BILL NUMBER: S3966

SPONSOR: STAVISKY
 
TITLE OF BILL:

An act to amend the education law, in relation to requirements for
licensure as a dentist

 
PURPOSE:

The purpose of this bill is to provide a near-term boost to the pool of
dentists practicing in underserved areas while also providing a viable
pathway to licensure for qualified dentists from other jurisdictions who
seek to work in New York in the field of public health dentistry.

 
SUMMARY OF PROVISIONS:

Section 1: Subdivision 4 of section 6605 of the education law, as
amended by chapter 57 of the laws of 1999, is amended and two new subdi-
visions 2-a and 6 are added to read as follows:

2-a. (a) On recommendation of the board , the department may issue a
              

limited permit for instructing in dentistry to a dentist not licensed
under this article to participate as a general practice dental preceptee
in a preceptorship program under the supervision of a licensed dentist
practicing in a federally qualified health care facility or similar
facility that primarily serves an underserved population, and in doing
so to practice dentistry as defined In this article, but only on the
premises of such federally qualified health care facility or such simi-
lar facility as may be, used to conduct the preceptorship program,
provided such preceptee: (I) is licensed to practice dentistry in a
jurisdiction other than New York: (ii) has completed a dental program
accredited by an organization accepted by the department as a reliable
authority for the purpose of accrediting such programs ( such as the
commission on dental accreditation) ; (iii) has completed a preliminary
competency examination in accordance with the commissioner's regu-
lations; (iv) has a minimum of five years full - time dental practice
experience or the equivalent thereof within the seven years immediately
preceding the request for a limited permit ; and (v) practices for the
duration of the preceptorship program exclusively in a federally quali-
fied healthcare facility or similar facility that primarily serves an
underserved population.

(b) A licensed preceptor dentist who supervises a preceptee pursuant to
this subdivision shall have practiced for at least three years imme-
diately preceding the assumption of a preceptorship and shall have under
their supervision not more than one full- time preceptee nor more than
two part-time preceptees.

4. A limited permit under this section shall be valid for one year or
until ten days after notification of denial of an application for
license. A limited permit may be renewed for one year, except if the
applicant is serving in a residency program in a hospital or school of
dentistry or preceptorship program in a federally qualified health care
facility or such similar facility in this state. A limited permit my be
renewed annually for the duration of such residency program or precep-
torship program. The fee for each limited permit and for each renewal
shall be one hundred five dollars.

6. A dentist that complies with the provisions of subdivision two or two
- a of this section for a duration of five years, upon satisfactory
competition of such five years of practice, may apply for licensure as a
dentist in this state.

Section 2: Subdivisions 3 and 6 of section 6604 of the education law,
subdivision 3 as amended by chapter 613 of the laws of 2022 and subdivi-
sion 6 a amended by chapter 669 of the laws of 2022, are amended to read
as follows :

(3) Experience: have experience satisfactory to the board and in accord-
ance with the commissioner's regulations, provided that such experience
shall consist of (i) satisfactory completion of a postdoctoral general
practice or specialty dental residency program, of at least one year's
duration, in a hospital or dental facility accredited for teaching
purposes by a national accrediting body approved by the department, or
(II) satisfactory competition of at least five year's duration practic-
ing as a dentist with a limited permit issued in accordance with subdi-
vision two or two-a of section sixty- six hundred five of this article ,
provided , further that any such residency program , employment by a
registered school of dentistry or preceptorship program shall include a
format outcome assessment evaluation of the resident's or dentist's
competence to practice dentistry acceptable to the department;

(6) Citizenship or immigration status; be a United States citizen or a
noncitizen lawfully admitted for permanent residence in the United
States ; provided , however , that the board of regents may grant a
three year waiver for a noncitizen to practice in an area which has been
designated a federal dental health professions shortage area, except
that the board of regents may grant an additional extension not to
exceed six years to a noncitizen to enable (him or her) such noncitizen
to secure citizenship or permanent resident status , provided such
status is being actively pursued; and provided further that the board of
regents may grant an additional three- year waiver, and at its expira-
tion, an extension for a period not to exceed six additional years, for
the holder of an H -1 b visa, an 0-1 visa, or an equivalent or successor
visa thereto;

Section 3: establishes the effective date.

 
JUSTIFICATION:

Despite graduating 750 dentists annually - among the highest numbers of
any state - New York continues to struggle with unmet need, particularly
with respect to Medicaid recipients and other vulnerable populations.
Several barriers contribute to the challenges of providing access to
dental care to low-income, rural or developmentally disabled Individ-
uals, including a net annual out-migration of New York dentists,{1}a
decline in CODA*-accredited dental residency programs,{2} too few
dentists practicing in rural and high need areas,{3} the exorbitant
costs of attending dental school{4}and establishing a dental practice,
perennially insufficient Medicaid reimbursement rates, and a wave of
dentist retirements in the wake of the pandemic.

New York State currently has 156 dental Health Practitioner Shortage
Areas (HPSAs), including 92 designated HPSA facilities and 64 designated
HPSA population groups (mostly Medicaid eligible populations).{5}This
means that each of these designations has a population-to-provider ratio
of at least 4000 people per 1 dentist.  Because NYS currently meets only
16.68% of the documented need, the federal Health Resources and Services

Administration (HRSA) estimates that New York needs an additional 1,100
dentists to remove all of its dental HPSA designations.{6} The NYS
Department of Health also recognizes the need for additional dentists in
strategic locations and, beginning in 2010, identified strategies, for
increasing access to dental services.(7)

Current Department of Education regulations require all dentists who
have graduated dental school to complete a one-year graduate residency
program as a prerequisite to becoming licensed in New York.  This
requirement applies to all dentists new and experienced - meaning that
even dentists with years of practice experience in another jurisdiction
must currently complete a graduate residency program before qualifying
to practice in New York. (New York's residency requirement is an outlier
among other states.) Because dental residencies are quite expensive and
the number of programs has declined significantly,181this requirement
creates a substantial barrier to attracting experienced dentists to
practice in New York. This bill offers qualified dentists the option in
lieu of a residency program - to join the full-time faculty of a dental
school or complete a preceptorship In a private practice, hospital or
clinic setting in a dental HPSA. By doing so, New York will become
better able to attract qualified dentists while still maintaining
current quality of care standards.

 
LEGISLATIVE HISTORY:

2023/2024 - A8363-A / S.9216 Referred to Higher Education

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.
* CODA is the Commission on Dental Accreditation of the American Dental
Association.
(1) Health Policy Institute, American Dental Association. U.S. Dentist
Migration Dashboard.  https://www.ada.org/resources/research/health-
poticy-institute/dentist-m igrationdashboard. Accessed online on
11/8/2023.
(2) Health Policy Institute, American Dental Association. Trends in
Advanced Education in General Practice Residency Programs in the U.S.,
December 2021. See www.ADA.org/HPI.
(3) Health Resources and Services Administration, U.S. Department of
Health & Human Services. HPSA Designations. HPSA Find. See
https://data.hrsa.gov/tools/shortagearea/hpsa-find.
(4) Whereas the average medical school graduate in 2023 owes $251,000,
the average dental student in 2023 owes $293,900. See
https://educationdata.org/average-medicalschool-debt and
www.tendingtree.com/student/dentalschool-worth-it.
(5) Health Resources and Services Administration, U.S Department of
Health & Human Services. Health Workforce Shortage Areas.
https;lidate.hrsa.gov/topics/healthworkforce/shortage-areas. Accessed
online on 11/27/2023.
(6) Bureau of Health Workforce, Health Resources and Services Adminis-
tration, U.S. Department of Health & Human Services.  Designated Health
Professional Shortage Areas Statistics, Fourth Quarter of Fiscal Year
2023 Designated HPSA Quarterly Summary. As of September 30, 2023.
(7) NYS Department of Health, increasing the Supply of Dentists,
Midwives, Physician Assistants, and Nurse Practitioners in Underserved
Areas Through Doctors Across New York Physician Loan Repayment Program
Incentives, February 2010.
(8) Health Policy Institute, American Dental Association. Trends in
Advanced Education in General Practice Residency Programs in the U.S.,
December 2021. See www.ADA.org/HPI.