This section defines many, but not all, of the numerous steps to follow when creating a Collaborative Agreement program....
However, the first thing you want to think about is how your role as a collaborative practice dental hygienist will differ from a role in a private practice dental office. You will be working in a "public health" realm and it is important to review basic public health principles and program planning concepts.
If you have not yet viewed the "So You Want to Be a Public Health Dental Hygienist" video, please refer back to the home page of this website!
Section I. Collaborative Agreement Forms and Format
In the State of Minnesota, there is not one standard Collaborative Agreement form that must be used. The document can be created in any style chosen by the dentist and dental hygienist who are entering into the Agreement. Minnesota does, however, require that all pertinent information identified in Minnesota Statute and Minnesota Rules be addressed in the Agreement.
Click here to access a blank Collaborative Agreement Template that you are welcome to work off of, making changes as you see fit.
Section II: Best-Practices for Creating a Collaborative Agreement
Please note that the following information includes statements that are both "mandated" through legislative language and "suggested" i.e. NOT mandated, by oral health professionals to be "best practices". It is the responsibility of the dental hygienist and dentist who are entering into a collaborative agreement to assure that all statutorily-mandated requirements are met.
The Collaborative Agreement Shall:
- Include all categories, requirements, mandates etc. that are legally required and identified in MN Statute 150A.10, subd. 1a
- Include name, address, phone numbers, credentials and professional license numbers of both the dental hygienist and dentist who are entering into the collaborative agreement.
- Identify all known locations at which the dental hygienist expects to practice. If the dental hygienist finds the need to provide services at an additional location, the dental hygienist will notify the dentist of this proposed change.
- Include age and procedure-specific standard collaborative practice protocols, including recommended intervals for the performance of dental hygiene services and a period of time in which an examination by or referral to a dentist should occur.
- Be reviewed/updated annually by both parties.
- Identify a process for dental hygienists to legally obtain prescription products (e.g. chemotherapeutics, fluoride varnish) pertinent to the provision of dental hygiene services and which are to be utilized in community-based programs.
- Outline a billing/reimbursement process for services rendered by a dental hygienist in the public health setting, if indicated.
- Identify a record keeping process indicating compliance with HIPAA regulations to include the location in which patient dental records will be kept on file.
The Collaborating Dentist Shall:
- Possess a current dental license in good standng (a Minnesota license, unless employed with the Indian Health Service).
- Be available to provide an appropriate level of contact, communication, collaboration and consultation with the dental hygienist, although the dentist need not be present when the procedures are performed.
- Make provisions for a dentist to act in their place if the dentist should need to be away/unavailable for an extended period of time.
- NOT be obliged by MN Statute 150A.10, subd. 1a to provide follow-up care for the patients treated by the dental hygienist as part of a public health activity and thereby, those patients will not become patients of record for the collaborating dentist.
The Collaborating Dental Hygienist Shall:
- Be a graduate of an accredited dental hygiene program.
- Possess a current Minnesota dental hygiene license in good standing.
- Have been actively engaged in the profession of dental hygiene which includes familiarity with current clinical procedures and materials and demonstrable clinical competency for the hours identified in Statute.
- Register the collaborative agreement with the Minnesota Board of Dentistry.
- Provide proof of personal professional liability insurance for each location or program at which services are provided by the dental hygienist.
- Perform those duties within the dental hygiene scope of practice specified in Minnesota Rules 3100.8700.
- Follow appropriate public health guidelines and maintain adequate parameters of care in the proposed settings including appropriate OSHA/infection control standards.
- Comply with HIPAA regulations.
- Be current in CPR for the Health Care Provider and have documented participation in courses in infection control and medical emergency protocol within their current continuing education cycle.
- Be responsible and liable for acts and omissions in the collaborative dental hygiene practice.
- Have each patient, parent or guardian sign a consent to treatment form prior to provision of services. Or, if the sponsoring entity utilizes a negative consent or similar process, that protocol shall be followed.
- Inform the patient, parent or guardian both verbally and in writing that dental hygiene services do not substitute for a comprehensive examination by a dentist.
- Provide a written plan for referral or an agreement for follow-up, recording all conditions that should be called to the attention of a dentist.
- Must submit to the dentist and facility/program either annually or at the completion of a program a summary report to be kept on file by both parties. The report shall be kept on file in accordance with Minnesota Board of Dentistry record keeping rules.
Original document written in 2003 by: Colleen Brickle RDH EdD, Deb Jacobi RDH MA, Clare Larkin RDH MEd
Revisions: 8/06; 8/08; 6/10
Section III. Register Your Collaborative Agreement with the Minnesota Board of Dentistry
New Collaborative Agreements must be registered (and Agreements that are no longer active must be dissolved).
Log in to: https://www.hlb.state.mn.us/mnbod/ca/
Minnesota Board of Dentistry
University Park Plaza
2829 University Avenue, SE
Minneapolis, MN 55414-3246
Fax: 612. 617.2260
MN Relay Service for Hearing Impaired: 800. 627.3529
Section IV. Minnesota Department of Human Services Protocols
If the collaborative agreement program will be billing the state for services rendered, the dental hygienist must enroll with the Minnesota Department of Human Services. Refer to the Collaborative Practice Dental Hygienist Enrollment and Reimbursement.
Section V. Billing and Financial Considerations
Depending on the collaborative agreement you have designed, you may or may not be billing for dental hygiene services. You may be working under a grant; providing services that will be billed through a dentist-employer; working for a community dental clinic; or offering care on a volunteer basis.
To be eligible for reimbursement for care provided to Minnesota Health Care Program (MHCP) enrollees, a collaborative practice dental hygienist must enroll with the Minnesota Department of Human Services. (See above).
A large portion of MHCP dental services delivery is subcontracted to outside health plans, e.g. Delta Dental of MN, Doral, Medica etc. Collaborative Practice dental hygienists may need to be "credentialed" by each organization. Not all counties facilitate the same health plans for their residents so it is necessary to contact applicable organizations for guidance.
Section VI. Professional Liability Insurance Coverage
Minnesota Statute 150A.10, subd. 1a states that the dentist is liable for the "services provided by the dental hygienist".
Neither MN Statute 150A. 10, subd 1a nor Minnesota's Dental Practice Act requires that a collaborative practice dental hygienist maintain professional liability insurance. Whether you plan to design a stand-alone collaborative agreement or work through an employer, hospital, etc, you are highly encouraged to enroll in an individual professional liability insurance plan.
It is not mandatory for a dentist in Minnesota to carry professional liability insurance. Therefore, dental Dental hygienists should inquire if the collaborating dentist carries professional liability insurance also.
One benefit of membership in the American Dental Hygienists' Association is an opportunity to purchase a very reasonable group professional liability policy. Two reputable companies that offer liability insurance to dental hygienists are Marsh Affinity (group rate offered through ADHA membership- see the ADHA link on the home page) and HPSO