In March 2017, the Colorado Dental Board started a stakeholder process to develop a rule regarding the involvement of dentists in sleep apnea services. The CDA encouraged the participation of key dental experts throughout the stakeholder process to ensure the development of sound policy, as rules developed regarding sleep apnea could have broad ranging implications for other areas where dentistry intersects with the traditional practice of medicine. Many CDA members who would be affected by potential rules participated, sharing their opinions and insights during the stakeholder process. In April 2017, the Dental Board discussed a draft rule developed as part of its stakeholder process and opted to consult the Colorado Medical Board for input prior to adopting the final rule. The Colorado Medical Board met in May 2017 and elected to appoint a joint workgroup to consider adoption of a joint medical-dental policy on sleep apnea services.
In July 2017, the joint workgroup of the dental and medical boards met to continue discussion of sleep apnea policy. CDA staff had less than an hour notice prior to the meeting, in spite of repeated outreach to the dental board regarding scheduling and the existence of a previous stakeholder process, creating an expectation of ongoing communication. The group’s acknowledgment of attempts to reduce public participation in the new workgroup is of great concern, and the CDA is currently working to address this perhaps inappropriate restriction of public participation by a state agency with the state’s Department of Regulatory Agencies.
During the July 2017 joint workgroup meeting, an overview of the process to date was provided to the new workgroup members. Board staff highly encouraged the medical and dental boards to adopt a joint policy, as opposed to a rule, which requires greater stakeholder participation and offers greater flexibility in the face of legal challenges in other jurisdictions. Some dental board members expressed strong concern about the ability of the board to enforce and impose discipline if a policy were to be adopted. Ultimately, the group directed that the dental board’s draft rule should be used as the basis for drafting a new joint policy for future consideration by the workgroup. Representation from the Colorado Nursing Board would be invited to participate in future meetings, as nurses can provide a sleep apnea diagnosis within their scope of practice. The primary area of remaining debate in the workgroup appeared to be around the ability of dentists to order and dispense a home sleep study (Rule XXVI (A)(2) in the draft rule), with strong opinions on both sides of this issue among workgroup members.
The CDA is working to ensure that appropriate notice is given for future meetings, even if public comment continues to be limited. We will update members as we learn more.