 from various dental license fees to cover the cost to regulate
dental therapists. Revenue to the Professions and Occupation Cash Fund is subject to the state’s
TABOR limit.
Fee impact on dental therapists and other dental licenses. Colorado law requires legislative service
agency review of measures which create or increase any fee collected by a state agency. These fee
amounts are estimates only, actual fees will be set administratively by DORA based on cash fund
balance, estimated program costs, and the estimated number of licenses subject to the fee. Table 2
below identifies the fee impact of this bill. The fiscal note assumes that dental therapists will pay an
initial licensing fee and then will renew on March 1 every even year starting in 2024. In addition, the
fiscal note assumes dental therapists will pay the same fee as dental hygienists, and that fees will be
raised on all dental licensees to cover costs in FY 2023-24.
Table 2
Fee Impact on Dental Therapists
Fiscal Year
Type of
Fee
Proposed
Increase Fee
Number
Affected
Total Fee
Impact
FY 2022-23
New – Dental Therapist Fee $150.00 69 $10,350
FY 2022-23 Total $10,350
FY 2023-24
Renewal – Dentist $12.66 5,135 $65,014
Renewal – Hygienist $2.88 4,757 $13,715
Renewal – Inactive Dentist $12.66 47 $595
Renewal – Academic Dentist $9.23 13 $120
Renewal – Moderate Anesthesia $6.10 156 $952
Renewal – Inactive Hygienist $2.88 51 $147
Renewal – General Anesthesia $5.68 162 $921
Renewal – Minimal Anesthesia $1.71 253 $433
Renewal – Local Anesthesia $1.21 3,892 $4,716
Renewal – Dental Therapist $71.88 69 $4,960
FY 2023-24 Total $91,573 Page 4
July 29, 2022 SB 22-219
State Expenditures
The bill increases state expenditures in DORA by $14,786 in FY 2022-23 and $42,864 in FY 2023-24 from
the Professions and Occupations Cash Fund. Expenditures are shown in Table 3 and detailed below.
In addition, workload to the Judicial Department and the Department of Health Care Policy and
Financing (HCPF) will increase, as described below.
Table 3
Expenditures Under SB 22-219
FY 2022-23 FY 2023-24
Department of Regulatory Agencies
Personal Services - $15,832
Operating Expenses - -
Capital Outlay Costs - -
Legal Services $14,786 $14,786
Consultant Costs - $5,400
Centrally Appropriated Costs
1
- $6,846
FTE – Personal Services - 0.2 FTE
FTE – Legal Services 0.1 FTE 0.1 FTE
Total Cost $14,786 $42,864
Total FTE 0.1 FTE 0.3 FTE
1
Centrally appropriated costs are not included in the bill's appropriation.
Department of Regulatory Agencies. Starting in FY 2022-23, expenditures in DORA will increase to
regulate dental therapists as described below.
Staffing costs. Starting in FY 2023-24, DORA will require 0.2 FTE to provide outreach to the dental
community, assist the board in promulgating rules, respond to complaints, investigate complaints,
process applications, and answer any questions when it comes to licenses. Workload occurring in
FY 2022-23 is assumed to be absorbable.
Legal services. DORA will require 150 hours of legal services for rulemaking in FY 2022-23 and
for general counsel regarding investigations that are referred to the Attorney General Office
starting in FY 2023-24. This assumes there will be one case referred to the Attorney General Office.
Legal services are provided by the Department of Law at a rate of $98.57 per hour.
Consultant costs. Starting in FY 2023-24, expenditures in DORA will increase to contract with an
expert consultant to assist in cases that enter formal investigation. The consultant will serve as an
expert on the board until a dental therapist is appointed to the board. The fiscal note assumes that
90 hours of contract work is required at $60 per hour.
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July 29, 2022 SB 22-219
Judicial Department. Starting in FY 2022-23, workload to the trial courts may increase to the extent
dental therapists appeal any disciplinary decisions. The fiscal note assumes any workload will be
minimal and does not require a change in appropriations.
Health Care Policy and Financing. In FY 2022-23 only, workload in HCPF will increase to add a new
provider type to the Medicaid Management Information System, adopt new rules to allow dental
therapists to bill for services, and to establish rates according to the standard fee schedule. No change
in appropriations is required. In future fiscal years, because service costs will depend on how dental
therapist services are utilized and at what reimbursement rate, any cost adjustments will be addressed
through the annual budget process, as necessary.
Centrally appropriated costs. Pursuant to a Joint Budget Committee policy, certain costs associated
with this bill are addressed through the annual budget process and centrally appropriated in the Long
Bill or supplemental appropriations bills, rather than in this bill. These costs, which include employee
insurance and supplemental employee retirement payments, are shown in Table 2.
Other Budget Impacts
TABOR refunds. The bill is expected to increase the amount of state revenue required to be refunded
to taxpayers by the amounts shown in the State Revenue section above. This estimate assumes the
March 2022 LCS revenue forecast. A forecast of state revenue subject to TABOR is not available
beyond FY 2023-24. Because TABOR refunds are paid from the General Fund, increased cash fund
revenue will reduce the amount of General Fund available to spend or save.
Effective Date
The bill was signed into law by the Governor on June 7, 2022, and takes effect January 1, 2023,
assuming no referendum petition is filed.
State Appropriations
For FY 2022-23, the bill requires and includes an appropriation of $14,786 from the Division of
Professions and Occupations Cash Fund to the Department of Regulatory Agencies, which is fully
reappropriated to the Department of Law with 0.1 FTE.
State and Local Government Contacts
Information Technology Health Care Policy and Financing
Public Health and Environment Regulatory Agencies
The revenue and expenditure impacts in this fiscal note represent changes from current law under the bill for each
fiscal year. For additional information about fiscal notes, please visit: leg.colorado.gov/fiscalnotes.