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SENATE DOCKET, NO. 1697 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 1569
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Jason M. Lewis
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act to improve oral health for all Massachusetts residents.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :Jason M. LewisFifth MiddlesexSal N. DiDomenicoMiddlesex and Suffolk2/3/2025James B. EldridgeMiddlesex and Worcester2/11/2025Bruce E. TarrFirst Essex and Middlesex2/27/2025 1 of 17
SENATE DOCKET, NO. 1697 FILED ON: 1/16/2025
SENATE . . . . . . . . . . . . . . No. 1569
By Mr. Lewis, a petition (accompanied by bill, Senate, No. 1569) of Jason M. Lewis, Sal N.
DiDomenico, James B. Eldridge and Bruce E. Tarr for legislation to improve oral health for all
Massachusetts residents. Public Health.
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 2740 OF 2023-2024.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Fourth General Court
(2025-2026)
_______________
An Act to improve oral health for all Massachusetts residents.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 71 of the General Laws is hereby amended by inserting after
2Section 34H the following new section:-
3 Section 34I. A public school shall notify the parent or legal guardian of a pupil described
4in the second paragraph of section 57 of chapter 71 concerning the importance of oral health
5screenings. The department of public health, in consultation with the board of registration in
6dentistry, shall develop a standard form of notice containing, at minimum, information on the
7importance of primary teeth; information on the importance of oral health to overall health as it
8relates to learning; contact information for local public health departments; and information
9about programs and services to access affordable dental care. 2 of 17
10 SECTION 2. Paragraph 4 of subsection (d) of section 7 of chapter 94C of the General
11Laws, is hereby amended by striking out the words "practical nurse or a licensed dental
12hygienist" and inserting in place thereof the following words:- practical nurse; a licensed dental
13therapist under the supervision of a practitioner as defined in section 1 for the purposes of
14administering analgesics, anti-inflammatories and antibiotics only; or a licensed dental hygienist.
15 SECTION 3. Subsection (a) of section 9 of said chapter 94C is hereby amended by
16adding the following paragraph:-
17 A practitioner, as defined in section 1, may cause controlled substances to be
18administered under the practitioner's direction by a licensed dental therapist, for the purposes of
19administering non-narcotic analgesics, anti-inflammatories and antibiotics only.
20 SECTION 4. Subsection (c) of said section 9 of said chapter 94C is hereby amended by
21adding the following paragraph:-
22 A licensed dental therapist who has obtained a controlled substance from a practitioner,
23as defined in section 1, for dispensing to an ultimate user pursuant to subsection (a) shall return
24to such practitioner any unused portion of the substance which is no longer required by the
25patient.
26 SECTION 5. Subsection (a) of section 4O of chapter 111 of the General Laws is hereby
27amended by adding the following paragraph:-
28 The dental director shall be responsible for recruiting, monitoring progress of, and
29supporting dental health providers. The dental director shall aim to increase the delivery of
30preventive dental services to underserved and vulnerable populations, including, but not limited 3 of 17
31to, those residing in dental health provider shortage communities and pediatric and geriatric
32patients.
33 SECTION 6. Paragraph (5) of subsection (b) of said section 4O of said chapter 111 is
34hereby amended by striking out the words “community water fluoridation programs” and
35inserting in place thereof the following words:- annual community water fluoridation programs.
36 SECTION 7. Section 43A of chapter 112 of the General Laws is hereby amended by
37inserting after the definition of "Appropriate supervision" the following definitions:-
38 "Board", the board of registration in dentistry or a committee or subcommittee thereof
39established in the department of public health pursuant to sections 9 and 19 of chapter 13,
40chapter 30A and sections 43 to 53, inclusive.
41 "Collaborative management agreement", a written agreement that complies with section
4251B between a dental therapist and a supervising dentist, as defined in section 43A, who holds a
43valid license issued pursuant to section 45, who agrees to provide the appropriate level of
44communication and consultation with a licensed dental therapist to ensure patient health and
45safety.
46 SECTION 8. Said section 43A of said chapter 112 is hereby further amended by inserting
47after the definition of "Dental hygienist" the following definition:-
48 "Dental therapist", a person who has been licensed by the board to practice dental therapy
49under section 51B, and who has the appropriate training and works pursuant to a collaborative
50management agreement as provided in section 51B. 4 of 17
51 SECTION 9. Said section 43A of said chapter 112 is hereby further amended by adding
52the following definition:-
53 "Supervising dentist", a dentist licensed in Massachusetts who is a provider enrolled in
54the division of medical assistance, or who works for an entity that is a provider enrolled in
55division of medical assistance, who maintains an active patient list and routinely provides care,
56and who enters into a collaborative management agreement with a licensed dental therapist.
57 SECTION 10. The fifth sentence of the third paragraph of section 51 of said chapter 112
58is hereby amended by striking out the words “by Medicaid but except as required by federal
59Medicaid law, shall not seek reimbursement from any other insurance or third party payor”.
60 SECTION 11. Said chapter 112 is hereby amended by inserting after section 51A the
61following section:-
62 Section 51B. (a) Any person of good moral character, who: (i) is a graduate of a master's
63level dental therapist education program that includes both dental therapy and dental hygiene
64education, or an equivalent combination of both dental therapy education and dental hygiene
65education, if all education programs are accredited by the Commission on Dental Accreditation
66and provided by a post-secondary institution accredited by the New England Association of
67Schools and Colleges, Inc.; (ii) passes a comprehensive, competency-based clinical examination
68that is approved by the board and administered by a recognized national or regional dental
69testing service that administers testing for dentists and other dental professionals or equivalent
70examination administered by another entity approved by the board; and (iii) obtains a policy of
71professional liability insurance and shows proof of such insurance as required by rules and
72regulations shall, upon payment of a fee to be determined annually by the commissioner of 5 of 17
73administration under the provision of section 3B of chapter 7, be licensed as a dental therapist
74and be given a certificate to practice in this capacity. A licensed dental therapist shall have
75practiced under the direct supervision of a supervising dentist for a minimum of 2 years or 2,500
76hours, whichever is longer, before practicing under general supervision pursuant to a
77collaborative management agreement.
78 For the purposes of this section, "general supervision" shall mean supervision of
79procedures and services based on a written collaborative management agreement between a
80licensed dentist and a licensed dental therapist but not requiring a prior exam or diagnosis by a
81supervising dentist or the physical presence of a supervising dentist during the performance of
82those procedures and services unless required by the supervising dentist in the collaborative
83management agreement.
84 (b) Any person licensed as a dental therapist under this section may also be registered as
85a dental hygienist and be given a certificate to practice in this capacity.
86 (c) An applicant for licensure as a dental therapist educated in the commonwealth must
87graduate from a master's level dental therapy education program that is accredited by the
88Commission on Dental Accreditation provided by a post-secondary institution accredited by the
89New England Association of Schools and Colleges, Inc. All dental therapy educational programs
90in the commonwealth must include at least one licensed dentist as an instructor. The board shall
91provide guidance for any educational entity or institution that may operate all or some portion of
92a master's level program, or may collaborate with other educational entities, including but not
93limited to universities, colleges, community colleges, and technical colleges, to operate all or
94some portion of a master's level program. The board may also provide guidance to develop 6 of 17
95mechanisms to award advanced standing to students who have completed coursework at other
96educational programs accredited by the Commission on Dental Accreditation. All education
97programs must prepare students to perform all procedures and services within the dental therapy
98scope of practice as set forth in this section.
99 The educational curriculum for a dental therapist educated in the commonwealth shall
100include training on serving patients with special needs including, but not limited to, people with
101developmental disabilities including autism spectrum disorders, mental illness, cognitive
102impairment, complex medical problems, significant physical limitations and the vulnerable
103elderly.
104 Not later than January 1, 2027, the board shall approve a comprehensive, competency-
105based clinical dental therapy examination that includes assessment of technical competency in
106performing the procedures and services within the scope of practice as set forth in this section, to
107be administered by a recognized national or regional dental testing service that administers
108testing for dentists and other dental professionals. The examination shall be comparable to the
109examination given to applicants for a dental license but only for the limited scope of dental
110services in the dental therapy scope of practice as set forth in this section.
111 (d) The board shall grant a dental therapy license by examination to an applicant, upon
112payment of a fee as determined annually by the secretary of administration and finance under
113section 3B of chapter 7, provided the applicant is of good moral character and has: (i) met the
114eligibility requirements as defined by the board; (ii) submitted documentation to the board of a
115passing score on a comprehensive, competency-based clinical examination, or combination of
116examinations, that includes both dental therapy and dental hygiene components and is approved 7 of 17
117by the board and administered by a recognized national or regional dental testing service that
118administers testing for dentists and other dental professionals; and (iii) submitted to the board
119documentation of a passing score on the Massachusetts Dental Ethics and Jurisprudence
120Examination or any other successor examination. An applicant failing to pass the examination
121shall be entitled to re-examination pursuant to the rules and guidelines established by the
122Commission on Dental Competency Assessments, for which the applicant shall pay a fee as
123determined annually by the secretary of administration and finance under section 3B of chapter
1247.
125 The board shall require as a condition of granting or renewing a license under this
126section, that the dental therapist apply to participate in the medical assistance program
127administered by the secretary of health and human services in accordance with chapter 118E and
128Title XIX of the Social Security Act and any federal demonstration or waiver relating to such
129medical assistance program for the limited purposes of ordering and referring services covered
130under such program, provided that regulations governing such limited participation are
131promulgated under said chapter 118E. A dental therapist practicing in a dental therapist role who
132chooses to participate in such medical assistance program as a provider of services shall be
133deemed to have fulfilled this requirement.
134 The board shall grant a license by credentials, without further professional examination,
135to a dental therapist licensed in another jurisdiction, upon payment of a fee as determined
136annually by the secretary of administration and finance under section 3B of chapter 7, provided
137the applicant is of good moral character and has: (i) met the eligibility requirements as defined
138by the board; (ii) furnished the board with satisfactory proof of graduation from an education
139program, or combination of education programs, providing both dental therapy and dental 8 of 17
140hygiene education that meets the standards of the Commission on Dental Accreditation,
141provided, however, that an applicant who graduated from a dental therapy education program
142established before the Commission on Dental Accreditation established a dental therapy
143accreditation program is eligible notwithstanding the lack of accreditation of the program at the
144time the education was received; (iii) submitted documentation of a passing score on a dental
145therapy examination administered by another state or testing agency that is substantially
146equivalent to the board-approved dental therapy examination for dental therapists as defined in
147this section; (iv) submitted documentation of a passing score on the Massachusetts Dental Ethics
148and Jurisprudence Examination or any other successor examination; and (v) submitted
149documentation of completion of 2 years or 2,500 hours, whichever is longer, of practice. If such
150practice requirement is not met, a dental therapist shall be required to complete the remaining
151hours or years, whichever is longer, under direct supervision in the Commonwealth prior to
152practicing under general supervision.
153 (e) Pursuant to a collaborative management agreement, a dental therapist licensed by the
154board may perform: (i) all acts of a public health dental hygienist as set forth in regulations of the
155board and (ii) all acts in the Commission on Dental Accreditation's dental therapy standards.
156Dental therapists shall have the authority to perform an oral evaluation and assessment of dental
157disease and formulate an individualized treatment plan as authorized by the supervising dentist in
158the collaborative management agreement. A dental therapist may dispense and administer the
159following medications within the parameters of the collaborative management agreement and
160with the authorization of the supervising dentist: non-narcotic analgesics, anti- inflammatories
161and antibiotics. The authority to dispense and administer shall extend only to the categories of
162drugs identified in this paragraph and may be further limited by the collaborative management 9 of 17
163agreement. A dental therapist is prohibited from dispensing or administering narcotic analgesics.
164A dental therapist may oversee not more than 2 dental hygienists and 2 dental assistants, but
165shall not oversee public health dental hygienists.
166 After entering into a collaborative management agreement with a supervising dentist,
167dental therapists shall practice under direct supervision for not less than 2,500 clinical hours or 2
168years, whichever is longer. After completing 2,500 clinical hours or 2 years, whichever is longer,
169of practice under direct supervision, dental therapists are authorized to perform all procedures
170and services listed in the Commission on Dental Accreditation's dental therapy standards and all
171procedures and services within the scope of a public health dental hygienist, as set forth in
172regulations by the board, under general supervision if authorized by a supervising dentist
173pursuant to a written collaborative agreement. In addition, the following procedures, referred to
174in this section as advanced procedures, may be performed under direct supervision: (i)
175preparation and placement of direct restoration in primary and permanent teeth; (ii) fabrication
176and placement of single-tooth temporary crowns; (iii) preparation and placement of preformed
177crowns on primary teeth; (iv) indirect and direct pulp capping on permanent teeth; (v) indirect
178pulp capping on primary teeth; and (vi) simple extractions of erupted primary teeth, provided
179however that the advanced procedures may be performed under general supervision if authorized
180by the board pursuant to subsection (f) of this section.
181 Pursuant to a collaborative management agreement, a dental therapist may provide
182procedures and services permitted under general supervision when the supervising dentist is not
183on-site and has not previously examined or diagnosed the patient provided the supervising
184dentist is available for consultation and supervision if needed through telemedicine or by other 10 of 17
185means of communication. If the supervising dentist will not be available, arrangements shall be
186made for another licensed dentist to be available to provide timely consultation and supervision.
187 A dental therapist may not operate independently of, and may not practice or treat any
188patients without, a supervising dentist. A dental therapist is prohibited from practicing without
189entering into a collaborative management agreement with a supervising dentist.
190 (f) No later than January 1, 2027, the department of public health, in consultation with the
191board and any other entity they deem appropriate, shall begin an evaluation assessing the impact
192of dental therapists practicing under general supervision in Massachusetts and the rest of the
193United States, specifically on: (i) dental therapists' progress in expanding access to safe and
194effective dental services for vulnerable populations including, at a minimum, MassHealth
195members and individuals who are underserved as defined in this section; (ii) an appropriate
196geographic distance limitation between the dental therapist and supervising dentist that permits
197the dental therapist to expand access to vulnerable populations including, at a minimum,
198MassHealth members and individuals who are underserved as defined in this section; and (iii) the
199number of dental hygienists and dental assistants a dental therapist may oversee.
200 Not before January 1, 2028 and no later than December 1, 2029, the department of public
201health, in consultation with the board and any other entity they deem appropriate, shall make a
202recommendation, based on its assessment of whether dental therapists should be authorized to
203perform one or more of the advanced procedures, as defined in subsection (e) under general
204supervision pursuant to a collaborative management agreement. The department shall also make
205a recommendation on an appropriate geographic distance limitation between the dental therapist
206and supervising dentist that permits the dental therapist to expand access to vulnerable 11 of 17
207populations including, at a minimum, individuals receiving benefits through the division of
208medical assistance and individuals who are underserved as defined in this section. After the
209department completes its assessment and submits its recommendations to the board, the board
210shall make a determination, with consideration to how authorizing general supervision will
211expand access to safe and effective dental services for vulnerable populations including, at a
212minimum, MassHealth members and individuals who are underserved as defined in this section,
213whether to authorize performance of one or more of the procedures as identified in subsection
214(e), under general supervision pursuant to a collaborative management agreement.
215 Should the board, in consultation with the department and any other appropriate entity,
216determine that dental therapists shall have the authority to perform 1 or more of the procedures
217and services as identified in subsection (e) in their scope of practice under general supervision,
218then the board shall establish regulations no later than 6 months following the recommendation,
219authorizing dental therapists to perform one or more procedures as identified in subsection (e)
220under general supervision pursuant to a collaborative management agreement after receiving
221advanced practice certification.
222 The board shall grant advanced practice certification for a dental therapist licensed by the
223board to perform all services under general supervision pursuant to a collaborative management
224agreement if the dental therapist provides documentation of completion of at least 2 years or
2252,500 hours, whichever is longer, of direct supervision pursuant to subsection (a) of this section,
226and satisfying any other criteria established by regulation adopted by the board as authorized in
227this section. 12 of 17
228 Should the board determine that dental therapists shall continue to perform one or more
229of the advanced procedures under direct supervision, the department, in consultation with the
230board, shall re-evaluate annually the impact of dental therapists practicing under general
231supervision in Massachusetts and the rest of the United States, and the board shall annually
232reassess whether to authorize general supervision for the advanced procedures in order to
233improve dental therapists' progress in expanding access to safe and effective dental services for
234vulnerable populations including, at a minimum, MassHealth members and individuals who are
235underserved as defined in this section.
236 (g) The board shall establish appropriate guidelines for a written collaborative
237management agreement. A collaborative management agreement shall be signed and maintained
238by the supervising dentist and the dental therapist and shall be submitted annually to the board.
239 The agreement may be updated as necessary. The agreement shall serve as standing
240orders from the supervising dentist and shall address: (i) practice settings; (ii) any limitation on
241services established by the supervising dentist; (iii) the level of supervision required for various
242services or treatment settings; (iv) patient populations that may be served; (v) practice protocols;
243(vi) record keeping; (vii) managing medical emergencies; (viii) quality assurance; (ix)
244administering and dispensing medications; (x) geographic distance limitations; (xi) oversight of
245dental hygienists and dental assistants; and (xii) referrals for services outside of the dental
246therapy scope of practice. The collaborative management agreement shall include specific
247protocols to govern situations in which the dental therapist encounters a patient who requires
248treatment that exceeds the authorized scope of practice of the dental therapist. The supervising
249dentist is responsible for directly providing, or arranging for another dentist or specialist within
250an accessible geographic distance to provide, any necessary additional services outside of the 13 of 17
251dental therapy scope of practice needed by the patient. A supervising dentist may have a
252collaborative management agreement with not more than 3 dental therapists at the same time.
253Not more than 2 of the dental therapists may practice under general supervision with certification
254to perform 1 or more of the advanced procedures. A practice or organization with more than 1
255practice location listed under the same business name may not employ more than 6 dental
256therapists, provided, however, that this requirement shall not apply if such an organization or
257practice is a federally qualified health center or look-alike, a community health center, a non-
258profit practice or organization, public health setting as defined by 234 CMR 2.02, or as otherwise
259permitted by the board.
260 (h) No medical malpractice insurer shall refuse primary medical malpractice insurance
261coverage to a licensed dentist on the basis of whether they entered into a collaborative
262management agreement with a dental therapist or public health dental hygienist. A dental
263therapist may not bill separately for services rendered; the services of the dental therapist are the
264services of the supervising dentist and shall be billed as such.
265 (i) Not less than 50 per cent of the patient panel of a dental therapist, as determined in
266each calendar year, shall consist of patients who are MassHealth members or are considered
267underserved; provided, however, that this requirement shall not apply if the dental therapist is
268operating in a federally qualified health center or look-alike, community-health center, non-profit
269practice or organization, or other public health setting as defined by 234 CMR 2.02, or as
270otherwise permitted by the board. As used in this section, "underserved" means individuals who:
271(i) receive, or are eligible to receive, benefits through the division of medical assistance; (ii)
272receive, or are eligible to receive, social security disability benefits, supplemental security
273income, or a Massachusetts state supplement program; (iii) live in a dental health professional 14 of 17
274shortage area as designated by the federal department of health and human services; (iv) reside in
275a long-term care facility licensed under section 71 of chapter 111; (v) receive dental services at a
276public health setting as defined by 234 CMR 2.02; (vi) receive benefits, or are eligible to receive
277subsidized insurance through the commonwealth health insurance connector authority; (viii)
278receive benefits, or are eligible to receive benefits, through the Indian Health Service, tribal or
279urban Indian organizations, or through the contract health service program; (ix) receive benefits,
280or are eligible to receive benefits, through the federal department of veterans affairs or other
281organization serving veterans; (x) are elderly and have trouble accessing dental care due to
282mobility or transportation challenges; (xi) meet the Commission on Dental Accreditation's
283definition of people with special needs; (xii) are uninsured and have an annual income at or
284below 305% of the federal poverty level; or (xiii) as otherwise defined by the board.
285 An employer of a dental therapist shall submit quarterly reports to the board that provide
286information concerning the makeup of the dental therapist's patient panel, including the
287percentage of underserved in the patient panel. No later than January 1, 2027, the secretary of
288health and human services may establish by regulation penalties for employers who fail to meet
289the requirements pertaining to the percentage of underserved in the dental therapist's patient
290panel.
291 (j) Not later than January 1, 2028, the board, in consultation with the department shall
292establish regulations to implement the provisions of this section for the practice of dental therapy
293to protect the public health, safety and welfare, including, but not limited to: requirements for
294approval of educational programs; guidelines for collaborative management agreements,
295continuing education requirements, license renewal, standards of conduct, and the investigation
296of complaints, conduct of disciplinary proceedings and grounds for discipline. 15 of 17
297 SECTION 12. The definition of ''Core competencies'' in section 259 of chapter 112 of the
298General Laws is hereby amended by inserting after clause (i) the following clause:-
299 (j) Oral health education;
300 SECTION 13. The second paragraph of section 260 of chapter 112 of the General Laws
301is hereby amended by adding the following sentence:- As a condition for licensure or renewal of
302licensure, the board shall require community health workers to receive education or training in
303oral health.
304 SECTION 14. The definition of “health care provider” in subsection (a) of section 79L of
305chapter 233 of the General Laws is hereby amended by inserting after the word "dentist," the
306following words:- dental therapist,.
307 SECTION 15. The department of public health, in consultation with the executive office
308of health and human services, shall perform a 5-year evaluation of the impact of dental
309therapists, as established under section 51B of chapter 112 of the General Laws, on patient
310safety, cost-effectiveness and access to dental services. The department may enter into an inter-
311agency agreement with the health policy commission, established under chapter 6D of the
312General Laws, to provide assistance to the department in conducting such evaluation, as it deems
313necessary. The department shall ensure effective measurements of the following outcomes and
314file a report of its findings, which shall include the:
315 (i) number of dental therapists in the commonwealth each year;
316 (ii) number of licensed dental therapists in the commonwealth each year;
317 (iii) number of new and total patients served each year; 16 of 17
318 (iv) impact on wait times for needed services;
319 (v) impact on travel time for patients;
320 (vi) impact on emergency room usage for dental care; and
321 (vii) costs to the public health care system.
322 The report shall be submitted not later than 5 years after the date of graduation of the first
323graduating class of dental therapists educated in the commonwealth to the joint committee on
324public health, the joint committee on health care financing and the senate and house committees
325on ways and means.
326 The center for health information and analysis shall, by the first day of January of each
327year, submit a report on dental therapists, including information on:
328 (i) number of dental therapists in the commonwealth;
329 (ii) number of licensed dental therapists practicing in the commonwealth;
330 (iii) number of new and total patients served;
331 (iv) number of new and total pediatric patients served, including geographic location and
332insurance type;
333 (v) practice settings; and
334 (vi) commonly performed procedures and services.
335 Not later than 3 years after the date of graduation of the first graduating class of dental
336therapists educated in the commonwealth, the first annual report shall be submitted to the joint 17 of 17
337committee on public health, the joint committee on health care financing and the senate and
338house committees on ways and means.